Growth and differentiation of aggregating fetal brain cells in a serum-free defined medium. Aggregating cultures of mechanically dissociated fetal brain cells provide an excellent system for neurobiological studies of cellular growth and differentiation, but, in common with almost all culture systems, they have the disadvantage that crude serum is required in the medium. Although several cell lines have either been adapted to serum-free conditions or grown normally in serum-free media supplemented with hormones, trace elements and defined serum components, this approach has never been applied to differentiating primary cells of the central nervous system. We now describe the successful cultivation of aggregating fetal rat brain cells in a chemically defined, serum-free medium.


Relationship between sister chromatid exchange and mutagenicity, toxicity and DNA damage. Reciprocal exchanges of DNA in sister chromatids (SCEs) are induced by various carcinogens and mutagens, although the quantitative relationship between the number of mutations and SCEs induced varies among chemicals. Nevertheless, the analysis of SCE production by various agents is often proposed as a sensitive and quantitative assay for genetic damage of the sort leading to mutation and cancer. In V-79 Chinese hamster cells we have been measuring DNA damage by alkaline elution, mutation induction as detected by 6-thioguanine resistance, and cytotoxicity as detected by colony formation for different physical and chemical agents. Some of the agents produced varying forms of DNA damage but undetectable increases in either mutation or toxicity. We report here that some undetectably mutagenic and/or toxic agents produce increases in SCE frequency and that DNA single-stranded breaks, DNA--DNA interstrand cross-links, and DNA--protein cross-links are not necessary for SCE.


Epidermal Langerhans cells are derived from cells originating in bone marrow. Langerhans cells constitute a morphologically well characterised subpopulation (3--8%) of mammalian epidermal cells which, in contrast to the bulk of epidermal cells, bear Fc-IgG and C3 receptors, express immune response-associated (Ia) antigens and function as antigen-presenting cells and allogeneic stimulatory cells to primed T lymphocytes. The ontogeny of Langerhans cells has been a subject of considerable debate since their discovery. Although some studies suggest that Langerhans cells are of mesenchymal as opposed to neural or melanocytic origin, direct evidence for this has not been presented. In this study we demonstrate that, after 3 weeks, most of the Langerhans cells (LC) in parenteral skin which had been transplanted on to F1 hybrids were of recipient origin whereas keratinocytes remained of donor origin; this indicates that the LC are derived from a mobile pool of cells. Furthermore, in studies of skin from radiation-induced bone marrow chimaeric animals we found that, depending on the strain combination, up to 80% of the epidermal LC were derived from the bone marrow of the donor animals.


The transforming gene of Moloney murine sarcoma virus. A cleavage map of the Moloney murine sarcoma viral DNA was constructed and compared with that of a spontaneously occurring deletion mutant. By restriction enzyme analysis, it was shown that a region encompassing over 40% of the viral information was not essential for transformation or rescue of the deletion mutant. The transforming region was further localised by analysis of the transforming activity in tissue culture of isolated restriction fragments of linear duoble-stranded sarcoma viral DNA. In each case, DNA fragments that retained transforming activity preserved the cell-derived insertion sequences of the viral genome. Moreover, such transformants invariably expressed RNA specific to this region. By these two approaches, it was possible to demonstrate that the transforming region of the viral genome begins very near or within the cell-derived insertion sequences. Thus, the transforming gene of this mammalian sarcoma virus originates from within the mouse cell genome.


The analysis of sound by the sprat ear.

The analysis of sound by the sprat ear. In the acoustico-lateralis systems of vertebrates the individual hair cells are usually polarised in their responses to displacements of the liquid in which they lie, and are often arranged in back-to-back pairs or groups with different polarities. A simple example to investigate, mechanically as well as electrically, is the utriculus of the sprat (Clupea sprattus L.). The acoustico-lateralis system of the sprat and other clupeids has two partly gas-filled bony bullae which transform pressure changes into liquid displacements capable of stimulating the sense organs of the ear and lateral line. With its related structures the utriculus is a very sensitive sound pressure detector which has one population of receptors that respond to the compressions and another that respond to the decompressions of a sound wave. We now give additional evidence that this type of organisation is unlike that of the mammalian cochlea in being specialised more for the detection of phase/time relationships than for frequency analysis.


Induction and kinetics of natural killer cells in humans following interferon therapy. Natural killer (NK) cells are non-B, non-T lymphocytes that effect spontaneous cytolysis of both virus-infected and neoplastically transformed target cells. These NK lymphocytes have been detected in several species including man. Interferon is a primary regulator of natural killer activity. Because NK cells have been implicated in the regulation of tumour cell expression and can be induced by interferon in murine models, we have studied patients receiving large doses of interferon to determine (1) whether interferon could induce NK lymphocytes in the peripheral blood of man, and (2) whether there are characteristic kinetics for the appearance, disappearance and reactivation of NK lymphocytes following interferon therapy. We report here the activation of human NK cells by the systemic inoculation of human subjects with interferon. Five patients received interferon as therapy for non-Hodgkin's lymphoma. All showed a marked increase in NK cell activity 12--24 h after inoculation. Peak NK activity occurred 18 h after introducing interferon, and thereafter declined rapidly but remained above pre-interferon levels. Induced NK activity occurred with reintroduction of interferon but at lower levels of activity and with different kinetics.


Complete nucleotide sequence of an influenza virus haemagglutinin gene from cloned DNA. A synthetic fowl plague virus (FPV) haemagglutinin gene has been cloned in bacteria and the complete sequence of the RNA gene deduced. It is 1,742 nucleotides long and the mRNA codes for 56.3 amino acids in an uninterrupted sequence. The nature of some of the important domains in the haemagglutinin has been established, and their structure is discussed in relation to their function. Extensive amino acid sequence homologies exist between FPV and human influenza haemagglutinins.


Nerve sheaths and motoneurone collateral sprouting. When disease or injury causes partial loss of innervation from a muscle, the remaining axons sprout and form new connections to the denervated muscle fibres. Sprouting can occur in two ways: from axon terminals (terminal sprouting) or from the intramuscular axons themselves, probably from the nodes of Ranvier (collateral sprouting). Terminal sprouting has been induced experimentally using various methods, including partial denervation, nerve conduction block and nerve transmission block. A common factor in the induction of terminal sprouting seems to be changes in the surface membrane of muscle fibres; these changes and terminal sprouting are prevented by direct stimulation of the muscle. Collateral sprouting has been induced only by partial denervation and is not prevented by direct stimulation. This has been taken as evidence for an earlier suggestion that products of nerve or axon degeneration may be a direct stimulus for collateral sprouting. We report here that axon degeneration products alone are probably not the stimulus for collateral sprouting.


Teratogenic drugs inhibit tumour cell attachment to lectin-coated surfaces. Interactions between embryonic cells are generally thought to have a central role in the control of development. When these morphogenic interactions are interrupted by either physical intervention or genetic defects, normal development is impaired. In accord with these experiments, specific interactions between embryonic cells have been demonstrated in several in vitro systems. Many investigators have described homotypic aggregation of chick embryo cells, and heterotypic specificity has been described. Because of the importance of morphogenic cell-cell interactions in development it follows that agents that interfere with these interactions, regardless of the interference mechanism, are potential teratogens. Here we have used a simple in vitro cell to surface recognition system in an attempt to screen for potential teratogens. We have found a very high correlation between inhibitory activity in the in vitro assay and reported teratogenic activity in human or animal studies. This suggests that many teratogenic agents may act by interfering, in an as yet unknown way, in normal cell to cell interactions.


Antibody-mediated enhancement of Flavivirus replication in macrophage-like cell lines. Interactions between animal viruses and antiviral antisera may exceptionally result in an apparent increase in viral infectivity. Halstead and coworkers demonstrated enhanced replication of dengue virus (a Flavivirus, family Togaviridae) in human or simian peripheral blood leucocytes carrying Fc receptors at subneutralising concentrations of antidengue antibody. We have used three continuous cell lines which express macrophage markers to explore the mechanism of this phenomenon. Dengue virus failed to replicate in these cells, but West Nile virus, another Flavivirus, replicated in all three, and we were able to demonstrate reproducibly 50--100-fold enhancement of virus yields in the presence of Flavivirus antisera, the effect also being directly demonstrable in P388D1 cells by increased numbers of virus-induced plaques. The phenomenon of antibody-dependent enhancement of viral replication is not unique to dengue virus, and may have far wider relevance in other viral infections.


Different receptors for distribution of peanut and ricin agglutinins between inner and outer segments of rod cells. Lectins can be used as probes for cell-surface oligosaccharides1-4. These proteins display high specificities for certain haptene sugars, although the details of the sugar linkages and the three-dimensional array of the oligosaccharide may all be involved in determining the affinity of a lectin for its receptor. We have now shown that peanut and ricin agglutinins bind differentially to the surfaces of rod inner and outer segments.


Energy uptake in the first step of visual excitation. Perception of light by the retina starts with the absorption of a photon by 11-cis retinal, which is covalently incorporated into the membrane-bound protein, rhodopsin. The initial result of photon capture is the very rapid formation of a red-shifted species, bathorhodopsin (also known as prelumirhodopsin), which is (meta-)stable at liquid nitrogen temperature but which decomposes at higher temperatures, in the dark, through a series of intermediate stages, resulting in the release of all-trans retinal from the apoprotein, opsin. Bathorhodopsin formation is the only photochemical step in the overall reaction and, therefore, merits investigation. Several models for the process have been proposed, and have been critically reviewed, although no consensus yet exists as to the nature or mechanism of formation of the batho intermediate. I report here on the first direct measurement of photon energy uptake during bathorhodopsin formation from bovine rhodopsin, and on its possible significance.


[Biological monitoring of water quality]. The degree of purity of surface waters can be seen from investigations on the communities of life of plant and animal organisms. A great number of organisms characteristic of certain degrees of pollution were classified in the "saprobic system", which is still valid. As a supplement to the chemical water analysis, the bio-ecological test is an optional method for characterizing the quality of waters--as, for instance, in the case of the river Lippe.


[Amatoxins and mushroom poisoning].

[Amatoxins and mushroom poisoning]. Amatoxins are the sole cause of human Amanita poisoning, inhibition of transcription eventually leading to cell necrosis. The toxins are easily excreted into the bile fluid, a fact which postulates the interruption of the enterohepatic circulation. All therapeutic means should be applied in order to decrease the serum concentration of the toxins as soon as possible.


New information from bloodstains.

New information from bloodstains. The traditional philosophy behind the grouping of bloodstains in the Forensic Science Laboratory is described. It is emphasised that while these blood-grouping methods are highly discriminating in the sense that they may distinguish one person's blood from hundreds, or thousands of others, such information may be of limited value in many crime investigations. The reason for this is that such information does not normally relate to physical features of the individual with which we are all familiar such as sex or age. Recent research work is described in which efforts are being made to deduce from small bloodstains information which indicates the donor's sex, age, ethnic origin and perhaps clinical history.


[D-Penacillamine. From constituent of penicillins to significant drug]. D-Penicillamine is used against a variety of diseases. For many years it has been successful in treating Wilson's disease, cystinuria and heavy-metal poisonings. It also proved to be effective against rheumatoid arthritis, scleroderma, chronic active hepatitis, pulmonary fibrosis and multiple sclerosis. However, the use of D-penicillamine is still limited owing to the frequent occurrence of considerable, though generally reversible, side effects. This article deals with the history of D-penicillamine as well as the methods of its synthesis, its pharmacokinetics, effects and side effects. In addition, the significance of the stereo isomeric L-penicillamine is discussed.


Characteristics of histamine tachyphylaxis in canine tracheal smooth muscle. In isolated canine tracheal smooth muscle, repeated administrations of histamine result in a rapid reduction in contractile response to about 15% of the initial contraction (tachyphylaxis). Development of this tachyphylaxis is specific inasmuch as: 1) it does not develop to acetylcholine (10(-6) M or 10(-4) M), or serotonin (10(-5) M; and 2) maximally developed histamine tachyphylaxis is not associated with a parallel reduction in response to acetylcholine. Pretreatment with propranolol (10(-5) M) or phentolamine (10(-4) M) does not prevent tachyphylaxis: however, pretreatment with atropine (10(-4) M) does prevent tachyphylaxis in about 50% of the animals tested. Tachyphylaxis to histamine can be reversed in a dose- and time-dependent fashion with prostaglandin synthesis inhibiting agents. The order of potency obtained with such compounds (indomethacin greater than mefenamic acid greater than oxyphenbutazone greater than acetylsalicylic acid) is consistent with potencies for inhibition of prostaglandin synthesis found in the literature. Also, in indomethacin pretreated strips in which tachyphylaxis to histamine was prevented, exogenous addition of PGE2 (1.42 x 10(1-) M to 2.84 x 10(-9) M) and PGA2 in a high concentration (2.9 x 10(-9) M) are capable of selectively reducing the response to histamine without an effect on acetylcholine-induced contractions. These data suggest that the mechanism of histamine tachyphylaxis in the canine tracheal smooth muscle preparation involves prostaglandin synthesis.


In vivo release of endogenous catecholamines in the hypothalamus. The posterior hypothalamus of anaesthetized cats was superfused with a push-pull cannula and the release of the endogenous catecholamines noradrenaline, adrenaline and dopamine was determined in the superfusate. The rate of release of the three catecholamines followed an ultradian rhythm, the time interval between two adjacent phases of high rate of release being about 70 min. Pretreatment of the animals with reserpine decreased the levels of catecholamines in the hypothalamus and rest of the brain and reduced their rate of release into the superfusate. Hypothalamic superfusion with superfusing fluid of high concentration of potassium and low concentration of sodium enhanced the rate of release of noradrenaline and adrenaline; this effect was abolished when the hypothalamus was superfused with calcium-free solution. Electrical stimulation of the locus coeruleus ipsilateral to the superfused hypothalamus increased the release of noradrenaline and adrenaline, stimulation of the contralateral locus coeruleus enhanced the release of noradrenaline, adrenaline and dopamine. In both cases, the rate of release of adrenaline was enhanced to a lesser extent than the rate of release of noradrenaline. The release of noradrenaline and adrenaline was increased to a higher extent on stimulation of the ipsilateral locus coeruleus than on stimulation of the contralateral one.


In vivo release of endogenous GABA in the cat hypothalamus. The posterior hypothalamus of anaesthetized cats was superfused with artificial cerebrospinal fluid through a push-pull cannula and the release of endogenous GABA from the hypothalamus into the superfusate was studied. The resting release of GABA varied rhythmically, since phases of high rate of release were separated from each other by phases of low rate of release. The time interval between two adjacent phases of high rate of release was about 70 min. Electrical stimulation of the posterior hypothalamus with the tip of the cannula enhanced the rate of release of GABA in a frequency-dependent way. Superfusion of the hypothalamus with CSF which contained a high concentration of potassium and a low concentration of sodium increased the rate of release of GABA; this effect was dependent on the presence of calcium ions in the superfusing fluid. Pretreatment of the cats with reserpine reduced the levels of GABA in hypothalamus and rest of brain and the concentration of GABA in the superfusate as well. Stimulation of the locus coeruleus with a bipolar electrode elicited an increased release of GABA in the hypothalamus.


Chlorophenylpiperazine: a central serotonin agonist causing powerful anorexia in rats. Meta-chlorophenylpiperazine inhibited serotonin and noradrenaline uptake by synaptosomes to the same extent with IC50 of 1.3 x 10(-6) M and 5.8 x 10(-6) M respectively. Dopamine uptake was less affected by meta-chlorophenylpiperazine (IC50 of 2.2 x 10(-5) M). Unlike d-amphetamine and d-fenfluramine, the drug did not significantly increase monoamine release in synaptosomal preparations. On the other hand, metachlorophenylpiperazine showed an IC50 of 620 nM in displacing 3H-5HT binding to brain membranes. Meta-chlorophenylpiperazine produced a dose-dependent reduction of food intake and this effect was prevented by a pretreatment with methergoline, a serotonin antagonist. The effect of metachlorophenylpiperazine was not modified by an intraventricular injection of 6-hydroxydopamine, electrolytic lesions of nucleus medianus raphe or ventral noradrenergic bundle, nor by a pretreatment with penfluridol, propranolol or phentolamine. The data suggest that the decrease of food intake induced by metachlorophenylpiperazine depends on its ability to act as a serotonin agonist is the brain. The specificity of the effects on serotonin suggests that this compound could prove an important tool for studies aimed at elucidating the functional role of serotonin in the central nervous system.


Effect of acute and chronic treatment of tandamine, a new heterocyclic antidepressant, on biogenic amine metabolism and related activities. The effects of tandamine, a clinically effective heterocyclic antidepressant, administered either acutely (10 mg/kg i.p.) or chronically (10 mg/kg i.p. daily for 21 days) on biogenic amine uptake and metabolism in the rat were determined and a comparison with desipramine was made. Tandamine, similarly to desipramine, blocked norepinephrine (NE) uptake in rat brain and heart following both acute and chronic administration. No effect of tandamine on dopamine (DA) or serotonin (5-HT) uptake was observed. Both drugs lowered endogenous brain NE when given chronically but not acutely. In contrast, no such effect on brain DA and 5-HT or heart NE was observed. Tandamine, like desipramine, administered chronically prior to an intraventricular injection of 3H-NE, produced increases in the decline of 3H-NE as indicated by decreased 3H-NE with increased levels of 3H-normetanephrine in brain stem of rats, suggesting an increased turnover of NE. No such effect was observed following acute treatment. Both drugs increased the behavioural effects of L-Dopa following and acute oral administration, with tandamine appearing superior to desipramine at the lower dose examined (10 mg/kg). Tandamine was 57--833 times less effective in binding to rat brain muscarinic receptors than desipramine, imipramine, butriptyline and amitriptyline, respectively. Thus, tandamine affects biogenic amine mechanism following either acute or chronic administration in a fashion similar to desipramine, but unlike desipramine, it exhibits relatively little anticholinergic properties, a further indication of the potential use of tandamine in the treatment of human depression, particularly where an increase in drive is desired.


Inhibition by cholinergic agonists of the prolactin release induced by morphine. The cholinergic agonists, pilocarpine, physostigmine and nicotine, inhibited the prolactin release induced by morphine in male rats in vivo. Pilocarpine also inhibited the release of prolactin induced by beta-endorphin or metoclopramide without affecting the basal and haloperidol-stimulated serum prolactin levels. The inhibitory effect of pilocarpine on the morphine-stimulated release of prolactin was antagonized by concurrent administration of atropine but not by atropine methylnitrate or by mecamylamine, while the inhibition by nicotine was antagonized by mecanylamine but not by atropine. The stimulation of prolactin release by morphine and its reversal by pilocarpine were observed after the administration of haloperidol or alpha-methyltyrosine. These results suggest that the central cholinergic system exertes an inhibitory influence on the prolactin release induced by morphine or beta-endorphin and the cholinergic inhibition is not mediated via catecholaminergic neurons.


Centrally and peripherally mediated inhibition of intestinal motility by opioids. Intracerebroventricularly injected morphine is 50-fold more potent in arresting intestinal peristalsis in rats, mice or guinea pigs than morphine administered systemically. Using quaternary naloxone as narcotic antagonist, it has been demonstrated that the peripheral pathway of the centrally mediated constipatory effect of morphine does not involve opioid peptidergic mechanisms. Further, this effect is not due to the release of opioid peptides from the pituitary, since hypophysectomy fails to affect the antipropulsive activity of morphine. On the other hand, the intestinal motility can be affected directly by activation of opiate receptors located in the gut. This was best demonstrated with loperamide, which exhibits predominantly a peripheral site of action. Thus, two mechanisms of the action of morphine on gastrointestinal propulsive activity have been demonstrated. One arises in the central nervous system (CNS) and is mediated peripherally not by opioid peptidergic pathways, whereas the other is due to a direct action of morphine on the gut.


Inhibition of PGE1 induced intestinal secretion by the synthetic enkephalin analogue FK 33-824. 1. The effects of the enkephalin analogue, FK 33-824 were compared with those of morphine and naloxone on the prostaglandin E1-induced increase in intestinal fluid volume and unanaesthetized and pithed rats. 2. FK 33-824 inhibits the prostaglandin E1-induced increase in intestinal fluid volume both in unanaesthetized and pithed rats. 3. Naloxone abolished the inhibitory effect of FK 33-824 in both experimental models. 4. It can be concluded from the experiments in pithed rats that the inhibitory effect of FK 33-824, like that of morphine, on prostaglandin E1-induced secretion is caused by a peripheral action. 5. It is assumed that endogenous enkephalins protect against prostaglandin-mediated loss of fluid into the gut lumen. This protective effect can be mimicked by an enkephalin analogue and blocked by naloxone.


Acetate intolerance in chronic uremic patients. The metabolic effects of an acute acetate load have been investigated in chronic uremic patients and in controls. The decay rate of blood acetate levels was significantly lower in patients than in controls. Higher levels of blood acetoacetate and 2-oxoglutarate and plasma triglycerides were observed in the patients after the load. No difference was detectable in plasma levels of unesterified fatty acids and cholesterol between the two groups of subjects. Acetate oxidation in citric acid cycle may be reduced in uremia owing to a lack of coenzyme A. These observations raise the possibility that chronic acetate administration with the dialysate induces hypertriglyceridemia and accelerates the development of atherosclerosis in hemodialysis patients.


Immune deposit nephritis and single-component cryoglobulinemia associated with chronic lymphocytic leukemia. Evidence for a role of circulating IgG-anti-IgG immune complexes in the pathogenesis of the renal lesion. 2 patients developed the nephrotic syndrome several years after diagnoses of chronic lymphocytic leukemia. In both cases light microscopy showed membranoproliferative glomerulonephritis. Electron microscopy and immunofluorescent staining revealed electron-dense deposits and deposition of immunoglobulins and C3. Both patients had single-component IgG cryoglobulinemia. The eluted glomerular-bound protein contained IgG only. IgG in patients' sera, cryoglobulins, and kidney eluate had kappa light chains only. Immune complexes were detected in the sera and in the cryoglobulins by the Clq binding test. Immunoadsorption studies revealed anti-IgG antibodies in the patients' sera, cryoglobulin, and kidney eluate. Direct immunofluorescent studies using the patients' sera, cryoglobulins, and kidney eluate on frozen sections of patients' kidneys were positive, providing additional evidence for the immune complex nature of the glomerulonephritis. The immunohistochemical studies of our patients are suggestive of the presence of circulating IgG-anti-IgG immune complexes and their possible involvement in the pathogenesis of the glomerulonephritis and the nephrotic syndrome in these 2 cases.


Improvement of hypercalciuria, potassium wasting and hyperreninemia in incomplete distal renal tubular acidosis by indomethacin. A patient with incomplete distal renal tubular acidosis (RTA) demonstrated hypercalciuria, potassium wasting and hyperreninemia. Indomethacin administration resulted in sustained improvement of these abnormalities. The results suggest that overproduction of prostaglandins contributes to hypercalciuria, potassium wasting and hyperreninemia in some patients with RTA and that indomethacin may be useful in treating patients with this disorder.


Acute renal failure in marathon runners. The Comrades Marathon is a gruelling test of man's stamina and only trained athletes participate. It is surprising that of over 2,000 contestants each year on a 90-km (56.25-mile) course, severe cardiac and renal damage does not occur more often. We are able, however, to report 10 cases over 9 years when renal damage did occur. 3 cases required haemodialysis; 1 had peritoneal dialysis; 2 patients had renal biopsies. Possible idiosyncratic factors are discussed as is the pathogenesis of acute tubular necrosis.


Body fluid changes in hypertensive rats. Their modifications by saline load. Subtotal nephrectomy was produced in male Wistar rats and the evolution of arterial pressure, water distribution and electrolytic composition of muscle and arterial tissue were studied. Also, the modifications produced by a chronic administration of saline load were evaluated. The incidence of hypertension is higher in the group that received saline load but the levels of the blood pressure were similar in both groups of hypertensive animals. The total water is increased in all the groups, except at the fourth week in the animals that did not receive saline load, in which it was decreased. The extracellular space is augmented in all groups and the plasma volume increased in the early phases of the experimental period with exception of the normotensive rats without saline load. No alterations were observed in the electrolytic muscle content, and the total water and potassium and chloride content of the arterial tissues was increased without modifications in the sodium content. The possible relationship of these alterations with the development of hypertension are discussed.


Effect of beta-adrenergic blockade by propranolol upon intravascular coagulation in the rat kidney. Disseminated intravascular coagulation in rats was induced by intravenous infusion of thrombin for 30 min. The glomercular filtration rate was measured as the clearance of polyethylene glycol 1000. The fibrin deposition in organs was quantitated by a method using previous injection of 125I-labelled fibrinogen. Administration of the beta-adrenergic blocking agent, propranolol, prevented the decrease in glomerular filtration rate after infusion of thrombin. This result could be explained by an observed partial redistribution of the fibrin from the kidneys to the lungs.


Natural history of post-biopsy renal arteriovenous fistula: a 10-year follow-up. Arteriovenous fistula of the kidney is a common complication of percutaneous needle biopsy with a reported incidence of as high as 15% in some series. Although a few cases eventually may develop hypertension, cardiomegaly, or congestive heart failure, most heal spontaneously within 1-18 months. Those which do not heal within this time are usually treated surgically and consequently there is little available information concerning the long-term conservative management of this problem. The subject of this report is a patient who has been followed medically for 10 years and who, despite the persistence of a large fistula, remains in good health.


Topical thrombin and control of bleeding from the fistula puncture sites in dialyzed patients. The length of bleeding from the puncture sites of internal arteriovenous channels was markedly reduced with the use of topical thrombin in 12 patients treated with hemodialysis. This procedure can, therefore, save patient and staff time, minimize recurrent blood loss with each dialysis, and prolong the life of vascular access by diminishing the length of potentially hazardous compression needed for proper hemostasis.


Aseptic peritonitis in patients on maintenance peritoneal dialysis. An 'epidemic' of aseptic peritonitis occurred in our peritoneal dialysis unit, affecting 5 of 20 patients. Acute and convalescent viral titers were normal in all 5. The peritoneal fluid of the affected patients was not tested for endotoxin, but endotoxin was found in subsequent dialysis fluids from two machines in the unit. This endotoxin might have been the causative agent of this outbreak. Rapid recovery ensued in all patients following peritoneal lavage.


[Tumours of the pineal region: Part II: results of treatment in 23 patients (author's transl)]. The outcome of 23 patients with tumours in the pineal region was investigated following treatment with shunting, irradiation, extirpation or with a combination of these three procedures. The choice of therapy is difficult because in most cases the kind of tumour is unknown. The irradiation of radioresistant lesions however causes an unnecessary injury of the surrounding tissue whereas the trial of extirpation of a radiosensitive tumour exposes the patient to an unnecessary danger. After the results of therapy a method of treatment is proposed.


Some physical principles of intracranial pressure measurement. The general formula for the pressure difference across a curved flexible membrane has been applied to a number of intracranial pressure (I.C.P.) measuring systems and certain criteria deduced for the accurate measurement of I.C.P. The Numoto bag, the implanted extradural transducer and the intracerebral bag have been shown to be acceptable providing these criteria have been met. Some deductions about the magnitude sign and constancy of the zero error have been made. Some other I.C.P. measuring systems have been shown to have serious and unknown zero errors which vary from hour to hour. Because of the curved surface of the ventricle itas been shown that ventricular fluid pressure cannot equal the tissue pressure (though it may closely approximate it) and the difference between the two increases as hydrocephalus progresses.


Electroencephalographic (EEG) investigations in medulloblastomas. Electroencephalographic investigations were done in 24 patients suffering from medulloblastoma. All underwent subtotal or total removal of the tumour and a shunt procedure, foowed by irradiation therapy. The most frequent pre-operative finding was general slowing, the degree of which could be correlated to the amount of papilloedema and obstructive hydrocepalus. In about one third of the patients we found abnormal rhythmic theta and delta activities, especially marked in the occipital regions. This could be explained by the pathogenesis of hydrocephalus in the child. In the acute post-operative stage in some cases only the general slowing was worse. A return to normal of the EEG disturbances was seen in the later post-operative course and after irradiation therapy. This return to normal seemed to depend only on the time factor, but not on the mode of treatment.


[The importance of axial computer tomography of the neurocranium in neurotraumatology (1) (author's transl)]. Computer tomography enables exact diagnostic clarification of intracranial lesions in trauma of the neurocranium. Subdural or epidural as well as intracerebral haemorrhages can be localised, and a circumscribed contusion and cerebral oedema become tangible. The article reports on 90 patients subjected to computerized tomography following trauma of the neurocranium. In about 50% of the cases, the trauma had been caused by a traffic accident. About 27% of the accident victims were children and adolescents. In about one-half of the examined persons, subdural or epidural haemorrhages were found, whereas in about 20% of the cases, contusions, partly with mild haemorrhages, were seen. In about 10% of the cases a more or less severe oedema was seen. About 20% of the patients yielded no abnormal finding by CT in accordance with the age of the patient.


Neurological results in spinal cord metastases. Btween 1971 and 1978 140 cases of spinal metastasis treated by decompression or possible removal of secondary neoplasm, were studied. Patients were divided according to their preoperative neurological conditions and then evaluated on the ground of regression of spinal cord and root symptom. The possibility of treating this type of compressive spinal pathology surgically is discussed.


[Traumatic sinus injuries and their operative treatment in the light of the normal anatomy of the cerebral sinuses and its variations (author's transl)]. In the light of our personal experiences, the present day possibilities of operative repair of sinus injuries are reported. The bases for such work is an exact knowledge of the topographical anatomy of the sinuses and its variations, which are described here. In addition to a historical survey of the development of the operative techniques the present-day procedures are described. The frequency and the prognosis are discussed.


Agenesis of the vermis cerebelli and malformations of the posterior fossa in childhood and adolescence. Three cases of cerebellar vermis agenesis are reported and the relevant literature (19 other cases) is reviewed. Other posterior fossa malformations, such as a mega-cisterna magna, arachnoid cyst and Dandy-Walker syndrome, are discussed both from the pathological and clinical view point. We put forward a hypothesis that agenesis of the cerebellar vermis and Dandy-Walker syndrome could be regarded as two different stages of the same malformation.


Meningioma of the foramen magnum presenting as subarachnoid haemorrhage and cerebellar haematoma. An unusual case of a posterior fossa meningioma which caused subarachnoid haemorrhage (SAH) and cerebellar haematoma is presented. The possible causes of tumoral bleeding and the surprising clinical course are discussed in the context of the few similar cases reported in the literature. The importance of cerebral CT scan ning in SAH without angiographic demonstration of an aneurysm or angioma is emphasized.


Paraplegia due to bilateral angioma of the paracentral area. The authors present a case of bilateral angioma of the paracentral area with paraplegia and generalized epileptic seizures. The onset of the disease was after a head injury.


Effect of amphetamine on plasma corticosterone in the conscious rat. The effect of amphetamine (AMPH) on plasma corticosterone was studied in the conscious, unstressed rat. AMPH (0.5-5.0 mg/kg) produced a dose-dependent increase in plasma corticosterone. This rise in plasma corticosterone was not altered by the adrenergic blocking agents phenoxybenzamine or propranolol. In contrast, the serotonergic depleting agent p-chloroamphetamine significantly inhibited the AMPH-induced rise in corticosterone. In addition, the serotonergic blocking agent methysergide, but not cyproheptadine, inhibited the corticosterone increase induced by AMPH.


Effects of destruction of the suprachiasmatic nuclei on the circadian rhythms in plasma corticosterone, body temperature, feeding and plasma thyrotropin. To study the role of the suprachiasmatic nuclei (SCN) in generating circadian rhythms in female rats, lesions were placed in the SCN or in the medial preoptic (PO) region. Serial blood sampling at 4-hour intervals at 3 and 13 weeks after surgery indicated that complete SCN destruction abolished rhythmic fluctuation in plasma corticosterone levels in individual rats. Partial destruction produced less interference, while medial PO lesions that spared the SCN were without effect. Similar effects were noted on daily changes in body temperature at 10 weeks after surgery; however, some rats showed evidence of dissociation of these two rhythmic functions in that some lesions appeared to affect one and not the other. In ancillary studies, it was found that all lesioned groups showed nocturnal feeding patterns similar to those of the controls and that the diurnal pattern in plasma thyrotropin (TSH) levels was altered by complete destruction of the SCN. These data suggest that the SCN are essential for the circadian rhythms in pituitary-adrenal function and body temperature and that separate pacemarkers may be present in these nuclei for these two periodic functions. The SCN may also control rhythmic TSH secretion, but these nuclei and the medial PO region do not appear essential for nocturnal feeding.


Characterization of a cytosol progesterone receptor in bovine pineal gland. The possible existence of pineal progesterone (P) receptors was assessed in 105,000 g supernatants of bovine pineal glands incubated with 3H-P in the presence of 10 microM cortisol. By charcoal adsorption analysis specific binding (defined as the difference between 3H-P binding in the absence and presence of 1,000-fold excess of unlabeled P) attained its maximum after 60 min at 37 degrees C. Binding was abolished by heating the cytosol or by preincubating it with trypsin. A single population of binding sites with a Kd = 1.64 nM and binding site concentration = 34 fmol/mg of cytosol protein was detectable by Scatchard analysis. In competition experiments the B50 progesterone values (nM) were: P (2), 20 alpha-dihydroprogesterone (12), 20 beta-dihydroprogesterone (25), estradiol (158), testosterone (675) and corticosterone (greater than 1,000). After sucrose gradient centrifugation of pineal cytosol incubated with 3H-P a discrete peak of radioactivity in the 7-8 S region of the gradient was observed, and disappeared following incubation with excess unlabeled P. These results indicate that P receptors are present in the bovine pineal gland.


Hippocampal function and putative corticosterone receptors. Effect of septal lesions. In order to investigate the relation between septohippocampal function and hippocampal corticosterone (B) receptors, discrete septal areas were destroyed by electrolytic lesions; the effects of the lesions on cytosol receptor binding of B in the hippocampus were determined 10 or 30 days after lesioning in male rats adrenalectomized 12 h prior to sacrifice. The septal lesions were also characterized functionally by endocrine, neurophysiological and behavioral parameters in the same group of animals. Hippocampal B receptor activity was increased 30 days after lesioning the lateral septal area. The same lesions impaired the acquisition of a conditioned avoidance response. The increase was not due to a behavioral deficiency per se as lesions in the parafascicular nucleus did impair acquisition behavior without affecting B receptors. There was no change in B receptor activity 30 days after destruction of the medial septal nucleus, although such a lesion completely abolished the hippocampal theta activity measured at 10 days. In another group of animals hippocampal B receptors were not affected at 10 days after any of the lesions, while a transient increase in basal plasma levels of B was noted at that time. It appears that the hippocampal receptor activity for B depends on the integrity of the efferents from the hippocampus and/or the dorsolateral septal B receptor system rather than on the septal afferents to the hippocampus.


Effects of septal lesions and adrenalectomies on the acquisition and extinction of shuttle avoidance in the rat. Rats with septal lesions and rats with both septal lesions and adrenalectomies (SEP-ADX) acquired avoidance behaviors faster and extinguished these behaviors slower than rats with adrenalectomies or control lesions. Rats with septal lesions also showed increased intertrial crossings during habituation, acquisition, and extinction while rats in group SEP-ADX only had increased intertrial crossings during acquisition. These findings are consistent with the hypothesis that the avoidance performance of rats with septal lesions is a result of neural rather than hormonal factors.


Less severe ovarian atrophy in hypophysectomized hemiovariectomized rats than in hypophysectomized animals with two ovaries. The effect of unilateral ovariectomy (OVX) on the weight of the remaining ovary was studied in hypophysectomized (HYPOX) rats. 2 weeks following hypophysectomy + unilateral OVX the weight loss of the ovary is significantly less than that in HYPOX rats having two ovaries. Present data together with previous findings suggest that a neural pathway between the ovaries and the CNS may be involved in the mechanism of compensatory ovarian hypertrophy following removal of one ovary.


The genesis and significance of delayed traumatic intracerebral hematoma. During a 34-month period, 12 cases of delayed traumatic intracerebral hematoma (DTICH) were diagnosed among 162 consecutive prospectively studied patients admitted to the Medical College of Virginia with severe closed head injuries. All patients were unresponsive to command and unable to utter formed words at the time of admission. The interval from injury to diagnosis of DTICH by computerized tomography (CT) was within 48 hours in 11 of the 12 cases. Six patients had no decompressive surgery before the development of the lesion. Four patients had undergone decompressive surgery and then developed DTICH on the contralateral side. Two patients developed lesions in the vicinity of the operative site that were thought not to be the result of operation. The development of DTICH was not heralded by neurological deterioration nor by elevation of intracranial pressure. Eleven of the 12 patients had suffered a secondary hypoxic insult soon after the head injury. We suggest that the CT appearance of DTICH is likely to represent hemorrhage into an existing traumatized area and is an epiphenomenon rather than a cause of severe primary and secondary brain damage.


Rupture of intracranial aneurysms during cerebral angiography: report of ten cases and review of the literautre. Ten new cases of intracranial aneurysms that ruptured during cerebral angiography, obtained from four local hospitals and the practices of eight angiographers, are detailed. A review of the literature reveals 28 other well-documented cases. An analysis of this clinical material shows that internal carotid injections are not necessarily more dangerous than common carotid injections. Although critically ill patients are at higher risk and must be treated with caution, there is not enough evidence to warrant a delay in angiography to avoid rupture. The recent trend toward early angiography in cases of subarachnoid hemorrhage is reflected in the statistical analysis. A plea for meticulous angiographic technique is advanced.


Surgical treatment of basilar aneurysms. The surgical therapy and results in 17 cases of basilar aneurysms are reported, extending a series of 15 reported previously. Three surgical approaches were used: subtemporal, pterional, and suboccipital. The subtemporal route was satisfactory for most lesions, although the pterional approach has advantages for upper basilar aneurysms projecting either more than 1 cm above the dorsum sellae or directly anteriorly. A low lateral-suboccipital approach is described and recommended for aneurysms of the proximal basilar trunk and vertebrobasilar junction. The recent literature regarding surgical results, classification, pathogenesis, and technical developments for management of these lesions is reviewed. Most of the morbidity resulting from surgery in the midbrain and pontine region is due to direct or indirect injury to perforating vessels. Superiorly directed bifurcation aneurysms carry the highest risk because of their association with perforating vessels. General precepts regarding size, location, patient condition, and timing of operation with respect to aneurysms of the anterior circulation hold true for aneurysms of the posterior circulation.


Selective treatment of infants with myelomeningocele. Selective treatment of infants with myelomeningocele is said to be beneficial to the infants, their parents, and to society. One group of arguments intended to support this point of view is analyzed. Recent data do not support the factual basis on which these arguments rest; moreover, the moral assumptions that lie behind them should be emphasized. The values held by participants in a discussion of allowing infants to die are as important as facts about treatment options.


Prevention of neurosurgical infection by intraoperative antibiotics. For the past 5 years at Mount Sinai Hospital, an intraoperative prophylactic antibiotic regime consisting of intramuscular gentamicin or tobramycin, intravenous vancomycin, and streptomycin irrigating solution, with no preoperative or post operative antibiotics, has provided complete protection against operative infections in neurological surgery. There have been 1732 major clean operative cases with no instance of operative infection and no complication due to the antibiotics.


Hysteresis in the relationship between cerebrospinal fluid absorption minus formation and cerebrospinal fluid pressure in the dog. In this study the difference between cerebrospinal fluid (CSF) absorption and formation (A -- F) was measured as a function of CSF pressure in the living and dead dog. We determined this relationship between A -- F and CSF pressure during both increasing and decreasing CSF pressures. A hysteresis effect was identified in 78% of living animals, but was not seen in the dead animals. This suggests that the mechanism of CSF absorption in the living dog is nonpassive and pressure-sensitive.


Closed irrigation-suction technique in the treatment of lumbar laminectomy infection: case report. The irrigation-suction technique was used to treat a patient who developed a deep infection after removal of a herniated lumbar disc. The patient made an excellent recovery. The advantages of this modality of treatment over the standard approach to this problem are emphasized.


Abdominal metastases of primary intracranial yolk sac tumors through ventriculoperitoneal shunts: report of three cases. Three cases of rare primary intracranial yolk sac tumor are reported. Two cases had a pineal location, whereas the third presented as a suprasellar mass. After the placement of ventriculoperitoneal shunts for relief of hydrocephalus, all of the patients developed metastases restricted to the peritoneum, as demonstrated by autopsy in one patient (Case 1) and clinical and radiographic evidence in two patients (Cases 2 and 3). The peritoneal metastases were directly associated with the death of one patient, but were successfully treated with chemotherapy in another patient, who is still alive more than 2.5 years after initial presentation. The value of ascitic fluid cytology and alpha-fetoprotein determination in the diagnosis of this complication was demonstrated in one patient. These cases emphasize the need for awareness of this mode of metastasis and its potentially lethal effect.


Tension pneumocephalus of the cranial subdural space: a case report. A case of subdural tension pneumocephalus is presented. Computerized cranial tomography permitted rapid diagnosis including localization of the air, thus facilitating prompt treatment. Tension pneumocephalus should be considered in a patient with a cerebrospinal fluid drainage device who deteriorates after craniotomy.


Ganglioglioma--neurogliogenic tumor involving the left frontal lobe: case report. A 5-year-old boy presented with a 7-month history of headache and projectile vomiting. Computerized axial tomography revealed a large, high density lesion involving the entire left frontal lobe. At operation a 330-g, apparently encapsulated, mildly cystic neoplasm was removed from the region of the left frontal operculum. Microscopic examination demonstrated moderately cellular astrocytic tissue interspersed with several large, bizarre, and occasionally binucleate ganglion cells. The pathological entity of ganglioglioma is briefly reviewed.


Benign intracranial hypertension without papilledema: case report. An obese young man presented the typical features of benign intracranial hypertension (BIH), including raised intracranial pressure. Despite elevated intracranial pressure, papilledema did not develop. The syndrome resolved after medical treatment and, on examination 6 months later, the patient was normal. The absence of papilledema in this case is discussed together with data available from the literature.


Interhemispheric and sex differences in the visual evoked response recovery cycle. The recovery cycle of the flash-evoked response was studied in 6 female and 6 male right-handed subjects of comparable age. The aim of the study was to evidence possible interhemispheric differences between occipital leads. Two flashes, presented at graded time intervals between 20 and 150 msec, allowed the computation of an amplitude ratio between the second and the first evoked response, considering the III--IV peak-to-peak amplitude. A faster recovery was found for the left hemisphere, with more pronounced interhemispheric differences in male than in female subjects. Women showed a more reduced amplitude recovery than men and a somewhat different time-course of the recovery function. Women also showed less waveshape similarity between evoked responses elicited by the second of a pair of flashes in the right and left hemisphere. These findings are discussed in terms of differences in speed of information processing by both cerebral hemispheres. It is suggested that recovery cycle studies may contribute to brain laterality research and be of particular relevance to psychiatric studies involving assumptions about differential hemispheric excitability.


Plasma DBH, platelet MAO and proteins of red blood cell membranes in individuals with variants of the normal EEG. Plasma DBH, platelet MAO and proteins of red blood cell membranes were examined in healthy male carriers of variants of the normal resting EEG. The variants included low-voltage EEG, badly synchronized alpha-EEG, diffuse beta-EEG and monotonous alpha-EEG. Mean DBH activity of the low-voltage EEG group was only half that of the monotonous alpha-EEG group. No difference between EEG types in platelet MAO activity and in polypeptide pattern of erythrocyte membranes after electrophoresis could be detected.


Lack of counteracting effect of liposomes on benserazide-induced hyperprolactinemia. Benserazide induces an increase of serum prolactin in man, possibly as the result of an impairment of the dopamine effect on the pituitary and/or on the outer median eminence caused by the inhibition on L-dopa decarboxylase. On the other hand, liposomes obtained from bovine brain cortex phospholipids reduced serum prolactin possibly through an effect of phosphatidylserine on dopamine biosynthesis at the level of tyrosine hydroxylase. Benserazide, given orally (125 mg) to 5 normal subjects, induced an increase of serum prolactin that did not change when 300 mg of phospholipid liposomes were given intravenously 60 min later. An increase of L-dopa synthesis does not seen to be capable to overcome the effects of the decarboxylase inhibition.


Endorphins in CSF of chronic pain patients, in relation to augmenting-reducing response in visual averaged evoked response. In 45 consecutive patients with chronic pain, visual averaged evoked responses (VAER) and the levels of fraction 1 endorphins in CSF were investigated. Patients with an augmenter response in VAER, i.e. the maximum amplitude increases when stimulus intensity is increased, were found to have significantly lower levels of fraction 1 endorphins than patients with a reducer response, i.e. the maximum amplitude in VAER decreases when stimulus intensity is increased. The results indicate that the endorphins function as endogenous antinociceptive factors.


Effect of benztropine on haloperidol-induced prolactin secretion. The effect of benztropine on haloperidol-induced prolactin secretion was investigated in 10 normal male volunteers. Benztropine had no effect on basal prolactin secretion but significantly enhanced the increased induced by haloperidol. The magnitude of the enhancement, however, was relatively small. These data suggest that in man cholinergic mechanisms have no effect on basal prolactin secretion but exert a weak inhibitory effect under conditions of dopamine receptor blockade. Differences in intrinsic anticholinergic properties may account for some of the variations in potency of different neuroleptics in increasing circulating prolactin concentrations.


Periodic homeostatic fluctuations of skin temperature in the sleeping and waking state. 53 healthly persons were monitored for skin temperature by a Hardy dermal radiometer every 60 sec. Readings continued until a spontaneous cycle appeared. 32 subjects were examined awake and 21 while asleep. A spontaneous rhythm with a mean of 4.25 min was found for the awake subjects, and one of 8.33 for the asleep subjects. To confirm these findings longer recordings were made by a thermocouple electronic thermometer in a further 23 subjects. Observations were continued until the awake subject slept. The results were analyzed by autocorrelation. In 13 records the sleeping rhythm was significantly longer than the waking. Another thermocouple probe in 14 subjects was used to measure axillary temperature. In 7 subjects a shorter cycle was seen while awake and a longer one while they slept. The properties of a perceptual clock are reviewed. It is suggested that the relative awareness of the subject be added to them.


[Late physiopathological aspects of the Billroth I gastric resection. Analysis of 109 cases]. Following an assessment of the long-term results of a homogenous series of 109 patients with gastroduodenal ulcer treated surgically according to the Billroth I technique, a personal opinion on this type of gastric resection is given. It may be considered positive, in the light of the data collected, both clinically and functionally. The need is also stressed for further, broader analysis for the purpose of a precise evaluation of the operation.


[Primary tumors of the common bile duct. Apropos of 24 cases]. Surgical management of 24 cases of primary carcinoma of the main extrahepatic bile duct are presented. This tumour forms less than 2% of the cases in which bile duct surgery is required and its intermittent appearance makes rational exploitation of surgical management difficult. Obstructive icterus is the main and constant symptom. Preoperative diagnosis of the obstruction necessarily requires transhepatic cholangiography following incision under local anaesthesia. Resection starting from the middle third of the duct was performed in 4 cases. A palliative biliodigestive shunt was applied in 5 and decompression by means of a Kehr tube was adopted in 11. Intraoperative mortality was high, mainly on account of frequent liver cell damage. In some instances, however, survival was measured in years, even in the absence of surgical resection. Surgery must thus be tailored to the patient's strength. When the patient's condition is good and the tumour is situated in the common bile duct or distal hepatic duct, an internal shunt can always be attempted. When higher segment of the duct are involved, a shunt on a Kehr tube or in the form of a U probably offers the best solution.


[Adrenal cysts].

[Adrenal cysts]. Suprarenal cysts may be clinically silent and discovered by chance, or they may present clinically if they attain marked dimensions by means of compression of surrounding formations. Examinations that lead to precise diagnosis are: direct abdominal X-ray integrated with scanning, echoscanning, urography and selective arterial and especially venous vasography. Two clinical cases that may be considered typical of the two varieties, true cyst and pseudo-cyst, are reported.


[Anicteric calculosis of the common bile duct]. In a series of 158 patients who underwent surgical treatment for biliary lithiasis, we have had 109 (69%) lithiasis of the gallbladder (CC) and 48 (31%) lithiasis of the common bile duct. In the last group 19 (38%) were without jaundice (CAEC) and 30 (62%) with jaundice (CIEC). We have compared the three group of patients (CC, CAEC and CIEC). It has come out that CAEC is between CC and CIEC and that attacks of biliary fever and high levels of alkaline phosphatase and transaminases in the serum are the helpful findings for preoperative diagnosis. Intravenous cholangiograms can confirm the diagnosis in 80% of one series but the operative cholangiography remains the definitive test. Finally CAEC seems to be the "benign" lithiasis of the common bile duct, a first stage that getting worse will became CIEC.


[A case of hematic pseudocyst of the spleen]. A case of extremely voluminous haematic pseudocyst of the spleen that provoked serious anaemia is reported. Stress is laid on the rarity of the disease and the preoperative diagnostic difficulties. The pathogenesis, pathological anatomy and clinical aspects on splenic pseudocyst are recalled.


[A middle esophageal ring].

[A middle esophageal ring]. The Authors, having observed a case of middle oesophageal web giving rise to severe dysphagia, discuss the aetiopathogenesis, the diagnosis and therapy of these rare oesophageal lesions. Because of its pathological feature, the reported case was succesfully treated by surgical resection of the ring, using a transthoracic approach.


[Malignant ano-rectal melanoma].

[Malignant ano-rectal melanoma]. Malignant melanoma of the anus, anorectal junction and ampulla respectively was observed in 3 patients treated at the Busto Arsizio Hospital's General Surgery Division in the period 1967 to 1978. An account is given of the anatomopathological picture, symptoms, treatment, and prognosis of these forms.


[Personal experience with bilio-digestive anastomosis]. The indications and contraindications for the various types of bilio-digestive anastomosis operations are assessed with due allowance for the physiopathological aspects of main bile way function. Careful analysis of the data obtained in pre- and intra-operative investigation permits a precise choice of the required intervention in all cases. The advantages offered by restoral of bile flow at duodenal level, as occurs in EDDP, are stressed.


[The choice of operation in perforated gastroduodenal ulcer]. The main point for a surgeon treating a perforated peptic ulcer is to choose between a simple treatment of the complication and a treatment both of complication and ulcer disease. So, the A. have analysed their series of 58 patients with perforated peptic ulcer: one patient underwent nasogastric suction as suggested by Taylor, 16 patients underwent suture plication of the perforation, 41 underwent immediate gastrectomy. A fully follow-up was performed: in the suture-plication group only 28.5% was symptonfree, the remaining 71.5% had recurrent dyspepsia or underwent definitive gastrectomy. Follow-up results of the immediate gastrectomy patients and elective gastrectomy patients are the same. The A. discuss the different procedures of treatment and their specific indications. Surgical treatment is the selected one and simple suture and immediate gastrectomy are not opposite.


[Modified Thal operation in the treatment of achalasia of the esophagus]. The results of modified Thal (cardioplasty with gastric patch) in the surgical treatment of oesophageal achalasia are reported. Clinical, endoscopic, radiological, pHmetric and manometric findings offer evidence of the value of the technique.


[Anti-edema activity of injectable Venoruton in abdominal surgery]. The anti-oedema activity of an injectable drug (HR; active principle: 0-(beta-hydroxyethyl)-rutoside) was assessed in 60 gastric extrahepatic bile duct, and large intestine surgery patients (30 being used as controls). Gastroscopy (with biopsy), gastroduodenoscopy, colonoscopy (with biopsy) and radiological examination were usually performed on the 5th and 10th post-operative days. The drug showed significant therapeutic effects: rapid resolution of oedema, especially at the sutures, leading to early cicatrisation, canalisation and the prevention of dehiscence. Finally, duration of hospitalisation was less than in the untreated cases. The gastroscopic, radiographic and biopsy findings are considered to have shown clear evidence of the drug's action against oedema formation.


[Non-appendicular primary pathology of the large intestine as a cause of emergency surgery. Clinico-statistical evaluation of its incidence in a provincial hospital]. Reference is made to the relevant literature in a description of cases of non-appendicular primary diseases of the large intestine necessitating emergency surgery at the Tradate District Hospital over the last five years. Emphasis is placed on the wide aetiological variety of these cases, their different clinical pictures, the types of operation performed, the possible complications, and the causes of death prior to discharge.


[Comparative observations on the course of different types of necrosis]. Histological comparison between cryonecrosis and thermonecrosis has shown that cryonecrosis in generally better delimited and surrounded by a layer of finer and more regular granulation tissue than thermonecrosis. Moreover, the course of the cold lesion is faster and is less open to phenomena of suppurative septic and oedematous phenomena.


[A case of pleuro-pericardial celomic cyst]. Reference is made to a case of coelomatic pleuropericardiac cyst in an account of the relative clinical silence of this form and the difficulties involved in its differential diagnosis. The aetiology, pathological anatomy, diagnosis and treatment of diseases of this patient are also described.


[A case of acute pancreatitis and ileal volvulus]. A case of pancreatitis that preceded and complicated, in the postoperative phase, one of ileal volvulus imprisoned in the Douglas and operated two days after admittance is reported. Clinical and laboratory data only permit hypotheses and this uncommon case of associated pathology is reported so that the situation can be borne in mind in the practical solution of surgical emergency.


[Clinical study on the use of methergoline for the inhibition of lactation during the puerperium]. Methergoline was administered for 5 consecutive days starting on the morning after delivery in the block of lactation in 30 patients. The efficacy of the drug was evaluated in terms of milk production, and mammary congestion and pain. The results obtained and the absence of side-effects showed that the drugs was very suitable for this purpose.


[Uterine surgery. Clinical results in 40 cases]. The results obtained in 40 cases of uterine malformation following metroplastic surgical correction have been examined. The technique employed is based on the Brett-Palmer technique with some variations designed by P. N. Siliquini aimed at respecting the myometrium of the two matrices.


[Reye's syndrome. Discussion of a clinical case]. A case of Reye's syndrome in an unweaned child aged 5 1/2 months is reported. The boy presented ingravescent neurological symptomatology accompanied by sporadic gastrointestinal signs and by marked renal impairment, with total, or nearly total absence of pathognomonic laboratory data. The diagnosis was confirmed by autopsy.


[Maternal and neonatal factors determining bilirubinemia during the 1st four days of life]. The influence of various maternal and neonatal factors on blood bilirubin is examined. An increase in neonatal values may be due to the relatively advanced age of the mother, whereas neonatal age, sex and weight, increase in maternal weight during pregnancy, and maternal body surface area would appear to be without influence.


[Bulbar hypertension in eye surgery].

[Bulbar hypertension in eye surgery]. Perfusion althesin, pentazocin and an association of halothane was used in more than 500 eye operations. A number of parameters (left humerus arterial pressure, heart rate, CVP, IOT) were measured and assesed statistically in 21 selected patients and a pathogenetic interpretation of observed bulbar hypotonia attempted. The important bulbar hypotonizing action brought on by this anaesthetic procedure, and the favourable course of surgery with the technique are confirmed.


[Effect of prolonged nicotinic acid load on the tolbutamide test]. The action of prolonged, high doses of nicotinic acid on carbohydrate metabolism has been studied. Results were discordant and did not throw light on the problem, and nor does the literature.


[Breast pneumocystography. 96 tentative cases]. Successful execution of mammary pneumocystography in 87-96 attempts is reported. A brief description of the method and a statistical assessment of the incidence and features of the cysts observed are followed by the expression of a very favourably judgment on the soundness of the technique, and the presentation of several of the more meaningful cases.


[Our experience in preoperative embolization in kidney neoplasms]. 11 cases of preoperative embolization with Spongostan in renal tumours are reported. Contraindications, indications and the by no means negligible advantages which application of this technique offers the surgeon are discussed briefly.


[Facial telethermography in the diagnosis of carotid insufficiency in the extracranial sector]. The usefulness of facial telethermography in the diagnosis of circulatory insufficiency owing to occlusion of the extracranial vessels is discussed. The method has proved of great assistance in the screening of patients with vascular diseases, and in the choice of a subsequent contrastographic examination. It gave a significant number of positive findings in cases of insufficiency of the internal carotid artery. The number of false positives and false negatives was virtually negligible.


[Value of thermography in the postoperative control in direct arterial surgery]. 21 patients suffering from arteriopathy of the lower extremities and treated with a variety of surgical techniques and arterial recanalization have been studied by means of pre- and post-operative angiography and thermography. After analysing the results, the value of thermography, particularly as regards assessment of the surgical results and subsequent long-term controls, is confirmed.


[Distribution and incidence of malignant tumors in various valleys of the Biella district]. Statistical assessment is made of the cases of malignant recorded in the Piedmont Tumour Register for the nine Biella districts in the period 1965-1971. Differences in the distribution of tumours were noted. Taken overall, however, the results in the Biella district, the province of Vercelli, and the rest of Piedmont were much the same.


[Considerations on myocardial scintigraphy with 201thallium after stress]. An heterogeneous group of 12 patients has been studied with 201thallium myocardial scintigraphy after stress (MSS); has been used an electronic calculator which made it possible to increase the reliability of the method. Eight patients were males, 4 females; the average age were 52.6 years. The 201thallium (1.7-2 mCi) is injected (through a Teflon cannula inserted in the forearm) 1' before the interruption of the stress test on the cycloergometer. After 10' tests are made in AP-LAO and LL view; a second test is carried out after an hour, and, if necessary, after 4-6 hours time. The results are interpreted as: a) positive: absence (++) or obvious defect in perfusion (+); b) negative: normal perfusion (-); c) questionable: activity not significantly reduced (+/-). In some cases, the authors studied correlations and discordances between MSS and clinical, coronarographic and echocardiographic data. It has been considered moreover, the uptake's and release's variations of the radio-isotope in relation with experimental knowledge of myocardial extraction and clearance. We conclude by emphasizing the interest of this method and suggesting some practical considerations: 1) Patients with negative MSS don't need coronarography. 2) Positive MSS, but restricted deficit, good delayed reperfusion, good clinical pharmacological control would permit a delay of coronarography. 3) Clear multiple deficit need coronarography. 4) Usefulness of the MSS for long-term control of the evolution of coronary disease and of patients operated of aortocoronary bypass.


Eisenmenger's syndrome and pregnancy.

Eisenmenger's syndrome and pregnancy. Two additional cases of successfully managed Eisenmenger's syndrome (ES) during pregnancy are described. A review of the literature on this subject revealed 115 reported cases, of which only 44 (including our two cases) were felt to be adequately documented, representing 70 pregnancies. These formed the material for statistical evaluation. Fifty-two per cent of all patients died in connection with pregnancy. Thirty and three-tenths per cent of all pregnancies results in maternal death. Maternal mortality in first, second, and third pregnancies was not significantly different. A high incidence of maternal death was assoicated with hypovolemia, thromboembolic phenomena and preeclampsia, but mortality was not higher in the toxemia than in the non-toxemia group. Cesarean sections and other operations are associated with extremely high maternal mortality during pregnancy. Thirty-four per cent of all vaginal deliveries, three out of four cesarean sections, and only 1 out of 14 pregnancy interruptions (the only one by hysterotomy) resulted in maternal death. Abortions are significantly safer than any kind of delivery (p less than 0.05). Ventricular septal defect (VSD) is the most frequent underlying shunt defect. Maternal mortality in association with VSD is higher (60%) than in association with atrial septal defect (ASD) (44%) and patent ductus arteriosus (PDA) (41.7%). The majority of maternal deaths occurred during or within the first week after delivery. Only 25.6 per cent of all pregnancies reached term. At least 54.9 per cent of all deliveries occurred prematurely. Thirty and two-tenths per cent of all infants showed intrauterine growth retardation. This represented almost half of all new borns with available information. Perinatal mortality reached 28.3 per cent and was significantly associated with prematurity (p less than 0.001). Pregnancy is contraindicated in patients with ES. Abortion is the treatment of choice, once pregnancy has occurred. Where interruption of pregnancy is refused, utmost care must be taken to assure maternal and fetal survival. A protocol for the management of such pregnancies is discussed on the basis of available information.


The streak gonad syndrome.

The streak gonad syndrome. The streak gonad syndrome is described in detail with a reveiw of the literature and a report on the diagnosis of 38 additional patients. Certain signs and symptoms of the syndrome are always present, ie, female phenotype, primary amenorrhea, infantile breast status, sparse public and axillary hair, infantile external genitalia and vagina, atrophic vaginal smear, immature uterus, high serum follicle-stimulating hormone (FSH) level, low urinary estrogen, retarded ossification, osteoporosis, and the streak gonad. Therefore, they are considered to be cardinal features. Certain somatic anomalies known as associated stigmata occur with varying frequency in accordance with the karyotype. Thus, patients with the streak gonad syndrome can be classified into groups according to their chromosomal complements. It is believed that the term streak gonad syndrome instead of Turner's syndrome, gonadal dysgenesis, or other terms is a much more accurate description of the syndrome, at least from the clinician's point of view.


True hermaphroditism with peripheral blood and gonadal karyotyping. Eight documented cases of true hermaphroditism have been seen in the reproductive endocrine unit at the Medical College of Georgia since 1969. There was histologic evidence of both ovarian and testicular tissue in all cases. Seven patients had peripheral blood karyotypes: 6 had normal 46,XX peripheral blood karyotypes, and 1 patient had a normal 46,XY blood karyotype. Four of the 7 patients studied had chromosomal analysis of 1 or both gonads. Five gonads were karyotyped as 46,XX and 1 revealed a mosaic gonadal pattern of 46,XX/46,XY. The clinical features, anatomic findings, and cytogenetic studies of these patients are reviewed. Discordant findings in peripheral blood and gonadal chromosomes are discussed.


A comparison of netilmicin and gentamicin in the treatment of pelvic infections. Seventy-five women admitted with the symptom complex suggestive of pelvic inflammatory disease( PID) were started on a penicillin-aminoglycoside antibiotic regimen. An aminoglycoside, gentamicin or netilmicin (Schering-Plough), was chosen randomly and given parenterally. Forty-two patients received netilmicin and 33 received gentamicin for 5 days. Therapeutic response to the 2 antibiotic regimens was similar. Aminoglycosides have been associated with both nephrotoxicity and ototoxicity. Blood chemistries were studied in all patients. The only manifested toxicity was in 2 patients treated with gentamicin. Endometrial-endocervical cultures were obtained before and after therapy. The microbacteria isolated by standard culture techniques before therapy revealed Neisseria gonorrhoeae in 69% and 51% of the netilmicin and gentamicin groups, respectively; anaerobic organisms were cultured in about 75% of each group.


T mycoplasma in human reproductive failure. In a study of 50 women of child-bearing age, half of whom had infertility problems, it was demonstrated that the infertile group more commonly yielded Ureaplasma urealyticum on culture (84% versus 60%), had more than twice the recoveries from the endocervical canal than fertile women had (80% verse 36%), and grew a much higher log number of T mycoplasma from this locus. No particular serotype predominated as an isolate from infertile women in this study, although antisera to serotype 3 inhibited growth of most of the T mycoplasma recovered. Strains insensitive to erythromycin were recoverable from more than half of the fertile women. Of 143 patients without fertility problems there was no significant difference in Ureaplasma isolation between women who used an intrauterine device (IUD) and those who did not.


The clitoral index: a bioassay of androgenic stimulation. The glans clitoris is a target organ that is responsive to androgenic stimuli and enlarges throughout life. The size of the glans clitoris can be quantitated by determining the clitoral index (CI), which is the product of the sagittal and transverse diameters of the glans. Four hundred ten patients, ranging in age from 17 to 35 years, were examined. Ninety-five percent of 249 normal women had a CI less than 35 mm2. Of 85 patients with clitoromegaly (CI greater than 35 mm2) in addition to at least 1 other clinical sign of excess adrogenic stimulation, 53 (62%) had abnormally high values for either or both total serum testosterone and 17-ketosteroid levels. The CI is a useful bioassay for the clinical recognition of excess androgenic stimulation.


Microsurgical conization of the cervix by carbon dioxide laser. The carbon dioxide (CO2) laser has been used to treat cervical intraepithelial neoplasis (CIN) by vaporization of colposcopically visible lesions. Recently, several investigators have reported a series of laser-treated CIN with very promising cure rates. The use of the laser to excise cervical tissue surgically has been neglected. A series of patients who have undergone cervical cone biopsies taken by the CO2 laser is presented. The tissue sections obtained from these cone biopsies are suitable for pathologic interpretation and study. The complication rate for cervical conization by laser is very low. Other advantages of this method of cervical conization are discussed.


Accuracy of lymphangiography in the diagnosis of paraaortic lymph node metastases from carcinoma of the cervix. A study was undertaken to evaluate the use of lymphograms as a method of diagnosing cancer of the cervix metastatic to the paraaortic lymph nodes. Twenty-one patients underwent lymphograms, surgical biopsy, and histologic examination of the paraaortic nodes. The specificity of lymphangiographic examinations is not accurate enough to be of clinical significance in the detection of paraaortic lymph node metastasis from carcinoma of the cervix. Lymphangiography can be of assistance in locating suspicious lymph nodes. These nodes should then be biopsied. The final therapeutic decisions should be based on tissue diagnosis.


Lipoid cell tumor of the ovary.

Lipoid cell tumor of the ovary. An androgen-secreting tumor of the left ovary was preoperatively localized in a 55-year-old virilized woman by radioimmunoassay of blood androgens. The blood sample was obtained by bilateral catheterization of the ovarian and adrenal veins using a percutaneous retrograde femoral approach. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed, and revealed a lipoid cell tumor of the left ovary and right ovarian stromal hyperplasia. Despite early postoperative return of plasma adrogens to the normal range, virilizing signs persisted almost unchanged 1 year after surgery.


Comparison of prostaglandin E2 and intravenous oxytocin for induction of labor. One hundred nulliparas at term were randomly given oxytocin intravenously or prostaglandin E2 (PGE2) gel (0.5 mg PGE2) intracervically in order to study the effect on cervical ripening and the frequency of successful inductions. In the presence of a favorable cervix both methods seemed equally efficacious in inducing labor. However, when the cervix was unfavorable, 53% of the patients could be delivered with PGE2 gel, compared with 31% when oxytocin was given. In patients with a highly unfavorable cervix this difference was significant (P less than 0.02). In patients not induced into labor, PGE2 gel caused a considerable ripening of the cervix, with a change in Bishop score from 2.9 to 6.3. In patients undelivered after oxytocin stimulation, no change in Bishop score occurred. This effect of locally applied PGE2 gel on cervical ripening was highly significant (P less than 0.001). No adverse maternal or perinatal effects were observed, irrespective of the mode of treatment.


Body temperature recordings during oral prostaglandin E2 induction of labor. Body temperature measurements have been recorded in 99 patients during the course of labor induction with oral prostaglandin E2 (PGE2). From the data obtained, there is no evidence that oral PGE2, in the usual dosage for induction of labor, acts as a pyretic agent. If fever is encountered during the course of an oral PGE2 induction, the obstetrician would be advised to look for some other cause for the temperature elevation.


Ripening of the term cervix with laminaria. Laminaria tents were used to ripen the cervix in cases where induction of labor was indicated and the Bishop score was less than or equal to 5. Induction of labor was significantly more successful in these cases as compared with a matched control group where the cervix had not been ripened.


The fetal and labor outcome of 102 positive contraction stress tests. A total of 5447 contraction stress tests (CST) were performed on 3246 high-risk patients during pregnancy. Positive tests occurred in 102 patients (3.1%), 59 of whom had primary cesarean sections. Labor was induced in 40 patients (39.2%), and 17 developed cardiotocographic evidence of fetal distress. In 2 patients labor was terminated due to prolapse of the umblilical cord, and the remaining 21 patients did not develop fetal distress. Fetal distress was more common in patients with proved intrauterine growth retardation (IUGR) and where the acceleration patterns were not noted during the CST. Only 23% of the patients delivered vaginally. The fetal loss was 100% in those infants weighing less than 1000 g, but no infant weighing greater than or equal to 2500 g died. The overall perinatal mortality was 8.7%. The incidence of late decelerations during labor, low 5-minute Apgar scores, and small-for-date infants was significantly higher in patients with positive stress tests than in a control group of 257 patients with negative stress tests done over the same period of time.


Prediction of intrauterine growth retardation via ultrasonically measured head/abdominal circumference ratios. This prospective study examines the reliability of ultrasonically measured head/abdominal (H/A) ratios in detecting uteroplacental insufficiency (UPI)-related intrauterine growth retardation (IUGR) in 47 patients. Normal H/A ratios were found in 37 (79%) fetuses. None of these infants was classified as small for gestational age (SGA) on newborn pediatric evaluation. Ten fetuses (21%) had H/A ratios greater than +2 SD for gestational age. On this basis, UPI-related IUGR was correctly predicted in all 10 infants. It is concluded that the H/A ratio is a sensitive indicator of UPI-related IUGR. Moreover, this technique is particularly valuable in patients referred for initial scanning after 30 weeks' gestation when it is difficult to distinguish accurately between true IUGR and an "error in dates" on the basis of biparietal diameter (BPD) measurements alone.


The management of severe toxemia in patients at less than 36 weeks' gestation. Fifty-five patients at less than 36 weeks' gestation with severe toxemia were treated conservatively. The pregnancies were continued for a mean duration of 19.2 days and the mean gestation at delivery was 35.2 weeks. Fifty-three percent of the deliveries were by cesarean section. Of the neonates, 56.5% showed severe intrauterine growth retardation (IUGR), 17% had asphyxia neonatorum, and 13.2% developed respiratory distress syndrome (RDS). There were 3 stillbirths and 2 neonatal deaths for a mortality rate of 8.9% and a corrected rate of 7.1%.


Effects of ethanol on the circulation and acid-base balance of pregnant sheep. Nine infusions of 15 cc/kg/120 min of 9.5% ethanol were administered to 4 chronically catheterized ewes, at 109-135 days' gestation. Stabilization periods ranged from 6 to 28 days postoperatively. Maternal and fetal concentrations of ethanol were almost identical (r = 0.9925), with peak levels of 122 +/- 20 mg/100 ml (mean +/- 1 SE) and 121 +/- 19 mg/100 ml, respectively, at the end of infusion. Maternal pH decreased from 7.50 +/- 0.02 to 7.44 +/- 0.02 (P less than 0.005) at 120 minutes. Maternal glycemia increased from 76 +/- 14 mg/100 ml to 162 +/- 23 mg/100 ml (P less than 0.005) at 120 minutes. Maternal heart rate, blood pressure, PO2, O2 content, PCO2, and bicarbonate remained unchanged. Fetal PO2 increased during and following infusion from 18.9 +/- 0.9 mmHg to 22.0 +/- 1.0 mmHg (P less than 0.005) at 180 minutes. Fetal blood pressure increased from 51.3 +/- 3.1 mmHg to 53.7 +/- 3.3 mmHg (P less than 0.01) at 30 minutes. Fetal pH, PCO2, glucose, and lactate levels remained unchanged. The authors conclude that ethanol crosses the sheep placenta readily, causes maternal acidosis and hyperglycemia, and increases fetal PO2, blood pressure, and heart rate without any effects on fetal acid-base status.


Serum levels of placental alkaline phosphatase in high-risk pregnancies. A recently developed radioimmunoassay (RIA) for placental alkaline phosphatase (paf) was used to estimate the maternal serum levels of the enzyme in 51 women with various complications of pregnancy. The results were compared with a reference group of 242 women with apparently normal pregnancies. Women with intrauterine growth retardation (IUGR) or severe or mild preeclampsia had significantly low weight of the fetoplacental unit. Simultaneous determinations of PAF in maternal serum and the urinary total estrogen/24 hr gave a clear differentiation of the IUGR group from the other pregnancies at risk. All PAF values from risk pregnancies were below the mean values of normal pregnancy.


Alterations in the prothrombin coagulation pathway due to preeclampsia. Circulating plasma levels of human prothrombin antigen and activity were determined in normal pregnancy and in pregnancies complicated by hypertension, eclampsia, or preeclampsia. The ratio of prothrombin antigen to activity (Ag/Act) was within normal limits for all hypertensive patients. However, every untreated preeclamptic patient, as well as 2 eclamptic patients, had abnormal prothrombin antigen to activity ratios.


Evaluation of the FELMA microviscosimeter in predicting fetal lung maturity. A new, rapid technique for determining fetal lung maturity, the FELMA, was tested against the standard lecithin/sphingomyelin (L/S) ratio in predicting hyaline membrane disease (HMD). The FELMA was tested on 236 samples, 154 of which were compared with the L/S ratio; 102 neonates were delivered within 48 hours. There was a significant correlation between methods ( r = 0.47). No neonate with a mature FELMA score developed HMD. Of 5 neonates with HMD, 2 had mature L/S ratio in predicting lung immaturity, providing a rapid result without the necessity of thin-layer chromatography.


Proctectomy combined with vulvectomy for carcinoma of the vulva. Carcinoma of the vulva occasionally involves the anal canal and the lower rectum. A method is presented for removal of the vulva, anus, and distal rectum by the perineal approach.


Fetal heart rate tracing during sickle cell crisis: a cause for transient late decelerations. A case of maternal sickle cell anemia crisis is presented. A continuous fetal heart rate (FHR) tracing demonstrates late decelerations that reversed when the mother's condition improved. The importance of recognizing this reversible late deceleration problem is discussed in terms of increasing fetal maturity.


Cholestatic jaundice of pregnancy: new perspectives. Cholestatic jaundice of pregnancy is a condition characterized by pruritus, icterus, or both during pregnancy.  A total of 9 pregnancies complicated by cholestatic jaundice are presented. Three of these cases are presented in detail because they reflect complications that can occur with this condition. The literature on cholestatic jaundice is reviewed. This condition has been regarded in the past as benign to the mother and fetus, but these cases and other recent investigations suggest high perinatal mortality and morbidity rates.


Recurrent endodermal sinus tumor during pregnancy. A case is reported of a patient who was found to have an endodermal sinus tumor coincident with pregnancy. She maintained a complete clinical response for 12 months after conservative surgery, uterine aspiration, and multiple-agent chemotherapy. Tumor recurrence appeared with a second pregnancy. A healthy infant was delivered despite resumption of chemotherapy. The use of cytotoxic chemotherapy during pregnancy is reviewed.


Endometrioid-type cystadenocarcinoma arising in the mesosalpinx. A case is presented of what is believed to be the first reported instance of endometrioid-type cystadenocarcinoma discovered in a paraovarian cyst. The literature on paraovarian carcinomas is reviewed.


Brenner tumor and mucinous cystadenoma of borderline malignancy in a patient with Turner's syndrome. A 64-year-old woman with a 45,X karyotype and Turner's syndrome and recent onset of right lower quadrant pain was found to have a mucinous cystadenoma with focal areas of borderline malignancy and a typical Brenner tumor in the right adnexa. Ovarian tumors in patients with a 45,X karyotype and Turner's syndrome are extremely rare. The present paper is the first report of concurrence of these 2 tumors in an affected individual. The simultaneous occurrence and intimate admixture of these tumors in a patient believed to be devoid of germ cells would seem to favor a common histogenesis from the germinal epithelium.


Adenocarcinoma in situ of the cervix during pregnancy. A case of adenocarcinoma in situ of the cervix during pregnancy, appropriately diagnosed by conization, is reported. A review of the literature reveals that this neoplasm is rarely encountered during pregnancy. Guidelines for diagnosis and treatment of this unusual lesion are suggested.


Was the pre-biotic atmosphere of the earth heavily reducing? A calculation of the net oxygen released by photosynthesis, and of the possible sinks for such oxygen, shows clearly that the pre-biotic atmosphere of the earth must have been heavily reducing.


Metalloporphyrins and molecular complexes of amino acids with porphyrins in juvenile volcanic ash. In samples of juvenile ash of the volcano Tjatja, USSR (that erupted in 1973) metalloporphyrins were found. With respect to the fluorescence spectra free bases of the compounds were close to the pigments that formed in abiogenic synthesis experiments (predominance of long-wave length fluorescence band). The pigments detected occurred in the ash as molecular complexes with amino acids which seem to be a abiogenic origin. These findings are of interest in terms of exploration of the processes of chemical evolution and emergence of life on the Earth.


The radioracemization of amino acids by ionizing radiation: geochemical and cosmochemical implications. A number of optically active amino acids, both in the solid state and as sodium or hydrochloride salts in aqueous solution, have been exposed to ionizing radiation from a 3000 Ci60Co gamma-ray source to see if radioracemization might accompany their well-known radiolysis. gamma-Ray doses causing 55--68% radiolysis of solid amino acids typically engendered 2--5% racemization, while aqueous solutions of the sodium salts of amino acids which underwent 53--66% radiolysis showed 5--11% racemization. Amino acid hydrochloride salts in aqueous solution, on the other hand, showed little or no radioracemization accompanying their radiolysis. Both radiolysis and radioracemization were roughly proportional to gamma-ray dose in the range studied (1--36 x 10(6) rads). Mechanisms for the radioracemization of amino acids in the solid state and as aqueous sodium salts are discussed, and the absence of radioracemization for aqueous hydrochloride salts is rationalized. Isovaline, a non-protein amino acid which has been isolated from the Murchison meteorite, contains no alpha-hydrogen atom and is therefore incapable of racemization via the chemical mechanisms by which ordinary amino acids racemize. Nevertheless, isovaline suffers radioracemization in the solid state to an extent comparable to that shown by ordinary amino acids, as do its sodium and hydrochloride salts in the solid state. The sodium salt of isovaline in aqueous solution, however, fails to racemize during its radiolysis. Several implications of the newly described phenomenon of radiomization are pointed out for the fields of geochemistry and cosmochemistry.


Antiquity and evolutionary status of bacterial sulfate reduction: sulfur isotope evidence. The presently available sedimentary sulfur isotope record for the Precambrian seems to allow the following conclusions: (1) In the Early Archaean, sedimentary delta 34S patterns attributable to bacteriogenic sulfate reduction are generally absent. In particular, the delta 34S spread observed in the Isua banded iron formation (3.7 x 10(9) yr) is extremely narrow and coincides completely with the respective spreads yielded by contemporaneous rocks of assumed mantle derivation. Incipient minor differentiation of the isotope pattersn notably of Archaean sulfates may be accounted for by photosynthetic sulfur bacteria rather than by sulfate reducers. (2) Isotopic evidence of dissimilatory sulfate reduction is first observed in the upper Archaean of the Aldan Shield, Siberia (approximately 3.0 x 10(9) yr) and in the Michipicoten and Woman River banded iron formations of Canada (2.75 x 10(9) yr). This narrows down the possible time of appearance of sulfate respirers to the interval 2.8--3.1 x 10(9) yr. (3) Various lines of evidence indicate that photosynthesis is older than sulfate respiration, the SO4(2-) Utilized by the first sulfate reducers deriving most probably from oxidation of reduced sulfur compounds by photosynthetic sulfur bacteria. Sulfate respiration must, in turn, have antedated oxygen respiration as O2-respiring multicellular eucaryotes appear late in the Precambrian. (4) With the bulk of sulfate in the Archaean oceans probably produced by photosynthetic sulfur bacteria, the accumulation of SO4(2-) in the ancient seas must have preceded the buildup of appreciable steady state levels of free oxygen. Hence, the occurrence of sulfate evaporites in Archaean sediments does not necessarily provide testimony of oxidation weathering on the ancient continents and, consequently, of the existence of an atmospheric oxygen reservoir.


Archean photoautotrophy: some alternatives and limits. From the Archean geological record, one can infer that photoautotrophy evolved early in earth history; however the nature of this photosynthesis -- whether it was predominately or cyanobacterial -- is less clearly understood. General agreement tht the earth's atmosphere did not become oxygen rich before the Early Proterozoic era places constraints on theories concerning more ancient biotas. Accommodating this limitation in various ways, different workers have hypothesized (1) that blue-green algae frist evolved in the Early Proterozoic; (2) that oxygen producing proto-cyanobacteria existed in the Archean, but had no biochemical mechanism for coping with ambient O2; and (3) that true cyanobacteria flourished in the Archean, but did not oxygenate the atmosphere because of high rates of oxygen consumption caused, in part, by the emanation of reduced gases from widespread Archean volcanoes. Inversion of hypothesis three leads to another, as yet unexplored, alternative. It is possible that physiologically modern blue-green algae existed in Archean times, but had low productivity. Increased rates of primary production in the Early Proterozoic era resulted in the atmospheric transition documented in strata of this age. An answer to the question of why productivity should have changed from the Archean to the Proterozoic may lie in the differing tectonic frameworks of the two areas. The earliest evidence of widespread, stable, shallow marine platforms is found in Lower Proterozoic sedimentary sequnces. In such environments, productivity was, and is high. In contrast, Archean shallow water environments are often characterized by rapid rates of clastic and pyroclastic influx -- conditions that reduce rates of benthonic primary production. This hypothesis suggests that the temporal correlation of major shifts in tectonic mode and atmospheric composition may not be fortuitous. It also suggests that sedimentary environments may have constituted a significant limit to the abundance and diversity of early life.


The Ear, Nose, and Throat Devices Classification Panel of the Food And Drug Administration. The passage into law in 1976 of the Medical Device Amendments authorized the FDA to regulate the safety and efficacy of medical devices. The effects of this regulation are contrasted with the mode of entry of medical devices onto the market prior to 1976. The structure and operation of Ear, Nose, and Throat Devices Classification Panel is described briefly. Continued input from otolaryngologists and allied professionals is encouraged.


Solitary neurogenous sarcomas of the head and neck. The clinical histories of three patients with neurogenous sarcomas involving the head and neck are detailed. The most satisfactory treatment suggested for such tumors involves combined therapy with chemotherapy, radiation, and radical surgical excision. By so doing, potential patient cure might be further increased and survival rates further improved.