[Correlative relationship between changes in the volume rate of cerebral and peripheral blood flow and the outcome of severe cranio-cerebral injuries]. On the basis of a complex of investigations, the results of quantitative study of the volume rate of cerebral and peripheral blood flow in 42 patients with severe carniocerebral trauma are presented. Analysis of the changes provides evidence of their dependence on the severity of the trauma and the stage of the comatose state. A definite correlation between cerebral and peripheral blood flow in the acute period of a severe craniocerebral trauma was revealed. No correlation between the parameters mentioned was found in patients with a favourable course of the disease. With growth in the severity of the craniocerebral trauma the degree of correlation between the cerebral and peripheral blood flow increased. Total correlative dependence between them was found in patients with the most severe craniocerebral trauma.


[Relationship between changes in the mechanical properties of arteries at the base of the brain and the features of cranio-cerebral injuries]. Craniocerebral injuries were examined macromorphologically on autopsy of 123 persons who had died of the trauma. According to the site to which the force had been applied and the direction of the axis of the blow, all craniocerebral traumas were distributed among 6 types (modification of classifications suggested by Spatz, Unterharnsheidt and Ripperger, and Mayer). The main mechanical properties of the arteries of the base of the brain were determined in 45 casualities: relative deformity in a force of small load, maximum (destructive) relative deformity, and strength. Drastic changes in these properties were revealed in cases with a severe cerebrocranial trauma terminating in death, which was particularly characteristic of types I, II, and III craniocerebral trauma.


[Repeated intracranial hemorrhages, their prevention and treatment]. The formation of recurrent hematomas was encountered in patients operated on for intracranial hematomas of traumatic and nontraumatic origin and for contusion of the brain. To prevent recurrent hemorrhages, the authors employed active aspiration of the wound canal contents by means of a three-jar aspirator or a microaspirator in the postoperatice period in 56 cases. It is noted that active aspiration of the wound discharge, continued for 2--4 days, makes it possible to avoid the formation of recurrent intracranial hematoma and to reduce resorption of the decomposition products, this improves the course of the postoperative period.


[Late results of balloon occlusion of the afferent vessels of arteriovenous aneurysms]. The remote results of balloon occlusion of the afferent vessels of widely-spread arteriovenous aneurysms in 50 patients are discussed. The average follow-up period was 4 1/2 years. A favourable result was noted in 21 of 30 patients with epileptic seizures. Recurrent hemorrhages developed in 3 of 36 patients who had one or more intracranial hemorrhages before the operation. Headache was relieved in the patients after the operation.


[Clinical picture and diagnosis of subdural hematomas in children]. Thirty-six children, aged from 5 months to 14 years, with subdural haemorrhages are discussed. In 31 the hemorrhages were of a traumatic character, in 5 their origin was unknown. The authors draw the conclusion that the course of subdural hematomas in children is marked by peculiarities which often make the clinical diagnosis difficult. Examination of the cerebrospinal fluid, echo-encephalography, and angiography helped in all these cases to identify the character of the process and its localization properly. All children underwent operation with a satisfactory outcome.


[Hemodynamic changes during the orthostatic test in patients with spinal cord damage at different levels]. Hemodynamics were studied during orthostatic load on a special orthotable in 54 patients with different levels of spinal cord interruption. With the patient in a horizontal and then in a vertical position, the arterial pressure, pulse, volume rate of blood flow in the forearm, and the cardiac output were recorded every minute. The total resistance of the vessels was calculated. Absence of constrictor reactions in the lower half of the trunk was revealed in patients with a high level of spinal cord damage, due to whicorthostatic collapse developed within the first minutes after they had been placed in a vertical posture. The orthostatic stability of such patients may be somewhat improved by producing additional external pressure to the lower part of the trunk (with special suits) and by means of other forms of special training. Patients with the spinal cord damaged at a low level (below the sixth thoracic vertebra) tolerate a 10-minute orthostatic load quite satisfactorily.


[Micturition disorders in patients with severe injuries to the cervical portion of the spinal cord]. Disorders of micturition in 163 patients with a severe trauma of the cervical portion of the spinal cord are analysed. The data obtained concerning the functional condition and afferentation of the urinary bladder and the severity of the developing combined urologic complications (pyelonephritis, urolithiasis, vesicoureteral reflux, etc.) are evidence of marked disorders of micturition which are directly dependant on the time elapsed since the injury to the spinal cord had occurred and its severity.


[Relationship between the state of consciousness following cranio-cerebral injury and the parameters of the blow]. Data on the dependence of the clinical manifestations of the initial period of craniocerebral trauma in a human being on the physical parameters of the blow were treated by the method of correlation and regression analysis. A regression equation was obtained specifying linear dependence between the traumatic value of the blow and the characteristics of the kinetic energy of the blow. The presumed dependence of the severity of the clinical manifestation of the trauma on the localization of the blow is statistically substantiated. On the basis of the established dependence, curves were plotted for the probability forecast of the state of the injured person's consciousness depending on the rate at which the blow occurred and its localization, which may be used in the elaboration of methods for the appraisal of protective helmets and headpieces.


Aesthetic blepharoplasty, ectropion and incipient ectropion. Postoperative ectropion of the lower lid is the most common serious complication of aesthetic blepharoplasty. Important points in the surgical technique are described. The emphasis is on judicious skin excision. The management of postoperative ectropion is outlined. A lax, pre-ectropic lower lid constitutes an additional risk. The technical modifications which will prevent changing an incipient ectropion into a postoperative ectropion are reviewed.


Shock of anaphylactoid type induced by protamine: a continuous cardiorespiratory record. The intravenous administration of protamine to a patient after cardiac bypass caused a sudden increase in airway resistance and lung stiffness, and a severe drop in arterial blood pressure. The ventilatory obstruction reached its maximum after 30 s and had returned almost to normal in 3 min. Arterial hypotension with low pulse amplitude, decreased heart rate and ST depression in the ECG tracing developed 1.5 min after the respiratory symptoms. In spite of rapid blood transfusion, arterial pressure reached a low level after 5 min, but rose after isoprenaline administration. It is suggested that changes in the vascular and respiratory compartments occur in parallel with, but independently of, myocardial injury and depressed cardiac contractility.


[Surgical treatment of pulmonary metastases (author's transl)]. From April 1954 till February 1976, pulmonary resections for metastases of primary extrapulmonary malignancies have been done on 35 patients, 21 men and 14 women with average age of 49 years 7 months. In about half of the cases the lung opacities were discovered occasionally. Three patients have undergone a second thoracotomy for a recurrent metastasis. Of the 48 resected metastatic lesions, 31 were located in the right and 17 in the left lung. Thirty were on resection unilateral and solitary. There was no operative mortality and the postoperative morbidity was neglectable. The cumulative 3- and 5-years survival percentages as obtained by the life-table method were 44.6 and 31.2. Better survival rates were found in the age group of 0-40 years and in the group of the sarcomas. Worse results were obtained when the primary tumor was invasive or associated with regional metastases. Resection of metastatic lung lesions larger than 5 cm diameter and especially the resection of multiple lesions gave poorer results. The time-interval between the primary operation and the pulmonary resection had no clear prognostic value. The factors determinating the palliative character of the pulmonary resection had a negative influence on the survival. None of the 9 patients with pulmonary metastasis and secondary intrathoracic lymphatic metastases did survive longer than 3 years. All these patients had a primary carcinoma. Out of this study no conclusions can be made as to the extension of the pulmonary resection.


[Selective cooling of the spinal cord and spinal nerve roots in patients with spastic and pain syndromes]. Selective cooling of the spinal cord and its roots was applied in 26 patients with a high degree of muscle spasticity of various genesis and in 12 of those with various pain syndromes. Hypothermia was conducted by the open and closed (puncture) methods. The subarachnoid space was cooled to 11--7.5 degrees C. Spasticity diminished to grade I--II in 15 patients and to grade III in 9; in 2 patients it did not change. In 3 of 12 patients the sensation of phantom and pain were completely relieved, marked improvement occurred in 6 patients, while in 3 patients the effect proved short-lived or doubtful.


[Transtentorial ventriculocisternostomy]. Transtentorial ventriculocisternostomy was performed on 21 patients. It led to the correction of the hypertensive-occlusive phenomena in all of them. No accumulation of cerebrospinal fluid in the soft tissues along the shunt-tubes, liquorrhea or purulent complications were encountered in the postoperative period. Transtentorial ventriculocisternostomy is indicated as the final stage of exploratory trephination of the posterior cranial fossa during which occlusion of the c.s.f. passages, irreparable by any other means, is revealed. It may also be the operation of choice for patients in whom high occlusion was diagnosed during a preoperative examination. Irrespective of the level and causes of occlusion of the c.s.f. passages and the operative method, bilateral ventriculocisternostomy is expedient.


[Hyperselective vagotomy (author's transl)]. Hyperselective vagotomy is an operation to be performed with utmost care and necessitates control of the nerve ending during resection. The operation is extremely well tolerated and yields excellent results in simple duodenal ulcers. It is more delicate in perforated or bleeding ulcers. However one should ascertain the benign nature of the lesion and pathologic studies must be performed on frozen sections at the operation. Long term follow-up is not yet available.


[Paraduodenal hernia (author's transl)]. The internal paraduodenal hernia is a most unusual disorder of the alimentary tract, due to a failure of the process of intestinal rotation. There exists a right and left variety, each of them presenting specific features. Often there are no symptoms or perhaps a vague abdominal malaise. Occasionnally one finds the clinical picture of obstruction, even of strangulation. The preoperative diagnosis is seldom made; however, it could be done if one keeps the possibility in mind. A successful surgical treatment necessitates an understanding of the mode of origin and a throughout knowledge of the anatomic variations.


Occupational hazards to reproduction and health in anaesthetists and paediatricians. A mail questionnaire was sent to Finnish anaesthetists and paediatricians to evaluate the risks of reproductive, teratogenic and health complications related to the professions. The incidence of diagnosed spontaneous miscarriages in anaesthetists' families was 10.2% of all pregnancies and it was 13.2% in paediatricians' families. Smoking seemed to increase markedly the incidence of spontaneous miscarriages, which was 22.9% in smoking female anaesthetists and 17.2% in smoking female paediatricians. The gestation times in cases of both full-term pregnancies and miscarriages were shorter in the anaesthetist group than those in the paediatrician group. Congenital abnormalities appeared at an equal rate in both anaesthetist and paediatrician groups, but strikingly, there were nine musculoskeletal abnormalities in the anaesthetists' children compared to no such defects in paediatricians' children. Serious diseases occurred at low frequencies, but three cases of hepatic jaundice and three cases of viral myocarditis in anaesthetists indicate possible infectious hazards to health in anaesthetic work. Different infectious diseases to the respiratory and urinary tracts were commonest among paediatricians. Cancer was not reported in the anaesthetist group. The study does not indicate that gas pollution in operating rooms is harmful to the personnel.


Acute free perforation as first sign of Crohn's disease. Free perforation with generalized peritonitis remains a rare manifestation of regional enteritis. Most of these perforations occur as complications of recurrent, well-diagnosed regional enteritis. A review of the literature reveals only 14 recorded cases of free perforation in patients without any previous abdominal complaints. The present report describes two more cases. Both of them were treated by resection of the involved segment with immediate anastomosis.


[Agenesia of the gallbladder. Report of two new cases (author's transl)]. A propos 2 personal cases of a rare malformation, agenesia of the gallbladder, the authors reappraise the anomaly, of which the precise diagnosis is essentially surgical. They stress the frequency of associated malformation and the usefulness of operative exploration with cholangiography. There is no specific treatment for this condition. Draining the principle bile duct is warranted in case of choledocotomy.


Aorto-enteric fistula as clinical entity. A 19 year experience (1958-1977) with aortoenteric fistulas is presented. An aorto-enteric fistula is a direct communication between the aortic lumen and the gastro-intestinal tract producing a gastro-intestinal bleeding. The commonest cause of a primary or spontaneous aorto-enteric fistula is aneurysm formation. If there has been an operation on the aorta then the aorto-enteric fistula is called secondary. No primary aorto-enteric fistulas were encountered but thirteen secondary aorto-enteric fistulas are reported on a total of 841 aorto-femoral by-pass operations reviewed. Six hundred and sixty-one of these had an acceptable follow-up: this gives a 2% incidence. Our survival rate is 40%. Four different possible mechanisms are proposed for the formation of the secondary aorto-enteric fistula: anastomotic aneurysm formation, fibrous reaction, intra- or postoperative contamination or a combination of these possibilities. Some etiological factors as type of anastomosis, suture material, prosthesis material, hypertension, end-arterectomy and preoperative aneurysmatic tendency are analysed. A study is made of the different available diagnostic tools and the different possible therapies are discussed.


Early postsurgical bacterial contamination of the airways: a study on 28 open-heart patients. One pre- and two postoperative cultures of tracheo-bronchial secretions were obtained from 28 cardiac patients, subjected to open-heart surgery. Four patients received preoperative antibiotics, and all but one received postoperative prophylactic antibiotics. Preoperatively, only one patient had potential pathogens; after surgery (mean intubation time 4.2 h), four patients (14.3%) had organisms; and after 19 h of intubation, 28% of the patients had potential pathogens in their tracheo-bronchial secretions. Only three of the seven organisms recovered from the last sample were clearly sensitive to the antibiotics given prophylactically; and two of these organisms were Group A beta-haemolytic streptococci. The early presence of organisms in the airways after intubation, the high incidence of colonization, and the ineffectiveness of prophylactic antibiotics in preventing this contamination are pointed out. The factors that may possibly influence colonization of airways among these patients are commented on.


Althesin in neurosurgical patients: effects on cerebral hemodynamics and metabolism. The effect of althesin 0.5 ml/10 kg on arterial blood pressure, intracranial pressure, cerebral blood flow and oxygen uptake was studied on 19 occasions in 16 patients with varied cerebral pathology. Cerebral blood flow (CBF) was measured using the intracarotid 133xenon method and a 35-channel scintillation detector after cannulation of the internal carotid artery, the internal jugular bulb and the lateral cerebral ventricle. Arterial and intracranial pressures were recorded continuously. Blood gas tensions were measured in simultaneously drawn samples from the internal carotid artery and the jugular bulb. Cerebral oxygen uptake was calculated from the product of CBF and arteriovenous oxygen content difference. Control values were obtained with the patients under a basic general anesthesia, consisting of N2O/O2 pancuronium. The effect of a bolus injection of althesin was then studied 1 and 20 min after the injection. A significant reduction in intracranial pressure, cerebral blood flow and metabolism at 1 min was found to have essentially subsided 20 min after the injection. In patients with focal brain damage, regional flow analysis revealed a paradoxical increase in flow after althesin in the areas corresponding to the focus.


[Causalgia: Report of a case (author's transl)]. The authors present the clinical course of a 48 year old workman who developed a progressively extending pain, after having wounded his left second finger with a metallic rod at work. This pain increased despite multiple surgical and medical treatment, including repeated amputations of the segments of the finger and the resection of the corresponding neurovegetative chain. When, two years later, the patient is seen by the authors, psychological analysis clearly shows an imbalanced evolution since chilhood: the pain is a focussing of various physical disconforts. A neuropsychological treatment is started in accordance with the noted background and the pain subsides within a few weaks. The result is stabilized in many months of treatment. From this clinical case, the authors stress the often dominant influence of the mental state in pain in general, and more specifically is the so called causalgic pain.


A circle system without carbon dioxide absorption. An anaesthetic circle system without a carbon dioxide absorber is described. The efficiency of the circle, i.e., the fraction of alveolar gas in the outflow from the circle, was measured in 15 patients during halothane anaesthesia or neurolept analgesia. The fraction ranged from 0.88 to 0.95 (mean 0.91), while the ratio between the alveolar ventilation and the fresh gas inflow ranged from 0.97 to 1.71. The efficiency was not correlated to this ratio. There was no need for hyperventilation if the fresh gas inflow was 10% higher than the alveolar ventilation required to maintain normal PaCO2. The circle was used in 50 patients manually ventilated by nurse anaesthetists. Mean fresh gas inflow was 60 ml/kg. Mean PaCO2 was 5.47 kPa (41 mmHg). In a similar group of 50 other patients, in which the standard circle used in the department was employed, the mean PaCO2 was 4.80 kPa (36 mmHg). The frequency of hypercapnia was equal in the two groups, but hypocapnia was not seen when the circle without absorber was used.


Hemodynamic observation in relation to extensive surgical treatment of patients with increased operative risk. In 25 patients, considered high surgical risks according to clinical criteria, systemic and pulmonary hemodynamic parameters were monitored using a flow-directed pulmonary arterial thermodilution catheter before, during and after major vascular surgery. During and after the operation, hemodynamic complications were observed in 13 patients. The following conditions were dealt with: hypovolemia, increased systemic vascular resistance, and left ventricular failure in hypervolemia and in normovolemia. Tachy-arrhythmias seen in six of the patients were associated with left ventricular failure, hypovolemia or normal hemodynamics. Operation for renovascular hypertension and thoracolaparotomy carried the highest risk. Two of the patients died from primarily surgical complications.


Postanaesthetic postural stability following thiopental or propanidid anaesthesia. Using a quantitative Romberg-test performed on a computerized force-plate-system, postural stability was tested in 39 patients before and 3 hours after general anaesthesia with either thiopental (20 patients) or propanidid (19 patients). Sway-tendencies in the sagittal and the transversal direction were recorded. Comparing pre- and postoperative test results, patients anaesthetized with thiopental had a decreased postural stability 3 hours after anaesthesia, indicated by a significantly (P less than 0.05) increased sway-tendency of 22.6% in the sagittal direction. No change occurred in sway-tendency in the transversal direction in this group. In the propanidid group no significant differences were found between pre- and postoperative test results.


Effect of pain on human psychomotor performance. The effect of pain on human psychomotor performance was measured in seven healthy volunteers after an intramuscular injection of vitamin B or saline using a controlled cross-over method. Vitamin B, causing moderate to severe pain, or painless saline was injected into the buttock at a time when the subjects' performance was impaired after an intravenous injection of diazepam (0.3 mg/kg). The subjects' psychomotor performance was tested before and 2, 3, and 4 h after diazepam (before, 15 min, and 1 h 15 min after the vitamin B and saline injections). The effects of the vitamin B injection on the subjects' divided attention, reaction or co-ordination skills or their ability to discriminate the fusion of flickering light did not differ from the corresponding effects of the saline injection. The results suggest that pain as such does not have any major influence on human psychomotor performance.


[Anterior falcate artery in the adult].

[Anterior falcate artery in the adult]. The anterior falcate artery (arteria falcea anterior) represents the continuation of the anterior ethmoidal artery. In the adult, it has been described previously only in its rostral portion, which supplies the falx cerebri. In the present study, however, it is shown that there exists a continuation which runs in the parietal dura of the superior sagittal sinus and which unites with the frontal branch of the middle meningeal artery at the border between the frontal and parietal bones. In addition, the anterior falcate artery, by means of arterioarterial connections, is associated with the nearby branches of the frontal ramus that supply the frontal dura. The anterior falcate artery, mostly paired, is furnished with cross-connections. Venae comitantes are absent from the parallel-running main branches. In occlusion of the ophthalmic artery, the anterior falcate artery, due to its connections with the middle meningeal artery, may be significant in the establishment of a collateral circulation to the orbit.


Innervation of the carotid body. An experimental quantitative study. The innervation of the carotid body in the cat was studied by means of light- and electron-microscopic techniques. Sinus nerve resection, glossopharyngeal resection, bilateral cervical sympathectomy, excisions of two nerves, and injection of 6-hydroxydopamine (6-OH-DA) were performed in different groups of animals. It was found that resection of the sinus nerve produces a rapid phase of degeneration of intralobular fibers and synaptic boutons, followed by a reinnervation with a progressive reappearance of these elements. This reinnervation is retarded by sympathectomy and prevented by 6-OH-DA. It is therefore concluded that reinnervation is due to collateral regeneration of nearby sympathetic fibers. Resection of the sinus nerve produces an increase in the number of argentaffin cells and dense-cored vesicles in the cytoplasm of principal cells. These findings suggest the existence of efferent synaptic contacts between this nerve and principal cells. Part of the intralobular fibers and synaptic boutons degenerate after bilateral sympathectomy demonstrating that sympathetic axons connect synaptically to the principal cells. Sympathetic fibers reach the carotid body, not only from branches of the cervical plexuses but also from fibers running in the adventitia of the common carotid artery, and via glossopharyngeal and sinus nerves. The vagus nerve contributes a few fibers to the parenchymal lobules of the carotid body.


Neuro-histochemical study of the adrenal gland of Rattus rattus rufescens (Indian black rat) as revealed by cholinesterase technique. The present investigation was undertaken to study the innervation and acetylcholinesterase (AChE) distribution in the adrenal gland of Rattus rattus rufescens (Indian black rat) by cholinesterase technique. The percentage of myelinated nerves in the cortical zone (cortex) and medulla zone was high. AChE-positive and multipolar ganglia on the outer medulla region, and the ganglia and nerve cells, arranged in chain-like fashion in the chromaffin tissue, were recorded. AChE activity was marked in the cortical zone (in the form of spots) and in the medulla zone (in the form of white and black grains).


[Testis and ovary in a didactic histological and terminological comparison]. The so-called sex glands are not glands but germ hives. The germ cells are surrounded by nurse cells which alone build the tubulus or follicle epithelium (spermio- and oonutricytes). In the testis there is being differentiated between intra- and extratubular blood-germ cell barriers. The sperm cells should ultimately be called spermiocytes, the egg cells no longer be confused with the egg. The 4 germ cell generations and their 4 developmental phases in both organs are compared point by point. The interstitial cells are named andro- and gynocytes for considered reasons. The search for suitable names promotes knowledge and teaching.


Electron microscopy of lymphatics of the porta hepatitis. The ultrastructure of the lymphatics of the porta hepatitis at the junction with the liver parenchyma has been examined. The lymphatics are composed of endothelium composed of flattened cells containing occasional mitochondria, pinocytotic vesicles and nuclei. The cells are bound by maculae adherentes, zonulae occludentes and desmosome-like structures. There are occasional fibers between endothelium and underlying collagen. Occasional pores closed by diaphragms are present. There is very little basement membrane. There is no definite communication with the spaces of Mall and Disse, but the lymphatic lumens are separated from these areas only by the junctional processes, which may be permeable. Lymphatics are present only in collagenized portal areas and not in the liver parenchyma proper.


Limbic projections to the cat thalamus. A horseradish peroxidase study. Retrograde axonal transport of horseradish peroxidase was used to identify the afferent projection systems of the anterior thalamic nuclei in the cat. The results indicate that fibres projecting to the three anterior nuclei of the thalamus arise from the hippocampal region, septum and cingulate cortex unilaterally and from the hypothalamus (mamillary nuclei) both bilaterally and unilaterally. The cells of the medial mamillary nuclei send their axons to the ipsilateral AV and AM nuclei whereas the lateral mamillary nucleus projects bilaterally to the AD nuclei.


[New system for the preservation and storage of anatomical matter]. The authors introduce a new system of preservation and storage of anatomical material. The system accomplishes the following demands: (1) avoidance of fungi on section material, (2) alternative application of various preservation fluids, (3) utmost flexibility of storage capacity, (4) clearness and easy control, (5) elimination of unpleasant smell, (6) smallest possible need of staff and (7) low working expenses.


Histochemical studies on the peroxidase localization in the rat ovary and uterus during various reproductive stages. A histochemical study has been made of peroxidase changes in rat ovary and uterus during different developmental stages of the normal and pregnant rats. The peroxidase was found to be present in the corpus luteum of the ovary of both normal and pregnant rats as well as in the allantochorionic placenta, while the growing follicles in the immature and mature rat ovary showed no activity. The possible physiological significance of the peroxidase changes in relation to luteal steroidogenesis has been discussed.


Psychomotor epilepsy and psychosis. I. Physical aspects. In a controlled investigation the clinical findings in 96 patients with paranoid/hallucinatory psychosis and partial epileptic seizures with complex symptoms, were compared with the findings in 96 control patients with the same type of epilepsy without psychosis of median 24 years' duration. The median age at onset of psychosis was 34 years, after epilepsy of median 21 years' duration. The seizure frequency of complex, partial seizures was significantly lower in the psychotic group, while the frequency of generalized seizures did not differ. A significant preponderance in the psychotic group of left-handed patients, etiological factors and neurological signs reflecting organic damage, and seizures of automatic behaviour indicates that epileptic psychoses are caused by structural lesions affecting the deep parts of the temporal lobe.


Psychomotor epilepsy and psychosis. II. Electroencephalographic findings (sphenoidal electrode recordings). The EEG findings in waking, sleep, and sphenoidal electrode recordings in 96 patients with partial epileptic seizures with complex symptoms, who, after a median interval of 18 years developed paranoid/hallucinatory psychosis, were compared with the findings from a group of patients without psychosis, who had had the same type of epilepsy in median 24 years. There were no significant differences between the two groups with regard to median age at onset of epilepsy or complex partial seizures, age, or duration of epilepsy at time of examination. The psychotic patients had a significant preponderance of temporal medio-basal spike foci, recorded on the sphenoidal electrode, indicating deep temporal lobe dysfunction as an important factor in the pathogenesis of psychosis. A significant higher frequency of bilateral and multiple spike foci, together with a significant frequency of slow-wave admixture to the waking background EEG activity, indicated more extensive and severe epileptogenic lesions in the psychotic patients. There was no correlation between psychosis and unilateral EEG-foci in either temporal lobe.


Demonstration of cerebrospinal fluid lymphocytes sensitized against virus antigens in mumps meningitis. Virus-induced proliferation of cerebrospinal fluid (CSF) lymphocytes and blood lymphocytes was studied in patients with mump meningitis and in patients with aseptic meningitis of other etiology. In four out of five patients with mump meningitis the proliferation of CSF lymphocytes after mumps virus stimulation was higher than obtained with the corresponding number of blood lymphocytes. No proliferation was registered when lymphocytes from patients with other aseptic meningitis were stimulated with mumps virus. These data indicate the occurrence in CSF of lymphocytes specifically sensitized against mumps virus in patients with mumps meningitis.


Hereditary myelopathy of Afghan hounds, a myelinolytic disease. A disease described previously as hereditary necrotizing myelopathy and myelomalacia was studied in four Afghan hounds. Light and electron microscopic investigation revealed sieve-like degeneration of spinal white matter. Despite extensive spongiform degeneration of myelin that progressed to micro- and macro-cavitation, substantial numbers of axons were preserved. This canine myelopathy was compared and contrasted with various toxic/metabolic conditions including subacute combined degeneration.


Hypoplasia of hemispheric white matter, peculiar pallidal changes and dysplastic inferior olives in a child with psychomotor retardation. A 25-month-old child with nonprogressive psychomotor retardation is described. Symmetrical hypoplasia of hemispheric white matter with an apparently intact cortex was a major finding. Maternal trauma to abdomen at 25 weeks of gestation was probably implicated in precipitating the condition. Also, changes resembling hypertrophy of the inferior olives were found in the pallida and were associated with dysplasia of the inferior olivary nuclei. There were other findings to suggest that the pallidal and olivary changes were secondary to deafferentation.


Dysmyelination of the central nervous system in the Chow-Chow dog. Five Chow-Chow dogs from three different litters had generalized body tremors since birth. Histologically a severe myelin deficiency was found in the central nervous system. The peripheral nerves were normally myelinated. Electron microscopically abnormally thin myelin sheaths and completely naked nerve fibers were found. There were many astrocytes in the myelin deficient areas as well as cells with the characteristic features of oligodendrocytes but also containing fibrils. The present cases are compared to other dysmyelinating diseases and possible pathogenetic mechanisms are discussed.


A morphologic study of opportunistic cerebral toxoplasmosis. The morphology of toxoplasma and its interaction with the cellular elements of the brain were studied in a patient who dies of extensive cerebral toxoplasmosis superimposed on Hodgkin's disease. The cerebral lesions were devoid of inflammatory cellular response and contained numerous organisms mostly in isolated multiplying forms in neurons, glia and vascular walls. Encysted forms containing multiplying organisms were seen infrequently. Intracellular parasite was identified in normal-appearing neuropil. The mode of multiplication and cyst formation of toxoplasma appeared basically similar to that described under experimental conditions. In addition, a rapid evolution of the cerebral lesions was suggested by computerized tomography. This study suggests that tissue necrosis in human cerebral toxoplasmosis is the result of an increased rate of multiplication and enhanced cellular invasiveness of the parasite most likely related to impaired cellular immunity as has been postulated by clinical and experimental data.


The spreading of focal brain edema induced by ultraviolet irradiation. Focal brain edema limited to one cerebral hemisphere was produced by ultraviolet irradiation of the exposed cortex. Tissue water content was determined by the gravimetric method which allows microsampling. Therefore, the spread of edema around the small necrotic area could be mapped more precisely than by determination of dry weight which calls for larger samples. As early as 30 min following irradiation, hyperemia and swelling of the brain are observed under the operating microscope. This correlates with venous stasis, hyperemia, and broadened perivascular spaces around venules and large capillaries accompanied by a marked rise in the specific weight of the tissue. After 4 h an edema front can be observed spreading from the perinecrotic zone in which there is a marked rise in endothelial cell vesicular activity. Edema reaches maximum levels in the deep white matter at 48 h post irradiation with normalisation of the tissue water content after 96 h. The velocity at which the edema front spreads from the cortex to the periventricular area lies in the range of 0.25 mm/hr. Edema reabsorption coincides with signs of retrograde micropinocytosis in endothelial cells.


Ventral porencephaly: a cerebral defect associated with multiple congenital anomalies. An infant with multiple congenital anomalies was found at autopsy to have a porencencephalic defect on the ventral surface of the left frontal lobe. The intracranial defect was seen in association with an anomalous configuration of the circle of Willis. The zone of tissue destruction corresponded to the vascular territory of the anterior choroidal and lenticulo-striate branches of the proximal middle cerebral arteries, which were absent on the left. The developmental anomaly of the circle of Willis may have predisposed to tissue destruction by compromising cerebral perfusion at midgestation, a stage of rapid brain growth.


DNA alkylation and neuro-oncogenesis by 3,3-dimethyl-1-phenyltriazene. The role of DNA alkylation by the neurooncogenic agent 3,3-dimethyl-1-phenyltriazene (DMPT) was investigated perinatally and in adult rats. Following a single subcutaneous injection of 14C-DMPT (100 mg/kg) on the 21 day of gestation, the concentration of methylated purines was similar in both fetal liver and brain whereas during postnatal growth this treatment resulted in an increasingly preferential methylation of liver DNA. In 30-day-old and adult rats the concentration of 7-methylguanine in liver was about 8 times higher in brain DNA, suggesting that during prenatal development both liver and brain DNA are transplacentally methylated by a proximate carcinogen produced by maternal organs. Multiple doses of 14C-DMPT (50 mg/kg) to adult rats led to a preferential accumulation of O6-methylguanine in cerebral DNA. This supports the hypothesis that the deficient repair excision capacity of the hypothesis that the deficient repair excision capacity of the central nervous system is a significant factor in the organ-specific carcinogenicity of DMPT and related carcinogens.


Tumor specific fluorescent and complement-dependent cytotoxic antibodies in the serum of rats with chemically induced brain gliomas. Brain tumors were induced in Sprague-Dawley and Long-Evans rats by administration of N-methyl-N-nitrosourea in the drinking water. Of these tumors, a grade 2 mixed glioma, a grade 2 to 3 astrocytoma and a grade 1 to 2 oligodendroglioma were established in vitro, maintained in culture and designated 75SD-G-376, 75SD-G-420 and 77LE-G-180, respectively. Of these mass cultures, two were successfully cloned and are currently available as 75SD-G-376C and 75SD-G-420C cell lines. Clonal lines produce S-100 protein and grow as tumors when isografted in young rats. Using the cultured cells as target cells , specific antibodies were searched for in the sera of the rats with the primary tumors by means of an indirect fluorescent antibody staining method and a complement-dependent antibody-mediated microcytotoxicity assay. Fluorescent and cytotoxic antibodies were demonstrated in the sera of the mixed glioma- and astrocytoma-bearing animals. However, a variable proportion of cells of the 75SD-G-376 and 75SD-G-420 lines showed no reaction with the corresponding sera. Furthermore, cytotoxic antibodies had a lytic effect on the autologous glioma cells only in the presence of rabbit complement.


Some contributions of electron microscopy to the diagnosis of brain tumors. Selected examples of neoplasms of the central nervous system are reviewed in which the electron microscope has been instrumental in establishing the diagnosis. These include ependymoma, ependymoblastoma, epithelial cyst, paraganglioma in the cauda equina and cerebellar neuroblastoma.


Barriers of peripheral nerve towards exogenous peroxidase in normal and protein deprived rats. The protective barriers of the sciatic nerve in protein deprived and normal rats have been studied. Horseradish peroxidase (HRP) was applied extra-neurally in rats aged between 4 and 26 weeks. The spread of the tracer was investigated 2 h, 24 h, and 3 days after application. Passage of tracer into the endoneurium was found in all rats but decreased with age. Within the endoneurium, HRP was phagocytized by normally occurring endoneurial histiocytes, which constitute part of the protective barrier system of peripheral nerves. The functional development of the nerve protective barriers was retarded in protein deprived rats. Observations made in this study support the concept of a transperineurial vesicular transport of macromolecules.


The effect of extraction of the intrafascicular contents of peripheral nerve trunks on perineurial structure. The intrafascicular contents have been extracted from the tibial nerve of the rabbit through perineurial incisions. Within 6--8 days following this procedure, the perineurial cells separate from one another, become dissociated from their basement membranes and assume a fibroblast-like appearance. The intrafascicular space becomes populated with endoneurial fibroblasts. With the ingrowth of regenerating axons, bundles of axons and associated Schwann cells become surrounded by cells of fibroblastic appearance which undergo perineurial transformation resulting in the development of multiple small fascicles. The cells of the surrounding perineurium appear to reassume a lamellar organization and to reestablish contacts with each other with the formation of junctional complexes. It is therefore suggested that neural structures may be responsible for the development and maintenance of the structural organization of the perineurium.


Quantitative analysis of voluntary muscles from routine autopsy material with special reference to the problem of remote carcinomatous changes ("neuromyopathy"). Specimens from the deltoid muscle of 210 randomly selected autopsy cases without previous clinical evidence of primary neuromuscular impairment were examined with regard to the influence of extramuscular diseases on voluntary muscle. Differences between malignant tumours and other disorders were of special interest with respect to the question of the possible existence of a remote effect of cancer on skeletal muscle. The number of central nuclei within muscle fibre cross sections was considered as the most simple parameter for myopathic reaction. Atrophic fibre changes were examined quantitatively by measurement of the orthogonal fibre diameters and calculating the variation of fibre size. In addition, a semi-quantitative histological evaluation of the muscles was performed. While tumor cases did not show a significant difference from the remainder with respect to myopathic changes, they did display a significant difference with regard to scattered and small-group fibre atrophy. The reasons for the muscular changes are discussed. From the present investigation the changes seem to be due chiefly to metabolic impairment and wasting. No signs for a specific carcinotoxic effect on skeletal muscles could be demonstrated.


[Myelinopathy due to carbon monoxyde poisoning. A study in ultrastructural neuropathology (author's transl)]. A 24-year-old woman was found comatose after 2 days of cephalalgia and vomiting. An immediate diagnosis of carbon monoxyde poisoning was disclaimed when blood carbon monoxyde was found to be 1.75 ml/100. A diagnosis of acute intracranial hypertension led to trephination with ventricular punction and brain biopsy on the third day. The patient died on the eleventh day. Ultrastructural study of biopsy tissue showed nearly normal cortex, and injured white matter, with disrupted or destroyed myelin and pycnotic oligodendroglia in contrast with nearly normal axons, astrocytes, and capillaries. Autopsy showed a typical semioval center myelinopathy. After discussion of the histotoxic, vascular, and edema theories for myelinopathy pathogenesis, primary oligodendrogial lesion is considered, and correlated with the diphasic evolution often observed in the course of carbon monoxyde myelinopathy.


Changes of the ratio between myelin thickness and axon diameter in the human developing sural nerve. Axon caliber and myelin sheath thickness of individual nerve fibers were evaluated in the developing human sural nerve using three different methods of measurement: 1. ocular micrometer evaluation of large fibers, 2. photographic enlargements for evaluating large numbers of nerve fibers of all sizes, and 3. electron microscopic enlargements for more precise measurements in selected nerves. The average axonal diameter doubles from 5 months gestation to about 5 years of age. Large fiber group axons increase, during the same period, by a factor of 3--3.5 with a slight decrease thereafter. The myelin thickness increases more slowly, but continuously, between 5 months gestation until the age of 14. This asynchronous development of axons and myelin sheaths results in a statistically significant change of the ratio between axonal caliber and myelin thickness. The slope of the regression line is steeper in older than in younger individuals, and the correlation coefficient increases during development of the nerve.


Contribution to the histology of tick-borne encephalitis. The light microscopic changes of the first human case in which electron microscopic identification of the virus was successful, are described. They are compared with the findings accepted in the literature as characteristic of tick-borne encephalitis. Although meningeal and intracerebral infiltrations were partly connected, the process cannot be regarded as a meningoencephalitis. The choroid plexus remained free from infiltration. The discontinuous inflammatory process was severe in the cerebral cortex in the pre-central region, further in the temporal lobe, and became even more accentuated in the amygdaloid nucleus. Reduction in the number of nerve cells could be ascertained chiefly in the motor cortex. The tick-borne encephalitis belongs to the group of disseminated polioencephalitides with predilection site in the brain stem, all of them caused by ribonucleic acid viruses, irrespective of whether the virus belongs to the families of Picorna-, Toga-, or Rhabdoviruses. Within this histologically outlined group the individual entities possess distinctive traits. The significance of the anoxic-vasal factor in the process formation is displayed on the instance of some traits of the histological pictures.


Gross vascularization of experimentally induced transplanted tumors of the central and peripheral nervous system. Subcutaneously and intracerebrally transplanted neurinomas as well as intracerebrally grafted gliomas, both derived from primary tumors with resorptive carcinogens were investigated after injection of micropaque by conventional histologic methods and by postmortem X-ray analysis. Growth pattern and vasculature were similar in subcutaneously and intracerebrally transplanted malignant neurinomas. The most common feature was a parallel arrangement of vessels as shown by microradiography and vessel free zones. In intracerebrally grafted glioma, the growth of tumors was confined to or starting from the ventricular system. Sinusoidal vessels, capillary proliferations and proliferation of vessel wall were found. The outstanding feature was the occurrence of extravascular contrast deposits, thus indicating the vulnerability of tumor vessels and frequency of hemorrhages into these tumors.


Chronic relapsing experimental allergic encephalomyelitis: CNS plaque development in unsuppressed and suppressed animals. Central nervous system (CNS) lesion morphology has been studied in inbred Strain 13 guinea pigs sensitized for chronic relapsing EAE in which the disease was either left to develop (unsuppressed) or was suppressed with injections containing myelin basic protein (MBP). Pathologic changes correlated well with clinical activity. In unsuppressed chronic EAE animals, active clinical disease was invariably matched by acute inflammation in the CNS. In more chronic states, the CNS displayed fibrosis and remyelination while relapses showed the CNS to contain recent changes superimposed upon old lesions. In animals in which the disease was suppressed by injections of MBP, clinical signs did not develop. However, some early subclinical changes were seen morphologically. These lesions were able to remyelinate early on and there was no progression in lesion formation. Apparently, therefore, MBP had a beneficial effect upon the course of the disease and had promoted structural repair.  It thus appears that MBP therapy might be one effective approach for the prevention of chronic relapsing EAE. The findings should prove relevant to future MBP trials in multiple sclerosis.


Ultrastructural cytochemical demonstration of peroxidase-positive monocyte granules: an additional method for studying the origin of mononuclear cells in encephalitic lesions. Unlike lymphocytes, blood monocytes possess in their cytoplasm peroxidase-positive (azurophil) granules (ppg) which largely correspond to the homonymous organelles of neutrophil granulocytes. We tested whether ppg, demonstrated cytochemically at the submicroscopic level, could serve as markers of monocyte-derived reactive mononuclear cells in encephalitic lesions. Samples of cerebrocortical tissue from adult albino mice with experimental yellow fever virus encephalitis were incubated in a medium containing diaminobenzidine and H2O2 for localization of peroxidatic activity. Mononuclear cells exhibiting ppg were found (1) in the lumen of brain venules, (2) in different stages of migration through the walls of such vessels, (3) in perivascular areas, (4) in the glioneuropil, either loosely scattered or forming small clusters, (5) in a satellite position to neurons, and (6) in leptomeningitic inflitrates. Several mononuclear elements harboring ppg had assumed an elongated, rod cell-like outline. Amongst the peroxidase-negative mononuclears were fully developed brain macrophages and elements showing morphologic features characteristic of activated lymphocytes. Most mononuclear cells without ppg resembled the peroxidase-reactive ones. The results of this study provide direct evidence in favor of a monocytic origin of, at least, numerous reactive mononuclear elements in encephalitic lesions. The approach followed in the present study is not suitable for quantitative investigations of the histogenesis of mononuclear cells responding to brain injuries, since emigrated blood monocytes rapidly lose their ppg, particularly, when they display enhanced phagocytic activity.


Encephalitis following vaccination against distemper and infectious hepatitis in the dog. An optical and ultrastructural study. A 4-month-old, male, healthy dog developed CNS-symptoms 10 days after the second vaccination with live, attenuated distemper and canine hepatitis virus. The animal was euthanized after 2 weeks of illness. Light and electron microscopic examination of the CNS showed a partly necrotizing encephalomyelitis with numberous intranuclear and intracytoplasmic inclusion bodies, and the presence of probable pseudomyxovirus nucleocapsids and of crystalloid and tubuloreticular aggregates. Although there was conformity of inclusion bodies and probable viral structures as revealed by electron microscopy, the latter showed a much wider distribution. In addition, viral structures of a different type were found in polymorphonuclear leukocytes and vascular endothelial cells. Several morphological criteria led to the supposition that they are Picornaviruses, or possibly Arenaviruses. It is thought that their role in the disease process was at best an indirect one.


Larsen's syndrome.

Larsen's syndrome. A girl with the characteristic abnormalities of Larsen's syndrome is presented. A soft flabby consistence of the cartilaginous skeleton of the larynx and trachea was thought to be the cause of attacks of respiratory failure which suddenly caused her death at the age of 9 months. Microscopy revealed a considerably reduced number of elastic fibres in the larynx, trachea and bronchi. Closed reduction of the knee dislocation by skin traction seemed to be successful.


Recurrent ulnar nerve dislocation at the elbow. Report of a non-traumatic case with ulnar entrapment neuropathy. An unusual case of habitual recurrent ulnar nerve dislocation at the elbow is described. The case was complicated by non-traumatic ulnar entrapment neuropathy interfering with the patient's profession as a musician (cello).


Abduction contracture of the shoulder. A report of two patients. Two cases of winged scapulae due to fibrosis of the deltoid muscle are reported. The fact that these two patients were healthy and well prior to injections suggests that intramuscular injeciton is the causative factor. Treatment by simple division is satisfactory.


Lumbar intervertebral disc herniation in the young. A survey of 37 young patients, 10 to 18 years of age, with lumbar intervertebral disc herniation is presented. Local physical findings and limitation in straight-leg raising are often more marked in the young than in adults, whereas pain may be slight or even absent. Neurological findings were normal in 40 per cent of the cases, and when deficits were found, they were usually of a minor nature. Herniated disc syndrome in children and adolescents is characteristic and should not be difficult to recognize. With surgical treatment good results were obtained in nearly all cases.


Pyogenic spondylitis.

Pyogenic spondylitis. During the period 1972-1974 10 patients suffering from pyogenic spondylitis have been treated at the Central Hospital of Middle Finland. Three of the patients had become acutely ill with septic fever and back pain. In the remaining cases the onset of the disease was insidious. Fever, weight loss and fatigue were the general symptoms. Percussion revealed local tenderness at the site of infection in all patients. Two patients showed neurological signs. The ESR was elevated in all cases and alkaline phosphatase was elevated in six patients. Blood culture was positive in those three patients who had become acutely ill. Narrowing of the intervertebral space was observed in all patients. Scanning with Tc99 was performed in nine patients, seven of whom were at an early stage of the disease; a significant uptake was recorded in five of these cases. The average interval between the onset of symptoms and the diagnosis was 3 months, range 1 to 5 months. The treatment consisted of bed rest and antibiotics. All the patients recovered and became symptom-free.


Hemipelvectomy. Postoperative rehabilitation assessed on the basis of 41 cases. Rehabilitation was evaluated on the basis of 41 consecutive hemipelvectomies for malignant tumours. Owing to early metastasization and death, 11 patients were not supplied with prostheses, while prosthetic fitting was attempted in the remaining 30. Of this number 27 completed prosthetic training, with the result that 15 used their prosthesis, while 12 discarded it after some time, six because of poor general health owing to recurrence of the tumours and six because they felt that the prosthesis was too heavy and difficult to wear. Twenty-three returned to work. After elimination of the most severely tumour-affected patients, there were 19 one-year survivors without recurrence. Thirteen of them were using their prosthesis every day, and thirteen had gone back to work. Serious mental sequelae were found in five patients, including four with long-lasting exogenous depressions and one with anxiety neurosis.


Impacted fractures of the femoral neck treated by early mobilization and weight-bearing. Among 280 patients with femoral neck fractures 46 were classified as having impacted fractures according to the criteria mentioned below. The treatment of patients with impacted femoral neck fractures was determined to be mobilization with partial weight-bearing from the first day of admission. Among the 42 patients successful in immediate mobilization there were eight whose fractures disimpacted. Three cases of avascular necrosis were recorded but no cases of non-union. In order to determine the predictive signs of secondary dislocation the X-ray findings were subjected to statistical analysis. The inclination of the fracture line, dislocation into a valgus or varus position and the presence of retroversion did not influence the tendency to disimpaction. More than 80 per cent of the fractures healed without disimpaction.


Methylmethacrylate hypersensitivity in orthopaedic surgery. The sensitivity to methylmethacrylate monomer in 25 patients undergoing orthopaedic surgery was studied. No relation could be found between the cardiovascular reactions observed during the cementation of the femoral prosthesis and the complement system, investigated by measuring the serum concentration of the haemolytic complement, components 3 and 4.


Experiences with total hip replacement arthroplasty ad modum ring. The results of total replacement of the hip joint ad modum Ring are presented. The review includes 63 hips (from among the total number of cases operated by the various methods) followed up for periods ranging from 6 months to 5 years. The assessment has shown excellent results in 33.3 per cent, good results in 50.8 per cent, fair in 9.5 per cent and poor results in 6.4 per cent. Advantages and disadvantages of the method are discussed.


Demonstration of rotatory instability in injured knees by stress radiography. Rotatory instability of injured knees may be demonstrated by stress radiography by recording the different movements of the medial and lateral tibial condyle at pull or push with the knee in 90 degrees flexion. The displacements of the condyles are expressed in millimetres, not degrees. Comparison with the healthy knee is always used. The displacement of a tibial condyle has to exceed 3.0 mm in relation to the healthy knee to be defined as pathological. If the movements of both condyles exceed the movements in the healthy knee by more than 3.0 mm in the same direction a drawer sign is present--if only one of them moves, an abnormal rotation is present. When a drawer sign is present there may still be a greater displacement of one of the tibial condyles which means a rotatory instability added to the drawer sign, designated a complex rotatory instability. All types of rotatory instabilities, simple and complex, are defined and discussed, in relation to the classification of Nicholas, Trickey and Slocum & Larson. Forty-one cases of abnormal rotation were demonstrated in this series by stress radiography. The direction of rotation and the type of instability are described and compared with the operative findings. The findings are in agreement with those of the above-mentioned authors and the experimental work of Warren et al.


Pseudochondromalacia patellae.

Pseudochondromalacia patellae. A condition causing knee pain with retropatellar crepitus similar to chondromalacia patellae is described. The symptoms seem to be due not to chondromalacia of the patella, but to a local synovial thickening proximal to the articular surface of the medial femoral condyle. Thirteen patients, aged 10 to 21 years, were operated upon because of this condition, three of them bilaterally. In most of them the changed synovial membrane was excised. The operation in eleven of the knees was followed by considerable or complete relief. Of the remaining five knees, three were temporarily improved.


Asymmetry of plantar flexion strength in the foot. A study of plantar flexion strength and calf circumference in 30 conscripts is submitted. It showed an asymmetry of strength amounting to 6--11 per cent (95 per cent confidence limits). The right leg was significantly stronger than the left, but there was no difference in strength between the dominant and non-dominant leg. There was little correlation between circumference and strength.


Haematopoietic stem cells (CFUc) in human cord blood. Colony forming units (CFUc) giving rise to myelocytic colonies in methylcellulose cultures were found among non-adherent mononuclear cells of human cord blood with a frequency of one in 1678. The number decreased makredly during the first 8 to 10 days of life. They were rarely detected in adult blood by this technique.


Childhood cancer in Sweden, 1958-1974. I. Incidence and mortality. All cases of tumours and tumour-like conditions in children 0-14 years reported to the Swedish cancer registry during the period 1958-74 have been studied. The material consists of 3797 individuals on file in this registry. The most common cancer diagnoses in children 0-14 years are leukemia and tumours of the central nervous system (together constituting approximately 58% of all cases). Almost half of the cancers affect children below five years of age. The lowest incidence occurs in the ages 7-8 years, and the highest occurs during the first year of life. The types of tumours below one year of age show a different distribution than in any other age groups. A significant increase in the incidence of childhood cancer occurred, while the mortality rates showed a slight decrease during the period studied. A remarkable increase in the incidence figures was noted concerning tumours of the nervous system, especially in boys. The decrease in the mortality rates was most obvious regarding Wilms' tumour, and leukemia in children 0-4 years of age.


Mannitol osmolar clearance in diabetes insipidus of children. A modified technique of amnnitol-induced diuresis is described, in order to assess renal concentrating ability in infants and children. The infusion of 10% mannitol in 0.9% saline avoided the hypertonic saline overload and the fluid restriction period, both badly tolerated by infants and small children. In a control group of children aged from two months to seven years, the values of T(H2O) plotted against C(OSM) allowed to calculate the adjustment curve y=0.80x0.75, r=0.98 (p is less than 0.0001). In six patients with pituitary diabetes insipidus (PDI), the test was used in order to quantify the degree of ADH deficiency and evaluate the carbamazepine and clofibrate effect, in the renal concentrating mechanism. The test was tolerated perfectly in every case, obtaining qualitative and quantitative data and avoiding the hyponatremia and hypokalemia produced by the mannitol.


Frequency of psychotropic drug prescribing for children in Tampere, Finland. The purpose of the present study was to determine the frequency with which psychotropic drugs are prescribed for children under 10 years of age in outpatient care in Finland. This frequency was estimated from the reimbursements paid by the Social Insurance Office of Tampere City in 1974. Every third psychotropic drug prescribed for children born in 1965-74 was included. This resulted in 319 children with 375 psychotropic drug prescriptions. About 4% of children under 10 years old in the Tampere area had received within one years's time one or more psychotropic drugs in outpatient care. About half of the psychotropic drugs were prescribed by general practitioners. Sedatives were the most frequently prescribed drugs, especially in the younger are groups. Antidepressants and antiepileptics were common in the older age groups. The most commonly specified indications were fever and restlessness.


Growth, body weight and insulin requirement in diabetic children. The weight and height development of 51 boys and 48 girls who had developed diabetes prior to the age of 15 years was followed for a minimum of 3 years, mean 8.3 years, up to the age of 18 for the girls and 20 for the boys. In addition, the insulin requirements were recorded. Weight and height proved to be within the normal range, and height at onset of diabetes was normal. After a long duration of diabetes, however, there occurred a reduction of height increment of obout 1/2cm/year. This reduction was greater in children who rarely attended as compared with those who frequently attended a sub-specialized clinic. The daily dose of insulin increased with age, the greatest increase coinciding with the growth spurt. During the first 4 years of diabetes the 24-hour dose/kg body weight increased, indicating a decreasing endogenous insulin production. Later it was constant at around 0.9 i.u./kg. Modern management of diabetic children leads to normal adult stature.


Vitamin E requirements of preterm infants. Differences between feeding practices in earlier investigations prompted the present study of iron and vitamin E supplementation in breast milk fed preterm infants. A new and highly sensitive technique for quantitation of alpha-tocopherol in serum was used. Studies on 34 infants with a birth weight below 2000 g or gestational age less than or equal to 35 weeks showed that supplementation with 16.5 mg tocopheryl acetate/day from 10 days of age resulted in a significantly higher haemoglobin concentration and lower reticulocyte count at 8-10 weeks than supplementation with 1.5 mg/day (p is less than 0.05). Studies on 23 infants with a birth weight of 2000-2499 g revealed subnormal alpha-tocopherol levels in 2 of the infants given 1.5 mg tocopheryl acetate/day but there was no effect on the haemoglobin concentration at 8-10 weeks. There were no untoward effects of an early iron supplementation with 2-3 mg Fe++ (as ferrous succinate)/kg/day. It is concluded that extra supplementation with vitamin E is advisable also in breast milk fed preterm infants. A low dosage iron supplementation from 3 weeks of age is safe.


Does overnutrition or obesity during the first year affect weight at age four? 226 of 243 infants who took part in a prospective study of nutrition and weight during the first year of life were reviewed at age 4 years. 23 of 243 infants (9%) were obese on one or more controls the first year, and 4 of 226 (2%) at age 4 years. Only 3 of 23 infants remained obese. The weight and length of the children obese at 0-1 year of age were significantly increased at age 4 years. Overnutrition occurred during the first year in 26 infants and the number of obese infants in this group was significantly increased at age 7-12 months and of overweight children during the first two years of life. At age 4, however, none of them were either obese or overweight.


On cerebral infarction in childhood and adolescence. This report is based on a retrospective analysis of clinical and angiographic findings in 14 children and adolescents suffering from cerebral infarction. They were all examined during the acute stage and selective angiography was performed within a day or two of the stroke. Pathogenesis is discussed and focuses particularly on the occurrence of segmental arteritis from unknown (infectious?) aetiology.


Physical health of ten-year-old children. An epidemiological study of school children and a follow-up of previous health care. At 10 years of age, all 223 children in a school district underwent a physical examination and a screening for vision and hearing defects within the school health services. The purpose of the study was to detect health problems of importance for the day-to-day functioning of the child. In 26.1% significant deviations were found. Physical disorders comprised 11.7% visual defects 11.7% and auditory impairment 2.7%. The vast majority of significant health problems were previously known and in only 4.4% of the 223 children newly detected, 0.9% by the physical examination, 2.7% by the vision screening and 0.9% by the auditory screening. The most frequent health problem of all was allergy in 13.5%, in 5.4% regarded as functionally important. Minor orthopaedic deviations and motor disturbances were common but not often considered to affect the functioning of the child significantly. As a whole, the children's health was very good and the outcome of the physical examination at this age was not impressive. It is evident that the physician's role in the school health system needs to be reconsidered.


Synovectomy as a prophylactic measure in recurrent haemophilic haemarthrosis. Follow-up of 23 cases. Because of frequently recurring haemarthrosis which could not be controlled by conservative management 19 haemophiliacs were subjected to synovectomy on a total of 23 joints--17 knees, 5 elbows, and 1 hip. The patients were followed for an average of 23 months. Primary postoperative complications occurred, in the form of recurrent bleeding, in 8 joints. Rehabilitation was often difficult and long-lasting, and the range of joint motion  was essentially restricted in 4 cases. After a follow-up period exceeding 6 months the findings in the remaining, mobile 19 synovectomized joints were: 12 had been relieved of haemorrhage, 5 had rare and two frequent haemorrhages. The reduction in the number of haemorrhages was significant (p is less than 0.01). In the light of the complicated postoperative course it is concluded that synovectomy should be used only on strict indications, viz. only in otherwise intractable cases of progressing haemophilic arthropathy.


Transient erythroblastopenia in childhood. A study of 15 cases. A survey is presented of 15 patients from the Aurora Hospital and 35 patients reported in the literature with transient erythroblastopenia of childhood (TEC). The children were hospitalized because of pallor and tiredness, some of them having signs of mild infection. They displayed normochromic anaemia, reticulocytopenia and erythroblastopenia during the severe stage of the disease. In addition, they had moderately high values for serum iron and iron-binding saturation. No other haematological, chemical or cytogenetic abnormalities could be demonstrated. 80% of the children were between 6 and 48 months old and the sexes were equally affected. In the 15 patients from the Aurora Hospital a barely significant (p=0.02-0.05) association with blood group A was recorded. Remission, indicated by a rise in the reticulocyte count, begins within a week after the diagnosis is made, even without treatment. The aetiology of the disease is unknown. Analysis of the red blood cell population at the time of diagnosis indicates that damage to the red cell precursors has occurred 2-3 months before the child is brought for examination.


Kawasaki disease in Kuwait. A report of two cases. Kawasaki disease was first reported in Japan in 1967. Since then, it has been reported from the United States, South Korea, Greece, Canada, Australia, Scandinavia and Scotland. Two cases of Kawasaki disease are presented from Kuwait and believed to be the first report of the disease from the Arab world.


Malformation of the great vein of Galen with neonatal heart failure. Report of two cases. The clinical and patholgoical findings in two neonates with the malformation of the great vein of Galen are given. They both reported with serious neonatal heart failure suggesting congenital heart disease. In one of them cardiac catheterization revealed a foetal pattern of circulation causing cyanosis. A bruit and in one of them a thrill over the skull gave the clinical diagnosis of an intracranial arteriovenous aneurysm. They died 48 and 144 hours after birth in spite of medical treatment. The outlook for patients having malformation of the great vein of Galen and suffering neonatal heart failure treated conservatively, seems hopeless.


The absence of factor II in a child with systemic lupus erythematosus. This report describes a patient with active system lupus erythematosus (SLE), who developed haemorrhagic diathesis due to a lowering of plasma factor II activity. No evidence was found suggesting a plasma inhibitor of factor II. The present case indicates that in some patients with SLE, factor II activity may be low or completely absent due to impairment of factor II synthesis, further that prednisone, but not azathioprine, may ameliorate this defect.


Natural history of juvenile rheumatoid arthritis. A follow-up study of a case with special reference to clinical, electroencephalographic and neuropathological findings. A detailed comparison between the clinical and EEG findings is made in a case of a boy with juvenile rheumatoid arthritis (JRA) who died at 15 years, 6.5 years after the beginning of the follow-up period. In the course of the disease, seven EEG recordings were made, showing a progressive diffuse slowing and disorganization with some improvement during short remissions. In relapses, diffuse slowing was associated with grave asymmetries in the EEG which, however, fluctuated and later disappeared without accompanying clinical or neuroradiological abnormalities. An abundancy of different residual findings, however, remained in the EEG after relapses. There were spike-and-wave paroxysms in every record except at the terminal stage. A stepwise slowing and disorganization was also seen in these paroxysms as background activity. The final cause of death was an intraventricular haemorrhage. No cerebral amyloidosis was found at autopsy. In conclusion, it is suggested that JRA is also a brain disease manifested as a cerebral vasculitis.


Mechanism of the formation of megamitochondria by copper-chelating agents. IV. Role of fusion phenomenon in the cuprizone-induced megamitochondrial formation. Megamitochondria were induced within 36-40 hours in mouse hepatocytes by injecting cuprizone into the peritoneal cavity. Induction of megamitochondria was dependent upon the amount and the time intervals of the injection of cuprizone: 200 mg of cuprizone/kg of body weight-injected every 12 hours or 400 mg of cuprizone/kg of body weight-injected every 24 hours. When the latter amount of the noxious reagent was administered to the animal every 12 hours, fatty changes of the liver was observed. Involvement of the fusion phenomenon in the mechanism of megamitochondrial formation is discussed in the light of turnover rates for various components of the mitochondrion.


Pathological study on amyloidosis--relationship of amyloid deposits in the aorta to aging. Senile aortic amyloidosis in 224 autopsy cases over 40 years was investigated comparing cardiac and pancreatic amyloidosis in them. A total of 176 cases of aortic amyloidosis was found for an average incidence of 79%. Under the 5th decade the incidence was 51% and it rose sharply with age and reached 95% in over the 8th decade. The incidence of cardiac amyloidosis also increased with age, but it was always higher in the aorta. Aortic and cardiac amyloid were both positive in the DMAB method for tryptophan. The major part exposed to amyloidosis in the aorta was the media. The medial amyloid consisted of numerous minute deposits and had no relation to atherosclerosis. Some comments about the pathogenesis of senile amyloidosis were also mentioned.


A study on the melanin-laden dendritic cell (melanocyte) in ovarian cystic teratoma. To confirm the existence and to analyse the distribution of the melanocyte in cystic teratoma of the ovary, 51 cases were collected, among which 47 were found suitable for gross and histological examinations. The tissue components of cystic teratoma where the melanocyte was seen more or less associating were; the squamous, cuboidal and columnar cell epithelia especially the epidermal epithelium, the brain tissue principally the leptomeninx, and the interstitium. The frequency of melanocytes' association in the respective tissue was shown and compared between each other. One thing which was quite interesting for us was the relationship between the existence of brain tissue and the development of melanocyte in cystic teratoma. The melanocyte appeared in the above tissues, especially the interstitium, of cystic teratoma more frequently when the brain tissue was coexisting in the same tumor. These findings seem to be of meaningful suggestions concerning the melanocytogenesis not only of cystic teratoma of the ovary, but also in a physiological condition in man.


Function of phagocytosis and intracellular killing of peripheral neutrophils in Kawasaki disease. NBT (Nitroblue Tetrazolium) test was performed in 17 patients with Kawasaki disease to examine the function of phagocytosis and intra-cellular killing of neutrophils. The value was high compared to other pediatric patients. Activation with Proteus OX-2 antigen before NBF test showed a significant higher level than other proteus antigens, which correspond in serum level. With previous electronmicroscopic observation of rickettsia-like body in biopsy specimen, these findings suggest the existence of an agent in Kawasaki disease which shares antigenicity with Proteus OX-2.


A pathological study of dissecting aneurysm in individuals under forty years of age including a case of a 13 years old boy. The author has investigated grossly and microscopically 12 cases (5 males and 7 females) of dissecting aneurysm in individuals under 40 years of age, autopsied during the last 6 years at the Tokyo-to Medical Examiner Office. They composed of 6 cases of Marfan's syndrome, 3 cases of obesity, and one case each of pregnancy, aortitis syndrome, and male pseudohermaphroditism, respectively. The 6 cases other than Marfan's syndrome were also thought to belong to the Marfan group from the gross and microscopic examinations of the aorta. As to the cases of dissecting bleeding of the aorta, Erdheim's idiopathic cystic medial necrosis was as a rule authentical up to date, but the author has never observed the bleeding within the cysts which were said to be formed due to accumulation of metachromatic ground substance. On the contrary, the medial bleeding occurred always in the weakened area in where the elastic fibers were disrupted and disappeared accompanying with the diminution of metachromatic substance. The author assumed that the diminution of metachromatic substance might be the most important etiologic factor of dissecting bleeding of the media and the extension of dissection might occur along such weakened foci of the media.


The effect caused by the double condition of potassium loading and simultaneous sodium restriction on the glomerular zone of rats. Histochemical and ultrastructural study. The effect caused by the double condition of potassium loading (K loading) and simultaneous sodium restriction (Na restriction) on the glomerular zone of rats is reported. After 2-week-diet of K loading and simultaneous Na restriction an increase of width of glomerular zone and decreases and micronization of fat granules were seen. Enzymic activity (glucose-6-phosphate dehydrogenase, steroid 3beta-ol-dehydrogenase) was increased. After 3-week-diet of the same condition the width of glomerular zone became 1/4 to 1/5 of the whole cortex. The cells in the glomerular zone demonstrated a trabecular arrangement. Ultrastructurally, hypertrophy of cells became marked and the size of cell was about 1.5 times that of normal cells. Dense body increased in number and became irregular in shape. In the widened cytoplasm, smooth endoplasmic reticulum and Golgi apparatus were well developed with numerous coated vesicles. Changes of mitochondria such as increase in number, transformation into round shape and vesicular cristae were characteristic. The severity of these changes was proportional to the duration of K loading and simultaneous Na restriction. After 8-week-diet the increase of large-sized lipid vacuole and dense body, and intramitochondrial deposition were observed in parallel with the above-mentioned changes. The changes observed in this study appeared earlier and stronger than those in the single-conditioned group of only K loading or Na restriction. The cause of these changes were considered to be a result of accelerated function of the glomerular cells.


Thromboplastic and fibrinolytic activities of V2 and V7 carcinomas of rabbit, with special reference to fibrin deposition and thrombus formation in the tumors. Thromboplastic and fibrinolytic activities of V2 and V7 carcinomas, the two transplantable rabbit tumors of the same viral origin, were studied in relation to fibrin deposition and thrombus formation in the tumors. Thromboplastic activity of V7 carcinoma was comparatively high, while that of V2 carcinoma was as low as that of muscle tissue. More fibrin deposits in the stroma and more thrombi in the small vessels were found at the advancing border of V7 carcinoma than that of V2 carcinoma. These differences might be associated with higher thromboplastic activity of V7 carcinoma than that of V2 carcinoma. Fibrinolytic activity of both tumors was high and it was confirmed to be localized in the tumor cells by Todd's method. Fibrin deposits in the stroma were found more abundantly somewhat apart from the advancing border of the tumor nests of both tumors. It was suggested that plasmin activated by plasminogen activator released locally from the tumor cells might digest fibrin deposited in the stroma just close to the tumor nests.


A family of Gardner's syndrome with report of an autopsy case. A family with Gardner's syndrome including one autopsy case is reported. A 22 year-old man had multiple polyposis of the colon and the small intestine, epidermal cysts, soft part tumor of the abdominal skin and osteomas in the calvarium and rib, and died of a carcinoma in the transverse colon and embolism of the brain. Histologically, all polyps were diagnosed as adenomatous polyp. The greater their diameter, the higher the tendency of atypism was observed. However, the polyps around the cancer were few, small, and with low atypism, and we could not obtain evidence showing direct transformation of adenomatous polyps into carcinoma. His two elder brothers had multiple polyposis of the colon, epidermal cysts and osteomas in the calvarium or mandibular bone, but are still alive.


Idiopathic pulmonary ceroidosis.

Idiopathic pulmonary ceroidosis. An autopsy case of diffuse pulmonary ceroidosis was presented in a 55 year-old man who had died suddenly. Autopsy, revealed noteworthy findings only in the lungs. Light microscopically, brown pigmented cells were proved to diffusely proliferate in the pulmonary tissue, particularly in the alveolar spaces. Histochemically, intracytoplasmic accumulation of ceroid-like pigment was confirmed in the majority of the pigmented storage cells. Hemosiderin-laden cells were less frequent or rare. Ultrastructurally, numerous osmiophilic inclusions delimited by a single membrane were present in the cytoplasm of the storage cells. No evidences of any basic disorders to induce such a pulmonary ceroidosis were detected at autopsy. From these findings, this case should be called "idiopathic pulmonary ceroidosis". In reviewing the literature, such a peculiar pulmonary disorder has never been recorded to date. Pathological distinction of this disorder from various pulmonary hemosideroses was discussed.


Median rhomboid glossitis associated with amyloid deposition. There are some controversies over the pathogenesis and clinical features of median rhomboid glossitis. A case of median rhomboid glossitis associated with amyloid deposition was presented. Clinically there was no organ involved in amyloid other than the tongue. It was suspected that median rhomboid glossitis occurred first and that amyloid was induced later.


Glomerular lesions in multiple myeloma.

Glomerular lesions in multiple myeloma. An autopsy case of multiple myeloma (IgG, lambda type), clinically characterized by decreased glomerular filtration rate, is reported with particular emphasis on changes in the glomeruli of kidneys. Histologically, the glomeruli revealed slight increase in mesangial matrix and focal thickening of tuft capillary wall. Electron-microscopically, deposits were observed in a subendothelial location in the glomerular capillary walls, and inclusions were noted in the cytoplasm of the visceral epithelial cells. Histoimmunofluorescent study of the kidney demonstrated intense focal and slight diffuse positivity against labelled antisera of anti-IgG and anti-lambda type of light chain on the capillary wall of the glomerular tufts. Other immunoglobulins were not demonstrable in capillary walls. These findings represent the intraglomerular deposition of paraprotein of multiple myeloma without amyloidosis.


Hughes-Stovin syndrome. Report of a female autopsy case and review of the literature. A 37-year-old female with multiple pulmonary aneurysms, thrombotic obstruction of the inferior vena cava and mural thrombosis in the right heart was reported. Arterial blood culture repeatedly examined had been negative. The patient died of massive hemoptysis. This case was equivalent to Hughes-Stovin syndrome and was the first female case of typical Hughes-Stovin synrome. Review of the literature revealed 9 typical cases of this syndrome and 5 atypical cases who had solitary intrapulmonary aneurysm. It was obscure whether the typical cases were essentially different from the atypical ones or not, but the cases with solitary pulmonary aneurysm might proceed to the cases with multiple ones, as shown in this case. Pathogenesis of the syndrome has been controversial. In the present case, development of pulmonary aneurysms seemed to be closely related to thromboembolization derived from venous thrombosis due to artificial abortion.


Effects of sodium salicylate on plasma insulin concentration and fatty acid turnover in dogs. The effects of intravenous sodium salicylate administration on plasma concentrations of insulin, free fatty acids (FFA) and glucose were studied in intact, anaesthetized dogs both during basal and isoprenaline stimulated lipolysis. In both situations sodium salicylate reduced the plasma concentrations of insulin. The reduction was associated with decreased plasma FFA concentrations and FFA turnover rate, while plasma glucose concentrations remained unaltered. The reduced plasma insulin concentrations effected by sodium salicylate is most likely secondary to the concomitant fall in plasma FFA concentrations due to inhibition of FFA mobilization from adipose tissue.


Regional changes in structural and functional integrity of myometrial adrenergic nerves in pregnant guinea-pig, and their relationship to the localization of the conceptus. Pregnancy is accompanied by a reduction in uterine noradrenaline, and the study was undertaken to investigate associated structural and functional integrity of the sympathetic nerves in the organ. The formaldehyde-induced fluorescence of adrenergic nerves was studied in different uterine regions before and after in vitro incubation or injection with alpha-methyl-noradrenaline in pregnant and puerperal guinea-pig uterus at 6 time periods, from early pregnancy (about 20 days post coitum) to 3 months post partum. The changes were related to the position of the fetuses, which were often present in only one of the two uterine horns. There was a drastic loss of fluorescent adrenergic nerves in myometrial tissue from horns distended by fetuses. Attempts to restore this fluorescence by incubation or injection with alpha-methyl-noradrenaline were essentially ineffective. Tissues from uterine regions outside (and not distended by) fetuses (in the case of early pregnancy), from horns devoid of fetuses (in the case of unilateral pregnancy), and from the cervix also lost their noradrenaline-fluorescent nerves, but this occurred at a much later stage of pregnancy. After treatment with alpha-methyl-noradrenaline, a fluorescent plexus of sympathetic nerves could be restored to a considerable extent in these latter tissues. In puerperal animals the horn that had been devoid of fetuses regained its endogenous fluorescence much faster, and the uptake of alpha-methyl-noradrenaline was more efficient, than in the horn which had contained fetuses. In this latter horn clear signs of restoration of endogenous adrenergic fluorescence and a clear uptake capacity was not found until 3 months after delivery. In the tubal end of the uterus, the reduction in the number of fluorescent nerves was only insignificant, and the region thus clearly differed from the rest of the uterus. It is concluded that (1) there are clear regional differences with regard to the disappearance of the noradrenaline transmitter in the uterus, (2) this disappearance in early pregnancy is related to the position of the conceptus, and (3) the changes involve de- and regenerative phenomena as well as alterations in transmitter levels of intact neurons.


The postnatal development of the inferior oblique muscle of the cat. I. Isometric twitch and tetanic properties. The postnatal development of the inferior oblique muscle in the cat has been studied with physiological and histochemical techniques. This paper describes the changes with age in isometric twitch and tetanic response characteristics. The twitch amplitude increased and the twitch contraction time (ct) and half-relaxation time (hrt) decreased almost linearly from birth to adulthood. The relation between the strength of nerve stimulation and twitch ct and hrt changed during development with a threshold slow response appearing at 10 weeks. Twitch responses in cats 6 weeks of age or older were of longer duration than in younger cats, in spite of the longer ct and hrt in young cats. Fusion frequency of the tetanic response reached a constant level in muscles 6 weeks or older. The maximum rate of tension rise remained the same from birth to 6 weeks of age and later increased markedly up to 20 weeks of age. The contracture induced by succinylcholine was the same in muscles of all ages. These data were related to previous findings on the postnatal development of fast and slow muscles and motor units in the hindlimb of the cat. A differentiation of the development of fast and slow eye muscle fibers is suggested. Slow fibres seemed to have completed their maturation at about ten weeks of age, while the development of fast fibre properties continued, probably up to the adult stage.


The postnatal development of the inferior oblique muscle of the cat. II. Effects of repetitive stimulation on isometric tension responses. The changes with postnatal age in post-tetanic potentiation (PTP) and fatigue of the inferior oblique muscle have been studied in the cat. PTP of the twitch amplitude increased steadily with age up to 20 weeks after birth. Twitch contraction time (ct) and half relaxation time (hrt) was not significantly changed. The potentiation of the tetanic response also became more prominent with age. The young muscles (10 weeks and below) were slightly more susceptible to fatigue than older muscles, but recovery was rapid in muscles of all ages. Intensive stimulation induced post-tetanic depression of twitch responses in muscles older than 1 week, but none in the muscles of new-born cats. Ct and hrt were greatly prolonged in muscles above six weeks of age. In these muscles, but never in the very youngest, repetitive firing could be observed in response to post-tetanic single nerve stimulation. The results are compared with those obtained in similar experiments on hind-limb muscles by other workers. They further support the idea, raised in a previous paper, that slow eye muscle fibres develop quicker and reach maturity earlier than fast fibres.


Pharmacological properties of curare-sensitive receptors mediating post-tetanic potentiation in rat masseter muscle. Post-tetanic potentiation (PTP) of single muscle twitches after "tetanic" stimulation at 1 to 20 Hz in rat masseter muscle has been studied. PTP was inhibited by d-tubocurarine (2--6 microgram/kg), hexamethonium (1.75--2.25 mg/kg), succinylcholine (5--7 microgram/kg), prostigmin (1.0--1.5 microgram/kg), lidocain (3--4 mg/kg) and ouabain (215--240 microgram/kg). The doses did not affect the control twitches. Prostigmin could not reverse the blocking effect on the PTP caused by these drugs. Atropin was without any effect on the PTP. The nicotinic receptors mediating PTP differ from both end-plate and ganglionic receptors since drugs blocking both types of receptors are effective. The sensitivity to the blocking agents is higher or the same (in the case of hexamethonium) as for the two other types of nicotinic receptors. Thus the PTP is dependent on activity of a "nicotinic" receptor active during physiological conditions, suggesting the presence of an additional mechanism for neuromuscular transmission in rat twitch fibres.


Maintenance of lactose secretion during acute insulin deficiency in lactating goats. Induction of alloxan diabetes in 5 lactating goats resulted in reduced milk yields in 3 of the animals, while the yield was unchanged in two. After treatment of the diabetic goats with insulin for 4--5 days--the last 24 h intravenously--lactose secretion returned to the control values before alloxan administration provided that normoglycemia developed. In 2 experiments infusion of a large dose of insulin caused hypoglycemia and a 20--30 per cent reduction in lactose secretion rates. In the course of 1 h after withdrawal of the insulin infusion, patent signs of insulin deficiency developed as evidenced by steadily increasing plasma glucose concentrations. Nevertheless, lactose secretion continued at the same rate as during insulin infusion for the 4 h studied after discontinuation of the insulin infusion. In the goats where lactose secretion was reduced due to insulin-induced hypoglycemia, lactose secretion returned to control values when following discontinuation of insulin infusion the plasma glucose concentrations increased into normal and diabetic ranges. It is concluded that during insulin deficiency of short term duration, mammary lactose secretion was maintained at a normal rate. Since lactose is the major product of mammary glucose utilization, it is suggested that glucose uptake in the mammary gland was not reduced by short term insulin deficiency.


Morphology and contraction properties of cat lumbar back muscles. The gross morphology, innervation pattern and contraction properties of lumbar back muscles in the cat were investigated. The medially located multifidi and interspinales are formed by short bundles interconnecting adjacent vertebrae. Laterally located bundles composing longissimus and iliocostalis are attached to the spinous processes by a fascial layer and to the pelvic bone by a well developed intermuscular septum. Different spinal segments innervate the various sections along the muscles in such a way that the myotomes composing a muscle belly seem to be arranged after one another, in a row. The contraction time of a maximal isometric twitch is 34 ms for multifidi and interspinales and 29 ms for longissimus and iliocostalis. No large segmental variations of contraction times were found. The time course of twitch responses and a study of reflex contractions in middle and lower sections of lateral muscles indicate the presence also of a slowly contracting portion located to the longissimus. The initial muscle length is more decisive for the twitch amplitude of medial than of lateral muscles. In medial muscles summation of individual twitches starts at a stimulus frequency of 10--15 Hz and apparent fusion occurs at about 50 Hz. For lateral muscles corresponding values are 15--20 Hz and about 70 Hz. The contractile tension declines markedly in all muscles during a 10 min period of stimulation at 5 Hz.


Pseudocyesis.

Pseudocyesis. The psychiatric literature on pseudocyesis (false pregnancy) is reviewed and four new cases are described and discussed. The psychopathological significance of insecurity feelings is discussed and it is formulated that an insecurity-produced non-conscious motive aiming at an important benefit contributes to the strong wish for a child shared by all four patients with pseudocyesis. Attention is drawn to the fact that the condition may relapse as shown in one case, or precipitate a severe depressive illness as demonstrated in another. It is emphasized that prompt diagnosis, full support and responsible and tactful handling are essential in dealing with a condition as delicate as pseudocyesis. The need for close cooperation between gynaecologist, psychiatrist and psychiatric social worker is stressed.


Cognitive processes and cognitive progresses as didactic tools in psychiatry. The authors expose the characteristics of two methods about the teaching and the learning of Psychiatry. Hermeneutic method is based on the model: "this want to say that". It gives rise to rapid and diffused learning which are rarely personalized and it attributes activity to the teacher and passivity to the pupil. "Conjectural" method is based on the model: "this is one of the aspects of a polymer of significances that we may point out as probable conjecture and not as truth". It produces learning less rapid, less diffused but more personal. It attributes activity and passivity as to the teacher as to the pupil. The first method tends to provoke pathological dependence as proselitism and/or contest so the pupil difficulty may assume the heritage of the teacher by having idealized or killed him. The second method tends to form self-governing pupils able to break away from the teacher after having learned from him new knowledges which they use in a personal way.


Mortality in the long-stay population of all Dutch mental hospitals. A study of 1,506 deaths reported over a period of 2 years to the National Psychiatric Case Register of the Netherlands, on the total cohort of 17,211 long-stay patients counted on prevalence day (31 December 1969), showed very much higher death-rates than in the general population. Malignancy and cardiac disease were not so common, while respiratory disease was still common in inpatients.


Female virgin and nonvirgin psychological orientations toward premarital virginity. Literature on premarital heterosexual intercourse suggest increases in its incidence, frequency and acceptance among college-aged youth. Simultaneously, the studies suggest a decline in female premarital virginity. The present study was conducted to determine perceived psychological orientations toward premarital virginity of female virgins and nonvirgins. It examined the possibility of different orientations for different virgin or nonvirgin classifications and motivations. Results suggested significant differences between female virgins and nonvirgins among ten psychological orientation criteria.