The clinical significance of protein-bound hydroxyproline fractions in sera of patients with adult rheumatoid arthritis. Clq levels in sera of adult patients with rheumatoid arthritis (RA) were found to be significantly higher than corresponding levels of normal subjects (p less than 10(-3)) The increase in Clq observed in RA was not seen in systemic lupus erythematosus, chronic polyarticular gouty arthritis, ankylosing spondylitis, Paget's disease of bone, or Hodgkin's disease. Clq levels were determined both chemically (calculated) from the protein-bound hydroxyproline content of the euglobulin fraction) and by radial immunodiffusion. Although the estimates of Clq by these 2 methods did not agree, the increase of Clq in RA was found by the use of either method.


Hepatic abnormalities in adult onset Still's disease. Five patients with adult onset Still's disease are reported. Three had abnormal liver function tests (LFT) prior to receiving salicylates. Liver biopsy in 1 of these 3 and in another with normal LFT was abnormal. The elevated LFT returned to normal with high dose salicylate therapy coincident with remission of disease activity. It is proposed that hepatic abnormalities in Still's disease frequently reflect the underlying disease and not salicylate hepatotoxicity (SH).


Hypertrophic osteoarthropathy, phalangeal and synovial metastases associated with bronchogenic carcinoma. A 61-year-old woman with bronchogenic carcinoma simultaneously developed hypertrophic osteoarthropathy (HOA), phalangeal metastases, and metastatic carcinoma of the synovium. The right knee synovium showed several blood vessels containing carcinomatous cells. Although the association of HOA phalangeal and synovial metastases in this case is likely a chance occurrence, awareness of this possibility is extremely valuable as it has important therapeutic implications.


Plasmapheresis combined with corticosteroids and cyclophosphamide in uncontrolled active systemic lupus erythematosus. A case is described of severe systemic lupus erythematosus, uncontrolled with moderate dosage of corticosteroid and cyclophosphamide, which responded quickly after 3 courses of plasmapheresis. The result obtained with combination corticosteroids, cyclophosphamide and plasmapheresis was maintained for more than 18 months.


Lactic acid levels in cerebrospinal fluid from patients with systemic lupus erythematosus. Cerebrospinal fluid (CSF) samples from 22 patients with systemic lupus erythematosus (SLE) and 20 samples from normal controls were studied for lactic acid levels. Ten samples were obtained from SLE patients with active central nervous system (CNS) involvement and 12 from SLE patients with inactive CNS disease. The mean CSF lactic acid level in patients with SLE was 17.24 +/- 1.25 mg/dl (range 31-10.2 mg/dl) which was not statistically different to the normal control mean of 14.75 +/- 0.9 mg/dl (range 9-28 mg/dl). Thus, lactic acid levels in active or inactive CNS disease of SLE appear to be normal. Due to the fact that lactic acid levels are elevated in the CSF of patients with bacterial meningitis, lactic acid levels can be of potential value in the differentiation between bacterial meningitis and CNS involvement of SLE.


Mixed connective tissue disease. Appearance of antibodies to ribonucleoprotein following corticosteroid treatment. Antibodies to ribonucleoprotein are the serological marker of mixed connective tissue disease (MCTD). Five patients are presented who had negative or low titer anti-RNP antibodies despite characteristic MCTD. In all 5 patients antibodies to RNP appeared after they had taken prednisone for periods ranging from 3 wk to 15 months.


Long-term evaluation of colchicine in the treatment of scleroderma. Fifteen patients with PSS, 4 with CRST syndrome, and 4 with localized scleroderma have been treated with colchicine at the maximum tolerated individual doses for an average of 39 months (range 19--57). All but 2 of the 19 patients with generalized scleroderma and 3 of those with localized scleroderma improved. Patients who had had scleroderma for less than 5 yr when begun on colchicine, and those who received total doses of colchicine of more than 1,438 mg, scored a significantly higher mean response index than those with longer disease duration, or those who received less colchicine.


Pulmonary hypertension in a child with mixed connective tissue disease. Mixed connective tissue disease (MCTD) is characterized by high titers of antibody to ribonucleoprotein (RNP) in patients with features of several rheumatic diseases. We describe a child whose MCTD included arthritis, Raynaud's phenomenon, mucocutaneous ulcerations, sclerodermatous skin changes, restrictive lung disease, reduced carbon monoxide pulmonary diffusing capacity, abnormal esophogeal motility, and severe pulmonary hypertension. High antibody titers to ds-DNA and RNP were present. Clinical improvement followed therapy with prednisone and cyclophosphamide. Improvement in the degree of pulmonary hypertension was documented by repeat cardiac catheterization 8 months after the initiation of combination therapy.


The prevalence of ankylosing spondylitis among B27 positive normal individuals--a reassessment. Previous workers reported symptomatic, but undiagnosed, ankylosing spondylitis (AS) in some 20% of blood donors with HLA B27. As part of an ongoing population study, we compared 139 B27 positive individuals with 128 controls and found no differences in spinal mobility or back pain. There were no differences when all available radiographs were compared. No case of AS was identified. It is concluded that AS occurs in far less than 20% of B27 positive individuals and that the prevalence of AS is of the order predicted by conventional epidemiological surveys. Although HLA typing can be helpful in excluding AS suspected on clinical grounds, it cannot be used to confirm the diagnosis.


Resocialization of Chimpanzees. Ten years of experience at the Primate Foundation of Arizona. Sixty-one chimpanzees (Pan troglodytes) from various sources and backgrounds have been resocialized in a cage setting and integrated into social unit groupings. Rehabilitated animals have been temporarily recycled into non-destructive research and breeding projects.


Immunopathologic aspects of the HBsAg carrier state in chimpanzees. The tissue distribution of hepatitis B virus antigens was correlated with the distribution of immunoglobulins and complement and with histopathological changes. Although no circulating antibody was detected, the participation of humoral immune mechanisms in the elimination of HBsAg from the circulation was suggested by presence of HBsAg, immunoglobulins, and C'3 in germinal centers of mesenteric lymph nodes and HBsAg mixed with immunoglobulins in the mesangium of kidney glomeruli. The results support the hypothesis that the immune status of HBV chimpanzee carriers is associated with hyporesponsiveness rather than tolerance.


Structure and formation of ankylosis in Xenopus laevis. The structure of ankylotic teeth in Xenopus laevis was studied by light, transmission, and scanning electron microscopy as well as by microradiography in decalcified and undecalcified specimens. The mature teeth of Xenopus laevis are calcified from the crown to the base, fused to the jaw bone, and have no uncalcified area, such as a fibrous ring separating the tooth into the crown and pedicle. Microradiography shows that the mature tooth and jaw bone appear as an X-ray opaque area, except for the basal region of the dentine. This region is composed of an X-ray translucent area and an X-ray opaque thin layer on the lingual side of the translucent area. The mature tooth is composed of two differently calcified areas: (1) a highly calcified area, which makes up almost all of the tooth and contains a thin layer of the basal dentine on the lingual side, and (2) a lowly calcified basal dentine, which is fused to the jaw bone. Therefore, the lowly calcified area does not completely separate the dentine and jaw bone. Repeating banding patterns among the collagen fibrils differ among the dentine-forming area and the matrices of dentine and jaw bone. During the formation of ankylosis of the tooth germ, collagen bundles in the dentine-forming area accumulate directly on the surface of the jaw bone. Consequently, the mature teeth of Xenopus laevis fuse to the jaw bone directly without the mediation of the other structures.


The timing of the onset of osteogenesis in the tibia of the embryonic chick. Haematoxylin, Alcian Blue-Chlorantine Fast Red (ABCR) and the Ralis osteoid-specific stain were employed to closely follow  the histogenesis of the tibia of the embryonic chick so as to provide an accurate description of the onset of ossification. An overview of the major cytological events preceding osteogenesis in the tibia was obtained from hindlimbs of embryos of H. H. (Hamburger and Hambilton, '51) stages 16-26 (2.5-5 days of incubation) stained with ABCR. A description of the cytological changes in the periosteum as it develops from the perichondrium and an analysis of the timing of the onset of osteoid deposition was obtained from the tibiae of accurately aged and staged embryos of H. H. stages 28-32 (5.5-8 days). These tibiae were stained specifically for the detection of osteoid: the freshly-secreted, unmineralized product of fully-differentiated osteoblasts. The perichondrium transformed into a bi-layered periosteum at H. H. late stage 29 (6.5 days) while osteoid was first detected adjacent to the hypertrophic cartilage of H. H. stage 30 (6.5-7 days) tibial diaphyses. These results, correlated with the immunoflourescent studies of Von der Mark et al. ('76a,b), which revealed the presence of Type I (bone-type) collagen-synthesizing cells in the perichondria of tibiae from embryos of H. H. stage 28 (5.5-6 days), demonstrated that the onset of determination of cells for osteogenesis and the cytodifferentiation of the periosteum are not temporally coupled.


Negative attitudes toward masturbation in sex therapy. The incidence of masturbation in males and females as reported by Kinsey was cited as basic data to support Gagnon and Simon's theoretical conceptions of differences in the psychosexual development of males and females. The use of masturbation as treatment in sex therapy was reviewed. An inventory to measure negative attitudes toward masturbation was described, and four research studies supporting its construct validity was summarized. The affective-cognitive structure of masturbation-guilt was posited to inhibit masturbatory behavior and to elicit negative affects such as guilt and disgust as a consequence of masturbation. The use of the inventory measuring negative attitudes toward masturbation was illustrated using the P-LI-SS-IT model. Intensive therapy from a gestalt sex therapy perspective was illustrated as integrating the negative masturbatory schema into self-regulating awareness-expression cycles. A caution to sex therapists alerted them to the importance of awareness of emotions, fantasy, and sociosexual meanings in sex therapy rather than using masturbation as a packaged technique.


The role of dreams in sex therapy.

The role of dreams in sex therapy. The interpretive use of dreams has become an established part of all dynamic psychotherapies. Their usefulness in sex therapy has thus far not been acknowledged. For the psychodynamically oriented sex therapist dreams can be particularly valuable in furnishing an understanding of those unconscious factors that cause sexual dysfunction, those that perpetuate dysfunction, and those that interfere with efforts to treat the dysfunction. By utilizing and integrating dream material into the sex therapy format, treatment is more likely to be successful and in a shorter period of time than can be accomplished by either sex therapy or psychoanalytic psychotherapy alone.


Social skills training as an adjunct to sex therapy. Many single men and women with sex problems lack the skills or confidence to meet potential partners and develop relationships. Social skills training is presented as a useful adjunct to sex therapy with such individuals. The relative strengths of group, workshop, and individual formats are discussed as well as screening procedures, important issues and methods in such training, and the results achieved by it. As more sex therapists break away from the couples model of treatment and work with men and women without partners, the need for social skills training will increase.


Developmental human sexuality: the introduction of a new curriculum in child psychiatry training. The training objectives, content and course evaluation results of a new curriculum offering, Developmental Human Sexuality, for child and adult psychiatric residents are described and discussed.


Psychotherapy of an aging transvestite.

Psychotherapy of an aging transvestite. Proper categorization of individuals with gender dysphoria allows rational psychotherapy. The treatment of an aging transvestite who requested sexual reassignment is presented to demonstrate the clinical features of the disorder and the course of the illness. The initial task was to place the patient into the proper clinical category of individuals with gender dysphorias. The clinical details of this disorder include an episoidic course with individuals who have previously had clear masculine identities. In the past they have been labeled secondary or marginal transsexuals as well as fetishtic cross-dressers. The patient, who had a long-standing history of cross-dressing, reacted to specific life stresses by the symptomatic wish for sexual reassignment. The individual psychotherapy consisted of phases of symptomatic expression, emerging depression, interpersonal awareness, symptom resolution and disavowel of the wish for sexual reassignment. The genesis of this perversion appears to be identification with a phallic maternal figure. Discussion of the descriptive and dynamic literature is reported in relation to the reported case. Identification of important losses in this patient's recent life allowed proper diagnosis and appropriate ongoing therapy to prevent the patient from irreversible surgery for a condition that was a symptom not an ingrained belief of gender dysphoria.


What to do when non transsexuals seek sex reassignment surgery. A request for sex reassignment by a non-transsexual frequently leads to a serious confrontation between the patient and therapist. Therapists should explore and resolve the specific issues that have lead to such requests. As those issues are resolved, the non-transsexual usually drops his/her demands for sex reassignment.


A study of media effectiveness for sickle cell anemia education in a rural community. A study was done in Orangeburg County, South Carolina, in order to determine the relative effectiveness of the various mass media (television, radio, and newspaper) in delivering an educational message about sickle cell anemia. The study also focused on different subpopulations. It was found that subpopulations varied in the extent to which they were reached by the message through a given medium. This indicates that any plan for media utilization in a campaign for sickle cell anemia education should take into consideration the subpopulation at which the message is aimed.


Total lung irradiation and chemotherapy in pulmonary metastases from carcinoma of the uterine cervix and endometrium. Despite the radiocurability of stage I and II squamous cell carcinoma (SCC) of the cervix, palliation of patients with pulmonary metastases has been disappointing. Four patients with pulmonary metastases (three from cervical and one from endometrial carcinoma) were treated with total lung irradiation, followed two to three weeks after termination of radiotherapy with combination chemotherapy consisting of vincristine 1.4 mg/m(2) IV+ adriamycin 50 mg/m(2) IV + cyclophosphamide 500 mg/m(2) IV repeated at four-week intervals. Radiotherapy was delivered through a Co(60) teletherapy unit in a daily dosage of 100 rads in anterior and posterior opposing fields. After completion of irradiation in one lung, the other lung was similarly treated if involved with gross disease. Two out of four patients (both with cervix SCC) obtained complete tumor regression, whereas the other two patients had stabilization of their pulmonary lesions. The survival of the two responders was 216+ and 621 days from the start of irradiation. The two nonresponders survived 56 and 109 days. Except for one patient who died of pulmonary metastases, the remaining three patients died of metastases elsewhere. While only one patient developed radiation pneumonitis, all four had alopecia and leukopenia <4000/mm(3) from chemotherapy. Total lung irradiation and combination chemotherapy appear to have activity in the treatment of pulmonary metastases from SCC of the cervix and warrant further exploration.


Perinatal asphyxia II: Clinical management of multisystemic sequelae. This paper discusses the management of multisystemic sequelae of perinatal asphyxia. Appropriate intrapartum and subsequent adequate neonatal monitoring are an absolute necessity for the early detection of systemic dysfunctions. Prophylactic and therapeutic measures applicable to the various organ malfunctions are described.


Effect of type and duration of anemia on placental weight and villous histology. The effect of anemia during pregnancy on placental weight and villous histology has been studied in a group of Nigerian women. It has been shown that the weight of the placenta is not dependent on the type or duration of anemia that is present. Neither is there a correlation between these two aspects of anemia and the histological feature of villous fibrosis, which is an earmark of the placenta in anemia.


Pneumonectomy in Nigeria: indications and results. This report reviews the authors' experience with 35 pneumonectomies over a ten-year period at the University College Hospital, Ibadan, Nigeria. The most common indications for pneumonectomy were TB-destroyed lung and life threatening pulmonary hemorrhage due to suppurative lung disease. Malignant tumors of the lung were featured twice as the cause for pneumonectomies in this study.Results show that until 1973, when most pneumonectomies were performed for TB-destroyed lungs, the mortality rate was nine percent, but after 1973, when more pneumonectomies were performed for life threatening hemoptysis, the mortality rose to 29 percent.From this study, it will appear that penumonectomy carries a grave prognosis when performed for suppurative lung disease, when there is active and massive hemorrhage, and when performed under emergency conditions.


Obstructed groin hernia in a tropical African population. In a 15-month period, at the University College Hospital, Ibadan, 44 cases of obstructed hernia were treated by emergency operation. More than 94 percent were inguinal, but femoral hernia was not common. The ratio of females to males was 1:6.4, and more than 68 percent of hernias occurred on the right side. The youngest patient was two weeks old. One incarcerated hernial sac contained an ileoileal intussusception and a segment of sigmoid colon.


Do psychiatric outpatients need professionals? A large majority of psychiatric outpatients (70 percent) could be diagnosed by nonprofessionals, and an even larger proportion, 80 percent, of 36 patients evaluated could be treated by nonprofessionals. Where the nonprofessional needed professional assistance to diagnose and treat the patient, it was a medical doctor rather than a mental health professional who was needed in every case except one. The 36 psychiatric outpatients all had "problems of daily living" rather than "real" psychiatric illness.


Intravenous iron-dextran in the treatment of iron deficient anemia. Administration of oral ferrous salts is the preferred method of treatment for anemia due to iron deficiency. However, in certain clinical situations, the response to oral therapy may be suboptimal. Parenteral iron therapy is effective in these instances and may produce a faster response than the oral route.Of 30 patients treated by total dose intravenous infusion of iron-dextran, a prompt reticulocytosis occurred in all patients except one case associated with systemic lupus erythematosus. Hematologic improvement in this case followed remission of the systemic lupus erythematosus. Hematologic response was complete in 18 patients in five to nine weeks, but could not be evaluated in 11 cases because of recurrent bleeding. There were two adverse reactions: generalized pruritus after injection in one patient, and superficial thrombophlebitis at the injection site of another.The response to therapy in iron deficient anemia is dependent on bone marrow capacity, the severity of the anemia, and the availability of iron. Response was fastest in those who had been severely anemic for prolonged periods of time. Total dose infusion with iron-dextran is a safe and effective treatment for iron deficient anemia in selected cases. Initial response appears to be faster than that on oral therapy with the exception of those with a mild degree of anemia.


A study of tubo-ovarian abscess at Howard University Hospital (1965 through 1975). Unruptured tubo-ovarian abscess was diagnosed in 40 patients over ten years. This was three percent of 1,154 patients admitted to Howard University Hospital for pelvic inflammatory disease. The admitting diagnosis was 33 percent correct.The treatment was individualized with 23 percent receiving total abdominal hysterectomy with bilateral salpingo-oophorectomy. Twelve young women received unilateral salpingo-oophorectomy.We feel that early detection and aggressive medical treatment for pelvic inflammatory disease will decrease the incidence of tubo-ovarian abscess and the necessity for surgery.


Education for humanism in a pro-white, anti-black society. Humanism has been defined as "any system or way of thought or action concerned with the interests and ideals of people." Racism has been defined as "pro-white, anti-black paranoia." This paper treats the factors in the American racist society that serve to erode humanistic values. This erosion is especially pronounced in a racist, capitalistic society that subjugates blacks and engages in exploitation based on profit-making. The author poses six hypotheses that define the problems, implicit in which reside solutions.


International health--a traveler's alert. The human population of the earth is estimated to be approximately four billion people, the majority of whom live in developing countries of Africa, Asia, and Latin America. They are the poorer segment of the world's population and live in the world's warmest places. Infectious communicable endemic diseases also abound in these poverty areas. Millions of Americans travel to these less developed countries (LDCs), thus exposing themselves to unfamiliar health conditions. The United States no longer requires an immunization certificate for travelers from these LDCs. Tropical diseases also represent a type of pathology infrequently seen by many American medical practitioners. Additionally, the curricula of medical schools allocate only a fractional amount of time to specific disease problems of LDCs. Important gaps exist in both knowledge and application of knowledge in terms of many such diseases.The international travelers to LDCs must not be lulled into believing that travel precautions are unnecessary. Lack of preparedness can be hazardous and even fatal to international travelers. Those who purchase souvenirs such as art works and handicrafts often are not aware that these items may pose health hazards. The health professions, particularly the public health department official, should develop a continuing health education regimen in the area of health care for international travelers. The American traveling public deserves better service in this matter.


Rapport as a factor in the diagnosis and treatment of physical illness. If one fully recognizes that a patient's physical illness belongs to him, one is then led to believe that the patient has a crucial part in his treatment process-that he has information, thoughts, feelings, and experiences related to his illness that are important to diagnosis and treatment. The art of engaging the patient's willingness to share that information, and effectively encouraging his involvement in such a way as to maximize his benefits from a prescribed treatment regimen, may be defined as rapport-and it is crucial to each phase of the diagnostic and treatment process.


Experience of children with sickle cell anemia in a regular summer camp. The Sickle Cell Program of the Queens Hospital Center Affiliation of the Long Island Jewish-Hillside Medical Center arranged for a group of children from the hospital Sickle Cell Clinic to spend one week during the summer of 1978 in a sleepaway camp for healthy children. This paper analyzës the results of the experience.


The relationship of diet to blood pressure control. Sodium restriction has become an integral part of the medical management of hypertension. In general the degree of sodium restriction recommended by physicians depends upon the severity of the disease. The commonly prescribed sodium restricted diets are classified as mild and moderate. Mild sodium restriction refers to a diet in which 3.0-4.0 gm of sodium are allowed per day. Moderate sodium restriction is indicated when hypertension is more severe; 1-2 gm of sodium are allowed daily. Sodium added in the processing of foods contributes significantly to the sodium content of the diet. "Convenience" and "fast" foods are high in sodium and are not allowed the hypertensive patients. Significant advances have occurred in the past decade in the medical management of hypertension. The sodium-restricted diet remains the cornerstone of effective blood pressure control. Therefore, nutrition must become an integral part of the hypertensive treatment program.


Ego functioning during latency.

Ego functioning during latency. The latency period is an extremely important transition between the preschool years and adolescence. Normal ego functioning is described, especially cognition, socialization, motor development, and defensive functions.


International health: why are we involved? The question is often raised by various segments of black America about the logic of American involvement in international health, and why black American universities and health scientists should devote energies in this area when there are so many domestic health needs.The government's position recognizes that ignorance, want, and despair breed subversion and are counterproductive to world peace. America is economically linked to Africa and other developing nations. Black Americans are likewise linked with greater cultural ties. Black American institutions and health scientists cannot be content with merely addressing the health needs of black people domestically. The health care needs of black people around the world cry out for help.It is recognized that the domestic health needs are great and the manpower inadequate. However, black Americans have always had barriers and seemingly impossible tasks. President Obasanjo of Nigeria indicated that for black Americans "... there are two bridges to cross. The first concerns their relationship to the society in which they must live, and the second is the question of their relationship with their origins. The two are interwoven and interconnected, but still capable of separate treatment."


Endogenous uveitis in children.

Endogenous uveitis in children. Endogenous uveitis, with its ocular sequalae, accounts for a significant number of blind children in the world today. Even though these children are asymptomatic by ophthalmic history, they usually present with ocular pathology compatible with chronic intraocular inflammation. Although loss of vision is invariably due to cataract formation, fluorescein angiogram, binocular indirect ophthalmoloscopy, and fundus contact lens examination often reveal pathology of the optic nerve and retina, accounting for a significant degree of visual loss. While actual etiologic agents are usually not identified in the majority of children, toxoplasmosis, sarcoidosis, and childhood arthropathies occur with such high frequency that mention is made of these diseases. Conventional surgical procedures for ocular sequalae such as cataract and glaucoma, are known to yield poor results. Corticosteroids administered either topically, periocularly, or systemically appear to be of value in the treatment of these diseases, although control studies have not been done. Efforts to lessen the visual morbidity in these children should begin by a cross-fertilization of information between primary care physicians, pediatricians, and ophthalmologists.


Predicting minority student performance in the first medical school year. Impressions and anecdotal evidence have raised concerns that traditional cognitive measures of past performance may not be predictive of the performance among minority students in medical school. This study assessed the relationship between nine objective measures and actual first year academic performance for cohorts of minority students enrolled in a single medical school between 1973 and 1976.The findings support previous impressions that objective measures together explain less than half of the variance in academic performance. Furthermore, the cumulative undergraduate college average and the competitiveness of the undergraduate college are consistently the strongest predictors of academic performance among this group.


Digitalis in pneumonectomy and its implication. Between 1968 and 1977, 87 patients underwent pneumonectomy at Rhode Island Hospital. Postoperatively, 25 patients developed arrhythmia (29 percent), giving rise to hemodynamic deterioration necessitating aggressive treatment. There were nine hospital deaths (10 percent). The effect of preoperative digitalis was analyzed in 68 patients over age 50 years.In Group 1, digoxin was not used until the onset of arrhythmia. There were 40 patients in this group; 18 developed arrhythmia (45 percent) with four deaths (22 percent).In Group 2, patients were given digitalis preoperatively. There were 28 patients; six developed arrhythmia (21 percent) with no deaths.Thus, the high incidence (45 percent in Group 1 and 21 percent in Group 2), as well as risk of mortality (4/18 patients) from arrhythmia following pneumonectomy, in patients over 50 years of age without digitalization, is a strong indication for preoperative digitalis.


Metastatic brain tumors in two predominantly black hospitals: a statistical analysis. A retrospective statistical analysis was done on metastatic brain tumors collected from two predominantly black hospitals in Washington, DC. A composite African series of metastatic brain tumors was also constructed for comparison. The results indicate that bronchogenic carcinoma is the predominant metastatic brain tumor (45.2 percent) among American blacks in Washington, DC, and chorioepithelioma, the most common (20.0 percent) among African blacks. In comparing these two series, much dissimilarity in the pattern of tumor distribution between these two genetically related ethnic groups suggests an important environmental role in the genesis of metastatic brain tumors.The present study also reveals a relatively high proportional frequency of prostatic carcinoma among metastatic brain tumors in blacks (3.8 percent in Washington, DC, and 2.1 percent in Africa).


Sjogren syndrome presenting as pulmonary pseudolymphoma: report of a case. A case of pulmonary pseudolymphoma and Sjogren syndrome is presented. Unusually, the lung involvement preceded the salivary disease by more than two years. The initial gammopathy and abnormal serologies are more consistent with uncomplicated Sjogren syndrome, but were present when the pseudolymphoma was solely apparent.


Reflections on the current status of the national sickle cell disease program in the United States. Some clouds of concern now appear on the horizon for the national sickle cell disease program. There is flagging general attention by the black population and a dilution of interest in and visibility of the sickle cell problem brought about by political maneuvering to bring the program under the legislative umbrella of many other genetic diseases (which occur predominantly in Caucasians). In addition, the federal program has recently phased-out six comprehensive sickle cell centers and imposed budgetary cutbacks in the remaining centers. The victims of this disease, the black population in general, and the researchers and investigators who seek ways to bring this disease under control need reassurance from the current national administration that the sickle cell program will not be permitted to die a slow death from financial attrition, attenuation of interest, and skillful neglect leading to the phasing-out of another "minority project." The national sickle cell program, in the relatively short span of six years, has made significant and notable progress not only in research endeavor but also in improved patient care and community-wide education. In this context, certainly, the positive aspects of the national sickle cell disease program continue to far outweigh any negative ones.(1)


A follow-up study of the geographic distribution of selected malignancies among Kentucky residents, 1969-1976. A study of 533 brain tumors, 339 lung tumors, and 299 breast tumors was made in a contiguous six-county area of Kentucky to determine if a previous clustering of brain tumors with a rate 3.37 times the state rate still existed. No significant difference in incidence by age, sex, or race could be found between this six-county area and the entire state. It was therefore concluded that either the original study constituted a statistical artifact, or that the factors responsible for the initial observed increase are no longer operative.


Experience with bronchiectasis in Nigeria. Between April 1975 and March 1978, 54 patients were treated for bronchiectasis at the University College Hospital, Ibadan. The sex distribution was equal and ages of the patients ranged from five to 67 years with a peak incidence of the disease in the third and fourth decades of life.One third of the patients had tuberculous bronchiectasis with destroyed left lung syndrome, another third had chronic sinusitis, while nine percent had sickle cell hemoglobinopathy. One case of Kartagener syndrome, pulmonary aspergillosis, poliomyelitis, and aspiration of a foreign body were associated with bronchiectasis.Factors influencing the clinical course and prognosis of this disease in this environment include life threatening hemoptysis, bilateral disease, associated lung abscess or empyema, malnutrition, and chronic anemia.Twenty-six patients were treated conservatively with one death, while 28 patients were treated surgically with three deaths. Twenty percent of the surgical patients developed recurrent bronchiectasis within one to 31/2 years, in lobes which were bronchographically free of disease prior to surgery. These findings suggest that bronchiectasis is a progressive disease and that elective surgery for localized disease probably does not affect its clinical and natural history in this environment.


Effects of cockroach salivary secretions and serum on human blood cells. Salivary fluids of Blaberus craniifer, a common pest species of cockroach, were found to produce leukocytolysis and hemagglutination reactions of human blood cells under in vitro conditions. Blood sera from these insects produced similar reactions, as well as the capacity to lyse human erythrocytes. The cockroach is known to regurgitate while feeding. These findings suggest the potential of the insect to induce adverse effects on human blood cells as a consequence of persons being bitten or having lesions that serve as skin sites for cockroach feeding.


Bilateral pneumothoraces secondary to colonic endoscopy. Fiberoptic colonoscopy has significantly altered the managment of patients with colonic diseases. Complications of colonoscopy are not common, but most often include hemorrhage and perforation. This report describes an unusual and interesting case of colonic perforation related to fiberoptic colonoscopy in which the perforation presented as bilateral pneumothoraces.


Carcinoma of the esophagus.

Carcinoma of the esophagus. Carcinoma of the esophagus, previously thought to be rare in West Africa, is now known to be relatively common in Ibadan. In a 39-month period, extending from January 1975 to March 1978, 30 cases of esophageal carcinoma were seen on the surgical service of the University College Hospital, Ibadan. Males were affected more than females by a ratio of 2.3 to 1, and the highest incidence was found in the sixth and seventh decades. Many of the affected people belong to the low socioeconomic class. The predominant cell type is the squamous cell carcinoma and the most common site is the lower third of the esophagus (51.85 percent), followed by the mid-thoracic esophagus (29.6 percent). Because most patients presented very late in the course of the disease, only 11 patients had esophagectomy and esophagogastrostomy. Six of these (54.6 percent) recovered from the operation and were discharged. Only one patient had an insertion of a Mousseau-Barbin tube. In our environment, where there is no adequate radiotherapy facility, resection of esophageal carcinoma is recommended when feasible, even as a palliative measure.


Echocardiographic comparison of black and white hypertensive subjects. Echocardiography was used to compare cardiac structure and function in 35 pairs of hypertensive blacks and hypertensive whites matched for age, sex, level and known duration of hypertension, treatment status, and renin level.Echocardiographic abnormalities were common in both groups and included increased ventricular septal thickness and/or left ventricular free-wall thickness in 51 percent of black hypertensives and 69 percent of white hypertensives. Paired analysis indicated no significant difference between black and white hypertensive subjects in any of the echocardiographic parameters including ventricular transverse dimensions (at end diastole and at end systole), left atrial and aortic root dimensions, left ventricular ejection fraction, and mitral valve E-F slope. Thus echocardiographic evaluation of black and white hypertensive subjects, matched for clinical characteristics, suggests a similar prevalence of cardiac abnormalities in the two groups.


Radiology of the acute surgical abdomen in infants and young children. The most common nontraumatic acute surgical lesions of the infant abdomen are considered. These abdominal lesions are divided into those which do and do not cause bowel obstruction. Lesions causing bowel obstruction are almost always identified as being surgical and are usually appropriately treated. Most common in this group are incarcerated inguinal hernia and malrotation. Among the non-obstructive lesions, appendicitis is the most common and frequently very difficult to diagnose in this age group. The early use of a barium enema is advocated if appendicitis is a diagnostic possibility. Profound ileus can be seen in a variety of medical conditions and several examples are cited.


Hematologic and myelogenous effects of inhaled benzene in the pig and the rat. Four groups of 4 domestic pigs were exposed to 0, 20, 100, and 500 ppm benzene vapor 6 h/d, 5 d/wk, for 3 wk. Two groups of 10 rats were exposed to 0 and 500 ppm: the exposed rats for 6 h/d, 5 d/wk, for 3 wk, the nonexposed rats for 6 h/d, 5 d. Rats were killed within 72 h after exposure; values for pigs were obtained shortly after exposure and on final examination at 4-16 wk after exposure. Pigs were evaluated for changes in white and red blood cell counts, hemoglobin level, lymphocyte count, proportion of E-rosette-forming lymphocytes, myeloid-erythroid ratio, and presence of multinucleate erythroblasts. With the exception of the E-rosette test, the same parameters were measured in the rat. Statistically significant (p less than 0.05) depression of white cell counts, total lymphocytes, and proportion of E-rosette-forming lymphocytes was observed in pigs exposed to 500 ppm; recovery to values not significantly different from control values was observed on final examination. Fewer postexposure effects were seen at 100 ppm, and there were no significant differences from control values at 20 ppm. Both pigs and rats exposed to 500 ppm showed a significant decrease in the mean myeloid-erythroid ratio within 72 h. These values returned to normal in the pig 4-16 wk after exposure; recovery in the rat was not evaluated. An increased number of bone marrow erythroblasts with more than 2 nuclei was found on final examination of pigs exposed to 500 and 100 ppm, but the difference was significant only at the 100-ppm level because of the variability at the higher level. A significant increase (p less than 0.004) in multinucleate cells was seen in the rats exposed to 500 ppm.


Toxicity of 0.4- and 0.8-microm sulfuric acid aerosols in the guinea pig. To determine mortality caused by inhaled sulfuric acid mist, groups of Hartley guinea pigs 2-3 mo old were exposed for 8 h to graded concentrations of aerosols of 0.4 or 0.8 microm mass median aerodynamic diameter. Relative humidity during exposures was maintained at 70-80%. Based on probit analysis, the concentration required to produce 50% mortality (LC50) for deaths to 21 d after exposure was 30 mg/m3 for the 0.8-microm aerosol. For the 0.4-microm aerosol, the LC50 was above 109 mg/m3, the highest concentration obtainable at that particle size. At both particle sizes, the animals either tended to develop severe dyspnea and die minutes (0.4 microm) or hours (0.8 microm) thereafter or appeared nearly unaffected. Lesions in animals that died as a results of 0.4-microm exposures were restricted to hyperinflation; animals that died as a result of 0.8-microm exposures also showed hemorrhage and transudation. No gross or histopathologic changes were observed in animals that appeared unaffected during exposure. Differences in total and/or regional respiratory tract deposition may account for the different responses to the two aerosols.


Human biochemical response to ozone and vitamin E. To determine whether vitamin E (dl-alpha-tocopherol) supplementation of the diet provides protection from inhaled oxidants such as ozone (O3) in community air pollution, its effects were studied in healthy adult volunteers, Experimental groups received 800 or 1600 IU of vitamin E for 9 wk or more; control groups received placebos. Double-blind conditions were maintained throughout the study. Biochemical parameters studied included red blood cell fragility; hematocrit and hemoglobin values; red cell glutathione concentration; and the enzymes acetylcholinesterase, glucose-6-phosphate dehydrogenase, and lactic acid dehydrogenase. No significant differences between the responses of the supplemented and placebo groups to a controlled O3 exposure (0.5 ppm for 2 h) were found for any of these parameters. The results indicate that vitamin E supplementation in humans, at the levels employed in this experiment, gives no added protection against blood biochemical effects of O3 in intermittently exercising subjects under exposure conditoins simulating summer ambient air pollution episodes.


Toxicity of abrin and ricin in mice and dogs. Mice and dogs, were treated iv with the cytostatic proteins abrin and ricin and observed for clinical, biochemical, and morphological aberrations. In both mice and dogs death occurred within a narrow dose range. Dogs given toxic doses of ricin and abrin showed weakness, anorexia, apathy, and moderate fever. No signs attributable to the central nervous system were observed. Dogs dying from intoxication expired after 15-40 h. After nonlethal doses the animals recovered, apparently completely, in 1-3 wk. No delayed changed were observed in dogs after 4 mo. Abrin and ricin, in contrast to most other cytostatic agents, did not inhibit myelopolesis. However, after sublethal dpses a rapid but translent decrease of peripheral thrombocytes was observed. No evidence for specific liver damage or impairment of kidney function was obtained. Few abnormalities were observed at autopsy or on microscopic and electron microscopic examination of the tissues, in contrast to the findings of some earlier investigators. The results indicate that in mice and dogs given sublethal doses of highly purified toxins the symptoms are reversible. There was no finding militating against a phase 1 clinical trial.


Interspecies comparison of carcionogenic potency. For guidance in decisions on how to safeguard humans from carcinogens, it is necessary to use data on carcinogenesis in animals. This paper disucsses how such data, combined with human experience, may be used quantitatively in such decisions. It is demonstrated empirically that good correlations exist between different species for suitably defined carcinogenic potencies for various chemicals. This allows sufficient accuracy in extrapolating form animal data to human risk to support a logical scheme for the evaluation of such risks. Some recommendations for future research are given.


Toxicity of Secalonic acid D.

Toxicity of Secalonic acid D. Toxicity of secalonic acid D was examined by using lethality, growth retardation, and histopathology as indexes. The ip LD50 values of 37, 31, and 27 mg/kg were obtained for Charles River CD-1, Texas (ICR), and Sprague-Dawley (CF-1) strains of mice, respectively. The ip LD50 was 52 mg/kg in female CD-1 mice. The iv LD50 was 25 mg/kg in CD-1 male mice. Oral LD50 values of 400 mg/kg in male CD-1 mice and 25 and greater than 400 mg/kg in Sprague-Dawley day-old and weanling (21 d) rats of both sexes, respectively, were obtained. Doses of 20 mg/kg or more ip retarded growth and doses of 30 mg/kg or more ip were lethal to CD-1 mice. Oral doses required to produce such effects in day-old rats were 5 and 20 mg/kg (or higher), respectively. All ip doses of secalonic acid D caused pulmonary atelectases and foccal peritonitis in male CD-1 mice. The latter involved surfaces of abdominal viscera and produced limited subcapsular necrosis of hepatic parenchyma. Exposure to a single lethal dose iv (25 mg/kg or more) of secalonic acid D caused limited hepatic portal necrosis but no peritonitis or other associated local effects observed in CD-1 male mice after ip exposure. Cytoplasmic liposis and loss of glycogen and RNA from hepatocytes were observed in a single mouse receiving 50 mg/kg iv. Death resulting from cardiac and/or pulmonary insufficiency was suggested by atelectasis, pulmonary hemorrhages and edema, and massive atrial dilation in mice that died after lethal ip or iv doses of secalonic acid D. Five daily sublethal ip doses in CD-1 male mice resulted in dose-dependent mortality (LD50, 11.5 mg/kg) indicating cumulative effects.


Distribution, retention, and elimination of pyrene in rats after inhalation. Pyrene was measured in tissues of Fischer 344 rats are various times after inhalation of pyrene aerosols (500 microgram/l; mass median diameter, 0.3-0., micrometer) for 1 h. Significant quantities of pyrene were found in nasal turbinates, trachea, lungs, kidney, and liver immediately after exposure. Clearance from the respiratory tract was rapid; concentrations in the trachea and lungs 48 h after exposure were 20 and 5% of the concentrations present 1/2 h after exposure. Pyrene also cleared from liver and kidney at a relatively rapid rate; concentrations in these tissues 48 h after exposure were approximately 10% of those 1/2 h after exposure. Concentrations in the gastrointestinal tract 24 h after exposure were 4 times those found 1/2 h after exposure. Pyrene cleared from the gastrointestinal tract approximately 4 d after exposure. Thus, inhaled pyrene is rapidly cleared from the respiratory tract by mucocilliary action from the trachea and bronchi and by translocation from the respiratory tract to the liver and kidney; it is eliminated primarily through the gastrointestinal tract.


Normal levels of cadmium in diet, urine, blood, and tissues of inhabitants of the United States. Cd was measured in the feces, urine, blood, and hair of U.S. inhabitants without known high Cd exposure in Chicago, Illinois, and Dallas, Texas, and in autopsy tissues of accident victims in Dallas. The average intake of Cd in food was estimated to be 13-16 microgram/d and was higher for males than females. The average levels of Cd were 0.59-0.77 microgram/l in urine, 0.09-0.11 microgram per 100 ml in blood, 0.83-1.10 microgram/g in hair, 21 microgram/g in kidney cortex, 1.2 microgram/g in liver, 0.067 microgram/g in muscle, 0.58 microgram/g in pancreas, and 0.040 microgram/g in fat. Hair Cd was higher for males than females. Cd levels increased with age in urine and all tissues and were higher in cigarette smokers than nonsmokers in urine, blood, and all tissues.


Investigation of molluscicidal activity of certain Sudanese plants used in folk-medicine. I. A preliminary biological screening for molluscicidal activity of certain Sudanese plants used in folk-medicine. A preliminary biological screening for molluscicidal activity of certain Sudanese plants used in Folk-medicine was carried out. 78 samples belonging to 51 species, 45 genera and 28 families were screened. The aqueous extracts of 18 samples belonging to 8 species, 6 genera and 5 families were found to be active against Bulinus truncatus and 7 of these were also found to be active against Biomphalaria pfeifferi. Successive extraction of the 18 active samples with petroleum ether, ethanol and water showed that the petroleum ether extracts of only 4 samples were active against Bulinus truncatus; while the alcoholic extracts of 16 samples were found to be active against the same snail species. Only the alcoholic extracts of 4 samples were proved to be active against Biomphalaria pfeifferi. In the successive extraction technique, only the aqueous extract of Gardenia vogelii fruit pulp was proved to be active against the two snail species tested.


Investigation of molluscicidal activity of certain Sudanese plants used in folk-medicine. II. Molluscicidal activity of the different morphological organs of Gnidia kraussiana Meisn "abu gotna" family Thymelaeaceae. The molluscicidal activity of Gnidia kraussiana Meisn leaf, stem and root was studied. Each morphological part was extracted with cold and boiling water, different organic solvent and successively with organic solvents of increasing polarity. Throughout it was found that the extracts of the root were the most potent followed by the stem. Boiling water extracts were more potent than cold water extracts, while in case of extraction with different organic solvents, the petroleum ether extracts of the root and stem were the most potent, while for the leaf, the ethanolic extract was the most potent. On successive extraction, the petroleum ether extracts of all organs were the most potent. Saponification of the petroleum ether extract of the root was carried out and the activity of the different fractions were tested. Different extract fractions were obtained from the 80 per cent ethanolic percolate of the root. Some of the physical properties and the phytochemical screening of the successive extractives of the three organs were studied.


Evaluation of the paralyzed face.

Evaluation of the paralyzed face. The face is a dynamic organ of expression and communication. It is the most important area for recognition and identification of an individual. Paralysis of the face disturbs these social factors deeply. An understanding of facial movment and anatomy is presented to allow for better cosmetic and functional analysis. Hence, medico-legal documentation and the selection of the appropriate techniques for surgical rehabilitation becomes a simpler task.


The use of lymphocyte transformation and IgM estimation as diagnostic aids in leukaemoid reactions. Twenty-two patients with lymphocytosis and sometimes accompanied by splenomegaly selected from our difficult diagnostic cases over the past two years are presented. The clinical and laboratory features pointed to one of the following: chronic lymphatic leukaemia without lymphadenopathy, lymphosarcoma or other lymphoreticular tumour, tropical splenomegaly syndrome with a lymphatic leukaemoid reaction. The precise diagnosis was usually made by haemotological laboratory tests - viz. (a) Lymphocytes transformation test (LTT) (b) Serum/Plasma IgM estimation. It was found that: (1) There was markedly raised IgM in the responders i.e. patients with Tropical Splenomegaly Syndrome (TSS) whose spleens regressed following treatment with antimalarials, contrasting the normal levels of IgM in the non-responders to antimalarial therapy. (2) The PHA - Lymphocytes Transformation in the TSS was normal while that of Chronic Lymphatic Leukaemia (CLL) was abnormally low. These combined tests (LTT & IgM) are recommended as investigations for leukaemoid reactions involving lymphocytes.


A focus of human fascioliasis in the Nile Delta, Egypt. This study was carried out in Abis II village. A representative sample of the population was examined for parasitic infections. Of these 40 cases were positive for Fasciola ova and the diagnosis was confirmed. The prevalence of fascioliasis was 7.3 per cent. The egg size was determined in both human and animal samples. Although the ova measurements corresponded in many instances to Fasciola hepatica, yet the identification of the Fasciola spp. needs further investigations.


Extratemporal facial rehabilitation.

Extratemporal facial rehabilitation. Treatment of the paralyzed face has made significant advances over the past 30 years. Evaluation of the paralyzed face with the concepts of early and delayed extratemporal facial rehabilitation and a review of the multiple methods of re-animation are discussed. Dynamic reconstruction is preferred to static methods except under special circumstnces. The many modalities of treatment include nerve grafting or crossover, regional muscle transposition or free muscle grafts, muscle interdigitation, and nerve implantation with the static methods of fascial stripping and rhytidectomy used in exceptional cases.


Chronic hepatitis B antigenaemia in patients with hepatosplenic schistosomiasis. Thirty-five male patients with decompensated hepatosplenic schistosomiasis were longitudinally studied and divided into 3 Groups; with hepatitis B surface antigen (HBsAg) or antibody (anti-HBs) and a control group negative to both. Patients with HBsAg were persistently carrying the antigen as estimated by radioimmunoassay (RIA) for up to 3 years and when compared with the other 2 groups, they had significantly higher serum glutamic transaminases, their liver biopsy showed more destructive liver cell lesions in the form of chronic active hepatitis or liver cirrhosis, they were refractory to diuretic treatment and had higher mortality rate (64% in 3 years compared to 22% and 33% in the other 2 groups). The majority of patients with dual infection are at greater risk in spreading hepatitis B as they proved to carry the 'e' antigen.


Laryngotracheobronchitis--a continuing challenge in child health care. Laryngotracheobronchitis (LTB) continues to occur in epidemics necessitating many hospital admissions. A short barking cough, stridor with a crowing sound on inspiration, and retractions of the intercostal respiratory muscles are hallmarks of the disease. LTB is most frequently a viral disease causing acute inflammation of the subglottic area, the trachea, and the segmental bronchus. Increasing subglottic edema and generalized fatigue of patients with this disease can cause progression of airway obstruction. Respiratory and cardiac arrest follow unless an immediate airway is established. The management of LTB is primarily medical and consists of moist air, sedation, close observation, and occasionally antibiotics. Patients with respiratory difficulties severe enough to require intubation should undergo direct laryngoscopy and bronchoscopy to rule out other causes of airway obstruction.


Immunological evaluation of children undergoing tonsillectomy. This study was carried out on 80 patients undergoing tonsillectomy for chronic tonsillitis. Twenty healthy school children in the same age group were investigated for control values. Ten children were also available for evaluation of any immunological change after tonsillectomy. No significant variation was seen in the serum IgG, IgA, and IgM levels before and after tonsillectomy. Peripheral absolute lymphocyte count was higher in the pre-operative cases as compared to the control group, and this count became near normal following tonsillectomy. Skin tests with recall antigens PPD and Candida and contact sensitizing agent 2:4 DNCB showed an improved cell mediated immune response following tonsillectomy.


An unusual cutaneous amoebic ulcer.

An unusual cutaneous amoebic ulcer. A case of cutaneous amoebic ulcer, a rare extra-intestinal lesion in the skin of the leg, is presented. The diagnosis was made after examination of ulcer exudate and skin biopsy. The possible mode of infection of the skin is discussed.


Congenital angiodysplasia of the parotid area--report of two cases. Two cases of angiodysplasia of the parotid area are reported. Both appeared to consist of an anomalous mature venous mass. Both patients complained of a swelling which grew hard and bulged when the internal jugular vein pressure was elevated. Venography demonstrated venous enlargement while arteriography failed to demonstrate small arterial communications such as were present in one case. Radical surgical resection was successfully performed. Pathogenesis, classification, and treatment of these lesions are discussed.


Ectopic thyroid tissue--a review of the literature. With only two cases in 20 years in their service and considering the low incidence of ectopic thyroid gland, the authors present a review of the literature with emphasis on clinical and pathological description and modern medical or surgical management of this entity known as ectopic thyroid gland.


Leprosy in Libya (Benghazi): a clinical study. A clinical study of leprosy as it occurs in the Eastern part of Libyan Arab Republic (Benghazi) is presented. Lepromatous leprosy was the commonest type (76.47%) observed. Maximum number of cases were seen in the age group 20--49 years. An insight into the magnitude of the leprosy problem in the Libyan Arab Republic is presented.


Surgical treatment of extensive tumors of the lateral face and auricular area by radical soft tissue and subtotal temporal bone excision with deltopectoral flap coverage. A method of excision of extensive tumor in the parotid and peri-auricular area with a partial temporal bone excision in discontinuity, has been described. In selected tumors local control has been as satisfactory as following more radical en bloc soft tissue and temporal bone excisions and without significant morbidity or operative deaths. The results in 15 patients treated by this method are described. The authors believe that the small number of patients in this and other reported series does not accurately reflect the frequency of tumors which could be treated successfully by this method, but does reflect a reluctance to advise the better known radical en bloc temporal bone excision with its associated morbidity and operative mortality.


Management of brachial plexus tumors.

Management of brachial plexus tumors. Three cases are reported of brachial plexus tumors that presented as a lump in the neck. Problems that arise when faced with such a diagnosis are discussed. A suggested protocol of management of these cases is described. The possibility of a brachial plexus tumor should be included in the differential diagnosis of a patient presenting with a mass in the neck.


Diagnostic precision in a new rotatory vestibular test. Quantification of the vestibulo-ocular reflex for the purpose of clinical diagnostics is dependent upon measurements within that portion of the dynamic range which has a constant gain, independent of visual contamination. Head oscillation at about 3 Hz is characterized by unity gain irrespective of visual influence. At lower frequencies visual tracking dominates compensatory eye movements and fixation suppression of the VOR can be quantified precisely. The new test is based upon power spectral analysis of compensatory eye movements during rotatory stimulation on a powerful hydraulic rotation chair. There is evidence suggesting that this test can precisely quantify vestibular lesions and provide side detection of peripheral damage.


[A procedure for avoiding reflux in uretero-ileal implantations during enterocystoplasty (author's transl)]. Excellent results are obtained when treating infiltrating bladder cancer without lymph node invasion, by means of a total prostatocystectomy and replacement enterocystoplasty using an ileal loop: 66 per cent survival after 5 years and 51 per cent after 9 years. It appeared logical to the authors to try to prevent urine reflux into the ureters in order to prolong survival. Their procedure consists of burying half of the length of the 4 cm long ureteral stump between the mucous and muscle layers, leaving the other half free in the ileal lumen. No cases of stenosis or reflex occurred during 10 consecutive ureteral implantations in 6 patients, but there has been an insufficient follow-up period for any definite conclusions to be drawn.


[Double ureter with one blind branch (author's transl)]. The authors report the 22nd case of double ureter to be published in the literature, in which one ureteral branch had a blind ending and did not terminate in any parenchyma. The condition was discovered during on antireflux operation for reflux in the lower pelvis of one Kidney which was known to be duplicated, and reflux in an apparently single contralateral pelvis. The pathological implications of this blind ureter are not well defined. The embryogenesis of the ureter and of ureteral duplications is reviewed and a general classification of double, bifid, and blind ureters outlined. Double ureter with one blind branch are three times more frequent in women than in men and are associated in 30 per cent of cases with contralateral bifid or duplicated ureters. The published literature is reviewed in detail.


[Revascularization of bladder neoplasms after percutaneous embolization of the hypogastric arteries]. The authors report a case of revascularization through the inferior mesenteric artery of a bladder tumor, which had previously been treated by embolization of both hypogastric arteries because of hemorrhage. Percutaneous embolization of the hypogastric arteries with various types of material has stimulated considerable interest among urologists, when used to treat hematuria which cannot be checked in patients with inoperable vesical neoplasms. As described by various authors, a tissue adhesive, N-butyl-2-cyanoacrylate (Blue histoacryl = Braun), which produces definite and irreversible circulatory arrest in the circulation in the neoplastic mass, was studied. The use of this material, introduced into clinical practice in Italy, especially by Giulian's school after many animal experimental studies, appeared to the authors to be elective in certain cases studied. The first patients in which it was used produced very convincing results as the hemorrhagic symptoms stopped immediately, without any obvious secondary reactions being observed. In one case, however, the immediate good result was followed by a return of the hemorrhage 6 months later.


[Cowper's canals and glands. Pathological manifestations and radiologic aspects]. From 11 personal case studies, the authors conduct a general review of the problems raised by Cowper's glands. Cowper's glands, accessory sexual glands, are made up of main glands situated behind and on either side of the bulbar urethra right at the level of the urolgenital diaphragm and of accessory glands situated in the thickness of the bulbar spongy body. The main glands are drained by long canals (several centimeters in length) which empty into the bulbar urethra by paramedian orifices. The fusion of these canals into one single canal at the urethral opening, although rare, could lead to obstruction. These canals can be the site of cystic dilatation ranging from a few millimeters to as much as 6 cm in diameter. These cysts are rarely due to terminal canal obstruction as the result of chronic inflammatory urethritis. Most often they are congenital. The cysts which develop at the level of the accessory glands are usually obstructive while those which develop at the level of the main glands rather have a perineal expansion. The indicative signs of this particular pathology are not specific (pyuria, hematuria, enureis, known urethral stenosis, dysuria with pollakuria, perineal pain with post voiding urethral dripping). Voiding urethrography investigation (the best) shows: --either cystic dilatation seen as a lacuna on the ventral aspect of the urethra, --or opacification of the dilated cavities of the exretory canals which have been spontaneously broken or opened by endoscopic manoeuvres. The opacification of these cavities leads often to the erroneous interpretation of "diverticula" of "incomplete duplication of the urethra" and yet their essential characteristic is twofold: they are oriented in an anterior-posterior direction with respect to the urethra and lead back and away from it; they have a canal type of morphology for at least part of their course.


[General pharmacology of cefadroxil (author's transl)]. The general pharmacological properties of cefadroxil which is a new semisynthetized cephalosporin were examined and following results were obtained. 1) Cefadroxil had no appreciable influences on the central nervous system in mice and the EEG in cats. 2) Cefadroxil had no effects on the isolated smooth muscle organs. 3) Cefadroxil had no effects on the passage of charcoal meal in mice and the motility of the stomach in situ in rabbits. 4) Cefadroxil inhibited the gastric secretion in pylorus-ligated rats. 5) Cefadroxil induced no marked changes in the respiration, blood pressure, heart rate, electrocardiogram and femoral blood flow in anesthetized dogs. Cefadroxil had no effects on the isolated hearts and ear vessles of rabbits. 6) Cefadroxil decreased the urine volume and the excretion of electrolytes (Na+, K+ and Cl-) in first three hours in rats. 7) Cefadroxil increased the biliary secretion in rats. No significant effects of cefadroxil were found in the other pharmacological experiments.


[Absorption and excretion in constant infusion of cephaloridine (author's transl)]. Using 6 healthy adult male volunteers, who were divided in halves, the serum and urinary levels of cephaloridine were determined during and after 2-hour constant drip infusion of 2 g cephaloridine dissolved in 500 ml physiological saline solution (= Group I) and 1-hour constant drip infusion of 1.5 g solution (= Group II); besides, pharmacokinetic analysis was made for one-compartment and two-compartment models. On the basis of the values of serum levels obtained from this trial, pharmacokinetic parameters were calculated and simulation curves of serum levels for various doses (0.5 approximately 2 g) and duration (1 approximately 4 hours) of cephaloridine drip infusion were drawn.


Histopathological subtypes of Hodgkin's disease in childhood in Iraq. The histopathologic studies of 103 patients under 16-years old with Hodgkin's disease including 5 cases who had staging laparotomy during the last 10 years were reviewed. The following conclusions were drawn: 1. No significant sex differences among subtypes were noted. 2. Associated glomerulopathy, nephrotic syndromes, and amyloidosis were occasionally found. 3. In childhood, lymphomas excluding leukemia are the most frequent malignancies. Among the lymphomas, Hodgkin's disease predominates. 4. The most frequent subtype both in the original biopsy and after staging laparatomy was mixed cellularity. The nodular sclerosis type was the rarest. The subtypes generally did not change during the subsequent biopsies and in laparotomy done up to 6 months later. 5. Lymphomas were most frequently noted in cervical area. Males are affected more severely than females. The peak incidence was around 8 years. A brief review and discussion on the comparison of data from other countries are also given.


Incorporation of [15N]-ethanolamine and [15N]-choline into phospholipids in various organ tissues of young and adult mice after the intraperitoneal injection. Incorporation of [15N]-ethanolamine into phospholipids in various organ tissues of 12-days-old and adult mice was investigated in the time course after the intraperitoneal injection. The incorporation of [15N]-choline into phosphatidylcholine was also investigated only in adult mice. Concentration of 15N-atom% excess in different phospholipids was determined by optical emission spectroscopic 15N-analyser. It was found that the incorporation of [15N]-ethanolamine into phosphatidylethanolamine gave different rates in various organ tissues. The [15N]-phosphatidylethanolamine was converted into [15N]-phosphatidylcholine only in liver which gave the highest incorporation rate of [15]-ethanolamine into phosphatidylethanolamine. The rates of transmethylation of phosphatidylethanolamine into phosphatidylcholine were estimated and found to be much higher in young mice than in adult, even if the time lag in the transmethylation was observed in young mice. Also, it was noted that [15N]-choline was actively incorporated into phosphatidylcholine specifically in liver, but hardly in the extrahepatic organ tissues. The phosphatidylcholine synthesized in liver seemed to be rather transferred directly to the extrahepatic organ tissues.


Effect of disinfectants with and without usage of detergent for the flexible fiberoptic bronchoscope. The purpose of this study was to find a safer, more rapid and easier disinfection process for the flexible fiberoptic bronchoscope (F.F.B.) by using ordinary disinfectants and a detergent. Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aures, E. coli, Serratia marcescens and Candida albicans were used as sources of contamination. The mixed bacterial growth preparations for contamination of the F.F.B. were the same as those previously mentioned in our study. Comparative bacteriological studies, between glutaraldehyde (GA) ethylalcohol (AL) and chlorhexidine (CHX) with and without usage of benzalkonium chloride (B.C.) solution and sterile water (W) as the detergent were performed and the following conclusions were obtained: 1. Contaminating microorganisms were reduced from 10(-3)/ml to 10(-4)/ml colony count after flushing with W and B.C. This procedure is very helpful for consecutive rapid disinfections or sterilizations of the F.F.B. 2. The effect of disinfectants with usage of a detergent was much better than without a detergent. Required immersion time in the disinfectants with detergent was reduced to periods as short as 60 seconds. 3. Of the three disinfectants, the most effective was CHX, GA next, and AL third. 4. Unsatisfactory disinfection occurred in some instances when there were functional disorders with the F.F.B. despite adequate amounts of disinfectant and detergent.


Effect of a streptococcal preparation on the complement system. Streptococcal preparation OK-432 (Picibanil), clinically being used as an immunopotentiator, has been shown to activate the complement system either through the classical or the alternative pathway in vitro [15]. In this experiment, OK-432 was found to increase serum complement level in guinea pigs, and in human without malignancy, when investigated by hemolytic assay using sensitized sheep erythrocytes (EA) for the classical pathway activity and unsensitized rabbit erythrocytes (RaE) for the alternative pathway activity. Assay of complement components revealed a significant increase in C3, but decrease in Clq, while no specific tendency was observed in C4, C5, C9, properdin, C3 activator and Cl-inhibitor. These evidences suggested that OK-432 might potentiate immune response of the host by elevating serum complement level, in addition to activate the complement system.


The in vitro effect of metal ions on the activity of erythrocyte delta-aminolevulinic acid dehydratase. The effects of a total of 15 metals on the activity of erythrocyte delta-aminolevulinic acid dehydratase (ALA-D) were investigated in vitro. The degree of inhibition of the ALA-D activity by copper, tin, mercury and silver was almost equal to that by lead, when the metal was added to the hemolysate of whole blood at the concentrations of 0.1 to 1.0 mmol/l in the ALA-D assay. Magnesium, manganese and beryllium had no effect on the ALA-D activity at the same concentrations. Zinc had a mild activating effect on ALA-D at the optimum concentrations and it eliminated the inhibitory effect of lead to some extent. However, the inhibitory effects of both mercury and cadmium on ALA-D were not quite eliminated even by the addition of zinc. These facts seem to suggest that the inhibition mechanism of lead on ALA-D differs from those of other metals.


[A theoretical study on the maximum permissible concentration of mercury vapor (author's transl)]. Mercury concentrations in the brain of man exposed to mercury vapor at or around the maximum permissible concentration were estimated by two mathematical models using informatins obtained from human and animal experiments. (formula: see text) Ac=concentration in the brain, C=concentration in air, V=ventilation volume, T=daily exposure time, R=proportion of mercury vapor retained after a single inhalation, D=proportion distributed to the brain, W=weight of the brain, b=elimination constant of mercury vapor in the brain, d=elimination constant of mercuric mercury in the brain, c=proportion of oxidization of elemental mercury in the brain. Model 1 is composed from a simple hypothesis that mercury vapor retained in the brain takes a single elimination coefficient, and in Model 2, a modification of Model 1, the part of elemental mercury retained in the brain is oxidized and thus has a different biological half-time from elemental mercury. During exposure to mercury vapor at the concentration of 0.05 mgHg/m3, estimated concentrations in the brain by Model 1 do not exceed a hypothetical critical concentration in the brain of 1.0 micrometerHg/g tissue but the estimated concentration by Model 2 exceeds this level.


Sampling and analysis of organic solvent vapours--with special reference to sampling tubes for a short time and for the working period. The present paper concerns the sampling and analysis of organic solvent vapours for a short period of time and for the working period. Porous polymer beads, Porapak Q, was applied to the adsorbent of the sampling tube for mixed vapours of aromatic compounds (benzene, toluene and xylenes). The adsorbent was packed in stainless steel column of a suitable size, and the adsorbed vapours were released by heating in the flasher then analysed by gas chromatography. The concentrations of the mixed vapours could be measured simultaneously with sufficient recoveries at the ordinary concentrations in the working yeard. The sampling conditions by pumps and the practical recoveries were tested. Being sucked with the vacuum pump using a Gastek detection tube (100 ml), the recoveries proved to be almost 100%. Being sucked with portable diaphragmatic pumps at a slow flow rate (22 ml/min), the recoveries were constant with only small variations. At a relatively fast flow rate (220-230 ml/min), the recoveries were not so high as those at the slow flow rate. These findings indicate that the sampling tube with Porapak Q is useful for aromatic compounds not only as a room air sampler for a short period of time but also as a personal air sampler.


[A study on the vibration hazards due to using bush cutters (author's transl)]. Bush cutters were introduced into Japanese forestry for cutting bush in 1957 or thereabout. Thereafter, they have been used widely not only in forestry but also in agriculture, public engineering, etc. In spite of the fact that vibration acceleration levels of the bush cutters are high, vibration hazards due to using these tools have not been studied. The reason lies in few professions using bush cutters exclusively. Moreover, the tool is only used seasonally from June to September. The author examined 641 bush cutters users in the State Forestry in southern Kyushu and compared the results with a sample of chain saw users matched by age, duration of use, and district. The prevalence rate of Raynaud's phenomenon is 0.4% at 4 years after beginning the use of bush cutters, 4.0% after 10 years and 9.2% after 18 years. The prevalence of Raynaud's phenomenon in chain saw users is twice as great as that in bush cutter users. Bush cutter users are attacked by Raynaud's phenomenon after about 1,000 hours' use of the tool. The difference is regarded to depend on the difference in the density of use and the difference in the levels of vibration acceleration. The vibration hazards due to using bush cutters were characterized by relatively mild complaints in the upper extremities, together with disturbances of peripheral circulation but not always with peripheral neuropathy.


[Studies on the change of spontaneous locomotor activities in rats due to forced exercise (author's transl)]. The authors have devised an apparatus for monitoring the spontaneous locomotor activity of rats, with which the patterns of locomotor activity under the condition of light-dark cycle (light period: twelve hours from 6 a.m., dark period: the other half of the day) were analysed. In addition, changes in locomotor activities due to forced exercise (swimming) were recorded. The results obtained were as follows: 1. The patterns of locomotor activities in rats recorded by the monitor showed the same patterns as reported already by other researchers. The authors believe that this new apparatus can be used practically as a locomotor activity monitor. 2. Due to exhaustive exercise by swimming, changes of the ultradian rhythm in rats were observed. 3. By loading of swimming, locomotor activities in rats decreased significantly, especially in the dark period. These results suggest that this newly devised apparatus is useful as a locomotor activity monitor, and that the fatigue in rats caused by physical load can be shown as the change in locomotor activities.


[Studies on the items for diagnosis of the vibration disease. Part 1. Examination of healthy workers using vibratory tools]. 1,215 male workers using bush cleaners in Hokkaido were examined by the method based on the notification of the Labor Standard Bureau. The results obtained from clinically normal 548 workers among them were analysed especially on the finger skin temperature, vibratory sense threshold, maximum grip strength. 1) Data of the vibratory sense threshold, maximum grip strength and endurable grip strength showed normal distributions. Data of the finger skin temperature, however, showed a skewed distribution. 2) In parallel with aging, the vibratory sense threshold increased, in other words, lowered in function, and the maximum grip strength lowered. 3) The endurable grip strength measured by the five-time repetition method decreased along with aging. 4) Values of one-tail limit of the finger skin temperature were calculated in all 548 workers, and those of the vibratory sense threshold, maximum grip strength and endurable grip strength were done in each age group. The values were compared with the already proposed criteria and discussed.


Hypoglycemia in mice administered with fusarenon-X. Histological observation combined with determination of the serum glucose level and histochemical detection of liver glycogen was undertaken to examine the acute toxicity of fusarenon-X (FX) in mice. Mice intraperitoneally injected with a sublethal dose of the toxin showed rapidly developed hypoglycemia followed by depletion of liver glycogen. Mitotic inhibition was observed in many visceral organs and most markedly in the intestinal crypt cells, where the mitotic figures completely disappeared prior to the increase in number of the degenerated and nucrotic cells. No glycosuria was found. The disturbing effect of FX on the oral glucose tolerance test suggested the involvement of accelerated glycolysis and, more likely, of intestinal malabsorption.


Field assessment of B-2 as a new molluscicide for the control of Oncomelania nosophora. Sodium 2,5-dichloro-4-bromophenol named B-2 was evaluated for application in the field as a molluscicde against Oncomelania nosophora. A dosage of 10 g/m2 as 25% liquid form or 25 g/m2 as 10% granular form of B-2 was suggested as a standard dose for the control of O. nosophora. The residual concentration of B-2 in the soil after application was observed to decrease more rapidly than did that of NaPCP. The residual level of B-2 in the rice grains harvested from the paddy field in which the chemical was applied at most 4 times during the planting season did not exceed 0.03 ppm.


Renal disease due to schistosomiasis of the lower urinary tract. The literature concerning renal impairment and damage due to vesical schistosomiasis has been reviewed, with emphasis on radiologic, biochemical, and renographic studies of renal function in affected persons. Presently available evidence suggests that infections due to S. haematobium constitute an important public health problem because they are widely prevalent. A high proportion of affected persons suffer renal impairment and damage due to obstructive uropathic lesions in the lower urinary tract and, probably, through direct immunologic involvement of the kidney. It is therefore important that efforts should be intensified to better define the size and scope of the problem, and to control the disease.


Renal tubular transport and catabolism of proteins and peptides. The kidney plays an important role in the metabolism of proteins and peptides. Current evidence indicates that only the proximal tubule possesses the mechanism for degradation or transport of these substances and reabsorption of metabolic products. Proteins and large polypeptides filtered at the glomerulus are absorbed from proximal tubular fluid by luminal endocytosis into apical vacuoles. These fuse with primary lysosomes, where hydrolysis occurs followed by diffusion of metabolites out of the cells and into the blood. Recent evidence indicates that small linear peptides are handled by a different mechanism. It is likely that small peptides are degraded at the luminal surface of the brush border of proximal tubules, which contains many hydrolytic enzymes, by the process of membrane or contact digestion with reabsorption of the breakdown products. The probable biological significance of proximal tubular mechanisms for handling of proteins and peptides are conservation of amino acids, inactivation of toxic substances, and participation in the regulation of the circulating level of protein and peptide hormones.


Effects of dextran on lysosomal ultrastructure and protein digestion in renal proximal tubule. The effects of dextran on renal ultrastructure and on the handling of protein by renal proximal tubules were evaluated in dextran-tolerant rats. In vivo and in vitro systems were studied by a combination of electron microscope and cell fractionation techniques. Dextran was demonstrated by electron microscopy in endocytic vacuoles and lysosomes ing a dextran-retaining fixative, and there was an increase in the number and size of the lysosomes in the proximal tubule cells using a dextran-retaining fixative, and there was an increase in the number and size of the lysosomes in dextran-treated rats. A lysosomal accumulation of dextran was also demonstrated when 3H-dextran T-80 was injected i.v. and the renal cortex analyzed by tissue fractionation. When radioactive lysozyme was injected into dextran-treated rats, there was less filtration of the protein in the kidneys than there was in the controls, but the rate of degradation of the labeled protein in slices prepared from the renal cortex and incubated in vitro was the same in the two groups. Electron microscope autoradiography revealed that radioactive lysozyme reabsorbed by the tubule cells had a similar location in both control- and dextran-treated rats. It is concluded that lysosomal protein catabolism is not altered by the presence of dextran despite pronounced ultrastructural changes in the lysosomal system. The decreased filtration of labeled protein after dextran infusion is probably related to the decreased GFR during and immediately after the dextran infusion.


Excretion and synthesis of basement membrane disaccharide units in Masugi nephritis. During nephrotoxic nephritis in the rat, an increased urinary excretion of glucosyl-galactosyl hydroxylysine and of galactosyl-hydroxylysine has been observed in the autologous phase of the disease. This due mainly to an elevation of the polypeptide-bound fraction of these hydroxylysyl glucosides with a molecular weight over 1,000 daltons. The levels of both urinary hydroxylysyl glucosides were correlated with proteinuria. Their increased excretion appears to originate in the lysed glomerular basement membrane. At the same stage of nephrotoxic nephritis, an increased glucosyl transferase activity could be demonstrated in the isolated glomeruli, correlated with albuminuria, attesting a higher turn-over of the disaccharide units of the glomerular basement membrane.


Nephrotoxicity of Bence Jones proteins in the rat: importance of protein isoelectric point. Bence Jones proteins (BJP) were isolated from the urine of 12 patients with multiple myeloma and various degrees of renal dysfunction. Proteins were characterized as to type (six type lambda and five type kappa), isoelectric point (pI), and secondary structure by circular dichroism (CD). Clinical renal function was more impaired with type-lambda proteins and with proteins of pI greater than 5.7. CD studies distinguished kappa from lambda proteins in most cases but did not correlate with nephrotoxicity. Protein dimer preparations were tested for nephrotoxicity in aciduric, hydropenic, female, Sprague Dawley rats by following renal function and morphology over 6 hours after injection i.p. of 300 mg of protein. Twelve rats of urine pH less than 5.5 injected with four BJP of pI less than 5.7 showed a mean rise in SUN of 5.3 mg/dl and in creatinine of 0.06 mg/dl, compared with a mean rise of 28.0 mg/dl (SUN) and 0.75 mg/dl (creatinine) in 21 rats injected with seven BJP of pI greater than 5.7 (P less than 0.01). Seven sodium-bicarbonate-fed rats of urine pH greater than 8 injected with a BJP of pI 6.2 showed mean rise in SUN of 1.8 mg/dl and in creatinine of 0.01 mg/dl, compared with 19.3 mg/dl (SUN) and 0.55 mg/dl (creatinine) in 7 aciduric rats injected with the same BJP (P = 0.009). Morphologic and immunohistologic studies showed distal cast formation in 9 rats with acute deterioration in renal function. It is concluded that BJP of pI greater than urine pH are acutely nephrotoxic in the rat by a mechanism that may involve a charge interaction in the distal nephron.


Macromolecule transport across glomerular capillaries: application of pore theory. Developments in the hydrodynamic theory of solute transport through porous membranes are reviewed, with emphasis on their application to macromolecule movement across capillary walls. A model that treats the capillary wall as a barrier containing uniform cylindrical pores, and permeating solutes as hard spheres, is shown to be successful in describing the size-selectivity of the glomerulus. Influences of various hemodynamic perturbations on solute transport are also accounted for by this approach. Possible extensions and modification of the theory, to account for the influence of molecular charge and other factors on glomerular permeability properties, are discussed.


Glomerular albumin filtration: a comparison of micropuncture studies in the isolated perfused rat kidney with in vivo experimental conditions. Glomerular albumin filtration was investigated in the isolated perfused rat kidney and compared with in vivo experiments. Applying micropuncture techniques, we obtained samples from the glomerulus or adjacent early proximal convoluted tubules (EPT) of cortical nephrons and analyzed them for albumin using ultramicrodisc electrophoresis. By determining albumin in glomerular filtrate, we could calculate the sieving coefficient (EPTalb/Palb) directly. The control in vivo value was 0.27 +/- 0.05 X 10(-3) (N = 11). In the isolated perfused rat kidney, the sieving coefficient was 2.1 +/- 0.8 X 10(-3), N = 18 (30 g/liter albumin in perfusate) and 2.3 +/- 0.8 X 10(-3), N = 13 (50 g/liter albumin in perfusate), which is approximately eight times the control in vivo value. With elevated renal venous pressure (20 cm H2O), it increased further to 5.4 +/- 1.6 X 10(-3), N = 8. In all experiments, GFR and proximal transit times were similar to the in vivo controls. Although no major morphologic changes could be detected in any instance, the albumin filtration was greatly elevated. These data confirm the role of a functional barrier in the prevention of glomerular albumin filtration.


[Differential diagnosis of the juxtapapillary racemose hemangioma (author's transl)]. The racemose hemangioma sometimes resembles the retinal angiogliomatosis and the retinal and pigment epithelium hamartoma. Dirty gray opacity and hypervascularity of the juxtapapillary retina are the common symptoms, the variety of the hypervascularity as well as the condition of the pigment epithelium make the different features.


[Case of malignant melanoma of the choroid operated on as retinal detachment (clinical aspects)]. Report of a case of secondary retinal detachment that was refered to as a month after having had an operation using an identating technique. Through echography and axial computarized tomography the presence of an intraocular tumour was verified. This case stresses the importance of diaphanoscopy in detachment surgery as well as that of echography and scanning in dubious cases.


[Case od malignant melanoma of the choroid operated on as retinal detachment (pathology)]. Histopathological study of an eye that had been enucleated following the suspicion of malignant tumour, after an ephemeral success of an operation for retinal detachment, confirmed the presence of a malignant melanoma. The importance of diaphagnoscopy in retinal detachment cases is stressed by this observation.


[Sebaceous carcinoma of eyelid presenting as dry-eye-syndrome (author's transl)]. A case of sebaceous gland carcinoma presenting as a dry-eye-syndrome is documented. In spite of total removal of the primary tumor, as confirmed histopathologically, the patient developed metastases to the neck lymph nodes several months after orbital exenteration. The importance of early diagnosis is stressed.


[Secondary glaucoma mechanisms (author's transl)]. A new classification of the glaucomas concerned with the mechanisms of the intraocular pressure rise is presented. We differentiate hyperproduction and outflowblock glaucomas. The latter are divided into pre-, intra- and postrabecular forms. It is stressed that a gonioscopically open angle can be hydrodynamically closed and vice versa. This classification is based on the anatomical location of the outflow blockage and not on the gonioscopic impression.


[General guidelines for the implantation of prepupillary lenses. (author's transl)]. The general guidelines for the implantation of prepupillary lenses concern the patient (right of impartial orientation, right of decision with regard to the nature of the future aphakic prosthesis), the ophthalmologist (duty of relevant orientation, duty to accept the patient's decision) and the ophthalmo-surgeon (right to reject an implantation). Following a thorough training in implant surgery general conditions, such as technical and personnel means have carefully to be estimated before starting with the implantation of intraocular lenses.


[Laser trabeculotomy and laser iridectomy. 3 Years' experience with the Glaucoma Research Laser (Britt) (author's transl)]. This report presents a 3-year study of treatment of the anterior portion of the eye with the Glaucom Research Laser, Model 152, made by Britt Corp. Los Angeles. This study deals specifically with laser trabeculotomy and iridectomy. In this period of time 176 eyes were treated with trabeculotomy and 60 with iridectomy. All types of glaucoma were represented. The technique and the results are demonstrated. This pulsed Argon laser permits surgery with a high rate of success without any serious complications.


[Strabismological terminology (author's transl)]. Differences and confusion in strabismological terminology are pointed out, i.e. in fixation behaviour, in classification of strabismuc angle, in naming of scotomas. On the whole about 20 differences in different languages are discussed.


[Orthophorization. The binocular position of the eyes after a Kestenbaum operation (author's transl)]. Orthophorization is a slow mechanism that compensates disturbances in the binocular eye position. Normal binocular vision is a prerequisite. Because of orthophorization patients who have undergone a Kestenbaum operation for ocular torticollis remain orthophoric postoperatively.


[A simple test for the comparative measurement of cyclodeviation (author's transl)]. A simple home-made addition to the tangent-screen allows determination by a test which, although subjective, is anatomical and not sensorial. It is felt that comparison with sensory tests is important since these are often fallacious.


[Diagnostic value of anesthesia for the surgery of strabismus]. There is no clinical test to detect a blockade. Under Anesthesia it is possible to discover a suspected blockade, so this test is quite helpful. Even in small babies this test can be applied in order to dected a pseudoparalysis of the external recti. We decide to operate after evaluation of the clinical facts and the findings under anesthesia according to the Zato test. We especially observe the positions of the eyes during normal breathing and the position under deep anesthesia.


[Twins with congenital oculomotor apraxia (Cogan's syndrome)]. Cogan (1952) described a syndrome he called congenital ocular motor apraxia. The syndrome is characterized by 1. absence of voluntary gaze movements and fast phase of optokinetic response in horizontal direction, 2. typical jerky head movements in attempted gaze to either side, 3. nomral random movements and 4. normal vertical eye movements. A report is given on this disorder in the case of female twins.


[Strabismus in cerebral paretic and normal children. Comparison of motoric symptoms (author's transl)]. Investigations of 94 children with cerebral palsies have shown 55% strabismus incidence. Motoric symptoms like varying angles, nystagmus (latens), A-V phenomena, dissociated hypertropia and compulsive head postures are presented, frequently more often than in a number of comparison cases of undamaged squinting children. However, these symptoms have not permanently been found even in severly damaged children. With the exception of compulsive head postures, no symptoms are found in strabismus cases of cerebral paretic children that do not occur in congenital strabismus patients as well. A frequent family heredity strain of strabismus has also been noted. There is a striking proportion of divergence cases (27%). The authors do not believe in a simple damaging etiology. Pleoptic-orthoptic exercises are hardly ever practicable. Early operation may improve the initial situation as far as the neuropediatric therapy is concerned.


[Diplopia frequency as a result of the surgical treatment of concomitant squint]. Postoperative diplopia in cases of congenital strabismus or early onset occured in 5% of patients operated on in 1977. We cannot calculate the frequency of diplopia in children operated on up to the age of 9 years old (290 cases) since no child suffered from diplopia. Its incidence-5% (9 out of 177 cases) relates to patients older than 9 years at the time of surgery, 6 patients out of 20 cases with consecutive exotropia complained of diplopia (following revision surgery). Amblyopia - foveal or eccentric fixation-alone seems to be a less important risk than consecutive exotropia. Preoperative wearing of prism to compensate the objective angle of squint over a few days can reduce but not exclude the general risk of postoperative diplopia.


[Better prognosis for amblyopics by means of full prismatic correction after monocular treatment (author's transl)]. Binocular training with full prismatic correction after the monocular therapy by occlusion brings a further improvement of the visual acuity as well as shown in a study of 29% (138 cases) of 469 selected cases with binocular problems and 43% (260 cases) of about 600 unselected cases of squint actually in treatment in the practice and orthoptic years the strength of the prisms is determined with the monocular covertest, in elder patients with the Polatest. If the amblyopia is connected with squint, an operation will only be performed after the amblyopia is improved and some degree of binocularity is reached by means of prisms. - 80% of the selected and 48% of the unselected cases reached a visual acuity of 1,0 on the amblyopic eye, including originally severe cases with eccentric fixation. In about 80% of all cases binocular single vision and stereopsis were reached. Failures were mainly due to remaining eccentric fixation, mostly connected with severe ARC, too advanced age at ting the prisms, too long intervals between controls etc.) - Finally, the importance of cooperation with an orthoptist and the social medical aspects of better chances for amblyopics are accentuated.