Correlation of absorption coefficients with intracranial fluid protein concentrations and specific gravities. Samples of ventricular cerebrospinal fluid, tumor cyst fluid, and subdural fluid were obtained from 30 patients at operation. The protein concentration and the specific gravity of each sample were measured and the corresponding mean absorption numbers were calculated from the numerical printout of the preoperative computerized tomogram. For fluids with a specific gravity greater than 1.005, a linear relationship was demonstrated between protein concentration and specific gravity. For protein concentrations greater than 300 mg/dl, there was a linear relationship between protein concentration and the mean absorption number. As the precision of present instrumentation improves, it is expected that a noninvasive technique for estimating intracranial protein concentration will have a number of clinical application.


The early ultrastructural alterations in the rabbit cerebral and cerebellar cortex after compression ischaemia. The ultrastructural alterations in the rabbit cerebral and cerebellar cortex resulting from 30 minutes complete, permanent cerebral ischaemia were studied. The ischaemia was induced by raising the intracranial pressure (ICP) above the systolic arterial pressure (compression ischaemia). Immediately after releasing the ICP the brain was fixed by intravascular glutaraldehyde perfusion. Samples from the cerebral and cerebellar cortex were processed for electron microscopy. The ultrastructural changes were relatively minor; there was a generalised, slight intracellular oedema, most prominent in the subpial area; the nuclear chromatin was clumped, the endoplasmic reticulum and cisternae of the golgi apparatus became somewhat dilated, the inner matrix of the slightly swollen mitochondria showed increased electron lucency, and microtubules and ribosomes began to loose their compact structure. These changes, unaccompanied by any extensive volumetric change of any cellular compartment, agree well with the recently presented hypothesis of two different types of anoxic-ischaemic nerve cell injury. This cellular reaction to complete, permanent compression ischaemia represents the type of injury that is seen resulting from ischaemic insults during which no flow of fluid irrigates the ischaemically injured cells.


Extracranial-intracranial arterial bypass in the treatment of aneurysms of the carotid and middle cerebral arteries. Eleven patients with lesions of the internal carotid and middle cerebral arteries that could not be treated by direct approach are presented. Major vessel occlusion was chosen as definitive therapy. Prophylactic extracranial-intracranial bypass was employed in an attempt to reduce the incidence of ischemic complications. Emphasis is placed on complications, from which several important lessons were learned. Our best results occurred in patients with carotid artery lesions treated with bypass and immediate internal carotid ligation. We believe this to be an effective and safe mode of therapy in cases in which direct approach is not feasible. The low risk and high potential benefit of prophylactic bypass justifies its use before major vessel occlusion in selected cases.


Traumatic lesions of the corpus callosum. We investigated the mechanism of damage to the corpus callosum in a study of 46 brains obtained at the autopsies of patients with head injuries. After correlating the gross findings with the site of impact on the head, we think that such lesions in the corpus callosum are caused by stretching of callosal fibers and/or shearing forces in cases in which lateral movement or twisting of the brain occurs. This mechanism of the dynamic development of callosal injuries is also supported by the retraction bulb formation of axons found histologically in the corpus callosum.


Epidural measurement of intracranial pressure. Although the measurement of intracranial pressure (ICP) is gaining widespread acceptance, the most desirable method of measurement is disputed. Subdural fluid-coupled techniques are associated with an increased risk of infection, and epidural techniques are associated with decreased accuracy. We investigated epidural measurement techniques and suggest that the necessary and sufficient criteria for accurate epidural measurement of ICP are adequate transducer size and stiffness, transducer-dura coplanarity, transducer-guard ring coplanarity, complete dural contact, and rigid fixation. An epidural transducer design was developed and prototypes were constructed using these principles. The transducer requires no percutaneous connections, fluid coupling, or batteries. Transducer accuracy was +/- 2.2 torr in bench stability studies lasting up to 198 days, +/- 3.0 torr in acute animal studies of less than 24 hours, and +/- 7.9 torr in chronic animal studies lasting up to 112 days. Error bounds are expressed such that 95% of individual measurements are expected to have error less than the bound; average error is one-third of the bound. Average transducer drift was 0.1 torr per day; our reported accuracy in chronic studies used drift correction from preimplantation data. We conclude that accurate measurement of ICP using an epidural transducer is feasible.


Sarcoma metastatic to the central nervous system: report of three cases and review of the literature. Sarcoma metastatic to the central nervous system is generally considered to be rare. In this report three cases of sarcoma with metastasis to the central nervous system are presented. The case of rhabdomyosarcoma of the lung probably represents the first reported instance of such tumor metastatic to the central nervous system. The case of fibrosarcoma of the thigh is thought to be the first report of metastatic sarcoma with leptomeningeal dissemination. The metastatic brain lesions of the alveolar soft part sarcoma were incidental findings at autopsy. A summary of 22 cases previously reported and a brief discussion of the mode of metastasis of sarcoma, as compared to that of carcinoma, are also presented.


Assessment of the postoperative course of excised brain abscess by computerized tomography. We present two patients with brain abscess who underwent complete excision with a satisfactory clinical outcome although serial computerized tomography (CT) Scans in the early postoperative period seemed to indicate a large residual abscess in each case. We recommend treatment based on the clinical course rather than the CT scan appearance, indicate that earlier reports on this topic may be misleading, and suggest an explanation for these findings.


Symptomatic cyst of the choroid plexus of the lateral ventricle. A case of symptomatic cyst of the choroid plexus of a lateral ventricle in a child is reported. The characteristics of the case are compared with those of the other three cases in the literature.


Cervical dermal sinus and intramedullary spinal cord abscess: case report. Congenital dermal sinuses in the cervical region are rare. A case report is presented in which the persistent anomaly led to formation of an intramedullary spinal cord abscess. The clinical presentation, radiological diagnosis, and surgical management are discussed.


The normal angiographic sylvian point on the lateral cerebral angiogram. The angiographic sylvian point (ASP) is one of the most useful landmarks on cerebral angiograms for detecting retrosylvian masses. Although it is suggested to be the halfway point on the clinoparietal line (CPL), its exact normal position has not been defined. The lateral carotid angiograms of 100 consecutive patients from 22 to 65 years of age were used to study the normal ASP in relation to the CPL. Patients with severe neurological deficits or angiographic evidence of hydrocephalus, severe vascular disease or mass lesions were eliminated from this study. In our 100 normals, the normal ASP was within 8 mm above and below the CPL, and in the majority (82%) it was located behind the midpoint of the CPL. It was not situated more than 14.4 mm posterior and never more than 3.1 mm anterior to the midpoint. Application of these normal relationships facilitates detection of small, deep retrosylvian masses occupying the medial portions of the parietal, occipital and temporal lobes.


Persistent proatlantal intersegmental artery and occipital artery originating from internal carotid artery. A case of a combined anomaly of persistent hypoglossal and proatlantal intersegmental arteries, proved on arteriogram obtained by the insertion of a needle into the common trunk of both arteries, is presented. In addition, a case of anomalous occipital artery arising from the internal carotid artery associated with an intracranial aneurysm and arteriovenous malformation is presented. Based upon analysis of the persistent proatlantal intersegmental artery and the anomalous occipital artery, we conclude that both arteries have an identical embryological origin.


Computed tomography and intracranial aspergillosis. A case of aspergillosis of the central nervous system with multiple granulomas examined by computed tomography is reported. The findings are those of chronic mass lesions with and without calcium deposits. An associated cystic configuration probably is not specific for aspergillomas.


Pseudoaneurysm formation secondary to spontaneous thrombosis of a massive cerebral arteriovenous malformation. A case of a large cerebral arteriovenous malformation (AVM) with spontaneous partial thrombosis and intracerebral hematoma is reported. The unusual and unique features of the radionuclide brain scan and cerebral angiogram are described. The characteristic angiographic features of residual tortuosity and dilatation or pseudoaneurysm formation at the bifurcations of the feeding arteries in a partially thrombosed cerebral AVM have not been described previously in the literature.


Congenital absence of a pedicle in the cervical spine: a new approach with CT scan. After complete review of the literature concerning the congenital absent pedicle syndrome, another typical case is presented. In the opinion of the authors, the diagnostic importance of the associated clinical symptoms is doubtful. Furthermore they demonstrate the great value of CT in the differential diagnosis of this lesion.


Factors influencing the development of periventricular lucencies in patients with raised intracranial pressure. Sixty patients with raised intracranial pressure and lowered attenuation areas around the lateral ventricles ('periventricular lucency', PVL) on CT scanning were reviewed, and compared with a control group of 90 similar patients who did not have PVL. It was confirmed that PVL tends to occur in patients with acute or subacute obstructive hydrocephalus due to a tumour, and is more common in the presence of papilloedema and/or a decreased level of consciousness. Patients with very dilated lateral ventricles did not in general have PVL, but it was frequently seen in association with diastasis of the sutures. Twelve patients with PVL had no other clinical or radiological indication of raised intracranial pressure. Comparison with the control cases did not reveal any reason as to why some patients should develop PVL while others did not.


Computed tomography and spinal dysraphism: clinical and phantom studies. Two cases illustrating the value of CT in the assessment of spinal dysraphic tissue are presented. In one case, the configuration and origins of two osseous diastematomyelic spurs were shown well; in the second case, the CT recognition of a sacral lipoma led to air myelographic confirmation of the tumor and tethered cord. CT phantom studies indicated that dysraphic tissues, such as fat, cartilage, and fibrous tissue, are better identified and quantitated in the spinal canal when surrounded by air. Varying degrees of image degradation occur with water (simulating CSF) or metrizamide.


Metrizamide cisternography and computed tomography for the investigation of pituitary lesions. Metrizamide cisternography and computed tomography (CT) have been performed on 22 patients suspected of having pituitary or suprasellar lesions, using a low dose of metrizamide. These patients would otherwise have been subjected to air encephalography. The technique is described and the results are presented. The lesions demonstrated included empty sellae and suprasellar extensions of pituitary tumours. We also identified those patients in whom there was no suprasellar extension of a pituitary  tumour. The diagnostic information required was obtained in all cases by a combination of the two techniques and air encephalography was avoided in all but one case. The side effects were mild and no serious complications were encountered. We consider this combination of methods to be very useful for the investigation of pituitary lesions.


Angiotomography for aneurysms and arteriovenous malformations of the head and neck. Angiotomographic studies were performed preoperatively on 201 arterial aneurysms and arteriovenous malformations (AVMs) of the head and neck. There were two extracranial aneurysms, 186 intracranial aneurysms and 13 intracranial AVMs. The equipment used was the Philips NeuroDiagnost, either armed with a single multisection cassett for single-phase angiotomography or a triple cassette system on a motor-driven prism for serial amgiotomography. Angiotomography was limited to lesions where its use promised to add significantly to the information already obtained from conventional angiograms. Angiotomography was found to be of particular value for the differentiation of small aneurysms from normal vascular structures, for the study of morphology and topography of more or less spherical aneurysms in close proximity to a number of neighboring arteries, for the study of giant aneurysms, for the demonstration of very small AVMs (microangiomas) and for the evaluation of feeding and draining vessels of midline AVMs.


Cerebral arterial air embolism due to an esophago-atrial fistula seen on CT. A case of cerebral air embolism from a rather unusual cause is reported; an esophago-cardiac fistula permitted food particles and air to enter the systemic arterial circulation. Massive embolization caused the patient to become deeply comatose rather suddenly. The computed tomogram (CT) revealed massive cerebral edema with the contradictory finding of wide superficial subarachnoid spaces. These subarachnoid spaces on further evaluation proved to be air in the cerebral vessels.


Morphology of the cervical spinal cord on computed myelography. To ensure adequate use of the technique of computed myelography (CM) it is necessary to have an exact picture of the morphology of the normal spinal cord as demonstrated by this technique. This has been obtained by studying the morphology and measuring the frontal and sagittal diameter of the cervical cord in 20 patients. The normal values are presented. The changes of this morphology in one patient with a tumour, one patient with atrophy of the spinal cord and in some patients with congenital malformations are also reported.


Xenon enhancement for computed tomography of the spinal cord. The spinal cord is not consistently shown by plain computed tomography or with iodide enhancement. Xenon enhancement increases the attenuation of the spinal cord and visualization is improved considerably; fluid-filled cavities, including syringohydromyelia, do not enhance and are clearly defined.


The projection of the calcified pineal gland on slightly rotated AP films as a reliable landmark. A CT study. The projection of the pineal gland between the two outer tables of the skull in the AP film has been reconstructed on the basis of the CT print of the head, with and without lateral rotation. In this experimental approach it is proven that rotation up to 5 degrees does not influence the position of the pineal gland on the AP film. The range of the normal position of the pineal in the frontal plane is defined and the normal distribution is given.


Computed tomography in alcoholic cerebellar atrophy. This is a controlled CT evaluation of the infratentorial region in 41 male alcoholics under age 35. Criteria for the presence of atrophy are outlined. Twelve patients had cerebellar atrophy. Vermian atrophy was present in all. Atrophy of the cerebellar hemispheres was demonstrated in eight patients as well. The results are statistically significant when compared to an age-matched group of 40 non-alcoholic males among whom two cases of vermian atrophy were found. There were clinical signs of alcoholic cerebellar atrophy in one patient only. The disparity between the clinical and the radiological data are discussed with reference to previous pneumoencephalographic findings.


The Evans ratio for ventricular size: a calculation error. The suggestion that the Evans ratio, the ratio of the transverse diameter of the anterior horns of the lateral ventricles to the internal diameter of the skull, was a more significant quantity than the ventricular measurement alone was based on a calculation error. The value of this ratio and other such ratios involving linear skull measurements is unproven.


Ectasia of the basilar artery: the breadth of the clinical spectrum and the diagnostic value of computed tomography. Five angiographically confirmed cases of ectasia of the basilar artery are described. Three patients presented with the classical combination of lower cranial nerve, bulbar, cerebellar and long tract signs and dementia, one as obstructive hydrocephalus with papilloedema, and the fifth with symptoms of chiasmal compression. All were above middle age and hypertensive. CT scanning demonstrated a partially calcified, tubular, enhancing prepontine and suprasellar mass in every case. Ventricular enlargement and cerebral parenchymal abnormalities were also present. These appearances are sufficiently characteristic to make invasive radiological investigation unnecessary.


Giant aneurysms of the posterior fossa suspected as neoplasms on computed tomography. Giant intracranial aneurysms of the vertebral and basilar artery can be mistakenly diagnosed as neoplasms of the posterior fossa on the basis of their clinical presentation and CT findings. The following report of three cases of tumorous aneurysms emphasizes the complementary value of angiography and computed tomography for the localization and correct diagnosis of space-occupying lesions of the posterior fossa.


Intracranial fibromuscular dysplasia and stroke in children. Fibromuscular dysplasia (FMD) is an arterial lesion of unknown origin which may sometimes affect intracranial arteries. In recent years a few rare cases, mostly involving younger people, have been described. The present case concerns a child of 8 years in whom the finding of hemiplegia led to a diagnosis of intracranial fibrodysplasia which was proven by arteriography and biopsy. This arterial lesion is described within the context of stroke in children.


[Treatment of acute pancreatitis with glucagon]. Personal experience in the treatment of acute pancreatitis with glucagon is reported. Results are highly satisfactory and encouraging in oedematous, interstitial and circumscribed steatonecrotic forms, disappointing where the disease has caused extensive damage to the gland.


[Calcified pseudocyst of the spleen. Report of a case]. The description of a case of calcific pseudocyst of the spleen has provided the opportunity for a review of the literature on the subject and for further study, on the basis of clinical and anatomo-pathological data, of the problem of the aetiopathogenesis of non-parasite splenic cysts.


[Spontaneous rupture of the subdiaphragmatic esophagus]. Personal experience with an extremely rare clinical picture, spontaneous rupture of the subdiaphragmatic oesophagus is reported. In the case in question, the laceration occurred in a free peritoneum,  unlike what occurred in the first reported case, that of Strauch and Lynch in 1965, where the lesion was retroperitoneal. On the basis of this experience, certain pathogenetic and diagnostic factors are discussed, but most attention is paid to the surgical treatment of this exceptional lesion.


[Segmentary necrosis of the main bile pathway. Presentation of a clinical case]. Reference is made to a personal case in an examination of the more controversial aspects of segmentary necrosis of the main bile pathway. Attention is drawn to the leading features of the pathogenetic evolution of this lesion. Bearing in mind the almost insurmountable difficulty of formulating a preoperative diagnosis, an examination is made of the possible therapeutic solutions. In the light of the data presented, the suggestion is made that the only effective prevention is offered by early surgical management of all pathological situations affecting the main bile pathway that may, if neglected, lead to the setting up of segmentary necrosis within it.


["Cold" nodules of the thyroid gland. (Clinical statistical study)]. A series of 718 scintigraphically cold thyroid nodules observed between 1965 and 1976 at the Turin University Endocrine Surgery Centre is presented. This form was more common in women (80%) and mainly occurred in the 3rd and 5th decade of life. Malignancy was present in 88 cases (12.27%): 49 papilliferous tumours, 25 follicular, 9 Hurthle-cell, and 5 anaplastic. A reference is expressed for unilateral lobectomy followed by suppressive management as opposed to total thyroidectomy since malignancy is low in forms where a tumour has a single site in a cold nodule. Furthermore, this approach spares the patient from the severe consequences of inevitable post-operative hypothyroidism. Total resection is, however, mandatory in anaplastic forms. A detailed account is offered of the typical echotomograms associated with individual pathological situations. These are enough to support a preoperative diagnosis of malignancy.


[Carcinoma of the convergence of the hepatic ducts. A case treated with extended hepatic resection]. The case of a patient with carcinoma of the convergence of the hepatic ducts successfully treated with more extensive hepatic resection is reported. Stress is laid on the problems of exact preoperative diagnosis and of treatment. Most operations are in fact purely palliative and the literature contains very few cases of hepatic resection for neoplasia of the convergence.


[Metabolic changes after extended hepatic resection]. Two cases of right hepatic lobe resection, one due to trauma and the other to echinococcosis. Adequate support therapy can be used to control the protein, lipid and sugar metabolic changes that occur after this operation. The seriousness of the postoperative course is related to the amount of healthy tissue removed.


[Endoscopic papillotomy. Indications and limitations]. Personal experience of 161 cases of endoscopic papillotomy (EP) is reported. Indications and contra-indications are considered in relation to the therapeutic effectiveness of the technique and to the lower percentage of morbidity and mortality connected to it with respect to that following on laparatomic surgery. On the basis of results obtained and of the data reported in the literature, it is pointed out that EP represents real progress in the treatment of calculosis of the hepatocholedochus and of stenosing papillitis.


[Transgastric lymphadenography].

[Transgastric lymphadenography]. The transgastric lymphadenography technique carried out by the endoscopic route in 52 patients at the Digestive Endoscopy Centre of the 3rd Surgical Clinic of Rome University is described. On the basis of personal results it is considered that transgastric lymphadenography represents an interesting technique for the study of perigastric lymphnodes in normal and pathologic conditions. It is thought that it could also be useful in the study of the abdominal lymphatics although further verification and a larger series are necessary.


[Carcinoma with a branchial origin].

[Carcinoma with a branchial origin]. Carcinoma was observed in a patient with a branchial cyst of about 40 years' standing. The neoformation was removed, but the patient died as a result of cardiocirculatory complications a little more than a year later. Note is taken of the rarity of this form and the compliance of the reported case with the criteria laid down by Martin et al. in 1950.


[Hepatic hamartoma. Description of a case in a child]. A case of hepatic hamartoma in a child of 13 months, treated with atypical resection of the right lobe of the liver, is reported. The tumour was of whitish colour and weighed 800 g. Its size was 16 X 9 X 10 cm and its section revealed a hyaline-fibrous appearance with reddish areas and others of cystic appearance. At follow-up, the child did not complain of digestive trouble and grew normally.


[A case of retroperitoneal cystic lymphangioma]. A case of retroperitoneal cystic lymphangioma in a 62-yr-old woman presented as symptom-free abdominal swelling. The intraoperative diagnosis was confirmed histologically. Radical management consisted of stripping of the cyst from its adjacent structures. The postoperative course was uneventful.


[Late obstructions of aorto-bifemoral prostheses]. The factors underlying late thrombosis of aortobifemoral by-pass are analysed on the basis of personal experience and reported data. They are considered to be due to progressive degradation of the prosthesic tissue and, particularly, to the lack of an adequate back flow route, apart from any faults in the actual construction of the femoral anastomosis. Treatment of the thrombotic complication involves considerable technical and operating problems which have two main solutions: substitution of the thrombosed branch, or its disobstruction. Intimately linked with restoral of by-pass patency is the reconstruction of an adequate back flow route either by means of profundaplasty or by extending the branch as far as popliteal level. Of 83 patients discharged with patent prosthesis, thrombosis occurred in 7 and 10 reoperations were necessary. Reconstruction of branch patency was done in the majority of cases by thrombectomy. Profundaplasty was associated in 4 cases while in other 4 popliteal extension was necessary. Analysis of results shows that the operation of choice on the affluxion route seems to be replacement of the thrombosed branch.


[Value of the use of ultrasonics in the diagnosis of aneurysms of the abdominal aorta]. An account is given of the basic theory underlying the use of ultrasounds in the diagnosis of dilatation of the abdominal aorta, and its practical value. The limitations of physical examination and vacuum radiography, and the contraindications, inconveniences and risks associated with aortography are points in favour of echography. The salient features of its application in suspected aneurysm are described with reference to 12 clinical cases. This simple and harmless examination offers a reliable and non-invasive means of detecting the presence and determining the size of such aneurysms with safety and certainty.


[Arteriovenous fistulas for hemodialysis. Experience in 366 cases]. The surgical techniques adopted in performing 366 a-v fistulas for hemodialysis in 346 patients over ten years' experience are presented. A survey of the results obtained is then made as well as the evaluation of the same, based upon functional and clinical parameters. The technical details sometimes adopted, the occlusions and the principles drawn out for personal experience in this field are described.


[The superior mesenteric artery syndrome. Anatomo-clinical study and therapeutic possibilities in vascular compression of the duodenum]. Four cases of superiore mesenteric artery syndrome are presented. Reference is made to the difficulties involved in the clinical diagnosis of this form. It is pointed out that radiological examination is essential, since it dispel all doubts in nearly every case. Associations between the syndrome and peptic ulcer are relatively, and the joint surgical resolution of both forms is recommended.


[Preventive medicine in adults. Fundamentals and prospects]. The Author puts in evidence the need of a real development of the Medical Science, so to give the basis for a program of preventive medicine of the adult, that is prevention of degenerative pathology. A new way of thinking about this pathology starts from its relation with the aging process. This "interpretative way" may often be much more usefull than the mere diagnostic definition (as in the traditional medicine for the infectious disease) with its consequences of therapeutic activism and of a "by any way gained" normalization of biological parameters. Under this point of view one can look at the various aspects of the prevention. So the Author claims for a real evaluation of the risk factors and quite important, of the protective factors. These protective factors are probably of big value for preventive medical practice, as important as the health education. Actually people's health must be driven and saved much more than restored, a "Utopia" in the field of degenerative and senile pathology.


[Sleep characteristics of elderly and very long-lived subjects]. Through the method of the "questionnaire" quantitative and qualitative aspects of the sleep of a group of 24 eldery people and of 24 very old people have been studied. Regarding the sleep of the eldery person the attention is recalled to two data: the presence of dreams of "erotic" contents in 50% of the subjects and the lack of a substancial difference between the agregate duration of sleep of the adult compared to that of the eldery person. About the sleep of the very old person the A.A. underlines the tendency to sleep more in old age: in this research, one hour more than the eldery. The very old people in the total of examined cases are people that, during life, have always gone to bed "early" in the evening. It is suggestive that only two out of 24 very old people have declared to have "anguishing" dreams.


Leiomyosarcoma of the uterus: case reports and a review. Eight patients with leiomyosarcoma (LMS) of the uterus recently treated at our institution are reported. Modes of initial therapy in these patients included surgery alone, radiation therapy alone, or surgery plus radiation therapy. Mitotic counts were greater than 10 per 10 high power fields in the tumors of all of these patients. Only two patients are currently alive, and both have been treated for metastatic neoplasm to the lungs. A comparison of the histological material of these patients with criteria outlined in the recent literature for a diagnosis of uterine LMS is made. The possible role of a hormonal influence on this neoplasm is discussed. It would appear that a more aggressive initial therapy plan may improve survival in patients with this lethal malignancy.


Changing trends and prognostic features in endometrial cancer associated with exogenous estrogen therapy. A study was undertaken to investigate changing trends in the microscopic patterns of endometrial carcinoma and to compare the biologic characteristics of those cases associated with and without estrogen usage. After each case was reviewed independently and in a random order by at least 2 pathologists, a diagnosis of cancer was agreed on in 274 patients who had been treated by 5 gynecologists at the Masachusetts General Hospital between 1940 and 1971. Six microscopic patterns were identified (adenocarcinoma, adenoacanthoma, atypical adenoacanthoma, adenosquamous carcinoma, clear-cell adenocarcinoma, and undifferentiated carcinoma). The frequency of each pattern relative to the other 5 changed only slightly during the 30-year interval. The tumors that developed in estrogen users were more highly differentiated than those that developed in nonusers (P less than 0.005) and were found at an earlier average age (P less than 0.02). That the adenoacanthoma was associated with estrogen usage more frequently (51%) than any other tumor type (P less than 0.02) may reflect, in part, a similar and lower mean age of estrogen users (56 years) and patients with adenoacanthoma (55 years) compared with that of nonusers with the other forms of tumors (60--67 years). Although the overall 5- and 10-year survival rates of the estrogen users were higher than those of the nonusers, the differences between the 2 groups disappeared when the grade of the neoplasm was considered.


The transverse vaginal septum: a clinicopathologic evaluation. Twelve cases of transverse vaginal septum were clinically and pathologically evaluated. Seven cases were treated with electrosurgical excision of the septum with encouraging results. Histologic findings in the patients in this study support the view that the epithelium of the vagina and the transverse septum are of mesonephroid origin.


Fatal perineal cellulitis from an episiotomy site. Perineal cellulitis originating from an episiotomy incision resulted in 20% of the maternal mortality in King County, Washington, between 1969 and 1977. Necrotizing fasciitis was present in 2 of the cases, and clostridial myonecrosis was present in 1. These fatalities occurred because the practitioners were not aware that necrotizing fasciitis can occur in the fatty superficial fascia of the perineum and that resection of the necrotic tissue is necessary for successful therapy.


A comparison of different methods of instrumental delivery based on electronic measurements of compression and traction. Electronic measurements of compression, using a hydrostatic technique, were made during 44 normal deliveries and compared with the values obtained during 32 deliveries using Kielland's forceps, 21 using Neville Barnes' forceps, 48 using Moolgaoker's adjustable forceps, and 26 using Malmstrom's vacuum extractor. Electronic recordings of traction, using strain gauges, were made simultaneously during all the instrumental deliveries except those with Kielland's forceps. By exercising suitable controls over most of the multiple factors operating at the time of any delivery the authors were able to compare objectively the efficiency of the different methods of instrumental delivery. Smaller forces of compression and traction were exerted and better Apgar scores were recorded in infants delivered with the adjustable forceps than in infants delivered with the other instruments. The superiority of the adjustable forceps was most noticeable during midcavity deliveries of the malrotated head.


A paired controlled study of vaginal and abdominal delivery of the low birth weight breech fetus. In a paired, controlled, retrospective study, 44 low birth weight breech fetuses delivered vaginally were compared with 44 breech fetuses delivered by cesarean section. Seven deaths occurred in the vaginal delivery group, compared with only 1 in the abdominal delivery group. Asphyxia, trauma, and intracranial hemorrhage were also found more frequently among vaginally delivered fetuses. The authors conclude that for the low birth weight breech fetus, delivery by cesarean section is preferable.


hPL: physiologic and pathophysiologic observations. Serum human placental lactogen (hPL) levels were studied in 806 women in late pregnancy. The hPL levels were positively correlated with birth weight but were unrelated to maternal age, parity, socioeconomic status, or the sex of the newborn. The hPL levels peaked at 37 weeks' gestation and then declined moderately. An individual's hPL levels in late pregnancy are quite constant week to week. Patients with severe chronic hypertension have low hPL values; those carrying twins have high values.


Glycosylated hemoglobins in normal pregnancy and gestational diabetes mellitus. Glycosylated hemoglobins (HbA1) were measured in 23 nonpregnant women, 53 normal pregnant women, and 22 Class A diabetics; the results were 6.1 +/- 0.7%, 5.8 +/- 1.0%, and 7.0 +/- 1.3% in the 3 groups, respectively. The decrease in normal pregnancy was insignificant, whereas the increase in HbA1 in Class A diabetics over the other 2 groups was statistically significant (P less than 0.05). HbA1 did not correlate with maternal age, gravidity, or gestational age at the time of sampling. There was no difference in HbA1 between whites and blacks [patients with sickle hemoglobin (HbS) were excluded] (P = 0.35), nor between primigravidas and multigravidas (P = 0.8). HbA1 levels did not correlate with the birth weight ratios in either normal pregnancies (r = 0.06, P = 0.7) or in Class A diabetics (r = -0.4, P = 0.09). This is probably due to the long interval between HbA1 determination and delivery (9.9 weeks).


24-hour urine creatinine excretion in pregnancy. A total of 489 consecutive 24-hour urine collection from 162 patients were analyzed for creatinine excretion. The 24-hour creatinine excretion increased with the urine volume. Creatinine excretions in 24-hour urine collections were not statistically different between in- and out-patients. The results indicate that the mean urine creatinine per 24 hours is 1.08 g for 24-hour urine volumes between 500 and 1500 ml. For urine volumes greater than 1500 ml it is 1.22 g. For 24-hour urine volumes less than 500 ml, the mean creatinine is 0.63 g.


Consolidation of hospital obstetric services--is it a reality? Despite efforts toward regional planning of maternity services and consolidation of small hospital units, the number of US hospitals with maternity services has increased every year since 1973. Only 2 states have significantly reduced the number of hospitals performing less than 500 deliveries annually. The average number of annual deliveries per hospital is 728. No state has achieved an average number of deliveries as high as the 1500 deliveries called for in national guidelines for health planning.


Vaginal epithelialization with human amnion. Human amnion is a readily available and inexpensive allograft with low antigenicity, high antimicrobial potential, and the ability to foster epithelialization. It has been used to reconstruct the vagina in 2 patients following vaginectomy for diffuse carcinoma in situ (CIS) and in 1 patient following severe, corrosive, vulvovaginal burns. It was also used to construct the vagina in 1 patient with müllerian agenesis. In all 4 cases, epithelialization was complete within 8 weeks.


Contact hysteroscopy: a new technique to explore the uterine cavity. Contact hysteroscopy is a new endoscopic technique that allows direct examination of the uterine cavity. The procedure is performed using ambient room light, which is collected by a special light trap incorporated into the body of the instrument. The mechanism for gathering and transmitting light eliminates the need for any electric connections whatsoever. The optical design enables the examiner to see the endocervix and endometrium even in the presence of bleeding. Neither gas nor liquid media are required for observations since the uterine cavity is not distended. An initial appraisal of 80 women with the contact hysteroscope proved successful from the standpoint of technical simplicity, diagnostic accuracy, and absence of complications.


Preeclampsia and the patient with myasthenia gravis. Three cases of myasthenia gravis in pregnancy are presented. In 2 cases there were moderately severe hypertension or preeclampsia and difficulty in controlling the myasthenia symptoms. The other case was uncomplicated. The possible relationship between myasthenia gravis and preeclampsia is discussed.


Recurring oral pregnancy tumors.

Recurring oral pregnancy tumors. Two cases of recurring "pregnancy tumors" are described. The likelihood of these lesions occurring and recurring following conservative therapy is enhanced by hormonal concentrations in the gingival tissues in conjunction with local factors produced by poor oral hygiene. This condition may pose a clinical problem in the pregnant woman.


The oxytocin challenge test: an ominous pattern associated with severe fetal growth retardation. Four cases of a rare atypical fetal heart pattern obtained during the oxytocin challenge test are described. In all cases, there were marked oligohydramnios and fetal growth retardation with a severely compromised fetus, and in 3 cases the fetuses died.


The use of quinidine sulfate throughout pregnancy. A gravid patient was given quinidine sulfate for idiopathic ventricular tachycardia. The serum levels of quinidine remained stable throughout pregnancy. At delivery, maternal and neonatal quinidine levels were equivalent, while the level in the amniotic fluid was significantly elevated. Explanations for the latter include 1) a concentration of quinidine in amniotic fluid due to spontaneous fetal voiding and 2) the use of a nonspecific protein precipitate method to measure quinidine that is unable to differentiate quinidine from its nonfunctioning metabolites. The diffusion of quinidine into breast milk was related to the serum quinidine concentration.


Hydranencephaly in a twin gestation.

Hydranencephaly in a twin gestation. Hydranencephaly in a twin gestation was demonstrated prenatally by ultrasonography and confirmed following delivery by cranial computerized axial tomography (CAT). Prenatal diagnosis of intracranial anomalies is possible with the use of ultrasonography. This is the third report of the occurrence of hydranencephaly in a twin gestation.


Diagnosis of congenital mitral and aortic stenosis from the fetal electrocardiogram. A case of congenital mitral and aortic stenosis diagnosed from the fetal electrocardiogram (FECG) during labor is presented. Cardiologic work-up and autopsy findings in the neonate confirmed the diagnosis. This is the first case in which prenatal diagnosis of a specific anatomical lesion of the heart was made from the FECG and confirmed clinically as well as at autopsy.


Cerebral abscess associated with an intrauterine contraceptive device. The present communication is the first report of a metastatic brain abscess occurring as a complication of severe intrauterine device (IUD)-related pelvic inflammatory disease (PID). The diagnostic and therapeutic problems are discussed, and a suggestion is made for the reporting of all IUD-associated infections to a central agency.


Postpartum hypokalemic paralysis.

Postpartum hypokalemic paralysis. An attack of hypokalemic paralysis occurring in a 23-year-old woman during the immediate postpartum period of her fourth pregnancy is described. A flaccid paralysis of her extremities and markedly diminished deep tendon reflexes developed 3 hours after delivery, at which time her serum potassium level was found to be 1.7 mEq/liter. Hypokalemic paralysis has not been previously reported as an immediate postpartum complication. The pathophysiology and management of this condition are discussed, as are the treatment and follow-up of this specific patient.


Fetus papyraceus causing dystocia: inability to detect blighted twin antenatally. A case is reported of fetus papyraceus diagnosed intrapartum. There was no clinical evidence in early and midpregnancy to suggest such a diagnosis. Ultrasound examination performed 1 week prior to delivery was nondiagnostic, but an x-ray taken intrapartum revealed dystocia caused by fetus papyraceus, thus necessitating cesarean section. It is suggested that the clinician consider x-ray as well as ultrasound in the diagnosis of fetus papyraceus. In addition to the obstetric morbidity, there is considerable neonatal morbidity which further increases the importance of antenatal diagnosis of fetus papyraceus.


Uterine artery ligation for postabortal hemorrhage. A case is presented that demonstrates that bilateral ligation of the ascending branches of the uterine artery to control uterine hemorrhage is as effective in the first trimester as it is in the last trimester.


A giant fibroid uterus.

A giant fibroid uterus. Giant uterine fibroids are those weighing greater than 25 lb (11.4 kg). Such a fibroid may appear as a solitary tumor or as a conglomerate mass of uterine fibroids presenting as a single uterine tumor. The challenge of these tumors lies in their proper surgical management. Combined preoperative and postoperative mortality is approximately 15%. The paucity of recent reports encountered in the literature of uterine fibroids of this magnitude reflects their rarity.


Gonadal dysgenesis with vulvar carcinoma. An unusual case of vulvar carcinoma in a gonadal dysgenesis patient is described. In addition to clinical manifestations, certain laboratory data related to endocrine status were gathered from serum and urine analyses. Finally, receptors for estrogens, progestins, and glucocorticoids were determined on biopsies of the vulvar carcinoma.


Hindgut duplication with rectovaginal fistula. Complete colon duplication is an extremely rare congenital anomaly that occasionally presents diagnostic problems. This report presents a 23-year-old black woman with complete duplication of the colon and distal ileum, with termination of 1 colon into the vagina.


Cephalothoracopagus (Janiceps) twinning. Conjoined twins occur with a frequency of 1/50,000--1/100,000 deliveries. The cephalothoracopagus variety is particularly rare. This paper presents a case report of cephalothoracopagus (Janiceps) twinning, with a detailed pathologic analysis, as well as an historical review and discussion of diagnostic modalities.


Microspectrofluorometric analysis of surface antigens of murine melanoma and hamster peritoneal cell hybrids: comparisons of species antigenicity, chromosome number, and tumorigenicity. Somatic cell hybrids from viral fusions of murine melanoma (PAZG) X Chinese hamster peritoneal cells (CH) were compared with respect to surface antigenicity, karyotype and tumorigenicity. One line, F57-(9), which arose from the hybridization of two CH cells and one PAZG cell, had slight (6%) CH chromosome loss but 80%PAZG chromosome loss after 10 months in culture. These cells expressed CH antigens strongly and PAZG antigens weakly. In comparison, another hybrid, F57-(7), formed from one CH and one PAZG cell, lost 20% of its chromosomes after 10 months in vitro. These cells had a stronger expression of PAZG antigens and weaker expression of CH antigens than F57-(9). These findings indicate a direct relationship between chromosome number and antigenicity; tumorigenicity, however, does not appear to depend on the chromosome numbers of the parental cells.


A possible association of pernicious anemia with neoplasia. 7 out of 39 patients with pernicious anemia developed 9 different neoplasms during a period of 3--20 years after the diagnosis of pernicious anemia. These primary neoplasms originated from the lymph nodes, larynx, colon, stomach, kidney, meninges, maxillary sinus and eighth nerve. Treatment with vitamin B12 did not influence the development of tumor. Statistical analysis showed that the observed incidence of 9 neoplasms in this group was significantly higher than the expected 3.3 cases during the aggregate follow-up period (p = 0.002). Although a higher incidence of neoplasms in patients with other underlying diseases does not necessarily indicate an association, a high degree of suspicion for neoplastic disease is justifiable in patients with pernicious anemia.


N-acetyltransferase activity as a possible criterion in prognosing the anti-tumor effect of cyclophosphamide. The results obtained in the present study indicated that a reduction in the activity of N-acetyltransferase (EC 2.3.1.5) occurs in cyclophosphamide-treated mice with sarcoma 37. A difference in variations of the level of N-acetyltransferase activity in outbred mice with and without tumors was observed in cyclophosphamide-treated animals. It was established that the effect of cyclophosphamide on the activity of N-acetyltransferase depends on the initial level of the enzyme activity (phenotype of acetylation) as well as on the genotype which determines the N-acetyltransferase activity.


Serum long-chain alcohol levels in healthy individuals and in patients with breast cancer. Total long-chain alcohols were analyzed in blood sera from normal individuals and patients with diagnosed breast cancer. Tetra-, hexa- and octadecan-1-ol were the major long-chain alcohols detected in both groups. While the qualitative composition of the serum alcohols was similar in the two groups the average alcohol content of the serum of the breast cancer patients was approximately six times greater than that of the normal group. This difference in serum alcohol levels between the two groups was significant at p less than 0.01.


Chemotherapeutic agents and estradiol receptor binding capacity. Cytotoxic agents used for the treatment of breast cancer did not inhibit the growth of uterus following estradiol injection to ovariectomized rats. They had no effect on the estradiol binding ability and on the dissociation constant of estradiol receptor binding of rat uterus. In addition, 1,2:5,6-dianhydrogalactitol, a highly active, proximal alkylating agent, applied in vitro did not alter the relative binding ability to tamoxifen to the cytoplasmic estradiol receptor of rat uterus and human breast cancer tissue. In summary, the present experiments did not reveal any disadvantageous interaction between simultaneously administered hormonal and cytotoxic drugs.


Positive correlation between breast cancer incidence and HLA antigens. HLA determinations were made at the time of diagnosis among a lot of 141 patients with breast cancer. Values of relative risk as well as frequencies of antigens at the first and the second locus were confronted to data found in a control population. Subdivisions of the neoplastic population according to hormonal status and parity led to the emergence of significant differences: frequency of A28 in menopausal nulliparous women with breast cancer is 26 vs. 7% in controls (p corrected = 0.038) with relative risk = 6.63 (p 0.001).


Potentiating role of previously administered agents in the combination chemotherapy of breast cancer. 91 women with metastatic breast cancer, who received prior CTX-5FU or CTX-5FU-PRD, were treated in 3 consecutive clinical trials with either CTX-5FU-PRD-MTX-VCR, MTX-VCR, or MTX-VCR-PRD in order to elucidate whether the effectiveness of 5 drugs was due only to the newly added drugs (MTX-VCR +/- PRD) or whether the previously used drugs (CTX-5FU) were necessary as potentiating agents. There were 17 or 39 responders (43%) in the 5-drug group, 3 of 25 (12%) in the MTX-VCR group and 3 of 27 (11%) in the MTX-VCR-PRD group. The survival in the group treated with 5 drugs was significantly longer. Our results show that CTX-5FU-PRD-MTX-VCR was significantly more effective than MTX-VCR or MTX-VCR-PRD used alone after the patient had already had CTX-5FU +/- PRD. Thus, the previously used drugs (CTX-5FU) seemed to improve the response to the new agents (MTX-VCR +/- PRD) by a potentiating action in the subsequent combination. It is concluded that the exploitation of this enhancing effect represents a significant improvement in the treatment options now available.


Pleural effusion secondary to tumor regression. 2 patients with metastatic cancer (Ewing's sarcoma and breast cancer) developed pleural effusions while undergoing systemic therapy for pulmonary metastases. Thoracenteses failed to reveal malignant cells and in both instances the characteristics of the fluids were those of transudates. The effusions developed in association with dissolution of pulmonary lesions and presumably represent a reactive process to tumor regression.


[Osteogenic aneurysmal orbital cysts].

[Osteogenic aneurysmal orbital cysts]. The orbital form of this osseous tumor-like dystrophy is quite rare. The illustrated description of a new case is reported and the 13 cases of the literature reviewed. The main clinical and radiological data as well as the different treatments are commented upon. The anatomo-pathologic discussion focuses on the morphological aspects, hypotheses on the pathogenesis and differential microscopic features of the lesion as compared to other osseous lesions of the orbital bones.


Rare association of hyperglycinuria and lenticonus in two members of the same family. 2 cases of posterior lenticonus associated with hyperglycinuria without iminoaciduria, found in the same family, were examined. After a review of the literature, the rarity of this association is stressed.


[Risk of transmission of hepatitis B through contact lens fitting set]. 8 out of 19 cases of acute or chronic hepatitis, with positive hepatitis B surface antigen (HBsAg) had HBsAg-positive tears. In 25 healthy HBsAg carriers, no HBsAg was found in the tears. The HBsAg concentration in the tears of hepatitis patients was less than 1% of the HBsAg in their blood. Contact lenses (soft hydrophilic, silicone) experimentally contaminated with HBsAg were practically free of it after the usual cleaning and washing with a commercial contact lens cleaning fluid. No adsorption of HBsAg was found on hydrophilic soft lenses; a minimal adsorption on silicone lenses could not be entirely excluded, but practically it was without any importance. In 14 samples of 79 storage fluids of a contact lens fitting set HBsAg was found. The cause of this contamination is not clear.


Naevus of the choroid.

Naevus of the choroid. Despite their common occurrence and benign character, choroidal naevi show a number of interesting features. Hyper- and hypopigmentation, drusen, pigment-epithelial detachment, retinal deposits and capillary circulatory disturbances are described. Colour and red-light photography appear to be the most appropriate techniques for documentation.


Eye position and electromyographic observation of squint eyes under general anesthesia. The position of eyes under general anesthesia was measured in different groups of nonparalytic strabismus. Almost all patients with esotropia or hyperactive inferior oblique muscle showed divergent eye positions while patients with exotropia showed no consistent trend. The eye position of patients with lid ptosis without squint, which served as a control group, were divergent in all cases. Electromyographic observation of the medial rectus muscle under the same condition of anesthesia revealed that muscle discharge disappeared almost completely at the stage at which the eyes were in a well-stabilized position.


The effects of impulse noise on the eardrum and middle ear. Noise rarely damages the tympanic membrane and middle ear. High intensity impulse noise (explosions) can rupture the eardrum and disrupt the ossicular chain. Middle ear muscles play no part in the defense of the inner ear against high intensity impulse noise. Other mechanisms that protect the inner ear are slippage of the incudomalleal joint, a maximal limit of stapes displacement, and unlinking of the ossicular chain.


Sociopsychological factors affecting the human response to noise exposure. Community noise is reported to be the most often mentioned undesirable neighborhood condition in a recent U.S. Census survey. Understanding community response to noise involves the measurement of a number of complex acoustic and nonacoustic variables and establishing the chain of relationships between physical exposure, perception, annoyance, and acceptability responses and finally complaint behavior. The perceived loudness of a noise is the most important acoustic parameter influencing annoyance and complaints, and the simple dBA unit can be used to integrate spectral characteristics of complex sounds in community studies. Although energy averaging such as Leq or Ldn can be used to describe multiple noise exposures over time, the variable trade-off relationships between number and level of exposures are somewhat obscured by such summary measures. However, they are still the best available descriptors and, until more accurate ones are developed, can be used to measure community noise environments. Perception of an identical noise exposure can vary according to the physiological noise sensitivity of a person and the activity context in which the noise is heard. Although the acoustic quality of the noise itself usually explains about 10 to 25 per cent of the variability in annoyance responses, sociopsychological variables measured in field studies account for 35 to 50 per cent of the variations in human annoyance responses. Three of the most important nonacoustic factors are the connotative fear effects of the noise signal, the feeling that those responsible for the noise are misfeasant in not reducing the noise, and the feeling that harmful health effects are produced by the noise. When residents report great fear, a high misfeasance, and marked health effects, about 90 per cent report a high annoyance level whether their noise exposure level is above 90 Ldn or 65 to 70 Ldn. In contrast, if the feelings are a low fear level, a low degree of misfeasance, and minimal health effects, only 3 to 10 per cent give high annoyance responses. Complaint behavior, although based on intensity of annoyance, is modified by a number of other sociopsychological factors and often is an unreliable indicator of an environmental problem.


An introduction to the measurement of sound. The need for greater interest and participation in hearing conservation on the part of otolaryngologists, audiologists, and others is growing. Ever increasing numbers of people are being handicapped by noise induced hearing impairment. This costly damage is not curable but is preventable. Complaints of noise or annoyance must be investigated, and the primary tool for investigation is the sound level meter. It can be used by anyone with some basic knowledge to identify hazardous noise levels. Understanding the parts of the meter, the standards governing its construction, the basic steps in reading hazardous noise levels, including sources of error, methods of reporting the readings and knowing where expert assistance is available form the basis for monitoring hazardous noise levels. The following references contain material that can be used for additional study and sources of professional help. The number of publications dealing with noise has, as with the number of instruments and companies dealing with noise, risen sharply in the last three years. The sources listed constitute only a small portion of those available. These are selected for their detailed information, or their concrete and practical approach in providing immediately useful information, and for their usefulness as sources for further study materials or help with your hearing conservation program.


The economic impact of noise control.

The economic impact of noise control. This article has briefly summarized the cost of noise control for two standards under consideration by OSHA. Readers are encouraged to find ways to protect the hearing of workers in any way it can be done.


Industrial hearing conservation.

Industrial hearing conservation. Hearing conservation programs, when appropriate in industry, are now a necessity. Even though one may not wish to adopt an altruistic attitude toward the conservation of hearing, one must, like it or not, initiate a hearing conservation program because of both federal and state regulations. Since industrial noise exposure produced more hearing loss in more people than all other causes of hearing loss combined, it is incumbent on all industries with noise makers to do something about protecting human hearing. The tragedy is that nearly all industrial hearing loss can be prevented with proper hearing conservation measures. The cost of hearing conservation is far less than the cost of hearing loss in terms of human suffering and dollars in the compensation courts. Proper education of both managment and labor can result in successful hearing conservation programs. The method of choice is reduction of the noise at the source, but in many cases this is infeasible both technically and economically and therefore protection at the ear must be used. Experience has shown that with proper supervision ear protection programs can prevent the majority of instances of hearing loss in the majority of individuals exposed.


Audiometric evaluation of noise induced hearing loss. Audiometric evaluation in conjunction with other components of the hearing conservation program serves to minimize the potential hazard of noise related hearing loss. Success of the industrial hearing conservation program rests in large measure with the implementation of competent audiometric testing procedures. Thus, consideration must be given to certain critical factors necessary for measurement of hearing sensitivity, such as the qualifications of the examiner, monitoring schedules, test environment, instrumentation, method of testing, recording of results, interpretation of test findings, and appropriate referral criteria.


Aural rehabilitation in noise induced hearing loss. The patient with noise induced hearing loss presents complex aural rehabilitative problems. Such patients are not generally good candidates for "traditional" aural rehabilitation involving speech reading therapy and auditory training. Instead aural rehabilitation efforts involve individual evaluation of the communication handicap, non-medical relief for tinnitus, possible hearing aid use with carefully selected amplification and earmold, and counseling on hearing and listening.


Congenital syphilis.

Congenital syphilis. The most outstanding aspects of congenital or fetal syphilis, emphasizing its epidemiology, clinical aspects, diagnosis, prevention and treatment, are studied. The authors point out the increasing frequency of this treponematosis, which should still be considered as a worldwide endemic disease, though it is foreseeable and tractable. Some new data about the problem are provided, apropos of recent observations.


Candida infections.

Candida infections. The authors present a review of the epidemiology, pathology, diagnosis and treatment of candidiasis in the child. Their studies on the favoring factors in cutaneous forms as well as their experiences in pulmonary forms are emphasized.


Neonatal sepsis.

Neonatal sepsis. A review of neonatal sepsis, based on 30 recent cases is presented. After analyzing their personal experiences, the authors review the etiopathogeny (higher incidence in small-for-date, preterm, postterm and in some macrosomic newborns; predominance of gram-negative germs), the importance of early diagnosis, and correct treatment, adapting the antibiotherapy to the bacteriological flora of the location at the time of treatment.


Mycoplasma pneumoniae infections.

Mycoplasma pneumoniae infections. A review of infections with Mycoplasma pneumoniae in children, emphasizing their frequency, association with viral infections, nonspecific clinical aspects, diagnostic data, and extrapulmonary possible manifestations is presented. This work was based on 320 analyses made in a period of 3 years. 15 of those analyses were serologically positive for M. pneumoniae, and 10 of them were also serologically positive for virus.


Current status of active immunization procedures. A review of the present status of the principal active immunization procedures used in pediatric ages is presented. Great advances are emphasized in smallpox, diphtheria, tetanus, poliomyelitis, measles, rubella, etc. Others less effective vaccine or those at an experimental stage, are also described. A vaccination calendar is also presented.


Septic shock in pediatrics.

Septic shock in pediatrics. A review of the septic shock syndrome in pediatrics, analyzing its actual incidence in clinical practice, etiopathological factors, physiopathology, clinical manifestations in the different stages of the disease, diagnostic criteria, prognostic, and treatment is presented.


[Asplenia and DIC (author's transl)].

[Asplenia and DIC (author's transl)]. 3 cases of severe septic shock are described; a 5 month old girl with congenital hyposplenia, a 2 3/12 year old boy splenectomized because of microspherozytosis and a 11 6/12 year old boy splenectomized because of Hodgkin's disease. In 2 cases pneumococci were found in the blood cultures. In all 3 cases the coagulation analysis showed a consumption coagulopathy. Intravenous streptokinase treatment was applied in addition to general treatment for shock and antibiotic therapy. 2 patients survived and made a complete recovery, whereas the 2 year old boy died. The histological findings showed a severe DIC. In the Department of Surgery, Innsbruck, 44 children have been splenectomized during the last 6 years, 38 of whom we were able to follow up on for an average of 3.3 years. After an average of 1.2 years following splenectomy, 4 patients (including the 3 cases mentioned above) contracted acute septicaemia; a further patient also incurring a probable sepsis with DIC. 3 of these 5 children died, representing a morbidity rate of 13% and a mortality rate of 8%. The mortality rate is thus as high as that caused by the primary disease, indicating the urgency of prophylaxis for infections of this kind. 3 prophylactic forms of treatment are suggested: protection with penicillin, active immunization with polyvalent pneumococcal antigen and spleen preservation whenever possible.


[Childhood injuries treated at a university clinic for traumatology (author's transl)]. The accidents to all children up to the age of 14 years admitted to the I. Universitätsklinik für Unfallchirurgie in Wien in 1976 (2977 children) were analysed as to age-distribution, cause of accident, type and location of injury. There was an increase in accidents to older children. 13% of the injuries were due to traffic accidents; 60% occurred in the course of play; 27% on the field of sport. More than 60% were only minor injuries such as abrasions, lacerations, crushed fingers and toes etc., 30% bone fractures and ligamental injuries; 2,5% brain traumas. Most of the bone fractures were localized iment and no lethal injuries.


[Exaggerated somatomedin activity in the Beckwith-Wiedemann syndrome (author's transl)]. Beckwith and Wiedemann described the syndrome of exomphalos, macroglossia and gigantism with hypoglycemia and visceral organ hyperplasias. In some cases of severe hypoglycemias hyperplasia of beta cells of the pancreas was found. Hyperinsulinism, which has to date rarely been investigated, reacts strongly to beta cell stimulation and can hardly be suppressed. The cause of gigantism and organ hyperplasias is still unknown. After a short description of a case of hypoglycemias in the first two weeks of life a long-term profile of the endocrinologic abnormalities and carbohydrate metabolism is given. Growth hormone response to insulin is normal, tolbutamide is followed by severe hypoglycemias without an increase in the immunoreactive insulin levels; the activity of somatomedin is excessively increased. The high activity of somatomedin explains the high potency of growth in the different tissues and the hypoglycemic reactions and it seems reasonable to assume that somatomedin could create nesidioblastosis of the pancreas with hyperinsulinism and severe hypoglycemias. It is likely that the Beckwith-Wiedemann syndrome and the Laron type familial dwarfism with high plasma growth hormone, absent activity of somatomedin, and disorders in carbohydrate metabolism represent complementary diseases.


[Subclavian steal syndrome in childhood (author's transl)]. The authors report on four children with subclavian steal associated with coarctation or interrupted aortic arch. All children showed a stenotic origin of the left subclavian; in addition three of them had an extreme hypoplasia of the proximal segment of this artery. Two children had typical symptoms of insufficiency of the vertebral and basilar circulation (headache, dizziness, syncopal attacks, vision and hearing disorders) since the age of 7 and 8 years, respectively. The clinical findings, such as reduced pulses and blood pressure of the respective arm, may suggest the provisional diagnosis. The principles of congenital subclavian steal are discussed.


[Tetracyclin intoxication versus idiopathic pancreatitis: report of a case with multiple organ involvement (author's transl)]. The tetracycline class of antibiotics is infrequently used in clinical pediatrics due to its side effects: they include anorexia, nausea, vomiting and diarrhea. Hypersensitivity, a photosensibility reaction and a brownish discoloration of teeth is less frequently, a pseudotumor cerebri is rarely seen. Once therapeutic plasma levels are exceeded however, either by overdosage or decreased renal or hepatic clearance of the drug, serious complications like a secondary Fanconi-Syndrom or a nephrogenic diabetes insipidus can occur. The increased toxicity of tetracyclines in pregnant women is well known. We would like to report a fatal case, where serious complications like a secondary Fanconi-Syndrom, toxic degeneration of the liver, a clinically undected pancreatitis and a protein loosing enteropathy are though to be either direct consequences of tetracycline overdosage or the indirect effect of a shocklike syndrom by means of a nonoliguric renal failure induced by tetracycline.


[Pneumoperitoneum in a newborn without intestinal perforation (author's transl)]. This is the report of the rare complication of an isolated pneumoperitoneum in a premature infant of 28 weeks gestation with artificial ventilation due to severe RDS. This rare occurrence in immature babies with artificial ventilation should be considered in the differential diagnosis of abdominal emergencies in this age group. Etiology as well as therapeutic consequences will be discussed.


[Thrombasthenia in a newborn (author's transl)]. Thrombasthenia is an extemely rare hereditary disorder of platelet function characterized by impairment of adhesiveness, ADP-induced aggregation, and clot retraction. Petechiae and ecchymoses in a newborn infant followed by prolonged jaundice facilitated early diagnosis.


The inheritance of thiabendazole resistance in Haemonchus contortus. Haemonchus contortus worm populations isolated from naturally infected sheep at the Pastoral Research Laboratory, Armidale, N.S.W., were found to contain approximately 20% of worms resistant to a 50 mg/kg dose of thiabendazole. Following 3 generations of selection with 50 mg/kg thiabendazole the number of worms removed by the anthelmintic was too small to detect differences between treated and control groups. After more than 15 generations of selection, matings between males from the selected strain and non-resistant females produced resistant males and females in equal numbers. Thus, thiabendazole resistance does not appear to be sex-linked. A dose--response assay on the F2 adults indicated that worms from female resistant x male non-resistant crosses were more resistant than F2 adults of the reciprocal cross. An in vitro technique that identified thiabendazole-resistant eggs by their ability to hatch in a solution containing thiabendazole and 0.1% NaCl solution was also used to study the inheritance of resistance. F1 eggs had similar LC50's to the resistant parents. F2 and back-cross eggs from an original mating of thiabendazole-resistant females x non-resistant males had a higher LC50 than F2 and back-cross eggs from the reciprocal mating, indicating a degree of matroclinous inheritance of resistance. However, the resistant parents had tolerances to thiabendazole exceeding those of F2. F3 eggs had a resistance distribution that ranged from that of the resistant to the non-resistant parent. No significant deviation from linearity was observed in any of the dose--response lines. These results indicate that thiabendazole resistance in H. contortus worms is inherited as an autosomal and semi-dominant trait.


Transplantation of adult Trichinella spiralis between hosts: worm survival and immunological characteristics of the host--parasite relationship. A technique for the transplantation of Trichinella spiralis worms directly into the host intestine is described. Infections established by the direct transfer of adult worms were essentially normal both in terms of their survival and reproduction and in their stimulation of, and susceptibility to, host immune responses. Worms transplanted from NIH mouse donors at intervals after infection had an equal ability to survive in the recipient, even when taken from the donor shortly before or during the process of worm expulsion, showing that expulsion does not require worms to be irreversibly damaged. It was noted, however, that after 7 days in the donor the ability of the worm to reproduce in the recipient was temporarily impaired.


Oogenesis and egg-shell formation in Aspiculuris tetraptera Schulz (Nematoda: Oxyuroidea). The ovary of Aspiculuris tetraptera has a prominent terminal cap cell. This is considered to be part of the ovarian epithelium. Oogonia detach from the short rachis and increase in size from 6 to 60 microns; accumulating hyaline granules, shell granules and glycogen. The hyaline granules persist in the eff cytoplasm after shell formation has been completed and are considered to be lipoprotein yolk. The shell granules contribute to the non-chitin fraction of the chitinous layer. A classification of the cytoplasmic inclusions of the nematode oocyte is proposed. Upon fertilization a vitelline membrane is formed which constitutes the vitelline layer of the egg-shell. The chitinous layer is secreted in the perivitelline space, between the vitelline layer and the egg oolemma. Upon completion of chitinous layer synthesis, the egg cytoplasm contracts away from its inner surface. The material of the lipid layer is secreted at the surface of the egg cytoplasm and adheres to the inner surface of the chitinous layer. During secretion of the chitinous and lipid layers by the egg cytoplasm, the uterine cells secrete the unit membrane-like external uterine layer and the crystalline internal uterine layer. A complex system of interconnecting spaces develops in the internal uterine layer. This system is open to the exterior via breaks in the external uterine layer. There is no direct involvement of the uterine cells in the formation of this structure.


The structure of the egg-shell of Aspiculuris tetraptera Schulz (Nematoda: Oxyuroidea). The egg of Aspiculuris tetraptera is an ellipsoid measuring 93 x 40 microns. The shell consists of 5 layers: the external uterine layer, internal uterine layer, vitelline layer, chitinous layer and the lipid layer. This nomenclature is based upon the formation and histochemistry of the shell layers. The internal uterine layer contains a system of interconnecting spaces, partly filled by uterine secretion, which open to the exterior of the egg via breaks in the external uterine layer. The surface of the egg is covered by a system of interconnecting grooves. Freeze-etching reveals that the internal uterine layer is open to the exterior via pores, which open into the grooves. Rod-shaped particles are also revealed in the external uterine layer. The operculum of the egg consists of a modification of the uterine and chitinous layers of the shell.


Further observations on immunization of sheep against Schistosoma mansoni and S. bovis using irradiation-attenuated schistosomula of homologous and heterologous species. This paper describes further characteristics of the immunization of sheep against schistosomes using live, irradiation schistosomula. Sheep immunized with a non-virulent strain of Schistosoma mattheei were protected against a more virulent strain of the same species for over a year. As there was no evidence that the irradiated parasites were able to persist this long, it was concluded that the vaccine had induced a sterile resistance. Heterologous vaccination, using irradiated S. mattheei schistosomula to immunize against S. bovis or irradiated S. mansoni schistosomula to immunize against S. mattheei, failed to induce any protection.


A reappraisal of the taxonomic status of Eimeria mivati Edgar and Seibold 1964, by enzyme electrophoresis and cross-immunity tests. An examination of 2 strains of Eimeria acervulina var. mivati (since 1973 E. mivati has been regarded as a variant of E. acervulina) showed that previous confusion over the taxonomic status of E. mivati arose because the investigations were done using laboratory cultures of E. mivati which were contaiminated with E. acervulina. Electrophoretic analyses of enzymes, host specificity and cross-immunity tests have revealed that: (1) The 1971 Houghton strain of E. acervulina var. mivati was a mixture of 2 parasites. (a) Passage of this strain in embryonating eggs resulted in a selection against that parasite previously characterized as E. acervulina. (b) The parasite which did reproduce in eggs did not immunize chickens against subsequent challenge with E. acervulina. This parasite is most likely E. mivati. (c) E. mivati recovered from eggs did, however, immunize chickens against challenge with a new field strain which was morphologically identical to E. mivati and characterized by the same electrophoretic forms of 2 enzymes. (2) A strain of E. acervulina var. mivati from the USA was also a mixture of E. acervulina and E. mivati.


Rejection of Eimeria by foreign hosts.

Rejection of Eimeria by foreign hosts. Oocysts of Eimeria maxima inoculated into guinea fowl do not develop. Infection occurs when intestinal mucosa or liver tissue from guinea fowl given E. maxima is transferred to susceptible chickens. By transferring material at different times after inoculation, it was shown that most of the stages are lost between 6 and 12 h and few, if any, survive to 48 h. Sporozoites of E. tenella had low infectivity after 48 h contact in vitro with peritoneal macrophages from guinea fowls and turkeys. Sporozoites of E. grenieri from the guinea fowl appeared to be destroyed within macrophages taken from chickens.


The triad of pneumonitis, pleuritis, and pericarditis in juvenile rheumatoid arthritis. There are few reports of pleuroparenchymal and pericardial involvement secondary to juvenile rheumatoid arthritis (JRA) in the literature. This article presents two such cases and gathers scattered information about this combination previously reported by few others. We wish to emphasize that the combination of pericardial and pleuropulmonary involvement in a youngster may be the only presenting clinical manifestations of rheumatoid arthritis, whereas in others, it may be associated with arthritic symptoms at the same time.


A potential pitfall of operative cholangiography in infants. Retrograde linear extravasation of contrast media along the anatomical course of intrahepatic arborizing structures may occur during intraoperative cholangiography for evaluation of prolonged neonatal jaundice. The resultant image may mimic the appearance of intrahepatic biliary radicles.


Ultrasound diagnosis of extrahepatic portal vein obstruction in childhood. The sign of the subhepatic sponge-like mass. Portal vein obstruction in childhood produces portal hypertension and hepatopetal collaterals surrounding the obstructed portal vein; this is the "cavernomatous transformation of the portal vein" which is a well defined angiographic entity. Clinically findings are the various manifestations of Banti's syndrome, especially splenomegaly and gastrointestinal bleeding. Ultrasonic diagnosis is possible on the associated findings of splenomegaly, normal liver, a subhepatic sponge like mass corresponding to the hepatopetal collaterals. These signs must be sought in the ultrasonic differential diagnosis of splenomegaly in pediatrics.


Coexistent neuroblastoma and Hirschsprung's disease--another manifestation of the neurocristopathy? Abnormalities of neural crest development may be manifested in a wide variety of ways ranging from von Recklinghausen's disease to Sipple's syndrome -- pheochromocytoma and medullary thyroid carcinoma. We report here yet another manifestation -- coexistent multiple neuroblastomas and Hirschsprung's disease in a newborn. In a review of the English literature we have found the combination of neuroblastoma and Hirschsprung's disease recorded only once previously [2]. However, the relationship between the two diseases was not discussed. The two diseases may be at the extremes of a spectrum of neural crest development pathology, i.e., Hirschsprung's representing a deficiency and neuroblastoma representing malignant proliferation of cells of neural crest origin.


Radiation gonad doses received by children in intravenous urography and micturition cysto-urethrography. Measurements of gonad doses in intravenous urography (IVU) was performed on 47 children and in micturition cysto-urethrography (MCU) on 57 children. Ionization chamber dosimeters were placed rectally in girls and fixed on the scrotum in boys. Gonad dose ranged from 27 mrad to 201 mrad in girls and from 7 mrad to 112 mrad in boys during IVU; during MCU doses ranged from 53 mrad to 1900 mrad in girls and form 24 mrad to 309 mrad in boys. Risk of leukemia and genetic risk were calculated.


Sclerosteosis in children.

Sclerosteosis in children. Craniotubular dysplasias and craniotubular hyperostoses are a group of confusing disorders in which the cranial involvement may cause compression of facial and auditory nerves. Two of the hyperostotic conditions that regularly produce cranial nerve compression are sclerosteosis and the recessive form of endosteal hyperostosis (van Buchem's disease). Both have identical radiological features with cranial involvement presenting in childhood. The Dutch and South African cases have come from relatively close-knit communities, those in the latter country being Afrikaners who had their origins in Holland. The radiological features of three such cases of sclerosteosis are briefly presented.


A familial syndrome of diaphyseal cortical thickening of the long bones, bowed legs, tendency to fracture and icthyosis. The clinical and radiological features of a dominant bone disorder found in six members of the same family are described. The bone disorder was mainly characterized by endosteal cortical thickening of long tubular bones and bowing of the weight-bearing ones. The clinical symptoms were waddling gait, muscle weakness and leg pains, and there was a tendency to fractures. All affected individuals had icthyosis of slight or moderate degree.


Haemorrhagic right upper lobe infarction as a complication in primary end-to-end anastomosis of oesophageal atresia. The clinical and radiological features of right upper lobe haemorrhagic infarction as a complication to end-to-end anastomosis in oesophageal atresia are presented.


Early osseous abnormalities in Menkes' kinky hair syndrome. Bone changes in a 4 m.o. infant with Menkes' Kinky Hair Syndrome, who also had a skeletal survey as a newborn, are reported. Whereas the late bone changes were diagnostic, the neonatal ones were similar to congenital rubella and cytomegalic virus infection. However the distribution of the metaphyseal changes were different.


Common pulmonary vein atresia without anomalous pulmonary venous connection. Common pulmonary vein atresia without pulmonary venous connection is a rare form of congenital heart disease. No communication exists between the confluence of the pulmonary veins and the heart or a major systemic vessel. A case diagnosed antemortem is presented. Correct early diagnosis is imperative as surgery may be corrective.


Rheologic properties of erythrocytes in Duchenne muscular dystrophy. The transformation of erythrocytes into echinocytes by suspension in isotonic phosphate buffer was increased in patients with Duchenne muscular dystrophy (DMD) as compared to healthy controls. The transformation was enhanced when glass slides instead of polystyrole slides were used for observation. Viscosity of erythrocyte suspensions with a hematocrit of 80% was the same in patients and controls. The mean flow rate of erythrocyte suspensions in autologous plasma was only slightly reduced in the patient group, but decreased markedly after suspension of the cells in phosphate buffer, without as well as after preincubation with 10 mM Na salicylate. The decreased flow rate in patients is probably due to the increased number of echinocytes and not to an increased membrane rigidity, because the membrane flexibility of isolated ghosts, measured in a viscosimeter, was normal at all shear rates. Echinocyte formation in patients with DMD is strongly dependent on the techniques applied and difficult to evaluate quantitatively by phase contrast microscopy. Filtration of erythrocyte suspensions seems to be a more reliable, quantitative test for increased erythrocyte vulnerability.


Some observations on the properties of precipitating antibody to Staphylococcus aureus in children with kwashiorkor. Using three relatively sensitive immunochemical assay procedures, we were unable to detect either precipitating or hemagglutinating antibodies to food antigens in sera from normal and kwashiorkor Nigerian children. However, antibody to Staphylococcus aureus, a common pathogenic bacteria in the tropics, could be detected in the sera of 28 of 30 control children but in only 7 of 30 kwashiorkor cases, suggesting that there is an impairment to specific antibody production in children with malnutrition. Comparative biologic and physicochemical studies carried out on precipitating antibodies to S. aureus isolated from normal and kwashiorkor subjects showed that the antibody from malnourished individuals fixed complement less readily and was deficient in some essential amino acids. These defects might in part explain why children with protein-energy malnutrition are more susceptible to infection in spite of the fact that they have normal serum immunoglobulin concentrations.


Perinatal changes of 2,3-diphosphoglycerate and oxygen affinity in mammals not having fetal type hemoglobins. The interrelationship of 2,3-diphosphoglycerate (2,3-DPG) and P50 levels during the fetal and postnatal life were determined in two mammalian species which do not have a switchover of hemoglobin type at the end of their fetal development. In the guinea pig and rabbit, the 2,3-DPG levels remain low during fetal life and increase only after birth remaining elevated throughout adult life. The adult levels were reached at 2 days of age in the guinea pig and the 20th day in rabbit. Fetal P50 values increased only after birth, paralleling the rise in the 2,3-DPG. The rapidity of the postnatal rise in 2,3-DPG and decrease in P50 appears related to the maturity of the newborn animal at birth in these species.


Equations for estimating percentage of body fat in children 10--14 years old. Measurements of the percentage of body fat (derived by underwater weighing), height, weight, and triceps skinfold thickness were determined for a volunteer sample of 214 children, 10--14 years old. The bivariate correlations, by sex, of percentage of body fat with five obesity indices are highest with the triceps skinfold and least with weight-height. Five sets of equations are presented for predicting percentage of body fat based on measurements of either height and weight, triceps skinfold, or height, weight, and triceps skinfold. Cumulative frequency distributions of the percentage of body fat (based on height, weight, and triceps skinfold) are shown by race and sex for a total community of 10- to 14-year olds.


Cerebral blood flow during acute acidosis in perinatal goats. Changes in cerebral blood flow in response to three states of acute acidosis, posthypoxic, lactic acid, and respiratory, were estimated by the microsphere technique. In all three states, the fraction of the systemic blood flow reaching the brain and the rate (ml/min) of blood flow to it increased. The increase in flow was linearly related both to the PaCO2 and to H+. Others have shown the flow rate to increase with hypercapnia, but the increase associated with an increase in hydrogen ion concentration while the PaCO2 was maintained at control levels does not appear to have been observed in mature animals.


Immunoglobulin subclasses in normal children. The range, mean, and normal bounds of serum IgG 1--4 subclass concentrations in children 0--16 years old are given. Levels increase with age, plateauing at different ages. Definition of the normal range will permit better identification of individuals with either low or high levels.


Infant heart rate response to trigeminal airstream stimulation: determination of normal and deviant values. In this study, trigeminal airstream stimulation is used on a group of normal, sleeping infants to screen for reflex bradycardia. Infants were tested at 1--3 days and at 4, 8, 12, and 16 weeks of age. The usual heart rate response was acceleration above the prestimulus level. The amount of heart rate change was seen to depend on prestimulus rate and, to a lesser extent, postconceptional age. Multiple regression analysis of the data provided estimates of expected responses, given postconceptional age and prestimulus heart rate. From these, ranges were established for classification of normal or abnormal responses. Six deviant data points over 2 SDs from expected values were identified. Two of these represented heart rate increases and four were heart rate decreases. One deviant heart rate decrease was over 3 SDs from the mean. Although the deviant increases were thought to represent exaggerated startles, the more severe heart rate decreases were believed to be a reflex resembling the diving reflex.


Hormone ontogeny in the ovine fetus. IV. Serum somatomedin activity in the fetal and neonatal lamb and pregnant ewe: correlation with maternal and fetal growth hormone, prolactin, and chorionic somatomammotropin. Somatomedin (SM) activity was measured by a placental membrane receptor assay using 125I-labeled somatomedin A, as radioligand in serum samples obtained from 33 ovine fetuses, 14 neonatal lambs, 8 pregnant, and 3 postpartum ewes. The mean serum concentration of SM activity in eight adult rams was 2.06 +/- 0.12 U/ml. In fetal sheep, SM activity was detected at 66 days gestation (term 147 days), in the youngest fetus studied. Before 100 days of gestation, SM was lower (P less than 0.001) in fetal sheep (1.08 +/- 0.18 U/ml) than in adult rams. In fetuses between 101 and 125 days, SM rose (P less than 0.001) to 2.64 +/- 0.32 U/ml. In late gestation fetal serum SM fell but during the neonatal period it rose to 3.38 +/- 0.3 U/ml, higher (P less than 0.01) than that in adult rams. Serum SM activity in the pregnant ewe prior to 100 days was 1.01 +/- 0.11 U/ml, increased (P less than 0.05) to 1.75 +/- 0.21 U/ml between 125 days and term, and rose further to 2.56 +/- 0.32 U/ml in the postpartum period. Maternal concentrations of serum SM in late gestation were significantly less than in the fetus. Gel chromatography of fetal, maternal, and neonatal sera indicated that over 90% of SM activity circulated in high-molecular weight form. The rise in SM activity in fetal serum between 100 and 125 days parallels the rise in fetal growth hormone and prolactin concentrations; however, in maternal serum the increase in SM activity is associated with rising maternal chorionic somatomammotropin concentrations.


Inducibility of metallothionein biosynthesis in cultured normal and Menkes kinky hair disease fibroblasts: effects of copper and cadmium. Metallothionein biosynthesis is not induced by extracellular copper in Menkes Kinky hair disease (MKHD) or in normal cultured fibroblasts under the conditions of these experiments. In the presence of copper, MKHD fibroblasts also incorporated less cysteine than did normal fibroblasts. Extracellular cadmium greatly enhanced the uptake of cysteine in both normal and MKHD cultures. By the technique of polyacrylamide gel electrophoresis, it was demonstrated that metallothionein is induced by cadmium in normal and MKHD-cultured fibroblasts.


Energy retention, energy expenditure, and growth in healthy immature infants. Energy balance studies were done during 10-29 days on 15 immature infants of mean birth weight 1581 g. Mean gross energy intake was 757 kJ/kg (181 kcal) and 79% of this was retained, so that metabolizable energy was 602 kJ/kg (143 kcal). Mean resting metabolic rate was 244 kJ/kg (58.1 kcal), and it increased with advancing maturity. Minimum resting metabolism averaged 199 kJ/kg (47.5 kcal). Energy expended in activity increased with maturity, but amounted to less than 17% of the total energy turnover. Postprandial metabolism caused the mean VO2 to rise by 17% in the hour after a feed, and during 24 hr resulted in consumption of energy equivalent to about 10% of the resting metabolism. Stored energy amounted to 230 kJ/kg (55 kcal) and was linearly related to weight gain (r = 0.92). Energy cost of weight gain was 24 kJ/g (5.7 kcal) and energy stored in new tissue was 16.8 kJ/g (4.0 kcal). Maintenance energy requirement at zero growth rate was about 270 kJ/kg (64 kcal).


Transient partial hGH deficiency in prepubertal children with delay of growth. The hGH response to an ornithin or an insulin test was measured in 105 children from 11-18 yr old with delay of growth more than 2 SD. Besides 74 subjects with normal values and 7 with complete lack of response, 24 subjects exhibited a partial rise of GH. Most of the latter had decreasing growth rate and no sign of puberty. Out of 15 assessed for GH function after onset of puberty, 14 showed a normal response accompanying a markedly increased growth velocity. Four other subjects with partial response who were receiving sexual hormones for 48 hr before the second test showed a normal response also. An exogenous hGH treatment administered in two of these patients resulted in a marked and sustained growth increase far before entering puberty. The findings that plasma GH responses to stimulation tests is reduced in some children with decreasing growth rate before puberty and return to normal after onset of sexual development, would suggest a transient and functional defect in growth hormone secretion and the physiologic role of sexual hormones on GH release mechanism at that period of life.


Adaptive gluconeogenesis in preterm and term rabbits. Carbohydrate metabolism in the developing rabbit was investigated for deficiencies that may be responsible for the failure of many preterm (28 1/2--29 1/2  day) animals to survive the first hours of life. The preterm animal shows an inability to reverse glycogenolysis or initiate gluconeogenesis from lactate or alanine in the first hours of life. This impairment, coupled with 50% less liver glycogen stores than the term animal, places the preterm animal at jeopardy for energy substrate early on in life. Unexpected was the early, rapid conversion of glycerol to glucose by the preterm animal. This ability seemed to be the primary difference in carbohydrate metabolism between the surviving and nonsurviving preterm rabbit. Impaired glyconeogenesis from lactate and alanine in the preterm animal coupled with active gluconeogenesis from glycerol suggests that substrates from lipolysis may be very important for early adaptation. Preterm animals endowed with limited fat stores, thus, minimal available glycerol, would be incapable of survival.


Lung volume changes, occlusion pressure and chest wall configuration in human infants. Measurements of respiration were compared in normal, full term and premature infants before and after application of 5 cm H2O continuous negative pressure (CNEG) around the body below the neck. Mean minute ventilation in the full term infants decreased when CNEG was applied, secondary to a decrease in respiratory rate, with tidal volume relatively unchanged. The premature infants showed no consistent ventilatory response to CNEG. There were variable changes in occlusion pressure at increased lung volume. Observation with rib cage and abdomen anterior-posterior (A-P) magnetometers showed that the increase in end-expiratory lung volume was accounted for largely by expansion of the rib cage so that the configuration of the diaphragm and its mechanical advantage were maintained. These results suggest that the diaphragm is the major determinant of mask occlusion pressure in infants. The effects of increased lung volume on the configuration of the chest wall may relate to the success of continuous distending pressure in the treatment of respiratory disorders in infants, including apnea of prematurity.


Control of vasopressin secretion in the newborn lamb. The plasma sodium, osmolality, and arginine vasopressin (AVP) responses to phlebotomy, hypertonic saline, water loading and fluid restriction were studied in 2--49 day old lambs. Phlebotomy of 10 and 20% of the lamb's estimated blood volume produced 37- and 44-fold increments in plasma AVP, without a concomitant change in plasma sodium or osmolality. The infusion of 10 mEq/kg sodium chloride produced a 12% rise in plasma sodium concentration accompanied by a 7-fold rise in plasma AVP. Water loading with 100 ml/kg hypotonic fluid produced a significant fall in plasma sodium concentration (10.7%) and a decrease in plasma AVP. Eighteen hr of water deprivation evoked a 7-fold increase in AVP. These results indicate that the newborn lamb is capable of responding appropriately to known stimuli for AVP secretion. The stimulus response ratio (SRR): (formula: see text) of newborn lambs was nearly identical after hypertonic saline and water loading and was also quite similar to that of the adult ewe after a saline challenge. The SRR of water deprived lambs was greater than that after the other stimuli, presumably reflecting combined volume and osmolar stimuli. We conclude that the neurohypophysis and the volume receptor systems of the newborn lamb are capable of appropriate, mature AVP responsiveness during the first days of extrauterine life.


Prolonged expiratory duration with elevated lung volume in newborn infants. End-expiratory lung volume increased 17.5 +/- 5.4 ml (mean +/- SD) in full term infants and 7.7 +/- 2.1 ml in premature infants when 5--7 cm H2O continuous negative pressure (CNEG) was applied around the thorax. In the full term infants, respiratory rate decreased from 52--43 min-1 (P less than 0.001), mean inspiratory duration (ti) was unchanged, and mean duration of expiration (te) increased from 0.62 +/- 0.14 (SE)-0.84 +/- 0.22 sec (P less than 0.001) after application of CNEG. Te of occluded efforts on CNEG was also prolonged (P less than 0.005), although less than te of spontaneous breaths on CNEG (P less than 0.005). Te increased in four of eight premature infants when CNEG was applied. We conclude that phasic vagal feedback regulates Ti and te is controlled by tonic vagal activity. Premature infants may have an optimum functional residual capacity (FRC) which can be achieved with continuous distending pressure, resulting in regularization of respiration.