Prescribing glasses for myopia.

Prescribing glasses for myopia. Myopia is a one-symptom refraction problem: blurring of distance vision. Correction of the myopia should eliminate this symptom, but a prescription for glasses may, in fact, produce other symptoms equally--or more--disturbing. A few of the more common pitfalls in prescribing for the myopic patient are: (1) failure to recognize accommodative stress masquerading as low myopia; (2) confusion as to when, or whether, to prescribe for the unilateral myopic patient; (3) overcorrecting the myopic refractive error and failure to appreciate the symptoms that result from overcorrection; (4) difficulties in gaining acceptance of bifocals by the myopic presbyopic patient; (5) appropriate selection of bifocal segments; and (6) acquired myopic anisometropia caused by sclerosis of the crystalline lens. Although myopia would appear to be the least troublesome of all refractive problems, the maximizing of visual potential with comfort and safety needs refracting skills, experience, and clinical judgement.


The effect of atropine on myopia.

The effect of atropine on myopia. Sixty-two children were treated with atropine in one eye for one year; the fellow eye was the control. The eyes were switched the second year. Twenty-eight patients were treated for four years on the same basis. Control eyes showed significant increases in myopia compared to treated eyes. Some treated eyes showed decreases in myopia; no decreases were seen in control eyes. Posttreatment data analysis indicates the effects are long-term.


Ophthalmic findings in dural arteriovenous shunts. Five cases of dural carotid arteriovenous shunts in the region of the cavernous sinus are reported. Discussion of the specific carotid angiographic features stresses the pathophysiologic characteristics of these shunts in relation to the ophthalmic findings. In all cases, the meningohypophyseal artery was involved as the sole or predominant source of the afferent arterial supply, and the degree of proptosis, epibulbar congestion and secondary glaucoma correlated with retrograde filling of the superior ophthalmic vein from the cavernous sinus. The ophthalmologist's early recognition of this entity as a "spontaneous" pathologic occurrence is important, since he is intimately involved in its diagnosis and long-term management.


Retrocorneal pigment proliferation after cataract extraction. Retrocorneal pigment proliferation after cateract extraction is not rare. Downgrowths proliferate from fragments of iris pigment or peripheral iris in the corneal wound edges and occur slowly. Vision is affected if the central cornea is involved. Preventive measures include minimizing iris trauma and irrigating pigment fragments from the cornea and incision during surgery. In the study presented, patches of dislodged iris pigment epithelium were observed in 22 eyes. Lace-like downgrowths occurred in 18 eyes of 14 patients.


Capillary hemangioma of the lids and orbit: an analysis of the clinical features and therapeutic results in 101 cases. The clinical records of 101 patients (biopsies done on 48) with capillary hemangiomas of the orbit, orbit and lids, and lids were analyzed. Lesions predominated in females and typically appeared at birth or within the first two months of life. The superior orbit and lids were definite sites of predilection. Telltale periocular cutaneous involvement occurred in one third of the cases. Pure proptosis caused by a deep orbital tumor without an anterior component was found in seven cases. Proptosis in general was mild, but in two cases was severe enough to cause corneal exposure. Findings suprortive of a diagnosis of an orbital or periorbital hemangioma include (1) change in tumor size on crying (46%); (2) a dark vascular coloration to the subcutaneous tissue (80%); and (3) the existence of nonperiocular strawberry marks (25). Diagnostic tests of most value were plain radiography, ultrasonography, computed axial tomography, and arteriography. The complication rate in the 50 patients followed up over five years was 80% (60% with amblyopia). Present treatment modalities do not appear to be achieving the desired goals of a good cosmetic and functional outcome. Radiotherapy and corticosteroids are both effective in individual cases, but many lesions are resistant to all forms of present treatment. Amblyopia therapy is difficult and often unsuccessful in these patients.


Congenital, infantile, and juvenile glaucoma. The appearance of the anterior chamber angle shows considerable variation in eyes with glaucoma caused by congenital or developmental causes. These differences, in over 100 eyes studied, correlate well with the effectiveness of trabeculotomy in controlling the intraocular pressure. In angles harboring what is probably embryonic mesoderm (although they may vary in their gonioscopic appearance), prognosis for control of IOP by trabeculotomy is excellent, while in those that show evidence of a fibrotic process at the limbus, the prognosis for trabeculotomy is hopeless. The latter, once recognized, should be treated by trabeculectomy, this condition being the only good indication for trabeculectomy in these eyes.


Orbital tumor evaluation.

Orbital tumor evaluation. The key tests in the evaluation of orbital pathology--orbital roentgenograms, CT scans, and ultrasonography--are defined.


Orbital septa: anatomy and function.

Orbital septa: anatomy and function. As a consequence of some puzzling motility disturbances in patients with blow-out fractures, a new anatomic approach to the human orbit was developed. This new approach revealed unknown connective tissue septa inside the orbit. These connective tissue septa were highly organized and formed an accessory locomotor system. This system is involved in pathologic circumstances like blow-out fractures and can account for the motility disturbances in these cases; additionally, it plays an important, yet to be unravelled, role when normal eye movements are performed.


Diagnostic modalities and natural behavior of optic nerve gliomas. The preoperative evaluation of a patient with a suspected optic nerve glioma has been enhanced by the use of recently developed techniques such as computerized tomography and ultrasonography, which enable evaluation of tumor configuration. Conventional radiographic studies with stereoscopic orbital foramen views, as well as tomography of the optic canal, are important and permit accurate measurement of canal size, shape, and margins. The glioma characteristically develops as an intradural, monolobular, fusiform enlargement of the orbital, canalicular, or chiasmal portion of the nerve. Enlargement may be produced by astrocytic proliferation within the nerve or within the perineural sheath, by arachnoid hyperplasia, intracellular mucosubstance production, or by vascular congestion. Each of these features will be described and discussed.


Vascular problems of the orbit.

Vascular problems of the orbit. Vascular neoplasms and malformations of the orbit are unusual and fascinating problems. The benign capillary and cavernous hemangiomas are the most common vascular tumors and are classified separately because of distinct clinical and pathologic differences. The capillary hemangiomas progress rapidly in early childhood but have a tendency to regress. The cavernous hemangiomas occur later in life, progress slowly, and often require surgical excision. The orbital aneurysm, venous malformation, arteriovenous malformation, and carotid-cavernous fistula all may cause exophthalmos, visual loss, and other ocular abnormalities. They can be differentiated clinically; however, recent advances in ultrasonography, venography, and arteriography usually permit an exaxt diagnosis. They may be treated surgically, but the mortality and morbidity associated with such surgery must be balanced against the threat of loss of vision.


Orbital lymphangiomas.

Orbital lymphangiomas. The exact nature of lymphangiomas of the orbit is controversial. Nineteen cases with typical clinical, surgical, and histopathologic findings are presented. These tumors are diffuse, slowly progressive, difficult to remove, and relatively insensitive to irradiation. They frequently hemorrhage, causing rapid increase in proptosis, which may require emergency surgery, and they fluctuate in size with upper respiratory tract infections. Optic disc edema and amblyopia secondary to astigmatism are occasionally noted.


Surgical approaches to the orbit.

Surgical approaches to the orbit. After the appropriate workup, the size, location, and consistency of an orbital mass will dictate the surgical approach chosen. Masses in the muscle cone area or in the temporal portion of the orbit are most easily approached by the lateral orbitotomy. For lacrimal gland tumors a superior extension of the lateral orbitotomy will expose the lacrimal fossa area. The superior medial subperiosteal approach is indicated for masses in the superior medial orbit. For the more difficult area between the medial rectus and optic nerve, the combination lateral-medial orbitotomy through the medial fornix will expose the medial retrobulbar area. To reduce postoperative morbidity, emphasis is placed on adequate exposure, careful manipulation of tissues, and meticulous hemostasis.


Radiation treatment of orbital lymphoid hyperplasia. Ten patients with biopsy-proved lymphoid hyperplasia (pseudotumor) of the orbit were treated with radiation therapy individed sose ranging from 2,500 to 3,000 rads. Five of the ten patients had prior treatment with corticosteroids in high dosages with only partial or no response. All ten patients had clinical resolution of the lymphoid hyperplasia orbital mass within three weeks following radiation therapy. A follow-up period of six months to five years has demonstrated no recurrences. There were no discernible complications from the radiation therapy. We believe that radiation therapy should be considered as a primary treatment of benign lymphoid hyperplasia of the orbit.


Clinicopathologic characteristics of orbital lymphoid hyperplasia. The clinical characteristics and microscopic features of the biopsy specimens of 66 patients with orbital lymphoid tumors were analyzed with respect to clinical outcome (disease remaining localized to the orbit or developing associated extraorbital lesions). The patients' average age was 63 years, and their tumors had a marked tendency to arise in the anterosuperior orbit. No clinical or radiographic findings helped to distinguish the cases of localized disease from disseminated disease. The lesions were divided microscopically into three categories: reactive lymphoid hyperplasia (16), atypical lymphoid hyperplasia (38), and malignant lymphoma (12). Extraorbital lesions developed in 25%, 50%, and 75% of cases, respectively. The five-year mortality rates were also significantly different for each type of lesion: 6%, 19%, and 58%, respectively.


[Epidemiology of hepatitis A: serological study among a French population (author's transl)]. To investigate the prevalence and distribution of antibodies to hepatitis A antigen (anti HAV Ab) we tested 848 French people living mainly but not exclusively in Franche-Comté (East of France). In Franche-Comté, 76 per cent of all the subjects studied were found to be anti-Hav ab positive, as determined by specific radio-immuno-assay. The rate of antibody detection was correlated with age; the prevalence was low (38 per cent) in childhood and adolescence, gradually increasing throught adulthood, and reaching its peak level (greater than 95 per cent) in people aged 40 and above. Anti-HAV Ab was detected more frequently in farmers (89 per cent), factory workers (87 per cent) and office employees (80 per cent) than in hospital personnel (53 per cent). Socioeconomic differences were found to be important in young people but tended to disappear at about 40 years of age. No difference was found in the prevalence of anti-HAV Ab between national servicemen from Franche-Comté and those from other regions. In 3 per cent of cases anti-HBs Ab was associated with the presence of anti HAV Ab. The subject possessing anti HBS Ab had the same prevalence of anti-HAV Ab (75 per cent) as those without (76 per cent).


[Malignant myelofibrosis. One case (author's transl)]. In a 75-year-old man, the rapid development of a pancytopenia as a result to total marrow failure, in the absence of tumour or extramedullary myelopoiesis, but with a histological appearance of the marrow identical to that seen in agnogenic myeloid metaplasia led to a diagnosis of malignant myelofibrosis. The patient died 7 months after the apparent onset of the disease. The 48 other published cases are discussed. Only 17 are considered to be true cases of malignant myelofibrosis.


[Antimicrobial therapy in granulopenic patients with malignant hematologic diseases (author's transl)]. Rational antimicrobial therapy in neutropenic patients includes early empiric therapy with combinations of antibiotics active in vitro against the causal pathogen. The duration of therapy is to be adapted to the clinical response. In patients who do not respond to antimicrobial therapy, transfusion of granulocytes and empiric use of antifungal drugs should be considered.


[Hemoglobin G Coushatta (beta 22 (B4) glu leads to ala) in Algeria: an homozygous case]. In this paper, we report the first observation of Hb G Coushatta (beta 22 (B4) Glu leads to Ala) in North Africa. An homozygous case was discovered and studied. The structural abnormality was characterized by using S. aureus protease. The analytical methods capable of distinguishing these hemoglobins from D Punjab, D Ouled Rabah and D Iran which have similar hemoglobin electrophoretic mobilities will be discussed.


Methylcellulose culture of human granulocytic progenitor cells (CFC *): results of bone marrow and blood cultures for normal subjects. Normal values for the colony-forming ability of granulocytic progenitor cells (CFC) were established for 26 samples of normal bone marrow and 8 samples of normal blood cultured in methylcellulose. The concentration of CFC in the marrow was measured classically as the number of CFC per 10(5) nucleated marrow cells plated and, in addition, as the number of CFC per 10(5) precursors (myeloblasts, promyelocytes, and myelocytes) and per 10(5) metamyelocytes. A value approximating the total number of marrow CFC was calculated by using the number of CFC per 10(5) metamyelocytes. The normal value for circulating CFC were determined as number per ml of blood, per kg of body weight, per 10(5) circulating lymphocytes, and per 10(5) circulating granulocytes. The value of these different modes of expression are discussed. Although the values reported are not directly applicable from one laboratory to the next, they may constitute a useful reference point. Furthermore, they show that the statistical variation in the results is sufficiently small to permit the comparison of values found for pathologic samples with those determined for normal samples.


Sequential study of the bone marrow granulocytic progenitor cells (CFC *) in children treated by chemotherapy for non-hodgkin malignant lymphomas. We have studied the time course changes in committed granulocytic progenitor cells (CFC) in 54 pediatric patients treated by chemotherapy for a malignant non-Hodgkin lymphoma. This study has revealed the following points: 1) In the absence of patent bone marrow invasion, the bone marrow CFC concentration is, before treatment, less than normal; 2) Bone marrow invasion coincides with a large decline in bone marrow CFC concentration; 3) The aplasia induced by the initial chemotherapy is mediated by a quasi-complete destruction of CFC; 4) After regeneration from the initial therapeutic aplastic state the CFC exhibited a quite variable behavior from one patient to another. This phenomenon is probably linked to the variable recuperation time for each patient; 5) Following the conclusion of treatment, the patients, although having a normal peripheral leukocyte count, appeared to maintain a major aftereffect characterized by a clear and prolonged reduction in the concentration and total number of CFC.


Possible psychopharmacological agents. Part 3: Synthesis and CNS activity of some new fluorine-containing pyrazolo[3,4-e][1,4]thiazepines. A series of new fluorine-containing pyrazolo [3,4-e][1,4]thiazepines has been synthesized by the condensation of 5-amino-3/1, 3-substituted pyrazole with appropriate arylaldehydes or ketones and mercaptoacetic acid in dry toluene. All synthesized compounds have been characterized by their m.p.'s elemental analysis, IR, H-NMR and F-NMR. A representative number of compounds has also been screened for their CNS activity and found to act as mild stimulants.


Possible psychopharmacological agents. Part 7: Synthesis and CNS activity of some fluorinated 2,4,7/8-trisubstituted-3H-1,5-benzodiazepinium monoperchlorates. A series of new fluorinated 2,4'7/8-trisubstituted-3H-1,5-benzodiazepinium monoperchlorates have been synthesized and characterized by IR and NMR spectral studies. Representative compounds have been screened for their CNS activity viz., behavioural, analgesic, anticonvulsant and antireserpine. 8-Chloro-2-(4'-fluorophenyl)-4-phenyl-3H-1,5-benzodiazepinium monoperchlorate has shown pronounced antireserpine activity.


[Micromethod for the determination of phospholipids (author's transl)]. Optimal conditions for separation and analysis of phospholipids in very small tissue samples have been elaborated. The phospholipid pattern of the rat vena portae and arteria mesenterica was determined.


[Studies on the separation and photometric determination of antiepileptics (author's transl)]. Well-known methods for the photometric determination of antiepileptics in body fluids were tested from the aspect of their utilization in a pharmacokinetic therapy service of clinical pharmacology. In the framework of a comparative synopsis of methods, specifications are given for the determination of phenytoin, phenobarbital, methylphenobarbital, and carbamazepine.


[The excretion of hippuric acid and ascorbic acid in the urine of liver-damaged rats (author's transl]. The authors investigated the effects of the administration of thioacetamide, carbon tetrachloride and aminophenazone on the excretion of ascorbic acid and hippuric acid in adult male and female Wistar rats. After a single application of thioacetamide and aminophenazone, the ascorbic acid content in the urine showed a dose-dependent increase, whereas that in the liver had decreased. This increase in the urinary ascorbic acid might be due to a release of stored ascorbic acid from the liver cells. When thioacetamide was given for a prolonged period, the ascorbic acid content in the urine increased at the beginning; later one, at the end of three weeks, it was slightly inferior to the control value. Both single and repeated applications of thioacetamide led to a decrease in the excretion of hippuric acid in the urine, which is attributed to an impairment of the mitochondrial hippuric acid synthesis. Long-term treatment with aminophenazone resulted in an increase of ascorbic acid in the urine, which is indicative of an induction effect, whereas the ascorbic acid content in the liver remained unchanged. There was no effect on the excretion of hippuric acid. In regard to their use in the toxicological evaluation of drugs, these two metabolic effects offer no decisive advantage over current liver function tests.


Possible psychopharmacological agents. Part 9: Synthesis and CNS activity of some new fluorine-containing 1,2,4-triazolo[4,3-b]pyridazines. A number of new fluorine-containing 1,2,4-triazolo[4,3-b]pyridazines have been synthesized by the condensation of 4-amino-(4H)-1,2,4-triazole with appropriate fluorinated beta-diketones in glacial acetic acid. All synthesized compounds were characterized by their m.p.'s, nitrogen analysis, IR, 1H NMR and 19F NMR. A representative number of compounds was screened for their CNS activity and found to be mild stimulants.


[On the polymorphism of barbiturates in powders and tablets - Part 3: The effect of the pressing power on the modification of barbital (author's transl)]. The authors took X-ray diffraction pictures from two commercial brands of barbital (produced in the GDR and in the Hungarian People's Republic, respectively), the interpretation of which convinced them that these two commercial brands are different modifications. These crystals were brought by pressure (10 and 20 kN) into the shape of tablets. Textural studies showed that both commercial brands are easy to compress. An increase in pressing power caused insignificant changes in the structure of the GDR product; and in the Hungarian commercial product, only slight changes were observed. It could be proved by X-ray diffraction analysis that the form of the barbital crystals is affected by the application of pressure. But this change occurs already under a pressure less than 10 kN. A further increase in pressing power produces no further changes in crystal structure.


[The effects of various factors on the in vitro velocity of drug release from repository tablets. Part 4: Isoniazid (Rimicid) respository tablets (author's transl)]. The authors investigated the release of isoniazid from repository tablets as related to form, processing technology, strength constant and storage for 5 years. On determining the diffusion coefficient (D), the initial dissolution rate (Vo) and the time required for the diffusion of the releasing medium to the middle of the tablet (t1/2), it was found that the difference in release rate between the flat and the biconvex tablets is small. Furthermore, it was stated that the three-layer tablets have very high D and Vo values and very low t1/2 values, for what reason they are unsuited for repository tablets of the composition under investigation. Moreover, it was found that an increase of the strength constant does not affect the D, t1/2 and Vo values, and that the release of isoniazid is retarded only in flat tablets with the highest strength constant. Storage exerts no effect on the drug release from these tablets. The industrial production of these tablets is under way.


Compatibility of a new suppository base with certain pharmaceuticals. The compatibility of the macromolecular product Novosup-78 (mixture of polyethylene glycol esters with the free acids of sunflower oil and lard) with certain drugs relatively widely used in the suppository formulations was studied. By means of the solubility procedure and the UV spectral technique, significant interactions only with definite amounts from both components can take place. A predominant micellar solubilization in Novosup-78 solutions up to 0.5% was assumed. Taking into consideration the dependences obtained, it was concluded that the minimum ratio of drug to Novosup-78 in the proposed suppository formulations is not favorable for complexation interactions.


[Biotransformation and Stability of Hydrocotarnine and Diazocarbonylhydrocotarnine and -hydrohydrastinine derivatives (author's transl)]. After oral application of the weakly basic (pKs = 6.18-6.26) and relatively stable (1 at pH = 7.4; t1/2(35 degrees C) = 6.9 h) secondary 1-diazocarbonylhydrocotarnine or -hydrohydrastinine derivatives 1-4 and of hydrocotarnine (6) to rats, a total of 18 metabolites, predominantly isoquinolines of varying degrees of hydrogenation (7-19), were isolated from 48-hour urine specimens. These isoquinolines result from cleavage of the C-1/C-1' bond as well as from oxygenation (11, 15, 17-19), N-dealkylation (13, 15, 17-19) and O-dealkylation (8-12, 18, 19). Among these isoquinolines were some phenolic betaines (8-11) of which 9 is the major metabolite of the cotarnine derivatives. Furthermore, C-1-substituted metabolites as well as metabolites with benzo-1,2-diazaindolizine (23, 24) or benzodiazepine structure (20, 21) were isolated. Also in an aqueous-alkaline or an aqueous-acidic medium, the cleavage of the C-1/C-1' bond as well as the formation of benzodiazepines follows a non-enzymatic pathway as evidenced by stability studies. The structures assigned to the different compounds are supported by high-resolved mass spectra, further spectroscopic studies (UV, IR and  1H-NMR spectra) and, in part, by comparison with authentical material.


On the local anaesthetic action of propolis and some of its constituents. An ethanolic propolis extract and some constituents isolated from propolis were tested on the cornea of the rabbit and of the mouse for local anaesthetic activity. Total anaesthesia was obtained with the total extract as well as with the compounds 5,7-dihydroxyflavanone (pinocembrin), 5-hydroxy-7-methoxyflavanone (pinostrobin) and with a mixture of caffeic acid esters. Each of these compounds was nearly thrice as potent as the total extract. Propoxypiperocaine which was tested for the purpose of comparison was still efficient in an almost 10-fold lower concentration. When applied subcutaneously, pinocembrin and the mixture of caffeic acid esters produced nearly the same anaesthesia as lidocaine.


[Economic aspects of the treatment of leg ulcers]. The authors have compared the healing time and the cost of leg ulcers of venous origin according to whether they were treated on an out-patient basis or by admission to hospital. The healing times were extremely similar, but the cost of cure by hospital admission was twenty times as great. Although one cannot claim to cure all leg ulcers on an out-patient basis, it is clear that significant public economies could be achieved by avoiding or shortening some costly hospital admissions.


[Generalization of leg eczema].

[Generalization of leg eczema]. Extensive secondary eczema of the legs and chronic venous insufficiency coexist fairly often ; among aetiological factors are considered atopy and multiple sensitivities, contact dermatitis, and eczematizations of infective origin (bacterial or fungal) from organisms with weak pathogenic potency but strong allergenic potency. There is a short clinical description referring to the phenomena of primary irritation and controlateral extensions of the eczema. The pathogenesis relates to immunological phenomena and antigen-antibody conflicts. These types of eczema come for the most part into the category of delayed hypersensitivity type IV of the Gell-Coombs classification.


[Nosology of so-called capillaritis ulcers]. It was with ochre dermatitis that the clinical notion of "capillaritis" was first put forward, but in what sense is it still possible today to speak of "capillaritic ulcer"? Although some special characteristics have been ascribed to it, this ulcer is derived from a microvascular and tissue reaction to venous stasis, whether the latter is primary due to varicose veins or secondary due to "post-thrombotic syndrome" or obliterative arteriopathy of the supplying trunks and especially the nutritional branches of the dermohypodermic network. This type of ulcer involves the Circulatory Unit and is expressed by an imbalance in irrigation, the result of a whole sequence of capillary closures and anastomotic openings, of which the "mosaic" appearance on infra-red thermography is evidence. It is a stasis ulcer in which the mode of distribution of the capillaries is involved just as much as the thickness of the skin of the groove of Bisgaard, but it is the result of the majority of the angiopathic states of the lower limb.


[Acquired telangiectases of the lower extremities]. The aim of our study is to place the different forms of telangiectasia of the lower limbs in their clinical categories, before tackling, along with Dr OUVRY, the therapeutic problem with which the phlebologist is daily confronted. The idiopathic telangiectasias of the lower limbs are very common in women, and are considered as simple, but clearly form an entity within the framework of venous pathology : unfortunately we do not have a very precise pathophysiological explanation to provide a basis for prophylaxis, which is still doubtful, or for definitive treatments : nevertheless that is a field for the exercise of the phlebologist's skill. Other types of telangiectasia, which we have mentioned, should call for a search for a general pathology in terms of a complete physical examination from a dermatological viewpoint. More rarely, their precise dermatological category will be that of a dysembryoplasia, while others will be vascular naeval disorders with delayed manifestation. These will all require a specific therapeutic approach.


[Sclerosing treatment of telangiectasis of the lower extremities]. Sclerosant treatment of the telangiectasias should follow several rules : --Sclerosis of varicose veins, then of varicosities, should always precede sclerosis of the telangiectasias. --Small amounts of sclerosant material should be injected at a time, using numerous points of injection. --The author describes the material employed and recommends the use of loop glasses for the treatment of the smallest telangiectasias. --The efficacy of sclerosant treatment is greater than that of other known methods.


[Indications for corticotherapy in phlebology]. Corticosteroid therapy has not revolutionised phlebology but it is very useful in certain cases. The following indications are considered, with or without associated antibiotics : anaphylactic shock after sclerosant injections, chronic lymphangitis of the lower limbs, sclero-inflammatory hypodermatitis, eczemas, phlebitis, ulcers and angiomas. Various forms of corticosteroid therapy are considered ; injectable, long-acting, local and oral.


[Functional disorders of the venous muscular pump seen in chronic venous insufficiency]. The study of the functioning of the venous muscle pump by means of plethysmographic tests allowed us to discover a clearly marked condition in the varicose veins combined with chronic venous deficiency and in the thromboses of the deep veins. In the case of varicose veins, we found an interdependence between the gravity of the functional lesions and the existence of insufficient perforating veins. The study, which dealt with cases of thrombosis, showed that the trophic skin lesions appear only after several years of poor nervous pump functioning.


[Personal experience in the diagnosis and treatment of post-phlebitis syndrome]. The author proposes a new classification of the post-phlebitic syndrome which he has used for several years. The term chronic thrombosis is used together with the name of the thrombosed vein. Note is made of the degree of chronic venous insufficiency, the causal disease and the date of onset. Treatment is above all medical (compression, physiotherapy, mineral spring therapy, rehabilitation and instruction of patients). Radical surgical treatment is indicated when phlebography shows a recanalization of the deep veins.


[Circulatory effect of saphenous reflux in primary varicose veins]. The authors studied venous pressure in the posterior tibial vein and the internal saphenous vein in primary varicose veins and after saphenous ligation with stripping. It is saphenous reflux which is the cause of all the disorders and which it is necessary to suppress by a perfect saphenous arch ligation. He has done this successfully in 358 cases.


[Facial erythrosis].

[Facial erythrosis]. At the borders of two sister disciplines, facial erythrosis is a fairly disabling microvascular phenomenon, since it appears most frequently in women. From several rather special cases, the authors review the aetiology and differential diagnosis of these manifestations. An attempt is made to explain the pathogenesis of these phenomena. The authors stress the absence of treatment, but base their hopes on certain dimers or tetramers of hyaluronic acid, provided for their use by Dr CURRI.


[Team-cooperation and its pitfalls in psychotic states (author's transl)]. This article describes the reasons why pluriprofessional teams offer the ideal conditions for the therapy of psychotic states. Only they can reach the stability and the flexibility necessary to serve as a "container" for the fragmented ego of the patient in psychotic crises. But in this function, the team may fail. A new pathology arises, beyond the well-known "institutional neurosis". We call this pathology the "combined institutional-psychotic syndrome". Different forms of such syndromes are described. Last of all, we reflect on the consequences of these considerations for the conception of psychiatric institutions.


[Onward along the beaten track? or: psychiatrists at the crossroads (author's transl)]. Within the framework of present-day strained relations between physicians, respectively their professional changes of making a career on the one hand, and society on the other, psychiatrists will be facing an even more critical controversy with their colleagues and psychologists. Looking to the demands made by these groups of physicians in respect of medical importance, psychiatrists are compelled to reconsider their own actions and professional pattern more thoroughly and purposefully than ever before.--A cursory glance at the increasingly obvious tasks of meaningful psych-iatry will immediately show that besides the very serious material problems in this underdeveloped branch of medicine, other and even more difficult tasks have to be tackled. One of the most serious problems, which is particularly delicate because it touches upon the psychiatrist's medical self-understanding, is the manner in which psychiatrists should conceive their own activities as a part of medical science and how they should arrive at mutually acceptable terms with their medical colleagues on the one hand and with psychologists on the other, the ultimate aim being to serve medical interests and not only the professional interests of the groups of physicians and allied specialists.


[Models for the integration into therapy of work performed by helpers within the framework of psychiatric wards (author's transl)]. Several models for the integration of the work done by nurses and attendants into therapy are presented. In particular, the use of the "Scale for Behavioral Observation in Wards" is described. Important modes of behavior, which are relevant for therapy, can be trained for the benefit of nurses and attendants by observing the patients' behavioral patterns. The approach described in this article can improve the co-operation between the psychiatrist and nurses or helpers.


Psychoendocrinology of the menstrual cycle: I. Enjoyment of daily activities and moods. Thirty-three women participated in a study of the relationship between moods and enjoyment of activities during the menstrual cycle. All subjects had normal cycles and were screened for psychological health. None were taking oral contraceptives. Each subject filled out daily the Profile of Mood States (POMS) and the Social--Sexual Activities Log (SAAL). They also completed the Moos Menstrual Distress Questionnaire (MDQ) once a month. The SSAL was developed as part of this research in order to provide a means of assessing subjective enjoyment of daily activities. SSAL items were developed from semistructural individual interviews and assessed behavior across eight different categories. Results suggest that the SSAL is a reliable self-report instrument. Although there were no changes in either moods or enjoyment of activities as a function of cycle phase with either the POMS or the SSAL, scores on the MDQ showed the usual cycle-related differences. These findings raise questions concerning the validity of retrospective methods in general, and of the MDQ in particular, as techniques for assessment of personal distress during the menstrual cycle. Equally important, the results suggest that when changes in psychological states are assessed concurrently during the menstrual cycle, the fluctuations observed in a healthy population are minimal.


Psychoendocrinology of the menstrual cycle: II. The relationship between enjoyment of activities, moods, and reproductive hormones. Fourteen women served as subjects in a study of the relationships between emotional states, enjoyment of activities, and reproductive hormones. Each subject was psychologically and physically healthy, had a documented history of normal and regular menstrual cycles, was not taking oral contraceptives, and was involved in an ongoing heterosexual relationship. Each woman participated for at least two complete menstrual cycles. The Profile of Mood States and the Social-Sexual Activities Log were filled out daily; other questionnaires were completed less frequently. Blood was drawn between 3 and 5 times/week and was analyzed, using radioimmunoassay methods, from plasma levels of estradiol, progesterone, and luteinizing hormone. Twenty-seven of the twenty-eight cycles appeared to be normal and ovulatory, according to accepted endocrinological criteria. Results showed that in this sample of healthy women there was no relationship between mood states or enjoyment of activities and phase of the menstrual cycle, and no relationship between these psychological states and absolute levels of the reproductive hormones estradiol and progesterone.


Asthma attack frequency in a pediatric population. The joint occurrence of asthmatic symptomatology and psychological maladjustment does not necessarily imply a functional relationship between these two sets of phenomena. To test the contribution of psychological adjustment to the prediction of asthma symptomatology, a stepwise multiple regression was applied. Pulmonary and psychological adjustment variables were included in the regression analysis. The single best predictor of attack frequency was the pulmonary factor MMEF. Predictability was significantly increased with the family adjustment rating, the pulmonary factor FEV1, and the Child Adjustment Rating entered into the equation. The results were interpreted to be consistent with psychosomatic theory.


Psychological factors in the prognosis of malignant melanoma: a prospective study. Sixty-four patients with Stage I or II malignant melanoma who were apparently disease free rated the amount of adjustment needed to cope with their illness on a scale of 1 to 100. The resultant figure was called the melanoma adjustment score. Twenty-nine patients who relapsed within 1 year of surgery reported a score of 53 +/- 31 (mean +/- SD); 35 nonrelapsers reported a score of 80 +/- 20, p less than 0.001. Based upon analysis of indivual melanoma adjustment scores in the first 31 patients, we predicted that subjects scoring greater or equal to 65 would stay in remission, whereas those scoring greater than 65 would relapse. Applying this prospectively to the next 33 patients we correctly identified 25 of 33 outcomes (76%), p less than 0.03. This psychological variable was independent of known biological prognostic factors, which did not predict 1 year survival. The melanoma adjustment score was also independent of the number of positive lymph nodes, which did correlate with outcome in these patients. The results suggest a role for psychological factors in the one year prognosis of this malignancy.


Divorce and remarriage in a 65-year-old male following transphenoidal surgery and bromocriptine of hyperprolactinemic impotence: a dilemma. Hyperprolactinemia, hypogonadotropinism, and subnormal plasma testosterone were found in a 65-year-old patient who had an enlarged sella turcica, complained of fatigue, and addmitted to decreased sexual interest and potency. Selective nontotal tumorectomy followed by bromocriptine therapy resulted in normoprolactinemia, increased plasma testosterone, and "rejuvenation difficult to follow" according to his wife. This patient described his sexual status as comparable to that of age 24 when he fathered his only child. Both wife and husband attributed the changes to bromocriptine and requested discontinuation (wife) and continuation (husband) of the treatment; because of the clinical indications, treatment was continued. Legally, a medical certification of a normal state of health was required before divorce--and subsequent marriage to a young woman--were permitted.


Neutron activation analysis of biological materials by the monostandard method. Instrumental neutron activation analysis by the monostandard method has been applied to the analyses of biological NBS standard reference materials; 1571 Orchard Leaves and 1577 Bovine Liver. Aluminum foils containing 0.100% gold or 2.00% cobalt were used as the monostandards. The gamma-ray spectral data were recorded on punched paper tape and were analyzed by a computer assisted data processing. The following 25 elements were determined: Al, Ca, Cl Cu, Mg, Mn, V (by short period irradiation), As, Ba, Br, Co, Cr, Cs, Eu, Fe, Hg, K, La, Na, Rb, Sb, Sc, Se, Sm and Zn (by long period irradiation). The results were compared with the certified values by NBS and the reported values in literatures to prove the reliability and accuracy of the monostandard method.


Studies on the biotransformation of paeonol by means of isotope tracer techniques.--Synthesis and physicochemical properties of carbon-13 and deuterium labeled compounds--. In order to perform the metabolic study of paeonol (I) in human and animals by using isotope tracer techniques, synthesis of I and its urinary metabolites labeled with carbon-13 or deuterium was investigated. 2-Hydroxy-4-methoxy[d3]acetophenone, 2,5-dihydroxy-4-methoxy[d3]acetophenone, and resacetophenone[acetyl-13C2] were synthesized from methyl iodide-d3, dimethyl sulfate-d6, and acetic acid-1,2-13C2, respectively. Physicochemical studies by IR and NMR spectra showed that stable isotope was not eliminated during the synthetic process of each compound. For the quantification of the metabolites by GC-MS analysis, isotope effect on gas chromatography and fragmentation was studied.


Whole-body autoradiography of bumetanide-14C in dogs by round saw method.--A combined method of autoradiography and tissue radioassay--. The distribution of a new potent diuretic, Bumetanide, in dogs was studied by means of a combined method of whole-body autoradiography and tissue radioassay, after oral administration of Bumetanide-14C to five young beagle dogs (ca. 1.2 kg). A round saw method developed by Kalberer was applied to obtain frozen slices of dog whole-body with a thickness of 3 mm. After exposure to X-ray films from both sides of the slices at -60 degrees C, frozen samples of the main tissues as well as the blood, urine, bile and intestinal contents were obtained to be assayed for radioactivity and to be analyzed for metabolites by TLC. The advantages of the round saw method (thick slices) in larger animals as dogs and monkeys as compared to the conventional microtome method (thin sections) were pointed out and discussed.


[Myocardial imaging with thallium-201--subtraction imaging with 201TlCl and 99mTcO4- for the visualization of the right ventricle--(author's transl)]. The dual radioisotope techniques with 201TlCl and 99mTcO4- were performed in 30 cases inclusive of various heart and lung diseases, using a scintillation camera coupling to a small digital computer. The scintigraphic procedures were started about 5 minutes after intravenous injection of 201TlCl. The myocardial images such as anterior, 60 degrees left anterior oblique, and left lateral view, were obtained. Next, 30 degrees left anterior oblique view was taken and radionuclide angiogram with 99mTcO4- was done in the same position too. This joint use of the myocardial imaging and radionuclide angiography could increase diagnostic reliability. Superimposing the image as iso-count map extracted out of radionuclide angiogram to the brightness image of 201TlCl, the anatomic orientation of the image of 201TlCl was improved. Subtracting the blood pool image with 99mTcO4- or radionuclide angiogram, which showed visualization of the right ventricle, lungs and left ventricle, from the image of 201TlCl, the subtraction image was obtained. The right ventricle was visualized more clearly on this subtraction image than the original image of 201TlCl. Good visualization of the right ventricle was shown in 25 cases on the subtraction image, and in 17 cases on the original image of 201TlCl.


Analysis of physical parameters of discrete cell populations. (Double data control by combining specific density and sedimentation velocity cell separation techniques). Physical cell separations are employed in a number of investigations in cell biology, immunology, haematology, etc., when the study of homogeneous cell populations is required. Differences in physical characters are reflected in the various functions and differentiation stages of the individual cell lines, which can be concentrated and separated into discrete cell classes by these methods. The correct utilization of the separation techniques mainly depends on the knowledge of the physical laws on which they are based. This paper discusses the theoretical background and a practical application of a combined separation procedure which uses velocity sedimentation and linear density gradient and also gives a double check of the physical data obtained in the different experiments. As an example of this analysis, cells from the lymph nodes of Hodgkin's patients were separated, and the physical parameters as well as some sources of 'error' in the experimental results obtained with these 'Hodgkin's cells' are reported and discussed.


Radiopharmacology. (The state of the art). The past, present and future development of radiopharmacology as a new branch of science is being presented. Radiopharmacological techniques have been applied by many scientists in the past, not knowing that they were developing a new scientific field. With the advancement of these techniques, the creation of a specialized teaching program and the organization of the first international symposium on radiopharmacology, the first specialized meeting in this area, radiopharmacology became a discipline standing on its own feet. The main purpose of radiopharmacology is to study the chemical properties of radiotracers, and their interactions with living organisms. In order to promote and further expand this field, an international association of radiopharmacology was created. The main purpose of the association is to congregate all those interested in the uses of radiotracers in biological sciences, including medicine, by the organization of national and international meetings.


Liver involvement in essential mixed cryoglobulinemia. Twenty-one of 30 patients with essential mixed cryoglobulinemia (EMC) had evidence of liver involvement. The liver disease was characterized by the absence of clinical symptoms, hepatosplenomegaly, mild elevation of enzymes, abnormal BSP retention and low albumin levels. Histology, available in 12 patients, showed either chronic persistent or chronic active hepatitis or liver cirrhosis; 44% of the patients had HBsAg or HBsAb in sera and/or cryoglobulins, confirming the high frequency of exposure to hepatitis B virus (HBV) infection in EMC. However, liver lesions were similar in all patients, regardless of HBV exposure. Since other factors usually associated with chronic liver diseases were absent or apparently irrelevant, it is temptative to speculate that a 'cryoglobulinemic hepatitis' may exist as a distinct syndrome. The characteristic complement profile of the patients with EMC (low CH50 and C4, normal C3PA), not related to albumin levels, can help to differentiate this disease from chronic liver disease without cryoglobulins.


IgA nephropathy (Clinical, pathological and immunological findings). Seventy-five biopsy samples from patients with chronic renal disorders were examined by the usual techniques of light microscopy and immunofluorescence; in fifteen patients IgA nephropathy was found. These patients were young adults; the onset of the disease was characterized by macrohematuria, and recurrent episodes of hematuria were observed. Histological examination revealed proliferative endothelio-mesangial glomerulonephritis at various stages of development with focal or diffuse patterns; immunofluorescence revealed constant and intense positive reactions for IgA mainly in association with C3. It is assumed that there is a relationship connecting the more advanced histological changes, a more severe clinical course and the presence of IgM deposits.


Plasma bile pigment conjugation modalities in icterus syndromes of various origin. Plasma azopigments derived from conjugated bilirubin were analyzed by thin-layer chromatography according to HEIRWEGH et al. in 14 cases of obstructive jaundice and in 11 of acute hepatitis. The chromatographic patterns were compared with those obtained from azopigments derived from 8 normal bile samples. The plasma pigment patterns did not differ from those of the bile in number and chromatographic mobility of the spots. However, the quantitative percentages of the plasma azopigments were significantly modified: the alpha 0 fraction (free azodipyrrolic pigment) increased in both icteric syndromes, while the delta fraction (mainly glucuronide azopigment) decreased. Moreover, the behavior of two closed components of the delta group showed significant differences in both icteric syndromes. It can be postulated that the synthesis of bilirubin diconjugates decreases both in hepatocellular and cholestatic jaundice, while monoglucuronidated as well as saccharide and glucoside conjugates increase. In cholestatic jaundice the conjugation with glucuronic acid mainly takes place in the normal way, whereas compounds with different features are formed in hepatitis.


[Radiocompetitive dosage of 25 hydroxyvitamin D and 24, 25-dihydroxyvitamin D in geriatrics. Study of seasonal variations]. Dosages of 25 (OH) D and of 24, 25 (OH) 2 D in the plasma were done in March and October in 26 women more than 70 years old, hospitalized in a semi-chronic disease hospital of the Paris area. Eleven young adults, studied in June, served as control. There was a significant decrease of 25 (OH) D and 24,25 (OH) 2 D in older individuals (pL 0,001). In march, the levels of 25 (OH) D and 24,25 (OH) 2 D were respectively 2,7 +/- 1,6 mg/ml and 0,88 +/- 0,53 mg/ml. In October the level of 25 (OH) D (5,8 +/- 2,6 mg/ml) were significantly higher (p L 0,01) whereas the level of 24,25 (OH) 2 D did not vary (0,84 +/- 0,58 mg/ml). These results are in agreement with those obtained in England. The underline the relative deficit vitamin D in older individuals. The constant decrease of 24, 25 (OH) 2 D remained unexplained.


[Cutaneous psoriasis. Symptoms and therapy]. Skin psoriasis, a multi- causal disease with unknown mechanism, has several clinical aspects. Besides ordinary psoriasis with mica-like plaques and its special locations, two less known notions are underlined: the localized forms are often less typical (for example: scalp, ears, folds of the hand, foot and nails). They may be relevant to the rhumatologist for the diagnosis the inflammatory forms are often disseminated with pustules and keratosis and constitute another groups where the rhumatologic manifestations are more frequent and more severe. Various forms of treatment are active on the cutaneous symptoms, chronic or relapsing topical therapy with  tar, corticoids, nitrogen mustard, photochemytherapy, oral derivatives of retinoic acid, and exceptionally immunosuppressors. Each technic has its advantages, its disadvantages on a short or long term. Therefore each patient should receive the therapy which is adapted to his form of psoriasis, the need and possibilities of the patient. Collaboration is a must and each patient should receive the adequate care making possible an improvement of his condition.


Heating at 56 degrees C does not eliminate immune complex-bound Clq. The effect of heating at 56 degrees C on free and complex-bound Clq was studied by radioisotope and sucrose gradient centrifugation techniques. The ability of soluble complexes of egg albumin, rabbit anti-egg albumin, and human Clq to bind extrinsic iodinated Clq did not increase following heating at 56 degrees C. The results of this study did not support the postulated release of complex-bound Clq on heating at 56 degrees C. They also showed that free Clq was more heat-labile than Clq in the Clqrs state. The importance of elimination or monitoring of intrinsic Clq in Clq assays for circulating immune complexes is stressed.


Effect of dipyridamole on the survival of experimental critical skin flaps. The effect of dipyridamole (Persantin) on the survival of experimental skin flaps was studied. In controls 39% of the skin flap area survived. Intraperitoneal injection of dipyridamole 4 mg/kg twice daily starting four hours preoperatively increased the surviving area with 18%. This increase is statistically significant (p less than 0.05). The improved survival could be due to the vasodilatory action of the drug and/or proliferation of small bloodvessels induced by the drug.


Reconstruction of articular cartilage with free autologous perichondrial grafts. An experimental study in rabbits. An experimental study in adult rabbits has been performed to find out whether the cartilage forming capacity of the perichondrium could be utilized in reconstruction of articular cartilage. The normal articular cartilage of the glenoid surface of the humero-scapular joint was completely removed. Auricular perichondrium was grafted to cover the exposed bony surface with the active chondrogenic layer of the perichondrial graft facing the joint cavity. The joint was not immobilized but the operated limb was amputated at wrist level to avoid weight bearing. The animals were sacrificed at different time intervals ranging from 1 to 17 weeks. In 12 out of 14 grafted rabbits regeneration of cartilage occurred. In 6 of 10 control cases where no perichondrium was grafted to cover the resected surface no cartilage was found. In the other 4, only small areas of mature cartilage were seen, probably remnants of the original articular cartilage.


The cartilaginous potential of the perichondrium in rabbit ear and rib. A comparative study in vivo and in vitro. In an experimental study the cartilaginous protential of the rabbit ear perichondrium has been compared with that of the rib in vivo and in vitro. Perichondrium was transferred as free autologous grafts to the subcutaneous tissue on the scalp and as loose bodies into the knee joint. The presence of cartilage in the grafts was examined after six weeks. In vitro explants of rabbit perichondrium from the ear and the rib were maintained in an organ culture system. The presence of cartilage was analyzed after one to three weeks. Rabbit perichondrium from the rib appeared to have a greater cartilaginous potential than that from the ear both in vivo and in vitro. Chondrogenesis in perichondrium was demonstrated in vitro.


Healing of membranous and long bone defects. An experimental study in growing rabbits. Different isolation models have been used for qualitative and quantitative studies on the individual roles of periosteum, cortical bone, endosteum and bone marrow in the repair of long bone defects. Corresponding skull defects were studied to evaluate also the dural osteogenetic capacity. A total of 53 operations were performed on the tibia and skull of 33 growing rabbits. The animals were killed 10-12 weeks after surgery. Ordinary rough histological methods were used for studying bone formation, and quantitative estimates were made using serial sections. The cortex, endosteum and bone marrow were demonstrated to play a minor part in the healing of tibial defects. Periosteum, on the other hand, had the most potent healing capacity. Calvarial periosteum, however, was found to be less bone producing and in that respect not to be superior to the dura. For a complete bony restoration combined periosteal and dural bone formation is necessary, also regarding the structural normalization.


Subperiosteal early resection of the mid-palatal suture. A morphological study in twelve patients operated for choanal atresia. Twelve patients with choanal atresia were operated on by a method which involves a subperiosteal resection of the hard palate including the posterior two-thirds of the mid-palatal suture. In 7 patients, admitted for reoperation, peroperative examinations revealed an osseous defect in the posterior part of the hard palate. Biopsies showed that repair in this area was mostly by connective tissue, indicating that formation of new bone, regenerated from periost, is minimal in this part of the palate. Fresh specimens from 5 previously unoperated patients and from the anterior intact part of the palate of the reoperated patients, displayed that the mid-palatal suture was not obliterated even at 26 years of age. Longitudinally orientated intrasutural fibres and signs of active growth were evident up to puberty. The suture seemed to consist of three layers.


The effect of the lip adhesion procedure on the alveolar arch. With special reference to the type and width of the cleft and the age at operation. In a material of 89 wide clefts, we measured the effect of the lip adhesion on the width of the cleft, the deviation of the maxillary arch segments, and in bilateral clefts on the premaxillary protrusion. The width of the unilateral complete cleft diminished by two-thirds, on average, depending upon decreasing positive deviation of the major alveolar segment, while the minor segment did not react at all. In unilateral alveolar clefts the effect was in principle similar. In bilateral complete clefts the width of the cleft diminished by only 40-50%, on the average, and the protrusion of the premaxilla by 8-23%, while the primarily always negative segmental deviation decreased by about 40%. The age at operation within certain limits did not seem to influence the results in any significant way. Lip adhesion is thus recommended especially in wide unilateral complete clefts as an operative orthodontic procedure to facilitate subsequent final repair.


Cutaneous malignant melanoma. Studies on the find structure of cells and their surface morphology in relation to tumour type and clinical course. Cutaneous malignant melanoma occurs in three forms: lentigo maligna melanoma, superficially spreading melanoma, and nodular melanoma. The histology, the clinical development and the biological malignancy of these tumours differ. The purpose of the study reported here was to provide a clearer picture of the surface morphology of the malignant cells and to relate their fine structure to both the tumour type and the clinical development of the malignant melanoma. This investigation of 28 tumours from 22 patients of Scandinavian origin shows that at the electron microscope level there is no difference between malignant cells in the invasion nodulus of superficially spreading melanoma and nodular melanoma. The primary tumours were often built up of 2 or 3 differently differentiated cell clones. Metastases were built up of the same cells or cell clones that were found in the primary tumour. In several cases the surface of the malignant cells was folded, and covered with microvilli, microblebs and blebs. These surface alterations could be related in several cases to changes in the cytoskeleton of the cell (microtubuli and microfilament complexes). The clinical course of the malignant melanoma could best be correlated to the histogenetic type of tumour, depth of invasion, nucleus polymorphy and the quantity and arrangement of the microfilament complexes.


Excisional biopsy and delayed wide excision versus primary wide excision of malignant melanoma. In a retrospective study of 269 cutaneous malignant melanomas in stage I the influence of biopsy on survival was studied. Sixty patients were treated with primary wide excision and 209 patients with excisional biopsy followed by wide excision. The 5-year survival rates for the two groups were 75.0% and 82.8% respectively. There was an equal distribution of prognostic factors such as thickness, level of invasion, presence of ulceration, location and maximal size of the tumours in the two groups. As excisional biopsy with subsequent wide excision gives an accurate histopathologic diagnosis and permits a more rational treatment of thin melanomas, this form of treatment is recommended.


On the pathogenesis of bedsores. Skin blood flow cessation by external pressure on the back. This paper is devoted to elucidation of the question: Which external pressure is required to stop skin blood flow at the skin - support interface in humans lying on the back in the supine position? Cessation of blood flow was recorded as cessation of washout of an intracutaneous depot of 131I-antipyrine mixed with histamine. The external pressure was measured by a small airfilled plastic cushion connected to a mercury manometer. In 11 normal subjects, eight patients with hypertension and seven patients with tetra- or paraplegia the "flow cessation external pressure" (FCEP) was strongly correlated to the auscultatory brachial mean blood pressure (p less than or equal to 0.001). The difference mean blood pressure - FCEP was on average 4 mmHg (range (-11) - (+20) mmHg) and there was no significant difference between the three groups studied. Thus external pressure exceeding the actual mean blood pressure will stop skin circulation.


Ulcus cruris recidivans caused by auto-mutilations. Case report. Two patients are reported with repeated, nonhealing wounds due to auto-mutilation. The diagnostic and psychiatric problems involved are discussed.


Acne keloidalis of the burned male face. Case report. Acne keloidalis is characterized by infected keloid-like nodules in the short-cut nuchal region probably caused by recurving, ingrowing hairshafts. A case with a deep, partial-thickness burn of the hair-bearing part of the face of a man is reported. After healing, the patient started shaving himself thus inducing a severe state of acne keloidalis. It seems advisable in males not to shave during the first eight eight to ten months after a partial-thickness burn of the face in order to avoid this troublesome condition.


Direction of spatial error in the copying of visual stimuli: the relevance of focal brain damage. Hemisphere-damaged patients and control subjects were tested by copying visual stimuli from a large display. The vertical and horizontal components of the errors and the overall accuracy were analysed with the following results: (i) all the subjects displaced downward in the left half of the display and upward in the right half, except for the left hemisphere-damaged patients with visual field defect, (ii) both left and right hemisphere-damaged patients with visual field defect displaced the copied point toward the damaged hemisphere, and generally were inaccurate only in the half of the copying set opposite to the damage hemisphere, without asymmetry between the effect of left and right posterior lesion except for the presence of unilateral neglect only among subjects with right hemisphere lesions.


[What Swiss psychiatrists think of schizophrenia]. The author has made an inquiry with all the swiss FMH psychiatrists, the subject being their opinion on the origins of schizophrenia. 69% answered. The majority of psychiatrists questioned, think that it is impossible to establish priorities between the psycho-genetical determinatives on one hand and hereditary and neuro-biochemical components on the other. The author was able to establish a ststistically significative correlation between the age of the psychiatrists and their opinion on the origins of schizophrenia. On the other hand, their opinion on the origins of schizophrenia was not influenced by the fact that a member of their family was schizophrenic.


[Vegetative parameters under the effect of ouabain (g-strophanthin) in endogenous depressive patients. 2. The acral heating rate]. In 12 patients with endogenous depression the longitudinal variations of the time of acrale reheating was measured. Under the treatment with Ouabain (g-Strophanthin) both the depth of depression and the time of acrale reheating was diminished between day 0 and 12.


[Several aspects of programming errors in the frontal syndrome]. In order to study different aspects of programming impairment, 32 patients with frontal lesions and other pathological groups were given two tasks: (a) "REY's Complex Figure" the results of which were compared to those of other graphic tasks; (b) an alternation task. The results of the first task indicate that the frontal subjects show characteristic disturbances, which are described. These patients encountered specific difficulties in the second task when the rule to be found involves asymmetrical sequences. The relationship between the different tasks and the programming impairment is discussed.


[Myelography as a cause of persistant cerebral vascular spasm]. A few hours after an ascending myelography with Pantopaque, a woman aged 52 presented light coma with signs of meningeal reaction, left hemiparesis and a central deficit of the left facial nerve. 24 hours later, a computer axial tomography revealed the presence of the contrast media (Pantopaque) in the basal cysterns. Three days after, the right carotid angiography indicated the presence of a diffuse spasm of the intracranial branches of the internal carotid artery, particularly a spasm of the cortical ascending parietal and descending temporal ones, without deplacements. A second CT investigation revealed a slow, but complete recovery of the neurologic functions in the following 10 days. According to the Authors, this clinical observation reproduces the experimental pattern of the cerebral spasm caused by the administration of a spasmogenic chemical factor in the basal cysterns, because of the following clinical aspects: blood absence in the liquor; T wave inversion (the electrocardiographic symptom considered as a predisposing factor); meningeal reaction owing to the irritation of the myelographic contrast and persistent vasospastic answer of the right carotid circle, as it may be seen in the angiographic control.


[A case contribution on the question of primary intramedullary melanoma]. The author describes a case of primary intramedullary melanoma of the spinal cord with intermittent symptomatology and further discusses problems involving the pathology, diagnostics, therapy and prognosis.


Pure word deafness and bilateral posterior perisylvian softenings: report of a case with neuropsychological-C.A.T. correlation. A case of Pure Word Deafness (PWD) with bilateral perisylvian softenings is described. The C.A.T. findings fit the classical anatomical counterpart of PWD: a nearly complete acoustic disconnection of the Wernicke area. The associated severe apraxic disorders are discussed.


[Cultures of tissue from central nervous system tumors. Part 1. Neuroglial tumors]. The authors report their experience with monolayer culture of 80 neuro-glial tumors. Of these 45 were glioblastomas and 17 astrocytomas. 7 glioblastomas gave long term lines, two of which have been transplanted into nude mice and studied by electron microscopy. The morphological and biochemical characteristics of neuro-glial tumors are discussed.


[How long does suicide threaten divorced people?]. The interval between divorce and suicide in 66 divorced men and 42 divorced women was compared with the interval between divorce and death from other causes in a control group of 87 divorced men and 93 divorced women. The interval between divorce and death was shorter on average for the suicide group than for the control group. Among men, the risk for suicide was especially great in the first half year after divorce.


[Indication for psychotherapy. Study of 233 cases]. If in the final analysis the value of the projected treatment can only be considered relative to results obtained by therapy which it has motivated, would it not be possible as implied to assure from the very beginning its effects? The author's research based on statistical and clinical analysis of 233 files drawn up by the Policlinique psychiatrique de Lausanne, between 1967 and 1975, allows an affirmative reply. And if on the one hand this work goes as far as to relativise or even to negate the capacities of the therapist (a therapist considered mediocre obtaining almost identical results to one who is not seen as such), and on the other to show that all the inconstant elements studied are no longer likely to be mastered by the medical prerogatives alone, the latter is not put into doubt but simply becomes better adjusted to prevailing socio-cultural conditions.


Prevalence of tenosynovitis and other injuries of the upper extremities in repetitive work. The purpose of this investigation was to compare the prevalence of soft tissue disorders in the neck, arms and hands between packers doing repetitive work and shop assistants with variable tasks. One hundred and fifty-two female assembly-line packers in a food production factory and 133 female shop assistants were interviewed about their symptoms and given a clinical examination of the neck and upper extremities. The number of cases of tension neck, cervical syndrome, scalenus syndrome, and humeral epicondylitis did not differ significantly between the two groups. The prevalence of tenosynovitis and humeral tendinitis was significantly higher for the assembly-line packers. The packing work consisted of static muscle work by the arms, grasping and maximal extensions of the fingers, and lateral deviations of the wrists. The movements numbered up to 25,000/workday. A relationship between some work load factors and some disorders of the upper extremities is probable.


Effects of motion load changes on tendon tissues and articular cartilage. A biochemical and scanning electron microscopic study on rabbits. The motion load of rabbits was increased by treadmill running during a 5-d period. One group ran on a level surface, while the other ran uphill. After the running, the glycosaminoglycan metabolism and scanning electron microscopic photographs of different tendon, ligament and cartilage samples were analyzed. Uphill running decreased the glycosaminoglycan metabolism of articular and costal cartilage. The clearest irregularities of articular cartilage studied by scanning electron microscopy were also seen in the uphill running group. Increasing the motion load increased the glycosaminoglycan synthesis of stretched tendons. The possible combination of general inhibitory and local stimulating effects is discussed.


[13 Years of veterinary mycological routine diagnostics. Isolation of dermatophytes in the years 1965-1977]. Over a thirteen year period (1965 to 1977) a total of 4790 skin scrapings and hair samples of animals were examined mycologically. 887 strains of dermatophytes were isolated out of 885 of these samples (= 18,5%). Most frequently Trichophyton verrucosum was identified in samples from cattle, followed by Microsporum canis isolated from cats, dogs and zoo animals. T. mentagrophytes was mainly found on guinea pigs, chinchillas and dogs and T. equinum on horses. Although the total number of the samples examined within the last 8 years increased, the total of the dermatophytes isolated remained proportionately the same. The relative numbers of the various species of dermatophytes isolated did not change within the period of investigation.


[Intradermal reactions with coccidioidins in different towns of San Luis Province]. Intradermal tests were used to determine the extent of the endemic zone of coccidioidomycosis in Argentina. We performed our endemiological study among school-aged children and grown-ups in San Luis city and in the following towns: Nogoli, Villa de la Quebrada, Balde, Salinas del Bebedero, Beazley, Fraga and Eleodoro Lobos. We employed three coccidioidins for each person--Negroni's coccidioidin, coloured coccidioidin and uncoloured coccidioidin. Reactions were usually read 48 h after inoculation. After inoculating 1,262 individuals we could read only 1,069 results. Overall, the positive reactors to one, two or three coccidioidins were 14.8%. We found no relation between positive reactors and the sex of subjects, but every group showed a noticeable relation between age and positive reactions, especially in older people. The positive reactors for each of the coccidioidins were as follows: Negroni coccidioidin: 10.1%: coloured coccidioidin: 4.9% and uncoloured coccidioidin: 5.0%.


Low-income widows and other aged singles. Based on data collected in a nationwide survey in late 1973, this report describes the living conditions, health, social activity, and attitudes of unmarried older persons at low to middle income levels--that is, below $5,000 per year. Although most previous research has focused on the special situation of widows, the current findings indicate that lower income widowers and divorced/separated/never-married persons generally experience many of the same problems as the widows and respond to them in a remarkably similar fashion. Old age without a spouse or adequate income seems to dictate the same material and social hardship regardless of whether the spouse was lost to death, divorce, or separation, or was never acquired in the first place.


Complementation of genetic disease: a velocity sedimentation procedure for the enrichment of heterokaryons. Methodology is described to enrich for heterokaryons after mammalian cell fusion. A heterogeneous cell mixture can be separated on a Sta-Put apparatus into fractions of uniform size cells by sedimentation through a 1% bovine serum albumin-5% Ficoll gradient. Unfused RAG and LM/TK- cells, differing by 10% in diameter, have been sorted by size; following fusion, larger and faster sedimenting cells were shown to be hybrids. This methodology can be utilized in genetic complementation studies of human genetic diseases where selection procedures for proliferating hybrids do not exist. When fibroblasts from individuals with Tay-Sachs disease [deficient in hexosaminidase A (HEX A-)] and Sandhoff-Jatzkewitz disease (HEX A- and HEX B-) are fused, HEX A is generated, demonstrating complementation of two different mutations. After Sta-Put fractionation, the HEX A complementation product was associated with the faster sedimenting multinuclear cells and not with the mononuclear parental cells. This methodology will facilitate detection of genetic differences in fibroblasts from related inherited disorders.


Restoration of metabolic cooperation in heterokaryons between HGPRT-deficient mouse A9 fibroblasts and chick embryo erythrocytes. Genetic determinants of metabolic cooperation were studied by fusing chick erythrocytes to HGPRT- mammalian cells. Heterokaryons were then tested for their ability to incorporate [3H]hypoxanthine and to transfer radioactive material to HGPRT- recipient cells. Chick erythrocytes (CE) have nuclei which are inactive but contain the HGPRT gene and some cytoplasmic HGPRT enzyme activity. They are unable, however, to cooperate with HGPRT- cells. Of the two mammalian cell lines used, the human GM29 line is HGPRT- and capable of functioning as a receptor cell in cooperation experiments with HGPRT+ cells. The HGPRT- mouse A9 line on the other hand is unable to cooperate. Immediately after fusion, both types of heterokaryons incorporated [3H]hypoxanthine, indicating the presence of some chick HGPRT enzyme contributed by the erythrocyte partner at the time of fusion. While the CE-GM29 heterokaryons participated in metabolic cooperation shortly after fusion, the CE-A9 heterokaryons did not. However, four days after fusion, i.e., at a time when the erythrocyte nucleus had been reactivated, the CE-A9 heterokaryons did cooperate. This suggests that in CE-A9 heterokaryons the genes required for metabolic cooperation are expressed by the previously dormant chick erythrocyte nucleus.


Somatic cell genetic analysis of transgenome integration. The site of association of the human transgenome and host murine chromosomes was determined in several subclones of a stable human/mouse transformed cell line. Chromosomes were transferred from each of three transformed subclones into Chinese hamster recipient cells, and selection was applied for the expression of human transgenome-encoded HPRT. A series of trispecific microcell hybrids was isolated and characterized for each subclone. Evidence is presented that, within  a given transformed subclone, only a single host (murine) chromosome was associated with the human transgenome. This contrasts with previous results which utilized a newly stabilized transformed cell line as the microcell donor and in which a variety of chromosomal sites of association existed. The results presented here support the view that the heterogeneity of transgenome association (integration) sites in newly stabilized transformants was due to the fact that these populations were multiclonal mixtures resulting from independent stabilization events. The initial heterogeneity in the population was subsequently reduced upon prolonged cultivation, as a subset of the original population became predominant.


Dedifferentiated variants of a rat hepatoma: analysis by cell hybridization. Two independent dedifferentiated variants, H5 and FaoflC2, derived from the Reuber H35 hepatoma, produce trans-acting diffusible substances(s) that extinguish the expression of liver-specific proteins when hybridized with a well-differentiated cell line of the same origin (Fao and Fu5-5, respectively). H5 x Fao hybrids show total and stable extinction of four liver functions and clonal variability in the expression of three others. FaoflC2 x Fu5-5 hybrids are initially flat (like FaoflC2 cells), and die in glucose-free medium where survival requires expression of hepatic gluconeogenic enzymes, but then evolve to hepatoma-like and finally round morphology; these latter cells express all liver functions analyzed including the gluconeogenic enzymes. Two exceptional clones that remained flat long enough for complete analysis showed extinction of all hepatic functions not expressed by FaoflC2 cells. We conclude that this transitory extinction reflects the action and then loss of extinguishing factor(s) contributed by FaoflC2. When crossed with BW1-J mouse hepatoma cells. FaoflC2 causes stable extinction of mouse aldolase B. We propose that production of extinguishing factor(s) is the rule for dedifferentiated variants.


Expression of fetal and neonatal hepatic functions by mouse hepatoma-rat hepatoma hybrids. In order to analyze the mechanisms implicated in the expression of differentiated functions during development, we have studied ten hybrid clones arising from fusion of cells of a mouse hepatoma characterized by the expression of only fetal hepatic functions with those of a rat hepatoma which express, like adult hepatocytes, a set of neonatal as well as fetal hepatic functions. The cells of most hybrid clones contain one set of chromosomes of each parent and coexpress the hepatic functions common to both parents. Among the hepatic proteins characteristic of only one parental line, some continue to be expressed while others are extinguished. The three functions out of the eight examined which are subject to extinction are expressed uniquely by the rat parental cells and appear only near or at birth during normal liver development. These results suggest that regulatory mechanisms (whose final effect is negative) operate in fetal cells to inhibit the expression of differentiated functions limited to a later stage of development.


Phenotype and surface antigens of mouse teratocarcinoma x fibroblast cell hybrids. Numerous colonies of hybrids between PCC4-aza 1 teratocarcinoma cells and fibroblasts of the heteroploid Cl.1D cell line were examined. All of the hybrids were fibroblasts showing extinction of the multiple developmental potentialities of the teratocarcinoma cell parent, irrespective of whether the teratocarcinoma parent was diploid or tetraploid. The hybrids did not show loss of any specific chromosome contributed by the PCC4-aza 1 cell parent. In contrast with the PCC4 parental cells which carry F9 antigens and do not express H-2b, the hybrids do not express F9 antigens and carry H-2 alloantigens of both parental specificities. These results suggest that in hybrids whose phenotype is that of the Cl.1D parent, a change may occur in the genetic program of the teratocarcinoma cells.


Distinctive properties of fucosyl glycopeptides on human teratoma cells. Fucose-labeled glycopeptides from four human teratoma cell lines of independent origin show similar elution profiles on Sephadex G-50 column chromatography. The fucosyl glycopeptides elute in two major regions: one near the void volume, the other in fractions corresponding to a molecular weight of 2500-3000. These elution profiles are very different from those obtained with the other human cell lines examined which included 3 lymphomas, 2 colon carcinomas, and HeLa. The elution profiles of the human teratomas, however, show remarkable similarities to those obtained with murine embryonal carcinoma cell culture and early mouse embryos. These results suggest that the excluded G-50 fraction may well contain glycopeptides playing a role in mammalian embryogenesis.


Ovarian localization by embryonal teratocarcinoma cells derived from female germ gells. Embryonal carcinoma cells derived from several different spontaneous ovarian teratocarcinomas of strain LT mice form tumors that are located exclusively, in many cases, in the ovaries of female mice. Embryonal cells previously unselected for site specificity localize in the ovaries regardless of route of entry of the cells, and produce very few tumors in males following intraperitoneal injections. The ovary tumors have been verified as originating from the injected cells by chromosomal and drug resistance markers, as well as by general in vitro growth characteristics. Cell-cell adhesion studies suggest specificity at the level of tumor cell-ovary organ cell interaction.


Genetic and adaptive differences in the expression of drug resistance in hybrid cells. Hybrids between Chinese hamster cells were isolated and maintained in media that were selective or nonselective for markers present in the parent cells (HGPRT and TK deficiencies, respectively). Segregation frequencies for resistance to azaguanine (AZG), thioguanine (THG), or bromodeoxyuridine (BrdU) could be enhanced for some groups of hybrids if the stock cells were maintained under nonselective conditions rather than in HAT medium. In these populations the expression of resistance was dominant or codominant even though marker patterns were recessive for the same cells in HAT. Clonal analysis showed that enhancement took place by adaptive shifts rather than by variation and selection. Segregation frequencies in hybrids were also found to differ significantly between clones isolated by replicate fusions of any two parental cell types. The basis for this heterogeneity is unknown and deserves further study.


Studies on Chinese hamster ovary mutants showing multiple cross-resistance to oxidative phosphorylation inhibitors. Several stable Chinese hamster ovary (CHO) mutants were selected after ethylmethane sulfonate mutagenesis for resistance to oligomycin, ruatmycin, venturicidin, or antimycin. These mutants shared a number of common properties. They exhibited cross-resistance to those drugs which act on oxidative phosphorylation, irrespective of the structure and site of action of the drug. All the mutants showed a reduced ability to grow in suspension and to reach high saturation densities. They were also unable to use galactose as a carbon source. The short lag period required for selection (10-15 days), the similarity of the mutation rates for resistance to each of the four drugs, the high variance/mean ratios in fluctuation tests, and the recessive behavior of the resistance marker in hybrids suggest that the mutations responsible for resistance to oxidative phosphorylation inhibitors in CHO cells are coded by nuclear DNA. Segregation experiments indicated no linkage between the oligomycin-resistant marker (OLG) AND Thg (thioguanine resistance). Oxidative phosphorylation, as measured by the rate of respiration coupled to phosphorylation in whole cells remained as sensitive to the drugs in the mutants as in the parental cell line. Glucose transport and the overall Krebs' cycle activities also appeared similar in the mutants and the wild type. All the mutants had an increased rate of lactic acid production (up to twofold), associated with increased specific activities for several glycolytic enzymes when assayed in cell-free extracts.


Resistance to bromodeoxyuridine mutagenesis and toxicity in mammalian cells selected for resistance to hydroxyurea. Mutant cell lines resistant to hydroxyurea (HU), an inhibitor of the enzyme ribonucleotide reductase, were selected from a line of Syrian hamster melanoma cells. Mutant lines were selected for resistance to 0.3 mM HU, and from these lines, second-step mutants were selected for resistance to 1.9 mM HU. The HUr lines were tested ffor their responses to 5-bromodeoxyuridine (brdU), in terms of toxicity, mutagenesis, and incorporation of BrdU into DNA. All of the HUr lines showed increased resistance to the toxic effects of BrdU. in addition, the HUr lines all were resistant to BrdU mutagenesis. Overall, there was good correlation among the levels of resistance to HU toxicity, BrdU toxicity, and BrdU mutagenesis in the HUr lines. These tests were carried out under conditions such that the parental and HUr cells incorporated equal amounts of BrdU into nuclear DNA. Therefore, the resistance of the HUr cells to the effects of BrdU cannot be attributed to decreased incorporation of BrdU into DNA. These results suggest that the HUr cells have an lateration in ribonucleotide reductase activity that simultaneously confers resistance to HU and BrdU. The properties of the HUr cells suggest that the perturbation of deoxcytidine metabolism by BrdU. The properties of the HUr cells suggest that the perturbation of deoxcytidine metabolism by BrdU triphosphate inhibition of ribonucleotide reductase activity plays a key role in the toxic and mutagenic effects of BrdU in mammalian cells.


Inheritance of malignancy in somatic cell hybrids. After a recall of the importance of early basic developments of in vitro established cell lines for investigations on malignant transformation, a survey of essential steps in the study of malignancy by means of somatic cell hybridization is presented. Since the early sixties, in vitro crosses of malignant versus nonmalignant parental cells have provided many experimental models in which mechanisms of expression of malignancy have been approached. Allogenic as well as xenogenic cell matings resulted in tumor-producing or nontumorigenic hybrids which have been analyzed, particularly in terms of karyology in order to determine possible chromosomal patterns linked with inheritance of malignancy and its suppression. The authors discuss the successive concepts devised for interpretation of experimental data, implicating specific genetic "normalizing" information, genetic dosage as well as, more recently, epigenetic and cytoplasmic mechanisms.


HLA and cancer in South African Indians. Two-hundred-and-forty-nine Indian cancer patients were tested for 39 HLA antigens and the antigen frequencies were compared with those of 603 control subjects. Comparisons were also made between cancer patients and controls for each ethnic group and for each site of cancer. There was an increase in the frequency of the HLA antigens A11 and Bw52 in patients with malignancies. Heterozygosity at the B locus was significantly increased in patients with cancer of the breast. The Aw24, B17 haplotype was also associated with breast cancer.


HLA phenotypes and cadmium blood level.

HLA phenotypes and cadmium blood level. The distribution of HLA phenotypes was studied and the amount of cadmium blood level was determined in a group of 100 healthy subjects. The HLA-A3 phenotype seems associated with high cadmium levels in the blood. The lymphocytes transformation test with PHA and different concentrations of cadmium indicates that A3 cells are more sensitive than others to inhibition by cadmium.


HLA-A, B, Bf three point association of 1,072 haplotypes in a German population. Altogether 1,072 HLA-A, B, Bf haplotypes in 536 parents of 268 German families were analyzed by gene and haplotype counting in order to investigate the two and three point association of HLA-A and B antigens with Bf alleles. In agreement with previously published data (Albert et al. 1975, Bender et al. 1977) significant positive linkage disequilibria were found for HLA-A3 and BfF, B7 and BfS, B8 and BfS, Bw35 and BfF, whereas significant negative Delta values appeared to exist for HLA-A3 and BfS, B7 and BfF, B8 and BfF, B12 and BfS, as well as Bw35 and BfS. Significant positive three point Delta values were found for the following haplotypes: HLA-A11, Bw35, BfS, HLA-Aw23, Bw35, BfS, HLA-A28, B12, BfS, HLA-A2, B17, BF, HLA-A3, Bw35, BfF, HLA-Aw24, b12, BfF and HLA-A29, B12, BfF. According to the large number of comparisons performed calculating the level of significance of the three point associations, these data have to be corroborated by further investigation. The three point Delta values, obtained by calculation from the patients' phenotypes differed markedly from those results obtained by haplotype counting.


Theoretical considerations on HLA-associated illness-susceptibility genes in dermatitis herpetiformis and psoriasis. The frequency of an HLA-associated illness-susceptibility (Is) gene can be estimated by a simple equation: the frequency of the Is gene is equal to the prevalence of the disease in the population divided by the penetrance of the illness in first-degree relatives with the HLA marker antigen, with the quotient further divided by two. This equation is valid if the gene is dominant and its gene frequency is low. An analysis of HLA data of 61 patients with dermatitis herpetiformis (DH) showed that the HLA-associated DH susceptibility gene is obviously dominant. The frequency of this DH susceptibility gene was estimated to be at least 0.0005 and the frequency of psoriasis susceptibility gene about 0.02 in Finland.


Possible microwave mechanisms of the mammalian nervous system. The hypothesis is examined that the living mammal generates and uses electromagnetic waves in the lower microwave frequency region as an integral part of the functioning of central and peripheral nervous systems. Analysis of the potential energy of a protein integral to the neural membrane compared to that of an extracellular positive ion yields major known features of action potential generation, and identification of the integral protein as a microwave emitter and absorber by changes in rotational energy state. Prolate spheroidal analysis of the adult human brain/skull cavity shows capability to support modes in the range 200 MHz to 3 GHz; spatial mode properties correspond to gross anatomy and neuromorphology of the brain. Phase-lock loop interaction between lower microwave modes and action potential conduction results in pulse microwave/action potential generation observable by EEG instrumentation as brain waves; alpha waves occur if the corpus callosum is the major neural tract involved. Spatially consistent Lorentz forces of standing microwaves provide physical basis for correspondence of spatial properties of microwave modes with brain anatomy, and for the formation of myelin sheath and the nodes of Ranvier on larger neurons.


Effect of furosemide on the ionic composition of the arterial wall. Furosemide decreased the intracellular H2O, Cl and K content and Cl concentration of dog carotid arteries incubated in normal or high K Krebs (123 mM). Cl loss exceeded K loss in normal Krebs but was of the same magnitude in high K Krebs. The findings are compatible with the inhibition of a neutral K-Cl coupled uptake.


Patterns of recovery of renal function after surgical relief of chronic bilateral partial ureteral obstruction. A canine model of bilateral chronic partial ureteral obstruction with one side severely obstructed and the other side moderately obstructed was used to determine which kidney should be released initially to facilitate maximum recovery of renal function. The data show a significantly greater return of total renal function (20%) if the more severely injured kidney is released first.


Review of experience with vesicovaginal fistula repair. Experience with suprapubic closure of vesicovaginal fistulas in 42 patients considered candidates for this procedure is reviewed. Five patients required a second operation for cure and the reasons for failure are discussed. Wide exposure with tension-free closure of well vascularized flaps and the judicious interposition of pedicled omentum have produced the most encouraging results. The litigious nature of this distressing condition is lessened when primary closure is successful and supravesical diversion by ileal or colonic conduits can be avoided.


Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. The difficult problem of a vesicovaginal fistula originally was cured surgically by Sims in 1849. During the last 25 years at UCLA and affiliated hospitals 68 patients have been treated by urologic surgeons for fistulas between the vagina and the urinary tract: 21 ureterovaginal and 47 vesicovaginal and urethrovaginal fistulas. The ureterovaginal fistulas often were complex and patients presented the most challenging diagnostic problem. However, they usually were repaired successfully by simple ureteroneocystostomy. Vesicovaginal and urethrovaginal fistulas were repaired transvaginally in 24 cases, with 70% success at the first attempt and 92% success with 2 attempts. Transabdominal or combined approaches were less successful. Only 58% of the cases were closed at first attempt. The transvaginal approach required less operating time, and resulted in less blood loss and shorter hospital stays than the transabdominal approach and will be described in detail.


One-stage operation for male transsexuals. A simplified surgical technique for a male-to-female transsexual operation has been developed and applied satisfactorily in a series of carefully selected patients. The simplicity of the technique allows relatively brief hospitalization for 1-stage sex conversion, provides satisfactory cosmetic and functional results and has not been accompanied by any untoward complications.


Experiences with urinary undiversion in children with neurogenic bladder. Six children have undergone reconstruction of the urinary tract 14 months to 14 years after supravesical diversion for neurogenic bladder dysfunction. Five are continent: 4 by intermittent catheterization and 1 by voiding to completion. One child is just beyond infancy and wets but is not yet on a systematic program. One boy was considered a technical failure despite incontinence because of progressive hydronephrosis from a non-compliant bladder but he subsequently had an augmentation cystoplasty. Urinary undiversion into a neurogenic bladder is an acceptable option as an alternative to ileal conduit revision or for reasons of patient preference, provided bladder storage capacity is adequate at acceptably low resting pressures, without incontinence.


Cis-diamminedichloroplatinum as a therapeutic agent in metastatic transitional cell carcinoma. Cis-platinum as single agent therapy was investigated in 8 patients with stage D transitional cell carcinoma of the bladder. Dramatic responses were obtained in some patients and the quality of life was improved for as long as 8 months but no cures were obtained. Also noted was an occasional marked loss of renal function as measured by creatinine clearance despite a carefully managed protocol to avert this known side effect of cis-platinum (nephrotoxicity). No auditory problems were noted in these 8 patients.


Observations on the small kidney associated with vesicoureteral reflux. Of 63 patients with reflux and renal atrophy renal dysplasia was found in 9.5%. Pyelonephritis was apparent in 81% of the atrophic lesions. Urinary obstruction or ectasia was apparent in each case with dysplasia and only 2 were associated with histologic evidence of pyelonephritis. Pyelonephritis appears to be a major causal factor in atrophy occurring in renal units with reflux. Early urinary tract obstruction or distension may predispose to renal dysplasia.


Utricular configuration in hypospadias and intersex. To evaluate the incidence and significance of an enlarged prostatic utricle in hypospadiac patients without underlying intersex 44 patients with the meatus located in the perineum, penoscrotal junction or proximal two-thirds of the penis were evaluated with cystourethroscopy immediately before the operation. There was an abnormally enlarged utricle in 57% of the perineal, 10% of the penoscrotal and none of penile hypospadiacs, for an over-all incidence of 14%. Concurrent analysis of a series of phenotypic male patients with hypospadias and intersex revealed a high incidence of enlarged utricle or the presence of a vagina masculinus. Utricular enlargement in itself does not indicate intersexuality but careful cystoscopic examination of its vault needs to be undertaken, searching for a cervix. An enlarged utricle can be a manifestation of delayed müllerian duct regression or decreased androgenic stimulation of the urogenital sinus.


Microphallus: distinction between anomalous and endocrine types. Operative treatment of microphallus has been proscribed in recent reports. It is not indicated for the more common endocrine type because of deficient gonadotropin, primary testicular disorder or end-organ defect. However, an operation may be quite necessary for the other form owing to defective morphogenesis--the anomalous type. Representative cases provide evidence that the method of treatment depends on the type of microphallus.


The role of estrogen, androgen and progestogen receptors in the management of carcinoma of the prostate. Identification of specific 17-beta-estradiol, 5-alpha-dihydrotestosterone and progesterone binding proteins in 10 patients with metastatic adenocarcinoma of the prostate is presented. A synthetic androgen radioligand (R1881) and a synthetic progesterone (R5020) were used. In all but 1 patient receptor protein assays were done before hormonal manipulation. Based on the preliminary findings it seems probable that prostatic carcinoma might be categorized for endocrine therapy similar to the method used for carcinoma of the breast.