Relative utilization of fatty acids for synthesis of ketone bodies and complex lipids in the liver of developing rats. The regulation of hepatic ketogenesis, as related to the metabolism of fatty acids through oxidative and synthetic pathways, was studied in developing rats. [1-14C] palmitate was used as a substrate to determine the proportions of free fatty acids utilized for the production of ketone bodies, CO2 and complex lipids. Similar developmental patterns of hepatic ketogenesis were obtained by measuring the production of either [14C] acetoacetate from exogenous [1-14C] palmitate or the sum of unlabeled acetoacetate and beta-hydroxybutyrate from endogenous fatty acids. The production of total ketone bodies was low during the late fetal stage and at birth, but increased rapidly to a miximum value within 24 hr after brith. The maximal ketogenic capacity appeared to be maintained for the first 10 days of life. 14CO2 production from [1-14C] palmitate increased by two- to fourfold during the suckling period, from its initial low rate seen at birth. The capacity for synthesis of total complex lipids was low at birth and had increased by day 3 to a maximal value, which was comparable to that of adult fed rats. The high lipogenic capacity lasted throughout the remaining suckling period. When ketogenesis was inhibited by 4-pentenoic acid, the rate of synthesis of complex lipids did not increase despite an increase in unutilized fatty acids. During the mid-suckling period, approximately equal amounts of [1-14C] palmitate were utilized for the synthesis of ketone plus CO2 and for complex lipid synthesis. By contrast, in adult fed rats, the incorporation of fatty acids into complex lipids was four times higher than that of ketone plus CO2. These observations suggest that stimulated hepatic ketogenesis in suckling rats results from the rapid oxidation of fatty acids and consequent increased production of acetyl CoA, but not from impaired capacity for synthesis of complex lipids.


Erucic acid and phospholipids of newborn rat heart cells in culture. Erucic acid (delta 13-docosenoic acid), labeled with 14C in the 1- or 14-position, was incorporated into fetal calf serum and fed to beating, neonatal rat myocardial cell in culture. Uptake of the docosenoic acid during the first 6 hr of incubation was 41 nM/hr/mg protein in 7-day old cells and 29 nM/hr/mg protein in 14-day old cells. Fifty-seven percent of the 14C-activity was taken up from the medium in 24 hr, of which 77% was in the cells and 23% was unaccounted for. Of the 14C-activity taken up, 26% was in extractable lipid, with two-thirds in neutral lipid and one-third in phospholipid. Within the neutral lipid fraction, 88% of the 14C-activity was present in triglycerides; while in phospholipids, 66% of the 14C-activity was in phosphatidylcholine (PC); 14% in phosphatidylethanolamine (PE); 6% in sphinogomyelin (SPH) and 1% or less in cardiolipin (DPG). PC had the highest specific activity, followed by SPH and PE. The specific activity of PE was one-half that of SPH when the 14C-erucic acid substrate was labeled at the carboxyl position, but increased to equal that of SPH when the substrate was labeled at the double bond. The fatty acids of PC, PE, and SPH were influenced by erucic acid in the growth medium, but the amounts of each phospholipid were not affected. It is proposed that the altered fatty acid composition associated with incorporation of erucic acid or its metabolites into PC, PE, and SPH may affect integrity and function of heart cell membranes.


Influence of fasting-refeeding and dietary linoleate on liver glucose-6-phosphate dehydrogenase and phospholipid fatty acid composition in rats adapted to a purified diet. Responses to refeeding after fasting were studied in male rats fed a purified casein-sucrose diet containing 5% safflower oil. After a 48 hr fast, the rats were fed either the same diet or the same diet minus oil (fat-free diet). These experiments were designed to distinguish changes due to fasting and refeeding alone without a change of diet from those changes caused by refeeding a diet of different composition. In the first experiment, rats were refed for 3 or 7 days. In rats refed either diet, liver glucose-6-phosphate dehydrogenase (G6PD) activity was elevated above refasting levels, but after 7 days, activity in rats refed the 5% safflower oil diet was significantly lower than in those refed the fat-free diet. The amount of liver arachidonate in rats refed the safflower oil diet was the same during refeeding as before fasting. In the second experiment, rats were refed the fat-free diet for 1, 2, 3, or 7 days. Liver G6PD and fatty acid synthetase were measured, as well as fatty acids in liver total lipids and phospholipids. G6PD activity increased above prefasting levels after one day refeeding and continued to increase for 7 days. Fatty acid synthetase activity increased for the first 3 days of refeeding, with no additional increase after 7 days. In all rats refed the fat-free diet, the proportions of arachidonate and linoleate in liver phospholipids diminished with time, and eicosatrienoate appeared. These results show that (a) maintenance of liver phospholipid arachidonate did not prevent increased G6PD activity in early refeeding, but the elevated G6PD activity later declined when phospholipid arachidonate was maintained by feeding a source of linoleate; (b) the metabolic state of fasted-refed rats had not returned to prefasting conditions even after 7 days of refeeding a linoleate-rich diet to which the rats were adapted before fasting.


Identification of the trans isomers of octadecenoic acid in human milk. The presence of trans octadecenoic acid isomers was detected and analyzed in 24 hr pooled samples of human milk. Amounts of the trans isomers of the C18 monoenes ranged from 2% to 4% of the total fatty acids. For purposes of comparison, three commonly used brands of infant formula were also analyzed and found to contain 0.1% to 1.3% of trans monoene isomers. Data indicate that breast-fed and bottle-fed infants are receiving minimal levels of trans fatty acids via milk.


[A case of toxoplasmosis detected by the Sabin-Feldman test]. A case of abortion in a mother who suffered a two month abortion was diagnosed and the course of the infection was followed up by before and during the therapy, using the Sabin - Feldman test.


[The antigenic relationship between Syringospora albicans, Candida rhagii and the salmonella C1 group O antigen]. The immune sera for Syringospora albicans and Candida rhagii agglutinated Salmonella cholerae suis (0 6,7). The immune serum for S. cholerae suis agglutinated Syringospora albicans and Candida rhagii. Absorption and agglutination cross test demonstrated common antigenic factors in the tested fungus species and in S. cholerae suis (0 6,7).


[Immunological reactions related to drugs]. Drugs, when bound with proteins invivo, become immunogenic. The immunogenic response is usually unnoticed, but occasionally it may be the cause of reactions which induce tissue damages. The immunologic mechanisms which induce tissue damages are classified in four types: 1) anaphylactic, 2) cytolytic, reactions mediated by immune complex, 4) delayed type hypersensitivity reactions. Besides these reactions certain drugs induce autoantibodies which give lupus signs. In the diagnosis of drug-induced reactions the history after drug intake is considered important. The prophylaxis and treatment of these reactions are discussed briefly.


[Methods for the preparation of a pure soluble antigen from Toxoplasma gondii]. In this study we report 4 methods for separating leucocytes from toxoplasma found in peritoneal exudate of infected mice. a) Passage through No: 26 needle, b) glass adherence, c) passage through glass wool, d) sonic vibration. Experiment showed that sonic vibration at 60 watt; 60 seconds was the best way to destroy selectively almost all leucocytes present in the preparation. In order to prepare a soluble antigen  from clean toxoplasmas sonic vibration at 70 watt, 60 second was found sufficient to destroy all parasites present in the suspension. We suggest that this pure T. gondii antigen, may give more reliable results in passive hemagglutination, precipitation and complement fixation tests.


[West Nile arbovirus antibodies with hemagglutination inhibition (HI) in residents of Southeast Anatolia]. 937 sera collected from different persons in Southeast Anatolia were studied for antibodies against West Nile - Virus by HI test. 763 out of 937 sera were from the research area, 42 from the neighboring districts and 21 from soldiers recently come to the research area, the features of the remaining 111 sera, except the ages of 4 could not be recorded. In the sera from the research area the West Nile antibodies were positive in 41.80%. The positive ratios were 40.49% in Diyarbakir, 47.83% in Mardin, 44.82% in Siirt, 38.09% in Urfa and 41.17% in Elâziğ. In 916 sera, the positive ratio was 40.06%. The ratio increased with the age, 5 out of 21 sera from soldiers were positive. It seems that in research area an active West Nile virus or a closely related one is found. We think that in neighboring areas some active foci of West Nile wirus are found.


[The mycological and bacteriological flora of cigarettes and its relation to human throat culture and inhalation air]. In our research we studied the mycological and bacteriological flora of both filtered and non-filtered Turkish cigarettes. We also studied by bacteriologic and mycologic methods, the specimens taken from throath of healthy people of varied ages who smoke and who do not smoke, and the flora of inhalation air from different area.


[Evaluation of new media for the isolation of salmonella and shigella]. Two hundred stool specimens were studied by using direct and indirect methods on XLD, HE, EMB and SS culture media. The results were consistent with the previous studies. As the media currently used in Turkey seem inadequate in the bacteriological diagnosis of salmonella and shigella infections, the introduction of the more satisfactory media such as XLD and HE is suggested for routine use.


[A case of pulmonary moniliasis following the misuse of antibiotics]. Our patient is a 30 year old, married female, with one daughter. She has been coughing about 200-250 cc purulent, blood stained sputum per day for the last three years. In the microscopic examination of sputum, abundant leukocytes, a small quantity of red blood cells and epithelia were found. Elastic fibres were absent. In cultures C. albicans and beta hemolytic streptococci were isolated. Coughing, sputum, and scattered moist rales at the bases (see the chest x-rays) were found clinically. Other systems were normal. An amelioration began on the third day of mycostatin treatment. There was complete healing by the tenth day of the treatment.


Introducing medical students to family therapy using simulated family interviews. Small groups of medical students are introduced to the subject of family therapy using a technique involving the simulation of family interviews. The students are called upon to enact a situation in which family members visit their general practitioner with a problem relating to one of the children, and the diffusion of this problem within the family is traced during the course of the simulation. Discussion is focused on the feelings evoked by the simulation, the psychodynamics of the simulated family and the quality of the relationship between the general practitioner and the family as it arises out of the interview. An effort is made to help the students to get in touch with some of their feelings towards disturbed families and to mobilize these feelings towards the effective management of the family's problems. By role playing the general practitioner, students can prepare themselves for their future professional roles in a situation which allows for feedback from colleagues and experimentation. At the same time, when family members are role-played, the process of identification and empathy with patients is enhanced. The technique is potentially stressful because of the unusual demands that it makes upon the students in terms of personal involvement, but the experience derived from successive groups of students over a 2 year period has been consistently rewarding, and most students have expressed an enthusiastic interest in the exercise.


Clinical factual recall and patient management skill in general practice. A battery of assessment measures, including MCQ measures of factual recall, MEQ measures of problem-solving skills, measures of attitudes, intelligence and ability, and personality factors, was administered to the trainee intakes of a number of post-graduate training courses for general practice on a pre-course/post-course basis (trainee sample N = 80). The tests were administered in parallel to a similar number of registered general practitioners (N = 80). The trainees in the sample were also regularly assessed by their teachers, hospital consultants and registered general practitioners by means of rating scales described below. In this paper, attention is focused on the MCQ and MEQ measures. The results show significant improvement in post-test scores, particularly among the poorer students and particularly in the crucial area of problem solving skills. This was related to the organizational structure of th courses: the poorer students gained greatest benefit from courses which featured the regular and frequent use of seminars and group teaching methods. Below we have given the correlations between the pre- and post-test scores for both the best students and poorest students as determined by the in-course performance measure, the rating scales used by the consultants and general practitioner tutors.


The degrees of MD and ChM in British and Irish universities, 1953-70. About 80% of MBs who proceed to MD or ChM do so within 15 years of obtaining their primary medical qualification. Using this measurement as a yardstick, an attempt is made to draw a valid reflection of the award of thses postgraduate degrees in the twenty university medical schools during the period 1953-70. London produced half as many MDs and ChMs as expected, Oxbridge considerably more and Scotland about half the expected ChMs.


Measuring medical students' empathy: a validation study. The aim of this study was to validate the empathy scale (Hogan, 1969) for use in the context of medical education in Australia. Empathy Scale scores of students in their first clinical year at Monash University were correlated with patient ratings, self ratings, and peer ratings of empathy. Inter-rater and intra-rater reliability were assessed. Correlations were also obtained between Empathy Scale scores and course marks in psychiatry. Of the empathy ratings only those by peers correlated significantly with Empathy Scale scores (r = 0-45, P less than 0-05, n = 29). Empathy Scale scores were unrelated to academic performance. In a separate part of the study, not connected to the establishing of criterion-related validity, Empathy Scale scores of the medical student group were found to be significantly higher (t=4-44, df = 52, P less than 0-001) than the scores of psychiatric patients with a diagnosis of "personality disorder". This study provides some support for the Empathy Scale as a measure of interpersonal effectiveness, but has not established it as a valid measure of empathy in a clinical setting.


The relative role of "A" level chemistry, physics and biology in the medical course. The performance of 209 students in the 2nd MBBS, first clinical year and final MBBS examinations has been compared retrospectively with their grades in chemistry, physics and biology at "A" level. The mean grade has also been determined for students from different social classes and secondary education. Significant differences in marks for biology were found between successful and not so successful students, especially in the pre-clinical part of the course. Significnat differences in marks and significant correlations were also found for physics but not to any great extent for chemistry. The relative role of these three basic sciences in the medical course is discussed. The suggestion is made that there is a need for a re-appraisal of the privleged position of chemistry and an unquestioned science requirement for entry to medical school.


Paediatric option of MRCP examination: a survey into the results of candidates electing to take the paediatrics option in MCRP (UK) Part II. Five surveys on the performance of candidates in the paediatric option of MCRP(UK) Part II examination show the paediatric candidates to be at a disadvantage in the written part. The paediatric candidate is later in his career to obtain his MRCP (UK), as the mean interval from qualification to success at Part II is 41-7 months compared with 34 months for non-paediatric candidates (P = 0-0026). Lower marks were scored by paediatric candidates in the written section on the whole (P = 0-055), slide identification (P = 0-015), data interpretation (P = 0-065) and non-paediatric case histories P = 0-023) as seen in those candidates who passed each part at first attempt, the discrepancy being wider in those having more attempts to pass. In the oral examination the paediatric candidate scored higher (P = 0-07) but no significant difference in the clinical marks. Although it appears that few paediatricians have been severely penalized by the present system, it does require the paediatric candidate to orientate his preparation for Part II towards his books rather than towards his clinical practice, which is contrary to the aim of the Part II examination of the MRCP(UK). Plans have been announced by the Presidents of the three Royal Colleges of Physicians of the United Kingdom for an entirely paediatric Part II.


Sodium, water and acid-base balance: teaching transient and steady states. We suggest that medical teaching should give greater emphasis to the interpretation of measurements in patients with chronic disturbances of homeostatic mechanisms, and some principles are outlined. The single principle which is most useful in reducing confusion is that in the steady state excretion rate is equal to intake or metabolic production rate, and rarely helps to decide the nature of a homeostatic disturbance.


Motivations for studying dentistry among first-year dental students. Reasons for choosing dentistry as a profession were analysed among first-year dental students at the University of Toronto. The motivations of various sub-groups were also examined. It was found that an extrinsic motivation, financial rewards, was the most widespread, although the other widely chosen motivations referred mainly to intrinsic aspects of the profession such as working with and for people, stimulating work, and being autonomous. Cross-tabulation analysis and mutli-variate analysis of the motivations of various socio-demographic sub-groups were carried out. Three sub-groups showed more extrinsic orientations than the class as a whole: those of "other" religious preference; students feeling different from their classmates; and those from medium-sized towns. The most intrinsically oriented groups were: older students; those high in SES; and Jewish students.


[Shunt operations of the small intestine in cases of extreme adiposity (author's transl)]. Report is made about 15 patients suffering from most serious adiposity; owing to complete inefficiency of conservative methods of therapy whatsoever, a shunt operation of the small intestine according to Payne Dewind, modified after Baden, was carried out in these patients. After a period of observation, weight decrease amounted to 40 to 50 p.c. of the starting weight. Side effects having manifested immediately after operation, such as weariness, giddy sensations, nausea, flatulence, sweating stages, etc., disappeared after about six months. The highly increased frequency of stools was reduced--after two years--to one to two defectations per day. Increased blood pressure values returned to normal.


[Reversal of intestinal segments for therapy of malabsorption after small bowel resection. Experiments on animals (author's transl)]. Following massive small bowel resection malnutrition occurs as a result of impaired digestion and malabsorption. Of the numerous methods of operation suggested to improve intestinal absorption only the reversal of intestinal segments seems to be promising. Since so far this method was used clinically only in single cases, the method was studied experimentally in 50 minipigs (divided in 4 groups: 90 p.c.-small bowel resection without reversal, with primary or secondary reversal, and normal controls). The reversed segments 5 or 10 cm in length were inserted in the middle or at the end of the remaining jejunum or ileum. In comparison with the animals without intestinal reversal the animals with reversed segments showed a significant increase of intestinal transit time and of absorptive capacity, a nearly normal weight development and a considerably better adaptation of the remaining small bowel. In contrast to that the animals without reversal showed after an average of 3 months extreme cachexia. These encouraging experimental results with reversed segments in short bowel syndrome justifies in our opinion the application of this therapeutic principle in humans.


[Rupture of the uterus (author's transl)]. There have been made investigations at 142 Patients, who have delivered after earlier operations of the uterus. At 10 cases (7%) there occured a rupture in the scar. At 6 cases the rupture was detected by postnatal manual control of the cavum uteri. At 4 cases the rupture was found whilst the repeated caesarean section. The letality of mothers and children was 0. It is demanded, to give severe indication for caesarean section and not to perform it in all concerned cases. It is necessary to keep the concerned women under surveillance in late pregnancy and under delivery. If spontaneous delivery is prolongated or complicated secondary section is to be performed.


[The practicability of the gravlee-jet-wash-technique--results of a laboratory (author's transl)]. The matter of examination were 171 jet-wash-proofs of 166 patients. In working up the material we aimed to get "sedimentsmears" and "specimens" by the aid of the cellbloc-technique. In the case of seventeen patients there was no material to be evaluated. Counting the 13 cases which were found necessary to be repeated because the quantity of material was too little, 17,5% of the cases finally could not be diagnosed. Using the histology of curettage, or the surgery preparations of 148 patients, we had something to compare with the results of the jet-wash-proofs. 11 out of 13 endometrial carcinomata (84,6%) were registered by the aid of the jet-wash-technique; this was contrasted with two false positive results out of 148 cases. The reasons of false positive and false negative results are being discussed. The efficiency of the jet-wash-technique depends on the prooftaking method, the way the material is worked up, and the kind of the dammage of the endometrium. The results show, that the use of a jet-washer is now, after a phase of learning, a diagnostical completion for the recognition of the endometrial carcinoma in high risk patients.


Towards a unified theory for immunogenetic systems. I. Probing the serologic field--a meta-serologic approach. A serologic field (SEF) is produced by the in vitro studies of antibody-antigen interactions and usually includes serologic information processing (SIF). SIF can be regarded as the process whereby essentially "meaningless" raw data or experimental observables emanating from an input reality are structuralized and hence falsified into a "meaningful" pattern, Gestalt or output image. According to this "black box model", different "fact categories" (FC) can be identified in SEF. Traditional serology generally confounds its FC whereby fact category mistakes (FCM) are produced. Some FCM are structurally similar to the description of "mice" as four-letter animals or as a four-legged word--i.e. facts about "thing-properties" (animals, legs) are confounded with facts about "language-properties" (letters, words). In SEF, antibody and antigen molecules (thing-properties) are similarly endowed with "empty symbols" (language-properties). Due to such FCM, radically new meanings are assigned to experimental observables if the serologic language and/or theory is changed. The present meta-serologic approach consists of the design of a meta-serologic symbol language (SL-2) which includes the contemporary (simple-complex) conceptual framework (language and theory) as a limiting case. Consequently, some truly radical and revolutionary Gestalt switches will be generated when a specified SEF is mapped onto SL-2.


Retrospectroscope: the single breath test of diffusing capacity for carbon monoxide. In this paper I briefly review the significance of the single breath test of diffusing capacity for carbon monoxide (DLCO). I then attempt to answer the question of why this simple test has not become widely used in the past twenty years. The reasons are primarily due to failure in communication between research workers and practicing physicians. The practicing clinicians have difficulty with mathematical analyses and do not appreciate the limits for which the test is valid. Under steady-state conditions DLCO measures the transfer factor for the whole lungs, i.e. the volume of CO taken up by pulmonary capillary blood from alveolar gas when the alveolar CO pressure is one. It is independent of regional inhomogeneities. DL is the product of Krogh's K and alveolar volume. Krogh's K tends to become constant near total lung capacity while DL does not. For this reason K will probably vary less than DL and should always be reported when doing this test. In terms of the simple lung model with a single homogeneous alveolar compartment K is equal to DL per unit alveolar volume. I expect the measurement of K and DLCO by the modified Krogh single breath test to become a screening test for lung disease in its early stages.


[Therapy with alllopurinol and benzbromarone, single and combined. Renal elimination of lithogenous and colloid protective substances (author's transl)]. 12 hyperuremic male patients got during two comparative tests for 16 days 300 mg/die Allopurinol or 100 mg/die Benzbromarone or a combination of 100 mg Allopurinol with 20 mg Benzbromarone. During this time the renal elimination of uric acid, sodium, calcium, magnesium and citrate war measured and the renal clearance of uric acid, creatinine and sodium was determinated. Without any therapy the combination of 100 mg Allopurinol with 20 mg Benzbromarone per die reduces the elimination of uric acid significantly under the original value in the 24-hour-urine. The elimination of the uric acid increases with 300 mg/die Allopurinol. The clearance ratio of uric acid and creatinine rises 33% to 60%. With 100 mg/die Benzbromarone this value goes up to 233% compared with the results without therapy. At the same time the therapy with Brenzbromarone makes the clearance ratio of uric acid to sodium rise significantly to 257%. Under the 3 types of therapy there is no significant change in the 24-hours-urine of the clearance of creatinine and sodium, the clearance ratio of sodium to creatinine and the elimination ratio of sodium, calcium, magnesium and citrate. Hyperuremic patients with urolithic diathesis need Allopurinol therapy without any combination.


Basic pressure: an important feature of the vascular system. Starling's concept, "mean systemic pressure", is considered and its implications discussed. It is argued that since cardiovascular capacity and blood volume must obviously always be identical, any addition to or loss from the blood must simply compel an identical change in vascular capacity, without necessarily being associated with any change in venous return. Reasons are given for a need to differentiate between pressure and compression, and for appreciating that though the two are usually equal to one another, the second is not the cause of the first (as it is often thought to be). Indeed, the origin of blood pressure is the net osmotic pressure of plasma. We have demonstrated experimentally that Starling's method of measuring "mean systemic pressure" did not correspond to mean vascular compression during life. Moreover, when we remeasured mean systemic pressure by a method not much different from Starling's own, we arrived at quite a different figure. This fact we have attempted to explain. Finally we have described an entity which we hold to be more closely representative of mean systemic compression during life, and have shown how to arrive at it.


[Are diabetic angio- and neuropathies avoidable? (author's transl)]. By an early start of a good and consistently continued therapy, it is possible to slow for several decades the evolution of diabetic angio- and neuropathy and to keep them so mild that, even after 30 and 40 years duration of diabetes, the majority of well controlled patients preserve normal, age adjusted activity. The influence of good control of the diabetes on long-term diabetes, on micro- and macroangiopathy, on the duration of diabetes, on the fitness of the patient, on growth of diabetic children, on the outcome of pregnancy in diabetic women are reported. A rare, special benign form of diabetes is mentioned.


[Lactic acidosis after administration of guanidine derivatives (buformine, phenformine) (author's transl)]. Three patients are reported on, who at the time of admittance showed a decompensated metabolic acidosis, elevated concentrations of serum lactate and a reduced kidney funktion. All the patients had taken guanidine derivates (phenformine, buformine) because of diabetes mellitus. The serum biguanid concentrations, however, were elevated in only two cases. Therapy of the lactic acidosis has to be directed at the underlying disease. In biguanid incluced acidosis, haemodialysis with simultaneous administration of sodium bicarbonate is indicated.


[Similarities and differences after head injuries in children and adults (author's transl)]. The results of a systematic neurological and electro-encephalographical follow-up study in 344 head injured adults and 116 children were compared. The results show that posttraumatic EEG abnormalities lasting more than 24 hours, are equally frequent in children (53%) and in adults (49%). Mostly short lasting neurological signs of focal tissue damage are however significantly more frequent in children (30% vs. 13% and EEG-abnormalities (foci and general slowing) are on the average more pronounced. The recovery of EEG abnormalities follows the same pattern as in adults, occurs however faster among children. In both groups the normalization of general slowing precedes that of focal abnormalities only in 25% of the cases. Amnesias on the average last shorter in infants. Their duration seems of lesser significance for the judgement of the severity of the trauma in children than in adults. 6 months after the trauma children complain less frequently about headache, dizziness, or impaired memory and diminished ability to concentrate; emotional lability and impairement of drive, however, are more frequent than in adults. The results indicate an equal diagnostic and prognostic importance of systematic EEG studies (within 2 days, after 1 week and 6 month after the trauma) in both groups.


[Sports accidents of tennis players (author's transl)]. An analysis of 144 sports accidents of 275 tennis players in Switzerland (203 men, 72 women) showed fractures of bones in 5,5% open wounds in 14,5%, torsions in 33% and other injuries in 47%. The head was injured in 9,5 and the legs in 76%, the arms in 11,5% and the trunk in 11,5%. Two fifth of all leg injuries were on the left side, three fifth on the right side. The arms were hurt in 98% on the right and only in 2% on the left side. Causes of accidents were in 21% slipping on wet ground, in 17% related to the rackets, in 33% a too speedy start with damage to muscles and tendons, in 14% stepping on tennisballs lying on the ground. A tennis sport accident required an average of 35,8 days of treatment by a medical doctor and an average of 0,7 days of clinical treatment. Already 33% of the men and 26% of the women suffered from the so called "tennis-elbow".


Polyribosomes and messenger RNA from rat liver mitochondria. Rat liver mitochondrial polyribosomes were isolated free from cytoplasmic ribonucleoprotein contaminations in a number of criteria (sedimentation and buoyant density patterns, ribosomal RNA composition). Heterogeneous poly A containing RNA from mitochondrial polysomes was purified by two-stage cellulose chromatography. This RNA was in vitro labelled with 125I up to specific activity approximately 10(6)-10(7) cts.min-1.microng-1 and used for hybridization experiments with separate complementary strands of mitochondrial DNA and nuclear DNA fragments. The proportions of mitochondrial poly A containing RNA that is complementary to heavy and light strands of mtDNA were respectively 31.5% and 8.3%. Besides, a significant RNA fraction was complementary to unique sequences of nuclear DNA (2-3 copies per haploid genome). The hybrids that were formed possessed a high Tm indicative of a perfect base pairing. A dual intracellular origin of mitochondrial messenger RNA is discussed.


[Factors causing apneas in otherwise healthy newborns: a neurophysiological Concept (author's transl)]. The possible origins of apneic spells in otherwise healthy neonates are reviewed. An analysis is made of how breathing is organized by the central and peripheral neuronal system, and how the overall control of breathing is sometimes inhibited by various active sleep mechanisms. From the neurophysiological point of view, a review is also made of various therapeutical approaches for the prevention or reduction of apneas. The hypothetical correlation between the sudden infant dealth syndrome and neonatal apneas is disussed briefly.


[Treatment of phenylketonuria: psychological results of a 5-year follow-up study (author's transl)]. In addition to earlier reports findings of a psychological five-year-follow-up of PKU-children are presented. Intelligence and motor development of these children depend significantly on age at onset of therapy and quality of dietary control. After dietary treatment over several years older PKU-children with late onset of therapy display no structural change as far as cognitive and motor development are concerned. Furthermore, a psychodiagnostic approach is presented to predict quality of dietary control. Although this approach did not yet yeald positive results because of insufficient sample-size it should be applied to further studies in the future.


[Vitamine A acid therapy in autosomal dominantichtyosis (author's transl)]. In autosomal dominant ichthyosis, a permanent cure is impossible, and symptomatic treatment is most important. At present, known therapeutic procedures have had little or no influence in this disease. Following the application of 0.1% vitamin A acid ointment, especially in children, the skin became free of scales within a few weeks. After improvement, a maintenance dosage of one application per week in most cases was sufficient to avoid any recurrence. Possible side effects of this treatment are mentioned. Sereral possibilities regarding the mode of action of vitamin A acid are discussed.


[Subglottic stenosis of the larynx following prolonged translaryngeal endotracheal and nasotracheal intubation in infancy (author's transl)]. Illness or injury prompting respiratory support, choice of size of the endotracheal tube, the extent of mechanical mucous membrane damage, the duration of intubation as well as additional bacterial and chemical toxins are the main factors for the development of subglottic stenosis following prolonged intubation. All this has to be considered when translaryngeal endotracheal or nasotracheal intubation has to be performed. The evaluation of 56 cases of postintubation subglottic stenoses showed an almost complete neglect of these decisive parameters as shown by the resulting serious consequenses for the somatic and intellectual development of the befallen children.


[Pseudohypoaldsteronism. A further case report (author's transl)]. The clinical symptomatology and diagnostic procedures of pseudohypoaldosteronism in an 8 days old male newborn infant are described. The course of the disease was initially characterized by failure to thrive, renal salt loss, hyponatremia and hyperkalemia. Daily treatment with 3 g sodium chloride improved symptoms. Hydrocortisone and desoxycortiscosteronacetate were without any effect. Urinary aldosterone excretion was increased 10 to 20 times of normal. 17 ketosteroid and pregananetriol were normal. The infant died of ulcerative enterocolitis at the age of 1 1/2 years. Beside the first description of the disease by Cheek et al. (1958) 13 further publications have been collected from the literature. Symptoms at the beginning, sex, serum electrolytes, aldosterone excretion, somatic development, observation period, treatment and duration of therapy are compared with the presented case report.


[Incidence of peculia cytoplasmic structures in the cytotrophoblast cells in pre-eclampsia]. Occurrence of glomerular-bodies or nucleolus-like bodies in the cytotrophoblast cells of the human placenta in praeeclampsia is described. Structural details and intra-cytoplasmatic localization of nucleolus-like-bodies are discussed. Function of this structure is recently unknown but it is remarkable that it occurs in great number at one of the most serious pathological process in pregnancy--at praeeclampsia.


[Membranous glomerulonephritis caused by HBs (Australia) antigen-antibody complexes]. Authors describe a case of chronic aggressive hepatitis with persistent HBs (Australia) antigenaemia and nephrosis syndrome. The renal process microscbically appeared to be membranous glomerulonephritis. By immunofluorescent method antigen deposits IgG, IgM, C3 and HBs of the granular type have been revealed on the glomerular basal membranes. Deposits of the IgA were partially of granular, partially of linear type. Electronmicroscopically on the glomerular basale membrane subepithelial deposits were seen. The results of this study indicate that in the case reported diffuse membranus glomerulonephritis occurred due to HBs antigen-antibody immuno-deposits on the glomerular basal membrane.


[The Duffy blood group system in the determination of paternity]. Authors report in detail recent achievments the investigation of Duffy's blood group system. Genetics of the system is shortly reviewed. Results of their own population-genetical investigation--carried out on 723 non-related persons by the aid of anti-Fy(a) and anti-Fy(b) serum--are also described. According to the author's data frequency of the phenotype Fy(a+b-)=19,63%, of the phenotype Fy(a+b)=50,91%, and of the phenotype Fy(a-b+)=29.46%. Data of the gene-frequency: Fya=0,451; Fyb=0,549. Presence of the gene Fy(-) was not revealed. The Duffy system--among others--was examined in 299 cases of discussed paternity. In 30 cases (10.3%) paternity was excluded on the base of it. In 31 men (8.29%) out of 374 the paternity cystem. Maximal (theoretical) chance of exclusion calculated from the data got in own investigations: 18.625%. Examined and calculated values of the chance of exclusion in cases of opposed homozygotes (12.26%) and in cases of the lack of characteristics (6.36%) were similar to a suitable degree. Technical problems of the investigation are further discussed. Author recommend the use of the examination of Duffy system in cases of discussed paternity.


Mouse oocyte dominant-lethal response to chronic gamma irradiation. Adult mouse females were given 500 rad of chronic gamma rays at 0.01 rad/min and mated to unirradiated males during seven successive weeks to score the frequency of dominant-lethal mutations. Total dominant lethality was increased for any of the weeks post-radiation. Post-implantation dominant lethal yields were low, ranging from 2.5 to 6.1% for individual weeks p.r.


Culture of pre-implantation Chinese hamster (Cricetulus griseus) embryos in vitro. Pre-implantation embryos from Chinese hamsters (Cricetulus griseus) were cultivated under completely defined conditions. The embryos were placed in drops of chemically defined medium under liquid paraffin and cultured in an atmosphere of 10% CO2 in air. By this method, development will proceed in vitro from the two-cell stage up to the blastula within 72 h. It is possible to stop the cultivation at different stages of development, to fix the embryos and analyse the chromosomes. The method described in detail seems to be appropriate for examination of the induction of genetic defects during the first days of embryogenesis.


Chromosomal radiosensitivity and karyotype in mice using cultured peripheral blood lymphocytes, and comparison with this system in man. The frequencies were studied X-ray-induced dicentric chromosomes and deletions in peripheral blood lymphocytes of mouse and man, cultured in vitro. After doses of 100 and 200 rad, (a) the mouse was equally sensitive as man to the induction of dicentrics, and (b) the frequency of deletions was higher in the mouse, reaching statistical significance at the 200 rad level only. At the 200 rad level, the mouse with normal karyotype was compared with the T(1;13)70H translocation heterozygote and the Ts(1(13))7OH tertiary trisomic of normal appearance. No differences were found either with respect to dicentrics or to deletions. At the 100 rad level, the normal mouse was compared with the tertiary trisomic mouse of the affected phenotype and with the tobacco mouse. The frequency of dicentrics was significantly higher in the phenotypically abnormal trisomics, whereas the deletion frequency was higher in the tobacco mice. C-banding of the slides enabled the locating of breaks in constitutive hetero-chromatin and euchromatin. When exchanges were classified into three categories, i.e. those between eu- and euchromatin, eu- and hetero-, and hetero- and heterochromatin, there was a preference for the first and the last whereas only few occurred between chromatins of contrasting type. Differences between previous determinations of the chromosomal radiosensitivity of mouse and man, using peripheral blood lymphocytes (i.e. man is twice as sensitive as mouse), and the one presented here could be attributed to differences in harvest time of the mouse peripheral blood lymphocytes. Thus the so-called "arm number" hypothesis of Brewen et al. [5] is not confirmed by the present results.


The effect of x-ray induced mitotic delay on chromosome aberration yields in human lymphocytes. The extent to which X-ray induced mitotic delay at 150 and 400 rad influences chromosome aberration yields was examined in human peripheral blood lymphocytes. The dicentric was used as a marker and aberrations yields were obtained for mixed cultures prepared from equal numbers of normal and irradiated cells. The cultures were terminated following incubation times of 36-120 h. Greater mitotic delay of the order of a few hours was observed at the higher dose. However most reduction in the number of lymphocytes arriving at metaphase by 48 h may be ascribed to interphase death or failure to transform. Analysis of the dicentric distributions which were expected to follow Poisson statistics indicated that cells containing dicentrics were delayed relative to irradiated but aberration-free cells. Cells with one dicentric moved more easily through the first cell cycle than cells containing two dicentrics. Following accidental partial body irradiation, selection in culture favouring the unirradiated lymphocytes does not distort the aberration yield sufficiently to warrant incubation times in excess of the standard 48-52 h.


The inhibition of repair in UV irradiated human cells. We have used three different assay procedures to determine the effects of hydroxyurea on excision repair in UV-irradiated HeLa cells. The results were as follows. (a) At the cytological level, incubation of UV-irradiated metaphase cells with hydroxyurea caused chromosome decondensation. (b) Using a modified alkaline sucrose gradient sedimentation technique involving minimal lysis before centrifugation, we found a marked retardation in the sedimentation of DNA from UV-irradiated cells incubated for a short period with hydroxyurea. (c) The effect of hydroxyurea on the incorporation of[3H]thymidine by UV-irradiated G1 cells was found to depend on the concentration of thymidine present in the medium. Normal primary human cells resemble HeLa cells in the response of chromosomes and DNA to UV plus hydroxyurea. Xeroderma pigmentosum cells, deficient in excision repair, are not sensitive to hydroxyurea in our assays. Chromosome decondensation and retarded DNA sedimentation occur also after incubation of irradiated HeLa cells with deoxyadenosine, but not thymidine, at concentrations which inhibit semiconservative DNA synthesis. The effects of hydroxyurea or deoxyadenosine on chromosomes and DNA are not seen if all four deoxyribonucleoside precursors of DNA are supplied exogenously. These results point to an inhibition of repair DNA synthesis by hydroxyurea (or deoxyadenosine), at the level of the supply of DNA precursors, i.e. in the same way that these agents inhibit semiconservative DNA synthesis. In the presence of these inhibitors, single-strand gaps accumulate in the DNA.


Spinocerebellar ataxia and HLA linkage: risk prediction by HLA typing. To determine the possibility of genetic linkage of spinocerebellar ataxia with the histocompatibility loci, we performed HLA typing and linkage analysis on 19 members of a kindred in which spinocerebellar ataxia was segregating in an autosomal dominant inheritance pattern. The ataxia locus was located on chromosome 6 at 12-cM distance from the HLA complex with lod score of 3.15 (odds is greater than 1400:1 favoring linkage over chance findings). Thus, the presence of the ataxia gene in members of this kindred at risk can be predicted with about 90 per cent accuracy by means of HLA typing in informative matings.


Mid-trimester abortion by dilatation and evacuation: a safe and practical alternative. Abortions by dilatation and evacuation after the 12th menstrual week of pregnancy are said to be both hazardous and impractical. To evaluate this hypothesis, we compared the safety and feasibility of 6213 abortions by this means and 8662 induced by intra-amniotic instillation of saline during the 13th to the 20th week of pregnancy. Abortions by dilatation and evacuation had a lower rate for major complica-tions (0.69 vs. 1.78 per cent; P is less than 0.001) and lower rates for treatment of complications, including antibiotic administration (2.22 vs. 5.65 per cent; P is less than 0.001), blood transfusion (0.19 vs. 0.91 per cent; P is less than 0.001), and curettage or manual evacuation of the uterus (0.98 vs. 34.10 per cent; P is less than 0.001). Such abortions also had a lower rate for failure of the method to produced abortion (0.11 vs. 2.52 per cent; P is less than 0.001). Although large, randomized trials are required to determine the appropriate role of mid-trimester abortion by this means, this method appears safe and practical through the 20th week of pregnancy.


Altered relation of two collagen types in osteogenesis imperfecta. To ascertain if the features of osteogenesis imperfecta could be due to an abnormality in two genetically distinct collagens, Type III and Type I, we measured, in pepsin digests of skin, the ratio of the alpha 1, (III) to alpha 1 (I) chains derived from the two types, using a method of interrupted polyacrylamide-gel electrophoresis. In 40 control subjects this ratio decreased from about 0.45 in early fetal life to a mean (+/-2 S.D.) of 0.14 +/- 0.06 in 14 adults. Seven of nine adult patients with mild osteogenesis imperfecta had ratios of more than 4 S.D., above this mean, as did two of five patients with severe osteogenesis imperfecta. The increased ratio was probably due to a reduction of Type I collagen. If this reduction were generalized it could contribute to the bony fragility of osteogenesis imperfecta, since mineralized bone contains Type I collagen only.


When may research be stopped?

When may research be stopped? The prohibition of research with recombinant DNA must rely upon some argument that both establishes a principle, applicable to research in any sphere, identifying kinds of defect or hazard that are intolerable, and shows that recombinant DNA research is intolerably defective or hazardous in the ways specified by that principle. No such argument succeeds. Of arguments proposed to defend prohibition it may be fairly said either that the major premise (the principle of prohibition) is false, or when sound principles are put forward, that the minor premise (specifying recombinant DNA research as defective or hazardous in the ways called for) is far from established. There is no valid practical syllogism, having true premises, whose conclusion is that research with recombinant DNA should be stopped.


Study on the chemical nature of sterols contained in Bulgarian sunflower oil. The free sterols, the sterol esters and the sterol glycosides of the crude sunflower oil as well as those of the technical lecithin, the pitch and the deodorizer distillate of the latter oil were isolated by preparative TLC. The nature of sterols contained in the isolated sterol derivatives was elucidated by GLC and combinded GLC-MS. Major sterols of all examined sterol fractions are sitosterol, campesterol and stigmasterol, the amount of sitosterol being prevalent. Unknown sterol with a molecular weight of 428 is present in sterols of the crude oil and the deodorizer distillate. Sterols of the deodorizer distillate contain an unknown sterol with a molecular weight of 430. Stigmasterol is present in the sterol fraction of the deodorizer distillate in high amounts. It was established that delta7-sterols of the crude oil occur only in esterified form. The hydrolysis of the sterol derivatives in acid medium leads to dehydration products known as steroid dienes and disteroid ethers. Hydrolysis without dehydration was achieved by enzyme preparations. Some sterols of the crude oil were esterified with the same higher fatty acids contained in the glycerides of the sunflower oil.


[Evaluation of nutrition by means of an electronic data processing method for controlling and influencing adequate planning of the structure of the diet]. Electronic data processing is more used also in the analysis, control and surveillance of human nutrition. The present paper deals with a method that permits to evaluate the nutritional structure of all-day canteen feeding by means of a computer program based on the dishes actually delivered by the canteen. Apart from the energy value, the values for animal and vegetable proteins, fats, carbohydrates, calcium, vitamin A and vitamin C have been adopted as criteria. The evaluation was based on a specific scoring system. The results obtained are made available to the respoective institutions in the form of graphs. The qualitative and quantitative effects produced by this method of evaluation have been studied in 10 selected canteens during a period of 3 years.


[Effects of two special diets on the body weight of rats]. The authors studied the effects of 2 special diets on the weight behaviour of male Wistar rats (aged 4--5 weeks) from Schönerlinde near Berlin up to the age of 35 weeks. The weight behaviour of rats fed a standard diet (commercially available pellets) lies between those of the experimental rats and near that of the rats on low-fat (3%) diet. The one special diet that contains 3% of fat is low-fat (8.4% of the gross energy of the feed) and high-protein (69.3% of the gross energy); the other diet that contains 50% of fat is high-fat (76% of the gross energy). The two diets (containing 331 and 612 kcal/100 g, respectively) are not isocaloric but the animals on the low-fat diet ate twice as much as the animals on the high-fat diet. The rats on the high-protein low-fat diet were prone to copious sweating. It was generally noticed that the animals on the high-fat diet became to a greater extent hypokinetic with increasing age. The weight difference between the two dietary groups increased with increasing age, reaching its maximum value (77%) at the age of 24 weeks and then decreasing to 60% (at the age of 35 weeks). Up to the age of 12 weeks, the rats are in the more "dynamic" phase of weight increase; and from the 16th week, in the more "static" phase of weight increase.


Short-term fasting in the treatment of obesity. Short-term fasting (five days) accompanied by negative nitrogen balance induced protein sparing effect in the realimentation period at obese persons on the hypocaloric diet. To utilise the starvation induced activation of mechanism compensating the losses of body protein 5-day starvation was alternated with 3-day intervals on 500 kcal diet (60 g of protein), the cycle was repeated five-times. The results of repeated estimations of body composition (densitometry) revealed, that at this regimen the losses of the body fat were in a marked preponderance over the lean body mass (63% versus 37% of the weight decrease). The repeated periods of starvation are well tolerated and appeared to be effective and safe (provided that states with contraindication of starvation are excluded).


[Amino acid composition of unresorbed peptide fractions in the contents of the distal part of rat small intestine. 1. Nitrogen-free diet and diets with casein, sunflower protein isolate and defatted sunflower seeds]. After feeding with protein containing diets the protein quantity increases in the aqueous supernatant (U1), in the trichloracetic acid soluble (U2) and precipitable (S2) fractions of the content of the distal part of the small intestine of rats. Independent of the dietary proteins the amino acid composition of both fractions (S2 and the peptides from U2) is similar in relation to protein-free feeding; a similarity with the amino acid composition of the dietary proteins doesn't exist. In relation to fraction S2 the peptides of fraction U2 show anording to the higher content of amino acids, which are difficult to liberate by protein cleavage, a high proteolytic degradation.


Experimental infection of pregnant goats with Akabane virus. Ten pregnant goats were inoculated  intravenously with a newly isolated strain of Akabane virus. As a result, vertical infection and experimental reproduction of congenital morphological abnormality were accomplished. Fetuses were removed from two of them 10 days after inoculation and used for recovery of the virus. Clinically, the goats were free from any abnormal sign. Mild viremia was demonstrated in one of them inoculated with the virus at 30 days of pregnancy, but the fetus removed from this goat was negative for virus recovery. No viremia was demonstrated in the other one inoculated with the virus at 55 days of pregnancy, but two fetuses removed from it were positive for virus recovery. No abnormal clinical signs were observed in eight goats inoculated with the virus at 40 approximately 115 days of pregnancy, but leukopenia was noticed in five of these goats. Viremia was demonstrated in all the goats. It persisted for 2 to approximately 4 days. Seven goats were held under observation up to the time of spontaneous parturition. Ten neonatal kids were obtained. All of them were normal, except three which were particularly weak and one which was mummified fetus. When precolostral serum was examined, it contained neutralizing antibody against Akabane virus in five of eight neonatal kids. Two fetuses (120 days of intrauterine life) were removed from the remaining one pregnant goat 80 days after inoculation.  Congenital morphological anomaly was reproduced in one of them. The other was a normal fetus. Serum collected from the umbilical cord was positive for neutralizing antibody against Akabane virus in both fetuses.


Circadian changes of the duration of action of local anaesthetic agents. A statistically significant circadian rhythm of the duration of local anaesthesia produced by lidocaine and betoxycaine was found in both human skin and teeth. In adult subjects with diurnal activity and nocturnal rest the longest duration was found around 15.00 (3 p.m.) with a large peak-trough difference amounting to more than 100% of the 24 h mean. Such chronopharmacologic rhythm might be related to circadian rhythms in catecholamine secretion and/or in circadian changes of cell membrane properties.


The influence of temperature upon reserpine-induced supersensitivity of guinea-pig isolated atria to isoprenaline and salbutamol. 1. The aim of this investigation was to determine whether supersensitivity of isolated atria to sympathomimetic amines following pretreatment with reserpine was evident at low temperatures, which alone induced supersensitivity. 2. Cumulative dose-response curves for the positive inotropic and chronotropic responses of isolated guinea-pig atria to isoprenaline and the partial agonist salbutamol were plotted as a percentage of the maximum response to isoprenaline. 3. In atria from reserpine-pretreated guinea-pigs set up at 38 degrees C, supersensitivity of both rate and tension responses was observed as a shift of the curves to the left and an increase of the maximum responses to salbutamol. Tension responses were potentiated more than rate responses. At 30 degrees C the supersensitivity became less apparent and at 25 degrees C was virtually absent. 4. The dose-response curves in untreated atria at low temperatures revealed that hypothermia itself produced supersensitivity of rate and tension responses. The dose-response curves were displaced to the left and the salbutamol maxima were raised so that at 25 degrees C it became almost a full agonist. The hypothermia-induced supersensitivity was therefore sufficient to mask any supersensitivity resulting from pretreatment with reserpine. 5. The hypothermia-induced supersensitivity of the rate response was dependent upon the method of plotting. When plotted in absolute units of beats per min no supersensitivity of the rate response was evident. Supersensitivity of the tension response at the lower temperatures and of both rate and tension responses following pretreatment with reserpine were independent of the plotting method.


Effects of hexoestrol on the contractility of the isolated, blood-perfused canine papillary muscle and of the guinea-pig ileum. The effects of hexoestrol were studied on the blood flow and the tension development of the isolated, blood-perfused papillary muscle of the dog, as well as on the contractions of the guinea-pig ileum induced by acetylcholine, histamine or BaCl2. Hexoestrol caused an increase in coronary blood flow and a negative inotropic effect in a dose-dependent manner. High doses of hexoestrol produced a loss of contractility of the papillary muscle without significant alterations of the amplitude and shape of the electrical activity recorded extracellularly. Hexoestrol had a strong non-selective relaxant effect on the guinea-pig ileum and was 10-20 times more potent than papaverine in antagonizing contractions induced by the 3 agonists. These results indicate that hexoestrol probably acts by blocking certain steps in the process by which extracellular and/or superficially bound Ca ions move to the contractile machinery in cardiac and in smooth muscle cells. Thus, it may bear some resemblance to the so-called calcium antagonists.


Angiotensin II-induced contractions of rabbit splenic capsular strips and release of prostaglandins. Use of radioimmunoassays for prostaglandins E1 and E2. Rabbit splenic capsular strips contract in response to angiotensin II and simultaneously release prostaglandins E and F into the bath fluid. Contractions, though not sustained, and prostaglandin release are dependent on the concentrations of angiotensin II. Addition of indometacin to the bath fluid inhibits prostaglandin release and potentiates the angiotensin II-induced contractions. Similarly, 5,8,11,14-eicosatetraynoic acid, another blocker of prostaglandin synthesis, potentiates contractions elicited by angiotensin II. Exogenous prostaglandin E1 (300 ng/ml) tends to decrease angiotensin II-induced contractions, while prostaglandin E2 (300 ng/ml) as well as prostaglandin F2alpha (300 ng/ml) significantly increase the contractions produced by angiotensin II. The prostaglandin endoperoxide analogues (15S)-hydroxy-9alpha,11alpha-(epoxymethano)prosta-5Z,13 E-dienoic acid and (15S)-hydroxy-11alpha,9alpha-(epoxymethano)-prosta-5Z,13 E-dienoic acid in concentrations of 300 ng/ml are either without effect or weak smooth muscle stimulants of their own, but do not influence the effect of angiotensin II. By the simultaneous use of sensitive and specific radioimmunoassays for prostaglandins E1 and E2 the prostaglandin E-like substance released by the rabbit splenic capsular strips was found to resemble serologically much more the dienoic prostaglandin E2 than prostaglandin E1. The potentation of the effect of angiotensin II by indometacin and 5,8,11,14-eicosatetraynoic acid might be caused by inhibition of synthesis of prostaglandins or related compounds in the splenic tissue. However, an undefined sensitizing effect of indometacin and 5,8,11,14-eicosatetraynoic acid, not related to their effect on prostaglandin synthetase, on the smooth muscle preparation cannot be excluded.


Influence of hydrostatic pressure gradients on net transfer of sodium and water across isolated rat colonic mucosa. 1. The dependence of net transfer of water and sodium on hydrostatic pressure gradients from the serosal to the mucosal side was investigated in everted sacs of the stripped mucosa of the rat colon. 2. In the range of 3-20 cm H2O both, net sodium and water transfer were linearly dependent on hydrostatic pressure. The hydraulic permeability coefficient was 1.1 ml per gram dry weight, hour and cm H2O. At a pressure gradient of 5.8 cm H2O the net movement of water from the mucosal to the serosal side ceased. Above this pressure a net movement in the opposite direction occurs. Sodium net movement from the mucosal to the serosal side ceased at 11 cm H2O. The fluid, which appears-driven by higher values of hydrostatic pressure-on the mucosal side, is  hypotonic. 3. Oxyphenisation increases the hydraulic permeability of the colonic epithelium. The fluid, which appears--driven by the hydrostatic pressure gradient--on the mucosal side, is isotonic.


Formation of chlorpromazine sulphoxide and monodesmethylchlorpromazine by microsomes of small intestine. The metabolism of chlorpromazine by microsomal preparations of the small intestine from guinea pig and rat was studied. 35S-chlorpromazine was incubated with these preparations in Krebs-Ringer bicarbonate buffer at 37 degrees C. Control values were obtained by performing the assay at 0 degrees C. The metabolites were extracted with dichloroethane and separated by TLC. In incubations with intestinal microsomes from guinea pigs chlorpromazine sulphoxide and monodesmethyl chlorpromazine were identified as main metabolites. The apparent Michaelis constant for sulphoxidation of chlorpromazine is approximately 20-30 micronM and for N-demethylation in the range of 30-100 micronM. Using microsomal preparations from rat intestine, however, noteworthy formation of chlorpromazine metabolites could not be found. This observation can be explained by the fact that the cytochrome P450 content of rat intestinal microsomes was extremely low compared with that determined in guinea pig microsomes.


Glomerular cell proliferation in human and experimental glomerulonephritis. Light- and electron-microscopical, and autoradiographic observations. Three mitoses of endothelial glomerular cells have been observed by electron microscopy in 3 different nephropathies (a mixed membranous and proliferative glomerulonephritis, an intracapillary glomerulonephritis, and a mixed IgG-IgM cryoglobulinemia). Further light- and electron-microscopical and autoradiographic investigations on the occurrence and nature of the dividing cells responsible for glomerular hypercellularity in glomerulonephritis have been carried out in rats with an immunocomplex-induced glomerulonephritis. A statistically significant difference between treated and control animals have been found in the number of mitoses and DNA-synthesizing nuclei. All dividing glomerular cells observed by electron microscopy were endothelial. It is therefore proved that in glomerulonephritis an actual glomerular cell proliferation does occur; proliferating cells are suggested to be endothelial in nature.


Control of plasma aldosterone during hemodialysis in patients with terminal renal failure. The control of plasma aldosterone during hemodialysis was investigated in 31 patients with terminal renal failure. While before hemodialysis renin predominantly influenced aldosterone, this effect dissipated during hemodialysis. In addition, no relationship was observed between changes in aldosterone and those in sodium, potassium and plasma cortisol. In a group of 10 patients isokalemic and isonatremic hemodialysis failed to document an effect sodium or potassium on hemodialysis induced changes in aldosterone. Our data suggest that none of the four factors - renin, ACTH, sodium and potassium - had constantly caused the observed changes in aldosterone during hemodialysis.


Plasma and urine amino acid concentrations in children with chronic renal insufficiency. Amino acids were determined in plasma and urine from controls and children with chronic renal insufficiency. Significant differences were found in the mean plasma concentration of serine, threonine, glutamic acid, tyrosine, arginine, cystine and glycine in children with severe renal failure. There was a marked increase in clearance of the majority of amino acids when glomerular filtration rate (GFR) fell below 30 ml/min/1.73 m2: the exceptions were the basic amino acids and cystine which did not change. As GFR decreased there was a significant reduction in the percentage tubular reabsorption of individual amino acids. Children with severe renal failure excreted up to 40% of the filtered load of amino acids in the urine. This significant increase in urinary amino acid loss may contribute to the derangement of plasma amino acid conentrations found in uraemia.


Erythrocyte electrolyte content and sodium efflux in chronic renal failure. The cation content of the eythrocyte was studied in 36 patients with chronic renal failure; A normal or high erythrocyte potassium was found. Erythrocytes sodium values showed a wide range, from very high to very low, and the rate constant for Na efflux was found to be higher than normal. The interpretation of these findings is discussed. It is suggested that the higher than normal. The interpretation of these findings is discussed. It is suggested that the high erythrocyte K content may reflect abnormal total body K, may be explained on the basis of a young red cell population or may be related to abnormal function of the erythrocyte cation pump. It is probable that the development of these changes in chronic renal failure depends on many factors.


Effects of hemodialysis and saline loading on body fluid compartments, plasma renin activity and blood pressure in patients on chronic hemodialysis. The influence of one hemodialysis session and of subsequent loading by 1.5-2 liters N saline on blood pressure, PRA and body fluid compartments was assessed in seven patients with chronic renal failure on maintenance hemodialysis. Dialysis caused only slight decreases in plasma volume, ECV and in TEBS. Lying mean blood pressure by 5-10 mm Hg and PRA increased by 30%. Saline loading resulted in a significant increase in plasma volume by 0.4 liters and in blood pressure by 10-5 mm Hg, but in a decrease in PRA by 40%. The changes in mean blood pressure correlated positively with the changes in plasma volume, and negatively with the changes in PRA. It is concluded that the renin-angiotensin system in patients on chronic hemodialysis still functions as one of the adjustment mechanisms for the circulatory homeostasis, when challenged by volume loss or volume and sodium loading.


Echocardiography in uraemic pericarditis with effusion. Serial chest radiology and echocardiography were performed in seven patients undergoing chronic haemodialysis who developed pericarditis. Echocardiography was helpful in making an early diagnosis of a pericardial effusion in the absence of specific clinical or radiological signs of an effusion. It also enabled changes in the thickness of a pericardial effusion to be detected, which was of value when clinical features suggestive of cardiac tamponade occurred during dialysis, and showed that the effusion could increase in size despite the use of regional heparinisation for dialysis. Resolution of a pericardial effusion could be defined accurately using echocardiography, whereas this was not possible clinically or radiologically. It is concluded that serial echocardiography is a good method of monitoring a pericardial effusion in dialysis patients.


The role of prostaglandins in the natriuresis of acutely salt-loaded rats. Mechanisms determining the natriuresis in ECV expansion are not yet completely known. The present study was therefore performed to investigate (1) the extent to which prostaglandins (PG) are involved in the natriuresis of ECV expansion and (2) by which mechanisms PG may affect renal Na absorption. In nonexpanded rats the prostaglandin synthetase inhibitor indomethacin (INDO) had no effect on renal function. In 16 Sprague-Dawley rats EVC expansion with isotonic saline corresponding to an increase in body weight of 10% was induced and maintained for 60 min. Ten animals received an oral dose of 10 mg/kg BW of INDO prior to ECV expansion. Six animals served as controls (C). Blood pressure (INDO: 132 +/- 4 (SE); C: 130 +/- 3 mm Hg), GFR (INDO: 12.5 +/- 1.0; C: 10.5 +/- 0.9 ml/min/kg BW), fractional K excretion (INDO: 32.1 +/- 2.6; C: 43.4 +/- 4.8%), CH2O and Na-k-ATPase activities in renal cortex, medulla and papilla did not significantly differ in either group. Significant differences were observed in urinary flow rate (INDO: 0.82 +/- 0.8; C: 1.82 +/- 0.23 ml/min/kg KG) and fractional Na absorption (INDO: 91.9 +/- 1.1; C: 81.7 +/- 1.2%). The results indicate that PG are involved in the natriuresis following acute expansion of the ECV and suggest that PG may inhibit the intrinsic tubular capacity for Na absorption in the rat.


Effect of fructose and mannitol on dog renal cortical adenine nucleotide content, in vivo. The renal cortex of anesthetized dogs was found to contain per gram lyophilized dry weight 9.5+/-0.6 micronmol ATP, 3.2+/-0.5 MICRONMOL ADP, 0.68+/-0.3 MICRONMOL AMP, and 22.5+/-4.4 micronmol Pi. These amounts were unchanged by the administration of moderate amounts of saline or hypertonic mannitol in load doses of about 20mmol/kg. Fructose in doses of 5 mmol/kg was found to cause a marked decrease in cortical ATP content. In doses of 20 mmol/kg fructose not only caused a decrease in ATP, but in total adenine nucleotides and Pi content as well. These results are consistent with the mode of action proposed for fructose, in rat kidney.


Diphenylhydantoin-induced acute renal failure. A case of acute renal failure developing at two separate times after the use of diphenylhydantoin is described. On both occasions the patient also had other manifestations of a hypersensitivity reaction and recovered normal renal function after the withdrawal of the drug and institution of corticosteroid therapy.


Monitoring of intracranial pressure in patients with severe head injury. Direct measurements of intracranial pressure in 100 patients with severe cranio-cerebral injuries showed that the development and progress of the post-traumatic brain edema did not follow any definite pattern. Likewise, the clinical findings did not allow any clear conclusions to be drawn regarding the height of the intracranial pressure. Among the different osmotic and saline diuretics tested, only mannitol and sorbitol seemed to be able to produce a rapid and effective lowering of acutely raised pressure. Indeed, even here the duration of the action varied very widely. Apart from the usual routine treatment, dexamethasone in very high doses was able significantly to reduce the frequency of pathological rises of pressure. By means of high doses of steroids and monitoring of the intracranial pressure, the mortality after severe brain injuries can be significantly reduced.


[External ventricular drainage--a new aspect in the operative treatment of head injury (author's transl)]. It is not only for CSF-removal in conservative treatment of oedema and control of the effectiveness of osmo-onco-therapy, contricosteroids, anticholinergics and aldosterone-antagonists, that external CSF drainage in severe cerebral trauma has proved of value. It has also made it possible to assess objectively the indications for bitemporal craniotomy in raised intracrainial pressure with an acute midbrain syndrome caused by tentorial herniation. Continuous monitoring of ICP permits an intervention at the right time and prevents one from operating too late, namely at a moment, when manifest neurological signs already indicate cerebral decompensaervative steps failing, a bitemporal craniectomy is indicated: in this way we lower intracranial pressure, liberate the rostral brain stem out of its strangulation and improve cerebral perfusion and metabolism.


[Glucose tolerance test and some pathways of glucose metabolism in patients with craniocerebral trauma]. Intravenous glucose tolerance test was done and concentrations of lactic acid and pyruvic acid were determined together with the lactic acid/pyruvic acid index and lactic dehydrogenase activity in fasting venous blood and 35 and 90 min. after glucose load. The investigations were carried out in 30 patients with cerebral concussion and 20 patients with cerebral contusion on the 1st, 3rd and 7th days after trauma. Thirty healthy subjects served as controls. Presence of hyperglycaemia in fasting state and impairment of glucose tolerance were demonstrated in the first week of the disease. These disturbances were accompanied by significant decrease of the activity of lactic and pyruvic acid metabolism during the first three days after trauma. The values of lactic acid/pyruvic acid index and LDH activity were not changed significantly. Disturbances of carbohydrate metabolism persisted during the first week after trauma and were more frequent, more intense and persisted longer in patients with brain contusion than in those with brain concussion but showed no significant differences related to the degree of trauma.


[Behavior of the local lymphatic system after aorta-iliaco-femoro-popliteal reconstruction]. As a result of the observation of oedemas of the lower extremities and lymphorrhoea in the immediate postoperative course of surgical reconstruction of the aorto-iliaco-femoro-popliteal arterial axis (and on the basis of similar cases in the literature), the participation of the lower extremity return circulation in this facet of vascular surgery has been documented. The venous system was never impaired whereas the local lymphatic system was always damaged by surgical aggression on the arterial vessels. However, the extensive anatomical lesions shown up by lymphography are not reflected in evident clinical signs; whenever oedema or lymphorrhoea of the surgical wounds are observed, these symptoms are always of slight importance and easily and quickly resolved. At long-term follow-up, no clinical evidence of impairment ot the venous and lymphatic venous return circulation was ever encountered. For prophylactic purposes the lymphatic structure encountered during the operation should be carefully ligated to counteract another dangerous complication: infection.


[Electromanometric extradural recording of intracranial pressure]. The author studied experimentally the method of continuous electromanometric extradural recording of intracranial pressure. In the experiments a pressure chamber is introduced into the cranial bone extradurally. The pressure is transduced to a measuring set based on Elema-Schonander electromanometer. The pressure changes are being transduced by means of a hydraulic system. The experimental material comprised 12 dogs. Intracranial pressure measurements were carried out under condtions of considerable dynamic changes of this pressure caused by removal of cerebrospinal fluid, intravenous infusion of distilled water, expanding body (a baloon placed in the extradural space), brain oedema. The investigations confirmed the value of the method. Furthermore it was found that measurements of intracranial pressure by means of suboccipital tap give false results. The results of the reported experiments served for introduction of the method for clinical use.


[Adenocarcinoma of the jejunum].

[Adenocarcinoma of the jejunum]. An uncommon case of annular, jejunum-constricting adenocarcinoma with subocclusive attacks in a woman of 56 is reported. The patient had been suffering from disturbances in the intestinal passages for some 5 months. The suspected diagnosis based on a fleeting objective symptom was confirmed by radiology with barium meal.


[Clinical study of a new preparation in the treatment of anorectal varices]. Sterectal is a new antihemorrhoidal drug which contains prednacinolone, lidocaine hidrochloride and ephedrine hidrochloride. The results of the double blind, between patient, clinical study carried out in order to detect effectiveness of Sterectal compared with placebo show that the new drug owns a more rapid onset of therapeutic activity and exhibits a greater reduction in symptom severity than placebo. Both treatments were well tolerated.


[Functional changes in the esophagus and action of pentagastrin on the competence of the lower esophageal sphincter (LES) after esophageal vagotomy]. In pursuance of an investigation of oesophageal physiopathology, a study has been made of the problem of the functional regulation of the inferior oesophageal sphincter in the light of new findings. Experiments carried out on six dogs made it possible to study functional modifications of the oesophagus after vagotomy, completing the technique by administering pentagastrin for the first time in vivo. Radiological and mano metric controls showed in the post-operative period a dilated oesophagus with a fall, in the lower third, of normal pressure values that did not undergo change, unlike what happened in the non-denervated oesophagus after administration of pentagastrin. The results obtained show that the integrity of the nervous structures is not only necessary for the perfect coordination of oesophageal peristalsis, but vital for normal functional response of the inferior oesophageal sphincter, since gastrin action is always mediated by release of acetylcholine by the post-gangliar vagal nerve endings.


[Reccurrent lingual hemiatrophy].

[Reccurrent lingual hemiatrophy]. The author reported a 45-year-old woman with numerous developmental anomalies in whom lingual hemiatrophy preceded by strong occipital headaches followed tonsillectomy. After treatment considerable regeneration of tongue nuscle took place. The course of the disease was recurrent. In the differential diagnosis the author considered inflammatory processes, neoplastic diseases, developmental anomalies and toxic effect of procaine used in tonsillectomy as well as the possibility of deeply situated adhaesions in the vicinity of the hypoglossal nerve.


[Hazards of uncontrolled administration of dehydrating agents]. A 38-year-old male patient was admitted to a neurosurgical hospital department because of hemiparesis and speech disturbances which had developed during an acute febrile disease. In view of supposed brain tumour the patient had been given prior to admission to the neurosurgical department high doses of dehydrating agents which resulted in high grade dehydration of the patient. During 10 days it was possible to achieve compensation of water and electrolyte disturbances and simultaneously hemiparesis regressed and function of speech improved. Angiography ruled out presence of brain tumour. The patient had no neurological disturbances during follow-up examination 6 months after discharge from the hospital. In the case the cerebral distrubances were due probably to venous thrombosis and intensive dehydrating therapy had contributed considerably to the severe condition of the patient.


[Occlusions and perforations caused by carcinoma of the colon and rectum]. A group of 137 patients observed at the Emergency Surgery and First Aid Division of the Fatebenefratelli Hospital of Milan between 1971 and 1974 is examined. The patients all presented a clinical picture of occlusion and/or perforation of the colon and rectum due to carcinoma, requiring emergency surgery. The clinical material examined is analysed and the surgical treatment adopted and the results obtained reported. Post-operative mortality was 16.8% in cases of occlusion, 21.6% in cases of perforation, and 36.4% in mixed cases. 63 patients, i.e. 46%, were subjected to more or less extensive resection and the mortality in this group was 11.2%; in the remaining 74 patients, ax only palliative measures were possible and mortality was 28.3%. It is observed, finally, that among emergency colon operations, right colectomy carried out immediately offers encouraging results, while resection of the left colon, apart from certain special cases, should be preceded by decompressive colostomy.


[Traumatic thrombosis of the peripheral arteries]. Ten cases of post-traumatic arterial thrombosis are described. The anatomopathological, diagnosis and therapeutic aspects of peripheral artery lesions of this type are examined. Surgical exploration followed by reconstruction are dictated by the presence and degree of seriousness of ischaemia; they are not subordinate to arteriography, itself not always necessary. Resection of the confused segment and reconstruction is the management of choice. Thrombectomy and thromboendarteriectomy cannot be considered as rational operations, even though they can be used in a few special cases, such as iatrogenic forms. Reconstruction is best achieved by direct anastomosis or with the aid of venous grafts. A prosthesis, on the other hand, is liable to produce less satisfactory long-term results.


[Electroencephalographic studies in patients with vertebrobasilar insufficiency]. Thirty-seven patients with vertebrobasilar arterial insufficiency were divided into two groups depending on their clinical condition. In the group of patients with more severe clinical manifestations the intensity of EEG changes was correspondingly greater. In this group in 7 patients the EEG background activity was disturbed, in 4 of them focal changes were present in the left temporal area. Of the patients with less severe clinical changes the background activity was disturbed in 1 cases only.


[Case of false meningeal hematoma in a patient with meningioma of the cerebral convexity]. The authors presented a case of meningioma of cerebral convexity which produced in cerebral angiography findings resembling meningeal haematoma (false meningeal haematoma). On the basis of a survey of literature the authors discuss other intracranial pathological processes which may give rise to similar angiographic changes. They believe that the possibility of false meningeal haematoma should be taken into account in the choice of surgical treatment.


[Reconstructive surgery of the biliary tract]. Reconstructive surgery of the bile ways involves a great commitment owing to the technical difficulties, the diversity of the nature, site and extent of the alteration to be treated, and because of the particular anatomical structure of the formations which have to be operated. The conditions that can benefit most from this type of surgery are represented by preoperative lesions of the bile ways and particularly stenoses which but not only follow such lesions if they are not treated in time, but may also follow other processes of a benign nature such as calculosis, cholangitis, anomalies of the bile ways treated wrongly during previous cholecystectomy, and at times malignant processes. Reconstructive surgery in bile way surgery means direct re-establishment of the duct to enable bile to flow from the liver to the duodenum. It presupposes a number of local conditions, such as the circumscription of the condition so that the stenotic segment can be removed and long-lasting end-to-end anastomosis effected. When it is possible, this must be considered the ideal procedure since it offers anatomophysiological recovery of bile way function. Operations have also been performed using various vein, artery, appendix, fascia lata, etc. grafts and prostheses using foreign matter such as rubber, vitallium,dacron, etc. tubes but results have always been hazardous and debatable. Personal cases and techniques are reported.


[Nervous system changes in patients treated with penicillin during the period of symptomatic and early asymptomatic syphilis]. The results of cerebrospinal fluid examination of 451 patients treated for syphilis were analysed. In 34 patients abnormalities were found in the protein level, cell number and serological investigations. Thus, there is an absolute indication to cerebrospinal fluid examination in each case in which serological tests remain positive despite adequate specific therapy.


[Muscular malformation of the wrist in an initial carpal tunnel syndrome. Clinical case]. A carpal canal syndrome in a young female subject was found at the operating table to be due to a wrist muscle abnormality. An extra muscle leaving the styloid process of the radius in the direction of the transverse ligament of the carpus, and an abnormal distal development of the muscular belly of the superficial flexor of the third finger, had led to compression on the median nerve corresponding to the carpal canal. Check on motor and sensitive conduction of the median nerve revealed nerve damage at wrist level. Removal of the extra muscle and section of the transverse ligament of the carpus resolved the painful symptomatology. Control of nervous conduction two months after operation confirmed the improvement.


[Appendectomy and colo-rectal carcinoma. Clinico-statistical and experimental studies]. A clinico-statistical investigation has been carried out with a view to establishing whether or not there is any correlation between appendicectomy and onset of colorectal cancer. The analysis showed that the frequencies of appendicectomy in the sample studied and in the control sample were not statistically different. On the other hand, it was observed that in patients suffering from colorectal carcinoma, the age at which appendicectomy was performed is is greater than in control subjects, with a constant mean interval in males and females (17 years). Experimental research on appendicectomized rats confirmed that the incidence of clinically induced tumours is no greater than that observed in control animals.


[Sarcomas of the small intestine].

[Sarcomas of the small intestine]. Four cases of sarcoma of the small intestine (2 leiomyosarcoma, 1 fibrosarcoma, and 1 Hodgkin's disease) are described. In each case, diagnosis was the outcome of surgery: emergency operation for acute abdomen in three cases (2 mechanical ileus, 1 perforation); exploratory laparotomy for recurrent haemorrhage following negative X-ray examination per os and clyster of the digestive tract on a number of occasions. The relevant literature is surveyed. Attention is drawn to the different anatomopathological and clinical forms, and to the difficulty of diagnosis.


[Semeiology of bronchogenic carcinoma. Limitations of explorative thoracotomy]. Modern methods of semeiological detection of bronchiogenic cancer are discussed in the light of experience gained in a hospital chest surgery centre. Emphasis is laid on the advantages offered by new advances in nuclear diagnosis and bronchial endoscopy. The limitations of exploratory thoractomy are explained. Attention is drawn to the by no means inconsiderable number of cases in which early knowledge of the nature of the process could not be obtained. A series of illustrative cases are presented.


[Use of discriminating function in the study of lipid metabolism in normal subjects of various ages]. Analysis of the discriminating function was applied to 15 plasma lipid parameters: palmitic, palmitoleic, stearic, oleic and linoleic acids, total NEFA, total lipids, triglycerides, phospholipids, total cholesterol, alpha and beta lipoproteic cholesterol, and lipoproteic alpha: beta, cholesterol: triglycerides and cholesterol: phospholipids ratios, in 84 healthy, normosomic subjects, divided into young, presenile and aged. Highly significant discrimination was obtained between all three groups. The coefficients of discrimination of all the variables employed in individual comparisons are illustrated. A brief account is given of the importance of biohumoral data in the detection of aging, and of the theoretical and practical utility of an investigation of this kind.


[S-adenosylmethionine as a regulator of protein synthesis. Influence on plasmatic fibrinogen]. S-adenosyl-L-methionine (SAMe) is a physiological compound which plays an important role in numerous biological processes, such as transmethylations, transulphurations and aminopropylations. Starting from a study about the usefulness of the SAMe to normalize protein synthesis in old age, the drug was found to have an interesting action with respect to fibrinogen. Later research regarding a large number of patients, led us to discover after treatment for 40 days with 60 mg/die of SAMe, highly significant variations in fibrinogen values with constant normalization of this parameter, in both hypo- and hyper-fibrinogenemia. So far we don't know anything about the action of the drug on various metabolic stages of the fibrinogen; interestingly however our data exclude a rise in fibrinolysis.


[Acute hemodialysis with a single needle]. The problems of vascular access in acute haemodialysis are illustrated in brief. On the basis of the literature and personal experience, the usefulness of percutaneous cannulation of the femoral vein is maintained and its technical advantages, reasonable simplicity and practicability are recalled. Finally the use is proposed of a technique based on a new single needle capable of speedily resolving the problem of vascular access in acute patients.


Congenital malformations in infants of diabetic mothers. Congenital malformations are contributing greatly to the perinatal morbidity and mortality of the infant of the diabetic mother. Can we discover the cause or causes of these lesions? Can they be prevented? Are they consistently detecable? The answers to these questions will significantly benefit all pregnancies as well as those complicated by diabetes mellitus.


Laterality and prognosis in ovarian cancer. Data from the End Results Group file at the National Cancer Institute indicate that in primary ovarian cancer neither the stage of disease at diagnosis nor patient survival is related to which of the two ovaries is first involved. Women with cancer in both ovaries have lower survival rates than women with unilateral cancer, though if the disease is still limited to the ovaries at the time of diagnosis this difference is small.


Microglandular hyperplasia in vaginal adenosis associated with oral contraceptives and prenatal diethylstilbestrol exposure. Eight cases of microglandular hyperplasia arising in vaginal adenosis are presented. Five of the patients were known to have taken oral contraceptives and a sixth was pregnant at the time the lesion was discovered; a history of prenatal exposure to diethylstilbestrol (DES) was present in 5 cases. It is important to differentiate microglandular hyperplasia, which is benign, from clear cell adenocarcinoma, which also arises in a background of vaginal adenosis.


Vaginal vault reconstruction.

Vaginal vault reconstruction. This report describes a new surgical technic for vaginal vault reconstruction performed on 116 patients either at the time of vaginal hysterectomy or in cases of post-hysterectomy vault suspension for vault prolapse. The repair maintains and restores proper vaginal vault support, preserves or increases overall vaginal length and preserves the proper angle of the vaginal canal. High extraperitoneal plication of the uterosacral ligaments is used to prevent enterocele, and provides hammock-like support of the vaginal vault. The paracervical fascia of the vaginal cuff is closed transversely in the midline rather than anterior-posteriorly.


Plasma hormones in clomiphene citrate therapy. Daily plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrone (E1), estradiol-17beta (E2), progesterone (P), androstenedione (A), and testosterone (T) were measured in six clomiphene citrate (Clomid) treated cycles. Three patients ovulated and 1 of them conceived during the study cycle. Three other patients failed to ovulate in spite of some evidence of ovarian response to clomiphene treatment in 2 of them. Plasma gonadotropin levels, of LH in particular, rose during the clomiphene therapy and reached a peak during Day 5 to Day 7 of therapy. Levels of plasma estrogens, both E1 and E2, gradually rose, reflecting follicular maturation in the ovary. When E2 reached a critical level as in the normal ovulatory cycle, it triggered an LH surge which consequently initiated ovulation. When the E2 level was inadequate or excessive, ovulation failed in spite of an LH surge. Following ovulation, plasma P rose and fell in a manner similar to the normal ovulatory cycle, with occasional values that exceeded the normal range. Levels of androgens, both A and T, rose during clomiphene therapy in some cases and T seemed to fluctuate in correlation with LH level. The possible local inhibitory influence of high E2 and T levels on follicular maturation in the ovary during clomiphene therapy is suspected in some cycles in which ovarian response was evident, but ovulation failed to occur.


Amniotic fluid cortisol as an index of fetal lung maturity. Amniotic fluid cortisol concentration was compared with lecithin/sphingomyelin ratio, gestational age, and eventual birth-weight in a large series of normal and high-risk human pregnancies in an effort to determine whether cortisol could be used as a reliable indicator of fetal maturity. It appears that when used alone amniotic fluid cortisol is of limited clinical value as an antepartum predictor of fetal respiratory status because of unacceptable percentages of false positive and false negative predictions. Whether amniotic fluid cortisol can be used as an adjunct in the evaluation of high-risk pregnancies with "transitional" L/S ratios remains to be explored.


Placental transfer and metabolism of betamethasone in human pregnancy. The concentration of betamethasone has been measured in maternal peripheral plasma, umbilical cord artery and vein, and amniotic fluid following maternal administration of betamethasone phosphate and betamethasone acetate on 3 consecutive days. Betamethasone was measured by radioimmunoassay following column chromatography. The findings show that betamethasone is transferred across the human placenta, circulates in the fetus and appears in amniotic fluid. During the 3 days after the start of treatment, levels of the betamethasone were similar in maternal and umbilical cord blood and in amniotic fluid. Thereafter, although levels in the mother were measurable for up to 7 days after the initial injection, the drug was detected in the cord plasma of only one baby. In vitro incubation studies of human placental tissue with 3H betamethasone identified 11-keto betamethasone as the major metabolite of betamethasone.


Prenatal diagnosis of bilateral renal agenesis. Bilateral renal agenesis (BRA), or Potter's syndrome, is a rare genetic disorder in which agenesis of the kidneys is associated with pulmonary hypoplasia and characteristic facial features. Oligohydramnios or virtual absence of amniotic fluid is found in most pregnancies with BRA. Clinical observation and serial ultrasonography scans made it possible to diagnose BRA prenatally in a fetus at risk. Postmortem examination confirmed the diagnosis.


Analysis of variables affecting perinatal mortality: St. Louis City Hospital, 1969-1975. A marked drop in perinatal mortality at St. Louis City Hospital No. 1 (SLCH) from 1974 to 1975 (39.7 vs 20.6 per 1000 births) prompted a detailed analysis of various factors which might have effected the change. Comparisons were also made between SLCH and St. Mary's Health Center (SMHC), a private hospital affiliated with St. Louis University. The significant drop in perinatal mortality at SLCH in 1975 seems to be due to a combination of various factors: 1) improvement in antepartum care, 2) increase use of cesarean sections, and 3) the influence of intrapartum fetal monitoring.


Postpartum spontaneous rupture of ovarian artery aneurysm. A case of spontaneous rupture of a right ovarian artery aneurysm after delivery is presented. Search of the literature revealed 3 similar cases of spontaneous rupture during early peurperium and 1 case of spontaneous rupture of an ovarian artery on the third postpartum day with no abnormal findings of the vessel at the site of rupture.


The incidence of gestational diabetes.

The incidence of gestational diabetes. The incidnece of gestational diabetes has been quoted as being between 1 and 2%. The criteria used to establish this incidence may be in error, leading to identification of fewer patients. Using the criteria established by O'Sullivan et al, we were able to determine the incidence of gestational diabetes to be 6.0% in a private patient population. In addition, in previous pregnancies of these gestational diabetic patients, the incidence of congenital abnormalities was 13.6%, and perinatal mortality was 4.5 per cent.