A study of the effect of vinca alkaloid 'vinblastine' on gastrointestinal motility in rats. Vinblastine an alkaloid of the periwinkleplant (Vinca), produced marked alterations in the motility of gastrointestinal tract in rats. The alkaloid reduced the rate of gastric emptying and slowed the transit of test substance through the small intestine. The effect of the drug on gastric emptying appeared to be dose-dependent. The latency of drug action on gut motility was found to be 5--10 min, when injected through the jugular vein.


Chromatographic fractionation and characterization of the active platelet aggregation inhibitory factor from bromelain. Isolation and characterization of the platelet aggregation inhibitory factor of bromelain have been presented in this study. Commercial bromelain consists of 3 major components as demonstrated by discontinuous sodium chloride gradient chromatography through carbixymethyl-sephadex column. Fraction I constituted approximately 19% of the total fraction. This fraction had no proteolytic activity or platelet aggregation inhibiting activity, but showed peroxidatic activity. Fraction II and III, which constituted the remainder of the fraction eluted with 135 mM and 800 mM NaCl concentrations, respectively, showed both proteolytic and inhibition of platelet aggregation, but no peroxidatic activity. Immunoelectrophoresis and polyacrylamide electrophoresis showed fraction I with beta-mobility while fraction II and III demonstrated gamma-mobility. It is suggested that the proteolytic activity is associated with the inhibition of platelet aggregation, since oxidation of fractions II and III with sodium tetrathionate abolished both activities. The mechanism of inhibition of platelet aggregation by bromelain is presently unknown but may involve its influence on the prostaglandin synthetic pathway of platelets.


Serum electrolyte and acid base composition. The influence of graded degrees of chronic renal failure. Data from 41 ambulatory patients with graded degrees of uncomplicated, chronic renal failure were used to define the quantitative relationship between serum acid-base and electrolyte composition and the serum creatinine level. Even in patients with only moderate renal insufficiency, serum total carbon dioxide (tCO2) content was reduced significantly. This early fall in tCO2 was offset by an increase in serum chloride (Cl-), serum undetermined anton concentration (A-) remaining normal. In patients with more severe degrees of renal insufficiency, further decrements in tCO2 occurred that were proportional to the increment in serum creatinine. These latter decrements in tCO2 were associated with equivalent increments in A-, serum Cl- remaining unchanged at the elevated level observed during moderate renal insufficiency. Confidence limits of 95% for tCO2 and A- were calculated from the data.


Leukopenia and hypoxemia. Unrelated effects of hemodialysis. Hemodialysis-induced hypoxemia has been attributed to membrane-related complement activation leading to pulmonary leukostasis and to hypoventilation secondary to carbon dioxide losses via the dialyzer. We have separately assessed the role of membrane- and dialysis-related factors by using different dialyzers and sequential ultrafiltration and hemodialysis with first-use cellulose dialyzers produced both leukopenia and hypoxemia. With reused cellulose and polyacrylonitrile dialyzers, hypoxemia still occurred, but without leukopenia. Ultrafiltration produced leukopenia and no changes in Pao2; during the subsequent hemodialysis, hypoxemia developed as the leukocyte count increased by 50%. Our data indicate that leukopenia and hypoxemia are unrelated effects of hemodialysis, and favor hypoventilation as the major determinant of hypoxemia during hemodialysis.


Analysis of clinical susceptibility bias in case-control studies. Analysis as illustrated by the menopausal syndrome and the risk of endometrial cancer. Epidemiologic studies of causes of disease rarely contain adjustments for inequalities in diseases susceptibility caused by baseline differences in clinical phenomena. In the controversial association between estrogens and endometrial cancer, the menopausal syndrome was suspected as an independent risk factor for the development of endometrial cancer, irrespective of estrogen use. To investigate this suspicion, personal interview data from a case-control investigation were collected and analyzed. The odds ratio for the association between menopausal symptoms and endometrial cancer was 1.12 and 0.85 for two different sets of cases and controls assembled at the same institution. When the data were partitioned according to estrogen usage, the odds ratios became consistently less than one. The results suggest that the menopausal syndrome is not a risk factor for endometrial cancer.


Serum thyroid hormone levels in patients with liver disease. Levels of serum triiodothyronine (T3), reverse triiodothyronine (rT3), and thyroxine (T4) were determined in 29 patients with alcoholic cirrhosis, seven patients with acute hepatitis, and 14 control patients hospitalized for chronic disease. Serum T3 levels were decreased significantly and serum rT3 levels increased significantly in the patients with alcoholic cirrhosis. Serum T3 and T4 levels were lower and rT3 levels higher in the cirrhotic patients who died within three months of the study compared with those who survived. A combination of prothrombin time, aminopyrine breath test results, and rT3 and T3 determinations gave significant predictive information about survival in patients with cirrhosis. The data suggest that assay of serum thyroid hormone levels together with prothrombin time and the aminopyrine breath test may be helpful in assessing the course and prognosis of patients with liver disease.


Infectious arthritis.

Infectious arthritis. One hundred thirteen patients with 120 episodes of septic arthritis were seen during a 14-year period. The most common bacteria cultured from joint fluid or blood during the acute episodes were gonococci, staphylococci, and streptococci. Seventeen other bacteria were the infecting organisms in one or more cases each. Other infections and medical conditions frequently were present. In some instances the septic arthritis was a complication of another infection. In other patients septic arthritis appeared to occur because of diminished resistance to infection. The majority of patients responded well to medical treatment, but eight died and 26 had persistence of articular pain at follow-up examination.


Solid tumors complicating Hodgkin's disease. A report on two patients with immunoglobulin deficiency. Multiple epithelial malignant neoplasms developed in two patients with Hodgkin's disease subsequent to radiotherapy and intensive chemotherapy. At the time of diagnosis, each patient also demonstrated a serum immunoglobulin deficiency. The significance of the occurrence of solid tumors in patients following therapy for Hodgkin's disease and the significance of cellular and humoral immunodeficiency in Hodgkin's disease in relation to second cancer development were studied. We suggest the establishment of a registry of leukemias and solid tumors developing in patients treated for Hodgkin's disease and other malignant neoplasms, possibly with detailed recording of immunocompetence data.


Retinal arteriolar changes as an indicator of coronary artery disease. Funduscopic examination was performed in 70 non diabetic, nonhypertensive patients without valvular heart disease undergoing coronary angiography for evaluation of chest pain syndromes to determine if retinal arteriolar changes could reliably predict presence of coronary artery disease. Retinal arteriolar changes were graded with respect to light reflex, vessel caliber, arteriovenous crossing defects, and vessel tortuosity without knowledge of angiographic findings. Each coronary vessel was graded with respect to its most occlusive lesion by angiography; coronary index was derived for each patient without knowledge of eye findings. Abnormal light reflex changes were the most sensitive indicators of presence and extent of coronary artery disease. Abnormal vessel tortuosity and decreased caliber were less sensitive but more specific; their presence also suggested more extensive coronary lesions. Thus, funduscopic examination demonstrating specific retinal arteriolar lesions may indicate presence of coronary artery disease and may correlate with extent of lesions in selected patients.


Therapy of primary amyloidosis with melphalan and prednisone. Two patients with progressive primary amyloidosis, monoclonal serum and urinary proteins, multiple organ involvement, and nephrotic syndrome were treated with melphalan and prednisone for one year. In one patient, splenomegaly and nephrotic syndrome rapidly responded to therapy but massive hepatomegaly responded slowly, requiring 15 months' time for normalization of size. Results of liver function tests, although improved, remained abnormal, and amyloid deposits remained in the marrow. A second patient also demonstrated dramatic diminution in proteinuria and improvement in liver function abnormalities, but macroglossia persisted. These observations suggest that amyloid organ involvement may be reversible with differences in organ responsiveness to chemotherapy. An empirical trial of chemotherapy may be indicated in some patients with progressive primary amyloidosis, and therapy may need to be continued for a prolonged period of time before seeing an effect.


Altered control of growth hormone secretion in patients with cirrhosis of the liver. Ten male patients with cirrhosis of the liver (three with portacaval anastomosis [PCA]) and eight sex- and age-matched controls underwent an arginine infusion test followed by an intravenous glucose tolerance test. Plasma glucose and growth hormone (GH) levels were measured during a period of three hours. In the normal subjects, the peak GH response to arginine occurred 60 minutes after the start of the infusion and was followed by a progressive decline in GH concentration; dextrose injection resulted in a further rapid fall in GH concentration. In cirrhotic patients, both fasting and postarginine GH concentrations were significantly higher than in controls; in addition, the dextrose injection, after causing a transitory drop in plasma GH levels, resulted in a marked increase in plasma GH concentration. In the patients with PCA, the plasma GH increase after arginine and after dextrous was more marked. In these cirrhotic patients, the plasma GH levels correlated directly with the magnitude of the portal hypertension and inversely with the serum albumin concentration, suggesting that the abnormality of GH secretion was a reflection of the derangement in liver function.


Cardiac findings in Charcot-Marie-Tooth disease. A prospective study of 68 patients. Charcot-Marie-Tooth disease (peroneal muscular atrophy) has been reported to cause cardiac arrthymias and conduction disturbances in association with peripheral muscle atrophy. To establish more accurately the frequency of such cardiac disorders in this disease, 68 patients with Charcot-Marie-Tooth disease were evaluated prospectively for evidence of cardiac involvement. Cardiac findings were limited to five patients with conduction defects, two patients with supraventricular tachycardia, two patients with ischemic heart disease, and 20 with mitral valve prolapse. The frequency of each of the abnormal cardiac findings, with the possibly emalities in the population at large. The low incidence of cardiac involvement in patients with Charcot-Marie-Tooth disease may be helpful in distinguishing this disorder from Friedreich's ataxia, an entity that may mimic Charcot-Marie-Tooth disease but that is frequently associated with heart disease.


Development of a research program in a community teaching hospital. Affiliation between community hospitals and university centers has become a prominent trend. St Mary's Hospital, a 298-bed community hospital, affiliated with the University of Rochester, School of Medicine and Dentistry, and in five years developed an academic program. The strategies we utilized included the following: (1) definition of the number of specialists needed for the hospital's patient population; (2) development of specific subspecialty units with more than one member with the primary intent of fostering an investigative program; (3) analysis of total projected faculty salary and laboratory renovation and equipment costs to allow staged development of the program; (4) design of a flexible research areas; and (5) joint use of equipment and space with the Clinical Laboratory Service. The program was financed through third-party reimbursement, faculty-generated Department of Medicine funds, gifts by private patrons, and extramural grants. At a time of diminishing investigative support, a medium-sized community hospital can develop a research program.


Infected left atrial myxoma with bacteremia simulating infective endocarditis. A 58-year-old man had intermittent fever of eight months' duration following a dental extraction. There were no abnormal cardiac auscultatory findings. Multiple blood cultures yielded Streptococcus mutans. Treatment for infective endocarditis was initiated; however, an echocardiogram suggested the presence of a left atrial myxoma. The diagnosis was confirmed by angiography and the infected tumor was removed successfully. Differentiating features between left atrial myxoma and mitral valve endocarditis may not be obvious clinically, and bacteremia does not preclude atrial myxoma as a diagnostic possibility. We therefore suggest that all cases of infective endocarditis be evaluated by echocardiography to elucidate lesions such as large vegetations or left atrial myxoma, both of which may require urgent operative intervention.


Pseudothrombophlebitis syndrome in the arthropathy of granulomatous colitis. A case of pseudothrombophlebitis syndrome occurred in a young man with colitic arthropathy who was seen because of a swollen leg. The salient features of this syndrome, the difficulty in differentiating it clinically from true deep venous thrombosis, and the importance of correct diagnosis are stressed, particularly in light of the fact that patients with inflammatory bowel disease are predisposed to occlusive venous disease.


The echocardiogram in scleroderma endocarditis of the mitral valve. Echocardiography was performed in a woman with long-standing scleroderma with the CRST syndrome in whom the murmur of mitral regurgitation had been present for one year. The echocardiogram showed an irregular shaggy thickening of the anterior mitral valve leaflet. At autopsy three months later, myocardial fibrosis, small coronary artery sclerosis, and nodular thickening of the mitral valve were found. To our knowledge, anterior mitral leaflet thickening in scleroderma has not been reported previously. In this patient, it was associated with a poor prognosis.


Agranulocytosis associated with aprindine therapy. Aprindine hydrochloride is an antiarrhythmic drug now under investigation. The drug is most effective in prophylaxis of ventricular dysrhythmias. Previously recognized toxic effects include neurological side effects, nausea, vomiting, as well as a reported association with agranulocytosis. To our knowledge, this is the first report of agranulocytosis associated with documented elevated serum concentrations of aprindine. Further correlation of drug levels with toxic reactions may help in establishing the mechanism of bone marrow suppression.


Hematogenous vertebral osteomyelitis. Pasteurella multocida as the causative agent. Human disease caused by Pasteurella multocida is well documented, and a wide variety of clinical syndromes have been described. We describe herein a patient with vertebral osteomyelitis, discitis, and paravertebral abscess caused by P multocida, a presentation that has not been described previously, to our knowledge.


Membranous nephropathy with epithelial crescents in a patient with pulmonary sarcoidosis. Renal failure in patients with pulmonary or extrapulmonary sarcoidosis has been attributed to interstitial disease. Reports of cases of primary glomerular abnormality with renal failure in patients with sarcoidosis are rare. We describe a patient with pulmonary sarcoidosis and renal failure due to membranous nephropathy with epithelial crescents. A review of primary glomerular involvement in patients with sarcoidosis and the association of immune complexes in the pathogenesis of the two diseases is discussed.


Hypouricemia and malignant neoplasms. A new case of xanthinuria. An 80-year-old man with squamous cell carcinoma of the parotid gland was noted to have persistent severe hypouricemia with serum uric acid values of 0.5 to 1.0 mg/dL. Urinary excretion of uric acid was very low and a diagnosis of xanthinuria was made.


Idiopathic hypothalamic hypogonadotropic hypogonadism with polyostotic fibrous dysplasia. A 22-year-old woman had polyostotic fibrous dysplasia (POFD) and idiopathic hypothalamic hypogonadotropic hypogonadism (isolated gonadotropin deficiency). Recurrent fracture of dysplastic bone during childhood was associated with primary amenorrhea, clinical and laboratory evidence of estrogen deficiency, and subnormal circulating and urinary gonadotropin levels during adolescence. Gonadorelin (luteinizing hormone-releasing hormone) stimulation initially showed a luteinizing hormone (LH) response but absent follicle-stimulating hormone (FSH) response. After three months without estrogen and progesterone and after four days of gonadorelin "priming," a subsequent gonadorelin infusion produced an enhanced LH and FSH response. All other tests of peripheral and trophic hormone levels and pituitary trophic hormone reserves were normal. Whereas POFD is known to occur with sexual precocity and other endocrinopathies, to our knowledge this is the first report of its association with isolated gonadotropin deficiency.


Runaway pacemaker. Unpredictable pacemaker failure. The runaway pacemaker is an uncommon but very serious complication of permanent artificial pacemakers. Although the runaway pacemaker has been most frequently encountered in older (fixed rate) pacemakers, this problem has also been reported in various types of newer models manufactured by different companies. The most striking finding in our case is that the pacemaker was reported by a reliable pacemaker follow-up service to be working normally only one week before the development of the malfunction. The extremely rapid pacing rate (750 beats per minute) was a manifestation of a far-advanced runaway pacemaker. The manufacturer believes that this is the first reported incident of a runaway pacemaker in this model. This indicates that the runaway pacemaker is still a potential problem, even in newer pacemakers, and reemphasizes the unpredictable and serious nature of this medical emergency.


Bacterial endocarditis in a patient with mitral valve prolapse. Bacterial endocarditis developed following dental manipulation in a child with mitral valve prolapse. Antibiotic prophylaxis is recommended for patients with this cardiac abnormality who undergo procedures that may be associated with bacteremia.


[Metabolic products of microorganisms. 175. Tetracenomycin C (author's transl)]. Streptomyces glaucescens, strain Tü 49 = ETH 22794, produces hydroxystreptomycin as well as the tetracenomycins, a mixture of several lipophilic antibiotics. The main component and the most active one is tetracenomycin C. Tetracenomycin C has a molecular formula C23H20O11 and is chemically related to tetracyclines and anthracyclinones. The pale yellow antibiotic is active against some gram-positive bacteria, especially against streptomycetes. Gram-negative bacteria and fungi are not inhibited. In considering the differences of biological activity and the functional groups of the molecule, tetracenomycin C is not a member of the tetracycline or anthracyclinone group of antibiotics.


[Mucolipidosis II (I cell disease): a sialidosis?]. I cell disease is characterised by loss of lysosomal enzymes from fibroblasts with accumulation of the same enzymes in the surrounding fluid. The urine oligosaccharides are composed by sialyl-oligosaccharides with equal numbers of alpha (2--6) and alpha (2--3) neuraminic acid -beta-galactoside bonds. A defect in the alpha (2--6) and alpha (2--3) neuraminidase activity in leucocytes and fibroblasts has been demonstrated. This deficit is the primary abnormality in I cell disease and it can be compared to the partial enzyme deficiencies described particularly in Mucolipidosis type I.


[Hepatitis in 2 stages in children].

[Hepatitis in 2 stages in children]. Twenty seven children with relapsing hepatitis have been reviewed. The characteristic clinical course and the excellent prognosis of this form of hepatitis is emphasised. After an apparently ordinary initial episode of hepatitis followed by recovery, a relapse occurs within 1--3 months that is usually more severe clinically and biochemically. The histological appearances are similar to those of acute hepatitis. A delayed but spontaneous recovery occurs. No satisfactory explanation has been proposed for this condition.


[Neonatal hematemesis caused by peptic esophagitis]. Five full term neonates presented with haematemeses on one of the first three days of life. All but one had been given vitamin K at birth. Two out of five had clotting abnormalities that suggested vitamin K deficiency. All had evidence of hiatus hernia and, on oesophagoscopy, had evidence of peptic oesophagitis. Bleeding is another complication of neonatal peptic oesophagitis.


[Familial tubulopathy associating hypercalciuria and saline diabetes. Favorable results of indomethacin therapy]. The association of hypercalciuria, salt losing renal disease, and a defect in urine concentrating ability with high renin and aldosterone levels is described in two brothers. One child had marked nephrocalcinosis by the age of 3 and the other severe growth retardation. In one child all the abnormalities were abolished with indomethacin which was responsible for a marked decrease in urinary. The data and the family study suggest that this condition is a proximal tubular disorder with atuosomal recessive inheritance.


[Unusual sequelae of a cranial injury].

[Unusual sequelae of a cranial injury]. A 13 year old child who had an apparently mild head injury presented with psychiatric sequelae. The main feature was a variable level of consciousness. The only explanation for the symptoms lay within the family environment. A hysterical converion symptom was possible but the start of a psychosis could not be excluded.


[Neonatal renal papillary necrosis].

[Neonatal renal papillary necrosis]. Renal papillary necrosis was detected early by plasma and urine analyses in a neonate with the respiratory distress syndrome. The intravenous urogram demonstrated characteristic features of the condition. Initial symptoms were polyuria, urinary salt loss and haematuria, but the only residual abnormality was a mild defect in urinary concentrating ability.


[Pulmonary aspergillosis and chronic septic granulomatosis]. Two children with chronic granulomatous disease who developed diffuse pulmonary aspergillosis are described. The outcome was satisfactory in one case with miliary disease because the diagnosis was made early by an open lung biopsy. In the other case the diagnosis was delayed and the child died after 7 months with disseminated haematogenous spread of the fungal infection. Although most of the infections of chronic granulomatous disease are bacterial, the abnormalities of phagocyte killing will also predispose to fungal infections. The prolonged survival of affected children because of antibiotic therapy will increase the risk of parasitic and fungal infections.


Biologic heterogeneity and psychiatrict research. Platelet MAO activity as a case study. This article examines current research strategies in biological psychiatry and the possible effects of biological heterogeneity on these strategies. First, the limited power of t test comparisons of measurements obtained from groups of patients and controls is demonstrated through a computer simulation. Second, we examine statistically the data from 14 recent platelet MAO studies to see if the heterogeneity in results of these studies could relate to an underlying biological heterogeneity. Finally, we suggest research methods we believe may be more useful than the current standard paradigm for elucidating the biological etiologies of psychiatric syndromes.


Reliability and descriptive validity of PSE syndromes. Despite extensive research use of the Present State Examination (PSE), the validity of classification based on PSE data has not been studied extensively. We have examined a consecutive series of functional psychiatric admissions using the PSE and systematically gathered clinical and demographic data in order to study not only the reliability but the descriptive (construct) validity of classification based on PSE data. We have found that the PSE can be used in a psychiatric hospital to reliably describe and classify schizophrenic and affective syndromes with considerable descriptive validity in terms of clinical and demographic variables. We believe that this type of validity is an important step in establishing validity of clinical disease entities. The interrelationship among different kinds of validity (descriptive, concurrent, predictive) might provide clinical disease concepts with more definitive validity.


Comparative evaluation of research diagnostic criteria for schizophrenia. Criteria for establishing a diagnosis of schizophrenia have been proposed by several different authors. This study compared six different research diagnostic criteria (RDC) in a series of 166 patients who received a clinical diagnosis of schizophrenia in a multicenter study. The alternative criteria differed in the proportion of clinical diagnoses that were confirmed, with the Washington University (Feighner) criteria accepting only 26%. The criteria also disagreed concerning which particular patients qualified for the diagnosis. The Washington University and New York RDC disagreed 50% of the time, and some other disagreement rates were even higher. More evaluative research is needed before arbitrary criteria are permitted to redefine the concept of schizophrenia.


A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders. I. Agreement with expected diagnosis. This study was conducted to compare DSM-II and DSM-III in the diagnosis of childhood and adolescent psychiatric disorders. Twenty psychiatrist-raters completed standardized diagnostic questionnaires for 24 actual case histories. This report, the first of four, presents the rater agreement with the "expected diagnosis," ie, the diagnosis that we considered most appropriate for each case. The average rater agreement with the expected diagnosis was less than 50%. It was highest in cases of mental retardation, psychosis, hyperactivity, and conduct disorder. In only five cases did the most common diagnosis of the raters differ from the expected diagnosis. Analyses of these cases and those we selected to present specific diagnostic problems to the raters have produced suggestions to improve the reliability of DSM-III.


A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders. II. Interrater agreement. A case-history format was utilized to compare interrater agreement on childhood and adolescent psychiatric disorders, using DSM-II and DSM-III. The average interrater agreement was 57% for DSM-II and 54% for axis I (clinical psychiatric syndrome) of DSM-III. There was high agreement in both systems on cases of psychosis, conduct disorder, hyperactivity, and mental retardation, with DSM-III appearing slightly better. There was noteworthy interrater disagreement in both systems for "anxiety" disorders, complex cases, and in the subtyping of depression. Overall, the reliability of DSM-III appears to be good and is comparable with that of DSM-II and other classification systems of childhood psychiatric disorders.


A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders. III. Multiaxial features. A major feature of DSM-III is its multiaxial format. One purpose of this study was to examine the purported advantages of a multiaxial system as compared to those of a multicategory system, eg., DSM-II. We found that the multiaxial system led to a more complete and reliable diagnosis of complex clinical cases. Concomitant medical disorder and psychosocial stressors were coded with high levels of interrater agreement. We conclude that the multiaxial framework is a major strength of DSM-III.


Development of psychological distress among young adults. Persons with high scores on psychiatric screening scales appear frequently in general medical settings, psychiatric outpatient clinics, and other agencies providing assistance, but there is considerable controversy concerning the appropriate interpretation of high scores on such scales obtained in community epidemiological studies. Data are presented from a 16-year follow-up study of children, first studied in 1961, examining developmental aspects of achieving high scores on such scales. Data come from the children themselves, their mothers, teachers, and school records. The findings are consistent with the hypothesis that such generalized distress reports are in part a learned pattern of illness behavior involving a focus on internal feeling states, careful monitoring of body sensations, and a high level of self-awareness.


Pretraining for group psychotherapy. A cognitive-experiential approach. Pretherapy training for group psychotherapy is conceptualized in terms of learned conditions of preparedness (objectives) and in terms of methods of preparation (procedures). Controlled studies of pretraining for group psychotherapy were reviewed in reference to these two dimensions and their effects. A controlled study of pretraining involving five outpatient therapy groups that used a new cognitive-experiential approach to pretraining was performed. Pretrained groups had significantly higher patient attendance and significantly fewer dropouts than nonpretrained groups.


The psychological treatment of depression. Evidence for the efficacy of psychotherapy alone, in comparison with, and in combination with pharmacotherapy. Seventeen clinical trials are identified that test the efficacy of various psychological treatments (behavioral, cognitive, group, marital, interpersonal) alone, in comparison with, and in combination with pharmacotherapy in homogeneous samples of depressed outpatients. I describe the results of these studies, gaps in the evidence, and suggestions for future research directions.


Cloward's anterior fusion in the treatment of cervical spinal traumatic injury and degeneration. The aim of this study was to evaluate the long-term results of Cloward's anterior interbody fusion of the cervical spine and to identify the factors influencing them. The series consisted of 29 patients operated on in 1968--75. The indication for operation was in 12 cases intensive radicular symptoms, not responding to conservative treatment, in connection with considerable degeneration of the corresponding spinal segment only, and in 17 cases instability of the cervical spine caused by traumatic injury followed by dislocation and radicular or medullary symptoms enhancing in spite of conservative treatment by skull traction or collar. Twenty-five patients (86%) attended follow-up after an average time lapse of 6.5 years from operation. The operative result was evaluated considering objective neurological improvement, subjective improvement, present symptoms and working capacity. The operative result was at least fair in 7/11 in the degeneration group and in 12/14 in the traumatic injury group. All fusions were radiologically successful. Adequate correction of a primary flexion deformity of more than 15 degrees was not achieved. Age over 35 years and motor defect preoperatively proved to be statistically significant prognostic factors for a poor operative result in the traumatic injury group. Preoperative sick-leaves and a duration of preoperative symptoms exceeding six months proved to be prognostic factors for a poor result in the degeneration group. In spite of the relatively good clinical results obtained, this study does not justify any conclusions concerning the value of Cloward's procedure compared to other methods of treatment, since no control material was available.


[Delayed complications after dislocations and fractures in the pelvic region (author's transl)]. In the case of surgically dressed necroses of the hip condyle and coxarthroses a condition was found after fracture of the pelvis or after dislocation of the hip joint in 7.2% of the cases. In 13.2% of the cases a trauma was found anamnestically. It was subdivided into fractures of the acetabulum, fractures of the pelvic girdle, dislocations, and fractures of the pelvic brim on the basis of the system of Judet and Engler as well as Feldkamp. Fractures of the pelvic brim through muscular traction, traction of the ligament, and direct trauma were discussed. The most frequent delayed consequences arising after dislocations of the hip joint and fractures of the acetabulum are: necroses of the head of the femur, coxarthroses, pseudarthroses, and myositis ossificans. The pathogenesis of the delayed injuries resulted from: capsular and vascular lesions, damage to cartilage with fractures in the spongiosa region, incongruence of the surface of the joint, insufficiency of the static structure of the pelvic ring, deposit of calcium salt outside the bone. In some cases the progress of the necrosis could be arrested by means of osteotomy and spongiosa filling. The rate of necrosis increases in proportion to the period between the time of occurrence of the accident and reposition (limit of 6 h). Even though about half the pelvic girdle fractures show good results with conservative treatment, in the case of fractures of the acetabulum a reconstruction as far as possible continuous and without stages is to be aimed at. In many cases the development of a myositis ossificans cannot be prevented.


Measurements of cefuroxime concentration in bone in dogs and man. Measurements of Cefuroxime levels performed in dogs show a decrease against time in well perfused tissue similar to that in serum, while in bradytrophic tissue--such as bone and articular capsule--there is a distinct rise of these values in the time scale assessed. In similar investigations in man the higher levels in bradytrophic tissue are attributable to delayed elimination from the compact and spongy bone as compared to the serum. The effect on osteomyelitis, to be derived from this, is discussed.


Unhooking of GSB total knee during dislocation of the patella. This is a case report of a special and undoubtedly rare complication occurring in a hinge joint with a moving instant center such as the GSB total knee joint. The preoperative situation, the history of the incident and the operative report are being described as well as a radiological follow-up. The mechanism of unhooking of the tibial shaft from its junction with the femoral stem during dislocation of the patella is being reconstructed.


Injuries of the thoracolumbar junction. Clinical and radiological results in 149 patients. In a series of 149 fractures of the thoracolumbar junction (Th12-L1), treated at the Central Hospital of Tampere from 1968 to 1975, 101 patients were seen after an average interval of 5 years. Over half of the fractures were sustained at home or in leisure hours. Over 90% were anterior wedge fractures. One patient died in the hospital of other injuries. The injury caused peraplegia in three cases and other neurological lesions in six. The treatment was conservative except in the patients with paraplegia, who were surgically treated. The patients were mobilized after an average of 15 days. The neurological condition did not deteriorate. Noteworthy changes of the radiological findings occurred during follow-up. The clinical result was considered good in two thirds of the patients, and 91% were able to return to work. The frequency of neurological findings was significant in patients showing radiological deformities. The force responsible for the fracture correlated with the radiological findings and the occurrence of neurological lesions. Narrowing of the vertebral canal and degenerative changes observed on admission had a significant and unfavorable effect on the clinical result.


Fractures of the lumbar spine. Clinical and radiological results in 94 patients. Sixty-six (70 per cent) of 94 patients with fracture of the lumbar spine (L2-L5), treated at the Central Hospital of Tampere in 1968--1975, were seen after an average interval of 5 years and 4 months. The mean age of the patients at the time of injury was 40.4 years. Somewhat less than half the fractures were sustained at home or in leisure hours and one third were due to traffic accidents. Two thirds were anterior wedge fractures. One patient died in the hospital of other injuries sustained in the same accident. Paraplegia was caused in one case, other neurological lesions in six cases. The treatment was mainly conservative and based on the principle of early functional exercises. Surgery was used in 2 cases of fracture-dislocation. The patients were mobilized after an average of 19 days. The mean duration of hospital treatment was 26 days. Seventy-nine per cent were able to return to work after an average of 3.6 months. No noteworthy changes in the neurological state occurred during follow-up. Half the followed-up patients considered the state of their back at least good. Poor end-results were more frequent in patients over 40 years old than in those under 40. Radiological deformities were more often observed in patients showing neurological symptoms. Increased interspinous distance and flexion or compression deformities had an unfavourable effect on the clinical result.


Injuries of the cervical spine. Clinical and radiological results in 119 patients. Seventy-one patients of 119 with injury of the cervical spine were re-examined an average of 5 years and 5 months after the accident. The mean age of the patients was 39 years. There were 91 male and 28 female patients. The majority of injuries (51) were sustained by car drivers and passengers involved in traffic accidents. More than one cervical vertebra was damaged in 36 patients. Neurological lesions were observed in 59 patients; tetraplegia was present in 19 of these. The average duration of hospital treatment was 37 days. Twenty-four patients were treated at the intensive care unit. Skull traction was used in 69 cases for an average of 38 days to bring about reduction and immobilization. Reduction and anterior spondylodesis by Cloward's technique was performed on 13 patients. Of the operated patients, 11 showed root symptoms or incomplete cord lesions. The 19 tetraplegics were all conservatively treated. Fourteen patients died of their cervical spine injuries and 7 remained permanently disabled. Half the patients recovered to a pain-free state and one third became asymptomatic. Of the radiological deformities observed on admission, lowering of the disc space increased during follow-up, and forward sliding, increase in interspinous distance and narrowing of the vertebral canal decreased. The clinical result was poorer if flexion deformity, compression, forward sliding, narrowing of the vertebral canal or lowering of the disc space were observed at the last radiological examination.


A bacteriological evaluation of a programme for preoperative total body-washing with chlorhexidine gluconate performed by patients undergoing orthopaedic surgery. Twenty-eight orthopaedic patients were taught to wash their entire bodies with chlorhexidine gluconate on two consecutive days preoperatively, starting in their homes. The operation field was also washed a third time. A bacteriological evaluation was performed using contact plates. A significant reduction of the skin flora, including Staph. aureus, was registered. No adverse side effects of total body-washing were observed.


[Fracture healing and folic acid (author's transl)]. The reaction of folic acid on fracture healing was tested on the basis of 113 rabbits. In both cases, the only application of folic acid and the combination with amino acids, the results can be regarded positively. This is also true when we consider possible methodic faults.


Treatment of periarticular calcification after total hip arthroplasty. Calcification after total hip arthroplasty resulting in severely impaired function requiring reoperation is rare. This is a report on one patient with wide spread calcification where the patient was treated with Indometacin and the total hip exchanged.


Excisional biopsy for bone tumours.

Excisional biopsy for bone tumours. Compartmental muscular resections without open biopsy is a common procedure for soft tissue tumours suspected of malignancy. In bone tumours, where the diagnosis is supposed to be sarcoma, an excisional biopsy is seldom possible without severe recontructive problems and it may be unnecessarily mutilating should the tumour be benign. For the fibula, the clavicula, metatarsal and metacarpal bones, the distal third of ulna and the proximal third of radius, however, excisional biopsy as the primary procedure should be taken into account. The resulting loss of function is minor and can well be accepted even if the tumour turns out to be benign. On the other hand, if it is malignant as supposed, the radical excisional biopsy saves the patient from amputation. When incisional biopsy is used instead of excisional biopsy the definite surgery has to be made much wider and will often be mutilating. A case of chondrosarcoma illustrates the advantage and the disadvantage of this principle as well as an unusual reconstruction.


Quality of care for completed stroke without rehabilitation: evaluation by assessing patient outcomes. Using the method of quality assurance of stroke rehabilitation developed at the University of Minnesota (UMn) by assessing patient outcomes on the basis of a modification of the Williamson Functional Limitation Scale (WFLS), 84 patients (group H) with completed stroke were surveyed 8 months to 13 years following treatment without rehabilitation at Hennepin County General Hospital. Because a greater percentage (42%) than estimated (29%) had died, the percentage of those not independent in self-care (31%) was less than estimated (46%). These patients were not matched with a group given rehabilitation (group U) previously studied at UMn but were generally less severely involved, although older on the average. However, even so, only 47% of those still living were independent in self-care in group H in contrast to 69% in group U. Also 42% of group H were in nursing homes or board-and-care facilities while only 18% of the rehabilitated group were. Although the modified WFLS is used in outcome studies for quality of rehabilitation, it is even sensitive enough to show differences in outcomes in a comparative study such as this.


Computed tomography: its potential as a predictor of functional recovery following stroke. In a 6-month period, 40 consecutive patients with a diagnosis of cerebral infarction had computed tomography (CT) scanning. The purpose of this study was to evaluate the association between the location and size of the lesion on CT scan and the functional status of the patient on discharge and follow-up. The results of the CT scan were divided into the following major groups: deep (involving the basal ganglia, internal capsule and thalamus), superficial large and superficial small (involving the cerebral hemisphere up to and including the external capsule) and normal. At discharge, patients were divided into 2 major functional groups: group A, minimal assist to independent in transfers and ambulation; and group B, moderate to maximal assist in transfers and maximal assist in ambulation. Ten of 11 patients with small superficial lesions were in group A, and 10 of 13 patients with deep lesions were in group B. Of 10 patients with large superficial lesions, 5 were in group A and 5 in group B. All 6 patients with normal CT scans results were in group A. Thus, results of CT scanning appear to be associated with degree of functional recovery.


Isokinetic torque levels for high school football players. One hundred fifteen high school football players were screened isokinetically for the knee extensor and flexor torque generating capabilities and muscle imbalances. Each player was tested on a Cybex II at speeds of 30 degrees/sec and 180 degrees/sec. The subjects were stratified by age (15, 16, 17) and by position (linemen vs receivers and backs). Significant (p less than 0.05) torque differences were observed at both the slow and fast speeds for the knee extensors and flexors across the 3 age groups. However, the flexion to extension ratios did not differ significantly. On the other hand, when considering the positions, flexor torque and flexion to extension ratio at the slow speed were greater (p less than 0.05) for the linemen than the receivers and backs. Partial correlation analyses showed that body weight had the greatest effect on the knee torque values. It was concluded that basic torque measures differed with age and by position in the sport of football. Also, speed of movement altered the force generating capabilities of the muscle and resultant ratios.


Physiologic effects on adult men of circuit strength training and jogging. The purpose of this study was to determine the effects of 8 weeks of circuit strength training (CST) followed by 8 weeks of jogging and then 8 weeks, of CST or jogging. During the final 8 weeks, the subjects were randomly assigned to either CST or jogging groups. The subjects (n=16, x age = 29 yrs) exercised 3 days/week. The strength training involved 2 circuits of reciprocal exercises using isokinetic devices with 10 to 15 repetitions/set and 30 seconds of rest between sets. The subjects jogged 3 miles/day during the jogging program. After the initial 8 weeks of CST, significant changes were found in treadmill performance time, maximum oxygen uptake (VO2max), maximum pulmonary ventilation (VEmax), body fat, total skinfold fat, fat weight, lean weight, isotonic bench and leg press, and isokinetic slow speed, fast speed, and power endurance measures. The jogging program elicited significantly greater changes in treadmill performance time and VO2max. Further reductions were found in total skinfolds and waist girth during the jogging program. Leg strength was maintained during jogging but upper body strength was reduced significantly. Physiologic levels were maintained during the final 8 weeks and showed no differences between the CST and jogging groups.


Physiologic responses to exercise in myocardial infarction patients following residential rehabilitation. The physiological responses to exercise were studied in 16 men (33-52 years of age), 8--12 weeks after a first uncomplicated myocardial infarction and following a 3--4 week period of attendance at a residential rehabilitation center at which the patients were required to participate in a controlled program of exercise, sport and recreation. Data were also collected on an inactive, but otherwise healthy group of men of the same age and occupational status, and on an occupationally and recreationally active healthy group. The patient group were indistinguishable from the healthy inactive group in their response to submaximal exercise, although both of these groups showed differences when compared with the active group. Symptom-limited maximal data were also collected and these are reported in relation to the energy requirements of some common leisure, occupational and domestic activities.


Isometric muscle contraction response during recovery from reduced intramuscular temperature. This study was done to determine the effects of a 30-minute cold water bath on intramuscular temperature and plantar flexion strength, immediately after treatment and during a 3-hour posttreatment recovery period. Twenty persons were tested twice, receiving treatment once and serving as controls once. Measurements were taken prior to the treatment period, immediately after treatment and then every 30 minutes for 3 hours. The dominant leg was submerged in water at 10 C for 30 minutes. Plantar flexion strength was measured with a cable tensiometer and intramuscular temperature was measured with a hypodermic thermistor probe. Intramuscular temperature significantly decreased immediately posttreatment on the experimental days and then increased significantly during the recovery period. Significant increases in strength were noted during the recovery period. A definite relationship exists between intramuscular temperature and plantar flexion strength.


Musculocutaneous nerve palsy: an isolated complication of surgery. Isolated paralysis of the musculocutaneous nerve, as reported in the literature, is an extremely rare phenomenon. It is our purpose to document the occurrence of one case as a complication of abdominal surgery. Possible mechanisms suggest why the musculocutaneous nerve may be vulnerable to injury during surgical procedures that incorporate certain methods of patient positioning. The particular pattern of nerve damage reflected in this case report may be helpful in further elucidating the other, more common, diffuse postoperative brachial plexus palsies.


Osteolysis of the ribs in progressive systemic sclerosis. In a patient with progressive systemic sclerosis (PSS), osteolysis of the posterior portion of the rib cage developed in an insidious fashion, without symptoms or preceding trauma. Six previous examples of rib resorption in PSS are reviewed. The destructive mechanism is unknown but may be related to endarteritis and ischemia.


EMG biofeedback in stroke: effect of patient characteristics. Forty-eight upper and 44 lower extremities of 52 stroke patients were treated using a clinical emg biofeedback training approach. The age, sex, hemiparetic side, duration of stroke or previous rehabilitation, and number of biofeedback training sessions had no significant relationship to treatment outcomes. Lower extremities responded more favorably to training than upper extremities, and the prospects for successful treatments in the upper limb were further diminished when proprioceptive impairments were present. Possible explanations for the poorer responsiveness of the upper extremity to emg biofeedback training are provided, the importance of a motivational element is stressed, and a suggestion is offered for the direction of future work designed to predict the value in applying this modality.


A psychological profile of the sexual dysfunctions. The present report summarizes an assessment of the psychological characteristics of a sample of sexually dysfunctional patients and compares them to those of a sample of heterosexual normals. Forty-seven male and 40 female dysfunctional patients were evaluated on the Derogatis Sexual Functioning Inventory (DSFI) and contrasted to a group of 200 heterosexual normals. Findings indicated substantial differences between dysfunctionals and normals on seven of the eight subtests of the DSFI. Both male and female patients showed higher levels of psychological distress and dysphoric affect than normals, and also revealed decrements on sexual information. Particularly noteworthy among male dysfunctionals were lowered sexual drive levels and a somewhat constricted repertoire of sexual experiences. Male dysfunctionals also revealed gender role definitions less polarized in the masculine direction. Female patients did not reveal any additional decrements beyond those mentioned previously, and some equivocation in defining gender role. However, detailed analyses of Experience and Fantasy subtests depicted female patients as more creative and less constrained in their sexual activities. Conclusions suggest that sexually dysfunctional patients do maintain a characteristic psychological profile but one that is distinct for males and females.


Primal-scene experiences: quantitative assessment of an interview study. Data are reported from detailed semistructured interviews with 25 males and 25 females, 18-30 years of age. Special attention is given to age and reactions at time of initial awareness of parents' sexual relationship and at time of any possible primal-scene witnessing, beliefs about parents' present sex lives, and interviewees' own ideas of how their parents' sexual attitudes and relationship may have influenced them. Particularly interesting are data indicating that primal-scene experiences, including actual witnessing, do not necessarily result in pathological consequences for psychosexual functioning or satisfaction. The importance of family-relationship patterns as determinants of reactions to primal-scene experience is emphasized.


On the stability of stigmatization: the case of ex-homosexual males. We undertook to empirically identify variables that influence the stigmatization of ex-homosexuals by analyzing the relationship between stigmatization and seven variables held to influence negative attitudes toward members of other ex-deviant groups: the stigmatizer's age, highest achieved educational level, amount of interaction the stigmatizer has had with an ex-homosexual, degree of effectiveness attributed to treatment in changing the homosexual to a heterosexual orientation, degree of responsibility that the stigmatizer attributes to ex-homosexuals for their prior homosexual behavior, degree of dangerousness attributed to ex-homosexuals, and degree of seriousness attributed to homosexuality. Analysis of data obtained by questionnaire from 281 respondents showed that the variable most strongly related to stigmatization of ex-homosexuals was the degree of dangerousness attributed to them. There was a profound direct relationship between these variables. Further, educational level, belief in the effectiveness of treatment, and amount of interaction of ex-homosexuals were inversely related to stigmatization, while degree of seriousness attributed to homosexuality was directly related to stigmatization. Respondents' tendency to stigmatize was not found to be related to age or to their attribution of responsibility to the ex-homosexual for his previous sexual orientation.


Color as a variable in making an erotic film more arousing. Eight adult male subjects participated in a counterbalanced, repeated-measures design to determine the relative efficacy of color and black-and-white visual sexual stimuli in eliciting sexual arousing, as objectively measured by a mercury-in-rubber strain gauge transducer. There were no consistent or significant differences in either the intensity of the pattern of penile responding during color and black-and-white presentations of the same film.


Sexual stereotyping of black males in interracial sex. Beliefs about black males' sexuality are pervasive in this society, but little studied. This investigation examined white subjects' perceptions of black and white characters in sexually explicit stories, some of which depicted interracial pairings. The perceptions were then examined in relationship to authoritarianism and sexual repression. Overall results suggest that black males are stereotyped as more potent than white males. The theoretical implications of this finding are discussed.


Castration for sex offenders: treatment or punishment? A review and critique of recent European literature. The recent European literature on surgical castration in treatment of sex offenders is reviewed. Results are reported of the most important empirical studies conducted in this field of sex research in Germany, Switzerland, Norway, and Denmark. Methodological problems of follow-up studies on castrates as well as the subject of castration as treatment for sex offenders as a whole are discussed. The main conclusion is that there is no scientific or ethical basis for castration in the treatment of sex offenders.


'Malignant' diverticulitis: a clinical entity. A form of severe diverticulitis exists that is characterized by (1) phlegmonous inflammation of the sigmoid and rectosigmoid colon, often extending below the peritoneal reflection, (2) frequent fistulization to skin, urinary bladder, and small intestine, (3) frequent colonic obstruction, and (4) high postoperative morbidity and mortality. The clinical similarity to granulomatous colitis is very apparent, but pathologic findings are consistent with severe diverticulitis rather than granulomatous colitis. The term "malignant" diverticulitis is suggested because of the progressive nature of the disease process and the frequency of severe morbidity associated with it. Seventeen patients have been studied since 1965, comprising approximately 7% of patients operated on for diverticular disease at Cedars-Sinai Medical Center.


Congenital diaphragmatic hernias: eleven years' experience. Fifty-five patients with congenital diaphragmatic hernias (1966 to 1976) were studied and compared to 65 similar patients reported previously (1953 to 1963). The mortality was found to be the same in the two groups despite the fact that in the current series, patients were diagnosed and operated on at a younger age. Initial uncorrected pH value was found to be of prognostic importance. All babies whose initial uncorrected pH was greater than 7.0 survived and almost all those whose pH was less than 7.0 died, with the group in-between having a 50% chance of survival. Earlier operation and correction of acidosis did not substantially improve the chance of survival. Hypoplasia of the lungs and major cardiovascular anomalies contributed to death in a number of patients. Pulmonary hypertension causing a right-to-left shunt was responsible for the deaths of others and, therefore, the use of vasodilator drugs deserves further evaluation.


Gastrointestinal anomalies associated with esophageal atresia or tracheoesophageal fistula. A retrospective analysis of 150 consecutive patients with esophageal atresia and/or tracheoesophageal fistula was undertaken. The incidence and variety of gastrointestinal (GI) anomalies, the method of management, and the cause of death were critically reviewed to outline preferred methods of management. Of these patients, 87 were male and 63 female. There were 62 GI anomalies in 40 patients. The most common GI anomalies included anorectal anomalies in 17 patients, malrotation of the midgut in 13 patients, duodenal atresia or stenosis in ten patients, and annular pancreas and ectopic pancreatic tissue in three patients each. Six patients had the combination of tracheoesophageal fistula, duodenal obstruction, and anorectal anomaly. Of the 150 patients, 23 have died, with 15 deaths occurring in those with associated GI anomalies. The GI anomalies contributed directly to the deaths of five of these 15 patients. Delay in diagnosis and, on occasion, improper initial management resulted in increased morbidity and mortality.


Surgical management of congenital lymphedema in infants and children. Of 67 children and infants with lymphedema, 28 had the congenital type. Congenital lymphedema appears during the first few weeks of life, frequently involves more than one extremity, and enlarges at a slower rate than general body growth. The swelling usually becomes less pronounced with age, and no specific therapy is required in two thirds of the patients. Seven of the 28 children had swelling of the upper extremities and a generalized lymphangiopathy syndrome. Subcutaneous lymphangiectomy was performed on ten of 28 patients who had moderate to severe swelling. Those with hand and arm involvement were particularly benefited; however, operations on the dorsum of the foot produced hypertrophic scars in one third of the cases. The operation is deferred until after age 2 years to permit optimal technical repair and to identify those patients whose conditions will improve spontaneously.


Carotid bruit: a follow-up report on its significance in patients undergoing an abdominal aortic operation. The records of 516 patients who underwent an elective abdominal aortic operation for aneurysmal or occlusive disease are reviewed. Four patients operated on twice are considered an individual patient for each operation. Excluding 27 patients who had a prior carotid endarterectomy, there were 84 with a carotid bruit. Thirty-six patients without a carotid bruit had experienced an episode of cerebral ischemia. Four patients had a postoperative stroke. There was no correlation between the stroke and presence of a carotid bruit or history of cerebral ischemic symptoms. We do not challenge the validity of prophylactic carotid endarterectomy but question if the need for an abdominal aortic operation should be considered indication for carotid angiography and surgery in patients with a carotid bruit.


Surgical safaris with the East Africa Flying Doctor Service. A few hundred small mission and government hospitals serve the 20 million people who live in rural East Africa. The physician-patient ratio is 1:25,000. Surgical support to many of these hospitals is provided through the East Africa Flying Doctor Service of the African Medical and Research Foundation. Small aircraft that are coordinated by a wide radio network bring surgical capability to a maximum number of patients in this area of 1,300,000 sq km (500,00 sq miles). The clinical problems, differential diagnoses, operative decisions, risk, and complications of surgical care all have a distinctly African quality. The working conditions and variety and magnitude of problems provide a stimulating challenge. Surgical safaris are a catalyst for gaining acceptance of modern scientific methods by Africa's tradition-oriented tribesmen.


'Kissing' duodenal ulcers.

'Kissing' duodenal ulcers. Among 70 cases of perforated duodenal ulcers treated by plication, eight were complicated by massive postoperative hemorrhage from a syncronous posterior "kissing" duodenal ulcer. Critical analysis revealed that only signs of gastrointestinal (GI) bleeding preoperatively had predictive value for postoperative hemorrhage. Twenty-four patients had one or more predictive signs, and eight actually bled postoperatively. There was a 50% mortality and 75% additional complication rate for the bleeders. In contrast, the nonbleeders had a mortality and a complication rate of only 18% and 35%, respectively. There was no observed superiority of either surgical or medical treatment for postoperative hemorrhage. In perforated duodenal ulcer with evidence of GI blood loss, an intraoperative search for a posterior kissing ulcer is recommended. If a kissing ulcer is found, an acid-reducing operation and suture ligation of the ulcer is indicated.


Selective management of subphrenic abscesses. Although extraserous drainage of subphrenic abscesses has gained wide acceptance, there is some renewed enthusiasm for the more frequent use of a transperitoneal operation because it affords the opportunity to discover unsuspected pathologic conditions, particularly heterotopic abscess. In 44 patients with postoperative subphrenic abscesses, the approach to drainage was selected on the basis of the clinical circumstances. Among 28 patients whose abscesses were drained extraserously, the incidence of heteroptic and recurrent abscesses was low. No serious complications of peritoneal or wound soilage occurred after transperitoneal drainage in 16 patients, yet the problems of inadequate drainage and heteroptic abscess were not eliminated. Celiotomy prior to definitive abscess localization was required for 13 patients. Five patients died. The operative approach should be based on the clinical assessment of the patient and particularly on the probability that multicentric intra-abdominal pathologic conditions exist.


Cholate sodium infusion for retained common bile duct stones. Eight patients with stones retained in the extrahepatic biliary tract underwent cholate sodium infusion for dissolution of the stones. In six patients, the stones disappeared. However, in two of the patients, the stones did not disappear, and they were removed with the ureteral basket. Infusion of cholate sodium was well tolerated by six patients, but was accompanied by nausea, vomiting, and abdominal pain in two patients. In one case, mucosal deformity of the common bile duct was noticed during the infusion, but it was not apparent on a subsequent cholangiogram. As a result of our experience, we conclude that cholate sodium infusion is a safe procedure for the attempted dissolution of retained common bile duct stones.


Raynaud's phenomenon: primary and secondary causes. The terms "Raynaud's disease" and "Raynaud's phenomenon" are often used interchangeably, as if they were a single problem. Because prognosis and therapy are different with each of these entities, 86 patients with episodic digit ischemia were evaluated over the past five years. All patients were evaluated similarly with plethysmography, angiography, and other studies for underlying causes of the digital ischemia. From the study, it was concluded that the majority of the patients had an underlying cause for the problem even though they satisfied the commonly accepted criteria for the diagnosis of Raynaud's disease. It is clear that the diagnosis of Raynaud's disease must be one of exclusion, because it is more uncommon than is generally appreciated by the medical community.


Duodenal ulcer: its treatment by parietal cell vagotomy at the time of cardiovascular operation. The existence of duodenal ulcer disease constitutes a potential threat during the recovery that follows any major operative procedure. At the time of cardiovascular operations, it would be desirable to treat the coexisting duodenal ulcer disease with a definitive ulcer operation if it could be done without entering the gastrointestinal (GI) tract, thereby eliminating the risk of graft contamination. Parietal cell vagotomy with pyloroplasty meets these conditions. During an 18-month period, 309 patients underwent cardiovascular procedures; ten underwent parietal cell vagotomy at the same time for treatment of duodenal ulcer. None of the patients experienced GI complications or the development of any other operative complications referable to the gastric procedure. Parietal cell vagotomy for active duodenal ulcer disease seems to be eminently suited as a companion for cardiovascular procedures that must be expedited.


Pancreatitis associated with thiazide administration. A role for the parathyroid glands? Twenty-one of a total of 72 patients with acute pancreatitis admitted to a university hospital over a three-year period were found to have "idiopathic" pancreatitis. Of these, six nonalcoholic patients without gallbladder disease were receiving one of the thiazide diuretics prior to the onset of pancreatitis. Three patients taken from an earlier series likewise had pancreatitis associated with thiazide administration and at the time of autopsy harbored parathyroid hyperplasia. It is suggested that both the parathyroids and the pancreas may be affected by thiazide administration, and that a history of ingestion of these drugs should be sought in patients who have idiopathic pancreatitis.


Variable manifestations of vascular injury during lumbar disk surgery. Major vascular injury is an unusual but well-recognized complication of lumbar disk surgery. Clinical manifestation of such injuries may be extremely variable. Isolated arterial laceration is most common, with early manifestation due to retroperitoneal hemorrhage. There are often few external signs of blood loss, however, and the diagnosis may not be recognized initially. Formation of an arteriovenous fistula or false aneurysm produces even fewer early signs, and diagnosis is often delayed for weeks or years. Six cases are described that illustrate the full spectrum of acute and chronic manifestations of such injuries. Two cases of acute hemorrhage due to arterial trauma were seen; one case was recognized intraoperatively and one in the recovery room. In four cases arteriovenous fistulae developed and were diagnosed from eight hours to eight years postoperatively. Two cases also had associated false aneurysms, one the probable source of pulmonary emboli and one the principal manifestation of the vascular injury.


Obturator canal bypass grafts for septic lesions of the femoral artery. Infection of the femoral artery results in false aneurysm formation and hemorrhage unless appropriate reconstructive measures are taken. We reviewed ten such cases managed by obturator canal bypass with autogenous saphenous vein. The graft maintained viability of the extremity in every case in the early postoperative period. One death occurred related to cardiac disease, and there was one late failure. This experience confirms the usefulness of the obturator canal as a method for bypass of the infected femoral artery.


Predicting success of forefoot amputations in diabetics by noninvasive testing. Sixty-six diabetic patients underwent needed forefoot amputations when clinical assessment indicated a reasonable chance of healing. All patients underwent noninvasive testing consisting of segmental systolic pressure measurements and pulse volume recordings (PVRs) taken at the thigh, calf, ankle, and forefoot levels. Segmental systolic pressures were falsely high (greater than 200 mm Hg) and therefore not useful in 56%. Ankle systolic pressures predicted failure in 36% of patients who healed and success in 64% who failed to heal. Segmental PVRs were sequentially predictive in only 50%. Forefoot PVR traces predicted failure in 50% of patients whose amputations healed. No patient should be denied a forefoot amputation solely on the basis of unfavorable results of noninvasive tests. Favorable clinical signs and a strongly positive forefoot PVR trace are the best predictors of successful forefoot amputations in diabetic patients.


Prophylactic interruption of the inferior vena cava: immediate and long-term hemodynamic effects. Two hundred patients were evaluated retrospectively to determine the clinical effects of prophylactic inferior vena cava (IVC) interruption in association with aortic reconstruction. No pulmonary embolism occurred in the group with IVC interruption, but embolisms did occur in seven of 68 patients who had aortic reconstruction performed without IVC interruption. In two patients, the pulmonary embolism was fatal. Postoperative incidence of deep vein thrombosis was fatal. Postoperative incidence of deep vein thrombosis was 9% in both groups. Clinical and hemodynamic effects of prophylactic IVC interruption were studied in 20 additional patients. Venous hemodynamics (maximum venous outflow, inferior vena cava pressure, and ambulatory venous pressure) showed no change following interruption in 19/20. Sixteen patients from the original group of patients with prophylactic interruption were studied hemodyamically. No pulmonary embolism was clinically evident. One new case of deep vein thrombosis was seen. Again, venous hemodynamics showed no change as a result of IVC interruption. Prophylactic IVC interruption is a safe means of decreasing the incidence of pulmonary embolism without increasing venous-related morbidity.


Positive blood culture as an aid in the diagnosis of secondary aortoenteric fistula. The successful management of aortoenteric fistula (AEF) requires early diagnosis. To evaluate the accuracy of our diagnostic approach, the hospital course of seven patients with AEF was reviewed. In six patients, the initial bleeding episodes were of the low volume type characterized by hematemesis and melena or by melena alone. All patients were febrile. In six patients, blood cultures obtained preoperatively were positive for enteric organisms identical to those found in cultures obtained intraoperatively from the AEF site. Roentgenographic examination of the upper gastrointestinal (GI) tract performed in three patients was diagnostic for AEF in only one. Endoscopy in seven patients revealed a bleeding suture line in one. Angiography was not diagnostic in the six patients in whom it was performed. When patients are seen with the triad of GI bleeding, a history of aortic surgery, and fever, aerobic and anaerobic blood cultures should be obtained. If blood cultures are positive for enteric organisms, the diagnosis of AEF should be strongly suspected, and early surgical intervention is indicated.


Limitations of noninvasive evaluation of carotid occlusive disease. A series of 32 patients examined by two different noninvasive techniques in two different laboratories and by cerebral angiography were retrospectively studied. Significant differences in ophthalmic artery pressures as measured by oculopneumoplethysmography (OPPG), and significant delays in ocular pulse arrival time combined with characteristic recorded bruits as determined by oculoplethysmography/carotid phonoangiography (OPG/CPA) were considered as an index of carotid stenosis. Cerebral angiography was performed on all 32 patients to confirm or refute the diagnosis suggested by noninvasive testing. In this selected group of patients with difficult diagnostic problems, only 67% of significant (greater than 50% diameter) stenoses were detected by OPPG, and only 58% by OPG/CPA. Combining OPPG and OPG/CPA increased the probability of detecting a greater than 50% diameter stenosis to 92%.


Simplified splanchnic artery revascularization using extra-anatomic bypass grafts: a report of ten cases. Revascularization of the superior mesenteric artery or renal artery is frequently complicated by concomitant atherosclerotic disease in the adjacent aorta. In ten patients, extra-anatomic saphenous vein bypass grafts to the splanchnic vessels were constructed and inflow was obtained from the external iliac artery. All patients recovered without complication and have had functioning grafts on follow-up arteriography. This extra-anatomic bypass provides a simple method for splanchnic artery revascularization.


Portal hypertension after bile duct obstruction: effect of bile diversion on portal pressure in the rat. Biliary obstruction of 14 and 28 days induced in the rat an increase of portal pressure (PP) and wedge hepatic vein pressure (WHVP); the higher these were, the longer was the obstruction. Occurrence of portal hypertension seemed related to portal and periportal fibrosis. Relief of obstruction after 14 days by bilioduodenal anastomosis brought back to normal PP and WHVP. In rats with longer obstruction periods, bilioduodenal anastomosis failed to lower PP and WHPV although biological signs of cholestasis returned to normal levels. These results suggest that portal hypertension may arise very shortly after biliary obstruction in rats and that it may persist in animals with a prolonged biliary obstruction despite an efficient bile drainage. In clinical conditions, such results would favor early treatment of lesions that usually cause prolonged bile duct obstruction, such as postoperative bile duct stenosis.


Acute diverticulitis of the transverse colon with perforation: report of three cases and review of the literature. Three cases of perforated diverticulitis of the transverse colon are added to 19 case reports in the English literature. This unusual disease entity is usually confused with acute appendicitis prior to operation and with carcinoma of the colon during the procedure. The cause of these diverticula is unclear, and their clinical presentation resembles that of right-sided diverticula. Segmental resection of the transverse colon together with end-to-end anastomosis is the treatment of choice, except in the occasional instance of a large intra-abdominal abscess, when anastomosis may be deferred.


Right paraduodenal hernia: a source of chronic abdominal pain in the adult. Right paraduodenal hernias are a relatively rare congenital malformation with a total of 50 clinical cases having been reported. This anomaly can be seen as total encapsulation of the small bowel or a single loop within a hernia sac. Symptoms are often chronic vague abdominal pain and intermittent obstructive episodes. Barium studies in patients with moderate and large defects, and angiography in small hernias may provide the diagnosis. The method of repair is dependent on the size of the hernia encountered. The management of two patients with this problem is described.


Chronic pseudo-obstruction secondary to side-to-side intestinal anastomosis. An unusual late complication of side-to-side intestinal anastomosis, chronic small-bowel obstruction with massive proximal ileal dilation despite a widely patent anastomosis, occurred in a patient. The classic blind loop syndrome was not present. Several potential mechanisms are suggested, including regional absence of normal peristalsis on a mechanical basis and bacterial overgrowth. This report adds support to the concept that side-to-side intestinal anastomosis should be avoided whenever possible.


Giant diverticular of the sigmoid colon: a review of differential diagnosis and operative management. Giant sigmoid diverticula ("giant gas cysts," "giant sigmoid cysts") are an unusual complication of diverticulitis. We have recently seen two patients with such lesions, bringing the total number of reported cases to 48. Most patients are elderly and complain of abdominal pain or the presence of an abdominal mass. Air trapping by a ball-valve mechanism may be responsible for formation of the fibrous cysts. The gas-filled structures can usually be differentiated from other conditions by contrast studies. Excision of the cyst and adjacent colon with anastomosis can usually be accomplished safely under elective circumstances.


Repair of massive inguinal hernia: with pneumoperitoneum and without using prosthetic mesh. There was an unusual need for preoperative induction of an artificial pneumoperitoneum in two cases of inguinal hernia. Both hernias were very large and associated with extensive intertrigo. Daily insufflations of air were performed for 13 and 11 days, with the patients compensating for this increased intraabdominal pressure over this time. Operation with removal of the ipsilateral testicle, cord, and scrotum was then straightforward and convalescence uneventful. The pneumoperitoneum allowed a repair to be effected without using a prosthetic mesh.


Colonic complications of acute pancreatitis. Colonic complications of acute pancreatitis include "pseudo-obstruction," necrosis, hemorrhage, fistula, and ischemic colitis. With the ten cases reported in this article, there are now 75 cases reported in the literature to our knowledge. The fulminating lesions (necrosis and hemorrhage) are usually associated with pancreatic abscess and/or pseudocyst and may occur because of a direct pressure effect with secondary vascular compromise. The lesions are predominant in the transverse colon and at the splenic flexure. Because the risk factor for a colonic complication from pancreatitis is highest in those patients with inflammatory masses in the body and tail of the gland due to colon contiguity, such masses require individualized treatment, including frequent clinical examination with sequential ultrasonography, and probably early surgical intervention.


Investigation of cardiac glycoside levels in human post mortem blood and tissues determined by a special radioimmunoassay procedure. Even after the introduction of radioimmunological methods the question of a cardiac glycoside causing or contributing to the death of a patient can not be answered satisfactorily. By means of a special radioimmunoassay procedure for digoxin as well as for the structurally related methyl- and acetylderivatives we measured the concentrations in human blood and post mortem tissues. We investigated the glycoside contents in the blood of intravenously digitalised (Novodigal) al) patients before and after death. At autopsy blood specimens were taken from the heart and the femoral vein. We found an increase of the glycoside level up to a highly toxic range (7--15 ng/ml) especially in the heart blood. Thus post mortem blood levels of digoxin and its derivatives are not suitable for a final decision in alleged cases of fatal poisonings. Measuring various concentrations in tussues and body fluids of the above cardiac glycosides mentioned revealed the kidney concentration to be of high value in confirming a digitalis poisoning. This organ and the heart show the highest tissue concentrations. Interpretations of fatal digitalis poisonings should be based on the additional knowlege of these concentrations. Individual cardiac glycosides may be analyzed by a combination of thin layer chromatography and radioimmunoassay.


Isolation and determination of quaternary ammonium compounds by means of amberlite XAD-columns and thin layer chromatography. The potentials of XAD-columns for the isolation of quaternary ammonium compounds from aqueous media have been investigated. When adequate amounts of counter ions (perchlorate, chloride, phosphate, nitrate) were added to the aqueous sample, to the column pretreatment fluid and to the aqueous washing fluid, most quaternary compounds investigated were retained on the column and could be recovered by elution with methanol. This approach proved also suitable for urine. Quantitation of quaternaries isolated in this way from urine samples could be performed on silicagel thin layer plates through visualization with iodine, followed by densitometric evaluation. For decamethonium detection limits were 0.1 micrograms/ml. Recoveries at the 1 micrograms/ml level were between 80--90% with variation coefficients of less than 10%.


The effects of 2,2-diethylallylacetamide on hepatic cytochromes in rats and in vitro. The application of 0.15 and 0.3% of diethylallylacetamide (DA) in the drinking water to rats during 10 days increased the relative liver weight, the yield of hepatic microsomes, and cytochromes P-450 and b5. Single s.c. doses of 400 mg DA per kg reduced cytochrome P-450 concentrations in the hepatic endoplasmic reticulum of rats. This effect was considerably more pronounced in rats pretreated with phenobarbital. The activity of 5-aminolaevulinic acid synthesis in liver mitochondria, and total liver porphyrins increased. In incubations of metabolizing hepatic microsomes from rabbits pretreated with phenobarbital 75% of 0.1 mM DA was degraded after 1 h. The aerobic incubation of 0.1 mM DA with rabbit hepatic microsomes in the presence of NADPH produced 50% destruction of cytochrome P-450 within 1 h. Addition of EDTA revealed that a part of this destruction cannot be explained by accelerated lipid peroxidation.


Properties of a newly isolated, serologically distinct avian paramyxovirus. The morphological, bio-physical and growth properties of the isolate duck/Hong Kong/D3/75 (D3/75) were consistent with this virus being a member of the paramyxovirus group. Using haemagglutination inhibition and neuraminidase inhibition tests no serological relationships between D3/75 and other paramyxoviruses could be demonstrated. The structural polypeptides of D3/75 were also typical of paramyxoviruses, consisting of 6--7 polypeptides ranging in molecular weight from 46,000--200,000 under reduced conditions. Two polypeptides were glycosylated.


[Several morphologic changes in the blood vessels of the rabbit medulla oblongata arising under the influence successive exposure to gravitational overloading and hypokinesia]. Morphological changes in blood vessels of the rabbit medulla oblongata were studied after successive effects of maximum-bearing gravitational overloadings of 10 units applied at different directions and hypokinesia of various duration. Blood system of 35 rabbits was injected with Gerota's mass, cleared horizontal sections of the medulla oblongata 120 mkm thick were stained with hematoxylin--eosin and after Van Gieson. The experiments demonstrated various, quantitative and qualitative, changes in the vessel structure of the medulla oblongata, prevalence of one of the factors applied--in one combination and successive application; total resulting effect of overloading and hypokinesia--in the other combination; peculiar morphological changes unusual to any of the two factors--in the third combination. It was also demonstrated that readaptation for 12 weeks resulted in a significant restoration of the blood vessel structure in the rabbit brains preliminarily subjected to a successive effect of hypokinesia for 4 weeks and overloading in cranio-caudal directions.


[Age and features of the construction and cellular composition of superior tracheobronchial lymph nodes in adult humans]. Age peculiarities in composition of the upper tracheobronchial lymph nodes have been studied in 60 corpses at the age of 16-70 years. Cause of death has not been connected with diseases of blood, lymphatic system or thoracic origins. Routine histological and morphometric methods have been applied. Certain age-dependent rearrangement in the connective tissue stroma, trabecular vegetations and differences in correlations of structural components have been noted. A rather essential volumetric increase of the medullary substance takes place at the level of hilus of the lymph node. Cellular composition of the lymph nodes is greatly polymorphous but is more or less constant for each age group. The number of macrophages containing carbon pigment is increasing with age.


[Anatomy of lymph nodes situated adjacent to the axilla in adult humans]. In 50 right and 50 left upper extremities examined in adult persons of both sex at the age of 28-90 years, delto-thoracic lymph nodes were revealed in 30% (right) and in 22% (left), and interthoracic lymph nodes--in 6% (right) and in 12% (left). The lymph nodes in question were revealed by the method of section after interstitial injection of Gerota's blue intradermally to fingers, palm, back of the hand deltoid area, lateral thoracic surface (at the level of the 6th intercostal space) and to the external part of the mammary gland. Injection was also performed into lymphatic vessels revealed by means of the interstitial injection. The delto-thoracic nodes were stated to situate in both the delto-thoracic sulcus and the delto-thoracic triangle. These vessels are situated along the course of the lateral collector of the free upper extremity. Deferent vessels of the delto-thoracic nodes flow into the apical axillary lymph nodes, into the deep and superficial cervical nodes, into the interthoracic lymph nodes and also into the subclavicular or into the jugular vein near a corresponding venous angle. Interthoracic lymph nodes, situated between musculus pectoralis major and minor, get their lymphatic vessels from lateral, inferior and central axillary nodes, from delto-thoracic nodes and also those lymphatic vessels that go from the mammary gland area. Deferent vessels of the interthoracic nodes flow into the apical axillary nodes.


[Ultrastructural demonstration of rabbit heart myocyte metabolism during fasting]. Thirty mature rabbits were completely deprived of food but water ad libitum for 10 days, then half of the animals were decapitated. The remaining animals were sacrificed 10 days after a sound diet. Histological, histochemical (estimation of glycogen, lipids, acid glycosamineglicans) and electron microscopic investigation of the myocardium was carried out. Degenerative and necrobiotic alterations were not revealed in muscular cells of the heart. At fasting accumulation of lipids and glycogen in the cardiac myocytes was evident. In fasting animals ultrastructure of the muscular cells of the heart demonstrated a certain decrease in synthetic processes. After a 10-day sound diet, the cardiac myocytes were actively involved into the process of intracellular regeneration. Increased lipid content in the rabbit myocardium, occurring at fasting, is connected with the necessity to provide the heart with an effective energy substrate required to preserve its contractile function and in this way adaptive-compensatory processes are demonstrated.


[Composium of the histiocyte population of the subcutaneous tissue of white rats (according to the results of a morphometric analysis of their ultrastructure)]. Investigations on polymorphism of histiocytes (macrophages) in the rat normal loose connective tissue support the suggestion about a complex composition of these cellular population. Two classes of cells (subpopulations K-1 and K-2) separated by means of multidimension morphometric analysis of ultrastructure are well identified by several morphologic criteria of weighed informativity. The cells of both populations are recognized under conditions of the organism's functional loadings supposed to produce macrophage activation. Quantitative rearrangements in the subpopulations composing the histiocyte population and a number of morphological transformations revealed in them as specific for fasting and degeneration proved a real importance of the classification.


[Evolution of the allantoid placenta in placental mammals]. The article surveys the literature concerning comparative morphology of allantoic placenta and presents some evolutionary-morphological conclusions. The initial form of allantoic placenta is non-deciduate that occurs in 7 orders of placental mammals. The non-deciduate placenta is especially characteristic for lower primates and Cetacea. The non-deciduate placenta in lower primates and the fact that in some modern species of insectivores the non-deciduate placenta is also preserved speaks in favour of the opinion that insectivores of the Cretaceous period had non-deciduate placenta. The non-deciduate placenta in Cetacea that take their origin from ancient carnivores (from procreodonts) demonstrates, in its turn, that the non-deciduate placenta was the initial form. The deciduate placenta was the means for changing many of vital activities of the organism--it is connected with shortening or lengthening of individual life duration and duration of pregnancy. In the course of evolution the allantoic placenta improved towards intensified metabolism between the embryo (fetus) and the maternal organism. Relations between the evolution of mature specimens and evolutional changes in placenta are at their initial stage of investigation.


[Ultrastructural informational analysis of the dynamics of liver cell recovery after performance of a biliodigestive anastomosis in mechanical jaundice]. Hepatic ultrastructure has been studied in dogs at the level of cholestasis and at different time after cholecystenteroanastomosis. Owing to theoretico-informative approach applied in the investigation, it was possible to reveal certain essential disorganization in hepatic ultrastructures on the 7th day after the operation. This phenomenon seems to explain the occurrence of acute hepatic insufficiency at early postoperative stages not infrequently observed in clinic. Changes produced by 30-days' cholestasis are demonstrated to be reversible.


[Dynamics of structural changes in the organs of immunity of rabbits with acute experimental appendicitis]. Cyto- and histological analysis of the whole immunogenic system at the development of an acute experimental appendicitis in rabbits has demonstrated that all the constituent parts of the system are involved into the reaction. In the central organ of immunity--thymus the main change is its progressive exhaustion, while peripheral organs of immunity are subjected to rather essential cytological rearrangements and activation of both cellular and humoral immunity. Accordingly to the type of the reaction, two groups of peripheral organs of immunity can be distinguish: the first--the appendix and the iliocecal lymph node which predominantly participate in the immunoblastic reaction and in the reaction of young plasmatic cells and demonstrate increased signs of immature cells emigration; the second--the axillary lymph node, as a representative of somatic nodes, and the spleen--the main carriers of the reaction in mature plasmic cells. Structural peculiarities of the complex appendix--iliocecal lymph node in intact animals and in the experiment make it possible to consider the complex as a peculiar functional link of the immune peripheral organs.


[Electron microscopy of human articular cartilage]. Scanning and transmission microscopy of the articular cartilage was performed in femoral condyles of persons at the age of 30-50 years. It was demonstrated that hyaline cartilage is covered with a protective fibrillar layer consisting of tightly pressed collagenous fibrillae with an underlying layer of fibroblastic cells. In the intracellular substance of the hyaline cartilage fibrillar structures form a complex reticular web with vertical arrangement of the main collagenous fasiculi. In the superficial layer of the hyaline cartilage the collagenous fibrillae and their fasciculi form arcade-like structures. Lacunar chondrocytes have a rough villose surface, cellular secrete is discharged as round granules through cytoplasmic membrane. Ultrastructural changes in chondrocytes are observed simultaneously with their degenerative-dystrophic changes.


[Chondrocyte differentiation and bone growth during the development of the cartilaginous skeleton of chickens]. Certain local alterations in functional and reproductive activity of chondrocytes were stated at the development of the cartilage skeleton. In epiphyses chondrocytes gradually pass into the phase of rest (G0) with subsequent multiplication during the process of skeletal development. In these structures biosynthesis of nonsulfated proteoglycans predominate, in time, while in other cartilage zones--that of sulfated ones. Proofs are furnished on gradual transition of epiphyseal chondrocytes into the state peculiar for cells of the proliferative zone accompanied by an intensified biosynthesis of sulfated proteoglycans and collagenous proteins. Owing to these peculiarities they can be compared with the cells of the reserve zone in the mammalian metaepiphyseal cartilage. It was stated that intensity of chondrogenesis and growth of bones are affected by several processes: intensity of chondrocyte multiplication, the rate of their repeated division in the proliferative zone, the velosity with which the cells transfer into the state of hypertrophy and the rate of the periostal bone formation at the border-line of metaphysis and diaphysis.


[Demonstration of brain capillaries using acetyl-CoA]. The method is based on a reduced procedure for revealing cholinacetyltransferase when the stage of preincubation treatment of the material and inhibitor is omitted. The possibility to investigate the human and animal brains with a complete revealing of the capillary network, which corresponds to injection of the vessels with Indian ink, is proved.


[Simple flow chamber for embryos].

[Simple flow chamber for embryos]. The chamber is made of two subject glasses arranged in such a way that nutritional medium can flow through it. In order to prevent washing out of the embryos by the stream of nutritional medium, a porous packing is inserted through which the nutritional medium is flowing. The upper subject glass has a hole through which the embryos are put into the chamber. The hole is covered with a covering glass. The chamber can be preserved for a long time "avaiting" for the cultivated material at any regime of the stream or at a static regime.


[Current clinical medicine and the problem of a "second" disease]. Different interpretations of the term "second disease" are discussed. Most attention is given to the "second disease" as an independent suffering which in the majority of cases develops in connection with medical interference. The causes, pathogenesis, and practical importance of "second diseases" at the present stage of the development of clinical medicine, and their place in the pathoanatomic diagnosis and in tanatogenesis are considered.


[Degree of maturity and histogenesis of stomach cancer and their importance for prognosis]. The intensity of differentiation of adenocarcinoma and non-differentiated cancer cells was studied histochemically and electron microscopically. A higher ratio of nucleus volume to cytoplasm volume and nucleus nuclei acids to cytoplasm RNA, low secretory activity in adenocarcinoma cells as compared to nondifferentiated cancers were found. Adenocarcinomas were shown to have a higher activity of NADP-dependent dehydrogenases, more numerous free ribosomes as compared to nondifferentiated carcinoma. This suggests a lower degree of cell differentiation and high proliferative activity in adenocarcinomas than in nondifferentiated carcinoma. Differences in the intensity of cell and tissue differentiation in adenocarcinomas and nondifferentiated carcinoma and due to differences in their histogenesis and must be taken into account in evaluations of the prognosis.


[Complication of resuscitation and intensive therapy]. On the basis of data from the literature and the author's own observations the paper analyses complications of resuscitation and intensive therapy recently classified as a special part of human pathology (resuscitation pathology). A classification of this pathology is suggested, indicating most important complications, causes of their development and preventive measures. Examples of changes in the clinico-morphological picture of the main disease under the influence of resuscitation and intensive therapy are presented.


[Morphological characteristics of early stomach cancer (analysis of 150 cases)]. One hundred and fifty early carcinomas of the stomach were studied. Morphology of 5 anatomic types (polypoid, raised, flat, superficial ulceration, ulcerative) corresponding to endoscopic types of early carcinoma is described. Previous diseases, age and sex of patients were found to influence the macroscopic and histological structure of the tumour, the rate of invasion of the submucosa. Therefore, the authors distinguish a) early carcinoma in the presence of polyps or chronic gastritis and b) carcinoma in the presence of peptic ulcer. The latter comprises nearly 80% of all early carcinomas. Three zones where the tumor arises were found: angle of the stomach, pyloric fold, and the border between the esophagus and stomach. Various forms of carcinoma have different rates of affection of each of these zones.