Neutral sugar composition of proteins of human seminal plasma from different andrological diagnoses. The neutral sugar content of proteins of human seminal plasma from different clinical diagnoses has been determined by gas-liquid-chromatography. Galactose, mannose, glucose and fucose were the predominant carbohydrates. Sometimes small quantities of arabinose, rhamnose, xylose and ribose were detected. Our analysis indicate that the concentration of galactose and fucose was distinctly higher in the group with azoospermia.


Effects of serotonin antagonists in sexually impotent men. Thirty-one men affected with sexual impotence were studied. Since sexual function in the male seems to be controlled by both dopaminergic stimulatory and serotoninergic inhibitory mechanisms, the patients were treated with serotonin antagonists. In basal conditions mean serum LH, FSH, PRL and testosterone did not significantly differ from those found in normal subjects; no significant variations, except for PRL reduction, were observed after treatment. Both methysergide, in association with bromocriptine or mesterolone, and metergoline, either alone or in association with mesterolone, were ineffective in significantly improving sexual activity.


[Electrical risks and safety during the monitoring (author's transl)]. The different sorts of medical equipment, whose number is constantly increasing in the last few years in the patients environment, entail several kinds of risk for patients, users and surroundings. The authors give a few examples of these risks, which may occur in particular during the monitoring of physiological parameters and urge the people concerned to observe, in their own interest, the very strict safety rules imposed by the new I.S.O. (International Organization for Standardization) and I.E.C. (International Electrotechnical Commission) international standards. These standards, already made known through official publications, or as intended to replace national standards, which are often out of date in comparison to the evolution of medical technology. It is regretable that some people responsible for medical research have not attached sufficient importance to the safety problems of equipment used in medical practice.


[Biotelemetry in anesthesia and intensive care (author's transl)]. Biotelemetry and patient monitoring are two fields closely related, and should contribute to the contiuous measurement of physiological parameters from patients with little impediment. In anesthesia the requirement of minimal impediment is less important. Here wireless transmission has two advantages of great importance, namely: minimization of the risk of electricl shock by the incorporation of batteries and a complete separation of the patient and the recording equipment, and the possibility of connecting the patient to the measuring equipment before transporting him into the operating theatre. The telemetry of several parameters, especially of the cardiovascular and respiratory system is described, including the telemetry of blood-pressure, blood flow, cardiac output, ECG and arterial PO2, as well as respiratory flow, respiratory PO2 and its derived values, such as tidal volume, ventilation and oxygen uptake.


[Cardio-circulatory monitoring. Special protection in operating room (author's transl)]. Authors who organised the 3e Réunion Inter-Régionale Nord d'Anesthésiologie sur le thème "Practice of Monitoring in Anesthesia and in critical care" proposed the creation of an incidents recorder for increasing patients' safety and medico-legal protection of Anesthesiologists.


[Pediatric ECG monitoring. 2,500 pediatric patients under anaesthesia (author's transl)]. The authors report 98 cases of cardiac arrhythmia observed in the course of 2,500 pediatric anesthesias performed with constant electrocardiographic monitoring. The patients, aged 0 to 18 years, were in most cases healthy. Anesthesia was performed by different techniques for both surgical and non-surgical interventions for a variety of conditions, both serious and routine. Other than 3 cases of cardiac arrest (1 death) cardiac arrhythmias usually followed a benign course without hemodynamic repercussions. The authors emphasize the value of early detection of cardiac arrhythmias as well as vigorous treatment of predisposing conditions such as inadequate ventilation, acidosis and pain. The absence of correlation between the degree of rick, as estimated preoperatively (related to patient or procedure risk factors), and the frequency of occurrence seems to point to the value of more widespread use of ECG monitoring of pediatric patients undergoing anesthesia.


[Validity of a teaching method of arrhythmias with a simulating machine (author's transl)]. The authors have tested a method of teaching the arrhythmias with a simulating machine. Two groups of students have been drawn by lot and have set for a first test on their knowledge about dysrythmias. One group was instructed in a classical way, the second one was instructed with the simulating machine which reproduces the majority of rhythm modifications on electrocardioscopic screen. At the end of the teaching, a post-test took place, then a last one a month later. The comparison of the two methods by measuring the residual knowledge enables to prove the interest of using simulating machine to teach disorders of cardiac rhythm.


[Monitoring of anaesthesia breathing systems by capnography (author's transl)]. Continuous measurement of the CO2 concentration in inhaled gas is the best method to know accurately the importance of rebreathing. Four anesthetic breathing systems were studied in 60 adult patients (Dighby-Leigh valve, circle system with and without soda lime. Waters system without soda lime, Bain circuit). Fresh gas flows (FGF) inspired and end-expired concentrations of CO2 (FI CO2, FE' CO2) and PaCO2 are measured. The FI CO2 seems to be negligible with Dighby-Leign valve and circle system with soda lime but important with other systems, even with FGF as high as 200 ml/kg, the FI CO2 is about 1 p. cent for Bain circuit, 2 p. cent in spontaneous ventilation, 2,7 p. cent in controlled ventilation for Waters valve. It is possible to theoretically determine that the FI CO2 would not exceed 1 p. cent.


[Monitoring of arterial oxygen pressure (author's transl)]. Arterial partial pressure of oxygen (PaO2) can be measured continuously either directly in the blood (in an artery or in an arterio-venous shunt), or indirectly, using the transcutaneous method or by measuring respiratory oxygen. Construction of miniaturized PO2 electrodes according to the polarographic principle (1.2 and 2 mm in diameter) with ring-shaped cathodes, allowing fast assession of arterial PO2 with little sensitivity to blood flow, and its clinical application are described. An exhausting investigation of the electrod properties, including in vivo parameters allowed continuous monitoring of PaO2 either directly in the radial artery or more often in an arterio-venous shunt under clinical routine circumstances in a large number of patients up to 24 hours. The recordings obtained with both methods are identical and show three types of oscillations.


[Definition and realization of a microprocessor system for monitoring during artificial ventilation (author's transl)]. A medical application of a microprocessor system is presented. The definition of a system able to control the quality of the respiratory exchanges for a patient submitted to artificial ventilation is given. The measurement system is composed by two rapid analysers of CO2 and O2 (Beckman LB2 and OM 11), a flow meter devices and an airway pressure sensor (Monaghan M 700). The monitoring of the ventilation is based on the determination of FAECO2 simultaneous the determination of FECO2, FIO2, FEO2 and FAEO2 allow, with the sequential entries of the blood gaz values, to calculate: VA/V, D (a--A) CO2, D (A--a) O2, VO2, VCO2 and respiratory quotient. Now, we are working out a system composed by: a microprocessor (Intel 8080) which allows acquisition and treatment of the signals; a peripherical with a key board for the dialogue between the operator and the system; a visual display unit and a printer. Measurements are made on the patient every 13 mn during five respiratory cycles. All the stated above parameters are then computed. When there is a variation of FAECO2, an alarm is triggered, of predeterminated threshold is exceeded. This system simple, not too expensive, not invasive, has been conceived to work on one to four patients.


[Monitoring of intracranial pression in acute neurotrauma by extra-dural screw (author's transl)]. These data emphasize the interest of the study, in acute traumatic comatose, of the brain-stem reflexes and level of coma (Plum, Posner, Perez-Dominguez, Barge, Espagno) and the monitoring of the intracranial pression (ICP) by extra-dural screw (Vries, de Rougemont, J. Brunon). It is possible to describe: 1)The bilateral hemispherical contusions: with cortico-subcortical level and bilateral decorticate comatose. The normal brain-stem reflexes (N.B.S.R.) are presents. The monitoring of ICP allows to separate the reversible bilateral hemispherical contusions (ICP can present unstable recording during 3 days with pressure-waves--B waves--or to be stable (between 10--15 mm Hg)), from the severe bilateral contusions with rostro-caudal evolution and "plateau-waves". 2) The brain-stem contusions: the clinical level is often a mesencephalic level with decerebrate rigidity and N.B.S.R. +/- (Automatic Eye Movements). In severe injury the ICP is increased and unstable with A waves. In reversible brain-stem contusions the ICP is often stable and low with arteriography and ventriculography insignificant. 3) The associated contusions: In general, the head injuries of this group are alternatively decorticate or on decerebrate rigidity ("ambiguous reaction"). In the severe associated contusions the ICP shows A waves. In reversible contusions ICP is stable with normal supratentorial angiogramm and ventriculography.


[Systolic time intervals measurement by electrical plethysmography (author's transl)]. The determination of left systolic time intervals by electrical impedance plethysmography, using precordial pick-up electrodes, gives as good results as classical method using phonocardiogramm and carotid pulse trace. Moreover the measurement of right systolic time intervals is possible with this method. Another advantage of this technic is that it only requires affixing four electrocardiographic electrodes to the thorax and is usable during relatively long periods of time. The value of the basal thoracic impedance provides also a mean of following intrathoracic fluid changes and an early detection of pulmonary oedema, pleural effusion or hemorrage into the chest. So, cardiac impedance plethysmography appears as a good tool for cardiac monitoring.


[Influence of the use of a video device for monitoring and visits on psychologic relations between patients, families and medical staff in an intensive care unit (author's transl)]. The use of a video device for monitoring and familial visits in a medical intensive care unit has various effects on psychologic relations between the patient, his family and the medical staff. Such a device is used since 1972 in Lille and has concerned more than 10,000 patients. On one hand, the monitoring of the patient is facilitated. His dependence to the staff is enhanced and allows a better taking of responsibility from the nurses and a good adhesion to the cares. At last, the video device gives to the patient and his family a real feeling of security during the early phase of the hospitalization. On the other hand, and particularly after this early phase, the use of a video device has deleterious effects on the psychologic relations of the patient with his family: enhancement of the psychologic regression, creation of an additional agression which jeopardizes the restoration of normal relations after attempt of suicide or prolonged artificial ventilation. This underlines the need for a real psychologic management of the video device in the reception of the families and the frequency of the relations with the medical staff.


[Computer aided monitoring systems after open heart surgery (author's transl)]. Four intensive care beds for open heart surgery have been equipped with a computer aided monitoring system following J. W. Kirklin and L. L. Sheppard (University of Alabama). Choice and motivations are discussed and material and programs are briefly discussed in this paper.


[Computers in intensive care units (author's transl)]. The increasing amount of physiological data which is required to be stored and displayed has created a need for computers in Intensive Care Units. Small computerised units are now available with three main advantages: 1. A memory allowing the display of parameters value and trend curves. 2. A "decision table" allowing more sophisticated diagnosis. 3. The use of new programmes without having to change the unit. These systems are reliable, providing the quality of the input signal is adequate.


[Technical characteristics of a new computerized system for quantitative evaluation of cardiac arrhythmias (author's transl)]. The ATREC system is designed to carry out at sixty times real time the quantitative evaluation of arrhythmias in 24 hour magnetic tape recordings. A preprocessing unit eliminates the low frequency waves (P and T) and artefacts, and furnishes the computer (Mitra 15/35, 16 K words of core) with information on R-R interval, QRS duration, regular or irregular rhythm, bradycardia or pauses, transient to sustained tachycardia, and ventricular fibrillation. Extrasystoles are analyzed in terms of enlargement, number, coupling interval, bi or trigeminy, doublets or salvos. Trends of mean and extreme cardiac rate, and R-R interval histograms, are also available. The system is also available for ECG real time monitoring of patients in coronary care units. The computer can analyze 8 ECG tracings simultaneously. The ATREC system provides an important aid in the quantification of arrhythmias and improves the evaluation of antiarrhythmic drugs efficacy.


[Standardization of monitoring accessories and reliability of supply role of a medical supply unit (author's transl)]. After a brief review of the range of monitoring accessories, the author considers the problem of their hospital standardization (various needs of the different hospital units, diversity of the monitors, existence of central purchasing departments, pressure from the treasurer's office). The availability of supply is assured by a medical supply unit, which is managed by the anesthesiology department. Its function is to fulfill all hospital requirements for disposable minor medical and linen supplies. The medical supply unit must resolve three problems: a medical problem (choice of supplies); a management problem (availability of supply); and a financial problem (survey and control of expenses). It requires the participation of a competent physician, and a close and trustful collaboration with the various partners: medical units, hospital administration, exterior suppliers. The existence of a Medical supply unit in a hospital should not be considered as a purpose in itself, but rather as a relatively simple medium for improving the quality and quantity of the supplies required in good patient care.


[Innovation and obsolescence (author's transl)]. The economists analyse the facts of our everyday--or professional life to insert management--or anticipation rules from them. The progress of innovations and their obsolescence fall within these studies. Recent works have shown that the spreading of innovations in the medical fields was practically identical to that in the industrial field, and that its function in relation to time was written under the form of: P = K divided by 1 + e-(a+bt) P representing the proportion of departments which adopted an innovation at the time t, K representing the proportion of those which will adopt this innovation (a and b are constants). The derivated coefficient in relation to t, that is to say the variation of the proportion of departments adopting innovations in relation to time, measures the speed of diffusion of this innovation (Louise B. Russel, 1977). But can this equation be applied in the field of health, to organisational innovations as well as to those which have a material, therefore industrial support? On the other hand do techniques and equipments become obsolete simultaneously? Finally does the public or the private hospital slow down or speed up the appearance of innovations and their obsolescence? Such are the problems we will endeavour to set... before being able to solve them.


The massively obese hypertensive patient: an analysis of blood pressure response to weight reduction with supplemented fasting. A 42.4% incidence of hypertension was seen in 783 massively obese patients admitted to a supplemented fasting program between February 1974 and November 1976. Chosen for this study were the 99 hypertensives who had not received any antihypertensive medication before admission. The blood pressure response after 1 week of inhospital fasting was compared with that at the end of a period of outpatient fasting. Reduction in blood pressure was noted in 85 patients by the end of the first week; by the end of the fasting period, 68 patients were normotensive. We conclude that the elevated blood pressure common in a high percentage of massively obese patients is primarily volume-dependent.


Connective tissue in varicose veins.

Connective tissue in varicose veins. The collagen, elastin, total sugar, and nonscleroprotein content was evaluated in 32 samples of saphenous varicose vein and in 34 controls. A significantly lower collagen and elastin content was found in the varicose samples without correlation with the degree of pathologic broadening. Otherwise the total sugars and the soluble nonscleroproteins were found to be increased in varicose samples. The results are more significant when expressed as milligrams per surface unit of endothelium. Our data support the hypothesis that the decrease in collagen and elastin content is a primary rather than secondary change.


Detection of early myocardial infarction by radioimmunoassay of myoglobin. A newly devised radioimmunoassay for the measurement of myocardial myoglobin has been modified by us to measure circulating myoglobin levels in rats subjected to isoproterenol-induced myocardial infarction of various degrees of severity. The method has been found to be very effective. Myoglobinemia proved to be a sensitive index of early myocardial damage in rats, perhaps superseding the enzyme CPK in detecting early myocardial damage. Both myoglobin and CPK were equally effective in providing an index of the extent of histopathologic myocardial infarction. The changes in myoglobin and CPK did not correlate well with the changes in plasma SGOT, SGPT, and LDH, which are more diagnostic of the later stages of acute myocardial infarction. Myoglobinemia offers excellent promise as a diagnostic aid in detecting early myocardial infarction in rats, and perhaps ultimately in humans, since there are only small differences between the immunologic specificity of human versus rat myoglobin.


Arrhythmias during upper gastrointestinal endoscopy. Electrocardiographic monitoring of 52 consecutive patients undergoing upper gastrointestinal endoscopy revealed that arrhythmias during the procedures were common (38.5%) and tended to occur more frequently in the elderly (75%), in persons with heart disease (54.5%), and in persons with chronic lung disease (89%). The incidence of ventricular premature contractions in patient with no evidence of heart or lung disease was 19%. In one patient with advanced chronic lung disease, the procedure had to be terminated because of development of high-degree atrioventricular block. A high incidence of arrhythmias during endoscopy has not been previously reported in patients with chronic lung disease.


Electrophysiologic properties of nitroprusside in man. The effects of nitroprusside on His bundle electrograms, when given intravenously for 10 minutes, were studied in 14 patients with heart disease. Recordings were made at varied heart rates using atrial and ventricular pacing. Nitroprusside significantly reduced the AH interval, but it had no effect on the HV interval. Functional and effective refractory periods were measured by the extrastimulus technique. The functional refractory period of the AV node as well as the effective refractory period of the ventriculoatrial conduction system significantly decreased after nitroprusside infusion. This improvement in conduction can probably be explained by the systemic hypotension produced by nitroprusside, which reflexly will increase sympathetic drive to the heart and decrease vagal tone.


Serial hemodynamic studies during the treatment of congestive heart failure with isolated low-dose oral prazosin therapy. Prazosin was administered orally at a maximal dose of 2 mg every 6 hours to 4 patients with congestive heart failure (CHF) who had not received either digitalis or diuretics for 72 hours before therapy. Three of the 4 patients had hypertensive and arteriosclerotic heart disease. Hemodynamic monitoring indicated a significant reduction of preload and afterload with a concomitant rise in the cardiac index. We concluded that isolated low-dose oral prazosin has salutary effects on indices of hemodynamic function in selected patients.


The effect of splenectomy on pulmonary infection in newborn mice. Overwhelming postsplenectomy infection is a widely discussed and studied problem. The route of infection, the specific organisms involved, and the age at splenectomy and bacterial challenge are crucial factors in determining the genuine threat of the disease. We studied Staphylococcus aureus respiratory infection in 10-day-old mice who had undergone splenectomy or sham operation 7 days earlier. We did not find an increase in fatal staphylococcal pneumonitis under these conditions. Further laboratory definition of this complex issue is warranted.


Improved methodology for the Grassi test for intraoperative determination of completeness of vagotomy. The Grassi test for completeness of vagotomy is a useful adjunct to vagotomy that aids the surgeon in severing all the vagal innervation of the acid-producing portion of the stomach. The Congo Red stick allows the surgeon to perform the Grassi test with a significant reduction in the amount of equipment and personnel required by either pH electrode or liquid Congo Red methods.


Effect of pulmonary artery ligation on the developing fetal lung. Ligation of the left pulmonary artery was performed in fetal lambs. The procedure was well tolerated and most animals survived to birth. At birth, the animals were in no distress but had mild pulmonary hypertension. The lung to which the pulmonary artery was ligated underwent normal intrauterine maturation.


Effects of postpneumonectomy distention on pulmonary compliance and vascular resistance. Postpneumonectomy pulmonary distention has been considered harmful by many clinicians. We measured changes in pulmonary compliance and vascular resistance with distention in five dogs. There was no significant change in compliance and vascular resistance in the range of pulmonary distention seen following pneumonectomy.


[Scurvey, presentation of six cases (author's transl)]. Authors present six cases of scurvy admitted in their hospital from September 1977 to July 1978. Symptoms were similar in the majority of them: irritability, skin haemorrhages, swollen gums, scorbutic rosary, swelling and tenderness lower limbs. Radiographic findings more common were: Fraenkels' line "ground glass" appearance, corner sign, Wymberger sign, and in some cases subperiosteal haemorrhages with calcification. Ascorbic acid levels were below normal values in all cases, and overload test showed typical pattern found on patients with scurvy. Special mention is made on the low incidence of this disease in the last few years and also the causes that have motived the existence of this six cases in such a short period of time are analyzed.


[Angiocardiographic study of 30 patients with complete A-V canal (author's transl)]. Authors present the results of angiocardiographic study on 30 patients with complete A-V canal. This study is divided in two parts: First, they define general concepts such as aortic suspension, anterior common valve-theoretical right border angle, left and right regurgitation, etc. Secondly, they classify A-V canal in two groups according to the following characteristics: 1) Anterior common valve normal, moderate suspension of the aorta less than 50%, rough right border of the left ventricle, angulation less than 45 degrees, medial interventricular communication and left regurgitation. 2) Common anterior valve small, important suspension of the aorta greater than or equal to 50%, smooth right border, angulation greater than or equal to 45 degrees, large communication and left and right regurgitation. Differential data between interventricular communication and valvular regurgitation are commented. They emphasize how important the posterior smooth septum and the common anterior valve are in producing the suspension of the aorta and also in the narrowing and elongation of the infundibulum. Finally, some considerations about the surgical implications according to the type of canal are made.


[Neonatal changes in relation to mother's oxitocyn administration (author's transl)]. Authors have studied in four groups of newborns the possible relationship between administration of oxitocyn to the mother during labor or during the pregnancy and appearance of neonatal jaundice, alterations of hematocrit and Na+ levels in the immediate hours post-partum. In the present study, with dosages of oxitocyn administered during true labor which never exceded 1,200 mUI, no significant differences appeared between levels of bilirubin present in newborns and those whose mothers did not receive this type of treatment (p greater than 0.05). Sodium levels in the first day of life did show significant difference when comparing control and problem series respectively (p less than 0.01).


[Reference values of A.S.T., L.D.H., isoenzymes of L.D.H. and A.D.A. in cerebrospinal fluid of children (author's transl)]. From 230 C.S.F., authors found the reference values of A.S.T., L.D.H., isoenzymes of L.D.H. and A.D.A. in children from the area of Barcelona. The reference values obtained were: A.S.T.: n, 208; mean, 6.91 U/l., and s, +/- 2.71 U/l. A.D.A.: n, 175; percentil 50, 0.388 U/l.; percentil 97.5, 1.64 U/l., and percentil 2.5, 0 U/l. L.D.H.: n, 148; percentil 50, 9.54 U/l.; percentil 97.5, 24.96 U/l., and percentil 2.5, 3.81 U/l. Isoenzymes of L.D.H.: n, 82; L.D.H.-1: mean, 41.31 per cent and s, +/- 5.41 per cent. L.D.H.-2: mean, 30.79 per cent, and s, +/- 2.84 per cent. L.D.H.-3: mean, 20.3 per cent, and s, +/- 4.11 per cent. L.D.H.-4: mean, 6.02 per cent, and s, +/- 2.48 per cent. L.D.H.-5: mean, 2.47 per cent, and s, +/- 1.7 per cent. Higher activities of A.S.T. and L.D.H. were found in newborns, also varying the distribution of isoenzymes of L.D.H. The A.D.A didn't show variations.


[Hiatal hernia following T.E.F. repair (author's transl)]. Hiatal hernia and/or gastroesophageal reflux are studied in 182 pediatric patients after surgical correction of esophageal atresia. Clinical and radiological aspects, along with postoperative complications, are reviewed. Special stress is given to late stenosis that does not cure with conventional treatment and are originated by undiagnosed reflux. Hiatal disfunction screening is proposed in following up patients of esophageal atresia in avoidance of disphagic and aspirative complications.


[Toxopachyosteose diaphisaire tibioperoniere (Weismann-Netter syndrome) (author's transl)]. A two-years-old male with toxopachyosteose diaphisaire tibioperoniere (Weismann-Netter syndrome) is presented. First observation of this syndrome in spanish publications. Basic signs of this syndrome: dwarfism with bilateral tibio-fibula incurvation and sclerosis, are remembered, as well as deafness like associated symptom. Radiologic signs to differentiate between others process, specially rickets and syphilis, with which it was for a long time confused, are remarked.


[Peutz-Jeghers syndrome. comments on a new case (author's transl)]. Authors report a new case of Peutz-Jeghers syndrome which is the earliest of the 20 cases published in our country. Out of 450 rectoscopies carried out in their hospital, they found 64 patients with polyps in the rectum and sigma, and in only one case this was associated with pigmentation on the lips establishing the diagnosis of Peutz-Jeghers syndrome. A review of the literature and comments on pathogenesis, hereditary aspects, clinical signs, prognosis and treatment are made.


[Follow-up of 28 cases of hypothyroidism in children (author's transl)]. Author reports follow-up of 28 cases of hypothyroidism evaluated for a period of several years according to the following parameters: growth in weight and lenth, bone age, cortical thickness, bone diameter and linear growth prognosis. He classifies the cases according to the type of hypothyroidism and age of patient in which diagnosis was made. Two-third of the cases are female. As a whole, he considers acceptable results of the evaluation. Nevertheless, in the group of glandular dysgenesis, evaluation is poor, but it is very trustworthy in those with hormonogenesis alteration, and in the group of pituitary-hypothalamic hypothyroidism. Those patients in whom diagnosis was made before 12 months of age, the degree of impairment is lesser and the course changes only scantly by treatment. On those on which diagnosis was made after 12 months of life, are more seriously damaged and they usually need treatment for four years or more for a catch-up growth period. Early recognition is crucial and if possible, it must be carried out through newborn screening test.


[Problems related to tricuspid atresia during the first year of life (author's transl)]. Sixty six per cent of cases need surgical treatment during the first months of life. The high mortality rate (23 to 40%) in those children which need pulmonary banding or sistemic pulmonary shunts authors believe is due to: 1) The existence of coartation of the aorta in 83% of the cases with trasposition of the great arteries and high pulmonary blood flow. 2) The small diameter of pulmonary arteries in cases with low pulmonary blood flow (smaller than those presenting Fallot's Tetralogy). 3) The association, in 25% of the cases with normally related great arteries, with a subaortic myocardiopathy. These findings require before use of surgical methods: a) Practice of aortography in cases with transposition of great arteries. b) Proper evaluation of pulmonary artery branches diameter performing, if needed, a contrast injection in pulmonary vein. c) Angiographic and echocardiographic studies of left ventricle to rule out association with a hypertrophic myocardiopathy.


[Influence of ileocecal valve resection on nutrient absorption in the pig (author's transl)]. The report deals with how the resection of the ileocaecal union, with or without caecum, and in diets of different fat levels, affects the absorption of various nutrients, the nitrogen balance, and the intestinal aerobic flora, in young pigs during periods of rapid growth. It describes the technical procedure and the results obtained from experiments on digestibility and the nitrogen balance, both in tests carried out in the immediate post-operative period and after four months; it was found that those animals operated on showed a lower protein, fat and gross fibre absorption, as well as a decrease in the percentage of nitrogen retained and efficiently used; in many cases the difference between operated and control animals was statistically significant. In those animals undergoing surgery changes occured in the intestinal aerobic flora: a greater number of germs were found in the jejunum, and a smaller number in the middle and distal ileum. The histological study of the ileocaecal union in these animals showed great similarity to the same area in man. Author attributes changes to the loss of valve and sphincter function in the removed area.


[Neonatal transitional care unit (author's transl)]. Statistical analysis between a two year period with a five year interval (1972-1975) in a neonatal transitional care unit is evaluated. Number of resucitations doubled and neonatal mortality in the first seven days of life as well as in the first twenty four hours decreased significantly, being newborns under 1,000 gr. of weight and malformations the first two causes of death in both periods. Factors related to hypoxia which accounted for other 25% of deaths should be prevented. Importance of this type of units in huge maternities is emphasized considering their role in immediate neonatal care.


[Congenital syphilis (author's transl)]. Authors present a study on eleven patients affected with congenital syphillis treated during the last six years. All of them presented bone lesions in one or more locations. Familiar antecedents, mechanism of infection, clinical symptoms and radiological findings are analized, emphasizing the importance of prophylaxis and early treatment with procaine penicillin in a dosage of 50,000 U./Kg. day for at least ten days.


[Lodgement of the intraventricular catheter into cerebral parenchima in infantile hydrocephalus (author's transl)]. Ten cases of hydrocephalus of diverse ethiology, treated with ventriculo-peritoneal shunt are presented. In following controls it was observed that extreme of the catheter was located in cerebral parenchima. These features were followed of minimal clinics alterations and electroencephalographic focal manifestations. The pathogenesis of the complication due to the findings in the computerized axial tomography (CAT) and the real value in the diagnosis of this complication are analized.


[Idiopathic left anterior hemiblock in a child (author's transl)]. Authors present a child three years old with an idiopathic left anterior hemiblock. Causes of left anterior hemiblock in children are reviewed, and it is concluded that although a left anterior hemiblock justifies a thorough non-invasive cardiologic and sistematic study and long-term follow-up, sometimes it may be the expression of an anatomic and/or physiologic variant.


[Mesomelic dwarfism Langer type associated to mixed gonadal dysgenesis, whit cariotipe 46,XY/45 X (author's transl)]. Authors present a case of Langer type mesomelic dwarfism in a six months infant, who presented preferentially a mesomelic affection of the limbs, with a typical shortening and deformity of the ulna, radius, tibia and fibula. Articular alteration of the phalanxes of both hands has not been found described in the literature revised. The inusual association of intersexual condition, which corresponds to a Shoval mixed gonadal dysgenesis, with cariotype 46,XY/45 X seems of great interest.


[Mesenterial lipoma in a child (author's transl)]. A rare case of a 16-month old infant with a mesenteric lipoma is presented. Symptomatology, diagnosis and surgical approach are discussed. Authors make a review of previously reported cases in the infant age.


[Crohn's disease in childhood. Comments on one case (author's transl)]. Chronic inflammatory diseases of the bowel are specially frequent in the adult, with peak incidence during adolescence and early adulthood. There are, however, increasing number of reports in the pediatric age group, mainly coming from anglosaxon countries although more recently also from countries of Southern Europe. Authors present a case of Crohn disease occuring in a child, with typical clinical, radiological and pathological features, since they are not aware of any report in the Spanish literature. Comments are made upon pathogenesis, clinical features and pathological findings and specially upon the treatment established in the present case in relation with the indications of other authors.


[Hemolysis in Kala Azar: isotopic study, possible role of a PNH like defect (author's transl)]. A case of Kala Azar with prevailing hemolytic anemia is reported. The hemolysis has been associated during a short time with positive PNH test (i.e.: Crosby and sucrose tests). According to the data found in the Litterature, the hemolysis occurs quite frequently. One of the possible mechanisms is an abnormal sensitivity of the erythrocyte membrane to complement, which had not yet been described.


[Cutaneous, subcutaneous, and lymph node cryptoccosis in a patient with sarcoidosis (author's transl)]. An Algerien patient aged 31 years with a histologically confirmed mediastinopulmonary sarcoidosis had a persistent stable miliary pulmonary x-ray image after cortisone therapy. Eighteen months after stopping the corticotherapy, he developed cryptococcosis which was mainly cutaneous, but associated with subcutaneous abscesses and peripheral adenopathy, and without lesions in the viscera or deep nodes. Cryptococcus antigens were present in the serum and there was a humoral and cellular immunity reaction towards the cryptococcus. Recovery occurred after amphotericin B and 5-fluorocytosine.


[Atypical forms of Ebstein's disease: value and limitations of ultrasonography and cardiac catheterization (author's transl)]. Diagnostic ultrasonography signs of Ebstein's disease are delayed closing of the tricuspid valve in relation to the mitral valve, and the possibility of recording from the tricuspid valve when the transducer is outside of the left median clavicular line. These criteria were present in 8 out of a series of 10 cases and 6 of these patients had also had haemodynamic tests which showed auricularization of a portion of the right ventricle in all of them. Details are described for 3 of these patients to illustrate the different atypical clinical forms of Ebstein's disease, and the value and limitations of complementary investigations for establishing the diagnosis of this affection.


[Medullary compression revealing the presence of an epidural nodular lymphoma (author's transl)]. A case of medullary compression is reported which was found to be due to an epidural lymphoma of the nodular type, which was centrofollicular, with only slight lymphocytic differentiation, and appeared to be isolated. The hour-glass appearance of the tumour suggested, however, that it was not the primary tumour. The short term outcome appeared to be favourable after surgery and radiotherapy but a limited period of chemotherapy is being given. Reports on the frequency of medullary compression during malignant non-Hodgkinson lymphomas vary between 1 and 15% of cases, and many cases have revealed the actual cause, especially in neurosurgical practice. Most authors do not accept the existence of lymphomas primarily located in the epidural space, and feel that they result from metastatic invasion or by contiguity. Prolonged survival can be hoped for after mixed treatment of these tumours, especially in histologically favourable forms.


[Multiple recurrent paralysis of the cranial nerves (author's transl)]. The authors describe three patients presenting several episodes of paralysis of the motor and sensory cranial nerves and discuss possible aetiological factors. The paralytic attacks were regressive and were repeated at irregular intervals over a period of several years. It was confirmed that no local or general cause for the symptoms existed and the conclusion was reached that they were part of an autonomous clinical syndrome of unknown aetiology. Other cases have been reported in the published literature in which a non-specific inflammatory mechanism is suggested but no biological or pathological basis exists to support this physiopathological hypothesis. The clinical syndrome follows a benign course, the paralysis being regressive and the affection remaining confined to the peripheral nervous system of mesencephalic origin.


[Diagnostic value of the acid production from galacturonate to differentiate strains of "Salmonella" sub-genus I and monophasic sub-genus III from the other "Salmonella" strains belonging to sub-genera II, diphasic III, IV, "Citrobacter" and "Hafnia alvei" (author's transl)]. Two methods were compared: (1) the ability to use sodium glacturonate as source of carbon and energy in defined medium; (2) the ability to produce acid by fermentation of this substrate in peptone water with phenol red. Results of growth on, acid formation from, galacturonate are identical. Salmonella strains of sub-genus I and monophasic serotypes of sub-genus III do not use galacturonate. Salmonella of sub-genera II and IV as well as diphasic serotypes of sub-genus III use galacturonate. Glacturonate-negative Salmonella are isolated mainly from man and warm-blooded animals whereas galacturonate-positive Salmonella are most often isolated from cold blooded animals and from the enrivonment. Citrobacter and Hafnia alvei which may be confused with Salmonella spp. are galacturonate-positive.


[A method for the preparation of a Chlamydiae group-specific antigen on hela-229 cells infected with a strain of "Chlamydia trachomatis" for use in the complement fixation test (author's transl)]. A simple method for the preparation of a potent group-specific antigen on HeLa-229 cells infected with MRC-1 (LB) (TRIC/GB/MRC-1 Gf) strain of Chlamydia trachomatis is outlined. HeLa-229 cells are infected (MRC-1 strain, 102 inclusion-forming units per cell) with centrifugation at 4,000 g for 1 h in flat-bottomed vials. The cells are removed by brief trypsinization with 0.25% trypsin and put into 75 cm2 culture flasks (12 x 106 cells by flask) in BHK-21 medium supplemented with foetal bovine serum. The flasks are incubated for 5 days at 37 degrees C. The destroyed cell monolayer and the supernatant are centrifuged at 100,000 g for 1 h. The pellet is collected and resuspended in PBS and subjected to ultrasonic vibration for 30 min. This antigen may be used for detection of complement-fixing antibodies in lymphogranuloma venereum and ornithosis.


Cellular depletion in Peyer's patches after cyclophosphamide treatment in mice. The cytotoxic effects of cyclophosphamide (CY) in mice given by the intravenous route at the dose of 200 mg per kg of body weight, were investigated in Peyer's patches comparatively with peripheral blood and mesenteric lymph node as well as changes in the spleen weight. Peyer's patches are the sites of a more intense and durable cellular depletion than the mesenteric lymph node, observed as soon as day 1. A partial restauration of cell populations was observed from the 9th day, but even at day 21 their number remained lower than in control mice. Histological studies failed to show any germinal centre throughout the experiment; just a few cells were observed, 2 days after CY injection, in the interfollicular areas in which cells in mitosis were only seen at day 7. This preliminary results allow to study the role of the Peyer's patches as first barrier against penetration of an enteropathogenic bacteria able to invade the host tissues through the intestinal wall components after local or general acquired immunodeficiency.


Borrelia persica and B. baltazardi sp. nov.: experimental pathogenicity for some animals and comparison of the ultrastructure. The ultrastructure of cells of Borrelia persica was compared with that of cells of a new isolate of Barrelia (Borrelia "x"). This organism (B. "x") was isolated in a region of Iran where B. persica is already known to exist. The morphology of the cells of the two strains differed in mean cell length and cell diameter. Cells of B. persica were covered by a regularly structured surface layer, while those of B. "x" possessed an amorphous surface coat. Furthermore, the strains differed in their experimental pathogenicity for animals. It is concluded that the new isolate represents a new species of the genus Borrelia, and Borrelia baltazardi sp. nov. is proposed.


[Activity of antibiotics and heavy metals against "Aeromonas" isolated from aquatic environments: phenotypic and genetic transfers (author's transl)]. In this study, 64% of the 197 strains of Aeromonas isolated from different stages of aquatic environment (surface water, sewage...) were resistant to one or two antibiotics, and 20% to four or more antibiotics. These multiresistant strains were only isolated from sewage and their resistances were transferable by conjugation to different species of Gram-negative bacilli. The incidence of these results is discussed.


[Aminopeptidase activity in "Corynebacterium vaginale" (author's transl)]. Aminopeptidase activity can only be detected in significant amounts in Gram-negative bacteria with a test reaction using L-alanine-4-nitro-anilide as substrate. Corynebacterium vaginale show no aminopeptidase activity even after prolonged reaction times. This indicates surely that this microorganism is nt a Gram-negative bacteria.


[Poly(A) sequences associated with rabies virus mRNA (author's transl)]. Polyadenylate sequences have been found in numerous RNA with messenger function, and in several viruses in which the genome is its own messenger. With rabies virus we observed a fixation of viral RNA on Sepharose poly(U) column in the mRNA region (8-25S) and in the double stranded RNA region (25-35S). These percentages of fixation are very low compared to those of VSV in the same regions, but they are significant compared to the uninfected cells and to Lumbo RNA fixation. In order to determine the nature of the RNA bound to poly(U)-sepharose, fractions of the region 8-25S and 25-35S obtained after elution with formamide were centrifuged through a sucrose gradient. We found in the 8-25S region an RNA profile which was identical to the initial profile of this region. In contrast, the 25-35S region exhibited a heterogenous profile which looked like the total virus RNA profile obtained from infected cells. This may be due to the presence of double-stranded RNA in this region which is partially adsorbed on poly(U) and denatured by formamide in RNA molecules of genome and mRNA size. We conclude from our results that the low percentage of fixation of rabies mRNA on poly(U)-sepharose columns could mean either that a small number of molecules are polyadenylated or that a large number exhibit poly(A) tracts too short to be retained by the poly(U).


[Evolution of the concept of residues in the products of animals raised with the use of antibiotics]. The concept of residues of antibiotics used as feed additives or veterinary drugs in food producing animals is analysed, and implications on human public health are discussed. The examples of Tylosin and Penicillin are developed to illustrate the both notions of "high risk residue" and "toxicodisponibility" of residues. The "high risk residue" may be an active metabolite different by its chemical structure and by its pharmacological properties from the original drug administered. Slight modifications of the molecule, as the rupture of the beta lactam ring of the Penicillin, occuring in vivo, lead to a metabolite, e.g. penicilloyl group, that has lost all antibiotic activity but possesses allergenic potential. Toxicity of the residue, compared with that of the original drug, can then be modified or increased. On the other hand, such an active metabolite having a definite chemical structure, even if different from the original compound, can be present in the organism, either free or bound to serum or tissues proteins. Moreover, it is shown here, that in the case of a covalent binding of the drug or its metabolite (e.g. penicilloyl group) to serum albumin, the residues are mostly masked inside the tertiary structure of the albumin molecule, and are not accessible to antibodies. These different forms have then an effect upon the biodisponibility, the "toxicodisponibility", of the residues for the human consumer of animal products where they are present. These forms are only accessible with more and more specific and sensitive analytical methods which relates also the qualitative and quantitative notions of residue to the technological degree used for investigation, determination and identification. As to cooking techniques, they can lead to a thermodegradation of the residue or, on the opposite, to an unmasking of the residue present as a protein conjugate, e.g. penicilloyl-protein conjugate in milk.


[Relation between ceruloplasmin and vitamin A in Sprague-Dawley rats]. The Moore's hypothesis concerning a relationship between the metabolism of copper and that of vitamin A led us to consider a possible relationship between this vitamin and ceruloplasmin, the carrier protein for copper. Experiments were carried out on Sprague-Dawley rats. The ceruloplasmin level of control animals and vitamin A - deficient rats was determined An average increase between 22 and 33% was observed in the animals with vitamin A deficiency, the highest levels being observed in the females. These results are in agreement with Peterson's previous work. A second type of experiment was carried out to confirm these results. The rats were raised in a copper-deficient diet and the vitamin A level was regularly determined. In these conditions serum and liver levels of vitamin A are normal and do not vary, ceruloplasmin level is zero; however apoceruloplasmin is still being synthetized : Nevertheless at the ultime state of the deficiency vitamin A level decreases while apoceruloplasmin increases. These results raise the following question. Could the relationship between ceruloplasmin and vitamin A be possibly due to an inflammatory state in vitamin A deficient rats. In this respect a third series of experiments were undertaken and are in progress; the vitamin A and ceruloplasmin levels are regularly determined.


[Supplement No XXII (1978) to Kauffmann-White scheme (author's transl)]. In this supplement are given the characters of 40 new Salmonella serotypes recognized in 1978 by WHO collaborating Centre for reference and research on Salmonella: 29 belong to the sub-genus I, 3 to the sub-genus II and 8 to the sub-genus III. Biochemical and antigenic variants of already known serotypes are described. A new H factor (Z63) is recognized.


[Rebound nystagmus: a new cerebellar sign (author's transl)]. Rebound nystagmus is a special type of nystagmus provoked by excentration of gaze of a sight (gaze nystagmus). Gaze nystagmus is absent when looking straight ahead, and is already clearly evident after excentration of gaze of less than 20 degrees. It beats in the direction of the excentration. The first special feature of rebound nystagmus is the fact that it disappears in 10 to 20 seconds. Its diagnostic significance could be based upon this feature alone, as was though up to now. However, its second original feature is fundamental. After excentration, gaze is brought back to the primary position (straight ahead). As confirmed by all the literature its value is of being pathognomic of a lesion of the cerebellar pathways. It is of the greatest simplicity, and it is sough by asking the subject to follow the finger of the examiner.


[Relationship between cochlear fatigue and the asymmetrical non-linearity of microphonic responses in the guinea pig (author's transl)]. It is classically considered that cochlear fatigue and acoustic trauma occur when intensity is such that the ear is saturated, i.e. when the microphonic potential fails to increase in a linear fashion in relation to intensity and when distorsion appears. The present report concerns a study in the guinea pig of the relationship between the non-linearity of microphonic responses, and their fatigability. The results show that fatigability is related not only to non-linearity but also to the asymmetry of responses. The asymmetry of microphonic responses may be interpreted as reflecting an asymmetrical ionic flow at the upper pole of hair cells, resulting in an accumulation of potassium ions within and around hair cells and thereby creating a depression of responses.


[Auditory fatigue in individuals having sustained an acoustic trauma (author's transl)]. A comparison was made between losses of auditory sensitivity after a fatiguing sound exposure of the ear in two groups of subjects: audiometrically normal subjects and subjects with early acoustic trauma. Subjects with cochlear impairment sustained an auditory loss apparently less than that of normal subjects when this loss is measured at threshold level. However, at supraliminal levels the loss of sensitivity, as measured here, would seem to be equal in both groups of subjects. In fact, the dynamics of sonic variations, already reduced by the cochlear impairment, is even further decreased by the effects of fatigue.


[Respiratory obstacle and gastro-oesophageal reflux. Pathogenic link (author's transl)]. The finding of the frequent association in the infant of endothoracic tracheal compression and of GOR leads to discussion of their pathogenic link. In cases of endothoracic compression, manometric recording demonstrates the presence of an inversion of intragastric pressures with expiratory hyperpressure and a decrease in anti-reflux gradient. These data represent an argument in favour of medical anti-reflux treatment following discovery during endoscopic investigations for chronic or recurrent bronchopneumonia of the association of tracheal compression and gastrooesophageal reflux. Manometry should make it possible, where medical treatment proves unsatisfactory, to differentiate those cases where anti-reflux surgery is justified and those requiring a decompression procedure.


[Branchio-oto-renal malformation syndrome (author's transl)]. After a brief review of the dysgenetic abnormalities which may affect the ear, branchial arches and pouches and the kidneys, the authors summarise those syndromes associating abnormalities of the ear and kidney on the one hand, and secondly abnormalities of the ear and facial and cervical fistulae. However, they are specifically interested in the branchio-oto-renal syndrome, reporting 5 cases. The syndrome combines deafness (middle ear and inner ear), pre-auricular and cervical fistulae and renal abnormalities. They attempt to summarise the syndrome by combining these 5 cases with the 15 published previously (4 initial cases of Melnick in 1974, 4 cases of Fitch in 1976, 7 of Fraser in 1978). The genetically transmissible nature of the syndrome would appear to be beyond doubt. The branchio-oto-renal syndrome was described for the first time in 1974 by Melnick, Bixter and Silk, who reported its existence in a father and three of his children, with an association of a malformation of the middle ear (block of the stapes), of the inner ear (cochlear hypoplasia), bilateral pre-auricular fistulae, bilateral cervical fistulae and renal hypoplasia with or without displasia. In 1974, Fitch and Srolowitz reported 4 new cases, and Fraser, Ling, Ologe and Nogrady a further 7 in 1978. The 5 cases published here bring the total known number to 20.


[Laryngeal cysts in the newborn (9 cases) (author's transl)]. Nine cases of laryngeal cysts in the newborn were seen over a period of 8 years. After reviewing data from the literature, the authors emphasise treatment. Simple puncture aspiration was invariably followed by a recurrence. Marsupialisation or endoscopic resection was associated with 5 successful results. An external operative approach was necessary in 4 cases because of multiple recurrences. No tracheotomy was necessary.


[Functional reinnervation of the larynx. Experimental study (author's transl)]. This study of reinnervation of the larynx results from the research for a functional method of treatment for laryngeal paralysis of peripheral origin. The physiological reality of reinnervation of a denervated muscle by a nerve other than that anatomically destined for it, or "neurotisation", is now an established fact. This experimental study in 12 dogs consisted of neurotisation of a posterior crico-thyroid muscle, denervated by section of the recurrent laryngeal nerve, by implantation of a graft of sub-hyoid muscle with a nerve pedicle. Only one positive result at six months was seen. 8 failures could be explained by the absence of ventilatory difficulty necessary for the sub-hyoid muscles to be brought into action, and the other 3 failures two months after the operation by muscular fibrosis of the graft before neurotisation could occur. Physiology and the experience of other teams justify the continuation of this study.


[Pathological manifestations of tonsillar hypertrophy (author's transl)]. The authors describe the rare but essential indication for tonsillectomy in the child based upon 4 personal cases of pseudolaryngeal dyspnoea during sleep due to prolapse of the tonsils in the hypopharynx. They indicate the grave cerebral and cardiac consequences which could result from neglect of this symptom which at first sight has the characteristics of ordinary snoring. Paediatricians, anaesthetists and laryngologists are equally concerned by this alveolar hypoventilation of high obstructive origin.


[Two cases of laryngotracheal stenosis in children suffering from punctate epiphysis disease (author's transl)]. The authors report two cases of congenital laryngotracheal stenosis in children with punctate epiphysis disease. This rare condition manifests itself clinically by dwarfism of the extremities, saddle-shaped deformity of the nose, cataract and visceral lesions. The specific common feature is the presence of radiological calcifications in bones with chondral ossification. Laryngeal or tracheal localisations are rare. They may be associated with laryngotracheal stenosis. On the basis of these two cases and of eight other found in the recent literature, the authors attempt to define the relationship of such stenosis with the existence of laryngotracheal calcifications and to define their prognostic significance in the course.


[False appearances of aortic arch in laryngomalacia (author's transl)]. The authors report six cases of congenital laryngeal stridor in which appearances of oesophageal compression had led to a diagnosis of abnormalities of the aortic arches. Two children underwent surgery, thoracotomy failing to reveal any abnormality. The other four were investigated by endoscopy which made it possible to eliminate the diagnosis of tracheal compression. All of these children were suffering from laryngomalacia. These cases indicate the need for complete routine studies, in particular endoscopic, in all cases of stridor, as well as for careful definition of the radiological criteria of abnormality of the aortic arches. The pathogenesis of these false appearances of oesophageal compression in laryngomalacia is discussed.


[Anaesthesia for laryngoscopy in suspension in the child (author's transl)]. After reviewing the different methods of ventilation by pulsed oxygen used for anaesthesia during laryngoscopy in suspension in the child, the authors describe a technique of introduction of the endotracheal catheter which makes it possible to reduce the risk of alveolar hyperpressure at the time of installation of the laryngoscope and at the time of waking.


[Circulating immune complexes in primo-secondary and serological syphilis (author's transl)]. Some clinical features of syphilis suggest that immune complexes may be a pathogenetic factor in the syphilitic lesions. Recently, circulating immune complexes have been reported in six patients with secondary syphilis by Søling et al. In our study, the presence of circulating immune complexes was investigated in 42 patients with syphilis (primary, secondary, serological) by the method of C1q binding test. Elevated C1q binding activity was demonstrated in two-thirds of the patients with primo-secondary syphilis, with a significant difference between this group and the controls. Only two of the 21 patients with serological syphilis showed elevated C1q binding activity. Circulating immune complexes, often at moderates rates, appear very early and decrease rapidly during treatment. It was not possible to demonstrate a decline in serum complement in association with elevated C1q binding activity. During five Jarisch-Herxheimer reactions, no increase in circulating immune complexes has been noticed compared to pre-treatment values: this suggests that circulating immune complexes have no essential importance in this reaction. The characterization of the components of these circulating immune complexes by the previously described "radioimmunoprecipitation PEG assay" (RIPEGA) will enable us to state their specificity and to conceive their potential responsibility in some lesions of secondary syphilis, such as nephrotic syndrome.


[Haemorrhagic oedema acute in neonatal skin. Immunological and ultrastructural examination (author's transl)]. There are three reports on acute haemorrhagic oedema of the skin of infants, an illness which English-speaking authors do not individualize but only regard as a clinical variety of Henoch-Schönlein purpura. Yet the features of the disease, as described in children under two years of age, are very characteristic. --Clinical feature is the sudden appearance of oedemas on face and limbs and of cocarde-like purpura with an occasional temperature. --Histological feature is the presence of leukocytoclastic vasculitis. --Immunologically the disease is characterized by the deposit of immune complexes. --Ultrastructural examination confirms the presence of leukocytoclastic vasculitis accompanied by deposit of immune complexes and of platelets. These three reports enable the authors to study the nosological aspects of the illness among the varieties of allergic vasculitis.


[Association of ectodermal dysplasia, cleft of the lip palate and "scrubbing-brush hair". Its situation in "D. E. F. syndromes" (ectodermal dysplasia, cleft of the lip and/or palate (author's transl)]. The "D. E. F.-syndromes" consist of ectodermal dysplasia, cleft of the lip and/or palate (fente labiale et/ou palatine). This group includes the A. E. C.- and the E. E. C.-syndromes. We are reporting two cases of D. E. F.-syndrome, in which there was a very particular hair dysplasia, which we named "scrubbing-brush hair". The first case was a boy. The disease was probably transmitted on the dominant autosomal mode. The ectodermal dysplasia was of hypohidrotic type. The second case was also observed in a boy. There was no similar genetic abnormality in the family. The ectodermal dysplasia was of hidrotic types. The embryological findings account for the association between the ectodermal dysplasia and the medial dysraphia of the face.


[Grover's acantholytic dermatosis (transient acantholytic dermatosis) (author's transl)]. The authors report two cases of Grover's transient acantholytic dermatosis. These two cases exhibit some unusual features. Case no. 1 is that of a 39-year-old female with typical lesions on chest, neck, back and upper limbs. The course was cyclic with spontaneous regressions. This condition had been present for 4 years. Case no. 2 was that of a 46-year-old man with a large erythemato-squamous plaque of the left chest wall exhibiting a vesicular lining. In both instances the histologic findings revealed a picture similar to that of Hailey-Hailey's familial benign pemphigus. In spite of these unusual data, long duration and atypical clinical aspects, these two cases are consistant with the diagnosis of Grover's disease as evidenced by description found in the literature.


[Ecology of leishmaniasis in the south of France. 11. Canine leishmaniasis: successful experimental transmission from dog to dog by the bite of Phlebotomus ariasi Tonnoir, 1921 (author's transl)]. As part of a study of visceral leishmaniasis in the Cévennes in southern France, an infection was transmitted from dog to dog by the bite of a single sandfly, Phlebotomus ariasi Tonnoir, 1921. The role of this species as a vector, suspected from earlier studies, is, therefore, confirmed. Twenty female sandflies, which had engorged on a naturally infected dog 23 +/- 2 days previously were put with a healthy dog which, after an incubation period of 15 months, developed viscero-cutaneous leishmaniasis. In dissections of the sandflies immediately after contact with the experimental dog, it was found that only one had engorged. All of 17 sandflies dissected had midgut infections: 10 of these also had infections in the pharynx. The engorged specimen additionally had parasites in the proboscis, a condition thought by many workers to be necessary for the parasite to be transmitted by bite.


A taxonomic revision of small neotropical saurian Malarias allied to Plasmodium minasense. Saurian malaria species which produce schizonts smaller than normal erythrocyte nuclei, with 4-8 merozoietes and gametocytes equal to or smaller than erythrocyte nuclei in size, parasitizing hosts of the lizard families Scincidae, Iguanidae and Teiidae in the Neotropics are considered to be Plasmodium minasense Carini and Rudolph, 1912. Subspecific designations are given to distinctive populations parasitizing different host species: P. minasense minasense is recognized from the type host, Mabuya mabouya of Brasil; P. minasense carinii Leger and Mouzels, 1917 from Iguana iguana of coastal South America; P. minasense anolisi subsp. nov. from Anolis limifrons of Panama; P. minasense capitoi subsp. nov. from Anolis capito of Panama; P. minasense plicae subsp. nov. from Plica umbra of Guyana; P. minasense tegui subsp. nov. from Tupinambis teguixin of Venezuela; and P. minasense diminutivum Telford, 1973, new combination, from Ameiva ameiva of Panama. Plasmodium rhadinurum Thompson and Huff, 1944 is recognized as a distinct species at present on the basis of possessing schizonts of different shape, asexual stages with filamentous projections in most portions of its range, and larger gametocytes, as well as apparent sympatry with P. minasense carinii in some areas.


[Ecophysiological study on the parasitic action of Cymothoids (author's transl)]. An ecophysiological study on certain parasitisms by Cymothoids allows the elucidation of the following points: --occurrence of oesophagien-side glands producing an anticoagulant effect on the blood of host, the absorption and metabolism of haemoglobin derivatives (hematin and iron) are performed by the hepatopancreas; --existence of immunological reactions between host and Cymothoids; --existence of biochemical, histological, haemotological and biometrical variations among fishes infected by these parasites.


[Receptivity of some Helicids frequent in Morocco to the infestation by the larvae of Protostongylids. Factors of variation (author's transl)]. Several species of Helicids common on pasture in the Rabat area were infected by a plurispecific mixture of larvae of Protostrongylids. The fecal or pulmonary origin of the larvae does not seem to influence their infective ability. The age of the larvae used for infection displays an important role on the future degree of infection of Molluscs: the young larvae are more infestive. The Helicids that were most receptive to infection are, arranged in a decreasing order: Otala lactea, Cochlicella conoidea, C. acuta and Euparypha pisana, Helicella gigaxii. O. lactea and E. pisana permitted the development of Muellerius capillaris, Cystocaulus nigrescens and Neostrongylus linearis. The former species of Helicid is a new intermediary host. The two species of Cochlicella were not suitable for M. capillaris. The Helicids ensure the quantiative and specific regulation of the infection of the Ovines.


[Transmission of bovine Onchocerrca, O. gutturosa, by Culicoides (author's transl)]. Observations made by the author lead to suspected that O. gutturosa is not transmitted by Simulia but by Culicoides: 1. S. ornatum, the vector said to transmit O. gutturosa, bites preferentially the cattle in the ventral area, but the microfilariae observed in this area pertain to O. lienalis and not O. gutturosa, of which the microfilariae are, at the opposite, located in the dorsal area. 2. Records of O. gutturosa in places where simulia are absent or nearly so, are in accordance with these observations. Experimentally, the cycle of O. gutturosa is obtained in C. nubeculosus with a high level of infestation. Thus the author concludes that O. gutturosa is transmitted by Culicoides and that the cycle, in Simulia, attributed to O. gutturosa,pertains in fact to O. lienalis.


[The life cycl of Maritrema pyrenaica Deblock et Combes, 1965, a parasite of insectivorous micromammals in the Pyrences (author's transl)]. The life cycle of Maritrema pyrenaica is described. M. pyrenaica develops to the sporocyst stage in the snail Bythinella reyniesii. The xiphidio-cercaria, monostomous, anenterous in type, is liberated in water and actively penetrates a Crustacea Gammarus pulex where it encysts. From the point of view of epidemiology, the focuses of M. pyrenaica are divided into two different areas: the area where the parasites multiply (that we call "l'endemiotope") coinciding with the Bythinella biotope and the area limited to the length of the river where the Vertebrate is parasitized.


The influence of prostaglandins and vasoactive amines on the intestinal phase of experimental trichinellosis in CBA mice and Wistar rats. The intestinal phase of experimental trichinellosis in CBA mice and Wistar rats is modified by the intraduodenal injection of prostaglandin (PG) E1 and, to a greater extent by PG E2. The resulting changes are dose-dependent and are a function of the point of the infectious cycle at which the injection is performed. Three dose-related phenomena are thus observable: a delay, an acceleration of the process of expulsion of adult worms or no effect, the latter arising if the prostaglandins are injected later in the cycle. Under the same conditions, no significant effects are exerted by PG A, B or F, by histamine or by serotonin.


Extraamniotic intermittent administration of prostaglandin F2 alpha during the first and second trimesters of pregnancy. Extraamniotic application of prostaglandin F2 alpha (PGF2 alpha) was used for legal abortion in the series of 1012 women. The pregnancies were terminated by abortion between the 6th and 27th weeks of pregnancy. In 86.7% of the cases, intermittent extraamniotic application of PGF2 alpha led to complete or incomplete abortions. Of the 26 failures, nine were caused by technical difficulties. In 17 primigravidae, the cervical canal remained closed. There were no statistically related differences between the different weeks of the pregnancy with regard to success and failure rates. The mean PGF2 alpha dose and abortion time increased significantly (p less than 0.01) with increasing duration of pregnancy. 80% of the patients suffered from undesirable side effects. The morbidity rate for the period up to six weeks following the abortion was 3.2%.


Foetal drug exposure following intravenous injection of diazepam immediately before breech delivery. The transplacental passage of diazepam (DZ) was studied in 32 cases of vaginal breech delivery. DZ (30 mg) was injected intravenously 15--170 seconds before delivery in order to induce sleep, and general anaesthesia was maintained with N2O/O2. The concentration of DZ was measured in blood obtained from the mother, the umbilical cord and the newborn. In the majority of the infants the drug concentrations in mixed cord blood and in capillary blood at the age of 2 hours were lower than previously observed in infants with cephalic presentations delivered by forceps. The short injection-delivery (I-D) intervals in breech deliveries may limit the transfer of drug to the foetus, but cord compression and circulatory changes may also lead to reduced materno-foetal exchange of DZ.


Controlled hypotension and moderate haemodilution in major hip surgery. This study presents a series of 38 patients in whom total hip replacement was performed by using a hypotensive anaesthetic technique with moderate haemodilution. 17 patients operated on during normotension without haemodilution served as controls. Halothane, d-tubocurarine and pentolinium tartrate were the agents used. During the operation circulation was monitored carefully. Hypotension with haemodilution decreased the amount of the transfused blood to 1/3, compared with the normotensive group. The bloodless field during the hypotension also shortened the duration of the operations. No complications attributable to the hypotensive technique occurred. The results suggest that the hypotensive anaesthetic technique with haemodilution reduces the need for blood transfusion in major surgery. However, only patients in good cardiovascular status are suitable for this technique, and careful monitoring of the circulation is mandatory during the anaesthesia.


Benign ureteric polyp. Report of a case. A rare case of benign ureteric polyp simulating ureteric stone in its clinical course is reported. Tumour pathology and treatment of benign ureteric tumours are discussed in relation of literature on the subject.


Fractures of the proximal femur in Finland in 1975. Hospital admissions due to fractures of the proximal femur in Finland increased 50% between 1968 and 1976.  In this study the established differences and results of treatment in regional and district hospitals are reviewed. From the mortality incidence and the length of hospitalisation, the results were better in regional than in district hospitals, and better for operatively than for conservatively treated patients. Of the different operative methods, the best primary results were obtained with endoprosthetic replacement and osteosynthesis with a fixed-angle nail plate.


Carcinoma of the colon in pregnancy.

Carcinoma of the colon in pregnancy. Carcinoma of the large bowel in association with pregnancy is extremely rare. A case report is presented, where the patient had a malignant tumour in the sigmoid colon with metastases in the liver. The diagnosis was made at caesarean section after acute onset of symptoms 3 weeks prior to the expected date of delivery. The case is discussed in some detail.


Acromioclavicular complete dislocation. Analysis of the operative results in 48 patients. Complete acromioclavicular separation in 48 patients was treated by operation, using Kirschner wire for fixation in 20 cases and the A--O cortical screw in 17. Late resection of the distal end of the clavicle was performed in 11 cases. Follow-up examination was performed on average two years after the operation. Attention was paid to subjective symptoms, the objective state, duration of incapacity, radiological evidence of dislocation without stress and under stress, osteoarthrosis and soft-tissue calcification. Pain, function and mobility were evaluated by a point system. In the groups primarily treated by surgery the result was at least good in 73%, fair in 16% and poor in 11%. Excellent results were noticed more often in patients under 30 years old than in those over 45 (p less than 0.01). Mobility of the shoulder joint was significantly more often normal when Kirschner wire was used for fixation than after screw fixation (p less than 0.05). Late resection gave at least a fair functional result.


Arthrography of the hip in the diagnosis of postoperative painful conditions after total hip replacement. Arthrography of the artificial hip joint was performed postoperatively in 29 patients with pain after total hip replacement. In 23 cases the arthrographic findings were checked by operation and corresponded in 91%. In two arthrographies which did not give reliable results sinuses outside the thigh or a large pseudocapsule prevented a satisfactory performance of the arthrography. The unoperated patients had only mild discomfort or were considered a high risk for reoperation; they were treated with physiotherapy and medication. As a result of this investigation arthrography can be regarded as a highly reliable method of diagnosing the various causes of pains in the hip after total hip replacement.


Vaginal smear history in patients with invasive cervical carcinoma. In 23 (about 43%) patients cytologically screended within 4 years before the diagnosis invasive cervical cancer 11 had a benign smear; when reviewed, two were borderline cases and three were misinterpreted. Twelve patients had different degrees of squamous cell dysplasia. In three of these the cancer was detected during the follow up procedures. Four did not respond to calls for follow up. Five were checked without any active measure but sampling new smears. Atypical smears must be clinically evaluated and treated in order to detect invasive carcinomas. The therapeutic results, however, may be controlled by repeat smears.


Intravesical formalin instillation in the treatment of massive haematuria. 16 patients with massive haematuria due to bladder cancer or cytostatic or radiation cystitis have been treated with intravesical instillation of 4% formalin solution. The method proved to be effective in the control of bleeding in 15 cases, but produced complications two of which were severe. This mode of treatment should thus be limited to debilatated patients in whom other conservative methods fail to control the bleeding. Complications and mode of action of formalin instillation are discussed.


Deleterious effect of pharmacological doses of corticosteroids after partial hepatectomy in rats. The aim of the present investigation was to determine whether pharmacological doses of corticosteroid can be used safely in the treatment of haemorrhagic shock during major hepatic resection. Following two-thirds hepatectomy in the rat the administration of dexamethasone, 4 mg/kg of body weight, produced higher morbidity and mortality compared with that in the control groups. This was considered to be mainly due to substantial suppression and retardation of liver regeneration. In addition, the steroid therapy exaggerated the degree and time of liver steatosis with marked elevation of serum fatty acid, triglyceride, phospholipid, and cholesterol concentrations. It appears therefore that it would be very hazardous to treat haemorrhagic shock as a result of major hepatic resection with pharmacological doses of corticosteroids.


Premedication for out-patient endoscopy of the upper gastro-intestinal tract. Upper gastrointestinal endoscopy was performed on 342 out-patients. The patients were allocated to four groups according to premedication given. The premedication used was atropine 0.1 mg/10 kg (A), atropine 0.1 mg/10 kg and diazepam 5 mg (AD), atropine 0.1 mg/10 kg and fentanyl 0.2 mg (AF), atropine 0.1 mg/10 kg diazepam 5 mg and fentanyl 0.2 mg (ADF). Premedication was given about 30 minutes before the procedure intramuscularly; the mouth and pharynx were sprayed with 10% lidoc,ine. The patients as well as the endoscopist considered the premedication in groups A and AD to be satisfactory. From the patient's point of view there were hardly any differences between the var;ous groups, except in drowsiness, which occurred more often in groups where fentanyl had been used. From the endoscopist's point of view groups A and AD were preferred because they offered better working conditions for the procedure. The longest period of observation was required in group ADF. On the basis of these results premedication with only atropine or if desired a combination of atropine and diazepam in addition to local sprayed anaesthesia of the mouth and pharynx is sufficient, and is recommended for endoscopy of the upper gastrointestinal tract.


Hydroxyproline metabolism in type II hyperprolinaemia. Hydroxyproline metabolism was studied in two patients with type II hyperprolinaemia (HP II) using oral loadings of hydroxyproline or hydroxyproline-ornithine. delta 1-pyrroline-3-hydroxy-5-carboxylic acid (3 OH-PC) and delta 1-pyrroline-5-carboxylic acid (PC) were identified in the urine. The urinary excretion of both 3-OH-PC and PC increased in HP II patients but not in healthy controls during oral loading of hydroxyproline and hydroxyproline-ornithine. The plasma level of proline in patients with HP II is very high but the hydroxyproline concentration is normal or only slightly increased. Therefore one can assume that hydroxyproline is converted to pyrrole-2-carboxylic acid, which is excreted in urine as a glycine conjugate. In this study it was demonstrated that the highly elevated plasma level of proline in one of the patients with HP II decreased greatly after hydroxyproline-ornithine load; this change was followed by a 40-fold rise in urinary excretion of proline.


Temporal changes in the concentrations of serum constituents in healthy men. Distributions of within-person variances and their relevance to the interpretation of differences between successive measurements. The distributions of within-person variances in the concentrations of 10 commonly assayed serum constituents have been derived from data on 37 healthy male subjects studied at weekly intervals over a period of five months. All 10 distributions appear to be of log-normal form. The relevance of the findings to the interpretation of differences between serial measurements in a given individual is discussed. Examples are given to show how the information on within-person variances for a particular analyte, organised into a simple graph, may be used to test medical opinions on threshold values for serial changes in the concentration of this analyte in a given individual. In this way, biological variability as well as analytical error may be taken into account quantitatively when assessing the significance of a difference between two serial measurements.


Diagnosis of red cell G-6-PD deficiency in a Chinese neonate. In a neonatal period, a red cell deficiency of glucose-6-phosphate dehydrogenase (G-6-PD) may result in jaundice, the severity of which will vary between patients. Diagnosis of this inborn error of metabolism presents a problem if there is a large number of young enzyme-rich red cells in circulation, and this paper details the technique used to confirm a red cell deficiency of G-6-PD in a neonate.


Is the L/S ratio really a lecithin/sphingomyelin ratio? Fetal lung maturity is commonly assessed by determining the ratio of lecithin/sphingomyelin in centrifuged amniotic fluid. In a variety of chromatographic systems currently used for the routine determination of the lecithin/sphingomyelin ratio, including the systems recommended in the original procedure, at least one and frequently two additional phospholipids, normally present in amniotic fluid, tend to chromatograph between or overlapping with lecithin and/or sphingomyelin. These phospholipids have been tentatively identified as phosphatidylserine and phosphatidylinositol. The extra phospholipids contribute significantly to the routine lecithin/sphingomyelin ratio with considerable variation between individual cases. Treatment of dried lipid extracts with cold acetone before chromatography, as suggested in the original lecithin/sphingomyelin ratio procedure, does not remove the interfering phospholipids.


Use of sodium salicylate as a blocking agent for cortisol-binding-globulin in a radioimmunoassay for cortisol on unextracted plasma. This report describes investigations into the use of sodium salicylate as a cortisol-binding-globulin blocking agent and the subsequent development of a radioimmunoassay for cortisol on unextracted plasma. Cortisol antiserum was raised against a cortisol 3-O-(carboxy-methyl) oxime-bovine serum albumin conjugate. A 125I-labelled cortisol-tyrosine methyl ester conjugate was also prepared for use in the assay. The radioimmunoassay developed involved no pre-treatment of extraction of the samples before analysis and was extremely simple to perform. Comparison with another radioimmunoassay for cortisol and with the Mattingly fluorimetric assay gave good correlation.


A simple procedure for the determination of carbamazepine in plasma by high pressure-liquid chromatography. We describe a simple, rapid procedure for the estimation of carbamazepine in plasma. Protein is precipitated, and extraction is achieved by the addition of acetonitrile containing the internal standard N-acetyltryptophan ethyl ester. Separation is by reverse-phase high-pressure liquid chromatography with an acetonitrile: water mobile phase, and detection is by UV absorption at 280 nm. Total retention time is less than 7 minutes. Initial results gave within-batch and between-batch coefficients of variation of less than 2%, and mean recovery of 97%. The method is free from interference by other common anticonvulsant drugs.


Legionnaires' disease pneumonia: histopathologic features and comparison with microbial and chemical pneumonias. The histopathologic findings in lung tissue are reported from five cases of Philadelphia Legionnaire's Disease and the results are compared to pneumonias caused by other microbial and chemical agents. Histopathology of lung tissue was similar in all cases, despite the fact that death occurred between the fourth and 14th day of clinical illness. The inflammatory response was almost totally limited to the lower respiratory tract and primarily involved respiratory bronchioles, alveolar ducts and alveoli. Major bronchial branches and pulmonary interstices showed little or no involvement. There was considerable variation in the extent and nature of the consolidation, but the overall reaction pattern was highly characteristic of diffuse alveolar damage. Most involved areas showed intra-alveolar, fibrinocellular mononuclear cell predominant exudates, associated with pneumonocytic hyperplasia and slough. These findings plus the presence of erythroleucophagocytosis by macrophages and paucity of polymorphonuclear leucocytes are commonly associated with psittacine pneumonia, and much less so with classic patterns of bacterial, viral, fungal or rickettsial pneumonias. Of the toxic inhalants, nickel carbonyl, phosgene, nitrous oxide, cadmium oxide and some halogenated hydrocarbons have been associated with this tissue reaction pattern. Bacteria were notably absent in lung tissue stained by methods used to demonstrate the Legionnaires' Disease agent.


Improved method for the measurement of pregnanetriol in urine. A procedure for the measurement of pregnanetriol in urine by gas chromatography is described. The internal standard is added to the standards, controls and unknowns prior to the enzymatic hydrolysis of the steroid conjugates. Next, the hydrolyzed steroids are extracted from urine and converted to the volatile trimethylsilyl ether derivatives prior to gas chromatography. The initial addition of the internal standard appears to compensate for all procedural losses in this rather complex procedure. The intra- and interassay coefficients of variation at a level of 1.3 mg per liter were 5.3% and 11.8%, respectively. The method is linear to a pregnanetriol:internal standard ratio of 0.871. The analytical recovery for the method was 103 +/- 10.2%.


Evaluation of two new assays for determination of serum fibrinogen/fibrin degradation products. Two new commercial assays for the detection of degradation products of fibrinogen/fibrin (FDP) were evaluated against two standard procedures. The first, a new hemagglutination inhibition (HAI) assay using glutaraldehyde-treated cells, was compared with the tanned red cell hemagglutination inhibition immunoassay (TRCHII). Analysis of 43 samples from patients with a variety of bleeding disorders and thrombotic conditions showed a high degree of correlation between methods (r = 0.934). The second new assay, a rapid slide test using antibody-coated latex particles, was compared with results obtained by electroimmunoassay. There were no significant differences in the results as assessed by two statistical parameters. It was concluded that both new tests are useful for routine use in clinical laboratories.


Neural cells in culture.

Neural cells in culture. In vitro culture of neural cells (nerve sheath cells, melanoblasts, neuroblasts, astrocytes) for three to 20 months revealed a non-mitotic type of replication characterized by appearance between 30 and 120 days. Unipolar and bipolar neural cells, resulting from an initial phase of mitotic reproduction, developed multipolar and dendritic forms with large cell bodies and numerous primary and secondary processes with broad proximal ends exhibiting right-handed helices by phase contrast, differential interference electron microscopy and time lapse cinemicrophotography. The nuclei of the conspicuous cell bodies were quite large, one to three, and contained round, rod, ovid or comma nucleoli up to three or four per nucleus. After 30 days of culture, the nuclei of the cell bodies were notably quiescent with regard to mitotic proliferation, but nucleoli were active and mitochondria were numerous around the nuclei. The cytoplasm of the cell bodies often contained channels interpreted as cisternae of endoplasmic reticulum. The helices of the processes were interpreted as cytoplasmic pumps for conveying mitochondria into their distal ends. The slender distal ends became packed with rod and filamentous mitochondria, which then broke up into fine granules associated with the formation of new nuclei appearing in the preterminal and terminal ends of the processes. The preterminal or terminal unit--knob containing nucleus and distal end of process packed with mitochondrial dust--detached by was of a thread-like connection as a new cell, which entered into a new growth phase toward non-mitotic proliferation.


The Njinga of Angola: a serogenetic study. The Njinga, a matrilineal kiMbundu-speaking Negro people of northern Angola, inhabited the coast near Luanda during the sixteenth century, and were driven inland by Portuguese expansion subsequently. There is no evidence from the present sterogenetic study that they have received any appreciable contribution of Caucasoid genes. Nor is there any evidence of San ('Bushman') admixture apart from a moderate frequency of Gm; their genetic profile and their anthroposcopic traits disclose a greater similarity to West African than to Southern African Negroes. The present study confirms previous findings on the ABO, MNSs, Kell, Duffy, erythrocyte acid phosphatase, adenosine deaminase and adenylate kinase systems, and contributes the first account of the peptidase A, B, C and D, first and second locus phosphoglucomutase, glucose-6-phosphate dehydrogenase, esterase D, haptoglobin, transferrin, Gm and Inv systems in the Njinga.


Medullary carcinoma of the thyroid in the multiple mucosal neuromas syndrome. The clinical features of the multiple mucosal neuromas (MMN) syndrome permit the recognition of these patients and their potential development of the associated medullary thyroid carcinoma (MTC). The distinctive physical appearance caused by the mucosal neuromas, the Marfanoid habitus and, occasionally, the positive family history aid in establishing the diagnosis. Neurogangliomas are frequently present in the gastrointestinal tract of these patients who may have megacolon, constipation and diarrhea. The third instance of the MMN syndrome is reported in the newborn as intestinal obstruction. It is suggested that the syndrome be considered in the differential diagnosis of Hirschsprung's disease and bowel obstruction in the neonate. Serum calcitonin measurements following stimulation by calcium or pentagastrin infusion reliably detect incipient MTC and may be used to select those MMN patients requiring thyroid surgery. Recognition of patients with the MMN syndrome and subsequent calcitonin screening and early surgical intervention will significantly reduce the chance of their developing terminal MTC. All MMN patients with mucosal neuromas or intestinal neurogangliomas should have such evaluations at least yearly. Relatives who are at risk for inheriting this dominant disease should be similarly evaluated, regardless of their normal appearance.


Invasion of the Fallopian tube by Enterobius vermicularis. A solitary granuloma containing a gravid female pinworm was incidentally found in the fallopian tube of a 27 year old woman. On rare occasions, pinworms have been found outside the gastrointestinal tract, most frequently in the peritoneal cavity. The reported cases have been found at all levels of the female reproductive tract from the introitus to the fallopian tube. Thus, the hypothesis is supported that the worms reach the pelvic cavity via the genital tract. In addition, pinworm granulomas have also been found in the liver, lung, prostate and the renal pelvis. Awareness that such lesions may occur is important since the lesions may be interpreted as being malignant with subsequent unnecessary surgical intervention.


The analysis of whorls on specific fingertips with respect to sex, bilateral asymmetry, and genetic relationship. In a sample of 539 Polish families, 1000 individuals (515 males and 485 females) were analysed to determine the distribution of whorl patterns on specific fingertips, to compare their frequencies in males and females, and to determine whether asymmetry of these dermatoglyphic pattern elements is genetically controlled. Whorls occur most commonly on digit VI on both hands and in both sexes. The difference between males and females for mean values of occurrence is not significant. Using the bimanual difference between hands (right minus left), the digital asymmetry was determined, and correlations with asymmetrical occurrence of whorls was made between parents and children, and between sibs, in all combinations. In each case, there was a positive correlation pairs of relatives, demonstrating a genetic component in whorl determination and their asymmetrical occurrence.


Measurement of breast volume in females: description of a reliable method. Breast volume measurements were made on 47 adult subjects using a casting method. After drying, fast-setting plaster casts were filled with sand of known density to a level approximating the curvature of the chest wall. The reliability of both sand filling and casting proved to be high, r = 0.97, and r = 0.99, respectively. The total variable error was 10.2%. The effects of position (standing versus lying) was investigated in a separate sample of 15 subjects. No significant difference (P less than 0.05) was found between methods. The relationship between breast volume, girths, skinfolds, and body density was reported to be low.


The age of menarche in Nigerian urban school girls. In March and April 1978, a sample of 1365 girls from three secondary schools within and near Enugu (capital of Anambra State of Nigeria) were interviewed regarding date of birth and menstrual status. Using probit analysis, the mean age at menarche was 13.54 +/- 0.07 years, implying, when compared with earlier studies, a rate of decline in the average menarcheal age of about four months per decade. Significant differences were observed in the menarcheal ages of the girls with respect to their geographical residence and the occupation of their fathers. The results obtained in the study are similar to those reported by Oduntan et al. (1976) for south-western Nigeria, and they lend support to the proposition that improvements in nutrition and the elimination of infectious diseases (characteristic associated with socioeconomic development) tend to reduce the average menarcheal age.


Dermatoglyphics in the testicular feminization syndrome. Dermatoglyphic characteristics, both quantitative and qualitative, of fingers and palms of 19 46,XY propositae with the complete form of the testicular feminization syndrome, derived from 28 index kinships, have been analysed in detail. The results reveal trends which allow the tentative conclusions to be reached that in normal circumstances, and insofar as the sex chromosome influence is concerned, aspects of the development of the palmar patterns of loops and triradii may be directly influenced by the sex chromosomal complement of the fetus; by contrast the digital ridges, and, secondarily, the digital patterns, may be influenced to an extent by testicular androgens.


Sheldon's trunk index and the growth of the thoracic and lumbar trunk. The trunk index (TI), a ratio of the area of the thoracic trunk to that of the lumbar trunk, is measured on a somatotype photograph marked according to defined criteria. Photographs of 82 boys from the Harpenden Growth Study were measured at ages 5 to 18 years, in an order that obscured which photographs were of the same boy at different ages. Remeasurement two months later of 12 boys at each of ages 5, 11, and 18 years showed retest correlations of 0.97 or higher for thoracic and lumbar areas separately and of about 0.95 for their ratio. When 57 boys aged 17 to 20 years were measured by another worker, their TI values correlated 0.90 with those used in this study. Inter-age correlations among the unedited TI values were approximately 0.9 between ages a year apart and declined as age differences increased. Correlations with values at age 18 increased from about 0.7 at age 5 to 0.9 by age 16. Editing was done by remeasuring all values that deviated by more than 0.05 TI units from a regression line based on each subject's total array of values. In the edited data, correlations with TI values at age 18 increased, ranging from 0.8 at age 5 to 0.95 by age 16. Mean TI was quite stable, ranging only between 1.45 and 1.51 for the whole age span, with the lowest values appearing from 11 to 14 years. In 43 of the 59 boys whose series allowed determination of peak height velocity (PHV), a 'TI dip' appeared: one to three TI values fell more than 0.05 TI units below the boy's overall regression line shortly before PHV. Distance and velocity curves are given for growth of the thoracic and lumbar trunk areas. Peak velocity of growth of the lumbar area occurred on average a little earlier than that for the thoracic area; the TI dip was in part a result of this. Alterations of fat distribution as seen by skinfolds probably also contributed. Judging by their individual regression lines, about 80% of the boys showed no more than chance variation from a horizontal slope, their TI neither increasing nor decreasing overall. An additional 10% appeared to show significant slopes only because their series started or ended too near their TI dips. The remaining 10% of boys appeared to show real changes in TI as they grew. Examples of the most extreme changes are shown.