[New problems and results in behavior therapy]. What is presently observed is not only a rapid increase in the number of publications, but also a major change in the theoretical principles of behavior therapy. The former onesidedness of a form of behavior therapy theoretically substantiated by classical conditioning only may be regarded as having been completely overcome. For example, this is evident from new approaches to behavior diagnosis as an essential prerequisite of differentiated therapy planning. Recent concepts of the theoretical substantiation of the effectiveness of behavior therapy lead to an increasing consideration of both cognitive and motivational aspects and also take into account the complexity of the patient's social relations. This, in turn, results in the availability of a wide range of indication-specific methods of behavior therapy.


[Theory and method of self-assertion training]. Lack of assertiveness is considered, in the sense of the theoretical concept of Ullrich de Muynck and Ullrich, to be due to such components as 1. abnormal attitude toward oneself, 2. fear of criticism and failure, and 3. inadequately developed social skills; after this, the term 'assertiveness' is defined. Previous therapeutical approaches to the remedying of unassertiveness and the underlying theoretical assumptions are critically examined and discussed with particular reference to their effectiveness. These include the training programs developed by Salter and Wolpe which are characterized by certain onesidedness as well as the concept of Ullrich de Muynck and Ullrich, which has a sound theoretical basis and a rather differentiated or specialized structure. Reference is also made to the author's own research projects.


[Behavior therapeutically oriented correction of under-achievement in students]. Two methods of correction by behavior therapy of psychogenic disorders manifesting themselves in a decrease of the proficiency level of students are presented: Individual behavior guidance and a group training course. The objective of the two methods is to familiarize students with the techniques of behavior analysis, stimulus control, and self-invigoration in order to gradually develop an adequate proficiency-oriented behavior. The purpose of the training course is to enable students to acquire, under the direction of a therapist, skill in the use of effective methods of working. Various forms of verification and relaxation during breaks are used to insure successful correction of such disorders.


[Behavior therapy in sexual deviation].

[Behavior therapy in sexual deviation]. The author, after discussing theoretical aspects of the development and treatment of sexual deviations, describes methods of behavior therapy which when used in combination and by experienced clinicians will yield promising results. In addition, a number of cases are reported, and these indicate some special problems associated with the therapy of sexual deviations.


[Apparative aversive therapy in combination with verbal suggestions in special obsessional syndromes (initial investigation)]. The author restricts the use of aversion therapy by means of deliberate production of pain to obsessional, especially therapy-resistant disturbances of a permanent nature, with consideration being, of course, given to ethical factors. Experiences worthy of generalization are derived from methodically varied courses of treatment, bringing out suggestive moments subliminally involved in any therapeutical situation and also specifically used by the therapist. In addition, the author emphasizes the need for simultaneously developing, besides aversion therapy, positive attitudes and behavior patterns.


[Possibilities of behavior therapy in childhood]. The author, after discussing methods of conditioning and their theoretical substantiation, describes the behavior disorders, forms of malconduct, and development disorders where methods of behavior therapy have so far been made successful use of. Possibilities of, and technical problems associated with, the treatment of nocturnal enuresis are discussed in addition to methods of treatment of autistic, electively mutistic, and stuttering children. Also discussed in this paper are methods of behavior therapy of states of anxiety, phobias, and hypermotor conditions as well as the instruction of educators in the use methods developed on the lines of behavior therapy. Behavior therapy is characterized as a form of psychotherapy which cannot replace general pedagogic influences.


[Apparative therapy of enuresis nocturna, experience and problems]. Eleven patients aged 5 7/12 to 15 9/12 years were treated with the "pillow wakener" (a device developed by the author and his associates) within the framework of an exploratory study of apparatus-assisted treatment of bed-wetting. The critical analysis of this device and form of therapy has as its objective to encourage investigators to make further studies in the field of treatment of bed-wetting. Particular difficulties such as technical deficiencies, the need for the interruption stimulus immediately following the activity of the bladder the problem of deep sleep, etc. are pointed out.


[Experiences with behavior therapeutically oriented instruction to educators of mentally handicapped children]. The paper describes the use of techniques of behavior therapy in the education, both at home and in day-core clinics for unschoolable, but group-educatable children. These may be used for the correction of undesirable behavior and the development of certain skills, but cannot be considered to be exclusive means of a normal process of education.


[The formation of self-help groups. A report for participants and experts (author's transl)]. The report begins with a short summary of the various types and forms of self-help groups and their distribution. The usual requirements of a self-help group are briefly discussed. This is followed by basic information on the importance of group self-therapy. Expectations, initial steps, the question of whether guidance is necessary, and the organization of a general meeting are dealt with in the next section. Then the internal resistance on the part of experts and participants toward self-help groups, and hence their new relationship, is discussed. Finally, a suggestion is made concerning those persons for whom self-help groups might be helpful.


[Communal psychiatry: psychiatric treatment center, Mönchengladbach (author's transl)]. In a town area of 140 000 inhabitants an organized psychiatric treatment and welfare unit with an out-patient department and complementary services has been built up based on a day-and-night clinic dating from 1969 and a clinic which opened in December 1972. In co-operation with other persons and institutions working in the psychosocial field it cares for mentally ill adults of the region, including addicts and mentally ill aged persons. The stages of development, the present-day structure and functioning of the system are described; in particular, problems are discussed which arise from the shifting of treatment, aid and care from the intramural to the extramural sector as a result of the consistent application of the communal aid concept.


[Musicotherapy--possible uses in social psychiatry (author's transl)]. The importance of musicotherapy as a type of treatment within the framework of psychiatry is examined. Musicotherapy, as used in the treatment of schizophrenia, is considered to be a communicative therapy with a tendency to regression. A plan for treating psychotics with a non-verbal and a verbal track is outlined. The special approach to patients offered via musicotherapy is seen as follows. The terapist-patient relationship is established on a preverbal communicative level in a zone which is free from anxiety. The shelter afforded by a common musical experience enables self-regulation of the balance between symbiosis and separation, and hence the development of a therapist-patient relationship. The feedback provided by establishing structured objects represents an integration aid for the self and the ego of the patient. Therapy practised as active group musicotherapy forms part of a social field within the group.


[Effects of psychiatric treatment in the view of psychiatric inpatients (author's transl)]. The opinions of four psychiatric diagnostic groups (schizophrenia, depression, addiction, neuroses) concerning 11 methods of treatment are compared. In the effects of treatment there were as well similarities as differences specific for each of the above groups. Surprisingly similar to a corresponding American investigation, the traditional concept of treatment therapist and drug is considered the most effective.


[Ideas on the part of patients and doctors regarding the adequacy of psychiatric inpatient and outpatient treatment (author's transl)]. One fixed day the doctors of a Psychiatric University Clinic were asked what form of therapy would be best for each of their inpatients (n = 164), and whether these patients could leave the inpatient treatment in case the desired ambulant therapy institutions existed. Half a year after this inquiry questionnaires were sent to the patients, and 104 replies were received. The opinions of the patients which treatment would have bee best for them were compared the doctors' judgements. Both, doctors and patients wanted more ambulant therapy opportunities than existed. There was little unity between doctors and patients about the question with patient would profit from what sort of therapy. We assume that a deciding factor in this disagreement between doctors and patients is the doctor-patient-relationship.


[Taking the state examination while under psychiatric treatment casuistic sketch of a pedagogic intervention (author's transl)]. The preparation of a young candidate for several state examinations which she took during the aftermath of a psychotic episode is described casuistically. Her case once again raises the question of how a psychosocial system working on the therapeutic community principle can reconcile an individual aid program with precisely this community principle and the rejection of unjustified privileges for selected patients.


[Proliferation kinetic examinations on an experimental renal tumour with high portion of hypoxic tumour cells (author's transl)]. By autoradiographic examination by means of pulse labelling with 3H-thymidine cell cycle times were determined in solid Ehrlich carcinomas (early carcinomas) in order to obtain comparative values for irradiated tumours. The subcells of the initially labelled cells near the capillaries were found to distribute themselves in the course of 48 h over the whole tumour and to emigrate to hypoxic tumour areas.


[Crisis intervention among adolescents. A social model in Vienna]. An institute for adolescents can meet the specific adolescent crises in all their manifold manifestations. The crisis intervention model in the form of a youth centre for information and counselling as described here has the task of giving information and advice anonymously and free of charge in a way appropriate for young people, while being nonbureaucratic and not under the direct influence of the civil authorities. The work methods of the Info-Centre in Vienna are described.


[Teamwork in juvenile social work as an instrument in crisis intervention]. The changing emphasis in psychiatric care demands the use of new strategies and the development of sociopsychiatric institutions. The term 'crisis intervention' is suitable in this respect insofar as it also includes the aspects of prevention and follow-up care. An attempt at the development of a model for multiprofessional teamwork in juvenile social work is outlined under the aspect of sectorised sociopsychiatric care. The exhaustion of the basically available possibilities is at the moment limited due to structural difficulties.


[Psychiatric crisis intervention. Oranizational and administrative services in the Governmental health service]. After describing the principles and structure of the psychiatric services in Bulgaria, the author goes in more detail into the organizational and administrative conditions of psychiatric crisis intervention. It is emphasized that the main basis for psychiatric crisis intervention must be the psychiatric out-patient service which includes and coordinates all service branches and works together with the non-psychiatric services. The author stresses two channels of information about crises: 'passive', when psychiatric services receive information from the family or non-psychiatric agencies associated with crisis interventions (e.g. general medical agencies, councelling centres, administrative authorities, etc.); 'active', if the dispensary itself collects information as e.g. by regular observation of registered patients, by psychiatric or general medical field investigation as may be carried out by the Prevention Department, etc.). A few ideas are also offered concerning the organization of a subsystem for crisis intervention within the entire psychiatric service delivery system.


[The concept of crisis. Historical roots and actual problems of the concept of crisis]. An analysis of the concept of crisis cannot ignore that it is often used in a highly suggestive way, nor should it neglect to look at its historical roots. The psychosocial crisis concept as it is used in psychiatry, psychotherapy, social work, etc. has two historic roots: one root lies in the medical-natural-sciences tradition; the other in the dramaturgical i.e. healing tradition, and they both flow together in the concept as commonly used. At present, there are numerous crisis definitions each of which emphasizes a different aspect. Greater precision, models and operational definitions are indispensable for exact research. Crisis precipitation, disposition (crisis proneness) of the system, environment and reaction of the system are discussed as separate aspects of a crisis. Finally, the innovative and constructive role is stressed which the crisis concept plays in research and practice.


[Crisis intervention technic].

[Crisis intervention technic]. Based on the various principles of crisis intervention, a model of it is designed which divides it into four phases: (1) beginning of intervention (established of a relationship, assessment of the client's condition, estimate of the gravity of the problem, and design of the plan of action along the lines of minimal difference); (2) actual intervention; (3) conclusion of the crisis intervention, and (4) follow-up. This system conveys a good insight into the activities of a crisis centre, and it can contribute to the diffcult and up to now unsolved problem of how such institutions can be evaluated.


[Reflections on the therapeutic possibilities of a technic of provoked crisis]. The author demonstrates the therapeutic possibilities of a technique of 'provoked crisis' on the ground of theoretical models and practical examples. Such a technique seems mainly indicated in situations of chronified and stagnant equilibrium in individual patients, families or groups, which cannot be changed by stepwise proceedings.


Morphologic analysis of the "spina mentalis" in adult mandibles of Brazilian whites and negroes. This study was carried out to verify the morphology of the spina mentalis. We observed 275 human adult mandibles of both sexes and ethnic groups. An analysis of the results allows the following conclusions: 1. The spina mentalis exists in 90.04% +/- 1.8 of the mandibles of Whites and Negroes; 2. The typical form with four tubercles, as described by some authors, is rarely found; 3. In most cases it characterized by the presence of two upper tubercles (27.27% +/- 7.2); two superior tubercles and one inferior (24.72% +/- 6.7), and one elongated median tubercle (24.0% +/- 6.6); 4. The forms and volumes of the tubercles are very irregular and seem not to depend on age, sex or ethnic group; 5. The spina was absent in 9.8% +/- 3.2 of the cases, especially in mandibles of White teethless individuals; 6. An hypertrophic spina mentalis, generally formed at the expenses of the upper tubercle, is observed in only 1.45% +/- 0.5 of the cases.


Psychopharmacological properties of the viminol-p-hydroxybenzoate. The authors studied the viminol-p-hydroxybenzoate (RN: Dividol) through some psychopharmacological tests, making its comparison with neuroleptic and narcotic drugs, with the principal aim of determining if its analgesic action is correlated with a narcotic or psychotropic activity or both of them. The results are discussed.


[Experimental venous thrombosis in guinea pigs: effect of heparin and drugs affecting platelet function (author's transl)]. Thrombosis was induced in the jugular vein of guinea pigs by damage of the epithelium with a sclerosing solution. The effect of heparin, Dextran 70, acetylsalicylic acid, dypriridamole and phenilbutazone in preventing the development of the thrombus was investigated. Only heparin in high doses showed this effect.


[Chemical composition of Brazilian marihuana samples and the importance of several constituents to the pharmacological activity of the plant]. The gas chromatographic analysis of marihuana samples seized by the São Paulo State Police showed high levels of delta9-trans-tetrahydrocannabinol (delta9-THC) the most active of cannabis constituents. The cannabiol (CBN) levels were also high and probably able of interfering with delta9-THC actions in some samples. The cannabidiol (CBD) and delta8-trans-tetrahydrocannabinol (delta8THC) levels were generally low. When compared to marihuanas used in other countries the amount of delta9-THC in our samples was in average higher. When the pharmacological activity of one of those marihuana extracts, called natural extract containing a high delta9-THC to the others cannabinoid ratio (CBD, CBN and delta8-THC) was compared to a synthetic extract with the same proportions of those cannabinoids, the activity was not identical in all animals tests used. The possibility of others substances present in the plant, besides those cannabinoids listed before, of interfering with the plant's pharmacological activity is discussed.


[Stabilizing action of verapamil "in vivo" upon the membrane of heart lysosomes (author's transl)]. The effect of the verapamil upon the stability of the membranes of lysosomes isolated from rabbit hearts was studied by means of the acid phosphatase activity, the mapping enzyme of the cytoplasmic organelles. A dose of 2.5 mg of verapamil was injected endovenously in each animal. After homogenization of a sample taken from the lower end of the heart, the lysosomes were isolated by fractionated centrifugation and refrigerated at 2 degrees C. The lysosomal activity of non treated animals was 43.1 +/- 8.9x10(-1)mU/mg. The activity of lysosomes isolated from verapamil treated animals without previous treatment "in vitro" with digitonin was 8.7 +/- 1.6x10(-1)mU/mg and the activity of those with previous treatment of digitonin was 9.1 +/- 2.1x10(-1)mU/mg. The activity of lysosomes isolated from the control group and treated "in vitro" by digitonin was 193.9 +/- 40.5x10(-10)mU/mg. Consequently, the verapamil proved to have a strong capacity of protection of the lysosome membranes when "in vivo".


Influence of acute hypophysectomy on the natriuresis of dogs submitted to expansion of the extracellular fluid volume. Three days after creating an access to the turcica on the sphenoid bone, twelve anesthetized mongrel dogs, after control collections, were submitted to extracellular volume expansion with saline. Thereafter, maintained constant the rate of saline infusion, the dura-mater covering the pituitary gland was incised in all dogs, the hypohysis being removed in seven and remaining untouched in the other five dogs. Pharmacological doses of pitressin, glycocorticoids and mineralocorticoids were administered to all dogs. It was shown, for the same filtered sodium load(p is greater than 0.05), that hypophysectomy produces a significant reduction (p is less than 0.05) in urinary sodium excretion previously elevated by the extracellular volume expansion, while durostomy only, without removal of th hypophysis, did not change (p is greater than 0.05) the rate of sodium excretion. Thus, the pituitary gland could be considered as contributing to natriuresis during extracellular volume expansion, all other factors related to this expansion remaining constant in both, hypophysectomized and sham operated dogs.


[The influence of mail service on the incidence of absentees in a children health care center (author's transl)]. The authors have made a research on the influence of mailing letters on keeping up the returns in an ambulatory of health care service. The purpose of the paper was to seek a way to improve the return rate, which is usually low, and brings up difficulties to structure adequately a staff. One hundred children who had failed to come to their last appointment were studied and divided in two groups: 50 children to whose responsible were sent letters setting up a new appointment were included in group I; group II served as a control group. Out of the 97 absentees, 36 children (37.1%) returned. Their return was spontaneous in 22 cases (22.7%)--12 children of group I and 10 of group II. 14 mothers returned on the date set up by mail. Out of the 47 mailed letters, 20 (42.5%) were sent back by the post office. The authors have concluded that mailing letters was an effective method to decrease the number of children who miss their follow-up in ambulatory of health care service.


Communication by harmonization of electric organ discharge frequencies by Eigenmannia virescens (Sternopygidae, Pisces). Spectrum analysis of the combined electric organ discharges of confined, interacting Eigenmannia virescens individuals indicated 1) the relative frequency position of each individual in the group's "chord" was invariably conserved, i.e. the fish do not cross each other in frequency; 2) the ratios of 2:3 and 3:4 between the frequencies of two individuals were conserved over intervals of many days; 3) changes in group size induced frequency shifts that were often quite dramatic. It is suggested that this "chord" may function in the communication of information regarding a group's spatial position and its social rank relations.


Encephalization and quantitative brain composition in bats in relation to their life-habits. A quantitative analysis of the brains of 43 bat species is presented. Eleven brain components were studied. The species were arranged according to seven distinct dietary groups and it was found that the relative development of the principal components is related to those groups. The importance of neocorticalization as a reflection of evolution of all the bats in contrast to specialization in some species is stressed. This work gives a clearer view of Chiropteran progressiveness or primitiveness: the insectivorous forms occupy the least advanced, although most specialized, level; the vampires, the carnivorous species and the flying foxes are at the top of the scale. The importance of behaviour and the relative development of the central nervous system in the hierarchial classification of mammals is stressed.


Perspectives in sensory-ecological studies of higher vertebrates. It is firstly recalled that, among Vertebrates, in peripheral sense-organs on the one hand, in encephalic relays and terminals on the other hand, not only the types but also the numbers of neurons, are determining factors for the kinds of relations that exist between organisms and environments. It is thus necessary to consider the quantitative developments of relay-stations and the volumes of brain-components when studying such relations. The very concept of sense-organ may even have to be broadened, because it should include central transmission structures along with peripheral starting points. It is stressed that progresses achieved by Vertebrates in the course of their history by quantitative increases of either terminals or relays should be labeled either as specializations or as evolutions, for these two concepts must not be confused.


[Resistance of earthworms Lumbricus terrestris and Allolobophora turgida to the fungicide captan 50 W.P]. Two species of earthworms were kept in Muck, Chicot and Ste-Sophie soils treated with captan 50 W.P. solutions of 700, 1 400 and 2 800 ppm. After a 42-day treatment period, L. terrestris had a 95% survival and A. turgida 100% survival. Using a gas chromatograph method, no captan was detected in tissue extracts of exposed earthworms. Based on the survival rate and the undetected presence of captan in earthworm tissues, we concluded that soil residues of this product are unlikely to be harmful to the animal's ecology.


Diameters of bronchi at asymmetrical divisions. The weight, and hence volume, of a cast of the bronchial tree of a sheep distal to any point was found to be a function of the diameter of the bronchus at that point. This result has been used to derive a relationship between the diameter of a bronchus and the diameters of its branches which is applicable to different types of branching and is consistent with principles of minimum energy loss within the bronchial tree.


Cardiorespiratory effects of temperature in the turtle, Pseudemys floridana. Weight specific VO2 of resting Pseudemys floridana at body temperatures (BT) between 12 to 38 C was studied in relationship to VE, VT, f, pulmonary and systemic blood flow, and blood PO2, PCO2, pH and O2 content. The slope of the curve for VO2 against body mass was similar to that for mammals and differed from that of lizards. VE increased with BT while VE/VO2 fell, resulting in an elevation of arterial PCO2 and a decline in arterial pH of 0.013 unit/degrees C [HCO-3] and total CO2 remained constant. Increments in VE were achieved by decreasing apneic time and increasing VT up to VT of 18 ml.kg-1 when further rise in VE was exclusively on account of breathing frequency. Mean pulmonary and arterial blood flows were incremented in direct proportion to VO2, and no net intracardiac shunts was demonstrable. Ventilation-perfusion ratio fell with BT while EO2 increased. Arterial hemoglobin saturation varied inversely with BT while the arteriovenous O2 difference remained constant. EO2 was found to be highly dependent on the constant blood convection requirement as VE/VO2 fell. At similar BT, VE/VO2 was similar to that for man while Qpul/VO2 was in inverse proportion to maximum O2 capacity of the blood for the two species.


Oxidative cost to ventilation in a turtle, Pseudemys floridana. Estimates of oxidative cost of ventilation for Pseudemys floridana were obtained by comparison of mean resting VO2 with that obtained while artificially ventilating the lungs with a constant air flow in excess of the normal VE, a circumstance during which the animals remained apneic due to reduction in alveolar PCO2. At a body temperature of 22 degrees C, the oxidative cost attributable to ventilation was 0.0047 ml O2/ml gas ventilated, a value about 10 times that of man. This cost of ventilation is then related to values of VO2 and VE at various body temperatures. The oxidative cost of ventilation, expressed as a percentage of resting VO2, is given by the equation: cost = 0.47 VE/VO2. Relative cost declines with body temperature since VE/VO2 (resting) declines according to the equation: VE(BTPS)/VO2 = -0.017 BT -0.025 log Wt + 2.01 where units are in ml, kg and min. At body temperatures of 10 and 37 C relative costs were 30 and 10% VO2, respectively. While the inverse relation between VE/VO2 and body temperature has important implications for regulation of arterial pH through influencing arterial PCO2, it has the additional meaning of reducing the relative oxidative cost of ventilation as VO2 increases.


Chemoreceptor influence on pulmonary blood flow during unilateral hypoxia in dogs. Dogs anesthetized with 30 mg/kg pentobarbital were artificially respired after differential cannulation of the main stem bronchi. Following median sternotomy, blood flow was monitored by electromagnetic flow probes on the left pulmonary artery (QL) and on the pulmonary trunk or aorta, QT. Following 10 min of bilateral 100% O2, QL was 42.5 +/- 7% of QT. When 6% O2, was substituted as the gas mixture inspired by the left lung while the right lung remained on 100% O2, PaO2 was above 70 mm Hg and QL fell to 24.5 +/- 5% of QT. Room air was then used to ventilate the right lung while the left lung remained on 6% O2. This caused PaO2 to fall to 42.3 +/- 3 MM Hg and QL to rise to 38.3 +/- 6% QT. This increase in blood flow to the unilaterally hypoxic lung during systemic hypoxemia did not occur in dogs after peripheral chemoreceptor denervation. Therefore, interference with the local response to alveolar hypoxia during systemic hypoxemia appears to be mediated by the arterial chemoreceptors.


Behavior of slowly adapting stretch receptors in the extrathoracic trachea of the dog. We have studied the response of 40 slowly adapting stretch receptors located in the extrathoracic trachea to maintained positive and negative pressures together with their behavior during the breathing cycle and inspiratory efforts against closed airways in anesthetized dogs. Like the other tracheal stretch receptors they are located in the smooth muscle of the posterior wall and are stimulated either by inflation or deflation. Most of these receptors are active at zero transmural pressure and increase their response with positive pressure; with negative pressure their resting discharge decreases at first (-5 to -10 cm H2O) and then increases, but it is generally lower than that of the corresponding positive pressure value. As predicted by their static response, the activity of these receptors decreases during inspiration and increases during expiration and therefore it is out of phase with the discharge of the other airway stretch receptors. Their activity is related to the corresponding transmural pressure and therefore to airflow and upper airway resistance. During inspiratory efforts against the closed airways their activity decreases, unlike that of the intrathoracic airway receptors, which retain essentially their FRC activity.


Post-hypercapnia recovery in the dog: arterial blood acid-base equilibrium and glycolysis. Changes in acid-base equilibrium and blood lactate and pyruvate concentrations were studied during recovery (breathing room air) after three days hypercapnia (FICO2 = 0.10) in awake dogs. Fast return to FICO2 = 0 produced a slight alkalosis in arterial blood and an increase in lactate and pyruvate concentrations which seemed to be maximum at the 15th minute. These changes were inhibited by previous injection of acetazolamide (50 mg/kg body weight). During progressive return to FICO2 = 0, over 1 hour, the peak value of blood lactate and pyruvate was delayed until the end of that hour, at the same time as a slight blood alkalosis appeared. These phenomen are most probably explained by a stimulation, due to alkalosis, of glycolysis at the level of phosphofructokinase.


[HL-A and periodic disease].

[HL-A and periodic disease]. In the department of Professor Dausset 41 cases of periodic disease referred by 7 clinics in Paris were examined. Two studies were carried out. A series of 31 not related patients was testes with 30 locus A and B antigen and the frequencies observed were compared with the frequencies in a French and Yemenite Jew population. No statistically valid increase of an HLA gene indicative of a relationship between periodic disease and HLA was found. In 5 cases of amyloidosis HLA A 28 was present and it is possible that this gene is related to the amyloid complication. A family study on 12 families, 7 of which included at least 2 affected children, confirmed the recessive hereditary character of the disease, but not in relation to the HLA system. A parallel clinical study was made, which corroborated the previous studies as regards the frequency of clinical signs. The therapeutic study proved the value of long-term colchicin treatment with or without antihistaminics. The frequency of pain and abdominal crises was reduced, but there was little effect on the articular manifestations.


[Radioimmunologic determination of plasma parathormone in hypercalcemia caused by cancer with osseous metastases]. The plasma parathormone was measured by radioimmunological determination in 23 cases of cancer with bone metastases, 8 of mammary origin. In 11 cases the plasma parathormone (iPTH) was less than 4 ng/ml (lower normal limit), as might be expected in view of the hypercalcemia. In 12 cases the iPTH was higher than 4 ng/ml, in 8 of these higher than 8 ng/ml (upper normal limit). These results are suggestive of the role of a substance analogous to parathormone in the genesis of the hypercalcaemia and peritumoral bone resorption of bone metastases of solid tumors.


[Post-meningococcal rheumatism (apropos of 3 cases)]. A report is given on 3 cases of arthritis after cerebrospinal meningitis caused by B meningococci, with a relapsing course in 1 case. The observations are compared with the literature and the characteristics of articular manifestations of meningococcal infections are outlined. Three types are distinguished. Type I is characterized by banal arthralgias masked by the symptoms of meningitis. Type II encompasses septic arthritides preceding or concurring with the meningitis and like the latter sensitive to antibiotics. Type III includes postmeningococcal arthritides with sterile articular fluid refractory to antibiotics and showing a spectacular reaction to non-steroid anti-inflammatory drugs. These arthritides constitute a true infective rheumatism, post-meningococcal rheumatism, and should be related to other post-meningococcal manifestations such as pericarditis, myocarditis, cutaneous and ocular changes. All these manifestations are attributed to the production of immune complexes. Postmeningococcal arthritides, whose characteristics are described, may occur after septic meningococcal arthritis or appear as such. The distinction of postmeningococcal rheumatism where only anti-inflammatory treatment is effective might lead to the question whether certain postgonococcal arthritides refractory to antibiotics and responding to anti-inflammatory drugs are not provoked by an immuno-allergic mechanism leading to postgonococcal rheumatism -a nosological entity that has been abandoned possibly too fully and definitively.


[Study of optimal posology of penicillamine in the treatment of common rheumatoid polyarthritis (apropos of a personal series of 200 cases)]. A comparison of two series of patients with rhe,matic polyarthritis, the one (n = 140) treated with dosage equal to or higher than 900 mg, the other (n = 60) with dosage between 600 and 750 mg, did not reveal significant difference in clinical and biological efficacy. The number of side-effects was not significantly reduced by lower dosage, except for digestive tract disorders. A reduction of dosage does, therefore, not permit less strict supervision and monitoring for side-effects of treatment.


[Physiopathology of articular chondrocalcinosis]. The physiopathological mechanisms leading to precipitation of pyrophosphate in the articular cartilage remain unclear. Numerous findings suggest an error in pyrophosphate metabolism: excessive production or defective degradation, a primary modification of the fundamental substance leading to crystallization, a chondrocyte dysfunction being a possible cause of these two anomalies. The relationships between deposition of calcium pyrophosphate and changes in the subchondral osseous plaque common to several metabolic diseases are even more mysterious.


[Synovectomy in the treatment of acute arthritis caused by Micrococcus pyogenes]. In addition to antibiotic therapy associated with immobilization in a plaster cast, effective in the majority of cases of acute arthritis caused by St. pyogenes and resection-arthrodesis which is necessary in the stage of osteoarthritis, synovectomy occupies an intermediate position. During a period--possibly not a short one--when the lesions are still purely synovial and do not regress under medical treatment, their ablation permits recovery from the infection with restoration of the functional activity of the joint. The experience is based on 26 observations (19 knees, 3 hips, 2 shoulders, 1 thumb, 1 metacarpo-phalangeal lesion). In 2/3 of cases these arthritides were iatrogenic (13 after cortisone infiltration, 4 postoperative, 1 haematogenic from i.v. catheterization). Synovectomy should be complete; haemostasis must be rigorous; an aspiration drain is left in place for 5 or 6 days; additional immobilization in plaster is not obligatory; antibiotic treatment is continued until the BSR has returned to normal. As regards control of the infection, this was obtained in 19 of 26 operations. As regards function, in 10 of these cases the results were very good, in 7 good (slight persistent restriction of movement), in only 2 cases the results were unsatisfactory. The factors that appear to affect the results are on the one hand rigorous technique and on the other sufficiently early operation before the lesions have become too fully established. However, a study of arthritides after cortisone infiltration of previously affected joints has shown that even relatively late operation can lead to satisfactory results (9 of 13).


Satisfaction with fitted hearing aids. II. An investigation into the influence of psycho-social factors. In the first article an analysis of technical information about hearing aid satisfaction, obtained by a questionnaire, was presented. To obtain complementary information, interviews were held with patients who showed a low satisfaction. This has led to an inventory of the factors in the psycho-social field of importance in the process of rehabilitation. The questionnaire has been modified and 165 hearing aid patients have been evaluated with this updated questionnaire. Analysis of the information obtained shows that the answers given intercorrelate well. It may be surmised that the approach is based on a sort of "attitude" incorporated in the given score and defining the hearing aid satsifaction. The audiometric features of the patients intercorrelate as well. It is surprising that the correlation between the audiometric features and the satisfaction with the aid is low, and this is discussed. The question arises as to what degree the routine audiometric tests reveal the relevant features and the impaired hearing. Where it seems to be impossible to use the available audiometric features for making a prediction about the satisfaction, the conclusion is drawn that full attention must be given to training in the use of the hearing aid.


Tympanometry in three-year-old children. I. A regional prevalence study on the distribution of tympanometric results in a non-selected population of 3-year-old children. Epidemiological data on middle-ear pathology during pre-school age are lacking the striking frequency of middle-ear symptoms in this age group. To evaluate the applicability of the impedance test in the younger age groups and to make an epidemiological study of the distribution of tympanogram types in a normal group of pre-school children, an attempt was made to examine all 523 3-year-olds in a limited geographic area. 1005 ears in 504 children (96.4% of those invited) were fully investigated with tympanometry and otoscopy with Siegle's speculum within 4 weeks. 62.8% of the ears showed type A tympanometric curves, 9.8% type B and 27.4% type C. Bilateral type A tympanometric curves were found in 276 children (55.4%). The prevalence of abnormal tympanometry proved to be unexpectedly high in both sexes. This finding is discussed. Even with the use of conventional technique and standard equipment, the 3-year-old clientele presented no testing problems.


The effect of onset, offset and rise-decay times of tone bursts on brain stem response. Auditory-evoked brain stem responses (BSRs) were recorded from the scalp in 4 cats and 10 human subjects. Auditory stimuli consisted of 1 kHz tone bursts and their duration, intensity and rise--decay time were varied. The BSR evoked by the tone bursts consisted of on- and off-responses. The off-responses showed different intensity--amplitude and different intensity--latency functions from the on-responses. In the feline subjects, an increase in rise time as an input resulted in an increase in the number of recorded sharp waves of the on-responses, indicating that several cycles of tone bursts during the rise time take part in generating on-responses. In both the feline and human subjects, BSRs were evoked by tone bursts with a rise time of as long as 10 msec; an increase in the rise time resulted in an increased latency and broadened waveforms of the on-responses. These demonstrated properties of BSR may provide useful information in determining input parameters, such as rise--decay time, appropriate for audiometric assessment.


The value of some suprathreshold auditory measures. Factors, both acoustic and non-acoustic, which may influence the Most Comfortable Loudness Level, the Uncomfortable Loudness Level, the Acoustic Reflex Threshold and the Threshold of Overload are reviewed. A direct experimental comparison of these measures was made with respect to their absolute values and the between- and within-subject variances. The Most Comfortable Loudness Level was found to have the greatest within- and between-subject variability. The Uncomfortable Loudness Level, although having high between-subject variability, did not have significantly greater within-subject variability than the Acoustic Reflex Threshold. The significance of these results is discussed.


Cardiac output and regional blood flow in untreated and triglycylvasopressin-treated burned mice. Cardiac output and regional blood flow to different organs were determined at one hour and at 24 hours after burn in untreated mice and in mice treated with triglycylvasopressin (TGLVP). A decrease in cardiac output was found in all animals at one hour after burn. At 24 hours cardiac output was decreased in the burned untreated group, while cardiac output of TGLVP-treated animals did not differ from that of unburned animals. Organ blood flow was decreased in all animals at one hour after burn. Such a decrease was seen in the untreated group also at 24 hours after burn, while organ blood flow in the TGLVP-treated group had returned to preburn values.


On aetiological factors in hypospadias.

On aetiological factors in hypospadias. An analysis of genetic and non-genetic factors which might be of importance for the aetiology of hypospadias was performed in a clinical and in a registered material comprising altogether 893 hypospadiacs. Of 213 index patients in the clinical material, the probable aetiology was known in 11: in 3 patients chromosomal aberrations, in 2 well-defined syndromes with a known genetic background, in one maternal diabetes, in 2 maternal rubella, and 2 of the hypospadiacs were born after the mothers' use of anticonvulsant drugs and one after the mother's use of thalidomide. Other hypospadiacs were identified in 28 of the families of the remaining 202 index patients. As regards inheritance, 10 cases of hypospadias associated with clinodactyly were found in one family and this suggests an autosomal dominant gene as the cause of hypospadias. In the great majority (174/213) of index patients neither genetic nor non-genetic factors could be demonstrated but a significant cyclic trend for the month of birth and the month of the last menstrual period was found.


Malignant melanoma of the skin in children registered in the Swedish cancer registry during 1959-1971. A clinical follow-up and histopathological reexamination of 26 cases originally diagnosed as malignant melanoma in children under 14 years of age registered in the Swedish Cancer Registry during 1959-1971 has been undertaken. Only one met current criteria of a malignant melanoma. This tumour occurred in a giant naevus in a 3-year-old girl, who died with widespread metastatic melanoma within a year. The other cases were reclassified as melanocytoma of Spitz, cellular blue naevus, compound naevus and neurofibroma. The results confirm that malignant melanoma is a rare tumour in prepubertal children. The risk for histophatological overdiagnosis is much higher in children (95%), than in adults (4%).


Treatment of burns with zinc-tape. A study of local absorption of zinc in humans. A report is given on local wound treatment in humans with adhesive zinc-tape. Measurements of the zinc content of the tape before and after treatment and in wound secretion and serum demonstrate that zinc is most likely absorbed into the granulation tissue and serum. The possible advantages of local absorption of zinc are discussed. The evaporative water losses through the tape have also been recorded. The fresh zinc-tape is almost impermeable to water. After 24 hours of burn treatment the evaporative water loss through the tape is similar to the water loss through a homograft.


The incidence of malignant transformation in giant pigmented nevi. 151 patients with benign giant pigmented nevi registered in the Danish Health system during the 60-year period 1915-75 were retrieved via the national register. A questionnaire was sent to all surviving patients asking for information about their health and especially whether they had had any treatment or had observed any changes in the nevus. All of the patients replied to the questionnaire. No patients had been cured from malignancy or were alive with known malignancy. Three patients had died from malignant melanoma during the period of observation. These case histories are reported. It is calculated that 4.6% of the patients with congenital giant nevi should be expected to develop malignant melanoma provided the incidence is the same in all age groups. Some uncertainty remains on account of the limited number of cases and an unsettled question about a higher incidence in childhood.


Permeability of intraneural microvessels and perineurium following acute, graded experimental nerve compression. Experimental compression lesions of peripheral nerves were induced by applying pressure direct to exposed rabbit nerve trunks. A specifically designed compression chamber was used, enabling application of graded pressures (50--600 mmHg) to the nerves for various periods of time (15 min to 6 hours). After releasing the pressure, analyses were performed concerning the intraneural microvascular permeability and the barrier function of the perineurium. The method used was fluorescence microscopic tracing of intravenously injected or locally applied albumin labelled with Evans blue. The results indicate that a slight trauma to a nerve (e.g. 50 mmHg during 2 hours) induced an epineurial oedema by increasing the permeability of the epineurial vessels, which were more susceptible to compression trauma than the endoneurial vessels. Compression at higher pressure levels or of prolonged duration caused injury also to the endoneurial vessels, leading to intrafascicular oedema formation, which generally was most prominent at the edges of the compressed nerve segment. The perineurial barrier was remarkably resistant to compression trauma. Possible pathophysiological effects of various degrees of post-traumatic intraneural oedema formation are discussed.


Replacement of carpal bones with exact-fitting silicone rubber implants. An experimental study. In a pilot study in dogs, carpal bones were removed and replaced with silicone rubber implants fashioned to fit exactly into the space left by the excision. The implants were fabricated from Dow Corning MDX-4-4210 and Silastic 399 Medical Grade Elastomers. Bone cement was used for the cast and the mould was made of alginate or plaster of Paris. It was intended to replace the bone in a one-stage procedure. MDX-4-4210 was found unsuitable because adequate cure could only be achieved in about 5 hours, even when accelerated with external heating. Silastic 399 cured rapidly and was ideal for the experiment. Implants of exact fitting were fabricated, sterilized and inserted within 1--2 hours. 6 dogs were used and the follow-up period ranged from 1 to 7 months. The results were good in 5 and unsatisfactory in 1 dog because of postoperative infection. The method presented permits exact reproduction of the excised part, which guarantees an accurate fitting and consequently reduced risk of implant rotation and migration.


The vascularization and structure of the human digital tendon sheath as related to flexor tendon function. An angiographic and histological study. The gliding surfaces of the flexor tendons and the tendon sheath are delicate structures of the complex digital flexor system. Beside the fibrous parts, the tendon sheath also exhibits membranous synovial components, which represent a dialysing membrane producing a plasma ultrafiltrate--the synovial fluid. In this study, interest was focused on the vascularization of the synovial sheath. By a microangiographic method it was demonstrated that this membrane is richly vascularized and that the vascular plexus is in continuity on the outside of the fibrous pulleys. The friction surfaces of the system--the inside of the pulleys and the surface of the flexor tendons--are devoid of vessels, and here a differentiation into chondrocyte-like cells is observed. It is suggested that these tissue areas, in analogy to joint cartilage, are nourished by diffusion from the synovial fluid, and that the flexor system can be regarded as a specialized joint, sliding longitudinally and exhibiting an extremely large range of motion.


Experimental restoration of the digital synovial sheath. The digital synovial sheath constitutes an important component of the delicate mechanism of flexor tendon nutrition and gliding function, In the present study the true nature of the inner cell layers of secondary healed defects in the tendon sheath as well as of free tendon sheath autografts were studied. Leghorn chickens were used as experimental animals and the gradual development of the pseudosheath as well as the healing of sheath autografts were studied both macroscopically and histologically including transmission electron miscroscopy. Synovial regeneration by extension from intact parts of the sheath was never observed and the pseudosheath formed around silastic rods consisted of granulation tissue with fibroblasts and macrophages. The free tendon sheath autografts demonstrated a normal process of healing at the edges of the defect. Synovial regeneration appeared to be that of metaplasia and proliferation of fibroblasts and macrophages. This phenomenon was demonstrable both in the secondary healed defects and more convincingly in the sheath autografts. Further, the silastic rod was found to induce foreign body reaction in the healing synovium. It is concluded that grafting of autologous tendon sheath tissue seems to be a promising method for restoration of defects in the digital tendon sheath.


Postanesthetic ulnar neuropathy at the elbow. In the present study 19 patients with postanesthetic ulnar nerve lesions treated during the period 1973--76 are reviewed. The lesions were localized to the cubital tunnel region and appeared subsequent to recent, otherwise uncomplicated operative procedures commonly performed under general anesthesia. Mechanical factors caused by malpositioning of the arm during the course of anesthesia and operation resulted in direct, compressive nerve injury. Hypermobility of the nerve was found to be a predisposing local factor. The roentgenologic configuration of the postcondylar groove showed considerable variability and did not correlate with the location of injury. The potential risk positions with the arm in either prolonged extreme elbow flexion or with applied surface pressure over the cubital tunnel region must be avoided in placing the patient on the operating table.


A modified McCash operation for Dupuytren's contracture. The open palm technique for Dupuytren's contracture in connection with a midlateral ulnar incision on the fifth finger was used in selected cases of severe contracture with skin shrinkage (13% of all cases during a 2 1/2 year period). Special attention was drawn to the "cornerflap" of the incision, but no vascular problems were found. All wounds closed spontaneously in 3--6 weeks. The finger release was as good as in other series of patients with similar severity of the disease. We propose this technique only in cases with severe contracture and in good physical and mental condition.


Resection arthroplasty of the metacarpophalangeal joint a.m. Tupper using interposition of the volar plate. Tupper's resection arthroplasty with interposition of the volar plate was performed 75 severely destroyed metacarpophalangeal joints in 22 patients during the period 1970--74. The average passive mobility obtained was 63 degrees. The operative technique and complications are described, and the obvious advantages of the method are emphasized. This procedure is one part of a more comprehensive reconstruction whose functional result is influenced by the overall condition and balance of the hand.


Symptomatic chondrocalcinosis at the wrist. Twenty-two patients with chondrocalcinosis in the wrists were treated for symptoms of pseudogout. All but 3 had signs of degenerative arthropathy; 2 patients also had chondrocalcinosis of other joints in the hand. The degree of chondrocalcinosis and the grade of arthrosis varied but there was no certain correlation between the two. Attacks of arthritis were the clinical features in 13 cases. The usual treatment was immmobilization and administration of phenylbutazone.


Reimplantation of an amputated hand. Long-term follow-up report. A case of nearly total amputation of the right hand is described. The hand was reimplanted with initially good result. A final evaluation of the hand was attempted 6 years following the accident. It is concluded that the unsatisfactory nerve regeneration renders the final result a function failure. However, the psychological and cosmetic effect of a real hand may justify the reimplantation.


Ulnar tunnel syndrome caused by anomalous muscles. Case report. Two cases of ulnar tunnel syndrome at the wrist are described. In both cases an anomalous hypothenar muscle, flexor digiti minimi brevis accessorius, was in part the causative factor. Contributing to the symptoms of nerve compression was swelling associated with rheumatoid disease and Colles' fracture, respectively. Decompression of the nerve including subtotal removal of the anomalous muscle effected complete recovery. Its phylogeny, morphology and clinical significance are discussed in relation to previously described anomalies of the hypothenar muscles.


[Effective energy values of 90 degree scattered photons during urological and bronchial fluoroscopy]. During fluoroscopic bladder and bronchial examinations the radiation workers concerned are exposed to 90 degrees--scattered photons. The effective energy expressed in mm AI was measured for these photons exited at tube potentials in the 60--100 kV RANGE. An increase also depends on whether the measurements are made in the direction of the long axis or the short axis of the phantom. These findings are contrary to the recommendations stipulated in the code of practice SABS 07-1972.


Treatment-orientated classification of subarachnoid haemorrhage. The prognosis of patients with cerebral aneurysms has improved greatly with modern management, notably hypotensive and steroid therapy and microneurosurgical techniques. A new classification of subarachnoid haemorrhage is discussed to clarify the early management of patients and their referral to specialized units for intensive medical care and curative surgery.


[Mumps meningitis--bromine-82 partition test and cerebrospinal fluid glucose]. A case of mumps meningitis is reported where a low cerebrospinal fluid (CSF) glucose level, a positive bromine-82 partition test and the fact that the patient's sister had recently had tuberculous meningitis complicated the diagnosis.  Mumps meningitis may be associated with low CSF glucose levels. Patients with viral meningitis usually have normal CSF glucose levels, and, during a recent study, false-positive results of 82Br partition tests were not found. Mumps meningitis, however, proves to be an important exception.


Casualty evacuation in the Rhodesian terrorist war. The involvement of the Rhodesian Medical Association in providing medical services to both the troops and the African clinics because of the terrorist war is described. Experiences in the handling and evacuation of casualties by air or road are described, and immediate emergency measures are mentioned. Measures taken to meet a possible escalation of the conflict are reported.


Rubella--a reappraisal.

Rubella--a reappraisal. Rubella infection is reviewed and new information about congenital infection, possible sources of infection in pregnant women and the optimum ages and population groups for rubella vaccination is considered. Investigations required to confirm a suspected and possibly 'silent' infection during pregnancy are outlined.


The epidemiology of rubella in Cape Town. This preliminary study indicates that a high proportion of adult females in Cape Town are immune to rubella, and that, unlike the situation in the UK, natural rubella infections are common before 4 years of age. At least 10 children with the congenital rubella syndrome have been seen in the Cape Town group of teaching hospitals in a 5 1/2-year period since October 1971. Continuous serological surveillance is essential in order to implement the most effective programme of immunization in any particular area and also to be able to determine whether the vaccine is successfully preventing the birth of children with congenital rubella infection.


Nursing staff stress in an intensive care unit. The stresses associated with nursing in an intensive care unit were assessed. A comparison was drawn between a group of Black and a group of White nurses. Proposals aimed at reducing the observed stress patterns are suggested.


[Causes of burn injuries in children].

[Causes of burn injuries in children]. In this article the causes of burn injuries in a series of 236 children admitted to the burns unit of Red Cross War Memorial Children's Hospital are investigated. Special reference is made to housing conditions as a contributing factor. The findings suggest that overcrowding and inadequate bathing and cooking facilities are conditions permeating almost all other contributory factors. More pertinent preventative measures are recommended.


The effect of frequency tolerance on audiometer accuracy. Investigations into the methods used to calibrate audiometers reveal that the 6 000 Hz frequency is particularly liable to yield inconsistent results when calibrated in the usual way. It is shown that the TDH39 telephone receiver which is usually calibrated on a 9A coupler in accordance with the International Standards Organization recommendation R389 will depend to a considerable extent on the precise frequency used and may differ by as much as 7 db when the frequency is varied but still retained within the specified tolerance limits. A new telephone receiver, the TDH50, is much less sensitive to frequency variation. It is shown that this receiver should be calibrated with the same threshold figures as the TDH39.


Report on a free sterilization service in Natal. In this article the results of a pilot project (carried out at King George V Hospital, Durban, and later extended to include all Natal Provincial Administration hospitals) offering free sterilization to persons who attend family planning clinics are reported. A mini laparotomy technique which requires little operative skill, minimizes operative trauma and requires only 24 hours postoperative hospitalization is described.


Pancreatic ascites: report of two cases. Two cases of pancreatic ascites are reported in which endoscopic retrograde and operative pancreatography were used to demonstrate the source of leakage from the duct system. Both patients were successfully treated by surgery. The management of patients with pancreatic ascites is discussed.


Register of cases of subacute sclerosing panencephalitis (SSPE) in Southern Africa. An analysis of cases of subacute sclerosing panencephalitis (SSPE) in Southern Africa to the end of 1976 is presented. In the 2 years since the last report in 1975, 15 new cases have been added to the register. Seven patients from the Cape Province were investigated in Groote Schuur and Red Cross War Memorial Children's Hospitals in Cape Town and a recent postal survey revealed 6 cases in the Transvaal and 1 each from South West Africa and Rhodesia. This analysis indicates that the high incidence and temporal clustering of cases in the Cape Province is continuing, and that the relatively constant annual number of cases in the Transvaal and the apparent absence of the disease in Natal and the Orange Free State are being maintained.


Serum lysozyme in Crohn's disease and ulcerative colitis. Serum lysozyme (muramidase) concentrations were determined in 55 patients with inflammatory bowel disease, 6 with miscellaneous bowel disease, 40 with pulmonary tuberculosis, and in 20 normal subjects. The mean (+/- SE) lysozyme concentration for each group was as follows: controls 6,95 +/- 0,36 microgram/ml; ulcerative colitis 9,61 +/- 1,02 microgram/ml; inactive Crohn's disease 7,61 +/- 0,53 microgram/ml; active Crohn's disease 20,77 +/- 2,17 microgram/ml; sputum-negative tuberculosis 13,05 +/- 1,06 microgram/ml; and sputum-positive tuberculosis 20,35 +/- 2,08 microgram/ml. The mean enzyme levels were significantly higher in patients with Crohn's disease than in those with ulcerative colitis (P less than 0,05) or in normal controls (P less than 0,01). Our findings suggest that serum lysozyme levels may be useful in differentiating active Crohn's disease from ulcerative colitis, but the results overlap somewhat. However, the enzyme level may be a useful index of disease activity in following up patients with Crohn's disease. As tuberculosis is endemic in this country it must first be excluded, because patients with pulmonary tuberculosis have similarly high levels of serum lysozyme.


Skinfold thickness measurements in assessment of nutritional status of Indian and White schoolchildren. A statistical comparison is presented between height, weight, and subscapular and triceps skinfold thickness for age of Indian and White schoolchildren. It was found that (i) although a high degree of correlation existed between height and weight for age of White children, this was not true for Indian children; (ii) for both White and Indian children of both sexes inconsistent variations occurred between both height and weight and skinfold thickness; (iii) despite extremely low heights and weights observed for Indian children, which could be interpreted as depicting chronic undernutrition, the skinfold thicknesses of the latter children were close to normal as judged by conventional standards: the subscapular skinfold thicknesses in Indian girls actually exceeded the conventionally accepted normal standard values. It is concluded that in the indirect assessment of nutritional status of Indian subjects, anthropometric variables should be used with caution. Finally, it is proposed that further anthropometric and individual energy balance studies be conducted on a cross-section of various socio-economic, age and sex groups of the Indian population in an attempt to establish the basis for the described anomalies.


Gram-negative bacillary infections in cancer patients. The majority of infectious complications in cancer patients are caused by Gram-negative bacilli. The most common organisms are Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa. Sites of infection are related to the patients' underlying malignancies, but pneumonia and septicaemia occur most often. Important newer antibiotics for the therapy of these infections are aminoglycosides and semisynthetic penicillins. It is advisable to utilize combinations of antibiotics for serious infections in cancer patients, and therapy should be instituted promptly at the onset of infection.


Ultrastructure of duodenal epithelial cells in patients with active duodenal ulcers and after treatment with cimetidine. Comparative ultrastructural studies were conducted on biopsy specimens taken under direct vision by endoscopy from the normal duodenum, from the edge of deep and flat duodenal ulcers, and from areas 1 cm away from such ulcers. In addition, the ultrastructure of biopsy tissue from the scar of ulcers which healed after 6 weeks' therapy with the histaminastructural studies of tissue form the edge of both flat and deep duodenal ulcers showed gross pathological changes, particularly with regard to microvilli. Cells from the edge of deep ulcers showed increased secretory activity. Epithelial tissue 1 cm from flat duodenal ulcers exhibited ultrastructural changes far more severe than cells 1 cm from deep duodenal ulcers. The epithelial tissue from the scar area after 6 weeks' treatment appeared capable of regaining a fully functional role, although it was not normal in all specimens.


The paediatric primary health care nurse project in Soweto. The in-service training of paediatric primary health care nurses at Baragwanath Hospital, and the implementation of this project with health care teams in the Soweto clinics, is discussed. Appropriately trained members of the community can provide better comprehensive primary care, and optimal use is made of available manpower. Similar schemes in other parts of the world are briefly considered.


Management of meconium ileus by resection and end-to-end anastomosis. Six patients with meconium ileus, in whom bowel resection and end-to-end anastomosis were performed, are presented. Meconium ileus may be simple or complicated. The simple form may be treated by Gastrografin enema. Surgery is indicated if conservative treatment fails and for patients with a complicated obstruction. Provided the bowel is disobstructed and carefully resected, end-to-end anastomosis is preferable. Confirmation of the diagnosis by careful histological examination of the resected bowel is urged.


The effect of lumbar epidural analgesia on the fetal heart. Fetal heart rate was monitored by continuous cardiotocography in 67 patients who were subjected to standard epidural block. In 43% of cases a deterioration in the fetal heart rate pattern was observed. The abnormal heart rate usually responded to conservative treatment. In 3 cases caesarean section was necessary. The deterioration of the fetal heart rate was usually associated with maternal hypotension.


Spontaneous abortion in perspective. A 7-year study. Ten per cent of all pregnancies end in spontaneous abortion. Only by thorough history taking, physical examination and selected biochemical and biological investigations can potential causes of abortion be recognized and treated. The lesser known factors concerned with abortion are emphasized, and the role played by human chorionic gonadotrophin therapy in selected cases is considered.


Recurrent postmenopausal bleeding.

Recurrent postmenopausal bleeding. Thirty-four patients with recurrent postmenopausal bleeding are reviewed. All had previously undergone dilatation and curettage after a first episode of postmenopausal bleeding, and no pathological cause had been found. When they presented with recurrence of bleeding, 32 of the 34 patients underwent total abdominal hysterectomy and bilateral salpingo-oöphorectomy and the excised organs were submitted for histological examination. In 2 patients clinical cervical carcinoma was found and they received radiotherapy. Hysterectomy was warranted in 5 patients with endometrial glandular hyperplasia and in 2 with uterine fibroids. Fibroids which distort the uterine cavity can result in an inadequate curettage. In 2 patients, failure to take adequate endocervical cytology smears resulted in a pre-operative diagnosis of endocervical carcinoma being missed. In recurrent postmenopausal bleeding, the taking of an adequate cervical smear and repear dilation and curettage are indicated as initial procedures. In obese patients, in whom palpable ovarian tumours may be overlooked, and in those with distortion of the endometrial cavity due to fibroids, total abdominal hysterectomy with bilateral salpingo-oöphorectomy is preferable, because underlying genital cancer can be missed in these cases.


Cancer of the ovary.

Cancer of the ovary. One hundred and forty-two cases of ovarian cancer seen at the Johannesburg General Hospital are reviewed. The poor prognosis associated with this disease is directly related to the fact that at the time of presentation the cancer had spread beyond the confines of the ovary. Results of therapy are poor, with no major impact recorded on survival rates for many years. Therapeutic possibilities are reviewed. When the disease is in stage I and the tumour is completely removed by surgery, the use of postoperative chemotherapy is suggested as a possible means of preventing recurrence or to destroy unrecognized areas of microscopical spread.


Squamous cell carcinoma arising in a dermoid cyst of the ovary. A case report. A case of advanced squamous cell carcinoma arising in a benign cystic teratoma is presented. The carcinoma occurred in a 48-year-old Black patient who died from widespread disease within 5 months of diagnosis. Carcinomatous change in a dermoid cyst is an uncommon occurrence, with a poor prognosis.


Primary ovarian pregnancy and the intra-uterine contraceptive device. Report of two cases. Two patients with unequivocal primary ovarian pregnancies are presented, one with an intra-uterine contraceptive device in situ. The increased prevalence of primary ovarian pregnancies, as revealed in the English literature, and the increasing association of extra-uterine pregnancies with intra-uterine contraceptive devices in situ, are discussed.


Haemoperitoneum due to placenta percreta. A case report. A case of haemoperitoneum due to placenta percreta occurring at approximately 22 weeks' gestation is presented. The diagnosis and treatment are discussed.


Postsynaptic membranes in the electric tissue of Narcine: I. Organization and innervation of electric cells. Fine structure of nicotinic receptor-channel molecules revealed by transmission microscopy. The ventral, postsynaptic membranes of the electroplaques of Narcine were examined for structures corresponding in location, numbers, position and form with nicotinic acetylcholine receptor-channel molecules. Electron micrographs of conventionally fixed material showed that the thickened outer lamina of these membranes contained about 6100 stained structures/micron 2; and calculations from this packing density and the estimated area of postsynaptic membranes/g tissue yielded a total number of structures within a factor of two of the number of receptor molecules/g determined from the binding of alpha-bungarotoxin. Examination of tissue prepared with a tannic acid/glutaraldehyde fixative revealed that the structures were uniform in character, cylindrical in shape, transmembrane in position, and that each contained a central core. Their diameter matched that of isolated receptor molecules, and their size can account for most of the receptor protein. We conclude that these receptor molecules are largely intramembranous, cylindrical and exhibit transmembrane pores.


Postsynaptic membranes in the electric tissue of Narcine: II. A freeze-fracture study of nicotinic receptor molecules. The ventral, postsynaptic membranes of the electroplaques of Narcine were found to containe intramembranous particles similar in location, packing density (about 5700/micron 2), transmembrane position and end appearance to nicotinic acetylcholine receptor-channel molecules. In fixed tissue the particles were limited to the cytoplasmic lamina, while in unfixed tissue an equivalent number were found symmetrically in both laminae. Four populations of particle diameters were observed in each unfixed lamina, even though other morphological evidence indicates the presence of large number of molecules of uniform structure, and biochemical studies of isolated postsynaptic membranes indicate that at least 70% of the membrane protein is receptor-channel protein. Intramembranous particles in dorsal, non-innervated electroplaque membranes, presumably representing Na+, K+-associated ATPase and other channel proteins, were found to have similar characteristics to particles in ventral membranes. Receptor-channel molecules cannot, therefore, be distinguished from other intrinsic membrane proteins by freeze-replication alone.


Postsynaptic membranes in the electric tissue of Narcine: III. Isolation and characterization. Postsnyaptic membranes in homogenates of the electric tissue of Narcine were identified by labelling nicotinic acetylcholine receptors in the membranes with radioactive alpha-bungarotoxin. Various media and centrifugation conditions were examined in an attempt to obtain highly purified postsynaptic membranes. The main criterion for purification was approach towards the specific activity of the pure receptor protein, 9--10 nmol toxin-sites/mg protein. Isolation of tissue microsomes with Tris buffer, EDTA and the protease inhibitor phenylmethylsulfonylfluoride (PMSF), conditions which preserve the receptor molecules optimally, yielded about 50% of the tissue toxin-sites, 5% of the protein, 4% of the ATPase and less than 2% of the acetylcholinesterase (AChE). Further separation of vesiculated membranes in continuous density gradients of sucrose showed that the major contaminants of postsynaptic membrane vesicles were damaged mitochondria and tubular vesicles of dorsal electroplaque membranes rich in ATPase. Mitochondria were effectively removed from homogenates by 'differential' centrifugation, and ATPase-rich vesicles could be largely removed by causing their agglutination with calcium ions, or by controlled proteolysis in the absence of PMSF. Partially purified postsynaptic membranes were obtained having about 7 nmol toxin-sites/mg membrane protein. Further purification appears possible by affinity techniques.


Ultrastructure of the protocerebral neurosecretory cells of larval Galleria mellonella, in situ and after culture of the brain in vitro. Three major groups of neurosecretory cells are described in the larval brain of Galleria mellonella at two different times during the last larval instar and in larval brains after 72 hr of culture in vitro. The medial group in vivo consists of four distinct neurosecretory cell types, based on characteristic size and morphology, while the posterior and lateral groups each contain a single distinct type of neurosecretory cell. Morphological differences between the same neurosecretory cells at the different times during the last instar are most apparent in the lateral L-1 cells and in the medial M-2 cells, where pleiomorphism is particularly evident in the size, density and accumulations of neurosecretory granules. The only neurosecretory cells in which apparent synthesis of neurosecretory granules is still observed after culture of the brain in vitro are the medial M-2 cells. The other neurosecretory cell types show no accumulation of neurosecretory granules nor new synthesis of neurosecretory material, but are similar to neurosecretory cells in the brain in vivo in all other respects. The morphology of the neurosecretory cells in the larval brain in vivo and in vitro is discussed in relation to their appearance at the light microscopic level and to a known neurohormonal function of the brain which is maintained during 72 hr in vitro.


Structural changes in light- and dark-adapted compound eyes of the Australian earwig Labidura riparia truncata (Dermaptera). The apposition acone eye of Labidura is relatively small--550-600 facets--with a thick corneal lens and shallow retina. The retina cell columns are each formed of six peripheral cells plus two central cells, a partially fused rhabdom, and dense pigment in two or three cell types. Upon adaptation from light to dark, the most striking photomechanical response is a proximal broadening of the cone cells, which results in a 38-fold increase in cross-sectional area of the aperture. While longitudinal rhabdom movement is small, microvillar diameters swell in response to light and contract in the dark. Irregularities of facet pattern and shape, and in ommatidial alignment were found, particularly towards eye margins. Three types of interommatidial sense organs on the eye surface are described, one of which has not been previously reported. An argument is presented to explain how the field of view and sensitivity are both apparently decreased in the acone eye by exposure to light.


The ultrastructure of the posterior midgut caecum of Pachygrapsus crassipes (Decapoda, Brachyura) adapted to low salinity. The effects of salinity adaptation and of composition and tonicity of fixatives upon the ultrastructure of the posterior midgut caecum (PMC) of Pachygrapsus crassipes have been studied. The PMC epithelium consists of a single layer of columnar cells with a microvillous border. The apical cytoplasm contains numerous mitochondria, lysosomes, and much smooth endoplasmic reticulum. Rough endoplasmic reticulum and Golgi apparatus are situated in the perinuclear cytoplasm. This epithelium resembles other transporting epithelia in that the basal cytoplasm has an extensive system of branched tubules formed from invaginations of the lateral and basal plasma membrane. Numerous mitochondria are associated with the basal tubular system. To determine the possible contribution of the PMC to the osmoregulatory ability of Pachygrapsus, the ultrastructure of the PMC from animals adapted to 40, 50, and 100 and 150% sea water was investigated. Enlargement of basal tubules and intercellular spaces at low salinity, suggestive of fluid-transport activity, was found to be an artifact of fixation. The most consistent response when animals were acclimated to dilute salinities was that some basal mitochondria assume a more complex shape, usually appearing as rings in cross sections of the caecum. A hypothesis concerning the functional significance of these mitochondria is proposed.


Cytodifferentiation in the accessory glands of Tenebrio molitor. III. Fine structure of the spermathecal accessory gland in the pupa. To establish indices for studying the hormonal control of differentiation of the accessory reproductive glands of insects, the ultrastructural development of the spermathecal accessory gland (SAG) of female mealworm beetles has been analyzed. Over the 9 days between adult and pupal ecdysis, the SAG transforms from a stubby sac of columnar epithelium into an elongate cylindrical gland, lined with cuticle, and containing several distinct types of differentiated cells. The first phase of pupal differentiation is one of cell division and overall gland morphogenesis which lasts 3--4 days; at its close, two populations of cells can be distinguished. One of these populations will produce the cuticular ductules while the other will yield the three-cell secretory units or organules. In the second phase which lasts 2 days, the three cells of each organule become wrapped around one another and then the innermost puts out a pseudocilium and retracts within the next ensheathing cell. In the third phase which lasts 4 days, the cuticles of the axial duct, of the efferent ductule, of the vestibule upon which the ductules converge, and of the end apparatus, are deposited. The ciliary process degenerates, and after ecdysis, the secretory cells undergo peak differentiation.


Gill receptor arrays in the horseshoe crab (Limulus polyphemus). The branchial warts on the endopodites of the gills are covered with goblet-shaped cuticular appendages, whose internal structure shows them to be chemoreceptors. The innervated goblets have a cuticular tubule that connects an external pore through their hollow interior with the epidermal sensillum. Associated sensory neurons give rise to small axons that pass through a synaptic plexus below the epidermis. The sense organs seem specialized for sampling the exhalent water current.


Geographical pathology of cancer of the uterine cervix. The availability of age-standardized cancer incidences for different parts of the world has enabled a thorough and meaningful analysis of the geographical distribution of cancer of the uterine cervix. The high morbidity and mortality from cervical cancer reported for most European countries and North America at the beginning of this century has, in recent years, been superseded by those for Asian, African, Latin American and Caribbean countries with the provision of additional data. Striking differences in cervical cancer incidences have been observed among various ethnic groups in Africa which seem to reflect variations in the intensity of certain environmental influences. Cervix cancer is uncommon in the white population of North America and Europe with the exception of West Germany, Denmark, Sweden and Yugoslavia. In the United States, the highest incidence occurs in Puerto Rican women of New York City and the Latin population of the South. The very low incidence in Jewish women is virtually the same in New York City as in Israel. This world-wide survey has shown that poor sexual hygiene rather than lack of male circumcision per se is a more important aetiological factor in cervical cancer.


Oesophageal carcinoma in India. Some epidemiologic and morphologic considerations. Oesophageal carcinoma constituted 2.39% of all malignancies, and 17.11% of gastrointestinal tract malignancies, over a period of 12 years, in Sir Sunder Lal Hospital population in Varanasi. The highest frequency occurred in the sixth decade. The male:female ratio was 2.2:1, this ratio tended to diminish with age. Out of 202 cases the middle third of the oesophagus was involved in 104, the lower third in 72 and the upper third in 26 cases. Although squamous cell carcinoma was by far the most frequent histologic type (193 cases), genuine primary oesophageal adenocarcinoma did occur in 3, and the tumour was completely anaplastic in the remaining 6 cases. The prognostic bearing of certain morphologic features has been discussed. Oesophageal carcinoma is one of the most frequent malignancies of the gastrointestinal tract and a common tumour in elderly Indian men and women.


Anaemia of pregnancy in Kathmandu, Nepal. A clinical appraisal of statistical predictions of anaemia in a population. A detailed clinical study of 151 women in the third trimester of pregnancy in Kathmandu, Nepal (altitude 1450 m), indicates a previously reported statistical approach via mass screening of a population without regard to potential haematologic abnormalities appears valid in establishing (a) the lower limit of a normal hemoglobin (Hb) level in pregnancy, (b) the approximate percent of the population which is anaemic, and (c) the distribution of anaemic values. The existing WHO criterion regarding low normal Hb levels in pregnancy was misleading when used to diagnose the most common cause of anaemia. It was found that a pregnant woman with a Hb of 9.0 g% could conceivably not be anaemic at this altitude.


Anaemia in non-sickling Nigerian children around Enugu. Severe anaemia often assumes emergency dimensions in West Africa. Previous studies in Nigeria and Ghana incriminate malaria as the main single cause of anaemia in early infancy. This prospective study was conducted to verify this for the Enugu region. The series included 50 anaemic patients aged between 4 months and 10 years admitted to the children's ward. Our results rank poor nutrition much more then malaria among the causes in children under 2 years of age. Hookworm infestation may be a more common cause in children over 2 years.


Blood pressure survey of Zambian primigravidae. The systolic and diastolic blood pressures during pregnancy of 146 Zambian primigravidae between the ages of 15 and 19 were recorded. A control group consisted of non-pregnant school girls of similar ages. Upon comparison of the compiled data, both the systolic and diastolic blood pressures of the primigravidae were found to be significantly lower than those of the non-pregnant school girls. Differences in social circumstances, body weight and the pregnancy itself may explain these results. During the third trimester of the pregnancies the systolic and diastolic blood pressure did not rise. Factors that can contribute to the prevalence of pre-eclampsia are discussed. The prevalence of pre-eclampsia in Nchelenge District, Zambia, seemed to be relatively low.


Hepatitis B surface antigen (HBsAg) subtypes in Uganda. A preliminary report. Hepatitis B surface antigen positive sera for 34 African residents in Uganda were analysed for antigenic determinants and ethnic groups. Twenty four of the subjects belonged to Bantu ethnic groups and the rest to non-Bantu ethnic groups. Nineteen of the Bantu had antigenic subtype adw and only one of the non-Bantu had subtype adw. The association between subtypes and ethnic groups was found to be statistically significant (p less than 0.01). The results in this preliminary report agree with reports from West Africa of a high preponderance of hepatitis B surface antigenic subtype ayw among the non-Bantu West Africans.


Painful ophthalmoplegia.

Painful ophthalmoplegia. A syndrome of acute periorbital pain, followed by the onset of ophthalmoplegia, has, in recent years, been recognised as a distinct entity. Six patients conforming to this clinical picture are presented from Zambia, and the characteristics of the syndrome is described. Attention is drawn to the existence of the condition in Arica and to its dramatic improvement with systemic steroid treatment. Particularly in those areas with limited investigatory facilities, the use of steroids can constitute a therapeutic test.


Protecting the Nigerian child against the common communicable diseases. A pilot survey was done on a sample of 141 women in Lagos to find out the influence of their social, economic and educational background on the level of immunization of their children against the common childhood infections. The level of immunization was generally low, the lowest being for poliomyelitis (28%). The following factors are important for improvement in the level of immunization of the children: a reduction in the number of attendances required to a minimum, easy availability, accessibility and acceptability of health services, raising the educational level of the people and their socio-economic status, and ensuring maximum utilization of health services by health education of the people.


Evaluation of the indirect haemagglutination and intradermal tests on hydatid and nonhydatid cases. Evaluation of the immediate intradermal (ID) test showed a direct relationship between nitrogen concentration and sensitivity. Antigens of low nitrogen concentration were less reactive but more specific. Intradermal antigens prepared from Echinococcus multilocularis can be used in Isfahan, Iran, for the diagnosis of E. granulosus in man. The ID delayed reaction was observed in a few patients who had positive immediate skin tests. Because of its high sensitivity, the indirect haemagglutination (IHA) test was preferred for the serologic diagnosis of echinococcosis. Based on the results outlined in their study the IHA test appears to offer good sensitivity, and the ID, with an antigen of low nitrogen concentration, good specificity.


Haematobium schistosomiasis among seminomadic and agricultural Afar in Ethiopia. Parasitological and malacological surveys were made in the Afar tribal area on the flood plains of the Awash River. S. haematobium--infections are most prevalent among seminomadic Afar living around the swamps and lakes in the middle part of the Awash Valley. Infection rates between 6 and 52% were found among seminomadic Afar and between 0 and 27% in agricultural groups. The highly localised distribution of vesical schistosomiasis is maintained by the distribution of the swamps, lakes and the human population and by migration patterns. On the marshy plain near Gewani significantly higher infection rates occur among Afar females than males. This is apparently due to sex differences in water contact patterns.


Mortality and other parameters of concomitant infections in albino mice: the Schistosoma-Toxoplasma model. Inocula of S. mansoni and T. gondii well tolerated by albino mice when given singly, were given concomitantly to groups of animals. Few notable effects were observed when toxoplasmosis preceded schistosomiasis, but the S. mansoni leads to T. gondii model, with an interval of 59 days between infections, led to massive mortality, great weight loss and a striking splenomegaly. These findings are very similar to data from previous work on the S. mansoni leads to Trypanosoma cruzi model. The authors believe that other examples of such a type of potentialization should be searched for in human schistosomiasis also.


The predatory activity of Lebistes reticulatus (Peters, 1859) on Schistosoma mansoni miracidia in laboratory experiments. Laboratory experiments were conducted to evaluate the role of the guppy, Lebistes reticulatus (Peters, 1859), as an active predator on Schistosoma mansoni miracidia. When five guppies were introduced into 3.5 liters of water containing 500 and 1200 miracidia on two corresponding tests, a dramatic reduction in number of miracidia was observed. In one experiment, no miracidia could be found after 60 minutes of exposure. The infection rates of vector snails, Biomphalaria glabrata, exposed to approximately 3000 miracidia in the presence of guppies were also greatly reduced. The results obtained suggest that L. reticulatus is a probable predator of S. mansoni miracidia and may, under field conditions, play an important role as a limiting or interfering factor in the transmission of S. mansoni.


The prevalence of hookworm and of S. haematobium in rural Zambia. The prevalence of hookworm and of S. haematobium in a representative sample of the rural population of seven provinces of Zambia was assessed during a National Nutrition Status Survey. A total of 7212 people of all age and sex groups were examined for hookworm, of whom 4920 (68%) provided a stool sample and of these 48.6% were positive. Regional figures ranged between 11.4% and 77.1%. No differentiation between species of hookworm was attempted nor was it possible to assess the worm load of the individuals surveyed. Hookworm is highly endemic within the rural areas and this is discussed in relation to its known effects on the general health of the population studied during the survey, and the impact of hookworm infestation on morbidity.


Beetle-eating: a Malaysia folk medical practice and its public health implications. A reported practice of live beetle ingestion in Southeast Asia was investigated among urban Chinese in Kuala Lumpur, Malaysia. Results of four casefindings are: (1) this practice may not be confined to West Malaysia, (2) it occurs among Chinese and Malays, (3) the original use of the beetles as an aphrodisiac has been modified to include treatment of a wide variety of ailments and diseases and (4) the practice is relatively uncommon among urban Chinese. It was also found through experimental studies that ingestion of the live beetles (Palembus dermestoides) represented a potential public health hazard in that the beetles were able to serve as a host for the human-infecting tapeworm Hymenolepis diminuta (Sullivan et al., 1977).


Agents affecting health of mother and child in a rural area of Kenya. III. The epidemiology of measles. Between April 1974 and March 1976 surveillance of measles has been conducted by 12 fieldworkers making fortnightly home visits among a total population of 24,000 living in nearly 4000 households scattered in variable density throughout an area of 87 sq km in the northern division of the Machakos district, Kenya. The diagnosis of measles was verified by one of the project's physicians according to standardized procedures and was, whenever possible, supported by virus isolation and serum antibody level determination. Because not all reported patients were actually seen during the period of clinical manifestations, the diagnosis remained doubtful in a number of cases. Incidence and mortality figures have been estimated with 95% confidence limits based on the assumption that doubtful cases represent a probability of measles of .33 and probable cases a probability of .67. The estimated attack rate for the susceptible population 0-15 years of age was 13.5%. When related to all children--susceptible or not--the attack rate was highest in the 1-2 years age group (11%). Almost 15% of cases occurred below the age of one year, 1% below 6 months of age and 6% between 6 and 8 months. The estimated case fatality rate was 6.5%, fatality being highest between 1 and 2 years of age. For the age group 0-15 years measles accounted for 16.7% of all deaths. The estimated death rate per 100,000 total population was 113. The epidemiological pattern of measles suggests continuous re-introduction of the measles virus in a dispersed population causing micro-outbreaks of the disease in geographically widely separated spots throughout the year which tends to keep the proportion of susceptibles down and the attack rate during a protracted epidemic relatively low.


Providing maternal and child care in rural Malaysia. Since Independence, gained in 1957, major changes have occurred in the rural areas of Malaysia not least amongst which has been the provision of maternal and child care services to hitherto neglected areas. In the first part of this paper, the demographic and disease patterns are described. The second part outlines the general development efforts and describes in greater detail the rural health services that have been organized in Malaysia. In the concluding section, changes in mortality and morbidity are examined.


Simplified Technique for Ureteroneocystostomy: A modification of Politano-Leadbetter operation. The Politano and Leadbetter antireflux ureteroneocystostomy is the most accepted method for ureteral reimplantation. A modification of this procedure is suggested. The main differences are the way the submucosal tunnel is prepared, the resection and spatulating of the  terminal ureter and a new concept of suturing the ureter to the bladder mucosa.


[Occurrence of fetorenal antigens in renal adenocarcinoma]. An antigen sharing common antigenic determinants with Australia-Antigen was found in the renal excretory ducts of human fetuses. Moreover, in the sera from patients suffering from kidney tumours, antibodies against Australia-Antigens should be found. This has not been proven by us, nor has the presence of this kind of fetorenal antigen in the tissues of 25 renal carcinomas been found using a very sensitive radioimmunoassay. Therefore, the search for an Australia-Antigen-like antibody or antigen cannot be used as a tumour test nor has the theory of the carcinogenesis yet been questioned.


Flavoxate hydrochloride in the treatment of detrusor instability. 42 patients with 'unstable bladder' were treated with flavoxate hydrochloride. A previous treatment with parasympathicolytic drugs (propantheline bromide and/or emepronium bromide) was unsuccessful. The instability of the detrusor was proven by a urodynamical investigation. Flavoxate hydrochloride is a papaverine-like smooth muscle relaxant. The results and the complications of the treatment are discussed.


Alterations of serum lactic dehydrogenase and its isoenzyme V fraction levels following hyperglycemic condition in patients with geitourinary neoplasms. In patients with various genitourinary neoplasms, except in those with untreated bladder carcinoma, changes of SLDH and SLDH-V fraction levels owing to hyperglycemic conditions were statistically not significant to the pretreatment levels. In patients with untreated bladder carcinoma, the levels after 48 h were statistically significantly lower than the pretreatment levels. However, these decreases disappeared after radical treatment. In patients having abnormally high pretreatment levels, the frequency of cases which decreased to more than 20% of their pretreatment levels was 47% for SLDH and 60% for SLDH-V. This test was useful not only as a diagnostic tool, but also as a means of predicting therapeutic results.


Mucosal sensory threshold of urinary bladder and urethra measured electrically. Urodynamic investigation consists of evaluation of detrusor stretch responses, muscle strength and motor activities. The electrosensitivity test is the only method to evaluate mucosal sensory threshold of exteroceptive receptors in urinary bladder and posterior urethra thus checking integrity of sensory reflex arcs. A constant current square wave pulse of 0.5 msec duration and 10 msec interval is used with increasing amplitude from 0 to 25 mA until the patient registers sensation. Skin electrosensitivity is tested to start with, then perception threshold of urinary bladder and posterior urethra is recorded. Sensory deficits after segmental sacral nerve lesions or after peripheral nerve injuries postoperatively can be quantitated in terms of milliamperes. The urgency syndrome in adult women is characterized by a low perception threshold in the posterior urethra (below 1 mA) while the bladder electrosensitivity is within normal range (3--10 mA).


[Thawing of bovine seminal fluid].

[Thawing of bovine seminal fluid]. Comparative experiments were carried out at 39 degrees C and at 70 degrees C in water bath for the thawing of seminal fluid frozen in straws. The motility of spermatozoa was followed up as well as the absolute survival rate after thawing. By means of a thermocuple the temperature rise was traced as occurring in independence on the weather. The results spoke in favour of the regime at 70 degrees C for 7 sec. They were statistically significant (p less than 0.001). At 39 degrees C motility of spermatozoa was 36.26 per cent, and the absolute value of survival rate--353.85 min. (at 70 degrees C--45.47 per cent, and 376.85 min respectively). It is suggested to use the regime at 70 degrees C in an automatic apparatus, which is now being tested by the author.


[Differentiation of non-specific positive brucellosis reactions using an antigen stained with rose bengal]. A Brucella buffered antigen, stained with Bengal rose by a method of the authors, was obtained. It showed a high distinguishing capacity with regard to the nonspecific agglutinations after Huddleson and Wright at a negative complement-fixation test for brucellosis with sera from cattle, pigs, sheep, and horses. Such differentiation, however, proved to be incomplete and for sera of different animals varied within the range of 34 to 0.0 per cent.