[Use of inderal for the treatment of different forms of arterial hypertension].

Results are presented on the treatment with Inderal of 57 patients with essential hypertension and symptomatic renal hypertension in whom the changes in central and renal haemodynamics were carefully traced. In all the patients with renal hypertension (chronic pyelonephritis, chronic glomerulonephritis) the function of the kidneys was adequate. Inderal when used in a daily dose of 120--160 mg produces a hypotensive effect in patients with stage IB and IIA essential hypertension with unstable symptomatic renal hypertension who have a predominantly hyperkinetic type of the circulation. In such cases the haemodynamic changes manifest themselves in a considerable reduction of the cardiac output at the expense of a slower pulse rate and decreased stroke volume; the total peripheral resistance was moderately elevated. In patients with stage IIB of essential hypertension and in those with persistent and severe symptomatic renal hypertension the hypotensive effect of Inderal given in a daily dose of 480 mg and sometimes even higher was accompanied by a statistically significant decrease in the total peripheral resistance and a moderate reduction of the cardiac output and cardiac index at the expense of a slower pulse rate.


[Evaluation of physical adaptation of patients after surgical correction of congenital non-cyanotic heart defects].

A successful surgical correction of congenital non-cyanotic heart diseases (patent arterial duct, ventricular and atrial septal defects, isolated pulmonary stenosis) results in full normalization of the haemodynamics. But the long-lasting existance of the pathology, the limited phsical activity of the patient result in the development of a state of lack of training. In such cases the degree of the physical adaptation of the patient after surgery had to be assessed which will permit to determine the program of his physical rehabilitation. The studies conducted by means of bicycle tests and running on the spot with recording the pulse rate, respiration rate, arterial pressure and ECG have demonstrated that the degree of the physical adaptation of the patients varies, although the general results of surgery are qualified as good. No correlation of this adaptation with the clinical factors could be revealed in this study. Further investigations are necessary in order to take into account the effect of the training regimens on the degree of physical rehabilitation.


Role of the disulfide bridge and the C-terminal tripeptide in the antidiuretic action of vasopressin in man and the rat.

The antidiuretic action of a number of vasopressin analogues has been measured in the rat and man in water diuresis. These analogues had the following categories of structural alteration: a) substitution of -CH2CH2-(dicarba) and -SCH2-(6-monocarba) for the natural -SS- bridge between residues 1 and 6, b) changes in the nature of the C-terminal tripeptide produced by substitution of D-arginine and L-Nalpha-methylarginine for L-arginine in sequence position 8 and L-leucine for proline in position 7, and c) combinations of a and b. In addition, a highly active analogue which results when valine is substituted for glutamine in position 4 was tested. Trained, unanesthetized rats and normal human volunteers were complemented by a volunteer patient with posttraumatic diabetes insipidus (DI) in the total group of experimental subjects. The only change in the C-terminal tripeptide which was associated with a high antidiuretic action was D-Arg substitution. The meArg and Leu analogues showed low to very little activity and no signs of antidiuretic antagonist action. All of the carba analogues showed both high potency and prolongation of antidiuretic action in the following order (for both potency and duration): monocarba + 8-D-Arg greater than 4-Val + 8-D-Arg greater than 8-D-Arg alone, all in deamino form. None of the 8-D-Arg analogues had any side effects on the cardiovascular system, gut, uterus, bladder, etc. The prolongation was such that even with a DI patient refractory to the action of lysine-vasopressin and relatively resistant to deamino-[8-D-Arg]-vasopressin, water turnover could be reduced from untreated levels of 20 to 30 liters/day to less than 2 liters/day with only a single administration of deamino-6-carba-[8-D-Arg]-vasopressin as nose drops. The significance of these structural alterations in the vasopressin molecule for interaction with both antidiuretic and smooth muscle receptors was discussed.


Effects of dietary protein restriction and glucocorticoid administration on urea excretion in rats.

Rats were sampled for clearance studies under anesthesia after 0, 2, 4, 7 and 14 days of dietary protein restriction. Mean fractional urea excretion decreased between day 2 and day 7 of protein restriction after a two-day lag in response. Seven-day administration of dexamethasone in protein-restricted rats caused a significant increase in mean fractional urea excretion. Adrenalectomized rats fed a normal diet had fractional urea excretion values resembling those in protein-restricted rats. Chronic administration of dexamethasone in adrenalectomized rats caused a consistent increase in fractional urea excretion. Fractional urea excretion values were no lower in protein-restricted adrenalectomized rats fed a normal diet. The mean plasma corticosterone concentration (measured 6 to 8 PM) was decreased in rats fed a low protein diet relative to rats fed a high protein diet. The results suggest that glucocorticoids may play a role in the tubular regulation of urea excretion either by a direct effect on the renal tubule or through some intermediate factor. A mediating role of glomerular filtration rate in glucocorticoid-induced changes of fractional urea excretion could not be ruled out, however.


Effect of 25-hydroxycholecalciferol on calcium absorption in chronic renal disease.

Calcium absorption was measured in eight uremic patients before and after eight days of treatment with 100 or 500 mug of 25-hydroxycholecalciferol (25(OH)D3) per day. Fractional calcium absorption was estimated by administering 47Ca i.v. and orally on separate days and counting forearm radioactivity four hours later. Calcium absorption in four patients with residual renal function rose from 16.3 +/- 2.5 to 40.8 +/- 5.5% after treatment. In order to determine if the increased calcium absorption was mediated by an increase in the production of 1,25-dihydroxycholecalciferol (1,25(OH)2D3) by virtue of increased substrate delivery to the 25-hydroxycholecalciferol-1-hydroxylase system present in the residual renal tissue, identical studies were performed in four anephric patients. Calcium absorption in these patients averaged 15.7 +/- 2.2% during the control period and rose to 46.0 +/- 11.1% after treatment. Increments in serum calcium after treatment were similar in both groups of patients; the mean concentration rose from 9.6 +/- 0.3 to 11.0 +/- 0.6 mg/100 ml. The results indicate that 25(OH)D3 can improve calcium absorption in the absence of renal tissue suggesting that its conversion to 1,25(OH)2D3 may not be necessary for its effect on the gastrointestinal tract in the uremic patient.


[Experiences with the treatment of amblyopia with excentric fixation by means of changes of the innervation stimulus of the external eye muscles by means of prismes and operative methods according to Cüppers' principles (author's transl)].

An analysis of 59 cases with excentric fixation shows the special efficacy of treatment methods, which are related to variations of the innervation stimulus with prisme, operative methods and especially with the "Fadenoperation" developed by Cüppers.


[The paralytic dyssynergies--the squint dyssynergies, and Cüppers' syndrome (author's transl)].

The study of kinetic pattern is essential for all oculo-motor disorders. The authors have settled on an original electro-oculographic device for potential recordings, and a new apparatus allowing various types of ocular movements, mathematically specified (Ocular-kinetic explorer). With this method they have been able to discover important and various kinetic troubles. The present work is devoted only to the kinetic dyssynergies. Firstly the authors state the very particular features of dyssynergies with opticokinetic nystagmus, the pursuit and saccardic movements in ocular palsies. Then the kinetic dyssynergies registered in squints are enumerated; the recordings prove they are mostly dissociated, and therefore entirely different from paralytic anomalies. The oculographic facts in the blocking nystagmus syndrome firmly prove the conception of Cüppers' about the blocking of convergence. The dissociated dyssynergies are the exact expression of this motor phenomenon.


[A method of feating intermittent divergence strabismus (author's transl)].

Patching appears to have sensory and motor effects on intermittent exotropia. The sensory effects we have observed are reduction in the size of the scotoma as measured on haploscopic devices and improvement in fusional amplitudes. The motor effects has been increased control of the deviation. A series of patients was studied to document these effects, and their significance in management was discussed.


[Suprachoroidal (subscleral) fillings of human fat for the operation of retinal ablations (author's transl)].

A report is given of experimental and clinical experiences on application of suprachoroidal (subscleral) fillings of human fat (0,5-0,8 cm3) for the operation for retinal detachment. The subcutaneous homoioplastic fat is homogenized and injected under the sclera close behind ligamentum pectinatum. After injection there is a hump similar to choroidal amotio. The filling is tolerated well. It serves to reduce the space of vitreous in relation with Custodis operation and cerclage of the bulbus. It is resorbed slowly and incompletely, or organised. Complications are to be feared if the ciliary body is perforated by injection and fat comes into the vitreous.


[Atypical oculoplastic surgery in children (author's transl)].

The problems of restorative surgery for inborn eyelid-alterations are indicated here with examples. The following experiences result. 1. Inborn eyelid colobomas without disfigurement of the inner canthus are in general readily correctable. 2. Inborn eyelid colobomas with a disfigured inner canthus and atresia of the canaliculi hardly ever permit the production of a cosmetically satisfactory inner canthus, and never permit a functionally satisfactory one. The use of lacoductorhinostomy, according to L. Jones, is problematic here. 3. The correction of inborn eyelid colobomas in the case of Goldenhar's syndrome is difficult because, due to additional dermoids and fibromas, irregular excisions become necessary. Thus, the lid margin becomes significantly deformed. A considerable temporal displacement of the skin cannot be avoided. 4. Any plastic correction of an inborn, genuine eyelid tumor is difficult, if the important structures of the eyelid--especially the tarsus and levator muscles--are only fragmentarily developed. In the case of the large, soft fibroma of the upper eyelid in neurofibromatosis, only a static eyelid in middle position can be accomplished. 5. Very often, motility problems arise in this connection. Both in Goldenhar's disease and in Recklinghausen's disease, primary dysplasis of the rectus externus muscle occurs.


[Experiences in the measurements of correspondence using dark red glass and according to image after Cüppers (author's transl)].

The measurement of correspondence using a dark red glass in front of the fixating eye and a foveal after image in the deviating eye according to Cüppers is really an efficient clinical method. In spite of the fact that we are dealing with a dissociating test this method offers these advantages: 1. The objective angle is well known at any time. 2. This method allows a sufficient discrimination in the range of 15 min. of arc. 3. There is a permanent retinal stimulation contrary to the method utilizing after-flash images.--General objections to dissociating tests, for example that given by Goldman, are only limited value, because of the fact that patients with disturbed functions must be differentiated easily from normal persons. Sources of error system mainly from inconcentrated fixation. There is a great demand for attention on the part of the patient. Using this method we have been able to show the 17 cases examined up to now a paradoxical anomaly, demonstrated by a larger subjective angle than the objective angle. Besides that we could prove that lability of correspondence, characteristic for an anomaly, and its alteration depending on which method was used. A paradoxical anomaly was also obtained with other methods such as Hering's after images alone, after image plus real object + Haidinger brushes (synoptophor). From five examples the conditions are presented under which this phenomenon was observed up to the present. The reason of paradoxical anomaly may be seen in the loss of specific ability of cortical cells to localize exactly, especially those cells which are stimulated by foveal area, so that subjective localisation becomes very inexact.


[Cüppers' "Fadenoperation" for complicated eye-muscle disturbances and non-accomodative convergence-excess (author's transl)].

More than ever the "Fadenoperation" according to Cüppers has become an important method to improve the pathological relation between eye position, innervation, and resulting motility. This is achieved by sutural fixation of an over-acting muscle far behind its original insertion. In particular a palsy can be influenced by making a handicap for the contralateral yoke muscle. 40 patients (palsies, nystagmus, strabismus incomitans), who have been treated so far, may demonstrate how the purpose of changing the innervation rather than the length of muscles can be integrated in general therapeutic schemes. The procedure is also helpful in weakening the over-acting int. rectus muscle in strabismus cases with habitual excessive convergence.


[Results of penalisation treatment (author's transl)].

The results of penalisation treatment are given in the cases of 233 children with squint and 9 with amblyopia without a squint angle. With regard to amblyopia treatment penalisation is indeed not so effective as direct total occlusion, but it can be used, for example when the parents or children fight against the occlusion or when a plaster allergy is present. Even in school children the near-penalisation in cases of amblyopia diagnosed too late can bring very satisfactory visual improvements (in over 50%), provide care and stamina are present. For prophylaxis against amblyopia, the penalisation is especially suitable. In only 1/3 of cases the squint angle becomes obviously smaller, and signs of incomitance are not affected. Less than one third incomitance are not affected. Less than one third of the children attain with penalisation alone binocular vision--and even this usually on the basis of anomalous development.


[Postoperativ binocular function after full prismatic correction in patients with concomitant convergent strabismus and exuberance of convergence (author's transl)].

We investigated the cases of 50 non amblyopic children with concomitant convergent strabismus and exuberance of convergence, in which a prolonged prismatic correction was performed. 31 children had a 5 degree higher angle of squint in near vision before the application of prism. In 13 out of 31 the angle of squint, which was measured at the gaze for distance, increased more than 6 degrees. The ratio of normal retinal correspondence (NRC) to abnormal retinal correspondence  (ARC) is 14:17. 19 patients developed only after prismatic correction of the angle of squint an exuberance of convergence. This phenomenon we call secundary exuberance of convergence. In this group the angle of squint for distance vision increased in only three children more than 6 degrees, while 6 children had a decrease by up to 11 degrees. The ratio NRC: ARC is 7:12. Postoperativ follow-up of binocular function over 4-5 years showed, that the prognosis in case of primary exuberance of convergence is worse than in secondary.


[The results of surgical treatment of convergent strabismus (author's transl)].

From the results of 628 operations on strabismus convergens, the individual corrections were related to the achieved reduction of the angle of deviation. The evaluation showed that strabismus operations may be well dosed not only with a view to a general improvement of the squint angle but also as a specific influence on the squint angle as to distant vision and near vision.


[Diagnosis and therapy of post-traumatic diplopia (author's transl)].

The authors describe the diagnosis and operative methods for the treatment of 36 patients which were operated on in the last two years. These patients included 32 with various face fractures, of which 7 had blow-out fractures. In 4 patients the diplopia was caused by injuries to the soft tissues without bony fracture. The examinations comprised x-ray methods and also ophthalmological examinations, especially with the synoptometer. In 24 operated patients, reposition of the bony fragments or autologous bone grafts were done according to the kind of injury present. Although 17 patients were operated on very late (some weeks up to several months after the trauma), in 13 patients (54%) a complete cure could be achieved, and all the other patients showed an improvement. In 3 patients there was only a minor improvement, and it was decided to perform further operations on the extrinsic eye muscles. The authors emphasize the special sense of multi-disciplinary working together in the diagnosis and therapy of patients with face injuries, while this is very important for the success of the treatment.


[Problems on expert classification in cases of traumatic disturbances of ocular motility (author's transl)].

The classification of reduction in ability to earn a livelihood in cases of traumatical disturbances of ocular motility is still mainly based on antiquated values which no longer do justice to the real sensomotor situations. Today new diagnostic methods, most of them developed by Cüppers, give a better and more certain base as to the objectivation of the disturbances and the subjective troubles of the subjet. Moreover, new operative indications and techniques can cure them. Four cases are demonstrated as examples for an equivalent and adequate classification.


[Microscopic examination of unused synthetic suturing material before and after ray-treatment (author's transl)].

Unused 9/0 nylon suture show before and after ray-treatment mostly sagittal tears, besides this oblique and horizontal tears. Circumscribed distensions and attentuations were only found in suturing material which had undergone ray-treatment therapy. Microscopic examination was done in 474 cm unused suturing material, that means 203 cm 9/0 nylon sutures after and 81 cm before ray-treatment; these sutures were manufactored by the firm Klein, Heidelberg- besides this 98 cm 9/0 nylon sutures after and 92 cm before ray-treatment; these sutures were manufactored by the firm Ethicon, Hamburg.


[Morphology of the peripheral choriocapillaris in patients of various ages (author's transl)].

A study of the choroidal vascular system in post-mortem eyes with negative histories of ocular and systemic vascular disease showed that there are progressive capillary changes with increasing age. The investigation was limited to the equatorial and peripheral choriocapillaries. Capillary changes and a patchy vascular atrophy of the capillary layer with increasing width of the intercapillary connective tissue were observed to start in the area of the ora serrata. Atrophic changes were most commonly located in the temporal zones. In contrast to the senescent changes of the capillaries, involvement of the arterioles was relatively mild; complete obliteration of an arteriole has not been observed even in atrophic capillary zones. Causal relationships of senile capillary changes could not be ascertained on a pure morphological basis. Clinical relevance has been discussed.


[Aqueous dynamics and ciliary epithelium enzyme systems (author's transl)].

Aqueous humour is produced by ultrafiltration (30%) and active ion transport (70%) predominantly achieved by nonpigmented ciliary epithelial cells. They need chemical energy supplied by intracellular metabolisms. Suspensions of isolated ciliary epithelial cells and ciliary cell layers prepared from single rabbit eyes have been assayed for activities of glucose-6-phosphate-dehydrogenase, lactate dehydrogenase, malate dehydrogenase, NAD- and NADP-depending isocitrate dehydrogenase. Levels of enzyme activity were found to be higher in the nonpigmented cell type. Enzyme activity of cell layers exceeded those of isolated cells for technical reasons. By comparing ciliary epithelial enzyme patterns to those of different tissues it may be deduced that ciliary epithelium draws its energy chiefly from pentosephosphate and citric cycle. High levels of lactate dehydrogenase activity suggest special functions of this in enzyme in aqueous formation.


[Fixation devices for the cover-test (author's transl)].

A special fixation device for distance consisting of a music box and a fixation light with changing colour is described. For near examination a fixation bar with a vertical row of pictures and numbers, and a fixation cube with pictures are recommanded.


[Lid retraction in chronic progressive external ophthalmoplegia (author's transl)].

Three cases with chronic progressive external ophthalmoplegia are presented. They showed an upper lid, retraction which was due to a better preservation of lid elevator function as compared to ocular elevator function.


[Penalization in microtropia (author's transl)].

Near penalization was carried out in 113 children, from which 35 were younger than 5 1/2, and 78 older than 5 1/2 years. We were especially interested in the older group with small angles of squint from zero to five degrees. The treatment with regard to amblyopia in this group is difficult, but we saw also in cases with non-foveal fixation a rapid increase of the near visual acuity because of spherical overcorrection. The distant visual acuity was increased mainly to 0.6. There was no influence upon the angle of squint and the correspondence. In the younger group (below 5 1/2 years) the results with regard to visual acuity, fixation and angle of squint were more favourable. We think, that we will get these results only by occlusion and prism over- and full-correction, if there are no external reasons, such as schoolage, which prevent this treatment.


[Contribution to the problem of central serous retinal detachment (author's transl)].

We described extensive and multifocal serous detachment of the neuroretina in cases of Harada's disease, optic head pitting, coloboma of choroid and optic nerve-head and bullous retinal detachment (Gass). Peripapillary serous detachment occurred in an additional case after branch occlusion of central retinal artery. Systemic steroids were useful in Harada's disease. The other cases required photocoagulation or argon laser treatment. Bullous retinal detachment did not heal until a buckling procedure was performed. The serous detachment of the neuroretina is considered as an uniform tissue-reaction of choroid, pigmentepithelium and neuroretina. The pathogenesis for this is unknown.


[Congenital hypoplasia of the optic nerve (author's transl)].

The authors investigated 7 children with developmental anomalies of the optic disc. In all cases a typical pattern of hypoplasia was observed. In all patients was found a very marked impairment of visual acuity or even blindness of the affected eye with most frequently squint and nystagmus. Besides ophthalmological investigation, neurological examination were carried out in these children and the Wassermann reaction was determined, together with tests for toxoplasmosis and radiograms of the optic foramina.


[Further investigations on cellular immunodeficiency in uraemic patients and the effect of haemodialysis (author's transl)].

The spontaneous rossette-formation of lymphocytes and the rate of the DNA-synthesis was determined in 33 uremic patients of the haemodialysis unit. 1. Spontaneous rosette-formation of uremic lymphocytes (39,5%,n=16) did not differ from normal lymphocytes (39,3%,n=39). 2. The absolute lymphocyte count was slightly but not significantly reduced in uremic patients compared to normal controls and the slight increase after dialysis was not significant. 3. The PHA-induced DNA-synthesis of lymphocytes of 23 uremic patients was significantly reduced compared to normal controls. 4. The reduced PHA-induced DNA-synthesis of lymphocytes of uremic patients was not different in patients dialysed two times (22 hours) per week and patients dialysed three times (30 hours) per week. 5. No correlation of the reduction of PHA-induced DNA-synthesis to the underlying renal-diseases could be found.


[Morbid-anatomical findings in human bone marrow in shock (author's transl)].

In a post mortem study of shock-induced changes in the bone marrow, marrow from six different parts of the skeletal system was examined in a total of 109 patients. The comparison of a group of 64 subjects deceased in shock conditions with a control group of 25 deceased without shock showed: In 76,6% of all patients with shock, fibrin networks were found in the sinus and perisinoidal interstice of bone marrow. This can be demonstrated abundantly in every fourth patient with shock. Microthrombi and emboli occluding vessels in the marrow were seen in only 6.3% of the shock cases (controls 0%). The different forms of fibrin precipitates appear most commonly after shock caused by infection. Platelet aggregates in the vessels are seen in 28.2% of all cases with shock (controls 8%). 5% of the cases with shock showed infarction-like necroses of the bone marrow and a further 23% necroses of small cell groups. In every fifth patient with shock, a great number of nucleated blood cells and their precursors were found in the marrow sinus (controls 8%). In a third group of 20 patients with serious illness alledgedly without shock, 45 per cent had a fibrin network when compared with the control group. When several of these findings are present simultaneously, one can apply the term "shock marrow".


Immunological study of HB-AG carriers.

The serum immunoglobulin levels, the presence of circulating autoantibodies, the number of peripheral "atypical" lymphocytes and the number of DNA and RNA synthesizing mononuclear cells were studied in a group of "healthy" HB-Ag (australia Antigen) carriers and in a group of healthy HB-Ag negative control subjects. In the HB-Ag carriers, in spite of the persistent antigenaemia, all these immunological findings were normal (as in the control subjects).


[Mode of action of bisacodyl (dulcolax) on isolated muscles of human colon (author's transl)].

The effects of bisacodyl (4,4-diacetyl-bis-hydroxyphenyl-pyridyl-(2)-methan, Dulcolax) on the tone of isolated muscle strips of human colon were examined. Maximal contractions achieved by 10 mug/ml of bisacodyl were quite comparable to those due to 1 mug/ml of acetylcholine, 1 mug/ml of histamine and 0.5 mug/ml of nicotine, respectively. However, peak contractions were attained with a greater latency and could not be prevented by the anticholinergic agent atropine, the H1-antihistaminic diphenhydramin or tetrodotoxin blocking axonal conduction. On the other hand, pretreatment with verapamil -- antagonizing calcium influx into the muscle cell -- abolished bisacodyl effects. These results provide evidence for a direct action of bisacodyl on smooth muscle cells of human colon.


Present status of 32P-therapy in management of polycythemia vera.

The aim of this study is to assess the present status of 32P-therapy in the management of polycythemia vera. The nature of the disease and its associated clinical problems was considered with respect to the characteristics of the different therapeutic approaches. We concluded that 32P is preferably administered to older patients, especially if long term remissions are achieved, if drugs are taken unreliably, or if patients are difficult to supervise. At present chemotherapy is preferably administered to younger patients, to those who respond inadequately to 32P, or who demonstrate early relapsing hyperproliferation of granulocytopoiesis, or who require 32P-administration at intervals shorter than one year.


[The effect of acute diuresis augmentation on urea and creatinine clearance in healthy people and in patients with chronic renal insufficiency (author's transl)].

According to earlier observations no further augmentation of urea clearance should be possible above a urine flow of 2 ml/min (so-called augmentation limit). In normal people and in patients with renal insufficiency no augmentation limit of urea and creatinine clearance could be ascertained: increasing urine flow was correlated with augmentation of urea and creatinine clearance. Calculating the protein equivalent the augmentation of urea excretion by increased diuresis seems to be of clinical importance only in the treatment of renal insufficiency with small basic diuresis.


[Aplastic anemia-a preleukemic stage (author's transl)].

In a group of 44 patients with primary and secondary aplastic anemia, four (9%) developed an acute leukemia. Cytological changes that pointed to a preleukemia were not observed during the preleukemic stage. The possibility is discussed whether a aplastic anemia and a preleukemia can be distinguished by cytological, cytochemical and cytogenetic tests, by agar-culture technique, liquid-culture and determination of reverse transcriptase.


[Regan-isoenzyme of alkaline phosphatase in sera of cancer patients (author's transl)].

The Regan-Isoenzyme of alkaline phosphatase was determined immunologically measuring the antibody-fixed tumor alkaline phosphatase activity. In 68 blood donors the normal range varied from 0.1145 to 0.6351 (delta E/20 min at 405 nm, chi = 0.3748, standard deviation = 0.1013). 28.9% of 83 patients with different carcinomas showed a pathologically elevated Regan-Isoenzyme activity in the serum. The percentage of positive results as compared to previous reports is higher due to a more sensitive technique.


[Investigation of the mucociliary clearance by means of 99mTc-labelled sulfur colloid (author's transl)].

The mucociliary system of the lung was studied in eight normal subjects and ten patients with chronic bronchitis, using sulfur colloids, labelled with 99mTechnetium. By recording the radioactive impulses over the lung with a scintillation camera and analysing the data with a computer, we were able to exclude extrapulmonary artefacts and to select central areas of the tracheobronchial tree. Time activity curves obtained over the central airways were interpreted by means of a model. In bronchitics the disappearance rate of the radioactive particles was found to depend upon the pattern of deposition and the degress of airway obstruction. Because of the good reproducibility in one and the same subject, the effect of drugs, influencing the mucociliary system, can be tested. We used a newly developed vagolytic substance which did not influence the mucociliary system and which reduced little the airway resistance in patients with chronic bronchitis at the administered dose.


[Red cell mass and plasma volume in chronic cor pulmonale (author's transl)].

Red cell mass and plasma volume were simultaneously measured by Cr51 and J125-albumine, respectively, in 36 patients with chronic obstructive lung disease and cor pulmonale. Additionally, pulmonary function tests and arterial blood gas analyses as well as pulmonary circulatory and right ventricular hemodynamic measurements were performed the same day. Patients were divided into 3 clinical subgroups: 1. a predominantely emphysematous A-type (n =12), 2. a predominantly bronchial B-type (n = 12), and 3. an intermediate type (n = 12) with about equal scores for A and B. With regard to the cardiac state, A-patients were clinically characterized by small ptotic hearts on chest x-ray and the absence of overt cardiac failure during the whole course of illness whereas B-patients generally showed radiological evidence of heart dilatation associated with recurrent episodes of manifest right ventricular failure. Patients of the intermediate type mostly had recovered from cardiac failure. The following results were obtained: 1. Red cell volume, plasma volume, and total blood volume were within normal limits in A-patients and in patients of the intermediate type. A marked hypervolemia in B-patients was almost entirely due to an increased red cell volume. 2. Close correlations of the red cell volume and total blood volume, respectively, to the arterial PO2 as well as to the arterial PCO2 could be established. 3. Total blood volume was significantly correlated to certain hemodynamic parameters, including cardiac output, stroke volume, pulmonary artery pressure, and right ventricular enddiastolic pressure. 4. The quotient body hematocrit/venous hematocrit was lowered to a significant degree as compared to normal subjects. As a consequence, indirect determination of red cell volume and total blood volume from plasma volume and venous hematocrit leads to a consistent overestimation of both parameters, amounting to 28% in the mean for the red cell mass and to 12% for the total blood volume in the present series.


[Effect of D-penicillamine on the humoral primary response (author's transl)].

The influence of D-penicillamine (Pen) on the humoral primary response was studied systematically. Inbred rats are sensitized with erythrocytes of mice of one strain. Pen given at various schedules (dosage: 3 X 100 resp. 3 X 1000 mg/kg at 24 h intervals) showed no effect on antibody titer 7 days after sensitization. When Pen is given before the antigen the slope of the titer after day 7 is accelerated. Compared to experiments with alkylating drugs and antimetabolites in the same model Pen does not show immunosuppressive potency.


[Perimembranous glomerulonephritis after treatment with D-penicillamine. Report on 31 cases (author's transl)].

This report includes 31 patients who developed a perimembranous glomerulonephritis generally 7 months after the onset of the treatment of various illnesses with D-Penicillamine. In all cases the patients had a proteinuria, associated with a hematuria in 12 cases. After the treatment was stopped 8 patients rapidly developed a nephrotic syndrome, while its onset was more gradual in 12 other patients. 5 patients initially with a nephrotic syndrome had no proteinuria at the time of a second biopsy made up to 12 months later. In these 5 cases the typical changes of perimembranous glomerulonephritis observed on electron microscopy were much reduced in the second biopsy.


The pathogenesis of Vaccinia virus toxicity. I. The role of virus-platelet interaction.

When mice are injected intravenously with a large dose of vaccinia virus, prepared in the Ehrlich ascites carcinoma of the mouse, there is a precipitous loss of plasma fibrinogen and blood platelets. Death occurs usually within 24 hours. A specific role of the virus in this toxic syndrome can be demonstrated when heparin is employed to circumvent intravascular coagulation and fibrinogen loss. Heparin does not prevent a profound thrombocytopenia from occurring, but it modifies the rate of platelet loss. Toxicity is prevented when heparinized virus preparations are pretreated with beta-propiolactone or specific antibody, although a mild thrombocytopenia occurs. Thrombocytopenia does not occur in mice injected with heparinized material prepared from uninfected tumors. These studies indicate that the basic mechanism of vaccinia virus toxicity is an early interaction between infectious virus and blood platelets, with marked thrombocytopenia and consequential pathophysiologic changes.


Personal evaluations, laughter, and affective judgments.

Fifty-six subjects read positive or negative evaluations of their personality made by a bogus same-sex peer and then rated their immediate feelings. A second group of 22 subjects rated their feelings after reading the evaluations of a third person. It was found that personal evaluations evoked more spontaneous laughter than did the evaluation of a third person (p less than .001). Inclusion of the factor of laughter in the experimental design disclosed that subjects who laughed felt more pleasant than those who did not laugh (p less than .008) and that laughter was associated with affective state only in the negative evaluation condition (p less than .003).. Also, positive evaluations made the subjects feel good, and negative ones made them feel bad (p less than .001). Results seemed to suggest that extreme affective arousal engenders laughter which, in turn, alters the judgments of one's affective state.


Habitual exercisers: a blood serum and personality profile.

In summary, this study indicated that those subjects who participated in regular physical activity were distinguished from nonexercisers by being more tough-minded, prudent, and relaxed in so far as their personality characteristics (16 PF) are concerned. If we consider the above mentioned statement by Birren, it is our feeling that these traits are highly desirable for interpersonal relations and are antithetic to the theory of avoidance behavior shown to increase with age. In relation to the blood serum profile, the habitual exercisers were seen to possess, in particular, lower levels of serum alkaline phosphatase. This finding may be indicative of the compressive or tensile effect of chronic physical activity on the skeletal system and has led us to embark upon further studies in this area.


Cardiac stroke volume: effects of athletic training.

A high capacity oxygen transport system requires a large cardiac stroke volume. This may be achieved by an increase in the systolic emptying of the heart as might occur with training programs of one to three months. Any major increase in stroke volume must be achieved by an increase in the diastolic heart volume. Only the athlete with an extraordinary degree of endurance fitness develops this change and it likely requires at least a few years of training. Some of this training may have to take place during puberty and rapid growth years. To some extent the capacity to increase stroke volume may be genetically determined. We have no information on the best way to train the heart to have a high stroke volume. The inadequate data available suggest that moderately intense interval work with supine recovery periods results in the largest possible stroke volume, but it is not known whether this is of any practical value for training athletes.


Swimming and cardiovascular fitness in the older age group.

Coronary artery disease is an extraordinarily common and devastating disorder of middle aged and even young men in the United States and Western Europe. An increasing risk of developing the disease is associated with such factors as high blood pressure, obesity, high levels of cholesterol in the blood serum, cigarette smoking, certain behavioral patterns, decreased vital capacity and a low level of physical activity. There is much evidence to indicate that exercise may well help prevent heart attacks through such mechanisms as increasing heart efficiency, decreasing the level of serum cholesterol, decreasing obesity, decreasing high blood pressure and promoting psychic well-being. It is necessary, however, that the exercise be continued throughout life. Athletic activity in high school or college is of no help in later years. The exercise must be part of a regular scheduled year-round activity. It is suggested that swimming has many unique advantages for such an endeavor. The Amateur Athletic Union of the United States has developed competition in older age groups as a motivating force for the continuance of a regular training program of a healthful nature.


Traumatic joint effusion and the synovium.

The morphology and function of synovial membrane is considered for its roles in development of traumatic joint effusions. Careful diagnostic study, including analysis of synovial fluid, is needed to be certain that one is dealing with uncomplicated traumatic effusion. Conservative treatment with cold application, rest and aspiration, seems effective and in line with known, basic experimental work for this generally self-limiting problem.


Stereotypes of football players as a function of positions.

Sports experts agree that different football positions require different personality characteristics and a varied level of motor skill, e.g., quarterback position presumably demands a calm personality, a cerebral endowment, and great motor finesse. By contrast, some other positions may require sheer physical strength and a combative aggressive personality. This study investigated whether football coaches stereotype players according to their various positions and attempted to determine the profile, magnitude and consistency of such stereotyping on both personality traits and motor skill dimensions. This study also investigated the relationship between such stereotypes and the players' scores on psychological tests. On two separate occasions, each of six coaches rated thirteen football positions as to their players' motor skill and personality characteristics. Coaches were instructed to base their ratings on their actual experiences with the players of each position throughout their coaching careers. MMPI-derived scales and the 16 PF test were administered to 251 players. Test-retest correlation coefficients indicate that the six coaches were reliably stable in their stereotypes of the players. Coefficients of concordance indicate significant agreement among the coaches on the stereotypes. Only the 16 PF scores yielded a personality picture consistent with the coaches' stereotypes. Effect of such stereotyping on interpersonal relationships between coach and player are discussed.


Adrenaline, arousal and sport.

In general, the literautre review provides theoretical explanations for the popular, common-sense belief that a little stress improves performance, whereas when stress becomes severe, performance declines and ultimately breaks down. In terms of psychological stress (as opposed to physiological) the single most important variable appears to be the subject's interpretation of the stress-producing stimuli. Increases in adrenaline and noradrenaline accompany a variety of emotional responses, but differential proportions are not seen as characterizing the various emotions. Noradrenaline secretion appears to be related to physiological stress, or the amount of work attempted by the organism. Adrenaline secretion seems to be more-directly related to mental stress and emotional response. As emotional involvement increases, adrenal medullary secretion of adrenaline increases. The accompanying physiological and metabolic responses faciltate performance to a point; however, extremely high levels of arousal may adversely affect the athlete's proficiency. This is expecially true of sport skills requiring steadiness, precision, and concentration. Finally, for the sake of perspective, it should be stated that any contribution or complication created by the catecholamines is minimal when the entire ability range of competitors is considered. Whereas near superhuman feats by ordinary individuals caught in life-threatening situations have been reported, variations of great magnitude are unlikely in sport. The average individual is not transformed into a world class athlete merely by "getting the adrenaline flowing." Among athletes of similar physical stature and physiological function, however, adrenaline and arousal may certainly tip the scale of performance in sport.


"Helicopter" fracture.

An interesting fracture of the fibula is described which occurs very close to the radiographic isthmus of the bone. This fracture is produced by a rotational maneuver but does not result in a rotational type injury. It is our conclusion that these fractures were produced by a force distributed along the long axis of the fibula and bear a direct relationship to that fibula's anatomical ability or inability to transmit the force required of it at the moment of forcible dorsiflexion of the foot.


The effects of conditioning on cardiorespiratory function in adolescent boys.

Pulse rate and oxygen consumption were measured for 19 boys (agen 12-13) assigned to either Distance, Interval, or No-Training regimens, during a 5 min. run at 6 m.p.h., zero % grade on a motor driven treadmill prior to a 12 week conditioning period, following conditioning, and after four months of deconditioning. Oxygen consumption was assessed by opencircuitry and heart rate monitored by direct electrocardiography. Both conditioning groups significantly improved cardiovascular fitness (Distance group: 175-152 beats/min. and Interval group: 175-159 beats/min.) at P less than .01, but no differences were noted between them. They differed significantly from the Control group (P less than .05) which showed no change (172-173 beats/min.). No significant differences occurred between any of the groups for Vo2 variables, but Within group analysis statistically favored the Distance group. Post-conditioning and -deconditioning comparisoms indicated taht deconditioning had a deleterious effect on cardiorespiratory function. Cardiorespiratory fitness improved to the extent that competitive running events of 2-6 miles are suggested for this age group, but as the data indicated, only after sufficient training. Task similarity of training and standard test and running volume apparently afforded a slightly greater improvement of cardiorespiratory fitness in the Distance group. Marked deterioration of fitness during deconditioning was attributed to complete absence of a training stimulus.


Heat production and metabolism during the contraction of mammalian skeletal muscle.

Methods are described whereby initial processes of muscular contraction may be investigated in a mammalian preparation, the soleus muscle of the rat. Conditions are chosen so that recovery is avoided. An isometric tetanus is investigated and an energy balance sheet is drawn up. It is found that there is more heat evolved than can be accounted for in terms of measured chemical reaction. This discrepancy is discussed with reference to the similar results that have been obtained using frog muscle.


Conformational flexibility and structure of creatine kinase.

The structural flexibility of creatine kinase has been investigated with the covalent hydrophobic probe 2-[4'-(2"-iodoacetamido) phenyl] aminonaphthalene-6-sulfonic acid (IAANS) which reacts at vastly different rates with the two subunits to give a protein conjugate with fluorescence characteristic of reaction with a site in a hydrophobic cleft. Binding of purine nucleotides greatly enhances the probe fluorescence while pyrimidine nucleotides quench the fluorescence. Small anions bind to nucleotide-free creatine kinase near the location of the transferable phosphoryl group and quench both the IAANS fluorescence of modified creatine kinase and the tryptophan fluorescence of native creatine kinase. Chloride and nitrate non-competitively inhibit MgADP binding both with and without creatine. Fluorescence energy transfer demonstrates that the active sites of creatine kinase are well separated and become further apart after the nucleotide-induced conformational change.


Successful surgical repair of aortico-left ventricular tunnel in an infant.

Aortico-left ventricular tunnel is a rare congenital malformation in which a perivalvular tunnel produces free communication between the aortic root and left ventricle. The hemodynamic consequences of this lesion are similar to those of aortic valve incompetence. Infants with this condition have clinical findings that should suggest it as a diagnostic possibility, and aortic root angiocardiography can establish the diagnosis. Early severe congestive heart failure is common in infants with this malformation, and in such patients prompt surgical correction of the deformity is recommended. This paper reports surgical correction of aortico-left ventricular tunnel in a 9-month-old child, the first reported patient to be successfully operated on before age 2 years.


C-peptide analysis in diagnosis of factitial hypoglycemia in an insulin-dependent diabetic.

Factitial hypoglycemia from the surreptitious self-administration of insulin by an insulin-dependent diabetic, shown to have C-peptide secretory ability by glucose and tolbutamide stimulation tests, was strongly suspected by finding low plasma C-peptide immuno-reactivity and high plasma insulin levels during "spontaneous" hypoglycemia whereas during hyperglycemia the D-peptide immunoreacitivity was higher and the plasma insulin was lower.


Mediastinal granuloma.

In a group of 47 patients with mediastinal granulomas, the most common clinical symptoms were cough, chest pain, dysphagia, hemoptysis, and dyspnea. The main laboratory findings were right paratracheal or hilar mass on chest roentgenogram, positive histoplasmin skin test, and caseating granuloma on histopathologic examination. Complications included fibrosing mediastinitis with superior vena cava obstruction, esophageal compression, and major upper airway compression. Treatment was usually surgical resection or evacuation of caseous contents. The prognosis in most patients with mediastinal granulomas appears to be good--long-term survival with minimal or no disability.


Surreptitious laxative ingestion. Delayed recognition of a serious condition: a case report.

A 46-year-old man with chronic diarrhea underwent exhaustive investigations, including laparotomy, but a definitive diagnosis could not be made. It was not until a colonoscopic biopsy demonstrated the pigment of melanosis coli that the surreptitious use of laxatives was considered seriously. This diagnosis was confirmed by simple chemical tests that demonstrated phenolphthalein in the feces and urine.


Age-related changes in a spontaneously reassociating fraction of mouse DNA.

Rapidly reassociating fractions have been isolated from mouse brain and liver nuclear DNA by hydroxyapatite fractionation of sonicated and denatured preparations incubated at a Cot of 1. When prepared by thermal denaturation, a subfraction of this DNA, representing approximately 0.6% of liver and brain DNA, has been shown to spontaneously reassociate at Cot 10(-5). This fraction increases 3-fold in DNA from old animals. When prepared by alkaline denaturation or treated with pronase, no age-related increase is observed, suggesting the presence of an alkali-labile stabilizing protein component in DNA from old cells. A portion of this fraction is observed by electron microscopy under denaturing conditions to consists of looped hairpin structures in DNA from old, but not from yound or mature animals. These structures are not seen after pronase treatment.


Cholesterol turnover in plasma, aorta, muscles and erythrocytes in young and old rats.

Turnover of cholesterol was measured in 2 and 14 months old male rats (120 yound and 109 old) using a single intravenous injection of 3H-cholesterol and following the radioactivity of serum, aorta and muscle for 12 days. Blood cholesterol level is higher in the older animals. T 1/2 of the fast exchanging pool of cholesterol (compartment A) is 0.7 days in young rats and 0.9 days in the old rats )p is less than 0.025). T 1/2 of the slow exchanging pool of cholesterol (compartment B) in the young rats is 22 days and 32 days in the old rats (p is less than 0.025). Additional mathematical analysis showed that there is a decrease of the production of cholesterol and slower removal of cholesterol from both pools during aging. The effect of aging on cholesterol metabolism is exactly the opposite to the effect of cholestyramine as described in the literature. The speed of exchange of 3H-cholesterol between the plasma lipoproteins and erythrocytes is the same in the young and old rats both in vivo and in vitro measurements. Exchange of cholesterol between the blood and muscle or aorta is slower in older animals. Specific activity of the aorta in the old animals never reaches the specific activity of the blood. This shows that a part of the cholesterol pool in the aorta of old animals in metabolically very inert.


Hydroxyproline and hydroxylysine in different tissues of human embryos.

The collagen content in various tissues of human embryos was studied at four different steps of the maturation process. The umbilical cord of a 16-17 week old embryo was found to be active in collagen biosynthesis, Tibia, articular cartilage and skin showed of a peak of total hydroxyproline in the 16-17th week, decreasing later on, while the hydroxyproline decreased in umbilical cord from the 15-16th week to the 24th week. Hydroxylysine followed the hydroxyproline changes in articular cartilage and umbilical cord.


The lack of altered enzyme molecules in "senescent" mouse embryo fibroblasts in culture.

In order to compare the biochemical events occurring in senescent animals in vivo with those of fibroblasts demonstrating a limited life span in tissue culture, experiments were performed to determine whether altered enzyme molecules are produced in late passage mouse embryo fibroblasts in tissue culture. Such altered enzymes have been previously described by us in both senescent mice and nematodes. Fibroblast cultures, initiated from BALB/c embryos underwent approximately 7 population doublings before reaching stationary phase. A comparison was made of the enzyme activity and the quantity of antigen of the enzyme aldolase present in these cultures. The amound of aldolase per cell as well as the amount of enzyme per unit of antigen remained constant throughout the in vitro lifespan of these cells. Further evidence testifying to a lack of enzyme alteration in vitro was obtained in experiments testing temperature sensitivity. The aldolase from all passages was equally sensitive to heating at 60 degrees C.


Lay-professional conflict in a Canadian community health center: a case report.

Early in 1974, the entire medical staff resigned from the Regina Community Clinic over a dispute with the lay board of directors. The turbulent history of this pioneer consumer-sponsored clinic is reviewed and documented. The affair provides a case study in the conflict between the traditional professional dominance of doctors and the demand of consumers for a role in decision-making in areas of health care delivery.


Medical ideologies in conflict.

During the 1960s, the growing dissent within the medical profession heightened the ideological differences among physicians. This paper focuses on the ideological differences among three groups within medicine: traditionalists, liberals, and radicals. A content analysis of selected medical editorials and articles during 1972 was used to identify differences in ideological content for the following areas: professional unity; authority; self-regulations; self-education; the role of health professionals; manpower; medical education; research; health care; financing health care; and governmental relations.


Use of traditional Indian medicine among urban native Americans.

The purpose of this paper is to provide a systematic explanation of the use of traditional medicine among the native American population living in the San Francisco Bay area. Several hypotheses concerning the factors associated with this behavior are tested. These include tribal grouping, socioeconomic and sociocultural factors, as well as the relationship between traditional medicine and modern Anglo medicine. The analysis is based on a probability sample of 277 native American families, systematically drawn from a specially prepared list of 5,000 in three Bay area counties with the largest native American population (Alameda, San Francisco, and Santa Clara). Traditional medicine was used by almost one of three families in the sample and it is shown that use of traditional medicine, although related to sociocultural factors, did not detract from the use of modern Anglo medicine.


Inequality of the services received by individuals: a suggested index and an illustrative application.

Population groups that are homogeneous with respect to such factors as insurance status, income level, and proximity to sources of care can still exhibit great internal inequality in the amount of care received by individuals. A statistical measure of this inequality is proposed and its application illustrated on employee groups living in two underdoctored areas. Utilization of physician services in these areas was found to be significantly less equal (as well as lower) than in comparable groups who live in areas with higher ratio of physicians to total population.


Impact of integration of mental health service and comprehensive medical care.

Effect of the introduction of mental health services into a comprehensive prepaid medical care facility was studied. The subjects were two independent subsamples of all individuals seen in the mental health service for the first time in 1967, and two comparison groups not seen in the mental health service. Data consisted of medical visits from 1962 through 1969 and mental health visits from 1967 through 1969. Insufficient support was found for the assertion that mental health services produce savings of medical care. Some of the complex interactions between care for somatic and mental health treatment variables, and points for future study are noted.


An examination of the effect of market demographic and competitive characteristics on gross margins of prescription drugs.

This study was carried out to determine the influence of selected demographic and competitive market factors on community pharmacy operations. Data were collected from a panel of pharmacies located in large mid-western city. A sample of 300 prescriptions was obtained from each of the panel pharmacies. From the prescriptions, the gross margins and the addresses of the patrons were determined. A profile of the demographic and competitive factors was determined. Eight research hypotheses were tested. The variables were subjected to regression analysis with per cent markup and dollar markup-on-retail being the dependent variables in each case. The simple regression analysis did reflect a significant relationship between select competitive variables and per cent markup. The stepwise regressions indicated a significant relationship between all demographic and competitive market factors and per cent markup. No significant relationships were found in the simple regression treatment of a dollar markup and the market variables. The stepwise regression routine yielded a nonsignificant relationship between dollar markup and all market variables except income and education. It can be concluded that pricing in this market is reflective of both demographic and competitive market factors of the trading area.


Resources utilized for the care of surgical patients in the emergency department.

A classification system for surgical patients and a quantitative index of services have been developed to determine the resources utilized for medical care in an urban hospital emergency department. Five classes of surgical patients based on patient management reflect, the amount of diagnostic and therapeutic work performed. Quantitative estimates of workload and rates at which services are delivered to each patient class are included. This classification of patients which is derived from a natural grouping of common patient problems with common patterns of management, can be an important aid to effective analysis and planning of medical care in outpatient settings.


Computer-aided management of hypertensive patients.

A computerized system has been developed which potentially enables a single expert physician to monitor a large number of hypertensive patients being seen at distant locations. The patients may receive their care directly from primary care physicians or nurse-physician surrogates. Primary care physicians can use the same data bank to monitor their own panels of patients. These goals are accomplished through a special purpose, interactive programming language which can be used to perform sophisticated data retrieval along different complexes of parameters. The physician is able to query the computer, via a terminal, about any group of patient he defines and have displayed to him the clinical data requested. The system is open-ended, enabling one query to lead to another. Four hundred and ninety-three patients have been entered into this program so far, including 29 patients with diastolic pressures greater than 115, 92 with diastolic pressures of 104 to 114, and 372 with diastolics of 90 to 104. Among patients who have been on therapy for at least six weeks, 80 per cent were at goal blood pressure. Ten to 14 weeks after therapy was initiated, 69 per cent of all patients in the program were at goal blood pressure. The system provides a useful means of monitoring a large hypertensive population of patients. Such a system can result in a more efficient utilization of medical personnel and can bring the consultative services of highly trained specialists to larger segments of the population.


Data retrieval in the coronary care unit: prospective vs. retrospective.

A standardized system for recording patient care data for medical audit was developed and implemented in six community hospitals' coronary care units. It utilized the principles of predefining the data base and having both nurses and physicians participate. This system was compared with conventional retrospective record abstraction as a source of information for medical audit. The results suggest that the proposed system produces slightly more clinical data relevant to diagnostic impressions. Accuracy is comparable to that achieved by standard computerized abstraction procedures. Such an approach is readily adaptable for implementing medical audit to meet the requirements currently imposed upon community hospitals.


A demographic evaluation of acute drug reactions in a hospital emergency room.

This study investigated a sample of persons treated for acute drug reactions (overdoses) in a hospital emergency room setting to determine the general characteristics of these drug abusers and the incidence of drugs responsible for their admission. Detailed information is provided on the race and sex composition of these drug abusing patinets and comparisons are made with the general population of the area serviced by the hospital. The sample consisted of 1,128 persons who entered Jackson Memorial Hospital, Miami, Dade County, Florida during 1972. A profile of the typical admission for emergency care of a nonfatal overdose reveals a white female, who is 18 to 24 years old and who has overdosed on a single legally manufactured and distributed substance, usually a sedative. Implications from the data for changes in health care delivery for acute drug reactions are provided.


Glottic cancer with extension to the arytenoid.

Hemilaryngectomy with removal of a greater part or all of the arytenoid was done in 79 patients with good functional results with an overall cure rate of 94 percent. The survival rate for the primary modality of therapy was 90 percent.


Laryngeal structure following microcauterization.

The paper supports and reaffirms the objectives of contemporary laryngology in the treatment of cancer of this organ. These objectives are, first and foremost, the eradication of the tumor, and second, the preservation of function. A relatively recent contribution to the "state of the art" has been the development of the field of microlaryngology. The introduction of the surgical microscope has provided the laryngologist with better means to judge the type, localization and extent of neoplastic lesions. Reports indicate that superficial limited carcinomas of the larynx with good vocal cord mobility can be successfully treated by vocal cord stripping and/or radiotherapy. This paper presents the serious challenge posed by these limited tumors when they recur after radiotherapy. In a selected number of these patients radical surgery has been prevented by treating these recurrent tumors with the microcautery. Some of these patients, so treated, have been free of disease for more than three years after their recurrent tumors were destroyed with the microcautery. During this time these patients have enjoyed adequate voices. Extensive studies that have been performed in dogs with the microcautery indicate that: a. An excellent recovery of the larynx is the rule, if microcauterization is carried out superficially. These initial experiments were performed on 10 dogs, duplicating the type and extension of microcauterization, as this procedure is usually performed clinically in the treatment of patients. b. The anterior and posterior commissures of the larynx were found understandably vulnerable to severe degrees of cauterization.


Intratracheal thyroid.

Ectopic thyroid tissue within the trachea (intratracheal or endotracheal tissue) is a rare cause of upper airway obstruction. The symptoms may be classical or, as in most cases in which the voice is not affected, the first sign may be a wheeze. This may result in the symptoms being mistaken for asthma. The presence of a submucosal upper tracheal mass is quite unusual. If one is familiar with the fact that thyroid tissue may occur in this location, then this diagnosis should be considered in patients with such symptoms, and the appropriate diagnostic studies and surgical management should be instituted. The present case report entailed a 56-year-old female who was admitted to the hospital after having been treated for a year in an outlying area. She had increasing shortness of breath and wheezing and had been treated several times for asthma. Indirect laryngoscopy revealed an upper tracheal submucosal mass which was confirmed by direct laryngoscopy and by tomography. Biopsies were taken confirming nodular ectopic thyroid tissue. The patient was operated on through a cervical incision and a tracheal flap was elevated in order to carry out a submucosal dissection of this mass. The patient has done well for more than a year following surgery, and histologically this lesion was benign in the thyroid tissue.


Cricopharyngeal myotomy in the treatment of dysphagia.

Deglutition is a complex neuromuscular act. Alterations in anatomy and physiology may lead to dysphagia. The role of the cricopharyngeus appears to be the keystone in the rehabilitation of many patients with dysphagia. This paper examines the physiology of swallowing as well as the patho-physiology of its abberations. Techniques and complications of cricopharyngeal myotomy are presented. Cases of dysphagia due to ablative surgery of the head and neck, dermatomyositis, cerebrovascular accidents, and cricopharyngeal achalasia in which cricopharyngeal myotomy was utilized, are reported. It would appear from this small number of cases, that cricopharyngeal myotomy is indicated in the rehabilitation of dysphagia in patients with varied disease states.


"Smokers' larynx" and carcinoma of the larynx in Syrian hamsters exposed to cigarette smoke.

Several groups of investigators have recently produced carcinoma of the larynx in Syrian hamsters. This study reports on the effects of cigarette smoke from Kentucky reference cigarettes in an inbred strain (BIO 15.16) of Syrian hamsters. After "smoking" five days each week for two years, 20 percent of the surviving animals had cancer of the larynx; 40 percent had severe epithelial changes. These observations emphasize the role of cigarette smoke in the genesis of laryngeal cancer and respiratory tract cancer in general. An experimental method is now available for comparative studies of cigarettes and as a quide toward less hazardous smoking materials.


Etiologic factors in non-suppurative otitis media.

Two observations in non-suppurative otitis media, namely the serous fluid and the tympanic membrane retraction, may have separate explanations as to the etiologic factors. The first is the obstruction of the collecting lymphatic tubules of the middle ear and eustachian tube as they drain to the retropharyngeal lymphatics. This leads to a transudation of fluid in the middle ear or serous fluid. The second observation, retraction of the tympanic membrane, may be due to an absence or significant reduction of the surface tension lowering substance (Surface Active Membrane) of the eustachian tube, preventing the transmission of air to the middle ear from the nasopharynx.


Hearing loss of acquired syphilis: diagnosis confirmed by incudectomy.

Syphilis, both congenital and acquired, may cause sensori-neural hearing loss. Congenital syphilis presents in two forms: early (infantile), and late (tardive). Acquired syphilis, both secondary and tertiary, may cause deafness. The clinical course of the acquired and congenital forms are similar. Sensori-neural hearing loss with low discrimination scores may affect both ears simultaneously or sequentially, and vestibular complaints are common. A clinical diagnosis can be made on the basis of history, the presence of other stigmata of syphilis, and serological tests, including the FTA-ABS. The histopathology of acquired and congenital forms is indistinguishable and is essentially twofold: first, syphilis may cause a miningo-neurolabyrinthitis with round cell infiltration of the labyrinth and VIIIth nerve as the predominant lesion in early congenital syphilis and the acute meningitides of secondary and tertiary acquired syphilis. Second, syphilis may cause a perivascular round cell osteitis of the temporal bone with secondary involvement of the membranous labyrinth in both late congenital and acquired late latent or tertiary syphilis. Endolymphatic hydrops may be seen in both the congenital and acquired forms. A case of bilateral sequential sudden deafness due to acquired syphilis is presented. A histological diagnosis of syphilitic involvement of the temporal bone was made by incudectomy. Treatment with prednisone and penicillin over a three-month period resulted in return of good cochlear function in one ear.


Synthesis and analysis of phytyl and phytenoyl wax esters.

An efficient procedure for preparing phytenic acid methyl ester, free of isomers, from phytol is reported. Phytyl phytenate and other isoprenoid wax esters were synthesized. Gas liquid chromatography of these wax esters and other compounds related to phytol and phytenic acid is described. The alkyl constituents of isoprenoid wax esters can be analyzed after alkaline methanolysis and the acyl constituents after acidic methanolysis. The applicability of these methods to natural mixtures was demonstrated with wax esters from mosses which contained both types of isoprenoids and with wax esters from healthy and frost damaged grass which contained phytol, but not phytenic acid.


Failure to demonstrate degradation of (4-14C) cholesterol to volatile hydrocarbons in rats and in human fecal homogenates.

The inability of previous workers to recover completely the radioactivity from ingested [4-14C] cholesterol has led to the hypothesis that the colonic flora of some individuals degrade the sterol nucleus to volatile hydrocarbons, particularly CH4. In the present investigation, the production of radioactive volatiles was measured following incubation of [4-14C] cholesterol with 8 human fecal homogenates or after instillation of the labeled sterol into the cecum of 3 rats housed in a closed rebreathing system. Three of the 8 homogenates and each of the 3 rats produced copious CH4. However, analysis by combustion demonstrated no radioactivity above background in the volatile headspace of the homogenates or the gas space of the closed system housing the rats, indicating that less than 0.001% of the number 4 carbon of [4-14C] cholesterol could have been converted to volatile hydrocarbons. This study, therefore, provides no support for the concept that volatile products account for the incomplete recovery of ingested sterols observed in certain subjects. However, this hypothesis can not be excluded entirely until similar results are obtained with subjects who can be shown to degrade cholesterol.


Examination of acetolysis products of phosphatidylcholine by gas chromatography-mass spectrometry.

A comparison of monoacetyldiglycerides obtained from authentic phosphatidylcholines by acetolysis with those obtained by phospholipase C-acetylation was made to examine the intermolecular acyl migration, the intramolecular acyl migration between C-1 and C-2, and the formation of 1,3-isomer in the acetolysis reaction. Egg yolk phosphatidylcholine also was used. It was revealed that is acetolysis, the intermolecular acyl migration and selective degradation of polyunsaturated fatty acids did not take place at all. The intramolecular acyl migration, including the formation of 1,3-isomer, occurred to a small extent. Appreciable difference was not found in comparison of molecular species compositions of monoacetyldiglycerides derived by both methods from egg yolk phosphatidylcholine, except small differences found in the contents of two kinds of molecular species.


Comparison of phospholipid composition of Aedes aegypti and Aedes albopictus cells obtained from logarithmic and stationary phases of growth.

Aedes aegypti and Aedes albopictus cells were grown in tissue culture and harvested at logarithmic and stationary phases of development. The phospholipids were extracted, separated into lipid classes, and fatty acid composition of each fraction determined. The phosphatidylethanolamine fraction was the major lipid (42-54%). With aging, the A. aegypti cells showed an increase in polyenes in the phosphatidylcholine and phosphatidylethanolamine fractions and in monoenes and polyenes in the phosphatidylinositol fraction. The lysophosphatidylcholine fraction had an increase in chain length of the fatty acids with aging of the A. aegypti cells. The A. albopictus cells, with aging, showed increases in chain length and in the relative percentage of polyenes in the lysophosphatidylcholine, phosphatidylcholine, and phosphatidylserine fractions. In the phosphatidylinositol fraction, chain elongation of fatty acids occurred as the cells aged. In the ceramide phosphorylcholine fraction, there were increases in saturation and chain elongation of the fatty acids from the logarithmic to the stationary phase of the A. albopictus cells. An increase in polyenes was observed with aging of the cells in the phosphatidylethanolamine fraction.


Furanoid fatty acids from fish lipids.

Fatty acids, recently reported as constituents of certain fish lipids, were identified to be derivatives of furan (furanoid fish fatty acids). 12,15-Epoxy-13,14-dimethyleicosa-12,14-dienoic acid is predominant among the furan acids and is associated with bis-homologs in regard to chain length. Monomethyl acids, such as 12,15-epoxy-13-methyleicosa-12,14-dienoic, are present in appreciable amounts. The structures were concluded from oxidative degradations, from mass spectrometry of methyl esters of the novel acids and fatty acids derived from them by opening the ring, and from nuclear magnetic resonance, infrared, and Raman spectra. The results from chemical procedures and from spectrometric methods were in agreement with those obtained with authentic methyl 9,12-epoxyoctadeca-9,11-dienoate. The number of substituents at the furan ring greatly influences hydrogenation, hydrogenolysis, and hydrolysis reactions of the ring.


Distribution of cholesteryl esters and other lipids in subcellular fractions of the adrenal gland of the pig.

Total lipids from whole pig adrenal glands as well as from their mitochondria, microsomes, liposomes, and cell sap were extracted and fractionated first into neutral lipids and phospholipids. The highest percentage of neutral lipids was found in the cell sap, and the lowest in the microsomal fraction. Neutral lipids were subfractionated into cholesteryl esters, free cholesterol, triglycerides, and free fatty acids. Cholesteryl esters were distributed throughout the liposomes. Free fatty acids represented a substantial part of cell sap lipids, but were present also in the mitochondria, microsomes, and liposomes. Fatty acids of all fractions were analyzed by gas liquid chromatography. Free fatty acids and cholesteryl ester fatty acids from all cellular fractions were similar in composition and were characterized by considerable quantities of linoleic and arachidonic acid. Triglycerides were characterized by an increased percentage of palmitic and a low content of arachidonic acid. Phosphatidyl choline, phosphatidyl ethanolamine, diphosphatidyl glycerol, and sphingomyelin plus phosphatidyl inositol were isolated from the lipids by preparative thin layer chromatography, and their fatty acids analyzed by gas liquid chromatography. Phosphatidyl choline and phosphatidyl ethanolamine from mitochondria, microsomes, and cell sap were very similar in respect of their fatty acid composition. Sphingomyelin plus phosphatidyl inositol was characterized by a high content of C22:2omega6. Diphosphatidyl glycerol was present in mitochondria and in the cell sap.


Subnanogram detection of t-butyldimethylsilyl fatty acid esters by mass fragmentography.

The mass spectra of t-butyldimethylsilyl fatty acid esters all display a pronounced (M-C4H9)+ ion. The proportion of the total ionization carried by this fragment, particularly for saturated and mono-, di-, and tri-unsaturated acid derivatives, facilitates their qualitative analysis at the subanogram level by mass fragmentography.


Mass spectrometric localization of methyl branching in fatty acids using acylpyrrolidines.

Localization of a methyl branch in a fatty acid molecule by mass spectrometry is facilitated by using the pyrrolidide rather than the methyl ester. Branched fatty acid methyl esters are converted to pyrrolidides and are than analyzed by gas chromatography and mass spectrometry. The diagnostic fragments indicate position of the methyl branch.


Emergence of overt diabetes in offspring of rats with induced latent diabetes.

A single subdiabetogenic dose of alloxan administered to the weanling rat induces a persistent state of latent diabetes which progresses to fasting hyperglycemia by the seventh generation. Initial descendants of alloxan-treated animals have hyperinsulinism which progresses to insulinopenia in later generations. Later generation animals develop ketoacidosis when challenged with a dose of alloxan that has no effect on control animals. The significant sex difference in glucose tolerance rates disappears as the animals become more diabetic and decreased fertility and parity become apparent. One explanation for this data remains the hypothesis of paramutation, induced by alloxan, affecting regulator gene activity. Light microscopy of diabetic animals shows no pathology.


Metabolic and histopathologic changes in arteriosclerotic versus nonarteriosclerotic rats following isoproterenol-induced myocardial infarction with superimposed diabetes.

Male and female, arteriosclerotic and nonarteriosclerotic rats were subjected to acute myocardial infarction by two, subcutaneous injections (spaced 24 hr apart) of isoproterenol. During the immediate postinfarct repair phase all of the experimental animals were made severely diabetic with alloxan. Two weeks later the animals were sacrificed and their blood and pertinent organs analyzed for biochemical and pathologic changes. Females survived the myocardial infarct with superimposed diabetes in significantly greater than males. In addition to marked loss in body weight all of the experimental animals developed marked adrenal hypertrophy and thymus gland involution, cardiac hypertrophy, and unusual increase in ovarian or testicular size and weight. The combined conditions of myocardial infarction + diabetes led to substantial increases in serum creatine phosphokinase (CPK) and glutamic oxaloacetic transaminase (SGOT) whereas the enzymes glutamic pyruvic transaminase (SGPT) and lactic dehydrogenase (LDH) were reduced. Although serum triglyceride levels were greatly elevated, total cholesterol and free fatty acids were reduced. All of the animals were severely hyperglycemic and had greatly increased B.U.N. levels. Diabetes caused hypercalcemia but diabetes + myocardial infarction was associated with a definite reduction of this hypercalcemia. Despite marked adrenal hypertrophy, circulating Cmpd. B levels were subnormal. The diabetic condition and its attendant hyperlipidemia did not alter the morphologic nature of the arterial lesions in the breeder rats but the diabetes did cause definite impairment of the usual myocardial repair process observed in these rats with a particularly high incidence of left ventricular aneurysms in males.


Effects of mazindol on carbohydrate and insulin metabolism in obesity.

Oral administration of a single dose of the anorectic agent mazindol to obese subjects led to a significant improvement in oral glucose tolerance and a concomitant reduction in insulin secretion, but had no effect on the blood glucose and plasma insulin responses to glucose given intravenously. Mazindol, when given to obese subjects in conjunction with a hypocaloric diet, was associated with progressive weight loss and reduction in the fasting levels of blood glucose, plasma insulin, serum triglyceride, and serum cholesterol. When oral glucose tolerance was retested after 16-20 wk, blood glucose and plasma insulin responses were significantly decreased compared with initial control values. It is concluded that one effect of mazindol, when given acutely, is to impair absorption of glucose from the gut. Changes in carbohydrate metabolism after chronic administration of mazindol are entirely consistent with weight loss, although a separate effect of the drug cannot be excluded.


Dissociation of calcium and sodium clearances in patients with hypoparathyroidism by infusion of chlorothiazide.

Previous reports have identified a deficient hypocalciuric response to chronic treatment with thiazide diuretics in patients with hypoparathyroidism. The present study was designed to ascertain if the acute response to thiazide diuretics is impaired in hypoparathyroidism. Five normal subjects and five patients with hypoparathyroidism were studied with the renal clearance technique during water diuresis. In normal subjects the clearance of calcium/clearance of sodium was 0.98 +/- 0.14 before, and 0.33 +/-0.03 during the intravenous infusion of chlorothiazide. In patients with hypoparathyroidism the corresponding ratios were 1.69 +/- 0.27 and 0.57 +/- 0.10. In both groups the drug-induced fall in clearance was 65% of control. The concentration of chlorothiazide in plasma and its rate of excretion were comparable in both groups. It is concluded that the acute action of thiazides is not impaired in hypoparathyroidism.


Adipocyte metabolism in endogenous hypertriglyceridemia.

In order to define specific metabolic abnormalities of adipose tissue metabolism in endogenous hypertriglyceridemia (EH) patients with this condition were compared with normolipidemic controls matched for body fat and fat cell size. In vitro the enlarged fat cells of EH were found to have an increased basal and noradrenaline-stimulated lipolysis in comparison with cells of the same size from normolipidemic controls. The insulin inhibition of noradrenaline-stimulated lipolysis was blunted. Lipoprotein lipase activity in these cells was clearly depressed. Basal triglyceride synthesis from labeled glucose was low in relation to plasma insulin. The reduction of insulin tolerance in vivo suggested that the depression of plasma glycerol and free fatty acid concentration was small in EH, suggesting that the more detailed findings in vitro were of relevance for in vivo conditions. It was suggested that the hyperinsulinemia and decreased glucose tolerance of EH may well be responsible for some of the aberrations of adipocyte metabolism in EH. The decreased responsiveness of lipolysis to insulin and the low lipoprotein lipase activity are, however, findings not typical for enlarged fat cells exposed chronically to insulin and might be characteristic for the fat cells of EH. It seems of importance to further define the factor(s) responsible for these metabolic aberrations, because the abnormalities of the acipocyte metabolism in EH may well offer a possible explanation to the pathogenesis of that condition.


The effect of iodine deficiency on thyroid function in the infant rat.

We have studied rats born to severely iodine-deficient mothers and subsequently maintained on a low-iodine diet (LID) from birth to 41 days. They were compared with controls born to mothers fed a high-iodine diet (HID). LID babies from birth on had large goiters, high thyroid labeled MIT/DIT ratios and radioiodine uptakes, high plasma TSH and low plasma T4 in comparison to HID controls. Thyroid labeled T3/T4 ratios were low in all babies at birth but were higher in the LID than HID babies from day 5 on and were greater than 1 after day 10, approximating the T3/T4 of the mothers. Coupling efficiency, as indicated by thyroid labeled (T3 + T4)/(MIT + DIT), was relatively low for the first 4 postnatal days for both the HID and LID babies and was associated with a lower plasma T4 than at later intervals. Injection of 0.05 mug 127I- simultaneously with 131I- caused an acute increase in labeled T4 and decrease in MIT formation in LID babies of all ages, but did not affect T3 synthesis. Doses of 127I- 20 times as large had no effect on labeled iodoamino acid synthesis in HID babies. Thyroid organic radioiodine content in newborn LID rats was 65% lower at 24 hr than at 4 hr after 131I injection, indicating that thyroid secretion was occurring. A few of the LID pups were "runts" approximately 60% the size of HID babies the same age. However, the overwhelming majority of LID babies maintained the same weight as HID controls from birth until weaning. After weaning, the LID babies grew at a slower rate than the HID controls. Relative thyroid weight, radioiodine metabolism and plasma TSH were no different in runts of various ages or in their mothers than in the "normal" LID controls. Adaptation was apparently adequate in the LID babies to maintain a nearly euthyroid state. We suggest that the low labeled T3/T4 ratio in the first few days of life in the LID babies may be due to a coupling deficiency in newborn rats resulting in a proportionately greater formation of iodotyrosines than of iodothyronines compared to older animals. This results in a greater intrathyroidal retention of iodine during intracellular thyroglobulin proteolysis and a more highly iodinated thyroglobulin in the LID babies than after normal coupling is achieved.


Effects of 1alpha-hydroxy-vitamin D3 and 1,25-dihydroxy-vitamin D3 on calcium and phosphorus metabolism in hypoparathyroidism.

The effects of 1alpha-OH D3 or 1,25-(OH)2D3 on calcium and phosphorus metabolism have been evaluated in five hypoparathyroid patients to establish the direct effects of these compounds in adult humans, uncomplicated by compensatory changes in parathyroid hormone secretion. Doses of 1-2.5 mug/day in four patients (5 mug/day in a fifth patient on diphenylhydantoin and phenobarbital) caused a marked increase in serum calcium concentration and urinary calcium excretion, without significant changes in renal calcium clearance or urinary hydroxyproline excretion. These results suggest that the correction of hypocalcemia involved primarily a stimulation of intestinal calcium absorption rather than a stimulation of skeletal calcium resorption. Simultaneously, there were increases in urinary phosphorus excretion and variable changes in serum inorganic phosphate concentration. These effects were produced by doses of 1alpha-OH D3 and 1,25-(OH)2D3 which approach the dose needed to prevent rickets, in contrast to the very large doses of vitamin D or 25-OH D3 required for comparable effects in hypoparathyroid patients. The increased relative effectiveness of these one-hydroxylated forms of vitamin D reveals a deficiency of vitamin D one-hydroxylation in hypoparathyroidism. The rapidity of action of 1alpha-OH D3 and 1,25-(OH)2D3 was also striking. Apart from its physiologic implications, the potency of the one-hydroxylated forms of vitamin D offers significant therapeutic advantages in some patients whose hypoparathyroidism is difficult to control with vitamin D itself.


Chromosomal aberrations in malnutrition.

The effects of feeding high (18%) and low (5%) protein diets on chromosomal aberrations in bone marrow cells of rats were investigated. Malnourished rats maintained on low protein diet had significantly higher incidence of breaks and deletions as compared to wellfed rats maintained on high protein diet. Well fed rats showed an increased aberration rate when switched over to a 9% protein diet. On the other hand, malnourished rats showed a decrease in aberration frequency when fed 9% protein diet and still lower frequency when fed 18% protein diet.


On the nature of hyaline zones in the cytoplasm of Amoeba proteus.

Investigations with the Nomarski DIC (differential interferece contrast) microscope and the electron microscope on the nature of hyaline zones in the cytoplasm of Amoeba proteus revealed that these regions represent pure ground cytoplasm. Differences between specimens 1) treated with 2% ethanol, 2) released from high hydrostatic pressure or 3) preincubated at 35 degrees C for 30 minutes could not be observed. Only dying cells undergoing lysis contained a watery solution within the zones of hyaline appearance. The existence of a so-called cell surface complex composed of the plasma membrane and an electron dense filamentous layer of groundplasm was demonstrated by the electron microscopical analysis of narcotized and pre-heated amoebae. This complex corresponds morphologically to the cell surface complexes in tissue cells. Hence it seems possible that the cell surface complex of amoebae is also responsible for changes of the cell shape and movements of the cell membrane. Observations with the DIC microscope also revealed the existence of two types of hyaline caps in A. proteus: in pseudopodia extending during normal locomotion the hyaline cap consists of pure ground cytoplasm, whereas in specimens  showing fountain-like streaming the cap is built up by a large vacuole containing a watery fluid.


Hypnosis in medical practice.

Hypnosis has a role in medical practice as an adjunct to many therapies. A brief review of the history, theory, induction procedures, phenomena and practice of hypnosis is given. The use of hypnosis in the therapy of anxiety is illustrated by a report of a 44-year-old woman suffering from an aeroplane phobia.


The value of endoscopy and biopsy in the diagnosis of gastric carcinoma.

The value of endoscopy and biopsy in the diagnosis of gastric carcinoma has been examined. Out of a total of 550 patients, gastric carcinoma was suspected in 101. Endoscopy and biopsy provided a firm diagnosis in 43 of the 44 cases of gastric carcinoma present, and effectively excluded gastric carcinoma in 48 cases. We recommend endoscopy and biopsy as valuable diagnostic procedures in the investigation of patients suspected of having gastric carcinoma. Used together they can eliminate the necessity for diagnostic laparotomy.


Melioidosis in a child in papua new guinea successful treatment with kanamycin and trimethoprim-sulphamethoxazole.

An instance of melioidosis is described in a five-year-old Papua New Guinean. The disease did not involve the lungs, but the patient presented with an abscess on the abdomen and with numerous abscesses on the feet. The disease was successfully treated with kanamycin and trimethoprim-sulphamethoxazole. This is the fourth case known to have occurred in Papua New Guinea, and the patient is the first to have survived.


Chronic melioidosis.

This report is of a man who suffered from chronic melioidosis contracted in Malaysia. In the course of the disease he had a lobe of a lung resected, developed empyema and, while this was still draining, developed infection in an ankle. Both the empyema thoracis and the ankle infection were due to Pseudomonas pseudomallel. He now appears to be cured, probably by massive doses of tetracycline.


Use of on-line computer facilities in a respiratory function laboratory.

Experience in the use of on-line computer facilities in a respiratory function laboratory is described. An improved level of service and patient care has been demonstrated. Avenues for further development are discussed.


A department of personal and family medicine.

There has been increasing, worldwide dissatisfaction with the relevance of medical education to health care. Recently, a special task group set up by The Royal Australian College of General Practitioners made a study of how a department of personal and family medicine could participate in the education of the medical student. The task was to present first steps in a research and development programme for education of health personnel to work in and near the family setting. Two academics, two nurse educators, two general practitioners, one specialist surgeon involved in medical education and a fifth-year medical student made up the group. It worked at the task during a six-day live-in teaching and leadership seminar at Leura, New South Wales, in February, 1973.


Education in community medicine with an emphasis on the health of an Aboriginal community: a pilot project.

An outline is given of a pilot project to introduce medical students to the broad concept of community medical practice with the emphasis on a rural Aboriginal community. The subjective experiences of the students are recorded and discussed. It is suggested that similar projects are essential to give balance to the bias of hospital training of medical students and to attract doctors to this discipline. The main advantages of such a scheme are that it broadens the perspective of the medical student, widens his potential choice of career, and gives him insight into the medical needs of a socioeconomically deprived group and into the wider role that a doctor can play in the health of the community.


Learning by experience. A student residential workshop in hospital.

A four-day residential workshop was conducted for students beginning their clinical studies at the St George Hospital in 1974. The aim of the workshop was that the students should understand the functioning of the hospital and feel comfortable as students in the hospital, so that they would learn their clinical skills more effectively in their subsequent years at the hospital. Each student lived in a hospital bed with an "illness" for two days, and spent another two days helping care for these "student patients" and exploring the hospital. Evaluation at the end of the workshop suggested that the objectives had been achieved.


Undergraduate general practice teaching in Australasian medical schools: the student viewpoint.

A survey was conducted to find what type of general practice teaching is offered to Australasian undergraduates. Of 11 medical schools, one had no pretence at general practice teaching, four had very inadequate and six had sufficient courses devoted to the subject. Comments on the place of general practice teaching in the medical curriculum are added. An attempt is made to summarize student expectations.


An experimental brief course in sexual behaviour and counseling.

A brief course in sexual behaviour and counseling was given to a sample of 30 fifth-year medical students from Monash University, as an adjunct to their curriculum in gynaecology. The effectiveness of the course in increasing the student's knowledge of sexual behaviour and ability in sexual counselling, and in reducing anticipated anxiety or embarrassment in sexual discussions, was assessed by precourse and postcourse measures. It was concluded that the course was reasonably successful in achieving these aims and provides a basis for desirable future developments in this area.


Combined diphtheria-tetanus immunization of adults.

The administration of a combined adult-type diphtheria-tetanus vaccine to a group of 35 adults seeking booster tetanus immunization produced a secondary immune response to the diphtheria antigen in 26. A satisfactory response to the tetanus antigen was noted in all those who gave a reliable history of active tetanus immunization, including eight individuals who had not received a dose of toxoid for 25 to 28 years. No systemic reactions were observed, but significant correlation was found between local reactivity and a high post-booster titre of tetanus antitoxin. Selective use of the combined vaccine instead of tetanus toxoid alone offers a means of raising the diphtheria immunity in the adult population.


Effect of long-term co-trimoxazole therapy on renal function.

In order to study the effect of long-term administration of co-trimoxazole on renal function, creatinine clearance rates were measured in 18 patients with neurogenic hypotonia of the bladder due to paraplegia, quadriplegia, hemiplegia and cerebrocervical injuries. The duration of the prophylactic treatment was between 60 and 80 days. The initial average creatinine clearance rate of this group was 99-0 ml/min and the final one was 110-7 ml/min (P = 0-15, n.s.). In addition, in seven cases the prophylaxis was extended to a period of 330 to 430 days. In this group the initial average creatinine clearance rate was 104-4 ml/min and the final one was 94-7 ml/min (P greater than 0-3, n.s.). It is concluded, therefore, that prolonged administration of co-trimoxazole to patients with creatinine clearance above 50 ml/min does not cause any marked deterioration in the renal function.


Birth weight in pregnancies after induction of ovulation with pituitary gonadotrophins.

Birth weights offer a means of determining normality of babies born after induction of ovulation with human pituitary gonadotrophins. A study of 62 patients treated under the auspices of the Australian Human Pituitary Advisory Committee shows that birth weights of the babies were not significantly different from those in two large Australian obstetric populations. Multiple pregnancies are more common after ovulation induction. Birth weights in twins are approximately 85% of those in singleton pregnancies.


Villous adenoma of the colon with electrolyte depletion.

The case is presented of a villous adenoma of the colon associated with profuse, watery diarrhoea of such severity as to cause dehydration and electrolyte depletion.