[Erythropoietin in congenital anemias in children]. The results of the erytropoietin level determination in serum and urine of patients with congenital anemias are presented and compared to the results obtained in children with acute aplastic anemias. Three patients with congenital hypoplastic anemia Diamond-Blackfan, two with Fanconi's anemia, one with congenital pancythopenia with hyperplastic marrow and five patients with acute aplastic anemia were studied. The increased serum erythropoietin level was found in every patient whose blood hemoglobin was less than 12g%. Erythropoietin was detected in nonconcentrated urine when serum erythropoietin level was higher than 0,5 units/ml. The statistically significant negative correlation between the serum erythropoietin level and blood hemoglobin concentration was found. In two patients suffering from congenital anemias, in whome the significantly increased erythropoietin level (about 1.0 units/ml) was detected, increased ammount of hemoglobin F in peripheral blood as well as increased MCV--signs of so called "stress" erythropoiesis-were noted. The results presented, together with the results obtained by other authors, indicate that congenital anemias studied here are not due to the disturbance in erythropoietin production.


[Fanconi's anemia in 2 brothers].

[Fanconi's anemia in 2 brothers]. Two cases of Fanconi anemia in brothers are described. Reticulocytosis and shortened survival of red blood cells in younger brother were observed. Ethiopathogenesis, therapy and prognosis are discussed.


[Familial pancytopenia of the Fanconi type]. Familiar pancytopenia (Fanconi type) is inharited disease of the familiar type with unadequate function of the bone-marrow associated with various congenital malformationes and specific cytogenetic abnormalities. This study deals with two cases of Fanconi pancytopenia found in brother and sister who were treated in the Pediatric Department. This disease has been proved on the basis of the clinical laboratory and rentgenological findings which have been complemented with the cytogenetic method.


[Congenital aplastic anemia-Fanconi].

[Congenital aplastic anemia-Fanconi]. Results of the investigation of 3 children aged from 2 to 7,5 with diagnosed aplastic anemia of Fanconi type are presented. Two children were females and one child was a male. Their illness symptoms appeared at the age of one, three and four respectively. All three patients had similar symptomes: palenes, tiredness, epistaxis, appearance of hemorrhagic syndrome and delayed growth. The following anomalies were also present: small size, microcephaly, mandibular hypoplasia, high palate and malformation of the urinary tract. In one child ductus Botalli persistens was also revealed. The laboratory findings showed presence of pancytopenia of the blood and increased level of both iron and erythropoietin in the serum. The karytype of two children revealed several cells with broken chromatin and with polyploid and tetraploid cells. The meiogram showed presence of all cells in bone marrow but in lowered number. Celularity I.


[Fanconi's anemia].

[Fanconi's anemia]. We have presented a case of Fanconi's anemia in six years old boy hospitalised in our Institute fifteen years ago. Beside hypoplastic pancitopenia, there is a growth retardation (under P3), late skeletal maturity, microcephalia, narrow rimae oculi, hyperpigmentetad skin, congenital abnormalities of both thumbs cryptorchidism, troubled speech, hyperagility. Cariogram was not performed, but present clinical-hematological signs confirme the diagnosis.


[Constitutional aplastic anemia (Fanconi type)]. We are treating successfully for seven years a nineteenyear-old girl with Fanconi's aplastic anemia combining androgenes and corticosteroids. The cytogenetic analyses of the other family members showed typical chromosome abnormalities in her father, mother and a twelve-year old sister. In the bone marrow of this sister there are already present the first morphological abnormalities, although the values of her peripheral blood counts are still normal. In the present paper we are discussing when to start the specific therapy in the affected sister.


[Tri-phalangeal thumb and hypoplastic anemia in a family]. The congenital erythroid hypoplastic anemia is a rare disease of the early childhood and is manifested through isolated hypoplasia of the red blood cells. The authors present a case of a mother and her daughter with a classical picture of the congenital erythroid hypoplasia appearing jointly with some anomalies. The mother was found to have triphalangia of both thumbs while the child had hexodactylion, the simian scar and hypogammaglobulinemia; Both mother and child were of small size (below 3 PC). This rare syndrome of joint anomalies and congenital hypoplastic anemia may show different expressivity of particular signs which is evidenced through the presented patients.


[Inherited elliptocytosis in a family].

[Inherited elliptocytosis in a family]. Elliptocytosis is a rare disease which is transmitted autosomally and dominantly and is mainly discovered on the occasion of the regular check up. Except for the changed morphology of erythrocytes at the stage of the cell maturity the disease most often appears without clinical symptoms. The boy and the members of his family presented here had a very mild form of the disease which was not followed by any clinical manifestations except for the changed morphology of the erythrocytes. Discreet laboratory abnormalities were present in the members of the maternal family. The disease is shown as a rare one and is interesting from the hematologist's point of view. The clinical importance of the disease is lower because of its rare occurrance in the human population and because of its rare and slight clinical expressivity.


[Roentgenomorphologic aspects of osseous lesions in thalassemia]. In bones two functionally different organs are closely mingled: osseous tissue and osseous hematopoietic system. In the work their interrelation and laws governing it are discussed. In cases of aggression toward osseous hematopoietic system osseous lesions, with their evolutive stages, are formed. Certain evolutive stages are so characteristic in their morphology that radiologic diagnosis of the illness can be made without any hesitation. The work also includes the authors' opinion on appearance of pseudotumorous structures on the paravertebral sections of the ribs.


[Calculosis of biliary and urinary tracts in children with congenital hemolytic anemias. (Retrospective view of some published work and certain investigations)]. During the last ten years twenty children with hereditary haemolitic anemia were admitted to the Children's University Hospital. As hyperbilirubinemia is one of the factors influencing calculi formation, we made systematic examination of the biliary and urinary pathways, because throughout these the excretory activity of bilirubin and its compound urobilinogen is performed. Owing to such a procedure, out of twenty children ten were discovered to have biliary calculi and other ten biliary and urinary calculi. As far as we learned from the available literature, parallel examination of these two pathways in children hereditary haemolitic anemia had not been made before.


[Treatment of decompensation of the heart in hemolytic anemias]. The author presents the experiences and the results in the treatment of congestive heart failure in children sick of haemolytic anaemias. The long lasting anaemias, followed by anoxia, treated with frequent blood transfusions, lead to cardiac haemosiderosis and to damage of the myocardium. During the period of ten years, out of 20 treated patients with haemolytic anaemias, two children suffering of beta thalassemia/Hb Lepore, have had a congestive heart failure. Two children were treated with cardiotonics and diuretics. The author analysis the question of giving Calcium to children treated with blood transfusion and is of the opinion that it is necessary to be careful in giving Calcium preparations to these patients, because it increases irritability of the myocardium and toxic effect of digitalis.


[Blood groups in chromosome disorders].

[Blood groups in chromosome disorders]. The authors investigated blood groups of two cases of polisomia, and 6 cases of chromosomal aberations. While the polisomia demonstrated no abnormalities of the blood groups, three cases of the chromosomal aberation show an alteration on the chromosome 2 and atypical inheritance of the MNSs groups, confirming autosomal location of these blood groups.


[Genetic counseling in hematologic diseases]. In patients with hereditary haematologic diseases risk of repetition of these anomalies in brothers and sisters of probands and their progenies was assessed. In haemiphilia and Wiskott-Aldrich's. thrombocytopenia, both caused by a mutant gene in an X chromosome, prenatal pole determination was consulted in order to have a pregnancy with a male fetus interrupted due to high risk. Dominantly hereditary spherocytosis, eliptocytosis, chronic benign neutropenia are the diseases which do not appear in such a severe form that ceasation of further pregnancies should be consulted, instead, an early postnatal diagnosis is suggested to the families with increased risk of these anomalies. In the recessive hereditary beta thalassemia and in Fanconi's anemia in which prenatal diagnosis can not be made for the time being, level of risk for the further children is told to the parents after the child has been born. The parents are then left to decide whether to take a risk and have other children who might suffer of these severe haemolitic diseases. In the haemolitic diseases with often occurrence in certain families, but in which the manner of inheritance is not clear, as for example in the Kasebach-Meritt's syndrome, risk for the following children is uncertainly increased so that the genetic counsel is uncertain and unprecise. In the hereditary haemolitic diseases which appear sporadically, either of known or unknown etiology, such as congenital teleangiectasis of capillary vessels or Sturge-Weber's syndrome with severe vascular and nerval disorders, the parents are stimulated to further pregnancies as they are not followed by increased risk.


[Genetics in blood diseases].

[Genetics in blood diseases]. The mechanisms of the haemoglobin's disturbances provoked by the mutation or the insufficient function of genes which regulate the synthesis of the corresponding polypeptide chains of haemoglobin have been described. Especially the authors pointed out the well known relation between the change of the primary structure of these chains and the structure of new codon created by the mutation of gene. Some important mechanisms which regulate the degree of oxygen affinity of haemoglobin and which are considerably altered in some haemoglobinopaties have also been described.


[HLA system antigens in Hodgkin's disease in children]. The authors investigated HLA antigens in 11 children treated of Hodgkin's disease and compared them with 540 healthy nonrelated persons. Antigens HLA-A2, HLA-A9 and HLA-A10 were found in 5 treated children (45.4%). Antigen HLA-B5 was found in 4 children (33.4%). Antigen HLA-Bw16 was found in three patients (27.2%) which is much higher percentage than that of the control group. Haplotype A10-Bw16 which had not been found in the control group was present in two patients. Four patients (36,3%) had antigen HLA-B5 in localized form (I and II clinical stage). Four children (36,3%) had antigen HLA-A10 but only in histologic type of the lymphocytic predomination. Due to the small number of the investigated patients it was not possible to draw a definite conclusion on whether there is a significant occurence of certain antigens of the HLA system in children treated of Hodgkin's disease.


[Wiskott-Aldrich syndrome].

[Wiskott-Aldrich syndrome]. Within the group of diseases of immunodeficiency Wiscott-Aldrich syndrome can be excepted as one with well definical picture. Here presented are two patients with allness onset in the earliest childhood. Their chinical picture was a typical one showing often infections, thrombocytopenia and later appearance of eczema. Beside the dicreased number of the thrombocytes both patients had eosynophilia, changed immunoglobulines and lack of isohemogglutinin. One of them also showed low response to phytohemagglutinin and low values of the T and B rosettes. One of the patients lived until four years of age while the other one is aged five now and is in relatively good condition.


[Congenital enzymopenic methemoglobinemia and its pharmacogenetic aspects]. The authors report on their experience in nearly 10 years follow-up of four families with hereditary enzymopenic methemoglobinemia. In patients a dangerous elevation of methemoglobin level was never observed, what is probably due to the information of the patients and the family doctor about the nature of the patient's constitution. All gene--carriers were practically healthy. In one family 10 children died from convulsions as newborns. Mental retardation was not present in these four families.


[Hemoglobinpathy S--clinical manifestations in children in a Zairian family]. The clinical aspects of Hemoglobinopathy S in children of a black family from Zair living in Belgrade are discussed in the paper. The parents and two brothers are heterozygous carriers for patologyc hemoglobines; those children had, sauf permanent anaemia, the crysis of dyspnea, cyanosis, cough, evidence of subperiosteal bone formation, associated with vitamin D deficiency. The Youngest child, girl two years of age, is homozygous with complete Sickle cell disease: hand-foot syndrome, heterotopic paravertebral hematopoetic tissue, lung infarctions, cardiomegaly, severe drepanocytic anaemia; she succumbed in an a attack after many episodes of severe hypoxia.


[Osmotic resistance of erythrocytes as a screening method in detecting heterozygotes in beta-thalassemia]. Osmotic fragility of red blood cells in three different buffered solutions, i.e. 0,32%, 0,36% saline and 0,40% Tyrode solution was studied as a screening test for the detection of beta-thalassemia trait. 90 genetically designated beta-thalassemia heterozygotes were studied for the screening tests. In addition 514 school children and 161 patients suffering from anemia of different etiology were also examined for the osmotic fragility screening. The results of the studies indicated that the one tube method screening test with 0.36% buffered saline solution was the appropriate solution in screening for beta-thalassemia trait since the solution was able to detect 99 to 100% of the carriers. However, about 15% of normal individuals were also found to give a false positive for the 0.36% saline screening test. It is recommended that 0.36% buffered saline solution be used as a first screening test for the detection of beta-thalassemia trait since it is simple, rapid, cheap and applicable. Those who are positive with this test are required to be completely studied in hematology for the final diagnosis of either beta-thalassemia trait or other hematologic disorders.


[Deficiency of pyruvate kinase in erythrocytes: biochemical studies. Preliminary communication]. Pyruvate kinase deficiency was found to be the causative factor in a family with nonspherocytic hemolytic anemia. Biochemical findings were the following: decrease in adenosine-5'-triphosphate (ATP) concentration (59 micromoles per 100 ml of erytrocytes; normal: 150 +/- 59), increase in 2,3-diphosphoglycerate (2,3-DPG) concentration (13611 micromoles per 100 ml of erythrocytes; normal: 480 +/- 80) and low level of pyruvate  kinase activity (955 U) mmol Hb; normal 2700 +/- 498. The deficiency of enzyme activity in the hexose-monophosphate shunt was excluded on bases of normal or elevated glucose-6-phosphate and 6-phosphogluconate dehydrogenase activities, normal reduced glutathione concentration and normal glutathione stability in vitro. The Michaelis constant for phosphoenolpyruvate of the patient's pyruvate kinase was found to be normal; thus, the mutation affected only the Vmax of the enzyme.


[Importance of the determination of glucose-6-phosphate dehydrogenase in the diagnosis of congenital hemolytic anemias]. In the present paper, the enzyme activity of glucose-6-phosphate dehydrogenase (G-6-PD) was determined in blood haemolysate of 300 children, in the aim of differential diagnosis. In the studied group we found 2 children with markedly low activity of G-6-PD. The activity of enzyme in those patients ranged 0-37 mU/0,1 ml packed red cells. We investigated the activity of enzyme G-6-PD in the blood haemolysate of the parents and other relatives too. On that way we were able to establish that the mode of inheritance of defective enzyme activity was homozygote dominant, e.g. hemizygote recessive, respectively. Our study enabled us to discover the patients with inherited deficiency of erythrocytic G-6-PD in Belgrade.


"Family somatics"--a neglected edge.

"Family somatics"--a neglected edge. Although the family interaction viewpoint has been more widely adopted since it was first introduced and family therapy more widely practiced, there has not been a parallel growth in the practical or theoretical application of the interactional viewpoint. This paper makes a plea for the relevance of this orientation to illness and disease. This area has received some consideration but deserves a much more extensive examination and research effort.


The removal of a psychosomatic symptom: effects on the marriage. This study examined the effects on the marriages of twelve patients who underwent intestinal bypass surgery for extreme obesity. Marked conflict and disruption were observed. Most striking were changes in the areas of sexuality and dependence/independence parameters. The authors discuss the function of the symptom of obesity within these marital systems.


Emergency psychology: a mobile service for police crisis calls. The Emergency Treatment Center, a new program of crisis intervention services, has been in operation since February 1975. This seven-day-week, twenty-four-hour-a-day program backs up ten Northern California police departments to provide help to people who are experiencing psychological emergencies such as violent family fights, suicide attempts, and severe emotional disturbance; in addition, the Center responds to any kind of crisis call involving adolescents. The population of the area served is approximately 750,000 of whom approximately 110,000 are adolescents between 10 and 17 years of age.


Patterns of transactional style deviance in the TAT's of parents of schizophrenics. Parents of schizophrenics show more transactional style deviance in diverse situations than do other parents. In a sample of families of nonschizophrenic outpatient adolescents, a manual for scoring such deviance on stories told for seven TAT cards was developed. This scoring system was shown to be composed of six meaningful factors. When this system was applied to the TAT's of parents of offspring with a variety of psychiatric diagnoses, a total deviance score did not discriminate among the parents. High scores on two particular factors were found only in parents of hospitalized schizophrenics, but four factors were nondiscriminating. Parents of young adults with schizophrenia spectrum disorders were more likely to show high scores on at least one of these six factors than other parents. Considering the scores of mothers and fathers together yielded the best discrimination of parents of schizophrenia spectrum disorders from other parents.


Owning and disowning: the structural dimension. Stierlin (11) recently examined owning and disowning in the parent-child relationship from a psychoanalytic-developmental perspective. This paper examines the same phenomena from a structural viewpoint, deriving implications for the conduct of therapy.


Family therapy after the divorce: developing a strategy. Family therapy with the whole family after a divorce has taken place provides a unique opportunity for intervention. Though the spouses have legally terminated their relationship, their parenting function remains. However, this reality is often clouded by the emotional conflicts generated by the divorce. Family therapy can be useful in facilitating life in the post-divorce period. A four-part model for intervention is described. The first task is to redefine the family as existentially including all members. Next, generational boundaries are firmed in order to reduce the parentification process, often intensified by the parent's physical absence. Third, the family needs to have a replay of the history of the marriage to correct developmental distortions and offer a changce to mourn the loss of the intact family. Finally, the therapists attempt to facilitate an emotional divorce. A case study is presented to elucidate the manner in which these steps unfold in treatment.


Ambulatory monitoring of the electrocardiogram: an important aspect of pacemaker surveillance. Of the 353 patients followed in the pacemaker surveillance clinic between July 1976 and July 1977, 25 patients complained of episodes of dizziness and faintness. 20 of these had normal pacing function and pacemaker parameters at routine clinic testing. 18 patients had 'demand' units and 2 had fixed-rate pacemakers. The indication for permanent pacing was complete heart block in 16 patients and sinoatrial disease in 5 patients. At clinic follow-up, there was unequivocal evidence of vertebrobasilar insufficiency in 5 patients and postural hypotension in 4 patients. In 11 patients, the cause of presyncope was not evident at the clinic. All patients were monitored by 24-hour tape recording until an episode of pre-syncope occurred. In 8 patients, there was evidence of intermittent failure to pace associated with the episodes of presyncope. In 2 patients, an additional cause for presyncope was found at clinic examination. Ambulatory 24-hour tape monitoring of the electrocardiogram is an important adjunct to pacemaker follow-up especially when other methods such as transtelephone monitoring are not available in the United Kingdom. Routine electronic testing of pacemaker function does not always reveal intermittent abnormalities related to changes in threshold or unstable electrode positions.


Radiotelemetry-based study of occupational heat stress in a steel factory. Heat stress conditions prevailing in a steel factory were evaluated using a newly developed radiotelemetry system. This system was used as a station monitor for determining environmental temperature conditions and as a personal monitor to obtain data of worker physiological responses. Environmental information was used in calculating wet-bulb globe temperature heat stress index values. Physiological data were used in confirming safety limits. The study demonstrated the effectiveness of radiotelemetry in assessing occupational exposures to heat stress.


A portable miniature solid-state heart rate recorder for monitoring daily physical activity. A compact, rugged, solid-state heart rate recorder (63 X 94 X 22 mm, 195 g) to measure normal daily heart rates over periods of up to 33 h is described. With an interval switch a selection can be a mean heart rate over 30, 60 or 120 sec. The ECG amplifier filter is equipped with an automatic gain control to eliminate R-wave amplitude changes during physical activity. A continuous acoustic check on correct electrode attachment and sufficient signal amplitude is possible by means of an earphone. Data may be stored on punch tape, tape recorder, or processed on-line, or plotted directly one a line writer to obtain a heart rate profile over the measured time. In 45 studies with adults and children the heart rate recorder has proven to be a reliable instrument.


Circadian variations of blood pressure in patients with different degrees of hypertension. Changes induced by hypotensive treatment. Arterial pressure was continuously recorded for 24--48 h in 3 normotensive subjects and in 60 hypertensive patients. The greatest variations occurred in those with labile, mild or moderate hypertension compared to those with severe hypertension or normal blood pressure. Atenolol (100-200 mg) administered once or twice daily produced a significant reduction of arterial pressure and a smaller response to the cold pressor test, hand grip and step test in patients with established hypertension, but little change in those with labile hypertension. The evening dose was not followed by a decrease in pressure greater than that observed without treatment, but determined a smaller rise on awaking.


The isolation amplifier, an interface between EEG recorder and data processor. An isolation amplifier is presented which is intended as an interface between electrophysiological recorders and standard data processing equipment. Due to its floating input and output, differences in ground potentials do not disturb the transmitted signal. Hence, recorder and data processors can be grounded according to the manufacturer's recommendation. Powerline leakage currents are also prevented from loading the ground of the electrophysiological recorder. Compared to the isolation transformer this device saves space, while polarity restorations can be made and no modifications are needed in any piece of equipment.


[Human celosomias].

[Human celosomias]. Definition and nomenclature of celosomia are based on a historical review which provides a system of classification. Morphology and organogenesis of celosomia were studied on 64 embryonic and foetal bodies. The anatomical study of 6 cases of human celosomia provided a definition of the characteristics of major celosomia, by showing the constant elements of the syndrome (particularly the parietal malformation) and the anomalies frequently found in each of the different types:--anterior (or superior) celosomia;--middle celosomia, including laparoschisis;--posterior (or inferior) celosomia, among which exstrophy of the bladder may be either one of the constant elements of the syndrome, or a limited form of the inferior celosomia;--total celosomia, of which one case was studied for this report, and of which the major forms, the schistosomia, chelinosomia and strophosomia types, seem to constitute forms of transition with other types of monstruosity. With improved knowledge of anatomy and organogenesis the possibilities of treatment have improved over the past few years, but still remain limited in the more monstrous forms of celosomia.


Controlled environment treatment for limb surgery and trauma (a preliminary report). This paper demonstrates a new approach to postsurgical and post-traumatic wound management in the lower limbs. Our own results of 20 below-knee amputations are documented. A less detailed report is then given of experience with an additional 20 amputees: this second group includes experience not only here at Seattle but at five other centers in the United States. The same method for wound management and for control of edema was employed in all cases. The method, Controlled Environment Treatment (CET), uses filtered air as a dressing medium, with a control console to maintain the pressure, constant or varying, according to a preset program. Temperature and humidity are also controllable, as is gas composition. The limb, together with its controlled environment, is contained with a pliable, transparent, treatment bag, which permits inspection and palpation of the wound site without disturbing the bacteriologically sterile air within the chamber. A special seal reduces air leakage yet avoids constriction of the limb. This CET system was originally developed by the Department of Health and Social Security, Biomechanical Research and Development Unit, Roehampton, England. Subsequent developments are also noted of an improved Mark II CET Unit and of simpler, related, management systems for conditions not requiring sterile environments.


Slipping cane and crutch tips. Part I--static performance of current devices. A variety of commercially available cane and crutch tips were tested on surfaces of ice and soapy tile under varying axial (thrust) loads. The output measurement consisted of the angle between the vertical and the cane axis at which slip occurred. It was learned that: 1. From the viewpoint of a user, a minimal slip angle of roughly 25 deg is desirable. 2. On ice-rink ice, a number of cane tips approach the desired slip angle under conditions of low temperature; fewer appear safe at elevated air temperatures. Only one of the tested devices appears truly safe under any ice condition. 3. On rough tile flooded with soapy water, some cane tips offer adequate performance. However, no tested cane tip offers acceptable performance on slick tile flooded with soapy water. 4. There appears to be no simple relationship between the slip performance of a cane tip on ice-rink ice and that developed on soapy wet tiles. 5. No simple relationship between thrust load and slip angle emerged. Similarly, no simple relationship between contact area and slip appeared in the data.


[How effective are the international sanitary conventions with regard to the current cholera pandemic]. The present cholera pandemic spread proves that nations are powerless to establish an inter-coordination strong enough to bring under control problems of geographic diffusion and endemisation of new territories. The authors, after having pointed out certain International Health Regulations deficiencies and brought to mind their faults in execution, consider that an epidemiologic phenomenon of this scale dictates a reconsideration of the present system of international sanitary practices.


[Isolation of the Lagos-bat virus in the Central African Republic]. The second reported isolate of Lagos-bat virus has been obtained from bats Micropterus pusillus caught in 1974 in the Central African Empire, thus extending the geographic area of this virus and adding another species of vertebrate host among its reservoirs.


[Mixed sero-epidemiologic study of arbovirus-arenavirus in the small mammals of Tunisia]. Blood samples of 156 small mammals caught in Tunisia in 1976 and 1977 were examined for the presence of antibodies to some arboviruses and arena-viruses. Haemagglutination-inhibiting antibodies against West Nile virus were detected in 19.8 0/0 of examined sera, mainly from Mus sp., Rattus rattus, Eliomys tunetae in the northern part of the country and from Ctenodactylus gundi and Pipistrellus kuhli in the south. In addition, antibodies against Uukuniemi and Bhanja were found in 3.2 0/0 and 4.5 0/0 respectively of the same sera.


[Cutaneous leishmaniasis in the Republic of Guinea]. The authors give a geographical and climatic description of the Guinean Republic and report the results of a survey carried out at Kamsar by means of intradermoreaction with leishmanine. They have observed 14,7 0/0 positive reactions in an apparently healthy population which did not present any leishmaniosis history. After discussion of the findings the authors report a case of skin leishmaniosis recently observed at Conakry.


[Imported malaria in the hospitals of Marseilles from 1973 to 1976: epidemiological characteristics]. Between 1973 and 1976, 96 confirmed hospital cases of imported malaria occurred in Marseille. The collected epidemiological data indicate the recent increase of the annual incidence and an equal number of cases in immigrants and in people returning from the tropics. Among them, tourists, servicemen and merchant seamen are the groups most at risk. A high proportion of infections are with P. falciparum, mainly from Africa, Malagasy and Comoros. The diagnosis is only confirmed on an average of 6 days after the first medical advice and 2 patients died from falciparum infections. Travellers to tropical countries are often careless about taking prophylactic drugs and the danger of imported malaria should be emphasized.


A comparative electrophysiological and histological study of sensory conduction velocity and Meissner corpuscles of the median nerve in pneumatic tool workers. The sensory conduction velocity of the median nerve has been determined according to the technique described by Buchthal and Rosenfalck in 32 pneumatic tool workers and in 32 normal controls of the same age group. In each worker and in 8 normals of the same age group the Meissner corpuscles of the skin of the thumb of the side investigated were studied according to the technique described by Ridley and Dickens et al. The only relevant electrophysiological finding was represented by a decreased amplitude of the evoked response of the median nerve at the wrist, probably pointing to some degree of distal axonal degeneration. As to the histological findings, no significant variations from normal were found in the Meissner corpuscles of the workers. A trend towards a quantitative reduction of the corpuscles in those subjects who showed a decreased amplitude of the evoked response did not reach the level of significance.


Acute pure vertiginous dysequilibrium in cerebellar infarction. A clinical example of an acute cerebellar infarct mimicking an acute end-organ labyrinthine disease is reported to foster general familiarity with the simulation of a benign disorder by a potentially serious one. The utility of certain neurologic findings in distinguishing a peripheral from a central vestibulo-cerebellar disorder is discussed.


Occlusive cerebrovascular disease in young adults. 13 patients under 40 years of age had cerebral infarction and angiographic evidence of arterial stenosis or occlusion. None of them had cardiac disorders prone to cerebral embolism. Five patients had occlusion at the origin of the internal carotid artery, one had occlusion of the common carotid artery and one each had stenosis at the origin of the internal carotid and common carotid arteries, respectively. Two patients had unilateral occlusion of the supraclinoid portion of the carotid artery with basal collaterals that had some resemblance to the Moyamoya disease. Three patients demonstrated stenosis or occlusion of the middle and/or anterior cerebral arteries. Three patients had hypercholesterolemia, one of whom was hypertensive. None had confirmed diabetes mellitus. One female, who died, had taken oral contraceptives for 3 years. A male, with internal carotid artery occlusion, had serological evidence for syphilis.


Distinctive features of unilateral spatial agnosia in right and left brain-damaged patients. In order to study the distinctive features of unilateral spatial agnosia shown by right and left brain-damaged patients, a test of copying drawings with guiding landmarks was given to 83 control subjects and to 248 patients affected by right (n = 108) or left (n = 140) hemispheric damage. The test enabled us to obtain a quantitative assessment both of the lines omitted ('omissions') and of the lines wrongly traced ('errors') on the half page contralateral to the damaged hemisphere. Results showed that contralaterally to the hemispheric locus of lesion a clear-cut double dissociation can be found between right and left brain-damaged patients: the former showed a striking tendency to omit the lines lying on the left half of the sheet, whereas the latter tended mainly to trace faulty lines on the right half of the drawings.


Polycythemia vera and transient monocular blindness. Observation of the platelet embolic phenomena in the ocular fundus. Transient monocular blindness in the patient with polycythemia vera has generally been considered to be caused by retinal arteriospasm. In the present case with complaints of frequent monocular blindness, ophthalmoscopic observation and serial photographs of the ocular fundus were made. During these acute attacks, microembolic phenomena were noticed in the retinal arteries. Laboratory examination showed abnormal platelet aggregability, increased platelet adhesiveness and a significantly decreased platelet count during attacks. It is suggested that transient monocular blindness is caused by platelet emboli. The cause of intermittent cerebral ischemic attacks in the patient with polycythemia vera is probably platelet emboli.


Traumatic middle meningeal arteriovenous fistula. Report of 3 cases and analysis of 32 cases. Three cases of traumatic middle meningeal arteriovenous fistula are reported and 32 cases, including ours, reported in the literature are analyzed. In these 32 cases, the appearance of the arteriovenous fistula at angiography exhibited one of three different configurations: type 1, the middle meningeal vein shows a railway configuration; type 2, the middle meningeal vein shows a rod configuration; type 3, extravasation of contrast material and/or pseudoaneurysm are concomitant. In correlating the angiographic type and clinical course, the following tendencies were observed: the clinical course was good in type 1, fair in type 2 and poor in type 3, respectively.


Methotrexate treatment in dermatomyositis. Two patients with dermatomyositis were treated with methotrexate, given intravenously. They were unresponsive to corticosteroids. The patients were bedridden and paralysed and one seemed to be in the terminal phase of the disease. The response to courses of methotrexate treatment was satisfactory and sustained over a 2-year follow-up period; muscle enzyme studies indicate that the muscle disease is no longer active. Although steroid therapy alone may be effective, its usefulness is unpredictable and may lead to dependence and undesirable side effects. Our experience with these two patients suggests that a combination of the two drugs may be justified as initial treatment in severe cases.


Toxic neuropathy as a complication of thiophenicol therapy. Two cases with sensory neuropathy due to thiophenicol therapy are reported. Thiophenicol neuropathy is hitherto unreported in literature published in English. Neurological manifestations of these cases were similar to those of chloramphenicol neuropathy, but rather marked impairment of position sense in the lower extremities was characteristic. Thiophenicol neuropathy reported in Japanese literature was reviewed and it is concluded that thiophenicol administered in large doses (70-150 g) or for long periods (more than 3-5 months) appeared to have a toxic effect on the nervous system.


Computer-assisted recording of the objective neurologic finding. Main principles of a computerized data collection system of the objective neurologic finding are presented. In the course of the findings recording, the physician communicates with the computer by an alphanumerical display in an interactive mode. The recording procedure is suggested by the computer program. The data are stored for further processing and are available as a narrative printout. The program uses a driving data structure of tree-like organized medical expressions with some control and formating parameters assuring medically correct procedures.


Argyll-Robertson-like pupils in the neural type of Charcot-Marie-Tooth disease. The authors report of Argyll-Robertson-like pupils in three patients presenting the neural type of Charcot-Marie-Tooth (CMT) disease with peroneal muscular atrophy. Up to now the light-near dissociation had been reported in the hypertrophic variety of CMT disease. Stress is laid upon the fact that the presence of the light-near dissociation in patients with CMT disease does not help in clinically differentiating the neural from the hypertrophic type of this disease.


Scapulo-peroneal muscular atrophy. Full autopsy report. Unusual findings in the anterior horn of the spinal cord. Lipid storage in muscle. Morphological findings of 3 cases of Kaeser's scapulo-peroneal muscular atrophy are described. 1 of them is the first complete autopsy report on this disease. While the number of motor neurons in the spinal cord was grossly normal, the neuropil of the anterior horn exhibited axonal swellings, accumulations of possibly pathological lipofuscin and intra-axonal corpora amylacea. In the muscles, changes were partly those of neurogenic atrophy, partly of a primary myopathy. There was also an accumulation of neutral fat in the muscle fibres, mainly of those of type I.


Compartmental analysis of cerebrospinal fluid-blood albumin transfer: consideration of kinetics in normal animals and animals with chronic communicating hydrocephalus. Transfer of radioactively labelled albumin from the cerebrospinal fluid (CSF) to the blood was monitored in 15 dogs with normal cisternograms and in 8 dogs with induced communicating hydrocephalus. Blood concentration curves alone are of limited value and give less than satisfactory information about CSF distribution spaces and were corrected for albumin disappearance from the blood to other compartments. The transit time in animals with hydrocephalus was much greater than in normals and entry into the intravascular compartment was delayed. Mathematical analysis to the indicator movements appears to offer understanding about CSF compartments and transfer of molecules in different types of hydrocephalus.


The use of hyperbaric oxygenation in the treatment of spinal cord lesions. In 13 patients with compressive spinal cord lesions we performed a trial of treatment with hyperbaric oxygen (HO). This therapy was postoperatively administered when neurological deficit persisted. In order to assess the effect of each individual HO session (given daily at an inspiratory oxygen pressure (PO2) of 1.5 atmospheres absolute for 40 min) as well as of the entire HO therapy (consisting of 10-15 single sessions in each case) neurological and electromyographical follow-up examinations were regularly performed. In 6 of the 13 patients we found a marked improvement, particularly in motor functions. The other patients only showed little change in neurological status. Arterial and cerebrospinal fluid (CSF) PO2 were concurrently measured in 8 patients during HO sessions. The values of both showed a considerable increase. The rise in CSF PO2 may be regarded as indicative for an improved oxygenation of the spinal cord tissue during HO treatment. On the basis of these findings we may assume that repetitive HO treatment can be helpful in the management of compressive spinal cord lesions.


A case of lipid storage myopathy with carnitine deficiency. Biochemical and electromyographic correlations. Histochemical, biochemical and electromyographic studies were performed in a case of carnitine deficiency in serum and in muscle. Clinical features include proximal muscle weakness, predominant type I fiber impairment, excess of triglycerides and moderate glycogen accumulation in muscle. No abnormalities of palmityl CoA synthetase, carnitine palmityl transferase, carnitine acetyl transferase and lipase were evidenced. An interesting EMG decremental pattern was recorded. Correlations between electromyographic and biochemical findings are considered. A clinical improvement, a normal plasma carnitine level and a normal response at EMG repetitive stimulation were found after carnitine treatment.


Folate-responsive neurological and mental disorders: report of 16 cases. Neuropsychological correlates of computerized transaxial tomography and radionuclide cisternography in folic acid deficiencies. Two groups of patients with folic acid responsive neurological and psychiatric disorders are reported. The first group (7 patients) had well-established acquired folate deficiency due either to defective absorption (4 cases with atrophy of jejunal mucosa) or to a deficient diet (3 cases). One patient had a subacute combined degeneration of the spinal cord while others were depressed and had weight loss, permanent muscular and intellectual fatigue, restless legs syndrome, depressed ankle jerks, diminution of the sense of vibration in the knees and a stocking-type tactile hypoesthesia. The second group (9 patients) comprised idiopathic cases of folic acid deficiency. Their main subjective complaints were chronic fatigability and familial restless legs syndrome. The neurological findings were similar to those of the patients with acquired disorders. Neuropsychological testing procedures revealed an abnormal intellectual functioning in all 16 patients. Abnormal patterns of radionuclide cisternograms and computerized transaxial tomography (CTT) were found in 11 patients. After 6-12 months of folic acid therapy a striking improvement regarding their intellectual functioning was noticed: the IQ, Kohs Block Design and Category tests were significantly improved. The correlation of neuropsychological findings with CTT and radionuclide cisternograms led to the conclusion that chronic folate deficiency could induce cerebral atrophy.


Pain arising in the posterior arch of the atlas. Headache of cervical origin is by no means an adequate diagnosis. The exact mechanism has to be established for the case in question. A type of cervical headache which arises from the posteriorr arch of the atlas is described. The basic finding is tenderness of this structure on palpation; the technique of palpation is described. In a majority of cases movement restriction (blockage) between the occiput and the atlase is found. The headache as described by the patient is not characteristic, migrainous attacks being present in about one-third of the cases. A frequent feature is pain on retroflexion of the head. Treatment consists of manipulation of the blockage, and infiltration or needling of the posterior arch of the atlas if there is no blockage or if pain continues after the restoration of mobility. In the more complicated cases remedial exercise is indicated. Experience with 64 cases is described.


Myxedema myopathy: a case report.

Myxedema myopathy: a case report. A classical case of myxedema, demonstrating the typical Hoffmann syndrome (muscle weakness, hypertrophy, pseudomyotonic phenomena) and the usual rise in serum creatine phosphokinase (CPK), is discussed. Assuming that there is a CPK loss in the muscle fiber, the pseudomyotonic phenomena may be due to an increase in ADP, which in turn inhibits the calcium pump. Furthermore, light-microscopic and electron-microscopic findings are reported.


Karyometric changes in human muscle with age. Human muscle cell growth was studied to investigate the nucleo-cytoplasmic ratio during development and ageing. The mean muscle fibre size, as well as the number and size of myonuclei were estimated in human muscle biopsies from normal individuals whose ages ranged from 1 to 71 years. Changes in muscle fibre size were accompanied by similar changes in nuclear number, the size of which remained the same. This resulted in a constant nucleo-cytoplasmic ratio during the age range studied. The role of the satellite cell in the maintenance of this ratio was discussed.


Neuromyotonia. Report of a case.

Neuromyotonia. Report of a case. The authors report the case of a 67-year-old man, affected by diffuse spasms evoked by ischemia and voluntary and reflex movements electromyographically characterized by an intense repetitive activity. There was also a modest and diffuse muscle wasting with lower limbs areflexia; no myokymia. The EMG showed severe neurogenic changes and a considerable reduction of the MMCV in the lateral popliteal nerve area.


Glycolytic substrate utilization and energy consumption in the cerebral hemispheres of the mouse during experimental anuria. The glycolytic substrate utilization and energy consumption of hemispheres of adult mice were studied by converting the heads into a closed system by decapitation. It was concluded that progressive insufficiency of renal function is paralleled by an increase in brain permeability for glucose and a progressive reduction in brain energy metabolism.


Renal clearance of pyridostigmine in patients with myasthenia gravis. The urinary clearance of pyridostigmine was studied in six patients with myasthenia gravis. In three patients on pyridostigmine alone, renal clearance ranged from 349 to 481 ml/min, corresponding to a pyridostigmine:creatinine clearance ratio of 2.64 to 3.46. In a patient on bendrofluazide as well as pyridostigmine, a similar clearance ratio was observed. By contrast, the urinary clearance of pyridostigmine and the pyridostigmine:creatinine clearance ratio was reduced in two myasthenic patients concurrently treated with other basic drugs. It is suggested that these results may reflect competition for renal tubular excretion.


Chronic spinal muscular atrophy simulating facioscapulohumeral type and limb-girdle type of muscular dystrophy. Report of two cases. Two cases of chronic spinal muscular atrophy simulating the clinical picture of the facioscapulohumeral type and limb-girdle type of muscular dystrophy are reported. Both patients had a waddling gait, Gowers' maneuver in arising, terminal atrophies and pseudohypertrophies of some muscles, marked fasciculations, and fascicular tremor. The electromyogram revealed signs of anterior horn cell disease. Calf muscle biopsy (case 2) revealed 'myopathic' changes.


Dynamic aspects of gastric emptying in patients with peptic ulcer according to ulcer stages. The pattern and the time of gastric emptying were investigated in 38 patients with peptic ulcer and 7 healthy volunteers using the double-sampling method. The pattern of gastric emptying assumed the following three attitudes, that is, exponential (44%), quadratic (29%) and unclassified (27%) pattern. These patterns appeared to depend on the distance from the gastric angle to the pyloric ring measured from X-ray pictures in the upright position. There was no significant difference in the gastric emptying time in patients with peptic ulcer according to its site. During follow-up observations of the same case, the gastric emptying time had a tendency to shorten in patients with duodenal ulcer while it showed no definite variation in patients with gastric ulcer.


Possible role of succus entericus in amino aicd homeostasis in the dog. Succus entericus from jejunal Thiry-Vella fistulae in fasting conscious dogs was analyzed for amino acids before and after incubation for 15 and 30 min at 38 degrees C in vitro. Total amino acid concentration of succus entericus as collected was about twice that of blood plasma. After incubation, it was increased 76% above control at 15 min and 137% at 30 min. Because succus entericus does not exhibit proteinase activity, and no enzyme or substrate was added before incubation, the increase in amino acid concentration was probably due to hydrolysis of peptides by peptidases normally present in the juice. Volume of secretion and output of amino acids were greatly increased by intravenous administration of glucagon, but the amino acid pattern was quite different from blood plasma. The concentrations of aspartic and glutamic acids were 10- and 5-fold greater than in plasma, and tryptophan was usually undetectable.


Effect of portacaval shunt on serum bile acid concentration in patients with cirrhosis. A retrospective study was carried out to examine the influence of portacaval shunt (PCS) on serum bile acid concentration in 47 cirrhotic patients. Cirrhotic patients with PCS had a significantly higher serum bile acid concentration than cirrhotic patients without PCS whatever the duration between the diagnosis and the time of measurement. Serum bile acid concentration was significantly higher 3--12 months after PCS (67.90 +/- SD 15.90 micrometer; p less than 0.001) and 12 months or more after PCS (94.11 +/- SD 33.86 micrometer; p less than 0.001) than before the shunt (18.98 +/- SD 13.62 micrometer). The mean concentration 12 months or more after PCS was significantly higher than that found 3--12 months after shunt (p less than 0.02). This progressive increase in serum bile acid concentration may indicate a deterioration of hepatic function in shunted patients.


Glycerol-ester hydrolase from human small intestine and its possible role in the degradation of neutral lipids. A glycerol-ester hydrolase has been characterized and partially purified (23-fold) from human small intestine. A pancreatic origin was excluded through the use of an immunoserum directed against human pancreatic juice, while a pharyngeal (gastric) origin was unlikely owing to the optimum pH range of activity of the gastric enzyme as compared to that of the intestinal enzyme. The glycerol-ester hydrolase is mainly active toward short- and medium-chain di- and triglycerides and toward micellar long-chain monoglycerides. A role in the absorption of neutral lipids, mainly in pathological situations, is postulated.


Specificity of increased amylase to creatinine clearance ratio in acute pancreatitis. The amylase to creatinine clearance ratio was found to be normal in 11 of 33 patients with acute pancreatitis. The ratio was elevated in 10 of 19 patients with renal insufficiency. Thus, it does not seem to be a specific index in the diagnosis of acute pancreatitis.


Ratio of urinary 6beta-hydroxycortisol to 17-hydroxycorticosteroids in patients with liver disease. The ratio of 6beta-hydroxycortisol to 17-hydroxycorticosteroids in the urine of 73 patients with liver disease, and 53 controls has been measured. The mean ratio was significantly greater in the liver disease group (p less than 0.001), this elevation being most marked among patients with liver metastases and patients with acute hepatitis. We feel that the use of the ratio as a test of early liver cell dysfunction requires further evaluation, in particular in the early recognition of metastatic liver disease.


Effects of hydrochlorides of amino acids in test meals on gastric emptying. Four subjects were given test meals containing various concentrations of hydrochlorides of glycine, alanine, arginine, phenylalanine and tryptophan. The gastric contents were recovered after 20 min. The volume of the original meal recovered was assessed from the amount of marker substance aspirated. It was found that the slowing of gastric emptying of amino acid hydrochlorides was consistent with their action as weak acids. However, tryptophan and phenylalanine were slightly more effective than was predicted on the basis of their actions as acids.


Effects of oral and rectal BCG administration on chemically-induced rat intestinal carcinoma. Intestinal carcinomas were induced by repeated subcutaneous injections of 1,2-dimethylhydrazine in syngereic BD-IX strain rats for 12 weeks. At the end of the treatment, one group received 2 doses of 50 mg BCG by a gastric tube, then a dose of 50 mg BCG by rectal instillation. The other group received no BCG. There was no significant difference in survival time, total number of cancers per rat, or cancer localization between the treated or untreated groups. Disseminated peritoneal metastases were more frequently found in BCG-treated animals. These results do not support the use of orally administered BCG in the treatment of human colorectal cancer.


Gastrin release in response to arginine infusion. Intravenous infusion of arginine has been reported to be a powerful stimulus of endogenous gastrin release. This response has been re-examined in 12 normal human subjects. 6 of the subjects showed a 40% or greater rise in serum gastrin, and these responses were widely scattered in time. Changes in overall mean serum gastrin were small and showed a significant (p less than 0.05) rise over mean basal levels at only one point in time which was during arginine infusion. In this study arginine infusion resulted in a much smaller and less consistent serum gastrin response than previous reports.


A study of acidic glycosaminoglycans in human gastric tissue. The acidic glycosaminoglycans (AGAG) in normal portions of human gastric tissue were separated by electrophoresis in 3 buffer systems. Paper chromatographic separation of the constitutional disaccharide units by digestion of chondroitin sulfates (CS) with chondroitinase-ABC and chondroitinase-AC was carried out after fractionation of CS by ion-exchange resin column chromatography. Thin-layer chromatography of hexosamines and other biochemical analysis were also performed. The presence of hyaluronic acid in the gastric tissue was substantiated by the enzymatic susceptibility to streptomyces hyaluronidase. The results indicated that human gastric AGAG consisted of, in the order of amount, heparan sulfates, dermatan sulfate, hyaluronic acid, chondroitin-4-sulfate, chondroitin-6-sulfate and presumably oversulfated chondroitin sulfate.


beta-Glucoronidase and the gastric epithelial cell. A study using organ culture. In an attempt to determine the significance of increased beta-glucuronidase content of gastric juice of patients with gastric carcinoma, gastric mucosal cells were exposed, in organ culture technique, to a known gastric carcinogen and indices of carcinogenic activity were studied in the ambient fluid and in the mucosal cells. Isotopic methods were used to determine cell viability. Indices of carcinogenic activity in the ambient fluid were beta-glucuronidase and lactate production and changes in the LDH isoenzyme pattern of the homogenates of the exposed cells were also studied. Incubation with the carcinogen resulted in increased production of beta-glucuronidase and lactate, suggesting the increased beta-glucuronidase activity in the gastric juice of patients with gastric cancer indicates malignancy.


Enterokinase activity in human intestinalized gastric mucosa. Enterokinase activity was demonstrated in biopsies obtained during gastroscopy specimens in 6 patients with extended intestinal metaplasia of gastric mucosa. These observations seem to support the hypothesis that intestinalized brush border cells of gastric mucosa may have the original absorptive and secretory capacity of true intestinal epithelium.


Influence of aspirin on healing of chronic gastric ulcers in dogs. Gastric ulcers induced in dogs by transserosal injection of 1 ml of 40% acetic acid healed completely by the 7th week after ulceration and never reulcerated during the observation period up to 12 weeks. Acetic acid ulcers in the active (at 1 week), quiescent (3 weeks) or healed (at 7 weeks) stages were not influenced by the daily administration of aspirin 2 g/dog/day for for 5 consecutive weeks. All examinations were done by gastroscopy in addition to macroscopical and histological observations at autopsy.


Comparison of the step-dose and single-dose acid response to histamine and pentagastrin in chronic gastric fistula rats. Time-response and dose-response curves for acid output to continuous infusion of histamine (HIST) and pentagastrin (PG) were determined by two techniques in conscious rats provided with chronic gastric fistula. With the step-dose technique the dose of the stimulant was increased each hour; with the single-dose technique only one dose of the stimulant was administered on each test day. The observed maximum acid output (OMAO) was obtained either by infusion of PG at a rate of 6 microgram/kg/h using both techniques or HIST at a rate of 1 mg/kg/h with the single-dose and 2 mg/kg/h with the step-dose technique. These OMAO were in the order: single PG greater than single HIST greater than step Hist greater than step PG in ratios 100--99--83--82. The dose-response curves were also analyzed by application of the Michaelis-Menten equation. For each stimulant there was no difference between the calculated maximum acid output (CMAO) whatever the technique used, but PG gave lower CMAO than HIST (p less than 0.05). For both stimulants the calculated doses for half the calculated maximal response (CD 50) are significantly higher with the step-dose than with the single-dose technique. These results are compared with those previously described in the literature for cats, dogs and man.


Influence of an elemental diet in protein exudation in chronic inflammatory bowel disease. 13 patients with chronic inflammatory bowel disease were treated with an elemental diet (Vivasorb). Intestinal protein exudation was studied during the treatment by means of of 131I-albumin. 131I-albumin studies showed no significant change of albumin degradation and, by inference, of intestinal protein loss in the group as a whole. A high initial albumin degradation rate augured treatment with elemental diet and prednisone to be unsuccessful. It is concluded that measurement of intestinal protein leakage is of no predictive value as regards the effect of treatment of chronic inflammatory bowel disease with elemental diet. Apparently, diminishing protein exudation is a late phenomenon during a course of clinical remission.


Zinc deficiency in Crohn's disease.

Zinc deficiency in Crohn's disease. Zinc nutriture has been studies in 30 patients with Crohn's disease using plasma zinc, hair zinc, and taste acuity as indices. Significant reductions in plasma zinc concentrations and taste acuity were seen in the patient groups as compared with normal controls. Hair zinc content was also generally low with several deficient values encountered among the Crohn's patients. A highly significant correlation between plasma zinc and albumin suggests a possible role of plasma-binding alterations in the depressed plasma zinc levels of patients with Crohn's disease patients and a potential influence on growth and healing in this disease must be considered.


Species specificity and other aspects of chymotrypsin inhibition by plasma. The inhibition of chymotrypsin activity by pig, dog, human and rat blood plasma was studied. N-Benzoyl-L-tyrosyl-p-amino-benzoate (PABA-peptide) was used as the substrate. Crystalline bovine chymotrypsin as well as activated lyophilized human, pig, rat and chicken pancreatic secretions were used as enzyme sources. Certain species differences were noted. Swine plasma had no effect on bovine or human chymotrypsin while it inhibited that of the chicken by 67%. Dog plasma was a potent inhibitor of chymotrypsin activity from all sources tested. An acute pancreatitis model using the rat was also developed in which pancreatic juice flow was blocked without interference with biliary flow. After 24 h, these animals had increased plasma amylase activity, decreased plasma protease inhibitor and decreased hematocrit. By 72 h, amylase, trypsin inhibitor and hematocrit had nearly recovered while chymotrypsin inhibitor had actually increased above control levels. In rats subjected to hepatectomy or to hepatectomy plus pancreatic blockage, plasma protease inhibitor was even more severely depressed and remained so.


Carcinomas of the liver and forestomach in mice ingesting chlorobenzilate. The maximal tolerated dose of chlorobenzilate was given by continuous oral administration, starting at the age of 7 days, to both sexes of two hybrid strains of mice-(C57BL/6 X C3HAnf)F1 and (C57BL/6 X AKR)F1. There was an increased incidence of tumors in one or more organs in male mice of both strains and female mice of the (C57BL/6 X C3HAnf)F1 strain. Male mice of both strains developed significantly elevated incidences of carcinomas of the liver. Female (C57BL/6 X C3HAnf)F1 strain mice had a significantly increased incidence of hyperplasia and carcinomas of the forestomach.


Primary humoral immune response against tumor membrane antigens and foreign antigens by plasma cell tumor bearer mice. The MOPC-460 plasma cell tumor possesses tumor specific antigens. It nevertheless grows and kills its syngeneic host. The possible impairment of immune responsiveness in tumor bearing mice was investigated by measuring their ability to mount a humoral immune response against foreign antigens, such as sheep red blood cells or bacteriophage T4. No significant decrease in the response to either antigen was found until the tumor mass exceeded 10-15% of the host's body weight. Moreover, circulating anti-tumor antibodies were detected in the serum throughout the initial period of tumor growth. The possible interference of these antibodies with cell-mediated defence mechanism was ruled out by experiments where the humoral response was selectively suppressed from birth by repeated administrations of anti-immunoglobulin heavy chain antiserum. In a "suppressed" mice, tumors took, grew and developed more rapidly than in controls. It is concluded that, at least in the model studied, the humoral immune response operates as a defence mechanism against expansion of the tumor clone.


[The etiology of urinary tract infections]. The Authors have planned a program in order to file and elaborate with a computer the results of urine cultures. From 8.600 specimens, about 86% were negative or doubtful. The data obtained from 1201 positive cultures were processed in order to state the absolute and relative frequency of the bacterial species isolated and their distribution according to their genera, antibiotic resistence, month and sex. Among the most representative species the pattern of antibiotic resistence was surveyed. E. coli shows very high frequency (38%). The frequency of Pseudomonas increases while staphylococci frequency decreases as compared with the previous statements of various Authors. The analysis of the antibiotic sensitivity spectrum of 534 specimens shows that about 50% of E. coli strains are sensitive to 10, 11 and 12 antibiotics and their pattern of resistence involves no more than 9 antibiotics; on the contrary more than 60% of Pseudomonas and Proteus rettgeri are resistant to 10, 11 or 12 antibiotics and at any rate to no less than seven. Enterobacter and Proteus mirabilis present an intermediate pattern of resistence.


Ultrasound evaluation of the nonvisualized gallbladder. Grey-scale ultrasonography is a relatively new diagnostic modality which can be employed to evaluate the cholecystographically nonvisualized gallbladder and the jaundiced patient. The procedure is simple to perform and causes no discomfort to the patient. Ultrasonography can detect gallstones and differentiate obstructive (surgical) from hepatocellular (medical) jaundice. Frequently, it is also instrumental in diagnosing the cause of biliary obstruction in the patient wiht obstructive jaundice. Eleven illustrative cases are presented in which ultrasonography played a key role in establishing the correct diagnosis.


Gallstones preventing ultrasonographic visualization of the gallbladder. Ultrasonography can be used to diagnose the presence of multiple gallstones, despite the fact that the gallbladder, per se, may not demonstrated. The finding of many echoes in the area occupied by the gallbladder that cast a large acoustical shadow is strongly suggestive of gallstones.


Choledochal cyst in adults. A clinical and radiological study in ten cases. Choledochal cysts are being recognized with an increasing frequency among the adult population. In this series a correct preoperative diagnosis was established in eight of the ten patients. The clinical tirad of obstructive jaundice, right upper abdominal pain, and a palpable flactuant mass was noted in only two cases but at least one of these symptoms was present in all patients. Acute pancreatitis, cholecystitis, and biliary calculi were the commonly associated findings. New etiologic and clinical concepts of choledochal cysts are reviewed and the spectrum of radiographic features in adults is presented.


Chiba needle percutaneous transhepatic cholangiography. Percutaneous transhepatic cholangiography with the Chiba University needle has been utilized in 30 patients. The ducts were successfully demonstrated in all 21 patients with obstructive jaundice. Sixty-seven percent of normal or stenosed ducts were visualized. No serious complications occurred and emergency post-procedural laparotomy was unnecessary. Our results reflect other reports. Percutaneous transhepatic cholangiography is an efficacious method of evaluating the hepatobiliary system.


Percutaneous forceps extraction of retained biliary tract calculi. The experience of the authors with postoperative extraction of retained biliary calculi in 35 cases is presented. Successful removal of the stones was achieved in all patients without any significant complication. The advantage of the Mazzariello-type metal forceps as compared to the Burhenne method is emphasized and illustrative examples are presented. Specific guidelines for a successful application of various techniques of stone extraction are provided.


Cholecystokinin cholecystography in the diagnosis of chronic acalculous cholecystitis and biliary dyskinesia. A cirtical appraisal. Now that the active fragment of the cholecystokinin molecule has been made available for use in clinical pracitce, reports on the value of cholecystokinin cholecystography must be re-evaluated to determine if the procedure is worthwhile in patients with persistent symptoms and a normal conventional oral cholecystogram. Such an analysis discloses that there is no uniform agreement on what consitutes an abnormal examination and raises serious questions concerning the scientific validity of much of the data. It is apparent that there is no immutable evidence to date to indicate that cholecystokinin cholecystography is an accurate technique to determine which patients in this category will benefit from cholecystectomy.


X-ray examination of endoscopy? A blind prospective study including barium meal, double contrast examiniation, and endoscopy of esophagus, stomach, and duodenum. One hundred and one consecutive patients with upper abdominal dyspepsia were examined by conventional barium meal, double contrast examination, and endoscopy of the stomach and the duodenum in a blind prospective investigation. All the examiners were specially trained. Only small differences between the sensitivity and the specificity of the methods were found, but the clinical importance of the false positive and the false negative errors of the three methods of examination was not the same. The sensitivity of the ordinary X-ray examination was found to be sufficiently high for still recommending this method for primary screening. In case of posivite findings in the stomach, supplementary gastroscopy ought to be performed in order to increase the diagnostic specificity.


Pancreatic pseudocysts involving the spleen. Pancreatic pseudocyst involving the splenic parenchyma itself is an unusual complication of pancreatitis. The diagnosis is best established by arteriography, isotopic studies, and sonography. Once confirmed, surgical intervention is mandatory because of the danger of secondary hemorrhage.


Double contrast examination of the small bowel. The technique for contrast examination of the small bowel has been considerably elaborated during recent years by the reintroduction of duodenal intubation by Sellink. A double contrast method for the small bowel via duodenal intubation is presented based on a prospective study of 202 patients. When the injected contrast medium had reached the cecum, air was introduced and double contrast views were obtained of the terminal ileum and cecum. It was noted that air passed very rapidly through the bowel but did not seem to influence that transit of the positive contrast medium. The duration of the examination in 75% of the cases was less than 45 min.


Crohn's disease of the small bowel examined by double contrast technique: a comparison with oral technique. The combination of orally administered bartion is an old method which has come into use again. The technique is simple to perform and the examination is of short duration. In order to evaluate the applicability of this method it was compared with the oral technique in 43 patients with Crohn's disease of the small  bowel who were examined by both methods. The tube technique revealed more clearly all pathologic changes except fistulas. The proximal extension of the changes and their demarcation from healthy intestine appeared more distinctly with the tube technique.


Per oral pneumocolon examination of the ileocecal region. The combination of orally administered barium and the introduction of air rectally at the time the barium column is in the region of the cecum and terminal ileum leads to an excellent visualization of the ileocecal region. It may be used whenever a conventional barium enema examination fails to show this region adequately.


Urological complications of regional enteritis. Urological complications of regional enteritis occur frequently and may be clinically unsuspected. Radiographic findings include nephrolithiasis, characteristic stricture of the ureter, panvesiculitis, and enterovesical fistual. Less specific findings include renal amyloidosis and retroperitoneal abscesses. Mucosla nodularity of the bladder dome, even without gastrointestinal symptoms, should raise the possibility of regional enteritis. On the other hand, occult ureteral stenosis in patients with known regional enteritis may be present. For this reason, it is recommended that routine and periodic excretory urograms be a central part of the evaluation of the patient with regional enteritis.


Preoperative radiographic diagnosis of a Spigelian hernia containing large and small bowel. A case is reported in which the preoperative diagnosis of a Spigelian hernia containing both large and small bowel was made by radiographic means. The anatomy, clinical findings, and radiologic picture of this condition are discussed.


Radiology in the current assessment of ulcerative colitis. Plain abdominal radiography in acute ulcerative colitis is essential to detect acute colonic complications, such as acute dilatation and free perforation. Sealed perforations may not be detected. Useful information can be gained as to the extent and severity of the mucosal lesions, but can be unreliable so that a contrast examination is required. The double contrast barium enema is more accurate than the single contrast study in revealing the early mucosal lesions of colitis. It is the examination of choice to show the extent and severity of disease, and is of considerable value in the differential diagnosis of colitis. In active colitis, the unprepared double contrast barium enema is recommended. The success of the examination relies on the absence of fecal residue adjacent to an active mucosa. The technique, uses, and limitations of this type of examination are described. In the long-term management of colitis, the role of radiology is to show the presence of extensive disease, which indicates an increased risk of malignancy. Lesions such as strictures or polyps may be found and are more likely to be benign than malignant, but confirmation often requires endoscopic biopsy. In the search for malignancy regular barium enema examination is not recommended, as this can only reveal an overt tumor, whereas premalignancy can be detected histologically from an endoscopic biopsy.


Tubeless hypotonic examination of the afferent loop of the Billroth II stomach. In 39 out of 50 consecutive radiologic examinations in 48 pateints with a Billroth II gastroenterostomy, excellent hypotonic images of the afferent loop were obtained after an intravenous injection of 1-2 mg of glucagon. In six examinations the results could be classified as satisfactory; in five as unsatisfactory.


Duodenal intussusception secondary to Brunner's gland hamartoma. A case report. Intussusception of the duodenum is a relatively rare event, and usually results from the presence of benign tumors. A case of duodenal intussusception secondary to Brunner's gland hamartoma is described and its differential diagnosis discussed.


Food as a cause of small intestinal obstruction. A report of five cases without previous gastric surgery. The clinical and roentgenographic findings in five patients with small intestinal obstruction caused by food impaction are presented. None had undergone previous gastric surgery. While the clinical features are those of small intestinal obstruction, an upper gastrointestinal study may demonstrate the exact site and nature of the obstruction.


Unusual causes of gastrocolic fistula.

Unusual causes of gastrocolic fistula. 1. Three cases of gastrocolic fistula of unusual cause are presented. These include one patient each with carcinoma of the left kidney, gastric lymphoma, and granulomatous colitis. 2. The relationships between the kidneys and gastrointestinal tract are illustrated by a cadaveric cross-section. 3. The wide variety of diseases resulting in gastrocolic fistula is discussed. 4. Careful fluoroscopic and radiographic study may be necessary to detect the site of the fistula and to identify its cause.


Colonic necrosis complicating pancreatitis. Bowel necrosis is an uncommon complication of pancreatitis. Two patients are reported who developed ileocecal and descending colon changes as a result of ischemia following severe pancreatitis. Arteriography in one patient confirmed the presence of intraluminal thrombi.


Ischemic colitis associated with carcinoma of the colon. Two cases of ischemic colitis occurring proximal to carcinoma of the colon are described, with special reference to the barium enema and pathological findings. The association of these two conditions is rare but when present may cause some confusion. It is possible that the two lesions may, for instance, be considered to be both due to ischemic colitis, or mistaken for granulomatous colitis with a stricture.


Colonic ileus.

Colonic ileus. Nine cases of colonic ileus, characterized by selective or disproportionate distention of the large intestine without organic obstruction, are detailed. Massive cecal dilatation often dominates the radiographic presentation and may portend perforation. While management is generally conservative, cecostomy may be necessary to prevent peritonitis.


Congenital positional anomalies of the colon: radiographic diagnosis and clinical implications. I. Abnormalities of rotation. Positional anomalies of the colon may be explained by an arrest in the normal development process of the distal midgut. Aberrations involving the incipient stages of rotation lead to severe malpositions, while those involving the latter stages to milder forms. The normal embryology of the distal (postarterial) segment, as well as forms of complete and partial nonrotations, are discussed and illustrated. A survey of 39 consecutive cases of rotational abnormalities of the midgut with special emphasis on the configuration of the colon is presented. There is a high incidence of associated failure of fixation resulting in mobile colons that can be demonstrated radiographically. In addition, the great majority of colonic malrotations demonstrate rotational abnormalities involving the proximal intestinal tract. Their clinical implication is related to the presence of other incidental congenital anomalies or to complications derived from faulty mesenteric fixations such as peritoneal bands, adhesions, kinking, or intestinal volvulus.


Congenital positional anomalies of the colon: radiographic diagnosis and clinical implications. II. Abnormalities of fixation. Defective fixation during embryologic development is responsible for a variety of segmental colonic malpositions seen during barium enema examinations. A review of the normal development process of fixation is presented, together with the most common and significant aberrations. On the right side clinical entities such as axial torsion, cecal bascule, retrocolic sigmoid, and pericolic bands are discussed and illustrated. On the left side, the configuration and clinical implications of the malposition of the splenic flexure are analyzed. It is pointed out that reversed configurations of the splenic flexure associated with failure of fixation of the entire descending colon may occur as an isolated congenital abnormality and may not necessarily be associated with renal anomalies. The characteristic radiographic appearance of the persistent descending mesocolon and its potential for complications is in addition emphasized. Familiarization with the radiographic appearance and clinical implications of these common abnormalities is essential in the daily interpretation of barium enema examinations.


Cecal changes following appendectomy.

Cecal changes following appendectomy. The appearance of the cecum was followed from two days to 18 months after appendectomy in a series of 12 patients. The changes were often discrete and well defined. The typical localized deformation of the medial aspect of the cecum due to the invaginated appendiceal stump disappeared in half of the patients while its size was not reduced in the other half of the patients. The localized deformation was rather constant in size and measured approximately 2 X 2 cm.


Problems in the diagnosis of pancreatic carcinoma by endoscopic retrograde cholangiopancreatography. Diagnostic problems occurred in five out of 55 patients undergoing endoscopic retrograde cholangiopancreatography who subsequently proved to have carcinoma of the pancreas. In one patient the pancreatic duct was normal, two had non-specific ductal abnormalities, one had pancreas divisum, and one had ductal ectasia. Two patients with non-specific changes on retrograde pancreatography had evidence of tumor on their retrograde cholangiogram. Two patients had ductal obstruction simulating pancreatic cancer, in one due to compression by the thoracic spine, in the other by inflammatory changes.


Percutaneous fine needle aspiration biopsy of pancreatic carcinoma. Carcinoma of the pancreas was diagnosed in 13 patients by percutaneous fine needle aspiration. The tumor was localized by angiography in eight, ultrasound in five, and endoscopic retrograde pancreatography in three patients. In four patients aspiration was performed using two of the three localizing techniques. Cytological diagnosis of carcinoma of the pancreas can be made accurately by percutaneous fine needle aspiration of the tumor and operative intervention avoided in those patients who do not require operative bypass procedures. Percutaneous fine needle aspiration can be used with equal facility with arteriography, ultrasound, or endoscopic retrograde pancreatography. There have not been complications due to fine needle biopsy, and one can expect a 77-86% positive diagnostic yield.


Metastatic colon carcinoma simulating primary bile duct carcinoma via endoscopic cholangiography. A case of metastatic colon carcinoma simulating primary bile duct carcinoma is presented. The radiographic similarities via endoscopic retrograde cholangiopancreatography include bile duct narrowing and mucosal destruction. A distinguishing feature, however, is failure of the intrahepatic bile ducts to dilate in metastatic carcinoma to the biliary tree.


Splenic uptake of 99mTc-diphosphonate in sickle cell disease associated with increased splenic density on computerized transaxial tomography. Splenic uptake of 99mTc-diphosphonate was found on the bone scan of a patient with sickle cell disease. No splenic activity was demonstrated on 99mTc-sulfur colloid liver-spleen scans and no evidence of splenic calcification was seen on plain abdominal radiographs. A computerized transaxial tomographic scan, however, did demonstrate a small spleen denser than other abdominal organs. The splenic accumulation of 99mTc-diphosphonate and the increased density on computerized transaxial tomography could be attributed to microscopic splenic calcifications and/or iron deposits in the spleen.


Emphysematous gastritis and gastric perforation. An unusual manifestation of alkaline corrosive ingestion. The stomach is usually not affected in cases of alkaline corrosive ingestion, being protected by its acid content. With large amounts of alkali ingestion there may be gastric necrosis leading to early perforation. We report a case of alkali ingestion with two unusual findings: emphysematous gastritis and late perforation.


Pneumatosis cystoides intestinalis and obstructing intussusception in celiac disease. Spontaneous penumoperitoneum and pneumatosis cystoides intestinalis have been undescribed complications of celiac disease. In the case reported, small bowel gas cysts caused an obstructing intussusception. The etiology of the pneumatosis cystoides intestinalis is discussed.


Ischemic jejunitis and pneumatosis intestinalis secondary to anastomotic obstruction following jejunal atresia repair. An infant with jejunal atresia developed ischemic jejunitis with intramural and portal venous gas postoperatively following prolonged anastomotic obstruction. The importance of differentiating ischemic bowel disease secondary to obstruction from classic necrotizing enterocolitis is illustrated by this case report.


A comparison of colonoscopy and roentgenography for detecting polypoid lesions of the colon. This study compares the effectiveness of the roentgen and colonoscopic examination of the colon for detecting polypoid lesions. We evaluated the findings in 64 patients with suspected or known polypoid lesions who received the same colon cleansing regimen for both examinations, and were studied by examiners of similar expertise. As in other studies, the endoscopist had the advantage of knowing the roentgen findings, and the colonoscopic findings were often taken to indicate whether or not a lesion was present. In about half the patients, however, a second roentgen examination, repeat colonoscopy, or surgical specimen provided additional information for scoring. For example, a filling defect of the same size and location on two roentgen examinations, but not demonstrated at colonoscopy was scored as a false negative colonoscopic finding. The study results indicate that 54% of small polyps less than or equal to 0.9 cm in size were missed on roentgen examination, whereas no proven misses for lesions of this size were shown for colonoscopy. This absence of colonoscopic false-negative findings for small polyps, however, may be partially explained by a relative insensitivity of the roentgen method. For larger lesions greater than or equal to 1.0 cm in size the miss-rate for the two examinations was similar: 15% for roentgen examination and 12% for colonoscopy. We conclude: (1) Colonoscopy is a more sensitive method than roentgen examination for detecting small polyps of the colon, and (2) Performance of the two examinations may be comparable for demonstrating lesions 1.0 cm or larger in size.


Pseudoulcerations of the colon on barium enema examination. Marginal spiculations and punctate collection of barium may occasionally be identified on barium examination in patients with a normal colon. These may be due either to filling of the crypts of Lieberkuhn with barium or retention of barium in the innominate grooves of the colon. Perhaps both combine to produce the radiographic findings. This normal variant must be carefully distinguished from actual ulcers associated with inflammatory bowel disease in order to avoid making a major error in diagnosis.


Yersinia colitis.

Yersinia colitis. A 2-year-old child with a febrile, non-bloody diarrheal illness of acute onset with repeatedly negative stool and blood cultures for pathogenic bacteria is presented. Sigmoidoscopic and roentgenographic studies revealed an inflammatory colitis. Unfortunately, diagnostic perserverance and a high index of suspicion resulted in a positive stool culture for Yersinia enterocolitica. Serologic study and clinical course provided data consistent with the diagnosis of an infectious colitis due to Yersinia enterocolitica. This case demonstrates the necessity to consider Yersinia enterocolitica in the radiographic differential diagnosis of Crohn's disease of the colon or ulcerative colitis, as well as intractable diarrhea of childhood.


A comparative study of intravenous cholangiography and 99mTc-pyridoxylideneglutamate in patients with hepatobiliary disease. The purpose of this investigation was to compare the diagnostic value of intravenous cholangiography with 99mTc-pyridoxylideneglutamate, a new radioisotopic biliary imaging agent, in 15 patients with suspected hepatobiliary disease. Each subject had both examinations, and the studies were interpreted independently. The results suggest that intravenous cholangiography may provide more specific information about the ductal system but is of limited value in patients with elevated bilirubin. In these patients 99mTc-pyridoxylideneglutamate may show patency of the bile ducts and distinguish between partial and complete biliary tract obstruction. Depending upon the serum bilirubin level, both studies may provide useful and complementary information about the biliary tract.


Choledochocele demonstrated on percutaneous cholangiography: a patient with acute fulminant pancreatitis. A patient with a choledochocele associated with development of acute fulminant pancreatitis is presented. Treatment had been severely compromised by this rare anomaly before it was identified by percutaneous cholangiography. Because it is potentially curable with surgery, identification of the lesion by percutaneous or intravenous cholangiography has important clinical significance.


Hepatic angiography in hereditary hemorrhagic telangiectasia. Three patients presenting with gastrointestinal bleeding and characteristic radiologic findings of hereditary hemorrhagic telangiectasia are described. Emphasis is placed not only on the angiodysplasia evident from abdominal angiography, but also on the demonstration by the chest radiograph of a chronic mild hyperdynamic state.


Clinical value of hepatic vein catheterization. Improved pracability by balloon catheter technique. Techniques of hepatic vein catheterization, hepatic venous pressure measurement, and occlusion phlebography using a balloon catheter are described. Hepatic venous pressure measurements (n=95) and hepatic occlusion phlebography were combined in 32 cases. In patients with liver cirrhosis (n=63) a significant elevation of hepatic venous pressure gradients was found. A decrease of the pressure gradient was seen after portacaval and splenorenal shunt operations. Hepatic occlusion phlebography showed alterations of hepatic veins only in patients with cirrhosis. A rough correlation between pressure gradients and the extent of changes in the liver veins was found. Hepatic occlusion phlebography, in patients who had undergone shunt procedure, demonstrated various collaterals. Combined hepatic vein pressure measurements and hepatic occlusion phlebography using a balloon catheter are proposed as a very suitable method for the evaluation of chronic liver disease and portal hypertension.


Optimum viscosity of barium suspension for use in the double contrast barium meal. The effect of viscosity of barium sulphate suspensions on coating was assessed by glass slides as in vitro, and the rat as in vivo models. It was found that below a certain viscosity (as measured by a cup viscometer) coating was impaired. As increasing viscosity is associated with increasing bubble retention and, eventually, when very high viscosities are reached, poor surface flow of suspension, it is recommended that the viscosity of the medium employed should be kept within a narrow range, approximately equal to 70% w/v Baritop, 80% Micropaque, 115% E--Z-paque, 150% Barosperse, or 200% HD 200.


Pneumatosis intestinalis.

Pneumatosis intestinalis. Pneumatosis intestinalis is a usually benign condition which may affect any segment of the gastrointestinal tract from the stomach to rectum. Occasionally, however, it may be a grave prognostic sign. This article presents the spectrum of diagnostic radiographic features of the entity with emphasis on differentiation of the underlying etiologic factors. Representative examples of pneumatosis intestinalis complicating various gastrointestinal disorders are illustrated.


Ischemic disease of the small bowel and colon associated with oral contraceptives. The widespread use of hormonal contraceptive pills by young women has caused a documented increase in thromboembolic disorders. This article describes yet another of the drug-induced complications namely, the development of ischemic bowel disease in seven cases. The ischemic changes which involved the small intestine in three and the colon in four patients became reversible after conservative management and discontinuance of oral contraceptive agents. The importance of clinical and radiologic consideration of ischemic bowel disease in young females receiving birth control pills is emphasized.


Radiologic manifestations of iatrogenic changes of the esophagus. The review of the roentgen manifestations of iatrogenic changes in the esophagus permits their grouping into two major categories of intentional and nonintentional alterations. In the first group, iatrogenic changes are encountered following reconstructive or other types of surgery, radiotherapy, and their respective complications. Nonintentional changes of the esophagus include injuries induced during diagnostic procedures, life-saving measures, and drug therapy. The knowledge of the spectra of possible iatrogenic alterations is important for accurate radiologic evaluation of the patients and the recognition of complications.


Postgastrostomy deformity of the stomach. Temporary postoperative tube gastrostomy may produce permanent deformity of the stomach as visualized on an upper gastrointestinal series. Six cases were studied illustrating two configurations of the gastric deformity. These appear to be related to the location of the gastrostomy opening in the stomach. The findings were either anterior displacement of the gastric antrumwith adherence to the anterior abdominal wall or acute angulation of the gastric body in a medial and anterior direction.


Intestinal pneumatosis--a complication of the jejunoileal bypass procedure. Six cases of intestinal pneumatosis following the jejunoileal bypass procedure are reported. Although the radiographic pattern of the pneumatosis intestinalis suggested severe disease, such as bowel infarction or necrotizing enterocolitis, all cases followed a benign course.


Cervical Thorotrast granuloma: an iatrogenic cause of dysphagia. Thorotrast granuloma of the neck is an extensive benign connective tissue overgrowth secondary to localized extravasation of contrast. This can present with dysphagia secondary to mass effect or motor disorder of swallowing related to demyelinization of the ninth through twelfth cranial nerves. The radiographic appearance is characteristic in both location and density.


Hepatic arterioportal fistula related to a liver biopsy. A case of hepatic artery portal fistula, presenting with bleeding esophageal varices five months following a liver biopsy for cirrhosis, is presented. The angiographic features of the lesion are illustrated and the pertinent literature concerning etiology of hepatic arterioportal shunts is reviewed.


[Obtaining autosomal recessive mutations in the silkworm by exposure to nitrosomethylurea]. Mutagenic effect of N-nitrosomethyl urea (NMU) was studied in silkworm Bombyx mori L. Taking into consideration the specificity of the mutagen action, the main part of the work delt with the search for the optimum regime of the mutagen administration. The NMU effect is observed at different stages of the silkworm development by means of different methods. Maximal frequency of mutation in +re locus, obtained by the method of abdominal injection of the male-morth comprised 1.4%. Genetic analysis of the nature of the mutants obtained has revealed them to be point mutants.


[Quantitative assessment of human chromosomal polymorphism with regard to paracentromeric heterochromatin]. The measurement of C-segment length in chromosomes 1, 9 and 16 of 7 individuals was carried out. The regression analysis was employed to study a change of the C-segment sizes in the process of mitotic chromosome condensation. Typical values of C-segment length for chromosomes 1, 9 and 16 are about 1.4, 1.1 and 0.8mu respectively. Among 7 individuals there was no two which had identical size of C-segments for all three chromosomes studied. In six individuals heteromorphysm of C-segments was revealed. It was found that visually detected heteromorphysm may be expressed quantitatively as ratio length of C-segments in homologous chromosomes.


Melanocyte colonization and pigmentation of breast carcinoma. Colonization of mammary cancers by melanocytes with attendant pigmentation of cancer cells by melanin occurs in most cases of breast cancer in which the dermal--epidermal interface is reached by the tumour cells. There is evidence to suggest that the mammary cancer may become colonized at the expense of the epidermis, which is focally depleted of melanocytes. Melanocytes can even be found in groups of tumour cells within lymphatics. Colonization and pigmentation of breast cancer is usually only easily detected by selective staining methods. In very rare cases it can be gross and easily detectable in routine stains. The implications of this migratory phenomenon are discussed in terms of the biology of the melanocyte.


Eosinophilic granuloma of lymph nodes.

Eosinophilic granuloma of lymph nodes. Two examples are reported of eosinophilic granuloma presenting as lymphadenopathy and being apparently confined to lymph nodes. The affected nodes were characterized by a striking sinus histiocytosis, a heavy infiltration with mature eosinophils and retention of normal lymphoid follicles. The differential diagnosis of this histological picture is discussed and the prognosis considered.


Chronic hepatitis: a problem for the pathologist. The accepted histological categories of chronic hepatitis are chronic persistent hepatitis (CPH) and chronic active or aggressive hepatitis (CAH). A third form, chronic lobular hepatitis (CLH), encompasses those cases in which the lesion is predominantly within the lobules and in which portal and periportal inflammation are mild. CLH has many synonyms. International agreement on a reproducible and rational nomenclature of chronic hepatitis is still far from complete. CPH is characterized by portal inflammation. Histological definition is simple, but there are diagnostic pitfalls. The category may need subdivision on the basis of immunological studies. CAH should be regarded as a complex rather than a single disease, and it is important to specify the aetiology and pathological components in each instance. The concept of CAH must be altered to incorporate the lesion of bridging hepatic necrosis (BHN). Piecemeal necrosis, accompanied by inflammatory infiltration, is considered to be the most important of the various pathogenetic factors in CAH, but BHN probably plays a significant part in accelerating the development of cirrhosis. An excessive portal and periportal inflammatory reaction with or without BHN, in a liver biopsy taken during the course of an acute hepatitis, helps to predict a possible  chronic course.