Guillain-Barré syndrome: a 42-year epidemiologic and clinical study. The central medical-records linkage system at the Mayo Clinic for the population of Olmsted County, Minnesota, provided the necessary data resource for the identification and follow-up of virtually all diagnosed cases of the Guillain--Barré syndrome over a period of 42 years. During this time, a total of 40 Olmsted County residents had clinical signs and symptoms of the disease. The mean annual incidence rate was 1.7 per 100,000 population. There was a significantly higher incidence rate (P less than 0.01) among patients 40 years of age and older. In four patients malignancies developed; however, the occurrence of the Guillain-Barré syndrome had no significant effect on survivorship in these patients. A case-control comparison of suggested etiologic factors supports the view that there is a significant association between antecedent infections and the Guillain-Barré syndrome.


Developmental changes in delta-aminolevulinic acid dehydratase (ALAD) activity and blood reticulocyte percent in the developing rat. A brief note. A correlation between blood reticulocyte percent and the activity of erythrocytic delta-aminolevulinic acid dehydratase (ALAD) in the developing rat has been established during the progression from a state of macrocytic hypochromic anemia at birth to a normocytic normochromic state at puberty, and finally to a state just prior to adulthood at which the reticulocyte percent had stabilized. Both reticulocyte percent and erythrocytic ALAD activity was found to decrease with age, rapidly at first until a normocytic normochromic state was reached at puberty and then more slowly until just before adulthood when both plateaued. A direct, linear correlation between erythrocytic ALAD activity and blood reticulocyte percent was found with a P value of less than 0.001. These findings should be carefully considered when using the rat as a model for lead poisoning and possibly for other disorders of heme biosynthesis.


Correlation between DNA repair of embryonic fibroblasts and different life span of 3 inbred mouse strains. Primary mouse fibroblast cultures were established from 10 day old embryos of 3 inbred strains with a genetically determined different life expectancy. The capacity for unscheduled DNA synthesis following u.v. irradiation was studied in these cells at various passage levels of the in vitro ageing process. The mouse fibroblasts show considerable repair synthesis corresponding to the duration of exposure time. The capacity for induction of unscheduled DNA synthesis was different in the cells of each strain and correlated to the natural life span of the animal. In each case, however, the ability to perform repair synthesis was subjected to an age-associated decline, although semiconservative DNA synthesis and proliferative potential of the cells was not changed until the cultures entered phase III passages.


Age-dependence of isoproterenol-induced DNA synthesis in submandibular glands of BALB/c mice. The age-dependency of isoproterenol (IPR) induced DNA synthesis was investigated in different organs of Balb/c mice. Although modifications of the physiological rate of DNA synthesis after IPR injection occurred also in liver and spleen, a quasi-linear decrease of the peak of IPR response with advancing age was observed only in submandibular glands. Such a decrease was observed when animals were injected with 10(-4) g IPR per g body weight, lower doses being unable to discriminate between young and old mice. In spite of some differences between mice and rats, the early appearance and linearity of the age-dependency remain common features of IPR response.


Thymus-dependent reversibility of physiological and isoproterenol evoked age-related parameters in athymic (nude) and old normal mice. In order to assess the relationship between the thymus and aging processes, a linear age-dependent parameter in mice such as the response of the submandibular gland to an injection with isoproterenol has been evaluated in athymic (nude) and thymectomized Balb/c mice. The IPR-induced DNA synthesis is reduced in both experimental groups when compared to untreated normal littermates and is recovered by grafting a neonatal thymus. Moreover, the impairment of IPR response in old animals is recovered to young levels by grafting one neonatal thymus one month before test. Neonatal thymus grafts in old recipients are also able to correct their abnormal serum levels of triiodothyronine and insulin. The influence of neonatal thymus on such non-immunological and age-related parameters suggests that this gland can control aging processes, probably through its implication with the endocrine system.


Age dependent kinetic studies of cytoplasmic and lysosomal enzymes of the normal and D-galactosamine injured rat liver. Rats of two age groups (6 weeks and 30 months) received (1) a single dose of 600 mg D-galactosamine (GalN)/kg body weight by intraperitoneal (i.p.) injection, (2) a single dose of 600 mg GalN/kg body weight i.p. combined with 20 mg prednisolone/kg body weight subcutaneously at the beginning of the experiment. The kinetic studies disclose that GalN produces more severe changes in old than in young animals, represented by the activities of cytoplasmic (glutamic oxaloacetic transaminase, glutamic pyruvic transaminase) and lysosomal (beta-acetylglucosaminidase beta-glucuronidase, cathepsin D) enzymes. Prednisolone diminishes the morphological liver changes as well as the biochemical disturbances in young rats. There is only a protecting effect in morphological changes of old animals within the first 12 h. The prevention of cytoplasmic enzyme activity increase is limited to the first 12 h.


A differential effect of protein and calorie deficiency on ovarian follicular growth in the sow. Either protein or calorie deficiency alters the pre-antral growth of ovarian follicles in the sow. Protein deficiency depressed the rates of oocyte, oocyte nuclear and oocyte nucleolar growth in follicles composed of one or more layers of granulosa cells. Calorie deficiency depressed the growth of the follicle envelope but only in multilaminar follicles. It is concluded that the effect of protein deficiency on ovarian follicular growth differs significantly from that of calorie deficiency in this species. Neither treatment altered the maximum dimensions of the oocyte at the completion of the intra-ovarian growth phase (phase A).


Differentiation and aging of the rat intestinal mucosa. II. Morphological, enzyme histochemical and disc electrophoretic aspects of the aging of the small intestinal mucosa. At different times of day (08.00, 12.00, 16.00 and 24.00) the small intestinal mucosa of four month (adult) and 30 month (senile) old rats was examined histologically, by scanning electron microscopy, autoradiography, enzyme histochemistry and disc electrophoresis. In senile rats a villous atrophy is found histologically and an irregular architecture is found in scanning electron microscopy. The changes are essentially restricted to the proximal small intestine. The enterocytes of adult and senile rats show an identical enzyme histochemical picture. In the proximal small intestine of adult and senile rats, synchronous statistically significant fluctuations of the activity of alkaline and acid phosphatase were revealed in the disc electropherograms. Likewise statistically significant are the at all times of day low enzyme activities in the intestinal mucosa of senile rats as compared to the findings in adult rats. The fall in activity of alkaline and acid phosphatase in old rats is attributed to the numerical reduction of the enterocytes which is caused by the age atrophy of the intestinal mucosa. These findings are discussed in connection with results of our own studies of proliferation kinetics and those of other authors.


Expectations and experience of HMO enrollees after one year: an analysis of satisfaction, utilization, and costs. The impact of HMO enrollment on utilization and satisfaction in a sample of industrial employees was investigated using a panel study design. Preenrollment and postenrollment ambulatory utilization rates, out-of-pocket costs, and measures of satisfaction are presented for enrollees in two closed- and one open-panel HMO-type plans. Their health care experiences are compared to those of reenrollees remaining in the HMOs during both surveys, as well as to those retaining their Blue Cross-Blue Shield membership. Lack of access to and dissatisfaction with previous sources of care distinguished the preenrollment experience of those who selected the closed-panel plans; their postenrollment experience produced increasing satisfaction reflecting that their expectations in these areas were met. Continuing enrollees in closed-panel plans were somewhat less satisfied after a year of experience than they were earlier. Those who joined the open-panel plan did so because of the expanded benefits and financial advantages which, their postenrollment experience showed, were accurately perceived. Utilization patterns also changed: continuing enrollees in both types of plans made fewer illness but more preventive visits; new enrollees used greater numbers of both types of services after enrolling than before.


Factors affecting children's use of physician services in a prepaid group practice. This paper examines factors affecting children's use of physician services in a prepaid group practice. The independent measures come from questions asked of mothers in a survey interview, while the utilization data come from their children's medical records. All independent variables were measured prior to the period of utilization studied. The results provide some evidence in support of the view that physician utilization for children is affected by characteristics of the mother, as well as the child's age and health status. Somewhat different variables were related to whether health services were used at all as compared with magnitude of use. Special consideration is given to the effect of the mother's level of psychological distress on her propensity to use medical services for children. The results suggest that distress was relevant, but only for the white families included in the sample. Also, distress was more important in explaining extent of use than accounting for whether utilization occurred at all. Various hypotheses are examined to explore white-nonwhite differences.


Primary care treatment of emotional problems in an HMO. Integrating mental health services into primary care should improve the availability, access, and delivery of psychiatric care to the whole population. Health maintenance organizations (HMOs) are settings for the development of integrated medical-mental health services. This paper reports findings of a project to evaluate a team collaborative model in an HMO. In this model, primary care clinicians carry major responsibility for emotional problems of their patients, and mental health clinicians collaborate with and support primary care clinicians as well as treat referred patients. Over a two-year study period, 15.7 per cent of all patients who visited the HMO presented a mental or emotional difficulty. When psychotropic drug prescriptions were used as an unobtrusive measure for estimating underenumeration, this prevalence figure rose to 19 per cent. Primary care clinicians treated an increasing proportion of the emotional problem demand, although this increase could not be attributed only to the establishment of the team collaborative model. Findings concerning the psychiatric problems treated and psychotropic drugs prescribed by primary care clinicians are also presented. We conclude that the primary care clinicians did assume major responsibility for emotional problem treatment when encouraged and supported through the team collaborative process and other organizational arrangements.


The cost of a primary care teaching program in a prepaid group practice. Costs were determined for a teaching program in general pediatrics and general internal medicine for advanced residents in a prepaid group practice, the Medical Care Group of Washington University. A time and motion study was conducted to measure the productivity of faculty physicians before and after the establishment of the teaching program. There was a statistically significant loss in productivity for internists and an apparent loss, though not significant, for pediatricians as a result of their teaching effort, but the productivity of the residents more than compensated for the loss. The residual positive value of a full time equivalent (FTE) pediatric resident after reimbursement of all possible lost productivity by faculty pediatricians represented 43.9 per cent of a FTE pediatrician. For a FTE resident in internal medicine the residual positive value was 49.7 per cent of a FTE internist.


Compound frontal sinus injuries with intracranial penetration. Extensive trauma to the forehead, resulting in large penetrating wounds of the frontal sinus that extend into the frontal lobes of the brain, has traditionally been treated by frontal sinus ablation. Although this operation eliminates dead space, it leaves the patient with a depressed area in the forehead with little protection for the brain. The success of Nadell and Kline in replacing skull fragments following compound depressed skull fractures yet avoiding infection has spurred us to attempt this technique in penetrating injuries of the frontal sinus. By preserving the anterior frontal sinus wall, we have not only afforded protection for the frontal lobes of the brain, but, at the same time, avoided the cosmetic defect that would be left by an ablation procedure. This procedure has been performed on two patients at our institution. After a two-year follow-up, excellent forehead profile preservation has been achieved and there has been no evidence of bone absorption or infection at any time since surgery.


Place of total thyroidectomy in rhinolaryngologists' surgical treatment of thyroid disease. Total thyroidectomy is more frequently performed and is becoming more widely accepted as the treatment of choice for more surgical diseases of the thyroid gland. Improvement in anesthesia, presurgical and post-operative care, as well as more meticulous surgical technique, have decreased the complications associated with this operation. As is demonstrated, morbidity and complications of total thyroidectomy are no more frequent nor severe than when subtotal thyroidectomy is performed. This allows boadening of the indications for total thyroidectomy to include more cases which will be better controlled, but for which total thyroidectomy had been withheld because of the fear of increased morbidity.


The dilemma of the second surgeon.

The dilemma of the second surgeon. The dilemma of the second surgeon is created when a patient is seen who has received advice and/or treatment by a colleague in the same specialty. The problem is compounded when conflicting opinions as to diagnosis, treatment, and results occur. This is discussed in the context of providing optimal care, maintaining effective communication, and avoiding the obvious pitfalls.


Xeroradiography and otolaryngology.

Xeroradiography and otolaryngology. As a diagnostic tool, a new horizon in otolaryngology has become apparent in the past several years. It is known as xeroradiography and is a convenient technique requiring minimal patient cooperation and enjoying excellent acceptability for both patients and physicians. Speed, efficiency and consistently high image quality make xeroradiography suitable for otolaryngologic applications in the office, as well as in operating and emergency rooms. All tissue densities are represented in a single image, eliminating the need for taking two films of different densities, while radiation exposure in the same. Now popular for use in mammography, the technique is especially useful for detailed studies of the areas of interest to otolaryngologists. Certain inherent disadvantages in the technique are mentioned and guidelines are given to make these disadvantages an acceptable trade-off in actual application.


Management of parasymphyseal fractures of the mandible. Fractures of the parasymphyseal mandible occur in 15% of all cases of mandibular fracture. The experience obtained from 32 consecutive parasymphyseal fractures is outlined. Open reduction and internal fixation was required in patients having severe comminution, a mobile central fragment, or bilateral subcondylar fractures. These circumstances constituted 15% of all parasymphyseal fractures. The techniques utilized have been outlined.


The biphasic acoustic reflex: a new perspective. The anatomic, neurologic, and physiologic characteristics of the middle ear structures have created confusion concerning the nature of the intraaural muscle reflex. After reviewing the relevant literature, we correlated this information with our studies of human temporal bones and computer analyses of the acoustic reflex responses of individuals with normal hearing. Our hypothesis is that although the stapedius is the initiator of the reflex and the primary contributor to ossicular chain fixation, the tensor tympani is responsible for the major observed response. The negative deflection present in normals tested on the impedance bridge is caused by the stapedius, whereas the large positive deflection is the result of the tensor tympani contraction. We postulate that proprioceptive feedback mechanisms located within the stapedius muscle and tendon permit and/or initiate tensor tympani contraction during acoustic stimulation.


Nerve conduction time in Bell's palsy.

Nerve conduction time in Bell's palsy. This paper deals with the problem of idiopathic Bell's palsy. One hundred thirty seven cases of Bell's palsy were analyzed. It is shown that the use of E.M.G., facial nerve conduction time, and stimulating thresholds necessary to achieve supramaximal stimulation reduced the number of patients with complete paralysis in the poor prognosis group to 20.6% as compared to 37.5% when the nerve excitability test alone was utilized.


Hearing investigation in relation to the duration of acoustic signals. The present study was designed to test the peculiarities of hearing perception on dependence of acoustic signal duration both in normal hearing subjects and in those with conductive and sensorineural deafness. It was found that in patients with pure conductive hearing impairment the shortest time necessary for tonal sensation of the sound signal corresponded to normal values. However, in 35 out of 63 patients investigated with cochlear deafness, it was found that the signal had to be of longer duration before pitch could be distinguished from a click.


Bone apposition rate as an index of bone metabolism. The rate of bone apposition was studied by labeling bone with four or five sequential doses of oxytetracycline given at equal intervals of 2 or 4 days in rats and rabbits. The rate was estimated in bone formation sites bearing all the doses. This method has the advantage of assessing the rate of new bone mineralization during the active bone-forming phase only. This index of bone formation was found to be independent of the location of bone samples in the skeleton, and therefore might be under the influence of general body mechanisms only. Preliminary study in the rats indeed yielded results indicating that this bone apposition rate is accelerated by dietary deficiency in calcium.


Abnormal concentration and anomalous distribution of apolipoprotein A-I in Tangier disease. A double-antibody radioimmunoassay was used to determine the concentration and distribution of apolipoprotein A-I (apoA-I) in the plasma of patients with Tangier disease. Obligate heterozygotes for Tangier disease had apoA-I levels that were 50% or less of controls, even when estimates of high-density lipoprotein cholesterol concentration were normal. Plasma apoA-I levels in Tangier homozygotes were at most 3% of normal. Most of the apoA-I in the plasma of homozygotes sedimented in the ultracentrifuge at density 1.21 g/ml, and no more than 20% was recovered in the plasma lipoprotein fraction. Radioimmunoassay demonstrated no immunochemical differences between Tangier and control apoA-I.


Stimulatory effect of glycine on human growth hormone secretion. Glycine (250 ml 0.3 M glycine) was administered orally to 19 nonobese normal subjects and 12 subjects with partial gastrectomy. In the normal subjects, a clear and significant increase of serum human growth hormone (hGH) level was observed (p less than 0.001), whereas serum immunoreactive insulin (IRI), prolactin (PRL) and blood sugar (BS) levels were not affected after the drug administration. A more pronounced and significant increase of hGH value in serum was found in the subjects with gastrectomy than in the normal controls (p less than 0.001). Thus we administered the drug intraduodenally in normal subjects. The similar rise of hGH to that of the gastrectomied group was obtained in normals by this administration. The facts demonstrated that glycine is one of the stimulatory agents inducing the pituitary gland to secrete hGH. In addition, in nonobese diabetics, no significant increase of serum hGH level, even after the intraduodenal administration of glycine, was observed in the present study.


[Does oxazepam (ADUMBRAN) interfere with anticoagulant treatment. A controlled study. (author's transl)]. Newer communications dealing with drug interaction between tranquillizers and anticoagulants and the frequent combined intake of these drugs have induced us to perform a series of coagulation-and platelet parameters in 21 antiocoagulated patients with and without oxazepam (Adumbran). Control of adherence to the prescriptions was stressed upon: all cases were controlled by analysis of urin and nonadherent patients were excluded from statistical evaluation of hemostatic parameters. In the obtained well defined group no differences were observed in the effect of constant doses of anticoagulants and different tests of plasmatic coagulation and platelet aggregability.


[Coumarin-necroses: An allergic reaction or a local Sanarelli-Shwartzman-phenomenon? (author's transl)]. In a 70-year old woman presenting with extended coumarin-necroses on her right thigh and shin histological findings, immunofluorescence and coagulation-parameters favoured a mechanism closely related to a local Sanarelly-Shwartzman-reaction. A primary immunological process involving the vessel walls could be ruled out.


[Therapy of Marchiafava-Micheli's disease: Remission under therapy with Lynestrenol (author's transl)]. The remission of a case of Marchiafava-Micheli under therapy with Lynestrenol is represented. The observation period is 16 months. The therapeutical purpose--stabilizing the red cell membrane by increasing the serum cholesterol concentration--is discussed by laboratory findings. Moreover the clinical picture and other common treatments against this disease are demonstrated by the example of this case.


Characterization of analog resistance and purine metabolism of adult rat-liver epithelial cell 8-azaguanine-resistant mutants. Adult rat-liver epithelial cultures were sensitive to the lethal effects of 8-azaguanine (AG), but lines contained variants resistant to AG. The frequency of retrievable AG-resistant colonies varied with both the concentration of AG used and the seeding density of the population under selection. Cells resistant to AG were also cross-resistant to 6-thioguanine and unable to grow in medium containing hypoxanthine, aminopterin and thymidine. Resistance was stable. AG resistance was due to a deficiency of hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) activity which was not caused by an inhibitor. In the assay for HGPRTase, a substantial amount of product appeared as inosine (In) in addition to inosine monophosphate (IMP). Purine nucleoside phosphorylase will generate In from hypoxanthine and, indeed, the cells did possess this activity. However, several findings indicated that the In was derived from IMP by catabolism by 5'-nucleotidase (NTase): (1) IMP decreased as In increased and (2) the inhibitors of NTase, adenosine monophosphate and thymidine triphosphate, reduced the generation of In by over 90% without inhibiting purine nucleoside phosphorylase. The cells possessed substantial NTase activity, 35% of which was located in the cytosol along with 69% of HGPRTase. Several lines of evidence suggested that the NTase activity limited the amount of 8-azaguanylic acid presented to the cells by catabolising the nucleotide and, thereby, reducing the toxicity of available AG.


The influence of caffeine on the mitomycin C-induced chromosome aberration frequency in normal human and xeroderma pigmentosum cells. The clastogenic effect of mitomycin C (MC) was determined in two normal fibroblast cell lines and two xeroderma pigmentosum (XP) cell lines, a variant and a group A excision-deficient line. The group A xeroderma cell line was substantially more sensitive to MC than either the XP variant or the normal human cells. On caffeine post-treatment potentiation of the MC-induced aberration frequency occurred in all the cell lines. The XP variant cell line exhibited a distinctly higher sensitivity to caffeine than the classical XP or the normal human cell line.


Linear dose-response of acentric chromosome fragments down to 1 R of x-rays in grasshopper neuroblasts, a potential mutagen-test system. Grasshopper-embryo neuroblasts have no spontaneous chromosome breakage; therefore they permit easy detection of agents that break chromosomes. An X-ray exposure of 1 R induces in them a detectable number of chromosome fragments. The dose-response of acentric fragment frequency fits a linear model between 0 and 128 R. Thus another cell type is added to those previously demonstrated to have no threshold dose for the induction of chromosome or gene mutations.


Dominant and recessive effects of induced-lethals in female mice by exposure to gamma-irradiation during the 10th to 14th day of intrauterine life. The frequency of (dominant and) recessive lethal mutations induced by 160-rad chronic gamma-irradiation given with a dose rate of 0.03 rad/min during the 10th to 14th day of gestation has been studied in female CBA-mice. An increased rate of recessive lethal equivalents by about 10% has been noted. This increase corresponds to a mutation rate of 6.3 X 10(-4) mutation/rad/genome. There were not found any dominant mutations, nor any dominance effects from the induced recessive lethal equivalents. The hazards after irradiation during foetal development are discussed.


alpha-Amanithin-resistant mutants of Chinese hamster ovary (CHO) cells. Spontaneous and EMS-induced alpha-amanitin-resistant CHO cells have been isolated and characterized. DNA-dependent RNA polymerase II in cell-free extracts from a mutant (ARM-1) was partially resistant to alpha-amanitin. Growing mutants for several generations in the presence or absence of alpha-amanitin did not change the pattern of inhibition. The mutants grew with a lag following transfer to medium with or without alpha-amanitin. The mutants have an altered RNA polymerase II, and possibly an altered cell membrane.


Correction of human cyclic neutropenia with prednisolone. A 70-year-old woman with cyclic neutropenia was treated with 16 mg of etiocholanolone and 25 mg of prednisolone intramuscularly every other day. During 14 weeks' treatment amplitude of cyclic fluctuations in neutrophil counts gradually decreased, but pretreatment cycles returned promptly after treatment was stopped. Prednisolone alone every other day (25 mg) reproduced this result, and by 23 weeks, neutrophil counts became stable at about 1500 per cubic millimeter. tcycling of monocytes, platelets and reticulocytes was also eliminated, as were symptoms that had accompanied neutropenic periods. In addition, bone-marrow neutrophil precursors and neutrophil marrow reserves were stabilized. The patient was subsequently maintained satisfactorily with oral prednisolone, 20 mg every other day. These studies demonstrate that the discontinuous myeloid maturation that occurs in cyclic neutropenia can be corrected with prednisolone every other day.


Chlamydia trachomatis as a cause of acute "idiopathic" epididymitis. To assess the etiologic role of C. trachomatis and other micro-organisms in "idiopathic" epididymitis, 23 men underwent microbiologic studies, including cultures of epididymal aspirates in 16. Eleven of 13 men under the age of 35 years had C. trachomatis infection whereas eight of 10 over 35 had coliform urinary-tract infection. Cultures of epididymal aspirates yielded C. trachomatis alone in five of six men under 35, and coliform bacteria alone in five of 10 over 35. These results suggest that C. trachomatis is the major cause of "idiopathic" epididymitis, and coliform bacteria the major cause of epididymitis in older men. Expressible urethral discharge and inguinal pain were more common in the chlamydial cases, whereas concurrent genitourinary abnormality and scrotal edema and erythema occurred more commonly in the coliform cases. The morbidity attributable to C. trachomatis is as serious as that attributable to Neisseria gonorrhoeae.


Porphyria cutanea tarda in three generations of a single family. We examined conjugal and blood relatives of one kindred for evidence of porphyria cutanea tarda. The disease was identified in eight family members in three generations. Four were classified as having overt porphyria cutanea tarda because of four criteria: photo-enhanced dermatosis; excessive urinary excretion of uroporphyrins; characteristic thin-layer chromatographic pattern of urinary porphyrins; and decreased activity of erythrocyte uroporphyrinogen decarboxylase. Two patients with excessive excretion of uroporphyrins or characteristic chromatograms, or both, and decreased uroporphyrinogen decarboxylase activity were classified as having subclinical porphyria cutanea tarda, and two with decreased uroporphyrinogen decarboxylase activity only were classified as having latent porphyria cutanea tarda. This study provides further evidence that prophyria cutanea tarda can be a familial disease inherited in an autosomal dominant fashion. We propose a reclassification of porphria cutanea tarda as an overt, subclinical or latent disorder.


History of recurrent sore throat as an indication for tonsillectomy. Predictive limitations of histories that are undocumented. As part of a prospective study of indications for tonsillectomy and adenoidectomy, we followed closely 65 children with histories of recurrent throat infection that seemed impressive (at least seven episodes in one year, five in each of two consecutive years or three in each of three consecutive years), but lacked documentation. During the first year of observation, only 11 children (17 per cent) had episodes of throat infection with clinical features and patterns of frequency conforming to those described in their presenting histories. Of the remaining 54 children, 43 (80 per cent) experienced no, one or two observed episodes each, and most of the episodes were mild. We conclude that undocumented histories of recurrent throat infection do not validly forecast subsequent experience and hence do not constitute an adequate basis for subjecting children to tonsillectomy.


Folate-induced remission in aplastic anemia with familial defect of cellular folate uptake. Severe aplastic anemia developed in a young man with an extensive family history of leukemia, pancytopenia, and neutropenia. Megaloblastic changes became evident, and treatment with high doses of folic acid resulted in striking clinical improvement. However, red-cell folate levels remained persistently low despite high serum folate levels. A defect in cellular folate uptake was suspected, and, indeed, uptake of 5-14CH3-H4-folate by stimulated lymphocytes and by bone-marrow cells from the patient was significantly reduced (P less than 0.05 as compared to normal cells. Further characterization of folate metabolism showed that intestinal absorption of the vitamin, membrane transport of 5-14CH3-H4-folate by mature red cells, folate utilization in the conversion of deoxyuridylate to thymidylate and polyglutamate formation were all normal. At least five other family members manifest decreased uptake of 5-14CH3-H4-folate by stimulated lymphocytes. These studies suggest that a genetically induced abnormality of folate uptake contributed to this patient's severe, but reversible, aplasia.


The diagnostic importance of the normal finding. When a diagnostic test is reported as normal, the clinician generally uses it only to rule out certain diseases. However, if properly interpreted, the normal value may help to differentiate among diagnoses that yield normal results with different frequencies. A simple method permits the extraction of such information. The physician estimates the probability of various diagnoses and then combines these estimates with the anticipated frequency of negative results for each disease under consideration.


alpha-Helix-double helix interaction shown in the structure of a protamine-transfer RNA complex and a nucleoprotamine model. Single crystal X-ray diffraction and circular dichroism studies of protamine binding to a tRNA suggest that the protamine molecule changes its conformation from a random coil to a structure containing a helices on binding to tRNA, and that alpha-helical segment(s) of protamine bind approximately along a shallow groove of a double-helical portion of ttrna. based on these observations, a structural model for nucleoprotamine is proposed.


Structure of vancomycin and its complex with acetyl-D-alanyl-D-alanine. Vancomycin, a broad-spectrum antibiotic, inhibits the growth of cell walls by complex formation with peptides terminating in D-alanyl-D-alanine. The structure of vancomycin was determined by X-ray analysis of the degradation product CDP-I. A model of the complex is proposed based on this study and spectroscopic data.


Can a myosin molecule bind to two actin filaments? It is suggested that in striated muscles the two heads of one myosin molecule are able to interact with different actin filaments. This would provide a simple explanation for the appearance and arrangement of cross-bridges in insect flight muscle in rigor.


Structural comparison of glycophorins and immunochemical analysis of genetic variants. Differences in amino acid sequence of erythrocyte membrane glycophorin A are correlated with M or N blood group activity. A second sialoglycoprotein, glycophorin B, has an amino acid sequence identical to that of glycophorin AN in the first 23 positions and carries N activity only, suggesting that different structural genes code for the glycoproteins carrying these antigens. Certain genetically variant cells lack glycophorin A, as determined by immunochemical methods, and serological MN activity. Other variants lack MN activity, but contain normal amounts of glycophorin A in the membrane.


Age-dependent distribution of acidic glycosaminoglycans in human kidney tissue. Acidic glycosaminoglycans (AGAG) of human kidneys prepared from subjects of different ages were purified and determined by an enzymic assay with chondroitinases. The resulting disaccharide units and the undigested AGAG after digesting with the enzymes were identified by paper chromatography, electrophoresis and thin-layer chromatography. The age-dependent changes were: heparan sulfates accounted for 43-74% of total AGAG and the proportion to total AGAG appeared to decrease with advancing age. Dermatan sulfate remained without change. The proportion of hyaluronic acid appeared to decrease at 19-21 years and increased again with aging. The ratio of the 4-type chondroitin sulfate to the 6-type decreased with advancing age.


Renovascular hypertension. Relationship between hepatic blood flow and plasma renin activity. Hepatic blood flow and peripheral plasma renin activity were determined in 15 true renovascular hypertensive patients and in 13 patients with essential hypertension. In the renovascular hypertensives, plasma renin activity and hepatic blood flow were negatively correlated ( p less than 0.01). In contrast, no relationship was observed in the essential hypertensives. The study suggests that hyperactivity of the renin-angiotensin system could induce splanchnic arteriolar constriction in patients with renovascular hypertension.


Increase in plasma extracellular fluid volume ratio caused by bilateral nephrectomy in patients on maintenance hemodialysis. Changes, observed in rats after bilateral nephrectomy, in blood pressure and in the relation betwen plasma volume-extracellular fluid volume or plasma volume-interstitial fluid volume, are consistent with the postulation that the kidney secretes a substance that regulates, to some degree, the compliance of the interstitial space. In order to evaluate the possibility that this also occurs in humans, we have carried out a retrospective analysis of measurements of extracellular fluid volume, plasma volume, and blood volume made prior to and after bilateral nephrectomy in a group of 9 patients. It was observed that significant increases had occurred in both the plasma-extracellular fluid volume ratio (0.22 before, 0.26 after) and in the blood-extracellular fluid volume ratio (0.27 before, 0.32 after). These data are consistent with a reduction in compliance of the interstitial compartment caused by bilateral nephrectomy in man, even though other explanations cannot be excluded.


Renal clearance of amino acids in patients with severe chronic renal failure. The renal clearance of 21 amino acids was investigated in 5 patients with chronic renal failure (inulin clearance = 5--10ml/min) during the 6-week administration of a low-protein diet. The results were compared with values obtained in 6 volunteers. The renal clearance of all investigated amino acids (with the exception of Asp, His, Tau) did not differ significantly from healthy controls. The excretion fraction (amino acid clearance inulin clearance.100) was in all investigated amino acids significantly higher than in controls with the exception of Tau. The excretion fractions of Asp, Ser, Cys, Tyr, His, Thr, Tau and Gly were, on average, above 20%. The findings suggest that the fractional reabsorption of amino acids in residual nephrons is decreased.


Globin synthesis by nucleated erythroid cells in chronic glomerulonephritis. Globin synthesis rate (GSR) by nucleated erythroid cells was investigated in 40 patients suffering from chronic glomerulonephritis, in 24 subjects with other renal diseases and in 8 healthy controls. GSR was reduced in nephrogenic anemia; moreover, this reduction took place in a few patients without anemia. The correlation between GSR and some characteristics of erythropoiesis was examined. The supression of GSR is probably one of the important causes of nephrogenic anemia.


Tubular handling of sodium and phosphate in cirrhosis with salt retention. Tubular handling of sodium and phosphate were studied in 4 patients with cirrhosis and ascites. The control group consisted of 5 patients with cirrhosis without sodium retention. The degree of phosphaturia was assumed to reflect proximal tubular reabsorption. Whereas fractional excretion of phosphate was comparable in both groups, fractional excretion of sodium was strikingly diminished in the patients with ascites. This observation suggests that sodium retention in these patients occurs beyond the proximal tubule. This interpretation is in accord with our previous observation, based on clearance data, that the proximal tubular reabsorption of sodium in cirrhosis may be normal even in the face of edema formation.


Augmenting/reducing: an adaptive switch mechanism to cope with incoming signals in healthy subjects and psychiatric patients. The tendency to 'augment' or to 'reduce' the amplitude of the response to stimuli of increasing intensity is a matter of much interest in the neurophysiological, psychophysiological and psychiatric literature. According to their response, individuals have been divided so far into 'augmenters' and 'reducers', and different mechanisms beyond these types of response have been discussed. In most studies, however, the major emphasis has been laid upon 'reducing', which has been regarded as deviance from the expected 'augmenting'. In the present article, a new theory referring to a two-directional adaptive switch mechanism for coping with incoming stimuli is presented together with some hypotheses which can be derived from such a general theory. In the following, evidence from experimental work is presented which supports the main theoretical principles, and also the hypothesis that both basic characteristics of the central nervous system and biochemical variables contribute to the determination of the individual augmenting/reducing response.


Suicide and endogenous depression with somatic symptoms in the Lundby study. The purpose of the study was to elucidate the role played by the so-called masked or somatic depressions in suicide. The records of 28 suicide persons were analyzed concerning depressive symptoms at time of death. The suicide group was drawn from a prospective longitudinal cohort study of 3,563 persons which began in 1947 (the Lunbdy Project) and was followed up during 25 years. All persons had been examined once or twice before the suicide. 14 were considered to have suffered from depression. Irrespective of any reactive factor, most of the depressive persons had symptoms of endogenous type. In 19 out of the 14 persons with depression the clinical picture included also somatic symptoms. The persons with depression had often sought medical advice, though mostly not psychiatrists'. Many of them had been difficult to treat and had shown negativism to medical care. An important suicide prophylactic measure would be to enhance the awareness of hospital clinicians and practitioners of the existence, diagnosis and treatment of endogenous depression.


Enhancement of the antidepressant response to L-tryptophan by a liver pyrrolase inhibitor: a rational treatment approach. In an open preliminary investigation, pre- and concomitant treatment with a liver pyrrolase inhibitor allopurinol to depressed male outpatients receiving L-tryptophan suggests a rational approach to treatment with this serotonin precursor. The combination is both safe and apparently effective; the rapidity of response in some patients underscores the clinical effects. Implications are that serotonin, or rather an excess in serotonin, is involved in the symptomatic relief of depressions in man.


Dopamine receptor stimulation in the treatment of depression: piribedil (ET-495). ET-495, a putative central dopamine receptor stimulant, was givem to endogenously depressed individuals, all of whom were largely unresponsive to previous drug treatment. The drug exhibited a rapid and, in some cases, a pronounced antidepressant effect. This effect was short-lived, however, and, within a brief period, depression returned accompanied by a consistent syndrome of anger, irritability, hostility and poor temper control. In one individual with a bipolar history, the induction of a paranoid psychosis and auditory hallucinosis occurred. While the data suggests a role for dopamine in the symptomatic relief of depression in man, they also imply that this monoamine cannot, in and of itself, be considered as the primum movens in either the action of other (established) antidepressant drugs, or as underlying depressive illness.


[Spontaneous electrodermal activity and moods (author's transl)]. The systematic recording of spontaneous electrodermal activity (EDA) on 23 normal subjects during 5 15-min sessions and the self-rating of anxious and/or depressive moods (Q-sort forced choice) shows a positive linear relationship between spontaneous EDA and anxious mood despite a low covariation between those two variables. The same relationship is found with a lower degree of confidence in depression. A greater EDA is observed in the rare pattern of "depression higher than anxiety', than in the opposite case. The discussion of the results deals with the parallelism between a physiological continuum and affective states.


Sulpiride and extrapyramidal syndromes in chronic heroin addiction. During the treatment of 53 young heroin addicts with intramuscular sulpiride for the prevention of withdrawal symptoms, the emergence of extrapyramidal manifestations involving the head, neck and upper trunk in about 40 percent of the patients has been observed. These symptoms occurred with sulpiride dosages in the 'antineurotic' range (not more than 400 mg daily), which practically never produce such symptoms in patients receiving the drug for other clinical indications. The symptoms appeared soon after the first few injections of sulpiride, and yielded readily to a single or repeated intravenous diazepam administration (10 mg). The possible mechanism involved in the production of extrapyramidal manifestations from sulpiride, and a tentative explanation of why such symptoms are produced by doses of this drug lower than those needed to produce the same effects in nonaddicts, are discussed.


Changing indications for cesarean section. A 38-year experience at a community hospital. A review of a 38-year experience with cesarean section at a community hospital shows considerable change in both the rate and indication of cesarean sections. A marked increase in the cesarean section rate was noted after 1972. This increase was due primarily to an increase in the primary cesarean section rate for cephalopelvic disproportion and labor abnormalities, fetal distress, and the breech presentation. As a result of this study, we anticipate a primary cesarean section rate of approximately 10%: 3-5% for cephalopelvic disproportion and labor abnormalities, 1-1 1/2% for fetal distress, 3% for breech presentation, and 1-2% for all other indications.


Acute inversion of the uterus.

Acute inversion of the uterus. Acute inversion of the uterus is a rare emergency that occurs during the third stage of labor. Three cases of this complication are reported. General anesthesia, fundal pressure on a soft uterus, fundal implantation of the placenta, and adherent placenta were identified as the possible causes. Prompt recognition and replacement are essential in the management to preempt morbidities and mortality. The prevention, etiology, and management of this serious complication are discussed.


Effect of pregnancy on liver tumor associated with oral contraceptives. Four cases of liver adenoma associated with oral contraceptives complicating pregnancy are reported. All patients were symptomatic during pregnancy and 2 were admitted with rupture of the adenoma. One subsequently died. Increased growth and vascularity of adenomas during pregnancy is highly likely. The potential for development of lethal complications is considerable.


Correlation between amniotic fluid optical density, L/S ratio, and fetal pulmonary maturity. The correlation between lecithin/sphyngomyelin ratio (L/S ratio) and amniotic fluid optical density at 400 (OD400) and 650 (OD650) nm was studied with 102 samples of fluid obtained from 72 patients. The accuracy of each method in predicting the respiratory outcome of the newborn was also evaluated in 28 patients who delivered within 48 hours after amniocentesis. Results indicate that the correlation between spectrophotometric analysis and L/S ratio is poor and that the latter is a better predictor of neonatal respiratory outcome. It is concluded that measurements of amniotic fluid optical density are not an acceptable substitute for the L/S ratio in evaluating fetal pulmonary maturity.


Fetal weight estimation by ultrasonic measurement of abdominal circumference. The purpose of this study was to compare ultrasonic measurements of fetal abdominal circumference to ultrasonic measurements of fetal biparietal diameter, as a means of estimating fetal body weight. Of 58 fetuses who had abdominal circumferences measured, 48 (82%) of the predicted weights were within 15% of the actual birth weights. Forty-four of the same 58 fetuses had satisfactory biparietal diameter measurements, but only 21 (48%) of the predicted weights were within 15% of the actual birthweights. Ultrasonic measurement of abdominal circumference appears to be a more reliable index of fetal body weight than other currently available techniques.


Intrauterine breathing movements and fetal presentation. Fetal breathing movements in 14 twin pregnancies were examined with ultrasonic technique. The twin fetuses I in cephalic presentation showed a significantly higher percentage of apnea and periodic breathing compared with twin fetuses II. No such difference was found in twin pairs with Twin ti in breech presentation. Also in the control group of 27 singleton pregnancies, the fetuses in cephalic presentation had a higher incidence of apnea and periodic breathing than those in breech presentation. The position of the fetus seems to be decisive for the character of the breathing movements before birth.


Correlation between first morning sample and 24-hour urinary estriol excretion. The estriol concentration of a morning sample of urine from high-risk pregnant women was correlated with the total 24-hour estriol excretion. One hundred seventy sample pairs compared the estriol concentration of the morning specimen with those of a 24-hour specimen of the previous day, while 110 sample pairs compared the value of morning specimen with those of a 24-hour specimen of the following day. Although there is highly significant statistical correlation between those sample pairs, they are of modest magnitude. The mean values of the sample pairs are significantly different. Also, the morning sample estriol concentrations are significantly more variable than those of the 24-hour specimen.


Rapid B-scan (real-time) ultrasonography in the identification and evaluation of twin pregnancies. Real-time ultrasonography utilizing a hand-held linear array transducer provides a highly accurate method of identifying and evaluating the twin gestation. The rapidity of real-time scanning eliminates interpretational problems caused by fetal movements. Additionally, the versatility of transducer positioning facilitates recognition of appropriate fetal planes for assessment of viability and growth. A prospective study of 595 consecutive pregnancies yielded no misdiagnoses of the number of fetuses present and only one false positive diagnosis of fetal viability.


Abnormalities of lymphocyte transformations in women with condylomata acuminata. The cellular immunity of 16 women with recalcitrant condylomata acuminata was investigated with an in vitro assay of antigen-induced lymphocyte transformations. Results were compared to those of 24 age-matched controls. Lymphocyte transformation responses (in counts per minute) for women with condylomata were much lower than controls for phytohemagglutinin-P, 32,285 and 60,015, (P less than .001); for concanavallin A, 28,664 and 58,605, (P less than .001); and for pokeweed mitogen, 34,941 and 73,394 (P less than .0001). No significant differences in lymphocyte transformations were noted between the 2 groups to Candida or streptokinase-streptodornase antigens. Immunosuppressive diseases, recurrent infections, and intraepithelial neoplasms of the genital tract were more frequent in the group of women with condylomata, and this seems to clinically substantiate the depressions noted in their in vitro cellular immunity. A refractory course of condyloma acuminatum in some women may be a reflection of an underlying state of immunosuppression.


Blood group incompatibility and cervical hostility in relation to sterility. Fifty-two sterile couples, characterized by persistent and unexplained incompatibility between spermatozoa and cervical mucus, without any other evident factor to explain their sterility, were investigated for the possible role of blood group incompatibility as a cause of their sterility. After a study of the distribution of blood groups in sterile and fertile couples, the distribution of blood group substances in pairs of husbands and wives, and the effect of blood group antibodies on sperm migration, it seems highly unlikely that blood group incompatibility contributes significantly to cervical hostility and the resulting sterility.


Intrasellar subarachnoid herniation or empty sella associated with galactorrhea. Eight of 115 patients with empty sella had concurrent galactorrhea. All 8 patients had abnormal sellae, and the diagnosis of empty sella was made by polytome pneumoencephalography. There were no obvious endocrine dysfunctions, but 2 patients had elevated prolactin levels. One mechanism for production of galactorrhea may involve compression of the hypothalamus and/or pituitary stalk; this was suggested by most of our observations. There may be a coincidental association of empty sella with galactorrhea, and this association is probably more common than previously noted. Evaluation of patients with galactorrhea and abnormal sellae by polytome pneumoencephalography is emphasized.


Serum 17beta-estradiol. Index of follicular maturation during gonadotropin therapy. Thirteen patients with hypogonadotropic hypogonadism were treated with human menopausal gonadotropins (hMG) and human chorionic gonadotropin (hCG) to induce ovulation. Daily serum 17beta-estradiol (E2) assays were used to monitor the ovarian response to HMG. Apparent ovulation, documented by basal body temperatures, occurred in 41 of 53 hMG-hCG treatment cycles. Thirteen pregnancies occurred in 8 of the 13 patients. One twin pregnancy resulted. The hyperstimulation syndrome did not occur. Our data indicate that an optimal pregnancy rate with a minimum risk of hyperstimulation can be achieved when ovulation is induced 24 hours after the preovulatory serum E2 concentration has reached 500 to 900 pg/ml. Ovulation is induced by administering 10,000 IU and 5000 IU hCG on successive days. In addition, we now routinely give two or three injections of 2500 IU hCG at subsequent 3- to 4-day intervals to support the corpus luteum.


Ovarian germinomas (dysgerminomas).

Ovarian germinomas (dysgerminomas). The clinicopathologic findings of 13 patients with ovarian pure germinomas (dysgerminomas) were studied to assess modes of therapy. The patients' ages ranged from 12 to 40 years. Ten patients had unilateral tumors clinically confined to the ovary (Stage I), including 1 patient who had an unsuspected microscopic germinoma in a normal-appearing ovary. Of those with Stage I tumors, only 1 patient developed metastases and died; however, the presence of other elements in the mestases suggested that her primary ovarian neoplasm actually may have been a malignant mixed germ cell tumor. The other 9 patients are alive without tumor after postoperative intervals of 0.3 to 29 years. Three patients had more advanced lesions (Stages II-IV) and 2 died of metastases following orthovoltage irradiation. The results of this study support the concept of individualized therapy for patients with ovarian germinomas.


Endodermal sinus tumor of the ovary. The orphan tumor. The endodermal sinus tumor of the ovary is a rare and highly lethal germ cell tumor. At least 10 different names have been applied to it, and so long as its name remains unsettled the collection of information will continue to be greatly impeded. One of the patients who came under our observation died after 21 months despite surgical removal of all evident disease followed by radiation and chemotherapy; the other patient, whose tumor could be removed only partially, and who received intensive chemotherapy for 4 months but refused all treatment thereafter, is well without evidence of disease 3 years after the initial diagnosis was made. Despite the dismal outlook for patients with this tumor, a few encouraging features emphasize the need to report new cases as they appear, and to continue the search for agents that will control it.


Mechanisms of placentofetal blood flow.

Mechanisms of placentofetal blood flow. The average length of the umbilical cord at delivery is 21 +/- 1 in., but lengths vary from 10 to 50 in. When distended and carrying blood between the fetus and the placenta, the cord is longer; the distended areteries and vein are spiraled about each other. No physiologic data explain the manner by which blood flows from the placenta to fetus. When pressures (60-80 mmHg in arteries 10-20 mmHg in the vein) are recorded simultaneously, arterial pulse pressure has been observed to rise and umbilical vein pressure to fall. They are 180 degrees out of phase. When necessary physical factors are taken into account, it is found that the system satisfies all requirements of a pump known as one of the pulsometer type. This system is one that is widely used by engineers, but it is unique among physiologic systems.


[Autism Asperger of early schizophrenia (author's transl)]. Sometimes there exist difficulties to differentiate between adolescents with autistic personalities (autistic psychopathy, Asperger) and schizophrenia. The authors describe a 16-years old autistic boy demonstrating that a clear cut separation of these two different nosologic entities is only possible by means of a longitudinal observation. By this method psychopathological disturbances will be interpreted correct and within the context of the underlying syndrome.


Umbilical vessel catheterization; the immediate risks with the venous route. Seven cases of heart arrest or pronounced bradycardia during 308 correct catheterizations of the umbilical vein in the first hours of life are reported. The indications for the catheterization were: 1. unsuccessful catheterization of the umbilical arteries in newborns with respiratory distress or post-asphyxia syndrome; 2. exchange transfusions for severe neonatal hyperbilirubinemia or sepsis; 3. monitoring the central vein pressure in severely compromised shocky newborns. Cardiac massage was always effective, at least temporarily, in restoring the heart activity. However, only three infants survived. Two of them had normal follow-up reported at 6 and 12 months respectively. The immediate risks and the necessary precautions for carrying out umbilical vein catheterization in severely ill newborns in the first hours of life are stressed.


[On the reliability of maternal recall of aspects of child development (author's transl)]. In a pilot study about the rate-rerate-reliability of maternal recall of aspects of child development (pregnancy, childbirth, early childhood development) 100 mothers (mean age 35 years) answered an questionnaire twice. The mean retest interval was 12 days with a standard deviation of 6 days, the mean age of the children (54 boys, 46 girls) was 9 years. The results showed that the rate-rerate-reliability was not ever sufficient especially with regard to clinical relevance of the questions (e. g. in context with the diagnosis of brain damage). Factors influencing the rate-rerate-reliability of anamnestic date (e.g. age, sex, number of children) have been investigated: there was only one significant result. Mothers with less reliable data and great differences between their answers tend to be elder.


[Paroxysmal tachycardia in infancy and childhood (author's transl)]. 23 cases of paroxysmal tachycardia in infancy and childhood (22 cases of supraventricular and 1 case of ventricular paroxysmal tachycardia) are reported. Clinical problems of 13 infants aged 1 day to 6 months are compared with those of 10 children and discussed. A primary disease e.g. congenital heart disease, myocarditis was observed in 8 cases and WPW-syndrome in 4 cases. Owing to the threatening cardiac failure especially in infancy a special attention should be taken to the immediately diagnosis. Treatment and prevention are discussed.


[Investigations concerning temperature and serum concentrations of paracetamol in febrile infants following rectal application of paracetamol (author's transl)]. If paracetamol as an antipyretic is applied as suppository, absorption is much slower than after oral application. With the same dosage serum concentrations are lower after rectal application than after oral. It is necessary to give nearly twice the dose using rectal rather than oral application to reach the same antipyretic effect. The duration of efficacy is longer after rectal application because serum concentrations decline slower.


[Heroin-withdrawal-syndrome in the newborn (author's transl)]. A case of a heroin-withdrawal-syndrome is reported. Diagnostic, therapeutic and social aspects of this syndrome are discussed. Newborn infants delivered from mothers addicted to heroin often develop a deprivation syndrome. 40% of these children are small for date babies. Symptoms of deprivation begin after delivery or between the 1st and 4th week of life. Generally the onset of symptoms lies between the 1st and 3rd day of life with irritability, tremor, restlessness, and shrill cry. The degree of illness depends upon mother's last heroin intake. Treatment for drug addicts are tinctura opii (3--5--10 drops orally following 4 hours) and Chlorpromazine (2,2 mg/kg/25 hours orally or i. m.). The mortality rate increases when treatment is missing.


[Thrombosis of the renal artery in a newborn (author's transl)]. Very rare informations about thrombosis of the renal artery in newborns in the literature could be found. In a six years old girl in the course of a perinatal asphyxia complicated by shock a renal artery thrombosis was observed. Profuse bleeding, anemia, thrombopenia, prolonged bleeding time and coagulation time and a low percentage of the thrombotest suggested an intravascular coagulation as a possible factor of this disease. The treatment of the coagulopathia was effective. The physical and psychical development of the girl is normal. The inhibition of the renal function, however, is in a compensated state.


Adaptation to extrauterine existence: cardiac and respiratory rates during the first 72 hours. In 29 asymptomatic underweight newborns, 10 true preterms and 19 small-forgestational age (SGA), recordings of respiratory and cardiac rates were performed during the first 72 hours of life. The results may be summarized as follows: 1. Respiratory rates (RR) are slightly elevated during the first day of life. 2. The respiratory-to-cardiac ratio (RR/CR) is very constant throughout the first three days. 3. Low-Apgar infants initially have an elevated RR. 4. True preterm infants have higher cardiac rates (CR) than SGA infants. Not all of the phenomena observed can be totally explained on the basis of existing knowledge.


[Treatment of iron deficiency anemia with ferrosulfate serin komplex (author's transl)]. The results of treatment of iron deficiency anemia in 217 children and infants (aged 8 months to 12 years) with ferrosulfate serin complex are demonstrated: 208 children with simple iron deficiency anemia with hemoglobin 9.1 g/100 ml before treatment had in the first 4 weeks a daily increase of 0.082 g/10000 ml hemoglobin; in 3 children with severe anemia of chronic blood loss the daily increase was 0.21 mg/100 ml and in 6 children with hypoxic polycythemia with congenital heart disease and so called latent iron deficiency anemia the increse was 0.16 g/100 ml. Through the better absorption of this serin-ferrosulfate complex the required dosis is only 3 mg/kg/d. The benefit of this small dosis is the low rate of side effects.


[Biological characteristics of the invasive stage of Myxosoma cerebralis (Myxosporidia: Myxosomatidae)]. The data concerning biological peculiarities of spores of Myxosoma cerebralis obtained by the author and other researchers are summarized. The life cycle of M. cerebralis is well adapted to the seasonal cycle of the host owing to the fact that the infectivity of the spores is attained only after 4 months of aging in water and that the spores are highly resistive to freezing and drying. No sexual process during 4 month aging was observed. It is supposed that the maturity of spores depends to a great extent on the ability of polar capsules for extrusion.


[Ultrastructure of the midgut in Ornithodoros papillipes (Acarina, Argasidae) nymphs in the blood assimilation period]. Three types of cells (reserve, digestive and secretory) differing in their ultrastructural characters were found to exist in the epithelium of the midgut of nymphs of O. papillipes during the blood assimilation. Reserve and secretory cells are dominant at the first stage of digestion while digestive cells are most abundant at the second one. Ultrafine structure of secretory and digestive cells points to the labile relationship between these types of cells. The same digestive cells assimilate blood both by means of phagocytosis of formed elements and by pinocytosis of its liquid components. The identity of ultrastructural peculiarities of endocytosis and intracellular blood digestion in ixodid and argasid ticks is shown.


[Epizootiological importance of Frontopsylla hetera (Siphonaptera) fleas in the Gorno-Altai natural plague focus]. Experiments conducted during all seasons have established that F. hetera, one of the mass species of fleas in Mountain Altai, can be infected both by the strain of selective virulence typical to this nidus and by the non-typical non-virulent mountain-altai strain of plague agent. The non-virulent strain does not form in fleas the block of proventriculus and within 1.5-2 months they become free from the microbe. At the infection with the typical strain of the altai subspecies rare transmissions of the agent to Pallas' pika can take place as well as its long preservation in fleas.


[Type and parameters of common warble fly (Hypoderma bovis) larval distribution in cattle herds in different parts of a geographic range]. The method of statystical analysis of the distribution of the 2nd and 3d instar larvae of Hypoderma bovis in 54 herds (8120 heads) of cattle from Czechoslovakia and in 20 herds (1809 heads) from Mongolia has shown that in most cases the negative binomial distribution models the distribution of larvae with sufficient reliability and that the variability in parameters of the distribution is stable independent on the parts of the area.


[Karyotypic characteristics of the genus Prosimulium Roub. (Simuliidae) and the problems of systematics]. A comparative-karyologycal study of 12 species of black flies of the genus Prosimulium was carried out. Species referring to the groups hirtipes and macropyga have similar karyotypical characteristics differing in general in the degree of ploidy of chromosomal sets. Species which form the group alpestre possess peculiar karyologycal characters occupying due to this an intermediate position between the genera Prosimulium and Helodon. They should be separated into a distinct superspecies taxon, Ahaimophaga Chubareva et Rubzov gen. n. P. multicaulis differs karyotypically from other species of the genus Prosimulium but displays a great resemblance to species of Helodon; due to this it should be assigned to the latter.


[New mosquito species, Aedes (Ochlerotatus) sergievi sp. n]. The description of female, male genitalia and the fourth instar larva of a new species of mosquito, A. (O.) sergievi, from the Tuva ASSR (South Siberia) is given as well as data on its breeding places. It belongs to spring and early summer species and breeds both in fresh and salt waters. Anal gills in the larvae breeding in fresh waters are significantly (P greater than 0.001) longer than those from salt waters (mean ratio between the upper anal gill length and saddle length is 2/3 and 1/2, respectively). A. sergievi is apparently related to East Asia steppe zone (Mongolian - Chinese formations) : besides Tuva, it is found in East Kazakhstan and may occur in Zabaikalye, Mongolia and North China.


[Life cycle of Psilotrema simillimum (Mühling, 1898) (Trematoda: Psilostomidae)]. Psilotrema simillimum has one intermediate host, the mollusk Bithynia leachi. Cercariae emerging from the mollusk encyst in the environment. Adolescariae become infectious in 3-7 days. In the definitive host trematodes become mature on the 9th day. The development of miracidium in an egg finishes in 19 days at 20-24C. Egg, miracidium, redia, cercariae, adolescariae and marites obtained in the experiment are described.


[Species affiliation of metacercaria of the genus Metorchis (Trematoda, Opisthorchidae) from fishes in Western Siberia]. Two larval species of the genus Metorchis, M. bilis and M. xanthosomus, are reported from fishes of West Siberia. Larvae of the first species can develop into adult forms in birds (terns, gulls, ducks) and in mammals (cats, golden hamsters, white mice). Larvae of the second species developed only in ducks. Experimental infection of golden hamsters, white mice and black terns with M. xanthosomus failed. On the results of the experimental infection and literary data the synonyms, M. bilis and M. xanthosomus, are given.


The use of vitamin K deficient diets in the screening and evaluation of anticoccidial drugs. Vitamin K (as menaphthone sodium bisulphite) added to a deficient diet reduced mortality due to Eimeria tenella or E. necatrix, had a slight effect on haematocrit, but had no obvious effect on weight gain or faecal blood; 0.1 ppm gave a maximal response. The effect of vitamin K on mortality was not absolute; the magnitude of the effect depended on the size of the challenge dose of oocysts. Likewise, the response of an infection to anticoccidial drugs, particularly monensin, depended on the severity of challenge. The effect of adding vitamin K in the presence of drug was to effectively reduce the coccidial challenge; no other interaction of vitamin K and drug has been found. No effects with vitamin K deficiency or supplementation were seen in cases of infections with E. acervulina, E. brunetti or E. maxima. The use of a deficient diet for experimental work is therefore quite justified--particularly as it results in a 4-fold saving of oocysts for inoculation purposes in the case of the haemorrhagic species.


[Changes in the sulfhydryl group content in the hemolymph of freshwater gastropods infected with trematode parthenitae and larvae]. A study was conducted on the changes in sulphhydryl groups in the haemolymph of Lymnaea stagnalis infected with partenites of Opisthioglyphe ranae, Planorbis corneus infected with partenites of Cotylurus cornutus and females of Viviparus viviparus infected with partenites and larvae of Echinoparyphium petrowi. At the infection in the haemolymph of hosts were recorded statystically reliable changes in the protein sulphhydryl groups which are blocked by toxines excreted by the parasites. The reduction rate in the content of these substances depends on the localization of the parasites and infection intensity of the hosts.


Heterologous immunity between piroplasms and malaria parasites: the simultaneous elimination of Plasmodium vinckei and Babesia microti from the blood of doubly infected mice. Mice which have recovered from infections with the avirulent piroplasm Babesia microti are also resistant to challenge with the virulent malaria parasite Plasmodium vinckei. In mice infected with P. vinckei before the peak of the B. microti infection the numbers of malaria parasites in the blood increase until that peak and are then eliminated at the same time as the piroplasms. In mice infected with P. vinckei at or after the peak there is no apparent multiplication and the malaria parasites begin to disappear from the blood immediately. The malaria parasites in doubly infected mice show signs of degeneration similar to those seen in mice pre-treated with Corynebacterium parvum and it is suggested that a common mechanism exists in homologous and heterologous immunity and in immunity following pre-treatment with C. parvum or BCG.


[Phlebotomus (Paraphlebotomus) jacusieli Theodor, 1947, a new species of sandflies for the fauna of the USSR]. After examination of sandfly collection from Agdam (Azerbaijan SSR) it was stated that all sandflies previously identified as Phlebotomus mongolensis belong to another species Ph. jacusieli. Ph. jacusieli has not been recorded in the fauna of USSR before. Probably all records of Ph. mongolensis in Transcaucasia are wrong. Description of Ph. jacusieli and some ecological data are given.


[Fleas from bird nests in southwestern Tuva]. 14 species of fleas were recorded from 173 nests of 47 species of birds. Most abundant of them are Ceratophyllus vagabundus, C. gallinae, C. borealis. The abundance of fleas was found to depend on season and hosts' habitat. The above species were most frequently encountered in nests in May. The high abundance index of fleas was registered in birds nesting in hollows, burrows of small mammals and in clefts of rocks.


The effect of variations in host and parasite density on the level of parasitization of Lymnaea truncatula by Fasciola hepatica. Groups of the snail Lymnaea truncatula, maintained at a range of spatial densities, were exposed to different densities of miracidia of Fasiola hepatica. The resulting degree of parasitization was measured 3--4 weeks after infection. The relationship between parasite densities and parasitization appeared to be curvilinear. The lower than expected parasitization at high parasite densities could be explained by the multiple infection of some snails by two or more miracidia. The level of parasitization was not related exponentially to the temperature at which infection was carried out. This was thought to be due to the inverse relationship between miracidial longevity and swimming speed, with respect to temperature. A depth of free water overlying a mud surface was an absolute requirement for miracidia to successfully infect snails.


Microtia--a long-term follow-up of 44 reconstructed auricles. Forty-three microtia patients have been reviewed 6 to 19 years after auricular reconstruction with autogenous rib cartilage. The adverse emotional reaction to microtia has been ameliorated in 88 percent of them. The need for subsequent revision of the reconstructed auricle has been almost eliminated.


Experimental study of the optimal time for tenolysis. We have attempted to define the optimal time for tenolysis by evaluating the blood supply, the rupture rate, and the tensile strength of tenolysed and control tendons. In 128 chickens tenolysis was performed 1, 3, 6, 12, 16, and 24 weeks after primary tendon repair. Tenolysis at 1 and 3 weeks resulted in devascularization, weak tendons, and high rupture rates. Tenolysis at 6 weeks after the primary repair had mixed effects on the blood supply but weakened the tendon. Tenolysis at 12 weeks after the tendon repair did not weaken the tendon and resulted in an increased blood supply. Tenolysis at 16 and 24 weeks did not weaken the tendon, but had varied effects on the blood supply. We recommend an interval of 12 weeks between primary tendon repair and tenolysis.


Results of surgical lengthening of the short nose in the bilateral cleft lip patient. Some children with bilateral cleft lips do not grow a long enough nose and require surgical lengthening of the nose. We review our 12-year experience with a one-stage slide operation to achieve this. Seven males and 5 females had this operation at ages 7 through 13 years, and we have followed them from 6 months to 12 years. The results, and the subsequent growth effects are described. In general, good long-term improvement has been achieved and the external scars have not proved to be a major drawback. Subsequent procedures upon the columella, alae, and upper lip are often required to establish an unobtrusive nasal appearance.


Soft tissue response to Proplast: quantitation of scar ingrowth. We compared, histologically and biochemically, the effects of blood pretreatment vs. no pretreatment on the ingrowth of scar into subcutaneously implanted blocks of Proplast in rats. No significant differences were found.


Correction of lower eyelid ptosis in the anophthalmic orbit with an autogenous ear cartilage graft. We describe the correction of lower eyelid ptosis in patients with an anophthalmic orbit, using ear cartilage grafts. This procedure has been particularly useful in the scarred or previously reconstructed lower eyelid.


Neurilemmoma presenting as a tumor in the tail of the parotid. We describe our experiences with 8 patients who had expanding neurilemmomas of the posterolateral parotid area. Treatment is surgical dissection of the encapsulated tumor mass from its nerve of origin, under magnification, with preservation of that nerve and removal of the mass.


Frequency of occurrence of the transversus menti muscle. The transversus menti muscle was present in 9 of 16 cadaver specimens. The anatomy and the frequency of this muscle are discussed, as is the possibility of its clinical use in the reconstruction of defects around the angle of the mouth in selected patients.


Prognostic value of vascular invasion in squamous cell carcinoma of the head and neck. Vascular invasion by malignant cells has been an accepted secondary diagnostic or prognostic factor in malignancies of the thyroid and kidney. This study of the initial biopsies from 80 patients with squamous cell carcinoma of the head and neck indicates that penetration of the vascular channels by the tumor is a reliable indicator of the tumor's aggressive character. If discovered in the initial biopsy, this may be a reason to plan more comprehensive and intensive treatment than would be indicated by the clinical stage alone.


Fibrinolytic activator activity in human neoplasms. The results of this study suggest that many malignant tumors contain low levels of fibrinolytic activator activity. Evidence is presented to suggest that this low activity may be due to the presence of an inhibitor of fibrinolysis. The presence or absence of measurable fibrinolytic activator activity, and/or inhibitor in neoplastic growths may enable one to predict the probability of viable metastases to a distant site.


Migration of silicone gel after the "squeeze technique" to rupture a contracted breast capsule. Case report. While the squeeze capsulotomy is a simple and effective method for managing capsular contracture around a breast implant, with extreme force the rupture of the prostheses can occur. With the concomitant use of a pressure dressing and breast massage, there was distant migration of the extravasated gel in one case, so this should be considered as a potential complication of this technique.


Congenital amputation of the toes with replantation at the site of a constriction band in the mid-calf. Case report. We present a case of congenital amputation of the toes with replantation at the site of a constriction band in the mid-calf. The theories of the etiology of constriction bands are discussed, and the importance of this case in supporting the amniotic constriction band theory is emphasized.


Placement of the umbilicus in an abdominoplasty. The location of the umbilicus was measured in 100 randomly selected non-obese subjects. It was found that a line drawn from the highest level of the crest of one ilium to the same point on the other side will transect the umbilicus in 96 percent of the subjects. This relationship can be of use during an abdominoplasty, when determining the location for the umbilicus.


Conditioned responding of the neurogenic bladder. Classical conditioning techniques were employed to condition responding of the spastic neurogenic bladder in a man with quadriparesis and urinary incontinence secondary to spinal cord injury at the cervical level. A neutral stimulus of mild electrical stimulation to the thigh was paired temporally with an unconditioned stimulus (UCS) of stronger electrical stimulation of the lower abdomen, and then was presented alone as a conditioned stimulus (CS) to elicit the conditioned response (CR) of voiding. The previously neutral CS reliably elicited large amounts of urine and left little residual urine in the subject's bladder. Following the experimental sessions, the subject self-applied the CS on a predetermined schedule during his daily routine outside of the laboratory. The CS initially was successful, but after several days the CR exhibited extinction. Additional CS-UCS pairing sessions did not reinstate the responses satisfactorily. Aspects of the experimental procedure and the results are discussed as well as the feasibility of conditioning the human spinal cord in the absence of an intact central nervous system


Coronary-prone behavior: one pattern or several? A cohort of 2750 healthy men who responded to a 61-item questionnaire was studied prospectively for 4 years, by which time 67 sustained acute myocardial infarctions (AMI), 30 were discovered by ECG to have had myocardial infarctions, which had gone clinically unrecognized ("silent") (SMI), and 23 had developed classical angina pectoris without ECG changes indicative of infarction. Item analysis of the questionnaire using multi-group optimal scaling and discriminant function revealed the patterns of responses to be characteristically different among the three clinical presentations of coronary disease and those men who remained healthy. The psychological properties of the three significant dimensions of discrimination are discussed. A second study, involving largely healthy men from the same population, supported the inference that the dimensions isolated were statistically and psychologically genuine. The implication is that different facets of the coronary-prone Type A behavior pattern may be specifically associated with different clinical manifestation of coronary disease. Refinement of these dimensions may lead to more specific prediction of coronary disease risk in the future.


Errors in reporting cancer and other conditions by persons in a prospective study. The hospital records of 553 men were compared with their medical histories obtained by interviews after hospitalization. Forty men had documentation of cancer in their hospital records stated that they had the specific condition. However, 21 other cancer patients did not give a positive history of their documented disease and 4 who stated that they had a malignancy did not have cancer according to their hospital records. In contrast to cancer, respondents overreported surgery for peptic ulcer and colorectal polypectomy. The greatest extent of agreement between the hospital record and the medical interview was noted for surgical patients with gallbladder disease; all 43 of these patients gave a positive history for this condition.


Hypertension control through the design of targeted delivery models. If we discard some of the assumptions upon which curatively oriented medical care is based, we can design models to deliver more effective services for those with chronic diseases. Assumptions to be discarded are--that disease processes can be cured through the delivery of a "magic bullet" rather than controlled through continuous surveillance, -that the physician must be an active decision maker and thus act as gatekeeper and monitor for all disease victims, and -that care for a family of consumers must be provided together. Models for the delivery of services can then be designed to provide continuity of care for those with a specific chronic disease, and paraprofessionals can be used as gatekeepers and monitors, in combination with physicians, rather than physicians alone, to give services. Models can be targeted to reach specific high-risk groups within the population at the workplace, the school, unemployment office, or wherever groups routinely congregate for purposes other than health care. Building targeted models requires extensive knowledge of the specific geographic area and its population as well as knowledge of the natural history of the disease and its treatment. For hypertension programs, goals can be set in terms of numbers of persons whose disease is controlled and the number of new programs initiated as the result of the control efforts.


HLA-B27 associated arthropathies.

HLA-B27 associated arthropathies. The association between histo-compatibility antigens and disease is reviewed, in particular that between HLA-B27 and spondylitic disorders, i.e., ankylosing spondylitis, Reiter's arthritis, psoriatic arthritis, and ankylosing hyperostosis. We determined whether the presence of HLA-B27 predicted specific radiographic findings and, conversely, whether specific radiographic changes predicted antigenic status. The prevalences of the HLA-B27 antigen in our patients were: ankylosing spondylitis, 100%; Reiter's arthritis, 93%; psoriatic arthritis, 55%; and ankylosing hyperostosis, 12%. The only specific radiographic finding associated with B27 positivity was severe spondylitis in psoriasis.


Adjustable sliding aluminum wedge filter: device for angiographic enhancement. Since the human body is of neither uniform thickness nor uniform composition, opacified vessels may be optimally exposed on a portion of the radiograph and overexposed on an adjacent portion. This unwanted nonuniformity in image darkness can be eliminated or reduced using a so-called compensating filter. In this paper such a filter in the form of an adjustable sliding aluminum wedge, that has been employed in angiographic procedures in our laboratory for the past four years, is described. The application of this filter to angiograms of various body parts is illustrated with clinical examples.


Jerman Memorial Lecture. Scanning a new image: proposal for professional standards. An analysis of trends in radiologic technology in other countries of the world is compared with current standards of education and socioeconomic practices in America. From this background, radiologic technologists are challenged to reassess their position in American health care and forge new directions to make radiologic technology an independent, self-governing profession and an equal partner in the health-care team.


The relationship between HLA-B27 positive peripheral arthritis and sacroiliitis. HLA typing for B27 antigen is a helpful diagnostic aid in the classification of peripheral arthritis patients (especially young patients) who are rheumatoid factor negative. We studied 109 patients with seronegative peripheral arthritis belonging to various clinical categories; 23% proved to be B27 positive in comparison to 7% of normal controls. In spite of a paucity of spinal manifestations there was a high prevalence of sacroiliitis (83%) in the B27 positive peripheral arthritis patients as opposed to only 21% in those without B27 antigen. HLA-B27 typing and radiographs of the sacroiliac joints are important differential tests.


Reiter disease with atlanto-axial subluxation. The authors report the first known case of atlanto-axial subluxation in Reiter arthritis. The type of analysis, including radiographic and laboratory examinations, required for a diagnosis of atypical Reiter disease is an important feature of the case.


Personnel management in a radiology department. Many administrative technologists find interviewing and management of their departmental personnel and the function of a department of personnel difficult to understand. That can result in the personnel department having total control of radiology personnel. The purpose of this article is to offer supervising technologists insight into personnel management.


Radiological and pathological manifestations of osteochondritis dissecans of the distal femur. A study of 50 cases. The specimens from 50 operated cases of osteochondritis dissecans of the distal femur were analyzed histopathologically. Radiodensity of the specimens of osteochondritis dissecans was due (a) attached subchondral bone, (b) degenerative secondary calcification of articular cartilage, (c) revascularization with new bone, and, in the free bodies, (d) calcification in new surface layers of cartilage and bone. The pathological findings in the specimens suggested an etiology from trauma rather than avascular necrosis. Half of the specimens of osteochondritis dissecans contained no subchondral bone but only articular cartilage. It was postulated that the relationship of the attached lesions to the intercondylar notch of the femur, which permitted a partially retained blood supply, created a spectrum of different histopathological changes in the subchondral bone of those specimens with attached bone.


Our professional image: as we are seen.

Our professional image: as we are seen. Concerned with the poor professional image radiologic technologists seem to have with patients, nurses, and non-radiology physicians, a survey was conducted and suggestions elicited from the three groups. Through additional personal interviews the author has concluded that the results are representative of a widespread problem, which can be corrected.


Radiographic findings in the hands in patients with systemic lupus erythematosus. Hand radiographs of 59 patients with systemic lupus erythematosus (SLE) were examined. Thirty-four revealed radiographic abnormalities, most commonly periarticular soft-tissue swelling or demineralization. Alignment abnormalities, acral sclerosis, avascular necrosis, soft-tissue calcification and terminal tuft resorption were also seen. All patients with periarticular calcification or terminal tuft resorption had Raynaud's phenomenon. Clinical indicators of disease activity (including low serum complement levels) did not correlate with the presence or severity of radiographic abnormalities. Patients with abnormal radiographs generally were older at the time of diagnosis than those with normal studies.


Radiographic evaluation of tibial plateau fractures. Thorough radiographic evaluation of tibial plateau fractures is necessary in order to determine the extent and type of injury. Routine anteroposterior and lateral radiographs should be supplemented by oblique and horizontal beam lateral views. Tomography most accurately delineates fracture anatomy and thus plays a key role in planning treatment; the surgical approach is determined by the tomographic localization of the fracture fragments. The radiologist's understanding of tibial plateau fractures aids the orthopedic surgeon in the management of these patients.


Computed tomography: an overview.

Computed tomography: an overview. Instrumentation for computed tomography (CT) can be put into three categories that are defined in this article. The basis for this categorization depends on the number of detectors and the type of scanning mode used by each. The goal of each generation scanner is to provide a measurement of x-ray absorption coefficients of cross-sectional portions of the anatomy. The technology of each generation is also presented.


The joint space in normal hip radiographs. The hip joint space in standard anteroposterior images of 120 normal subjects was measured with the aid of a special transparent pattern. The normal value was slightly over 4mm, scattered between 3 and 5 mm, except for elderly men in whom values of 6 mm or more may be normal. The lower borderline value does not change with age, nor is there any change in the average joint space with age except in men in whom it increases slightly. A narrow joint space in an elderly patient should not be expected simply because the patient is old. The measuring technique is useful in population studies. In individual cases a simple measurement with a ruler serves the same purpose if the outline of the acetabular roof is well-defined on the images.


Lower limb angiography in leprosy.

Lower limb angiography in leprosy. Bilateral lower limb angiography was performed on 58 patients with leprosy and compared with bilateral lower limb angiography performed on 63 non-leprosy patients. The vessels in leprosy were narrow and constricted. Decreased blood flow through arteries in the distal third of the lower limb was present. Abnormal AV fistula formation in the thigh and calf muscles and in trophic ulcers of the feet was also seen. Deep inflammatory granulomatous reaction surrounding the arteries as a result of leprosy is a possible explanation for these angiographic findings and is felt to be related to trophic ulceration. These findings were specific for leprosy, precede clinical manifestations, and are helpful in management.


Slipped capital femoral epiphyses complicating renal osteodystrophy: a report of three cases. Three adolescents with bilateral slipped capital femoral epiphyses complicating renal disease are presented. In one case, the severity of the deformities necessitated total hip replacement. Pathological specimens were available for evaluation. In all 3 cases, epiphysiolysis was accompanied by severe subperiosteal reabsorption along the medial aspect of the femoral neck, widening of the cartilaginous growth plate, and coxa vara. The radiographic diagnosis of a minimally displaced femoral epiphysis may precede the clinical symptoms. Early recognition of this complication is important, since the treatment of choice is prophylactic surgical stabilization before disabling deformities occur.


Adrenal hemangiomas: angiographic appearance of a rare tumor. Only 13 cases of adrenal hemangiomas have been reported, none studied angiographically. Two additional cases, evaluated preoperatively, are presented. The radiographic finding of phleboliths, when present, with the characteristic angiographic appearance of hemangiomas, allows the radiologist to correctly diagnose this benign tumor preoperatively, and where surgical risk is high, prevent a serious operative procedure.


Angiographic findings following surgical treatment for renovascular hypertension. The authors present the postoperative angiographic appearance of the revascularized renal artery in 128 patients. The angiographic findings in four types of surgical procedures (saphenous bypass graft, dacron graft, endarterectomy, and reimplantation of the renal artery) are discussed. Postoperative angiography accurately demonstrates graft patency or occlusion.


The radiological appearance of pulmonary blastomycosis. A retrospective analysis of patients with pulmonary blastomycosis was made. Correlation of the mode of clinical presentation with the thoracic radiograph revealed a spectrum of clinical and radiological disease. The results substantiate the absence of specific clinico-radiological patterns, and amplify current concepts of clinical and radiological manifestations.


The radiographic findings in acute silicosis. The radiological features of 4 cases of acute silicosis in sandblasters are described and correlated with the pathological findings. Alveolar involvement was more extensive than in chronic silicosis; in 2 cases an alveolar exudate similar to that found in alveolar proteinosis was present. The radiological changes in acute silicosis differ substantially from those in classical silicosis, mainly on the basis of the differing alveolar response.


Tuberculous mediastinal lymphadenitis in the adult. The authors present the roentogenological findings and response to treatment of 10 patients with tuberculous mediastinal lymphadenitis (TML). The clinical presentation is usually nonspecific except for the positive tuberculin skin test. The roentgenographic appearance varies but very often includes right tracheobronchial involvement. Tissue diagnosis is often necessary to establish the diagnosis. Since the epidemiology of tuberculosis is shifting, TML will be encountered more frequently in the adult.


Tuberculous mediastinal lymphadenopathy in adults. Three cases of paratracheal and hilar lymph node enlargement without parenchymal lung lesion simulating sarcoidosis, lymphoma, and metastasis were finally proved to be tuberculous lymphadenitis. Although it is not a common manifestation of tuberculous infection in the adult, this possibility should be considered in the differential diagnosis of mediastinal lymphadenopathy, especially in non-whites.


Narrowing of the airway in relapsing polychondritis. Relapsing polychondritis, once thought to be a very rare disease, is being recognized with increasing frequency. It is characterized by inflammation of cartilaginous structures throughout the body. In some cases, the eye and ear are involved; aortic aneurysms develop in a minority of patients. The cartilages of the airway are affected in more than 50% of all cases, and the resulting stenotic lesions can be life-threatening. Radiographic study of the airway is of great value in detection and evaluation of upper respiratory involvement.


Superior vena cava syndrome: a complication of transvenous pacemaker implantation. Superior vena cava syndrome developed in 4 of 1,000 patients in whom a transvenous pacemaker had been implanted. In all cases, endocardial leads were inserted through the cephalic vein and positioned at the apex of the right ventricle. The classical signs and symptoms of superior vena cava hypertension were observed from two weeks to one year after implantation, and the diagnosis was confirmed by cavography. Symptoms resolved following heparin therapy and long-term anticoagulation.


Precipitation of water-soluble contrast material (Gastrografin) in the stomach in a case of outlet obstruction. Precipitation of water-soluble contrast material (Gastrografin) within the fundus of a man with gastric outlet obstruction is discussed. Precipitation can occur in a stomach with increased acidity; the resultant precipitate possibly causes mucosal irritation, erosion, and bleeding.


Hemangiomas of the liver in patients with renal cell carcinoma. Five patients with renal cell carcinoma were noted at angiography to have vascular hepatic lesions which resembled metastatic renal cell carcinoma but which proved to be benign hepatic hemangiomas. The angiographic differentiation between small hemangiomas and metastatic vascular neoplasms of the liver can be difficult; angiographic characteristics may not be definitive. Surgery to remove the renal tumor should not be deferred solely on the basis of vascular hepatic lesions found at angiography.


Computed tomography of pediatric head trauma: acute general cerebral swelling. General cerebral swelling was the most common CT finding in 100 pediatric patients with acute head injury, and was demonstrated by CT as absence or compression of the lateral and third ventricles and perimesencephalic cisterns. Up to 50% of the children who die from head injury are conscious on admission. The most common pathological findings are diffuse cerebral swelling, loss of cerebrospinal fluid spaces, and venous congestion of the cortex.