Anaesthesia in a delightful setting: Gull Force Medical Aid Project in Ambon.

Civil aid projects in developing countries and military experience in South Vietnam have enabled numerous Australian and New Zealand anaesthetists to experience and evaluate anaesthetic techniques, drugs, unfamiliar apparatus and the anaesthetic training of paramedical personnel under unusual conditions. Supply problems, economic conditions, climate, educational standards of trainees, and the health of the community are some of the factors which influence the methods which have been adopted. The value of this experience is seen in its continuing commitment to civil aid projects in developing countries, and parallels are also seen in the anaesthetic requirements for major disasters, whether civil or military.


The Dalkon Shield contraceptive device in general practice.

The value of the Dalkon Shield as a means of birth control in general practice is reviewed, and the continuation rate is found to be disappointingly low in a well motivated group of women. These findings are at complete variance with those of Watson (1975).


Hydrocephaly, microcephaly and anencephaly diagnosed in pregnancy by ultrasonic echography.

The antenatal diagnosis of hydrocephaly, microcephaly and anencephaly is discussed and it is shown that ultrasonic echography is suited to the earliest diagnosis of these conditions. In hydrocephaly, demonstration of ventricular size and anatomy is used to assess the severity of the disease.


Bioavailability of phenytoin from various pharmaceutical preparations in children.

In children, the blood level of phenytoin was found to be significantly higher when 100 mg capsules rather than 100 mg tablets were administered. When, on the other hand, 30 mg capsules and tablets were compared; the situation was reversed; tablets produced significantly higher blood levels of phenytoin than did the capsules. The significance and possible explantation of these findings are discussed.


The incidence of Australia antigen in hospital staff members.

A survey of Sydney Hospital staff members for Au antigenaemia was performed during a six-month period in 1972. Nine hundred and forty-six staff members were tested by the immunoelectroosmophoresis (IEOP) method and two asymptomatic chronic carriers were detected. Subsequently, it has been hospital policy to test all new staff members. Eight hundred and ninety additional sera from staff members were obtained and 12 were found to be Au positive. Of these, only one had evidence of liver disease. The results show a slight increase in the incidence of Au positivity in hospital staff members as compared with that of the general Australian population. However, in our series the majority of chronic carriers were immigrants from countries with known high incidence of Au antigen positivity. We therefore postulate that this increase is due not to the hospital environment, but to the carrier's country of origin.


Uterine fibroid: an unusual cause of recurrent haemorrhagic pleural effusion.

A 51-year-old woman presented with dyspnoea due to pleural effusion, which repeatedly reaccumulated rapidly after tapping. A pelvic mass was present and she was considered to have disseminated ovarian malignant tumour. Total hysterectomy with bilateral salpingo-oophorectomy was performed, and the tumour was shown to be a necrotic uterine fibromyoma. After the operation the patient has been well, with no recurrence of the effusion. This is the twelfth reported case of the association of hydrothorax with uterine fibromyoma, and is a form of the rare pseudo-Meigs' syndrome.


The role of the general practitioner in an obstetrics teaching hospital.

A scheme is presented for the appointment of general practitioners to the staff of a university teaching hospital. The doctors have bed rights for the management of their private and intermediate patients. They are appointed to the teaching and service units of the hospital and cooperate with a Department of Community Medicine, the full-time Director of which is also a general practitioner with senior staff status. The hospital appointment has the title Affiliated Medical Officer and is made subject to written acceptance of special conditions which include practice restriction in the management of complicated cases. The scheme has operated satisfactorily for two years.


Four hour-test for the identification of Enterobacteriaceae.

A set of 12 rapid biochemical tests--lysinedecarboxylase, ornithinedecarboxylase, beta-galactosidase, urease, hydrogensulphide, indole, acetoin, deoxyribonuclease, esculin, mannitol, raffinose and sorbitol--were selected from an original set of 13 tests and were found to give 98% accurate reactions within 4 hrs of incubation for the identification of bacteria belonging to Enterobacteriaceae. This set permits identification on the genus and/or species level for Escherichia, Shigella, Citrobacter, Salmonella, Klebsiella, Enterobacter, Serratia and Proteus.


Studies on bacteriophages of Propionibacterium acnes.

With the help of adaptation experiments, 61 phage preparations out of 36 Propionibacterium acnes bacteriophages (32 isolated by us and 4 sent from abroad) were established. On the basis of their stability, spectrum of activity, and virulence, 13 phages were selected for phagetyping. 58 well-classified P. acnes strains were grouped into 7 phage-types. 7 strains of P. granulosum, two strains of P. avidum, and one yet ungroupable microserophilic propionibacterium strain were resistant to all 61 phages, even when tested in 100 X RTD. A combination of phagetyping with biotyping resulted in data especially useful for the differentiation of P. acnes.


X-ray images of small blood vessels in angiography: question of isoplanatism.

The basic theory of x-ray image formation of blood vessels, which is related to isoplanatism, is discussed. The x-ray intensity distributions of the blood vessel images are derived first for the actual case, which gives "correct" x-ray images obtained by the ray-tracing method. Secondly, as an approximation of the actual case, the image distributions are derived by the convolution method, which corresponds to an isoplanatic case. It is concluded that, under practical conditions, x-ray images of blood vessels are given approximately by a convolution integral of the object distribution, that is, the input x-ray pattern of the vessel exposed with a parallel x-ray beam, with the line spread function of geometric unsharpness. Therefore, this theory provides support for the experimental procedure commonly used in obtaining blood vessel images, and for the validity of applying in angiography the concept of the line spread function and the modulation transfer function of geometric unsharpness.


Lesion detectability as a function of pulse-height selection for dynamic imaging with 99mTc.

Previous studies on pulse-height selection for scintillation cameras have been concerned with static imaging or asymmetric window settings around the photo peak. For count densities typical of those encountered in flow studies and for the customary symmetric window it is shown here, both computationally and experimentally, that a window setting in the range of 25-35% provides the maximum lesion detectability rate for lesions of 0.5- to 2.0-cm diameter.


Accuracy in patient setup and its consequence in dosimetry.

Analysis of 5575 settings on a computer-monitered Theratron-80 60Co unit demonstrates that human error does occur in treating patients with radiation. The errors are due to inaccurate setting of such parameters as field size, gantry angle, collimator rotation, treatment time, etc. The error rate per parameter was found to be about 3%, and more than two-thirds of the patients monitored with the PDP 11/45 computer had at least one error at some stage during the full course of treatment. Both the dose and the dose distribution may be affected by these errors and have been studied in a few typical cases. The errors in timer setting have the largest effect on the prescribed dose and may change the probability of local control appreciably.


Stem corrections for ionization chambers.

Ionization chambers often exhibit a stem effect, caused by interactions of radiation with air near the chamber end, or with dielectric in the chamber stem or cable. These interactions contribute to the apparent measured exposure. To determine the stem efffect for several common ionization chamber systems, exposures were measured with TLD capsules placed at the center of 60Co fields of various sizes. These exposure measurements then were repeated with various ionization chamber systems, including two Victoreen R meters (25- and 100-R chambers), a Capintec 192 dosimeter with a Farmer 0.6-cm3 probe, a PTW transit dose probe, and an EG and G IC-18 probe with a Keithley 610-B electrometer. From a comparison of TLD and ionization chamber measurements of the variation in exposure rate with field size, stem corrections for the different systems were determined within 1%.


Calf blood extract in treatment of equine foot lesions.

A deproteinized calf blood extract (Solcoseryl: Solco Basle, Ltd, Switzerland) enhanced healing of induced and naturally-occurring lesions in the feet of 30 horses and donkeys.


Cycloheximide resistance in Chinese hamster cells. III. Characterization of cell-free protein synthesis by polysomes.

Two clones were selected for mass cultivation from 18 phenotypically stable CHM-resistant CHO clones. The polysomes isolated from these two clones were compared with CHO wildtype polysomes and rat liver polysomes in a cell-free protein synthesis system for their ability to incorporate amino acids. CHM had an inhibitory effect on the protein synthesis activity of CHO wildtype and rat liver polysomes, but had no effect on the polysomes obtained from either of the mutant CHO clones.


A pleiotropic regulatory mutation in lambda bacteriophage.

Lambda bacteriophage mutants, lambdasar, were isolated. These mutants can form plaques on a non lysogenic lawn and are unable to grow on nonimmune (imm-), cro constitutive hosts. Analysis of the restriction of lambdasar by a set of defective lysogens suggested that both the cro and cII gene products participate in the inhibition. The sar mutations were mapped in the ori region between the genes cII and O. Complementation experiments showed that under the restrictive conditions lamdasar is defective in the expression of both the N and the O genes. Transcription analyses support these findings, as lambdasar is unable to serve as a template for transcription after infecting cro constitutive hosts. In addition lambdasar does not replicate under the restrictive conditions, although its DNA can bind to the host membrane to some extent. The Sar phenotype can be relieved by removing sites of action of cro either by a V2 mutation or by substituting the lambda immunity region by imm434 or imm21. Similarly introducing a cy mutation, which interferes with the action of the cII gene product, also eliminates the Sar effect. The sar mutation can suppress cy mutations as manifested in plaque morphology, lysogenization frequency, cI repressor synthesis and the expression of rex function. Suppression takes place only when the sar mutation is present in cis to cy and it requires the action of the cII and cIII gene products. It is suggested that the sar mutation suppresses cy by activating a new promoter for repressor synthesis, pro. The results also suggest that the cII and cIII gene products may act at a site other than y.


Glycolytic metabolism in cultured cells of the nervous system. II. Regulation of pyruvate and lactate metabolism in the C-6 glioma cell line.

Pyruvate and lactate efflux from C-6 glioma cells has been found to be regulated by both the medium glucose concentration and the medium concentration of the two acids. Each moves down a concentration gradient until the extracellular level is in equilibrium with the intracellular. Long-term growth studies demonstrated that the cells preferentially utilize glucose but that once it is depleted, they will take up first pyruvate, followed by lactate, for further metabolism. Changes in the intracellular levels of the two metabolites correspond to those seen in the medium. The rate of glycogen breakdown parallels that of medium glucose ultilization. Preliminary results with the C-1300 neuroblastoma cells showed pyruvate and lactate efflux rates comparable to those of the glioma cells.


Glycolytic metabolism in cultured cells of the nervous system. III. The effects of thiamine deficiency and pyrithiamine on the C-6 glioma and C-1300 neuroblastoma cell lines.

The effects of thiamine deficiency and of the antithiamine drug pyrithiamine on the C-6 glioma and the C-1300 neuroblastoma cell lines have been studied. Thiamine deficiency increased the doubling time of the neuroblastoma cells without affecting that of the glioma cells. Pyrithiamine prevented both cell lines from doubling even once. (hiamine deficiency had only slight effects on intracellular pyruvate and lactate levels or on efflux rates for the acids, but pyrithiamine treatment resulted in large increases in both the intracellular levels and the efflux in both cell lines. For comparison, the pyruvate and lactate levels in mouse brain were measured. The levels from thiamine-deficient mouse brain were essentially unchanged from controls while pyrithiamine treatment caused a significant elevation only of the pyruvate concentration.


The relationships between vitamin B12 and folic acid and the effect of methionine on folate metabolism.

The relationship between vitamin B12 and folate and the effect of methionine on folate metabolism during B12 deficiency in rats is best explained by the prevention of the accumulation of 5-methyl-H4PteGlu by vitamin B12 and/or methionine. Although several points remain to be clarified, the 'methyl trap' hypothesis provides the most satisfactory explanation for the relation between vitamin B12, methionine and folic acid. This concept is extended by the hypothesis that H4PteGlu is the most active substrate for pteroylpolyglutamate synthetase, and thus accounts for the effect of methionine or vitamin B12 increasing liver folate levels.


Variation in average unit chain length of glycogen in relation to developmental stage in Blastocladiella emersonii.

Synchronous, single generations of Blastocladiella emersonii were grown along either the ordinary colorless or resistant sporangial plant pathways. Samples of cells were withdrawn at different developmental stages and glycogen was extracted, purified, debranched by isoamylase treatment, and its component unit chains separated by gel permeation chromatography. The elution profiles showed the distribution of unit chains. Average unit chain length was determined for plants at different developmental stages and shown to vary between 9 and 16. Some of these variations were correlated with other developmental events in the fungus.


Run-off ribosomes in liver, spleen and pancreas of the rat.

Free polyribosomes, isolated from liver, spleen and pancreas of the rat, were suspended in a medium at 0.5 mM Mg2+ and analyzed in the analytical ultracentrifuge. The percentage of run-off ribosomes, distinguised by a sedimentation coefficient below 77S was calculated from centrifugal experiments. The amount of run-off ribosomes differed in the various tissues of the rat but was not influenced by fasting overnight.


Aspects of ketogenesis: control and mechanism of ketone-body formation in isolated rat-liver mitochondria.

The synthesis of ketone bodies by intact isolated rat-liver mitochondria has been studied at varying rates of acetyl-CoA production and of acetyl-CoA utilization in the Krebs cycle. Factors which enhanced the rate of acetyl-CoA production caused an increase in the fraction of acetyl-CoA which was incorporated into ketone bodies. On the other hand, it was found that factors which  stimulated the formation of citrate lowered the relative rate of ketogenesis. It is concluded that acetyl-CoA is preferentially used for citrate synthesis, if the level of oxaloacetate in the mitochondrial matrix space is adequate. The intramitochondrial level of oxaloacetate, which is determined by the malate concentration and the ratio of NADH over NAD+, is the main factor controlling the rate of citrate synthesis. The ATP/ADP ratio per se does not affect the activity of citrate synthase in this in vitro system. Ketogenesis can be described as an overflow of acetyl-groups: Ketone-body formation is stimulated only when the rate of acetyl-CoA production increases beyond the capacity for citrate synthesis. The interaction between fatty acid oxidation and pyruvate metabolism and the effects of long-chain acyl-CoA on mitochondrial metabolism are discussed. Ketone bodies which were generated during the oxidation of [1-14C] fatty acids were preferentially labelled in their carboxyl group. This carboxyl group had the same specific activity as the acetyl-CoA pool, whereas the specific activity of the acetone moiety of acetoacetate was much lower, especially at low rates of ketone-body formation. The activities of acetoacetyl-CoA deacylase and the hydroxymethylglutaryl-CoA (HMG-CoA) pathway were compared in soluble and mitochondrial fractions of rat- and cow-liver in different ketotic states. In rat-liver mitochondria, both pathways of acetoacetate synthesis were stimulated upon starvation or in alloxan diabetes. In cow liver, only the HMG-CoA pathway was increased during ketosis in the mitochondrial as well as in the soluble fraction.


The presence of 5 S RNA genes in two consecutive chromosome bands in Chironomus tentans.

It has earlier been shown by in situ hybridization that the 5 S RNA genes are located in region 2A of chromosome II in Chironomus tentans [1]. In the present study the resolution in this chromosome region could be considerably improved by using the inversion 1 A/9C of chromosome II, which carries region 2A, not in the usual position close to one end of chromosome II, but in the middle of the chromosome. It was then revealed that electrophoretically isolated 5 S RNA hybridized in situ with two adjacent bands in the region 2A. It was also observed that in heterozygotes harbouring one normal chromosome II and one with the inversion 1 A/9C, there is a close physical contact between the bands containing the 5 S RNA genes and the nucleolar organizer region.


The relationship between molecular size and electrphoretic mobility in agarose gels as determined from a single population of growing RNA molecules.

Growing RNA molecules obtained from a defined transcription unit, the 75 S RNA transcription unit in Balbiani ring  2 of Chironomus tentans, have been analysed by electrophoresis in agarose. This set of RNA molecules forms a broad distribution of molecules with sizes ranging from very small up to the final product of giant size corresponding to 75 S RNA. The relative molecular weights along the migration path were calculated from a simple activity relationship derived from the expected distribution properties of a single population of growing RNA molecules. It was concluded that there is a linear relationship between the molecular weight and the logarithm for the mobility.


Studies on chromatin. III. v-Bodies and free DNA in chromatin lacking histone H1.

Chromatin lacking histone H1 was found by electron microscopy to contain 'beaded' deoxyribonucleoprotein fibers. Adjacent beads are connected with each other by threads having a DNA-like appearance. At least some of threads are shown to be free DNA stretches. Average length and the content of free DNA stretches in histone H1-depleted chromatin depends on the ionic conditions of the medium. The appearance of individual beads is similar to that of chromatin subunits or v-bodies [1] in the original chromatin. Thus, in agreement with the X-ray data [2], histone H1 apparently is not required for maintenance of a compact state of DNA in chromatin subunits.


Analysis by two-dimensional polyacrylamide gel electrophoresis of the in vivo phosphorylation of ribosomal proteins derived from free and membrane-bound polysomes.

Analysis of in vivo phosphorylation of mouse liver ribosomal proteins was performed by two-dimensional polyacrylamide gel electrophoresis following 32P-injection. Our method is special and differs from other eukaryotic systems reported in that all proteins separated on the first dimension gel are completely solubilized, moving quantitatively to the second dimension gel. Only ribosomes from polysomes were used, ensuring analysis of ribosomes actively engaged in protein synthesis. We resolved sixty-five distinct proteins from ribosomes from membrane bound or free polysomes. In both cases radioautography revealed similar labeled patterns with one highly phosphorylated ribosomal protein and five marginally labeled spots.


Globin messenger sequences in nuclear ribonucleoprotein particles of avian erythroblasts.

Nuclear ribonucleoprotein particles were isolated from chick erythroblast nuclei. The particles were found to sediment as heterogeneous material. The major fraction of the rapidly synthesized RNP sedimented at 30 S, whereas the nuclei were found to contain a major, apparently more stable, RNP component sedimenting at about 40 S. The RNA isolated from the RNP particles was assayed for globin messenger activity in a wheat germ cell-free system. RNP sedimenting at relatively low S values (approx. 15 S) as well as RNP-particles of larger size code for globin. In addition to globin, the RNA of the particles codes also for other, not yet identified, proteins.


Studies on chromatin. IV. Evidence for a toroidal shape of chromatin subunits.

Electron microscopy of purified chromatin subunits (v-bodies [17] or nucleosomes [2] revealed a hole or at least a deep indentation in the globular nucleosome. A hole in the nucleosome was visualized using rotatory shadowing with platinum-palladium or more directly, by negative staining with sodium phosphotungstate. The diameter of the hole as measured from negatively stained samples is 10-25 A. The external diameter of the negatively stained nucleosome equals 75 +/- 15 A. Although most of the data are formally compatible with either a hole or a deep indentation in the nucleosome, some views of the particles in the negatively stained samples suggest a hole rather than an indentation. The possible significance of a toroidal structure of the chromatin subunit is discussed in the accompanying paper [3].


Studies on chromatin. V. A model for the structure of chromatin subunit.

A new model for the fine structure of the chromatin subunit (or 'nucleosome') is proposed. The model is based on previous experimental findings [1-14] and on two new suggestions, namely: (1) Eight histones form a toroidal-shaped histone coe of nucleosome and are arranged in the following ciruclar sequence: (see article). (2) DNA is 'kinked' around a toroidal-shaped histone core in a 'solenoid-like' mode, each kink occurring every 10 base pairs along DNA. The electron microscopic evidence for a toroidal shape of the nucleosome is described in the preceding paper [13]. The possibility of the existence of kinks in the DNA double helix was considered recently by Crick and Klug [14]. The proposed model of the nucleosome, being more detailed than earlier models permits us to explain in direct structural terms the yet unordered set of data bearing on the pattern of histone-histone interactions in chromatin, the results of a mild deoxyribonuclease digestion of DNA within the nucleosomal particle and also the quantitative data on the unwinding of the DNA duplex upon formation of the nucleosome.


On the nature of stability of the nucleotide base associates in water solution.

Expression for the long-range intermolecular interaction energy obtained by the perturbation theory method in atomic dipole approximation are used for the study of the nature of base interaction in stacked dimers formed of two neighbouring DNA base pairs. Base wave functions are computed by the CNDO-CI method. The inplane interactions are shown to give the dominant contribution into the DNA stabilization energy in vacuum. The estimations performed for the solvent effect on intermolecular interaction energy allowed us to draw conclusions about the decisive role of hydrophobic interactions in a base stacking.


[Thyroxine treatment in acute renal failure (author's transl)].

8 patients suffering from acute renal failure (shock kidney) with anuria extending over 3 to 5 days, were treated with L-thyroxine for 5 to 9 days (5-6 mug per kg body weight per day orally). Diuresis was restored within 34 to 46 hrs. Plasma levels of urea and creatinine decreased earlier and much more rapidly to normal than was to be expected from the natural history of the disease, indicating the prompt and extensive increase of glomerular filtration rate. Polyuria seemed less pronounced and also shortened as compared with the ordinary course of that form of sudden renal insufficiency. Obviously, the well-known diuretic response in the normal individual to high doses of thyroid hormones in not a factor in the induction of diuresis in acute renal failure. The tendency with L-thyroxine treatment to dilate the preglomerular arterial vessel is considered a consequence of the stimulation of sodium reabsorption in the upper nephron. High values of RPF and GFR, regularly observed in hyperthyroidism or after L-thyroxine administration, do not depend on any augmentation of cardiac output or on arterial hypertension, since such symptoms were missed in our patients and, in our view, such an interpretation is excluded by the very existence of the so-called autoregulation of the kidney which leaves RPF (and therefore GFR) independent of systemic blood pressure. The same intrarenal feed-back mechanism, normally adapting the glomerular blood supply to the resorptive capacity of the proximal-tubular epithelium (mediation via the juxta-glomerular apparatus), is responsible for the GFR- and RPF-raising effect of exogenous L-thyroxine in the intact kidney as well as in acute renal failure: both sodium reabsorption and sodium filtration are accelerated.--The special conditions under which L-thyroxine interferes with the pathogenetic process of acute renal failure, the latter being characterised by the critical insufficiency of tubular sodium reabsorption and therefore by preglomerular arterial constriction, is discussed on the basis of a new hypothesis concerning the thyrogenic nephrotropic effects in general.


[The difficulties to diagnose a clinical important defect of disaccharidases (author's transl)].

Duodenal mucosa of 100 infants and children was histologically investigated and the activities of dissaccharidases in the mucosa homogenate were determined. In addition, a combined xylose-lactose loading test was carried out and the behaviour of the stools under the test conditions was observed. The results were compared with regard to the clinical importance of an enzyme defect. The rise of xylose in blood gives no evidence for a defect of disaccharidases in the mucosa. The determination of the glucose maximum after a loading test with disaccharides seems rather to lead to false-normal results. The possiblity of a false-pathological interpretation by an exclusive determination of enzymes must be prevented by further gastroenterological examinations.


[Course and treatment of osteomyelitis in childhood (author's transl)].

In the years 1955-1972 132 children with osteomyelitis were treated in the Pediatric, Surgical and Orthopedic Department of the university of Kiel. There was no increase in the incidence of osteomyelitis during this period. Acute hematogenous osteomyelitis was diagnosed in 111 children, chronic hematogenous osteomyelitis in 11 children, traumatic and postoperative osteomyelitis in 10 children. Secondary chronic osteomyelitis occurred in 1 patient. Mainly staphylococci (in 90%) were the pathogenic bacteria, whereas haemophilus, pseudomonas, streptococci group A, E. coli and mixed infections occurred less frequently. In 17 of 111 patients with acute hematogenous osteomyelitis there were no roentgenological changes. Bacteriological investigations of blood and pus, and the antistaphylolysin reaction (repeated in the course of the disease) were helpful to establish the diagnosis in many cases. 107 of 111 patients with acute hematogenous osteomyelitis were cured (8 patients with defects). 4 children died in septic shock or because of complications (meningitis, pleural empyema, pneumonia). Bactericidal antibiotics in high dosage (penicillins, gentamicin) were superior to bacteriostatic antibiotics. Additional surgical treatment was necessary in 49 of 111 patients with acute hematogenous osteomyelitis. Recommendations for antibiotic therapy of osteomyelitis are given.


[Ten years' daily prophylaxis against rickets--review and outlook (author's transl)].

Ten years of experience with daily prophylaxis of rickets brought about isolated knowledge which corrected old mistakes and demands a revision of older attitudes towards the usual prophylaxis. Prophylaxis of vitamin D according to the most modern and reliable knowledge in the best way promotes the growth and mineralisation of the skeleton with dosages of 400 to 800 I.U. smaller or higher dosages are disadvantageous. By observing the above given dosage, rickets and hypercalcaemia are rare and only conceivable under special pathological conditions. The diagnosis of beginning rickets must be well known, otherwise unspecific symptoms of rickets may induce the administration of unnecessarily high amounts of vitamin D. The symptoms of rickets show a gradual increase: the increase of serum alkaline phosphatase precedes the clinical and radiological symptoms. The reliable radiographic deformities of the hand can first be seen at the Ulna, then at the Radius and later at the secondary centers of Metacarpals. Among the relatively reliable clinical symptoms there its first the rosary later the Marfan-sign and eventually the deformation of the long bones. For infants protected by vitamin D, craniotabes as a sign of rickets is completely unreliable as well as the Harrison grooves and rachitic kyphosis. If one observes all these rules and rachitic kyphosis. If one observes all these rules and criterions vitamin D is as reliable in the prophylaxis as in the therapy of vitamin D deficiency rickets.


Epidemic lead absorption near an ore smelter. The role of particulate lead.

Blood lead levels were determined on a random sample of persons in all age groups living near a lead-emitting smelter in El Paso, Texas. A blood lead level of greater than or equal to 40 mug per 100 ml, which was considered indicative of undue lead absorption, was found in 53 per cent of the children one to nine years old living within 1.6 km of the smelter and in 18 per cent of those from 1.6 to 6.6 km; beyond that distance in older persons levels were lower. Children in the first 1.6 km with blood levels of greater than or equal to mug per 100 ml were exposed to 3.1 times as much lead in dust as children there with lower blood values (6447 vs 2067 ppm). There was also airborne lead exposure (8 to 10 mug per cubic meter, annual mean). Paint, water, food, and pottery were less important as sources. The data suggest that particulate lead in dust and air accounted for most of the lead absorption in El Paso children. The smelter was the principal source of this lead, especially within 1.6km of itself.


Use of platelet aggregometry in selection of compatible platelet donors.

To determine if platelet aggregometry was useful in selecting compatible platelet donors, six patients who had become refractory to random platelets were studied. Serum from the patient was added to citrated platelet-rich plasma from the prospective donor in a standard aggregometry system. Serial aggregometry studies revealed no platelet aggregation unless the refractory state had been reached. At that time positive aggregation occurred only between the poorly matched pairs. A correlation between platelet aggregation and HL-A histocompatibility was noted. Family members with negative aggregation were selected as donors, and their platelets were able to provide consistently satisfactory increments in the platelet count of the recipient who was refractory to random donors. In contrast, platelets from family members who exhibited positive aggregation failed to do so. These findings suggest that platelet aggregometry can be used to select compatible platelet donors.


Total cortisol in amniotic fluid and fetal lung maturation.

Total cortisol was determined by radioimmunoassay in 48 samples of amniotic fluid obtained at various stages of normal pregnancy. Before the 34th week, all cortisol levels were less than 40 ng per milliliter. At 35 to 40 weeks the mean value was 2.4 times higher than that at 20 to 34 weeks. In pregnancies greater than 40 weeks, a further increase in total amniotic-fluid cortisol was observed, and values greater than 120 ng per milliliter were found only in patients of this group. A good rank correlation between cortisol and lecithin/sphingomyelin ratio was found in 43 samples (r = 0.83, p less than 0.001). No respiratory-distress syndrome of the newborn occurred when total amniotic-fluid cortisol was greater than 60 ng per milliliter (16 patients). Total amniotic-fluid cortisol may reflect initiation of fetal lung maturation, and may help identify pregnancies with a gestation period of over 40 weeks.


Licensure, competence, and manpower distribution. A follow-up study of foreign medical graduates.

Medical statistics report United States medical graduates licensed at higher rates than foreign medical graduates. This difference is often interpreted to show greater medical competence of United States graduates. This study questions this interpretation by analyzing 1971 licensure rates for both groups who had been interns and residents in 1963. We found that factors unrelated to competence--namely, visa-citizenship status and state of examination--are associated with holding a license. Moreover, quality of medical education is not an accurate predictor of licensure. It follows that the use of licensure rates as measures of medical competence distorts understanding of the quality of medical care in the United States. More probably, the difficulties in obtaining medical licensure experienced by foreign graduates result from the use of such graduates to relieve specific medical-manpower shortages.


Linkage disequilibrium between H-2 and t complexes in chromosome 17 of the mouse.

Mice with t factors belonging to the same complementation group carry similar, if not identical, H--2 haplotypes although these factors were derived from widely separated geographical areas. This association between t and H--2 complexes suggests more than a casual relationship between the two complexes, at least at the population level.


Statistical mechanics and topology of polymer chains.

The statistical-mechanical treatment of closed polymer chains based on algebraic topology is proposed. Using the Monte-Carlo method numerical results were obtained for the probability to knot formation during random closing of polymer chains of different length. For very rigid chains such as DNA double helix the probability of knot formation is rather great. Topological restrictions in a system of two polymer chains are shown to lead to a specific topological interaction between them.


Heat resistance of bacterial endospores and concept of an expanded osmoregulatory cortex.

The extreme resistance of bacterial endospores to heat may result from dehydration of the central protoplast brought about and maintained by osmotic activity of expanded electronegative peptidoglycan polymer, and positively charged counterions associated with it, in the surrounding cortex. The cortex may thus act as a specialised osmoregulatory organelle. Changes in the environment which would be expected reversibly to affect osmotic properties alter the heat resistance of spores.


As a guest of the Chinese Academy in Peking and Shanghai.

At the invitation of the Chinese Academy of Sciences (Academia Sinica) the President and seven members of the Max-Planck Society visited the People's Republic of China in April 1974. Their aim was to become acquainted with the scientific activities at the institutes of the Academy in Peking and Shanghai. They also established contact with the University of Peking. In the course of the visit, the Academia Sinica and the Max-Planck Society agreed to have a regular exchange of scientists in future.


Choleresis and hepatic transport mechanisms. II. Influence of bile salt choleresis and biliary micelle binding on biliary excretion of various organic anions.

To investigate, whether binding to micelles has a function in hepatic transport, biliary excretion of three organic anions, phenolphthalein-beta-D-glucuronide (PG), dibromosulphthalein (DBSP) and indocyanine green (ICG) was studied in rats during saline, taurocholate or dehydrocholate administration. Taurocholate causes a weak choleresis with formation of biliary micelles, dehydrocholate a strong choleresis with little micelle formation. The two bile salts did not uniformly influence biliary excretion of the organic anions: biliary excretion of ICG (12.9 mumoles/kg) and DBSP (75.0 mumoles/kg) was stimulated by both bile salts: ICG excretion most pronounced by taurocholate and DBSP excretion most strongly by dehydrocholate. Biliary output of PG (25.8 and 200 mumoles/kg) was not stimulated by bile salt administration. Binding of PG, DBSP and ICG to biliary micelles was studied in sedimentation experiments by ultracentrifugation. PG, DBSP and ICG in bile showed a similar sedimentation pattern as 3H-taurocholate in bile, which indicates an association of all three anions with biliary micelles. Thus, the influence of bile salts on biliary transport of organic anions varies with the compound studied and the bile salt used, effects which cannot be explained by differences in binding to biliary micelles.


Inhibition of the action of bradykinin and acetylcholine on paravascular pain receptors by tetrodotoxin and procaine.

Intra-arterial injection of the algogens bradykinin and acetylcholine into the isolated perfused rabbit ear connected to the body by its nerve only elicit a dose-dependent reflex fall in blood pressure. Procaine and tetrodotoxin were used to investigate whether bradykinin and acetylcholine exerted their algesic effect via different types of nerve fibers. Procaine reduced the effect of bradykinin and acetylcholine to a very similar degree. Tetrodotoxin reduced the effect of bradykinin slightly more than that of acetylcholine. It is assumed that on the whole bradykinin and acetylcholine act via the same nerve fibers but bradykinin seems to have some more affinity to fibers with a fewer number of sodium channels than acetylcholine.


Stimulation of beta-adrenergic receptors in the pineal gland increases the noradrenaline stores of its sympathetic nerves.

The administration of isoproterenol decreases the level of serotonin in the rat pineal gland and at the same time it increases pineal noradrenaline. These effects depend on the stimulation of a beta-adrenergic receptor because they are blocked by pretreatment of the animals with propranolol; this drug by itself does not modify either serotonin or noradrenaline levels in the pineal. The elevation of noradrenaline produced by isoproterenol is selective for the pineal because it is not observed in the salivary gland innervated by postganglionic adrenergic fibers from the same origin as pineal nerves. Pineal serotonin is stored in equilibrium in two compartments, i.e., the parenchymal cells and the adrenergic nerves and thus is most probably reduced in both sites. Since noradrenaline and serotonin are detected in pineal nerve vesicles and may coexist in them, the diminution of intravesicular serotonin, by making more storage sites available, probably determines the selective increase of pineal noradrenaline. A similar modification in the ratio of intravesicular amines as a result of the physiological stimulation of pineal beta-adrenergic receptors by the adrenergic neurotransmitter may explain some of the changes observed in the content of pineal amines.


Muscarinic inhibition of potassium-induced noradrenaline release and its dependence on the calcium concentration.

1. Noradrenaline release from the isolated rabbit heart was evoked by perfusion with a medium containing 135 mM potassium and 17 mM sodium ions (high K+-low Na+). 2. The noradrenaline output in response to high K+-low Na+ was dose-dependently decreased by methacholine (0.625-320 muM) and this effect was reserved by atropine 1.44 mM. 3. Lowering the calcium concentration of high K+-low Na+ from 1.8-0.1125 mM decreased the noradrenaline output by 85%. The effect of methacholine, expressed as % inhibition of noradrenaline release, was potentiated by lowering of the calcium concentration. 4. Both at normal and lowered calcium concentrations the inhibitory action of methacholine was larger from 0-5 than from 5-10 min after perfusion with high K+-low Na+. 5. Perfusion of hearts with media containing high K+-low Na+ or normal K+-low Na+ caused noradrenaline outputs somewhat smaller than those after high K+-low Na+. The release from 0-5 min was both calcium-dependent and inhibited by methacholine. 6. High K+ and/or low Na+ solutions caused an increase in coronary perfusion pressure which was little affected by the noradrenaline released simultaneously. 7. It is concluded that activation of muscarine receptors at the terminal adrenergic fibre decreases the availability of calcium for transmitter release.


Phencyclidine and ketamine: comparison with the effect of cocaine on the noradrenergic neurones of the rat brain cortex.

In slices of rat occipital cortex, the influence of phencyclidine and ketamine on the accumulation of 3H-noradrenaline and the subsequent outflow of tritium was investigated, and was compared with the effect of cocaine.--All three drugs inhibited the accumulation of tritium during incubation of the slices with 3H-noradrenaline. Phencyclidine was slightly, whereas ketamine was much less effective than cocaine.--All three drugs accelerated the spontaneous outflow of tritium from slices preincubated with 3H-noradrenaline. The acceleration caused by low concentrations probably reflects an inhibition of the re-uptake of spontaneously released 3H-noradrenaline; in addition, high concentrations (10(-4) M phencyclidine, 3 X 10(-4)-10(-3) M cocaine and 10(-3)-3 X 10(-3) M ketamine) appear to release tritiated compounds from the neurones. The distance between uptake-inhibiting and releasing concentrations was much greater for cocaine than for phencyclidine and ketamine.--All three drugs enhanced the overflow of tritium evoked by electrical field stimulation. The increase probably reflects an inhibition of the re-uptake of released 3H-noradrenaline; in addition, phencyclidine appears to enhance the release of noradrenaline per pulse.--The actions of phencyclidine and ketamine on central noradrenergic neurones may contribute to the characteristic psychotropic side-effects of these general anaesthetics.


On the influence of chloramphenicol on the induction of lung adenomas by urethane in mice.

It has been shown by a number of authors that the antibiotic chloramphenicol (CP), produced in the USSE under the name of levomycetin, had considerably inhibited the growth of liver tumors, induced by various carcinogenic compounds [3,7,8,21]. Moreover, it has been found by ourselves and other authors that CP greatly reduces the toxic effect of carcinogenic polycyclic hydrocarbons on cultures of embryonic fibroblasts of mice and the adrenals of rats [5,9,20,23]. As the full extent of the antiblastomogenic activity of CP has so far not been studied, it was important to elucidate its influence on other groups of chemical carcinogens. In experiments described in the present paper we have investigated the influence of CP on the incidence of lung adenomas in mice after administration of urethane.


On the enhancement of oncolytic effect of laser radiation by means of fast electrons.

Non-inbred albino mice were inoculated subcutaneously or intraperitoneally with Ehrlich carcinoma cells pre-exposed in vitro either to different doses of laser radiation or to fast electrons alone, or to both agents. The statistical data on the latency of tumors, their weights (subcutaneous inoculation) and the survival time in group "laser + electrons" (intraperitoneal inoculation) were found to differ considerably from those for the mice inoculated with the ascitic tumor cells pre-exposed either to laser radiation or fast electrons alone. The enhancement of the oncolytic effect of laser radiation combined with fast electrons is gained through the addition of the effects of each of these agents.


A freeze-etch study of occurrence of nuclear pores in normal and tumor cells.

A freeze-etch study of nuclear pores performed on human lymphocytes, epidermal and corneal cells, on hamster fibroblasts, on rat and hamster sarcoma cells and cells from a human malignant melanoma, revealed that the frequency of pores as a part of very important biological cellular structures increases in proliferating cells, and that there is a statistically significand difference between normal and tumor cells. Once produced the pores maintain and their frequency practically does not change. The pores are randomly distributed on the nuclear envelope. Markham rotating method revealed an octa- or nonaedric outside shape of the pores and round inner margin with eight or nine granules. One bigger granule was found in the center of the pores. The granule is with a great probability filamentously attached to the margin of the pore. Fibrillar structures running to the pores on inner surface of nuclear envelope as far as the chemical composition of granules need special cytochemical examinations.


Changes in nucleolar number of ascites tumor cells treated with actinomycin D.

In the nuclei of Ehrligh and NK/Ly mouse ascites tumor cells the number of nucleoli varies between 1 and 10. The average nucleolar number is 3.3 +/- 1.3 for both tumors. This value as well as the distribution of nuclei with various nucleolar number are parctically constant between the 5th and 15th day of transplantation. The nucleolar changes resulting from the effect of a single 200 mug/kg i.p. dose of actinomycin D take place in two phases, almost in the same manner for both tumors. Within 24 hours the mean nucleolar number decreases by about 20 percent accompanied by a diminution of size of nucleoli. 15 to 20 percent of nuclei does not contain real nucleoli but has small spots showing nucleolus-like staining ("scattered" nucleolar cells). The second phase is characterized by a 25-35 percent increase in the mean nucleolar number followed by a nucleolar enlargement. The process returns to normal within 6-7 days.


Hypoxanthine guanine phosphoribosyltransferase (HGPRT) activity in hybrids derived from HGPRT+ and HGPRT- mouse cells.

By utilizing the selection system, a population of hybrid cells with the gene coding HGPRT and sensitive to 8-azaguanine (8-AG) was isolated from a mixed population of hybrid cells derived from malignant diploid HGPRT+ mouse lymphosarcoma cells (LS/BL) and L cells resistant to 8-AG (HGPRT-, R-AG/20 strain). During back-selection of this hybrid population , cultivated in vitro, HGPRT- negative fractions of the cell population, resistant to 8-AG, appeared in a high frequency. As a rule, the telocentric chromosomes (or chromosome), originated from the HGPRT+ parental cells (LS/BL), were lost in these cells. The X chromosome of the LS/BL cells coding the HGPRT enzyme was not present in all cells of the hybrid HGPRT+ population. Hence it is assumed that the fusion of HGPRT+ (LS/BL) and HGPRT- (R-AG/20) cells resulted in a reexpression of the HGPRT activity from the R-AG/20 parental cells.


Heterogeneity of human adenocarcinomas of the colon and the stomach as regards sensitivity to cytostatic drugs.

In the present paper a test model was used to examine if human adenocarcinomas of the colon and the stomach are heterogenous as regards the sensitivity to cytosine arabinoside, melphalan, vinblastine sulphate, amethopterin and 5-fluorouracil in vitro. The effects of the five drugs were measured as the differences in incorporation of tritiated thymidine and deoxyuridine in drug-containing tubes and control tubes. It was found, that different parts of eleven colon and five stomach cancers differ significantly in their sensitivity to the same cytostatic treatment in vitro.


Occurrence of paraproteins in melanoblastoma.

Besides paraproteins in melanoblastoma, the study also follows the quantitative values of immunoglobulins during the course of the disease. According to the immunoglobulin values, the patients may be divided into two groups: those with a striking decline of IgG and a simultaneous generalization of the process; those without any significant alteration in the immunoglobulin values, but with paraproteins. The presence of the latter, particularly of gM became reflected in a stagnation of the entire process. Immunological results of sera from patients surviving 5 years, bear out this finding.


Atopy and cancer.

Malignancies were observed less frequently in the closest relatives of the patients suffering from hay fever with the most proved hereditary liability of atopy than in the relatives of control groups.


Vitiligo and malignant melanoma.

Six patients with vitiligo and malignant melanoma are reported. The relationship between vitiligo and melanoma seems to be a firm one. This process is supposed to represent an expression of induced autoimmunity.


Main principles of the organization of cancer control in USSR and selected data on cancer incidence.

The main principles and the structure of the cancer control organization in the USSR are described. The trends in the incidence of selected forms of malignant tumors and regional differences in USSR are documented with statistical data.


On the so-called MAC (Maximal Allowable Concentrations) for carcinogenic hydrocarbons.

The paper deals with some results of work done in the USSR to establish maximal allowable doses (MAC) for the carcinogenic hydrocarbon benza(a)pyrene in human environment. At the same time it is a brief review of some discussions on this item which took place in USSR and on the international level.


Electrochemical properties of polycyclic compounds studied by the polarographic method in anhydrous systems. II. Polarographic study of carcinogenic nitrogen compounds in dimethylformamide and comparison of half-wave potentials with quantum-chemical calculations of molecular orbitals.

Reduction of half-wave potentials and the mechanism of reduction of 20 polycyclic nitrogen compounds were studied on a dropping-mercury electrode in anhydrous dimethylformamide using tetrabuthylammonium perchlorate as the supporting electrolyte. The measured values of the reducing half-wave potentials of the polycyclic aza-compounds were compared in view of their carcinogenic activity with parental carcinogenic polycyclic hydrocarbons. Electrochemical measurements have confirmed that the size of the shift in reducing potentials towards the more positive values and the decline of the carcinogenic activity generally depend on the number and position of the nitrogen atoms in the molecule of the polycyclic nitrogen compound under study. At the same time, the experimental electrochemical measurements were matched with the results of the quantum-chemical calculations of the molecular orbitals and this showed a good agreement to exist between the values of reducing half-wave potentials obtained by experimental measurement and by calculation.


Incorporation of exogenous DNA and its localization in the chromosomes of the host cell.

Incorporation of isologous 3H-DNA of exogenous origin into chromosomes of the L cells was investigated by means of autoradiographical technique. It was shown that during short time intervals of incubation of 3H-DNA with the host cells (1--3 hr), nearly double quantity of the mitoses was labelled, when compared with 3H-TdR used as a control. During longer time intervals, no difference between number of the mitoses labelled with 3H-TdR and exogenous isologous 3H-DNA was observed.


Methotrexate and folic acid effect in normal and sarcoma 180 bearing mice.

Four- to six-fold surplus of folic acid in oral application reduced the toxicity of methotrexate administered repeatedly in high therapeutic doses. The therapeutic effect of methotrexate applied intraperitoneally to mice with the ascitic S 180 sarcoma, as measured by their survival, can be reliably demonstrated; moreover, the survival can be prolonged by adding folic acid into drinking water. In the solid form S 180 the intraperitoneal administration of methotrexate did not significantly reduce the weight of tumors of treated aminals as compared to untreated animals. The maximum tolerated dose of methotrexate was lower in animals with the ascitic tumor than in non-tumorous animals.


The influence of N-(2-hydroxyethyl)-palmitamide on virus-induced sarcomas in chickens and Rauscher leukemia in mice.

The effect of N-(2-hydroxyethyl)-palmitamide (PEA), an active endogenous compound, which may be useful in preventing virus infections of the respiratory tract, was studied in chicken sarcoma RBA-34 and mouse Rauscher leukemia. The experiments showed that PEA did not influence the induction, development and severity of experimental oncogenic diseases investigated.


Soluble melanoprotein of tumor origin.

The procedure for isolating soluble melanoprotein from human malignant melanoma was described. Electron microscopy confirmed the absence of any contaminating organized particles. The melanoprotein was brown hygroscopic substance with 8.8% of melanin, easily soluble in water. The solution revealed general absorption with a shoulder at 280 nm. Chemical composition was typical for a melanoprotein complex with characteristic high sulphur content (2.1%) and abundance in zinc (210 mug Zn/g dry sample). Sedimentation and electrophoretic properties indicated relative homogeneity. Similar substance could also be isolated from Harding-Passey mouse melanoma. Such soluble melanoproteins have been needed for their broad exploitation in tumor immunology.


Level of SH groups in paraproteinemic sera.

SH groups were determined in the sera of 131 subjects with paraproteinemia and in 100 healthy controls of a corresponding age. Significant decrease in the amount of SH groups in the serum was observed in IgG and IgM paraproteinemias.


Perspectives in scintigraphic detection of gynecologic tumors using labeled estrogen.

After having succeeded in imaging the prostate with 131I-Estracyt in our former experiments we tried to use the same method for scanning gynecological tumors. In about fifty per cent of the patients (34 cases) there was a convenient accumulation of the labeled estrogen, first of all the adenoid tumors, myomas of uteri and carcinomas can take up this radiopharmacon. Though the number of cases is rather low it is to be concluded that tumors of hormonal dependence can be scanned using estrogen hormon. Further investigations are in progress.


Serum immunoglobulin levels in cancer patients. I. Serum immunoglobulins and primary tumor localization.

A comparison was made between the mean values of immunoglobulin IgG, IgA and IgM in patients sera in various primary localizations of malignant tumors. The values ranged generally above the upper limit stated for the so-called healthy population, the highest being in Ca of kidneys of Grawitz type, Ca laryngis and Co bronchogenes. In the IgG class higher values appeared mainly in Grawitz tumor, however, a certain elevated level with respect to the other groups of malignancies occurred also in Ca vesicae urinariae and in Ca bronchogenes, but the differences are without statistical significance. No changes were observed in the IgM group.


A definition problem in cancer metastasis.

Orthodox definitions of cancer metastasis state that deposits which qualify for this name are those found distant from the primary tumor. This qualification has led to considerable confusion in the literature. A study of the etymology and pathology of metastasis leads to the conclusion that the essential feature is transportation and not distance. Accordingly, metastasis should be defined simply as "the formation of another growth in any site following the transportation of tumor cells from the initial growth". This definition will probably improve knowledge of the statistics of cancer metastasis.


Large-scale screening of the population of early detection of malignant tumors in the USSR.

Some selected data on cancer statistics in the USSR and results of the nationwide cancer screening activities are presented. The usefullness of some new methods in prophylactic examination is discussed.


Stimulation of rat liver regeneration by chloramphenicol.

The administration of chloramphenicol in high doses (300 mg per kg body weight in 6 hour intervals) to partially (70%) hepatectomized rats resulted in a marked stimulation of liver regeneration.


Effects of long-term low protein diet on albumin metabolism in chronic uremia.

The effects of long-term low protein diet on albumin metabolism of uremic patients were evaluated. Studies were performed on 62 patients divided into two groups depending on the duration of the diet (35 subjects from 6 to 30 days, 27 subjects from 6 months to 5 years). All patients received a diet containing at least 20 g of high biological value proteins per day. Albumin catabolism and distribution were measured by the two-tracer technique, after simultaneous i.v. injection of 131I-human serum albumin and of free 125I-iodide. Albumin synthesis was directly determined in 10 patients by two tracers, 14C-carbonate and 131I-albumin, according to the xanthydrol technique for specific activities of urea and albumin guanido carbon in plasma. The main features of albumin metabolism observed in both groups studied were: normal intravascular albumin mass, marked reduction of extravascular and total albumin pools, with proportionally reduced catabolism. No significant turnover difference was found between the first group and the patients on diet from 0.5 to 5 years, thus suggesting that dietary treatment per se is not responsible for the albumin depletion observed in chronic uremia.


Autonomic function in patients with chronic renal failure on intermittent haemodialysis.

The cardiovascular responses to the Valsalva manoeuvre and sustained handgrip were measured in 26 patients with chronic renal failure treated with intermittent haemodialysis. Twelve (50%) had an abnormal Valsalva response and ten (45%) had an abnormal handgrip response. There was a reduction in the beat-to-beat variation of heart rate at rest in those patients who had abnormal Valsalva manoeuvres, independent of age or the resting heart rate. It is concluded that autonomic nerve fibres may be damaged in patients with chronic renal failure on intermittent haemodialysis in the absence of symptoms of autonomic neuropathy. These studies suggest three simple ways of testing autonomic function in haemodialysis patients which could routinely be performed to detect patients at risk of developing an abnormal reaction to volume depletion during haemodialysis.


Chronic haemodialysis using saphenous vein fistulae.

Since 1969 four leg fistulae and 14 arm fistulae using the saphenous vein have been constructed in chronic haemodialysis patients. The operative procedures are described and the results show that these fistulae are an excellent alternative when the construction of Cimino-Brescia fistulae becomes impossible. Of the 14 arm fistulae, nine are still patent and in use, three have thrombosed and two patients have died of unrelated causes with the fistulae intact.


[Giant bilateral parasagittal fronto-parietal hyperostosing meningioma. Clinico-therapeutic considerations in a particular case].

A case of giant bilateral parasagittal fronto-parietal hyperostosing meningioma is discussed. Its weight was 910 gr., it was removed in two operations and finally an acrilic cranioplasty was done. The patient pas followed for 24 years and no neurological sequelae have been found. He is still working as a farmer. The author reviews the relevant literature and discusses the differential diagnosis.


[Catheterization of the sylvian aqueduct. Its present role in the surgical treatment of sylvian aqueduct stenosis of PCF tumors, and of syringomyelia].

Catheterization of the Sylvian aqueduct is an elective technique for the surgical treatment of syringomyelia with Chiari's defect. It completes efficiently the decompression of the defect and makes possible exclusion of the IV th. ventricle and of the ependymal orifice of the syringomyelic cavity. The operative results appear thus more regular and more stable than those obtained with simple decompression. Intubation of the aqueduct has opportune indications in the treatment of tumors of the P.C.F. in the case of incomplete exeresis or when a secondary blockade of the spinal fluid is to be feared. Intubation of the aqueduct constitutes a useful complement for those patients treated during childhood for hydrocephalon with sylviduct stenosis and that evidence lately a poor functioning of the ventricular tube with ventricles exhibiting a reduced volume and hypereacute accidents of intra-cranial hypertension.


[Neurosurgery in strict asepsis. First trials in an operation isolator during the placement of 10 ventriculoperitoneal derivations].

Authors report on a series of ten ventricular-cardiac or peritoneal derivations performed under operative field isolation, air-tight and sterile enclosure that makes possible to perform surgery under strict aspsis. The first results compared with those mentioned in the medical literature, let foresee a fall in the occurence of post-operative infections. The technique is adaptable to neurosurgery and does not complicate the operative process.


[Comparative study of complications observed in ventriculo-atrial and ventriculo-peritoneal derivations. Apropos of 106 cases].

In this study that concerns 106 cases, authors insist on the frequency of the infectious and mechanical complications. They make a review of the etiologies and of the various materials used by themselves and study successively the mechanical, infectious and mixed complications, sector by sector. They drive, at each level, conclusions concerning the results with their subsequent lessons. Having recalled, in short, the principles of supervision of any child bearer of a "valve", they conclude by developing their present idea of the "ideal derivation" by on the base of the material submitted to experimentation. They insist on the value of the ventricular-peritoneal derivations in the new-born.


[Arteriography in pituitary tumors. Pseudotumoral aneurysm].

In the presence of any "expansive process" of the sellar region, one must recall that in I % of the instances there may be the possibility of a pseudo-tumoral aneurysm. In a number of cases, neither the clinical study, nor the roentgenologic and tomographic balance of the sellar region, will allow to differentiate an aneurysm and a pituitary tumor. Only the carotid arteriography makes possible a diagnosis of certainty under the condition to make a bilateral study (compression being insufficient). This kind of investigation will therefore be systematic, particularly in those cases in which a sphenoid route of access is considered for the management of the expansive process of the sellar region.


[Radicular sciatica due to an intrarachidian mucoid cyst in a child].

In a 15 years old boy, a sciatica appears, at surgery, to be related with the compression of one SI root, and into the epidural space, by a pseudo-cyst, limited by a connective wall and containing a mucoid substance. Authors note the similarity of this lesion with the para-synovial cysts of extremities and with the colloid degeneration of the tunica adventitia of some vessels or of the connective sheath of the peripheric nerves. To their knowledge, such formations with mucoid content, at the spinal level, have only been reported on in the adult subject; they insist therefore on their patient's young age.


Serial angiotomography in supratentorial tumors.

Serial angiotomography is a selective investigative method which contributes to exact differential diagnosis and localization of the tumor. With the localization near the midline of the supratentorial tumors it can occasionally be the only arteriographical method which will bring a definite result. With basal processes the relationship of the tumor to the bones and dura can be demonstrated more accurately. In addition angiotomography brings new haemodynamic aspects with regard to the circulation time and intensity of the tumor stain of glioblastoma.


Pineal veins in vertebral angiography.

Angiographic patterns of pineal veins in normal and pathological conditions are examined. The diagnostic value of these veins for midline growths is limited owing to their inconstant visualization, multifarious angiographic patterns and minute size. With this in mind, greater significance of classical displacements of the internal and basal veins is outlined.


A practical approach to the phlebographic study of the lateral cerebral ventricles.

The main anatomical features of the subependymal veins of the lateral ventricles are summarized. The important role of the subependymal veins for the study of the size and shape of the lateral ventricles is outlined. The most typical modifications which occur in cases of ventricular enlargement or ventricular deformation due to cerebral tumors are illustrated. The importance of the criteria to be followed for the exact identification of the lateral and medial veins to each ventricular portion are stressed. This is possible thanks to the combined study of the phlebograms in the right angled projections.


Dissecting aneurysm of the petrous portion of the internal carotid artery. Case report and review of previous cases.

A "spontaneous" dissecting aneurysm of the petrous portion of the right internal cartoid artery in a 60 year old man was demonstrated angiographically. It showed a typical double lumen which is rarely demonstrated by angiography. It was probably of atherosclerotic origin. In addition, a survey of the positions and angiographic characteristics of the 29 traumatic and "spontaneous" dissecting aneurysms of the common and internal carotid arteries found in the literature is presented.


Outlet obstruction of the fourth ventricle in sarcoidosis.

Central nervous system sarcoidosis and its varied neuroradiological manifestations are reviewed. Two cases of mechanical obstruction secondary to sarcoid granulomata at the outlet of the fourth ventricle are described.


Hemoclip-gelfoam emboli in the treatment of facial arteriovenous malformations.

Hemoclip-gelfoam emboli are more efficient than plain gelfoam for therapeutic embolization of arteriovenous malformations because of their weight and length. Additional advantages are ease of handling, fluoroscopic monitoring and suitability for conventional neuroradiological catheters.


Catheter embolization of intracranial arteriovenous malformations as an aid to surgical excision.

Eleven cases of large arteriovenous malformations (AVMs) were treated from February 1974 to March 1975 by embolization via the internal carotid artery with beads, and 8 of them had subsequent surgery. There was one post-operative death. A second embolization was performed in 3 patients with further diminution of vascularity. Embolization improved the perfusion of the adjacent normal brain and was an important preoperative procedure which facilitated the operation and made it surgically feasible to operate on some cases which might otherwise have been considered to be inoperable.


Rotational cerebral roentgenography. I. Evaluation of the technical procedure and diagnostic application with model studies.

A rotational cerebral roentgenographic technique with a 70 mm camera is elaborated in model studies of the plain and cerebrovascular system. The tube-camera-unit rotates in a semicircle in 5 to 6 seconds around a skull placed in the isocentrum. All special projections of the skull are obtained routinely during one rotational manoeuvre, and intracranial calcifications, foreign bodies and abnormalities of the calvarium are demonstrated sequentially in oblique or tangential views. Studies of the basal cerebral arteries have shown that the localization, size and configuration of arterial aneurysms and stenoses can be demonstrated reliably without changing the position of the skull. An exposure frequency of 6/sec results invariably in excellent stereoscopic views. The diagnostic value and applicability of this technique is discussed.


[Mortality of cardiovascular diseases and hardness of the water in Turin in 1972 and 1973: preliminary results of an epidemiological survey].

An assessment is made of the possible relation between deaths due to cardiovascular disease and hardness of the water in Turin during 1973 on the basis of a division into areas with different degrees of hardness and cardiovascular mortality.


[Anomalous immunoelectrophoretic behavior of ceruloplasmin in severely burned patients].

Laurell's two-dimensional technique was employed in a study of the immunoelectrophoretic behaviour of caeruloplasmin in 10 major burn cases. A double peak was noted throughout the entire course. The second peak disappeared on recovery whereas it persisted and was well marked in the case of those who died. It is suggested that this pattern reflects the severe liver damage sustained by burn patients.


[Significance of lactate dehydrogenase levels in the fluid and serum in the diagnosis of pleural effusions].

Lactic acid dehydrogenase (LAD) levels were determined in 82 pleural effusion liquids and the respective blood samples from 58 patients. Effusions were classed as transudates and exudates on the basis of clinical and laboratory data. The 16 transudates had absolute protein levels of less than 3 g/100 ml and a liquid: serum protein ratio below 0.5. LAD values were below 100 mU/ml and the liquid: serum ratio was less than 0.33, whereas both these levels were exceeded in the case of the 66 exudates. The liquid: serum LAD ratio is better suited for the differentiation of transudates and exudates, particularly if it is related to the liquid: serum protein ratio. Neoplastic effusions have the highest absolute LAD values and liquid: serum LAD ratios. Slighter lower values are noted in TB. Taken in conjunction with other parameters, liquid and serum LAD levels enable a transudate to be distinguished from an exudate and assist in aetiological diagnosis.


[Modified graphic solutions for determination of the K coefficient in the rapid intravenous hyperglycemia test].

Standard and modified graphical solutions for K rate determination of intravenous glucose tolerance test are presented and discussed. Some practical notices are collected. The procedures proved useful for the diagnosis of subclinical diabetes according to the WHO.


[Pathogenesis of cerebral hemorrhage considered in the light of objective lesions in the arteries of the brain (in 226 cases studied by autopsy)].

Conclusions drawn from the post-mortem examination of 226 subjects who died of cerebral haemorrhage are presented. There were slightly more women than men (53%) in the series. Arterial hypertension (68%) was the main cause of death, while renal disease, leukaemia, angioma of the pons, and embolism due to bacterial endocarditis were also observed. The most frequently noted sites are listed. Since cerebral haemorrhage follows the rupture of one or more already damaged deep arteries, as assessment was made of the part played by vascular lesions. 13 cases due to leukaemia and 35 to rupture of aneurysms of the polygon of Willis were discarded. In only 20 cases out of 138 in which convincing microscopic evidence of the vascular situation could be obtained was there an absence of significant alterations. The remaining cases consisted of serious hyalinosis (56%), fibrinoid necrosis (13%), and siderocalciosis (12%). An account is also given of the special pathogenetic conditions applicable to cerebral haemorrhage associated wtih serious gastrointestinal haemorrhage or recent myocardial infarct.


[The anatomo-radiological syndrome of the empty sella turcica].

The anatomo-radiological picture of "empty sella" is defined. Cisterno - pneumo - encephalographic investigation for correct diagnosis is indispensable every time standard radiography of the cranium shows enlarged sella turcica in subjects presenting poorly characterized polymorphous symptomatology. This rare syndrome is encountered prevalently in generally obese females of middle age. A case is presented.


[Directional hearing, temporal order, auditory pattern: new methods of symptomatological study of the central auditory pathways. Physiological data].

New tonal audiometry tests: directional hearing, temporal order and hearing pattern were experimented in 50 healthy subjects with normal hearing. These tests involve the ability to integrate and elaborate complex tonal stimuli at the central pathway level, in addition to the perception of tonal stimuli. The method and apparatus employed are described. In spite of the complexity of the latter, the tests are rapid and easily understood by the subject. They are thus suitable for extension from the laboratory into clinical practice. Their use has shown that the central routes display a variety of capabilities at different levels, of both dynamic and static type; the former are evaluated by the directional hearing test, the latter by the other two tests.


[Disadvantages of mechanical valve prostheses in the surgical treatment of mitral insufficiency].

Various disadvantages may be encountered with mechanical valve prostheses in the surgical management of mitral insufficiency; namely: 1) Early and secondary disinsertion; this is nearly always partial and is usually accompanied by haemolytic anaemial. 2) Infection with nil response to antibiotics. Death from septicaemia may be rapid. Replacement of the prosthesis is otherwise mandatory. 3) Thrombosis, usually partial, accompanied by one or more embolisms. Thrombo-embolism is more frequently noted in the first 6 months after implantation and becomes less common as time passes. 4) Deterioration of the movable part (ball variance) consisting of changes in colour and shape, with swelling and unevenness of the surface, breakage, pitting and loss of elasticity. 5) Low stroke volume syndrome. 6) Erosion of the septum and serious rhythm disturbances. 7) Proliferation of endothelial tissue leading to narrowing of the orifice. 8) Disturbed movement of the movable part, leading to intermittent or permanent blockage and loss of opening or closing play due to the interposition of fibrin and blood clots.


[Effect of 3,4,5-trimethoxy-benzoyl-aminocaproic acid on the cytolytic process in myocardial infarct. Working hypothesis].

The equilibrium of the ion pump is seriously disturbed at the cell level in acute myocardial infarct. The damaged cells are unable to take up potassium and this remains in the intercellular spaces, bound to acid substances released by the necrotic site. This results in self-perpetuating damage to surrounding tissue, together with extension and aggravation of the infarct. Early treatment with 3,4,5-trimethoxy-benzoyl-aminocaproic acid enables this secondary type of lesion to be prevented, since this substance is capable of fixing potassium ions and returning them to the cell.


[Social importance of cardiovascular diseases].

The continual increase in such cardiovascular diseases as rheumatic and sclerotic cardiopathy and cardiovascular syphilis over the last 30 yr is noted. The social and economic effects of these diseases is stressed and the hope is expressed that more active and effective measures will be taken by the State, especially with respect to worthwhile and radical prophylaxis.


[Radioisotope methods and technics in obstetrical and gynecological diagnosis].

Certain applications of radioisotopes to obstetric and gynaecological diagnosis are illustrated. Radioisotopes have been widely employed since the improvement in instrumental methods and the availability of short-life radioisotopes has removed the basic limitation which once prevented their use during the entire fecund period of the woman owing to the risk of radiation damage to the reproductive system. Particular attention is paid to the advances made in placental localization, in the study of thyroid and renal function in pregnancy, in the study of the diffusion of female genital tumours and relapses, and in early diagnosis of tumours of the uterus and ovaries. Dosimetric problems arising when using diagnostic techniques with radioisotopes in obstetrics and gynaecology are analysed.


[Review of studies on the epidemiology of obliterating arteriopathies in Sicily].

Data relating to three statistical, clinical and epidemiological research projects covering a total of 350 cases of peripheral obliterating arteriopathy, collected by the same group from different Sicilian provinces and based on the same classification, are presented. Athersclerosis was a prominent feature (50% in the eastern provinces, 60% in the west), especially in the 6th decade of life. Diabetes, alone or in association with athersclerosis, was also more common in the west (18%) as opposed to the east (5--%). Burger's disease was noted in 3% and infection in 8% (presumably viral on 3.5%). Comparison is made with the national statistics produced by Corsi and the partial results of other Sicilian workers. The clinical data showed: a) the disease appeared at least 10 years earlier in subjects with athersclerosis and diabetes; 2) these subjects was also more exposed to the risk of coronary and cereabral involvement; c) asymptomatic forms were observable in 8% of atherosclerotics and 20% of those with both diabetes and athersclerosis. Reasons for the increase of degenerative forms throughout the world are discussed. Correct, systematic examination for the detection of forms with few or no symptoms is definitely required.


[Correlation of some instrumental, metabolic and clinical parameters in cerebral atherosclerosis].

The epidemiological, clinical and instrumental features of cerebral circulatory insufficiency are examined in an assessment of the criteria required for correct diagnosis. The need to refer to both direct and indirect criteria is illustrated in the light of a series of cases. From the 4th decade of life onwards, males are more prone to cerebral arteriosclerosis. Hypertension, diabetes and obesity are significant risk factors. The findings obtained by various methods of examination are critically discussed. Their correct interpretation naturally demands correlation with the clinical data.


[Studies of cardiovascular damage in subjects with altered purine metabolism].

The percentage of arteriosclerotic changes with or without dyslipaemic humoral deviation was studied in a sample of subjects with altered purine metabolism of various corresponding clinical expression and the percentage of hyperuricaemia in a homologous sample of arteriosclerotics. It is concluded that a definite dependent relationship between arteriosclerotic lesions and abnormality of purine metabolism remains a hypothesis and that between the two metabolic alterations there is a more or less indirect associative, chronological and dysmetabolic involvement relationship.


[Protective effect of some hormones (insulin, testosterone, human chorionic gonadotropins) on testicular damage in alloxan diabetes in rats].

The effect of treatment with insulin, testosterone propionate and HCG on testicular damage in alloxan-induced diabetes was investigated in the rat. Both insulin and HCG offered protection, whereas testosterone, although it reduced blood sugar, did not have this effect. The protective action of HCG may be dependent on a reactive incretion of hypophyseal FSH.


[The efficacy of pyridonolcarbamate in diabetic angiopathy].

A group of atherosclerotic patients, some of whom were diabetics with clinical and instrumental signs of angiopathy, was treated with pyridinolcarbamate which was found to be elective for diabetic angiopathy. This was seen in the improvement in haemocoagulative alterations (platelet adhesiveness and clumping), that in certain lipidico-plasmatic alterations (normalization or reduction of glycoproteins) and in anatomofunctional modifications at wall level (rheographic modifications and changes in the diffusion curves with Alb labelled with I 131). These improvements were not observed in atherosclerotic subjects.


Permeability of the blood-brain barrier to long-chain alcohols from plasma.

Cis-9-octadecenyl alcohol was fed as a dietary supplement to adult male rats for 7 and 14 days. At the end of these feeding intervals, lipids were extracted from brain and liver. The neutral lipids were analyzed for free and esterified long-chain alcohols and alkyl and alk-1-enyl glycerols. Total lipid phosphorus, alkyl acyl and alk-1-enyl acyl phosphoglycerides were determined in the phospholipid fraction. A marked change was observed in these lipid types in the liver, but not in the brain. In liver the free and esterified long-chain alcohols increased threefold following feeding of the dietary supplement. Feeding cis-9-octadecenyl alcohol had no effect on the neutral alkoxy lipids of liver but resulted in an approximately three- to eightfold increase in the ionic alkoxy lipids.


Food and nutrient consumption of two rural population groups of Italy followed for ten years.

Two groups of men, 40 through 59 years old, from two rural areas of Italy (one in the north and one in the centre) were subjects of dietary surveys on three occasions over 10 years, using the individual weighing technique. Over the 10 years, changes in the consumption of some foods were observed; these were most striking in respect to cereals and legumes, which decreased, and to animal protein and fats, which increased. The decrease of energy was much greater than expected (partly explained by the current mechanization in agriculture in Italy). In one area a low intake of riboflavin was observed, but otherwise the diets could be considered to be nutritionally good. There was no correlation between some dietary variables and anthropometric and blood lipid data, as observed previously. This was probably because the population groups examined were practically homogeneous in regard to habits.


Protein metabolism in rats with ventromedial hypothalamic lesions: dietary effects on nitrogen retention.

The protein metabolism of rats bearing bilateral lesions in the ventromedial area of hypothalamus (VMH) was studied in nitrogen balance experiments employing high protein and high fat diets. The catabolic effect of VMH destruction was to a great extent counterbalanced by increased protein intake. This indicates that increased amino acid catabolism, rather than impaired mechanisms for protein synthesis, is responsible for the poor nitrogen retention of VMH-lesioned rat fed normal amounts of protein. A trend of increasing nitrogen excretion with increasing dietary fat was found when the caloric intake of VMH-lesioned animals was elevated by substitution of dietary carbohydrates with fat. Persistent liponeogenesis in spite of the high fat intake, is suggested as a possible explanation for this observation.


Bulking agents in the treatment of obesity.

The effect of two bulk-forming appetite depressants, methylcellulose and gum guar, on food intake has been studied in 11 (4 male, 7 female) healthy volunteers--3 of whom were overweight. 10 g of active ingredient were given in two equal doses daily for periods of 1 week of each agent. Individually weighed dietary intakes were obtained over four consecutive weeks; the first and third weeks were without medication. Both gum guar and methylcellulose were equally effective in reducing appetite by 10%.


Effect of a low protein diet and isoenergetic amounts of a high protein diet in the weanling rat on the free amino acids of the brain.

Giving weanling rats a low protein diet for 56 days retarded the growth of the brain, whereas giving isoenergic amounts of a high protein diet did not. The low protein diet resulted in higher concentrations of aspartic acid, glycine, alanine and histidine in the plasma and of glycine and histidine in the brain. The concentration of methionine was unchanged in the plasma, but raised in the brain. Isoenergetic amounts of the high protein diet did not change the concentration of plasma amino acids, but resulted in some changes in brain amino acids. On rehabilitation the plasma and brain amino acids of the low protein animals returned to normal.


Endometrial carcinoma in young women taking oral contraceptive agents.

The first 21 cases recorded in the Registry for Endometrial Carcinoma in Young Women Taking Oral Contraceptive Agents are reported. We have found no other such cases in the literature, and indeed several authors have stated that these agents, because of their predominantly progestional action, would be expected to be protective against this disease. In 8 of the 21 patients, factors were present which militated against a close relation between oral contraceptives and carcinoma, and 5 of these 8 patients had taken only or predominantly combined agents. On the other hand, 11 of the remaining 13 patients took sequential agents, a ratio directly opposite that of the usage of combined and sequential agents in the American population. The possible reasons for the excess of sequential agents, chiefly Oracon, are discussed, and directions for future study are suggested.


Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma.

There were 289 radical hysterectomies performed at Roswell Park Memorial Institute for Stage IB, IIA, and recurrent cervical cancer from 1957 to 1967. The prognostic significance of cervical lesion size, pelvic node metastases, and type of radical hysterectomy have been evaluated. Excellent 5-year survival rates for women with Stage IB cervical carcinoma were associated with cervical lesions measuring less than 3 cm and resected pelvic lymph nodes which did not contain metastatic cancer. In addition, 31% of women with recurrent cervical cancer treated by radical hysterectomy survived 5 years without recurrence.


Treatment of irradiation injury to the ureter by ileal substitution.

Ureteral obstruction following radiotherapy for cervical cancer is most often due to recurrent tumor. However, in a few patients ureteral stricture is secondary to radiation damage. Surgical treatment of this obstruction requires special consideration since many procedures for urinary diversion may be contraindicated in an irradiated pelvis. Ileal substitution (uretero-ileoneocystostomy) preserves renal function without resorting to external diversion of urine. A discussion of the method together with a report of 6 patients treated in this manner is presented. Results were excellent, with followup ranging from 11/2 to 4 years. A brief history of irradiation damage to the ureter and the use of small bowel as substitute ureter is discussed. Patient acceptance of this surgical approach was gratifying.


Surgery for gynecologic malignancy in the aged.

The hospital records of 24 patients over 75 years of age who had 25 surgical procedures in treatment for invasive gynecologic cancer were viewed. The patients were matched with control intraoperative and postoperative complications compared. The incidence of wound complications was higher in the elderly patients, while the other complications were lower. Age should not be an absolute contraindication to surgery for gynecologic malignancy if the prospects of cure are good.


Effect of povidone-iodine on herpesvirus type 2, in vitro.

Povidone-iodine solution (Betadine) at concentrations of 0.167% (v/v) reduced the end-point titers of Strain E.M. herpesvirus, type 2, by more than 99.99%. Even at concentrations of 0.0167% (v/v), povidone-iodine solution reduced the titers by 92%. The iodine solution, per se, had no effect on cultured human fibroblasts in concentrations of 1.67% (v/v).


Primary empty sella syndrome and amenorrhea.

The empty sella syndrome is defined anatomically and radiologically. A case report of an amenorrheic patient who was diagnosed as having the primary empty sella syndrome is presented. Its pathogenesis, clinical profile, and endocrine relationships are discussed. Specific reference is directed toward the capability of the empty sella syndrome to produce pituitary impairment and possibly amenorrhea.


The residual ovary syndrome.

Previous reports have demonstrated a significant incidence of pelvic symptomatology involving ovaries preserved following hysterectomy, to be called "the residual ovary syndrome." This report, in an 11-year retrospective analysis of all oophorectomies at The Methodist Hospital in Houston, Texas, identified 202 cases in which a previous hysterectomy had been performed. The majority of these patients presented with varying degrees of chronic pelvic pain (77.2%), asymptomatic pelvic mass (14.4%), and dyspareunia (67.0%). The incidence of malignant neoplastic change in these patients was 3.0%, related to whether hysterectomy was performed before or after the age of 40. In view of the incidence of the residual ovary syndrome and the risk of malignant neoplastic change when hysterectomy is performed after the age of 40, serious consideration of total ovarian ablation at the time of hysterectomy should be weighed against any temporary physiologic and/or psychologic benefits to be gained from conservation.


Progesterone and estrogen secretion by puerperal human ovaries.

Plasma progesterone, estrone, and estradiol concentrations were determined in peripheral and ovarian vein samples in 9 women 20 to 30 minutes after delivery of the placenta during cesarean section. Progesterone concentrations in the ovarian vein draining the corpus luteum were significantly higher than the contralateral side or the peripheral concentration, confirming the activity of the puerperal corpus luteum. Estrone concentrations showed no significant difference between peripheral and ovarian vein samples, indicating little or no ovarian estrone secretion. The estradiol concentrations of the ovarian vein samples were significantly higher than peripheral levels. This indicates ovarian secretion of estradiol in the puerperium by areas other than the corpus luteum.


Effects of norethindrone on carbohydrate and lipid metabolism.

A prospective study was undertaken to investigate the carbohydrate and lipid metabolic effects of the oral contraceptive norethindrone. An oral glucose tolerance test was performed before and 1 year after the daily oral administration of 0.35 mg of norethindrome to 31 women. Measurements were made of glucose, insulin, cholesterol, and triglycerides. During the year there was no significant weight change in the women, and the fasting cholesterol values were unaffected by the steroid. The fasting triglycerides decreased as normally occurs in the late postpartum period. There was no change in the blood glucose curve, but there was a statistically significant elevation produced in all of the plasma insulin values. These data suggest that this 19-nor progestogen steroid can affect the peripheral activity of insulin and thus require higher blood levels in order to obtain the same glucose homeostasis.


Initiation of human parturition. III. Fetal membrane content of prostaglandin E2 and F2alpha precursor.

Unesterified arachidonic acid is the obligatory precursor of the prostaglandins (PG), PGF2alpha and PGE2. In order to ascertain whether or not the human fetal membranes could represent a storage site for prostaglandin(s) precursor, the fatty acid content of human fetal membranes was measured. Approximately 20% of the fatty acids found in fetal membranes obtained from near-term, non-laboring women was arachidonic acid, whereas only 0.4% of the fatty acids of the parietal peritoneum of the mother is arachidonic acid. A small but significant decrease in the arachidonic acid concentration was found in the fetal membranes obtained from laboring women compared to that found prior to labor. On the other hand, the concentration of palmitic acid was increased in membranes obtained during labor while no significant changes in concentration in the remaining fatty acids were observed in membranes from laboring compared to non-laboring near-term gravidas. The significance of these observations in relation to the availability of prostaglandin precursor and the initiation of human parturition is considered.


Bladder injury associated with rupture of the uterus.

Rupture of the uterus is still a very common obstetric emergency in developing countries, and the urinary bladder is often injured in these patients. This fact is not fully documented in the literature. One hundred consecutive cases of rupture of the uterus in patients admitted during a 10-year period to the King George Hospital, Visakhapatnam, India, were analyzed. Bladder injury occurred in 22%. Thus, uterine rupture constitutes one of the important causes of bladder injury. In uterine rupture cases the most common clinical signs of concomitant bladder damage are hematuria and meconium-stained urine. Instillation of methylene blue solution into the bladder during surgery can help to identify small bladder rents. Routine postoperative drainage of the bladder by indwelling catheter in all cases of ruptured uterus with suspected bladder injury is an important aid to healing of the contused, devitalized bladder and can avert vesicovaginal fistula formation.


Relation of steroids and prostaglandin at vaginal delivery and cesarean section.

The simultaneous determination of estradiol, estrone, progesterone, and prostaglandins E and F has been made in fetal and maternal compartments in patients with and without the onset of labor. The decidua rather than the fetus or placenta was considered to be the site of prostaglandin synthesis, and prostaglandins present in the amniotic fluid during labor were thought to be a byproduct by myometrial activity rather than the factor initiating the onset of labor. Progesterone levels in the maternal plasma were lower during labor but estradiol levels were elevated. It was concluded that the steroid environment may contribute to the clinical course of labor by facilitating the local uterine production of prostaglandins. Whereas estradiol was high and estrone low in maternal circulation, the ratio was reversed in the fetus. This reversal may serve to protect the fetus from high maternal levels of estradiol.


Further observations on the nature of pressor responsivity to angiotensin II in human pregnancy.

The pressor dose of infused angiotensin II was determined before and after rapid volume expansion with 800 to 1075 ml of high-hematocrit blood. There was no remarkable change in sensitivity to infused angiotensin demonstrated except in two instances in which transient volume overload developed. The data support the hypothesis that increased angiotensin sensitivity observed in patients with pregnancy-induced hypertension is the consequence of increased vascular responsivity.


Amniotic fluid volume, total phospholipids concentratio, and L/S ratio in term pregnancies.

Amniotic fluid volume, lecithin/sphringomyelin ratio, total phospholipid concentration and total phospholipid per sac were investigated in 53 term pregnancies. A definite influence of amniotic fluid volume on the phospholipid concentration was noted, while no influence on the L/S ratio was observed. Amniotic fluid volume showed a tendency to decrease after the 40th week of gestation. The total quantity of phospholipids per sac showed no significant variation between the 36th and 42nd week of gestation.


Clinical experience using intraamniotic prostaglandin F2alpha for midtrimester abortion in 600 patients.

Six hundred consecutive patients received intraamniotic prostaglandin F2alpha to induce midtrimester abortion. The PGF2alpha was administered by a general population of gynecologists according to a standard protocol. The aim of the study was to observe whether results would be similar to those reported in various research studies. Of 600 abortions, 460 were complete, 140 were incomplete, and there were no abortion failures. Other parameters were also similar to previous research results, indicating that PGF2alpha can be an effective and safe means of inducing midtrimester abortion when administered by the practicing gynecologist.


Menstrual induction: its place in clinical practice.

From June 1973 to October 1974, 221 patients underwent menstrual induction in the private offices at a University Medical Faculty Group located in its major teaching hospital with ready access to operating room facilities. The rationale for subclassifying early abortion as "menstrual induction" is discussed. In this series menstrual induction was performed on patients who were 7 to 21 days beyond the date of an expected menses. Histologic examination of the tissue removed was consistent with a diagnosis of pregnancy in 98.2% of the patients. Complication rates following the use of the practices outlined in this report were acceptably low.


High-risk pregnancy. Unresolved problems of screening, management, and prognosis.

In the field of maternal and child health the concept of the high-risk pregnancy has been used in many studies. However, it is still beset by problems that must be solved if any real progress is to be made. The ideal of a simple, reliable screening technique has not yet been achieved. Present methods are not only complex, they are not well validated. High-risk factors must be quantified if the values of various regimens of obstetric care are to be measured and if prognostic success is to be attained. Moreover, efforts at prediction should not cease with the current pregnancy but should extend to subsequent reproductive performance. This long-range approach to prognosis could not only improve patient care during the current pregnancy but could also become an essential factor in achieving optimal results throughout reproductive life. An extensive bibliography of studies of high-risk pregnancies is presented.