[Pott's puffy pseudotumor].

[Pott's puffy pseudotumor]. This exceptionally rare pseudotumor of the vessels of the cranium still generates diagnostic discussions and attempts at establishing therapeutic indications. The case presented here (the second one in the romanian medical literature) had forensic implications and necessitated careful appraisal of the relationship between aggression and previous lesions of the bone, that occured at the same time or that followed the trauma.


[Postoperative alkaline reflux gastritis]. A statistic is discussed, concerning 88 cases of troncular vagotomies in which a total of 12 cases of reflux alcaline gastritis are mentioned. One of these necessitated a reintervention which is presented in detail. Reflux postoperative gastritis is a well defined entity in the group of disturbances occuring in patients with stomach surgical interventions. The cause is the bile reflux and that of alcaline duodenal fluids in the gastric stump. Short-circuiting of this reflux by a Roux-type anastomosis is the preferred procedure due to its simplicity and efficiency.


[Purification and properties of beta-N-acetylglucosaminidase from Mytilus edulis L. gonads (author's transl)]. beta-N-Acetylglucosaminidase (beta-2-acetamido-2-deoxy-D-glucoside acetamidodeoxyglucohydrolase EC 3.2.1.30) from Mytilus edulis gonads and a homogenous protein was obtained from it by ion-exchange chromatography, gel filtration and disc electrophoresis. The apparent molecular weight, determined by gel filtration was 140,000 +/- 5,000. Two subunits were identified. The molecular weights of both subunits calculated by disc-electrophoresis were 70,000 and 75,000 + 2,000. Maximal activity for pH was 4.2. At 50 degrees C the enzyme was still active; at 60 degrees C inactive. The values of the apparent Km's proved to be 0.57 mM and 0.076 mM for p-nitrophenyl-beta-D-N-acetylglucosaminide and p-nitrophenyl-beta-D-N-acetylgalactosaminide as substrates. In the incubation of the enzyme with hyaluronic acid, chitin, deacetilated glycol-chitin and p-nitrophenyl-beta-D-glucuronide, N-acetyl-beta-D-glucosamine and glucuronic acid were not liberated. N-acetylgluconolactone and N-acetylgalactonolactone are competitive inhibitors for the enzyme.


Loss of immunological and biological activity of insulin with a human muscle extract. The isolation of a human muscle extract that degrades insulin to products incapable of any immunological or biological activity is reported. The extract Km value for human insulin is 0.79, and 1.43 for porcine proinsulin. It does not degrade Human Growth Hormone at the concentrations tested, it is inactivated by N-ethyl-maleimide, Trasylol, and heat, and it does not require glutathione for its action. Human muscle, therefore can contain an enzyme similar to "insulin-specific-protease" present in rat muscle.


H-2 typing of RBL-5, TLX/9 tumour cells and L929 fibroblast. The H-2 specificities in two different H-2b tumour cells (TLX/9 and RBL-5) and a fibroblast line L929 (H-2k) have been studied. Tumour cells were passaged intraperitoneally in syngeneic mice and fibroblast was kept in vitro at 36 degrees C. The typing was performed by means of a postlabelling microradioassay for actively growing cells and 28 H-2 alloantisera of restricted specificity defining private H-2K, H-2D and public antigens. Unexpected reactions in disagreement with H-2 genetics were detected in both tumours but not in fibroblast line. The latter shed C-type particles whereas RBL-5 did not. The cytotoxicity of the alloantisera was quantitatively absorbed by normal lymphoid cells, although some extrareactivities were due to other antibodies present in the sera. RBL-5 grew in mice of different H-2 haplotypes with the same intensity as in syngeneic animals.


[Specific protection by sulfhydryl groups against inhibition of urease by hypoglycaemic drugs (author's transl)]. The effect of oral hypoglycaemic drugs, derivatives of sulphonylurea, upon urease has been studied. These compounds, structurally connected to urea, produce a competitive inhibition of enzyme activity with respect to substrate. Glutathioné (reduced form) and cysteine prevent inactivation of enzyme by sulphonylurea, whereas-oxidated glutathione and cysteine do not. The same phenomenon occurs in enzyme preparations inhibited by p-hydroxymercuribenzoate. The role of sulfhydryl groups in the formation of enzyme-substrate complex is discussed.


[Effect of insulin on germination and ionic exchange in Raphanus sativus (author's transl)]. Hypoglycemic sulfamide BZ-55 activates or inhibits germination of Raphanus sativus, depending upon the dosis. Since this drug acts upon the glycemia by increasing the secretion and action of insulin, the influence of this hormone on germination and ionic changes (Na+-K+) between seeds and culture medium, were studied. Seeds were incubated during 72 h with different concentrations of insulin in 10 ml deionized water or in 10 ml 18 mM K+ (KCl) solutions at 37 degrees C in vapor saturated atmosphere. A solution of 0.125 IU insulin/ml in water increases the germination to 110% whereas 0.175 IU insulin/ml inhibits it to 40% against controls. Further increases in insulin concentration always inhibit germination. Similar results have been obtained with K+ containing media. Germination rate changes in a small concentration range suggest that insulin might affect an enzymatic activity in the seed.


[Temperature effects on the EEG and evoked potentials in Reptilia (Lacerta galloti) (author's transl)]. The effect of temperatures from 5 degrees to 40 degrees C on EEG amplitude, evoked potentials amplitudes to optical stimuli and latencies of components of evoked potential in lizard Lacerta galloti, have been studied, by means of chronically implanted electrodes in dorsal and medial telencephalic cortex. Evoked responses show with greater amplitude in the medial cortex, although latencies were closely similar for both regions.


Stress simulation and iron metabolism: adrenaline administration. The effect of stress simulation on Wistar male rats through adrenaline administration (subcutaneous injection, 0.5 mg/kg) was investigated. Parameters measured were: plasma iron, copper and zinc levels; caeruloplasmin concentration and total ferroxidasic activity in plasma; iron, copper, zinc and manganese levels in liver and iron; copper and zinc levels in spleen. No significant short term effect of adrenaline administration on any of these parameters was observed.


Effects of testosterone on splenic and bone marrow erythropoiesis of fasted mice. Fasting in normal or erythropoietin treated mice results in parallel decrease of erythropoietic activity in spleen and bone marrow. In testosterone-treated animals, starvation only decreases the splenic fraction while the bone marrow erythropoiesis shows a marked increase above normal values.


Effects of quinolinic acid and glucagon on gluconeogenesis in the perfused rat liver. Previous findings that 2.5 mM quinolinic acid inhibits gluconeogenesis more strongly from alanine than from lactate have been confirmed. 15 mM quinolinic acid completely inhibited gluconeogenesis from lactate as well as from alanine whereas the formation of glucose from fructose and the production of urea from ammonia and lactose were not affected. The pattern of the gluconeogenic intermediates was the same in the presence of 15 mM quinolinic acid as with 2.5 mM of the inhibitor. It is concluded that high as well as low concentrations of quinolinic acid inhibit gluconeogenesis at the step between oxaloacetate and phosphoenolpyruvate. Furthermore, 5-methoxyindole-2-carboxylic acid, an inhibitor of mitochondrial pyruvate metabolism, also completely blocked gluconeogenesis from lactate whereas glycerol conversion to glucose was only weakly inhibited. All these results do not support the concept of an alternate pathway of gluconeogenesis from lactate proposed by others. 2.5 mM quinolinic acid also partially blocked the formation of urea from alanine. It is suggested that quinolinic acid may have a second site of action causing an inhibition of the glutamate-pyruvate transamination owing to lack of 2-oxoglutarate in the cytosol. In the presence of quinolinic acid, glucagon caused about the same increase in aspartate and malate tissue levels in the absence of added substrates as in the presence of added lactate or alanine. Therefore, no additional effect of glucagon on gluconeogenesis from lactate or alanine prior to the block by quinolinic acid could be demonstrated.


Serotoninergic stimulation of gastrin secretion. The effect of serotonin (10 mg/kg weight) on the gastrin serum levels in rats has been studied. Serum concentrations of gastrin increase significantly from the 56.52 +/- 6.68 pg/ml basal value to 116.87 +/- 3.27 pg/ml at 105 minutes, whereas gastrin in control animals decreases progressively throughout that time. Serum concentration of serotonin was also measured at different times after its administration. An increase to 3.31 +/- 0.6 microgram/ml, maximum value, at 90 minutes was observed anteceding the gastrin peak by 15 minutes.


Effect of various concentrations of calcium on arginine-induced insulin and glucagon release in vitro. The effect of extracellular calcium concentration on the insulin and glucagon release in response to arginine from the isolated perfused rat pancreas, has been studied. All the experiments were carried out in the absence of glucose in the perfusate. Arginine 10 mM elicited a biphasic glucagon release, and a monophasic insulin response. In the presence of calcium 2.5 mM an increase of total insulin and glucagon in response to arginine were obtained. The increase in glucagon release was only detectable during the second phase, while first phase was not modified by the concentration of calcium present in the perfusate. The results of this study show that extracellular calcium concentration influences positively insulin and glucagon responses to arginine in vitro.


The tubular system of human endometrium. The so-called "intranuclear" tubular system (TS) of human epithelial endometrial cells has been investigated in 50 specimens and has been found in some instances of secretory endometrium and in one case of hyperplastic endometrium with secretory change. The TS was found both in nucleus and cytoplasm. The intranuclear TS can be associated with the nucleolus, connected to the nuclear envelope or lying free in the karyoplasm. When it is connected with the nuclear envelope an intimately related cytoplasmic invagination containing many ribosomes is frequently found. The cytoplasmic TS is smaller than that found in the nucleus and is usually connected with rough endoplasmic reticulum profiles. These findings allow us to make the suggestion that the TS could have a cytoplasmic origin and subsequently migrate into the nucleus. The function of the TS is unknown.


[Liver and brain guinea-pig guanine aminohydrolase (author's transl)]. Guinea-pig brain guanine aminohydrolase (E.C. 3.5.4.3) (M = 120,000 +/- 5,000 daltons) only exhibited one active electrophoretic band; its mobility is similar with that observed for the guinea-pig liver molecular form III. Both forms appear to have coincident activity with pH, as well as an analogous thermal stability and Km values with different substrates showing a different behaviour with the molecular form I of guinea-pig liver enzyme. Brain guanine aminohydrolase and liver molecular form III have similar pK'a values suggesting the participation of histidine and cysteine (-SH) in the enzymatic catalysis. The competitive inhibition by p-chloromercuribenzoate may corroborate the intervention of the last-one.


[Kinetics of chicken liver mitochondrial and cytoplasmic glutamate oxalacetate transaminase (author's transl)]. Electrophoresis at pH 7.4, on cellulose polyacetate strips, and specific staining, show the occurrence of two molecular forms of the mitochondrial and soluble isoenzymes from chicken liver aspartate aminotransferase. The optimum pH of the cytoplasmic enzyme with L-aspartate and alpha-ketoglutarate as substrats is approximately 7, while the mitochondrial one is practically unaffected in the interval 6-8. The kinetic reactional mechanism is of ping-pong bi-bi type for both enzymes, as confirmed by the method of Garces-Cleland, and their inhibitions by excess of the substrates L-aspartate and alpha-Ketoglutarate are competitive, in accordance with the proposed mechanism.


[Legal capacity to act and the sexual life of the mentally handicapped in Sweden (author's transl)]. In Sweden efforts are being made to integrate the mentally handicapped as much as possible into society. If these efforts are to be successful society must concede to them the same rights it does to its non-disabled citizens. On the basis of the terms "legal status" and "legal capacity act" the article examines the consequences which might arise for the mentally handicapped from their being granted these legal rights. As the Swedish society principally allows the mentally handicapped the right to sexual intercourse difficulties arise, in particular, if there is the possibility of procreation and, even more, if children are desired. The pros and cons of pregnancy and its consequences for mentally handicapped people are discussed. Old and modern countermeasures (marriage obstacles, sterilisation, abortion) and the alternatives (systematic sexual instruction, counselling as regards preventive measures and control of their use) are compared and examined in view of their applicability in accordance with the Swedish normalisation efforts. The study showed that mentally handicapped persons can live--also in the sexual area--according to the same principles that guide us all, if we help and advise them adequately and at the right time. Under these circumstances restrictions are no longer the rule, but the exception.


[Vocational rehabilitation outcome in psychiatrically and mentally handicapped clients (1969/70--1977) (author's transl)]. Based on detailed statistical data--104 patients were studied--the article points out a success rate of 68% in connection with the vocational resettlement of psychiatric clients. The criteria used to determine success were at the time of discharge permanent employment in workshops for the disabled, competitive employment or part-time jobs. A follow-up study carried out about seven years later revealed a 39% success rate as regards the clients' stability in employment. These statistics demonstrate that of 37% rehabilitees who had formerly committed a criminal offence most probably only one percent was recidivious. Furthermore, the article reports on the methods considered to be causative factors for the therapeutic success: Adequate medicinal treatment, as well as an essential pre-requisite for rehabilitation, the creation of a therapeutic milieu. Also, particularly important for a lasting success is the continuing follow-up for which appropriate facilities, especially living accommodation, community living and homes must be provided.


[Personality traits of patients under spa treatment (author's transl)]. The article reports on psychodiagnostic examinations performed on clients under in-patient spa treatment. The groups studied--patients with psychosomatic and general internal diseases--were subjected to the Freiburg personality inventory, the colour pyramid test and the progressive matrices test. The results were compared with normal population standards and clinically diagnosed neurotic patients. Furthermore, the spa treatment results of the psychosomatic patients were recorded during the third and fifth week. The most important outcome was that both groups of patients presented a series of typically abnormal signs as regards clinically relevant factors, whereby the psychosomatic patients presented a very similar test picture to the in-patient clients receiving psychotherapy. In contrast to the patients with general internal diseases the psychosomatic patients showed more neurotic personality traits than the standard. The degree of severity of the clinically diagnosed neurotic disturbances is reflected in the neuroticism test values. In the psychosomatic patients the psychic complaints, in the narrow sense, were predominant. The complaints as a whole showed a regressive trend; of the individual complaints only physical fatigue diminished markedly. Periodically recurring symptoms were not observed.


Potentiation of isoproterenol cardiotoxicity by corticoids. In order to determine whether glucocorticoids share the ability of mineralocorticoids in sensitizing the myocardium to the arrhythmogenic property of isoproterenol, albino rats were implanted subcutaneously with prednisone or desoxycorticosterone acetate (DCA). Water was compared with 1% saline as drinking fluid in order to assess the role of a high sodium intake in the development of myocardial sensitization. At predetermined intervals during corticoid exposure, unanesthetized animals were challenged with a single subcutaneous dose of isoproterenol. In DCA-saline pretreated rats the LD50 of isoproterenol was determined to be 14.5 ug/kg. At a dose of 150 ug/kg isoproterenol, ventricular fibrillation was elicited in all DCA-saline pretreated animals, but in only 50% of rats implanted with predisone, receiving saline as drinking fluid. Substitution of water for saline did not prevent the development of myocardial sensitization. It is concluded that predisone pretreatment also sensitizes the rat myocardium to isoproterenol though to a lesser extent than DCA and that high sodium intake is not an absolute requirement for the development of this phenomenon by either corticoid.


Regional uptake of endogenous corticosterone by rat brain following stress. The stress-induced changes in the corticosteroid levels in four brain regions were studied in female Sprague-Dawley rats using the fluorometric assay following column chromatographic separation. Fifteen min after novelty stress, the corticosteroid levels increased 1.5-, 1.5- and 1.7-fold in hippocampus, hypothalamus and cerebral cortex, respectively, compared to 6-fold increase in plasma (60 mug/d1). In the second study in which the animals were sacrificed 60 min after ethanol stress (I.P. injection of 2 g/kg in 20% solution with physiological saline), there were 2.5-, 3.5- and 4.7-fold increases in hypothalamus, hippocampus and cerebral cortex, respectively, compared to 4-fold increase in plasma (77 mug/d1). There were marked increases of corticosterone in the pituitaries after stress. The results confirm the differential regional distribution of corticosteroid in the brain and the stress-induced corticosteroid elevations. These results support the idea that the brain levels of corticosteroid are determined by the existing plasma levels and by the duration of the hormone elevation. The possible significance of the brain levels of corticosterone is discussed.


Effect of hyperbilirubinemia on the pharmacokinetics of pentobarbital in the rat. The pharmacokinetics of intravenously administered pentobarbitol have been studied in heterozygous (non-jaundiced) and homozygous (jaundiced) Gunn rats following single doses of 30 mg/Kg. Plasma pentobarbital concentration time course data from heterozygous animals were fitted to a biexponential equation while a triexponential equation was required to fit the data from homozygous animals. A  slower plasma clearance rate and longer elimination half-life were observed in homozygous animals as well as increased overall volumes of pentobarbital distribution. These results suggest a possible effect of bilirubin on the distribution and elimination of pentobarbital. The volume of pentobarbital plasma distribution, however, was approximately equal in heterozygous and homozygous data, suggesting no competition between bilirubin and pentobarbital for serum protein.


A comparison of the augmentation of H1 and H2 receptor agonist stimulation of rabbit atrial chronotropic response by two phosphodiesterase inhibitors, papaverine and theophylline. Papaverine and theophylline both increase the chronotropic response of isolated rabbit atria, however, the maximum stimulation following papaverine is much smaller than that obtained with theophylline. When these phosphodiesterase inhibitors are used in conjunction with histamine (H1 and H2 receptor agonist), 2-(2-aminoethyl) pyrazole (H2 agonist) and 3-(2-aminoethyl) triazole (H1 agonist) the responses are all considerably more than additive. This suggests that both H1 and H2 histamine receptors can activate adenyl cyclase and therefore increase the formation of cyclic AMP in spite of reports that only H2 receptors stimulate adenyl cyclase.


Evaluation of Dopram(R) and its effects on hexobarbital narcosis. The effect of Dopram(R) on hexobarbital induced narcosis and hypothermia was determined. Sodium hexobarbital (70mg/kg, i.p.) sleeping times were assessed in saline, Dopram(R), 20 and 40 mg/kg, i.p., administered mice. A dose-response increase in sodium hexobarbital induced narcosis was produced by Dopram(R). The duration of Dopram(R) effect on hexobarbital narcosis was also assessed. Dopram(R) potentiated significantly hexobarbital sleeping times when administered two hours prior to sodium hexobarbital challenge. Dopram(R) also was observed to significantly increase the hypothermic response to hexobarbital. The effect of the individual components of Dopram(R) (doxapram hydrochloride and chlorobutanol) on hexobarbital narcosis and hypothermia was evaluated. It was found that doxapram hydrochloride (20 and 40 mg/kg, i.p.) and chlorobutanol (5 and 10 mg/kg, i.p.) potentiated sodium hexobarbital narcosis and hypothermia. It seems that doxapram hydrochloride and chlorobutanol are both responsible for the potentiation of hexobarbital narcosis and hypothermia by Dopram(R).


Inhibition of mitochondrial DNA synthesis by aflatoxin B1 and dimethylnitrosamine. The acute and subchronic effects of aflatoxin B1 and dimethylnitrosamine (DMN) on in vitro incorporation of thymidine-3H into DNA (mt-DNA) from mouse liver mitochondria were studied after single injection or after one month or three months of weekly injection. Both carcinogens induced 50% decreases in mt-DNA synthesis acutely, with a 50% decrease in synthesis of high molecular weight mt-DNA. Subchronic administration of aflatoxin B1 inhibited mt-DNA synthesis by 54% with elution profiles similar to the controls. DMN showed only a 29% inhibition of mt-DNA synthesis at one month increasing to 55% at three months.


Effect of acute and chronic paraquat on rat lung collagen content. The effect of acute and chronic paraquat administration on rat lung collagen was studied. A single dose of paraquat (35 mg/kg, ip) produces a transient increase in lung collagen synthesis within the first several days. In animals sacrificed 18 days later, there is insignificant accumulation of collagen (9%). Three injections of paraquat (25 mg/kg) spaced at weekly intervals produces a 31% increase in lung collagen by the middle of the fourth week. In view of the technical difficulties involved with the use of paraquat as a pulmonary fibrotic agent in the rat, search for an alternative model is suggested.


Studies on the distribution of phenylethanolamine N-methyltransferase and epinephrine in the rat. Using two independent criteria, we have found the enzyme phenylethanolamine N-methyltransferase (PNMT) to be present in the adrenals, lungs, brain stem, spleen, heart and skeletal muscle of the rat. The lungs contained more activity than the brain stem or any other extra-adrenal organ. PNMT was not detectable, however, in the kidneys, stomach, liver and plasma. Trace amounts of epinephrine were found in brain stem, lung and heart; norepinephrine, however, was the predominant catecholamine in these tissues. Substantial quantities of epinephrine were found in the adrenal and plasma of decapitated animals, but the latter were essentially eliminated by adrenal demedullation. Our data indicate that although the adrenal is the principal tissue source of epinephrine and PNMT in the rat, small amounts of both substances are present in several body organs.


Effect of platelet count and hematocrit on the coagulability of heparinized blood. The coagulability of heparinized blood is shown to be a function of platelet and red cell concentrations. Thrombelastrographic tests were conducted on celite-activated fabricated whole blood samples with heparin concentrations ranging from zero to 1.46 units per ml of plasma, hematocrits from zero to 50% and platelet counts from zero to 300,000/mm3. The thrombelastograph provides three useful parameters of coagulability in native and heparinized blood: clot time, rate of clot stiffening and final clot stiffness. Of these, only the clot time is determined with the common clotting tests, while the rate and final clot stiffness are measures of clot quality that are found to be particularly sensitive to thrombocytopenia. The test results indicate (i) increases of platelet concentration produce the expected decrease in clot time, increase in rate of stiffening, and increase in final stiffness; (ii) increases of the red cell concentration from zero to 20% hematocrit, produce nonlinear increases in clotability, while further increases beyond 20% hematocrit produce no additional effects if the heparin concentration is less than 1.2 units/ml. Quantative relations are derived between the thrombelastographic variables, heparin concentration, and platelet concentration for those samples with hematocrits greater than 20%. These data indicate further experiments for the study of possible interaction between cellular blood elements and heparin.


Capacity-limited elimination of procainamide in man. Procainamide (PA) pharmacokinetics were studied at steady state in 19 patients. The PA was given as 1.0 or 1.5 g eight hourly (L and H dose groups) and acetylator phenotype determined from sulphadimidine acetylation was classified as Slow or Fast (S or F). Thus, four groups were categorized, HF, LF, HS and LS with 7, 5, 3, and 4 patients in each respective group. Overall the mean steady state plasma concentration of PA (Cpss) expressed as a fraction of dose did not depend on dose or on acetylator status, but the HS group had significantly higher Cpss per gram dose (6.3 mug/ml) than LS (2.7 mug/ml) or the HF (2.3 mug/ml) groups. Clearance of PA be acetylation (C1A) was 23.8% of the total in fast acetylators and 16.5% in slow acetylators. C1A was not dose-dependent in the HF or LF groups (mean 177.9 ml/min and 168.4 ml/min) but was dose-dependent in the HS group (mean 74.6 ml/min) which differed significantly from the LS group (mean 113.4 ml/min).


The effect of ethanol on cerebral glycogen levels in the chick embryo. Ethanol (10 to 50 micro-liters/egg) was injected into the albumen of the 13 day chick embryo. The control solution and ethanol carrier was bacteriostatic saline (0.1 ml). The KOH-alcohol-Anthrone colorimetric method was used for glycogen determination. Ethanol at 20 or 30 mul/egg lowered the mean cerebral glycogen (p less than 0.05). Higher dosages elevated cerebral glycogen over the same time period (p less than 0.05). The glycogen-depleting effect of 20 mul/egg and the glycogen increasing effect of 40 mul/egg were maintained through 168 hours of ethanol exposure (20 days incubation).


The effects of chronic ethanol administration on acyl group composition of mitochondrial phospholipids from guinea pig adrenal. The acyl groups of diacyl-glycerophosphocholine1 (GPC) and diacyl-glycerophosphoethanolamine (GPE) in guinea pig adrenals are comprised mainly of 16:0, 18:0, 18:1, 18:2 and 20:4(n-6) with only trace amounts of the longer chain polyunsaturated fatty acids. There was an increase in the proportions of 18:2 and a decrease in the 20:4(n-6) of diacyl-GPC and diacyl-GPE with respect to chronic ethanol administration. Acyl group changes were more obvious in diacyl-GPC than in diacyl-GPE. It is conceivable that these changes may lead to an alteration of other membrane transport activities as well as functions of the adrenal gland.


Metabolism of an amino acid with antidepressant properties. The amino acid D-phenylalanine exerts antidepressant properties which are believed to be due to its metabolism to brain phenylethylamine. We now show that in mice, the increase in brain phenylethylamine levels induced by L-phenylalanine, but not D-phenylalanine, is antagonized by drugs which block the stereospecific decarboxylase enzyme. Our results show that D-phenylalanine metabolism to phenylethylamine is independent of pathways involving L-phenylalanine.


DOPA stability in plasma and plasma extracts. Unextracted heparinized plasma samples containing L-DOPA can be refrigerated or frozen with negligible losses in drug for at least two weeks. This stability of L-DOPA in the sample obviates difficulties in collection and processing of plasma samples within clinical settings which may be remote from the analytical laboratory facilities.


Affinity chromatographic demonstration of a thrombin binding protein from the platelet plasma membrane. Human platelet plasma membrane glycoprotein I with an apparent molecular weight of approximately 150,000 has been shown to be one of the proteins retained by thrombin immobilized on Sepharose 4B. The retained glycoprotein has been recovered by sodium dodecyl sulfate elution and characterized by SDS polyacrylamide gel electrophoresis in the presence of 2-mercaptoethanol.


CSF HCO3- regulation in isosmotic conditions: the role of brain PCO2 and plasma HCO3-. We have studied in anesthetized cats the response of CSF HCO3- to (1) an increase in CSF PCO2, plasma HCO3- controlled at the normal value; (2) an increase in plasma HCO3-, CSF PCO2 controlled at the normal value; and (3) an increase in both CSF PCO2 and plasma HCO3-. Plasma HCO3- was controlled via HCO3-/Cl- exchange without altering plasma Na concentration or osmolarity using the technique of peritoneal dialysis. The results suggest that CSF HCO3- regulation in these conditions is dependent on (1) a PCO2-dependent process in which HCO3- ions are formed in brain cells or choroid plexus and (2) an ionic movement of HCO3- from plasma to CSF dependent on an increase in plasma HCO3-. The first process is largely completed by 3 hours; the second takes 6 hours or more. An analysis of plasma and CSF HCO3-, Cl- and unmeasured anions (UA), (Na+ + K+ -CL- -HCO3-), suggests that CSF HCO3- regulation may be complex involving ionic exchanges of three or more anions between brain extracellular fluid, plasma and brain cells.


Gas exchanges during exercise in normoxia and hyperoxia. Exercises of constant workload (90 watt) have been carried out during normoxia or hyperoxia FIO2 = 0.45). It has been shown that, in spite of a significant dispersion in the values of O2 deficit and O2 debt calculated, these values are related to the increased blood lactate level which contributes to the marked acidosis observed in both conditions of oxygenation. Hyperoxia reduces lactate level as well as the O2 debt. In addition to the significant increase in arterial [H+] and PCO2, exercise provokes a slight decrease in PO2. It is suggested that the significant variations of these humoral factors might contribute to the control of ventilation during exercise in both conditions of oxygenation.


Diameter, length and branching angles of the upper airways in the dog lung. Polyester resin casts were made of the upper airways of 15 dog lungs. Diameter, length, and branching angles were measured, and the dimensions were normalized by dividing by cube root of body weight. The data are presented to facilitate experimental work on dog lungs, involving procedures such as intubation of individual lobar bronchi.


A study of the effect of SO2 on pacing and intrapulmonary chemoreceptor discharge in the domestic fowl. Kunz and Miller )1974) described a phenomenon called pacing in which FCO2 oscillations forced in the lungs of unanesthetized unidirectionally ventilated chickens cause one ventilatory movement per ECO2 oscillation. In the present study SO2 (0.08--0.32 vol%) added to the ventilating gas stream caused a loss of pacing in 11 of 12 birds. In 7 of the 11 birds in which SO2 was effective, pacing returned 3.2--7.0 min after removal of SO2. Intravenous infusion of a similar quantity of SO2 (dissolved in saline) did not block pacing. In a second series of experiments chickens were again unidirectionally ventilated and single nerve fiber recording was used to investigate the effect of SO2 on individual intrapulmonary chemoreceptors (IPC). Of necessity, this work was done on birds which were anesthetized and paralyzed. Discharge was abolished in 10 of 12 IPC by doses of SO2 similar to those which blocked pacing. In 6 of the 10 fibers in which SO2 was effective, discharge resumed after a mean period of quiescence lasting 7 min. It is concluded that pacing is mediated by intrapulmonary rather than systemic chemoreceptors.


The effect of hyperoxia, hypoxia and hypercapnia on FRC and occlusion pressure in human subjects. The measurement of pressure in the mouth 0.1 sec after the initiation of an occluded inspiratory effort (P0.1) has been proposed as an index of activity of medullary inspiratory neurons. If changes in FRC can be interpreted as important changes in the length-tension curve of the diaphragm or the total respiratory musculature, then changes in FRC from one occlusion pressure measurement to another can complicate such an interpretation of the P0.1 measurement. Forty-five subjects divided into three different groups were seated in a variable volume body plethysmograph. They had their FRC, P0.1, VT and VE measured while breathing air, 100% oxygen, 11% oxygen balance nitrogen, and 4% carbon dioxide in 20% oxygen balance nigrogen. All 45 showed a decrease in FRC during hyperoxia (-12%); 40 of 43 showed increases in FRC during hypoxia (14%); 42 of 43 showed an increased FRC during hypercapnia (15%). Changes in VE were small as were changes in P0.1 values. These latter changes generally followed the same pattern of changes as FRC though the magnitude of the changes showed more variability. We were unable to demonstrate a significant correlation between changes in FRC and changes in P0.1 under the conditions of our experiments.


Avian intrapulmonary chemoreceptors: respiratory response to a step decrease in PCO2. The contribution of intrapulmonary chemoreceptors (IPC) to the respiratory response, following a step decrease in PICO2 was assessed in anesthetized and unidirectionally ventilated chickens. Step changes in the PCO2 of the ventilatory gas (PICO2) to a single lung were introduced with PICO2 to the contralateral lung held constant. Respiratory amplitude and frequency were monitored. Experimental series were conducted under conditions such that (I) both systemic chemoreceptors and IPC, (II) systemic chemoreceptors alone and (III) IPC alone contribute to the ventilatory response. The results indicate (1) that a rapid component of the transient response (complete in 25 sec) is eliminated by sectioning the pulmonary nerves (Series II), and (2) within the rapid component, a localized minimum in respiratory amplitude was observed which was not seen in either Series II or Series III experiments. We conclude that the rapid component of the transient response is due to the CO2-sensitive IPC and that intrapulmonary and systemic chemoreceptors are not simply additive in the generation of respiratory amplitude and frequency, but a more complex interaction must be involved.


[Action of vaso-active drugs on gasz of cerebral tissue. Experimental study by mass spectrometry (author's transl)]. The authors describe a method for measuring cerebral tissue respiration by mass spectrometry. The first applications concern the action of vaso-active drugs on intracerebral PCO2 and PO2. The information gained with this method may prove of value in elucidating the mechanisms of drug action and the regulatory mechanisms of cerebral blood flow. Further prospects of experimentation offered by the method are mentioned.


[Dynamics of intestinal parasitic diseases in a students' hospital]. The present study, carried out in 1972-1975, extends, previous investigations on the dynamics of parasitic intestinal diseases. A number of 2723 Romanian and foreign students admitted to a students' hospital were investigated, finding 402 positive cases. Blood eosinophilia was likewis determined in 227 of these cases. There was a 3% decrease in the incidence of parasitic diseases, more marked among the foreign students. The most frequently encountered parasite was Tricocephalus; lambliasis showed a slight increase. The importance of coproparasitologic and haematologic examinations for the prevention, detection and treatment of parasitic diseases in the community investigated is emphasized.


[Primary amebic meningoencephalitis and the pathogenic potential of limax amoebas]. During the last two decades it has been proved that free amoeba of the Naegleria and Acanthamoeba (Hartmanella) genera, formerly considered as inocuous protozoa, are the etiological agent of a newly described morbid entity: primary amoebic meningoencephalitis. The clinical aspects of this disease, its clinical and laboratory diagnosis, the pathogenic potential of these amoebae, epidemiological data, prophylaxis and treatment, have promoted medical interest in this disease and in the possibility of a differential diagnosis with other meningoencephalitides.


[Comparative study of 2 serological methods of diagnosis of acute respiratory Mycoplasma pneumoniae infections]. Complement fixation (CF) and haemagglutination (HAP) with M. pneumoniae antigen have proved valuable methods for the etiological diagnosis of acute respiratory infections. Both methods are sensitive and specific, provided purified antigens are used, of the Kenny and Grayston lipid antigen type for CF and the antigen treated by ultrasound and purified by centrifugation for HAP. Concomitant and repeated use of both tests is recommended, following the taking of paired serum samples at 7 to 10 day intervals the first samples being taken within the first ten days of the disease. A single test can only be used for a presumptive serologic diagnosis of acute infection with M. pneumoniae and only if the minimal diagnostic titre is taken into consideration, i.e. 1/64 for CF and 1/160 for HAP.


[Prospective evaluation of the risk of congenital toxoplasmosis. II. Further data on the immune response during pregnancy]. The indirect immunofluorescence test was carried out in 500 pregnant women in urban and rural areas, with a view to following conversion to seronegative values. The evolution of the immune background in infection with T. gondii was followed up by comparative analysis of the seroepidemiological data obtained in 1976 and 1977. It was found that:--Variations in the intensity of endogenous and exogenous factors bring about changes in the frequency and intensity of the immune response in toxoplasmosis.--Postnatal evolution of the child can be correlated with the age of pregnancy when seroconversion accurred and with the intensity of the latter.--The predominance of seroconversion in the 6th and 7th month of pregnancy and negativation of some of the responses during pregnancy suggest the need of an additional serological control during these months.--The effect of optimal conditions during springtime resulted in seasonal appearance of seroconversions, offering an additional orientation.--In the neonates of seropositive mothers no cases of manifest disease were observed; the presence of infection has to be subsequently confirmed or invalidated.


[Antibiograms of Leptospira on solid media in Petri dishes]. The sensitivity of fowl leptospirae to antibiotics was tested by diffusiometry on solid media in Petri dishes. The method includes two stages: 1) visible leptospirae cultures are obtained by central seeding and incubation during 3--5 days at 28 or 37 degrees C; 2) antibiotic tablets are disposed at 2 cm from the visible edge of the multiplication zone of the leptospirae. The edge is marked with a pencil at the moment in which the antibiotics are applied. Incubation is continued at the same temperatures. The results are read after five days taking as reference the position of the marginal multiplication line. The sensitivity of leptospirae to antibiotics is expressed by arrested multiplication and resistance by advance of the marginal multiplication line up to or even beyond the antibiotic tablets. Fowl leptospirae are sensitive to penicillin, tetracyclin, chloramphenicol, streptomycin, novobiocin, polymixin, pristinamycin, neomycin, erythromycin, and resistant to mycostatin, septrin, rifampicin, optoquine, sulphatiazol.


[Isolation by uroculture of bacterial flora from ambulatory patients]. In the out patients investigated between 1974 and 1977 a number of 14046 quantitative urocultures were performed; 2206 (15.5%) gave relevant results for a diagnosis of urinary infection. In 98.5% of the cases, infection was caused by Gram negative bacilli, particularly Enterobacteriaceae (98.14%). A set of 11 biochemical tests, performed in a single stage, was used, correctly establishing the genus and in most cases also the species, thus realizing marked economy of material and work. It is considered that the taxonomic listing by this set is sufficient for a diagnosis of urinary infection. In such cases the clinical interest and testing the sensitivity of the strains to antibiotics is of greater importance than determination of the serotype, lysotype or biotype, of prevalent interest in other types of infection produced by enterobacteria, particularly those known to be pathogens.


[Cholangiocholecystitis, an acute attack with acarids in B bile]. The present paper reports on an acute febrile attack in a patient suffering from chronic non-lithiasis cholecystitis. Acarids and acarid eggs in various stages of development were found in bile B following duodenal intubation in the course of the attack. The administration of magnesium sulphate was followed by abundant biliary vomiting. Fever fell within 6 days and marked clinical improvement was obtained.


[Studies of the sensitivity to the usual domestic insecticides on insects of the Anopheles maculipennis group, and Musca domestica, Cimex lectularius and Blattella germanica species]. The present paper was designed to the study of the degree of sensitivity of mosquitoes, flies, bedbugs and cockroaches to organochloride and organophosphoric insecticides produced in Romania. Testing of the sensitivity to insecticides of these species, important as transmitters of human pathogens, showed the effectiveness of the products, which induced a high mortality rate in relatively small concentrations. Against Anopheles labranchiae atroparvus, the insecticides Detox, Carbetox and Lindatox proved efficient in concentrations of 1.0%, 0.5% and 1.0% respectively. Against Musca domestica Lindatox and Detox proved efficient in 1.0% concentration. Cimex lectularius responded with a mortality rate of 100% to 0.5% Lindatox, 1.5% Plotox and 1.0% Dipterex. Against Blattela germanica, 100% mortality was obtained after one hour exposure to Lindatox, Detox and Carbetox in 1.0% concentration, to 3.3% Plotox and 1% Piretrin.


[Angiotomography of the vertebrobasilar system technique-indication-results (author's transl)]. Angiotomography is a method which is particularly suitable for application in the diagnostics of the vertebrobasilar system on account of its ability to increase the selectivity of angiography, the definition of details, and spatial orientation. Available techniques include angioautomography with and without accessory device, and simultaneous angiotomography and its variations. Among the indications, those are predominant where disturbing vascular overshadowing should be eliminated and certain details emphasized. Angiotomography of the vertebrobasilar system visualizes important vascular structures without overshadowing, and hence also facilitates indirectly the assessment of certain neural structures. The visualization of the contours of vascularized tumors is also improved, and visualization of cystic processes becomes possible. The contrast of discrete tumor staining is enhanced, and, last but not least, visualization of the vessels themselves, as well as of important details, is increased.


[Roentgenological differentiation characteristics in odontomata of the jaw (author's transl)]. Odontomata of the jaw are relatively rare. They can be easily diagnosed by means of special x-ray techniques provided they are composite odontomata. Difficulties are created by ameloblastofibromes and complex odontomata. Complete excochleation predominates in surgical therapy, first importance being given to sparing vital neighbouring teeth and vasomotor nerve bundles.


[Optimal blurring in tomography (author's transl)]. The article discusses the effects on tomographic results exercised by uniform exposure distribution in linear direction, as well as by larger exposure fractions in the internal half of the pathway and outer pathway sections. Predominance of the interior exposure fraction may yield a tomogram which is equally significant as obtained with constant blurring, although the angle of the pendular movement must be considerably greater. Transferring the medium exposure to the outer pathway sections yields faulty images. Uniform exposure distribution produces the most favorable results. In multidirectional layers, spiral blurring with control-led intensity was found to be most appropriate. This requires the smallest pendular angle compared with other tomograms of equal contrast, and also avoids faulty images.


[Studies on the sensitivity of ionization chambers (author's transl)]. In spite of small geometrical dimensions of the ionization chambers, the sensitivity distribution throughout the entire chamber must be considered if conditions are extreme (small size of field, short distances). Various types of chambers were studied with regard to their response threshold along their axis. Taking the different wall thicknesses into consideration, different ionization chambers show good agreement with regard to the accumulation effect of Co-60 gamma radiation.


[The value of 100-mm-spotfilm-technique for investigation of the colon (author's transl)]. The diagnostic value of 100 mm-spotfilm-technique for investigations of the colon has been evaluated and compared to the conventional screen film technique. No difference has been found between the diagnostic value of the two methods, but the total number of exposures in the spotfilm technique has to be increased compared to the conventional method. There is a reduction of the x-ray dose, though not as big as expected.


[Epidemiology of mastocarcinoma (author's transl)]. Epidemiological examination of female patients with mastocarcinoma yields distinct differences in the rate of incidence among different groups of patients. In the industrial countries of the West, mastocarcinoma is 8 to 10 times more frequent than in the Far East and in some developing countries. In all groups under investigation, late primiparae are at an increased risk. Other risk factors are: previous familial history of mastocarcinoma, nulliparousness, women after a treated mastocarcinoma, as well as women with proliferating mastopathy. The setting up of risk groups enabled better on-target focussing of preliminary-care examinations.


[Pretherapeutical diagnosis of metastases in carcinoma of the breast (author's transl)]. Conscientious pretherapeutic search for metastases is a prerequisite for every curative local therapy of breast carcinoma. This must be preceded by thorough physical checkup, supplemented by the usual blood tests, thoracic x-ray, and contralateral mammography. The axillary lymphatic nodes should be biopsied, since clinical assessment alone, unsupported by other examinations, yields false results in about one-third of the cases. Skeleton scintigraphy is recommended for routine skeleton diagnostics, possibly followed by specific roentgenography or tomography of individual skeleton sections. Bone marrow biopsy as well as individual biochemical examinations (discussed in this article in detail) are hardly useful in the search for hidden skeleton metastases, but they can be of importance in assessing the course of therapy. If there is the slightest clinical suspicion of metastases of the liver, brain or other organs, additional special examinations must be performed. Scintigraphy in combination with laparoscopy or ultrasound tomography is recommended in liver diagnostics. Brain metastases can be reliably detected by means of computer tomography.


[Therapy of carcinoma of the breast. Surgery. Present state of knowledge and problems (author's transl)]. For breast cancer of a limited size a tendency away from the radical Halsted-mastectomy can be noticed. A number of studies conducted during the last few years demonstrate that procedures less than radical mastectomy do not necessarily jeopardize the primary goal, namely maximal survival without recurrence. Lumpectomy, axillary staging and curative irradiation can be applied to small breast cancers without clinical evidence of diseased axillary nodes. The quality of the rather difficult radiation therapy and of the follow-up are of paramount importance.


[Endocrinal and chemotherapy of the metastasising mastocarcinoma (author's transl)]. Treatment of the metastasising mastocarcinoma is based on endocrinal and cytostatic treatment methods arranged systematically in parallel and in series. With endocrinal therapy alone, remission rates of around 30% are achieved, whereas with polychemotherapy the remission rates are 50 to 60%. For a large proportion of the patients, the systematic application of both methods leads to definite increase in life expectancy at a tolerable quality of life level. The determination of steroid hormone receptors in the tumorous tissue allows better selection of the patients and hence better on-target therapy.


[Traumatic hemmorrhage of a kidney with three arteries: embolisation and development of intrarenally localised renorenal collaterals (author's transl)]. Successful embolisation with Gelfoam of renal hemorrhage caused by surgery. Embolisation was made easier by the fact that bleeding originated from the smaller of the three arteries for the right kidney. No persistence of hypertonia. Formation of intrarenally localised renorenal collaterals.


[Urographic alterations after kidney stone operation (author's transl)]. Postoperative excretory urography revealed severe complications after kidney stone removal in 17 of 102 patients. In 11 cases stone fragments or remaining stones were detected. The high frequency of prognostically important postoperative alterations justifies the postulation to carry out control urography after every kidney stone operation. Control examinations demonstrate prognostically less important changes which must be known by the radiologist to differentiate them from tumorous or inflammatory processes.


[Technique and use of percutaneous transhepatic cholangiography (PTC) with the CHIBA needle (author's transl)]. Experiences with the modified percutaneous transhepatic Cholangiography (PTC) with the CHIBA-needle ("skinny-needle") are evaluated and reported. The procedure is successul in almost all cases with dilated bile ducts. Therefore a failure to opacify the bile ducts with this method suggests an intrahepatic cause of cholestasis. No serious side effects have been observed in 45 cases.


[Duodenogastric reflux in roentgenexaminations (author's transl)]. Duodenogastric reflux (DGR) favours gastritis, ulcer and carcinoma of the stomach, as well as bleeding from oesophagealvaricosis. DGR is seen regulary in roentgenexaminations of the operated stomach--with exception of selectiv proximal vagotomie--, and in approximately 30-50% in roentgenexaminations of the non operated stomach. Quantification of the DGR is possible by intraduodenal application of Barium or Jodcontaining substances via transpyloric tube, endoscope or intracholedochal T-tube, and cinematographical and electronic registration of the roentgenexamination.


[Theories on radiobiological effects (author's transl)]. Radiobiology has revealed two entirely different effects on irradiated cells. An early, interphase, death (alpha-effect) and also sublethal and potential lethal damage causing mitotic abnormalities leading to a delayed death (beta-effect). The alpha-effect, caused by relative great ion densities, is now interpreted as a double break of the DNA molecule in the cell nucleus. The beta-effect, caused by smaller ion densities might be due to adjacent single breaks of the DNA. The nonlinear dose dependent of the beta-effect can be explained by rapid repair processe having a limited repair capacity. Slow repair of damaged normal cells in G1-phase can be enhanced by medical means and this might be important for clinical radiotherapy.


[Primary hyperparathyroidism as differential diagnosis of severe skeletal destructions (author's transl)]. The case of a 45-year old female patient with primary hyperparathyroidism is described to show that this disease can occur under the principal sign of a destruction of the cervical vertebral column. The roentgenological changes associated with primary hyperparathyroidism are discussed and their differential diagnostic significance is emphasised. The radially located subperiostal absorptions are the first roentgenological changes seen in PHPT and represent signs which make it highly probably that this disease is present.


[Roentgen diagnosis of injuries of the ankle joint (author's transl)]. Lesions of the ankle joint affect the bone and/or ligaments. It will often be necessary to conduct additional radiological examinations besides the standard x-ray films. These additional examinations should include: 1. roentgenograms taken at an oblique angle; 2. x-ray films taken in forced extreme joint position in two planes; 3. roentgenograms comparing right and left; 4. arthrography. The article discusses the value and significance of the additional roentgenograms, with particular reference to the importance of the films of the forced extreme joint position.


[Radial aplasia and associated defects (author's transl)]. The article reports on a newborn with multiple malformations, especially of the extremities, known as VATERS-association symptom complex. The clinical and roentgenological findings are described and the differential diagnosis of the most frequent symptom of radial aplasia is explained.


[Plain roentgenography findings of congenital heart disease (author's transl)]. Plain roentgenography of congenital heart disease in newborn is subject to narrow diagnostic limitations. The cardiac abnormalities should preferably be classified according to haemodynamic criteria. In most cases the diagnostic information is restricted to the statement whether the malformation detected plain roentgenography is associated with normal, increased or decreased pulmonary perfusion. Most cardiac abnormalities occur in conjunction with a more or less pronounced cardiomegaly, and only the tetralogy of Fallot, tricuspid atresia, and total anomalous pulmonary venous drainage are associated with a heart of normal or only slightly enlarged size. Configurations which are considered as being typical of congenital heart disease are only seen in the tetralogy of Fallot and in tricuspid atresia (wooden shoe deformity) on the one hand, and in the transposition of the great arteries and the truncus arteriosus on the other eggshaped heart). Differentiation between these malformations of the heart is sometimes possible via the position of the aortic arch. The factors mainly responsible for the development of cardiac insufficiency during the first few days of life should be the coarctation of the aorta and the hypoplastic left-heart syndrome.


[Exomphalos. A review of 23 cases (author's transl)]. The omphalocele is very often combined with congenital malformations and is primarely to be looked at as a medical and surgical disease. The radiological examination possibly can help to decrease the rate of mortality by disclosing the malformations. These very often consist of malformations, complicating ileus and Bochdalek's hernia. We present 23 cases with omphalocele with special regard to the congenital malformations, complications postoperatively and the causes of death.


[The use of nuclear medicine in the examination to liver and spleen (author's transl)]. The employment of scintigraphy in the examination of liver and spleen represents a simple and rapid diagnostic method which hardly burdens the patient since it is non-invasive. The accuracy ratings in respect of focal lesions show that it should not be over-estimated. When used in a meaningful and relevant manner within the spectrum of all available diagnostic measures, however, liver-spleen scintigraphy will often supply significant information.


[Internistic diagnosis of the parenchymatous epigastric organs (author's transl)]. Since endoscopy became part of routine diagnostic measures in epigastric diseases, less weight has been attached to x-ray examinations, although the range of application of radiological diagnosis has widened rather than narrowed. In the first place this must be ascribed to the combined diagnostic methods of endoscopic retrograde cholangio-pancreaticography (ERCP), percutaneous transhepatic cholangiography (PTC) and to a limited extent also to percutaneous transjugular cholangiography (PTJC). All three methods are typical examples of the increasing importance of teamwork between the internist engaged in gastroenterology and the radiologist. Other methods, too, the application of which is being practised both by internists and radiologists, are growing in importance, such as sonography and computerised tomography. However, the decisive factor is that today the indication for radiological examinations can be determined in a much more selective fashion than only a few years age: enzymological and serological laboratory and functional investigations are now being used as routine and screening methods and will enable the internist to direct pointed questions at the radiologist. X-ray diagnostics can hold its own within the framework of internistic general diagnostics only if it pays more attention to the more refined examination methods.


Value of the electrocardiographic stress test by atrial pacing in the healing stages of experimental myocardial infarction. To check up the value of atrial pacing (AP) in estimating the degree of healing in myocardial necrosis, an ECG study was carried out in 20 dogs with experimental myocardial infarction induced by ligation of the left descending coronary artery. The main ECG changes recorded after ligation i.e., Q waves in 14 animals (73%), S-T segment elevation in 14 (74%) and decrease of QRS voltage in 12 (63%), disappeared within a 7-day interval. Anesthesia with Nembutal 56--57 days after ligation and before AP application induced the occurrence of Q waves in 6 animals, S-T segment depression in 18 and T wave inversion in 12. AP during 20 minutes, at a heart rate of 200 beats/min, produced the appearance or the increase of S-T segment depression in 14 animals and T wave inversion in 12. These findings support the assumption that the AP stress test can be used for the evaluation of the necrosis degree in the healing stages of experimental myocardial infarction, but a correct interpretation of the ECG changes induced by AP should also take into account the previous abnormalities due to anesthesia.


The methodology of cardiovascular disease epidemiology. Chronic disease epidemiology emerged from a methodological necessity, namely to break the deadlock of the medical science faced with a sudden upsurge of these diseases, especially cardiovascular, after the Second World War. The author analyses the shortcomings of clinical investigation in contrast with the epidemiological approach, the qualitative and quantitative prerequisites of the latter, as well as its methodological instruments, pointing out misunderstandings and improper uses of some terms i.e., epidemiology is not one and the same thing as ecology; epidemiology precludes passive detection; the environmental agent is not identical to the risk factor; the risk factor is not diagnostic. It is worth making these distinctions in order to enhance the value of epidemiology as a first step toward prevention.


Separation and purification of LDH and alkaline phosphatase isoenzymes for the improvement of organo-specific diagnosis. The LDH isoenzymes from mixed granulocytic populations and from homogenates of different organs, as well as alkaline phosphatase from human liver and intestine, were separated and purified by means of chromatography using ion exchangers (DEAE-cellulose and DEAE-Sephadex A50). Comparison of purified LDH isoenzyme chromatograms with the zymograms in agar gel has allowed the determination of the isoenzymatic pattern of the respective tissues and its correlation with the predominant energetic processes. The purified extracts of alkaline phosphate have lead to the characterization of the main molecular forms of the enzyme thus enabling a more precise organo-specific diagnosis.


Experimental studies concerning the mechanism of the thyroid-pineal interrelationship. I. The action of the pineal peptides on the thyroid gland. Subcutaneous administration of a pineal polypeptide extract, "Crinofizin", to adult male Wistar rats having the thyroid function inhibited by prolonged administration of MTU, has important effects on both the whole organism (slightly correcting the weight increase rate, loweri g cholesterolemia) and the thyroid gland (reducing thyroid hyperplasia and playing a part in various stages of thyroid hormones metabolism). Thus under pineal treatment one can observe a clear tendency to return to the normal values of the thyroid parameters strongly modified by MTU, as RIC, intrathyroid proteic iodine, tissue thyroid hormones distribution, blood PBI and total T4. It appears that these effects of pineal peptides are induced directly on the thyroid and/or via the hypophyso-thyroid axis which they intercept and equilibrate (moderate).


45Ca uptake in tooth germs: effects of parathormone, calcitonin and propranolol. Tooth germs harvested from 6-day-old rats were incubated in a 45Ca-containing medium for 6 hours. The addition of PTH consistently stimulated the increase in 45Ca uptake, while calcitonin significantly reduced both the PTH-stimulated incorporation and the spontaneous one. Dibutyrul CAMP (3.5 mM) had no effects. Propranolol significantly inhibited the spontaneous and stimulated 45Ca uptake. Results obtained support the concept that the two hormones have a clear influence on calcium entering the tooth germs in full calcification process probably by early membrane effect.


The thyroglobulin variations during the thyroid surgery for polynodular goiter, hyperthyroidism and cancer. A radioimmunoassay (RIA) double antibody system for human thyroglobulin (Tgl) was developed with a sensitivity of 2.5 ng/ml T3 and T4 did not interfere in the antibody Tgl binding. The blood was collected pre-, intra- and 24 hrs post-thyroidectomy from 50 females and 4 males diagnosed as polynodular goiter, hyperthyroidism, chronic thyroiditis and thyroid cancer. The ratios of the intra- and post-operatory values versus pre-operatory values were calculated. The basal values in the patients having thyroid troubles varied within very large limits (two orders of magnitude) and these values could not be clearly correlated to the thyroid pathology, However, in untreated hyperthyroid patients the basal values exceeded 100 ng/ml, while in medullary carcinoma they were near the sensitivity limit of the technique. The intra-operatory values varied within the percentual area (thyroid carcinoma), multiplicative area (polynodular goiter and some cases of hyperthyroidism) and the order of magnitude area (hyperthyroid patients and some of the polynodular goiters). The value of the RIA measurement of the Tgl in the serum as an adjuvant in the post-treatment follow up of thyroid patients is discussed.


The enteroendocrine cells during the normal development of the rat and in some human digestive diseases. The enteroendocrine cells were studied in rats from one day to two years of age. A gradual increase in the number of argentaffin granules and cell volumes paralleling the ageing was observed. The volumes of argentaffin cells in rats reached a maximum at 9 months and decreased towards two years. The argentaffin cells of the intestine are significantly larger than the gastric ones. No significant correlation was found between argentaffin granules number and cell volumes and the gastric or duodenal ulcers. A slight hyperplasia of enteroendocrine cells around the gastric ulcers was noticed.


Cardiovascular pathology in acromegaly and some effects of the 90 yttrium implant in the hypophysis. Examination of the cardiovascular apparatus (cv) of 25 acromegalic patients revealed an increased incidence of cardiovascular pathology as against normal individuals. Acromegalic patients with arterial hypertension (AH) show a twice higher incidence of ischemic cardiopathy, cardiomegaly with obvious or latent cardiac failure, arrhythmias, which frequently lead to death. The uncertain pathogeny of cardiomyopathy implied: hypoxia due to heart hypertrophy (over 500 g and increased cross-section of the fibre to over 26/mu), adrenergic deficiency resulting from increased protein synthesis and decrease in thyrosine, a precursor of myocardic cathecolamines. The increased incidence of coronary pathology is favoured in acromegalic patients by diabetes, hyperlipoproteinemia, low endogenous heparin, increased ureic acid and platelet adhesivity. Hypophysectomy by hypophysolysis (20 cases) brings relief and cures cardiovascular pathology, reduces AH, corrects the coronary risk factors, cures hypophyseal diabetes. The existence of AH and cardiovascular pathology is an indication for surgical treatment in evolutive acromegaly.


Percutaneous fine-needle aspiration biopsy during endoscopic retrograde cholangio-pancreatography. In 12 non-icteric patients, changes in the pancreatic duct indicative of carcinoma were found during endoscopic retrograde cholangio-pancreatography (ERCP). Percutaneous fine-needle biopsy was positive for cancer in six cases. Nine of the 12 patients were later proved to have carcinoma of the pancreas. There was one falsely negative biopsy but no false positives. In two cases no pancreatic cells were found in the smear. It seems that percutaneous fine-needle aspiration biopsy during ERCP is a feasible procedure and can be recommended in ductal changes indicative of carcinoma.


Influence of repeated administration of cholecystokinin and secretin on the pancreas of the rat. Repeated injections of cholecystokinin (CCK) during a period of up to 3 weeks significantly increased the weight of the pancreas in rats. This was associated with an increase in the amount of protein per unit weight of DNA, suggesting hypertrophy of the acinar cells, and with increase in the total amount of pancreatic DNA, indicating additional hyperplasia of the gland. CCK administration also increased the pancreatic content of amylase and trypsin, but the content of lipase remained unchanged. The rate of secretion of the two enzymes increased in the CCK-treated rats, although it appeared that the functional capacity of the individual pancreatic acinar cells was not increased. CCK injections had no effect on the insulin content of the pancreas or on the composition of the partoid glands. Repeated injections of secretin in the doses used in this study had no effect on the pancreas.


Clinical studies of the utilization of an oligopeptide-containing synthetic diet. Preliminary communication. In 12 patients comparative studies were carried out, to assess the therapeutic effect of synthetic diets containing either oligopeptides (Oligopep) or pure amino acids (Viva-sorb). Owing to side effects and failing therapeutic success it was possible to carry through nitrogen balance studies in only 7 patients. No difference could be shown between the two preparations with respect to nitrogen balance, stool mass and clinical effect. Four of the 7 patients had ulcerative colitis.


Gastric emptying of a liquid meal in health and duodenal ulcer disease. In the present investigation an extension of the method of George was used, which allows the rate of emptying of the gastric content (GC) to be assessed. The aim of the study was to find out whether ther is any difference in gastric emptying rate of a liquid meal of 750 ml 10% glucose (glucose monohydrate, mol. wt. 198) between healthy subjects and duodenal ulcer patients (DU). The straight numerical volume of GC, the logarithm and the square root of GC were related to time, and these functions were compared. The correlation coefficient for the regression line for these functions showed that data both for healthy subjects and DU gave a better fit to the GC/time and GC/relationship than to a semi-logarithmic function, when the starting point at time zero was excluded. Regardless of the type of transformation of the basic data, there was no difference between healthy controls and DU as regards the regression coefficient, indicating that from 20 min after the installation of the test volume the GC is decreasing at the same rate in the two groups. When the straight numerical volume of GC was used, there was a significant difference in the extrapolated Y-intercept for the regression lines between healthy subjects and the DU, indicating an increased initial emptying in the DU patients. This was further confirmed when the volume emptied during consecutive 20-min periods was estimated. Furthermore, there was a shorter emptying time in patients with duodenal ulcer than in healthy controls.


Comparative effects of synthetic and natural vasoactive intestinal peptide on pancreatic and biliary secretion and on glucose and insulin blood levels in the dog. The effects of synetic porcine vasoactive intestinal peptide (VIP) on pancreatic and biliary secretion and on glucose, insulin and calcium blood levels were examined in the dog and compared with the effects of natural porcine VIP. Synthetic VIP was a secretin-like partial agonist of pancreatic and biliary secretion with efficacies relative to secretin of 0.27 and 0.41, respectively. Consistent with its weak secretin-like action, synthetic VIP augmented the pancreatic response to CCK-OP and the submaximal but not the maximal response to secretin. Synthetic VIP also produced a dose-dependent increase in blood glucose levels and a synchronous and proportionate increase in blood insulin levels. A slight increase in total calcium levels was equivocal. The effects of antural VIP on pancreatic and biliary secretion and on glucose and insulin blood levels were identical to those of synthetic VIP. The identity of effects supports the validity of the postulated structure of porcine VIP. Although elicited at high doses, the effects of VIP on exocrine and endocrine secretion may be relevant physiologically in the context of a neurocrine or paracrine role for VIP.


In vitro medullary granulocytic progenitor (CFUc) cultures from 6 cases of granulocytopenias. Medullary granulocyte progenitor (CFUc) cultures were grown in vitro from samples taken from 6 patients with toxic granulocytopenia caused by either thiamphenicol cephalothin or amidopyrine and who are now apparently cured. A decreased in the medullary concentration of CFUc has been observed and a calculated estimate shows that there was a decrease in their absolute number. A decrease in the number of CFUc per 10(5) metamyelocytes suggests a possible compensation by mitotic amplification between the stem cell and the differentiated cells. Two successive cultures have shown that the course of such medullary cultures is variable. The existence of medullary anomalies before drug toxicity as well as the practical consequences of the contrast between the apparent cure and the decrease in CFUc are discussed.


Iron kinetics and erythropoiesis in Fanconi's anaemia. Ferrokinetic studies were carried out in 4 patients with Fanconi's anaemia (FA). Experimental data were analysed by means of a mathematical model of iron kinetics in order to obtain a quantitative assessment of effective and ineffective erythropoietic activity, mean red cell lifespan, and non-erythroid iron turnover. The major pathogenetic mechanism of the anaemia appeared to be relative marrow failure, i.e. a reduction in the proliferative capacity of the erythroid marrow. The role of ineffective erythropoiesis was of minor importance. On the basis of the results obtained both the pathogenesis and the natural course of the disease are discussed.


Hairy cell leukaemia. Clinical features and effect of splenectomy. Hairy-cell leukaemia (leukaemic reticuloendotheliosis) is a well-defined clinical entity. Most of the recent reports are almost entirely concerned with the pathological and functional aspects of the disease. In the present retrospective study the clinical features and laboratory data of 12 patients were analyzed together with a series of 123 adequately clinically documented cases from the literature. The Hb level and the sex of the patient proved to be the only parameters having some prognostic value for the survival time after diagnosis. The effect of splenectomy was assessed in two comparable groups of 24 splenectomized and 51 non-splenectomized patients. The operation seemed to be beneficial, but after 2 years the difference was not significant(.05 less than P less than .10). Analysis of subgroups showed that splenectomy was definitely beneficial in women, in patients with a Hb level over 8.0 g/dl or a platelet level above 50 X 10(9)/1, in patients with leucocytes below 3 X 10(9/1, , and also in patients with hepatomegaly (P less than .05 in all cases). These findings suggest that splenectomy is beneficial in cases where anaemia and thrombocytopenia are not very severe; in severe cytopenia the operation does not increase the life expectancy.


Type I congenital dyserythropoietic anaemia with myelopoietic abnormalities and hand malformations. Type I dyserythropoietic anaemia was diagnosed in an infant, who presented with respiratory distress and hepatosplenomegaly soon after birth. Anaemia became manifest during the neonatal period. The case clearly proves the congenital nature of the disease. Abnormalities of the myelopoietic series indicate that it might be a stem cell disease and the presence of skeletal anomalies of the hands suggests a genetic relationship to some cases of Fanconi and Diamond anaemia. No serum lipid or vitamin E deficiency was present as in type II congenital dyserythropoietic anaemia. Serial serum ferritin determinations indicated that iron stores are increased early in type I congenital dyserythropoietic anaemia despite no transfusion load.


Congenital factor V deficiency. A family study. A 14-month-old girl suffering from a heavy bleeding tendency, caused by a severe isolated congenital factor V deficiency is described. In this study 56 family members were examined. 10 of them had a factor V level ranging 26-60% of the normal--these were classified as heterozygotes. The case histories of the heterozygotes did not reveal a bleeding tendency. The inheritance of this factor V deficiency is autosomal recessive, with varying expressivity in the heterozygotes.


Lymphomatoid granulomatosis of the lung, liver and spleen. A female patient with lymphomatoid granulomatosis (LYG) involving lung, liver and spleen is described. Our case presented with signs and laboratory data indicating severe hepatic failure. It is not clear if this disorder represents a distinct pathological or clinical entity. In this report the differences between LYG and the two disease groups which it most resembles, Wegener's granulomatosis and malignant lymphoma are discussed.


Effect of tissue specific mitotic inhibitors on survival time of spontaneous and virus-induced murine leukaemia and influence on myocardial degeneration. Treatment of adult AKR mice with tissue-specific mitotic inhibitor mol. wt. 1,000--20,000 extracted from the AKR thymus significantly delayed the onset of spontaneous thymus leukaemia, whereas extracts of other organs were without effect. A slight prolongation of survival time was found with spleen extract when administered to BALB/c mice infected with Rauscher virus, which causes leukaemia starting in the spleen. Thymus extracts of MW 100,000--300,000 caused myocardial degeneration in some leukaemic and nonleukaemic mice.


Reversible severe anaemia and granulocytopenia caused by procainamide. A case report. A 64-year-old male developed severe anaemia during procainamide therapy. At the same time granulocytopenia was found. Discontinuation of procainamide led to complete recovery. Severe anaemia due to the use of procainamide is not well known. The available data indicate a maturation block of the erythropoiesis as the possible cause of the anaemia, perhaps in combination with an autoimmune haemolysis.


Interpretation of measured red cell mass in the diagnosis of polycythaemia. Expression of predicted and measured red cell mass (RCM) in terms of ml/kg body wt. lacks precision. The use of formulae for prediction of normal mean red cell mass derived from the blood volume prediction (BV) of Nadler et al (1962) has been examined. It is proposed that a more accurate determination of mean normal predicted red cell mass (MNRCM) is obtained by using: 0.47 X 0.91 X BV = MNRCM for males; 0.43 X 0.91 X BV = MNRCM for females. The MNRCMs given by these formulae agree with those given by predictions based on lean body mass and surface area. Examination of the '95% confidence limits' of the 'Nadler' prediction indicates that males with measured RCMs greater than 25% and females with measured RCMs greater than 30% above their MNRCM may be regarded as having polycythaemia.


Fletcher factor deficiency: report of a new family. 3 cases of Fletcher factor deficiency in a family not related to the 6 families already published (Hathaway et al 1965, Hattersley & Hayse 1970, Abildgaard & Harrison 1974) are studied. In the family described here, 3 of 4 siblings have a Fletcher factor level of less than 1% and the fourth has a level of 46%; the Fletcher factor level in the father is 48% and in the mother 38%. This suggests an autosomal recessive transmission. Clinically they do not present spontaneous bleedings and only one of the siblings required a unit of blood after an amygdalectomy. It is also of interest to emphasize that 3 of the siblings suffered from congenital multiple arthrogryposis and that 2 of them presented the arthrogryposis together with the Fletcher factor deficiency, a circumstance which could have been favored by the consanguinity of the parents. The fact that the family described here is white and of Mediterranean origin contradicts the idea that there exists a special predisposition among members of the black race for this disease.


Healing of experimentally induced burn wounds. A comparative study of the healing of exposed burn wounds and burn wounds covered with adhesive zinc-tape and a scanning electron microscopic study of the microvasculature of wound healing in the rabbit ear. A comparative study of the healing of experimentally induced burn wounds on the inner side of the rabbit ear treated with either adhesive zinc-tape or exposure to the air is presented. During tape treatment, tissue necroses were dissolved, thus exposing the granulation tissue surface. In wounds treated with zinc-tape, fewer and smaller perforations to the opposite side of the ear were found, compared with those in exposed wounds. It is suggested that the frequency of perforations can be used as a simple measure of extension of tissue necroses after burning in relation to different methods of wound treatment. A microangiographic method is also presented for three-dimensional visualization of vascular events during healing using scanning electron microscopy on vascular casts.


Absorption, retention and excretion of 65Zn in rats with wounds treated with 65Zn-labelled zinc tape. Absorption, retention and excretion of 65Zn in rats from excisional wounds treated with 65Zn-labelled zinc tape were studied. The absorption of 65Zn was marked and indicates that the absorption of zinc from the tape is more than sufficient to account for the increases in zinc concentrations seen in several tissues. The distribution, retention and excretion of 65Zn from the zinc tape followed a pattern similar to that of 65Zn injected into non-operated and operated rats. This indicates that the zinc from the tape is present in the body not as zinc oxide, as it is in the adhesive substance of the tape, but as zinc in those forms which are originally found in the body and that zinc oxide is ionized before absorption. In tissues with a rapid uptake of zinc more than 50% of the total concentration of zinc derived from the zinc tape after eight days of treatment. In operated animals which were not treated with zinc tape a decline was seen in the serum zinc concentration and excretion of zinc with a concomitant increase in the liver concentration of zinc.


Perfusion and reimplantation of a free skin flap in a dog. A preliminary report. This report describes perfusion and subsequent reimplantation of an isolated lower abdominal skin flap with an axial vascular pattern. Perfusion was maintained for 80 min at +8 degree C using a hemoglobin-free perfusate. Reimplantation was performed by microvascular anastomoses. Healing was complete.


Midline cervical clefts. Case report.

Midline cervical clefts. Case report. Midline cervical cleft is a rare congenital deformity in the anterior portion of the neck. A skin lesion is present with an underlying fibrous cord-like formation that in severe cases caused contracture. Disagreement exists as to the pathogenesis. Treatment comprises excision and Z-plasty. A case is reported where the MCC coexisted with a thyreoglossal duct fistula.


A new tongue flap for closure of a pharyngo-cutaneous fistula. Case report. An apparently original version of the several available tongue flaps is presented for the reconstruction of a lateral pharyngo-cutaneous fistula in a patient where several reconstructive attempts after excision for a malignant tumour had failed.


Treatment of prostatic carcinoma with cyproterone acetate. Sixteen patients with prostatic carcinoma were treated with 200 mg of Cyproterone acetate daily. No other kind of hormonal treatment was administered. Increasing skeletal metastases were observed in 6 patients, whereas significant reduction of metastases took place in 2 patients. Objective relief of stranguria was observed only in 3 patients. The amount of residual urine increased in 3 patients and was reduced in 5. In about one third of the patients, the prostate gland became smaller and softer. The acidic phosphatases decreased from pathological to normal values in 7 patients. There were no observed hepatic, renal or haemotological side-effects. However, serious cardio-vascular complications occurred in 6 patients, while arterial hypertension developed in 4. It is suggested that Cyproterone acetate cannot be recommended as the only kind of hormonal treatment of prostatic cancer.


On gestagen treatment of advanced prostatic carcinoma. Depostat treatment was found to reduce plasma testosterone and to have a gonadotrophin suppressive effect in males. In our study the clinical effect on prostatic cancer was, however, disappointing when compared to the well established effect of orchiectomy. The therapeutic failure of Depostat might be related to the incomplete suppression of plasma testosterone compared to that observed after orchiectomy.


Bladder function in healthy elderly males. Bladder function was studied in 20 healthy elderly male volunteers using cystometry, uroflowmetry and voiding cystourethrography. Two persons were excluded from the study as neurological examination had shown evidence of organic neurological disease, and one person did not complete the study. 53% of the remaining 17 persons had detrusor hyperreflexia. Urinary flow rates were reduced and maximal intravesical pressures elevated in the persons studied, although they claimed to have a normal voiding pattern. No correlation was found between the reduction of urinary flow rate respectively increase in maximal intravesical pressure and the presence of detrusor hyperreflexia. The high incidence of detrusor reflex disturbances thus suggests that incipient infravesical obstruction in old age and possible subclinical impairment of the central nervous control of the micturition reflex are major etiological factors in detrusor hyperreflexia.


Tissue adhesive in surgical and crush renal trauma. An experimental angiographic investigation in the rabbit. Angiography and nephroangiography has been performed 3 and 6--10 weeks after induced trauma to 18 rabbit kidneys. The lesions, mimicking crush trauma or surgical ectomy, were repaired using a cyano-acrylate. Perinephric tissue was adhered to the wound and made repair easier in crush trauma. In the resected kidneys it constituted a new pelvic wall. The angiographies demonstrated that in essence only the directly traumatized arteries were abnormal, that the cortical lesions were very small and the venous drainage unimpaired. The function, assessed on urograms, was good. No ureteric obstruction was present.


HLA and kidney stone disease.

HLA and kidney stone disease. Normocalcemic patients with recurring kidney stones were HLA typed. 54 patients with an idiopathic high urinary excretion of calcium but without signs of renal tubular defect showed a B27 phenotype frequency which was more than twice that of the controls and a CW1 frequency that was doubled. After correction for the number of tested HLA specificities the increase was not significant. 35 patients with renal tubular acidosis and 16 patients with no metabolic diagnosis had no deviant HLA antigen distribution.


Comparison of radiological measurement and actual size of ureteral calculi. 100 ureteral calculi were measured on X-ray films and directly on the stone after passage or removal. The largest diameters were compared. The size of the stone was radiologically overestimated for 59 stones, correct for 26 and underestimated for 15. 73 of the stones were radiologically measured within +/-25% of the actual size.


Transurethral extraction of ureteral stone guided by television fluoroscopy. In 45 patients with ureteral calculi 2 to 8 mm in diameter, attempts were made to remove the stones transurethrally, using a Dormia extractor and television fluoroscopic monitoring. The procedure was successful in 34 patients. The success rate was 74% when the stones were 5 mm or less and 68% with the larger stones. In 10 patients when instrumental extraction failed, this was followed immediately by open surgery, for removal of stone. The reasons for failure of the transurethral procedure are presented. Great care in performance and preparedness for open surgery are always required, especially when the stone is large. Television facilities should be good and include image intensifier. There were no serious complications of instrumental or surgical removal of calculi.


A longitudinal study of arterial blood pressure in chronic haemodialysis patients with different levels of plasma renin concentration. The purpose of the study was to examine the value of regular measurements of plasma renin concentration (PRC) in selecting those chronic haemodialysis patients suitable for bilateral nephrectomy to prevent development of uncontrollable hypertension. Regular measurements of arterial blood pressure (BP) and PRC were performed during one year in 31 patients undergoing regular haemodialysis because of end-stage renal disease. Among 18 patients with PRC greater than or equal to 100 micro Goldblatt units per ml plasma (microGU/ml) systolic and/or diastolic hypertension persisted or developed in 12. In contrast, among 13 patients with PRC greater than 100microGU/ml, BP became normal in all but one, who had a slightly increased systolic BP. However, hypertension was mild and easily controlled by conventional therapy in all except one, who probably had an overlying volume-dependent hypertension. Therefore, bilateral nephrectomy was not necessary in any case. The results indicate that hypertension in the majority of chronic haemodialysis patients with high PRC can be adequately controlled without surgical intervention and that regular measurements of PRC have no practical value in forecasting the development of uncontrollable hypertension in chronic haemodialysis patients.


Mathematical and clinical investigation of the RP6-rhodial 75 system. Evaluation of high and low middle molecular clearance dialysis. The clearance for "middle molecules" measured in vitro was considerably higher for a polyacrylonitrile than for a cuprophan membrane, even when the former had been used for patients three times. Using a two pool mathematical model, an adequate correlation was found between the calculated values and those measured during RP6-Rhodial 75 dialysis (RP6). The treatment time needed for dialysis of "middle molecules" with the Gambro 13.5mu in single pass (Gambro S. P.) was four times longer than with RP6. In a long-term clinical study, when RP6 and Gambro S. P. dialysis were compared, no difference in the clinical condition of the patients was found. Clinical condition was not affected by the urea or "middle molecule" levels. The ultrafiltration tolerance was improved during hemodialysis with systems resulting in a low urea clearance.


Refluxing ureteral stump.

Refluxing ureteral stump. Two cases are presented of reflux into a residual ureter causing recurrent urinary tract infection. A voiding cysto-urethrogram should be included in the investigative routines when nephrectomy for unilateral chronic pyelonephritis is planned. If severe reflux is seen, the entire ureter should be removed along with the kidney.


Secondary hyperparathyroidism combined with uremia and giant cell containing tumor of the cervical spine. A case report. A 47-year-old woman with chronic pyelonephritis since 1950 was prepared for hemodialysis or kidney transplantation. Investigation disclosed secondary hyperparathyroidism and an osteolytic lesion in C VII and Th I causing a subluxation. There were minor neurological symptoms and apparent risk of luxation of the cervical spine with resulting injury to the spinal cord. Operation was performed with total parathyroidectomy and excision of the bone tumor, followed by fixation of the cervical spine with bone graft. There were no major complications during the postoperative period and the patient was mobilized four months after the operation.


[Spinal surgery in peridural analgesia]. Epidural analgesia has an ideal application in laminectomies and explorations of the spinal column. It has a great number of advantages for the patient and the surgeon and a small amount of disadvantages, if the method of epidural analgesia is applied by a skilled hand, serious dangers of complications occur very seldom.


[Case of compulsive-obsessive neurosis. Clinical observations]. The authors describe a clinical case of obsessive-compulsive neurosis, from eight years of evolution. The out-lined therapy was in agreement with the principles of "behaviour therapy" and had two main goals. The first one, was obtaining the emotional desinhibition of the patient and, the second one, preventing him from doing any ritual, 24 hours per day, using the method of "response prevention". By now he has more than a year after treatment and is maintaining without medicines and leading a professional, active life.


[Social psychiatry].

[Social psychiatry]. The author attempts an analysis of some of the socio-cultural elements which have marked the birth of (modern?) psychiatry and which have consequently influenced the education, identity and ethical values of the practitioner who choses to become a psychiatrist. The author draws attention to the problem of the psychiatrist's autonomy by stressing the important relationship between autonomy (or lack of autonomy) and the dominant political ideologies. Such relationship appears more clearly when the psychiatrist uncritically accepts to become "the psychiatric expert" in criminal and civil law, suicide, sex, death, etc., in other words, whenever accepting the role of "managerial technician". It is evident that the psychiatrist cannot renounce the social responsibilities which fall upon him because of his understanding and analysis of human behaviour, but it is also evident that a redefinition of the psychiatrist's role in society is called for. Such a re-definition will be possible only by the permanent exercise of self-criticism, honesty towards oneself, moral integrity and the capacity to differentiate between true autonomy and the illusion of autonomy when operating in the name of an official psychiatry which is often also a vehicle for the enforcement of a political ideology.


[Social targets of psychiatry].

[Social targets of psychiatry]. The challenge and political implications of public health problems invite psychiatrists to a better self declaration and explanation of what they do and what they want. The author discusses questions concerning the mandate, therapeutic goals, patients' selection and utilisation of therapeutic potentials in psychiatry.


[Psychiatry and mental disorders].

[Psychiatry and mental disorders]. The analysis of the relations between social order and mental disorder is first based on the social system considered as the order of the differences and of the significant disparities in a stratified and hierarchial society. As psychiatry belongs to the system, it received the monopoly of access to the symbolic and mental dimension which is included in the disorders. We intend to show by some examples how psychiatry applies in this way a specific social order. Then we analyse the results of the setting of this order, results which are different according to the social position of the patients and their status in the psychiatric system. The efficiency of symbolic domination is not only for patients with disorders but also and more basically for the whole social system and the maintaining of its order.


[The unwisdom of reason and social injustice]. This paper attempts to show that in cases of conflict between a patient and any given agency (e.g. insurance company), the conclusions to which the expert will arrive at are often biassed by the spirit of the law. So when dealing with "responsibility" the law is often stressing a concept which is closer to that of "guilt" (the patient is guilty or the insurance company, or society are guilty). This then brings about an endless conflict where neither party is ready to accept fault. Thus, all measures which could lead to an adequate solution seem to be automatically excluded. Therefore, both parties find themselves in an inevitable deadlock due to the "causal" appreciation of the problem to be solved. The above situation could be avoided if the focus were shifted on results and the means to attain them, instead of trying to establish the origin of a given behaviour. In other words, a "system theory" approach appears to be the best frame of reference for the expert. Such an approach would not only have an impact on the spirit of the law, but also throw a new light on the role of the expert, who would no longer have to seek for more or less fair solutions, but would be able to propose constructive measures liable to solve the conflict.


[Penal responsibility and the unconscious conflict]. Although the same model of the delinquent's penal responsibility still exists in law as well as in psychiatry, it is rapidly giving way to the concept of personality. Moreover, the psychoanalytical model is currently being used. The sole point of reference used by the psychiatrist is his relationship with the delinquent. He thus constructs a "new history" for the delinquent. This psycho-dynamic approach to the delinquent makes us formulate two fundamental objections: 1) It often is forgotten that the Freudian topical approach and its instances of personality are metaphorical. Out of context, that is of a relationship in time and space, it becomes void of meaning. Thus, the use of psychoanalytical concepts is epistemologically inacceptable. 2) Psychoanalytical theory, on a par with all systems of thought, has constituted its own system of values. Thus, neurotic structures, being nearer to that of the expert himself, take a privileged position. To summarize, it is the author's purpose to show that intra-psychic conflicts cannot be reduced to inter-personnel conflicts, most of all not in the field of crime.


[Psychiatry and ethics].

[Psychiatry and ethics]. A certain contemporary anti-psychiatric movement denounces the violence of any form of psychiatry that could only repress, in what would be a sociopolitical gesture, the alleged mentally-ill's deviation. If such a risk cannot be excluded, it is nevertheless necessary to reveal the fallacious antinomy that underlies this controversy and consists in opposing an organic disorder, used as an alibi, to the claim of an utter liberty. The judiciary, on its part, can but escape with difficulty this dichotomy--that a certain psychiatric practice occasionally reinforces--of a mental "disease" and of a self-reliant responsibility. The only difference then is that what appeared to be an alibi on the one hand, is an excuse on the other. The question, in fact, is not so simple. One cannot associate, without further ado, a psycho-pathological disorder to one of organic origin. It is the essential being of man as a whole that is here implicated, a being of language, desire and meaning who must be heard and understood as such. But one cannot claim further that this meaning is in full and immediate possession of itself and expresses without restriction i.e. a political choice opposed to malicious and repressive machinations. The acknowledgement of this meaning certainly does not make the psychiatrist's job easier, especially when he must intervene on social grounds, there where the risk of suicide and aggression are prevalent. An irresponsible non-interference, far from being a liberator, could only lead to a much more unrelenting tightening of the circle of violence.