Immunoproliferative alterations in lymphoid tissues and liver in mice stimulated with Corynebacterium parvum. Morphological alterations in the spleen, liver, lymph nodes, thymus, bone marrow and blood were studied in DBA and Balb/C mice treated with Corynebacterium parvum. The spleen lymph nodes and liver increased in size and weight, whereas thymus showed decrease in weight compared to the control group. A marked, early proliferation of monocytes in the bone marrow preceded infiltrations by macrophages in lymph nodes, spleen and liver. These infiltrations were closely related to the vascular structures, became nodular and decreased around day 12 after the injection. A rapid increase in the number of monocytes and transformed lymphocytes of the peripheral blood were noted almost immediately after the administration of the vaccine. No relationship between the degree and duration of the histological changes, strain of mice, and number of inoculations was found. It is suggested that the increase in size and weight of the lymphoid organs and the liver is primarily caused by invasion of macrophages, perhaps secondary to a preceding proliferation of monocytes in the bone marrow.


Brief report. In vitro effects of Rubella virus, strain RA 27/3, on human lymphocytes. III. Inhibition of mitogen stimulation transferred by supernatants from virus-infected cultures. When lymphocytes from humans with serological immunity against rubella were incubated with live rubella virus, supernatants were obtained which when added to non-infected lymphocytes gave a significant inhibition of phytohaemagglutinin (PHA)-induced proliferation. In contrast, supernatants from virus-infected lymphocytes from donors lacking immunity against rubella gave no inhibition of the PHA response.


Protective antitoxic cholera immunity in mice: influence of route and number of immunizations and mode of action of protective antibodies. An adult mouse model has been elaborated for studies of experimental cholera (Vibrio cholerae enterotoxin-induced intestinal secretion) and protective antitoxic immunity in either ligated small bowel loops or intact small intestine. Mice of different inbred strains varied markedly in intestinal susceptibility to toxin, C57B1 being the most sensitive strain tested. Fluid accumulation started within 1 h after the inoculation of toxin and was maximal after 5 h, whereafter recovery gradually ensued. The dose-response curve was sigmoid, the ED50 of crude toxin being equivalent to about 0.1 microgram purified toxin/cm in the loops and 0.3 microgram/cm in the nonligated intestine. Two peroral (p.o.) immunizations induced significant protective immunity which increased markedly after two further immunizations by the same route. Additional p.o. immunizations did not appreciably enhance the protective immunity any further. Intravenous (i.v.) vaccination had to be repeated more than 5 times before intestinal immunity could be observed. No correlation between serum antitoxin titers and protective immunity was found. Electron microscopic examination revealed that whereas peroxidase-coupled cholera toxin bound tightly to intestinal microvilli from unimmunized or 5-times i.v. immunized mice it did not bind to the microvilli of p.o. immunized animals. The data thus suggest that the protective immunity is mediated exclusively by locally produced antibodies which prevent the binding to toxin to the gut epithelium.


Localization of Fc receptors in human and rat malignant tissues. Three human malignant tumors and a rat carcinoma (Walker 256), which all showed strong Fc receptor activity in tests with sheep erythrocytes (E) sensitized with rabbit IgG antibodies (A), were used to study the distribution of the receptor in subcellular fractions isolated by differential centrifugation. Smears of the three crude sediments obtained (nuclei, mitochondria rich and membrane rich) all possessed receptor activity. EA incubated in the suspension of cell fractions did not attach to Fc receptor positive tissue sections or to cells in suspension. Cells from which the surface receptors had been eluted still showed activity in sections of cell pellets. Apparently the Fc activity is connected with both external and internal membranes.


Immuno-suppressive effect of human macrophages. I. Evidence for an unstable soluble factor(s) inhibiting DNA synthesis and proliferation in PHA-stimulated lymphocytes. Macrophages obtained by culturing blood monocytes in vitro for 8 days showed capacity to inhibit DNA synthesis and cell proliferation in PHA-stimulated lymphocytes separated from the macrophages by a membrane with pore size 0.2 micron. The DNA synthesis was measured as 3H thymidine incorporation and the proliferation as cell counts. The depression was reduced when the distance between macrophages and lymphocytes was increased concomitant with increased culture volume. Heat-killing of macrophages abolished their lymphocyte depressing capacity. Full inhibitory effect was established within 4 hours when lymphocytes were cultured in the proximity of macrophages. The effect was blocked by molecular filtration membranes with nominal molecular weight limits (nmwl) 1,000 and 10,000 whereas membranes with nmwl 25,000 only partially blocked the effect. No inhibitory effect was registered in the supernatants from macrophage-depressed lymphocyte cultures. Presumably the lymphocyte depressing effect is mediated via an unstable soluble factor(s).


Immuno-suppressive effect of human macrophages. II. Influence of macrophages on the kinetics of DNA, RNA and protein synthesis in PHA-stimulated lymphocytes. Human macrophages obtained by culturing blood monocytes in vitro for 8 days release a soluble factor(s) inhibiting DNA synthesis and cell proliferation in PHA-stimulated lymphocytes. Synthesis of RNA and protein was strongly inhibited in PHA-stimulated lymphocytes sedimented on macrophages, as well as in lymphocytes separeted from the macrophages by a membrane, thus demomatrating that inhibition of RNA and protein synthesis was also mediated by a soluble factor(s). The kinetics of the factor-mediated inhibition showed that RNA synthesis was readily inhibited, whereas there was a delay in the inhibition of protein synthesis, thus indicating that the inhibition of protein synthesis and cell proliferation is a result of a blocking effect on the nucleic acid synthesis. The kinetics of DNA and protein synthesis in lymphocytes relieved from macrophage-mediated inhibition indicate a cytostatic effect.


Choline acetyltransferase activity in postganglionic parasympathetic nerves after "pharmacological decentralization". The ganglion blocking drug chlorisondamine given frequently and in gradually increasing doses over a period of time to adult rats causes the activity of choline acetyltransferase to fall in the postganglionic parasympathetic nerves of parotid glands. Such a "pharmacologically" decentralized gland was also found to have lost weight and to have developed a supersensitivity to chemical stimuli. All these phenomena are thought to be consequences of loss or reduction of secretory impulses from the central nervous system due to impaired ganglionic transmission.


Effects of nifedipine on the smooth muscle of the human urinary tract in vitro and in vivo. Smooth muscle preparations of the urethra, bladder, and ureter were obtained from patients undergoing operations for various urological disorders. The urethral preparations were contracted by noradrenaline (0.1-3 microgram . ml-1), prostaglandin F2alpha (1-10 microgram . ml-1), and potassium (127 mM), the bladder preparations by carbacholine (0.004-1 microgram . ml-1), prostaglandin F2alpha (1-10 microgram . ml-1), potassium (127 mM), and barium chloride (3 mM), and the ureter preparations by potassium (127 mM), and barium chloride (3 mM). Irrespective of the mode of activation, pretreatment with nifedipine (0.1 microgram . ml-1) for 10 min. reduced the responses. Nifedipine also relaxed preparations contracted by the contractile agents used. In 19 female patients, aged 20 to 73 years, undergoing investigation because of urgency and/or urge incontinence, simultaneous urethrocystometry at rest was performed before and after oral administration of 20 to 40 mg nifedipine. Bladder capacity and residual urine were also determined. Nifedipine did not affect the pressures within the bladder and urethra, nor did it increase the bladder capacity. However, after nifedipine intake there was a statistically significant increase in residual urine. The results suggest that nifedipine can inhibit contractile activity induced by drugs with different modes of action; the drug does not affect the tone in bladder and urethra.


Interaction of vitamin E and selenium with the hepatotoxic agent dimethylnitrosamine. Pretreatment of rats with vitamin E, 0.02% w/w of the diet and a sc dose, 200 mg/kg, given 48 hrs. before dimethylnitrosamine, DMNA, was found to ameliorate the acute hepatotoxicity of DMNA (30 mg/kg) as reflected in reduced plasma asparagine-amino-transferase (AspAT) activity. This effect was confirmed by histological evaluation. No significant effect of DMNA on plasma levels of vitamin E was observed, however, DMNA significantly increased the hepatic level of vitamin E supplemented rats. Pretreatment with selenium, 0.5 mg/kg given intraperitoneally 48 hrs. before DMNA, was found to enhance the acute hepatotoxicity of DMNA as reflected in increased elevation of plasma AspAT activity. This effect was not confirmed morphologically. DMNA did not have any effect on the hepatic selenium state in selenium pretreated rats; however, selenium pretreatment tended to decrease hepatic and plasma tocopherol levels. To explain the effects observed in the present investigation, various mechanisms were discussed. If the compounds were acting as antioxidants, then the difference in intracellular localization had to be important. More likely a specific biochemical function involving drug metabolizing enzymes could be involved. Finally vitamin E could protect membranes from damage during the necrotizing action of DMNA.


Effect of melperone, two of its metabolites and thiothixene on central monoamine metabolism and prolactin levels in rodents. The effects of melperone and thiothixene on the concentrations of monoamine metabolites in brain and prolactin in the serum of rats and mice were determined. Both drugs increased brain concentrations of dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in a dose-dependent manner. 5-Hydroxyindoleacetic acid (5-HIAA) was unaffected. The effect of thiothixene was longer lasting and about 5 times greater than that of melperone. Melperone, but not thiothixene, increased levels of 3-methoxy-4-hydroxyphenylethylene glycol (MOPEG). Several hours after administration of melperone, levels of HVA and MOPEG were diminished. Both drugs increased prolactin concentrations in rat serum. Thiothixene was about 10 times more potent than melperone. Of two urinary metabolites of melperone investigated, one caused the same qualitative effects on monoamine metabolism as melperone itself but with reduced potency. The other metabolite was ineffective.


Effects of extracellular calcium on potassium and noradrenaline induced contractions in the aorta of spontaneously hypertensive rats--increased sensitivity to nifedipine. Isolated preparations of the thoracic aorta from spontaneously hypertensive rats (SHR) and normotensive Wistar rats (NWR) were contracted by noradrenaline (NA) 1.8 X 10(-5)M, and potassium (K+) 127 mM, after 30 min. pretreatment in a Ca++-free medium. In both SHR and NWR aortae, the contractions were markedly reduced; no significant differences were found between the two types of vessels in Ca++-free medium. On addition of Ca++, the contractions were restored to a significantly greater extent in the NWR than in the SHR aortae. In the presence of nifedipine 7.2 X 10(-9)M, the response to Ca++ was significantly more reduced in the SHR than in the NWR preparations. Relaxation of NA and K+ contracted preparations was induced by wash-out of the contractile agents, by addition of nifedipine 2.9 X 10(-8)M, and by introduction of a Ca++-free medium. After wash-out of NA, relaxation was slower in SHR than in NWR vessels. Relaxation induced by nifedipine and Ca++-free medium was more complete in SHR than in NWR preparations. After wash-out of K+, relaxation was more rapid in NWR than in SHR aortae. Nifedipine and Ca++-free medium induced relaxation was more complete in SHR than in NWR preparations. The results suggest that in the SHR aortae contraction induced by NA and K+ is more dependent on extracellular Ca++ than is the response in the NWR preparations; the SHR vessels are also more sensitive to the relaxing effects of nifedipine.


Is moderate ethanol consumption teratogenic in the rat? Female Wistar rats were given ethanol in their drinking fluid to cover 20-25% of the total calories consumed for 3-4 weeks prior to, during and also after pregnancy in some experiments. Soya oil was substituted for ethanol isocalorically in the control groups. Apart from a statistically significant reduction in litter size based on the number of apparent normal foetuses at intrauterine examination, no significant changes in reproductive performance could be recorded after ethanol treatment. In the offspring, examined up to 24 days of age, the body and some viscera weights were statistically significantly higher at some stages from 2 to 14 days. The general trend, however, showed that there were no significant differences in body, brain, liver, kidney, and heart muscle weights between control and ethanol offspring measured in rats between 0 and 24 days of age. Two gross malformations were recorded among 321 pups of ethanol treated mothers, whereas no malformations were found in 444 control pups. It was concluded that moderate ethanol consumption by rat mothers for 3-4 weeks before and during pregnancy as well as during the suckling period, had no serious effects on their reproductive performance and the development of their offspring measured by the parameters used in the present investigation.


Transport and binding of lidocaine by lung slices and perfused lung of rats. The accumulation of radioisotopically labelled lidocaine was investigated in lung slices and perfused lungs of rats. Lidocaine was taken up by rat lung slices incubated in an oxygenated physiological solution (pH 7.4) at 37 degrees. 14C-lidocaine accumulated in lung slices to a much greater extent than did 3H-sucrose, and the lidocaine space was approximately 7 times that of the extracellular space. No metabolism of lidocaine took place during the incubation period. The accumulation of lidocaine was inhibited by low temperature, while anaerobic conditions had no inhibitor effect. The uptake of lidocaine (0.028 mM) was slightly antagonized by high concentrations of Ca2+ (10 mM). The isolated perfused lung model was used for studying the pulmonary absorption of lidocaine from the vascular bed. Lidocaine was rapidly extracted from the perfusion solution and the drug appeared to accumulate in at least two compartments. It seems that in the rat lung a portion of the lidocaine taken up had accumulated within the cells, while some of it may be fixed to the cell surfaces.


The significance of lymphocyte lipid changes after smoking hashish. The increase of lymphocyte total lipids and phospholipids after smoking hashish, indicates either a lipid transfer from their site of production after smoking the drug or a mobilization of their biosynthetic mechanism in the lymphocyte. A fluctuation of individual phospholipid concentrations after "smoking" is related to the influence of certain hashish compounds on the various biosynthetic pathways of phospholipids in lymphocytes. Changes in phosphatidylcholine, phosphatidylinositol and phosphatidylserine are related to a possible fluctuation of the overall immune ability of the lymphocyte, by affecting the lymphocyte membrane enzyme mechanisms.


A study on the fate of curcumin in the rat. The uptake, distribution and excretion of curcumin in Sprague-Dawley rats has been studied. When administered orally in a dose of 1 g/kg, curcumin was excreted in the faeces to about 75%, while negligible amounts of curcumin appeared in the urine. Measurements of blood plasma levels and biliary excretion showed that curcumin was poorly absorbed from the gut. No apparent toxic effects were seen after doses of up to 5 g/kg. When intravenously injected or when added to the perfusate of the isolated liver, curcumin was actively transported into bile, against concentration gradients of several hundred times. The major part of the drug was however metabolized. In suspensions of isolated hepatocytes or liver microsomes 90% of the added curcumin was metabolized within 30 min. In view of the poor absorption, rapid metabolism and excretion of curcumin, it is unlikely that substantial concentrations of curcumin occur in the body after ingestion.


A fine structural study of liver (littoral) cells of methylmercury fed Japanese quail (Coturnix coturnix japonica). Tissues of Japanese quails were subjected to electron microscopical study. The birds had received 0-8 ppm methylmercury added to their diets for 6 weeks. The ultrastructural changes in the littoral cells of the liver were swollen mitochondria, with dilatation of the endoplasmic reticulum, loss of ribosomes from the rough endoplasmic reticulum and an increase in the number of vesicles in the cytoplasm. The nuclear membrane in some littoral cells became dilated, and the nuclear chromatin was condensed. The physiological effect of the destruction of the littoral cells is discussed.


Influence of intravenously administered catecholamines on cerebral oxygen consumption and blood flow in the rat. In order to study effects of catecholamines on cerebral oxygen consumption (CMRo2) and blood flow (CBF), rats maintained on 75% N2O and 25% O2 were infused i.v. with noradrenaline (2, 5, or 8 microgram.kg-1.min-1) or adrenaline (2 or 8 microgram.kg-1.min-1) for 10 min before CBF and CMRo2 were measured. In about 50% of animals infused with 2--8 microgram.kg-1.min-1 of noradrenaline, CMRo2 (and CBF) rose. However, there was no dose-dependent response, and CMRo2 did not exceed 150% of control. The effects of noradrenaline in a dose of 5 microgram.kg-1.min-1 on CMRo2 and CBF were blocked by propranolol (2.5 mg.kg-1). In animals infused with adrenaline (8 microgram.kg-1.min-1) CMRo2 was doubled and, in many, CBF rose 4- to 6-fold. It is concluded that, when given in sufficient amounts, catecholamines have pronounced effects on cerebral metabolism and blood flow, the effects of adrenaline on CMRo2 and CBF resembling those observed in status epilepticus.


Frequency selectivity of the peripheral auditory analyzer studied using broad band noise. The sharpness of the frequency tuning of single auditory nerve fibers was studied in the rat on the basis of responses to broad band noise. The cross-spectra between the sound stimulus and the sound-to-stimulus locked discharge rate were used as estimates of the transfer functions of the peripheral auditory analyzer. The sharpness of the tuning obtained in that way was measured as Q3dB and Q10dB. It was found that these Q-values decreased with increasing stimulus intensity but that the decrease was different when it was based on measurements at 3 dB points of the obtained transfer functions compared with measuring it at 10 dB points. The change in width was less for fibers with low CF. In all the fibers studied the frequency of maximal response (CF) decreased with increasing sound intensity. The implication of these findings for pitch perception and for noise induced hearing loss is discussed.


Ultrastructural evidence for an innervation of epithelial enterochromaffine cells in the guinea pig duodenum. The innervation of the duodenal enterochromaffine cells (E.C.) of the guinea pig was studied at the electronmicroscopic level. Pretreatment with 5-OH-dopamine was performed to visualize catecholaminergic (CA) nervous elements. Near the basement membrane of all examined E.C. in the crypts, bundles of unmyelinated nerve processes were observed, only partly ensheathed in a Schwann cell cover. At least 4 types of processes could be observed. 1) Boutons containing only small clear vesicles, probably cholinergic fibres; 2) boutons with small clear vesicles, and in addition large (greater than 200 nm) granules with a dense matrix (P-type-fibres); 3) boutons with small electron-dense vesicles, probably CA-fibres; and 4) processes with few vesicles but having the appearance of dendrites. No typical synaptic arrangements were observed, but the minimal distance between the E.C. and the nerve bundles was 150 to 250 nm, thus well within the functional limits of the "autonomic gap". Thus epithelial E.C. may be influenced by several types of nervous elements, including CA-fibres.


Efferent innervation of the small intestine by adrenergic neurons from the cervical sympathetic and stellate ganglia, studied by retrograde transport of peroxidase. The nervous pathways between the small intestine of cat and guinea pig and various sympathetic ganglia were investigated by the retrograde horse-radish peroxidase (HRP) technique. HRP was injected at multiple sites in the wall of the duodenum and the first third of the jejunum. At 1--5 days after the injections, the HRP reaction product was searched for in various sympathetic ganglia. Not only the coeliac and nodose ganglia, but also the superior cervical, medial cervical, stellate and thoracic ganglia contained HRP-positive nerve cells. Crushing the cervical vagal nerve prevented the occurrence of HRP-reaction in the cervical ganglia, indicating that the HRP was transported from the gut to the cervical ganglia via axons in the vagal nerve. The results demonstrate that the sympathetic ganglia in the neck (sup, and med. cerv. ganglia and stellate ggl.) send efferent fibres to the small intestine.


The influence of scrotal warming on testicular blood flow and endocrine function in the rat. The effects of local heating on testicular and epididymal vascular resistance in sodium pentobarbitone anesthetized rats was measured with a microsphere technique. When exposing the left scrotum to 33 and 37 degrees C for 30 min, no significant effects on blood flows were observed in comparison to those of the right side. Exposure to 41 degrees C caused a significant (p less than 0.05) decrease in vascular resistance of both testes and epididymides. The response was more pronounced at 43 degrees C. The Leydig cell function, as judged from the testosterone concentrations in plasma and testicular tissue after LH stimulation, was significantly (p less than 0.01) depressed at 41 and 43 degrees C. It was concluded that the impaired Leydig cell function was unrelated to testicular blood flow.


"Psychogenic needs" in patients with affective disorders. To investigate the occurrence of different psychogenic needs or groups of needs, 118 consecutive out-patients with previous depressive disorders were asked to complete the Cesarec and Marke Personality Inventory; 103 completed it. Strict diagnostic criteria were used in subgrouping the series which thus consisted of unipolar depressive psychosis (UP), 26 patients; bipolar depressive psychosis (BP), 16; unclassified depression (NUD), 8; and reactio neurotico-depressive (RND), 15. BP distinguished themselves from the other groups by a tendency to have a reduced need of approval, dependency, guilt feelings and ego conflicts and a stronger wish to dominate and lead. These results are in line with earlier findings. The NUD group was small but tended to have extreme scores, i.e. a particularly weak need to dominate and to be in the centre but also to be cared for.


Traffic accidents involving psychiatric patients. Characteristics of accidents involving drivers who have been admitted to Danish psychiatric departments. A nationwide study of psychiatric in-patients driving motor vehicles and involved in accidents causing bodily injury in the years 1972--74 was undertaken. Compared with drivers in general involved in accidents causing bodily injury, drivers with a psychiatric record were characterized by an over-representation of women. A preponderance of psychiatric drivers in the age group 25--54 was observed. About 3% of drivers with a psychiatric record were involved in two or more accidents during the period studied. A greater proportion of the psychiatrically diseased group drove stolen vehicles, without valid licences, and were found not to have used safety belts at the time of the accident. Occurrence of injury was more frequent among the diseased drivers. They were more frequently alcohol intoxicated and with a higher blood alcohol level. The most commonly encountered diagnostic groups were personality disorder and transitory reactions.


Life events and primary affective illness. Life events at the onset of primary affective illness were assessed in 183 patients with primary affective disorder who were attending a research lithium clinic. About 50% of patients recalled significant life events in the 3-month interval preceding their initial affective episode. Family history data of those patients who reported life events were not significantly different from those who did not report life events at onset. Furthermore, there were no significant differences among patients classified as bipolar or unipolar regarding reporting of life events at onset of illness. These data suggest that the delineation of a subgroup of patients with "reactive" primary affective illness is not supported by a decreased familial load for affective disorder in their relatives.


Free-thyroxine index in psychotic and neurotic depression. The mean free-thyroxine index value of a group of 25 psychotic depressive patients was found to be significantly lower than that of an age- and sex-matched group of 20 neurotic depressives (P less than 0.01). These findings support the view that psychotic and neurotic depression are differentiated not only with respect to their clinical expression, but also on account of their biological substrate. Comparison of free-thyroxine index values of each group of patients with a group of 240 euthyroid subjects hospitalized for various somatic illnesses revealed a lower mean free-thyroxine index value in the group of psychotic depressives (P less than 0.001). The neurotic depressives were not differentiated from the group of euthyroid subjects. The decreased thyroid activity in psychotic depression might be interpreted in the light of recent findings implicating catecholamines in both the release of hypothalamic hormones and the neurochemical mechanism of the affective disorders.


Psychomotor seizures, arterio-venous malformation and the olfactory reference syndrome. A case report. A case history is reported of a 44-year-old man with a 6-year history of psychomotor seizures. For the past year he had described persistent olfactory hallucinations of an unpleasant nature which he referred to himself. In many respects these symptoms conform to the pattern observed in the olfactory reference syndrome, a recently described but apparently quite discrete psychiatric disorder; there were, however, certain atypical features. At a later stage unilateral anosmia was noted. Radiological examination then demonstrated an arterio-venous malformation in the right frontal lobe. The relationship between the malformation and the psychomotor seizures, and the implications that each has for the development of an olfactory reference syndrome are fully discussed.


Lithium concentrations in saliva, plasma and red blood cells of patients given lithium acetate. Lithium concentrations in saliva, plasma and red blood cells were measured in: 1) six hospitalized patients under long-term lithium therapy, at 2, 5, 9 and 24 hours after oral doses of 24 mEq Li acetate and 2 or 12 hours after 8 mEq Li acetate; and 2) 10 outpatients under chronic lithium treatment at two occasions 8 days apart. With changing plasma concentrations, [Li] saliva varied without any notable time lag. [Li] saliva was always much higher than [Li] plasma. The ratio [Li] saliva/ [Li] plasma water averaged 3.2 +/- 0.2 in 62 determinations, but varied widely at different times after oral lithium in the same individuals and less widely between different individuals. "Prediction" of plasma lithium concentration from measured [Li] saliva appears hazardous, and may provide reliable indications only if [Li] saliva is measured repeatedly. Salivary lithium concentrations were not correlated with either potassium or sodium concentrations. Lithium concentrations in red blood cells were always lower than in plasma: [Li] red blood cell water/ [Li] plasma water averaged 0.37 +/- 0.03. With changing plasma concentrations, rise and fall of red blood cell lithium lagged considerably behind plasma changes. This resulted in a rise of the red blood cell/plasma concentration ratio from a very low value 2 hours after an oral dose to a rather high value 24 hours after an oral dose.


Who shall be hospitalized? Some social and psychological correlates of alternative dispositions of the mentally ill. This study conducted in Cali, Colombia, focuses on the question of why persons sharing similar background characteristics and even the same diagnosis often receive varying prescriptive evaluations which lead to alternative types of psychiatric care: hospitalization, outpatient care and no systematic treatment at all. An index group of 70 hospitalized patients is compared with 53 outpatients and 30 "nonpatients" matched for sex, age, marital status, social class and diagnosis. Interviews were conducted with patients, relatives and the admitting doctors. A selected group of variables representing perceptions, opinions and attitudes of the relatives, subjective evaluations of the patients and perceptions of the admitting physician are examined in terms of their association with the three types of care. It is concluded that interpersonal factors exert a significant influence on the process of assigning cases to alternative types of psychiatric care. Typical profiles for each category are outlined.


The scientific foundation of anti-psychiatry. Anti-psychiatry has exerted a substantial influence on the thoughts of workers in the field of mental hygiene; on those of the psychiatrically trained, but even much more on those without psychiatric training. Consequently it seemed important to me to investigate the strength of the foundation of this school of thought. This has been the objective of this study. The point of crystallization of anti-psychiatry is the labelling theory on the origin of deviant behaviour. The scientific status of anti-psychiatry stands or falls with that of the labelling theory. Since this theory has not been formulated in verifiable hypotheses, I ventured to formulate "theses", and then tested these against empirical obtained data. The results of this study were largely negative. The empirical material does not support the labelling theory, and in many cases even contradicts it. Consequently anti-psychiatry--as a model to explain the development of psychological disorders--has not a leg to stand on. The labelling theory has had great merits as a "sensitizing theory". It has given momentum to innovative tendencies in psychiatry. Now that it has proved to be untenable on its principal points, however, it should be abandoned. It has become a rubber check, which has no scientific buying-power.


Review of the relationship between obsession and depersonalization. Depersonalization is discussed and a brief outline of the primary symptoms is presented. The relationship between obsessionalism and depersonalization is reviewed in the literature, and subsequent similarities are presented. The intellectual obsessive depersonalization syndrome is postulated as a variant, and also as an exposition of what might occur in many other cases of depersonalization. Finally, a picture is presented which takes into account a strong component of obsessionalism in both the etiology and course of depersonalization.


Proteinuria following nephroangiography.  III. Role of osmolality and concentration of contrast medium in renal arteries in dogs. Nephroangiography in dogs, with renal artery injections of Urografin 76%, resulted in massive albuminuria. Unilateral nephroangiography causes massive albuminuria only from the injected kidney. Significantly less albuminuria was caused by renal artery injections of a corresponding volume of a sodium chloride solution of equal osmolality or intravenous injections of twice that volume of Urografin 76%. Thus, the hypertonicity of the contrast medium is not the main cause of the albuminuria. The degree of albuminuria is related to the concentration of medium in the renal arteries and not to the amount excreted.


Roentgen stereophotogrammetry for evaluation of liver volume and shape. Model experiments and tests on 2 patients were performed to probe the feasibility of roentgen stereophotogrammetry for evaluating variations in shape and volume of the liver. The surface of the object was marked with indicators, and the three-dimensional marker coordinates were determined. The model experiments demonstrate a good correlation between true volume and the volumes defined by the indicators, and also demonstrate the possibility of localizing an expansivity. The variability of the volume of a polyhedron defined by 15 liver indicators with stage of breathing is discussed.


Roentgenologic appearance of fibromuscular dysplasia. Clinical and roentgenologic findings in 100 hypertensive patients with fibromuscular disease of the renal arteries are presented and compared with the experiences obtained from previously reported large series. Frequency of bilateral disease and abnormal findings at urography, involvement of segmental arteries and occurrence of extrarenal manifestations are reported. A striking female preponderance is noted, and there is evidence that the disease inflicts middle-aged rather than young women.


Angiography in vesical and perivesical neoplastic and non-neoplastic lesions. Seven cases of neoplastic and non-neoplastic lesions involving the urinary bladder and perivesical tissues are presented. Each of the described lesions may have nonspecific angiographic appearances and hence angiography does not permit a specific diagnosis to be made. The primary object of performing angiography is to localize the lesion and identify the vascular supply.


Displaced renal lobe simulating tumour.

Displaced renal lobe simulating tumour. Three cases of renal pseudotumour are presented, with the radiographic appearances.  At urography, a mass is demonstrated. Angiography reveals slight displacement of the interlobar arteries, a normal venous phase, but no tumor vessels. The nephrographic effect is similar in the mass and in the renal parenchyma. The nephroscintigraphy is likely to be normal. The main differential diagnoses are mentioned.


Experimental colonic tumours in the rat. II. Double contrast examination and microscopy. Experimentally induced tumours in the colon of the rats were examined with a double contrast method.  Carcinogenic agents were administered to 114 rats. The development of the colonic tumors was recorded by repeated examinations. In the dead rats a thorough necropsy was performed. The radiographic and microscopic results were correlated and the radiographic appearances of colonic tumours were evaluated.  The diagnostic accuracy of the radiographic method in distinguishing between benign and malignant lesions was 92 per cent.


Malignancy of colonic polyps. Diagnosis and management. The risk of malignant degeneration of colonic polyps has traditionally rested on various roentgenographic criteria such as broad base, irregular surface and size larger than 1 cm. With the aim of facilitating the choice of treatment of colonic polyps, an appraisal is made of the morphology of 200 polyps removed from 154 patients.  The results of barium enema and double contrast techniques are compared with those obtained at colonoscopy. Radiography is found to have considerable shortcomings in evaluation of the appearance of the polyp. As the correlation of the gross morphology of the polyp of histology is weak endoscopic polypectomy should be performed whenever possible.


Soft tissue abnormalities at fracture of the scaphoid. In a retrospective examination of the films from 53 cases with fracture of the scaphoid it was possible to demonstrate soft tissue alterations within the scaphoid fossa. All these cases were examined adequately, i.e. with correct projections and satisfactory penetrating exposure. A somewhat higher quality of the views was obtained on industrial film.


Image distortion in narrow beam rotation radiography. A mathematical analysis. A general mathematical analysis of the image distortion in narrow beam rotation radiography has been performed. Distortion effects are often evident in panoramic images exposed in clinical practice. It is found that in spite of this general experience panoramic images, exposed with the aid of a rotating narrow beam, are reliable for ordinary clinical demands when the object morphology is to be assessed. This statement is valid provided that the object has been properly positioned at the exposure.


Medichrome film as an alternative to silver-free recording systems. A shortage of silver is forcing film manufacturers to lower the silver content of radiographic films.  No further lowering seems possible without film quality being adversely affected. Various ways to solve the silver problem in the future are discussed and colour radiography is regarded as one solution since it makes possible a high degree of immediate recovery of silver.  The feasibility and proper use of the only colour film available, Medichrome, is discussed.  Suitable screens in order to compensate for the low sensitivity of the film without loss of image quality and a strong light source containing a monochromatic sodium lamp for inspection of dense areas are recommended.


Quantitative lymphoscintigraphy for detection of metastases to the internal mammary lymph nodes. Biokinetics of 99Tcm-sulphur colloid uptake and correlation with microscopy. Dymanic quantitative activity determination and accurate scintigraphic localization of parasternal lymph nodes were obtained from antero-posterior measurements with a scintillation camera. The scintigraphic observations were compared with microscopy of the nodes removed at operation. The 99Tcm-sulphur colloid indicated a high frequency (7/16) of absent uptake in normal lymph nodes. However, the technique used indicates that a similar technique with smaller particle size may be a useful method for proper classification of the clinical stage of carcinoma of the breast.


Dose and dose rate in 192Ir interstitial irradiation for carcinoma of the tongue. Seventy-three patients with carcinoma of the tongue were treated with 192Ir implantation. The total dose for control of the primary lesion without late radiation injury could be fixed to about 70 Gy with a variation of the dose rate between 0.25 and 1 Gy per hour. Additional external irradiation, without reduction of the dose from the interstitial irradiation, involves a high risk of local necrosis.


Effects of irradiation on the immune function in patients with mammary, pulmonary or head and neck carcinoma. The immune functions in patients with mammary, pulmonary, or head and neck tumors were investigated after irradiation. The treatment caused an initial lymphopenia and longlasting depression in the lymphocyte proliferative responses to PHA, Con A and PPD. The percentages and the ratio of E and EAC rosette forming cells remained unchanged.


The Paris system in interstitial radiation therapy. As a result of almost 20 years' experience using 192Ir wires in interstitial radiation therapy, a new method of dose calculation has been evolved, which is especially suitable for the techniques employed. Because this system was developed and brought into routine use in Paris, it was called the Paris System. Its basic principles are outlined in this report and the manner in which it is used in clinical practise is explained.


Carcinoma of the eyelid.

Carcinoma of the eyelid. A series of 274 cases with eyelid carcinoma, 92 per cent irradiated, was analyzed. The results show that the majority of eyelid carcinomas can primarily be irradiated with satisfactory curative and cosmetic results, but operation may be considered in larger and deeper infiltrating tumours. Recurrence after primary irradiation should be operated.


Prognostic significance of histologic subdivision of Hodgkin's disease nodular sclerosis. Sixty-seven patients with nodular sclerosis (Hodgkin's disease stages I and II) have been subclassified according to the cellular composition and the amount of fibrosis. Predominance of mature lymphocytes and rarity of Reed Sternberg cells were associated with less extensive disease at presentation and more favourable outcome. A less definite correlation to the amount of fibrosis was found.


Scintigraphic estimation of thyroid volume and dose distribution at treatment with 131I. A scintigraphic method for estimation of thyroid volume and dose distribution for 131I in the thyroid gland is presented using a gamma camera with pinhole collimator connected to a minicomputer and digital system. The three dimensions of each lobe are measured and the volume calculated using the ellipsoid model. Problems regarding changes in magnification and sensitivity with object to collimator distance have been investigated. The iodine distribution in the thyroid gland has been followed for 72 hours after oral administration of 131I in 25 cases. No significant change in distribution was observed in any of the cases.


Dose distribution around a new flexible afterloading applicator. A new afterloading applicatory, together with a computer program, is described. A comparison of the calculated and measured dose distribution around different applicators shows that in the future the described computer program can be used. The development of the new applicator and the computer program increases the flexibility of possible dose distribution.


Irradiation of mice pre-treated with radiation protective substances. A pathologic and haematologic investigation. CBA male mice were irradiated with single doses of 7.1, 8.6, 10.0, 11.4 or 12.8 Gy, respectively. A protective substance, 2,2-Dithiobis(N-[(1-adamantyl)methyl]acetamidine)-dihydrochloride, here called S-75, was administered orally, 45 min before start of irradiation. Cysteamine-HCl was used as a reference protective substance. Pathologic and haematologic examination of irradiated animals was performed. Cysteamine had somewhat better protective abilities than did S-75, but the latter had some other properties which indicate its possible usefulness in practice.


Time factor in PHA responsiveness of human blood lymphocytes after in vitro irradiation. Human blood lymphocytes were irradiated in vitro prior to or following PHA-stimulation. Radiation dose-response profiles indicate that PHA-pretreatment of cells has no protective effect. PHA-reactivity of the cells decreases with increase of the time interval between irradiation and subsequent PHA stimulation.


Patient exposures and radiation risks in Swedish diagnostic radiology. Results are reported of measurements around 1974 on a thousand patient at 13 Swedish hospitals, and additionally at several photofluorographic and dental installations. Energy imparted as well as doses to the thyroid, breast, lung, bone marrow, ovary and testis have been calculated for many types of examination. Collective doses have been calculated and risk estimates made. The energy imparted corresponds to an annual mean body dose to the Swedish population of about 1 mGy (100 mrad), and the genetically significant dose was about the same as the 1955 total of 0.4 mGy; in both cases the uncertainty of the estimate is about +/- 50%. The possibility of dose reduction by a factor of 2 or more using available techniques is demonstrated. The risk of future serious injury is estimated to 0.0002 cases per joule of energy imparted to the patient.


Radiation response modified by degradable starch microspheres. Experiments on the rat's foot. Skin reaction in the rat's foot was used as an experimental method to evaluate the protective potential of profound temporary hypoxia against roentgen radiation produced by a linear accelerator. Hypoxia was induced by intraarterial injection of degradable starch microspheres. The irradiation dose needed to evoke a certain reaction in the hypoxic feet was 2.0 times the dose giving the same reaction in a control group. The results point towards a new technique of inducing local hypoxia in healthy tissues which need to be protected in an irradiation field.


General equations for the calculations of biologic effect ratios for parallel opposing fields. The tolerance level of normal tissue, which is the concept of NSD, is the limiting factor in radiation therapy. It is well known that the two parallel opposing fields should be treated at each session instead of alternating one field per session. The biologic effect ratios between the normal tissue at the depth of maximum build-up and the midline for parallel opposing fields were published by ELLIS et coll. General formulae are now presented providing biologic effect ratio at any two locations in terms of per cent depth doses in the treatment volume for parallel opposing fields. Examples at the depth of maximum build-up and certain depth of the connective tissue at the tumor site are also given.


Dosimetry intercomparisons for evaluation of late effects of ionizing radiation. In 1971, 1973 and 1976 intercomparisons of absorbed dose and dose distribution over a mouse phantom for roentgen irradiation were performed as part of the program of the European Late Effects Project Group (EULEP). Sixteen institutes from 8 countries participated in the sessions of the third intercomparison. In general, progress has been made concerning accuracy and precision of the dosimetry; in 2 cases, discrepancies could be resolved after additional measurements. With regard to the dose distribution over a mouse phantom, the results are not satisfactory; 4 out of 15 participants are still unable to perform uniform irradiations. The necessity of repeated intercomparisons is clearly demonstrated to allow a comparison of biologic results obtained in cooperative research programs.


Image intensifier tomofluorography. Experimental evaluation and clinical potentialities. Caesium iodide image intensifier tubes have improved the image quality of 70- and 100-mm fluorograms. It is possible to produce tomograms with satisfactory resolution ability in 100-mm film. The geometry and distortion of the tomographic image recorded by an image intensifier with spherical input phosphor are presented from the theoretical and practical points of view. It is concluded that 100-mm tomofluorograph is a useful method, particularly in connection with TV tomofluoroscopy and TV tomometry.


Treatment of diuretic-resistant fluid retention with ultrafiltration. Nine patients with diuretic-resistant edema, secondary to congestive heart failure, liver cirrhosis, or nephrotic syndrome, were treated with ultrafiltration using high water flux dialyzers. Access to the blood stream was obtained by femoral vein catheterization. As much as 8.3 kg of fluid were removed in 3--4 hours with only transient decline in blood pressure. The procedure was well tolerated and yielded immediate symptomatic relief. The potential for restoration of an edema-free state in patients with diuretic-resistant edema suggests that further experience with this technique is justified.


Influence of sodium intake on hydrochlorothiazide-induced changes in blood pressure, serum electrolytes, renin and aldosterone in essential hypertension. To determine the influence of dietary sodium intake on the effects of hydrochlorothiazide (HCT) on blood pressure (BP), serum electrolytes, renin and aldosterone, nine male patients with uncomplicated essential hypertension were studied during the following therapeutic regimes: 1) sodium restriction alone (50 mmol/day), 2) sodium restriction combined with HCT (50 MG TWICE DAILY), 3) HCT alone, and 4) sodium restriction combined with HCT. Low sodium diet alone and HCT alone lowered BP to the same extent. The combination of HCT and sodium restriction had no extra effect on supine BP, but elicited complaints of dizziness and weakness in each patient, and overt orthostatic hypotension in three cases. Sodium restriction during HCT treatment caused hyponatraemia and aggravated hypokalaemia. Hyponatraemia could not be accounted for solely by changes in cumulative sodium balance. Plasma renin concentration rose markedly during the combined treatment. Plasma aldosterone was normal during HCT alone, but elevated when HCT was combined with sodium restriction. These results cast some doubt on the therapeutic value of prescribing a low sodium diet to patients with essential hypertension treated with thiazide diuretics. Overactivity of the renin-angiotensin-aldosterone system during this regime might explain both the lack of a beneficial effect on BP and the adverse influence on serum potassium.


Oesophageal function and coronary angiogram in patients with disabling chest pain. Sixty-four patients with a history of disabling chest pain belonging to groups III or IV classified according to the NYHA criteria were examined with oesophageal function tests, coronary angiography and bicycle ergometry and also answered a symptom questionnaire. At the exercise test, 52 had effort angina; 45 (89%) of them had a pthological coronary angiogram and 22 (42%) had signs of oesophageal dysfunction (OD). OD as the single possible etiological factor for typical effort angina therefore seemed unlikely. Chest pain was absent or atypical at the exercise test in 12 patients, 11 (92%) of whom had signs of OD. This incidence is significantly higher (p less than 0.01) than that found in the patients with effort-related chest pain. Five (42%) of the 12 patients with atypical chest pain at the exercise test had a pathological coronary angiogram, an incidence which is significantly lower (p less than 0.001) than that found in the group with effort-related chest pain. In patients with a history of disabling chest pain but with atypical chest pain in connection with the exercise test, OD was more frequent than coronary disease and therefore more likely to have caused the symptoms.


Effect of nifedipine (Adalat) on coronary haemodynamics in patients with coronary arteriosclerotic disease. Effects of the new Ca++ antagonist nifedipine (Adalat) on coronary haemodynamics were studied in 8 patients with documented ischaemic heart disease. The continuous infusion thermodilution technique was used to measure cardiac venous blood flow. Sublingual application of 10 mg nifedipine caused a significant increase (16%) in myocardial blood flow and a decrease (18%) in coronary arteriolar resistance at rest, but not during a submaximal atrial pacing test. There was no change in coronary arteriovenous oxygen difference, myocardial oxygen consumption, oxygen consumption per unit of heart rate blood pressure index or left ventricular efficiency index. The effects on the coronary haemodynamics are discussed in relation to the simultaneous changes in general haemodynamics. Systolic aortic pressure was slightly reduced, significantly only at rest, while peripheral vascular resistance decreased and cardiac output increased also during atrial pacing. No change in free fatty acid metabolism was observed. It is concluded that nifedipine is a mild coronary vasodilator. No effect was observed on myocardial oxygen demand. The oxygen cost of left ventricular work was unchanged by the drug both at rest and during the submaximal stress test.


Renin release in relation to plasma noradrenaline during supine exercise in cardiac patients. Plasma renin activity in the brachial artery and in the renal vein together with arterial noradrenaline concentration were determined repeatedly during and after 10 min of dynamic exercise in eight cardiac patients. Arterial renin increased slightly during exercise and gradually returned to control level after exercise. Renal vein renin increased markedly during exercise and returned to the resting value immediately after exercise, similarly to the changes in plasma noradrenaline and heart rate. A close temporal relationship between the changes in the renal veno-arterial renin difference, plasma noradrenaline and heart rate strongly suggests that the sympathetic nervous system is a major determinant of renin release in man during exercise.


Dialysis fistulas and cardiac failure.

Dialysis fistulas and cardiac failure. A haemodialysis fistula may be a factor in the development of cardiac failure, and surgical reduction of fistula blood flow can improve the condition. We have investigated 6 patients with dialysis fistulas and closed the fistula in one of them, with marked improvement of cardiac failure. It is unlikely that a peripheral dialysis fistula can cause cardiac failure by itself, but it may be a contributing factor when the cardiac reserve is reduced due to other causes.


Hemodynamic effects of the cardioselective beta-blocking agent metoprolol in acute myocardial infarction. A 24-hour catheterization study. Hemodynamic changes were studied in ten patients with uncomplicated transmural myocardial infection during 24 hours on beta-blockade. The cardioselective beta-adrenergic blocking drug metoprolol was injected (15 mg i.v.) within the first 24 hours after onset of chest pain and was followed by oral therapy (25-50 mg at 6-hour intervals). There was a decrease in heart rate, systolic BP, and cardiac output, which was most marked after the injection. The stroke volume and diastolic BP for the whole group of patients remained unchanged. The pulmonary artery end diastolic pressure did not change significantly after the injection but a continuous fall was obtained in three out of four patients with initially elevated values. The preejection period, measured from the ECG and carotid pressure curve, as initially short and was prolonged in all patients after administration of the beta-blocking drug. It is concluded that the cardioselective beta-blocking drug metoprolol may be used in selected patients in the acute phase of myocardial infarction without danger of hemodynamic deterioration during the first 24 hours of therapy. The selection of patients can be based on clinical criteria. In this study signs of left heart failure, hypotension, poor peripheral circulation, bradycardia, and AV block were regarded as contraindications.


Prognostic implications of ventricular arrhythmias registered before discharge and one year after acute myocardial infarction. The prognostic weight of ventricular ectopic beats (VEBs) was evaluated in 160 patients discharged after a CCU-treated acute myocardial infarction (AMI) and followed for two years. VEBs were registered prior to discharge by 6 hours of telemetry (3 hours during daytime including exercise and 3 hours at night) and again one year after the AMI. During the first year of follow-up, 11 patients died suddenly and 20 suffered reinfarction. Sixteen (55%) of these had shown severe VEBs, i.e. multiform, paired, R-on-T, or ventricular tachycardia, as compared to 42 (29%) of the remainder. During the second year of follow-up, eight patients suffered reinfarction and five died suddenly. The occurrence of severe VEBs prior to discharge was not of prognostic value for the second year per se but continued to carry prognostic weight for the first plus the second year. One year after the AMI the VEB incidence in 122 survivors without reinfarction increased insignificantly from 71 to 78%. VEB severity increased in 43% and decreased in 27% and the shift towards severe forms is significant. Severe VEBs one year after the AMI carry a prognostic weight for the second follow-up year, as 18% of patients with severe VEBs reinfarcted or died suddenly against 5% of those with nor or uniform VEBs only. Patients who had severe VEBs both prior to discharge and one year later did especially badly.


Homozygous expression of haemophilia B in a heterozygote. A case of clinically severe haemophilia B in a woman is described. In 1977 she was delivered of a healthy male child, showing that she is heterozygous for the haemophilia gene. This seems to be the first report of a proven heterozygote with the homozygous expression of severe haemophilia.


Bartter's syndrome without hyperplasia of the juxtaglomerular apparatus, treated with indomethacin. The present report describes a case of potassium-wasting nephropathy with the physiological and endocrinological findings that are typical for Bartter's syndrome (BS). However, the renal juxtaglomerular apparatus showed no hyperplasia at two renal biopsies two years apart. The short-term (9 days) effect of indomethacin in combination with spironolactone was a suppression of hyperreninemia and hyperaldosteronism and an increase in vascular sensitivity to angiotensin II associated with potassium and sodium retention. Subsequently, on indomethacin alone, potassium balance was obtained on a lower level with persistent hypokalemia and persistent renal potassium leakage. Hypokalemia persisted during long-term (9 months) treatment with indomethacin despite normalization of the activity of the renin-aldosterone system. The results indicate that indomethacin as long-term treatment may be ineffective in maintaining a normal potassium balance in BS.


Ectopic secretion of calcitonin.

Ectopic secretion of calcitonin. In 7 out of 25 unselected patients (28%) with a malignant disease, the circulating calcitonin level had increased. Pentagastrin i.v. gave no elevation of the calcitonin level comparable to the response in patients with medullary carcinoma of thyroid.


Bone mineral loss during maintenance hemodialysis. With the aim of investigating bone mineral loss during maintenance hemodialysis (MDH), bone mineral content (BMC) was measured by means of two-dimensional scanning photon absorptiometry in 47 chronic renal failure patients on MDH: 13 females (age range 22-50 years, mean dialysis duration 189 days) and 34 males (age range 23-69 years, mean dialysis duration 449 days). Measurements were carried out in most patients three times at an interval of 6 months. Initial mean BMC values were for both sexes significantly lower than normal, but did not correlate to duration of MHD. The longitudinal measurements demonstrated a highly significant decrease in BMC with time: the mean BMC values after 6 and 12 months, respectively, were for females 95.8 and 93.4% and for males 97.3 and 94.4% of the initial values with no significant differences between sexes. The fall in BMC did not correlate to duration of MHD, initial BMC value, or age. In some of the patients a substantial loss of BMC was observed, and it is suggested that these patients in particular may develop server bone disease. A BMC method with high precision is mandatory for selection of such patients.


The relation between extra- and intracellular electrolytes in patients with hypokalemia and/or diuretic treatment. The relation between extra- and intracellular electrolytes has been studied by means of percutaneous muscle biopsies in 107 patients with hypokalemia and/or treatment with diuretics. No relation was found between the extra- and intracellular concentrations of Na or Mg. The serum and muscle contents of K correlated weakly. The correlation coefficient tended to be stronger when S-creatinine was normal, total carbonate was between 25 and 30 mmol/l, muscle Mg content was greater than or equal to 3.95 mmol/100 g fat free dry solids, and when no treatment was given with digitalis and/or diuretics.


C-reactive protein, C3, C4 and properdin during the Jarisch-Herxheimer reaction in early syphilis. The occurrence of plasma CRP during the febrile response after the first injection of penicillin was followed in 10 patients with early syphilis. An increase in CRP was noted after 12 hours, with a maximum after 24 hours. The appearance of this acute phase protein could not be correlated to cutaneous reaction, increased body temperature or leukocytosis, nor were baseline values of CRP correlated to clinical or serological activity of the infection. Patients with high levels of CRP prior to treatment suffered the most intense systemic reactions. No activation of the complement system during the Jarisch-Herxheimer reaction was detected from sequential determinations of C3, C4 and properdin.


Storage of polyvinylpyrrolidone (PVP) in tissues following long-term treatment with a PVP-containing vasopressin preparation. The parenteral use of polyvinylpyrrolidone (PVP) leads to PVP retention in the human organism. Four case histories dealing with patients on long-term treatment with a PVP-containing vasopressin preparation are presented and the possibility of a harmful effect of the PVP storage is discussed. The presence of PVP in serum, demonstrated by lipoprotein electrophoresis, is described. Based on the literature and the present findings, a withdrawal of PVP-containing preparations for injectional purposes is advocated.


Single and multiple beam echocardiography in aortic valve endocarditis. Report of three cases. Three patients with aortic valve endocarditis were studied. The single beam M-mode echocardiographic findings comprised the appearance in diastole of a cluster of shaggy echoes at the aortic valve in all three patients. Mitral flutter was seen in two patients and premature closure of the mitral valve in one patient. At multiple beam two-dimensional echocardiography, the echo cluster could in all three patients be seen to move perpendicular to the sound beams, ascending into the aorta in systole and descending in diastole. At valve replacement, vegetations were found that explained the abnormal echo cluster. The multiple beam echocardiography facilitated the interpretation of the single beam findings and increased the confidence therein. By applying the non-invasive modality of echocardiography in these patients with their high risk of embolism, cardiac catheterization may possibly be avoided.


Severity of aortic stenosis assessed by carotid pulse recordings and phonocardiography. The external carotid pulse, the PCG, and the ECG were studied in 26 adult patients with valvular aortic stenosis whose systolic peak pressure gradients ranged from 18 to 165 mmHg. A significant correlation was found between the rapidity of the pulse upstroke, as measured by the T-time, and the location of the peak of the systolic murmur during ventricular ejection, on the one hand, and the gradient, on the other. The left ventricular ejection time (LVET) related directly and the pre-ejection period (PEP) indirectly with the gradient. There was a signficant inverse relationship between the PEP/LVET quotient and the pressure gradient but this quotient did not classify the patients according to the severity of the stenosis as well as the T-time and the location of the peak of murmur. When a combination of the T-time, the PEP/LVET, and the  location of the peak of the murmur was used in each patient, a good discrimination between the patients was achieved. When the pressure gradient was above 50 mmHg, at lease one of the measurements was abnormal and when it exceeded 100 mmHg, at least two measurements were abnormal. The study further showed that it is possible to separate patients with valvular aortic stenosis from those with hypertrophic obstructive cardiomyopathy lidiopathic hypertrophic subaortic stenosis) or mitral insufficiency on the basis of carotid pulse tracings and PCGs.


Electrocardiographic changes in right ventricular infarction. A case report. ST segment elevations in leads CR4R or V4R indicating right ventricular (RV) involvement are sometimes seen in patients with acute inferior transmural infarction. Whether the RV lesion per se or the concomitant infarction of the posterior septum causes this ECG pattern is unknown. We describe a patient with anteroseptal transmural infarction who developed unusually marked ST segment elevations in lead V4R. At autopsy, extensive old fibrotic infarction was found, involving the anterior and lateral RV walls, as well as recent necrosis of the interventricular septum. These findings suggest that the ST segment elevation in V4R in patients with RV infarction may not be caused by the RV necrosis per se but rather by visualization of the posterior septum through the necrotic RV myocardium.


Mycobacterium valentiale sp. nov. A new species of rapidly growing mycobacteria. Five strains of rapidly growing scotochromogenic mycobacteria have been isolated from soil and sputum. This study comprises 101 biological, biochemical and morphological characteristics, as well as the behaviour against the common antituberculous drugs at several concentrations. The organisms are considered to belong to a new species of the genus Mycobacterium bacterium and are named Mycobacterium valentiae sp. nov. They have been deposited in the American Type Culture Collection, Rockville, Md., U.S.A. as 29356 and the Czechoslovak Collection of Microorganisms in the Czechoslovak National Collection of Type Cultures, Institute of Epidemiology and Hygiene Prague, as My 220/77.


Haemophilus paraphrophilus isolated from endocarditis. Isolation and microbiological features of a Haemophilus paraphrophilus strain which caused a subacute bacterial endocarditis are described. The isolate conformed to the first description by ZINNEMANN et al., except that it was sensitive to ampicillin.


Effect of dialysable leukocytes extracts on antibody-dependent cellular cytotoxicity and lymphocyte Fc receptors. Dialysable leukocyte extracts significantly inhibited the antibody-dependent cell-mediated cytotoxicity of normal human peripheral blood lymphocytes in both xenogeneic and allogenic assays. The inhibitory effect was dose-dependent. Fractions of dialysable leukocyte extracts separated on Sephadex G-25 column differed in their capacity to suppress cytotoxicity. Dialysable leukocyte extracts did not block EA-rosetting but inhibited the resynthesis of Fc receptors. Some explanations for the observed suppressive effect are discussed.


Stimulation of phagocytosis by human lymphokines. Supernatants of concanavalin A stimulated human lymphocytes increased the phagocyting and intracellular killing activities of human macrophages and neutrophils tested with particles of Saccharomyces cerevisiae.


Experiments on the chemotheraphy of a transplantable glioblastoma in the rat, employing 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU). A glioblastoma was induced in BD-II rats by weekly i.v. injections of methylnitrosourea and transplanted intracerebrally in numerous passages. The take rate was 100%. For the experiments with CCNU, solid pieces of tumour were implanted into the right parietal region. The cytostatically treated animals lived significantly longer. The untreated tumour rats had an average survival time of 18 days (counted from the time of transplantation), and the rats treated with CCNU had an average survival time of 28 days. The median values were 19 and 28 days.


Chemotherapy of malignant gliomas: comparison of the effect of polychemo- and CCNU-therapy. Postoperative survival times of patients suffering from glioblastoma (astrozytoma III-IV) were compared in unselected groups receiving different forms of therapy: standard surgical therapy (16 cases, mean survival time 6.27 +/- 3.75 months), postoperative polychemotherapy (16 patients, survival time 8.96 +/- 4.97 months) or postoperative CCNU-monotherapy (24 cases, survival time 6.98 +/- 4.46 months). The mean survival time in the group receiving polychemotherapy was prolonged significantly when compared to the group with standard treatment. Survival time of the patient group treated with CCNU was not significantly increased. The results indicate that postoperative combination chemotherapy is more effective than CCNU monotherapy.


Operative indications in glioblastoma.

Operative indications in glioblastoma. General aspects of glioblastomas are considered such as preoperative diagnosis, stereotactic punctures for tissue samples, location and tumour size, interference with CSF circulation. The operative risk and different approaches to treatment are discussed, and the results are compared. The described combined treatment of operative, local cytostatic, and irradiation therapy appears promising, with 22% of patients alive, and a maximum survival time of 51/2 years. Attention is drawn to proper information of the patient and his family regarding the disease and possible outcome.


The liquefaction (oncolysis) of malignant gliomas by a non pathogenic Clostridium. Vascular glioblastomas become liquefied when contaminated with spores of the non-pathogenic Clostridium butyricum M 55. The spores are administered by intracarotid injection. The oncolysis is complete one week after injection. The glioblastoma is converted into a brain abscess which is then operated on appropriately. Forty nine patients have been treated in this manner. The rate of recurrence, however, remained uninfluenced.


Radiological detection of glioblastoma recurrence. Brain scanning is of great value in detecting glioblastomas. Since there is little stress upon the patient by this method it is specially suitable for follow-up after surgical treatment and radiation therapy of this tumour, thus giving the best chance of an early detection of a recurrence. On the other hand angiography is essential if further surgery is necessary. Diagnostic problems may arise when using arteriography in cases of avascular recurrences and lack of space-occupying symptoms due to the following factors: Position and small size of the recurrence, growth into the operation cavity, and postoperative cerebral atrophy. Avascular mass lesions of other origin may mimic a tumour recurrence in the angiogram. Thus, a combined use of isotope studies and radiological investigations is necessary for an unequivocal detection of glioblastoma recurrences.


The brain surrounding malignant gliomas: an ultrastructural study. Brain samples were taken in macroscopically oedematous zones during 21 operations for malignant glioma, and studied with the electron microscope. Oedema was found in 17 cases, mostly as serous extracellular fluid. Vascular changes in the oedema region are mostly as serous extracellular fluid. Vascular changes in the oedema region are mostly secondary to oedema: the origin of oedema fluid ought to be found in the tumour proper. Cellular reaction is slight; neuronal lesions may be ascribed mostly to a perturbation of axonal flow. Oedema round malignant gliomas and oedema round other malignant or benign tumours are morphologically distinct.


Axial transverse computerized tomography in 73 glioblastomas. Among 2,600 patients, examined by computerized tomography, 404 had brain tumours, which were gliomas in 150 cases. There were 73 glioblastomas. Examination was performed according to Ambrose's method using an intravenous injection of 1 ml 60% contrast medium per kg body weight. Thus 98% of all gliomas could be demonstrated. Glioblastomas are shown in three different forms: an annular type (55%), a nodular type (18%), and a combined type (27%). Perifocal oedema is found in 88% of glioblastomas. The oedema most frequently belongs to grade II or III. Differentialdiagnosis of gliomas, abscess, metastases and other tumours with central necrosis are discussed.


Boron-neutron capture therapy in relation to immunotherapy. The essential feature of tumour therapy rests upon host-tumour interaction. To achieve therapeutic effects, a prerequisite to immunotherapy is the reduction of tumour cells in the host's body. Such measures should not be immunosuppressive. Cytotoxic chemotherapy is not appropriate in this regard. Supraradical surgery and non-specific radiotherapy are not desirable for preservation of nervous function, if their immunosuppression is not as severe as cytotoxic substances. Boron-neutron capture therapy is a highly specific and least immunosuppressive means of reducing tumour cells of the central nervous system. A brief introductory review of basic research is presented. The interim clinical results are: (i) Treatment of recurrent glioblastoma: Survival extension obtained by neutron capture therapy is 21.9 +/- 7.2 mos in contrast to that obtained by conventional treatments of 6.7 +/- 0.6 mos (p less than 0.001), (Total survival 26.3 +/- 6.7 mos); and (ii) only three patients including two glioblastoma cases were treated with neutron by the same surgeon who, by performing the first tumour operation, had the advantage in topographic knowledge for determining the radiation field. They survived 4, 5, and 6 years in almost fully active conditions. The new Musashi Institute of Technology Reactor Thermal Neutron Therapy Facility and the increased domestic production of boron-10 isotope have enlarged the therapeutic capacity to two dozen patients a year.


Combined chemotherapy with VM 26 and BCNU for recurrent malignant gliomas after operation and irradiation. The preliminary results of a combined chemotherapy trial with VM 26 and BCNU for recurrent malignant gliomas are presented. Four patients out of seven responded favourably to this treatment. Toxicity was mild and reversible.


Studies on tuberoinfundibular dopamine neurons. All dopaminergic neurons in the central nervous system do not respond to pharmacological and endocrinological manipulations in the same manner. Tuberoinfundibular neurons appear to be regulated, in part, by circulating levels of prolactin. Prolactin increases the activity of these neurons by acting directly within the medial basal hypothalamus, possibly on the tuberoinfundibular neurons.


The preparation and analysis of myelin from small quantities of central nervous tissue: regional studies of the quaking mouse. Myelin of considerable purity may be isolated from small (minimum 1 mg wet weight) samples of central nervous tissue, using a 4-step centrifugation procedure. The separation of myelin proteins by micro-linear gradient polyacrylamide gel electrophoresis yields similar results to those obtained by macro-scale (homogeneous) gel systems. These techniques have been employed for a preliminary study of the regional composition of myelin fractions from the Quaking mouse.


Abnormal myelin maturation in vitro: the role of cerebrosides. Myelinating neonatal rat cerebellar explants were maintained for up to 130 days in vitro. Myelin fractions were extracted from explants of different ages and purified by density gradient centrifugation. Three fractions obtained were termed "light myelin", "heavy myelin" and "membrane fraction" and were deficient in glycolipids compared to myelin fractions prepared from 15-day-old rat cerebellum. The culture myelin has an apparently normal ultrastructure but may not be as stable as myelin with a normal glycolipid composition.


The molecular architecture of myelin: identification of the external surface membrane components. Basic information concerning the molecular organization of the myelin membrane is an intrinsic requirement for understanding the neurochemical events leading to myelination, as well as the potential mechanism of demyelination that might exist at the molecular level for a variety of neurological diseases. The application of chemical, enzymatic, fluorescent, and immunological membrane probes has contributed significantly to this end, although the diverse structural complexity of the myelin sheath has permitted only a rudimentary understanding of its molecular organization. Nevertheless, compelling evidence is accumulating which suggests that components of myelin are asymmetrically distributed in the membrane. Such membrane asymmetry should not only provide important clues to the mechanisms of membrane assembly in the process of myelination, but should also serve as a paradigm for potential functional asymmetry of the individual components at the molecular level. One particularly useful membrane probe is galactose oxidase which has the capacity for identifying surface galactose residues in both glycoproteins and glycolipids on the external surface of the myelin sheath. The identification of these surface components on the myelin sheath is of primary importance since such components might be more readily susceptible to immunological damage or act as a viral receptor which ultimately might lead to demyelination.


Covalent probe investigations with isolated central nerve myelin preparations. The interaction of the covalently reacting probes dansyl chloride, fluorodinitrobenzene and trinitrobenzene sulphonic acid with isolated central nerve myelin sheath preparations has been studied. The three probes interact preferentially with accessible amino groups on lipid and protein in the membrane. With isolated myelin some 13% of the total phosphatidyl ethanolamine is labelled with dansyl chloride while the figure is 66% with fluorodinitro benzene and 47% with trinitrobenzene sulphonic acid. Lower levels of phosphatidyl serine are labelled. Phosphatidyl ethanolamine seems to be more accessible to probes in the myelin sheath than is phosphatidyl serine perhaps because the ethanolamine-containing lipid class is localised partially at the external apposition surfaces of the membrane which are most accessible to the probes. The serine phospholipids may not react so well because they are preferentially distributed at the cytoplasmic surface of the system. Analysis of protein labelling patterns after reaction of intact myelin with dansyl chloride indicates that the high molecular weight proteins and the proteolipid protein is accessible to the probe while the basic protein is not, even though this latter component is readily labelled with dansyl choride in purified form. It is suggested that the inability of the basic protein to react with myelin is perhaps due to the fact that it is occluded from interaction with the probe at the cytoplasmic apposition surfaces of the lamellae.


Lipid and fatty acid composition of human cerebral myelin during development. A development study of major lipid fatty acids in human brain myelin was undertaken and compared to those in cerebral white matter of the same region. The myelin was isolated from 23 subjects at ages from newborn to old age. The proportions of cholesterol and galactolipids increased in myelin during the first 6 months of age and up to 2 years of age in cerebral white matter. During the same periods the individual phospholipids also showed marked variations. Serine phosphoglycerides and especially sphingomyelins increased, and choline phosphoglycerides decreased. The fatty acid patterns of ethanolamine phosphoglycerides (EPG) and sphingomyelins underwent the largest maturation changes. The proportions of saturated fatty acids in EPG diminished rapidly with a corresponding increase of monoenoic acids. Fatty acids of the linoleic acid series showed a peak between 4 months and 12 months of age, and then their proportion slowly diminished to old age. The fatty acid changes in serine phosphoglycerides were much less pronounced than in EPG but of similar type. In sphingomyelin the proportion of saturated long-chain fatty acids diminished while the proportion of monoenoic acids increased--this increase continued at least to the age of 15 years. The same fatty acid changes occurred in cerebrosides and sulfatides as in the sphingomyelins, but they were less pronounced. The fatty acid changes during development were much more pronounced in white matter than in myelin but already from 1-2 years of age the lipids of myelin and white matter had the same patterns--in the galactolipids from 2 months of age. The individual variations of the lipid fatty acid patterns were small except for at the youngest ages and the variations found for this period might depend on the difficulties in determining the gestational age.


The action of trypsin on central and peripheral nerve myelin. In contrast to other studies, our results demonstrate that low concentration of trypsin degrades a high proportion of proteolipid from CNS myelin. The Wolfgram protein and BP are vulnerable and completely lost on trypsinolysis, perhaps accounting for some of the peptides retained by the myelin. In PNS myelin, the major PO protein, a hydrophobic glycoprotein, is readily degraded to a stable 18,000--19,000 molecular weight unit, referred to as TPO protein, still retaining the carbohydrate unit which probably exists as a nonasaccharide grouping. Production of the TPO glycoprotein results from cleavage of a lysinyl-methionine or arginyl-methionine linkage probably found approximately 80--100 residues from the NH2-terminal isoleucine of the PO molecule. This linkage must be especially accessible to trypsin since the TPO protein is also generated in high yield when isolated PO protein is treated with trypsin in solution for 0.5 hours. Further incubation for 24 hours fully degrades the TPO protein to over 20 tryptic peptides, shown by peptide mapping, unlike the situation in myelin where the TPO unit is stable and resists further proteolysis. The TPO unit is also produced when PO protein is treated with BrCN. The PO protein contains 3 methionine residues but presumably the methionine residue in the trypsin-sensitive region is crucial; cleavage leads to the same TPO unit minus NH2-terminal methionine. Another methionine residue also exists in the TPO protein but it may be resistant to BrCN cleavage or else occupy a near-end position. Other proteins were also identified on PAGE of trypsinized PNS myelin: albumin, P2 protein, and PO protein. Albumin and P2 protein were identified in the acidic extract by reaction with specific antibody. The PO protein was isolated; it moved similarly to standard protein on SDS-PAGE and gave the appropriate amino acid analysis. However, it cannot be determined at this time whether a portion of these proteins remains because they are partially inaccessible to trypsin, or else are slightly attacked and thus represent early stages of trypsinolysis. The P2 protein of trypsinized myelin appears to migrate slightly faster than standard P2 protein on PAGE. Further work should clarify this point. Amino acid analysis and sequence data show that the PO protein is particularly hydrophobic, very likely existing in PNS myelin as an amphipathic molecule which penetrates the bilayer but which has a hydrophilic portion exposed. It is this hydrophilic region that contains much lysine, particularly the crucial lysinyl-methionine linkage, that is so trypsin-sensitive. Determination of the amino acid sequence of terminal portions of the isolated PO and TPO proteins serves to firmly establish the PO protein as a unique entity probably exclusive to PNS myelin. It can be concluded that the study of trypsin activity toward PNS myelin has made possible a new understanding of how proteins are positioned in the membrane, and provided valuable insight into the PO protein.


The effect of intoxication with alkylnitrosourea derivatives on cerebral myelin. Adult BD IX rats were injected with methylnitrosourea and pregnant mice on the 15th day of gestation with a single intravenous dose of ethylnitrosourea and pregnant mice on the 15th day of gestation with a single intravenous dose of ethylnitrosourea. The cerebral myelin fraction of adult BD IX rats and of the mice offsprings was studied. It was found that a part of the rats intoxicated with methylnitrosourea developed spongious changes in the cerebral and cerebellar white matter. The myelin fraction of intoxicated rats also showed severe losses of sphingomyelin with a steady increase in the cholesterol ester content. The myelin fraction from mice intoxicated during the foetal development appeared deficient with respect to galactolipids and plasmalogen. It is concluded that, besides the carcinogenic effect, alkylnitrosourea derivatives effectively disturb the lipid metabolism of membrane structures of the central nervous system.


The immune response in human demyelinating diseases. Lymphocytes present in the brain, meninges and cerebrospinal fluid (CSF) in multiple sclerosis (MS) are capable of synthesizing IgG. The CSF in MS contains more T-lymphocytes and fewer B-lymphocytes compared to blood. The reactivity of CSF lymphocytes in MS to T-cell mitogens and probably also to a combined B-and T-cell mitogen is absent or heavily reduced. This unresponsiveness of CSF lymphocytes may be a consequence of their previous activation. The blood lymphocytes in MS are not altered regarding distribution of B-and T-cells, nor regarding responsiveness to mitogens, when compared with healthy controls. An asynchronous synthesis of heavy and light immunoglobulin chains occurs within the CNS in many MS patients, giving rise to oligoclonal band patterns on electrophoresis and abnormal kappa/lambda light chain ratios of CSF. The synthesized immunoglobulins are most probably antibodies which may play a role in the pathogenesis and course of human demyelinating diseases. The brain must be regarded, from an immunological point of view, as a privileged site with its own immune system and its characteristic immune reactions, and future research concerning demyelinating diseases should, if possible, include investigations of these reactions.


Proliferating cells in demyelinating states. Proliferation of mononuclear cells was examined with an autoradiography method in the CSF and peripheral blood of 13 patients with multiple sclerosis (MS), serially during activation of disease in one patient with subacute sclerosis panencephalitis (SSPE), and in some control patients with various neurological conditions. High cerebrospinal fluid (CSF) cell labelling indices, up to 1.7%, which could not be directly related to the clinical activity of the disease, were found in some MS patients. During activation of SSPE there was marked increase in labelled cells of CSF, up to 4.3%. In controls, corresponding CSF indices ranged from less than 0.1% to 0.4%. Mononuclear cells in CSF and peripheral blood behaved as clearly different cell populations.


Metabolic studies of adrenoleukodystrophy. Two series of metabolic studies were prompted by the previous finding that the brain and adrenal tissues of patients with adrenoleukodystrophy, an X-linked genetic disorder, contain unusually long-chain (C22--C32) fatty acids in cholesterol esters and gangliosides. Postmortem brain tissues from three patients were assayed for activities of the three distinct cholesterol ester hydrolases, using [4-14C]cholesterol oleate, lignocerate and cerotate as the substrates. No deficiency of the crude mitochrondrial (pH 4.2), the microsomal (pH 6.0), or the myelin-localized cholesterol ester hydrolases was detected, although the activities of the myelin-localized cholesterol ester hydrolase against cholesteryl lignocerate and cerotate were too low for reliable assays. The activities of the microsomal and myelin-localized hydrolases were actually higher in adrenoleukodystrophy than in controls. Uptake and exclusion by cultured fibroblasts of [1-14C]stearic, [1-14C]lignoceric and [1-14C)cerotic acids were also examined. All fatty acids were avidly taken up by the fibroblasts. Stearic acid was excluded from the cells much more rapidly than lignoceric or cerotic acid. No difference was observed in the uptake and exclusion of fatty acids between the controls and adrenoleukodystrophy, except that cells from some cases of adrenoleukodystrophy consistently took up the very long chain fatty acids at greater rates than the control cells. Neither did the distribution of the label among individual lipids reveal differences between the controls and adrenoleukodystrophy, although there were interesting and dramatic differences in the metabolism of lignoceric acid and cerotic acid. Cerotic acid appeared largely inert with 90--95% remaining intact over eight days, while lignoceric acid was mostly incorporated into complex lipids. This series of studies did not uncover the fundamental genetic defect underlying adrenoleukodystrophy.


Biochemical study on myelin in adrenoleukodystrophy. Two myelin fractions, heavy and light, were isolated from white matter of a patient with adrenoleukodystrophy. Morphologically, heavy myelin fraction showed compact lamellar structures, and light myelin fraction consisted of loose lamellar structures and rod-like clear space. Analytical studies demonstrated that the chemical composition of heavy myelin fraction was almost the same as that of normal myelin and that light myelin fraction consisted mainly of cholesterol. Long chain saturated fatty acids, C25:0 and C26:0, were increased and C24:1 was decreased in sphingoglycolipids of heavy myelin fraction of the patient.


Studies of isolated, maintained oligodendroglia: biochemistry, metabolism, and in vitro myelin synthesis. Oligodendroglia can be isolated in bulk from dissected white matter of lamb or bovine brain. Studies of the composition of the whole cell and of glial subfractions were performed to detect similarities to mature myelin. With care isolated oligodendroglia can now be maintained in culture for three to four days. While in culture the cells elaborate a form of glial myelin which has characteristics of both the intact cell and of mature myelin. Glial myelin reacts with both the antiserum to oligodendroglial surface components and with antiserum to galacto-cerebroside; it increases in amount with time in culture; if various radiolabeled substrates are added to the cells in culture, the glial myelin has both lipids and proteins which are extensively radiolabeled; the glial myelin has both basic protein and 2',3'-cyclic AMPase associated with it. Thus this model system may be an excellent system for studying myelin assembly in vitro.


Regulation of the activity of respiratory muscles during sleep. This review concerns studies on the electrograms of respiratory muscles carried out in unrestrained sleeping cats. The respiratory unit discharges of the diaphragm and intercostal muscles undergo only quantitative changes from quiet wakefulness to synchronized sleep. Intercostal postural activity is also evident whereas such activity is practically absent in diaphragmatic electrograms. During desynchronized sleep the activity, both postural and respiratory, of intercostal muscles is tonically depressed and highly irregular, while diaphragmatic electrograms are scarcely affected, except for random disturbances related to the phasic events of this stage of sleep (rems, muscle twitches). The changes in the activity of intercostal muscles do not depend on modifications of the activity of respiratory centres as phrenic motor neurones are not tonically depressed. Only strong phasic influences of non-respiratory brain stem structures may affect phrenic motor neurones during desynchronized sleep. The depression of intercostal respiratory activity during this stage of sleep rather depends on the tonic inhibitory influences of brain stem structures on spinal motor neurones affecting also intercostal postural activity. The respiratory frequency during desynchronized sleep increases and decreases above eupneic and below polypneic values of synchronized sleep, respectively. Such a phenomenon cannot be related to the tonic brain stem inhibition of spinal motor neurones occurring during desynchronized sleep as it is unlikely that the same influence may elicit two opposite effects. These effects can be better explained on the basis of a release of respiratory centres from higher controls, particularly hypothalamic. In conclusion, the clear dichotomy in respiratory motor innervation between synchronized and desynchronized sleep reveals a basic change in respiratory regulation whose functional significance is still obscure.


[An analysis of the efficiency-stage in pupils suffering from chronic nonspecific lung diseases (CNSLD) (author's transl)]. Investigations were performed into school-certificates of 70 school-children suffering from CNSLD (controllgroup: 360 healthy children). Although the quantity of the days of the absence from school in the CNSLD-group is more than six times higher--most differences between the two groups were not significant, or the results of the sick children were even rather better than those of healthy ones. The eventual causes of this phenomenon are discussed (a good attitude in learning? a systematic promotion of this children at school and in the family? etc.).


[Morbidity analysis and rehabilitation of children and young people exempted from obigatory sports at school (author's transl)]. Stress is laid on the importance of sports instruction in the process of educating the young generation. Illness and injuries have a bad effect and result in exemption from sports lessons at school. The extent of these factors in the district of Weissenfels is shown in analysis and a therapy schedule based on empirical data has been developed for the rehabilitation of children and young people exempted from obigatory sports at school.


[Development of body-height in children from Görlitz (author's transl)]. The growth from birth till to last school-health-examination of 3 annual-sets (1957, 1958 and 1959) in the town of Goerlitz is presented. There are significant differences between the sexes. The growth of girls is more harmonious than that of boys. The growth rate in puberty in girls starts earlier and ends quicker. In boys the same phaenomenon begins later. The period of growth in boys is longer and produces a higher result.


[On the phenomenology of juvenile sexual delinquency and on the phenomenology of juvenile sexual delinquents - child-neuropsychiatric aspects of prevention of deviating sexual behaviour. Juvenile sexual delinquency:introduction to the problems, phenomenology (author's transl)]. The prophylaxis and clearing-up rate of deviating sexual behaviour of adolescents could be favourably influenced, if doctors, teachers and judicial administrators had a better knowledge of the phenomenology of sexual delicts as well as sexual delinquents. 87 expert opinions on juvenile sexual delinquents were analysed under this aspect. In the majority of cases sexual delicts of adolescents reveal a far more extensive disturbance in their individual and social development.


Postural and reflex integration in schizophrenic patients. The relationship among primitive postural reflexes, postural and bilateral integration, and premorbid adjustment were examined in 29 subjects who were divided into 3 groups: normal, chronic process nonparanoid schizophrenic, and chronic paranoid schizophrenic. Significant differences were found between the normal and szhizophrenic groups on the tonic labyrinthine reflex and on five of the six measures of postural and bilateral integration. No significant differences were found between the two schizophrenic groups on any of the test variables. There were significant positive correlations between the tonic labyrinthine reflex, postural and bilateral integration, and premorbid status in the subjects studied.


The effect of concurrent manual activity on the dichotic listening performance of boys with learning disabilities. Three groups of learning-disabled children, defined according to their Wechsler Intelligence Scale for Children (WISC) profiles, and one normal control group, were given both a standard dichotic listening task and a dichotic listening task performed concurrently with a manual tapping task. Learning-disabled children who showed no disparity in their verbal and performance subscale scores on the WISC demonstrated a right ear preference under standard testing and when tapping with the left hand, but not the right, which was nearly the same pattern as that obtained by the control group. Learning-disabled children whose verbal WISC score was at least 15 point lower than their performance demonstrated a right-ear preference only when tapping with their left hand. Finally, learning-disabled children who had high verbal, low performance WISC profiles showed no ear preference under any conditions. These results were interpreted as indicating that these three types of learning-disabled children are differentially lateralized and differentially affected by the facilitory-inhibitory effects of concurrent hemispheric activities.


Sex of a parent and knowledge about cerebral palsy. Parents of cerebral-palsied children who attended a rehabilitation center were asked to complete both a subjective questionnaire and an objective scale to tap their knowledge about cerebral palsy. A 33 percent return was obtained. According to the results from the questionnaire, both parents tended to believe that mothers are more knowledgeable about cerebral palsy. However, an analysis of the results of the scale indicated that a parent's knowledge about the disability and how to treat it is determined or influenced by the sex of the handicapped child. Other information gained suggested that the rehabilitation center therapists are important sources of information about cerebral palsy for most parents, and the parents also suggested ways in which to improve community services to the families of children with cerebral palsy.


Correctional institutions: an overview.

Correctional institutions: an overview. Correctional programs may be viewed as providing treatment or as providing services. These views are based upon various theories of criminal behavior, and influence the approaches and activities to be used within the programs. Programs based upon a treatment approach exhibit many similarities to programs for psychiatric patients. The prison as a total institution bears many resemblances to the long-term psychiatric hospital. These are discussed, together with the validity of treatment approaches and alternative service approaches. A brief historical overview of the prison is also given. Correctional theories and salient points from the literature are examined to identify concepts important for correctional programs, and several implications for occupational therapists in correctional programs are discussed.