[Progressive enlargement and thrombosis of an anterior communicating artery aneurysm. Clinical, radiological and histological study (author's transl)]. A non operated aneurysm of the anterior communicating artery enlarged considerably over a seven years period; it finally thrombosed and behaved like a suprasellar tumor. The clinical course, the angiographic evolution and the anatomical examination allowed, in this case, to account for the increase in volume by progressive stretching of the wall, and not by incorporation of a false aneurysmal sack resulting from an encapsulated haematoma. Histologically, the wall of this giant aneurysm showed various changes : on the inner aspect, progressive thickening occurs, due to fibrous organization of mural thrombosis; in the depth, far from the nutrient sources, necrotic atheromatous like foci occur, which isolate an inner leaflet, prone to become nectrotic at a later stage. Distension of such a weakened wall may lead to several consequences; a progressive increase in volume of the aneurysm, partial ruptures with haemodissection starting from the aneurysmal lumen, or even complete rupture of the wall and subarachnoid haemorrhage. On the other hand, circulatory stasis, due to the important increase in volume, may facilitate progressive thrombosis of the aneurysm. The living character of the wall is emphasized by the coexistance of these unfavourable (degeneration, ruptures) and favourable (thrombosis, fibrous organization) features, which continuously influence the spontaneous evolution of the aneurysm.


[Post-traumatic arteriovenious fistula of the posterior fossa (author's transl)]. The authors report a case of post-traumatic arterioveinous fistula of the dura-mater associated with an extradural hematoma of the posterior fossa. The traumatic nature of the lesion is confirmed by the presence of an occipital fracture facing the fistule responsable for the extradural hematoma. The authors have found on similar case citied in the literature (11).


[A Study of the enzymes of the alkaline phosphatase in commercial sera (author's transl)]. We have examined alkaline phosphatase in five commercial sera employing three analyzers. Alkaline phosphatase in three samples is underestimated or overestimated according to the analyzers used. Therefore we have studied the isoenzymatic fractions employing the fractionation of alkaline phosphatase on celluloseacetate. Alkaline phosphatase isoenzymes have physical and biochemical marks different from human sera. In human sera on the contrary have not noticed any difference according to the analyser used.


[Research on the eventual cross-reactivity of anti-Wr(a) with various viral, bacterial and mycotic antigenes (author's transl)]. Among the sera of 1011 blood donors, they have been collected 34 anti-Wr(a) antibodies. By IgG antiglobulin test, the titer was 1/8 or more in 21 sera. After absorption on viral, bacterial and mycotic antigens, the sera were still reactive with Wr(a) + red blood cells. These results show that no tested antigen is cross-reactive with Wr(a) antigen. However, the AA. suggest that the research of a widley diffused antigen, cross-reactive with Wr(a) + red blood cells, is a valuable approach to the problem of IgG anti-Wr(a) antibodies in normal, never transfused blood donors.


[Organization, possibility and limits of the automation in an hospital testing laboratory (author's transl]. The AA. analize the most important items and they make some considerations to put in evidence which should be the general lines for a right application of an automation of an Hospital testing laboratory. After having studied carefully the essential items to face the automation, the AA. analize the advantage and the disadvantage of the matter. They sustain the essentiality to give to an outline of a rapid and exact entry on the most complete way to give to doctors the possibility to improve the clinical-diagnostics valutation and reduce the periods in bed. Having considered the different systems of automation, the AA. examine the problems relative to the cost of equipment, to the rooms, to the personnel, studying in particular the costs relative to the repeated tests, to the specific tests and to the urgencies. They conclude stating again that a good equipment can resolve the actual difficulties existing in the labs and that can improve the functionality of the Hospitals.


[Quantitative evaluation of HbA2. Comparison of 3 methods]. Two electrophoretic tests and one based on column chromatographic method have been studied for quantitative and qualitative evaluation of HbA2. Results of 1069 assays demonstrated a satisfactory qualitative resolution for the three methods but for the best quantitative precision, the test of choice is the chromatographic one.


[Enzymatic determination of uric acid in serum with the trinder reaction (author's transl)]. We describe a direct colorimetric method for the enzymatic assay of uric acid. 50 microliters serum aliquots are incubated for 30 min with a diluted hexacyanoferrate solution, to remove interference by non-specific reducing agents. Uric acid is then oxidized to allantoin in the presence of uricase (Aspergillus flavus), with the simultaneous production of hydrogen peroxide; this is measured by a modified Emerson-Trinder reaction, in which phenol has been replaced by sulphonated 2,4-dichlorophenol, a more sensitive chromogen. The method gives linear results up to 20 mg of uric acid/100 ml.


[A chromatographic method for the urinary pregnanediol dosage for routine analyses (author's transl)]. The AA. aiming at a handy and speedy system admitting of being fitted to the equipments of any laboratory hospital have taken into account two procedures, one proposed by Varley and the other of Fotherby and Love reported by Wootton and King for pregnanediol. The two methods have been combined in order to make the process easier. The procedure is based upon chromatography on alumina of ethereal extracts dissolved in cyclohexan. Glucuronate hydrolysis has been obtained with beta-glucuronidase.


[Current methodological problems in the determination of erythrocytes, hemoglobin and hematocrit]. Four instruments for the determination of RBC, Hb and PCV, with different degree of automation, have been compared in strictly routinary working conditions. Experimental protocols were designed in order to collect data for the assessment of both precision and accuracy: accuracy has been estimated by assuming the values obtained with the Coulter S as provisional reference values. In most instances, with particular reference to RBC, precision was higher with automated machines; however, Hb was quantitated with sufficient precision with a semi-automated technique and in the determination of PCV precision of the manual micro-centrifuge compared with precision of the automated instruments. As far as acuracy is regarded, collaborative experiments showed general agreement with the (provisional) reference values, with occasional occurrence of typical systematic errors in RBC and Hb determinations. The magnitude of the systematic error, however, was not constant with the same instrument in several analytical series. The whole of the results point out to the feasibility of obtaining clinically-significant analytical values with the several instruments tested. However good calibration and quality control procedures are necessary in order to maintain accuracy at acceptable levels. Improvement of precision is also needed in some instances.


[Preparation of a standard for the hemocromocytometric autoanalyzer (author's transl)]. It is possible to prepare a primary standard for emocromocytometric autoanalyzer, where is a Center or Trasfusional Service. The blood is pick (about 4/5 ml) during an usual bleeding (EDTA as anticoagulant); 0,1 ml of Destrosio 1,47% is added. Blood is preserved into dark glass test-tubes at + 4 degrees C. This preparation may be used within 11 days.


[Importance of new diagnostic techniques in oncology (author's transl)]. The A. reviews the most recent diagnostic techniques in oncology, discussing their advantages and disadvantages. He weighs the importance of the determination of the clinical stage in decision as to therapy and as to application of the TNM system, which includes the use of symbols capable of defining the anatomical extension of a neoplasia. He reports on the Arbor classification of stages of malignant lymphomas, expressing hopes for the elaboration of a clearer and more complete classification for the purposes of diagnosis and prognosis of neoplastic diseases.


[Cancer of the head of the pancreas and common bile duct (an anatomical, cholangiographic and clinical study)]. A study was carried out on the principal alterations of the common bile duct in pancreatic neoplasms by gross and microscopic morphological examinations and intraoperative cholangiographies. Correlation of the data furnished evidence of various coinvolvement mechanisms of the lower common bile duct by the neoplastic process, mechanisms that lead to a closer understanding of the clinical symptomatology and interpretation of intraoperative cholangiographies.


[Prevention of postsurgical thromboembolism with small doses of heparin]. The study includes 390 patients of different age, operated for various conditions during the last quarter of 1975, and systematically treated post operatively with heparin (the cases in which heparin was contraindicated were not included). None of the patients developed signs of thromboembolism after the operation. The drawbacks of the method are virtually inexistent as compared to the gravity of postoperative thrombolic complications. A further study included 1708 operated patients of whom 223 (13.0%) received the heparin treatment and 1485 (87.0%) did not. There was no thrombolic-embolic complication in the former lot and 12 cases (0.8%) in the latter. Three of 15 patients (20%) in whom the postoperative heparin treatment was interrupted immediately or very soon, developed thromboembolism. The method is efficient provided it is applied after the operation up to complete mobilization of the patient. The method is readily applicable, there is no risk and haemostasis is insured.


[Causes of failure in surgical arteriovenous anastomoses]. The causes of failure in surgical arteriovenous anastomoses are discussed with reference to 60 operations performed on 52 patients suffering from chronic renal insufficiency in the uremic stage. The various technical variants applied are shown, as well as the early and late complications and the order in which reinterventions were performed. The work concludes with an original mathematical study of the blood output in the three fistula variants practiced by the authors, designed to supply evidence of their functional value.


[Bilateral scapulohumeral luxation, a complication of aldrin poisoning]. The present paper reports on a case of bilateral scapulohumeral luxation caused by convulsions brought about by intoxication with Aldrin, an organochlorate insecticide.


Four drug combination cytotoxic chemotherapy following surgery for breast cancer. A prospective randomized clinical trial of treatment with vincristine, cyclophosphamide, methotrexate and 5-fluorouracil after conventional curative treatment for stage II breast cancer is described. The results at 2 years are recorded together with details of toxicity. Future plans are discussed briefly.


Ovarian irradiation and prednisone following surgery and radiotherapy for carcinoma of the breast. Following surgery and regional radiotherapy for operable carcinoma of the breast in premenopausal women, ovarian irradiation (2000 rad in five daily fractions) plus prednisone (7.5 mg per day) results in delayed recurrence and prolonged survival.


Malignant melanoma (stage 1): a clinical trial of adjuvant BCG immunotherapy. A prospectively controlled randomized clinical trial of adjuvant BCG immunotherapy in patients with stage 1B malignant melanoma (Clark's level 3--5) is described. The combination of intradermal and oral BCG allows approximation of the bacilli to any microscopic foci of residual disease. The trial was activated in May 1975 and to date 107 patients have been admitted to the trial, 49 patients being randomil entered patients, there have been five relapses of 49 patients in the treatment group and ten relapses of 58 patients in the control group. This encouraging trend is not yet statsitically significant at the 5% level (P = 0.17). If evaluable patients with Clark's level 3 and 4 lesions are assessed separately, there is a significant trend in favour of the immunotherapy group (P less than 0.05) with three relapses in the treatment group and ten relapses in the control group.


Environmental radioactivity in the Faroes in 1977. Measurements of fallout radioactivity in the Faroes in 1967 are presented. Strontium-90 (and 137Cs in most cases) was determined in regularly collected samples of precipitation, grass, milk, fish, sea water, bread, and drinking water. In addition, analyses were made of spot samples of lamb, sea birds, potatoes, sea plants, vegetables, eggs, and human bone. Estimates are given of the mean contents of 90Sr and 137Cs in the human diet in the Faroes in 1977.


[Clinical and instrumental study of familial congenital myasthenia]. Congenital familial myasthenia occurred in two male brothers, born from non affected mother. The diagnosis was based on anamnestic and clinical data, on electromyographic features, and on the effect of specific therapy. The differential diagnosis and the classification of congenital familial myasthenia are discussed. This type of disease represent 1% of all cases of myasthenia, but--excluding the "transferred" myasthenia to the newborn by affected mother--the percentage raises to 3--4%. The possibility of identifying two distinct formes of familial myasthenia is emphasized, the first with "early onset" where the symptoms become evident before two years of age, the second "late onset" clinically evident later in life seems doubtful that the two forms of the disease might be due to the same underlying pathological condition.


[In vivo aminoacid transport in the brain of the rat with porto-caval anastomosis (author's transl)]. Cerebral capillary permeability to L-amino acids was studied in rats submitted to porto-caval anastomosis 4 weeks before. The short-term intracarotidal injection technique described by Oldendorf was used throughout. Neutral amino acid permeability appeared to be greatly increased, the most important enhancement being for the tryptophan. On the opposite, basic amino acids showed a net decrease in their rate of passage from blood to the brain. No changes were observed for GABA and glutamic acid. These data suggest a marked modification of the permeability of the cerebral capillary membranes in the rat with chronic portocaval anastomosis. Moreover, such alterations are selective for the different amino acid transport classes. Competitive inhibition decreased the permeability of methionine at the same level in both control and experimental animals: therefore, the neutral amino acid increased entry into the rat brain after porto-caval shunt is due to an enhancement of the transport processes.


[Optokynetic and ocular dysmetria tests in the diagnosis of atypical internuclear ophthalmoplegia (author's transl)]. In a patient with atypical bilateral internuclear ophthalmoplegia the optokynetic test and the ocular dysmetria test detected an infraclinical bilateral lag of adduction. The optokinetic test showed amplitude asymmetry of nystagmus, which was larger in both eyes when the fast phase was in abduction. The ocular dysmetria test showed in both eyes that saccades were slower in adducting than abducting saccades: the latters overshooted and showed transient nystagmus. Since bilateral internuclear ophthalmoplegia is often indicative of multiple sclerosis, these tests are particularly helpful in those patients who otherwise would require more complex diagnostic investigations.


[Progressive external ophthalmoplegia: clinical observations in two cases (author's transl)]. Two patients developed Progressive External Ophthalmoplegia at the age of 20 and 50 years respectively. There was no clinical invovlement of either skeletal muscles or the CNS. Electron microscopy of the lateral rectus muscle showed in one case regressive changes in the myofibrillary apparatus and in the mitochondria. Light microscopy of the quadriceps muscle in the other case showed only mild non-specific myopathic changes. EMG of the ocular muscles suggested a primary muscular damage in both cases.


[Bromocriptine in Parkinsonian syndromes. Results obtained in a group of patients treated for 8 months]. Antiparkinsonian treatment with L-Dopa gives rise to a number of problems: I) lack of initial response in a few cases; II) side-effects; III) becoming less effective after the first few years of treatment. Consequently, various drugs have been tried to replace, or combine with, L-Dopa. Among those drugs bromocriptine has been described the most effective. Twelve patients suffering from severe parkinsonism, all being intolerant to L-Dopa, have been treated with Bromocriptine. They fell into stage V of the Hoehn and Yahr's scale after 8 days of complete withdrawal of therapy with L-Dopa. Benefit and side-effects have been assessed as follows: a) L-Dopa alone; b) bromocriptine alone; c) combination of a and b. A daily dose of 30 mg of bromocriptine was given for 4 months. This was then reduced to 15 mg with the addition of L-Dopa for another 4 months. The results were: I) bromocriptine scored higher in all patients except one; II) bromocriptine has been consistently less effective than L-Dopa; III) side-effects were similar to those of L-Dopa but less frequent; IV) the combined effect of the two drugs was superior to each drug given alone.


Obesity treatment: research and application. This paper reviews the research that reports (a) some of the physical and social considerations in treating the obese, (b) characteristics that identify overeaters and some implications for treatment, and (c) treatment settings and personnel who treat the obese. It then examines three major treatment approaches utilized by social workers and other health care professionals and reports findings on the effectiveness of each. Finally, it describes one weight reduction treatment program in which social work intervention is viewed as a central and vital component. In conclusion, issues for the practitioner's further consideration regarding intervention with this population are presented.


The family and health care: explorations in cross-cultural settings. This article discusses what a social worker or health practitioner should know about the family and its influence on health care among various ethnic groups, focusing first on basic information on family organization and interrelationships and then on the family's role during health care. The material is presented in a format designed to be useful to the practitioner in the field, discussing what important aspects of various topics the worker might investigate, why the information is important, and how to gather it.


Touching: a legacy from the encounter movement for social work practice. Human touching within helping relationship became especially prominent during the so-called encounter movement of the late 1960s and early 1970s. This indeed may be the movement's major legacy to clinical social work practice. As furor about the movement has declined it is now possible to take a look at its contributions. This paper examines social conditions that encouraged the use of touch as therapy and evaluates the possibilities of person-to-person tactile contact becoming an acceptable intervention in psychiatric and medical settings.


Training in prevention: an educational model for social work students. Graduate schools of social work have made infrequent use of public health settings as a locus for practice education and a particular resource for learning in prevention. This report is on a project aimed at the development of an educational model in preventive work with families and children, using a student unit in fieldwork in a county health department. The 3-year project emphasizes early intervention with concern for developmental and life cycle tasks of families. Ongoing evaluation of process indicates clearer identification of populations "at risk" and changes in student appreciation of collaborative roles with other disciplines in patient care, as well as specific learning tasks and roles associated with screening, case finding, referral, and treatment.


Biochemical profiles of stone-forming patients: a guide to treatment. A formal protocol, controlled metabolic evaluation is essential to the most effective treatment of any patient with renal calculi, regardless of the crystalline composition of the stone. The design of the protocol and of the data sheets should be compatible with ease of diagnosis and selection of corrective therapeutic measures. These data also serve as a reference to monitor response to treatment. Treatment is highly individualized with the objective to reduce all potentially crystallizable ions to basal levels. If this is difficult to accomplish certain ratios of ions are brought to as near normal values as possible.


Experience with high dose, short course preoperative radiation therapy and immediate single stage cystectomy in management of bladder cancer: a preliminary report. This preliminary report concerns our experience with the use of high dose, short course preoperative radiation therapy and immediate single state cystectomy for the management of bladder cancer. Data reveal that 1,660 rad delivered in 4 days and followed by immediate cystectomy do not increase operative morbidity or mortality. The operative mortality and morbidity of a single stage radical cystectomy with en bloc pelvic node dissection and urinary diversion are no greater than that reported for less radical procedures without node dessection. In this series the incidence of nodal involvement ranged from 10 percent for PIS and P1 tumors to 50 per cent for P3 tumors, implying the need for treatment of pelvic nodes whenever cystectomy seems indicated.


Urological applications of computerized axial tomography. Computerized tomography (CT scanning) of the chest and abdomen has been used as a diagnostic technique in more than 7,200 patients since 1974, 250 of whom had histological proved disorders of the genitourinary system and retroperitoneum. On the basis of this experience CT scanning has been found to be safe and effective, and offers certain advantages over conventional techniques. The number, extent and content of adrenal and renal mass lesions can be determined with relatively great accuracy. The presence and extent of metastases into the retroperitoneum, liver and chest often can be shown by CT scanning when other tests are negative. Placement of needles for aspiration, biopsy, injection of contrast medium or insertion of drainage tubes can be done accurately under computerized tomographic control. Air contrast scanning of the bladder can be of real help in staging bladder tumors, espically in obese patients. Computerized tomography in itself is non-invasive, carries a low radiation exposure comparable to other radiographic procedures and therefore, can, be valuable in following the course of patients with various diseases during and after therapy. While CT scanning will not replace other diagnostic procedures it should lead to a more judicious selection of potentially hazardous tests, such as angiography, aspiration and open biopsy.


Posterior urethral stricture repair.

Posterior urethral stricture repair. Experience with 54 operations for the membranous-prostatic urethral stricture is presented. There were 7 operations performed through pubectomy exposure, 6 Badenoch operations, 31 exteriorization 2-stage operations using a perineal-scrotal flap for the first state and 10, 1-stage transperineal end-to-end anastomoses after scar tissue had been excised. The technique for the transperineal approach is presented. Presently, a 1-stage end-to-end anastomosis of the bulbomembranous urethra to the prostatic urethra through a perineal approach is preferred. Exteriorization urethroplasty using the perineal-scrotal flap is recommended when an end-to-end anastomosis is not feasible, either because of a long stricture or severe scar secondary to previous operative failures. The pubectomy approach is seldom needed but the Waterhouse pubectomy procedure is recommended as a possibility in patients who cannot be placed in the exaggerated lithotomy position.


The use of adenosine triphosphate with magnesium chloride in the treatment of post ischemic renal injury. Minipigs (20 to 25 kg.) were subjected to bilateral renal artery occlusion for 60 minutes. Renal blood flow was reduced to 65 per cent and glomerular filtration rate to 40 per cent of normal in control animals. Administration of adenosine triphosphate with magnesium chloride intravenously immediately after the period of ischemia resulted in restoration of renal blood flow to normal and glomerular filtration rate to 74 per cent of normal 24 hours later. Bilateral renal artery occulsion for 90 minutes resulted in a more severe impairment of renal function, which was not improved by the administration of adenosine triphosphate with magnesium chloride. Adenosine triphosphate with magnesium chloride may exert its effect by improving renal blood flow through inhibition of post-ischemic intrarenal vasoconstriction or possible by enhancing restoration of intracellular adenine nucleotides. The exact mechanism remains unclear.


The use of microsurgical denervation of the spermatic cord for orchialgia. Orchialgia is a term that can only lead to confusion with regard to symptoms and etiology of the symptoms. It implies testicular discomfort or testicular pain that is intrascrotal. Testicular pain per se probably is appreciated in the lower abdomen and internal ring and not in the testicular body. Therefore, true orchialgia, namely testicular pain of unknown etiology, would be more appropriately described as lower abdominal pain (in the absence of any inflammatory ailments), which is worsened by testicular pressure or palpation. Treatment of the patient with orchialgia has been a difficult and often unrewarding clinical situation. Return to gainful activity without significant use of analgesics is the desired goal. Microsurgical testicular denervation has been used in 2 patients in an effort to achieve this goal without sacrifice of the testes.


Intrarenal stone manipulation: summary of recent experience. Since first described in 1975, non-operative external manipulation of small intrarenal calculi has been done on 30 individuals. This procedure has facilitated stone passage successfully in 80 per cent of the cases and, thus far, has been free of significant complication. Fluoroscopic control and materials available in most radiology departments allow for intrarenal manipulation to dislodge small calculi in virtually any calix, permitting spontaneous and usually asymptomatic passage. The procedure and subsequent management are described in detail.


Ureteral calculus: experience with 521 stone extractions. Few urologic problems require the consideration of so many factors as does an obstructing calculus in the ureter. The questions that arise in each case are whether an operation should be done for immediate relief of the obstruction or whether manipulation should be done, possibly subjecting the patient to a period of disability, painful attacks of colic and febrile reactions.


Glucagon, ureteral colic and ureteral peristalsis. Experimentally, glucagon is an effective ureteral relaxant that induces a moderate diuresis. Our data suggest that in specified cases of ureteral colic, before the development of a ureteral bar, flaccid dilatation of the pelvis and renal shutdown, glucagon may facilitate the expulsion of small ureteral calculi. When the ureteral pain is due to hyperperistalsis the drug has promise in the alleviation of pain. The complexities of the pathophysiology of ureteral colic in an experimental model support the treatment of ureteral edema in colic with anti-inflammatory drugs but suggest certain precautions in the design of any investigation of drug therapy for colic, lest a good drug be found ineffective for the wrong reason-that it was used in an impossible situation.


Directional growth of renal calculi.

Directional growth of renal calculi. The forces involved in shaping urinary calculi reside in crystalline characteristics and especially in local influences. Box pelves may restrict passage and, by allowing mobility, help shape a round calculus. Fixation, occurring with a rapidly growing infection stone, facilitates initial growth on a matrix mold in a funnel pelvis, further aided by pelviocaliceal paralysis from bacterial endotoxins and later by stasis. Branched calculi are further shaped by contact with the pelvic and infundibular walls. Through pressure and mucous coating they grow only at the ends. Late caliceal obstruction frees the ends for clubbing. Consideration of these forces aids in prognosis and surgical removal, and may offer opportunities for prevention.


Male exstrophy patients: a preliminary report on the reproductive capability. Semen analyses from 9 male patients with bladder exstrophy revealed a high incidence of infertility (7 cases). Possible causes and measures that might help to preserve the fertility potential are suggested.


The quantitative nuclear cystogram: an aid in determining the spontaneous resolution of vesicoureteral reflux. The quantitative data derived from serial nuclear cystograms during a 5-year period in 39 children were compared to the clinical course. A direct correlation (93 per cent) between an increasing bladder volume at which reflux occurs was observed in the clinically stable group. In the clinically unstable group there was a 77 per cent correlation of an unchanged or decreasing bladder volume at which reflux occurs. The quantitative nuclear cystogram provides an objective as opposed to subjective data base for management of patients with vesicoureteral reflux.


Further experience with chemotherapy in the Dunning prostatic adenocarcinoma. A number of chemotherapeutic agents, including L-asparaginase, actinomycin D, chloroethylcyclohexy-nitrosourea, 5-flourouracil, cyclophosphamide, hydroxyurea, cis-platinum, adriamycin and methotrexate, alone and in combination and at variable dose levels, were applied against the Dunning R3327 rat prostatic adenocarcinoma-subline G. We found a continuing parallel between responses of the human and rat tumors and conclude that the usefulness of this animal model as a screening system for agents against the human tumor is further supported.


Immunologic studies of prostatic cancer using the R3327 rat model. We report herein on the destruction by cryosurgery of the Dunning R3327 adenocarcinoma grown in the prostate. Tumors less than 1,000 mm.3 were destroyed by a single freezing procedure within 2 to 4 weeks, whereas tumors greater than 1,000 mm.3 could not be destroyed completely. We also have been able to demonstrate antibody and cellular immune responses to antigens on the R3327 cells. Species, organ and tumor specific antigens were identified by xenogeneic antiserum produced in the rabbit, while major and minor antigens were identified by alloantisera produced in the rat. Tumor antigens were characterized by a variety of in vitro and in vivo immune responses. In addition to the rabbit xenoantisera used in cytotoxicity assays, mixed lymphocyte tumor interaction produced a demonstrable in vitro immune response, lymphocytes from rats immunized with tumor cells were cytotoxic to radiolabeled tumor cells in culture, rats immunized with tumor cells in adjuvant demonstrated protection against subsequent challenge and immunological stimulation of lymph nodes draining the site of tumor cell inoculation was demonstrated by an increase in lymphocyte trapping. Clearing, the R3327 tumor system in the rat is suitable for immunological studies of prostatic cancer.


The effect of dietary cadmium on prostate growth. We investigated the effect of chronic non-toxic ingestion of cadmium chloride on the growth of the prostate, seminal vesicles and testes of the white rat. Cadmium chloride seems to have a statistically significant dose-related adjuvant effect on the weight of these organs when administered continuously to the white rat during a 6-month period.


The use of estramustine and prednimustine versus prednimustine alone in advanced metastatic prostatic cancer patients who have received prior irradiation. Estramustine has been shown previously to be an effective drug in the treatment of metastatic prostatic cancer, demonstrating significant objective and subjective responses in long-term non-randomized trials and in other randomized trials. In this study prednimustine alone has shown a minimal over-all objective response rate of 12.9 percent of the cases, although with marked subjective improvement of pain relief and patient performance status. The combination of prednimustine with estramustine did not result in improvement of objective or subjective response parameters. The effects in terms of responses or in terms of toxicity for either agent were not additive when they were given in combination. Cross-over for those patients whose disease progressed on prednimustine therapy to estramustine had some benefit in over-all survival. Prednimustine alone or in combination with estramustine may be used safely and could improve markedly the quality of life for irradiated patients with advanced prostatic cancer who failed on hormonal treatment and have too poor a bone marrow reserve to be treated by other currently available myelosuppressive agents.


Intratesticular grafts: the testis as an exceptional immunologically privileged site. The testis is an immunologically privileged site despite a normal lymphatic drainage, whereas the anterior chamber of the eye is a privileged site because it lacks normal lymphatics. Parathyroid grafts were transplanted between several strains of inbred rats (Buffalo leads to Lewis and Lewis X Brown Norway F1 leads to Lewis). Allografts were placed in the testis, thigh muscle, prostate, lymph nodes, anterior chamber of the eye and adrenal gland. The survival of intratesticular allografts also was tested in animals whose pituitary gonadotropins were suppressed by testosterone and estradiol implants. The effects of steroid implants were documented by measuring testosterone and progesterone concentrations in the serum and whole testis homogenates of these animals. Allograft survival was judged by fasting plasma calcium concentrations. The data show that 1) the adrenal is included among naturally occurring immunologically privileged sites, 2) the prolonged survival of intratesticular allografts may be related to the local production of steroid hormones, although allograft survival is not critically dependent on pituitary gonadotropins and 3) temperature differences and a high zinc concentration within the testis are not important to allograft survival.


Replacement of the ureter by small intestine: clinical application and results of the ileal ureter in 89 patients. Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95 per cent of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81 per cent of the cases. Serum creatinine was unchanged or decreased in 75.7 per cent and the pyelogram was unchanged or showed decreased dilatation in 84.6 per cent of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5 per cent) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.


[Physicochemical studies of Pharmachem's tylosin]. Studied is the effect of high temperature, light, moisture, the type of the solvent and the reaction in the medium on the chemical stability and biological activity of the tylosine base, tylosine tartarate and tylosine phosphate, produced by the "PHARMACHIM" State Economic Corporation. The evaluation of the effect is carried out by using the spectrophotometric (in the UV-region) and microbiological methods (diffusion in agar with Sarcina lutea A. T. C. C. 7341 as a test microorganism). It is found that tylosine is stable thermally both as substance and as solution, yet it loses a large part of its activity when the solutions are exposed to ultraviolet or direct sun light. This calls the solutions of the antibiotics in the course of their preparation, storage and application to be protected from the direct effect of light and that they should be packed in light-proof material. Depending on the air moisture (72--98 per cent), the tylosine base absorbs water from 4 to 11 per cent, the tartarate--from 9 to 37.5 per cent, the phosphate--from 8 to 28.5 per cent, the tylosine tartarate (water-soluble form)--from 7 to 32 per cent, and the tylosine phosphate (granules)--from 12 to 39 per cent of their weights. This requires their storage to be limited to dry, airy premises or they should be hermetically packed. Water, ethanol, methanol, phosphate buffers with pH 6--10.0, dimethylformamide and dimethylsulphoxide do not affect the activity of tylosine, but the last two solvents inhibit the diffusion of the antibiotic in agar and are unsuitable for biological tests. The tylosine base, manufactured by the "Elanco" Company, manifests similar properties in relation to thermal stability, light sensitivity, hygroscopicity and diffusions in agar.


[Comparative study of the muramidase (lysozyme) activity in the blood cells of laboratory and agricultural animals]. Comparative studies have been carried out on the blood of certain laboratory and farm animals and birds, whereby the activity of muramidase (lysozyme) is established in neutrophilic cells of mice, guinea pigs, rats, rabbits, dogs, hens, turkeys and geese and in the monocytes of rabbits and dogs. The percentage of cells with muramidase activity manifests species features. No cells with a presence of muramidase activity have been found in the perypheral blood of cattle, sheep, pigs, goats, horses and bullalos. Certain questions of a general biological aspect about the origin of muramidase in the blood serum are examined on the basis of the results obtained and recent data from analyses of human blood.


[Variability and the virulence of the Newcastle disease virus]. Six isolates of the Newcastle Disease virus (NDV), taken at different periods of time after provocation of immune birds with velogenous viscerotrophic strain, are used. It is shown that the virulence of the initial NDV challenge strain remains unchanges up the 46th day of persistence. The isolate, taken after 70 days of carriage, manifests a considerably decreased virulence. It is established that the reduced virulence is not genetically stable and reverts towards the initial one following passage through appropriate host organism. The latent infection with NDV is examined from ecological and practical aspects.


[Allergen effect on the number of monocytes in guinea pigs]. Followed up are the changes in the number of monocytes under the effect of venal injection of an allergen from Salmonella abortus ovis to guinea pigs, sensibilized by live and killed cultures of the same Salmonella. After inoculation of healthy guinea pigs with a live culture, the number of monocytes doubles and remains at this level up to the 11th day after the infection. The killed culture of this Salmonella does not possess a similar action. A venal injection of Salmonella abortus ovis allergen to sensibilized guinea pigs, possessing a dermal-allergic reaction, leads to a marked decrease in the number of monocytes in the blood on the 2nd and 6th hrs after application of the allergen, while on the 24th h their number regains the level prior injection. The "disappearance" of monocytes from the peripheral blood is antigen-specific and the assumption is made that it is the result of the synthesis of the migration-inhibition factor in blood circulation at the contact of the sensibilized "T" lymphocytes with the specific antigen.


[Comparative studies on the quantity of fructose and citric acid in the sperm from bulls at different seasons of the year]. The contents of fructose and citric acid in the semen of seven bulls of different ages were examined over a one-year period. The bulls were used as sires in the Artificial Insemination Station. The semen production was within the normal range. In the course of the investigations the temperature and moisture regimes of the air in the barns was optimal for the semen production of the bulls. No statistically significant changes in the amount of fructose and citric acid were established at different average diurnal temperatures and the relative moisture content in the different annual seasons. A marked positive correlation (r = 0.070 +/- 0.04) was observed between the changes in the contents of fructose and citric acid throughout the year. These changes were in an inverse correlation with the number of spermatozoa per mL of semen (r = 0.26 +/- 0.08) and in a moderate one for the citric acid (r = 0.49 +/- 0.06). In the bulls of the Red Dannish cattle there was a statistically significant decrease in the number of spermatozoa and a statistically significant increase in the number of immobile spermatozoa in the winter season.


Kinetics of vegetative growth of Thermoactinomyces vulgaris. The growth of Thermoactinomyces vulgaris on solid media was studied by microculture technique. Starting from a germinating spore the further development was followed by phase contrast microscopy. From serially taken photographs the kinetics of growth and branching of the mycelium was calculated. Also some observations on morphological behaviour were made. Regarding the total mycelium developing from one spore the growth occurred witha constant exponential growth rate, at least for the time tested (about ten doublings). The constancy of the mycelial growth rate was not attributed to constant rates of hyphal growth or branching. The hyphal growth rate increased during the development of the mycelium, so that the length produced by a hypha within a given time was smallest after germination and largest at the end of the experiment. Between the first and the 10th doubling of the mycelium the mean hyphal growth rate increased by the factor 27, in some cultures even by the factor 40. While hyphal growth changed from exponential to linear, branching was first linear and then approached exponential kinetics. Under different conditions of cultivation mycelia could have identical doubling times, but different hyphal growth rates and vice versa. Yeast extract caused a reduction of the hyphal growth rate and an enhancement of branching. Likewise the diminution of the supply of oxygen did not reduce the mycelial growth rate, but markedly decreased the hyphal growth rate, especially of the germ tube. The data obtained concerning the kinetics of growth and branching can be explained by a special form of cooperation of cytoplasmic and cell wall synthesis. With respect to the synthesis of cytoplasma a T. vulgaris mycelium behaves as one individual, which is not differentiated into replicating and non replicating areas (as recently was shown to be likely for Streptomyces hygroscopicus by Schuhmann and Bergter 1976). The mycelial growth rate thus reflects the rate of the synthesis of cytoplasm. The hyphal growth rate is moreover determined by the rate of cell wall synthesis at the tip of each hypha. The observed increase of the hyphal growth rate is explainable by an acceleration of the cell wall synthesis during the development of the mycelium. Probably the branching is regulated indirectly. According to the different manner of cytoplasmic and cell wall synthesis, within a hypha a balance between both processes is maintainable only for a limited time. As soon as the momentary apical capacity for cell wall synthesis is exhausted, the balance is attained anew by originating a new site for wall synthesis, i.e. by branching. Branching was often defective. Especially in the absence of yeast extract a lot of lateral branches arose, which ceased further growth at an average length of 2.5 micron. It is suggested that yeast extract supports the transport of the nucleoids into the lateral branches, which otherwise is often infeasible. Reduction of the supply of oxygen favoured apical branching, so that dichotomous forms resulted.


[Inhibition of chitin synthetase of Mucor rouxii in vitro by fungicides and other compounds]. Comparative investigations on the inhibition of chitin synthetase of Mucor rouxii revealed that in contrast to results obtained in vivo, only few fungicides and other compounds inhibit the enzyme in vitro. Besides the well-known effect of polyoxin D, an inhibition was demonstrated for terrazol, tridemorph, hinosan, and formulated preparations of dimilin (PH 60--40, 60--38). The latter preparations, however, showed growth inhibition also with fungal species which do not synthesize chitin and the pure compounds are ineffective. Inhibition by phospholipase C, unsaturated fatty acids, and the reversibility of the inhibition caused by terrazol after addition of procain-hydrochloride demonstrates that phospholipids are essential for the activity of the enzyme, whereas sterols seem to be ineffective. Action of trypsin, PCNB, pentachlorophenol, and some similar compounds results in significantly increased activity, which in the case of trypsin could be due to the hydrolysis of a protein inhibitor. Hinosan inhibits the enzyme indirectly in a still unexplored manner.


Hydrostatic pressure effects upon cellular leakage and active transport by Vibrio marinus. Hydrostatic pressures greater than ca. 400 atm cause release of cellular components of Vibrio marinus MP-1 in the order protein greater than RNA greater than malate dehydrogenase greater than DNA greater than amino acids. Increased pressures also slow the rate of cycloleucine (non-metabolizable analogue of L-leucine acid L-valine) uptake but increase its efflux rate. Lineweaver-Burk plots (1/V versus 1/[S]) of cycloleucine uptake indicate that the Km increases with compression which suggests a decrease in affinity of the transport system for substrate at increased pressures.


Studies on the prevalence of renal disease and hypertension in relation to schistosomiasis. III. Proteinuria, haematuria, pyuria and bacteriuria in the rural community of Nigeria. Midstream specimen of urine was collected from the total population of two rural communities in the immediate environs of Ibadan. One has a higher and the other a low endemicity of urinary schistosomiasis. Proteinuria, haematuria, pyuria and bacteriuria were found to be significantly more frequent in the area of high than low endemicity.


Studies on the prevalence of renal disease and hypertension in relation to schistosomiasis. V. Radiological findings: plain X-ray abdomen and intravenous pyelogram. After studying two rural communities with varing endemicity of urinary schistosomiasis by total cross-sectional population survey, a stratified sample was obtained using defined criteria. Plain X-ray abdomen and intravenous pyelogram were carried out on the sample. Findings on plain X-ray of the abdomen, using the usual parameters of psoas and kidney shadows in the Nigerian, indicate that the two communities studied are similar but urinary calculi and urinary tract distortion are significantly more prominent in the community with the higher endemicity of urinary schistosomiasis.


The radiologist and health care in West Africa--new perspectives. In a brief survey of the history of modern radiology, Roentgen's discovery of X-rays in November, 1895 demonstrates the qualities of a research scientist, as well as the application of products of research to solving human problems. The modern Radiologist as a diagnostician and therapist, armed with modern tools, is a versatile member of the medical team. At the Lagos University Teaching Hospital, close collaboration between the gastroenterologist and the radiologist resulted in an improvement in the accuracy of diagnosis of upper gastro-intestinal disease from 66% to 95% in 300 patients who were subjected to both fluoroscopy and endoscopy. The practice, and training programme for radiology in West Africa should reflect the scarce human and natural resources of West Africa, as well as the peculiar problems of the region, within the context of the acceptable pattern of health care delivery. Hazards of excessive radiation, both within the rank of the profession, and more so among patients undergoing sometimes unnecessary X-ray investigations, demand urgent attention.


Experience in cardiac catheterisation and angiocardiography in the diagnosis and management of heart diseases in Lagos university teaching hospital. The present set up of the Cardiovascular Laboratory of Lagos University Teaching Hospital and our experience in cardiac catheterisation and angiocardiography in the laboratory between 1972--1976 are documented. Most of the patients studied were adults and all but one had both right and left heart catheterisation. Trans-septal procedure and selective coronary angiography were not undertaken during the period under review. In about 25% of the cases studied the clinical diagnosis was proved incorrect or incomplete at cardiac catheterisation. There were no major complications during or following any of the procedures probably because of the limited procedures; the point is however made that cardiac catheterisation is not innocuous, and while it offers an important and valueable means of establishing the diagnosis of specific cardiac malformation and haemodynamics, it must be used indiscriminately.


Some preliminary observations on the effects of kola nut on the cardiovascular system. The prevalence of kola nut chewing and the effects attributed to it are briefly reviewed. Except for a generalisation that its effects are probably due to its caffeine content, no attempts have been made to quantify its specific actions. Preliminary observations on the cardiovascular system of the cat show that aqueous extracts of the nut evoke a dose dependent differential response - the 8 - 9% hypertensive effect of 0.01 ug - 1mg/ml doses contrasting with the 18--71% hypotensive response of 10--1000mgs/ml doses. Adrenergic receptor blockade showed no significant alteration of the response. With larger doses a bradycardia developed and cardiac arrythmias were observed as a terminal event. These results are compatible with the action of xanthines on the heart and peripheral vasculature. The possible role of the habitually chewed kola nut in the pathophysiology of cardiovascular disease and its implications have been briefly discussed.


Surgery for congenital heart disease in Ibadan. I: Non-cyanotic heart defects. Congenital heart disease represents about 5% of all cardiovascular diseases in Nigeria today. Its incidence has increased in the last decade because of improved neonatal care, increased awareness and clinical acumen of physicians, better diagnostic tools and the introduction of newer techniques in cardiac catheterization. It is now possible to make the diagnosis with certainty and to define the extent of the pathology thus making it possible to select the appropriate surgical therapy for these children. This article reviews the commonest types of noncyanotic heart disease, the indications for surgery and the types of surgical procedures available in Nigeria today. The simple extracardiac defects, such as patent ductus arteriosus and coarctation of the aorta can be corrected with little or no mortality, but the more complex intracardiac defects can only be palliated pending the introduction of open heart surgery in Nigeria.


Contact allergic dermatitis "current topic in tropical dermatology". Out of a total of 2,666 new dermatology patients, 128 (4.8%) were clinically diagnosed as allergic contact dermatitis. Of these, 107 (4%) reacted positively to different antigens in the patch-test. The commonest contact sensitizers among females were nickel and dyes. Among male patients, the commonest sensitizers were mecaptobenzol-thiazole, chrome and nickel. The incidence of occupational contact dermatitis among bricklayers, construction workers and builders were found to be low and the sensitization rate against chromate was 0.6%. There was no sensitization against cobalt and nickel in the group, however, the length of occupational contact with cement among these group was short. Allergic contact dermatitis is not as uncommon among the Nigeria populace as is generally believed. It seems to be on the increase especially with increase rate of industrialization.


Observations on the value of vaginal cytology in the assessment of ovarian function in Nigerians. One hundred and twenty-two patients who attended the author's Gynaecological Clinic at The Logas University Teaching Hospital complaining of infertility, amenorrhoea or irregular menstruation were each studied during a minimum of three menstrual cycles. Cytological Curves based on weekly karyopyknotic indices of their vaginal epithelial cells were plotted throughout the duration of the study. Basal body temperatures and endometrial biopsies were also obtained from all of the patients. In the absence of vaginitis, cytological studies were found to be useful in determining the period of maximal fertility in infertile women and in detecting abnormal oestrogen excretion in women with functional menstrual abnormalities.


Clinicopathological appraisal of Brenner tumours of the ovary in Ibadan. A review of the clinical and pathological features of 31 cases of Brenner tumour of the ovary showed a higher frequency in the postmenopausal age group and larger number of bilateral tumours (13%) than reported hitherto. Most cases of the tumour were incidental findings; cystadenoma of the ovary and uterine leiomyomata were the most frequent lesions with which the Brenner tumours were associated. None of the cases of Brenner tumour was malignant. Presumed hormonal activity could not be morphologically correlated with any of the tumours.


Prevalence and severity of tooth attrition in Nigerians in rural areas. A study of the prevalence and severity of attrition in both anterior and posterior teeth has been conducted in two rural communities in Nigeria. 5984 teeth in 190 subjects were examined. Age range of the subjects was from 15-55 years and 58.9% of them were male, while 41.1% were female. The number of subjects with little or no attrition increased with increasing age while varying degrees of severity of attrition increased with increase in age. Attrition was more marked in the mandibular teeth (56.52%) than in the Maxilla (46.71%). The first molar was the most consistently attrited and since tooth attrition can be a cause of neuralgia in the oral region, dentine exposure due to severe attrition should be considered in the differential diagnosis of pain in and around the mouth.


Study of the comparative effectiveness of Dulcolax, Laxadine, Dorbanex, Normacen and Senokot laxatives in the bowel preparation of patients for radiological examinations. The effectiveness of five laxatives - Dulcolax, Normacen, Laxadine, Dorbanex and Senokot in the bowel preparation of adult patients for radiological examinations has been compared. The value of using suppositories in addition to the tablets in those preparations that have tablet and suppository forms has also been assessed. The use of Dulcolax tablets plus suppository was most effective. Dulcolax, especially its suppository, was however very expensive and more frequently attended by side effects when compared with the other preparations. Normacen tablet was the second most effective and it is cheap and quite free of side effects. It is therefore given the position of first choice. Laxadine tablet plus its suppository was third best. It is cheap and free of side effects. Dorbanex was fourth best but it is rather expensive. Senokot tablet was the least effective but it is cheap and relatively free from side effects. In those laxatives with tablet and suppository forms, the use of both tablet and suppository is much more effective than the use of the tablet form alone.


Fracture of the penis. Case report.

Fracture of the penis. Case report. A rare case of fracture of the penis is reported. Review of the literature shows only 58 previously reported cases. (Meares 1971) A simple method of treatment under local anaesthesia is described.


Candida albicans and otorrhoea in children. Case reports. 5 cases of Nigerian children, all below 2 years of age are presented. Common to all is a history of treated ear infections with subsequent development of otorrhoea. Both smears and cultures of the ear swabs documented candida albicans, and all the patients responded well to oral Nystatin. There is as yet little emphasis in published works on the relationship between candida albicans and draining ears.


Tc 99m bone scanning in early detection of rhabdomyosarcoma metastases. A case report. Employing the Siemens Scintimat II, a skeletal scintigraphy was successfully appled in the early detection, localisation and delineation of bone metastases to the knee from rhabdomyosarcoma of the right pectoral region. However repeated radiographs of the knee continued to be negative. As all other treatment approach of the painful knee: physiotherapy (short wave diathermy) had failed to produce relief, radiotherapy was applied as a last resort; the swelling regressed and the pain disappeared. This was indicative of the positive detection of early rhabdomyosarcoma metastases to be bones as a positive scan is seen in all areas of bone accretion whether malignancy is present or not.


[Ecology and psychiatry].

[Ecology and psychiatry]. Psychiatry, with a recent history as to a pragmatic discipline and a progressive development from the individual to the social, finds a holistic perspective of singular heuristic value in the ecological proposition. Ecopsychiatry is a general approach in which the diverse sources of psychiatric knowledge are grouped in order to get a view of macro-reality emerging from a methodological integration of behavior sciences and a unified theory orientating to a realistic praxis in the normative. This paper reviews the rationale, notion and historical development of the ecological principle in psychiatry. After a superficial analysis of the first contributions in this field, it is intented to outline the real of the actual psychiatric ecology mentioning their methods and contents. Following Bateson's postulation it is emphasized that ecological principles cannot be isolated from their own ideological contents--the ecological system necessarily involves science's ideas for their concepts need a constant evaluation.


[The decision to speak].

[The decision to speak]. The decission "to speak", that is, to begin an utterance in an informal interactive situation, conveys information about decissions of the speaker, but also about those of other participants, especially when the outcome of that act--whether in fact the subject was allowed to "ocupy the channel", etc.--is analyzed. This variable seems to be of relevance for the study of the development of what has been named in the literature on communication the "definition of the relationship". In this paper, the decission to speak is explored both descriptively as well as through the dicussion of the result of a research project on interactional processes.


[Reflexions on a group after its dissolution]. This paper begins with the summary of a therapeutic group session within the setting of psychoanalytic psychodrama. It corresponds to a stage in which the therapist had to take the decision of dissolving it. The authors tell us their thoughts about the indication to dissolve the group and the right moment for it, as well as about the conditioning causes, the relationship with the group and individual background, the possibility of passing pathogenetic and normal elements from one group to another. They also discuss the feelings, sensations, fantasies and theories not only of the patients but particularly those of the cotherapist. Some conclusions are extended to other therapeutic process, lots of questions are posed and some preventive and curative criteria are stated. Finally, they present various attitudes that the therapists may have before death diving them into those which favour the process of working through and those which hinder it.


Peptides in Parkinson's disease.

Peptides in Parkinson's disease. Peptides have found a progressively more important role in the biochemistry and physiology of the brain in recent years. Many possess neurological and behavioral actions in addition to their function in endocrinology. This paper reviews the formation and distribution, as well as the neurological action, of peptides probably involved in Parkinson's disease: beta-LPH and its derivatives (MSH, ACTH4-10, beta-endorphin). It also recounts the experience of many authors with prolyl-leucyl-glycine-amide (PLG) in that disease. Finally we propose a new theory of the etiology of Parkinson's disease, based on a postulated deficiency in the important trophic function upon catecholaminergic neurons of A.P.U.D. cells.


Age-related changes in penile erections and circulating testosterone in middle-aged male rats. The relationship between aging changes in pituitary-testicular function and the penile erection reflex was examined in middle-aged male rats. Significant decline in circulating LH and testosterone is first apparent in male rats during middle-age (13-15 mos). In Experiment 1, middle-aged (13-15 mos) and young (3-4 mos) rats were tested for erections  responses. The erections were measured in animals held supine and mechanically stimulated by retraction of the penile shealth. Middle-aged rats had substantially fewer erections than young animals. In Experiment 2, groups of middle-aged and young animals were castrated and provided equivalent levels of circulating testosterone (T) through the use of Silastic capsules. The levels were measured directly by radioimmunoassay of plasma T. In animals with supraphysiological T levels, erection frequency was low, but there was no significant difference between middle-aged and young animals. The results suggest that middle-aged rats do not have irreversible deficiencies in the somatic and neural mechanisms regulating erection nor are they significantly less responsive to androgen stimulation. The decline in circulating testosterone with age may therefore be a primary factor in the reduction of penile erections in middle-aged rats.


Biogenic amine-stimulated adenylate cyclase and spiroperidol-binding sites in rabbit brain: evidence for selective loss of receptors with aging. Evidence for selective decreases in biogenic amine receptor function with age in the rabbit has been obtained. Dopamine-stimulated adenylate cyclase activity in the striatum (caudate-putamen) of rabbit brain declined by about 50 percent as rabbits aged from less than 1 to 4 to 5 years of age. Similar decreases in transmitter-stimulated adenylate cyclase activity were found for histamine as well as for dopamine and norepinephrine in hypothalamus, frontal cortex and anterior limbic cortex. Isoproterenol-stimulated activity was also decreased with age in frontal cortex. These changes appeared to represent decreases in maximal response and not alteration in affinity for amine. In contrast, dopamine-stimulated adenylate cyclase of retina and transmitter-independent (basal or Gpp(NH)p-stimulated) activity in each of the regions studied were not altered with age. Dopamine receptors in striatum directly assessed by measurement of [3H]-spiroperidol binding revealed a comparable decrease in the number of binding sites without change in ligand affinity. Preliminary data also indicated decreased spiroperidol binding sites in the cortical regions of older animals. These changes in striatum and cortex were evident in the absence of decreases in either dopamine content or choline acetylase activity, an activity presumed to be present in neurons containing dopamine receptors. It is proposed that selective age-dependent decreases in postsynaptic biogenic amine receptor content occur in the absence of, or independent from, neuronal cell loss, possibly by a mechanism involving receptor desensitization. These changes occur in the animal model in those brain regions which in man are thought to be of importance in the loss of cerebral function that is found with senscence.


Potentiation of vincristine cytotoxicity by hormones: corticosteroids, androgens, estrogens and progestins. Using an in vitro system to evaluate the simultaneous use of two drugs, we previously have confirmed the synergism of vincristine and prednisolone cytotoxicity against lymphoid cells. Experiments were now carried out to determine whether other steroid hormones can be substituted for prednisolone. Partial or complete potentiation of vincristine cytotoxicity comparable to that achieved by the addition of prednisolone was observed when the latter drug was replaced by a variety of mineralocorticoids (aldosterone, desoxycorticosterone and fludrocortisone), glucocorticoids (hydrocortisone, dexamethasone), androgens (testosterone, methyltestosterone, androsterone, dehydroepiandrosterone, etiocholanolone), estrogens (estrone, 17-beta estradiol) and progestins (progesterone, pregnanediol). No potentiation of cytotoxicity was observed when nonsteroidal hormones (thyroxin, ACTH) were added to vincristine. It is concluded that a wide variety of compounds with the basic perhydrocyclopentanophenanthrene nucleus of the steroid molecule are capable of enhancing the cytotoxicity achieved with vincristine.


The lipids of the erythrocyte in paroxysmal nocturnal hemoglobinuria. Paroxysmal nocturnal hemoglobinuria (PNH) is a disorder characterized by the production of abnormal erythrocytes (PNH-E). The PNH-E undergoes early intravascular destruction which appears to be related to an intrinsic membrane defect that results in extreme sensitivity to lysis by complement. The lipids of the PNH-E have been evaluated because of the variable results reported in the past. This study shows a normal content of cholesterol and lipid phosphorus with a normal distribution of the phospholipids except for a slight increase in lysophosphatidyl choline (LPC) when measured using the complete lipid extract of the PNH-E. Fractionation of the lipid extract over a silicic acid column produced an alteration in the distribution of the phospholipids, with LPC and sphingomyelin increasing, and the other phospholipids decreasing. These alterations were seen only when the phospholipids were fractioned over a silicic acid column and were clearly an in vitro phenomenon. The levels of plasmalogen and malonaldehyde were normal, unlike those seen with oxidant stress. Fatty acid analysis of the phospholipids showed small but consistent changes: increased 16:0 and decreased 18:2. The total glycosphingolipids were slightly decreased in the patients with severe PNH. The results support and extend previous lipid data indicating abnormalities in the phospholipids of the PNH-E. The alterations of the phospholipids with fractionation correlate with previous whole cell data that suggest lipid instability in the PNH-E.


Unbalanced globin chain synthesis by Hb Lincoln Park (anti-Lepore) reticulocytes. Hemoglobin synthesis was studied in vitro in reticulocytes from a patient with the anti-Lepore variant Hb Lincoln Park. Incorporation of L-leucine-3H into the alpha and beta delta chains of Hb Lincoln Park was substantially less than the incorporation into the corresponding globin chains of Hb A, with the rate of synthesis of the beta delta chain being similar to that of the delta chain of Hb A2. Synthesis of the alpha and total non-alpha globin components was unbalanced, with a substantial excess of alpha chain synthesis. These findings help to explain the mild hemolytic disease present in individuals with this hemoglobin variant.


Quantitation of globin chains using cellulose acetate electrophoresis: analysis of fetal globin chain production. A technique involving the quantitative estimation of globin chains using cellulose acetate electrophoresis is described, and applied to the analysis of fetal globin chain production. When cord blood was analyzed, there was poor correlation between the globin chain ratios namely beta/alpha, gamma/alpha and beta/gamma ratios with either age or weight of newborn babies between 36-40 weeks gestation: best correlations were obtained for the beta/gamma ratio against weight (P less than 0.05). However, there was highly significant correlation between the various globin chain ratios and either age or weight of the newborn infant up to 12 weeks of age (P less than 0.001). This technique allows visual demonstration and quantitation of abnormal haemoglobins in a single procedure.


Methods for increasing bioavailability of cycloplegics. Since it has been shown that (1) fluid instilled in the pouch created by pulling the lower lid away from the eyeball is entrapped, (2) no fluids move into the lacrimal sac when the eyelids are shut and (3) gravity is important in tear-flow dynamics, we reasoned that an instillation technique for topical ocular drugs could be devised which would increase the drug effect for a given amount of drug. To test this hypothesis we administered one drop of 0.5% tropicamide to the right eyes of 12 young adults using an experimental method of instillation and to the left eyes using the conventional technique. The experimental technique produced a significantly greater loss of accommodation than the conventional technique. Wtih this experimental or similar technique, it may be possible to use lower concentrations of a drug to produce the same ocular effects produced by a higher concentration instilled in the conventional manner.


Strength of thin chemtempered lenses: drop-ball testing. Failure heights were measured in drop-ball tests for both chemtempered and heat-tempered plano, white crown glass lenses from five different optical laboratories. It was found that (1) failure height was proportional to the square of the lens thickness, (2) chemtempered lenses substantially thinner than 2.0 mm are as resistant to breakage as 2.0-mm-thick heat-tempered lenses, and (3) a close correlation existed between results of single-drop and multiple-drop tests and between results of tests using rigid and compliant mounts.


Flicker effects of receptor directional sensitivity. When a Maxwellian-view test field is alternately presented through different small areas in the pupil, a residual flicker is observed even though the luminance of the field is adjusted to compensate for the Stiles-Crawford effect. The stimulus alternation frequency that eliminated this residual flicker was used to estimate the magnitude of modulation in the receptors resulting from the difference in direction of illumination. These results support the concept that directional sensitivity of cones is much more acute than the directional sensitivity represented by conventional measures of the Stiles-Crawford effect.


Effect of a yellow ocular filter on chromatic aberration: the fish eye as an example. Reduction of chromatic aberration is one of the suggested functions of yellow ocular filters. This possibility was tested by (1) determining the effect of an artificial yellow filter on the chromatic aberration of the eye of two fish species having no obvious ocular filters and (2) comparing in vivo chromatic aberration with that of the excised lens in a species of fish having a yellow cornea. The results indicate that yellow filters reduce the measured chromatic aberration of the eye by more than one-third.


Corneal topography and monocular diplopia following near work. Monocular diplopia, reported by a subject following near work, was shown to be caused by changes in the corneal topography. Prior slit lamp biomicroscopy had revealed no corneal abnormality. The degree of corneal distortion and ray tracing calculations confirmed the presence and position of the resultant diplopia.


Home visual therapy for constant esotropia with anomalous correspondence. A home therapy method for eliminating anomalous correspondence is described. This method is applicable to patients over 12-yr old with esotropia greater than 15-20 delta. A case report included.


Headborne illuminator for the partially sighted. An inexpensive, headborne device is described that provides a bright spot of light on reading material even when the material is brought within 1 or 2 cm of the viewing eye. This aid has been used with great success by one of the authors for about 2 yr. This illuminator, or modifications of it, should prove valuable to other partially sighted people.


[The formation of tooth germs in teratomas]. The teeth buds which are observed in some teratomas ought to provide a useful system for the study of the development of organ structures in these tumours. They exhibit well defined characteristics in space and time. In contrast with normal development tooth bud formation in teratomas display malformations and other observable characteristics which are primarily the consequence of defects in coordination of activities among cells. Cyto-differentiation appears to be normal and the defective organogenesis must represent a breakdown of the principles which underlie the organization of structures. The possible role of the environment in organizing structure is discussed. Teratomas are unique biological systems which display in a dynamic way a panoply of teratological developmental processes of which teeth buds represent a fragmentary, repetitive and conspicuous expression.


[Ultrastructure study of the preneoplastic colon (carcinogenesis with 1,2-dimethylhydrazine)]. 100 Wistar rats, belonging to a series of 500 animals, were treated with increasing doses and for increasing periods of time with 1,2-dimethylhydrazine. A previous study has shown that tumors begin to appear only after the 19th week. Before this period there are abnormalities of mucin secretion (by the 2nd week), and then there are dysplasic lesions (after the 4th week). The ultrastructure study, done before the 19th week ("pretumor" phase) confirms some previous observations (increase in the zone of mitosis, secretory changes, mutation producing effects). These features are reminiscent of the histochemical characteristics of the human foetal colon. They show an epitheliomesenchymatous disorganisation unrelated to inflammation. There are abnormally early changes in the vasculature, there is loss of the (epithelial) coat, there is dissociation of the basal membrane and abnormal connections between it and the epithelial cells, collagen and fibroblasts; all this represents a disorganisation of the regeneration system of the colon mucosa. This loss of equilibrium between the parenchyma and the mesenchyma may represent a factor favoring excessive and disorganised growth of the mucosa.


[The dynamics of the amniotic fluid].

[The dynamics of the amniotic fluid]. Morphological study of the ovular membranes showing that under the amnion, until term, there persists perfectly live and active chorial cytotrophoblast covered by a well vascularised and developed parietal decidua. Under the electron microscopy, the apical pole of the amniotic cells as well as their intercellular space are bordered by microvilli. Their basal pole has squat pedicels. The chorion which supports the amnion is avascular. The surface of the cytotrophoblast opposite the chorio-amnion is raised by numerous protuberances in the form of pedicels. The trophoblast is also furrowed by intercellular canals bordered by microvilli and reinforced by desmosomes. Two cellular appearances may be distinguished in the trophoblast: elements similar to the syncytial type with the characteristics of steroid cells and elements of a Langhans type which may play a role in protein synthesis. The decidual cells, in a quinconcial perivascular arrangement, are rich in pinocytotic vesicles. Thus whilst it is undeniable that the foetus plays a certain role in the dynamics of the amniotic fluid by swallowing and urinary excretion, these phenomena are minimal in relation to exchanges through the ovular membranes. Transamniotic passage is the first stage in movement of the fluid. The chorion, by virtue of its plexiform, areolar structure forms the next stop. From the chorion, the circulation continues through the intercellular canals of the trophoblast and the amniotic fluid is thus brought into the well vascularised parietal decidua. In addition to this extracellular circulation, the authors fell that there exists an intracellular passage by uptake and secretion, as evidenced by the high degree of pinocytosis within the cells.


[Ocular and cutaneous melanosis associated with the Sturge-Weber syndrome: clinical, histological, and ultrastructural studies of one case (author's transl)]. A 3 year old portuguese boy with the Sturge-Weber syndrome also had oculocutaneous melanosis. The cutaneous melanosis extended to more than 50 p. 100 of the body surface. Hands, feet and the face were spared. The abnormal pigmentation of the eyes involved the sclerae bilaterally. Clinically, the cutaneous hypermelanoses most likely represented a widespread aberrant mongolian spot. Histological study of the hyperpigmented skin revealed dermal melanocytes in the superficial and mid-dermis. Ultrastructural study showed that most of the dermal melanocytes were loaded with mature melanosomes. All development stages of melanosomes were observed in some of them. Average melanosomal size in the dermal melanocytes was slightly increased when compared to that of melanosomes in epidermal keratinocytes. From this case and from a review of the literature, the authors suggest that the association between the Sturge-Weber syndrome and disturbances of the melanin pigmentation of the skin and eye is probably not coincidental. An embryologic abnormality, affecting both the neural crest (from where melanoblasts originate) and the primary vascular plexus may explain such an association. Various disorders, including nevus of Ota, nevus Flammeus, the Sturge-Weber syndrome associated with ocular and cutaneous pigmentary abnormalities and the Sturge-Weber syndrome in the complete or incomplete forms, may represent the clinical picture of the same embryologic disturbance. The clinical picture might be related to the time at which it acts, the receptivity of the various structures and their level of differentiation.


[Solitary nodular calcinosis of the skin with clinical and histological particularities. About two cases (author's transl)]. We report 2 exceptional cases of solitary nodular calcinosis of the skin, the first to be observed in Greece, with the clinical appearance of cutaneous horn and milium respectively. The latter clinical form has not been described in the literature. Histopathological examination of the first case shows the presence of numerous calcified concretions in the papillary dermis, directly beneath the epidermis, which is intensely hyperkeratotic and papillomatous. The calcified concretions are also seen in the lymphatic capillaries, the intraepidermal sweat ducts and horny layer; at a site they perforate the epidermis and penetrate in a sweat pore. The stroma presents an angiomatous appearance. Histopathological examination of the second case shows the presence of two well demarcated calcified masses in the upper dermis, the larger one being subepidermal, the other one being situated a little further from the epidermis. The smaller mass contains numerous hair shafts and is partially surrounded by a true epithelial wall, similar to that of an epidermal cyst.


[Hypomelanosis of the skin and malignant melanoma (author's transl)]. 8 patients suffering from malignant melanoma have been found to have various degrees of hypomelanoses of the skin. Depigmentation of the skin and/or hair associated with malignant melanoma may take several forms. Schematically six clinical types are described: - vitiligo-like hypomelanoses distant from cutaneous tumors; - vitiligo-like depigmentation associated with uveitis (incomplete Vogt-Koyanagi); - hypomelanoses in the primary tumor and/or its metastases; - "halo melanoma" in which the hypomelanoses encircles the primary tumor and/or its metastases; - halo nevi around preexisting benign nevocellular nevi; - "non-specific depigmentary phenomen" distant from the primary tumor or its metastases. Histological and ultrastructural studies of the depigmented skin show an absence of melanocytes. The association of hypomelanoses of the skin with malignant melanoma is probably not coincidental. Various hypothesis are discussed as well as the prognostic significance of such an association.


[The mammary gland of the male rat: a histological, histochemical and ultramicroscopic study (author's transl)]. Results of a histological, histochemical and ultramicroscopic study of samples taken from the mammary glands of male Wistar, Sprague-Dawley and Long Evans untreated rats, aged about 8 weeks, are reported. Lobulo-alveolar epithelial formations were observed together with increased metabolic and secretory activity, more frequent in Wistar rats than in other strains. No visible morphological abnormality was noted in the genital tract or adenohypophysis. There was no sign of feminization. The same findings were observed in male Wistar and Sprague-Dawley rats given three different diets of which one was semi-synthetic. The possibility of an exogenous mammotropic dietary factor is therefore very improbable. Endogenous hormonal stimulation, especially consecutive increases in oestrogens and prolactin in the prepubertal period, is possibly the cause of development of mammary tissue. These results show that the mammary gland, in the normal male rat, is not inactive. It seems, therefore, that this organ is not a suitable model for the evaluation of experimental mammotropic effects.


[Childhood immunization procedures in the C.E.E. countries (author's transl)]. After having submitted for review the legislation on the subject of vaccinations in infancy in Common Market Countries, the Author notes that the divergiences revealed on the matter, and others that may still possibly be revealed by a more profound valuation of the various standards, justify the conclusion that harmonization of the various arrangements is not only desirable but necessary. The Author adds that, as far as compulsory vaccinations is concerned, it is possible to find a way to overcome the situation by intensifying and extending in a more detailed manner the work of health education since, in the present social context, a sound vaccination policy ought to be based more on public collaboration than on coercive interference. In awaiting the issue of a community regulation the Author concludes proposing the adoption of an individual health card and vaccination calendar for persons within the Community.


[Rubella, measles and mumps. Epidemiology and prophylaxis (author's transl)]. The results of a large serological survey on Lazio population are reported and discussed. Sera from 26,500, 17,205 and 7,800 subjects of both sexes and various age were tested for rubella, measles and mumps antibody content respectively. Immune status was age dependent and on the whole the 15.2%, 20.0% and 69.8% of the population studied were negative (less than 1:8) for each of the three above cited antibodies.


[HBsAg and viral hepatitis in a hemodialysis center (author's transl)]. The behaviour of HBsAg and hepatitis B in 86 patients and in 24 medical personnel of a hemodialysis Center during 5 years is described. Hepatitis B antigen was detected in 28 patients (32.55%); hepatitis B infection developed in 7 of them and in 2 of the medical staff. Some problems of prevention and therapy are discussed.


[Epidemiological aspects of the hospitalized patients with acute viral hepatitis (author's transl)]. The Authors propose epidemiological studies on 179 patients hospitalized for viral hepatitis in the Department of Medicine of Fiorenzuola D'Arda Hospital from 1966 to 1977. The Authors prove, besides, the worrying incidence of disease and locate two zones of different frequency of hepatitis in the considered territory; they advise any possible causes of thys; they put forward any proposals about the control of disease.


[Relation between a rapid polyvalent test and single antistreptococcal tests]. ASO and Streptozyme tests have been comparatively tried on 11,200 sera. The former detected 11.96% positive and the latter 13.5%. The difference was due to a greater sensitivity of the Streptozyme test since the most of the Streptozyme positive and ASO negative sera resulted positive in one or more of the single antistreptococcal tests (SK, ADN, SJ, DNA). Only few of the sera which give rise to a positive Streptozyme reaction were otherwise negative and the positive result could be considered aspecific.


[Comparison of the anticholinesterase action in vitro of tetanus toxin and parathion]. It is compared the true cholinesterase inhibition exerced in vitro either by the tetanus toxin and by "parathion". Rabbit's brain homogenates are used as source of the ChE. 4000 MLD of tetanus toxin show the same inhibitory effect than mg 1 of "parathion", during 30 min of incubation at 37 degrees C.


[Behavior of serum and erythrocyte cholinesterase in experimental tetanus in rabbits]. In rabbits injected i.m. with 1 MLD of tetanus toxin, the levels of the serum cholinesterase and of the erythrocytic cholinesterase were determined twice every day, during the course of the intoxication, until the death of the animals. The levels of the serum cholinesterase were decreasing day by day, while these of the erythrocytic cholinesterase did not show any significant variation. These results are strictly comparable to those one may observe in organophosphorus poisoning.


[Possible interference between tetanus toxin and organo-phosphorus esters in blocking of cholinesterase]. As tetanus toxin results inactivated when mixed with mammals brain homogenate (Wassermann-Takaki phenomenon), the same may be observed for the organophosphorus compounds. When the brain homogenates are mixed before with one of both poisons and subsequently, after incubation, with the other, this one keeps its typical toxic activity. This behavior seems to be interpreted as the result from the linkage between the true cholinesterase and one toxic (Wassermann-Takaki phenomenon both for the tetanus toxin and the "parathion"), with the following interference for the second toxic, when added, at the enzymatic level, so that the second toxic remains free.


["Klebsiellae" infections (author's transl)]. Results are presented on the frequency of Klebsiellae recovery from biologic materials (urines, pleura or peritoneal exudates, cerebrospinal fluids, blood specimens) examined during one year. Tobramycin was the antibiotic with the highest in vitro activity against the isolates.


[Comparison between similar antibiotypes isolated in high infection risk wards and in general medical departments. Preliminary investigation (author's transl)]. From the comparison between antibiograms of bacterial species isolated from biological materials of wards with a high infection risk (General Intensive Care Unit and Neurosurgical Intensive Care Unit) and wards for internal diseases (General Medicine and Paediatric Wards), the AA. met with a very high frequency of bacterial species with identical sensitivity to antibiotics in the General Intensive Care Unit and Neurosurgical Intensive Care Unit. The data reported indicates a high cross-infection risk in the above Wards.


[Sensitivity in vitro of 61 strains of Salmonella to aminoglycoside antibiotics and to cephalosporins]. The in vitro susceptibility of 61 strains of Salmonella from pathological specimens was tested by an agar dilution technique to four aminoglycoside and to seven cephalosporin antibiotics. Aminoglycosides were effective against these isolates. Ten strains of Salmonella wien were found resistant to cephapirine, cefazolin, cephaloridine, cephalotin, but susceptible to cepharidine and expecially to cefuroxim.


Is the Hancock porcine valve the best cardiac valve substitute today? Valve replacement with the Hancock stabilized glutaraldehyde porcine aortic valve has been accomplished in 454 patients. Hospital mortality (influenced by a high proportion of patients in New York Heart Association Functional Class IV) was 17.6% (80/454). The first 221 patients discharged from hospital were followed for 36 to 75 months after valve replacement. There have been 26 late deaths among these patients; 88% (195/221) are alive. Of these 221 patients, 185 had single-valve replacement, (125 mitral and 60 aortic), and 36 underwent multiple-valve replacement. There have been 260 valves at risk up to 6 1/4 years, which is equivalent to 12,984.5 valve-months or 1,082 valve-years. Average follow-up is 4.16 years. There have been 13 valve failures in 10 patients. In 4 patients endocarditis was proved to be the cause of failure, and in 5 it was suspected; in 1 patient the failure the failure is unexplained. The pathological similarity between those in whom infection was documented and the other 5 is remarkable and raises the question of whether low-grade infections may be the cause of certain types of valve failure.


[Identification and antibiotic resistance of non-fermenting gram-negative bacteria (author's transl)]. Occurrence of non-fermenting Gram-negative bacteria was investigated by the Authors in various clinical specimens expecially of compromised hosts. 15 non-fermenting Gram-negative bacterial strains were isolated and identificated by two routine diagnostic systems. Isolates, were resistant to tetracycline, ampicillin, chloramphenicol and carbenicillin, while were shown to have different pattern of susceptibility to the aminoglycoside antibiotics examined.


Thrombosis and degeneration of Hancock valves: clinical and pathological findings. Of 415 Hancock valves implanted in 370 patients, 26 valve specimens were recovered at postmortem examination and 8 at reoperation. In 9 of these 34, thrombosis had formed without apparent alteration of the heterograft tissue (Group A). All were mitral prostheses, and the thrombi were attached to the sewing ring. Six of the patients died in the early postoperative period following prolonged low cardiac output syndrome and coagulation disturbances. Three patients had late valve thrombosis 12 to 26 months after operation and were in chronic atrial fibrillation with a very large left atrium. Four valve specimens (Group B) demonstrated degenerative changes of the heterograft leaflets such as shrinkage, perforation, and calcification. The clinical courses and possible pathogenesis are discussed.


Durability of prosthetic heart valves.

Durability of prosthetic heart valves. Accelerated fatigue testing of clinical heart valves has been performed at cyclic rates of 33 to 35 cycles per second at 37 degrees C using water for non-biological valves and glutaraldehyde solutions for tissue valves. Flows were in the physiological range, and the pressure difference across each valve during closure was 100 +/- 25 mm Hg. The results showed that major fatigue occurred for the Starr-Edwards 2320 at 150 million cycles, the Hufnagel trileaflet at 124 million cycles, the Björk-Shiley Delrin disc at 140, the Björk-Shiley Pyrolite disc at 973, the Beall 103 at 60, the Hancock porcine at 62, the Carpentier-Edwards porcine at 34, and the Ionescu-Shiley porcine pericardial prosthesis at 65 million cycles. The Lillehei-Kaster was removed after 762 million cycles without discernible wear. Three facts emerged from the testing data: (1) the component worn in vitro wears in vivo; (2) the sites of in vitro fatigue on the component are identical to clinical specimens; and (3) those valves that have high durability in vitro have given similar performance in patients. The in vitro and clinical data for tissue valves do not correlate. The possible reasons for the discrepancy are discussed, and a note of caution is made regarding realistic expectations of clinical durability of tissue valves.


Hemodynamic evaluation of Lillehei-Kaiser and Starr-Edwards prosthesis. The central-flow low profile disc-valve prosthesis has been offered as an alternative to ball- and tissue-valve prostheses. Extensive laboratory investigation with both pulse duplicator and experimental animals has been reported for the Lillehei-Kaster prosthesis. A series of patients receiving this prosthesis underwent postoperative cardiac catheterization to better define the hemodynamic function of this prosthesis in vivo. Because of the variations in reports of hemodynamic data from various institutions, the results of post-operative studies in an earlier group of patients with Starr-Edwards prostheses were used as a standard for comparison. Good hemodynamic function was found with the pivoting-disc prosthesis in all but the smallest valve sizes. Lillehei-Kaster and early model Starr-Edwards prostheses with equivalent tissue annulus dimensions were found to have nearly equal valve areas in vivo in the aortic position. The Lillehei-Kaster mitral valves provided larger areas than Starr-Edwards prostheses in large tissue annulus sizes.


Operative closure of isolated defects of the ventricular septum: planned delay. Selection of patients and the timing of operation for closure of ventricular septal defect (VSD) can be difficult because the risk of operation must be balanced against the hemodynamic abnormality and the age and size of the infant. In the past 6 years we have individualized our approach to the timing and necessity of operation in the patient with an isolated VSD. During this period, 133 patients with VSD were evaluated, and 71 underwent operative closure of the VSD. Of the 133 patients, 90 were 2 years old or younger, and 40 of them required operation because of congestive failure and growth retardation. Of the 45 infants who did not undergo operation, 17 have small intracardiac shunts with normal pulmonary vascular resistance while the other 28 infants remain compensated and are growing despite moderate left-to-right shunts. A persistent, large intracardiac shunt was the indication for operation in 31 of the 48 older patients; the other 17 older patients remain well. Although 3 severely growth-retarded infants (2 to 4 kg) died soon after operation, all infants weighing 4 kg or more survive. No child has died during preoperative observation, and irreversible pulmonary vascular changes have not occurred. Most infants with VSD and large intracardiac shunts do require early VSD closure, but the risk of operation remains high in the tiny neonate with profound failure. With appropriate hemodynamic and clinical criteria, operation for selected infants can be delayed so that the risk of operation can be minimized.


Determinants of long-term survival after ventricular aneurysmectomy. To determine the effect of aneurysmectomy solely or combined with direct revascularization, 349 consecutive surgical patients treated between 1962 and 1972 were retrospectively reviewed. The minimum follow-up for survivors was 5 years (mean, 7 years). Single-vessel disease occurred in 171 (49%) and only ventricular aneurysmectomy was performed (Group 1). Multiple-vessel disease was found in 178 (51%), of whom 79 (44%) had resection of a ventricular aneurysm and revascularization of all major obstructed vessels (Group 2); 99 (56%) had aneurysm resection and incomplete revascularization (Group 3). Survival at 7 years was 69% for Group 1, 65% for Group 2, and 51% for Group 3. Actuarial survival at 7 years was 70% for patients operated on for angina; 55% for congestive heart failure; 57% for a combination of angina and heart failure; and 64% for ventricular tachycardia. Survival of patients with multiple-vessel disease who underwent aneurysmectomy and complete revascularization was similar to that of patients with single-vessel disease who underwent aneurysmectomy alone. Longevity is adversely influenced by incomplete revascularization (p less than 0.005) and preoperative congestive heart failure (p less than 0.005).


Monilial esophagitis: an increasingly frequent cause of esophageal stenosis? Acute monilial esophagitis generally responds well to oral nystatin therapy, and long-term sequelae of this condition have not been well recognized. Nor is it generally appreciated that Candida infections of the esophagus may occur in subacute or chronic form. Four men, 34, 40, 41, and 49 years old, have been treated for esophageal stenoses resulting from different types of chronic monilial esophageal involvement. All were seen with painless dysphagia and strictures of the upper half of the thoracic esophagus. In 2 patients, an associated roentgenographic pattern of "intramural esophageal pseudodiverticulosis" was present. Two patients have been treated successfully with esophageal dilation, 1 required substernal colonic bypass of the stenotic, perforated esophagus, and 1 is being evaluated for esophageal bypass. Esophageal moniliasis must be considered in the differential diagnosis of benign esophageal strictures, particularly those involving the upper half of the thoracic esophagus.


Surgical management of malignant mesothelioma. The surgical management of 18 patients diagnosed as having malignant mesothelioma is reviewed. Of these patients, 7 received limited treatment--pleurectomy or biopsy. The mean survival was 10 months, and no patient was disease-free at time of death. The other 11 patients were treated by radical extrapleural pneumonectomy. There were 2 long-term, disease-free survivors at 2 and 4 years. Mean survival for the entire group was 15 months, but most patients received good palliation following tumor removal. Surgical procedures for removal of malignant mesothelioma can be accomplished safely and without major morbidity. When possible, radical extrapleural pneumonectomy affords the best palliation and the only opportunity for cure.