[Mechanics of breathing and exertion dyspnea in silicosis (author's transl)]. Mechanics of breathing as studied in patients with different stages of silicosis in rest and during exercise show the following: dynamic compliance and work against elastic and viscous resistances could not be found to be decisive indices of exertion dyspnea. Evidence of exertion dyspnea could only be achieved by means of the ration VT/PT (VT equals tidal volume, PT equals tidal esophageal pressure). Exertion dyspnea was observed at less than 0,081 VT per cm H20 PT. In accordance with Campbell and Howell, dyspnea is seen as an inappropriateness between ventilation and pressure needed.


[Statistical study on correlations between spirometric data and arterial blood gas tensions. I. Under testing conditions]. Spirometric data, resting Pao2 and Paco2 have been statistically evaluated in 152 patients with chronic obstructive bronchitis. Spirographic studies show a restrictive and obstructive syndrome, associated with hypoxaemia and hypercapnia. Partial correlations show that Pao2 is positively correlated with age and negatively with VC (predicted percentage) and with FEV1 (predicted percentage); Paco2 is only correlated with FEV1 (predicted percentage). FEV1 (predicted percentage) divides the patients into two groups, the hypercapnic and normocapnic. These data show the interest of the FEV1 (predicted percentage) values.


Respiratory function in esophageal hiatus hernia. I. Spirometry, gas distribution, and arterial blood gases. As a part of a preoperative investigation, spirometry and blood gas tensions were studied in 64 subjects with X-ray-verified hiatus hernia (34 sliding, 22 mixed, and 8 of paraesophageal variety). According to the transverse diameter of the hernia. They were divided into 3 groups, small (2-5.9 cm), medium (6-9.9 cm), and large (10-17 cm) hernias. No correlation between the size of the hernia, reflux incidence, and spirometric findings could be demonstrated. A significant reduction of the arterial oxygen tension was found in small hernias and in vital capacity and maximal voluntary ventilation (MVV) in medium-sized hernias. Significant reduction in MVV was noted in the large hernia group. A common spirometric finding in all groups was a significant increase in residual volume and wash-out volume. The incidence of restrictive or obstructive pulmonary impairment was high in large (39%) and small (32%) hernias and relatively low in medium-sized hernias (8%). Roentgenological fibrosis was not found in any of the patients, while 4 showed emphysematous changes.


Bronchial lability in children suffering from some diseases of the bronchi. The authors studied bronchial reactivity in children with cystic fibrosis and with deformative bronchitis. The reaction of the bronchi was studied both by inhalatory and exercise provocation. Inhalatory tests were monitored by means of a whole body plethysmograph. Free-range run was used for the exercise test, and the peak expiratory flow rate was measured. The described technique of inhalatory tests was accurate, safe, and not tiring for the patient. No distinct difference in bronchial reaction between the two groups of patients could be stated. The bronchial reaction to the inhalatory and exercise tests was stronger in both groups than in normals but not as strong as in asthmatics. The nature of bronchial hyperreactivity in those patients is still unknown. The inhalatory test seems to be more sensitive than the exercise test in detecting that hyperreactivity.


Functional evaluation of a corticosteroid molecule activity, dexamethasone-isonicotinate, by aerosol dosage in obstructive lung disease. The authors experimented with a corticosteroid molecule, dexamethasone-isonicotinate, by pressurized aerosol, testing it on 15 subjects suffering from a bronchial obstructive syndrome (7 cases of asthmatic bronchitis, 6 of chronic bronchitis with pulmonary emphysema, 2 of bronchial asthma). In such patients clinical evolution, spirographic patterns, and airway resistance were studied by means of body plethysmograph before and after administration of 0.25 mg dexamethasone-isonicotinate four times a day. In four subjects daily variations of airway resistance before and after 10 days of treatment were evaluated: in three cases the resistance diminished noticeably at all times of the day after therapy. In eleven cases the functional parameters were recorded before and after 7 days therapy, and ten subjects were followed up by a monthly, check during 6 months of therapy. In both methods, the authors obtained good or very good results in more than half of the subjects and fair results in a fifth of the subjects; in the remaining patients poor results were obtained. Side-effects attributed to improper dosage were never observed.


Influence of tuberculin on ventilatory parameters in patients with chronic bronchitis. The influence of tuberculin administered in aerosol on the ventilatory parameters in patients suffering from chronic bronchitis has been studied. The diameter of the tuberculin skin reaction 1 day after inhalation of tuberculin was found to be related to a decrease in maximal 1-sec forced expiratory volume and maximal midexpiratory flow-rate. Significant decrease in the parameters of dynamic pulmonary ventilation occurred only in a certain proportion (24.6%) of tuberculin-positive patients suffering from chronic bronchitis of the obstructive type.


Crescent sign in pulmonary hematoma.

Crescent sign in pulmonary hematoma. The pathophysiology of pulmonary hematoma is discussed. The presence of the air-crescent sign in a coin lesion is nonspecific; however, it may direct the attention of the physician to consider a traumatic etiology.


Interspecific competition: a new approach to the classical theory. The biological consequences of the classical theory of competition are shown to be at least partly a function of a very special way of interpreting particular constants in simple equations. Ii is shown how altered consequences may be obtained by different, but equally plausible, interpretations of those constants.


Thyroid allograft immunogenicity is reduced after a period in organ culture. The survival time of mouse thyroid, transplanted under the kidney capsule of an H-2 incompatible recipient, is extended by holding the thyroid in organ culture for 12 days prior to transplantation.


Nuclear magnetic resonance of rotational mobility of mouse hemoglobin labeled with (2-13C)histidine. Carbon-13 nuclear magnetic resonance studies were made on mouse hemoglobin specifically labeled at the C-2 histidine position. Measurement of the spin lattice relaxation times of the label before and after hemolysis of the erythrocytes provides information on the intracellular fluid viscosities.


Inhibition of immune responses in vitro by specific antiserums to Ia antigens. Mouse antiserums prepared against Ia antigens, which are products of I (immune response) region genes of the H-2 complex, can inhibit both primary (immunoglobulin M) and secondary (immunoglobulin G) immune responses in vitro by mouse spleen cultures to heterologous erythrocytes. Antiserums directed specifically at products of either the H-2K or H-2D loci have no effect on this response.


Development of specific sensory-evoked synaptic networks in fetal mouse cord-brainstem cultures. Neurites of nerve growth factor-enhanced fetal mouse dorsal root ganglion cells can not only establish characteristic sensory synaptic network functions in dorsal regions of attached spinal cord explants, but some of the neurites may grow through the cord tissue in these cultures and make similar functional synaptic connections with specific types of "target" neurons in localized zones within nearby medulla explants.


Vaterite: a mineralization product of the hard tissues of a marine organism (Ascidiacea). X-ray diffraction and infrared absorption spectra show that the spicules of the common tropical ascidian, Herdmania momus, are mineralized with vaterite. These are the first strictly marine organisms known to normally precipitate vaterite. The biomineralization of vaterite may constitute another link between the urochordates and vertebrates. The vaterite of ascidian spicules immersed in natural seawater remains mineralogically unchanged for 1 year, which indicates that vaterite may be preserved transiently in marine sediments.


Luminous and chromatic flickering patterns have opposite effects. When stimulated in phase by a sinusoidally flickering, uniform field, the red and green cone systems tend to inhibit each other. This inhibition is minimized by (i) counterphase (luminance) patterns or (ii) red/green (chromaticity) flicker. However, when (i) and (ii) are combined, the usual flickering-pattern effect is reversed: instead of enhancing chromatic flicker, counterphase patterns tend to suppress it.


Partition of gross peripheral nerve activity into single unit responses by correlation techniques. The neural activity in the medial articular nerve is partitioned on the basis of conduction velocity by correlation techniques. Because of the small number of cat knee joint units (two to ten) responding under a prescribed set of rotational conditions, it is possible to partition and simultaneously study the units' responses to periodic joint articulation waveforms.


Studies of the erythron.

Studies of the erythron. Radionuclide studies of the erythron are valuable to the physician in evaluating the clinical situation in a wide variety of hematologic disorders. A complete and accurate analysis of the life cycle of the red cell can be obtained with a full iron kinetic study, in conjunction with a DF32P red-cell survival study. However, a complete iron kinetic study is not always necessary. It may be abbreviated by deleting the in vitro phase of the iron kinetic procedure. The abbreviated iron kinetic study is also done in conjunction with a DF32P red-cell survival study. It can easily be performed by injecting 59Fe-labeled plasma and monitoring externally over the spleen, liver, and sacrum. Measurements of red-cell survival may be obtained with either 51Cr or DF32P. Although 51Cr provides a relatively uniform label of circulating red cells and is convenient to count in vitro, its highly variable elution rate precludes an accurate measurement of erythrocyte survival. The 51Cr method provides only a rough index of circulating red-cell half-times as a measure of red-cell survival. DF32P, HOWEVER, IS A PERMANENT LABEL OF CIRCULATING RED CELLS. It provides a direct measurement of erythrocyte survival and permits in vivo labeling of red cells simply by means of direct intravenous injection. Because it has an elution rate that is virtually zero after minimal elution on the day of injection, and because it is not reutilized, DF32P is unquestionably the best agent known for the determination of red-cell survival. In addition to these diagnostic data, the complete iron kinetic study can provide data on the deposition of iron in storage and the rate of iron storage exchange. It can also determine if erythropoiesis is quantitatively abnormal and if the abnormality is located in the bone marrow or in other organs such as the liver or spleen. Although the study of hematologic disorders is one of the most rapidly developing areas of medical research, techniques that are currently available can provide an understanding of the life cycle of the red cell and valuable data that can be applied directly to the clinical situation. When performed accurately, these studies provide a thorough analysis of the pathophysiology of the erythron and are valuable clinical tools that can be used successfully in the diagnosis and evaluation of a broad spectrum of hematological disorders.


Technical considerations in labeling of blood elements. The technical difficulties of labeling albumin, red blood cells, white blood cells, and platelets are discussed with respect to the effect of procedual differences on the in vivo fate of the radiolabeled blood element. Albumin can be labeled with 99mTc by a variety of procedures that have not been proved clinically. The labeling of erythrocytes with 51Cr is well defined, but the demand for a better radionuclide has not led to a routine procedure for 99mTc-labeled red blood cells. The procedure for labeling white blood cells and platelets with 51Cr has been established, but the in vivo viability of the cells remains in question. Labeling techniques with other isotopes such as 67Ga and 99mTc are still being developed. Blood elements labeled with 51Cr are by far the best defined species, but much remains to be done with isotopes having better physical properties.


The spleen as a hematological organ.

The spleen as a hematological organ. The spleen has multiple roles in human physiology. Eitht major functions are discussed in this review (hematopoiesis, erythrocyte destruction, hormonal function in hematopoiesis, culling and pitting, platelet and leukocyte destruction, particulate removal, reservoir function, and immunologic function). Splenic trapping of red cells, and the concepts of hypersplenism, are major responsibilities of this organ. These aspects are placed in perspective for the reader.


Antimicrobial mechanisms in neutrophilic polymorphonuclear leukocytes. Microorganisms ingested by PMNs are exposed to a variety of antimicrobial systems. Together they comprise a formidable armamentarium, and few organisms survive. The predominant antimicrobial system would be expected to vary with the species, the availability of oxygen and the type of microorganism ingested. There is considerable evidence that the MPO-mediated antimicrobial system plays an important role in the destruction of certain microorganisms in most species; chicken heterophils, however, do not contain MPO,40 and some microorganisms are resistant to this system due to the nature of their cell wall material.146 Further, microbial catalase may offer some protection. The granulocytes of some species (e.g., rabbit, chicken) are rich in cationic proteins and these agents may play a particularly important role in these cells. Granular cationic proteins are less plentiful in human cells.111 Organisms vary in their susceptibility to lysozyme and this enzyme is absent from bovine leukocytes.113 It is probable that the total microbicidal potential of the leukocyte is in excess of its needs under most circumstances. This "overkill" capacity is a reflection of both the level of activity of individual systems and their variety. Particular organisms are susceptible to more than one antimicrobial system and thus may be effectively handled by back-up systems when one is absent. Thus, an organism normally killed by the peroxidase system may be handled less efficiently but adequately when MPO is absent by other oxygen-dependent antimicrobial systems. When a defect in oxidative metabolixm is present as in CGD, both MPO-catalyzed and nonenzymatic oxygen-dependent systems are absent. The ingested organism can, in some instances, supply the needed product of oxidative metabolism (i.e., H2O2); in other instances, oxygen-independent antimicrobial systems are adequate to prevent microbial growth. However, in yet other instances, the organisms survive and multiply and severe infection results.


Prurigo nodularis and uremia.

Prurigo nodularis and uremia. Patients with uremia frequently have generalized pruritus that is usually related to a disturbance of calcium and phosphorus metabolism. This report describes three patients with uremia who had prurigo nodularis due to localized scratching and rubbing. The diagnosis of uremia in one case was made when the patient was hospitalized for evaluation of skin lesions.


Vascular and adjacent soft tissue injuries associated with fractures of the pelvis. One hundred fifty-one patients with fractures of the pelvis and associated injuries have been reviewed. Patients who have these injuries are likely to have uncontrollable, fatal hemorrhage. Of this group, nine died, 11 had exploratory laparotomies, ten had bladder injuries, and two had rectal damage. Blood gas determinations, arterial catheterization, and pulmonary wedge pressure determinations are valuable in making and early diagnosis of pathologic changes resulting from internal hemorrhage.


Primary operative management: method of choice for stab wounds to the heart. Experiences in managing patients suffering cardiac stab wounds and coming to the University of Alabama Hospital in Birmingham from January 1964 to July 1972 are reviewed. From 1964 through July 1971, conservative management was used primarily, but most patients ultimately required operation. Analysis of our experiences during this period convinced us of the advisability of primary operative management for these patients, and since July 1971, primary operative management has been used. In the years from January 1964 to July 1972, 34 patients with cardiac stab wounds were treated at our hospital. Ten were managed conservatively with three deaths among this group. The remaining 24 received operative management either primarily or secondarily, and all of these patients survived. A patient managment program is outlined.


Cryosurgery in dermatologic office practice: special reference to dermatofibroma and mucous cyst of the lip. The use of liquid nitrogen therapy by spray, probe, and direct application in benign skin conditions is described. Most dermatofibromas do not require treatment, but for various reasons some are objectionable to the patient. Forty-five dermatofibromas were treated by cryospray, with five receiving a second treatment. Diagnosis was made clinically and confirmed in ten cases by shave biopsy of the elevated portion of the fibroma immediately after thawing. In all cases the resulting scar was minimal but sometimes hypopigmented. There was one depressed scar but no hypertrophic scars. Four mucous cysts of the lip were treated successfully by the cryoprobe without any visible or palpable scar. There was one recurrence. We know of no previous reports of cryosurgical treatment of mucous cysts of the lip.


Carcinoma of the parathyroid.

Carcinoma of the parathyroid. The histologic diagnosis of carcinoma of the parathyroid is difficult to make, and invasion of contiguous structures or metastasis must be present before the diagnosis can be established. The serum calcium level is usually high, and the tumor is palpable in approximately one half of the patients. A case of parathyroid carcinoma is presented in which the patient had a high serum calcium level, a palpable tumor with invasion of the thyroid gland and metastasis to a local lymph node. Treatment consists of en bloc resection of the tumor and, if possiblethe metastasis. Usually an ipsilateral neck dissection is indicated.


Managing depression in the '70s.

Managing depression in the '70s. Depression is among the most common of clinical conditions. Like problems such as anemia, it is not one disease, but a constellation of signs and symptoms which may occur as the result of several psychopatho-physiologic processes. This paper summarizes the recent dramatic advances in research into the neurochemistry of the major affective diseases, provides a conceptual way of viewing depressions, and summarizes current fundamentals of managment.


Villous tumors of the rectum: excision by the posterior approach. Villous tumors of the rectum require complete excision for accurate histologic diagnosis. The posterior rectotomy approach of Kraske is presented and described in detail as an excellent method for use in the surgical managment of these lesions. The technic is simple and postoperative morbidity minimal. The procedure is curative for benign lesions and does not interfere with further radical resection of malignant lesions.


The epidemiology of cancer in Oklahoma: examination of Cramer's hypothesis. Cancer epidemiology was studied from mortality data using age-specific and age-adjusted rates by sex and county of residence for 1956 to 1960 and 1961 to 1965. Geographic and time variations were examined as well as sex ratios and proportionate death rates. Age-adjusted rates for two time periods were used to examine Cramer's hypothesis which states that host susceptibility to cancer is predetermined and external factors determine the site of cancer occurrence. Elevation in total cancer mortality occurred in the urban northeast geographic area, reflecting perhaps the high rates for specific sites such as lung and cervix. Variations with time appeared for the different systems and the sex subgroups but not for total cancer. This finding is consistent with Cramer's hypothesis. Additional findings show an increase in susceptibility of men to cancer over women for most sites, and a proportionate death rate of about 33.4%, 23.2%, 16.1%, and 10.3% respectively for the gastrointestinal, reproductive, respiratory, and hematopoietic systems. Analysis of the data was limited to the white population.


Metastatic melanoma of the brain presenting as subarachnoid hemorrhage. Case reports of two patients with metastatic melanoma of the brain who presented with subarachnoid hemorrhage are described. The importance of considering metastatic melanoma to the brain in the differential diagnosis of subarachnoid hemorrhage is emphasized.


Leptospirosis: an underdiagnosed cause of acute febrile illness. Two cases of leptospirosis diagnosed at the Texas Medical Center in a two-week period are presented. Most cases of leptospirosis go undiagnosed because the symptoms and signs are nonspecific. Leptospirosis should enter the differential diagnosis when symptoms of influenzal illness, aseptic meningitis, and viral gastroenteritis occur, especially if abnormal hepatic and renal function are shown to be present. Many, but by no means all, patients will give history of exposure to livestock or rodents. Diagnosis is best made by serologic methods; Treatment is usually not required since the disease is self-limited, and even in the more severe form, antibiotics have not been conclusively shown to be of benefit.


Bromism: recent perspectives.

Bromism: recent perspectives. The introduction of bromureides on a large scale in England and Australia has resulted in a major health hazard. Attention is directed to this problem so preventive measures may be taken in this country to discourage their marketing. We recommend that physicians acquaint themselves with the active ingredients of over-the-counter sedatives and cough medications and that they consider the potential risks involved before prescribing bromides in organic combination. We maintain that bromism is not a relic of the past but rather a serious problem in some countries and a potential one in ours. In addition to reviewing the present status of bromide intoxication in the United States and abroad, we report an atypical case of possible bromide intoxication from a water supply in a rural area of the Midwest United States. Because of reports of bromide intoxication in rural areas, we speculate that some of these cases may be secondary to contaminated water supplies.


Postoperative hypoglycemia in congenital hypertrophic pyloric stenosis. One infant with congenital hypertrophic pyloric stenosis developed severe hypoglycemia with lethargy, irritability, cyanosis, and convulsions in the immediate postoperative period after Fredet-Ramstedt pyloromytomy. A likely hypothesis for this mechanism has been reported as hepatic glycogen depletion secondary to malnutrition. Any infant with malnutrition, from whatever cause, should be assumed to have glycogen depletion, and repletion should be started and continued with all intravenous fluids given during the preoperative period. Hypoglycemia should be suspected when an infant develops any unusual or unexplained symptoms or findings in the immediate postoperative period. Prompt and intensive treatment with intravenous hypertonic glucose infusion must be begun and continued until blood glucose determinations remain at a safe level with oral feedings alone.


A practical approach to the patient with vertigo: an outline of diagnosis and management for the nonspecialist. A careful history is the most important part of a medical examination for vertigo, especially to establish whether it is acute, chronic or recurrent. If the patient spontaneously volunteers ear complaints, such as fullness, tinnitus, or hearing loss, the cause is probably otologic and deserves immediate referral. If no otologic complaints are volunteered, the whole body becomes a source of investigation. All nonvital drugs should be withheld while the vertigo study is progressing. A complete physical examination and blood profile should be carried out. Roentgenograms of the skull and chest should be obtained. Accurate diagnosis and proper management are possible only with prolonged follow-up. Unnecessary expense, inconvenience, and discomfort for the patient can be avoided by a screening audiogram to identify unilateral hearing loss. All unilateral hearing loss should be investigated thoroughly in order to diagnose serious retrocochlear disease early.


Megaloblastic anemia in a vegetarian taking oral contraceptives. A case is reported of megaloblastic anemia resulting from folate deficiency in a vegetarian who had been taking oral contraceptives for eight years. A brief report of the pertinent literature is included,


Gram-negative bacillus pneumonia.

Gram-negative bacillus pneumonia. Our experience with gram-negativebacillus pneumonia (GNBP) was examined to assist us in the diagnosis and treatment of this serious condition. The patients were divided into three categories: those with primary GNBP, those with primary nosocomial GNBP, and those with superinfection GNBP. Mortality correlated highly with the severity of underlying disorders. Aspiration occurred or was suspected before most instances of primary GNBP. Tracheostomy, inhalation therapy, and aspiration were common events before development of primary nosocomial GNBP and superinfection GNBP. Half the patients survived the two primary varieties of GNBP. A striking leukocytosis developed at the onset of most cases of primary nosocomial GNBP and superinfection GNBP.


Massive orbital invasion by small malignant lesions. In diagnosing and treating small malignant lesions of the eyelids, physicians should be alert for possible extension of the cancer into the orbit, endangering not only the patient's sight but his life as well. Important signs and symptoms include bone thickening, disturbances of ocular motility, intermittent epiphora, and positive results of radiologic studies. From histopathologic study of the resected carcinomatous tissues, it is apparent that the creeping, cicatrizing, ulcerated, and invasive patterns of basal cell carcinoma predominate in this group of eyelid tumors, all of which are aggressive lesions; however, the histologic type is quite variable and no definite trends can be established.


Guidelines for blood pressure mass screening projects. Community-wide blood pressure screening is one of many methods of detecting unknown or inadequately treated hypertension. The first mass blood pressure screeing in a major metropolitan area was conducted in New Orleans on Aril 28 and 29, 1973. The 43 public and parochial schools were used as screening sites. Medical volunteers screened 30,329 individuals, 8,953 of whom were referred to their physician for treatment of high blood pressure. This project has shown that with adequate volunteers and publicity, mass screening is feasible and may be the only realistic method of reaching the numerous undetected hypertensives. An added bonus has been the spin-off in public awareness of the problem and its sequelae. A follow-up program for those individuals referred for further evaluation is strongly recommended. Guidelines and suggestions for mass screeings are described for use by medical groups or agencies. The blood pressure data are studied in relation to demographic data to facilitate comprehension of the problem on a larger scale.


Manpower and the future role of otolaryngology. Much discussion has taken place in the past three years in the media and in Congress concerning the delivery of health care in the United States. Our concern is to supply manpower to deliver adequate health care, to train enough new specialists, and to encourage needed research. There is presently a debate among otolaryngologists as to the scope of their specialty. Some believe that family practitioners should receive some training in this specialty, be certified by our Board, and act as the primary otolaryngologists. The need for fully trained otolaryngologists would then be reduced radically. Otolaryngologists could be concentrated in the medical centers, where they would act as tertiary physicians. Others believe that better quality care would be delivered by fully trained otolaryngologists, and that many otolaryngologists prefer to be primary and secondary physicians. This debate must be settled quickly in order to plan our manpower pool for the future. Decisions involving future manpower needs in our specialty must be made by the otolaryngologists.


Congenital posterior angulation of tibia and fibula. Congenital posterior angulation of the tibia occurs less frequently than congenital anterior bowing. Concomitant deformities of the foot and contractures of the soft tissue usually exist. A review of the literature indicates that nonoperative treatment is usually successful in correcting the deformity. Tibial growth is frequently less than normal and epiphysiodesis of the opposite extermity may be necessary. Three patients are presented who have been followed up for 17 years, two years, and over one year. Improvement is occurring with nonoperative treatment.


Carcinoma in situ of the gallbladder: A dilemma. The prognosis for advanced carcinoma of the gallbladder is grave, but a reappraisal of the histologic and gross presentation of the disease may uncover a group of patients with significantly better prognosis. During any cholecystedtomy, the gallbladder should be opened by the surgeon and frozen sections should be obtained for suspicious lesions. Carcinoma in situ appears to be well treated by cholecstectomy alone. Microinvasive carcinomas of the gallbladder require wider surgical excision


Loss of transferase enzyme activity of transfused erythrocytes in galactosemia. Rapid loss of erythrocyte galactose-1-phosphate uridyl transferase in hemolysates from an infant 26 days after transfusion led to investigation of the possiblity of an unstable enzyme or other variant of galactosemia. However, the child was found to have the classic type of galactosemia. The seeming transferase instability was attributable to loss of enzyme activity in hemolysates from blood containg aged, transfused cells, the source of the enzyme. Thus when transfusion is necessary, transferase assay for diagnosis of the enzyme deficiency before transfusion avoids confusion attributable to the enzyme supplied in the transfused cells.


Carotid artery injury produced by blunt neck trauma. Three patients with extracranial carotid artery injury are presented. The trauma to the neck was blunt and nonpenetrating. Two patients showed the progressive neurologic signs of an intracranial lesion three and seven days respectively after head injuries. Injury to the neck did not appear to be a factor in one and, at most, a minor factor in the other. The provisional diagnostic impression in each instance was subdural hematoma. The third case was found in a patient with brain contusion, fractured mandible, and severe neck contusion, who was investigated by contrast study when he failed to respond. All three patients showed compromise of the lumen of an extracranial internal carotid artery on arteriography and on exploration. Two reacted promptly and well to surgical intervention. The third recovered slowly from the brain contusion, but we believe that additional complications were averted by appropriate intervention.


Aspirin allergy: a clinical study.

Aspirin allergy: a clinical study. The following beliefs about aspirin sensitivity are widely held: (1) it usually is accompanied by nasal polyps. (2) It occurs primarily in nonallergic patients. (3) Its most common manifestation is asthma. (4) When it is combined with polyps and asthma (the so-called "aspirin triad"), the prognosis is unfavorable. (5) Polypectomy may precipitate asthma in aspirin sensitive patients. This paper, based on a study of 112 private patients, presents clinical evidence to refute these beliefs. It shows the following: (1) Aspirin allergy is accompanied by polyps in less than 5% of cases (13% of asthma patients). (2) In most cases, patients show well-defined allergy to an inhalant, food, or other drug. (3) Its most common manifestations are urticaria and angiodema, not asthma. (4) The prognosis is favorable, whether or not polyps are present. (5) Polypectomy does not precipitate asthma in aspirin-sensitive patients.


The management of organophosphate intoxication. This review attempts to reiterate the problem of organophosphate intoxication and the pathophysiologic problems created by these compounds. A discussion of management is included. The case reported of a two-year old child serves to illustrate the tremendously high doses of atropine which may be required to block the acetylcholine accumulated at cholinergic synapses as a result of phosphorylation of acetylcholinesterase by organophosphorus compounds.


Sebaceous carcinoma of the caruncle.

Sebaceous carcinoma of the caruncle. A rare case of sabaceous carcinoma of the caruncle with intraluminal shedding of tumour cells into the canaliculus is presented. The possibility of metastatic spread via this route and its clinical implications are discussed. Although the patient had tumor extending to the deep surgical section, he is alive 29 months after the initial surgical excision without subsequent treatment.


Gastrins in human antrum, duodenum and peripheral circulation. Previous studies have shown that arginine-stimulated gastrin release disappears after pyloric antrectomy in the human, while conflicting evidence indicates that gastrin is released by the human duodenum. The present study reconciles this conflict by showing that the major form of gastrin in the pyloric antrum is the heptadecpeptide form, while the duodenum contains mainly "big" and almost no heptadecapeptide gastrin. Fasting serum samples contain mostly "big" gastrins, while stimulated serum contains increased proportions of the heptadecapeptide and minigastrin species. It is suggested that local factors operative at the different G-cell sites determine the nature of gastrin released since "big" gastrins occur in most sites containing gastrin.


Biochemical monitoring of the surgical patient. The need for prognostic and biochemical monitors of cellular function becomes increasingly evident with the further elucidation of the metabolic pattern secondary to disease. Thus far studies have shown that lactic acid may be one of these biochemical parameters. Investigations are now in the process of defining other biochemical indicators of cellular dysfunction.


Intraoperative esophagoscopy, gastroscopy, colonoscopy, and endoscopy of the small bowel. Intraoperative endoscopy of the gastrointestinal tract is probably much more widely used than has been publicized in the recent literature. Application of this new tool to the surgical armamentarium depends only on the limits of the imagination of the operating surgeon and his endoscopist colleague, in most cases, the gastroenterologist. The operative maneuverability of current endoscopes make every portion of the gastrointestinal tract accessible to direct visualization without incision into it, both by the operating surgeon and by the endoscopist. For the full potential of this modality to be realized, the same sort of cooperation between gastrointestinal surgeon and gastroenterologist must be achieved as currently exists between cardiac surgeon and cardiologist and between transplant surgeon and nephrologist. Once this cooperation has been established, application of these tools to gastrointestinal diseases should become commonplace in gastrointestinal surgery.


Dysplasia of the quadriceps mechanism: hypoplasia of the vastus medialis muscle as related to the hypermobile patella syndrome. Disturbance of the patellofemoral mechanism is the most common cause of dysfunction in the knee, especially in athletes of all age groups. This is primarily a congenital familial abnormality due to poor development in the vastus medialis. The patella develops in the line of maximum pull of this muscle group; in this congenital condition it develops in line with the stronger antagonist to the vastus medialis, the vastus lateralis muscle. Therefore, the position in the extremity that the patella assumes is the result of abnormal muscle development. This brings about other changes in the lower extremity that increase the tendency of the patella to migrate laterally. This condition, hypoplasia of the vastus medialis muscle, exists in a large number of people (about 40% of my patient population) in an asymptomatic form that predisposes them to degenerative changes of the patellofemoral articulation later in life, even without symptoms related to dysfunction of the patellofemoral mechanism. These individuals are also predisposed to disturbances of the patellofemoral mechanism which may cause symptoms, that is, the painful knee for which they seek medical attention. The symptomatic types of dysplasia of the quadriceps mechanism are usually brought on by injury to the medical quadriceps retinaculum that stretches or tears it, allowing the lateral migration to increase and producing pain in the inner aspect of the knee. Disuse atrophy of the vastus medialis accentuates the clinical picture as the condition worsens. As the asymptomatic type may progress into the midly symptomatic variant and eacy may worsen into a more serious disabling variety as reinjury occurs, it is important to recognize each type and to treat them properly.


Scope and limitations of stroma-free hemoglobin solution as an oxygen-carrying blood substitute. One hundred years of study of stroma-free hemoglobin have generated much information regarding its scope and limitations as an oxygen-carrying blood substitute. The most important development in recent years is the development of a truly stroma-free hemoglobin solution. At this time, we know that SFH can readily bind, transport, and unload oxygen. It does not appear to be nephrotoxic or significantly antigenic. It may not be converted to methemoglobin in the body in significant amounts. Its short in vivo half-life may have important advantages.


Newer Techniques in evaluation of injured patients. Effective management of the severely injured requires an experienced, knowledgeable, and thoughtful physician who has a rational approach to both evaluation and treatment firmly in mind. When in doubt, access to a Trauma Registry (computerized) can be exceedingly valuable to assist in selecting the most effective treatment for a given clinical problem. The evaluation of the patient centers about general metabolic considerations, including acid-base disequilibrium, respiratory insufficiency, fluid volume monitoring, tissue perfusion (urine output), and osmolality. Diagnostic efforts to identify organ injury include infusion pyelography, paracentesis, radionuclide scanning, and angiography. The most critical diagnostic evaluation, however, remains frequent, careful examination of the injured patient, meticulously noting and interpreting all changes in physical findings.


New insights in cardiac trauma.

New insights in cardiac trauma. Recent advances in cardiac surgery associated with newer diagnostic modalities have decreased the mortality from cardiac wounds. With decreasing operative mortality, previous nonoperative approaches have been abandoned while judicious total repair of valvular, septal, and coronary artery injuries at the initial operative procedure seems resonable and justified.


Bilateral traumatic carotid-cavernous fistulae. The author reports a case of bilateral traumatic carotid-cavernous fistulae successfully treated by cervical carotid surgery alone. The right fistula was presumably cured by the thrombotic process induced by muscle embolization and carotid ligation (Brooks method). The left shunt was selectively obliterated by controlled embolization with preservation of the carotid permeability (variant of Isamat technique).


Combined subarachnoid and subdural spinal hematoma following spinal puncture. A case of combined subarachnoid and subdural spinal hematomas secondary to lumbar puncture during myelography is described. Contributing factors to this particular syndrome are discussed and the separate clinical syndromes of epidural and subarachnoid spinal hematomas are described. The incidence of all spinal hematomas appears to be increasing, due to the combined factors of spinal trauma and anticoagulant therapy. Spinal hematomas typically present with severe and localized back pain, rapidly progressive myelopathy and a poor prognosis for functional recovery unless immediate decompression is performed.


Intraspinal enterogenous cyst: delayed appearance following mediastinal cyst resection. A case of delayed appearance of a cervicothoracic extra-medullary intradural enterogenous cyst was disclosed in a boy at the age of four years and 9 months. The patient had had removal of an enterogenous mediastinal cyst without any demonstrable anatomical connection to the spinal cord at the age of three weeks.


Effect of phenoxybenzamine on experimental cerebral arterial spasm in cats. The effect of topical and intravenous administration of phenoxybenzamine, an alpha adrenergic blocking agent, on experimental vasospasm was studied in cats. Topical application of phenoxybenzamine prevented the occurence of vasospasm without noticeable systemic alpha adrenergic blocking effect. Intravenous use, however, was ineffective in the dosage with which total systemic alpha adrenergic blockade was obtained. Effects of intravenous administration in much larger dosage seemed to be largely due to the non-specific action of phenoxybenzamine on vascular smooth muscle.


Salmonella meningitis.

Salmonella meningitis. Three cases of salmonella meningitis in infants were successfully treated with a combination of intraventricular and systemic antibiotics after standard treatment had failed. The intraventricular antibiotics were administered through a subcutaneously implanted ventriculostomy reservoir. The ventricular fluid cultures were positive in all cases. The organisms in the ventricle may periodically reinoculate the subarachnoid space and add to the difficulty in curing salmonella meningitis. Details of the prolonged treatment (29-59 days) and the antibiotic levels obtained are presented. No local reservoir complications were encountered. All three patients were developing normally 10 to 18 months following treatment including two who required a shunt procedure for nonabsorptive hydrocephalus.


Interhemispheric subdural empyema: angiographic diagnosis and surgical treatment. Interhemispheric subdural empyema, secondary to frontal sinusitis in two girls is described. Headache, hemiparesis more marked in the lower extremity, fever, focal seizures, stupor and stiff neck were the principal features of the clinical course. The angiographic appearance of the lesion was the key to the preoperative diagnosis. Surgical evacuation of the purulent collection resulted in complete cure in both cases.


Cranio-cerebral injuries from nail-gun used in the construction industry. The nail-gun has been used in the construction industry world-wide. An increasing number of injuries to the cranium and other parts of the body has been reported due to its careless use or mishandling. Some of these are reviewed with emphasis on craniocerebral and spinal cord involvement. Two cases are reported here. Both of these patients survived and have returned to gainful employment.


Cerebellar abscesses: a review of seventeen cases. Seventeen cases of cerebellar abscesses are reviewed. The incidence was 18% of all brain abscesses. Thirteen were males, and four were females. Headache was the most common presenting symptom. These abscesses have a better prognosis for survival and neurological function than supratentorial abscesses. They are less likely to be encapsulated. Continued neurological decline in the face of adequate surgical treatment of a single abscess should alert the physcian to the possibility of a second abscess.


Traumatic pseudoaneurysm and arteriovenous fistula involving the middle meningeal artery. Two cases of traumatic pseudoaneurysm and arteriovenous fistula involving the middle meningeal artery are reported with a review of the world literature on these specific entities. The two conditions appear to evolve through similar mechanisms and may lead to a confusing clinical picture. High quality angiography is important in making an early diagnosis, prior to performing a definitive surgical procedure.


A case against heparin therapy of intravascular coagulation. Administration of a potentially dangerous drug like heparin should not be based on theroretical considerations and innumerable case reports but 1) on a firm diagnosis and 2) on a critical evaluation of the clinical benefit. The validity of criteria for the diagnosis of intravascular coagulation (IC) is discussed. It is emphasized in particular that loss of fibrinogen into extravascular spaces can only be excluded by assays of the level and disappearance rate of serum proteins not subject to the proteolytic action of thrombin or plasmin. Even when the diagnosis can be reasonably established, heparin therapy in a particular condition should only be advocated if its clinical benefit has been demonstrated in controlled clinical trails. Our conviction that heparin has as yet a small if any place in the management of patients with so-called intravascular coagulations is based mainly on two sets of arguments, one stemming from a critique of the diagnosis of IC, the other from a general attitude in the evaluation of therapeutic procedures.


Ultrastructure of mitosis in the amoeboflagellate Naegleria gruberi. Naegleria gruberi is an amoeboflagellate found in soil; mitosis is restricted to the amoeboid phase of its life-cycle. Ultrastructural examination of mitotic stages has confirmed some aspects of karyokinesis reported in earlier light-microscopic studies and expanded on other features of nuclear division described in electron-microscopic studies of Naegleria. The nuclear envelope remained intact throughout division, the nucleolus persisted, and centrioles were not found. Chromosomes were indistinguishable at the ultrastructural level, nor was any evidence detected of sites of microtubular attachment to possible chromosomes. An interzonal body, formed during separation in two of the nucleolus, was not an invariable feature of mitosis. The same was true of the polar caps, which appeared to be little more than the ends of the mitotic spindle. It is suggested that, in line with comparable situations in other protists, expansion of the nuclear envelope is chiefly responsible for separation of the nucleus into two daughter nuclei.


The role of the Golgi complex in the isolation and digestion of organelles. The origin of the membranes and lytic enzymes involved in autophagy has been studied in metamorphosing insect fat body. The Golgi complex has two functions in the organelle destruction which takes place when fat body cells change their activities. (1) It gives rise to envelopes which extermalize organelles scheduled for destruction. Microbodies, mitochodria and rough endoplasmic reticulum are sequentially removed from the cytoplasm by investment in isolation membranes. During the isolating phase, isolation membranes have the same osmiophilia as the outer saccular and microvesicular components of the Golgi complex, they do not contain lytic enzymes and they are specific in their adhesion to organelles scheduled for destruction. (2) The Golgi complex gives rist to lytic enzymes. Primary lysosomes which contain acid phosphatase fuse with the isolation bodies formed from invested organelles to become autophagic vacuoles. During this lytic phase, acid phosphatase is present in the inner saccules and microvesicular components of the Golgi complex, in the primary lysosomes seen fusing with isolation bodies and in autophagic vacuoles.


Fenestrated endothelium of the adrenal gland: freeze-fracture studies. Little is known of how adrenal hormones pass from the interstitial to the vascular space. We have begun to examine the adrenal endothelium as a barrier to hormone passage, by the freeze-fracturing technique. The endothelium of both cortex and medulla is fenestrated. Fractures from both regions show endothelial cells to be extremely thin in regions where fenestrations are abundant. En face fractures show fenestrae disposed in tracts; the fenestrae reaching a distribution of 35/mu2. In both cortex and medulla there are areas of continuous endothelium which contain caveolae. Structures believed to represent fenestra diaphragms contain randomly disposed particles and occasional pits. We have not identified in replicas the central ring and pore described in thin-sectioned material (Elfvin, 1965). The main differences between freeze-fractured aspects of cortical and medullary endothelium are the greater abundance of caveolae in the medulla and the size of the fenestrae (fenestra rims in the medulla are 525-780 A in diameter; in the cortex 570-1660 A). These differences may reflect the different embryological origins of the medulla and cortex. While caveolae may participate in hormone transport, there is no evidence for this. In the medulla the caveolae are more numerous and may have a function not necessarily related to transport. Possibly, caveolae play a role in processing hormones and related substances. For example, ATP and specific proteins are released as well as epinephrine during exocytosis from chromaffin cells. Epinephrine enters the vascular space but ATP does not. ATPase enzymes are a common feature of caveolae of other endothelia and may occur as well in adrenal endothelium.


Some ultrastructural observations on the integument of a pentastomid. The cuticle of the cephalobaenid pentastomid Reighardia sternae is described at various stages of the moult-intermoult cycle. The intermoult cuticle comprises four layers: an outer epicuticle; an underlying dense layer, the protein epicuticle; a fibrillar endocuticle; and a denser subcuticle. The overall similarity between the structure and composition of these layers and those of insects is discussed. However, the orientation of the chitin-protein fibres in the endocuticle does not show the rotating structure characteristic of many arthropod species, but this does appear in the sclerotized hooks. It is suggested that this comparatively loose, poorly oriented endocuticular structure produces a highly extensible cuticle which is precisely adapted to the specialize, endoparasitic habit of this species. Events at ecdysis, particularly the secretion of moulting fluid and the deposition of cuticulin, follow the insect pattern precisely. The phyletic significance of these observations is discussed.


The fine structure of the cockroach subgenual organ. This paper describes the fine structure of the cockroach subgenual organ, a complex ciliated mechanoreceptor that detects vibrations in the substrate upon which the animal stands. Located beneath the knee in each walking leg, the cockroach subgenual organ is a thin, fan-shaped flap of tissue slung across the dorsal blood space of the tibia at right angles to the leg's long axis. It is innervated by approximately 50 chordotonal sensilla. The fine structure of the chordotonal sensilla is is described in detail; possible transducer sites are discussed.


Effect of clomiphene on the ponderal, histological and biochemical changes induced by stilbestrol and testosterone in the uterus of rats. A comparative study on the effects of clomiphene on the stilbestrol- and testosterone-induced changes in the weight, histology and biochemical constituents of the uterus was undertaken. Clomiphene counteracted the stilbestrol-induced increase in the weight, and the absolute contents of the glycogen, protein and RNA of the uterus, possibly by competitive inhibition. It failed to prevent such changes induced by testosterone: on the contrary, there were some additive effects. The results of the present study indicate that the binding sites for the estrogen and the androgen in the uterus are different.


Steroid hormones in the ovarian blood of the laying turkey. In the present study estrone, estradiol, progesterone, the two 20-dihydroprogesterone, 17-hydroxyprogesterone, and testosterone were isolated for the first time from the ovarian plasma of laying turkey hens. The isolated steroids were identified by comparing their chromatographic mobilities in thin-layer, liquid, and gas-liquid chromatography and, when sufficient material was isolated, by combined gas-liquid chromatography-mass spectrometry.


Adrenal and liver metabolites of 18-hydroxy-11-deoxycorticosterone in the rat. Identification of reduced compounds (18-OH-TH-DOC). The presence of reduced metabolites of 18-hydroxy-11-deoxycorticosterone has been investigated in the adrenals of 23 day-old and adult rats and in the liver of adult rats. By thin-layer chromatography a fraction of the adrenal steroid extract migrating like tetrahydrocorticosterone has been isolated. By gas chromatography-mass spectrometry several isomers of 3,18,21-trihydroxy-pregnan-20-one (18-OH-TH-DOC) have been separated in this fraction and identified by comparison with authentic samples which have been chemically and enzymatically synthesized. The major tetrahydrogenated metabolite in the adult and prepuberal rat adrenals is 3beta,18,21-trihydroxy-5alpha-pregnan-20-one (18-OH-TH-DOC II). The 3alpha,18,21-trihydroxy-5beta-pregnan-20-one has been found only in the prepuberal rat adrenal. A third tetrahydrogenated isomer has been tentatively indentified as 3alpha,18,21-trihydroxy-5alpha-pregnan-20-one. Quantitative measurements by mass fragmentography show that adrenal reductase activity on 18-hydroxy-11-deoxycorticosterone is higher than on corticosterone. The 18-OH-TH-DOC II has been identified in the liver of adult male rat.


Neural uptake and metabolism of testosterone and dihydrotestosterone in the guinea pig. Neural tissues from adult, castrated male guinea pigs were examined for their capability to concentrate and metabolize [1,2-3H]testosterone (T) and [1,2-3H]dihydrotestosterone (DHT), both in vitro and in vivo. In vitro uptake of DHT and T was greater in the hypothalamus and anterior pituitary than in the cerebral cortex. With DHT as the substrate, the 800 times g particulate concentration of this compound was highest in the hypothalamus, although in this tissue, particulate concentration was less than that of the cytoplasm. In the cerebral cortex 5alpha-androstane-3,17-dione was the most abundant metabolite, whereas 5alpha-androstane-3,17-dione, 5alpha-androstane-3alpha,17beta-diol, and 5alpha-androstane-3beta,17beta-diol were all present in equivalent amounts in the hypothalamus and pituitary. Incubation with T resulted in the formation of DHT, 4-androstene-3,17-dione, and a compound with the mobility of 5alpha-(or 5beta-)androstane-3,17-dione. The radioactivity associated with DHT was the most prevalent in the pituitary (1.3%), and least prevalent in the cerebral cortex (0.6%), and in all cases cytoplasmic concentration of this compound exceeded the concentration in the particulate fraction. Recrystallization failed to confirm the presence of estradiol-17beta. Although there were no apparent tissue differences in the uptake of DHT or T 1 hour after their injection, intracellular distribution varied. In all tissues examined, that percentage of total radioactivity attributable to DHT was greatest in the 800 times g particulate preparations, particularly in the hypothalamus. Thus neural tissues in the guinea pig, as in other species, exhibit differential uptake and metabolism of androgen through which physiological and behavioral effects may be mediated.


Inhibition of 17,20(17-hydroxyprogesterone)-lyase by progesterone. 14C-17-hydroxyprogesterone was incubated with 7000 times g times 20 min supernatants of rat testis homogenates in the presence of various concentrations of 3H-progesterone, both under conditions where metabolism would take place and where it would be prevented. When metabolism was prevented, the ratio of progesterone to 17-hydroxyprogesterone in the microsomal fraction was 3 times that which was added to the incubation medium. Progesterone competitively inhibited 17,20-lyase action on added 17-hydroxyprogesterone but not on 17-hydroxyprogesterone formed from the added progesterone. The rate of formation of 17-hydroxyprogesterone from progesterone, however, was inhibited by added 17-hydroxyprogesterone. The results indicate that there is no free exchange of an intermediate between progesterone and androstenedione with the soluble fraction, either inside or outside the microsomal vesicle. The limited exchange with 17-hydroxyprogesterone in solution probably represents exchange with an enzyme-bound intermediate.


Synthesis and biological activity of 25xi,26-dihydroxycholecalciferol. 25xi,26-Dihydroxycholecalciferol (25xi,26-dihydroxyvitamin D3), a metabolite of vitamin D3 preferentially active on intestine has been synthesized. This compound was prepared by converting 3beta-hydroxy-27-norcholest-5-en-25-one to 25xi,26-epoxy-5-cholesten--3beta-ol and base-catalyzed hydrolysis of the latter to 5-cholestene-3beta,25xi,26-triol; allylic bromination of the corresponding triacetate, and dehydrobromination gave the required 5,7-diene which yielded the vitamin derivative upon photolysis (Figure 3). The synthetic product shows the same activity pattern as the natural metabolite: at dose levels of 0.25 mug, the compound stimulates intestinal calcium transport, but has no effect on bone calcium mobilization in rats maintained on a vitamin D-deficient, low calcium diet. Higher doses (2.5 mug) elicit a more pronounced intestinal calcium transport response, but also have no significant effect on the bone mobilization system. The compound exhibits no biologial activity in nephrectomized animals.


Plasma estrogens, progesterone and chorionic gonadotropin in pregnant rhesus monkeys (Macaca mulatta) after ovariectomy. Maternal peripheral plasma concentrations of estrone (E1), estradiol-17beta (E2), and progesterone (P) were determined in 4 rhesus monkeys ovariectomized in early pregnancy (22-24 days). After ovariectomy, plasma concentrations of E1 and E2 were basal for 1 to 2 weeks. In contrast, slightly higher estrogen levels, which may be attributed to the ovaries, were found in intact pregnant monkeys. E2 levels increased rapidly after this and exceeded those of E1 until the 5th month of gestation. From that time until parturition, E1 levels equaled or exceeded those of E2 in most instances. The pattern of P concentrations was similar to that observed in intact monkeys. Urinary chorionic gonadotropin (MCG) levels in ovariectomized monkeys were not significantly different from those found in normal pregnancies. Thus, the pattern for circulating E1, E2 and P, as well as for the excretion of MCG, after ovariectomy were remarkably similar to those found in intact, pregnant rhesus monkeys, indicating minimal ovarian influence.


Effects of estrogen and progesterone on uterine sialic acid in ovariectomized rats. The effects of estradiol-17beta and progesterone on uterine sialic acid of ovariectomized rats have been examined. In contrast to a previous report, progesterone was found in two of three experiments of different design to increase uterine sialic acid concentration above that produced by estradiol-17beta alone; in the third experiment, it had no significant effect. This effect of progesterone was independent of the duration of treatment with exogenous hormones or of whether or not uterine luminal fluid was removed by blotting before assaying sialic acid. In a factorially designed experiment with four levels of estradiol-17beta and three of progesterone, a dose-response relationship was found between estradiol-17beta, but not progesterone, and uterine sialic acid concentration. It is concluded that, in some circumstances, estrogen and progesterone can act synergistically to increase uterine sialic acid concentration.


Assessment of national family planning programs in developing countries. Today, 34 developing countries have policies and programs to lower fertility, and an additional 32 countries provide family planning services for health and humanitarian reasons. Specific causal relationships and linkages between social and economic development, family planning programs, and fertility levels and changes remain mostly unclear at this point. Based on percent acceptors, percent users, and changes in fertility rates (the most commonly used measures to evaluate family planning program accomplishments), however, the performance of programs on the whole has been moderately encouraging.


Evaluating family planning program effectiveness and efficiency. This article proposes an integrated in-house evaluation model for family planning programs. The model is designed to meet the need of program management for an operational and internal evaluation system suited to the ongoing character of program activities and focused on the feedback of information for program planning. The ideas presented are applied to the context of the Albany County Family Planning Service, Inc., Wyoming.


The role of voluntary organizations in national family planning programs. A meeting of an expert group was held on 7-12 August 1972 in Bangkok, Thailand, to discuss existing patterns of relationships between governments in Asian countries implementing national family planning programs and the private national family planning associations. The concept of a suitable working relationship and division of labor was explored. It was felt that a nationwide program can best be administered under government leadership but that voluntary organizations should be involved to the maximum extent possible. The need for communication and coordination at all levels of planning and operation was stressed.


Screening oral contraceptive candidates and inconsequential pelvic examinations. Among 1,201 women who requested oral contraceptives (OCs) at a large London family planning clinic between 1 January 1971 and 9 March 1971, 51 (5 percent) were initially denied this method because of contraindications discovered by medical histories and examinations. Twenty-four of the 51 women received OCs at subsequent visits, raising the overall proportion receiving OCs to 97.4 percent. Initial screening procedures detected 44 contraindications by medical history, six by blood pressure determination, one by breast examination, and none by pelvic examination. Examination by a physician did not appear to be essential in the screening process at this clinic.


An economic framework for fertility analysis. The standard formulation of the microeconomic theory of fertility, which emphasizes the demand for children and, to a lesser extent, the costs of fertility control, is too limited in its scope for use by most demographers and sociologists. The approach advanced in this paper adds to the usual theory a more explicit and formal treatment of the production of children, including the possibility of shifts in production independent of demand conditions. This more comprehensive framework is compared with the usual approach in the analysis of several empirical problems-non-marital fertility, premodern fertility fluctuations and differentials, and the secular fertility decline-and is shown to be better suited for incorporating the concepts and hypotheses of noneconomists along with those of economists.


REALPOP: a mathematical model for resource allocation in population programs-results from a test in the Dominican Republic. The structure of a computerized mathematical model for resource allocation in population programs (REALPOP) and its application to the Dominican Republic's national family planning program are described. The model integrates demographic and management science approaches in the analysis of resource allocation, program planning, goal evaluation, and growth strategies of a family planning program. It is designed primarily to aid administrative decision-makers. The Dominican National Population and Family Council (NPFC) established a goal of reducing the crude birth rate from its 1968 level of 48 per thousand population to 28 per thousand in 15 years. Further, the program has established a clear set of program plans and alternatives. This study investigates the implication of these plans for the program's stated goals.


The relationship between change in educational attainment and fertility rates in Taiwan. Using vital statistics data for 1966 on age-education-specific marital fertility rates and comparable data drawn from a sample of Taiwanese women in 1971, the author computes the separate effects of changes in marital fertility, proportions married, age distribution, and educational distribution on changes in the crude birth rate and the fertility rate between 1966 and 1971. The changing educational distribution appears to have been fairly important, accounting for 24 percent of the 1966-1971 change in crude birth rate, holding other factors constant. For young women, the closely related factors of education and age at marriage seem to dominate fertility over the period, probably reflecting the widespread adoption of contraceptive practice by the lower educational strata. The effects of organized family planning program efforts are probably felt here.


Washed hyperpacked frozen and shelf red blood cells. In order to determine the maximum degree to which blood units could be packed and still be effective, shelf stored blood and previously frozen red blood cells were washed and hyperpacked to hematocrits of 90 to 98 per cent. These products had average volumes of 180 and 162 ml, respectively. When transfused into a group of patients with stable nonhemolytic anemias or with slow or intermittent blood loss, the hyperpacked shelf stored blood resulted in average hematocrit increments of 4.4 per cent; the hyperpacked frozen red blood cells resulted in average hematocrit increments of 3.4 per cent. Conventionally packed unwashed red blood cells had approximately 10 per cent more hemoglobin and volumes of 270 to 330 ml, but resulted in average hematocrit elevations of only 2.8 per cent. Unwashed blood hyperpacked to hematocrits of 90 per cent with removal of the visible buffy coat took much longer to administer. Thus, by washing and hyperpacking shelf stored blood or previously forzen red blood cells, transfusions with the minimal amount of extraneous material can be given.


Identification of strong Sd(a+) and Sd(a++) red cells by hemagglutinins from Salvia horminum. Anti-Sd-a is difficult to identify, unless a special technique and strongly reacting Sd(a+) red blood cells are used. Sd-a has a broad distribution of antigen strength. The strongest examples [Sd(a++) or "Super Sid" and strong Sd(a+)] may be readily identified by using an extract from the seeds of Salvia horminum.


In vitro metabolism of packed erythrocytes stored in CPD-adenine. In vitro metabolism of erythrocytes packed at 70 and 90 per cent hematocrits and stored in various CPD-adenine preservatives was studied. It was found that maintenance of acceptable levels of adenosine triphosphate (ATP) for the full 42 days of storage could be accomplished only if glucose levels were doubled from the standard 138.7 mM concentration to 277.5 mM level. If glucose levels were doubled, the amount of adenine could be decreased from 4.07 mM (0.50 mM final concentration) to 2.04 mM (0.25 mM final concentration) with maintenance of ATP at greater than 2.0 mumoles/g Hb. 2,3-diphosphoglycerate concentrations were essentially absent by 21 days in the various media studies. Thus, in vitro levels of ATP appear to be maintained at acceptable levels in a CPD media modified to contain 2 times glucose and 2.04 mM adenine.


Two further examples of anti-Gy.

Two further examples of anti-Gy. Two new patients with anti-Gy-a (Gregory) are reported. Both patients are from an area where consanguineous marriage is common. The two kindreds may be related.


The effect of agitation on in vitro metabolism of erythrocytes stored in CPD-adenine. Agitation of blood stored in plastic containers has been reported to lead to improved posttransfusion survival and it has been found that, in some media, agitation has improved erythrocyte 2,3-diphosphoglycerate (2,3-DPG) levels. Using CPD II media (CPD with 277.5 mM glucose and 2.04 mM adenine), we were not able to identify any improvement in levels of adenosine triphosphate, 2,3-DPG or glucose in whole blood under various agitation conditions when compared with nonagitated control. The 2,3-DPG level was moderately improved through 28 days in the 90 per cent hematocrit packed erythrocytes but the results were not considered to be significantly beneficial to warrant agitation. Thus, the application of agitation to the CPD II blood storage system was of no great benefit in improving metabolic intermediate levels.


Potassium load in CPD-preserved whole blood and two types of packed red blood cells. The potassium load of transfused blood must be minimized. We have compared the total plasma potassium content of units of CPD-preserved stored whole blood (SWB), stored packed cells (SPC), and packed cells prepared from stored whole blood (WB-PC). Plasma potassium concentrations, unit weights, and hematocrits of 20 units of SWB, 27 units of SPC, and 20 units of WB-PC of various ages were measured. During the 21-day storage period, total plasma potassium content per unit increased in units of SPC at the same rate as in units of SWB, because plasma potassium concentration increased in SPC at three times the rate of SWB. The values for total plasma potassium per unit at 14 and 21 days in mEq/unit were: SWB, 4.4, 5.8; SPC 3.1, 4.4; and WB-PC 1.9, 2.5. Thus, SPC units may contain substantial amounts of plasma potassium when stored for two to three weeks. However, removal of most of the remaining supernatant plasma from SPC units just prior to administration provides a readily available supply of low potassium blood while allowing maximum conservation of scarce blood resources.


Blood banking as a professional discipline in medicine. A closer orientation of blood banking toward optimal donor and patient care will depend upon an enlargement of the manpower pool of physicians with specific competence in this area. Toward this end, programs must be developed within medical school curricula, and comprehensive postgraduate training programs must be available for those interested in committing themselves fully to this specialty. Continuing education must be made available to part-time blood banking professionals in order that they remain abreast of newer developments. Recognition of their skills can now come about through competence testing and certification programs. Improvements in management of the blood resource may then be expected to occur in parallel with the increase in numbers and quality of the professionals within this unique specialty.


Effects of donor recruitment methods on population responses. It is important to know the preferences of blood donors and nondonors as to 1) the method of contact of the prospective donor by the recruiter, 2) the character of the relationship between the recruiter and the recruit, 3) the recruitment message used by the recruiter, and 4) the logistics of the collection. Interviews with almost 2,000 blood donors and nondonors in the Buffalo region were done to provide information on these preferences. Results of the studies include evidence that face-to-face recruiting is over three times as effective as is recruiting by the telephone. the relationship between recruiter and recruit is important primarily to first-time donors. The recruitment message should include all of the reasons for donating. Replacement donors are a good source of future volunteers, and the logistics of blood collection, particularly selection of donor sites and overall time required to donate, are crucial in determining donor responses.


On the sparse seeding of bone marrow and thymus in radiation chimaeras. The repopulation of the thymus was studied in mice after a potentially lethal dose of irradiation and injection of different numbers of syngeneic but chromosomally distinguishable bone marrow cells.  The more bone marrow cells were injected, the earlier was the changeover from dividing host cells to dividing donor cells observed.  At both 30 and 60 days after irradiation, the number of donor-derived T cells in the peripheral blood responding to phytohemagglutinin was directly proportional to the number of donor bone marrow cells injected, but the number of host-derived T cells was inversely proportional.  Experiments in which mistures of two syngeneic chromosomally distinguishable haematopoietic cell populations were injected after irradiation suggested that relatively small numbers of haematopoietic cells can be responsible for repopulating a single femur.  Analysis of the thymus showed that the dividing cell populations within the thymus can also derive from very few precursor cells, possibly as few as one or two.


Donors and nondonors: communication and information. Donors and nondonors from six states were surveyed to determine differences in: 1) socioeconomic and demographic characteristics, 2) knowledge about blood donation, 3) access to information about donating, and 4) motivation to donate. The findings indicate that the present donor pool consists largely of socioeconomically advancing young adults. There was little difference between donors' and nondonors' knowledge of the donating process and access to mass media-disseminated information about blood donation. Nondonors receive more information about donating from friends than do donors and interpersonal influence is an effective means of donor recruitment. The use of motivators other than humanitarianism may also be useful for inducing volunteer donations. Nondonors do lack knowledge about the location of local collection facilities. The present sample is socioeconomically and demographically representative of the U.S. adult population. As such, it provides information useful for developing effective donor recruitment strategies.


A computerized donor processing system for a regional blood collection center. The initial phase of a computerized on-line donor processing system was developed and demonstrated at the American National Red Cross, Washington Regional Donor Center and at bloodmobile operations. It was used for entry of donor registration information and for screening donors early in the donation procedure against a list of deferred donors. This demonstration took place with the computerized donor processing system running in parallel with the present manual operations. Since volunteer staff usually assist in the operation of most blood collection facilities, it was necessary to demonstrate that nontechnical personnel could operate the computerized system.


Granulocyte harvest for transfusion: donor response to repeated leukapheresis. Leukapheresis of normal donors with the NCI-IBM Continuous Flow Blood Cell Separator was compared with the method of filtration leukapheresis. An average of 5.7 times 10-9 (range 1.4 to 10.9 times 10-9) granulocytes were collected on 25 occasions with the blood cell separator compared with an average of 36.6 times 10-9 (range 20.1 to 61.3 times 10-9) obtained by filtration leukapheresis on 85 occasions. Donor platelet counts decreased following donation by an average of 29,000/mul (14%) with continuous flow centrifugation (CFC) and an average of 40,000/mul (17%) with filtration leukapheresis (FL). Estimated donor packed red blood cell loss, including blood obtained for investigative purposes, was 80 ml per donation with CFC and 67 ml per donation when FL was used. FL resulted in at least a 25 per cent increase in the granulocyte count of donors by donation completion in 61 per cent of donors, although postdonation granulocytosis did not correlate with increased cell harvest. CFC donors generally displayed a postdonation decrease in granulocyte count. Normal numbers of granulocytes were maintained in donors undergoing frequent leukapheresis and no donor's health was compromised by the removal of large numbers of granulocytes. Repeated donations were possible with both systems. Although platelet counts dropped more with FL, the procedure was performed as frequently as eight times in a ten-day period without development of severe donor thrombocytopenia. Donor red blood cell loss appears to be the limiting factor in the repeated use of either system. Blood loss could be significantly decreased under routine conditions if fewer samples were obtained for investigational purposes. Filtration leukapheresis offers the advantage of significantly greater granulocyte yields than is possible with CFC unless modifications such as arterio-venous shunts or the use of steroids and/or rouleaux-inducing agents are employed.


[Device increasing the capabilities of the MUF-5 microspectrophotometer]. Technical data for coordination of the device electric scheme and the MUPH-5 scheme (both with and without the integrator MIU-2) are presented together with a following computer analysis. The device enables to record discrete changes of optical density on the scanning pathway thus giving an advantage in application for quantitative analysis of histochemical enzymatic reaction as compared with the graphic registering.


[Linear differentiation of the X-chromosomes of the field vole Microtus agrestis]. Morphology of the fibroblasts X-chromosomes obtained from the female field vole Microtus agrestis and cultured for 4--5 hr before fixation in 5-bromodeoxyuridine, was studied. A clear differential condensation along the lenght of the whole X-chromosome was observed. A difference between homologues in the degree of uneven condensation was noted both in the short arm (facultative heterochromatin) and in the long arm (constitutive heterochromatin).


[Electron microscopic study of the formation of pancreatic endocrine A-cells from acinar epithelium in normal and experimental conditions]. Electron microscope studies in the pancreas of intact white rats and cats and after folliculin administration showed presence of acinar-islet cells with zymogen and endocrine A-granules. Different structure organellas, different amount of zymogen and incretory granules in these cells gave an idea of the process of acino-insular transformation. At later stages of the transformation, participation of the elements of laminar complex of the transitional cells in formation of secretory A-granules, was noted. Presence of the acinar-islet cells in normal and a high amount of them in the pancreas of experimental animals corroborated the essential role of the acinar-islet transformation in the genesis of A-cells of the Langerhans islets.


[Role of cations and surface membrane proteins in the adhesion of rat liver parenchymal cells. I. Effect of dirrerent perfusion periods on the structure of cellular junctions]. Electronmicroscopic study of the structure of the rat liver cell junctions in the normal conditions and after 90 min. perfusion by the physiological solution showed 4 kinds of specialized junctions between the hepatocytes with typical structure: tight junction, gap junction, intermediate junction, and desmosomes. The long perfusion does not cause visible changes in the contact structure or the sizes of the intercellular space. The preservation of the tight junction after the long perfusion is demonstrated by the lanthanum tracer: lanthanum is never found in the tight junction and in the bile capillary. Lanthanum reveales globular structure of the middle layer of the gap junction.


[Nuclear apparatus of the oocyte and accessory cells in the oogenesis of 2 ant species]. The accessory nuclei are present throughout vitellogenesis. They originate from the oocyte nucleus. Structurally they resembe nuclei and, besides, their inclusions contain RNA of nucleolar origin. But the inclusions of accessory nuclei are Feulgen-negative.


[Mechanism of potentiation of contraction in glycerol-treated muscles]. The glycerol was shown to lead to a considerable though transient increase in the contractile amplitude of the m. sartorius. Prolonged incubation of the muscle in the Ringer and Ca-free solutions in presence of glycerol led to a decrease in the response following potentiation. The potentiation due to glycerol seems to be caused by Ca2+ release which, in its turn, is due to the glycerol effect on membranes of SR and T-systems.


[Increase in the time of conservation of contractility of glycerinated muscles exposed to subthreshhold concentrations of chemical agents]. The response of glycerinized frog muscles to the action of chemical agents at subthreshold concentrations was the same as that of living muscles. Preservation of contractility (up to 50--200% over the control time) in response to ATP was achieved by incubation of the muscle models in solutions of chloral hydrate (0.0038--0.015M), urethan (0.09--0.35M), urea (0.5M) and sodium chloride (0.035--0.070M). Concentrations of these agents were always about 15--45% of the toxicity threshold. The prolongation of the "survival time" is suggested to depend on changes in the contractile proteins of muscles.


[Time dependence of the reaction rate constant of potassium permeability of Ranvier's node membrane]. To describe the kinetics of potassium permeability (conductance) changes in the  squid giant axon membrane the Hodgkin--Huxley formulation uses a single first-order in time variable n with forward and backward rate constants, respectively alpha-n and beta-n, potential-dependent but time-independent. It has been shown by Frankenhaeuser that in the potassium-carrying system of the myelinated nerve fiber membrane of Xenopus laevis the rate constant beta-n is dependent on the duration of previous depolarization, i. e. the beta-n of this membrane is time-dependent. Started from the FitzHugh--Cole--Moore translation principle for potassium current experimental data of Frankenhaeuser have been analysed to show that the rate constant alpha-n in the X. laevis nerve fiber membrane is also time-dependent. To keep the conventional Hodgkin--Huxley formulation valid in case of the potassium-carrying system of the X. laevis nodal membrane involvement of an additional first--order in time component (n-II) has been postulated, which is compatible with Frankenhaeuser's experimental results. This component n-II appears to be identical to the n-II-component in the potassium-carrying system of the Rana ridibunda nerve fiber membrane. Both are rather slow and activated within the potential range more negative than the basic n-I-component (corresponding to Frankenhaeuser's variable n). The component n-I seems to be identical to the n-component of many other excitable membranes with fast action potentials. The existence of the third, very slow nIII-component is also possible. The independent components in question are believed to be associated with different independent potassium channels within the same membrane. It is likely that the existence of several independent components is a general feature of the potassium-carrying mechanism in the excitable membranes essential for a particular type of electrogenesis.


[Grouping of neurons according to their RNA content during different functional states of the cerebral cortex]. In the cat somatosensory cortex intact and after epileptiform activity induced by electric stimulation, neurons formed groups on the basis of similarity of their RNA contents. The highest degree of grouping was observed during the epileptiform cortical activity. Functional significance of these groupings is discussed.


[Effect of light deprivation and light stimulation on the RNA content of neurons in the adult rat visual analyzer]. By means of two-wavelength visual cytospectrophotometry, a content of nucleic acids per cell was determined in the gallocyanin chrome alum stained sections of the adult rat nervous system. Illumination of normal rats with constant or flashing light for 2 hr resulted in an accumulation of RNA in II--III layer neurons of the visual cortex and in the retina ganglionic neurons. After the rats had been kept for 30 days in a complete darkness the nucleic acid content in their visual cortex neurons was increased. Illumination of these animals with constant or flashing light for 2 hr gave rise to a return of the nucleic acid content in the cortex neurons to the normal. Under the effect of 30-day light deprivation, the nucleic acid content in the retina ganglionic neurons remained unchanged. Illumination of the light-deprived rats with flashing light for 2 hr also did not change RNA content in these retina neurons. The data obtained indicate the prolonged hypofunction in adult animals to induce marked changes in nucleic acid metabolism in the neurons of visual analyser. A relationship between the function and metabolism in adult neurons is emphasized; differences of the function-dependent metabolic responses in the cell structures of central and peripheral parts of the visual analyser are discussed.


[Ultrastructural characteristics of the mitochondrion of flagellates of suborder Bodonina]. The presence of "free" mitochondria in addition to the single mitochondrion associated with kinetoplast, was observed in flagellates. Ultrastructure of the mitochondria was described. The presence of kinetoplast was observed in Pleuromonas jaculans.


[Symbiotic bacteria of the macronucleus of Paramecium caudatum]. Particles of a newly described endosymbiont of Paramecium caudatum, clone M-115, here referred to as iota--particles, are Gram--negative bacteria. The symbionts are only present within macronuclei and not in the cytoplasm or in the micronuclei. The cells of clone M-115 iota do not display any killer-effect when mixed with "clean" cultures of Paramecia. In life cycle of the symbiont, there is an alternation of two morphological forms: a spindle-shaped form 2.0--2.5 microns long and a rod-shaped form -- about 18 microns long. The data obtained revealed a high ability to infect cell of "clean" clones of P. caudatum with iota-particles. The antagonistic relationships between two different species of endonucleosymbionts: iota- and omega-particles, are detected. The revealed biological features of iota can be used for studying the mechanisms of nuclear differentiation in ciliates.


Diagnosis of neurologic disorders of micturition without evidence of the pathological process by measuring conduction velocity of sacral roots. In cases of neurogenic bladder disturbances-especially if the pathological process cannot be clinically approved-useful information could be obtained by measuring conduction velocity between sacral roots and striated pelvic floor muscles. Measurements have been performed to determine normal conduction time. Technique and results are presented.


Visco-elastic properties of the bladder wall. Stepwise cystometry is a new method proposed to analyse the visco-elastic properties of the bladder. It is based on a mathematical analysis of the pressure decay after a stepwise filling. By assumption of a mechanical visco-elastic model of bladder tissue and a model of the geometry, the derived parameters are interpreted as elasticity and viscosity moduli. Static cystometry is involved in this new procedure. From analysis by stepwise cystometry it is concluded that static cystometry attained by following a slow-filling procedure is unacceptable in studying elastic behaviour.


Bladder base insufficiency.

Bladder base insufficiency. The normal female bladder base is defined. It is shown that the trigone does not always form part of a flat base. In 25% of all female patients referred for cystourethrography a specific defect of the anterior part of the base is seen caused by an insufficient upwards and backwards suspension of the bladder neck. 92% of these patients are stress incontinent. Urodynamically they have low protracted flows, but the most characteristic feature is a very low intravesical pressure and particularly a very low opening pressure. The low pressure is due to the fact that the internal orifice does not close correctly because of insufficient support. The protracted and low flows are due to an increased tone in the posterior urethra needed for continence when the bladder neck has lost its passive continence function.


Tubular cystourethroneostomy after total prostatectomy. After radical prostatectomy cystourethroneostomy is done as a tubular cystourethroplasty. In the last 13 months 14 patients have been operated on in this manner. In 12 patients continence was achieved; 2 patients had a temporary stress incontinence. The stress incontinence could be treated successfully by temporary electrostimulation of the pelvic floor by an anal plug stimulator.


Lioresal in the treatment of neurogenic bladder dysfunction. Lioresal is a very effective compound in treatment of the neurogenic uninhibited bladder due to spinal cord lesions. It does not decrease, however, bladder spasms due to cerebral lesions. In detrusor-sphincter externus dyssynergia as frequently encountered in discreet spinal lesions Lioresal restores the normal reciprocal innervation of bladder and sphincter externus again. This effect is demonstrated electromyographically. Lioresal is of no effect on the normal bladder. Bladder capacity and micturition reflex before and after Lioresal therapy are unchanged.


Urinary manometry in spinal cord injury patients. External urethral sphincter pressure recordings before and after sphincterotomy. Recordings of local pressure within the membranous urethra were performed in 15 male spinal cord injury patients before and after external sphincterotomy. Transurethral division of the external sphincter reduced the intraurethral pressure by 55% in the upper part of the membranous urethra and by 66% in the lower part. The local pressure within the membranous urethra seems to diminish in proportion to the importance of the incision of the urethral wall.


Twelve o'clock sphincterotomy: technique, indications, results. (Abbreviated report). In contrast to other investigators, the authors regard a transurethral sphincterotomy at the 12 o'clock position alone as sufficient and preferable. The anatomy of the external sphincter and the blood supply in this area may explain the good results.


Simultaneous cine-urographic and manoflowmetric evaluation of the neurogenic component in incontinence. For diagnosis of incontinence the exact analysis of the dynamics of micturition is of great importance, primarily in order to evaluate the urethral flow-resistance and detrusor activity. Extending already existing methods for the evaluation of urodynamics, we developed a complex method of cine/pressure/flow/cystourethrography. All data were recorded and simultaneously stored on videotape. Especially in cases of incontinence with a neurogenic component important information for a causative therapy was gained using this complex investigation. Thus in 20 patients with incontinence, studied for exclusion of a neurogenic component, we found two patients with a neurogenic bladder dysfunction that had been unknown prior to the examination. The neurogenic component in each case had remained unnoticed by usual routine diagnostic procedures.


Electromyography of the perineal striated muscles during cystometry. The electromyographic patterns of the external urethral sphincter, the anal sphincter, and the levator ani during cystometries have been analyzed. Synchronized activity changes occur during abdominal straining. Muscle fatigue is very pronounced. Activity may be less synchronized during bladder filling and micturition, even in normal cystometries. In neurogenic diseases, true dyssynergia between the striated muscles may be observed.


[Kidney function during total blood substitution in the rat (author's transl)]. Urine production, glomerular filtration rate (GFR) and Na+ transport of the kidney were studied in rats after complete substitution of the blood with a fluorocarbon emulsion. The urine production is found to be increased, the GFR lowered. The Na+ load as a function of the GFR is reduced while the relative Na+ reabsorption with values in the range of 98-99% of the load is normal.


[Water and ionic variations in dog kidneys during hypothermic plasma perfusion(author's transl)]. Dog kidneys have been perfused with homologous plasma at plus 6 degrees-C for 24 and 48 h and the water, K+ and Na+ variations in the cortex and medulla have been studied. After 24 h perfusion Na+-gain and K+-loss in the cortex are found while water content shows no changes. After 48 h perfusion additional increase of Na+ and gain of water are observed while the K+ content remains unchanged as compared with the cortex after 24 h perfusion time. In the medulla after 24 h perfusion K+ loss and water gain are registered while the Na+ content remains unchanged. In the following 24 h no additional changes of the K+, Na+ or water contents are observed.


[Extracorporeal renal surgery using a new preservation method(author's transl)]. Extracorporeal renal operations were performed in 12 dogs to determine the efficacy of a new renal preservation method. Serveral ex vivo surgical techniques are described, illustrated and the literature reviewed. A single perfusion of the totally ischemic kidney with a new hyperosmolar intracellular electrolyte solution provided sufficient protection from the otherwise lethal effect of 5 hours ambiothermic exposure. Pre- and postoperative serum creatinine levels were assessed to determine renal function.


[Late effects of neurogenic bladder dysfunctions in paraplegics (authors's transl]. The experience is based upon the care of paraplegic patients admitted to the Rehabilitation Centre Tobelbad, near Graz. Pathological changes in the urinary tract are reported as late effects in bladder dysfunctions of paraplegics. The study reviews the late complications of urethra and bladder and outlines the effects of chronic urinary infection, where particular attention is paid to the vesicoureteric reflux. Finally, the problem of urinary stones in paraplegic patients is discussed.


[Late effects of neurogenic bladder dysfunctions in paraplegics]. The experience is based upon the care of paraplegic patients admitted to the Rehabilitation Centre Tobelbad, near Graz. Pathological changes in the urinary tract are reported as late effects in bladder dysfunctions of paraplegics. The study reviews the late complications of urethra and bladder and outlines the effects of chronic urinary infection, where particular attention is paid to the vesicoureteric reflux. Finally, the problem of urinary stones in paraplegic patients is discussed.


Double-layer needle cannula for percutaneous artery or vein catheterization in patients requiring hemodialysis. In this paper the structure and use of the double cannula needle, designed to simplify percutaneous catheterization in hemodialysis, is introduced. The cannula needle is used mainly in cases with acute renal failure, and sometimes in cases of chronic renal insufficiency requiring weekly maintenance of hemodialysis.


Treatment of organic impotence by implantation of silicone penile prosthesis. To help bolster penile tension mechanically, we have tried implantation of silicone penile prostheses varying in type. Our simple and apparently successful procedures for organic impotence with the implantation of intrapenile silicone prostheses may well deserve recommendation in view of spinal impairment therapeutically categorized irreparable.


Peripheral nerves controlling the closure of internal urethral orifice during ejaculation. The peripheral nervous pathways controlling seminal emission and closure of the internal urethral orifice during ejaculation were examined experimentally using male adolescent dogs. The experimental methods were measurement of the contraction of the internal urethral orifice and measurement of the change of the posterior urethral pressure induced by selective stimulation of the nerves related to the hypogastric nerve. Further, the change of actual ejaculation caused by manual stimulation of the penis was observed after excision of the nerves. Results included the following: (1) The seminal emission and the closure of the internal urethral orifice on ejaculation were controlled by the hypogastric nerve. (2) The nerve fibers which controlled these two phenomena took different paths above the lower mesenteric plexus. (3) Seminal emission was controlled by the splanchnic nerves which originated from the lower thoracic and upper lumbar ganglia of the sympathetic trunk, and the closure of the internal urethral orifice by those which originated from the lower lumbar ganglia of the trunk.


An observation on the composition and recurrence of urinary calculi. Seven hundred patients with 735 urinary calculi were studied for the compositions of calculi by infrared analysis and for stone recurrence. Of these 700 cases, 422 cases were possible to follow up, and 250 cases have had no further stone; 138 cases experience recurring stones, and 34 cases had multiple stones. The length of follow-up period was 1-19 years averaging 8 years, 8 months. 41.2% of patients with calcium oxalate-calcium phosphate calculi had stones recurrently, and although there was some variation of recurrence rates for patients with various proportions of oxalate to phosphate in the calculi, it was impossible to predict the tendency of recurrence by these proportions. The stone recurrence was noted in 38.6% of patients with magnesium ammonium phosphate calculi, in 38.9% with mixed magnesium ammonium phosphate-calcium oxalate calculi, in 55.6% with uric acid calculi, and in 50% with cystine calculi.