High potassium-induced, calcium-dependent monoamine release from brain slices of the newborn rat. To determine the functional significance of monoamines taken up into the newborn rat brain, a high K+-induced, Ca2+-dependent release of noradrenaline (NA), dopamine (DA) or serotonin (5-HT) from brain slices of the newborn rat was investigated and compared with that of the adult animal. Depolarization by increasing the potassium concentration in the medium induced the release of L-[3H]NA,[3H]DA or [3H]5-HT from brain slices prelabelled with the radioactive monoamines in the 2-day- or 3-day-old rat as well as in the adult. The release of three [3H]amines was markedly inhibited by perfusing with Ca2+- free medium in the presence of EGTA (2.0 mM) at both newborn and adult stages, although the inhibitory potency of Ca2+- deficiency in the newborn preparation was lower than in the adult. The degree of the release against [3H]amines initially taken up in the newborn was of the same order of magnitude as those in the adult. It is suggested that NA, DA and 5-HT are stored in a functionally releasable pool of the nerve terminals of the central monoamine neurons in the rat and that these compounds act as neurotransmitters at birth and at the adult stage.


Interaction between aspirin and prostaglandins in the isolated guinea-pig tracheal muscle. The effects of PGE2 and PGF2 alpha on the tonus of isolated guinea-pig tracheal chain were investigated and compared with those of histamine and acetylcholine. PGE2 reduced tonus in normal resting state, but elevated tracheal tonus reduced by aspirin. Such PGE2-induced contractions did not exceed the initial resting tonus, and the magnitude and duration of the contractions progressively diminished with increase of PGE2 concentrations. Aspirin produced neither relaxation nor contraction in the presence of a low dose of PGE2. Unlike PGE2, PGF2 alpha produced a dose-related contraction in the normal tracheal chain, and the contractile response to PGF2 alpha was markedly potentiated by aspirin. In the presence of PGF2 alpha, aspirin no longer produced tracheal relaxation but produced a dose-related contraction. The contractile effect of histamine but not of acetylcholine was also potentiated by aspirin, but there was a slight difference between PGF2 alpha and histamine in that the potentiation of action of PGF2 alpha by aspirin was more easily diminished by PGE2. These results suggest that PGE2 plays an important role in the maintenance of the resting tonus of the isolated guinea-pig tracheal chain, and in large doses it also acts as a tracheal relaxant and attenuates the tracheal responses to PGF2 alpha and histamine.


[The importance of the plasmatic blood clotting system in the early stages of arterial thrombogenesis (author's transl)]. Apart from today's concept of arterial thrombogenesis, a mechanism of the early events in arterial thrombus formation is proposed, which also includes recent insight into the nature of the blood vessel wall and its interaction with the plasmatic blood clotting system. Observations have accumulated indicating that at the site of lesions of the interior vessel lining thromboplastic activity does appear to induce local thrombin formation. Under conditions of high arterial blood flow thrombin interacts with platelets culminating in the formation of a white thrombus. Based on these considerations, which in part may still be speculative, the possibility may evolve to develop a new highly specific prophylaxis and therapy of arterial thrombosis.


[Angioimmunoblastic lymphadenopathy and persistent virus infection? Discussion of immunohistological findings on two cases (author's trsnsl)]. The presence of rubella virus antigen was demonstrated by means of immunohistological methods in two cases of angioimmunoblastic lymphadenopathy. One patient had elevated serum anti rubella titer and myocarditis. These findings support the idea that angioimmunoblastic lymphadenopathy develops as a combined effect of persistent virus infection and partial immune deficiency.


[On circadian variations of the placebo effect on the pain threshold of healthy teeth: Contribution to a physiology of placebo effects (author's transl)]. Placebo doses can influence the pain threshold of healthy teeth according to the label. Systematic longitudinal researches over the day with measuring the utilization time of cold stimulus on healthy front teeth demonstrate that the placebo effect is subject to significant circadian variations. During daytime a pseudo-analgesic causes a stronger and steeper onset of increase of the tooth pain threshold than during the night, when the pain threshold is influenced only minimal or even inverse. The placebo effect can come up to 40% of the pain threshold increase caused by a usual analgesic; this portion, however, is as well subject to high circadian variations. The extent of the placebo effect corresponds to the order of magnitude of the spontaneous circadian variations of pain threshold and correlates positively to it. These correlations are considered as indicating that those vegetative mechanisms causing the circadian variations of the pain threshold are equally involved in affecting the placebo actions.


Hemoperfusion in chronic schizophrenics: a critical report. Ten chronic schizophrenic patients were treated with hemoperfusion on a weekly or twice weekly basis for 6 to 10 weeks. Two of the patients improved markedly, while the condition of three of them deteriorated. These findings indicate that this method might not be of general usefulness in the treatment of chronic schizophrenic patients.


Hallucinogenic plant use and related indigenous belief systems in the Ecuadorian Amazon. This review article focuses on the on-going use of plant hallucinogens, especially various Banisteriopsis species, among contemporary aboriginal populations of Ecuador. It surveys the evidence of prehistoric ayahuasca use by interpretations of Ecuadorian archaeological remains, and surveys in detail the use and belief systems connected to major plant hallucinogenic use among the Jibaro Indians and other tribal groups. A secondary theme includes coastal and Inter-Adnean aboriginal drug use. The article stresses the interrelatedness of aboriginal belief systems, folk medicine and world view linked to plant hallucinogenic ingestion.


Coca pests and pesticides.

Coca pests and pesticides. The major pests of coca are listed and discussed along with methods used to control them in the past and present. Results of analyses for pesticide residues in samples of commercial Peruvian coca leaves are presented. Levels of pesticides found in these samples are too low to be considered a medical risk to coca chewers.


Evidence of an ethnomedical form of aversion therapy on the United States-Mexico border. Ethnographic data are presented on the use of a seed, haba de San Ignacio (Hura polyandra L. and Hura crepitans L.) to promote an aversion to the consumption of alcohol by problem drinkers in Mexican American and Mexican national populations on the United States-Mexico border.


Anatomical study of the pulmonary lymphatics. As the result of anatomical as well as histological investigations on the lymphatics of the human lung, the authors have arrived at the following conclusions: 1. According to the distribution and the direction of lymph flow, pulmonary lymphatics are classified into two systems and four groups. 2. The lymphatics cannot be found in the interalveolar septum. 3. The extravascular fluid pathway system plays an important role for cleaning particles in the most peripheral part of the respiratory tract where no lymphatics are found. 4. Efferent lymph flow reaches the venous angles via two routes on both sides respectively.


The flow and composition of pulmonary and systemic lymph in dogs with edema. In animals with edema, pulmonary and systemic lymphatics may function to remove accumulated extravascular fluid in addition to responding to events as they occur in the exchanging vessels. We tested this hypothesis by measuring the flow rate and composition of thoracic duct and right duct lymph in anesthetized dogs made edematous by rapid fluid infusion. During a fluid challenge equivalent to 30% of body weight, thoracic and right duct lymph flow rates increased 30- and 60-fold, respectively. After the infusion, lymph flow rates rapidly decreased even though the dogs were edematous. During the postinfusion period, the decrease in right duct lymph flow rate was directly related to a decrease in estimated net pulmonary fluid filtration pressure. We conclude that lymph flow rate and composition reflect events occurring in the microvasculature whether or not edema is present.


Pulmonary oxygen toxicity: increased microvascular permeability to protein in unanesthetized lambs. To study transvascular filtration of fluid and microvascular permeability to protein in the lung during prolonged hyperoxia, we measured lung lymph flow, protein transport, and simultaneous pulmonary vascular pressures of six lambs breathing 100 percent O2 for five days. Lymph flow doubled, protein flow increased by 131 percent, and radioactive tracer studies demonstrated a clearcut increase in pulmonary microvascular permeability to protein after five days of continuous O2 breathing.


Distribution of interstitial compliance and filtration coefficient in canine lung. Utilizing a modification of the isogravimetric methodology, we have estimated the perivascular interstitial compliance and filtration coefficient in the canine lung. These values averaged 1.8 g/cm H2O and 34 (g/h)/cm H2O, respectively, per 100 g lung wet weight. By studying lungs at both low and high states of inflation (where the alveolar septae are collapsed) we were also able to determine the spatial distribution of both the interstitial compliance and filtration coefficient. We estimate that of the above total interstitial compliance a maximum of 55% is around alveolar septal vessels, 20% around extra-alveolar arteries and 25% around extra-alveolar veins. Of the above total filtration coefficient, 50% represents filtration from alveolar septal vessels, 23% from extra-alveolar arteries, and 27% from extra-alveolar veins. Our results imply that there are finite interstitial compliances communicating with all permeable vessels. Significant pressures can be built up in these spaces, thereby acutely limiting the further formation of interstitial edema.


Pulmonary transvascular fluid dynamics in sheep during hemorrhage. The effects of hemorrhage on pulmonary hemodynamics and lung transvascular fluid dynamics were studied in sheep. We found that 2 hr of hemorrhage caused a fall in lung lymph flow (p less than 0.05) and no significant change in lymph protein concentration. The fall in lymph flow was not due to decreased vascular surface area since the regional distribution of pulmonary perfusion was not altered during hemorrhage; however, the decrease in lymph flow was associated with decrease (p less than 0.05) in the calculated pulmonary microvascular pressure. The extravascular lung water lung content per g bloodless dry lung was increased (p less than 0.05) in the hemorrhaged sheep from the control values. Pulmonary edema was not due to increased lung vascular endothelial permeability since the net transvascular protein flux was not increased. The finding that pulmonary edema occurred despite the consistent decreases in lymph flow suggests that edema may be due to hemorrhage-induced lymphatic "failure" or that edema fluid is sequestered in spaces (e.g., endothelial cells) where if cannot be drained by the lymphatics.


Lactic dehydrogenase activity in lung lymph during hemorrhagic shock, resuscitation and recovery. Lactic dehydrogenase activity was determined in lung lymph before, during and after hemorrhagic shock to determine if this insult produced pulmonary cellular damage. Lung lymph flow and lymph protein content, reliable indices of fluids filtration rate and microvascular protein permeability were also monitored. The experiment was performed in unanesthetized sheep with a chronic lung lymph fistula. Lymph flow, lymph LDH and protein content did not change during the period of shock. Lymph flow increased significantly during resuscitation but lymph LDH and protein content decreased in relation to plasma values indicating the sieving effect of the microvascular membrane for protein to be intact. The increased flow was most likely caused by an increase in microvascular hydrostatic pressure. Plasma LDH was significantly increased during the 72 hour recovery period with lymph flow, lymph protein and lymph LDH being normal. We therefore found that hemorrhagic shock produced a systemic cellular injury reflected in an increased plasma LDH activity. No pulmonary cellular damage was noted.


Morphological and physiological study of the effect of histamine on the isolated perfused rabbit lung. Histamine causes interstitial pulmonary edema, but whether this is the result of an increased permeability of the pulmonary circulation or only of the bronchial circulation remains to be determined. In order to selectively study the effect of histamine on the pulmonary circulation, we used an isolated perfused rabbit lung preparation because in this species, the bronchial circulation is poorly developed. Edema formation was assessed by continuously monitoring the weight of the lung perfused at constant pressure. These studies were supplemented by electron microscopic observations using hemoglobin as an ultrastructural tracer for microvascular permeability. We found that histamine (8.0 microgram base/100 ml of perfusate) did not cause lung weight to increase. Ultrastructural studies showed that histamine, at this dosage, did not cause a greater leakage of hemoglobin that occurred in the control lungs. Thus, we have concluded that histamine does not increase the permeability of the pulmonary microcirculation in the isolated perfused rabbit lung.


Vertical gradient in regional vascular resistance and pre to post capillary resistance ratios in the dog lung. The ratios of pre-capillary (Ra) and post-capillary (Rv) resistances to total vascular resistance (RT) were measured at different vertical distances in the lungs of supine dogs. Capillary pressures were estimated as the algebraic sum of the alveolar absorption pressure for Tyrode's solution and the plasma colloid osmotic pressure. Segmental resistance fractions (Ra/RT, Rv/RT) were calculated using the pressure drops between arterial, capillary, and venous pressures at each vertical distance within the lung. In a second group of animals, total vascular resistance was calculated at each lung level using regional blood flow as measured by radiolabelled microspheres and the corresponding regional vascular pressures. The total vascular resistance was lowest in Zone III portions of the lung, but Ra/RT and Rv/RT were constant throughout this zone (n = 22) averaging .63 +/- .02 (SEM) and .37 +/- .02 (SEM, respectively, resulting in Ra/Rv of 1.70). Total vascular resistance increased markedly in Zone II portions of the lung, but the relative contribution of Ra/RT decreased from .62 +/- .07 (SEM) to .45 +/- .05 (SEM). Thus Ra/Rv decreased from 1.70 to .82 in Zone II. The absolute values of pre- and post-capillary resistances were lowest in Zone III but post-capillary resistance increased to a greater degree than pre-capillary resistance up Zone II.


On the existence of stretchable pores in the exchange vessels of the isolated rabbit lung preparation. In the present work our aim has been to seek evidence for or against the existence of stretchable pores in the exchange vessels of the lungs. In isolated rabbit lungs ventilated by positive pressure and perfused with homologous blood we performed repeated tests with fluid filtration from the exchange vessels. In these tests the outflow pressure was elevated to specific values for periods of 6 min. The rate of weight gain of the preparation during the last 2 min of each test period was taken as the rate of fluid filtration from the exchange vessels. We found a linear relationship between rate of filtration and outflow pressure in the range from 5 to 20 mm Hg. This indicates that the hydraulic conductivity of the exchange vessels did not change with outflow pressure and thus that no pore stretching occurred within this pressure range. An abrupt increase in filtration rate took place when the outflow pressure was set at 25 or 30 mm Hg. The hydraulic conductivity of the exchange vessels was therefore probably increased at these high pressures. Since in 3 lungs this increase in filtration rate was fully reversible we suggest that a stretching of pores in the exchange vessels of the lungs contributed to the increase in hydraulic conductivity. This stretching of pores occurred only when vascular pressures were at or above the upper level of the physiological pressure range for the lungs.


Fibrinogen clearance from the pulmonary interstitium. Previous experiments demonstrated that 125I-human fibrinogen (125-RIF) instilled into the distal airway of the right lower lobe in intact dogs passed through the microairway into the interstitium. This report analyzed the subsequent interstitial clearance of this fibrinogen by analyzing plasma and lymph samples for 125I activity. This activity was separated into clottable, and trichloroacetic acid (TCA) insoluble and soluble components. Clottable and TCA-insoluble 125-RIF in the same ratio appeared in lymph from the right lymphatic duct (RD) and thoracic duct (TD). From standard mixing equations we calculate that 1.4 times as much lymph from the right lower lobe flows into the TD as into the RD. With one exception, clottable 125-RIF appeared in plasma only in the absence of an RD; this suggested the presence of accessory lymphatico-venous communications rather than back flux of 125-RIF at the capillary wall. By injecting 131I-human fibrinogen intravenously, we observed a small reduction in clottability (maximum of 10%) in lymph both from the RD and TD. Equilibration in RD lymph was only 1/5 as fast as albumin, and from the measured equilibration rate constant, and the assumption that interstitial fibrinogen clearance is entirely convective, we estimate that the pulmonary interstitial distribution volume for fibrinogen is 70% that for albumin. Non dialyzable 125-RIF products generated in the distal airway adhered to intracapillary, circulating erythrocytes. These products retained fibrinogen antigenicity, and appeared to be further degraded in the vascular compartment.


Equilibration of intravascular albumin with lung lymph in unanesthetized sheep. In 16 unanesthetized sheep with chronic lung lymph fistulas we measured pulmonary vascular pressures, lymph flow, lymph and plasma total protein and albumin concentration. We determined the rate of equilibration of radioiodinated albumin between plasma and lung interstitial fluid (lung lymph) in three steady-state conditions; baseline (n = 14), increased pulmonary microvascular pressure (n = 9) and increased microvascular permeability (n = 4). The tracer protein equilibration proceeded according to single compartment wash-in kinetics in all experiments. Lung lymph flow averaged 5.3 +/- 2.8 (S.D.)ml/h under baseline conditions, 16.1 +/- 10.6 ml/h during increased pressure and 37.3 +/- 29.4 ml/h during increased permeability. The half time of equilibration averaged 2.9 +/- 1.0 h, 2.2 +/- 1.0 h and 0.7 +/- 0.2 h, respectively. Lung interstitial fluid equilibrates with plasma proteins more rapidly than most other organs. The marked difference between increased permeability and the other conditions demonstrates the sensitivity of this method. No evidence was obtained that any tracer protein entered lung lymph within the caudal mediastinal lymph node.


Errors in a computerized medical records system (CLINICS). The accuracy of computer-held medical information can be of critical importance in patient care, therefore it is important not only to know the error rate in the stored data but also to know the effectiveness of error checking and correction programs. This paper reports on the errors which were detected by checking the consistency between stored data and incoming data (context checks), in Southampton University Primary Medical Care computer system (CLINICS). The majority of detected errors were traced either to the registration of new patients or to the doctors failing to pay adequate attention to detail in their record keeping (or to their legibility). 7% of incoming data had errors detected by the context checking program and subsequently corrected; we calculate that the stored data contains less than 1% in error.


A computer-aided interactive procedure to improve nurse-training programmes. Nurses represent the largest single resource in terms of numbers of staff employed as well as the revenue cost within the National Health Service. As trainee nurses constitute about 30% of the nursing staff and in some cases provide more than 60% of the bedside care, the effective design of nurse training programmes must receive considerable analytic attention. A computer-aided interactive procedure is described which enables senior nursing administrators to evaluate and improve, from service point of view, a given nurse training programme.


The problems of transferring software: a medical case history. This paper discusses the problems which arose in the transfer of a Pathology Laboratory data-base system from a CTL Mod 1 computer to a Ferranti Argus 700E computer. Both systems were programmed in CORAL-66. Definition of the analytical tests, the wards and clinics and G.P.'s addresses serviced by the laboratory proved to be a much larger task than had been anticipated. The mirroring of the comparative facilities of the two hardware systems is also described.


Medical audit and reliability control of cranial computer tomography. A long-term documentation is presented which serves different quality-control mechanisms in computer tomography (CT) reporting. Developed by co-operation between different departments of the Hannover Medical School it has been based on 1000 CT reports and the experiences gained from them. The modular straightforward design makes the system applicable for routine documentation as well as for scientific investigations. It allows easy statistical analysis of the data gathered and can be used as a differentiated master file for special investigations, for example pattern-recognition procedures on the original data matrices. With regard to medical audit it allows the patients who really need it, access to the limited CT capacity.


MUMPS as an education tool.

MUMPS as an education tool. The department of Medical Informatics at the Free University is, in addition to research, responsible for the education of medical students in medical-information processing. The Department has a PDP 11/70 running part-time under MUMPS-11 V4B, and since 1978 has had a PDP 11/60. A set of medical education programs has been developed consisting of: (a) A simple introduction to MUMPS. (b) A patient-census module. (c) A neonatal module. (d) A dental data-base. In this paper the educational programs are outlined and examples of their use are given.


Velocity-diameter relationships of the microcirculation. An analytical expression for the relationship between velocity (and blood flow) and diameter for vessels in the microcirculatory range up to 900 mum diameter is presented. Both the arterial and venous systems are considered. The analytical expression for these relationships has been derived from computer analysis of data obtained from individual measurements reported in the literature. Computer analysis shows that blood velocity is a nearly linear function of diameter of blood vessels for the arteriolar tree. The relationship for blood flow as a function of diameter is Q = 108d3.101 for arteries, arterioles and capillaries in the diameter range 5 to 900 mum and for the venous system in the range 5 to 115 mum is Q = 334d2.388 where Q is in mum3 per second and d is in mum. Comparison of the results of this study for the arterial system to the Hagen-Poiseuille Law reveals close agreement, if correction is made for geometric factors of blood vessels and for the variation of viscosity with diameter for blood.


[Disarticulation in the knee joint (author's transl)]. Based on the results with thirty patients, disarticulation in the knee is to be recommended as a very good amputation level. Two groups of patients seem to be especially suitable for this amputation level: patients with malignant bone tumors of the proximal tibia or fibula and patients with peripheral vascular diseases. Above all, the easy operational technique and the functionally valuable long thigh stump offer decisive advantages as compared with amputation of the thigh. Problems with prosthesis fitting were solved through modification of the socket shape as well as new developments in artificial knee joints.


[Miniaturized methods to monitor intracranial pressure. Technical and clinical results (author's transl)]. The prognosis of numerous diseases of the central nervous system is essentially determined by the intracranial pressure (ICP) and its therapeutic influencing. Long-term monitoring of the ICP must therefore be the objective in neurological and neurosurgical patients at risk. For this purpose, miniaturized methods were tested and developed. To monitor the intracranial pressure in patients who were not operated on, a miniature pressure transducer the size of a match head was used which was directly implanted 'percutaneously' in the intensive care unit: After a stab wound had been made in the skin, a 5-mm burrhole is made; the specially constructed miniature coaxial burr which disengages as soon as it touches the dura automatically enables coplanar epidural implantation of the transducer by means of an adapter capsule. The skin is closed without tension. For monitoring the pressure after trepanation, a spiralled miniature pressure transducer is implanted. The equally flattened receiver with lateral membranes is placed intracranially as desired, e.g., epidurally or subdurally, durin the operation. The zero point can be checked from outside without danger of infection. After the end of the measurements the recorder is easily extracted. Up to the present time, the epidural pressure has been reliably monitored for several weeks by this method in 86 patients. Ten comparative measurements showed corresponding cerebrospinal fluid pressures to within a few mm Hg with very good reproduction of frequency and amplitude. Small zero drift and the external zero control give an accuracy of measurement +/- 5 mm Hg independently of the time of measurement. The measurement permits early recognition of progressive intracranial space-occupying lesions. In 14 patients (16%) a measured rise in intracranial pressure was an essential basis for indication for neurosurgical operations. In addition, the pressure measurement provides an objective assessment of the effect of measures to lower the ICP; progressive increases in intracranial pressure which cannot be influenced conservatively can be brought for surgical decompression in good time before the brain has been irreversibly damaged by pressure. In craniocerebral traumata, monitoring the intracranial pressure permits the differentiation of primary damage to the brain stem with uniform, normal intracranial pressure from secondary constrictions of the brain stem with considerable rise of intracranial pressure and disturbed autoregulation. Only in chronic subdural haematomata are considerable displacements of intracranial masses to be seen with only slightly increased ICP ( less than 30 mm Hg). Besides space-occupying lesions, the measurement of pressure also detects generalised epileptic attakcs due to a considerable rise in intracranial pressure caused by hyperemia. Also disorders of respiration are recognised by supervision of ICP. The procedures described seem suitable for routine monitoring of ICP in patients at risk, with little operative effort and minimum danger...


[Primary carcinoma of the extrahepatic bile ducts (author's transl)]. From 1957--1977 193 patients were treated at the surgical clinic of the University of Tübingen for carcinoma of the extrahepatic bile ducts. Gall bladder carcinoma made up 139 cases; 54 were of bile duct carcinoma. The tumors were no longer operable in two-thirds of the patients with extrahepatic bile ducts cancer. The life expectancy rate of five years for patients with gall bladder carcinoma held for 7%. Up to now only one patient with a bile duct malignancy has survived longer than five years. In the last decade essentially no improvement of median life expectancy has occurred despite improved operating techniques. Due to uncharacteristic, misleading upper abdominal symptoms, patients who suffer gall bladder or bile duct cancer are unfortunately accurately diagnosed only after the carcinoma has overcome organ borders or is already metastatic. There is reasonable hope for improved early prognosis of extrahepatic bile duct carcinoma with ERCP (Endoscopic Retrograde Cholangio-Pancreaticography) and computer-tomography. Because the possibility of a relationship between gall bladder stones and/or the chronic inflammation of gall bladder and bile ducts and the development of cancer is not out of the question, widespread prophylactic cholecystectomy and gall passage cleansing should be employed.


[On diagnosis of heart contusion in blunt thoracic trauma. Investigation in dogs (author's transl)]. The reliability of CKMB for diagnosis of cardiac damage in cases of thoracic contusion is tested in dogs. Results show that increased level of CKMB identificates the risk group of heart contusioned patients early and clearly, so that an continuous supervision of these patients can be established.


[Experimental and clinical employment of an endovenous-myocardiac screwing electrode (author's transl)]. A common postoperative complication following transvenous endocardial pacemaker implantation is the dislodgement and displacement of the electrode. Following trial of a new endovenous-myocardiac screwing electrode in dogs we have tried this electrode since December 1976 on 105 patients, of which 84 cases were implanted primarily and 21 secondarily. The average stimulation threshold was 0.7 V at a pulse width of 1 ms. 6 patients had complications. By making a judicious use of this electrode the rate of electrode dislodgement can be reduced appreciably.


[Pathogen elimination after surgical interventions on common bile duct (author's transl)]. Of 130 bile samples from the choledochus, 64% were positive for bacteria. Different antibiotics were administered according to the susceptibility tests. Colony counts were monitored daily. Beta-lactam antibiotics lead to a more rapid pathogen clearance than the tetracyclines. Antibiotic therapy is discussed especially in older patients and in patients with recurrent interventions on common bile duct. Bile cultures were positive in most of these patients.


[What position does primary scar carcinoma of the lung take in surgical treatment of lung cancer? (author's transl)]. The results of surgical treatment of 295 resected peripheral carcinomas of the lung were analysed by tumor staging and histology. 89 cases of scar cancer of the lung have been compared to 206 peripheral cancers. The overall 5-year survival rate was far less in the peripheral lung cancer group (24%). Best prognosis had patients with tumors without lymph node metastasis or adenocarcinoma in the scar (39--45%). These tumors tend to be slowly progressive and metastasize late. When early characteristic signs can be seen on x-ray examination, lung scars should be followed carefully.


[Anatomical variations of frontal sinus duct system. results of radioresistometric examinations (author's transl)]. With the aid of the authors x-ray examination of radioresistometry the multiple variations of sinus frontalis drainage ways are classified in accordance with the nomenclature of Prott. A simple connection between the frontal sinus and the nose has been found in only one third of cases, in all other cases the drainage ways are divided during the passage of the ethmoideal cell system.


[The transseptal-transsphenoidal approach to the pituitary gland--a common problem of otorhinolaryngology and neurosurgery (author's transl)]. Most of the hypophyseal adenomas can be removed by extracranial operation techniques. The ENT specialist prepares the approach to the pituitary gland while the neurosurgeon will resect the adenoma after having given the indication for this procedure. In this paper special attention is called to one of the extracranial techniques i.e. the sublabial-transseptal-transsphenoidal approach in hypophysectomy. It seems to be more advantageous than the other because the pituitary gland can be exactly removed oppositely. By that way the damage of the sinus, the carotid artery or the optic nerve can be avoided. The possibility of perforation of the nasal septum, deformation of the nose or atrophic rhinitis is of small importance especially if the otorhinologist will prepare the extracranial part of the operation. Moreover the neurosurgeon meets with a great and clear operation area because the anterior wall of the sella turcica can be resected extremely. Besides further advantages discussed in the paper the transseptal-transsphenoidal approach is rather simple, distinct and shortens the operation time.


Phosphatase activity in susceptible and resistant cultivars of Brassica juncea inoculated with isolates of Macrophomina phaseolina and Sclerotinia sclerotiorum. Inoculations with isolates of Macrophomina phaseolina and Sclerotinia sclerotiorum resulted in a significant increase in the acid phosphatase activity of susceptible and resistant cultivars of Brassica juncea, which appeared to be related to the disease reaction of different host-pathogen combinations. After an increase on the 6th day of inoculation there was usually a fall in activity on the 12th and 18th days. Resistant cultivars showed very poor activity in comparison to their susceptible counterparts.


Nutrition and growth of the moderately halophilic bacteria Micrococcus morrhuae K-17 and Micrococcus luteus K-15. Chemically defined media have been developed for the growth of two moderately halophilic bacteria, Micrococcus morrhuae K-17 and Micrococcus luteus K-15. M. morrhuae K-17 grows well in a synthetic medium (SM-1) which contains a number of salts, 0.21 M KCl, 2 M NaCl, D-mannose, five vitamins and ten amino acids. The synthetic medium (SM-2) for M. luteus K-15 contains a number of salts, 0.21 M KCl, 1 M NaCl, D-fructose, nine vitamins and nine amino acids. Nutritional studies show that M. morrhuae K-17 can utilize a large number of organic compounds as carbon and energy source while the ability of M. luteus K-15 in utilizing the organic compounds is rather limited. The minimum salt requirement is 0.5 M NaCl for both strains when growth at the optimum temperature of 30 degrees C. However, this requirement can be lowered to 0.2 M in M. luteus K-15 when grown at a lower temperature of 25 degrees C. It is concluded that the ability to grow in a wider range of salt concentrations in response to temperature is species specific in moderate halophiles. The salt range for growth to occur can be extended when cells of both strains are grown in complex medium which might provide the amino acids and growth factors that cannot be synthesized by these strains at high salt concentrations.


Ultrastructure of the asexual apparatus in Mycotypha (Mucorales). The development of the asexual apparatus of Mycotypha africana and Mycotypha poitrasii observed by means of scanning electron microscopy is reported. Using ultrathin sections and freeze-fracture replicas, sporangiole structure is described. Sporangiospore structure is compared with that of other members of the Thamnidiaceae.


Influence of temperature on ionic sparing effect and cell-associated cations in the moderate halophile, Micrococcus varians var. halophilus. Cells of the moderately halophilic Micrococcus varians var. halophilus grew well in a chemically defined medium containing 1 to 3 M NaCl and 0.0103 M K+. The requirement for NaCl could be partially replaced by K+,:Li+ and Cs+. The efficiency of the sparing effect of these cations for NaCl was in order of K+ GReater than Li+ greater than Cs+. Increase in growth temperature was found to enchance the sparing effect of Li+ and Cs+ but not that of K+. Over the range of NaCl concentrations in which the cells grew well, cell-Na+ concentrations were similar to the medium NaCl concentrations while cellK+ concentrations were several-fold that in the medium. Cell-bound Na+ and K+ concentrations increased proportionally with medium NaCl concentration and growth temperature. The temperature-dependent cation accumulation was more obvious with K+ than Na+. The cell-associated Na+ + K+ concentrations were almost as high as or slightly higher than the external media which contained appropriate levels of NaCl regardless of the growth temperature.


Binding of lectins to membranes of mycoplasmas from aging cultures. The binding of iodinated concanavalin A (Con A) and Ricinus communis agglutinin (RCA) to intact cells and isolated membranes of Acholeplasma laidlawii, Mycoplasma hominis and Mycoplasma capricolum decreased with the progression of the culture from the mid- to the late-logarithmic phase of growth. The binding of the lectins to Acholeplasma laidlawii membranes had no significant effect on membrane fluidity, as assessed by electron-paramagnetic resonance spectroscopy of spin-labelled fatty acids, and had no effect on several membrane-associated enzymic activities. Temperature affected the binding of Con A and RCA in an opposite manner: the binding of Con A increased, whereas that of RCA decreased, on raising the temperature from 4 degrees C to 37 degrees C. No significant difference in lectin binding was found between oleate- and elaidate-enriched membranes at low temperatures where the former was in the liquid-crystalline state and the latter in the gel state, suggesting that membranes fluidity does not influence the binding of Con A and RCA to Acholeplasma laidlawii membranes.


Preventive measure against nitrous oxide induced volume and pressure changes of endotracheal tube cuffs. Endotracheal tube (ETT) cuff volume and pressure changes were studied in patients receiving 70% and 50% nitrous oxide for anaesthesia. ETT cuffs were inflated with either room air or inhalation mixture. There was a significant increase in cuff volumes and pressures in ETT cuffs containing room air compared to insignificant changes in cuffs containing the inhalation mixture during a two hour study period. A simple measure of substitution of air by the inspired anaesthetic gases for ETT cuff inflation is highly beneficial in the prevention of detrimental changes due to excessive increase in cuff volumes and pressure during nitrous oxide administration.


Characterization of multi-layered membrane generated by rabies virus. Electron microscopy revealed multi-layered membranes within the cytoplasmic inclusion (accumulation of nucleocapsids) produced by rabies virus. When infected BHK cells were maintained at 31 C, an enhancement in production of these membranes occurred in approximately 60% of inclusion-containing cells. Multi-layered membranes were composed of an alternate array of two different layers; an electron-dense, thin membrane and a less dense layer which was thicker. SDS-polyacrylamide gel electrophoresis and immune electron microscopy of isolated multi-layered membrane preparations demonstrated that the structures contained viral G and M2 polypeptides. Our observations suggest that these membranous structures are not a degenerative product of rabies virus infection but rather are related to the replication of viral envelope constituents, although they represent themselves to be an abortive form of viral assembly.


[Evaluation of cytophotometric DNA-measurements of samples from the uterine cervix (author's transl)]. Results of DNA-cytophotometric studies of samples from the uterine cervix are evaluated in normal cervical epithelia, inflammation, dysplasia, carcinoma in situ, and invasive squamous cell carcinoma. As to their significance for cytology-automation the results suggest an arbitrary DNA-value in the range of 4.5 to 5 c by which precancerous lesions and invasive squamous cell carcinoma can be distinguished from benign squamous epithelia. Possibly a higher DNA-value is acceptable if larger cell populations are analyzed.


[Drug interaction during therapy with tolbutamide. The influence of some commonly used drugs on plasma level and half life in diabetic out-patients (author's transl)]. Tolbutamide belongs to those drugs responsible for the majority of drug interactions. E.g. Tolbutamide metabolism has been shown to be inhibited by coumarole derivatives. We determined plasma-tolbutamide levels in diabetic out-patients for one year. The results obtained indicate no difference in patients additionally treated with either digoxin or digoxin and alpha-methyldopa, or buformin and phenprocumone as compared with control groups. Interactions with respect to biotransformation should not be expected as far as digoxin, alpha-Methyldopa, or buformine were concerned, since these compounds do not share a common metabolic pathway with tolbutamide. In a different group of patients the elimination half life of tolbutamide under the influence of phenprocoumone was additonally determined. Differences could not be detected. This finding can be explained by means of enzyme-kinetic considerations, since phenprocumone, in contrast to dicoumarole, becomes metabolized according to a first order reaction. Competitive enzyme inhibition with tolbutamide which is metabolized similarly to phenprocoumone, therefore appears improbable.


[The range and lipid-lowering effect of etofibrate as a retard-preparation in patients with hyperlipoproteinemia type IIa (author's transl)]. Patients with hyperlipoproteinemia, type IIa, were treated with an adequate diet; additionally they were given 500 mg etofibrate daily. Within 14 days the total cholesterol-level in serum, LDL and LDL-cholesterol were reduced significantly, whereas the level of HDL was not affected. The potency of etofibrate is equal to approximately 50 to 80% of the lipid-lowering effect of clofibrate in an optimal dosis of 2 g/day.


[Anamnesis of sleep in the internal medicine hospital (author's transl)]. An anamnestic sleep questionnaire was developed with which 41 unselected but seriously ill hospitalised patients in the age of 23 to 71 years (43,7 y.) were investigated. 1. The data analysis suggests that disturbed sleep is an universal problem but it shows significantly in the clinic. The frequently fragmented sleep occurs to be the most important form of disturbed sleep patterns. 2. Answers to often used stereotyped questions on the conditions of sleep are neither correlated to the subjective status nor to objective behavioral datas of sleep. 3. Physical-technical stimulus patterns occur to be of minor importance related to internal conditions in disturbing the sleep. Highly range fear of medical investigation (71%) and expectation of an uncertain future. This underlines the necessity of a psychosocial guidance of hospitalised patients. 4. Accordingly the medication rate of hypnotices and tranquilizers is high-rated; the percentage of patients who are engaged in exercising consciously presomnic behavioral patterns is low. Patients who demonstrate a negative attitude towards soporifics perceive side effects on a significantly larger scale than positively motivated patients. A negative attitude towards these drugs has no behavioral consequences.


Antiemetic effect of intravenous diazepam in patients receiving cis-diamminedichloroplatinum II: a pilot study. A pilot study suggesting the usefulness of intravenous diazepam as an antiemetic for adult patients receiving cis-diamminedichloroplatinum is presented. Observations included 24 patients and 34 courses of therapy. Patients received diazepam and prochlorperazine, and the incidence of vomiting and subjective evaluation of nausea were compared to previous courses of therapy with prochlorperazine alone. A positive response was observed in 87% of the patients. Use of other antiemetics is briefly reviewed.


Combination chemotherapy of colorectal cancer with 5-fluorouracil, methyl-1,3-cis(2-chloroethyl)-1-nitrosourea, and vincristine. The combination of 5-fluorouracil (5-FU), methyl-1,3-cis(2-chlorethyl)-1-nitrosourea (methylCCNU), and vincristine (VCR) has been reported to produce a 43.5% response rate in metastatic colorectal cancer, although subsequent studies did not produce such good response rates. The clinical trial reported here was undertaken to assess the reported results. In 52 evaluable patients the overall response rate was 11%. No complete remissions were observed. Six patients with colon carcinoma had a partial remission lasting for a median of ten months, with a median survival of 15 months. No responses were observed in rectosigmoid cancer. The median survival for nonresponders was 7.5 months. Thirty-three percent of the patients had significant hematological toxicity (while count) less than or equal to 1,000/mm3, platelets less than or equal to 50,000/mm3); 58% of the patients experienced nausea and vomiting; and 32% experienced some degree of neurotoxicity. In our hands the combination of 5-FU, methylCCNU, and VCR produced a response rate of 11% in metastatic colorectal cancer with a considerable amount of toxicity.


Remission induction in acute nonlymphocytic leukemia: comparison of a seven-day and ten-day infusion of cytosine arabinoside in combination with adriamycin. Forty-six previously untreated patients with acute nonlymphocytic leukemia were treated with a remission induction regimen consisting of three daily doses of Adriamycin (30 mg/m2/day) and a ten-day continuous infusion of cytosine arabinoside (ara C) (100 mg/m2/day). The overall remission rate was 72%, with 88% of the patients less than 50 and 62% of patients greater than 50 years old achieving complete remission status. Thirty-one of the 33 complete remissions occurred after a single course of chemotherapy. Retrospective comparison of this regimen with its predecessor (identical, except that a seven-day infusion of ara C was administered) demonstrated that the increase in duration of ara C administration resulted in greater antileukemic effectiveness without an increase in hematologic toxicity to the patient.


Estrogen receptor determination in percutaneous bone marrow biopsies of patients with metastatic breast cancer. Estrogen receptor determination in metastatic breast cancer has been shown to be important in determining potential for response to endocrine therapy. One limitation to this procedure can be the availability of neoplastic material for receptor assay. This report describes patients in whom estrogen receptor status was determined using malignant cells obtained through routine posterior iliac crest bone marrow biopsy. The ability to obtain receptor data from percutaneous bone marrow biopsy specimens has proved to be of important in patients in whom other sites involved with tumor were not accessible.


What, when, and how about why: a longitudinal study of early expressions of causality. Children's expressions of causality in natural discourse with adults were examined in terms of linguistic, contextual, and pragmatic influences. Specifically, the causal statements, questions, and responses to causal questions of eight 2-3-year-old children were examined in terms of developments in language content, form, and use. With respect to content, the referential and functional uses of causal expressions for both children and adults were to ongoing or imminent situations, with the speaker commenting on his or her intention to act, or requesting the listener to act. The major categories of reference in all three utterance types were negation, direction, and intention. In terms of form, there were (a) increasing use of connectives to link clauses for all the children, and (b) three main patterns of clause order differentiating among the children: cause/effect, effect/cause, and equal use of both orders. The use of expressions of causality developed in the order: child statements less than adult questions less than child responses less than child questions. The relationship of the linguistic context to these developments was found to be one of mutual influence between child and adult. The results are discussed in terms of previous hypotheses concerning (a) causal reasoning (especially those put forth by Piaget, and by Werner & Kaplan in 1963), (b) the relationship between language and conceptual development, (c) the constraints involved in different discourse situations, and (d) variation in child language.


Spontaneous feline sporotrichosis: a fine structural study. Fine structural details of the parasitic yeastlike phase of Sporothrix schenckii contained in biopsy tissue from a naturally-occurring case of disseminated feline sporotrichosis are described and illustrated by electron microscopy. Both free and phagocytosed fungal cells were observed. The fungal cells were contained within an extracellular, electron transparent vacuolar area which was bounded by a limiting membrane of probable host origin. The yeastlike cells were characterized by a conspicuous layer of osmiophilic microfilaments which occurred along the outermost surface of the cell wall. In many yeastlike cells, scattered, membrane-bound vacuoles containing electron opaque material were observed in the cytoplasm. Asteroid bodies were not observed.


Electrochemical properties of polycyclic compounds studied by the polarographic method in anhydrous systems. VII. Polarographic oxidation of carcinogenic hydrocarbons in dimethylformamide. The electrooxidation of polycyclic carcinogenic hydrocarbons in dimethylformamide solutions was studied by polarography. The results generally have confirmed that a correlation exists between oxidation potentials and carcinogenic activity of the studied polycyclic aromatic hydrocarbons. The half-wave potentials of the polarographic curves have been found to be directly related to the root xn of the Hückel secular equation for the highest bonding orbital and to the reduction potentials measured in dimethylformamide.


Serum immunoglobulin levels and survival rates in bronchogenic carcinoma patients. Serum immunoglobulin IgG, IgA and IgM levels were estimated in 112 patients with bronchogenic carcinoma, and the obtained values were as follows: IgG = 1762 +/- 595 mg/100 ml; IgA = 332 +/- 104 mg/100 ml; IgM = 157 +/- 76 mg/100 ml. Subsequently the patients were divided in a group of 74 patients with epidermoid carcinoma, and a group of 38 patients with small cell anaplastic carcinoma of the bronchus. In patients with epidermoid carcinoma, in cases with disseminated disease the mean survival was shorter (7.9 months) when compared to the mean survival of patients with localized disease (20.8 months). Similarly, a depression of lymphocyte counts was observed in cases with disseminated disease. In cases with IgA concentrations ranging from 300 to 410 mg/100 ml longer survival rates were observed. In patients with small cell anaplastic carcinoma variety, the survival rates in patients with localized disease were almost identical with those in patients with disseminated disease (11.4 months versus 9.9 months). The longest survival rates were observed in cases with IgG concentrations ranging from 1600 to 2100 mg/100 ml, and IgM concentrations ranging from 190 to 320 mg/100 ml of serum.


Stress, behavioral arousal, and open field activity--a reexamination of emotionality in the rat. The effects of stress upon emotionality, and of emotionality upon the open field activity of rats have now been studied for over four decades. Controversy remains however regarding the degree to which stress alters behavior, and the direction of that change. One reason for this is the absence of an adequate behavioral definition of stress. The present series of experiments demonstrates a standard relatively nontraumatic stress induction procedure which may be used in conjunction with open field testing. Pre-exposure to moderately intense light and white noise facilitated open field activity as measured by initial activity, lowered defecation scores, and supplementary measures (rearing, grooming, center field penetration). Further parametric, psychoendocrine, and pharmacological studies characterized the nature of the facilitation, its time course, and its modification by other manipulations. Our results suggest the initial behavioral response to stress in an open field is activation. Previous studies may have differed in their results relating stress and behavior because of subtle procedural distinctions, some of which may be identified using the present technique.


Reoperations in strabismus.

Reoperations in strabismus. Reoperations in strabismus are done for overcorrection, undercorrections, and new strabismus problems such as dissociated vertical deviation and ptosis. Each patient requiring reoperation should be thoroughly evaluated on the basis of current findings with the understanding that some alteration in anatomy will be found. Restrictions must be freed and muscle force balanced to first provide straight eyes in the primary position and secondly the best vision possible. With persistence, 80% to 90% of patients requiring reoperation can expect a satisfactory end result.


The four-step test for diagnosis of paralytic and/or restrictive strabismus. By placing four diagnostic steps in a logical sequential manner, the diagnosis of a paralytic or restrictive deviation is made somewhat easier. Each time an incomitant strabismus is presented to an ophthalmologist, the four-step procedure should be used. Versions, ductions, and the cover test will reveal the eye to be investigated. Saccades, forced ductions, and/or forced generations will determine the problem and direct a surgical approach if needed.


Internal ophthalmoplegia following inferior oblique myectomy: a report of three cases. Three patients are reported in whom paralysis of accommodation and mydriasis (internal ophthalmoplegia) developed following inferior oblique myectomy. In all three patients, accommodation eventually returned to normal; in two, mild anisocoria persisted; in one patient, pupillotonia was noted after 2 1/2 years. The mechanism of this previously unreported surgical complication is thought to be excessive stretching of the nerve to the inferior oblique muscle with secondary trauma to the ciliary ganglion.


The effects of congenital nystagmus surgery. Anderson-Kestenbaum operations for congenital nystagmus with severe head turn have been employed for the past 25 years. They have been documented as being effective in correcting head turns associated with congenital nystagmus. We have studied a group of patients with congenital nystagmus and head turn, both preoperatively and postoperatively, by means of recordings of eye movements. We have documented the effect of surgery in shifting the null position, in broadening the null position, and in lowering the nystagmus intensity. In some cases, an improvement of the visual acuity has also occurred.


Dissociated hypertropia: surgical treatment. Dissociated hypertropia can be corrected surgically by recession of the superior rectus muscle or resection of the inferior rectus muscle. The usual "maximum" amount of surgery of 4-5 mm is the minimum amount of surgery necessary for correction of this cosmetically disfiguring strabismus. Complications relate to narrowing of the palpebral fissure width and restrictive hypotropia" both following marked inferior rectus muscle resections.


Unilateral four-muscle surgery for large-angle exotropia. Eight patients with large-angle exotropia and unimprovable poor vision in one eye were treated with conventional maximum horizontal rectus recession/resection plus weakening of both obliques of the poorly seeing eye. This appears to be a useful alternative to "supermaximal" recession/resection procedures, which are more likely to lead to deficient or restricted rotations. The effect is probably due to the release of additional sites of contracture that occur in the oblique muscles. The principal disadvantage is a small postsurgical hypertropia of the operated eye, for which routine infraplacement of both horizontal recti can compensate adequately.


Clinical observations in cyclodeviations. Cyclodeviations differ from other strabismus forms in several aspects. Adaptive mechanisms other than suppression cause the patient to remain asymptomatic in spite of ophthalmoscopically demonstrable torsion of the globe around the sagittal axis. These mechanisms include cyclofusion and a monocular sensory adaptation causing the images seen by the paretic eye to appear vertically and horizontally aligned even though they do not fall on the vertical and horizontal anatomic-geometric retinal meridians. Pure excyclotropias, ie, those not associated with vertical deviations, respond well to anterior and lateral displacement of the anterior portion of the superior oblique tendon. The operation eliminated the cyclodeviation in four eyes (three patients); however, a partial recurrence was observed in one case.


Dynamic depth reversal stereograms.

Dynamic depth reversal stereograms. A new stimulus was generated to create dynamic stereopsis. Binocular disparity was alternated between crossed and uncrossed conditions, while mean luminance remained constant, to produce a stereoscopic stimulus that appeared to move continuously in depth. These dynamic depth reversal stereograms provided an effective stimulus to elicit the visual evoked potential (VEP). Neural coding of stereopsis was reflected in the cortical response with VEP amplitudes changing as a function of binocular disparity and of image blur in the stereograms.


Indications, complications and results with silicone stents. Fifty-two patients with complicated lacrimal problems were treated with silicone stents. Our overall success rate, judging from a minimum 6-month follow-up, was 40% in these complicated cases, accepting only positive dye tests as our criteria for success. We divided these cases into six groups with successes ranging from 0--68%. Twenty-nine percent of patients had complications related to their stents. While silicone stents are probably the most important recent advance in lacrimal surgery, one must be aware of their indications, limitations and complications.


Nasolacrimal duct probing in infants.

Nasolacrimal duct probing in infants. Use of a fiberoptic endoscope to visualize the vault of the inferior turbinate during lacrimal duct probing and irrigation revealed a high incidence of false passages. This was confirmed on dacryocystofluoroscopy. The creation of false passages as documented by us can help explain clinical probing failure in apparently successful probings in which "metal on metal" is felt in the nose.


Aponeurotic defects in congenital ptosis. Levator aponeurosis disinsertion is an accepted etiologic factor in some acquired ptosis cases, but it has not previously been reported as a cause of congenital ptosis. Forty-six congenitally ptotic eyelids in 36 patients with no history of birth trauma were surgically explored and three eyelids were found to have levator disinsertions. All three cases were treated by aponeurotic repair with excellent results. These cases and suggestions that help to preoperatively identify congenitally ptotic eyelids with levator disinsertions are presented. We feel the aponeurotic approach to ptosis correction is applicable to cases of congenital ptosis with at least 5 mm of function.


Management of subretinal and vitreous cysticercosis: role of photocoagulation and surgery. Treatment of intraocular cysticercosis requires selection of the proper method, prevention of complications, and careful follow-up. Small subretinal cysticercus can be treated with xenon or argon photocoagulation. Macular cysticercus are extracted through a sclerochoroidal incision. Large cysticercus can be removed in selected cases with an outcome probe placed in the subretinal space. Cysticercus in the vitreous should be removed with a suction-cutter probe via the pars plana.


Suction ophthalmodynamometry in the diagnosis of carotid stenosis. In a prospective evaluation of 39 patients who had arteriography for suspected carotid stenosis, suction ophthalmodynamometry correctly identified 86% of the patients who had radiographically demonstrable unilateral or asymmetric obstructions. This compares favorably with carotid compression tonography, oculoplethysmography, and Doppler flow studies. The false-positive rate was 27%, a figure higher than the latter two noninvasive tests.


Giant dermoid cysts of the orbit.

Giant dermoid cysts of the orbit. Giant dermoid cysts of the orbit are developmental abnormalities that are usually found near the lacrimal gland in adults. The diagnosis of giant dermoid cysts can usually be established by radiographic studies and computed tomographic scanning. A surgical technique for the removal of these lesions with minimal complications is described in detail. Two cases are presented to demonstrate the methods used to diagnose and completely remove giant dermoid cysts with recovery of visual function and extraocular movements.


Angle closure in carotid-cavernous fistula. The case reported is one of the angle closure and pupillary block associated with carotid-cavernous fistula. Pathophysiologic mechanisms, involving elevated orbital venous pressure, are explored.


Wound healing by primary intention in the larynx. In this article, I have attempted to bring forward well known and widely accepted principles of wound healing and to show how they are pertinent to the repair of severe acute and chronic crush injuries of the larynx. The process has brought some time honored practices into question and forced a search for new, more effective ones.


Management of glottic stenosis.

Management of glottic stenosis. Limited glottic stenosis may be managed by microlaryngoscopy. The extensive lesions should be managed by extralaryngeal procedures. The techniques described here give the patient adequate respiratory and vocal rehabilitation with early decannulation. The lack of response to the more conservative procedures should indicate exploration via laryngofissure with precise incision and excision of the scar tissue and without resection of other vital laryngeal structures. Defects should be covered with acceptable flaps or grafts.


Submucosal cordectomy for laryngeal stenosis. Submucosal cordectomy, an old procedure first described for the treatment of bilateral abductor vocal cord paralysis, was used to relieve glottic or minimal subglottic stenosis in four patients. Three attained adequate airways with no further procedures; one required subsequent dilations for granulation tissue after which decannulation was successfully effected. Although airway restoration has been successful, the resultant voice has been poor, poorer than that usually achieved with arytenoidectomy. When cricoarytenoid scarring precludes arytenoidectomy and lateral vocal cord fixation, an adequate laryngeal lumen can be restored with submucosal cordectomy if sufficient laryngeal cartilage support remains.


Tracheal stenosis: conservative surgery as a primary mode of management. Tracheal and laryngeal stenosis has become increasingly common following prolonged intubation or tracheostomy for mechanical ventilation and is directly related to trauma. Tracheal resection up to 4 to 5 cm. with an end to end anastomosis is the generally accepted treatment. However, tracheal resection carries the danger of mortality and considerable morbidity. From 1974 to 1979 all patients in our series with tracheal stenosis, even with laryngeal involvement, regardless of etiology and age were intiially treated by conservative surgical management consisting of dilation, severance of the stenotic ring, intralesional injection of triamcinolone acetonide, and stenting with a silicone T tube for 90 days. Sixteen of 19 patients obtained good results and enjoy an adequate airway without a tracheostomy tube. The longest follow-up period was five years and the shortest, six months. Intralesional injection of triamcinolone acetonide is essential for successful treatment. No mortality or serious complications resulted from this treatment. Our experience indicates that patients with tracheal and laryngeal stenosis should undergo a primarily conservative surgical management. This technique appears worthy of trial prior to contemplating a more extensive procedure.


Population regulation in ticks: the role of acquired resistance in natural and unnatural hosts. Attachment, engorgement and subsequent development of successive infestations of Ixodes trianguliceps larvae and nymphs on natural hosts, Apodemus sylvaticus, and unnatural hosts, laboratory mice, are compared. In laboratory mice, primary infestations above a threshold level of about 10 ticks elicit an immunological response which reduces, in a density-dependent manner, the rate of successful tick engorgement during subsequent infestations. In contrast, in A. sylvaticus successive infestations of larvae result in unchanged or slightly improved survival through to nymphs. The relevance of these results to the concept of host-parasite co-evolution and to tick population regulation is discussed.


The effect of age, acquired resistance, pregnancy and lactation on some reactions of cattle to infection with Ostertagia ostertagi. An experiment is described in which the effects of age, previous infection, pregnancy and lactation on some reactions of cattle to infection with Ostertagia ostertagi were studied. It was found that an acquired resistance to the establishment of worms developed more rapidly in 20-month-old heifers than in calves, that it was unaffected by pregnancy of the host but that it was largely lost by heifers in early lactation. The rate at which populations were turned over, i.e. the mean life-span of worms through the late 4th and 5th stages was unaffected by the factors studied. Although, in the conditions of the experiment, development of the worms was not arrested in susceptible calves, both age of the host and its previous experience of infection were significant causes of arrest, and in previously infected 20-month-old cattle 86% of the worms of a challenge infection were arrested. Pregnancy did not affect the proportion of worms that was arrested but in lactating heifers only marginally more worms were arrested than in calves. Worms that were not arrested grew more rapidly in calves and in lactating heifers than in empty heifers or those in mid-pregnancy.


Factors influencing the assessment of anticoccidial activity in cell culture. A comparative study has been made of the factors influencing the assessment of anticoccidial potency in vitro against Eimeria tenella using established anticoccidials and arprinocid and some of its analogues. Drugs whose potency depended upon medium composition were amprolium, lasalocid and halofuginone. There was a difference in strain sensitivity with robenidine. Host cell type had an important effect on potency of monensin, decoquinate, arprinocid and its analogues. Arprinocid was active in chick liver cell systems but totally inactive in chick kidney cell systems, although its N-oxide was active in both cell types. Arprinocid-containing medium, conditioned by supporting the growth of chick embryo liver cell cultures, had an anticoccidial effect on E. tenella growing in chick kidney cells. It is deduced that the anticoccidial activity of arprinocid in the chick is due to a metabolite.


Tracking radioactive larvae of Strongyloides ratti in the host. Infective larvae of homogonic Strongyloides ratti grown in faecal culture with 32P or 75Se acquired a significant amount of radioactivity which was firmly attached to them. Heating removed most of the 32P but left 75Se in place. Subcutaneous injection of virgin and nursing mother rats with living and heat-killed radioactive larvae resulted in a pattern of labelling in the small intestine of injected animals and, in the case of 75Se, those of suckling pups, which can only be explained if labelled worms follow the natural migratory routes. The use of this tool in migratory studies is discussed, with precautions to allow for flaws in the technique.


Schistosoma mansoni: a histological study of migration in the laboratory mouse. Quantitative histological methods were applied in a study of the migratory route of schistosomula within the definitive mammal host. The observations are consistent with an entirely intravascular mode of migration in the direction of blood flow. They do not support a trans-diaphragm route. Schistosomula can be identified in low numbers in systemic organs, in the left side of the heart and in the venous compartment of the pulmonary circulation. They were not observed penetrating the diaphragm or the capsule of the liver. No histopathological evidence was found to suggest that the tissue responses of previously unexposed hosts affect migrating schistosomula at any stage during migration. These non-specific tissue responses were marked only in the skin phase of migration.


Prevalence of schistosome infections within molluscan populations: observed patterns and theoretical predictions. The paper draws together a large and scattered body of empirical evidence concerning the prevalence of snail infection with schistosome parasites in field situations, the duration of the latent period of infection in snails (and its dependence on temperature), and the mortality rates of infected and uninfected snails in field and laboratory conditions. A review and synthesis of quantitative data on the population biology of schistosome infections within the molluscan host is attempted and observed patterns of infection are compared with predictions of a schistosomiasis model developed by May (1977) which incorporates differential snail mortality (between infected and uninfected snails) and latent periods of infection. It is suggested that the low levels of prevalence within snail populations in endemic areas of schistosomiasis are closely associated with high rates of infected snail mortality and the duration of the latent period of infection within the mollusc. In certain instances, the expected life-span of an infected snail may be less than the duration of the latent period of infection. Such patterns generate very low levels of parasite prevalence. A new age prevalence model for schistosome infections within snail populations is developed and its predictions compared with observed patterns. The implications of this study of observed and predicted patterns of snail infection within molluscan populations are discussed in relation to the overall transmission dynamics of schistosomiasis.


Evolutionary implications of Leishmania amastigotes in circulating blood cells of lizards. Amastigotes of 2 Leishmania species are reported from the Pakistani lizards Teratoscincus scincus (Gekkonidae) and Agama agilis (Agamidae) collected in western Baluchistan and north-central Sind, respectively. Parasites were seen only in blood cells primarily within thrombocytes, and were detected on smears of peripheral blood. Slides made at 3-day intervals for 38 days from an infected hatchling T. scincus demonstrated an increase with time in the mean number of amastigotes/infected thrombocyte. No evidence of an infection focus in fixed cells of the viscera was found. It is suggested, in view of reports of amastigotes in circulating blood cells of hosts belonging to 5 genera, collected in 5 countries from India to France, that saurian Leishmania may behave simply as parasites of circulating blood cells, thus illustrating an early stage in the adaptation of leishmanias to the vertebrate host.


Phagocytosis and killing of Trypanosoma dionisii by human neutrophils, eosinophils and monocytes. The cell-mediated resistance of human leucocytes to Trypanosoma dionisii, a bat parasite related to T. cruzi, was investigated. Human peripheral blood neutrophils and monocytes were cytotoxic to T. dionisii as assessed by electron microscopy and by induction of 99mTc release from trypanosomes pre-labelled with [99mTc] pertechnetate. The enhancement of cytotoxicity by specific antiserum varied considerably from one individual to another. Neither blood lymphocytes nor blood eosinophils induced 99mTc release from T. dionisii. The trypanosomes were readily phagocytosed by neutrophils and monocytes even in the absence of added antiserum but the rate was enchanced when antiserum was present. Eosinophils also phagocytosed T. dionisii but only in the presence of antiserum. Investigation by electron microscopy revealed that T. dionisii is rapidly destroyed in the phagocytic vacuole of enutrophils and monocytes and by eosinophils. Phagocytosis, ultrastructural damage and induction of 99mTc release occurred more rapidly in neutrophils than in monocytes.


An experimental study of the effects of Nosema eurytremae (Microsporida: Nosematidae) on the liver fluke Fasciola hepatica. A microsporidian parasite, Nosema eurytremae, was fed to Lymnaea trunculata infected with Fasciola hepatica. Microsporidian infection of the snail was always light, though spores were present in all tissues but the rediae became heavily infected in the parenchyma. The proportion of infected rediae increased with time and was especially high in ageing infections. Although rediae were only lightly infected when examined before cercarial release began, the infections became progressively heavier, so that towards the end of the life of the snails a high proportion of rediae were totally destroyed and contained no cercariae. Cercarial output was significantly depressed over a long period of active shedding by snails which had been hyperinfected with 1 x 106 spores and some of the liberated cercariae were themselves infected.


Fasciola hepatica: attempts to induce protection against infection in rats and mice by injection of excretory/secretory products of immature worms. In vitro excretory/secretory products of 4-week (immature) and 8-week-old (mature) Fasciola hepatica parasites, derived from rats, were injected together with adjuvant into naive rats and mice. Resistance to infection was assessed in rats by counting adults in the bile ducts at 9 weeks, or in mice by recording deaths after oral challenge with a high dose of viable metacercariae. Exposure of rats to excretory/secretory products of immature F. hepatica conferred a significant degree of resistance which was comparable to the level of resistance induced following oral administration of a low number of metacercariae. No protection against infection was seen in rats injected with excretory/secretory products from mature, bile duct-derived worms. In mice, no obvious mouse strain variation in susceptibility to first infection existed and hypothymic nude mice were as susceptible to infection as intact mice. As determined by protection against death, vaccination with excretory/secretory products derived from immature F. hepatica was without effect in mice. It is concluded that "host protective antigens", at least for rats, were present in the excretory/secretory products of immature F. hepatica larvae.


Hymenolepis diminuta: the role of the tail in determining the position of the worm in the intestine of the rat. One-worm infections of Hymenolepis diminuta in rats had their strobila severed surgically, in the neck region, on day 14 of an infection. The scolex and remaining strobila survived but were recovered from a more posterior region of the intestine where small worms are attached during development. The movement to the new region was usually not complete in 24 h, but was complete by 72 h, and probably by 48 h. The operation, involving laparotomy and an incision in the duodenal wall which avoided severing the strobila, had no effect on the position of the worm but did depress the growth of the worm during the ensuing 24 h. It is suggested that (1) the preferred site for H. diminuta is 30-50% down the small intestine, (2) the worm monitors information about its position from all over its strobila and (3) as the worm grows, its position is determined by balancing the input of adverse information from its tail and head ends. The slowness with which surgically shortened worms return to the preferred site may be due either to delay in the worm "realising" it has no tail, or to the location stimuli in the intestine being disturbed for 24 h by the operation.


New CNS-active 3-methyl-4-substituted methyl-delta 2-isoxazolin-5-ones. Eight 3-methyl-4-substituted methyl-delta 2-isoxazolin-5-ones were synthesized and evaluated for central nervous system (CNS) activity. All compounds at a concentration of 1 . 10(-3) mol/l inhibited rat brain monoamine oxidase (MAO) in vitro and provided protection against pentetrazole-induced convulsions in mice at a dose of 100 mg/kg i.p. Compounds 2 and 6 showed 80% protection. All isoxazolines (100 mg/kg i.p.) potentiated pentobarbital sleeping time in mice.


[Biologically active N-Mannich bases of isatin-3-(phenyl)-imines (author's transl)]. By the condensation of isatin and 5-nitroisatin with substituted aromatic amines, isatin- and 5-nitroisatin-3-(phenyl)-imines (azomethines) are formed which are converted into N-Mannich-bases by aminomethylation and may be formulated as azomethines with E configuration. A biotest of Lepidium sativum L. was used to prove mitodepressive properties. Some compounds showed a significant growth-inhibiting activity. It was found that a change in activity is produced by condensation on the carbon atom in position 3 and by aminomethylation on the nitrogen atom in the isatin nucleus.


Potential fungicidal and bactericidal agents. Synthesis of certain 4-(2-amino-1,3,4-thiadiazol-5-yl)quinolines. The synthesis of some new 4-[2-alkyl (aryl or aralkyl) amino-1,3,4-thiadiazol-5-yl]-2-substituted quinolines is described. IR, UV, NMR and MS data of representative examples are discussed. Most of the compounds prepared showed a reasonable antifungal and antimicrobial activity.


[Studies on suspension ointments. Part 2: The Diffusion of salicylic acid as influenced by the colloid chemical properties of the vehicle (author's transl)]. A comparative study of the solubility and the diffusion of salicylic acid in two hydrocarbon gels (Plastibase, vaseline) has been made. It was found that there was no difference in solubility, whereas the diffusion rate was greater in Plastibase. The solubilities and the diffusion rates were identical in the liquid components of the gels. The difference in diffusion rate between the two gels is attributable to the different properties of the solids in the gels. The greater in vitro diffusion rate in Plastibase results in a more rapid drug release in vivo. Suspension ointments may be regarded as saturated solutions with an excess of the drug in suspension. For this reason, the studies were undertaken mainly on saturated solutions.


[Interactions between macromolecular adjuvants and drugs. Part 18: The binding behaviour of sodium carboxymethylcellulose and other macromolecules towards streptomycin sulphate (author's transl)]. Unlike the other macromolecules under investigation (polyvinylpyrrolidone, methylcellulose, polyvinyl alcohol), sodium carboxymethylcellulose acts on streptomycin sulphate, which leads to isolable precipitates. By equilibrium dialysis in electrolyte-free and electrolyte-containing solutions, the interaction was characterized in more detail and described by Donnan curves. The associates (which contained, on an average, 40% of streptomycin) proved to be resistant to light and air, and stable to thin-layer chromatography. Microbiological assays on the test strain Bacillus subtilis SG119 revealed a decrease in activity of the streptomycin-sodium carboxymethylcellulose associates compared to pure streptomycin (tested in the solid form, using rice granulate as a carrier substance). In contrast, the associate was as efficient as the antibiotic when dissolved in a concentrated solution of sodium chloride.


The absorption and excretion rates of a new pyrido[1,2-a] pyrimidine derivative (Chinoin 123) in rats. The metabolism and absorption of a potential new drug, Chinoin 123, having an antiatherogenic effect, were studied in rats. Using different methods it was confirmed that the main metabolite of the drug is a free acid form, formed by ester hydrolysis. In Sartorius Resorption Model only the gastric absorption was confirmed and calculated. In vivo experiments in rats showed rather good absorption. The blood and urine concentrations of the drug were determined.


Correlation between the spermicidal activity and the haemolytic index of certain plant saponins. The haemolytic index, the spermicidal efficacy and the effect on the vaginal mucosa of some plant saponins were determined. It was proved that a certain correlation exists between the haemolytic index and the spermicidal efficacy of these saponins. Saponin of Gypsophila paniculata was proved to be relatively superior when used in aqueous solution or when formulated in polyethylene glycol ointment base.


Complex encoding in word-final voiced and voiceless stops. The multifunctionality of vowel and closure duration is investigated in two experiments using the word pair 'bag'-'back'. In experiment I, categorization of synthetic stimuli at three simulated rates of speech supports the notion of the vowel/vowel + closure quotient as a tempo-independent cue to the final 'voiced'-'voiceless' opposition. In experiment II, manipulated natural stimuli are tested at two rates of speech, sentence-medially and finally. In final position, the results of experiment I are confirmed though durational and nondurational properties interact. Medially, a specific context effect is found.


Some relationships between speech production and perception. EMG studies of the American English vowel pairs /i-I/ and /e-epsilon/ reveal two different production strategies: some speakers appear to differentiate the members of each pair primarily on the basis to tongue height; for others the basis of differentiation appears to be tongue tension. There was no obvious reflection of these differences in the speech wave-forms or formant patterns of the two groups. To determine if these differences in production might correspond to differences in perception, two vowel identification tests were given to the EMG subjects. Subjects were asked to label the members of a seven-step vowel continuum, /i/ through /I/. In one condition each item had an equal probability of occurrence. The other condition was an anchoring test; the first stimulus, /i/, was heard four times as often as any other stimulus. Compared with the equal-probability test labelling boundary, the boundary in the anchoring test was displaced toward the more frequently occurring stimulus. The magnitude of the shift of the labelling boundary was greater for subjects using a production strategy based on tongue height than for subjects using tongue tension to differentiate these vowels, suggesting that the stimuli represent adjacent categories in the speakers' phonetic space for the former, but not for the latter, group.


Some observations on velar movement in plosives. Using a photoelectric device, velar movement of 6 subjects is continuously registered in test words containing /p, t, k, b, d, g/. There are differences in both timing and degree of velar movement patterns as a function of voicing, place of articulation, vocalic context, and mode of release. There is extensive coarticulation in both directions. A hierarchical relationship for the realization of velar height targets for vowels and consonants is found, leading to the supposition that there are two different kinds of coarticulation on the neuromotor level.


Feeding cholestanol to infants causes atherosclerosis. The atheromas of adult aortas have been found to be composed mostly of tabular crystals of a highly insoluble cholesterol-cholestanol-water adduct designated C-C-2W. Early feeding of cholestanol risks precipitation of C-C-2W on the incomplete membranes of infants. Resultant impairment of cell permeability and reactivity can give rise to incipient atherosclerosis. The pathological condition becomes patent only with adulthood, when the aorta intima-media will be stacked with the adduct and fatty streaks will occur. Cholesterol, as provided by the usual dietary sources, contains from 3 to 10% of cholestanol, quantities more than sufficient to reach the solubility product of C-C-2W: 10(-7) mg/ml. It follows that much atherosclerosis could be avoided if cholestanol-containing foods, specifically dietary cholesterol, were not fed to infants or children. Cholestanolosis and hypercholestanolemia are new concepts to be considered in dietary approaches to control of atherosclerosis.


Relation between suicide and the electromagnetic field of overhead power lines. Laboratory studies have shown that electromagnetic fields similar to those from high-voltage transmission lines can produce biological effects. Surveys of the actual effects of such lines on exposed individuals usually have been hampered by complicating factors tending to blur the data. By means of a new approach, however, correlation has been established between the presence of transmission-line fields and the occurrence of suicides in part of the Midlands of England.


Chemical characterization and biological activity of an anticancer agent of marine origin. Clinical interest in the pharmacology of medicinals from marine organisms has heightened due to anticancer effects indicated for Mercenaria marine clam components. This report further characterizes the anticancer principle. Hydrophilic products were extracted by aqueous and/or salting-out methods followed by dialysis. Organic solvent extraction produced a new family of active agents related to the hydrophilic component. Thin layer and liquid column chromatography as well as enzymatic degradation were used to secure a more pure product for analysis. Assay included P388 leukemia and B16 melanoma. Oligonucleotide fractions and smaller components were observed to increase survival rate; treated mice remained at 67% survival when control animals had reached zero. A many-fold purified product was effectively reduced from 300 mg/kg body weight to 5 mg/kg to achieve anticancer activity. Chemical analysis suggested a product composed of carbohydrate, phosphate, peptide, and an unidentified material. Acid hydrolysis revealed the presence of hexoses, pentoses, and a full spectrum of amino acids. Several distinct components found to comprise the active samples may act as the effective product or as a carrier.


Long-range dielectric aspects of the eukaryotic cell cycle. The phases of the eukaryotic cell cycle are described in terms of H. Fröhlich's theory of long-range coherence in biological systems. A phonon condensation is believed to initiate the S phase of the cycle. Following this event, an increasing polarization of the cell should occur, resulting in a phase transition to a metastable ferroelectric state at the beginning of mitosis. This polarized state is expected to be dissipated after mitosis is completed. It is believed that malignant cells possess a ferroelectric state throughout their life cycles.


Temperature dependence of 31P-NMR spectra of chicken erythrocyte nucleosomes. The shape of the 31P-NMR signal of DNA in nucleosomes isolated from chicken erythrocytes has been examined in the temperature range of 15--80 degrees C at 40.48 MHz. This resonance is composed of at least two partially overlapping peaks with different line-widths and chemical shifts. The relative intensities of the peaks were found to vary with temperature. Although a quantitative analysis of the components is difficult at this frequency, the presence of various peaks under the resonance signal is further confirmed by inspection of the partially relaxed spectra at 15 degrees C. A comparison of the thermal behavior of protein-free DNA isolated from nucleosomes with that of DNA bound to histones indicates that DNA segments in nucleosomes take on several conformational states.


Pulsed nuclear magnetic resonance studies on nuclear fractions of normal and malignant tissues. Nuclear fractions isolated from normal liver tissues and an experimental tumor--mouse fibrosarcoma (MFS)--were studied by pulsed NMR. Findings were: (1) T1 values of nuclear fractions are higher than those of the tissues or origin. (2) T1 values of nuclear fractions isolated from liver of tumor-bearers are higher than T1 values of nuclear fractions of normal liver. (3) T1 values of nuclear fractions of MFS tumor are higher than nuclear fractions of liver of tumor-bearing mice. Comparison of T1 values of the nuclear fractions shows a hierarchy of T1 from liver to MFS.


[The unstable-frequency EEG--as a concept and its correlations to neuropsychiatric diseases in children]. A total of 21,040 electroencephalograms obtained from 6,834 children constituting the routine patient stock of an electroencephalographic department of a pediatric clinic were checked for "frequency instability". It was possible to observe an age dependence of this characteristic and determine statistical correlations with certain clinical disease units showing different frequencies of this particular characteristic, especially neuropathies and neuroses.


[Electromyographic examinations of the musculus sphincter urethrae in children with meningomyelocele]. Thirty children with neurogenic voiding attendant upon myelomeningoceles were examined, and for twenty-three children the electromyographic findings were compared with urodynamic measuring results. The authors conclude that an increase in subvesical resistance is due not to an increase of tonicity of somatic sphincter muscles but to a predominance of sympathetic over parasympathetic innervation.


[Importance of "accentuation" for diagnostics in practical medicine]. The report is about a study made in the USSR of 840 people (sick persons, female students, workers, intellectuals). All were given questionnaires acc. to H. Schmieschek in a Russian version, and the author (V. N. Belyayev) lists the results in tables and analyzes them. Reference is made to various aspects which are of importance for practical medicine and relate to a diagnosis of "accentuation" acc. to K. Leonhard.


[Variability of normal grapho-elements and the assessment of abnormal grapho-elements in the EEG of clinically healthy test persons]. The percentage pattern and topical distribution of alpha, beta, theta and delta waves, the occipital voltage level asymmetry of the alpha waves and the frequency of temporal functional disorders were studied in 100 17-year-olds, 273 male test persons of various age and 6,000 healthy persons. The results indicated that 1/4--1/8 of the test section is precentrally taken up by theta waves in the E.E.G. of healthy 17-year-olds. Random sampling on a larger scale shows that left occipital alpha wave domination is just as frequent as on the right; voltage level symmetry occurs only in 13--23 per cent of all cases. Three per cent of the clinically healthy persons showed local temporal E.E.G. anomalies which were on the left in 96 per cent of the cases. Attention is drawn to possible consequences with regard to nomenclature, evaluation and diagnostic assessment.


[Requirement for and position of partial clinical treatment in the system of psychiatric care]. Reference is made to the level of development of psychiatry in the USSR and the general principles of psychiatric care accepted in the country. Part of the development in the GDR is then described, followed by an argument in favour of day and night care for patients. This is an area where much remains to be done. This partial clinical treatment is to fill the gap between inpatient and outpatient facilities and should be available in the residential area of the patient.


[Results of treatment of leg paraspasm cases following longitudinal frontal myelotomy]. Follow-up examinations of 14 patients on whom longitudinal frontal myelotomy had been performed because of extreme leg spasms, showed consistently good results as far as spasm removal was concerned. Effective rehabilitation is possible only if the basic condition is stationary, if the operation is made at an early stage and followed by a comprehensive rehabilitation programme. For patients with an advancing condition the operation can alleviate the subjective discomfort felt, and it can make care easier.


[Experiences and empirical results of ambulatory psychotherapy in care and treatment of special psychosomatic disorders (neuroses)]. Object of the outlying paper are some few practical experience and theoretical based reflections in application of some elements of special-psychotherapeutical, personality- and conflict-centred techniques by treatment of psychosomatical disorders or likewise structured disorders in a district near Berlin (GDR). The methodical and methodological basis is directly related to some elements of the psychotherapeutical system of Oderich, developed while the last ten years have passed. In the centre of this methodical procedure we see especially self-relaxation, active therapeutical attitudes by patient and real-demand-related and patient-centred, conflict-orientated treatment as basis for systematic behavior modification. In the last part of this paper we refered some aspected results of empirical-statistical analysis.


[Treatment of neurotic sleep disorders with the use of V. E. Frank's logotherapy]. V. E. Frankl's logotherapy is a useful method of treatment in the psychotherapy of neuroses. Its systematic approach to reorientation, the assistance it provides is adopting an optimistic outlook on life, and its dynamic character and comparative limitation in time make it ideal for outpatient therapy. Patients easily adopt its two recommendations, the "paradoxical intention" and "dereflection", and these have a capacity for overcoming symptoms. This frees the patient sufficiently to make it possible for him to deal with the causes of his crisis. Through analyzing his conflict with the environment he can arrive at a new synthesis and find a meaningful philosophy of life.


[The epidemiology of Wilson's disease in the German Democratic Republic and current problems from the viewpoint of population genetics]. Between 1949 and Nov. 30, 1977 a total of 123 cases of Wilson's disease have been registered in the GDR. Using the available statistics the incidence rate of the disease is assumed to be about 2.9/100,000, the gene frequency approx. 0.53 per cent and the heterozygote incidence 1.05 per cent, supposing that the Hardy-Weinberg law applies to a large extent. Conclusions are drawn from the available material with a view to detection of the disease infuture and to genetic family counselling.


[Intravenous tolbutamide test in depression]. The intravenous tolbutamide test (ORABET) shows pathological developments in timid and depressive patients, regardless of their nosological classification as suffering from unipolar endogenic depressions, the depressive phase of MDK and reactive depressions. With the disappearance of the depressive--timid psychopathological picture the i.v. TT also normalizes.


[Abnormal corpus callosum and epilepsy--a catamnestic report]. A catamnestic account is given of a case of corpus callosum deficiency. The clinical symptoms and para-clinical findings could not be interpreted with the syndrome. A short reference is made to the importance of the corpus callosum deficiency.


[The clinical picture of essential myoclonus]. Familial essential myoclonus, a rare hereditary disease, is characterized by spontaneous myocloni without any other neurological and psychic symptoms. The report deals with two sisters who suffered from the disease and in whose family the syndrome occurred in two more generations. The outlook for a favourable therapeutic effect is limited. The prognosis is good.


[Prognosis in epilepsy and tactics to be applied in terminating anti-epilepsy therapy]. This paper compares basic concepts published by eminent epileptologists, supplementing them by a specific analysis of 350 case records. The author, on the basis of data reported in the literature and the results of his own investigations, makes concrete recommendations for the discontinuation of anticonvulsives in the treatment of epilepsy.


[The EEG and its correlation with the intermittent vertebrobasilar syndrome]. A total of 325 patients with an intermittent vertebrobasilar insufficiency syndrome were subjected to electroencephalography. Certain characteristic features could be determined. Dominant among pathological findings were beta wave frequency bands in females. Normal electroencephalograms were obtained especially in males. There was frequently observed a low level of brain potentials, but this should not be regarded as an obligate criterion. Correlation of the electroencephalogram with the clinical syndrome was only possible by taking into account the patient's medical history and by taking additional diagnostic measures, more especially as other processes in the middle and posterior cranial fossae also tended to produce corresponding changes in electroencephalograms. Also dealth with by the author in his present paper are pathophysiological relationships.


[So-called slow posterior activity in the EEG and the sensori-motor reaction time. Results of re-examinations made after 5 years]. Six persons showing what is called slow posterior activity (4/s rhythm) in the electroencephalogram were reexamined after a period of five years. Sensorimotor reaction times were recorded in addition to the electroencephalogram which was analyzed for the frequency of LPA and for the degree of stability of time dependence. The frequency and distinctness of LPA were found to be stable after five years (r = 0.09 and 0.82, respectively; p less than 0.001), whereas the alpha rhythmus of the subjects had undergone considerable changes (r = 0.34; p greater than 0.05). The extension of reaction times to be observed under the influence of LPA was also seen to remain constant (r = 0.79; p less than 0.05). Accordingly, LPA proved an extremely stable characteristic which did not show any substantial variations in the course of five years.