Extra-articular processes in osteoarthropathia psoriatica. 1. Osteo-articular manifestations in the context of osteoarthropathia psoriatica are characterized by two completely different processes. 2. The intra-capsular synovitis does not differ qualitatively in respect to twelve morphological characteristics from that of rheumatoid arthritis. Only RA-necroses never occur in psoriatic arthritis. 3. The extra-capsular process occurs at the compact as well as the spongy bone of the phalanges. The process shows no sign of a previous or current inflammation or of osteoclast activity. It is characterized by a focal loss of proteoglycan interstitial substance and the exposure of the collagen fiber matrix. 4. This focal proteoglycan loss sets off a process which takes place in four phases: a) Loss of proteoglycan interstitial substance and exposure of the preserved collagen fiber matrix of the bone. b) Deposition of osteoblast chains to the area of the exposed bone and formation of osteoid within the old collagen fiber framework. c) Remodelling of bone defects through filling in of the preserved collagen fiber matrix with newly formed woven bone. d) Reconstruction of this bone into lamellar bone, whereby excessive bone structure ("protuberances") may develop, but final balance of bone remains negative. 5. The described process, which begins with proteoglycan loss, is considered as an enzymatic disturbance, which is causatively connected to the skin process. Scintigraphic examinations indicate that this extra-articular process in the bone, in contrast to arthritis, in part clinically unobserved, is to a high percentage connected to the skin process and is, therefore, probably an integral part of psoriatic disease.


The transgluteal approach to the hip joint. A modified transgluteal approach to the hip joint without osteotomy of the trochanter is described. The advantage of this approach is a better view of the acetabular rim, prevention of gluteal muscle damage and protection of the superior gluteal nerve.


The Chiari pelvic osteotomy--indications and results. Chiaris pelvic osteotomy with or without intertrochanteric osteotomy was performed in more than 100 cases during the past ten years. An evaluation of 97 operations showed good results in younger patients (age groups from 5-17 years). In adults with evident signs of arthrosis a higher rate of failures was obvious and therefore the indication for the pelvic osteotomy in this group of patients should be restricted.


Arthrodesis of the metatarsophalangeal joint of the great toe. Since 1975 the usual treatment of hallux valgus and hallux rigidus at the Medical High School, Lübeck, has been arthrodesis of the metatarophalangeal joint of the great toe. We report 48 operations performed between 1975 and 1977 on 35 patients with a follow-up of 3-32 months. The operative technique, using the "dynamic compression plate" is described in detail. The patient's assessment and the clinical and radiological situations were recorded. There were only three poor results. Thus, arthrodesis of the metatarsophalangeal joint is considered to be a reliable therapeutic method in hallux valgus, with minimal post-operative complications. It compares well with other operations, including Keller's arthroplasty.


Initial experiences with a total knee prosthesis implanted without bone cement. Prosthetic loosening and stem fractures have been the most frequently encountered complications of knee arthroplasties using the Guepar Hinged prothesis. The insufficient intramedullary fixation of the stem and the use of cement in the femur and tibia are primarily responsible for these complications. In our clinic, we have used an altered Guepar Hinged prothesis since 1975. The femoral and tibial stems are lengthened with medullary nails, resulting in stems with high bending and torsional stress capacities. The fixation strength of these special long stems in the medullary cavities is such that we no longer use cement for this prosthesis. The initial results of our cementless implantation of these special long-stem knee prostheses, and the advantages of this method are reported.


[The motility of hip joint endoprostheses (author's transl)]. The motility of a healthy hip joint normally seems to be better than the motility of an endoprosthesis. The movement of all models of endoprostheses must fulfill minimum requirements as well in total motility as in each way. The arithmetical investigation of the motility of commercial total endoprostheses shows good locomotion for most cases. Decisive is the relation between prosthesis head- and prosthesis neck diameter. Insufficient motility of endoprosthetic models results if especial--redundant--constructive details of the socket are selected. It seems to be more problematical to produce double cup endoprostheses which reveal sufficient function. Normally the motility of double cup prostheses must be essentially less than that of total endoprostheses or of a healthy hip joint. A special implant technique and various constructive assumptions are necessary to reach a sufficient functional result.


Vascular extracellular tissue and atherosclerosis. If at all successful, tis paper will emphasized the perspective  that the current understanding of the interactions between arterial walls and the flowing blood, the major events leading to the development of arterial diseases, still has many obvious gaps. Even as superficial and selective a discussion as this one points out the truism that any hypothesis for the pathogenesis of atherosclerosis which considers only one of the structural elements in the artery wall is almost certainly incomplete. Decades ago, one of the great conceptual insights developed in the pioneering studies of intermediary metabolism was that well-integrated biochemical pathways have multiple interrelated controls. The many extracellular molecules present in aorta with both structural biochemistry and functions as yet only partially understood may well be components of analogous control systems.


Inhibitors of platelet function and atherogenesis. Platelets play an important role in atherogenesis. This has given rise to the speculation that inhibitors of platelet function may prevent atherosclerotic changes. Two distinct therapeutic goals might be achieved by the use of inhibitors of platelet function in vascular disease - one, the prevention of thrombosis and, two, the prevention of atherosclerosis. The choice of inhibitor may well determine the goal achieved. Thus far, the data available indicate that inhibitors of platelet aggregation, such as aspirin, are the most effective in the prevention of thrombosis, while inhibitors of platelet adherence, such as dipyridamole, are likely to be the most effective in the prevention of atherosclerosis.


Physiologic and pharmacologic implications of fibrinolysis. According to the thrombogenetic (encrustation) theory of atherogenesis first postulated by Rokitansky, accretions of blood components including fibrin and platelets may be the initial event. Since fibrinolysis has a profound influence on the resolution of fibrin deposits, the role of fibrinolysis in atherogenesis is discussed. Evidences supporting this role include the demonstration of inhibitors of fibrinolysis, decreased circulating fibrinolytic activity in patients who are atherosclerotic, and inhibition of circulating fibrinolytic activity by several atherosclerosis-risk factors such as increasing age, cigarette smoking, hypercholesterolemia, hypertriglyceridemia and diabetes mellitus. It is concluded that a combination of systemic inhibitions of fibrinolysis over a long-term period and a local vascular injury, play a decided role in atherogenesis.


[Functional morphology of the adrenergic innervation and adrenocontaining structures of the lymphoid organs]. Topography of adrenergic neural fibres and adrenodependent structures in lymphoid organs of some mammals (rat, cat, dog, guinea-pig, golden hamster) has been studied by means of Falck's method with other histochemical methods applied simultaneously. In thymus, spleen, tonsils, lymph nodes and appendix adrenergic innervation is performed at the expense of adventitial vascular plexus and some neural fibres directed towards the organs' parenchyma. In the parenchyma of the lymphoid organs some fluorescent interfollicular macrophages and intrafollicular cells with serotonin and catecholamines in their cytoplasm were detected spectroscopically. These two types of cells respond differently to increasing amount of free amines in the organism. Orthochromic mast cells and elastic fibres also possess fluoresent properties which are connected with the presence of serotonin and catecholamines in the lymphoid organs.


[Cytophotometric study of the AChE-containing nerve cells and fibers of the rabbit heart after electrostimulation of the area hypothalamica posterior]. By means of cytophotometry and a computer in the cardiac intramural neural plexus of 17 experimental and 17 control rabbits acetilcholine esterase (AChE) activity (revealed by Karnovsky--Roots' method) was investigated. It was stated that a prolonged electrostimulation of the area hypothalamica posterior (AHP) produced statistically significant 2-fold decrease of AChE activity in the cardiac neural cells and fibres. When the stimulation of AHP was stopped, the decreased enzymatic activity was observed for the first two weeks, then by the end of the 4th week it again reached its control level. The results of the work were discussed in view of possible disorders of regulating vegetative-trophic effects of the posterior hypothalamus on innervative and executive tissue elements of the heart.


[Reaction of the elements of the hypophyseal-adrenal system in "starting" states]. Morphological elements of the system hypophysis--adrenals have been studied in 19 dogs. Nine animals were given single individually dosed physical loading (running in the treadmill) up to the III stage according to an original technique. The III stage of the organism's response is characterized, according to physiological and biochemical parameters, as a "starting" condition. The other 10 animals served as a control. Biometric, histologic, histoenzymatic and electron microscopic methods were used for the study. The "starting" conditions were demonstrated to determine variously directed dynamics and unequal involvment of cellular elements and zones of the system hypophysis--adrenals. The greatest reactive degree was noted in basophilic adenocytes and chromophobes, as well as in the medullar substance of the adrenals. Acidophils and cells of the fascicular zone play the least role in the response. Unequal participation of the adenohypophyseal cellular elements and the adrenal zones in the organism's response at the "starting" conditions form a predominance of certain processes of cellular activity in them.


[Ultrastructural analysis of the effect of vagotomy on the state of the exocrine portion of the rat pancreas]. Dynamics of reactions in the main components of the exocrine part of the rat pancreas (capillary, nerve, pancreocyte) was subjected to ultrastructural analysis at bilateral subdiaphragmatic vagotomy within 24 hours--30 days. It was stated that certain ultrastructural shifts developed in all the components mentioned above; at first they are within the limits of physiological parameters (the first three days), and then destructive processes occur (up to destruction of a part of cells) reaching their maximum by the end of the first--beginning of the second week and having a focal character. Then compensatory-recovery rearrangements begin to predominate, and by the 30th day they result in a considerable but not yet complete normalization of the ultrastructural organization of the gland. Three stages (phases) can be mentioned in the development of the neurodistrophic process: the first--stress reaction of the organ and the whole organism to the operation; the second--predominance of destructive changes; the third--development of compensatory-adaptive processes. Possible mechanisms of the rearrangements occurring are discussed.


[Effect of progesterone and estrogens on the state of the hypothalamo-hypophyseal neurosecretory system in pregnancy and labor]. Morphofunctional state of the hypothalamo-hypophyseal neurosecretory system was studied in rats at late stages of pregnancy. No special differences both in function of the supraoptical and praventricular nuclei, and in the hypophysis of intact and pregnant rats at administration of progesterone were noted. When estrogenes were administered to pregnant animals, a sharp increase in functioning of the supraoptic and especially of the paraventricular nuclei was noted. The greatest activity of the supraoptic nucleus was observed at delivery that could be resulted from a stress reaction to pain.


[Functional and morphological basis for the nature of the microcirculatory bed reactions of the bulbar conjunctiva in experimental occlusion of the cranial mesenteric artery]. A complex analysis on changes occurring in conjunctival microcirculation and a number of indices of hemodynamics, hemorheology and metabolism at different time of experimental occlusion in the cranial mesenteric artery has demonstrated certain objective and many-sided correlations that prove a systemic character of biomicroscopical changes in the conjunctiva. The degree of changes in the conjunctival microcirculation depends on duration of occlusion. After a 3 hours' occlusion revascularization is accompanied by reversible general microcirculatory disorders that are registered in bulboconjunctiva. In a 6 and 12 hours' occlusion revascularization is characterized by increasing general changes in microcirculation.


[DNA content and the endometrial cellular mitotic activity in the phase of menstrual bleeding]. Endometrium obtained during menses from 46 healthy women in reproductive age was investigated morphologically and cytospectrophotometrically in order to solve the problem on the source of the cells reepithelizing the uterine mucous membrane after desquamation. It was stated that desquamation takes place not in the whole functional layer of endometrium, some mucous fragments, covered with persisting luminal epithelium, are always preserved. During endometrial regeneration the cells of the luminal and glandular epithelia and those of endometrial stroma are predominantly diploid. The amount of premitotic cells in population is so small that they cannot secure any intensive cellular proliferation. Mitogenesis in endometrium is stimulated only after a complete restoration of the epithelial layer. It is suggested that persisting luminal epithelium is the source of cells for reepithelization; they migrate towards endometrial "wounds" and repair defects in the uterine mucosa during the regeneration phase.


[Formation of adaptive structures at tendon compression sites]. The structure of tendons in long and short human fibular muscles, in superficial and deep toe flexors of the dog hind paws has been studied histologically and histochemically. In the parts of tendons experienced pressing down, various degree of tendinous transformation into cartilaginous and osseous tissue has been revealed. The degree of transformation depends on the power of pressing factor and on the age of the individual. In the course of adaptive changes in these parts certain constructions appear that are oriented transversally to the tendinous fasciculi, but along the pressing vector and having the appearance of basophilic "cross-bars" and oxyphilic "columns". These constructions contain acidic mucopolysaccharides (glycosaminoglycans) of chondroitinsulfates of A, B, C types and keratansulfate. In the course of reconstruction of cartilaginous tissue into the osseous, avascular tissue transforms into the tissue rich in blood vessels.


[Morphologic changes in skin tumors induced by pulsed laser radiation]. Pathomorphological changes in melanoma, basalioma, and squamous cell carcinoma of the human skin caused by impulse neodime laser radiation were studied. Laser radiation was found to exert damaging effects on the tumour of various degrees of intensity, the degenerative changes reaching the highest degree, necrosis, in the zone of the direct effect of the ray. Morphological changes in tissues developing under the influence of laser radiation are in many aspects similar to electrocoagulation necrosis. At the same time, foci of laser lesions have some features distinguishing them from common thermal injuries. Cytological examination was shown to be a highly effective method permitting to determine the degree of radical healing of skin tumors treated with the laser ray.


[Lymphogranulomatosis of the thymus gland ("granulomatous thymoma")]. Thirteen tumors of questionable genesis located in the thymus were studied. The microscopical structure of these tumors was identical to lymphogranulomatosis of other localization. Reactive proliferation of the thymic epithelium and cyst formation are characteristic of lymphogranulomatosis primarily developing in the thymus. The disease was not "granulomatous thymoma" since giant multinuclear cells by their structural characteristics corresponded to reticular elemens and the epithelial component was absent in extrathoracal formations.


[Changes in the urinary bladders of rats during experimental carcinogenesis]. Rats receiving with drinking water a 0.4% solution of a-butyl-N-butanol-nitrosamine developed by 4 months transitional cell papillomas and by 10 months transitional cell carcinomas in their urinary bladders. Histochemical examinations of the transitional epithelium in the course of malignization revealed a gradual decrease in the activity of nonspecific alkaline phosphatase and increased activity of monoaminoxidase and beta-glucuronidase. A significantly increased activity of nonspecific acid phosphatase was observed in areas of squamous cell metaplasia.


[Changes in neuromuscular synapses in myasthenia and lymphoepithelioma of the lymphoid type without myasthemia]. Comparative electron microscopic examinations of 35 neuromuscular synapses were done in 3 patients with generalized myasthenia accompanied in 2 cases by thymus hyperplasia and in 1 case by lymphoepithelioma of the epithelial type after treatment with anticholinesterase drugs, and 33 neuromuscular synapses in a patient with lymphoepithelioma of the lymphoid type without myasthenia who had not taken the above drugs. Similar changes of the synapse ultrastructure were found consisting in extension and reduction of the synaptic folds and secondary synaptic splits with the presence in them of granulo-fibrillar substance, and a decrease in the number of synaptic vesicles. It is assumed that ultrastructural changes of postsynaptic membrane in myasthenia are non-specific and are not due to anticholinesterase drugs.


[Electron microscopy in the differential diagnosis and prognostic evaluation of muscle tissue tumors]. The ultrastructure of striated and smooth muscle tumors of man was studied. A set of features indicating the histological origin of these tumors was established. The most informative feature for tumors of both groups is the presence of fragments of specific microfibrillar apparatus. An analysis of the extent of its development in the cell cytoplasm showed that this feature adequately reflects the tumor cataplasia. Thus, for rhabdomyosarcomas it was considered to be expedient to distinguish three groups according to the degree of the involvement of the myofibrillar apparatus (fibrillar, filamentous, and poorly differentiated types) which may be important for the prognostic evaluation of these tumors. Similar relationships were found with smooth muscle tumors. It is concluded that electron microscopy may be used successfully for differential diagnosis and determination of the degree of cataplasia of human muscle neoplasias.


[Interrelationship between atherosclerotic changes in different arterial basins]. The evaluation of atherosclerosis of 310 sets of arteries stained with sudan IV was done visually by the planimetric method using the WHO criteria. Based on the evaluation in each case of 50 arterial segments, standardized values were calculated for the 9 main basins which permitted to determine the place of each vascular area in the atherosclerotic process and to reveal its characteristic features in different basins. The development of atherosclerosis in the human arterial system was of systemic nature as indicated by significant positive correlations between various basins. The severity of the involvement of one vascular area, however, was not an adequate indication of the severity of involvement of the other systems. Since the area of the involvement did not always reflect the severity of the process, it is suggested that the severity of atherosclerosis be evaluated by strength of correlation between the area of raised lesions and severe stenoses and occlusions.


[Morphologic changes in the ovary upon exposure to low temperatures (-196 degrees C) using cryoprotection]. The biological action of deep freezing (-196 degrees C) on the ovary with the purpose of establishing the possibility of using low temperatures for long-term storage of this tissue was studied. The use of polyethylene oxide of molecular weight 400 at an optimal concentration (20%) for freezing at a rate of 1 degree per minute to -8 degrees C, then 10 degrees/min to --196 degrees C permits to retain the functional activity of the ovary and restoration of its function after transplantation.


[Morphology of the Fahr syndrome (idiopathic calcification of the cerebral vessels)]. Two observations of the Far syndrome manifested by calcification of the brain tissue, oligodendroglia, arterial walls, arterioles, capillaries and veins are described. In the first case, the Far syndrome developed against the background of hypoparathyreosis with longterm disturbance of phosphorus-calcium metabolism, in the second--against the background of endocrine polyadenomatosis (trabecular adenoma of the thyroid gland, clear cell adenoma of the adrenals) with hyponatremia.


[Pathologic diagnosis of certain congenital heart defects]. Morphometrical examinations of 265 normally formed hearts collected at autopsies of infants under 2 years of age were used as a control of the heart weight and size of the pulmonary trunk and aorta. The time of anatomical closing of the arterial duct and oval window were established. Comparisons of the results of morphometry of normal and 173 malformed hearts with the tabulated data were used to develop objective criteria for pathological diagnosis of congenital heart diseases: open arterial duct and centrally located defect of the interatrial septum in infants dying within the first two months of life. The criteria for the detection of marginal forms of stenosis of the pulmonary trunk ostium and isolated coarctation of the aortal isthmus were established.


Vidian neurectomy: neuroanatomical considerations and a report on a new surgical approach. If conventional treatment fails, vidian neurectomy is a viable alternative for therapy of chronic rhinitis with recurrent polyposis of the nose and sinuses. From a neuroanatomical point of view beneficial and adverse effects of this surgical procedure are discussed. According to our own investigations and experiences, vidian neurectomy should be performed together with clearing out of the sinuses in every case. Beginning with this precondition a new surgical approach was developed: the vidian nerve is detected through a transethmoidal route in the pterygoid canal at the bottom of the sphenoid sinus and dissected using the operation microscope.


[Autoradiographic investigations on the developing otic capsule of hamsters (author's transl)]. Cellular and intercellular metabolism of the developing otic capsule of the newborn hamster is investigated by means of autoradiography. The labelling patterns of periostal and endostal osteoblasts are compared with the finding on long bones. The low metabolic turnover within the cartilage before ossification and histological changes in an ossification center are discussed. The number of interglobular spaces decreases in the early phase of life and do not show activity. The globuli ossei appear to be a bony new formation. No indication for metaplastic development from the original cartilage was found. Labelling patterns appeared identical as in other developing ossicular bone. Intralacunar apposition of osteocytes was seen.


Hair cell degeneration in guinea pigs intoxicated with kanamycin during intrauterine life; a structural and ultrastructural study. The structural ototoxic effect of kanamycin during intrauterine life has been shown in guinea pigs. The extent of the loss mostly affected the outer hair cells of the basal part of the cochlea. Ultrastructural studies demonstrated a hair cell degeneration pattern similar to that previously described in adult animals following antibiotic intoxication.


The applicability of porous polyethylene for tympanoplasty; an animal experimental study. The problem of a replacement material for the reconstruction of the posterior wall of the auditory canal, as well as for the obliteration of the radical cavity has not been solved satisfactor;ly so far. In order to examine the possible applicability of porous plastics, the posterior wall of the auditory canal of guinea pigs was first removed and then reconstructed using porous polyethylene and filling the bulla tympanica with fine polyethylene chips. One third of the animals had an infected middle ear at the time of implantation. Histologic assessments were made until 24 weeks after implantation. In 80% of the animals the implant settled well, even in cases where the middle ears had been originally infected. By proliferation of vessels and connective tissue, the polyethylene had almost been completely integrated into the surrounding tissue after one week. Extent and frequency of metaplastic osseous growth was greater inthe chip-filled bulla than in the reconstructedposterior wall(Fig. 9). After four weeks, the new osteoid substance was firmly connected with the regional bone (Fig. 4). According to these results, it would seem possible to use porous polyethylene even for the nonaseptic implant bed as it is found in the chronically infected middle ear.


Supraglottic surgery in vestibular cancer. This paper deals with the experience acquired in the E.N.T. Clinic of the University of Ferrara regarding horizontal supraglottic laryngectomy in vestibular cancer. The anatomical background of this functional surgery and the most important principles of the technique are specified. The results regard 121 cases (13 T1 cases, 93 T2 cases and 15 T4 cases) divided into three groups: 1. patients who had only surgery (68 cases); 2. patients who for various reasons also had complementary postoperative radiotherapy (39 cases); 3. patients with extralaryngeal expansion who had preoperative radiotherapy (14 cases). The high overall survival rate for the 121 cases is particularly significant, as is the shortening of the high-risk period to less than the usual 5 years. The 4-year cure rate is 78% and remains unchanged right through the 7-year follow-up. The authors feel that these data demonstrate further the validity of supraglottic laryngectomy when its precise indications are rigorously observed.


Congenital ossicular anomalies without malformations of the external ear. Eighteen ears of congenital ossicular malformation without deformities of the external ear were presented. They were classified into three groups; eight incudostapedial joint separations, three malleus and/or incus fixations, and seven stapes fixations. The surgical correction for the first group was to connect the malleus handle to the stapes using a silicon tube specially designed or a gelfoam wire in the uncustomary way. This group showed the best surgical results with 35.4 dB of the average hearing gain in speech frequencies. In the second group, removal of the fixed part of the ossicles yielded satisfactory results, but mobilization failed to improve the hearing. For the group of stapes fixation, stapedectomy and the gelfoam wire prosthesis were performed. The result was not satisfactory in some cases with the undeveloped oval window. The embryological consideration leads us to the following conjecture; the incudostapedial joint separation results from the failure in build-up of "the secondary continuity", the malleus and/or incus fixation is the result of disturbances in separation process by the undifferentiated mesenchyme, and the stapes fixation is due to maldevelopment of the stapedial lamina. This classification for the congenital ossicular malformation is practically valid as it would suggest the maldeveloped point in ossicular genesis and results of surgical correction.


Electrocochleography and experimentally induced loudness recruitment. The relationship between changes in loudness and the cochlear whole-nerve potential following experimentally produced deafness was studied in an animal model. Reaction time of a subject's response to an auditory stimulus has been shown to be an index of loudness in human experiments and has been adapted to nonhuman primates. In a series of experiments, four macaque monkeys were operantly conditioned to respond to 8-kHz tones over a range of 3--80 dB SPL, and their reaction times to pure tone stimuli were measured. Whole-nerve cochlear action potentials were recorded from chronic inner-ear electrodes. The relationship between behavioral and electrical measures of loudness recruitment were examined in animals with both temporary and permanent noise-induced hearing loss. Loudness recruitment was demonstrated experimentally after a 1-h exposure to a high-intensity 8-kHz octave band of noise. Excellent agreement was observed between the reaction time function and the action potential input-output function at intervals of 0.5, 12, 24, 48, and 84 h after exposure. Permanent hearing loss was produced in some of these animals by a much longer duration of exposure to the 8-kHz octave band of noise. Recruitment was observed in both the behavioral and the electrical measures. Histological studies of these damaged cochleas revealed primarily outer hair cell destruction, with a relative sparing of inner hair cells and nerve supply. The findings of this study are interpreted as strong support for the clinical electrocochleogram as an objective indicator of the presence of loudness recruitment.


[Blockage of cochlear aqueduct for examination of perilymph (guinea pig) (author's transl)]. To prevent the perilymph (guinea pig) from contamination with CSF during the sampling the aqueductus cochleae (AC) was blocked by injection of tissue adhesive into the meningeal aperture. The control of an exact blockage of AC was carriedout by examination of perilymph-outflow after opening the cochlea (injection of fluorescein-Na into the CSF-space), analysis of perilymph-protein-concentration, macroscopic and microscopic examination of the temporal bones. In all cochleae we have found the same morphological structures, notwithstanding whether the AC was blocked (for a time from 30 min to 7 weeks) or not: The cochlear aqueduct is filled with a mesh of mesenchymal tissue, which grows more dense towards the cochlear aperture andcontinues into the round window membrane. From scala tympani the AC is always limited by one layer of cells forming a sort of membrane (under light microscope). It seems possible that CSF moves in the inner of the round window membrane between AC and subepithelian space of middle ear mucosa, whereas perilymph of scala tympani is not in direct contact with the flow of CSF. The scala tympanic side of the round window membrane may be a big area for diffusion and there also may be an exchange between CSF and perilymph. The outflow of CSF into the cochlea after experimental opening of the cochlea is an artifact, caused by damage of pressure equilibration between CSF-space and cochlea. 30 min and 5--7 weeks after blockage no morphologicaland electrophysiological alterations from those of the control ears were to be seen. The protein concentration, however, increased significantly 5--7 weeks after blockage from normally about 200 mg/100 ml toalmost the double especially in the scala tympani (see Table 1).


Embryogenesis of the inner ear. I. Development and differentiation of the mammalian crista ampullaris in vivo and in vitro. The embryonic development of the crista ampullaris in the CBA/CBA mouse was followed comparatively in vivo and in vitro after explanation of the 13th gestational day otocyst. Special attention was paid to hair cell differentiation. In general the in vivo and the in vitro groups of inner ears showed a similar morphological maturation of hair cells on the ultrastructural level. The first sign of hair cell differentiation occurred on the 14th day in vivo and after 1 day in culture showing a thickening of microvilli presumably indicating the development of future sensory hairs. On the 16th day or after 3 days of in vitro culture the sensory hairs were regularely arranged with the kinocilium located at the cell periphery. Afferent nerve endings were identified on the 17th gestational day and some nerve terminals were suspected to be of efferent character appearing on the 18th day. On the day of birth there did not occur complete nerve chalices but a differentiation of hair cells into type I and II was indicated on the 19th gestational day by a slight difference in hair cell configuration and extension of innervation.


A slow brain stem response for low-frequency audiometry. Proper choices of stimuli and of brain stem electric responses allow us to estimate peripheral auditory thresholds at 500, 1 000, 2 000 and 4 000 Hz with an accuracy of about +/- 10 dB. With the help of sedation (secobarbital), such audiograms may be obtained from each ear of a child of any age in a single session. Tone pips (filtered clicks) or very brief tone bursts give a frequency selectivity that is clinically adequate. The rise time must be adjusted to the center frequency. A rise time of two periods with a plateau from zero to one period gives a good compromise between frequency specificity and a synchronous neural discharge. The best threshold indicator for tone pips of 2 000 Hz or higher (or unfiltered clicks) is P6 (Jewett V). At 60 dB nHL its latency is 6.0-7.0 ms (for children of 1 year or older), but near threshold it is 8.0-9.5 ms. An input pass-band of 140-3 000 Hz is appropriate. The best threshold indicator at 500 or 1 000 Hz is a nearly neglected slower wave with a scalp-negative crest at about 10 ms following a 60-dB click. Latency is 15 ms following a 500-Hz tone pip at 15 dB SL. We call this wave "slow negative (ten)" or SN10. To see it well a wider input pass-band such as 40-3 000 Hz is needed. SN10 is usually obscured by P6 or by frequency-following response at stimulus levels above 35 dB SL. The details are given of a clinical routine that allows the determination (+/- 10 dB) of 8 threshold endpoints within about 80 min. Several precautions and limitations are discussed, and also the origin of the SN10 wave.


Intersubject variability of the auditory-evoked brain stem potentials. The potential usefulness of the auditory-evoked brain stem potentials in audiological assessment has been the subject of increased clinical enquiry. Several requirements need to be met by any response parameter if it is to be clinically useful: parameters should show a clear, and ideally simple, relationship with stimulus intensity; they should be stable within any subject under fixed stimulation conditions and intersubject variability within any clinical group should be small. Response latency has been shown to satisfy the first two of these conditions. However, intersubject variability has been less clearly defined. In a sample of normal controls we have found that the standard deviation of latency at any specific intensity was substantial, exceeding the difference found between mean responses at neighbouring intensities of auditory stimulation. In an investigation of the origins of this variability we have found a clear gender difference, maximal for later components in which the male responses were significantly later than the female responses. The clinical significance of this finding can be seen in the latency intensity input/output function. By treating each gender group separately, intersubject variance values were reduced by approximately 40% compared with the total group variance, so enhancing the usefulness of latency as a parameter in the objective assessment of auditory function.


Recovery function of the human brain stem auditory-evoked potential. Amplitude reduction and peak latency prolongation were observed in the human brain stem auditory-evoked potential (BEP) with preceding (conditioning) stimulation. At a conditioning interval (CI) of 5 ms the alteration of BEP was greater than at a CI of 10 ms. At a CI of 10 ms the amplitudes of some BEP components (e.g. waves I and II) were more decreased than those of others (e.g. wave V), while the peak latency prolongation did not show any obvious component selectivity. At a CI of 5 ms, the extent of the amplitude decrement of individual BEP components differed less, while the increase in the peak latencies of the later components was greater than that of the earlier components. The alterations of the parameters of the test BEPs at both CIs are ascribed to the desynchronization of intrinsic neural events. The differential amplitude reduction at a CI of 10 ms is explained by the different durations of neural firings determining various effects of desynchronization upon the amplitudes of individual BEP components. The decrease in the extent of the component selectivity and the preferential increase in the peak latencies of the later BEP components observed at a CI of 5 ms are explained by the intensification of the mechanism of the relative refractory period.


Use of frequency modulation combined with amplitude change to elicit frequency-specific whole-nerve response. The averaged whole-nerve response to frequency modulation combined with amplitude change was recorded from the round window of the guinea pig. A downward shift of 20% in the frequency of a 500-Hz, 1-kHz or 2-kHz pure tone with an amplitude increase elicited the responses. The latency for each frequency was investigated at different intensities. The latency is greater for lower-frequency tones and this latency increase agrees well with the traveling wave delay for the intensity range used in this study. A downward shift with an amplitude decrease failed to yield the response. These findings suggest that the response to a downward shift of frequency with an amplitude increase results from new activation due to an apical extension of the envelope of the traveling wave and thus represents the activity in a restricted area of the basilar membrane. Thus, the frequency-modulated tone in downward direction with increased amplitude can be a frequency-specific stimulus.


Scalp-recorded frequency-following responses in neonates. Low-frequency tone bursts (250, 500 and 1 000 Hz) were used to elicit frequency-following responses (FFRs) from full-term, healthy neonates. Easily identifiable FFRs were recorded from all well babies with stimulation at low-to-moderate levels (30-45 dB HLn). The amplitude and threshold values of neonatal FFRs were not significantly different from those of normally hearing adults. As in the adult, neonatal FFRs elicited by tone burst stimuli of 250 and 500 Hz were of greater amplitude and were observed at lower stimulus levels than FFRs recorded at higher frequency stimuli. At stimulus levels of 65 dB HLn, latency to the first peak in the FFR decreased as a function of increasing stimulus frequency. Neonatal FFRs evoked by tone bursts of 250 and 500 Hz exhibited significantly longer latencies compared to FFR recordings obtained from adults. These results suggest that: (1) Low-frequency basilar membrane sensitivity in neonates can be assessed as early as the first day of life. (2) The response properties of the FFR recorded from neonates were similar to the response properties of the FFR recorded from the adult. (3) For infants who fail conventional brainstem-evoked response screening procedures and/or for infants who are born "at risk", the FFR holds great promise as an assessment technique to determine the integrity of the low-frequency-sensitive regions of the cochlea and auditory brainstem.


Periodicity, pulse interval and pitch.

Periodicity, pulse interval and pitch. In an analysis of the relation between perceived pitch and auditory nerve impulse pattern, the distinction between periodicity and pulse interval is emphasized. Periodicity has previously been shown not to be uniquely related to pitch, and it is now demonstrated that pulse interval is also not necessarily a pitch correlate.


Luganda speech audiometry.

Luganda speech audiometry. Monosyllabic, quasi-monosyllabic and disyllabic word lists have been constructed from Luganda language material. These lists readily afford a means for determining speech-hearing ability for Luganda-speaking subjects. The speech-audiometric curve obtained on normally hearing Luganda-speaking subjects with monosyllabic material has a form which is similar to that for the normal curve obtained with English monosyllabic word lists on English-speaking subjects. As indicated by previous authors, the form of the speech-audiometric curve is that of a cumulative distribution, making presentation of the data on arithmetical probability paper convenient. Since monosyllabic words are uncommon in the Luganda and other Bantu languages, it is considered that quasimonosyllabic lists might be preferred in clinical situations.


Influence of amplification on the discrimination of dichotic consonant-vowel syllables in a population with sensorineural hearing loss. This study was designed to investigate the premise that the long-term use of monaural amplification influences dichotic listening conditions in a population with sensorineural hearing losses. 30 subjects with moderate, bilateral sensorineural hearing losses and 10 normally-hearing adults were chosen for this study. 20 of the subjects with sensorineural hearing loss had worn amplification successfully for at least 1 year prior to testing. 10 of these subjects had worn amplification only on the right ear while the remaining 10 had worn amplification only on the left ear. All subjects received 60 monaural and dichotic consonant-vowel (CV) nonsense syllables presented at equal loudness levels using the most comfortable level (MCL) as the loudness criteria. While monaural scores revealed nonsignificant differences between ears for all subjects, using percentage of error, dichotic results produced a right-ear advantage for the right-ear-aided, unaided and normally-hearing subjects. A significant left-ear advantage was seen for the left-ear-aided subjects. Results of this study suggest that amplification introduces selective listening effects which alter reported dichotic test scores.


Immunization of broiler breeder chickens against Newcastle disease with an oil-emulsion vaccine. Antibody response was rapid and high in broiler breeder chickens receiving 1 or 2 vaccinations with oil-emulsion vaccine against Newcastle disease at 23 or at 23 and 26 weeks old. The antibody titers remained high during the 41-week experimental period. At 64 weeks old, about 41 weeks after vaccination, the geometric mean hemagglutination-inhibition antibody titer was 67 from the single vaccination, and 103 from the double vaccination. The immune response to live-virus vaccine given at 2, 9, 20, 30, 42, or 54 weeks of age via the drinking water was high, but uniformity was lacking in the antibody response in the breeders and maternal antibody response in the progeny. Maternal antibody levels in one-day-old chicks were related to the titers of antibody in the dams. Maternal antibody titers of chicks originated from breeder flocks that were vaccinated with the oil-emulsion vaccine remained high for all hatches.


A comparison of immune responses of broiler chickens to different methods of vaccination against Newcastle disease. One-day-old broiler chicks from 4 groups of broiler breeder chickens were immunized by different methods of vaccination: 1) aerosol; 2) intratracheal; 3) drinking water; or 4) unvaccinated. The breeder flock from which the chicks were derived was vaccinated by one of the following methods: 1) a single injection of an oil-emulsion Newcastle disease virus (NDV) vaccine; 2) two vaccinations with oil-emulsion NDV vaccine; 3) vaccination with a live NDV vaccine; and 4) unvaccinated controls. Aerosol vaccination induced higher serologic responses than water and intratracheal vaccination, as well as giving the highest levels of protection against challenge. Mortality ranged from 20% to 66% in all eight groups of birds vaccinated intratracheally and challenged at 6 weeks of age. Results of challenge tests, in agreement with results of HI tests, further demonstrated that intratracheal vaccination at one day of age does not elicit a satisfactory immune response in birds with a maternal antibody titer of 15 or higher.


Adaptation of chickens to their handler, and experimental results. Chickens were adapted to their handler before the experiment. Adapted birds produced more antibody, had more blood protein, gained more weight, and were more resistant to Mycoplasma gallisepticum than unadapted birds. The antibody response to sheep red blood cells was not reduced for fasting for 48 hours in adapted birds but was in unadapted birds. Differences in antibody titers, blood protein, and weight gains between controls and birds fed 80 ppm of deoxycorticosterone could be demonstrated only with adapted birds.


Transmissibility of Australian strains of Newcastle disease virus. The transmission of Newcastle disease virus strains from infected to direct-, indirect-, and aerosol-contact groups of chickens was studied. Chickens 7, 21, and 63 days old were used in separate trials. Chicken age and virus strain were found to be important in spread of the virus. Strain V4 spread quickly to all contact groups and was classed as highly transmissible, whereas strain JA failed to infect all contact chickens of each age group, thus spreading less efficiently than strain V4. The viruses spread more readily among the 2 older groups. The significance of the transmissibility of Newcastle disease virus vaccine is briefly discussed.


Newcastle disease virus--some properties of Australian strains. Seventeen Australian strains of Newcastle disease virus were tested for their biological properties: mean death time, heat stability of the hemagglutinin and infectivity of the virus at 56 C, the elution time of virus from chicken erythrocytes, and the ability to hemagglutinate equine red blood cells. The strains differed considerably in their reactions. All had mean-death-time indices of 112 or greater, indicating that all were lentogenic. Strains were identified that had heat-labile and -stable hemagglutinin and infectivity, slow and fast elution, and variable ability to agglutinate equine erythrocytes. The significance of the results is discussed in terms of their usefulness in identifying exotic strains of the virus.


Spectral composition of the underwater environment and the refractive state of the eye. Scientists and clinicians concerned with underwater vision have not considered the relationship between chromatic aberration, water color, and the refractive state of the eye. Recent research indicates that the red end of the visible spectrum is in focus when the eye is not accommodating. On this basis, and on the basis of the monochromatic nature of clear acquatic environments, it is suggested that divers may be myopic by as much as 1 D when underwater.


Immunization of White Pekin ducklings against Pasteurella anatipestifer infection. Since Pasteurella anatipestifer (PA) serotypes 1, 2, and 5 gave no significant protection against heterologous serotype challenge, a trivalent formalin-inactivated bacterin containing all these serotype cells was developed and tested in the laboratory. Two inoculations of bacterin in White Pekin ducklings at 10 and 17 days of age gave highly significant protection against challenge with virulent organisms. The protection lasted only 2 weeks after the second inoculation. A third bacterin inoculation given at 31 days or exposure to an active field infection during the period of protection extended protection to market age (7 wk). Aluminum-hydroxide-gel-adsorbed bacterin gave no better protection than bacterin without adjuvant. One inoculation of multiple oil-emulsion (MOE) bacterin gave absolute protection up to market age: unfortunately, it produced noticeable tissue reactions at the site of inoculation. Day-old ducklings were also responsive to PA bacterin, and developed significant immunity against experimental challenge.


A modeling approach to the assessment of smooth pursuit eye movement. We have proposed a quasilinear model of the oculomotor system in the performance of a smooth pursuit tracking task. Model parameters (gain, phase, and spectral purity) have been measured for 21 normal subjects at stimulus frequencies of 0.2, 0.4, 0.8, 1.2, and 1.6 Hz. The normal oculomotor system was found to be quite linear when tracking at the three lowest frequencies, with up to 95% of the output power being linearly correlated with the input stimulus. Data from patients with known pathology are presented to demonstrate model parameter sensitivity to oculomotor dysfunction.


Cryptosporidia in the cloacal coprodeum of red-lored parrots (Amazona autumnalis). Cryptosporidiosis was diagnosed in the cloacal coprodeum of two red-lored parrots (Amazona autumnalis). The parasites were adhered to the microvillus border of epithelial cells and their presence was associated with loss and atrophy of microvilli. Merozoites, trophozoites, gametes, and oocytes were identified with light and transmission electron microscopy. The coprodeal epithelium was hyperplastic and the lamina propria was infiltrated with moderate numbers of heterophils and lymphocytes.


Regional cerebral blood flow in conscious miniature swine during high sustained +Gz acceleration stress. The two major factors limiting performance during high +Gz acceleration stress are loss of vision, and loss of consciousness. These symptoms are believed to occur as a result of insufficient blood flow to the retina and brain. This study was conducted to determine the effects of +Gz stress on regional cerebral blood flow. Cerebral blood flow (CBF) was measured in 22 conscious, female, miniature swine with the radio-labeled microsphere technique. Acceleration exposures consisted of 60-S plateaus at +3Gz, +5Gz or +7Gz. Microsphere infusions were made before, during, 1.0-6.0 min after, and 10 min after +Gz. Blood flow to the retina was significantly decreased during exposure to +5Gz and ceased during exposure to +7Gz stress. Mean, resting control CBF was 34 +/- 4 ml/min/100 g. Exposure to +3Gz and +5Gz had no significant effect on CBF. Exposure to +7Gz appeared to cause a redistribution of CBF, with blood flow to the brain stem being preserved and flow to the cerebrum being diminished.


Fowl cholera: cross-protection induced by Pasteurella multocida separated from infected turkey blood. Crude liver homogenates from turkeys that died of fowl cholera produced by serotype 1 or 3 Pasteurella multocida induced cross-protection. Pasteurella multocida harvested from the blood of infected turkeys by a centrifugal technique were as immunogenic as the liver homogenates. Neither bacterial cell-free blood plasma nor washed P. multocida from infected turkeys induced significant cross-protection. Blood plasma containing P. multocida induced significant cross-protection. Pasteurella multocida grown in the turkey underwent bacteriolysis after thawing from a frozen state. Filtered lysates did not induce cross-protection when used as vaccines whereas unfiltered lysates did. Membrane filters impeded passage of immunogenic material.


Responses of domestic fowl to repeated +Gz acceleration. The responses of domestic fowl to repeated exposures of 4 min to +6Gz (8 times daily, 5 d weekly) are reported. Survivorship curves for the test group of 48 birds divided into three response categories: mode I, highly susceptible, with all individuals dying on the first day; mode II, more tolerant, with mortality occurring within the first 20 d of treatment; and mode III, highly tolerant, with mortality occurring only after 20 d of treatment. Observations of lymphocyte frequency, an index of systemic stress, and postmortem observations indicate that this heterogeniety has a biological basis.


The 24 hour cycle and nocturnal depression of human cardiac output. The NASA-developed version of the impedance plethysmographic method for the determination of left ventricular stroke volume was applied to the investigation of daily variation of cardiovascular function. Hourly determinations of cardiac output and arterial pressure (auscultation) were obtained from two male subjects over the course of a 48-h period in the laboratory. Cardiac output displayed a strong 24-h cycle of nearly 1 1/min, peak-to-peak, cresting in the late evening hours. Nocturnal sleep was associated with a reduction of cardiac output characterized by a minimum in the early morning hours. It was concluded that a nocturnal, 24-h cyclic depression of waking cardiac output is exacerbated during sleep periods, and mechanisms for this exacerbation were suggested.


Systolic time intervals and other cardiovascular changes following leg elevation. Cardiovascular responses were noninvasively monitored as the legs of 16 supine human subjects were passively elevated to increase return of blood to the heart. Forearm vasodilation occurred promptly as previously observed by Roddie and Shepard (7). Arterial pressure and heart rate were unchanged. Ventricular performance, monitored by systolic-time-interval analysis, was enhanced after a delay of approximately 6 s, an effect which lasted throughout the 40-s leg-elevation period. All affected variables returned to control levels after the legs were lowered. This delayed response could result reflexly from stimulation of receptors in the left atrial region causing an increase in sympathetically mediated contractility or directly from the Frank-Starling mechanism in response to increased left ventricular filling.


Insecticide poisoning of peafowls and lead poisoning in a cockatoo. The deaths of peafowls and a cockatoo were respectively traced to insecticide and lead toxicities. The specific insecticide could not be identified but was demonstrated in the liver by use of fruit flies. The liver of the cockatoo contained 7.1 ppm of lead. The source was presumably a plastic feeder painted with a leaded paint.


A micromethod for plasma uric acid determinations in companion birds. A simple inexpensive method is described for determining plasma uric acid levels in companion birds. Plasma uric acid concentrations in 33 healthy parakeets were determined by a modification of the uricase spectrophotometric procedure utilizing 50 microliters of plasma. The mean uric acid level in parakeets was 5.60 mg/dl blood plasma, with no significant difference between males and females. In White Leghorn chickens, however, the mean level of uric acid in plasma was 7.19 mg/dl in males and 3.05 mg/dl in females. This method may be useful for the diagnosis and study of gout in small birds.


Noise dosimeter measurements in the Air Force. Personal noise dosimeter monitoring devices, operating on the Air Force rule of 4 dB per doubling time and 84 dB(A) criterion level, have been used for the past year in determining the occupational noise exposures of Air Force personnel working in hazardously noisy jobs. The research conducted by the Aerospace Medical Research Laboratory has resulted to date in 418 8-h occupational noise exposure measurements being collected on 120 different individuals. The 8-h occupational noise levels ranged from 66-111 dB(A) with the median level at 84.5 dB(A). In addition, noise dosimeters have been used at Air Force bases across the country in an experimental effort to see how well their use would fit in with existing Air Force hearing conservation programs. A total of 567 noise data measurements have been received from various bases. The base response data noise exposures ranged from 60-101 dB(A) with a median level of 80.1 dB(A). Along with the 8-h occupational noise exposure study, 16 individuals wore an equal energy noise dosimeter for 24-h or more to determine their nonoccupational noise exposure. A total of 73 separate 24-h measurements were taken. The median daily A-weighted average sound level was 77 dB(A). This is only 2 dB higher than the median of 75 dB(A) found for the typical American by previous studies. Some of the merits of noise dosimeters, as well as some of the problems involved in setting up ongoing noise monitoring programs, are discussed.


Effects of pseudoephedrine and triprolidine on visual performance. The effects of q.i.d. administration of 60 mg pseudoephedrine (Sudafed) tablets or pseudoephedrine-triprolidine (Actifed) tablets after 5 d of medication were measured on tests of night vision, color perception, stereopsis, and reaction time. Neither drug appeared to impair performance.


Inclusion body hepatitis in broiler chickens in Iraq. Eighteen outbreaks of inclusion body hepatitis (IBH) were identified in broiler chickens in Baghdad in 1977 and 1978. The disease was seen mainly in 4-to-6-week-old broiler chickens. The mortality rate did not exceed 1% in any outbreak investigated. The most common gross findings were stellate or punctiform hemorrhagic areas in markedly fatty livers. Noticed in many cases were enlarged and pale kidneys, hemorrhagic lesions in the skeletal muscles, and pale fattened bone marrow. Histological examination of tissues revealed fat droplets and intranuclear inclusion bodies in degenerated liver cells. Eosinophilic inclusion bodies were seen in all cases. Only five cases had basophilic inclusions along with the eosinophilic ones. The etiologic agent was isolated on chorioallantoic membrane (CAM) of 12-day-old embryonated chicken eggs. The disease was produced experimentally in 4-week-old chicks using infected CAM suspension.


Survey on eye comfort in aircraft: II. Use of ophthalmic solutions. Flight attendants frequently use ophthalmic solutions (eye-drops) to relieve their eye discomfort while working in the aircraft. The purpose of this paper is to present some insight concerning the use of ophthalmic solutions by flight attendants. This paper follows Part I, a survey that evaluated some of the environmental conditions in the aircraft that influenced eye comfort. A questionnaire was developed in conjunction with the Air Safety Department of the Association of Flight Attendants. The common eye problem characterized by conjunctival redness and eye irritation occurred with 95% of the 774 respondents. Furthermore, 60% of these respondents indicated that they have used eyedrops while in flight. The majority of the respondents were using an ocular decongestant; however, this author suggests that the use of artificial tears would be more effective in relieving eye discomfort in the aircraft.


Sickle cell trait and the aviator.

Sickle cell trait and the aviator. Sickle cell trait (SCT) for years has been a controversial disorder within the aerospace medicine community. Some authorities consider SCT to be an entirely benign condition without particular significance, at least to moderate altitudes. Others are in disagreement and consider it a serious enough threat that flying duties should be precluded for all individuals with this disorder. These issues are addressed by reviewing SCT, its relationship to altitude, and its risk to aviation. The author concludes that flying organizations must establish their own policy on flying status for individuals with SCT based upon mission peculiarities and the assessment of risk inherent in that mission.


Acanthocephalan parasitism in the Western Bluebird (Sialia mexicana). Acanthocephalan parasites of the species Plagiorhynchus (Prosthorhynchus) formosus Van Cleave, 1918, were recovered from the intestinal tracts of two male and two female wild Western Bluebirds (Sialia mexicana). Parasitism by P. formosus was considered to be a contributory cause of death of these breeding adult bluebirds. This is the first reported recovery of acanthocephalan parasites from Western Bluebirds.


Student pilots referred to the neuropsychiatry branch, USAFSAM 1968-78: implications for selection. The case records of 76 student aviators referred to the Neuropsychiatry Branch of the USAF School of Aerospace Medicine during the period 1968-78 are reviewed. Demographic and diagnostic data are provided including source of recruitment, age, marital status, aircraft flown, flying hours, and diagnostic categories. Psychophysiological categories are particularly scrutinized and cameo case histories provided. Implications for pilot selection are discussed.


Origin of flight nursing in the United States Army Air Forces. The years of World War II mark the first extensive use of flight nurses in the United States military. These select flight nurses in the United States Army Air Forces during World War II, set the precedent for a unique field of nursing which has continued to the present day. This historical study traces the origin of flight nursing in the United States Army Air Forces from 1937, when the need for specially designated flight nurses could not be justified, until 1942, when flight nursing in the United States Army Air Forces became a reality.


Physician-nurse collaboration: a nurse's perspective. An epidemiologic follow-up study of aircrewmen with asymptomatic exercise-induced ventricular tachycardia was recently conducted by a physician-nurse team at the USAF School of Aerospace Medicine. Using a general systems framework, this paper presents the nurse's perspective of the collaborative effort. Several system elements--such as input, throughout, output, cycles and feedback--are used to analyze the process of physician-nurse interaction during the course of the collaboration.


Lower body negative pressure box for +Gz simulation in the upright seated position. The cost of purchasing and operating a human centrifuge is substantial. Lower body negative pressure (LBNP) is considered an acceptable experimental substitute for the +Gz stress of the centrifuge. Since civil aviation pilots are usually subjected to +Gz stress in an upright seated position, an upright seated version of the supine LBNP box was developed. In this version, a negative pressure of -40 torr is considered the equivalent of a 2 +Gz stress. This box has successfully withstood a test pressure of -120 torr. Pedal ergometry within the box is easily accomplished. The box was anthropometrically engineered to accommodate a human height range of 160-195 cm. Locating the box within an altitude chamber allows the application of LBNP at any level of chamber altitude. The total cost of fabrication is approximately $500.


Effect of carotid pressoreceptor stimulation on integrated systemic venous bed. In 9 mongrel dogs, venous return was completely drained from the caval veins to an oxygenator and returned to the femoral arteries with a roller pump. Perfusion rate of systemic circulation and blood pressures in both caval veins were kept constant. Changes in the oxygenator weight were recorded and reflected reciprocal changes in integrated systemic venous blood volume. The vagal nerves were dissected. The carotid sinuses were separately perfused with blood by means of a pump. In 25 experiments, increases in carotid sinus pressure of 15 to 74 mm Hg resulted in decreases in systemic arterial pressure of 10 to 57 mm Hg and increases in systemic venous blood volume of 1.1 to 4.7 ml/kg. On an average, systemic venous blood volume was changed by 1.25 +/- 0.08 ml/kg when the change in systemic arterial pressure was 10 mm Hg. It is concluded that the carotid sinus pressoreceptor reflex considerably alters the systemic venous capacity which in tern alters venous return and cardiac output. These changes in cardiac output are expected to be small, but sufficient to alter the arterial pressure considerably. Thus, they might contribute nearly as much as the reflex effect on total peripheral resistance to the reflex control of arterial pressure.


Myocardial substrate utilization and hemodynamics following repeated coronary flow reduction in pigs. The effect of repeated local ischemia and reperfusion on myocardial metabolism and ventricular performance was studied in 12 open-chested pigs fasted overnight. Myocardial ischemia was induced by reduction of the flow in the left anterior descending coronary artery to 40% of control during 30 min. After 35 min of reperfusion a second 30-min occlusion period was started, again followed by a 35-min reperfusion period. At the end of both reperfusion periods coronary flow and coronary resistance had returned to control values. During control there was lactate uptake, but no significant uptake of glucose, free fatty acids (FFA), triglycerdies, glycerol and inosine. During the first occlusion period the heart released lactate and inosine, and used glucose and FFA. At the end of the first reperfusion period lactate uptake approached control values, but inosine was still released by 10 of the 12 animals. In the second ischemic period, glucose and FFA were again taken up. Lactate and inosine were released, but the production was much smaller than during the first occlusion period. Depletion of myocardial glycogen and high-energy phosphates could be responsible for this quantitatively different response. Necrosis may have played a role, although enzyme release was minimal and only observed after the second occlusion period. Heart rate, peripheral resistance and ventricular filling pressure were virtually unchanged throughout the course of the experiments. Maximum rate of fall of left ventricular pressure (min LVdP/dt) decreased during ischemia and did not recover during reperfusion. Changes in min LVdP/dt and cardiac output were more closely related than changes in max LVdP/dt and cardiac output. This model cannot be used for the study of interventions during myocardial ischemia in which the animal serves as its own control.


Degree of granulation of atrial cardiocytes: its decrease after aorto-caval fistula in the rat. The experimental creation of an aorto-caval fistula in the rat leads to a decrease of the degree of granulation of atrial cardiocytes. This decrease is significant for granules distal to the nucleus and not for paranuclear granules. This partial degranulation reinforces the hypothesis according to which atrial cardiocytes participate in some sensitivity to local changes in blood pressure and flow.


Transmural perfusion gradients distal to various degrees of coronary artery stenosis during resting flow or at maximal vasodilation. Regional myocardial perfusion (assessed by 15 mu tracer microspheres) was determined at various levels of stenosis of the left circumflex coronary artery in anesthetized dogs. Measurements during control and at three levels of stenosis produced by a micrometer-driven mechanical occluder were made in each heart. No change was found in the transmural distribution of coronary blood flow until 93% stenosis. At levels above 93% stenosis there was a linear decrease in subendocardial perfusion with only minor changes in subepicardial perfusion. During maximal vasodilation produced by reactive hyperemia, the decrease in subendocardial flow was observed at levels greater than 60% stenosis. It is concluded that the subendocardium of the left ventricle has a large vasodilator reserve and severe stenoses are required to disrupt flow when autoregulation is intact. When autoregulation is abolished, reduction in subendocardial flow occurs at lesser degrees of stenosis.


Influence of verapamil on cellular integrity and electrolyte concentrations of ischemic myocardial tissue in the cat. Verapamil, at a dose of 1 mg/kg, was given intravenously to anesthetized cats one hour after coronary artery occlusion. Verapamil significantly reduced mean arterial blood pressure, but produced an increase in heart rate, partially offsetting the reduction in myocardial oxygen demand resulting from the reduction in pressure. Verapamil failed to prevent the elevations in the S-T segment of the electrocardiogram observed in cats subjected to myocardial ischemia (MI) and given only the vehicle for verapamil (i.e., 0.9% NaCl). Moreover, verapamil also did not prevent the accumulation of creatine phosphokinase (CPK) activity in the circulating blood after MI. Nevertheless, verapamil significantly prevented the loss in CPK and in amino-nitrogen observed in the ischemic region of the myocardium, indicating some protective effect on myocardial integrity. The major effects of verapamil on electrolyte content of ischemic myocardial tissue were a decrease in sodium and an increase in potassium. However, calcium gain by the heart was not prevented by verapamil. Verapamil, therefore, exerts a partial degree of protection of the ischemic myocardium but exerts some other effects which do not help prevent the spread of ischemic damage in the myocardium.


The mechanical properties of exposed human common carotid arteries in vivo. In exposed common carotid arteries of 15 patients (36-74 years) undergoing neck surgery, the intra-arterial pressure (P) was recorded by means of a catheter-tip manometer and, at the same site, the external diameter (D) by means of a contact-free photoelectric device. On the average, the pulsatile diameter changes were 5.6% of the end-diastolic diameter at pulse pressures of about 50 mm Hg. Due to viscoelasticity, the P-D diagrams exhibited hysteresis loops. Using the criterion of loop elimination, an iterative procedure was applied which permitted, by the use of an appropriate computer program, the separation of the purely elastic and the purely viscous components of the P-D relationships. In all cases, the purely elastic P-D curves markedly deviated from linearity. The tangential elastic modulus (Et) and the pulse wave velocity (c) calculated from these curves were normalized by dividing these quantities by the respective end-diastolic values and plotted against the normalized external diameters. During each pulse cycle, Et increased, with increasing diameter, by a factor between 1.2 and 3.5, while c increased by a factor between 1.1 and 1.9 with reference to the respective end-diastolic values.


Relationship between epicardial and intramyocardial ST-segment voltage and myocardial blood flow during graded coronary constriction in the dog. This study was undertaken to examine the relationship between electrographic ST-elevation and regional myocardial blood flow during graded coronary constriction. Electrograms from the epicardial surface, outer and inner layers of the myocardium were recorded. Regional blood flow to the outer and inner layers of the myocardium was measured by means of a heat-clearance method. With the application of a coronary constriction, myocardial blood flow to the inner layer began to decrease with a 75% coronary constriction, while flow to the outer layer was maintained at near normal up to least an 80% coronary constriction. Non-linear squares curve of between ST-elevation and the decrease in myocardial flow resulted in y = 18.80 exp-0.06x - 0.02 in the outer layer and y = 9.22 exp-0.02x - 1.54 in the inner layer. Also the non-linear squares curve of between epicardial ST-elevation and the decrease in myocardial flow resulted in y = 50.91 exp-0.11 x + 0.04 in the inner layer and y = 10.29 exp-0.07 x + 0.03 in the outer layer. The standard deviations of the coefficients of the latter two equations were higher than those of the former two equations. The higher values indicated larger variations of the parameter coefficients and data points. These results clearly demonstrated that a regional intramyocardial electrogram more closely reflects local ischemia than does an epicardial electrogram.


[Maternal hemoglobin level and fetal and neonatal prognosis]. Maternal and feto-neonatal pathology in pregnant women with Hb values less than 10 gr./100 ml. in the last ten weeks of pregnancy was estimated. WHO considers HB values (gr./100 ml.) a valid and sufficient parameter for a clinical classification of the different degrees of anaemia in pregnancy: the authors agree with this suggestion.


[Surgical treatment of obliterating arteriopathies of the lower limbs in the aged]. The Authors review 86 cases, aged over 70, needing surgical treatment because of atherosclerotic obstructive disease of the lower limb, stage III-IV. 35 patients underwent thigh amputation with 14% mortality in the early post-operative period (30 days) and 32% in the late post-operative period, considered up to 6 months. For 38 patients who underwent a revascularisation procedure mortality resulted 8% in the 30 post-operative days and 10% at 6 months. Escluding the aorto-iliac reconstructions through a trans-peritoneal approach, the overall mortality is limited to 3,2%. A major amputation was avoided in 76% of patients who underwent a revascularisation. On the base of their results the Authors discuss the indications of direct surgery in treatment of advanced ischemic lesions in elderly patients concluding that a surgical correction should be always considered in the aim of avoiding or limiting the amputation. In these high-risk elderly patients the extra-peritoneal aorto-iliac reconstructive technique must be preferred together with extraanatomical femoro-femoral or axillo-femoral by-passes.


[Hygroma of the posterior cranial fossa. Case report]. Posterior fossa hygroma is a rare entity. In a series of 553 cases of surgically treated traumatic subdural lesions, reported by Jamieson and Yelland, only 14 were in the posterior fossa; of these 7 were hygromas and 7 haematomas, giving an incidence of only 1,4% of all subdural haematomas. This report describes a case of a posterior fossa hygroma, that occurred in a 16-years-old boy, 4 days after an occipital head injury.


[Transduodenal papillosphincterotomy in treatment of biliary lithiasis]. The Authors report 180 cases of transdudenal papillosphincterotomy. Medium follow-up at 5 years revealed a complete recovery in 87 of 100 controlled patients. Nine cases revealed persistence of some degree of dyspepsia, while a second operation was necessary for the remaining patients to remove recurrent calculi in 2 cases and because of Oddi's stenosis in other two cases. A 4,4% mortality operative was observed, following postoperative pancreatitis in 1,1%, duodenal fistula or haemorrhage in 1,6%, and 1,6% from other causes. On the basis of their results the Authors conclude that transduodenal papillosphincterotomy is an effective procedure in treating complicated lithiasic biliary disease when respecting the reported indications.


[Cytosegregosomes in the kidney tubule cells in a case of acute renal insufficiency (ARI) caused by gentamycin]. The Authors describe one case of acute renal insufficiency in a patient treated with high doses of gentamicin over a period of three weeks. The documentation includes electron microscope observations of needle biopsy material revealing the presence of electron-dense masses (cytosegregosomes) in the epithelial cells of the proximal renal tubules, such as had previously been described only in animal experiments and human autopsy studies. The clinical course and favorable outcome of this case of gentamicin-induced renal failuse afford the opportunity for some interesting considerations concerning the kinetics and toxic proclivities of this aminoglycoside antibiotic.


[Trigeminal neuralgia: interpretation of the results of the Dandy method of rhizotomy]. The patterns of sensory loss in 29 cases of Juxta pontine trigeminal rhizotomy are reported. The section of 70% of the portio major gave a similar impairment of tactile, thermal and pain sensibility in the facial area corresponding to the portio of the nerve section in all the patients. These findings do not support Jannetta and Rand's statement that partial to complete section of the porto major at the pons with complete preservation of the intermediate fibre does not affect the perception of light touch. The reported data suggest:  1--intermediate fibres are not mode specific fibres for light touch; 2--clear separation between thermoalgesic and tactile afferent rootlets does not exist in the trigeminal root; 3--saving the portio minor and the intermediate fibres ensures the preservation of perception of tactile, thermal and pain sensibility, thus avoiding postoperative painful anesthesia and keratitis.


[Congenital arteriovenous fistula between the subclavian artery and vein. (Discussion of a surgically treated case) (author's transl)]. The Authors report a case of a congenital arteriovenous fistula between the subclavian artery and vein in a 42 years-old woman. The clinical examinations are discussed for the exact classification and the topographic localisation. The surgical treatment (extirpation of the fistula) is necessary especially because arteriovenous fistulas have a tendency to progress, which may lead to severe cardiac insufficiency, aneurismatic dilatations and risks of endocarditis.


[Neuropsychological studies of two subjects after the transection of the splenium of the corpus callosum (Part 3. The tactile recognition) (author's transl)]. We made the neuropsychological tactile studies of two right-handed subjects who had undergone the transection of the splenium of the corpus callosum for the pineal operation (the teratoma by the histopathological examination). The transaction grade was 2.0 cm and 2.5 cm. In this paper we examined the tactile recognition neuropsychologically: A. Superficial sensory modalities: light touch, pain perception, temperature discriminations. B. Deep sensory modalities: vibration perception, position sense, motor sense. C. Perception of material: rough or smooth, heavy or light, hard or soft. D. Perception of size: appreciation of shape in two dimentions: circle, triangle, square, cross, rhomb, appreciation of form in three dimensions: ball, column, cone, trignonal prism, cube. E. Identification of simple objects: eraser, pencil, hair pencil, fountainpen, telephone, glasses. F. Identification of japanese letters: Kana (phonetic symbols) and Kanji (essentially nonphonetic logographic symbols representing lexical morphemes). According to the papers of Akelaitis, Van Vleuten, Goldstein, the subjects after the transection of the corpus callosum could name the objects and the card board letters placed in their right hands with their eyes closed, but they could not name in their left hand by contrast. In our subjects, the identification of simple objects and the identification of japanese letters were complete good. But they had the neuropsychological visual and auditive disorders. The result shows that the commissure fibres of the identification of the simple objects and letters of two hemispheres does not connect through the splenium of the corpus callosum.


[Long-term prognosis of cerebral infarction--influence of arterial stenotic lesion for survival (author's transl)]. Cerebral four vessel angiography was performed in 85 patients with non-embolic cerebral infarction and followed for ten years. Of 45 patients with arterial stenosis of 25 per cent or more, 21 (46.7%) survived at 5 years and 12 (26.7%) at 10 years after onset of the stroke. In contrast, survivors of 45 patients with stenosis less than 25 per cent or with no stenotic lesion, were 35 (87.5%) at 5 years and 29 (72.5%) at 10 years after the onset. The survival rate of the former patients group was lower significantly than the expected survival rate in a general population. Arterial stenosis of 25 per cent or more suggested a trend of poor prognosis in patients with multiple stenosis, especially those of bilateral internal carotid arteries, and of better prognosis in patients with stenosis in vertebrobasilar system. Patients with stenosis of 50 per cent or more in sphenoidal portion of the middle cerebral artery seemed to have a poor prognosis than those in the internal carotid artery.


[Quantitative analysis of EEG basic rhythms in epileptics (author's transl)]. Basic rhythms of EEG were quantitatively analyzed in 92 adult idiopathic epileptic patients and in 57 age-matched control subjects. Epileptic patients have been administered one or both of anticonvulsants, phenobarbital (PB) and diphenyl-hydantoin (DPH). Before the EEG study, blood samples were taken from patients and serum concentration of PB and DPH was examined with UV method. Dose and serum level correlation was statistically significant in both drugs but fairly inferior in DPH. Dominant posterior rhythms in awake subjects were restored in a medical computer. These data were transformed with a Fast Fourier method into amplitude spectra, which were expressed in percentage distribution of each frequency band, i.e. delta (1.0--3.5 Hz), theta (4.0--7.5), alpha (8.0--12.5) and beta activity (13.0--29.5 Hz). As the first result, it was found that slow wave activity significantly increased and alpha activity decreased in epileptics compared with control subjects. No difference was found in beta activity. So as the next step, the etiologies of abnormal slowness of epileptic EEG were investigated in relation to serum level of anticonvulsants, age of seizure onset, seizure frequency, duration of medication and seizure types. These analysis confirmed that slowing of epileptic EEG has statistically significant correlation with the following factors, 1) high serum level of anticonvulsants (PB greater than 20 microgram/ml), DPH greater than 15 microgram/ml) 2) high frequency of seizures (more than once per month) 3) seizure onset at young ages (0--5 yrs.) 4) psychomotor seizure type. When these slowing factors are plurally involved in one patient, the degree of EEG slowness increased in proportion to the numbers of these factors. On the other hand, if the comparison was made between epileptics without these factors and control subjects, strikingly no minimum differences was found in basic rhythms. This result induces the very important conclusion that epilepsy itself has no direct effect on slowing of basics rhythms and if there exists slowing, some secondary reasons must be searched. The author also speculated pathogenetic causes of EEG slowing by these factors and insisted that there exist very close interrelation between basic EEG rhythms and prognosis of epilepsy.


[Intracranial hemorrhage in autopsy cases with occlusion of the circle of Willis (author's transl)]. Seventeen autopsy cases with occlusion of the circle of Willis were examined clinicopathologically. These patients ranged in age from 8 years to 64 years and consisted of 6 males and 11 females. The following results were obtained. 1. Fresh and massive intracerebral hemorrhage was confirmed in 13 of 17 patients and cerebral infarct in 4 of 17 patients. 2. Among these 13 patients, massive hemorrhage was found in basal ganglia, thalamus and hypothalamus of 9 patients, and in thalamus, cerebral peduncle and midbrain of 4 patients. 3. Rupture of the dilated muscular-type arteries was noted in the thalamus and basal ganglia in 2 of 13 patients. Ruptured arteries with organization of the lumen were found in the old hemorrhagic foci in one of them. 4. Overgrown and dilated arteries, branching off from the circle of Willis, were confirmed in 11 patients. These arteries consisted of "perforating" arteries well developed as collateral circulation. 5. No ruture in these arteries of the subarachnoidal spaces was found in 11 patients. In one of them, a small saccular aneurysm was found. These findings strongly suggest that in patients with occlusion of the circle of Willis intracerebral rupture of overgrown "perforating" arteries as collateral circulation may be the main cause of intracranial hemorrhage and intracerebral hemorrhage due to rupture of the arteries may be repeated.


[A case of multiple fusiform aneurysms presenting homonymous hemianopsia (author's transl)]. Fusiform Aneurysms are encountered in elderly persons with advanced arteriosclerosis. When they are enlarged to compress the neighboring structures, they may resemble tumors symptomatically. Especially when situated in close relation to the optic nerve or chiasmatic region, pituitary tumor is likely to be suspected. This is a case of 62 year old female with a giant fusiform aneurysm of the right internal carotid artery extending to the middle cerebral artery which caused left homonymous hemianopsia and a large aneurysm in the cavernous portion of the left internal carotid artery with fusiform extension of the distal portion of the carotid artery which presented left blepharoptosis, dilated pupil and total ophthalmoplegia. The basilar artery and the right meningohypophyseal artery showed fusiform dilatation as well. Systemic atherosclerotic change, abdominal aortic aneurysm, nephrosclerosis were also accompanied. The computed tomography demonstrated the aneurysms distinctly. Left oculomotor palsy disappeared after six months with residue of left homonymous hemianopsia. Surgical intervention was not attempted, because of the widely distributed constitutional aneurysms in the whole body.


[Pharmacokinetic analysis of ACNU in brain tumors (author's transl)]. In order to establish the standard of administration of ACNU against brain tumors, pharmacokinetic analysis of ACNU in tumor tissue, cystic fluid, cerebrospinal fluid and blood was performed. The sample specimens were obtained sequentially after intravenous administration of 1--2 mg/kg/BW of ACNU and quantitatively analysed by high-performance liquid chromatography in 3 cases of glioblastoma and each one case of astrocytoma, meningioma and brain metastasis. Concentrations of ACNU in blood was calculated by two compartment open model and those in cystic fluid was calculated by one compartment model using BMDP-3R program. The half-time in blood was 2.6--4.1 min, and its distribution was very fast. The penetration of ACNU into the tumor tissue was sufficient, because the central compartment was 23% and the tissue compartment was 77%. The transmission rate constant into the cyst was 1.8 and the elimination rate constant was 0.96. The maximum concentration in the cystic fluid 42 min after intravenous injection of 2 mg/kg/BW of ACNU was 0.27--0. 35 mg/dl. In conclusion, 3--4 mg/kg/BW of ACNU should be injected intravenously at one time.


Halothane does not inhibit human neutrophil function in vitro. Various indices of function of neutrophils from normal healthy volunteers have been examined after in vitro exposure to halothane. Random free movement on glass was unaffected, but random migration through millipore filters was slightly increased. There was no significant change in migration in response to casein chemotaxis. Phagocytosis, degranulation and the enhanced non-mitochondrial respiration associated with phagocytosis were unaffected. Electron-microscopic appearance at 30 s after exposure to latex particles was normal in all respects.


Brain water and electrolyte distribution during the inhalation of halothane. The brain concentration of Na+, K+ and Cl-, water content and total brain osmolality were measured in six normocapnic dogs under pentobarbitone narcosis (30 mg kg-1). These studies were repeated in six additional dogs after exposure for 1 h to the inhalation of halothane 1% (end-tidal); there was an increase (P less than 0.05) in Na+, Cl- and water content but no change in K+ content in the grey matter, but in the white matter only Cl- increased (P less than 0.05). These findings were associated with a decrease in total brain osmolality (P less than 0.05) and a negative brain-cisternal c.s.f. osmotic gradient. The changes in the grey cortical matter were interpreted as a pattern of metabolic brain oedema related to interference with water-ion transport mechanisms across cell membranes. The observed brain-c.s.f. osmolality deficit could be related to a time-lag in the intracellular water-solute adjustment or to a deficit in osmotically active brain amino acids induced by the anaesthetic agent, or both.


Methodology of a prospective study of changes in liver enzyme concentrations following repeat anaesthetics. The methodology of a large prospective study on the influence of repeated anaesthetics on liver function is reported and the problems involved are discussed. The most suitable patients were those presenting for endoscopic examination of the bladder and urethra, for urethral dilatation and for cervical implantation of radium. Blood samples were taken immediately before induction of anaesthesia and on days 3-4 and 13-15 after operation, when a clinical assessment of the patient was also carried out. The concentrations of six enzymes (lactate dehydrogenase, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, serum cholinesterase and gamma glutamyl transpeptidase) werechosen specifically as indices of liver function. The eosinophil count was measured to reflect any hypersensitivity reaction. The non-Gaussian distribution of these necessitated using appropriate non-parametric tests together with parametric tests on logarithmic transformed data. In addition a quantal method was used to measure the frequency of patients showing an "abnormal" increase in enzyme concentrations.


A prospective study of liver enzyme and other changes following repeat administration of halothane and enflurane. A prospective study of liver enzymes and other measurements following repeat administrations of halothane or enflurane was carried out in patients undergoing minor urological operations. The patient populations were similar with respect to frequency of factors which might influence liver function, social habits, drug therapy and time intervals between administrations. Sixty-three received two or more administrations of halothane and 66 received two or more administrations of enflurane, both drugs given with nitrous oxide in oxygen. There was a greater frequency of increased enzymatic activity following repeat administrations of halothane than following enflurane and the average alanine aminotransferase and gamma glutamyl transpeptidase concentrations were increased to a greater degree following halothane than enflurane. There was no change in the eosinophil count and no significant postoperative morbidity. Change in alanine aminotransferase, lactate dehydrogenase and gamma glutamyl transpeptidase occured more frequently in obese patients receiving halothane.


Morbidity after day-case gynaecological surgery. Comparison of enflurane with halothane. In 105 patients undergoing day-case surgery recovery of consciousness was significantly faster after enfluane compared with halothane anaesthesia. There was no difference in postoperative morbidity between the two anaesthetic groups.


Local complications of thiopentone injection. A further report. Cases of local complications following the injection of thiopentone and reported to Medical Defence Union and to the Medical Protection Society in the period 1970-77 were analysed. There was no case of gangrene distal to the site of injection, but two cases of isolated damage to nerves, muscles and tendons and two cases of local tissue necrosis at the site of injection. A comparison of the results of the present investigation with those of two previous investigations indicates that the frequency of such complications has diminished over the period 1957-77.


Comparison of etomidate in combination with fentanyl or diazepam, with thiopentone as an induction agent for general anaesthesia. In 104 premedicated patients undergoing general surgery, anaesthesia was induced either with etomidate 0.3 mg kg-1 preceded by fentanyl 1.25 or 2.5 microgram kg-1 i.v.or diazepam 0.0625 or 0.125 mg kg-1 i.v., or with thiopentone preceded by fentanyl 1.25 microgram kg-1 i.v. Despite the use of fentanyl or diazepam, the frequency of pain on injection in patients receiving etomidate was between 32% and 53%, being rated as severe in 5-20% of patients. No pain was experienced by patients receiving thiopentone. The frequency of involuntary movement was 15-35% with etomidate and 15% with thiopentone. The frequency of both pain and involuntary muscle movements was least when fentanyl 2.5 microgram kg-1 preceded the administration of etomidate. There was no significant relationship between the pain and muscle movement; three of 10 patients given etomidate into a central vein had such movements.


Effect of premedication on etomidate anaesthesia. The effect of premedication upon the induction of anaesthesia with etomidate was studied in 74 adult patients undergoing elective orthopaedic surgery. Premedication with fentanyl plus atropine or with diazepam plus atropine decreased the frequency of involuntary muscle movements without modifying the pattern of the circulatory effects of etomidate, although fentanyl increased the frequency of apnoea. Pain at the site of injection was not modified by premedication.


Effects of ketamine on the pregnant uterus. Intra-uterine pressure was recorded by placing a Foley catheter in the extra-amniotic space before the termination of pregnancy in 25 patients, and Caesarean section in 12 patients. The effects of administration of i.v. ketamine 2 mg/kg body weight, sodium thiopentone 4 mg/kg body weight and ergometrine 0.5 mg, and intra-cervical 0.5% lignocaine 20 ml were measured in the first trimester of pregnancy, and i.v. ketamine and sodium thiopentone in late pregnancy. Ketamine was found to cause uterine contraction (mean increase 16.1 mm Hg) equal to ergometrine (mean increase 14.8 mm Hg) in early pregnancy, but exert no effect (mean decrease -- 1.33 mm Hg) in late pregnancy. Lignocaine in early pregnancy given as a paracervical block had no significant effect on intrauterine pressure (mean increase 0.33 mm Hg). Sodium thiopentone (mean decrease -- 4.28 mm Hg first trimester and -- 2.22 mm Hg at term) in late pregnancy had no significant effect on intra-uterine pressure.


Ketamine infusions: pharmacokinetics and clinical effects. The clinical effects and pharmacokinetics of ketamine, administered as an i.v. infusion, were studied in 31 patients. Anaesthesia was induced with ketamine 2 mg kg-1 i.v. and maintained using an i.v. infusion of ketamine, supplemented by nitrous oxide. The plasma concentrations of ketamine, nor-ketamine and dehydro-nor-ketamine were analysed using gas-liquid chromatography. The average maintenance dose of ketamine was 41 +/- 21 microgram kg-1 min-1, but there was an obvious decrease in the dose required as anaesthesia progressed. This dose gave a stable plasma concentration of ketamine of 9.3 +/- 0.8 mumol litre-1. Patients recovered at 2.7 +/- 0.9 mumol litre-1. Plasma half-life of ketamine was 79 +/- 8 min. Maximum concentration of nor-ketamine was 4.7 +/- 2.4 mumol litre-1 and of dehydro-nor-ketamine 3.2 +/- 1.9 mumol litre-1. There were transient increases (15-30% of pre anaesthetic values) in arterial pressure, heart rate and cardiac output during operation. No post-operative respiratory depression was seen.


Plasma viscosity and cremophor-containing anaesthetics. The cremophor-containing anaesthetic agents, Althesin, propanidid and diazepam, were added to plasma in vitro and administered to patients. In vitro these anaesthetics, and cremophor alone in concentrations equal to those obtained in vivo, decreased the viscosity of plasma 45% at shear rate 11.5 s-1. In 11 patients given cremophor-containing anaesthetics to induce anaesthesia, plasma samples obtained 5 min after injection showed a mean decrease in viscosity of 42% compared with the pre-induction values. The effect on viscosity after a single dose disappeared in 50 min. Triton x-100 added to plasma caused a decrease in viscosity similar to that of cremophor. The interaction in vitro of cremophor and Triton x-100 with concentrated urea was found to be identical both in plasma and dextran. This suggests that cremophor acts by increasing the sheet of structured water around the protein molecules, thereby preventing the aggregation of proteins.


Use of mandatory minute volume ventilation in the perioperative management of a patient with myasthenia. The anaesthetic and postoperative management of a patient with established myasthenia gravis, using a mandatory minute volume system (MMV), are described. Before operation the patient was receiving large doses of anticholinesterases and steroids. The anaesthetic and postoperative drug therapy and management were simplified by the use of the MMV system.


The Johannesburg A-D circuit switch. A valve device for converting a co-axial Mapleson D into a co-axial Mapleson A system. A simple valve device is described for a co-axial tubing anaesthetic system which enables selection of the circuit characteristics of either a modified Mapleson A system for spontaneous breathing or a modified Mapleson D system for controlled ventilation. Thus, the system allows an economical fresh gas flow to be used during either controlled or spontaneous ventilation. The mode of ventilation may be changed during anaesthesia without adjusting the patient tubing or the attachment of the system to the anaesthetic machine.


Effect of an alpha- and beta-adrenoceptor-blocking agent (labetalol) on haemodynamics in hypertension. 1 The effect of an intravenous bolus of labetalol (0.6--1.6 mg/kg body weight) on central and peripheral haemodynamics was studied in nine subjects with essential hypertension and in eleven subjects with chronic renal disease and hypertension. 2 The BP reduction amounting to 20/13 mmHg was entirely due to the lowering of the total peripheral vascular resistance. This also included the vascular resistance in the muscles. 3 This peripheral vasodilatation was not counteracted by a reflex increase of the cardiac output. 4 The reflex tachycardia and overshoot of BP in Valsalva's manoeuvre were largely abolished. 5 Central and peripheral venous BPs, vascular volume of the forearm and venous distensibility did not show any significant change after treatment with labetalol. 6 In spite of the lowering of the vascular resistance of the forearm by labetalol, forearm blood flow was not significantly affected due to the parallel decrease in the perfusion pressure. 7 Plasma renin activity fell after labetalol in all instances.