[Serum immunity against influenza viruses A/Hongkong, A/Zürich, A/Victoria and A/Swine in the Swiss population]. The HI antibody against the influenza virus A/Zürich/18/75 was titrated in 2351 sera from 17- to 75-year-old blood donors living in 24 different parts of Switzerland. 518 sera selected from these donors with the same distribution of age and location were tested against the viruses A/Hongkong/1/68, A/Victoria/3/75 and A/Swine/15/31. The percentage frequency of 91.7% and 89.4% positive sera reveal almost complete exposure of the population to A/Hongkong and A/Zürich. But only half of the donors possess antibody against the A/Victoria/3/75 virus. It is therefore reasonable to expect that the A/Victoria virus or a closely, antigenetically related virus will cause influenza cases in the winter of 1976/77. Despite small regional differences the distribution of influenza in Switzerland appears to be uniform, in view of the fact that the geometric mean titre of the donors from different parts of the country showed no significant deviation from the total geometric mean. The largest number of positive sera were in the youngest and oldest age groups and the smallest in the 30- to 50-year age group. Antibody to A/Swine/15/31 virus was found almost exclusively in sera from persons aged 50 or over.


[Post-transfusion hepatitis 1973 and 1974 in the Zürich region]. More than 100 000 units of blood were tranfused during the years 1973-74 in the region of Zurich. 30 cases of posttransfusion hepatitis (PTH) reported in this period were investigated with regard to the origin of the tranfused blood, and 24 (71%) proved to be hepatitis B antigen (HBS-Ag) positive. Despite the use of a sensitive method for HBS-Ag screening, transfusion of HBS-Ag positive blood was found to be responsible for PTH in 4 cases only. In 88% of the cases there was no proof that the PTH was caused by blood transfusion. Hepatitis A virus, EPstein-Barr virus and Cytomegalovirus do not appear to be important causative factors in PTH syndrome. Reasons for failure to detect hepatitis virus in donor blood are discussed. There appear to be other sources of hepatitis-virus infection than blood transfusion.


[Spiegeli's hernia].

[Spiegeli's hernia]. Spontaneous lateral ventral hernia (spigelian hernia) is briefly reviewed in the light of 7 patients with a total of 8 hernias. The relatively high incidence of spigelian hernia (5% of all abdominal hernias operated on in 1 year) suggests that this hernia type is not uncommon if borne in mind when diagnosing conditions with abdominal pain. Pain, tenderness and a palpable mass along the lateral edge of the rectus abdominis are the leading symptoms. Since the operation is simple and the postoperative period uneventful, operative treatment is strongly recommended. Accurate diagnosis with resultant surgery for this type of hernia spares the patient unnecessary examinations and totally relieves symptoms.


[Correlations between blood pressure, blood volume and plasma renin during therapy with diuretics in essential hypertension. Comparison between the mineralocorticoid antagonist spironolactone and the "loop" diuretic mefruside]. 35 patients with benign essential hypertension were treated for 6 weeks with high doses of the mineralocorticoid-antagonist spironolactone (400 mg/day), or with the "loop-diuretic" mefruside (mean maximal dose 110 mg/day). Spironolactone caused greater reductions in blood pressure and blood volume and a more marked increase in plasma renin activity (PRA) than mefruside (p less than 0.05). It appears possible that he weaker antihypertensive effect of mefruside may relate partly to its lesser influence on circulatory volume. With both diuretics, mean decreases in blood pressure were greater in patients with low pre-therapeutic PRA than in patients with normal or high PRA. However, the diuretic-induced changes in blood pressure did not correlate with the associated variations in blood volume or PRA. Thus, the increased blood pressure sensitivity to diuretics in patients with low-renin essential hypertension did not appear to be volume or renin-dependent. Under normal conditions, the maintenance of a constant blood pressure during volume depletion may partly depend on compensatory activation of the sympathetic nervous system. Moreover, patients with low-renin essential hypertension have been found to have decreased adrenergic activity. It seems possible, therefore, that the marked blood pressure sensitivity to diuretic treatment in such patients may be the result of an impaired compensatory sympathetic response to sodium and volume depletion. Analysis of the literature suggests that the diuretic furosemide, a structural relative of mefruside, may also have less blood pressure lowering efficacy in patients with essential hypertension than the distally-acting thiazides, chlorthalidone or spironolactone. Consideration of possible differences in the blood pressure reducing potential of certain diuretics thus appears to be necessary in planning the pharmacotherapy of essential hypertension.


[The medico-psychological service in an internal medicine department as evaluated by the patients]. Where a medico-psychological liaison service is available, such as that run by the Inter Medicine Department, Zürich University Hospital, do the patients feel it meets their needs? To investigate this, the replies are analyzed to a questionnaire sent to patients who had used this service, are analyzed. The majority of those answering it a) had felt a need on entering the clinicl for a conflict-oriented interview; b) felt the encouragement toward such an interview to be appropriate; c) had positive expectations about the interview; d) experienced a feeling of relief after the interview had taken place; e) developed a certain amount of insight into their conflicts; f) felt the interview to have been helpful. The patients who found it had been most helpful were those who had felt the need for it most strongly in advance. However, the fact that, of the patients who had no felt such a need in advance, more than half afterwards felt that it had been valuable; indicates the effectiveness of the interview technique used. Neither the wish for such a consultation nor the estimated value of it afterwards was dependent on the sex of the patient involved. The interview was in general more successful when the patient had been carefully oriented by the referring doctor in advance. The greater the number of interviews conducted in the clinic with any given patient, the more that patient seemed to feel the need to continue such interviews after leaving the clinic.


[Frequency of hepatitis A antibodies in populations of various European countries]. Using a solid phase radioimmunoassay, prevalence of anti-HA was determined in sera of 661 German patients treated following accidents, 70 persons born in Mediterranean countries and 175 persons from Lillehammer, Norway. In Germany (55% positive) an increase in prevalence of anti-HA from 13% in the group below 20 years of age to 92% in persons over 49 was noted. This and further data suggest that after infection anti-HA is detectable for life. Persons from Norway (17% positive) aged below 40 years had a low prevalence of anti-HA (4-10%), whereas even young persons from Mediterranean countries (81% positive) hat antibody in about 80% of cases. Prevalence rates in different age groups suggest a remarkable decrease in incidence of hepatitis A infection over the last three decades in Germany. This results in a rise in the mean age at which hepatitis A infection is acquired and high morbidity during travel abroad. Only one of 10 hepatitis A infections appears to produce clinical disease. Young anti-HA positive individuals exhibit higher titers on average than older ones.


[Post-partum survival of fetal lymphocytes in the maternal blood]. Cells of fetal origin have been searched for in the peripheral blood of mothers following delivery of a boy, using mepacrine fluorescence of the Y chromosome. In a series of 62 women such cells have been found for approximately two years in more than half of cases. Their number decreases thereafter but in some instances Y chromosome-bearing cells have been observed 5 years after delivery.


[Stewart-Treves syndrome: post-mastectomy angiosarcoma]. A case is reported of angiosarcoma occuring in the chronic-lymphedematous right arm of a 56 year-old woman 9 years after radical mastectomy for cancer of the right breast. This is a characteristic example of Stewart-Treves syndrome (angiosarcoma in chronic lymphedema). The patient died within the year from multiple metastases. About 200 such cases are reported in the literature: the prognosis is bad, the best therapy reported being amputation of the extremity. Early diagnosis is essential through frequent checks for chronic lymphedema, which is seemingly the crucial etiologic factor in the occurrence of this angiosarcoma. Histogenesis has yet to be fully explained.


[Treatment of psoriasis with an orally effective aromatic retinoid]. Results of treatment of psoriasis and various keratinizing dermatoses with an orally effective, aromatic retinoid are presented. Results in 39 of 55 psoriatic patients ranged from satisfactory to excellent. All side effects are restricted to hypervitaminosis A. The therapeutic margin of this new retinoid is clearly better than that of natural vitamin A and vitamin A acid preparations and other previously tested synthetic retinoids. Even after long-term treatment of 14 patients for more than 2 years no side effects of vital importance have as yet appeared.


Studies on humans exposed to airborne sewage sludge. A clinical investigation was made among workers in a sewage treatment plant and age matched controls not exposed to sewage. Acute incidences of fever and eye symptoms were found in about 50% of  the exposed population. Serum immunoglobulins, white blood cells and thrombocytes were elevated in the exposed group. A higher percentage of increased levels of C-reactive protein and fibrinogen degradation products was found in the exposed group. Although no definite cause-effect relationship can be established the responsible agent in the environment could well be endotoxins.


[Treatment of idiopathic fibrosing alveolitis. Therapeutic experiences with azathioprine-prednisolone and D-penicillamine-prednisolone combination therapy]. Lung function data during three different therapies for idiopathic fibrosing alveolitis are presented. Corticosteroid monotherapyis without effect. A combination of prednisolone and azathioprin improves vital capacity by more than 15% in half of cases. Under this treatment the resting PO2 improves in a third of patients. No improvement in PO2 under exercise is observable in any patient. Combined therapy with D-penicillamine and prednisolone improves vital capacity and PO2 both at rest and under exercise; this therapy thus appears to be superior to the other two. The effectiveness of D-penicillamine-prednisolone therapy can be enhanced by adding azathioprin, as has been found in a pilot study thus far covering 4 patients.


[Does steroid therapy have an effect on the course of Löfgrenn syndrome? Catamnestic studies on 25 patients with Löfgren syndrome at the Zürich county hospital]. To investigate whether steroids influence the course and prognosis of acute sarcoidosis (Löfgren syndrome) 35 patients who developed this disease during the period 1960-1970 were examined and retrospectively divided into two groups, one of which had received steroids and the other not. At the onset of the disease all the patients had had typical symptoms of acute sarcoidosis: bilateral hilar lymphadenopathy, erythema nodosum, arthralgia, fever and elevated sedimentation rate. Biopsy of hilar lymphnodes had revealed non-caseating granulomas in all cases, whereas such granulomas were present in only 7 of 15 liver biopsies. The Kveim reaction was positive in 89% and the tuberculin skin test was negative in 51%. The duration of the disease was 6-7 weeks in both groups, i.e.  steroid treated and non-steroid treated. The radiological chest abnormality had usually disappeared within one year. All chest X-rays had completely normalized after two years. Neither the course nor the prognosis differed in the two groups. However, patients receiving steroids had had more side effects. Acute sarcoidosis should not be treated with steroids; symptomatic therapy with other, less toxic antiinflammatory drugs suffices. The outcome is good. None of the patients has progressed to chronic sarcoidosis.


[A case of broncho-pulmonary aspergillosis developing for 24 years]. A case of allergic broncho-pulmonary aspergillosis has been diagnosed on the basis of recurrent, transient pulmonary infiltrates, serum precipitins against Aspergillus fumigatus and a dual-type reaction to intradermic testing with aspergillus antigen. Despite a prolonged course (24 years), lung function tests do not show changes.


[Clinical aspects and therapy of candidiasis in pneumological patients]. 13 cases of deep candidiasis (two or more positive blood cultures or histological evidence) are reported. The patients were hospitalized because of respiratory problems (pneumonia, neuromuscular respiratory failure, bronchial carcinoma, brochiectasis, chronic bronchitis and acute laryngitis). Frequency, clinical signs and symptoms and therapy are discussed. The importance of early diagnosis is stressed.


[A bronchial allergy to vine pollen and 2 precipitin lung diseases. Various approaches to etiological diagnosis]. Three observations are adduced to illustrate the relative importance of clinical and immunologic data and the patient's history in the diagnosis of allergic lung disorders. A case of sensitization to vineyard pollen has been identified by intradermal test and the effect of specific hyposensitization.


[Evolution of tuberculosis and lung perfusion]. Ten patients with pulmonary tuberculosis of strikingly long duration despite intensive antituberculous therapy were examined by combined lung scintigraphy (133Xe in physiologic saline i.v. and 99mTc-MAA/microspheres). As a rule the scintigraphic perfusion defects far exceeded the lesions seen radiologically. These results appear to justify the presumption that the decrease - or even absence - of perfusion in the affected areas is responsible for protracted healing in these patients.


[The bronchial alveolar carcinoma as a solitary coin lesion]. Bronchiolo-alveolar carcinoma is a well-differentiated adenocarcinoma which starts as a peripheral solitary nodule and gradually spreads via the bronchi to give rise to a disseminated, diffusely infiltrative tumor. A series of 17 cases presenting with solitary nodules is reported. A long interval before operation did not adversely affect prognosis, provided the nodule remained relatively small and there were no lymph node metastases. Radical cure by resection was possible only with solitary nodules, but not with multinodular or infiltrative tumors. Prognosis was worse if lymph nodes were involved but not if there was intrapulmonary lymphatic invasion without spread to lymph nodes. Large solitary nodules shortened survival, especially if the radiographic diameter was greater than 5 cm. On the other hand, in four cases where evaluation was possible, the rate of growth had no effect on prognosis. Patients with positive cytology had shorter life expectancy since the tumor had already spread to the bronchi. Unexpectedly, cellular signs of malignancy had no influence on prognosis. Invasion of blood vessels, however, was a poor prognostic sign and was not observed in early cases or in patients with prolonged survival.


[The spontaneous, non-traumatic chylothorax. Therapy by means of pleurectomy and decortication]. Two cases of chronic spontaneus chylothorax were successfully treated by small thoracotomy with parietal pleurectomy or decortication after unsuccessful needle aspiration and intercostal tube drainage with suction. In the one case the chylous effusion occurred spontaneously 29 years after extrapleural pneumothorax. The tuberculosis was long cured. In the other, apparently idiopathic case, the chylothorax on the left side disappeared completely after pleurectomy. Six months later a chylous effusion appeared on the right side. Mediastinoscopy then revealed an oatcell carcinoma in lymph nodes without a primary pulmonary tumor. One year after radiotherapy the patient died in heart failure. No primary tumor was found. Residual chylothorax was present only on the right side.


[Atelectasis without bronchial obstruction]. Five patients with acute pneumonia and transitory atelectasis without bronchial obstruction are presented. The reduced lung volume in these cases, in a case of shock lung, together with a similar phenomenon in pulmonary embolism, is tentatively related to a possible disorder of the surfactant system.


Zinc, copper, cadmium and chromium in polished and unpolished rice. One hundred samples of polished and 27 of unpolished rice were collected from 22 countries and areas and analyzed for Zn and Cu by flame atomic absorption, for Cd by carbon furnace atomic absorption, and for Cr by neutron activation. Unpolished rice contains on average 16.4 mug/g Zn, 4 mug/g Cu, 0.029 mug/g Cd and 0.011 mug/g Cr. Polished rice contains 13.7 mug/g Zn, 3 mug/g Cu, 0.029 mu/g Cd and 0.012 mug/g Cr. Thus, polishing brings about a loss of the essential elements Zn and Cu, but not of Cd, a toxic pollutant. Japanese rece has high Cd content. In countries where rice is a major staple food, high Cd content in rice may cause excessive absorption of this toxic metal.


Natural radionuclides in industrial and rural soils. Radium-226, lead-210, uranium and thorium are dispersed in the environment by fly ash emitted by coal fuelled power stations. Concentrations of these nuclides have been determined in fly ash from three power stations and in soils collected in six industrial and twenty rural regions. In industrial areas the concentrations of natural radionuclides, in a 5 cm thick surface soil layer, were found to be higher than in lower layers. With the exception of lead-210 this effect was not observed in rural soils, which contained less of radium-226, uranium and thorium. It was found that the type of coal, or combustion technology, influences the amount of radium-226 dispersed in the environment which is accessible to plants.


Lead, cadmium, and arsenic residues in animal tissues in relation to those in their surrounding habitat. The relationships of the residues of lead, cadmium, and arsenic in animal tissues to those in surrounding vegetation and soil were determined in a natural habitat representing a wide range of such residues. The samples studied were selected from 18 different locations. Analyses were performed on a total of 113 animals, 332 plant specimens (representing 33 species), and 408 soil samples (taken at different depths). For the purpose of evaluating relationships, the samples from each location were averaged and reported as parts per million on a dry weight basis. The average lead residues from different locations ranged from 1.4-9.2 ppm in the liver, 45-195 in bones, 4-283 in vegetation, and 15-1399 in soil samples. The cadmium contents ranged from 1-27 ppm in the liver, 3-77 in bones, 0.5-5 in vegetation, and 1-10 in soil. The arsenic contents in different components of the ecosystem varied with an average of 1-9 ppm in liver, 0.6-94 in vegetation, and 7-655 in soil samples. The soil residues varied considerably according to the depth of sampling. Little variation was noted in different species of vegetation or in soil and vegetation samples according to the time and year of sampling. Statistical analyses performed on the averages indicated a significant correlation between vegetation and soil residues for all three elements, and also between animal to vegetation and animal to soil cadmium residues. Multiple linear correlations for all elements in soil, vegetation, and animal tissues were determined. The results indicated a possibility of an increase in cadmium in animal tissues depending upon the increased residues of this metal in the environment.


Fluidity in the membranes of adult and neonatal human erythrocytes. Several antigens and receptors are mobile in the plane of the membrane of the intact neonatal human erythrocyte but not in the membrane of the normal adult cell. In this report, measurements of the fluorescence polarization of perylene dissolved in isolated erythrocyte membranes are reported, which are indistinguishable for the two kinds of cells. This result indicates that the viscosities of the membrane interiors of the two cells are the same. The observed mobility differences, therefore, cannot be attributed to different lipid viscosities in the two membranes.


13-cis-retinoic acid: inhibition of bladder carcinogenesis in the rat. Transitional cell and squamous cell cancer of the bladder was induced in Wistar/Lewis female rats by direct instillation of N-methyl-N-nitrosourea into the bladder. Feeding of the synthetic retinoid, 13-cis-retinoid acid, inhibited the incidence and extent of bladder cancer in these rats, even when 13-cis-retinoic acid administration was begun after completion of the carcinogen treatment.


Liposome-cell interaction: transfer and intracellular release of a trapped fluorescent marker. When small, unilamellar lipid vesicles containing a high concentration of the fluorescent dye 6-carboxyfluorescein are incubated with either frog retinas or human lymphocytes, fluroescence distributes widely throughout each cell. Since "self-quenching" largely prevents the dye from fluorescing as long as it remains sequestered in vesicles, it is clear that a considerable amount of dye is released from the vesicles and diluted into the much larger volume of the cell.


Hyperosmolality in intraluminal fluids from hamster testis and epididymis: a micropuncture study. Intraluminal fluids from hamster seminiferous tubules, rete testis, and caput, corpus and cauda epididymidis were obtained in vivo by micropuncture. Rete testis fluid is isosmolar with serum. Fluids from the seminiferous tubules and all sites in the epididymis are hyperosmolar.


Antibody binding measurements with hapten-selective membrane electrodes. Direct antibody-hapten binding measurements were carried out with the use of a hapten-selective membrane electrode. Potentiometric titrations of rabbit antibody to the hapten trimethylphenylammonium ion demonstrate the speed and convenience of the new method for the determination of binding equilibria. Average intrinsic binding constants obtained agree well with those measured by equilibrium dialysis techniques.


Calcium-induced displacement of membrane-associated particles upon aggregation of chromaffin granules. Isolated chromaffin granules incubated in 10 millimolar calcium chloride aggregated, forming contact sites with a pentalaminar membrane structure. These circular attachment sites were free of membrane-associated particles, which accumulated at the periphery. Incubation in 20 millimolar ethylenediaminetetraacetic acid reversed these changes, which are regarded as initial events in the membrane fusion reaction.


Pyrrolizidine alkaloids: their occurrence in honey from tansy ragwort (Senecio jacobaea L.). The hepatotoxic alkaloids known to occur in tansy ragwort (Senecio jacobaea L.) are also present in honey produced from the nectar of this species. These alkaloids, which inclued senecionine, seneciphylline, jacoline, jaconine, jacobine, and jacozine, are potentially carcinogenic, mutagenic, and teratogenic and may pose health hazards to the human consumer.


Memory for lists of sounds by the bottle-nosed dolphin: convergence of memory processes with humans? After listening to a list of as many as six discriminably different 2-second sounds, a bottle-nosed dolphin classified a subsequent probe sound as either "old" (from the list) or "new." The probability of recognizing an old probe was close to 1.0 if it matched the most recent sound in the list and decreased sigmoidally for successively earlier list sounds. Memory span was estimated to be at least four sounds. Overall probabilities of correctly classifying old and new probes corresponded closely, as if recognition decisions were made according to an optimum maximum likelihood criterion. The data bore many similarities to data obtained from humans tested on probe recognition tasks.


Ornithine decarboxylase may function as an initiation factor for RNA polymerase I. Reparts suggest that the activity of RNA polymerase I is modulated by a labile protein with a hlaf-life of 10 to 20 minutes. Ornithine decarboxylase is the only labile protein (half-life, 10 to 20 minutes) that increases in activity prior to increased RNA polymerase I activity. The addition of a small amount of a highly purified ornithine decarboxylase preparation to an RNA polymerase I assay increases the initial rate of the reaction as well as the time for which the assay is linear. The incorporation patterns of 14C-labeled adenosine triphosphate and 32P-labeled adenosine triphosphate into RNA indicate that the addition of ornithine decarboxylase to the RNA polymerase assay increases the rate of initiation. This report demonstrates a novel way to purify ornithine decarboxylase by RNA polymerase I affinity chromatography and presents data in support of the hypothesis that the labile protein which modulates RNA polymerase I activity is ornithine decarboxylase.


Circadian organization in lizards: the role of the pineal organ. After pinealectomy, the iguanid lizard Sceloporus olivaceus exhibits a "splitting" of the circadian activity rhythm into two components, marked changes in the period of the rhythm, or arrhythmicity. These effects are consistent with either of two hypotheses: (i) The pineal organ is a coupling device between circadian oscillators in a multioscillator system, or (ii) the pineal organ is itself a master oscillator, which entrains other circadian oscillators and imposes its frequency upon them.


Concomitant elevations in serum sialytransferase activity and sialic acid content in rats with metastasizing mammary tumors. Rats with transplantable spontaneously metastasizing mammary tumors have elevated levels of both serum sialoglycoconjugate and serum sialytransferase activity compared with normal female rats or rats with various nonmetastasizing mammary tumors. A direct relationship was observed between the amount of serum protein-bound sialic acid and serum sialyltransferase activity in all rats studied. Serum sialyltransferase activity in rats with a representative metastasizing mammary tumor, SMT-2A, was also correlated with tumor age. Microsomes prepared from the SMT-2A tumor have a sixfold higher sialyltransferase activity than do microsomes prepared from the nonmetastasizing mammary tumor MT-W9B. Normal rat liver microsomes have the same level of activity as microsomes prepared from livers of animals with either SMT-2A or MT-W9B tumors. The data indicate that spontaneously metastasizing mammary tumor cells have an increased production and release, perhaps through cell surface shedding, of a sialyltransferase. It is suggested that this sialyltransferase may increase the serum half-life of certain tumor-specific circulating glycoconjugates by increasing the content of protein-bound sialic acid and may thereby play a role in the immune escape mechanism of metastasizing tumor cells.


Intravenous self-feeding: long-term regulation of energy balance in rats. Rats learned to press a lever for intravenous self-injection of liquid diet during periods of several weeks when oral food was not available. The intakes were low but regulated, and were sufficient to balance energy expenditures at low body weight. Systemic receptors alone are thus adequate to motivate feeding behavior and meter the caloric yield of the intravenous injections.


Evolution in a time-varying environment. A simple model of competition in a time-varying environment was developed and used to discuss the evolution of life-history strategies.


Terrestrial locomotion in penguins: it costs more to waddle. The energetic cost for walking is relatively higher for penguins than for other birds or for quadrupeds of similar body mass. The morphology of penguins seems to represent a compromise between aquatic and terrestrial locomotion wherein both energy economy and speed suffer when the birds move on land.


Some unusual features of gouty arthritis in females. Gouty arthritis in females is relatively infrequent, although the sex ratio may be somewhat altered in different races. A positive family history is relatively prevalent among females whose onset of gout is premenopausal. In those patients with a postmenopausal onset, the incidence of diuretic-associated gout is high. The bimodal distribution of serum urate might be related to some variance of genetic transmission in female gout. Hypertension and coronary heart disease are common coexisting conditions, as is true of gouty arthritis in males. Chronic urinary tract infection dating from previous pregnancies is a frequent complication. The relative prevalence of proteinuria and diminished renal function leads to increased hyperuricemia, with a tendency to a low urinary uric acid output. This explains in part the higher incidence of extensive tophaceous deposition but lower incidence of renal calculi. Diuretics are associated with a higher urine pH, likewise, they reduce the urinary uric acid excretion. This also may contribute to the lower incidence of renal calculi. There may be some statistical support for the low fertility rate among the gouty females. Only two females became pregnant after the onset of gouty arthritis. All other pregnancies occurred before the onset of arthritis. Even then, abnormal pregnancies were relatively frequent. Some hormonal malfunction among the gouty females cannot be discounted. Both renal calculi and tophi are frequent in female gout associated with blood dyscrasias. They may manifest early, preceding the first attack of acute gouty arthritis. In both the male and female secondary gout, the primary underlying disease governs the uric acid metabolism and the clinical symptomatology of gout. The predominant role in pathogenesis is the excessive rate of uric acid production, and its disposal is governed by the different stages of the underlying disease and the treatment. Thus, secondary gout in females appears to be somewhat different from primary gout in females, but not different from secondary gout in males.


Cardiovascular nuclear medicine.

Cardiovascular nuclear medicine. Exciting developments in radiopharmaceuticals and instrumentation have established the field of cardiovascular nuclear medicine as an extremely useful clinical tool. Depending on the patient's problem, one may elect to perform myocardial perfusion images with 201Tl, infarct avid images with 99m Tc, or wall motion and other functional studies with multiple gated acquisition techniques. Often, a combination of these studies is useful in elucidating a particular problem.


Evaluation of radioactive potassium and its analogues for imaging myocardial infarcts. An extensive clinical evaluation was undertaken to assess the value of myocardial infarct imaging with radioactive potassium and analogues. Of 130 patients so examined, 80 were diagnosed as having suffered infarcts in the recent or distant past on the basis of all information other than the scan. The radionuclide imaging results were abnormal in 87.5% overall, 97% in acute transmural infarcts, and 83% in lesions over 3 weeks old. In 50 patients not considered to have had myocardial infarcts or contusions, apparently false abnormal results were obtained in 15%. These were all patients in whom additional diagnostic help was desired after the ordinary laboratory tests and electrocardiograms. Excellent agreement of infarct location was discovered on comparing radionuclide scans with radiographic contrast ventriculography. On comparing electrocardiograms with scans for infarct location, 85% complete or partial correlation was revealed. Agreement between scan abnormalities and significant-appearing coronary arteriographic lesions was rather poor, causing one to realize that 43K scan abnormalities indicate regions of poor blood extraction by old or recent infarcts, rather than just poor regional arterial perfusion. While costly, radionuclide scans often provide worthwhile information about presence or absence of infarcts as well as about their location and size. Electrocardiograms and blood enzyme levels each cost less, but are almost always performed in serial fashion. This makes them actually more expensive than a single scan. Furthermore, a normal scan in a patient being considered for acute coronary care may be used as potent argument against the presence of an infarct, thereby saving costly intensive care and monitoring.


Nitrogen-13-labeled ammonia for myocardial imaging. Cyclotron-produced nitrogen-13 (half-life 10 min), as labeled ammonia (13NH4+), has been evaluated as a myocardial perfusion imaging agent. The regional myocardial uptake of 13NH4+ has been shown to be proportional to regional tissue perfusion in animal studies. Intravenously administered 13NH4+ is rapidly cleared from the circulation, being extracted by the liver (15%), lungs, myocardium (2%-4%), brain, kidney, and bladder. Myocardial ammonia is metabolized mainly to glutamine via the glutamine synthetase pathway. Pulmonary uptake is substantial, but usually transient, except in smokers where clearance may be delayed. The position annihilation irradiation (511 keV) of 13N may be imaged with a scintillation camera, using either a specially designed tungsten collimator or a pinhole collimator. After early technical problems with collimation and the production method of 13NH4+ were overcome, reproducible high quality myocardial images were consistently obtained. The normal myocardial image was established to be of a homogeneous "doughnut" configuration. Imaging studies performed in patients with varying manifestations of ischemic and valvular heart disease showed a high incidence of localized perfusion defects, especially in patients with acute myocardial infarction. Sequential studies at short intervals in patients with acute infarction showed correlation between alterations in regional perfusion and the clinical course of the patient. It is concluded that myocardial imaging with 13NH4+ and a scintillation camera provides a valid and noninvasive means of assessing regional myocardial perfusion. This method is especially suitable for sequential studies of acute cardiac patients at short intervals. Coincidence imaging of the 511 keV annihilation irradiation provides a tomographic and potentially quantitative assessment of the regional myocardial uptake of 13NH4+.


Particulate myocardial perfusion scintigraphy: its clinical usefulness in evaluation of coronary artery disease. The determination of myocardial viability is a crucial parameter in the evaluation of a patient with coronary artery disease. Particulate myocardial perfusion scintigraphy (PMPS) is one of several methods available for this determination. A brief comparison between PMPS and two other commonly used methods is described in this review. The technique and analysis are described and applied to 194 patients with 366 surgically bypassed regions. The patients are analyzed for postoperative regional wall function and for total ventricular function as expressed by ejection fraction. PMPS is a highly accurate and unique study for clinically predicting myocardial viability.


Radiocardiography in clinical cardiology. Quantitative radiocardiography provides a variety of noninvasive measurements of value in cardiology. A gamma camera and computer processing are required for most of these measurements. The advantages of ease, economy, and safety of these procedures are, in part, offset by the complexity of as yet unstandaridized methods and incomplete validation of results. The expansion of these techniques will inevitably be rapid. Their careful performance requires, for the moment, a major and perhaps dedicated effort by at least one member of the professional team, if the pitfalls that lead to unrecognized error are to be avoided. We may anticipate more automated and reliable results with increased experience and validation.


[The control of medicines and related substances, Law 101 of 1965: a short review]. Act 101 of 1965, as amended by Act 65 of 1974, published on 21 February 1975, has far-reaching implications as regards the manufacture, distribution and use of medicines in South Africa. Some aspects in connection with the annexures to the Act relating to the pharmaceutical industry, doctors, pharmacists and the public, are discussed.


Pyomyositis in Swaziland.

Pyomyositis in Swaziland. Pyomyositis was studied in 25 patients over a period of 1 year. The patients lived in a subtropical region, latitude about 27 degrees S, but the disease described is the same as that which occurs in the tropics and which goes by the name of "tropical myositis". The aetiology proposed for tropical myositis is regarded as not applicable to the same disease described here, of which the cause remains uncertain. This aspect of the problem is discussed with reference to the possible role played by a deficiency of ascorbic acid in the diet. Incision and drainage is the only method of treatment.


Underweight - a nutritional risk?

Underweight - a nutritional risk? Weight-for-age (Harvard standards) and mean weight and height studies on South African preschool and school-child populations have revealed that (i) 25% of preschool children, and 50-75% of young non-White school-children are underweight for age; (ii) the incidence of underweight-for-age rose from birth to 12 years, and fell rapidly by 17 years, without dietary intervention; (iii) White children showed similar profiles of underweight although the respective incidences were lower; (iv) there has been a fall in the incidence of underweight in Black children although it still remains high; and (v) significant increases of mean weights and heights have occurred at certain ages in Blacks, particularly rural groups, with decreases in height in some groups of White preschool children. In spite of there having been no dietary intervention, the incidence of underweight-for-age has decreased, and the mean weight and height have increased over a very short period of time. Height as well as weight shoudl be taken into consideration in assessing satisfactory growth.


Misleading pneumoperitoneum.

Misleading pneumoperitoneum. Misleading pneumoperitoneum takes one of two forms: true pneymoperitoneum without peritonitis or pneumoperitoneum simulated by adventitious x-ray shadows. In both instances, the roentgenographic appearance of free intraperitoneal air proves to be a specious indication for laparotomy. Twenty-eight per cent of 29 patients with misleading pneumoperitoneum were subjected to operations that, retrospectively, might not seem absolutely necessary. The decisions to operate on patients with pneumoperitoneum without peritonitis were based on the amount of pneumoperitoneum roentgenographically visualized. The instances of pseudopneumoperitoneum had several common features. The diagnosis often was based only on x-ray films of the chest. Compatibility with clinical features was marginal; the radiolucency was often not truly at the apex of the diaphragm. Finally, the x-ray films, interpretation and working conditions frequently were suboptimal.


Long term survival after compound hemipelvectomy. Three patients survived free of disease ten and one-half, ten and almost six years, respectively, following compound hemipelvectomy for a variety of tumors. Each patient had been operated upon previously at least three times, but the tumors were still well localized despite the propensity for local infiltration or growth. In addition to the lower extremity and the ipsilateral pelvic bones, varieties of organs were resected. In one patient with chondrosarcoma of the pelvis, there was a local recurrent mass and, in another with adenocarcinoma of the appendix, a solitary pulmonary metastasis. Both of these lesions were successfully resected, and the patients remained free of disease nine and four and one-half years, respectively, after resection of the recurrent lesions. The third patients had carcinoma of the penis with metastases in both groins; carcinoma of the breast devedeveloped nine and one-half years after hemipelvectomy. The two younger patients were fitted with prostheses, and all three adjusted fairly well physically and psychologically to their disability. Frequently, the huge size of these tumors, the infiltration of many contiguous structures and, possibly, other features known to be associated with a bad prognosis make them appear to be incurable. We suggest that slowly growing tumor which remain localized for a long time can be controlled if adequately excised, possibly because they may be associated with strong systemic immunity. The extremely few such patients who may be encountered in surgical practice ought, therefore, to be recognized as potentially curable and treated accordingly, despite the often formidable risk or technical problems at operation and the resultant postoperative disabilities.


Blood supply of the head of the femur in traumatic hip dislocation. Traumatic dislocation of the hip causes circulatory embarrassment in the femoral head in both adult and immature rabbits. Damage to the extraosseous epiphyseometaphyseal vessels of blood supply and drainage is a major causative factor. Disturbance of circulation is most severe in immature rabbits and worsens with continued dislocation to finally reach a maximum within a period of 24 hours. In adult rabbits, the intraosseous epithyseo-metaphyseal anastomoses across the obliterated growth plate minimize the effects of damage to the extraosseous epiphyseal nutrient system. Early reduction of the dislocated hip enhances early and complete recovery of blood supply to the femoral head. Reduction of the dislocated hip delayed to 12 hours or longer does not benefit the rate and extent of the circulatory recovery of the femoral head. Histologically demonstrable aseptic necrosis of the femoral head occurs in the majority of rabbits, regardless of skeletal maturity or reduction. It is more common and extensive in immature rabbits. Abnormal roentgenologic features within the femoral head are observed infrequently between five and ten weeks after dislocation, despite the high incidence of aseptic necrosis.


Gastric bypass for morbid obesity in patients more than fifty years of age. Morbid obesity, a weight twice that ideal for a given height, has evolved as a disease of affluent societies. Surgical treatment of this disorder has largely involved intestinal bypass procedure. Thirty-six patients more than 50 years of age have undergone a gastric bypass for the treatment of morbid obesity. The 28 females as well as the eight males were part of a group of 503 patients undergoing gastric bypass for treatment of morbid obesity. The mean age was 55 years, with extremes at 50 and 68 years, respectively. Weight loss was 40 per cent less than for the younger patients, averaging only 29 kilograms after two years, and the operative mortality was four times that for younger patients. The cause of limited weight loss after gastric bypass in this older age group of patients is unclear. However, unless there is specific value to be obtained from a modest weight loss, gastric bypass is not recommended as treatment for morbid obesity in patients more than 50 years of age.


Prevention of gallstone formation in rabbits by the oral administration of kanamycin. Rabbits fed a diet containing 40 per cent casein, 15 per cent oleic acid and 45 per cent laboratory pellets developed glycoallodeoxycholic acid and glycodeoxycholic acid gallstones. The oral administration of kanamycin prevented allo bile acid stone formation in the oleic acid fed rabbit without leading to cholesterol gallstone formation. Kanamycin reduced the concentration of allodeoxycholic acid in the bile of oleic acid fed rabbits from 16.6+/-4.1 per cent of total bile acids to 1.1+/-1.1 per cent, with a reciprocal increase in deoxycholic acid concentration. The allodeoxycholate concentration was far below that found in control bile samples, 10.2+/-2.3 per cent. If the effect of kanamycin on the bile composition is by its antibiotic action, this eliminates the importance of a hepatic contribution to allodeoxycholate stone formation.


Variations in plasma levels of adenosine 3',5'-monophosphate during clinical sepsis. Plasma levels of adenosine 3',5'-monophosphate were measured in 43 patients with bacterial infections of varying degrees of severity. The most severely ill patients, who died within 48 hours of study, had the highest levels of plasma adenosine 3',5'-monophosphate, 38.4+/-29.8 picomoles per milliliter. A significant and progressive decrease in plasma adenosine 3',5'-monophosphate level toward normal was found with lesser degrees of sepsis. However, even those patients who survived exhibited elevations of plasma adenosine 3',5'-monophosphate levels, 12.9+/-5.4 picomoles per milliliter, significantly above normal. Shock and impaired renal function appeared to contribute to the elevated levels found in the most severely ill patients. In those less severely ill, with normal renal function and no shock, the plasma adenosine 3',5'-monophosphate level was still significantly elevated above normal, suggesting that severe bacterial infection itself contributes to the generation of elevated plasma adenosine 3',5'-monophosphate levels. Various hormonal changes or increased cellular permeability, or both, may account for some of the increase of this intracellular nucleotide in the plasma. It is suggested that extremely high levels of plasma adenosine 3',5'-monophosphate are indicative of a poor prognosis.


Excision and delayed closure of pilonidal sinuses. An alternative drainage procedure, a technique of excision and delayed closure for the treatment of pilonidal sinuses, was used upon 78 patients. The procedure compared favorably with marsupialization as well as the excision and semiprimary closure technique with regard to healing time and low recurrence rates.


Laparotomy for staging of Hodgkin's and non-hodgkin's lymphoma. To justify the performance of an invasive technique as an aid to determining diagnosis and therapy in any condition, one must correlate the benefits derived with the adverse effects of performing that procedure. The review of the records of the patient indicates that clinical staging remains a moderately inaccurate means of assessing the extent of the disease in patients with Hodgkin's and non-Hodgkin's lymphoma. Lymphangiogram remains an aid to the surgeon in the localization of suspicious nodes. It is of greater accuracy in the patient with Hodgkin's lymphoma as compared with those with non-Hodgkin's lymphoma. Conversely, laparotomy for staging was not of as great a value in the patients in the non-Hodgkin's group as in those in the Hodgkin's group, and the incidence of complications was higher in the non-Hodgkin's group; especially in the patients with advanced disease. Laparotomy for staging is of significant benefit in the Hodgkin's lymphoma group, and the complication rate is not prohibitive. Laparotomy for staging in the non-Hodgkin's lymphoma group, on the other hand, is of less value than it is in the Hodgkin's group and is associated with a substantially higher complication rate in the face of advanced disease. In non-Hodgkin's lymphoma, individual decisions regarding laparotomy must be used, and the routine use of laparotomy may not be warranted.


Treatment of carcinoma of the biliary system. A series of 23 patients with carcinoma at the hilus of the bile duct were studied. Fourteen of the 23 patients underwent surgical resection. Nine of the 14 patients had a curative resection. Six patients are alive after a follow-up period of five to 25 months. The remaining five patients had noncurative resection, and four of them died from metastatic carcinomas during the next 14 months. One patient who had a left hepatic lobectomy is still alive eight months after operation. The other three patients with advanced carcinoma at the hilus of the bile duct were treated by intraoperative radiotherapy. A single dose of 3,000 rads was emitted directly to the tumors. The remaining six patients were treated by drainage procedures only. Four patients with advanced carcinoma of the gallbladder had received radiotherapy. Six of the eight patients who were treated by radiotherapy are alive, although the follow-up period extends to 11 months only.


Management of perforating diverticulitis of the colon. A retrospective study was carried out of all patients admitted to the hospital with either local or free perforating diverticulitis. Fifty-one patients had perforating diverticulitis of the sigmoid colon with local abscess formation, while 26 patients had free perforation with generalized peritonitis. Of the 67 patients who had a defunctioning colostomy, 18 died, while of ten patients who had either resection or exteriorization of the perforated segment, one died. Thus, exteriorization or resection as the primary surgical procedure for perforating diverticulitis is the procedure of choice, since it leads to a low operative mortality because of removal of the septic focus, preventing continuing intraperitoneal soilage.


Gastrin levels and gastric acidity in the pathogenesis of acute gastroduodenal disease after burns. To better define the pathogenetic relationship between gastric acid secretion, serum gastrin levels and acute gastroduodenal disease in burned patients, fasting serum gastrin levels were correlated with the results of a nonaugmented gastric analysis performed in 31 hemodynamically stable burned patients. Gastroduodenoscopy documented the status of the gastric and duodenal mucosa at the time of acid analysis and serum gastrin collection. Twenty-two patients had acute gastroduodenal disease. Dffuse, superficial, gastroduodenal erosions were present in 17 patients; five additional patients had ulcerative lesions. Nine patients had normal endoscopic examinations. Gastrin levels were not predictive of the incidence, severity or location of disease. Gastric acidity, however, did correlate with disease severity-correlation coefficient, r=+0.41,p less than 0.05-being lowest in normal persons, intermediate in superficial disease and highest in ulceration. There was no correlation between the levels of serum gastrin and gastric acid secretion. The relative hyperacidity in patients with acute gastroduodenal disease suggests that acid may be one of the factors potentiating mucosal injury in these patients and may be particularly important in the evolution of life-threatening ulceration.


Surgical complications after radiation therapy for carcinoma of the breast. Surgical complications were studied randomly in 137 women with operable carcinoma of the breast, receiving preoperative irradiation or no preoperative irradiation. Wound infections and severe seromas are shown to be more frequent in patients in the irradiated group. On the whole, radiation induced complications were mild and easily manageable.


Post-traumatic pulmonary insufficiency.

Post-traumatic pulmonary insufficiency. Pulmonary insufficiency is occasionally a life-threatening sequel to severe nonthoracic trauma. A similar disturbance of pulmonary function may be a feature of hepatic cirrhosis, fulminant hepatic failure, liver homotransplantation and major hepatic resection for blunt injury. In addition to the respiratory changes, other associations common to both post-traumatic pulmonary insufficiency and liver disease are disturbance of consciousness and susceptibility to infection by organisms normally found in the gastrointestinal tract. If failure of some aspect of liver function is responsible for the development of pulmonary insufficiency, it is likely that it is the hepatic reticulo-endothelial cells rather than the parenchymal cells which are concerned, because hepatic parenchymal cell failure is not a feature of post-traumatic pulmonary insufficiency. It is suggested that the hepatic reticuloendothelial system normally protects the lungs by acting as a prepulmonary filter removing and inactivating noxious macromolecular and particulate matter in the blood, such matter arising mainly from the intestine and the blood coagulation and fibrinolytic systems. Experimental evidence indicates that hypovolemia increases the load of circulating phagocytosable material and depresses activity of the hepatic reticuloendothelial system, while trapping of the pulmonary reticuloendothelial system is considerably enhanced. This noxious material, normally dealt with by the hepatic reticuloendothelial system, may accumulate during and after hypovolemia in active form in the lungs as a result of the action of three mechanisms: direct pulmonary reticuloendothelial phagocytosis from the blood, transfer in hepatic reticuloendothelial cells from liver to lungs and uptake from the blood by polymorphonuclear leukocytes which become sequestered in the lungs. The ensuing pulmonary injury caused by this material may then be manifested by progressive pulmonary insufficiency and the impairment of activity of the hepatic reticuloendothelial system by the presence of gram-negative infection. The reticuloendothelial system has been largely neglected in man, and it is considered that evaluation of reticuloendothelial activity in injured patients may lead to the definition of a syndrome of failure of the reticuloendothelial system of which pulmonary insufficiency may be an integral part.


Bilateral subfrontal glioma simulating a meningioma. An intracranial glioma, presenting with clinical signs and symptoms, as well as angiographic evidence of a meningioma, is presented. The computerized axial tomogram was the only diagnostic study that suggested the presence of a glioma.


Anterior fibular interbody fusion in the treatment of cervical spinal cord injuries. A series of six patients with cervical spine fracture and spinal cord injury treated by removal of the fractured vertebral body and fibular strut graft is presented. There was no immediate mortality or major complication associated with the procedure. The stabilization achieved allowed early mobilization. Solid fusion was achieved in three months in all patients. Postmortem examination in one case showed union at the ends of the graft and bridging of the injured area by new bone. In selected patients interbody fusion is an important adjunct in the treatment of the fractured cervical spine.


Spinal epidural hematoma due to hemangioma of vertebra. A case of acute flaccid paraplegia is reported, due to epidural bleeding in the dorso-lumbar region. A hitherto undiagnosed and asymptomatic hemangioma of a dorsal vertebra was considered to be the source of the haemorrhage. Recovery followed early laminectomy and evacuation of blood clots.


Dural arteriovenous malformation treated by artificial embolization with liquid silicone. The successful treatment of a dural arteriovenous malformation in the region of the transverse-sigmoid sinus by artificial embolization with liquid silicone is reported. The clinical and radioanatomical characteristics of the lesion are described. The technical feasibility of embolization is discussed and compared with other surgical treatments.


Effect of sodium nitroprusside on cerebral blood flow in conscious human beings. Hemispheric cerebral blood flow was measured in 14 patients prior to and after the injection of sodium nitroprusside. The intracarotid method of Xenon was utilized, and flow was calculated by the flow initial technique. With a small reduction in blood pressure during the administration of sodium nitroprusside, the cerebral blood flow fell significantly by 15.9+/- 5.6%.


An unusual entrance site of venous air embolism during operations in the sitting position. Embolism of air into the venous system occurs during approximately 25% of neurosurgical operations performed with the patient in the sitting position. The present report calls attention to an unusual entry site for such air embolism-the punctures in the scalp made by a neurosurgical pin-type head holder.


Intraneoplastic injection of CCNU for experimental brain tumor chemotherapy. Chemotherapy experiments were performed with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) in an experimental mouse brain tumor model. Cell suspensions of a transplantable mouse ependymoblastoma were injected intracerebrally by means of a stereotactic frame. CCNU was given either intraperitoneally or by direct intraneoplastic injection beginning the fifth day after tumor cell implantation. Intraneoplastic injection beginning the fifth day after tumor cell implantation. Intraneoplastic injections of drugs were made with the stereotactic frame. A single intraneoplastic injection of CCNU was found to be highly effective in increasing the median day of death and in yielding large numbers of long-term survivors. In some experiments CCNU injected into the neoplasm produced increased numbers of long-term survivors and less systemic toxicity than when injected intraperitoneally.


Benign osteoblastoma of vertebral column and skull. Three cases of benign osteoblastoma in children are reported; two in the spine and one in the occipital bone. clinical, pathological and X-ray appearance are discussed. The importance of complete removal whenever possible is stressed. Radiation therapy is not considered to be beneficial.


The danger of intracranial wood.

The danger of intracranial wood. Peri-orbital puncture wounds by sharp wooden objects are not rare, but can be dangerous when there is intracranial penetration by and retention of the wooden foreign body. Days to years after an apparently trivial initial wounding, serious intracranial complications can occur. The authors have reviewed 42 case reports from the literature. Morbidity-defined as permanent neurologic sequelae-occurred in 74% of the cases. Intracranial suppuration was the major complication, with brain abscess having occurred in nearly one-half of the cases. Mortality occurred in 25% of 28 cases occurring in the post-antibiotic era. The qualities of wood which make it especially hazardous as a wounding agent  and foreign body are discussed. The role of orbital anatomy in affording easy access to the cranial contents is described. Surgical exploration in all those cases in which there is a reasonable suspicion of intracranial injury is recommended.


Corneal preservation: recent advances.

Corneal preservation: recent advances. New methods of corneal preservation for penetrating keratoplasty have recently been developed to meet the increasing demand for donor corneal tissue. Techniques utilized in the laboratory to evaluate the viability of the corneal endothelium and the clinical results obtained with each method are discussed. All of the new methods (storage in serum or McCarey-Kaufman medium, cryopreservation and organ culture) required excision of the cornea from the donor eye. Good clinical results have been obtained in several ophthalmology centers with cryopreservation and storage in McCarey-Kaufman (M-K) medium. Storage in M-K medium has rapidly become popular because it is a simple and inexpensive method and appears to maintain endothelial viability for about 4 days. Cryopreservation is a more complicated procedure, but it enables longterm storage of donor tissue. Organ culture is still experimental and requires careful technique, but offers promise of maintaining endothelial viability for 3 to 4 weeks.


Human umbilical cord vein for vascular replacement: preliminary report and observations. Human umbilical cord vein allografts (HUCVAG) were prepared by sequential treatment of fresh cords with 95 percent ethanol and 1.3 percent dialdehyde starch. Twenty-six of 30 canine aortic implants of fully treated grafts were patent at the end of 8 months. Among 25 aortic interpositions of untreated and 70 percent ethanol-treated grafts, the mean survival was 13 and 34 days, respectively. Five of ten 70 percent ethanol:1.3 percent dialdehyde starch-treated implants remained patent for 8 months. Graft failure was attributed to incomplete antigenic suppression manifested by rejection changes, including thrombosis, anastomotic disruption, aneurysm formation, and intimal degeneration. HUCVAG has been used in five patients who required femoropopliteal bypass. Of three successful revascularizations, two remain patent beyond 8 months without aneurysm formation. These results suggest that the processed, valveless, unbranched HUCVAG, in unlimited supply, may serve as an available alternative in the absence of a suitable saphenous vein.


Quantification on the pinhold effect.

Quantification on the pinhold effect. Can the pinhold principle be practically applied to solving the problem of providing useful vision for aphakics without resorting to aphakic spectacles? The authors have experimentally quantified the pinhold effect and concluded that the pinhold, successfully produced by miotics in certain patients or by a thin, dyed contact lens, may have clinical value.


Mesenteric and peripheral vascular ischemia secondary to ergotism. At the present time ergotism is due primarily to excessive use or abuse of ergot preparations for migraine headaches. The diagnosis may be made with the evidence of vascular ischemia in the presence of a history of migraines and its treatment with this drug. The therapy for the vasospasm is directed chiefly at the discontinuation of the ergot preparation, with further treatment aimed at the relief of symptoms or prevention of complications. A case is presented of lower extremity ischemia with impending gangrene of both feet in a patient with a history of chronic schizophrenia. Arteriograms revealed symmetrical vasospasm in the lower extremities as well as spasm of the superior mesenteric artery and its intestinal branches. This is believed to be the first documented case of mesenteric vasospasm due to ergotism. Treatment was instituted with low molecular weight dextran, tolazoline, and reserpine with rapid and complete resolution. Caution is advised in the use of ergot preparations in neuropsychiatric disorders.


Squamous cell carcinoma of the conjunctiva. Value of exfoliative cytology in diagnosis. Cytologic examination is of potential value to the practicing ophthalmologist in confirming the clinical impression of cancer of the eye. Scrapings of conjunctival lesions can be prepared in the office, stained with Giemsa stain and rapidly examined. Carcinoma in situ and squamous cell carcinoma of the bulbar conjunctiva were presented as illustrations of the usefulness of exfoliative cytology in clinical ophthalmology.


Nontraumatic perforations of the small intestine. The etiology of nontraumatic small bowel perforations in 24 operated patients was as follows: strangulation in five, diverticulum in four, foreign bodies in four, idiopathic in three, Crogn's disease in two, malignant atrophic papulosis of Degos (MAP) in two, and tuberculosis, carcinoid tumor, radiotherapy, and iatrogenic in one. The high mortality rate in these patients appeared to be a funciton of the disease process rather than of the means of treatment. In favorable circumstances, as in strictly localized lesions with well known etiology and otherwise normal bowel, a simple closure of perforation is warranted. In more far advanced cases operated upon early enough, we still consider bowel resection and primary anastomosis as the best method of treatment, though it yielded poor results in procedures are advisable to protect the anastomosis.


Malakoplakia of the colon and rectum: report of a case and review of the literature. A case of malakoplakia with primary involvement of the sigmoid colon and rectum in a 19-year-old man who died by extension of the disease to the bladder, right ureter, and retroperitoneum 4 years after the diagnosis was established is presented. A review of the 20 previously reported cases of malakoplakia of the colon is included also.


Hepatic reticuloendothelial protection against bacteremia in experimental hemorrhagic shock. Gram-negative septicemia is an increasingly common problem, and various suggestions have been made about the cause. One not often considered is that it may be the result of failure of hepatic removal of organisms which have crossed the intestinal mucosal barrier from the large bowel lumen to the portal blood stream. Splanchnic hypoperfusion both increases mucosal permeability and reduces the ability of the hepatic reticuloendothelial system (RES) to remove particulate matter from the blood. If RES funciton is reduced further by blockade with colloidal carbon, then any tnedency for bacteremia to occur in shock might be enhanced. Splenectomized greyhounds, who had received a portal perfusion of either colloidal carbon or saline, were subjected to a period of hypovolemia and then were resucitated. Peripheral blood cultures were sterile at all times in the control animals and before bleeding in the dogs that recived carbon. However, all the RE-blockaded animals developed bacteremia during shock, It was condluded that hepatic RES funciton was essential in the prevention of bacteremia in the hypovolemic dog and that investigation should be directed toward studies of RES  function in man with a view to determining the importance or otherwise of the RES  in relation to gram-negative bacteremia.


Malignant tumors of the extrahepatic bile ducts. A series of 76 patients treated for carcinoma of the extrahepatic bile ducts at three Swedish hospitals during the years 1952 to 1973 was studied. The mean age of the patients was 68 years. Gallstones were found in 22 patients, whereas 11 patients had undergone cholecystectomy earlier for gallstone disease. At operation widespread metastases were found less often in patients with cancer of the papilla of Vater than in patients with cancer of other locations. This is interpreted as indicating that patients with papillary carcinoma are treated in an earlier stagage of the disease. This interpretation is supported by the finding that these patients had a longer length of survival after bypass supported by the finding that these patients had a longer length of survival after bypass supported by the finding that these patients had a longer length of survival after bypass operations (11.5 months). In spite of treatment in an early stage, survival after radical surgery was disappointingly short (4.6 months). On the other hand, patients with cancer located above the papilla of Vater survived for 6.8 months after bypass operations as compared with 23.3 months after rescetion. The possibilities of radical surgery should be considered carefully, especially in patients in whom the malignancy is located above the papillary region.


Mesenteric panniculitis: review of the leterature and presentation of cases. Sixty-two cases of mesenteric panniculitis collected from the literature and six cases treated by the authors are reviewed. Symptomatology, pathology, treatment, and outcome of this disorder are discussed. It seems that mesenteric panniculitis is a well established clinical entity of unknown etiology, with a benign course and favourable outcome. Radical surgical treatment is not advised. The sole surgical intervention advocated would be deviation of the gastrointestinal tract in patients with symptoms of obstruction.


Traumatic false aneurysm and arteriovenous fistula of the profunda femoris artery: surgical management and review of the literature. Successful surgical repair of a false aneurysm and an arteriovenous fistula of the deep femoral vessels has been achieved 8 years after the initial injury. A review of the literature disclosed 20 other similar cases from military and civilian practice; ligation of the artery was utilized 14 times with generally poor results when long-term follow-up was available. Most vascular wounds were due to fragments, as was the case in our patient, and involvement of the deep femoral vessels was recognized more frequently in delayed complications than in acute injuries. Ten cases of false aneurysm of the deep femoral artery without arteriovenous fistula have been found to be associated with fracture or orthopedic precedures. Mild intravascular hemolysis was present in our patient and was corrected promptly after operation. Only one other such case was found in the literature. The profunda femoris artery, which was dilated and elongated, resumed a normal caliber in its proximal segment on arteriography performed one year after the operation. Preservation of the deep femoral artery may be of significance for a good clinical result in the treatment of arteriovenous fistulas and is of special interest in view of its potential importance in reconstructive procedures for atherosclerotic occlusive disease. Early diagnosis and treatment of arteriovenous fistulas for the prevention of hemodynamic, systemic, and structural changes in the vessel wall are advocated.


The false-normal oral cholecystogram.

The false-normal oral cholecystogram. Five case reports of patients at Akron City Hospital who underwent cholecystectomy following normal oral cholecystograms and who were found to have cholelithiasis or acalculous gallbladder disease are presented. In spite of the present day 90 to 95 percent accuracy of oral cholecystography, there may be occasional pharmocological and mechanical factors contributing to the nonvisualization of biliary calculi. However, the gallbladder which visualizes normally during cholecystography, on occasion, may contain nonvisualized biliary calculi or may be diseased in the acalculous state, resulting in the so-clled false-normal x-ray and presents several means by which the surgeon may prove or disprove biliary disease. We conclude the emphasis must be placed on surgical judgment when a patient presents with symptoms of cholelithiasis in the face of normal oral cholecystography.


[Methods for assessing permissible levels of intentional and unintentional food additives (author's transl)]. Foods may contain intentional and unintentional additives. The former group includes, for example, flavours, colouring substances and preservatives, while the latter includes pesticides and mycotoxins. To determine the amount of these substances that are admissible in man, extensive toxicological tests have to be performed with experimental animals to establish a no toxic effect level. Based on the no toxic effect level and applying a safety factor an "acceptable daily intake" (ADI) can be calculated for human beings. The problems outlined in the article are illustrated by several examples, such as the presence of DDT and aflatoxin M1 in milk and of mercury in fish.


[Supervision in veterinary health (author's transl)]. The supervision programme of the Veterinary Chief Inspectorate of Public Health comprises nearly fifty projects, a number of which are discussed. This will give the authorities an opportunity to gain a more complete view of the state of the human food package, for which inspection of the individual animal in the slaughter-house does not so far offer any practical possibilities. Attention is drawn to the important place occupied by the veterinary nutritionist in the protection of human health.


[The veterinarian acting in behalf of poultry production and public health (author's transl)]. It is anticipated that the consumption of meat will eventually show a marked decrease for reasons of scarcity, economic and ethics. This will be made possible by developments in protein technology, For the time being, poultry production can still be expected to expand, particularly in developing countries. Veterinary supervision of the production and processing of poultry is of importance for two reasons: (1) control of quality for the consumers; (2) control of diseases of poultry for the producers. A number of zoonoses in poultry are briefly reviewed. As a rule, they do not constitute a serious hazard to man but they also cannot be posibility ruled out by inspection. Veterinary inspection of poultry has a more general hygienic significance. A number of European regulations are discussed. More effective antemortem inspection, truly equal application of regulations in all EEC countries and adequate education of consumers regarding hygienic handling of poultry products in the household are advocated.


[The role of polyfactorial diseases in livestock husbandry in the Netherlands today and in the future (author's transl)]. The role of polyfactorial infectious diseases has increased as a result of the indstrial scale of livestock farming. Industrial livestock husbandry means keeping a single species of animal in large groups, optimum production on rational grounds being a concurrent object. Polyfactorial diseases are those diseases which are due to an infectious component and the clinical pictures of which are also determined to a considerable extent by the environment and by the animal itself. The problems associated with dysentery (Doyle), Atrophic rhinitis, Aujeszky's disease, Enzootic with nastitis, Chlamydia infection and Enzootic bronchopneumonia in cattle are discussed. In controlling these diseases, attention should not only be paid to the infectious component but also, and possibly to an even greater extent, to improvement of the environment and herd management. The view is advanced that efforts should be made to live with the disease. To stress a single measure is a technical error. Attempts should be made to improve the entire living environment of the animals by a number of measures. This requires constant expert supervision by the veterinarian. In supervising the health and welfare of farm animals, the veterinarian shluld be advised by the Provincial Health Services. These Health Services should be informed on possible or existing problems by post-mortem studies, serological studies and the study of secretions and excretions. Efforts should be made to ensure health control and health supervision in the entire field of livestock farming. It was pointed out that the hazards to attendants in livestock husbandry and the risks to consumers involved in the consumption of products of animal origin have been reduced to a minimum in 1976. Moreover, the risks are decidely smaller than those involved in keeping pets. Food poisoning caused by bacteria and bacterial toxins is a problem of hygiene rather than a problem of infection. From the point of view of prevention, improving hygienic conditions in the production, processing and manufacture of products of animal origin and altering particular eating habits should therefore be stressed.


[Certain features of environmental pollution (author's transl)]. Substances injurious to animals may be present in the air, soil, water and plants. When these substances are taken up by animals, they may have adverse effects. Whether these effects occur will depend, among others, on the nature and amount of the substance and the period for which it is taken up. Effects may occur immediately, after some time or after a prolonged period. In view of the fact that wind force is almost invariably present and therefore that the degree of dilution of the concentrations of pollutnats on immission level is generally speaking rather low, the intake of substances trough the respiratory organs will rarely show severe clinical effects. In almost every case, injurious substances will have been ingested (contaminated food and water, unless it is tap water). Adverse effects will appear in the entire or nearly herd of cattle. The importance of an adequate anamnese and correct sampling of plants-, water- and animal-samples is stressed. Accurate cattle recording also is of paramount importance. In addition to diagnosis and cattle recording, the settlement of losses is discussed.


I1Legal measures in behalf of veterinary medicine and public health (author's transl). The constantly growing world population and the altered consumption pattern have considerably increased the demand for more, and more refined, food, particularly that of animal origin. Altered methods of production, highly concentrated froms of animal husbandry but also the resulting increase of the need for the cheapest possible materials for the mixed feed industry, the more rapid and greater transport facilities, the markedly increased trade in animals and particuarly in products originating fromthese animals, they all involve an increased risk of the import and outbreak of animal disease. The increased use of animal drugs, production-increasing agents and pesticides involve the danger of injurious residues being left in products of animal origin as a result of the comulative factors in animals. Therefore, the entire chain of production, beginning at the earliest possible stage, should be closely supervised. Supervisotry programmes of the Chief Veterinary Inspectorate of the Ministry of Health and of the Veterinary Service are, in a manner of speaking, the search-lights which, thanks to the refined methods of analysis developed by research workers, are able to detect and point out failings and deficiencies. An anticipated amendment of the Livestock Breeding Act, an anticipated replacement of the Antibiotics Act and a regulation forming part of the Statutory Trade Organization are designed to make it possible to respond more promptly to these signals.


[Studies on cattle in anoestrus (author's transl)]. One of the items of a herd management programme concerned with reproduction consists in a study of those animals which have not yet come into oestrus within fifty to sixty days after parturition. On twenty farms, an inventory was made of the causes of anoestrus in these animals and the effects of anoestrus on fertility were studied. In addition, studies were done to determine whether there was a possible relationship between the causes of anoestrus and the age of the animals, the season, type of housing and the course of the last parturition and puerperium. Of the total number of 2,720 animals which had calved, 438 (16 per cent) had not yet come into oestrus within fifty to sixty days after parturition. This proportion varied markedly from one herd to another (8-24 per cent). The following causes of failure to come into oestrus were diagnosed: suboestrus (76 per cent), genuine anoestrus (9 per cent), ovarian cysts (2 per cent), pyometra (6 per cent) and gestation (1 per cent). All these changes obviously had an effect on the fertility of the herds (Table 1). Genuine anoestrus was found to occur particularly in primparous cows, whereas ovarian cysts and pyometra were diagnosed in the older cows (Table 2). It also became apparent that suboestrus and genuine anoestrus mainly are problems in tying stalls during the winter season (Table 3). There was not found to be any relationship between the presence of suboestrus or genuine anoestrus and the course of parturition and the puerperium. Fifty-two per cent of those animals in which a diagnosis of pyometra was established, had shown retained placentas (Table 4). In view of the fact that a diagnosis of suboestrus was so frequently established, particular attention should be paid to the detection of oestrus.


Nutrition of dairy cows in late pregnancy during the housing period and its relationship to health and milk yields. The relationship between the plane of nutrition in dry cows and heifers during late pregnancy on the one hand and health and milk production on the other is discussed. It is concluded from findings reported in the literature as well as from personal observations that when the animals are in normal condition, a plane of nutrition in excess of that required for maintenance plus from 5 to 10 kg. of milk will not enhance the milk yield but will increase the risk of milk fever, acetonaemia, digestive disorders, laminitis, udder problems and reproductive failure. Finally, suggestions are made regarding the plane of nutrition (concentrates) during late pregnancy and early lactation.


Treatment with oxytetracycline hydrochloride in the prevention of atrophic rhinitis in baby pigs. Atrophic rhinitis (AR) caused serious losses in a breeding herd including approximately 120 sows. The extent to which piglets were affected by AR was assessed by determining the degree of shortening of the upper jaw. Animals showing a crooked nose or grade two or more of shortening of the upper jaw were considered to be clinically positive. Grades three and four of the upper jaw were observed in those animals which were severely affected by Atrophic rhinitis. Treatment of all piglets up to about eight weeks of age by the antibiotic oxytetracycline hydrochloride directed against the bacteria Bordetella bronchisepica and Pasteurella multocida was successful in reducing the proportion of clinically affected piglets from 30 per cent to 0 per cent within eight weeks. There was found to be a positive relationship between the proportion of piglets infected with the two above bacteria at an age of about five weeks and the incidence of shortening of the upper jaw at an age of about eight weeks. The proportion of piglets with shortening of the upper jaw rose following a marked increase in the number of piglets in farrowing and flat-deck houses and as a result of the supply of inadequately medicated feed.


Histochemical quantification of glucose-6-phosphate dehydrogenase activity in human hair follicles. Glucose-6-phosphate dehydrogenase activity was studied in hair follicles from both the bald and hairy regions of the scalp of 5 patients with male pattern alopecia by the application of the method of Lineweaver-Burk to the histochemistry and by the fluorometric method of Lowry. In vitro experiment showed that the incubation time necessary for yielding a certain amount of formazan is related to the amount of enzyme present. In the case of section experiment, the time required for the first appearance of formazan deposition in the tissue at various substrate concentrations was plotted against the reciprocal of the substrate concentration. The data obtained by this method seem to be consistent with the data by the fluorometric method.


Insulin response to glucose or glucagon in subclinical diabetes previously injected with tolbutamide. Thirty-one patients with subclinical diabetes, who showed diabetic or impaired glucose tolerance after treatment for diabetes, were investigated in order to clarify the abnormalities of insulin response in diabetes mellitus. These patients showed a delayed response of plasma insulin during oral glucose loading. In the tolbutamide-glucose test, in which glucose loading followed the intravenous tolbutamide injection at a 60-min interval, the insulin level at 90 min was significantly lowered in a group of 20 patients with subclinical diabetes. In the tolbutamide-glucagon test, in which 1 mg of glucagon was injected 60 min after tolbutamide injection, the maximal level of plasma insulin was significantly decreased in a group of 10 subclinical diabetes except for one patient. These results indicate that insulinogenesis and/or release of insulin were decreased even in subclinical diabetes, suggesting that such a defect in islet function might be one of the abnormalities in primary diabetes.


Effects of vitamin E on the platelet aggregation induced by combined adenosine diphosphate and hydrogen peroxide. Hydrogen peroxide can either induce or inhibit or enhance the platelet aggregation in vitro depending upon the experimental conditions. Vitamin E and vitamin E-nicotinate are found to be effective to inhibit, to some extent, the platelet aggregation induced by combined adenosine diphosphate (ADP) and hydrogen peroxide (H2O2), added simultaneously, to the platelet rich plasma (PRP). Vitamin E and vitamin E-nicotinate seemed, however, to be unable to prevent the reduction of platelet response to ADP, which was brought about by the pretreatment of PRP with H2O2 of a lower concentration.


Effects of eye movements upon excitability of cat superior colliculus as tested by electrical stimulation of the cortico-collicular pathway. Influences of saccadic eye movements upon excitability of superior colliculus (SC) were examined in chronic cats carrying implanted electrodes and in encéphale isolé cats. Excitability of SC was assessed by recording responses of SC to electrical stimulation of cortico-collicular (CC) pathway. The SC response to stimulation of CC fibers consisted of two componenets, i.e. presynaptic T and postsynaptic R. Eye movements enhanced R but did little change T. Enhancement of the postsynaptic component R was ascribable to a central factor on the basis of the following results: 1) Enhancement of R occurred independently of whether the ambient illumination was present or not. 2) Saccade-like movements of a slit of light in front of immobilized eyes never induced enhancement of R. 3) PRF stimulation, effective to cause saccade-like eye movements, always elicited enhancement of R, independent of the ambient condition of eyes and even after eyes had been immobilized.


Thin layer chromatography and fluorescent scanning analysis of porphyrins. A combined technique of two dimensional thin layer chromatography with fluorescent scanning was applied to the estimation of urinary porphyrins in 2 patients with porphyria cutanea tarda. Porphyrin patterns were also examined with the technique on urine, liver and skin samples obtained from a hexachlorobenzene-induced porphyric rat. Results obtained showed that uroporphyrin and hepta-carboxylic porphyrin were predominant in the urine, liver and skin.


A comparative study of the effect of vitamin E-nicotinate and the combination of vitamin E and nicotinic acid on the hydrogen peroxide-induced platelet aggregation. The inhibitory effect of vitamin E-nicotinate upon the hydrogen peroxide (H2O2)-induced platelet aggregation was found to be greater than that of either vitamin E alone or the combination of vitamin E and nicotinic acid. Nicotinic acid showed no inhibitory effect. It was suggested that the effect of vitamin E-nicotinate was not due to the additive effect of vitamin E and nicotinic acid produced by hydrolysis, but to the unique and distinctive property of vitamin E-nicotinate itself.


Response of lower esophageal sphincter pressure to beef soup or AOC-tetrapeptide stimulation in esophagitis. In this study is intended a measurement of the pressure of the lower esophageal sphincter (LES) in resting state and after various stimuli such as beef soup and AOC-tetrapeptide in cases of healthy subjects and various diseases by means of an infused open-tip method. The following results were obtained: In the cases of esophagitis, the resting LES pressure is lower than in the cases of healthy subjects and after stimulation by beef soup or tetrapeptide the LES pressure is less elevated. Based on these observations, we concluded that there are some factors other than gastrin which make the LES pressure in the cases of esophagitis lower than in controls.


Local recurrence of breast carcinoma after mastectomy and radiotherapy. 19% of 102 operable cases of breast carcinoma irradiated postoperatively developed local recurrences in the thoracic wall and/or regional lymph nodes during the observation time of five years. Of the 41 radically operated cases of stage I disease only one had recurrence in the chest wall and three metastases in the regional lymph nodes. As the number of local recurrences after mastectomy and evacuation of the axilla combined with postoperative irradiation was fairly small if compared with the results achieved with conservative surgery and irradiation presented in literature, the radical treatment schedule is recommended even in stage I breast carcinoma. The local reappearance of carcinoma is always strenuous for the patient even if the prognosis of a local recurrence after conservative surgery is better than that of the local recurrence after mastectomy.


[Brachial edema after treatment of mammary carcinoma: significance of phlebography (author's transl)]. The frequency of thromboses or of obstacles to the venous flow in brachial or axillary regions has been examined by a phlebographic survey of 102 patients who were treated surgically and radiotherapeutically because of cancers of the breast. Thromboses or venous obstruction were found in the 86 patients with brachial edema. Ten of the patients (12%) with brachial edema had thromboses. Further 15 suffered from an obstruction to the venous flow. The results are discussed in detail, and compared with the rather contradictory data in literature. As a consequence of this study an indication for brachial phlebography would be justified on a larger scale with patients having been treated surgically because of mammary carcinoma.


[Radiation sensitivity of lymphocyte stimulation. 1. Experiments on in-vitro sensitivity of cell number and mitosis activity]. Radiation-induced transformations of stimulated lymphocytes are not to be regarded as characteristical responses of lymphocyte populations as such, but represent general radiobiologic principles of the stimulated proliferation. Thus, basic problems of stimulated proliferation in comparison with a spontaneous quick proliferation of normal cellular systems in vitro have chiefly been studied by means of two stimulation models in vivo, the model of liver regeneration following partial hepatectomy and the model of beta stimulation of the salivary glands. The radiosensitivity of the lymphocyte stimulation in vitro as well as in vivo has been analyzed especially with regard to its quality as a model. The task was approached methodically by: a) Determination in vitro of the number of cells (66 cultures), b) morphological analysis of the mitotic activity in vitro (270 cultures), c) measurements in vitro with 3h-thymidine of the DNA synthesis using liquid scintillation counts (more than 3000 cultures), d) measurements in vitro with 3H-thymidine of the DNA synthesis using autoradiography (66 cultures), e) determination in vivo of the DNA synthesis by means of the incorporation of 131I-desoxyuridine into the mouse spleen (investigation with 100 mice). For a model of lymphocyte stimulation mainly that of PHA stimulation in vitro and in vivo of T-lymphocytes was chosen, supplemented by the one of PWM stimulation of T- and B- lymphocytes for measuring in vitro the DNA synthesis. In particular, influence of in vitro irradiation upon several variables of the stimulation model was investigated in order to examine the methodics critically: a) During the determination of the mitotic index too short an acbition by partial synchronization effects within the dose range of 10 to 500 R. The chronological analysis of the process during determination of the mitotic activity is indispensable in order to differentiate the mitotic inhibition from a mitotic delay in the case of high doses, b) For the determination of the DNA synthesis the concentration of stimulative PHA or PWM has no substantial influence on the radiation-induced inhibition effect; the constancy of serum percentage in the culture system, however, is an important condition for comparability of different experiments. Moreover, only a short period of labeling with 3H-thymidine, lasting 1.5 to 12 hours, interferes with radiation-induced inhibition of the DNA synthesis, this probably being also due to partial synchronization effects within the dose range of 10 to 500 R. c) In order to determine the DNA synthesis wether in vitro or in vivo, a chronological analysis is a condition indispensable for differentiation between the three factors involved: Delay of DNA synthesis, blockage of DNA synthesis, and inhibition of the proliferation...


Kinetic analysis of tumor regression during the course of radiotherapy. A model of tumor regression during the course of radiotherapy is presented, which considered the lethal effect of radiation, the elimination of dying cells and the reproduction of surviving cells. The model was applied to multiple lung metastases in a woman, which were treated with different doses per fraction. The regression of tumor volume was measured from chest radiographs which were taken once a week during the treatment. Radiosensitivity of tumor cells estimated by the model was of D0=150 R and n=5. The half life of dying cells in the tumor was 15 days.


[Computed tomography of the whole body as a means of radiation planning (author's transl)]. Computed tomography of the whole body offers the first possibility to obtain individual tomographs with high resolution and in correct scale from all regions of the body. Using the "Sicograph", large-sized copies are obtained, which are therefore particularly useful for radiation planning. The size and location of tumors relative to critical organs can be determined exactly. The efficacy of radiation therapy in every individual case may be estimated on the basis of the controlled course (radiobiological information), [2,4,6,11,16,17,18,24,30], and the necessary modifications of the therapeutic schedule can be adopted early, allowing the complete utilization of the advantages of the shrinking field technique [8,19,26]. Since ultrasonic tomographs in many cases furnish additional information, we regard the combination of computed and ultrasonic tomography as the best way to obtain an accuracy of radiation planning previously unknown.


[Reproducibility and accuracy of an optical ssd pointer (author's transl)]. The reproducibility and accuracy of an optical source-surface distance measuring device was systematically examined. The standard deviation of twenty equal distance settings was +/-0,5%. The error in dose-rate caused by one single adjustment did not exceed +/-2%. The position of the effective source-center is defined by a special inverse square plot. A periodical check is recommended.


Development of narrow-band lamps for testing and clinical use. A compact narrow band lamp for high intensity irradiation has been developed. It consists of a high-pressure mercury lamp, a shutter and water cooled filters for spectral isolation of the light. A mixing device permits simultaneous irradiation with two different wavelenghts by using two lamps. The spectral distribution of the light within the bands is given for seven filter combinations. The construction and calibration of a power meter is also described.


[Radiation response and radiation effects in salivary glands (author's transl)]. Using nuclear medical techniques, especially that of functional scintigraphy with the gamma camera after injection of 99mTc-pertechnetate, it is possible to objectify dose-dependent radiation effects on the salivary glands: Radiation doses from 500 to 1200 rd lead to a temporary reduction of the capacity to accumulate the 99mTc-pertechnetate. This functional restriction is reversible. With radiation doses of more than 2000 rd there appear irreversible functional disorders being proportional to dosage. Focal doses of about 6000 rd produce a complete loss of the capacity for 99mTc accumulation of the salivary glands. The chronological course of radiation response is characterized by a) an activation of the radionuclide accumulation following ca. 3000 rd in about three weeks, b) a following decrease of the capacity for accumulation of 99mTc, c) a renewed activation after the end of irradiation, and d)the progressive and irreversible loss of function of the salivary glands.


Regional cerebral blood flow in the anesthetized mouse as measured by local hydrogen clearance. Platinum microelectrodes were used to measure H2 clearance in mouse brain, and the clearance curves were used to calculate regional cerebral blood flow (rCBF). The curves were usually biexponential, whether or not electrode placement was confined to the cortex. When calculated by the height over area method, rCBF in anesthetized mice averaged 37+/-14 and 49+/-15 ml/100 gm per minute in two successive groups where cortical placement had been made. After CO2 breathing, which raised PaCO2 to 77+/-18 torr, the mean rCBF of the latter group was elevated to 70+/-36 ml/100 gm per minute. Our basal rCBF values are lower than literature values for rats or mice, when compared with data obtained by other techniques. However, our data are comparable to rat rCBF data obtainted by others using H2 electrodes and are comparable also to data for whole brain CBF obtained by a variety of methods in larger anesthetized mammals. It is possible that H2 electrodes provide low values for supposedly "cortical" rCBF in the very small mouse brain, because is such brains the electrode is usually close enough to a slow clearing compartment for the electrode reading to be influenced by that compartment. At the same time one cannot rule out the possibility that other techniques when applied to small rodents may, on occasion, produce spuriously high values for CBF. Indeed, while some studies using the latter techniques do show unusually high values for cortical flow in these animals, other studies using similar methods do not.


XIV. Cerebral ischemia: the role of thrombosis and of antithrombotic therapy. Study group on antithrombotic therapy. A revival of interest in antithrombotic agents for the treatment of ischemic cerebrovascular disease has resulted in the widespread use of oral anticoagulants for the prophylaxis and therapy of the ischemic variety of stroke, and has generated enthusiasm for the use of platelet-suppressant agents such as aspirin, dipyridamole, and sulfinpyrazone. In delineating the several clinical types of focal ischemic disease and outlining the causes of cerebral ischemia and infarction, the study group considers the problems of data interpretation in the face of inconsistent terminology. The basic mechanisms of hemostasis and thrombogenesis are concisely detailed. Finally, the study group critically reviews extensive earlier reports of clinical trials of anticoagulants, platelet function suppressants, and thrombolytic agents, and reassesses according to present-day statistical standards the significance of the results. The information contained in this report should familiarize the reader with sufficient data to permit him to utilize antithrombotic agents under a variety of circumstances and to appreciate the contraindications and potential dangers in their use.


Reserpine and cerebral vasospasm.

Reserpine and cerebral vasospasm. Cerebral vasospasm was produced in the dog basilar artery by topically applied five-day-old clotted autologous blood, but not by freshly drawn blood. The spasm was reversed by methysergide, an antiserotonin agent. However, vasospasm was not produced by five-day-old clotted autologous blood from dogs pretreated with reserpine. This suggests platelet serotonin or a similar, unidentified substance as the vasospastic element in dog blood responsible for experimental vasospasm from topically applied whole blood. Other experimental data support these findings.