Pseudoobstruction of the colon.

Pseudoobstruction of the colon. Pseudoobstruction of the colon is a specific variety of adynamic ileus. Its characteristic clinical presentation is severe cramping lower abdominal pain, a massively distended abdomen, and a characteristic x-ray picture. Thirty-five patients with this disease complex have been reviewed, and their surgical and medical therapy is discussed. Guidelines for continued medical versus surgical intervention are suggested. Two patients underwent decompression with the colonoscope. Its use and a possible hazard of the procedure are discussed. For those patients who develop pseudoobstruction after trauma or surgery, a pathophysiologic explanation is offered. The possible role of prostaglandin abnormality in the genesis of pseudoobstruction is also discussed.


Temporary cardiopulmonary bypass for the treatment of endotoxic shock. New Zealand white rabbits were employed in the laboratory to evaluate the efficacy of temporary cardiopulmonary bypass in the prevention of pulmonary injury from endotoxin. Partial cardiopulmonary bypass using peripheral cannulation was carried out for 15 minutes after intraarterial administration of E coli endotoxin of LD90 doses. A significantly better long-term (1 month) survival rate of the treated animals (60 per cent) versus the untreated animals (10 per cent) as well as less severe pulmonary changes in those that succumbed after treatment were observed. It would appear that temporary cardiopulmonary bypass by peripheral cannulation warrants further study in the treatment of patients identified early as suffering from otherwise irreversible septicemic shock.


Carcinoma of the extrahepatic bile ducts: a ten year experience in Hawaii. A ten year review (1966-1975) of extrahepatic bile duct carcinoma in three major Honolulu hospitals is presented. Fifty-seven patients satisfied the criteria for the study. The disease occurs predominantly in the Japanese population. Survival of patients with upper third lesions proximal to the cystic duct is poor, and all patients followed died within seventeen months of hospitalization or operation. In patients undergoing bypass procedures for lower third (intrapancreatic) lesions, palliation averages ten months. The Whipple operation, performed in fourteen selected patients with favorable lesions, affords palliation averaging twenty months, and five patients were long-term survivors, including two with five year cures. However, morbidity and mortality for the Whipple procedure is high. Methods for improving palliation in upper third lesions and lowering morbidity and mortality from pancreatoduodenectomy are proposed.


[Respiratory depression after fentanyl and antagonism by naloxone (author's transl)]. The postoperative respiratory depressant effect of fentanyl in combination with flunitrazepam (Rohypnol) was assessed in awake and in unconscious patients. In awake patients respiratory function was measured with blood-gas analyses. For measurements in unconscious patients the administration of nitrous oxide/oxygen was continued postoperatively and the respiratory depression was judged from the increase in respiratory minute volume after the i.v. administration of 0.05 mg naloxone (Narcan). In the group of awake patients blood-gasvalues were within the normal range after anaesthesia with flunitrazepam (1 mg) and fentanyl (0.80 mcg/kg body weight/10 min anaesthesia; last fentanyl given 40 min before the end of the operation), and the administration of naloxone was without any effect. If, however, naloxone was given while the patients were kept under light nitrous oxide/oxygen anaesthesia, the effect was different. The respiratory minute volume was considerably less than its predicted value in all groups of patients having received fentanyl, and naloxone caused a marked increase in respiratory minute volume and in respiratory rate. In a group of patients which have received no opiate but enflurane, naloxone showed no effect. After premedication with pethidine as compared with flunitrazepam the effect of naloxone on ventilation was more pronounced. This marked difference in the postoperative effect of fentanyl on ventilation depending on the state of consciousness has to be attributed to an interaction between a residual respiratory depressant effect of fentanyl and the effect of unconsciousness. Since after the combined use of flunitrazepam and fentanyl deep postoperative sleep occurs quite frequent, a residual effect of fentanyl should always be antagonized with naloxone to protect the patients from a possible hazardous effect of this interaction.


[The effect of naloxone and levallorphane following fentanyl on the blood gases, EEG and psychodiagnostic tests (author's transl)]. After administration of fentanyl, 0.15 mg naloxone or levallorphan or placebo were given several times and in increased doses and at same intervals of time to six volunteers. The experiment has been done after the rules of a double blind study. Naloxone has shown its superiority to levallorphan. The study demonstrated a faster and better action of naloxone in the way of a return to initial conditions of respiratory frequency, blood gases, and EEG. The concentration and attention faculties after naloxone have become clearly better in contrary to the results after levallorphan. At the end of an anaesthetic procedure, the greatest care should be given to the patient. First of all effective antagonism of the respiratory depression should be obtained without concomitant sedative and psychomimetic effects. The use of antagonists with agonist properties to reverse respiratory depression due to a morphinomimetic drug is not justified and so naloxone should supplant levallorphan.


Pharmacokinetics of pancuronium in patients with normal and impaired renal function. Plasma concentration curves of patients with normal and impaired renal function are fitted to a tri-exponential function according to an open three compartment pharmacokinetic model. A detailed discussion of the relationship between theoretical distribution volumes, clinical pharmacodynamics and morphological or biochemical structures provides the basis for the concept of a central application and measuring compartment, a pharmacologically specific compartment and a non specific one. The distirbution of pancuronium from the application compartment to the specific compartment results in the onset of muscular paralysis. The recovery is governed by renal elimination of the unchanged drug as well as by its redistribution into the non specific compartment. In anuric patients the spontaneous recovery after 3--4 h is the effect of redistribution only. Neither metabolic degradation nor increased biliary elimination can sufficiently compensate for the lack of the renal pathway. The clinician should always keep in mind that after the recovery from pancuronium-induced muscular paralysis, both in patients with or without renal pathology, considerable residues of the active drug are stored at nonspecific and even specific receptor sites for many hours.


[Haemodynamic effects after rapid infusion of dextrane in geriatric patients (author's transl)]. In 85 geriatric premedicated patients haemodynamic effects were investigated following rapid infusion of 500 ml dextrane. The data measured one day preoperative revealed typical age-related changes of the cardiovascular system: decrease of cardiac output, stroke volume and heart rate; increase of peripheral vascular resistance and mean arterial pressure. After infusion of dextran central venous pressure rose by 4.9 mm Hg (mean), mean arterial pressure by 7.5 mm Hg (8.5%) and cardiac output by 1.04 1/min (24.3%). Heart rate alterations were insignificant, but total peripheral resistance decreased significantly by 12.5%. Pulmonary capillary pressure rose to 15.4 +/- 3.4 mm Hg. We conclude that it is possible to increase cardiopulmonary efficiency by extracardiac measures preoperatively even in aged patients. In no case critical left- or right ventricular filling pressure exceeded, so we cannot accept the often expressed warnings against induced hypervolaemia in patients with no cardiac failure except old age.


The thymus of Nu/+ mice.

The thymus of Nu/+ mice. At one month, the thymus weight of NMRI mice heterozygous for the Nu gene was lower than that of the wild type. However, the thymic structure was normal and no significant anomalies at the ultrastructurallevel could be found either in epithelial cells or in thymocytes. Stereologic data showed that the loss of weight was only due to a decrease of the lymphoid population, whereas the absolute number of epithelial cells was unmodified. Several hypotheses that could explain the reduced number of thymocytes were discussed.


The timing and sequence of events in the development of the human digestive system and associated structures during the embryonic period proper. A documented scheme of the early development of the human digestive system is presented. It is based on (1) reports of workers who personally studied staged embryos, and (2) personal observations and confirmations. The necessity of studying staged embryos in order to determine the precise sequence of developmental events is stressed.


On the migration of myogenic stem cells into the prospective wing region of chick embryos. A scanning and transmission electron microscope study. In chick embryos undifferentiated myogenic stem cells migrate from the ventrolateral somite respectively dermatome edge into the prospective wing region after the second day of incubation. At first, single cells that are elongated in mediolateral direction, later also small groups of cells, are found in the space between somites and somatopleura at the wing bud level. The leading ends of the migrating cells are formed like finger-shaped lobopodia as well as flattened lamellipodia from which thin filopodia arise. The main structural features of the cell processes are microtubules and microfilaments predominantly oriented parallel to the long axis of the cells. The filopodia are found to be in close connection with the surrounding network of collagen fibrils. Since the main strands of the fibrils show a mediolateral orientation, it may be assumed that the direction of cell migration depends on the arrangement of the collagen fibrils.


A quantitative approach to cytoarchitectonics. I. The areal pattern of the cortex of Tupaia belangeri. The cortical map of Tupaia belangeri, evaluated with an automatic quantitative procedure using the Micro-Videomat (Zeiss), shows a well differentiated allocortex and periallocortex with 19 areas, and proisocortex and isocortex with 20 areas. The boundaries of the different areas are based on quantitative differences and the areal pattern of the cortex is, in most cases, compatible with physiological results found in the literature. Tupaia belangeri has a cortex which is largely dominated by primary and secondary sensory areas in its iscortical part and by the impressive visual system. The well differentiated allo- and isocortex show conditions more similar to prosimians than to insectivores, especially when considering the occurrence of primary and supplementary regions. Quantitative analyses of the separate areas with a higher resolution (Zilles et al., in prep.) are necessary in order to provide a basis for further comparative investigations of the Tupaia cortex.


The stress at the human atlanto-occipital joint. I. the development of the occipital condyle. The development of the occipital condyle has been observed in human fetuses, neonates, children, and juveniles. In contrast to some authorities, the authors believe the occipital condyle to originate from the basioccipital and the exoccipital of the occipital bone. The bony parts of the condyle are divided by the synchondrosis intraoccipitalis anterior. The rostral area on the basioccipital occupies about one-fourth to one-seventh of the surface of the subchondral bone. The sequence and mode of ossification of the synchondrosis intraoccipitalis anterior has been investigated. A causality between the synchondrosis and the occasionally observed subdivisions of the articular surface in the adult does not exist.


Some observations on the development of the human hyoid bone. Investigations on the human hyoid bone in several developmental stages reveal that with the chondrification of the mesenchymal blastema a typical interzone between the body and the greater cornua is formed. This disc of closely packed blastemal cells, distinct and broad in the earlier stages, is reduced in thickness in the course of further development. In fetuses between 5 and 6 months old and in newborns the formation of joint cavities can be seen in some cases. In other cases, however, a small transverse line of cells persists between the two cartilaginous elements. These findings are interpreted as different developmental stages of a diarthrosis generally formed between the corpus and the cornu majus. The fact that in the adult the lesser horn is connected directly to the cornu majus and not to the body is confirmed by the embryological investigations reported in this study.


A liquor contacting area in the pineal recess of the golden hamster (Mesocricetus auratus). The wall of the third ventricle in the pineal recess of the golden hamster (Mesocricetus auratus) has been investigated by light and electron microscopy. Deep in the pineal recess, where the ependymal lining is thin and non-ciliated, clusters of pinealocytes protrude into the ventricular lumen. They force the ependyma apart so that their surface is directly exposed to the CSF, while basal processes extend towards the hypependymal pineal tissue. It is assumed that these cells may secrete melatonin into the CSF which is known to contain varying amounts of this hormone.


Effect of chronic centrifugation on bone density of the dog. Sixteen male Beagle dogs, 293 to 509 days old, were exposed almost continuously for 3 months to 2.0 G on a 7.9m radius centrifuge. The dogs were maintained on the centrifuge by means of a specially designed, automated waste disposal and life support system. Bone density was measured by a 125I Profile Scanner in the anterior, medial posterior and lateral cortex of the femoral mid-shaft. As compared to mean density in the femora of normal gravity controls, centrifuged dogs showed a 0.8% (P less than 0.05) lower mean linear absorption in their femora. However, the regression of density on the square-root of cross-sectional area/pi differs very significantly in the animals living at earth gravity and those living at hypergravity. Thin hypergravic bones are denser, thick hypergravic ones are less dense than the corresponding ones of normal gravity controls.


The relation of aberrant vasculogenesis to skeletal malformation in the hamster fetus. Oral administration of teratogenic doses of retinoic acid to pregnant hamsters on day 10 of gestation is associated with dysmorphogenesis of the appendicular skeleton. During the 24 h following retinoic acid treatment, the developing limb bud vasculature was disorganized, with blood vessels encroaching on areas where mesenchymal condensation of the skeletal blastemata normally occurs. Large, branching marginal folds and endothelial cell vesiculations protruded into the blood vessel lumina. It is suggested that the vascular changes observed may affect the concurrent early development of the skeleton and contribute to the skeletal malformation seen in near-term fetuses.


Changes in the mechanical properties or rat tail tendon during postnatal ontogenesis. The ultimate tensile strength, elasticity modulus and ultimate elongation of tail tendon in rats age 1-18 months were measured with an Instron tensile apparatus. An increase in all these parameters was observed during the period of maturation, with a later levelling off of the tensile strength and the ultimate elongation. The value of the elasticity modulus attained a maximum during sexual maturation, and then decreased and stabilized.


Endoderm regeneration in the chick embryo studied by SEM. Regeneration of the area pellucida endoderm of the chick embryo was studied by scanning electron microscopy (SEM). A new endoderm was formed by in situ changes in the shape and relationships of mesoderm cells. Initially the cells flattened and lost their processes except along cell boundaries. Later even these processes were lost and an epithelium was formed. The area of regenerated endoderm coincided with the area of mesoderm at the time of endoderm removal, confirming the mesodermal origin of the new layer. Remnants of the original endoderm did not contribute to the regenerated layer. Contact inhibition was observed at the boundary between original and regenerated endoderms.


The ependymal and glial configuration in the spinal cord of urodeles. The structural organization of the ependymal and macroglial components of the central field of the spinal cord of postmetamorphic ribbed newts has been reinvestigated using elaborate fixation procedures for transmission electron microscopy. All along the central canal, the ependymal cells display ultrastructural features that strongly suggest a secretory activity. Infrequent mitotic images, occurring spontaneously among the ependymal cells, were observed. The tightly compacted periependymal stratum contains two types of glial cells: 1. oligodendrocytes, also observed outside this stratum as neuronal satellites, and 2. radial astrocytic cells, whose somata, exclusively located in the periependymal stratum, send their processes to the subpial lamina. The intercellular relationships between ependyma, oligodendrocytes and astrocytic cells are illustrated to show the continuity of the neuroepithelial configuration. Morphologic clues for identifying the cells of the central field of the urodele spinal cord are given. A gradient of differentiation of the oligodendroglial components could be postulated. In normal conditions, the astroglial differentiation is permanently arrested at the stage of radial glia. Some considerations concerning regeneration in the urodele spinal cord are submitted.


The pterygoid and ectopterygoid in mammals. A dorsal pterygoid element and a ventral ectopterygoid element can be recognised during the development of monotremes, marsupials and eutherian mammals. Their homology with the elements so named in fossils ancestral to mammals can be established by positional evidence. In monotremes the elements remain distinct and show specialised features, including a hamular cartilage in the ectopterygoid of one specimen of Ornithorhynchus. In most higher mammals the pterygoid element is much reduced and is replaced anteriorly by the perpendicular plate of the palatine. Posteriorly the pterygoid element fuses with the ectopterygoid, in many cases before the onset of ossification. The hamular cartilage arises by chondrification within the ectopterygoid element and shows no sign of being a separate morphological entity, but must be regarded as a specialised feature associated with the architecture of the palatal musculature. There is a strong case for the value of recognising that the 'pterygoid process' of higher mammals includes both a pterygoid and an ectopterygoid moiety.


Development of adrenergic innervation of the iris and fluorescent ganglion cells in the choroid of the chick eye. The developing innervation of the chick eye has been studied using catecholamine histofluorescence. The innervation of the pupillary dilator by the superior cervical ganglion begins on day 13 of incubation when fluorescent axons can be seen in the ciliary zone circumscribing the dilator. On day 14 a few processes are seen to branch from this band into the dilator. The number of processes in the dilator increases on days 15 and 16. After day 16 there is a reorganization of the fibers radially accompanied by a moderate increase in the number of processes. In addition, a group of fluorescent cells can be seen in the choroid adjacent to the ciliary body. These cells are bipolar at day 9 and become multipolar by 12 days of incubation. These cells contribute to a fluorescent plexus of processes in the choroid which stops abruptly at the border of the choroid and ciliary zone. It is thought that they represent a terminal sympathetic ganglion receiving preganglionic input from the carotid nerve.


Distribution of surface coat material on fusing neural folds of mouse embryos during neurulation. Fusing and non-fusing regions of neural folds from mouse embryos were examined during neurulation for the distribution of extracellular macromolecules (surface coats) prior to and at the time of closure. Ruthenium red staining of 10th day ICR/DUB mouse embryos was used to detect the distribution of surface coat material. Light microscopic examination of fusing and non-fusing regions in the midbrain, hindbrain, and spinal cord showed a consistent increase in ruthenium red positive material immediately prior to closure. Heavy deposits of positive staining material were present along apical neural fold borders and overlying ectoderm cells. This staining pattern was consistent in the three regions examined, but the pattern of initial contact between opposing neural folds differed. In mid- and hindbrain areas contact was initiated by overlying ectoderm, whereas in spinal cord regions contact was first established by neuroepithelial cells. Once contact between opposing neural folds was initiated a decrease in stainable material was observed.


The effect of Marcaine on muscle and non-muscle cells in vitro. The effect of the local anaesthetic Marcaine on muscle and non-muscle cell types was examined using an in vitro assay. Each of the cell types examined (myotubes, myoblasts, fibroblasts and liver parenchyma) expressed morphological alterations when incubated in Marcaine-medium. Myotubes were the most sensitive of the cells studied and exhibited several pronounced membrane structural changes after short incubation periods in Marcaine-medium. The toxic effects of Marcaine were irreversible and the myotubes continued to degenerate despite being placed in fresh medium. Myoblasts and non-muscle cells, however, demonstrated a rapid recovery when removed from the Marcaine-medium. Since Marcaine is thought to complete with Ca++ for specific sites on cell membranes, it is proposed that the differential effects which were observed are dependent upon the level of calcium related activities being carried out by the cells.


Satellite cells of rat muscles as studied by freeze-fracturing. Satellite cells in rat muscles were studied by freeze-fracturing. They were found not to be fusiform but to have several narrow projections embedded in grooves of the muscle fibre membrane. Short projections of the muscle fibre covering the outer face of the satellite cells were observed as well. In the P-face of the cell membrane of satellite cells, membrane particles and caveolae were less frequently seen than in the P-face of the muscle membrane. Thus the surface of the satellite cells looked more smooth than that of the muscle fibres. Junctions between muscle fibre and satellite cell were not found. The presence of cytoplasmic extensions of satellite cells may suggest that these cells are motile.


Morphological studies on the adrenergic innervation of white adipose tissue. White adipose tissue was obtained from the mesentery, epididymis, omentum and subcutis of rats which were fed, fasted or fasted and then refed. Tissue samples were prepared using the glyoxylic acid method to detect adrenergic nerves by fluorescence histochemistry. Other tissue samples were fixed with an aldehyde solution containing sodium molybdate which is specific for catecholamine granules in nerve terminals. Thin and serial thick sections (0.25-0.5 micron) were viewed with a conventional electron microscope and with the high voltage electron microscope. With fluorescence microscopy it was found that most of the blood vessels except veins and venules were richly innervated. The most extensive branching of nerves down to the capillary level was found in the mesentery and epididymal fat of fasted-refed rats. Relatively few adipocytes appeared to be innervated. With electron microscopy, nerve terminals were found distributed with most blood vessels including capillaries, and with some adipocytes. Only 2-3% of all dipocytes were innervated by adrenergic nerves. It is suggested that in the adipose tissue sites studied the major adrenergic innervation is mainly for the supply of blood vessels.


Scanning electron microscope study of the developing trout pelvic fin bud. The growth of the pelvic fin bud has been studied with the SEM along with the characteristics of the pseudoapical epidermal ridge which occupies the free margin of the bud. SEM revealed fluffy protuberances in many of the epidermal cells, distinguishing the fin bud territory from adjacent areas. When the pseudoapical ridge appears, all the cells show this feature but their relative number decreases and these cells, termed the "tassel cells," are finally restricted to the base of the fin bud. This particular surface structure of the superficial cells may be unique to the fish, since it has not been heretofore reported in SEM studies of tetrapod limb bud.


[Diagnosis of traumatic rupture of the thoracic aorta. Apropos of a series of 15 observations]. Urgent diagnosis of the rupture of the aorta is emphasized. If deceleration is one of trauma factors and the chest Xray shows a widening of the mediastinum and/or a tracheal deviation towards the right, the diagnosis must be ascertained by angiography. If positive, the patient must be immediately transfered to a specialized surgical unit.


[Pneumoencephalotomography under diaz-analgesia and narco-analgesia]. The authors reported 92 observations of anesthesia for gaseous encephalotomography interest the adult. The contrast produce is air. 49 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, pancuronium bromide N2O to 60 p. 100. 25 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, succinylcholine, N2O to 60 p. 100. 18 under narco-analgesia and myoresolution. +Fentyl, pancuronium bromide N2O to 60 p. 100. The conditions of the study are described in the first part. The results and their analysis permit the appreciation of: - the patient confort, the quality of the examination; -the respect of the hemodynamics for this examination, reputed to be "difficult"; -the immediatly noticeable diminution of side effects; -the absence of side effects; -the justification and interesting of the control ventilation; -the quality of waking up. In the conclusion the authors underline the interest of their different techniques and the possibility of using them in operations in sitting position in neurosurgery, and all important chirurgical intervention.


[Apropos of 164 aortographies performed with diazepam neuroleptoanalgesia]. The authors report their experience with the use of a semi-conscious anesthetic technique for translumbar angiography of the abdominal aorta by the means of diazepam neurolept analgesia. This technique permits gathering all the data necessary for the angiographic examination. It is easy to manipulate and  enables a certain comfort for asthenic patient.


Anthelmintic activity of fenbendazole against gastrointestinal nematodes in calves. Anthelmintic activities of fenbendazole were evaluated in a controlled experiment. Forty calves artificially infected with gastrointestinal nematodes were allotted to 4 groups. Calves in group 1 were used as nonmedicated controls; the other calves were given (orally) fenbendazole at the dose level of 5 mg/kg in the forms of a suspension (group 2), medicated feed to individual calves (group 3), and medicated feed to the group (group 4). These treatments were given on day 35 after calves were inoculated with infective nematode larvae. In groups 2, 3, and 4, overall reductions (based on geometric means) were 99.5%, 99.7%, and 99.6%, respectively. These reductions were highly significantly different (P less than 0.01) from the control calves. Nematodes present in the calves were Haemonchus contortus, Ostertagia ostertagi, Trichostrongylus axei, T colubriformis, Cooperia onchophora, C punctata, and Oesophagostomum radiatum.


Humoral immune responses of cattle vaccinated with leptospiral pentavalent outer envelope and whole culture vaccines. The humoral immune response of cattle vaccinated with leptospiral pentavalent outer envelope and whole culture vaccines was monitored with the microscopic agglutination (MA) test and the leptospiricidal activity (LA) test for a 2.5-year period. The serovars present in the vaccines were canicola, icterohaemorrhagiae, grippotyphosa, pomona, and hardjo. The LA test had greater sensitivity than the MA test for detecting antibodies to the hardjo, canicola, and icterohaemorrhagiae components of the pentavalent vaccine and was approximately equal in sensitivity to the MA test for detecting antibodies to the grippotyphosa and pomona components of the leptospiral vaccine. Both IgM and IgG were produced in similar amounts in the immunized cattle, and both classes were reactive in the MA and the LA tests. The IgM class of antibodies was more reactive in the  MA test, whereas the IgG class of antibodies was more reactive in the LA test. Using the MA test as the criterion of evaluating, the immunogenic potency of the individual vaccine components was found to be canicola more than icterohaemorrhagiae more than grippotyphosa more than pomona more than hardjo. A direct correlation between protective antibodies, as determined by the hamster passive protection test, and antibodies reactive in the MA and the LA tests was observed.


Elimination of the carrier state of bovine anaplasmosis with a long-acting oxytetracycline. A long-acting formulation of oxytetracycline (L-200) was injected at a dose level of 20 mg/kg intramuscularly into 12 yearling cattle that had been experimentally inoculated with Anaplasma marginale 64 days previously. Four cattle were treated twice, 4 were treated 3 times, and 4 were treated 4 times. All injections were given once ever 7 days. Previous work (unpublished) with this formulation has revealed prolonged blood values following a single injection. The blood (80 ml) of each calf was inoculated into a susceptible test calf 83 days after the last treatment dose. Anaplasmosis did not occur in any of the test calves. Two infected cattle were treated with 12 daily injections of oxytetracycline (L-50) at a dose level of 11 mg/kg to establish the sensitivity of the parasite to oxytetracycline. Subsequent calf inoculation tests showed that A marginale was eliminated. Two unmedicated, infected cattle remained infected throughout the study. Complement-fixation tests with A marginale antigen at 6 months after treatment showed average sera titers of less than 5 in the treated cattle and 45 in the unmedicated cattle.


Ultrastructure of anaplasmal inclusions (Pawhuska isolate) and their appendages in intact and hemolyzed erythrocytes and in complement-fixation antigen. Hemolysis of parasitized erythrocytes augmented visualization of the anaplasmal inclusion, including its initial bodies, inclusion membrane, and inclusion appendage ("tail" or "band"). A dense attachment complex joined the appendage to the inclusion membrane (wall of the inclusion vacuole). The inclusion appendage consisted of tightly packed, interconnected laminae and assumed loop, dumbbell, and comet configurations described by other workers. The erythrocytic plasmalemma and the inclusion membrane had a thickness of 9.0 +/- 0.8 nm and similar structures. The initial bodies were covered by a thin inner organismic membrane (7.0 +/- 0.7 nm thick) attached to the organismic chromatin, an intermembranous matrix, and by an outer membranous sheath or pellicle (12.5 +/- 1.2 nm thick). Dense granular aggregates (24 to 40 nm in diameter) within chromatin clumps were the only structures in the initial body remotely similar to ribosomes, yet they were too large, were never free of chromatin, and appeared to disappear upon hemolysis. Complement-fixation antigen prepared by fractionation contained initial bodies, inclusion appendages, a few mitochondria, vesicularized membranes, and stromal debris. The preparatory treatment caused segregation of the organismic chromatin into independent dense particles 103 +/- 12 nm in diameter still bound by inner organismic membrane. Similar particles were seen also in the plasma and inclusion vacuoles of hemolyzed erythrocytes.


Quantitative study of the decussating optic axons in the pony, cow, sheep, and pig. A quantitative study of optic axons in the optic tracts of several species was performed to determine the number and percentage of optic axons that decussate. Animals were prepared by unilateral ocular enucleation, and light microscopic techniques were employed to count the fibers. The mean number of fibers projecting from a single eye was 732,119 for the pony, 1,041,739 for the cow, 534,755 for the sheep, and 442,629 for the pig. The mean degree of crossover at the chiasm was 80.8% in ponies, 82.9% in cattle, 88.9% in sheep, and 87.8% in pigs.


Potency of halothane-N20 in the horse.

Potency of halothane-N20 in the horse. The minimal alveolar concentration (MAC) of halothane which just prevented purposeful movement in response to electrical stimulation was determined in 11 young, healthy, unpremedicated horses breathing oxygen (O2) or nitrous oxide (N2O) and O2. Ventilation was controlled during these MAC studies. The arterial PO2 was always greater than 90 mm of Hg and the average PaCO2. range was 36 to 40 mm of Hg. The MAC for halothane in O2 was 0.93 vol %. Alveolar N2O concentrations of 25% and 50% reduced the halothane MAC about 12% and 25%, respectively. In 8 of these horses, the cardiovascular effects of halothane-50% N2O-balance O2 (H50N2O) were determined during spontaneous and controlled ventilation and were compared with previously reported results of halothane-O2 studies. Similar to halothane-O2 anesthesia, increasing dosages of H50N2O caused a decrease in cardiovascular function. With the exception of N2O-associated increase in cardiac output and left ventricular work at MAC 1.0 and 1.5, little difference was seen between the 2 forms of general anesthesia during controlled ventilation. However, when H50N20 was administered to spontaneously breathing horses, most indices of cardiovascular function were depressed less than with a similarly administered equipotent level (MAC 1.5) of halothane-O2 anesthesia.


Pathologic changes and pathogenesis of Parascaris equorum infection in parasite-free pony foals. Parasite-free pony foals (n = 10) were infected orally with 1000,000 Parascaris equorum embryonated eggs. One pony foal each was euthanatized on days 1, 3, 5, 7, 11, 16, 23, 27, 42, or 80 after infection. Foals infected for more than 7 days showed signs of coughing, anorexia, rough coat, and weight loss. Cellular changes in the blood were mild anemia, marked eosinophilia, and leukopenia. Gross postmortem lesions included hemorrhage, edema, and white-to-yellow necrotic foci (0.5 to 1.00 mm) in lungs, liver, and bronchial and hepatic lymph nodes. Microscopically, the liver was hemorrhagic and had focal necrosis and eosinophilic granulomas. Eosinophilic lymphadenitis with edema was in the hepatic and bronchial lymph nodes. The lungs had focal areas of necrosis with hemorrhage and interstitial pneumonia with hyalinization of the alveolar walls. Larvae were first seen in the liver at postinfection hour 24 and in the lungs on postinfection day (PID) 11. Average length of larvae in the liver was 1 mm and 2.5 mm in the lungs. Larvae were not found in the liver after PID 11 or in the lungs after PID 42. The migratory pathway of P equorum was similar to that of Ascaris lumbricoides because the larvae migrated via lymph and blood vessels to the liver and then to the lungs. After migrating through the lungs, the larvae were coughed up and swallowed and then developed in the small intestine.


Evaluation of delayed hypersensitivity responses in normal horses and immunodeficient foals. Delayed hypersensitivity (DH) responses of normal and immunodeficient horses were evaluated with antigens [dinitrochlorobenzene (DNCB), keyhole limpet hemocyanin (KLH)] and phytolectins [phytohemagglutinin (PHA), concanavalin A (Con A)]. Immunologically normal horses sensitized with 5 daily applications of 2 mg of DNCB developed positive skin reactions upon challenge with 0.4 mg of DNCB. The delayed onset of the reaction and the predominately mononuclear cell infiltration at the test site indicated these were DH reactions. Normal horses sensitized with 500 microgram of KLH and challenged with 100 microgram of KLH developed skin reactions appearing earlier and composed of neutrophils and mononuclear cells, suggesting involvement of both humor and cellular mechanisms. Arabian foals with combined immunodeficiency failed to respond visibly to either antigen. Intradermal injection of 50 microgram of PHA induced visible reactions in all normal horses tested. The slow development and the predominately mononuclear cell infiltrate of PHA reactions resembled DH responses to antigen. Reactions were induced by Con A in 15 of 16 normal adult horses and 7 of 14 normal foals. The reactions were rapid in onset and contained numerous eosinophils. All 6 foals with combined immunodeficiency failed to respond to PHA injection, whereas 5 of 6 did not respond to Con A. Based on the results of these studies, it appears that in vivo skin tests with PHA and DNCB can be used to screen horses for deficient T-lymphocyte responses.


Isolation of Mycoplasma arginini from swine and from a swine waste disposal system. Mycoplasma arginini was isolated from the pharynges and tonsils of 4 of 6 swine necropsied during an epizootic of respiratory tract diseases and lameness. The organism was also isolated from 2 of 16 asymptomatic swine examined in the same herd approximately 10 months after the epizootic. In addition, M arginini, Acholeplasma laidlawii, and other acholeplasmas were isolated from recycled effluent of an anaerobic lagoon used for disposal of waste from the swine herd. This observation represents the 1st report of a Mycoplasma species isolated from a lagoon or sewage system. The pathogenicity of a strain of M arginini isolated during the epizootic was examined by inoculating young swine intranasally, intratracheally, intravenously, and intraperitoneally. The agent colonized in the pharynges of 2 pigs inoculated intranasally, but did not produce overt signs of clinical disease. Although neutralizing antibodies to M arginini were not detected, 1 animal that had been infected naturally and 2 that had been inoculated intravenously did develop complement-fixing antibodies. The findings indicate that M arginini can colonize in the nasal and pharyngeal mucosae of swine, but that it is not highly pathogenic for these animals.


Immunity to Lancefield's group E Streptococcus: passive protection of swine. Healthy swine from one source were randomly allotted to 3 groups of 3 pigs each. Troup I and II pigs were parenterally dosed with serum obtained from swine in the convalescent stage of streptococcic lymphadenitis of swine. Group III pigs were contact controls. The swine of all groups were orally exposed to Lancefield's group E Streptococcus sp. During the next 3 weeks, the controls evidenced little resistance to the development of streptococcic lymphadenitis of swine, whereas the principals evidenced considerable resistance to development of the disease.


Succinylcholine chloride as a euthanatizing agent in dogs. In order to determine the efficacy of succinylcholine chloride as a euthanatizing agent, the possible situation encountered in mass euthanasia was recreated. While anesthetized or awake, sixteen 2-year-old Beagles of both sexes were subcutaneously injected with either 1.1 g or 11 mg of succinylcholine chloride/kg of body weight. Positive pressure respiration was given to 2 dogs, otherwise the treatment was allowed to run its course. Electrocardiogram, electroencephalogram, and impedance pneumogram recordings were obtained for time comparisons and for determination of the ultimate cause of death.


Megaloblastic erythropoiesis and tissue depletion of folic acid in the cat. Dietary requirement for folic acid was shown in the cat. Folic acid deficiency was produced by feeding young cats a deficient diet (0.125 mg of total folate/kg of dry weight by analysis) for 22 weeks. The folic acid-deficient cats grew normally, but had reduced plasma, red blood cell, and liver folate concentrations in comparison with those concentrations in cats fed a control diet (1.36 mg of total folate/kg).. Urinary excretion of formiminoglutamic acid was increased in all deficient diet cats 24 hours after L-histidine injection. Erythroblasts in bone marrow smears from folic acid-deficient cats were megaloblastic; they showed abnormal nuclear chromatin patterns and had nuclear-cytoplasmic asynchronism.


Pharmacokinetics of penicillin G in the turkey. Parmacokinetics of penicillin G was determined for the turkey. The study was prompted by the isolation of a sulfonamide-resistant strain of Pasteurella multocida from tissues of turkeys involved in an outbreak of fowl cholera and the subsequent discovery that little pharmacologic information was available concerning other antimicrobial agents in that species. Penicillin G was chosen for study because P multocida is susceptible to this antibiotic. The elimination of the antibiotic followed first-order kinetics, and the half-life was found to be 0.5 hours. Parenteral administration of benzathine-procaine penicillin G resulted in higher concentrations, which persisted for longer periods than did procaine or potassium salts of the antibiotic.


Anaerobic arterial sampling technique in the bovine species. An arterial sampling technique was used in the unanesthetized bovine species. Samples for acid-base and blood gas analyses were obtained from a branch of the caudal auricular artery and required minimum restraint of the animal. The technique would be useful for research and clinical practice.


Toxicologic evaluation of microencapsulated formulation of diazinon applied dermally to cattle. Acute toxicity studies in 24 newborn calves and 12 two-year-old steers were conducted with a microencapsulated formulation of diazinon (O-O-diethyl O-(2-isopropyl-6-methyl-4-yrimidinyl) phosphorioate) after dermal applications. For calves, the maximum safe dosages of a diazinon wettable powder formulation were identical with those of the new formulation (0.05% concentration); for older cattle, safe dosages were 0.25% concentration. Thus, because of the slow release and absorption of diazinon, the safety factor for mature cattle is fourfold. In the present study, there was cholinesterase depression in calves at the toxic concentrations of 0.1% and in steers at concentrations of 2.0%. As determined by the mean cholinesterase depression activity, the dose-response relationship was true in the 4 treatment groups of older cattle, but was erratic in the 6 groups of calves. The use of modified and improved insecticidal formulations, such as the encapsulated type, is recommended. Their use may prolong acaracidal activity due to effective residues, eliminate the need for repeated applications at shorter intervals of time, and possibly allow increased dosages to mature cattle, without toxicity, and thus reduce acquired resistance of ticks and other insects.


Study of TAMe (p-tosyl-L-arginine methyl ester) esterase activity of bovine plasma. The TAMe (p-tosyl-L-arginine methyl ester) esterase activity of mature and immature bovine plasma was studied and compared with the activity of this enzyme in human plasma. Kaolin activation of 2 minutes was required to produce maximal activation in cattle, as compared with 1 minute activation in man. The kaolin-activated TAMe esterase values in bovine plasma were approximately one-half the values found in human plasma. The activity of this enzyme was statistically greater in immature than in mature cattle (P less than 0.05) at kaolin activation times of 1, 2, 15, and 20 minutes.


Comparison of the oral lethality of lead acetate and lead carbonate to the rabbit. A significant difference (P = 0.025) was detected between the total amount of lead acetate and lead carbonate fed to rabbits before death occurred. Rabbits given lead carbonate were fed an average of 59% more lead before death occurred than rabbits given lead as a lead acetate.


Absence of inductive effect of hyperoxia on superoxide dismutase activity in rat alveolar macrophages. Mammalian cells may be protected from damage by hyperoxia through the induction of enzymes that reduce destructive oxygen-free radicals. One such enzyme is superoxide dismutase, which reduces superoxide to form hydrogen peroxide and O2. We studied the concentration of this enzyme in rat alveolar macrophages exposed to 85 to 90 per cent O2 in vitro for as long as 6 days and in macrophages obtained from rats exposed to 85 to 97 per cent O2 in vivo for as long as 7 days. In no case was there an increase in superoxide dismutase in rat alveolar macrophages, despite a doubling of superoxide dismutase in whole lungs of rats exposed to 85 to 90 per cent O2 for 7 days in vivo. We concluded that the macrophage of the adult rat does not defent itself against hyperoxia by the induction of superoxide dismutase and does not participate in the increased superoxide dismutase activity of lungs of these animals exposed to hyperoxia.


Distribution of HLA antigens in idiopathic pulmonary fibrosis. Divergent observations suggest that genetic factors contribute to the susceptibility to or clinical course of idiopathic pulmonary fibrosis. To determine whether there is an association between the major histocompatibility (HLA) system and idiopathic pulmonary fibrosis, the distribution of 35 antigens of HLA loci A and B was determined among 33 white patients with idiopathic pulmonary fibrosis and 329 healthy white control subjects. Although certain antigens tended to be more prevalent among patients with idiopathic pulmonary fibrosis compared with control subjects, there were no significant differences in the phenotype frequencies of the HLA-A and HLA-B antigens between these 2 groups. Thus, although subtle associations may exist between the HLA loci and idiopathic pulmonary fibrosis, these results indicate that antigens of the HLA-A and HLA-B loci are not linked with major risk factors in this disease.


Bronchoscopic needle aspiration biopsy of paratracheal tumors. Primary lung carcinoma adjacent to the trachea and paratracheal nodal metastasis without evidence of the primary tumor or airway invasion require invasive surgical procedures to obtain adequate diagnostic tissues. Adequate diagnostic tissue was obtained in 3 of 5 patients with paratracheal masses by means of a bronchoscopic needle aspiration technique. There were no complications.


The beneficial effect of nasal breathing on exercise-induced bronchoconstriction. In the first step of a study of the relation of nasal and oral breathing during moderate treadmill exercise to the onset of bronchoconstriction in young patients with perennial bronchial asthma, it was observed that most subjects spontaneously breathed with their mouths open when instructed to breathe "naturally." Subsequently, when they were required to breathe only through the nose during the exercise, an almost complete inhibition of the postexercise bronchoconstrictive airway response was demonstrated. When instructed to breathe only through the mouth during exercise, an increased bronchoconstrictive airway response occurred, as measured by spirometry, flow-volume relationships, and body plethysmography. These findings suggest that the nasopharynx and the oropharynx play important roles in the phenomenon of exercise-induced bronchoconstriction.


Transcutaneous oxygen tension in sick infants. The clinical usefulness of the transcutaneous O2 electrode was investigated in 30 sick infants; 159 simultaneous measurements of arterial PO2 and transcutaneous PO2 were made. During the comparisons, arterial blood pressure, heart rate, and thoracic impedance were continuously recorded, and skin axillary and environmental temperatures and hematocrit were noted. Despite a wide range of arterial blood pressure and hematocrits, arterial PO2 and transcutaneous PO2 were similar (slope, 0.963), except for 2 groups of sick infants. Some infants with severe, persistent pulmonary hypertension who were receiving an intravascular infusion of tolazoline and infants with mean arterial blood pressures more than 2.5 SD less than the predicted average had values for transcutaneous PO2 that were lower than PO2. The surface O2 electrode is safe and relatively easy to use and provides data that can help in the management of most sick infants.


Management of small bowel obstruction.

Management of small bowel obstruction. Preventable deaths from small bowel obstruction result from misdiagnosis, inappropriate delay in operation, inadequate preoperative preparation, and a poorly performed operative procedure. A systematic approach to each of the factors includes repeat physical examination, x-rays and CBC four hours after initial study in questionable cases, a pre-planned therapeutic interventions timetable, adequate intravascular volume and electrolyte levels, and a carefully designed operation which includes as little bowel manipulation and entrance as possible.


Experience with intra-aortic balloon counterpulsation in a community hospital. Intra-aortic balloon counterpulsation is well established as an adjunct in the treatment of refractory cardiac failure in university centers. We have analyzed the practicality of its use at a community hospital without cardiovascular resident coverage. Between 1971 and 1976, 27 patients were subjected to counterpulsation. The survival rate was 44%. This compares well with university centers where various reports listed survival rates between 14% and 50%. We believe that IABP is a valuable adjunct in the total care of cardiac patients and should be used in all community hospitals in which cardiac surgery is done.


Pyloric stenosis.

Pyloric stenosis. In this study, pyloric stenosis appeared to be a commonly occurring, independent, entity probably resulting from antral pyloric canal gastritis rather than from an ulcer crater per se. An appropriate term might be stenosing pyloritis. Intraoperative effects on the pyloric sphincter from glucagon and atropine administration and stimulation of the vagi and gastric pacemaker were not detectable in a limited study on four cases. A local autonomy of sphincteric action was noted which was not affected by trunkal vagotomy.


Volvulus of the cecum.

Volvulus of the cecum. Twenty-one cases of volvulus of the cecum are discussed; mortality was 9.5%. Eight patients underwent right hemicolectomy, but gangrenous changes were found in only one of these cases. No distal obstruction was found. The female-to-male ratio was 16:5. The roentgenographic diagnosis is highly suggestive in flat film of the abdomen and conclusive in contrast examination. Treatment of cecal volvulus by simple detorsion or cecopexy is inadequate and associated with a high recurrence rate. Primary resection of the right colon with ileotransverse colostomy is the treatment of choice for all types of cecal volvulus.


Use of progressive pneumoperitoneum in the treatment of giant abdominal hernias. The preoperative use of progressive pneumoperitoneum in the treatment of large or complicated ventral hernias is established to be safe and useful. Indications for use of this technique include massive hernias, hernias that are repaired in a contaminated field, hernias in patients considered poor operative risks, and recurrent hernias. Five patients are described in whom this technique was used; all five hernias were closed primarily without tension, mesh, or postoperative complications. follow-up reveals no evidence of recurrence.


An epidemiologic study of postoperative staphylococcal wound infections in patients having vascular procedures. An epidemic of postoperative wound infections caused by Staphylococcus aureus in 15 patients during a four-month period in 1974 is reported. An unusual staphylococcal antibiogram served as a marker for the multiresistant strain of hospital-acquired infections and raised suspicion of a common source for the infections. The spread of infection began shortly after isolation was discontinued in the index case. An epidemiologic investigation showed that 14 patients were on the same ward, and one patient from another ward had opportunity for contact with the index case. The epidemic was controlled by prompt isolation of all infected patients, adherence to strict isolation techniques, aseptic technique for dressing changes and by treatment of nasal carriers among ward personnel with appropriate antibiotics.


Surgical treatment of the acute stroke caused by proven vertebral-basilar artery insufficiency. Five patients with acute strokes caused by proven vertebral-basilar artery insufficiency had restoration of acutely lost neurologic function with revascularization of ischemic tissue and cells of the hindbrain, including upper and lower motor neurons of the brainstem. This was done with an operation to correct partial extralumenal obstruction of the proximal vertebral artery. The operations were performed three to seven days after the onset of the acute strokes. Patient selection is dependent on angiography of the aortic arch with visualization of the vessels of the neck, the vertebral and carotid arteries. There was no mortality and no significantly morbidity among these patients.


Cysts of the parathyroid gland: report of two cases and review of the literature. Two patients are presented, each of whom had a clinically symptomatic neck mass due to a parathyroid cyst. The literature concerning these cysts is reviewed with exclusion of cases considered to be parathyroid adenomas which have undergone cystic change.


Metastatic basal cell carcinoma: a review of the literature and report of two cases. A total of 95 cases of metastasizing basal cell carcinomas have been recorded in the literature with 20 of these metastatic to bone. Two additional cases of metastasizing basal cell carcinoma with osseous metastases are presented, with a review of the literature.


Menopause and coronary heart disease. The Framingham Study. A rise in coronary heart disease incidence after menopause and a dramatic increase in the severity of the presenting diseases are noted in a cohort of 2873 Framingham women who were followed up for 24 years. No premenopausal woman developed a myocardial infarction or died of coronary heart disease. Such events were common in postmenopausal women. Even in women under 55, 40% of the postmenopausal coronary heart disease presented in these more serious forms, whether menopause was natural or surgical. The contrast was especially marked in the age group 40 to 44 years. In the age groups 45 to 49 and 50 to 54 years, incidence rates in menopausal and postmenopausal intervals were more than double those in premenopausal intervals, whether menopause was natural or surgical. In surgical menopause there was excess incidence whether the ovaries were removed or not. Postmenopausal women on hormones had a doubled risk of coronary heart disease.


Noninvasive diagnosis of deep venous thrombosis by phleborheography. Phleborheography, a recently described noninvasive test for deep venous thrombosis, was compared with leg venography in 75 patients. Acute deep venous thrombosis was accurately diagnosed by phleborheography in 24 patients, with no false-positive diagnoses. External venous compression without thrombosis was diagnosed correctly in two patients. The remaining patients appeared normal or had chronic venous disease by phleborheography; however, 11 of these had acute deep venous thrombosis by venography, for a false-negative rate of 31%. Most undetected thrombi were in small calf veins. The specificity of phleborheography is thus 100%, but the sensitivity is only 69%. Similarly, its positive predictive value is 100% and the negative predictive value is 78%. When phleborheography shows acute deep venous thrombosis, this diagnosis may be accepted with confidence and therapy chosen accordingly, without venographic confirmation. Venography may still be required to withhold anticoagulation when phleborheography is negative.


Therapy of the hypereosinophilic syndrome. Previous studies of patients with the hypereosinophilic syndrome have found very significant morbidity and a high mortality of 77% at 3 years. Our study analyzes the therapy and prognosis of 26 patients with the hypereosinophilic syndrome. Five patients showed no evidence of progressive organ-system dysfunction and were given no therapy; all have done well. Sixteen patients with progressive organ dysfunction were treated with corticosteroids; six of the 16 had a good response and needed no further therapy. Five patients were treated with various chemotherapeutic agents that proved to be ineffective. In eight patients who were unresponsive to corticosteroid therapy, hydroxyurea produced excellent responses in six and partial responses in two. With the above regimen, our 26 patients (including 12 with poor prognostic indicators) have had a marked increase in survival (3-year mortality of 4%) when compared with the historical control group.


Factor V antibody and disseminated intravascular coagulation. A factor V inhibitor arose in a 79-year-old man within 1 month of an operation for a fractured leg. Absorption studies with solid-phase antibodies to human immunoglobulins showed the inhibitory activity to be primarily in the IgG class, but also in the IgA class, of immunoglobulins. This is the first report of an IgA immunoglobulin with factor V inhibitory activity. While the inhibitor was present, and at a time when no circulating Factor V activity was detectable, the patient developed septicemia and disseminated intravascular coagulation. The mechanism sustaining disseminated intravascular coagulation despite the absence of circulation factor V activity remains unexplained. The factor V inhibitor disappeared within 5 months of its initial detection. Possible origins of factor V inhibitors are discussed.


T-wave abnormalities of intermittent left bundle-branch block. Ischemia is traditionally considered a cause of intermittent left bundle-branch block (LBBB), and some patients have right precordial T-wave inversion in the normally conducted beats. Clinical correlates of T-wave abnormalities were examined in 46 consecutive patients with intermittent LBBB. Thirty-three patients (72%) had at least transient right precordial (V-14) T-wave inversion suggesting ischemia in normally conducted beats. Seventeen such patients had no evidence of coronary heart disease, including five with normal arteriograms. During LBBB conduction, T-wave abnormalities (upright T-waves I, aVL, V5-6) were frequent (48%) and more common than among patients with permanent LBBB (p less than 0.005). The T-wave abnormalities during LBBB conduction occurred in the absence of coronary heart disease in nine patients, including two with normal arteriograms. Thus, right precordial T-wave inversion may result from recent LBBB itself, associated with T-wave abnormalities during the LBBB, in the absence of coronary artery disease.


Thrombocytopenia and intravenous heroin use. Five young male heroin users presented with a syndrome resembling acute immune thrombocytopenic purpura. Although a viral, autoimmune, or toxic origin cannot be conclusively excluded at present, data are most consistent with the hypothesis that the thrombocytopenia was due to a drug-related immunologic mechanism that resulted in peripheral platelet destruction. Epidemiologic considerations suggest the common agent involved in their illnesses was present in the heroin they used. Although glucocorticoid therapy was followed by clinical recovery in four of the five patients (one was lost to follow-up), it is not certain that this represented a causal relation.


Halothane hepatitis: benign resolution of a severe lesion. Three patients with halothane hepatitis were studied during the acute phase of their illness and for 10 to 14 months thereafter. Clinical, biochemical, and histologic data were obtained initially and during the course of follow-up. Despite initially severe clinical and biochemical presentations, with extensive bridging hepatic necrosis on liver biopsy, all three patients resolved completely and had minimally abnormal liver biopsy appearances at last follow-up. The results of this study suggest that hepatic necrosis associated with halothane hypersensitivity is self-limited and that despite the initial severity of the hepatic lesion, postnecrotic cirrhosis does not develop. Based on these three patients' courses, survival of the acute bout of halothane hepatitis is apparently accompanied by an excellent prognosis ultimately, provided that reexposure to halothane is avoided.


Hyperparathyroidism and radiation therapy. Hypercalcaemic hyperparathyroidism has been diagnosed more commonly in recent years. This reflects an increasing awareness of and a growing interest in the disease. In the search for possible aetiologic mechanisms behind the development of parathyroid adenomata, certain environmental factors have been suggested. This study indicates that a significantly (p less than 0.01) greater number of patients who had parathyroid adenomata had previously undergone radiation therapy involving the neck region compared with normocalcaemic control subjects. The observed and controlled cases originate from a medical screening programme done as part of a health check-up including almost 16 000 persons in the Stockholm area. It is recommended that special attention to a past history of possible neck irradiation be paid in subjects suspected of suffering from hyperparathyroidism.


Lactase deficiency: prevalence in osteoporosis. We determined the prevalence of lactase deficiency by analysis of respiratory hydrogen (H2) in 30 women with idiopathic postmenopausal osteoporosis and in 31 female control subjects without evidence of metabolic bone disease. Eight subjects with osteoporosis had breath H2 excretion greater than 0.20 ml/minute at 2 h after receiving 50 g of lactose and were considered lactase deficient; only one control subject was lactase deficient (P less than 0.05). Symptoms developed in seven of the nine lactase-deficient persons after receiving 50 g of lactose; in contrast, only three of the 52 lactase-normal subjects had symptoms. Although none of the lactase-deficient subjects was aware of milk intolerance, their intake of both lactose and calcium was significantly lower than that in the lactase-normal group. Lactase deficiency appears to be one of several factors that predispose to the development of osteoporosis, probably through diminished calcium intake and possibly through an effect on calcium absorption.


Variegate porphyria.

Variegate porphyria. In temperate and cold climates the most usual presenting symptom of variegate porphyria is an acute porphyric attack, indistinguishable from that seen in acute intermittent porphyria. Increased fragility of the skin in sun-exposed areas occurs in only half of such patients, and even then is usually mild and easily overlooked. The diagnosis depends on fecal excretion of porphyrins, which is greatly increased in variegate porphyria and consists predominantly of protoporphyrin. Urinary excretion of porphobilinogen and delta-aminolevulinic acid increases only during acute attacks. There are reasons for thinking that variegate porphyria is commoner than hitherto supposed. During an acute attack a patient without skin symptoms may well be misdiagnosed as having acute intermittent porphyria, because of identical symptoms and excretion of porphobilinogen in the urine. Thus, for a correct diagnosis, every patient presenting with symptoms of acute porphyria requires a fecal analysis.


Clinical problem solving: a behavioral analysis. To extend the understanding of the clinical problem-solving process, we have analyzed the tape-recorded behavior of experienced clinicians engaged in "taking the history of the present illness" from a simultated patient. We showed that specific diagnostic hypotheses were generated often with little more information than presenting complaints, that testing of diagnostic hypotheses consisted of various case-building strategies for corroborating and discrediting hypotheses, and that the process of information gathering included techniques to evaluate the validity of data and assess the need for immediate action. Overall strategies were more difficult to discern but included a focused approach, a systemic exploration method, and a chronologic technique. The data have potential value in medical education and in developing computer programs to simulate the diagnostic process.


[Apropos of a paranoid filiation delirium: the "intelligence" complex of dementia and psychiatry with associated absence of critical "control"]. Based on a clinical observation of a paranoid filiation delirium, the authors raise the fundamental question of the nature of psychotic structure itself. They suggest an interpretation of the structure of the psychosis as an attempt to rationalize and give shape to an inarticulate discourse. This work as a whole should be looked upon in the perspective of a new approach to the psychiatric occurrence through what might be called a relativist epistemology.


[Semantics of psychopathological expressions. 2. Productive interpretation and narrative semantics in delirious expressions]. The second part of "The semantics of psychopathological statements" concerns delirious utterances. The relations between the utterance act and the statements implicity constitute the delirium in the operational texture of the psychopathological process. Only the productive interpretation can relate the links between the diegetic elements of the utterance to the ensuing reading effects the words of which diachronically constitute a delusion. The meaning effects of the clinical statements, i.e. the symptoms and their narration have recurring repercussions on the semantics of the delirium process.


[Mental disorders in adolescence and their therapeutic approach implications between theory and practice]. After a developmental description of the adolescent process, the author describes the manner of initiating psychotherapeutic treatment for psychologically disturbed adolescents. Despite the inevitable reappearance of primitive defense mechanisms and ego positions, it is possible and necessary to distinguish between temporary stress or crises and psychic breakdown corresponding to specific development impairment necessitating, imperatively, therapeutic  help. The author attempts to find a conceptual link between apparently opposite theoritical positions such as intra- and supra-individual doctrines. Ideally, when confronted with borderline or psychotic pathology, family therapy should be coupled with individual psychotherapy. Finally, the therapist's counterattitudes are discussed.


["Border-line states": psychodynamic and existential approach, apropos of 8 case reports]. This study attempts to determine the specific characteristics of this psychopathological concept, and demonstrate its operational interest. The traditional classification is clearly insufficient, and the clinical findings require metapsychological and existential references. The comprehensive approach to these morbid forms with polymorphic outlines, and variable symptoms, implies a deeper approach to the psychodynamic and structural planes. The experience of these subjects is characterised by sadness and lack of pleasure in life; they oscillate between a feeling of solitude, to which may be attached an anguish of separation and a flight from others when their relationship does not correspond to their special requirements and their modes of exchange with, in addition, an intrusion anxiety. Two references, one to Feeling alone by M. Klein and the other The ability to remain alone by D.W. Winnicott shed light on the psychogenetic basis and on the prevalence of phenomena of idealisation. The coexistence of sectors of mental function and defence mechanisms of different registers intervening together or alternately explain the "stability in instability". The existential continuum bears the traces of sudden ruptures. This paper includes the presentation of 8 cases.


[Various metabolic or toxic effects which can result from short term ingestion of sulfurous acid by the rat]. The work reported below was conducted for the purpose of evaluating the toxicity of two levels of potassium metabisulfite on various aspects of metabolism in adult rats. It appears that the two doses do not disturb the activity of acid plasmatic phosphatase. The increase of the pyruvic acid o blood caused for the higher level of sulfite (50 mg/kg/day) is considerably increased for absorption of a diet containing 67% of sugar, and considerably decreased by injection the day before the dosage of 200 microgram thiamine. The highest level (50 mg/kg/day) increased the urinary calcium however same larger quantities of sulfite did not cause any augmentation of fecal calcium. The "creatinine clearance" is not modified, the seric transaminases (G.O.T.-G.P.T.) are not disturbed, moreover, hematologic controls during the five months of experimentation did not show any perturbation.


Comparative effects of a protein deprived diet on the weight, lymphocyte content and the number of DNA-synthesizing and dividing cells in the lymphoid organs of the rat. Influence of the diet on the stimulating action of phytohemagglutinin and the inhibitory action of cortisone. The changes induced in adult male rats by a protein deprived (PD) diet lasting 7 weeks were investigated from the viewpoint of the cell contents of the popliteal lymph nodes (PLN), spleen and thymus; the levels of DNA-synthesizing lymphocytes counted on cell smear autoradiographs, and the levels of mitoses. The stimulating effect of a subplantar injection of phytohemagglutinin (PHA) and the inhibitory action of cortisone (3 mg/100 g per day for 5 days) were also determined in normal and PD rats. The PD diet significantly reduced the cell contents, primarily in the thymus, as well as the number of labeled cells and mitoses per mg of tissue and per entire organ. When expressed on the basis of 10(3) cells, the levels of both cell groups were also reduced in the spleen but not in the PLN's where they were already very low with a balanced diet. In the thymus, the sharp drop in the mitotic index (M.I.) contrasted with unchanged levels of labeled cells and an important increase in the labeling density per cell. PHA increased the M.I. to a great extent in the PLN's and spleen in normal rats but not in PD rats. In contrast, the labeling index (p. 10(3) cells) in the spleen, as well as the number of labeled cells per mg and per organ, increased in PLN's and the spleen after PHA to a much greater extent with a PD diet than with a normal diet. These results suggest a premitotic block of the cell cycle after protein deprivation. Also, the mitotic index appears to be a more reliable test, than the labeling index, of the lymphostimulating action of PHA and of its inhibition following protein removal from the diet. The effects of cortisone in normal rats resembled to a large degree those of a protein-free diet. If the hormone was administered to PD rats, the residual lymphocytes of the atrophic thymus were still more cortisone-sensitive than those of normal rats. On the contrary, DNA synthesizing cells in the PLN's and spleen, and mitoses in the spleen resisted cortisone in PD rats, while they were partly destroyed by the hormone in the controls. This suggests that primarily the cortisone-resistant lymphocytes of these organs are capable of synthesizing DNA after prolonged protein deprivation. The results are in agreement with the hypothesis of an intervention of endogenous glucocorticoid hormones in the protein lack-induced lymphoid involution.


Scanning and transmission electron microscopy study of ferret respiratory mucosa infected with influenza A virus. The use of both SEM and TEM techniques in studying the alterations of the columnar ciliated epithelium of the whole respiratory tract of ferrets enables the authors to find a significant discrepancy between tracheal and nasal mucosa destructions. This discrepancy is not a function of the anatomical location of virus instillation. Theoretical and pratical meanings are discussed.


[Role of protein in control of the growing chick's appetite]. After a short study of the literature about the effect of proteins on the food intake regulation, the authors conclude that the only way to compare two feeds about their intake level consist in a comparison with animals of nearly the same live weight by expressing the intakes plotted against live weight. Themselves, they compare ingestions by chickens of rations which vary by their protein level and quality. In a first step, authors show that increasing the protein content of the ration led to a rise in the food intake, but then, beyond a critical level of protein, the food intake decreases gradually. In a second step, authors show that a better quality of the food protein leads to an increase on intake. In conclusion, proteins influence food intake not because they satisfy the nitrogen need of the animal, but because they saturate the blood in products coming from the catabolism of their non utilised fraction.


[Aflatoxin inactivation after ammonia treatment. In vitro studies on detoxified peanut meals]. The maximum allowable tolerance of aflatoxins in animal feeds is becoming lower and lower, and it is obvious that the fairly high level of aflatoxin B1 found in almost all peanut meals in recent years restricts this protein source for use in the diets of most animal species. Among the different chemical methods for aflatoxin inactivation, treatment by gaseous ammonia under a pressure of 2 to 3 bars, appears a very attractive solution because it may be achieved by a fairly easy and rapid procedure. This treatment markedly reduces--up to 95 p. 100--the aflatoxins content of the meal. An increase in the nitrogen content, mainly in the non protein form, is observed. Ammoniation has no adverse effect on in vitro pepsin digestibility and even improves the sensitivity of the meal towards proteases. It slightly reduces protein deamination in the artificial rumen and nitrogen solubility in a buffer solution at pH 7,5; these effects seem to be favourable for the utilization of the treated meals by rumiinants. The amino acid compostion of the meal is not significantly changed, particularly with regard to total and available lysine. However, cystine undergoes partial destruction; but this loss could be counterbalanced by a supply of synthetic methionine.


[Isolation of a strain of Mokola virus in Cameroon (author's transl)]. A strain of Mokola virus has been isolated in Cameroon from a shrew (Crocidura sp.). In Nigeria, where the virus was isolated for the first time, two human cases with one death were reported. The possibility of transmission of this virus by the bite of an arthropod is discussed.


[Protein metabolism in vitamin A deficient rats. I. Protein and DNA turn-over in rat liver]. The effect of a vitamin A deficient diet on liver proteosynthesis was studied with in vivo and in vitro methods. Weanling rats obtained from vitamin A rstricted female were fed "separate diet". Control animals received vitamin A in protein diet. Deficient rats were used at the weight plateau stage. The RNA, DNA and protein liver content was unaffected by vitamin A deficiency and the same result was found for free amino acid pool. The turn-over rate of protein and RNA of cellular fractions and total liver was studied. (14C) leucine and (3H) uridine was injected intraperitoneally. Animals were killed at 20-40 minutes and 2-4-6-8-10 days after injection. Synthesis rate of liver proteins was the same in both groups. Our results indicate no difference in the average rate of (14C) protein degradation between control and deficient animals. Vitamin A deficiency decrease the turn-over rate of total ribosomal and soluble RNA. Polyribosome and postribosomal supernatant from deficient rats liver  were less active for protein synthesis in vitro than corresponding fractions from well nourished rats. The lesion was located in the post ribosomal supernatant fraction by "crossing over" experiments. Polyribosome desimentation analysis on sucrose gradients revealed no difference between the two groupe. The results indicate that vitamin A deficiency decrease cell proliferation without degeneracy. The limitative agent of proteosynthesis is situated at RNA level. However protein synthesis is unaffected in our experimental procedure.


[Protein metabolism in vitamin A deficient rats. II. Protein synthesis in striated muscle]. Parameters of skeletal muscle protein synthesis was studied in vivo and in vitro. The experimental design was previously described. Muscle humidity, protein and DNA content are not modified by vitamin A deficiency. RNA and free amino acids are modified. Glutamine, serine and threonine level decrease while phenylalanine and leucine increase in vitamin A deficients. After a single intra-peritoneal injection of (14C) leucine, the incorporation of radioactivity into total ribosomes and postribosomal supernatant protein was studied. The rats were killed 20, 40, 60 minutes and 2,6,10 days after injections. The half time for radioactivity accumulation was four times higher into total and ribosomal protein, two times higher into postribosomal supernatant protein in vitamin A deficient rats than in well-fed rats. The decay of acid soluble radioactivity was similar in the two groups, although protein synthesis was lowered by vitamin A deficiency. It was then supposed that leucine, enters into other metabolic paths. Sedimentation analysis in sucrose gradients revealed a lower proportion of higher ribosomes species in muscle of deficient rat than in normal ones, but ribosomes from deficients were more active for protein synthesis in vitro than ribosomes from well-fed rats. The vitamin A deficiency decrease the muscle protein synthesis and lead to important changes on in vitro and in vivo ribosomal activity.


[New aspect of carbohydrate metabolism in vitamin A deficient rats: absorption of glucose during intestinal perfusions in vivo]. 24 hour fasting rats are anaesthetized and the small intestines are perfused in situ with a Tyrode solution at 37 degrees C, 1 ml/min., containing 0,5 to 15 g of glucose per liter. Larger amounts of glucose and water are absorbed by the intestine of vitamin A-deficient rats at all oncentrations of glucose. Intestines of meal fed rats absorbed more glucose than ad libitumnes. Plasma glucose and insulin levels are measured both before and during the perfusions everal higher values of hyperglycemia are noted in deficient rats which developed a particular lower insulinemia (these results are detailed in a further article).


[Glycemia and insulinemia of vitamin A deficient rats after administration of glucose]. We have studied the variations of the blood glucose and insulin concentrations of control and vitamin A-deficient rats after administration of glucose by various ways. The avitaminosis decreases the initial glycaemia and insulinaemia in fasting rats. It seems that the insulin release from the pancreas of the deficient rats is normal after a moderate treatment: for example after a single injection of glucose 0,5 g/kg in the carotide, or during the digestion of a mixed meal (rats trained to eat their day's food in a short time), or during an intestinal perfusion in vivo of weak concentrated glucose solutions (0,5 to 2 g/l). But after meal feeding a glucose rich diet (65 p. cent) or during intestinal perfusions of solutions with a higher glucose content (up to 15 g/l) the hyper-insulinaemia is fleeting in the deficient rats and its appeared highest hyperglycaemia in some perfused animals. The endocrine regulations of the vitamin A-deficient rats are considered in the discussion.


Systemic antibiotics for use in ocular infections--penicillin-resistant Staphylococcus. An analysis is made of the usefulness of various antibiotics in the systemic treatment of bacterial endophthalmitis. The staphylococcus is a common causative organism, particularly in cases following ocular trauma. Methicillin is the drug with which ophthalmic investigators have had the most experience, and is an acceptable therapeutic choice in the treatment of gram-positive endophthalmitis. Oxacillin has not been shown to penetrate the blood-aqueous barrier, and should not be used systemically. Dicloxacillin, currently not available for parenteral administration, is the penicillinase-resistant penicillin of choice. Cephalothin penetrates the eye well, but satisfactory levels are not maintained for a sufficient length of time. Cephaloridine, with excellent intraocular penetration and gram-negative coverage, may well be the optimal drug in patients with normal renal function.


The dynamic film thickness of cushioning agents on contact lens materials. Using an in vitro technique, a number of commercial as well as pure polymer solutions were evaluated for their ability to form thick aqueous layers on contact lens materials. It was demonstrated that the thickness of adhered pure polymer films was strictly viscosity dependent and did not depend upon the solution's wetting properties (ie, contact angle and surface tension) nor the surface upon which the solution was deposited (eg, glass, a hydrophilic surface versus Plexiglass, a relatively hydrophobic surface). The clinical implications of this study are that the desired solution properties of tear substitutes may be quite different from those of wetting and "cushioning" solutions.


Treatment of acute gonococcal conjunctivitis. Because of the remarkable increasing incidence of gonorrhea, there is danger that gonococcal conjunctivitis also will increase. The ability of the gonococcus to rapidly cause corneal destruction and become increasingly resistant to penicillin make it imperative for ophthalmologists to keep up to date on effective treatment methods. A treatment schedule for acute gonococcal conjunctivitis is presented.


Congenital toxoplasmosis: chances of occurrence in subsequent siblings. Occurrence of congenital toxoplasmosis in subsequent siblings after the birth of an affected child is discussed. Toxoplasmic retinochoroiditis was found in 3 surviving siblings. The diagnosis was made by the typical fundus lesions in children, intracranial calcification in one child, and significant positive titer for toxoplasmic antibodies in all the children and the mother, who was asymptomatic. Serology for syphilis, skin tests for histoplasmosis and tuberculosis, blood studies with sedimentation rate, and chest roentgenograms were all negative in mother and all 3 children. The view that transmission of infection from mother to the fetus may result from a chronically infested uterine wall is supported and is thought to be the probable cause in the cases reported here. After the birth of one child with congenital toxoplasmosis, the parents may be reassured about the favorable prognosis of subsequent pregnancies with some reservation. However, it appears unwise to categorically refute the repetition of congenital toxoplasmosis in siblings. It is also suggested that because of possible danger of reactivation, the healed toxoplasmic chorioretinal lesions should be properly monitored if the patient is to be given corticosteroids for any other reason.


An irrigation-aspiration handpiece.

An irrigation-aspiration handpiece. An irrigation-aspiration handpiece consisting of 4 stainless steel pieces affords control and variability for the physician in removal of soft cataractous material.


Topical anesthesia for inferior rectus recession in thyroid ophthalmopathy. The restrictive hypotropia seen in thyroid patients is most commonly due to an infiltrative myopathy of the inferior rectus muscle. With the described technique, using topical anesthesia, the degree of muscle contraction and inelasticity determines where the inferior rectus should be placed to permit full upgaze. This provides full correction of the restrictive hypotropia with the least possible amount of muscle recession.


Eye-cosmetic-induced conjunctival pigmentation. Light and electron microscopic study of conjunctival pigmentation in a 27-year-old woman who used eyelid cosmetics is presented. The deposited material consists of ferritin particles and probably iron oxide and carbon. A review of the literature on conjunctival pigmentation secondary to eyelid cosmetics is presented.


Prolonged hypotony following cataract extraction. Hypotony after intracapsular cataract extraction was prolonged in 3 eyes because cyclodialysis clefts were inadvertently formed. One eye became normotensive with the topical application of corticosteroid; 2 required surgical intervention.


The monocularly elicited visual evoked response in chronic glaucoma. The monocularly elicited transscleral visual evoked cortical response was measured in a group of patients with asymmetric visual field loss due to chronic open-angle glaucoma. It was established that the visual field loss in the 2 eyes was statistically different in the patients. In addition, the peak amplitude of the visual evoked response obtained from a common occipital cortical position was statistically different when the 2 eyes were separately stimulated. A good linear correlation was found between the amplitude of the monocular transscleral visual evoked response and the amount of visual field remaining on tangent screen perimetry. The best correlation was found when a red stimulus was used to elicit the VER. The monocularly elicited visual evoked response provides an objective measurement of visual field in chronic open-angle glaucoma. It has value in those patients who have asymmetric disease and who are unable to provide reliable subjective responses. It may be useful in such patients to follow progression of the glaucomatous process.


Systemic lupus erythematosus presenting as optic neuritis. A 57-year-old white man presented with unilateral optic neuritis. General physical examination and neurologic consultation revealed no further findings. Laboratory investigation, however, yielded an elevated sedimentation rate, positive LE preparation, elevated ANA titer, false-positive VDRL, and red blood cell casts in the urine. A diagnosis of systemic lupus erythematosus (SLE) was made. The patient was treated with sub-Tenon and systemic corticosteroids. There was a moderate improvement in central visual acuity. The suspected pathophysiology of SLE is reviewed. The papillitis presumably reflects the generalized vasculitis of SLE and may be responsive to corticosteroids as are other signs and symptoms of this disease.


Dextrocardia and ventricular septal defect in the Möbius syndrome. A case of Möbius syndrome is reported with the additional features of dextrocardia and a single ventricle, neither of which have been previously reported in the literature with this syndrome. Correlation of the period in embryogenesis of cardiac partitioning and rotation with the appearance of the cranial nuclei and limb buds would support the proposal that the fourth to the seventh week of gestation is the critical period of embryogenesis, wherein an intrauterine insult could give rise to the Möbius syndrome.


Retinal vascular occlusions and their treatment with low molecular weight dextran and vasodilators: report of six years' experience. Fifty-two cases of retinal vascular occlusions were treated with retrobulbar injection of lidocaine (Xylocaine) and acethylcholine and systemic administration of low molecular weight dextran and papaverine hydrochloride. Twenty-eight patients had arterial occlusion while 24 patients suffered from venous occlusion. Improvement in vision was observed in 13 eyes (46%) with arterial occlusion. Sixteen patients (66%) with venous occlusion showed improvement in vision. Only 9 cases (17.3%) recovered completely (3 arterial occlusion and 6 venous occlusion). Good results were achieved only if treatment was started shortly after the onset of the disease. Systemic side effects of low molecular weight dextran were observed in 6 cases, all of which were excluded from the present study. Despite the relatively good results obtained with the use of low molecular dextran combined with papaverine hydrochloride in the treatment of retinal vascular occlusions, this treatment cannot be considered a revolutionary breakthrough.


Traumatic central retinal vein occlusion. A patient with the clinical picture of thrombosis of the central retinal vein following relatively minor head trauma is discussed. Only 2 reports in the literature have documented a similar event. It is suggested that the condition may have arisen as a result of an abnormality of the central retinal venous outflow system since such an abnormal pattern was discovered on orbital venography.


Iontophoretic local anesthesia for conjunctival surgery. An iontophoretic unit, originally designed to deliver local anesthesia to the tympanic membrane, has been adapted for use on the tarsal conjunctiva before excision of conjunctivolithiasis plaques and other intra- and subconjunctival lesions.


Numerical grading of the disc.

Numerical grading of the disc. The current method of grading the optic disc cannot replace stereoscopic photography. The present method of describing the optic disc is misleading and does not supply as much information as could be provided. The proposed method adds both vertical and horizontal dimensions. It takes very little time to record and supplies both the reader and subsequent examiner with a more detailed description of the disc, cup, disc ratio.


Congenital medial canthal tendon malposition. This report describes the characteristics and treatment of a syndrome in which the predominant ophthalmic defect is a congenital malposition of the medial canthal tendon. The syndrome is illustrated by 3 patients, each of whom had associated nasal deformities on the ipsilateral side. These congenital anomalies most likely resulted from an arrest in development during the second month of embryonic life. A combined effort by the ophthalmic plastic surgeon, the general plastic surgeon, and the otolaryngologist has been found useful in the management of these patients.


Bietti's crystalline fundus dystrophy.

Bietti's crystalline fundus dystrophy. Two cases of Bietti's crystalline fundus dystrophy are presented. The crystals in the posterior pole are associated with a diffuse tapetoretinal degeneration. The functional symptoms are less severe than in pigmentary retinopathy.


Delayed onset chloroquine retinopathy: case report. A patient presented with decreased visual acuity and retinal findings compatible with chloroquine retinopathy 5 years after discontinuing regular usage of chloroquine for rheumatoid arthritis. A review of the literature on chloroquine retinopathy is outlined. In addition, the characteristic findings including fluorescein angiography, retinal physiologic studies, and symptoms are reviewed. Chloroquine retinopathy is dose related and essentially irreversible and often progressive once typical findings are noted. To our knowledge very delayed onset of chloroquine retinopathy is a relatively rare phenomenon but the medical and ophthalmic communities must be alerted to the possibly severe complications of this iatrogenic disease entity.


Ocular complications of electroconvulsive therapy. Multiple cardioversion shocks were recently reported to cause disruption of the iris pigment epithelium. Pigment debris was deposited on the anterior lens surface, iris stroma, corneal endothelium, and trabecular meshwork. Similar findings were observed in 3 of 4 patients receiving more than 10 electroconvulsive therapy shocks and in a fifth patient who became attached to an electrified fence.


Peripheral retinal neovascularization in sarcoidosis with thalassemia. A black youth with peripheral retinal (sea fan) neovascularization had both sarcoidosis and alpha-thalassemia. The possibility that both of these disease entities were responsible for the observed pathology is explored. Most of the pathology present, the stasis, the hypoxia, and the vasoproliferation, is presumed to be due to the sarcoidosis. No definite relationship was established in this case for the alpha-thalassemia, a rare genetic abnormality of hemoglobin production.


Some observations on ocular manifestation of sickle cell disease. The ocular manifestations of 76 sickle cell disease patients are reported. Our findings indicate that any type of sickle cell oculopathy may appear in conjunction with any type of hemoglobinopathy and that no single ocular finding is specific to any one type of sickle cell anomaly. Sickle cell oculopathy, particularly retinopathy, is found to be a slowly progressive condition. Treatment of retinal and vitreal neovascularization with photocoagulation seems to be indicated to stop the disease process. Acute retinal vascular occlusion seems to respond favorably to the intravenous administration of low molecular weight dextran and papaverine hydrochloride. Sickle cell patients suffering from retinal detachment do not respond favorably to conventional retinal detachment surgery.


A new gas permeable hard contact lens.

A new gas permeable hard contact lens. In reviewing the literature, it becomes apparent that there is continued interest in a gas permeable contact lens. Although silicone is the logical choice of material because of its unusual oxygen permeability, its hydrophobic characteristics, poor centering characteristics, and problems with proper edging have prevented its widespread use. This paper reports on a preliminary study in a group of 25 phakic patients fitted with a lens made of a new material consisting of polymethylmethacrylate in combination with silicone. The material is reported to be gas permeable although advantage is also taken of the lens flexibility to enhance the interchange of tears to maintain normal corneal metabolism. The other advantages of the lens are its wettability and its unusual degree of comfort.


Cyclic esotropia.

Cyclic esotropia. A recent case of cyclic esotropia is reported. Factors precipitating the cycle and theories about the clock mechanism are discussed. At present the exact nature and location of the clock mechanism remains speculative.


Intraepithelial epithelioma (Bowen's disease) of conjunctiva and chronic lymphocytic leukemia. Occurrence of intraepithelial epithelioma (Bowen's disease) of the conjunctiva in a 54-year-old white man with chronic lymphocytic leukemia and bilateral labiopalatine clefting is discussed. The lesion developed slowly during 3 years following mechanical trauma to the eye. The interrelationship between trauma, Bowen's disease, and chronic lymphocytic leukemia remains obscure. It is postulated that an altered immunologic status might be responsible for neoplastic changes in the posttraumatic healing process. Intractable lesions in a patient with abnormal immunologic system or with an already proven malignancy should be studied by excisional biopsy.


Effect of xenon arc photocoagulation on corneal endothelium. Xenon arc photocoagulation of the fundus of pigmented rabbits resulted in no corneal endothelial cell damage when the experiment was designed to minimize corneal temperature rise by frequent topical instillations of ophthalmic irrigating solution.


Rhegmatogenous retinal detachments in blacks. Primary rhegmatogenous retinal detachment is probably much less common in blacks than whites. We reviewed 100 consecutive black patients with retinal detachment who were seen over a 3 year period, and compared them to a randomly selected group of 100 whites seen during the same period. Trauma was the most common cause of detachment in blacks (52%), but was a relatively uncommon cause in whites (12%). Posterior vitreous detachment was the most frequent etiology of detachment in whites (47%), but was rare in blacks (15%). Aphakia was the second most common etiology in whites (30%), while it was relatively uncommon in blacks (13%). Myopia and/or lattice was a more frequent associated finding in blacks with detachment (19%), than in whites (9%). These findings are discussed and the literature reviewed.


Minimum ptosis corrected by lid fold procedure. The lid fold procedure has become a popular ophthalmic plastic surgical procedure among Oriental girls following World War II here in Hawaii and in the Orient. In addition to creating a lid fold, the procedure can be used to correct a mild degree of ptosis (1 to 3 mm). When done under local anesthesia the width of the fold, the amount of elevation, and the matching symmetry of the eyelids can be readily controlled.


Lindner posterior vitreous fistula with senile cataract extraction for quick reformation of anterior chamber: indications, technique, and results. Pars plana partial vitrectomy using Lindner posterior vitreous fistula was prophylactically used with senile cataract extraction in cases known to be liable for nonreformation of anterior chamber and gelly vitreous with perfect results as regards postoperative maintenance of anterior chamber aphakic depth. The combined operation is indicated in cases (1) if the other eye was lost through nonreformation of anterior chamber after a perfect senile cataract extraction; and (2) in very old patients with very shallow anterior chamber especially when there are other senile ocular changes such as flatter, thinner cornea, tendency for uveal vascular engorgement and exudations (after hypotony of operation), and bad wound healing. This is especially true in small hypermetropic eyes with small cornea. The technique of the combined operation is described.


Pigmented paravenous retinochoroidal atrophy. A patient with paravenous pigmented chorioretinal atrophy is presented. A differential diagnosis and review of the literature are discussed. Fluorescein angiography confirms the presence of a widespread paravenous retinal pigment epithelial defect with minimally affected choroidal vasculature. The visual fields are constricted in proportion to the extent of the pigmentary abnormality. The electro-oculogram and electroretinogram show reduced responses indicative of a more extensive abnormality than is visible ophthalmoscopically. The etiology and natural course of this entity are unknown.