[The influences of anesthetic methods on intraoperative cholangiometry (author's transl)]. The influence of several anaesthetic methods on the tonus of the sphincter of Oddi was investigated in 45 selected patients undergoing cholecystectomy (halothane; fentanyl; fentanyl-droperidol (DHB); all in combination with N2O:O2 and relaxant). The fentanyl collective showed a significant rise of the common bile duct pressure, while the fentanyl-DHB and the halothane collectives did not show any statistical difference in their parameters. From these results neuroleptanalgesia appears to be a surtable method for biliary surgery.


[A neurometric analysis of brain functions after halothane anaesthesia, neuroleptanalgesia and combined acupuncture-analgesia (author's transl)]. In a comparative examination of the effects on brain function of three anaesthetic methods--halothane anaesthesia, neuroleptanalgesia and combined acupuncture-analgesia--typical and characteristic changes in brain metabolism, brain electrical activity or psychological test parameters were observed with each method. Brain function is understood here as complex of consciousness and pain. Loss of consciousness is defined as the suspension of intelligence quotient with characteristic changes of brain activity and metabolism. Pain is defined as the central perception of senses evoked by peripheral sensors. Loss of consciousness is only the evident and monotone finishing result of different effects of the anaesthetic methods on brain function. In using combined acupuncture analgesia a hypalgetic method is introduced to the anaesthetists armamentarium. Possible mode of action are discussed. In place of the name acupuncture-analgesia ther term electrohypalgesia is recommended.


[The cardiovascular response to gradual increase of intracranial pressure in experiments on animals (author's transl)]. Experiments were performed on dogs to examine the cardiovascular response (Cushing' reflex) to slow increase of intracranial pressure (ICP) by means of an epidural balloon. In contrast to the acute increase in ICP, a slow but constant increase of the cardiac output (CO) was observed, followed later by a short and steep increase of blood pressure, in various experiments with different ICP. In the range of ICP from 30 to 100 mm Hg a linear relation existed between the ICP and CO. The experiments indicate that with the slow ICP increase the so-called cardiovascular response does not occur, or only occurs rudimentarily, in contrast to a swift ICP-increase. It seems therefore obvious that a suppression of the cardiovascular reaction occurs which is dependent on the sympathicoadrenergic system by the parasympathetic fibers. The reflex mechanism is discussed. The release mechanism of the circulation reaction is not specifically dependent on pressure but is the consequence of a nonspecific lesion of the circulation centre in the medulla oblongata.


[Complete occlusion of an endotrachealtube in the course of long-lasting anaesthesia. A hazard of reinforced latex tubes (author's transl)]. A case of sudden occlusion of a reinforced latex endotracheal tube is reported. The event took place four hours and twenty minutes after induction of anaesthesia. Reintubation during operation became necessary under difficult circumstances. The causes of such incidents, and appropriate preventive measures are discussed.


Multinational evaluation of etomidate for anesthesia induction. Conclusions and consequences. An overall analysis was made of 4763 case report forms from 45 anesthesiologists who used etomidate (Hypnomidate) routinely as an induction hypnotic in a total of 4127 surgical cases or compared it to thiopental in a series of controlled studies (325 on etomidate, 311 on thiopental). Premedication was standardized only in the controlled studies, and there were no restrictions on the use of anesthetic agents or techniques. Etomidate proved to be a safe and effective induction hypnotic. Sleep was deep and long enough to allow the normal induction and maintenance procedures. Blood pressure and heart rate remained remarkably stable in the 3 study groups. The incidence of respiratory depression was higher for thiopental; anesthesiologists' acceptance of etomidate was, however, reduced by the occurrence of venous pain during injection and of associated involuntary muscle movements. It is expected that these adverse effects will be largely eliminated by using the recently introduced new formulation of etomidate shortly after fentanyl.


Venous pain and involuntary muscular movements during and after administration of etomidate. A comparison of two different formulations. Anaesthesia was induced in 209 patients with etomidate, using either the two vidal formulation, i.e. a solution of 30 mg etomidate sulphate in 20 ml phosphate buffered solution or the new formulation i.e. 5ml ampoules containing 2% etomidate base in polyethylene glycol 1000 (PEG 1000), a ready-for-use solution. Amongst patients who received the two vial formulation of etomidate (n = 105), 26 reported pain on injection as compared with six patients who received etomidate in PEG 1000 (n = 104). In the former group, involuntary muscle movements were reported in 12 patients, three of them being disturbing. In the latter group slight involuntary muscle movements occurred in 15 patients, but were never disturbing.


[Comparative investigations on the influence of etomidate, thiopentone and methohexitone on the intracranial pressure of the patient (author's transl)]. Intracranial pressure was measured under the influence of the new hypnotic etomidate (Dosage: 0.15 to 0.30 mg/kg b.w.). For comparison thiopentone (Trapanal: 3 to 4.5 mg/kg) and methohexitone (Brevimytal: 1 to 1.5 mg/kg) were given. The investigations were performed on 28 neurosurgical patients, who thereafter underwent surgery. The patients already had a closed or open ventricular catheter by means of which intracranial pressure was continuously measured. Etomidate lowered intracranial pressure. This happened during induction of anaesthesia and later during neuroleptanalgesia when etomidate was again injected. The pressure fall after etomidate was similar to that seen after thiopentone. It was at the time of induction 5 and later on 3mm Hg. Methohexitone showed a somewhat smaller effect. The cerebral perfusion pressure was calculated. When etomidate was given during the course of a neuroleptanalgesia the cerebral perfusion pressure merely decreased slightly (-7 per cent). Perfusion pressure remained stable after thiopentone and methohexitone.


[Effects of etomidate and thiopentone on the primarily elevated intracranial pressure (ICP) (author's transl)]. In 8 patients having primarily an increased ICP, the effects of etomidate on ICP, arterial pressure and cerebral perfusion pressure (CPP) were studied by comparison with thiopentone. The patients received no premedication or basic anaesthesia and relaxation was obtained using pancuronium bromide. Blood gas analysis was performed at regular intervals to maintain a constant level of the arterial pCO2. Under the conditions of a reduced intracranial compliance and an elevated ICP, thiopentone lowered the arterial pressure considerably in contrast to etomidate. The primarily elevated ICP was reduced by both, etomidate and thiopentone to an extent of 27 per cent for more than 10 min. The considerable decrease of arterial pressure by thiopentone caused marked lowering of CPP during more than 10 min. In the same period etomidate did not influence either arterial pressure or CPP. These results show that for the induction of anaesthesia in neurosurgical patients having a primarily increased ICP etomidate has good properties.


[The effect of operation, anaesthesia and blood viscosity on haemodynamic during aortofemoral bypass operation (author's transl)]. Cardiac index, total peripheral resistance, blood, plasma and serum viscosity in patients with peripheral vascular disease were measured pre-, intra- and postoperatively. Besides plasma and serum viscosity, most obviously blood viscosity decreased during anaesthesia and operation. The decrease of blood viscosity is caused mainly by the falling haematocrit. Red blood cell aggregation occuring under low-flow conditions is decreased. Thus blood viscosity additionally is diminished at least in the area of low shear rates. Corresponding haemodynamic measurements revealed that decreasing viscosity improves cardiac index and total pressure resistance if normovolaemia exists, but in general is masked by anaesthesia and operation.


[Acute posttraumatic renal failure following therapy with antibiotics and beta-aescin (author's transl)]. A case of acute renal insufficiency after therapy with gentamycin and beta-Aescin is reported. The role of these two agents in the causation of the acute renal failure is discussed. Renal function was restored using the REDY-Hemodialization System.


[Caryometric studies on the cortex of the adrenal gland of parathyroidectomized and thyroparathyroidectomized female rats both during and without hormonal substitution (author's transl)]. 80 female Wistar rats were either parathyroidectomized or thyroparathyroidectomized and subsequently substituted with one of the following hormone regimes: thyroxine, parathormone, calcitonin, thyroxine + parathormone, or thyroxine + calcitonin. On the fifteenth day following the operation the animals were killed, the adrenals immediately removed, fixed in Bouin's fluid, dehydrated through methylbenzoate and embedded in paraffin. 5 micrometer thick sections were stained with hematoxylin--Organe G--phosphotumgstic acid--Aniline blue (HOPA). From 5 different animals in each experimental group, 200 nuclear diameters were measured in the Zona glomerulosa, Z. Fasciculata, and Z. reticularis. Statistically significant differences (P less than 0.01) were found only in those cases were the hormonal balance between thyroxine, parathormone and calcitonin was disturbed, i.e. in experimental groups receiving one of the above mentioned hormonal regimes following operation. In contrast, no significant difference was attained in nuclear diameter between nonoperated animals and those animals in which all three hormones were lacking, i.e. when a thyroparathyroidectomy was performed.


Hypothalamo-hypophysial vascularization of the teleost, Puntius sophore (Ham.) with special reference to its tetrapodan features. In Puntis sophore a hypothalamo-hypophysical portal system structurally comparable to the tetrapods is present. Apart from this the teleostean type of neuroadeno-interface vasculature is also evident. The hypothalamic artery gives rise to the primary capillary plexus of the infundibular floow. The protal vessels formed from them largely irrigate the adenohypophysis through their secondary vascular network. The dense neurosecretory axonal ramifications present in the infundibular floor are in close morphological contact with the primary plexus. This region also exhibits intense monoamine oxidase activity. Thus, the infundibular floor of P. sophore is structually comparable to the meidan eminence of the higher vertebrates.


[Compression tests on the human hip joint (author's transl)]. Three human pelvises were subjected to static loading in the course of the experiments. The values determined for the elasticity modules lie between 2 and 4.5 kp/min2. The values range between 5 and 14 kp/mm2 if only the compacta is considered. The experiments show that the elasticity modules obtained at cross sections through the Os coxae are higher than those for sections through the hip joint and its immediate surroundings. Here the elasticity module reaches the minimum value of 0.77 kp/cm2 (Fig. 1, cross section No.2, Table 3). The highest breaking strain was 1045 kp (Pelvis II). The longitudinal contraction of the three pelvis was 26.6 mm on average. For the mean height of 27.2 cm for the specimens used, this means that the pelvis, as a system (with hip joint) can be reduced in length by about 10% before a fracture occurs under static load conditions.


[Compressive loads on the human knee joint (author's transl)]. A total of five human knee joints fixed in formalin were available from the 1975/76 dissection course at the Anatomical Institute in Rostock. The different joints where loaded while bent at rightangles (Fig. 1). The maximum load varied between 280 and 400 kp. The length reductions at the compression fracture load were between 5.3 and 10.5 mm. The curves shown beyond the fracture region in Fig. 2 result from the reconsolidation of the fractured bone as an additional elastic region. Bone is generally regarded as a completely elastic material. The load range prior to fracture can probably be considered as elastic in the sense defined by Hooke's law; the curves are correspondingly approximately linear. This also applies to our knee joints, which require a system approach.


Gross, histomorphological and histochemical changes in thyroid gland of goat with age. II. Occurrence of ultimobranchial follicles. Occurrence and histomorphology of ultimobranchial follicles in the thyroid glands of 26 goats of six different age groups (ranging from 20 days to above five years) was studied. The occurrence of ultimobranchial follicles was 38.46%. In 15.38% of the cases, it was found with and in 23.08% without any association of the thymic tissue. Its association with parathyroid tissue has also been recorded in one of the goats aged 7 months 11 days. Their size and shape varied greatly and were narrow and wide tubular, epithelial pear like, long follicle with colloid, sheet of stratified squamous cells attached to follicle, bilobed, evaginated and a group of follicles. The latter three forms of follicles were due to the branching of main stem UB follicle, present at different levels. They were located in perivascular connective tissue in the deeper zone of the thyroid gland but their presence in periphery of thyroid gland within the capsule was not uncommon. The epithelial lining of these follicles was highly variable from simple squamous to columnar with or without cilia which may be stratified. Light cells were seen among epithelial lining. The lumen of the follicles was filled with nucleated, non-nucleated and colloid debris which was PAS-positive. In older animal colloid contained acid mucopolysaccharides.


Gross, histomorphological and histochemical changes in thyroid gland of goat with age. IV. Histomorphological study. Histomorphological changes on the thyroid gland of 26 goats of different ages ranging from 20 days to over 5 years and of both the sexes were studied. The main fibroarchitecture was of collagen and reticular fibres, the latter fibres being gradually replaced by former with advancing age. The presence of thyroid lobule was observed in all age groups. The interfollicular connective tissue was constantly found around the follicle and increase with age. The follicles became irregular in outline and their diameter increased in the older subjects. The follicular epithelium comprised of two types of cells--Follicular cell and light cell and had tendency to become squamous with ageing. The mitotic division was occasional in younger and rare in older age groups. The mode of secretion was of merocrine and apocrine type. The solid form of colloid was observed in oldest goat. Accessory thyroid tissue and isthmus had similar histomorphology, however, the glandular sthmus was replaced by fibrous tissue with ageing.


A comparative histologic study of thyroid follicular size and epithelium percentage in certain mammals. The size and epithelium percentage of mammalian thyroid follicles were studied by making camera lucida drawings of histologic sections on calibrated graph paper. The average horizontal dimension of 500 follicles per animal was calculated together with the percentage amount occupied by follicular epithelium. With a few exceptions, folicular size tends to increase with increasing body size, while epithelium percentage decreases.


On magnopyramidal temporal fields in the human brain - probable morphological counter parts of Wernicke's sensory speech region. Posterior parts of the human superior temporal gyrus have been examined by means of stereomicroscopical observations of pigment preparations up to 800 microgram thick. As a rule, the proximal half of the first transverse gyrus of Heschl is covered by an extremely lightly pigmented conicortex which is surrounded by belt areas, a proncoinocortex anteriorly and paraconiocortical fields posteriorly and laterally. The paraconiocortex is divisble into a primitively organized part lying just behind the conicortical core and a more advanced portion forming the temporal magnopyramidal region. This extended lateralmost part of the paraconicortex is more or less richly endowed with unusually large and pigment-rich IIIc-pyramids. Third layer pyramidal cells showing densley aggregated lipofuscin deposits are rarely encountered within the human isocortex. As regards the temporal lobe, pyramids of this type, in general, do not occur outside the magnopyramidal region. The magnopyramidal region covers only a part of the temporal plane but extends much more in the lateral direction spreading over distal portions of the first and the second transverse gyri, posterior parts of the exposed surface of the superior temporal gyrus and those of its lower wall. The extension of the magnopyramidal region varies considerably from one side of the brain to the other. It is also subject to a pronounced variation from one individual to another. On account of its localization and its uniqueness in cortical structure, the temporal magnopyramidal region is considered to represent the morphological counterpart of the sensory speech centre of Wernicke.


Cell death in the mosaic epididymis of sex reversed mice, heterozygous for testicular feminization. Sex reversed mice heterozygous for testicular feminization are genetic females which are converted to males by the autosomal Sxr ("sex reversed") mutation, thus imitating the Y-chromosome. They carry on one of their X-chromosomes the mutation for testicular feminization. Then, X-inactivation leads to the formation of a mosaic of androgen insensitive XTfm and androgen sensitive X+ cells. In the epididymis the Tfm cells are maintained into adulthood as undifferentiated flat cells. There are however, always less Tfm cells than expected from random X-inactivation. Therefore, in the present study the role of cell death in the modification of the original mosaic is investigated before and after castration. It is shown that survival or elimination of Tfm cells depends on the structure of the smooth muscle layers around the epididymal duct. In addition to elimination  of whole Tfm sections, a steady loss of single cells, not only in the Tfm but also in the wild-type fraction occurs. In the connective tissue distinct necrotic areas are present. After castration massive necroses appear in both cell types. In Tfm sections disintegration of the wall layers again leads to elimination of Tfm cells and to protrusion of epithelial cells in the interstitium which later on may be organized as abnormal sprouts and ducts. The observations indicate that the testosterone dependent trophic principle is based on short-range intercellular interactions and presumably arises in the connective tissue component of the epididymis.


A Golgi-study of oculomotor neuroblasts migrating across the midline in chick embryos. The Golgi-Stensaas impregnation technique was employed at appropriate stages of development to study the morphology of the oculomotor neuroblasts as these migrate across the midline. Data reported in previous publications were confirmed, such as the timing of the migration (occurring between the 4th and the 9th days of inoculation), the fact that the migrating cells carry their axons across the midline as trailing processes, and the absence of pre-existing fibrillar structures able to provide contact guidance for this migration. The most striking new fact discovered is that the leading processes of the oculomotor neuroblasts are often branched, and that all these branches are uniformly oriented towards the midline. This seems to indicate the existence of a non-random growth process. It is argued in the discussed that this can be explained through the presence of an orienting neurotropic influence. This one could have its source in certain non-oculomotor neuroblasts which were detected within the midline ventricular zone. On morphological grounds, this group of cells may be tentatively identified as the avian counterpart of the midventral mesencephalic proliferation described in several mammals. This proliferative zone is known to contain dopamine at early stages of development. A hypothetic casual mechanism of the oculomotor migration is therefore advanced, wherein dopamine, diffusing out of the non-oculomotor midline neuroblasts, induces at short range oriented outgrowth of oculomotor leading processes across the midline.


The ependyma on the pineal of the Guinea pig (Cavia cobaya). A scanning electron microscopic investigation. The proximal part of the epiphysis cerebri of the guinea pig is in close contact with the cerebrosopinal fluid of the third ventricle. A direct contact is not present as the pineal tissue is covered by a continuous ependymal layer. Two types of ependymal cells with different surface protrusions are discussed as being involved in possible interactions between the neuroendocrine tissue of the pineal organ and the cerebrospinal fluid. In addition, two different types of supraependymal structures are found on the ependymal surface of the habenulae and the wall of the third ventricle. Because of their morphological characteristics, these supraependymal structures are thought to be neural elements.


The ultrastructure of normal myogenesis in the limb of the mouse. The ultrastructure of myogenesis in the mouse hind limb has been studied from day 12 to birth. Mononucleated cells with myofilaments are small and infrequent during myogenesis and never line myotubes. Only mononucleated cells without myofilaments cover the myotubes are involved in mass fusion. These mononucleated cells are pleomorphic and undifferentiated during early myogenesis. They have a heterochromatic nucleus and many accumulate mitochondria and lengthen during days 16-18. After day 18 they are normally elongate with a heterochromatic nucleus and packed with free ribosomes. The multinucleated cell development may be divided into four stages. 1. Immature myotube (days 14-15). Their fibrils are small, out of register and some poorly defined. Many myofilaments are not in rigid hexagonal alignment. The sarcoplasmic reticulum is simple and randomly oriented and triads are absent. Large clumps of glycogen occur between euchromatic nuclei which are in chain formation. 2. Mature myotube (days 16-18). Small groups of fibrils show alignment. Glycogen granules and sarcoplasmic reticulum become numerous between fibrils. Triads are sparse and mitochondria cluster in subsarcolemmal regions and between nuclei. 3. Young myofibers are present by day 19. More fibrils are aligned and compact. The filaments are in a rigid hexagonal array, the glycogen is dispersed and nuclei are peripherally located and moderately heterochromatic. Triads are frequent but often obliquely oriented and mitochondria are elongate and numerous between fibrils. 4. Mature myofibers occur postnatally (2 weeks).


The structure of the epididymis, efferent ductules and ductus deferens of the guinea pig: a light microscope study. In the guinea pig, the narrow part of the epididymis that traverses the upper pole of the testis and passes downward over the entire length of the gonad is composed exclusively of efferent ductules and the initial segment (zone I) of the epididymal duct. At the beginning of zone II, the narrow contour of zone I expands into a large globular region which lies adjacent to the caudal pole of the testis. The globular region of the guinea pig epididymis is commonly referred to as the cauda epididymidis but in the present study, examination with the light microscope reveals that it is composed of five histologically distinct zones (zones III through VII). A detailed histological analysis of the characteristics of the epithelium in the seven zones of the guinea pig epididymis and in the efferent ductules and ductus deferens was udertaken to obtain a better understanding of structure-function relationships in the epididymis of the guinea pig. It was found that each of the zones could be readily distinguished on the basis of its histological features and primarily on the basis of the appearance of the principal cells.


Development of the fetal pituitary-testicular system based on the observation of Leydig cells in encephalectomized, hypophysectomized and control fetal rats. The time of onset of brain regulation of the pituitary-Leydig cell system in fetal rats was assessed by fetal encephalectomy, which allowed the pituitary to persist in situ. The effects of encephalectomy were compared with those of fetal hypophysectomy (surgical decapitation). The parameter for interpretation of these effects was the collective volume of Leydig cells, measured by the method of Chalkley ('43). The normal increase in the collective volume of Leydig cells in fetuses encephalectomized on day 17 of gestation and autopsied on day 18 was not retarded, whereas that in decapitated fetuses of the same age was retarded. In all other one-day experimental periods (day 18-19, 19-20, 20-21, and 21-22), the increase in volume was retarded to approximately the same extent in encephalectomized as in decapitated fetuses. The collective volume of Leydig cells continued to increase to some extent without the brain until day 20, after which it ceased to increase. The results suggest that in fetal rats, the brain control of the pituitary-Leydig cell system begins to operate from day 18 of gestation, when the day following overnight mating was designated as day 1 of gestation.


Rat adrenocortical carcinoma 494: an integrated structural, stereological, and biochemical analysis. Snell adrenocortical tumor 494 was implanted into male Sprague-Dawley rats and recovered 7, 14, 21, 28 or 35 days following initial detection by palpation (7-10 days following transplantation). Electron microscopic, stereological and biochemical analyses of the tumor were compared to adrenals of normal animals to serve as a baseline for further studies of the effects of chemotherapeutic agents on tumor cells. Tumor cells possessed oval or elongated mitochondrial profiles with tubular cristae, one or two very large (greater than 5 micrometer) lipid droplets, abundant ribosomes and coated vesicles, and sparse rough and smooth endoplasmic reticulum. Stereologic evaluation revealed that tumor lipid volume was 41% and mitochondrial volume 29% that of the normal adrenal controls. Tumor nuclei were 2.5 times larger than adrenocortical nuclei while cellular volumes were similar. On a net weight basis, tumor cholesterol was 55%, cholesterol ester 2.2%, and lipid phosphate 25% of respective mean values for normal adrenal glands. The tumor cholesterol: cholesterol ester ratio progressively decreased with time but remained 18-fold greater than the normal adrenal. Plasma corticosterone levels in tumor-bearing rats were elevated 3-fold by 14 days and initial detection. The adrenals of the tumor-bearing host exhibited marked involution, the extent of which was directly related to tumor size.


Ultrastructure of the harderian gland in male albino rats. Harderian glands of adult male albino rats were examined by light and transmission electron microscopy. The animals were divided into the following experimental groups: (1) castrated only, (2) castrated with testosterone replacement and (3) sham operated controls. Two types of secretory cells, designated as A and B, comprise the glandular epithelium and are distinguished on the basis of morphologic differences in the following cellular components: cytoplasmic secretory vacuoles, mitochondria and smooth endoplasmic reticulum (SER). Cell type A is more numerous and contains larger secretory vacuoles than cell type B which is characterized by the presence of large numbers of mitochondria and packet-like arrangement of SER profiles. The glandular secretion appears to be elaborated via merocrine mechanisms and consists primarily of lipids and a fibrogranular substance. The latter component may consist of porph,yrin compounds. Nerve endings are found in the connective tissue interstices of the gland. Direct synapses were not observed in association with either gland cells or myoepithelial cells. Castration did not produce significant alterations in the morphology of the glandular epithelium. Results of the investigation suggest that the rat Harderian gland may serve as a useful model for the study of cellular mechanisms involved in the production of human porphyrias.


Gross and histological variations along the length of the rat vas deferens. The gross morphology of the vas deferens of the rat and the changes that occur along its length are reported. It is shown that the organ can be divided into proximal, distal and terminal portions. Each portion is histologically unique and is situated in a different part of the body. The differences are discussed in relation to the function of the organ and their possible role in the consequences of vasectomy.


Ultrastructural identification of collagen and glycosaminoglycans in notochordal extracellular matrix in vivo and in vitro. Notochordal extracellular matrix consists of a continuous basal lamina, amorphous materials and microfibrils embedded in the ground substance of low electron density. Together they comprise the notochord  sheath and are of considerable interest because of their suspected role in early embryonic tissue interactions. The notochord is particularly well-suited to morphological investigation of extracellular matrix because it is one of the few embryonic epithelia which produces ultrastructurally recognizable stroma in vitro without the advantage of a collagenous substratum. Furthermore, these matrix components produced in vitro are morphologically identical to those observed in vivo. The present study used ruthenium red staining to demonstrate that notochordal microfibrils exhibit collagen-like cross-banding patterns both in vivo and in vitro. Collagenase and testicular hyaluronidase digestion studies designed to localize collagen and glycosaminoglycans show a reduction of microfibrillar diameters by 30-35%. Furthermore, these enzyme treatments frequently result in enhanced striations of microfibrils. When cis-hydroxyproline (a proline analog) or beta-aminoproprionitrile (BAPN, a lathyrogenic compound) is added to the culture medium, a similar reduction in microfibrillar diameters is seen. Moreover, increased ruthenium red-positive surface coats and large collagen fibrils are frequently present in BAPN-treated cultures, implying a stimulatory metabolic effect. We conclude that most, if not all, notochordal extracellular matrix components are composed of both collagen and glycosaminoglycans and suggest that the entire extracellular matrix should be considered a macromolecular composite which acts in concert to induce or stabilize developmental interactions.


Fenestrations in endothelium of rat liver sinusoids revisited by freeze-fracture. The freeze-fracture appearance of fenestrations of sinusoidal endothelial cells has been reassessed in perfusion-fixed rat liver. Fenestrations, limited to the attenuated portions of the endothelial cell cytoplasm are usually round or oval in shape, with diameters ranging from 40-600 nm. Within a given fenestrated region, they are disposed in clusters forming sieve plates. In addition, the presence of wide, irregularly shape openings suggest that adjacent fenestrations may coalesce and result in the larger openings. Our data thus confirm the existence of both small and large fenestrae in the endothelial wall, in contradistinction to previous studies showing only regular, medium sized (100 nm) openings.


Cilia of neonatal articular chondrocytes: incidence and morphology. Cilia in neonatal canine articular chondrocytes were studied using morphometric techniques and transmission electron microscopy. The cilia in chondrocytes were morphologically similar to cilia in a variety of other cell types. A chondrocytic cilium consisted of a basal body and a ciliary shaft. The cylindrical basal body was 0.21 micron (S.D. = 0.01 micron) in diameter, 0.50 micron (S.D. = 0.03 micron) in length and contained nine microtubular triplets. The ciliary shaft was 0.196 micron (S.D. = 0.02 micron) in diameter and 1.76 micron (S.D. = 0.80 micron) in length. The number of microbtubular doublets in the ciliary shaft varied depending on where along the length of the shaft the section was taken. This study demonstrates that on the average the frequency of cilia in neonatal articular chondrocytes, as estimated sterologically, was about one cilium per cell.


Perisynaptic satellite cells in the developing and mature rat soleus muscle. In mature rat soleus muscle it is shown that satellite cells are not evenly distributed over the surface of myofibers but are more numerous in the vicinity of the motor endplate. In this location they commonly lie close to the post synaptic membrane where they are termed perisynaptic satellite cells. In developing muscle several satellite cells may be seen close to the endplate and give the impression of limiting the spread of the axon over the myofiber. In addition these satellite cells make close plasmalemmal contact with Schwann cells and appear as a continuation of the Schwann sheath onto the surface of the myofiber.


The morphology and kinetics of spermatogonial degeneration in normal adult rats: an analysis using a simplified classification of the germinal epithelium. The phenomena of spermatogonial degeneration have been studied in normal adult rat testes using a simplified classification of the germinal epthelium based upon the six types of differentiating spermatogonia. The following features distinguished this from schemes based on acrosome development. Rather than 14 states of unequal duration, there are only six stages, five of which are the same length. The classification starts at the beginning of spermatogenesis with A1 spermatogonia rather than at the onset of spermiogenesis. The classification is derived from acutal biological events in spermatogenesis, namely generation times of spermatogonia, rather than upon arbitrary events in acrosome development. Most importantly, this new classification can be used with most types of preparations and in most experimental conditions. Examination of tubular whole mounts reveals that degeneration preferentially occurs in types A2 and A3 and to a lesser extent A4 spermatogonia, and is rarely seen in generations of A1, In or B cells. Deterioration is first manifested in clusters of cells joined by the intercellular bridges as they complete DNA synthesis and enter the 2 phase of cell cycle. It is characterized by a denser staining of the nuclear membrane, coalescence of chromatin into several pyknotic bodies, and eventual extrusion of the nuclear mass, leaving a cytoplasmic ghost. The sequential steps in degeneration may often be traced from one end of a synctial chain to the other, suggesting that the process may start with just one cell and then spread via intercellular bridges to involve all spermatogonia within the clone. Quanitatively, degeneration is a relatively constant feature of spermatogonial development. Only 25% of the theoretically possible number of pre-leptotene spermatocytes are produced from th original population of A1 spermatogonia; most of this loss is incurred during the maturation of A2 and A3 generations. While the reason for spermatogonial degeneration in the normal generminal epithelium remain obscure, it is proposed that the numerical ratio of A spermatogonia to Sertoli cells may be a significant limiting factor.


Responses to fasting and lipid infusion of epinephrine-induced arrhythmias during halothane anesthesia. Sensitivities to epinephrine in fasted and non-fasted rats anesthetized with halothane or pentobarbital were determined. The arrhythmic threshold for epinephrine, i.e., the dose which upon injection produced four or more premature ventricular contractions, was significantly lower for 12-hour (5.5 +/- 3.2 microgram/kg), 24-hour (2.2 +/- 1.3 microgram/kg) and 48-hour (2.25 +/- 0.6 microgram/kg) fasted rats than for non-fasted rats (10.9 +/- 3.4 microgram/kg) at the same dose of halothane (2.0 per cent). Fasting had no effect on the arrhythmic threshold for epinephrine in rats anesthetized with pentobarbital (35 mg/kg). Infusion of a 10 per cent fatty acid emulsion caused a significant lowering of the arrhythmic threshold for epinephrine of fed rats, while infusion of acetoacetic acid had no effect on the arrhythmic threshold. It is concluded that the combination of fasting and halothane anesthesia renders the heart more sensitive to epinephrine than halothane anesthesia alone.


A new concept in controlled ventilation of children with the Bain anesthetic circuit. The Bain anesthesia circuit was studied as a semi-open or partial rebreathing system during controlled ventilation in 16 children weighing from 7.5 to 48 kg. During anesthesia the lungs were ventilated with a volume ventilator set at three times the calculated alveolar ventilation to provide optimum mixing in the exhalation tube of the Bain circuit. Fresh gas inflow rates initially were set equal to the calculated alveolar ventilation, and after 30 to 45 min, PCO2, PO2 and pH values were measured. At the same time, the fractional concentration of mixed expired carbon dioxide (FECO2) was recorded from a capnograph inserted between the ventilator and the Bain circuit. After initial readings, the fresh gas inflow was varied over a range of 1,400-3,000 ml/m2/min at 20-min intervals, with the arterial blood-gas values and FECO2 recorded at each setting. The results indicate that a lower fresh gas inflow than previously recommended can be used safely in children. When the minute ventilation is three times the fresh gas inflow, values for FECO2 correlate closely with PaCO2 values; with a fresh gas inflow of 2,500 ml/m2/min,PaCO2 values can be maintained near 40 torr.


Metabolism of sodium nitroprusside in dogs awake and anesthetized with halothane. Sodium nitroprusside (SNP) is rapidly metabolized to cyanide (CN) and thiocyanate (SCN). The authors determined the rates of CN and SCN production during SNP infusion sufficient to maintain blood pressure at 80 per cent of baseline in the dog awake and during halothane anesthesia. Each dog served as its own control. The endogenous whole-blood CN concentration was significantly lower in anesthetized dogs (0.6 nmol/ml) than awake dogs (1.8 nmol/ml). CN concentration increased similarly during SNP infusion in awake (4.5 nmol/ml) and anesthetized dogs (2.3 nmol/ml). In another group of dogs, whole-blood CN concentration decreased significantly due to halothane anesthesia. The regression coefficient was -0.21 nmol CN/ml/hr. There was no significant difference in plasma SCN concentration following infusion of SNP in both awake (33 nmol/ml) and anesthetized dogs (26 nmol/ml). The cause of this decreased blood CN concentration with or without SNP infusion during halothane anesthesia is not known.


Neural pharmacokinetics of epinephrine.

Neural pharmacokinetics of epinephrine. The effects of 3H-epinephrine on the duration of block and on the time course of uptake and efflux of local anesthetic (14C-lidocaine hydrochloride) were determined in the infraorbital nerve of the pentobarbital-obtunded rat. Epinephrine, 1:50,000, doubled the duration of behavioral block produced by 37 mM (1 per cent) lidocaine; 1:100,000, 1:200,000 and 1:400,000 prolonged the block correspondingly less, the relation being inversely proportional to the log of the epinephrine concentration. The nerural level of 3H-epinephrine reached a peak within 10 minutes and then declined linearly with time, as did the associated neural level of 14C-lidocaine. Linearity apparently results from the summation of the time-linked decreasing diffusion gradient of drug and the consequently increasing rate of perfusion with blood. Phentolamine antagonizes the epinephrine-caused prolongation of behavioral block. The results suggest that in spinal anesthesia the extent of dilution of an epinephrine additive by cerebrospinal fluid will significantly affect the duration of the block.


Significant effects on the blood pressure of an apparently trivial atrial dysrhythmia. Continuous automatic monitoring and recording, at slow paper speed, of the intra-arterial blood pressure revealed serious disturbances in blood pressure in a small number of patients undergoing general anesthesia. In all instances, the underlying mechanism was found to be a rhythm disturbance so trivial as to have escaped earlier detection by means of conventional audio-visual monitoring. The practice of routine monitoring and recording of the intra-arterial blood pressure would appear to receive support from these findings.


Simultaneous colour discrimination in chicks is improved by brief exposure to light. Dark-reared chicks were exposed to white light for 1 h at age 24 h. At 48 h these chicks, and others kept in the dark throughout, were given the opportunity to obtain a heat reward by choosing the correct arm in a Y maze. The discriminanda were red and blue illuminated circles, each being the positive stimulus for half the chicks. Light-exposure resulted in faster learning, especially when the positive stimulus was blue. This is taken as further support for the view that brief exposure to light activates the visual system non-specifically, affecting many kinds of visually guided behavior.


Models of parent-offspring conflict. II. Promiscuity. The population genetics of Trivers (1974) concept of parent-offspring is examined for species in which the effects of the conflict are felt by future half-sibs, as in promiscuous mating systems in which the male shows no parental care. Whether or not a rare conflictor gene will spread in a non-conflictor population depends on f(m) greater than (m + 1)/(0.5m + 1.5) for a dominant gene, and on f(m) greater than 1/4(7 + 3) for a recessive gene; f(m) is the fitness gained by a conflictor relative to a non-conflictor offspring [f(m) greater than 1], and m is the amount of parental investment taken by a conflictor relative to m = 1 for a non-conflictor. The ESS value for conflict (mo) in promiscuous species with zero male parental care has mo = f(mo)/4[df(mo)/dmo]. However, where the male maintains the same harem for several breeding seasons, or where there is promiscuity but both sexes contribute equally to parental care, conditions for conflict are equivalent to monogamy.


Orienting behaviour during aerial and underwater visual discrimination by the mink (Mustela vison schreber). Orienting responses by mink during aerial and underwater visual discrimination tests were most frequent when the grating lines subtended angles at the eye near the visual threshold angle. Factorial analysis showed that in air and in water at ranges from 10 to 90 cm most responses occurred at 30 cm discrimination distance and more occurred to marginally supra-threshold than to marginally sub-threshold stimuli. Between media, more responses occurred in air than in water. At longer ranges the mink oriented less readily than at 30 cm but if orienting occurred better discrimination followed than if the mink did not orient.


Phototactic responses of anuran amphibians to monochromatic stimuli of equal quantum intensity. The phototactic responses of anuran amphibians to narrow-band monochromatic stimuli of equal quantum intensity were measured for the first time in eight new experiments. The unimodal spectral response, obtained from dark-adapted American toads (Bufo americanus), peaks near 626 THz of frequency (480 nm wavelength). The bimodal, U-shaped spectral response, obtained from dark-adapted tailed frogs (Ascaphus truei), has the anti-mode at about 589 THz (510 nm) and is not merely the spectral mirror-image of the unimodal response. Absolute level of the spectral stimuli of equal quantum intensity did not affect the spectral response of dark-adapted toads, but light-adaptation enhanced a component that has the same spectral peak as the visual pigment absorption spectrum of principal and single cones of the frog's retina.


Comparative aerial and underwater visual acuity of the mink, Mustela vison schreber, as a function of discrimination distance and stimulus luminance. The aerial threshold visual angle of mink rose from 15.4 min at 10 cm stimulus distance to 19.1 min at 90 cm and the underwater angle varied from 32.7 min at 10 cm to 46.6 min at 90 cm, all at 34 mL luminance. At constant 30 cm stimulus distance, the aerial angle rose from 15 min at 34 mL to 51.7 min at 0.012 mL, the underwater angle from 31.4 min at 34 mL to 95 min at 0.012 mL, the aerial and underwater data forming similar curves. If mink hunt in water at somewhat higher light levels than in air they can obtain equal acuities in the two media.


Models of parent-offspring conflict. I. Monogamy. Theoretical models for Trivers (1974) concept of parent-offspring conflict are examined for species in which the effects of the conflict are felt by full sibs. A rare conflictor gene will spread if (f(m) greater than 1/2(m + 1), where f(m) is the fitness gained by a conflictor relative to a non-conflictor offspring (f(m) greater than 1), and m is the amount of parental investment taken by a conflictor relative to m = 1 for a non-conflictor. The range of m alleles which can spread against the parent optimum decreases as the cost to the parent increases until a point is reached where there is no conflict of evolutionary interests. There would be no polymorphism for conflictor: non-conflictor alleles unless special conditions prevail. The conflictor allele which spreads most rapidly as a rare mutant against the parental optimum is not an evolutionarily stable strategy (ESS). The ESS for parent-offspring conflict in monogamous species has mo = f(mo)/2[df(mo)/dmo]. The analytical solutions are confirmed throughout by simulations.


Allergens in hymenoptera venom. V. Identification of some of the enzymes and demonstration of multiple allergens in yellow jacket venom. Yellow jacket venom (YJV) contains acid phosphatase, hyaluronidase and phospholipase but neither allergen C nor melittin as bee venom (BV). YJV enzymes did not cross react with antisera to BV enzymes. YJV was separated into seven fractions, all of which had some activity in RAST. Sera were found specific for the fractions containing phospholipase and acid phosphatase. The other three protein fractions also exhibited substantial RAST activity, suggesting there are at least five allergens in YJV.


Tympanometry in children with allergic respiratory disease. The results of pneumatic otoscopy and tympanometry were compared in 102 children who were being followed in allergy clinic for allergic rhinitis or asthma. Forty-five abnormal tympanograms were found in 30 children, including six type B tympanograms, 20 type C and 19 with reduced compliance. Acoustic reflexes were absent or elicited only at thresholds greater than or equal to 100 DbHL in 45 ears of 34 children. Agreement between two examiners and tympanometry improved significantly during the study from 62% to 75% and from 62% to 79%, respectively. Tympanometry is an important adjunct to the evaluation of allergic children and supplies objective information useful in teaching proper evaluation of signs of middle ear disease.


Treatment of severe attacks of asthma in children with nebulized B2 adrenergic agents. Selective B2 adrenergic agents given by nebulizer is described as a hospital or office treatment for severe attacks of asthma. Salbutamol and Bronkosol are shown to be effective and safe drugs. The method is a simple alternative to IPPB and is easier to use in small children. The use of long-acting, selective B2 adrenergic drugs by nebulizer is recommended in preference to non-selective and short-acting adrenergic agents like epinephrine and isoproterenol.


Possible immediate hypersensitivity reaction of the nasal mucosa to oral contraceptives. Nasal provocation tests with suspension of oral contraceptive drugs (OCD) as well as of their components (Estrogen, Progestin, Non-hormonal components) were performed in two groups of women, mostly suffering from perennial rhinitis or pollinosis, and all taking oral contraceptive drugs. Thirteen of the 15 patients from the first experimental group, in whom the increase of the nasal complaints was anamnestically related to the oral contraception, and three of the 34 patients from the second experimental group (without anamnestical relation to the oral contraception) demonstrated a positive nasal mucosa response after topical challenge with OCD. All OCD positively reacting patients showed also a positive nasal mucosa response after challenge with the Estrogen and one patient also after Progestin challenge. Non-hormonal components did not cause any reaction. This nasal mucosa response was interpreted as a possible allergic reaction. Type I (immedicate hypersensitivity of the nasal mucosa due to Estrogen in blood contraceptives. This response begins within 10 minutes, reaches its maximum within 30 minutes, and does not disappear completely within 60 minutes in most patients. None of the patients from control groups (atopy--without OCD; OCD takers--without atopy; male volunteers without atopy) demonstrated any positive nasal mucosa response to OCD or their components.


Primary lung cancer and asthma.

Primary lung cancer and asthma. 6,021 40-year-old and older chronic asthma suffers, seen during the past 20 years, were analyzed with regard to the development of primary lung cancer and their smoking habits. Over this period only two developed lung cancer, 0.032% as compared with 0.314% in the general population. Only 16.9% of chronic asthmatics had smoked over any significant period during the five years prior to assessment as compared with approximately 40% of the general population. Of those who did smoke, the tendency was to a lesser extent. This survey adds further evidence that cancer develops less frequently in patients suffering from an allergic disease such as asthma, perhaps because of (1) some enhanced immunological activity preventing the advent of new growth or (2) reduced smoking habits of chronic asthmatics.


Effect of gold salts on the IgE immune response in mice. In vivo effect of gold salts on the IgE immune response was investigated in mice and rats. It was demonstrated that gold salts did not suppress but rather enhanced the antigen-specific IgE immune response in mice. Moreover, gold salt had on mast cell degranulation in vivo in rats.


A laboratory system for production of flexion rates and forces in the forelimb of the horse. The distal portion of the forelimb of the horse is provided with a stay apparatus composed of tendons, ligaments, and fascia. This stay apparatus provides the major resistance to joint flexion during the support phase of the stride. The laboratory test system described was shown to be able to reproduce in vitro limb motions and hoof forces measured with a running horse. These results indicated the stay apparatus operates in a largely passive mode, active muscle contraction apparently serving to provide rigidity only early in the support phase of the stride. The testing system described was designed to take advantage of the passive nature of the stay apparatus in order to study in vitro the forces, accelerations, and deformations encountered by the limb of the galloping horse in vivo.


Study of homologous and heterologous antibody response in California horses vaccinated with attenuated Venezuelan equine encephalomyelitis vaccine (strain TC-83). Of 359 horses vaccinated with attenuated Venezuelan equine encephalomyelitis (VEE) vaccine (strain TC-83), 87% developed hemagglutination-inhibition (HI) antibodies to VEE virus within 1 month. Blood from a subsample of 101 of the 359 horses was obtained over a 1-year period. Within 1 month after vaccination, 84% of the 101 horses had developed VEE HI antibodies, 87% had developed VEE-neutralizing (Nt) antibodies, and 78% had developed VEE complement-fixing (CF) antibodies. One year after vaccination, 58% of the horses had VEE HI antibodies and 73% had VEE Nt antibodies. The percentage of horses with VEE CF antibody titers dropped to a low level (46%) within 6 months after vaccination, and most horses were seronegative for VEE CF antibodies 1 year after vaccination. The presence of antibodies to heterologous (western equine or eastern equine encephalomyelitis, or both) alphaviruses suppressed VEE antibody formation in horses vaccinated with TC-83 vaccine. However, the proportion of horses that developed VEE antibodies exceeded levels that generally were believed adequate to suppress a VEE epizootic in a population. There was an 88% correlation between the HI and Nt tests for VEE antibodies.


Surgical implications of extensibility of the skin of the equine carpus. To determine the lines of maximum extensibility of the skin over the equine carpus, round puncture wounds were made 2.0 cm apart over the carpal area of 5 horses (7 carpi). The direction of elongation of the round puncture wound was observed and photographed. Lines of maximum extensibility that occurred over the surfaces of the equine carpus were determined to be proximal to distal, except in a small area over the accessory carpal bone where a state of anisotropism existed. In an immobilized carpus, direction of a surgical incision was not as important as it was in a mobile carpus, in which the incision should parallel the lines of maximum extensibility. This was especially true on the dorsal, lateral, and medial surfaces of the carpus. Curved or straight surgical incisions could be made on the palmar side of the carpus, but straight incisions parallel to these lines should be made on the dorsal, lateral, and medial surfaces of the carpus.


Phagocytosis of serum-resistant and serum-sensitive coliform bacteria (Klebsiella) by bovine neutrophils from blood and mastitic milk. Phagocytic activity of neutrophil leukocytes from bovine blood and mastitic milk was determined for 2 strains of Klebsiella, 1 resistant and the other sensitive to serum bactericidal activity. Both strains were easily phagocytized in the presence of an opsonic agent, but milk neutrophils seemed to be less efficient than blood neutrophils in this respect. Phagocytosis was maximal after incubation for 60 minutes at 37 C and decreased markedly with reduction in incubation temperature. The opsonic activity of mastitic milk was considerably higher than that of normal milk and approached that of fresh bovine serum. Precolostral calf serum was deficient in opsonic activity and anti-bovine leukocyte serum was antiphagocytic.


Toxicologic evaluation of a microencapsulated formulation of methyl parathion applied dermally to cattle. Acute toxicity studies in newborn calves and 2- to 3-year-old cattle were conducted with methyl parathion (O,O-dimethyl O-(p-nitrophenyl) phosphorothioate) in the form of a 22% microencapsulated slurry used in a manually operated sprayer. Twelve calves and 9 cattle were tested. The minimal toxic dosages were 4 L of a 0.5% concentration for calves and 10 L of a 0.25% concentration for mature cattle. At all toxic dosages, cholinesterase activities were decreased--that of the calves to 0 and that of the cattle to 50% of base line or less. Weight losses 2 weeks after single exposures to the treated cattle ranged from 6.5% to 11.5% of total body weight. Absorption of the formulation in its entirety or its metabolic products resulted in a possible interference with feed utilization.


Effects of aflatoxin on the development of acquired immunity to swine erysipelas. The effect of aflatoxin consumption on the development of acquired immunity to swine erysipelas was studied. Twenty-four pigs were divided into 4 groups (6 pigs/group). Two groups were fed a normal diet and 2 groups were fed the same diet but containing aflatoxin. One group from each diet treatment was given a single injection of an erysipelas bacterin, and 21 days later all pigs were given a challenge inoculum of virulent Erysipelothrix rhusiopathiae organisms. On the basis of the response to the challenge inoculation, pigs were classified as immune, partially immune (PI), or susceptible. Three of the vaccinated pigs fed the normal diet were immune, 2 were PI, and 1 was susceptible, whereas none of the vaccinated pigs given the aflatoxin diet were immune, only 1 was PI, and the remainder were susceptible. Two of the nonvaccinated pigs fed the normal diet were PI and 4 were susceptible; all of the nonvaccinated pigs fed the aflatoxin diet were susceptible. It was concluded that aflatoxin consumption interfered with the development of acquired immunity and apparently increased the severity of the E rhusiopathiae infection in unvaccinated pigs.


Disposition of sulfonamides in food-producing animals: pharmacokinetics of sulfathiazole in swine. Disposition of sulfathiazole in plasma and urine of swine was determined following single intravenous and oral doses. Pharmacokinetics of the drug were described by a 1-compartment open model. The drug was rapidly eliminated, mainly by renal excretion of unchanged sulfathiazole and metabolism to acetylsulfathiazole, with a biological half-life of 1.4 hours. Sulfathiazole (in solution) was absorbed rapidly (half-life 0.8 hour) and relatively completely (73%) following oral administration.


Echinococcus granulosus in dogs and sheep in central Utah, 1971-1976. During 1971 to 1976, a survey was conducted to determine the prevalence of Echinococcus granulosus infection among dogs and sheep in central Utah. For each year, the number of dogs positive for adult tapeworms of the total number examined and the percentage infected were: in 1971, 14 of 51 infected (27.4%); in 1972, 13 of 46 infected (28.3%); in 1973, 7 of 36 infected (19.4%); in 1974, 34 of 244 infected (13.9%); in 1975, 13 of 267 infected (4.9%); and in 1976, 14 of 195 infected (7.2%), or a 6-year total of 95 of 839 infected (av = 11.3%). For each year, the number of sheep positive with hydatid cysts of the total number examined and the percentage infected were: in 1971, 103 of 1,007 infected (10.2%); in 1972, 235 of 1,808 infected (13.0%); in 1973, 242 of 2,003 infected (12.1%); in 1974, 105 of 1,406 infected (7.5%); in 1975, 96 of 1,599 infected (6.0%); and in 1976, 96 of 1,171 infected (8.2%), or a 6-year total of 877 of 8,994 infected (av = 9.8%). These results represent a definite decline in numbers of infected animals and suggest that preventive and control measures advocated in central Utah are being implemented.


Cestocidal activity of albendazole in calves. Sixty commercial-grade calves naturally infected with tapeworms (Moniezia benedeni and M expansa) were used in a controlled experiment to evaluate the anthelmintic efficacy of 4 dose levels of albendazole. Calves were randomly divided into 5 groups of 12 each. One group served as non-medicated controls. Other groups were drenched with albendazole (methyl [5-(propyltion)-1H-benzimidazol-2-yl] carbamate) at dose rates of 20, 10, 5 and 2.5 mg/kg of body weight. Calves were necropsied 14 days after treatment. Doses of 20 and 10 mg/kg were 100% efficacious in reducing the number of tapeworm scolices, and doses of 5 and 2.5 mg/kg were 97.8%. Medicated cattle did not show signs of intoxication.


Experimental infection of calves with Leptospira interrogans serotype szwajizak. This is a report on the experimental infection of cattle with Leptospira interrogans serotype szwajizak. The principal clinical features in three 4-week-old Holstein-Friesian heifers intravenously inoculated were fever, listlessness, anorexia, weakness, and diarrhea. Szwajizak was isolated from the blood for the first 5 to 8 days after inoculation. Leptospires were recovered from kidneys, but not from liver, spleen, brain, or urine. Two of the 3 calves produced homologous agglutinins, with maximum serum titers of 1:80 and 1:160. The sera of the 2 calves that developed szwajizak agglutinins showed cross reactivity with wolffi and hardjo antigens. There were not significant differences of plasma and urine constituents between the inoculated calves and the control calf. Endocardial hemorrhages and large soft black-red spleen were present in the 2 calves given the greatest numbers of leptospires. Histopathologically, kidney of all infected calves had multiple small foci of lymphoid cells, chiefly pasmacytes, which were present in periglomerular and interstitial areas.


Activation of latent Salmonella and Arizona organisms by dehydration of red-eared turtles, Pseudemys scripta-elegans. Salmonella and Arizona organisms could not be isolated from water samples, feces, and tissues of turtles prior to the experiment. After stressing, Salmonella organisms were isolated from tissues of 7 of 27 stressed turtles and from only 1 of 12 unstressed turtles. Arizona organisms were isolated from 9 of 36 stressed turtles whereas results for all 12 unstressed turtles were negative.


Enhanced clearance of secretions from the human lung after the administration of hypertonic saline aerosol. The radioaerosol method was used to measure the effect of saline aerosol on the rate of clearance of secretions from the lung. Two trial runs were done in each of 7 patients with chronic obstructive lung disease (mean +/- SD ratio of 1-sec forced expiratory volume for forced vital capacity, 50 +/- 15 per cent), a control run and a saline run. In both runs, 5.0 +/- 0.7-micron polystyrene particles tagged with 99mTc were inhaled under controlled conditions by the patients, and their subsequent clearance was monitored for 6 hours by whole lung counters. Scanning was also done with a gamma rectilinear scanner. The saline run was identical to the control run except that 30 min after inhaling the radioaerosol the patient inhaled an aerosol of hypertonic (1.21 M) saline for 11 min from an ultrasonic nebulizer. Although the initial distribution of the radioaerosol along the airways was the same in both runs, whole lung clearance during the first 50 min was twice as fast after the inhalation oft he hypertonic saline aerosol as in the control (P less than 0.01). The mean weight of sputum produced was higher (P less than 0.05) in the saline run. The number of coughs in the 2 runs was the same.


Prevalence of respiratory abnormalities in a rural and an urban community. Population samples stratified on sex, age and smoking habits were studied in a rural and an urban community with a low level of air pollution to establish "normal" values of parameters derived from the single-breath N2 curve, the effect of smoking on these parameters, and any differences related to an urban or rural environment. Respiratory symptoms and past illnesses, smoking habits, and residential as well as occupational history were obtained by a respiratory questionnair. Pulmonary function was assessed by the single-breath N2 test and the forced vital capacity maneuver. In "healthy" nonsmokers, residual volume/total lung capacity, closing volume/vital capacity on expiration, and closing capacity/total lung capacity were significantly related to age. The slope of phase III was related to neither height nor age. There was no significant difference in prediction equations between the 2 communities for any of these parameters. Multiple regression analysis indicated that smoking had an effect on residual volume/total lung capacity, closing volume/vital capacity on expiration, closing capacity/total lung capacity, and the slope of phase III in both sexes. Abnormal values were more prevalent among male than female smokers in both communities, the highest prevalence being found in the slope of phase III in both sexes (35 to 40 per cent). The slope of phase III and closing capacity/total lung capacity were consistently related to the current number of cigarettes smoked per day.


The refractory period after exercise-induced asthma: its duration and relation to the severity of exercise. A study was carried out to determine whether an episode of exercise-induced asthma (EIA) is followed by a refractory period and to assess the factors that affect it. Nine children, 9 to 14 years of age, were studied during repeated, paired exercise tests on a treadmill. Respiratory function was assessed by measuring peak expiratory flow rate before and after exercise. Changes were related to measured uptake of O2 during exercise. When paired tests were at a constant metabolic load, the severity of EIA was relatively constant in the first test of each pair, but it diminished in the second tests as the interval between tests decreased. The ability to bronchoconstrict fully was recovered within 4 hours after a test. When tests at varying metabolic loads were followed after 30 min by tests at a constant load, the severity of EIA increased in proportion to the load in the first test of each pair. In the second tests it was inversely related to that which occurred in the first tests. These results were compatible with the suggestion that the development of EIA requires the release of a stored mediator or enzyme precursor.


Improvement of platelet survival time with oxygen in patients with chronic obstructive airway disease. Platelet survival time has been found to be shortened in hypoxemic patients, and these patients may have an increased risk of thromboembolism. Supplemental O2 was administered to 10 men with sever chronic obstructive airway disease and hypoxemia. Oxygen increased platelet survival time from a mean +/- SE of 1.9 +/- 0.16 to 2.5 +/- 0.21 days (P less than 0.005; normal half-time, 3.7 +/- 0.03 days); the survival half-time was increased by 0.03 days or more in 9 of these 10 men. Arterial Po2 was increased (46.0 +/- 1.1 to 60.0 +/- 1.5 mm Hg; P less than 0.001) in all men. Results suggest that hypoxemia is associated with shortened platelet survival time and that an increase in arterial Po2 is associated with an increase in platelet survival time. Although not established by this study, the increase in platelet survival time associated with supplemental O2 may decrease the risk of thromboembolism.


Influence of the panting technique on the plethysmographic measurement of thoracic gas volume. In 7 normal subjects we studied the effect of different panting techniques on the measurement of thoracic gas volume (VTG). When inspiratory efforts against the occluded airway were performed primarily with intercostal and accessory muscles, the value of VTG was significantly larger than during efforts performed primarily with the diaphragm. The difference could be as large as 900 ml during the same occlusion and was due to compression and decompression of abdominal gas. The divergence of the measured VTG from the true VTG depended on the volume of abdominal gas (Vab) and the ratio of gastrict to mouth pressure changes (deltaPg/deltaPm). In our normal subjects, Vab was 358 +/- 65 ml (mean +/- SE) and deltaPg/deltaPm ranged from 0.7 to -2.5. In 10 randomly selected patients with a variety of pulmonary disorders, the mean value of deltaPg/deltaPm was 0.32. In one subject with asthma who increased his total lung capacity by one liter after exercising, deltaPg/deltaPm did not change significantly from the control value. Our results indicated that the pattern of panting is an important determinant of the accuracy of plethysmographic measurement of VTG. However, preliminary results from studies of patients suggest that the error is small and does not account for the large changes in lung volume measured in patients with acute asthma.


The fate of newly synthesized lung collagen after endotracheal administration of C-proline to hamsters. The endotracheal administration of 14C-proline to young adult golden hamsters was effective in radiolabeling collagen and resulted in a greater specific activity for hydroxyproline than did intraperitoneal administration of the amino acid. The isolation of purified isoluble collagen was accomplished with the aid of pancreatic elastase. Enzyme treatment of lung homogenates resulted in the solubilization of 35 per cent of total lung collagen. The residue obtained after elastase treatment was pure collagen. A significant portion of the radiolabeled collagen was solubilized by the elastase treatment, which suggests that elastase may be helpful in distinguishing between newly synthesized and total lung collagen. Studies performed at various times after administration of 14C-proline indicate that a greater portion of the collagen radioactivity is solubilized during the early days after treatment with the amino acid. The methodology and procedures outlined in this communication allow for additional insights into the metabolism of connective tissue, specifically collagen, in normal and diseased lungs.


Possible mechanisms of emphysema in cigarette smokers. Release of elastase from human polymorphonuclear leukocytes by cigarette smoke condensate in vitro. Human polymorphonuclear leukocytes, when incubated in vitro with cigarette smoke condensate, release beta-glucuronidase, acid phosphatase, and elastase and fail to exclude trypan blue. The released elastase is active on an elastin substrate even in the continuing presence of cigarette smoke condensate. When mixtures of human polymorphonuclear leukocytes and cigarette smoke condensate are instilled into rat lungs in vivo, the elastase is also released and can be traced to conneective tissue targets by immunohistochemical and enzyme-histochemical techniques.


Ultrastructure of the mucociliary interface in the nasal mucosa of the chicken. The ultrastructure of the extracellular mucous blanket at the nasal cavities of the chicken was preserved by a method that stabilizes primarily carbohydrate moieties. The cilia were apparently fixed as if "frozen" in the act of beating. The blanket was markedly heterogeneous, with a basic fibrous structure, and it contained membrane remnants. The lumenal surface of the blanket was smooth, but the surface in contact with the cilia penetrated to varying depths between the ciliary shafts. The findings are discussed in terms of the assumptions made by others on the basis of indirect evidence.


Aortoenteric fistula following renal revascularization. Aortoduodenal fistula following renal revascularization is a rare and frequently lethal event. This report records the first known survivor of aortoenteric fistula following renal revascularization alone. Four previously reported cases followed secondary operations such as nephrectomy or autotransplantation necessitated by thrombosis of aortorenal bypass grafts. Synthetic prosthetic material led to the fistula in all instances. Infection occurred in only one. This complication may be prevented by the use of autogenous tissue grafts, monofilament suture, and interposition of viable tissue between anastomosis and gastrointestinal tract. When massive upper gastrointestinal bleeding occurs following aortic-prosthetic vascular procedures and standard studies prove nondiagnostic, prompt celiotomy is recommended.


Principles and management of penetrating vascular injuries secondary to shotgun wounds. The characteristics of shotgun ammunition and ballistics are discussed to give an understanding of how shotgun wounds differ from all other types of civilian penetrating wounds. Five case examples of shotgun injuries to blood vessels involving the neck and extremities are presented to highlight problems encountered and to point out the principles of management. The importance of muzzle-to-victim range, preoperative arteriography and the definite place of conservation treatment are stressed.


Continuous ambulatory peritoneal dialysis. The technique of continuous ambulatory peritoneal dialysis was evaluated in nine patients during 136 patient weeks. The major objectives were to see if continuous ambulatory peritoneal dialysis would provide [1] acceptable control of serum chemistries by usual criteria, [2] adequate removal of sodium and water, [3] tolerable protein losses, and [4] a low prevalence of peritonitis with episodes responsive to therapy with continuing continuous ambulatory peritoneal dialysis. Preliminary findings suggest continuous ambulatory peritoneal dialysis represents an effective ambulatory, portable, internal dialysis technique. Larger-solute clearances per week may approach values six times greater than with most hemodialysis techniques. Small-solute clearances approach dialysate flow rate (8.3 ml/min) and are comparable to other dialysis techniques on a weekly basis. Edema is readily controlled and protein losses should be tolerable with adequate protein intake. Peritonitus occurs on the average every 10 weeks but responds to therapy promptly with continuing continuous ambulatory peritoneal dialysis. If the prevalence of peritonitis can be reduced, continuous ambulatory peritoneal dialysis appears to represent a very attractive dialysis technique.


Propranolol effects in long-term hemodialysis patients with renin-dependent hypertension. We evaluated propranolol effects on blood pressure, plasma renin activity, and erythrocyte production in nine chronically hemodialyzed and four nondialyzed patients with hypertension and high plasma renin concentrations. Propranolol, at a maximum daily dose of 240 mg, controlled blood pressure in 12 of the 13 patients. During propranolol treatment of dialyzed patients, mean blood pressure fell from 133 +/- 1 to 113 +/- 4 mm Hg (P less than 0.005) and plasma renin activity from 3093 +/- 423 to 689 +/- 218 ng/dl 3h (P less than 0.001). Similar results were obtained in nondialyzed patients. In both groups hematocrit and red cell mass were unchanged, although ferrokinetic measurements suggested a decrease in erythropoiesis. Thus propranolol alone reduces blood pressure and renin activity in chronically dialyzed patients with hypertension and high renin concentrations. No hematologic complications or other side effects were observed. These findings suggest that propranolol may be an effective alternative to bilateral nephrectomy in the control of renin-dependent hypertension in selected patients.


Meningoencephalitis and brain abscess due to a free-living amoeba. A 47-year-old diabetic woman developed fatal meningoencephalitis due to a free-living amoeba. The responsible organism appeared to be neither Naegleria nor Acanthamoeba-Hartmannella. Both acute and chronic (granulomatous) inflammatory reactions of the brain were present, and both cysts and trophozoite forms were readily visualized. The latest classification and methods of identification of such amoebae are reviewed and their threat to public health underscored. It should be realized that a variety of free-living amoebae exist in nature, which potentially can produce meningoencephalitis in humans, and that none of these organisms should be labeled or considered as "avirulent" or "nonpathogenic" until proved otherwise.


The free triiodothyronine (T3) index.

The free triiodothyronine (T3) index. In a large number of normal men (n = 111) and women (n = 110) the free triiodothyronine (T3), index, calculated from serum total T3 and T3-uptake, was highly correlated with free T3, measured by equilibrium dialysis. The correlation was almost as high as that of the free thyroxine (T4) index with free T4. The correlations of the total T3, free T3, and free T3 index with, respectively, the total T4, free T4, and free T4 index were much lower, though still statistically significant. The free T3 index is clinically useful because serum total T3 may sometimes be misleading. Hyperthyroid patients with apparent T4-toxicosis and normal total T3 may have an elevated free T3 index and thus physiologically elevated levels of both thyroid hormones. Calculation of the free T3 index might also make possible the diagnosis of T3-toxicosis in a patient with a normal free T4 index and normal total T3. Total T3 may be elevated without an elevated total T4 in women taking oral contraceptives; thus the free T3 index may prevent a misdiagnosis of T3-toxicosis. The free T3 index seems no better than total T3 in the diagnosis of primary hypothyroidism, but it can confirm the diagnosis of T3-hypothyroidism.


High-fiber diets in the treatment of diabetes mellitus. Eight patients with insulin-requiring diabetes were given, in random order, a diet containing 3 g and one containing 20 g of crude fiber. Each diet was maintained for 10 days and was the same in calories, carbohydrate, fat, and protein. Insulin dose was kept constant. Mean plasma glucose on the low-fiber diet was 169.4 +/- 11.7 mg/dl, significantly higher (P less than 0.001) than the value of 120.8 +/- 10.1 on the high-fiber diet. Hypoglycemic reactions were more common on the high-fiber diet. Weight remained essentially constant on both diets. Mean serum glucagon level on the high-fiber diet was significantly lower (P less than 0.001) than on the low-fiber diet, while serum free insulin levels were unchanged. These data indicate that substantial changes in fiber content of the diabetic diet may lead to marked changes in diabetic control and that increasing dietary fiber may be a useful means of lowering plasma glucose in some diabetic patients.


Prevalence of intrahepatic cholestasis of pregnancy in Chile. The prevalence of intrahepatic cholestasis of pregnancy was studied immediately postpartum in 869 women from three distant Chilean cities differing in climate and food supply. Cholestatic jaundice of pregnancy was detected in 2.4% and pruritus gravidarum in 13.2%, without significant differences between the three cities. Every woman was then ethnically classified as predominantly Caucasoid, Araucanian Indian, or Aimara Indian. A significantly higher prevalence of cholestatic jaundice of pregnancy (5.5%) and pruritus gravidarum (22.1%) was found in Araucanians than in Caucasoids (2.5% and 12.6% respectively) or in the Aimaras (0 and 11.8% respectively). The prevalence of intrahepatic cholestasis of pregnancy in Araucanians increased directly with the degree of "ethnic purity." Recurrence of the disease in multiparous women was also greater in Araucanians (13.8%) than in Caucasoids (5.5%) or in the Aimaras (3.9%). We propose that an ethnic predisposition to develop intrahepatic cholestasis of pregnancy is present in Araucanian women and that the high prevalence of the disease in Chile is mainly influenced by ethnic admixture with this South American Indian (ethnic) group.


Thalassemic osteoarthropathy.

Thalassemic osteoarthropathy. Patients with beta thalassemia major may develop a specific osteoarthropathy as they approach the second and third decades of life. Twenty-five of 50 patients between the ages of 5 and 33 years had evidence of periarticular disease that consisted of dull-aching ankle pain exacerbated by weight bearing and relieved by rest. Involvement was symmetrical with mild swelling and pain on bone compression. Arthrocentesis showed no evidence of inflammation. Radiographic changes included osteopenia, widened medullary spaces, thin cortices with coarse trabeculations, and evidence of microfractures. Histologic studies confirmed the presence of microfractures and showed osteomalacia and an increase in osteoblastic and osteoclastic surface area with iron deposites at the calcification front and cement lines. The relative roles of iron overload, divalent cation metabolism, erythroid hyperplasia, or other factors in the pathogenesis of the syndrome remain unknown, and no specific therapy can be recommended at present.


Role of aluminum in dialysis dementia.

Role of aluminum in dialysis dementia. Between September 1972 and January 1976 an outbreak of dialysis dementia affected 20 patients maintained by long-term hemodialysis. The clinical picture was characterized by an insidious onset of altered behaviour, dementia, speech disturbance, myoclonus, and convulsions. Nineteen patients died, but one patient has survived for 16 months. It was later established that in June 1972 the city had altered its method of water purification and that this resulted in higher water aluminum levels. The temporal relation between periods of high water-aluminum content and the appearance of new cases supports the view that aluminum may play a role in the causation of dialysis dementia.


Spinal fractures complicating ankylosing spondylitis. The ankylosed osteoporotic spines of patients with long-standing ankylosing spondylitis are prone to fracture. The spinal trauma is of a trivial nature in many patients and the diagnosis may be overlooked, unless neurologic damage occurs. The fractures most commonly occur in the cervical region and may be multiple. Because of spinal osteoporosis and deformity, radiographic visualization of the fracture site may be difficult. Tomography may be helpful in some patients. Management may be conservative or surgical and is complicated by increased instability of the fracture site, spinal osteoporosis, and deformity. Conservative management of cervical fractures is probably best accomplished by halo traction and body cast. Progression of the neurologic deficit is an indication for surgical intervention.


Ombudsmen (medical-psychiatric) rounds. An approach to meeting patient-staff needs. Ombudsmen rounds conducted jointly by a medical attending physician (ombudsman) and a psychiatrist bring the entire staff on each of the medical wards of Montefiore Hospital together weekly. An attempt is made to address both staff and patient needs on an inpatient medical service. Through group discussions and patient interviews, in which the patient has an opportunity to express his own feelings about his illness and his care, the staff becomes aware of the psychosocial issues that are universally evoked by illness and hospitalization. All staff members are also encouraged to relate their reactions to the patient and their interactions with each other. The ombudsmen-rounds concept maximizes the use of the internist and liaison psychiatrist, and makes psychosocial-medical teaching routine on the medical service in a contemporary teaching hospital where the practice of holistic medicine has been so difficult to implement.


Peripapillary disciform degeneration of the retina: diagnosis and treatment. Peripapillary disciform detachments are infrequent disorders of the ocular fundus. They may occur in patients of all age groups and result from a number of different causes. It is important to suspect this potentially treatable diagnosis when a patient presents with visual loss and a rounded, oval, or tongue-like mass extending from the optic nervehead in any meridian. Accurate diagnosis depends on intravenous fluorescein angiography. The subretinal neovascular net extending from the optic nervehead peripherally can be demonstrated only with angiography. Treatment of peripapillary disciform macular degenerations with photocoagulation is often successful, but is difficult due to their location. With inadequate treatment, the subretinal neovascular membrane may continue to spread and proliferate, and with excessive treatment, there may be damage to the papillomacular nerve fiber bundle, with permanent loss of central vision. It is most important to carry out close postoperative patient follow-up and retreatment when indicated once treatment has been initiated.


Phacoemulsification and retinal detachment. Retinal detachment is not eliminated nor decreased to a rare complication after phacoemulsification. There were 94 eyes examined with retinal detachments after phacoemulsification and the majority were operated upon. The fundus view might be hampered and some areas of the retina obscured by this form of lens extraction. There are, however, some cases where the small incision and relative clarity of the media, soon after cataract surgery, offer an advantage.


Crystals in the aqueous humor of normal eye. An unusual and extremely rare occurrence of the free floating crystals in the aqueous humor of a structurally healthy and functionally normal eye of a 15-year-old white girl is described. The exact nature of these crystals could not be determined but their iridescent nature suggests that they might be cholesterol. This observation leads one to believe, contrary to the current concept, in the very interesting possibility of the crystal formation (or synchysis scintillans) in an apparently healthy eye.


Traumatic serous detachments of the retinal pigment epithelium. Two cases of contusion injury to the anterior segment of the globe are reported which resulted in unusual fluorescein angiographic findings at the posterior pole of the eye. The posterior lesions seen in each case were difficult to interpret by conventional methods. It was thought that fluorescein angiography was of value in better delineating the nature of the clinical findings.


Spontaneous lens rupture following pars plana vitrectomy. This paper presenta a case of pars plana vitrectomy with spontaneous posterior lens capsule rupture 7 weeks after surgery and 1 week after discontinuation of cycloplegia. The diagnosis, treatment, sequelae, and etiology of this spontaneous lens rupture receive discussion. The accommodative mechanism in the postvitrectomy eye may explain the cause of lens rupture and suggest methods of prophylaxis.


A small pupil binocular indirect ophthalmoscope. A description of a lightweight small pupil binocular indirect ophthalmoscope is presented. This instrument can be used with well dilated pupils and clear media as any stereoscopic indirect ophthalmoscope. However, the instrument can be simply and easily adjusted for usage in patients with small pupils or opacities of the media. The optical and mechanical principles employed are presented. The technique of utilization for small pupil viewing is outlined.


CT scan appearance of dysthyroid orbital disease. Two cases of dysthyroid orbital diseases are presented which on CT scan had the characteristic appearance of intraorbital tumors. An operation was performed on one of these patients based on the CT scan appearance. This entity should not be confused with true intraorbital neoplasms. One must not rely exclusively on the CT scan in questionable cases as with any other ancillary diagnostic acid and one must bear in mind that dysthyroid disease in evolution may exactly mimic the CT scan appearance of an intraorbital tumor.


Corneal edema with a ciliary body melanoma. A 40-year-old woman is described with a ciliary body melanoma presenting with localized corneal edema and keratic precipitates. A ciliary body mass was visualized when the pupil was dilated. The mass was excised by corneoscleroiridocyclectomy and was a spindle B melanoma of the ciliary body. There has been no evidence of recurrence of the tumor, and the visual acuity has been stable at 20/25 for the past 3 years. This is the first case known to us of a ciliary body melanoma presenting with localized corneal edema and keratic precipitates.


Ultrasonic fragmentation using the automatic suction aspiration pump. This technique is a further modification of the original technique as introduced by Dr. Louis Girard thus making this procedure a one man operation instead of the three man operation as originally introduced by Dr. Girard.


Anterior segment necrosis following treatment of central retinal artery occlusion: a clinicopathologic case report. A 45-year-old man with an internal carotid artery occlusion, cerebral hemispheric infarction, and an ipsilateral central retinal artery occlusion developed anterior segment necrosis after retrobulbar injection of lidocaine hydrochloride (Xylocaine) for treatment of an occlusion of the central retinal artery. Multiple embolic plaques in the retinal circulation with occlusion of the posterior ciliary arteries were found. The clinical and postmortem histopathologic findings are presented.


Superior oblique tenectomy in a pattern strabismus. Nineteen patients with A pattern exotropia and 1 with A esotropia, all of whom had marked overacting superior oblique muscles bilaterally, were evaluated surgically. Nine with A exotropia and 20 prism diopters or less in the primary position were treated only with bilateral superior oblique tenectomy. Very little correction occurred in the primary position while an average correction of 35 prism diopters occurred in downgaze. Eleven patients with at least 25 prism diopters of deviation in the primary position were treated with bilateral superior oblique tenectomy in addition to horizontal rectus muscle surgery at the same sitting. A routine amount of horizontal surgery was performed with good results without regard for any effect which superior oblique tenectomy might cause in the primary position. This is a safe method for planning surgery in A patterns as abduction by the superior oblique muscles occurs mainly in downgaze.


The intraocular lens: preliminary results in southwestern Indians. We implanted Copeland iris plane lenses in 15 Navajo and Pueblo Indians. Visual results were gratifying. Complications have been minimal to date due to adherence to certain technical points and the use of postoperative steroids. The technique using standard intracapsular extraction is relatively simple. It is easier than the extracapsular technique or tying sutures inside the anterior chamber. The implant is certainly valuable in our population who uniformly fail with contact lenses. The mediocre acceptance and tolerance of aphakic spectacles, which is more common in Indian patients, is likewise overcome by the implant. Patients who have advanced unilateral cataract can now be operated upon and visually rehabilitated. More observation time is needed to evaluate the potential problems of cystoid macular edema and poor pupil dilatation complicating retinal detachment surgery.


Corneal astigmatism following cataract surgery. Seventy-seven cases of intracapsular cataract extraction were analyzed for immediate and long-term induced corneal astigmatic changes. Sutures used were predominantly interrupted, absorbable sutures buried under a limbus-based conjunctival flap. The average induced astigmatism in the first week after surgery was 3.87 diopters with-the-rule. The average induced astigmatism after six weeks was 0.79 diopters against-the-rule. The cause of the induced change is discussed.


Immune response and non-specific immunotherapy in melanoma. Tumour-associated antigens and specific immune response to these antigens have been clearly demonstrated in patients with melanoma. Impaired cellular immune reactions are evident in patients with progressive and disseminated disease. Immunotherapy is used to heighten the host resistance and hence prevent recurrence and spread of the tumour. BCG vaccine has been used to produce nonspecific stimulation of the immune system. Preliminary evaluation of the effect of adjuvant systemic BCG therapy suggests that the treatment may have a beneficial effect on patients with early melanoma.


Incarcerated inguinal hernia in children. A survey has been made of 110 children under 4 years of age who developed inguinal hernias. Of these, 61 became incarcerated at some time, the highest incidence being in the youngest infants; the bowel was not strangulated in any of these hernias. No untoward effects were seen to result from a short trial of conservative treatment in incarcerated hernia.


Odontogenic cyst growth and prostaglandin-induced bone resorption. Forty-six odontogenic cysts produced significant quantities of bone-resorbing prostaglandins (PGs) in tissue culture. The follicular and periapical cysts released a mixture of PGEs and PGFs, while the keratocysts released only PGE2. There were also quantitative differences between the cyst types. Follicular cysts produced small quantities, as did keratocysts when allowance was made for their thin walls, whereas periodontal cysts are capable of relatively high activity. This prostaglandin activity can be related to the clinical behaviour of these lesions.


Life-threatening surgical infection: its development and prediction. A number of clinical, investigational, immunological, and peroperative host factors are identified which will predispose the patient to a serious postoperative infection that may endanger his life. The degree of the risk and the severity of the infection can be predicted, but only fairly crudely at present. The future holds a more precise identification of these risk factors and thus greater accuracy in predicting operative risk. The methods of preventing life-threatening postoperative infections, both those currently used and those projected for the future, are discussed.


A new approach to the treatment of renal failure. There is an apparent need for an alternative form of treatment for renal failure. In this study, therefore, an attempt was made to determine the feasibility of dialysing across an isolated loop of colon and its possible application to augment failing renal function in patients with chronic uraemia.Colonic loops were isolated in sheep and studies performed to find an effective solution in terms of urea clearance. The best solution was then used (1) changing the speed of flow, (2) changing its temperature, and (3) with the addition of vasodilators. It was then used in animals subjected to bilateral nephrectomy and, compared with control animals, life was prolonged significantly (P<0.03). Dialysis was also carried out on sheep made temporarily uraemic by injecting them subcutaneously with ureaphil and also on sheep in which chronic uraemia had been induced by an immunological method. These animals also lived significantly longer than controls (P<0.05). Antibody titres in these sheep were estimated and found to be higher than in non-dialysed uraemic animals.Once it had been established that urea could be removed across the colonic mucosa this method of dialysis was used in patients with established isolated loops of colon. Even though they had normal blood levels urea was recovered in the dialysate. The results indicate that colonic dialysis, which is simple and inexpensive, may have a place as an adjunctive therapy in the treatment of chronic renal failure.


Thyrotoxicosis and pregnancy. An analysis of 43 pregnancies in 42 thyrotoxic mothers. During the period 1965-1976, 43 pregnancies in 42 thyrotoxic mothers were seen. Thirty-nine pregnancies in 38 patients were analyzed further. Twenty-six patients (27 pregnancies) were treated with antithyroid agents with (9) or without (17) supplemental thyroid hormone therapy  and 5 were subjected to subtotal thyroidectomy. In these groups spontaneous abortion occurred in 4 patients (12.5%), prematurity in 3 (9.4%) and perinatal death in one whereas 25 pregnancies ended at term (78%). Two pairs of twins were born and the number of live children in these 32 pregnancies was 29. Hypothyroidism developed in one patient after operation. Thyroid crisis occurred at delivery in one patient in whom the antithyroid therapy was interrupted before labour. Seven patients were not treated with specific antithyroid therapy. In this group there was one twinbirth, one premature birth, one stillbirth and one child died shortly after birth. Thyroid crises developed at delivery in two mothers. The authors use subtotal thyroidectomy if usual indications for operation are present and antithyroid therapy when the thyroid gland is small and diffuse. Beta-receptor blocking agents are recommended only as adjuncts to the antithyroid therapy. A close surveillance of the patients and the free thyroid hormone level during therapy is important and after thyroidectomy treatment with thyroid hormone is recommended until after delivery.


Mechanical small bowel obstruction due to adhesions. During the years 1971-1975, 103 patients were operated on for adhesive small bowel obstruction, giving an incidence of 80 per 1 million inhabitants per year. Previous laparotomy caused the obstruction-provoking adhesions in 90% of the cases. Appendicectomy, gynaecological operations, and operations on the intestine were the three most common surgical procedures performed prior to the obstruction. In 40 cases with clinically less severe symptoms and signs follow through radiological studies with contrast medium secured the diagnosis of obstruction. The mortality rate was 5.8% and increased with the duration of symptoms. Two patients died of complications caused by intestinal fistula following lysis of extensive, firm adhesions. Bypass or bowel resection might be safer procedures in those cases. Bowel resection did not affect the mortality rate. None of the 23 patients with strangulation died. This may be due to early operation since the mortality rate in the series as a whole doubled when symptoms had lasted for more than 24 hours. Recurrence rate after operation for adhesive small bowel obstruction was 27.8% and eight patients required relaparotomy.


Lipids in the pulmonary circulation after fatal trauma. A postmortem study. Lipids in the pulmonary circulation were determined biochemically and histologically in seven patients (group A) who died following multiple blunt trauma and in five patients (group B) who died of some other traumatic or nontraumatic cause. Autopsy was performed on average 4.5 hours after death. Blood samples were collected from the right ventricle (RV) and the left atrium (LA). The vasculature of the left lung was perfused in a retrograde direction. The inferior lobe of the right non-perfused lung was examined histologically. Intravascular pulmonary fat was observed in 4/6 cases in group A and in 1/5 cases in group B. No intravascular fat was observed in the tissue samples of brain, liver or kidney. The concentration of free fatty acids (FFA) in blood from RV was higher than in blood from LA both in group A (P is less than 0.01) and in group B (P is less than 0.05). The considerable difference in concentrations of FFA between RV and LA and the low concentration of FFA in the lung perfusate may be due to some kind of "fixation" of FFA in the lung tissue, possibly connected with the aetiological factors of the fat embolism syndrome (FES).


Colitis cystica profunda. Report of a case. Colitis cystica profunda is a non-neoplastic condition characterized by intramural mucus-containing cysts of the colon and rectum. The cysts are in most cases located as polypoid masses 5 to 12 cm from the anal margin. The diameter of the cysts varies from less than 0.1 cm to 3 cm. Since this rarely recognized condition undoubtedly is a benign lesion, it is important to identify it from other colorectal tumours and ulcerative colitis. Extensive colorectal surgery should be avoided.