The effect of indomethacin on plasma renin activity and urinary aldosterone of patients with essential hypertension. The effect of indomethacin on plasma renin activity (PRA), urinary aldosterone, 17 OH ketogenic steroids and plasma cortisol was studied in twenty-three patients with essential hypertension and compared in eleven patients to oxprenolol effect by 2 x 2 factorial trial. Indomethacin decreased PRA and urinary aldosterone: its effect was maintained when the drug was given for three days and it was related to basal PRA and aldosterone values. Therefore in patients with low PRA (renin-sodium index) PRA and aldosterone were unchanged, while they decreased in the normal high PRA group. Aldosterone changes were related to those of PRA, while 17 OH ketogenic steroids and plasma cortisol were unchanged. Both indomethacin and oxprenolol decreased PRA, but no interaction or additive effect was found between the two drugs. The present data indicate that indomethacin can decrease both PRA and aldosterone to an extent which is related to basal values and that aldosterone changes are mainly explained by those of PRA. The PRA unresponsiveness to indomethacin found in low renin patients may suggest renal prostaglandin deficiency. Finally the lack of interaction or of additive effect between indomethacin and oxprenolol may be explained by postulating either that the two drugs act on a common pathway or that an additive effect on PRA cannot be detected renin being maximally suppressed by full renal beta-receptors blockade.


Sleep-wake differences in serum prolactin levels in children. Sleep-wake differences in prolactin serum levels have been studied in 47 prepubertal children of both sexes, aged 1 to 12 years. Sampling has been made in each subject once during wake and once during sleep. The serum levels of prolactin were found to be higher during sleep than during wake (p greater than 0.01). When the children were divided into age groups, a statistically significant difference between wake and sleep was observed in all groups considered, including that with children aged 1 to 2 years. This indicates that the sleep connected rise of prolactin levels occurs very early in chidhood. No sex releated difference either in absolute hormone serum levels or in wake-sleep changes is apparent.


Reciprocal effects of prolactin and thyroxine on the growth rate of rat pups from weaning to puberty. Prolactin and thyroxine were added to the daily diet of rat pups from weaning to puberty (days 20--40). While prolactin significantly retarted the pups' growth, thyroxine stimulated growth and even compensated for the depression caused by prolactin. The significant retardation in the growth of the prolactin-treated pups around days 30--35 of age indicates that at that period they are extremely prolactin-dependent, thus confirming previous reports that exogenous prolactin inhibits its own endogenous secretion. On the other hand, the possible growth promotion caused by thyroxine is mild and does not initiate a feedback mechanism. This suggests that prolactin is indispensable for the normal development of the weaned, immature rat.


Hospital law: the changing scene.

Hospital law: the changing scene. The liability of hospitals in tort law has been a fairly recent development. Formerly, hospitals were protected from liability under the doctrine of charitable immunity. Legal "immunity" avoids liability in tort essentially under all circumstances. It is conferred not because of the particular facts of the situation but because of the status or position of the favored defendant. It does not deny the tort, merely the resulting liability. Such immunity does not mean that conduct that would amount to a tort on the part of other defendants is not still equally tortious in character, but merely that for the protection of the particular defendant, or of the interests which he represents, he is given absolution from liability. Similarly, the "captain-of-the-ship" and the attendant "borrowed or lent servant" doctrine is being abandoned. As medical technology continues to advance, the modern hospital will undoubtedly assume a greater responsibility toward its patients--with amplified medical-legal implications. The hospital is no longer a hotel where patients stay, awaiting treatment by their private physicians. The theory that the hospital does not act through its employees--physicians, nurses, and others--no longer reflects the trend in judicial philosophy. The decisions cited reflect the current trend in judicial analysis and thinking. Medical science has provided numerous benefits to humankind, but along with those benefits, numerous risks have accrued. Whether hospitals should have to bear the responsibilities inherent in such risks is a much-argued matter. However, hospital liability, in fact, is the trend of our judicial determination. The ramifications of this trend have been many. Hospitals and physicians will closely scrutinize surgical operations and other hospitals procedures and practices. The fact remains clear that responsibility for every patient is now shared by both the physicians and the hospital--share and share alike. The present thinking is that the liabilities can be minimized, without shifting the duties, obligations, and responsibilities, through risk management. Prevention, as always, is the best cure.


Microbial degradation of diethanolamine and related compounds. Thirteen diethanolamine compounds were tested for their biodegradability employing (1) a bacterium selectively isolated from an industral cutting fluid, and (2) an acclimatized sewage population obtained from a domestic waste treatment plant. Pure culture growth and biochemical oxygen demand studies with the isolate showed that only diethanolamine, methyl-diethanolamine, triethanolamine, and laurylsulphate-diethanolamine were degradable. Biochemical oxygen demand techniques using the acclimatized sewage micro-organisms as seed yielded similar results with only diethanolamine, methyl-diethanolamine, triethanolamine, and laurylsulphate-diethanolamine being oxidized to any meaningful extent. Cyclohexyldiethanolamine, phenyl-diethanolamine, and m-tolyl-diethanolamine had oxygen demands of less than 1% of their theoretically calculated values, while ethyl-diethanolamine and benzyl-diethanolamine accounted for 3.6 and 2.3% of their theoretical values respectively. In both systems employed substitution of the tertiary hydrogen of the amine group with isopropyl, 3-aminopropyl, n-butyl, or t-butyl resulted in biologically recalcitrant compounds.


Effect of sublethal heat injury on tumour induction and RNA synthesis in Agrobacterium tumefaciens. When cells of Agrobacterium tumefaciens are subjected to sublethal heat injury at 45 degrees C for 20 min, less than 5% of the viable population retain their ability to initiate tumour formation on Kalanchöe daigremontiana. If the cells are then incubated in phosphate buffer at 27 degrees C for 2 h, tumour initiation returns to control levels. Inhibitors of DNA and protein synthesis had little effect on the recovery of tumour initiation after heat injury. Rifamycin, a specific inhibitor of RNA synthesis, dramatically reduced recovery of tumour formation. During the heating process large amounts of RNA leaked from the cells which correlated with a degradation of rRNA. The addition of Mg to the heating buffer reduced the loss of RNA into the medium and the degradation of rRNA and tumour initiation was retained at control levels. It is concluded that while current evidence indicates that DNA is probably the transforming agent, RNA synthesis is an important component of the induction process.


Effect of arginine analogues on a fish pathogen, Aeromonas salmonicida. The effects of arginine analogues on a fish pathogen, Aeromonas salmonicida, were investigated. This organism proved to be resistant in various degrees to most arginine analogues tested but was found to be sensitive to arginine hydroxamate. Inhibition of growth by arginine hydroxamate was reversed by the addition of arginine to the bacterial culture. Incorporation of 14C from 14C-amino acids, namely, guanidoarginine, glutamate, asparate, alanine, isoleucine, serine, methyl-methionine, and cystine was affected.


Liquid culture of Diplodia maydis.

Liquid culture of Diplodia maydis. Diplodia maydis, a Zea mays L. stalk rot causing fungus, was grown in Czapek-Dox broth and modifications of Fries liquid media using combinations of 1% cellulose, 1% sucrose and ammonium or nitrate-nitrogen. Conditions are defined to yield consistently maximum mycelial dry weight in two days in contrast to the usually reported five-day incubation period.


Autoactivation of spore germination in mutant and wild type strains of Dictyostelium discoideum. Freshly formed wild type Dictyostelium discoideum spores are constitutively dormant, and thus require an activation treatment to germinate. Wild type spores may germinate without an activation treatment (autoactivate) after a period of ageing (maturation) in the intact fruiting body. Mutants have been isolated which autoactivate without the need for ageing. Autoactivation of mutant and aged wild type spores appears to occur by identical mechanisms; thus the mutation may involve premature maturation. Autoactivation is mediated by autoactivator substances released from spores as they spontaneously swell. These factors are readily chromatographed, and elute from a Biogel P2 column in three peaks of activity. One activity peak appears only after spores have begun to germinate. No autoactivator substances are released from heat activated spores. Autoactivation is sensitive to cychloheximide, and may result from altered spore permeability. Autoactivation is likely to be the mechanism of D. discoideum spore germination in nature.


Improved growth of Thermus aquaticus on cellular lysates. Studies on the thermophilic bacterium Thermus aquaticus have demonstrated the ability of this organism to exist on its own cell lysates. The use of 0.1% tryptone, and 0.1% yeast extract and a mineral salts lysate medium increased growth 9-to 44-fold over the above medium without cell lysates. It has also been established in this study that, due to the high growth temperature of T. aquaticus, its metabolic activities are greatly accelerated resulting in early cell destruction. Therefore, bacterial lysates from which other cells could derive nutrients and/or growth factors would constantly be available in the environment immediately around the organism to aid the growth of cells in natural as well as man-made thermal environments.


Cis-and trans-octa-1,5-dien-3-ol, new attractants to the cheese mite Tyrophagus putrescentiae (Schrank) (Acarina, Acaridae) idintified in Trichothecium roseum (Fungi Imperfecti). The volatile materials emitted by Trichothecium roseum (Fungi Imperfecti) at a very low concentration are strong attractants for Tyrophagus putrescentiae (Schrank, 1781) (Acarina, Acardae). The identification of cis- and trans-octa-1,5-dien-3-ol, the main attractant constituents of these volatile materials, was performed by spectroscopic methods (GC/MS and NMR) on a microsample (less than 100 micrograms) isolated by a new pre-concentration method. Although this unsaturated alcohol has only been found in Trichothecium roseum and in a Rhodophyta, it may be present in other microfungi and in fungi and may be implicated in the ecological process.


[Population structure and consaguinity in Dota, Costa Rica, 1888-1962]. A study of consanguinity and population structure was carried out in a sample of 498 consanguineous (MC) and 570 non-consanguineous matings (MNC) in the Parrish of Dota, Costa Rica, during a period of 75 years. The inbreeding coefficient (F) shows fluctuations in time (476 to 194 x 10(-5) with an increase from 1888 to 1917, followed by a decrease in the last years but remains high in nonmigrant marriages. There is a high frequency of unions among second cousins. The endogamy percentage is high, greater in MC (80%) than in MNC (61%). Exogamy tends to diminish with time among both types of union. Effects of age distributions in the groups was not found. Marital and migrational distances are short and tend to become shorter in the final periods. There is a positive correlation (r = 0.71; p less than 0.05) between these distances in MC but not in MNC; distances are shorter in MC. Immigration is minimal and reduced to short distances. Post-marital movement is intense (37%) and involves greater distances. Emigratory behavior is identical in MC and MNC.


[Development of Golgi apparatus ultrastructure during meiosis and spermiogenesis in the hamster (Mesocricetus auratus)]. During meiosis and espermiogenesis the Golgi apparatus shows the greatest morphological and physiological changes. During the second meiotic division it appears as a very large organelle, formed by prominent dictyosomes and by two types of vesicles: one in the external part of the body with diameters that range from 40--100 nm, and the other in the central part of the organelle, larger in size, from 200 to 500 nm. The acrosome, once formed, is spheric (1600 nm in diameter) with the glucoproteins forming a round and dense body occupying its central zone. Later the acrosome moves against the nuclear membrane. These morphological changes occur within a very short time, while the spermatid practically continues occupying the same position in the cellular association of the seminiferous tubule.


Behaviour of aminohexoses and sialic acids in subacute intoxication of guinea pigs with "Elocron 50 WP". The behaviour of sialic acids and aminohexoses was examined in subacute intoxication of 60 guinea pigs with "Elocron 50 WP". Elocron 50 WP was administered in soy-bean oil emulsion by means of a stomach tube for 28 and 85 days. The daily dose was 1/3 LD50. Further animals were kept for 28 days on food sprayed with "Elocron 50 WP". These animals were kept in quarantine during the period of treatment. The sialic acid level was found to be increased in the liver and in the other examined organs (heart, brain, kidney, lung) and slightly decreased in the serum. The aminohexose level was increased in the heart, kidney and brain, and decreased in the liver and lungs, in the early stage of intoxication (28 days) and in the group of the so-called "fodder" animals. In the late stage of the intoxication (85 days) an increased content of aminohexoses was observed in the brain and in the kidney, the increase was very slight in the heart and brain, whereas in the lung tissue the aminohexose level was subnormal.


Light and electron microscopic investigation of the sensory dendrites in the epidermis of the foot of the snail, Helix pomatia L. The fine structure of epithelial cells, supporting cells and the sensory dendrites running toward the surface between the former two was investigated in the epidermis of the foot of Helix pomatia. Cilia orienting in regular lines and possessing 9 + 2 tubular structure occur on the surface of the cylindrical epithelial cells lying on the basal lamina. The cilia terminate in basal bodies. The epithelial cells can first of all be characterized by a well-developed Golgi-apparatus and endoplasmic reticulum system as well as a developed tonofibrillar system. The supporting cells differ from the epithelial cells mainly in the poorly-developed tonofibrillar system and small number of cilia. Septate desmosome and zonula adherens are the common connecting structures between the cells composing the epithelium. According to the surface specialization, two types of sensory dendrites running toward the surface were distinguished: dendrites with and dendrites without cilia. On the surface of the former cilia with 9 + 2 tubular structure are randlomly distributed and are present in varying number. In their cytoplasm there are many mitochondria, few clear vesicles and multivesicular bodies. From the surface of the dendrites without cilia, microvilli of different diameter originate and sometimes a centriole was observed below the distal membrane. Their cytoplasm contains many clear vesicles, a well developed smooth endoplasmic reticulum system and few mitochondria. Comparing our results with literary data, we suppose that the differences between the two dendrite types in the presence and number of cilia as well as in the diameter of the microvilli show different forms of appearance of one type of dendritic terminal.


The effect of lesions of the epithalamus on plasma aldosterone and corticosterone levels in Japanese quail. The peripheral plasma aldosterone and corticosterone concentrations were measured by CPBA and RIA method in Japanese quails in which the subcommissural organ (SCO) or the habenula had been destroyed. Lesion of the SCO reduced the plasma aldosterone level by 50%. The lesion of n. habenularis medialis and lateralis on the other hand did not affect the plasma corticosteroid level. It is suggested that in birds the SCO takes part in a multifactorial regulation of aldosterone secretion.


Hypostase, embryonic sac and endosperm in Anethum graveolens L., and in various families. The presence of pyriform hypostase tissue was investigated before double fertilization till the fusion of free endosperm nuclei in the embryonic sac of A. graveolens. Hypostase a glandular tissue, can secrete its cell contents into the embryonic sac during the development of free endosperm nuclei. Of 78 randomly selected families, 19 display different numbers of species with hypostase. In 15 of these families the hypostase is present together with the Polygonum type of embryonic sac and nuclear type of endosperm.


Monolayer cultures of rat pituitary intermediate lobe: growth and fine structure of epithelial cells. Rat hypophyseal intermediate lobe cells, partially dispersed by trypsin, were cultivated on an inert surface. The attaching capacity, the growth of the cultures and the fine structure of the epithelial cells developed during cultivation were studied. The majority of the cell groups attached to the inert surface within 72 h after explantation. Epithelial islands developed, with a layer consisting of fibroblast-like cells beginning to form at their periphery. By the end of the second week of cultivation the epithelial islets and fibroblast-like cells formed a monolayer. The epithelial cells survived for five weeks. The granular cytoplasm of the epithelial island cells could be well identified on the phase-contrast microcinematographic frames of the young cultures; both epithelial and fibroblast-like cells divided. The mitotic ability of both cell types could be confirmed by their tritiated-thymidine incorporation, too. In young cultures, the fine-structural features of epithelial cells were practically identical with those of the glandular cells in intact glands. In older cultures, the secretory granules in the epithelial cells were lower in number; the localization of the granules at the periphery was predominating.


[High, asymptomatic and persistent thrombocytosis in splenectomized subjects]. The Authors illustrate clinicals evaluations of tree splenectomised patients, whose platelets' counts were normal in the pre-operatory period. The patients had shown, after splenectomy, high (platelets' count upper than 10(6)/mmc), asymptomatic (without hemorrhage and thromboembolism), persistent father four months, spontaneously and progressively decreasing thrombocytosis. Clinical evaluations and blood analysis concern respectively periods of four years and six months, two years and two months, three years and six months after splenectomy. Furthermore the Authors examine the splenectomy's role into thrombocytosis, and remark, on the contrary of inherent literature, that, in some occurrences, the splenectomy produces high, persistent and asymptomatic thrombocytosis.


[Pyogenic granuloma: report of a case].

[Pyogenic granuloma: report of a case]. An instance of pyogenic granuloma in a nine years old boy is reported as well as clinical features, hystology, radiographic report and post-operative result.


A therapeutic trial of maytansine.

A therapeutic trial of maytansine. A phase II clinical trial of maytansine, a stathmokinetic ansa macrolide, was undertaken in 70 patients. The maximally tolerated dose was 2.0 mg/m2 repeated at 21-day intervals. Gastrointestinal and central neurologic toxicity were dose limiting. No myelosuppression was noted. Two patients demonstrated transient responses. Therapeutic results from four other clinical trials were reviewed. Although additional clinical trials may be warranted in patients with bladder and small cell carcinoma, at the dose schedule reported, maytansine does not appear to possess a broad spectrum of antitumor activity. Additional clinical trials should be limited.


Clinical trial methodology.

Clinical trial methodology. A number of recent conferences have emphasized the importance of clinical trials methodology. The most significant of these was the one held in France in January, 1978. Much discussion centered around the use of matched historical controls from the same institution in comparison with randomized, prospectively controlled clinical trials. It was concluded that controlled clinical trials are required to answer comparative therapeutic questions in a convincing manner and that statistical advice is critical at all stages of such trials.


Adjuvant radiotherapy--preoperative, postoperative, or both: a proposal for a new approach. A new approach to adjuvant radiotherapy is presented using a "sandwich technique" of low-dose preoperative irradiation (500 rads) and high-dose postoperative irradiation (4500 rads in 5 weeks) in the treatment of operable carcinomas of the rectum and bladder. The rationale for this approach and the preliminary results of a pilot study in 28 patients (19 with carcinoma of the rectum and nine with carcinoma of the bladder) are presented. This appears to be a very feasible and logical approach to treatment, with very few complications and excellent local control of disease.


Phase I trial of ICRF-159 in combination with 1.3 bis-(2-chloroethyl)-1-nitrosourea (MeCCNU). Both ICRF-159 and methyl-CCNU are agents with antitumor activity against gastrointestinal carcinoma; hence the exploration of this combination for possible synergism. Results of the study involving 19 patients show that bone marrow toxicity is the limiting factor for this combination of drugs. Moreover, a dose of 130 mg/mg of MeCCNU with 800 mg/m2/day of ICRF is well tolerated.


Phase II evaluation of anguidine (NSC-141537) for adenocarcinoma of the colon or rectum. Anguidine was administered in a dose of 5.0 mg/m2 (3.5 mg/m2 for patients with hepatic dysfunction) intravenously daily for 5 days in a phase II evaluation of 19 patients with metastatic adenocarcinoma of the colon or rectum. Courses were repeated every 3 weeks. No responses were observed but five patients had disease stabilization. Toxicity was marked, causing discontinuation of therapy in several patients. Anguidine appears ineffective in patients with metastatic colon or rectal cancer in the dose and schedule used in this study.


Note on the design of multi-institution three-treatment studies. Attention has recently focused on the appropriate use of statistics for the analysis of end results from clinical trials, with a corresponding lack of emphasis concerning the experimental design of such studies. In this paper, a particular design for a three-treatment multi-institution clinical trial is reviewed due to its recent increase in popularity. Although it may appear desirable at first, further investigation indicates that several difficulties may arise in the subsequent analysis and interpretation of the data. Defects of the design are discussed, and an alternative design is recommended.


Cooperative clinical trials and community outreach: the conceptual approach in Northern California. Despite major advances in cancer treatment, one of the major challenges in oncology is the integration of community oncology and clinical research. A balance needs to be achieved between efforts to increase patient accrual into protocols and education designed to achieve minimal standards of care. The planning efforts in Northern California are one approach to the challenge, but it will take years before answers are available.


Treating the untreatables: identifying the somaticizing borderline patient. Both medical and psychiatric services have long been challenged by patients with either clear psychosomatic disease or disease complicated by functional elements. Not only are these patients unresponsive to the usual medical management, but they seem to derive little benefit from the usual psychotherapeutic approach. This paper is intended as an examination of this group of difficult patients for the purpose of: 1. creating a suggestive profile to aid in the identification of such patients; 2. anticipating some of the difficulties experienced by clinicians and institutions responsible for their care; and 3. formulating a framework for understanding the basic difficulty experienced by some of these patients as an expression of borderline personality phenomena.


The relationship between response qualities of life change events and future illness rates. A prospective study over three months explored whether measures of response "qualities" of life change events (e.g., whether the event was positive or negative in its subjective impact) enhance the ability of a simple counting of recent life change events to predict near future illness rates. Thirty-four nursing students were studied. Results confirm previous reports that future illness rates increase positively and significantly in direct relationship to the accumulation of recent past life change events. A simple count of the number of untimely or unexpected life stresses (31% of total life changes) or a simple count of the number of negative life events (53.8%) were as potent predictors as the total count of recent life changes. The total number of times each event occurred did not add to the predictive power of a count of the number of events experienced. Anticipated life events were poor predictors of future illness rates. The subjective life change unit scaling system (SLCU) did not add to the predictive power of a simple count of the number of events. Social support availability did not significantly lower illness rates.


Hedonic deficit in chronic schizophrenia. Forty-two chronic schizophrenic patients were evaluated for extent of hedonic deficit and compared with a demographically matched sample of normals. Schizophrenics rated themselves as experiencing significantly less pleasure on four of ten pleasure factors. When the schizophrenic sample was divided into depressed and non-depressed subgroups, the depressed subgroup was found to account for these differences in pleasure between schizophrenics and normals. Psychobiological implications of these results are discussed.


Treatment of chronic pain in the general psychiatric hospital. Patients with chronic pain present many diagnostic and therapeutic challenges to primary physicians and psychiatric consultants. The authors present a series of twelve patients with chronic pain who were hospitalized on the psychiatric ward of a general hospital. Ten of the twelve patients presented decreased their medication use and were markedly improved at the end of their brief stay. Treatment goals, attitudes and interventions are discussed.


Encopresis in Hirschsprung's disease: a report on two cases. Two patients with persistent severe encopresis after surgery for Hirschsprung's disease were treated with a token economy type of behavior modification therapy. After eight weeks there was very marked improvement, which persisted after discharge home without relapse after four and eight months respectively.


Discourse analysis and the doctor-patient relationship. This article describes a system of discourse analysis, called a "taxonomy of verbal response modes," which can be applied to medical interviews. The taxonomy identifies eight basic categories: disclosure, question, edification, acknowledgement, advisement, interpretation, confirmation, and reflection, which are defined by three principles of classification. The categories are mutually exclusive and exhaustive. Each mode conveys a particular interpersonal intent and also has a characteristic grammatical form. With eight forms and eight intents, the taxonomy includes sixty-four possible verbal response modes, eight "pure modes," in which form and intent coincide, and fifty-six "mixed modes," in which form and intent differ. The taxonomy has yielded fine-grained descriptions of patient-physician interaction and has identified particular types of utterances and verbal exchanges that are associated with patients' satisfaction with their medical interviews. The system provides a detailed descriptive vocabulary that may be useful for teaching interviewing skills.


Narcolepsy with tinnitus aura: interpretation. A fifty-five year old man was admitted to our ward for evaluation of narcoleptic-cataplectic attacks which were signaled by a "hissing sound like high pressure steam leaking out of a pipe." This tinnitus was exclusively localized to the right ear. It started about sixty-to-ninety seconds before the cataplectic episode (affecting mostly the jaw muscles) and lasted through part of it as it became progressively louder toward the end and ceased abruptly. It is postulated that, along with the collapse of tonic musculature of the mandible, a decrease of proprioceptive tone also affected the tensor tympani muscle leaving the middle ear vulnerable to internally generated noise. We further postulate that tinnitus was finally arrested by the generation of phasic bursts of contraction of the tensor tympani and/or the stapedius muscle at a later stage of cataplexy.


Cancer: denial or suppression?

Cancer: denial or suppression? Medical personnel often reach erroneous judgments on the reaction of cancer patients to death and dying. Patients with terminal cancer sometimes will say little or nothing to hospital staff members or other professionals about their fears or expectations. This silence is generally construed as indicative of the primitive defense mechanism of denial. Usually, however, such patients are not truly "denying" cancer and its consequences, but have merely decided, more or less voluntarily, to "suppress" these thoughts as a method of coping with their illness. The medical staff, through careful observation of cancer patients, and through discussions with patients' families, should be able to distinguish between denial and suppression. This distinction can be significant because it enables the staff to understand the patient's feelings correctly, and thereby to provide more effective care. The staff, and the patients themselves, are thus in a better position to orchestrate the patients' various physical, emotional and interpersonal needs and resources optimally.


Pediatric oncology: a review of the changing psychological aspects. This paper outlines the psychological concerns in pediatric oncology. Taking an historical perspective, early concerns pertained to issues of death and dying and what to tell the child about his diagnosis. With the marked improvement in the early diagnosis and treatment of childhood cancer, the psychological issues have changed considerably. There is ample evidence to indicate that psychological problems in the child and his family result from the turmoil from these diseases. However, current concerns may focus on problems of living rather than problems of dying. The child and his family being encouraged to live as normal a life as possible, may need assistance from the professional community in the attempt to achieve this status. This presents an ever increasing need for the health care professional to interface with not only the child and his family, but also with the school and community at large so that the child and his family alone do not shoulder the burden of the normalization process and so that the school and community may be in a better position to assist in the reintegration process.


The physician's work and marriage.

The physician's work and marriage. Medicine and personality characteristics of its practitioners pose for physicians unique hazards to emotional health and marital satisfaction. The attempt to meet too many emotional needs in work may preclude adequate attention to personal and family problems. The physician should be more aware of his own and his family's emotional needs, and be less threatened by less-than-perfect adjustment in himself or other family members. Suggestions include: teaching psychiatry on a developmental and adaptational model; offering marital groups in medical school; and encouraging the process of marital contracting and the use of marital therapy when emotional problems arise in either spouse. The understanding and resolution of emotional distress of one marital partner often requires the involvement of both, as people intimately attached to each other tend to have neither problems nor solutions in isolation.


Some subjective reactions of a behavioral scientist involved in thanatological research. Ethical and pragmatic considerations often preclude the application of classical experimental approaches to in vivo thanatological research. While quasi-experimental and correlational designs may be employed to circumvent a number of potential problems, many more empirically testable research questions simply remain unaskable in the applied setting. Clearly, extra-experimental sources of information are of particular value in such situations. The present paper reports some of the observations and subjective reactions experienced by the writer while engaged in a series of experimental thanatological research studies. The issues addressed include the motivations of thanatological investigators and research participants, personal awareness of death, displacement of grief, anxieties about personal utility, paternalism, and honesty (i.e., frankness) as a primary ethic in facilitating a peaceful, "natural," death in the moribund individual.


The identification of psychiatric morbidity by internists and subsequent selection for psychiatric referral. Past literature raises the question as to the degree of identification of psychiatric morbidity among medical inpatients. A psychosocial information scale was used to rate charts of seventeen inpatients who later received a psychiatric consultation and seventeen who did not during the index admission. More psychosocial items were generally present in the charts with those patients receiving later psychiatric consultation overall and specifically in the areas of psychiatric chief complaint, history of behavior change and past psychiatric history. It was concluded that many patients with psychiatric morbidity on medical wards were not so identified and this was a prime reason for their non-referral, although several of the sub-groups of such patients could benefit from psychiatric treatment. Non-psychiatrists were urged to adopt a more holistic approach to medicine with emphasis on continuity of care to insure comprehensive diagnosis and management.


Who gets referred? Child psychiatric consultation in a pediatric hospital. The authors approach the question, "Who receives a child psychiatry consultation?" in several ways. First, by reviewing the consultation patterns in a pediatric hospital over a five year period as a new array of liaison services were being provided, they found the overall consultation rate decreased. Yet in absolute numbers the referral rate for consultation around diagnostic issues remained relatively constant. This underlines the core importance of the child psychiatry consultant as diagnostician. Second, in matching a group of children receiving a psychiatric consultation against a group of children who did not, the authors found somewhat more psychosocial information recorded in the charts of the former group. However, it is doubtful that this played any direct role in the generation of the referral per se. The authors stress the finding that the pediatric hospital is a medical setting and unless the child's psychological problems impinge directly on that system, such problems are likely to remain hidden and beyond the scope of the consultation process.


Bilateral recording of early auditory evoked responses in the cat. The brain-stem electric responses of the cat evoked by a short 4 kHz tone burst have been differentially recorded between vertex and both ipsilateral and contralateral ear electrodes. Six vertex-positive waves can be recognised in both recordings. Animals with hereditary unilateral anacusis were studied in order to avoid cross-stimulation of the opposite ear. The cochlear microphonic and summating potential can be readily recorded in young animals, occur simultaneously in both tracings, and show polarity inversion at the contralateral electrode. The later neural potentials have the same polarity and practically identical latencies in the ipsilateral and contralateral recordings, whilst the first three brain-stem waves show approximate polarity inversion and variable latency relationships in the two recording situations. It is concluded that none of the brain-stem waves represents electric activity from a discrete generator.


Electrical resistance of the cochlear partition. The relationship between the calculated value of the effective electrical resistance of the cochlear partition and the distance between the electrode for measuring the EP and the stimulating electrodes has been studied. The calculated value of the effective electrical resistance of the cochlear partition declines linearly with increasing distance between these electrodes. The correlation coefficient (r) is -0.806. In calculations of the effective electrical resistance of the cochlear partition, attention must be paid to the distance between the microelectrodes.


Outpatient requests, initial sessions and attrition. Treatment attrition in a psychiatric outpatient department was evaluated. Of eighty-two consecutive new patients, fifty-three (65%) showed up for a second appointment while twenty-nine (35%) failed to return. None of the demographic variables or specific categories of patient requests differentiated continuers from non-continuers; nor was attrition significantly influenced by feeling one's problems were understood, symptomatic improvement or receiving the kind of intervention originally desired. Treatment continuers were more likely to have been referred by other hospital clinics or psychiatric care facilities, and more often had previous outpatient contact, but these differences did not reach statistical significance. The only outcome measures significantly related to continuation were: perceiving one's feelings understood in the initial session, feeling satisfied with the interview, and planning to return for the next appointment. Theoretical and practical implications of these findings are discussed.


Euglycemia: a psychological study.

Euglycemia: a psychological study. A questionnaire study of 197 insulin-dependent diabetics which was supplemented by individual interviews with fourteen of the respondents suggests that few diabetics maintain tight control. Most maintain the level of control at which they are most physically or psychologically comfortable. However, tight control is feasible for the average diabetic. The main factors which impede tight control are difficulty coping with stresses of daily living, eating to satisfy emotional needs, discomfort at euglycemic levels, and fear of hypoglycemia. Re-regulation must therefore employ temporary reduction of life stress, some impediment to snacking, support through the discomfort of altering blood sugar level, and careful monitoring to avoid severe hypoglycemia. A specific type of hospital experience and/or involvement in an outpatient educational and treatment milieu are possible avenues to provide these necessary factors.


A correlation of the effects of normoxia, hyperoxia and anoxia on PO2 of endolymph and cochlear potentials. Change in PO2 in endolymph, endocochlear potentials and cochlear microphonics have been tested in normoxia, hyperoxia and anoxia on 24 guinea pigs. The polarographic method and construction of oxygen-sensitive microelectrodes is described in detail. The normal level of PO2 in endolymph vaires between 20 and 30 mm Hg. One-minute anoxia induced by breathing 100% N2 caused a decline in PO2, EP and CM, but during recovery only PO2 returned with over-correction to the preexposure level. Hyperoxia evoked by breathing 100% oxygen failed to increase the cochlear potentials and the PO2 in the endolymph. This suggests that vasoconstriction most likely occurs proximal to the capillaries bed of the stria vascularis.


The effects of ethacrynic acid upon the potassium concentration in guinea pig cochlear fluids. After i.v. injection of 50 mg/kg ethacrynic acid (EA), potassium concentration in the endolymph (Ke+) measured with K+-specific microelectrodes decreases by 10 mM at the most and endocochlear potential falls to negative values. Potassium concentration in the perilymph (Kp+) generally does not change, but sometimes a transient decrease in Kp+ level of about 0.5 mM was observed, presumably due to the electrogenic effect of the time-related decrease of the endocochlear potential. When anoxia is induced approximately 120 min after EA administration Ke+ slowly decreases. The decrease in Ke+ 50 min after the arrest of ventilation is smaller when compared with the Ke+ anoxic decrease without preceding EA administration. The endocochlear potential, which falls to negative values during anoxia after EA administration, does not return to the zero level as in the case when only anoxia is applied. Similarly, during anoxia, which follows EA administration, the perilymphatic Ke+ concentration increases more slowly than in the case when only anoxia is introduced. It is assumed from the results that EA abolishes activity of the positive electrogenic K+ pump and reduces the passive permeability of the walls of the cochlear duct to the potassium ions.


Cancer: a challenge to clinicians and biomedical scientists. The multidisciplinary study of cancer by clinical and scientific oncologists is discussed. This approach is proposed as the optimal method of improving our understanding of the disease. The future role of general hospitals and of University Medical Schools in creating the appropriate environment for such work is outlined.


Acoustic input to the lateral pontine nuclei. Axon and terminal degeneration were studied in the cat dorsolateral pontine nucleus (DLPN) after lesion of the inferior colliculus. In separate experiments the acoustic responses of 111 units of the lateral pontine nuclei were studied in cats anesthetized with chloralose-urethane. Lesions of all three nuclei of the inferior colliculus (central, pericentral and external) lead to a very similar pattern of terminal degeneration in a discrete region of ipsilateral DLPN. This is suggestive of a highly convergent projection in which topography may be blurred. Most units responded to binaural stimulation, and the most common binaural response consisted of excitatory inputs from each ear which were facilitated at some binaural intensity levels and occluded at others. Discharge rates changed as a result of alterations in the number of spikes evoked at the onset of the stimulus, and sustained discharges were rarely encountered. Units were broadly and irregularly tuned; binaural inhibition was very uncommon. Unit response characteristics suggested that, while the projection from the inferior colliculus was highly convergent, only a subclass of inferior colliculus neurons may be involved. However, the acoustic properties of lateral pontine units were strikingly similar to those of the cerebellar vermis, a region to which DLPN is known to project.


Dvelopment of the Harderian gland in the chicken: light and electron microscopic investigations. The Harderian gland of the chcken develops from epithelial cones of the conjunctiva between the 11th and 12th day of embryonal life. The development of the organ proceeds in two phases. During the stage of epithelial development (days 13 to 17 of embryonal life) the acinar epithelium differentiates into a lumen-adjacent glandular epithelium, and a separate layer of basal epithelial cells. This basal layer is initially compact but later forms a loose meshwork. The basal cells differ from the myoepithelial cells found in the Harderian gland of rodents by virtue of their smaller number of myofilaments; and they resemble the reticuloepithelial cells in the Bursa of Fabricius. On days 17 and 18 of embryonal life the interstitial tissue is invaded by eosinophils and by small 'blasts', up to 4 microns in diameter, both of vascular origin. Between days 17 and 20 the glandular epithelium undergoes secretory transformation. At the time of hatching (day 21), the secretory function is fully developed. The mode of secretion is partly apocrine, partly merocrine. During the following phase of plasmacellular development (from day 17 of prenatal until day thirty of postnatal life) interstitial plasma cells are formed from the immigrant small 'blasts'. Their number increases until the fourth week after hatching; thereafter the plasma cell population remains stable.


An ultrahistochemical study of the placental content of respiratory enzymes in normal and prolonged pregnancies. The placental content of malate dehydrogenase and lactate dehydrogenase has been studied at the ultrastructural level. In the trophoblast both enzymes have a predominantly mitochondrial localization although occasional membrane-bound extra-mitochondrial activity is also seen. As compared with the first trimester placenta, there is a highly significant decrease in the activity of both enzymes within the trophoblast at term; this may represent an adaptative change to reduce placental oxygen consumption and increase the amount of oxygen available to the fetus. In prolonged pregnancies, there is a continued decline in trophoblastic malate dehydrogenase activity but the lactate dehydrogenase activity tends to increase, these changes suggesting that there is a switch from oxidative pohosphorylation to anaerobic glycolysis. It is not clear whether this change to a less efficient mode of energy generation is due to an intrinsic ageing change within the trophoblast or is secondary to placental ischaemia.


[The value of the lymphocyte transformation index induced by mitogens in cervical carcinoma]. Dynamics of immune reactivity in patients with the carcinoma of the cervix was determined. The transformation of their lymphocytes was induced in vitro by phytohemagglutinin (PHA), and the transformation index--a correlate of immunological reactivity--was determined at the following intervals: just before the start of the therapeutic procedure, at the end of the procedure, and every three months afterwards. Very low values of the transformation index, i. e. pronounced immunosuppression, characterized the initial period in all the patients, regardless of either the degree of the disease or the age of the patients. The suppression was prominent during 6 to 18 months following the therapeutic procedures and was overcome earlier in young patients bearing smaller tumors. The results indicate that in tumor-bearing patients a pronounced suppression of immune reactivity occurs after the PHA administration and that it could persist several months after the therapy.


[Comparison of the effectiveness of metal and flexible plastic cannulas in abortion by vacuum aspiration]. A total of 300 abortions were performed--150 with each kind of cannula, selected at random. Except for the cannula, all other elements of abortion were the same and did not change during the whole study. The characteristics of women undergoing abortion did not differ either. The occurrence of complications in women having undergone abortion by the use of metal or the use of flexible plastic cannulas did not differ significantly, the duration of the procedure was the same, but the amount of the tissue exceeding 10 g which was obtained by the subsequent exploration of the uterus was significantly higher with the use of metal than with the use of flexible plastic cannulas. Also the metal cannula got obstructed in the course of the procedure significantly more frequently. The authors conclude that everything considered, the flexible plastic cannula is somewhat more efficacious than the metal one when used for the interruption of pregnancy up to the tenth week of gestation.


[Intrauterine development of newborns of mothers with diabetes mellitus]. The examination of 170 babies born to diabetic mothers revealed that the body weight of these children was by a significant percent higher than that of other babies of the corresponding gestation age. Hypertrophic babies are born more frequently to mothers with manifest diabetes than to those with gestation diabetes. In mothers with the long-lasting disease accompanied by vascular lesions, retardation of the intrauterine fetal growth may occur. In order to improve the condition of these infants, their mothers should be constantly supervised during pregnancy and they should be prescribed adequate diet and therapy. Diabetic mothers also require greater care at delivery and a more liberal attitude towards the application of the cesarean section in order to prevent hypoxia and obstetric traumas of the infant.


[Dynamics of changes in fetal presentation and position in late pregnancy]. The frequency of various presentations and positions of the fetus in individual gestational weeks in the third trimester was examined in 1137 pregnant women based on 1785 ultrasonic findings. Cephalic presentation at 28 weeks was observed in 62% cases and at the end of pregnancy in 95%. Breech presentation decreased from 29% to 4% before delivery, and transverse presentation was 10 times less frequent at delivery than at the beginning of the third trimester. The first and second fetal positions occurred almost equally in both of the main longitudinal presentations. Dynamics of changes regarding position and presentation was examined in 32 patients regularly each week. In 10 of them there was no presentation change and in 22, changes occurred once or several times, tending to attain a physiologic cephalic presentation before delivery. This presentation, once attained, did not change after the 33rd week. With regard to breech presentation, changes are possible even up to the 36th week. The optimal time for ultrasonic examination with the purpose of determining fetal presentation and position is 33-37 full gestational weeks.


[Uterine "glioma"].

[Uterine "glioma"]. In a 23-year-old woman without any subjective complaints a small cervical polyp was detected during systematic examinations. The histologic finding of the removed polyp showed accumulations of gliogenous tissue. This finding is very rare; in the literature available only 27 similar cases are recorded. Most authors are inclined to consider this tissue as implanted by instruments in the course of abortion. The change is considered an entity and uterine "glioma" is reported as the most appropriate term for it.


[Hypocalcemic tetany in pregnancy].

[Hypocalcemic tetany in pregnancy]. Two cases of hypocalcemia tetany in gravidity are presented. The value of blood calcium amounted to 6.9 mg% and 7.3 mg% respectively. Satisfactory results were obtained by the administration of calcium, vitamin D, and diet rich in minerals, in calcium in particular.


[Childbirth in multiparae].

[Childbirth in multiparae]. The authors present problems of multiparity in women with four or more deliveries, by analysing the course of delivery in these women. To this end they made a retrospective study of 299 such deliveries, by comparing them with 100 randomly selected primiparae from the same period. The results have shown as follows: The incidence of multiparae is about 1.04%; multiparae are significantly older than primapare; multiparae have a larger of spontaneous deliveries, whereas directed and induced labour proved more frequent in primiparae; in primiparae there are significantly more interventions in the course of labour (episiotomy and manual revision of the uterine cavity); labour in multiparae lasts less and their offspring has less wight and less vitality (more at risk); stillborns are four times as frequent in multiparae (3.68%) as is the general rate of mortality (0.94%).


[Structural chromosomal aberrations in parents with spontaneous abortions]. In the Laboratory for Human Cytogenetics of the University Hospital Department of Gynecology and Obstetrics in Beograd a cytogenetic analysis of 30 families with spontaneous abortion was performed. In two families structural chromosome aberrations--Y chromosome deletion and 13/14 translocation--were detected. Phenotypic normal male members of one family revealed the same type of deletion of the larger part of the distal region of the long Y chromosome arm (46, X, del (Y) (q12)). In the other family, in a phenotypically normal parent, a balanced translocation (45, XY, t (13/14)) was observed. The authors discuss the correlation between structural aberrations. Yq delation and 13/14 translocation on the one hand and spontaneous abortion on the other.


[Characteristics of the vasculosyncytial membranes in human chorioplacental villi]. The results of a quantitative study of vasculosyncytial membranes in 123 placentas are presented. A low number of vasculosyncytial membranes suggests either villous immaturity or villous regressive changes. A low VSM count as a reflection of villous regression was found in placentas from prolonged pregnancies and, to a lower degree, in placentas from pregnancies complicated by preeclamptic toxemia. The findings are compared with the status of the newborn. Mature babies whose placentas had a low VSM count suffered from a high incidence of hypoxic complications.


[Pregnancy in hereditary enzymatic methemoglobinemia]. The authors describe a case of successful pregnancy in a patent with hereditary enymopenic methemoglobinemia. The course of pregnancy was followed up by the use of ultrasound and the control of CTG, estriol, and pregnanediol. No signs of the intrauterine fetal threat were noticed. The methemoglobin value in the mother's blood ranged from 6.4% at the beginning of pregnancy to 32% at delivery, going down to 2.2% on the third postpartal day. Its reduction was increased by 2.0 to 3.0 g of C vitamin a day throughout all the time of pregnancy. The use of drugs with reduction properties is contraindicated. Genetic analysis of both parents is imperative, because a homozygote newborn could suffer from convulsions. Under conditions of present-day perinatal supervision and adequate therapy, hereditary enzymopenic methemoglobinemia is no contraindication for the performance of the reproductive function.


[Hormone therapy of spontaneous abortion. Our experience with treatment with Gravibinan]. The results of the treatment of 151 pregnancies with threatened and/or habitual abortions by using high hormonal dosages (Gravibinan "Alkaloid") are presented. Eight pregnancies were in primigravidas, the remaining 143 patients having previously had 47 interruptions of pregnancy, 66 deliveries, and 313 spontaneous abortions. Disregarding artificial abortions in 379 previous pregnancies there were 313 or 82.5 per cent spontaneous abortions. The treatment was performed by i. m. applications of Gravibinan, during the first week every two days, during the following two weeks every three days, and until the accomplished 16 weeks of pregnancy every five days. Besides hormonal therapy, all patients were on bed rest; in the following course of pregnancy tocolysis and in the case of opened cervix the cerclage cervicis were performed. The vitality of the ovum and the fetus, as well as the efficacy of the treatment were evaluated by clinical findings, HCG and estriol urinary eliminations, and by ultrasonography. Out of 151 treated pregnancies, 21 (13.91%) resulted in early abotion, 17 (11.26%) in mid-trimester abortion, 6 (3.97%) in pre-term, and 107 (70.86%) in term deliveries. There were two (1.77%) perinatally dead premature infants. HCG urinary eliminations were significantly lower in pregnancies resulting is missed abortion or first-trimenon miscarriage, whereas no difference was established between pregnancies resulting in delivery or mid-trimester abortion. The authors recommend hormonal treatment in early threatening and/or habitual abortions by administering high dosages of estrogens and gestagens. Such a treatment stimulates secretory transformation of the endometrium at the beginning of pregnancy, and this allows early placentation and the uterine growth with a simultaneous quiescence of the myometrium, which, in turn, makes the growth of the ovum possible. The authors stress the importance of a complex procedure in the establishment of the etiology and in the treatment of spontaneous and/or habiutal abortion.


[Late results of several new methods of ureterocystoneostomy]. In 27 women having undergone ureterocystoneostomy by using some of antireflux additives, 21 kidneys retained their normal function and their normal morphology. In none of the 22 followed-up patients (26 organs) did the reflux in the miction cystogram appear. None of the patients died. Recovery even in one-kidney patients was quick.


[The importance of epidemiology for research on pneumoconiosis in Belgium]. Epidemiological surveys of coal workers' pneumoconiosis are only possible by means of periodic X-ray examinations, repeated with a reasonable frequency in order to allow an identification of the first X-ray anomalies of simple pneumoconiosis in exposed workmen. Incidence studies to detect simple pneumoconiosis at its first stages and its progressive increase in cohorts of coal-miners whose dust exposure is known are indeed theoretically the best way to approach these problems. For many reasons, discussed in this paper, such incidence studies are nowadays impossible in Belgium. The survey technique used in our country is based on repeated transversal surveys. Its results are illustrated and commented.


[Dust control in Belgian coal mines. Status at the beginning of 1978]. The present communication gives a general view of the methods of dust control in the Belgian coal mines at the beginning of 1978. The statistical data received from the mines are presented in tabular form. The length and the output of coal faces treated by the classical methods of pre-spraying of the wall, wet cutting, water infusion and wet pneumatic picks, are given separately; in some cases two or more of these technics are used together on the same coal face. The number of stone drivages in which different methods of dust control are used, is also given.


Preliminary study of sex hormones of medical importance in Bangladeshi plants. Twenty six different Bangladeshi plants of folkloric contraceptive use were screened for their oil content, percent unsaponifiables and steroids particularly estradiol, and estrogenic steroids. The distribution of these parameters were studied in seeds, roots, leaves, barks and whole plants. The oil content ranged between 0.23 and 6.75% being highest in Jasminium sacbac (family : oleaceae) seeds. The unsaponifiables varied from 0.04 to 7.87% showing highest content in Xanthium stamanium (roots), and least in Litsea sebifera (Leaves). All plants tested showed positive Salkowski test. Of all 26 plants screened, Synedrella Nodiflora (whole plant), Heliotropicum indicum (root), Belva chal (Bark) and Phyllanthus neruri (whole plant), showed high content of estradiol. Amongst these four, Heliotropicum indicum root showed highest concentration of estradiol.


Disease agents carried by flies in Dacca city. Studies were conducted to determine the different disease agents naturally carried by flies in Dacca city by collecting outdoor unbaited flies from 8 different representative locations and identifying the agents in the laboratory. Out of 96 fly pools containing 25 flies each, 62.5%, 46.9%, 15.6%, 8.3%, 8.3%, 15.6% and 6.2% of the pools were found positive for Ascaris lumbrioeides, Trichuris trichiura, Hookworm, Enterebious vermicularis eggs and Entamoeba coli, Trichomonas spp Giardia spp. cysts, respectively. Similarly, out of the same number of fly pools, 8.3%, 6.25%, 66.6%, 20.8% and 29.2% of the pools were found positive for Shigella flexner-3, Cholera vibrio, Escherichia coli, Staphylococcus aureus and Pseudomonas, respectively besides many other non-pathogenic bacteria.


Some thoughts on the nature of mind. A holistic concept of nervous system function. Some practical neurological ideas concerning the nature of mind are presented to assist clinicians in appreciating the fact that brain physiology first creates and then serves the mind--the highest of the hierarchical functions of the nervous system. The qualities of the mind are shaped and modulated by life experience and many disturbed responses can be tempered by a knowledgeable approach. To gain a holistic concept of the functioning nervous system one must recognize and accept that all manifestations of behavior, including those termed psychological, are the product of physiological processes.


The role of anti-acetylcholine receptor antibody in neonatal myasthenia gravis. An opportunity to investigate the role of anti-acetylcholine receptor antibody (anti-AcH R-antibody) in neonatal myasthenia gravis was presented when an infant was born to a symptomatic myasthenic mother who elected to breast feed the child. Pyridostigmine bromide determinations in plasma and breast milk were made by quantitative gas liquid chromatography. Anti-AcH R-antibody was assayed by an immunoprecipitation method. Simultaneous maternal blood and milk samples did not suggest concentration of pyridostigmine bromide in milk or significant transfer of medication through demand breast feeding. Weakness was not noted in the neonate in spite of high levels of anti-AcH R-antibody demonstrated in her blood. Presence of a markedly elevated anti-AcH R-antibody in a pregnant patient symptomatic with myasthenia gravis does not necessarily predict a clinically affected offspring, nor does the elevated antibody in the infant, presumably acquired transplacentally, necessarily result in clinical symptomatology in the newborn period.


Evaluation and management of spinal cord arteriovenous malformations. This review discusses the classification, pathophysiologic mechanisms, clinical presentation, diagnostic evaluation, and management of spinal cord arteriovenous malformations. Our series of 21 patients with spinal cord AVM's is briefly discussed. The clinical presentation of these relatively rare lesions is varied, and diagnosis and treatment are often delayed. The majority of these lesions can be excised using microsurgical techniques. The key to successful management is early diagnosis and microsurgical removal before severe compromise of spinal cord function occurs.


Doppler imaging of the carotid arteries. One hundred patients with suspected cerebrovascular disease were studied, using Doppler imaging techniques (Dop-Scan), as described by Spencer in 1974. Using a continuous wave Doppler probe, derived images of the carotid vessels and their tributaries were constructed. Twenty-nine of these patients had angiographic studies. A close correlation between Doppler imaging and angiography was found. Although the imaging of the bifurcations does provide useful clinical information compatible to information obtained at angiography, it is necessary to supplement this by analyzing the Doppler signals generated at defined segments of the circulation. Some of the pitfalls of Doppler diagnosis of extracranial vascular disease have been avoided by the dual techniques of imaging and analyzing the Doppler signals directly over the neck vessels. Doppler imaging techniques allow safe, inexpensive, noninvasive studies which are reproducible and reliable. The techniques are easily adaptable to office and hospital practice and have the distinct advantage of saving some patients from angiographic investigation.


Comparative anatomy of the caudate nucleus in different mammals. Volumetric comparisons of the caudate nucleus of different mammals including rat, rabbit, cat, zebra, deer, antelope, bull, horse, dolphin (Stenella graffmani) and human are presented. A linear regression coefficient is obtained with its corresponding correlation coefficient. The results indicate that there is not a close correlation between the size of the caudate nucleus and the brain weight of the different animals studied when the caudate of the horse is included. When it is omitted there is a close correspondence. The caudate nucleus of the horse is extremely large in relation to its brain weight. The possible meaning of this fact is discussed. Measurement of different brain structures is of interest, both from the purely descriptive aspect and because it can suggest phylogenetic relations as well as explanation of functional differences in different animal species (1, 2).


A comparison of single fiber and routine EMG in normal subjects and patients with inflammatory myopathy. We performed electromyography on the vastus lateralis muscle in 36 normal subjects and in 18 patients with inflammatory myopathy using a specially constructed dual electrode. This permitted simultaneous recording of a motor unit from a single fiber (SF) and standard sized electrode surface. We then correlated parameters of the SF potential (jitter, blocking, fiber density and duration) and the motor unit potential (MUP) (number of phases, duration) for different sites within the same individual. The mean values for the above parameters were correlated between individuals, and the group means were compared for the control and the inflammatory myopathy group.


Patient care appraisal as a guide for the design of continuing medical education: 10 years' experience in the Maritime provinces. Patient care appraisal is a process whereby physicians set down criteria and standards of patient care, prepare a summary of relevant health care activities derived from medical records and other sources of data, analyse the shortcomings discovered and design remedial programs. An attempt was made to introduce such a peer review system to 19 community hospitals in the Maritime provinces as a mechanism to improve the quality of health care. Maximum use was made of all existing quality assurance methods, complemented by innovations compatible with known educational and psychological principles. The staffs of the hospitals were willing to participate but problems were encountered in maintaining their motivation. Much of the success was related to the appropriate use of interested and competent medical record librarians in the retrieval, compilation and display of information. A positive attitude towards peer reviews and peer learning evolved in the participants. It is recommended that practising physicians, health care institutions and university divisions of continuing medical education continue and extend such cooperation and find new ways to apply the peer review mechanisms.


Management of confusion in elderly persons. Confusional states in the elderly are not uncommon and demand a high level of diagnostic and therapeutic skills in the physician. An immediate requirement is to provide protection and care while the cause is being elucidated. Tranquilizing medication is useful but the dosage must be both sufficient for the patient to gain control and monitored to prevent overdosage. Confusion may be due to disorder in various body systems with effects on the brain, or to a primary brain disorder. Careful evaluation of general health and also of cognitive, affective and social factors is necessary to clarify diagnosis and management.


Cutaneous vasculitis.

Cutaneous vasculitis. In this paper the current concepts of cutaneous vasculitis are reviewed, with emphasis on clinical patterns, strict pathologic criteria and mechanisms of injury. A plea is made to classify vasculitis not as syndromes but (a) according to organ involvement (limited cutaneous or complicated multisystem), (b) by cause, (c) by pathologic description and (d) by anatomic depth and type of vessel involvement.


Toxic epidermal necrolysis in Stevens--Johnson syndrome. Three cases are described in which Stevens-Johnson syndrome progressed in the course of a few days to toxic epidermal necrolysis. Trimethoprim-sulfamethoxazole, allopurinol in combination with hydrochlorothiazide, phenytoin and possibly ampicillin were implicated in the causation of the disease.


Prognosis for survival in neonatal meningitis: clinical and pathologic review of 52 cases. A retrospective review of 52 cases of neonatal meningitis diagnosed and treated at the Hospital for Sick Children, Toronto, was undertaken to determine which clinical or laboratory features were useful in predicting survival. Escherichia coli and group B streptococci were the most common bacteria isolated. Ventriculitis, cerebritis and arteritis were seen at autopsy with either gram-positive or gram-negative infection. Features associated with a good prognosis for survival were (a) peripheral neutrophil count greater than 2,000 x 10(9)/L; (b) normal platelet count or estimate (more than 100 x 10(9)/L), (c) birth weight greater than 2500 g and (d) age at the time of diagnosis more than 1 day. Information on all four features was available for 44 newborn infants. Of those with three or four of the features 87% survived, while of those with one or two features 14% survived. The overall mortality was 48%. The features outlined are useful in determining the severity of disease and therefore may alert the attending physician to the need for more intensive therapeutic and supportive care.


Immunocompetent cells in malignant disease in man. II. Clinical and immunologic correlates in a case of non-Hodgkin's lymphoma. The immunocompetence of the circulating lymphocytes of a patient with non-Hodgkin's lymphoma was evaluated before, during and after treatment. The immunologic features investigated were (a) the degree of blastogenic transformation induced by phytomitogens (phytohemagglutinin-M, concanavalin A and pokeweed mitogen); (b) the formation of E, EA and EAC rosettes; and (c) antibody-dependent, cell-mediated cytotoxicity. Prior to treatment the subnormal in vitro responsiveness of the cells and the very low concentrations of circulating immunoglobulins suggested immunoincompetence. A gradual shift towards normal in vitro values was observed during treatment, which corresponded to the clinical improvement in the patient's condition.


[Studies on the estimation of the postmortem interval. 8. Burned bodies (author's transl)]. The authors have investigated 15 kinds of findings of 30 bodies burned at known times and autopsied in our laboratory. The conclusions are as follows: As the criteria for determining the time of death, external findings of cadavers burned lose value considerably, but internal findings, especially undigested food in the stomach remain as valuable as in ordinary circumstances. The usual criteria can be applied with the same degree of success to burned bodies, because appearances of findings caused by cadaveric phenomena show neither acceleration nor retardation in bodies burned so far as they are not severely destroyed.


[Behavioral changes in the rats following inhalation of mercury vapor (author's transl)]. The present study was designed to determine critical brain mercury concentrations associated with specific behavioral changes during exposure to mercury vapor. Rats exposed to 3 mg of Hg/m3 for 3 hours, 5 days per week, for 15-42 weeks, showed a decline in conditioned avoidance response. The latency of escape response also increased in pole climb shock escape. The time to the onset of effects varied from 12 to 39 weeks among 14 rats exposed to mercury. All rats recovered to preexposure baseline within 12 weeks after the termination of exposure. A significantly poor behavioral performance was noticed in rats with brain mercury concentration of approximately 20 microgram Hg/g. Behavioral recovery was seen when the mercury concentrations decreased to 10 microgram Hg/g brain tissue. These results suggest that the critical concentration of inorganic mercury in the brain associated with behavioral changes in the rat ranges about 10 ppm to 20 ppm. In spite of the high concentration of mercury, the nervous tissues of rats in this experiment with mercury vapor intoxication were normal.


Heavy metal binding properties of earthworm chloragosomes. The highest concentration of metal in Lumbricus terrestris and Lumbricus rubellus chloragosomes was Ca++ folowed by Fe+++, Zn++ and Mg++. Chloragosomes and body wall extracts bound Pb++ and to a lesser extent Cu++ but not Zn++. Binding of Pb++ and Cu++ was greater in chloragosomes than body wall homogenate. Maximum binding capacity for Pb++ was higher in Lumbricus terrestris than Lumbricus rubellus. The binding of Pb++ to chloragosomes appears to be unrelated to phospholipid content. The release of most Zn++ and Ca++ in chloragosomes by 0.01 M HCl but release of Fe+++ requiring 5 M HCl suggests that the latter may be in the form of an organometallic complex. Release of Cu++ from chloragosomes by 0.001 M HCl but only 20% of the bound Pb++ indicates that Pb++ is more firmly bound to chloragosomes than Cu++. Bound Pb++ in body wall extracts is released by 0.001 M HCl.  The addition of Pb++ to a chloragosomal suspension caused a drop in pH and release of mainly Ca++ with smaller amounts of Zn++ and Mg++ indicating a cation exchange was taking place. It is concluded that earthworm chloragosomes bind heavy metal by a cation-exchange system which may be related to the chemical constituents of chloragosomes being similar to ion exchange compounds.


Effect of Pb++ on Fe+++ tissue concentrations and delta-aminolaevulinic acid dehydratase activity in Lumbricus terrestris. Iron was found at the highest concentration in the chloragogenous tissue with smaller amounts in the intestine and the lowest concentration in the body wall. Earthworms treated with Pb++ for 20 days showed a decrease in the concentration of Fe+++ in the intestinal tissue but no significant changes in the other tissue. The enzyme delta-aminolaevulinic acid dehydratase (ALAD) was not detected in isolated chloragosomes but it was found in the chloragocyte cytosol, body wall and intestine. L. terrestris treated with Pb++ showed a decrease in the activity of ALAD in all tissues where it was located and particularly in the chloragocyte cytosol.


How paradise fish (Macropodus opercularis, L.) explores a chessboard. We investigated the exploratory movements of Anabantid fishes in a chessboard-like aquarium (divided into 25 communicating compartments) as a new environment. The analysis was based on the observation of the route of two inbred strains of paradise fish (Macropodus opercularis; Teleostei, Anabantoidae). We recorded their movement within the blocks until 100 steps, and compared the obtained process with hypothetical random walks. It turns out within the same period of time the fish meets significantly more new compartments than in the simulated process. The discrepancy between the two processes can be interpreted as the result of a successful exploratory strategy of the fish. In this exploratory movement the fish prefers the outer compartments to the inner ones, a fact that explains the striking difference between the actual behaviour and the "uniform simulation". This is obviously so, since the empirical data show that the transition probabilities from the actual compartment to the possible neighbouring compartments differ greatly. However, a model taking this inhomogeneity into account still does not fit sufficiently, indicating that this exploratory strategy is more complicated than our memoryless construction. Moreover, there are differences between the two strains investigated, which might reflect some role of genetic factors.


Identification of epithelial cells and fibroblasts in hypophysis intermediate lobe cultures by scanning electron microscopy. Cell cultures of the rat pituitary intermediate lobe grown for eight days were studied in the scanning electron microscope. The epithelial cells and fibroblasts could be differentiated by the characteristic structures of the cell surface and the cell association features, The epithelial cells were characterized by blebs and rugae, microvilli, and occasionally by some cilia. The surface of the fibroblasts was smooth or bore microvilli. Scanning electron microscopy may provide special information for the characterization of endocrine cell cultures.


Comparative electron microscopic study of clear cells in epidermodysplasia verruciformis and flat warts. Are Epidermodysplasia verruciformis (E.V.) and disseminated flat warts different diseases? Are there any diagnostic criteria between them? In order to attempt answering these 2 questions, fundamental for prognosis and nosology, a comparative ultrastructural study was made of epidermal clear cells of 2 cases of E.V. and 4 flat warts from 4 patients of whom 3 were under immunosuppression drugs. The reason of cytoplasmic electron translucency was mainly a reduction in tonofilaments and keratohyalin amounts in E.V. and a centrifugal edema and vacuolization in flat warts. On the other hand, the number of ribosomes was raised in E.V. and reduced in flat warts. These findings allow differentiation between the 2 diseases and suggest a possible different host-virus relationship.


[Restriction of washing and its effect to the normal human skin flora. Quantitative and qualitative investigations of the aerobic skin flora (author's transl)]. The behaviour of the aerobic skin flora of the flexor sides of the forearms, under a three-week restriction of washing, was investigated in twenty-four patients for its quantitative and qualitative aspects. The combined scrabbing-washing method was used as described by Burtenshaw with Ringer's solution. After a three-week restriction of washing, using the Wilcoxon-Test, statistically no significant changes in the total number of microorganisms were found in areas investigated in the intermittent sampling of the skin flora. A three-week restriction of washing in the region of the flexor sides of the forearms does not induce significant changes in the composition of the normal aerobic skin flora. The percentage of differences in the total number of bacteria fluctuates up to the mark in wide limits; statements about standard deviations are not permitted because of the technical and experimental conditions. There was no shifting of the Resident flora to other groups of bacteria in the patients under study. Pathogenic microorganisms could not be found in higher numbers after the second sampling.


Presence of two typical DNA-binding nonhistone proteins in psoriatic scales contrary to normal human dermis, epidermis and horny layer. The composition of DNA-binding proteins (DBP) was shown to be tissue-specific and to vary at different stages of gene expression. As the accelerated epidermopoesis in psoriasis indicates changed gene activities, DBP of psoriatic scales were compared with those of normal human epidermis, dermis and horny layer. Each skin fraction is characterized by its own DBP pattern, indicating different cell species. 1. The DBP of normal human epidermis shows only a small accordance with the DBP of human dermis and implies their difference in origin, function and cell types. 2. Psoriatic scale DBP and epidermal DPB contain more corresponding proteins which can be deduced from the scale's origin from epidermis. However, the composition of all proteins differs to a great extent. This either occured during parakeratotic keratinization or reflects differences of normal to psoriatic epidermis. Imposing for psoriatic scale DBP are two protein bands with molecular weights of 84,000 and 90,000 daltons. Evidently both are not present in the DBP of other skin layers. 3. The horny layer contains a very small amount of DBP which might represent DNases to a major part. The small DBP content in horny layer confirms the previous supposition of psoriatic scales, to be mostly derived from the preserved nuclei of the parakerototic scale layer.


The effect of systemic treatment with 5-fluorouracil on the epidermis of the guinea pig. The thymidine labelling index and the mitosis rate (blocked by colcemid) in the basal cell layer of the guinea pig were determined before and during treatment with 5-fluorouracil (1 mg i.p. in 2 day's interval/100 g body weight). Additionally, the epidermal area and thickness and the number and size of cells were measured. 5-Fluorouracil equally reduces the thymidine labelling index and the mitosis rate with the full effect after treatment of at least 22 days. From these findings it is concluded that the S-phase--calculated from the end of the thymidine synthesis--is not altered. Furthermore atrophy of the epidermis runs parallel with the reduction of the 3H thymidine labelling index and the mitosis rate.


Acute effect of 8-methoxypsoralen and ultraviolet light on sister chromatid exchange. The acute effect of 8-methoxypsoralen (8-MOP) and 8-MOP + long wave ultraviolet light (UVA) on sister chromatid exchange (SCE) has been examined in an in vitro experiment. The SCE count was significantly increased by 8-MOP without light, but the effect was substantially greater (50%) by 8-MOP + UVA. In addition, mitoses with banded staining of the chromosomes were seen after 8-MOP and UVA. These changes were dose dependent, and they might be responsible for the reduced cell turnover in psoriasis plaque after PUVA.


Acidic glycosaminoglycans in skin and urine of a patient with wide-spreaded lichen sclerosus et atrophicus. Changes of dermal and urinary acidic glycosaminoglycans in Lichen Sclerosus et Atrophicus (LSA) were investigated with the following results: 1. Hyaluronic acid (HA) was excreted in urine of a patient with LSA. 2. HA and low sulfate chondroitin were eluted with 0.5 M NaCl by Bio Rad AG 1- x 2 (Cl- form) column chromatography. 3. Involved dermal tissue contained only about 50% of HA in the skin of a healthy adult.


Faecal porphyrin excretion in various types of porphyria. Thin layer chromatographic study. A new method of thin layer chromatography was used for the study of faecal porphyrins in 31 porphyric patients (20 cases of porphyria cutanea tarda, 5 cases of porphyria variegata, 2 cases of hereditary coproporphyria, 1 case of acute intermittent porphyria and 3 cases of erythropoietic protoporphyria), 14 of their clinically normal relatives and 5 controls. The pattern obtained was characteristic of each type of porphyria and compared to previously published data.


[Physical bases of blister formation. II. A study of the total osmotic pressure in the blister fluid of suction blisters and of "naturally" occurring blisters as well as in the serum]. Total osmotic pressure does not differ significantly in suction blister fluid or in serum of healthy persons from blister fluid, suction blister fluid or serum of patients with dermatitis herpetiformis, bullous contact dermatitis and pemphigus vulgaris. The average values reach about 293 mOsmol/kg. This results from direct measurement of total osmolality with an electronic semimicroosmometer based on the principle of freezing point reduction. In opposite to colloid osmotic pressure the total osmotic pressure does not take part in blister formation of human skin in spite of the different concentrations of the single electrolytes in the fluids of various blisters.


Preliminary studies into percorneal penetration and elemental content of the stratum corneum using X-ray microanalysis. A technique is described which measures the penetration of substances through the stratum corneum (SC) and the distribution of elements in this structure employing scanning electron microscopy and energy dispersive analysis. Preliminary observations show that the normal SC shows a concentration gradient of potassium, high in the surface layers and lowest deeper down whereas the reverse is true for phosphorus. It has been shown that sulphur rapidly tranverses the SC and seems to penetrate through all parts of the horny layer whereas lead and zinc do not easily enter this structure.


The proliferation of epidermal cells in mouse ear organ culture. Mouse ear fragments were cultured for up to 1 day in a chemically defined fluid medium and for 2-3 days in a solid Agar medium. Within 24 h of incubation, the epidermal cells were found to migrate towards the cut edges, a process which led to an epithelialization of the denuded surface. Concomitantly, the epidermal cell proliferation was enhanced: an entry of increasing numbers of interfollicular cells into S phase occurred after 7-10 h of incubation and was maximal around the 20th h. Correspondingly, the mitotic rate rose after 20 h. During an incubation period of 48-72 h in solid medium, the mitotic activity of the proliferating tissues in mouse ear skin continued, and the interfollicular epidermis in the proximity of the cut edges became hyperplastic. Thus, mouse ear epidermis kept in this organ culture seems to resemble a wounded epidermis in vivo. Epidermal cell proliferation was studied by determining (a) the mitotic rate and (b) the incorporation of tritiated thymidine by means of liquid scintillation spectrometry and autoradiography. Various factors affecting the incorporation of tritiated thymidine were investigated, and it was concluded that liquid scintillation spectrometry proves to be a rapid and suitable method for determining the effects of both growth-promoting and growth-inhibiting agents on epidermal cell proliferation.


Comparison of DNase, DNA-polymerase and RNA-polymerase activities present in the DNA-binding proteins of normal human dermis, epidermis, horny layer and psoriatic scales. DNA-binding proteins (DBP) of normal human dermis, epidermis, horny layer and psoriatic scales represent a tissue-specific group of mostly nuclear nonhistone proteins. To analyse their function, the different DBP fractions were examined concerning the presence of DNase, DNA-polymerase and RNA-polymerase activities. DBP of normal epidermis and horny layer contain four different DNases. One DNase of both DBP fractions is active only at pH 5.0. Three DNases of epidermal DBP are active at a pH-range from 5.0--8.5, while the corresponding DNases of horny layer-DBP are most active at pH 7.4. Probably these DNases have changed their pH-optimum during keratinisation. DBP of psoriatic scales include no activity of these three DNases and the pH 5.0-DNases seem to have reduced DNA-affinity. Human dermis DBP contain quite another set of four DNases which hardly can be correlated to the DNases of epidermal DBP. DNA-polymerase activities are present in each fraction and derive from different DNA-polymerases. Two DNA-polymerases with pI-values of 4.5 and 9.3 may correspond to beta- and alpha-DNA-polymerase of eukaryotes, respectively. Further activity of proteins which are focussed at pH 6.5--7.2 and 8.2 could be detected. The proteins represent either tissue-specific DNA-polymerases or further thymidine monophosphate incorporating enzymes. Contrary, RNA-polymerase activity could not be enriched from correlating extracts by DNA-cellulose chromatography.


On the control of microcirculation in the cerebral cortex during and following ischemia. The aim of the present study was the elucidation of the functional behaviour of the pial arteries and their microvascular effectors which are responsible for the microcirculation in the cerebral cortex - large and small pial arteries (PA), sphincters at the offshoots at the pial arteries (SOPA), precortical arteries (PCA) and pial arterial microanastomoses (PAMA) - both under ischemic and postischemic conditions. During ischemia the majority of the studied microvessels underwent dilatation which under conditions of decreased intravascular pressure seems to be active and should be aimed at compensating for the defficiency of the blood supply to the cerebral tissue. Besides, a constriction of some microvessels, especially of SOPA and PCA, was also observed, the amount of such responses of SOPA being increased in the postischemic period. It might be conjectured that the vasoconstrictor responses may be responsible for the ischemic damage of some cortical areas, but it may be also directed to a redistribution of blood to compensate for ischemic changes in individual areas of the cerebral tissue. The active constriction of SOPA in the postischemic period might be also considered as a compensatory microvascular reaction which is directed to restrict the excessive blood supply to the brain tissue and to prevent edema development in it.


Factors affecting the larval growth and development of laboratory-reared Ambystoma gracile (Baird) from natural populations of different temperature regimes. Temperature-transfer of Ambystoma gracile larvae from 11 degrees C to 21 degrees C does not significantly alter growth rates at the higher temperature when compared to larvae continuously grown at 21 degrees C. Temperature-transfer does not alter the incidence of neoteny within populations, even though interpopulation neotenic tendencies differ. Salamander larvae from the high altitude population exhibit larvae from the high altitude population exhibit faster growth rates than the larvae reared from eggs from the low altitude-population. These high altitude larvae exhibit faster growth rates both at the lower and higher temperatures suggesting a greater sensitivity to growth-promoting factors and/or higher rates of synthesis or secretion of such factors. Experiments utilizing ovine prolactin indicated that prolactin-injected experimentals were significantly longer (P less than 0.025) after 60 days of treatment than were placebo-injected controls. A prolactin-like hormone is suggested as thepossible growth-promoting factor in larval Ambystoma gracile.


Histochemical and cytological studies on the resorptive bodies of Poecilocerus pictus Fabr. Histochemical and cytological study of the resorptive bodies in Poecilocerus pictus has been made at different conditions such as just after laying and 15 days after laying and also during different periods of starvations i.e. 4 days, 8 days, 12 days and 20 days. The lecitholytic cells seems to be responsible for the breakdown of yolk. Resorption of the corpus luteum and oosorptive bodies seems to be a similar process. Yolk gets dissolved and is utilised for resorption.


Estimation of normal ranges for various biochemical parameters. Frequency distributions of ten biochemical parameters are reported for a sample (40000 events) of the populations of Milano. Average values and standard deviations have been calculated for the female and male populations, subdivided in four classes of age. The values of the parameters increase with age; generally, except in the case of the rate of sedimentation, the values for the female population are lower with respect to those for the male population.


In vitro culture of thymic epithelial cells from various autoimmune diseases: its thymosin-like effect on human peripheral lymphocytes. We succeeded in the culture of the thymic epithelium which obtained from the patients with various autoimmune diseases aged from 20 to 65 years whose thymuses should have already been involuted with decreased thymic function. The mean percentage of active rosette-forming cells significantly increased after the incubation with thymic monolayer culture medium. These observations suggest that thymic epithelia in autoimmune diseases produce thymosin-like factor(s) in culture medium.


The distribution of haemoglobin S and other haemoglobin variants in a sample of Liberian paediatric subjects. The investigation of haemoglobin S in a sample of Liberian paediatric subjects revealed a relatively low incidence of this haemoglobin variant. There is no significant difference from its incidence in the adult population. The low frequency of haemoglobin S is rather paradoxal since malaria is still endemic in Liberia. Tribal variation has been revealed. Other haemoglobin variants were found to be rare.


Toxic effects of aflatoxin B1 on Bacillus brevis. At a concentration of 50 microgram/ml and below, aflatoxin B1 inhibited Bacillus brevis (2611) bacteristatically, but at a concentration of 100 microgram/ml the inhibition was bactericidal. Bactericidal inhibition was further studied by determining the mean single survivor times of the bacterium in 100 microgram/ml aqueous solutions of aflatoxin B1 (18.2 mins.) and phenol (16.6 mins.). Further study on the bacteriostatic inhibition within the bacteriostatic concentration limit of 50 microgram/ml shows that the doubling time of B. brevis exposed to 5 microgram/ml aflatoxin B1 is approximately half that of the bacterium exposed to 10 microgram/ml. At the molecular level, 50 microgram/ml aflatoxin B1 inhibited the synthesis of DNA (78%), RNA (15%) and Protein (18%) in B. brevis. The strength of the affinity of subcellular fractions of B. brevis for aflatoxin B1 during inhibition was studied by assessing the resistance of aflatoxin B1 bound to cell fractions to removal by water. 66% (w/w) of the aflatoxin B1 bound to B. brevis after six successive washes in 50 ml distilled water, remained bound to the cell membrane fraction. The implication of this preferential strong binding to cell membrane was studied by investigating its effect on oxygen uptake. Results of inhibition of oxygen uptake is compatible with aflatoxin B1 binding to cell membrane. Vitamin k, however, reversed this inhibition.


Observations on the osmotic pressure measurement in cryptonephric insects. Osmotic pressure of the haemolymph, perirectal fluid and of the rectal fluid of four "Species of cryptonephric insects (Tenebrio, Dermestes, Galleria and Pieris) has been measured. In all cases the osmotic pressure of the rectal fluid is much higher than that of the haemolymph and the osmotic pressure of the perirectal fluid is intermediate between these two. The cryptonephric Malpighian tubules increase the osmotic pressure in the perirectal fluid. Consequently between the blood and the rectum there is a chamber which has an osmotic pressure higher than that of the blood but lower than that of the rectum. This higher osmotic pressure in the perinephric chamber enables the modified epithelium to do less work in the absorption of water and nutrient salts from the faecal waste.


[Diaphyseal and articular fractures of the growing skeleton of the hand]. The closed as well as the operative treatment of fractures of the skeleton of the hand during growth must take into consideration the growth potential of the bones. It is particularly important in its potential to correct shortening as well as axial deviation and angulation (except rotational deformity). There are, however, limits to this potential as shown in epiphyseal fractures. Modern internal fixation has, therefore, an important -- though very restricted -- place in the treatment of these epiphyseal fractures. Other rare indications are mentioned.


[Distal radial fracture in childhood].

[Distal radial fracture in childhood]. Injuries of the distal forearm region demand careful examination in children if green stick fractures or dislocations of the epiphysis with spontaneous reduction are not to be overlooked. The treatment should be principally conservative with a plaster splint including the elbow joint following reduction. Exact and repeated radiological controls are necessary because of loss of reduction is not infrequent. Operative treatment is indicated in cases of any obstruction to reduction, inadequate reduction of fractures with epiphysis involvement, open fractures with marked dislocation and for the correction of axial and rotational deformities.


[Treatment of soft tissue injuries of the child's hand]. There are three major facts which differentiate injuries in children and adults: 1. The size of the hand and its anatomical structures which require finer instruments and a meticulous -- almost microsurgical -- operative technique. 2. The better healing and better regeneration following injuries which lead usually to a better functional result. 3. The relationship between scars and growth: a scar will not grow in the same way as normal skin, so that contractures may occur some years after the injury even in areas of the hand where in adults scar contractures may never occur. In this lecture, presented at the 17th Annual Meeting of The German Speaking Society for Surgery of the Hand in Tübingen, several cases demonstrate the general principles and special details in the operative treatment of soft tissue injuries in children. For the skin the correct placement of incisions in reconstructive surgery and the conversion of wounds into suture lines which will not lead to scar contractures are mentioned. Some cases with correction of existing scar contractures and prevention of new ones are shown (fig. 1 to 12). For flexor tendon injuries some of the satisfactory results after primary repair and secondary reconstruction are demonstrated. Also in nerve injuries the better regeneration in children will lead to good functional results following nerve grafting. In irreversible nerve damage tendon transfers are employed by the same technique as in adults (fig. 13 to 15). For the operative treatment of ischemic contractures of the forearm and the hand the different procedures are mentioned. The importance of the intrinsic test (PARKES) for the diagnosis of the contracture of the interossei is stressed (fig. 16 and 17). A case of thumb reconstruction in a four year old girl by transposition of the index finger on a neurovascular pedicle shows that in smaller children complicated reconstructive procedures can give excellent results (fig. 18).