Recurrent operable breast cancer following incomplete mastectomy. Forty patients have been treated with recurrent operable breast cancer after having undergone procedures less extensive than modified radical mastectomy as a treatment of the primary, with or without radiation therapy. Initial pathology was invasive cancer in 21 patients, and treatment (excision or simple mastectomy, with or without radiation therapy) has been offered as the treatment of choice. Completion of radical mastectomy was done here in 30 patients, extended radical mastectomy in 3, and local excision in 7. Eleven received postoperative radiation therapy. The overall 5-year survival rate from the time of treatment, free of disease, was 40 per cent, and the 10-year survival rate was 20 per cent. If initial treatment included radiation therapy, survival was improved (12/25 vs 4/15 having no radiation therapy). Axillary nodal involvement was extensive, with 13 patients having positive level III nodes. Such patients should be followed closely in order to detect recurrence earlier. Adjuvant radiation therapy and chemotherapy trials post mastectomy should be evaluated in the hope of improving survival.


Chromosomal repatterning in Acrididae.

Chromosomal repatterning in Acrididae. Studies on the chromosomes of the acridid grasshoppers Acrida turrita, Poekilocerus pictus and Chrotogonus oxypterus have led the authors to surmise that structural re-arrangements must have played a major role in chromosomal repatterning and karyotypic evolution. Moreover, the telocentricity noticed in the Cryptosacci was evident in the Chasmosacci without the presence of the metacentric chromosomes to account for the reduction in the chromosome number. Possible trends in the evolution are discussed.


Isolated metaphase chromosomes: scanning electron microscopic appearance of salt-extracted chromosomes. Scanning electron microscopy of salt extracted, isolated metaphase chromosomes has been used to further the understanding of the role of proteins and DNA in chromosome architecture. Metaphase chromosome surfaces consist of numerous compact microconvules with an average diameter of 520 +/- 78 A which result from several orders of supercoiling. Treatment of isolated chromosomes with various salt concentrations ranging from 0.4 to 2.0 M NaCl revealed a longitudinal array of fibres within the chromatids as well as regions of coalesced nucleoprotein. The results demonstrate sensitivity of chromosome structure based on chromatin supercoiling, to progressive extraction of chromosomal proteins and DNA over the range of salt concentrations examined.


An in vitro method to determine the sensitivity of solid malignant tumours to cytostatic agents. A simple technique is described in which several human solid tumours were assessed in vitro for their sensitivity to cytostatic agents. The technique is reliable, simple, and can be used as an aid to implement chemotherapeutic regimes.


Isolation and preliminary characterization of drug resistant mutants of human lymphoblastoid cells. Mutants of human lymphoblastoid cell lines have been isoalted, which are resistant to 6-thioguanine or to 2,6-diaminopurine. They have been partially characterized and shown to be almost totally deficient in HGPRT and APRT, respectively. Cell lines doubly mutant for HGPRT deficiency and resistance to ouabain have also been isolated. All mutants were indistinguishable from the respective parental lines by criteria other than those leading specifically to their drug resistant phenotypes. The use of these mutants in the production of hybrids between two lines of suspension-growing human lymphoblastoid cells is discussed.


Delay in migration of symbiotic algae in Hydra viridis by inhibitors of microtubule protein polymerization. An English strain of the fresh water symbiotic coelenterate Hydra viridis was experimentally "bleached" of its Chlorella algae and maintained indefinitely by feeding. The algal symbiosis could be re-established by injecting other symbiotic algae into aposymbionts. Although algal uptake and recognition were not affected by microtubule protein polymerization inhibitors, these compounds i.e., podophyllotoxin, beta-peltatin and vinblastine had delaying effects on the migration of the algae through the host digestive cells. Picropodophyllotoxin did not delay migration. The rates, the reversibility and the sensitivity of algal migration to low concentrations of drugs known to bind tubulin suggests the symbionts migrate somehow via labile polymerization of host hydra tubulin into microtubules.


Monitoring the dose of digoxin.

Monitoring the dose of digoxin. All patients being prescribed digoxin in a general practice were examined and the serum urea, creatinine, electrolytes, and digoxin concentrations were determined.Sixty-six patients were identified (0.73 per cent of the practice population). After excluding six, whose tablet-taking was unreliable, it was found that two patients had serum digoxin levels above the usually accepted upper limit and a total of 23 patients (38 per cent of the digoxin takers) had some alteration made to their dose, including eight whose digoxin was stopped. We believe that serum digoxin estimations are useful in determining the optimum dose of digoxin in general practice.


The therapeutic effect of taking a patient's history by computer. Sixty young women who presented at a general-practice health centre had their medical and social history taken by a computer before having an interview with the doctor. The average length of the automated interview was 90 minutes for the 54 patients who completed the programme, during which an average of 211 questions were answered. The patients found this method acceptable and we think that one of the main reasons for this was that the computer programme was so designed that the patients felt that the doctor was involved throughout.The computer/patient interview also appeared to have therapeutic benefits, and the computer's summary of the history was a sensitive indicator of those topics about which the patient was most concerned. This combination enabled the doctor to communicate more quickly and in greater depth in the time available. In effect, the time which the doctor could spend with the patient was magnified.We suggest that the benefits of this system for taking a history from a patient, of which one is the fact that any language or combination of languages can be used, could be extended to all classes of society.


Risks to trawler fishermen: Orkney waters. Over a period of 26 months, emergency medical contact was made with 63 sick or injured trawlermen from Hull and Grimsby who had been fishing in the fishing grounds around the Orkney Islands. The majority of accidents were due either to falls in heavy weather, entanglement with winching or fishing gear, or burns and scalds in the galley. Nearly 80 per cent of the episodes of illness which were seen might not have required the emergency service had the trawler crews been properly screened before going to sea, or trained in elementary first aid.


Holidaymakers in a seaside town.

Holidaymakers in a seaside town. A general practice in a holiday area has problems in dealing with the demands for general medical services by holidaymakers. A survey was devised to study these demands and their effect on the work of the practice. Throughout the summer months every eighth patient seen in the surgery was a visitor and at the peak period every fifth patient was a temporary resident. Temporary residents requested proportionately more home visits late in the day and those staying more than 15 days had a higher doctor contact rate.


Ten-year follow-up of obesity.

Ten-year follow-up of obesity. The care of 43 patients with obesity has been reviewed at least ten years after first presentation. In five patients (12 per cent) there was a successful result, 27 patients (63 per cent) were regarded as failures, and the remaining 11 (25 per cent) were only partially successful. These results are similar to reports from hospital obesity clinics but less favourable than those from general practitioners with an interest in obesity.No definite correlation with the ultimate results of weight control was shown with age or a family history of obesity, but patients who coincidentally required tranquillizers and anti-depressants were more successful at long-term weight loss. Initial weight loss on diet alone gave no guidance as to the final result. Patients who received anorectics for periods totalling more than 12 months had poor long-term benefit.


The anorectic and hypotensive effect of fenfluramine in obesity. A trial is reported of the hypotensive and anorectic effect of fenfluramine in general practice when combined with Yudkin's modification of the Marriott diet. The results confirm the anorectic effect and show that the maximum reduction of blood pressure occurs during the first four weeks of treatment.


Recording family and social history.

Recording family and social history. A diagrammatic method of recording family and social history using a family tree is described. Its advantages are identified and details of the way it has been introduced into the records in one general practice are given.


Audit of a general practice.

Audit of a general practice. During a period of one full week, an analysis was made of the activities of patients (demand) and workers (service) in a suburban general practice. A data collection system was constructed and used by all the health centre workers. We sought to measure demand and service and to show the value of measurement (audit) of an aspect of service, i.e. prescribing.


The cost and advantages of establishing an age-sex register. The advantages and disadvantages of different methods of creating an age-sex register are described. The cost of setting up such a register in a NHS practice with 10,000 patients is shown, and it is suggested that financial advantages may cover the costs involved.


An audit of the care of diabetics in one general practice. I designed and implemented a simple audit of the care of diabetic patients on one general practitioner's list. The audit demonstrated a lack of adequate care in some aspects, so it was used to improve the care offered in future by designing a method of diabetic follow-up incorporating an effective recall system, shared and integrated care between doctor and nurse, and a clear method of recording essential information.I suggest that audit is not adequately completed until the new systems developed have themselves been adequately audited and consequential changes in care measured.


Influenza. The Birmingham Research Unit of the Royal College of General Practitioners. The ;weekly returns' system for the reporting of infectious and communicable diseases to the Birmingham Research Unit of the Royal College of General Practitioners is described. A detailed analysis of the influenza returns for the winter epidemic of 1975/76 is presented and compared with similar data from the previous ten-year period.This analysis allows the following generalizations to be made which can, to a limited extent, be used as broad guidelines for predictions.In any week in which a rate of 20 or more reports per 100,000 population is followed by a week in which there is a trebling of the rate, a major epidemic is imminent in which a peak rate of 500 cases per 100,000 population can be expected within three to four weeks.In any week other than a week referred to previously in which a rate of 30 cases or more per 100,000 population is followed by a doubling of the rate, a moderate epidemic is imminent and peak rates in the range 150 to 500 per 100,000 population will be reached within three to four weeks.The earlier in the critical period just before and just after Christmas that either of these changes are noted, the earlier and larger the peak is likely to be. Where neither of these thresholds is crossed, the peak rate for reported influenza is unlikely to exceed 150 cases per 100,000 people.


The length of consultations in general practice. FOUR CHARACTERISTICS OF PATIENTS WHICH MIGHT AFFECT THE LENGTH OF TIME SPENT IN CONSULTATIONS IN GENERAL PRACTICE WERE STUDIED: the sex, diagnosis, age, and social class of the patient. The sex of the patient was not shown to be significantly associated with any difference. The diagnosis of ;psychoneurotic' conditions was significantly associated with long consultations (p < 0.001) and this is discussed.The number of consultations lasting less than the median time for the whole series was significantly more common in the 15 to 29 age group.There have been few reports published on this topic, which seems important, and I hope further work will examine this aspect of the work patterns of established and trainee general practitioners.


Child care in the new towns in the UK.

Child care in the new towns in the UK. New towns with large populations of children present ideal opportunities to study and implement extended primary care services for children. It appears that workload in most new towns is higher than in established communities. Often, the demanding nature of new town practice seems to have precluded innovations in primary care services for children. This report, which is general-practice orientated, can only indicate some aspects of child care in new towns which require further scrutiny. General practitioners are strongly divided in their views as to how they can act most effectively in child health, but there is no doubt that there is a chance in our new towns to nurture the idea of expanding the general practitioner's role in child care.


Deliberate self-poisoning: implications for psychotropic drug prescribing in general practice. Several surveys have confirmed that the majority of patients who take an overdose of drugs have seen their general practitioner within the preceding few weeks; as many as a third attend within the previous week.We studied 130 patients who had taken an overdose and interviewed 122 of the general practitioners. We found that they had identified many interpersonal problems and had usually prescribed psychotropic drugs.We question the wisdom of this response and suggest other ways of handling such problems in general practice.


Genetic diseases in general practice.

Genetic diseases in general practice. Genetic diseases are important to family doctors. I have analysed my role as a Dutch general practitioner in caring for patients with such disorders and describe this with some examples.


Early detection of chronic simple glaucoma in general practice. Chronic simple glaucoma, also known as open-angle glaucoma, is the cause of blindness in about 13 per cent of people on the Blind Register, and 40 per cent of these have had no treatment before registration. Patients over the age of 60 are most liable to the disease and it is rare under the age of 40; there is often a family predisposition. I carried out a routine test for the disease in 300 patients over 60 years of age in my general practice with the object of detecting chronic simple glaucoma at an early stage. Anyone with an intraocular pressure of over 23 mm of mercury in either eye was referred to a consultant ophthalmic surgeon for further investigation. Seven patients (2.3 per cent of those examined) were confirmed as suffering from chronic simple glaucoma.


Family-doctor support for patients on a psychiatric case register. The family-doctor consultations of 76 patients on a psychiatric case register and 76 matched controls were examined. During a two-year period the psychiatric patients consulted just over twice as often as the controls (p < 0.001). Contact with the psychiatric services did not reduce the psychiatric patients' demand for general-practitioner time.


Contraceptive workload in general practice in the Trent Region. A prospective study was made of the contraceptive workload of general practitioners in the Trent Region between November 1973 and January 1976. This was carried out in three stages allowing comparison between a period of time when patients paid for all contraception, when only contraceptive advice from the general practitioner was paid for, and when contraceptive services and supplied were free from all sources in the NHS. The study shows that the introduction of free contraception services under the NHS Reorganization Act 1973 led to little change for many general practitioners. The number of patients seen each week for contraception did rise slightly, but the characteristics of these patients did not change over the two years.


Learning about the elderly.

Learning about the elderly. I visited nine medical schools on an Upjohn Travelling Fellowship to see how medical students were learning about the care of the elderly. I found a great variety in methods, a variation in quality of teaching, a dearth of educational aims, and little or no evaluation of the students' learning.


Monitoring Section 63 activities.

Monitoring Section 63 activities. The descriptions published about educational activities provided for general practitioners under Section 63 in the North-West Region have been analysed and the pattern of attendance by general practitioners on the list of the Salford Family Practitioner Committee examined. On the one hand there was a small group of 25 out of 131 (19 per cent) of frequent attenders, who accounted for over half of all attendances; on the other hand there was a group of 18 out of 131 (14 per cent) who never came at all. More than 80 per cent of the topics fell in the area (1) of the Royal College of General Practitioners (1972). Evening meetings were preferred to lunch-time meetings and few general practitioners (12 per cent) travelled more than ten miles from Salford to attend Section 63 meetings in 1973 to 1974. We suggest that local organizers should be requested to complete a form giving brief details of such meetings to assist in regional planning.


Doctors' anxieties in prescribing.

Doctors' anxieties in prescribing. Anxieties about prescribing were examined in two seminars for trainee general practitioners. These were caused by four main problems: inadequacies in diagnostic skill, treatment policy, understanding or experience, and anxiety about control of the treatment. Ways of reducing these anxieties, for example by sharing them with the patient, are discussed.


Trainee learning.

Trainee learning. A study of the learning achieved by a small group of vocational trainees during the first six months of their year in general practice showed significant gains (p<0.001) in factual recall as measured by multiple choice questions.Changes were also observed in the answers to a repeated modified essay question test, suggesting that the same trainees were becoming more aware of emotional and social factors in their patients.


A british view of American family practice. I report my impressions, as a British doctor, of American family practice and describe training schemes for family practice and the American approach to assessment and continuing education.


Symptomatic urinary infection in childhood: presentation during a four-year study in general practice and significance and outcome at seven years. Thirty-eight children (12 boys and 26 girls) with symptomatic urinary infection have been studied in general practice. Patients were collected over a four-year period and we report an incidence of urinary infection according to Kass's criterion of 7.7 per 1,000 girls at risk per year and 3.8 per 1,000 boys at risk per year. Eighty-four per cent of the children had symptoms which suggested an origin in the genitourinary tract. Proteus infection was found in five of the boys and only one of the girls. At the end of the four-year study period follow-up had taken place over a mean period of 25 months and recurrent infection had been demonstrated in four boys and 12 girls. All the children had an excretion urogram and two children, both girls, were found to have pyelonephritic scarring. Twelve children with recurrent infection were investigated for vesicoureteric reflux, which was found only in the two children with scarring. At seven years 31 of the children remained in the practice and, with a mean follow-up of 42 months, no significant alteration in the figures for recurrent infection was demonstrated. Guidelines are suggested for the management of childhood urinary infection in general practice.


Coeliac artery compression syndrome: can we believe our ears? Two patients with coeliac artery compression syndrome' are described.Symptoms were vague and nonspecific, and the diagnosis was made by finding an epigastric bruit on auscultation of the abdomen and confirming the presence of a vascular lesion by angiography. Both patients were cured by surgical decompression of the coeliac trunk. Auscultation of the abdomen can be a useful part of physical examination in general practice.


Raised blood pressure and psoriasis.

Raised blood pressure and psoriasis. Male patients with psoriasis in one general practice have a significantly higher blood pressure than males in the general population. Such patients have been compared with the values recorded by Hamilton and colleagues (1954) and with matched pair controls from the same general practice. Statistical analysis using four separate methods has shown a highly significant association between psoriasis and hypertension in males, with close agreement between the tests.


Attendance at a London casualty department. Patients who attended the casualty department of the Middlesex Hospital during one week in 1973 were interviewed. A predominantly young and working population used the department. Relatively few patients lived close to the hospital but many worked nearby. One third of all attendances were by patients who had been asked to return by casualty doctors. About half the new patients came of their own accord; the next largest group had been sent directly from work by an employer or occupational health service. Half the patients came with injuries, many of them superficial, although there were also serious accident cases. One fifth of the patients had no general practitioner whom they could consult. Age and geographical mobility were related to whether or not patients were registered with a general practitioner. The main reasons for not consulting a general practitioner were that patients felt they needed hospital treatment or that it was more convenient to attend the casualty department. It is suggested that the view that casual attenders with relatively trivial complaints should be encouraged to go to a general practitioner is not always applicable since social as well as medical circumstances determine whether or not patients decide to visit casualty.


Establishment of two group practice centres by conversion of existing houses. A practice of five (later six) doctors established their own group practice centre by purchase and conversion of an existing house. Later a second, smaller centre was established in the same way to replace an existing branch surgery.The planning, financing, and execution of these projects is described.


Once daily sotalol in the treatment of hypertension. In a small group of hypertensive patients studied at home, once daily early morning sotalol therapy effectively decreased lying, standing, and post-exercise blood pressure and pulse rate. A dose-response relationship was seen. Adverse effects were mild and transient. The once daily regimen is easy to administer and appears to give precision in blood pressure reduction. Providing there is no subsequent escape from control, once daily beta-blocking therapy should aid long-term hypertension treatment in general practice.


General practitioners and the independent contractor status. Primary medical care can be provided either by a bureaucratic hierarchical organization or alternatively by independent contractors. Most members of the caring professions in medicine, nursing, and social work are employed in bureaucracies, whereas general medical practitioners, general dental practitioners, opticians, and pharmacists are independent contractors.The independent contractor status has recently been heavily attacked from within the medical and nursing professions, and also from outside. It has been suggested that contracting for services is an inappropriate and anomalous way of arranging medical care, which should now be stopped. However, this process of contracting for services can be analysed, using perspectives from some of the behavioural sciences, to reveal hidden depths in the independent contractor status which suggest that the provision of primary medical care is best carried out by independent contractors.


Unit responses of the first and second somatosensory areas to stimulation of the ventroposterior thalamic nucleus. Single unit responses of the first (SI) and second (SII) somatosensory areas to stimulation of the ventroposterior thalamic nucleus (VP) were investigated in cats immobilized with D-tubocurarine. In response to VP stimulation 12.0% of reacting SI neurons and 9.5% of SII neurons generated an antidromic spike. In most antidromic responses of both SI and SII neurons the latent period did not exceed 1.0 msec. The minimal latent period of spike potentials during orthodromic excitation was 1.5 msec in SI and 1.7 msec in SII. Neurons with an orthodromic spike latency of not more than 3.0 msec were more numerous in SI than those with a latency of 3.1--4.5 msec. The ratio between the numbers of neurons of these two groups in SII was the opposite. In SII there were many more neurons with a latency of 5.6--8.0 msec than in SI. EPSPs appeared after a latent period of 1.1--9.0 msec in SI and of 1.4--6.6 msec in SII. The latent period of IPSPs was 1.5--6.8 msec in SI and 2.2--9.4 msec in SII. The relative importance of different pathways for excitatory and inhibitory influences of VP on SI and SII neurons is discussed.


Synchronization of spontaneous activity of skeletal muscle, autonomic nerves, and brain structures in cats. Acute and chronic experiments with recording of electrical activity of skeletal muscle, autonomic nerves, and some brain formations were performed on cats. Spectral correlation analysis showed that the spatial synchronization of electrical activity for the autonomic nerves and brain formations within the frequency range of 25--35 Hz, revealed by previous investigations, extends also to skeletal muscle. It is postulated that the presence of a widespread rhythm of 25--35 Hz is a factor facilitating the transmission of influences in the nervous system through frequency potentiation of synaptic action.


Spontaneous and evoked hypothalamic unit activity in kittens during development. Spontaneous and evoked hypothalamic unit activity in response to sensory stimuli was studied in acute experiments on anesthetized kittens. After the second day of postnatal development, spontaneous unit activity can be recorded in the posterior hypothalamus. Evoked responses to sciatic nerve stimulation were recorded on the fourth to fifth day after birth. In the early stages of development phasic and tonic types of unit responses are present in the hypothalamus, with some predominance of phasic. At the end of the third week responses of hypothalamic neurons in kittens have still not reached their definitive formation.


Changes in reflex excitability of spinal motor neurons during day sleep in newborn infants. A study was made of monosynaptic reflexes elicited by electrical stimulation of the ulnar and fibular nerves (H-reflexes) in newborn children, age five to seven days, during the sleeping--waking cycle. The amplitude of the H-responses was maximal and the coefficient of variation was minimal during the orthodox sleep state (OS) characterized by slow EEG waves and synchronous movement of the chest and stomach. During paradoxial sleep (PS), characterized by desynchronous EEG activity, rapid eye movements, and asynchronous breathing movements of the chest and stomach, the amplitude of the H-responses fell to 25 to 40% of the level during OS, and the coefficient of variation was in excess of 100%. The amplitude of H responses during the waking state was 60% that of the OS stage. The results of the study are considered from the point of view of existing theories about the reorganization of the system of controlling movements during the sleeping--waking cycle.


Layer by layer analysis of commissural hippocampal evoked potentials during glutamate microiontophoresis. Commissural evoked potentials (EP) in hippocampal area CA1 were investigated during microiontophoretic application of sodium glutamate (SG) in experiments on unanesthetized rats immobilized with diplacin. EP were recorded by the central barrel of a five-barreled microiontophoretic microelectrode before and during application of SG. The effect of SG in the region of EP reversal was characterized by depression of the initial positive phase of the response and an increase in negativity. In the radial layer SG caused a substantial increase in the commissural response recorded at a depth. At a distance of 100 mu from the tip of the iontophoretic pipet no changes in EP were found. An increase in the intensity of transhippocampal stimulation was accompanied by a marked increase in the amplitude and a change in shape of the individual phases of EP and it abolished the effect of the microiontophoretically applied SG. During paired stimulation with an interval of 20--200 msec different effects of SG on the testing response were recorded depending on the length of the interval.


Microelectrode recording of responses in visually observed neurons of the cat motor cortex. With a contact optical system it is possible to carry out intravital studies of neurons and other structures, stained with vital dyes in reflected light in a specially prepared specimen of the cat cerebral cortex. The high-quality characteristics of the optical system used have made combined morphological and intracellular electrophysiological investigations of these neurons possible. The nature of intravital morphological changes in cortical neurons was established in response to their puncture by microelectrodes with tips with different external diameters and configurations; certain morpho-functional correlations were found in the response of pyramidal neurons to disturbance of their temperature regime.


Tectocortical connections in the rat visual system. Electrical stimulation of the superior colliculus by square pulses evokes responses in the ipsilateral occipital region whose localization coincides with the zone of evoked potentials to photic stimulation. The short latent period of the visual cortical evoked potentials to stimulation of the superior colliculus (mean 3.2 +/- 1.1 msec; P less than 0.05) together with morphological data suggests that only one relay, in the structures of the thalamus, occurs along the tectocortical pathway in the rat visual system. In the poorly differentiated cortex of the rat no separate representation of retino-geniculo-cortical and tectocortical channels could be found.


Effect of microiontophoretic application of acetylcholine on visual cortical evoked activity to direct cortical stimulation. Responses of visual cortical neurons (area 17) to direct cortical stimulation of visual areas 18 and 19 were investigated in acute experiments on adult unanesthetized cats, immobilized with diplacin, under local anesthesia, after microiontophoretic application of acetylcholine. Selectivity of the action of acetylcholine on the individual components of the unit responses to direct cortical stimulation was established. The role of acetylcholine as mediator of information in the mechanisms of transcortical interneuronal interaction within the visual system is discussed.


Reflection of visceral afferentiation in unit activity in the caudate nucleus. Responses of spontaneously active neurons to visceral (splanchnic nerve) stimulation were recorded extracellularly in the head of the caudate nucleus of immobilized cats. The presence of multimodal neurons responding to stimulation of visceral, somatic, and auditory sensory systems in this structure also was established. It is concluded from these facts that neurons  of the caudate nucleus may play a role in the mechanisms of interaction of visceral impulses with somatic and auditory impulses.


Preferential ipsilateral influence of the posterior hypothalamus on the neocortex. On the 10th--20th day after precollicular transection of the brain stem weak low-frequency electrical stimulation of the posterior hypothalamus preferentially activates the ipsilateral neocortex. After unilateral injury to the posterior hypothalamus, synchronous activity predominates in the ipsilateral neocortex. In premesencephalic animals weak single electrical stimulation of the posterior hypothalamus evokes the appearance of spindles in ipsilateral zones of the frontal cortex, whereas stronger single stimulation causes the diffuse generation of spindles in various parts of the neocortex. Besides this preferential unilateral effect, the influence of the posterior hypothalamus is found to be more strongly expressed in the frontal than in the occipital cortex. It is postulated that the posterior hypothalamus exerts its influence on the neocortex through the thalamic nuclei.


AMP (PAS) and BPRS: a comparison of two assessment methods. The aim of this investigation was to contribute to the validation of the AMP(PAS) system. As a criterion we used the BPRS because it has been accepted as one of the most widely used scales in the English-speaking countries. Our study includes the following steps: a) comparison of AMP syndromes and BPRS dimensions by computation of a factor analysis of both scales; b) comparison of each homogeneous group found by cluster analysis techniques of the AMP with its values on the BPRS: c) comparison of discriminative power of both scales concerning different groups (nosological or found by cluster analysis) by discriminant analysis. In a sample of 70 female patients with acute psychiatric symptoms we found that both scales describe psychopathological phenomena and classify patients in a very similar way. However, we were able to classify patients into homogenous groups by cluster-analysis techniques in a more consistent manner with AMP than with BPRS. Both scales gave better results in description and classification of psychoses than of neuroses, although the AMP system separates psychotic patients from neurotic patients more accurately than the BPRS. Our results suggest that the AMP system permits a more differentiated psychopathological description and a more accurate and consistent classification of psychiatric patients than the BPRS, at least in the special patient sample used for this investigation.


Impairment of vigilance and performance under lithium-treatment. Studies in patients and normal volunteers. Subtle changes of adaptive behaviour under lithium treatment may possess interest not only as side-effects, but also as a possible explanation for the mechanism of action of lithium salts. - In 18 patients under long-term lithium treatment and 10 normal volunteers before and after one week of lithium application the EEG was recorded and performance as well as psychophysiological tests were carried out. The results, particularly of the d-2-test point to a considerably reduced performance in patients and normal volunteers. The EEG data in both groups suggest reduced vigilance until stage B3 or C (in the sense of Head of Bente); CFF was significantly elevated only during the first days of lithium application in the normal volunteers. Whereas EEG changes persist, other symptoms as CFF reduction, fine hand tremor, or reduced performance resolved at least partially 7 days after lithium withdrawal in the normal volunteers.


Some effects of mianserine (ORG GB 94) on amine metabolism in the rat brain. The effects of the tetracyclic antidepressant drug mainserine (code Nr. ORG GB 94) on biogenic amine metabolism in the rat brain are summarized. After either acute or chronic administration, mianserine increases the turnover of noradrenaline without appreciably affecting that of dopamine or serotonin. No evidence can be found that it affects amine reuptake in vivo. In its effect on amine turnover and reuptake, mianserine differs qualitatively from the dibenzazepine antidepressants. It is concluded that drugs need not be amine reuptake inhibitors before they are considered to be potential antidepressants.


A new animal model for the prediction of antidepressant activity. Animal models presently in use for the screening of potential antidepressant drugs yield numerous false positives and false negatives. In search of a more specific model, we have studied the effects of psychotropic compounds on the behavioural changes induced in rats by the removal of the olfactory bulbs. We have observed that subchronic treatment with antidepressants in general reverses the behavioural alterations displayed by bulbectomized rats in tests of conditioned behaviour. The present paper describes a brief test, the so-called anxiosoif test, which may be used to assess the effects of drugs on the behaviour of bulbectomized rats. Removal of the olfactory bulbs leads to increased water intake in the anxiosoif test and to an attenuation of avoidance when the drinking spout is electrified. This latter effect can be reversed by subchronic treatment with the antidepressant drugs amitriptyline and mianserine (Org GB 94). It is suggested that the behavior of bulbectomized rats may be used as a specific tool in the prediction of antidepressant activity of novel compounds.


[Videotape methods for assessing nonverbal cues of behavior in depressive syndromes (author's transl)]. We proceed from an earlier study with a behaviour-oriented judging scale and report a first attempt of quantifying systematically non-verbal elements of behaviour, taking into account the time-course of drug induced amelioration of psychopathology. The study is based on 7 cases of psychotic agitated depressions. We analyzed 4 video-taped interviews of every patient which were recorded during an antidepressant drug period of 21 days. Frequency respectively duration of defined modes of hand movements, classified with reference to Freedman were registered without sound and under the condition of time-blindness. We found a monotonous decrease of "continuous body-focused movements" in correlation with a redcution of the AMP item "depressive agitation". On account of this finding we consider a decrease of "continuous body-focused movements" as an objective indicator for amelioration of depressive agitation. A comparison between the activity of the two hands yielded a pronounced left-weightiness of object-focused, continuous body-focused and discrete body-focused movements in contrast to findings on normal persons. It seems to be remarkable that only the two latter modes of hand movements show a tendency to symmetry in the course of clinical improvement. Neuroethological implications of these findings are discussed.


Serum iron levels in depressed patients. 76 depressive patients (male and female) suffering from different kinds of depression (involutional, uni-and bipolar, neurotic, postpartum) showed no reduced serum iron levels. Even after a three to five weeks therapy with tricyclic antidepressants the serum iron levels of 17 of these patients were still within the normal range. On the basis of these results we can neither see a correlation between hyposideremia and the depressive syndrome, nor a hint for a decrease of serum iron levels under treatment with tricyclic antidepressants.


[Quantitative EEG analysis of the effects of carbocromen, pentetrazole, beta-methyldigoxin, and strophantin-K in normal human volunteers (author's transl)]. With EEG-interval analysis we studied the influence on C.N.S. of some drugs normally used for cardiovascular diseases: carbochromen, pentetrazole, beta-methyldigoxin and Strophantin-K. All investigated drugs induced activation of alpha-waves, especially in frontal areas with primary small alpha-activity. Dominant alpha-frequency was accelerated. These results confirm the direct and stimulating effects of these drugs on C.N.S. in therapeutic doses. Alpha-acceleration may not only indicate psychostimulation but also indicate epileptogenic effects. All these drugs may provoke epileptic seizures in toxic doses.


Animal models for tardive dyskinesia: effects of thioridazine. After repeated administration of classical neuroloptics to the rat, supersensitivity of striatal dopamine (DA) receptors towards DA-receptor agonists can be demonstrated. This effect can be quantified (a) by measuring the turning response to apomorphine in rats with unilateral striatal lesions or (b) by measuring the changes induced by neuroleptics in the DA metabolism in the striatum of intact rats. In these test systems, thioridazine induces an increase in DA-receptor sensitivity which is significantly less intense and of shorter duration than that induced by haloperidol. The tendency of a drug to increase DA-receptor sensitivity has been related to its propensity to induce tardive dyskinesia in man, and on this basis it may be expected that tardive dyskinesias following treatment with thioridazine will be rare and less intense than those seen after classical neuroleptics.


[Absorption and biological availability of drugs]. Bioavailability is a term used to indicate measurement of both, the relative amount of and administered drug that reaches the general circulation and the rate at which this occurs. Assessment of bioavailability indeally requires specific and sensitive methods for determination of drug concentrations in human body fluids. For the purposes of most bioavailability studies, it is sufficient to determine four indexes: maximum drug serum concentrations (Cmax), time of maximum drug concentration (tCmax) area under the drug serum half life of the drug. Potential drugs interactions and the effect of the disease state must also be evaluated, to adjust drug dosage in order to obtain an optimal therapeutic effect with minimal unwanted side effects.


[Liver actinomycosis. Report of a case]. A case of liver actinomycosis is presented. It was diagnosed 15 days after the patient had undergone appendicectomy. Emphasis is made concerning the diagnostic difficulties in the clinical, radiological and bacteriological areas. In the present paper note is made of the low frequency of this disease in Mexico. In this case it was possible arrive at a definitive diagnosis only after the histopathological study of material obtained in a needle liver biopsy which demonstrated the sulfur granules that are characteristic of the lesion. Information is given concerning the clinical and surgical evolution as well as therapeutic management. The case is illustrated with representative roentgenograms and a microphotograph of the lesion.


[Dust control in Belgian coal mines. Status at the beginning of the year 1977]. The present communication gives a general view of the methods of dust control in the Belgian coal mines at the beginning of 1977. The statistical data received from the mines are presented in tabular form. The length and the output of coal faces treated by the classical methods of pre-spraying of the wall, wet cutting, water infusion and wet pneumatic picks, are given separately; in some cases two or more of these technics are used together on the same coal face. The number of hard headings in which different methods of dust suppression are used, is also given.


[Peutz Jeghers syndrome. 6 patients in a family]. The authors describe 6 cases of the Peuzt-Jeghers syndrome found in one family. The clinical, radiological, endoscopical, laboratorial and surgical points of view are discussed. Through these different diagnostic methods polyps in the esophagus (1 case), stomach (2 cases), small intestine (2 cases) and colon (4 cases) were identified. Of these patients the two with polyps in the small intestine were operated on for intestinal occlusion. In this paper the authors discuss, and doubt, the reported rarity of this syndrome, as well as the true frequency of distribution in the digestive tract.


[Diagnosis of carcinoma of Vater's ampulla by duodenoscopy]. Cancer of the ampula of Vater occurs in 10% of cases of jaundice caused by malignant neoplasms. Endoscopy with biopsy and citological study helps to establish the diagnosis in most instances, utilizing a duodeno fibroscope JFB-2. Fourteen patients, ten men and four women, were studied in a five year period in the Service of Endoscopy in the General Hospital of National Medical Center of the Mexican Institute of Social Security. All the patients presented with obstructive jaundice and only in four was papilary carcinoma suspected from the clinical and radiological studies. Direct biopsy was performed in all patients and brush biopsy for citology in 9. In all 14 patients a malignant lesion was observed macroscopically in the ampula of Vater projecting in to the duodenum. In thirteen of fourteen the lesion was diagnosed microscopically as adenocarcinoma and in eight of nine citologically. The utilization of this methodology facilitates the early diagnosis of the lesion in this way improves considerably the prognosis.


[Evaluation of the effects of cooling clothes on the adaptation to prolonged exertion in high temperatures by miners]. In order to improve the working conditions of coalminers exposed to high ambient temperature, the authors have studied the effects of wearing an under-vest and a cowl covering the head and shoulders made in sponge-cloth and soaked with cold water (cooling clothes). Eight coalminers volunteered for this study which included three sessions of prolonged intermittent exercise performed in a climatic room with the following ambient temperatures:--experiment A (comfortable environment): td = 28 degrees C; twb = 20 degrees C; bare head and bare torso;--experiment B (hot environment) :td = 38 degrees C; twb = 30 degrees C; bare head and bare torso;--experiment C (hot environment and cooling clothes) : td = 38 degrees C; twb = 30 degrees C; wet undervest and cowl soaked with cold water (16 degrees C) every 15 minutes. Each experiment included 5 periods of exercise each lasting 15 minutes separated by periods of rest lasting 15 minutes; the exercises were performed on a bicycle ergometer or on a treadmill and their intensity corresponded to 50% of the maximal oxygen intake. In the comfortable environment (experiment A), all subjects completed the experiment without undue fatigue; the final heart rate was 81/min and the final rectal temperature was 37.6 degrees C; the weight loss never exceeded 1 Kg. In the hot environment (experiment B), all subjects were exhausted at the end of the study which had to be shortened in 2 cases. The final heart rate was 125/min and the final rectal temperature 38.8 degrees C; the weight loss was above 2 Kg. The use of the "cooling clothes" in the hot environment (experiment C) resulted in significantly (p less than 0.001) lower heart rate (104/min), rectal temperature (38.3 degrees C) and weight loss (1.5 Kg); all subjects completed the experiment, none was exhausted and the "cooling clothes" were appreciated by all subjects. We conclude that the "cooling clothes" tested in the present study significantly reduce the physiological and subjective strain due to intermittent work in a hot environment; this cooling system is simple, of low cost and our results indicate that it is will be very useful in climatic conditions similar to those adopted in the present experimental protocol. Its usefulness in less severe climates has to be established but it might be limited by the subjective reactions of the subjects to the transient but sudden sensation of cold given by the "cooling clothes".


[Hepatinecrosis caused by furosemide. Special lesions of various species?]. Furosemide is a wellknown hepatotoxic agent in rodents. Toxicity is result of the production of a catabolite by action of microsomal enzymes. The goal of this study was to demonstrate differences in toxicity between two rodents species: rat and hamster. Animals received 400 mg/k/i.p. of furosemide, with or without pretreatment with phenobarbital as enzymatic inducer. Adequates controls were used. Microscopic findings were different in both groups. Rats treated with furosemide plus phenobarbital, exhibited extensive mediozonal necrosis; when those without pretreatment, showed less extensive necrosis of liver cells, erratic in distribution. In contrast, it was a lack of necrosis in hamsters' livers, showing only unremarkable changes.


[Treatment of extreme obesity].

[Treatment of extreme obesity]. 23 patients whose weight varied from ninety-eight to 220 kilos were subjected to four different types of jejuno-ileal by pass operations: terminal-lateral (14 X 4) in three, terminal-terminal (14 X 4) in fifteen, (12 X 8) in two, and (10 X 8) in three. The defunctionalized intestine was anastomized to the transverse colon. Liver, jejenum and ileal biopsies as well as profilactic apendectomy were performed in all the cases along with colecistectomy when possible. All our patients were carefully studied in the pre and postoperative periods. The postoperative follow-up varied from 16 to 72 months, during which time a short and long-term mortality of 8.6% was observed. In eight patients it was necessary to reestablish normal intestinal transit for one or two reasons: rapid weight loss or total lack of patient cooperation. During the first few months post-op, diarrhea, nausea, vomiting, loss of apetite, weakness, inactivity, depression, electrolyte anormalities, anemia and increased hepatic esteatosis were the clinical and pathological findings most frequently encountered. With the cooperation of the patient it is possible to correct all these alterations: it is for this reason that the importance of right patient selection is emphasized. The rate of post-operative weight loss varied from patient to patient with an ideal weight being achieved between 18 and 24 months after the operation. Only in those patients reoperated upon to establish normal intestinal transit was the lost weight recuperated. Along with rigid patient selection, the success of this operation depends upon interspecialty teamwork during the preoperative evaluation as well as the follow up period in order to resolve the intricate physio-pathological problems that so frequently arise.


[Morbidity and mortality of appendicitis]. A retrospective analysis of the case histories of 238 patients who were hospitalized with acute appendicitis in the Clinical Hospital 60 of the Instituto Mexicano del Seguro Social from 1970 to 1971 revealed the following: 36% of the patients were operated in the earliest stage of acute appendicitis, 21.8% presented with perforated appendix and 32.6% with local and systemic septic complications. The group with perforated appendix presented most frequently with high levels of leucocytes and abscesses in incisions. All the cases of residual abscesses were found in this group and also two deaths were reported. It was interesting to find that routine drenage of the apendicectomy did in result in a decrease in local and systemic complications; in fact, they were found to be increased. Similarly it was found that the irrational use of antibiotics did not prevent abscess formation in the incision in the less seriously ill group and only served to confuse the clinical picture and impede the initiation of opportune treatment. Generally the diagnosis can be established from the clinical picture, but ocasionally it is necessary to operate in order to accurately evaluate the gravity of the lesion.


[Hepatic changes caused by contraceptive steroids]. The number and type of contraceptive side effects is constantly increasing. Several abnormalities have been observed regarding liver function, these include: Jaundice, cholestasis, hepatitis, changes in the rate synthesis of many serum proteins and coagulation factors. One of the most dangerous complications in the liver is the risk to develop hepatic adenoma which has been reported in 250 cases. An even more dangerous complication is the development of liver cancer of several histological types which so far has been observed in 21 patients. Women receiving contraceptive steroids should be alert regarding their potential hazards and the physician must be informed of such risks and observe special control care in these patients.


Medicinal iron-induced hepatic cirrhosis: reversal by phlebotomy: studies on pathogenesis. A patient with no underlying hematologic or iron metabolic disorder developed iron induced hepatic cirrhosis as a consequence of long term medicinal iron ingestion. Marked improvement in liver histology followed removal of 28 grams of iron by phlebotomy. Radioautographic studies in rats showed a periportal hepatocyte concentration of radioiron absorbed from the intestine while plasma transferrin was saturated. Based on these and other observations an hypothesis is proposed to explain liver damage in disorders of iron overload.


The natural history of coronary artery disease: an update on surgical and medical management. The current series represents the total experience of one institution that has treated concurrently a large number of patients with medical or surgical therapy. As previously reported, surgery offers a greater chance for pain relief but no obvious protection from future myocardial infarction. Patients with single artery disease show no difference in survival or future myocardial infarction rate whether treated medically or surgically. Improvement in survival following surgery, determined by univariate analysis of clinical descriptors, in several subsets of patients in the present series has not been confirmed when multivariate analysis techniques are used. If surgical mortality can be further lowered there may well be subsets of patients with coronary artery disease who will outsurvive similar medically treated patients. The current and future natural history of coronary artery disease, whether treated medically or surgically, is not settled by this or any other series because both forms of therapy are rapidly changing and no current series meets valid statistical criticisms. We are in a state of evaluation concerning not only therapeutic approaches, but also the development of suitable statistical methods for determining the efficacy of various forms of therapy. Only by continual modification of therapeutic approaches and the statistical tools to measure their effectiveness can we approach confident conclusions.


The species of viridans streptococci associated with microbial endocarditis: incidence and antimicrobial susceptibility. Streptococcal endocarditis has been well recognized for decades and over the years investigators at The New York Hospital have defined many of the diagnostic and therapeutic modalities currently employed in patients with this disease. In this study, speciation of the viridans streptococci has provided new insights into the relative frequency and antimicrobial susceptibility patterns of these organisms. Indeed, recent studies also suggest that S. milleri endocarditis is associated with a high incidence of suppurative complications and that patients with S. bovis endocarditis may have a significant incidence of underlying but asymptomatic lower gastrointestinal malignancies. Further studies correlating viridans streptococcal species with other clinical and laboratory parameters of endocarditis should provide additional insights into this disease.


[Urologic involvement caused by pancreatic cyst]. Pancreas-cysts seldom occur in surgical practice and rarely cause urological complications. The history of a patient is presented in whom dislocation of the kidney and compression of the ureter together with pyelectasis have been observed. Operation revealed that the urological symptoms were elicited by a cyst on the pancreas. Attention is drawn to this rare disease.


[Etiology of pancreatitis in 10 years of case material]. The aetiology of the 166 pancreatitis-casts observed in the authors' department between January 1, 1966, and December 31, 1975 is analysed. In 123 (74%) cases the aetiology could be clarified, while in 3 cases even the autopsy failed to throw light on the pathogenesis of the fatal pancreatitis. The distribution of complications and mortality according to aetiology is presented. The conclusions drawn from the material indicate that the frequency of pancreatitis is increasing and a shift occurs towards the young age groups. The less frequently occurring aetiological factors are pointed out and the importance of a careful history is stressed. Early operation of patients with gallstones is an important factor in the prevention of pancreatitis.


[Sclerotic occlusion of venous bypass].

[Sclerotic occlusion of venous bypass]. The case of a patient is presented in whom in the course of repeated vascular surgery a venous by-pass was prepared. Eighteen months after the operation a sclerotic plaque occluded the bypass. After successful de-obliteration the patient became free of complaints. A review of the pertaining literature is presented and the possible causal factors are discussed.


Electric activity and oxygen tension of the brain during ischaemic anoxia and reperfusion. Electric activity of the cerebral cortex and the mesencephalon and pO2 of the brain surface were analysed in 47 dogs after serial periods of cerebral anoxia induced by clamping of the aorta for less than 3 minutes and subsequent reperfusion. After restoring the circulation, characteristic stages were observed in the normalization of cortical electric activity and pO2. Improvement in cortical oxygen utilization progressed parallel to the return of rapid activity, though normalization of the EEG preceded that of oxygen utilization. The relative duration of the stages determined from the pO2 curve and from the parameters of electric activity allowed conclusions concerning the injury of the brain tissue. It is assumed that [1] after ischaemic anoxia an excess perfusion develops in the brain; [2] during anoxia, autoregulation of the cerebral vascular system ceases simultaneously with the disintegration of the oxidative metabolic processes of the brain; [3] restitution of the cortex is indicated more reliably by its oxygen consumption rate than by the normalization of EEG activity.


Structural changes in temporarily ischaemized and reperfused dog kidneys. The functional and structural study of the ischaemic renal parenchyma has become a central problem from the aspects of kidney transplantation. Reliable data are needed to establish the tolerance of separate or simultaneous cold and warm ischaemia. The changes appearing after 1- and 2-hour ligation of the renal artery (warm ischaemia) followed by autogeneous reperfusion after 3 to 24 hours were analysed on dog kidneys by means of light and electron microscopy. After 1 hour ligation, the changes seem fully reversible as the structures (mitochondria, basal membranes, brush border) suffer no fundamental lesion in spite of a general oedema. In contrast, 2-hour ischaemia caused serious morphological lesions (breaking up of the mitochondrial cristae, decay of the brush border, cell desquamation, necrosis, extensive oedema) leading to no-reflow phenomenon and irreversibility.


Ultrastructure of the liver after 24-hour preservation with various solutions. The effect of 24-hour preservation with 5% dextrane solution, Collins C3 solution and 5% human albumin solution, as well as of pretreatment with phenoxybenzamine on the ultrastructure of the rat liver has been studied. It was found that 1. the moment of the irreversible damage of the liver cannot be assessed from the electron microscopic picture; 2. though the ultrastructure offers no clue to the exact length of the effectiveness of a preservation procedure, the different methods can be compared among each other; 3. of the investigated solutions the 5% solution of human albumin appeared to be the most favourable, as with this solution the ultrastructural changes appeared late and in the least pronounced form; 4. phenoxybenzamine pretreatment might be of importance in warm ischaemia as it seems to delay the consequences.


[Uterine and bladder prolapse causing kidney damage]. A case of severe renal disturbance caused by uterine and bladder prolapse was observed and successfully treated by vaginal operation. Among the surgical indications of vaginal prolapse the lesions of the urinary system must also be considered.


A pulse-position-modulated multichannel radio telemetry system for the study of the avian nest microclimate. A multichannel biotelemetry system using pulse position modulation has been developed to monitor continuously the environment in birds' nests. Probes to measure temperature at six points, relative humidity, light and egg attitude, together with a transmitter and power supply are contained in a fibreglass shell, having the shape, size and weight of the egg of the species being studied. The sensing egg is placed in the nest at the completion of a clutch and not removed until the young have hatched. A low-power transponder is used to relay the signals up to 2 miles to a data-logging system in the laboratoy.


A method for the analysis of the data represented by a multiple exponential function. A method for the analysis of the data represented by the sum of multiple exponential functions is proposed in which each component of f(t) = n sigma i=1 aie -zetait is expressed as a spectrum. The convolution integral is derived by applying the Laplacian integral to f(t) with suitable transformation of the variables, and the spectrum representation is obtained by using the Fourier transformation. A generalized theoretical analysis is made and several results of numerical evaluations for model data or experimental data are briefly described.


The use of hybrid integrated circuit techniques in biotelemetry applications. A review is presented of some features of hybrid integrated circuits that make their use advantageous in miniature biotelemetry applications. The various techniques for fabricating resistors, capacitors and interconnections by both thin film and thick film technology are discussed. The use of chip capacitors, resistors, and especially standard IC chips on substrates with fired-on interconnection patterns is emphasized. The review is designed primarily to acquaint biotelemetry users and designers with an overview of this fabrication technique so that they can better communicate their needs with an understanding of its limitations and advantages to facilities specializing in hybrid construction.


The anti-Müllerian hormone.

The anti-Müllerian hormone. Müllerian regression in the male fetus is mediated by a discrete fetal testicular hormone, different from testosterone and synthetized by Sertoli cells. Secretion of AMH begins shortly after testicular differentiation and lasts into the perinatal period; however, the müllerian duct is responsive to AMH only during a short "critical" period at the end of the ambisexual stage. Species-specificity has not been demonstrated in mammals, but avian müllerian ducts do not respond to mammalian AMH, although the mammalian müllerian ducts to respond to avian AMH. Investigations concerning the biochemical nature of AMH have been carried out on incubation media of calf fetal testes. Anti-müllerian activity of the incubation medium is not affected by dialysis, is enhanced by concentration by ultrafiltration and is not correlated with the testosterone content of the medium. Gel filtration of the incubation medium on Sephadex G 200 and Biogel A-5m indicates that the anti-müllerian hormone is a protein of relatively high molecular weight, between 200,000 and 320,000 daltons.


Retraining in literal alexia: substitution of a right hemisphere perceptual strategy for impaired left hemispheric processing. An adult patient with literal alexia, agraphia, slight anomia, and dyscalculia due to a left hemisphere infarct showed lack of sequential skills while pattern recognition remained intact. Some words were recognized as patterns, but could not be read phonetically. Therapy concentrated on forming an association of the visual pattern of the complete word with the retained auditory pattern. In this way the patient learned to read several hundred words and short phrases, even as anomia worsened. The patterns learned could not be generalized to noun declension or verb conjugation, or broken into smaller words. This learning process is characteristic of right hemispheric skills which were utilized as left hemispheric functions deteriorated.


Transcallosal approach to third ventricle tumor: case report. Partial removal of an infundibuloma (grade I astrocytoma arising from the floor of the third ventricle). A care is described of an astrocytoma grade 1 arising from the floor of the third ventricle, operated upon transcallosally. No disconnection symptoms were produced. Five years later the patient has above normal intelligence and is attending school at normal grade level in spite of a CT scan suggesting recurrence of the tumor.


Epidural spinal metastases: factors related to selection of cases for decompressive laminectomy. We have treated a selected series of patients with spinal epidural metastatic tumors by dorsal decompression according to principles we presumed would produce the most favorable therapeutic results. There was no operative mortality, and morbidity was minor. In the first postoperative week, improvement in motor function was apparent in 44% of cases. By 3 months postoperatively, 40% of the patients were independently ambulatory and an additional 28% were ambulatory with minimal assistance. This 68% composite compares favorably to the 30 to 40% results in several series of unselected cases. On the basis of this data, it is concluded that consideration of the tumor's histological type, biological history, the host's response, the extent of neurological deficit, the progression of neurological deficit, and dissemination of disease will aid in the definition of those cases with epidural metastases which may be expected to benefit from surgical decompression.


Physiologic secretion of growth hormone and prolactin in male and female rats. Growth hormone and prolactin are secreted episodically in man and experimental animals. To investigate physiologic mechanisms of GH and PRL secretion, a series of experiments were performed in individual, unanaesthetized male and female rats. GH secretion in the male rat is characterized by intermittent surges that occur approximately every 3 h and are entrained to the light-dark cycle. Peaks reach 200--400 ng/ml and troughs are unmeasurable. PRL is secreted in more frequent episodes with a pattern distinct from GH. In the female rat, GH surges occur more frequently--approximately once each  hour. PRL levels are low (less than 15 ng/ml) except on the afternoon of pro-oestrous when they surge to levels of 100--300 ng/ml. Prolactin rises 4--6 h before delivery. Levels decline rapidly at the onset of parturition and surge with each episode of suckling in the post-partum period. Growth hormone and corticosterone rise during delivery and remain elevated for several hours after delivery. Reinstitution of suckling after removal of pups causes an immediate rise in PRL and GH. The PRL response is sustained for 3--4 h, whereas the GH response is brief with return to baseline within 1 h. The time courses of the two responses are clearly independent. Stress in the male rat causes a rapid rise in PRL and suppression in GH. The PRL surge to stress is brief with return to baseline by 1 h. GH pulses are suppressed for up to 5 h after stress. These studies indicate that separate neuroendocrine control mechanisms exist for regulation of the episodic release of GH and PRL in the rat.


Prevention and suppression of post-partum lactation with 2-bromo-alpha-ergocryptine (CB-154). Most clinical trials to date have demonstrated the effectiveness of 2-bromo-alpha-ergocryptine in suppressing the onset of puerperal lactation and confirmed the postulative mechanism of action by suppression of serum prolactin concentrations during its administration. The present study involving 112 patients was carried out to demonstrate the dose response and the timing of the administration. The drug was administered in two dose schedules of 1 mg t.i.d. and 2.5 mg b.i.d. commencing immediately after delivery and continued for 14 days. A third group of patients had 2.5 mg administered b.i.d. only after acute engorgement became a problem in the post-partum period. The drug was just as effective in the lower dose schedule and almost complete relief of pain and engorgement spared both the patient and the nursing staff many complaints. A dramatic relief was also obtained within 48 h even after engorgement had occurred and an overall incidence of rebound filling of 19% is similar to that reported by others.


The theory and practice of psychological medicine in the Ayurvedic tradition. In this paper I attempt to elucidate and render intelligible to a non-Western reader the internal logic and the consistency in both theory and practice of Ayurvedic psychological medicine. In Part 1, I deal with the classical metaphysical base (Samkya philosophy) on which the Ayurvedic concept of mind rests. I also deal with the theory of psychological medicine as stated in ancient Sanskrit texts. In Part II, I deal with the manner in which the classic theory is implemented in contemporary practice in Sri Lanka, while Part III deals with case studies of two patients taking Ayurvedic therapy.


Order, analogy, and efficacy in Ethiopian medical divination. An important source of the efficacy of techniques for managing sickness is their capacity for symbolically ordering the disordered states associated with disease. (The ability to give empirical proofs is another source.) This article describes the symbolic ordering wirked by a method of divination that is practiced by the Amhara of Ethiopia. Emphasis is given to indicating how order is accomplished through linking disease with phenomenological domains that are remote from the biophysical locus of sickness. The point is made that ordering and linking depend on processes of analogy.


The scope of ethnomedical science.

The scope of ethnomedical science. The subject matter of the field of ethnomedicine is outlined in this paper. Basic concepts and problem concerns are described. The linkages which ethnomedicine has with the other social and biologic disciplines are discussed. Ethnomedicine deals with information pertaining to social adaptation, deviant behavior, illness, disease, medical taxonomy, folk medical knowledge, and systems of medical care. Some of the problems inherent in studying these issues are described. Attention is also given potentially rich areas of inquiry which, heretofore, have not been cast in an ethnomedical context.


Assessment of the trace organic molecular composition of industrial and municipal wastewater effluents by capillary gas chromatography/real-time high-resolution mass spectrometry: a preliminary report. In summary, the use of HRGC/HRMS and ECC can provide valuable information on the organic constituents of refinery wastewater samples, even when present in extremely complex mixtures. In many cases, the low-resolution (nominal mass) spectra would not have been interpretable without the availability of the corresponding high-resolution (accurate mass and elemental composition) information, since, even with the use of capillary columns, the components of these complex mixtures were not chromatographically resolved. It is apparent that additional components in these fractions could be identified if additional data processing followed by detailed analysis of the ECC data set is carried out incorporating the retention index information derivable from the series of n-alkanes present, although the incomplete chemical fractionation of the samples is a complicating factor in these particular wastewater extracts.


Induction of hepatic microsomal enzymes by diuron, phenobenzuron, and metabolites in rats. Microsomal liver enzymes are induced in rats which are fed a diet containing 1000 ppm of phenobenzuron, a phenylurea herbicide, for 7 days: All parameters measured are about 50% higher than control values. This increase is lower after 14 feeding days. Diuron and 3,4-dichloroaniline have a similar, although lower, effect than phenobenzuron. Two other metabolites have no action on microsomal enzymes. The transitory and weak inducing effect of these phenylureas is interesting when compared to other organochlorine pesticides.


Phthalic acid esters in various foodstuffs and biological materials. Phthalic acid esters (PAEs) are ubiquitous environmental contaminants in Japan. Di-n-butyl phthalate (DNBP) and di-2-ethylhexyl phthalate (DEHP) are the most commonly found of nine PAEs examined. DNBP and DEHP residues in 22 kinds of commerical foodstuffs (55 examples), mostly in plastic containers, are recorded. The level is generally higher in powdered foodstuffs than in other materials and the content of PAEs increased sharply during their storage. A close correlation is found between the content of PAE residues in packing materials and those of foodstuffs. The levels of DNBP and DEHP in human blood samples are found to be much higher than those of PCBs.


Fertilizers for food production vs energy needs and environmental quality. The world is experiencing an energy crisis that is restrictive to agricultural requisites production at the same time that food is becoming increasingly short on a global basis. Fertilizers are the most energy demanding of these inputs and have become very expensive and intermittently short in supply with the reduced availability of fossil fuels. They have been indicted, furthermore, as environmental pollutants due to their presumed role in eutrophication and in being a source of excessive NO3-N that may accumulate in some leaf crops and in drinking waters. Exponential growth in fossil fuel consumption cannot continue. Economies can be made in the agricultural sector, which does indeed consume substantial quantities of energy. The energy consumed in this very essential food-producing process, however, is almost insignificant compared with that involved in transport and processing of food beyond the farm and with other energy expenditures in modern society. A shift in priorities will certainly be required in adapting to the real world of the 1970s if man's first need is to be met. Economies in fertilizer use can be made by adherence to known agronomic principles. Savings in fossil fuel energy can probably be effected also in the production of N fertilizer, by far the most fossil-energy-demanding process in the realm of agriculture. Considerable research remains to be done, however, under varied climatic conditions for understanding and controlling processes by which residuals from fertilizers may become environmental pollutants. The various issues in this paper must be resolved promptly in consideration of the now-existing energy crisis and the imminent world food crisis.


Human poisoning with pentachlorophenol and its treatment. A case of intentional intoxication with pentachlorophenol has been described. Salient features observed included pyrexia, diaphoresis, hyperkinesis, muscle twitching, tremors, epigastric tenderness, leg pain, tachypnea, and tachycardia. The patient's restlessness and agitation were controlled with phenytoin and phenobarbital. Forced diuresis with furosemide and mannitol resulted in a large increase in urinary excretion of pentachlorophenol. It is suggested that such therapy may be life saving in such intoxications.


Public nuisance and entropy increase.

Public nuisance and entropy increase. Public nuisance if the inevitable physical conclusion of the second law of thermodynamics, the increase of entropy, under which humans make efforts to build up order, that is, to make states of lower entropy, scattering much entropy into the environment. In other words, humans live on negentropy, negative entropy. Saving of negentropy is the first means of conserving the environment. Soon after C. E. Shanon had introduced the idea of entropy in information theory, N. Wiener showed the relation between entropy of thermodynamics and entropy of information. Wiener showed that the paradox of Maxwell is not a contradiction if we consider the entropy of demon's information. This idea is very suggestive. Moral principles, tax systems, and price mechanisms are effective for the conservation of the environment. Good information systems can conserve good environments. This is the second means. The third way is the use of biological systems. For example, in sewage treatment plants the active sludge purifies polluted water. The reason why microorganisms can select some substances in polluted water is that they have received the information by heredity, the information carried by the double helical structure of DNA.


Fate of [14C]aldrin in crop rotation under outdoor conditions. [14C]Aldrin was applied to soils (about 3kg/ha) in outdoor boxes at various locations (Germany, England, and United States), and crops were cultivated (maize, wheat, sugar beets, and potatoes). In the following year, crop rotation experiments were carried out in the same soils without retreatment; in addition, wheat was grown in soils retreated with [14C]aldrin (3.5 kg/ha). After the harvest of both years, the distribution of aldrin and major metabolites (dieldrin; photodieldrin; hydrophilic metabolites including dihydrochlordene dicarboxylic acid; an unidentified nonpolar compound X; and unextractable metabolites) was determined in plants, soils, and leaching water. Two further conversion products, photoaldrin and aldrin-trans-diol, occurred in trace amounts only in a few samples. Metabolic pathways for aldrin under outdoor conditions are presented. The distribution of radioactive residues in soils and plants as well as their quantitative chemical composition are discussed, and comparisons are made between the different experimental sites, the crops, the first and second year, and retreated and nonretreated samples. The quantitative results are compared to those of field trials.


Halogenated hydrocarbons in the atmosphere. The sources, sinks, and tropospheric abundancies of the gaseous halocarbons, so far as they are known, are listed and discussed. The relative importance of natural and of man-made halocarbons is discussed within the context of contemporary concern about the depletion of stratospheric ozone by chlorine-bearing compounds.


Comparative ecotoxicology of halogenated hydrocarbon residues. The term ecotoxicology is adopted in the sense of a comparative and integrated study of the undesirable effects of trace contaminants on the range of fauna and flora of an "ecosystem" or of a defined part or unit thereof. The importance of population changes over long periods of time is stressed. Sources, usage, and global trends of representative halogenated hydrocarbon (HHC) residues which appear as trace contaminants of environment, food, and living organisms are briefly compared: industrial solvents and intermediates, chlorofluoromethanes as an atmospheric pollutant, methyl bromide as a food and soil residue, HCH (hexachlorobenzene) as a fungicide residue, DDT, lindane (gamma-hexachlorocyclohexane), and dieldrin as insecticide residues, and polychlorinated biphenyls (PCBs) as industrial contaminants. A simple mathematical approach to the problem of relating inputs, persistence, and steady-state residue levels is explained. Persistence and biodegradation of representative compounds are compared. Attention is drawn to the persistence of hexachlorobenzene, the p,p'-dichlorodiphenyl- and hexachlorocyclopentadiene-derived moities of HHC residues. Ecotoxicological effects and their implications are discussed comparatively under the indirect effects of atmospheric pollutants and direct and indirect effects of trace contaminants of soil and aquatic ecosystems. Some conclusions related to research and "impact monitoring" are drawn.


Grocery purchases as a function of obesity and assumed food deprivation. Six hundred and four grocery shoppers were observed unobtrusively at three supermarkets to investigate the relationship between grocery purchasing and the factors of obesity, assumed food deprivation, social class, and meal hour. It has been suggested that shoppers will purchase more if they shop prior to eating rather than after (Stuart & Davis, 1972), although such a notion conflicts with Schachter's (1971) internal-external hypothesis and with the conclusions of one field study (Nisbett & Kanouse, 1969). We found that female shoppers who shopped prior to standard meal times consistently purchased more than those who shopped after meal times (P less than 0.001), regardless of social class or meal hour. Males displayed the same tendency though differences were not significant. No obese-normal differences were found for either sex. A negative relationship between obesity and social class was found amoung females (P less than 0.001).


A long-term evaluation of very low calorie semi-synthetic diets: an inpatient/outpatient study with egg albumin as the protein source. Fifty-two obese patients were studied initially for two weeks as inpatients on very low calorie diets, containing 0.76-1.34 MJ (180-320 kcal) as 15-40 g egg albumin, 30-40 g oligosaccharides, vitamins and minerals. Patients were seen weekly after discharge from hospital. Forty-one patients were able to continue treatment for more than eight weeks, and 29 for more than 16 weeks. In terms of weight loss, 41 patients lost at least 10 kg body weight, 29 at least 15 kg, and 14 at least 20 kg; 17 patients came within 15 kg of their ideal body weight. With 40 g/day carbohydrate, the quantity of egg albumin required to give nitrogen equilibrium was estimated to be about 25 g/day. All patients were able to resume their normal activities on discharge from hospital and had no major side-effects from treatment. Routine clinical, biochemical and haematological examinations showed no significant changes. In particular, serum proteins, electrolytes, uric acid, cholesterol and blood haemoglobin and haematocrit were unaffected. Ketosis was minimal or absent. It is concluded that the use of very low calorie semi-synthetic diets is a feasible and safe method of weight reduction for obese patients.


Predictors of successful weight loss in an outpatient obesity clinic. Patients attending weight reduction clinics were tested at the beginning of the program to assess a variety of background variables which might influence successful weight loss. These included measures of self-esteem, social acceptance, locus of control, responsiveness to external stimuli, attitudes toward weight loss, and knowledge about nutrition. Success was related to social conformity and desire for social acceptance but not to self esteem or locus of control. Individuals who believed that poor eating habits caused their obesity and those who were less responsive to environmental cues which may trigger feeding, were also more successful.


Eating in public places: a review of reports of the direct observation of eating behavior. A review of 13 studies of the direct observation of eating was undertaken in an effort to learn what these studies tell us about the causes and control of obesity. The studies assessed several measures of eating behavior but few of them assessed the same measures. There was no agreement about a distinctive 'obese eating style', but two measures showed promise in discriminating obese from non-obese persons. The first was food choice: obese persons chose more food than non-obese persons (and men chose more than women and tall persons more than short ones). The second measure was rate of eating: obese persons consumed more food per minute than non-obese persons. The studies point up the remarkable plasticity of human eating behavior and the wide range of factors which influence it. This plasticity has profound implications for both research and therapy. It means that only unusual care in the identification and control of extraneous variables will permit adequate assessment of the variables under investigation. Its second implication is as important: if eating is so dependent upon environment, it may be easier to modify than previously thought.


Response of plasma insulin to small doses of tolbutamide in obesity and acromegaly. The early response of plasma insulin (IRI) to successive intravenous doses of 50, 100 and 200 mg of tolbutamide was studied in nondiabetic obese subjects, in acromegalic patients, and in healthy controls. The smallest dose raised the plasma IRI level within two minutes in all subjects. The insulin response was correlated with the basal IRI in controls and in obese subjects but not in acromegalic patients. At each tolbutamide dose level the mean IRI response of obese subjects was about three times greater than in controls. In acromegalic subjects an increased response was observed only after the 200 mg dose of tolbutamide. The results suggest that in obesity the stimulus-secretion coupling of insulin output is normal but the number of secretory units is increased. In acromegaly the insulin release pattern is compatible with an increased number of secretory units which, however, are relatively insensitive to tolbutamide, probably due to an elevated serum growth hormone level.


Lowered oxygen consumption and heart rate as early symptoms of the obese-hyperglycemic syndrome in mice (ob/ob). Latent obese-hyperglycemic mice exhibit significantly subnormal heart rate and level of oxygen consumption as early as three and eight days post-partum, respectively. Also, loss of body weight during a three-hour fasting period is detectably less extreme in obese than in normal litter mates as early as five days post-partum. Regression analysis of the differences between the latent obese and normal litter mates suggests that these symptoms begin developing at birth.


Eating in the laboratory: behavioural aspects of the positive energy balance. A survey is made of a number of experiments conducted in our laboratory over the last six years. Our working hypothesis assumes that positive energy balance, which should not be prematurely defined as the cause of obesity, is itself caused by disturbances in appetite and satiation control which, given certain environmental conditions, can favour the occurrence of obesity. Three points are considered: (1) The hyperphagic reaction as a response to stress. The experimental findings suggest that the hyperphagic reaction is not primarily a biologically determined phenomenon but rather a learned response. The hyperphagic reaction is found more frequently in female and overweight persons. Most children react to stress with a decrease in food consumption. (2) Disturbances of satiation control. The food intake of obese Ss has a linear time function, whilst children and normal weight adults reveal a biological, negatively accelerated satiation curve. (3) Increased responsiveness to external cues. The concept of externality is extended to include the aspect of an internal-external stimulus discrepancy. The findings show that not only manifest obese Ss but also latent obese Ss are characterized by an increased responsiveness to external cues. In three different experiments with the same Ss it could be demonstrated that externality is to a greater or lesser extent independent of the experimental procedure. Finally, methodological aspects are discussed, because in studies on human appetite the possibility exists that experimental procedure, sample composition and laboratory conditions can exert a direct influence on the results.


Effects of severe diet restriction on the oxygen consumption of obese women during exercise. Eleven moderately obese, but otherwise healthy, young women were studied for three days while being fed their normal, unrestricted diet and then again for a two week period while being fed an energy-restricted, high-protein diet--220 kcal (0.92 MJ)/day as casein. Oxygen consumption (VO2) was measured 32 times for each subject, both at rest and during bicycle exercises. For each subject oxygen consumption was significantly lower, at rest and during moderate exercise, when the subjects were being fed the restricted diet. There was no significant difference among the diet treatments at the highest activity levels. The explanation proposed (though without experimental proof) is that, during the restricted diet, the increased reverse triiodothyronine (rT3) would result in a decrease of the aerobic glycolysis and no change in the anaerobic glycolysis.


Adipose tissue cellularity in relation to prognosis for weight reduction. Ninety obese adult women were analysed with respect to adipose tissue cellularity and divided into hypertrophic, hyperplastic and combined groups of obesity. Their spontaneous body weight development was analysed over a period of six years. A reference group, with normal body weight, gained weight at an average of 0.25 kg per year. Patients with hyperplastic and combined forms of obesity gained significantly more (2.5 and 3.1 kg per year, respectively) when essentially untreated. The increase for the patients with hypertrophic obesity did not differ significantly from the reference group. During a standardized treatment period on an energy reduced diet (1100 kcal/day or 4600 kJ/day) the hypertrophic, hyperplastic and combined groups reduced by 11, 15 and 20 kg, respectively. There were strong positive correlations between total weight reduction and rate of weight reduction on the one hand and FCN and initial body weight on the other. The combined and hyperplastic groups were on average able to maintain their reduced weight for 12 and 15 weeks, respectively, while the hypertrophic group managed for 51 weeks. There was a strong negative correlation between duration of steady weight after weight reduction and FCN. When the relapse started the rate of regain was three times faster in the hyperplastic and combined groups than in the hypertrophic group. The rate of regain correlated positively with FCN. Thus, the patients demonstrated a characteristic three phase pattern in weight change with a period of reduction followed by periods of steady weight and of weight gain. The higher FCN, the faster this cycle was completed. It is concluded that the long-term prognosis for weight reduction is worse for hypercellular forms of obesity than for the hypertrophic form. However, this does not mean that patients with hypercellular forms of obesity should not be treated at all since their serious spontaneous weight development might be lessened by repeated treatments.


[Anesthesia of the ambulatory patient].

[Anesthesia of the ambulatory patient]. The risks associated with general anaesthesia for ambulant patients demand a high standard of organisation, preoperative assessment, and postoperative surveillance and evaluation. Guidelines are presented to help surgeons and anaesthetists to enserve an adequate standard of clinical care.


[Intrathoracic pancreatic cysts and fistulas]. Intrathoracic extension of inflammatory pancreatic diseases is a serious complication. In the course of an acute pancreatitis, a left-sided transdiaphragmatic pleural effusion and empyema most commonly occurs and is well known. Transhiatal pseudocysts into the mediastinum as well as fistula formation to the pleural cavity or bronchial system are less frequent although of great clinical importance. These diseases can lead to serious diagnostic errors and can cause complex therapeutic problems. A case is reported; the morbidity, lethality and complications are discussed on the basis of 34 cases reported in the literature.


[Adenocarcinoma of the appendix. 6 cases and review of the literature]. The adenocarcinoma of the vermiform appendix is most frequently discovered at the pathological examination, which causes the problem of a second operation. Our study was done on 145 patients and compares survival according to the attitude taken by the surgeon. It seems that the most favorite treatment is a precocious right hemicolectomy.


[Thyroid gland metastases: presentation of 2 cases]. Metastases of the thyroid gland originate mostly from carcinomas of the urogenital tract, the lungs or the digestive organs. Though they are thought to be rather uncommon, they may give rise to delicate therapeutic problems. The two cases of metastases of digestive origin reported by the authors join a series not very important to this day and presenting a rather dark prognosis. The authors consider the surgical problems as regard to aetiology which determines the length of survival. As a rule, an isolated metastasis of the thyroid gland requires a total thyroidectomy, if only to avoid the compressive effect occurring very rapidly. On the other hand, if the thyroid invasion is a part of a general formation of metastases, removal of the gland will not alter the prognosis.


[Total gastrectomy with substitute stomach]. A modified technique of jejunum-reservoir after total gastrectomie for gastric cancer is recommended. The advantages of this method are the simplicity of technique, the preservation of duodenal passage, the avoiding of reflux and the normal emptying time of reservoir.


[Duodenal duplication. Case report and review of the literature]. A case of duodenal duplication (cyst) in a 42-year-old male is reported. The late manifestation of this rare, little-known, but noteworthy congenital malformation was characterized by repeated attacks of acute pancreatitis and development of a high, duodenal obstruction. Radiographic examination and fiberoptic endoscopy was followed by exploratory laparotomy which demonstrated the accurate diagnosis. A review of the literature including 39 duodenal duplications in more than 300 duplications of the alimentary tract is presented.


[Results of conservative treatment of transverse fracture of the distal tibia and fibula in children]. 66 children who were admitted to the Surgical Department of the University Children's Hospital in Zurich because of transverse fracture of the distal tibia and fibula were followed up. They were treated conservatively by reduction followed by immobilization in a plaster of Paris cast reaching to the upper thigh; the foot was placed in the equinus position. Perfect axial reposition should be aimed at. If this cannot be achieved, a varus deformity of up to 6 degrees, a valgus deformity of up to 10 degrees and antecurvation of up to 10 degrees are permissible, as this malposition usually cures itself in time. If the malformation exceeds the limits described above, operative reduction and fixation should be carried out in children over 12 years of age. All children with malposition must be followed up for a long time to observe whether the malposition will gradually disappear and to ascertain whether static difficulties will occur and may have to be corrected by osteotomy.


[Subhepatic abscess after cholecystectomy with coagulation active substance]. 4 cases of postoperative subhepatic abscess formation after cholecystectomy are reported, where absorbable hemostatic agents for control of bleeding had been used. The etiology of these complications is discussed. The use of local hemostyptica is strongly disadvised in all possibly bacteriologically contaminated procedures.


[Artery ligation as an alternative to hepatic resection in liver injury]. In severe liver trauma the selective ligation of a lobar branch of the hepatic artery is proposed as an alternative to hepatic resection. The relatively simple procedure stops bleeding efficiently without damaging the liver function, as a collateral circulation is reestablished within 2 weeks.


[Postoperative Viscum album therapy after surgery of breast neoplasms]. From a selection of 547 patients with mamma carcinoma stages I and II it is statistically shown that the 5- and 10-year survival rates are significantly improved with postoperative use of Iscador (Viscum album); this in comparison with the conventional treatment on its own. No toxic side effects have been experienced.


[Recurrent dislocation of the shoulder]. Study of 55 cases of recurrent dislocation of the shoulder treated by the operation of Bankart and Putti-Platt during 10 years. A new dislocation after the operation was present in one single case. The authors opinion is that the most important point of the technique is the correct reinsertion of the anteroinferior part of the capsule. If the glenoidal labrum is detached from the rim, the Bankart technique must be combined with the Putti-Platt. A comprehensive review of the results demonstrates that the patients are rarely disturbed by the limitation of external rotation of the operated shoulder.


[Hyperbaric oxygenation in gas gangrene therapy]. Gas gangrene which is caused by gram-negativ rod-shaped bacilli appeared longtime in war only. Now an increase of infection is noted by heavy traffic accidents. Reporting about 18 patients and treatment results we suggest for therapeutic proceeding: excision of wounds without primary amputation followed by hyperbaric oxygenation. In our opinion, surgical intervention and hyperbaric oxygenation should not be rival but complementary treatment of equal value.


Necrosis of the proximal epiphyseal plate cartilage of the femur following detachment of the perichondral ring. Its relationship to the etiology of proximal epiphysiolysis of the femur. A histological study of the proximal epiphyseal plate cartilage of rabbit femurs following detachment of the perichondral ring was performed. 15 animals were used, 5 of which being controls. Slight to severe necrotic changes in the plate were present in 9 out of 10 animals. In severe necrosis there was formation of fissures similar to those seen in human femoral epiphysiolysis. The necrosis was considered ischemic in nature and due to the detachment of the perichondral ring with involvement of the blood supply for the femoral epiphysis. Also the epiphyseal and metaphyseal bone marrow and bone tissue, as well as the articular cartilage, presented necrotic changes in a few animals. Such necrosis of the epiphyseal plate may be a factor in the pathogenesis of human proximal epiphysiolysis of the femur.


[Results and advantages of simultaneously measured peroperative arterial and central venous pressure]. Central venous pressure and intravasal arterial pressure have been followed up during different operations in 80 patients of different age and sex. At the same time we have determined an exact fluid balance and blood gas analysis pre-, intra- and postoperatively. These examinations had some interesting results. In our view the most important result is that the anesthetist gets more suitable informations about intraoperative blood volume therapy by continuous measuring of central venous pressure than by the continuous following up of intravasal arterial pressure which is practised very often to-day.