Hepaticogastrostomy: ulcerogenic preparation or therapeutic alternative. Recent laboratory and clinical studies have implicated bile salts in the patogenesis of gastric ulceration. Common hepatic duct to stomach anastomosis results in total diversion of bile to the stomach and has been utilized at the Lahey Clinic occasionally for bypass of the obstructed common bile duct in difficult technical situations where conventional procedures were deemed prohibitively difficult. Of seven patients undergoing hepaticogastrostomy, two had upper gastrointestinal bleeding in followup. One of these patients had documented esophageal varices and stopped bleeding after splenorenal shunt. The other had massive sepsis which predisposed him to gastric ulceration. From this small series it is clear that the entire biliary output of the liver can be shunted into the stomach without greatly increased risk of clinically significant gastric ulceration. Hepaticogastrostomy provided relief from jaundice in all but one of the seven patients in the series and remains an occasionally useful procedure. These data indicate that diversion of the entire flow of bile from the liver into stomach does not cause gastric ulcers.


Effects of cortisone acetate, methylprednisolone and medroxyprogesterone on wound contracture and epithelization in rabbits. Standardized flank wounds were made on 20 rabbits divided into the following five groups: Group 1 served as controls, Group 2 were given cortisone acetate 6.25 mg/kg/day (I.M.), Group 3--methylprednisolone (Solu-Medrol) 1 mg/kg/day, Group 4--medroxyprogesterone (Depo-Provera) 35 mg/kg/day, Group 5--methylprednisolone 1 mg/kg/day and medroxyprogresterone 35 mg/kg/day. Wound contracture and epithelization was measured by planimetry of photographs taken twice weekly; weekly weights were recorded, and the maturation phase of wound healing followed in the control and methylprednisolone groups. All three steroids prolonged the latent phase of wound healing, slowed the rate and decreased the total amount of contracture. Cortisone showed the most inhibition of wound contracture and was the only steroid to inhibit epithelization suggesting it may have a slightly different or more potent mode of action. When the methylprednisolone group was followed for seven weeks on daily injections, the maturation phase of wound healing was inhibited, and this inhibition persisted during the next nine weeks after the drug was withdrawn. Only the control and the medroxyprogesterone group gained weight. Combining medroxyprogesterona and methylprednisolone resulted in the severest weight loss of 20% with a 60% mortality.


Laser surgery in exsanguinating liver injury. Thirty-two conditioned 15-18 kg dogs underwent laparotomy, heparinization, left lateral hepatic lobe injury and subsequent partial left lateral hepatic lobectomy. The hemostatic capabilities of the surgical scalpel combined with suture ligatures and stay sutures, the Bovie, and the CO2 laser were compared. The CO2 laser proved significantly more effective in achieving hemostasis both in comparison to the Bovine and the surgical scalpel combined with classical methods. The postoperative mortality utilizing the Bovie was 11%, the scalpel 30% and the laser 23%. Two of the three laser deaths were related to a bulky laser delivery system which can be redesigned. Postoperative laboratory evaluation revealed that SGOT, LDH, alkaline phosphatase, total protein, albumin and hemoglobin levels were altered in the postoperative period but returned to normal levels in uniform fashion in all groups. There was no statistical difference between various surgical modalities with regard to these parameters. The white blood count was significantly lower in laser dogs when compared to the other two groups. Other laboratory parameters were unchanged. Damage to liver tissue may be less extensive when the laser is utilized as opposed to the Bovie or stay suture methods of hemostasis and healing is equally good. The CO-2 laser is considered a valuable ancillary tool in hepatic resection and clinical evaluation is warranted.


Carcinoembryonic antigen and prognosis in patients with colon cancer. One-hundred and fifty patients with non-metastatic colo-rectal cancer were followed for a period of 24 to 36 months postoperatively. Preoperative CEA values have been shown to correlate with the extent of the disease and the patient's prognosis. The prognosis for recurrences is greater in patients with elevated pre-operative CEA values regardless of the stage of their disease. This tendency to have recurrences is 1.8 times higher in individuals with increased pre-operative CEA levels. This same relationship occurs to a greater or lesser extent at each stage of the disease.


Management of umbilical hernias associated with hepatic cirrhosis and ascites. A series of 35 umbilical herniorraphies in patients with cirrhosis of the liver is reported. In this group there were eight significant complications (22%) and six deaths (16%). There was no evidence in this study of increased likelihood of esophageal variceal bleeding secondary to the interruption of portosystemic collaterals in the umbilical region. An aggressive surgical approach is indicated in cirrhotic patients, with umbilical herniae complicated by incarceration, strangulation, rupture, ulceration, and leakage of ascitic fluid. On the other hand it is recommended, that repair of non-complicated umbilical herniae be delayed until the cirrhosis is stabilized, ascites has diminished and nutrition has been improved. In many instances herniorrhaphy may not be necessary after disappearance of ascites.


Management of ileal perforation due to typhoid fever. The results of the surgical management of 161 cases of ileal perforation due to typhoid fever are presented. Most were seen after an illness of 2-4 weeks, and because of delays in seeking hospital admission, more than half were explored more than 24 hours after their perforation occurred. All patients were prepared for operation with nasogastric suction, intravenous fluids, and antibiotics. At laparotomy, 80% had considerable quantities of pus and small bowel contents in the peritoneal cavity and the remainder had localized abscesses; there were no instances of localization of the perforation. One hundred three of these patients underwent simple closure of their perforations, while 43 underwent small bowel resection, usually because of multiple perforations. Exteriorization or drainage were performed only in patients too sick to tolerate a more appropriate procedure. The overall mortality was 9.9%. The authors believe that typhoid perforations can best be dealt with at operation. Delay in operative intervention adversely affects the survival rate after surgery. Chloramphenicol is used as the drug of choice.


The surgeon, the surgery, the patient, and the disease: factors complicating colonic surgery. A review of 231 cases of colonic operations performed during the year 1971 by, or under the supervision of, 32 attending surgeons in an 850 bed private community medical center was undertaken. The overall mortality rate was 5.6% while a 35.5% overall complication rate was also noted. Factors significantly associated with increased overall complication rate were: emergency operations, preoperative anemia (hemoglobin less than 10 gm%), preoperative hypoalbuminemia (serum albumin less than 3 gm%), preoperative obstruction, malignant lesions of the colon and ulcerative colitis, prolonged operation, operations requireing a large quantity of packed cell transfusion, coexisting hepatic disease and operations performed by surgical attending staff under 50 years of age in this institution. Each of these factors is discussed individually. Several factors that were expected to be associated with increased complication rate failed to show significant statistical correlation in this series. These are: age of the patient, coexisting diseases other than hepatic disease, absence of prophylactic parenteral antibiotics, preoperative perforations and operations involving resection of the colon. Hypotheses are offered to explain a number of unexpected poor correlations.


Traumatic injuries to the duodenum: a report of 98 patients. Data of 98 patients who had sustained traumatic injuries to the duodenum during a recent 7-year period is reviewed. The overall mortality was 23.5%; that of the blunt injury group was 35%, that of the penetrating injury group was 20%. However, after the establishment of a trauma unit, the mortality for duodenal injuries fell from 32% to 12%. Death from duodenal wounds may be reduced by earlier hospitalization, earlier diagnosis and consequently earlier surgical repair. Vigorous treatment of shock is essential. A specialized trauma unit with personnel experienced in the management of shock and trauma problems provides a better environment to carry out the preoperative and postoperative care of the acutely injured patient. Adequate surgical treatment of the blunt injury and missile injury of the duodenum should consist of the following procedures: 1) repair of the duodenal wall utilizing conventional techniques; 2) internal decompression of the repair by afferent jejunostomy; 3) efferent jejunostomy for postoperative feeding; 4) temporary gastrostomy; and 5) external drainage of the repair. In certain selected instances, the simple stab wound of the duodenum may be treated by conventional repair without decompression, but a loop of jujunum should be sutured over the repair to prevent delayed disruption. The majority of patients with injuries to the duodenum have associated organs injured which also require considered surgical judgment and action.


Physiologic effects of hyperventilation and phlebotomy in baboons: systemic and cerebral oxygen extraction. Eighteen anesthetized baboons were studied to determine the effects of passive hyperventilation and phlebotomy on oxygen transport. After 1 hour of hyperventilation a significant increase in the red cell affinity for oxygen occurred in vivo. This was not associated with any significant changes in cardiac output, oxygen consumption, or in lactic acid production. There was a 40% decrease in cerebral blood flow, a 10 mm Hg decrease in the pulmonary artery Po2 level, and a 17 mm Hg decrease in the jugular venous Po2 level. After 1 hour of hyperventilation, the plasma inorganic phosphorus level decreased significantly, the red cell ATP level decreased slightly, and the red cell 2. 3 DPG level increased significantly, indicating that inorganic phosphorus had been removed from the blood during hyperventilation. Passive hyperventilation was maintained, and the baboons were bled 32% of their red cell volume. The blood volume was partially restored with nonbuffered isotonic saline. One hour after the phlebotomy and volume restoration (2 hours of hyperventilation) there were no changes in oxygen consumption, cardiac output, cerebral blood flow, or blood lactate levels, but the pulmonary artery Po2 level was decreased by 15 mm Hg, and the jugular venous Po2 level was decreased by 20 mm Hg. Systemic oxygen consumption was not affected by the significant decrease in pulmonary artery Po2.


Esophageal perforation: an increasing challenge. Esophageal perforation continues to be a challenge. The overall incidence is rising even though iatrogenic perforations are decreasing. With early diagnosis followed by prompt surgical treatment, most patients can be expected to survive. Roentgenographic contrast studies demonstrated a perforation in all but 1 of our patients who had this examination and should be used early in patients suspected of having an esophageal perforation. The mortality rate is directly related to the interval between perforation and initiation of treatment. Nonoperative treatment, even for cervical esophageal perforations, is not advocated. An aggressive approach, consisting of closure of the perforation and adequate drainage, is indicated for both diagnosis and surgical treatment.


Use of intercostal muscle in primary repair of esophageal atresia with tracheoesophageal fistula. Forty-one patients with esophageal atresia and distal tracheoesophageal fistula underwent primary repair. Results are compared among patients in whom an intercostal muscle graft was interposed between the trachea and esophagus and those without the graft. Patients with muscle interposition had lower morbidity and mortality and better long-term results.


Anesthesia for prolonged bronchoscopy.

Anesthesia for prolonged bronchoscopy. At the Mayo Clinic, experience with 22 patients undergoing bronchoscopy on 29 occasions has shown that prolonged operative manipulation in the airway can be carried out safely and satisfactorily using general anesthesia. Requisites for this procedure include a period of apneic oxygenation, an adequate-sized endotracheal tube, hyperventilation of the patient during operative manipulation, and careful attention to management of postoperative bronchospasm. Prolonged bronchoscopy under general anesthesia has permitted localization of occult bronchogenic carcinoma at an earlier stage than has been possible up to this point.


Transbronchial catheterization of pulmonary abscesses. A major indication for bronchoscopy in patients with pulmonary abscess is the need to establish adequate drainage. Often, associated bronchial swelling precludes direct entry into the cavity with standard suctioning devices. Satisfactory drainage may require numerous bronchoscopic procedures, prolonging hospitalization and subjecting the patient to the complications of pyogenic pulmonary abscess. We have recently adopted the technique of passing angiography catheters through the rigid bronchoscope into the abscess cavity, thereby facilitating the bacteriological diagnosis and drainage of the cavity.


Current concepts in thoracic drainage systems. Thoracic drainage systems are currently marketed in many varieties, resulting in significant cost and complicating patient management. Realistic needs have been identified from a survey of thoracic surgeons. These are: (1) clear plastic chest catheters with multiple drainage holes in sizes 28, 32, and 36F for adults and 16, 20, and 24F for infants and children; (2) serrated plastic connectors that can be sized at operation; (3) connecting tubes of clear plastic 6 feet long with a diameter of 1/2 inch; (4) a single graduated volume-collecting bottle of 1- to 2-liter capacity that can be emptied and marked, with a separate waterseal component and an associated manometer; and (5) a highflow vacuum source. A drainage system with these characteristics should be safe, effective, simple, and less costly.


Subdural hematoma following open-heart operations. Six patients who died following open-heart operations were found at postmortem examination to have acute subdural hematomas. On the basis of the clinical and postmortem findings, two factors in the pathogenesis of the hemorrhage are postulated. In the presence of intraoperative heparin administration, significant hematoma formation may result from damage to the bridging dural veins from minor, inadvertent head trauma or alterations in cerebral volume from fluid shifts. Manipulation of the head in patients who have been given heparin should be undertaken with extreme care, particularly in infants. In any patient with neurological dysfunction who has also had an open-heart operation, the possibility of an expanding subdural hematoma must be considered.


Late complications of aortic valve replacement with cloth-covered, composite-seat prostheses. A six-year appraisal. Advanced actuarial techniques are used to analyze early and late results in a closely followed series of 396 patients who received a cloth-covered, composite-seat aortic prosthesis. Late mortality and various complications are carefully assessed, and most late deaths are seen to be unrelated to the prosthesis. One hundred sixteen patients with Model 2310-2320 prostheses who received warfarin postoperatively had no thromboembolic complications in 360 patient-years of follow-up (average, 3.1 years per patient); 134 patients who had the same prosthesis but did not receive warfarin had 9 emboli per 100 patient-years (average follow-up, 1.7 years per patient; total, 228 patient-years). By comparison, in 9 years' experience with non-cloth-covered Model 1200-1260 valves, 132 patients had 4.0 emboli per 100 patient-years (average follow-up, 5.1 years; total, 673 patient-years). The safety of cloth-covered valves is clearly enhanced by concomitant use of anticoagulants; the possibility that antiplatelet drugs may suffice has not yet been demonstrated. Strut cloth wear was found at reoperation in 10 patients. The Model 2400 composite strut ("track") valve with a narrow metal track on the inner surface of each strut prevents this complication.


Effects of an abdominal left ventricular assist device on myocardial oxygen supply/demand ratios in normally perfused and ischemic bovine myocardium. The effects of an abdominal left ventricular assist device (ALVAD) on subendocardial oxygen supply/demand ratios as reflected by diastolic pressure-time index/tension-time index (DPTI/TTI) were investigated in calves. Control DPTI/TTI ratios were 1.09 plus or minus 0.12 (mean plus or minus SD). With ALVAD actuation the ratios increased to 5.73 plus or minus 3.2. Following circumflex coronary artery occlusion, control ratios decreased to 0.04 plus or minus 0.05 in the ischemic area and 0.97 plus or minus 0.20 in the nonischemic areas. With ALVAD actuation in the presence of circumflex occlusion, the depressed ratios were increased to 1.37 plus or minus 0.39 in the ischemic zone and 9.71 plus or minus 2.5 in the nonoccluded segments. Subendocardial oxygen supply/demand ratios were significantly improved by ALVAD assistance following induced subendocardial ischemia.


A simple model of the hemodynamic effects of a proximal coronary artery narrowing. A simple mathematical model of the hemodynamic effects of a discrete proximal coronary artery obstruction is presented. The model demonstrates that resting myocardial flow demands fail to be met when the vessel diameter is decreased by 75% or greater. More strikingly, it shows that the maximum flow obtainable for increased myocardial oxygen demand begins to fall significantly with a lesion causing a 40 to 50% obstruction. The implications of these findings in relation to stress-induced angina are discussed.


Primary amyloidosis of the respiratory tract. Two patients with solitary amyloidosis of the respiratory tract are discussed. Bronchial obstruction caused by amyloid deposits led to the death of our first patient. Diagnosis in the second patient was made after removal of a localized amyloid deposit within the lung parenchyma.


Coronary venous retroperfusion for myocardial revascularization. Although the use of retrograde arteriovenous bypass perfusion may seem appealing in those patients with diffuse occlusive coronary artery disease in whom arterial bypasses are not possible, the likelihood of success seems small. Experimental evidence indicates that such retroperfusion in opposition to antegrade perfusion causes the myocardium to become hemorrhagic. Further experimental evidence indicates that this damaging effect on the myocardium may be prevented by a second bypass which vents the arterial side to a low-pressure system.


Microbodies in methanol-assimilating yeasts. Cells of 3 yeast species capable of assimilating methanol have been examined by electron microscopy. When grown on methanol as the sole source of carbon and energy they contained many microbodies. Cells grown on glucose or ethanol either did not contain such bodies at all, or only to a limited extent.


Amino sugar and amino acid constituents of the cell walls of the extremely halophilic cocci. Cell wall hydrolysates of nine strains of extremely halophilic cocci all contained gylcine, glucosamine, galactosamine, and gulosaminuronic acid. Muramic acid was not present in any of the strains.


Utilization of mental health services. I. Patienthood and the prevalence of symptomatology in the community. We explored the association between patienthood and prevalence of symptomatology in the community. Base line data on prevalence were obtained through the use of a household survey. Characteristics of survey respondents (N equals 938) and patients admitted from the surveyed area to a Connecticut Mental Health Center during a 12-month period (N equals 808) were compared. High utilization of facilities was associated with the prevalence of symptoms in the community, particularly where defining characteristics were descriptors of disadvantaged social status. A second set of variables correlated with mental health center use but not with the prevalence of symptoms in the community. By and large, these characteristics describe a lack of social supports not necessarily related to social status. Finally, certain groups were underrepresented as patients even though comprising polulations-at-risk in terms of levels of symptom impairment in the community.


Utilization of mental health services. II. Mediators of service allocation. Data were obtained from a mental health survey of a representative sample of 938 adults from a defined geographic area and 808 patients from the same area who were admitted to a community mental health center. Multivariate techniques were used to isolate factors that best predicted mental health center use. The existence of "patienthood" as a dimension of residence-related behavior was confirmed. Although psychological impairment was predictive of patienthood, other factors including age and familial and social disorganization also acted as mediators of patienthood. Indexes of social status, such as race and social class, did not emerge as major allocative mediators.


Natural history of male psychological health. III. Empirical dimensions of mental health. In a nonpatient polulation, the concept of mental health was operationally defined both in terms of behavior and of abstract psychological functioning. Ninety-five college sophomores, selected for psychological health, were prospectively followed up for 30 years. They were assessed by independent raters on a scale reflecting objectively defined healthy adult adjustment; on a scale of clinically defined psychiatric illness; and on a scale of maturity of ego defenses. These three scales were highly correlated. It seemed likely that relatively objective items like length of vacation, divorce, heavy use of mood-altering drugs, career dissatisfaction, and visits to medical physicians can--as a cluster--statistically identify the abstract concept of mental health.


Developmental aspects of aging in women. A comparative study of dreams. Changes with age in the nature of women's inner experience were investigated through a comparison of the manifest dreams of a group of older women (ages 40 to 85 years) with the dreams from two groups of younger women (ages 18 to 26 and 16 to 17 years). The major comparative findings include a narrowing down of internal personal investments, a decrease in concerns about aggression, a decrease in the dreamer's sense of herself as pivotal, and, strikingly, an augmented amount of internally represented robust and locomotor activity for the older women. These results seem to correspond with other reports in the literature on the experience of aging women.


Reactive psychoses. A family study.

Reactive psychoses. A family study. Reactive, or psychogenic, psychoses have been given the most attention in the literature by Scandinavian investigators. We defined diagnostic criteria for reactive psychoses emphasizing differences with manic-depressive psychoses and schizophrenia. Forty Danish probands were selected and family history data was obtained by personal interview and record review. In order to compare our results with other investigations, we age corrected family history data. Siblings of reactive probands were found to have significantly more reactive psychoses than siblings of manic-depressives or schizophrenics, and significantly less schizophrenia than siblings of schizophrenics. Although there was some genetic overlap with manic-depressive psychosis, we believe that the findings are sufficiently distinct to warrant the separate diagnostic category of reactive psychoses.


A longitudinal study of three brain damaged children. Infancy to adolescence. The developmental course of three children with brain damage (now 14 to 16 years of age) was followed since early infancy in the New York Longitudinal Study. Data on behavioral characteristics, patterns of parental attitudes and practices, clinical neurological, and psychiatric evaluation, and psychometric findings at different age periods are available. Each child has shown a different behavioral course that could not be explained only in terms of motor dysfunction, intellectual deficit, patterns of parental management and attitudes, or more general features of environmental demand alone, but also required a consideration of the constellation of temperamental organization. Patterns of adaptation and levels of functioning were the complex product of the interaction of all these factors. One child developed the clinical syndrome of childhood schizophrenia.


Parent-child relationships and psychopathological disorder in the child. This report uses naturally occurring adoptions to tease apart the effects of heredity and rearing on the development of psychopathological disorder in the child. The quality of relationship between the child and his adoptive parents was assessed in four groups of subjects, and the degree of illness in the child was correlated with the quality of parent-child relationship. Quality of rearing and hereditary input both affect the development of psychopathological disorder, but the amount of variance explained by rearing tends to be low.


Human growth hormone response to levodopa. Relation to menopause, depression, and plasma dopa concentration. After ingestion of 500 mg of levodopa, postmenopausal women had significantly diminished human growth hormone (HGH) responses (mean, 4.6 ng/ml), as compared with those of age-matched men (mean, 9.1 ng/ml; P smaller than .05). The differences between the groups were not related to plasma dopa concentrations. The HGH responses to levodopa of age-matched unipolar and bipolar depressed men, and of unipolar depressed postmenopausal women, did not differ significantly from their respective normal control groups. Depressive illness of these types does not appear to affect the HGH response to levodopa, once the effect of the menopause is taken into account.


Dimensional diagnosis and the medical student's grasp of psychiatry. Two problems that interfere with the student's understanding and acceptance of psychiatric knowledge result largely from the use of a categorical model for psychiatric diagnosis. These two problems are: (1) the apparent inapplicability of the standard system of psychiatric diagnosis to real patients; and (2) the apparent irrelevance for general medical practice of psychiatric diagnosis and theory. Both problems may be avoided by presenting psychiatry in the framework of a multidimensional diagnostic schema that used familiar terms but treats them as dimensions with severe, moderate, and mild degrees of impairment rather than as categories of mutually exclusive psychiatric diseases. A teaching program is described in which detailed review of student interviews with psychiatric and especially nonpsychiatric patients is employed to demonstrate the usefulness of multidimensional psychiatric diagnosis.


An alternative frame of reference for rehabilitation: the helping process versus the medical model. In rehabilitation the frame of reference of the helping professions is significantly different from the standard medical model in the following areas: the dynamics of the relationship, basis for client's trust of the professional, activity versus passivity of both the client and the professional, and the approach to identification and solution of client problems. "The helping process" as practiced in the helping professions is not doing the task, but assisting the client to do it himself, for himself. In this process the needs, values and feelings of both the helper and the helpee must be recognized and dealt with. For the helping process to be successful, three basic conditions are required: development of mutual trust, joint exploration of the problem(s) and listening by both sides. Also involved in attaining success in the helping process is an awareness of not only the barriers in receiving help but also the difficulties in giving help.


Effectiveness of aides in a perceptual motor training program for children with learning disabilities. A program for children with learning disabilities associated with perceptual deficits was designed that included elements of gross and fine motor coordination, visual and somatosensory perceptual training, dance, art, music and language.  The effectiveness of nonprofessional "perceptual-aides," who were trained in this program, was evaluated.  Twenty-eight children with learning disabilities associated with perceptual deficits were treated by occupational, physical, recreational and language therapists; and 27 similarly involved children were treated by two aides, under supervision, after training by therapists.  Treatment in both groups was for four hours weekly over a four to seven month period.  There was significant improvement in motor skills, visual and somatosensory perception, language and educational skills in the two programs. Although there was no significant difference between the two groups, there was a slight advantage to the aide program.  The cost of the aide program was 10 percent higher than the therapist program during the first year, but 22 percent lower than the therapist program during the second year.


Time care profile: an evaluation of a new method of assessing ADL dependence. Valid and reliable measures of dependency in activities of daily living (ADL) remain a critical area in rehabilitation medicine for determining the patient's progress and assessing program effectiveness.  This paper describes a new approach to ADL evaluation which utilizes a diary method to record the amount of time the patient receives assistance during the course of a normal day as an index of dependency.  Results from a validity study using this approach on hospitalized patients in which staff members made on-the-spot time recordings of assistance provided suggest the following conclusions: (1) a diary-type record of information indicating the length of time (time measurements) an activity lasted is relatively inaccurate; and (2) the same kind of diary approach provides a highly accurate record of the number of times (frequency measurements) an activity occurred and the distribution of assistance throughout the day.  In five of six activities studied, frequency measurements recorded by staff members agreed with those of an independent observer 84 percent or more of the time. Frequency measurements in a diary format appear to represent a feasible and useful method for quantifying and evaluating patient performance in nontest situations.


Excitation overflow: an electromyographic investigation. The amount of excitation overflow into a nonactive upper limb can be predicted when the active limb is isometrically contracted during a standardized exercise.  Bilateral electromyographic recordings from the biceps brachii and brachialis demonstrated that the amount of excitation overflow in the nonactive limb is between 10 percent and 20 percent of the maximal intensity of activity measured in the exercised limb.  This amount appears to be independent of the position of the active limb (supination, neutral, or pronation) and the amount of force used during the isometric contraction exercise.  Excitation overflow, using the exercise described, should be considered as a reliable rehabilitation technique for maintaining a degree of muscle tone and tissue turgor in a limb that is temporarily immobilized.


Verlo orthosis: experience with different developmental levels in normal children. Fifty-three normal children ranging in age from 11 to 36 months were trained to ambulate 3 meters in the Verlo brace using a walkerette.  The children were divided into five age groups: 11 to 15 months, 17 to 21 months, 22 to 27 months, 29 to 34 months, and 35 to 36 months.  The age groups were compared with respect to the percentage in each group that completed the training protocol and the average number of minutes required by those subjects to do so.  Results ranged from a low 36 percent completion with an average training time of 366 minutes in the youngest age group to a high of 100 percent completion with an average training time of 70 minutes in the oldest age group.  There was an increasing tendency in the three older groups to resist getting into the brace.


Rehabilitation care course for paraprofessional personnel. A survey of training activities was conducted at Mass Rehabilitation Hospital by Research and Training Center No. 8 (RT-8), Temple University, Philadelphia. The findings revealed that primary teaching consideration was being given to trainees from affiliated institutions and professional employees rather than allied health professional personnel (occupational and physical therapy aides, nursing assistants and hospital corpsmen). This personnel group is the largest group of employees who spend the most time with patients, but have the least amount of formal education or training. A second survey of this group revealed they were interested in a continuing education course designed for them. As a result of the surveys, a course entitled, "Aspects of Rehabilitation Care," was designed for paraprofessional employees. The nine-month course was designed so that the material and language was kept at an appropriate level, with supplemental material and audiotapes of the course available for review. The lectures were evaluated each week by the students and this data was analyzed by RT-8. Results indicated that attendance was good, averaging 54 (73%) persons per week, and the course was a success as a learning experience. This paper presents the need, organization, content and evaluation of a rehabilitation care course designed for paraprofessional personnel.


Fabrication of a polysar, temporary prosthesis in a hospital setting. The Physical Therapy Department at Kessler Institute for Rehabilitation has been fabricating temporary prostheses since 1967.  Initially, these below-knee limbs were constructed with a plaster socket attached to a modular type prosthesis.  Early in 1970, we began to use polysar, a thermoplastic compound.  It is nonirritating to the skin, light, durable, easily moldable, relatively inexpensive, retains suspension mechanisms adequately, and allows the production of a cosmetically acceptable training limb.  Because we had difficulty with the direct forming method as described by Staros and Gardner, the indirect method was adopted.


Therapeutic groups for patients with spinal cord injuries. A preliminary study was conducted to determine the effectiveness of therapeutic patient groups in a rehabilitation setting.  A spinal cord knowledge "Inventory" test was designed to evaluate the success of the group method in disseminating information to patients.  The first part of this test assesses the patient's knowledge about body physiology and functioning, health care, and community resources.  The second part attempts to evaluate the patient's feelings regarding his body image, sexual attractiveness, and family relationships.  The test was administered to 31 spinal cord injured patients upon admission and again just prior to discharge.  Eighteen patients participated in a therapeutic patient group, which met twice  a week for a month.  The other group did not participate in such sessions. The purpose of the meetings was to help the patient adjust to his disability by exchanging commonly needed information and discussing experiences and feelings.  Initial results suggest that therapeutic groups can provide an effective means for imparting information to patients.  The test also indicates that many patients experience changes in their attitudes and feelings around such sensitive areas as personal worth and self-esteem.


Frequency of training as a determinant for improvement in cardiovascular function and body composition of middle-aged men. Frequency, duration and intensity of training have been shown to be important determinants for improving various physiological functions. This report represents a series of six training investigations conducted by the investigators over the past seven years. Within the six investigations ten separate groups were studied. These data were combined and tabulated to look at frequency of training as a determinant for improving cardiovascular function and body composition of middle-aged men. The subjects included 148 healthy, sedentary, volunteer men ranging from 28 to 64 years of age (x equal to 41). The experiments were carefully controlled and included running 30 to 45 minutes for two (four groups), three (three groups) or four (three groups) days each week for 20 weeks. The results show that all frequencies had a significant effect on cardiovascular function, but only three and four days/week regimens showed reduction in total body weight and fat. Changes in maximum oxygen consumption (VO2 max) were similar for two and three days/week programs, and significantly greater for four days. The data support the notion of frequency of training being an important criterion for improving cardiovascular function and body composition.


Temperature distribution produced in models by three microwave applicators at 433.92 megahertz. Temperature distributions produced in phantom models by diathermy applicators operating at a frequency of 433.92 MHz, a frequency not approved for diathermy by Federal Communication Commission regulations, and an experimental cooled contact applicator operating at an assigned frequency of 915 MHz were compared. The specially designed direct contact applicator with surface cooling elevated deep muscle temperatures as effectively as the "Rundfeldstrahler" operating at the lower frequency in spite of the better penetration of the energy at the lower frequency. The "Pyrodor" and the "Langfeldstrahler," the largest of the applicators operating at 433.92 MHz, do not appear to offer any advantage over existing diathermy equipment. The highest temperatures produced with these applicators were at the fat-muscle-interface.


Optimal isokinetic loads and velocities producing muscular power in human subjects. The torque values of the quadriceps muscles of 16 college football players were tested by means of an isokinetic dynamometer in order to determine the optimal loads and velocities producing muscular power. The men were tested at velocities ranging from 5 to 25 rpm and throughout a range of knee extension between the positions of 85 degrees to 50 degrees of knee flexion. Isometric measures were also recorded at corresponding angles. The muscular torque values recorded isokinetically at the various velocities were then compared to the isometric forces at the corresponding angles of knee extension to ascertain the arithemtic proportion of isokinetic to isometric torque which produced maximum muscular power. The results indicated that the proportionate values of isokinetic to isometric torque and isokinetic velocities which produced maximum power were not directly comparable to similar loads and velocities found in vitro. The weight of the leg may have contributed to submaximal isometric recordings, thus resulting in higher proportionate values of isokinetic to isometric force. Changes in these values as the knee was extended were deemed to be a result of variance in the isometric torque since the isokinetic torque stayed relatively constant throughout the range of movement. The data suggested that a plateau of isokinetic torque may have been reached in the production of maximum power. Maximum isokinetic torque values tended to shift to more extended joint positions as the speed of knee extension increased. This shift may have been due to the momentum of the leg during the faster isokinetic speeds overcoming some of the inertia of the weight of the leg as it was extended.


American Indian sign: a gestural communication system for the speechless. American Indian sign, used as a gestural communication system for the speechless, served the daily life needs of patients with a variety of deficits, many with unfavorable prognosis for oral speech rehabilitation. The project included total glassectomees, laryngectomees, dysphonics, dysarthrics and apraxics. Many of the last named were hemiplegics. The sign was effectively interpreted by hospital personnel, patients and visitors, none of whom had received any instruction in interpreting the sign. This system may be a desirable new tool from an old culture for the professional repertoire of the speech clinician. An illustrated manual and instructional videotapes are in preparation.


Pressure sores: an operant conditioning approach to prevention. A training system for the prevention of pressure sores has been designed to teach the paralytic person to relieve pressure intermittently from his ischium while sitting in a wheelchair. The system automates the training of wheelchair pushups, and conditions the person into exercising, based upon modified avoidance learning procedures. Results indicate that the paralytic person can be trained to pushup intermittently and efficiently using this system, thus reducing the incidence of pressure sore formation. Further long-term study is needed to assess the effectiveness of the training system as a preventative program for pressure sores.


The reality of restorative care in Harlem's municipal hospital: the patient as a therapeutic agent. Motor-oriented rehabilitation programs are of limited value in attaining the goals of the physically impaired poor in the cities. The location and the physical and social structure of the ghetto municipal hospital and the population served necessitate modification of rehabilitation methods. Patients must participate in decision-making. Staff must assist the patient in attempts to change the environment. In the process of working closely with patients towards non-motor goals, professionals learn to play the role of the advocate.


Mate swapping: Perceptions, value orientations, and participation in a midwestern community. This article attempts to illuminate the understanding of swinging, or mate swapping, an increasingly common form of extramarital sexual activity. A theoretical  formulation argues that swinging is a form of extramarital sexual activity which serves to define as good and acceptable a behavior that in other forms and in the past has been considered deviant or immoral. A stratified area probability sample of 579 married adults was drawn from a Midwestern community of 40,000. Areas investigated included community knowledge and perception of swinging, values of respondents with regard to participation in and acceptance of swinging, and the incidence of swinging in the community. Most respondents dispproved of mate swapping as well as other forms of extramarital sex. Over half of the respondents knew about mate swapping, although less than 7% of the sample would consider participating. Swinging was found to exist in the community, but less than 2% of the respondents had ever participted. The data analysis is descriptive and exploratory, focusing on social correlates and characterisitics.


Volunteer bias and personality traits in sexual standards research. The effects of personality traits and volunteer bias in sexual standards research were studied. Two hundred and fifty-four subjects completed Jackson's Personality Research Form (PRF) and were subsequently sent either a sex or a control questionnaire. Return rates for the two groups were comparable. Also, the analyses of the PRF scores failed to show sex volunteers as having unique personality characteristics. These results are interpreted as grounds for rejecting the widely held stereotype that volunteers for sexual standards surveys are inevitably an atypical, deviant group. The possible limiting effects of age and method of soliciting information are discussed.


Male to female: the role transformation of transsexuals. Twelve male transsexuals were found to have acquired a successtion of gender roles from childhood to adulthood-ambivalent, homosexual, drag queen, and transsexual. Thse roles constituted different stages of their livers during which they were clarifying their psychosocial gender role as transsexuals. Their transition through these roles suggests that these individuals are a subset of the transsexual phenomenon, for many--probably most--other transsexuals do not adopt these roles prior to becoming adult transsexuals. The social interaction of these transsexuals with significant others differed from the ways in which sociological role theories view this process: the significant others in their lives (apart from their mothers) primarily influenced their role changes by withdrawing from and/or rejecting these individuals--not by inducing them to conform to their role expectations. As permanently cross-dressed transsexuals, these individuals continued to associate with the institutions of the gay world, which alone was tolerant of them and where they could draw on the emotional support of other transsexuals in this last presurgery role. At this point they had become their own reference group.


Families of seven male-to-female transexuals after 5-7 years: Sociological sexology. Four black and three whilte families have a male-to-female transexual member surgically reassigned more than 5 years ag. The black families were more open than the white in declaring the reassignment within the family and community. Thereby they relieved themselves and the transexual member of a need for deception, defiance, or defensiveness, and they were less scheming and manipulative. Without the anxiety of concealment, they could feel more positive about sex reassignment as a form of rehabilitation. A formal public declaration of sex reassignment, analogous to a declared change of citizenship, would be advantageous in transexual rehabilitation.


Heterosexual copulatory patterns in stumptail macaques (Macaca arctoides) and in other macaque species. A comparison of the mating behavior patterns of several macaque species reveals that the mating behavior of Macaca arctoides exhibits several unique features. The laboratory groups of stumptail monkeys observed had exceptionally long single-mount copulations characterized by a large number of pelvic thrusts, a slow thrusting rate, and an unusually salient male orgasmic pattern (characterized by body rigidity followed by body spasms and a typical facial expression and vocalization). The frequency with which the copulation culminates in ejaculation is unusually high, and copulating stumptails generally manifest "tieing" in a genital lock after ejaculation.


Spasm and operative cholangiography.

Spasm and operative cholangiography. Operative cholangiography is a commonly employed adjunct to biliary operation and is useful in identifying unsuspected common duct calculi. Spasm of the sphincter of Oddi from administration of anesthetic agents like fentanyl citrate (Sublimaze) and morphine sulfate and from operative manipulation may lead to misinterpretation of the cholangiograms and unnecessary surgical procedures that increase morbidity and mortality. Six case reports illustrate these hazards, and the influence of medications that exacerbate spasm of the sphincter of Oddi is emphasized. Recognition of the factors that cause spasm of the sphincter of Oddi will prevent unnecessary common duct explorations and reduce morbidity and mortality in biliary tract operations.


Humoral and secretory antibody responses to immunization with low and high dosage split influenza virus vaccine. Tri (n-butyl) phosphate (TNBP)-split vaccine containing 6400 CCA units of influenza virus A/Aichi/68 (H3N2) was given intramuscularly to a group of volunteers. The changes in serum haemagglutination-inhibiting (HI) and nasal wash neutralizing antibody were measured, and the results compared with that of volunteers given a TNBP-split vaccine containing 400 CCA of the same virus. More volunteers given the high-dose vaccine developed a fourfold rise in serum HI antibody, and there was a greater increase in geometric mean titre in this group. In addition, more volunteers given the high-dose vaccine developed detectable nasal wash neutralizing and anti-neuraminidase antibodies. Following low-dose vaccine, the production of nasal wash antibody was not related to the serum antibody response. For both groups given vaccine, antibody was detected most frequently in nasal washings with relatively high levels of protein and IgA; the concentration of IgA was also directly related to the protein concentration.


An attenuated variant of Eastern encephalitis virus: biological properties and protection induced in mice. Wild type Eastern equine encephalitis virus (E) was compared with a mutant (Em) derived from it. The latter was tested as an attenuated vaccine in mice. They differed in the following properties: Em formed smaller plaques on chick embryo (CE) cell monolayers and, unlike E, did not plaque on mouse embryo (ME) monolayers. Futher, Em had a longer latent period and attained a lower peak titer than E after infection of CE cells, was more senssitive than E to chick interferon, and was less virulent for mice (SC and IP routes) and hamsters (IP route) than E. Both viruses were similar in several other properties tested. The mutant was found to induce a gradient in the specificity of protection in mice against challenge by selected viruses after a single subcutaneous injection of living virus. The protection was best against autologous (Em) challenge, was next best against challenge by the virulent parent (E) virus, but was not demonstrable against cross challenge by Venezuelan encephalitis (V) virus. Conventional hemagglutination-inhibiting (HI), complement-fixing (F), and neutralizing (N) antibodies could not be detected in Em-immunized mice even when fresh monkey or guinea pig serum was included in Ntests to provide complement and/or accessory factor(s). However, N antibodies were detected in protected mice by an indirect antiglobulin test. Passive protection by serum or ascites fluids (a.f.) was characterized by a lower but otherwise similar protection gradient like that found after active immunization with virus as described above. Interferon was not detected in the a.f. used for passive protection, nor was heterologous interference evident in Em immunized mice challenged 18 days later with vaccinia or vesicular stomatitis virus. Immunized mice that survived autologous (Em) challenge showed broadened protection against a second challenge by parent E virus, and cross protection against V virus. This typical protection was associated with the presence of HI and conventional N antibodies, except for V which showed no detectable neutralizing antibodies by either a standard or antiglobulin technique.


Replication of a strain of feline calicivirus in organ culture. The zwitterionic buffer HEPES was used successfully to maintain organ cultures of kitten tongue and trachea for 10--15 days in vitro. A strain of feline calicivirus grew to high titres in both tongue and tracheal explants but it was not possible to ascribe specific histological changes to virus infection in either tongue or tracheal organ cultures. Cells in tongue explants retained specific virus receptors for at least six days in vitro and virus grew to high levels in the cultures infected six days postinitiation of explants. These results suggest that at least some strains of feline caliciviruses have tropism for lingual epithelium as well as respiratory tract tissues.


Study of the antigenic and immunogenic properties of neurovaccinia virus TS mutants. The antigenic and immunogenic properties of five ts mutants of neurovaccinia virus with markedly reduced pathogenicity for laboratory animals as compared with "wild" type virus were studied. The antigenic and immunogenic activities of the mutants correlated with their capacity to reproduce in the skin of the inoculated animals. When similar doses of UV-inactivated mutants were used for immunization of rabbits, significant differences (more than 100-fold) in their antigenic activity were found. When rabbits were immunized with active virus, neutralizing antibody in titer of 1:800 protected all the immunized animals against intracerebral challenge with log 4.0 LD50 of neurovaccinia virus. On the other hand, the neutralizing antibody formed in response to inoculation of UV-inactivated virus did not protect the immunized animals in titers exceeding 1:2560. A correlation between the antibody titer for "extracellular" virus and immunity in vaccinated rabbits has been demonstrated.


Isolation, characterization, and pathogenicity studies of a bovine respiratory syncytial virus. The isolation and characterization of a bovine respiratory syncytial (RS) virus is described. Serological studies indicate that bovine RS virus is widespread in Iowa cattle and that it is involved in some outbreaks of respiratory disease. Experimental infection in calves indicates that the virus can cause illness in calves, particularly those with serum neutralizing antibody.


The ribonucleic acid of infectious bronchitis virus. Analysis of the nucleic acid of infectious bronchitis virus by SDS polyacrylamide gel electrophoresis revealed an RNA of molecular weight 9.0 times 10-6 Daltons. The RNA was shown to have a sedimentation coefficient of 50.


Two cases of acute pandysautonomia.

Two cases of acute pandysautonomia. Two men had acute nonprogressive pandysautonomia. Both of them showed orthostatic hypotension, fainting in upright position, pupillary disturbances, diminished sweating, anacidity, and impotence. Case 1 showed considerable but inadequate improvement within 31 months. Case 2 recovered completely after 11 months. Clinical and pharmacodynamic investigations suggested that the main lesion was located in postganglionic fibers in case 1 and in preganglionic fibers in case 2. The cause of this disorder is unknown, although both patients had undergone substantial weight loss.


Glue-sniffing neuropathy.

Glue-sniffing neuropathy. Although industrial exposure to n-hexane is known to cause neuropathy, it is less well recognized that inhalation of n-hexane present in the vapors of some commercial contact cements is also neurotoxic to peripheral nerves. A young man with a long history of addictive glue-sniffing developed severe distal symmetrical polyneuropathy several months after switching to a cement containing n-hexane and gradually improved several months after switching to another cement containing no n-hexane. Fascicular biopsy of radial cutaneous nerve showed striking segmental distention of axons by neurofilamentous masses with secondary thinning of myelin sheath, paranodal myelin retraction, and widening velocities were correspondingly slow. We conclude that n-hexane used as a solvent in some contact cements may be neurotoxic when inhaled to excess and, further, that the neuropathy has characteristic electrophysiological and pathological features.


Myotonia. An evaluation of the chloride hypothesis. The muscle membrane in myotonia congenita is characterized by a normal resting potential with a greatly increased resting resistance usually attributed to a decrease in membrane chloride permeability (PC1). In this report, the hypothesis that decreased PC1 alone can account for the repetitive action potentials of myotonia is tested with a mathematical model of the muscle membrane and is shown to be valid. Reduction of Pc1 to 20% of control values will produce myotonic activity in response to a single stimulus. Membrane resistance and potential approximate those found experimentally. The model predicts that increasing external K+ will aggravate myotonia due to a reduction of PC15 while decreasing Kout will prevent repetitive spiking. Further, myotonia can be prevented by reducing peak membrane sodium permeability or by shifting the voltage dependency of the membrane rate constants for sodium in a depolarizing direction. These results are shown to correlate well with clinical observtonia.


Ocular skew deviation. Analysis of 100 cases. In 100 patients with ocular skew deviation, the lesion was usually on the side of the lower eye, particularly when patients with internuclear ophthalmoplegia were excluded, but exceptions were sufficiently frequent to diminish the clinical lateralizing value of skew. Pontine damage was most commonly encountered, but midbrain-pretectal and medullary lesions were frequent. The onset of skew frequently coincided with acute brain stem damage, and while a wide variety of diseases produced skew deviation, stem strokes were present in more than two thirds of the patients. The hypothesis that skew results from damage to tonic otolith-ocular pathways is generally compatible with both the known anatomy of otolith pathways and the clinical presentation of skew. Otolith function testing in patients with skew, further anatomical definition of otolith-ocular pathways, and clinicopathological study of discrete lesions associated with skew should help resolve the causative role of the otolith organs in skew deviation.


Convergence-evoked nystagmus. Congenital and acquired forms. Pendular nystagmus occurring during binocualr fixation and pursuit of near objects is true convergence-evoked nystagmus. Two forms of this nystagmus are described, one congenital and the other acquired in the course of multiple sclerosis. The congenital form was conjugate and the acquired form disjunctive. Neuropathological examination provided no morphological explanation for the congenital pattern. These two unique forms of nystagmus are induced by one of the visuomotor subsystems controlling convergence.


Aphakic retinal detachment. Management of the fellow eye. One hundred eighty-five patients with unilateral aphakic retinal detachment were studied to determine the frequency of retinal detachment in the fellow eyes undergoing cataract surgery. It was found to be four times higher than the frequency in those eyes that remained phakic (26% vs 7%). Despite the high incidence of detachment, 94% of the aphakic group had a final visual acuity of 20/60 or better in the second eye. At the time of surgery, the macula was still attached in only 17% of the 185 first eyes as compared to 57% of the 21 second eyes that developed an aphakic retinal detachment.


Occipital lobe arteriovenous malformations. Clinical and radiologic features in 26 cases with comments on differentiation from migraine. The differentiation of migraine headache, preceded by visual aura, from cerebral arteriovenous malformation (AVM) is often regarded as difficult. A study of 26 patients with occipital lobe AVM revealed two distinct syndromes in 18 patients--occipital epilepsy and occipital apoplexy. Occipital epilepsy is characterized either by elementary visual phenomena, such as brief flashes of light, or by dimming of a homonymous field. Occipital apoplexy results from hemorrhage and hematoma formation within the occipital lobe and is characterized by sudden headache and homonymous visual field loss. We conclude that patients harboring occipital AVMs may, indeed, have visual phenomena and headache that should not be confused with migraine because either a history of generalized seizure or bruits on examination will probably be present.


Microwave lens effects in humans. II. Results of five-year survey. Individuals selected on the basis of likelihood of occupational exposure to microwaves were subjected to a biomicroscopic examination of the lens. Control personnel were also examined along with them, the examiners having no knowledge of the exposure history of any examinee prior to or during the examination. Objective evidence of lens abnormality (opacities, vacuoles, or posterior subcapsular iridescence) was recorded and a comparison made between the two groups on the basis of that evidence. The comparison showed the two groups to be essentially the same and did not support the hypothesis that human lens damage is occurring in the military environment in this country. Instead, it tended to support the assumption that the existing safety level of 10 MW/sq cm is adequate.


Ultrastructure of human organ-cultured cornea. II. Stroma and epithelium. The stroma and epithelium of human corneas that had been stored in organ culture medium for 10 to 22 days at 37 C were examined by light and electron microscopy. Total corneal thickness was found to be doubled at ten days and there was no further increase even at 22 days. The posterior portion of the stroma was more hydrated than the anterior region. Stromal cells were reduced in number and normal-appearing cells were present only in superficial stroma. The epithelial basement membrane was irregular and thickened. Although the epithelium was reduced to three or four cells in thickness and the intercellular spaces were dilated, the epithelial cells contained normal subcellular organelles and appeared to be viable.


Is the lacrimal gland dispensable? Keratoconjunctivitis sicca after lacrimal gland removal. A persistent, unilateral keratoconjunctivitis sicca developed immediately after palpebral dacryoadenectomy in a healthy 43-year-old woman with normal eyes and tear function before the operation. The unoperated on fellow eye remained normal during a ten-year period. Eight similar cases are collected from the literature. On the basis of the presented cases, we believe that the main lacrimal gland is an indispensable element of the tear system, and the accessory lacrimal glands are unable normally to prevent tear insufficiency.


Relationship between morphologic features and hardness of the subchondral bone of the medial tibial condyle in the normal state and in osteoarthritis and rheumatoid arthritis. In osteoarthritis and rheumatoid arthritis the hardness of the subchondral bone of the medial tibial plateau is lower than in normals. In order to further analyse this study of the morphologic characteristics in bone from the mentioned region was carried out in 22 normals, 14 osteoarthritis and 12 rheumatoid arthritis. Specimens from these groups were subjected to a radiologic assay, a light microscopic investigation and an evaluation of the occurrence of intraosseous lipids. The normals showed a remarkable integrity of the subchondral trabecular network with advancing age only with slight osteoporosis and occasional sclerosis. In osteoarthritis there were osteoporosis, osteolysis, sclerosis and osteophytes all in good correlation to the grade of osteoarthritis present. In rheumatoid arthritis there were areas of rarefaction, fractures of the trabeculae, sclerosis and invasion of granulation tissue. The radiologic appearance corresponded well with the morphologic observation. No abnormal presence of lipids was encountered. This investigation supports the concept that the hardness of the subchondral bone of the medial tibial plateau much depends on the morphologic structure of the bone.


[Whiplash injuries of the cervical spine. A catamnestic study]. Whiplash injuries of the cervical spine are due to the rapid sequence of movements in opposite direction. They are mainly following rear-end collisions where the trunk is pushed rapidly forward. Very important forces act therefore on the different segments of the cervical spine and lead to lesions of the perispinal soft tissues, of the ligaments, of the disks and the bony structures. In 24 tables, the signs and symptoms in 104 personal cases observed for a period which lasted more than 4 years are described. Amongst the clinical signs there are cervical strain, cervico brachial pain, headaches, radicular signs as well as symptoms of concussion and cercial medullar lesion. Radiological findings are discrete; functional X-rays sometimes show local diminution of motility in a single segment. The treatments, amongst these immobilisation and local heat, are discussed. The unusually long duration of local disturbance is stressed. Signs of neurasthenia are part of the typical findings and do not at all mean a secondary neurotic development.


[Volume changes of bone cements].

[Volume changes of bone cements]. The volume changes of hardening cements are measured with the buoyancy method. During hardening the polymerisation shrinkage runs through distinguished phases, totaling from setting in the bone to the final state 2 to 4 volume percents. Expansion and contraction because of temperature changes superimpose the measurements by a rate of 0, 21%/10 degrees C. - Factors influencing the volume changes are discussed.


[Microstructural examinations of the behavior of human cortical bone after compression osteosynthesis]. 20 samples of human cortical bone removed from the subtrochanteric region after introchanteric femoral osteotomies with subsequent fixation by a blade plate were examined for studies of the phenomenon of cancellous transformation. Previous experiments with animals can be confirmed. A dilatation of Haver's canals in the direction from endosteum peripherally becomes apparent. This quantitative loss of cortical density is associated with a loss of mineral density. Under polarisation and scanning microscopy a derangement of collagen fibrils usually arranged in an oriented fashion can be shown. The loss of mechanical properties is discussed in connection with the derangement of orientation of collagen fibrils.


[Internal compression arthrodesis of the ankle joint (with examination of stability for comparison]. A new technique of arthrodesis of the ankle joint by internal fixation with self-compression blade-plates is presented. The both possible techniques of inserting the plate lateraly or medialy are described. We prefer the lateral approach. After resection of the ankle joint we also resect the tibiofibular syndesmosis putting than in a transfixion screw. We than compare under biomechanical aspects the new techniques with Charnley's external fixation with compression clamps. The osteosynthesis with blade-plates gives a higher stability in which external splintage with plaster becomes unnecessary. Following our experiences consolidation occurs after 8 tp 12 weeks.


[The cartilage-damage after fracture of the patella]. At least 16 cases of posttraumatic chondromalacia of the patella out of a total of 79 patients operated between 1968 and 1971 were diagnosed on the basis of a questionnaire and follow-up examination. The clinical findings and delineation of this complaint from femoro-patellar osteoarthritis are discussed. The diagnosis was confirmed by arthroscopy in 2 patients. The significance of cartilagenous damage due to direct contusion is pointed out. The mechanisms which result in a degradation of the cartilagenous layer in the weeks following the accident are mentioned. The therapeutic consequences for the treatment of fractures of the patella are as follows: One must aim at exact bony reduction. Macroscopically damaged parts of the cartilage should be removed. Indication to partial patellectomy should be on a broad basis. A long term treatment with salicylic acid or Chloroquin-both of which are said to prevent enzymatic degradation of cartilage-should be considered.


[The surgical treatment of distal humeral fractures]. The treatment of this kind of fractures, especially involving the elbow-joint still is difficult and needs a thoroughly preoperative planning as well as an exact operative technique. Even in spite of optimal therapy failures are not avoidable in some cases, as our statistic shows.


Surgical treatment of orbital floor fractures. Ninety patients with orbital floor fractures were treated by the Otolaryngology Service of the Columbia-Presbyterian Medical Center. Of these 90 patients, 58 were classified as coexisting and 32 as isolated. All fractures with clinical symptoms and demonstrable x-ray evidence should be explored. Despite negative findings by routine techniques, laminography may confirm fractures in all clinically suspicious cases. In this series, 100% of the patients explored had definitive fractures. A direct infraorbital approach adequately exposes the floor of the orbit. An effective and cosmetic subtarsal incision was utilized. Implants were employed when the floor could not be anatomically reapproximated or the periorbita was destroyed.


Temporal bone resection. Review of 100 cases. One hundred cases of temporal bone resection for cancer of the ear were reviewed retrospectively, allowing for a survival five-year follow-up period in all cases. Operative technique previously described varied from case to case but essentially involved subtotal resection of the mastoid, petrous pyramid and squamosa of the temporal bone, temporomandibular joint, base of zygoma, and attached adjacent soft tissues. The procedure sacrifices the facial nerve and hearing in the involved ear. Preoperative radiation or a sandwich technique of preoperative and postoperative radiation was used. Many complications were encountered, but with hypotensive agents, high-speed air drills, and adequate coverage of the defect, the death rate was reduced from 10% in 1954 to 5% in recent years. The overall five-year cure rate was 27%, with a 25% cure rate for squamous carcinoma.


Pain control in recurrent head and neck cancer. Retrolabyrinthine section of the fifth and ninth cranial nerves. The present-day otolaryngologist who is amply trained in the area of head and neck cancer surgery has the additional otologic surgical skills that can be applied to the control of head and neck cancer pain, utilizing the retrolabyrinthine route to the preganglionic pain fibers. Patients who can benefit from this surgical procedure have pain in the distribution of the fifth, seventh, ninth, and tenth cranial nerves that requires administration of narcotics for control. The complications of meningitis, bleeding, facial paralysis, and hearing loss are possible and must be appropriately treated, if present.


The short arm deletion syndrome of chromosome 4 (4p- syndrome). Partial deletion of the short arm of chromosome 4 (4p-) represents another (rare) cause of cleft lip and cleft palate. Further characteristic manifestations of the syndrome (also called Wolf or Wolf-Hirschhorn syndrome) are growth failure, microcephaly, prominent glabella, hypertelorism, beaked nose, poorly differentiated and low set ears, cardiac and renal malformation and hypospadias. Life expectancy is often shortened. The 4p- syndrome has many features in common with another deletion syndrome, the cri-du-chat syndrome, and also with the Smith-Lemli-Opitz syndrome. The latter is a hereditary condition with normal karyotype. The cri-du-chat syndrome is characterized by a peculiar high-pitched, mewing cry and can be differentiated from the Wolf syndrome by the different staining characteristics (banding) of chromosomes 4 and 5.


Medial orbital wall fracture with rectus entrapment. Two cases of medial orbital fracture with medial rectus muscle entrapment are reported, one a bona fide blowout fracture. Review of the literature reveals six previous cases. Clinically, patients complain of diplopia with lateral gaze and forced duction tests confirm medial rectus entrapment. Radiographic confirmation is best obtained with hypocycloidal tomography. Surgical therapy is indicated for diplopia or enophthalmus.


Misdiagnosis complicating acupuncture.

Misdiagnosis complicating acupuncture. A 33-year-old man, profoundly deaf since the age of 5 from meningitis, received 25 acupuncture treatments at a center in western Massachusetts. Subsequent hearing evaluation at the Yale New Haven Medical Center again confirmed his profound deafness. He also was found to have cerumen (rock-hard and long standing) in both ear canals. Final removal of the cerumen one week later permitted inspection of a normal eardrum on the right and a debris-filled retraction pocket on the left. The diagnosis of cholesteatoma was confirmed at surgery. Representatives of the medical profession should accept responsibility for adequate examination and diagnosis before starting treatment.


Eversion of the laryngeal ventricle.

Eversion of the laryngeal ventricle. Eversion of the laryngeal ventricle is a rare lesion that presents with cough and/or voice changes. Laryngoscopy reveals a polypoid mass arising from the ventricle. Microscopically a polyp covered with ventricular mucosa and containing normal laryngeal mucous glands is seen. Chronic inflammation is usually present. Treatment in symptomatic cases consists of surgical removal endoscopically or by laryngofissure. The management of one patient is reported with a discussion of the cause, symptoms, and treatment of this condition.


Cricoid arch replacement in dogs. Further studies. Published reports by Delahunty et al and Alonso et al described the feasibility of correcting subglottic defects with cricoid arch transplantation. Using normal dogs, satisfactory results, including airway patency and vocal cord function, were reported. This report describes a second series of dogs in which subglottic stenosis was first induced by an open procedure and was subsequently repaired with an allotransplanted cricoid arch. The resulting subglottic defect in the donor dogs was repaired by autogenous hyoid arch transposition. No immunosuppressive measures or stents were used in either group. The animals were followed for periods up to one year prior to histologic study. Satisfactory results were obtained in both groups.


Technique for closure of the floor of the mouth in monobloc resection. Closure of the floor of the mouth after resection with or without partial mandibulectomy is often unsatisfactory. The wound may fail to heal per primum and transient orocutaneous fistulas are not uncommon. A technique of closure of the floor of the mouth, based on a series of 68 patients treated by monobloc or "three-dimensional" resection, uses the hyoglossal muscle as a new muscular sling to close the surgical defect. The overlying hypoglossal nerve is mobilized in a neuromuscular transplant that preserves tongue function and speech. Such a procedure facilitates the successful surgical management of stages I and II carcinomas of the floor of the mouth.


Diagnosis and management of tuberculous cervical adenitis. In a series of 133 patients with a primary diagnosis of tuberculosis admitted to the Naval Regional Medical Center, San Diego, Calif, during a four-year period from July 1967 to July 1971, 29 (16.7%) had extrapulmonary lymphadenitis. The cervical region was involved in 20 (68.7%) of these cases. This report reviews the history of scrofula and deals with specific diagnostic tests which are helpful in separating tuberculous adenitis from other masses found commonly in the neck. Excisional biopsy and methods of handling these specimens are stressed. The higher incidence of tuberculous lymphadenitis in dark-skinned individuals, especially Orientals, when compared with a similar population group with pulmonary tuberculosis is noted and theories for this stated.


Carotid body tumors.

Carotid body tumors. The anatomy, physiology, embryology, and pathology of the carotid body are reviewed, stressing the capability of the normal and neoplastic structure to produce pressor amines. Nine new cases of carotid body tumors are reported including a patient with a malignant tumor with a facial nerve paralysis and regional node metastases. The clinical presentation and management emphasize the preoperative catecholamine determinations and angiographic studies.


Auditory evoked frequency following responses in man. A sound-evoked sinusoidal response was recorded from the temporal scalp area in six humans. This evoked signal is similar in its characteristics to (and may correspond with) the "frequency-following response" of Worden and Marsh recorded on the scalp in man by Moushegian and colleagues. The site of origin of the response recorded in these subjects is not known, but it is of interest that the aspect of the scalp, and that the influence of arousal state on response amplitude paralleled the described effects of changes in arousal state on the primary auditory cortical evoked response. This technique may allow for the direct measurement of auditory thresholds across the frequency domain. This is possible because measured responses can be obtained at sound levels of the order of 15 to 20 dB across the frequency range from 300 to 2,500 Hz.


Spindle cell carcinoma (pseudosarcoma) of the larynx. "Pseudosarcoma", initially considered a benign response of connective tissue to an adjacent squamous carcinoma, is now regarded as a spindle cell variant of epidermoid carcinoma. Nine cases of spindle cell carcinoma of the larynx are presented. Characteristically, the lesion appears as a large, gray, polypoid tumor. In contrast to other reports, a correlation between gross morphology and prognosis could not be made. The prognosis is more closely related to the size and location of the tumor. Biopsy specimens of the tumors in seven of the nine cases showed only the spindle cell pattern. This may be confused with granulation tissue. Spindle cell carcinoma was metastatic to the neck and lungs in three patients. Our average follow-up time was 3.8 years with two of the nine patients dying of recurrent disease. Most of our patients were successfully treated with conservation surgery.


Management of traumatic tracheoesophageal fistula. Traumatic injury to the trachea most commonly results in separation of the trachea from the cricoid cartillage. In severe cases, this injury is complicated by an esophageal injury that is seriously complicated by a tracheoesophageal fistula. The repair of such a fistula is a prime priority. Surgical repair of the tracheal injury must be associated with esophageal repair and this is best accomplished by the interposition of the sternothyroid muscles between the trachea and the esophagus to strengthen the esophageal repair. The use of a laryngeal drop will also be of value in relieving the tension on the esophageal suture.


Treatment of the fractured larynx. Use of a new grafting technique. Laryngeal fractures are best handled early by the meticulous apposition of mucous membrane and reconstitution of the laryngeal skeleton. Postoperative dilatations may deal successfully with any stenosis that occurs. However, the loss of critical supporting structures such as the cricoid ring or large amounts of mucosa may result in stenosis that requires the addition of structural elements from elsewhere in the body. This is a five-year follow-up on such a patient in whom ultimate reconstruction was accomplished by the use of mucous membrane from the maxillary sinus as a lining for the reconstructed larynx while costal cartilage provided additional supportive structural material for the compromised cricoid and thyroid cartilages.


Tongue flap reconstruction in cancer of the oral cavity. The mobility, size, and composition of the tongue make it ideal for oral cavity reconstruction following resection for carcinoma. The tongue flap provides a ready means of primary closure without increased morbidity, especially in patients who have had extensive therapeutic or preoperative irradiation treatment. The position of the tongue adjacent to the surgical defect and its excellent blood supply allow its nondelayed utilization. In most cases, use of the tongue flap precludes the necessity for multiple-staged reconstruction with regional pedicle flaps, with an improvement in functional results in terms of immediate healing, swallowing, and articulation over previous methods of reconstruction.


Reconstructive procedures for congenital aural atresia. The three surgical methods currently in use to improve hearing for patients with congenital aural atresia are fenestration of the lateral semicircular canal, canal plasty, and type III tympanoplasty. Because the surgery is difficult and the functional rewards are modest, it should ordinarily be reserved for patients with bilateral atresia. Of the 12 ears operated by the technique of type III tympanoplasty, the average gain in hearing was 22 dB, with seven attaining a 30 dB or better air-conduction threshold. When aural rehabilitative and cosmetic surgery are contemplated, coordinated planning by the surgeons is necessary to acquire the best end result.


Voice rehabilitation after laryngectomy. Results with the use of a hypopharyngeal prosthesis. The Northwestern voice prosthesis for laryngectomees is described. The prosthesis contains no vibrator but activates vibration of the patient's pharyngeal or upper esophageal tissue by transporting air from the tracheostoma to a fistula in the upper neck, well away from major blood vessels. The prosthesis fits directly onto the laryngectomy tube and allows the patient to breathe, speak, and cough without any manual adjustments. The important advantage of this prosthesis is the fistula location. It can be placed at the time of original surgery and is also workable in patients who have had radiation and extensive radical surgery with total reconstruction of their gullet. The prosthesis can be used by primary total laryngectomees while learning esophageal speech or installed in those who are unable to use the electronic larynx or to learn esophageal speech. Four case studies are presented.


Protection against malpractice litigation. Malpractice insurance costs are based on loss experience and defenses of expenses. Physicians in the high-risk category are in that position because, as a group, they have a high frequency of claims, a high average cost, or both. True, "defensive medicine" is the best way to minimize the risks. This does not mean ordering unnecessary tests or refusal of essential treatment. Rather, it is the habit of exercising extra care and foresight to avoid medical hazards and to apply prompt remedial measures when they occur. It means being aware of the patient's personality and needs. It means taking time to talk to the patient about proposed procedures and their risks. This kind of "defensive medicine" offers the best hope for reducing the frequency and cost of claims that result in the present critical malpractice problems.


Distribution of labeled chloroquine in the inner ear. Autoradiography of the inner ear was performed at varying intervals following intravenous injection of either chloroquine tagged with carbon 14 (14C), or an iodine 125 (125l)-labeled analogue of chloroquine, in rats. In pigmented rats a strong accumulation and retention was noted in the melanin-bearing tissues. In the inner ear there was a very high concentration in the melanin-containing tissues, eg, the stria vascularis and the planum semilunatum. A strong retention was found in these structures 13 days after injection. Accumulation was not observed in the endolymph nor in the perilymph. No accumulation was found in the inner ear of an albino rat. The ototoxic effects of chloroquine may be caused by an accumulation of the drug in the melanin-containing structures in the inner ear, leading to pathological changes in these tissues and secondary lesions in the receptor cells.


Stroboscopic microsurgery of the larynx. An attempt was made to develop a new method of microsurgery of the larynx. A newly designed laryngostroboscope suitable for our purpose was employed in our new method. The vibratory pattern was stroboscopically examined through the operating microscope throughout the operative procedure while the patients who were able to phonate due to neuroleptanalgesia were asked to do so. Thus, the determination of the completion time of the operation was obtained mainly by the observation of stroboscopic vibratory patterns of the vocal cords. Since the beginning of 1972, this stroboscopic microsurgery of the larynx has been satisfactorily employed in more than 200 cases of various kinds of laryngeal lesions. As a result, a remarkable improvement of the postoperative voice was observed by phonatory examinations as well as by audible estimation.


Chin reduction in profileplasty.

Chin reduction in profileplasty. An intraoral method of reduction mentoplasty by subapical horizontal osteotomy of the mandibular symphysis is used in the profileplasty of patients with a protuberant chin who have a normal or functionally satisfactory occlusion. Dental and cephalometric evaluation are necessary to determine if resection of the mandible or orthodontic surgery is necessary for correction of the facial deformity. Because of the tendency toward postoperative osteoneogenesis and fibrosis, overcompensation in the amount of bone removed is important in gaining the maximum aesthetic improvement.


Staged surgery in ears with excessive disease of tympanum. Results regarding tympanic healing and hearing improvement are reported in a series of 84 one-stage operations on the middle ear, using thin silicone elastomer sheeting, and of 76 two-stage operations using temporary filling of the middle ear with paraffin wax, and of ten with silicone elastomer sponge. All epithelium was removed from the tympanic cleft at the primary operation. Staging of the operation gave better hearing results and resulted in fewer adhesive middle ears. Middle ear mucosal biopsies from ears with mucus production around the paraffin showed an increased number of glands and secreting epithelial cells, much as in glue ears. Residual or recurrent cholesteatoma appeared in only 2.4%, which is attributed to resection of the posterior canal wall in cases of cholesteatoma, as contrasted with the intact canal wall technique.


Stenting in experimental laryngeal injuries. This experimental pilot project studies acute laryngeal injuries in 20 dogs and compares the use of three types of stenting materials with using no stent at all following the production of a "controlled airway deforming injury." Each injury was repaired meticulously using stainless steel wire to immobilize the cartilage separations, and fine catgut to close the mucosal lacerations. Animals were killed after observation for periods of two to six weeks postoperatively. Marked infection, ulceration, and granulation tissue formation were observed in most of the stented animals, with the nonstented animals showing the most complete and uncomplicated healing. In this experimental model, acute laryngeal "fractures" were adequately stabilized by suturing and a stable cartilaginous framework supported the healing intralaryngeal soft tissues. Avoidance of stenting in this animal series appears to decrease infection, ulceration, and granulation tissue formation resulting in improved healing.


Animal model acoustic neuroma.

Animal model acoustic neuroma. As part of an effort to develop a longterm animal model simulating the effects of acoustic neuromas, a series of shortterm electrophysiological experiments were performed in the cat. The eighth nerve, as it exits the internal auditory meatus, was exposed and a silicone baloon catheter secured over the nerve. Pure tones and clicks were introduced ipsilaterally and primary evoked potentials were recorded from the contralateral auditory cortex. Alterations in the evoked potentials were examined as the baloons were inflated and deflated. Several reproducible phenomena were recorded: (1) contact between the silicone balloons and eight nerves resulted in substantial reductions in the evoked potential; (2) there was a further reduction in the evoked potential with inflation of the indwelling balloons; and (3) there was a prolongation of the latency period between auditory stimulation and the onset of the evoked potential with balloon inflation. All of these phenomena were reversed when either the contact was broken or balloons deflated.


Maximum compliance and the symptom of fullness in Meniere disease. The symptom of fullness in Meniere disease was investigated in relation to measurements of maximum compliance (Cm) at the eardrum. The symptom of fullness is considered to be related to an increase in inner ear fluid pressure in Meniere disease. The Cms between ears were measured and compared for 36 patients with Meniere disease and the symptom of fullness in only one ear (full ear). A comparison of the Cm between the full ear and nonfull ear showed that the Cm was reduced for 32 of the patients. The data were interpreted as indicating that the Cm can be affected by pathological mechanical changes in the inner ear.


Heterograft Myringoplasty.

Heterograft Myringoplasty. Heterograft myringoplasty on dogs was performed. Serosa of the cecum of the calf was used in eight middle ears and cadaver tympanic membrane of the calf with the malleus attached in four. All canine eardrums were healed 10 to 12 weeks postoperatively. The heterografts were then unidentifiable. In only two middle ears did a mild inflammatory reaction occur with serosa grafts, but in three of the four middle ears with cadaver eardrum grafts, severe inflammation and scarring appeared. The attached denatured calf malleus was being remodeled into a canine ossicle by new bone deposits. The results with calf serosa graft indicate that tolerance and survival might be expected using it in the human ear. However, the experiences with the calf cadaver tympanic membrane suggest a need for great caution in expanding the present information to surgical use in the human.


Radiologic diagnosis of chondroma and chondrosarcoma of the larynx. The radiographic findings in chondroma and chondrosarcoma of the larynx basically comprise a discreet soft tissue mass on plain lateral and anteroposterior film, a smooth mucosal outline to the lesion, calcification, with either peripheral or central stippling and ossification. Secondary signs are also noted. Definition of these criteria are illustrated in order to apply these findings to the radiographic diagnosis of chondroma and chondrosarcoma of the larynx.


Rerouting the external auditory canal. A method of correcting congenital stenosis. An hourglass or funnel-shaped, stenosed, external auditory meatus with a normal tympanic membrane, middle and inner ear is one of the congenital anomalies that occasionally occurs. Such abnormality was present in both ears of a woman and caused chromic otitis externa and deafness. A routine meatoplasty on the right ear failed because of an unusual cephalad position of the drumhead in relation to a "downhill" position of the stenosed outer meatus. Rerouting the ear canal to a horizontal position by removing bone of the canal superiorly, posteriorly, and inferiorly, and grafting the now horizontal canal with skin taken from the postauricular fold produced a good result. This is a satisfactory procedure for a woman, but would be cosmetically unacceptable for a man.


Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease). An electron microscopic study of the vascular lesions before and after therapy with hormones. Eight patients with hereditary hemorrhagic telangiectasia and severe epistaxis were treated with norethynodrel with mestranol (Enovid). Biopsy specimens of typical lesions from two patients were taken for electron microscopy before and after several months of therapy. Characteristic endothelial cell damage and nectosis were noted in the dilated venules of patients before treatment but not after. Unlined channels of blood were found in connective tissue before treatment but not after. These are thought to arise from leaks in the affected venules, and it is suggested that later indothelial ingrowth gives rise to the propagation of lesions that are known to develop with age. Reduplicated basal laminae and regenerating endothelial cells were found both before and after treatment.


Fish bone fistulae.

Fish bone fistulae. This is a communication of a fish bone in the cervical esophagus of an adult causing a common carotid false aneurysm with fistula to the esophagus (not reported previously).


Gnathostomiasis. A case of otological interest. A young Thai man was afflicted with neurognathostomiasis. The symptomatology was distinct from that of eosinophillic myeloencephalitis. In view of its neurootological flavor, it is proposed that this newly described symptomatology of neurognathostomiasis should be referred to as the neurootological gnathostomiatic syndrome(NOGS).


Fatal bronchopulmonary hemorrhage due to unrecognized amyloidosis. Amyloidosis of the larynx and tracheobronchial tree is usually described as a nonbleeding lesion. However, severe hemorrhage, often fatal, is reported in other organs involved by this disease. A fatal bronchopulmonary hemorrhage was found in a 23-year-old woman unsuspected of having amyloidosis. The possible causes of hemorrhage in this disease are a vessel wall involvement or disturbances of the blood clotting mechanism.


Polytef granuloma clinically simulating carcinoma of the thyroid. A case of a foreign body granuloma to polytef (Teflon) appeared as a mass on the left side of the neck and clinically simulated carcinoma of the thyroid. Autopsy results demonstrated that the intracordal polytef extended through the cricothyroid membrane via a fistulous tract forming a suprathyroid nodule.


Ischemic carotid endothelium.  Scanning electron microscopical studies. The normal luminal surface and the effect of ischemia on the endothelium of the common carotid arteries of rhesus monkeys were examined by scanning electron microscopy.  Clamps were placed proximally and distally on the right common carotid arteries, totally occluding the vessels for periods ranging from five minutes to four hours.  The clamps were then removed and fixation carried out by intravascular perfusion.  The contralateral sham-operated carotids, as well as those from unoperated animals were used as control specimens.  The most obvious effect of ischemia was the appearance of conical, crater-like defects in the cytoplasm of endothelial cells.  Such "craters" were observed following as little as 15 minutes of ischemia, were much less frequent in sham-operated vessels, and were not seen in the unoperated control specimens.


A key to identify heart valve prostheses. A system for the identification of heart valve prostheses has been developed.  A series of observations is made on the structure of a prosthesis.  Following each the most appropriate choice of two or three alternative findings is made.  One is then directed to the next observation until a genus of prostheses is found with structural characteristics like the unknown one.  Positive identification is aided by a brief description of each prosthesis in the genus.


Primary sarcoma of the aorta.

Primary sarcoma of the aorta. A 70-year-old man had an obstruction of the aortic bifurcation by a primary aortic sarcoma.  The tumor was not fibrosarcomatous, as are the majority of primary aortic tumors.  To our knowledge, this is the third occurrence of this type of primary aortic malignant neoplasm to be reported in the literature.  A possible endotheliomatous origin is suggested.


Single coronary artery with myocardial infarction and AV block. A case of single coronary artery with myocardial infarction was found in a 77-year-old woman.  Study of the conductive system in this case did not show any abnormalities that could be correlated with the terminal clinical episode of heart block.  In seven anatomically proven cases reported, the single coronary artery arose from the right aortic sinus, which suggests a possible causal relationship to infarction.


Glomerular lesions of diabetes mellitus in Mystromys albicaudatus. The kidneys of 175 nondiabetic and diabetic Mystromys albicaudatus were evaluated histologically by light microscopy.  The degree of capillary basement membrane thickening and the predominant glomerular histologic pattern were recorded.  Statistical analyses indicated that glomerulosclerosis is associated with diabetes in this species.  In addition, a granular capillary basement membrane lesion occurred more frequently in diabetic than in nondiabetic animals.


Nodal angiomatosis.

Nodal angiomatosis. Four patients with nodal angiomatosis were examined.  Nodal angiomatosis consisted of a bengin vascular proliferation coincidentally encountered in lymph nodes that were removed for other reasons.  Although the lesion is uncommon, it is important to distinguish nodal angiomatosis from primary Kaposi sarcoma of the lymph node.


Anticoccidial activity of Lasalocid in control of moderate and severe coccidiosis. The fermentation product lasalocid ("Antibiotic X-537A," Hoffmann-LaRoche) showed good anticoccidial activity when administered via feed at 50 or 75 ppm in a replicated floor-pen experiment. Lasalocid was compared with monensin (121 ppm) ("positive control") and also with unmedicated ("negative") controls in pens heavily seeded or indirectly seeded with eight species of coccidia (Eimeria acervulina, E. brunetti, E. hagani, E. maxima, E. mitati, E. necatrix, E. praecox, and E. tenella). Under severe coccidiosis exposure (litter seeded by infected birds) both anticoccidials permitted significantly increased weights, improved feed conversions, and reduced lesion scores. Shank depigmentation was numerically less in anticoccidial-treated birds than in unmedicated controls, though not significantly. Coccidiosis mortality (lesions or parasites demonstrated) was 10% in unmedicated controls. Lasaloic reduced this mortality significantly to 0.8% at 50 ppm and 0.4% at 75 ppm. No coccidiosis mortality occurred with monensin-fed birds. With moderate exposure (indirect seeding) both anticoccidials permitted significantly greater weight gains and less shank depigmentation than in unmedicated controls. In unmedicated pens severity of coccidiosis was significantly greater in the intentionally seeded pens than in indirectly seeded pens with all parameters except depigmentation. This design provided a practical procedure for testing anticoccidials in a single experiment against severe and moderate exposures to coccidiosis as are normal in broiler production.


Influence of strain of Mycoplasma synoviae and route of infection on development of synovitis or airsacculitis in broilers. Two strains of Mycoplasma synoviae (WVU 1853 and F10-2AS) were compared for their relative pathogenicity in terms of airsacculitis and synovitis. Both strains produced air-sac lesions after aerosol exposure of chickens vaccinated against Newcastle disease and infectious bronchitis; both produced synovitis when inoculated into the foot pad. The WVU 1853 strain was more likely to result in synovitis, whereas the F10-2AS strain was more apt to produce air-sac lesions.