[Symptomatic hernia (author's transl)].

[Symptomatic hernia (author's transl)]. A symptomatic hernia (most inguinal or femoral hernia, seldom epigastric, umbilical or post-operative hernia)--appeared a little while ago--originates from a preexisting, so far unknown or long since known illness. All patients with a hernia--especially those over 40 years old--are to be carefully asked for preexisting illnesses. Barium-enema and rectoscopy are not indicated at each inguinal or femoral hernia as a screening-method to exclude a symptomatic hernia; however, both methods must be employed in suspicious cases. 320 Patients with a histologically verified carcinoma of the rectum and colon had no inguinal or femoral hernia. From 387 patients with an inguinal or femoral hernia 318 patients were over 40 years old; at these patients polyps were found in five cases by rectoscopy, but never by barium-enema, and two carcinoma of the colon transverse appeared by barium-enema. A 23-years old patient with a great intraabdominal malignant tumor must be added to the sum total.


[The uricosuric effect of benzbromaron and probenecid under fasting conditions (author's transl)]. As we could demonstrate in a group of 39 obese subjects submitted to a 15-days period of absolute fasting, the developing hyperuricemia coincides with a decrease of uric acid clearance following an increase of the reabsorbed amount of filtered uric acid. After daily application of 2 g probenecid a marked uricosuric effect was detectable only during the first 3 days, while in the following time this effect was perceptible only impaired. As a reason for the diminution of efficacy the fasting-dependent urinary acidosis is discussed, which leads to low tubular concentration of the pharmacon by non ionic diffusion. In a dosage of 100 and 300 mg/day benzbromaron proved to be a much more potent uricosuricum. Additionally, related to the increase of dose the unproportional strong fall of serum uric acid levels, which stood in contrast to higher rations of uric acid excretion under a lower dose and which exceeded the dose-depending increase of uric acid clearance, indicated an additional extrarenal site of action. The depression of PAH-excretion after application of 2 g/day probenecid, which comes about the competitive inhibition, did not occur under 100 mg/day benzbromaron. This difference signifies, that benzbromaron does not develop its uricosuric effect by influencing the tubular transport system, which is specific for PAH and probenecid.


[Gray-scale ultrasound B-scanning in case of cholelithiasis, especially with negative cholecystoradiogram (author's transl)]. Report on the accuracy of gray-scale B-scanning concerning cholelithiasis. In 37 cases out of 43 examined patients sonographical results could be compared to operative and radiological results. In the case of 20 patients with a negative cholecystangiogram the results of sonography could be compared to operative results. Sonographically the gallbladder was shown in 89% of the cases. Gallstones were diagnosed at a high percentage (sensitivity 80%, specificity 88%). There were 20% false-negative diagnoses and 13% false-positive diagnoses.


[Diagnostic features of the abnormal endoscopic pancreatogram (author's transl)]. Features of 75 abnormal pancreatograms are analysed. Radiomorphology is conferred with surgical or postmortem findings in all cases. None of the anatomical alterations was found to be specific for any given diseases entity, some consistency was verified however. Solitary stenosis suggests cancer. Diffuse alterations point to chronic pancreatitis. Cave filling is a likely sign of cyst or pseudocyst. Since, however, these features are nonspecific, the diagnosis must be based on clinical data as well.


[Effect of Dapotum D minor on somatization (unstable stomachs on a vegetative base). 2nd Communication (author's transl)]. This study established that as a result of treatment of fluphenazin dekanoate (Dapotum D minor)--additional to the usual treatment for a nervous unstable stomach--the therapeutical effect could be improved. For this purpose 30 patients underwent a double blind trial for 6 weeks with a "cross over" after 3 weeks. In order to control the therapeutical effects the patients were given special questionnaires and in addition to this they had to answer a memorandum-sheet of self assessment as well as a self rating scale so that the stabilizing of the "vitality level" could be checked. Test data were analysed by variance and covariance analysis. After analysing the medical results by way of statistics the self assessment scale showed that by "unstable stomachs on a vegetative base" an additional treatment with Dapotum D minor achieved superior results over the conventional treatment.


Autosomal phosphoglycerate kinase linked to mouse major histocompatibility complex. The mouse  autosomal locus that determines the form of phosphoglycerate kinase found only in testes is shown here to be closely linked to but not included within the major histocompatibility complex on chromosome 17. Data are presented that strongly favor the location of this locus, designated Pgk-2, distal to H-2, Qa-1, and Qa-2, and closely associated with T1a. The Pgk-2 strain distribution pattern for 103 inbred and congenic strains of mice is given. Because Pgk-2 is polymorphic among inbred strains, it should be of value in linkage studies.


Treatment of hypoparathyroid patients with chlorthalidone. In an effort to maintain normal serum calcium levels without inducing hypercalciuria, we treated seven hypoparathyroid patients for up to 25 months with chlorthalidone, a thiazide-like sulfonamide diuretic, plus a salt-restricted diet, without added vitamin D. Mean 24-hour calcium excretion decreased from 179 to 88 mg (P less than 0.001), and mean serum calcium increased from 8.2 to 9.3 mg per deciliter (P less than 0.05). Diuretic therapy or moderate salt restriction alone was not as effective as combined therapy. Beneficial effects were sustained for as long as therapy was maintained. The rise in serum calcium, which involves the filterable and ionized fractions, cannot be due entirely to reduced excretion and may in part be explained by increased intestinal absorption. Oral chlorthalidone plus a low salt diet appears to be an effective alternative to vitamin D in the maintenance therapy of at least some patients with hypoparathyroidism.


Interpandemic influenza in the Houston area, 1974-76. Prospective virologic surveillance has defined two influenza epidemics representing the fifth and sixth outbreaks attributed to H3N2 viruses since the prototype, A/Hong Kong/68 ((H3N2), emerged in 1968. The 1975 epidemic was caused by influenza A/Port Chalmers and yielded an estimated attack rate of 9 per cent; the second, attributed to influenza A/Victoria, produced an explosive outbreak, with an estimated attack rate of 18 per cent in 1976. The highest morbidity occurred in preschool children, with an estimated attack rate of over 30 per cent. During the early stages of both epidemics there was a predominance of cases among school-aged children, and school absenteeism peaked earlier than other nonvirologic indexes. These observations support the concept of rapid dissemination of influenza among schoolchildren and suggest that control of epidemic influenza might be facilitated by prophylaxis for that age group and other accessible, healthy populations.


Family practice in evolution: progress, problems and projections. Family practice has developed in direct response to the public need for primary care with the elements of comprehensiveness, continuity and accessibility. This specialty represents a re-emphasis of the generalist role in medicine, with particular concern for the family as the unit of care. Since the American Board of Family Practice was formed nine years ago, the first phase of development has been completed. Teaching programs in family medicine have been effectively established at undergraduate and graduate levels throughout the country in both university and community settings. Refinement of teaching programs and initiation of a strong ongoing research effort are now required. The continued successful evolution of family practice as a foundation of primary care in the United States is essential to extend the highest possible quality of care to the entire population at a cost that can be afforded in a society with limited resources for health care.


Transmission of hepatitis B virus infection by transfusion of frozen-deglycerolized red blood cells. Chimpanzees were used to determine the ability of prior freezing of red blood cells to prevent the transmission of Type B post-transfusion hepatitis. Four units of human whole blood were each inoculated with 10(6) infectious doses of hepatitis B virus. Although all units became HBsAg negative after freezing and deglycerolization, hepatitis B virus infection developed in all four chimpanzees when these units were transfused. Two of these chimpanzees had only serologic evidence of infection, including the development of HBsAg and antibody to both the hepatitis B surface and core antigens; in these animals, the incubation periods were prolonged (24 to 25 weeks). In contrast, the other two animals also had elevated serum glutamic pyruvic transaminase (peaks of 190 and 461 IU per liter) and had a more rapid onset. There was no hepatitis B virus infection in two nontransfused controls. Our results do not support the use of frozen red blood cells for the prevention of post-transfusion hepatitis.


Thyroid function after surgical treatment of thyrotoxicosis. A report of 100 cases treated with propranolol before operation. We assessed thyroid function for 12 months after subtotal thyroidectomy in 100 tyrotoxic patients treated with propranolol alone before and immediately after operation. The operation proved safe, with low morbidity. Suppression of the hypothalamic-pituitary-thyroid axis, present in the majority one month after operation, was evidenced by normal or low levels of serum total tri-iodothyronine and thyroxine, but absent or subnormal serum thyrotropin response to thyrotropin-releasing hormone. Eighty patients were euthyroid at 12 months. Three patterns of thyroid function were observed in this group between the first and 12th months: normal serum total tri-iodothyronine, thyroxine and thyrotropin levels at all stages (20 patients); normal serum total tri-iodothyronine and thyroxine, but raised thyrotropin levels on one or more occasions (40 patients); and temporary hypothyroidism (20 patients). Of the remaining 20 patients, permanent hypothyroidism developed in 14, and six relapsed. Postoperative thyroid function was related to the estimated weight of the thyroid remnant.


Racial patterns in pernicious anemia. Early age at onset and increased frequency of intrinsic-factor antibody in black women. Pernicious anemia affects primarily elderly northern Europeans, but may affect others more often than previously thought. Therefore, we analyzed the data from 156 documented cases: there were 73 patients of "European" origin, 52 black patients and 31 Latin-American patients. The mean age (+/- 1 S.D.) at presentation among black women, 53 +/- 16 years, was lower than that of all the others (P less than 0.001 in most comparisons), and seven of the 33 black women were less than 40 years old. In addition, 23 of the 24 black women tested had circulating antibody to intrinsic factor. A similar though less striking antibody prevalence (85 per cent) and age pattern (60 +/- 13 years) in Latin-American women did not reach statistical significance. No other group exceeded the usual 55 to 70 per cent prevalence of antibody. These finding suggest a different form of or a different response to the disease in black women and perhaps in Latin-American women.


Familial hypopituitarism with large sella turcica. We studied endocrine function in three siblings with short stature and enlargement of the sella turcica. Sellar volumes were 5.9, 3.7 and 4.0 standard deviations above age-specific means. Computed tomography or pneumoencephalography showed full sellae without suprasellar extension. Basal thyrotropin levels were low despite hypothyroidism and increments were less than 3 micromicron per milliliter after thyrotropin-releasing hormone injection. Stimulated growth hormone levels were less than 5 ng per milliliter, declining to less than 2 ng per milliliter after thyroxine treatment. Both thyroxine and growth hormone treatments were required for rapid growth. Impaired thyrotropin responses to thyrotropin-releasing hormone distinguish these patients from most cases of idiopathic or familial deficiency of thyrotropin and growth hormone. Persistent deficiency of growth hormone during thyroxine treatment indicates that the defects is not limited to thyrotropin structure or release. The findings are compatible with either familial neoplasia of the anterior pituitary or a regulatory defect promoting anterior pituitary-cell hyperplasia and inhibiting thyrotropin and growth hormone release.


Chlamydia trachomatis infant pneumonitis: comparison with matched controls and other infant pneumonitis. We determined the prevalence of Chlamydia trachomatis infection in 30 consecutive hospitalized infants less than six months of age with pneumonitis and in 28 matched controls (nine of 30 vs. one of 28. P less than 0.05). In comparing 16 cases of pneumonitis due to C. trachomatis with 27 not due to that agent, we found several distinguishing clinical and laboratory features: C. trachomatis was highly correlated with radiographic hyperinflation, prolonged cough and congestion, greater than or equal to 400 eosinophils per cubic millimeter and serum lgG greater than or equal to 500 and lgM greater than or equal to 110 mg per deciliter. C. trachomatis was responsible for 13 of 21 cases seen at three to 11 weeks vs. three of 22 seen at other ages. Antibody to C. trachomatis in tears (13 of 14 vs. two of 27), nasopharynx (12 of 14 vs. one of 27) and blood (16 of 16 vs. two of 23) was specific for C. trachomatis pneumonitis. C. trachomatis is prevalent among hospitalized infants with pneumonitis. Conjunctival infection precedes C. trachomatis pneumonitis more commonly than has previously been thought.


A twenty-five-year follow-up study of women exposed to diethylstilbestrol during pregnancy. To assess the long-term effects of diethylstilbestrol we conducted a health survey among 693 mothers who had taken the drug during pregnancy and a comparable group of 668 who had not. These women had participated in a study during 1951-52 to evaluate the drug. There were 32 (4.6 per cent) breast cancers among the 693 exposed and 21 (3.1 per cent) among the 668 unexposed, but the difference was not statistically significant (P = 0.16). No statistically significant differences occurred between the groups in any of the other categories of disease. The occurrence of breast cancer in both groups was compared to the Connecticut State Tumor Registry for 1963-65. Compared to the registry data, a significantly (P less than 0.01) higher incidence of breast cancer occurred in both the exposed and unexposed groups at ages over 50. The reason for this increase is not known, but effects linked to the selection of mothers participating in the original clinical study cannot be excluded.


Clinical healing two to six years after poststreptococcal glomerulonephritis in Trinidad. To determine the incidence of chronic nephritis after poststreptococcal acute glomerulonephritis in Trinidad, 760 patients (41 adult) were examined two to six years after recovery from the illness, 344 being studied twice (four and six years). Only 1.8 per cent had persistent urine abnormalities on their last follow-up examination, and another 8.0 per cent had abnormalities that were transient or occurred only after the patient had assumed the lordotic position. In 1.4 per cent hypertension was present, whereas only one had azotemia. Both persistent urine abnormalities and hypertension increased in prevalence with age at onset of prior poststreptococcal glomerulonephritis but did not vary between sexes, races or epidemic versus endemic forms. Half the urine abnormalities present four years after recovery were absent two years later. Thus, poststreptococcal acute glomerulonephritis appears to have a low incidence of chronicity in Trinidad, with continuing resolution for more than four years.


Structures and moelcular motions in alkaline earth hexammines. The alkaline earth hexammines have novel structures and molecular motions. The ammonia molecules in these compounds adopt an entirely different geometry from that of normal ammonia. There are two motional transitions as the temperature is increased. The first transition is due to ammonia rotation, and the second results from ammonia diffusion.


Nucleotide sequence of the origin of replication in bacteriophage phiX174 RF DNA. The gene A protein of bacteriophage phiX174 has been used in vitro to convert phiX RFI DNA into the relaxed RFII form by nicking the viral strand. The nucleotide sequence at the 3' end of the nick has been determined as -- T G C T C C C C C A A C T T Goh. This sequence gives the exact position of the origin of phiX RF DNA replication.


31P magnetic resonance of DNA in nucleosome core particles of chromatin. The 31P magnetic resonance spectrum of nucleosome cores from calf thymus nuclei has been measured. The spectrum consists of a single symmetric line, with a maximum second component of 5%. It is argued that this reflects a single average state of the DNA backbone, and does not support models that invoke backbone kinking at a frequency of 1 in 10 base pairs.


Neurophysiological basis of directional hearing in amphibia. Discrete regions of neural tissue along the anterior-posterior axis of the torus semicircularis act as resonators, each one broadly tuned to a different range of frequencies, and each one responding optimally to the incident sound from a different direction. In this way, a map of auditory space is represented in the midbrain.


Computer simulation of the solvent structure around biological macromolecules. The structure and energetics of the solvent, both ordered and disordered, in a small peptide crystal and in the triclinic lysozyme crystal have been simulated using the Monte Carlo method. The results are in good agreement with the experimental data and provide insight into the role of solvent structure around biological macromolecules in solution.


[Neurons of the rabbit visual cortex with simple and complex visual fields]. The receptive filelds of orientation-selective neurons were studied in the rabbit visual cortex. Two mechanisms of the selectivity were found: the mutual inhibition between on- and off-regions of the receptive field (simple type) and the orientation-dependent inhibition within the uniform region of the receptive field. The non-selective neurons could exhibit the lateral inhibition within the uniform region of the receptive field also. It is supposed that both "simple" and "complex" cells originate from the non-selective units.


[Responses of neurons in the Clare-Bishop cortical association area of the cat cerebral cortex to photic stimulation]. In acute experiments on cats with protrigeminal section immobilized by flaxedil the electrical activity of single neurons in associative visual cortex of Clare-Bishop was investigated by the extracellular registration of their spike activity. 95.5% of investigated neurons responding to natural stimulation (light spots) were sensitive to the movement of stimulus through the receptive field. Nearly 55% of neurons exhibited selective responses to the direction of stimulus movement. Some neurones responded only when the stimulus was crossing the border points of receptive field. Nearly 85.3% of neurons responded to the flashing spot with "on", "on-off" and "off" reactions, and also to the stimulation by diffuse flashes. Receptive fields of neurons in the Clare-Bishop area were of strip-like form with longitudinal axis in horizontal orientation. Presented observations allow concluding that the Clare-Bishop cortical association area plays an essential role in the central processing of visual information.


[Analysis of the neuronal activity of the lateral geniculate body in cats]. Activity of the lateral geniculate body neurons was studied in immobilized cats. Four parameters of impulse activity of every neuron were determined by computer analysis: T1, minimal, T2, average interspike intervals of the spontaneous activity, T3, latent period, and T4, duration of the first cluster of poststimulation activity. Classification of neuronal groups was made according to these parameters. This classification was used as a basis for the construction of a scheme of neuronal interaction in the lateral geniculate body.


[Alteration of the functional organization of the lateral geniculate body after injection of tetanus toxin into it]. Changes in neuronal activity of the lateral geniculate body were studied in cat under conditions of the formation of a generator of pathologically enhanced excitation after local injection of tetanus toxin into this nucleus. To evaluate the changes, an analysis of interdischarge intervals histograms of spontaneous activity and poststimulation histograms were performed. A conclusion was made that as a result of the tetanus toxin injection the inhibitory mechanisms of many relay neurons became destructed, producing substantial changes in their discharge patterns.


[Spike activity of superior colliculus neurons following blockade of corticofugal regulation]. Changes in background and evoked activity of the superior cooliculus neurons were studied in cats before and after cessation of ipsilateral corticofugal connections. On the operated side of the brain the superior cooliculus neurons slackened their impulsation and most of them were unresponsible to light stimulation (only 7.1% neurons responded to light after operation). It is suggested that afferent inputs to superior colliculus neurons are modulated by corticofugal mechanisms.


[Postsynaptic potentials of motor neurons in the nucleus of the hypoglossal nerve in cats, evoked by rubrofugal impulses]. The effects of ipsi- and contralateral red nuclei stimulation on the hypoglossal motoneurons were studied in the cats under chloralose-nembutal anesthesia. Repetitive ipsi- and contralateral rubrofugal volleys evoked PSPs in 35 (69%) from 51 investigated motoneurons (3-5 stimuli of threshold intensity at frequency 500-600 per/s were used). EPSPs appeared in 33 motoneurons with latencies from 3.5 to 14.0 ms (mean value 5.7 +/- 0.75 ms for ipsilateral and 6.8 +/- 0.8 ms for contralateral rubral stimulations). In two motoneurons IPSPs were observed with latency 6.2 ms. Stimulation of the lingual nerve evoked EPSPs and action potentials in 31 motoneurons and IPSPs in 4 motoneurons. 16 motoneurons which could not be activated by rubral stimulation also responded by IPSPs to lingual nerve stimulation. The presented data testify to the existence of two rubrobulbar systems connected by polysynaptic pathways mainly with motoneurons of tongue retractor muscle.


[Changes in the RNA concentration in neurons of the superior olivary complex in cats following monaural and binaural stimulation]. The nature of binaurally converging connections on the level of the superior olive nuclei was studied in cats anesthetized by the method of quantitative cytospectrophotometry. Significant increase in cytoplasmic RNA content in neurons of ipsi- and contralateral medial and lateral nuclei was observed after 2 hrs monaural stimulation nad 1.5 hrs binaural stimulation by rhythmical noise signals. The volume of functioning neurons of the nuclei studied was observed either to increase or not to differ from the control. The increase in RNA quantity both in ipsi-, and contralateral medial and lateral nuclei permits making the conclusion on the uniform distribution of binaurally converging connections on the neurons of these nuclei. Moreover, the data obtained enable us to assume that the accumulation of cytoplasmatic RNA occurs not only during excitation but also during inhibition.


[Mechanism of perception of magnetic field changes by the ampullae of Lorenzini of elasmobranchs]. Investigating the impulse activity from single nerve fibres connected with Lorenzinian ampullae in Black Sea skates, the mechanisms of changing magnetic field detection were studied. It was shown that the receptor to magnetic stimulation were caused by induction of electric currents in fish body or sea water. The peculiarities of receptor responses enable the animal to differ magnetic stimuli from any other stimuli. An increase in fish receptor reaction to magnetic stimulation near the "coast" of the tank was observed. The biological significance of magnetic detection by the Lorenzini ampullae is discussed.


[Relationship between the spike responses of crayfish mechanoreceptor neurons and the initial functional state and degree of aggregation of their Nissl substance]. The discharges of a single neuron in the crayfish isolated stretch receptor to square standard adequate stimuli were studied. The following parameters were analyzed: response duration, number of impulses per burst, inhibitory pause duration, amplitude and shape of the frequencygram. Preliminary desaggregation of Nissl substance correlated with increase in discharges. When initial frequency of the discharge was low or when the stretch receptor was in resting state, especially in winter time, and the Nissl substance showed high degree of aggregation, discharges to the same stimuli were weaker, and their range diminished. It is suggested that intensified discharges are determined by intracellular redistribution and uptake of calcium which take place during desaggregation of the Nissl substance.


[Variations in the membrane potentials of motor neurons during the generation of scratching]. The activity of motoneurons of the ankle flexor and extensor muscles was recorded intracellularly during fictitious scratching in decerebrate curarized cats. Before the beginning of rhythmical oscillation a large depolarization and tonic discharge were observed in flexor motoneurons, while the membrane potential of extensor ones did not change. When the rhythmical generation began, a short periodic hyperpolarization and corresponding pause in the discharge lasting for the extensor phase of the cycle appeared in flexor motoneurons. In extensor motoneurons a periodic depolarization increasing in the course of the flexor phase was observed; a maximal depolarization occurred in the extensor phase in which a short burst of spikes was generated.


[Effect of blockers of pre- and post-synaptic inhibition on processes of habituation in the system of cutaneous sensitivity]. The role of pre- and postsynaptic inhibition in the habituation of spinal ascending neurons transmitting cutaneous sensory signals was studied in cat. Pharmacological blockade of these types of inhibition by strychnine, bicuculline and picrotoxin did not evoke substantial changes in initial suppression of neuronal discharges during prolonged high-frequency (more than 50 per s) stimulation. Neuronal responses to stimulation of a cutaneous nerve fibres were not influenced during habituation of the neuron evoked by stimulation of other converging cutaneous nerve fibres.


Calcium flux during hemodialysis.

Calcium flux during hemodialysis. A system of equations has been derived, and examined, to decribed membrane permeability and calcium fluxes within a commonly used hemodialyzer, the Mini-Kiil. By a statistical technique of sequential multiple regression analysis, factors which might influence these variables were tested on data derived from 74 hemodialysis periods in 5 patients. Calcium flux from plasma to dialysate was influenced positively by dialysate calcium concentration and plasma volume flow and negatively by dialysate volume flow. Calcium flux from dialysate to plasma was influenced positively by dialysate calcium concentration and plasma volume flow and negatively by plasma phosphate concentration. Net calcium flux from dialysate to plasma was influenced positively by the calcium gradient (dialysate calcium minus plasma ultrafiltrable calcium) and plasma volume flow and negatively by plasma phosphate concentration (coefficient of multiple correlation =0.970). Because of the magnitude of regression coefficients, manipulations of the dialysate calcium concentration and plasma phosphate concentration were concluded to be the most practical means of adjusting calcium delivery during dialysis.


HgCl2-induced acute renal failure studied by split drop micropuncture technique in the rat. Proximal tubular reabsorption was studied by the split drop micropuncture technique in HgCl2-induced severe as well as mild acute renal failure. 4 mg/kg of HgCl2 given subcutaneously to normal rats resulted in severe and usually oliguric acute renale failure at 48 h, mean plasma creatinine and urea having risen to 6.9 +/- 0.4 and 420 +/- 30 mg%. On inspection of the kidney surface, usually more than 50% of the convolutions appeared white opaque and collapased. Split drop reabsorption of 0.9% NaCl, 20% mannitol and 20% albumin was markedly accelerated in these necrotic tubular segments, while reabsorptive rates were usually quite reduced in the normal-looking red transparent convolutions. DOCA/saline-pretreated rats developed mild renal failure, with plasma creatinine and urea rising slightly to 1.6 +/-0.3 and 83 +/- 14 mg%, respectively, at 48 h after 4 mg/kh HgCl2. Reabsorptive rates were almost uniformly reduced from 0.55 +/- 0.02 in controls to 0.32 +/- 0.03 nl-mm-2 sec-1 in mild HgCl2-induced acute renale failure. Mild proximal tubular injury features decreased reabsorptive rate while severely damaged tubules appear to be leaky to the extent of allowing rapid disappearance from the tubular lument of the normally barely reabsorbable 20% albumin. Although compatible with unrestricted passive backflow being an additional factor in the pathogenesis of HgCl2-induced acute renal failure, these results do not challenge the importance of primary filtration failure.


Effect of furosemide on acut ischaemic renal failure in the dog. The effect of furosemide on the development of the acute ischaemic renal failure in the dog was studied. 11 canine kidneys were used as controls (group I) and 12 as a group where furosemide (6-8 mg/kg of body weight) was given (group II) immediately after releasing the clamps. Urine volume and sodium clearance were found significantly higher in the second group of kidneys during a period of 60 min after restoration of the blood flow to the kidney. Urea clearances remained low with no noted difference between the 2 groups. By the end of the first hour osmolar and potassium clearances were found to be significantly higher in the second group. The above findings suggest that furosemide given after an induction of acute ischaemic renal failure in the dog provides, up to the 1st hour after recirculation, some benefit in water and solute excretion but no benefit in urea clearance.


Cigarette smoking habits and urine characteristics: urinalysis abnormalities are more common is smokers, but the reasons are unclear. Voided urines of 53,000 white and 9,3000 black cigarette smokers and nonsmokers were studied. Proteinuria was found to be commoner in smokers of both races and sexes. Heavy smokers showed proteinuria more frequently than light smokers. Of eight possible explanatory variables, one, alcohol consumption history, showed some interrelationship in that the smoking status-proteinuria association disappeared among heavy drinkers. Stopping smoking was not associated with a relative decline in proteinuria prevalence. Proteinuria associated with smoking did not appear to be indicative of more serious renal disease. There was a smoker-nonsmoker difference in urine glucose response to oral glucose challenge, apparently explained by higher average 1-hour serum glucose values for smokers, of unknown mechanism but partially explained by differences in alcohol usage. Hematuria, bacteriuria, and high urine acidity tended to be more prevalent in smokers, though these relationships were not consistently significant.


Albumin excretion by the kidney: the effects of osmotic diuresis. Urine albumin excretion rate in female Sprague-Dawley rats was measured duing a stable period of normal hydration and following mannitol-induced osmotic diuresis. Mannitol infusion resulted in a significant increase in urine volume and fractional excretion of sodium, but glomerular filtration rate, albumin excretion rate, and the sieving coefficient for albumin remained stable. The results suggest that under physiological conditions, changes in albumin excretion are dependent upon changes in glomerular filtration rather than urine flow.


[Critical evaluation of neurosurgical methods of treatment in so-called normal pressure hydrocephalus (author's transl)]. This retrospective investigation of 55 patients, who had been treated with shunts, on account of normal pressure hydrocephalus (NPH) is an evaluation of the results in relation to the type of shunt and the complications developing from it. Sixty per cent of these patients showed an objective improvement after diversion of the CSF, 44 per cent had complications, which were fatal in 9 per cent. The patients who had a primary theco-perintoneal shunt showed a greater amount of improvement and fewer severe complications after the shunt. The successfully treated complications were not incompatible with a post-operative improvement.


Hydrocephalus associated with subarachnoid haemorrhage. That blood in the subarachnoid space could possibly produce hydrocephalus was first suggested by Bagley in 1928 (3, 4). His conclusions were based on both experimental and clinical studies even though he actually failed to demonstrate a communicating hydrocephalus. Subsequent workers have repeatedly demonstrated leptomeningeal thickening associated with blood in the subarachnoid space from a variety of causes (8, 9). Recently neurosurgeons have become more aware of this pathological and clinical entity and have reported excellent results in patients treated soon after its recognition (5,9,16). We report a single case of post-subarachnoid haemorrhage hydrocephalus which we feel serves to emphasize the dramatic improvement which can follow treatment of the hydrocephalus.


[Meningiomas in childhood (author's transl)]. A case of meningioma in an 11-year-old boy is described. Attention is called to the rarity of these tumours in childhood. The diagnostic and therapeutic methods are also discussed.


Arnold-Chiari type II malformation. A clinicopathological study with special reference to its surgical treatment. We report two cases of Arnold-Chiari type II malformation which died as a result of respiratory arrest due to malfunction of a ventriculo-peritoneal shunt. The autopsy findings are described with special reference to surgical treatment of the condition.


[Closure of traumatic internal carotid-cavernous fistula with an improved type of captive embolus (author's transl)]. A 29-year-old male was treated for a traumatic internal carotid-cavernous fistula by embolization with an improved type of captive polyurethane foam embolus which was inserted through the common carotid artery. Neither the intracranial nor cervical carotid artery was ligated. The angiogram of right carotid taken one month after the surgery revealed satisfactory closure of the fistula and a perfect blood flow from the carotid artery involved. Soon after the operation, the chemosis, exophthalmos and disturbance of the right ocular movements began to diminish. The intracranial noise and bruit disappeared completely. There have been several opinions concerning the best kind of embolizing material and operative procedure. In our case, we devised an improved type of captive mooring embolus. A cylindrical piece of polyurethane foam was used because of its elasticity, plasticity and unabsorbability. To make our embolus we tied one end of a cylindrical embolus with a mooring suture of Nylon mono-filament so that its tip would be small enough to pass easily into the fistula, threaded discoid piece under the other end of the embolus for hook holding action, and fixed a silver clip marker at the tip of the embolus for locating with X-ray. We kept the mooring Nylon thread straignt without curling till operative use. The incised common carotid artery was closed by Iwabuchi's interlacing vascular suture method with excellent results.


[Postoperative systemic candidiasis in neurosurgical patients (author's transl)]. Two cases of postoperative systemic candidiasis in neurosurgical practice are reported. Postoperatively these patients showed signs and symptoms of systemic infection and unfortunately died in spite of intensive chemotherapy. In both cases systemic candidiasis became evident by histological examinations at autopsy. Long use of antibiotics and aggressive nosocomy were supposed to be the cause of the systemic candidiasis. The authors emphasized a high possibility of opportunistic fungal infection in neurosurgical practice. The symptomatology, treatment and prevention of this disease are also discussed.


[Spontaneous regression of sinus pericranii--report of a case (author's transl)]. Spontaneous regression of sinus pericranii has not been reported in the literatures. The aurthors presented a very rare case of sinus pericranii, which was diagnosed as early as nine days after birth and completely disappeared in seven years. The patient was a nine-day-old boy from normal delivery in full term, who had a soft tumor simulating cephalhematoma in the right parietal region. The overlying scalp looked like a hemangioma bitemporally connecting with strikingly dilated scalp veins. Soft X-ray examination of the skull revealed a homogenous mass and a small bone defect beneath the mass. Venous blood was punctured from the tumor. By means of direct injection of contrast media into the tumor, the superior sagittal sinus as well as many extracranial varicositous veins were shown. No intracranial vascular anomaly. In a year the tumor spontaneously declined and in the following seven years it disappeared completely. Pathogenesis of this lesion was discussed with special reference to cephalhematoma and a possibility of spontaneous regression of sinus pericranii was stressed.


[Pisani's pressopodostatiradiography: an x-ray method of study of the weight-bearing foot]. Further reference is made to Pisani's pressopodostatiRXgraphy as a means of obtaining X-ray evidence of the plantar support surface, its skeletal segments, and load distribution. Data collected have been employed in the elaboration of isobaric charts as an indispensable aid in the diagnosis of functional pathology and disorders due to altered load.


[Evaluation of the flow/volume curve in normal subjects. Study of the flow fall index]. Variations in the flow/volume curve have been examined in normal subjects in relation to age. It was noted that although flow varies in absolute terms, its fall is constant in both men and women, at equal age. On the other hand, a flow reduction first of 25% and then 50% of CVF was noted in relation to age.


[Pulmonary oncoscintigraphy using 67 Ga]. Following a survey of the literature on oncoscintigraphy, investigation with radiogallium is examined. If carried out following careful patient selection, it has been found personally that use of this element is highly advantageous in oncological diagnosis in the pulmonary field. Results (no false negative and only one false positive) confirm this.


[Contribution of radiological and radioisotope technics to the study of lung physiopathology]. Reference is made to the problems posed by the physiopathology of the senile lung and the manifold effects of structural deformities. A comparison is made between the possibilities offered by radiological techniques and the quantitative and qualitative evaluation of scintiscans obtained after the perfusion of 131I MAA. Examination of the data from healthy subjects of various ages and those from patients with obstructive bronchopathy and emphysema showed that uniform distribution of the isotope can generally be expected in 2/3 of subjects with "senile lung". Uneven borders and occasionally irregular distribution of radioactivity were noted in the remainder.


[Effects of isoprenaline bronchodilation on the partial pressure of oxygen in various clinical forms of bronchial asthma]. Blood gas disturbances noted in recent asthma were fully corrected with 1% isoprenalin aerosol, though changes in PaO2 were usually unobtainable in patients with chronic bronchopneumopathic obstruction. Simultaneous administration of 70% hyperoxygenated air via an intermittent positive pressure respirator led to a significant increase in this parameter, but was rarely followed by normalisation of the blood gas picture. It is considered that this finding is attributable to increased anatomical shunt at the alveolocapillary level.


[Frequency distribution of excess weight and comparative results of somatotype aspects over a period of 8 years. Studies made in young Sicilian subjects]. Weight excess frequency distribution with respect to ideal weight was studied in a sample of 2000 men and 2000 women from Sicily aged between 19 and 24. The following findings were made: greater representation of subjects with excess weight in the female sample (18.75%) than in the males (11.80%); about twice the percentage of females in classes with greater overweight incidence (+20 +29%; +30% and over); a slight distributional discrepancy of weight excess in relation to province of origin of the subjects under examination. The standards of thirteen somatic measurements obtained in the samples were compared with those obtained personally in 1967 in a sample of Sicilian men and women with similar characteristics, for the purpose of assessing any modifications in somatotype aspects between 1967 and 1975. No statural growth was found in either men or women while both showed fair weight decrease (about 3 kg) together with a reduction in almost all trunk diameters and extremity perimeters. Thus the somatic aspect of the 1975 sample compared with the 1967 sample would seem to be slimmer and more agile.


The normal menstrual cycle. Chronology and mechanism of endometrial desquamation. Morphologic studies were performed on 25 uteri obtained at different times during the menstrual cycle, ranging from 2 to 140 hours following the onset of menstruation. The amount of endometrium desquamated varied; usually only the more superficial parts--the compacta layer and small areas of the spongiosa--were shed, but in some instances desquamation extended almost to the muscularis. The remaining spongiosa, depleted and shrunken, is misleading in its appearance, resembling a basalis layer. Actually, such a layer appears morphologically distinct only during the initial parts of the cycle and undergoes secretory changes at the same rate as the rest of the endometrium. Desquamation and regeneration coexist, desquamation appearing almost complete by 60 hours, whereas regenerating epithelium is seen as early as 36 hours. Complete regeneration takes place by 140 hours after the initiation of menstruation.


Ovulation and pregnancy rates with clomiphene citrate. A review of recent experience with clomiphene citrate at the Yale-New Haven Medical Center yields the following conclusions: 1) Clomiphene citrate administered at high doses (150 mg and 200 mg) is effective in inducing ovulation in women who would otherwise have failed to conceive if treatment were restricted to only lower dosage regimens. 2) Therapy with clomiphene citrate should be initiated with the 50-mg dose. The 100-mg dose should be reserved for those who fail with the lower dose. 3) Children resulting from clomiphene-induced ovulations appear to be developing normally both mentally and physically. Congenital malformations found in children from clomiphene-induced pregnancies are those seen commonly in general obstetric practice resulting in no significant problems for the children. 4) After 3 ovulations with clomiphene citrate approximately 50% of the patients can be expected to conceive. A 50% conception rate after 3 ovulations with clomiphene citrate does not represent a discrepancy between ovulation rates and pregnancy results, for it agrees statistically with the results obtained for the general population.


Stimulation of follicular growth with "pure" FSH in patients with anovulation and elevated LH levels. Ovarian follicular growth was stimulated in 4 patients with clomiphene resistant polycystic ovary (PCO)-like disease, with "pure" human pituitary FSH during 10 cycles. In 8 cycles additional hCG was given to induce ovulation. Serum LH and FSH and plasma estradiol and progesterone were determined daily. From the response patterns of steroidogenesis, four functional stages of follicular development can be distinguished, each subsequent stage being characterized by an increasing spontaneous estradiol production and a decreasing capacity to produce extra estradiol in response to stimulation with additional hCG. It is concluded that the unpredictable response to gonadotropin stimulation of patients with PCO-like disease is due to the varying state of development of the follicles at the start of the stimulation. The suggestion is made, based on the different responses in 3 cycles of the same patient (EW), that the lack of positive estrogen feedback in patients with PCO-like disease may be a hyposensitivity to estrogens rather than an absolute insensitivity.


Fetal well-being in gravidas with diminished fetal activity at term. Twenty-five patients reporting a marked diminution in fetal activity at term in otherwise normal pregnancies were compared with 25 controls, matched for age, parity, and other factors, in whom movements were reported to be vigorous. Fetal well-being was assessed by maternal serum human placental lactogen concentration, maternal urinary estriol excretion, and fetal scalp blood acid-base values and hemoglobin concentration. Fetal biologic maturity was assessed by liquor creatinine concentration, percentage of orange cells on Nile blue staining, and "shake" testing. The 2 groups of patients showed no difference in fetoplacental well-being or degree of fetal biologic maturity.


Real-time sonography in obstetrics.

Real-time sonography in obstetrics. Three hundred fifty real-time scans were performed on pregnant women for various indications. Placental localization was satisfactorily obtained in 173 of 174 studies. Estimates of fetal gestation from directly measured biparietal diameter were +/-2 weeks of actual gestation in 153 of 172 (88.9%) measurements. The presence or absence of fetal motion and cardiac activity established a diagnosis of fetal viability or fetal death in 32 patients after the first trimester. Accurate diagnosis was made in 52 of 57 patients with threatened abortions, and two of these errors occurred in scans performed before completion of the eighth postmenstrual week. Because of the ability to demonstrate fetal motion, real-time sonography should have many applications in obstetrics.


The value of amniocentesis in prolonged pregnancy. A total of 2702 transabdominal amniocenteses performed at the Los Angeles County--University of Southern California Medical Center were reviewed, with particular emphasis on 392 samples performed beyong 41 weeks' gestation. A significant rise in the percent of amniocenteses with meconium staining was found to occur at an beyond 39 weeks. Meconium-stained fluid at amniocentesis was found to be associated with an increased incidence of babies weighing greater than 4000 g, maternal diabetes mellitus, and cesarean deliveries, in comparison to samples with clear amniotic fluid. Infants with meconium-stained fluid had an increased incidence of low 1-minute Apgar scores, but all 5-minute Apgar scores were 7 or greater. Ten perinatal deaths occurred after an amniocentesis with clear fluid in prolonged pregnancy, with four of these occurring within 7 days of amniocentesis. Lecithin/sphingomyelin (L/S) ratios less than 2.0 were found in 6% of amniocenteses performed beyond 41 weeks. However, none of the newborns with low L/S ratios develop subsequent neonatal respiratory distress syndrome. Amniotic fluid creatine values or blood-contaminated fluid were not found to be correlated with fetal outcome. No fetal mortality was attributable to amniocentesis. In view of the significant amount of false-positive and false-negative results, and the rare inherent danger associated with amniocentesis, its use solely to demonstrate the presence or absence of meconium staining appears to be of questionable value in the management of prolonged pregnancy.


Insulin therapy for gestational diabetes. Seventy-two patient with gestational diabetes were randomly treated with insulin (20 units NPH and 10 units regular) and diabetic diet, diet alone, or neither. Of the 27 patients treated with insulin and diet, 2 (7%) had babies weighing more than 8 1/2 pounds. Of the 11 patients treated with diet alone, 4 (36.4%) had babies weighing more than 8 1/2 pounds. Of the 34 patients treated with neither diet nor insulin, 17 (50%) had babies weighing more than 8 1/2 pounds. These data support the hypothesis that treatment of the gestational diabetic with insulin will reduce the incidence of fetal macrosomia.


Prostaglandin F2alpha human blood during labor. Plasma prostaglandin F2alpha (PGF2alpha) concentrations were determined by radioimmunoassay in serial samples during labor and the early postpartum period. PGF2alpha was also measured during and between contractions every 20 to 30 seconds. The highest levels of PGF2alpha were found during expulsion of the fetus and placenta with an additional rise half an hour after delivery and a decrease 2 hours after delivery to the levels of first stage of labor. PGF2alpha values from cord blood were higher than in maternal peripheral blood in labor. The maximum PGF2alpha concentration occurred between 100 to 120 seconds after the peak uterine contraction and between 40 and 60 seconds prior to peak of the next contraction. The possible explanation is that PGF2alpha initiates uterine contractions and plays a role in the maintenance of labor, in the expulsion of the fetus and the placenta, and in the involution after delivery.


Comparative risk of death from legally induced abortion in hospitals and nonhospital facilities. The rapid emergence of nonhospital abortion facilities as alternatives to traditional hospital-based surgical care has raised important questions concerning their safety. Using 1974--1975 data from the Center for Disease Control's nationwide surveillance of abortion mortality and the Alan Guttmacher Institute's nationwide surveys of abortion providers, we have calculated the risk of death from legally induced abortion in the United States at less than or equal to 12 menstrual weeks' gestation in hospitals and nonhospital facilities (clinics and physicians' ofices). The adjusted death-to-case rate for hospitals was 1.1 deaths/100,000 abortions, compared with a crude rate of 1.0 for nonhospital facilities. The risk of death from legal abortion in nonhospital facilities is apparently similar to the risk in hospitals.


A randomized comparison of the Ypsilon-Y and Lippes loop D intrauterine devices in parous women. A randomized single-blind clinical study was performed to determine whether there was any difference in the termination event rates between parous women using the Ypsilon-Y intrauterine device (IUD) and those using the Lippes loop D. A total of 174 women received the Ypsilon-Y IUD and 173 women received the loop D. A significant higher incidence of expulsion occurred with use of the Ypsilon-Y IUD.


Ultrasonic localization of missing intrauterine contraceptive devices. Ultrasonic localization of missing IUDs was performed on 51 patients with a high degree of accuracy. This method also demonstrated pregnancy where present and other pathologic conditions including fibroids and ovarian cysts. Other methods recommended for localization of missing IUDs are discussed with particular reference to their adverse effects. A protocol for localizing missing IUDs using ultrasound is recommended.


Postoperative electroanalgesia.

Postoperative electroanalgesia. Fifty-six patients who had undergone abdominal hysterectomy and 10 patients who had undergone cesarean section had fine steel wires placed subdermally in order to provide continuous electrostimulation for pain relief during a 5-day postoperative period. Compared to the same number of patients with identical surgical procedures and postoperative medication orders, but no electrostimulation, they required considerably less analgesic medication. A smaller group of 20 patients who had had abdominal hysterectomy and received mock electrostimulation required approximately the same average amount of medication for pain relief as the group without electrostimulation. Other beneficial effects noted in the patients with electroanalgesia included marked stimulation of the bowel and contraction of the postpartum uterus.


Aspiration curettage for asymptomatic patients receiving estrogen. Recent epidemiologic data suggest that patients treated with exogenous estrogens have an increased risk of developing endometrial carcinoma and support the concept that patients taking estrogens must be monitored with special vigor. The hypothesis that endometrial aspiration curettage might be an appropriate modality to accomplish adequate surveillance was tested from January 1, 1976, to January 1, 1977, on a group of 208 consecutive patients undergoing hormonal replacement therapy. Although no patient in the test group experienced abnormal or unusual bleeding, focal adenomatous hyperplasia or a more severe lesion was found in 16.0% of the specimens. Among these were 4 cases of endometrial adenocarcinoma and 2 of atypical adenomatous hyperplasia. This study demonstrated that routine endometrial aspiration curettage of patients receiving exogenous hormone replacement therapy can not only help diagnose very early lesions which are amenable to definitive and completely corrective treatment, but also can uncover significant endometrial pathology before it becomes symptomatic. It further suggests the possibility that the incidence of such pathology among this category of patients might be higher than previously suspected.


Cervical cytologic screening among females with nongynecologic hospital admissions. Routine vaginal cytologic screening in nongynecologic admissions to Tygerberg Hospital revealed a detection rate for pelvic neoplasia of 9.3/1000 patients. Of these, 22 (16%) did not derive any benefit from this program because of the severity of the primary extrapelvic disease. However, 57% of those detected were still in the in situ stage and should have a 100% 5-year survival. The treatment was considered to be complete in 54.4% of the cases. As this service is performed by nursing personnel as part of their daily duty, this program seems to be a sound economic proposition.


Urogenital sinus origin of mucinous and ciliated cysts of the vulva. The origin of mucinous and ciliated cells in the vulva and the pathogenesis of cysts lined by these epithelia were investigated. Small mucinous glands numbering from one to more than a hundred were encountered in 9 of 19 vulvas (53%) that were consecutively examined at autopsy. Eleven other cysts were encountered clinically. Six were lined by mucinous epithelium, three by pseudostratified cells with cilia plus small foci of mucinous epithelium, and two by ciliated epithelium only. Four of the cysts with ciliated epithelium were otherwise typical Bartholin's gland cysts. It is concluded that glands lined by either mucinous or ciliated epithelia are normal constituents of the vulvar vestibule, are derived from urogenital sinus, and develop into cysts when the neck leading to the vulvar surface becomes inflamed and obstructed.


Melphalan chemotherapy in advanced ovarian carcinoma. One hundred and eleven consecutive women with FIGO Stages III and IV ovarian adenocarcinoma were treated with melphalan as their initial chemotherapy. The response rate was 19.8% with 10.8% having a complete response. There was a statistically significant improvement in response in those women with no prior radiation therapy. Moreover, there was a statistically significant improvement in median survival in those patients achieving a complete response to melphalan as compared to those with a partial response, with no change or progression of their malignancy. A review of the results of maximal surgery and combination chemotherapy is presented as a plan of therapy to improve upon the results of melphalan chemotherapy in women with advanced ovarian carcinoma.


Surgery for congenital absence of the vagina. The Counsellor modification of McIndoe's procedure was used to create a vagina in 12 of 15 patients who presented with Rokitansky-Kuster-Hauser syndrome. Eighty percent of these patients, followed postoperatively from 4 months to 8 years, report satisfactory coital function. Our experience suggests that a malleable stent fashioned to conform to the surgically created neovagina is superior to a preformed, nonmoldable stent to which the endopelvic fascial dissection must conform.


Microinvasive carcinoma of the vulva.

Microinvasive carcinoma of the vulva. A case is presented of a patient with microinvasive carcinoma of the vulva which was treated by conservative surgery. Six years later, the patient developed inguinal and pelvic lymph node recurrence of carcinoma. A review of the literature on similar cases is also presented.


An alternative birth center in a community teaching hospital. The hospital-based alternative birth center answers the needs of many low-risk patients. At the same time, it provides safety factors that cannot be approached by home delivery. A home-like environment facilitates labor, simplifies delivery, and strengthens the family unit.


Hyperstimulation of the uterus during the oxytocin stress test. Two thousand seven hundred ninety two contraction stress tests (CST) were analysed. Oxytocin was administered in 1730 of these to stimulate uterine contractions and the hyperstimulation which occurred in 48 tests (2.8%) was studied extensively. Seven patients went into labor within 24 hours of the hyperstimulation. Two infants weighed less than 2500 g. One was mature but small-for-dates and the other (who died neonatally) had a trisomy-18 syndrome with severe congenital abnormalities. There were no other intrapartum or neonatal complications. Ten CSTs demonstrated hypertonicity without any preceding oxytocin administration. No harmful effects from the hyperstimulation could be found.


Growth adjusted sonographic age. A simplified method. It recently has been shown that the sonar predictive accuracy of gestational age can be markedly enhanced by separating fetuses into one of three cephalic growth patterns, namely, large, average, and small. In this way it becomes possible to adjust fetal age in relation to biparietal diameter (BPD) growth. In this report we are defining the application of a growth adjusted sonographic age (GASA). Additionally, we are introducing a table which simplifies the assignment of GASA on a routine basis.


[Differentiation of astroglial cells of the cerebellar cortex in the postnatal development of the rat: a morphological and histochemical study]. The morphological autoradiographic and cytospectrophotometric analysis of proliferation and differentation of the cerebellar cortex astroglial cells has been carried out during the rat early postnatal development. The proliferating astroglial cells constitute a major part of the whole cell population of the internal granular layer during the first week. It was proved by means of double labelling (3H- and 14C-thymidine) that these cells synthesize DNA and divide repeatedly, their division proceeding without preliminary morphological dedifferentiation, i. e. with the preservation of plasmatic processes. A suggestion is put forward that the precursors of the cerebellar cortex astroglial cells under study take their origin from the subependymal zone during the prenatal development. The results obtained allow to identify the proliferating glial cells as the Bergman's glia.


[Electron microscopic analysis of the fibroblast differentiation of amebocytes in the common snail, Lymnaea stagnalis L. (Mollusca, Gastropoda) in a lesion focus]. The amoebocytes and fibroblasts of intact connective tissues of the common pond snail foot, as well as the amoebocytes of the burn wound were studied by means of electron microscope. The found transitional forms from the amoebocytes to the fibroblasts allowed to conclude that there were cells--precursors of fibroblasts among the amoebocytes migrating in the wound. A tentative scheme of histogenetic series of amoebocytes is given.


[Analysis of the steroid hormones in pig blastocysts]. The steroid hormonal activity was established in the pig blastocysts by means of histochemical methods. This is supported by the presence of hormones (pregnenolon, pregnandion), activity of 3beta-ol steroid dehydrogenase, high content of lipids (sterols) in the trophoblast. The results of thin-layer chromatography on silicagel suggest that the qualitative composition of lipids of the early embryos and the yellow bodies of the ovaries at the corresponding stage of pregnancy is the same.


Epidemiology of essential hypertension in youth--implications for clinical practice. Essential hypertension, a highly prevalent and devastating disease, likely begins in childhood, and presumably might respond at this stage to general preventive measures. The problems encountered in the recording of reproducible blood pressure levels are largely of a quantitative nature, and involve instrument validity, observer (examiner) training, and the interaction between the child and the physician's office environment. The problems of early diagnosis of hypertension are related to the lack of long-term observations of children. Population percentiles of normal blood pressure values could aid in the early diagnosis of hypertension. For this purpose the method of blood pressure measurement in the physician's office has to be strictly comparable to methods employed in accumulating the percentile or reference observations. Repeated measurements under basal-like conditions are advised, and the weight or height of the child is more important for standardization than is age.


Clinical and physiological significance of borderline hypertension at youth. Marginal blood pressure elevation at youth is widely prevalent. Clinically such patients represent a dilemma, since they are at highest risk to develop hypertension and its sequelae, but the risk is not sufficiently strong to mandate antihypertensive medication. The decision as to whether to treat will depend on the presence of other risk factors for hypertension. Multiple and complex pathophysiologic abnormalities have been described in borderline hypertension. A better understanding of the relationship of some of these abnormalities to the development of hypertension is needed.


Hypotheses in perception: their development about unambiguous stimuli in the environment. A series of seven photographs which depict a real scene as it is approached by an observer were shown, in sequence, to ninety-six university students. The photographs were either projected colour transparencies or black-and-white prints. Two sixes of photographs were used in each set and the series was presented with or without the first photograph. In earlier studies in which blurred photographs were used as stimuli, observers were unsure about their hypotheses. That was not the case in this study. Although individual observers differed widely in their initial hypotheses, the initial photographs were not perceived as ambiguous. It required on average from 2.9 photographs (large, black-and-white, full series) to 4.5 photographs (small, colour, full series) for correct identification. In general, colour is a hindrance to correct identification. For the full series approximately three hypotheses are put forward before the scene is correctly identified.


The use of numerical and graphical statistical methods in the analysis of data on learning to see complex random-dot stereograms. Several numerical and graphical statistical methods are illustrated in an analysis of data from an experiment that investigated a hypothesis of Julesz that giving a person a priori information about the structure of a complex random-dot stereogram reduces the time needed to perceive it when it is viewed. The data are divided into two groups, one consisting of those observers who received no cue or verbal cues (NV) and the other consisting of those who received verbal-visual cues (VV). A quantile-quantile plot shows that the NV times (mean = 7.6) are longer than the VV times (mean =5.6). By using probability plots, it is shown that the perception times have an exponential probability distribution. A hypothesis test based upon this distribution is used to show that the difference between the NV and VV times has significance slightly below 0.05.


A possible explanation as to why the newly sighted commonly perform well on pseudoisochromatic colour vision tests. Patients whose vision has been restored after long periods of blindness commonly experience difficulty in perceiving. Parodoxically, such patients often perform well on pseudoisochromatic colour-vision tests. A well-known example is Gregory and Wallace's subject, S.B. who performance on the Ishihara test was perfect. It is suggested that restoration of vision may be associated with relatively poor visual acuity and that this, by filtering higher spatial frequencies, enhances the legibility of pseudoisochromatic test patterns. Two experiments confirm that the Ishihara plates are more legible when seen as defocused images.


Op art and visual perception.

Op art and visual perception. An attempt is made to list the visual phenomena exploited in op art. These include moire frinlude moiré fringes, afterimages, Hermann grid effects, Gestalt grouping principles, blurring and movement due to astigmatic fluctuations in accommodation, scintillation and streaming possibly due to eye movements, and visual persistence. The historical origins of these phenomena are also noted.


Pictorial depth and related constancy effects as a function of recognition. It is argued that while pictorial cues must be fundamental in the perception of an extended ground plane in daily life (and, by definition, in the perception of depth in pictures), the traditional pictorial cues such as perspective or texture gradients are neither a necessary nor a sufficient basis for it. That they are not necessary was shown by experiments in which such cues were eliminated from pictures representing a scene in depth. Illusory size perception based on localization of objects in depth in such pictures nonetheless occurred. That they are not sufficient was shown by experiments in which photographs of grassy fields did not yield impressions of depth or related size illusions when conditions were such that the scene was not recognized. Once recognized, however, these same pictures did yield such perceptions. It is suggested that a critical step in perceiving depth based on pictorial information is recognition of the scene.


The role of apparent depth and context in the perception of the Ponzo illusion. The role of apparent depth features and the proximity of the test lines to the adjacent contours in the actuation of the Ponzo illusion was examined. Six versions of the Ponzo figure were employed: a standard Ponzo figure and five modified figures in which the test lines varied in orientation (horizontal or vertical) and in location (inside or outside the converging contours). Both manipulations resulted in a significant decrease in the magnitude of the illusion in comparison to the standard Ponzo figure. The results suggest that the Ponzo illusion is significantly affected by contextual factors.


Are curves detected by 'curvature detectors'? Five experiments which attempted to evaluate the relationship between orientation and curvature selectivity in human vision are described. In the first two experiments, threshold elevation for curved gratings was measured after exposure to similar gratings, with the use of either an adaptation (experiment 1) or a masking (experiment 2) paradigm. In both experiments threshold elevation occurred which was selective for both the degree and the direction of curvature of the adapting pattern. Experiment 3 compared the effects of adapting to tilted rectilinear or vertical curved gratings upon threshold for a vertical rectilinear grating. Threshold elevation declined systematically as the adapting gratings were either tilted or made more curved. Experiment 4 measured curvature selectivity as a function of the orientation of a curved adapting grating. Threshold elevation declined as the adapting grating was tilted more, but curvature selectivity remained. Experiment 5 measured the orientation tuning for curved gratings directly. Threshold elevation declined to 50% of its maximum value at an adpating orientation of about 28 degrees. This was constant for all values of curvature used. The resulsts are discussed with reference to the question of whether the human visual system contains 'curvature detectors' or linear-contour detectors which respond to the tangents of curves.


Storage of spatially specific threshold elevation. The decay of several visual aftereffects may be prolonged by interposing a period of light-free or pattern-free viewing between adaptation and testing. We demonstrate that this storage phenomenon can be observed using the threshold elevation aftereffect that follows inspection of a high-contrast grating pattern. Control experiments comparing thresholds for vertical and horizontal gratings after adaptation to a vertical grating reveal that the stored aftereffect, like its unstored counterpart, is pattern-selective. Storage is equally pronounced with stimuli that are detected by pattern-analyzing or movement-analyzing visual channels. Unlike other aftereffects, the threshold-elevation aftereffect requires that the storage period be light-free; no storage is seen if a blank field is inspected between adaptation and testing. The results are discussed with respect to the nature of visual aftereffects, and possible cognitive or physiological models of storage.


Apparent movement, eye movements and phoria when two eyes alternate in viewing a stimulus. Three experiments were conducted to test the hypothesis that the apparent movement of a stimulus when the two eyes are alternately occluded can be explained by phoria and Hering's principles of visual direction. In experiments 1 and 2, the direction of apparent movement, eye position, and eye movements were measured when eye movements did and did not occur. In experiment 3, the magnitude of apparent movement and the extent of phoria were comapred. Results from the experiments 1 and 2 indicated that the direction of apparent movement could be predicted from the direction of phoria, in conjunction with Hering's principles, and was not contingent on eye movements. In experiment 3, a high positive correlation (r = 0.95) between the magnitude of apparent movement and the extent of phoria was obtained.


A delayed induced-motion illusion.

A delayed induced-motion illusion. We report a striking visual illusion which involves an induced motion that is delayed in time. An observer visually tracks a moving target in the neightborhood of a fixed target. The fixed target appears to be entrained by the moving target and appears to follow its movements after a lag of 0.33 second. A series of experiments showed that while the illusion depends on low background salience it obtains with both smooth and oscillatory motion in all directions including depth, under monocular and binocular viewing, in the absence of vestibular and kinesthetic motion cues or eye movements, and under a wide range of relative and absolute target luminance and position. The strength of the illusion and the magnitude of the induced movement's delay seem not to depend on any of the above factors. The illusion, by resisting a peripheral explanation, may provide some clues to central perceptual processing. In addition, we suggest the possibility that errors of judgment based on the nonveridical perception of motion displaced in time may play a role in nighttime automobile and aircraft accidents.


Feedback versus an illusion in time.

Feedback versus an illusion in time. The accuracy of many perceptual comparisons depends greatly on the order in which the to-be-compared stimuli are presented. With comparisons of durations around 300 ms, these presentation-order effects do not diminish, even with extended practice, when feedback about response accuracy is withheld. Providing such feedback greatly diminishes presentation-order effects and coincidentally produces substantial increases in response accuracy. The feedback acts in part through inducing response biases and in part through changes in sensitivity. The contradiction between studies which report time-order errors in duration comparison and those which do not is attributable to differences in the use of information feedback.


Pandemonium and visual search.

Pandemonium and visual search. Pandemonium-like models have played a central role in theories of perceptual recognition. One model is examined which asserts that information is sorted unidirectionally through a hierarchy of increasingly abstract levels only to a depth required by the logical demands of the task and read off from the appropriate level to control response decisions. The support originally claimed for the model in terms of its application to visual search performance is questioned. It is suggested that the pervasiveness of such models is not due to their competition with alternative theories but rather to methatheoretic considerations.


Mammary-coronary artery anastomosis for myocardial revascularization. My experience with the use of mammary-coronary artery anastomosis for myocardial revascularization in 1,500 patients over a nine-year period has been described. The procedure was used in approximately 85% of patients undergoing coronary bypass surgery, but mammary arteries accounted for only one third of the grafts. Patency rates as determined by arteriography performed from two weeks to seven years after operation were more than 95%. No late alterations in the mammary artery grafts have been seen. Clinical results have been so gratifying that I regard the procedure as the one of choice for bypass of stenosis of the left anterior descending coronary artery.


Putting zip in prescription writing a proposal. For centuries tedious, often confusing Latin abbreviations have been used in writing prescriptions. A simple four-digit (zip) code is proposed as a new method of writing directions for most drug regimens.


Acute and chronic hepatitis in children. Discrimination between hepatitis A and B is becoming easier as the serologic and clinical characteristics of each type become better known. Hepatitis A is generally a benign pediatric illness with few sequelae. In contrast, hepatitis B is more often associated with complications and may progress to chronic liver disease in as many as 10% of cases. Chronic persistent hepatitis appears to be a benign disorder not requiring therapy. Occasionally related etiologically to virus B, chronic active hepatitis is often associated with severe clinical illness. However, it generally responds to steroid therapy, at least initially, and may be arrested or cured.


Spirometry in office practice: getting full measure from a useful tool. Spirometry is a simple but underutilized test that is particularly well suited for office practice. With it, the physician can distinguish among different types of ventilatory impairment and follow the patient's course. It also permits detection of small-airway disease at an early stage, when measures to prevent development of chronic bronchitis and emphysema may be effective.


Insulin allergy and insulin resistance: two immunologic reactions. Insulin allergy and insulin resistance can cause life-threatening problems for diabetic patients. Fortunately, allergic manifestations are usually localized, but increasingly severe local reactions can precede a systemic reaction. How use of newer and purer insulin preparations than those previously available will affect the incidence of immunologic reactions is yet to be determined.


Myocardial revascularization 1978.

Myocardial revascularization 1978. After more than ten years of clinical application, direct myocardial revascularization with saphenous or mammary vein grafts is becomining one of the most common types of elective major surgery performed in the United States. The need for and the results of revascularization surgery are determined by cine coronary arteriography. The principles on which this type of surgery is based are simple. Critical occlusion of a coronary artery may produce an arteriographically identifiable area of myocardial perfusion deficit in the left ventricle. The functional demand for blood that results is usually manifested by anginal pain. When the occlusion is reduced by rest and administration of vasodilators, the immediate threat of infarction is alleviated. When pain persists in spite of treatment, direct revascularization surgery should be considered. This type of surgery need not involve ultrasophisticated adjuncts. Some of these adjuncts increase morbidity and contribute appreciably to the cost of operation and hospitalization. The record of myocardial revascularization suggests that the surgical treatment of coronary artery disease can and should be done in qualified community hospitals.


When to operate for carcinoma of the lung. Surgical resection remains the accepted treatment of localized carcinoma of the lung. The present means of patient evaluation have made possible accurate tumor staging and have led to an appreciable increase in the rate of resectability. When the tumor is found at operation to be localized to the lung, the patient has a 35% to 50% chance of surviving for five years. This observation makes it imperative that patients with bronchogenic carcinoma be evaluated rapidly and operated on, if indicated, as quickly as possible.


Case report: Infectious mononucleosis in a 41-year-old man. A 41-year-old man was found to have infectious mononucleosis, a disease frequently overlooked in patients of this age group. The symptoms and signs observed in this patient are seen in less than 10% of patients with this disease: arthralgia, epistaxis, jaundice, skin rash, and pneumonitis. Although mildly depressed platelet counts are common in patients with infectious mononucleosis, the count in this patient was markedly depressed.


Pericardial effusion and electrical alternans: echocardiographic assessment. Clinical diagnosis of pericardial effusion is often difficult, and assessment of the effects of effusion on cardiac hemodynamics is often imprecise. Electrical alternans is a reasonably specific ECG indicator of the presence of a large effusion and imminent or actual cardiac tamponade. If echocardiography verifies the presennce of pericardial fluid and shows abnormal cardiac motion, a diagnosis of cardiac tamponade can be made without further, more invasive, studies.


How mind, body, and environment influence nutrition in the elderly. Eating habits, food preferences, and attitudes affecting nutrition in the elderly are the result of the interaction of numerous interpersonal and intrapersonal forces. The physiologic changes that accompany aging must be understood by the clinician and accepted by the elderly person. Social stress and other environmental factors can adversely affect nutritional status.


Vitamin needs of the elderly.

Vitamin needs of the elderly. Vitamin deficiency is a result of gradual depletion of body stores secondary to poor dietary habits or to disease. Marginal or preclinical vitamin deficiency results in nonspecific symptoms such as malaise, irritability or somnolence, loss of appetite and weight, and impairment of psychologic and physical performance socially or at work. These signs precede clinical signs of disease. The elderly are particularly vulnerable to vitamin deficiency because of the high incidence of illness and disability in the later years of life and because of other common problems, such as low income, poor appetite, and social isolation.


Case report: fatal anaerobic pulmonary infection due to Bifidobacterium eriksonii. This case illustrates progressive anaerobic pleuropulmonary infection caused by Bifidobacterium eriksonii that eventually was fatal. Aspiration pneumonia, lung abscess, empyema, and finally necrotizing pneumonia characterized the clinical course. The organism is difficult to recover, but there is reason to suspect that it may be of greater etiologic importance than heretofore recognized in debilitated patients with pleuropulmonary infections. This patient was a 52-year-old alcoholic with periodontal disease. Both conditions are well-known factors underlying anaerobic pleuropulmonary infection. Alcoholism probably predisposed the patient to aspiration of oral secretions, the likely source of the infection.


Antibiotics: how to use them in 1977-1978. Cases 21, 22, and 23. Self-assessment case studies illustrating prudent selection of antimicrobial agents in septic shock following urinary catheterization, bacteremia and skin lesions in an immunocompromised patient, and endocarditis in a patient with a prosthetic heart valve.


Endometriosis: when is surgical treatment indicated? Although oral contraceptives provide the primary therapy for endometriosis, surgery is sometimes indicated. Surgical treatment should be conservative, with salvage of as much tissue as possible. Ovarian and presacral neurectomy, in addition to dissection and desiccation, should be done in most cases. Hysterectomy is often elected by middle-aged patients in preference to almost continual suppressive therapy. Retroperitoneal endometriosis must be treated by dissection and electrocoagulation to prevent ureteral obstruction.


Case report: severe respiratory alkalosis--unusual manifestation of viral hepatitis. A middle-aged man who had been in good general health presented with marked hyperventilation and severe respiratory alkalosis. Typical signs and symptoms of viral hepatitis subsequently developed. Investigation showed that he and 32 other patients with hepatitis had all eaten at the same restaurant prior to illness. Because of his distressing constitutional symptoms and markedly elevated hepatic enzyme levels, corticosteroid therapy was begun. The symptoms and hyperventilation improved dramatically. Although respiratory alkalosis has been observed during the course of other infectious diseases, to our knowledge it has not previously been reported in association with hepatitis A infection.


Nonsteroidal antiinflammatory drugs: new alternatives for rheumatic disease. New antirheumatic drugs which are moderately effective clinically and less toxic than similarly acting, previously available drugs are believed to act by blocking certain mediators of inflammation. At present, there is no evidence that they influence the release of lysosomes, inhibit the action of complement, or modify immune mechanisms.


Complications of sinusitis: what to watch for. Sinus infection remains a common cause of orbital inflammatory disease, and prompt diagnosis is essential. A team approach early in the course of the disease, with an otolaryngologist serving as coordinator, is recommended. If vigorous medical therapy fails, abscess formation should be suspected and surgical drainage instituted without delay. Of 24 patients hospitalized with complications of sinusitis, 13 were found to have acute inflammatory disease and 11 had mucocele formation. Mortality in patients with acute inflammatory was 30%; in those with intracranial extension of infection it was 67%.


Effects of cooling on the levels of acetylcholine, cholinesterase, choline acetyltransferase and the intramural electrical stimulation on the guinea pig ileum. The effects of hypothermia (4 degrees C) on the components of the cholinergic system of the ileal longitudinal muscle and the adherent Auerbach's plexus of the guinea pig ileum have been investigated. Acetylcholine (ACh) content of the muscle was determined by pyrolysis-gas chromatography. It decreased from 119 to a fairly steady level of 16 nmol/g of wet tissue during the first 72 h of cold storage at 4 degrees C under anoxic conditions. Concomitantly, responsiveness to intramural electrical stimulation decreased by 72%. Cholinesterase (ChE) and choline acetyltransferase (ChA) activities each dropped by 40% during this period. However, the de novo synthesis of ACh over the period of study did not change significantly. The response of the preparation to the exogenously applied ACh remained fairly constant suggesting that the changes in the cholinergic receptor are not accountable for the decrease in responsiveness to intramural stimulation. From the results of this study, it has been concluded that cold storage for 5 days leads to: (1) a significant decline in ACh content within 72 h of storage; (2) a decrease in ChE and ChA activities; (3) no significant effect on the cholinergic receptor; and (4) a decrease in responsiveness to intramural electrical stimulation which is probably due to a malfunction of the ACh-releasing mechanism.


Variations in hepatic microsomal drug metabolism in C57Bl/6 mice from three different suppliers. Drug metabolism by hepatic microsomal and soluble fractions was compared in male C57Bl/6 mice purchased from three different suppliers. Mice were studied at 9 weeks of age after having been purchased either as weanlings or at 8 weeks of age. Significant differences were found in the specific activity of several mixed-function oxidase enzymes and in amounts of cytochrome P-450 among the three sources of mice.


Interrelationships between the gastric secretory responses, prostaglandin E2 inhibition and serum level of immunoreactive gastrin in pylorus-ligated and antrectomized rats. The effects of prostaglandin E2 (PGE2) have been studied on the gastric secretion and the serum level of immunoreactive gastrin in pylorus-ligated and antrectomized rats. It has been observed that: (1) a significant inhibition of gastric secretion (volume and acid output) was caused by PGE2, applied in doses of 75, 150 and 300 microgram/kg body weight, subcutaneously, in both pylorus-occluded and antrectomized rats: PGE2 inhibition of gastric secretion was more pronounced in rats with antrectomy; (2) no significant changes were found in the serum gastrin levels of both pylorus-ligated and antrectomized rats, and (3) no significant changes in serum levels of immunoreactive gastrin were produced by different doses of PGE2, in comparison with their marked inhibitory effects on gastric H+ secretion. It was concluded that there is no essential role of the immunoreactive gastrin, originated from the antral part of the stomach, neither in development of gastric hypersecretion nor in PGE2-produced inhibition on gastric secretion of the pylorus-occluded rats.


Effects of 6-hydroxydopamine-induced depletions of brain catecholamines or dopamine on meperidine antinociception in rats. The participation of brain norepinephrine (NE) and dopamine (DA) in the production of the antinociceptive effect of meperidine was investigated. Rats were permanently depleted of brain catecholamines via 6-hydroxydopamine treatments at 2 weeks of age. 6-8 weeks later, the antinociceptive activity of meperidine was determined in control, NE- and DA-depleted, and DA-depleted rats by both the tail-flick and hot-plate methods. The antinociceptive activity of meperidine was reduced in DA-depleted male rats. In DA-depleted female rats, however, the antinociceptive activity was increased at low doses of meperidine and decreased only at higher doses of the drug. In male NE + DA-depelted rats, the activity was generally intermediate between that seen in DA-depleted and control rats. No consistent change in the activity of meperidine was observed in female NE + DA-depleted rats.


Comparative antiphlogistic activity of meseclazone, 5-chlorosalicylic acid, acetylsalicylic acid, phenylbutazone, indomethacin and hydrocortisone in various rat paw edema models. The antiphlogistic activity of meseclazone and its major metabolite, 5-chlorosalicylic acid, have been directly compared to acetylsalicylic acid, phenylbutazone, indomethacin and hydrocortisone in rat paw edema induced by eleven different phlogistic agents. Based on the profile of activity and milligram/kilogram potency displayed by meseclazone, it most closely resembles acetylsalicylic acid and phenylbutazone in its mode of action.


A new mechanical method for measuring rat paw edema. A new method is presented for measuring swelling or rat paw edema in inflammation induced by carrageenin injection. This technique is compared to other widely used ones. A spring-loaded dial indicator produces results that are accurate, precise and reproducible. It is recommended for investigators seeking the advantages of a noninvasive, low cost, rapid method quantifying the swelling of inflammation.


Effect of actinomycin D on pentagastrin- and histamine-stimulated secretion from isolated canine stomachs. Pentagastrin- and histamine-stimulated secretion of HCl was investigated using isolated canine stomachs perfused ex vivo with homologous blood. The effect of actinomycin D, an inhibitor of DNA-dependent RNA synthesis, on the secretion of HCl by so stimulated stomachs was assessed. The purpose of this experiment was to find whether the trophic action of pentagastrin (RNA synthesis) is interdependent with the secretory action of this hormone. Such interdependence was found in rats by other investigators who reported the suppression of pentagastrin-induced HCl secretion and of RNA synthesis by actinomycin D. Our study did not demonstrate any effect of actinomycin D on pentagastrin-stimulated HCl secretion by isolated canine stomachs. It appears that in dogs the trophic effect of pentagastrin is independent from its secretory action. Review of the literature suggests that the mechanism of gastrin-like hormones on gastric acid secretion in dogs differs from the one found in rats.


Combined motor and peripheral sensory insufficiency. III. Management of spinal cord injury. For clarity in presenting the concepts of care, the patients have been divided into discrete neurological levels according to their dominant patterns of muscle strength. Individuals can vary considerably, however, and these differences must be accommodated by corresponding modification in the orthotic functional plan. The C6 level patient, with his effective wrist extensor as well as arm musculature, can recover a single mode of grasp and release through a wrist-driven, flexor-hinge-hand orthosis, or a natural tenodesis. Available arm function, despite the loss of all wrist and hand musculature, enables the C5 quadriplegic patient to regain prehension with a passive ratchet flexor-hinge or an electric flexor-hinge-hand orthosis. Both groups of patients also require various aids to accomplish wheelchair propulsion, ischial pressure relief, bed transfers, and, for the C6 level, driving.


Central control insufficiency. III. Disturbed motor control and sensation: a treatment approach emphasizing upper extremity orthoses. In the discussion of the problems, the selection of patients, and some of the approaches to treatment, three major areas need emphasis. 1. Guidelines are necessary to select patients who require and can respond to treatment. The patients who will benefit the most must be identified and provided with structured therapy programs. 2. Effective bracing of the severely spastic wrist and hand may not be possible. The orthoses described are used to prevent deformity and relieve pain. 3. All motor control available to a patient must be incorporated immediately into the patient's daily activities.


Radiological determination of changes in bone mineral content. It is possible to obtain reliable data of changes in bone mineral content using simple radiographic techniques. Methods available include morphometry and densitometry. Of these morphometry of the third metacarpal is most accurate in our hands and cortical width is the most reliable of such morphometric data. Densitometry produces more variable results and shows no advantage over straight measurement of cortical width. The only acceptable alternative method of obtaining information about bone status is photon absorptiometry. Results of these methods are shown in a trial of oestrogen therapy for the prevention of post-menopausal osteoporosis. The data suggest that oestrogens prevent post menopausal bone loss when this is estimated by measurement of cortical width or photonabsorptiometry.


[Pathologic features in diagnosis and differential diagnosis of pyelonephritis (author's transl)]. Morphological diagnosis and differential diagnosis of pyelonephritis are discussed particularily considering macroscopic features. A special form with radiological significance is ncrotizing "emphysematous" pyelonephritis. Chronic non-obstructive pyelonephritis is rarer than formerly thought if strict morphological criteria are applied. It should be differentiated from nephropathy caused by analgetics. In analgesic nephropathy bilateral papillary necrosis is the earliest and most characteristic alteration. Differentiation between chronic pyelonephritis and analgesic nephropathy is possible in most cases but may be difficult if analgesic nephropathy is complicated by bacterial infection. A classification of "unilateral small kidney" is presented. Unilateral acquired "renal shrinkage" should be differentiated from congenital "unilateral hypoplasia". It remains to be discussed whether the so-called "Ask-Upmark-Kidney" is a malformation or the result of chronic pyelonephritis.


[Roentgen diagnosis of interstitial nephritis (pyelonephritis) by excretory urography and renovasography. Indications and diagnostic value of both methods including elektronic harmonization (author's transl)]. The roentgen signs of pyelonephritis may well be demonstrated by intravenous or infusion excretory urography. Discrete lesions of the calyces are better demonstrable by means of electronic magnification and harmonization. Inflammatory disease of the kidneys have characteristic patterns of vascular formation in renal arteriography. Electronic magnification and harmonization allow to detect initial stages of this illness.


[Hemangioma of the renal pelvis (author's transl)]. A cavernous hemangioma of the renal pelvis preoperatively diagnosed by angiography is reported. The pathologic-anatomical findings are included.


[The problem of angiographic diagnosis of giant cell tumors (author's transl)]. The value of angiography in the diagnosis of giant cell tumors of the bone was investigated in 12 patients listed in the Viennese bone tumor register. It could be shown that angiographic criteria of malignancy can frequently be found in grade II cell tumors. Therefore angiography does not seem to be helpful in differentiation and prediction of benign and malignant course of giant cell tumors.


[Radiology of bacterial and abacterial interstitial nephritis (author's transl)]. The x-ray findings of 727 patients with chronic interstitial nephritis are evaluated; these patients have been controlled over a period of several years: 594 suffer from chronic bacterial interstitial nephritis (pyelonephritis) and 133 patients from chronic abacterial interstitial nephritis of different etiology. The causes for the abacterial type of nephritis are phenacetin and primary gout. The radiological signs of the two forms of chronic interstitial nephritis in different degrees of involvement are pointed out. Whereas with the chronic abacterial interstitial nephritis symmetrical affection is typical, the chronic bacterial interstitial nephritis shows asymmetrical findings, especially in ascending pyelonephritis. Differentiation between the chronic bacterial nephritis and the chronic abacterial nephritis can be achieved in most cases by radiological signs, (morphological findings). The microscopic evaluation does not always allow a differentiation; because there are mixed forms and secondary bacterial infections are associated with primary chronic abacterial interstitial nephritis in the late stages. The multiple causes for chronic abacterial interstitial nephritis is radiologically reflected mostly by uniform signs during the different degrees of involvement.


The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arteriogram. Selective pulmonary arteriography, with superselective magnification views of the lung bases or other areas where abnormalities are shown on perfusion lung scans, performed within 24-48 hours after the onset of symptoms, can effectively rule out clinically significant pulmonary thromboembolism. One hundred and eighty consecutive patients (minimum follow up, six months) with suspected pulmonary embolism and negative pulmonary arteriograms were studied. Not one of the 167 untreated patients died as a result of thromboembolic disease during the acute illness (20 died from unrelated causes), and none of the 147 patients who survived suffered "recurrent embolism" during follow up.


Gangrene of the lung: successful medical management of three patients. Three patients with massive pulmonary gangrene who have survived without recourse to surgery are presented. In 2 cases, anaerobic organisms were suspected as being the causative pathogens although this was not proved. With resolution the radiological appearances of the involved lobe varied from no more than segmental to almost complete loss of the whole lobe.


Benign blood vascular tumors of the mediastinum. Report of four cases and review of the literature. The authors present 4 new cases and review 77 previously reported cases of benign blood vascular tumors of the mediastinum. The vast majority are hemangiomas (90%), occur in the first four decades of life (75%), and arise in the anterior mediastinum (68%). Compression and/or invasion of adjacent structures is not uncommon. Concomitant extrathoracic extension (2%) and multiple sites of involvement (2%) are rare. The tumors are smoothly outlined, occasionally lobulated and can be accurately identified when phleboliths are present (10%).