Androgen therapy of aplastic anaemia--a prospective study of 352 cases. A prospective study of 352 patients with aplastic anaemia on androgen therapy has been performed. The following main observations have been obtained: The actuarial mortality rate at the 20th month is 52%, half the deaths being observed during the first 3 months; these figures are similar to those previously published, from smaller series of androgen-treated patients, and lower than those of non-androgen-treated cases. Differences in survival and improvement were observed between groups of patients treated for more than 3 months with either alkylated or non-alkylated drugs. Signs of liver damage were observed no matter which was the drug used. Continous improvement can be observed even in the 2nd year of treatment indicating that full-dose androgen therapy should be continued up to 20 months in not fully improved patients. The degree of initial disease activity is a clear prognostic parameter for the mortality in the first quarter of the course. In case of survival of severe cases, improvement can be obtained to the same extent as in milder cases. This stress the need for adequate maintenance therapy in all types of patients. Addition of glucocorticoids harms the prognosis, mainly in most granulocytopenic patients. Glucocorticoids have no effect upon the liver damage induced by androgens.


Quantitation of erythropoiesis in myelomatosis. Quantitation of the erythropoiesis with radio-iron (59Fe) was applied to 9 patients with untreated myelomatosis. The method included blocking of the 59Fe reutilization by injection of non-radioactive iron. There was no uniform pattern in the Fe-kinetics values. The Plasma Iron Turnover (PIT) and the Red Blood Cell Iron Turnover (RBCIT) varied from subnormal to values markedly increased above upper normal limit. The calculated average Mean Red Cell Life time (MRCL) of erythrocytes was just below normal range. The mean Marrow Transit Time (MTT) was normal in the patients, despite subnormal venous haematocrit, indicating insufficient stimulation of the bone marrow. The renal function, measured as 51Cr-EDTA clearance, was found positively correlated to the RBCIT (r = 0.78, P less than 0.05). The results suggest that the previously demonstrated relationship between anaemia and renal failure in patients with myelomatosis is caused mainly by an inability of the bone marrow to produce sufficient red blood cells under the stress of anaemia related to the degree of renal impairment.


Development of human granulocyte and monocyte Fc receptors. Bone marrow cells were examined for the presence of IgG-Fc receptors using a red cell rosette technique. Receptors were demonstrated on some of the neutrophil promyelocytes, almost all of the neutrophil myelocytes, and a few of the eosinophil myelocytes. Cells which appeared on morphological grounds to be promonocytes also expressed Fc receptors.


A re-examination of the alleged monocytic features of hairy-cell leukaemia. A number of the 'monocytic' features of the hairy cells (HCs) of hairy-cell leukemia (HCL) are studied in detail and discussed in relation to the now established B-cell nature of the disease. By means of a rosette assay employing erythrocytes coated with IgG (EAG), a receptor for the Fc of IgG is shown to be strongly expressed on all HCs, whether in suspension or in monolayers. This receptor is shed and re-expressed over a period of some 6 h. In EAG rosette formation the indicator erythrocytes are deformed and the receptor is not blocked by an antiserum to the Ia-like antigen. By ultrastructural acid-phosphatase cytochemistry, it is established that HCs phagocytose latex particles, but do not phagocytose a variety of other particles to a significant extent. These, and other features, are discussed in relation to the literature and it is shown that all are compatible with the current view that HCL is a form of B-cell lympholiferative.


The varied sensitivity of partial thromboplastin and prothrombin time reagents in the demonstration of the lupus-like anticoagulant. An acquired inhibitor of blood coagulation, similar to that described in patients with Systemic Lupus Erythematosus (SLE), was detected during routine coagulation screening in 10 patients who did not meet the criteria for a diagnosis of SLE. The lupus-like anticoagulant (LLAC) was diagnosed on the basis of prolonged activated partial thromboplastin time (APTT) and/or prothrombin time (PT) which failed to correct when patient plasma was added to normal plasma; an additional criterion was an abnormal tissue thromboplastin inhibition test. No patient had a specific inhibitor directed against factors VIII and IX. Demonstration of LLAC was highly dependent upon the type of reagents adopted in the APTT and PT: the abnormality was detected consistently by one reagent only. One-stage assays of factors VIII and IX were characteristic of the presence of an inhibitor, showing non-parellel dose-response curves or decreased activity at low dilutions which were partially corrected at higher dilutions. Although 7 patients were free of abnormal bleeding, unequivocal signs of haemorrhagic tendency after a surgery were present in the remaining 3 patients. The findings suggest that LLAC is a non-exceptional cause of prolonged coagulation screening tests, and that it may sometimes be associated with impaired haemostasis.


Antithrombin III and the nephrotic syndrome. Plasma and urinary antithrombin III (AT-III) was measured in 15 cases of nephrotic syndrome. Plasma AT-III correlated well with serum albumin, but poorly with proteinuria, whereas urinary AT-III correlated well to proteinuria. The plasma AT-III level had a mean similar to 25 healthy controls, but the range was significantly wider. A case with nephrotic syndrome and left renal vein thrombosis is reported. The urinary output of AT-III rose and the plasma level fell with the activity of the disease. Although AT-III and albumin have similar molecule weight, their renal clearance was found to be different. It is suggested that urinary loss of AT-III plays a role in the hypercoagulable state sometimes found in the nephrotic syndrome.


Impairment of Jones-Mote hypersensitivity and specific antibody response against depolymerized flagellin in lepromatous leprosy. Cutaneous hypersensitivity and antibody-producing capacity were assessed in patients with lepromatous leprosy with defective immunity, by immunizing them with monomeric flagellin from Salmonella adelaide. Results were compared with those of controls, matched for age and sex, derived from similar socioeconomic stratum, but without any defect of the immunological system. In contrast to the normal individuals, who showed Jones-Mote type of hypersensitivity, no lepromatous patient could mount any 'delayed-in-time' cutaneous hypersensivivity reaction against an intradermal challenge of monomeric flagellin. However, when immunized through the subcutaneous route, both groups could produce adequate amounts of specific serum antibody. In addition to this unique split tolerance found in all lepromatous patients, some patients showed low levels of 'natural' IgM antibody, reduced formation of specific antibody when immunized through the subcutaneous route, and incomplete maturation of IgG class of anti-flagellin antibody. When immunized by the intradermal route, however, production of both anti-flagellin antibody and maturation of IgG antibody was significantly inhibited in normal adults but not in lepromatous patients. Thus, contrary to the earlier concept of hyperactivity of the humoral immune apparatus in lepromatous leprosy, the present study detected B-cell hypofunction in some patients.


Demonstration of anti-rubella antibody-secreting cells in rheumatoid arthritis patients. In the present study we describe a plaque-forming cell assay using erythrocytes coated with viral antigen, which detected anti-viral antibody-secreting cells against various viral antigens. These anti-viral antibody-secreting cell were studied in normal individuals with known viral infections and in rheumatoid arthritis patients. Rubella anti-viral antibody-secreting cells were present after induction in the peripheral blood of eight out of ten patients. No plaques were seen before induction. Synovial tissue of seven patients out of ten showed rubella-antigen-specific plaques before induction. In all three patients tested, the numbers of plaques increased after induction. The peripheral blood of only one patient showed plaque-forming cells against mumps virus and cytomegalovirus (CMV) antigen. No other patients showed any plaque against CMV, respiratory syncytial virus, mumps virus, measles virus, adenovirus, and varicella zoster virus antigens. The method appears to be promising in studying viral antibody-secreting cells in human immunopathology.


The amyloid P-component (protein AP): an integral part of the amyloid substance? The P-component of amyloid (protein AP) appears to be present in all types of amyloid substance regardless of the clinical category of amyloidosis or the chemical class of the amyloid fibril. The role of protein AP in the formation of amyloid substance has not been established. In a patient with primary amyloidosis, significant amounts of protein AP were found closely associated with the amyloid fibril proteins and was released from the latter only after dissociation and reduction of the amyloid fibril preparation. EDTA seemed to be very effective in releasing protein AP, and it is thought that the close association between the amyloid fibrils and protein AP is calcium-dependent. The very close association between the amyloid fibrils and protein AP suggests that the latter is an integral part of the amyloid substance.


Paravalvular fistula in mitral valve implant. Intimation of malfunction of implant and quantification of regurgitant flow from effective area measurements. Non-invasive ultrasound Doppler registrations and cardiac output determinations with a thermodilution catheter were performed in the presence of and after closure of a paravalvular mitral fistula in a 52-year-old patient with a 27 mm Björk-Shiley mitral valve. The data collected allowed the calculation of the regurgitant flow through the fistula. This study suggests that the method used can be of diagnostic value when mitral valve implant malfunction is suspected.


Bleeding complications following invasive cardiac studies in anticoagulated patients with artificial heart valves. The number and nature of bleeding complications subsequent to cardiac catheterization and angiography were determined in 50 anticoagulated and 50 control patients. There were six bleeding complications in the anticoagulated group and five in the control group. Although the complications were somewhat more severe in anticoagulated patients, the difference was not enough to justify a change in our general policy of continuing anticoagulant treatment in patients with artificial heart valves who are admitted for postoperative invasive cardiac investigations.


Congenital heart disease in the first month of life. During the years 1963--73, 276 children with congenital heart disease were admitted to this hospital during their first month of life. Ventricular septal defect was the most common cardiac anomaly and this lesion, together with transposition of the great arteries, comprised 35% of all cardiovascular malformations. Extracardiac malformations were found in 86 patients. The cumulative survival rate for all patients was 66% in the first month of life and 33% in the first year. Forty-three patients were operated upon, but it is estimated from necropsy reports and available clinical data that another 74 patients, who died without operation, would have been suitable candidates for total corrective surgery.


Surgical repair of isolated ventricular septal defects in the first year of life. Since October 1975, 6 infants ranging in age from 5 to 9 months and weighing from 5.2 to 7.8 kg have been treated with primary closure of ventricular septal defect (VSD) at Ullevål Hospital. The indications for operation were large left-to-right shunts combined with persistence of heart failure in 4 patients, a large left-to-right shunt only in one and elevated pulmonary arterial resistance in one patient. Conventional cardiopulmonary bypass was used in all cases. There were no early or late deaths during the mean observation period of 17.3 months (range 3--25 months). One patient developed a recurrent VSD and was successfully re-operated on 8 months after the first operation; otherwise no signs of recurrence were found. The growth and weight gains have been satisfactory and the psychosomatic development of all the infants has been normal. All are in sinus rhythm with right bundle branch block in 4. Cardiac arrhythmias have not been in evidence.


Atrial septal defect of secundum type in patients under 40 years of age. A review of 481 operated cases. Symptoms, signs, treatment and early results. In the period 1957--1976 481 patients under 40 years of age were operated on. Dyspnoea and increased fatigue were dominating symptoms in more than half of the series. In 202 cases the anomaly was discovered at routine examination in the absence of relevant symptoms. Almost half of the patients were operated under hypothermia, in the others extracorporeal perfusion was used. Four hospital deaths occurred, two of which were related to cardiopulmonary bypass.


Coronary artery spasm--a case with fatal outcome. The case of a 45-year-old man with nocturnal angina and angiographically verified spontaneous spasm of the left anterior descending and left circumflex coronary arteries is described. The patient died suddenly one month after investigation, despite treatment with a beta-blocker and nitroglycerin. Other forms of pharmacological treatment should be tried in such patients.


Resting blood pressure index in arterial occlusive disease of the lower limbs. The resting blood pressure index of the ankle by the Doppler Ultrasound technique was correlated to the clinical picture and angiographic appearances in 152 legs. A very good correlation existed between the clinical picture and resting pressure index. The latter followed the angiographic status expressed by a score. We could not show any differences between the gropus pains at rest, gangrene or ulceration, either by resting pressure index or by angiographic score. Statistically highly significant differences were found between the resting pressure index and the groups asymptomatic legs, to the intermittent claudication and claudication to pains at rest or gangrene. Irrespective of where the stenosis is localized, the resting blood pressure index of the ankle is the same when the functional status of the patient is the same. This method cannot define the anatomical distribution of occlusive disease; therefore it cannot replace the angiographic examination when there is an indication for reconstructive arterial surgery. However, in the routine assessment, it offers an objective, reproducible and simple method for evaluating the functional effect of occlusive arterial disease in the lower limbs.


Haemodynamic studies in renal artery stenosis. With the aid of an electromagnetic flowmeter and a mechano-electrical pressure transducer, peroperative renal artery blood flows and pressures in the aorta and the renal artery distal to the stenosis were measured in 48 patients with renovascular hypertension before and after renal artery reconstruction. Calculations of pressure difference across the stenosis and resistances over the stenosis and the renal parenchyma were made. There was a significant blood flow increase through the renal artery after arterial reconstruction in all patients, irrespective as to whether they were normotensive, improved or failures postoperatively. The pressure difference across the stenosis after reconstruction was eliminated in all 3 groups of patients. The highest resistances over both the stenosis and the renal parenchyma before arterial reconstruction were found in the normotensive group, but there was no significant variation between the 3 groups. After reconstruction, a significant decrease in resistance over the renal parenchyma was found in the normotensive and the improved group of patients. The resistance of the stenosis was higher than over the renal parenchyma only in the postoperatively normotensive patients. This indicates that the removal of a resistance over the renal artery stenosis, that is higher than that over the renal parenchyma, gives the most favourable long-term results concerning normalization of the blood pressure.


Carcinoma arising in a lung cyst.

Carcinoma arising in a lung cyst. Only a few reports on carcinoma arising in lung cysts exist. The literature is reviewed and one new case added, demonstrating the importance of establishing an exact diagnosis by surgery.


Multiple pulmonary hamartomas; a case report and review of the literature. Bilateral multiple hamartomas were found in a woman suspected of having metastatic malignancy of the lung. As extensive investigation for the primary tumour was unrevealing, a left exploratory thoracotomy and histological examination established the diagnosis. In view of the benign character of the tumours, local excision alone was performed. No surgical intervention was performed on the right side. Repeat chest films 12 months after surgery did not show the appearance of new lesions in the left lung or any increase in the size of the nodules in the right lung. This is the 12th case so far reported. The clinical characteristics and surgical management of these tumours are discussed.


Chronic spontaneous pneumothorax due solely to a pleurovisceral membrane. A case report. The case of a 28-year-old male with a neglected and protracted spontaneous pneumothorax is reported. The condition was diagnosed 45 days after the onset of symptoms. The affected lung had completely collapsed and was unexpandable. Subsequent thoracotomy revealed a firm membrane covering the visceral pleura as the sole explanation of the persistent pulmonary collapse. This variety of chronic pneumothorax seems to be rare. The lung expanded completely after decortication.


Congenital tracheo-oesophageal fistula in the adult. Report of a case and review of the literature. Congenital tracheo-oesophageal fistula without atresia can persist and remain undetected until adulthood. We present such a case and give a review of the literature. Symptoms are commonly present during infancy, but to confirm diagnosis of a fistula is often exceedingly difficult. We visualized the fistula in our case by means of a bronchofibrescope when all the other available tests had failed. The speculations as to how these patients reach adult life have been many, but we consider that we have found an important and hitherto undescribed answer to this question, namely a sphincter mechanism in the fistula.


Chronic haemolysis following combined mitral and aortic valve replacement. A randomized study between the Björk-Shiley and Lillehei-Kaster disc valve prostheses. Intravascular haemolysis was studied in a randomized series of 35 patients examined 12--24 months after combined mitral and aortic valve replacements with either the Björk-Shiley (pyrolytic carbon) tilting disc valve (19 patients) or the Lillehei-Kaster pivoting disc valve (16 patients). Red blood cell count, haemoglobin concentrations, and serum bilirubin varied within normal ranges with a few exceptions. Haptoglobin was absent or reduced in 86%, while elevated values for serum lactate dehydrogenase were found in 82%. The increase in serum lactate dehydrogenase activity was moderate and indicated a normal or only slightly reduced red cell lifespan in most patients. Although the intravascular haemolysis was of little clinical significance, the increase in lactate dehydrogenase was significantly higher in patients with the Lillehei-Kaster prosthesis than in patients with the Björk-Shiley prosthesis, indicating a slightly shorter lifespan in the former group. For both models, however, intravascular haemolysis was less severe than previously reported after combined aortic and mitral valve replacement with ball valve prosthesis.


Ten-year mortality from coronary heart disease among 172,000 men classified by occupational physical activity. A cohort of 172,489 males aged 20--64 years and employed by the Italian railroad system on 1 April 1963 have been classified by habitual physical activity at work and followed-up for death during a ten-year period. The overall crude mortality was 56.59 per 1,000 in ten years, and no significant differences were found between men in sedentary, moderate and heavy work. Age-corrected death rates for coronary heart disease, as manifested by myocardial infarction and sudden coronary death, were substantially different in the three activity groups, moderately active workers ranking first, sedentary workers second, but very close to the former, and very active workers being last. The age-corrected rates for all ages were 14.18, 12.55 and 7.63 per 1,000 in ten years, respectively. All differences were statistically significant, the mortality ratio between the sedentary and moderate groups combined versus the heavy group being of the order of 1.75 to 1.


Ten-year coronary mortality of workers exposed to carbon disulfide. Two cohorts, one comprising 343 viscose rayon workers exposed for at least five years to carbon disulfide (CS2) and the other made up of 343 nonexposed men, were followed from 1967 to 1977 with respect to coronary heart disease (CHD) mortality. In the examination in 1967 known risk factors of CHD were controlled; only blood pressure was slightly higher in the exposed group. The difference was considered a result of exposure. Five exposed and eight nonexposed men had experienced a previous clinical myocardial infarction. The total mortality was 48 (14%) in the exposed group and 31 (9%) in the compeer group (p congruent to 0.05); 29 exposed and 11 nonexposed men had died from CHD (p less than 0.01), and 5 exposed and 1 nonexposed from other cardiovascular causes (p = 0.1). All coronary deaths occurred in the age interval 40 to 69 years. The estimated risk of death from CHD for this 30-year age span, assuming no competing risks of death, was 31.9% for the exposed cohort against 13.3% for the compeers. A multivariate analysis yielded age, raised blood pressure, and exposure to CS2 as prominent risk factors. The contributory risk caused by past occupational CS2 exposure seemed to increase the already notoriously high risk of CHD mortality among Finnish men.


Long-term exposure to electric fields. A cross-sectional epidemiologic investigation of occupationally exposed workers in high-voltage substations. In the present epidemiologic study, 53 workers with a long-term (more than five years) exposure to the electric field of 400 kV substations were examined and compared with a matched reference group of 53 nonexposed workers from the same power companies. Matching variables included age, geographic location and employment time. The aim of the study was to investigate the possibility of persistent, chronic health effects in the exposed group as a consequence of exposure. The investigation indluded the nervous system (neurasthenic symptoms, psychological tests, electroencephalography), the cardiovascular system (symptoms, blood pressure, electrocardiography), and the blood (hemoglobin, red blood cells, reticulocytes, white blood cells including differential count, thrombocytes, sedimentation rate). Fertility was also assessed. The results showed no differences between the exposed and reference groups as a consequence of the long-term exposure to the electric fields. The groups differed, however, in that the exposed group had (a) consistently better results on the psychological performance tests, (b) a fewer number of children, especially boys, and (c) somewhat higher education. The differences in test results were due to the higher education among the exposed. The difference in number of children was also thought to be related to factors other than exposure since it was found to be present already 10--15 years before the work in 400 kV substations began.


Distribution of m-xylene to subcutaneous adipose tissue in short-term experimental human exposure. When volunteers were exposed in three different patterns of exposure to approximately 3.7--8.2 mumol/l (90--200 ppm, constant or time-weighted average concentration) of m-xylene for five consecutive days plus one day after the weekend, approximately 3.7--8.0% of the total body uptake was estimated to be distributed to the adipose tissue on the basis of m-xylene determinations made from subcutaneous fat. Distribution seemed to be affected by the exposure pattern; a proportionately greater distribution to subcutaneous fat occurred when the volunteers performed physical exercise part of the time, particularly when the peak xylene concentrations in the air coincided with the exercise. The median elimination half-time of m-xylene from subcutaneous fat was 58 h (range 25--128 h). A positive correlation was found between the individual elimination half-times of m-xylene in subcutaneous fat and the relative fat mass of the individuals in two exposure groups, but not in one.


Determination of inorganic fiber density in human lung tissue by scanning electron microscopy after low temperature ashing. The concentration of asbestos fibers in lung tissue may give information about previous occupational asbestos exposure. A procedure for the preparation, quantification and identification of asbestos fibers in human tissue is presented in this report. The procedure is based on low-temperature plasma ashing of dry tissue, examination of the ash by scanning electron microscopy, and energy dispersive X-ray microanalysis. The advantages and disadvantages of this method are also discussed briefly.


Styrene and styrene oxide concentrations in the air during the lamination process in the reinforced plastics industry. Styrene and styrene oxide concentrations were measured during the lamination process in the reinforced plastics industry. The mean concentration of styrene in the personal samples was 130 ppm, the highest value measured being 350 ppm. The average concentration for styrene oxide alone was 0.1 ppm, whereas the corresponding measurement for styrene oxide and its decomposition products combined was 0.7 ppm. In comparison then, the concentrations of styrene oxide and its derivatives were much lower (about 0.5% of the total) than those of styrene.


[New methods of radiologic diagnosis: ultrasonography and tomoradiometry (computer assisted tomography)]. The evolution of new and more accurate methods of examination is a welcome complement to current diagnostic resources. However, it is essential to use them intelligently to avoid a further undesirable rise in the cost of health. Now more than ever, the programme of radiologic examinations should be established by common consent between the practising physician and the consultant radiologist.


[Echocardiography. Advantages and limitations related to unidimensional and bidimensional technics in real time]. Mode-M echocardiography is the most valuable non invasive technique in cardiology, but as a one-dimensional technique it displays the cardiac structure in an unfamiliar form without resemblance to the cardiac anatomy. Two-dimensional ultrasonic imaging of the heart overcomes this disadvantage. However, the definition of these scanners leaves much to be desired and becomes very poor when the stop-frame mode is used. The major disadvantages of the "multiscan" are the length of the multicrystal transducer, distortion of the picture, spurious echoes and verticalization. The sector scanner has smaller transducers fitting the "echocardiographic window" and permitting an apical, subxiphoid and suprasternal approach. However, with this system resolution is usually poor in the first anterior 3.5--4 cm after the thoracic wall. The mechanical scanner causes a vibrating sensation occasionally irritating to the patient. The electronic sector scanner has the widest angle and provides the best quality images. Unfortunately, its cost is markedly higher than that of other two-dimensional systems.


[Possibilities of abdominal ultrasonics]. The potentialities of abdominal ultrasonography are discussed and illustrated by a number of cases. It is particularly indicated whenever aortic aneurysm, gallstones or obstructive jaundice are suspected. However, good results are obtained in research of most forms of abdominal mass lesion.


[Abdominal tomoradiometry: its possibilities]. Computer-assisted tomography opens up a new diagnostic chapter in research on abdominal lesions. The display of very faint contrasts, and the possibility of modulating them and of strengthening them by opacifying agents, afford hitherto unknown differentiations. The obtaining of cross-sections is another advantage of this method. Its use for study of the various abdominal organs is reviewed.


[Computer-assisted tomography of the chest]. Computer-assisted tomography of the chest is the most accurate technique in diagnostic imaging of tumoral disease of the mediastinum. It is also a reliable method of detecting lymphadenopathies and lung metastases, as well as any pathological process involving the pleura and the thoracic wall.


[Use of the determination of "fast" hemoglobins for surveillance and diagnosis of diabetes mellitus]. Personal results in the assay of "fast hemoglobins" in diabetics and normal controls are reported. For the latter, a normal range of 5.45--8.25% HbA1 has been determined. Correlation between HbA1 and fasting blood sugar was found for diabetics, the correlation being at its highest for a group of diabetics with rather constant fasting blood sugar. From the results of this group it proved possible to calculate a simple system for the evaluation of therapy. The diagnostic of HbA1 is limited, since concentrations remain normal in mild diabetics with normal fasting blood sugar.


[Control of oral anticoagulation: comparison between Quick and colorimetric factor X determination in 107 patients]. Since monitoring of oral anticoagulation (OA) by prothrombin time (PT) is a source of standardization difficulties, the authors have tested another approach. 107 patients under long term OA were monitored by both PT and a colorimetric factor X assay (in vitro activation of factor X with RVV and assessment of amidolytic activity towards S-2222). The PT values were between 10 and 34% (therapeutic range 15--25%), and factor X levels were between 10 and 44% (therapeutic range 16--24%). The correlation between the two methods was highly significant (r = 0.65, p less than 0.001). In 68% of the patients the two tests gave the same information (55 subjects were adequately, 16 insufficiently and 2 over-anticoagulated). For a slightly broader therapeutic range (PT 15--30%, corresponding to 16--28% factor X) concordant information was obtained in 82% of the patients. During stable OA, PT and factor X assay gave very similar information. An advantage of the latter method is the possibility of automation, while a disadvantage is its insensitivity to factor VII.


[Procetophen--an alternative in the treatment of hypercholsterinemia?]. 18 patients with primary hyperlipoproteinemia of type IIa and type IIb, on regularly controlled dietary treatment for 6 months and a 4 weeks placebo period, were given 300 mg procetofene per day for 12 weeks. The subjective tolerance of the drug was good. The serum triglyceride levels were lowered by about 35%, total cholesterol by 15%, LDL-cholesterol by 12% and Apo B by 20%. The HDL-cholesterol values remained unchanged. A slight increase in SGPT values indicates that liver function should be regularly checked in patients undergoing procetofene therapy.


[Popliteal cysts: unusual form of presentation]. Popliteal cysts are usually associated with abnormalities of the knee joint such as osteoarthritis, chronic inflammation or cartilage tears. 15 patients with popliteal cysts demonstrated by arthrography are described who had no obvious lesion of the knee. They had consulted their physician for symptoms without a clearcut relation to the knee joint, such as tenderness on the external side of the calf, ankle edema or paresthesia in the toes. Standard X-rays and clinical examination of the knee were normal except for tender swelling of the popliteal area. The symptoms improved after injection of triamcinolone into the knee joint. Unexplained symptoms of the lower leg may be due to popliteal cysts even in the absence of obvious knee pathology.


[Endocrinologic and ophthalmologic findings before and after transnasal surgery in so-called chromophobe pituitary adenomas]. Pre- and postoperative visual and endocrine functions were examined in 54 patients with so-called chromophobe pituitary adenomas operated on by the transnasal approach. The preoperative examination showed visual disturbances in 41 of 48 patients. A loss of gonadal function was present in 93% of the women and 69% of the men. Impairment of adrenal function was found in 37% and of thyroid function in 18% of patients. Hyperprolactinemia was present in 16 of 29 patients examined. The visual findings remained unchanged, normal or improved in 75% of patients. Impairment occurred in 3%. Eight patients experienced improvement of gonadal function and 3 of adrenal function, whereas no postoperative improvement of the thyroid function was observed. Deterioration of gonadal function occurred in 4, of adrenal function in 7, and of thyroid function in 9 patients. Hyperprolactinemia was reduced in all cases.


[Experiences with an oral cocaine-morphine solution (Brompton mixture) in the treatment of severe pain in patients with neoplasms]. One year's experience is reported in the treatment of terminally ill cancer patients with an oral solution of morphine and cocaine on a fixed schedule. 36 consecutive patients were treated for an average of 51 days. Excellent or good pain relief was achieved with 26 patients (72%). The initial mean daily dose of morphine was 35 mg. After 12 weeks, the dose had to be raised to an average of 52 mg per day. Some patients received up to 180 mg morphine per day. Side effects were not uncommon but were without clinical consequences in most patients. Side effects caused discontinuation of treatment in only 2 patients. Terminally ill cancer patients often derive great benefit from this treatment.


Isolation and partial characterization of a water-soluble receptor protein of insulin. By using the chelate EDTA at low concentration to remove the bivalent cations in the plasma membranes and followed by n-butanol to extract the membrane lipids, we have obtained a water-soluble insulin receptor without detergent from the liver-cell plasma membranes. This receptor protein does not precipitate by centrifugation at 300,000 X g for 70 min, nor does it retain on 0.22 micron millipore filter. It does not retard on Sephadex G-200 gel chromatographic column either. It is thus proved that the insulin-receptor protein obtained by this method is completely soluble in water. The dissociation constant of the water-soluble receptor of insulin at 24 degrees C is calculated to be 3.6 X 10(-9) M and its isoelectric point was approximately pH 4.1. As the fluorescence hydrophobic probe 1,8-ANS does not significantly affect the binding activity between the receptor and the insulin, it seems that in addition to a hydrophobic binding mechanism, there may exist some other forces of interaction.


Viroids: structure and function.

Viroids: structure and function. Viroids are nucleic acid species of relatively low molecular weight and unique structure that cause several important diseases of cultivated plants. Similar nucleic acid species may be responsible for certain diseases of animals and humans. Viroids are the smallest known agents of infectious disease. Unlike viral nucleic acids, viroids are not encapsidated. Despite their small size, viroids replicate autonomously in cells of susceptible plant species. Known viroids are single-stranded, covalently closed circular, as well as linear, RNA molecules with extensive regions of intramolecular complementarity; they exist in their native state as highly base-paired rods.


Genes coding for histone proteins in man are located on the distal end of the long arm of chromosome 7. Tritium-labeled complementary RNA's to two cloned sea urchin DNA sequences, one coding for histones H1, H2B, and H4 and the other for H2A and H3, were hybridized in situ to high resolution human chromosomes. Evidence is presented showing that the histone genes in man are localized in bands q32-36 on the long arm of chromosome 7.


Müllerian duct regression in the embryo correlated with cytotoxic activity against human ovarian cancer. A significant cytotoxicity index was obtained when human ovarian cancer cells in a microcytotoxicity assay were exposed during the S (DNA-synthesizing) phase of the cell cycle to purified fractions of testis exhibiting high Müllerian inhibiting substance bioactivity. The same effect was not observed when these fractions were tested against human glioblastoma or fibroblast lines. Most human ovarian cancers are said to resemble Müllerian tissues histologically. Müllerian inhibiting substance may thus deserve further study as a potential chemotherapeutic agent.


Vascular smooth muscle cell kinetics: a new assay for studying patterns of cellular proliferation in vivo. A new quantitative assay for studying the kinetics of vascular smooth muscle cells in vivo is reported. The assay was used to determine the specific activity of DNA from rabbit aortic smooth muscle cells stimulated to grow by removal of the endothelial layer. The specific activity of the DNA was correlated with the rate of tritiated thymidine incorporation as measured by autoradiography and with the rate of DNA synthesis as estimated by direct measurement of cellular proliferation. Smooth muscle cells exhibit a 24-hour latent period in vivo prior to DNA synthesis; the synthesis peaks at 48 hours and then rapidly declines. The decline in DNA synthesis is not related to endothelial regrowth, and may be of homeostatic significance in limiting luminal stenosis. The assay offers a rapid and reliable alternative to autoradiographic and morphometric techniques for evaluating growth kinetics and growth regulation in vivo.


Memory load and event rate control sensitivity decrements in sustained attention. The capacity to sustain attention at an efficient level deteriorates over time in discrimination and monitoring tasks. This "vigilance decrement" results from a decrement in perceptual sensitivity only if (i) target discrimination loads memory and (ii) stimulus events occur rapidly; otherwise, the decrement reflects temporal changes in response criteria. These results provide a basis for distinguishing between the perceptual and response processes underlying the vigilance decrement that may be generalized across a range of tasks.


Emergence of interoceptive and exteroceptive control of behavior in rats. The role of exteroceptive and interoceptive aversive stimuli in rats 2 to 14 days old was investigated according to an odor aversion paradigm. Amyl acetate odor was paired with eigher peripheral shock, intraperitoneal shock, or lithium chloride poisoning. Intraperitoneal shock was an effective unconditioned stimulus at all ages and produced odor aversions comparable to lithium chloride poisoning; peripheral shock, however, was effective only in rats 10 days of age or older. Interoceptive control of aversively motivated behaviors thus seems to develop before exteroceptive control, and the failure of previous studies to find reliable learning and retention of shock-motivated behaviors before 8 to 10 days of age may be attributable to the site to which shock was applied rather than to insensitivity to shock per se.


Lithium transport across red cell membrane: a cell membrane abnormality in manic-depressive illness. In the families of manic-depressive patients, relatives with a history of affective disorders had a significantly higher ratio of mean red cell lithium to plasma lithium in vitro than relatives with no such history. A genetically controlled abnormality in lithium-sodium transport, the mechanism that determines the lithium ratio, may play a role in the etiology of some forms of affective disorders.


Bitter taste of saccharin related to the genetic ability to taste the bitter substance 6-n-propylthiouracil. Bitter taste thresholds for 6-n-propylthiouracil are bimodally distributed, dividing subjects into tasters and nontasters. Their taste worlds differ with regard to the sweetness of sucrose and saccharin and to the bitterness of saccharin. These differences suggest that nontasters tend to perceive less bitterness in saccharin at concentrations used in beverages.


Insulin receptor binding in obesity: a reassessment. A defect in the binding of insulin to circulating monocytes occurs when obese patients are hospitalized and fed a liberal carbohydrate diet. Under ordinary circumstances, most obese patients have normal insulin binding despite very high concentrations of serum insulin. These results show that insulin does not necessarily regulate its own receptor in vivo--as it does in vitro.


Novel activation mechanism for the promutagenic herbicide diallate. The potent bacterial mutagen 2-chloroacrolein is formed from the carcinogenic herbicide S-2,3-dichloroallyl diisopropylthiocarbamate (diallate) on incubation with hepatic microsomal monooxygenases or on reaction with m-chloroperbenzoic acid. A proposed activation mechanism for this promutagen involves sulfoxidation followed by [2,3] sigmatropic rearrangement and 1,2-elimination reactions. A portion of the highly reactive intermediate, diallate sulfoxide (proximate mutagens), is attacked by glutathione in a reaction which competes with its transformation to the ultimate mutagen, 2-chloroacrolein.


Visual resolution and receptive field size: examination of two kinds of cat retinal ganglion cell. Intraocular recordings from brisk-sustained and brisk-transient ganglion cells in the cat's retina revealed a systematic increase in center size and decrease in spatial cut-off frequency with increasing distance from the area centralis. At any one eccentricity sizes of the centers of sustained and transient cells did not overlap, and the variation in cut-off frequency for each class was constrained to about one-half octave.


The central origin of efferent pathways in the carotid sinus nerve of the cat. The application of horseradish peroxidase to the central cut end of the carotid sinus nerve of the cat produced retrograde labeling of neurons in the ipsilateral medulla in the region of the nucleus ambiguus at anterior-posterior coordinates -8 to -10.5. These data coupled with previous electrophysiological observations suggest that the nucleus ambiguus may be the origin of an efferent inhibitory pathway to the carotid body.


Saccharin metabolism and tumorigenicity. Exposure of male Charles River CDI rats to a 5% saccharin diet in utero and throughout weaning, conditions associated with tumor induction, did not induce detectable metabolism (less than 0.4% of the oral dose) of tritiated saccharin in vivo. No metabolites (less than 0.06 microgram per kilogram per 24 hours) were detected in the urine of normal rats given a tracer dose. Pretreatment with 3-methylcholanthrene did not induce saccharin metabolism.


Subfornical organ efferents to neural systems for control of body water. The subfornical organ, a circumventricular structure of the central nervous system, has efferent neural projections to sites within the brain known to be involved in drinking behavior and secretion of antidiuretic hormone. By using anterograde tracing techniques, it is shown that the subfornical organ projects to the nucleus medians of the medial preoptic area, to the organum vasculosum of the lamina terminalis, and to the supraoptic nuclei bilaterally. Its efferent connectivity is confirmed by retrograde transport of horseradish peroxidase. The organum vasculosum of the lamina terminalis, another circumventricular organ and a suspected receptor site for angiotensin II, is involved in the circuitry of the subfornical organ and also has an efferent projection to the supraoptic nuclei.


3-Methoxy-4-hydroxyphenethyleneglycol production by human brain in vivo. A direct method has been employed to estimate the rate of production by human brain of 3-methoxy-4-hydroxyphenethyleneglycol, the major metabolite of brain norepinephrine, a brain neurotransmitter. Venous specimens were obtained from the internal jugular vein from ten awake human subjects at a puncture site above the common facial vein, the first major source of extracranial inflow. Arterial specimens were simultaneously obtained from the radial artery. Plasma samples were assayed and a highly significant difference was found in the concentration of the metabolite in plasma coming out of the brain (venous blood) as compared to plasma entering the brain (arterial blood). This venous-arterial difference was calculated to be 0.7 +/- 0.1 nanogram per milliliter of blood. Assuming an adult brain weight of 1400 grams and normal cerebral blood flow, it is estimated that the rate of production of 3-methoxy-4-hydroxyphenethyleneglycol by the awake human brain is approximately 597 nanograms per minute or 35.8 micrograms per hour. Urine specimens were also collected from six of these subjects during a period of 1 to 3.5 hours, which bracketed the time the blood samples were obtained. For these six subjects the output of 3-methyoxy-4-hydroxyphenethyleneglycol by whole brain was estimated to be 40.9 micrograms per hour, whereas the rate of its excretion into urine was 64.5 micrograms per hour.


Pigeons have magnets.

Pigeons have magnets. Research on pigeon homing suggests that magnetic field information is used for orientation. The ability of pigeons to sense magnetic fields may be associated with a small, unilateral structure between the brain and the skull which contains magnetic in what appears to be single domains.


Enhanced 5-fluorouracil nucleotide formation after methotrexate administration: explanation for drug synergism. Exposure of L1210 leukemia cells first to 0.1 to 100 micromolar methotrexate and then to 10 micromolar 5-fluorouracil produces a synergistic effect on the number of cells killed in culture. Methotrexate dose-related increases occur in the concentrations of intracellular 5-fluorouracil ribonucleotides and 5-fluoro-2'-deoxyuridylate and in the incorporation of 5-fluorouracil into RNA. These increases are correlated with increased concentrations of intracellular phosphoribosylpyrophosphate. It is proposed that the enhanced formation of ribonucleotides of 5-fluorouracil and the subsequent incorporation of these compounds into RNA in methotrexate-treated cells may account for synergism between these agents.


Iodine-125--labeled estradiol: a gamma-emitting analog of estradiol that binds to the estrogen receptor. 17 beta-[16 alpha-125I]Iodoestradiol has been synthesized by exchange of 16 beta-bromoestradiol with Na125I. The iodinated product is readily separated from the bromo reactant by column chromatography. It concentrates in the rat uterus in vivo and binds avidly and specifically to the uterine estrogen receptor in vitro.


Regrowth of severed axons in the neonatal central nervous system: establishment of normal connections. When pyramidal tract axons are cut in the adult hamster, fibers degenerate in both anterograde and retrograde directions from the lesion. If the same operation is performed on infant hamsters, however, there is massive regrowth of the severed axons via a new brainstem pathway to their appropriate terminal sites in the medulla and spinal cord. In contrast to previous studies, these results suggest that axons in the mammalian central nervous system damaged early in life may regenerate in a functionally useful way.


Plasma beta-endorphin immunoreactivity in schizophrenia. Plasma beta-endorphin-like immunoreactivity was measured by a method that was equally sensitive to beta-endorphin and [Leu5]-beta-endorphin. Immunoreactivity in 98 schizophrenic patients did not differ greatly from that in 42 normal subjects. No immunoreactivity was detectable in dialyzates from first-time hemodialysis of eight nonpsychotic renal patients and nine schizophrenic patients. These results are not compatible with recent reports of extremely high concentrations of [Leu5]-beta-endorphin in hemodialyzates from schizophrenic patients.


Psychotropic drugs as behavioral teratogens. Three psychotropic drugs were administered to pregnant rats and were then evaluated for their behavioral and reproductive effects in the offspring. Control rats received either saline or vitamin A. Prochlorperazine had the most disruptive effects on reproduction and growth, but had the least effect on behavior. Propoxyphene had no apparent effects on reproduction or growth, but produced a variety of behavioral changes. Fenfluramine was intermediate in its effects on reproduction and growth and had behavioral effects that were revealed in tests of preweaning development. The data suggest that systematic tests of behavior add important information to evaluations of reproductive toxicity that cannot, at present, be obtained by other means.


Geographic constraints on women's careers in academia. Male and female academics have very different residence patterns. Women are more concentrated in our largest urban centers; also, wherever they reside, women are less likely than men to change communities when changing institutions. Much of this sex difference is attributable to the constraints under which married academic women must manage their careers, in particular the requirements of two-career households. The authors argue that the status difference between men and women in academia is attributable, in part, to the geographic limitations on the locations of married women, as these prevent making strategic job changes to advance career prospects.


N-nitrosamines in the rubber and tire industry. Airborne N-nitrosomorpholine (0 to 27 micrograms per cubic meter) was found in two of four rubber industry factories. N-Nitrosodimethylamine was also found in two factories, but at lower levels. These findings may be relevant to the reported increased risk of certain types of cancer in rubber workers in some of the same areas where the N-nitrosomorpholine levels were highest.


Sister chromatid exchanges in human lymphocytes after exposure to diagnostic ultrasound. The frequency of sister chromatid exchanges increased in freshly isolated human lymphocytes as well as in a continuously growing lymphoblast line by exposure to diagnostic levels of ultrasound for 30 minutes. The results confirm previous findings indicating that ultrasound of diagnostic intensities can affect the DNA of animal cells.


Acridine araphanes: a new class of probe molecules for biological systems. The bis-acridine ring system forms the basis for new biophysical probes of novel stereochemistry. Spectral data indicate that certain alkylene bridged bis-9-aminoacridines have a parallel plane conformation of predictable interplane distance. The parallel plane conformation is independent of solvent and thus is different from nucleic acid systems. This stable conformation allows these compounds to be used as sensitive "rulers" for describing binding site geometry in cholinergic enzymes and in the delineation of the mechanism of allosteric control in acetylcholinesterase.


DNA synthesis and mitosis in adult amphibian cardiac muscle cells in vitro. High-resolution autoradiography and fine structural analysis of adult newt heart tissue in long-term culture revealed that tritiated thymidine was concentrated in the nuclei of dedifferentiated myocardial cells. Mitotic chromosomes were observed in some of these cells. This demonstrates that adult amphibian myocardial cells in vitro are capable of DNA synthesis and mitosis.


Cerebral specialization, writing posture, and motor control of writing in left-handers. It has been suggested that the inverted hand position of left-handers during writing indicates the left hemisphere of their brain is linguistically specialized and that the writing of these left-handers may be controlled via ipsilateral pathways. Electroencephalograph alpha asymmetry measures at central and parietal leads, as well as dichotic tests, differentiated right-handers from left-handers, but not inverters from noninverters. Electroencephalograph differences between hand posture groups did appear, but only at occipital leads during reading and writing tasks. Regardless of hand posture or speech lateralization, the right central region of the brain is significantly involved in the control of left-handed writing.


Pupillary responses during information processing vary with Scholastic Aptitude Test scores. The magnitude of task-evoked pupillary dilations during mental activity has previously been shown to index the cognitive capacity utilized in the performance of the mental task. To determine the relation between "intelligence" and capacity demands during mental activity, task-evoked pupillary dilations were measured while two groups of university students differing in their scores on the Scholastic Aptitude Test solved mental arithmetic problems. Over three levels of problems difficulty, more intelligent subjects showed smaller task-evoked pupillary dilations than did their less intelligent counterparts. Thus, the more intelligent appear to possess more efficient cognitive structures of information processing. These data provide evidence that physiological differences between individuals of differing psychometric intelligence emerge during mental activity.


Developmental fate of skeletal muscle satellite cells. Radioisotopically labeled satellite cells from clonal cultures were implanted into normal muscle of the original donor. Implanted cells invariably retained their myogenic potential by participating in the regeneration of damaged myofibers or in the development of existing fibers.


Auditory brainstem frequency following responses to waveform envelope periodicity. An auditory frequency following response (FFR) was recorded to four complx stimuli. The FFR corresponded to the waveform envelope periodicity but not to the "missing fundamental" pitch of the stimuli. The FFR may be significant for timbre perception and sound lateralization.


Baroreceptor activation reduces reactivity to noxious stimulation: implications for hypertension. The hypothesis was tested that an acute rise of blood pressure may reduce reactivity to noxious stimuli through a baroreceptor-mediated reduction of cerebral arousal. When blood pressure was raised by an infusion of phenylephrine, rats showed less running to terminate or avoid noxious stimuli than during saline infusions. This effect was not seen in rats with denervated baroreceptors. The results suggest that a rise of blood pressure could have motivational consequences significant for human hypertension.


The hyperactive child syndrome.

The hyperactive child syndrome. The behavioral characteristics of the hyperactive child are described at different stages of development. Recent and sometimes controversial research findings are discussed with respect to prevalence, etiology, treatment, and outcome. It is concluded that this syndrome can best be understood in terms of interactions between social, psychological, and biological variables.


Galactosemia: alterations in sulfate metabolism secondary to galactose-1-phosphate uridyltransferase deficiency. Cultures of nonmutant as well as galactokinase-deficient fibroblasts incorporate 20 percent more [35S]sulfate when galactose is substituted for glucose in the medium; galactose-1-phosphate uridyltransferase-deficient cells incorporate 65.5 percent less. In addition to incorporating less [35S]sulfate, the uridyltransferase-deficient cells showed significant accumulation of intracellular galactose-1-phosphate within 4 hours after galactose exposure. Under the same conditions, no difference in [3H]uridine incorporation was observed. This metabolic alteration, occurring in response to galactose exposure, may be related to the pathophysiology of classical galactosemia.


Meiotic maturation in Xenopus laevis oocytes initiated by insulin. Insulin can induce meiotic division in Xenopus laevis oocytes. This effect shows the specificity expected of a receptor-mediated mechanism. It is potentiated by ethynylestradiol, a steroid antagonist of pregesterone (the natural hormone that provokes meiosis). The Xenopus laevis oocytes may serve as a model for the study of the poorly understood effect of insulin on cell division.


Mutual repulsion between moving visual targets. When two spatially intermingled sets of random dots move in different directions, the direction of each set may be misperceived. Observers report that each set of dots appears to move in a direction displaced by as much as 20 degrees from the direction of its companion set. Probably the result of inhibitory interactions, this mutual repulsion occurs at a central site in the visual system and may normally enhance discrimination of direction.


Human language cortex: localization of memory, syntax, and sequential motor-phoneme identification systems. Subdivisions of the human peri-Sylvian language cortex were derived from stimulation mapping during craniotomies under local anesthesia. Naming, reading, short-term verbal memory, single and sequential orofacial movements, and phoneme identification were tested. Sequential orofacial movements and phoneme identification were altered from the same brain sites and thus identified a common system for language production and understanding. This system surrounded a final motor pathway for speech and was surrounded by a separate short-term verbal-memory system. Between the sequential motor-phoneme identification and memory systems were sites where only naming or reading were altered, including sites related exclusively by syntax.


Pseudohermaphroditism in Ilyanassa obsoleta (Mollusca: Neogastropoda). Field studies, a rearing and maintenance program, and a transfer experiment have shown that anomalous male traits found in some female Ilyanassa obsoleta are an expression of environmentally controlled psuedohermaphroditism. The particular pattern of pseudohermaphroditism discovered in this species has not been reported previously from any other group, but may be characteristic of the Neogastropoda.


Receptor-mediated internalization of fluorescent chemotactic peptide by human neutrophils. Tetramethylrhodamine labeled N-formyl-Nle-Leu-Phe-Nle-Tyr-Lys is a potent chemoattractant for human neutrophils. Binding of this peptide to living neutrophils was observed by means of video intensification microscopy. At 37 degrees C, diffuse membrane fluorescence was seen initially, followed by rapid aggregation and internalization of the fluorescent peptide. These processes are dependent on specific binding to the formal peptide chemotactic receptor.


Angiogenesis in the mouse cornea.

Angiogenesis in the mouse cornea. We have developed a method that permits analysis of neovascular responses in the mouse cornea. Using this method we have demonstrated that both allogeneic lymphocytes and a variety of tumors can induce angiogenesis, but that only the latter appear capable of eliciting secondary capillary sprouting.


Imbalance in X-chromosome expression: evidence for a human X-linked gene affecting growth of hemopoietic cells. In each of six family members who were heterozygous at the X-linked locus for glucose-6-phosphate dehydrogenase, only one or the other of the two alleles at that locus was almost exclusively expressed. The data are consistent with evidence that X-chromosome inactivation is a random process that may be followed by selection for one of the two resulting cell types on the basis of an unknown gene, which is located on the X chromosome and which can affect the rate of proliferation of hemopoietic cells in humans.


Perinatal exposure to cannabinoids alters male reproductive function in mice. Oral administration of delta 9-tetrahydrocannabinol or cannabinol to female mice late in pregnancy and during early lactation alters body weight regulation and pituitary-gonadal function and suppresses adult copulatory activity in their male offspring. These findings suggest that both psychoactive and nonpsychoactive constituents of marihuana can affect the development of male reproductive functions in mice.


Systemic sarcoidosis presenting with a testicular nodule. A patient presenting with the clinical and radiographic picture of pulmonary sarcoidosis was found to have a testicular nodule. Orchiectomy was done, and the pathologic specimen revealed only granulomatous inflammation. The involvement of the testis in sarcoidosis is reviewed, and recommendations are made regarding surgical diagnosis and medical treatment.


Multifocal malignant melanoma of the esophagus. We have described a case of primary melanoma of the esophagus in an asymptomatic patient. The tumor presented as a multinodular filling defect on a routine barium swallow. The distal esophagus and a proximal portion of the stomach were resected. The patient died ten days postoperatively of Klebsiella sepsis. Grossly, the surgical specimen showed multiple polypoid tumors which arose from separate pigmented areas shown microscopically to be melanoma in situ. By electron microscopy, the tumor cells contained numerous melanosomes in various stages of melanization. Primitive hemidesmosomes were found where a basal lamina was present. Better developed desmosomes interconnected the melanocytes.


Giant cell tumor of the ischium: unusual site and outcome. We have described an unusual case of giant cell tumor of the ischium. The remarkable features of the case are that it occurred in a relatively rare site and that it transformed radiologically from a localized, well circumscribed lesion into a very destructive lesion over a period of several months, though histologically it remained benign in appearance. The lesion was successfully treated by a modified hemipelvectomy. We emphasize that the treatment of choice in giant cell tumor of bone is total en bloc excision and not curettage or irradiation.


Familial nonhemolytic jaundice with free and conjugated hyperbilirubinemia, elevated serum bile acids, and liver pigmentation. We have described an 11-year-old patient with nonhemolytic hyperbilirubinemia, elevated serum bile acids, and liver pigmentation. The Bromsulphalein clearance was not typical of that seen in the Dubin-Johnson syndrome, but there was a secondary rise at 120 min. The abnormalities involving several organic anions and liver histology are compared to those seen in other types of familial nonhemolytic jaundice.


Severe pulmonary vascular disease in systemic lupus erythematosus. A young woman with systemic lupus erythematosus (SLE) had clinical evidence of acute cor pulmonale. Autopsy disclosed vascular lesions in the lungs resembling those seen in advanced pulmonary hypertension. This case illustrates that severe pulmonary vascular disease may complicate SLE and mimic pulmonary thromboembolic disease.


Cantharidin: a valuable office treatment of molluscum contagiosum. Cantharidin in either a 0.9% or 0.7% solution is a safe and effective office treatment for molluscum contagiosum. It simplifies the treatment, especially of children, by being a quick, simple, and painless procedure, but it should be applied only by the physician.


Periodontal disease: predisposing factor to chemotherapy-induced stomatitis. Periodontal disease and dental plaque may predispose patients receiving antineoplastic drugs to stomatitis. Dental evaluation and appropriate treatment including oral hygiene are proposed to reduce the incidence and severity of stomatitis.


Disulfiram-induced acute organic brain syndrome. Reversible acute organic brain syndrome is described in a patient receiving disulfiram, 250 mg daily. Slowing of the electroencephalogram (3 to 4 cycles per second) in the occipital region resolved ten days after discontinuation of disulfiram. Acute organic brain syndrome induced by disulfiram is not rare but is often not correlated, and it should always be considered a possibility in patients receiving disulfiram therapy.


Life-threatening metabolic alkalosis in a comatose patient. A 63-year-old man with obstructive pulmonary disease developed severe metablic alkalosis and coma while receiving steroid therapy and nasogastric suction. Treatment, which included the acute induction of hypercarbia and the simultaneous administration of acetazolamide and saline, restored acid-base balance within 24 hours. This combined approach eliminated the need to infuse hydrochloric acid.


Omental abscess: an unusual complication of cesarean section. A case of an omental abscess following low transverse cesarean section is described. The incidence of cesarean section is rising, and with this rise one might expect an increase in the number and types of complications. A review of the literature fails to demonstrate any mention of this particular complication. In the evaluation of patients, one must consider not only the known but also the possible.


Cerebrospinal fluid rhinorrhea complicating pregnancy. Cerebrospinal fluid rhinorrhea is an uncommone occurrence, especially when a history of previous trauma is absent. This report describes a case of cerebrospinal fluid rhinorrhea occurring in a pregnant patient during the pushing portion of her Lamaze exercises, and discusses the management of labor and delivery.


Controversies and hazards in the treatment of pit viper bites. This paper discusses the pathology produced by pit viper venom and the pharmacologically active substances released by the action of venom on human tissue. The risks of many of the popular methods of treatment such as tourniquets, cryotherapy, incisions, excisions, and cortisone are also discussed. A prospective treatment plan was devised which was limited to measures of proven benefit, and 28 patients were treated with no mortality or tissue necrosis.


Surgical face lift.

Surgical face lift. The growing importance of the face lift and related procedures to improve the aging face and the increasing demand by both men and women for these procedures is largely due to the prolonged good health, active life, and extended working years of many people. The technic described emphasizes support of the facial tissues upward and backward, leaving the resulting scars in the least obvious locations. Illustrative cases show improvement in appearance by upper and lower blepharoplasty and by the temple, cheek, and neck lift. The importance of a "segmental approach" is mentioned and other accessory procedures which may contribute further to improvement of the aging face are described, including rhinoplasty, mentoplasty, surgical abrasion, and chemical peel.


Symptomatic lower esophageal ring: treatment of 24 patients. The lower esophageal ring, or Schatzki's ring, consists of a thin, submucosal, circumferential scar which forms a thin incomplete diaphragm in the lower esophageal lumen. The symptoms may be either episodic aphagia or progressive dysphagia, and the severity of symptoms is related to the diameter of the ring. Between 1970 and 1978, we saw 24 patients with lower esophageal rings and complaints of episodic aphagia or progressive dysphagia. Symptoms of esophagitis were present in 20 of the 24. Twenty were treated surgically by interrupting the rings and repairing the sliding hiatal hernias. Two were treated by dilatation and two received no treatment to the ring. Hiatal hernias have recurred in two patients. In one, there is a recurrent ring and in the other, an acid peptic stricture. The ring has responded to dilatation and the peptic stricture to dilatation and repair of the recurrent hernia. Two patients without symptoms of esophagitis, treated by dilatation, are doing well but the follow-up period is so far too short to draw any conclusion.


Hemiagenesis of the thyroid.

Hemiagenesis of the thyroid. Congenital absence of a lobe of the thyroid gland is discussed and the literature is reviewed. Sixty-six cases have been gathered from the literature in approximately the past 100 years, and another six have been documented. Although no particular explanation has been forthcoming for the development of this anomaly, left lobe aplasia and predominance of occurrence in women have been noted. A variety of other thyroidal abnormalities have coexisted with hemiagenesis.


Carcinomatous meningitis in gastrointestinal malignancies. With the development of the Millipore filter, meningeal metastases are being identified more frequently as a complication of many types of carcinoma, including breast, lung, pancreas, stomach, and prostate. Regardless of the primary source, adenocarcinoma cells appear to have a propensity to metastasize to this site. In recent years, carcinomatous meningitis has been reported very infrequently in gastrointestinal malignancies, as compared with other primary sites. We present two cases of carcinomatous meningitis, one in a 29-year-old man with adenocarcinoma of the colon and another in a 51-year-old man with gastric carcinoma. Survival after this complication is presently poor, but treatment may offer amelioration of disabling symptoms. The aggressive nature of these metastases emphasizes the need for early clinical suspicion and examination of spinal fluid in patients with gastrointestinal malignancies.


Cervical cerclage: twenty years' experience. During a 20-year period, 40 pregnancies were managed in 32 patients with a diagnosis of an incompetent cervix, a ratio of 1:775 deliveries. Diagnosis before development of symptoms produced a 92% fetal salvage, with 68% reaching 36 weeks of gestation. Development of symptoms before cerclage resulted in only a 40% fetal salvage. Fetal salvage was reduced in cases where membranes bulged beyond the cervix, the cervix was more than 3 cm dilated, or the gestational age was greater than 26 weeks at the time of suture placement. No difference was noted between the Shirodkar and McDonald procedures. Major complications included uterine rupture in three patients and acute chorioamnionitis in two. Because of complications, treatment is contraindicated based on history alone or where close follow-up is not available.


Ligation of the superior vena cava for recurrent pulmonary emboli. A patient with polycythemia vera developed chronic thrombosis of the superior vena cava and had life-threatening pulmonary emboli despite anticoagulation and chemotherapy for the blood dyscrasia. After angiographic evaluation, the superior vena cava was ligated cephalad to the azygous vein. There have been no further clinical embolic episodes nor adverse effects over a three-year period of observation.


Pulmonary function tests in a community hospital. The purpose of this study was to determine the incidence of obstructive lung disease in a surgical population. Screening spirometric pulmonary function tests were performed in 300 consecutive ambulatory patients in a community hospital. A high incidence of moderate to very severe chronic obstructive lung disease was found, 66% of smokers and 38% of nonsmokers. The incidence of chronic obstructive lung disease is underestimated. The costs of this disease are staggering in terms of money and manpower, and there is great need for screening pulmonary function testing to promote early diagnosis. The community hospital appears to be the ideal environment in which to make an early diagnosis and initiate measures to attempt to change the natural history of chronic obstructive lung disease.


Correlation of intraoperative electroencephalography with neurologic deficit after carotid endarterectomy. In an attempt to prevent morbidity and mortality in carotid endarterectomy, we monitored 47 operations with intraoperative EEG to determine which patients should have a shunt during endarterectomy. The EEG was recorded for up to five minutes during test carotid cross-clamping. When EEG asymmetry between the cerebral hemispheres occurred, the clamp was immediately removed. A shunt was used in all patients who had EEG asymmetry. In the absence of EEG asymmetry, no shunt was used. Of the 38 patients with no EEG asymmetry intraoperatively, one patient had transient deficits postoperatively. Electroencephalographic asymmetry occurred in nine patients during test carotid cross-clamping. Postoperatively, five of these shunted patients awakened neurologically intact and four patients had transient deficit. When the EEG was normal and no shunt was used, patients did well; when the EEG was abnormal and a shunt was used, there was a high incidence of transient neurologic deficit.


A new problem in adolescent gynecology.

A new problem in adolescent gynecology. As more abortions are being done in teen-age girls than ever before, an unusually large number of complications are being seen by some private practitioners. Because many of these adolescent patients in whom complications develop do not return to the physicians who did the abortion, accurate data on the incidence of abortion complications are difficult to obtain. It is only reasonable that the teen-ager be given all the facts available on the significant complications of abortion and its possible effects on future childbearing.


Diagnostic exploratory celiotomy: an outdated concept in blunt abdominal trauma. Diagnostic exploratory celiotomy as the primary procedure in the trauma patient is rarely indicated since the validation of peritoneal lavage as a diagnostic technic. The accuracy of diagnostic peritoneal lavage is clearly superior to that of initial or repetitive clinical evaluation of trauma patients, and its cost is miniscule compared with unnecessary diagnostic celiotomy.


Umbilical anomalies.

Umbilical anomalies. During intrauterine development the primordia of the developing gastrointestinal and urinary tract come into close proximity in the umbilicus where the communication of these structures with the external environment is usually obliterated. In a small percentage of patients the omphalomesenteric duct and/or urachus may remain completely or partially patent. When complete patency is present, drainage of mucus, stool, or urine may occur. Partial patency may be manifest by an abdominal mass or by no symptoms at all. Definitive treatment includes total excision of the omphalomesenteric duct and/or urachus, lest recanalization of remnant tissue or carcinoma in later life occur.


Paramedical programs in rural Bangladesh. Two programs using locally trained paramedical personnel provide health care to villagers in Bangladesh. The general level of care rendered appears to be above average for the country, but varies with the individual paramedical worker. Field supervision is crucial to quality of care. The structure of the two programs places physicians in direct contact with the paramedical workers for supervision and consultation. Unlike most programs in less developed countries, these emphasize preventive care, prepaid insurance at minimal premiums (in one plan, premiums are payable by barter), and apparently high motivation of the staff, many showing personal concern as well as evidence of sound training.


Echocardiographic swinging heart motion in loculated anterior pericardial effusion. A patient in chronic renal failure presented with cardiomegaly. Echocardiography and cardiac scan demonstrated loculated anterior pericardial effusion. Another unusual echocardiographic feature was the presence of swinging heart motion, usually seen only with large nonlocalized pericardial effusion. When dialysis led to substantial regression of cardiac size, the echocardiographic abnormalities disappeared.


Lung cancer in shipbuilding and related industries in Louisiana. The relationship between shipbuilding and related industries and risk of fatal lung cancer (1960-1975) is described for selected Louisiana parishes. Deaths from lung cancer were matched to deaths not caused by cancer. Shipbuilders had a significantly increased risk (greater than twofold) of dying of lung cancer as compared with other causes. The risk of dying of lung cancer in related occupations (seamen and longshoremen) was also increased. Information on laterality of lung cancer was not supportive of particulate substances contributing to causality due to the large number of unspecified cases. The preponderance of deaths appears to be occurring in men with a greater number of years of exposure to this industry and in those aged 20 to 34 years in 1940. These common occupations in Louisiana could contribute to the high rate of lung cancer.


Anesthetic management of neck trauma.

Anesthetic management of neck trauma. In a retrospective review of one year's experience in the management of neck trauma, 88 cases comprising 42 gunshot wounds, 29 stab or slash injuries, and 17 injuries by blunt trauma were reviewed. Multiple injuries were noted in all groups, but a higher percentage was found in the blunt trauma series. Anesthetic management is reviewed, and emphasis is placed on careful evaluation of the patient's airway, using physical and roentgenographic examination to plan adequate airway management.


Laryngeal papillomatosis: anesthetic management. We reviewed the anesthetic management of all children admitted with laryngeal papillomatosis during a six-year period. This included 147 endoscopies on 16 patients, most referred with advanced disease after initial care in other hospitals. Onset of the disease before age 2 was associated with the most severe upper airway involvement. Eight patients required tracheostomy at some time during treatment, and management of the shared airway during surgical manipulation was particularly difficult in these children. Inhalational induction with halothane was used rountinely, with surprisingly few instances of laryngospasm or upper airway obstruction. Topical lidocaine spray and orotracheal intubation were preferred; insufflation technics were frequently abandoned when attempted. Extubation under deep anesthesia after clearing the glottis of secretions was usually followed by smooth emergence and minimal airway difficulties. There was only one instance of postoperative stridor suggesting croup. A standard anesthetic approach can be recommended, on the basis of the experience in this series, but possible variations in technic are also discussed for particular clinical applications.


Adverse effects of pancuronium in patients with hemorrhagic shock. Thirty-five patients with hemorrhagic shock had surgical repair of trauma to the great vessels using a ketamine-pancuronium-nitrous oxide sequence for anesthesia. The data of the cardiovascular and respiratory changes occurring during anesthesia and the operation were tabulated and subjected to multifactorial computer analysis. Fifteen patients died during or after operation because the injury was beyond repair. Twenty survived the oepration. Profound hypotension associated with mild tachycardia occurred with surprising regularity each time incremental doses of pancuronium were administered in nearly all patients. This hypotension was not associated with the administration of any other drug or with any other parameter and strongly implicates pancuronium as the causative factor. Pancuronium should be used cautiously and administered in small increments to this type of patient if it is used as a muscle relaxant.


Auriculotemporal syndrome after combined modality therapy for cancer. Auriculotemporal syndrome frequently follows trauma to the auriculotemporal nerve, a branch of the mandibular nerve. Classic symptoms are gustatory sweating and hyperemia, with pain occurring in less than 10% of cases. We have treated six patients for a variant of auriculotemporal syndrome following combined modality therapy for head and neck cancers. Unique was the presence of pain and the absence of gustatory sweating in all cases. The combination of radical surgery, chemotherapy, and irradiation obscured the "textbook" presentation, leading to initial misdiagnosis. Long-term relief (one year) from this atypical presentation of auriculotemporal syndrome was afforded by a simple mandibular nerve block, a technic that is of no sustained therapeutic benefit in the classic cases.


Sputum cytology in the diagnosis and treatment of lung cancer. To evaluate the contribution of sputum cytology to the diagnosis and treatment of lung cancer, 918 cases of lung cancer were reviewed. Of 105 patients with positive sputum cytology, 93 had other invasive procedures to establish the cell type or stage or to attempt to cure the disease. In 12 patients the presence of positive sputum prevented further invasive evaluation. Thus, the real benefit of sputum cytology was reduced to 12 patients, or little over 1% of the total number of lung cancer patients. It is concluded that sputum cytology is not an effective diagnostic approach to suspected lung cancer. It rarely precluded invasive proceudres because it failed to contribute to the staging of the disease. Therefore, it should be used in only those patients in whom the yield of positive sputum would direct therapy other than surgery.


Histoplasmosis: clinical manifestations and surgical management. In this retrospective study of 115 cases of histoplasmids, there were 66 male and 49 female patients ranging in age from 2 months to 79 years. The most common presenting symptoms were cough, chest pain, wheezing, weight loss, hemoptysis, and shortness of breath. Thirty-five patients (30%) were asymptomatic. Two patients had manifestations of obstruction of the superior vena cava. Radiologic findings simulated carcinoma, tuberculosis, pneumonia, and viral infections. Sixty-five patients had various operative proceudres, such as lung biopsy, wedge resection, lobectomy, pneumonectomy, resection of lymph node, and bypass of superior vena cava, for diagnosis and treatment. There were two deaths and two postoperative complications. A total of 15 patients received intravenous amphotericin B. Four patients with pneumonic infiltrates developed disseminated histoplasmosis.


Cutaneous horns: a histopathologic study. We report a series of 230 cutaneous horns, of which fewer than one fourth were frankly malignant. Actinic keratoses were the lesions most commonly found underlying cutaneous horns (37.39%). Cutaneous horns overlying a benign lichenoid keratosis, epidermolytic hyperkeratosis, trichilemmoma, an epidermal inclusion cyst, and a benign fibroma are reported. Three cases were nondiagnosable because of inadequate biopsies that were too superficial to show the base of the lesion.


Diagnosis and treatment of nonorganic pelvic pain. Pelvic pain was a prominent complaint among one third of 3,000 gynecology clinic patients. In 1.1% no causative disease could be found, and these patients failed to respond to routine therapy. Twenty of these patients who were studied minutely revealed some psychologic disorder including hysteria, passive-aggressive behavior, sociopathy, depression, and alcoholism. A strong tendency toward psychophysiologic disturbances in other systems was practically universal. Supportive psychotherapy, progressive relaxation training, and insight therapy were used. The greatest barrier to treatment success was refusal of patients to accept the psychologic factors in their total illness.


Lymphocyte toxicity in retinoblastoma.

Lymphocyte toxicity in retinoblastoma. Cytotoxicity can be used in the determination of patients with retinoblastoma. With further refinement, this type of test may become useful in aiding the physician in the detection of retinoblastoma.


Phylogeny and the herniated disc.

Phylogeny and the herniated disc. Using a phylogenic classification of the spine, one can identify precisely the numerical location of any vertebra or disc, including vertebrae with junctional anomalies at transitional zones. Such precision permitted comparisons of myelographic reports of sites of disc disease with the actual levels of extradural deformities and of charted levels of disc operations with the actual levels of disc curettements. Among 100 patients there were 33 with phylogenic or junctional departures from the human mode. Among these 33 there was a combined total of 18 identification errors, and there were four entries at incorrect levels. Preoperative landmarking would appear to be obligatory.


Screening for colorectal cancer.

Screening for colorectal cancer. A voluntary colorectal screening program was carried out in North Carolina to evaluate the public's willingness to perform a do-it-yourself bowel test, to educate the public on the importance of routine colorectal screening, and to assess the efficacy of a small-scale screening program in detecting colorectal cancer. A screening kit was requested by 1,204 individuals after hearing or reading about the program; 770 kits were returned. Of 29 (3.7%) positive test results, six were negative after retesting. Adequate follow-up was available for 18 of the remaining 23 positive results. Thirteen were due to anal bleeding, diverticulosis, or heavy ingestion of aspirin; five were considered false-positive results, since no evidence of disease could be found. No cases of polypoid tumors or carcinoma were detected. The main value of such a program in an area with a small population base is to increase the awareness of the public of the importance of routine screening for colorectal cancer.


Situs inversus and appendicitis.

Situs inversus and appendicitis. Two cases of left lower quadrant appendicitis associated with situs inversus totalis are presented. Historic, genetic, and embryologic aspects of situs inversus, as well as recent theories regarding etiology are discussed. The clinical recognition of appendicitis in situs inversus is often difficult because of the unusual location of the appendix and abnormal pain localization. The differentiation of situs inversus totalis and abnormal rotation of the abdominal viscera (situs indeterminus) is important surgically because fixation of the midgut loop may be indicated in patients with situs indeterminus.


Agenesis of the gallbladder and congenital lumbar hernia. We describe a case of congenital absence of the gallbladder and cystic duct, associated with a congenital lumbar hernia, and review the literature. Special emphasis is placed on the pathogenesis of common bile duct involvement and its effects. Treatment is aimed at correcting these primary defects and their complications.


(15S)-15 methyl prostaglandin F2 alpha levels in amniotic fluid and blood in second trimester abortions. A single intra-amniotic injection of (15S)-15 methyl prostaglandin F2 alpha (THAM) was used to induce second trimester abortion in five patients. Serial levels of (15S)-15 methyl prostaglandin F2 alpha were subsequently measured in amniotic fluid and plasma by radioimmunoassay. The slow removal of this drug from the amniotic fluid was documented. Plasma levels of (15S)-15 methyl prostaglandin F2 alpha increased fourfold to sevenfold after clinical rupture of the membranes in three patients, supporting the fact that prostaglandins are well absorbed from the vagina. Because this analogue of prostaglandin can cause marked peripheral bronchoconstriction when administered systemically, it is best to avoid its use in patients with a history of asthma.


Relationship between spray adhesives and congenital malformations. Evidence from clinical impressions and laboratory slides that spray adhesive products could have a potentially dangerous mutagenic or teratogenic effect was first reported in 1973. However, similar laboratory slides observed by others revealed no significant difference between chromosomal slides of malformed infants and those of normal children in households whose members were exposed to spray adhesives. Because of opposing opinions, a pilot epidemiologic study was initiated to investigate the association between the use of spray adhesives and congenital malformations. All congenital malformations reported on birth certificates from 1971 through 1974 in Oklahoma County, Oklahoma were used. A normal birth was selected as a matching control for each case. Complete and usable questionnaires regarding 112 malformed subjects and 116 controls, including 56 matched controls, were received. There was a statistical association between malformed subjects and household members using spray adhesives. There appears to be sufficient epidemiologic evidence to reopen the controversy with the appeal for further studies.


Keep warm stools cold: on the status of parasitology. Although the prevalence of parasites has decreased in some areas, no parasite has been eliminated, and the current literature indicates that parasitic diseases continue as a major cause of morbidity. In addition to endemic forms, imported parasitic diseases are being seen more frequently because of increased world travel and immigration. The high infection rates of intestinal helminths and protozoa being found in this country suggest the public is at risk of acquiring a parasitic disease. This report reviews the status of medical parasitology relative to laboratory methods and parasites prevalent in the United States.


Presumed respiratory syncytial virus pneumonia in an adolescent compromised host. A 15-year-old boy with nephrotic syndrome, renal insufficiency, and cutaneous anergy had severe pneumonia with pleural effusion. There was serologic evidence of respiratory syncytial virus infection, and extensive microbiologic, histologic, and serologic studies failed to identify any other etiologic agent. Respiratory syncytial virus as a possible cause of severe pneumonia in immunocompromised hosts has not been previously reported.


Severe hypernatremia caused by age, isolation, and obstructive uropathy. Although this is an extremely interesting case report from a medical viewpoint, inasmuch as it presents an unusual cause of hypernatremia, it is probably even more important because of its sociologic implications. The basic underlying causes are common in the aged, and as the number of senior and ultimately senior senior citizens increases, a repetition of the events enumerated here can be predicted in increasing numbers of patients.


Acute intermittent porphyria associated with inappropriate antidiuretic hormone secretion, hypokalemic alkalosis, and secondary hyperaldosteronism. A case of acute intermittent porphyria associated with inappropriate antidiuretic hormone secretion and secondary aldosteronism is presented. Hypokalemic alkalosis was a prominent feature of this case, and appeared to be at least partly caused by secondary aldosteronism.


Squamous papilloma of the esophagus.

Squamous papilloma of the esophagus. We have described two cases of squamous papilloma of the esophagus, one of which is an unusual case of probable malignant transformation of a benign squamous papilloma to a low-grade verrucous carcinoma.


Congenital pulmonary lymphangiectasis.

Congenital pulmonary lymphangiectasis. We have described an unusual case of congenital pulmonary lymphangiectasis which does not conform to Felman's classification. We suggest establishing a third category in the group with non-cardiac-associated CPL, entitled "noncardiac, intermediate onset."


Infantile Gaucher's disease.

Infantile Gaucher's disease. This case report calls attention to the fact that infantile Gaucher's disease can occur in black infants. The infant's age, neurologic manifestations, and pathologic findings support the diagnosis.


Right-sided posttraumatic diaphragmatic hernia presenting as a coin lesion. An unusual case of right-sided posttraumatic diaphragmatic hernia is described. Ten years after closed chest trauma a 51-year-old man presented with a coin lesion at the right lung base. Thoracotomy revealed a rounded ball of liver tissue protruding through a diaphragmatic tear.


Exacerbation of angina pectoris by prazosin. A case of angina pectoris worsened by prazosin is presented. Since a hypertensive population includes many patients with known or occult coronary artery disease, physicians should use prazosin cautiously in this subgroup, particularly when beta-adrenergic antagonists cannot be used concurrently.


Endocarditis caused by Actinobacillus actinomycetemcomitans. A case of endocarditis caused by Actinobacillus actinomycetemcomitans is described and 18 cases are reviewed. Clinical features of endocarditis caused by A actinomycetemcomitans and antibiotic susceptibility are reviewed. Because of the relative resistance of A actinomycetemcomitans to penicillin and ampicillin, high doses of either penicillin or ampicillin should be combined with streptomycin or gentamicin for four to six weeks.


Treatment of chorea gravidarum with haloperidol. Treatment of a case of severe chorea gravidarum with haloperidol is presented. A possible neuropharmacologic explanation of the beneficial effects of the neuroleptics, particularly haloperidol, is offered based on the dopamine antagonism of these drugs. Heightened dopaminergic activity in the striatum is postulated as the basis for the chorea. Indications for the use of haloperidol in chorea gravidarum are discussed.


Giant cell arteritis in a black patient. Giant cell arteritis has been thought to occur only in white patients. There have been several recent reports of this disorder to blacks, however, and this case of biopsy-proven giant cell arteritis in a black patient indicates the diagnosis should be considered in any elderly patient with typical symptoms regardless of race.


Subcutaneous inflammation (infection?) after synovial rupture: a complication of a complication. Six weeks after presumptive acute synovial rupture at the knee, a patient was admitted with cutaneous induration over the medial calf. Roentgenograms showed gas shadows within the involved area. A fluctuant area at the center of the indurated mass yielded a Corynebacterium species.


Anterior reduction of interlocking facets in the lower cervical spine. Twelve patients with locked facets of the lower cervical spine were surgically treated through an anterior approach. The interlocking was bilateral in 2 cases and unilateral in 10; in all patients, skull traction failed to obtain the reduction. The technique of anterior reduction is described, with particular attention to the importance of complete removal of the disc before insertion of the distractor. Reduction was easily and safely achieved in all cases, and no significant complication occurred.


Cervical spondylolisthesis.

Cervical spondylolisthesis. Cervical spondylolisthesis is a rare, unusual finding in patients with neck pain. Cervical pain without neurological deficit is most often seen with this abnormality. It usually involves a defect in the pedicle of the sixth cervical vertebra. Anterior interbody cervical fusion is recommended as the treatment of choice.


Halo-thoracic brace management of odontoid fractures. Thirteen patients with fracture of the odontoid were treated with halo-thoracic brace. Major trauma was responsible for the fracture in only 5. Neither the degree nor the direction of displacement prevented union, which occurred in all 13. All patients were treated for least 60 days; 11 were treated longer. No complications occurred. The method is recommended based on the results.


Transoral cervical corpectomy with the aid of the microscope. The transoral transpharyngeal approach to the upper cervical spine is useful in symptomatic cases of chronic atlantoaxial dislocation not reducible by other means. Spontaneous healing and fusion in such patients results in an anterior deformity or gibbus which indents the ventral surface of the spinal cord. This lesion is best approached anteriorly, with the neck in a neutral or extended position. Previously reported complications of the transoral operation, especially vertebral artery laceration, can be avoided through used of the microscope. The technique is described and 2 cases are presented. Spinal stability was not disrupted in either, and cord decompression was accomplished.


Intracranial aneurysm and hemorrhage following skull caliper traction. Review of skull traction complications. Serious complications of caliper skull traction for fracture-dislocations of the cervical spine are so rare that they are not discussed in most standard textbooks. A fusiform intracranial aneurysm which followed the placement of skull tongs is reported. Subsequent aneurysmal rupture produced an intracerbral hematoma requiring drainage. The literature recording the complications of skull caliper traction is reviewed and the indications for skull traction and the need for scrupulous surgical technique are emphasized.


Paget's disease. Reversal of severe paraparesis using calcitonin. Relatively short-term treatment of paraparesis due to Paget's disease with subcutaneous salmon calcitonin alone produced dramatic relief of sensory loss, pain, and paraparesis. The successful outcomes in 2 patients, one with spinal cord and one with cauda equina compression, indicate a potential alternative to surgery in reversing mild-to-severe neural dysfunction in Pagets disease. The proposed mechanisms of action of calcitonin include reduction of a direct bony impingement on the neural tissue and/or a decrease of neural ischemia. It is suggested that even if paraparesis does not improve with calcitonin alone, the medication given preoperatively would probably serve a useful adjunctive role by decreasing intraoperative bone bleeding. However, those patients whose pagetic bone is already metabolically inactive would probably not benefit from calcitonin therapy.


Experimentally induced hypermobility in the lumbar spine. A pathologic and radiologic study of the posterior ligament and annulus fibrosus. Experimental destructive lesions were produced at autopsy in the lumbar discs of nine spines including 29 radiologically normal adult lumbar intervertebral discs. Limited transverse surgical division of the posterior longitudinal ligament and adjacent annular fibers were performed followed by, in addition, the removal of the intervertebral nucleus pulposus. Without interfering with any other major structure, radiologic evidence of hypermobility was recorded in 20 of 29 normal intervertebral segments. The patterns of movement were measured by standardized radiologic criteria. The available evidence suggests that localized damage to the region of the posterior longitudinal ligament and adjacent annulus fibrosus can produce radiologic patterns of hypermobility.