Induction of hepatic microsomal cytochrome P-448 by 3,3',4,4'-tetrachloroazobenzene and the corresponding azoxy and hydrazo analogs. 3,3',4,4'-Tetrachlorazobenzene (TCAB) has been found to pose occupational health hazards among chemical workers as a consequence of its contamination in commercially important herbicides. The induction of hepatic microsomal cytochrome levels in male rats treated with TCAB or its azoxy and hydrazo analogs were examined in several short-term experiments. Five daily consecutive administrations of TCAB or 3,3',4,4'-tetrachloroazoxybenzene (TCAOB) at doses of 25 mg/kg/day yielded maximal stimulation of cytochrome levels. Both compounds induced cytochrome P-450 with absorption maxima (reduced, CO complex) at 448 nm to 2.7 times control levels. In contrast, cytochrome P-448 levels were enhanced less than twofold relative to controls in animals treated with 3,3',4,4'-tetarchlorohydrazobenzene (TCHB) under identical conditions. Cytochrome inductions arising from these chemicals are dose dependent. Parallel increase of the liver to body weight ratios was also observed in these studies. Further experiments using different regimens indicated TCAOB as being the most potent and persistent inducer among these three analogs. A twofold enhancement of cytochome P-448 levels was observed 14 days after a single ip injection of TCAOB at doses as low as 10 mg/kg.


Hepatic microsomal enzyme induction by trifluoromethyl compounds and some halogenated and nonhalogenated analogs. Trifluoromethyl derivatives of toluene, phenothiazine, benzimidazole and DDT were administered ip to male rats for 5 days and induction of hepatic microsomal enzymes catalyzing the metabolism of EPN, p-nitroanisole and aminopyrine measured. The addition of a trifluoromethyl substituent to toluene, phenothiazine and benzimidazole increased the inducing capacity of the parent molecule on p-nitroanisole metabolism. Dihalogenation of benzene with trifluoromethyl groups, regardless of position, resulted in induction of p-nitroanisole metabolism whereas halogenation of benzene with trichloromethyl groups did not. For these compounds, the size and electron-inducing capacity of the halogenated substituent may be relative to microsomal enzyme induction.


The effect of lead on aminopyrine N-demethylation. The effect of various lead salts on "in vitro" aminopyrine N-demethylation was investigated. Lead was administered to male rats as a 1% solution in the drinking water. After seven days of lead treatment it was found that lead chloride and lead acetate had no effect on microsomal aminopyrine N-demethylation while lead nitrate increased aminopyrine metabolism. Intraperitoneal administration of either lead chloride or lead nitrate at a dose of 20 mg./kg. decreased metabolism. Lead chloride by oral administration did not suppress phenobarbital induction of aminopyrine metabolism in rats.


[Phytohemagglutinin (PHA) skin tests: its relevance in carcinology (author's transl)]. The skin response to 1 microgram Phytohemagglutinin (PHA) was studied in 359 subject including 235 cancer patients and 124 without cancer. Responses to PHA, tuberculin, candidin were compared. A positive skin response to PHA was observed in 88% of patients without malignancy. This percentage remained almost equal in older patients (more than 70 years). Among patients with advanced malignancies, there was a fall down to 64.5% of the percentage of positive responses. A negative response to both PHA and tuberculin was observed in 6% of patients without malignancy and 28% of cancer patients. 38 +/- 5 days was the average survival of this last group. The arguments favouring the fact that PHA induces cutaneous basophilic hypersensitivity are reviewed. An advantage of this test is that no presensitization is required.


Toxic effects of peroral o-cresol intake on rat brain. Male Wistar rats were given o-cresol in their drinking water (0.3 g/l) for 20 weeks. The ingested cumulative dose exceeded the acute LD50 at the fourth week of the experiment. O-cresol induced an increased drinking rate initially which decreased significantly below the drinking rate of the controls at the end of the experiment. The biochemical effects in the cerebral homogenate were inconspicuous, and they included increased RNA content initially, and reduced glutathione concentration and azoreductase activity at the end of experiment. Glial cells displayed significant increases in the acid proteinase and 2',3'-cyclic nucleotide 3'-phosphohydrolase activities at the 20th week of exposure.


[True and false problems in surgery of pulmonary aspergilloma. Study of 220 cases (author's transl)]. Different problems involved in the surgery of 220 cases of pulmonary aspergilloma are analyzed. The operatory blood loss, which was more abundant than usual, did not bring about any complication. The authors believe that pleural cavities were observed for only 6% of the partial excisions, probably because of the complementary thoracoplasties they performed. The true problem is raised by the patients suffering from respiratory failure for whom techniques of direct approach are the only solution.


Brain sulfatide and non-lipid sulfate metabolism in leucodystrophic (jimpy) mice. In leucodystrophic (jimpy mutant) mice there is a marked depletion of brain sulfatide as compared to normal ilttermates. Subcellular fractionation showed decreased sulfatide concentrations in microsomal and synaptosomal fractions prepared from jimpy brains. The in vivo incorporation of 35SO4 into sulfatide of myelin, microsomal, mitochondrial and synaptosomal fractions was significantly inhibited in the jimpy mutant. In addition, the incorporation of 35SO1 into non-lipid brain membrane components (sulfated glycoproteins and mucopolysaccarides) was also decreased in jimpy mice. These results suggest that the jimpy mutation produces widespread alterations in brain sulfatide metabolism and also affects the metabolism of non-lipid membrane components of brain.


Effect of furosemide on peripheral venous compliance following ureteral ligation in the adult dog. The effect of furosemide on peripheral venous compliance in the absence of the diuretic effect of the drug was examined. Following bilateral ligation of the ureters, adult dogs were given furosemide, 2 mg/kg. A significant increase in peripheral venous compliance was observed as early as ten minutes after the drug was given (120% of control), and an additional increase was seen at 60 minutes after administration of the drug (136% of control). No change in peripheral venous compliance was observed in animals receiving only the furosemide vehicle, nor was there any change in animals in which bilateral nephrectomy had been performed prior to the administration of furosemide. These results indicate that furosemide produces a significant increase in peripheral venous compliance, which is independent of its diuretic action. However, the presence of the kidneys appears to be necessary for this effect.


Morphine, naloxone and kainic acid neurotoxicity. Local neuronal damage, as indicated by choline acetyltransferase and glutamate decarboxylase activities, elicited by intrastriatal injections of kainic acid was increased by local injection of morphine and decreased by prior injection of naloxone. Peripheral injections of morphine or naloxone had little significant effect although the same trends appeared.


The location of sensoric bronchoconstricting receptors in the upper airways. The bronchoconstrictoric influence of allergen and acetylcholine aerosol was tested in 16 boxer dogs. The animals were exposed to these substances through a mask. The aerosol was also administered directly to three restricted areas of the trachea. Both substances induced a strong bronchoconstriction when administered through the mouth. Only the allergen showed a similar strong bronchoconstriction when administered to a restricted area in the upper third of the trachea.


Helium-oxygen flow volume curves in young healthy adults. Helium-oxygen (HeO2) flow volume curves were done in young, healthy, nonsmoking adults. This paper discusses the theoretical design of the test, the nomenclature, and the results in this population. Our study shows that HeO2 and air curves crossed around 15% of vital capacity; one point of identical flow occurs more frequently than has been appreciated; and fully developed laminar flow occurs infrequently at low lung volumes in young adults.


Determination of anaerobic threshold by the ventilation equivalent in normal individuals. In 131 untrained healthy volunteers, unsteady-state upright bicycle ergometry was carried out by means of computer-assisted on-line ergospirometry. In 11 males and 4 females capillary lactate and blood gas analyses sampled simultaneously at 1-min intervals revealed that it is possible to determine the 'anaerobic threshold' (AT) and a 'threshold of decompensated metabolic acidosis' (TDMA) from the respiratory gas exchange by controlling the ventilation equivalent for oxygen (VEO2 = VE/VO2) and carbon dioxide (VECO2 = VE/VCO2). There is no necessity of invasive measurements. Solely ergospirometrical tests in 66 males and 50 females, aged 20--65 years, showed the expected higher work load levels and VO2 at AT and TDMA in males. There was a significant negative correlation to age. In contrast, there are no differences with regard to sex in AT and TDMA for weight-corrected work rates. In the age group 20--39 years, AT is about 1 W/kg body weight, TDMA at about 2 W/kg body weight. The larger maximum exercise capacity weight corrected for males (3 W/kg) in comparison to females (2.6 W/kg) was dependent on a greater capability in the range of maximum exertion and not on a different level of AT and TDMA.


[Left ventricular function in chronic obstructive pulmonary disease after decompensation (author's transl)]. 13 patients with chronic obstructive pulmonary disease (COPD) were studied for left ventricular function immediately after acute decompensation. Parameters of right and left ventricular function were measured. Mean pulmonary wedge pressure (Paw) was elevated (11.9 mm Hg) but there was no correlation between Paw and left ventricular end-diastolic pressure (LVEDP). The indices of left ventricular contractility were in the normal range. In 4 patients, LVEDP was too high. A correlation was established between RVEDP and LVEDP. Left ventricular compliance, as studied by the index of Diamond and Forrester, was abnormal. Two conclusions are discussed: (1) in COPD, Paw cannot indicate left ventricular dysfunction; (2) alteration of left ventricular compliance is possibly related to an elevation of RVEDP.


Gas exchange, pulmonary mechanics and haemodynamics in adult respiratory distress syndrome: experimental results in Lewe miniature pigs. Adult respiratory distress syndrome (ARDS) is a common medical emergency in respiratory care complicating a great variety of traumas and diseases. An animal model from Lewe miniature pigs has been developed to study the ARDS under standardized conditions; it is based on aspiration pneumonitis, a disorder often observed in ARDS, injuring the lung alveolar surfactant system. The experimental study was conducted under neuroleptanalgesia. ARDS was produced by intratracheal application of hydrochloric acid (0.2 mol/l) in an amount of 1.0 ml/kg body wt. The animals were ventilated automatically by a standardized ventilatory pattern in IPP mode. In all animals the time course of oxygenation ratio (Pa,O2/F1O2), arterial CO2 tension (Pa,CO2), ratio of alveolo--arterial oxygen tension difference to inspired oxygen fraction (Aa,DO2/F1O2), oxygen exchange ratio ((AaDO2/Pa,O2), lung compliance (CL), inspiratory airway resistance (RrsI), dead space ratio VD/VT), pulmonary artery pressure (PAP) and systemic blood pressure were studied. Changes in quasi-static volume--pressure curves, percentage change in lung water content and gross pathological finding were used to integrate the findings into a system of pathophysiological changes in ARDS. The animal group to which hydrochloric acid was administered shows severe pulmonary distress leading to death within 3.5--7.5 h. No significant changes in the measured parameters could be observed in the control group over a 14 h period. The results suggest that aspiration pneumonitis in Lewe miniature pigs is very suitable to investigate various problems in pathogenesis of ARDS. The model provides reproducible results which correlate very well with findings in different ARDS states. The models serves both to compare clinical states and to search for newer therapeutic manoeuvres.


A case of poisoning with mercuric chloride. A male patient was admitted to hospital 12 h after self-poisoning with mercuric chloride. He suffered multiple complications including acute renal failure, ulcerative colitis, anaemia, disseminated intravascular coagulation, chronic sepsis and severe weight loss. Initially he responded well to resuscitative measures and intensive supportive therapy, which included ventilation of the lungs, haemodialysis, dimercaprol, antibiotics, parenteral feeding and gastrointestinal surgery. Unfortunately the sepsis was never satisfactorily eradicated despite satisfactory serum concentrations of the appropriate antibiotics. On day 43 after poisoning he had a grand mal fit; after this there were focal neurological signs and on lumbar puncture he was found to have a raised protein concentration and raised pressure in his cerebrospinal fluid. The condition of the patient rapidly deteriorated and on day 47 he died. Post-mortem examination revealed a large cerebellar abscess. The literature on mercury poisoning is reviewed.


Transient CO2 elimination and storage as functions of the ventilatory response to CO2. The effect on CO2 storage and elimination of variations in the slope and intercept of the ventilatory response to CO2 curve was examined. Theoretical and experimental results show that although CO2 elimination rate following a transient ventilatory disturbance is decreased at low ventilatory response slopes, this decrease can be compensated by elevated PCO2 intercepts, or thresholds. Conversely, high CO2 elimination rate following a ventilatory disturbance due to a high ventilatory response slope can be off-set by a depressed PCO2 threshold. The results suggest that elevated thresholds which often accompany depressed ventilatory response slopes may be part of a compensatory mechanism for minimizing transient hypercapnia and acidosis.


Regional alveolar gas composition and lung function in sheep. The influence of regional alveolar oxygen and carbon dioxide tensions on the distribution of lung blood flow and gas exchange was studied in unanaesthetised sheep. Right apical lobe (RAL) hypoxia, induced by administering nitrogen or nitrogen/oxygen mixtures to the lobe, stimulated a prompt, graded and well sustained reduction in lobar blood flow. Maximum hypoxia was accompanied by an approximate 65% reduction in perfusion, a significant fall in RAL carbon dioxide tension and output, a reversal of lobar oxygen flux and an average 13 Torr fall in arterial oxygen tension. The reduction in perfusion and gas exchange persisted in the face of elevated systemic oxygen tensions produced by giving pure oxygen instead of air to the remainder of the lung (RL). Mild RAL hypercapnia potentiated the hypoxia-induced change in perfusion and gas exchange. During lobar hypoxia RL blood flow and gas exchange increased to maintain total pulmonary gas exchange at an essentially constant level. RAL hyperoxia did not significantly alter the distribution of perfusion or gas exchange.


Influence of lung inflation on the elastic properties of intra-and extrapulmonary airways in man. In excised human lungs, the proximal intrapulmonary airways and distal extrapulmonary airways were isolated in situ, by means of the technique of Takishima el al. (1975), and submitted to varying transmural pressures at constant lung inflation. Both intra-and extrapulmonary airways became stiffer, i.e. showed a decreased collapsibility, at higher levels of lung inflation. The altered mechanical behavior of the intrapulmonary airways with lung inflation, observed also by Hughes et al. (1974) and Takishima et al. (1975), has been attributed to a tethering action of the lung parenchyma on these airways. The same mechanism may be operating on the distal extrapulmonary airways, to the extent that the pleura and hilar structures transmit the stresses of the lung parenchyma. Alternatively, the elongation of the bronchi occurring during lung inflation might be responsible for their increasing resistance to collapse with lung volume. A separate study showed, indeed, that stretching of the bronchi reduces their collapsibility.


A Monte Carlo simulation of convective dispersion in the large airways. A numerical model describing the local interactions between convection and diffusion in the first 11 generations (0 to 10) of the human bronchial tree is presented. The model, based on a Monte Carlo procedure, is used to investigate the effects of four velocity profiles: (i) parabolic, (ii) asymmetrical, (iii) asymmetrical with swirling and (iv) flat. Behavior was investigated for three diffusivities: (i) 0.75 cm2/s (He/air), (ii) 0.25 cm2/s (N2/O2) and (iii) 0.1 cm2/s (SF6/air) on the convection-diffusion interaction. The results of these simulations showed that 'Taylor dispersion' is an important effect, with respect to tracer segregation, and that it is of major significance only in the largest airways. By generation 10, molecular diffusion begins to dominate over Taylor dispersion. It was also found that use of a parabolic velocity profile, or application of the Gill-Sburamanian dispersion theory seriously overestimates axial dispersion. On the other hand, the use of a flat velocity profile underestimates dispersion.


Effects of hypercapnia and hypoxia on laryngeal resistance to airflow. Ventilation, laryngeal resistance and electromyograms of the diaphragm, posterior cricoarytenoid (PCA) and thyroarytenoid (TA) muscles were recorded in anesthetized, spontaneously breathing cats during 100% O2 administration and during steady state inhalation of hypercapnic and hypoxic gas mixtures. As shown previously, hyperoxic hypercapnia lowered expiratory laryngeal resistance (RlarE). Isocapnic hypoxia also lowered RlarE, and hypercapnia superimposed on hypoxia decreased it further. Hypocapnia raised RlarE. Changes in inspiratory laryngeal resistance (RlarI) were similar to those in RlarE, but smaller. When ventilation was stimulated to the same extent by hypoxia and by hypercapnia, RlarE was lower under hypoxic than hypercapnic conditions in most animals. The electromyograms showed that the respiratory oscillations in laryngeal resistance and the laryngeal responses to hypercapnia and hypoxia were determined chiefly by the activity of the PCA muscle, the abductor of the vocal cords. The TA-a representative adductor muscle-was silent under all conditions studied. The results, considered with previous work, indicate that the larynx plays a part in determining the breathing pattern under resting conditions and during respiratory stimulation by hypercapnia and hypoxia.


Adaptation of pulmonary stretch receptors in different mammalian species. A consequence of the adaptation of pulmonary stretch receptors is that their pattern of discharge depends on both lung volume and its rate of change. For adaptation dependent, flow related information to modify the breathing pattern by a feedback process, appreciable receptor adaptation must take place during a single respiratory cycle. Moreover, for flow related information to have the same significance in all animals, the time course of stretch receptor adaptation would have to vary among species, being more rapid in small animals, with high respiratory frequencies. We recorded single fiber action potentials from 84 pulmonary stretch receptors in six species of mammals, ranging from hamster to dog. The response of the receptors to maintained transpulmonary pressures was similar in the different species,as was the time course of receptor adptation following sudden lung inflations to 5 and 10 cm H2O. These findings show that the behavior of pulmonary stretch receptors is similar in animals with widely differing respiratory frequencies, and that the significance of receptor adaptation for regulation of the breathing pattern must vary interspecifically.


Influence of immersion to the neck in water on airway closure and distribution of perfusion in man. We measured closing volume (CV), expiratory reserve volume (ERV) regional distribution of lung volume (Vr) and perfusion in 7 normal subjects in air and during immersion to the neck in water. In four subjects immersion resulted in a CV greater than ERV and the normal perfusion distribution became inverted. In the other subjects, ERV remained larger than CV and perfusion distribution during immersion was uniform, not inverted. In 5 subjects closing volume increased and in 3 of them, the ratio of apical/basal Vr increased significantly during immersion. One subject had nomeasurable CV and in the other it was not measured. The data suggest: (1) that when CV is greater than ERV during immersion there is an inversion of the normal perfusion distribution, caused by hypoxia and/or an increase in mean alveolar pressure in the alveoli beyond the closed airways, and (2) that an increase in pleural pressure gradient during immersion may contribute to the increase in C.V.


Nasal heat exchange in the giraffe and other large mammals. The respiratory air of the giraffe is exhaled at temperatures substantially below body core temperature. As a consequence, the water content of the exhaled air is reduced to levels below that in pulmonary air, resulting in substantial reductions in respiratory water loss. Measurements under outdoor conditions showed that at an ambient air temperature of 24 degrees C, the exhaled air was 7 degrees C below body core temperature, and at ambient air temperature of 17 degrees C, the exhaled air was 13 degrees C below core temperature. The observations were extended to two additional species of wild and four species of domestic ungulates. All these animals exhaled air at temperatures below body core temperature. The average amount of water recovered due to cooling of the air during exhalation, calculated as per cent of the water loss that would occur if air were exhaled at body core temperature, amounted to between 24 and 58%, the average value for the giraffe being 56%.


The uses of long sampling probes in respiratory mass spectrometry. We have compared the results of gas analysis by respiratory mass spectrometry using long (30m) sampling probes with those obtained using conventional short (1.3m) probes, examining both static gas mixtures and respired gas at the mouth during manoeuvres designed to make the concentrations of inspired marker gases change in a complex way within a breath. The experiments showed that no important errors were introduced by using the long probes, both for estimates of gas tensions and for derived physiological variables. A slight reduction in signal for a water-soluble component was noted when sampling a moist gas mixture with a long probe, but again this was of no practical significance. Ways in which the use of long sampling probes increase the versatility of the respiratory mass spectrometer are discussed. In essence they enable a greater range of subjects to be studied, they allow simultaneous events to be examined sequentially and they permit a single instrument to be shared between several patients or laboratories.


Artificial perfusion of the ponto-medullary region of cats. A method for separation of central and peripheral effects of chemical stimulation of ventilation. A technique is described by which the ponto-medullary region of anaesthetized cats is artificially perfused with their own blood in which the blood gas tensions are varied independently from gas exchange in the lung. Blood from a femoral artery is fed into a foamer and defoamer. After alteration of the blood gas tensions in this equilibrator it is pumped via a cannulated vertebral artery into the medulla oblongata, pons and cerebellum. In this way two separately perfused areas are obtained in which the blood gas tensions can be changed independently. The peripheral chemoreceptors are supplied with blood of the systemic circulation while the central chemoreceptors and respiratory integrating centres are artificially perfused. With this technique the contribution of the peripheral and central chemoreceptors to the total ventilation and their interaction can be assessed. In addition the method is also suitable for studying the effects of drugs on the central regulation of respiration and circulation.


Relative contribution of central and peripheral chemoreceptors to the ventilatory response to CO2 during hyperoxia. Using the technique of artificial ponto-medullary perfusion, the steady state ventilation during hyperoxia was measured in 15 anaesthetized cats as a function of the central PaCO2 (PaCO2) and peripheral PaCO2 (PapCO2). To a first approximation the ventilatory response was linearly related to both the central and peripheral arterial carbon dioxide pressures, viz. VE=SC . PacCO2 + Sp . PapCO2 - K where Sc and Sp represent the overall central and peripheral sensitivity to carbon dioxide. The mean ratio Sp/Sc was 0.48 (range 0.21 to 1.08). In carotid sinus denervated cats Sp was zero, while the values of Sc in these cats were in the range of Sc of cats with intact carotid sinus nerves. It is concluded that the peripse to CO2 under steady-state conditions. Chemodenervation experiments revealed that the carotid bodies play an essential role in this contribution.


[Neuropathological study of adult intracranial hemorrhage. General data in 500 cases]. The systematic pathological study of 500 patients with intracranial hemorrhages (ICH) [341 (68 P. 100) CEREBRAL HEMORRHAGES (C.H.); 119 (24 p. 100) meningeal hemorrhages (M.H.); 39 (7,8 p. 100) subdural hematomas (S.H.) and, at last, one extradural hematoma] has been practiced. Those cases were issued primarily from neurological and, at a lesser degree, from neurosurgical departments. Etiological data, complications, associated findings and causes of death have been analysed. High blood pressure is the main etiological factor in C.H. This is confirmed by the statistical comparison between the incidence of this factor in our material and in the whole French population. However, nearly 50 p. 100 of ICH occuring in normotensive patients are C.H. The incidence of cirrhosis is much higher in our study than in other reports from the literature. The frequently associated high blood pressure does not seem to enhance the incidence of CH in patients with liver cirrhosis. Although this last factor can be found alone, its real etiological importance in CH cannot be assessed on account of the lack of data concerning the incidence of liver cirrhosis in the French population. The incidence of anticoagulant therapy is high in S.H. On the contrary, this factor does not seem to enhance the risk of high blood pressure induced C.H. The traumatic etiology of S.H. is significantly higher than the anticoagulant therapy etiology which, however, is very high in our study.


[Adrenomyeloneuropathy: an adult form of adrenoleukodystrophy spastic paraparesis, and chronic adrenal insufficiency (concerning 3 cases) (author's transl)]. Three cases of adult males with spastic paraparesis and adrenal insufficiency are reported. The adrenal insufficiency is primary and in one case associated with Leydig cell insufficiency. Ultrastructural examination of peripheral nerve revealed abnormal cytoplasmic inclusions in Schwann cells. A decrease in the percentage of linoleate to total fatty acids was found in the sera. A child with adrenoleucodystrophy and an adult with adreno myeloneuropathy were observed in the same family. It allows adrenomyeloneuropathy to be considered as an adult form of adrenoleucodystrophy.


[Successive encephalic ischemic accidents in a young patient: Buerger's disease, buergerian syndrome, or juvenile atheroma? A report in clinical, angiographic, and anatomical findings in one case, compared to three other ones, in which a biopsy of the pulp of the toes was also performed (author's transl)]. A man of 19 years of age was found to have a diffuse livedo, a quadruple asphyxic acrosyndrome, and dementia. Angiography confirmed the presence of distal ischemia with multiple circulatory blocks and a reduced distal network. The patient died at the age of 25 years and histopathological examinations of the vessels demonstrated obstructive atheromatous lesions in the medium sized and small arteries of the brain and viscera. By comparing these findings with those observed in three other cases, in which biopsy of the pulp of the toe was also performed, the hypothesis can be advanced that these juvenile encephalic ischemic accidents are caused by atheroma, which can be detected, at an early stage, by studying the distal arteries in the finger or toe pulp.


[Associated vertebral angioma and epidural cavernoma (author's transl)]. A 27 year old man developed a pyramidal syndrome with hypoesthesia up to the level of D8, over a period of two months. Radiographic examination revealed the presence of an angioma of D8. Selective angiography demonstrated that there was epidural invasion as well as an angioma of the vertebral body, and enabled embolization of the 2 pedicles of the lesion to be performed. This produced only a partial, temporary improvement, and a posterior epidural tumor was found and removed by operation. The histological appearance of the tumor was that of a cavernoma, and rapid and permanent recovery of normal neurological function was obtained after the operation. The authors discuss the pathogenicity of the neurological disorders associated with single bone angiomas, and the problems raised by their treatment.


[A case of bilateral spontaneous external carotid-cavernous fistulae with intrahepatic gallbladder (author's transl)]. A 55-year-old female presented bilateral external ophthalmoplegias and a hypesthesia in the left face and then an intracranial bruit, bilateral conjunctival injections and bilateral chemosis. In her past history, there were right retinal hemorrhage, diabetes mellitus and hypertension but no cranial trauma. The arteriographical aspects were almost identical in both sides: selective external carotid arteriography revealed an opacification of the cavernous sinus through the ascending pharyngeal artery, the accessory meningeal artery and the middle meningeal artery, but the internal carotid arteries and the vertebral arteries did not participate in these fistulae. The association in our case of spontaneous external carotid-cavernous fistulae with intrahepatic gallbladder derived from a developmental arrest in the early stage of embryonic life suggests that spontaneous external carotid-cavernous fistula is derived from communications between extra-cranial vessels and the sinuses in the early stage of embryonic life.


[Rare etiology of hemiplegia with young adult: paradoxical embolism (author's transl)]. Paradoxical embolism is due to the passage of an embolic material from the deep veins of the lower extremities or pelvis, into the systemic circulation through an abnormal intracardiac communication. Only the angiographic and hemodynamic diagnosis practised on two young patients with a cerebral embolism, can explain the mechanism. The diagnosis is based on the arterial embolism, the venous thrombosis with or without pulmonary embolism, the abnormal communication favoring right-to-left shunting. The rising of right atrial pressures permits this shunting. This high pressure can result from a pulmonary embolism, a high blood pressue due to an effort, or an embolism that might coil up over the tricuspid valve.


[Purification and concentration of albumin solutions by diafiltration using a parallel membrane dialyzer]. The last two years, artificial Kidneys have been used for purification and concentration of human serum albumin solutions coming from plasma cracking in two Blood Transfusion Centers. Results are easily reproducible and the apparatus is reliable and of low cost. The properties of dialysis and ultrafiltration of the A.N. 69 membrane are useful for eliminating ethanol and water. The artificial Kidneys are effective at low pressure. It is then possible to use peristaltic pumps and to have a closed circuit. The whole apparatus must be sterilized with chemical reagents.


[Development of antigens ABH and Ii in children between 0 to 16 years old]. The ABH and I, i erythrocyte antigens of 926 children from birth to sixteen years were tested in a semi-quantitative assay in order to follow their development. Results show that total activities of A, B and H erythrocyte antigens are reached within 13 and 24 months, the main modifications being observed within the first three months of life. However, these activities depend on the agglutinins used in the test; notably the results with anti-H lectins from Ulex europaeus and Laburnum alpinum are not totally identical. The decrease of i reactivity and the increase of I reactivity are simultaneous, but at birth the I reactivity of cord red cells is widely distributed, while that of i is more homogeneous. The increase in H activity tested with Laburnum alpinum is directly related to the decrease of foetal hemoglobin in the children's red cells.


Degenerative joint disease in the hip and spine. Clinical and radiographic assessment of the spine was carried out in 75 patients with osteoarthrosis (OA) of the hip and in 75 controls without hip disease. Radiographic degenerative changes in the spine were more frequent in the patients with OA hips, occurring in both the dorsal and lumbar spine. Moderate or severe changes were found in the dorsal spine in 29 patients with OA hips (compared with 12 controls), and in the lumbar spine in 32 patients with OA hips (compared with 10 controls).


The distribution of radiological joint damage in the rheumatoid hand. We report a detailed study of the relative distribution of joint damage, as assessed by erosion and joint space scores, in the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the rheumatoid hand. Hand radiographs of 30 patients with erosive rheumatoid arthritis were studied. There was significantly more damage in the dominant hand. The little-finger PIP joints were more damaged and the thumb interphalangeal (IP) joints less damaged than the other PIP joints. The index and middle finger MCP joints were more damaged than the other MCP joints. There was a significant negative correlation between the erosion scores of the PIP and MCP joints of each individual digit, when digits with only minimal damage were excluded. These findings support the concept that joint damage in the rheumatoid hand is greater in those joints that are subjected to greater mechanical stresses, and that in any digital ray the damage is concentrated at either the IPI or MCP joint.


Intellectual impairment in multiple sclerosis and its relation to functional abilities. Sixty-four patients with advanced multiple sclerosis were assessed on intellectual and memory tests. They were rated by  occupational therapists on an Activities of Daily Living scale according to their abilities, and by relatives on the same scale, according to what they actually did. Results indicated that the multiple sclerosis patients had intellectual and memory deficits. A few discrepancies occurred between patients' abilities as rated by an occupational therapist and what they actually did as rated by a relative. These discrepancies were not significantly related to memory impairment.


Quantification of joint laxity.

Quantification of joint laxity. We have compared the finger hyperextensometer (Jobbins et al., 1978) and the scoring system of Carter and Wilkinson (1964), modified by Beighton et al. (1973), in the quantification of joint laxity in a population selected to demonstrate a wide range of joint movement. Both systems correlated well (P less than 0.001) with a 'global index' of joint laxity derived by adding the arcs of movement recorded at most joints in the body by the method of the American Academy of Orthopaedic Surgeons (1965). The Carter and Wilkinson system produced better correlations and is the method of choice for assessing generalized joint laxity.


Joint laxity leading to osteoarthrosis.

Joint laxity leading to osteoarthrosis. Joint laxity was compared in 50 females with symptomatic osteoarthrosis and an age-matched control group without osteoarthrosis. Generalized joint laxity measured by the scoring system of Cater and Wilkinson (1964) modified by Beighton (1973) was significantly higher in the osteoarthritic group (X2 = 10.00, P less than 0.05). In osteoarthritics the pattern of clinical joint involvement varied with the degree of generalized joint laxity.


Pain in the neck and arm.

Pain in the neck and arm. The clinical features of eight cases of carcinoma of the bronchus presenting as pain in the neck and arm, arising from a population of 320 000 in eight years, are described. The difficulties in establishing a diagnosis are discussed, and the implications for therapy and management are described. It would appear that carcinoma of the bronchus, whether local, as a Pancoast syndrome, or metastatic, is more common than is realized.


Spinal mobility in the adolescent.

Spinal mobility in the adolescent. The ranges of spinal movement in 390 healthy children aged from 10 to 15 years have been recorded. These measurements are in two planes, anterior and lateral; they are quick and easy to perform and require no special equipment, just a tape measure. Many conditions occurring in childhood can lead to limitation of spinal movement: these include juvenile ankylosing spondylitis, spondylolisthesis, Scheuermann's vertebral osteochondritis, discitis and vertebral fractures, the latter being not uncommon in children receiving prolonged corticosteroid therapy. The purpose of the present paper is to define the normal range for anterior and lateral spinal flexion in adolescents and to correlate these with sex, age, height and weight.


Calcitonin for myositis ossificans.

Calcitonin for myositis ossificans. A case of myositis ossificans, following a hemiparesis due to a cerebral haemorrhage and treated with synthetic slamon calcitonin, is described. An improvement in joint range and a cessation of further ectopic calcification was seen but, because of the remitting nature of myositis ossificans itself, the therapeutic role of calcitonin in this case is unproven.


Serum bile acids (a new advance in the diagnosis of liver disease). Serum bile acid measurements now available by radioimmunoassay have proven to be the most sensitive procedure developed to date to assess diseases of the hepatobiliary system in both adult and pediatric liver disease. Their clinical utility appears to hold particular promise in establishing the early diagnosis of liver disease when conventional liver function test such as SGOT, alkaline phosphatase, bilirubin and albumin are still normal. Serum bile acid determinations have been shown to be particularly useful in the diagnosis of alcoholic liver disease, drug-induced liver disease, viral hepatitis and cholestasis of intra- and extrahepatic origin. In infants, serum bile acid measurements can be used to establish the diagnosis of biliary atresia. When serum bile acids are determined post-prandially, they are the most sensitive indicator of liver dysfunction developed to date.


The indirect measurement of laryngeal and tracheal resistance. We used a body-plethysmograph to determine air-way resistances in 485 cases of laryngeal and tracheal stenoses. We decided in 143 cases to intervene after observing resistance exceeding 60 mm H2O/l and sec. A vocal chord was lateral fixated in 49 patients suffering bilateral recurrent paralysis. Optimal results were obtained at a postoperative resistance level of 30 mm H2O/l and sec (standard value: 14.77+/-6.53--n = 387). The patients could carry out work of medium intensity and had a steady voice. We performed tracheal interventions in 94 cases of tracheal stenoses. A mean, post-operative resistance of 29.9 mm H2O/l and sec, with a tracheal diameter of 7--8 mm was attained. In practice, only a few patients found the remaining obstruction a hindrance during work of maximal intensity. No recurrences were observed after treatment. Airway resistances exceeding 150 mm H2O/l and sec were found in 13 new admissions and 73 times in those undergoing therapy. In these cases asphyxiation threatens. These patients have to be tracheotomized or intubated immediately.


Structural modifications in membrane glycoproteins during the erythrocyte life-span. Erythrocyte membrane glycoproteins undergo various types of modification during the life of the cell in the circulation; when only sialic acid is removed, the younger red cells can be repaired in the liver and return to the circulation. Otherwise, when an autolytic mechanism removing a sialopeptide becomes active as a consequence of the metabolic impairment of the cell, the erythrocyte is probably trapped by the hemocatheretic organs and destroyed.


Methodological aspects of rhinomanometry. Rhinomanometry is an objective method for determining nasal patency; its reliability and relevance as an aid in defining and solving problems connected with nasal obstruction have, however, received scant attention. In the present study more than 200 subjects were submitted to rhinomanometry--most of them only by the posterior technique. In 50 of these subjects duplicate determinations of the pressure drop across the nose at the flow rate of 0.3 l/s were made within a short interval; the coefficient of variation was 20--25 per cent. The rhinomanometric values in a small group showed a day-to-day variation of 55 per cent. Because rhinomanometry allows only a moderate level of accuracy the method is unsuitable for detecting a borderline case. As the influence of the variability of the method is smaller in large materials, rhinomanometry is more suitable for comparison of groups than of individual patients.


Identification of vasopressor constituents of amniotic fluid in pregnancy toxaemia. The vasopressor activity of human amniotic fluid was assessed in 46 primigravidas during the third trimester of pregnancy. The subjects included 20 normal and 26 cases of pregnancy toxaemia. For identification of the vasopressor activity of the amniotic fluid, blood pressure measurements were made in the intact rat, and the smooth muscle contraction of the rat ascending colon preparation was determined in vitro. The samples of amniotic fluid showing vasopressor activity were lyophilized and subjected to gel filtration using Sephadex G-100. The various fractions thus obtained were monitored at 280 nm and the pressor activity was re-estimated. It was observed that most of the pressor activity of the amniotic fluid of the toxaemic patients was capable of causing contraction of the rat colon as well as a significant rise in the systolic blood pressure of the intact rat. Furthermore, this activity was found to be heat-labile and was completely blocked by cinnarizine. Fractionation of the amniotic fluid showing vasopressor activity by gel filtration further substantiated the findings reported above. On the basis of these results it was concluded that the pressor activity of the amniotic fluid was due to the presence of an angiotensin II-like substance. Its concentration was found to be higher in the toxaemic group than in normotensive subjects.


Nasal septal perforations: use of Silastic button in 108 patients. Between June 1972 and November 1977, 108 patients had medical-grade Silastic buttons inserted transnasally into a perforation of the nasal septum. This nonsurgical technique was done as an office procedure with use of 5% cocaine applied topically in 97 of the 108 patients. The Silastic button has remained in place in 70.4% of the patients, with follow-up ranging from 9 months to 6 years. This mechanical device is inserted easily and has reduced crusting and bleeding considerably in many patients. The failures frequently were related to patient intolerance or poor mechanical fit and occurred in the first few days or first few months after insertion.


Prevalence of HBeAg, anti-HBe and Dane particle-associated DNA polymerase activity in asymptomatic carriers of HBsAg. HBeAg/anti-HBe and Dane particle-associated DNA polymerase activity were detected in serum samples from 358 HBsAg asymptomatic carriers found during normal routine screening of 11,200 blood donors (HBsAg prevalence 3.1%). Since virus specific DNA polymerase activity and HBeAg seem to be associated in some way with hepatitis B virus infectivity and liver damage, 5% of the HBsAg carriers examined, as detected by the presence of HBeAg, and 9.5%, as shown by DNA polymerase activity, can be expected to have liver damage and a potential risk of transmitting hepatitis B to contacts. On the other hand, 48% of subjects were theoretically healthy and non-infective because of the presence of anti-HBe in their blood. The differentiation of groups of asymptomatic HBsAg carriers, on the basis of these serological markers, may have important clinical and epidemiological implications.


Phagocytosis and cellular metabolism (a study on mouse and human macrophages in culture). The uptake of foreign particles by mouse and human macrophages influenced by various metabolic inhibitors was examined in order to obtain further informations about the energy-dependent mechanisms which are involved in the phagocytic process. The inhibitors employed were iodoacetate, fluoroacetate, fluoride, malonate, sodium azide, 2-4-dinitrophenol, cycloheximide and ouabain. These substances were tested on monolayer cultures and the phagocytosis assay was performed by using zymosan suspension in the nutrient media. The quantitation of phagocytosis was obtained by the direct count of intracellular zymosan particles (immersion microscopy, 100x) and the results were evaluated and compared by biometrical analysis. The effects of these inhibitors on phagocytosis and their relation with the metabolic intracellular pathways are discussed.


The effects of septal surgery on the growth of nose and maxilla. Experiments in growing rabbits showed the great importance of the nasal septum for the postnatal growth of the facial skeleton. The influence of surgical procedures on the morphogenetic function of the nasal septum was investigated. The effects of unilateral and bilateral elevation of the mucoperichondrium and of submucous resection of various parts of the septal cartilage on the growth of the nose and upper jaw are demonstrated.


Dynamic lymphadenoscintigraphy of the lower limbs (notes on technique and normal findings). The use of dynamic lymphadenoscintigraphy is proposed for the study of the lymphatic flow in the lower limbs. The method is based on the determination of the flow curves of radiocolloid (antimony-sulphide labelled with 99mTc) in the lower limbs, on the time of its appearance in the inguinal lymphatic vessels and in the liver, and also on the recording by periodically repeated photoscans of the progress of the radiocolloid in the pre-lymph node ducts. Thus, the method is suggested for use in the observation of flow variations as an expression of metastatic or systemic lymph node diseases and in the differential diagnosis of lymphatic and venous oedema.


Morphologic aspects of the injured nasal septum in children. Biopsies from the septal cartilage in children have been examined histologically to study the influence of trauma, surgery, septal abscess, and transplantation on the growing cartilage. Loss of cartilage, complete, but mostly incomplete regeneration of the defects are the main reactions. A regenerative potential mainly arising from the perichondrium plays an important factor for restoring the septal structure, often in a deforming and excessive way. Even preserved cartilage implanted immediately into the septal abscess, may be transformed into autogenous cartilage if the perichondrium is preserved.


Internal 131Cs dosimetry.

Internal 131Cs dosimetry. Because of the growing interest in 131Cs as a tracer for myocardium and thyroid scintigraphy, its internal disometry in man was reviewed and determined. The absorbed dose was calculated using the method of Loevinger and Berman, with minor modifications, i.e. taking into account the different activities of the body organs and their contribution to the absorbed dose. Special attention was also paid to the softer and non-penetrating radiations, namely L and M, capture events and Auger electrons, in relation to the decay of the nuclide. Dosimetric data for the thyroid were determined experimentally.


Traumatology of the newborn's nose.

Traumatology of the newborn's nose. Three different types of nasal deformities are described in the newborn: 1. Fixed deviations caused by injury in the prenatal period, which are mainly selfcorrecting. 2. Deviations brought about during delivery, requiring repositioning, and 3. Deformities caused by pressure and moulding of the foetal head, which also require treatment. Methods for the detection of the last two groups are also described.


Septum surgery in children; indications, surgical technique and long-term results. This paper summarizes the author's experience with septum surgery in children from 1963 to 1978. Some 150 children have been operated upon and many of them could be followed up. A septal deformation with breathing problems at rest is an indication for conservative surgery regardless of the patient's age. If there is only breathing difficulty during exercise, other factors (age, external deformity, psyche) play a role in making the decision. Septal deformities without functional complaints are left untouched. The prevention of a growth deformity can be a concomitant factor in deciding whether to operate. Fresh fractures, septal haematoma's and abscesses are undisputable indications for surgery. The surgical technique as used in the two most frequent types of deformation is described. A boy operated upon at the age of 4 was followed-up over a period of 15 years. His nose developed normally until puberty. Then some growth disturbance became apparent.


[CT-evaluation in patients with testicular tumors (author's transl)]. Fifty CT examinations of 31 patients with testicular tumours were evaluated. In 13 patients, the CT findings were compared with results of histological-surgical or autoptic findings. Comparative evaluation of CT, lymphography and other methods of diagnosis is demonstrated. The high incidence (80 %) of correct CT results is emphasised, in staging patients and in the work up of patients with long treatment time and history of tumor recurrence. The advantages of CT are: 1) possibility of exact localisation and determination of tumor-size, as well as discovery and assessment of their patho-anatomic relations to the adjacent organs, 2) utilisation of these data in the planning of radiotherapy, 3) the possibility to document exactly any treatment sucess (reduction of tumor size). In more than 30 % of the patients, CT scanning revealed, despite radiological preliminary examinations, clinically and radiologically unexpected pathologic findings, such as osseous metastases (17%), non functioning kidneys, metastases in the liver and pleura.


[Comments on the problem of demonstrating vertebral bodies in the computer tomogram (author's transl)]. This article emphasises that computer tomography is suitable for disclosing occult destructions in the region of the vertebral column. On the other hand, computer tomography is of great importance for determining the extent of destructions which are already manifest, and any possible spreading of a pathological process in the soft parts to the vertebral column.


[Clear, unclear and significant chest-roentgenograms in relation to the miners of an allied mining operations for bituminous coal (author's transl)]. In the medical center of the Anna mine of the Eschweiler Bergwerksverein 3000 chest-roentgenograms per year are to be diagnosed. Apart from coal workers pneumoconiosis pathological lung findings are rare. In this report 9 lung findings are demonstrated briefly. Differentialdiagnosis and literature are discussed.


[Generally poor definition with oblique incidence of x-rays on the converter (author's transl)]. The article goes into the question of the effective values which must be taken into account with the generally poor definition resulting from oblique incidence of the X-rays on the converter. Particular attention is given to the conditions obtaining in horizontal and transverse tomography, including the spiral or pendular movement of the tube.


Enzymatic sulphation of bile salts in man. An investigation of the occurrence of glycolithocholate sulphotransferase in the human gastrointestinal tract and kidney is described. In addition to in the liver, glycolithocholate sulphotransferase was found in the small intestine, but no activity could be detected in the gastric mucosa, colonic mucosa, or kidney.


Bile-induced chronic gastric ulcer in swine with excised oxyntic gland area. After excision of the oxyntic gland area in seven miniature pigs and cholecystogastrostomy in six of them, two developed chronic gastric ulcers in the gastric remnant. No parietal cells were found in the two pigs with ulcers, whereas small areas with polypoid oxyntic mucosa were found in four pigs without ulcer. The study indicates that bile-induced chronic gastric ulcer can occur in the pig despite the absence of oxyntic cells.


Serum radioactivity of 14C-triolein and 3H-oleic acid ingested in a test meal:a rapid test of pancreatic exocrine insufficiency. A double-tracer technique to estimate lipid digestion was investigated. 3H-labelled oleic acid and 14C-labelled triolein were ingested in a test meal. The serum radioactivity of 3H after ingestion of labelled oleic acid depends on absorption and metabolism of free fatty acids, while serum radioactivity of 14C from triolein, in addition to the former, depends on triglycerol digestion. This study shows that the ratio between 3H and 14C 2h after the test meal gives a good qualitative and quantitative estimation of lipid digestion: the 3H/14C ratio in patients with maldigestion is significantly higher than for normals (P less than 0.01), the predictive value of the 3H/14C ratio in the diagnosis of maldigestion is high, that of a positive result being 1.0 and that of a negative 0.93, and quantitatively the 3H/14C ratio shows a highly significant correlation with faecal fat (P less than 0.001). The test is very easy to perform, lasts for only 2 h, and is without discomfort to the patient or nursing and laboratory staff. It gives information like or superior to that of faecal fat measurement.


Faecal excretion of intravenously injected 14C-cholic acid in patients with conventional ileostomy and in patients with continent ileostomy reservoir. Bile salt absorption, as determined by the faecal excretion in i.v. injected 14C-cholic acid (FBS) was studied in 13 ileostomy patients before and after conversion to Kock's continent ileostomy reservoir. The result was compared with that obtained in 8 ileostomy patients in whom about 50 cm of the terminal ileum has also been removed. As compared with 16 healthy controls, FBS was moderately increased in the conventional ileostomy patients, but still within normal limits. After conversion to ileostomy reservoir all patients had pathological FBS, although less severe than in the ileostomy patients with ileal resection. Bacterial contamination probably contributes more than the structural mucosal changes to the bile malabsorption in the pouch, whereas reduced mucosal surface and short small-intestinal transit time are the main causes of malabsorption in ileostomy patients in whom an appreciable amount of the terminal ileum has been resected.


Arterial oxygen tension changes in elderly patients undergoing upper gastrointestinal endoscopy. I. Possible causes. Measurement of arterial oxygen tensions in elderly patients undergoing upper gastrointestinal endoscopy and in a matched control group undergoing colonoscopy showed a slight but significant fall in the PaO2 in both groups following premedication. The initial fall in PaO2 was probably due to the intravenous atropine, diazepam, and meperidine, mainly the latter. This fall of the oxygen tension continued in the gastroscopy group until the instrument was removed, while the controls rapidly returned to basal levels. This persistently reduced PaO2 in the former group is therefore most likely due to the physical presence of the endoscope in the pharynx. To minimize the occurrence of hypoxemia during gastroscopy, narcotics should probably not be used in the premedication of elderly patients. The procedure should be carried out after optimal oxygenation of the patient and be of short duration, and a narrow instrument may be useful in this group.


Protection by trimipramine against gastric mucosal barrier dysfunction induced by ethanol + HC1 in rats. The effects of trimipramine (5 mg . kg-1 . h-1 intravenously) on the changes in gastric mucosal function evoked by 20% ethanol + HCl has been stuided in rats. The magnitude of the changes in potential difference, ionic fluxes (H+, Na+, and K+), and mucosal lesion score induced by ethanol + HCl were significantly less in animals treated with trimipramine than in control animals. It is concluded that trimipramine decreases the gastric mucosal damage produced the ethanol + HCl in rats. This activity may be responsible, at least in part, for the beneficial effect of trimipramine treatment in peptic ulcer disease.


Improved transvenous liver biopsy needle. A modified type of the standard transvenous cholangiography biopsy needle is described. The modified tranvenous liver biopsy needle caused only minimal artefactual changes of the liver biopsy specimens. The new type of biopsy needle is a modified Menghini needle. The conventional Menghini needle should be avoided for transvenous catheter biopsies because of risk of leaving catheter fragments in the liver.


The value of preoperative S-LD 5 isoenzyme determination in predicting the risk of serious liver injury after bypass operations for treatment of obesity. After bypass operations for obesity many patients had signs of liver injury (SLI). It has not earlier been possible to correlate changes in the preoperative liver function test with occurrence of postoperative SLI. The present study shows that those patients who before the intestinal bypass operation had a moderate to significant change in serum activity of S-LD 5 (isoenzyme 5 of the enzyme lactate dehydrogenase) were at risk of developing SLI after the operation. All five patients with SLI, of whom three died, preoperatively had an increase in S-LD 5 exceeding five times the normal mean value. The pattern in the transaminases and serum alkaline phosphatase were not as conclusive.


Effect of deglycyrrhizinated liquorice on gastric mucosal damage by aspirin. Gastric mucosal damage induced by giving 60 mg aspirin orally to rats was reduced by simultaneous administration of 100-500 mg deglycyrrhizinated liquorice. Human faecal blood loss induced by 975 mg aspirin orally three times a day was less when 350 mg deglycyrrhizinated liquorice was given with each dose of aspirin.


Dysphagia after proximal gastric vagotomy. Ten patients were examined before and after proximal gastric vagotomy with videotape recordings of barium passage in esophagus, esophageal pressure recordings, and the insulin test. Four of the patients complained of dysphagia after the operation. The dysphagia subsided spontaneously after 1--2 months. Patients with dysphagia showed dilatation of the body of the esophagus and a tapered narrowing in the distal segment. The pressure recordings showed increased frequency and strength of rhythmic pressure waves compared with the preoperative findings. Our results support the theory of a neuromuscular dysfunction.


Inhibition of gastric acid secretion by pirenzepine (LS 519) in man. Pirenzepine is a new tricyclic drug used in the treatment of peptic ulcer disease. The effect of two doses of pirenzepine (25 mg twice daily and 50 mg thrice daily) was examined in ten healthy volunteers during basal acid secretion and under stimulation with two doses of pentagastrin (0.166 microgram/kg . h and 1 microgram/kg.h given as continuous intravenous infusion). Serum drug concentrations were determined by radioimmunoassay, and parallel studies of the salivary function were performed. Pirenzepine, 25 mg twice daily, reduced basal acid output by 50% and 55%, respectively, and inhibited stimulated acid output by 31% and 26%, respectively. The higher dose of pirenzepine, 50 mg thrice daily, augmented the effect insignificantly despite markedly increased serum drug levels. The recommended therapeutic dose of 25 mg twice daily gave no salivary inhibition. Pirenzepine may have an anticholinergic effect on the parietal cell, although systemic side effects were not seen. Pirenzepine does not competitively inhibit pentagastrin-stimulated acid secretion.


The effect of pirenzepine on basal, pentagastrin- and insulin-stimulated gastric acid secretion in patients with peptic ulcer disease. The effect of pirenzepine on basal and stimulated acid secretion was tested in five patients with peptic ulcer disease and gastric hypersecretion. Two types of stimulation were compared, namely pentagastrin by intravenous infusion (1 microgram/kg/h) and hypoglycaemia induced by insulin given subcutaneously (0.125 IU/kg). Basal acid output/30 min was reduced by 44% and 69%, respectively. Pentagastrin-stimulated acid output was reduced by 30%/120 min, and insulin-stimulated acid output by 47%. The reduction was similar during the first and second hour of stimulation in both series. These results strengthen our previous impression that pirenzepine may interfere with cholinergic receptors at the parietal cell level. As the inhibition of gastric acid secretion by pirenzepine is similar to that produced by oral doses of cimetidine, pirenzepine may be useful in the treatment of peptic ulcer disease.


Aspirin damage to ischemic gastric mucosa in shocked cats. Cardiac output and blood flow to different regions and layers of the stomach were determined by the microsphere distribution technique. Aspirin tablets were placed in the stomach of anesthetized cats by gastrotomy. In some animals the arterial pressure was reduced to about 60 mmHg for 30 min by bleeding. The gastric mucosal blood flow decreased markedly during the bleeding. Three hours after reinfusion of the blood gastric mucosal erosions were present at the site of contact of the tablet with the mucosa. In most of the non-bled animals no mucosal lesions were found 4 1/2 after aspirin application. No mucosal damage occurred in animals subjected to bleeding without aspirin treatment. It is concluded that the aspirin damage to the gastric mucosa increases under hemorrhagic shock because of mucosal ischemia in the shocked animals.


Activation of the bactericidal capacity of polymorphonuclear granulocytes after surgery, measured with a new in vitro assay. A classic in vitro polymorphonuclear (PMN) granulocyte bactericidal system was used alongside a newly developed modification to see whether the new assay would increase the possibility to detect a stimulation of PMN bactericidal functions. In the new assay each granulocyte was provided with 30--40 bacteria, which is quite close to the maximal killing capacity (usually 60 bacteria per PMN). Granulocytes were obtained from 8 patients the day before, the day after and 2 d after they underwent thoracotomy with cardiopulmonary by-pass (CPS). The granulocytes from all patients showed an increased capacity to kill Staph. aureus in vitro 2 d after the operation, compared to before, when the submaximal bacterial concentration per granulocyte was used, whereas no change was observed with the standard bacterial concentration (3--4 bacteria per granulocyte). Thus, the new assay might make it possible to observe an enhanced PMN bactericidal ability.


Oscillations of granulocytic and megakaryocytic progenitor cell populations in cyclic neutropenia in man. The concentration of granulocytic progenitor cells in the bone marrow of 2 patients with cyclic neutropenia was assessed at intervals during the cycle. Syncroneous oscillations were observed for cells forming neutrophilic and megakaryocytic colonies in diffusion chambers in vivo (CFU-D), suggesting a close relationship between the two cell types. However, an almost reverse relationship was observed between CFU-D and cells forming colonies in agar culture in vitro (CFU-C), which cycled out of phase with CFU-D. This supports the concept that CFU-D and CFU-C denote different cell types.


Deoxyuridine metabolism in human megaloblastic marrow cells. Despite the clinical use of the 'deoxyuridine suppression test' to document vitamin B12 or folate deficiency its biochemical basis is unclear and currently disputed. Because of this the metabolism of deoxyuridine in marrow cells has been examined. In normoblastic marrow cells the ratio of radio-labelled deoxyuridine to thymidine incorporation into DNA approximates one and preincubation of cells with unlabelled deoxyuridine results in progressive reduction of uptake of both radio-labelled deoxynucleosides. In the same cells methotrexate significantly reduces the DNA incorporation of deoxyuridine but not that of thymidine. In megaloblastic marrow the ratio of radio-labelled deoxyuridine to thymidine uptake is less than one and the reduced deoxyuridine uptake is not significantly altered by either cyanocobalamin or folic acid. With megaloblastic samples the reduction by deoxyuridine of radio-labelled deoxyuridine uptake is less marked than that observed with normoblastic cells and to achieve similar results requires folic acid. These findings suggest that reduced deoxyuridylate conversion to deoxythymidylate by thymidylate synthetase is appropriate to explain the 'deoxyuridine suppression test' in megaloblastic marrow cells and that altered substrate requirements for this activity  may occur in megaloblastic cells.


Acquired stomatocytosis in alcoholic liver disease. The occurrence of transient stomatocytosis observed on peripheral blood smears and by scanning electron microscopy, was studied in 100 alcoholic patients admitted to a general medical ward. 15% of the patients manifested marked stomatocytosis, i.e. 10% or more of the cells being stomatocytes and a further 29% had slight stomatocytosis (3--9%). All patients with marked stomatocytosis had a daily average ethanol ingestion of 100 g or more, and had also more pronounced histological and biochemical evidence of alcoholic liver disease than those lacking stomatocytosis. MCV was significantly higher in these patients, but there were no differences in Hb, serum B12, folate, cholesterol or triglyceride levels. The stomatocytosis subsided gradually during 4--6 weeks of abstinence. Triconcave cells (knizocytes) were observed in 2 patients with terminal alcoholic liver disease. Along with an increased MCV, the presence of stomatocytosis may be a useful erythrocyte indicator of alcoholic liver disease.


An intestinal receptor for heme.

An intestinal receptor for heme. Porcine upper small intestine took up radioactive heme in vitro. The binder was localised to the brush borders, was solubilized with Triton X-100 and bound heme with high affinity. The binding was inhibited with non-radioactive heme but not with FeSO4, and control experiments indicated that it was not any of the known heme binders or aggregated heme. The binding factor could also be solubilized from human duodenum.


Phagocytic potential of hairy cells.

Phagocytic potential of hairy cells. The hairy-cells (HC) of 10 patients with hairy-cell leukaemia were studied with several techniques to evaluate their phagocytic potential. Mononuclear cells from normal donors and from patients with acute monocytic leukaemia served as controls. Light microscopically HC seemed to have ingested bacteria or latex particles. Treatment of the cells with lysostaphin, an enzyme that kills extracellular Staphylococcus aureus, showed that almost all 'ingested' bacteria were extracellular. Lanthanum nitrate, added during the fixation procedure for electron microscopy, stained both the outer cell membrane and the membranes of the 'phagosomes' of the HC, also indicating that the 'ingested' particles were extracellular. HC showed no increased oxygen consumption on exposure to bacteria in the presence of serum. Furthermore, HC showed no lysozyme or peroxidase activity, whereas non-specific esterase activity was much weaker than in monocytes. These findings, which show that HC are essentially non-phagocytic, constitute strong evidence against a monocytic origin of the malignant cells of hairy-cell leukaemia.


Quantitative evaluation of the mechanisms of the anaemia in heterozygous beta-thalassaemia. Ferrokinetic studies were carried out in 8 patients with heterozygous beta-thalassaemia with anaemia of varying severity. Effective and ineffective erythropoiesis, mean red cell lifespan and non-erythroid iron turnover were estimated from the experimental data through a mathematical model of iron kinetics. Erythropoietic activity was markedly increased in all patients, but was variably ineffective (from 10 to 74%). A negative correlation (r = 0.855, P less than 0.01) was found between the amount of ineffective erythropoiesis and Hb level. Red cell lifespan was variably shortened and there was a negative correlation between the degree of daily peripheral haemolysis and Hb level (r = 0.733, P less than 0.05). Non-erythroid iron turnover was increased in most patients. The results provide quantitative measurements of the mechanisms responsible for the wide variation of the Hb level in heterozygous beta-thalaeeaemia. Ineffective erythropoiesis seems to be the major reason for the anaemia. Peripheral haemolysis contributes to it, especially in the most severely affected patients. The increased non-erythroid iron turnover may be responsible for the pathology which characterizes heterozygotes in the adult life.


Effect of human serum from patients with haematological disorders on mouse pluripotent haemopoietic stem cells (CFU-S). Sera from 25 individuals (9 healthy subjects, 6 patients with systemic lupus erythematosus, and 10 patients with a variety of haematological disorders) were tested for anti-CFU-S by incubating suspensions of mouse marrow cells with serum and then assaying the cell suspensions for their capacity to form spleen nodules in lethally irradiated mice. The sera from 2 patients (1 with a preleukaemic disorder and the other with a malignant 'histio'-lymphoproliferative neoplasm) had anti-CFU-S activity which behaved like antibodies, rather than like the non-specific cytotoxic activity found in various sera for heterologous tissues, which in the past has been attributed to 'natural antibodies' and which, in recent years, has, in some cases, been found to be related to activation of the alternative pathway of complement. The anti-mouse tissue activity in the sera of the 2 patients may be related either to cross-reactivities between certain mouse and human tissues or to cross-reactivities between exogenous agents such as bacteria and mouse tissues.


Erythropoietin in patients with anaemia in rheumatoid arthritis. Iron status and erythropoietin (Ep) level in serum and urine were determined in 30 patients with anaemia in rheumatoid arthritis. The anaemia in these patients was mild and fulfilled the criteria for anaemia of chronic disorders. The iron status of these patients differed from the iron status in patients with sideropenic anaemia. Serum Ep, level, measured indirectly by the polycythaemic mouse bioassay, was either not detected or when detected it did not correspond to the degree of anaemia. The data suggest that the failure to produce sufficient amount of Ep, among other causes, could be important in the pathogenesis of anaemia in rheumatoid arthritis.


Biochemical studies in Hermansky-Pudlak syndrome. In order to find the basic defect in the Hermansky-Pudlak Syndrome (HPS), biochemical studies of platelets and leucocytes were undertaken. Glutathione levels of platelets were normal and regeneration of GSH similar to controls occurred after incubation with diamide (a specific agent for GSH oxidation). Phospholipid and fatty acid composition of HPS platelets was normal. The amount of peroxides found in platelet membranes was not elevated. A subnormal aggregation with arachidonic acid could be obtained in PRP using a high concentration of arachidonic acid (2 mM), but normal malondialdehyde levels were measured, suggesting a normal prostaglandin synthesis in HPS platelets. Glutathion peroxidase and p-phenylenediamide-mediated peroxidase (PPD-peroxidase) were normal in leucocytes of 1 HPS patient. Lysosomal enzymes as far as investigated were normal.


Triamterene-induced immune haemolytic anaemia with acute intravascular haemolysis and acute renal failure. Acute intravascular haemolysis and renal failure developed while a patient was taking triamterene. A direct antiglobulin test with a polyvalent reagent was positive. Serum caused agglutination of normal red cells in the presence of triamterene and caused an increase of partial haemolysis of both trypsin-treated erythrocytes and red cells from a patient with paroxysmal nocturnal haemoglobinuria (PNH) in the presence of complement. From the results of antibody-neutralization test and treatment with 2-mercaptoethanol, the presence of IgM antibody with lambda light chain could be demonstrated. The triamterene seemed to bind strongly to the red cells in vitro but in vivo there was no detectable adsorption to red cells. Haptenic inhibition was not demonstrated. From these results, it was assumed that this antibody was found to cross-react with methotrexate which has a structure similar to that of triamterene.


Preparation of platelet suspensions from whole blood in buffer. Description of a method which gives a large platelet yield. A simple method for preparation of platelet suspensions from whole blood in buffer is described. The platelets and a fraction of the erythrocytes are processed simultaneously, whereby the erythrocytes serve as a supporting cushion in the centrifugation steps. Using this earlier described principle of platelet separation, platelet yields of 90--100% from whole blood could be achieved. Investigations of platelet aggregation and platelet morphology indicate that this method of separation is gentle. By obviating the selection of certain platelet populations this may facilitate the interpretation of the results of in vitro and in vivo platelet-function studies.


Heterogeneity and mechanism of action of human natural killer lymphocytes: differential distribution of receptors for Helix pomatia haemagglutinin (HP receptors). Neuraminidase-treated lymphocytes from the peripheral blood of normal human donors were fractionated on columns charged with Helix pomatia haemagglutinin (HP) coupled to Sepharose 4B. While lymphocytes lacking HP receptors (HP-) passed directly through the column (fraction I), lymphocytes with HP receptors (HP+) were subsequently eluted in two distinct fractions with two different concentrations of the competitive hapten N-acetyl-D-galactosamine (fraction II and III, respectively). The natural cytotoxicity of these lymphocytes to various tumour target cells (K562, T24, MANO, HCV29) was tested in a 51Cr release assay. Natural cytotoxicity was found in all three fractions recovered from the HP columns. In general, the cytotoxicity of the lymphocytes in fractions I and II was significantly enhanced over that of the unfractionated lymphocytes. Surface marker analysis and fractionation studies indicated that natural cytotoxicity in these target systems is exerted by both HP+ and HP- lymphocytes bearing Fc receptors for IgG. Since the HP receptor is considered to be a marker to T lymphocytes, the findings suggest that a significant fraction of these NK cells may be of T-cell lineage. The surface marker profiles of these NK cells are very similar to those of antibody-dependent K cells. Addition of Fab fragments of immunoadsorbent-purified rabbit antibodies to human immunoglobulin inhibited the natural cytotoxicity of HP-column-fractionated lymphocytes to various degrees, indicating that part but not all of it reflects antibody-dependent K-cell reactions. Since cytotoxicity in all three HP fractions was inhibitable in this way, the results suggest that immunoglobulin-dependent natural cytotoxicity may be displayed by both HP+ and HP- effector cells.


Reduced in vitro response of CSF lymphocytes to mitogen stimulation in multiple sclerosis. By means of a microculture technique and calculation of incorporation of 14C-thymidine, cerebrospinal fluid (CSF) lymphocytes from multiple sclerosis (MS) patients showed low or absent proliferation when stimulated with phytohaemagglutinin, concanavalin A, or pokeweed mitogen, in contrast to peripheral blood lymphocytes (PBL) obtained simultaneously and investigated in parallel. A lower proliferation of CSF lymphocytes compared with PBL was also found in acute aseptic meningitis, although it has been reported that CSF lymphocytes show greater proliferation than PBL when specifically stimulated. The low proliferation of MS CSF lymphocytes on mitogen stimulation may be a consequence of prolonged sensitization to an as yet unidentified antigen. The proliferation of MS CSF lymphocytes was not improved by adding irradiated PBL, making helper cell insufficiency less likely. MS CSF had no inhibitory effect on proliferation of PBL, arguing against an inhibitory effect of soluble factors in the CSF as an explanation for the depressed response of CSF lymphocytes.


[Institutional therapy. Psychiatry and penitentiary problems. Introduction]. The author relates the history of the institutional therapies which have been developed, mainly since 1929, by Hermann Simon. This avant-garde psychiatrist has not only developed the occupational therapies but he has also recommended both the liberalization of the institution and the constant analysis of its problems. The institutional therapies have the tendency, nowadays, to increase infinitely but their choice is not always logically motivated and their use risks being not very useful, if it is not determined by a clear therapeutic plan regarding the patient and by a well defined therapeutic attitude in the institution. The author introduces then the second subject of the discussion: "Psychiatry and penitentiary problems" by recalling the difficulties of the modern psychiatry to abandon its origins and to get rid of the asylum ghetto. This is probably the reason why most of the psychiatrists elude the psychological and psychiatric problems presented in prison and why they avoid every collaboration with the judicial and administrative authorities. Delicate situations, which call the psychiatrists into question by posing them problems of freedom, human rights, justice and social demands.


[Social-therapeutic institution: illusion or reality?]. This report examines the theoretical, practical and judicial ideal underlying the basic foundations of penal institutions, with special reference to the German Fed. Rep. The author points out the reasons of failure of such institutions, as conceived by the 2nd revision of penal law. To date, all efforts to improve such institutions have remained fruitless. Nevertheless, the subject has generated a certain number of discussions which have resulted in more human conditions of emprisonment.


[Multiple therapy (complementary therapy)]. The term "Multiple therapy" is used to describe the combined use of more than one therapist for one patient following a preconceived plan (German: "Komplementärtherapie"). Combined with dynamic ward groups this approach intensifies the impact of short term in-hospital treatment. The purpose of this strategy is to fragment the patient's defenses, to shorten the therapeutic process and to prime and prepare the patient for ambulatory treatment after discharge. The employment of Multiple therapy in a hospital minimally necessitates workable interpersonal relationships between the members of the team, intensive supervision to prevent countertransference problems and a compatible point of view regarding the goal of treatment amongst the staff. All therapeutic methods, new or old, are in the final analysis nothing else than what the word connotes: a method, a means to an end. They never represent the way itself. The quality of psychiatric therapy and treatment does not depend upon the method, be it multiple therapy, individual analytic therapy, one of the non-verbal methods used or any other. What really counts is 1) whether the method is used by a team which truly wants to cooperate for the benefit of the patient, transcending their own ego demands, 2) whether it really improves interpersonal communication. Every psychiatric patient is somehow alienated and removed from his fellow men. Therapeutic methods employed at the hospital are valid if they facilitate to bridge this gap. If that is achieved, therapy can be considered successful. If not, such approaches merely represent meaningless occurrences which at best foster an illusion that "something really happened". That is not the same as when we see the beginning of a healing process. The therapeutic atmosphere in the hospital is meant to create a climate wherein a natural innate healingpower of man will be liberated. The Romans knew it already: Medicus curat, natura sanat.


[Treatment and resocialization of sexual delinquents by anti-androgen and psychotherapy]. The author presents the results obtained in the treatment of 40 sexual offenders receiving antiandrogens as well as psycho and sociotherapy. The paper covers the following topics: pathogenesis of sexual perversion, choice of treatment, therapeutic methodology (with particular reference to the above-mentioned combined treatment), duration of the treatment (long-term therapy), problems concerning provisory liberation and the continuation of treatment in ambulatory, prognosis, therapeutic results. The majority of these inmate-patients were treated for a period of 2 to 4 years. For 27 individuals, treatment was considered terminated after 3 to 6 years. The therapeutic results of the above-mentioned group were considered very good, that is: to date, 70% did not suffer relapse. Only 7 individuals out of these 27 relapsed and all within their first year of treatment. Thirteen out of 40 are still undergoing treatment (1 to 4 years). The majority have been liberated and continue being treated in ambulatory.


[Realta Institution in the eastern Swiss agreement on punishment and sentences]. The coming into effect of the Swiss Penal Code in 1942, marked a decisive step toward the protection of rights in our country. The agreement of Eastern Switzerland on the executive of sentences is based on article 383, paragraph 2 and it establishes that cantons may pass agreements on the common management of their institutions. The following cantons have joined in the above-mentioned convention: Zurich, Glaris, Schaffhouse, both Appenzells, St-Gall, Thurgovie and the Grisons. These cantons share different tasks related to the executive of sentences. The prison of Realta, in the canton of the Grisons, allows special imprisonment (art. 42), when sentences may be carried out in open prisons. In 1978 the canton of the Grisons has marked a new prescription concerning imprisonment which takes into account all the requirements of the European convention on Human Rights and the Swiss Penal Code. Partial imprisonment is possible when the execution of a full-time sentence has been refused. A qualification system has been introduced which is essentially based on the work and behaviour of residents. Employment of free time, tolerance to imprisonment, contact with the outside world, disciplinary punishments, the possibility to lodge complaints, all of these aforenamed situations conform to clear regulations.


[Film work of an autonomous group of patients]. For the past 16 years an autonomous group of patients has been making films at the university psychiatric clinic in Lausanne. A professional technician is available for consultation on technical problems, but strictly refrains from intervening in the creative work proper. In this way authentic documents emerge dealing with the group's collective experience, whilst each participant is conscious of his personal involvement in the enterprise. There is a discussion of the various therapeutic aspects of this kind of group work.


[Comparative catamnestic investigations concerning the psychological effects of sterilisation (author's transl)]. In a comparative catamnestic study the emotional working-through of sterilisation in 3 groups of 33 women was examined (duration of catamnesis: 10-12, 5, 2 years). Whereas in all the 3 collectives the upper lower class (according to Bolte) is represented the most frequently (58% in the 1st and the 2nd, 52% in the 3rd), as far as the lower middle class is concerned there is a higher fraction in the 3rd collective (p less than 0,05) and of the middle class there is a higher fraction in the collectives 1 and 2 (p less than 0,05). Women with a higher income (p less than 0,01) and with a better school and professional (p less than 0,05) training are overrepresented in the 2nd and 3rd collective. In the 3rd group only 6% indicated a religious bond, in comparison to 55% in the 1st and 49% in the 2nd group (p less than 0,01). Women of the 2nd and the 3rd collective were in comparison to those of the 1st group older (p less than 0,01) when they were sterilised, and had less children (p less than 0,05-0,01). In the 3rd group there were more divorced women (18%) in comparison to 3% in the 2nd and 0% in the 1st group (p less than 0,01). Concerning the indication for sterilisation medical-psychiatric causes were preponderant with 42% in the 1st group in comparison to 24% in the 2nd and 18% in the 3rd group (p less than 0,01), whereas in the 2nd group (61%) the social indications were predominant. The immediate cause for sterilisation was represented in the 2nd and the 3rd collective preponderantly by the desire to replace the hormonal contraceptives (p less than 0,01). The 1st collective mainly used insecure contraceptive methods before the operation, the 2nd and 3rd principally hormonal methods (p less than 0,01). In the 1st group it was mainly the insecurity of the method, in the 2nd and the 3rd there were more frequent side effects or contraindications (p less than 0,01), which caused the dissatisfaction with the anticonceptive method. The 3 groups differed significantly concerning the catamnestic evaluation of sterilisation. 100% of the last, 94% each of the 2nd and 3rd were satisfied concerning the sterilisation. To the question of working-through of sterilisation concerning psychic, somatic and especially sexual effects, most of the women in all the 3 groups responded favourably.


Joint involvement in systemic sclerosis. Eleven out of 24 patients with systemic sclerosis had radiological features of inflammatory polyarthritis. Juxta-articular osteoporosis was present in 9 patients, erosions in 5 and loss of joint space in 6 patients. Only one patient had a positive rheumatoid factor. Titres of rheumatoid factor, anti-nuclear factor, and plasma viscosity were comparable in patients with and without radiological abnormalities. Measurements of grip strength and finger-palm flexion also were similar in the two groups. However, in individual cases joint or tendon sheath disease was associated with loss of function.


Synovial fluid and serum hydroxyproline fractions in rheumatoid arthritis. In rheumatoid arthritis (RA) the synovial fluid lymphocyte count closely parallels the synovial fluid dialysable hydroxyproline, a marker of collagen resorption. This observation stresses the primordial role of lymphocytes in RA joint injury. The actual and eventually potential destruction of any single joint, as expressed by synovial fluid dialysable hydroxyproline levels, seems to reflect the general picture of disease activity as evaluated by the number of active joints (joint count), ESR and rheumatoid factor titres (latex fixation). Although urinary hydroxyproline levels are generally within the normal range in RA, they can be used as index of articular tissue destruction and as a parameter of overall disease activity when groups of patients are studied longitudinally in detail. The present study sheds no further light on the significance of synovial fluid and blood non-dialysable hydroxyproline levels.


Rheumatoid arthritis in a Norwegian community (Jondal). A study based on the local doctor's file. This study of rheumatoid arthritis has been made in Jondal, Norway, on 803 persons between the ages of 16 and 75 years. Patients suspected of suffering from joint disease other than traumatic lesions were selected from the general practitioner's file, and further information on these patients was obtained from the local hospital and from personal interviews. It was found that 0.5% of the men and 1.2% of the women suffered from rheumatoid arthritis. Six persons (0.7%) fulfilled the ARA criteria for classical and definite rheumatoid arthritis, one fulfilled four criteria (probable RA). However, only 0.4% of the investigated population had more severe disease.


Dermatomyositis associated with BCG vaccination. Two young boys developed serious forms of dermatomyositis following BCG vaccination. Possibilities of a causal relationship between the disease and the vaccination are discussed. Extensive immunological tests, however, including in vitro stimulation of lymphocytes with PPD, gave no decisive evidence of abnormalities. It is concluded that in cases of dermatomyositis there is an absolute indication for a full anamnesis with regard to previous vaccination, to obtain clarification of the practical and theoretically important questions of a possible connection in this respect.


Psychosocial readjustment in the spouses of aphasic patients. A comparative Survey of 79 subjects. The study set out to investigate readjustment to disability on the part of spouses of patients disabled by a cerebrovascular accident and to elicit the particular problems faced by the spouse of an aphasic patient. In a sample of 79 subjects, spouses of aphasic patients showed evidence of significantly poorer overall social adjustment then spouses of non-asphasic patients. The areas that were particularly impaired were social and leisure activities and marital relationships. In the marital area aphasia appeared to be particularly disruptive and the marriages were characterised by problems of interpersonal communication, diminished sexual satisfaction and loss of partnership. There was a raised incidence of minor psychiatric disorder in all spouses and again this was more pronounced amongst the spouses of aphasic patients.


Independent exercises versus physiotherapy in nondisplaced proximal humeral fractures. 42 patients with undisplaced, proximal humeral fractures were randomly assigned into two groups in order to compare the results of instruction to the patient for independent exercises and conventional physiotherapy. No differences appeared between the groups subjectively or as regards functional parameters at 1 as well as at 3 months after the fracture and at a follow up more than 1 year later. As no disadvantage could be found instructions to the patients should in these cases be regarded as a satisfactory after-treatment.


Assessment of gait disability in hemiplegics. Hemiplegic gait. A clinical method of recording gait patterns in patients with hemiplegia is described. The method is directed towards obtaining an objective assessment for research purposes primarily but could also be readily used clinically. The basis of the method is a pathway from which one can obtain measurements of the temporal and distance factors of gait. The data so obtained is processed to produce a comprehensive set of results presented in a readily understandable form. Sample results are illustrated and explained. Possible system improvements and applications are discussed.


Plasma concentrations of lidocaine during inhalation anaesthesia for fiberoptic bronchoscopy. The plasma concentration of lidocaine and its metabolite, mono-ethyl-glycine-xylidine, was measured furing fiberoptic bronchoscopy (FB) using an ultrasonic nebulizer to achieve topical anaesthesia. Most patients received additional anaesthesia of the laryngeal region and the tracheobronchial tree during the procedure. The achieved plasma concentrations showed that a substantial amount of lidocaine was absorbed, but toxic plasma levels were not reached. Lidocaine plasma concentration above the therapeutic range for treating cardiac diseases was observed in one patient. The use of an ultrasonic nebulizer with lidocaine before FB seems to give sufficient local anaesthesia and to be a safe method.


Density dependence of the maximal expiratory flow volume curves in normal and asthmatic children. We have studied the maximal expiratory flow volume curves with air and with an 80% helium-oxygen mixture, using 12 normal and 33 asthmatic children chosen according to clinical, functional and immunological criteria. In the normal children, the average delta Vmax (difference between the maximal flow in HeO2 and in air at corresponding lung volumes) was 49% and was similar from 60% to 20% of vital capacity. The iso flow volume (lung volume level at which the HeO2 and air flow volume curves intersect) was 3% of vital capacity. Eleven of the asthmatics were non-responders to the helium mixture (no significant differences in flow between HeO2 and air curves), five at 50% and 25% VC and six at only 25% VC. The other 22 asthmatics were responders, but nine of them showed a rise of the iso flow volume. Eight subjects showed no obstruction according to the flow volume curves in air; three of these had an abnormal response to the helium mixture. All the non-responders at 50% VC and half of the non-responders at 25% VC had a clinical history of recurrent infections. These results suggest, firstly, that when there is no history of recurrent infections, the site of obstruction in asthmatic children is mainly central. This does not exclude a coexisting peripheral obstruction which could persist after recovery of the central component. Secondly, by studying the HeO2 response at 25% VC, we can get more information than by measuring only the delta Vmax50 or iso flow volumes.


Effect of inspired volume on airway closure in relation to age. Closing volume (CV) was measured in 64 healthy subjects aged 18--76 years, in supine position, with a bolus (helium) technique in two ways: following a maximal (CV100) and a submaximal (=50% VC; CV50) inspiration from residual volume. With increasing age CV50 increased less than CV100 according to the equation CV100(%VC)-CV50(%VC)=0.13Xage-0.6(r=0.46, P less than 0.001), e.g. at 70 years of age CV100=32(%VC) and CV50=24(%VC). Therefore, during normal breathing elderly subjects to not presumably close airways at as high a lung volume as predicted from conventional CV-measurements. A strong correlation between CV50 and CV100 was found, CV50(%VC)=0.55XCV100(%VC)+5.3(r=0.90; P less than 0.001), thus allowing a more accurate prediction of CV50 from CV100 than from age. Neither smoking habits nor body position affected the decrease of CV with reduced inspired volume.


Familial diffuse interstitial pulmonary fibrosis associated with oculocutaneous albinism. Report of two cases with a family study. Two female patients with familial diffuse fibrosing alveolitis associated with oculocutaneous albinism are presented. A family study was carried out and two other female patients with oculocutaneous albinism and pulmonary disease were detected. Clinical, radiological and histological features are highlighted and the results of treatment discussed.


Mortality and autopsy rate for respiratory diseases in Finland in 1955--1973. Mortality from respiratory diseases in Finland in 1955--1973 was investigated using the official statistics and original death certificates. Total mortality from respiratory diseases in men was significantly higher than in women. Total respiratory mortality in men has increased slightly since 1963, whereas in women it decreased between 1955 and 1963 but has since remained almost constant. Mortality from lung cancer increased in men constantly in the years 1955--1973, but this was not found in women. Mortality from obstructive lung diseases in men increased slightly between 1955 and 1969 but not since. This increase was recorded only for the elderly whereas the opposite trend was found in younger people. The number of deaths from pneumonia decreased between 1955 and 1963. After 1963 these deaths increased again but only in the older age groups. Mortality from pulmonary tuberculosis showed a steady decrease. In 1973 the autopsy rate was 80.6% in pneumococcal pneumonia, 65.6% in pulmonary embolism, 48.1% in bronchiectasis, and 47.0% in pulmonary tuberculosis, exceeding significantly the mean national autopsy rate which was 38.3%. This might mean that at least some of these respiratory diseases are underdiagnosed clinically as the performance of an autopsy seems to increase their relative proportion in mortality statistics.