[Use of the CO2 laser in the treatment of burn injuries]. In the treatment of burn injuries the CO2-Laser has meanwhile proved to be an effective cutting-instrument as well as the Bowie-Knife. A trial-study was carried out in which the necroses were excised simultaneously with the Laser on one side of the body and with the Bowie-Knife on the other. Comparisons were made between blood-loss, time used for escharotomie, injury to the wound bed and post-operative healing of the autograft 4 and 8 days later. The results of the parameter showed that with the Laser there was a reduction in blood-loss of 50% compared with the Bowie-Knife. On the other hand the total operating-time was 1/3 longer, including the time necessary for hemostasis to take place. The blood-loss was measured with a Blood-Loss-Perometer and the result was converted according to the extent of the burned surface area. Histology showed less trauma of the wound bed compared with the Bowie-Knife, rare hemorrhages and inflammatory reactions in Laser so that healing of the autograft proceeded without complications.


[Plastic operations in facial paralysis]. From 1972 to 1977 we operated on 40 patients with complete or incomplete facial palsy. There were only such cases in which a spontaneous or operative reinnervation could not be expected. Anamneses between appearance of the facial palsy and its operation was 11,8 years on an average. Different substitute operations for aesthetic and functional improvement were applied. Only a combination of different operation methods leaded to a satisfying result.


[Transsexualism: indication and surgical treatment]. After the diagnosis of transsexuality is well definated and recognized in most western countries, the surgical transformation of the genital area is performed. Before surgical treatment an exact psychiatric clarification is absolutely essential. The operation is the last part of a long treatment. The surgical result in the more common female transsexual is quite reasonable. The treatment of the fewer male transsexuals is not solved completely, especially the reliable techniques for penis reconstructions are not very sufficient.


[The importance of Simon's symptom in cases of hanging (author's transl)]. Radiological and patho-anatomical investigations of the spines of 32 corpses of persons who had committed suicide by hanging revealed spine damage in 81% of the cases. The cervical spine was damaged in 69%, the lumbar spine in 56% of the cases. The typical damage of the cervical spine is a loosening of the discs at the dorsal side, usually at the level of C 4/5 to C 6/7. In the region of the lumbar spine, bleeding between the (anterior) ventral ligament and the discs is the most frequently observed damage (Simon's sy;mtpom). Simon bleeding is brought about by traction force and is not dependent on the age at death or on any existing degenerative changes of the spine.


[The significance of blocked arteries in the pathogenesis of hemorrhages and of minor hemorrhagic infarctions in the human lung in fat embolism (author's transl)]. The significance of blocked arteries with regard to minor hemorrhagic infarctions in the lung in venous and systemic fat embolism is discussed. In an experiment it is proved that blood in the anastomoses between the arteria bronchialis and arteria pulmonalis (blocked arteries) contains fat emboli. It is suggested that these fat emboli may in addition be transported into an area of the lung, which is no longer functional following embolic occlusion of a branch of the arteria pulmonalis.


[Detection of diatoms in bone marrow (femur) of nondrowned (author's transl)]. Diatoms in the bone marrow (femur) of 16 nondrowned bodies were detected by a modern method of ultrafiltration. The rate of diatoms were found to be in the same range as in cases of drowning. The results deny the proof of diatoms even in bone marrow to be useful any longer for the diagnosis of death from drowning.


[Lethal intoxication by acebutolol (author's transl)]. Report on suicidal intoxication by acebutolol (prent). Thin-layer and gas chromatography as well as spectrophotometry were used to show the presence of and to determine acebutolol and its aniline derivative arising from hydrolysis in all tissues. The highest concentrations were found in urine and liver.


[Postoperative urine transport disorders after supravesical urinary diversion]. By means of the intravenous urography we controlled the behaviour of the deriving urinary tracts after supravesical deviation of the urine using the intestine. In 70 patients 131 uretero-enterostomies were evaluated. The urogram pictures made postoperatively in different time intervals independent upon the intestinal segment used and upon the operation technique revealed after 4 weeks in 85.4% of the cases a clear disturbance of the transport of urine, partly up to the full picture of retention kidney. Under application of antibiotics and prednisolone these pathophysiological changes significantly receded. After 24 weeks the percentage decreased to 12.2.


[Kidney lesion from phenacetin].

[Kidney lesion from phenacetin]. After a short survey of the most important toxical lesions of the human organism by phenacetin a report is given on a 65-year-old female patient. An abuse of phenacetin lasting 20 years (calculated total quantity: more than 1 kg) led to a lesion of the kidney and rejection of the papilla. The anamnesis confirms the frequently thoughtless prescription of phenacetin-containing medicaments and emphasizes their sequelae. By a clarifying talk with the appreciative patient the abuse of phenacetin could be finished.


[Surgical treatment of plastic induration of the penis]. In a period of two years 16 patients with induration penis plastica were observed; 11 needed treatment. The therapy was performed according to the degree of severity with vitamin E or local injections of hyaluronidase-dexamethasone. When the conservative therapy failed the foci were removed by operation and the defect was covered by lyophilised dura. The results are rather encouraging. Disturbances of the erection could not be observed. In selected cases of successless conservative therapy the excision with covering of the dura seems to represent an accessible alternative.


[Comparison between ambulatory or stationary treatment systems for patients with rhematoid arthritis with reference to the development of the family situation]. The evaluation of a detailed questionaire which was issued to 44 German female rheumatoid arthritis patients (family mothers) who underwent "Kur" treatment courses and a comparable group of Dutch patients who had ambulatory treatment only shows little advantage to the "Kur" system). The "Kur" patients had adjusted somewhat better to their illness and had retained more easily the extra-familial social contacts. In contrast, statistically significant advantages were clearly evident in the Dutch ambulatory treatment programm: 1. Over-all reduction in "feeling ill" 2. Reduced stress in association with the objectively reduced joint mobility 3. Reduced stress in association with pain 4. The support of the patient by immediate family members and other relatives is generally better 5. Better patient support possibilities by family friends 6. Reduced negative effects on family life 7. Reduced disruptive effects in relationships between the patients and their husbands and children 8. Higher degree of satisfaction with physicians and the treatment. Even if national behavioral differences are taken into consideration, the ambulatory system as practiced in Holland seems to hold significant advantages to the "Kur" system.


[Anesthesiological experiences in urologic interventions]. It is reported on anaesthesiological experiences of 6,043 general anaesthesias with in-patients during a period of 15 years in the Urological Clinic of Jena University. The narcoses of the years 1965 and 1976 are compared and the further development of the techniques of anaesthesia are described taking into consideration the urological specialities.


Synovial nature of pathologic periarticular structures, including subcutaneous nodules. descent from embryonic arthrogenic fibroblasts: a hypothesis. In the embryo the periarticular fibroblasts were the producers of the greater part of the joint they surround in later life, as well as of the tendon sheaths and bursae. It is postulated that adult fibroblasts have retained atavistic arthrogenic properties, and may react to traumatizing, inflammatory and oncogenic stimuli by forming periarticular joint-like structures: "arthromas" such as ganglia, meniscal cysts, synovial cysts, synovial sarcoma and subcutaneous nodules. The arthroid nature of these growths manifests itself by the presence of a central cavity, which can be identified as a synovial cavity by histologic, histochemical and electron-microscopic methods. In case of affection of the joint all of these adnexa may be involved. A resemblance of these structures to embryonic joint tissues has been noted for years. The nature of the subcutaneous nodule is discussed at some length. It may contain one or more synovial clefts; synovial elements may be found in its centre by histochemistry and electron-microscopy. Recent and personal findings shed a new light on palisading cells, which may be fibroblasts, having taken up again their embryonic task as synovioblasts. From periarticular fibroblasts thus three kinds of tumors may arise; benign (ganglia, cysts, subcutaneous nodules), malignant (synovial sarcoma) and "semi-malignant" (pannus in rheumatoid arthritis).


Efficacy and safety of piroxicam and indomethacin in the treatment of musculoskeletal disorders. A double blind comparative study. A total of 17 patients suffering from musculoskeletal disease were included in a double blind study to compare the efficacy and safety of piroxicam and indomethacin. Seven patients received a single dose of 30 mg piroxicam daily for two weeks, an eight patient stopped treatment after two days because of thrombocytopenia of unknown origin. Nine patients received 50 mg indomethacin tid for two weeks although treatment was interrupted for 2 days in one patient when a pulmonary embolus (unrelated to trial treatment) developed. Both treatment groups showed significant reductions in pain scores assessed by the patient from day 2 in the indomethacin group and day 6 in the piroxicam group. There were significant differences between the groups in favour of indomethacin at days 5, 8, 11, 12 and 13, although the groups were not well matched at baseline. Other efficacy measurements including the patient's and physician's overall assessments showed an improvement in some patients in each group, but there were no significant differences between the two groups. Side effects recorded as due to trial treatment occurred in one piroxicam and four indomethacin treated patients. Minor abnormalities in laboratory test results without clinical significance occurred in both groups. One piroxicam treated patient had a low platelet count prior to treatment and a subsequent reduction on day 3 requiring treatment to be stopped.


[Subtotal parathyroidectomy in the advanced stages of renal osteodystrophy]. In 7 haemodialysis patients with progressing renal osteopathy a partly subtotal, partly total parathyroidectomy was carried out. Postoperatively in all cases a clinical improvement developed, which, however, in part was only transient. The laboratory parameters showed a rapid tendency to normalisation, the X-ray diagnostic finding and the bone mineral content remained essentially unchanged, also the histological skeletal findings. The results are compiled in form of tables. The value of the diagnostic measures which should precede a subtotal parathyroidectomy is discussed. At present the different postoperative courses apparently cannot be prospectively estimated with the help of the hitherto usual diagnostic measures. On the basis of the partly good results and of the operation risk which is to be thoroughly demanded of a haemodialysis patient it seems that after having used all conservative possibilities the surgical interventions nevertheless indicated in progressing renal osteopathy.


[Hemofiltration of lysozyme in dialysis patients]. With the help of the haemofiltration on the capillary dialysator CDAK 4 the behaviour of lysozyme (muramidase) was investigated in 20 dialysis patients. In 6 of 55 cases a measurable lysozyme concentration in the haemofiltrate was found. A relation to the size of the serum lysozyme level could not be established. The influence of defective capillaries is discussed. Despite the in most cases not measurable lysozyme concentrations in the haemofiltrate a decrease of the serum lysozyme level taking place parallel to creatinine could be proved during dialysis. Examinations of the influence of the renal rest function in dialysis patients with a rest diuresis resulted in a lower lysozyme concentration in the serum than in patients with complete anuria. These findings allow conclusions to the behaviour of low-molecular proteins in the kidney of dialysis patients and to their losses on the dialysis membrane.


[Normurat (benzbromaron) in the treatment of gout]. The anti-hyperuricemic effect of a daily doses of 100 mg of the normurat (Benzbromaron) was studied in 25 patients with gout. This agent leads to a rapid decrease to normal values of the elevated serum uric acid level. Within one week of discontinuation of the drug the serum urate levels rose to the initial pathological value. For some of the patients it was possible to keep the uric acid level within the normal range by administration of 50 mg of Benzbromaron daily or 100 mg every second day. The tolerance of the preparation was good and during the 4--6 months' long therapeutic trial there were no severe side effects.


[An Austrian model of rehabilitation after severe traumata (author's transl)]. After a short survey of the Austrian Social Insurance System, provisions for the rehabilitation of accident victims as carried in Austria are briefly described. This description includes the medical and social aspects as well as the coordinated function of both components of rehabilitation. The question of prosthetic appliances as well as rehabilitation and special care for paraplegics is also dealt with. Future developments such as day-centres for rehabilitation and a possible departure from the causeoriented principle in legal accident-insurance are also briefly outlined in prospective.


[Special diagnosis and treatment in injuries of parenchymatous organs (author's transl)]. The parenchymatous organs are mostly involved in blunt abdominal trauma. Besides the physical examinations, the additional peritoneal lavage is emphasized as a diagnostic tool of great importance. The special diagnostic and surgical proceedings in injuries of spleen, liver and pancreas are discussed in detail. In cases of spleen injuries -- even if there are only small lacerations -- the total exstirpation of the spleen is necessary. For sutures in hepatic injuries the application of "collagenous bands" is recommended. The different methods of treatment in pancreatic trauma reach from simple drainage to partial resection.


[Treatment of the complications of the reflux syndrome and secondary brachyesophagus]. Two surgical methods are compared: resection of the stricture and replacement by large bowel (out of 64 cases, 63 were elective and one emergency), and the usual anti-reflux procedures (13 cases). In this series the mortality rate and the functional results are reported as more favourable after resection and replacement by bowel, than with more conservative surgical methods, generally considered to be less risky. In the 63 elective operations (resection of the oesophageal stricture and replacement by a segment of isoperistaltic large bowel) there was no mortality; one patient operated because of acute bleeding died. After antireflux operations of 13 cases two patients died because of surgical complications two others as a result of nonsurgical ones.


[Surgical treatment of segmental occlusions of the popliteal and the crural arteries with modified vascular prostheses (author's transl)]. Possibilities and indications for reconstruction of the femoro-popliteal and femoro-crural region are dealth with. Autogenous veins still are the favoured graft material for the femoro-popliteal/crural bypass. If an autogenous vein is not available bovine arterial grafts, Gore-Tex-PTFE prostheses or modified human umbilical cord vein are alternative materials.


[Cystic-stump-syndrome (author's transl)]. When persistent or recurrent pain appears following a cholecystectomy, precise clarification is required (ERCP). A long stump of the cystic duct should be cited as one of numerous different causes. If reoperation is indicated, the stump must be searched for radiomanometry should be implemented in order to ascertain possible choledochus stones or a stenosis of the papilla and redress these in the course of the same operation. The existing stump must be resected in any case. Among 5020 operations for benign diseases of the bile duct (1961 to 1977) 88 cystic duct stump resections were performed without fatalities. With the exception of 2 cases the operation remedied the patients' complaints.


[Surgical intervention in cold nodules of the thyroid gland (author's transl)]. In statistical analyses the rate of malignancy of solitary cold thyroid nodules is estimated between 3 to 50%. In our records the incidence of malignancy is 6,6%. Concerning the pathogenicity of these thyroid nodules no conclusions can be drawn which are only based on the results of such analyses. Each thyroid nodule has to be classified either according to its clinical and morphological characteristics or to its morphology alone. The condition for an optimal diagnosis and therapy is provided by the surgeon and pathologist being acquainted with the criteria for morphological classification or clinical data respectively.


[In vivo investigations on suture reactions under sterile and not sterile conditions. Comparison of absorbable and nonabsorbable suture materials (author's transl)]. Suture materials from plant and animal substances are increasingly being replaced by synthetics. Among the nonabsorbable materials, synthetics are much superior regarding infection, threading and knot strength. A coating can improve management, which is currently more favourable with silk and cotton. Absorbable polyglycolic-acid sutures enable controlled reduction of thread breaking, but catgut sutures do not. Absorption is significantly accelerated by infections, while pH-fluctuation is less important. For infected tissue, monofile or pseudomonofile sutures are most suitable.


[Analysis of mechanisms of motor disorders in amyotrophic lateral sclerosis (from the results of a tonic vibration reflex study]. In 41 patients with lateral amyotrophic sclerosis the tonic vibrational reflex (TVR) was examined. The H-reflex, the M-response, the stretch reflex, and the maximal spontaneous contraction before and during the Achilles tendon vibration were recorded simultaneously. A relationship between the TVR change and the disease form was revealed, and so was the different character of the change of the spinal reflexes in the presence of vibration. Mechanisms of the changes revealed are discussed with reference to the role of the gamma-system and the intraspinal inhibition in the origin of the motor disturbances characteristic of that disease.


[Electoneuromyography in the study of diseases of the neuromuscular system]. Results of electroneuromyographic examinations of 207 patients with hereditary neuromuscular diseases are presented. Patients with neural amyotrophies showed a sharp slowdown of the speed of impulse transmission along the median and the tibial nerves, a lowering of the induced potentials of the muscle and the nerve, and an increase of the M-response. In patients with spinal amyotrophies a slight lowering of the speed of the impulse transmission along the tibial nerves with the transmission speed along the median nerves being normal, a diminution of the amplitude and a shortening of the duration of the M-response, and an increase of the amplitude of the nerve action potentials were revealed. Patients with myodystrophies exhibited a slowdown of the speed of impulse transmission along the afferent fibres, and increase of the motosensor coefficient, a moderate lowering of the maximal with a tendency to a heightening of the minimal amplitude of the M-response and the nerve action potential.


[Dynamics of changes in vibration sensitivity in syringomyelia]. The state of vibrational sensibility was studied in 35 patients with syringomyelia, with the aid of a special device, which evoked in the tuning fork a vibration of the same amplitude (128) in repeated studies. The indices of vibrational sensibility in patients with syringomyelia were compared to normal figures. As a norm the author employed the medium indices of vibrational sensibility in seconds in 50 normals. According to the vibrational sensibility all the patients were divided into 4 groups. The absence of vibrational perception, its drop below the norm and appearance of hyperpallesthesia corresponded to the most severe forms of the disease. In a drop of temporal indices, but not lower than the norm, the side, where the pathological process was more marked under the treatment influence, showed a restituted vibrational feeling. Disordered vibrational sensibility was found not only to the level of affected segments, but beyond them, which supports the conductive character of these disturbances.


[Diagnosis of subclinical manifestations of the pyramidal syndrome by stimulation electromyography]. The studies were carried out on patients with cerebral and spinal pathology (transient disturbances of cerebral circulation, post-traumatic epilepsy, cervical myelopathy with segmental disorders, etc.). Despite the absence of the clinical manifestations of the pyramid syndrome most patients showed diversely directed shifts of the amplitude of the soleus muscle H-reflex, absence of the depression of this response on high-frequency stimulation, presence of the H-potential in the foot muscles, and an increase of the amplitude of the H-reflex (withdrawn by needle electrodes) of the anterior tibial muscle. It has been concluded that of greater diagnostic value for revealing subclinical forms of the pyramid-extrapyramid insufficiency are electrophysiological findings characterizing the state of the spinal inhibition mechanisms, rather than tests characterizing the level of the motor neuron activity.


[Several methodologic aspects of the problem of aphasia]. Main concepts of aphasia are analysed. It is shown that each of them emphasizes analytically certain aspects of this complicated problem. It is maintained that the one-sided view on this problem is overcome historically in the context of developing dialectico-materialistic understanding of the scientific psychophysiological problem. It is proven that the intergrative methods of investigating speech functions are, of the greatest diagnostic value.


[Certain features of the speech of patients with parkinsonism]. The speech of patients suffering from parkinsonism is usually described on the basis of merely clinical criteria. The author for the first time uses K. M. Steingart's polygraphic method for examining the speech in patients with various clinical forms of parkinsonism. As a result, regularities of the temporal characteristics of the speech were revealed, these regularities being a proof of the fact, that in patients with parkinsonism there are no pronounced disturbances of the higher integrative levels. Intense irradiation on the part of motor functions and changes of vegetative reaction confirm the important role of the functional state of the subcortical structures (of the limboreticular complex) in the pathogenesis of the speech disturbances characteristic of parkinsonism. The study has made it possible to ascertain a number of functional changes in the activity of the brain structures including the speech system.


[Ontogenesis of the entorhinal region of the human cerebral cortex]. The ontogenesis of the entorhinal region of the human brain was studied on a series of continuous frontal sections of the brain in 13 pre- and postnatal ages. The sections were stained with crezyl violet. Use was made of the quantitative methods. The study revealed some peculiarities in the ontogenetic development of certain subregions and areas of the entorhinal cortex of the human brain. Peculiar of the development of the human antorhinal region in the second half of pregnancy is appearance of new areas typical in their structure of the man brain only. The entorhinal region cortex was found to develop intensely in the postnatal ontogenesis; its basic cytoarchitectonic development is completed by the 2nd--4th year of the life.


[Certain patterns in the formation of optical illusions]. A structural dynamic analysis of productive disorders in visual perception was attempted on the basis of psychological study of 344 patients. These disorders were studied according to the increasing degree of inadequacy (anisomorphia) of pathological images in respect to real stimula. Considering the differences of such phenomena according to the degree of discrepancy of their perceptive characteristics with the traits of real objects, some successively complicated pathological images were examined, including traditional false recognition, illusions and hallucinations, as well as interlapping intermediate structures. Some pathogenetical mechanisms in the formations of visual illusions are suggested. Clinico-psychopathological parallels are made between disorders of visual perception and disease entities.


[Psychopathology and the dynamics of cenestopathy in schizophrenia]. A total of 75 schizophrenic patients with cenesthopathic disturbances aged from 18 to 69 years and with a disease duration of 2--42 years were examined. The paper deals with studies on psychopathological traits of cenesthopathia and structurally related symptomatology in different stages of schizophrenia. The studied forms of schizophrenia were characterized by a systematization of cenesthopathias and were differentiated from somatoneurological sensations, pathological sensations, and hallucinations of general sensations. The studies on the psychopathological nature of cenesthopathia permitted to classify it as an independent syndrome in the clinical picture of schizophrenia.


[Psychopathology of protracted endogenous depressions]. A clinico-psychopathological study of 85 patients with protracted endogenous depressions permitted to distinguish 7 main syndromological types: melancholic, adynamic, dysphoric, anesthetical, anxious, cenestho-hypochondriacal and a complex type of depressive disorders with hallucinatory, delusional and catatonic disturbances. The first 5 types were characterized by syndromological simplicity and could be qualified as monomorphic. The latter 2 types of depressions had a complex structure with profound positive disorders and pronounced polymorphism, which in some cases had a clinical picture of a major syndrome.


[Features of psychopathologic disorders in schizophrenia complicated by psychogenic reactions]. In order to reveal psychopathological disturbances in schizophrenia appearing under the influence of psychogenic factors, 145 schizophrenic patients with attack-like progressive and continuous forms of development, accompanied by psychogenic reactions were examined. The significant changes in the clinical picture of such conditions expressed in atypical and fragmentary psychopathological signs indicate a deep influence of psychogenic reactions on the pathogenesis of the schizophrenic process. The study demonstrated as well a certain dependence of the psychogenic modification in the clinical picture of schizophrenia on the form of development and character of psychogenic disorders. The results of the study may help to overcome difficulties in differential diagnosis of schizophrenia complicated by psychogenic reactions.


[Features of thought formation in schizophrenic children]. The paper deals with problems related to the onthogenetic formation of a special type of the pathological cognitive activity. Such activity was expressed in disturbances of selective actualization of knowledge based on the past experience. Experimental psychological studies were performed in children from 5--14 years of age, with slowly progressive forms of schizophrenia. The data obtained indicate an acceleration (in comparison to normal children of the same age) in the development of thinking operations, demonstrate in a capability to generalize additive signs and relations. The results obtained also suggest that the capability to generalize subject properties hierarchied according to the degree of social priority, is formed by other regularities and is retarded in schizophrenic children in comparison to normal children of the same age.


[Experimental psychology study of certain aspects of reduced activity among schizophrenic patients]. Experimental psychological studies of some aspects of lowered mental activity, due to an increasing schizophrenic defect, were performed in 15 patients. Some traits of realization processes and goal selection as a reflection of certain aspects of activity were studied. The study included 2 groups of schizophrenic patients (with a continuous and shift-like development) with different degrees of a clinically pronounced defect. The results obtained indicate that along with a formation of a defect in this group there is also a change in some aspects of mental activity which is reflected in changed processes of goal realization and selection. The schizophrenic patients become less initiative, they are incapable of posing goals in compliance with previous levels of achievement, and as a result their activity becomes less productive.


[Correlation between psychopathologic and pathopsychologic aspects of thought disorders]. The paper is concerned with the evidence on correlations of psychopathological and pathopsychological aspects of disturbed thinking, obtained on the basis of clinico-psychopathological and pathopsychological examinations of schizophrenic patients. Four traits of correlations between pathology of thinking with psychopathological structures are discussed. The paper contains some explanations with respect to the reasons for relatively intact thinking in experimental psychological testing. The results of the studies do not confirm absolute obligatory disturbances of thinking for all forms of schizophrenia.


[Chemical and biological properties of a fluorescence derivative of gentamycin]. By reaction with 4-phenylspiro[furan-2(3H),1'-phthalan]-3,3'-dione a fluorescing gentamycin derivative was produced which is characterized by the following properties: High fluorescence intensity in UV light, which enables simple and sensitive determination up to 10(-9) M. In this way it is possible to determine the localization of this substance in tissues, cells and body fluids. When favorably stored, the derivative is chemically stable. At pH 8 and storage at +5 degrees C in the dark for 27 days the substance loses only 5% of its original fluorescence. In comparison with the nonsubstituted gentamyzin the derivative has a twofold higher binding capacity to serum albumin. The antimicrobial properties are retained; the range of antimicrobial effects is similar to that of gentamycin.


[Clinico-angiographic diagnosis of space-occupying lesions of the posterior cranial fossa in children]. Superior cerebellar arteries raised above Lisholm's line is the most constant sign of a volume process in the posterior cerebral fossa. In tumors of the brain stem, the angiograms demonstrate hypertrophied arteries of the pons and changes in the position of initial segments of the upper cerebellar arteries. Tumors of the fourth ventricle in most cases cause displacement of the basilar artery to the front and the tonsillar segments of the inferior posterior cerebellar artery to the back and downward. In a lesion of the vermis of the cerebellum the artery and vein of the inferior vermis are considerably displaced to the back toward the occipital squama. Tumors of the cerebellar hemisphere may cause no changes in the position of the basilar artery in relation to Blumenbach's clivus. Displacement of the inferior posterior cerebellar artery beyond the midline indicates the side of the lesion. Demonstration of the vascular network of the tumor itself is the most important sign in topical diagnosis.


[Free fatty acids as inhibitors of the respiratory chain in testicular homogenates]. The supernatants of the 440 000 . g . min centrifugation of homogenates of rat, bull and boar testicles and sperm inhibit the NADH-oxidase activity of non-phosphorylating submitochondrial particles (ETP). Whereas no inhibitory activity was observed with young rats (150 g), a marked inhibition was detected with heavier animals. The inhibitory activity of testicles was located in the microsomal fraction. The reaction of the testicular inhibitor with the ETP is initiated by an instant reversible binding followed by a slow irreversible inhibition of the electron transport. The reason of the time-dependence is neither an interaction between the enzymes of the ETP and those of the microsomal electron transport nor a slow degradation of the ETP by microsomal phospholipases. Some observations indicate an indirect involvement of phospholipase via the formation of free fatty acids (FFA). The inhibitory fraction could be solubilized from the microsomes both by sodium cholate treatment and by ethanol extraction. After separation of the lipid classes by chromatography on silica gel and gas-chromatographic analysis the inhibitory fraction was identified as a mixture of free fatty acids (FFA) of different chain lengths and degree of saturation. Thus a new effect of FFA on the mitochondrial electron transport has been detected which is different from other actions known up till now. The degradation of the phospholipids of the endoplasmic reticulum in the spermatozoa may be the source of the enhanced formation of FFA. An inhibition of the cell respiration presumably does not occur in vivo. The high FFA level in the testicular homogenates of sexually mature animals is a consequence of an intensive FFA metabolism, especially of high phospholipase activity.


[Time parameters of the retinal control of light intensity and influencing parameters]. The variability of the pupillomotoric control of light intensity was analysed in response to changes in the duration of the light flash, the respiratory phase during stimulation and the age of the subjects. The method of infrared pupillography was used to determine dynamic time parameters. With increasing duration of the light flash from 8 to 125, 250 and 500 ms we observed an acceleration of the latencies whilst the other time parameters were prolonged. There was no significant influence of the time of stimulation during the respiratory cycle. With growing age increased latencies and reduced time parameters of the pupillomotoric transient response were found. The possible reason and importance of the observed changes are discussed.


[Selective spinal angiography in children with intraparavertebral tumors]. Selective spinal angiography was conducted in 15 children aged from 2 to 15 years with tumours of the spinal cord predominantly of intraparavertebral localization. Direct and indirect angiographic signs of spinal cord tumours were demonstrated. The informativeness of the method in intraparavertebral tumours is emphasized. Selective spinal angiography may be considered a safe method causing little trauma when used for auxiliary examination of chidren with spinal cord tumours and is recommended for introduction on a wide scale in spinal neurosurgery.


[Diagnosis and treatment of birth injuries of the cervical portion of spine and spinal cord in newborn infants]. Experience in the treatment of 200 newborns with birth spinal cervical trauma in the acute period (under 3 weeks of age) is generalized. Forty-nine infants died; circulatory disorders and edema of the spinal cord were the prevalent morphological findings. The clinical manifestations were pareses of the upper extremities and, less frequently, truncal disorders. X-ray examination revealed spinal injury, epidural hematomas and edema of the spinal cord. Treatment included reduction of the dislocated vertebrae with subsequent immobilization of the cervical spine and rehabilitation therapy. Improvement and, sometimes, total normalization of the functions of the spinal cord were achieved.


[EEG-activity patterns in visual information processing: characteristics, variance-analytical deliminiation, discriminance-analytical determination of undispensable variables and scale level]. 1. In order to determine the variable distributions of 5 activation dependent EEG activity patterns occurring during visual information processing, mean values and standard deviations of the percental quantities of the frequencies 4, 5, ..., 13 Hz, 14 to 20 Hz and 21 to 30 Hz, as well as the mean amplitudes in the frequency bands 3.5 ... 7.4 Hz, 7.5 ... 13.4 Hz and 13.5 to 30 Hz were determined on corresponding to 10 s samples. It could be demonstrated by regression analysis that an interval scale level can be assumed already on the basis of cethe percental quantities in the three last mentioned frequency bands. 2. On the basis of 18 relevant variables, all the adjacent activity patterns could be separated from each other by means of univariate variance analysis at pairwise mean value comparison by at least two variables. 3. After stepwise reduction of dispensable variables in the framework of a linear discriminance analysis an optimal set of variables was determined, comprising the percental quantities of the frequencies 4, 5, 6, 10, 12 Hz, and 14 to 20 Hz, as well as the mean value of the amplitudes in the frequency band 3.5 to 7.4 Hz. In 4 our of 5 elementary discriminance functions, the mean values calculated for each pattern were significantly distinguishable from each other (analysis of variance, Newman-Keuls test). 4. By linear regression analysis it could be shown that the classification system of the EEG activity patterns at visual information processing can be mapped on an interval scale after the reduction of variables, too. Finally, data about the reliability of the scoring procedure are presented.


[Effect of fat free diet during the last week of pregnancy upon the linoleic and arachidonic acid content of fetal organ lipids and placenta lipids of the rat]. Pregnant Wistar rats were fed a fatfree diet from day 16--22 of pregnancy. On day 22, the fatty acid components of cholesterol esters, triglycerides, free fatty acids and phospholipids of maternal (brain, muscle, serum, white adipose tissue, liver) and fetal (brain, carcass, serum, liver) tissues, including the placenta, were examined gaschromatographically for the participation of linoleic and arachidonic  acid. In all fetal and maternal organs the linoleic acid levels in the fatty acid patterns were strongly reduced. The alterations nearly always involved all the lipid fractions of a tissue and were mostly equal within a tissue. The strongest decreases of linoleic acid occurred in the placenta, and the weakest, in the lipids of maternal muscle and maternal adipose tissue. The linoleic acid alterations were principally similar in fetal and the corresponding maternal tissues, while being less pronounced in case of maternal muscle. The participation of arachidonic acid in the fatty acid pattern is completely retained in the lipids of fetal organs, and is even enhanced in those of the placenta.


[Examination of conduction by injured nerves in children]. Increase of skin resistance in Ohms to 828--1000 kOhm, reduction of temperature by 1.4 +/- 0.5--2.2 +/- 0.5 degrees C, the absence of skin folds, pink color in the thermal test, an even parabola of the intensity-duration curve and the absence of induced muscle potentials in 91 patients one month and more after injury confirmed the diagnosis of total interruption of the nerve and the indications for its suturing. The presence of skin folds in the autonomous zone and deviations of the intensity-duration curve caused by muscle potentials were evidence of total disturbance of nerve conduction and indicated the application of nonoperative treatment.


The influence of prostaglandins E2 and F2 alpha on electrotropic and inotropic vagal effects on the isolated rabbit atrium. 1. PG E2 (2.10(-8) g/ml) produces a positive inotropic effect and lengthens the duration of the action potential at the level of 50% and 90% of repolarization. 2. PG F2 alpha acts negatively inotropic and shortens the action potential at the level of 75% and 90% of repolarization. 3. PG F2 alpha (2.10(-8) g/ml) increases both the electrotropic and inotropic vagal effects, PG E2 (2.10(-8) g/ml) decreases them. 4. PG E2 improves the electromechanical coupling, PG F2 alpha reduces it.


Effect of prostaglandin F2 alpha on temperature and behaviour of centrally sympathectomized rats. Prostaglandin F2 alpha (PG F2 alpha) in doses of 1 and 10 micrograms applied intraventricularly causes a rise in body temperature and exerts a sedative action on rat behaviour. Chemical sympathectomy of the central nervous system (CNS) induced by a twofold intraventricular administration of 250 micrograms of 6-hydroxydopamine reduces the influence of PG F2 alpha on the body temperature and behaviour. Reserpine administered to rats with chemical sympathectomy of the central nervous system reverses or prevents the PG F2 alpha action on body temperature of the animals. The results of the experiments seem to indicate that the central monoaminergic mechanisms play a role in the central action of PG F2 alpha on body temperature and behaviour.


[Role of the serotoninergic raphe-hippocampus system for the antinocifensive effect of morphine]. As revealed in earlier studies, the antinocifensive effect of morphine is brought about, among other things, with involvement of serotoninergic transmission mechanisms. In this context the role of the serotoninergic raphe-hippocampus system has been studied in this paper. Topical microinjections of serotonin into the dorsal hippocampus increased morphine analgesia in a dose-dependent fashion, while application into the striatum had no effect. Morphine injections into the median raphe nucleus in relatively low doses exert an antinocifensive effect which is inhibitable by methysergide. Lysergic acid diethylamide administered into the median raphe nucleus also abolished the effect of morphine in a dose-dependent manner. The results in connection with literature data lend support to the presumed integrative function of the serotoninergic raphe-hippocampus system in the mechanism of antinocifensive action of morphine.


[Effect of dopaminergic substances on the antinocifensive action of arecoline]. Based on earlier studies that revealed the analogical influence of noradrenaline and serotonin on morphine analgesia and the antinocifensive effect of arecoline, it was tested whether under the influence of dopaminergic substances the inhibition of nocifensive reactions is being altered by arecoline like the action of morphine. In fact, arecoline could be amplified in a dose dependent manner by apomorphine and amphetamine, which alone had no antinocifensive effects. On the other hand, no antagnoism of the dopamine receptor blockers, chloropromazine ahd haloperidole, against arecoline was demonstrable; only the additive effect of apomorphine and amphetamine could be abolished. Therefore it is concluded that dopamine is not directly involved in the spinal mechanism of the antinocifensive effect of central cholinomimetics, but that only supraspinal influences can be varied by the function of dopaminergic neurons.


[Receptors of human red blood cells for anti-TAH and anti-AHP in the course of intravascular aging]. Human o-erythrocytes aged in situ do not expose free receptors for anti-T agglutinin of Arachis hypogea. New receptors for concentrated anti-A agglutinin of Helix pomatia are manifested but are lost again in the course of further ageing of the cells in situ. A remasking of exposed receptors for anti-TAH and anti-AHP byautologous, strongly binding globulins is supposed. These globulins could constitute the decisive signal for the autologous phagocytosis of senescent red blood cells.


[Biochemical studies on histones of the central nervous system. I. Characterization and partial identification of the label of histones from rat brain following intraventricular administration of 1-[14C]-acetate]. Rat brain histones were acetylated in vivo by intraventricular injection of [14C]-acetate. More than 90% of the label is the result of a true acetylation. Enzymatic proteolysis of the labelled histone fraction and subsequent chromatographic investigation of the digestion products showed about 60% of the recovered radioactive material to be epsilon-acetyl lysine, whereas 22% of the radioactivity was found in an unidentified spot.


[Biochemical studies on histones of the central nervous system. II. Acetylation of histones from neurons and glia of the rat brain in vitro]. There are no qualitative differences in the electrophoretic patterns of histones from neurones and glia. A 25% increased acetylation rate is found in neuronal histones as compared to glial histones after incubation of chopped brain in a [14C]-acetate containing medium. This result probably reflects different condensation states of the chromatins of both cell types, as demonstrated by electron microscopy.


[Biochemical studies on histones of the central nervous system. III. Incorporation of [14C]-acetate into the histones of different rat brain regions during a learning experiment]. Long term memory formation obviously is accompanied by changes in macromolecule synthesis within the brain structures involved. The regulation of this process was investigated in various rat brain regions using the model of histone acetylation with [14C]-acetate during the training session, as well as 5 min and 120 min upon completion of training. Almost at all three times and in most brain structures the acetylation rate was diminished in trained animals as compared to pseudo-conditioned rats. With the exception of hippocampus labeling in trained animals was even lower in comparison to passive controls.


[Influence of starvation on the heart rate of rabbits]. The ECG was recorded in rabbits during EEG-controlled slow wave sleep and during food conditioning sessions. A 2-day food deprivation caused a significant slowing of mean heart rate during sleep. The heart rate increased in hungry animals waiting for food (food expectancy), but did not reach the values of saturated sleeping animals.


Affinity chromatography of human serum proteins using matrix bound lectins from Viscum album and Vicia faba. The D-galactose specific lectin from Viscum album and the D-mannose specific lectin from Vicia faba react with serum proteins which contain the corresponding carboyhydrate moieties. By affinity chromatography of human serum using the combination of insolubilized lectins coupled to Sepharose it is possible to fractionate serum proteins in 3 groups: 1. proteins which react with both of the lectins; 2. proteins which react only with one of the lectins; 3. proteins which do not display any affinity for one of the two lectins.


Interferon induction in human lymphocytes by complexes of vinyl copolymers with polynucleotides. Analogues of the dsRNA poly(I).poly(C), namely double-stranded like complexes of poly(I) or poly(C), respectively, with corresponding vinyl nucleobases copolymerized with various vinyl compounds are highly effective interferon inducers in human lymphocyte cultures. Like poly(I).poly(C) they stimulate the liberation of an inhibitor(s) of interferon activity and, moreover, display mitogenic effect. With respect to the extent of these effects the various inducers differ considerably.


Synthesis of spontaneous interferon by mouse peritoneal cells in vitro. II. Characteristics of the process of spontaneous interferon synthesis. As it was shown previously that the peritoneal cells of mice were capable of producing interferon spontaneously. Spontaneous interferon appeared after 5 to 6 h of incubation of peritoneal cells at 26 degrees C and its highest level has been found after 12 h. The production of spontaneous interferon was inhibited by 4 h incubation of peritoneal cells at a temperature of 37 degrees C as well as by actinomycin D added at 0 to 4 h.


Effects of anti-interferon serum on growth and regression of Moloney sarcoma virus induced tumours in mice. Administration of sheep anti-mouse interferon serum or globulin to weanling BALB/c mice infected with Moloney sarcoma virus (MSV) accelerated the growth of tumours at the site of virus inoculation, increased the number and size of tumours, and inhibited their regression. The outcome of the MSV-induced disease after injection of anti-interferon globulin depended on the age of mice. The antigenic stimulation by normal sheep serum or globulin also enhanced the growth and mortality due to MSV but to a significantly lesser extent than anti-interferon globulin.


Assay of interferon and viral antibodies in the cerebrospinal fluid in clinical neurology and psychiatry. Cerebrospinal fluids (CSF) of 245 neurological and 194 psychiatric patients were tested for viral antibodies and interferon. Complement dependent neutralizing antibodies to Herpesvirus hominis 1 were found in the CSF of patients with encephalitis (50.6%), meningitis (35.4%), lesions of peripheral nerves (36.9%), sclerosis multiplex (41.2%), schizophrenia (31.9%), senile dementia (51.4%), mental retardation (11.1%), ethylism (43.5%). Neutralizing antibodies to tick-borne encephalitis virus were found in the CSF of 38% patients with encephalitis, in 14% meningitis, 11% lesions of peripheral nerves and also in 5.6--11.8% of psychiatric patients. In encephalitis, meningitis and in lesions of peripheral nerves were found in the CSF frequently plaque neutralizing antobidies to the tick-borne orbivirus Lipovník, complement-fixing antibodies to lymphocytic choriomeningitis virus and hemagglutination inhibiting antibodies to measles virus. In multiple sclerosis were detected CSF antibodies to measles virus (44%), Herpesvirus hominis 1 (41.2%) and Lipovník virus (52.6%). In neurological patients were observed CSF antibodies simultaneously to two or three viruses in 16.7 to 40.6%, while in psychiatric patients in zero to 4.6%. CSF interferon was found in psychiatric patients with an equal or even higher incidence (33.7 to 57.1%) than in the neurological patients (29.6--38.6%, in multiple sclerosis only 16.7%). Non-interferon virus inhibitors were excluded. The evaluation of the ratio of serum and CSF titers of viral antibodies and of interferon indicated local synthesis of both in the central nervous system -- with the exception of antibodies to Herpesvirus hominis 1 in CSF of some patients with very high titres in serum and probable lesions of the blood brain barrier.


[Spontaneous right primary iliac arteriovenous fistula and an unrecognized aorto-caval fistula located above an aneurysm]. A patient admitted for treatment of an aorto-iliac aneurism presented himself with swelling of the lower extremities and a low grade bruit over the abdomen continuous throughout systole and diastole. Aortography demonstrated the presence of a suspected ilio-caval fistula. Surgical treatment consisted of closure of the fistula and vascular replacement with an appropriate aorto-bifemoral prosthesis. Large statistics report an incidence of aortocaval fistula up to 4% in association with rupturing aortic aneurisms. The grave clinical signs and aortography confirm the diagnosis. Some of those may obstruct themselves spontaneously only to reopen at the time of operation as in the case reported. The greatest peroperatory problems with closure of those fistulae are pulmonary emboli by air and aneurismal contents. In our first case a temporary caval clip was placed as a part in the management of the lesion.


[Complex anal fistulas. Current status of their treatment]. Out of 643 anal fistulae operated, 85 were considered complex. The author details the precautions that must be used in their cure in order to avoid a recurrence or an incompetence. Operated with these principles, a great majority of these fistulae cured completely, without important sequellae of the sphincter function. A small percentage of these fistulae are difficult to treat and liable to recurrence. These are the ano-rectal high supposedly blind fistulae or those that have an internal opening above the ano-rectal ring. The author prefers the treatment by modificating injections, of which he has a large experience. This procedure does not always guarantee cure but yields frequent long remissions.


[Giant diverticulum of the sigmoid].

[Giant diverticulum of the sigmoid]. This reports a rare case of diverticulum of the sigmoid in a 73 years old patient, which presence was detected about 4 years before surgery. This giant diverticulum manifested itself mainly through pain followed by anorexia. On X-ray it had the appearance of a gas cyst. The pathogeny of such a diverticulum is to be found in inflammatory factors at the base of implantation; it results from pressure effects in the diverticulum with the probable action of anaerobic bacterial fermentation. The pathologic examination does not always allow differenciation between a giant diverticulum and a duplication, especially where the later communicates with the digestive tract. The indications and surgical techniques are discussed.


[Strategy and results in the treatment of squamous cell carcinoma of the anal canal. A review of 51 cases (author's transl)]. In this retrospective study of 51 patients treated for squamous cell carcinoma of the anal canal some aspects of the natural history are touched upon. The authors also discuss their results and define their current therapeutic approach. It is a rare lesion; only 2-3% of all colorectal cancers with a predominance for women (4 to 1) and of 2 histological varieties. The epidermoid type (74%) is made more prevalent though the basal layer type (26%). The prognosis is very poor once the stage T, is passed. The simultaneous finding of a primary lesion and associated inguinal lymphadenopathy is of serious consequences. The proposed therapeutic schema consists of: --Radiotherapy exclusively for T1 lesions. --Preoperative radiotherapy and abdominoperineal resection for all large lesions T3-T4. --For the intermediate T2 lesion: initially radiotherapy (2,500-4,000 rads) followed by careful reevaluation under general anesthesia to define whether further curie-therapy or surgical resection when an unsatisfactory response.


[The surgical treatment of cancer of the rectum. Analysis of 391 cases (author's transl)]. From 1963 to 1977 included, the authors operated 391 cancers of the rectum, out of 396 cases, which makes up for 98.5%. The tumor was felt on rectal examination in 60% of patients. Resection was performed in 86% of the cases. Schematically the authors recognize 2 types of operations: the anterior resection and the abdomino-perineal amputation by 2 synchronic teams--operation of Lloyd-Davies--that represents a significant progress compared to Miles' operation. Lately preoperative cobalt therapy (2,500 r) has been used for low tumors. Postoperative mortality remains elevated: 9.1% of which 10.1% for the Lloyd-Davies procedures and 7.2% for the anterior resections. Two hundred and sixty-seven patients have at least a 5 year follow-up; four, i.e. 1.5%, were last to follow-up and are considered dead. Gross overall 5 year survival is 36%. Non corrected 5 year survival, after resection is 42.8% dividing in 37.3% for Lloyd-Davies procedures and 51.2% for anterior resections; these figures include all operated patients and not only those who survived the operation.


Value of colonoscopy in the detection of sigmoid malignancy in patients with diverticular disease. Sixty patients with diverticular disease, referred because a barium enema examination could not exclude a co-existing malignanty, were studied in a retrospective manner, to find out the contribution of colonoscopy in the diagnosis of sigmoid carcinoma in such patients. All X-ray studies were blindly reviewed and divided in two categories: a) diverticular disease with malignancy or strong suspicion for malignancy and b) diverticular disease without suspicion for malignancy. The accuracy of the endoscopical examination was evaluated by a follow-up study with a range of 3 months-3 years. Colonoscopy appeared to be accurate in more than 3/4 of the referred patients but was not helpful when there was a severe stenoisis and/or the diseases segment could not be reached for biopsy. The incidence diminished when a small calibre fiberendoscope was used, practically always allowing to reach or to pass the stenotic segment. There were no false positive nor false negative endoscopical results in our study. In a substantial number of patients major surgical exploration could be prevented. We consider colonoscopy therefore a valuable adjunct in detecting or eliminating cancer in colonic diverticular disease. The availability of various fiberendoscopic instruments is a prerequisite for reaching an acceptable success rate and diagnostic accuracy.


Serum zinc before and after cholecystectomy in zinc-treated patients. Nine female patients were given zinc sulphate (Solvezinc) 220 mg three times daily for 4 weeks prior to cholecystectomy. Mean serum zinc before zinc treatment was 17 +/- 0.8 mumol/l and rose 25 +/- 1.6 mumol/l after zinc treatment. 6 hours postoperatively serum zinc was 13 +/- 1.4 mumol/l. Thereafter it gradually increased to 20 +/- 0.7 mumol/l by the third postoperative day. The present investigation thus shows that pretreatment with zinc increases the serum zinc level but does not prevent the drop in serum zinc in connection with cholecystectomy. However, with the pretreatment serum zinc never falls below the normal range.


Prognostic significance of intra-operative blood transfusions and flow measurements in reconstructive vascular surgery. Intra-operative measurement of leg blood flow is useful not only for the detection of a technical fault. It has also proved to be a sensitive method to disclose hypovolaemia. Thus, if the blood volume is not restored, the peripheral vasoconstrictor tone remains elevated. In such a state, the basal leg blood flow is low, but increases markedly on pharmacological vasodilation. In a normovolaemic situation, however, the basal blood flow is higher with a less pronounced increase following vasodilation. In the present study, intra-operative measurements of graft blood flow using an electromagnetic flowmeter have been employed to evaluate the blood substitution needed during 114 consecutive reconstructions with femoro-popliteal reversed saphenous vein bypass grafts. The measurements resulted in a blood transfusion therapy that was, on an average, 38% higher that it would have been, if substitution had been based simply on a calculation of blood losses from volume measurements in the suction apparatus and from the drapes and swabs. Only three graft thromboses developed within the first month. The flow rate of these grafts was much lower than the grafts remaining open. The low early thrombosis frequency (2.8%) compares favourably with previous reports, which might partly be explained by generous intra-operative blood transfusion.


Gastric ulceration and changes in acid secretion and mucosal blood flow after partial gastric devascularization in cats. In anesthetized cats pentagastrin-stimulated gastric acid secretion and blood flow were determined 2 hours and one week after partial gastric devascularization. The blood flow to different regions and layers of the stomach wall and the cardiac output were determined by means of the microsphere distribution technique. The H+ output from the 30th to the 60th min of pentagastrin stimulation was used as the acid response value. Devascularization resulted in marked decrease in acid secretion after 2 hours and after one week, but the acidity of the gastric juice was not changed. The corpus/fundus mucosal blood flow was markedly reduced 2 hours after devascularization. After one week the blood flow was still low, but not significantly different from sham values. The ratio of acid secretion to mucosal blood flow was not significantly changed one week after devascularization as compared with the acute experiments. All cats examined one week after devascularization had developed ulcers at the midportion of the greater curvature, which was the area of the corpus/fundus that had the most markedly reduced mucosal blood flow. The data indicate that reduced gastric secretion and development of ulcers were due to reduced gastric mucosal blood flow caused by the devascularization. Our results are also discussed in relation to results and complications after highly selective vagotomy in man, as this operation includes partial devascularization of the stomach.


[Radiological aspects of peri-diverticular disease of the colon. An anatomo-pathological correlation (author's transl]. Sixty consecutive cases operated for diverticular disease of the colon within the last 10 years are reviewed. A comparative study is made of the anatomopathological examination of the specimens and their radiological aspect trying to establish the precise radiological picture of acute, chronic and fibrotic peri-diverticular disease. Plain films of the abdomen, intravenous uro- and cystography are very useful in acute cases. A baryum enema just prior to surgery (33 cases) heralds by the rigid aspect of the involved bowelsegment the acute case; spasms, thick disorderly folds and localized extravasation characterize the acute peridiverticulitis. Fibrotic peri-diverticular disease shows disorderly, fine but "ragged" folds associated with extrinsic fistulae. In many cases the inflammation is not purely acute nor chronic or fibrotic. The distinguishing histological types are simultaneously present and render the radiological picture complex.


Diverticular disease of the colon.

Diverticular disease of the colon. Diverticular disease is basically a disorder of muscle function, particularly of the sigmoid colon. Increase in tone of the muscle layers of the bowel with consequent muscular thickening of a characteristic pattern. The thickening is not a true cellular hypertrophy and there is no evidence of muscle cell hyperplasia. The formation of diverticula are distributed along the points of greatest weakness in the bowel wall, namely where the blood supply penetrates, suggests that pulsion plays a major role in their development. The inflammation in diverticular disease is purely a complication of the diverticulosis.


Primary results after resection and anastomosis for mid-rectal cancer with a new stapling instrument. A preliminary report. Early results after resection with primary anastomosis for cancer of the mid-rectum using a new stapling instrument are reported. 20 patients with an adenocarcinoma 7-12 cm from the anal verge were operated. On patient died postoperatively from respiratory complications but with no sign of anastomotic dehiscence. One patient had a clinically recognizable leakage which closed spontaneously within 2 days. Three patients had roentgenologically demonstrable leakage but no clinical symptoms. On examination, 1-3 months after the operation, all patients were continent for feces as well as for gas and none had more than four bowel movements per day. Resection and anastomosis by means' of the stapling instrument is practicable even at the lowest level, and is far less time consuming and does not require the same degree of training as low anterior resection with conventional suture anastomosis.


The role of colonoscopy in complicated diverticular disease. A review. Colonoscopy in complicated diverticular disease may assist the clinician in establishing the diagnosis of associated strictures. A review of the literature shows that carcinoma was identified in 21 (17%) of 125 patients and that an additional diagnosis was made in 40 (32%) patients. Although colonoscopy may be a difficult procedure in patients with diverticular disease the caecum was reached in 27 (61%) of 44 patients and took no longer than routine colonoscopic orpcedures. Further analysis of these results confirms that the barium enema frequently produces both false positive and false negative diagnoses of carcinoma and polyps. The presence of bleeding strongly suggests the presence of a concomitant lesion. Fifteen (11%) carcinomas were identified in a group of 135 patients with persistent rectal bleeding whose barium enema showed only diverticular disease and an additional diagnosis was made in 50 (37%) of these patients. Colonoscopy is an important investigation in patients with complicated diverticular disease.


The place of sigmoid myotomy in diverticular disease. The place of longitudinal myotomy in the treatment of diverticular disease of the sigmoid colon is discussed, with passing reference to the drawbacks of transverse myotomy. The prime indication for longitudinal myotomy is in the longstanding uncomplicated case of troublesome diverticular disease that has not responded to correct medical treatment, which should include high-residue diet and bran. Such cases are usually over 50 years of age, when a functional and reversible obstruction has become organic and irreversible. They comprise 75% of a series of 104 cases described. A secondary indication is in cases of diverticular disease which have been complicated by perforation, abscess formation, acute intestinal obstruction or fistulae. Such cases comprise 25% of the present series. They may settle after drainage and/or defunctioning colostomy. Myotomy can be carried out later, with or without limited resection, provided that all signs of pus or peritonitis have disappeared. The technique of the operation is described and the results are analysed.


Ultrastructure of the aorta in experimental uraemia. The effect of chronic experimental uraemia on the ultrastructure of the aorta was studied in rats. Pathological changes were found essentially in the media, in which the smooth muscle cells commonly had increased amounts of endoplasmic reticulum, Golgi structures and mitochondria, probably reflecting an increased synthetic and metabolic activity. In other areas of the media, degenerative and necrotic changes of the smooth muscle cells dominated. Increased amountes of collagen and the appearance of vesicular structures, probably cell debris, were noted in the extracellular space. Diffusely spread needle- and plate-shaped electron dense structures were seen in some necrotic areas. By X-ray microanalysis these structures could be demonstrated to have a high content of calcium, and probably represented hydroxyapatite crystals. Two types of circumscribed rounded electron dense conglomerates also appeared. At least one of these structures, in which X-ray microanalysis showed a high calcium content, is thought to represent a site of early calcification. Electron dense deposits in the elastic structures were only occasionally seen. The alterations occurred in both parathyroidectomized and non-parathyroidectomized uraemic animals. The study revealed no signs of intracellular calcification and suggests a close relation between necrosis of the smooth muscle cells and calcification of the aortic wall in experimental uraemia.


The treatment of uncomplicated diverticular disease of the colon with a high fibre diet. This paper describes the pathogenesis, aetiology, epidemiology and the historical emergence of diverticular disease as a clinical problem. The symptoms of the uncomplicated disease can be treated successfully and cheapli with a high fibre diet including miller's bran. The method of giving bran and its results are described. The adoption of a high fibre diet lessens the need for surgery in diverticulitis and the author believes that it could prevent the appearance of the condition in future generations.


[About 35 cases of perforated colon diverticulitis (author's transl)]. Thirty-five cases of perforated colon diverticulitis were treated by us between 1960 and 1977. An overall mortality of 34% reveals the seriousness of this disease. Perforation in open peritoneum doubles the mortality and morbidity rate of covered perforations and of secondary fistulisation. The surgical operations used--immediate resection or colostomy and a drainage--were imposed by the status of the patient and the local state of the lesion. The resection of the pathological colon segment, when feasable, caused no death in this series although a mortality of 48% was noted for multiple procedures. The diagnostical and surgical difficulties associated to profound biological and hemodynamic alterations in these old patients, justifies the multiple stage surgery in a large number of cases. Resection of the perforated segment remains the treatment of choice.


Uraemic myocardial disease. An experimental study, with special reference to the effect of parathyroidectomy. A histopathological study of the myocardium was performed in rats made uraemic by a 5/6 kidney resection. The examinations were performed after intervals up to 36 weeks. Uraemia caused focal myocardial necroses, the incidence and severity of which were related to the length and severity of the uraemic state. In the myocardium of some animals intracellularly located calcifications were found. The calcifications usually appeared only in the necrotic areas. The coronary arteries showed only slight or moderate arteriosclerosis without severe obturation of the lumens and the genesis of the necroses is suggested to be factors other than ischaemia or hypoxia. Since secondary hyperparathyroidism might be one such factor, the effect of prior parathyroidectomy was studied. Parathyroidectomy prevented the development of calcifications but not the development of necrosis. However, the significance of secondary hyperparathyroidism in the development of myocardial necroses cannot be fully evaluated from the present study. The protecting effect of parathyroidectomy was probably counterbalanced by the deleterious effect of further elevated serum phosphate levels in the parathyroidectomized animals.


[Peridiverticulitis of the colon: confrontation of pre- and postoperative diagnosis (author's transl)]. The authors report their experience with the surgical management of the peridiverticulitis coli (60 cases). It is frequently uneasy to have an accurate pre- and peroperative diagnosis of the nature and the grade of severity of the illness. So, the indication for surgery, the choice of the procedure, and the evaluation of the results are somewhat subjective. The microscopical study of the resected colons give objective data about the status of the bowel. Our pathological findings have shown major inflammatory lesions in the colons which were resected in emergency, in the cases operated upon for stenoses and fistula. On the other hand, when patients underwent an elective surgical procedure, after a primary conservative (medical or surgical) treatment, the inflammation could be absent. The risks of leaving in place some of these colons seem to be small.


Impaired lymphocyte transformation after accidental trauma. The effect of accidental trauma on lymphocyte transformation induced by phytohaemagglutinin (PHA), concanavalin A (Con A), pokeweed mitogen (PWM) and purified protein derivative of tuberculin (PPD) was studied in 66 patients with minor, moderate or multiple trauma. An in vitro whole blood micromethod was used. The lymphocyte transformation induced by the mitogens and the antigen was impaired in patients with trauma in proportion to the severity of the injury. A decrease of lymphocytic responses to a very low level had prognostic value for the patient as indicated by the two patients with very low lymphocytic responses and serious infectious complications.


Serum lipid levels and hyperlipoproteinaemia in gallstone patients. Gallstone disease has been reported to be common in hypertriglyceridaemic patients, especially those with type IV lipoprotein pattern. The object of the present study was to further investigate whether gallstone disease is associated with hyperlipoproteinaemia. Serum lipid levels and prevalence of hyperlipoproteinaemia in a consecutive series of patients with gallstone disease (315 females and 142 males) were compared to a control series (160 females and 94 males). Gallstone patients had higher serum triglyceride levels than those of controls whereas serum cholesterol levels were the same. The prevalence of hyperlipoproteinaemia was the same in both groups but there was an overrepresentation of patients with type II b and IV pattern among gallstone patients. Pregnancies, including miscarriages after the first trimester, and use of oral contraceptives were recorded in the female subjects less than or equal 30 years. Pregnancies and use of oral contraceptives among nonparous women were more common among gallstone patients than controls.


The treatment of acute cholecystitis. A series of 497 consecutive patients. In a five-year series of 497 consecutive patients with acute cholecystitis an overall mortality of 3.2% was observed. There was no significant difference in mortality between patients undergoing early surgery and those managed initially conservatively. The total incidence of postoperative complications was also similar in the early and delayed surgery groups, although wound complications were slightly more frequent after early surgery. A special risk group was formed by patients with unsuccessful conservative treatment demanding emergency surgery later. These delayed emergency cases contributed half of the deaths; the mortality was 28% in this group. Conservative initial treatment was followed by a recurrence rate of 21% before delayed surgery undertaken on average four months after the acute episode. With early surgery for acute cholecystitis recurrence and later emergencies can be avoided and the time of treatment approximately halved without significant increase in operative risks compared with delayed surgery. The data obtained under routine clinical work support the results of the prospective trial carried out at the same department of surgery (Järvinen & Hästbacka, 1979).


Bilio-intestinal shunt. A method and a pilot study for treatment of obesity. Diarrhea is a drawback in all types of small intestinal bypass operations for the treatment of morbid obesity. One of the causes of diarrhea is excessive amounts of bile acids in the colon. Therefore in five obese subjects, we complemented the usual jejuno-ileostomy end to side procedure with an anastomosis between the proximal end of the excluded blind loop and the gallbladder (bilio-intestinal shunt). In this way the enterohepatic circulation of bile acids is assumed to be preserved. The patients, subjected to this new methods, were compared to matched patients (age, sex, height, preoperative body-weight, Brocas index and total small intestinal length) following four other types of jejuno-ileostomies. The frequency of diarrhea in the subjects with the bilio-intestinal shunt was significantly less than in the other groups. Other parameters, such as rate and magnitude of weight reduction, changes in blood cholesterol and triglycerides, were the same in the control groups.


Infertility as a complication of perforated appendicitis. Late follow-up of a clinical series. In a retrospective study the frequency of infertility was estimated in women operated for perforated or non-perforated appendicitis before the age of 25. Of the 48 patients with simple perforation 19% were infertile, while this frequency was 31% in 16 patients with Douglas abscess. In the control group of 58 patients 12% could not have children. It is concluded that it is unlikely that appendicitis with perforation will cause infertility unless there is a Douglas abscess.


Contamination with enterobacteria and postoperative wound infection after appendicectomy. The impact of contamination on wound infections was investigated in 120 patients undergoing appendicectomy for appendicitis. A quantitative sample for culture of enterobacteria was obtained from the subcutaneous wound with the velvet pad imprint technique. Average number of enterobacteria (CFU) in the would was 1.2 logarithms higher in operations for gangrenous appendices and 2.3 logarithms higher in perforated appendices compared to flegmonous appendices. Infection rate was 2.5% in flegmonous, 10% in gangrenous and 27.5% in perforated appendices. The results focus the close relation between contamination and subsequent infection.


Arterial lesions of the radial artery in uraemic patients. Arterial specimens from the radial artery were removed in connection with Brescia fistula operations on 15 uraemic patients and were studied by light and electron microscopy. The patients lacked clinical signs of arterial insufficiency. Radial artery specimens from 15 humans that underwent forensic post-mortem examination served as controls. The intima of the uraemic patients was significantly thicker than that of the controls. In 8 of the uraemic arteries light microscopy disclosed necrotic areas in the media and in 2 cases such areas in the intima, compared to only one case with patchy medial necrosis in the controls. Calcification was histochemically demonstrated in 6 of the uraemic arteries while none of the controls showed this change. The presence of degenerated and necrotic smooth-muscle cells was verified at the ultrastructural level. Furthermore, modified smooth-muscle cells appeared in the intima and the media and were probably of significance for the synthesis of the increased amounts of collagen and mucopolysaccharides that could be demonstrated. Ultrastructurally evidence of calcification could be demonstrated in the internal elastic membrane and in necrotic areas in the intima and the media. In the latter localization the calcification process seemed to start in relation to extracellular vesicular structures, probably representing cell debris. The possible significance of the observed changes for the development of symptom-giving arterial disease is discussed.


Healing of jejunal fistula using a silicone tube and patch. In this case report is described a method of healing jejunal fistula by temporary use of a silicone tube and finally closing the defect in the intestinal wall by using a silicone patch. The patient was treated with parenteral nutrition during 7 months.


Glycosylated hemoglobin concentrations in patients with diabetic neuropathy. Glycosylated hemoglobin (Hb) concentrations were measured in 50 patients with clinically significant diabetic neuropathy. There were 24 males and 26 females with a mean age of 58.1 years and a mean duration of diabetes of 8.9 years. The glycosylated Hb concentration was not significantly different in these patients (13.9% +/- 2.4 SD) compared with randomly selected diabetic patients matched for age (+/- 5 years), sex and therapy without clinical evidence of neuropathy (13.6% +/- 2.2). There was no significant difference in the duration of diabetes between the two groups. The results would suggest that factors other than the degree of control of diabetes are important in the pathogenesis of diabetic neuropathy.


Study of bladder function in patients with prediabetes, latent diabetes, recent onset diabetes and juvenile diabetes. We have studied the vesical function in 4 prediabetics, 11 latent diabetics, 11 recent onset insulin dependent diabetics and a control group of 6 normal individuals. We found in recent onset of diabetics disturbances of cystometric parameters in a statistically significant proportion. This proportion increases with the evolution of diabetes. The difference in sensitivity to cold water that we found betwee SDB and NBD was statistically significant, so the denomination 'hyposensitive bladder' is well applied in this fist phase of vesical neuropathy.


Serum amino acids in hepatic encephalopathy--effects of branched chain amino acid infusion on serum aminogram. Encephalopathic patients with cirrhosis of the liver consistently showed elevated levels of the aromatic amino acids, phenylalanine, tyrosine and free tryptophan as well as methionine in serum, whereas levels of the branched chain amino acids, valine, leucine and isoleucine, were depressed. Comatose patients with fulminant hepatitis had markedly elevated levels of all amino acids, the results being greatly different from those of cirrhotic patients. Molar ratios of (valine + leucine + isoleucine)/(phenylalanine + tyrosine) decreased both in cirrhotics with and without encephalopathy and in cases with fulminant hepatitis. Infusion of a commercially available L-amino acid solution in a cirrhotic patient induced a strikingly abnormal aminogram documented in hepatic encephalopathy. Therefore, effects of branched chain amino acid infusion on the deranged amino acid pattern were primarily studied for the purpose of improvement in hepatic encephalopathy by normalization of serum amino acid patterns. Elevated levels of the aromatic amino acids and methionine could be apparently depressed in a cirrhotic patient by this type of infusion but not in a case of fulminant hepatitis probably because of the poor utilization of these amino acids in severely impaired liver.


Effect of glucose and insulin on protein and basement membrane synthesis in isolated glomeruli of diabetic rats. In incubation experiments with isolated glomeruli, an increased synthesis of protein and basement membranes was detected in diabetic rats compared to metabolically healthy controls. Different glucose concentrations in the incubation medium and insulin did not influence protein and basement membrane synthesis of nondiabetic glomeruli. On the other hand, in diabetic glomeruli the synthetic activity depends on glucose concentration. Insulin had a stimulating effect on protein and basement membrane synthesis diminished at lower glucose concentration. The increased synthetic activity demonstrated at higher glucose concentration was not inhibited by insulin.


Hepatitis-associated antigen in patients with liver diseases and in rural population of Iran. Increased incidence in men. Using the counter-immunoelectrophoresis technique, the presence of HBsAg was determined in sear of 227 cirrhotics, 132 patients with acute hepatitis, and 254 apparently normal villagers and 220 hospital personnel in Southern Iran. Findings show a very high frequency of antigenemia in cirrhotics as compared to the apparently normal population. Of interest was the male predominance of antigenemia both in cirrhotics (50% vs. 27%) and normals (2.1+ vs. 0.4%) but not in patients with acute hepatitis (42.6% vs. 32.8%). This data suggests the importance of HB antigenemia in the pathogenesis of postnecrotic cirrhosis in Iran, and the importance of male predisposition for the development of the carrier state in either healthy or cirrhotic individuals.


Differential diagnosis, laboratory tests and histology in 245 patients with cholestasis. In the course of 4 years, among 11,738 admissions there were 245 (2.08%) patients with cholestasis (106 women and 139 men). Intrahepatic cholestasis (i.c.) was detected in 46.5%, and extrahepatic (e.c.) in 53.5%. The most frequent cause of i.c. were alcoholic and nonalcoholic chr. liver disease (fatty liver, chr. hepatitis, cirrhosis) (37% and 30%), acute viral hepatitis (15%) and toxic liver injury (14%) respectively. The causes of e.c. were: choledocholithiasis (44%), cancer of the pancreatic head (15%), cancer of gallbladder and extrahepatic ducts (12%) and cancer of liver (10%). The causes of c. were benigne, in 78.2%, while malignant neoplasms were present in 21.8%. Out of the multitude of laboratory tests two appeared particularly significant: glut, transpeptidase was pathologic in 81% of alcoholic liver disease, in 62% of the cases with obstructive jaundice and in 27.7% of malignant neoplasms. LX-lipoprotein examined in 52 patients was positive in 24% of i.c., and 60% of e.c. Proliferation of bile ducts was the most frequent finding in surgical liver biopsies in choledocholithiasis cases.


Esophageal dysfunction in diabetes mellitus. Detailed roengenological examinations of the esophagus were carried out in 110 diabetics and 130 controls. In 50 (45%) diabetic patients functional abnormalities were detected. Wavy esophageal contours, irregular spontaneous contractions and functional diverticula were observable. In diabetes, these changes occurred at an earlier age and more frequently than in controls. Esophageal transit time was markedly prolonged. The clinical symptoms of dysphagia were usually mild or absent. Diabetic dysphagia is one of the manifestations of diabetic visceral neuropathy. It is attributed mainly to the diabetic damage of the vagus nerve.


The influence of somatostatin on the absorption of triglycerides in partially gastrectomized subjects. Serum triglyceride levels were measured in 10 partially gastrectomized patients after an oral fat load of 100 g. Postprandial triglyceride elevation was completely blocked by somatostatin infusion. This depression cannot be an effect of delayed gastric emptying, because all our patients were Billroth-II operated, but is considered to be due to a direct effect of somatostatin of intestinal absorption.


Altered glucose tolerance in carbon disulfide exposed workers. Oral cortisone glucose tolerance tests were performed in 66 CS2-exposed workers and in 66 individually matched control subjects. Results indicate a higher and significant (p less than 0.001) prevalence of latent diabetes in the CS2-exposed group (72.7%) as compared with the control group (16.7%), and the existence of a positive and significant (p less than 0.001) correlation between blood glucose values and exposure index. Possible mechanisms of action involving zinc metabolism and pyridoxine metabolism are discussed.


The effect of glucagon on the blood levels of gastrin, insulin and glucose in patients with gastric and duodenal ulcers. The blood serum levels of gastrin and insulin and arterial blood levels of glucose were determined immediately before intravenous injection of 1 mg of glucagon, and 10, 20, 40 and 60 minutes later in 12 gastric ulcer patients, 14 duodenal ulcer patients and 12 controls using the radioimmunological and orthotoluidine methods respectively. Following glucagon administration the gastrin levels dropped in the controls and the gastrin patients, and increased in the duodenal patients by an average of 30%. Insulin levels increased in all three groups, but the increase was statistically significant in the two patients groups. Glucose levels in the blood also increased with no significant differences between the groups. It is suggested that the different effect of glucagon on gastrin levels may be due to gastrin-insulin interaction; the levels of the two hormones in the blood of duodenal patients were higher than in the other two groups studied.


Insulin responsiveness of adipose tissue from normal weight subjects with early diabetes. In normal weight subjects, classified by a 2-h glucose infusion test as having normal (11), borderline (3) or pathological (9) carbohydrate tolerance (CHT), subcutaneous adipose tissue was removed under intracutaneous anesthesia by surgical biopsy. The biological responsiveness of isolated adipocytes as well as adipose tissue fragments measured as incorportion of (1-14C) glucose into CO2 or triglycerides was studied in the absence or presence of different insulin concentrations. In persons with normal CHT the insulin-stimulated (62.5 microU/ml) glucose conversion to CO2 by adipocytes as well as fat pads increased significantly up to 156 +/- 14% and 285 +/- 30%, respectively. Insulin enhanced the glucose incorporation into triglycerides up to 154 +/- 20% (fat cells) and 258 +/- 30% (fat pads) in adipose tissue from subjects displaying a normal CHT. Rates of glucose oxidation and triglyceride synthesis was markedly reduced in adipose tissue obtained from patients with borderline or pathological CHT. A significant positive relationship was found between glucose oxiation to CO2 and triglyceride production of fat cells and fat pads (r = 0.964 and 0.783, respectively). There was no correlation with responsiveness of adipose tissue to insulin and insulin secretion during glucose infusion test. The results indicate that sensitivity to insulin of target cells might be important for the development of carbohydrate intolerance also in normal weight subjects.


Parotid salivary gland function in patients with exocrine pancreatic insufficiency. Parotid function tests were performed on 12 patients with pancreatic insufficiency due to chronic pancreatitis. The concentrations of sodium and bicarbonate in stimulated parotid juice were reduced compared to controls (p less than 0.001). The secretion of 75Se-selenomethionine by the parotid salivary gland and exocrine pancreas following a Lundh test meal was measured in 12 patients with normal pancreatic function and 16 patients with exocrine pancreatic insufficiency. Eight of these patients had chronic pancreatitis both parotid and pancreatic secretion of the isotope were impaired. In pancreatic carcinoma the pancreatic excretion was impaired with no significant impairment of parotid secretion. The combined pancreatic/parotid radio-selenium test may be useful in differentiating between chronic pancreatitis and pancreatic carcinoma as the cause of pancreatic insufficiency.


The action of potato inhibitors on activation of zymogen forms of digestive system proteases. The potato inhibitors of proteases inhibit the activation of trypsinogen, chymotrypsinogen, proelastase, procarboxypeptidase A and B induced by trypsin. These inhibitors do not inhibit the activation of trypsinogen induced by enterokinase. Potato inhibitors have no influence on pepsinogen autoactivation and on pepsin activity.


Achlorhydria and benign gastric ulcer.

Achlorhydria and benign gastric ulcer. A 76 year-old man with a benign gastric ulcer and pernicious anemia is reported. The etiology of the ulcer is unexplained.


Pneumatosis cystoides intestinalis. A statistical study of 919 cases. Pneumatosis cystoides intestinalis, an uncommon disease characterized by the presence of gaseous bubbles in bowel wall, is studied by a review of 919 cases of the world literature. The subserous cysts are more frequently found in the small bowel while the submucous localizations are predominant in the colonic wall. The disease, occurring more frequently in males than in females, is associated with several other lesions: pyloric stenosis and scleroderma for small bowel pneumatosis, chronic cardiopathies and dolichocolon for colonic localizations. Jejunoileal bypass for morbid obesity is an increasing iatrogenic cause. Diagnosis is based on radiology and endoscopy with biopsy but is not yet correctly done in many cases. The treatment is essentially medical.


Enzyme induction in man: a study of the inducible systems of drug elimination. The individual enzyme inducibility was studied with methods of menthol loading and sulphobromophthalein in groups of patients with low and average metabolism. Both methods are suitable for testing inducible conjugation systems by providing indirect information on the rate of drug elimination. In the low-metabolism groups the response in per cent correlated inversely with the initial value, and the changes were significant not only in the low but also in the average-metabolism group at the end of 30 days of phenobarbital treatment. The results are discussed with regard to the avoidability of undesired drug effects.


Enzyme-inductive effect of a hypolipidemic compound N-bis-(p-chlorophenoxy)-acetyl-urea in man and rat. Besides its antilipidaemic effect, the new clofibric acid derivative (N-bis-(p-chlorohenoxy)-acetyl-urea) has an enzyme-inductive effect. The drug was administered (100 mg/kg orally) to male, Wistar rats for three days. The treatment raised the weight of the liver, the content of liver microsomal protein and cytochrome p-450 and shortened the hexobarbital sleeping time. The increase of cytochrome p-450 dependent biotransformation was found by in vitro methods in 9000-g supernatant of liver homogenate. There was a growth in biotransformation of substrates of type I (ethylmorphine, aminopyrine) and an extreme increase in reduction of nitrobenzene. We did not find any change in biotransformation of the type-II substrate aniline. In 16 patients suffering from Gilbert's syndrome, there was a decrease in the level of serum bilirubin, and increase of D-glucuric-acid output in urine and bromsulphophthalein transport maximum following the treatment of this drug given in 150 mg/day orally for three weeks. After this treatment, the level of gamma-glutamyl-transpeptides did not change. The authors highly recommend the serious consideration of metabolic interaction during the clinical application.


Diagnostic and therapeutic aspects of splenectomy in syndromes associated with hypersplenia. The value of splenectomy is assessed from diagnostic and therapeutic viewpoints in a series of 80 patients with various syndromes marked by hypersplenia. In the congestive type of splenomegaly, splenectomy resulted in complete normalization of the blood picture in all cases but one, and in primary splenic congestion it even proved curative in the majority of the cases. In leukaemia, non-Hodgkin's lymphomas, in myelofibrosis, and first of all in immuncytopenia, splenectomy was also of benefit, and had generally a palliative effect in non-autoimmune hypersplenia as well. In non-haematological syndromes associated with hypersplenia, namely, splenic tuberculosis, Boeck's sarcoid, SLE, haemorchromatosis and splenic vein thrombosis, splenectomy had generally a  palliative, and combined with other therapeutic measures, a curative effect, depending on the primary disease. In a number of patients with hypersplenia associated with splenomegaly, it was only with the aid of splenectomy that the primary disease could be diagnosed.


Measurement of blood loss by total-body counting on the basis of calculated and predicted blood volumes. Blood loss was measured by total-body counting in conformity with the fall in activity, the calculated or predicted blood volumes being known. On the ground of the predicted and calculated blood volumes it was the Nadler formula which gave the best approximation. The method was employed for the measurement of blood loss in users of intrauterine contraceptive spirals. It was found suitable for the measurement of a sudden blood loss of major intensity.


Clinical aspects of carotid sinus hyperaesthesia. Carotid sinus hyperaesthesia (CSH) was found in 605 of the clinical cases observed by the authors in a 6-year period. In the patients with CSH, disorders of impulse formation and conduction, both at rest and in response to the carotid compression test, were prevalent. No relationship was demonstrable between the duration of carotid compression and the consequent rhythm disorders. Nor did the vascular state of the CSH patients affect the type, duration or severity of arrhythmia elicited by carotid compression. In 8 cases of CSH unilateral carotid sinus infiltration with lidocain was performed with the objective of pharmacological denervation. Predominance of sympathicotonia induced in this manner was not found to be provocative of arrhythmia. Sensitization of the carotid sinus reflex in response to i.v. administration of 0.5 mg digoxin was confirmed on the evidence of clinical investigations.The results thus obtained are primarily attributed to a decreased sympathetic efferentation.


Study of the renin-angiotensin system in essential hypertension. 320 patients with essential hypertension divided into three groups (minor, medium and major severty) were studied against 50 normal controls. Plasma renin activity (PRA) was estimated in case of normal and low Na intake, furthermore, of low Na intake in association with administration of chlorothiazide, in the recumbent position as well as at the end of 4-hr walk. The hypertensive group of medium severity (Group II) revealed a significant decrease in PRA, compared with the controls and with the hypertensive group of minor severity (Group I), in each period of observation. A significant increase of PRA in response to insulin hypoglycaemia was demonstrable in all three groups and in the controls, but the increase was of significantly lesser degree in Group II than either in the controls or in Group I. The plasma catecholamine concentrations were found lower in Group II than in the controls and in Group I. An elevation of the plasma catecholamine levels was demonstrable in response to insulin hypeglycaemia, but it was of lesser degree in Group II than a Group I and in the controls. The poor responsiveness of the RAS in Group II is attributed to an inadequate adrenergic activity and to an increased mean arterial pressure in that group, but the higher age of patients and longer duration of hypertensive disease, both characteristic of the group of medium severity, may also effect the renin-angiotensin system.


A survey of nurse anesthetists--1977 a condensed review: part I. This review focused on the results of a survey conducted in December, 1977 by the Council on Practice. The purpose of the survey was to provide information concerning trends in the practice of nurse anesthesia and the professional milieu in which it is carried out. Questionnaires were snet to 14,344 members of the AANA; (Table XIX) 5,980 usable surveys were returned for a final response, a rate of 41.7%. The data obtained from this survey will be used by the AANA to develop future programs to meet the continuing and emerging needs of its members and to improve anesthesia services to the public.


Ratio of inferior olivary cells to Purkinje cells in a marsupial (Trichosurus vulpecula). An indirect estimate of the extent of branching of the olivary axons in the cerebellum in a marsupial (Trichosurus vulpecula) was carried out. The cells in the inferior olivary nuclear complex (IOC) of both sides were estimated (mean = 57,200), as were the cerebellar Purkinje cells (mean = 881,300). Assuming that all climbing fibers arise from IOC cells and that each Purkinje cell receives a climbing fiber input, each IOC cell sends climbing fiber terminals to 15 Purkinje cells.