Cerebromedullospinal disconnection after intraventricular methotrexate. A case of cerebromedullospinal disconnection or "locked-in" syndrome after intraventricular methotrexate is described. This is an unusual complication of intraventricular methotrexate instillation. Ventral pontine infarction is postulated to be responsible for the syndrome.


Epithelioma cuniculatum.

Epithelioma cuniculatum. The cases of epithelioma cuniculatum in this report illustrate the unusual appearance and diagnostic difficulty of the lesion. Early diagnosis resulted in apparent cure with adequate local excision in some cases, whereas amputation was necessary for advanced or recurrent tumors. Distant metastasis may occur. Superficial biopsy specimens may yield inadequate tissue for proper diagnosis. Verrucous carcinoma should be considered as a diagnostic possibility in any atypical or recurrent "wart" on the sole.


Viral hepatitis in pregnancy with disseminated intravascular coagulation and hypoglycemia. A case of a 26-year-old woman who presented at 38 weeks of gestation with severe hepatitis B complicated by disseminated intravascular coagulation (DIC) and hypoglycemia is reported. The clinical features of the illness suggested acute fatty liver of pregnancy. Cesarean section was followed by resolution of the coagulopathy and the hypoglycemia. Both mother and infant survived and remain well. The diagnosis of hepatitis B was confirmed by a transiently positive hepatitis B surface antigen and percutaneous liver biopsy. This case emphasizes the difficulty in distinguishing acute viral hepatitis from acute fatty liver of pregnancy. In addition, the predominant features of DIC and hypoglycemia in our case are reported.


The occurrence of zearalanone in raw and fermented products from Swaziland and Lesotho. Numerous reports of epizootics dur to zearalanone, and the subsequent experimental work upon it have implicated this oestrogenic mycotoxin as an important pathologic agent for the uterus and vagina. The finding of zearalanone in fermented products in an area in Southern Africa where human cervical cancer is prevalent may be related to this disease.


Pityrosporum pachydermatis in a black bear (Ursus americanus). Pityrosporum pachydermatis was repeatedly isolated from portions of alopecic tissue from the throax and ears of a black bear cub (Ursus americanus). Yeastlike cells morphologically identical with those of P. pachydermatis were observed in stained tissue sections. This is the first reported association of this yeast with a member of the family Ursidae.


Isolation of aminopeptidases from Histoplasma capsulatum. Two aminopeptidases (arylamidases) were isolated and partially purified from Histoplasma capsulatum. The larger molecular weight enzyme was a proline iminopeptidase and hydrolyzed primarily a synthetic substrate, L-prolyl-beta-napthylamide. The other aminopeptidase was less substrate specific and hydrolyzed rapidly the following amino acid beta-napthylamides (beta NA): L-arginyl-beta NA greater than L-lysyl-beta NA greater than -L-4-methoxy-leucyl-beta NA greater than L-leucyl-beta NA greater than L-phenylalanyl-beta NA greater than L-alanyl-beta NA. The proline iminopeptidase was purified 1420 fold while the leucine aminopeptidase was purified 650 fold with good recovery.


Microsporum canis infection: first epidemic in Israel. We report here on the first epidemic of Microsporum canis infection in Israel. All 78 cases were diagnosed in the port city of Eilat between August, 1975 and May 1976. The epidemic has apparently been controlled with Griseofulvin therapy and public health measures.


Survey of keratinophilic fungi in Alpine marmot (Marmota marmota) burrow soil and in adjoining soils. Soil samples from 127 marmot (Marmota marmota) burrows were examined for keratinophilic fungi along with 48 soil samples from adjoining areas. The occurrence of keratinophilic fungi (especially Microsporum gypseum) was significantly higher in burrow soil. A review of the literature and our results support the hypothesis that the "animalization" (i.e. the enrichment of soil with hairs, crusts and other organic matters) of the environment may create conditions suitable for the growth of keratinophilic fungi. The presence of keratinophilic fungi in alpine mountain soil was noted for the first time.


Financial status of social security program after the Social Security Amendments of 1977. The Social Security Amendments of 1977 resulted in substantial improvement in the current and projected financial condition of the OASDI program. This article reviews the causes of the recent operating deficits, describes the effects of the amendments that most influence the program's financial status, and gives projections of income and expenditures under the new law. The revised benefit formula eliminates the "over-indexing" expected to occur under the old provisions and results in stable earnings-replacement ratios under practically all future economic conditions. About one-half of the long-range actuarial deficit was resolved by this step alone. Increases in the contribution and benefit base, along with tax-rate reallocations and increases, prevent the imminent depletion of the OASI and DI trust funds. Increased income due to the higher wage bases is partially offset in later years, however, by greater benefit payments based on the increases in the coverage of total earnings. Overall, under the new law the OASDI program is projected to be financed adequately for about 50 years but significant operating deficits are expected after that. The financial condition of the hospital insurance program was substantially unchanged by the amendments, however, and the HI trust fund is expected to be exhausted in 1988.


Social Security Amendments of 1977: legislative history and summary of provisions. This article describes the legislative history of the Social Security Amendments of 1977 and contains a summary of the amendments. The major provisions revise the benefit structure so that future replacement rates--initial benefits as a percent of previous earnings--will be relatively stable and revise the tax structure to restore the financial soundness of the program in the short range and into the 21st century. Other significant provisions include: An increased special minimum benefit for long-term workers with future automatic adjustment to prices; a minimum benefit frozen at the December 1978 level (roughly $121) with automatic adjustment only for those on the rolls; a higher retirement test exempt amount of beneficiaries aged 65 and over; an annual measure of "quarter of coverage" and other changes in annual wage reporting provisions; and authorization for agreements with foreign countries for limited coordination between social security systems.


The definitive technique of selective proximal vagotomy with pyloroplasty appropriate to form and function in surgery of peptic ulcer disease. The overall efficiency of the ff-PYPL is most apparent when we compare our own large series of long-term observations of SPV, accompanied with these pyloroplasty forms with all types of DU, in contrast to the series of SPV without pyloroplasty of some other authors with a smaller number of patients and a shorter observation period (Table 1). The table shows that the combination operation of complete SPV with ff-PYPL (Fig. 17) assures the clinical permanent healing of DU. In GU the results of the nonresecting method are less satisfying. Twenty-two percent of the GU patients must have selective vagotomy with antrectomy because of antral disorder, destroyed antral innervation, or suspicion of malignancy.


A continent ileostomy and reservoir using the canine ileocolonic segment. The present study was an attempt to create a simple reservoir with a reliable continent ileostomy, so as to overcome the many drawbacks of the regular ileostomy. The ileocolonic segment was isolated and the ileum was intussuscepted into the colon to augment the ileocolonic sphincter. Pressure recordings disclosed a high pressure zone in the ileocolonic sphincter area reacting with a significant pressure increase to colonic distention. The proximal ileal end was anastomosed to the colonic part of the ileocolonic segment, and the ileal part of the ileocolonic segment was maturated as an ileostomy. The colonic reservoir was emptied by catheterization. Between catherizations, the ileostomies remained completely continent to small intestinal contents and gas. The reservoir and continent ileostomy are easily constructed, offer convenience and safety, voluntary and controlled emptying and conservation of part of the water and sodium excessively lost with conventional ileostomies. The procedure should be applied only to those patients in whom the right colon is unaffected or only slightly affected by the inflammatory process.


An experimental assessment of esophageal anastomotic integrity. A series of experiments was designed to establish the role of proximal diversion and perioperative antibiotics in primary healing of experimental esophageal anastomoses designed to stimulate the clinical leak and death rate seen in patients treated for carcinoma of the esophagus. Thirty-four cats underwent partial thoracic esophagectomy with end-to-end anastomosis. Seventeen cats were randomized to complementary proximal esophageal diversion. Postoperative mortality was 38 per cent. The over-all rate of anastomotic leakage was 18 per cent, with 83 per cent of these cats dying as a result of this complication. Proximal esophageal diversion had no demonstrable role in the prevention of anastomotic dehiscence or subsequent mortality. In 22 of 34 cats, systemic perioperative antibiotics were administered. Administration of perioperative antibiotics decreased anastomotic leak significantly, p less than 0.05, and lowered mortality, p less than 0.001, with or without proximal esophageal diversion.


Severe hyperchloremic acidosis complicating jejunoileal bypass. In summary, severe hyperchloremic acidosis developed in two patients as a late complication after jejunoileal bypass for morbid obesity. This acidosis was associated with episodes of dizziness, ataxia, headache, weakness, confusion and transient loss of consciousness. Recognition of this symptom complex in the patient with a jejunoileal bypass should suggest metabolic acidosis as a complication of this surgical procedure. Bicarbonate replacement provided prompt, but temporary, improvement in the symptoms and the acidosis. Revision of the intestinal bypass was required for correction. Special studies to rule out renal tubular acidosis were performed and definitely excluded the kidney as a source of the acidosis.


Comparison of three treatments for fractures of the diaphysis of the femur. Sixty-eight patients with fractured femurs were studied who, in terms of personal characteristics, associated injuries and type of fracture, could have been treated by intramedullary nailing or traction followed by the application of either a spica cast or fracture brace. Twenty-eight patients actually underwent intramedullary nailing, while 18 were treated with a spica cast and 22 with a fracture brace. Multiple outcome factors were studied and, based upon every comparison, intramedullary nailing was found superior. Among those patients treated by non-operative techniques, fracture bracing permitted earlier independent ambulation and increased the probability of normal knee motion at the conclusion of treatment.


The effect of a mechanical venous pump on the circulation of the feet in the presence of arterial obstruction. A boot of single layer, flexible vinyl sheeting and a pneumatic cuff encircling its top at the ankle, each independently inflatable, constitute a mechanical venous pump. Inflation of the cuff to the desired boot pressure is followed immediately by inflation of the boot from a reservoir with higher available pressure than that in the cuff. When the boot pressure reaches cuff pressure, the excess air escapes from the boot under the cuff. A low venous pressure at the foot could be maintained by compressing the foot for 2 seconds every 15 seconds with a pressure which is 10 millimeters of mercury above initial venous pressure. In seated patients with arterial obstruction whose supine ankle blood pressure was 60 milimeters of mercury or less, the rate of blood flow in the skin of the forefoot was increased by 104.1 +/- 43.7 per cent S.E.M., p less than 0.05, during venous pumping. In these patients, a change in posture alone from supine to sitting increased the rate of blood flow by 81.7 +/- 19.47 per cent, p less than 0.002. The combined effect of the erect posture and venous pumping was an increase of 185.7 +/- 49.63 per cent, p less than 0.01. Rest pain was relieved by the combined effect.


Evaluation of optimum time for surgical repair of coarctation of the aorta. The results of 182 patients operated upon for coarctation of the aorta from 1953 to 1976 were reviewed. The youngest patient was three weeks old, the eldest, 60 years. One hudnred and twenty-three patients had coarctation without complications, while 59 had other cardiovascular lesions. An end-to-end anastomosis was carried out in 144 patients. Artificial grafts were inserted in 33 patients, while individual techniques were applied in five patients. There were four peroperative deaths, five postoperative deaths and four late deaths. All of these patients had multiple cardiovascular lesions. With respect to the peroperative and postoperative complications and the effect of operation on blood pressure, correction of coarctation of the aorta should be carried out between the ages of five and 15 years.


Chronic appendicitis.

Chronic appendicitis. Twenty patients with chronic pain in the right lower quadrant of the abdomen were reviewed as to preoperative findings and pathologic findings at laparotomy. Eleven of the 20 patients had acute appendicitis, and 13 of the 20 had some appendiceal problem. The white blood count was not reliable in diagnosing this, as eight of the 11 of those with acute appendicitis had a normal white blood count. Barium enema examination was performed in ten of the 13 with disease, and abnormalities were noted in nine of the ten, an indication of a high degree of reliability of this examination. Long term follow-up study revealed that 17 of the patients in the study gained complete relief of symptoms after appendectomy.


The management of ureteral calculi during pregnancy. During the past seven years, 14 pregnant patients were admitted to our hospital for treatment of ureteral calculus. During this same period, 22,495 deliveries were performed, for an incidence of one calculus per 1,600 pregnancies. Eleven patients spontaneously passed the calculus, ten prior to delivery and one patient postpartum. Three patients required an operation, two antepartum and one patient postpartum. No maternal or fetal complications occurred. Management of urinary calculi during pregnancy must be individualized and should be based upon location of the stone, degree of obstruction, presence or absence of infection, general condition of the patient and stage of pregnancy. Surgical intervention to remove obstructing calculi is not contraindicated during pregnancy.


An analysis of phytohemagglutinin lymphoblastogenesis in whole blood. A population of 80 defined normal people ranging in age from 20 to 62 years were used to define a dose response curve in whole blood phytohemagglutinin blastogenesis of lymphocytes. Maximum stimulation occurred at four days of incubation and 18 hours of pulse labeling with tritiated thymidine using 50 micrograms per milliliter of phytohemagglutinin and 1 microcurie of tritiated thymidine. An analysis of variants indicates a statistically significant trend of reduction of disintegrations per minute per milliliter with advancing age. Likewise, there was an extremely significant difference between measurements performed in the morning and late in the afternoon. Measurements referred to sex and sequential testing were not shown to be significant. Therefore, whole blood phytohemagglutinin blastogenesis may be meaningfully performed and interpreted using nonparametric statistics and the raw blastogenesis of a standard amount of peripheral whole blood, provided that the remainder of the test conditions are rigidly controlled.


A modified technique for lateral internal sphincterotomy. A technique for lateral subcutaneous internal sphincterotomy has been used in 300 patients. In 200, the blind method was used, and in 100, the open technique was used. Although the number of patients and the follow-up period were not matched, the early results were somewhat better with the group of patients who underwent the open technique than with those who underwent the blind procedure, particularly in regard to postoperative bleeding. We recommend this technique both to minimize bleeding and to afford the surgeon more technical control.


Sliding appendiceal inguinal hernia.

Sliding appendiceal inguinal hernia. Rarely, the mesoappendix forms the sliding component of an inguinal hernia. Appendectomy, in such instances, permits effective repair of the hernia. This was accomplished in 16 patients without wound complication or recurrence of the hernia.


Delayed evolution of posttraumatic subdural hygroma. Five hundred and forty-six patients in a consecutive series of 1,601 patients with craniocerebral trauma had computed tomography. One hundred and ninety-six patients had a follow-up CT scan. Thirteen patients (6.6%) developed apparently "silent" subdural hygromas of delayed evolution noted from six to 46 days after injury (average 22 days). Three of 10 patients (30%) improved after operation. No patient with a severe cerebral deficit (decortication or decerebration) improved. The three unoperated hygromas and the six that persisted after operation tended to resolve spontaneously. The infrequent and modest improvement following surgical treatment and the tendency to spontaneous resolution suggest that operation may be unnecessary in many patients with posttraumatic subdural hygroma of delayed evolution.


Embolization and surgical excision of giant arterio-venous malformation. A case of a giant arteriovenous malformation involving almost the entire dominant hemisphere in a 32-year-old white male with progressive neurologic deterioration, presumbaly due to cerebral steal, is described. Special management included surgical intravascular embolization with latex spheres. and at a later date, resection of the arteriovenous malformation.


Cryptococcal infection of the central nervous system. Two patients with cryptococcal infection of the central nervous system are described. The first presented with signs of an intracranial mass and was subsequently shown to have two lesions within the brain which were later identified as cryptococcal granulomata. Antifungal therapy did not eradicate the lesions; following their excision and continued therapy, the CSF became sterile however. The other patient had signs of a fulminant meningoencephalitis which initially were thought to represent the pathophysiological expression of an expanding brain tumor. These reports are used as a basis to review the various aspects of central nervous system cryptococcosis, particularly as they may relate to the neurosurgeon and the therapy of the disease.


An endoscopic technique for third ventriculostomy. A simple technique for performing third ventriculostomy is described. The technique utilizes a fiberoptic endoscope inserted through a small burr hole over the coronal suture. The technique has been successfully employed in five patients without complications. If better criteria for selection of patients for third ventriculostomy could be established, this procedure would provide an ideal means for treatment.


Intracranial sarcoidosis presenting angiographically as a sub-dural hematoma. Intracranial sarcoidosis is rare. Usually it involves the cranial nerves and presents with symptoms of meningeal irritation, convulsive seizures, hydrocephalus, hemiparesis, mental changes and hypothalamic dysfunction. A case in which the condition simulated a subdural hematoma is reported.


Sarcomas metastatic to the brain: case report of a metastatic fibrosarcoma, and review of literature. A case of fibrosarcoma with metastases to the brain is presented with a review of the pertinent literature. This review demonstrates that the incidence of brain metastases in patients with sarcoma is probably higher than previously indicated.


Multiple meningiomas.

Multiple meningiomas. The authors report a patient with a right sphenoid wing meningioma 16 years after a left convexity meningioma was removed. She had no evidence of von Recklinghausen's disease. Both tumors were benign. The literature on multiple meningiomas is reviewed.


Giant cell tumor of the skull.

Giant cell tumor of the skull. A 23 year-old female had a giant cell tumor originating in the right temporal bone. A diagnosis was maed by biopsy. Microscopically it was sarcomatous in part. Two courses of radiation therapy, each total dose being 6000 rads and 3000 rads in air, were employed with good subjective response for a short duration. However, the tumor involving the petrous bone and the mastoid process extended, invading the epipharynx and the clivus. The patient died one year after onset.


Observations on moyamoya disease: a case treated with superficial temporal-middle cerebral artery anastomosis. A 24-year-old Caucasian woman with Moyamoya disease was treated by a superficial temporal, middle cerebral artery anastomosis. Her pre and postoperative angiograms revealed that the telangiectatic network in the region of the basal ganglion served as a transcerebral collateral circulation from the internal carotid artery proximal to its occlusion to the cortical branches of the middle cerebral artery. The transit through two capillary systems (basal ganglia and cortical) explains the slow circulation time. Prompt venous drainage was seen to occur once a more direct collateral supply was established by the superficial temporal-middle cerebral artery anastomosis.


Spinal epidural empyema with the Brown-Séquard syndrome. A patient with an acute onset of the Brown-Séquard syndrome, in whom the etiology was a painless thoracic epidural empyema, is discussed. The case is a unique presentation for spinal epidural empyema and presents a rare extramedullary cause of the Brown-Séquard syndrome. Pertinent literature for spinal epidural empyema is reviewed.


Embryonal carcinoma with teratomatous elements in the region of the pineal gland. An embryonal carcinoma with teratomatous elements arising in the region of the pineal gland of an eight-year-old boy is reported. Radiation therapy, chemotherapy and surgical intervention failed, and he died 16 months after the onset of the symptoms. His clinical and autopsy findings are described.


Somatosensory evoked potentials in acute spinal cord injury: prognostic value. The somatosensory evoked potential is absent in patients with complete motor and sensory loss below the level of spinal cord injury. When spinal cord injury is incomplete, these alterations in potential may be elicited from stimulation of a nerve entering the cord below the level of injury. The presence of such potentials soon after injury, or their early return, and progressive normalization of the wave form are sensitive early indications of favorable prognosis. Indeed, recovery of the somatosensory evoked potentials frequently precedes major clinical improvement and may occur in advance of clinical recovery or posterior column function.


Effect on canine cerebral blood flow of two common pressor agents during prolonged halothane anesthesia. Inasmuch as prolonged halothane anesthesia is often associated with hypotension, the effects of pressor agents possibly employed to adjust this hypotension on cerebral blood flow are of interest. In dogs, after prolonged halothane anesthesia, there was a marked difference in the effects of phenylephrine and angiotensin on cerebral blood flow at dosages which promote moderate rises in blood pressure. Phenylephrine had no effect whereas angiotensin had a significantly enhancing effect on cerebral blood flow.


Small bowel obstruction as a complication of disseminated varicella-zoster infection. A 40-year-old woman with Sjögren's syndrome and mixed cryoglobulinemia, treated with corticosteroids, presented with small bowel obstruction temporally associated with cutaneous varicella-zoster (V-Z) infection. At laparotomy a portion of inflamed, necrotic small bowel was resected. Cells in the margin of the lesion exhibited characteristic intranuclear inclusion bodies. This case report emphasizes the multiple organ involvement that can occur with disseminated V-Z infection. Despite the rarity of gastrointestinal involvement, this infection must be included in the differential diagnosis of the acute abdomen in patients with cutaneous vesicles.


Giving and getting surgery in Utah: an urban-rural comparison. Using the Blue Cross/Blue Shield and Medicare records for 1 year in Utah, we examined the pattern of surgical performance for 15 selected procedures. Only 60% of those identifying themselves as general surgeons had their specialty boards. General practitioners performed 24% of the procedures. Urban general practitioners performed proportionately more surgery than did their rural counterparts. There was no clear pattern of difference in fees or length of stay by specialty or board certification status. For most procedures studied, at least a third of the rural patients had their operations in urban hospitals. In only 3% of the cases did an urban physician operate in a rural hospital. The pattern of surgery for rural and urban residents was strikingly similar.


Maintenance of viable arterial allografts by cryopreservation. An experimental study, designed to investigate the feasibility of maintaining fresh, viable arterial allografts by cryopreservation, is presented. Cryopreserved femoral arterial allografts were shown to be equal in patency rate when compared with fresh controls. The cryopreserved allografts were shown to be superior to fresh allografts in the parameters of intimal integrity, absence of host rejection, and reduced surface thrombogenicity. This experimental study supports the thesis that cryopreservation in liquid nitrogen, utilizing 15% dimethyl sulfoxide (DMSO) and methylprednisolone as a cryoprotectant solution, is an excellent method of preserving and storing fresh allograft arteries for use as a small vessel replacement.


Automated perimetry: background, instruments and methods. The goal of automated perimetry is to reduce perimetrist involvement and testing time while maintaining standardized test conditions. Proper calibration of the perimeter background luminance and target intensity is important so that results can be compared between examinations and machines. Three testing procedures may be used alone or in combination: kinetic, threshold static and suprathreshold static perimetry. The Octopus and the Perimetron are fully automated perimeters. The former uses threshold static perimetry while the latter uses kinetic and suprathreshold static perimetry. They are operated by small-sized microprocessors using miniature silicone chip circuitry. They are accurately calibrated, fulfilling the specifications deemed necessary by visual psychophysicists. Although data display and plotting problems still exist, automated perimetry is ready for thorough comparisons with Goldmann and Tübinger manual perimetry.


In vivo observations on arterial micrografts. Few investigations have been made to date on the in vivo behavior of blood vessel grafts. An experimental model is described which permits continuous monitoring of grafted arteries both by gross examination and by in vivo microscopy. Allografts and autografts of the central ear arteries of rabbits, 0.5 mm in diameter and 10 mm in length, were transplanted in rabbit ears and subsequently enclosed with transparent plastic discs on each surface of the ear in place of the reflected skin. Allograft segments showed decreased vasomotor activity by about 3 weeks after grafting, whereas the recipient arteries and autograft segments retained their activity. Reduced activity of allograft segments was confirmed by their poor responses to vasoactive drugs. Many allografts thrombosed due to immune reaction between 3 and 8 weeks after grafting. Allografts that survived this episode went on functioning as efficient conduits of blood for many months thereafter.


The response of canine veins to three types of abdominal surgery: a scanning and transmission electron microscopic study. Several studies have suggested that events which initiate deep venous thrombosis (DVT) occur in the early postoperative or interoperative period. Since DVT is a complication of many surgical procedures, an understanding of the early events which initiate DVT would be highly desirable. We have studied these events in a canine surgical model. The early response of the endothelium and the adhesion of blood elements to the luminal surface of veins was compared following three types of surgical trauma. Sixteen dogs were divided into four groups (control, splenectomy, hysterectomy, intestinal anastomoses) of four animals each. Blood was removed by perfusion 4 hours after anesthesia alone (control dogs) or anesthesia and surgery (experimental dogs). Jugular veins were removed for scanning and transmission electron microscopy. Veins from control dogs were covered by a continuous sheet of endothelial cells with some pseudopod formation and minor deposition and adhesion of cellular and noncellular material on the luminal surface. The response of veins from experimental animals varied considerably in the three types of surgery studied. The least-affected veins were those from splenectomized animals. These veins had patchy areas of cellular and noncellular material (10 veins) and occasional microthrombi deposited on the luminal surface (one vein). The veins from dogs subjected to hysterectomy exhibited greater endothelial alteration, including crater formation (two veins) and more cellular adhesion, particularly erythrocytes (eight veins). The veins from intestinal anastomoses animals exhibited the greatest response. In these animals there was considerable cellular and noncellular material deposited on the luminal surface of six veins from three of the four animals. The cellular material consisted primarily of erythrocytes and leukocytes, and the noncellular material was an amorphous granular substance. The other two veins were similar in appearance to the control veins. These findings would support the concept that deep venous thrombosis can begin in the interoperative or early postoperative period and that therapeutic intervention in the preoperative and interoperative periods might help prevent subsequent DVT.


Entrapment of sized emboli by the KMA-Greenfield intracaval filter. Clinical studies demonstrating the effectiveness of the Kim-Ray Greenfield vena caval filter in the management of pulmonary emboli have stimulated efforts to accurately define this filter's capability to entrap sized emboli and maintain caval patency. Twenty-three dogs had filters inserted and positioned distal to the renal veins. Radiopaque emboli measuring 2 to 5 mm were introduced via the femoral vein. Cineradiography allowed direct observation of emboli capture and filter flow dynamics. Probability of entrapment was found to be related to (1) emboli size, (2) depth of filling of the conical-shaped filter by prior entrapment of emboli, and (3) absence of distal venous hypertension. The geometric design of the filter, which allows progressive vertical filling while maintaining circumferential blood flow, is thought to be responsible for entrapment of emboli and avoidance of venous thrombosis and hypertension.


Planned extra-anatomic cerebral revascularization for carotid artery ligation. Cerebral revascularization, using extra-anatomic bypass grafts of autologous saphenous vein, was performed in three patients to prevent or to compensate for ischemic effects of emergency ligation of a carotid artery. These ligations were required after spontaneous disruption of common carotid arteries in patients with previous irradiation and radical head and neck surgery. External-carotid-to-external-carotid cross-over (submandibular) bypass graft was performed once, and ipsilateral axillointernal carotid bypass grafts twice. The role of infection in carotid artery rupture, the unpredictable nature and different mechanisms of cerebral malfunctions after carotid ligation, technical details of extra-anatomic bypass grafts, and anatomic considerations in the prevention of recurrent infection and bleeding are discussed. A planned approach of cerebral revascularization at the time of ligation appears to be preferable to a fortuitous outcome. Neurological disability and death from cerebral ischemia can be prevented by using extraanatomic bypass vein grafts.


Follicular carcinoma of the thyroid with massive angioinvasion: extension of tumor thrombus to the heart. Angioinvasion is a well documented microscopic characteristic of follicular carcinoma of the thyroid. Patients with untreated tumors may die from local invasion or metastases to the lungs, bones, or other organs. A less well recognized cause of morbidity and death from this neoplasm is angioinvasion of cervical veins with direct extension into the great veins of the chest, to the heart. Six instances of this complication have been reported previously. The most common clinical presentation of patients with neoplastic thrombus within the great veins is the superior vena cava syndrome. In each case the patient died as a result of the vascular or cardiac involvement, shortly after diagnosis. The patient reported is the first in which follicular carcinoma with extensive angioinvasion was treated. A clinical diagnosis of superior vena cava syndrome was confirmed by angiographic studies. Resection of the primary thyroid tumor and the angioinvasive extension to the heart plus 131I therapy have controlled the malignancy for at least 3 years.


The effect of insulin on bile-salt-independent canalicular secretion. Mongrel dogs were prepared by cholecystectomy, ligation of the lesser pancreatic duct, and insertion of gastric and duodenal cannulas. The common bile duct was cannulated through the duodenal fistula. After stabilization of bile flow by intravenous infusion of sodium taurocholate, the dogs received an intravenous injection of insulin or 0.9% NaCl (control). This procedure was repeated with varying concentrations of sodium taurocholate to obtain taurocholate dose-response tests with and without insulin. Insulin caused marked increases in bile flow and the biliary clearance of erythritol, with no increase in bile-salt output The regression of bile-salt output on erythritol clearance was calculated for experiments with and without insulin. The resulting lines were compared by covariate analysis, which revealed a significantly higher intercept during insulin choleresis. This observation demonstrated that insulin stimulated the bile-salt-independent fraction of canalicular bile formation.


Ureteral pathology associated with aortic surgery: a report of three unusual cases. Intravenous pyelography is a necessary prerequisite to safe aortic surgery. Although urological complications of aortic pathology have been recognzized for 30 years, visualization of the urinary tract has not necessarily been routine practice in preoperative planning. With increasing frequency of aortic reconstruction, careful preoperative evaluation will continue to lower morbidity and mortality rates. Three unusual cases--one of perigraft ureteral fibrosis causing obstruction, one of ureteral obstruction due to retroperitoneal fibrosis, and one of ureterocutaneous fistula in a patient with an infected aortic prosthesis--are reviewed. These uncommon problems support the contention that information gained from routine excretory urograms will aid in careful preoperative assessment. Furthermore, the intravenous pyelogram will facilitate early recognition of postoperative urological complications.


Intraoperative autotransfusion in elective and emergency vascular surgery. Intraoperative autotransfusion was studied in 62 patients undergoing elective or emergency thoracic or abdominal vascular surgery systemic heparinization. The results in 58 patients who received a mean autotransfusion volume of 1.8 liters were compared with a group of four patients in whom 9 liters of blood was autotransfused. The quality of the autotransfused blood also was studied and was shown to have a normal platelet count (mean, 144,000/cu mm) and normal fibrinogen value (mean, 212 mg%). No significant differences in the hematological or coagulation parameters measured were detected in the groups given moderate or massive autotransfusion. The mean homologous blood requirement during the hospital admission in the "moderate" group was 300 ml and in the "massive" group 1,000 ml. With careful technique excessive hemolysis or pulmonary microaggregate embolism does not occur; 75% of patients required no homologous blood throughout their hospital admission. No complications which would be attributed to autotransfusion were seen in either group. It is concluded that intraoperative autotransfusion is safe and effective and deserves wider application.


Acute superior mesenteric arterial occlusion: a plea for early diagnosis. Acute mesenteric arterial occlusion is a curable disease, provided it is diagnosed and treated before irreversible changes occur in the ischemic bowel. Forty patients treated for proven mesenteric arterial occlusion were evaluated retrospectively in an effort to broaden the existing criteria for early diagnosis. Twenty-three patients suffered from mesenteric thrombosis and 17 sustained embolic occlusion of the superior mesenteric artery. The overall mortality rate was 77.5% (31 of 40 patients). Three patients survived without bowel resection. The appearance of acute abdominal pain accompanied by profuse cold sweating in a cardiac patient with apparently normal abdomen, hyperactive bowel sounds, and a history of embolic events should always raise the suspicion of acute mesenteric ischemia and should be verified immediately by mesenteric angiography. A high index of suspicion, aggressive measures for early diagnosis, and early operative treatment are presently the only possibilities to provide a better outcome.


[Antibiotic residues in bovine udders passed for consumption and meats containing milk-gland tissues (author's transl)]. Residues of identifiable antibiotics were found to be present in approximately 8.1 per cent of 999 bovine udders. In order to form an opinion on the consequences to consumers, the extent to which using milk-gland tissues results in the presence of detectable antibiotic residues in meats, was studied. For this purpose, 797 samples of meats were examined for antibiotic residues during the period from August to December 1976. The samples came from all over the country. Having been screened, the positive samples were examined by high-voltage electrophoresis on agar gel. The number of samples found to contain antibiotic residues could not be neglected. The results of these studies show that incorporating udder tissues in meats and meat-containing products is not acceptable without closer examination. It is doubted whether the decision to pass udders as fit for human consumption after palpation, incision and inspection is a correct procedure.


[Studies on the Microbiological Quality of Mammary Gland Tissues (author's transl)]. During the period from August to December 1976, 239 bovine udders were examined for their microbiological quality. Counts were made of the total number of aerobes, anaerobes, Enterobacteriaceae, coliform micro-organisms and staphylococci positive for coagulas and DNA-ase. The udders were examined for the presence or absence of Salmonella, E. coli and haemolytic streptococci. In addition, the Enterobacteriaceae were identified. The udders examined were from animals brought up for slaughter from all over the country. The studies were designed to examine whether udders are suited as raw material for products to be consumed by human individuals. The number of pathogenic bacteria isolated was found to be considerable and the average bacterial counts were rather high. The studies showed that the bacterial content of mammary-gland tissues has an adverse effect on the quality of raw meats made from these tissues so that they are not aceptable from the point of view of public health. Even when they are used as raw material for heated products, the risk of food poisoning caused by toxin produced by staphylococci cannot be entirely ruled out.


[To which extent do dogs, cats and farm animals compete with man in food consumption? (author's transl)]. Comparative calculation shows that approximately 80 million tons of "edible concentrates" which farm animals are fed and approximately 7.5 million tons of equivalent "edible concentrates" which dogs and cats are fed, are potentially lost each year for human consumption in the EC, the USA and Canada. These amounts could meet the nutritional requirements of approximately 400 million "standard citizens". Saving, for instance, 150 million world-citizen food equivalents by considerably reducing the number of domestic and farm animals in the western world will not afford any practical relief in regard to the enormous shortages which can be expected in the future. The share of cats and dogs in this consumption, being less than 10 per cent, is insignificant. Possible trebling of the population in the developing countries during the next fifty years will give rise to problems of an entirely different order of magnitude.


[Nematodirus battus in the Netherlands (author's transl)]. Infestation with Nematodirus battus was found to be present in sheep imported from Great Britain. This is the first report on the presence of this parasite, which is highly pathogenic for young lambs, in the Netherlands.


[Pulmonary adenomatosis (jaagsiekte) in imported sheep (author's transl)]. Pulmonary adenomatosis was diagnosed in a flock of Scottish Half-Bred sheep imported eighteen months previously. The differences between pulmonary adenomatosis (jaagsiekte) and chronic progressive pneumonia (zwoegerziekte) are stressed. These differences are clinical as well as morbid-anatomical and histological in character. This is the first time that pulmonary adenomatosis was reported as occurring in sheep in the Netherlands. The disease has not been reported in indigenous breeds of sheep.


Effect of oral administration of calcium carbonate, aluminum hydroxide gel and dihydrotachysterol on renal acidosis. The effects of oral administration of calcium carbonate, aluminum hydroxide gel, dihydrotachysterol (DHT) and sodium bicarbonate on metabolic acidosis and plasma calcium and phosphate were studied in 7 patients with chronic renal failure. Single administration of calcium carbonate alleviated the acidosis and increased the urinary bicarbonate excretion. These effects were potentiated when aluminum hydroxide gel was administered in combination with calcium carbonate. The plasma calcium was increased by this combination therapy. The effects of these two agents on acidosis and plasma calcium were further enhanced by the additional administration of DHT. Urinary bicarbonate excretion was less during the treatment with aluminum hydroxide gel and calcium carbonate than with aluminum hydroxide gel and sodium bicarbonate, when the excretions were compared at the similar concentrations of plasma bicarbonate. Aluminum hydroxide gel and DHT are likely to enhance the effect of calcium carbonate, which works as an alkalinizing salt on acidosis, probably through increasing calcium absorption in the intestine. And the three agents suppress the leak of bicarbonate into the urine contributing to the improvement of acidosis.


Regulation of regional perfusion distribution in the lungs. Experimental model and effect of alveolar pressure. An experimental model for studying changes in regional perfusion distribution in the lungs of a dog was described. The right upper lobe was separated in vivo from the rest of the lungs by a balloon catheter and gas exchange of the lobe was artificially done asynchronously with the rest of the lungs by using a gas of interest at a prescheduled aveolar pressure. 99mTc-albumin microsphere was the agent of choice for multiple sequential studies in one dog. Alveolar gas composition reached a plateau after the 4th inflation of the right upper lobe. Effect of alveolar pressure on regional perfusion distribution was studied by using nitrogen and air as exchange gases. Perfusion distribution in the right upper lobe was the least at the maximal alveolar pressure of 14 to 19 cm H2O, while it was the greatest at the tidal maximal alveolar pressure of 1 to-1cm H2O with either gas. Alveolar hyperinflation in a localized lung region due to the increase in regional alveolar pressure reduced regional perfusion distribution.


The presence of new permeability factor in serum of patients with systemic lupus erythematosus and its significance. We have found a new permeability factor in serum of patients with systemic lupus erythematosus. It is non-dialyzable, heat stable, and long acting as compared to histamine or bradykinin which is short acting. It has no esterolytic nor smooth muscle contracting activities. It is not inhibited by anti-histamine drugs, soy bean trypsin inhibitor, DFP or Cl esterase inhibitor. It is independent of the kallikrein system. It has the common antigenicity with IgG Fc fragments. Its approximate molecular weight is about 55,000. So we tentatively call this permeability factor IgG-PF. Intravenous injections of HGG-anti-HGG immune complex, which has been formed by antigen-antibody reactions in 20 times antigen excess, into rats resulted in no immune complex nephritis. However, intravenous injections of HGG-anti-HGG immune complex with IgG-PF resulted in immune complex nephritis in rats. The above immune complex nephritis was inhibited by administrations of sulfapyridine but not by administrations of anti-histamine. These results indicate that IgG-PF plays some roles in the mechanism of immune complex nephritis.


Diagnosis of placental function by prediction curves for heat-stable alkaline phosphatase (HSAP). In order to establish an effective diagnostic method for placental function using HSAP, the authors formulated two expressions to predict HSAP values for their rise before 38.7 weeks of gestation and declining after that; loge y = 1.03a-3.37 + 0.123x (i), and y = Y (1 + d/100( (ii), respectively. Further they prepared a chart of curves for these predicting expressions. The results obtained are as follows: (1) In normal pregnancies the deviation of prediction from measured values of HSAP was +/- 15% in 94% of the cases examined. (2) Many of cases of abnormal pregnancy showed a low level of HSAP, -15% or lower, and abnormal signs in HSAP pattern were found several days or weeks prior to the onset of fetal troubles. (3) Prolonged pregnancy with fetal troubles was able to be distinguished from "false" prolonged pregnancy. (4) In two consecutive pregnancies in the same woman, the courses of HSAP were strikingly consistent as far as both pregnancies were normal. The last fact suggests that the placental production of HSAP and its release into the maternal blood may be influenced by the individual constant a in expression (i). (5) It is recommended that the HSAP prediction curve is worthy to use as an easy screening method for placental function in the third trimester of pregnancy.


Urinary acid glycosaminoglycan in epidermolysis bullosa dystrophica (recessive type). A biochemical study was carried out on the urine of an 18-year-old woman with epidermolysis bullosa dystrophica recessive type E.b.d.r.). The urinary acid glycosaminoglycans were separated and subjected to quantitative and qualitative analyses by gel filtration and column chromatography. A hyaluronic acid and the 0.5 M NaCl elution fraction were increased characteristically in the acid glycosaminoglycan.


The simultaneous recording of the rhythmic contraction and electrical activity of the renal previs--a new in vitro method. A new in vitro method which enables the simultaneous recording of the electromyogram from various regions of the renal pelvis and the pressure changes associated with those electrical activities is described in an experiment on canine kidney. At the proximal end of the renal pelvis, the interval of the electromyogram was constant and pelvic pressure changes showed rhythmic activity, while the discharge interval of the proximal end was the same as the pressure interval. However, the discharge intervals of both the pelvic center and the pelviureteric junction were found to be multiples of that of the proximal end of the pelvis.


Listeria monocytogenes infection with brain abscess formation--the first case in Miyagi Prefecture. A rare type of brain abscess formation caused by infection with Listeria monocytogenes was observed in a 2-year-old boy. The patient did not respond to treatment with various antibiotics. The isolated organisms were found to be sero-type 4b. This is the first report of Listeria monocytogenes infection in Miyagi Prefecture.


Effect of furosemide on urinary kallikrein excretion in patients with essential hypertension. The effect of furosemide on urinary kallikrein excretion was studied in 10 patients with essential hypertension and 9 normal volunteer subjects. After intravenous administration of furosemide and 2 hours of upright posture, urine volume (UV), urinary sodium (UNaV) and potassium (UKV) excretion, plasma renin activity (PRA), plasma aldosterone concentration (PAC) and urinary kallikrein markedly increased. However, the augmentation of urinary kallikrein in patients with essential hypertension (1.50 +/- 0.19 EU/2 hr) was less remarkable than that in normal subjects (2.33 +/- 0.24 EU/2 hr), although the same degrees of response were observed in PRA and PAC. The increments of UV, UNaV and UKV in patients with essential hypertension were also significantly lower than in normal subjects. Significant positive relations were found between urinary kallikrein and UV or UNaV in both hypertensive and normotensive groups, but there was no such correlation before fursemide administration. It is likely that diuresis and natriuresis induced by furosemide are somehow associated with an increase in urinary kallikrein excretion. Blunted response of urinary kallikrein in essential hypertension may suggest an abnormality in the renal kallikrein-kinin system in this disease.


Fine structure of the spleen in autoimmune hemolytic anemia associated with systemic lupus erythematosus. The fine structures of the red pulp of the spleen and the liver of a patient with autoimmune hemolytic anemia, neutropenia and thrombocytopenia associated with systemic lupus erythematosus are described. The red blood cells were phagocytized in toto by the splenic macrophages. These also contained neutrophils and platelets in various stages of degradation. Sinus endothelial cells revealed occasional erythrophagocytosis. The Kupffer cells in the liver occasionally contained red cells and platelets. These morphological findings and marked improvement of hematological abnormalities following splenectomy suggested that the spleen was the major site of destruction of blood cells. Undulating tubules associated with the endoplasmic reticulum were present in the sinus endothelial cells of the spleen.


Lactate dehydrogenase and glutamic oxalic transaminase isozymes in heart muscle of forensic pathological cases. LDH and GOT isozyme patterns in the heart muscle of forensic pathological cases were investigated to find out the relationship between their changes and the causes of death. In most cases of death by violence, natural causes, poisoning and cold, the sum of LDH-1 and LDH-2 averaged about 80-90% of the total LDH, and GOTs was equal to or slightly lower than GOTm. In about two thirds of cases of asphyxia and drowning, LDH-1 and LDH-2 decreased and LDH-3, LDH-4 and LDH-5 increased. The activity of GOTs decreased and the ratio of GOTs/GOTm diminished. In neonate, LDH-3 showed the highest activity, followed by LDH-2 and LDH-1. GOTm was much less than GOTs. In most cases of cardiac death from unknown cause and cot death, LDH-3 increased remarkably, though it was less than LDH-1 and LDH-2, and GOTm became much less than GOTs. These findings revealed that there were some similarities in the LDH and GOT isozyme patterns in the heart muscle of the cardiac death from unknown cause and cot death and that of neonate.


Urinary prostaglandin and sodium metabolism in patients with essential hypertension. Urinary prostaglandin E (PGE) excretion as an indicator of renal PGE, urinary aldosterone excretion, plasma renin activity, urinary sodium excretion, and urinary potassium excretion were measured after sodium depletion in 15 patients with essential hypertension to investigate the interaction between renal PGE and sodium metabolism. Following sodium depletion, urinary PGE excretion decreased, whereas urinary aldosterone excretion and plasma renin activity increased. Significant positive correlations were found between urinary PGE excretion and urinary sodium excretion (r=0.41, p less than 0.01) or urinary sodium excretion-urinary potassium excretion ratio (r = 0.43, p less than 0.005). These results support the hypothesis that the renal PGE may play an important role in the regulation of sodium metabolism and this action of PGE is independent of the renin-aldosterone system.


Morphogenesis of axial sclerosis and fibrosis following proliferative glomerulitis and their significance for the nephrotic syndrome. Mode of development of axial sclerosis and fibrosis of glomerular loops following proliferative glomerulitis was studied on the basis of renal biopsies. The analyses of biopsy specimens revealed that mild proliferative glomerulitis with preservation of capillary structure is followed by axial sclerosis or sclerosis of mesangial area of glomerular loops, whereas marked or severe proliferative glomerulitis characterized by disorganization of glomerular architecture due to proliferation of local fixed cells with reticular arrangement, chiefly of endothelial origin, following histolysis of loop walls results in crowding of proliferated cells accompanied by formation of fibers along them toward axis of the loop (axial fibrosis) and recanalization at its periphery. It was also clarified that when cell proliferation and following axial fibrosis of glomerulus are pronounced, lobulation of glomerular loops associated with further formation of centrolobular nodules is brought about, which is the lesion characteristic of lobular glomerulonephritis. Some clinical features concerning these processes were presented and discussed, and significance of glomerular lesions here presented for the nephrotic syndrome was considered.


[Endolymphatic radionuclide therapy of the malignant melanoma (author's transl)]. In the radiological hospital of Essen, 139 patients with malignant melanomas on the extremities have been submitted to an endolymphatic radionuclide therapy between May 29, 1970 and January 1, 1976. The survival rates of the different tumor stages are indicated and the changes of the survival curves since the last evaluation of August 31, 1973 are discussed. If the endolymphatic radionuclide therapy is applied, there is no risk of important side effects or complications. If an adequate surgical therapy has been effected prior to the radiotherapy, we consider the endolymphatic radionuclide therapy to be indicated above all in case of a  malignant melanoma of the clinical stage I or II when the primary tumor is situated in the lower extremity.


[Radiation therapy of anal carcinome. Experiences in 28 cases during the years 1950 to 1975 (author's transl)]. From 1950 to 1975, there were 28 patients with anal cancer irradiated in the University Clinic for Nuclear Medicine of the Kantonsspital Zürich. All patients with small and perianally situated tumors were cured by radiotherapy. In advanced lesions, the cure rate was about 10 to 20%. Our own results and a review of the literature shows, that in most cases of anal cancer surgical treatment should be preferred. Radiotherapy should be reserved for small and superficial perianal lesions and for inoperable lesions. Treatment results may be improved by a combined treatment with surgery and irradiation.


[Results of radiotherapy of metastatic orbit tumors (author's transl)]. The results of radiotherapy of 18 patients with metastatic orbit tumors were analyzed in a retrospective study. Twelve of fifteen evaluable patients were free of all symptoms immediately after the irratiation. The findings of two patients showed an amelioration, and one patient did not present any therapeutic success at all. The late results of twelve patients could be determined. Nine of them showed nn recurrence of the orbit tumor. Severe side effects, especially cataracts, could not be observed.


CRE for brachytherapy.

CRE for brachytherapy. Various methods suggested in literature for estimating the ret dose for brachytherapy treatments do not provide unique answers to treatment scheduling problems. These schemes are reviewed with the aim to find out the cause of disparity and to suggest the most consistent system. The variability of the various schemes with the variations of the exponent of time is studied and the CRE system with its minimum variation is advocated for use in solving brachytherapy treatment scheduling problems. The average value of the exponent of time and the corresponding normalizing constant is used to evaluate CRE for brachytherapy fro various dose rates with increasing periods of treatments. Use of the CRE for solving treatment scheduling problems is simplified by providing ready made estimation of CRE for various dose rates and treatment times. A nomogram is devised which gives CRE values for various values of exponent of time.


Mechanism of liver lipid accumulation in x-irradiated rat. The incorporation, both in vivo and in vitro, of 14C-acetate into hepatic lipids, notably the triglyceride and free fatty acid fractions, is greatly reduced following whole-body irradiation and is indicative of significantly reduced lipogenesis. Irradiation results in a several-fold increase in fatty acid oxidation, by the liver in vitro as well as in the whole animal, during the phase of active hepatic lipid accumulation. Small increases in lipoprotein lipase activity of adipose, immediately following irradiation and up to 24 hours, and the attendant marked fall in adipose lipids are suggestive of increased mobilization of peripheral lipids during the early period. However, in view of the fact that the maximum lipid accumulation occurs very much later, inflow of extra-hepatic lipid into liver does not appear to be of major etiological significance. There is three-fold experimental evidence in support of an impairment of triglyceride transport from liver being primarily responsible for the build-up of liver lipids: (I) Triton WR-1339 induced hypertriglyceridemia is totally absent in the irradiated rat during the period when liver lipids increase significantly; (II) the rate of disappearance of radioactivity from pre-labeled hepatic lipids is considerably lower in the irradiated rats; and (III) the irradiated rats show decrease in lipoproteins of liver cell-sap and of serum, the latter being more marked and a lowered synthesis of the lipoproteins, as assessed by labeling of the protein moiety.


Studies on the intestinal parasites in African patients in Owamboland, South West Africa. The paper gives the results of a survey of intestinal parasites among 501 in-patients drawn from four mission hospitals in Owambo and Kavango in northern South West Africa. Most of the patients (90%) were examined twice by the formol-ether concentration method, while the remaining 10% had one stool specimen examined. 10 species of helminths and 3 species of potentially-pathogenic protozoa were recorded--Necator americanus, Strongyloides stercoralis, Strongyloides fuelleborni, Hymenolepis nana, Taenia saginata, Trichuris trichura, Enterobius vermicularis, Fasciola gigantica, Schistosoma mansoni and S. haematobium, and Entamoeba histolytica, Giardia lamblia and Balantidium coli. The loads of Necator americanus were recorded in a few cases. The results are compared with those of some other Central and Southern African countries. 96 blood smears were examined for filaria and 46 patients were tested for bilharzia using the bilharzial skin test. Both groups gave only negative results.


Bacterial colonization of jejunal mucosa in giardiasis. Nine of 14 cases of giardiasis and severe malabsorption were found to have numerous bacteria adjacent to the mucosa and within luminal fluid samples from the upper jejunum. Three species of enterobacteria (Klebsiella pneumoniae, Enterobacter cloacae and E. hafniae) were cultured from eight patients and from only one were Bacteroides isolated. Enterobacteria were not cultured from seven of eight patients who had giardiasis but only mild malabsorption (of xylose only) nor from seven patients without malabsorption. Intestinal colonization by enterobacteria may make an important contribution to the development of malabsorption in patients with giardiasis.


Central nervous system involvement in South American blastomycosis. The authors present a patient with South American blastomycosis with cerebral involvement in whom a ventriculography and a cerebral arteriography showed a tumour at the level of the fourth ventricle. After six months of therapy, clinical cure of some lesions was obtained while the neurological picture of right hemiparesia remained unchanged. Surgery was performed and the histopathological study revealed a tuberculoid, granuloma-forming gumma. The literature is reviewed and comments are made on the cerebro-spinal fluid changes and the types of involvement of the nervous system. The neurological examination and the analysis of the cerebro-spinal fluid indicated that the relative frequency of central nervous system localization in South American blastomycosis was not in agreement with current thought.


Effect of trimethoprim-sulphamethoxazole on vibrio clearance in cholera (El Tor): a comparative study. The efficacy of trimethoprim-sulphamethoxazole (TMP-SMX) has been compared with that of tetracycline and chloramphenicol in 175 bacteriologically confirmed cases of cholera admitted to the Infectious Diseases Hospital Delhi. Vibrio cholerae, biotype El Tor, serotype ogawa, were isolated from all the patients. TMP-SMX showed greater in vitro inhibition and earlier eradication from the intestinal tract and is recommended as a suitable vibriocidal agent against cholera.


Visceral leishmaniasis masquerading as a nasopharyngeal tumour. Report of a case. A 55-year-old male, a resident of a village in the foothills of the Himalayas in the north-western region of India, presented with a huge nasopharyngeal tumour but was subsequently found to be infected with Leishmania donovani, involving the nasopharyngeal tissue and the draining lymph nodes as well as a visceral infection.


The epidemiology of tropical myositis in the Mengo Districts of Uganda. In the five-year period 1964-68 1,335 patients were admitted to Mulago Hospital, Kampala, with tropical myositis. The marked increase in the number of admissions during the study period is attributed to a change in the utilization of the hospital rather than to a true increase in the incidence of the disease. There was found to be only slight variation in incidence between different age and sex groups and there was no convincing evidence that immigrants from high altitude areas, where the disease is rare, were at different risk. There was statistically significant month-to-month variation in admission rates but there was no apparent correlation with rainfall, and no marked seasonal variation. During the quinquennium there was a changing pattern of admission rates for patients from different counties, and some evidence of 'space-time' clustering. These findings are compatible with the primary muscle damage being induced by a virus or the presence of aberrant hookworm larvae, but an ingested toxin cannot be excluded. Trauma may also play a role in determining localization of the disease in some cases.


Macdonald's model and the transmission of bilharzia. The paper considers a model for the transmission of bilharzia based on Macdonald's assumptions, in the light of data observed in the field. It is shown, in particular, that the threshold parameter governing whether or not an endemic cycle can be established is closely related to the proportion of infected snails in a community, and that this proportion is normally observed to be rather smaller than is compatible with the model. By considering more sophisticated models, allowing for the latent period of infection in the snails, and also for spatial and seasonal heterogeneity, the effective proportion of infected snails, from the point of view of Macdonald's model, is shown to be rather larger, and expressions are given whereby it can be evaluated from observable quantities. However, for the data from Malirong which are taken as illustration, it is also demonstrated that an even more plausible threshold value is obtained from a simple model incorporating human immunity in addition to the assumptions of Macdonald's model, and that, if this model were reasonable, human immunity would appear to be the most important factor in controlling the level of the disease in Malirong.


Antibody responses in self-infections with Necator americanus. Antibody responses were measured in a volunteer infected four times with Necator americanus over a 27-month period. The main source of antigen was culture fluid in which living adult N. americanus had been maintained for several days. Antibodies to worm acetylcholinesterase and IgE antibodies were detected only with this material, but antibodies were identified by the enzyme-linked immunosorbent (ELISA) assay, with either adult worm secretions or extracts of third-stage infective larvae. The total serum IgE level fell after the first infection, but although it then increased during subsequent infections, it never rose above 600 U per ml. None of the antibody responses suppressed the rat of worm development to maturity, or reduced the fecundity of the parasites. However, it is suggested that the development of the immune response may be associated with the waning of the severe gastro-intestinal symptoms which were experienced in this infection, and which are frequently characteristic of hookworm infections.


Anaemia and Schistosoma haematobium infection in the North-Eastern Province of Kenya. The haemoglobin levels of 787 Somali people in north-eastern Kenya were measured. Severe anaemia was very common in both sexes of all ages. Possible causative factors are discussed. Adolescent boys had particularly low haemoglobin values (in one area 43% had levels below 8 g/dl) and this was related to Schistosoma haematobium infection. Such a clear relationshiop has not been shown before.


Study of coinciding foci of malaria and leptospirosis in the Peruvian Amazon area. A hyperendemic malaria focus, found in 1973 in a secluded valley in South-eastern Peru, was restudied in 1975. Tests for antibodies to Plasmodium and Leptospira were performed on blood serum and blood slides collected at three locations on the Rio Ene and confluent streams and at two locations in the neighbouring highlands. The hyperendemic focus of P. vivax-P. malariae found at Mission Cutivirini in 1973 was confirmed in this study. Another hyperendemic focus of predominantly P. vivax was found at the village of Saoreni. Lesser amounts of malaria were found at other locations. Serology indicated past or present contact with Leptospira of from 50 to 75% of individuals at all locations. The two hyperendemic malaria foci therefore were embedded in a much larger hyperendemic focus of leptospirosis. The value of the indirect immunofluorescence test for malarial antibodies as a sero-epidemiological tool was emphasized by this study.


Ia versus K/D antigens in immunological enhancement of tumor allografts. The respective role of anti-H-2 K/D and anti-H-2 Ia antibodies in allotransplanted tumor enhancement was tested in vivo on two experimental tumors. Sa I A/4 (H-2a, i.e., H-2k/d) was enhanced in CBA (H-2k) and C57BL/Ks (H-2d) strains with anti-A/J immune sera prepared in CBA and C57BL/Ks, respectively. EL 4, C57BL/6 (H-2b) lymphoma, was enhanced in DBA/2 (H-2d) and BALB/c (H-2d) with immune sera prepared in DBA/2 and BALB/c. Anti-K/D antibodies were obtrained by elution from glutaraldehyde-treated RBC previously incubated with corresponding alloimmune sera prepared in mice immunized with spleen cells, thymocytes, or two consecutive skin grafts syngeneic to the RBC. The residual complement-dependent serocytotoxicity for target lymphocytes observed after complete hemagglutinin absorption on corresponding RBC was attributed to anti-Ia antibodies. RBC eluates (anti-K/D) were found to be enhancing for both experimental tumors and for all studied sera. After RBC absorption, the sera lost all enhancing activity when they were prepared by immunization with spleen or thymus cells, but remained enhancing in some sera prepared by immunization with skin grafts. Both types of antibodies (anti-K/D and anti-Ia) therefore appear able to enhance allografts. These results are compatible with the in vitro correlates of the two phases of the transplantation reaction: initiation phase (mixed lymphocyte reaction) inhibitable by anti-Ia and effector phase (cell-mediated cytotoxicity) inhibitable by anti-K/D.


Living related kidney donors: complications and long-term renal function. Sixty-two living related kidney donors were nephrectomized during a 10-year period. The overall complication rate was 40%, most complications being minor. Among the major complications was one patient with pulmonary embolism and three patients with hepatitis. One female donor suffered a psychoneurotic reaction following rejection of the donated kidney and she is still away from work, more than 2 years later. The other 61 donors were back to work within 2 to 18 (mean 8) weeks. The mean serum creatinine livels increased from 0.95 preoperatively to 1.15 mg/100 ml at the followup examination, which took place between 6 months and 9 years after nephrectomy. The mean increase in serum creatinine was higher in donors above 50 years of age (P less than 0.02). The mean creatinine clearance of the whole group decreased from 111 to 90 ml/min. The mean increase in size of the remaining kidney was 22%. Donor nephrectomy is a safe procedure with few serious complications and the prognosis for the recipient is excellent. Therefore, we consider transplantation from a family member to be the treatment of choice in terminal uremia.


Ethambutol and intra-ocular pressure.

Ethambutol and intra-ocular pressure. Two groups of Korean patients with tuberculosis, matched in pairs for age and duration of chemotherapy, have been studied. One group had received ethambutol in a mean dosage of 14.4 mg/kg and the other antituberculosis chemotherapy not including ethambutol for at least 3 months. All patients had routine ophthalmological assessments on admission to the study, including examination of the fundi, visual fields and macular thresholds. Intra-ocular pressures were measured and a water-drinking test was then carried out. All the assessments were made by the same ophthalmologist who was at all times kept unaware of the treatment which each patient was receiving or which patients were paired. There was no evidence of ocular toxicity or that ethambutol in the dosages studied has an effect on intra-ocular pressure.


Tuberculosis of the breast.

Tuberculosis of the breast. The case histories of five women patients with mammary tuberculosis are described. All were treated by surgical excision of the lesion followed by antituberculosis chemotherapy. Recovery was uncomplicated in four of the patients but the fifth had a recurrence after 6 months for which a second operation was required. Tuberculosis of the breast is rarely diagnosed by clinical methods alone. The main problem is to distinguish it from pyogenic abscess in young women and from mammary carcinoma in older women. Surgical excision is often needed to prove the diagnosis. All patients should be given a standard course of chemotherapy but the value of surgery in the treatment of this disease has yet to be assessed.


Tuberculoma of the liver.

Tuberculoma of the liver. During the period 1973-76 2 patients, neither immigrants, were operated on and found to have tuberculoma of the liver. Both were successfully treated. Tuberculoma of the liver is an uncommon condition and is rarely encountered as a surgical problem. It can, however, present a surgical challenge as it must be distinguished from the more common types of right upper quandrant abdominal lesions such as biliary, gastroduodenal and other hepatic diseases. The occurrence of a tuberculoma of the liver without coexistent tuberculosis elsewhere in the body is extremely rare. Its presence in association with other tuberculous foci, whilst uncommon, has been recorded on a number of occasions.


Keratitis due to Mycobacterium chelonei. A case of ulcerative keratitis has been followed by ophthalmological, bacteriological and histopathological examinations. Mycobacterium chelonei has been repeatedly isolated from the lesion before and after surgical interventions.


Pulmonary oxygen toxicity in chickens and rabbits. Chickens exposed to hyperbaric oxygen (3 to 5 ATA) or to 100% oxygen at atmospheric pressure for prolonged periods showed no pathologic pulmonary damage, although hydrogen peroxide did accumulate in their airways. Superoxide dismutase in the peripheral nucleated red blood cells and the rate of oxidation of specifically labeled glucose were increased in chickens exposed to hyperbaric oxygen for three hours. Superoxide dismutase increased in the lung lavage of the rabbits and in the peripheral nucleated red blood cells. Glucose oxidation was unchanged. The difference in superoxide dismutase is probably the result of the desquamated, damaged cells found in the rabbit lung lavage. That only rabbit bronchi are lined with oxidant-sensitive ciliated cells suggests that the absence of these ciliated cells in fowl may well be responsible for the observed resistance of these birds to oxidant damage by oxygen.


Pulmonary alveolar macrophage response to hyperbaric carbon monoxide exposure. The sublethal effects of carbon monoxide (CO) in hyperbaric environments have not been adequately characterized. A physiologically sensitive indicator of sublethal effects of a contaminant is the pulmonary alveolar macrophage (PAM). The guinea pig PAM and its reaction to various CO concentrations at 8 atmospheres absolute (ATA) and the surface-equivalent concentrations at 1 ATA were studied in this experiment. In the absence of CO, PAM counts and viabilites from guinea pigs exposed to a helium-oxygen environment at either 1 or 8 ATA were not significantly different from one another. Mean PAM viability for guinea pigs exposed to CO concentrations at 2250--4200 mg/m3 at 8 ATA was 68.4 +/- 7.3% and was not significantly different from the 1-ATA viability value of 72.0 +/- 4.5% for the 1600--4200 mg/m3 CO range. The data show that at 1 to 8 ATA and CO concentrations of 1600--4200 mg/m3, the decrease in PAM viability was accompanied by dramatic five- to sixfold increases in PAM counts.


Aseptic bone necrosis among U.S. Navy divers: survey of 934 nonrandomly selected personnel. Nine hundred thirty-four U.S. Navy divers were selected and surveyed radiographically using standard techniques developed for detecting aseptic bone necrosis (ABN). X rays were read by qualified radiologists. A total of 16 positive cases was detected, and another 11 were interpreted as doubtful. ABN was found to be related to age and number of months in diving. After controlling for these factors, ABN could not be related to any of seven indices of diving activity. Divers with ABN did, however, have a history of more treatments for decompression sickness (DCS) than did divers without ABN. Implications of these findings are discussed, and the suggestion is made that ABN and DCS may not be related causally, but may be related to a third common factor. The need for controlled studies is discussed. The conclusion is made that the low prevalence rates of ABN among U.S. Navy divers cannot be related to any specific index of diving activity, and may not be causally related to DCS.


Physiological responses to head-out immersion in water at 11 ATA. Cardiorespiratory, thermal, and renal responses to a 30-min head-out immersion in 15 degree C water were studied at 1-ATA air and 11-ATA helium-oxygne environments in four male subjects wearing dry suits. Cardiorespiratory responses to immersion (reductions in heart rate, expiratory reserve volume, vital capacity, and thoracic impedance; and increases in stroke volume, cardiac output, and inspiratory capacity) were comparable at both pressures. However, thermal responses to immersion (a reduction in mean skin temperature and increases in skin heat flux and suit conductance) were significantly greater at 11 ATA compared to those at 1 ATA. The rate of urinary excretion of norepinephrine increased significantly during and after immersion at 11 ATA but not at 1 ATA. In contrast, the urinary excretion of epinephrine was not altered by pressure or immersion. The immersion diuresis was greater and lasted longer at 11 ATA than at 1 ATA although there was no difference in the endogenous creatinine excretion . This diuresis was accompanied by a significant natriuresis which was more marked at 1 ATA than at 11 ATA. At 1 ATA, the urinary excretion of both aldosterone and antidiuretic hormone (ADH) decreased during immersion. At 11 ATA, the rate of excretion of these hormones before immersion was lower compared to that at 1 ATA and did not change significantly during immersion. These results indicate that immersion in a hyperbaric helium-oxygen environment presents a greater cold stress than at 1-ATA air, and also that immersion diuresis and natriuresis at high pressure may be induced by a factor other than inhibition of aldosterone and ADH.


Effects of hyperbaric helium-oxygen on the antipyretic actions of aspirin and acetaminophen in rats. The effects of two antipyretics, aspirin and acetaminophen, were studied under hyperbaric helium-oxygen conditions. Groups of yeast-fevered rats were given three different doses of each antipyretic in 1-ATA air and 31-ATA helium-oxygen. Neither agent was as effective an antipyretic in hyperbaric helium as it was in 1-ATA air. Responses to acetaminophen were reduced an average of 73%, and those to the two lower doses of aspirin by 56%; the highest dose of aspirin (135 mg/kg) caused a significant elevation of temperatures in the hyperbaric environment. A similar increase in temperatures was observed in rats treated with 135 mg/kg of aspirin and exposed to hot (30--31 degrees C) air at 1 ATA. It is concluded that the decreased efficacy of antipyretics in hyperbaric helium environments is caused by the high ambient temperatures maintained in helium (34--35 degrees C) to compensate for the greater thermal conductivity of helium compared to nitrogen, which may limit the heat-dissipating abilities of rats in the hyperbaric environment.


Effect of cerebellar ablation on the high pressure nervous syndrome in rats. To evaluate the interaction between high pressure nervous syndrome (HPNS) seizures and cerebellar integrity, seizure threshold pressure (Pc) of normal rats was compared with that of rats sustaining cerebellar ablation two weeks prior to exposure to 136 ATA in a helium-oxygen atmosphere. All rats exhibited severe HPNS symptoms which culminated in seizures. Pc was reduced in cerebellectomized animals, and the number of seizure episodes increased twofold, but the average duration of seizure episodes was unchanged. The spike-and-wave pattern in the electroencephalogram remained a prominent feature in both groups.


Influence of hydrostatic compression of the chest and intrathoracic blood pooling on static lung mechanics during head-out immersion. The effect of water immersion on static lung volumes and pressure-volume curves was studied in five subjects. A special container allowed measurements during nonimmersion, head-out immersion, and thorax immersion leaving the head, pelvis region, and legs dry. It was thus possible to separate the part played by hydrostatic forces acting on the chest from the part played by intrathoracic blood pooling during immersion. Hydrostatic compression of the chest decreased total lung capacity (TLC) by 0.30 liter and residual volume (RV) by 0.25 liter. Blood redistributed into the thorax during head-out immersion caused a further reduction of TLC of 0.13 liter; RV increased by 0.10 liter, probably because expiration was hampered by air-trapping. Heal-out immersion reduced VC by 0.29 liter compared to nonimmersion, and this effect was wholly attributable to intrathoracic blood pooling. Lung compliance during head-out immersion was 0.11 liter x (cmH2O)-1 smaller than during nonimmersion; this was mainly due to intrathoracic blood pooling. Results support the notion that blood redistribution decreased lung compliance by exerting an erectile effect on the lung tissue.


Cerebral and blood glucose in central oxygen poisoning. Studies were carried out to determine the effect of high oxygen pressure (OHP) on brain and blood glucose. OHP increased cerebral glucose in mice killed at various stages of oxygen toxicity. This included times which corresponded to 75% and 100% of the CT50, the hyperactive state, and at seizure onset. Blood glucose also was increased but only when mice were exposed to oxygen for times which produced stress-related responses. These were at 100% of the CT50,during hyperactivity, and at the onset of seizures. The increase in cerebral glucose was due to the increased oxygen pressure and not to the pressure per se. Adrenalectomy blocked the oxygen-induced increase in blood glucose but not in cerebral glucose. Disulfiram, an effective oxygen protectant, markedly increased both brain and blood glucose.


Effects of varying thermal and apneic conditions on the human diving reflex. An investigation of the importance of water contact, cooling, and apnea to the development of the diving reflex in humans was performed in two experimental series. The first series involved exposure of different parts of the face to direct water contact, while the second consisted of face immersion in water baths of varying temperatures. Data were obtained on heart rate (ECG's) and peripheral vasoconstriction (by indirect blood pressure using sphygmomanometry). Results were interpreted to indicate that the diving reflex is actuated by both facial cooling and apnea, but not by any direct effect of water contact other than cooling.


Quantification of high pressure nervous syndrome (HPNS) tremor in the guinea pig. Previous studies have demonstrated two tremorgenic systems that involve separate brain mechanisms and exhibit different peak frequencies. One system (the thalamo-cortical) generates low frequency (4--8 Hz) tremor; the other (the olivo-cerebellar) produces high frequency (10--18 Hz) tremor. Based on this evidence, the present study focused on determining whether one or both of these tremor systems is involved in the high pressure nervous syndrome (HPNS). Specifically, the concern was to identify and to quantify amplitude and frequency characteristics of HPNS tremor in 8 guinea pigs breathing helium-oxygen during compression (40 ft/min) in a chamber dive to 61.6 ATA (2000 fsw) with a bottom time of 1 h. Rectal temperature was recorded and maintained at 39 degrees C +/- 1 degree. Leg tremor was recorded by magnetic inductance and stored on magnetic tape for power spectral analysis. Frequency histograms of the tremor data revealed development of a biphasic response. From surface to about 31.3 ATA (1000 fsw), a low-power, single, 4- to 6-Hz component was evident, which resembled fine or moderate tremor. Between 34.3 ATA (1100 fsw) and 61.6 ATA, a 12- to 18-Hz component emerged abruptly with a dramatic increase in power, which reflected coarse, uncontrollable tremors. In the first 5 to 10 min after the animals arrived at maximum pressure, relative power of the high frequency component dropped to and remained near base-line levels. These results support the hypothesis that HPNS tremor consists of two components and possibly two separate tremor systems.


[Bladder carcinoma associated with long-term treatment with cyclophosphamide for multiple myeloma (author's transl)]. A report is presented of a female patient who developed an extensive bladder carcinoma with severe hemorrhaging after many years of treatment with cyclophosphamide for multiple myeloma. The severe hemorrhage could only be controlled by drainage of the urine. The possible causes of the development of a second neoplasia, particularly of urinary bladder carcinoma following long-term therapy with cyclophosphamide, are discussed.


[Clinical and immunologic investigations of patients with urinary bladder tumors (author's transl)]. Forty patients with urinary bladder tumors (26 cancer and 14 papilloma) were investigated by clinical and immunological methods. Patients with Stage I and II bladder cancer had a decrease in their delayed cutaneous hypersensitivity reactions in comparison to healthy controls. The same was found in patients with proliferating papillomas (WHO I) and benign papillomas. Patients with carcinoma in Stages III and IV had a reduced reactivity to recall antigens and could be immunized to a significantly lesser degree with primary antigens. In most cases a transurethral resection of the tumor was followed by radiotherapy. In four patients local immunotherapy was performed after resection of most of the tumor mass.


[Andromastectomy for avoidance of gynecomastia in treatment of prostate carcinoma (author's transl)]. An operation is described for the prevention of hormone-related gynecomastia that has not yet been published in the literature. In the hands of an experienced plastic surgeon, the operation has proved to be without problems. However, certain guidelines for the operative technique which will be described in more detail elsewhere must be observed.


[A transurethrally transplanted model of a carcinoma in the area of the urinary bladder of the rabbit (author's transl)]. Thirty-nine rabbits were injected intratesticularly (n = 4), in the neck (n = 6), or in the submucosal area of the bladder (n = 29), with a 1-ml suspension of cells from a continuously passaged Brown-Pearce carcinoma. Actual submucosal transplantation (n = 9) caused, in addition to bladder tumors, massive metastases in the peritoneal cavity, the pleura, and the eyes. Animals receiving mucous membrane cornification prior to the submucosal infiltration (n = 15) developed exulcerated tumors in the bladder lumen and a primary bladder carcinoma like metastasis. Animals in which the tumor cell suspension was transplanted transurethrally (n = 5) likewise showed metastases in para-aortal lymph nodes and in the liver. The experiments indicate that the Brown-Pearce carcinoma, which is not indigenous to the bladder, will, with appropriate methodology, behave in a manner similar to that of a primary bladder carcinoma and can in addition be transplanted transurethrally. Tumors thus induced appear to be suitable models for studying different therapeutic approaches to bladder carcinoma.


[Local high-frequency hyperthermia of the Brown-Pearce carcinoma in the urinary bladder of rabbits (author's transl)]. The effect of a conductive high-frequency hyperthermia on a model tumor in the urinary bladder of rabbits (Brown-Pearce Carcinoma) was studied at a temperature of 43 degrees C, and with an application time of 30 min. The frequency used was 500 kHz, wattage 30-300 and wavelength 600 m. This resulted in the homogeneous warming of the urinary bladder tissue, in contrast to the results obtained when warm water was injected. Essential test results included: (1) a temperature gradient of max. 6.7 degrees C from the tumor center to the lumen of the urinary bladder, the tumor favoring the higher temperatures; (2) a prolongation of the survival time for animals with heat-treated tumors as opposed to the control animals. After transplantation heat-treated tumors evolved to receptor animals considerably less often than did untreated tumors.


[Hypernephroma as a cause of high blood pressure (author's transl)]. In the group of 111 patients treated for hypernephroma, 24 have shown in addition to their usual symptoms a more systolic an elevated blood pressure up to 22 mm Hg and higher. In two cases was hypertension the only symptom. In the hypertensive group, 20 patients underwent nephrectomy and blood pressure returned to normal in all but one. Four pathophysiologic mechanisms of blood pressure elevation in hypernephroma are discussed: (1) AV shunts; (2) Compression of the renal artery or its branches due to tumor expansion; (3) Polycythemia; (4) Hypernephroma with hormonal activity. The hypertension of 6 of our patients was due to AV shunts, of 7, to renal vessels compression, and of 6 others, to a polycythemia.


[A benign tumor of the kidney (author's transl)]. In discussing the frequency of kidney adenomas we present a rare case of a large oncocytoma, with all diagnostic and therapeutic aspects. The special angiografic picture of thistumor seems to be important. Furthermore the criteria for malignancy of epithelial tumors of the kidney are discussed.


[Cholesteatoma of the renal pelvis (author's transl)]. A 63-year-old male experienced pain in the epigastric region and a septic fiver. X-ray examinations showed a tumor-like process in the lower part of the left kidney with some concrements. Upon operation a nodular inflammatory tumor was found, occupying more than two-thirds of the left kidney. Histologic examination revealed a typical cholesteatoma of the renal pelvis and calyces with some concrements among the abundant keratin material.


[Clinical and morphological findings and problems in malacoplakia of the urinary bladder (author's transl)]. Malacoplakia of the urinary bladder (observations on 4 female patients, average age 47 years, longest duration 8 years) is, under light microscopy, arranged in 4 layers. Zone 1 contains inflammatory granulation tissue. Zone 2 is composed of von Hansemann cells (macrophages). In zone 3, Michaelis-Gutmann bodies appear. Finally, the deepest zone 4 contains connective tissue, blood vessels, and lymphoplasmacellular infiltrates. By electron microscopy, the gradual formation of residual bodies from the remains of phagocytosed materials in the macrophages in these layers can be observed. Through loading with calcium and iron compounds, the residual bodies take on the characteristic appearance of Michaelis-Gutmann bodies. Etiologically, the origin of malacoplakia is probably involved with coliform bacteria, but apparently additional factors are required for the development of a disease process: e.g., disturbance of macrophage function. There are certain parallels between malacoplakia and Whipple's disease. With atypical localization outside the urinary bladder, differential diagnostic difficulties can arise in separating malacoplakia from inflammatory-granulomatous processes (granulomatous orchitis, xanthogranulomatous pyelonephritis). The prognosis of malacoplakia in the urinary bladder is good in all cases, but timely treatment of recurrence and constant supervision are indicated.


Hematuria and proteinuria in pediatric patient. Diagnostic approach. Some of the first clues suggestive of renal disease are hematuria and proteinuria, and when present in a child, deserve careful consideration. The clinical experience and diagnostic evaluations at a new renal unit are examined to familiarize the practicing urologists with the diagnostic approach which will generate the correct diagnosis. The indications and results of kidney biopsy in children are also presented.


Dimethyl sulfoxide in treatment of inflammatory genitourinary disorders. Intravesical dimethyl sulfoxide (DMSO) has been used in the treatment of 213 patients with various inflammatory conditions involving the lower genitourinary tract, including intractable interstitial cystitis, radiation cystitis, chronic prostatitis, and chronic female trigonitis. Significant symptomatic relief has been achieved in the majority of patients so treated, and no systemic or local toxicity has been noted. Some patients failed to respond entirely, and others relapsed after DMSO treatment periods of several months, ultimately coming to augmentation cystoplasty or urinary diversion. However, because of its simplicity and ease of administration, intravesical DMSO therapy is recommended in all noninfectious or non-neoplastic inflammatory conditions presenting initially with severe symptoms, or that have failed to respond to conventional therapy.


Megaureters in children.

Megaureters in children. The results of surgery for megaureter are reviewed in 40 children. Special attention is focused on the etiologic causes of these dilated ureters in relation to the surgical results. Thirty of 31 children with obstructive or refluxing megaureters and normal bladders had satisfactory results. Less satisfactory results occurred in children with abnormal bladder dynamics. No child in this series required upper ureteral tapering. A discussion of the causes and further management of the surgical failures is presented.


Vasoseminal vesiculography in staging adenocarcinoma of prostate. We found vasoseminal vesiculography useful in staging adenocarcinoma of the prostate and in measurement of radiotherapy ports. In 12 patients who had radical prostatectomies, the histologic findings correlated well with the vasoseminal vesiculograms. Criteria for reading benign prostatic hyperplasia and prostatic carcinoma have been well established in the literature and are reviewed.


Chemotherapy trial with comp-F regimen in advanced adenocarcinoma of prostate. Multiple agent combination chemotherapy was used to treat 16 patients with Stage D adenocarcinoma of the prostate in relapse. Agents employed were cyclophosphamide (Cytoxan), methotrexate, 5-fluorouracil, vincristine, and prednisone. Results were encouraging. Six of 16 patients achieved an objective response (2 complete, 3 partial, 1 stabilization) for a 37.5 per cent response rate. Eleven of 16 patients achieved a subjective response for a 69% response rate. Soft tissue metastases may be more responsive than bony lesions. Employment of vincristine made no obvious difference in response rate in those patients in whom it was used. Toxicity was only moderate. Further studies are warranted.


Unilateral anorchism. Report of 11 cases with discussion of etiology and pathogenesis. Eleven cases of unilateral anorchism are presented. The patients, aged two to thirty-nine years, were explored for cryptorchism but, though ducts could be identified operatively in most cases, there was doubt regarding the presence of the testis. These tissues, including the putative testes, were excised and pathologically the excurrent ducts, consisting of vas deferens with or without epididymis, were seen in all cases. No tunica albuginea or testicular parenchyma was identified and the structures, submitted as possibly testicular, were nonencapsulated, well-circumscribed, subserosal foci of highly vascularized fibrous tissue with few small nerves and smooth muscle bundles. Dystrophic calcific deposits were seen in 2 cases and microfoci of poorly developed Leydig cells in 2 cases. A vascular hypothesis is proposed for the etiology and pathogenesis of unilateral anorchism.


Effect of pesticides on testicular function. Marked impairment of spermatogenesis was found in a group of men exposed to the pesticide 1,2-dibromo-3-chloropropane (DBCP), demonstrated by semen analyses, testicular biopsies, and hormone studies. The ramifications of the use of this pesticide are discussed.


Anterior urethral valves.

Anterior urethral valves. A case of anterior urethral valves is presented. A diagnosis of anterior urethral valves can be suspected clinically by watching the patient void. Dribbling and a diminished force of the patient's urinary stream are present in this condition. Confirmation is made with a voiding cystourethrogram and panendoscopy. Various modes of therapy are discussed.


Carcinoma of prostate metastatic to prepuce and glans penis. A case of adenocarcinoma of the prostate with metastases to the prepuce and glans penis is described. This is the second case reported. The various routes of tumor spread to the penis are discussed briefly, and the possibility of direct spread is postulated as the cause of "kissing" foreskin and glandular lesions.


Hydroxyurea and infected stones.

Hydroxyurea and infected stones. The formation of struvite stones is closely linked to the enzyme urease produced by certain bacteria found in urine. It has been shown that hydroxamic acids will block the activity of this enzyme. One of these, hydroxyurea, in a morning dose of 500 mg. was used in 21 patients for three months or longer. Most were then able to acidify their urine despite persistent urinary infection. After three months, treatment with nitrofurantoin (Macrodantin and hydroxyurea (Hydrea), 78.6 per cent of patients had persistently sterile urine. There are 11 patients who have been observed for one year, and no toxic effect of the drug has been found. Three patients have shown some decrease in size of their retained calculus. This experimental study has shown that hydroxyurea may be useful in the management of struvite stones and deserves further study.


Enzyme activity and distribution in rat prostatic adenocarcinoma. The activity and distribution of acid phosphatase, alkaline phosphatase, nonspecific esterases, beta-glucuronidase, and aminopeptidase were examined in the transplantable R-3327 rat prostatic adenocarcinoma and compared with those in the four prostatic lobes of the rat. Both the well and poorly differentiated tumor cells in R-3327 carcinoma were characterized by high activities of beta-glucuronidase and aminopeptidase. The poorly differentiated cells had a high alkaline phosphatase activity. The enzymatic profile of the R-3327 adenocarcinoma closely resembled that of the anterior and dorsal prostate. The origin of the tumor in one of these prostatic lobes is probable, but not certain.