[Renin and various factors of its regulation in acute myocardial infarct]. The activity of blood plasma renin and the content of aldosterone were studied in dynamics in 55 patients with acute myocardial infarction following a different course. The dependence of renin activity and potassium content is analysed. The authors did not find any dependence between the degree of growth of blood plasma renin activity and the course of the disease; exception to this were patients with disorders of rhythm and conductivity. It is presumed that changes in potassium metabolism play an important role in the changes in renin activity in myocardial infarction.


[Effect of periodicity of many days on the outcome of myocardial infarct in males]. The existence of an endogenic biological rhythm of 42-day duration, determining both the moment of development and the outcome of myocardial infarction, is shown. Mortality was highest among persons who had acquired the disease in the first and fourth weeks of this period. This may also testify to the existence of a 21-day cycle of periodicity which has an effect on the outcome of the disease.


[Diagnostic information content of electrocardiographic signs of myocardial scars in ischemic heart disease]. A study was made of 326 cases with scars of the myocardium more than 5 mm in size and of 697 cases without any scars. The ECG changes were classified according to the Minnesota Code. Among cased in which scars were found on autopsy, the ECG had made it possible to establish (by WHO criteria) myocardial infarction in 34%, other chronic forms of ischemic heart disease in 35%, miscellaneous changes in 26%, and showed no changes in 5% of cases. The sensitivity of the electrocardiographic method in revealing myocardial scars proved to be low: the frequency of false-negative results according to any of the signs exceeded 30% in transmural scars and 60% in non-transmural scars. The most valuable diagnostic information was yielded by Q and QS waves (Codes I-1 and I-2), artial fibrillation, changes in T waves (Code V-2) and total block of the left branch of the bundle of His (in diminishing succession).


[Disorder of erythrocyte membrane calcium binding in hypertension and experimental genetic hypertension]. Under conditions of physiological concentration of free calcium in the incubation medium (Ca2+f = 1.5 mM), the outer surface of the membrane of human and Wistar rat erythrocytes binds 435 +/- and 359 +/- 32 nmol calcium per 1 ml cells, respectively. The external surface of erythrocytes in patients with essential hypertension and in rats with spontaneous hypertension (SHR, Kyoto Wistar) also binds such amounts of calcium. With the concentration of calcium corresponding to its concentration in the intracellular space (Ca2+f less than 1 mcM), the inner membrane surface of eritrocyte ghosts binds only 3.53 +/- 0.16 and 4.28 +/- 0.39 nmol calcium per 1 mg protein of human and rat eritrocyte ghosts, respectively. The noted decrease in the calcium-binding capacity of the inner part of the erythrocyte membrane, being probably a characteristic feature of membrane alteration displayed also in other cellular structure, may determine the changes in tissue sensitivity to the effect of hormones and catecholamines in both types of hypertension.


[State of the microcirculation in hypertension according to conjunctival biomicroscopy data]. Microcirculation was studied by the method of conjunctival biomicroscopy in 276 practically healthy subjects and in 174 patients with various stages of hypertension. In 80 of these patients with hypertension the study was conducted in dynamics. Among healthy subjects abnormalities in the conjunctival microcirculatory bed were occasionally encountered, the possibility of their detection grew with the age of the person examine. Marked changes in the terminal blood flow, considerably exceeding the age norm, were revealed in patients with hypertension; these changes progressed with the growth in the severity of the disease. Microcirculatory disorders in patients with hypertension are rather stable in character.


[Aspects of a study of the blood enzymatic and isoenzymatic spectrum in different forms of ischemic heart disease]. Analysis of data obtained in the study of the blood enzymatic and isoenzymatic spectra (creatine phosphokinase and lactate dehydrogenase with simulatenous study of aspartate and alanine transaminases) in patients with various forms of ischemic heart disease showed the close correlation of the studied tests with the clinical picture of the disease, the degree and depth of myocardial involvement. The enzymatic tests studied are of diagnostic and prognostic importance and may be used in the differential diagnosis of various forms of ischemic heart disease.


[Rhythm of the daily changes in functions in ischemic heart disease]. The daily changes in the functional state of the cardiovascular system and in the indices of bioelectric activity and hemodynamics of the brain, as well as the daily variability of lipid metabolism, electrolytes and 17-OCS in urine and certain indices of hemostasis were studied in 162 patients with ischemic heart disease. It was shown that, as compared to healthy individuals, patients with ischemic heart disease had a smaller amplitude of fluctuations in the daily rhythm with displacement of the peaks of activity to a later time. The only exception was the daily excretion of 17-OCS and aldosterone, the amplitude of fluctuations of which was close to that of these indices in healthy individuals but was distinguished by a displacement of 4 hrs. It is concluded that the biological clocks are sensitive to the changing conditions in which the systems of the organism function in ischemic heart disease.


[Effect of insulin on coronary vessel adrenergic and cholinergic reactions]. The effect of a single insulin injection on the reaction of the coronary vessels to adrenaline, noradrenaline, and acetylcholine was studied in experiments on dogs. Insulin induces a decrease of arterial pressure and of the resistance of the coronary and peripheral vessels reduces the reflex cholinergic and beta-adrenergic reactions of dilatation of the coronary vessels, and promotes alpha-adrenergic reactions in intracoronary administration of adrenaline and noradrenaline. Insulin also weakens the immediate cholinergic reactions of the coronary vessels in stimulation of the effector systems with acetylcholine.


[Effect of the chronic stimulation hypothalamic negative emotiogenic zones on a change in blood lipid and heparin content and on arterial pressure]. Rabbits kept on a routine diet and subjected, under conditions of free behavior, to long-term chronic (for a period of 4 months) stimulation of hypothalamic zones which give rise to negative emotions had marked stable endogenic hyperlipidemia (hypercholesterolemia, hypertriglyceridemia), a decrease in the blood heparin content, shortening of blood coagulation time, and mild (by 11%) but significant increase of arterial pressure. The extent of these changes differed with the animals. The dynamics of the increase in the blood cholesterol and triglyceride levels differed both in the degree of the increase as compared to the initial levels (by 44 and 74%, respectively) and in the latent period of attaining maximum deviations. There was a definite connection between the changes in the levels of triglycerides and heparin in blood. When rabbits were given small doses of methylthiouracil and stimulation was continued on that background, the blood cholesterol level grew still more (up to 110% of the initial level). The data obtained attest to the role of prolonged emotional stress in the genesis of stable metabolic and vasomotor disorders which may promote the development of preconditions for the origin of such cardiovascular diseases as atherosclerosis, hypertensive disease, and coronary thrombosis.


[New approach to the deposition of biologically active compounds in the body: an experimental study of the intracoronary administration of modified Sephadex]. The possibility of depositing in the myocardium drugs immobilized on modified Sephadex was studied. The method makes it possible to produce optimum local concentration of the drug with a predetermined rate of its detachment and has significant advantages over the commonly used methods for introducing drugs. Appraisal of a complex of data, including the findings of morphologic examination and analysis of the ECG and the curves of changes in the activity of CPK and hypoxanthine, has shown that intracoronary administration of 0.02 mg of Sephadex microspheres (approximately 20 000 microparticles) 20--40 mc in diameter per 1 g of dog myocardium has no harmful microembolic effect.


[Lipid extraction from blood plasma and the subsequent administration of the autologous delipidized plasma as a possible agent for treating atherosclerosis (an experimental study)]. A method for the delipidization of blood plasma of rabbits and dogs with diethyl ether with its subsequent reinfusion into the animal's body is described. Triglycerides and cholesterol were mainly extracted from blood plasma, and only 1/3 of phospholipids. In dog experiments the plasma delipidization procedures led to a decrease of the cholesterol content in the overall fraction of atherogenic lipoproteins of low and very low density and an increase of the cholesterol content in antiatherogenic lipoproteins of high density. The lipoextraction procedures are harmless and may be employed for reducing the blood lipid level.


[Importance of Innerfield's serum test in the diagnosis of prethrombotic and thrombotic states in various cardiovascular diseases]. To appraise the diagnostic significance of Innerfield's serum test, 40 patients with ischemic heart disease were examined; 18 of them had angina pectoris, 22 myocardial infarction, in the acute of subacute stage, 15 hypertensive disease, and 27 patients had rheumatic heart disease. It is shown that the blood fibrinolytic system was depressed in most patients. A shorter serum test time was characteristic of these diseases when their course was complicated by thromboembolism. With due consideration for the data on the state of the blood coagulation and anticoagulation systems, the serum test may be used for identifying the prethrombotic condition in patients with various cardiovascular diseases.


[Erythrocyte aggregation and fibrinogen derivatives in ischemic heart disease]. Aggregation of erythrocytes was determined in 50 patients with angina pectoris and myocardial infarction and in 20 subjects of the control group by rheoscopy after Schmid-Schoenbein. It is shown that in patients with ischemic heart disease aggregation of erythrocytes is considerably increased and the hydrodynamic strength of the aggregates is greater. The erythrocyte aggregation curve is some patients with ischemic heart disease was of a biexponential character in distinction to that in subjects of the control group, which was of the monoexponential type. It was found that the increase in the strength of the erythrocyte aggregation and in the rate of aggregate formation was due to fibrinogen and its complex compounds with decomposition products.


[Thrombocyte functional resistance and histamine and serotonin metabolism in ischemic heart disease]. The functional resistance of blood platelets, the reserve and active forms of histamine and serotonin, and the activity of monoamine oxidase and histaminase were studied in 5 healthy subjects, in 64 patients with acute, subacute and rehabilitation stages of myocardial infarction, and in 33 patients during frequent attacks of angina pectoris and after their total subsidence. On the grounds of the data obtained, the authors conclude that: (1) the drastically disturbed blood platelet resistance, megathrombocytosis, and marked decrease in the content of reserve amine forms in ischemic heart disease should be considered an additional risk factor; (2) agents which improve blood platelet vital activity and/or block the release reaction should be included in the therapeutic program for patients suffering from ischemic heart disease with heightened risk factors.


[Diagnostic importance of a study of the rate of change in potential difference during the period of ventricular repolarization in ischemic heart disease]. In patients with the acute stage of myocardial infarction the ratio between the maximum rates in the different and afferent parts of the vectocardiographic ST--T loop decreases sharply and, accordingly, the ratio between the amplitudes of the second phase of the T wave and the first phase on the first ECG diminishes. The time needed for attaining the maximum value of acceleration in the initial phase of rapid repolarization is simultaneously reduced. With the gradual recovery of the patients, these indices tend to return to normal. During the bicycle ergometric test in patients with chronic ischemic disease of the heart the reduction of these indices is revealed more frequently and at lesser loads than the shifts which are characteristic of the ordinary ECG recorded in coronary insufficiency.


[Dynamic observation data on the course of ischemic heart disease]. The clinical course of ischemic heart disease was followed-up for 3 to 5 years after coronarography in 91 patients with atherosclerotic affection of the coronary arteries who had not been given purposeful treatment. In 30.8 per cent in cases the clinical picture of the disease grew worse: angina of effort became more frequent angina at rest occurred (19.8%), and myocardial infarction (7.7%) and symptoms of circulatory insufficiency (3.3%) developed. A lethal outcome was recorded in 16.5% of cases. A connection between the extent of the atherosclerotic process (the number of vessels involved) and the advancement of the disease was revealed.


[Indices of intracardiac hemodynamics and of myocardial contractile function in relationship to the total coronary artery lesion in stenocardia]. Study of the intracardiac hemodynamics, the work of the ventricles, and the findings of a phase analysis of the ventricular systole in various groups of patients with angina pectoris showed that the advancement of the atherosclerotic process in the coronary arteries is attended with disorders of contractile properties and with changes in the electromechanical activity of the cardiac muscle. Appraisal of the hemodynamic disorders according to the extent of involvement of the coronary arteries showed that maximum affection of the vessels is attended with marked abnormalities of hemodynamics. A similar regularity was found in analysis of the indices characterizing the contractile function of the myocardium.


[Treatment of ischemic heart disease of old age at a cardiologic sanatorium near Moscow]. On the basis of scientific and practical experience at a sanatorium located near Moscow, the authors claim that in the management of elderly patients with ischemic heart disease due consideration must be given to concomitant diseases and complications. The low adaptability of the organism of such patients and the increased meteorolability make it difficult to choose the dosage of the therapeutic natural and performed physical factors and call for careful control over the tolerance to the procedures and the course of the treatment, particularly in the rehabilitation departments. A properly chosen complex of sanatorium treatment promotes improvement of hemodynamics, hemostasis, and lipid metabolism and increase in the adaptability of the organism and in the patients' physical activity.


[Genetics of ischemic (coronary) heart disease]. On the basis of the medical history and clinical examination of members of families of 133 practically healthy probands and probands suffering from ischemic heart disease and comparison of the frequency of this disease among: (1) husbands and wives and relatives of brother-sisters of probands with ischemic heart disease; (2) husbands and wives, living together for a long time, one of whom had a favourable heredity while the heredity of the other is aggravated by vascular and metabolic diseases; (3) step-borthers and step-sisters born of remarriage of a healthy person to another healthy person in one case and to a sick person in another; (4) persons related in different extent to a sick proband, the authors conclude that genetic factors are very important in the development of coronary atherosclerosis and ischemic heart disease.


[Comparison of electrocardiographic (35 leads) and pathologicoanatomic diagnostic data in determining the dimensions of necrotic and peri-infarct zones]. Comparison of the data of electrocardiographic diagnosis for determining the size of the necrotic and periinfarction zones in records from 35 precordial leads with the results of pathoanatomical study of the size of the focus of affection in 8 dead persons who had suffered from acute myocardial infarction showed the adequacy of the method for assessment of the state of the necrotic and periinfarction zones in patients with acute myocardial infarction by the sum elevation of the ST segment in anterior myocardial infarction and by the area of segment ST depression in inferoposterior myocardial infarction.


[Antiglaucomatous trabeculectomy (author's transl)]. The case material covers 115 glaucoma patients in whom antiglaucomatous trabeculectomy had been performed. Observation times: between a maximum of 3 years (12 cases) and a minimum period of 6 months (18 cases). Open-angle glaucoma 28 cases (22.8%), narrow-angle glaucoma 22 cases (19.1%), air-block glaucoma 17 cases (14.75%), other types 16 cases (13.91%). Best results were obtained with the open-angle glaucoma; surgery had reduced the pressure to normal in 85.21% of the cases. In addition, normal pressure was achieved by drug therapy in 8.8% of the cases. Good results were also obtained in glaucomas with narrow angle of iris (pressure normalization in 86.3% of the cases), as well as in combined surgery when glaucoma and cataract occurred simultaneously. The mechanism of action of the surgical procedure consists in the formation of a fistulating excretory duct covered up by a scleroconjunctival wall, generally forming a flat seepage cushion.


[The effect of timolol eye drops on the intraocular pressure in simple glaucoma (author's transl)]. The intraocular pressure response to timolol ophthalmic solution, a beta-adrenergic blocking agent, was tested in two groups of open angle glaucoma patients using the 0,1% and the 0,5% solution. The 0.5% concentration gave a mean IOP reduction of 13 mm Hg in 39 glaucomatous eyes, corresponding to 46% of the pretreatment pressure level. The 0,1% concentration resulted in an average pressure decrease of 11,5 mm Hg in 22 glaucomatous eyes, corresponding to 40% of the pretreatment pressure levels. With both solutions a reduction of the first day's response was noted after repeated administration of timolol. In all patients tested timolol was tolerated well subjectively and objectively without any side effects. Timolol did not affect blood pressure or pulse rate. Tear production was not reduced after topical application of timolol. Pupillary diameter and facility of outflow were not changed significantly under therapy. It is concluded, that timolol acts primarily by reduction of aqueous inflow. The advantages of timolol as antiglaucomatous drug not affecting visual functions like miotics are discussed.


[Diploptics - brand-new system of concomitant squint treatment (author's transl)]. The present paper exposes the shortcomings of orthoptics and proposes an original system of concomitant squint treatment named diploptics. This system is based on the new conception of the role of bifixation in the physiology and pathology of binocular vision. The major principle of diploptics is to induce diplopia under natural conductions and further to "enliven" or develope the ability to overcome it with the help of the optomotor fusion reflex and thus to recover the auto-control mechanism of bifixation - the basis of the normal binocular vision. To realize this principle a number of methods are suggested. A trial of these produced hopeful results.


[Fluorescein angiographic study on the retinal vessels of young cigarette smokers (author's transl)]. Caliber irregularities of the small retinal vessels may usually be observed as an early sign of vascular disturbance in young cigarette smokers. A randomized blind study on 28 smokers and 30 non-smokers aged between 17 and 39 years, which were entirely healthy according to the results of physical and ophthalmoscopical examination, was undertaken with the aid of fluorescence angiography. Only smokers with a consumption of at least 15 cigarettes daily and a history of smoking of at least 5 years were taken into account for the study. The angiograms were read as fluorescein angiographic negatives under a stereomicroscope. To the person interpreting the angiograms, name or date of the angiograms were not know. Caliber irregularities of the retinal arteries, veins, arterioles and venoles were found in 18 of the smokers and 2 of the non-smokers. The incidence of vascular irregularity in smokers is highly significant at the 1% level.


[Familiary arhinia combined with peters' anomaly and maxilliar deformities, a new malformation syndrome (author's transl)]. A report is given on two sisters with arhinia, hypertelorism, Peters' anomaly and deformities of the maxilla. The lacrimal sacs in both patients were extirpated because of recurrent dacryoadenitis due to bilateral aplasia of the nasolacrimal ducts. One eye showing Peters' anomaly with microphthalmus was enucleated in the elder patient 12 years ago. Differential diagnosis includes frontonasal dysplasia and the different types of holoprosencephaly-syndromes. Probably this new malformation syndrome is a recessive inherited.


[Fluorescencangiographical and histopathological findings in cases of non-pigmentes iris cysts (author's transl)]. The clinical, fluorescencangiographical and histopathological findings in 3 cases of non-pigmented iris cysts are described. The first case was a posttraumatic cyst after cataractextraction, the second in all probability, also a posttraumatic cyst and the third case was a spontaneous intrastromal nonpigmented iris cyst. Although the clinical and histopathological findings are not always helpful in the differential diagnosis between non-pigmented posttraumatic and non-pigmented spontaneous iris cysts, we believe, that fluorescencangiography may provide valuable additional information. The preoperative differentiation is important, because radical excision including the affected cornea or sclera is necessary in the posttraumatic cases, whereas only a simple iridectomy is required for the spontaneous cysts.


[Videoprocessing pupillographic perimetry in hemianopsia (author's transl)]. In cases of homonymous hemianopsia, with the aid of pupillographic perimetry it is possible to differentiate between infra- or suprageniculate lesions. Principally the validity of Wernicke's theory remains unchanged. However in processes in the central visual pathways a hemihypokinesia of varying degree may be found. In the blind visual fields so far in our cases a congruence between pupillographic and perimetric thresholds has not been confirmed. The phenomenon of hemihypokinesia of the pupil is discussed.


[Alteration of gilded molybdenum-wire after implantation in the rabbit skin (author's transl)]. Changes in gilded molybdenum-wire after implantation in the rabbit skin were investigated by a scanning electron microscope. The described changes are caused by electrolytical action of the tissue fluid. Calcium-molybdat was found between the gold and the molybdenum layer.


[Cystoid macular oedema over a malignant melanoma of the choroid. Clinic, fluorescencangiography and histopathologic findings (author's transl)]. A case of cystoid macular oedema lying over a malignant melanoma of the choroid is reported. A direct correlation between the histopathological findings and the fluorescencangiographic picture is shown. The fluorescencangiography was taken 14 days before enucleation and showed the typical structure of a cystoid maculaoedema. The pathogenesis of the accumulation of the fluid within the layers of the Henle' fibres and the inner nuclear layer are discussed.


[Tear-sac concretions (author's transl)]. Report is given on three cases of dacryolithiasis. All cases were demonstrated by dacryocystography. Two dacryoliths were obtained at operation, another one by spontaneous passage through the nose. Histopathological examination of the dacryoliths in two cases revealed the presence of a mycotic infection, most likely with Candida albicans. The casts were found to be composed of layers of neutral and acid mucoproteids and lipids, accompanied by an infiltration with leucocytes.


[Double optic papilla in eye coloboma (author's transl)]. The article reports on a 4-year-old girl with multiple congenital malformations. Ophthalmological examination revealed microphthalmia, bilateral colobomas of iris, leukoma of the right eye, convergent strabismus in the left eye. An oval salmon-coloured area was seen at the fundus of the left eye where the retinal vessesl proceed into the depth. There was no vascular infundibulum. A papilla-like cavity was seen at the bottom left of the coloboma (possibly a circulus zinnii, also called circulus vasculosus nervi optici, may be present). Both papillae are connected with each other by means of a vein. This patient, therefore, presented an extremely rare case of malformation with two papillae in one coloboma.


[Treatment of amblyopia with soft occlusion lenses (author's transl)]. Inverse and regular occlusion therapy is carried out by means of a block coloured soft contact lens in cases, in which previous conventional patching had not been successful for external reasons. The technical data of the lens used and the indications for its application are given. Preliminary results show the usefulness of this method.


[High altitude retinal hemorrhages in mountain climbers (author's transl)]. A report is given on three patients who noticed an acute deterioration of visual acuity after a sojourn at 5000 altitude caused by retinal hemorrhages. We documented both the ophthalmological examinations such as visual acuity, fundus, perimetry and fluorescence-angiography and the systemic results. During the period of about half a year after the incidence of deterioration of visual acuity we followed the course of illness. The pathophysiological mechanism, and therapeutical and prophylactical possibilities are discussed in consideration of the results of other authors.


[Alport's syndrome (author's transl)].

[Alport's syndrome (author's transl)]. A case report is given of a 22-years old student (whose brother had Alport's syndrome) with recurrent central corneal swelling and paracentral erosions of the cornea of both eyes. Further signs of beginning Alport's syndrome in this case are disturbance of re-adaptation after dazzling (Mesoptometer) and paracentral scotomata in the visual fields. Remarkable was the small diameter of the disc in both eyes (1.37 mm). Local therapy was Scopolamin-eye-drops, Actihaemyl- and especially Cystein-Gel (2.4%).


[Conjunctivitis caused by fly larvae (author's transl)]. The author presents a case of ophthalmomyiasis externa which caused conjunctivitis. The larvae which were visible in photomicrographs were immobilised in paraffin oil.


[Levator strenght measurements. Oculomyodynamometry of the levator palpebrae superioris (author's transl)]. The author describes a method of levator strength measurement with the oculomyodynamometer with which he measured a maximum strength of the levator muscle in adults of 58 G. The levators were much weaker in congenital ptosis. In three such cases the levators had strengths of only 9 G, 5 G and 5 G. In cases of acquired ptosis the reduced strength of the levators was on an average about half normal. This method allows 1. better diagnosis with levator paresis, 2. a control of its behaviour during the clinical course, 3. profiting from the measurement results for correcting operations on the levator muscle.


[Use of a air pressure drill system for Toti's operation (dacryocystorhinostomy) (author's transl)]. Report concerning a high-speed drill system powered by compressed air (Air Drill 100) which considerably facilitates the trepanation of a bone window during Toti's operation in conjunction with a combined drill-miller. This instrument provides considerable advantages over traditional electrically operated instruments.


[Pigmentary corneal and scleral changes in Leschke's syndrome (author's transl)]. A complex of changes including pigmentary changes of tuberous type in the corneal limbus and scleral hyperaemia were observed in a patient with Leschke's syndrome. The small tumour in the corneal limbus was treated surgically with a good result confirmed by 4 years of observation. The histological diagnosis (pigmentary naevus) confirmed the benign character of the pathological process. The possibility of development of pigmentary corneal and scleral changes coexistent with presence of café au lait spots on the skin of the trunk and face and endocrine disturbances is stressed.


[Creatine kinase isoenzymes: idiopathic occurrence of creatine kinase BB activities in patient serum (author's transl)]. By differentiation of creatine kinase isoenzyme activities in sera using immunological methods the published data about occurrence of creatine kinase BB activities in patients with different diseases or after surgical treatment, respectively, cannot be verified in general. With a frequency in the order of magnitude of 1 : 1000 in the serum of old patients (age 57 to 85 years with one exception), however, creatine kinase BB activities can be measured. The range of activities is 15 to 234 U/1, or 19 to 94% of total creatine kinase activities, respectively. At the present time there is no possibility to correlate this phenomenon to any specific disease. These cases are detected by abnormally high results of CK-MB activity measurements with the immunoinhibition test (range 60 to 202% of total creatine kinase activities) which lead to a repeated analysis using immunoprecipitation. The results of all CK-BB patients investigated till now are presented and discussed.


[Tetanus antitoxin in serum and cerebral spinal fluid in viral meningitis in children (author's transl)]. Tetanus antitoxins were measured in serum and cerebro spinal fluid from 58 children--35 boys and 23 girls--with viral meningitis. The concentrations of IgG, IgA and IgM were also determined. The appearance of tetanus antitoxins in cerebral spinal fluid depends on absolute antitoxin levels in serum as well as on the antitoxin/IgG ratio. Antitoxin/IgG ratios in serum and cerebro spinal fluid were in the same order of magnitude. Detection of tetanus antitoxins in the cerebral spinal fluid of children with viral meningitis shows clearly that antibody found in cerebral spinal fluid is not an absolute proof of a certain disease. The results further indicate that local production of IgG antibody cannot be postulated by detecting certain antibodies in the CSF. It is also necessary to prove that antibody/globulin ratios are of significantly different magnitude in serum and CFS.


[Oral glucose tolerance test in women in relation to menstrual cycle (author's transl)]. A standardized 50 g glucose tolerance test was given twice to 192 women with regular menstrual cycle within an interval of some weeks. The data showed that higher blood sugar values and glucosuria occurred significantly more often in the second half of the menstrual cycle, which was true also for women using monophasic type contraceptives. However, the reproducibility of tests--performed twice in the second half of the menstrual cycle--was only 24%, as compared to about 60%, when the first test was performed during menstruation or in the first half between two bleedings. Therefore, the latter intervalls seem to be the most appropriate time to perform a glucose tolerance test on premenopausal women.


[Possible influence of plasma factors on lymphocyte blastigenesis and E rosette forming in rheumatoid arthritis (author's transl)]. The lymphocytes blastigenesis to PHA in culture with autologous or normal plasma, the formation of E rosettes and the presence of immunoglob-lins on the lymphocytes surface were evaluated in 51 patients with chronic primary polyarthritis. While the percentage of T and B cells was almost normal (52.1 +/- 2.1% and 18.1 +/- 2.1%, N.V. 55.6 +/- 2.0% and 16.2 +/- 0.8%), the blastigenesis was significantly reduced in cultures with a 25% autologous plasma (5399 +/- 709 cpm compared to 13,182 +/- 920 cpm of the normal standard) and returned towards normal values when it was replaced by the plasma of a normal subject (12,189 +/- 1081 cpm). The rheumatoid plasma was capable of reducing the blastigenesis in 11 normal subjects (7395 +/- 750 cpm). The preincubation for 90' of the lymphocytes of 14 controls in rheumatoid or autologous plasma induced a significant reduction in the formation of spontaneous rosettes (40.8 +/- 1.4 % and 56.2 +/- 1.7%). These results suggest that the reduced function of the T lymphocytes in this disease is due to plasma factors.


[Isoenzyme P of N-acetyl-beta-glucosaminidase in sera from patients with liver diseases (author's transl)]. The isoenzyme P of N-Acetyl-beta-Glucosaminidase (beta-NAG) is demonstrated in sera from healthy persons and patients with acute and chronic liver diseases by electrofocusing in polyacrylamide gel. Elevation of isoenzyme P is observed only together with elevation of Glutamate-Pyruvate-Transaminase (GPT) in patients with acute and chronic liver diseases of different etiology and activity. The correlation between isoenzyme P and GPT is significant. On the contrary whole beta-NAG is elevated due the activity of the mesenchymal reaction in the injured liver tissue, not related to enzymes of the cytosol like GPT.


[Mechanisms of action of estrogens physiological and pharmacological aspects of hormonal "receptivity". The anti-estrogens (author's transl)]. Receptivity to estrogens may indeed depend on the concentration of the corresponding receptor in the target cells. This concentration varies physiologically, and would possibly explain, at least in part, certain hormonal interactions and receptivity changes during the physiological cycles. The modifications of receptor concentrations could perhaps be of significance in explaining the effects of "priming" and the negative influence of one steroid on another. The simultaneous presence of different receptors for the same hormone or the competition of different hormones for the same receptor offer interesting pharmacological possibilities. It has already been shown that the characteristics of receptors can explain the differences between a natural hormone like estradiol and diethylstilbestrol, the hormone with the most common synthesis. A series of synthetic derivatives (triphenylethylene) seem to offer the possibility of an antagonist effect without pollution by significant estrogenic activity, and the potential therapeutic consequences are immense. Regulatory proteins, the steroid hormone receptors, provide some of the most advanced models for rational physico-chemical and physiological approaches to pharmacological and therapeutical problems.


Hypercalcitoninaemia in patients with pheochromocytoma. As pheochromocytoma sometimes is accompanied by medullary thyroid carcinoma (in the sense of multiple endocrine adonomatosis type II = Sipple-Syndrome), serum calcitonin (CT) was measured by radioimmunoassay in 4 patients with pheochromocytoma. Before extirpation of the adreno-medullary tumor, serum CT was distinctly increased to 3 and 30 ng/ml in 2 of 4 patients, respectively. After removal of the tumor, serum CT was normal in the patients and pentagastrin stimulation produced no exaggerated CT response. In hydrochloric acid extracts from the two corresponding pheochromocytoma tissues, immunoreactive-Calcitonin (IR-CT) was detected, the concentrations amounting 1 and 4 ng/mg wet tissue. These findings suggest that hypercalcitonism in patients with pheochromocytoma cannot always be ascribed to the thyroid, i.e. increased calcitonin levels do not necessarily indicate a medullary carcinoma of this organ.


Percutaneous transluminal dilatation: a new treatment of renovascular hypertension? Percutaneous transluminal dilatation of a left sided renal artery stenosis was performed in a 61 year old patient with hypertension. Biochemical and hemodynamic activity of the renal artery stenosis was demonstrated by measurement of renal venous renin-activity and determination of renal plasma flow and of pre- and poststenotic blood pressure values. Shortly after the dilatation procedure hypertension disappeared and renal plasma flow increased. The described procedure might be an alternative method to renal vascular surgery.


25-hydroxy-vitamin D levels in a patient with hypervitaminosis D. We measured the concentrations of serum calcium and 25-hydroxy-vitamin D in a patient with hypervitaminosis D during 3 months of therapy directed toward correcting the hypercalcemia. Serum calcium could not be maintained at normal concentration without specific therapy until 9 weeks after vitamin D was discontinued. Concentration of 25-hydroxy-vitamin D at the time was 285 ng/ml, approximately half of the value measured three weeks after withdrawal of vitamin D. Serial measurements of the concentration of 25-hydroxy-vitamin D seem to be a useful means of assessing the degree of intoxication in patients with hypervitaminosis D.


Methacrylate-embedded bone marrow particle histology. Histological sections of methacrylate-embedded bone marrow biopsies allow exact evaluation and classification of the cellular marrow components. We describe a simple method for preparation of sections of aspirated bone marrow particles following embedment in methacrylate. Comparison of histological sections from marrow particles and marrow biopsies demonstrated identical quality. Thus, preparation of methacrylate-embedded particle histologies will frequently abrogate the need for marrow biopsies performed in addition to a marrow aspiration. Routine preparation of both cytological and histological preparations from aspirated bone marrow allows more exact assessment of the bone marrow than cytological evaluation only.


Ultrastructural study of mesenteric lymph nodes in old rats. The large mononuclear cells showed the features of mononuclear phagocytes and were mainly characterised by a large number of vacuolar structures. The results suggest that there is storage of lipids and mucosubstances, probably in enlarged lysosomes.


Performance of the African giant rat (Cricetomys gambianus Waterhouse) on commercial rations and varying dietary protein levels. The growth performance of 24 weanling giant rats was studied in 2 experiments of 30 weeks duration with commercial livestock rations and graded levels of protein. Daily average liveweight gain was 5.1-7.3 g, food consumption 26.9-36.3 g on 6 diets. Food intake, growth rate and food efficiency ratio were very similar using the different commercial diets. Growth performance improved as the dietary protein level was raised from 10 to 13%, but a further increase to 16% did not result in greater growth. The commercial pig ration and the experimental diet containing 13% dietary protein level were found to give satisfactory growth, and are recommended for studies with these animals.


Partial hepatectomy and liver regeneration in Syrian hamsters. In Syrian hamsters 74-75% removal of the liver led to 8-10% mortality. Cell mitosis increased at 36-42 hours after the operation and reached a peak of 43-51% during the 3rd day. Individual variations in liver weight as well as in number of mitosis were smaller in 2-3 months old hamsters than in 6-12 months old animals.


Anomalies in the extrahepatic biliary tract of the rabbit. A systematic autopsy study found that 29 of 112 animals had anomalies of the bile ducts. Another rabbit had a septate gallbladder. Awareness of these variants is important during hepatic bile collection, studies involving surgical transplantation or manipulation of the extrahepatic ducts, interpretation of results in experimental cholelithiasis and extrahepatic obstructive jaundice.


Experimental breeding and cytogenetics of the soft-furred rat, Millardia meltada. The soft-furred rat, Millardia meltada, has bred successfully in the laboratory for 10 generations of brother x sister mating. It is half way in size between the rat and the mouse, and is gentle and easy to handle. Thin body hair and incisor teeth are present in the newborn. Some individuals have low blood pressure. Chromosome number (2n) in 50. It differs in several characteristics from the rat and mouse, and could become a useful experimental animal in biomedical research.


Cannibalistic traits observed in rats treated with a teratogen. Rat offspring malformed as a result of maternal exposure to a teratogen were cannibalized preferentially to apparently normal offspring. Lack of viability also appeared to be a factor in the cannibalistic tendency, since both normal and malformed dead pups were consumed more frequently than viable pups of either category. Of the 29 cannibalized pups observed, 86% were cannibalized in the 1st 24 h. The cause of this behavior is not known with certainty but maternal hormone imbalance may play an important role.


Alphaxolone-alphadolone anaesthesia in laboratory animals. The anaesthetic steroid combination alphaxolone-alphadolone is a well-established short-acting injectable agent for cats and primates. It can be recommended for intravenous administration to rats, rabbits, neonatal pigs, mice and hamsters. It has limited value in mice and hamsters by the intraperitoneal route, but provides sedation in ferrets and neonatal pigs when injected intramuscularly. It can be given repeatedly or continuously to maintain anaesthesia for long periods without the development of tolerance or cumulation.


A bacterial disease of the Darwin's frog (Rhinoderma darwini). Ulceration and necrosis of the rostrum in Darwin's frogs was investigated microbiologically and histopathologically. The condition was attributed to infection with Aeromonas liquefaciens and, possibly, an Acinetobacter sp.


Resistance of faecal cysts of Spironucleus muris to some physical factors and chemical substances. The effect of 5 disinfectants, and of saturated zinc chloride solution + sodium chloride solution, 2.5% potassium dichromate solution, and 0.12% dimetridazole on faecal cysts of Spironucleus muris were tested in vitro. The resistance of the cysts to high and low temperatures, low pH, high osmotic pressure, centrifugation and desiccation was also tested. After treatment the morphology of the cysts was observed microscopically and their infectivity tested in vivo on sensitive thymus-deficient nude mice. The cysts ceased to be infective after treatment with most of usual disinfectants and by high temperature (45 degrees C for 30 min). They resisted 0.12% dimetridazole, low temperature (-196 degrees C), low pH (2.2), high osmotic pressure (distilled water and 30% 'Ficoll'), centrifugation (1500 g/20 min) and desiccation (room temperature for 14 days). These data may be useful for the control of Spironucleus muris infection in rodents and for cryopreservation of the parasite for experimental purposes.


Histochemical study of mesenteric lymph nodes in old rats. The main positive reactions in the large mononuclear cell occurring in some nodes were shown with PAS, alcian blue, Sudan black B and acid haematin. The results suggest that in these cells, considered to be mononuclear phagocytes, there is a storage of hexose-containing mucosubstances, acid mucopolysaccharides and choline-containing phospholipids.


Sequential biochemical investigations in lepromatous leprosy. Sequential biochemical investigations were conducted in cases of lepromatous leprosy in the reactive as well as subsided phases. Low levels of blood sugar and serum cholesterol were indicated in the reactive phase of lepromatous leprosy. Significant increase in thymol turbidity and decrease in A/G ratio were noted in most of the cases of lepromatous leprosy. Enhancement of serum levels of transaminases was observed in the reactive phase of lepromatous leprosy. Serum protein electrophoresis indicated increases in alpha2--globulin and r--globulin and decrease in albumin in the reactive as well as subsided phases. The results are discussed in this paper.


Bone-marrow in tuberculoid leprosy.

Bone-marrow in tuberculoid leprosy. Twenty-four untreated patients of proved tuberculoid leprosy and five healthy controls were investigated for the involvement of bone-marrow. The cytology was essentially normal and no acid-fast bacilli was seen in the bone-marrow smears.


A histopathological study of lymphnodes in 43 cases of leprosy. Eighty cases of leprosy including 60 cases of lepromatous type and 20 cases of tuberculoid type, during the period of 1974-75, have been examined for evidence of lymphnode enlargement. Of the 52 cases of enlarged lymphnodes, lymphnode biopsy was done in 43 cases including 38 cases of lepromatous type and 5 cases of tuberculoid type. The lymphnodes have been studied for evidence of any pathological changes and presence of acid-fast bacilli. In cases of lepromatous leprosy, lepromas and acid-fast facilli were seen in 92.2 per cent of the cases and patchy fibrosis was noted in 23.6 per cent of the cases. No amyloid could be demonstrated. In cases of tuberculoid leprosy, only non-specific reticular hyperplasia was noted. No specific granuloma or acid-fast bacilli could be demonstrated. The findings have been described in detail and discussed in the light of previous published data.


Leprosy in Jodhpur (Rajasthan). Clinical and epidemiological study. A clinical and epidemiological study of leprosy revealed 232 cases in Jodhpur (Rajasthan); a non-endemic area. Males were three times more affected than females. Lepromatous leprosy was the most common type (70.70%). Maximum number of cases were observed in the age group 20-49 years. The probable causes for an increase in incidence are discussed.


Effects of social anxiety and social evaluation on beer consumption and social interaction. In an experimental "party" situation socially anxious subjects and subjects who received negative social evaluations drank less beer and had lower blood alcohol concentrations than did subjects who were not socially anxious or who received positive evaluations.


Effects of alcohol on psychomotor performance of men and women. The effects of alcohol on performance were investigated in 10 men and 10 women. On 4 psychomotor tasks minor gender-related effects of alcohol were found.


The Drinking-Related Locus of Control Scale. Reliability, factor structure and validity. A scale measuring locus of control in relation to drinking behavior found significant differences between alcoholics and nonalcoholics, while a scale measuring locus of control in gerneral did not.


The age variable in alcoholism.

The age variable in alcoholism. The younger the alcoholic at the onset of excessive drinking, the greater his emotional problems, the more severe his parents' drinking habits and the more negative the quality of his parents' marriage.


Ethanol consumption in genetically selected hypertensive and hypotensive mice. Hypertensive mice drank more alcohol than did hypotensive animals over a wide range of concentrations. The intake was not related to blood pressure phenotype in a causal manner, nor was age a factor in the results.


Effect of prolonged ethanol intake on glucose metabolism in normal rats. Ingestion of an ethanol liquid diet providing 20 or 36% of daily caloric requirements for 30 days resulted in impaired responses to a glucose tolerance test and as insulin sensitivity test.


Urinary metabolites of tryptophan, serotonin and norepinephrine in alcoholics. Levels of tryptamine, 3-methoxy-4-hydroxy phenylethylene glycol, 3-methoxy-4-hydroxy mandelic acid and the tryptamine: 5-hydroxyindole-3-acetic acid ratio differed between alcoholics, healthy volunteers and patients with nonalcoholic liver disease. There was no correlation between amine metabolite levels and results of liver function tests.


Reliability and validity of estimators of alcoholism prevalence. According to multivariate analyses of responses to four estimators of alcoholism prevalence, a questionnaire about "escape" drinking is the most reliable and the most valid.


Distribution of alcohol consumption and problem drinking. Comparison of sales records and survey data. Survey data on alcohol consumption in Iowa reveal seasonal fluctuations which, when due to increases in the quantity consumed per drinking occasion, are accompanied by increases in alcohol-related social problems.


Anomie and alcohol use. Drinking patterns in Mexican American and Anglo neighborhoods. Anomie failed to explain variations in drinking habits of Mexican Americans. It was concluded that deviant behavior must be culturally defined to have meaning as an effective predictor of alcohol use.


Personality changes in drinkers.

Personality changes in drinkers. A questionnaire survey of members of Mensa, all of whom have high IQs, found that perceptions of personality traits differed between social drinkers and alcoholics.


Mood differences of men arrested once and men arrested twice for driving while intoxicated. Men arrested for the first time for driving while intoxicated were more tense, depressed, angry and fatigued during the month preceding their arrest than were men arrested for the second time for the same offense.


Observations on the deep lymphatic circulation of the limbs and on its function: (the deep lymphatic vessels in the post-phlebitic syndrome of the lower extremities). In 60% of patients with post-phlebitic syndrome lymphography of the lower extremity shows involvement of the deep system. In 77% of the patients there was increase in the number and caliber of the deep lymphatic vessels. They frequently appear elongated, tortuous, and ectatic but usually do not show signs of insufficiency. It appears as if these vessels act as collaterals and compensate for difficiencies of the deep venous circulation. Multiple lympholymphatic and lymphovenous communications have been observed.


Effect of acute ethanol administration on the thoracic duct lymph flow in man. In 17 patients the thoracic duct was cannulated and the lymph continuously collected. Thoracic duct lymph flow and the concentration of total protein in the lymph and blood serum were repeatedly measured for 6 hours. Group I (9 subjects) received 0.7 g/kg of oral ethanol in the form of 40% solution, group II (8 subjects) an intravenous infusion of 0.75 g/kg of ethanol. Oral but not intravenous administration of ethanol significantly increased the thoracic duct lymph flow. Lymph total protein significantly decreased in group I only.


Regeneration of the deep cervical lymphatics--light and electron microscopic observations. Regeneration of the lymphatic vessels following ligation of the deep cervical lymphatics was studied in 35 rabbits using both light and electron microscopes. The newly formed lymphatics were evident under the electron microscope in the first post-operative week, in which the restoration of the affected endothelial cells of the lymphatics and reaction of the free cells such as fibroblasts and macrophages were observed.


Passage through the lymph node. Studies with watered and oiled contrast medium given into an afferent lymphatic. The authors investigated the passage of watered and oiled contrast media through the lymph node. Patent Blue dye diluted in saline has delineated as a rule only a circumscript area of the lymph node according to the supplying area of the afferent cannulated. Lipiodol Ultrafluid has been found suitable for filling up the whole node: at first only a small part of the node became filled primarily from the afferent, while other parts were filled secondarily from the hilus. The compartmentalisation of the lymph node has been proved by autoradiography (3H-thymidine), too.


Antioxidants prolong life span and inhibit the senescence-dependent accumulation of fluorescent pigment (lipofuscin) in clones, of Podospora anserina. Culture of clones of Podospora anserina s+ with either nordihydroguaiaretic acid or reduced glutathione (GSH) at concentrations that were not inhibitory to growth significantly prolonged the average time to onset of senscence. GSH also prolonged the average time to onset of clonal death. The specific concentration of chloroform-methanol soluble fluorescent pigment was larger in senescent than in pre-senescent cells. The pigment exhibited fluorescence excitation and emission spectra and fluorescence polarization numbers characteristic of lipofuscin, an end-product of lipid peroxidation. Analyses of the lipofuscin concentration in either sub-clonal fractions of different times of origin from senescent clones, or in sub-clonal fractions of identical age  in time of origin from parent clones of different age, revealed a similar concentrations distribution. Although pre-senscent cells contained rather large concentrations, a massive increase occurred during senescence prior to the time of onset of clonal death. Culture with GSH not only prolonged clonal life span but aslo inhibited the formation of lipofuscin by an average factor of 30. Furthermore, unlike untreated clones, the sub-clonal distribution of the pigment was not only low but was also independent of their age.


Nuclear area changes in senescing human diploid fibroblasts. The pattern of mean nuclear area changes was determined in human fibroblast cell strains from male donors of three different ages (8,40 and 84 years) during their in vitro lifespan. There was a statistically significant increase in mean nuclear area of cells of all three strains during their aging in vitro. A gradual increase of the subpopulation of cells with larger nuclei was also observed. Evidence for a positive correlation between aging in vitro, as reflected by mean nuclear areas at the tenth doubling from the end of in vitro doubling activity, and donor age is presented.


Control of placental 3 beta-hydroxy-delta 5-steroid dehydrogenase: partial characterization of an endogenous inhibitor and an endogenous activator. Two substances which affect the activity and kinetic characteristics of 3 beta-hydroxy-delta 5-steroid dehydrogenase (delta 5-3 beta-HSD) have been recovered from homogenates of term human placenta by extraction with organic solvents after ethanol precipitation of protein. One of these substances, an inhibitor of the enzyme, is a non-polar unstable substance, which dialyzes through a cellulose nitrate membrane and which appears to be present in the tissue both in the free state and bound to either the enzyme or the microsomal membrane. It was not possible to produce a delta 5-3 beta-HSD preparation free of the inhibitor. The other substance is an activator, polar and stable with a molecular weight of less then 500, which increases both the apparent Km and the apparent V max of delta 5-3 beta-HSD. It is postulated that both substances play a part in control of placental progesterone synthesis.


Control of placental 3 beta-hydroxy-delta 5-steroid dehydrogenase: an apparent endogenous regulator of porgesterone synthesis. Dilution of tissue fractions from human placenta resulted in an increase in the specific activites of 3 beta-hydroxy-delta 5-steroid dehydrongease and of 20 alpha-hydroxysteroid dehydrogenase. The apparent Ks and V max of 3 beta-hydroxy-delta 5-steroid dehydrogenase were altered. It is postulated that this dilution effect is caused by the presence in the placenta of an endogenous inhibitor of steroid synthesis which may be important in the regulation of steroid output by this organ. A mathematical model of such an inhibitor corresponds well to the experimental results.


Access to medical care in the U.S.: realized and potential. This paper seeks to provide a framework for understanding differential access to medical care in the U.S. population and to suggest ways to achieve equity of access. The framework is provided by a behavioral model of health services utilization which suggests a sequence of predisposing, enabling and illness variables that determine the number of times people will visit a physician. The model is operationalized using a path analytic technique. The data come from a national survey of the noninstitutionalized U.S. population conducted in late 1975 and early 1976. The results suggest services are generally equitably distributed since age and level of illness are the main determinants of the number of services people receive. However, remaining inequities might be reduced by providing people who report no regular source of medical care with a familiar entry into the health service system.


A model for health care delivery with an illustration of its application. A framework for conceptualizing the process of health care delivery is presented. The framework identifies broad categories of activities by which the functions of a health care provider can be organized, and has practical application to studies of the roles of a variety of health care personnel. By permitting clear identification of each component of a health professional's role, the model provides a method for quantitatively determining what an individual or group of individuals does. The utility of the model in operationalizing investigations of health care roles is illustrated by its application to a study of nurse practitioners. In this study, the conceptual model was used to structure a questionnaire for obtaining information about professional nursing roles. By providing a theoretical framework for the relationships between specific role components and certain outcome variables the model was also used in the generation of hypotheses and the design of statistical analyses. Results of some of these analyses are summarized.


Evaluating new methods for provision of primary care: an Ontario strategy. For several years, the government of Ontario has undertaken to foster and develop experimental systems for the delivery of primary health care in the province. At the same time, the government wished to devise a strategy whereby the new health care programs could be rigorously evaluated. A Task Force on Evaluation of Primary Health Care Services produced a plan which yields quantitative information about the function of primary health care units. Three essential indexes of performances, comprising categories of Utilization and Financial Performance (UF-Index), Availability, Accessibility and Scope of Services (A-Index) and Quality of Care (Q-Index), were designed. Two additional quantitative indexes, Consumer Satisfaction and Health Professional Satisfaction, were proposed. The derivation and determination of the three essential indexes are provided in the paper in detail, along with acceptable criteria for performance and methods for comparing the performances of different types of practices in different kinds of population.


Selection of regression models for health care data. We discuss several linear and nonlinear regression models and their appropriateness in modeling a set of data from a cohort study of the use of medical services in a prepaid medical plan. Although computational considerations once forced researchers to use linear models almost exclusively, modern computer hardware and efficient algorithms have made it possible to use nonlinear models almost as easily as linear ones. Thus, in choosing a regression model, a researcher should give strong consideration to  how well the model reflects (presumed) intrinsic properties of the phenomena under study, even if the consideration leads to the choice of a nonlinear model. Modern computer programs for nonlinear minimization should be employed to fit the model. The model should be judged on how well it describes the data and how reasonably it predicts the future.


Dental care in the People's Republic of China. In comparison to the living conditions that existed before 1949, the People's Republic of China (PRC) represents a remarkable story of achievement. Western knowledge about the PRC has recently increased by leaps and bounds as detente with the United States has allowed many Americans to witness the "awakening of the dragon." Many of the achievements have been in the development of a health care delivery system that uniquely addresses the needs of the most populous country. There are numerous reports on the advancements made in manpower development and deployment, infectious disease control, family planning and acupuncture anesthesia and therapy. Yet there is little information about dental care in China. Dental disease being an essentially preventable disease has an interesting status in the Chinese health care system which relies on prevention rather than cure. In September and October 1974, the author visited five cities in China, Kwangchou (Canton), Peking, Tientsin, Suchou, and Shanghai and the respective countrysides except for Tientsin. Though any account or description is certain to be but a glimpse of Hsin Hua (the New China), the story is worth being told even if it must be accomplished by small chapters contributed by many individuals. In this light, the author explores the following areas: dental manpower training, which in China has produced stomatologists, dental technicians and dental nurses; the oral health status of school age children, dental care delivery and facilities, and probably the most remarkable while at the same time provocative areas, acupuncture analgesia and therapy.


A study of the health status of the black population in Alameda County, California. The purpose of this paper is to compare the overall health status of blacks with whites in Alameda County, California, using an index based on the mortality and disability experiences of the two population groups. It is demonstrated that this index, which requires disease-specific mortality and disability data, can be easily adapted to make use of existing data files containing data on mortality and any indicator of morbidity or disability. It was found that in the year 1974, the blacks lost approximately 10,000 productive years unnecessarily through higher mortality and disability rates than those of the white population. This disparity between the two populations may be underestimated because Chicano/Mexican Americans, who are known to enjoy a lower health status than whites, were included as part of the white population. The implications of the findings are discussed.


The very old patient in ambulatory care. The aims were twofold: to determine differences between the very old and younger patients in ambulatory care and to examine their self-assessments of health and whether these related to: subjective data such as symptoms and attitudes, objective data such as utilization of health services, and physician assessments of the patient's health. Although they had about one more diagnosis, the very old were similar in most respects to younger patients. Variables that discriminated the groups were physician ratings. About two-thirds of the older and younger patients regarded their health as good. Good health perceptions were associated with fewer symptoms, outpatient visits, and hospitalizations in both groups. Physician assessments were only lowly correlated with patient assessments of health. Patient perceptions of health were highly stable over a two month follow up. The subjective belief that one is healthy or ill may be more important than actual medical condition in maintaining good emotional and behavioral functioning.


Foreign-trained physicians in American medicine: a case study. The understanding of reliance upon foreign medical graduates (FMGs) in the United States is vague and general. Little is known about the specific roles of FMGs or the populations they serve in relation to United States medical graduates (USMGs). The recent passage of the Health Professions Educational Assistance Act calls for significant reductions in the future influx of FMGs. Hence, there is an immediate need for detailed information upon which to base predictions of legislative outcomes. The American Medical Association's 1974 physician data tape for Maryland was used as the study population. These data were analyzed, using th Gini Index of Concentration and other test stastistics, for FMG/USMG distributional differences for 1) office-based practice and hospital-based practice,  2) catchment areas aggregated by income, 3) primary, secondary, and tertiary case specialty groupings, 4) level of development of country of medical education, and 5) all of the above in relation to population. Office-based and hospital-based catchment areas were developed  in order to create a valid consumer-provider relationship between the numerator and denominator of physician/population ratios. The major finding is that regardless of practice setting, FMGs are more evenly distributed relative to population than USMGs. This conclusion is in contrast with the notion that FMGs tend to locate where USMGs locate. A useful methodology has been presented for 1) development of catchment areas, and 2) examination of distributional differences in relation to population which can easily be duplicated.


An effect of organization of medical care upon health: manpower distribution. Data are presented from the Medical Care Group of Washington University and from several other organized medical care settings responsible for prepaid enrollees. As few as 8 per cent of visit may be made to specialists under systems which are organized to emphazide primary care. Further, the proportions of primary care and specialty visits vary inversely weith the "strictness" of this organization. Those groups which employ family physicians have a higher proportion of primary care physicians than do those which employ general intermists and pediatricans, or than exist in the medical care system at large. The data suggest strongly that the organization of medical care, as well as the training of personnel employed has a major influence upon the types of health manpower needed. Future research in this area is urgent, but even the currently available data have important implications for health manpower policy.


Factor affecting the choice between two prepaid plans. This study examines the factors affecting the choice between two comprehensive prepaid plans of medical care available to the staff of Stanford University. One is a Kaiser plan, offered since 1969. Under the other (Clinic plan for short), medical services are provided by a predominantly fee-for-service group practice and hospital services are covered by a standard Blue Cross hospital policy; the Clinic plan has been available since the 1950s. The Kaiser plan has only a token copayment for office and home visit while the Clinic plan has a 25 per cent coinsurance provision applying to all physician and outpatient ancillary services. It was found that the two major factors affecting choice were income and distance to the provider. The preference for the Kaiser plan increased as income decreased. Similarly, as distance from the Clinic increased and distance from a Kaiser facility decreased, the preference for the Kaiser plan increased. However, proximity to the provider was a more important factor for the higher-income Clinic plan subscribers. The data also show that the longer availability of the Clinic plan had a long-term effect on enrollment. A substantial proportion of long time Stanford employees who might have been expected to prefer the Kaiser plan stayed with the Clinic plan.


Enrollment choices in different types of HMOs: a multivariate analysis. Enrollment decisions of a sample of an employed population choosing among open-panel and closed-panel HMOs and Blue Cross/Blue Shield are analyzed. This report, unlike previous ones, overcomes some of the difficulties of bivariate analysis by the use of the multivariate logistic probability model, logit. The results show that there are four consistent predictors of enrollment choice: previous source of care as the measure of access; family life stage and chronic conditions per family member as indicators of health risk; per capita income as the measure of economic vulnerability; and health concern. Having a private physician as the source of care is the best single predictor, its absence predicting a higher probability of enrollment in the closed, and its presence in the open-panel HMO. Higher risk life stage families, younger and with more children, are more likely to join the open-panel plan than the closed or retain BC/BS; higher incomes and larger numbers of chronic conditions appear to have the same effects. Higher levels of health concern, on the other hand, predict a greater probability of choosing the closed-panel plan. The probability of enrollment in any HMO is predicted with more than 50 per cent accuracy for 60 per cent of the sample. Choice between open and closed-panel plans is predicted with an accuracy in excess of 50 per cent for 80 per cent, and with an accuracy greater than 90 per cent for over 10 per cent of potential enrollees. The applicability of this approach to HMO feasibility analysis and planning is clearly indicated.


Physician utilization of medical records: preliminary determinations. A study is reported of the ways in which 26 physicians, mostly internists, use the medical record. It was found that the items of greatest importance to the physicians, from the viewpoints of frequency of usage and of occasional interruption of the physician-patient transaction by being absent, were lab-test results, X-ray data, patient history, and previous treatments. The most common general problems cited uith the medical record were incompleteness (named by 38 per cent of the physicians), illegibility (27 per cent), and poor organization of the record (19 per cent).


Graduate education in computer systems in medicine--a conceptual model. Canadian Organization for Advancement of Computers in Health. A conceptual model of the graduate educational programme in medical informatics is discussed. Problems involved in different types of informatics training can be avoided by stressing the integrative aspects of a systems approach. This programme is designed to lessen the gulf between a higher level of hardware capability and the ability to use it. The increasing educational demands in medical information systems have put more pressure on educational establishments to respond more expertly.


Analysis of the occurrence of anencephalic stillbirths in the Fylde Peninsula, 1956--1967. Computer-based statistical signal methods have been applied to the analysis of case-occurrence time and location data from a 12-year complete series of anencephalic stillbirths in the Fylde peninsula of Lancashire. In the absence of any certainty about causative or contributory factors in these occurrences, the primary questions are if the underlying process is Poisson, or if there is evidence of a seasonal influence, and if any regional differences or communicable factors can be identified. With the limited case numbers (124) most small-sample statistical tests were not sufficiently informative. But using pattern and print-process analysis methods and simulation techniques, further elucidation is possible; for example, it is shown that a seasonally rate-modulated Poisson process is a reasonable model for case occurrences in the southern region, but not in the north, for which a different process must apply and where some evidence exists of clustering of preferred inter-event intervals. It is concluded in particular, that there is a regional dependence, with seasonal factors, of the process underlying case occurrences, and in general, that signal analysis methods are useful in the interpretation of small-sample spatio-tempered epidemiological data.


Statistical analysis of clinical breast cancer by computer. At the moment we still lack a clear correlation of clinical staging and pathology with therapy and prognosis in breast cancer patients. More studies need to be conducted dealing with the relationships of breast cancer to previous diseases, hormonal balance, conservative therapy and type of surgical therapy. These evaluations may be very important in supporting a less serious prognosis, a clearer clinical staging and a more certain choice of the right therapy. With computer help we have evaluated data from 500 patients with breast cancer. We have considered: age; previous breast diseases with particular regard to therapy; hormonal balance; obstetrical relevant past history; morphological and functional aspects of the breast; the histology of the tumour and metastases; and the results of therapy.


Creation and validation of medical data. The problems of creating and validating medical data are discussed. These difficulties relate to the structuring of data and its definiton. The necessity for clarity of thought, coherence and logic in data collection is stressed. Difficulty in medical and lay staff training shows that this is a continuing problem. Data validation must be the major province of senior as well as junior doctors. It is an absoulte essential continuing process and without valid data most analyses are not worthwhile because of high error rates and/or too much missing data.


The optimal design of MUMPS global file. This paper presents the basic consideration of global file design on MUMPS language. The major goal of global design is to reduce the number of disc accesses made over the long-term use of a file. To attain this goal, the procedure for finding the global file which minimizes the average number of disc blocks accessed to obtain a data node is proposed. Furthermore, the total number of blocks in use with file design are demonstrated by simple examples.


Objective specification of the incremental weight variable in weanling diarrhoeal disease of infants. The objective specification of the second variable (body weight) measured in an epidemiological field study of weanling diarrhoeal disease of infants has been approached by computer-based pattern analysis, complementing previous studies of the diarrhoeal signal of daily defaecation count (DS). The weight data are available for 64 weeks in a subset of 50 out of 139 infants in the study. A weekly incremental weight signal (IWE) was estimated by successively differencing each new observed weight with a smoothed version of the previous value. Variable latency of the different features of this variable precludes the formation of an average-profile by coherent averaging the ensemble of records; a feature-analysis method based on statistical trend analysis was therefore developed. Features of the resulting IWE average profile can be linked to weanling events, transient diarrhoeal episodes, and typical post-neonatal shifts in level of the diarrhoeal signal. The results are consistent with the view that both nutritional and infectious factors operate in most deviations from typical behaviour seen in individual IWE records. In all the infants having an abnormally low (64 week) weight gain, a sustained abnormal DS elevation can be recognized in the 7-15 week period, with recurrent diarrhoeal episodes (type P2, as previously classified) during the 45-60 week period; both abnormalities were associated with substantial effects on weight gain. But individual P2-diarrhoeal episodes occurring before about 40 weeks of age could be linked only to small, quickly-compensated effects on incremental weight.


[Kidney preservation by hypothermic storage in Collins and Sacks solutions: the influence of 0-30 min of warm ischemia on the available preservation period (author's transl)]. 123 kidneys of mongrel dogs were stored under hypothermic conditions in Collins or Sacks solutions for 12 up to 72 h and then transplanted. Before preservation the kidneys were subdued to 0-30 min warm ischemia. Kidney function after transplantation was measured by PAH-and inulin-clearances. Successful 24 h preservation was likewise possible with Collins and Sacks solutions if there was not any warm ischemia. Kidney function was reduced by the length of preservation, according to the formula; y = 166.02 . e-0,125x (y = PAH-clearance and x = preservation time). With both solutions the most attainable preservation time after 15 min warm ischemia was only 12 h, longer preservation time or ischemic periods were not tolerable. However, the function of the ischemically damaged organ was significantly better preserved by Sacks solution in comparison with Collins solution-although the preservation period could not be extended by this solution. Therefore, as far as human kidney preservation is concerned, Collins solution should be replaced by Sacks solution.


[Giant cavernous hemangioma of the liver. Case report and review of the literature (author's transl)]. The cavernous hemangioma of the liver is frequently seen as small tumor without any symptoms, but only rarely its diameter is more than 4 cm (161 cases in world literature). We can report on an additional patient. The peculiarities in this case were the tumor size, the presence of numerous phleboliths and the contrasting of the tumor taking place mainly from the venous part of the vascular bed of the liver. The main indication for a surgical intervention is the danger of rupture, but disturbances of the coagulation as well as intestinal suppression symptoms have also to be taken into consideration. The intraoperative tactics ought to be a standardised resection of the liver. The cavernous hemangioma must be differentiated from the hemangioendothelium: this usually occurs in children, causes cardiac failure due to a. v. shunts, and responds to conservative therapy (corticosteroids, radio-therapy).


[Experimental investigations on arter injury due to bone cement (author's transl)]. The observation of eight patients with lesions of great arteries after total hip replacement led to experimental investigations to determine whether Palacos might cause such vessel lesions. Palacos was applied to the adventitia of the abdominal aorta and both iliac arteries in rabbits. Angiographic examinations 14 days after implantation indicated no lesion at the intima of aorta and iliac arteries in the regio of Palacos. Histological investigations showed only necrosis of fat tissue and a slight distention of the muscle fibers of the artery wall. Lesions of aorta or great arteries are not caused by implantation of Palacos.


[Primary healing of the sacral cavity after proctectomy - a solvable surgical problem (author's transl)]. Primary healing of the perineal wound and the sacral cavity after a.p. resection of the rectum is an old surgical problem. In order to achieve primary healing we are using a lengthened omental graft to fill up the sacral space. Since January 1977 to July 1977 we used this method in 17 patients. 15 patients had very low rectal cancers. 2 patients had to undergo proctocolectomy because of ulcerative colitis. In 14 cases we achieved primary healing, among these the colitis patients. Overall we had three abscess formations in the sacral cavity. One of these patients got in addition an obstruction postoperatively.


[Surgical papillotomy, endoscopic-manometric and clinical results (author's transl)]. 4--9 years after transduodenal papillotomy an endoscopic-manometric and clinical control of the surgical result was done in 49 patients. The pressure difference of common bile duct and duodenum was of great interest. There existed a correlation between the pressure difference and other parameters so far, as air was frequently seen in those patients without pressure gradient between common bile duct and duodenum. Pathological activity of gamma-GT and a decrease of Prothrombine-time was found after a high pressure difference. It may be possible that anatomical variations of the biliary system and the duodenum have some importance for the formation of stones.


The tympanic isthmus: its anatomy and clinical significance. The tympanic isthmus is a narrow passage between the tubotympanic cavity and the atticomastoid air space. Obstruction of the tympanic isthmus is frequent in various types of middle ear disease and causes significant air-diffusion disturbance within the temporal bone pneumatic system. Using large numbers of fresh temporal bone specimens, anatomical boundaries of the tympanic isthmus are defined and pathological variations are investigated. Embryological origin of the isthmus and pathophysiological implications of the tympanic isthmus block are discussed. Among factors that cause obstruction of the tympanic isthmus are mucosal folds variations, inflammatory webs and exudate, retracted tympanic membrane, diseased attic mucosa, and cholesteatoma. Each factor is analyzed with representative specimen photographs. Clinical signs due to tympanic isthmus block often simulate or coexist with symptoms of eustachian tube obstruction. Surgical management of the tympanic isthmus block requires clear recognition of these disease processes. Understanding of the tympanic isthmus as an anatomical entity is essential in the management of middle ear and attic disease.


Mastoiditis and brain hernia (mastoiditis cerebri). Ten patients with brain hernia occurring as an insidious complication of chronic mastoiditis coincidentally discovered at the time of surgery are described. Four had previous surgery, six did not. A history of trauma was othwise absent. Cerebrospinal fluid otorrhea did not occur. Our method of management is described. Pathology and pathogenesis are discussed. Three patients had pedunculated brain hernias, while seven had diffuse (fungoid) herniation. Granulation tissue appeared as an important part of the disease process. These may represent abortive attempts at brain abscess formation since the widespread use of antibiotics. Pacchionian bodies may also play a role in the pathogenesis.


Tuberculous otitis media.

Tuberculous otitis media. Tuberculous otitis media is a variable and puzzling infectious disease which may remain undiagnosed or confused with other acute or chronic middle ear conditions if appropriate diagnostic studies are not performed. Among the common clinical findings are insiduous onset of painless watery drainage, severe hearing loss, multiple perforations of the tympanic membrane and subsequent appearance of profuse granulation tissue. As the disease progresses destruction of the middle ear conductive apparatus, facial paralysis, cochlear involvement with labyrinthitis and further hearing loss, and finally intracranial dissemination of infection may occur. The case histories of two patients recently treated at Mount Sinai Hospital illustrate some of the clinical problems encountered with this disease.


Underrated neurotologic symptoms.

Underrated neurotologic symptoms. Patients present themselves with neurotologic symptoms which may be early and subtle indicators of active vestibular pathology. The frequently slighted complaints of light-headedness, imbalance and a floating sensation are as important as "true rotatory vertigo." Ear fullness, the most underinvestigated of neurotologic complaints may be a cardinal symptom. Occipital headaches are a frequent complaint of the dizzy patient. Blurred vision, and, in some severe peripheral disorders, diplopia are symptoms referrable to oculovestibular interaction. Visual stimulation intensifies vestibular symptoms. Stress may precipitate or increase dizziness in patients who have partially compensated for a vestibular deficit. Anxiety, fatigue and systemic illness are exemplary. Patient histories are presented to emphasize clinical relevance and therapeutic modalities.


Serous otitis media associated with sensorineural hearing loss in children. The effect of a conductive hearing loss secondary to serous otitis media in children with sensorineural hearing loss was seen to be an increase in threshold and in one case a decrease in speech discrimination. The diagnosis of the conductive component can be made by means of measurement of impedance, middle ear pressure, the recording of a tympanogram and otoscopy. It is likely that a conductive component can lead to delay in the diagnosis of an underlying sensorineural hearing loss in some children which could result in exacerbation of speech and language deficits. Correction of the conductive component can convert a profound hearing loss to a severe hearing loss, or a severe hearing loss to a moderate hearing loss, and it may also increase speech discrimination.


Function of the Eustachian tube related to surgical management of acquired aural cholesteatoma in children. A group of 12 children with acquired cholesteatoma had the ventilatory function of the Eustachian tube assessed by the inflation-deflation technique. All had varying degrees of functional rather than mechanical obstruction of the Eustachian tube. In these children, the pathogenesis of acquired cholesteatoma appeared to be the result of the following sequence of events: functional Eustachian tube obstruction, high negative middle ear pressure, atelectasis of the tympanic membrane-middle ear, a retraction pocket in either the posterosuperior or attic portion of the tympanic membrane, and adhesive otitis media. Tympanoplasty in these children was not successful. It is suggested that when the middle ear-mastoidectomy cavity is allowed to remain open, then the bony portion of the Eustachian tube should be surgically closed to prevent postoperative reflux of nasopharyngeal secretions.


Homografts in chronic ear surgery.

Homografts in chronic ear surgery. There has been a considerable expansion in the use of tympano-ossicular homografts in the past decade. The use of homograft tympanic membranes and homograft ossicles as well as combined tympano-ossicular homografts has been shown to be effective in reconstructive surgery for chronic otitis media. While homograft tympanic membranes are effective in the repair of perforations, temporalis fascia is at least as effective and more readily available. Therefore, the unique benefit of the tympano-malleal homograft (TMH) is that it is an effective way of replacing the malleus, the "building block" for reconstruction of the ossicular chain. The indications and techniques for the use of the TMH are presented and illustrated through representative cases. The inclusion of the TMH in the otologist's armamentarium offers another avenue for reconstruction of the chronically diseased ear.


The evaluation of middle ear meningiomas using computerized axial tomography. Meningiomas localized within the middle ear and mastoid which have no intracranial component are rare tumors. Three patients with meningiomas which were thought to involve only the middle ear were treated surgically, were followed for two to six years and were thought to have been cured. However, when computerized axial tomography became clinically available, these patients were examined using this radiographic technique. Unexpectedly, all three patients were found to have a large intracranial meningiomatous extension. A review of the literature reveals only 13 primary meningiomas; these case reports are summarized. It was noted that definitive tests for an intracranial extension of the meningioma were performed in only 2 of the 13 cases. Therefore, in view of our recent clinical experience, it is recommended that a patient presenting with a middle ear meningioma should have a computerized axial tomographic examination of the head to detect the possible presence of a clinical silent intracranial involvement.


Stapes gusher and Klippel-Feil syndrome. The stapes gusher which is the most dramatic complication of stapedectomy arises from an abnormal communication between the subarchnoid and perilymphatic spaces. This congenital defect may be associated with other anomalies such as the Klippel-Feil syndrome. Two cases of stapes gusher in patients with congenital fixation of the footplate are described. One of them was combined with Klippel-Feil syndrome. The object of this paper is to emphasize the necessity of a complete preoperative examination of all cases of congenital footplate fixation.


Human incus long process depressions in the surface of the normal ossicle. Depressions in the bone surface of the normal human incus long process are found with great frequency. This paper reviews the frequency and distribution of these depressions, discusses their histologic appearance, and speculates upon their significance. While their clinical significance is unclear, they may be related to several conditions encountered in otologic practice.


Sequential rhytidectomy.

Sequential rhytidectomy. An alternate technique of rhytidectomy is described. After adequate undermining, hemostasis and imbrication, the skin flaps are rotated and advanced with sequential tension in contrast to the use of bipolar or tripolar anchoring points. They are then trimmed and sutured in a step-like sequential fashion starting at the temporal incision and proceeding around the ear to the occipital area. The technique has been used in over two hundred patients during a two-year period. The results have been encouraging in eliminating dog-ear formation, excessive tension on wound edges, and step deformities of the hair bearing tissues. A discussion of the advantages of the method and a comparison with other techniques is outlined.


"How I do it"--otology and neurology. A specific issue and its solution. The diagnosis of a posterior fossa tumor. In summary, the patient with a unilateral sensorineural type hearing loss, unilateral tinnitus, or dysequilibrium may have a tumor in the posterior fossa. This is diagnosed by the history, ear nose, throat and otoneurological examination, the audiological studies, electronystagmography, radiological tests using the Compere unit, the CT Scan, and when indicated the posterior fossa myelogram. The list of causes for these symptoms other than tumefaction is large and there are a significant number of cases that remain "cause undetermined." The latter requires diligent follow-up and even consultation elsewhere.


Ganglion cell populations in normal and pathological human cochleae. Implications for cochlear implantation. A histological study of 100 hearing ears showed that some capability for speech discrimination requires at least 10,000 spiral ganglion cells. The spiral ganglion cell populations were then estimated in another group of 62 ears which were profoundly deaf for a variety of causes and it was found that 45% of these met the criterion of having 10,000 ganglion cells. The ganglion cell populations were largest in ears deafened by sudden deafness, Meniere's Disease, and ototoxic drugs; they were somewhat less for those with vascular occlusion, temporal bone fracture, otosclerosis, and cochlear dysplasias; they were least in those with measles, bacterial labyrinthitis and congenital syphilis. The data is of relevance in the selection of patients for cochlear implantation.


Melanoma and the differential diagnosis of oral pigmented lesions. There are many pathologic processes that occur in the mouth which have various intraoral manifestations. The differential diagnosis of pigmented lesions of the oral cavity takes on a high degree of significance because therapy may span such a wide range from no treatment at all to massive radical resection for melanoma. A thorough understanding of pigmented lesions of the oral cavity would assist the clinician in establishing a diagnosis and subsequent treatment plan. A comprehensive review of the literature and a discussion of oral pigmented lesions including infiltrative malignant melanoma is presented.


Gelfoam paste injection for vocal cord paralysis: temporary rehabilitation of glottic incompetence. Vocal cord paralysis frequently results in open glottic incompetence with aspiration, an ineffective cough, and poor voice production. Glottic competence can be restored temporarily be injecting the true vocal cord with Gelfoam paste. This clinical use of Gelfoam for temporary rehabilitation is indicated in : 1) situations in which paralysis may be temporary, 2) patients for whom an open operative procedure must be delayed, and 3) circumstances in which it is desirable to determine the effect of vocal cord injection prior to placement of nonabsorbable material. The injection of Gelfoam paste results in minimal tissue reaction. Absorption is gradual over a period of six to ten weeks, allowing time for some glottic compensation. The injection may be repeated without adverse effects until the paralysis resolves or intervention of a permanent nature is indicated.


Eosinophilic granuloma in the head and neck: a five year review with report of an instructive case. Head and neck symptoms occurred in 87% of patients (14 of 16) with eosinophilic granuloma seen in a 5 year period. Two patients with head and neck disease died (14% mortality). Both had concomitant pituitary disease. The underlying pathology was discovered in each instance only after a year of extensive diagnostic effort. The specific problems in diagnosis and treatment are apparent in the case report of an initially misdiagnosed patient. The following recommendations are suggested to optimize the care of such patients. Eosinophilic granuloma must be suspected in a variety of clinical settings. Radiography is the only helpful noninvasive study and definitive diagnosis depends on microscopic tissue examination. Patients with symptoms of pituitary disease pose a frustrating diagnostic problem because of the inaccessibility of the location for pathologic study. In contrast, the head and neck, ear, nose and throat are easily biopsied and comprise the region most frequently involved. A careful examination of this area is mandatory in all patients with symptoms consistent with eosinophilic granuloma intracranially or elsewhere if the disease is to be diagnosed and treated without delay.


Etiologic factors in hypocalcemia secondary to operations for carcinoma of the pharynx and larynx. Hypocalcemia, although a relatively uncommon sequela of operations for carcinoma of the larynx and pharynx, often presents as an acute medical emergency. In its chronic form, hypocalcemia may be a difficult disorder to control. Understanding the etiologic basis of hypocalcemia secondary to operations for carcinoma of the head and neck requires knowledge of the pathophysiology of the preoperative and postoperative factors affecting calcium homeostasis. These factors include thyroidectomy, hypoparathyroidism, hypomagnesemia, anticonvulsant therapy, estrogen replacement therapy, oral contraceptives, blood transfusions, hyperventilation alkalosis, hypoalbuminemia, corticosteroid therapy, depression, emotional stress and diet. Often the onset of symptoms and signs of hypocalcemia occurs within 24 to 48 hours after the operation. The symptoms may include mental depression, headache, tingling of the hands and perioral region and abdominal pain. Unrecognized chronic hypocalcemia may lead to the development of cataracts, convulsions and psychosis.


Endoscopic examination of corrosive injuries of the upper gastrointestinal tract. The authors present the case histories of five patients who have sustained corrosive injuries of the upper gastrointestinal tract. Flexible endoscopic examination was successfully carried out in each patient to assess the extent of the injury and anticipate further therapeutic needs. Three patients sustained major gastric lesions, i.e., strictures or bleeding following the ingestion of alkali, acids, or phenol, and one instance of esophageal stricture was recognized. The endoscopic observation of antral gangrene was inexorably followed by antral stricture requiring surgical management. One fatality followed rigid esophagoscopic examination which resulted in esophageal perforation.


Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleep-apnea syndrome. Pharyngeal airway during sleep was observed with help of Fibro-optic flexible bronchoscope and cineradiography in 10 adult patients with Hypersomnia Sleep-Apnea (HSA) syndrome. The results of the study suggest that the structures involved in production of airway obstruction in the patients with HSA syndrome are the muscles of velopharyngeal sphincter and tongue. The laryngeal airway was not obstructed during the episodes of apnea.


The otolaryngologic manifestations of multiple myeloma. The purpose of this paper is to present the precursors and complications of multiple myeloma as manifested in Otolaryngology. The modern Otolaryngologist is well aware that systemic disease may manifest itself in our specialty. Multiple myeloma is a distinctive form of plasma cell dyscrasia which often manifests itself in Otolaryngology. For example, patients may present with epistaxis, hoarseness, asymmetry of the face, swelling of the palate, nasal obstruction and a multiplicity of other symptoms. Therefore, the practicing Otolaryngologist must maintain a high index of suspicion that a seemingly simple sign or symptom may represent one small facet of a generalized condition. The paper emphasizes that in many instances a slight extension of our history taking may provide us with information leading to the diagnosis of this systemic disease. Cases seen by the author are reviewed and the relevant clinical features are presented.


Carcinoma of the larynx: lymph node reaction patterns. In a double-blind retrospective analysis, sections of lymph nodes removed at the time of laryngectomy and homolateral neck dissection were microscopically examined to assess the histopathological manifestations of an immune response. Contrary to an earlier study, no strong correlation appears to exist between the host response as manifested by the lymphnode morphology and survival or metastases. The question of preoperative irradiation altering the lymph node's ability to respond effectively is raised and puts in jeopardy such a morphological assessment in patients who have received preoperative radiotherapy.


Letterer-Siwe disease. Presentation as an otologic problem. Letterer-Siwe disease is one of the three clinical syndromes that are collectively known as histiocytosis X. This is the most aggressive form of histiocytosis and is frequently fatal. Recently, however, early treatment with chemotherapeutic agents and steroids has prolonged survival and has even resulted in remission of a number of cases. This paper draws attention to a persistent external otitis as an early symptom of Letterer-Siwe disease and identifies, histologically, involvement of the external auditory canal.