Do oculomotor neuroblasts migrate across the midline in the retal rat brain? Toluidine blue-stained semithin sections and Cajal-Castro preparations are used to study in rat fetuses whether oculomotor neuroblasts migrate across the midline at a certain period of development. In confirmation of previous studies, a group of oculomotor neuroblasts was detected which first grow cytoplasmic processes into the mesencephalic midline, and afterwards translocate their somata towards the midline, between the 12th and the 15th days of gestation. At this moment a midline mass of neuroblasts characterizes the meeting at this landmark of both left and right migrating neuroblastic groups. No crossing oculomotor axons yet are demonstrable with reduced silver techniques. In further stages of development the neuroblasts continue their migration until they arrive at the contralateral nucleus at the 16th and 17th day of gestation. At the midline the mass of neuroblasts disappears gradually and crossed oculomotor axons become visible. The electron microscope was then used to study ultrastructurally the migrating motoneurons. It was discovered that no preexisting structure guides their movement by contact. Their leading processes show no filopodial activity, and contain abundant microtubules and thick bundles of neurofilaments in eccentric position. The neuroblasts carry their axon across the midline as a trailing process.


The pigment architecture of the human occipital lobe. With the aid of steromicroscopical examination of pigment preparations uo to 1,000 micronm thick the various areas of the occipital lobe of the human brain are described. In the occipital lobe there are three main cortical types, forming the striate, the parastriate area, and the peristriate zone. The parastriate area is a horseshoe-shaped fringe area adjacent to the primary visual field. It is conspicuously marked by a relatively dark stripe of pigmented granule cells dividing the fourth layer into a light upper, a  pigmented middle, and a light lower zone, a unique feature of the parastriate area, which is not to be found in any other isocortical area. This three-fold layer disappears abruptly as one passes from the parastriate to a peristriate area, permitting the definitive determination of this boundary. The peristriate zone is quite large in the inferior and the lateral parts of the occipital lobe and comparatively small in the superior parts. Its peripheral boundaries do not coincide with the limits of the occipital lobe. Parts of the cuneus on the one side are covered by parietal and temporal areas, whereas peristriate areas on the other side penetrate widely into the temporal lobe along the medial occipitotemporal and to a lesser extent the parahippocampal gyrus. As regards pigment architecture, the peristriate zone is divisble into ten areas. A relatively simply organized area accompaines the parastriate area. The structure of the cortex changes gradually until one reaches the various fringe areas adjacent to the parietal and temporal areas. The limit adjoining the temporal areas is sharply traceable, since the lower of two light cortical stripes vanishes abruptly when passing from a peristriate to a temporal area. The most highly developed field, the area peristriata magnopyramidalis, occupies part of the inferolateral margin of the occipital lobe. It displays a wealth of large pyramids in the lower reaches of the third layer, which contain tightly packed and densely stained pigment granules forming large rounded aggregates in the basal cytoplasm. Pyramids of this type give the field a close resemblance to association fields such as the posterior speech area, where they are commonly encountered as the predominant neurons of the third layer.


The effect of a synthetic progestine on the fine structure of the epididymal head (stereological analysis). The alterations induced in principal cells of the epididymal head tissue of the rat by administration of a synthetic progestine (R2323, ethinyl-norgestrienone) were studied by electron microscopy. A total of 3 male, sex mature rats was applicated ethinyl-norgestrienone during a 3 months period in low dosage (60 mug) per day and was studied with 5 control animals. Stereological methods devised by Weibel (1969) and Rohr et al. (1976) were applied to light and electron micrographs. The calculated values are related to 1 cm3 of epididymal tissue, 1 cm3 of epididymal cell and 1 cm3 of epididymal cell cytoplasm. The Golgi apparatus was further subdivided; the values for the Golgi compartments are therefore  refered to 1 cm3 of Golgi apparatus was further subdivided; the values for the Golgi compartments are therefore refered to 1 cm3 of Golgi apparatus. In the treated animals there was, related to the unit of epididymal tissue, a significant decrease in the volume density of the interductular tissue, whereas that for the lumina was significantly higher. The volume density of the glandular epithelium remains unchanged. Refered to the unit volume of principal cell cytoplasm the rough endoplasmic reticulum shows a signficant decrease by 6.5%, whereas the smooth endoplasmic retiuclum is increased by 6.3%. The volume density of the lysosomes was calculated to be 4.3% (Control 2.5%). The stereological data of the Golgi apparatus indicate a vacuolar transformation: Increased volume of vacuoles, decreased volume fraction of saccules and vesicles. However, the volume density of the whole Golgi apparatus remains unchanged. An impaired secretory activity of the principal cells could be assumed.


Structure of northern elephant seal population breeding on San Nicholas Island, California, in 1971. The structure of the population of northern elephant seals, Mirounga angustirostris, on San Nicolas Island, California, was studied during the 1970 and 1971 breeding season. At the population peak on 31 January 1971, there were 77 males, 306 females, 315 pups, and 6 yearlings on shore. The breeding population was subdivided into 15 groups, containing from 3 to 75 breeding animals. Fourteen of the groups were considered territories defended by individual males, and one group, the largest, was controlled by three males in a social hierarchy. The relatively small size of the San Nicolas population and the large amount of available beach space allowed the existence of numerous small breeding groups. Female elephant seals, although gregarious, apparently prefer to be in small groups when conditions permit it. It is likely that the same males that were territorial would have formed the nucleus of a social hierarchy if space had been limited enough to cause all of the females in the population to congregate in one large group.


An ethology-based catalogue of facial/vocal behaviour in infancy. The ethological approach is suggested as a fruitful research strategy in the study of how infants express emotions. This approach led to the development of a large catalogue of facial/vocal behaviour which was used in the systematic observation of 75 girl and boy infants, who in the last quarter of the first year of life were placed in a series of standardized laboratory situations. Each of the 42 facial expressions contained in the catalogue is precisely defined according to the expressive elements of the brow, eyes, mouth and other facial regions. The vocalizations are also operationally defined. The possible ways that the facial expressions and vocalizations could be combined in the expression of emotional behaviour in infants are discussed.


A new simple spirometric index for use with bronchial provocation tests. Spirometric indices such as the forced expiratory volume in one second (FEV1), the maximal expiratory flow rate (MEFR) and the maximal midexpiratory flow rate (MMFR) can be criticized for use with bronchial provocation tests since they are either partly effort-dependent or dependent on the forced vital capacity (FVC). These criticisms can be avoided by the use of a new index corresponding to the volume of air expired in one second starting at 75% of the control FVC, called the (FEV1)-25. This study was performed to evaluate the relative sensitivity of the (FEV1)-25 and the classical FEV1 in detecting airway obstruction caused by an inhaled carbachol aerosol in 20 asthmatic subjects. The mean fall in (FEV1)-25 of 46% following carbachol inhalation compared with a mean fall in FEV1 of 35% indicates that, in addition to its theoretical advantages, the (FEV1)-25 is a sensitive index for use with bronchial provocation tests.


Enrichment of human X- and Y-chromosome bearing spermatozoa by density gradient centrifugation. Human spermatozoa (120--180 Mill/0.6 ml Tyrode solution) were laid on the top of a continous density gradient column consisting of 4--16% bovine serum albumin. The columns were then centifuged at 1500--1600 rpm (200-240 g) at 20 degrees C or 4 degrees C for 15 min. By this procedure the spermatozoa sedimented within the tubes of normal distribution curves. The mean percentages of y-spermatozoa gradually decreased from 62,3 +/- 6,1% (max. 70%) in the upper fractions to 42,4 +/- 3,8% (min. 37%) in the bottom fractions. These results could be verified by inseminations of rabbit does with spermatozoa separated by the same technique.


Sperm motile efficiency.

Sperm motile efficiency. To provide an alternative to presently available subjective ways of measuring sperm motility which often yield inconsistent data, we devised a method for determining sperm motile efficiency with it one can express objectively the amount of active sperm movement. Using a melangeur for counting white cell, semen is diluted 20-fold in normal saline solution. With the diluted semen on Thoma's hemocytometer, spermatozoa passing its small quarter line in one minute are counted, and the value is divided by the estimated number of spermatozoa per ml. The quotient is multiplied by 100 and expressed by %/min. This shows the active movement of a spermatozoon per minute. In the present study, we measured sperm motile efficiency in 162 male sterility patients, 64 cases showed values of 49%/min or less, with a mean of 20.3%/min, 46, between 50%/min and 99%/min, with a mean of 70.1%/min; and the remaining 52 over 100%/min, with a mean of 195.9%/min. Among these there were 10 cases of successful pregnancy with a mean sperm motile efficiency of 152.7%/min, and 69.0%/min at the lowest. Our new method requiring no special equipment can easily identify active sperm movement and is easily reproducible,


Controlled trial of 6-month and 9-month regimens of daily and intermittent streptomycin plus isoniazid plus pyrazinamide for pulmonary tuberculosis in Hong Kong. The results up to 30 months. A comparison was made between 6-month and 9-month regimens of streptomycin plus isoniazid plus pyrazinamide given daily, 3 times a week, or twice a week in the treatment of newly diagnosed, smear-positive pulmonary tuberculosis in Chinese patients. At 6 months, the twice-weekly regimen was marginally inferior; treatment failed for 5 (4 per cent) of 126 patients with drug-susceptible strains before treatment compared with 2 (1 per cent) of 141 on the 3-times-weekly regimen and none of 137 on the daily regimen. The results for patients with pretreatment strains resistant to isoniazid, to streptomycin, or to both drugs were not as good, treatment failing for 10 (30 per cent) of 33 on the daily regimen, 15 (37 per cent) of 41 on the 3-times-weekly regimen, and 14 (39 per cent) of 36 on the twice-weekly regimen. In contrast, the relapse rates after chemotherapy were similar for patients with drug-susceptible and drug-resistance strains before treatment and for patients on the daily and intermittent regimens. By 30 months, 35 (21 per cent) of 167 patients with susceptible strains who were treated for 6 months and 10 (6 per cent) of 179 treated for 9 months had relapsed, all with strains still susceptible to isoniazid and streptomycin. The relapse rates for patients with resistant strains were 7 (24 per cent) of 29 and 1 (4 per cent) of 26, respectively. Drug toxicity was not a special problem.


Diagnosis of tuberculosis in children using fluorescence microscopic examination of gastric washings. In a clinical setting where malnutrition and far-advanced tuberculosis are common, experience with fluorescence microscopy of gastric washings was evaluated in 536 specimens. These specimens were obtained from 191 Haitian children whose illness was difficult to diagnose. Using the culture of gastric washings as a disease indicator, the prevalence of positive specimens was 24 per cent. The sensitivity, specificity, and predictive value were 58 per cent, 95 per cent, and 81 per cent, respectively. The agreement (J statistic) was +53 per cent. Combining the results of several series showed no differences in the sensitivity and specificity between fluorescence microscopy of gastric washings and fluorescence microscopic examination of sputum specimens. Among 49 children with positive fluorescence microscopy of gastric washings, pulmonary tuberculosis was bacteriologically confirmed in 85 per cent. Positive fluorescence microscopy of gastric washings was more frequent among children with far-advanced and miliary disease than children with less severe disease. The sensitivity and specificity of fluorescence microscopy of gastric washings make it a useful diagnostic tool in childhood tuberculosis, particularly in the presence of negative cutaneous reaction to purified protein derivative, extensive disease, or severe malnutrition.


Light scattering determination of various characteristic paramenters of spermatozoa motility in a serie of human sperm. In this paper are presented the results obtained by the light scattering method of systematic study of different parameters characterizing spermatozoa motility in a series of human sperms, one hour and five hours after ejaculation. These results are relative to the concentration of spermatozoa, the percentage and the number of motile spermatozoa, the characteristic velocity and the velocity distributions. All these parameters are discussed one by one, the advantages (objectivity, small quantity of not diluted sperm, short time needed for measurements) and the limits of the light scattering method being pointed out. A comparison is made with results obtained by conventional methods. The fineness of this study shows that this method can be used with success in fundamental research as well as in a routine functional sperm study, allowing an objective and precise analysis of motility in a given population as a complex factor.


Testosterone excretion in chronic prostatis. Urinary testosterone and epitestosterone were assayed in 60 men: 7 normals and 53 patients with chronic prostatitis (of these 8 patients had prostatis free of complications, 45 had prostatitis with disturbances of generative and copulative functions). In 73.1% of patients considerable reduction of testosterone excretion was revealed. Reduction of testicular endocrine function is in direct correlative dependence on severity of clinical symptoms, duration of disease and form of chronic prostatis. Disturbances of genital hormone metabolism are of considerable importance in case of chronic prostatitis and its complications.


Enrichment of X-spermatozoa and in vitro penetration through cervical mucus. Using the Sephadex Gel-filtration method (Steeno - 1975) we carried out a review of the data on the possibility of enriching X-spermatozoa. The testing procedure followed consisted of determining Y-chromatin positive spermatozoa after staining with quinacrine-mustard. We were able to confirm the data recorded by Steeno, according to which an enrichment of about 80-90% can be achieved after penetration through the Sephadex Gel filter. In addition to these investigations we also carried out tests with the enriched X-spermatozoa material to determine in vitro penetration through cervical mucus. No decline in the progressive motility of the spermatozoa was observed. After the Gel-filtration sufficient numbers of these were still able to cover penetration distances of 60 mm/hour. The enrichment effect of the X-spermatozoa declined at the beginning of in vitro penetration, but there was no further change in the subsequent course of penetration.


The relationship of childhood respiratory illness to adult obstructive airway disease. This study of a general population sample reveals close relationships between histories of childhood respiratory disorders and pevalences of symptoms, obstructive airway diseases, and ventilatory impairment in 2,626 adults more than 20 years of age. Although a history of pediatric respiratory illness is associated with relatively mild impairment of ventilatory function in young adults, subjects with such a history shown an excessive decline in function with advancing years and with cigarette use. Because some of the data are retrospective and subject to the bias of preferential recall of childhood events, these observations cannot be regarded as definitive. However, present observations are compatible with the hypothesis that pediatric respiratory illness represents an important risk factor for the development of obstructive airway diseases in adult life. It is suggested that these childhood respiratory illnesses cause the adult lung to be unusually susceptible to the adverse effects of a variety of bronchial irritants and infectious agents.


Pulmonary function in granite dust exposure: a four-year follow-up. Pulmonary function studies were performed on 974 workers in Vermont granite sheds in 1974. Of these subjects, 668 had been studied 4 years earlier and had remained in jobs in which their exposure to granite dust had not changed based on dust concentrations measured during 1970. The yearly decrement in pulmonary function observed in the 668 granite shed workers was excessive (0.07 to 0.08 liter per year for forced vital capacity and 0.05 to 0.07 liter per year for forced expiratory volume in 1 sec). This exceeded the expected decrement derived from several other occupational and population groups. Studies from this laboratory and published cross-sectional and longitudinal data consistently indicate a decrement of no more than 0.03 to 0.04 liter per year in both forced vital capacity and forced expiratory volume in 1 sec. The observed decrements were independent of exposure groups and not accounted for by cigarette smoking. In 528 additional granite shed workers, decrements in ventilatory capacity had been measured for one, 2, or 3 years and were consistently of the same order of magnitude. Dust concentrations within defined jobs and between granite sheds showed great variability. Despite this, a suggestive relationship between exposure and decrement in ventilatory function was demonstrated at the end of 2 years; however, at the end of 4 years the relationship could no longer be shown with these exposure groupings. The difficulty in characterizing individual dust exposures and projecting dust concentrations for several years is considered to account for the absence of a dose-response relationship at the 4-year follow-up. The results of this study suggest that our previous estimates of annual deterioration in ventilatory capacity attributable to work in granite sheds are underestimates. We conclude that present dust concentrations in Vermont granite sheds cause excessive deterioration of lung capacity. To prevent these effects, dust concentrations must be lowered.


Studies with an intravas nylon device in rat. Contraceptive efficacy of an intravas device (IVD) was investigated in rat. The IVD used consisted of a nylon suture which did not occlude the lumen of the vas completely and permitted a free passage of spermatozoa. Its presence for periods ranging from 15 to 180 days did not produce any changes in the histology of the testis and epididymis; In the vas deferens the tall columnar ciliated epithelium was replaced by squamous epithelium. A spermatic granuloma developed on the vas at the entry of the IVD and its frequency of occurrence and size increased with the passage of time. The device caused an increase in the vasal protein, sialic acid and phospholipid content, and a decrease in the level of glycogen and alkaline phosphatase activity at 15 days. The level of portein, glycogen and alkaline phosphatase activity returned to normalcy at 90 days but the sialic acid and phospholipid content remained elevated. Notwithstanding these alterations the device failed to affect the spermatozoal number, morphology, motility and their fertilizing ability. The significance of these findings is discussed.


Diagnostic accuracy of transtracheal aspiration bacteriologic studies. The diagnostic accuracy of transtracheal aspiration bacteriologic studies was examined in 488 patients. Twenty-three patients had bacteremic pneumonia, and in each instance the blood culture isolate was also recovered from the transtracheal aspirate. Clinical correlations in 119 patients with negative cultures of transtracheal aspirate indicated that 71 had an alternative diagnosis to explain an abnormal chest radiograph, and 44 appeared to have a bacterial infection but had received antimicrobial drugs before specimen collection. According to clinical parameters and final diagnosis, the incidence of false-negative cultures was 1 per cent among patients sampled before administration of antimicrobial drugs, and the incidence of false-positive cultures was 21 per cent.


Volume dependence of instantaneous time constants derived from the maximal expiratory flow-volume curve. A new approach to the analysis of forced expiration. A simple expansion of the information in the maximal expiratory flow-volume curve was used to measure the convexity to the volume axis of maximal expiratory flow-volume curves produced by 11 asymptomatic smokers and 11 asymptomatic nonsmokers. The ratio of remaining volume to maximal flow was equal to the product of upstream resistance and chord compliance. This "instantaneous time constant" increased more near residual volume in the smokers. Using this method, plethysmographically obtained maximal expiratory flow-volume curves were more sensitive than spirometrically obtained maximal expiratory flow-volume curves. This method compared favorably with moment analysis and helium response of maximal expiratory flow as a separator of asymptomatic smokers and nonsmokers.


Effect of kallidin, substance P, and other basic polypeptides on the production of respiratory macromolecules. When canine tracheal explants were incubated in culture medium 199 in the presence of D-glucosamine labeled with carbon-14 for 24 hours, a significant amount of radioactivity was found in the secreted macromolecules. When kallidin was present in the culture medium, the amount of radioactivity associated with a portion of these macromolecules was increased. A met-lys-bradykinin derivative had a similar effect, but bradykinin did not. When hexadimethrine, an inhibitor of kinin formation, was present in the culture medium, the amount of radioactivity in the macro-molecular fraction was decreased. Substance P and the structurally related polypeptides, physalaemin and eledoisin, also enhanced the production of tracheal macromolecules; they were several-fold more active than kallidin. The effect of polypeptides on the activities of glycosyltransferases was also investigated. One of the enzymes present in a microsomal fraction prepared from the mucosal lining of canine trachea was uridine diphosphate (UDP)-galactose:mucin galactosyltransferase, which required a 25 mM concentration of maganese ions to be present in the assay mixture to obtain maximal enzymatic activity. When the concentration of manganese ions was decreased to 2.5 mM, there was less than one third of the maximal enzymatic activity, but full activity could be restored by the addition of kallidin. Several other basic polypeptides had a similar effect on the enzymatic activity. Kallidin had little or no effect on the activities of several other glycosyltransferases. The results suggest that basic polypeptides may be important in controlling the synthesis and/or release of respiratory glycoproteins.


Regional lung function in spontaneous pneumothorax. Using xenon-133, we measured regional lung volumes in three seated young men with 25 to 40 per cent pneumothorax. There was no gravitational gradient of regional lung expansion in the lung affected by the pneumothorax. There was no gravitational gradient of regional lung expansion in the lung affected by the pneumothorax, whereas an apex-to-base gradient of regional volume was apparent on the contralateral, normal side. When over-all lung volume increased from residual volume to 20 per cent of vital capacity, there was little volume change in the lungs with pneumothoraces. These lungs received relatively small fractions of boluses inhaled at residual volume and bolus distributuion was even from apex to base on the sides with the pneumothoraces. Regional washout half-times were not prolonged in lungs with pneumothoraces and did not differ from apex to base, whereas in unaffected lungs, half-times at the apex exceeded those at the base. The results indicated that regional volume and half-time gradients were absent when gravitational gradients of pleural surface pressure were abolished by pneumothorax. Lungs with pneumothorax demonstrated uniform airway closure at low lung volumes, and it is suggested that this is the chief cause of ventilation maldistribution in spontaneous pneumothorax.


Dimethyl ethanolamine-induced asthma.

Dimethyl ethanolamine-induced asthma. Progressively severe sneezing, rhinorrhea, cough, wheezing, and dyspnea developed in a spray-painter, apparently in relation to exposure to a particular spray paint. A monitoring of exposure at work revealed the development of symptoms and a decrease in peak flow rates. Subsequent challenges in the laboratory performed under conditions resembling occupational exposure resulted in dual asthmatic responses on exposure to the whole paint (98 per cent methyl methacrylate emulsion and 2 per cent dimethyl ethanolamine solution) and to dimethyl ethanolamine solution (2 per cent) alone. Water, methyl methacrylate emulsion, and 1,4 dioxane (0.6 per cent) used as a thinner in the dimethyl ethanolamine did not produce a response in the airways. Allergy skin tests with dimethyl ethanolamine and a mixture of dimethyl ethanolamine and human serum albumin were negative. To our knowledge, this is the first report of asthma and/or rhinitis induced specifically by dimethyl ethanolamine. The mechanism of the specific reactivity is not known.


Availability of active amphotericin B after filtration through membrane filters. The availability of active amphotericin B after filtration of the intravenous form of the drug through in-line filters was examined. Filtration through circular filters of 25-mm diameter and 0.45-micronm pore size resulted in little loss of active drug, although a marked decrease in flow occurred with time. Filtration through either circular or cylindrical filters with 0.22-micronm pores resulted both in significant losses of active drug and in marked decreases in flow. Thus, membrane filters of 0.22-micronm pore size are not suitable for use in intravenous administration of amphotericin B. The use of filters of 0.45-micronm pore size is appropriate only in situations in which decreased flow is acceptable.


The detection of asympatomatic coronary artery disease. In summary, near-maximal or maximal exercise testing has a sensitivity of approximately 60% and a specificity of approximately 90% for coronary atherosclerotic heart disease. When screening asympatomatic men with exercise testing, an abnormal response identifies a group of men at very high risk for coronary artery disease. However, the predictive value limitations are obvious and the false-positive problem must be realized. At present, there is no second line of noninvasive studies that can separate an exercise-test false positive from a true positive with certainty. Risk-factor consideration may help separate them; The sensitivity limitations of exercise testing must be especially considered when evaluating people at high risk for CAD. An abnormal test response does not absolutely predict the presence of CAD and a normal response does not rule out its possibility. In appropriate instances where coronary angiography can be performed at minimal risk and when it is justified for reasons of public safety or individual well-being, this procedure can give a reasonably definitive answer. Creation of iatrogenic "cardiac cripples" can be the most common complication of screening tests and should be avoided. Therefore, good clinical judgment needs to be used in conjunction with any screening test.


[Treatment of primitive trigeminal neuralgia by differential thermocoagulation of Gasser's ganglion (author's transl)]. The authors report their experience in the Treatment of essential Trigeminal Neuralgia with controlled increments of radiofrequency heating from an electrode inserted in the Gasserian ganglion or the posterior rootlets. Assuming that the less myelinated small fibers (A delta and C) are more sensitive to the heat than the heavily myelinated A beta and A alpha fibers, graduate controlled thermo coagulation could produce a differential destruction of pain fibers. 30 patients were treated with this method since 10 months. In all cases, the patients experienced immediate relief. There was no mortality and no neurological morbidity outside the trigeminal nerve. The most serious undesired result has been the production of anesthesia or marked hypesthesia in 10% of our cases.


Papillary eccrine adenoma.

Papillary eccrine adenoma. We studied in 14 patients a distinctive eccrine sweat gland tumor that we have termed papillary eccrine adenoma. There was a majority of black patients, and the tumors were located most often on the distal extremities. Eleven patients were followed up for an average of 35 months after excision of the tumor. No tumor metastasized but one recurred, and since re-excision the patient has been followed up 30 months further regrowth. Although previously regarded sometimes as malignant, the papillary eccrine adenoma is considered benign on the basis of our experience. Excision, with assurance from pathologic examination that the surgical margins are free of tumor, is the treatment of choice. Recognition of the neoplasm is based on the microscopic appearance of a pattern of structures resembling eccrine ducts, usually dilated, associated with intraluminal papillations.


[About 500 carcinomas of the skin of the face (author's transl)]. After having studied etiological and histological cases of 500 malignant growth of the face's skin the authors think that: -- carcinomas of lips and ears are chiefly men's cancers and above all squamous cell-tumors. Ear-tumors beeing serious. For the other parts of the face, cancers are more frequently met in females than in males. Squamous cell-tumors are perhaps more frequent than usually said; -- as for treatment the authors had rather use surgery with immediate plastic reconstruction.


Psychogenic purpura.

Psychogenic purpura. Two young women had painful ecchymoses of their extremities. In one, this purpuric syndrome followed a chronic course and resulted in severe joint disability. In the other woman, the problem was transient and relatively benign. Emotional factors in their disease were of major importance. No abnormalities of hemostasis or immune function were found. These cases demonstrate the many problems encountered in the diagnosis and management of such patients.


[A description of surgery of the vidian nerve (author's transl)]. The authors expound a method wihch is initially surgical, for approaching the vidian nerve while preserving the innermost periosteal lining of the pterygomaxillary fossa, thereby avoiding the disadvantages of cutting into the contents of this fossa.


Elastosis perforans serpiginosa induced by penicillamine. A patient with Wilson disease, under prolonged treatment with penicillamine, developed lesions of elastosis perforans serpiginosa (EPS). Examination of biopsy specimens by light microscopy revealed the characteristic changes of EPS. Examination by transmission electron microscopy revealed structural changes in the elastic fibers not previously described. The appearance of the lesions by scanning electron microscopy is described for the first time. It is suggested that penicillamine induced EPS may be morphologically distinct from the idiopathic form.


Enzyme polymorphism and function during embryonic development. Alterations in multiple molecular forms of enzymes have been described during normal embryogenesis. Changes in electrophoretic patterns, which differ from the normal isozyme ontogeny, occur in embryos and their yolk-sacs during incipient maldevelopment secondary to teratogen exposure. One such isozyme change, in response to a teratogenic regimen using 9-methyl pteroylglutamic acid (PGA), is persistence of lactate dehydrogenase-5 (LDH-5) beyond its time of normal involution in the rat yolk-sac. Since LDH-5 is an allosteric regulatory enzyme which favors anaerobic metabolism, the cellular respiration of 9-methyl PGA-treated embryos was investigated and found to be depressed. However, no changes were found in the oxidative metabolism of visceral yolk-sacs from similarly treated pregnancies. A possible explanation for the unchanged oxygen consumption is the observed simultaneous quantitative alterations in other LDH-yolk-sac isozymes following 9-methyl PGA treatment. Other potential causes include known changes in isozymes other than LDH, limitation of enzyme function by its substrate or co-factor or the presence of a functionally inert LDH-5 isozyme. Changes in LDH and other isozyme patterns and their associated metabolic alterations may eventually prove useful in predicting chemical teratogenicity.


Foot ulceration and vertebral osteomyelitis with Corynebacterium haemolyticum. Diphtheroid or "coryneform" bacilli are usually considered to be nonpathogenic "normal flora" of human skin and mucous membranes. Because bacterial cultures are frequently contaminated with these organisms, the correct diagnosis and proper treatment may be delayed by the failure to recognize serious infections caused by them. This is a report of a 71-year-old woman with a diabetic foot ulcer and Corynebacterium haemolyticum osteomyelitis with bacteremia.


Enzyme tests in diseases of the prostate. Enzyme tests in diseases of the prostate focus primarily on the use of serum acid phosphatase assays in patients with suspected or histologically proved adenocarcinoma of the prostate. The purpose of this review is to consider various potential clinical uses of the assay, to examine the data available concerning the performance of the test in given clinical situations and to define those situations in which the test is actually useful. Included in this discussion will be sources of false positive and false negative values, predictive values of the test in clinical settings and efforts to minimize shortcomings.


Panniculitis of the legs with urate crystal deposition. Dark red nodules that drained an opaque amber liquid developed on the extensor surfaces of both legs in a 69-year-old woman receiving furosemide and spironolactone for congestive heart failure. In addition to asymptomatic cholelithiasis, the serum amylase, lipase, and uric acid levels were elevated. Other skin signs and joint manifestations of gout were absent. A biopsy revealed a granuloma with the needle-like crystals characteristic of gout.


Cell-mediated immunity in lichen planus. In vitro tests with extracts from lichen planus lesions. Extracts were prepared from lichen planus lesions and from healthy epidermis of normal controls. Their effect on the migration and lymphocyte transformation of autologous leukocytes was studied. On the whole, the ranges of variation and mean values of the autologous leukocyte migration indices obtained in the presence of LP skin extract or sediment from 10 LP patients did not significantly differ from those recorded in the presence of similar extracts prepared from the epidermis of 12 normal controls. Two assays with LP skin sediment antigen and one assay with LP supernatant antigen, however, fell within the range of significant changes in migration. Lymphocyte transformation, as indicated by increased thymidine uptake, was significantly stimulated by LP epidermis in 1 case of 5 LP patients. Extracts from normal epidermis did not affect the transformation of autologous lymphocytes. The phytohemagglutinin response of lymphocytes from LP patients was the same as that of normal controls. The results do not indicate that cell-mediated immunity toward epidermal antigens play any significant role in the etiopathogenesis of lichen planus.


A non-invasive microscopic method for measuring epidermal thickness in vivo. Some improvements are reported of a relatively unknown method for measuring the thickness of the epidermis in vivo. The excursion of a microscope tube is measured when focussing respectively on the summits of the dermal capillary loops and on the epidermal surface. With this method values may be produced with a standard deviation in the order of 10 micron. Averaged epidermal thickness on the flexor forearm was 60 +/- 1 micron, the spread being the standard error of the mean. In principle the thickness of the horny layer can be determined with this method by measuring thicknesses before and after stripping of the horny layer.


Ultrastructure of the contrasting types of keratinization seen in the tail epidermis of the laboratory mouse Mus musculus. The mouse tail epidermis undergoes contrasting forms of keratinization. Around the hair follicle there is a granular layer containing keratohyalin granules, and nuclei are absent from the horny layer. In the scale regions keratohyalin is not formed and nuclear remnants are retained in the horny cells as in parakeratosis generally. These findings from light microscopy were confirmed by transmission electron microscopy. The complete breakdown of organelles in the follicular regions contrastred with the retention of effete nuclei in the scales. Some of these nuclear remnants were pyknotic as in abnormal human parakeratosis, but most were further degraded with loss of nuclear membranes. In the boundary zone between the follicular and scale regions the epidermal cells had a few small keratohyalin granules and also showed incomplete degradation of nuclear remnants in the horny cells. The change from living epidermal cells to dead keratinized cells was abrupt in both the follicular and scale regions. In both sites the plasma membranes of the horny cells were thickened and there was a cytoplasmic meshwork of microfibrils in the cells.


The sensitizing capacity of naturally occurring quinones. Experimental studies in guinea pigs. I. Naphthoquinones and related compounds. Experimental studies on the sensitization capacity of naturally occurring naphthoquinones derived from plants and woods have been carried out with 6 compounds. With 4 of these substances (desoxylapachol, menadione, lapachenole andmacassar quinone) guinea pigs could be sensitized. Desoxylapachol, sensitizer from teak wood, and lapachenole, sensitizer from perobawood proved to be the most effective ones. Experiments with macassar quinone (oxidation product of a naphthalene constituent of macassar ebony) still demonstrate that even ortho-naphthoquinones are capable to induce contact allergy. Allergic cross reactions could be obtained with 9 out of 14 different napthoquinones. In animals sensitized with desoxylapachol menadione and lapachol showed the strongest eliciting effect. Furthermore the study demonstrated that the sensitizing effect of naphthoquinones depends on the length and position of the side chain attached to the quinoid ring as well as on the substitution of the carbon atom adjacent to the side chain bearing C-atom. With compounds substituted at this C-atom (e.g. position 3 of lapachol or didimethylallylnaphthoquinone) sensitization could not be obtained.


The dermal inflammatory reaction in initial psoriatic lesions. The cellular infiltrate in the dermis of incipient psoriatic lesions was qualitatively and quantitatively evaluated using cytochemical methods for the differentiation of inflammatory cells. The greatest intensity of the dermal infiltrate was always in the center of early lesions. It was shown that most of the inflammatory cells within the perivascular areas of the upper dermis were macrophages, monocytes and lymphocytes. The number of mast cells was not increased; eosinophils and plasma cells could not be detected. Only seldom could a single or a few polymorphonuclear leucocytes be seen in lesions at a more advanced stage. These findings are discussed in the light of known immunological and functional mechanisms.


The HLA system and the arthropathies associated with psoriasis. Histocompatibility typing was carried out in 74 patients with psoriasis and an inflammatory arthropathy. In 40 patients with peripheral arthropathy characterized by distal interphalangeal joint involvement, 13 (32-5%) were HLA-B27 positive, significantly higher than the control frequency (P = 5-8 X 10 (-6). 26 of the 40 patients did not have ankylosing spondylitis or radiological sacroiliitis and 7 were HLA-B27 positive, also significantly higher than in controls (P = 0-0049). All 7 patients with psoriasis and ankylosing spondylitis without peripheral arthropathy were HLA-B27 positive. The 10 patients with ankylosing spindylitis or radiological sacroliitis who were HLA-B27 negative all had peripheral arthropathy. It is suggested that being HLA-B27 positive increases the risk of a psoriatic patient developing both peripheral arthropathy and ankylosing spondylitis. In addition, some of the genes involved in susceptibility to psoriasis also have a role in the pathogenesis of both types of arthropathy. A hypothesis is put forward that some of the genes for psoriasis may be aetiologically important in some HLA-B27 negative patients with ankylosing spondylitis.


Lysosomal activation by neutral saccharides in cell cultures of synovium. On exposure to sucrose or neutral polysaccharides, cell cultures from human synovium showed cytoplasmic vacuolation, increased numbers of lysosomes, and ultrastructural changes simulating those described in rheumatoid synovial intima and similarly treated embryonic caritlage and bone. These changes were accompanied by raised intracellular lysosomal enzyme activity without corresponding increases in the extracellular level of these enzymes. Structural changes and enzymic responses were less intense during exposure to the neutral polysaccharides. The secretion of large polymers of hyaluronic acid was consistently decreased during sucrose treatment. Evidence of heightened hyaluronidase-like activity was found in cellular extracts of sucrose-treated cultures, but not in the culture medium.


Chondrocalcinosis in primary hyperparathyroidism. Influence of age, metabolic bone disease, and parathyroidectomy. Chondrocalcinosis is known to be common in hyperparathyroidism. In order to  discover the effect of parathyroidectomy on chondrocalcinosis and to investigate this association further, we studied two groups of patients. In one group were 41 postparathyroidectomy patients, and in the other 100 admissions to the acute geriatric unit. The total incidence of chondrocalcinosis in the parathyroidectomy group was 32%, and in the elderly control group 11%. There was little or no osteoarthrosis in these patients. It was found that chondrocalcinosis occurred in the normal population from the age of 75 and in the hyperparathyroid group from the age of 45. In both groups the incidence rose steadily with age. In the hyperparathyroid group alone, preoperative serum calcium levels were no different in those without chondrocalcinosis, suggesting that hypercalcaemia alone is not a sufficient stimulus for chondrocalcinosis. Those with chondrocalcinosis had higher mean preoperative alkaline phosphatase levels, nearly twice as much radiological bone disease, and were older. Parathyroidectomy had no effect on attacks of pseudogout or on preexisting cartilage calcification. A connection with high levels of circulating parathyroid hormone is suggested, and a link with physical age-related changes in cartilage postulated.


Correlation between levels of DNA antibodies and clinical disease activity in SLE. Sera were tested from 23 patients with systemic lupus erythematosus followed over a period of 1 to 5 years. Antibodies to native DNA were measured and correlated retrospectively with clinical evidence of disease activity. The overall degree of correlation between the presence of DNA antibodies and evidence of disease activity was good (P less than 0-001). Of 206 sera tested, only 4 had a normal DNA antibody at a time when significant clinical activity was noted. In contrast, 34 sera had mild to moderately raised DNA antibody levels at times of clinical remission. Although DNA antibodies are a useful investigation in the monitoring of disease activity, changes in therapy should not necessarily be made on DNA antibody levels alone.


Inhibition of Fc-rosette formation by synovial fluids from patients with rheumatoid arthritis. Human red cells sensitized with one of the Rh antisera (Ripley) form rosettes (Fc-rosette) with human B lymphocytes and the rosettes are well inhibited by aggregated human IgG. As synovial fluids from patients with rheumatoid arthritis are usually hypocomplementaemic and frequently contain immune complexes, they were used for the inhibition of Fc-rosette formations in this study. The Fc-rosette inhibitory rates were inversely correlated with the levels of CH50 and C4 in the synovial fluids. Fractionation studies of the synovial fluids by ultracentrifugation and Sephadex G200 gel filtration indicated that main inhibitory activities were present in macromolecular fractions. Reduction and alkylation of the synovial fluids resulted in marked reductions of inhibitory activities. The tested synovial fluids did not contain anti-HLA activity as assessed by the microcytotoxicity test. The Fc-rosette inhibitory rates were not correlated with the levels of C3 and immunoglobulins, nor with the activity of rheumatoid factors in the synovial fluids. These results indicate that the Fc-rosette formations are inhibited by the immune complexes contained in the synovial fluids and it was confirmed that the Fc-rosette inhibition test is a simple and sensitive method for the detection of circulating immune complexes.


Role of ineffective erythropoiesis in the anaemia of rheumatoid arthritis. The importance of inadequate haemoglobin synthesis and ineffective erythropoiesis in the anaemia of rheumatoid arthritis was studied by measuring the incorporation of 15N glycine into haemoglobin haem and early labelled bilirubin in a patient with severe anaemia before and after response to gold therapy. Initially, total erythroid haem turnover was decreased but haem turnover due to ineffective erythropoiesis was markedly increased, accounting for 29% of total erythroid haem turnover. Gold therapy resulted in marked clinical improvement, accompanied by a rise in haemoglobin to normal. Total erythroid haem turnover increased and the percentage ineffective erythropoiesis fell to normal. Ineffective erythropoiesis may thus be an important reversible factor in the production of the anaemia of rheumatoid arthritis.


Arthropathy of Wilson's disease. Study of clinical and radiological features in 32 patients. The principal clinical features and radiological findings relating to the locomotor system have  been studied in 32 consecutive hospital admissions of patients with Wilson's disease. 5 of these patients were recently diagnosed and had as yet received no treatment, while 27 were routine admissions for follow-up and biochemical supervision of their illness. No patient was specifically included or excluded from the series because of the presence or absence of locomotor symptoms. The most common radiological abnormality was a generalized increase of radiolucency, interpreted as skeletal demineralization (21 cases), followed by premature osteoarthrosis (8 cases). Changes in the spine were common and included osteochondritis, reduction of intervertebral joint spaces, osteoarthrosis, and a tendency to squaring of vertebral bodies. Other bony changes included fluffy irregularity of femoral trochanters, osteochondritis dissecans of the knees, osteophytic protrusions at bone ends, and bunches of tongue-like osteophytes at joint margins. The symptoms associated with these radiological abnormalities comprised back pain and stiffness with restricted movement, pain and stiffness of knees, hips, and wrists, and tenderness to pressure over margins of affected joints. Joint hypermobility was also observed in 9 patients. Episodes of acute polyarthritis with serological changes were seen in 5 cases; all these episodes appeared to be related directly to treatment with penicillamine.


Surgical experience with Cushing's disease. During the period 1952 to 1976 at Vanderbilt University Hospital 119 patients with pituitary-dependent hypercortisolism or Cushing's disease were studied. The less severe cases, which constitute a majority, were treated by pituitary irradiation with endocrinologic cure or improvement in two-thirds of the treated patients. Bilateral total adrenalectomy was reserved for the most severe cases and for failures of pituitary irradiation. In 29 patients with total bilateral adrenalectomy there was one postoperative death. Two of 28 survivors had incomplete relief of hypercortisolism and required additional therapy for its control. One patient with recent operation is improved and another with early improvement died suddenly at home three months after operation. The 24 other adrenalectomized patients, followed 6 months to 20 years, were considered endocrinologic cures of Cushing's disease. One patient in the group who had not received pituitary irradiation developed signs of expanding pituitary tumor after adrenalectomy (Nelson's syndrome) with satisfactory response to radiation therapy.


Is rib resection necessary for relief of thoracic outlet syndrome? Between 1966 and 1975, 425 patients with thoracic outlet symptoms were studied: 146 operative procedures were carried out in 103 of these patients. Division of soft tissues, only, in 129 cases offered relief of symptoms. In 10 cases bone resections (four cervical ribs, one second rib, one clavicle, and four first ribs) were done in an attempt to relieve the outlet problems. Preoperative evaluation included neurological consultation, x-rays of the neck and chest, detailed non-invasive oscillographic recordings of arterial flow during various outlet maneuvers, angiograms and in many instances electromyograms and nerve conduction studies. The axillary surgical approach to be various compression areas was preferred in that hyperabduction of the arm and costoclavicular maneuvers could be carried out under direct observation of the involved vessels. Accurate appraisal of the compression point could be assessed before and after the involved structure was divided or removed. Complications were limited to two hematomas postoperatively, and transient paralysis of the diaphragm in one patient. In all patients the vessel compression was relieved at the time of operation. In no instance was the first rib emperically removed as a "cure all" procedure. Six months following operation, patients were reevaluated and all except 8 patients (11 operative procedures) had relief of symptoms for a success rate of 92.5%.


Primary common duct stones.

Primary common duct stones. Thirty patients were identified as having primary common duct stones. Criteria for diagnosis included at least a two year symptom free interval following cholecystectomy; soft, light brown stones or sludge present in the common duct; and the absence of a long cystic duct remnant or a biliary stricture from the previous surgery. The average age of the 30 patients was 66 years. The interval between cholecystectomy and the diagnosis of primary common duct stones averaged 12 years. Acute cholangitis was a frequent mode of presentation. At the time of surgery the bile duct was often dilated out of proportion to the serum bilirubin. In only one of the 30 patients was ampullary stenosis present. Twenty-six of the 30 patients had only stone extraction and insertion of a T tube for treatment of their primary common duct stones. Twenty-two of the 26 were followed for an average of four years and nine months with no evidence of recurrent stones in 82% (18/22). Four developed recurrent primary common duct stones one, five, five, and 7 years later. It is concluded that most patients with primary common duct stones do well after stone extraction alone.


New trends in esophageal replacement for benign disease. In the past three years 21 patients have required esophageal replacement for benign disease: 6 patients with caustic stricture, 5 with reflux esophagitis, 5 with neuromotor abnormalities, 2 with strictures following radiation therapy, 1 with iatrogenic perforation, 1 with monilial esophagitis, and 1 with esophageal atresia. Esophageal substitution was achieved using isoperistaltic left colon 17 patients and stomach in 4. The preoperative evaluation, postoperative complications, and results of esophageal replacement in these patients are discussed. Changing trends in the benign conditions requiring esophageal substitution are reviewed.


Extracorporeal membrane oxygenation for massive pulmonary thromboembolism. This study was undertaken to determine whether extracorporeal membrane oxygenation (ECMO) could modify the effects of massive lethal thromboembolism and prevent death. Twenty anesthetized dogs were prepared for venoarterial perfusion with a demand pump and membrane lung and were perfused slowly for 1 1/2 hours to lessen homologous blood shock; 1 ml per kilogram of 24-hour-old tantalum-impregnated thrombus was injected intravenously. The dogs had profound systemic hypotension with an elevated mean pulmonary artery pressure (62.9 +/-4.5 mm Hg) immediately after embolization. Control animals generally died within 15 minutes. Four of the 10 ECMO-supported animals lived for six days, at which time they were restudied and killed. Not only can ECMO maintain an animal that would otherwise die quickly of massive pulmonary thromboembolism, but such support, even though temporary, can greatly improve the chances of survival.


Tree-shaped pulmonary veins in infracardiac total anomalous pulmonary venous drainage. Three consecutive patients undergoing corrective operation for the infracardiac type of total anomalous pulmonary venous drainage (TAPVD) were found to have tree-shaped pulmonary veins. Preoperative angiocardiography revealed that in 2 patients the superior and inferior pulmonary veins drained separately, bilaterally, into the vertical vein. In the third patient the right pulmonary veins united to connect with the vertical vein, while the left superior and inferior pulmonary veins drained separately into the vertical vein. At operation inferior pulmonary veins connecting separately with the vertical vein were found to be located posterior to the pericardium. In the previous literature dealing with successful repair of infracardiac TAPVD, there is no mention of the tree-shaped pulmonary veins described in this report. As this particular type of pulmonary vein does not seem to be uncommon, its possible presence should be kept in mind during operation, as it may dictate the selection of surgical procedures.


Ascending aorta-abdominal aorta bypass: indications, technique, and report of 12 patients. Use of the supraceliac segment of the abdominal aorta for ascending aorta-abdominal aorta bypass (AAAAB) offers a new technique for management of certain difficult surgical problems. Since 1973, we have performed AAAAB in 12 patients: 4 with recurrent coarctation of the thoracic aorta; 4 with coarctation of the thoracic aorta and associated cardiac lesions requiring a concomitant intracardiac procedure; 2 with recurrent aortoiliac occlusive disease (AIOD); 1 with interruption of the aortic arch requiring concomitant pulmonary artery banding; and 1 with coarctation of the abdominal aorta. In 3 of these patients (2 with recurrent AIOD and 1 with coarctation of the abdominal aorta) the distal anastomosis was made to the distal abdominal aorta or femoral arteries. Ten patients (83.3%) experienced satisfactory results; 2 patients (16.6%) died. The technique of AAAAB provides a practical solution to complex situations in which previous procedures preclude a standard operative approach, or when necessary concomitant procedures would otherwise require a two-stage operation.


Coronary venous arterialization: acute hemodynamic, metabolic, and chronic anatomical observations. Nine dogs that had anastomosis of the internal mammary artery (IMA) to the left anterior descending coronary vein (LADV) were studied acutely on right-heart bypass. Occlusion of the left anterior descending coronary artery (LADA) and LADV without venous arterialization resulted in a significant decline in stroke work, total coronary flow, and myocardial oxygen uptake; with reactive hyperemia an increase in lactate and pyruvate consumption resulted. Occlusion of the LADA and LADV with VA did not change these variables greatly, except for a marked increase in total coronary flow with reactive hyperemia. Chronic venous arterialization in 14 dogs was associated with a 14% mortality, while 10 controls had a 40% mortality. Dogs were killed at six weeks, and prior angiography in 9 showed patency of the IMA to the heart without filling of cardiac veins. All dogs had infarcts in the distribution of the LADA; these infarcts were smaller in dogs with venous arterialization. The anastomoses were obliterated by mature or maturing fibrous tissue, with alteration of the vein so that it was frequently not discernible, while the IMA was well preserved. Distal veins had foci of intimal proliferation, subintimal fibrosis, and medial hypertrophy. Although venous arterialzaiton provides protection for the acutely ischemic myocardium, this effect does not persist, perhaps because of anastomotic occlusion due to fibrous proliferation.


The subxiphoid approach in the treatment of pericardial effusion. Subxiphoid pericardiotomy for diagnosis and treatment of pericardial effusion is a safe procedure. Not only does it appear to be safer than aspiration, but it yields more information because of its ability to obtain pericardial tissue. The recurrence rate of pericardial effusion is lower using subxiphoid pericardiotomy. For these reasons it is the technique of choice for diagnosis and treatment of nontraumatic pericardial effusion.


Radiolucent retractor for operative coronary angiography. A new retractor has been designed for sternal separation during cardiac operations. This retractor has the advantage of radiolucent blades that allow visualization of the entire heart by roentgenographic techniques without compromise of surgical exposure during the course of operation. The retractor also has swivel blades that provide excellent conformity to the sternal edges without pressure points, which tend to produce fractures.


An improved introducer for the sutureless myocardial pacemaker lead. Although the sutureless myocardial pacemaker lead has proved a useful advance, the introducer supplied with it has had the disadvantages of requiring bimanual operation, creating forces directed toward the myocardium, and producing release of the lead head in a rotating motion. An improved introducer, described here, has overcome these problems and has further simplified the application of this useful device.


Anemia in primary hyperparathyroidism.

Anemia in primary hyperparathyroidism. Although anemia has not been widely appreciated as a complication of primary hyperparathyroidism, 5.1% of the individuals with this disorder seen at the Massachusetts General Hospital since 1962 had a normochromic, normocytic anemia that could not be related to blood loss,a deficiency state, or uremia. The anemic group had more advanced bone disease and higher levels of serum calcium, alkaline phosphatase, and parathyroid hormone than the nonanemic group. Results of bone marrow biopsies performed in five patients showed variable degrees of myelofibrosis. However, none of the patients had hepatosplenomegaly, a myelophthisic peripheral blood smear, leukopenia, or thrombocytopenia. Removal of the abnormal parathyroid glands led to improvement or correction of the anemia.


Jejunoileal bypass as a treatment of morbid obesity. Seventy-five morbidly obese patients underwent jejunoileal bypass between December 1968 and October 1975. The average weight of 45 patients who had had the bypasses for over two years stabilized at 62.4% of the maximum preoperative value. Postoperative complications included recurrent diarrhea in 11% (8/74) and serum electrolyte deficits in 64% (48/75), most of which were transient. Potassium and calcium deficiencies were usually correctable by oral supplementation, but hypomagnesemia persisted in 23% (16/71) despite supplementation. Nine percent (4/43) had biopsy-proved hepatic cirrhosis after one year. Other complications were polyarthralgia, bone demineralization, renal stones, and vasculitis. Three patients required reanastomosis to original bowel continuity; all rapidly regained weight. One died of vasculitis and hepatic failure attributable to the bypass. Jejunoileal bypass is suitable only in morbidly obese patients with particularly high motivation, whose risk factors outweigh those risks incurred through bypass.


Reflex and reticular modulation of first-order proprioceptive neurons of the mesencephalic trigeminal nucleus. Several investigations have shown that the vagus nerve and the reticular formation can affect the reflex responses of the masticatory muscles. The present research has been devoted to analyze the mechanism of such modulations of the masseteric reflex in the lamb. Extracellular records of the electrical activity of the mesencephalic trigeminal nucleus (MTN) was carried out in immobilized lambs by means of tungsten microelectrodes. Units were found which responded to lowering the jaw and to stretching the masseter muscle: they were identified as the first-order neurons of the masticatory proprioception on the basis of their electrophysiological properties. Single-shock or repetitive electrical stimulations of the cervical vagus nerve and of the bulbo-pontine reticular formation could affect the unitary discharge of the MTN: different patterns of activation and inhibition of the MTN units were seen; however, the activation was the most prominent effect. The responses did not depend upon the circulatory effects of the vagal stimulation. Thus the conclusion can be reached that the vagus and the reticular substance can modulate the masseteric reflex at level of the perikarya of the afferent pathway. Such a statement is supported also by the presence of synaptic boutons on the soma of the MTN neurons.


Improved results with femoropopliteal vein grafts for limb salvage. Over a ten-year period from 1966 to 1975, 154 femoropopliteal vein grafts were performed for limb salvage in 139 patients, including 42 diabetics. The average patient age was 70 years. The one-month operative mortality was 2.9% (four patients). Average preoperative Doppler ankle pressure was 46 mm Hg, with an average ankle-arm systolic blood pressure index (ASPI) of 0.33. The average postoperative Doppler ankle pressure was 96 mm Hg, with an ASPI of 0.76. Five-year vein graft patency was 72%. Poor quality of vein was a statistically significant cause of graft failure (P less than .015). Small saphenous veins of good quality and arm veins gave satisfactory results. Diabetics had a lower, but not statistically significantly decreased, five-year patency. Because of this high success rate and low operative mortality, we recommend an attempt at limb salvage by femoropopliteal vein grafting in patients threatened with limb loss because of atherosclerotic occlusive disease of the femoropopliteal segment.


Electroenterography after cholecystectomy. The role of high epidural analgesia. The electrical activity of the stomach and intestine was monitored during the postoperative period in 30 patients who underwent cholecystectomy. All patients received standard general anesthesia with artificial ventilation during operation; some received high epidural analgesia during surgery and postoperatively, and others, fentanyl analgesia during surgery and nicomorphine afterwards. Electroenterography (EEnG) showed that electrical activity decreased following surgery and returned to base line on the third or fourth day after operation. A marked increase in amplitude and frequency of EEnG oscillations was recorded in 80% of the patients who received bupivacaine injections into the epidural space. A decrease was almost always recorded after nicomorphine injections. During the postoperative period, eating caused a considerable increase in the amplitude and frequency of the electrical activity of the stomach and intestine in patients treated by epidural analgesia, whereas no observable change was recorded in patients treated by nicomorphine injections. It appears that high epidural analgesia may be useful in the treatment of postoperative adynamic ileus.


Thermography. A noninvasive method for diagnosis of deep venous thrombosis. Thermography is a simple, rapid, and noninvasive method for the diagnosis of deep venous thrombosis (DVT). A comparative study between thermography and conventional phlebography has been performed in 121 legs. The thermographic criteria for diagnosis of DVT are described; posterior views were found to be advantageous in interpretation. The diagnostic agreement between the two methods was 90.1%. The localization diagnosis was somewhat less correct. The thermographic method is a reliable alternative in the diagnosis of acute DVT.


Transmembrane bone morphogenesis across multiple-walled diffusion chambers. New evidence for a diffusible bone morphogenetic property. Bone generation and regeneration are associated with a bone morphogen that recruits mesenchymal cells for differentiation into bone. Experiments with particulate bone matrix gelatin implanted in multiple-walled diffusion chambers suggest that bone morphogen is a rapidly diffusible molecule, and consists of a noncollagenous bone morphogenetic protein (BMP). When particulate bone matrix gelatin is implanted inside of diffusion chambers constructed of two to five membranes, ranging from 300 to 750 cu micronm in total thickness, large deposits of bone develop on the outside. The volumes of the deposits of new bone are inversely proportional to the thickness (or distance) of transmission of the BMP. Transmission for long distances through interstitial fluid can be accounted for by a low molecular mass hydrophobic BMP, disseminated according to the laws of diffusion.


Evaluation of posterior gastropexy for gastroesophageal reflux. The efficacy of posterior gastropexy as an antireflux procedure and its mechanism of action were studied by manometry and cinefluorography in a canine model. Gastroesophageal incompetence was produced in 13 dogs by dividing the vagi below the diaphragm and displacing the gastroesophageal junction into the chest. Reflux was associated with a decrease in the lower esophageal sphincter (LES) pressure measurements and in its response to abdominal compression. Posterior gastropexy done in seven dogs, improved both the resting and compression pressures in the LES, increased the length of the LES, and corrected reflux in five dogs. Replacement of the LES in the abdomen and crural (Allison) repair resulted in a similar increase in LES pressures and restored competence in four of the six animals. Neither procedure was able to restore the LES response to abdominal compression. Posterior gastropexy, like Allison repair, improves LES function by replacing it below the diaphragm, but does not produce a new valve.


Portacaval diversion for severe hypercholesterolemia. Report of a case with measurements of glucose tolerance, insulin, and glucagon levels. An end-to-side portacaval shunt was performed in a patient with severe coronary arteriosclerosis and type IIa hypercholesterolemia. By one year postoperatively there was a decrease of serum cholesterol concentration of more than 40%. No adverse side effects were noted. Intravenous and oral glucose tolerance tests were performed and were within normal range preoperatively and postoperatively. However, preoperatively, during the oral test, the serum insulin levels exceeded the normal range. In addition, glucagon levels revealed less tendency to suppression during the preoperative oral tests. Psychological testing revealed no abnormalitites, and serum ammonia levels were only slightly elevated.


Biliary lithiasis associated with ascariasis in a Nigerian woman. We report the occurrence of gallstones and intrahepatic stones in association with ascarid invasion of the biliary tract in a 51-year-old Nigerian woman. Although biliary stones are known to be caused by products of Ascaris worms, no etiological association was demonstrable in this case. Invasion of the biliary tract by Ascaris worms is reported as rare in our environment where intestinal ascariasis is extremely common. It is suggested that the rarity is apparent rather than real and that it is important to bear this condition in mind in view of modern rapid migration of populations.


Benign gastrocolic fistula healing with conservative management. We report a case of gastrocolic fistula resulting from a benign gastric ulcer, diagnosed by barium meal and endoscopy. The fistula healed with conservative management and treatment with carbenoxolone sodium. To our knowledge this is the first reported case of successful conservative treatment of a benign gastrocolic fistula using carbenoxolone.


Intermittent dislocation of the liver. A syndrome associated with volvulus of the transverse colon and stomach and obstructive jaundice. Displacement of the right lobe of the liver into the left upper abdominal quadrant can occur only if the diaphragmatic attachments are congenitally absent or traumatically disrupted. To our knowledge, the former situation has not been previously described in an adult patient. A young man with a lifelong history of unexplained intermittent, bizarre upper abdominal pain was found to have a freely movable right lobe of the liver that was attached only to the inferior vena cava. When this lobe was intermittently displaced into the left upper abdomen, volvuli of both the stomach and transverse colon developed. Stretching and tension of the common bile duct on the round ligament resulted in intermittent jaundice. At operation, these findings were confirmed, and the right liver lobe was secured to the diaphragm in its normal position. In addition, the mesenteric attachments of the liver, stomach, and colon were plicated. The patient has had complete relief of all symptoms for the two years since his operation.


Metallic foreign bodies in the stomach.

Metallic foreign bodies in the stomach. We present a case of a patient who ingested 648 metallic objects that formed an intertwining mass within the stomach, requiring operative removal. Of interest was the absence of symptoms and complications after 11 years of continual ingestion. To our knowledge, this is the second heaviest accumulation of metallic foreign objects removed from the stomach of a living patient.


Bypass enteritis or obstructive volvulus? In a consecutive series of 40 Scott-type jejunoileal shunts for morbid obesity, only two patients had the bypassed bowel drained end-to-side into the midsigmoid colon. In both of these patients, typical "bypass enteritis" as described by Passaro developed, but they were found to have volvulus at the sigmoid anastomosis. Both were cured by take-down of the anastomosis and reimplantation of the bypassed bowel into the transverse colon. No antibiotic treatment was found necessary. We suspect that obstruction of a mechanical nature plays a basic role in most, if not all, cases of "bypassed enteritis."


Immunological potency of a subunit influenza vaccine in adults. The immunological potency of a subunit influenza vaccine (from A/England/42/72 virus) and of two commercial whole-virus vaccines (containing either A/England/42/72 or A/Hong Kong/68 virus) was studied in adults in an industrial plant. Serum samples were taken in vaccinated and control non-vaccinated subjects prior to and three weeks and five months after the vaccination.  Most of the vaccinees developed high levels of hamagglutination inhibiting antibodies against all the type A influenza viruses employed in the test; these antigens included a new strain (A/Dunedin/73) that had not previously circulated in Czechoslovakia. The antibody response after the subunit vaccine was somewhat better than after the whole-virus vaccines administration. The whole-virus vaccine from the A/England/42/72 virus was more efficient in inducing antibody response against the more recent isolates than the A/Hong Kong/68 virus vaccine.


Maturation defect of a temperature-sensitive mutant of western equine encephalitis virus. The defective step of a temperature-sensitive mutant of western equine encephalitis virus, which synthesize viral RNA but not mature virus at the restrictive temperature, was studied. Cells infected with the mutant virus at the restrictive temperature synthesized the same intracellular viral RNA as that in wild type infection. Cells infected with the mutant at the restrictive temperature formed three proteins (E1, E2 and C) which migrated to positions identical with those of purified virions and a precursor protein of E2 (PE2). The mutant virus was also able to form cytoplasmic nucleocapsids sedimenting at 140S as in the case of wild type infection. On the other hand, cells infected with the mutant could not induce a significant amount of hemadsorbing ability and the ability induced at the permissive temperature disappeared immediately after shifting up to the restrictive temperature. These results suggested that the mutant virus produced a defective envelope protein responsible for hemagglutination at the restrictive temperature. Owing to the incompleteness of the modification of the cell plasma membrane by the envelope proteins, viral nucleocapsids in the mutant infected cells could not bind to the plasma membrane.


Hamster brain tumor cells persistently infected with measles-subacute sclerosing panencephalitis virus. A persistent infection was established in a cell line derived from a hamster brain tumor (HBT) with the HBS strain of measles-subacute sclerosing panencephalitis (SSPE) virus. The persistently infected cells (HBT-M) were studied with regard to their growth in vitro and their transplantability in vivo. Although the growth of the HBT-M cells paralleled that of the HBT cells in vitro their transplantability was decreased in weanling hamsters. Hydrocortisone treatment of the hamsters abrogated the lowered transplantability restoring the tumor-producing capacity to levels comparable to the HBT cells. The decreased cell growth of the HBT-M cells in vivo was attributed to the acquisition of measles virus (MV) antigens and the host immune response directed against these new antigens.


[Autoradiographic study of mesothelial proliferation in white mice under experimental conditions]. The proliferative activity (mitotic cycle, proliferative pool) of the mesothelium of the parietal peritoneum of white mice acted upon by distilled water was studied autoradiographically with H3-thymidine. The mesothelium regenerated due to high mitotic activity and increased amount of polynuclear cells. The latter are formed as a result of amitotic and mitotic division of the nucleus without plasmotomy. The distribution of cells at the stage of DNA synthesis and mitosis in all the parietal peritoneum speaks of the absence of special proliferation zones.


[Histochemical characteristics of the epithelial secretions of the avian muscular stomach]. The work was devoted to a histochemical studying of the covering lamina and other epithelial secretions of the avian muscular stomach. It has been shown that in its histochemical properties the secreted mucin is similar to mucous secretions of the enterodermal lining of the mammalian stomach and contains neutral polysaccharides, sulfo- and slilosaccharides. The protein component is represented by aminoacid residues of lysin, cystine, cystein. Formation of the mechanically firm structure--lamina is based on the substances of carbohydrate--protein nature secreted by the epithelial lining of the stomach.


[Interaction of fibers from the retina and visual region of the cortex in several subcortical visual formations of rats]. The medial nucleus of the optic tract, the ventral lateral geniculate nucleus and the superior colliculus have been studied using the light (Nissl, Golgi, Viktorov) and electron microscopic methods in normal rats and in rats which survived for different periods after enucleation or occipital cortical lesions. Data were obtained on differences in terminal patterns of the afferent pathways. The study of the neuronal and synaptic organization of subcortical visual centers showed the distinctions and correlation between the complexity of neuronal and synaptic organization. Three types of interrelations between the optic and cortical pathways on the efferent neurons of the investigated structures are suggested.


[Morphologic changes in synapses following conduction block in a medium of diminished ionic strength]. The moment of the conduction block was determined in the 10th sympathetic ganglion of the frog with the help of electrophysiological control of the total synaptic activity. After supravital staining with methylene blue the morphology of the synaptic pericellular apparatus was studied. It has been shown that most of synapses are in the intermediate phase (after Majorov) and have swollen, loosing their dye synaptic bouttons against the background of non-stained bodies of nerve cells. A supposition is made that due to the presence of single synapses with less pronounced changes under complete block of conducting it can not be excluded that the block may develop in the transition of the synapse from the phase of stained pericellular apparatus into an intermediate phase.


[Morphologic changes in the internal organs and blood under conditions of disrupted lymph flow]. The histological study has shown that under conditions of the disturbed lymph outflow along the thoracic duct the intraorganic architecture of the vascular system of kidneys, liver, heart, lungs and pancreas undergoes reorganization and in the parenchyma and stroma of the organs there appear morphological changes. The intraorganic lymphatic and venous vessels were sharply dilated and considerable oedema of the perivascular connective tissue developed. Then, due to congestion of the lymph the interalveolar septa of the lung and the hepatic connective tissue fibres became hoarse and denser. In the heart and kidneys the protein dystrophy was mildly pronounced. The investigation of blood has demonstrated lymphocytopenia. The urea contained 1% of sugar.


[Sequential demonstration of nucleic acids and protein fractions in the same cells]. Some combinations are suggested to reveal cell components in the following sequence: 1) RNA--DNA--total proteins; 2) RNA--DNA--histones; 3) RNA--DNA--histones--total proteins; 4) RNA--DNA--acidic proteins. RNA is stained with pyronin Y (in the mixture with methyl green). DNA--by the Feulgen procedure (with TCA hydrolysis), histones and total proteins--by Alfert--Geschwind's method and acidic proteins--according to the technique of Smetana and Bush. The details of the whole procedure, adopted for formol-fixed smears are described.


[Morphologic changes in the myocardium outside the zone of an experimental infarct]. By means of histological and electron-microscopic methods of investigation it was established that in the areas of the myocardium remote from the zone of the ligated coronary artery at early periods of the experiment there were noted impairment of the circulation and also dystrophic and necrobiotic changes in myocytes. Therefore the extra-infarction regions of the myocardium may not be considered as intact. An important role in the development of changes in the contractile elements of the myocardium was played by impairment of the circulation in the areas of the cardiac muscle remote from infarction, their acute functional overloading and also activation of the sympathoadrenal system.


[Menetrier's disease associated with a rectal polyp]. A rare case of concomitance of Menetrier's disease and malignant polyp of the rectum in a 53-year old man is described. Histological and histochemical investigations of the polyp and the gastric mucosa showed that the latter was characterized by pronounced hypertrophy with the presence of numerous cysts of different sizes. In malignant areas of the polyp the slackening of Schick's test and activity of some enzymes were observed. The assumption was put forward that morphogenesis of such proliferation is based on similar disregenerative processes, despite different morphological manifestations of these processes depending on their localization.


Neuroepidemiology. Incidents, incidence, and coincidence. Neuroepidemiology is concerned with the study of incidents of neurological disease occurring in a community. It deals with the distribution and dynamics of neurological disease in human populations and the factors that affect these patterns. To estimate the magnitude of the disease burden in the population, the neuroepidemiologist calculates indices of disease, such as mortality, prevalence, and incidence. In studying factors associated with disease, the investigator must establish whether the relationship (1) is artifactual, (2) appears to be the result of a chance occurrence or coincidence, and (3) has any biologic significance. The clinical neurologist is the central figure in neuroepidemiologic investigations. The greater the accuracy and completeness of the neurologist's information, the better the quality of neuroepidemiologic studies based on these data.


Catecholamine-induced muscle weakness.

Catecholamine-induced muscle weakness. Infusions of epinephrine or levarterenol bitartrate into a rabbit nerve-muscle preparation decreased the force of the evoked twitch of anterior tibial and gastrocnemius-soleus muscles. The adverse effect of the catecholamines was not directly on skeletal muscle. The alpha-receptor blocking drug phenoxybenzamine hydrochloride prevented the adverse effect of the catecholamines if it was given prior to catecholamine infusions and unmasked a weak augmentation of twitch tension. Taken with the finding of abnormal accumulation of catecholamine in human dystrophic muscles, the production of an experimental myopathy resembling human dystrophy by the monoamine oxidase inhibitor pargyline hydrochloride, and the finding of excessive levels of catecholamines in the tissues and urine of dystrophic animals, these experiments support the hypothesis that catecholamines could play a pathogenetic role in some dystrophic diseases of muscle.


The cellular pathology of neuronal ceroid-lipofuscinosis. A golgi-electronmicroscopic study. A cerebral biopsy specimen from a 4-year-old girl with a moderately advanced stage of the late infantile form of neuronal ceroid-lipofuscinosis was observed in routine cell and fiber stains and in Golgi and electronmicroscopic preparations. There was no evidence of neuronal degeneration or loss. Golgi impregnations identified a fusiform enlargement of proximal axon segments of most pyramidal neurons and some polymorphic neurons but not of other cortical neuronal classes. Typical curvilinear inclusions were found in all cells and appeared to be impacted within the dilated proximal axon segments of pyramidal neurons. The numbers of type II synapses on the axon hillock and dilated proximal axon segments of pyramidal neurons were much reduced, whereas type I synapses remained abundant in the neuropil.


Transient global amnesia due to a dominant hemisphere tumor. Transient global amnesia is generally regarded as a benign syndrome of probable vascular etiology. We describe a man who experienced a single episode of transient global amnesia and subsequently developed a progressive dominant hemispheric syndrome. Neuroradiologic investigations and the patient's subsequent death strongly suggest that his disease was due to a left temporal-parietal mass lesion. Although the syndrome is most often benign, such patients should be examined for mass lesions.


IgE studies on respiratory tract allergies. The IgE content was determined and specific IgE antibodies were identified in serum samples and nasal secretions of 40 control subjects, 103 patients with nasal allergy, and 37 patients with bronchial asthma using a radioimmunosorbent test an both the serum samples and nasal secretions of allergic patients. Approximately 70% of the serum samples and nasal secretions obtained from patients with positive house dust skin test results were found to contain specific IgE antibodies to mites. The results of this study proved the usefulness of the determination of IgE and specific IgE antibodies in the diagnosis and study of the pathogenesis of respiratory tract allergies. The IgE in nasal secretions was much more closely related to pathogenesis of respiratory allergies than was IgE in serum samples. However, unless more concentrated nasal secretions are assayed, the diagnostic value is limited.


A reevaluation of the Frey syndrome following parotid surgery. The Frey syndrome, or gustatory sweating, is an accepted complication of parotid gland surgery that may occur with varying degrees of secerity. Since misdirection of auriculotemporal secretomotor nerve fibers has been found to play an important role in the development of the syndrome, a study was initiated to attempt mechanical interference with the regenerating fibers of the nerve. A superiorly based muscle flap from the sternocleidomastoid muscle was developed to cover the operative wound after either partial or complete parotidectomy. Results in 35 patients with such a muscle flap were compared with those in 35 control patients for the presence of absence of the Frey syndrome; the muscle flap was shown to be ineffective in preventing occurrence of gustatory sweating. Moreover, gustatory sweating to varying degrees was present in 34 patients with the muscle flap and in 33 control patients. Also, only 23 of the 70 patients had subjective complaints related to the syndrome, none of whom was incapacitated ore required additional measures for care.


Endolymphatic sac surgery for hearing conservation in Meniere disease. Thirty-five patients with Meniere disease underwent endolymphatic sac decompression and drainage with a Silastic sac-mastoid shunt. On the basis of patients' responses to a questionnaire and on analysis of preoperative and postoperative audiometric studies, we found the method to be an effective means for conservation or improvement of hearing and for relief of vertigo in patients with positive glycerol tests. Of the 35 patients, eight had negative glycerol tests and did not benefit from surgery (P less than .001). Of the 27 patients with positive glycerol tests, 70.4% (19) had no further vertigo, and 18,5% (5) had decreased frequency or severity of attacks (an overall relief of vertigo in 88.9%). Hearing was improved in 16 (59.2%) and stabilized in five (18.5%). Subjectively, 85.2% (23/35) of the patients were satisfied with the hearing results of their operation.


Anaerobic bacteria in chronic otitis media. The bacteriology of 70 consecutive cases of active chronic otitis media was studied. Using appropriate technology, anaerobic bacteria were recovered in 33%, Bacteroides species accounting for one half of them. They were always found in mixed infections involving the average of 3.8 bacteria, 1.9 anaerobic, and 1.9 facultative species. The bacteriology was relatively stable from one ear to the other in the ten bilateral cases studied. The results were alike in the groups differing with respect to local antimicrobial therapy or appearance of the middle ear discharge. The cases with chronic otitis in spite of previous radical surgery presented more often with anaerobic infection than the unoperated ones, and none of them yielded sterile cultures. The recognition of anerobic middle ear infections may be clinically significant because the susceptibilities of the organisms to antimicrobial agents and to air are characteristically different from those of aerobic or facultative bacteria.


Surgery and histopathology of the stapes in osteogenesis imperfecta tarda. Fourteen stapedectomies were performed on ten patients with osteogenesis imperfecta tarda. Clinically, the footplates were softer and more tenuously fixed than in otosclerosis and floating footplates seemed more common. Stapes and stapes fragments from all 14 operations were examined microscopically. The histopathology of osteogenesis imperfecta was contrasted to that of otosclerosis. We believe that the greater degree of structural disorganization and greater area occupied by resorption spaces clearly distinguish the new bone formed in osteogenesis imperfecta from otosclerosis.


Massive neuraxial spread of aural rhabdomyosarcoma. An embryonal rhabdomyosarcoma that initially was seen as a polyp in the external auditory canal underwent uncontrollable direct extension along the facial nerve through the internal auditory meatus, with encasement of the base of the brain and entire spinal cord despite radical surgery, supervoltage irradiation, and multidrug chemotherapy. This degree of massive neuraxial spread without systemic metastases appears to be unique.


Tuberculin sensitivity of cattle inoculated with atypical mycobacteria isolated from cattle, feral pigs and trought water. Each of 12 cattle was inoculated either subcutaneously and intradermally or into a mesenteric lymph node with 1 of 8 species of liver atypical mycobacteria isolated from cattle, cattle trough water and feral pigs. Seventy-eight days after inoculation the cattle were tuberculin tested with bovine PPD, avian PPD and homologous heat-concentrated syntheic medium tuberculins. They were killed 85 days after inoculation. Organisms were cultured from caseous granulomas at all sites in cattle inoculated with M. avium serotype 2. M. simiae was recovered from a granuloma at the subcutaneous site. Acid-fast bacilli were isolated from the mesenteric lymph node inoculated with trough water organisms. At 72 h, all the cattle had produced skin reactions of 4 mm or more to the homologous tuberculins and all except 1 produced a similar response to avian PPD. Only isolates of bovine origin sensitised cattle to bovine PPD to this degree, and these reactions were less than the corresponding response to avian PPD.


Synchronisation of oestrus in beef cattle artificial breeding programs using prostaglandin F2alpha. PGF2alpha either as a subcutaneous injection (8 or 10mg) or intrauterine infusion (dose 5 mg) successfully synchronised oestrus in beef cattle AI programs. The beef cattle programs were managed by 1 of the following 2 systems. 1. Two 10-day insemination periods, 1 for the first and the second for the repeat inseminations. Oestrus was detected and oestrus cows inseminated for the first 4 days of the first period. On the fifth day all cows not inseminated were treated with PGF2alpha. The treated cattle came into oestrus and were inseminated over the following 2 to 5 days. 2. Two PGF2alpha treatments 10 days appart followed by two 4-day insemination perids. During the first 4-day period, cows exhibiting synchronised oestrus were inseminated. Cows returning to oestrus were inseminated during the second 4-day period, about 18 days after the first, period. Synchronisation of oestrus was not sharp, oestrus being distributed over 7 days, with the majority of cows being in oestrus on the third (42.3%) and fourth (22.4%) days. The route of administration of PGF2alpha (injection or infusion) did not effect oestrus synchronisation. PGF2alpha by either route of administration did not effect the fertility of cows inseminated at either the synchronised or subsequent oestrus. Pregnancy rates at the synchronised oestrus were higher when cows were inseminated after dectection of oestrus than when they were inseminated without reference to oestrus at a fixed time 3 days after PGF2alpha treatment (mass injection). Oestrus synchronisation greatly reduced the input of time, labour and feed required during the total program. However, oestrus synchronisation did not alter the overall efficiency of artificial breeding programs measured in terms of the proportion of cattle entering a program that were inseminated and became pregnant. The main problem encountered was drug wastage through unknowingly treating cows and heifers that were not cycling.


Some causes of wastage in beef cattle artificial breeding. Causes of reproductive loss in beef cattle AI programs were inadequate oestrus detection, use of vasectomised bulls, reduced inseminator efficiency, inadequate nutrition and infectious reproductive diseases (vibriosis and IPV). Nine case histories were presented detailing the symptoms and diagnosis of low reproductive performance.


Studies on heat output from the hand of frostbite subjects. We studied 12 subjects, who had suffered first- to third-degree frostbite at high altitude during winter, at Delhi, India. At normal sea level pressure there (PB 740 mm Hg) and in a decompression chamber at a simulated altitude of 4085 m, the studies were at both 26 degrees C and 6.8 degrees C. A group of control (non-frostbite) subjects of comparable age were also studied for their heat output at 26 degrees C, PB 740 mm Hg. Heat output from the hands of a group of mountaineers from the sea level was also studied at 2121 m at 25 degrees C and 4485 m at 7 degrees C. The results indicated that the frostbite subjects had a significantly higher heat ouput at PB 740 mm Hg and 26 degrees C than the non-frostbite subjects. When the former were tested at sea level (PB 740 mm Hg) at 6.8 degrees C, the hand heat output showed a marked and significant decrease. On testing them at a simulated altitude of 4085 m at 26 degrees C and at 6.8 degrees C, a very highly significant reduction in hand heat output was observed compared to their initial value at sea level (740 mm Hg) and 26 degrees C. Their hand heat output also showed a very highly significant decrease compared to mountaineers at 4485 m and 7 degrees C.


Microvascular pressure responses of second-generation rats chronically exposed to 2 G centrifugation. The purpose of thses studies was to compare systemic arterial and microvascular pressures in the second generation of rats reared in a 2-G centrifuge with pressure data from animals subjected to 1 G centrifugation. Systemic arterial pressures were measured in anesthetized animals via carotid catheters and microvascular pressures were measured in mesenteric arterioles by a micropipette servo-null system. Systemic arterial pressures in the 1-G and 2-G groups were not significantly different from each other, but both were considerably higher than those reported for normal rats. In the microcirculation, pressures in the terminal arterioles (20 to 35 micron) were significantly higher in the 2-G animals, but pressures at the level of the smaller (10 to 15 micron) precapillary arterioles were not significantly different between the two groups. The pressure responses to intravenous infusion of norepinephrine were also compared in the two groups and found to be significantly less in the 2-G animals. It is concluded that both 1 G and 2 G chronic centrifugation will elevate arterial blood pressure, and that 2 G, of itself, will affect the pressure distribution in the microcirculation as well as attenuate the pressor effects of norepinephrine.


Noninvasive determination of cardiac output by a modified acetylene rebreathing procedure utilizing mass spectrometer measurements. A modified acetylene rebreathing technique for measuring cardiac output has been developed utilizing a mass spectrometer for measuring gas concentrations. Helium serves as an indicator of mixing and system volume. The disappearance rate of acetylene is proportional to pulmonary capillary blood flow, which is taken as an index of cardiac output. The method also provides an estimate of pulmonary tissue volume. The technique was assessed by comparing 22 simultaneous acetylene and dye-dilution cardiac outputs measured at rest and during exercise in six healthy subjects. There was no significant difference between the mean acetylene and dye-dilution cardiac output values (11.5 l/min vs. 11.24 l/min, respectively). The correlation coefficient was 0.94 and the S.E.M. difference was 0.53 l. The effect of the procedure on cardiac output was evaluated in a separate study of six subjects. There was a significant positive correlation between respiratory rate and cardiac output; but the magnitude of this effect was small, indicating that accurate measurements may be made at spontaneous respiratory rates.


Athletic endurance training - advantage for space flight?: The significance of physical fitness for selection and training of spacelab crews. While intensive physical exercise has been part of the conditioning of astronauts and consmonauts for spaceflights, its benefits have been questioned. After reviewing the pertinent literature, it is concluded that the morphological and functional changes obtained with athletic endurance training are rather  specific and of no general advantage for the tolerance to space stresses. Particularly during gravitational loads, in the relaxed subject, these changes allow a more pronounced shift of fluid into the lower extremities, with the possible consequence of a reduced tolerance. This unfavourable response, obviously, is accentuated through immersion and weightlessness. The aerobic work capacity is also more impaired in athletes. Based on these conclusions, recommendations for crews and passengers of future Spacelab missions are given with respect to selection and pre-and in-flight physical exercise.