The role of surgery in the management of endometriosis. Surgery has a specific and realistic place in the management of endometriosis. In the presence of an ovarian mass, diagnosis to rule out neoplasm is mandatory. Therapeutic surgery is carried out for the relief of pain when there is known symptomatic endometriosis or to provide improved chances of a successful gestation when there is infertility. The use of hormones preoperatively has not been routine but seems to be logical when there is extensive and significant scarring. It would seem appropriate to attempt to preserve childbearing function in those patients who are young and desirous of this. In older patients or those in whom the childbearing is complete, it seems unwise to leave behind diseased tissue that can require a subsequent operation. Conservative surgical treatment for infertility related to endometriosis has about a 40 percent chance of successful pregnancy; such conservative treatment carries a 10 to 12 percent risk of subsequent reoperation. The rate of malignancy in endometriosis is low. Intestinal tract endometriosis is uncommon. Bowel preparation is recommended if bowel surgery is anticipated because of the endometriosis. Urinary tract endometriosis is even more uncommon with the exception of the extrinsic pressure and scarring secondary to extensive pelvic endometriosis. tsurgical treatment seems to be of more value than hormone therapy when other organs are involved.


The use of a self-administered alcoholism screening test (SAAST) in a medical center. A self-administered alcoholism screening questionnaire was given routinely to 100 patients admitted to an alcoholism treatment unit as well as to 100 randomly selected patients in a medical population. The questionnaire differentiated the alcoholic group from the general medical group of patients. It was also successful in identifying the "hidden alcoholic" in the general medical population. It is concluded that this device would be a valuable part of a general medical screening questionnaire to detect the presence of alcoholism in the general medical-surgical patients.


Composition of uropygial gland secretions of birds of prey. The chemical composition of the uropygial gland secretion of five species of birds of prey was investigated by gas liquid chromatography-mass spectroscopy technique, and the results are discussed from the chemotaxonomical point of view. The secretion is a complex mixture of monoester waxes, the fatty acids of which are mainly dimethyl-branched, with the first substituent in 2 position and the other near the methyl end of the molecule. Mono-, trimethyl-, and unbrached fatty acids also are observed. The wax alcohols are mainly mono- and dimethyl-substituted. Unbranched alcohols and traces of trimethyl-substituted alcohols also were detected. Chemotaxonomically, the birds of prey differ from all orders hitherto investigated. The degree of substitution increases from the Falconidae to the Accipitridae.


Occurrence and chemical structure of nonmethylene-interrupted dienoic fatty acids in American oyster Crassostrea virginica. The American oyster, Crassostrea virginica, was found to contain structurally homologous nonmethylene-interrupted dienoic (NMID) fatty acids. The major C20 and C22 nonmethylene-interrupted dienoic fatty acid isomers were shown to occur as two pairs of homologues 5,13-20:2 with 7,15-22:2 and 5,11-20:2 with 7,13-22:2. A combination of analytical procedures was required for conclusive structure determination.


Presence of phytosphingosine combined with 2-hydroxy fatty acids in sphingomyelins of bovine kidney and intestinal mucosa. A minor part of sphingomyelins of bovine kidney and small intestine has been shown by mass spectrometry to contain phytosphinogsine in the earlier unknown combination with 2-hydroxy fatty acids.


Triglyceride composition of Sapindus mukorossi seed oil. The fatty acid composition of Sapindus mukorossi seed oil was determined by spectrophotometry, urea complexation, and gas liquid chromatography (GLC). The percentages of individual acids were found to be: palmitic, 4.0; stearic, 0.2; arachidic, 4.4; oleic 62.8; linoleic, 4.6; linolenic, 1.6; and eicosenoic, 22.4. Triglyceride composition was calculated from the fatty acid compositions of the native oil and of the monoglycerides produced from it by pancreatic lipase hydrolysis. The oil is composed of 0.1, 2.1, 22.0, and 75.8% trisaturated, monounsaturated disaturatd, diunsaturated monosaturated, and triunsaturated glycerides, respectively. The special characteristic of the Sapindus mukorossi seed oil is its content of 26.3 and 26.7% triolein and eicoseno-di-oleins, respectively.


Lipids of freshwater Dolphin Sotalia fluviatilis: comparison of odontocete bioacoustic lipids and habitat. The melon and jaw lipids of the freshwater dolphin Sotalia fluviatilis are composed mainly of isovaleroyl wax esters and diisovaleroyl triglycerides. The blubber fat contains only a trace of wax ester and is mostly tri-(long chain) and monoisovaleroyl triglycerides. Detailed gas liquid chromatographic analyses of the intact wax esters and triglycerides and of the derived fatty acids and fatty alcohols indicate common compositional patterns in the wax esters and triglycerides of the respective head lipids. Both odd and even long chain (C12-C16) isostructures are prominent in the melon and jaw lipids, but only higher odd chain length iso-acids are major components in the blubber. Sotalia fluviatilis (family Delphinidae) and Inia geoffrensis (family Platanistidae) share the same freshwater habitat in the upper Amazon River, and both utilize echolocation to navigate and to find food. Comparison of their respective bioacoustical lipid compositions show distinctive types of head fats, Sotalia being rich in iso-5:0 and Inia lacking iso-5:0. This indicates that iso-valeric acid per se has no obligatory role in dolphin echolocation.


Synthesis of prostaglandins in platelets of hypercholesterolemic rabbits. As a continuation of previous studies on the synthesis of prostaglandins in platelets of human venous blood, the present communication describes the synthesis of prostaglandins in experimental hypercholesterolemia induced in rabbits by dietary means. In such a condition, high serum level of cholesterol did not change the rate of prostaglandin synthesis.


Inhibition of enzymatic reduction of delta 14-double bond of 5 alpha-cholesta-8,14-dien-3 beta-ol and 5 alpha-cholesta-7,14-dien-3 beta-ol by AY-9944. AY-994 (trans-1,4-bis-(2-chlorobenzyl-aminomethyl) cyclohexane dihydrochloride), a potent inhibitor of the enzymatic reduction of the delta 7-double bond of delta 5,7-sterols, has been shown to inhibit, at higher concentrations (10-4 M), the enzymatic reduction of the delta 14-double bond of cholesta-8,14-dien-3 beta-ol and cholesta-7,14-dien-3 beta-ol.


Oxprenolol and hydrallazine in the treatment of hypertension. Oxprenolol and hydrallazine in combination were found to be as effective as methyldopa in a trial in hypertensive patients. The drugs could be given in a twice-daily dosage and had a much higher degree of patient acceptance. The side effects of this drug combination were usually due to hydrallazine and were mild and short-lived, but did require the withdrawal of one patient from the trial. Hydrallazine should be used with caution in the treatment of patients with a history of myocardial lschaemia.


Diuretics, beta blockers and vasodilators. Dosage in mild and moderate hypertension. This paper presents experience with the treatment of mild to moderate hypertension by means of a thiazide diuretic (cyclopenthiazide), a small dose of a beta adrenergic blocking agent (oxprenolol) and progressively increasing doses of a vasodilator (hydrallazine). Satisfactory control of blood pressure was achieved in 38 of 41 cases without the production of distressing effects. This treatment regime was acceptable to patients and appears more promising than other currently available methods for blood pressure control.


[Delusion and understanding (author's transl)]. This paper presents the psychodynamic investigation of a case of schizophrenia, which developed on the basis of a LSD-psychosis. It is a contribution to a treatment of schizophrenia, in which the coexistence of biological and psychological factors is taken into consideration. Biological premises do not invalidate the psychological understanding of many symptoms. Psychodynamic experience permits the psychiatrist to encounter the patient adaquately, even if the possibility for a long psychotherapeutic treatment is absent.


[Blood pressure in the beginning alcohol withdrawal state (author's transl)]. Blood pressure elevation was found to be a frequent cardiovascular symptom of the prodromal phase of alcohol withdrawal state: 21 of 25 patients (mean age 38 years) had hypertension (mean value 171/107 mm Hg) during the first two days of hospitalization, which returned to normal with the disappearance of the other withdrawal symptoms. Augmented activity of the sympathetic nervous systems is thought to be the most probable cause of blood pressure elevation in alcohol withdrawal state.


[Use of the adsorption method for regeneration of dialysate in hemodialysis (Redy-system) (author's transl)]. The adsorption method for regeneration of dialysate was introduced as a new principle in hemodialysis. To compare the efficacy of the Redy-system (regenerative dialysis supply system) which utilizes a sorbent cartridge, with the common single-pass systems, 2 patients were dialyzed weekly twice or three times 6 hours over a period of 3 months. Three different types of dialyzers were used: Cordis hollow-fiber, plate dialyzer Lundia Nova 17,0 mu and coil dialyzer Travenol Ultraflo II. Monitoring of serum nitrogen constituents (urea, creatinine, uric acid) showed that the efficacy especially of the hollow-fiber dialyzer was comparable with the single-pass-system. Serial measurements of electrolytes in dialysate and serum, as well as dialysate osmolarity and ammonia indicated that the adsorption method is a safe technique. The advantage of the Redy-system is its independency of a fixed and treated water supply system, since it is able to operate with 5.5 1 tap water, an electrolyte concentrate being added in the recirculation system. Therefore this dialysis device can be installed everywhere, giving the dialysis patient more independency.


[Sarcoidosis of the kidney (author's transl)]. The sarcoidosis of the kidney frequently shows little symptoms, but leads in more progredient stages to heaviest functional deficits and uremia. Beside this genuine sarcoidosis of the kidney a nephrocalcinosis caused by the often higher blood calcium level in sarcoidosis patients can occur. Its cardinal manifestation is a nephrolithiasis. Seldom in sarcoidosis patients a glomerulonephritis following to humoral immune reactions is appearing. A case of genuine sarcoidosis of the kidney with typical course and extended functional deficit, improved by intensive therapy with corticosteroids and immunosuppressiva is reported.


[Nephropathy and deafness (Alport syndrome) without positive family history (author's transl)]. This is a report of a 22-year-old man affected with hereditary nephropathy and deafness (Alport syndrome) without positive family history. The diagnosis is based on the typical clinical history, presence of symmetrical neural deafness, and terminal stage of renal insufficiency, that could not be classified otherwise following renal biopsy. The differential diagnosis and genetics are discussed.


[Breath rate as a function of parameters of pulmonary function in body plethysmography (author's transl)]. Parameters of pulmonary function were measured at resting breathing rates (mean 15-17/min) and at breathing rates of 20-40/min in 238 subjects (79 normals, 44 patients with normal pulmonary function in spite of lung disease, and 115 patients, most of whom had obstructive-emphysematous lesions) in a constantvolume body plethysmograph with a respiratory bag. In the subjects with normal pulmonary function the resistance increased significantly by 25 and 45 percent, resp., with more rapid respiration (p smaller than 0,01). Nevertheless it is assumed that this rarely accounts for false interpretations in everyday routine practice. No relationship of breathing rate to respiratory passage resistance was observed in patients with increased total resistance. By way of contrast, ventilation work of breathing (pV diagram) and the index of ventilation work of breathing (defined Vp ratio) showed a close correlation to breathing rate in all 3 groups. This leads us to conclude that these parameters provide more exact information on the breathing mechanism than does total resistance. Studies on ventilation work of breathing must be conducted under clearly defined breathing rates and consideration of the respiratory volume. intrathoracic gas volume was not correlated to the breath rate.


[Radiation late damage of the thoracic marrow after irradiation in the thoracic region (author's transl)]. A report is given about radiation late damage on the thoracic marrow, basing on the case histories of 100 patients irradiated in the mediastinal region with telegamma from a 60 Cobalt or 137 Caesium source between 1959, January 1st and 1972, december 31st. 77 patients were followed up during 18 months after the radiotherapy was ended; in 3 of them (equal to 4 p.c.) a radiation-induced myelopathy was found. These 3 cases were suffering from Hodgkin's disease, whereas in none of the patients with bronchial carcinoma--in spite of markedly higher radiation doses--any late damage was observed. Therefore, in irradiation of the mediastinal region, the exposure of the spinal marrow should be reduced, although the dose alone is not decisive for the development of a radiation myelopathy.


[The effect of Tropaacidester Sch 1000 on respiratory resistance (author's transl)]. The effect of Tropaacidester Sch 1000 on respiratory resistance, intrathoracical volume, peripheral blood pressure, and heart frequency over a period of 24 hours were examined in ten patients suffering from obstructive respiratory diseases. Compared with placebo 2 puffs of Sch 1000 administered 6 times significantly decreased respiratory resistance. The bronchodilatatory effects of Sch 1000 and Orciprenalin seemed to be almost identical. Side effects after application of Sch 1000 have not been observed.


Stray animals: their impact on a community. The statistical import of the study not-withstanding, we found the most serious problem to be the lack of understanding of the pet population crisis and compassion toward animals on the part of pet owners, as evident in the pet columns of the classified ads. Our study leads us to believe that pet owners are allowing the reproduction of kittens and puppies in such numbers that they often have no cash value and, in fact, the owners will spend money, in the form of advertising, to facilitate their disposal. The street observations indicated that relatively few animals (lessthan 1%) actually are allowed to run free. Dog bites occur at a ratio of 1:20 for the dog population. In the area under study, free roaming dogs and cats present a mild to moderate problem, originating from a small percentage of pet owners. Only a small amount of pet animal suffering occurs by death from environmental hazards (ie, automobiles), and there is just a moderate amount of intentional killing of nondersirable pet animals. We fell the method used in this study and the results obtained from it have importance elsewhere. It should be coupled with a broader based survey questionnaire to better establish the ratio of pet ownership to the general population and the reasons and benefits of pet ownership. We could then have the "facts" about the pet overpopulation problem, as well as better understand the community values toward pet animals. A complete report with additional accompanying tables is available from the senior author at Rural Route One, Urbana, Illinois 61801.


Problem behavior in dogs. Understanding the shy dog. The term "shy dog" should be qualified by examination of the dog's actual behavior and those things that stimulate the shyness. Dogs that display submissive behavior may suffer from a punishment syndrome created by overly harsh treatment. Others may suffer from kennelosis or other improper socialization during early critical periods. In all cases the dog's level of confidence must be increased vis a vis people. Rehabilitation requires avoidance of physical manipulation, gradual socialization, and demonstrative teaching for command responses.


Letters to the editor: On the transfer of nuclear RNA into isolated mitochondria. Further evidence for template properties of nuclear RNA taken up by isolated mitochondria. Some properties of nuclear RNA taken up by isolated mitochondria during aerobic incubation were studied. Nuclear RNA fraction re-isolated from incubated mitochondria was characterized by homogeneous sedimentation distribution in sucrose gradient (7-9S) and by absence of extended secondary structure. In this respect the RNA fraction differed from the nuclear RNA added to mitochondria and was similar to in vivo rapidly labelled mitochondrial RNA. The hybridization pattern of re-isolated RNA with nuclear DNA is consistent with the presence of transcripts from unique DNA sequences in this RNA fraction.


A proposed pathway of plasma glycoprotein synthesis. Plasma glycoprotein synthesis in the liver occurs in a stepwise fashion. The first sugar, N-acetyl-glucosamine, is attached to the protein during the growth of the polypeptide chain on the membrane-bound ribosomes. Subsequent carbohydrates are incorporated after the completion of the protein in the lumen of the endoplasmic reticulum and Golgi apparatus. The reactions are carried out by enzymes strongly bound to the membranes. Because the glycosylation reaction occurs in the interior of the cytoplasmic tubules a permeability problem for the nucleotide sugar exists. Recent studies indicate that sugar-lipids are formed on the cytoplasmic site of the membrane and these complexes transfer the sugars across the membrane. Experimental evidence for this pathway is presented in this article.


Water vapor sorption of keratan sulfate. Keratan sulfate was isolated from bovine cornea. The water vapor sorption isotherms were obtained on both sodium and calcium salts of keratan sulfate at different temperatures. Deuterated water sorption isotherms were obtained on sodium keratan sulfates. The infrared spectra of the keratan-sulfate was monitored as a function of water and D2O uptake. The results are discussed in terms of an open polymer matrix that exists in the solid state of keratan sulfate.


Suppression of delayed hypersensitivity in schistosome-infected patients by niridazole. Niridazole, an anti-parasitic drug, suppresses manifestations of delayed hypersensitivity and retards allograft rejection in laboratory animals. We investigated the immunosuppressive effects of the standard antihelminthic regimen of niridazole (25 mg/kg/day for seven days) in five patients with schistosomiasis. Although 15-minute skin reactions to schistosomal antigens remained unchanged, niridazole reduced or ablated positive 48-hour skin reactions to tuberculin (PPD), mumps and schistosome antigens in all patients tested six and 15 days after therapy began. Complete recovery of delayed dermal hypersensitivity was observed by 114 days. PPD-induced lymphocyte transformation was severely depressed in three and partially depressed in two of the five patients. Suppression was observed at either six or 15 days (or both) after beginning of treatment, and complete recovery at 114 days. It is concluded that therapeutic doses of niridazole suppress delayed hypersensitivity and antigen-induced lymphocyte transformation in man.


Total eosinophil counts in the management of bronchial asthma. Total eosinophil counts were investigated in asthmatic patients to determine their usefulness in the diagnosis and management of steroid-dependent asthma. Counts averaged 122 plus or minus 74 (S.D.) per mm-3 (65 untreated normal subjects) and 43 plus or minus 22 per mm-3 (six prednisone-treated normal subjects). Fifty-two patients with active bronchial asthma showed significant eosinophilia (greater than 350/mm-3 off and greater than 85/mm-3 on steroids), suggesting that eosinophilia is an important diagnostic feature of bronchial asthma. In 14 patients (60 observations), the counts showed significant inverse correlation with specific airway conductance--r equals 0.74, p less than 0.001--and with a variety of other measurements of bronchial dynamics and lung volumes, suggesting that the total eosinophil count reflects asthmatic activity and is useful for regulating steroid dosage and for early detection of exacerbations.


Renal urate excretion in normal man.

Renal urate excretion in normal man. The development of our knowledge of the intrarenal process involved in the control of urate excretion in normal man is summarized. Although there are many gaps in our current knowledge, and different interpretations may be given to the available data, current evidence seems to favor the existence of extensive tubular reabsorption of urate following its glomerular filtration. Subsequently, tubular secretion of urate and the reabsorption of an unknown amount of the secreted urate probably take place. For reasons discussed, it seems most likely that the regulation and control of urate excretion are accomplished through modulations in tubular secretion, post-secretory reabsorption, or both.


Origin and extrarenal elimination of uric acid in man. The origin of uric acid, metabolic pathways of purine metabolism and the disposition of uric acid in normal man are reviewed. Two thirds of the uric acid is normally excreted through the kidney while one third gains entrance to the gut where it undergoes uricolysis. The pathogenesis of hyperuricemia in primary and secondary gout is discussed. Increased production or decreased excretion of uric acid are the two principal mechanisms of hyperuricemia. The known biochemical defects associated with primary overproduction gout are outlined. Extrarenal uricolysis assumes a greater role when the renal excretion of uric acid is compromised.


Intrinsic renal disease leading to abnormal urate excretion. Since approximately two thirds of daily urate production is normally excreted by the kidney, intrinsic renal disease resulting in abnormalities of urate excretion may have a profound effect upon urate homeostasis. Alterations in the pattern of urate excretion encountered in chronic renal failure are reviewed in depth, with a description of adaptive mechanisms for urate excretion which develop in residual nephrons, as exemplified by the remaining normal kidney of transplant donors. In addition, abnormalities in urate excretion in the presence of a normal complement of nephrons are described. Diminished urate excretion per nephron appears to be responsible for hyperuricemia in some patients with gout, while a variety of tubular defects resulting in excessive renal urate excretion have been  documented as the basis for some cases of hypouricemia.


[Complications of anterior cervical fusion operations]. The authors describe the technique of operation and then report about 15 intra- and post-operative complications in 360 anterior cervical fusions in 307 patients who suffered from cervical disc lesions. The complication rate was 4.16%. Apart from one case of complete but clinically reasonably well compensated recurrent paresis, all complications healed without permanent deficit. The differential diagnosis, prophylaxis and therapy of these specific operative complications are discussed.


Demonstration of cervical spinal canal before and after fusion operation. With the help of myelography using "oil soluble" positive contrast media, it is possible with a horizontal beam and a prone patient to outline the dorsal limit of the vertebrae and to estimate the degree of disc protrusion in the cervical region. In order to demonstrate the effect of anterior "ventral" fusion and especially the removal of the disc protrusion a large number of patients were again subjected to myelography following operation. It was; therefore, desirable that the contrast medium instilled pre-operatively should be mobilized in order to achieve such a demonstration in the cervical region. The method of operative myelography are described and illustrated by photographs.


Carpal tunnel syndrome caused by the persistence of the median artery. As another cause for a symptomatic carpal tunnel syndrome the persistence of the median artery is postulated. This was observed by the authors in three cases all of whom presented a typical carpal tunnel syndrome. As the only cause in all three cases a persistent median artery was observed. The embryological facts and the possible pathogenetic causes discussed.


New possibilities of controlled hypotension in neurosurgery. The position of controlled hypotension in neurosurgery is reviewed including both the new and old techniques and the drugs used. A special emphasis is placed on our use of sodium Nitroprusside which allows short lived, but very significant lowering of the blood pressure. Using this technique it was possbile in three cases where rebleeding of the aneurysm occurred at operation and in a further six cases of considerable arterial haemorrhage, to, "dry" the field of operation i.e. reduce the bleeding to such an extent that satisfactory orientation and quick and accurate handling of the emergency could be achieved.


Intraspinal intramedullary epidermoid tumor. A case of an intraspinal intramedullary epidermoid tumor at the level of D 2-4 is reported on. The case history, diagnosis, causes, frequency, and age of onset of these tumors are briefly discussed.


[Clinical experiences with monocomponent insulins]. The immunogenicity of conventional therapeutical insulin is discussed according to the concepts of Schlichtkrull: the formation of insulin antibodies is not attributable to the pure Sanger's insulin molecule, but to related protein impurities, present in all crystallized pig and ox insulin preparations. The terms of monocomponent insulin, highly purified insulin, and single peak insulin in defined and personal clinical results obtained with Novo Monocomponent Lente Insulin over a period of 3 years are presented. The Hein Christiansen's radioimmunoelectrophoretic method fo estimation of 125I-insulin IgG binding was used to determine insulin antibody levels. It was found that: 1) Newly detected insulin-dependent diabetics, never previously treated with insulin, do not produce insulin antibodies at a significant level; 2) Long-term insulin treated diabetics, transferred to monocomponent treatment, tend to reduce their antibody levels, if initially high, altough with transient recurrent peaks; 3) Stimulation of the immunocompetent system by intercurrent infection does not generally modify the immunological situation. Apart from immunological changes, satisfactory clinical results were observed in cases of high insulin requirement, insulin allergy, insulin lipoatrophy. Present practical indications for monocomponent insulin therapy (Actrapid-Lenta) are proposed.


[Effects of propranolol on some metabolic changes induced with insulin]. The effect of propranolol on certain insulin-induced metabolic changes in man. The effects of 0.2 mg/kg/body weight propranolol perfused in 10' on insulin-induced (0.15 I.U./Kg i.v.)changes in blood glucose, pyruvate, lactic acid, phosphorus, and potassium levels were examined in 12 normal volunteers. The blood glucose curve was substantially unaffected. Insulin-induced increases in lactate and pyruvate were inhibited to a varying degree, namely 78% (61-93%) and 44% (0.94%) respectively. The fall in phosphorus was reduced in a more constant manner (mean 48; range 37-57%) in all subjects, while that of potassium was not altered. The data indicate that these insulin-induced changes are significantly, though variably, attributable to beta-adrenergic activity on the part of endogenous catecholamines released during insulin-induced hypoglycaemia.


[Trial treatment of diabetic retinopathy by inhibition of pituitary somatotropin secretion with MAP]. The recent literature relating to the pathogenesis of diabetic retinopathy, with or without nephropaty, is critically reviewed. Particular attention is given to the Growth Hormone (GH) hypothesis. The various procedures of hypophysectomy are discussed, including the possible ways of suppressing growth hormone production or overproduction by drugs, and expecially by medroxyprogesterone acetate (MAP). Personal results obtained with long-term administration of MAP in deposit form on alternate days in 10 patients with advanced retinopathy are described. An icostant and  rely significant suppression of the GH response to insulin-induced hypoglicemia was noted in 6 cases, showing that a complete pituitary inactivation had been achieved. Therefore, the modifications observed in the fundus picture (studied with retinal photographs according to the Hammersmith Hospital Standards) seem to have no relationship with such a condition. The features involved were Microaneurysms and Haemorrhages (HAEMS) and Exudates (EX);New Vessels (NV) and Retinitis Proliferans (RP) were unaffected. Subjective improvement is visual acuity appeared to be more frequent, with various possible explanations. MAP was without appreciable effect on the clinical and metabolic course of the diabetes, or on renal function in cases of concomitant nephropathy. In the light of these preliminary results, further investigations might seem to be justified.


[Chronic bronchopneumopathies in chest x-ray findings at the Centro di Medicina Preventiva e Sociale]. Screening of secundary school children and the general opulation of the V. Monaldi Hospital Preventive and Social Medicine Centre,Naples showed a by no means negligible incidence of chronic bronchopneumopathy, particulary in infants. It is felt that, if untreated, these forms may be responsible for chronic respiratory insufficency in adulthood. Marker success in this respect has been obtained with anti-inflammatory and anti-bronchospastic substances, particularly a diethyl-aminoethoxyethylic ester of alpha-phenylbutyric acid. Preventive and social management is thus primarily directed at infants and the aged.


[Clinico-prognostic significance of plasma cortisol half-life(after intravenous administration ) during acute and chronic hepatic diseases]. Plasma cortisol half-times following an i.v. pharmacological dose were determined in subjects with variously serious forms of liver disease in a search for data indicating the course and prognosis. Determinations were made by means of the competitive protein binding technique. In the normal subject, values remain within the range 49 to 95 min. In acute and chronic liver disease, it was found that values in subsequent controls varied in function of the course. Cases with clinically cured acute hepatitis presented values within normal limits, while stationary or aggravescent forms were always accompanied by values of over 95'. It is suggested, therefore, that this test will give useful information concerning the course and prognosis of both acute and chronic liver disease.


Maternal assessment of fetal activity in small-for-dates infants. Fifty consecutive obstetric cases have been analyzed in which there was a clear history of either vigorous or reduced fetal activity during the week preceding delivery resulting in the birth of an infant weighing 2.5 kg or less after the 37th week. Especially in such hypertensive pregnancies, a maternal history of reduced overall fetal activity is very suggestive of impending fetal death, while a history of vigorous fetal activity tends to denote that the fetus is in no immediate danger. A plea is made for a greater awareness of this econimical "test" of fetal well-being. It is suggested that in some circumstances both impaired fetal growth and reduced fetal activity may be teleologic adaptations to the threat of a negative energy balance.


A new method of fetal heart rate monitoring. A new method of continuous fetal heart rate monitoring, employing for cardiotachometry the fetal electrocardiogram obtained from electrodes placed on the maternal abdomen, was evaluated over a period of 26 months at the Lying-in Division of the Boston Hospital for Women. A total of 2460 hours of intrapartum monitoring were analyzed. This "noninvasive" method of fetal ECG-based monitoring was shown to be as accurate as the direct scalp electrode method and more reliable than indirect ultrasound. Useful fetal monitoring, from very early labor up to the time of delivery, was possible in 91% of 507 patients, using maternal skin electrodes alone. Beat-to-beat variability determinations, possibly of significance in evaluating fetoplacental function in the antepartum period, were precise and without the artifactuality of ultrasonic or phonocardiographic methods.


Changes in total body composition during normal and diabetic pregnancy. Relation to oxygen consumption. Serial changes in body composition during pregnancy have been measured in 5 normal and 2 diabetic women on controlled diets to compare with simultaneous measurements of oxygen consumption (V-O2). Total body water (TBW) was measured by D2O dilution, total body fat (TBF) calculated as 100-%TBW/0.732 and body cell mass (BCM) derived from total body 40K count by Moore's formula, BCM equals K-e times 8.33. Two normal subjects in caloric equilibrium lost 1.2 kg TBF, gained 5.5 kg TBW and 4.1 kg BCM. Two obese subjects in negative caloric balance lost 4.7 kg TBF, gained 7.3 kg TBW and 4.3 kg BCM. One subject on ad lib diet gained 7.7 kg TBF, 0.6 kg TBW, and 2.6 kg BCM. She continued to gain fat postpartum. Two diabetic subjects gained fat up to 28 weeks, lost it thereafter, and showed no net gain in BCM. Basal V-O2 correlated with BCM, while 24-hour resting V-O2 related to total body weight. It is concluded that fat storage in human pregnancy depends on food intake, as in the nonpregnant. BCM accumulation is independent of food intake, except protein, and depends on normal physiologic adjustments of pregnancy, which are upset by insulin lack in diabetes. The extra basal energy needs of gestation are determined by BCM acquisition, not total body weight.


Pregnancy complicated by heroin addiction. During a 5-year time span, 118 addicted women gave birth to viable infants. These patients were subject to an increased incidence of complicating medical problems as well as many obstetric problems leading to maternal or fetal risk. The obstetrician should be aware of the possibility of addiction and its effects on pregnancy, and when possible, appropriate management should be initiated. Intensive care of the neonate must be begun as soon as possible.


Progesterone in molar vesicle fluid and theca lutein cyst fluid. Serum progesterone was estimated by a competitive protein-binding method in the peripheral venous blood in 12 cases of normal pregnancy at the time of delivery and in maternal venous blood, umbilical venoms, and umbilical arterial blood in another 5 cases. Progesterone concentration in the peripheral blood and in the serous fluid of molar vesicles was measured in 18 cases of hydatidiform mole. The theca lutein cyst fluid from 3 patients with hydatidiform mole was also assayed for progesterone. Umbilical cord venous blood and umbilical arterial blood showed a variable concentration of progesterone with a mean fetal-maternal progesterone ratio of 4.7 plus or minus 0.6 and a mean umbilical vein-artery progesterone ratio of 5.7 plus or minus 0.4. Serum progesterone concentration in hydatidiform mole was from 25.0 to 263.2 ng/ml with a mean plus or minus standard error of 101.7 plus or minus 15.2 ng/ml, while the corresponding mole vesicle fluid progesterone concentration ranged from 260.5 to 1842.0 ng/ml with a mean plus or minus SE of 770.9 plus or minus 87.4 ng/ml. The ratio of progesterone in vesicle fluid and in the serum was 4.0 to 52.8 (mean, 7.6). Progesterone concentrations in the theca lutein cyst fluid from 3 patients with hydatidiform mole were 25,428 ng/ml; 7,635 ng/ml; and 4,686 ng/ml. The high fetal-maternal progesterone ratio and umbilical vein-artery progesterone ratio reflect preferential progesterone transfer to the fetus and utilization by the latter. The finding in hydatidiform mole is due to the absence of the fetus and indicates that the molar trophoblast produced progesterone in significant amounts and that theca lutein cysts have a very high but variable concentration of progesterone in their fluid.


Prehysterectomy curettage.

Prehysterectomy curettage. The efficacy of prehysterectomy curettage in ruling out an endometrial cancer was evaluated in three ways. First, by an evaluation of the extent of routine prehysterectomy curettage; second, by the assessment of the clinicians' ability to recognize endometrial cancer on the basis of curettings; and third, by evaluating the presence of a gross endometrial lesion in those uteri removed without a preoperative diagnosis of an endometrial malignancy. It was concluded that the examination of the opened excised uterus was more valuable than prehysterectomy curettage for the operative diagnosis of an endometrial malignancy.


Repeat ectopic pregnancy: a 16-year clinical survey. This study includes 347 cases of ectopic pregnancy. A comparison was made between patients having one ectopic pregnancy, those having a repeat ectopic pregnancy, and those whose first pregnancy was an ectopic one. Emphasis was placed on obstetric history and the reproductive future of these patients. Obstetric performance was poor for all groups of patients studied. In the patient whose first pregnancy was ectopic, total reproductive performance was complicated by an increased risk of a repeat ectopic pregnancy. The incidence of repeat ectopic pregnancy was 11.2%. The average interval between ectopic pregnancies was 2.83 years; 80% of the repeat pregnancies occurred within 4 years of the first ectopic episode. Obstetric outcome was likely to be poor after the second ectopic pregnancy.


Recent advances in the cytogenetic study of human spontaneous abortions. A cytogenetic study of 27 spontaneous abortions was carried out using the Q-banding technic. The specimens were selected for study in order to increase the likelihood of finding a chromosome anomaly. Sixteen of 27 specimens (59%) showed a chromosome abnormality. Trisomy was found in 9 of the specimens, and the chromosomes involved were Nos. 2, 8, 14, 16, and 22. There were 5 triploids and 2 tetraploids. Using marker chromosomes, it was found that the extra haploid set was paternally derived in two of the triploids which were favorable for study. The Q-banding technic provides accurate identification of the extra chromosomes in trisomy. When favorable markers are present in the parents, the source of the extra haploid set can be identified in triploid abortuses.


Malignant teratoma of the uterine tube.

Malignant teratoma of the uterine tube. A primary malignant teratoma of the uterine tube, encountered in a 22-year-old female, is described. Forty-four cases of benign "teratomas" of the oviduct have previously been reported. This appears to be the first reported malignant teratoma of the uterine tube.


Effects of electrical stimulation on human ovarian contractility. Electrical stimulation was applied to the follicular walls, capsules of corpora lutea, and pieces of atrophic ovaries obtained from 29 human ovaries. The quantitative analysis of contractile capacity in these ovarian strips was performed on the basis of stimulation-response relationships. Only with follicular walls and capsules of corpora lutea was the step linear dose-response relationship similar to that shown by the uterine rube obtained by alternating current stimulation. The basal portions of mature follicular walls showed much more distinct responses to AC-stimulation than the apical portions. This difference further indicates a possible role of contractions by basal follicular walls in the process of follicular rupture at the apex in the human ovulation. The contractile elements of these ovarian strips were electronmicroscopically investigated with the strips which had shown contractions and confirmed to be smooth muscle cells in the ovary.


Amebic abscess of the liver and spleen in pregnancy and the puerperium. Two patients who developed hepatic and splenic amebic abscesses during pregnancy are reported. The frequency of incorrect diagnosis in patients with these conditions is stressed. Factors that influence the course and outcome of amebiasis in pregnancy are discussed.


Rapid hCG-specific radioimmunoassay for menstrual aspiration. Fifty-one women with missed periods ranging from 5 to 14 days who suspected a pregnancy underwent an aspiration curettage with a flexible soft-tipped cannula attached to a Karman-type syringe. Sera from these women were measured for human chorionic gonadotropin (hCG) by a rapid 2-hour solid phase radioimmunoassay using an antibody with a specificity for the beta subunit of hCG. The sensitivity and specificity of this assay insured detection of bCG with 100% accuracy at the time of the missed period. Of the 51 women, 33 (64.7%) were found to have hCG in their serum, and 29 (56.8%) had histologic evidence diagnostic of pregnancy.


Randomized comparative study of the copper T 300, Dalkon shield, and Shell Loop in parous women. A randomized comparative study of the Copper T 300, the standard Dalkon Shield and the Silicone Shell Loop D was conducted on 776 parous women. Net cumulative first event rates at 1 year and at 18 months, calculated by life-table analysis, were as follows: Copper T 300--pregnancy 1.2/1.9, expulsion 6.4/7.0, removal for pain or bleeding 7.4/10.8; Dalkon Shield--pregnancy 2.7/4.5, expulsion 5.8/5.8, removal for pain or bleeding 7.7/14.7; Shell Loop--pregnancy 3.8/4.9, expulsion 0.5/0.5, removal for pain or bleeding 9.1/13.1. None of the differences in event rates, except the lower expulsion rate of the Shell Loop, were significant. The continuation rates for the three devices at both 12 and 18 months were similar, indicating that there was little difference in their performance. As the results of this study showed a similarity of the incidence of events among very differently disigned IUD's, previously reported differences in performance of these and possibly other types of IUD's may very likely be more related to differences among clinics than to differences among the devices themselves.


Prophylactic use of tetracycline for first trimester abortions. Because the efficacy of prophylactic antibiotic therapy has yet to be established and because numerous variables often hamper studies of such therapy, the results of prophylactic antibiotic therapy were studied in a homogeneous gynecologic population. The patients were 4000 women undergoing first trimester abortions. The surgical procedure, the gynecologists' skill, and the hospital environment were relatively uniform, as was the patient age range. Two groups of 1000 patients each received tetracycline; the other 2000 patients served as controls. The complications associated with abortion were then analyzed in those receiving tetracycline and in the 2000 controls. Complications were less frequent among patients receiving tetracycline. This finding supports the argument of those who favor the prophylactic use of antibiotics in the management of various high-risk surgical problems.


Prolonged end stage fetal heart rate deceleration. With the use of routine monitoring of all patients in labor, a number of confusing, seemingly ominous fetal heart rate tracings in otherwise normal, healthy patients have been observed. This report described one such type of pattern called prolonged end stage deceleration.


Cerebral metastatic choriocarcinoma: a postpartum cause of "stroke". This case presentation is that of a 23-year-old woman who developed a "stroke" shortly after delivering a normal full-term infant. Evacuation of an intracerebral hematoma was required and an underlying nidus of choriocarcinoma was discovered. The patient responded dramatically to chemotherapy and irradiation. Because this metastatic tumor is potentially curable, we emphasize the importance of considering this diagnosis in young women who present with "stroke" symptoms, and we outline the appropriate laboratory and radiographic investigations.


Pancreatic pseudocyst complicating pregnancy. A case of successful conservative surgical and obstetric management of chronic pancreatitis and pancreatic pseudocyst in a pregnant Pima Indian is presented. In addition, the correlated studies of maternal serum and amniotic fluid amylase values and their relation to fetal maturity are discussed.


Quintuplet pregnancy.

Quintuplet pregnancy. A quintuplet gestation after ovulation induction with clomiphene and HCG is described. This is the first quintuplet birth reported in Israel. The pregnancy was associated with ovarian hyperstimulation syndrome, toxemia of pregnancy, and pruritus gravidarum. Diagnosis and management of these cases pose a special problem for the obstetrician and neonatologist. The problem of multiple pregnancies and their control in the treatment of infertility with ovulation-inducing drugs is discussed.


Pregnancy and childbirth in a true hermaphrodite. A rare case of pregnancy and parturition in a true hermaphrodite is reported. This patient, who was 25 years of age when first seen, had an ovotestis on the left and an ovary on the right gonad, with a karyotype of 46,XX. Following removal of the left ovotestis and surgical correction of the external genitalia, she married at the age of 31 and subsequently delivered a normal male child, karyotype 45,XY, by cesarean section.


Unilateral hyperlucent lung with decreased vascular markings (Swyer-James syndrome). When diagnosing unilateral hyperlucency on a X-ray picture one of the possible underlying conditions is the Swyer-James Syndrome. It consists principally of hyperlucency, diminished size, deficient blood supply, decreased ventilation, and bronchiectasis of the affected lung. Frequently a preceding pneumonia, caused by adenovirus, seems to be of aetiological importance. A yound patient, in whom the Swyer-James Syndrome was diagnosed on clinical, radiological, angiographical and ventilatory symptoms, suffered from pneumonia shortly before. This pneumonia was probably caused by adenovirus type 7, as appears from this virus being isolated from the faeces at that time. Treatment of this condition consists of antibiotics, mucolytics, bronch-spasmolytis, and physiotherapy. Surgery is rarely indicated.


[Empirical Analysis of the Behaviour of the Nursing Staff of a Children's Hospital (author's transl)]. Using the method of systematic behavioural observation, an empirical analysis of the behaviour of the nursing staff was carried out. Nine observational categories of behavioural forms were elaborated. These were: administrative work; nursing; strength of contact in relation to nursing duties, i. e. contact of a positive or negative nature; spontaneous contact of a positive or negative nature; supervision; leisure; and absence f ;rom the ward. These points were evaluated for 12 nurses over a three-month period of observation. It was demonstrated that administrative and ward work constituted the greater part of the activities studied, contact on the other hand being only seldom observed. As a control on the external observation a questionnaire was elaborated to obtain the subjective value of the various work operations. The personal evaluations confirmed the observed findings: contact with the child ranked last in all questions.However, positive contact occurred more frequently than did negative contact. Considerable variation in the evaluation of the individual nurses was observed, which could be partly explained in the categories "administrative work" and "child-oriented activities" by the relative status of the nurses. The data can be interpreted as demonstrating that the nursing staff is overburdened with administrative work. They are also the result of an unsufficiently child-oriented attitude, which requires modification through explanation of the psychological significance of this aspect.


[Disturbance of the Histidine Reabsorption of the Renal Tubes in Patient with Cystine Lysinuria in Conjunction with Severe Cerebral Damage (author's transl)]. The case of a 12-year-old boy with cystine lysinuria is reported. Unusual in this case was the combination of severe mental retardation, cerebral attacks and temporary Parkinson-like neurological symptoms. Biochemically, a disturbance of the histidine reabsorption of the renal tubes was also apparent. Further examination that the renal amino acid reabsorption could not be influenced by treatment with tryptophan. The possible biochemical relationships are discussed.


[Congenital abnormalities of the foot (author's transl)]. As with cases of hip-joint dysplasia, the sooner treatment of congenital abnormalities of the foot (hook feet, flat feet, sickle feet, club feet) is begun the better. In most cases the initial impulse will come from the doctor who has treated the child in the first days of life, i.e. the obstetrician or paediatrician. The paper recalls diagnostic criteria, in particular in distinguishing between slight cases and harmless temporary malpositions and describes the therapeutic possibilities. In case of contractions manual correction is usually sufficient, naturally under strict abservation and control, but whenever there is any restriction of the limit of movement in the contrary direction orthopaedic measures (correction and intermediate cast) will be necessary. Treatment, especially of club-footedness, demands considerable skill and patience both from the doctor and from the parents, the latter being ofter the greater problem. The necessity of long periods of treatment and even longer periods of observation cannot be sufficiently emphasized or repeated too often. Paediatricians can be of decisive influence because of their much more intensive cantact with the family.


[Hypothyroidism : diagnostic error and sequenlae. Report of a case]. Case report of an 8 year old, untreated, hypothyroid boy from the size and weight of a baby. The delayed maturation of the skeleton caused by the severly retarded metabolism is demonstrated. Typical X-ray signs of the untreated hypothyroid skeleton, sclerosis of the base of the skull and the significant deformity of the anterior portion of the second lumbar body (Swoboda sign) are discussed. The severe retardation of brain development can be demonstrated by the slow and low voltage EEG.


[A new method of treating obesity in children--experience from two therapy camps (author's transl)]. A report is given on a new method of treating obesity in children. In the summer of 1973 two "therapy camps" were held by the Vienna Univeristy Children's Clinic in co-operation with the Salzburg section of the Osterreichisches Jugendferienwerk (Holidays for Young People) in a particularly beautiful area of the Austrian countryside. For the duration of the camps the children were served with a diet containing very little easily digestible carbohydrate (simple sugar) but unlimited calories, and at the same time given physical training and encouraged to spontaneous activity. In addition to a satisfactory loss of weight, the children's habits were considerably altered. The changes in attitude necessary to maintaining the diet and the required level of physical activity were retained in a high percentage of cases over the six months' follow-up period of observation. Medically the therapy camps correspond approximately to stationary hospitalized reducing therapy but have the advantages of being more attractive  to the child and considerably preferable for physiological and paedagogical reasons since they offer an effective means of providing the child with a better motivation for achieving a normal weight. In addition, therapy camps are much more economic and can be held on a much broader baiss without blocking hospital beds that are needed for other cases. For these reasons the above-mentioned groups intent to hold therapy camps throughout the next years.


Child abuse and neglect. A priority problem for the private physician. Child abuse and neglect is a complex, multi-dimensional entity that should be clearly understood by any physician (pediatrician, surgeon, etc.) who is consistently functioning as a primary care physician. We have many of the tools and enough understanding to significantly ameliorate this preventable tragedy.


Pancreatic and gastrointestinal trauma in children. Injuries to the pancreas and gastrointestinal tract following blunt abdominal trauma continue to be a significant cause of morbidity and mortality in the pediatric age group. Optimal treatment of these injuries is frequently hampered by considerable delays in diagnosis. Factors contributing to these delays include the location of much of the duodenum and the pancreas in the retroperitoneum resulting in an absence of initial symptoms and signs, the often trivial nature of some of the responsible blunt traumatic accidents, inappropriate child-parent or child-physician communication, failure to achieve a meaningful physical examination in uncooperative or unconscious patients, and false negative paracentesis. Eighty per cent of these injuries occurred in boys. Eleven of 16 patients with pancreatic trauma had pseudocysts. A persistently elevated serum amylase level was invariably noted and epigastric mass was palpable in eight patients. Significant delays in diagnosis were prevalent and pseudocysts was misdiagnosed as appendicitis in three cases. Internal drainage by cystgastrostomy or cystjejunostomy was effective operative treatment. In instances of acute pancreatic injuries, sump drains, gastrostomy, cholecystostomy, and total parenteral hyperalimentation were useful therapeutic adjuncts. There was one death for a 6.2 per cent mortality rate. Forty patients had gastrointestinal injuries involving the duodenum in 17, jejunum in 14, ileum in seven, and stomach in two. Perforations occured in 65 per cent of cases, obstructing hematomas in 30 per cent, and mesenteric avulsions in 5 per cent. Associated injuries were observed in 15 patients (37.5 per cent). Pain and tenderness were the only consistent findings. Upper gastrointestinal contrast studies were diagnostic of duodenal hematomas. Eighty per cent of perforations were managed by simple closures and 20 per cent by resection and anastomosis. Obstructing hematomas unassociated with other injuries may be expected to resolve without requiring operation in 50 per cent of patients managed conservatively. Complications occurred in 35 per cent of patients and the mortality rate was 12.5 per cent (five deaths).


Renal injuries.

Renal injuries. Renal injuries due to nonpenetrating trauma are common in children. Pre-existing renal abnormalities are found in 10 per cent of children who sustain kidney injuries. Associated injuries are found in approximately 40 per cent of childhood cases. The most common serious injuries are those to the brain and the spleen. A renal injury should be suspected in every child with flank tenderness and red blood cells in the urine. If the child is unconscious, gross or microscopic hematuria may be the only clue. The amount of blood in the urine does not correlate with the severity of the injury. Plain roentgenograms and an infusion pyelogram using 2 ml of 25 per cent Hypaque per pound of body weight should be obtained as soon after injury as possible. Bilateral visualization of contrast material implies intact renal vessels. Reduction of the amount of contrast seen on the injured side with compression of the collecting system and without extravasation is characteristic of renal contusion. Evidence of a coexistent flank mass implies disruption of the renal capsule. These injuries heal without either operation or prolonged bed rest. Extravasation of contrast material beyond the renal capsule signifies disruption of the collecting system, the parenchyma, and the renal capsule. Early elective debridement, repair, and drainage results in salvage of a useful kidney in about 90 per cent of cases. Nephrectomy is seldom necessary. Failure to demonstrate any contrast material on the injured side is an indication for immediate further study by renal scanning, retrograde pyelography, or aortography. If recognized and treated promptly, some kidneys deprived of blood supply by gradual arterial occlusion secondary to an intimal tear may be salvaged, whereas delay invariably results in death of the devascularized kidney.


Trauma of the central nervous system in children. In summary, the care of the patient with head trauma is not dissimilar to any other acutely ill individuals. Careful, systematic observation and recording of changing factors and physical signs is necessary. Proper application and appropriate treatment in response to dynamic changes will provide a satisfactory result as in any other form of illness or trauma. The patient with multiple injuries may call for compromise in treatment, however with the exception of gross hemorrhage, the head injury should take precedence in the early period following injury for there are other factors that may prove fatal. Do not accept unnecessary delay in the treatment of other injuries on the grounds that the patient has had a head injury. The orthopedic surgeon can treat the fractured femur, the plastic surgeon-the face, and the general surgeon-the abdomen, without jeopardizing brain recovery. The treatment of the patient with head trauma, as treatment of any other individual in present day medical practice, has become more of a team effort, not only involving the neurosurgeon, but the pediatrician, the specialist in pulmonary physiology, and other expert groups.


Spinal injuries in children.

Spinal injuries in children. Spinal injuries with neurologic sequelae are a rare but catastrophic injury. Many of these injuries might be preventable through proper parent and child education, particularly in water sports and vehicles accidents. A significant number of neurologic injuries are incomplete at the time of injury and proper rescue and initial care may make the difference between life as a quadriplegic and life as a normal individual. Because of the complexity of the management of the child with spinal injuries and their relative rarity, the definitive care is best undertaken at hospitals which specialize in the care of spinal injuries. Progressive deformity of the spine, a problem unique to childhood and adolescent paralysis, is often preventable with prolonged immobilization and protection of the spine. Progressive deformities which interfere with function or result in neurologic deterioration require an aggressive surgical approach.


Eye trauma in childhood.

Eye trauma in childhood. In summary, the following program should be useful for the physician who encounters a child with a suspected eye injury: 1. Obtain a history. What was the child doing when he hurt his eye? 2. Examine the child by first inspecting the lids. Evert the lids with a cotton tipped applicator if necessary and if the globe is intact. Look at the canalicular area and decide whether the lacrimal drainage system is disrupted. Is a lid laceration deep enough to affect the levator? Could the orbital rim or any bony structures be involved? Should an x-ray film for fracture or foreign body be obtained? Is the anterior segment of the globe intact? What is the condition of the conjunctiva and cornea? Should fluorescein stain be applied to the cornea in an attempt to determine the presence of corneal abrasion? Put proparacaine hydrochloride 0.5 per cent drops in the eye if it is too sensitive or photophobic to allow opening of the lids. Is there blood in the anterior chamber? Does the lens look opaque? Is the cornea lacerated, is the globe ruptured? Does the patient have double vision? Is the eye obviously displaced relative to the other eye? 3. Check visual acuity-! Visual acuity may be checked initially or after examination of the eye, but some recording of the visual acuity should always be made. An elegent chart is not necessary. The child may be asked to identify letters on a prescription pad or merely record the presence of light, count fingers, etc., whichever is nearest maximal visual potential. 4. A decision should be made with regard to further diagnostic techniques including the decision, should an ophthalmologist be consulted? 5. Treat minimal anterior segment or adnexal injuries with or without consultation with an ophthalmologist. 6. If the injury is extensive, resist the urge to do something immediately; merely patch the eye and put the child in the hands of an ophthalmologist.


Antacids and anticholinergics. Thoughts on how and when to use them. The antacids and anticholinergics should be considered potent pharmacologic agents with potentially serious side effects. When the conditions constituting major contraindications to these forms of therapy have been considered and their presence has been ruled out, the antacids and anticholinergics are useful in managing the symptoms and course of disease due to the effects of acid and pepsin. Antacid given an hour or so after meals and at bedtime and anticholinergic given at bedtime to selected patients are especially useful in management of peptic ulcer disease. More or less extensive schedules may be indicated, depending on the severity of disease and symptoms.


Raised intracranial pressure. Diagnosis and management. The complications resulting from increased intracranial pressure are serious and include visual impairment, compromise of venous and arterial circulation, and brain herniation. Thus, early diagnosis of increased pressure is essential. The presence of papilledema is important in making the diagnosis; however, important exceptions exist. Diagnostic lumbar puncture is not usually a recommended procedure. The choice of therapeutic agents depends mainly on the urgency of the clinical situation and the clinician's experience. The hypertonic osmotic diuretics rapidly reduce elevated intracranial pressure but, with the exception of glycerol, must be restricted to urgent situations because of complications associated with their use.


Symposium. ENT for nonspecialists. The nose: structure and function. The structural relationships of the upper lateral cartilage and the septum form an important anatomic area called the liminal valve, one of three known paired valves of the nose. A small deformity in the region of the liminal valve may cause significant airway obstruction that usually can be relieved by surgery. Eighty percent of the population has alternating congestion and decongestion of the nasal turbinates, a phenomenon know as the nasal cycle. The exact function of this cycle is unknown, although it probably allows the two nasal chambers to act in unison and function as one nose. It is important to recognize the cycle as a normal phenomenon and to differentiate it from pathologic causes of nasal obstruction.


Symposium. ENT for nonspecialists. Problems of the septal areas. The problems of the nasal septum can be best discussed by dividing the septum into five areas. Each area of the septum has common causes of nasal obstruction that are specifically pertinent. The principles of conservative septal pyramid surgery are also important considerations within each area.


Symposium. ENT for nonspecialists. Management of nasal injury. Nasal injuries frequently occur and may result in immediate or delayed disturbances in both function and appearance. Early evaluation and management are beneficial in lessening the complications and disturbances in nasal function. A thorough intranasal examination is necessary to evaluate the injury, and examination may require local or general anesthesia to assess the injury properly. Specific management depends on the extent of injury. Minimal nasal injuries in children may result in a major disturbance of nasal function.


Symposium. ENT for nonspecialists. The patient has a lump in the neck. When a patient presents with a hard, painless lump in the neck, one should assume that it is a cancer and that it is metastatic from a primary lesion located above the clavicle. A careful physical examination with the appropriate instruments most often will determine the site of the primary lesion. Laryngograms or lateral soft-tissue roentgenograms should not be used as a substitute for visual inspection and careful examination. Examination with the patient under anesthesia is not needed unless the office examination cannot be done or a specimen from the suspected region cannot be obtained and examined microscopically in the office. Taking blind biopsies from normal-appearing mucosa is seldom worthwhile. Excisional biopsy is usually done with the patient under general anesthesia; needle biopsy is seldom used. Pathologic diagnosis by examination of frozen section is mandatory. Definitive treatment depends on the surgical and pathologic findings.


Symposium. ENT for nonspecialists. Supraglottic. Because supraglottic cancer usually is diagnosed late and metastasizes early, the cure rate is poorer than for glottic cancer. Supraglottic lesions can spread in any direction. The main method of diagnosis is either indirect or direct laryngoscopy, and the main symptoms are vague throat pain, otalgia, hemoptysis, hoarseness, and enlarged cervical lymph nodes. Roentgenographic examination is useful only as a supplement to other diagnostic measures. Staging of the disease is important in determining the most effective therapy and in predicting the results of treatment. Treatment should be individualized for each patient and should be selected on the basis of lesion size and site, the presence or absence of regional metastasis, the general health of the patient, and the likelihood of faithful follow-up.


Obstetrics and gynecology: psychologic management of infertile women. The psychologic difficulties associated with treatment of infertility can be minimized by limiting the length of treatment and refraining from suggesting a psychologic cause unless a specific one can be adduced. If treatment is unsuccessful, referral for supportive therapy may be indicated.


Eye disorders: fluorescein angiography.

Eye disorders: fluorescein angiography. Fluorescein angiography of the ocular fundus has become a primary diagnostic tool in ophthalmology. It can be of great value in patients with visual loss without ophthalmoscopic abnormality.


Symposium. ENT for nonspecialists. The ear: structure and function. Every component of the ear is vital for this system to accomplish its demanding role as the sensor of hearing and balance. In the ear, as elsewhere in the body, structure reflects function.


Symposium. ENT for nonspecialists. The dizzy patient. Dizziness or vertigo may be a perplexing situation to both the patient and the physician, The most important diagnostic factor is a careful history; a dizziness questionaire may be helpful. An otorhinolaryngologic and neurologic evaluation is necessary, and additional consultations may be in order, including vestibular testing and other laboratory studies, The etiology still may not be apparent, and the patient may need to be treated symptomatically and reevaluated periodically.


Foreign bodies in the ear, nose, and throat. Foreign bodies of the ear should be removed by irrigation, suction, or forceps. General anesthesia may be necessary. Foreign bodies of the nose should be removed with suction or forceps, and sometimes intubation may be necessary. Most foreign bodies in the throat can be removed by use of a mirror and a long hemostat.


Effects of cigarette smoking on learning and retention. Verbal rote learning was studied on 10 habitual smokers in a smoking and non-smoking session. Smoking induced a significant decrease in the number of correct responses on the learning task as compared to non-smoking values. The imparied learning coincided in time by an increased arousal as measured by heart rate. A test of recall 45 min after the end of the learning period, when the pre-smoking arousal level had been restored, showed that retention was better in the smoking condition than in the non-smoking condition. The results were interpreted in terms of Walker's theory (1958) postulating a relationship between arousal level and consolidation of memory.


EEG correlates of impaired attention performance under secobarbital and chlorpromazine in the monkey. The effects of secobarbital and chlropromazine upon behavior in a continuous, rapidly presented successive (go-no go) discrimination ("attention") task were evaluated in six Macaca mulatta monkeys. Simultaneous monitoring of EEG activity from epidural and subcortical electrodes permitted an evaluation of the nature of altered central nervous system events during erroneous performance (errors of omission) on this task. The computer-assisted analysis of pre-stimulus and post-stimulus EEG frequency activity (baseline crossings) suggests that the best measure of attentive behavior from the pre-stimulus EEG is percentage of beta 2 (25-40 cps) activity. No difference could be observed between drugs or among cerebral placements in this regard. This was determined by comparing measures of EEG frequency, pooled for a given test period, with performance from the same test period. On a trail-by-trail basis. however, the beta 2 measure in the pre-stimulus epoch failed to ditinguish correct responses from errors of omission. Separation between correct responses and errors of omission is possible if comparisons are made between the changes in percentage of beta 2 activity in the pre-stimulus vs. post-stimulus occurs with correct positive trials and the smallest change with correct negative trials. For secobarbital, no difference could be detected between correct and incorrect positive trials. For chlorpromazine, however, there was significantly less change in beta 2 for incorrect positive than for correct positive trials. The results were interpreted in terms of the hypothesis that secobarbital produces errors by depression of the general level of activation whereas chlorpromazine acts by reducing the sensory input which is necessary for correct discrimination performance.


Acute tolerance to ethanol in the rat.

Acute tolerance to ethanol in the rat. Male Wistar rats were examined on the moving belt test at approximately 10, 30 and 60 min after administration of ethanol in doses ranging from 1.0-2.8 g/kg. Immediately after the test, each animal was sacrificed and ethanol concentrations were measured. The regression line of impairment as a function of brain alcohol concentration showed a progressive shift toward higher brain levels with increasing time after alcohol administration. The results confirm the existence of acute tolerance to ethanol, as defined by reduced impairment of function for a given blood level on the falling versus the rising arm of the blood alcohol curve. Confusion of interpretation due to arterio-venous differences in alcohol concentration was ruled out by simultaneous measurements in arterial blood and brain. Practice effects were ruled out by testing each animal only once.


The effects of mevinphos on appetitive operant behavior in the gerbil. The need for study of the effects on performance of non-lethal organophosphate insecticide exposure is founded on many reports of behavioral difficulties in aerial applicators following exposure. In this study, a different pair of gerbils served in each of the following schedules of reinforcement: FR 25, FR 75, DRL 12-sec, DRL 20-sec, and VI 1-min. Baseline performance in these tasks tended to be comparable to that of more common laboratory species, but was more variable in the case of the VI 1-min task. Mevinphos doses of 0.20 mg/kg and above produced observable somatic signs of poisoning and also produced dose-related decrements in performance in FR and VI tasks. Performance in the DRL schedule was affected only at a dose of 0.30 mg/kg. No performance deficits or overt somatic signs of poisoning were present at mevinphos doses of 0.10 mg/kg or lower. These results do not agree with those of an earlier study which decrements in VI performance of pigeons and squirrel monkeys appeared at low mevinphos doses which did not produce overt somatic signs of poisoning. The possibility of variations in mevinphos effect as a function of species and task was discussed.


Human circulating dopamine-beta-hydroxylase and epilepsy. The activity of circulatory dopamine-beta-hydroxylase (DBH) in humans is shown to be lower in some epileptic subjects than in normal subjects. The activity of the enzymes was found to be dramatically low in subjects who experienced an epileptic seizure 24 hrs before DBH activity was determined. The activity varied through the course of epileptic seizures induced by a convulsant drugs and these variations might be due to the "en masse" changes of the sympathetic nervous system.


Psychogenic purpura in a man.

Psychogenic purpura in a man. A 53-year-old man with chronic back and leg pain developed recurrent painful ecchymoses after lumbar laminectomy. No hematologic abnormality could be detected, but an ecchymosis developed after subcutaneous injection of his blood into the region of pain. A detailed study of the psychological setting of the illness and his personality revealed this to be an example of psychogenic purpura. This is the third report of the syndrome in a male.


The use of psychological test data to predict open-heart surgery outcome: a prospective study. In an attempt to predict survival of open-heart surgery, particularly among high risk subjects who undergo extra-corporeal circulation [ECG] using pump oxygenation perfusion, a preoperative battery including intellectual, personality and neuropsychological instruments and also ratings of cardiac impairment, was administered to 15 control [cardiac surgery without ECG] and 72 experimental [ECG] subjects. Subjects were divided into survivor [S] and fatality [F] groups, and preoperative test data were analyzed using multivariate stepwise discrimination techniques. In a variety of analyses, at least 86% and as high as 100% of subjects were correctly classified as survivors or fatalities on the basis of variables sampled, indicating the outcome of cardiac surgery may be predicted preoperatively with a high degree of accuracy.


Radiological visualization of Gartner's duct cyst. During hystero-salpingography a sharply outlined collection of contrast medium was observed near the cervical canal of the uterus and interpreted as filling of a Gartner's duct cyst, an observation that- to the best of our knowledge-has not yet been reported as a radiological finding.


Tarsoid and Gonoid malformations of upper limbs. A bizarre and apparently hiherto unknown malformation complex mainly affecting the upper limbs was observed in a boy who underwent radiologic examination at 6 and 15 years of age. The most conspicuous abnormalities are represented by knee-like elbows and carpal elements resembling tarsals, additionally there was also marked overgrowth of the tarsal bones. The combination of these virtually unique malformations might suggest the existence of some early morphogenetic factor responsible for differentiation of the lower limbs and capable create ectopic elements of the lower limbs by conversion of the homologous parts of the upper limbs.


[Osteomas of the paranasal sinuses].

[Osteomas of the paranasal sinuses]. Within a period of 16 months, 25 osteomas of the paranasal sinuses were observed. Symptomatology, sex and age distribution, localisation, size at the time of discovery, and rate of growth are reported. An individual radiological technique is indicated, especially concerning the localisation and origin of the paranasal osteomas. This is important in order to plan the course of treatment and the type of surgical procedure.


[Malignant tumors of the phalanges].

[Malignant tumors of the phalanges]. It is reported about two cases with squamous cell carcinoma originating from the nail bed. There are roentgenographic signs of expansive displacing lesions. In opposite there are signs of destructive lesions within the finger in metastatic bronchial carcinoma. A case of spina ventosa withe malignant degeneration and a case of rapidly growing melanosarcoma causing bone displacement are described also.


[Fibro-Adeno-Lipoma of the   BREAST].

[Fibro-Adeno-Lipoma of the   BREAST]. The Fibor-Adeno-Lipoma is a rarely seen benign lesion of the breast. The encapsulated tumor is smoothly outlined. The capsule can be well visualized by mammography. The lesion contains different amount of fibroglandular tissue. In that way the mammographic appearance is characteristic and diagnosis becomes easy. The authors discuss the clinical and radiological appearance of the Fibro-Adeno-Lipoma on the basis of 7 cases.


Irreversible binding of carbon tetrachloride to microsomal phospholipids. Free radical nature of the reactive specie and alterations in the physico-chemical properties of the target fatty acids. Thin layer and gas liquid chromatographic analysis of the fatty acid methyl esters derived from liver microsomal phosphatidylcholine from animals treated with 14CC1-4 revealed a very similar composition to that observed during the analysis of the reaction products arised by the in vitro benzoyl peroxide initiated CC1-4 chemical addition to double bonds of fatty acid methyl esters or to fatty acids in phospholipids later transformed to methyl esters. The well known CC1-3 free radical nature of this in vitro chemical reaction gives support to the possibility for a CC1-3 free radical formation in vivo.


Structure-activity relationships for antimicrobial cephalosporins. The antimicrobial activity of a series of 7-mandelamido-3-cephem-4-carboxylic acids was studied using the Free-Wilson method. Electron-withdrawing and lipophilic properties of the substituents are shown to play an important role in the activity.


Rapid photolysis of cholesterol.

Rapid photolysis of cholesterol. Studies of cholesterol photolysis demonstrated that over 50% of this sterol was converted to more polar photoproducts after 10 minutes exposure to broad spectrum radiation from a mercury arc lamp. Light of 254 and 265 nm wavelengths was most effective in alteration of the sterol. The major polar photoproducts formed were tentatively identified.


Cholesterol balance in atherosclerosis-susceptible atherosclerosis-resistant pigeons. On cholesterol-free diets, the total fecal steroid excretion was significantly lower in atherosclerosis-susceptible Whit Carneau pigeons than in atherosclerosis-resistant Show Racer pigeons, with major differences in the neutral sterol fraction.


Nonspecificity in the divalent cation antagonism of dihydrostreptomycin action on Mycobacterium smegmatis. A divalent cation-dependent antagonism of dihydrostreptomycin action on Mycobacterium smegmatis was demonstrated. However, the nutritionally nonessential cations Sr++ and Ba++ inhibited drug action as effectively as the essential ions Mg++ and Ca++, indicating a high degree of nonspecificity.


Digoxin concentrations in serum and saliva. Serum and mixed saliva concentrations of digoxin were measured in 34 hospitalized patients. The mean saliva:serum concentration ratio of digoxin was 1.14 (plus or minus 0.48). Of 20 patients with saliva digoxin concentrations in the range of 0.7 to 1.5 ng/ml, 18 patients had serum concentrations which were within the same range. Saliva offers a convenient and noninvasive means of monitoring the digoxin status of patients.


Thromboembolic complications of oral contraceptive therapy. During a ten-year period, 348 women were studied for a total of 5877 patient months for changes in hematologic parameters induced by oral contraceptives. Significant increases were observed in Factors I, II, VII, VIII, IX, X and plasminogen. Severe complications developed in four patients. All four had an abnormal blood coagulation profile, suggesting "hypercoagulability" before initiation of therapy. All four patients were of A or AB blood group. It appears from these data that hematologic workups may be useful in women who are about to embark on long-term oral contraceptive therapy.


Quantitation of continine in sera of smokers. Sensitive and specific radioimmunoassays were used to determine the levels of cotinine, the major metabolite of nicotine catabolism, in the sera of 22 typical smokers and of two individuals who smoked cigarettes of known nicotine content under controlled conditions. In samples from the random population, cotinine was detected in concentrations ranging up to 600 ng/ml. There was poor correlation between cotinine levels and the nicotine contained in the cigarettes smoked daily by the individuals. Whether this reflects differences in smoking habits, genetic factors, and/or represents the results of enzyme induction or adaptation is unknown at present. However, since nicotine has a short plasma half-life, it may be advantageous to assay for the longer lived and more abundant metabolite in studies designed to relate the effects of smoking to health. The radioimmunoassay method for cotinine is practical for epidemiological studies and offers distinct advantages over available chromatographic techniques.


Thyroid hormone control of serotonin in developing rat brain. The influence of thyroid hormone on serotonin was studied in different regions of the rat brain. Surgical thyroidectomy of adult male rats led to significant increases in the level of serotonin in the hypothalamus but had no effect on this biogenic amine in the brain stem and basal ganglia. Experimental cretinism, induced by daily propylthiouracil treatment starting at birth, caused increased serotonin levels in all brain regions studied. In contrast. neonatal hyperthyroidism, produced by daily administration of L-triiodothyronine from birth, had no effect on the ontogenic patterns of serotonin. The turnover of serotonin, estimated by determining the rate of increase of the amine following administration of the monoamine oxidase inhibitor, pargyline, was decreased in the brains of 30-day-old cretinous rats when compared to their control littermates. The data suggest that thyroid hormone may exert an important regulatory influence on serotonin metabolism in the developing brain.


DNA breaks in P288 tumor cells in mice after treatment with daunorubicin and adriamycin. Extensive DNA damage was found in tumor cells after therapeutic doses of daunorubicin and adriamycin (2.5 - 10 mg/kg) were administered to mice bearing lymphocytic leukemia (P-288). After low doses (0.6 mg/kg), DNA breaks were evident as early as 1-3 hr after daunorubicin and as determined with adriamycin the damage lasted as long as 72 hr. In a comparison, actinomycin D produced smaller amounts of damage by 3 hr after the administration of maximally tolerated doses (0.8 mg/kg) and even less after 0.4 mg/kg. These experiments indicate that the antitumor activity of daunorubicin and adriamycin in treated mice may result from damage to the cellular DNA.


Radiation modifying effects of meso-tetraphenyl porphyrins. The radiation modifying effects of a series of the metal chelates of meso-tetra(p-carboxyphenyl) porphine has been investigated using a human lymphoid cell line, RPMI 1788. These studies revealed that Ni and Zn porphyrins were effective radiation sensitizers at concentrations as low as 10-9M. Further studies with Zn porphyrin showed it to be almost equally effective when added immediately after irradiation and partially effective when added up to 90 minutes post irradiation, suggesting that it may be acting by interfering with a repair mechanism.


High pressure liquid chromatography of cannabinoids as their fluorescent dansyl derivatives. Four different cannabinoids were converted to their 1-dimethyl-aminonaphthalene-5-sulfonate (dansyl) derivatives. Standards mixtures were separated by high pressure liquid chromatography and detected with an experimental filter fluorometer with sub-nanogram sensitivity. The effect of solvent properties on fluorescence spectra and quantum yields was also studied.


Carbon tetrachloride induced polysome breakdown. Relative importance of lipid peroxidation and of binding to ribosomal components in the process. In vivo, CC1-4 causes an intense polysome breakdown; CHC1-3 effect is much less intense and CH2C1-2 effect is negligible. Previous administration of either diphenyl-p-phenyelnediamine or alpha-tocopherol to the rats does not prevent CC1-4-induced polysome breakdown. Promethazine and cystamine were able to prevent to a good extent the CC1-4 induced polysome breakdown process. 14CC1-4 irreversibly binds to ribosomal proteins but not to ribosomal RNA. Several hepatocarcinogens which are effective alkylating agents and cause in vivo polysome breakdown do not induce a lipid peroxidation process.


Effect of diazepam on unstimulated and on stimulated gastric secretion. The effect of intravenous diazepam on unstimulated and on pentagastrin-stimulated gastric secretion has been studied in normal subjects. No significant effect of diazapam was found on pentagastrin-stimulated gastric secretion. Unstimulated secretion was reduced by diazepam. This action of diazepam may be useful in peptic ulcer therapy.


Clostridium septicemia following biliary surgery in a gastrectomized patient. A 75-year-old woman was subjected to biliary surgery 38 years after partial gastrectomy for ulcer. There was a history of gallstones of 10 years duration, pentagastrin-resistant achylia, cholecystolithiasis and choledocholithiasis complicated by stenosis of papilla of vater, cholecystitis and pancreatitis. Peroperative cholangiography and biliary tract surgery were performed. On the third postoperative day heavy jaundice and hemolysis developed, leading to death of the patient. Culture of bile taken at operation revealed strains of Clostridium perfringens and Escherichia coli. Autopsy showed a picture of gas gangraena of the liver and Clostridium septicemia. The role of achylia, blind loop, and biliary obstruction in bile surgery is stressed.


Plasma concentration of lipoprotein-X (LP-X) in experimental bile duct obstruction. Sequential quantitative determinations of lipoprotein-X (LP-X), measurements of plasma lipids, initial rate of cholesterol esterification, and liver function tests were performed after experimental cholestasis in 6 dogs. In 3 animals ligation and transsection of the common bile duct were combined with cholecystectomy. In 2 other dogs a similar operation, but without removal of the gallbladder, was carried out. In the bile-duct-obstructed and cholecystectomized dogs, LP-X appeared 11-21 hours after operation, and in dogs with preserved gallbladder 32 hours after operation. During the observation periods (6-41 days), the LP-X levels were much higher in the cholecystectomized dogs than in the ones with preserved gallbladders. In most of the bile-duct-obstructed dogs the curves of LP-X concentrations in plasma were bi-phasic. The first peak after 1 to 5 days was followed by a fall, and 10 to 14 days after operation another rise was observed. Concomitant with the changes in the level of LP-X, fluctuations in the levels of phospholipids and free cholesterol occurred. An inverse relationship between LP-X and the activity of lechithin: cholesterol acyltransferase was found.


The motor-stimulating effect of metoclopramide and pyridostigemine bromide in normal man and laparotomized patients. A combined study of duodenal electric and motor activity. The effect of metoclopramide on duodenal motility was compared to that of pyridostigmine bromide by means of stimulaneous recordings of electrical action potentials (spike potentials) and intraluminal pressure variations in 40 normal young volunteers and 8 patients after intraperitoneal operations. Quantitative calculations according to a previously described system showed a significant increase in activity in the normal material after both drugs. The increase was greatest after metoclopramide and appeared more rapidly. Compared with the normal individuals, patients in the postoperative phase showed a moderately decreased activity before drug administration. No significant increase in activity could be demonstrated after either of the drugs.


Inhibition of gastrin-stimulated canine acid secretion by sham-feeding. In dogs with a Heidenhain pouch and oesophageal and gastric fistulae, sham feeding inhibited pentagastrin-stimulated Heidenhain pouch acid output. When secretion was stimulated with a combination of pentagastrin and betanechol chloride, the inhibitory effect of sham feeding was less pronounced. Histamine-stimulated secretion was not inhibited by sham feeding. The inhibitory effect was not affected by extragastric abdominal vagotomy but was reduced or abolished by truncal vagotomy. The results are consistent with the hypothesis that vagal activity releases a hormone which has an inhibitory action on gastric acid secretion.


Extraperitoneal perforation of the rectum during barium enema. During barium enema, barium pentrated the rectum to the perirectal extraperitoneal tissue in six patients. Four of these died, and the two survivors have permanent colostomies. The incidence of this rare complication may be further reduced if barium enema is postponed after instrumentation of the rectum, the enema can not lifted more than one meter, the balloon not distended too much, the tip of the balloon catheter made very short, and the personnel in the radiological department made aware of the complication. The complication is probably best treated by prompt diverting colostomy, drainage of perirectal tissue, and antibiotics.


Effect of two methylated prostaglandin E2 analogs on gastroduodenal pressure in man. The effect of two methylated analogs of prostaglandin E2 (PGE2), namely 16, 16-dimethyl PGE2 and 15 (S)-15-methyl PGE2 methyl ester, on gastroduodenal motility has been studied in healthy male volunteers. Oral administration of 140 mug of the 16-alkylated analog produced a significant decrease in motor activity in both the gastric antrum and the duodenum. 80 mug had no detectable effect on pressure. However, 80 mug of the 15-methylated analog administered directly into the duodenum caused an almost immidiated inhibition of the duodenal motor activity. In view of previous findings on the inhibitory action of these two analogs on gastric acid secretion, it seems as if the gastrointestinal smooth muscles are less sensitive to the action of the analogs than are the oxyntic glands.


Stimuli for heptadecapeptide gastrin release: a comparison of oral and intravenous arginiine-monochloride and oxo in normal, vagotomized and antrectomized patients. Arginine, administered intravenously, was a more potent stimulus to gastrin release than oral Oxo-feeding, while oral arginine failed to elicit a response in normal subjects. Intravenous arginine stimulated a rise in serum gastrin only in normal subjects but not in antrectomized or vagotomized patients. The gastric antrum appears to be the major site of production of heptadecapeptide gastrin and 'mini' gastrin, as measured by the anti-serum used in our radio-immunoassay.


Intragastric pressure/volume relationship in the normal human stomach. Intragastric pressure/volume relationship was studied twice in 8 healthy volunteers. Basal pressure and rhythmic contractile activity in response to defined volume loads were recorded. Reproducibility and precision of the parameters were evaluated. It is concluded that recording of the intragastric pressure/volume relationship is a valuable method for the evaluation of gastric motility, and it is well suited for clinical application. It is harmless and easy to perfrom. The reproducibility of the method and the precision of the parameters used are satisfactory.


Vitamin B12 absorption in patients with continent ileostomy. Vitamin B12 absorption was studied in 34 patients, 10 months to 6 years after construction of a continent ileostomy. Normal Schilling test values (greater than 10 percent) were obtained in 21 of the cases after a single determination. Repeated tests showed a normal B12 absorption in 8 of the 13 patients who had revealed a Schilling test value below 10 percent at the first determination. In the remaining 5 patients, repeated Schilling tests showed borderline values (5-10 percent) in 4 cases and a low value (mean 4.5 percent) in one case. One of the patients with borderline values had previously undergone resection of 80 cm of the terminal ileum. When vitamin B12-intrinsic factor complex was instilled directly into the reservoir in 3 patients, it was found that the vitamin was absorbed by the mucous membrane of the reservoir. The construction of a continent ileostomy reservoir thus does not appear to expose the patient to an increased risk of developing vitamin B12 malabsorption.


Mucosal morphology, bacteriology, and absorption in intra-abdominal ileostomy reservoir. Six patients who had undergone proctocolectomy and been provided with intra-abdominal ileostomy reservoirs were studied in intervals during the 24 postoperative months. The studies included the mucosal morphology, bacteriology, and the local absorption in the reservoir. The results showed that the mucous membrane of the terminal ileal segment used for construction of the reservoir underwent morphological changes characterized by an increased cell turnover and a shortening of the villi. These changes in morphological structure took place rather promptly after construction of the reservoir. No indications for a continuously progressing process could be found. The brushborder was intact and no cellular lesions were discovered. Soon after construction the reservoir was inhabited by a microbial flora which held an intermediate position between the flora of effluent from conventional ileostomies and normal faeces. The flora remained rather stable in the reservoir. In spite of the new microbial ecology and the morphological changes, the reservoir mucous membrane did retain absorptive capacity for D-xylose and phenylalanine.


Effects of carbenoxolone sodium and of aspirin on gastric mucosal potential difference in normal subjects. The fall in potential difference (p.d.) across the gastric mucosa induced by aspirin has been studied before and after administration of carbenoxolone sodium in normal subjects. The subjects received 300 mg of carbenoxolone sodium daily for 14 days. The mean percentage fall in p.d. measured 10 cm distal to the cardia was unchanged.


Bone mineral after partial gastrectomy II. The bone mineral content estimated by gamma ray attenuation method, serum calcium, phosphorus, alkaline phosphatase, and protein was examined in three types of patients with peptic ulcer. The bone mineral content in ulcer patients before surgery did not differ from that of the control series. In patients subjected to 1/3 gastric resection and Billroth I reconstruction with or without selective vagotomy 3.3-8.5 years previously, and in patients subjected to 2/3 gastric resection with Billroth II reconstruction 15-18 years earlier, the mineral density of bone was found to be lower than in a control series of matched age and sex. The mineral loss developed sooner in women than in men. Low serum calcium values were met most often in patients examined 3.3 to 8.5 years after surgery. The serum alkaline phosphatase level increased after surgery. However, there was no difference in bone mineral density in patient groups with low calcium or high alkaline phosphatase, compared with patients with normal values. In conclusion, gastric resection of 1/3 or 2/3 of the stomach, with or without vagotomy, using gastroduodenostomy or gastroenterostomy as the reconstruction, results in a lowering of bone mineral density. This decrease, however, was not found to have caused symptoms injurious to the health of patients examined in this study.


The trypsinogen and chymotrypsinogen contents of the pancreas during acute experimental pancreatitis of the rat. The trypsinogen and chymotrypsinogen contents of the pancreas were examined during acute experimental pacreatitiis of the rat. The proenzymes were activated with enterokinase and the amounts of active proteases were estimated with BAPNA (N-alfa-benzoyl-DL-arginin-4-nitroanilid hydrochlorid, Fluka AG) and SUPHEPA (succinyl-L-phenylalanine-p-nitroanilide, Schwarz/Mann, Division of Becton) as the substrates. The activation of chymotrypsinogen was more rapid than the activation of trypsinogen; maximal activation occurred in 3 hours. Under similar circumstances the activation of trypsinogen required 17 hours. Both trypsinogen and chymotrypsinogen content decreased significantly during the inflammation. In 8 hours the decline of trypsinogen content was 28.4 percent and that of chymotrypsinogen content 44.9 percent from the proenzyme content of the normal resting rat pancreas. This indicates that proenzymes and/or active proteases are liberated during the course of pancreatitis. No correlation was found between the trypsinogen and the chymotrypsinogen content of the normal pancreas, but during pancreatitis the proenzyme contents correlated clearly. The correlation during inflammation possibly reflects the amount of the viable pancreatic tissue and the rate of synthesis.


A histological study of gastric mucosa before and after proximal gastric vagotomy in duodenal ulcer patients. In 29 patients with duodenal ulcer, suction biopsies were obtained from the body of the stomach within 2 weeks before and 3 and 12 months after proximal gastric vagotomy (PGV). Only those with a negative insulin test were included in the study. Three months after PGV basal and pentagastrin-stimulated acid secretion was reduced by 82 and 64 percent of preoperative values, respectively. Twelve months after the operation the corresponding figures were 63 and 56 percent. There was a similar acid reduction in patients with or without gastritis. The number of patients with atrophic gastritis increased from 3 before the operation to 11 3 months after PGV (p smaller than 0.01). There was no further increase from 3 to 12 months postoperatively. The average thickness of gastric mucosa and the mean number of parietal cells per unit area before PGV did not show any significant change 3 months and 1 year after the operation. There was a significant correlation between the number of parietal cells per unit area and maximal acid output before (p smaller than0.01) but not after PGV. Acid output per parietal cell was higher before PGV, suggesting that the decrease in gastric secretion after PGV cannot be attributed to the development of gastritis or reduction of parietal cell number.