Myelopathy presenting as an intrinsic spinal cord tumor. Two patients are presented who became progressively quadriplegic with myelographic appearances suggesting intrinsic spinal cord tumors. In both cases, laminectomy and biopsy of the spinal cord disclosed non-neoplastic conditions (neuromyelitis optica and acute necrotic myelopathy) confirmed at autopsy. Since surgery is not helpful in such cases, the problems of differentiation between such lesions and intraspinal tumors are reviewed.


Delayed impairment of arterial blood oxygenation in patients with severe head injury: preliminary report. A drop in the arterial PO2 occurring 24 hours after head injury was identified in eight patients. Traditional modes of therapy include administration of supplemental oxygen and provision of an unobstructed airway. The latter proved to be inadequate to continually maintain the PaO2 at a level consistent with the O2 content of the inspired air. Initially, determination of the PaO2, after institution of supplemental oxygen, may demonstrate adequate oxygenation, but blood gas monitoring should be continued since a delayed fall in arterial oxygen tension may occur 24 hours after head injury. This period of potentially deficient blood oxygenation, if severe enough, may further aggravate preexisting brain damage and profoundly affect the ultimate outcome of the patient. The delayed fall in PaO2 is the result of intrapulmonary shunting principally due to a ventilation/perfusion mismatch. The precise mechanism of the ventilation/perfusion inequality in the brain-injured patient awaits further elucidation, but may differ from the alteration in pulmonary function seen in the Respiratory Distress Syndrome.


Acute transient rises of intracranial pressure (plateau wave type) seen with a pontine hemorrhage. A case of pontine hemorrhage is presented. Continuous intraventricular pressure recording disclosed frequent acute transient rises of intracranial pressure resembling the plateau waves as described by Lundberg despite a low basic level of intracranial pressure. One possible mechanism of producing the plateau waves is discussed.


Lundberg's B waves as a feature of normal intracranial pressure. Lundberg B waves have been said to be distinctive of low pressure hydrocephalus. A case is presented in which such waves were recorded from an apparently normal brain.


Microvascular perfusion experimental spinal cord injury. Microperfusion of the spinal cords in cats was studied using a colloidal carbon perfusion technique following compression injury at 1/2 hour, 2 hours, 4 hours, 8 hours, 24 hours, and 51 days. Quantitative estimates of vascular filling were determined at these post-compression intervals. Microperfusion diminished in both the gray and white matter at 1/2 hour following injury and severe lack of perfusion was evident at 8 and 24 hours. Diminished filling of the vessels of gray and white matter seemed to parallel the degree of hemorrhagic necrosis of the gray matter. An increased number of vessels were evident in the spinal cords of long term survivals. The observation that microperfusion in the white matter of the spinal cord was diminished at 24 hours is at variance with some previous investigations. The hypoperfusion of the white matter found in this study suggests that ischemia plays a role in paraplegia resulting from experimental compression injury of the spinal cord.


Lysosomal activity in experimental spinal cord trauma: an ultrastructural cytochemical evaluation. The possible role of lysosomal activity in the early post-trauma phase of severe experimental spinal cord trauma was assessed utilizing an acid phosphatase cytochemical ultrastructural study. The results indicate that there is no evidence for lysosomal alteration prior to the development of cellular degeneration or necrosis. No diffuse cytoplasmic staining was observed. This study indicates that physical lysosomal injury resulting in release of hydrolases into spinal cord cells is not a tenable hypothesis as a primary initiating event in the development of spinal cord necrosis following trauma. However, the data are consistent with the general theory that lysosomal activity is important in the secondary degradation of cells following their being altered beyond recovery.


Carotid-cavernous fistula associated with traumatic aneurysm of the internal carotid artery. We report a patient who suffered two traumatic lesions in the same internal carotid artery-a carotid-cavernous fistula and a traumatic aneurysm of the cavernous portion of the internal carotid artery. Both lesions were treated by trapping procedure combined with controlled muscle embolization. The value of intraoperative angiography is emphasized.


Decompression of vertebral artery in cases of cervical spondylosis. In four cases with symptoms of vertebral artery insufficiency, compression of the artery was abolished by removing the adjacent cervical osteoarthritic spurs. However, total relief could be achieved only by incision and resection of the constricting fibrotic ring around the vertebral artery. This periarterial fibrotic tissue appears to play a role in the pathogenesis of symptoms.


Bilateral intracavernous carotid aneurysms: treatment by bilateral carotid ligation. Bilateral carotid ligation was performed successfully in a patient who had bilateral aneurysms of the intracavernous portion of the carotid artery. The left common carotid artery was ligated for treatment of an intracavernous aneurysm. Three years later, as the patient developed signs of a contralateral cavernous sinus aneurysm, the right carotid artery was partially occluded. Except for a slight right ptosis and a limitation of vertical gaze, the neurological signs subsided completely.


Crossed external carotid ligation for giant aneurysms. Giant aneurysms of the carotid artery commonly produce a visual loss as their main or only clinical manifestation. On occasion they do not respond favorably to ligation of the carotid artery in the neck or even to direct surgical attack on the related carotid artery intracranially. In such cases additional ligation of the contralateral external carotid artery should be considered. Such a case is presented and the rational for such treatment discussed.


Malignant change in melanocytomas of the uveal tract. Melanocytomas are pigmented tumors of the uvea and optic nerve head composed of plump polyhedral melanocytes which have been regarded as nevus cells. There are few reports of malignant change in these usually benign lesions. This study documents 16 cases of malignant melanoma of the uvea, eight of which were characterized by the presence of plump polyhedral melanocytes in and around the tumor. The melanocytoma cells were aggregated throughout the tumors and/or at the margins of the lesions; these cells did not appear between the melanoma and the sclera, as has been reported with spindle-type nevus cells. Electron micrographs of these plump melanocytes had the characteristics of common uveal melanocytes, while the tumor cells had features of malignant melanoma cells. The clinician should recognize the potential of melanocytomas for undergoing malignant change and should follow patients who have this lesion with this in mind. Article is followed by comments of Dr. L. E. Zimmerman.


The management of small choroidal melanomas. There are a number of unresolved questions regarding small choroidal melanomas. At what stage in the natural history of these tumors do they develop the capacity to metastasize? What are the effects of various therapeutic modalities on the incidence of metastatic disease? Clinicopathologic studies suggest that patients with small choroidal melanomas (less than 10 mm in diameter and 3 mm in height) have an excellent prognosis. In patients with small choroidal melanomas with clear ocular media and no clinical retinal detachment, it is reasonable to do serial examinations without therapeutic intervention until growth is documented. In patients with small choroidal melanomas in which growth is documented, enucleation or alternate modes of therapy, including photocoagulation or radiation, are reasonable methods of treatment. Only by conducting prospective studies can we obtain a better understanding of the natural history of choroidal melanomas, determine at what stage these small lesions develop a metastatic potential, and evaluate the relative efficacy of various treatment modalities in preventing the development of metastatic disease.


Increasing the range of the keratometer. How can the ophthalmologist perform keratometry on a patient whose corneal curvature exceeds the limits of the keratometer? A technique for extending the range of the keratometer to test such patients, e.g., those suffering from keratoconus or corneal plana, is presented.


Fluorescein angiography of the fundus: a schematic approach to interpretation. Fluorescein angiographic patterns reveal a wide variety of anatomical, pathological and physiological information which, correctly interpreted, contributes to the differential diagnosis of fundus diseases and to the evaluation of appropriate therapeutic approaches. A schema for interpretation of the fluorescein angiogram is presented, following a logical progression from the initial determination of abnormal hypofluorescence of hyperfluorescence to the evaluation of the specific locations and features of the patterns, and their relationships to various disorders.


The relationship of gestational age to vitamin A induced postnatal dysfunction. In an effort to determine the relationship between time of administration and consequent behavioral effects on progeny, a uniform subteratogenic dose of vitamin A (80,000 I.U./KG) was administered to gravid Sprague-Dawley rats during one of five periods of gestation (days 5-7, 8-10, 11-13, 14-16 and 17-19). Offspring were examined for changes in rate of weight gain, locomotor activity and maze learning ability (T-maze with return to nest as reward and multiple T water maze escape). Vitamin A 8-10 animals were hyperactive, vitamin A 11-13 animals acquired T-maze slower than controls and both vitamin A 8-10 and 11-13 acquired water maze slower than controls. Vitamin A 11-13 animals were significnatly lighter than controls and all other vitamin A groups.


Abnormalities induced in cultured rat embryos by hyperthermia. Rat embryos were explanted at nine and one-half days of gestation and cultured for 48 hours in rotating bottles containing rat serum and a gas phase, at temperatures of 38, 40, 40.5 and 41 degrees C. The embryo cultured at 40.5 degrees C were retarded and many of them were abnormal, and at 41 degrees C, all the embryos were malformed and retarded. The most frequent abnormalities occurring at both these temperatures were microcephaly and oedema of the pericardium. Development of the embryos cultured at 40 degrees C was similar to that of the controls at 38 degrees C, and superficially they appeared to be normal. However, measurement of the head dimensions, and separate determinations of head and body protein contents showed that the 40 degrees C embryos were microcephalic.


Hemorrhagic necrosis of the central nervous system of fetal hamsters: litter incidence and age-related pathological changes. The occurrence, anatomic distribution, and character of lesions of spontaneous hemorrhagic necrosis (SHN) are reported in each hamster fetus of two affected litters examined on the fifteenth day of gestation and in selected individuals of other affected litters on the twelfth, thirteenth, and fourteenth days of gestation. The pathologic process seems primarily to affect the capillary vasculature of the central nervous system and shows a predilection for rapidly growing and differentiating regions of the fetal forebrain, thalamus, and brain stem. Lesions demonstrable in members of affected litters of susceptible stocks are of a progressive character, increasing both in severity and topographic extend with increasing fetal age and growth. Spontaneous patterns of regression and recurrence of SHN disease in susceptible stocks may reflect variable physiologic factors in the intrauterine environment.


Relationship of dietary zinc to 6-mercaptopurine teratogenesis and DNA metabolism in the rat. The possible interaction between the level of maternal dietary zinc and the teratogenic activity of 6-mercaptopurine was investigated. Pregnant Sprague-Dawley rats were fed diets containing 9,100 or 1,000 ppm zinc from day zero of pregnancy and were given a single intraperitoneal injection of 6-MP (55mg/kg) on day 11. At term, females in the group fed 1,000 ppm zinc (a high intake) showed less pronounced effects on reproduction and embryogenesis than did those fed 9 ppm (marginally deficient)  or 100 ppm (normal) zinc. Embryos examined on day 12 of gestation had similar concentrations of protein and RNA; however, the DNA content was lower and the incorporation of 3H-thymidine was greater in the drug treated groups than in non-drug treated controls. These results indicate that 6-mercaptopurine is acting to alter embryonic DNA metabolism and that high levesl of dietary zinc may ameliorate some of the deleterious effects of this drug on embryonic and maternal toxicity.


Attenuating effect of zinc on abnormal placental morphology in 6-mercaptopurine treated rats. Pregnant Sprague-Dawley rats were fed diets containing 9 (marginal level), 100 (control level), or 1,000 (very high level) ppm zinc and were given a single intraperitoneal injection of 6-mercaptopurine (6-MP, 55 mg/kg) or an equivalent volume of carboxymethylcellulose on day 11 of gestation. Live young and their placentas were recovered at surgery on day 21 of gestation: they were weighed, measured, and placentas were examined histologically. Placentas from drug treated animals were smaller in diameter and lighter in weight than controls; however, the placentas of animals fed the 1,000 ppm zinc diet were significantly heavier than those of the other drug-treated groups. Histologically, the placentas of the 6-MP treated dams showed a highly disproportionate reduction in the labyrinthine layer with larger, less subdivided maternal sinuses than in controls, reduction of fetal vasculature, vesiculation of trophoblast nuclei, deposition of PAS positive material in the septal wall, and fibrinous degeneration of trophoblast cells. These morphological changes were reduced in placental tissues of drug treated rats given 1,000 ppm of zinc. In contrast, no placental abnormalities were observed in rats not treated with 6-MP.


Congenital deformities produced in hamsters by potato sprouts. Dried gound potato sprout preparations from seven varieties produced congenital deformities in one strain of hamsters. Incidence of affected litters varied from 8 to 25%, depending on potato variety. Certain steroidal solanum and veratrum alkaloids produced similar defects. Neither peel nor tuber material was teratogenic from one of the potato varieties with highly teratogenic sprouts.


Cholinomimetic teratogens. VI. The interaction of cholinomimetic teratogens with the antimalarial drugs chloroquine and chlorguanide. A typical syndrome of short and crooked neck together with muscular hytoplasia of the legs occurs with low incidence in chicken embryos following injection into the egg at 24 hours of incubation of the antimalarial drug chloroquine; but treatment at later stages does not have similar effects. When, however chloroquine was used in addition to carbachol or neostigmine at 96 hours of incubation the malformations caused by the two cholinomimetic compounds, i.e., carbachol and neostigmine, occurred with greatly increased frequency and tended also to be exaggerated in expression. Chlorguanide, another antimalarial drug, when used as additive, reduced the teratogenic effects of such compounds as decamethonium and neostigmine. It appears that the neuromuscular pathways to teratogenicity are for carbachol and neostigmine and for chloroquine clearly related, if at different levels of expressivity.


The induction of axial blisters in the chick embryo by trypan blue. The hemorrhage, blister formation, and rumplessness observed in the chick embryo following treatment with trypan blue may be due to (1) increased ventricular blood pressure or (2) to necrosis and edema in the caudal region of the embryo by inhibiting nutrient utilization. To test the role of increased ventricular blood pressure in the induction of caudal blisters, primitive streak to 7-somite chick embryos were cut in half, separating the upper presumptive heart region from the lower presumptive trunk and tail regions. Each half was then explanted on media containing trypan blue for 24 hours. In intact embryos treated with 0.04 mM trypan blue the frequency of blisters in the posterior region was 80.8%. The blisters usually appeared on both sides of the neural tube, below or in the region of the last few somites. In transected embryos treated with trypan blue, the frequency of blisters in the posterior halves which had beating hearts was 2.6%. However, the frequency of blisters in the posterior halves which were not connected to beating hearts was 47.8%. In some cases the blisters were found in posterior halves in which the rump was not well developed or present at all. Thus, we may conclude that: (1) direct connection between the heart and the rump is not necessary for the induction of caudal blisters. (2) The presence of a well-differentiated rump is also not necessary for blister formation. We suggest that trypan blue acts directly on organs or structures found in the caudal region of the chick embryos.


A study of chloramphenicol distribution and residues in dairy cows. Distribution and residues of chloramphenicol were examined in 29 normal and 15 emergency-slaughtered dairy cows after parenteral injection of 3 chloramphenicol base formulations, using microbiological and chemical assay procedures. Five qualitative test methods for antibiotic residues failed to detect the presence of the drug even in samples collected within 18 hours of treatment at a dose level of 37 mg/kg, and in emergency-slaughtered cows known to have been treated with chloramphenicol before slaughter. The limited usefulness of these methods for the detection of chloramphenicol residues is stressed by observations indicating the presence of chemically measurable concentrations of the drugs (or its metabolites) in the muscle, kidney, liver, bile, and urine 65 hours after treatment. Quantitative microbiological assay procedures for chloramphenicol (sensitivity limits 1.0 microgram/ml tissue fluid) conducted on specimens of kidney and liver samples of cows treated with chloramphenicol (doses approximately 10 to 40 mg/kg intramuscularly) 1/2 ; 1; 3 1/2; 12; 18; 46; and 65 hours earlier were all negative. However, chemical assay procedures (sensitivity limits 0.2 to 3 microgram/ml or mu/g tissue) for chloramphenicol and some of its metabolites detected the drug in these samples as well as in the meat. Chloramphenicol is apparently extensively metabolized in adult bovines. The extended persistence of "chloramphenicol" residues in the carcass is due to the relatively slow elimination rate of the metabolized drug and the poor and slow absorption rate from the intramuscular injection site after treatment, with preparations containing chloramphenicol base dissolved in organic solvents. Examples are given of the predicting of of pre-slaughter carcass withdrawal times on the basis of arbitrary drug tolerance or detection levels.


ECG changes in dogs with hypothyroidism. The results of electrocardiogram (ECG) recordings in 19 dogs with primary hypothyroidism are presented. Low voltage and inverted T waves were the most frequently observed abnormalities. In a number of dogs the ECG changes contributed to the diagnosis of hypothyroidism. A  few dogs had even been referred to the cardiopulmonary service because of decreased exercise tolerance and the ECG pointed to the need for thyroid function studies.


Esophageal hiatal hernia. Case report of a dog and a cheetah. Case reports of a paraesophageal hiatal hernia in a French bulldog and an invagination of the stomach into the esophagus in a cheetah are presented. In both cases there was an enlarged hiatus and in the cheetah the hiatus was clearly bounded by a muscular loop. Treatment consisted of surgical narrowing of the hiatus. The pathophysiology of hiatal hernia is discussed with reference to experimental studies in dogs.


Effect of storage time on the fertility of bull semen frozen in straws. Fertility rates were analysed of more than 190000 first inseminations with frozen semen stored for up to six years in liquid nitrogen. Semen was used of 158 different bulls and frozen in 0.25 ml French straws. Fertility rates ranged from 69.1 to 75.9% non-return after 56 days. An influence of the storage time on the fertility could not be demonstrated.


[The xero-arteriography--methods, results, indications (author's transl)]. The simple method of transarterial Xero-Arteriography and its indications are described. This investigation provides useful information in angiography of the extremities. The main advantages are: small risk, investigation of ambulatory and bedridden patients.


[Experience with transvenous xeroarteriography in vascular surgery (author's transl)]. The edge contrast pattern in Xeroradiography allows blood vessels to be delineated with highly reduced concentration of radiopaque fluid. The contrast material is injected rapidly into a cubital vein. The brachial arteries are opacified 3--8 sec. and the femoral arteries about 7--15 sec. after the injection is finished. The arteriograms are of good quality which equals direct conventional angiography, if the vessels are not overlayed by bone structures. Thus the popliteal artery can be judged best in lateral view. The indications for transvenous Xeroarteriography are preoperative diagnosis especially in high risk patients, angiographic diagnosis of soft tissue tumors and postoperative control and documentation of vascular reconstruction in the extremities. Transvenous Xeroarteriography is a really noninvasive, painless and easy to handle method whiich allows visualization of peripheral vascular lesions and can be reproduced at short intervals without any risk.


[Operative treatment of arterial occlusive disease: the risk of operation in high age patients (author's transl)]. Comparative study of 2,168 revascularizations and 221 limb amputations at the surgical hospital of Fürth/Bavaria (1970--1977). The lethality rate after arterial reconstructions in older patients, depending on the type of revascularization, was 3.3 per cent up to 21.1 per cent, being considerably lower than after amputation after which 42.5 per cent of the patients died. Therefore vascular surgery should be considered at an early stage of the disease in older patients with problems of circulation, particularly before any limb amputation.


[The venous thrombectomy (author's transl)]. Between 1973 and 1977 we performed 106 venous thrombectomies. 100 of these cases showed occlusion in the ilio-femoral area and 6 in the axillary area. The postoperative mortality was 2 per cent in pelvic thrombosis and 0 per cent in the Paget-von-Schroetter-Syndrome. Fatal pulmonary embolism did not occur. Seventy per cent of patients were free of complaints 6 months postoperatively. Best results were achieved by early operation. The Paget-von-Schroetter-Syndrome is frequently caused by a thoracic outlet syndrome. Therefore, the first rib has to be removed during the second operation in order to prevent recurrence.


[Surgical treatment of therapy resistant ulcus cruris (author's transl)]. 30 patients with chronic venous ulcerations of the lower leg, unable to be cured definitely by commonly known medical, local or surgical therapy are reported. All patients were submitted to the little known ulcer circumcision published by Nussbaum in 1873. During a postoperative period of up to 10 years there was no recurrence of ulcers in any case. The operation is simple and time saving. Requiring an average hospital stay of 24 days, thus saves expenses as well. The procedure is described and the clinical results obtained have been documented.


[Early and late results in the prevention of pulmonary embolism and caval patency after implantation of caval clips according to Adams--De Weese as compared to Mobin-Uddin umbrella filters (author's transl)]. A collective of 56 female and 54 male patients between 15 and 78 years were operated to prevent pulmonary embolism. 27 umbrella filters and 83 vena cava clips were implanted. Postoperative mortality was 15 per cent after umbrella filter implantation as compared to 0 per cent after clip application. 35 clip and 9 filter implantations were followed up by cavographic examination. Venograms were classified in three types according to caval patency. A significantly higher number of complications were observed after filter implantation. On the basis of a flow physics hypothesis an explanation is suggested for the liability to caval thrombosis after filter implantation. An evaluation of both operative methods and their indications is given.


[Revitalization of bovine xenograft used for repair of experimental tracheal defects (author's transl)]. In 12 mongrel dogs tracheal defects of different size were covered by bovine xenografts. The grafts were subjected to electronmicroscopic examination 2 to 19 months after implantation. Following the ingrowht of fibroblasts and capillaries a basal membrane is formed on the side of the previous graft lumen. After 4 to 5 months this membrane is covered from the tracheal margins by microvillous cells. After 8 months ciliated epithelia and goblet cells are developed by cell metaplasia. Although the graft becomes revitalized and integrated into the tracheal wall, the layer of ciliated epithelia is interrupted by less differentiated cells. The possible causes for this phenomenon are discussed. Thus bovine xenograft used for the repair of tracheal defects has the following advantages: total revitalization, no shrinkage, less prone to infection and formations of ciliated epithelia.


[Revitalization of bovine xenografts used for experimental arterial replacement in dogs (author's transl)]. In 16 mongrel dogs bovine xenografts of 4 to 12 cm of length were used for arterial replacement. The grafts were removed after 30 minutes and up to 13 months for electronmicroscopic examination. The graft was shown to be significantly thrombogenic during the first six weeks after implantation. After 8 to 10 weeks an increasing revitalization of the graft is found starting from the ends of the canine artery. A cover of endothelial cells is formed in the graft lumen. The graft wall is enforced by formation of collagen and elastic fibers originating from capillaries and fibroblasts. Revitalization of the graft is limited to a rim of 2 to 3,5 cm next to the anastomoses with the canine artery. The remaining graft segment shows revitalization only on the outside wall. Degenerative changes take place in the inner layer of the graft with time passing.


[Comparative study of coronary vessel diameters in intravital and postmortal angiograms (author's transl)]. In a total of 21 mongrel dogs a comparison between intravital and postmortal coronary arteriograms was made so as to establish the difference in vessel diameter. Fresh postmortal hearts injected in situ showed an average increase in coronary vessel diameter of approx. 6 per cent. Examinations of 24 hour postmortal hearts which were removed from the animals showed a vessel diameter increase of barely 20 per cent in the mean. These 20 per cent correspond fairly well with literature information about the maximal widening of coronary vessels with nitroglycerin. Nerves which are still functioning, and humoral substances which may influence the still living muscle in vessel walls are supposed to be the reason for the smaller increase in fresh postmortal in situ illustrated coronary arteries. It must be stressed, that the measured differences between intravital and postmortal coronary artery diameters can only be representative of wall sections free of arterioslcerosis.


[Myocardial damage in coronary air embolism (author's transl)]. Haemodynamic changes after intracoronary air embolism (0,02 ml/kg air in the left coronary artery) were studied in 16 dogs. The air was introduced in 8 animals during cardiopulmonary bypass and in 8 animals without bypass. In both groups the air embolization caused acute ischemia with myocardial necrosis. Immediately after the injection the anterior wall became akinetic; 24 hours after injection CPK increased to more than 800 U. One half of the animals without cardiopulmonary bypass died during acute ischemia due to refractory arrhythmias; there was no mortality in the group with cardiopulmonary bypass. The left ventricular damage due to air embolization cannot be significantly reduced with cardiopulmonary bypass; the bypass only helps to "tide over" the animal during the period of acute ischemia.


[Myocardial stress of different surgically induced types of cardiac arrest in dogs evaluated by myocardial potassium and acid-base balance (author's transl)]. In mongrel dogs myocardial stress of the following types of artificial cardiac arrest in moderate hypothermia and cardiopulmonary bypass was compared: 1. Ischemic arrest after aortic occlusion lasting 30 or 45 minutes. 2. Injection-cardioplegia according to Kirsch lasting 90 minutes. 3. infusion-cardioplegia according to Bretschneider lasting 90 minutes. The following parameters were compared: extracellular potassium activity ([K+]e) during cardiac arrest and [K+] in arterial and coronary venous blood during reflow, total [K+] and acid-base balance during reflow, time course of [K+] and lactic acid release and uptake during reflow after cardiac arrest. In our experimental conditions the lowest alterations of myocardial [K+] and acid-base balance were observed after infusion-cardioplegia according to Bretschneider. Injection-cardioplegia according to Kirsch was less protective for the heart as evidenced by more intensive acidosis, enlarged [K+] loss and prolongation of [K+] uptake during reflow. Ischemic cardiac arrest in moderate hypothermia was the worst type of artificial standstill indicated by development of fatal myocardial acidosis.


[Myocardial contractility in different methods of Cardioplegia. An experimental study (author's transl)]. In 22 mongrel dogs the protective effect on the myocardium of Bretschneider- and Kirsch-Cardioplegia (90 minutes of cardiac arrest) was studied and compared with ischemic arrest (45 minutes at hypothermia of 30 degrees C). Myocardial contractility was evaluated by the following indices of contractility: t--dp/dt max., Krayenbühl-Index of contractility and max. Vce. Depression of contractility of 40 % was observed after ischemic arrest and Kirsch-Cardioplegia, whereas in Bretschneider-Cardioplegia depression was only 7 %. Forty-five minutes after reperfusion contractility had returned to normal in the last group. It is concluded that Bretschneider-Cardioplegia results in little reduction of postischemic contractility, and has a good protective effect on the myocardium.


[Artificial cardiac valve with curved disc (author's transl)]. Because of insufficient opening of Björk-Shiley- and Lillehei-Kaster-prostheses in vitro and in vivo a new pendulum valve is proposed. The skeleton line of the disc crossection is bent towards the main flow direction when the valve is closed. Thus during valve opening the blood stream is directed to the opposite of the opening direction as to add torque to the disc which enables complete valve opening. During flow observations in an open water table with eight different curved discs an increase of the opening angle with which the torque disappears could be measured with increasing curve of the disc. The pressure loss of the valve is smaller in comparison to the pressure loss of pendulum valves with plane or contrarily curved discs. Furthermore the curvature decreases the backflow volume during valve closure.


[Left ventricular dynamics with exercise after revascularization in advanced coronary heart disease (author's transl)]. 66 patients with 2 and 3 vessel coronary heart disease were studied before and after complete successful revascularization. Hemodynamic measurements and biplane left ventricular angiograms were obtained at rest and during supine bicycle exercise.--After operation a significant overall decrease of LVEDP with exercise was seen; exercise LVEF increased in cases with left main disease and in most cases with double vessel disease and double bypass. Inconsistant response was present in 3 vessel disease. Improvement of left ventricular dynamics with exercise in advanced coronary disease after complete revascularization can be expected mainly in 2 vessel disease and left main coronary disease.


Species-specific aggregation factor in sponges. XIII. Entire and core structure of the large circular proteid particle from Geodia cydonium. High-molecular weight particles have been isolated from the sponge Geodica cydonium. In the "native" from these particles consist of a spherical center and have 25-30 filaments attached to it. The core structure of the particles is assembled of a central circle and 25 radially-arranged filaments. The core structure is obtained from the entire structure by incubation in a medium, containing a non-ionic detergent and EDTA. The molecular weight of the enitre structure was in the range of 1.4 X 10(9) daltons or more and of the core structure 6.1 x 10(8) daltons. Two functional proteins are released from the "native" particles: the aggregation factor and the sialytransferase.


Freeze-etch localization and distribution of concanavalin A in normal and irreversibly sickled erythrocytes. Normal red blood cells and irreversibly sickled red cells (ISCs) were incubated in Concanavalin A (Con A) prior to freeze-etching. The Con A molecules could be visualized on the cells without conjugating the Con A to a larger molecule. No differences in the number or distribution of the Con A binding sites were observed between normal red cells and ISCs. Moreover, the number and distribution of the intramembranous particles (IMP) present on the fracture face of the cytoplasmic membrane leaflet were the same in normal cells and ISCs. Thus, the membrane differences that do exist between normal red cells and ISCs in terms of cell shape and adhesiveness are not reflected in Con A binding or IMP number and distribution.


Ultrastructure of lineus ruber (Rhyncocoela) epidermis. Recent evidence indicates that nemertean epidermis is capable of absorbing certain organic solutes from sea water via mediated transport mechanisms, as well as secreting mucoid substances. Morphological studies suggest that these functions may be restricted to distinct epidermal cell populations. Mucous secretion at the free surface of the epidermis is the result of synthesis and release activites of cells in both the epidermis and dermis (cutis). Secretion of dermal origin passes through the epidermis to the worm's exterior in slender cytoplasmic process (process (canaux d'evacuation) in the form of membrane bound vesicles. A single gland cell type, located entirely within the epidermis, releases externally a granular product histochemically identified as largely protein plus some amount of carbohydrate with low periodic acid-Schiff's reactivity. The close juxtaposition of granular endoplasmic reticulum and Golgi apparati to the secretory material is consistent with the composition of this secretory product. Interstitial cells possess microvilli projecting from their apical surface, in addition to cilia. The outer surface of the plasmalemma covering these ciliary projectons is unadorned, but microvilli possess a fuzzy coat. At the peripheral ends of the microvilli, the coat is filamentous, while at their base the coat consist of foliate structures. Cationic colloidal iron binding suggest that the filamentous portion of the fuzzy coat contains the greatest proportion of the acidic surface charge. The presence of periodic acid-Schiff's positive material in this region suggests that the fuzzy coat also contains carbohydrate. Lateral boundaries of the interstitial cell lacks obvious junctional specializations; however, the apical 150 nm intracellular space narrows to 40 nm and continues in a tortuous interdigitating path to the base of the adjacent interstitial cells. Where the apex of these cells is broad, the interdigitations are shallow, but the basal half of the interstitial cells have deep complex infoldings. Cytoplasmic organelles other than the nucleus, mitochondria and some granular endoplasmic reticulum, are restricted to the apical half of the cytoplasm. The presence of closely apposed Golgi complexes and smooth endoplasmic reticulum, multivesicular bodies, lysosome-like dense vesicles and coated vesicles suggests that these cells may play a role in intracellular digestion of phagocytized particulate matter from the external environment. The amplification of the interstitial cell's free surface suggests that these cells are primarily responsible for mediated solute transport across the epidermis.


Comparative ultrastructure of juvenile and adult nuchal organs of an annelid (Polychaeta: Opheliidae). Opheliid nuchal organs are composed of ciliated cells, retractor muscles, and sensory cells. The perikarya of sensory cells are located in the posterior portion of the brain, and their distal processes extend along the body wall, as the nuchal nerve, and terminate just anterior to the ciliated region. The nuchal nerve of the juvenile is composed of 30-35 dendrites; the adult nuchal nerve has 35-40 dendrites. The ends of the sensory dendrites form sensory bulbs which are clustered around the olfactory chamber, and each bulb bears a modified cilium. Sensory cilia lose their axonemes and extend as microvillous-like structures into the olfactory chamber. Supportive cells delineate approximately the posterior and dorsal portions of the chamber with sensory bulbs forming the remaining ventral and anterior portions. On the lateral aspect of the chamber, cuticular matrix. The adult nuchal organ is larger than that of the juvenile, and the sensory portion of the olfactory chamber wall is expanded. Expansion of the sensory area is apparently the result of size increase in sensory bulbs and by intrusion of supportive cells between sensory bulbs.


The parathyroid gland of the woodchuck (Marmota monax): a study of seasonal variations in the chief cells. The ultrastructure of the parathyroid chief cell in the woodchuck, Marmota monax, was studied during the four seasons of the year. Spring chief cells have stacks of granular endoplasmic reticulum, prominent multiple Golgi zones and many clumped mitochondria. Summer cells resemble those seen in the spring but the mitochondria are associated with stacks of granular endoplasmic reticulum. Multiple areas of stacked granular endoplasmic reticulum characterize the fall chief cells. Their Golgi zones are large and are associated with many dense core secretory granules. Lipoid vacuoles are frequently noted. Winter chief cells have secretory granules and phagolysosomes (dense bodies). Some of these cells contain stacked arrays of granular endoplasmic reticulum associated with mitochondria, others have only short segments. The above morphological findings are discussed in relation to those in other hibernators, the parafollicular (C) cell, and to the cyclic seasonal activities of the woodchuck.


Anatomical and ultrastructural study of the pharyngeal bulb in  Protodrilus (Polychaeta, Archiannelida). I. Muscles and myo-epithelial junctions. The pharyngeal bulb of Protodrilus is both a muscular and an epithelial organ whose function is the drawing up of food particles. The muscular system of the bulb is formed of tightly connected antagonistic muscles: the bulbus muscle and the sagittal and  "grating plate" muscles. All of them are composed of obliquely striated fibers whose ultrastructural characteristics are similar to those of Hirudina and even more to those of epitokous forms of Nereidae and Syllinadae. Myo-epithelial cells do not exist in the pharyngeal bulb of Protodrilus contrary to what was previously thought; the muscles and the stomodeal epithelium are united by junction areas on both sides of the basal lamina. These myo-epithelial junctions may be compared of the myoepidermic junctions known in several Arthropods. A comparison of the ultrastructural features of the bulbus muscle fibers of Protodrillus (Protodrilidae) and Trilobodrilus (Dinophilidae) shows that the Protodrilus fiber clearly belongs to the obliquely striated type classically found in Polychaeta, while the Trilobodrilus fiber is a very peculiar type of obliquely striated fiber. These differences do not agree with Jägerstens hypothesis on the unity of the Archiannelida established on the basis of a structural similarity of the bulbus muscles.


Anatomical and ultrastructural study of the pharyngeal bulb in Protodrilus (Polychaeta, Archiannelida) II. The stomodeal and its cuticle. The epidermal and stomodeal cuticles of Protodrilus are described then compared. The thin epidermal cuticle, the thickness of which is about the same over all the body, is characterized  both by the absence of fibrils in its deepest part and by the extension of epidermal microvilli above the cuticle. The stomodeal cuticle, the thickness of which is as variable as that of the epithelium, presents two layers of fibrils comparable to the collagen fibrils described in the cuticle of other Annelida, as well as a relatively diversified supramicrovillous coating. The anterior cuticular thickening or grating plate, is characterized by the length of the epithelial microvilli, the thickness of the cuticular matrix and the superficial cuticular zone with supramicrovillous denticles supported by an axis of fibrous bundles. In the stomodeal cuticle, the fibrillar material seems to give to the cuticle best resistance to deformation during the pharyngeal bulb contraction, while an especially elaborated supramicrovillous coating is found in regions most exposed to friction. These features contrast with the relative simplicity of the epidermal cuticle.


The kidney of the prussian carp, Carassius auratus gibelio (Cyprinidae). III. Glycogen-rich cells in the distal segment of nephronic tubule. Glycogen may be present in considerable amount in the distal segment of the nephronic tubule of a teleost freshwater fish, as revealed by light- and electron-microscopical observation. Adaptation of Crassiss auratus gibelio to increased salinity causes alterations of the cell fine structure (e.g. mitochondria and baso-lateral infoldings) but apparently does not influence deposition of glycogen. However glycogen storage is directly controlled by environmental temperature and may be part of an annual rhythm in carbohydrate metabolism.


Fine structure of tight junctions between rat choroidal cells after osmotic opening induced by urea and sucrose. After ventriculo-cisternal perfusion of hypertonic urea or sucrose, both the choroid plexus permeability to horseradish peroxidase and the structure of tight junctions between choroidal cells are modified. Intercellular spaces are swollen, continuous ridges are fragmented and intrajunctional spaces are invested by many membranous particles. These morphological alterations appear to be reversible. These ultrastructural data are related to an osmotic maladjustment induced by the introduction of hypertonic solutions into the cerebro-spinal fluid.


Early origins of definitive erythroid cells in the chick embryo. The early maturation stages of definitive erythroid cells are observed in the embryonic circulation of the chick yolk sac at 4.5--5 days of incubation. Light and electron microscope observation of the mesoderm of the yold sac membrane indicate that individual presumptive precursors of the definitive-line are present as early as 2 days of incubation and give rise to sequestered populations of immature erythroblasts within sinusoids during the period of 2.5-6 days incubation. Such isolated populations of definitive-line erythroblasts eventually connect with the established capillary circulation of yolk sac membrane but a large proportion of the erythroblasts temporarily remain associated with the endothelium prior to free circulation.


Fine structure of the tegumentary glands secreting the protective "shield" in a sessile insect (Homoptera, Diaspiddae). The tegumentary pygidial glands of Aonidiella aurantii (Homoptera, Diaspididae) produce a secretion forming the shield of these fixed parasites of plants. They are formed of seven cells: a principal unpaired secretory cell which produces an abundant glycoproteinaceous secretion; a small associated cell with a secondary reservoir for this secretion; two accessory secretory cells which have very abundant tubular extensions coming from the plasma membrane, and a flocculent secretion gathered in a large sub-cuticular space; two cells forming an enlarged part of the excretory canal, functioning like a spinneret; and finally a single cell forming the tubular duct of this complex gland. The cuticle of the secretory cells has a very special porous structure, through which the secretion passes. The final product is a ribbon formed by two hollow strands stuck together. The exact nature of this secretion is not clear. It is comparable to a silk secretion though it has its own particular characteristics.


Diagnosis and surgical treatment of "angiographically absent pulmonary artery syndrome". Among the heart diseases, there are some cases in which pulmonary arteries cannot be visualized by standard right ventriculography and aortography. We have categorized such a case as "angiographically absent pulmonary artery syndrome", which may include congenital or acquired absent pulmonary artery, and anatomically present but non-visualized pulmonary artery. It has been extremely difficult to achieve an accurate diagnosis in such cases and there has been no report of successful surgical treatment for them. Recently, we developed a method of retrograde pulmonary arteriography, with which the pulmonary artery can be successfully visualized in cases of angiographically absent pulmonary artery. Subsequently, re-establishment of the blood flow to the non-visualized pulmonary artery has been successfully performed in 7 of 8 cases of this syndrome. --angiographically absent pulmonary artery syndrome; retrograde pulmonary arteriography; surgical repair.


Prenatal diagnosis and fetal pathology of Niemann-Pick disease. Prenatal diagnosis was successfully accomplished by determining sphingomyelinase activity in the cultured amniotic fluid cells in a case of high risk pregnancy for Niemann-Pick disease (NPD), type A. No detectable activity of sphingomyelinase was found in the cultured amniotic fluid cells obtained at the 17th week of gestation. Patient's pregnancy was terminated and the aborted fetus was proved to be affected with NPD. The liver, brain and skin fibroblasts from the aborted fetus revealed a markedly diminished activity of sphingomyelinase. Sphingomyelin content in the liver of the affected fetus was found to be increased approximately sevenfold as compared with that in a control fetus liver. On the other hand, there was no increase of sphingomyelin in the brain from the affected fetus. No significant increase in cholesterol content was found in the liver and brain from the affected fetus. Electron-microscopic findings revealed membranous cytoplasmic bodies and electron dense material with vacuoles in cytoplasm of the liver cell and a number of Zebra body-like inclusions in the cerebral vessel wall. Biochemical and histological findings of the NPD fetus indicate that there is the progress of the disorder already in the midtrimester of gestation.


Experimental study on the segmental innervation of the spinal cord to the visceral organs. To clarify the segmental innervation of the spinal cord to the visceral organs, selective section of the individual spinal nerve root of the dog in different spinal segment was performed, and the distribution of distal degeneration of myelinated nerve fibers in the sympathetic trunk and in peripheral nerves was observed. From the results obtained, much wide-spread innervation of each spinal segment to the visceral organs was revealed, and an efferent system in the dorsal root of the spinal nerve was confirmed to be related to the visceral organ. Furthermore, widely extended innervation of the vagus nerve to the visceral organ was clarified.


Isolated, blood-perfused canine arteries: different vasoconstrictor responses of internal and external carotid arteries to 5-hydroxytryptamine. Canine carotid arteries were isolated, suspended in a bath and perfused under a constant flow rate with arterial blood led from a support dog. Resting perfusion pressure was set at a constant level over 50 mm Hg. Drugs were administered into the endothelial side of the artery through a cannulated tubing and the response was obtained as pressure changes. This preparation was proved to be superior to usual isolated arterial strips, since its reactivity was kept in a stable condition over 5-10 hours at 37 degrees C. Using this preparation, effects of 5-hydroxytryptamine (5-HT) on the internal and external carotid arteries were investigated in comparison with effects of norepinephrine. In the internal carotid artery, 5-HT caused a much more potent vasoconstriction than norepinephrine. On the other hand, in the external carotid artery, 5-HT caused only slight vasoconstriction, while norepinephrine produced a marked vasoconstriction.


Vasomotor waves during cardiopulmonary bypass. Vasomotor waves (VMW) were observed in nine cardiac patients during cardiopulmonary bypass. The period and amplitude of the waves were described together with their consistency and other pertinent data. Effects of several pharmacologic agents on these waves were tested. These VMW are likely to be caused by spontaneous oscillation of presso-regulatory feedback systems. Cerebral ischemic response is suspected to be the most likely candidate. However, no patients showed any gross neurological symptoms in the postoperative period.


Diagnosis of persistent truncus arteriosus by two-dimensional echocardiography: a case study. Two-dimensional echocardiography of a patient revealed overriding of the large aortic trunk which bifurcated above the semilunar valve, suggesting persistent truncus arterious. This diagnosis was confirmed by cardiac catheterization and angiocardiography. Surgery and autopsy also confirmed the accuracy of the two dimensional echocardiographic findings. Two-dimensional echocardiography is thus valuable in diagnosing persistent truncus arteriosus.


Neuromuscular blocking property of amikacin in man. The effect of amikacin on the neuromuscular junction was studied in man during anesthesia and surgery. Amikacin alone did not show any neuromuscular blocking action in normal man in therapeutic doses (100-200 mg). However, during recovery from either d-tubocurarine block or phase II block with succinylcholine, the intravenous administration of 200 mg of amikacin caused a decrease in twitch tension. This neuromuscular block aggravated by amikacin was antagonized by edrophonium (10 mg) or calcium chloride (400 mg). Data obtained from the peroneal nerve-anterior tibial muscle preparation of rabbits suggested that the neuromuscular blocking potency of amikacin was one-twelfth of that of kanamycin in therapeutic doses. Although amikacin is thus less potent than kanamycin, caution should be taken in its use for patients with myasthenic state.


The significance of the sweat test in chronic pancreatitis. In order to study the disposition which is thought to be latent in chronic pancreatitis, we investigated the sweat chloride concentration of 95 normal subjects, 43 cases of chronic pancreatitis, 12 cases of cholelithiasis, 15 cases of peptic ulcers, 16 cases of hepatic diseases and 23 cases of diabetes mellitus with the sweat test, using the method of pilocarpine iontophoresis. We obtained the following results. (1) In normal subjects, the sweat chloride concentration was inclined to rise gradually with age from childhood to adulthood; the mean value of sweat chloride concentration was 30.0 mEq/liter in adults from 20 years old, and the upper limit was about 60 mEq/liter. (2) The mean value of sweat chloride concentration was 60.0 mEq/liter in chronic calcifying pancreatitis; this value was markedly higher than that of control subjects of the same age (p is less than 0.001). (3) The mean value of sweat chloride concentration in cholelithiasis, peptic ulcer and hepatic diseases did not differ significantly from control subjects. The mean value of sweat chloride concentration in diabetes mellitus was significantly higher than that of control subjects (p is less than 0.01), but was significantly lower than that in chronic pancreatitis (p is less than 0.01). (4) It was supposed that some cases of chronic pancreatitis have a congenital disposition toward abnormal secretion of sweat glands and epithelium in the pancreatic duct, resembling cystic fibrosis, and this disposition leads easily to pancreatic disorders when the individual is exposed to various external factors.


Study on the porcine tubular basement membrane. Porcine kidney slices were gently homogenized with 0.9% NaCl in a Waring blender, followed by sieving of the homogenate to isolate tubules. The tubular basement membrane (TBM) was then prepared from the tubules by sonication in 1.0 M NaCl. Electron micrographs indicated a high degree of purity of the TBM with negligible contamination of fibrillar collagen. Analytical data showed that the TBM was a glycoprotein containing approximately 10% of carbohydrates. Of the sugar components, glucose and galactose comprised approximately 70% of the total carbohydrates and glycosylgalactosylhydroxylysine was detected in an alkaline hydrolyzate of the TBM. Besides them, mannose, fucose, glucosamine, galactosamine and sialic acid were also detected. The protein portion of the TBM contained hydroxyproline, hydroxylysine, half cystine, methionine and a large amount of glycine as the characteristic amino acids. Polyacrylamide gel-electrophoresis of the TBM gave 15 bands.


Parenchymal weight of the parathyroid gland and the kidney in chronic glomerulonephritis. This histomorphometrical study was performed on the kidney and the parathyroid glands of autopsy cases of chronic glomerulonephritis. The kidneys showed atrophy in varying degrees. Weight of the parathyroid glands increased because of proliferation of parenchyma. Weight of parathyroid parenchyma correlated negatively with weight of the kidney and volume density of tubules in renal cortex.


Dopamine and noradrenaline levels in the brains of lead and zinc poisoned rats. Acute plumbism include recurrent seizures, cerebral palsy and mental retardations. The impairment of the central nervous system (CNS) with increased lead absorption is of paramount concern which remains unsolved because of the lack of specific and sensitive neurochemical/biochemical indicators of the effect of lead on the CNS. In our experimental acute lead-zinc poisoning, significant increase in noradrenaline and slight decrease in dopamine have been found in the brains of rats, which suggest that there is change in neurotransmitter metabolism in lead poisoning.


Long-term toxicity studies of chocolate brown HT in mice. Groups of 48 male and 48 female mice were given diets containing 0 (control), 0.01, 0.1 or 0.5% Chocolate Brown HT for 80 weeks. There was a slightly reduced body weight gain and a lower heart weight in males given the highest dietary level. At the same level at week 77 the packed cell volume and total leucocyte count values in females were lower than those of the controls. However, the relationship of these findings to the treatment was questionable, as was the increased incidence of leucocytic infiltration of the liver in the female mice at the 0.5% level of treatment. A brown coloration of internal organs seen at the highest treatment level was due probably to the Chocolate Brown HT. The distribution of tumours was similar in all groups and it was concluded that there was no evidence of a carcinogenic effect with doses up to 700 mg/kg/day while the no-untoward-effect level was greater than 140 mg/kg/day.


Pyrimidine nucleotide synthesis in rat liver after the administration of cycloheximide. After the administration of cycloheximide (2 mg/kg) the utilization of [2(-14C)]orotic acid for the synthesis of pyrimidine nucleotides of acid-soluble extracts of the liver is not affected for about 7 h. The specific activities of uridine and cytidine components are increased later on, and this increase is higher in the case of cytidine components. Analogous changes undergoes the specific activity of RNA pyrimidine nucleotides. The increased utilization of labeled orotic acid for the synthesis of cytidine nucleotides can be observed also in the kidney and in the small intestine. The enhanced degree of labeling of cytidine nucleotides in vivo cannot be correlated with the activity of cytidine triphosphate synthetase (EC 6.3.4.2) of liver cytosol estimated in vitro. The amination of UTP is suppressed at later intervals after the application of cycloheximide. The same holds true for the activity of uridine phosphorylase (EC 2.4.2.3),5'-nucleotidase (EC 3.1.3.5) ATPase (EC 3.6.1.3) and of liver cytosol. The activity of uridine kinase (EC 2.7.1.48) is increased when tested both with uridine and cytidine as substrates. Cytidine deaminase activity (EC 3.5.4.5) raises markedly 3--5 h after the administration of drug; later on it decreases again.


Early destruction of cytochrome P-450 in testis of carbon tetrachloride poisoned rats. There is 20--36 percent decrease in the microsomal cytochrome P-450 (P450) content of the testes 3 or 6 h after CCl4 administration to Sprague--Dawley male rats. Irreversible binding of CCl4 metabolites to testicular microsomal lipids is observed as early as 3 h while CCl4 induced lipid peroxidation does not occur within the first 6 h of poisoning. Results suggest that reactive metabolites rather than lipid peroxidation is involved in P-450 destruction in the testes.


Chromosome studies in human lymphocytes after in vitro exposure to metal salts. The toxic concentration of different heavy metal salts was determined in normal stimulated human lymphocyte cultures and was found to be 3 X 10(-3), 1 X 10(-2) and 5 X 10(-4) for zinc chloride, lead acetate and cadmium chloride respectively. Furthermore 3 subtoxic doses of each salt (2, 10 and 100 times less than the toxic dose) were added to 48- and 72-h cultures at 0 h and 24 h after initiation. Chromosome preparations were made and 100 well spread metaphases from each culture were analysed for the presence of numerical and structural aberrations. The most common aberration found for all tested metal salts was the occurrence of chromosome fragments. Dicentric chromosomes were only recorded in lymphocyte cultures treated with the lowest concentration of zinc chloride (3 X 10(-5) M) added at time 0, regardless whether the cultures were fixed after 48 or 72 h.


Serum alkaline phosphatase elevation in female rats treated with ethinyl estradiol. Ethinyl estradiol treatment to female rats resulted in increased levels of serum alkaline phosphatase, but was not associated with any other manifestation of toxicity such as increased serum transaminases or toxic lesions. Elevated serum alkaline phosphatase seen in rats treated with chloroform was associated with frank hepatotoxicity. Induction of hepatic drug metabolising enzymes in rats by phenobarbitone treatment did not result in raised serum alkaline phosphatase levels. Estradiol benzoate treatment to rats also did not increase serum alkaline phosphatase levels. Ethinyl estradiol also resulted in increased alkaline phosphatase content in the liver, intestine and bone. The raised intestinal alkaline phosphatase content of rats treated with phenobarbitone or estradiol benzoate was not associated with an increase in the serum levels. There was histochemical evidence of induction of canalicular alkaline phosphatase in the liver in Ethinyl Estradiol treatment. The study of the electrophoretic separation of serum alkaline phosphatase of ethinyl estradiol treated rats revealed the presence of a new fast moving fraction, similar to those seen in bile duct ligated rats. It is concluded that the serum alkaline phosphatase increase during ethinyl estradiol treatment at least in part is from the liver, due to new synthesis.


[Possibilities, limitations and errors with ultrasound tomography in computer-assisted treatment planning (author's transl)]. Ultrasound tomography provides two-dimensional images, true in scale, of sonographic interfaces within nearly every sectional plane desired; it has become especially important, therefore, in irradiation planning. Complementary to results from a therapy simulator, an improvement in localization of tumor and target volume or of critical organs and of tissue inhomogeneities is possible. The hard-copy of gray-scale sonotomograms furnishes all essential geometric and anatomical input data needed for electronic systems used in irradiation planning. Technical, physical and diagnostic limitations of the method are stated. The possible systematic or technical-instrumental errors in sonographic treatment planning are discussed and the necessary calibration controls specified.


[Irradiation planning with ultrasound (author's transl)]. Sections of the body, being already an integral part of irradiation planning, can be obtained by ultrasonic instruments. This method is especially important for the representation of organs with a varying state of function or filling and for localization of contiguous tumors. After large surgical interventions involving an alteration of the anatomical situation, an ultrasonogram will be a valuable help for individual treatment planning.


[Tridimensional irradiation planning with Philips TPS and ultrasound gray-scale tomography in the course of routine work (author's transl)]. Extent and location of the target volume as well as the optimum choice of radiation and field and the use of wedges or compensation filters are critical parameters with respect to the quality of a treatment plan. The latter should always take into account the individual topography, even if standard concepts can be applied in some cases. We feel that treatment planning in each patient would require too much of the staff's time. Therefore equipment that helps to save planning time is welcome, particularly if it increases the reliability of the final results. In this respect ultrasonic tomography is a useful tool for solving many problems. These will be described, discussed and compared with the advantages of computerized tomography, which is just being introduced.


[The place of ultrasonic tomography in irradiation planning (author's transl)]. Therapy-planning frequently requires cross-section sketches of the body in correct scale. The use of anatomic-topographic standard cross sections can lead to considerable errors in the estimation of the actual position of the organs and yields no information on the extension of the pathological process. The kidney, the bladder and the prostate were used as examples to demonstrate the capacity of ultrasonic tomography to supply all information, including body contour, relevant to therapy planning, as long as no limits are set to the procedure, as in the thorax area. Ultrasonic tomography can supplement but not replace the radiological procedure in therapy-planning.


[Comparison of the results from sonographic and lymphographic examination in retroperitoneal tumor formations (author's transl)]. Retroperitoneal sonographic (grey scale) and lymphographic examination of 51 patients was performed in a prospective study. With either method, an 1:1 correlation was detected in 47 patients (92%). In nine cases, sonographic examination directly revealed extended tumors, whereas lymphographically only lesions within the not-enlarged lymph nodes were represented at the same level. Defective lymph nodes with minimum tumorous affection, on the other hand, were not detectable by sonography. The indications resulting from these findings are defined more precisely with regard to the examinations.


[Ultrasound in tumor diagnostics. Possibilities and problems with regard to internal medicine as an example (author's transl)]. Ultrasound B-scan (real time and gray scale technique) has proved to be a noninvasive, low expensive and suitable method in internal tumor diagnostics. The most important fields are the diagnosis of pancreatic tumors, of malignant lymphomas, of tumors of the kidneys and the adrenal gland. Furthermore there is possible the diagnosis of tumors of the liver, the bile ducts, the spleen and the thyroid gland. The differentiation between solid and cystic tumors has shown to be a domain of ultrasonography. The limitations of the method are caused by the relatively bad (lateral) resolution of ultrasonography. Therefore tumors smaller than 1.5 cm cannot be diagnosed regularly. There is, moreover, no ultrasonic pattern typical of malignancy.


[Ultrasound in mammary diagnostics (author's transl)]. The technique of ultrasound tomography was tested in nearly 200 patients at our institute and was compared to mammography; therefrom additional information was obtained for the differentiation of tumors, the site of which had been unfavorable to mammography. Differential diagnosis of solid tissues and cysts also is possible in this way, especially in voluminous breasts which are a difficult case for palpation examination. Ultrasound may be helpful, too, in localization for exact puncture. As the final images have shown, gray-scale technique offers new possibilities, mainly with the single-scan taking less time and having undoubtedly a better resolving power. In diagnostics of early cancer or carcinoma in situ, of which, naturally, palpation findings are not existent, the method is inferior to mammography and certainly not yet satisfying. Even in the case of a known early carcinoma, having been localized by means of a positive mammogram, no sonographic correlative can as yet be found. At present, ultrasonic diagnostics is insufficient as a sole method for examination of the female breast; the technique is evidently useful, however, in case of special problems.


[Ultrasonic diagnostics in the scope of clarification and prognosis of oncologic cases (author's transl)]. By means of ultrasonic diagnosis it is possible to represent neoplasms in the abdomen, retroperitoneum and small pelvis. The real-time scanner is utilized in tumor localization and search for metastases, whereas an exact measurement of the tumor, possible of a representative metastasis, and also the treatment planning, are performed with the cross-sectional images from the storage compound scanner. Controls during cancer therapy will give information about the therapeutic results. Recurrences or newly spread metastases may easily be detected by this method in the course of follow-up of the tumor patients.


[Frequency, clinical and radiological symptomatology and therapy of the arm oedema combined with mastocarcinoma (author's transl)]. In comparison with the first statistics published in Goettingen 10 years ago the frequency of the arm oedema has increased from 33,5 to 45,3%. Most arm oedemas appear within the first observation year after the operation or irradiation. Severe arm oedemas appearing immediately after the operation or irradiation as well as at a later date after a prolonged interval without any troubles are generally combined with a lymphogenic formation of metastases. A comparison of the two periods shows a significant difference of degrees within the observed groups. During the first observation period from 1950 to 1962, the frequency of the severe oedema is 6% higher than during the observation period of 1963 to 1975.


Electromyography in the estimation of nerve lesions after surgical and radiation therapy for breast cancer. EMG was performed on the upper extremity of the affected side in 55 breast cancer patients who had undergone mastectomy and postoperative radiotherapy. Radical mastectomy caused six latissimus pareses out of 26 patients and seven deltoideus pareses out of 49 patients. Simple mastectomy caused no pareses. As an early complication of radiotherapy five out of 16 patients developed slight EMG changes, most often in the biceps brachii muscle, but no clinical pareses were observed. In the follow-up group (at least 5 years after primary treatment) 18 out of 25 patients had varying EMG alterations. The relative frequency of EMG findings indicates an increasing number of neural changes caused by radiotherapy in the follow-up group. Severe pareses were infrequent as complications of radiotherapy. In neurography of the cutaneous branch of n. radialis a diminution of the amplitude of the sensory response was found one or two months after radiotherapy in the affected side. EMG proved to be useful in estimating both the early and late neural complications of primary treatment of breast cancer and in evaluating patients' capacity for work.


Changes in cell population of Ehrlich ascites tumor by irradiation. Although irradiated cultured cells undergo a limited number of cell divisions before their death, there exist several evidences that radiation-sterilized cells in solid tumors in animals were eliminated rapidly after irradiation. Experiments were performed to investigate whether rapid elimination of cells is observed in irradiated Ehrlich ascites tumor cells, but it could not be detected. This might be due to the differences of phagocytosis of sterilized cells between solid tumors and ascites tumors.


The synthesis of 25-hydroxycholecalciferol-23,23,24,24-t4 of high specific activity. Catalytic tritium reduction of cholest-5-en-23-yne-3beta,25-diol diacetate (VIII) gave cholest-5-ene-3 beta,25-diol diacetate-23,23,24,24-t4 (IX) having a specific activity of 92 Ci/mmol. Bromination, dehydrobromination and hydrolysis of the labelled material gave cholesta-5,7-diene-3beta,25-diol-23,23,24,24-t4 (XI) which was photolyzed to the previtamin and then thermally equilibrated to 25-hydroxycholecalciferol-23,23,24,24-t4 (I).


A quantitative gas-liquid chromatographic method for the estimation of hecogenin and tigogenin in the leaves, juice and sapogenin concentrates of Agave sisalana. A gas-liquid chromatographic method has been devised for the routine estimation of the hecogenin [3beta-hydroxy-(25R)-5beta-spirostan-12-one] and tigogenin [ (25R)-5beta-spirostan-3beta-ol] contents of Agave sisalana leaf and juice samples and of the crude sapogenin concentrates known as "coffee grounds". Because of partial degradation of the sapogenins in the GLC system it was found necessary to acetylate the compounds prior to their estimation. In East African samples the tigogenin proportion of the total sapogenin content is usually about 10%. At this level, the 95% inverse tolerance limits on predicted tigogenin weights are approximately +/- 7%.


Microbial transformations of natural antitumor agents. 7. 14-alpha-Hydroxylation of withaferin-A by Cunninghamella elegans (NRRL 1393). Microbial transformation experiments were conducted with the steroidlactone, withaferin-A (1a). Cunninghamella elegans (NRRL 1393) converts withaferin-A into two major metabolites, one of which has been indentified as 14alpha-hydroxywithaferin-A (1b). The metabolite is obtained in 37% yield, and its structure was determined on the basis of pmr and mass spectral evidence. The metabolite has the same level of antitumor activity as withaferin-A against the Sarcoma-180 tumor test system in mice.


A radio-gas chromatographic method for the determination of 11-oxotestosterone in fish plasma: its use in confirming estimations by radioimmunoassay. A radio-gas chromatographic method has been devised for the estimation of 11-oxotestosterone (17beta-hydroxyandrost-4-ene-3, 11-dione) in fish plasma samples which provides an independent means of validating the radioimmunoassay described earlier. Estimates of the concentration of 11-oxotestosterone in a sample of male rainbow trout plasma by radio-gas chromatography using peak height and peak weight measurements were 6.9 microgram/100 ml and 7.4 microgram/100 ml respectively, in good agreement with that of 7.1 microgram/100 ml determined by radioimmunoassay.


Effect of non-respiratory alkalosis on brain tissue and cerebral blood flow in rats with damaged blood-brain barrier. Acute alterations in plasma bicarbonate concentration have minimal effects on intracerebral pH and cerebral blood flow, perhaps due to blood-brain barrier mechanisms. To test this hypothesis, the consequences of an acute rise in the plasma bicarbonate concentration were studied in anesthetized rats previously subjected to an acute pressure pulse in the carotid system with unilateral damage to the blood-brain barrier. In rats subjected to a "heavy" hypertensive insult, the hemisphere on the side of the lesion showed a lactic acidosis, edema, and a depression of cerebral blood flow. An increase in the plasma bicarbonate concentrations of 15--20 mEq/1 during 35 minutes provoked a marked rise in the total CO2 content of this hemisphere, and a further increase in the lactate concentration, but did not later the brain edema nor affect further the already very low cerebral blood flow. An increase in the lactate concentration and a decrease of cerebral blood flow in the "reference" hemisphere indicated that the lesion was not completely unilateral. In rats subjected to a "moderate" hypertensive insult the changes were less pronounced and statistically not significant for all the parameters. There results illustrate the importance of an intact blood-brain barrier for the maintenance of intracerebral pH in the face of acute alterations in plasma [HCO3]. The impaired cerebral blood flow after an acute hypertensive insult did not appear to be influenced by the intracerebral [HCO3].


Effects of acute hypertension on brain metabolism in normotensive, renovascular hypertensive and spontaneously hypertensive rats. Effects of angiotensin-induced acute hypertension on cerebral metabolism were studied in normotensive (NTR), spontaneously hypertensive (SHR) and experimental renovascular hypertensive rats (RHR). Lactate, pyruvate and adenosine triphosphate (ATP) concentrations in the brain frozen in situ at 18--20 min after angiotensin infusion, which raised mean arterial pressure (MAP) by 28--62% of control, were determined by enzymatic methods. Supratentorial lactate was significantly increased to 135% of control in RHR, its increase being correlated with the degree of hypertension, wherease it remained unchanged in NTR or SHR. Furthermore, RHR showed a tendency toward increase in lactate/pyruvate ratio with a decrease in ATP despite no change of arterial acid-base balance measured simultaneously before and after acute induced hypertension. From the present study, it is postulated that some renal factor seems to contribute ischemic metabolic changes in RHR following acute hypertension. The possible effect of renin on the vascular permeability is discussed as the pathogenesis of hypertensive encephalopathy.


Comparative angiographic and histological evaluations of intracranial atherosclerosis in hypertensive and normotensive subjects. Cerebral atherosclerosis without luminal narrowing has been found macroscopically and by angiographic examinations in some patients with cerebral hemorrhage. In order to clarify the histology of non-stenotic atherosclerosis of the cerebral vessels, we examined cleared specimens and serial sections of the main trunks of the cerebral arteries. The middle cerebral artery was selected in 20 cases of cerebral hemorrhage and 7 cases of cerebral infarction. Non-stenotic atherosclerosis was found frequently in cases of cerebral hemorrhage, while most patients with cerebral infarction showed stenotic cerebral atherosclerosis. We counted the numbers of medial smooth muscle cells in 10 autopsied cases of cerebral hemorrhage and 6 of cerebral infraction. The mean numbers of smooth muscle cells per unit area in the patient with cerebral hemorrhage were less than those in cerebral infraction. In cerebral hemorrhage, the main trunks of the cerebral arteries were dilated, probably as a result of the damage to medial muscle cells and higher blood pressure during the course of intimal thickening. It is considered that arterial hypertension spreads to the peripheral, small arteries through the main trunks without luminal narrowing of the cerebral vessels.


Relationship between ophthalmic artery blood flow and recanalization of occluded carotid artery. Ultrasonic Doppler study. Ophthalmic artery blood flow in 5 patients with internal carotid artery occlusion of sudden onset was monitored by an ultrasonic Doppler flowmeter to investigate the possible relationship to spontaneous recanalization of the occluded artery. The occluded internal carotid arteries of 2 patients were confirmed angiographically to recanalize and the reversed flow of their ophthalmic arteries changed to physiological flow after the recanalization. The ophthalmic artery blood flow remained reversed in 2 patients whose occluded internal carotid arteries did not recanalize on the follow up angiograms. In the other patient, whose ophthalmic artery blood flow was not detected by the ultrasonic Doppler flowmeter in the acute stage, physiological flow through the ophthalmic artery was detected later. The occluded internal carotid artery did not recanalize and this physiological ophthalmic artery blood flow was filled through the circle of Willis.


Importance of the hematocrit as a risk factor in cerebral infarction. The relationship between the indicence of cerebral infarction and the hematocrit was studied using 432 consecutive autopsied patients with the average age of 77.1 years. The incidence of cerebral infraction was higher in patients with hematocrit values of more than 46%, (the average in younger adult subjects). The increase in the frequency of cerebral infarction with high hematocrit values was more conspicuous in patients with severe cerebral atherosclerosis than in those with slight cerebral atherosclerosis. High blood pressure per se did not influence the relationship between the hematocrit value and the incidence of cerebral infarction. With hematocrit values of more than 41%, cerebral infarction occurred more frequently in patients over 78 years of age than in the younger patients, but the difference was not significant statistically. High hematocrit values are associated with a higher risk of cerebral infarction in deep subcortical structures of the brain than for cartical infarctions. The pathogenetic and preventive implications of these results are discussed in the light of blood rheology.


Cardiac arrhythmias in acute stroke.

Cardiac arrhythmias in acute stroke. Cardiac arrhythmias were more frequent (p less than 0.001) in 312 stroke patients admitted to an intensive care stroke unit, than in 92 patients admitted to the unit and subsequently found not to have strokes. This significant difference remained when a stroke subgroup and the non-stroke group were matched for age, sex and duration of stay in the unit (P less than 0.005). Hypertension and hypertensive cardiac disease were more common in the stroke than in the non-stroke patients (P less than 0.001). Ectopic beats and atrial fibrillation, as well as other arrhythmias, were most frequent in patients with cerebral hemisphere infarction, and patients with hemispheric lesions had significantly more arrhythmias than those with brain stem lesions (P less than 0.05). The arrhythmias were rarely (2%) responsible for hemodynamic ischemic cerebrovascular lesions, but may have been associated with cerebral embolism in up to 17% of cases. The cardiac arrhythmias appeared to have little influence on the course of the subsequent recovery from stroke. Although these arrhythmias frequently reflect the high incidence of cardiac disease in stroke patients, in some cases they are secondary to the acute cerebrovascular lesion itself.


Death attitudes and experiences of rehabilitation counselors. A survey of the death attitudes and experiences of 54 rehabilitation counselors indicated that their personal beliefs could potentially influence service to disabled people, particularly in the areas of terminal illness and suicide. To balance such influence, contined training of counselors and research efforts concerning this problem are recommended.


Auditing the quality of care of a crisis center. The purpose of this paper is twofold: First, it defines and describes different types of audits and areas of patient care which lend themselves to a quality of performance review. Second, it describes an audit application at a hospital-based crisis intervention center and the corrective action taken on the basis of the findings. The major emphasis of the  audit was to determine the quality of medical-psychiatric consultation and to develop criteria for its initiation.


Multiple suicide attempts and informal labeling: an exploratory study. Attempted suicide is considered to be a form of deviant behavior. Multiple suicide attempts are evaluated within the labeling perspective. Specifically, it is determined if labeling theory can explain acts of repeated suicide attempts as a form of deviance. Two hypotheses are created to test the influence of informal labeling on multiple suicide attempts. Family and friends constitute the categories most important in informal labeling. Labeling by them is measured through a series of behavioral scales. It is hypothesized that the greater the labeling by each of these categories, the greater the likelihood of recurrence of attempted suicide. It is also predicted that the greater the "self concept as suicidal," the greater the likelihood of recurrence. Labeling by family and friends was found to be significantly related to repeat. Conclusions about the relationship between "suicidal self-concept" and repeat were not drawn.


Suicide attempts by rock-climbing falls. The true intent of a suicidal act is sometimes masked by it appearing as an "accident". Two cases are reported that present a unique opportunity to study suicide attempts that took the form of rock-climbing "falls" and to study the two people who chose this way to die. Rock-climbing falls, occasionally speculated about as possible suicidal equivalents yet having no recognition as such in the literature, are illustrated as methods used by these impulsive, action-oriented and risk-taking people.


Death by hand grenade: altruistic suicide in combat. Durkheim's theory of suicide is examined as it bears on the concept of altruistic suicide. A subtype called heroic altruistic suicide or self-sacrifice is identified. Relationships are hypothesized between cohesion and self-sacrifice and rank and self-sacrifice, and they are tested in combat situations, utilizing official published information on the Congressional Medal of Honor. Altruistic suicide is found to be higher in more cohesive than in less cohesive groups and more likely among enlisted men than among career officers and noncommissioned officers. In addition to testing hypotheses empirically, this study elaborates Durkheim by extending his analysis of altruistic suicide and clarifies his work by delineating sources of error in his hypotheses.


Consequences of helminth aggregation for the dynamics of schistosomiasis. The distribution of schistosome worms among their human hosts is not random but aggregated. The consequences of introducing aggregation into models of schistosomiasis transmission, especially that of Macdonald, are explored. There are two possibilities for aggregation, with the sexes distributed either independently or together. Both have profound though differing effects on the breakpoint concept, which is largely destroyed when the sexes are aggregated together, and Macdonald's epidemiological conclusions are not robust to variations from the Poisson distribution. The conclusion from his model that if schistosome densities in man are reduced appropriately the infection will spontaneously proceed to extinction even in the presence of conditions suitable for transmission, is also not therefore robust.


Virus-like rods associated with salivary gland hyperplasia in tsetse, Glossina pallidipes. Long, virus-like rods were discovered in hyperplastic salivary glands of Glossina pallidipes Austen from Kibwezi Forest (2 degrees 27' S, 37 degrees 55' E), Kenya. The glands were enlarged up to four times the normal diameter. This increase in size was due to a cellular proliferation of the glandular epithelial cells and hypertrophy of their nuclei and cytoplasm. Nuclear and cytoplasmic inclusions were present in the enlarged cells but were not found in cells of normal-sized glands. Electron microscopy revealed many virus-liked rods in the abnormal glands. Males with such glands were often completely sterile. Abnormal growth of the ovarioles was a significant feature of young females with hyperplastic glands. Both sexes of wild and laboratory-bred flies were found with enlarged glands. One way of transmission of the trait seems to be from mother to progeny.


Detection of H-Y antigen by fluorescence microscopy. A rapid and reproducible fluorescence microscopic technique has been devised to demonstrate H-Y antigen on membranes of human peripheral blood mononuclear cells. In 11 male subjects, 20 to 32% of mononuclear cells were positive for H-Y antigen, whereas less than 1% of such cells from 6 female donors were seen to be stained.


Haemoglobin S in Malays and Indians: association of Hb CoSp and Hb S in a Malay family. Four cases of Hb S were seen between Jan. 1976 and June 1976; three of them were newly discovered while the fourth was previously diagnosed. Out of the four cases, two were Malays and the other Indians. The family members of one Malay case were investigated. Six members had Hb S and three had Hb CoSp. Association of Hb CoSp and Hb S was seen in two of the members. Clinically they were healthy.


Naturally acquired measles immunity in Nepal and Sri Lanka. Serological surveys of naturally acquired measles antibodies in children 6--72 months of age were done in Nepal and Sri Lanka. The prevalences of naturally acquired measles immunity are compared by age groups with serological studies done in other countries. Suggestions are made regarding age ranges for measles vaccination programs.


Some socio-psychiatric attributes of patients utilizing the facilities of the traditional healers in the city of Ibadan. The socio-psychiatric attributes of 103 patients found with the traditional healers in the city of Ibadan, Nigeria are reported. The patients were from all shades of educational and social status. Almost all their in-patients were psychotics while the neurotics were treated as outpatients. The implications of these findings for collaboration between western trained physicians and traditional healers are discussed.


Ethiopian experience in health manpower training. A review of the Public Health College. Health manpower development in Ethiopia, mainly the paramedical personnel training programmes of the Public Health College, is reviewed and discussed. The 'health team' training programme in Gondar is the most practical and a significant development in the field of paramedical training for developing countries. The pattern and experience of the Gondar training programme could contribute to the world's knowledge of training and utilization of health teams for rural health services. It could serve as a model, with appropriate modifications, for other developing countries. The 'team' approach during training and services, the Health Officer, supported by paramedical personnel, who serves as the team leader, and the gradual development of medical education are realistic, and effective means for producing health manpower in the developing countries. The establishment of a definite career structure, with prospects for future continuing professional advancement, respectable status, appropriate authority, adequate technical supervision, administrative support, decent working and living conditions are vital for the success of this programma in Ethiopia.


Endemic familial arthritis of Malnad an outbreak in Southern India. An outbreak of a peculiar joint disease affecting the hip and knee had occurred during the last decade or so, afflicting about 140 families in parts of Malnad in Southern India. Results of epidemiological studies suggest that a recent change in the environment had perhaps precipitated the disease in a genetically susceptible population.


The prevalence of inguinal hernia in adult Ghanaian males. Indirect inguinal hernia imposes a heavy patient caseload on surgical services in Africa. This study, conducted in rural southern Ghana in 1973, showed a marked increase in prevalence in adult males aged 55 years and older. In contrast, hospitalized patients undergoing herniorrhaphy in Accra were evenly distributed through all age groups. As hospital services expand and rural patients have better access to surgical care, recent innovations such as short stay surgery may be important for coping with rising patient demand.


Waardenburg's syndrome in Kenyan Africans. Waardenburg's syndrome is characterized by deafness and pigment disorders of the eyes, hair and skin. Two types are distinguished; e.g. type I with dystopia canthorum and type II without dystopia canthorum. In Kenya 12 out of 724 pupils of schoools for the deaf were found to suffer from the syndrome. Ten of these belonged to eight families; 20 other members of these families had signs of the syndrome. Of these 30 patients 18 had type I, 12 type II. The expression of most characteristics in these Kenyan patients was almost the same as in Caucasians. The mode of inheritance was autosomal dominant, as in Caucasians. The interocular distances were measured in 168 healthy children and adults of the Luo tribe. In most age groups slightly larger values were found than in the Caucasian race. For the diagnosis of dystopia canthorum this should be taken into account.


Remittant diabetes mellitus in Nigeria.

Remittant diabetes mellitus in Nigeria. Forty three newly diagnosed non-obese Nigerian diabetic patients (20 males and 23 females), who required insulin for initial control, were left without dietary control and were followed up for a minimum period of one and half years in each case. Four patients (9.3%) are in true remissions up to the time of writing. Eight other patients (18.6%) went through varying periods of apparent remissions of between three months and 19 months. It seems that even non-obese Nigerian diabetics may remit despite a free diet and initial need for insulin. The reasons for diabetic remissions remain largely unexplained but may be related, in Nigeria, to the aetiological nature of diabetes mellitus in this part of the world.


Falls from trees.

Falls from trees. A prospective review of sixty consecutive patients who fell out of trees in a year was made. Fall from tree is an occupational hazard of traditional farmers, a rare cause of trauma, but a common cause of severe, crippling and often multiple injuries. It frequently resulted in spinal injury, and was the commonest cause of traumatic quadriplegia and paraplegia. The risk of fall and of sustaining spinal injury increased with age. Some school children also fell from fruit trees but they generally stood a better chance of getting away with relatively minor injuries. Methods of preventing or minimising the risk of this injury in farmers are highlighted.


Affections of conjunctiva and cornea in Bendel State of Nigeria. A review of conjunctival, episcleral and corneal diseases seen in Bendel State in the South of Nigeria shows significant differences in the pattern of conjunctional and corneal diseases. Onchocerciasis and trachoma which cause much ocular morbidity and blindness in the savannah north have little place in the rain forest areas of southern Nigeria. The relative rarity of herpetic dendritic ulcers and corneal dystrophies are highlighted while the major indication for keratoplasty in southern Nigeria is leucoma associated with measles or trauma. The place of measles immunisation, improved nutrition and treatment for xerophthalmia is emphasized.


Factors in the aetiology of chronic duodenal ulcer in Ibadan. The aetiological factors at work in Nigerians with duodenal ulcer were examined. Stress and dietary factors were found to be major agents in the precipitation of exacerbations and recurrences of symptoms. Of the dietary agents, chillies and cassava preparations in the form of 'eba' and 'gari' are potent ulcerogenic food substances. Aspirin, alcohol and smoking also contribute to the worsening of the conditions but are not major factors.


Thyroid carcinoma in Kenya.

Thyroid carcinoma in Kenya. Between 1964 and 1969 thyroid carcinoma was diagnosed in 63 Kenyans of African origin. The majority of tumours were differentiated in structure. Papillary carcinoma predominated in lowland tribal groups; follicular carcinoma in highland groups. A possible positive correlation between follicular carcinoma and endemic goitre is postulated.


Correlation of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and sickle cell trait (Hb-AS). 636 normal male blood donors were studied for haemoglobin genotype and G-6-PD deficiency. The results show that of 543 subjects with AA haemoglobin, 106 (19.5%) were G-6-PD deficient and of 93 individuals with AS haemoglobin 13 (14.0%). This difference is not significant.


Epidemiology of poly-parasitism. II. Types of combinations, relative frequency and associations of multiple infections. Frequency distributions, including all of the observed types of combinations of multiple infections with different helminths and protozoa are presented for sample villages of the African Savannah and of the trans-Andean part of Peru. Measurements of correlation between these infections based on properties of the multivariate, multinomial distribution are calculated to show age and sex patterns of association in different population samples. A correlation matrix for combined infections with Dipetalonema perstans, D. streptocerca and Loa loa, in villages in the rain forest of Zaire indicates that there is a statistically significant association between the two species of Dipetalonema and L. loa. There is also a strong association between the numbers of the microfilariae of D. perstans and D. streptocerca in multiply infected individuals. This correlation is strong only in the rain forest; it is insignificant in the other ecological zones of Bas-Zaire included in the study. The data suggest that there may be selective host factors that influence the extent, distribution and the types of multiple infections in a community.


Epidemiology of poly-parasitism. III. Effects on the diagnostic capacity of immunological tests. The paper describes some effects of interaction between different types of parasitic infections on the diagnostic capacity of immunological tests for parasitic diseases. Examples shown include an analysis of association for anergy to tuberculin in skin tests of individuals with and without skin manifestations of onchocerciasis; skin tests with P. westermani and C. sinensis antigens to detect double infections in patients harbouring both trematodes; geographical evaluation of the sensitivity of the complement fixation (CF) test for schistosomiasis with S. mansoni antigen between different communities in Chad; reduced sensitivity of the CF test for schistosomiasis in patients with confirmed schistosomiasis who have also onchocerciasis; studies on the specificity of the slide flocculation (SF) test for schistosomiasis in relation to specified intestinal parasites and to the presence of antibodies to E. granulosus and T. spiralis in villages of Afghanistan; and a study of association between poly-parasitism and anticomplementary activity in the sera of population samples from the African Savannah. The combined investigations indicate that there are large dissimilarities in test performance between communities with different disease spectra and nutritional status. The findings suggest that polyparasitism interferes with immunodiagnostic tests both directly through cross-reactions with antigens and antibodies and indirectly through its effects on nutrition and on mechanisms affecting the complement system. Large scale screening for parasitic diseases with immunodiagnostic tests in areas in which the medical problems are not well-known should be prededed by a small, well-planned pilot study in which the relative sensitivity and specificity of the test can be determined before its use in extensive population studies.


A transepidermal chemotherapy of onchocerciasis. Counts of microfilariae in the skin, and histological and electronmicroscopic procedures have been used to analyze the response of onchocerciasis patients to diethylcarbamazine citrate (DEC) given either orally or topically. Oral administration of DRC failed to eliminate all microfilariae. Transepidermal DEC resulted in rapid degeneration of microfilariae, and daily single applications of the drug greatly reduced or apparently eliminated microfilariae from the skin. Following weekly topical applications of a DEC emulsion, effective suppression of O. volvulus microfilariae in patients living in a hyperendemic area was maintained for many months; and the dermal pathology resolved.


Small-scale trials of six drugs against Onchocerca volvulus. Six drugs in common use for the treatment of parasitic infections of man were given to 18 adult patients suffering from onchocerciasis. None of the six (metronidazole, tinidazole, mebendazole, trichlorophone, oxamniquine and pyrantel pamoate) showed any evidence of substantial activity against the microfilariae or adult worms of O. volvulus. The mean reduction in skin microfilarial counts a week after drug treatment (a measure of microfilaricidal action) was highest in patients treated with trichlorophone (47.0%) and mebendazole (40.0%). The rate of build-up of microfilariae over a follow-up period of 24 months after treatment with the drug under test followed by DEC (a measure of macrofilaricidal action) was slowest in the groups treated with metronidazole and trichlorophone (22.9% and 27.0% of the pre-treatment counts respectively). These results fall short of those expected of drugs with potential value in the treatment of onchocerciasis.