Familial hyperkalemia, hypertension, and hyporeninemia with normal aldosterone levels. A tubular defect in potassium handling. A 52-year-old man had hypertension, persistent hyperkalemia, and hyperchloremic metabolic acidosis; renal and adrenal functions were normal. Four other members of the family have the same findings. The patient's plasma aldosterone (PA) level was within normal range, though plasma renin activity (PRA) was undetectable. The ability to conserve sodium with increased endogenous aldosterone levels, and the inability to increase potassium excretion while exogenous mineralocorticoid (fludrocortisone acetate) was administered, indicated a distal tubular defect in potassium handling. Effective reduction of the hyperkalemia by K+ -Na+ exchange resin also corrected the acidosis and the hyperchloremia, suggesting that hyperkalemia may cause metabolic acidosis.


A rapid method for the diagnosis of acute uric acid nephropathy. Acute uric acid nephropathy is a reversible type of renal failure that results from the deposition of uric acid crystals in the collecting tubules. The present study has compared a number of laboratory tests in 5 patients with a clinical diagnosis of this disorder and 27 patients with acute renal failure of other causes. Neither the serum creatinine, BUN, serum urate concentrations, nor the ratio of serum urate:BUN differentiated between these two groups of patients. However, the ratio of uric acid to creatinine concentration on a random urine specimen did differentiate between these two patient populations. All patients with uric acid nephropathy had a ratio greater than 1.0, while all patients with other types of acute renal failure had ratios of less than 1.0.


Echocardiographic interpretation of pericardial effusion. Echocardiography has proved to be quite useful in the detection of pericardial effusion. As little as 15 ml of fluid within the pericardial space can be detected. Specific signs of pericardial effusion, such as electrical alternans and paradoxical pulse, have become better understood by echocardiographic study. Yet, with all the benefits of echocardiography, the detection of pericardial effusion still may be quite difficult if careful attention is not given to technique. False-positive diagnosis of anterior pericardial effusion can be seen with epicardial fat pad, pericardial cyst, or foramen of Morgagni hernia. False-positive posterior pericardial effusion can be seen in large left pleural effusion, calcified mitral anulus, or excessively medial transducer angulation. New "switched-gain" circuits have helped detection of pericardial effusion by enhancement of pericardial echoes.


Jejunoileal bypass surgery and granulomatous disease of the kidney and liver. A 26-year-old woman, who had undergone jejunoileal bypass surgery six years previously for obesity, had symptoms of intermittent fever, myalgia, polyarthralgia, and aseptic joint swelling. These symptoms commenced one year after her surgery and gradually grew in intensity and frequency of occurrence. The patient, observed to have moderately decreased renal function, hyperoxaluria, and circulating cryoglobulins, underwent liver and renal biopsies. Both organ specimens demonstrated granulomatous involvement, but the kidneys exhibited no evidence of oxalate deposition. The findings of circulating cryoglobulins and suppression of symptoms with doxycycline, taken collectively with the circumstances surrounding this case, suggest that the observed granulomatous disease may be due to systematically adsorbed bacterial antigen(s).


Considerations in diagnosing brain abscess with computerized axial tomography. Four studies with computerized axial tomography (CT scan) were performed in a 20-year-old man in whom multiple brain abscesses developed while hospitalized for complications of regional enteritis. A large frontal lobe abscess appeared as a nonspecific region of decreased density on the initial CT scans. When iodine was used to enhance the diagnostic sensitivity of the CT scan, this areas was identifiable as an abscess. However, a 1-cm lesion in the right parietal area that extended into the choroid plexus was not delineated. Radionuclide scans detected both lesions, but did not allow pathological identification. We conclude that CT scans should be performed with iodine enhancement whenever brain abscesses are suspected, and that some abscesses that are undetected by CT scans even with iodine enhancment may be delineated but not identified by sodium pertechnetate Tc 99m imaging.


Sjögren's syndrome with pseudolymphoma 13 years after Hodgkin's disease. A patient who had Hodgkin's disease at age 11 that was cured by radiation therapy, had nonspecific adenopathy at age 20. When he was 24 years old, the symptoms of Sjögren's syndrome developed, and this diagnosis was confirmed by biopsy of the lip. The patient subsequently had dyspnea and a diffuse pulmonary infiltrate which, at open lung biopsy, was diagnosed as pseudolymphoma and has responded to cytotoxic chemotherapy. This is the first reported case of Sjögren's syndrome and pseudolymphoma following the cure of a malignant lymphoma. The interrelationship between lymphoid malignancies, autoimmune diseases, and pseudolymphoma is herein discussed.


Unusual immunologic findings in familial Mediterranean fever. Familial Mediterranean fever (FMF) is an inherited disease of unknown etiology. We report a case in which, during an acute febrile attack, rheumatoid factor and immunoglobulin levels rose, and the levels of complement components fell. The level of urinary fibrinogen degradation products also increased, and all results of tests returned to normal at the end of the acute attack. This suggests that an immunologic phenomenon may play a substantial role in the etiology of FMF.


Creatine phosphokinase isoenzyme fractions in the serum of a patient struck by lightning. Serial creatine phosphokinase (CPK) isoenzyme determinations were taken in an 8-year-old boy whose being struck by lightning resulted in prolonged cerebral anoxia, inferolateral myocardial infarction and death. All three isoenzyme levels (CPK-MM, CPK-MB, and CPK-BB) were elevated. The CPK-BB isoenzyme level increase was transient, being very high three hours postlightning strike and disappearing at approximately 24 hours.


Trypsin inhibitors and hemagglutinins in certain edible leguminosae. All raw legumes contain, in different proportion, several toxic substances that prevent consumption in their natural form. In this study the contents of the two main toxic products and their degree of destruction after thermic treatment similar to home cooking techniques were determined in 13 edible legumes. Proximate chemical analysis was made, and in vitro digestibility, contents of trypsin inhibitors and hemagglutinins in raw and cooked samples were studied. In the cooking treatment the legumes were boiled for two hours at boiling temperature under atmospheric pressure. Protein content in the samples was high, as in most legumes (20 per cent or more). Peas, lentils and broad beans had the lowest content of trypsin inhibitors and hemagglutinins. Cooking destroyed these substances, but did not improve in vitro digestibility, probably because of the reactions between their components when exposed to heat.


Proteolytic enzymes marking of malignant lymphoblasts, study of the L5178Y murine lymphoma. The bovine pancreatic inhibitor of trypsin (trasylol, Bayer) (T) and the soy bean trypsin inhibitor (SBI) were coupled with peroxidase (P). With each one of these coupling products (T and P and SBI and P) the cell distribution of proteolytic enzymes (PE) of ascitic cells of L5178Y murine lymphoma, was localized. The reactions were developed by means of Karnowsky's reaction with diaminobenzidine and H2O2. The preparations were observed under light and electronic microscopy. It was found that L5178Y cells contain intracellular PE in granules measuring 0.1 to 0.8 min diameter, and superficial PE that form a continuous layer of 80 to 120 nm over the cell surface. Superficial PE were not identified in 20 per cent of L5178Y cells, while in every case intracellular granules were found. Both the macrophages and the polimorphonuclear cells present in the ascitic fluid contained intracellular PE granules measuring 0.05 to 0.4 micron in diameter, and did not contain superficial PE.


Autolysis induction of malignant lymphoblasts. BALB/C mice were treated with epsilon aminocaproic acid (EACA), 0.1 to 3.2 mg/g body weight, subcutaneously every 24 hours for six days, starting on the second day after intraperitoneal transplantation of L5178Y lymphoma. Complete involution was observed in 20 to 90 per cent of the ascitic tumor and in 50 per cent of the solid tumor 72 hours after EACA was discontinued, tumoral involution and dosage were directly proportional. One hundred per cent of the non treated controls died 10 +/- 0.6 days after intraperitoneal lymphoma transplantation. During tumor involution malignant cells underwent autolysis and were attacked or phagocytized by activated macrophages. Since EACA is a proteolytic enzyme inhibitor, inhibition during treatment and activation of these enzymes after EACA was discontinued could have been the cause of autolysis of the L5178Y lymphoma cells.


Effects of administration of mannitol and furosemide in the renal hemodynamics of the dog. The action site of mannitol and furosemide in the nephron level was studied in two groups of dogs which, alternatively, were given both diuretics. The furosemide preferential action site was confirmed in the ascending limb of Henle's loop. It is suggested that mannitol acts on the descending limb of this loop, and that the dilution effects of this diuretic on the ascending limb are due to contamination. Changes in urinary excretion of potassium were not observed during mannitol administration. This fact coincides with the action site suggested for this substance.


Effects of the environmental light conditions on the ultrastructure of the harderian gland in the newborn rat. biochemical correlation with the pineal gland. Morphological changes at the levels of both light and electron microscopy were studied regarding the secretory elements of the Harderian glands of neonatal rats, induced by environmental lighting conditions. The results were correlated with biochemical determinations of serotonin levels and hydroxyindole-O-methyl transferase (HIOMT) activity in the pineal gland. Neonatal male albino rats were divided into three groups: 12 were exposed to a light period for seven days; 12 to a dark period, and 12 to diurnal lighting conditions (light, 12 hours; darkness, 12 hours), as controls. In each group some animals were killed at 1.00 pm. The Harderian gland of each animal was immediately fixed and processed for light and electron microscopy while the pineal gland was homogenized in a fixative for biochemical determination of serotonin levels and HIOMT activity. On the light period the acinar lumen was observed to be dilated with increased secretions from the acini and excretory ducts while on the dark period the acinar lumen narrowed with hardly any secretions. On the dark period there were no changes in the cyclic variations of serotonin levels and HIOMT activity in the pineal gland; while on the light period, these cycles disappeared. It is concluded that secretory activity of the Harderian gland is modified by environmental lighting conditions, and that secretions produced by this gland appear to be directly related to the control mechanism of melatonin production by the pineal gland in neonatal rats.


Studies on growth inhibition by lectins of Penicillia and Aspergilli. It has previously been shown in our laboratory that wheat germ agglutinin (WGA) binds to Trichoderma viride and inhibits growth of this fungus. Here we report on the effect of WGA, soybean agglutinin (SBA) and peanut agglutinin (PNA) on Penicillia and Aspergilli. Binding of the lectins to the fungi was examined with the aid of their fluorescein isothiocyanate (FITC) conjugated derivatives. FITC-WGA bound to young hyphal walls of all species, in particular to the hyphal tips and septa, in agreement with the chitinous composition of the cell walls of the two genera. Hyphae of all species examined were labelled, though in different patterns, by FITC-SBA and FITC-PNA, suggesting the presence of galactose residues on their surfaces. Young conidiophores, metulae (of the Penicillia), vesicles (of the Aspergilli), sterigmata and young spores, were also labelled. The three lectins inhibited incorporation of [3H]acetate, N-acetyl-D-[3h]glucosamine and D-[14C]galactose  into young hyphae of Aspergillus ochraceus, indicating interference with fungal growth. Inhibition of spore germination by the three lectins was also observed. Preincubation of the lectins with their specific saccharide inhibitors prevented binding and the inhibitory effects. We conclude that lectins are useful tools for the study of fungal cell surfaces, and may also serve as an important aid in fungal classification. The present findings also support the suggestion that one role of lectins in plants is protection against fungal pathogens.


[Langer's type mesomelic dwarfism. Apropos of a case]. One case of Lnger's type mesomelic dwarfism is reported in a 7-day old newborn. Height retardation was severe and concerned essentially the middle segment of limbs. Cubituses and fibulae were hypoplastic. The inferior mandible was intact. No biological change was found. The genetic transmission could be either recessive autosomal (parents double-first cousins), or dominant autosomal with pleiotropic expression (the mother, and an aunt on the father's side presenting with dyschondrosteosis).


[Plasma creatinine, and clearance and urinary excretion of creatinine in children]. The 24 hour clearance of endogenous creatinine was compared with that of inulin in 112 children aged between 15 months and 17 years. The children had a variety of kidney disorders with renal function than ranged from normal to terminal renal failure. When the inulin clearance was less than 10 ml/min/1.73 m2 it was on average 75% of the value of the creatinine clearance. Between 10 and 60 ml/min/1.73 m2 the relationship of the inulin clearance to that of creatinine was similar (77%) but above 60 ml/min/1.73 m2 the ratio of the inulin clearance to that of creatinine was 1.05 with a wide scatter. With increasing degrees of renal failure the plasma creatinine increased less in the children under 2 years old than in those over this age so it is poor index of glomerular function in infants. In renal failure the urinary excretion of creatinine in 24 hours was reduced. When the clearance was less than 10 ml/min/1.73 m2, the urinary creatinine excretion for children under the age of 2 was 58% of the normal for the age and for children over 2, it was 86% of the expected mean.


[Acrodermatitis enteropathica. Anatomo-clinical study of 2 familial cases treated with zinc sulfate]. Two familial cases of acrodermatitis enteropathica began at the time of weaning, with characteristic dermatologic lesions and digestive signs, resulting in lack of weight gain: at 13 months of age growth future was evident in the elder child. The anatomic lesions were those of an exophagitis and, in the duodenal mucosa, a dilation of the capillaries of the chorion in the absence of villous atrophy. The ultrastructural study showed inclusions in Paneth's cells, and changes in keratin cells, with intra-cytoplasmic vacuoles and abnormal melanin pigment in the skin. The administration of zinc sulphate induced a rapid recovery of cutaneous lesions and resumption of growth. The interruption of treatment resulted twice in a quite immediate relapse of cutaneous signs in the first patient, which was rapidly reversible with the reintroduction of zinc sulphate.


[Survey on the fate of newborn infants treated in pediatric intensive care units. II. Respiratory sequelae]. Five hundred sixty children treated at the neonatal period (between 1969 and 1972) were reexamined when they were 1 and/or 2 years old. At 2 years of age, the rate of anomalies considered as probable respiratory sequellae of the neonatal disease, was 10%. In this population, hyaline membrane disease was responsible for nearly 2/3 of the respiratory sequellae observed at 2 years of age, whereas it concerned less than 1/3 of the population under study. The overall prognosis of neonatal disorders for which treatment in an intensive care unit was required during the 4 years under consideration, is clearly improving, since the decrease of death-rate is not associated with an increase of respiratory sequellae among the survivors.


[Bronchial brushing in severe lung diseases in children]. A distal bronchial brushing was performed in 25 children having severe lung diseases. The age of the patients ranged from 7 days to 14 years. Seventeen children were immuno-depressed. Bacteria were isolated five times (2 Staphylococcus aureus, 1 Streptococcus pneumoniae, 1 Serratia marcenscens, 1 Acinetobacter lwoffi), viruses twice (cytomegalovirus, syncytial respiratory virus), Pneumocystis carinii, four times. Cytologic study revealed malignant cells, and cells with intranuclear inclusions, evoking a viral infection. This procedure appears to be harmless in children over 2 years of age. In younger children there is a risk of pneumothorax. the principal indication for distal bronchial brushing is lung disease in immuno-depressed children. It may, however, also be useful in prolonged, treatment-resistant, severe lung diseases.


[Laron type familial dwarfism; genetic primary somatomedin deficiency]. Five children from 3 different families presented with severe dwarfism and the morphological and biological features described by Laron: familial occurrence, small stature, peculiar facies, high levels of plasma HGH and resistance to treatment by GH. This therapeutic inefficiency is expressed by an absence of physical growth and unchanged nitrogen balance, during a prolonged treatment. The plasma levels of somatomedine were very low (K. Hall's biological method) and not influenced by administration of exogenous HGH. These findings suggest that the fundamental disorder is not an abnormal structure of the molecules of GH. This hypothesis seems further confirmed by the structural analysis of plasma HGH, which gave the same results as those of the reference GH.


[Acceleration of postnatal development, hypertony, enlargement of the middle phalanges and of the distal metaphyses of the femur, peculiar facies: a case of Weaver's syndrome?]. A child is described with accelerated bone maturation, large dysplastic ears, and hypertelorism. These are features of both the Marshall-Smith and Weaver's syndrome. The child was mentally retarded and had enlargement of the middle phalanges, features only seen in Marshall-Smith syndrome. However, there was also enlargement of the metaphyses, a characteristic of Weaver's syndrome. The possiblity that these syndromes may represent different manifestations of the same entity is discussed.


[Pharmacokinetic study of intravenous furosemide in nephrotic syndrome in children]. The pharmacokinetics and pharmacological effect of intravenous furosemide (F) (2 mg/kg body weight) were studied in 12 children with the nephrotic syndrome with or without renal failure (R.F.). The concentration of F in blood and urine was determined by a new spectrophotometric method. In the nephrotic syndrome alone, the rate of renal excretion was increased (increased slope of the pharmacokinetic curve, decreased t 1/2), which may be due to a decrease in the fraction bound to plasma albumin. In children with the nephrotic syndrome and renal failure, the decrease in the renal excretion of F was related to the degree of renal failure. In normal children the mean F clearance is 296. In patients with N.S. alone the clearance is greatly increased (X = 377) and in N.S. with R.F. it is reduced (0.17-90). The possible mechanisms and therapeutic implications of the results are discussed.


[Changes in the membrane proteins of blood cells in the course of embryonal megaloerythropoiesis in relation to hemoglobin maturation]. Membrane proteins in circulating blood cells were examined in chick embryos on the 4th, 5th, 6th, 7th and 10th incubation day, in chicks immediately after hatching, and in adult birds. Haemoglobin electrophoresis patterns were determined on cellulose acetate after solubilisation with urea, and in gradient of pH and concentration on acrylamide gels after solubilisation in SDS. Amino acids and other amino compounds were also determined after acid hydrolysis and resin chromatography. Haemoglobin patterns were similar to those displayed by the membrane proteins. The latter, however, changed more slowly.


Psychological adjustment of homosexual and heterosexual men: a cross-national replication. The present investigation of British subjects replicated an investigation conducted in the United States. There was considerable agreement in the findings of the two studies. A multidimensional evaluation of adjustment, based on questionnaire data, indicated that the total sample of British homosexuals described themselves as less well adjusted than the heterosexuals on four factors, better adjusted on two factors, and not different on six factors. There was a significant difference on only one dimension, however, for selected groups of masculine homosexuals vs. heterosexuals. Homosexuals and heterosexuals low on feminity, in addition, tended to be better adjusted than homosexuals and heterosexuals high on femininity. The possible confusion between adjustment and masculinity-femininity, as well as the importance of using a multidimensional approach when considering adjustment, is discussed.


[Primary hyperaldosteronism. Diagnostic procedure useful in hospital routine]. Personal experience in the management of three cases of primary hyperaldosteronism, in which a cure was obtained by surgical removal of an adrenocortical adenoma, is was used in the elaboration of a diagnostic procedure requiring hospitalisation for 12 days. During 6 days, the patient is kept on a diet containing 100 mEq Na and K, and blood potassium values are repeatedly determined. Other causes of hypertension are ruled out. On the 6th day, baselines for blood renin and urinary aldosterone are calculated. Next, a hyposodic diet is given for 4 days, and a diuretic is administered on the last of these days, after which renin is determined "in response to stimulation". Lastly, two days of i.v. NaCl loading are followed by the determination of urinary aldosterone "during inhibition". If the picture is positive for hyperaldosteronism, the patient is discharged and followed during treatment with spironolactone, and eventually subjected to renal and adrenal arteriography to determine the site of the adenoma. Division of the procedure into increasingly complex steps enables the examination to be halted at any point when evidence in support of the suspected diagnosis fails to appear. This feature, coupled with the simplicity of the procedures adopted, enables all young subjects admitted for unexplained hypertension to be screened for hyperaldosteronism, with the assurance of obtaining certain diagnosis without an excessively long stay in hospital.


Early sexual experience as a factor in prostitution. Using the literature of the early sexual histories of "normal" women and two recent studies on the sexual histories of prostitutes, this article examines the pattern of early sexual experience among prostitutes and how it differs from that common to nonprostitute women. Some significant differences found between the samples of prostitutes and the samples of "normal" women were that the prostitute samples, on the whole, learned less about sex from parents and more from personal experiences, as children experienced more sexual advances by elders, were more victimized by incest, generally initiated sexual activity at a younger age, more often had no further relationship with their first coital partner, and experienced a higher incidence of rape. The analysis of these data on early sexual history concentrates on abusive sexual experiences such as incest and rape. The authors believe that an abusive sexual self-identity relates to the development of an adult female pattern of occupational deviance such as prostitution.


[Changes in the level of erythrocyte phosphorylated compounds in patients with hepatic encephalopathy]. Automated ion exchange chromatography was used to compare red cell phosphorylates in clinically healthy subjects and 6 patients with hepatic encephalopathy. Significant changes in the distribution of these compounds were noted, including a marked increase in total acid-soluble content (particularly 2.3 DPG, R5P, 3MPG and G16DP) and a sharp fall in ATP. Increased 2.3 DPG explained the rightward shift of the haemoglobin dissociation curve seen in cirrhosis of the liver, but does not seem to fit in with enhanced blood ammonia. Deep-seated changes in red cell energy metabolism may have the same pathogenesis as the CNS metabolic change observed in hepatic encephalopathy.


Sexual behavior of Colombian female university students. The results of a survey of sexual behavior conducted among 113 female students of Caldas University, Manizales, Colombia, are reported. Among other findings, cumulative incidence of masturbation was 68.1% and that of premarital coitus 33.6%. On the other hand, 56.4% of the nonvirgins professed to have had oral-genital contacts and 28.2% of them said that they had experienced anal coitus. While 96.5% of the students admitted contact with pornographic materials and 40.4% had been sexually aroused by these materials, 18% of those subjects who had been exposed to "romantic" (nonsexually explicit) materials professed to have been sexually aroused. As to contraceptive practices, many students never used any contraceptive methods, and 11.4% of the coitally experienced respondents admitted to having had an induced abortion. This study also shows a negative correlation between religiosity and the subjects' sexual behavior. Highly significant sex differences in sexual behavior among Colombian university students are also revealed when this study's findings are compared with data from male medical students.


[The prognosis of fractures in hemophiliacs has improved]. A case of femoral fracture in diseased bone in an adult haemophiliac with relatively advanced arthropathy is referred to in discribing the principles underlying the relevant orthopaedic surgery, combined with suitable haematological preparation.


[Bencyclane in memory disorders. Treatment of memory disorders caused by electroshock in a group of depressed patients]. Subjects treated with electroshock and subjected simultaneously to bencyclan at a dose of 00 mg (2 ampoules) i.v. and 100 mg (1 pill) per os pro die did not present dysmnesia either during the intervals between one electroshock treatment and another, nor at the conclusion of treatment (on average 12 sessions in about 40 days), while a control group treated at the same rhythm and with the same number of sessions, but without bencyclan, presented considerable memory lapses which disappeared only after a lengthy period of this latter treatment. Memory disturbances have been evaluated with a memorization test to which all patients were subjected. This test belongs to the group of intellectual efficiency reactive tests used in the psychology laboratory of the Catholic University of Milan; it consists of a group of 12 figures of common objects which, once observed, have to be recalled exactly immediately and some time later by the patient, who has to indicate the name and position of the objects represented in the chart.


Diagnosis of occult familial medullary carcinoma of the thyroid using pentagastrin. Medullary carcinoma of the thyroid is unique in that it can often be diagnosed solely on the basis of abnormally high basal serum thyrocalcitonin levels. Two brothers described in this report were found to have normal basal serum thyrocalcitonin levels when examined after another family member died from metastatic medullary carcinoma of the thyroid. Pentagastrin, a synthetic analog of gastrin, was subsequently administered to these two high-risk relatives and found to stimulate the release of thyrocalcitonin to abnormally high levels. They were found to have occult medullary carcinoma of the thyroid. Eight other first-degree relatives of the deceased patient with normal basal serum thyrocalcitonin levels were screened with pentagastrin and found to have normal stimulated levels of thyrocalcitonin. This report reinforces the need to recognize that medullary carcinoma of the thyroid can be familial and that physicians are obligated to screen asymptomatic kin who are at high risk. We recommend that all susceptible relatives, even if they have normal basal serum thyrocalcitonin levels, undergo the provocative pentagastrin test with repeat annual testing if necessary. In addition, the provocative pentagastrin test can be used to follow up patients who have undergone thyroidectomy.


Dopamine-phenytoin interaction. A cause of hypotension in the critically ill. Five critically ill patients received dopamine hydrochloride intravenously to support their blood pressure. When seizures developed, intravenous phenytoin sodium therapy was begun. Coincident with the infusion of phenytoin, the blood pressure, which was stable on the dopamine infusion, declined rapidly. Analysis of these cases led to a hypothesis that the interaction of dopamine and phenytoin produced the hypotension. When this hypothesis was tested in the normovolemic dog, intravenous dopamine produced no change in the blood pressure, and the addition of a phenytoin infusion had little effect. In animals rendered hypovolemic and hypotensive by bleeding, intravenous dopamine returned the blood pressure to the prebleeding level. At this point, an infusion of phenytoin produced a sustained decrease in the blood pressure. The mechanism of this action may be related to  a combination of catecholamine depletion and myocardial depression.


Villous tumors of the stomach and small bowel. Villous tumors of the stomach and small bowel are premalignant lesions with focal adenocarcinomatous change as high as 72%. They are frequently multiple and associated with other gastrointestinal neoplasms. Thirty percent of those in the stomach are associated with an independent gastric carcinoma. Villous tumors have morphological features that facilitate specific roentgenographic diagnosis. Endoscopic biopsy may confirm the diagnosis but may give false-negative results for malignant neoplasms and therefore should not delay treatment. After diagnosis, surgical resection is mandatory and subsequent radiological-endoscopic follow-up is essential.


Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. An endoscopic technique is described for thoracic sympathectomy. After establishment of a pneumothorax, the thoracoscope is introduced into the pleural cavity. The telescope is equipped with a wire electrode, a grasping forceps, and a suction coagulation probe for endoscopic electroresection of the sympathetic trunk. In 63 patients, 124 endoscopic sympathectomies were performed. All patients were relieved of sweating in the hands; 18.6% still had some perspiration of the axilla. Side effects of thoracic sympathectomy were compensatory and gustatory sweating that, in four patients, were more embarrassing than the original form of hyperhidrosis. Fifty-five patients were highly satisfied with the result of endoscopic sympathectomy, which is considered the appropriate minor procedure for the treatment of upper limb hyperhidrosis, causing minimal discomfort to the patient and almost invisible scars.


Early restenosis after carotid endarterectomy. Restenosis within 24 months of carotid endarterectomy was discovered in 3.6% of 361 operations. The patients in this group of restenosis tended to be younger than the overall group. Hypertension and hyperlipidemia were also more frequent. Restenosis recurred within an average of 12.5 months of the first operation, with a range from five to 24 months. No surgical technical causes could be found. Restenosis is attributed to rapid, exuberant myointimal proliferation. This process is histologically distinct from the atherosclerotic plaque which is the cause of late restenosis. Reoperation on this group of patients with the fibrous myointimal proliferative type of lesion was difficult and was infrequently associated with improvement in the patients' signs and symptoms.


Coexistent parathyroid adenomas and thyroid carcinoma. Can radiation be blamed? The coexistence of parathyroid adenomas and thyroid cancer in a substantial number of patients with primary hyperparathyroidism has led to speculation implicating ionizing radiation as a possible cause. Experience with a group of 40 individuals harboring both tumors was reviewed and evidence of roentgen ray exposure to the head and neck was found in only one of these patients. Association of parathyroid adenomas and thyroid carcinoma cannot be explained on the basis of prior irradiation to the neck.


Construction of pancreaticocystogastrostomy using an automatic stapling device. The difficulties in employing standard techniques in the management of pancreatic pseudocysts led to the development and evaluation of a new approach. The advent of surgical stapling instruments has allowed the anastomotic procedures to be done in a more expeditious manner. For that reason, it was decided to treat pancreatic pseudocysts in two patients by constructing a pancreaticocystogastrostomy with the use of an automatic stapling instrument. The performance of the technique and the uneventful postoperative course encourages its continued use in cysts that are adjacent to the posterior gastric wall.


Removal of a thrombotic plug from an occluded limb of an aortofemoral graft. We describe a technique for removal of a thrombotic plug from an occluded aortofemoral bypass limb that only requires operative exposure of the involved graft limb and that utilizes a balloon-tipped catheter and a Cannon endarterectomy loop. This method assures pulsatile inflow and avoids extended reconstructive procedures.


Detection of lymphaticocutaneous fistula by radionuclide lymphangiography. The detection and evaluation of a postoperative lymphatic fistula using a simple and rapid method of dynamic radionuclide lymphangiography is described.


Complete obstruction of the gastric antrum in children following acid ingestion. We report on two children who experienced delayed complete obstruction of the gastric antrum following concentrated acid ingestion. Both patients required initial tube gastrostomy and subsequent antrectomy with intestinal reconstruction. Unlike the more common alkaline corrosives, ingested acids tend to spare the esophagus and gastric fundus. While gastric perforation and vascular collapse may occur immediately following overwhelming acid ingestion, the more common course is chronic gastric antral inflammation with subsequent fibrosis and, in some cases, complete stricture. Delayed surgical reconstruction is recommended to permit the acute inflammation and edema to subside.


Preduodenal portal vein: Two cases with differing presentation. Preduodenal or precholedochal veins are rare developmental anomalies of considerable surgical importance. Injury to these structures because of failure to recognize them during operations for unrelated diseases may result in thrombosis or hemorrhage. We recently encountered this anomaly twice, once in a newborn infant with duodenal obstruction and once in a 54-year-old woman undergoing cholecystectomy. The preduodenal vein was not the primary cause of obstruction in the infant, but injury to the previously unrecognized percholedochal vein in the woman resulted in a considerable loss of blood. Besides describing and illustrating these two cases, we also discuss the anatomy and the embryology of these structures and briefly review the patterns of 44 previously reported cases that we found.


Sigmoid volvulus in the young. A case following cesarean section. Sigmoid volvulus occurs more frequently in the younger patient than is presently thought. It is not infrequent in females. It usually presents with "colicky" abdominal pain, long-standing constipation or obstipation, and increasing distention of several days' duration. A history of similar attacks strengthens the suspicion for this diagnosis. Abdominal x-ray films will usually reveal severe colonic dilation down to a low point in the sigmoid, without gas in the rectum. The classic "horseshoe" sign is seldom seen, but when present, strengthens the diagnosis. Surgical manipulation and pregnancy may be contributing factors. Treatment should be surgical unless contraindicated by specific circumstances.


Oncocytoma of the parotid gland with malignant change. We report on a patient with preinvasive malignant change in an oncocytoma of the right parotid gland. Histologic transition from benign morphology to malignant cellular atypia, to our knowledge described only once previously in the literature, was present. Satisfactory results from wide surgical resection and postoperative radiotherapy in our patient serve as additional experience in the treatment of this rare malignancy.


Intermittent hydroephrosis. A cause of abdominal pain. Intermittent hydronephrosis may appear as acute abdominal pain. Between episodes of pain, the patient may be asymptomatic, and the intravenous urogram usually will be normal. The condition is diagnosed from intravenous urograms taken either during an episode of pain or after hydronephrosis has been precipitated by hydration. There are many causes of intermittent hydronephrosis; however, the closed renal pelvis and nondistensible ureteropelvic junction are important factors in nearly all cases. Pyeloplasty is the best treatment and is usually curative.


Treatment and prevention of Mobin-Uddin umbrella misplacement. Interruption of the blood flow in the inferior vena cava by a Mobin-Uddin umbrella has become a popular method of preventing recurrent pulmonary emboli. Although infrequent, complications are significant. An umbrella device was inserted in the right renal vein of a patient; the management of this complication is discussed. Immediate operative removal of the device with renal vein repair is recommended. Postoperative intravenous pyelogram and frequent urinalyses should be obtained to document continued renal vein patency and adequate renal function. Occurrence of this complication can be minimized by using a preinsertion cavogram to define anomalies of the venous system. Also, recent availability of an applicator that permits venacavography at the time of umbrella insertion should be of great assistance.


Tracheoesophageal fistula caused by cuffed tracheal tube. Successful treatment by tracheal resection and primary repair with four-year follow-up. A tracheoesophageal fistula secondard to prolonged nasogastric intubation and ventilatory assistance via a cuffed tracheostomy tube developed in a 27-year-old woman who had sustained a traumatic injury. The fistula grew progressively larger despite removal of the tubes, thus demonstrating the inherent poor prognosis associated with the untreated lesion. Since the cuff necessarily damages the trachea circumferentially at the same level, closure of the fistula and circumferential excision and reconstruction of the damaged tracheal wall were performed with an excellent result up to four years after the repair. This would be the preferred procedure when the patient can be weaned off the respirator and when the general condition and the size of the fistula allow such a definitive one-stage approach.


Carcinoma of the breast. A clinical study. An analysis of 1,686 surgically treated carcinomas of the breast in one community showed no statistically significant differences in five- and ten-year survival for simple, modified radical, or radical mastectomy. Further confirmation was obtained by computation of relative survival which in addition showed that older women more nearly approach normal life expectancy than younger ones. Bilaterality was found to be a decreasing function of age. Patients with medial and lateral tumors did not have significantly different rates of survival or sites of distant metastases.


Management of occult medullary thyroid carcinoma: evidenced only by serum calcitonin level elevations after apparently adequate neck operations. Following operation for medullary thyroid carcinoma, elevated serum calcitonin levels were present in 18 patients who had no clinically evident residual tumor. In eight of these patients, additional operations have been performed to achieve an appropriate thyroidectomy and cervical lymph node dissection. In six of these eight, elevated serum calcitonin concentrations persist. Extensive clinical examinations failed to identify a metastatic focus of carcinoma. Serum calcitonin concentrations have remained relatively stable for up to six years (average, 3.9 years) of observations in 12 patients after initial or only operations performed from one to 13 years (average 7.3 years) previously. This suggests that microscopic metastases of this carcinoma can remain relatively dormant for years. The management of medullary thyroid carcinoma requires initially adequate cervical operations, periodic serum calcitonin measurements postoperatively, reoperation if adequate neck surgery has not been performed and if serum calcitonin levels remain elevated and only periodic reevaluation for other asymptomatic patients with persistently elevated concentrations of serum calcitonin.


Management of severe hypercalcemia caused by primary hyperparathyroidism. Hypercalcemic crisis is a rare but often fatal complication of hyperparathyroidism (HPT). The reported mortality of 60% has been related to delay in diagnosis and appropriate treatment. During a 16-year period (1961 to 1977), 29 patients with severe symptomatic hypercalcemia caused by primary HPT were treated at the Surgical Service at the University of Michigan Hospital. This group represents 6% of the patients with primary HPT treated during this period. All but one patient had an exploration of the neck when the serum calcium level had been decreased to 12 mg/100 ml by intravenous hydration with saline, furosemide diuresis, and mithramycin when a hypocalcemic agent was required. One comatose patient died of irreversible shock. All of the 28 patients who had parathyroidectomies survived the early postoperative period. One patient died three weeks later of a myocardial infarction. This study demonstrates that emergent nonoperative care of parathyroid crisis, followed promptly by parathyroidectomy, can be successful in nearly all cases.


Primary hyperparathyroidism and peptic ulcer disease. To determine whether primary hyperparathyroidism is related to peptic ulcer disease, we evaluated 46 cases of concomitant primary hyperparathyroidism and peptic ulcer disease. Among these patients, there was no sex preponderance. The pathologic findings at parathyroid surgery, as well as the features of peptic ulcer disease, were the same as in patients with primary hyperparathyroidism or with peptic ulcer disease alone. The ulcer symptoms of 58% of the patients with adequate follow up improved after parathyroidectomy. Sixty-six percent of the patients who had active peptic ulcer disease at surgery improved as compared with only 44% of the patients who had complicated peptic ulcer disease. None of the factors studied (age, sex, serum calcium and serum parathyroid hormone levels, location, and duration of ulcer) had any effect on the peptic ulcer symptoms after parathyroidectomy. Our results and a critical review of the experimental and clinical literature suggest that the association between primary hyperparathyroidism and peptic ulcer disease is no more than coincidental.


Pulmonary effects of albumin resuscitation for severe hypovolemic shock. The effect of albumin when added to the resuscitation regimen of patients in hypovolemic shock was studied in a randomized prospective manner in 52 injured patients who received an average of 15.3 transfusions, 9.6 liters of balanced electrolyte solution, and 980 ml of fresh frozen plasma. Before and during operation, 27 patients received an average of 25 gm of albumin and 150 gm/day for three to five days. Patients who received albumin had greater dependence on respiratory support, averaging eight days while receiving ventilatory support with volume ventilator compared with three days in patients not receiving albumin. Furthermore, patients receiving albumin had forced inspiratory oxygen/Pao2 ratios that were statistically and significantly higher than those of patients not receiving albumin during all phases of their hospital course. These effects were associated with increased plasma volumes caused by the oncotic effects of albumin and by its interference with saline diuresis. On the basis of this preliminary report, albumin seems to have a detrimental effect on respiratory function.


'Lethal' burns. A progress report.

'Lethal' burns. A progress report. Sixteen consecutive patients, nine of whom also had inhalation injury, had burns over 72% body surface area or more. The expected death rate was 94%. In fact, all of the eight patients still alive after 48 hours survived. The early deaths were primarily due to inhalation injury, the treatment of which remains an unsolved problem. A mixture of cerium nitrate and silver sulfadiazine was used for topical wound antisepsis. The wound flora was sparse: 447 of 814 wound-surface cultures were sterile; Gram-negative bacteria were recovered in 13%. This efficacious wound bacteriostasis appeared primarily responsible for the absence of late death.


Traumatic injuries of the inferior vena cava. Three hundred and one patients with injury to the inferior vena cava have been treated over the past 30 years. Penetrating injuries predominated, with gunshot injury in 228 patients. The inferior vena cava was injured above the renal veins in 84 patients. One hundred and forty-eight patients had shock, 55 without palpable pulse or blood pressure. Vascular repair was accomplished in 234 patients. Ligation or packing was performed in 32 patients. Thirty-five patients died prior to vascular control or repair. Placement of intravascular shunts or occluding balloons was utilized in 25 patients. Mortality has decreased from a high of 100% in 1955 to 30% during the last six years of this experience. Reduction in mortality probably has resulted from shortened wounding to therapy intervals with more effective resuscitation and vascular control.


The validity of normal arteriography in penetrating trauma. The detection of underlying arterial injury is a major problem in the management of penetrating trauma. Arteriovenous fistula and false aneurysm are late sequelae of unrepaired injuries. The diagnostic accuracy of arteriography in clinically occult injury has not been defined. One hundred and seventy-seven patients with 183 penetrating extremity wounds underwent arteriography followed by operative vessel exploration. Arteriogram/operation correlation demonstrated 36 true-positive, 132 true-negative, 14 false-positive, and one false-negative arteriogram. Arteriography is sufficiency sensitive to exclude the presence of arterial injury in patients with equivocal clinical signs of injury. The radiographic changes are often sublte and diagnostic accuracy demands attention to the details of technique and interpretation. Unequivocal clinical signs of arterial injury and any arteriographic abnormality are indications for operative exploration.


Deep venous thrombosis and postsplenectomy thrombocytosis. Eighty-six patients undergoing elective splenectomy have been investigated preoperatively and postoperatively by serial platelet counts and leg scanning using iodine 125-labeled fibrinogen. The presence of deep leg vein thromboses detected by labeled fibrinogen was confirmed by dye phlebography. In only five patients (6%) did deep venous thrombosis develop. In none of these five patients did an elevation in platelet count to 600,000/cu mm develop before or at the time of development of the thrombosis. None of 21 other patients who did have a rise in platelet count greater than 1,000,000/cu mm had evidenced of venous thrombosis. These data do not substantiate the need for routine prophylactic antithrombotic therapy in patients in whom postsplenectomy thrombocytosis develops.


Early decortication after thoracic trauma. Twenty-three patients who sustained either blunt or penetrating thoracic trauma underwent early decortication after failure of chest tube drainage. Patients were divided into two groups: (1) ten with isolated chest injuries were compared with (2) 13 with chest trauma and other associated major injuries. Group 1 patients had earlier decortication (10.3 days), rapid recovery (home in 6.1 days), and little morbidity. Group 2 patients had later decortications (19.3 days), higher incidence of infected clot, yet were home in 9.8 days after thoracotomy. Early decortication is advocated as a safe and expedient means of dealing with the complications of traumatic pneumothorax and hemothorax.


Radiotherapy combined with curative surgery. Its use as therapy for carcinoma of the sigmoid colon and rectum. Local recurrence rates for colorectal carcinoma occur in the range from 20% to 35%. For this reason, postoperative radiotherapy was evaluated as a measure to achieve local disease control in the pelvis. Patients with tumors penetrating the entire bowel wall or with regionally involved lymph nodes received approximately 5,000 rads over a six-week period that commenced three to six weeks after surgery. Sixty-two patients treated by this method are compared with 168 patients treated without adjunctive radiotherapy. Five local recurrences occurred in the group receiving radiotherapy; a reduced incidence compared to the group managed by surgery alone. Complications attributable to radiotherapy included radiation enteritis and bowel obstruction. Measures to minimize complications with this combined approach have been identified. Surgery followed by adjuvant radiotherapy may be performed with an acceptable complication rate and this appears promising in reducing local recurrence of carcinomas of the sigmoid colon and rectum.


A critical evaluation of the Duhamel operation for Hirschsprung's disease. Eighty-nine patients with Hirschsprung's disease were treated from 1972 to 1977. Of the patients, 70 were boys, 85 were the result of full-term pregnancy, and four had Down's syndrome. There were 23 children, 32 infants, and 34 neonates including seven (20%) with enterocolitis. Early mortality was 8.8% in neonates and 3% in infants. After initial diversion (colostomy or enterostomy), 66 patients had "classic" (ten), modified (52), or "long" (four) Duhamel pull-through procedures at age 1 year. Operative mortality was zero. Three late deaths occurred; two of them were mongols. Fecaloma occurred in eight of ten classic cases that required revision. Postoperative enterocolitis occurred in three of four long procedures done for total colonic aganglionosis. The modified Duhamel procedure was associated with a low complication rate and good function. There were no instances of anastomotic leak, anal stricture, or genitourinary problems. These data indicate that the modified Duhamel operation is a highly acceptable procedure in the management of Hirsch sprung's disease.


Intra-abdominal infection and acute renal failure. The course of 76 consecutive patients with acute renal failure and severe intra-abdominal infection was reviewed to identify the microorganisms responsible, the factor precipitating reoperation, and prognostic indicators. Peritonitis occurred in 75 patients, 48 of whom had abscesses. Twenty-four patients (32%) survived. Anaerobes and fungi were commonly grown from blood. Gram-negative aerobic blood isolates were associated with the highest mortality. Leukocytosis, physical findings, and fever were factors that prompted reexploration whereas diagnostic procedures played an ancillary role. The finding of specifically correctable conditions at reoperation improved survival (P less than .05). Myocardial infarction and disseminated intravascular coagulation affected survival unfavorably whereas hyperalimentation had a favorable influence (P less than .05). Aggressive medical, nutritional, and surgical management results in improved survival rates in these patients.


Endoscopic electrocoagulation: an alternative to operative therapy in bleeding peptic ulcer disease. Twelve patients with severely bleeding peptic ulcers (six duodenal, five gastric, and one esophageal) who were considered to be at high operative risk were treated instead by endoscopic electrocoagulation of the bleeding point. Arrest of the bleeding was permanent in ten, one bled again two days later, and one patient died of nonulcer disease one day later. Although this method to control bleeding from peptic ulceration is new, it seems to offer promise especially when treating desperately ill people.


Proximal hepatic duct reconstruction. Repair using sutureless mucosal graft hepaticojejunostomy. Six patients who had hepatic duct lesions, five who had strictures, and one who had a right hepatic duct transection underwent repair by sutureless mucosal graft hepaticojejunostomy. All patients had initial improvement, and five have maintained excellent biliary-intestinal continuity after an average 25-month follow-up. In one patient, recurrent symptoms developed and she died of cholangiocarcinoma. This technique is simple and fulfills the criteria for successful high hepatic duct reconstruction. The promising early results in these patients suggest that this procedure may provide a superior approach to this difficult problem.


Inframesocolic transduodenal approach to the distal biliary-pancreatic ductal system. The usefulness of the inframesocolic transduodenal approach to the distal biliary system in patients in whom numerous previous procedures had been performed was evaluated. First, the feasibility of the technique was ascertained by anatomic study. Ten anatomic dissections were performed during routine postmortem examinations. This proved that the duodenum, ampulla of Vater, distal common duct, and head of the pancreas could be adequately exposed via the inframesocolic approach and that it was reasonable to use the procedure clinically. This approach has been used successfully in five cases. It was found that (1) the inframesocolic approach to the duodenum and distal biliary system is useful, particularly in those patients requiring second operations in the right upper quadrant; and (2) the approach allows ready access to the area through virgin territory and has distinct advantages in exposure, operative time, and information available.


Evaluation of ultrasound in the diagnosis of acute and chronic biliary tract disease. Oral cholecystography and intravenous cholangiography are the two studies most frequently used to confirm the diagnosis of biliary tract disease. Since it is not always practical to obtain these in acutely ill patients, gray scale sonography was evaluated to determine its accuracy. One hundred eight patients had sonography performed prior to operation. The sonogram was correct in 96 of the 108 patients (89%). There were four false-negatives (3.7%), one false-positive (0.9%), and seven patients (6.4%) in whom the study was nondiagnostic. Stones were seen in 88 patients and confirmed in 87 patients for an accuracy of 98.9% Sonography is a simple, noninvasive procedure by which cholelithiasis can be accurately detected. Because of the high correlation between sonography and operative findings, we suggest that cholecystosonography be used as the initial screening study in patients suspected of having biliary tract disease.


Pancreatic cystadenoma. A clinicopathologic study of 45 cases. Forty-five patients with pancreatic cystadenoma were treated surgically at the Mayo Clinic between 1939 and 1975. Each lesion was classified as mucous or serous. The most frequent lesion site was the tail of the pancreas. The typical patient was a middle-aged woman with upper abdominal pain and a palpable mass on initial examination. Total extirpation of the cystadenoma was the treatment of choice; internal drainage or external drainage of these cysts should not be done. Occasionally, the nearness of the tumors to the mesenteric vessels precluded excision. The mucous type had malignant potential whereas the serous does not. None of the cystadenomas subsequently underwent malignant degeneration. Because of the slow-growing characteristics of the tumor, undue operative risks should not be taken.


[Studies on nitrogen and amino-acid absorption in the swine. Part 2. The course of 15 N labeling in the chyme, urine and blood]. Three female pigs provided with re-entrant canulas at the beginning and the end of the small intestine and catheterized for blood and urine collection were once fed a 15N-labelled mixed diet. Until 48 hours after feed intake chyme from the canulas and urine and blood were collected at varying intervals. All 15N-frequencies measured in the duodenal chyme were found to be below the labelling of the feed protein. Until 11 hours after intake of the labelled feed, the residue obtained by centrifugation of the intestinal contents revealed the highest 15N-labelling. Only slight differences were found in the frequencies of the other fractions (proteins, peptides, free amino acids). The almost constant labelling of all fractions in that period is indicative of a dilution with endogenous nitrogen being constant in comparison with food N. The 15N-frequencies of the chyme fractions observed at the end of the small intestine allowed to conclude that the breakdown of the food proteins is more complete than the disintegration of the endogenous proteins.


[Studies on nitrogen and amino-acid absorption in the swine. Part 1. Passage of the chyme in the small intestine]. Three female pigs of about 50 kg liveweight were provided with re-entrant canulas in the upper and lower sections of the small intestine and were catheterized to collect urine and blood (vena jugularis). After feeding once the experimental diet containing 15N-labelled, fat extracted dry curd as protein component, it was possible to determine, on two days, the chyme passed through the canulas and to separate aliquote portions thereof for analysis. The cellulose contained in the food was used as indicator for the passage rate of the chyme in the small intestine. The passage rates in the small intestine calculated from the amounts of cellulose and chyme were found to agree fairly well. The passage rates in the upper part of the small intestine were characterized by strongly marked, short-time peaks, right after feed intake, and by periods of relatively even chyme flow some eight hours after feeding. At the end of the small intestine almost constant chyme passage rates were observed over the whole experimental period.


[Studies on the performance-related lysine requirement in fattening pigs. 1. Influence of energy and aminoacid intake on fattening]. A total of 110 barrows fed varying levels of energy and amino acids in 8 treatments, were tested. The weight gains per fattening day and energy expenditure were found to be mainly determined by energy intake. Up to a liveweight of 100 kg both low and high levels of amino acid supply produced the same fattening performance results as amino acid supply to standard. In the 100-120 kg liveweight range, the animals fed higher levels of protein proved slightly superior. As to energy expenditure, animals subjected to restricted feeding up to 70 kg liveweight and fed full rations later, consumed 2.22 kEFs (2.22 kilo energetic feed equivalents/swine) per kg gain and proved significantly superior to those animals that were very intensively fed at the beginning and put to restricted feeding beyond 70 kg liveweight (2.53 kEFs per kg gain) as well as to those receiving high levels of energy all the time (2.39 kEFs/kg gain). In the latter case, 23 g of lysine were required per kg gain.


[Influence of sex and live body mass on the true protein and amino-acid digestibility of various animal feeds in pigs. 1. Comparative studies between barrows and female pigs]. Growing barrows and female pigs of 3 liveweight ranges (20-30 kg, 50-60 kg, 80-90 kg) were used to study the true digestibility of protein and essential amino acids from 4 cereal species and 4 high-protein concentrate using the fecal analysis method and regression techniques. No significant differences were found between the females and the barrows in the true digestibility of the protein and most of the amino acids from the protein carriers under study. In the 3rd liveweight range, the true digestibility of some amino acids of the cereals proved somewhat lower in tendency with female animals. In comparison with the true digestibility of protein, in the cereals under study that of lysine gave significantly lower, and that of cystine, arginine, phenylalanine and histidine significantly higher values. The relative values (protein = 100%) were 85.0, 110.6, 106.8, 106.5 and 105.5 for lysine, cystine, arginine, phenylalanine and histidine, respectively. The true digestibility of the remaining amino acids is comparable to that of protein.


[Studies on the vitamin requirement and vitamin supply in fattening turkeys. 2. Checking the vitamin supplements to state-approved mixed animal feed for fattening turkeys]. In turkey fattening experiments, the vitamin A, vitamin D3, vitamin B6, vitamin B12, niacine, pantothenic acid, folic acid, biotine and choline chloride additions to mixed feeds for fattening turkeys were checked. The vitamin A requirement of the fattening turkey is met, in all stages of growth, by adding 3,000 I.U./kg feed. For vitamin D3 the necessary supplements are 1,000 and 500 I.U./kg for starter feed and fattening mixes, respectively. The requirements for vitamins B2, B6, B12, niacine, pantothenic acid, folic acid and biotine of the fattening turkey are covered by the respective amounts contained in the ration components. To ensure adequate choline supply (optimum gain, small losses) during the starter period, the addition of 500 mg/kg feed proved necessary. On the basis of the results presented, recommendations are given for requirement norms and mixed feed supplementation that have been fully implemented in the meantime.


[Effect of the roughage sequence and concentrates in animal feed on carbohydrate digestion and bacterial protein synthesis in the rumen of dairy cows]. In experiments with dairy cows provided with rumen fistulas and duodenal re-entrant canulas, the order of feeding roughage (chopped forage and pellets) and concentrates (maize and barley) was found to influence carbohydrate digestion and bacterial protein synthesis in the rumen. Feeding the roughage 90 min. before the concentrate caused a wider C2:C3 ratio and a sustained course of the pH-value (greater than 6.5) than the ratio other way round. This favoured cellulose digestion in the rumen when feeding chopped roughage. When feeding roughage before concentrates, the nonbacterial N-proportion in the duodenal contents proved greater than in the reverse order and revealed the highest values for roughage fed in pelleted form. Feeding structured roughage as first component of the diet with concentrates given afterwards is, therefore, recommended for dairy cows.


Characterization of the size and charge heterogeneities of human leukocyte interferon populations. Human leukocyte interferons are separable into two size components by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and are separable into two charge-components by DEAE-BiGel A chromatography. However, each of the charge-components resolved by ion-exchange chromatography contained both size-components, when analysed by SDS-PAGE. Thus, there are more than two distinct molecular populations of human leukocyte interferons.


[Thymectomy in myasthenia gravis. Evaluation of the results in 73 patients]. An evaluation of results obtained after 73 thymectomies is reported. A transthoracic approach was used on all of the patients. Thymomas were found in 9 out of the 73 patients with myasthenia. All of the 64 patients without thymomas suffered from generalized myasthenia gravis with predominance of severe forms. The results of the early, intermediate and late post-operative course were analysed. A comparative study of results as related to age, sex, duration of disease and presence or absence of thymomas was made. Statistical analysis failed to show any significant difference in the results of thymectomy between selected and randomly chosen patients without thymomas.


[The basilar impression and the Arnold-Chiari malformation. Techno-surgical considerations apropos of 13 cases]. The surgical technic for decompression of the posterior fossa in cases of basilar impression and malformation of Arnold-Chiari mainly based in (1) endotracheal intubation without any flexion of the head, (2) position of the head without anterior flexion during the surgery, (3) plastic of the posterior fossa with dura-mater of cadaver conserved in glicerina, was emploied in 13 patients. The plastic was made to create space at the craniocervical joint in order to avoid cerebrospinal fluid fistula and to restore the integrity of the dura. Infection was not observed.


[Neurological and electroencephalographic outcome in children after purulent meningoencephalitis]. Twenty children with meningitis diagnosed in the Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto between 1963 and 1967 were available for prospective study; each was submitted to neurological and electroencephalographic examination, D.Q. (Gesell) and I.Q. (Raven) tests. Patients were followed from 6 months to 3 years after the acute phase of the disease. There is statistically significant difference between the D.Q. of post-meningetic children and the D.Q. of non meningitic controls of same social class and ages, when the onset of illness was before 30 months of age. No statistically significant correlation was found between the D.Q. and the patient's length of hospitalization or the first cerebrospinal fluid protein level. There is a possibility that significant correlation between the D.Q. and age at onset of illness may be observed by studying a larger number of patients. No statistically significant difference was found between the I.Q. of post-meningitic children and controls when the onset of illness was after age 4.


[Schizophrenia and birth order].

[Schizophrenia and birth order]. With the possible most powerful goodness-of-fit test available until now, the Halperin's chi-square, a statistically significant association between schizophrenia and birth order in 1016 brazilian patients is reported. This association is with early and last born males, favoring theories which put emphasis on stressful experiences over children who are in the extremes of their sibships. There is a sex factor: females show no association. Factors which could introduce bias, as family size, social class and incomplete sibships were tentatively controlled. Since in Brazil no population data are available, the Greenwood-Yule method seems useful and valid for the purpose, with the aid provided by Halperin's chi square modification. A brief comment on results and earlier studies is made, together with suggestions for future research.


[Vogt-Koyanagi-Harada syndrome: report of a case]. A case of Vogt-Koyanagi-Harada syndrome which had an ocular onset unilateral in the beginning and bilateral afterwards is reported. One month after the disease had appeared a psychiatric disturbance was detected characterized by mania and loss of the critical sense. The alterations detected in the eletroencephalograms and cerebrospinal fluid are discussed. After a three and a half years follow up, despite the corticotherapy the patient had a poor evolution on the ophtalmological aspect but the psychiatric recovery was total.


[Thrombosis of the anterior and middle cerebral arteries as the 1st manifestation of systemic lupus erythematosus: report of a case]. The case of a young female patient with hemiplegia and aphasia of sudden onset as the initial manifestation of systemic lupus erythematosus is reported. The arteriographic study showed occlusion of the proximal portion of the left anterior cerebral artery and of the trifurcation of the left middle cerebral artery. The neurological manifestations in systemic lupus erythematosus may appear before there is any clinical evidence of involvement of others organs. The authors think that systemic lupus erythematosus should be suspected in every young female patient with acute cerebrovascular accident of unknown etiology.


[Solitary intramedullary tuberculoma: report of a case]. A case of an isolated tuberculoma of the spinal cord is reported. The 22 years old male patient came to the hospital with paraplegia and had a laminetomy performed for a compression of the spinal cord by a tumor mass. The histopathological study showed the presence of the acid-fast bacili in the tissue. After specific treatment the patient recovered partially.


[Fibromyxosarcoma in a child; report of a case]. The case of a six-year old boy's with intracranial hypertension and cranial deformities is reported. Radiological examination showed signs of intracranial hypertension and a large osteolitic area in the left posterior parietal region. Cerebral cintilography showed many abnormal captation areas. Pneumoencephalography showed deformation of the ventricular system without dilatation. Angiographic study gave images of tumoral compression by meningitic processes. Craniotomy in the osteolytic area showed an infiltrating tumoration between dura and piamater, reaching frontal, temporal and bilateral parietal areas. Histopathological examination confirmed the diagnostic of fibromixosarcoma.


Malignant hyperthermia and central core disease in a child with congenital dislocating hips. We describe a development of a malignant hyperthermia (MH) syndrome, partially aborted by therapy, in a child with central core disease and congenital dislocating hips. Patients with central core disease appear to be more susceptible to MH; possibly those with elevated serum creatine phosphokinase levels, as in our patient, are especially susceptible. We review the clinical and pathologic aspects, possible pathogenesis, and treatment of the MH syndrome. An increased calcium level within the muscle fiber is suggested as the major cytodestructive factor, and that increase could be consequent to a plasmalemmal susceptibility to the provoking drugs hypothesized to be the basic defect in MH. Prevention of the full manifestations of MH is predicated on (1) a high index of suspicion in the search for history of anesthetic complications in the patient and his family, with or without evident neuromuscular disease, (2) recognition that there is a somewhat greater risk of MH developing in a patient who has certain "musculoskeletal" abnormalities or muscle weakness but that is not-except for central core disease-a classic clinicopathologically defined disease, (3) close monitoring of patients during anesthesia, and (4) if the syndrome develops, prompt therapeutic measures, including cessation of anesthesia.


The syndrome of 'continuous muscle fiber activity.'. A 7-year-old boy who suffered from increasing stiffness and contractures of the extremities had distally pronounced atrophy and absent tendon reflexes. Electromyography showed continuous electrical activity during rest, sleep, after intravenous injection of diazepam, and after peripheral nerve block. The H reflex was elicitable; the silent period after the reflex was absent. Histopathological examination of the peroneus muscle disclosed a marked preponderance of type I fibers and slight atrophy of the type II fibers. Electron microscopic examination of the endplates demonstrated a marked atrophy of the postsynaptic regions and widened synaptic clefts. After one year's treatment with phenytoin, 200 mg daily, the patient showed an almost normal muscle tone. As not all of these electrophysiological phenomena can be fully explained by disturbances of the nerve terminals or the endplates, a further anomaly proximal from the peripheral nerve block seems to have been present.


Prognostic factors in the survival of 1,484 stroke cases observed for 30 to 48 months. II. Clinical variables and laboratory measurements. Using the life table method, 962 cases of infarction, 279 cases of hemorrhage, and 243 cases of undetermined type of stroke, occurring in Manitoba between Jan 1, 1970, and June 30, 1971, were analyzed for factors affecting survival. Survival until Dec 31, 1973, was found to be adversely affected by the presence of coma or unconsciousness and the absence of localizing signs and symptoms. Also, the prognosis was poor if the heart was enlarged on the x-ray film or the ECG was abnormal. On the other hand, the presence of individual clinical entities such as hypertension, hypertensive heart disease, myocardial infarction, atrial fibrillation, or diabetes did not affect the survival significantly. These findings will help in predicting the prognosis and in planning for management of stroke cases.


Tolosa-Hunt syndrome. Arteriographic evidence of improvement in carotid narrowing. Diagnosis of Tolosa-Hunt syndrome was made in a 25-year-old woman on the basis of unilateral third and sixth nerve paresis and possible involvement of the first branch of the ipsilateral trigeminal nerve, accompanied by headaches and ocular pain, which responded promptly to corticosteroid administration. Irregular narrowing of the right carotid siphon and occlusion of the homolateral superior ophthalmic vein were observed. During steroid therapy this stenosis improved in association with almost complete clinical recovery, although the vein was not recanalized. Of ten reported cases with contrast radiographic abnormalities, including our own, only two showed pupillary involvement. We hypothesize that the third nerve paresis with pupillary sparing in this syndrome may be attributable to the same underlying mechanism as that of diabetic ophthalmoplegia.


Abnormal iris vasculature in myotonic dystrophy. An anterior segment angiographic study. The microvasculature of the iris was studied in 35 patients with neuromuscular disease and 14 control subjects, using anterior segment fluorescein angiography. Myotonic muscular dystrophy, in which a variety of ocular changes have previously been reported, was found to be associated with both focal and generalized vascular abnormalities. Changes were seen in the fluorescein angiograms of all nine of the myotonic dystrophy patients in which the iris vessels could be seen. No evidence of a microcirculatory disorder was seen in patients with Duchenne's dystrophy, for which a vascular pathogenesis has been proposed. The angiograms of patients with limb-girdle dystrophy, facioscapulohumeral dystrophy, and Friedreich's ataxia were also normal.


Auditory nerve and brain stem responses. Comparison in awake and unconscious subjects. The recording of auditory nerve and brain stem responses to click stimuli is being used for the diagnosis of several conditions such as suspected hearing loss and suspected neurological disorders. The responses obtained in the patient group (often infants and children) are compared with those obtained in normal subjects of similar age who, for ethical reasons, are not sedated. In this study, recordings were made in normal subjects while they were awake and when they were unconscious in drug-induced sleep (being prepared for dental surgery). No significant difference could be observed between the recordings obtained in the awake state and when unconscious in the same subjects. Therefore, one is justified in using recordings made in awake subjects as controls for recordings made in other unconscious patients.


Prenuclear paresis of homolateral inferior rectus and contralateral superior oblique eye muscles. In a case of left inferior rectus paresis, it is demonstrated that the lesion must be prenuclear. On downward gaze, the left eye, although it reached the required target with a rapid saccade, drifted back towards the midline immediately afterwards. During the drift, several corrective saccades appeared. A dissociated "gaze paretic" nystagmus resulted. Synchronously, the right eye showed an incyclorotary nystagmus. We suspect a lesion of "tonic" fibers supplying the nuclear region of the left inferior rectus and the right superior oblique muscle.


Reversible effect of dantrolene sodium on twitch tension of rat skeletal muscle. The effect of dantrolene sodium on twitch tension in skeletal muscle of the rat was studied in short- and long-term experiments. The twitch tension is reduced to 50% of the control values within 20 to 30 minutes of drug administration. The recovery phase is considerably slower than the effect observed on the addition of dantrolene sodium, having a half time of 10 hours. Twenty-four hours after the drug injection, the twitch tension in the treated muscles is indistinguishable from that in the controls. It is shown that the reduction in the magnitude of the twitch produced by dantrolene sodium is slowly and completely reversible.


Axial myopia. A neglected cause of proptosis. Ten patients who had unilateral proptosis ranging from 2.5 to 4.0 mm were found to have axial myopia confirmed by ultrasonography and, in one case, by computerized tomography. The historical features emphasized include an acquired painless bulging eye, amblyopia, and a stable visual acuity. Noteworthy features on ophthalmologic examination include a difference in visual acuity and refraction between the two eyes, a difference in the lenses on inspection of the patient's glasses, and an ipsillateral myopic fundus. Careful history taking, examination, ultrasonographic evaluation, and inspection of old photographs will separate this group of patients and avoid unnecessary endocrine studies, angiography, and costly neuroradiologic investigations. Finally, it must be recognized that coexisting disease must be evaluated as if the proptosis did not exist.


Swine influenza vaccination in patients with multiple sclerosis. Swine influenza vaccination was tolerated well by 61 multiple sclerosis patients. A new neurologic symptom developed in one patient, one noticed the recurrence of previous symptoms, and two patients experienced systemic signs of toxicity.


Fatal massive intracerebral hemorrhage complicating cerebral amyloid angiopathy. A 58-year-old normotensive woman died 24 hours after a stroke. Two months earlier, she had a transient neurological episode consistent with cerebrovascular insufficiency. Necropsy demonstrated a massive recent hemorrhage in the right occipital lobe associated with severe cerebral amyloid angiopathy (CAA). The cerebral cortex showed interstitial and perivascular neuritic plaques but no Alzheimer's tangles. There was no family history of CAA. A review of the literature indicated that only ten cases of such hemorrhage caused by nonfamilial CAA have been reported. Massive intracerebral hemorrhage seems to be more common in patients with familial Icelandic forms of CAA.


The inverse Marcus Gunn phenomenon. An electromyographie contribution. A patient with the inverse Marcus Gunn anomaly is presented. Electromyographic studies showed the salient fact that the closing of the involved eye on opposite motion of the lower jaw was not mediated by seventh nerve stimulation of the orbicularis oculi but by inhibition of the homolateral levator palpebrae superioris. As a consequence of this observation, a specific and effective operation could be planned.


Spinal cysticercosis.

Spinal cysticercosis. Myelopathy in a Cambodian patient proved to be due to cysticercosis. Spinal cysticercosis is rare, and Indochina is an unusual place to have acquired it.


Speech arrest in a dextral with a right mesial frontal astrocytoma. A right-handed man had clustered groups of seizures characterized by speech arrest over a period of eight years. Later, speech arrest was accompanied by head-turning to the left and altered tone of the left limbs. An astrocytoma, centered in the right supplementary motor region, was identified. This case confirms the experimental data of speech arrest emanating from the right paramedian cortex of a right handed man.


Simulation of injuries in disaster exercises. It is essential that hospitals, doctors, nurses, ambulances, helicopters, police, fire services and all others involved in major accidents or disasters should have adequate training in the assessment, management and transport of casualties by the means of regular disaster exercises. These practices, whether small or large, are much more realistic if casualties are properly made up to simulate the injury that they are supposed to represent, and if the 'patients' can act the part. The illustrations in this article show how real the make-up can be and how seriously the doctors, nurses, ambulance officers, fire and police officers and others take these exercises which often have between 100-200 'victims'.


Safety at disaster sites.

Safety at disaster sites. Safety at a disaster scene is a subject rarely considered by medical personnel when preparing for rescue work. As no one can predict accurately the nature of the hazards rescuers may have to face, a common attitude is to ignore the subject and trust to common sense and good judgment to cope with the situation when it arises.


Crush syndrome.

Crush syndrome. The crush syndrome has been an accompaniment of crushing injuries following disaster situations. Recognition of the sequence of events and early institution of the appropriate therapy is essential, if life is to be saved in these critically injured persons. Treatment should be begun 'on site' and arrangement then made for transport to a major medical facility as rapidly as feasible.


Simple guidelines to disasters.

Simple guidelines to disasters. Good organization and communications are essential in the management of disasters and major accidents. A quick method of assessment of patients and simple guidelines to resuscitation, splinting and emergency care are given in this illustrated paper on the optimum procedures to be followed by doctors and other who may be asked to assist.


"Who cares?" A comment on the Australian general practitioner. The recent Australian publication "Who cares?" offers the family medicine student and the family physician: Affirmation of the preminence of the GP as the professional of first resort for a wide range of Australian families. A typology of families in terms of the way they relate to health care and its providers. A picture of the experience of health care offered to some Australian families, and its relevance to their condition. A typology of GPs in terms of their willingness to extend their role to include the family's total 'welfare'. Criticism of the GP in failing to refer patients to existing community services. Implications for medical education in terms of development of the GP's communication skills in relation to both patients and other health and welfare professionals.


The elderly isolate.

The elderly isolate. Isolates do not differ from other elderly people in respect of their medical illnesses. They do differ in their ability to cope. When well, they cope better than do non-isolates. However, when incapacitated by sickness, they require supportive help services more often and if these are lacking, are more likely to be admitted to a nursing home. Loneliness, alcohol dependence and depression are more often problems of the isolate.


The assessment of need for support services as seen by general practitioners and a geriatric population. The majority of doctors accepted the need for involvement in the management of patients with behavioural, family and welfare type problems. The health team concept was seen as desirable by a majority of respondents, though they appeared to feel that it made no great difference if the team members functioned from a health centre or were located in different sites. They were not so well informed as to the availability of supportive welfare services as they were of medical services. Of the elderly people interviewed, most had received medical care in the previous two months, and chiropody was the commonest supportive service used. About half were assessed as having at least one disability affecting their functional capacity, and a significant number were thought to be receiving inadequate care. There was an obvious need for home help services, which were in limited supply.


Relationship between CO2 levels and decompression sickness: implications for disease prevention. Extensive data concerning the incidence of decompression sickness among workers participating in the deepest caisson operation in Japan to date have been collected and analyzed for the period April through August, 1976. When the bottom pressure was between 3.0 and 3.2 ATA, the incidence of decompression sickness was 3.05%; subsequently, the incidence was only 0.96% between 3.2 and 3.4 ATA. The man lock (i.e., decompression chamber) had never been ventilated during the former group of decompressions and the level of CO2 had ranged between 1.8 and 2.3% (v/v); in the latter group of decompressions, the CO2 level ranged between 0.3 and 0.8% with ventilation. All other conditions, including the decompression table used, were the same. Moreover, based upon the nature of the muscular activity required of the caisson workers just prior to decompression, their most common site of affliction was found to lie within the body region where the highest tissue tensions of CO2 would be expected during decompression.


Effects of high altitude on plasma concentrations of testosterone and pituitary gonadotropins in man. Ten healthy male volunteers were rapidly taken to the top of Pike's Peak, altitude 14,100 ft (4,300 m) where they remained at the research station for 6 d. There were no significant changes, compared to their values at sea-level, in the plasma concentrations of testosterone, FSH, and LH during this period. There was a highly significant direct correlation between individual changes in testosterone and the gonadotropins on Day 1. Our data provide no evidence for an acute effect of high-altitude per se on the secretion of testosterone and the pituitary gonadotropins.


Improved method for studying the surface chemistry of bubble formation. Bubble formation in agarose gels as a result of rapid decompression following saturation with either N2, CO2, or He has been studied. Bubble number was observed to vary predominantly as a function of decompression magnitude and was virtually independent of the particular gas used. The cavitation threshold (i.e., 1 bubble in 50% of trials) was found to fall between -3 and -4 psig ( approximately -0.25 atm) for all three gases. Modification of the ionic content of the agarose gel medium, either by lowering the pH or including polyvalent cations, had only slight effects, if any, on the number of bubbles produced by a given decompression. From these results, and the work of others briefly reviewed in the paper, it is concluded that the surfactant monolayer surrounding a gas cavitation nucleus is comprised almost exclusively of nonionic surface-active molecules.


Effects of using long breathing hoses upon mask pressure. Effects of using oxygen breathing hoses from 0.9 to 8.2 m (3 to 27 ft) long and mask fit upon mask pressure during 0.75 to 12-s decompressions from 2,438 m (8,000 ft) to either 6,096, 10,668, or 15,240 m (20,000, 35,000 or 50,000 ft) were determined. Peak mask pressures and duration of high mask pressure were related to mask fit, mask and hose stretch compliance, pressure differential, decompression rate, and other factors, with mask pressure increasing with hose length. Peak mask pressures frequently exceeded 80 mm Hg, a high pressure associated with increased incidence of pulmonary damage. Cargo-type aircraft, however, have sufficiently large volumes so that they will not decompress rapidly enough to have high mask pressure, even with an 8.2-m long hose. Long breathing hoses should not be used in smaller aircraft since small cabin volume will result in rapid decompression rates and high mask pressure. Above a flight altitude of 2,438 m, oxygen should always be breathed if hoses longer than 2.9 m (9 ft) are used. This would help prevent hypoxia, associated with the need to deplete air in the hose before oxygen is breathed, should cabin pressure be lost at a high altitude. The fastest decompression rates compatible with preventing mask pressures from exceding 80 mm Hg during decompressions to different altitudes with different length breathing hoses are given.


Incremental exposure facilitates adaptation to sensory rearrangement. The rate of adaptation to unusual patterns of vestibular stimulation is enhanced if the final stimulus level is achieved gradually rather than in a single step (6,7). Measurements of adaptation to visual rearrangement elicited by stepwise and single-step exposure indicate that incremental exposure also facilitates adaptation to visual rearrangement; adaptation is diminished when the optical displacement is varied nonsystematically during exposure. Enhancement of adaptation to unusual patterns of sensory stimulation by incremental exposure may reflect a general principle of sensorimotor function.


Effects of long-hose breathing.

Effects of long-hose breathing. The need for aircrew members to use long breathing hoses between regulator and mask arises in the design of new transport aircraft and in several cargo operations requiring an open rear door. In this study, induced work of breathing through long hoses, the resulting changes in oxygen consumption, and comfort were studied in relation to altitude, hose length, and  exercise level. Conclusions were that, above 18,000 ft (5.5 km), a 30-ft (9.1-m) hose is acceptable for all reasonable work levels; for altitudes between 13,000 and 18,000 ft (4.0 and 5.5 km), the hose length should preferably be 18 ft (5.5m), and at altitudes below 13,000 ft (4.0 km), hose length should be limited to 12 ft (3.6). Moreover, at ground level, the hose length should be limited to 6 ft (1.8 m) for all but sedentary activity. Should the potential for rapid decompression exist, at any altitude, volume considerations limit hose length to 18 ft (5.5 m) since larger hoses possess excessive regulator-to-mask dead space.


Comparison of several G-tolerance measuring methods at various seatback angles. The most commonly accepted endpoint indicative of impending "blackout" for subjects (Ss) exposed to +GZ on a centrifuge is peripheral light loss (PLL). A comparison was made using PLL and cessation of bloodflow in the temporal artery, as measured in eight Ss with an externally mounted ultrasonic flowmeter using the doppler effect. Each relaxed S was exposed to increasing G (onset rates of 0.1 and 0.3 G/s), while positioned at seatback angles of 15 degrees, 60 degrees, and 75 degrees. In addition to the flowmeter, arterial oxygen saturation was monitored with an ear oximeter, and respiration and ECG were recorded. Tolerance to G loads was slightly greater with the more rapid rate of G onset. While use of the flowmeter resulted in obtaining reliable G tolerance endpoints in all cases, in only about 75% of these cases was the same true for PLL. Responses obtained from the ear oximeter were variable and delayed, showing only slight decreases in arterial saturation, which became more pronounced as the G-load exposure duration increased.


Survey of pilots' attitudes and opinions about drinking and flying. A mailed questionnaire was used to obtain biographic, attitude, and reported behavioral data from pilots with regard to consumption of alcoholic beverages and flying. A 40.8% return of 835 mailings was obtained. Only 12 pilots reported having flown after drinking. Approximately 50% of the respondents indicated it would be safe to fly within 4 h after drinking some amount of alcoholic beverage. Based upon alcohol absorption and oxidation rates, it was estimated that 27-32% of the respondents considered flying after drinking, within a time period which would result in a 15mg% BAC or higher, to be safe behavior. Discriminant analysis showed liquor consumption and opinions regarding number of mixed drinks which could safely be consumed within 1 h before flying would correctly classify 67.5% of the respondents in terms of attitude toward drinking and flying.


Visual detection of commencement of aircraft takeoff runs. Among other things, airport control towers should be sited so that controllers can readily detect whether an aircraft cleared for takeoff has commenced its takeoff run. The detection of movement is not well enough understood to enable confident prediction that a particular site for a tower will enable commencement of takeoff run to be easily observed. A field study was undertaken to establish detection times for commencement of takeoff run by groups of trained and trainee air traffic controllers and untrained observers. It was found that the mean response of observers occurs when the aircraft is displaced about 5' of arc, a value essentially independent of observer experience, observation distance, aircraft velocity, and the clarity with which the aircraft can be seen. Binoculars reduce the mean response time and response variability, although not as much as might be expected. Domains within which control towers can be located to enable detection of takeoff runs within 2 s and 4 s are defined.


Effects of ground trainer use on the anxiety of students in private pilot training. The self-reported anxiety levels of student pilot instruction entirely in an aircraft were compared to the anxiety levels of students who received a portion of their training in a ground trainer. It was found that experience in the trainer had little effect on student pilot anxiety. It was determined, however, that reported anxiety levels did vary as a function of the type of flight (solo, dual, or evaluation) undertaken.


Classification of sleep stage with period analysis features derived from the EEG. This paper details our experience with the use of regression analysis and discriminant analyses, combined with a Bayes classifier, to evaluate the usefulness of a series of features derived in real time from a single channel of EEG. These features were 1) the number of zero crossings, 2) the number of zero crossings of the first derivative of the EEG, and 3) the number of zero crossings of the second derivative and five additional "histogram" measures. Each histogram measure represented the number of occurrences of a zero crossing interval falling within an arbitrarily selected range of values. The distributions of several measures conditioned on sleep stage are presented along with night-to-night and subject-to-subject variations in the measures. These details provide a basis for understanding effectiveness and limitations of zero crossing measures and the regression and discriminant analysis techniques. Our results permitted a range of 57-90% accurate classification with just zero crossing measures with the cross-correlation between computer- and hand-scored nightly sleep patterns ranging from 0.63-0.94. We consider these to be good and acceptable accuracies for this type of analysis.


Comparison of exercise responses of males and females during acute exposure to hypobaria. Seventeen male and 20 female college students were tested on a bicycle ergometer in a hypobaric chamber to determine whether both sexes had similar submax and max exercise responses to acute hypoxia. Initial testing was at a terrestrial altitude of 1576 m, to which the subjects were acclimated; subsequent tests were at simulated altitudes of 2743 m and 3962 m. Analysis of covariance showed that inspired V was the only variable during submaximal work (50% max) to exhibit a significant difference in altitude response between males and females; women had a smaller increase than men. During max work, V and O2 pulse increased less in women. At 2743 m, max VO2 decreased more in females whereas, at 3962 m, no difference was noted. It was concluded that during both submaximal and maximal work with acute altitude exposure, women would demonstrate smaller relative increases in ventilation than would men.


The Concorde and cosmic rays.

The Concorde and cosmic rays. In 1976, Air France's Concordes operated 2,642 h of flight time during 772 commercial flights to Rio de Janeiro, Caracas, and Washington. The cosmic radiation dose equivalent rate was measured during each of these flights. The average amount recorded was 0.99 mrems/h. A distinction must be made between the high latitudes (Washington route), on which an average dose equivalent rate of 1.49 mrem/h was recorded, and low latitudes (Rio de Janeiro and Caracas routes), on which the average dose equivalent rate was only 0.78 mrems/h. These figures show that 1976 Concorde passengers and crews were exposed to very low quantities of radiation--very much lower than the maximum value recommended for the general public, which is 500 mrems per year.


Workload and operational fatigue in helicopter pilots. In light of the modern aetiopathogenic views, a brief review was made concerning possible causes of operational fatigue to which flying personnel in general are exposed in the exercise of flying activity. The author then describes and analyzes the meaning and importance of the various stressing factors that constitute the physical and psychic workload to which the helicopter pilot is subjected in performing his professional activities. Also analyzed are the influences exercised, both separately and jointly, on the genesis of flight fatigue in helicopter pilots by stressing and fatiguing effects of vibrations, noise, and psycho-emotional and psycho-sensorial factors related to the variety and danger of utilization of this modern aircraft. Such an analytical investigation enables the author to conclude that one must admit that helicopter piloting involves a psycho-physical workload certainly no less than that required by more powerful and faster aircraft.