Pre-operative arterial embolisation in renal carcinoma. Nephrectomy for carcinoma is often accompanied by moderate or severe bleeding but this may be reduced by prior occlusion of the renal artery. Embolisation with fresh autologous clot is rendered ineffective by rapid lysis. In vitro experiments showed that the clot could be stabilised by the addition of epsilon amino caproic acid (EACA). By injecting stabilised clot into the renal arterysatisfactory devascularisation of kidney and tumour was achieved in 10 patients.


The management of vesicoureteric reflux in children. One hundred and seventy children with vesicoureteric reflux have been reviewed. Conservative therapy was the treatment of choice in Grade I reflux. Children with Grade II and Grade II reflux treated conservatively developed progressive upper tract dilation and scarring. Unilateral reflux sometimes became bilateral. In addition, the grade of reflux could worsen in the absence of symptoms or overt infection. Cystourethroscopy was an important investigation as an aid to management: the findings of abnormal ureteric orifices in the presence of Grade II and Grade III reflux indicated early surgical treatment. Surgery was also indicated in the presence of ureteric dilatation on excretion urography aand/or micturating cystourography. Vesicouretic reimplantation gave excellent results with few complications.


The long-term follow-up of surgically treated vesicoureteric reflux. We have followed up 83% of a series of 166 patients with vesicoureteric reflux who were treated surgically more than 10 years ago. We found an incidence of hypertension of 12.8%. The need for careful follow-up of the blood pressure of patients with reflux nephropathy is stressed.


Total cystectomy--a review.

Total cystectomy--a review. Anlysis of 99 total cystectomies for malignant disease over a 10-year period in one unit has been carried out, in order to clarify the place of the operation in the overall management of the disease and to assess the quality of life in the patients so treated.


Radical cystectomy for carcinoma of the bladder. A personal series of 50 radical cystectomies has been reviewed to decide whether it is a justifiable operation and, if so, when it should be performed. In spite of the fact that radical cystectomy had a higher operative mortality than simple cystectomy and was sometimes followed by lymphoedema, in patients with invaded iliac lymph nodes it was followed by a 25% 5-year survival. It appears, therefore, to be a justifiable procedure. It is recommended that simple cystectomy should be performed for patients with papillomatosis, carcinoma in situ, and as a salvage procedure after radiotherapy has failed, and that radical cystectomy should be reserved for elective cases in of invasive vesical tumours, and for those patients who are found at exploration to have obvious metastic deposits in the iliac lymph nodes.


The induction of cystitis and the implantation of tumours in rat and rabbit bladders. A method of inducing tumour growth in rat and rabbit bladders is described. Tumour induction is dependent on a pre-induced cystitis. In rats, tumour also grows in the kidneys because of species characteristic vesicoureteric reflux. The possible significance is discussed in relation to the management of human bladder tumours.


The pseudo-obstructed bladder in enuretic children. In a minority of enuretic children with severe day symptoms, and especially when there is urinary infection, there a bladder diverticula and trabeculation and possbily also harmful vesicoureteric reflux which suggest the presence of an infravesical obstruction. However, in 11 children with this syndrome who underwent urodynamic studies, no anatomical or functional obstruction was demonstrable. It is contended that the obstructive signs are the result of uninhibited detrusor contractions being voluntarily resisted by contraction of the external urethral sphincter so that abnormallay high intravesical pressures result. Management involves the use of detrusor-inhibitory drugs. Ureteric reimplantation may be needed for reflux. In the majority of cases symptoms improve with time but the bladder diverticula persist.


Results of caecocystoplasty for tuberculous bladder contracture. The results of caecocystoplasty for tuberculous bladder contracture in 30 patients over a 15-year period are presented. The operative mortality was 3.3%. Poor renal function was not a contraindication to surgery. The results indicate that caecocystoplasty provided relief of symptoms in over 90% of patients. Renal function was preserved and associated obstructive uropathy was usually relieved. Efficient cystoplasty emptying was observed in 80% of patients if detrusor resection was kept to the minimum consistent with a wide caecovesical anastomosis.


The late symptomatic and functional results of enterocystoplasty. A symptomatic and, where possible, urodynamic assessment has been made in 19 patients undergoing enterocystoplasty over a 16-year period. It is suggested that this operation should be considered in those cases of interstitial cystitis and irritable bladder syndrome in which all recognised medical and surgical treatment has failed.


Idiopathic bladder instability treated by biofeedback. Biofeedback training has been used to treat 27 female patients suffering from symptoms associated with detrusor instability Re-education to auditory and visual stimuli took place during 4 to 8 one-hour sessions at weekly intervals. Using subjective and objective methods of assessment 81% of the patients were improved following treatment.


Bladder instability in women with recurrent cystitis. Factors in the aetiology of bladder instability in women with recurrent cystitis are analysed. A multifactorial approach to patient management is advocated and supported by a treatment failure rate of only 3.6% with these patients over a mean follow-up of nearly 2 years.


Bladder rupture: an acceptable complication of distension therapy? Bladder rupture complicating prolonged bladder distension is reviewed. Rupture occurred in 7 of 128 distensions for detrusor instability, in 5 of 34 distensions for interstitial cystitis and in one of 4 distensions for reduced bladder capacity of unknown aetiology. Management of extraperitoneal ruptures should be conservative, intraperitoneal ruptures should probably be explored. Rupture was more likely if the bladder wall was diseased, the distension pressure exceeded 145 cm H2O, and the patient was more than 50 years old. The eventual outcome of prolonged bladder distension was not adversely affected by bladder rupture.


A new self-retaining catheter with triple microtip pressure transducer: the Baghdad modification. A new self-retaining triple microtip pressure transducer on a silicone rubber catheter was assessed on 12 patients with bladder neck obstruction or obstruction at the distal urethral component (external sphincter). The catheter gave reliable and accurate information on pressures in the bladder, prostatic and bulbar urethras simultaneously. It is, however, an expensive piece of equipment and requires delicate handling.


Serial bone scanning: the assessment of treatment response in carcinoma of the prostate. Serial bone scans and radiographic surveys were performed in 167 patients with histologically proven carcinoma of the prostate: 435 scans and surveys were performed. Nineteen of 99 patients with negative findings on diagnosis have become positive on follow-up. Forty-nine patients had positive findings on presentation; 8 have regressed on follow-up and 26 have progressed; 15 have remained unchanged. This is a sensitive method of follow-up in patients with carcinoma of prostate. Changes occurred in bone scans and skeletal surveys before any alteration in serum acid or alkaline phosphatases, symptoms of metastases or change in prostatic size in the majority of cases. The documentation of progression from MO to M1 disease presents no problems. However, problems in quantitation may arise in patients presenting with M1 disease.


An experimental approach to the optimum oestrogen dosage in prostatic carcinoma. The action of diethylstilboestrol on the androgen response mechanism of the human prostate has been examined. A simple in vitro test system that assesses effects on hormone uptake, receptor binding and translocation to the nucleus has been employed. The test has also been modified to study the effect of diethylstilboestrol on the activity of 5 alpha-reductase, the enzyme responsible for the conversion of testosterone to 5 alpha-dihydrotestosterone. These results are discussed in relation to the dosage of diethylstilboestrol for treatment of carcinoma of the prostate.


Urethral injury and fractured pelvis.

Urethral injury and fractured pelvis. In 333 consecutive cases of fractures of the pelvis admitted as emergencies to one hospital 53% were in males, of whom 34 had suspicious clinical signs of urethral or vesical injury. In 15 patients catheterisation was performed uneventfully and in no case did this make the injury worse; in 8 an attempt at primary realignment was performed, resulting in 4 cases without any stricture, and 2 who needed annual dilation only. In 4 additional cases associated laceration of the bladder was repaired of which one had no stricture and 2 needed infrequent dilatations. In a further 41 cases a catheter was used and led to no strictures. Among 67 males with post-traumatic urethral injuries caused by pelvic fracture the best results were seen when the 2 ends were approximated. In 4 cases a stricture was prevented entirely, and in 17 others it led to an easy urethroplasty. Difficult strictures occurred in severe injuries with uncorrected displacement of the soft parts. Where feasible, early surgical repair appears to give the best chance of minimising the severity of subsequent urethral stricture.


Urethral tumours.

Urethral tumours. A series of 33 patients with urethral tumours has been studied to assess the risk of dissemination by endoscopic diathermy. This risk is less than that of cystourethrectomy. Urethral tumours should be treated like the vesical tumours they follow and so closely resemble: by endoscopic treatment while they remain small, sparse and superficial; by cystourethrectomy as soon as they become larger and more extensive. Recurrence of tumour in the urethral stump following cystectomy should always be treated by urethrectomy.


Endoscopic examination in children.

Endoscopic examination in children. Cystourethroscopy is an uncomfortable and often painful investigation for children. It is distressing to the parents, and even when it is done on a day case basis it can cause considerable disruption to the family. It should therefore only be considered when it is felt that the examination will contribute to the management of the urinary problem in the child, and then only after routine assessment including physical examination, urine culture, renal function studies, excretion urography and, where indicated, micturating cystogram. In a study of 242 children who had cystourethroscopy, it was found to be of only limited value in children with enuresis, incontinence, haematuria, recurrent urinary infection and painful micturition. In some children it provided an opportunity for either indirect (from instrumentation) or formal urethral dilatation and this seemed to be associated with post-operative symptom relief in some children. Endoscopy appeared to be of most value in the management of vesicoureteric reflux, upper tract duplication and specific urethral abnormalities. In these situations the examination provided essential information which was helpful with further management of the children.


Idications for testicular biopsy or exploration in azoospermia. Investigation of 311 azoospermic males has shown that the combination of estimation of testicular size and plasma FSH allows the spermatogenic function of the testes to be accurately assessed by non-invasive methods. Patients with small testes and grossly elevated levels of plasma FSH have absent, or grossly impaired spermatogenesis, and do not require surgical exploration. They should be advised with regard to adoption or artificial insemination. Patients with large testes (5 cm) or an FSH level which is not grossly elevated require operation and should undergo a surgical exploration and the possible correction of an obstructive lesion. A testicular biopsy is essential if no obstructive lesion is found as the histology of these patients may show a spermatogenic arrest.


The management of azoospermia.

The management of azoospermia. Azoospermia in the presence of a normally functioning testis and a normal vasogram has been thought to be due to an obstruction in the epididymis between the body and the head. However, bypass operations have been singularly unsuccessful except when there was evidence of past inflammation causing fibrosis of the body and tail of the epididymis. Two substances, glycerylphosphorylcholine and carnitine, which are known to be secreted by the epididymis, were investigated. The results of this preliminary study suggest that they may play a part in the management of patients presenting with azoospermia.


Obstructive azoospermia: respiratory function tests, electron microscopy and the results of surgery. Forty-five patients have been treated surgically for obstructive azoospermia. Fifteen underwent reversal of vasectomy and 40% of the wives became pregnant. Thirty had epididymovasostomy, and in only 2 (6.5%) did the sperm count become normal, although a few poorly motile sperms appeared in the ejaculate in a further 4 patients. Congenital abnormalities of the vasa in 7 cases and post-inflammatory blocks in 4 cases were examples of obstructive azoospermia due to well defined causes. However, in half of the patients (15 cases) the cause was obscure although it was associated with sinusitis, bronchitis or bronchiectasis (Young's syndrome). The results of pulmonary function tests in 30 cases, and electron microscopic studies of cilia from epididymes (10 cases) and bronchial mucosa (2 cases) indicated that the basic abnormality might be malfunction of the microtubules which appeared to be ultrastructurally normal in most cases. One case appeared to be associated with dietary deficiency, and correction of diet coincided with a successful result of surgery.


CT scanning and the surgery of metastatic teratoma of the testis: a preliminary report. Accurate definition of metastases in para-aortic lymph nodes and lungs is essential in planning treatment for patients with testicular teratoma. The addition of CT scanning to routine investigation of these patients has given additional sensitivity in detection and localisation of metastases. The extent of para-aortic metastases could be clearly defined, even when bulk replacement of nodes prevented definition by lymphography. This information was used in planning the best surgical approach for para-aortic lymphadenectomy, which was done as part of combined treatment of large volume metastases.


[Surgical aspects of thrombosis in the portal system (author's transl)]. The Authors present and discuss clinical and therapeutic aspects of several cases of chronic portal thrombosis, troncular and radicular, either isolated or variously associated. Splenoportography and selective arteriography do not always provide a clear-cut picture of the vascular situation, particularly in the presence of mural thrombi. Surgery may be needed as an emergency measure in cases of hemorrhage, but the best results are obtained if it can be done electively. Indications, however, must be evaluated very carefully in each individual case, especially for thrombosis not associated with cirrhosis of the liver, in which the tendency to a more favorable natural evolution may invite a more conservative approach. The choice of surgical procedures is dictated essentially by the site of obstruction in the portal system. After discussing the indications for various methods, the authors present some cases of thrombosis involving only the superior mesenteric vein, managed successfully by disobliteration and mesenterocaval anastomosis.


[Clinical and pathological staging of 85 patients with Hodgkin's disease: a clinical contribution (author's transl)]. This is a retrospective study of 85 patients with Hodgkin's disease undergoing studies of clinical staging. Of these, 28 were investigated by laparotomic splenectomy, which revealed evidence of disease progress not otherwise detectable in 10 cases (36%). The authors also note that cases with an unfavorable histotype are associated with a higher incidence of spleen involvement and a more advanced stage of disease.


[Paraganglioma of the posterior mediastinum (author's transl)]. The authors describe one case of paraganglioma of the posterior mediastinum successfully removed after being discovered accidentally in a young male patient who showed no symptoms attributable to the tumor. The latter was a round mass, about 6 cm in diameter, richly vascular, located in the right costomediastinal gutter. Histologically it was a functionally silent paraganglioma originating from the intrathoracic aortosympathetic paraganglia, these being part of the very numerous groups of the paragangliar system distributed segmentally into metamers, particularly in the adrenal medulla. According to the more recent views, chemodectoma or paraganglioma (chromaffine or non-chromaffine, functionally active or silent) and pheochromocytoma (functionally active or silent, adrenal or extra-adrenal) constitute a group of tumors sharing the same tissue matrix, namely paragangliar cells.


[Behavior of calcemia in breast malignancy. Note I (author's transl)]. The authors report a statistical investigation conducted in 95 patients with mammary carcinoma, designed to show the behavior of calcemia in the course of this malignancy. The data were analyzed statistically by the binomial test, the scatter of values (F test of Snedecor), and the t test of Student. The authors confirmed the existence of a statistically significant alteration of calcemia only in the group of patients with metastasis to bone versus control subjects; conversely there was no significant difference of distribution in the various groups in regard to values beyond those given as normal.


[Complications of lung surgery in the aged: relapsing postresection atelectasis (author's transl)]. The authors describe one case of relapsing postoperative atelectasis occurring with considerable severity after an upper left lobectomy for malignancy in a man of 68. Said complication recurred no fewer than six times during a hospital stay of 44 days and constituted a major threat to the good outcome of surgery. The patient was finally discharged in good conditions, and a later recheck revealed no important alterations in the surviving lower left lobe.


[Our criteria for surgical treatment of acute obstructions of the large gut of neoplastic origin (author's transl)]. The authors review a total of 132 cases of acute neoplastic obstruction of the large gut seen in their clinical material over the last twenty years. In the light of the results obtained they discuss the indications and limitations of the various surgical strategies adopted (radical surgery, derivative surgery, and palliative resection); they conclude that radical procedures are best for the majority of cases.


[Interatrial communications of the ostium secundum type in the adult (author's transl)]. On the basis of personal observations made during their first year of activity in cardiac surgery, the authors review the existing literature concerning surgical indications for interatrial communications in the adult. While they recognize that there is a strong correlation between patient age and mortality, they argue that corrective surgery for such defects can be done also in the older patients, with due regard to limiting criteria relative to pulmonary arterial pressure, pulmonary arteriolar resistance, and cardiac failure.


[Carcinoma of the appendix. Presentation of one clinical case and review of the literature (author's transl)]. After presenting one case of carcinoma of the appendix of their own observation, the authors discuss several aspects of the anatomopathology, clinical course, and diagnosis of tumors of the appendix. From a review of existing literature it emerges that no case of carcinoma of the appendix was ever diagnosed preoperatively. The authors evaluate the difficulties inherent in such diagnosis and recommend some means of investigation that are currently applied to other organs.


[Angiomatosis of the colon; presentation of one case and review of the literature (author's transl)]. Following a brief introduction in which they outline the frequency of colonic angiomatosis and its characteristic symptom triad, the authors describe one case of this condition come to their observation and treated surgically. Next they discuss the classification, differential diagnosis versus other colonic diseases and disorders, available diagnostic aids, and therapeutic resources. They stress in particular the difficulty of diagnosing this condition correctly, to the point where definite recognition is often made only by exploratory laparotomy.


[Surgery in radioactive patients (author's transl)]. The authors discuss some legal aspects and protection problems relative to surgical procedures involving radioactive patients, also in the light of recent European guidelines. They analyse in particular the radiation risk associated with the more common cases concerning radioactive substances that are administered for diagnostic purposes. This study affords a preliminary evaluation of the risk inherent in such surgery, in the light of experimental measurements.


[The acute calculus cholecystitis in the elderly patients. (Prognosis and therapy (author's transl)]. The Author describes 151 cases of acute cholecystitis in patients ranging from 70 to 95 years of age. He examines then the literature on the subject paying attention to the treatment of cases of acute cholecyst disease in aged patients. The Author shows the outstanding features of these cases in synoptic tables and discusses them making a comparison with the materials and results of the colleagues. Leaving necessarily aside the urgent operations a discussion is made on the choice between a cholecyst extirpation and a cholecyst anastomosis. On course, advantages and disadvantages of such operations in aged and weakened patients are taken into account. Death percentage results to be equal to 26,4%, a figure which is not far from that furnished by other statistics, bearing in mind the age of the patients.


[Causes and methods of re-operation in a patient with a jejuno-ileal bypass for obesity]. One case of re-operation in a patient who previously underwent a jejunoileal by-pass for obesity is described. The serious complications following first surgery are shown. Reasons for re-operation and special pre- and post-operative care are considered.


[Surgery of the left renal vein (author's transl)]. The authors offer a review of surgical procedures involving the left renal vein and including some major manipulation (disobstruction, ligature, or change of connections), either as part of a planned operation or as an emergency measure. They stress the concept that the surgical trunk of the left renal vein can be ligated and cut with no permanent functional damage to the left kidney.


[Preoperative assay of creatine phosphokinase as a precaution against malignant hyperthermia (author's transl)]. Following a synthetic description of malignant postoperative hyperthermia, the author recommends the inclusion of serum creatine phosphokinase (CPK) assay in the list of preoperative laboratory tests for all patients scheduled for major surgery. Because this serum enzyme is most often altered in candidates to malignant hyperthermia, the author advocates its preoperative testing in order to identify such patients and make adequate preparations to meet the emergency if its arises.


[Early reoperations in urgent surgery of the abdomen, after interventions on stomach and duodenum (author's transl)]. The problem of early re-operations in urgent surgery of the abdomen is taken into account in the light of a wide range of cases admitted into the urgent surgical ward of the Ospedale Maggiore "Cà Granda" in Milan. These cases refer to the 1950-1975 period necessitating repeated operations. The Author, after analysing the different and most important pathogenetic mechanisms, examines each case tabulating them. In the cases reported, the percentage of the re-operations is less than 20% with a total mortality rate of 33,3%, values which do coincide with the observations of other Authors.


The routine double-contrast examination of the esophagus. Double-contrast examination of the esophagus can be carried out routinely on most patients referred for an upper gastrointestinal examination. Although there are several methods of performing the examination, this author has found the use of effervescent solutions and a low-viscosity barium sulfate suspension to be the easiest and quickest. The technique leads directly into a subsequent double-contrast examination of the stomach. Routine views of the esophagus in a single projection are sufficient with the double-contrast method in most patients. Lesions are readily identified both en face and in profile. If a suspicious area is seen or the patient has dysphagia, multiple views can subsequently be obtained. Such esophageal lesion characteristics are size, smoothness, irregularity, ulceration, wall retraction, and distensibility can be readily appreciated. The technique also lends itself to the study of hiatal hernias and the gastroesophageal junction. This double-contrast esophageal technique has been used with no complications in over 4000 examinations. It is readily mastered by beginning residents.


The air meniscus as a radiographic finding: a review of the literature and presentation of nine unusual cases. In addition to echinococcal cysts and mycetomas, a wide variety of disorders can occasionally produce an air meniscus sign on a chest radiograph. A proposed classification follows: I. Infections A. Lung abscess (with or without pulmonary gangrene) B. Fungus ball C. Bacterial ball D. Tuberculoma E. Blood clot in tuberculous cavity, Rasmussen aneurysm F. Echinococcal lung cyst II. Neoplastic A. Bronchogenic carcinoma B. Primary lung sarcoma C. Metastatic carcinoma, sarcoma to lung D. Bronchial adenoma E. Cystic hamartoma III. Developmental A. Bochdalek hernia (pseudocavity) IV. Traumatic A. Pulmonary hematoma V. Hemodynamic A. Congestive heart failure (with or without bullae)


Effect of lincomycin on the dimorphic chloroplasts of Zea mays L. leaves. The effect of lincomycin treatment on the ultrastructure, and on the absorption and fluorescence emission spectra, of mesophyll and bundle sheath chloroplasts of maize was investigated. The ultrastructural and absorption changes affected mainly the unstacked lamellae (photosystem 1) in the treated mesophyll and bundle sheath plastids, while the fluorescence emission spectra reflect a changed energy transfer between the chlorophyll a forms. The results provide additional evidence for the compositional and developmental similarity of the intergranal lamellae of mesophyll chloroplasts to the membranes of the nearly agranal bundle sheath chloroplasts.


Effect of 2-(3-pyridyl)-1,8-naphthyridine and 2-methyl-3-acetyl-1,8-naphthyridine on chromosomes of germ cells in Poekilocerus pictus (Orthoptera). The cytological effects of two water soluble compounds, viz. 2-(3-pyridyl)-1,8-naphthyridine and 2-methyl-3-acetyl-1,8-naphthyridine, on the chromosomes of the male germ cells of grasshopper Poekilocerus pictus were studied. Of these two compounds, the former was more potent in inducing structural changes in the chromosomes.


Structural transformation and modulation of succinic dehydrogenase activity in the mitochondria of germinating seeds. Ultrastructural transformation of mitochondria in the cotyledons of dry and germinating seeds of Vigna sinensis from the 'orthodox' to 'condensed' forms is coupled with an increasing rise in the specific activity of succinic dehydrogenase (SDH). Apparently, the transformation of mitochondria to the 'condensed' form associated with the utilization of substrate which is reflected in the rise in enzyme activity. During the process of germination, the mitochondria of the cotyledonary cells undergo three different phases namely, (1) activation phase, (2) preparatory phase, and (3) multiplication phase.


Induction of multipolar spindle in Allium sativum. The effect of the polyene antifungal antibiotic aureofungin on the chromosomes of Allium sativum was examined. Mitotic studies showed chromosomal abnormalities of metaphase and anaphase. Besides these anomalies, the alteration of the spindle, i.e. tri- to multipolar condition, was also observed in treatment with 100 microgram treatment for 24 h, and 200 microgram for 12 h and 24 h. The chemical also inhibited cytokinesis; hence, the multinucleate condition was established. Due to fragmentation and unequal distribution of chromatin material, the nuclear volume was also observed to be variable.


Ultrastructural changes in lactating guinea pig mammary gland slices associated with theophylline inhibition of lactose synthesis. Mammary gland slices from lactating guinea pigs were incubated for periods up to 1 h in 10(-2) M theophylline which completely inhibits lactose synthesis. Ultrastructural comparison with control slices shows a significant increase in the size of the Golgi field involving an apparent back-up of microvesicles. Normally distended Golgi cisternae are flattened and contain fewer, less dense, protein granules. Theophylline decreases by 50% both types of secretory vacuoles present: a compact, 300 nm vacuole containing one 250 nm granule, and a swollen, approximately 700 nm vacuole with one or more granules. Changes in granule shape, density and formation were also observed. The findings suggest that the site where theophylline ingibits lactose synthesis may be in the translocation of substances, from the rough endoplasmic reticulum to the Golgi complex, e.g. the specifier protein alpha-lactalbumin which is essential to the lactose synthetase complex. The significance to the role of cyclic nucleotides in lactation is discussed.


A freeze-etching and replication study of wall deposition in elongating plant cells. The architecture of the expanding wall of mung bean hypocotyl (Phaseolus aureus) and collenchyma of celery (Apium graveolens) was examined using freeze-etching without any cryoprotectant, and surface-replication of frozen-ground and air-dried specimens. The polylamellated organization of the wall was seen. Freeze-etching clearly visualized, within one single fracture plans, the intermediate strata in which the microfibril orientation gradually changes between the main transverse and longitudinal directions. They corresponded to the bow-shaped arcs seen with surface replication and conventional microtomy. The organization of newly-formed microfibrils (periplasmic microfibrils) was seen by their imprints on the plasmalemma. When they were being deposited the microfibrils were loose and sinuous though tightly packed, rigid and parallel on the further layers. Therefore it seems that the fibrillogenesis and the spatial orientation of the microfibrils are two subsequent steps. The role of the periplasm in controlling the three-dimensional arrangement of the wall is emphasized.


Neuronal and non-neuronal choline ester hydrolases in the rabbit liver. Biochemical and histochemical methods have been used to determine both activity and distribution of choline ester hydrolases in the rabbit liver. Acetylcholinesterase was detected in kupffer cells, predominantly in th centri- and mid-lobular regions. Neither the activity nor the distribution of acetylcholinesterase activity was influenced by the intravenous injection of zymosan or the iron-dextran complex imferon on at dosages known to stimulate reticuloendothelial phagocytic function. Although this finding suggests that acetylcholinesterase is not primarily concerned with the pocesses of phagocytosis, there exists the possibility that reticuloendothelial acetylcholinesterase may have a function in metabolism of phagocytosed lipids and esters. Butyrylcholinesterase was present in both hepatocytes and the intrinsic hepatic nerves. Polarization of hepatocyte butyrylcholinesterase activity was noted; the enzyme activity being most marked in the centrilobular hepatocytes. Hepatocyte butyrylcholinesterase activity was unaffected by the intravenous administration of zymosan or imferon. The intrinsic hepatic nerves were present only in portal tracts and interlobular septa, there being no evidence for the existence of an hepatic parenchymal plexus. These findings by cholinesterase histochemistry were confirmed by controlled neurohistological techniques. The morphological findings suggest that the intrinsic hepatic nerves regulate blood flow through the organ and are possible sensory to the bile ducts.


Contributions to the karyology of Euconcocephalus incertus and Allodapia aliena (Tettigoniidae, Orthoptera. The chromosome complement of two species of Indian Tettigoniids, namely, Euconcocephalus incertus (2n male = 20A + XX) and Allodapia aliena (2n female = 28A + XX) have been reported for the first time. The former species has two pairs of metacentric and two pairs of submetacentric autosomes, and a pair of metacentric sex chromosomes, whereas in the latter species all the chromosomes are telocentric and the sex chromosomes are very long. The probable occurrence of centric fusions, translocations and inversions during the karyotypic evolution of these grasshoppers is discussed.


A preliminary map of the salivary gland chromosomes of Aedes (stegomyia) aegypti (Culicadae, Diptera). A preliminary map of the polytene chromosomes in Aedes aegypti has been prepared. The preparations were made from the salivary glands of the late 4th instar larvae reared at low temperature. The entire chromosome complement was divided into 45 zones. The chromosomes showed a meshwork of the contents wherein they have a tendency to adhere to each other so as to form a single chromatic mass. The technical difficulties encountered in obtaining suitable preparations have partially been overcome. The banding pattern of Aedes aegypti seems to be quite independent and may be considered as unique for Aedes.


[Symptomatology of inhibition].

[Symptomatology of inhibition]. This essentially descriptive paper deals with inhibition as a symptom or as a behavior pattern and studies the different areas of; inhibition of the intellect (i.e. a decrease in though production witnessed by disorders of language flow), reduced attention span (distractability, inability to concentrate), inhibition of volition (abulia, indecisiveness), memory inhibition (in the sense of selective amnesias, post-crisis amnesias, cyclical amnesias), restriction of the basic drives (which can touch the life principle, the need for sleep, hunger, sexual drive), emotional inhibition including a feeling of inferiority and self-doubt which affects interpersonal relations: in this sense inhibition can also manifest itself in experiences of estrangement and depersonalization. A dynamic study of inhibition should first deal with the presumed relationship between the symptom and a specific pathological process and analysis of the underlying inconscious mecanisms.


[Neurotic inhibition].

[Neurotic inhibition]. Inhibition is a normal neuro-physiologic regulation phenomenon which antagonizes the dangerous aspects of excitation and which facilitates the adaptation of man to his surroundings. Inhibition becomes neurotic: -- when it fails in its normative-connection with excitation. -- when accompanied by anxiety, -- when the subject cannot control it, -- however without blocking all the psychic functions as the psychotic inhibition does. Accompanying symptoms diversify its ways of expression. Contemporary to trauma in neurasthenia, it proceeds from early trauma in psychasthenia and in hystero-phobic neuroses. For some authors, it may be innate, perhaps hereditary. It appears particularly severe, because it lasts when the symptomatology has disappeared during the analytic therapy and it seems to resist more than the excitation to chemotherapies.


[Depressive inhibition].

[Depressive inhibition]. Inhibition is a fundamental concept in the field of depression. It underlies the notion of restraint, and one may recognize in it motor, affective and psychic components. This symptom can be identified from behaviour and actual experiences. Its coexistence with other depression target-symptoms helps to differenciate several clinical forms. It is a preferential symptom, especially at the time of the switch process, for establishing correlations with other parameters, biological and neurophysiological, of depression.


[Anxiety inhibitions].

[Anxiety inhibitions]. At the border of normality and of pathology, anxious inhibitions can have a double function either positive or negative in the psychic balance of the subject. A distinction can be made between: -- the paroxystic anxious inhibitions and stage-fright is a good example of defensive part in front of a menance directed toward the integrity of the Ego, -- and lasting anxious inhibitions, such as intellectual and sexual inhibitions that can induce a true limitation of personality. A psychological and psychopharmacological parallel is evoked about alcohol, a "polyvalent psychotropic drug".


[Schizophrenic inhibition].

[Schizophrenic inhibition]. The term "schizophrenic inhibition" can be related to different phenomenons. On one hand, there are symptoms of inhibition dealing with ideal, affects and motor behavior that are better described in terms of dissociation than simple deficiency. On the other hand, all along the evolution of the psychosis, we can see the onset of depressive syndroms where inhibition seems to be related to different mechanisms. Finally, the existence of deficit evolutions allows us to talk about the notion of deterioration which plays a major role in the history of the concept of schizophrenia.


[Inhibition in neurology].

[Inhibition in neurology]. The author recalls three examples of inhibition in neurology: -- in the somatic sensory area inhibition halo around the excited zone; -- in the organisation of painful perception, inhibition by stages of nociceptive impulses; -- in anterior limbic system, inhibition of excitations without concern with the given operationnal programme. From these three examples, he recalls that inhibition and excitation always go together in the functioning of nervous system; but, between the acceptation of the work inhibition in the two first examples and the third one, an important semantic slipping happens. It squares with the crossing of the clinical level to the physiological level.


[Disinhibition and its risks].

[Disinhibition and its risks]. The authors point out clinically the risks of desinhibition in psychiatry. The classical risk of suicide by suppression of inhibition with melancholic patients is well known and prevented. The main risk for neurotic patients is that of trying to get desinhibition by means of toxicomanic behavior essentially though alcoholism. As far as psychoses are concerned, the risk seems to be mainly that the psychiatrist might misunderstand the concept of desinhibition and make a wrong utilization of desinhibitory treatments. At last, the "institutional" desinhibition constitutes a misunderstanding for psychopathic personnalities.


[Etiopathogeneic aspects of inhibition. Psychodynamic approach to inhibition]. From a psychodynamic point of view it is not sure that the meaning of the term inhibition differs radically from the meaning of the same term when it is used in psychophysiology. It is stated in this paper that the psychodynamic point of view concerns the actions and inhibitions which can be seen as the non activation of an action with the substitution of a deplacement action. Inhibition of actions can be investigated in three clinical fields: intrapsychic and external conflicts, depressive reaction and psychotic lack of energy. It is clear that the psychological mechanism is not the same in the three kinds of disorders. In a second part, the authors try to bridge the gap between the psychodynamic point of view and the psychophysiological one.


[Autism, inhibition, electrophysiology and biochemistry]. The term "inhibition" is not usually employed in the psychopathology of schizophrenia. However, in defining some neuroleptics' action, the work "desinhibition" is currently used and Pavlov explained the main features of the schizofrenic syndrome through a transmarginal inhibition mechanism. The purpose of this study is to investigate if an inhibition process underlies some phenomena shown up by the evoked potentials (EPs) method. Usually, a lower EPs' amplitude is seen in schizophrenic patients than in normals. This phenomenon is displayed by: -- simple stimuli EPs: they show weak amplitude and high variability; -- double-shock EPs: they have a long recovery-cycle; -- conditioned EPs: their amplitude is minimally augmented by coupling the conditioned and the unconditioned stimulus; -- EPs in experiments with increasing-intensity stimuli: their amplitude decreases as stimulation intensity increases. Some of these concurrent data could indicate a transmarginal inhibition, particularly the lengthening of the recovery cycle and the amplitude-reduction phenomenon. Although these are preliminary results, nevertheless some relationships emerge between clemical, electrophysiological and biochemical data.


[Various biochemical aspects of the concept of inhibition in psychiatry]. After measuring the difficulty to relate biochemical data with an essential concept as the concept of inhibition in psychiatry, physiopathological models trying to integrate biochemical, neurophysiological and clinical data are proposed for the inhibition of depressive syndromes and the schizophrenic inhibition.


[Inhibition and antidepressive agents].

[Inhibition and antidepressive agents]. The author distinguishes inhibition as a symptom from inhibition as a processus in the three following situations: a) Antidepressants and melancholic inhibition: the action on inhibition is studied referring to Kielholz classification of antidepressants. The author points out the risk of suicide by suppressing inhibition. b) Antidepressants and chronical psychoses: the author compares effects of antidepressants and stimulating neuroleptics in these syndroms. He thinks that with the two types of psychotropic drugs, one can obtain a desinhibitory effect. But antidepressants can be better used in paranoid personnalities, loss of ego boundaries, and some schizophrenic-like syndroms, when neuroleptics seem to be more desinhibitory in hebephrenics. The author stresses the depressive core in these psychotic personnalities. c) The antidepressant effect has been studied in neurotic depressions. The author describes essentially cases with reinforcement of inhibition as a negative therapeutic reaction by antidepressants. It deals with neurotic depressions evoluting on narcissic personnality back ground.


[The place of carpipramine among the psychotropic agents]. Our purpose is to find objective statistic tests for classification of all psychotropic drugs. First a multifactorial analysis determine six profiles of groups. Results objectively confirm Delay and Deniker's classification and point out intermediate position of carpipramine. A specific method tries to put Carpipramine in one of these groups i.e. discriminant analysis. By this method it is impossible to classify nineteen psychotropic drugs, Carpipramine being one of them. Its clinical properties cannot brin together Carpipramine and other psychotropic drugs.


A comparison of 99Tc and 123I scintigraphy in nodular thyroid disorders. Out of 450 patients referred for thyroid scintigraphy 83 consecutive patients with nodular goitre were selected for dual scintigraphy with 99mTc and 123I. Seventy-four patients had one or more palpable nodules and the other nine patients had palpably diffuse goitres with one or more nodules on the routine 99mTc scintigram. For the comparison of scintigrams an eight level colour display was used, and regional differences between the 99mTc and 123I scintigrams were defined as a minimum of 25% (2 colour levels) variation of the relative activity in well defined areas. Thirteen patients, i.e. 16% of those with nodular goitre, had discordant scintigrams. All 13 patients had non-malignant thyroid disorders, (simple goitre, radio-iodine treated hyperthyroidism, autonomous adenoma, subacute thyroiditis, Riedel's and lymphocytic thyroiditis). The diagnosis was verified histologically in eight of these patients. Eight of the 13 patients had a high 99mTc activity relative to 123I, five patients showed the opposite discrepancy. Another 5 patients with a follicular or mixed follicular thyroid carcinoma had identical scintigrams. These findings indicate that 123I does not offer such diagnostic advantages over the cheap and readily available 99mTc, that its use for routine scintigraphy of the thyroid gland seems to be justified at present.


Scintigraphic methods in the diagnosis of M. Hodgkin. The authors examined 40 patients with Hodgkin's lymphoma suspected from the localization of the process in mediastinum. They used X-ray investigation, radioisotope lung perfusion, radiogold-colloid lymphography and 67Ga-citrate scintigraphy. They found that, when the disease was diagnosed, X-ray examinations including tomography and lung perfusion gave reliable information in only half the cases whereas the other two nuclear medical methods showed positive results in 88% and 82%, respectively. In the diagnosis of relapse, the yield of these former methods was substantially higher, between 82--90%.


Transit time of a radionuclide bolus through inferior vena cava. The effect of an intrinsic block or extrinsic pressure on blood flow through the inferior vena cava (IVC) was studied after rapid injection of 99mTc-pertechnetate or 99mTc-phytate into the femoral vein. Peak-to-peak transit time (PTT) between the curves generated at IVC origin and over the cardiac blood pool was measured in twelve normal patients (PTT = 2.0 +/- 0.7 s) and six patients clinically suspected of circulatory impediment through the IVC (PTT = 3.0 to 30.0 s). PTT measurements augmented the information obtained from sequential scintiphotos of IVC circulation. It is felt that this may be a more objective parameter for follow-up of patients having a progressive, primary disease of this vessel.


99MTc-HIDA, a gallbladder imaging agent: experimental aspects. The molecule N-(2,6-dimethyl-phenyl-carbamoyl-methyl)-iminodiacetic acid (HIDA), capable of chelating reduced 99mTc, was synthesized, characterized, labeled with 99mTc, and studied in experimental animals. The results indicated that the new 99mTc-radiopharmaceutical is rapidly cleared from the blood to the liver, then rapidly removed to the gallbladder and excreted into the duodenum through the common bile duct. A comparative kinetic study of 99mTc-HIDA and 131I-Rose Bengal performed in rabbits demonstrated that both radiopharmaceuticals had a similar blood clearance rate, but cleared at a different rate from liver to gallbladder. 99mTc-HIDA showed a faster accumulation in the gallbladder than 131I-Rose Bengal. These findings, combined with the advantage of the low acute toxicity of HIDA, were promising enough to encourage a further evaluation and clinical investigation of this new Tc-99m hepatobiliary agent.


Factors affecting the preparation of 99mTc-sulfur colloid. Some factors, such as the effect of mannitol as 'stabilizer', increased concentration of thiosulfate, autoclaving conditions, etc., that can affect the preparation of 99mTc-sulfur colloid and consequently its biodistribution into different tissues are discussed. Also discussed are parameters, such as distribution with respect to time, effect of storage, preloading dose, etc., that can influence the uptake of the radiopharmaceutical by the RES in animals and humans.


Clinical results with 131I-toluidine blue and triple radionuclide subtraction for preoperative localization of enlarged parathyroid glands. Clinical results from the application of a triple radionuclide subtraction study for preoperative localization of enlarged parathyroid glands are presented in this paper. A scintillation camera image was recorded after i.v. injection of 131I-toluidine blue. The contributions to this image from activity in the thyroid gland and in blood were determined after recording of additional images (obtained after injection of 99mTcO4- and 113mIn, respectively) using an iterative computer algorithm that also provides an estimate for a uniform background. Subtraction of these contributions gives an image that may be interpreted as an image of the selective accumulation of 131I-toluidine blue in the parathyroids. One or more enlarged glands were correctly localized in 17 of 21 cases, but in four cases there were only false positives. In ten cases the correctly localized glands weighed 900 mg or less.


Radionuclide diagnosis of venous angioma. Venous angioma is a rare vascular anomaly of the central nervous system. Pathologically, it resembles arteriovenous malformation, but the vascular changes are seen only in the veins. In the present case, the lesion was seen better with dynamic rather than static radionuclide examination. In a computerized dynamic study, the circulation time in the lesion was significantly prolonged compared with the circulation time in the symmetrical area of the contralateral hemisphere. The peak of the time-activity curve also appeared later in the lesion area than in the symmetrical contralateral area. Thus the use of the computerized gamma camera is useful in the diagnosis of venous angioma and the method seems to have some differential diagnostic possibilities.


Detection of metastatic thyroid carcinoma after the administration of a therapeutic dose of 131-iodine. A patient with thyroid cancer is described whose metastases were detected only after the administration of a large therapeutic dose of 131 Iodine. This suggests that very high doses of 131 Iodine might permit diagnoses of metastatic lesions not otherwise detected. This phenomenon may be explained by the improved counting statistics which occur with the use of a higher dose of the isotope. In such cases, exceedingly high doses of 131 Iodine might be necessary for successful tumor ablation.


Physiopathological approach to the management of cerebral ischaemia. Pharmacological therapy in ischemic and in microcirculatory and cerebral metabolic damage is considered. In the first case osmotic drugs and membrane stabilisers are useful, i.e., cortisone and non-steroid anti-inflammatory drugs, as well as anti-aminics and spasmolytics. Platelet anti-aggregants and increase in perfusion pressure are also useful in order to prevent the 'no-reflow' phenomenon. In the second case the theoretical possibilities of pharmacological action concern activation of glycogen synthetase and adenylcyclase or inhibition of phosphodiesterase. It will be necessary to remove the lactate increase and to raise the glucose supply, while for the oedema, osmotic and oncotic drugs will need to be used.


Cerebral metabolic, hemodynamic and antihypoxic properties of l-eburnamonine. l-Eburnamonine--16-oxoeburnane--assumes experimental cerebral 'oxygenator' and antihypoxic properties which appear more pronounced than those of vincamine. In anesthetized dogs, l-eburnamonine increases the cerebral oxygen supply and the cerebral oxygen consumption, without cerebral vasodilation; l-eburnamonine improves the cerebral capillary circulation, as observed on the rheoencephalogram. l-Eburnamonine inhibits the effects of hypobaric hypoxia in mice (increase of survival time) and in rats (inhibition of amnesic effects of hypoxia). l-Eburnamonine decreases the electroencephalographic consequences of the acute and iterative asphyxic anoxia in curarized rats and, by means of the protection of the cerebral cortex, inhibits the postischemic increase of thalamic somesthetic evoked potentials in curarized cats. Further studies are necessary to precise the mechanisms involved in these 'cerebral protective' properties of l-eburnamonine.


Therapy of ischemic brain edema.

Therapy of ischemic brain edema. With corticosteroids and diuretics, glycerol treatment may be an effective therapy of early edema accompanying focal brain ischemia. The suggested regimen for intravenous infusion is 500 ml of 10% glycerol solution during at least 2 h, twice a day, starting as soon as possible after stroke onset and continuing thereafter for 5--7 days.


Assessment of pharmacological effects on cerebral blood flow. The effect of various drugs on hemispheric and regional cerebral blood flow (CBF) was investigated in a total of 410 patients. While a few drugs (midodrin, proxazole, vincamine, hexobendine, extract of ginkgo biloba, dextran and ouabain) were able to improve hemispheric CBF, only ephedrine combined with xanthines decreased CBF. For vincamine the dependency of the effect on certain plasma levels was established. Only ouabain of the tested cardiac glycosides effected CBF; their similar hemodynamic actions suggest here an influence of ouabain on cerebral vessels. For the evaluation of drug effects on rCBF the detection of heterogeneous responses is important. Such responses may be quantified by regression analysis. While intracerebral steal effects were observed only under certain circumstances, inverse cerebral steal phenomena may be caused by diverging actions of several drugs. If treatment is aimed at improvement of cerebral hemodynamics, only drugs with a demonstrated effect, at least on perfusion of ischemic regions, should be employed.


Medical therapy of cerebral ischemia. Vasoactive and eumetabolic therapy. After briefly evaluating the contraindications and indications of vasoactive and eumetabolic therapy of cerebral ischemia, the paper considers the main drugs at present in use in therapy of the syndrome induced by diffused cerebral arteriosclerosis. Among the drugs with a mainly vasoactive effect, consideration is given in particular to nifedipine, cetiedil and nicergoline, which induced not only an improvement in the subjective symptoms, but also an increase--which was notable at times--in the sphygmic amplitude of the rheoencephalogram. Where drugs with a mainly eumetabolic action are concerned, xanthinol nicotinate, vincamine and (-)eburnamonine are discussed. The latter, in particular, proved effective in improving intellective recovery and mediate and deferred memory, accompanied by a fair increase in the sphygmic speed and amplitude on the rheoencephalogram.


(-)Eburnamonine in vascular lesions of the fundus of the eye (with 1 color plate). Using photographs of the fundus of the eye after injection of fluorescein and treatment by (-)eburnamonine the authors show the vasodilatation effect of the drug and the unquestionable appearance of circulation flow in the right middle nasal artery which was previously reduced to a silver thread-like aspect.


CBF changes after (-)eburnamonine infusion in patients with cerebrovascular insufficiency. The authors have made a study of CBF after (-)eburnamonine infusion, during angiographic examination of 6 patients with cerebrovascular insufficiency, for a hemodynamic evaluation of the drug efficacy on CBF. The measurement of CBF was done by 133Xe according to the method of Lassen and Ingvar. A correlation between clinical findings, angiographic findings and CBF changes was done to state the employment of (-)eburnamonine in patients with cerebrovascular insufficiency.


Atherosclerotic lesions and mechanisms of cerebral ischaemia. Main causes of cerebral infarction and focal transient cerebral attacks (TIAs) were evaluated. We distinguish between primary thrombosis, secondary thrombosis, and atherosclerotic embolism (platelet emboli-mixed emboli-atheromatous emboli). As to the haemodynamic significance of atherosclerotic lesions, the stenoses must be very tight, i.e., suppress 80--90% of the arterial lumen, for blood flow to be reduced. In clinical trials such a situation is not common and we rarely have found out that a stenosis has caused an infarct or focal TIA by reducing blood flow.


Circulatory and metabolic aspects of cerebral ischemia in experimental animals and in men. In normal conditions, there is a precise link between regional metabolism and blood flow in the brain. In pathological states there may be an uncoupling between CBF and metabolism, due to many mechanisms. In particular, anaerobic glycolisis, membrane depolarization, and altered neurotransmitter release are relevant for the final damage of the tissue. Postischemic recovery was analyzed in experiments with 14C-deoxyglucose. In men, the noninvasive approach with 15O by inhalation allowed the determination of regional oxygen utilization. In TIAs, there is a chronic ischemic condition, while in strokes there is often a relative luxury perfusion.


Clinical aspects of cerebral ischemia.

Clinical aspects of cerebral ischemia. Out of 1,120 cases with focal cerebrovascular lesions, 102 cases (9.1%) were classified as transient episodes under the heading of reversible ischemic attacks (RIA). RIA comprises classical transient ischemic attacks (TIA), clearing completely within 24 h, usually few minutes or hours, and strokes in which a full recovery takes place over an average of 3 weeks. The clinical definition of transient and/or reversible requires a complete negative neurological examination including the normalization of the EEG and brain scan as well as a normal computed tomography. Even multiple transient episodes quite indistinguishable from classical TIA can be brought about by cerebral tumors. TIA are important symptoms, not a disease in themselves. Hypertension and cardiac disease along with carotid stenosis and/or occlusion seem to constitute the main conditions responsible for an evolution from TIA to completed strokes.


Cerebral blood flow in cerebral ischemia. A review (with 1 color plate). In the majority of apoplexy patients the absence of a primary haemorrhage points to acute vascular occclusion with regional ischemia as the initiating event. Yet, in many such cases in particular with transient symptoms, no occlusions can be found angiographically. This along with other evidences suggest that early lysis of the occlusion is frequent. The critical levels of 20 and 10 ml/100 g/min of ischemia are discussed along with the therapeutic inferences. It is concluded that only by emission tomography--the radioisotopic counterpart to CT scanning--will a quantitation of ischemia and of metabolic integrity of tissue areas be possible as a prerequisite for rational therapy.


Retinal angiography in the study of cerebral ischemia. On the basis of the assumption of an affinity between cerebral and retinal vessels, it was sought to demonstrate that the variations induced in the retinal circulation are akin to those occurring at the cerebral level. The technique of retinal fluorescein angiography was used to evaluate the amplitude of the vasal lumen and the speed of circulation. In 5 patients, the drug used was (-)eburnamonine. While the calibre of the retinal arterioles did not undergo variations, a shortening of the mean transit time was observed in 3 of the 5 cases treated, evidencing an improvement in blood flow.


Computerized axial tomography (CAT) in cerebral ischemia. The CAT shows the site, extension and evolution of cerebral ischemic lesions, and implies no risk or pain for the patient. Cerebral ischemic lesions appear as dark, hypodense areas on the brain section planes and are well differentiated from the white hyperdense areas of hemorrhagic lesions. In the territory of the middle cerebral artery the symptomatology is well related to the extension of the lesions, but not to their site when they are 'limited'. At present the CAT is essential for the treatment of cerebral ischemic lesions.


Systolic arterial hypertension and cerebral ischemia. Systolic arterial hypertension in subjects with regional cerebral ischemia is considered and discussed as regards its frequency and its pathogenetic meaning, and criteria concerning the way of treating it. Systolic arterial hypertension presents a very high frequency in these subjects. At times it is accompanied by moderate diastolic hypertension, to which may be attributed, by way of hypothesis, a compensatory meaning. Considering the pathogenesis of systolic hypertension, the antihypertensive drugs at our disposal do not offer any valid and rational indication. We advance the opinion that a lowering of blood pressure in these subjects may be more harmful than helpful.


Indications for surgical treatment of cerebrovascular insufficiency. 197 cases of patients with CVI, subjected to surgery by carotid endarterectomy, are examined. The results were nearly always good and hence the technique is recommended. Particular interest is attached to the risk connected with carotid clamping, through intraoperative study of CBF with 133Xe, such a risk is practically removed.


Acute model for the estimation of the cerebral energy state during or after hypoxia and complete or incomplete ischaemia. The behaviour of fuels (glycogen, glucose), of glycolytic pathway intermediates (glucose-6-phosphate, pyruvate) and end-product (lactate), as well as the pool of labile phosphates (ATP, ADP, AMP, creatine phosphate) and the energy charge of the brain were studied in the motor area of the cerebral cortex of beagle dogs in hypovolaemic hypotension. These parameters were evaluated after acute hypoxia (obtained by altering the composition of the inhalation mixture), after acute hypoxia plus incomplete ischaemia, after acute hypoxia plus complete ischaemia, during post-hypoxic recovery (3, 15 or 30 min after the restoration of normal ventilation), during post-hypoxic recovery and recirculation. A comparative examination of the different conditions showed that the most dramatic fall in the cerebral energy state took place in hypoxia plus complete ischaemia followed, in the order, by hypoxia plus incomplete ischaemia and simple hypoxia. However, reversal was most difficult in hypoxia plus incomplete ischaemia. The different situations are discussed in this paper with regard to the changes taking place in cerebral biochemical events.


Effect of (-)eburnamonine, papaverine and UDP-glucose on cerebral energy state during and after experimental hypoxia and ischaemia in beagle dog. The effect of (-)eburnamonine, papaverine and UDP-glucose intracarotid perfusion has been evaluated in the brain of beagle dogs during various conditions of cerebral damage (hypoxia, hypoxia plus incomplete ischaemia, hypoxia plus complete ischaemia), and after 3, 15 or 30 min of the post-hypoxic recovery and recirculation. The behaviour of fuels (glycogen, glucose), of glycolytic pathway intermediates (glucose-6-phosphate, pyruvate) and end-product (lactate), of the pool of labile phosphates (ATP, ADP, AMP, creatine phosphate) and the energy charge potential of the brain were evaluated in the motor area of the cerebral cortex. The different pharmacological effects of (-)eburnamonine, papaverine and UDP-glucose are discussed with regard to the biochemical changes taking place during the physiopathological conditions tested.


Killed poliovirus antigen titration in humans. To establish the antigen content of a killed poliovirus vaccine sufficiently potent to induce immunity with one or two doses and to establish a reference standard vaccine which has been tested under field conditions, a titration was carried out in infants to determine the amount of each of the three antigenic types of poliovirus vaccine required to induce seroconversion with a single dose. It has been observed that over a critical range of antigen concentration there is an essentially linear relationship between antibody response and quantity of antigen administered. More than 90 percent of the groups studied had detectable antibody after receiving single injections of 80, 8 and 64 D-antigen units of Types I, II and III, respectively. Four-fold less antigen for each of the three types was less effective. The implications of these findings for an efficient immunization procedure are discussed.


The Chilean experience with antipoliomyelitis vaccination. The classical epidemiological picture of poliomyelitis in Chile completely changed in the 70s after the control programme had been steadily initiated in the early 60s. The technical and administrative approaches developed by the programme are presented. The epidemiological, immunological, managing and cost advantages of oral attenuated polio vaccine have proven in the Chilean experience to be highly efficacious when the vaccine is given to a community on the basis of permanent programmes with sufficient coverage. Different technical and administrative strategies in furnishing polio vaccine and the backing of the health infrastructure of the country have proved to be successful in reducing incidence to zero. The active role of the community, the steady and permanent adjustment of the programme, the integration of vaccination activities to a place of prime importance in local health services and epidemiological surveillance are all considered to be highly important in the results obtained.


Paralytic poliomyelitis in the Gaza Strip and West Bank during recent years. Numerous cases of paralytic poliomyelitis occurred during epidemic years and in interepidemic periods in recent years in the Gaza Strip and the West Bank. During the epidemics of 1974 and 1976, more than 100 paralytic cases were recorded each year. The dominant poliovirus was type 1. In interepidemic years, especially in the Gaza Strip, type 3 poliovirus was the prevalent type. The age group affected were infants and children up to 3 years and 50% of cases occurred during the first 12 months of life. Since 1968, oral poliovirus vaccine has been administered extensively to infants, 2 to 13 months of age. Though vaccine coverage was far from being complete, 3 doses of trivalent oral vaccine were given to the great majority of infants of this age group. Many of the paralytic cases occurred in unvaccinated or incompletely vaccinated (1-2 doses) children. However, numerous cases were recovered in children given three and four feedings. Serologic studies carried out on many of the paralyzed children indicated that "vaccine failures" had occurred. It seems that many of the vaccine failures were due to the massive and widespread circulation of various types of interfering enteroviruses. Laboratory tests of vaccine samples returned from the field prove that the vaccines used were undoubtedly of adequate potency. For these reasons we are planning a program of combined use of oral and inactivated vaccine in order to bypass the interference phenomenon.


A two-dose schedule for immunization of infants using a more concentrated DPT-vaccine. In a controlled field-trial in infants in the Philippines, a two-dose schedule with an interval of 6 months between injections using a concentrated adsorbed DPT-vaccine was evaluated. The serologic response against the three components in the vaccine was satisfactory, whereas the side-effects in the concentrated vaccine group did not differ from those observed in a control DPT group. After two injections, the coverage percentage with DPT-vaccine was shown to be higher than 70%. Two implications of the introduction of the two-dose DPT-immunization schedule are discussed, i.e. (a) the possibility of using it as the nucleus of a complete schedule including immunization against poliomyelitis, BCG, smallpox and measles, and (b) the consequences which the interval of 6 months might have on the epidemiological spread of B. pertussis infections.


The cell mediated immune response in acute poliomyelitis and its use in early diagnosis. Specific cell mediated immunity to polio antigens was investigated in 22 children suffering from acute paralytic poliomyelitis by the macrophage migration inhibition (MIF) technique. A positive response was observed in 9 out of the 11 patients tested 1-14 days after the onset of the paralysis and in 6 out of the 8 patients tested between 15-90 days. In one case, the response was positive even before paralysis became evident. Out of the 8 patients tested 90-360 days after paralysis, only 3 gave positive results. No response whatsoever could, on the other hand, be observed in the great majority of children tested 1-3 months after having received oral polio vaccine or in healthy adults. These findings demonstrate that in poliomyelitis the specific C.M.I. response can be detected before the circulating antibodies and suggest that possibility of the use of this technique in the early diagnosis of poliomyelitis as well as in the differentiation between this disease and other neurological disorders.


Improvement in the yield of oral poliovirus vaccine (Sabin strains) produced in human diploid cells. When stationary cultures of human diploid cells in conventional Roux bottles were replaced by the development of cells in roller bottles, the yield of poliovirus, Sabin strains type 1 and 2, showed an increase of 0.5 to 1 log10. No significant difference was noticed in the yield of these viruses cultured in WI-38 and MRC-5 human diploid cells.


[Properties and potency of a rabies vaccine produced on the brain matter of young goats and inactivated by beta-propiolactone]. The vaccine produced by the Institut Pasteur of Algeria consists of a 5% suspension of brain matter of young goats inoculated with the Louis Pasteur Saïgon strain. The suspension is BPL-inactivated, supplemented with a protective agent and lyophilized to a volume of 2 ml. The vaccine loses all specific and non-specific toxicity when injected into newborn mice, adult mice and rabbits. The stability of this vaccine, studied over a period of 24 months at room temperature and 6 months at 37 degrees C, is very satisfactory. The average protective capacity for some twenty batches is 1.60 as determined by the NIH test and 700,000 protective units according to the Habel test. The immunogenicity of this vaccine is evaluated by measuring the neutralizing antibodies in individuals who have been vaccinated for preventive purposes as well as in individuals who have been treated after a possibly contaminating contact. The possibility of reducing the number of injections to 7 + 3 boosters rather than 14 + 2 boosters is discussed in the light of the results obtained.


The stability of bacterial vaccines at elevated temperatures. The requirements for vaccines demand that they be safe and efficacious. The recommended storage temperature for vaccines is 2-8 degrees C, but their conditions of storage and transportation in the developing countries may frequently be far from ideal. This had led to the present study in which several vaccines have been stored at ambient temperature (+24 degrees C) and at +37 degrees C and their antigenic stabilities examined. Under these adverse conditions, typhoid, cholera and the components of DPT vaccines either in final containers or in bulk form have been shown to be stable for extended periods of time.


Stability of freeze-dried and reconstituted measles vaccines. The stability of the titer of live vaccines is a very important factor for successful immunization, especially in countries with a hot climate. For the freeze-dried vaccine, the results of stability tests show that the second generation Rimevax possesses the desired resistance to thermodegradation. In the refrigerator, the shelf life is at least 2 years. Exposure at 20--25 degress C for 1 month, at 37 degrees C for 7 to 14 days or at 41 degrees C for 3 to 7 days results in a vaccine retaining its full immunogenic activity. The value of an accelerated stability test at 37 degrees C for 7 days for the prediction of the potency of each lot is proven. This test should be part of the minimum requirements for live vaccines. The potency of reconstituted measles vaccines is evaluated. Rimevax shows a remarkable stability at higher temperatures. At 37 degrees C, the immunogenic activity is retained for 2 to 3 hours. Reconstitution with diluent at 41 degrees C and subsequent exposure to this temperature does not affect the titer significantly during the first half hour. The comparison of published stability data of measles vaccines shows that Rimevax is one of the most thermoresistant preparations.


Effects of adverse storage on live virus vaccines. A vaccine stored strictly according to the manufacturer's instructions can be used with confidence up to the designated expiry date. However, problems with transport, refrigeration plant, or electricity supply may lead to the exposure of a vaccine under field conditions, and particularly in tropical countries, to high or fluctuating temperatures. We have therefore studied the stability of the standard formulations of our live yellow fever virus, poliovirus and rubella virus vaccines, when they were deliberately exposed to high temperatures, or to alternating cycles of high and low temperatures, intended to simulate such conditions. Our results suggest that with these vaccines, the consequences of adverse storage are not likely to be serious.


The need for quality control in the developing countries. In the developing countries there is a need for greater activity in the quality control of vaccines used in immunization programmes. The establishment of a quality control facility can give assistance not only in the checking of vaccines at the time of release, but also in monitoring the efficacy of the cold chain. Furthermore, the antibody responses of the local child population to the vaccines can be measured. Quality control should be established before vaccine manufacturer, therefore, and the economics of importing vaccine in the bulk concentrated form with dilution, blending and filling locally is worthy of consideration.


[Results of simplified immunization schedules in the developing countries]. The results of studies on the immunization of people in developing countries with vaccines adsorbed on calcium phosphate are presented in this paper. Several programs which were studied with various organizations cooperating and which were intended to simplify vaccination campaigns brought us to the following conclusions: --that immunization against diphtheria and tetanus by two injections with an interval of one year between them is effective, --that two injections of inactivated trivalent poliomyelitis vaccine followed up by booster one year later ensure that 90% of the infants are protected, --that it is possible to vaccinate pregnant women by one or two injections of tetanus vaccine and protect both mothers and newborn babies against tetanus, and --that combined vaccines which enable simultaneous immunization of subjects against a maximum of infections are possible.


25 years of an integrated vaccination program in Chile. Various problems and subjects related to the long Chilean experience in vaccination programmes are reported. Emphasis is placed on proper administrative and planning steps in order to obtain the right epidemiological diagnosis, to develop the infrastructure of health, to support financially, to manage resources, to train personnel, to apply techniques and to evaluate periodically. The advantages of the integration of the programme in primary services are commented on. Epidemiological evaluation and surveillance are considered highly important in the successes obtained. The particular structure of health services in Chile has played a meaningful role in meeting public health requirements for the past 25 years, specifically with respect to vaccination programmes.


Controlled field trials with oral and nasal immunization against tetanus in humans. Under field conditions, the comparative effectiveness of oral, nasal and intramuscular vaccination of humans with tetanus toxoid was investigated. The effectiveness was tested by the determination of antitoxin titers with the L+-method. Oral booster vaccination produced only very low and irregular increases in antitoxin titer even at the highest dose of 6,000 Lf toxoid. In the most favourable case following triple oral immunization, a rise from 6.2 to 6.6 I.U. was achieved. Primary oral vaccination failed to stimulate measurable antitoxin production. After nasal booster vaccination with 1,000 Lf toxoid, a ten-fold rise in antitoxin titer was detectable. Following primary nasal vaccination, an average neutralization titer of 1 I.U. was achieved. The results of intramuscular and nasal booster vaccinations were similar although the antitoxin titers were significantly higher after primary intramuscular vaccination than after primary nasal vaccination. The average antitoxin titer amounted to 11.6 I.U. These results indicate that primary and booster vaccination against tetanus by the nasal route is a safe and effective procedure.


Vaccines and vaccinations in the under-fives in Ghana, a tropical developing country. In this paper, an attempt has been made to focus attention on the important childhood killer but immunizable diseases in Ghana, giving where available morbidity and mortality figures. Immunization schedules currently adopted in Ghana are discussed in the light of immunological considerations, the half-life of acquired maternal antibodies and from the point of view of known epidemiological patterns of these immunizable diseases. An attempt was thus made to justify the adoption of the immunization schedules currently in force in Ghana. Problems relating to some of the vaccines used in immunization of the under-fives in Ghana have been discussed in the light of personal experiences and the experiences of other colleagues, giving--where possible--suggestions for improvement. Finally, the paper delineates problem areas in immunization programmes of the under-fives in Ghana.


[Problems in production, control and utilization of veterinary vaccines in the developing countries]. For a whole series of reasons, most of which are political, the developing countries are following a policy of national self-sufficiency in veterinary vaccines. They are faced with problems at various levels: (1) at the level of logistic distribution, the developing countries suffer from a shortage of trained personnel, frequently lacking in enthusiasm, an often chronic shortage of funds; poorly equipped premises; poor maintenance of sophisticated but indispensable equipment (e.g. freeze-driers); a lack of facilities for cold storage and of distribution channels; field personnel with limited experience; (2) at the level of production, they must contend with difficulties in obtaining supplies of flasks and glassware; irregular supplies of water and electricity; difficulties in obtaining susceptible animals for quality control. The developing countries have found basically pragmatic solutions to these problems, such as the strict separation of the sites, materials and personnel involved in routine diagnosis and those involved in production; temporary foreign technical assistance, with or without financial aid; the use of simple, unsophisticated techniques, which are known to be reliable, even if somewhat outdated; manufacturing in bulk in multiple-dose bottles; research into the thermostabilisation of vaccine strains and the development of thermoprotective diluents for freeze-drying and reconstitution; the extensive use of combined vaccines; the establishment of production and control standards under the auspices of the WHO/FAO/OIE. In spite of these obstacles, the cost price is particularly low (from 0.20 to 0.35 francs per dose), which compares favourably with that of foreign private industry.


[Combined vaccines in veterinary medicine in the developing countries]. It is in the interest of developing countries to have combined vaccines in veterinary medicine, not so much because they reduce production costs, but rather because they increase convenience and efficacy concerning the logistics of prophylactic projects in the field, thus lowering the cost of these projects. Their drawbacks are basically due to the biological compatibility of immunogens (possible immunosuppression by some viruses) and to the interaction of the various components when mixed, or when lyophilization is carried out. Some examples of such associations of vaccines are: (1) cattle plague + pleuropneumonia and possibly anthrax, (2) anthrax + blackleg, (3) sheeppox + anthrax, (4) pleuropneumonia + blackleg, (5) Newcastle disease + fowlpox + fowl typhoid, (6) fowl typhoid + chicken pasteurellosis. Practical results have been most positive and include the eradication of cattle plague - a major scourge of almost all of the African continent - and control over peripneumonia as a first step towards its eradication.


The T1 vaccine used in the control of contagious bovine pleuropneumonia in Nigeria. A lyophilised T1 vaccine was produced by direct lyophilisation of a 72-hour broth culture to which 10% sterile sucrose solution was added. Each vial contained 2 ml to make a total of 10 doses when reconstituted. Each ml of the product contained an average of 109 colony forming units of the organism. When injected at the tip of the tail or subcutaneously behind the shoulder of 2,000 zebu and 1,0000 Ndama cattle, no outward reactions were observed. 12 zebu cattle were vaccinated and challenged 6 months later by direct contact with artificially infected cattle for 4 months. All the animals were completely protected against the disease.


[Hog cholera: active immunity conferred by the Chinese strain vaccine to young pigs born to immune sows]. This paper deals with the comparative development of active immunity in young pigs which were born from unvaccinated sows and from recently vaccinated sows. The development of immunity is expressed by the neutralizing serum antibody titer and protection against a pathogenic virus. The results show that: --the post-vaccinal increase in antibodies is inversely proportional to the titer of passive antibodies at the time of vaccination, --protection at the end of economic life depends on the antibody titer at the time of the challenge, --young pigs born from a mother which is not immune can be vaccinated starting at the age of 7 days, --the percentage of protection at the end of economic life of vaccinated baby pigs with colostral antibodies ranges from 50% when the vaccination was carried out at the age of 7 days to 100% when the vaccination occurs at the age of 2 months.


[Hog cholera: immunization of young pigs with the Thiverval strain vaccine in the presence of colostral immunity]. The vaccination of young piglets, with or without passive antibodies of colostral origin, was studied using the Thiverval strain. The various experiments, carried out under practical conditions, allowed us to observe the following phenomena:--in piglets without immunity of maternal origin we observed a classic primary reaction, with vigourous, lasting production of antibodies and resistance to the challenge;--in piglets with immunity of maternal origin, depending on when the vaccination was administered, the production of primary antibodies was non-existent or deficient; however, we noted that piglets vaccinated 35 days after birth resist the challenge.


[Prevention of animal rabies by an attenuated monovalent or mixed vaccine]. In view of the advantages and disadvantages of the different rabies vaccines, classified according to the production method of the virus and according to their nature - activated or inactivated - the choice of an activated vaccine produced on cell cultures is particularly justified for developing countries. The production of this type of vaccine, as well as the methods and results of the activity and innocuity controls are shown in detail. The interest of combined vaccines for certain developing countries, particularly the combined vaccine rabies/foot-and-mouth disease for ruminants, is stressed. The use of this type of vaccine on a vary large scale (more than 20 million doses up to this date) has given complete satisfaction. It should be noted that the same principles have been successfully applied to the realisation of a vaccine for human use, which can be administered before as well as after contamination.


Oral immunization of dogs against tetanus, diphtheria and pertussis. Mongrel dogs were revaccinated three weeks after basic parenteral immunization with a DT-vaccine with 3 X 3 capsules of an enteric coated oral vaccine, which contained 500 Lf in each of the capsules. When there was a basic titer of 0.005 IU/ml serum, the titer went up to 10 IU/ml by oral vaccination. Similar levels were obtained when lozenges containing the same amount of toxoid were used for revaccination. A twofold buccal vaccination without preceding parenteral vaccination yielded no protective titers. Also a parenteral basic immunization with a diluted DPT-vaccine, followed by oral vaccination with enteric coated capsules, containing a soluble pertussis vaccine, resulted in no titers measured by bacterial agglutination test. In the cases of diphtheria and tetanus only part of the animals showed elevated titres after oral vaccination and protective titers could only be reached if rather high amounts of toxoids were administered orally. It can be concluded from the results that an oral revaccination does not confer protective immunity comparable to that conferred by parenteral vaccination.


Toward the development of a standard reference cholera antitoxin. The need for a reference cholera antitoxin to serve as a standard for the calibration of cholera enterotoxin and toxoid as well as for measurement of the antitoxin response in animals and patients was recognized by the NIH Cholera Advisory Committee, NIAID, DHEW, USA. Two cholera antitoxins have been used for several years as provisional references, but neither was considered to embody all of the properties of an ideal standard. Accordingly, a lot of cholera antitoxin was prepared by immunization of goats with a formalinized, highly purified cholera toxin adsorbed on aluminum phosphate adjuvant. Booster injections were given at 8, 16 and 24 weeks. Plasma samples obtained from the 25 to 27 week bleedings were converted to serum, pooled, and freeze-dried. This serum possessed both high and constant toxin neutralizing activity in rabbit skin, rabbit ileal segment, mice, Y-1 adrenal cells and Chinese hamster ovary cells, and had high avidity by the rabbit skin assay. Hemagglutination tests gave identical values. It was shown to be highly specific by gel diffusion, but flocculation was relatively poor. On the basis of specificity, high avidity and toxin-neutralizing capacity this goat antitoxin (NIH Lot 1) was considered superior to previous provisional standards and is proposed as a satisfactory standard reference reagent.


[The passive hemagglutination test in the evaluation of antitetanus immunity]. The conditioned, passive hemagglutination method, which is simple, quick, economical and very sensitive, is suited for large-scale studies in which it is not possible to carry out the in vivo seroneutralization. However, our experience has confirmed that it has certain drawbacks and restrictions: (1) the technique must be applied very carefully and good laboratory training is required. The results obtained by this method vary according to several factors, especially the degree to which the antigen has been purified and its blood carriers, therefore these results are not always consistent; (2) the antibodies found were not a good indication of the degree of protection except at high titers. A study of correlations between HA titers and neutralizing (mice) titers carried out on the basis of 509 double titrations has demonstrated that, whereas they are satisfactory in clearly immune subjects, they show only mediocre results in subjects who are receptive or who are displaying a primary response: a wide range of variation has been observed as well as an optimalization of HA titers, perhaps because of IgM's. Therefore, the HA method, despite its usefulness, cannot provide precise evaluations for: --the amount of protection provided by an anti-tetanus vaccine, --the proportion of protected subjects in a certain group of people, --an injured person's anti-tetanus immunity. We should work to develop in vitro tests which are both sensitive and reliable in terms of the anti-tetanus protection threshold.


A consideration of some methods by which the cost of potency assays for diphtheria and tetanus vaccines might be reduced. Although recommended by WHO the high cost of parallel line quantal response assays for diphtheria and tetanus vaccines has retarded the introduction of comparative assays for these vaccines in developed countries and for the same reason is likely to discourage the introduction of adequate control standards in developing countries. These costs are mainly due to the large numbers of animals needed to obtain adequate precision when responses are assessed simply in terms of death or survival. The use of intradermal challenge scores for diphtheria and of semiquantal scores based on the onset of symptoms for tetanus together with the prospects for use of the same animals for both assays are discussed. Data are presented to show that the adoption of such methods would increase the information available from each animal and so reduce the number of animals required for the satisfactory standardization of diphtheria and tetanus vaccines.


BCG complications: an analysis of 36 cases. BCG administration is known to be a safe procedure. However of late, with increased immunization activities, a few complications following BCG administration have been noted and reported. 36 cases of BCG complications observed over a 4-year period were analyzed by age and sex distribution and by severity of lesion. The most common forms of lesions seen were localized subcutaneous abscesses and regional lymphoadenitis. More serious forms of complications such as mediastinal involvement, BCG lung infiltration and BCG papillitis occurred less frequently.


[Screening of hypertension in a community. Data from the "Camposampiero Project" (author's transl)]. During the initial phase of the international "Community Control Programme of Hypertension" sponsored by W.H.O., and carried out in Italy by the Clinica Medica II of the University of Padua, a random sample of 5852 subjects was screened (11% of the whole population). The response rate was of 75.3%; the prevalence rate of hypertension (160 or 95), based on casual blood pressure readings, was 29.5%. Measures of the control of hypertension and other relevant results are:  a 35.6% of all hypertensives were aware of their condition, and of these 41% were under treatment. Effective treatment of hypertension was seen in one 12.3% of all treated hypertensives (values lower than 16/95), while 14.2% of all hypertensives had values at or above 200 (systolic) or 120 (diastolic). 98.2% of all hypertensives were not under effective control. As a whole, control of hypertension was better in women and in elderly patients.


[Segmental anatomic diagnosis in congenital cardiac anomalies. II: Sequential localization of the cardiac chambers (author's transl)]. The approach to the diagnosis of congenital heart disease, based upon the identification of the cardiac chambers, the reconstruction of their sequence and final recognition of the basic circulatory model is discussed. Three cardiac segments are recognizable embriologically, anatomically and functionally: atria, ventricles and great arteries. Connexion is the sequential link of these segments, independently from their spatial relationship. Situs of the atria can be: solitus, inversus or ambiguus, and is determined by the thoracic situs which can be assumed from the bronchial anatomy. Atrio-ventricular connexion can be concordant, absent or double inlet ventricle. Ventricular-arterial connexion can be concordant, discordant, double outlet ventricle or single outlet heart. Since this approach aims to the reconstruction of the connexion among the cardiac segments, heart position and the infundibular anatomy are not relevant to the recognition of the circulatory model.


[Polycardiographic researches on over 90 years old subjects (author's transl)]. In the recent years an increasing attention has been focused on the systolic time intervals (STI) as reliable indicators of left ventircular contractile performance. As regards the diagnostic usefulness of STI in old persons only few papers can be found in the literature, all of them being concerned with subjects aged less than 90 years. With the aim to assess the usefulness and the reliability of the method and the caracteristics of left ventricular function in the tenth decade, STI as well as heart volume (HV) were determined on a group of 35 subjects aged 90 years and over (mean age 93.2 years) normotensive and free from clinical evidence of heart disease. STI (PEPI, LVETI, QS2I, PEP/LVET) values showed no differences with those considered as normal. A marked increase was recorded for the HV values. These results suggest that in the very advanced age a good level of left ventricular contractile performance can be mantained by the compensatory mechanism represented by heart dilation according to the Frank Starling principle.


[99m-Tc selective angiocardiography for evaluation of left ventricular function (author's transl)]. The Authors describe a method for isotopic left ventriculography and particularly the elaboration used in order to obtain washout curves expressive of left ventricular function. First pass left ventriculography is an appropriate method. It produces more exact end-diastolic outlines, identifies valvular rings and has a minor background compared to gated ventriculography.


[An echocardiographic study of the anatomo-functional alterations of the left ventricle in patients with different degrees of systemic hypertension (author's transl)]. An evaluation of the functional state of the left ventricle through an estimate of the mean Vcf (Vcf) and the ejection fraction (EF) was made i- 30 patients, subdivided into groups according to average blood pressure rate, degree of severity of the retinographic alterations and ECG pattern. In addition, the thickness of the interventricular septum (S), the posterior wall (PP) and the S/PP were measured. Lastly, the mass of the left ventricle was determined through the following formula: mass = (h1+h2+Dd)3 -- Dd3X1,050. Only one patient was under treatment with beta-blocking drugs, and no patient presented clinical symptoms of cardiac decompensation. The Vcf and the EF did not deteriorize when the hypertensive pattern worsened, while there was an expansion of the thickness of the S and an increase in the mass of the left ventricular. The increase of the ventricular mass, however, was not always found to be associated with normal functionality, nor was an increase of the mass always present even in cases of highly evident hypertension. It is likely, therefore, that other factors not taken into consideration (time factor, for example) play an important role in determining the functional state of the left ventricle and degree of hypertrophy.


[Evaluation of the radiological exposure for medical terms involved in haemodynamic examinations (author's transl)]. The radiation exposure of the medical team involved in 35 consecutive cardiac catheterisation procedures performed at the Istituto di Malattie dell'Apparato Cardiovascolare, University of Bologna, was calculated. A mapping of the iso-exposure lines and the values of radiation exposure of each component of the team were determined for each procedure. With these parameters the total amount of radiation for a normal diagnostic activity coul be calculated. The mean values obtained (150-250 mR/week) were in the range of the maximal values permitted to medical teams professionally exposed to the risk of radiation (3R/13 weeks). Rotation of the components of the team granted a continuing diagnostic activity within the limits of radiation exposure imposed by the law. An evaluation of the different procedures and techniques indicated coronary arteriography as the procedure with a higher risk of radiation (M = 50 mR/procedure) and pointed out the mechanism involved in order to obtain a considerable reduction of radiation exposure.


[Electrocardiographic records via telephone (author's transl)]. 666 electrocardiographic records have been transmitted via telephone from the peripheral Sections of the Cardiology Service of the Arcispedale S. M. Nuova of Florence to the central Unit, during the period november 1976 - June 1978. Transmitters were situated respectively 3, 5 and 15 kilometers from the central set where one or more cardiologists were available along 24 hours. Since the introduction of such tecnique faster electrocardiographic diagnosis in emergency calls was made possible and the immediate presence of a consultant cardiologist in the peripheral Sections required only in exceptional cases. Records of good quality are usually transmitted by this instrumentation (OTE Biomedica, Modello 1181-82) which requires only a minimum of knowledge of electrocardiographic tecnique. Lowering of the conversion voice at either end is avoided by disconnecting the transmitter and the receiving sets at the end of the recording procedure. The low price of such equipment favourably compares with the benefits of its use.


Lectin binding sites in glia of birds and mammals. Concanavalin A binding sites are studied in sections of nervous tissue from Central Nervous System of birds and mammals, paying special attention to the glial cells. The Con A-PO-DAB sequence for glycoproteins demonstration described by Bernhard and Avrameas (1971) was used. The highest concentration of Con A binding sites is demonstrated in the cells of the interfascicular oligodendroglia. Positivity resulting with the use of the Con A-PO-DAB serquence is much intenser in the oligodendroglia cells than in neurons. Ependymal cells also showed positivity specially at level of the perinuclear region. The intercellular space also presented Con A binding sites. All the cells of the interfascicular oligodendroglia presented the same characteristics, both in diverse localizations of the Nervous System of a certain species and in the different species studied.