Haemoglobin A1c separation by micro-column chromatography: a new rapid method of assay. Since at present chromatographic methods for the separation of the glycosylated haemoglobins and determination of haemoglobin A1c are time-consuming and require continuous monitoring, a new micro-column method is reported that is cheap, rapid, easy to perform and permits anything up to 30 columns to be run simultaneously. The haemoglobin A1c leve in fifty normal subjects was measured and found to have a mean of 5.3 +/- 0.5% (m +/- S.D.).


The usefulness of a rapid method for total fast hemoglobins determination in screening for diabetes control. We have used a simple and rapid method for the determination of total fast hemoglobins (HbA1a+b+c) in 102 diabetics and 36 normal controls. The method was described by Kynoch and marketed by Isolab. It proved to be useful in screening for patients with inadequate metabolic control in whom as a rule, total fast Hb values were higher than 8.5%. Mean Hb A1a+b+c value was significantly higher in the group of diabetics in comparison with normals (9.9 +/- 0.2 versus 6.9 +/- 0.8%). The diabetic patients were separated into four groups according to predetermined criteria of recent metabolic control. Even the patients considered to have a very good diabetes control during the past eight weeks, had supranormal total fast Hb values (7.7 +/- 0.2%). In the patients with good, poor and bad diabetes control, mean total fast Hb levels were respectively 9.3 +/- 0.3, 10.1 +/- 0.3 and 12.5 +/- 0.4%. In normals, there was a positive correlation between individual fasting blood glucose and total fast Hb values and in diabetics, mean blood glucose values correlated with total fast Hb levels. Hb A1a+b+c determinations also correlated with triglyceride values. We could find no significant association between high total fast Hb levels (greater than 8.5%) and the prevalence of retinopathy.


Genetic regulation of mup production in recombinant inbred mice. Inbred strains of mice excrete all three major urinary proteins (mups) when induced by testosterone, but differ as to the relative proportions and total levels of each mup present. We have now determined the urinary mup phenotypes before and after testosterone treatment of seven recombinant inbred strains derived from progenitor strains exhibiting different mup phenotypes. The results confirm previous observations indicating that total control of mup protein production is a multigenic process. One locus, Mup-a on chromosome 4, determines the relative mup protein proportions after induction by testosterone. Mup-a, together with other genetic sites, determines the basal mup proportions. Genes other than Mup-a determine the kinetics of mup induction and total mup excretion.


The surgical treatment of myelopathy secondary to rheumatoid arthritis of the lower cervical spine. There are few reports in the literature of the surgical treatment of cervical myelopathy secondary to rheumatoid arthritis below the level of the axis. Three cases are presented. All had severe motor and sensory loss in the upper and lower extremities. The cause of myelopathy differed in each case: in the first, the dura mater was infiltrated with rheumatoid material; the second was due to a stenotic spinal canal narrowed by a fixed subluxation of the cervical spine; in the third, traction myelopathy resulted from sub-axial subluxation and posterior angulation combined with cervical instability. Neurological assessment is particularly difficult in patients with rheumatoid arthritis of the cervical spine. Skull or halo traction is useful to gauge neurological improvement, to reduce the dislocation and to immobilise the cervical spine before, during and after surgery. Surgery is considered where conservative treatment is either ineffective or not tolerated, and is indicated if severe myelopathy is evident or progressive. Anterior interbody fusion is the operation of choice for mobile subluxation. Laminectomy is recommended in fixed subluxation where compression of the cord is demonstrated on myelography.


[Uncoforaminectomy of Jung in the management of osteoarthritis of the cervical spine and the post-traumatic cervical syndrome (author's transl)]. An anterolateral approach to the cervical spine with uncoforaminectomy is used to free the intra transverse portion of the vertebral artery (from C7 to C3) and the nerve roots. Four surgical indications are discussed; the cervicocephalic syndrome due to osteoarthritis of the joints of Luschka, the cervicobrachialgic syndrome which is often combined wirth the former, cervical myelopathy associated with osteoarthritis and the post-traumatic cervical syndrome. Clincal and neuro-radiological details are given. The results of operation are described in 149 cases and they have been successful in 82%.


Electrodiagnosis of compression of individual nerve roots of the cauda equina. Segmental electrodiagnosis of compression of individual nerve roots of the cauda equina has been attempted in 45 patients, including cases of disc hernia, spondylsis and spondylolisthesis. The needle electrode was inserted into the nerve root either just lateral to the intervetebral foramen or through the posterior sacral foramen. The recordings made on stimulating a single nerve root were somatosensory evoked potential, the cauda equina action potential and the M and H waves. Mixed spinal nerve root action potentials were also recorded by stimulating the sciatic, peroneal and tibial nerves. It was shown that a diagnosis could be made from the somatosensory evoked potential, the H wave and root pain reproduction, and also the diagnosis of a subclinical compression involvement. In other words, the neurophysiological state of dysfunction of individual roots in each aspect of compression can be expressed.


The recurrence of pain following operation for herniated lumbar disc: fresh herniation or extradural scar tissue? The clinical findings, the appearance of the myelogram and the findings at re-operation are described in 34 patients who had persistent or recurrent pain following operation for removal of a herniated lumbar disc. An attempt was made to distinguish before re-operation whether the residue symptoms were due to recurrence of, or a fresh disc herniation, or to extradural scarring. Persistence of pain after the initial operation or the time interval before pain re-appeared did not help to distinguish the causative pathology. A recurrent disc herniation was found if a different disc was involved, but was else best distinguished by myelographic demonstration of a short indentation in the contrast column at the level of a disc or a short root sleeve with a thickened associated nerve root. An absence of indentation in the column suggested extradural scarring. At re-operation disc herniation and extradural scarring without herniation were found in approximately equal numbers of patients.


The mechanism of fracture of the femoral prosthesis in total hip replacement. Examination of the fractured stems of 70 Charnley, flat back, femoral prostheses suggested that the causative mechanism was a torisonal loading of the proximal portion on the distal part of the stem. The main loading on the hip is applied from an anterosuperior direction. The square corners of the stem and its implantation in retroversion predispose to fracture.


Operative control of massive haemorrhage in comminuted pelvic fractures. In 42 patients, massive haemorrhage following comminuted pelvic fractures was treated by operation through a mid-line, Pfannenstiel, anterior iliac crest-femoral or posterolateral approach, or using these in combination. The superior and inferior gluteal, pudendal and obturator arteries were the usual source of bleeding. Bleeding from the pelvic bone tissue was of minor importance. Temporary compression of the abdominal aorta was sometimes required to help control bleeding before ligation of injured vessels could be accomplished. An average of nine units of blood was given to each patient before operation and 30 units during or after the procedure. Of the 12 deaths, only three were attributable to bleeding from the pelvic fractures, indicating the value of operation in the treatment of massive haemorrhage from such injuries.


Femoral and tibial torsion: a correlation study in dry bones. Measurements were made in 50 cadaveric femora and their corresponding tibiae. There was a significant correlation between the femoral and tibial torsion. The clinical and surgical implications of this finding are discussed.


The treatment of total ruptures of the Achilles tendon by plaster immobilisation. Twenty patients with total rupture of the achilles tendon were treated by immobilisation in plaster in the gravitation-equinus position for eight weeks. All were healthy persons with a mean age of forty-three years. After removal of the plaster, seven patients had a re-rupture, four of whom were treated by operation, whilst two others sustained a deep vein thrombosis with an associated pulmonary embolus in one case. At follow-up, between 6 and 29 months after the rupture, 16 patients had no complaints and the remaining four had only minor problems. The range of motion in the ankle joint was normal in all patients and the strength in the affected calf was restored to normal in the majority. However, the strength recovered less in those patients with re-rupture who were treated conservatively for the second time. Because of the high complication rate we consider plaster treatment inferior to surgical treatment of Achilles tendon rupture.


A study of the distribution of load under the normal foot during walking. A computerised instrumentation system which measures the distribution of vertical load under the foot has been used to measure and record the loading under 148 normal feet during walking. The correlations and variations with load, contact time, sex, age and angle of the toe out are discussed.


Chromosomal study after radioactive synoviorthesis for haemophilic haemarthrosis. Twenty joints in 19 haemophiliacs were treated by radioactive synoviorthesis with gold (Au 198) to prevent recurrent haemarthrosis. Twelve knees, six elbows and two ankles were treated in two separate groups (29. 9. 76 and 9. 5. 77). In eight cases (40%) no further haemarthrosis occurred. A diminution of bleeding was obtained in nine cases (45%), a total of 85% good results with 15% failures. One failure in the first group (an elbow) had a second synoviorthesis and was included in the second group also. Prior to synoviorthesis the joint was scanned with technetium (Tc99m) to compare the inflammation of the synovium with that of six months later. The technique including the dosage of Tc99m, Au 198, and factor VIII cover is presented. A leucocyte culture was performed in 16 cases to study any chromosomal breakage, by banding and fluorescent techniques.


Bipolar fixation of fractures of the distal end of the radius. The frequency fo secondary displacement in fractures of the distal end of the radius is very high and varies from 40 to 60% in various series. This results from the void in the epiphysis after reduction due to crushing of the cancellous bone. Secondary displacement can be easily avoided by the bipolar fixation method. This method is quite simple. Two strong Kirschner wires are driven into the radius and into the first metacarpal, and then incorporated in the cast after the reduction of the fracture. In this study we have followed 102 out of 250 patients treated by this method. The number of secondary displcements has been negligible. The functional results are excellent and we did not find any untoward effects attributable to our technique.


The correction of rheumatoid ulnar drift by silicone prostheses with tendon transfer. Fifty hands with rheumatoid ulnar drift treated by resection of the metacarpal heads and replacement with silicone prostheses were studied. The procedure is outlined which consists of an arthroplasty using a silicone prosthesis with tendon transfer. The complications are also studied and the results evaluated. Of the cases studied 20% were excellent, 40% were good, and 40% fair.


The long-term treatment of periodical and cyclic depressions with flupenthixol decanoate. In a 2- to 3-year open study 30 patients were treated with flupenthixol decanoate (depot form). These periodic and cyclic depressive patients had side effects during treatment with lithium salts. In comparison with the depressive and manic phases before the treatment, the prophylactic effect of flupenthixol decanoate on periodic and cyclic forms of depression was similar to the effect of lithium salts.


[Reproducibility of the factorial structure of the AMP system]. Using the data of 552 patients mainly suffering from endogenous psychoses, the factorial structure (2--9 factors) of the AMP system was determined and compared to the results of a previous analysis. The 2- to 5-factor solutions were reproduced. In the 9-factor solution, on which the 9 known AMP scales are based, 2 factors ('paranoid' and 'hypochondriac syndrome') were not completely reproducible.


[Construction of second order AMP scales: "manic depressives" and "schizophrenic syndrome"]. A previous two-factor solution of the AMP system was confirmed by a factor analysis in 552 patients, mainly suffering from endogenous psychoses. Based on these results, two second-order scales ('manic-depressive' and 'schizophrenic syndrome') were constructed according to the classical theory of mental testing. The scales are orthogonal. Their reliability and validity is satisfactory. It is suggested to use the two new scales together with the known 9 AMP scales.


[Study of the validity of the second order AMP scales compared to the Hamilton Depression Scale, BPRS and IMPS]. Comparisons in three samples of patients with well-known rating scales (BPRS, Hamilton, IMPS) showed a good validity of the two second-order scales of the AMP system 'manic-depressive syndrome' and 'schizophrenic syndrome'.


Therapeutic problems in the treatment of cartilaginous tumours of bone. Two cases of solitary cartilaginous bone tumours are presented. They were slow growing and the radiographs never showed any certain evidence of malignancy. The writers emphasize the difficulties in planning treatment, in view of the tendency towards malignancy shown by these tumours.


Present tendencies in the surgical treatment of pectus excavatum. Among the malformations of the chest wall, pectus excavatum is undoubtedly the most frequent. It may appear in various forms and may show varying degrees of severity. Surgical correction by operation is mostly sought by the patients for aesthetic reasons. After careful review of the methods proposed by various writers for the correction of this malformation, the present writers emphasize the advantages and disadvantages of these techniques, especially in relation to the methods of stabilising the reduction. Finally, they report on their own case material and present some significant examples.


Rigid osteosynthesis in open diaphyseal fractures of the long bones: immediate or deferred treatment. Fifty nine cases of open diaphyseal fractures of the long bones treated by rigid osteosynthesis were examined with reference to their course and outcome in relation to whether the operation was immediate of deferred. No significant differences arose as between the two groups of cases. It thus appears that the timing of the operation has no important repercussions on the course and the result.


Surgical treatment of subtrochanteric fractures of the femur: biomechanical aspects. The internal fixation of subtrochanteric fractures of the femur must meet precise mechanical requirements in order to be capable of resisting the considerable bending stresses acting on this part of the body. On the basis of the results obtained in ninety two fractures treated surgically with various fixation devices, the authors analyse the biomechanical characteristics of the various implants in relation to the different types of fractures.


Chondromalacia and recurrent subluxation of the patella: a study of malalignment, with some indications for radiography. The authors adopted four parameters in a study of 100 normal subjects and fifty patients affected by "chondromalacia" or by recurrent subluxation of the patella. These were: the quadriceps angle, the ratio between the length of the patellar tendon and the length of the patella, the femoral sulcus angle, and the congruence angle between the femur and patella. These parameters showed a statistically significant increase in the pathological group, thereby demonstrating that the majority of cases of "chondromalacia" of the patella and those of recurrent subluxation constitute two entities forming part of the same disease, the basis of which is malalignment and malposition of the patella.


Experimental study of the effects of cortical erosion on the resistance to compression of diaphyseal compact bone. The authors investigated the variations in breakage under comparable compression loads induced by concentric erosion of diaphyseal bone in experimental animals. The results varied according to whether the internal or external cortex had been eroded, and whether the proximal or distal segments of the diaphysis were involved. Our findings appear to have some practical relevance regarding the etiopathogenesis of pathological fractures.


Resection of the median nerve without sequelae (resection of 15 cm due to neurofibroma). A case of neurofibroma of the median nerve at the wrist is reported. An operation to resect 15 cm of the nerve was performed; no transplant was substituted. No motor or sensory paralysis was noted, either directly after the operation or at follow up after nine years. Injection of procaine into the ulnar nerve at the epitrochlear groove demonstrated complete compensation, by means of anastomoses between the two nerves at the upper third of the forearm. It is assumed that the type of lesion (circumscribed neurofibromatosis) beginning in infancy or childhood, had some influence in giving rise to this substitution.


Voluntary dislocation of the hip (a case report). An extremely rare case is presented of voluntary dislocation of the hip not preceded by trauma. Some pathogenetic hypotheses are discussed. The surgical treatment is described and illustrated and the result is followed up.


Quantitative analysis of the bone destroying activity of osteocytes and osteoclasts in experimental disuse osteoporosis. With the aim of analysing the role played by osteocytes in phospho-calcic homeostasis and in bone metabolism, the amount of bone tissue respectively reabsorbed by osteocytes and by osteoclasts had morphometrically been evaluated in unloaded skeletal segments.


Leontiasis ossea.

Leontiasis ossea. A case of leontiasis ossea, observed over a period of fifty years, is described with particular reference to certain similarities and differences as compared with Paget's disease of bone (osteitis deformans) and fibrous dysplasia. The differential diagnosis is discussed and it is concluded that leontiasis ossea is an entity in its own right.


An apparatus for the radiographic diagnosis of ligamentous lesions of the ankle dynamic projections. Functional radiographic investigation is indispensable to the clinical examination of ligamentous lesions of the ankle. It facilitates correct classification of the different lesions. This correlation of clinical findings and precise radiographical images to well defined anatomo-pathological lesions is particularly important in selecting the correct treatment. An apparatus is described which makes it possible to identify more precisely ligamentous lesions of the ankle, both the abnormal tilting of the talus in A.P. views, and forward talar sliding ("angle of ballottamento") seen in lateral views. This apparatus is easy to use in the First Aid department and can be used without general or local anaesthesia.


Giant cell tumour in a vertebra affected by Paget's disease of bone. A case of giant cell tumor in a vertebra affected by Paget's disease of bone is presented. This lesion, which is quite rare, has usually been observed in the bones of the skull and face, and is benign. It is probably hyperplastic rather than neoplastic in nature. Radiotherapy is contraindicated, since bone affected by osteitis deformans may possibly become malignant.


[Immunopathology of Duhring's dermatitis herpetiformis]. Dermatitis herpetiformis and gluten-sensitive enteropathy and their mutual association are discussed. Clinical, histopathological, immunopathological and genetic findings are emphasized, particularly with regard to the pathogenesis and diagnosis of both disorders.


[Erythema annulare centrifugum Darier].

[Erythema annulare centrifugum Darier]. The symptoms of erythema anulare centrifugum Darier are demonstrated in a 60-year-old patient. A paraneoplastic syndrome was sufficiently ruled out. The skin lesions quickly healed during treatment of an urinary tract infection.


[Preparative isolation of tri-, tetra-, penta- and hexapyrimidine nucleotides from hydrolysates of depurinated herring sperm DNA (author's transl)]. The pyrimidine nucleotides p(dC)3p, p(dT)3p and p(dT)4p and mixtures of the sequence isomers p(dC3, dT), (dC3, dT)p; p(dC3, dT)p; p(dC2, dT2)p; p(dC, dT3)p; p(dC3, dT2)p; p(dC2, dT3); p(dC2, dT3)p; p(dC, dT4)p; p(dC4, dT2); p(dC3, dT3); p(dC3, dT3)p and p(dC2, dT4)p have been isolated on a preparative scale from hydrolysates of depurinated herring sperm DNA. The DNA hydrolysate is first separated into a high- and a low-molecular weight pyrimidine nucleotide mixture by column chromatography at pH 7.5 on DEAE-cellulose. The high-molecular-weight pyrimidine nucleotide mixture is further separated into four peaks on QAE-Sephadex at pH 7.5. The second peak is re-chromatographed on QAE-Sephadex at pH 3.5. Pyrimidine nucleotides containing predominantly cytidylic acid units may thus be separated from these with predominantly thymidylic acid units. Subsequent separation according to number of phosphate groups at pH 7.5 on QAE-Sephadex yields products of 70--93% purity. In a final separation step, the pyrimidine nucleotides and mixtures of sequence isomers are once again chromatographed on QAE-Sephadex with 7 M urea at pH 7.5. The products thus obtained are generally chromatographically pure. Impurities which are not fully removed by column chromatography are separated by paper chromatography. The structure of the isolated DNA fragments and the composition of the mixtures of sequence isomers are determined from the chromatographic data, absorption characteristics and by enzymatic degradation.


Rapid thin-layer chromatographic photodensitometric method for the determination of metoclopramide and clebopride in the presence of some of their metabolic products. Metoclopramide and its newly developed analogue clebopride, together with some of their metabolic products are quantitated, following extraction from biological tissues and fluids, and subsequent separation on silica gel thin-layer chromatographic plates. Diazotisation, followed by coupling with N-(1-naphthyl)ethylenediammonium dichloride, carried out on the thin-layer plate, is utilised for visualisation. The intensity of the spots is measured by photodensitometric analysis. The effect of variation of various experimental conditions is studied. The method has proven to be satisfactory for the measurement of 20 ng/ml of these compounds in biological material; the results are well within the accepted limits of deviation.


Determination of nitrazepam and its main metabolites in urine by gas--liquid chromatography: use of electron capture and nitrogen-selective detectors. Nitrazepam and its main urinary metabolites, 7-aminonitrazepam and 7-acetamidonitrazepam, free and conjugared, were determined from 24-h fractions of human urine after a single oral dose of 5 mg of nitrazepam. Nitrazepam and the metabolites were extracted before and after glusulase hydrolysis with benzene--dichloromethane (90:10) from a 1.0 ml sample. Methylnitrazepam and methylbromazepam served as internal standards. Recoveries were better than 90%. GLC analysis of nitrazepam was performed using a 63Ni electron-capture detector. The metabolites were measured by a dual flameless nitrogen selective detector. The detection limits were about 0.2 ng/ml for nitrazepam and 50 ng/ml for the metabolites. The nitrogen-selective detector responds similarly to all three compounds. The 63Ni electron-capture detector gives very poor response to 7-amino-nitrazepam but allows very sensitive detection of nitrazepam. Combined use of the two detectors gives valuable information about the metabolic profile of nitrazepam.


Determination of clonazepam in human plasma by gas chromatography--negative ion chemical ionization mass spectrometry. Our previously reported gas chromatographic--mass spectrometric assay for clonazepam using positive ion chemical ionization has been modified to employ negative ion chemical ionization. The sensitivity using this technique (less than 0.1 ng/ml) is approximately twenty times better than the positive ion chemical ionization procedure with similar precision. The method was used to determine the clonazepam plasma concentration in one human for 96 h following a single 2-mg dose of clonazepam.


Determination of nikethamide and N-ethylnicotinamide in the blood and urine of greyhounds. Following the intramuscular administration of nikethamide to a series of greyhounds, both plasma and urine excretion levels were obtained. A qualitative urine screening procedure for both nikethamide and its major metabolite has been devised. The method involves solvent extraction, thin-layer and a two-system gas chromatographic system.


Simultaneous microdetermination of capsaicin and its four analogues by using high-performance liquid chromatography and gas chromatography--mass spectrometry. An improved method is described for the simultaneous determination of capsaicin and its analogues at levels from nanograms to micrograms using high-performance liquid chromatography (HPLC) and gas chromatography--mass spectrometry. This method consists of two steps: firstly, purification and determination of total capsaicinoid by HPLC, and secondly, the simultaneous determination of capsaicin and its analogues by mass chromatography (MC) or mass fragmentography (MF). Crude extracts of capsaicinoid were purified with a Zorbax SIL column. Total capsaicinoid was detected at 235 nm and measured automatically by a microcomputer. It was collected, evaporated, trimethylsilylated and subjected to MC or MF. After monitoring the molecular ions of trimethylsilyl derivatives of capsaicinoid and the internal standard, the absolute contents of each analogue were determined by computer. By using this method, capsaicin and all of its analogues can be determined simultaneously at levels from micrograms to nanograms without any interferences from other components.


Prazosin determination by high-pressure liquid chromatography using fluorescence detection. A high-pressure liquid chromatographic procedure using fluorescence detection for the analysis of prazosin in whole blood and plasma is described. It employs a simple and rapid method of sample preparation. Prazosin and an internal standard are chromatographed as ion-pairs with pentane sulfonic acid. The method is sensitive and reproducible with accurate detection as low as 0.2 ng/ml in whole blood and 0.5 ng/ml in plasma with a coefficient of variation of 5.6% and 5.4% respectively. If propranolol or quinidine is present, modifications of chromatographic conditions are used which separate prazosin from these two drugs. Prazosin is stable when frozen for a long period or refrigerated for short periods.


Determination of buflomedil hydrochloride [2',4',6'-trimethoxy-4-(pyrrolidinyl)butyrophenone hydrochloride] by reversed-phase ion-pair high-performance liquid chromatography. A simple and rapid method for the determination of buflomedil hydrochloride [2',4',6'-trimethoxy-4-(pyrrolidinyl)butyrophenone hydrochloride] in pharmaceutical formulations by reversed-phase ion-pair high-performance liquid chromatography is described. The sample is dissolved in methanol and 1,3,5-trimethoxybenzene is added as an internal standard. The resulting solution is chromatographed on an octadecylsilane column using ion-pair partition chromatography with lauryl sulphate as the counter ion. A 25-microliter injection (containing 3.5 micrograms of buflomedil hydrochloride) produces a 60% full-scale peak (0.2 a.u.f.s.) at the absorbance maximum (275 nm). The relative standard deviation of the method ranges from 1 to 3%, depending  on the particular tablet formulation examined. Excipients present in the preparations do not interfere.


Quantitative thin-layer chromatography: thin-film fluorescence scanning analysis of adriamycin and metabolites in tissue. A rapid, non-hydrolytic thin-film fluorescence scanning method is described for the quantitation of adriamycin and metabolites in tissues. Adriamycin, with daunomycin added as the internal standard, was extracted from tissue homogenate which contained 500 micrograms of oxalic acid, with ice-cold 0.5 N hydrochloric acid--85% isopropanol, separated by thin-layer chromatography, and quantitated in situ via a fluorescence scanning technique. This method has a sensitivity to 0.05 microgram per gram of tissue.


Evaluation of the characteristics of the differential amperometric detector in combination with anion-exchange chromatography, using L-ascorbic acid as test compound. The hydrodynamic characteristics of the thin-layer flow cell of the differential amperometric detector were deduced theoretically and confirmed by experiment. The response of the differential amperometric detector was compared with that of a fixed-wavelength UV detector in the analysis of L-ascorbic acid in combination with anion-exchange chromatography.


General method for computer measurement of complex chromatograms. Usual computerized methods for measuring peak areas and associated computations on chromatograms require relatively highly reproducible retnetion times. They are prone to mis-identification of substances in chromatography of physiological fluids. The method described was developed for amino acid analyses of physiological mouse tissues. It tolerates noisy output, drifting baselines, variable retention times and unidentified peaks.


Double-column gas chromatography using packed pre-columns and glass capillary main columns. Methods of column switching are described that make possible back-flushing, heart cutting and trapping. Conventional packed columns are employed as pre-columns for their high sample capacity, and glass capillary columns are used as the main columns for their high separation efficiency. Some typical examples of the application of double-column gas chromatography are presented: (1) solvent cutting for identification and exact quantitative determination of a phosphorus ester impurity in a sample of wheat flour (including trapping); (2) separation of trace amounts of methyl esters of fatty acids by means of back-flushing and trapping; (3) enrichment technique using trapping of trace elements in the front section of the capillary (plus solvent cutting, multiple injection and back-flushing); and (4) coupling a nitrogen-selective detector to the capillary main column to gain additional information. To illustrate the trapping effect, the separation number was determined with and without trapping.


[Autogenous ovary grafts in rabbits. Experimental study (author's transl)]. The authors report the techniques used and the results obtained in a experimental study of autogenous ovary grafts in rabbits. The various methods of control--histological, hormonal and isotopic--used to measure the vitality of the grafts, showed their good quality. Active ovarian tissue was found to be present within the graft: 17 beta-oestradiol and progesterone secretion was demonstrated by means of radio-immunological plasma dosages and LH fixation in the ovarian tissue graft was shown by means of 131 iodine. This recovery was however accompanied by a loss of ovarian functional potential and chances of impregnation and gestation were reduced due to a strong peritoneal reaction.


[Hormonal tests of pregnancy and congenital malformations (author's transl)]. I.N.S.E.R.M. has carried out two prospective inquiries centred on the evaluation of the teratogenic action of drugs on human beings. The first survey was between 1963 and 1969 and the second between 1975 and 1977 and they were carried out in maternity hospitals. The first test, which was carried out on 12,764 women, had shown no overall association between the use of hormonal tests for the diagnosis of pregnancy (oestrogens-progestogens) and congenital malformation in the infant. The second study, which was carried out on 3,451 women who were questioned in the same way, shows that there is an excessive number of newborn babies with malformations when the mothers took certain products (oestrogens-progestogens when the progestogen was a derivative of testosterone). The problem of a methodological bias is discussed and the results are interpreted in the light of epidemiological studies that have recently been carried out abroad.


[Plasma hormonal pattern of the late diabetic pregnancy (author's transl)]. Plasma estradiol, estriol, progesterone, H.C.S. and cortisol were measured (RIA methods) every two days, in 20 diabetic pregnancies (classes B, C or D of White), between the 33th week and the delivery, and were compared with normal pregnancies. Estriol was always normal, and progesterone values were at the upper limit of the normal range; estradiol, H.C.S. and cortisol were normal or elevated, with mean values significantly higher than controls. E2 and/or progesterone dramatically decreased in 5 cases before birth, just as the urinary measurements. In this study, the insulin requirements were not correlated with these plasma hormone values. Besides pathogenic hypothesis )glycemic control of H.C.S. and cortisol--abnormalities of metabolic pathways of estrogens ?), this work informs the inferred hormonal deficiency in diabetic placenta. Also, it is unable to determine the practical usefulness of these plasma measurements in the management of diabetic pregnancy.


[The psychoanalytic approach to contraception today (author's transl)]. The authors look at a consultation for contraception from the point of view of the doctor and emphasize the unusual character of this consultation: on the one hand the doctor is not asked to exercise his usual therapeutic function, and on the other hand he is put into the position where he has to be a "sexual educator", a particularly delicate position to be in especially when dealing with adolescents. The authors look then at the subject from the point of view of the patient who is consulting the doctor for contraceptive services and distinguish three stages: The patient or rather the consultee who is in full reproductive life and who asks for contraception (and its failures) in relationship to the ups and downs of her unconscious desire to have a child; the consultee at the end of her reproductive life who tries to establish a relationship of patient to doctor by avoiding a list of morbid symptoms; and particularly the adolescent whose demand for contraception is very delicate (as all medical interventions are at this age), and where the doctor finds himself in the privileged position of being able to restore individuality to the adolescent by refusing to allow the consultation to be directed by the mother.


[Placental sulfatase deficiency and sex-linked recessive ichthyosis. Two cases found in two sisters (author's transl)]. The diagnosis of placental sulfatase deficiency was made at the same time in two sisters who were pregnant. This is the first case history reported of two women who were carriers of this abnormality and who were linked by parentage. The inborn error of metabolism was able to be found in its post-natal state in two of the sons of one of the women in the form of retention cutaneous ichthyosis of a sex-linked type.


[A fetal distress signal: decreased fetal movements. A case of antenatal anaemia (author's transl)]. The authors report an observation of antenatal anaemia which showed as fetal distress found by a decrease of fetal movements and confirmed by cardiotocography. At birth, the baby was very pale and has a severe anaemia. The authors have investigated the method introduced by Sadovsky for analysing fetal activity in which the woman counted her fetal movements in accordance with a time schedule. Normal fetal movements are an indication of fetal well-being. Decreased fetal movements may be an indication of chronic fetal asphyxia. In this case, cardiotocography has to be undertaken. Analysis of their results demonstrated the value of this method which appears to be useful particularly for the assessment of chronic fetal distress.


[The results of two years of artificial insemination (author's transl)]. Artificial insemination donor (AID) is the solution for the sterility of many couples where the man is irreversibly sterile. We present the results of AID using frozen sperm in the two first years of work at the Centre d'Etudes et de Conservation du Sperme (C.E.C.O.S.), which is situated in the Midi-Pyrénées region of France. The results that have been obtained are satisfactory and prove the value of this method, but the means at present at the disposal of the Center do not always meet the demands made on it.


[Oral contraception with an associated therapeutic action using a progestational method at two levels (author's transl)]. The authors, basing their work on their experience over many years with a large number of cases, are proposing that synthetic progestational agents can be used at two levels of dosage, to serve as contraception and as a treatment when a progestational agent is used and is followed by micro-dosages of another progestational substance. So they prescribe at the end a of cycle following different dosages for different lengths of time, the same (or a different) progestational agent to treat breast troubles or menstrual troubles which are often intricate, particularly near the menopause. The authors in this way can compare by trials the effects of this method as compared with those of a progestational contraceptive administered in high doses and prescribed in an interrupted way and the prescription of micro-dosages of progestational agents that are taken "non-stop" which is now a classical method of treatment. This new method of contraception using progestational agents at two levels of dosage is particularly useful in patients who cannot take oestrogens because of metabolic upsets or because of tumours and who have reacted badly to the two other methods mentioned. If the dose, which can be calculated thanks to our knowledge of the hormonal background of the patient, is altered good therapeutic results and a relatively sure method of contraception is evolved without metabolic risks for the patient. This association of two progestational levels of dosage seems to be indicated particularly in women of over 40 years of age.


[Maturation of the cervix by prostaglandins before inducing termination of pregnancy, in the first trimester (author's transl)]. A new technique for instilling the gel of PGF2 alpha into the endocervix is presented. The study is concerned with 100 therapeutic terminations of pregnancy by dilatation and suction carried out in the first trimester of pregnancy. The efficacy of PGF2 alpha gel is compared with that for tablets of PGE2 and a placebo group. Softening of the cervix was evaluated using a tocodynamometer. PFG2 alpha gel often gives remarkable results, but the response to treatment is unpredictable. Secondary effects, and in particular digestive effects, occur frequently but are always easily controlled.


Design history of a cell kinetics simulation language. The field of cell kinetics relates to the movement and proliferation of cells through their generative cycle and to how this cycle is affected by chemotherapy treatment. CELLSIM is a discrete, digital simulation language for modeling this process. The language is interpretive, with the interpreter written in FORTRAN. It has been implemented on a wide variety of computer systems. The language features dynamic memory allocation, arithmetic string manipulation, and the capability of generating random variates from a number of probability distributions. The language has continued to evolve as the needs and desires of cancer researchers have been discovered. Its early use was only in experimental environments, but it is now being used to prescribe actual chemotherapy treatments.


Impact of government regulations on two management and clinical information systems in a medical school environment. Administrative and legal requirements and, in particular, federal and state government health care assistance and social services program regulations all combine to add complexity to the management and operation of ambulatory and inpatient health programs. This paper describes how constantly changing government regulations and differences in interpretations and definitiions have been expensive, time-consuming and sometimes detrimental to health care delivery for two large management and clinical computer-based information systems.


Government regulations and other influences on the medical use of computers. This paper presents points brought out in a panel discussion held at the 12th Hawaiian International Conference on System Sciences, January 1979. The session was attended by approximately two dozen interested parties from various segments of the academic, government, and health care communities. The broad categories covered include the specific problems of government regulations and their impact on specific clinical information systems installed at The University of Texas Health Science Center at Dallas, opportunities in a regulated environment, problems in a regulated environment, vendor-related issues in the marketing and manufacture of computer-based information systems, rational approaches to government control, and specific issues related to medical computer science.


Psychological systems questionnaire: a decision-relevant patient screening test designed for on-line administration. Developments in the field of computerized psychological assessment are reviewed. It is pointed out that the on-line computer medium differs radically from the traditional paper-and-pencil medium for psychological testing. This new medium calls for new types of instruments that are psychometrically well designed. The construction of one such instrument, the Psychological Systems Questionnaire, is described. The advantages of this approach are discussed.


Automated nerve fiber counting using an array processor in a multi-minicomputer system. It has been suggested that recovery of motor and sensory function in the site distal to a peripheral nerve lesion should be improved if the nerve bundles (fasciculi) are matched and individually sutured. Three parameters are proposed to provide quantitative data: the count of the nerve fibers that regenerate, the number of functional regenerated nerve fibers, and a measurement of end organ reinnervation. A thin cross section of a transected and repaired sciatic nerve of a mongrel cat is fixed, stained, photographed, and digitized through a microscope 6 months following nerve repair. The data arrays are then subjected to four basic processing routines: edge enhancing, thresholding, template matching, and peak detection. Finally, the peaks are counted and provide an estimate of the number of nerve fibers in the nerve under study. Comparing counts of nerve fibers proximal and distal to the transection site of the nerve provide data on the proportion of regeneration present at various times. The content of this paper is, to a large extent, describing the implementation of the needed image-processing algorithms for automated counting on the Multi-MiniComputer System (MMCS). Optimal use of the AP-120B array processor and the pipeline processing provided by using the Eclipse 200s and the Nova 3 make a marked improvement in overall throughput.


An analogue echogram range gate tracker for clinical echocardiography. The fundamental purpose of this paper is to present the results of a feasibility study for an on-line, real-time automatic range gate tracker (ARGT) for clinical echocardiography, specifically for the purpose of determining cardiac output noninvasively and in real time. The basic ARGT design represents an implementation of specific algorithms and a system controller that permit user interaction and interpretation of clinical echocardiograms. In its analytical mode, the ARGT automatically tracks cardiac echoes as visually perceived and selected by the user. While tracking specific cardiac echoes, the ARGT converts the complex ultrasonic echogram into a pair of meaningful analogue signals (corresponding to the motion of the anterior and posterior left ventricular walls) from which dimensional information corresponding to dynamic geometric changes of the heart are derived. From the information, the cardiac output is computed in real time.


Brain edema in acute arterial hypertension III: fluorescence microscopic results. Evans blue fluorescence micrographs were investigated from cat brain preparations 5 minutes after angiotensin-induced acute arterial hypertension and intravenous Evans-Blue injection to detect the main localization of Evans-Blue extravasation on the cerebral vasculature. The typical finding was pericapillary and perivenular fluorescence in the cortical grey matter, concentrated in the cytoplasm of neurons. Very intensive staining in the near vicinity of leaking vessels was additionally caused by diffuse fluorescence. The results support the hypothesis that acute arterial hypertension causes critical increase of cerebral venular pressure and venular congestion by overwhelming of cerebral venous outflow-capacity, followed by blood-brain barrier disturbance mainly at the capillaryvenular level.


Considerations on the origin of subarachnoid hemorrhages. The Authors emphasize the importance of C.T. in the study of subarachnoid hemorrhages. By means of this new radiological investigation they are able to exclude a vascular or tumoral etiology in those patients who had no aneurysms detectable by cerebral angiography, and suggest the problem of the so-called spontaneous subarachnoid hemorrhages. They discuss the degenerative nature of the endocranial aneurysms. Several interesting case-reports stress the importance of the primitive lesions of the arterial wall vessel in the degenerative origin of endocranial aneurysms.


Effects of the Feingold diet on seizures and hyperactivity: a single-subject analysis. The effects of a dietary manipulation on seizure frequency and activity level of a 3 1/2-year-old male with tuberous sclerosis, mental retardation, and uncontrolled seizures were assessed. Using a reversal design, the Feingold (K-P) diet was presented and withdrawn three times, while the medication regimen remained unaltered. Every application of the K-P diet resulted in substantial reductions in seizure frequency. During a 21-week follow-up, seizure frequency remained low despite the phasing out of one drug, and seizures were reportedly eliminated 1 year later. Brief objective measures of hyperactivity failed to show any effect due to the diet changes.


Cultural context of type A behavior and risk for CHD: a study of Japanese American males. A total of 2437 Japanese American men living in Hawaii were given the Jenkins Activity Survey (JAS) and classified as either type A or type B. Only 18% of the sample scored in the type A direction, a much lower percentage than usually found among white American males. There was a slightly higher prevalence of CHD among type A Japanese Americans than among their type B counterparts (5.7% vs. 3.6%, respectively). A factor analysis of JAS data produced three new factors for this population: HS (hard-driving and impatient), JH (ability to function successfully in job setting), and HW (hard-working). Those men who were more Westernized had a higher prevalence of CHD, expecially if they were also type A, in terms of both geographical mobility and intergenerational change. The results are discussed in light of the dual role of sociocultural influences and behavioral characteristics (type A/B) which predispose an individual to CHD.


Space occupying contusions of cerebral lobes after closed brain injury: considerations about 51 cases. Fifty one cases of space occupying contusions of the brain have been treated between 1967 and 1974. These represented 2.4% of all head injuries. Forty four were surgically treated and only clinically. The total mortality was 50.9% being 91.4% in patients above 50 years of age and 41% in patients below 50. In 66.6% of patients the lesions were localized in the temporal lobes, and two patients had localized cerebellar contusions. Surgery was performed in 44 patients. There were 13 craniectomies and 31 craniotomies. The operative mortality was 54.5%. Mortality was 65.2% in patients operated on within 24 hours of injury, and 12.5% in those operated on more than 72 hours after trauma. Twenty five patients (20 treated surgically and 5 managed clinically) were examined one year after injury. Eighty four percent were in either good or excellent condition.


A 1-year follow-up of Raynaud's patients treated with behavioral therapy techniques. The purpose of this study was to assess to what degree learned control of digital temperature and vasospastic attacks can be retained by Raynaud's patients over a full year period. Subjects were 19 patients suffering from diagnosed idiopathic Raynaud's disease who had undergone behavioral training. These patients had been trained to increase digital temperature using either autogenic training, biofeedback, or a combination of autogenic training and temperature biofeedback. Results indicated that the mean number of vasospastic attacks per day occurring 1 year after training was approximately equal to the number occurring at the end of the initial training (1.2-1.3 per day). Patient satisfaction with the treatment program was above average (3.5 on a 5-point scale). The patients' ability to maintain digital temperature during the cold stress challenge was imparied, however. At 1-year follow-up, digital temperature readings taken in the laboratory were identical to baseline levels.


Long-term monitoring of intracranial pressure in hydrocephalic children not affected by cerebral tumor. Long-term epidural intracranial pressure (ICP) recordings were performed in 10 hydrocephalic children, not affected by cerebral tumor. The work concerns the identification of A and B Lundberg's waves during normal sleep in the ICP pattern. Plateau-waves of high amplitude and long duration were measured in one patient. A base-line pressure higher than normal was found in the other cases in which waves during sleep were seldom revealed. Five children were monitored by studying the pressure pattern after shunt surgery. The Authors discuss the implication of the rarity of plateau-waves in infancy and the cause of this phenomenon.


Analysis of the process of cell degradation induced by Triton X-100 in Ehrlich ascites tumor cells. Analysis of the liberation degrees of intracellular materials from Ehrlich ascites tumor cells by treatment of Triton X-100 was performed. The liberation process has two stages. In the first stage, cytoplasmic inorganic phosphorus were liberated at a concentration of about 0.01% of the detergent, and in the second stage macromolecules such as lysosomal enzymes were liberated at a concentration of about 0.03% of the detergent. Morphologically, the cells began to swell in the first stage but were not stained by Trypan blue, and the cells in the second stage became fully swollen and ruptured. The staining curve of the swollen and ruptured cells was closely in parallel with the liberation curves of the macromolecules.


Giant unruptured aneurysm of the middle cerebral artery manifesting with epilepsy: successful surgical treatment. A case of a giant aneurysm of the middle cerebral artery (M.C.A.), presenting with history of visual hallucinations, is described. The aneurysm was successfully excised, with disappearance of previous symptoms. The interest of the case is constituted by the very unfrequent location for an aneurysm over 3 cm in diameter, by the occurrence of epilepsy as the first symptom and by the excellent response to surgical therapy. The morphology and location of giant aneurysms, their surgical treatment and especially the problem of aneurysm-induced epilepsy are discussed.


A proposal method for the assessment of cerebrospinal fluid pressure in the cerebral ventricles. This work presents a possible method of overcoming difficulties arising during the recording of intracranial pressure (ICP) from the cerebral ventricles of patients suffering from head injuries or intracranial space occupying lesions. The main difficulties in obtaining these measurements are the risk of infection and measurement errors caused by artefacts from head movements. These two problems arise when a cannula inserted into the cerebral ventricle is connected outside the skull to an external transducer measuring pressure. We propose a method utilizing a modified flushing shunt connected to a strain gauge epidural transducer. The characteristic (voltage against pressure) of the device was tested in vitro. This calibration gave satisfactory results both in the linearity of the characteristic and in the performance of the device.


On the metabolic detoxication of thymol in rabbit and man. The metabolic detoxication of thymol was investigated in rabbit and man. Thymol glucuronide which the aglycone is intact, was isolated from thymol medicated rabbit urine and identified as a acetyl derivative of methyl glucuronate. The hydroxylated product of thymol, thymohydroquinone, was recognized in a small amount in thymol medicated human urine. It was presumed that thymohydroquinone is excreted as ethereal sulfuric acid conjugate in man.


Effects of methylmercury chloride on various cholinergic parameters in vitro. The effects of methylmercury chloride and other mercury compounds on cholinergic parameters were studied in vitro. Methylmercury chloride (MMC) and phenylmercury acetate inhibited choline acetyltransferase (ChA) with 20 microM of I50, and mercury nitrate (MN) with 100 microM of I50. All the three compounds had little effect on cholinesterase activity. MMC inhibited a high affinity choline uptake with 41 microM of Ki, as well as a low affinity choline uptake with 250 microM of Ki. MMC did not affect a spontaneous and potassium-stimulated ACh release from brain tissue slices incubated in eserinized Krebs-Ringer's solution up to the concentration of 100 microM. It was shown that the organic mercury compounds, such as methylmercury, were potent inhibitors of the choline uptake systems, as well as ChA activity.


Deleterious effect of short-term exposure to Coca-Cola on rats. Semiacute toxicity of cola fluid, Coca-Cola, conducting for approximately a month in rats, was studied. A trend of cariogenicity of Coca-Cola was strongly indicated. When the fluid was given ad libitum, decarbonized Coca-Cola and carbohydrate solution, consisted 8% of glucose and 3.5% of sugar and then adjusted pH to 2.4 with oxalic acid, were consumed 2 to 3 times greater than the control (water). A hyperuresis was observed as the result of great consumption of liquid, but no liver nor kidney degeneration was observed by histopathological examination. The diet consumption of the groups of Coca-Cola and carbohydrate solution was approximately a half of the control, water. However, when a complete diet was given, no physiological difference in time was observed, except in diarrhea and depression of hair gloss in Coca-Cola group.


Plasma aspartate levels in rats following administration of monopotassium aspartate via three routes. Plasma aspartate levels were measured after potassium aspartate administration through different routes to rats of various ages. The changes in plasma levels were most significant with intraperitoneal injection. Dose- and age-related responses to aspartate load were obtained. The present data suggest that a marked elevation of plasma aspartate levels may result in neuronal necrosis. By comparing the plasma aspartate levels with the results on hypothalamic lesion (Okaniwa et al., 1979), plasma peak value associated with the lesion was estimated in each case of various administration routes and rat ages.


Immune responses in rabbits treated with tetracycline. Cellular and humoral immunological phenomena in rabbits treated with tetracycline were investigated by lymphocyte transformation, leucocyte migration inhibition, and indirect hemagglutination tests. Cellular and/or humoral immunity against tetracycline and/or homologous or autologous rabbit gamma globulin was acquired by about two-thirds of the rabbits, with some also acquiring immunity against homologous tissue antigen after prolonged tetracycline administration. Based on these results, the significance of immune responses to autoantigens by drug administration was discussed in relation to potential agents for the induction of autoimmune diseases.


Embryotoxicity of arsenic acid: light and electron microscopy of its effect on neurulation-stage rat embryo. To clarify the light and electron microscopic changes accompanying embryonic death from a lethal dose of arsenic acid, MP 1 pregnant rats were injected i.p. with 30 mg/kg arsenic acid at 1:30 p.m. on day 9 of gestation (the neurulation stage). At 4 hours after treatment, some cell necrosis occurred in the neuroectoderm and the mesoderm of the embryo. At six hours later, cell necrosis increased in the neuroectoderm and the mesoderm, whereas those in the surface ectoderm and the endoderm were very few. In the embryo 12 hours after treatment, abnormal mitotic cells exhibiting vesiculation of the endoplasmic reticula, and abnormal interphase cells characterized by the ring-shaped nucleoli in the nucleus and the enlargement of cisternae of the endoplasmic reticula and the nuclear envelope, were observed in the neuroectoderm and the mesoderm. Debris from cell necrosis and the said abnormal mitotic and interphase cells were ejected from the neuroectoderm into the amniotic coele. In the embryo 24 hours later, neurulation was stopped and the V-shaped neural fold remained. The somite formation was retarded. The surviving cells in the embryo sometimes contained phagocytic vesicles in the cytoplasm, but no other anomalies were encountered. It was considered that a variety of metabolic reactions may be disturbed by arsenic acid, resulting in numerous cell necrosis and abnormal mitotic and interphase cells in the neuroectoderm and the mesoderm of the rat embryo.


[The conflict between vision and touch: on visual capture (author's transl)]. This paper aims to examine the limitation of visual dominance under a situation of conflict between the visual and tactile shape of an object. The subjects were presented with an object of which shape was made to appear different visually from its tactile shape by optical distortion. To change the degree of conflict, three reducing lenses of differing powers were used. After simultaneously grasping and viewing the standard object, the subjects were asked to choose a comparison object in accordance with their impression of the shape of the standard. The results showed that the degree of visual capture was limited. Using a lens that reduced the apparent visual image approximately 1/8, most subjects were aware of the conflict between the visual and tactile impressions.


Renal tubular transport of gentamicin in the rat. The renal handling of gentamicin in the rat was examined by clearance, microinjection, and renal cortical-slice techniques. The steady-state renal clearance of 14C-gentamicin, when corrected for the 7.5% binding to plasma protein, was not significantly different from that of 3H-inulin. At the end of the renal clearance experiments, the cortical concentration of gentamicin was 93 +/- 7 microgram/g of tissue (N = 7), a concentration threefold greater than that of the medulla and 20-fold greater than that of serum. Absorption of 3H-gentamicin along the proximal convoluted tubule and loop of Henle was demonstrated by the tubular microinjection technique. No reabsorption of 3H-gentamicin was detected beyond the early distal convoluted tubule. The tubular absorption of 3H-gentamicin was load dependent. Fractional absorption of 3H-gentamicin averaged 30.1 +/- 2.7% when the dose of 3H-gentamicin injected into early proximal tubular convolutions averaged 132 +/- 17 pg. It was decreased to 13.6 +/- 2.6% when the microinjected dose of gentamicin was increased to 1996 +/- 388 pg. No evidence of transtubular absorption of 3H-gentamicin was detected during the microinjection experiments. Microperfusion of pertubular capillaries failed to demonstrate urinary precession of 3H-gentamicin over 14C-inulin, a finding which argues against a rapid transtubular secretory flux of gentamicin. Significant uptake of gentamicin was demonstrated by renal cortical slices incubated in medium containing 14C-gentamicin. The accumulation of 14C-gentamicin by renal cortical slices was not inhibited by probenecid or N1-methylnicotinamide but was inhibited by netilmicin and tobramycin. These data support the conclusion that the renal accumulation of gentamicin reflects transport of gentamicin across both the apical and basolateral membranes of proximal tubular epithelium.


Relationship between lactate and glutamine metabolism in vitro by the kidney: differences between dog and rat and importance of alanine synthesis in the dog. Interaction between lactate (1 or 5 mM) and glutamine (1 or 5 mM) metabolism was studied with renal cortical slices incubated at a pH of 7.0 and obtained from acidotic (ammonium chloride) dogs and rats. The effect of aminooxyacetate (0.2 mM), dichloroacetate (3 mM), and fluoroacetate (0.05 mM) was also studied. Significant differences were observed between dog and rat. In the dog, lactate had no effect on glutamine uptake and vice versa, but gluconeogenesis increased. Ammonia production, however, decreased by 13 to 21%, whereas a significant increase in alanine production was noted. In the rat, glutamine extraction and ammonia production dropped by 33% with 5 mM lactate. In contrast to the observation in the dog, no production of alanine was noted, but significant accumulation of glutamate took place. Amino-oxyacetate inhibited alanine production in the dog and reestablished ammoniagenesis, and it led to a marked decrement in the uptake of lactate and glucose production in both species. Dichloroacetate in the dog resulted in a reduction in pyruvate, alanine, glucose, and ammonia production while glutamate accumulation was observed. In both species, fluoroacetate stimulated glutamine uptake and ammonia production. With lactate alone, fluoroacetate decreased lactate uptake and glucose production. With both lactate and glutamine in the medium, fluoroacetate prevented any effect of lactate on ammoniagenesis. The present study demonstrates that lactate has a modest depressing effect on renal ammonia production by dog slices through increased synthesis of alanine and redistribution of nitrogen from glutamine. In the rat, the depressing effect of lactate on ammonia production in the alanine amino-transferase deficient kidney occurs through accumulation of glutamate. The data also reveal that oxidation of lactate to carbon dioxide is greater in the dog than it is in the rat, but that gluconeogenesis from lactate is more important in the rat.


Peritoneal clearance of creatinine and inulin during dialysis in dogs: effect of splanchnic vasodilators. The peritoneal clearance of creatinine and inulin during isotonic peritoneal dialysis was studied in dogs before and after the administration of two vasodilators: isoproterenol and glucagon. One-liter exchanges with 15-min dwell times were used. Blood flow in the superior mesenteric artery was recorded with an electromagnetic flow probe and used as an index for total splanchnic flow. Intravenous isoproterenol (2.4 microgram/min) increased blood flow by 88%, but did not alter peritoneal clearance. When isoproterenol was given i.p. (0.5 microgram/ml dialysis fluid), blood flow increased by 81%, and inulin clearance rose by 26.8% (2.06 +/- 0.18 to 2.61 +/- 0.23 ml/min; P less than 0.05). Creatinine clearance increased by 17.5%, from 10.94 +/- 0.32 to 12.85 +/- 0.34 ml/min (P less than 0.05). When blood flow was returned to control levels with a clamp, clearances also returned to control levels. Glucagon given i.p. (1.0 microgram/ml) had no effect on any measured variable. Glucagon given i.v. at 10 microgram/min caused blood flow to rise by 81% and inulin clearance to rise by 25% from 1.88 +/- 0.16 to 2.35 +/- 0.19 ml/min (P less than 0.05). Cp, inulin clearance remained at control levels. Vasodilators seem to exercise two effects in augmenting clearance of small and middle-sized molecules: a direct permeability effect and a blood-flow related effect, possibly in increasing the surface area available for exchange and/or increasing permeability of the capillary endothelium.


Distribution and density of the canine renal cortical lymphatic system. The pattern, distribution, and extent of the lymphatic circulation in the canine renal cortex was studied with light and electron microscopy, in two groups of animals, one with and one without ipsilateral ureteric obstruction for 3 days. Recognition of lymphatics in tissue sections was facilitated by mild dilatation, induced in both groups by ligation of the renal collecting vessels for 4 to 6 hours, and by retrograde injection of tracer in a third group. Of 77 lymphatics present in 180 blocks from six kidneys, approximately one third were intralobular, the remainder being primarily associated with interlobular blood vessels. The cross-sectional area of interlobular lymphatics was almost twice that of intralobular lymphatics. The relationships of these lymphatics were analyzed quantitatively. Intralobular lymphatics had primary relationships with terminal arteries, arterioles, renal corpuscles, and tubular elements. Both inter- and intralobular lymphatics had secondary relationships with a small proportion of all components of the cortical parenchyma including juxtaglomerular complexes. The most common association was between lymphatics and elements of the vascular tree. Morphometric analysis was used to obtain volume density data on the composition of the renal cortex. The volume density of lymphatics was 0.0026 in ureter-obstructed kidneys and 0.0017 in nonobstructed kidneys. The cross-sectional surface area of lymphatics in ureter-obstructed kidneys was significantly larger than those in nonobstructed kidneys. The volume density of other cortical components was found to be in good agreement with published data. From the volume density data, it was concluded that the volume of lymph in the renal cortex, under conditions of mild lymphatic dilatation, was about 1% that of the volume of blood in the cortical peritubular capillaries.


Bacterial and endotoxin permeability of hemodialysis membranes. Dialysis fluids containing at least 10(7) bacteria per milliliter and as much as 12,500 ng of endotoxin equivalents per milliliter were dialyzed and ultrafiltered with three types of disposable hemodialyzers. Neither bacteria nor endotoxin, as measured by the Limulus lysate assay, was detected in the sterile compartment despite ultrafiltration. Under these favorable conditions for endotoxin transfer, the maximum transfer rate was calculated to be less than 3.5 ng of endotoxin equivalents per hour. At this rate, it is unlikely that pyrexia during hemodialysis is due to the transfer of endotoxin across an intact dialyzing membrane. Provided that the integrity of the dialyzing membrane is maintained, this investigation indicates that the risk of endotoxemia or bacteremia associated with the use of contaminated dialysis fluids is negligible.


Glomerular microfibrils in renal disease: a comparative electron microscopic study. Microfibrils are a common component of connective tissue that have been described only rarely in the renal glomerulus. Structurally, microfibrils are fibrotubules with an average diameter of 12 nm, a lucid core, and a dark periphery. High resolution electron microscopy, including stereo microscopy performed on renal biopsy tissues, demonstrated the presence of microfibrils under the endothelium of the capillary walls and in the mesangium in several glomerular diseases. These diseases were characterized by widening of lamina rara interna or separation of the endothelium from the basement membrane, among them transplant glomerulopathy, focal segmental glomerulosclerosis (including a case associated with Marfan syndrome), preeclamptic toxemia, and less frequently hemolytic-uremic syndrome and malignant hypertension. The number of microfibrils generally correlated with the degree of subendothelial widening.


Preventing hemorrhage in high-risk hemodialysis: regional versus low-dose heparin. Hemodialysis in patients with increased risk for hemorrhage can be accomplished with either a regional or a low, total dose of heparin. In a prospective study of 69 series of dialyses performed on an alternating schedule of heparinization for each patient, bleeding complications during and immediately following dialysis occurred in 23 of 122 dialyses (19%) with regional heparin compared to 13 of 133 dialyses (10%) with low-dose heparin (P less than 0.05). The incidence of hemorrhage correlated with the estimated degree of bleeding risk both at expected and at occult bleeding sites, and was the same or higher with regional heparin in all categories. Hemorrhage was not correlated with preexisting coagulation abnormalities, concurrent anticoagulant drugs, level of azotemia, or ability to successfully limit systemic heparinization during dialysis. The incidence of partial clotting of the dialyzer was 3 to 5% with both heparin protocols. We conclude that regional heparinization has no clinical or practical advantage over low-total-dose heparin in preventing bleeding associated with hemodialysis.


Relationship between serum albumin concentration and tubular reabsorption of glucose in renal disease. Micropuncture studies in rats and dogs have provided evidence for a cause-and-effect relationship between peritubular protein concentration and proximal tubular reabsorption (PTR). If this effect is obtained in man, hypoalbuminemia in nephrotic syndrome should lead to a fall in PTR. Sodium excretion, however, is very low in nephrotic patients; but this sodium retention may be due to distal over-reabsorption. Glucose may be used as a marker of PTR. Because of the linkage between glucose and sodium, glucose reabsorption is expected to be suppressed when PTR of sodium is suppressed. Glucose titration studies were performed in 21 patients with chronic glomerulonephritis without renal failure divided in three groups: I (six patients) with serum albumin greater than 3 g/100 ml; II (five patients) with serum albumin of 2 to 3 g/100 ml; and III (10 patients with edema and nephrotic syndrome) with serum albumin less than 2 g/100 ml. The minimum threshold for glucose decreased in nephrotic patients (group III), and its fall was related directly to hypoalbuminemia. The splay of titration curve was markedly increased in group III when compared to the titration curves of patients without nephrotic syndrome (groups I and II). The splay point was 0.78 in group I, 0.52 in group II, and 0.37 in group III. These data provide evidence that glucose reabsorption is decreased in nephrotic syndrome and are consistent with a fall in PTR in nephrotic syndrome.


Evidence that resistance to the calcemic action of parathyroid hormone in rats with acute uremia is caused by phosphate retention. An animal model was developed to examine the cause of resistance to the calcemic action of PTH in renal failure. Thyroparathyroidectomized (TPTX) rats were repeatedly reinfused with their excreted urine, over a 5-hour period, to produce an acute uremic animal with normal kidneys. Nonuremic controls were infused with equivalent volumes of a simple electrolyte solution. Using this model, we have demonstrated impaired calcemic response to PTH (Lilly Parathyroid Extract, 80 U/100 g) in urine-infused rats compared with electrolyte-infused rats. The final plasma calcium concentrations were 12.0 +/- 0.3 and 14.9 +/- 0.3 mg/dl, respectively (P less than 0.001). The cause of this impaired calcemic response was investigated by reinfusing rats with their own urine that had been pretreated with either activated charcoal or zirconium oxide in two different anionic forms, or urine that had been ultrafiltrated through an Amicon membrane of which the stated molecular-weight cut-off of the smallest pore-size membrane was 500 daltons. It was found that charcoal and ultrafiltration techniques had no effect, whereas the zirconium oxide treatment completely corrected the impaired calcemic response and returned the plasma phosphorus to a concentration similar to that in nonuremic controls. This can be explained by the fact that the principal effect of zirconium oxide on urine is to remove inorganic phosphate. Other groups of TPTX rats given PTH extract were infused with an electrolyte solution containing varying amounts of phosphate up to a maximum similar to the amount that a urine-infused rat would receive. A highly significant inverse relationship was found between the dose of phosphate infused with the electrolyte solution and the measured calcemic response to PTH. This relationship is represented by the following equation: calcium (mg/dl) = 14.84 - 0.139 inorganic phosphate; r = 0.915, P less than 0.001. From these series of studies, we conclude that phosphate retention is the cause of resistance to the calcemic action of PTH extract in this acute uremic model.


A micropuncture study of renal sodium retention in nephrotic syndrome in rats: evidence for increased resistance to tubular fluid flow. Micropuncture studies were carried out in surface nephrons of rats with nephrotoxic-serum (NTS)-induced nephrotic syndrome during a period of active sodium and water retention. It was found that hydrostatic pressure and tubular diameter were increased in the proximal tubules (13.4 +/- 0.2 vs. 10.4 +/- 0.2 mm Hg; 31.3 +/- 0.9 vs. 18.4 +/- 0.7 mu), whereas pressure and tubular diameter were normal in the distal tubules. Single nephron glomerular filtration rate (SNGFR) was decreased and fractional reabsorption of fluid was markedly increased in the proximal tubules (74.1 vs. 61.7%). The increased pressure gradient between the proximal and distal tubules suggests a condition of increased resistance to flow between the proximal and distal tubules. Microinfusion of proximal tubules with an isotonic "equilibrium" solution led to little or no rise in intratubular pressure in normal rats but it led to a significant rise in nephrotic rats. When proximal tubules of normal rats were infused with a solution containing 100 mg/100 ml albumin, pressure rose to levels observed in nephrotic rats. The mechanism of the increased resistance to flow appeared to be related, therfore, to the presence of protein in the tubular fluid. Sodium retention in the nephrotic animals might be attributed to the reduction in GFR. In other types of renal disease in animals and man with comparable or greater reductions in GFR, sodium retention does not occur, however, and fractional excretion of sodium in the urine is increased in proportion to the reduction in GFR. Thus, the rise in proximal fractional reabsorption secondary to impaired fluid flow could be an important factor in the sodium retention of this disease.


Renal transport of oxalate: effects of diuretics, uric acid, and calcium. Clearance experiments were performed in the rat to examine the effects of diuretics on the renal transport of oxalate. In addition, the effect of infusing either uric acid or calcium on the renal transport of oxalate was examined. During control periods, the fractional excretion of oxalate (FEOx) averaged 118.0 +/- 2.1%. Acute administration of either chlorothiazide, furosemide, or indanyl-oxyacetic acid (MK-196), a new uricosuric diuretic, resulted in a significant decrease in the FEOx in all groups to 104.8 +/- 2.4%, 111.3 +/- 2.1%, and 108.6 +/- 2.7%, respectively. Infusion of uric acid increased urinary uric acid excretion from 2.41 +/- 0.28 to 4.26 +/- 0.03 micrograms/min/g kidney wt (P less than 0.001) and decreased FEOx to 104.0 +/- 2.4% (P less than 0.001 compared to control). Infusion of calcium chloride increased urinary calcium excretion from 0.10 +/- 0.04 to 0.44 +/- 0.06 micrograms/min/g kidney wt (P less than 0.001) but had no effect on the FEOx which averaged 118.3 +/- 8.3% (P = NS compared to control). These studies show that the acute administration of chlorothiazide, furosemide, or MK-196, as well as increasing urinary uric acid excretion by uric acid infusion, are all associated with a decrease in the FEOx. Acutely increasing urinary calcium excretion, however, had no effect on oxalate transport.


Regional membrane specialization in the thin limbs of Henle's loops as seen by freeze-fracture electron microscopy. Rat thin limbs of Henle were studied by freeze-fracture electron microscopy. Thin limb segments in both short- and long-looped nephrons were identified by previously developed ultrastructural criteria, continuity with known thick segments, and architectural relationships in the outer medulla. Intramembrane particle (IMP) density and the number of intramembrane fibrils comprising the zonula occludens were determined for each morphologically identifiable thin limb segment. The IMP density on the protoplasmic faces of both the luminal and abluminal membranes of the upper portion of the descending thin limb (DTL) of the long-looped nephron is quantitatively greater than in the short-looped thin limb, lower portion of the long-looped DTL, and in the ascending thin limb. The zonulae occludens in the long-looped upper DTL consists of a single fibril; the long-looped lower DTL contains 3.13 +/- 0.14 fibrils; the ascending thin limb contains 1.31 +/- 0.09 fibrils; and the short-looped DTL contains 3.75 +/- 0.19 fibrils. These studies further support the contention that there is anatomic heterogeneity among the thin limb segments. Because direct physiologic studies in the thin limbs are incomplete and conflicting, the need for correlative physiologic studies on anatomically characterized structures is indicated.


Ischemic heart disease in patients with uremia undergoing maintenance hemodialysis. The 6-year cumulative incidence of ischemic heart disease (IHD) in 382 dialysis patients (mean age [SEM], 43 +/- 0.7 years) was studied. Of 101 patients with IHD, only 39 developed symptoms following dialysis (cumulative incidence, 20.8%). This group was older than those with IHD, and in 55%, IHD occurred in the first year of dialysis. Analysis by sex and race showed the rate of IHD in men and women to be similar, but the rate in whites was twice that in blacks. In men, the rate was not different from nondialysis men with similar coronary risk factors, whereas in dialysis women, the rate was twice that of nondialysis cohort. The development of IHD did not adversely affect long-term survival in patients without prior evidence of IHD. Death from myocardial infarction occurred in 3 of 320 patients ar risk. Atuopsy data in 33 patients revealed 70% stenosis of coronary arteries in 7, 4 of whom had antecedent disease. Our major conclusions are (a) the incidence of IHD during dialysis was not different from similarly matched nondialysis subjects; (b) the rate of IHD in dialysis women was greater than it was in nondialysis subjects; (c) coronary artery disease only affected long-term survival of patients with preexisting disease; (d) autopsy data did not suggest accelerated atherosclerosis.


Follow-up of peritoneal clearances in patients undergoing continuous ambulatory peritoneal dialysis. Continuous ambulatory peritoneal dialysis (CAPD) might result in peritoneal membrane changes. First, CAPD exposes essentially continuously the peritoneum to peritoneal dialysis solutions. Such solutions differ from the usual extracellular fluid bathing peritoneal tissues. Second, this technique may be complicated by an increased frequency of peritonitis when compared to intermittent peritoneal dialysis. We undertook a prospective study of patients undergoing CAPD to determine if there were decreases in peritoneal clearances and if the peritoneal microcirculation maintained its responsiveness to nitroprusside. Peritoneal transport, as assessed by the clearances of urea, creatinine, inulin, and dialysate protein concentration, with and without nitroprusside addition in the dialysis solution, is unchanged in patients undergoing CAPD for up to 1 year, despite frequent episodes of peritonitis.


Renal stone epidemiology: a 25-year study in Rochester, Minnesota. There are no adequate studies of the incidence of urolithiasis in the United States, in spite of earlier claims that a "stone belt" exists in the southeastern section of the country. This report is the first description of the incidence and recurrence rates for symptomatic noninfected renal stones in a well-defined population. A total of 798 patients were enrolled in the study group, of whom 672 were incidence cases having had their first episode as documented residents of Rochester, Minnesota, between 1950 and the end of 1974. The annual age-adjusted incidence rate for females was stable over the 25-year study period at 36.0 per 100,000 population. That for males increased significantly (P less than 0.02) from 78.5 per 100,000 to 123.6 per 100,000. Recurrence calculations showed a high rate for both sexes in the first year, followed by lower but constant rates for all succeeding years.


Effect of renal vein constriction on the localization of immune complexes in the kidney. To determine the effect of renal venous constriction on the localization of immune complexes in the kidney, we performed unilateral renal venous constriction in 19 male albino rabbits 7 days after they were given an i.v. bolus (250 mg/kg) of bovine serum albumin (BSA) to induce the development of serum sickness nephritis. The rabbits were sacrificed on day 12 after BSA administration. Renal histology was evaluated by (1) light microscopy, with semiquantitative grading and enumeration of glomerular nuclei and (2) fluorescent microscopy. Six rabbits were nonresponders and did not exhibit nephritis. The remaining 13 rabbits had differential degrees of severity of nephritis between the control and experimental kidneys as assessed by light microscopy (in 7 rabbits) and by fluorescent microscopy (in 12 and 9 rabbits when examined for deposits of IgG and C3, respectively). In all instances, the experimental kidney (with the constricted vein) showed less severe alterations. The degree of protection appeared to correlate with the degree of renal venous constriction, as manifested by tubulointerstitial changes [rs = 0.77, P less than 0.01). We concluded that renal venous constriction exercises a protective effect on the impaction of immune complexes in the glomeruli and development of acute serum sickness nephritis.


Suppression of potassium-recycling in the renal medulla by short-term potassium deprivation. Recently we proposed that potassium, like urea, normally undergoes medullary recycling from collecting tubule to the pars recta or descending limb of the juxtamedullary nephron and suggested that the extent of recycling is a function of the concentration of potassium in collecting tubule fluid. To test this hypothesis further, we fed young rats a potassium-free diet for 3 days and then prepared them for micropuncture of the left renal papilla. Compared to findings in normally fed animals, potassium deprivation caused a significant fall in plasma potassium and urinary excretion of potassium. There was a striking decrease in the fraction of filtered potassium remaining at the end of the justamedullary descending limb for 94 +/- 11% to 38 +/- 3% (P less than 0.001). The latter value is not significantly different from the fraction of filtered sodium remaining (36 +/- 4%) and suggests that net addition of potassium to the pars recta or descending limb was completely abolished. A correlation was observed between the fraction of filtered potassium remaining at the end of the descending limb and either urinary potassium excretion (P less than 0.001) or urinary potassium concentration(P less than 0.001) in the contralateral unexposed kidney. These results lend further support to the hypothesis of medullary recycling of potassium.


Urinary matrix calculi consisting of microfibrillar protein in patients on maintenance hemodialysis. In seven patients on maintenance hemodialysis, de novo recurrent renal stone formation was observed. In all patients, the underlying disease was glomerulonephritis, with or without the nephrotic syndrome. All patients had considerable persistent proteinuria. The stones consisted predominantly of protein, as revealed by amino acid analysis, and had a negligible carbohydrate and lipid content. Only in some specimens, X-ray diffraction and scanning electron microscopy revealed the presence of small amounts of whewellit (calcium oxalate monohydrate) and/or uric acid. In semithin sections, the stones had a laminated texture and exhibited structural anisotropy under polarized light. With transmission electron microscopy, they were found to consist of peculair microfibrils. The proteinaceous material differed from fibrin or Tamm-Horsfall-protein, as indicated by ultrastructure, carbohydrate analysis, and amino acid analysis. Symptomatic de novo matrix stone formation constitutes another complication of dialyzed patients which has not been reported so far.


Influence of the emetic reflex on vasopressin release in man. The mechanisms underlying the frequent association of nausea and vomiting with elevations of plasma vasopressin(PAVP) were studied in man and rat. After oral water loads (N = 16), plasma osmolality fell in all human subjects and was associated with a decline in PAVP in 14 asymptomatic human subjects. In 2 human subjects, nausea occurred and was associated with increases in PAVP, without changes in blood pressure. During ethanol infusion (N = 28), PAVP was suppressed unless nausea supervened. In 4 nauseated human subjects, PAVP escaped from ethanol inhibition and rose to levels 10 times basal, despite the absence of hemodynamic changes. Apomorphine, a potent dopamine agonist and emetic agent, was administered to human volunteers in doses of 7 to 24 microgram/kg. There was no increase in PAVP in 3 human subjects who remained asymptomatic (7 to 16 microgram/kg). Ten human subjects experienced nausea after 16 microgram/kg, which was followed shortly by marked increases in PAVP. Emesis occurred in 5 human subjects given 16 to 24 microgram/kg, and was followed by PAVP levels similar to those seen with nausea alone. In 7 human subjects from the nausea group, the repeat study (16 microgram/kg) after pretreatment with dopamine antagonist (haloperidol, N = 4; fluphenazine, N = 3) resulted in complete blockage of apomorphine-induced AVP release. In rats, which lack an emetic reflex, apomorphine doses of 200 microgram/kg induced only slight increases in PAVP when compared to the response to 16 microgram/kg in man. These studies indicate that stimulation of the emetic reflex results in AVP-release in man. Nausea-mediated AVP release supervenes over concomitant osmolar or pharmacologic (ethanol) inhibition.


Polypoid and papillary epithelial hyperplasia: a potential cause of ductal obstruction in adult polycystic disease. In experimental models of cystic renal disease, functional studies define conditions that suggest increased resistance to outflow from dilated or cystic nephrons. Morphologically, models exhibit foci of cellular hyperplasia and micropolyp formation along outer medullary collecting tubules. Temporally, cellular proliferation precedes cyst formation. These findings in models have led to a hypothesis that polypoid hyperplasia participates in cyst formation in susceptible kidneys by increasing resistance to the outflow of tubular urine. The present study was undertaken to establish the presence, extent, and distribution of cellular hyperplasia in human adult polycystic kidney disease. Kidneys from four unrelated individuals were studied by light and by transmission and scanning electron microscopy. Foci of hocation of hyperplasia along the nephron were similar to those seen in the models. These findings delineate a heretofore unappreciated morphologic similarity between the models and human disease and add further support to the hypothesis that partial rubular obstruction participates in the pathogenesis of renal cystic disease, whether it be heritable or acquired, in animals and in man.


[Trophic corneal diseases. Their pathogenesis and corneal nutrition (author's transl)]. Experimental research has not provided any proof that "trophic" corneal diseases are caused by nutritional deficiencies. It seems that cases in which the course is chronic, but characterized by an absence of exacerbations of great pain and failure of medical therapy, are said to be trophic. Some of these diseases are dry eye conditions. Sensory disturbances lead to corneal complications by lowering the blinking frequency, but not seem to interfere with nutrition of the tissue. Otherwise keratoplasty would be impossible, since the innervation of the graft is often impaired for months or even years.


[Microscopically controlled excision of malignant eyelid tumors and subsequent reconstruction (author's transl)]. 35 patients, most of whom had recurrent or large malignant eyelid tumors (33 basal cell carcinomas and 2 squamous cell carcinomas), underwent microscopically controlled excision (Mohs' fresh tissue technique). This approach guarantees a complete removal of the tumor, while conserving as much healthy tissue as possible. Short time follow-up studies have shown that plastic reconstruction gave good functional and cosmetic results.


[Bulbus motility in early and late surgery of orbital floor fractures (author's transl)]. Among 638 patients with fractures of the middle third of the facial skeleton 139 were found to have clinically relevant fractures of the orbital floor. 74 of them were followed up ophthalmologically and by x-ray examination. In 49 patients the results of the operative treatment were judged from a detailed questionnaire. Operation within 2 weeks after the accident yielded better results than later operation. Persisting motility disturbances concerned mainly the upper field of gaze.


[Functional results following implantation of artificial lenses (author's transl)]. Between 1969 and 1979 626 Binkhorst artificial lenses have been implanted, 20 after extracapsular cataract extraction. Functional considerations relating to the indication for implantation are discussed in detail. Visual field and binocular vision in particular are superior in patients with lens implants. In addition, some details are given of surgical methods we have recently adopted.


[Herpes simplex virus isolations from the aqueous humor of patients suffering from focal iritis, endotheliitis, and prolonged disciform keratitis with glaucoma (author's transl)]. Aqueous humor from 33 herpes patients, 4 zoster patients, and 14 patients with etiologically unclear anterior uveitis was cultured for the presence of herpes viruses. Nine taps from 8 herpes patients with corneal endothelial disease and/or anterior uveitis yielded herpes simplex virus. In the case of one patient two taps were positive at 14 days' interval. Control cultures from the surface of conjunctiva and cornea were consistently virus-negative. Analysis of the virus-positive cases displayed three remarkable features: 1. Secondary glaucoma was uniformly present. This in itself is an indication for culturable herpes simplex virus in the aqueous. 2. Three clinical pictures could be differentiated biomicroscopically: focal iritis, peripheral endotheliitis, and prolonged disciform keratitis. 3. In a proportion of cases, tissue damage resulting from associated immune reactions seems to be more important for the functional outcome than tissue damage by viral cytolysis itself. After having tried several antiviral substances (trifluorothymidine topically, adeninearabinoside-monophosphate intravenously, human leukocyte interferon intramuscularly and intracamerally) we presently favour a topical combination therapy consisting of trifluorothymidine and steroids. This must be complemented by cycloplegics and--in cases of high intraocular pressure--by acetazolamide.


[Detection of HBsAg and HBeAg in cleaning, rinsing and storage solutions of contact lenses and in tear fluid of carriers of HBsAg (author's transl)]. Hepatitis-B-surface antigen (HBsAg) was not detected by sensitive radioimmunoassays in the tear fluids of 6 HBsAg carriers with low and medium titers of HBsAg (less than 1:10,000) in the serum. However, HBsAg could be demonstrated in low concentrations in tear fluids of 5 of 6 HBsAg carriers with high serum titers (greater than 1:10,000). The concentration of HBsAg in the tear fluid was at least 100 times lower than in the sera of these 5 persons. Correspondingly HBsAg could be found in only 1 of the rinsing and in none of the storage solutions of the contact lenses of 7 persons with high titers of HBsAg in the serum (greater than 1:32,000). HBsAg was not adsorbed to smooth HEMA-lenses. Because of the low concentration of HBsAg in tear fluids and the dilution effect (about 5 x 10(-10)) the transmission of hepatitis B by multiple use of contact lenses by several persons during adaption is lighly unlikely. In addition, a special cleaning solution (Liprofin) can destroy nearly completely the antigenicity of HBsAg at 60 degrees C.


[Vascular anastomoses at the posterior pole of the eye (author's transl)]. Anastomoses between vessels of the fundus may occur as congenital malformations or secondary to vascular diseases affecting the eye. Congenital anastomoses can be of the racemose hemangioma type, with severe malformation of the retinal vessels, ocular complications, and neurologic manifestations, or as simple A-V shunts with visual impairment but limited tendency to show other ocular or neurologic involvement. These anastomoses must be distinguished from other vascular malformations like telangiectasis (Leber, Coats) or the angiomatous lesions of von Hippel's disease. Secondary anastomoses may be confined to the retinal vessels or involve chorioretinal connections. Retinal anastomoses occur in vascular disorders like retinal vein occlusions, diabetes, periphlebitis and hemoglobinopathies. They are often amenable to treatment by light coagulation. Chorioretinal anastomoses occur whenever Bruch's membrane is destroyed by traumatic, inflammatory, degenerative or physical (light coagulation) influences. Light coagulation may be the appropriate treatment, although complications are not rare.


[Influence of an unilateral anophthalmos on the ophthalmo-dynamography (author's transl)]. In 30 patients with unilateral postoperative anophthalmos, by means of the ophthalmodynamograph model ODG 22 (Boucke) a bilateral ophthalmodynamography (Hager) was performed. The systolic and diastolic pressure of the ophthalmic artery showed no significant difference between the sides without and with the eyeball. The pulsation volume was, however, on the side of anophthalmos (97.9 mm3 in average) slightly, but significantly (p less than 0.05) decreased than the opposite side (103.7 mm3).


[Cresol burns in the eye (author's transl)]. A brief introduction to the pathomechanism of erosions in the eye is followed by a case report of a young soldier injured by a "peptizer" (2-methoxy-4-methylphenol). After early application of cortisone there was no cicatrization impairing function in the central corneal stroma. A row of small vesicles at the corneal limbus and in the conjunctiva were reminiscent of Labrador corneal dystrophy.


[Conjunctival myxomas (author's transl)]. Myxomas are rare mesenchymal tumors appear everywhere in the body, but occur very seldom in orbital or subconjunctival regions. Clinical and histopathological demonstration of two cases of epibulbar myxoma and discussion of possible pathogenetic mechanisms.


[Can local anaesthesia still be justified in intraocular surgery? (author's transl)]. Even modern long acting local anaesthetics can not avoid hazards encountered by using local anaesthetics. That these hazards are unavoidable by their nature is being shown by detailed analysis of facts conditioning the status of corpus vitreous on the open globe. These facts need not be identical with those that change the intraocular pressure in the closed eye. Intraocular pressure is no useful criterium when the eye is open. General anaesthesia in NLA and non depolarizing agents is presently the safest means not to leave corpus protruding facts to chance. There are no other disadvantages of the method as compared to local anaesthesia. Own experience in 2000 cataract operations confirm the thesis.


[Professional discretion in cases of unfitness to drive due to impaired vision (author's transl)]. The question of professional discretion is discussed in relation to cases where the physician believes that the patient's visual impairment renders him unfit to drive. It is often difficult for the ophthalmologist to make a valid judgment. Since physicians are not bound to report such cases to the traffic authorities or to third persons, any assumption of responsibility in making a statement, either without the patient's knowledge or against his will, is an infringement of professional secrecy. Article 34 of the (West German) Penal Code makes provision for "justified" disclosures. There is also a relevant verdict of the German Federal Supreme Court dated Oct. 8, 1968, case ref. VIZR 168/67, which deals with basic considerations. However, it is advisable in each case to consult the legal adviser of the responsible Medical Council prior to making any disclosure in order to establish whether it is justified.


[Silicon plug for retinal surgery (author's transl)]. For some time now a 7.5 mm wide plug made of hard silicon, with a grooved surface to facilitate fixing the thread, has been used in the surgery of retinal foramina to indent the bulbus. The plug has not caused any complications so far.