Menstrual induction: its place in clinical practice. From June 1973 to October 1974, 221 patients underwent menstrual induction in the private offices at a University Medical Faculty Group located in its major teaching hospital with ready access to operating room facilities. The rationale for subclassifying early abortion as "menstrual induction" is discussed. In this series menstrual induction was performed on patients who were 7 to 21 days beyond the date of an expected menses. Histologic examination of the tissue removed was consistent with a diagnosis of pregnancy in 98.2% of the patients. Complication rates following the use of the practices outlined in this report were acceptably low.


High-risk pregnancy. Unresolved problems of screening, management, and prognosis. In the field of maternal and child health the concept of the high-risk pregnancy has been used in many studies. However, it is still beset by problems that must be solved if any real progress is to be made. The ideal of a simple, reliable screening technique has not yet been achieved. Present methods are not only complex, they are not well validated. High-risk factors must be quantified if the values of various regimens of obstetric care are to be measured and if prognostic success is to be attained. Moreover, efforts at prediction should not cease with the current pregnancy but should extend to subsequent reproductive performance. This long-range approach to prognosis could not only improve patient care during the current pregnancy but could also become an essential factor in achieving optimal results throughout reproductive life. An extensive bibliography of studies of high-risk pregnancies is presented.


Disseminated intravascular coagulation in gynecologic cancer. Disturbances in the blood coagulation mechanism are seen by the obstetrician and gynecologist as rare complications of abruptio placentae, retained dead fetus syndrome, amniotic fluid embolism, toxemia, saline amnioinfusion, and septic abortion. Two cases of disseminated intravascular coagulation complicating gynecologic malignancy are presented. Laboratory studies showed thrombocytopenia, hypofibrinogenemia, and increased fibrin degradation products. Derangements of hemostasis in patients with malignancy are discussed from a clinical viewpoint.


Large bowel perforation by intrauterine contraceptive devices. Two cases of large bowel perforation by intrauterine contraceptive devices are presented. Both the Lippes LoopTM and Dalkon ShieldTM have the potential of evoking omental adhesions and causing bowel perforation. These serious complications justify the immediate removal of a contraceptive device from the peritoneal cavity by either laparoscopy or laparatomy.


Ultrasonic diagnosis of fetal life in early pregnancy. Ultrasound methods for detecting fetal life during early pregnancy are reviewed. By using recently developed techniques, fetal heart function can be detected as early as the 44th to 45th day of amenorrhea. Fetal movements in the amniotic cavity can be visualized from the 10th week on. If no signs of fetal life can be detected by ultrasound examination by the 10th week, the pregnancy is in jeopardy. However, the prognosis is favorable in over 90% of those cases of threatened abortion in which fetal life has been confirmed by ultrasound.


Determination of regional manpower requirements in obstetrics and gynecology. The number of trainees produced by a residency program must relate directly to manpower needs in a specialty, not to the service needs of the training institution. In order to avoid geographic maldistribution of specialists, it is preferable to determine correct trainee output on a regional basis and combine such information inductively to determine overall national needs. A model for determination of the number of residents appropriate to train in obstetrics and gynecology by 1985 in the University of Utah program has been constructed in the setting of regional requirements. Components of this model include detailed population growth forecasts at the county level, consideration of the impact of increased urbanization, age-specific data for attrition of regional specialists by death or retirement, and estimation of the proportion of regional requirements to be met by the University of Utah program on the basis of distribution data of previous graduates.


Mitoses in human epidermis. Clustering, sister cells, and findings suggestive of a spreading mitotic stimulus. 40 sections 8 mum/thick from each of 60 biopsies of human skin were studied intensively by oil immersion microscopy. Mitoses occurred isolated, and as clusters of twos and threes. Some clusters consisted of or contained touching mitoses. These touching mitoses could result from sister cells of a prior mitoses staying together through a cell cycle and entering mitosis again together. However, even when these touching mitoses were excluded, the number of clusters left was significantly more than expected from chance. To account for the clustering we may postulate a mitotic stimulus spreading from mitotic cells in human epidermis.


Cancer of the thyroid following radium application to the neck. A young patient, suffering from thyroid carcinoma 24 years after radium treatment of the neck, is presented. The cancer appeared in the area which has been irradiated. In the present case, the thyroid was exposed to a relatively low dose of radiation. The importance of ionizing radiation and its carcinogenic effect in the juvenile thyroid are discussed.


Lymphangitic pulmonary metastases secondary to breast cancer with normal chest x-rays and abnormal perfusion lung scans. Three patients with advanced breast cancer are described who developed lymphangitic pulmonary metastases with normal chest x-rays and abnormal perfusion lung scans. The abnormal lung scans can probably be attributed to embolization of the pulmonary vasculature, first described in association with lymphangitic pulmonary metastases in 1903. The importance of recognizing this condition in patients with breast cancer is shown by their frequently good responses to combination chemotherapy.


Plasma and body lipids in patients with carcinoma of the breast. Patients with breast carcinoma had elevated levels of plasma total lipids, phospholipids and cholesterol which were associated with increased amount of subcutaneous body fat as compared with the patients bearing non-breast carcinomas. The raised plasma concentrations of these parameters in the patients bearing breast carcinoma may be due to increased rate of lipid absorption as the fat-splitting enzymes, lipases, were also found to be increased in the patients.


Preliminary report on the effects of localized head irradiation on the development of transplanted tumors in C3H/HeJ mice. The growth rate, as measured by increases in volume of a transplanted tumor (adenocarcinoma), was compared in mice that were irradiated locally to the head and in nonirradiated mice. 6-month-old female C3H/HeJ mice were used, and those that were irradiated received dosages of 100 and 200 r from a Keleket 220 KVP 20 Ma X-ray machine. The dosages were delivered at 6.66 r/sec through a 0.25 cu/1.0 aluminium filter. The beam from the X-ray tube was then collimated through a series of lead shields before reaching the cranium of the mouse. 24 h after irradiation, some mice were transplanted into the left side of the axillary fold, with small pieces, approximately 2 mm3, of tumor tissue. Careful weekly examinations for 15 weeks after the initial transplantation revealed major differences in tumor volume between irradiated and nonirradiated animals.


Species-specific neoplastic progression by ultraviolet light on the skin of rats, guinea pigs, hamsters and mice. Repeated ultraviolet light (UV) irradiation on the skin of rats caused ulceration, scarring and epithelial tumors; 38% of the animals had ear tumors and 5% skin tumors. Guinea pigs presented minimal evidence of neoplastic transformation; only two tumors were seen while hamsters displayed localized epidermal hyperplasia, and 35% of the animals had papillomas and keratoacanthomas of the dorsal skin. In Swiss mice UV irradiation caused ulceration, necrosis and hyperplasia; moreover, fibromas and fibrosarcomas occurred in 17 of 20 tumor-bearing mice. Epithelial tumors originated from the proliferation of benign epidermal cells, through dysplastic changes in the surface epithelium, or from the borders of skin ulcers (in rats). These tumors were local and circumscribed in the hamsters, while covering the entire ear tip in rats. Dermal tumors, consisting of fibroblastic 'light' and 'dark' cells, occurred in mice previously showing extensive ulceration and scarring.


A new approach to testing the effect of ultrasound on tissue growth and differentiation. Pulsed ultrasound from a Picker Ultrasonoscopy Model 102, with a frequency of 500 Hz and an energy of 2.2 MHz was applied to the amputated left forelimbs of 24 adult newts. Exposure time was 5 min in half of the animals and 10 min in the remainder. The right forelimbs of these newts were also amputated at the same time, at the same anatomical level, and by the same operator of the left forelimbs, but were not exposed to sonication. Regeneration of both forelimbs was compared and found to be generally slower in the ultrasonicated limb. In 75% there was a definite retardation of growth. The results suggest that the the growth of rapidly proliferating embryonic tissue (newt regenerates are formed from embryonic cells in the stump) is inhibited by ultrasonication.


Tumour-associated surface antigen(s) in human astrocytomas. The cytotoxic properties of a hetero-antiserum have been used to demonstrate surface antigen(s) common to seven human astrocytomas. This has been designated human astrocytoma-associated antigen (HAAA). Tissue cultures of astrocytomas were prepared. A rabbit antiserum was raised to one of these and its antibody activity on the original tumour cells assayed by dye exclusion cytotoxicity testing. After repeated absorption with associated antigen(s). In a series of absorption experiments, HAAA was detected in six other human astrocytoma cultures, but not found in a series of other human tumours and tissues tested. Homogenates of two original astrocytomas absorbed out HAAA activity in a similar way indicating the presence of the antigen(s) in vivo. The significance of this HAAA is discussed.


Electron-microscopie observations of a human schwannoma in organotypic culture. A malignant Schwannoma of the cauda equina has been studied in long-term organotypic culture. Electron-microscopic observation demonstrates that, along with tissue organization, characteristic cell differentiation was retained in this type of culture, but with some morphological changes. As in the biopsy, the tumor cells were elongated and had abundant cell processes in vitro. An increase in the quantity of cytoplasmic filaments and changes in the form of cell processes were observed. Thus organotypic culture of human Schwann cell tumors provides a method of investigating factors which affect their development and differentiation.


Some toxic, physical and chemical properties of the oral secretion of the sand tampan, Ornithodoros savignyl Audouin (1827). Mice, exposed to the effects of the oral secretion of Ornithodorus savignyi by injection, revealed that a potent toxin is present in the secretion. Electrophoretic and chromatographic separations of the secretion showed a heterogeneous pattern of protein-like substances. Toxicity trials on these fractions showed that the toxic principle is protein in nature and fairly heat stable.


[Psychotic manifestations in childhood. III. Abnormal reactions to adventures (author's transl)]. In childhood psychotic manifestations are in most cases due to somatic diseases, but may be psychogenic. Abnormal reactions to adventures especially to very abnormal occurances--for instance in families with psychotic members--lead to psychotic symptoms. The appearence of those psychotic manifestations is influenced by the age of the child, by his hysterical, anancastic or austistic character and the pathological features (paranoic or depressive) of the inducing person. Usually hospitalization for diagnostic and therapeutical reasons is necessary. In case of induced psychoses separation must be long enough and has to be combined with treatment of the primary patient.


[Nitroblue tetrazolium-test and encephalitis (author's transl)]. The NBT-Test which is applied now in the differential diagnosis of viral and bacterial diseases was performed in 6 children sufferring from encephalitis. The modified technique described by Kim et al. was used. According to other reports dealing with NBT-Test in viral diseases all our patients showed normal percentages of NBT-positive cells. On the other hand a few authors report "false positive" NBT-tests in viral diseases. Therefore various factors, like stage and duration of the disease, damage of the phagocytes by toxins, influence of antibiotics, are discussed. Because of the occurrence of negative results in the early stages of bacterial meningitis the NBT-test in its present technique should not be used in differentiating bacterial meningitis from viral encephalitis.


[Dysplasia renofacialis (author's transl)]. Potter-syndrome with agenesia of the kidneys and typical face is only one variation of the big group of renofacial dysplasia. Among our patients which are under treatment because of malformations of the urinary tract very often we see children with dysplastic faces or malformed ears. Therefore vice versa patients with alterations of ears and face should be exactly investigated to exclude urinary tract malformations.


[Cyclizine-intoxication in six children (author's transl)]. Cyclizine hydrochloride (Marezine, Echnatol) an antihistaminic drug is commonly used for the treatment of motion sickness. During the past two years we observed six cases of accidental moderate intoxication with an average of 200 mg of cyclizine hydrochloride in children between 2 and 4 years of age. The symptoms became obvious about 1 to 2 hours following ingestion. Among the main symptoms our patients revealed were such as excitement, incoordination, ataxia, athetoid movements and severe hallucinationes. The faces were flushed, the pupils dilated, but dryness of the mouth and hoarseness were never found. Convulsions did not occur. The treatment is purely symtomatic, histamine, apomorphine, phenothiazines and analeptics should not be used.


[Epidemiologic and bronchologic aspects of chronic bronchitis in childhood (author's transl)]. After establishing a suitable definition of chronic and relapsing bronchitis in childhood in the G.D.R. in 1969 corresponding epidemiologic studies carried out in school beginners and school children in Dresden revealed a prevalence rate of 1,64% to 3,06% for this disease. The analysis of bronchologic examinations of 274 children performed at the Pediatric Clinic of the Medical Academy Dresden during the last four years showed a deforming bronchitis as the most frequent finding in the bronchogram of 51% of the patients. Malformations of the tracheobronchial tree could be demonstrated in 16% of the children examined. The frequency of bronchiectases was at a very low level (9%) and showed a regression by the half as compared with former results. The results of bacteriological examinations of the bronchial secretion, quantitative analyses of the immune globulins in the serum and the bronchial secretion and the alpha-1-antitrypsin are discussed as causative factors for chronic and relapsing bronchitis in childhood. For assessing the prognosis of deforming bronchitis 220 children had a bronchologic follow-up examination in four bronchologic centers for children in the G.D.R. after a one or several years' dispensary treatment. An improvement or a normalisation of the findings could be demonstrated by means of the bronchogram in 62% of these patients, whereas a deterioration or a transition to bronchiectases was observed in only 22% of the patients.


[On the differential diagnosis of hemolytic anemia (author's transl)]. Differential diagnosis of hemolytic anemia is discussed, with regard to the classification into corpuscular and extracorpuscular types of hemolysis. Presence of antibodies in a patient's serum, indicate extracorpuscular-acquired hemolytic anemia. Coombs test may be positive or negative according to the antibody present. A primary disease has to be excluded in each case. Abnormal hemoglobin, defect of the corpuscular-hereditary type. Direct laboratory enzyme estimation indicate enzyme deficiency (Glucose-6-P-dehydrogenase, Pyruvate-kinase, Glutathione-reductase). Hemoglobinelectrophoresis and special tests for unstable hemoglobins indicate this type of disturbance. For defect of the membrane measuring of osmotic fragility might be helpful. Activity of membrane enzymes and introduction of 32P in the fractionated membrane lipids, point out special types of a deficient membrane. 6 of our own cases are discussed.


[Congenital pernicious anemia (author's transl)]. Pernicious anemia is a rare disease of the pediatric age-group. Two kinds of pernicious anemia are known for this period, the "congenital" and the "iuvenile" form. Both are characterized by a megaloblastic anemia and a deficiency of the intrinsic-factor. The congenital form unusually begins before the second year of age and does not have changes of the mucous membranes of the stomach. The iuvenile form also called "adolescent or auto-immune pernicious anemia" has its beginning in the later childhood and shows like the adult form atrophy of the mucous membrane of the stomach, anacidity and antibodies against the intrinsic factor and parietalcells. A patient with congenital pernicious anemia is presented; the symptoms, diagnosis, differentialdiagnosis and therapy of this disease is reviewed.


[Coarctation of the aorta (author's transl)]. There is given a short summary of coarctation of the aorta, with clinical picture, complications and indication for operation. Pre- and postoperative blood-pressures are correlated in the own material of 43 children.


[Effect of insulin and glucagon on the anomeric composition of D-glucose in blood (author's transl)]. The effect of insulin and glucagon on the anomeric composition of D-glucose in blood of children in the timecourse of tolerance tests has been investigated. Employing an improved enzymatic micromethod, specific for the anomers of D-glucose, insulin could be shown to raise the percentage of the alpha-anomer of the total serum glucose, whereas glucagon has no direct effect on the anomeric composition. However, an insulin-like effect could be observed in the second part of the glucagon tolerance test, e.g. alpha-D-glucose increased relatively to total glucose in serum and erythrocytes.


[Diagnosis of intelligence and personality in 23 cases of Turner syndrome (author's transl)]. The psychological examination of 23 Turner-patients from 6 to 35 years of age gave the following results: 1. The mean Verbal IQ in the Hamburg-Wechsler-Test was 100,7. The Performance IQ was significantly lower, a result which is characteristic for organic brain damages. 2. Two thirds of the patients had a better curriculum than one would expect from the IQ. 3. In the Rorschach Test most patients showed signs of inhibition. 4. In reaction to the disorders the patients have inferiority complexes during puberty. When marriageable most patients find a partner. The desire for a child then tends to become less important.


[A scheme for RDS-prediction (author's transl)]. The presented scheme combines perinatal data through a formal-logic conclusion to a prediction concerning the occurrence of a respiratory disease, respiratory symptoms within the first 6 postnatal hours, RDS and death from RDS. The quality of prediction was examined on 140 prematures by calculating predictiv value, sensitivity and specificity of the selectiv scheme. In addition the prognosis for the selected groups was determined at four different times.


[Cercaria splendens Szidat--larva of the trematode Azygia lucii Looss]. The belonging of the only one "gigantic cercaria", Cercaria splendens, to the species Azygia lucii was proved experimentally. The geographic distribution of A. lucii is considerably wider than it has been indicated up to now. The distribution area of A. robusta is also confined not only to the Asiatic part of the USSR. The following characters are suggested for distinguishing the Azygia species: the shape and size of the pharynx, the spread of vitellaria beyond the posterior border of the testes and ratio between the sizes of suckers.


[Dynamics of the parasite fauna of various forms of chars, salvelinus alpinus L., of the Lake Azabach'e basin]. The paper deals with age changes in the parasite fauna of different intraspecific forms of chars. It is shown that this year brood and yearlings of predatory, benthofagous, stream and anadromous chars up to 10 cm in length have a similar parasite fauna. During the second year of life the chars come to different feeding; correspondingly changes their parasite fauna which differs considerably in the above forms of chars. Two groups of parasites are distinguished the infection with which increases and decreases with the age of fishes. Observations were carried out on the life cycles, developmental and maturation periods of some parasites of chars. Biological peculiarities of some mixosporidia are studied. A shift in the developmental periods of helminths is noted as compared to those from the European part of the USSR.


[Experience in the study of the peculiarities of the distribution of the tick Ixodes ricinus in a large territory]. Attempts were undertaken to study the character of the distribution of I. ricinus over a large territory. Methodic principles of the land survey of arthropods distribution and laboratory processing of its results, that were used before for I. persulcatus, were found to be quite suitable for I. ricinus. It was established that hungry adults of I. ricinus have at least three types of the distribution throughout the forests of Lithuania. Types of the distribution can be ascertained by the results of the record of I. ricinus nymphs with a flag.


Hemopoietic stem cells: An analytic review of hemopoiesis. Current knowledge and concepts about stem cells are reviewed. The best morphologic candidate today is a small nonlymphocytic bone marrow cell in mouse and monkey. Methods for concentration and separation of pluripotent and committed stem cells in mouse and monkey are well advanced. There is a common committed stem cell for granulocytes and macrophages. Tissue microenvironment and cell-cell interaction play important roles in determining the direction of differentiation of pluripotent stem cells in vivo. These factors are not required for in vitro growth and differentiation or in vivo growth in diffusion chambers. The CSF is produced by the monocyte-macrophage family of cells as well as other tissues. CSF is not produced by granulocytes. The latter, in fact, appear to inhibit granulopoiesis. An in vivo effect of CSF has not yet been convincingly demonstrated. Erythropoietin acts by initiating hemoglobin synthesis at CSC level and accelerating its synthesis in the differentiated erythropoietic compartments. Hypoxia produces respiratory alkalosis leading to an increased erythrocyte oxygen affinity Ep secretion followed by an increase in 2,3 DPG in erythrocytes and an increased flow of oxygen to tissues. Pluripotent and committed stem cells migrate through the blood. The daily blood turnover rate is equal to estimated pool of PHSC in the marrow. Presumably, the PHSC and the CSC are in dynamic exchange between the blood and blood-forming tissues. There is growing evidence that thymic cells exert a stimulatory effect on regeneration of injured PHSC and may in fact be related to normal steady-state kinetics. Hypoxia, bleeding, radiation, chemotherapeutic agents, and endotoxin direct an increased fraction of PHSC and CFU-C into DNA synthesis, thus increasing the number of cells produced per cell present. Whether absolute production increases depends on the total number of PHSC in S. Several lines of evidence now suggest the existence of a fast intramedullary feedback loop by which the PHSC senses depletion of the differentiated compartments and directs PHSC to differentiate, thus initially depleting the PHSC, which then shifts gears and produces more cells by the remaining cells going into S. A kinetic model of human PHSC and CSC is proposed based on known erythrocyte cell and granulocyte turnover rates and the structure of human marrow. This model states that in vitro assays for CSC grossly underestimate their abundance in the marrow. The frequency of mitosis was calculated based on the foregoing model, and it was suggested that human stem cells can divide many more times than human fibroblasts in culture.


[Feeding and reproduction of XX Ctenophthalus wagneri Tifl., 1928 (Ctenophthalmidae, Siphonaptera) in experiments]. Under laboratory conditions at 20 to 21 degrees C young imagos of C. wagneri proceed quickly to feeding and reproduction. They suck blood about three times a day and females oviposit three times, each laying consisting of three eggs. When placed in a refrigirator at 2 to 5 degrees some young individuals lay eggs, while others do not start oviposition up to 5 months (observation period). Fleas, which already laid eggs under laboratory conditions, being transferred into a refrigirator decrease the degree of their attachment to the host and feeding frequency (up to one time a day). Oogenesis of females is inhibited and most of them cease egg laying.


Atypical fibroxanthoma of skin: an electron microscope study. The ultrastructure of two atypical fibroxanthomas of skin is described. Most of the tumour cells were elongate, and contained abundant rough endoplasmic reticulum, well developed Golgi zones, and numerous small vesicles and filaments, the latter sometimes being related to masses of electron-dense material near the plasma-lemma. Their nuclei often showed deep surface indentations. The appearances were similar to those found in the socalled myfibroblasts that occur in granulation tissue. Multinucleated giant cells and lipid-laden cells in the tumours appeared to be merely modified forms of the basic cells type.


[Viability of sandflies (Diptera, Psychodidae, Phlebotominae) under the influence of infection with promastigotes of various species of Leishmania]. Sand flies were infected with different species of promastigotes from reptiles and warm-blooded animals. Optimal doses of promastigotes were used which ensured the adaptation of Protozoa in the host's intestine. The infection with a mixed culture resulted in the death of most Sand flies: the mortality rate was the highest at the simultaneous introduction of two species and was some what lower at the subsequent infection. The survival of Sand flies infected with one species of leishmania decreased to the greatest extent if "incidental" for them strains of promastigotes were introduced: for Ph. papatasi -- cultures isolated from reptiles, for Sergentomyia arpaklensis -- those isolated from L. tropica major. Natural infection rate of the genera Phlebotomus and Sergentomyia with leishmania of different species agrees with laboratory data on the survival of sand flies. Ph. caucasicus and Ph. papatasi are infected, in general, with L. tropica major, S. arpaklensis -- with L. gymnodactyli.


Immunoglobulin M in Murray Valley encephalitis. Twelve clinical cases of Murray Valley encephalitis are described, in which the sero-diagnosis was confirmed by the detection of Murray Valley encephalitis immunoglobulin M.


[Distribution of apiosomae on the body of fishes in the light of the parasite-host relationship]. The paper deals with the distribution of apiosomae over the body of fishes. The microecological condition (inhabitation on the skin, fins and gills) are analysed. Quantitative regularities are revealed in the distribution of apiosomae which are associated with differences in the inhabitation conditions on various parts of the nost's body and the character or morphological variability resulting from these differences. It was established that the fins, espeically the paired ones, and the surface of the body are most favourable for apiosomae. The gills have the least invasion density.


[Some problems in the study of mermitids for the purpose of the biological control of midges]. The method of "flooding" with mermitids, which was successfully used against mosquitoes, is unreal for biological control of black flies because of difficulties and unprofitableness of their laboratory maintenance and reproduction. A more probable way of solving the problem is the untroduction of effective forms of parasites. In perspective the cultivation of the adipose tissue of the host and biochemical overcoming of its protective reactions are necessary.


Minocycline, doxycycline and tetracycline levels in serum and bronchial secretions of patients with chronic bronchitis. Serum and sputum levels of minocycline, doxycycline and tetracycline were determined in patients with chronic bronchitis who were producing copious amounts of purulent sputum. Antibiotic estimations were carried out by the plate agar diffusion method using the Oxford staphylococcus. A close correlation was obtained between the sputum and the average serum levels for patients receiving tetracycline. Values obtained for minocycline showed a poor correlation between serum and sputum. A correlation between serum and sputum levels of doxycycline could not be established due to the low levels present in sputum. Our results indicate that while adequate serum levels of tetracycline reflect the attainment of theapeutic concentrations in bronchial secretions; the same predictions cannot be made for minocycline or doxycycline.


Teratomas in childhood.

Teratomas in childhood. Of 107 teratomas in children, 86 were benign and 21 malignant. Sacrococcygeal and pelvic teratomas predominated (51 cases) and these fell into 3 groups: post sacral, dumb-bell and presacral. The 34 purely posterior tumours were always congenital and benign, whilst the incidence of malignancy in dumb-bell and presacral teratomas increased as the tumour became more internal. Malignant teratomas were carcinomas, usually containing glandular, papillary and clear-cell areas, and metastases were similar. Immature tissues in benign teratomas were usually neural or connective tissue. They did not give rise to neuroblastomas or sarcomas, and did not indicate a worse prognosis. Only 2 originally benign teratomas later developed malignancy.


Antigen absorption from the small intestine and gastrointestinal disease. In this article, I have attempted to summarize the concept of intestinal permeability to antigens such as ingested food proteins, bacterial breakdown products, endotoxins, and enzymes. The mature gut retains the capacity to absorb macromolecules by a pinocytotic mechanism which is more pronounced during the neonatal period. The vast majority of individuals have no ill effects from the intestinal transport of large molecules. However, when increased quantities of toxic or antigenic macromolecules gain access to the body because of a derangement in the intraluminal digestive process or because of a defect in the mucosal barrier, antigen absorption may be altered and result in either local intestinal or systemic disorders. The speculative concepts suggesting that clinical disease states may be associated with altered mucosal permeability have been discussed.


Some biochemical effects of chloral hydrate in an infant with a tyrosinemia-like syndrome. An infant with a combination of clinical and biochemical features resembling those found in hereditary tyrosinemia ("inborn hepatorenal dysfunction with tyrosyluria") but with spontaneous recovery is described briefly. The child also had severe congenital hydrocephalus, and was being given chloral hydrate. She was not treated by restriction of dietary phenylalanine and tyrosine. The abnormal aromatic aciduria was unaltered by ascorbic acid administration. The results of loading tests with phenylalanine, tyrosine, and sodium 4-hydroxyphenylpyruvate are compatible with the existence of a partial block in the oxidation of 4-hydroxyphenylpyruvate to homogentisate which was exacerbated by administering chloral hydrate.


Somatic-respiratory reflex and onset of regular breathing movements in the lamb fetus in utero. Breathing activity of six mature lamb fetuses (greater than 135 days of gestation) in utero was monitored from recordings of intraesophageal pressure, intratracheal pressure, and tracheal circumference from a mercury strain gauge before, during, and after stimulation of the central end of a cut sciatic nerve. Stimuli were either low (0.5-2.0 cps) or high (66 cps) frequency, 6-15-V square wave pulses of 0.6-1.25 msec duration. The fetuses remained in utero throughout the experiments in which ambient temperature, paO2, paCO2, arterial pH, mechanical stimulation, and spontaneous respiratory center activity could be ruled out as primary stimuli of the breathing movements observed. In one-third of the trials a "somatic-respiratory reflex" was elicited in which breathing coincided with the period of stimulation: in over 85% of these trials with low frequency stimulation, breathing movements were synchronous with the stimuli; in the rest the synchrony was broken during the period of stimulation. In two-thirds of the trials the "reflex" response was followed by spontaneous regular breathing movements ("onset of regular breathing") which continued for 1 min to 2 hr 30 min after the stimulation was stopped. Thiopental administration to the ewe (5 mg/kg) seemed to depress respiratory responsivity for about 60 min. Changes of tracheal circumference reflected both transmural pressure gradients and possibly also rhythmic vagal activity associated with breathing.


Serum glutathione reductase and cystic fibrosis. Serum glutathione reductase (NADPH-GSSG oxidoreductase, EC. 1.6.4.2 (GR)) has been examined in cystic fibrosis subjects (CF), obligate CF heterozygotes, and control subjects. Serum protein concentration was similar in the three groups. Regardless of the units used to express activity (milligrams of protein or milliters of serum) or whether or not samples were dialyzed against water or phosphate buffer, mean serum GR in CF was greater than in control subjects (P less than or equal to 0.002) in all series over several years. Under the above assay conditions no difference in serum GR between control subjects and carriers was detected. Calculated and assayed values of combined control and CF sera agreed as did expected and observed 50% activity in 1:2 sera dilutions in CF, control subjects, and carriers. Addition of FAD to incubation media did not effect enzyme activity in the three groups. Differences between CF and control subjects persisted after dialysis in membranes permitting passage of molecules of approximately 12,000 mol wt or less. These findings would tend to exclude the effect of extraneous serum factors in explaining the diffferences between CF and control subjects. The percentage of initial GR activity after four days storage (0-4 degrees) was significantly greater in CF than in control subjects (P less than 0.025). The effect of heparin on serum GR was recorded as the percentage of activity after incubation with heparin vs. activity in the standard assay for individual subjects. The effect of incubation with 5 mug/ml heparin on serum GR activity was greater in control subjects than in carriers (P less than 0.0005) and CF (P less than 0.0005). Mean serum GR activity in CF and carriers was unaffected by heparin, whereas mean activity in control subjects was decreased. In no control was the percentage of initial activity with heparin greater than the mean of CF and carrier groups. Only 3 of 20 CF and 4 of 20 carrier individuals had percentages lower than the control mean. The CF and carrier distributions were clearly different from the control distribution. Serum GR was determined in seven non-CF individuals with chronic obstructive pulmonary disease (COPD). Activity in the COPD was different from CF and no different from control subjects. In none of these controls or COPD was serum GR as great as the CF mean. Serum GR in no CF was as low as the mean of control subjects or COPD. It is concluded that serum GR activity is greater in CF than in control subjects, carriers, and non-CF COPD subjects; that the difference in activity is not attributable to an extraneous serum factor, that the activity difference is not secondary to chronic respiratory disease; that in comparison with control subjects, GR from CF serum behaves differently after storage; and that serum GR from CF and carriers behaves differently from control GR in the presence of heparin.


Enzymatic adaptations by cultured adipocytes of human infants and children: effect of obese serum on the activities of lactate-, malate-, and glucose-6-phosphate dehydrogenases. To determine whether there are any biochemical characteristics which distinguish human adipose cells from human skin fibroblasts, assays of lactate dehydrogenase with pyruvate as substrate (LDH-P), malate dehydrogenase (MDH), and glucose-6-phosphate dehydrogenase (G6PDH) were done on both cell types after they had been successfully adapted to artificial medium in tissue culture and also while they were growing temporarily in serum from an obese individual. After undergoing transformation to a fibroblast-like appearance, the adipose cells (adipofibroblasts) contained significantly more of each enzyme than did the initial adipose cell isolates. The level of activities of LDH-P and G6PDH increased to the same levels as in skin fibroblasts (Table 2); however, MDH activities rose to much higher levels than those found in skin fibroblasts (Table 2). In obese serum, activities of LDH-P did not significantly change but the activities of MDH and G6PDH dropped sharply in adipofibroblasts (P less than 0.005, Table 2 and Fig. 5), whereas in cultures of skin fibroblasts, only the activities of G6PDH dropped significantly (P less than 0.025 Table 2), the other enzyme activities being unchanged. It is concluded that, on the basis of the biochemical behaviors of these two cell lines in culture, adipose cells are biochemically different from skin fibroblasts and are not to be regarded as just fibroblasts with lipid-storing ability.


Assessment of left ventricular function in secundum atrial septal defect: evaluation by determination of volume, pressure, and external systolic time indices. Left ventricular function and volume data from 17 control subjects and 27 young patients with secundum atrial septal defect (ASD) without overt left or right ventricular failure were compared. ASD patients were subdivided in low shunt (Qp/Qs less than 2.0) and high shunt (Qp/Qs larger than or equal to 2.0) groups. Mean left ventricular (LV) stroke volume was significantly less in ASD patients (46 +/- 16 ml/m2 in the low shunt and 44 +/- 9 ml/m2 in high shunt group) compared with control patients (51 +/- 13 ml/m2, P less than 0.01 and P less than 0.02, respectively). There was no significant difference in mean left ventricular end-diastolic volume (LVEDV) between any group of patients (control subjects 67 +/- 17 ml/m2; low shunt ASD 66 +/- 17 Ml/m2, and high shunt ASD 62 +/- 12 ml/m2). High shunt ASD had a significantly lower cardiac index compared with control patients (5.0 liters/min/m2 vs. 5.9 liters/min/m2, P less than 0.02). Both low shunt and high shunt ASD showed significantly lower stroke work indices than control subjects (42 +/- 13 GmM/m2 and 37 +/- 8 GmM/m2 compared with 51 +/- 14 GmM/M2 , P less than 0.05 and P less than 0.001, respectively) but only the high shunt group had a significantly lower peak systolic pressure (94 +/- 12 mm Hg vs. 109 +/- 11 mm Hg for control patients, P less than 0.01). There was no significant difference between the control and ASD groups in LV end-diastolic, mean right atrial, right ventricular end-diastolic, and pulmonary pressures. External systolic time intervals were compared in 5 control and 12 ASD patients. There was no significant difference between the two groups of patients in absolute values or indices for pre-ejection period, ejection time, or electromechanical systole. However, the ratio of the pre-ejection period index to left ventricular ejection time index (PEPI/LVETI) was significantly higher in ASD patients (P less than 0.05). In young subjects with large shunt ASD, certain indicators of left ventricular function are depressed. Evaluation of PEPI/LVETI may allow noninvasive determination of LV function.


Determination of phenylalanine hydroxylase activity in patients with phenylketonuria and hyperphenylalaninemia. The phenylalanine hydroxylase assay was modified by using biopterin, lysolecithin, and dithioerythritol. Liver tissue was obtained by percutaneous needle biopsies in patients with phenylketonuria (PKU) and hyperphenylalaninemia. The use of the naturally occurring cofactor biopterin is essential to measure low enzyme activities. Thirteen of 14 assay specimens in which no activity was detectable correlated with the clinical picture of classic PKU. Twelve assay specimens showed a residual activity up to 6% of normal. This group comprises patients with classic PKU and with so-called hyperphenylalaninemia. Four specimens ranged between 8.7 and 34.5% of the normal values. Patients in this group have developed normally so far without dietary treatment. It seems that patients with residual activity tolerate more phenylalanine in the diet than patients with no detectable activity. One infant with biochemical symptoms of classic PKU was found to have a normal phenylalanine hydroxylase activity.


Ligandin reverses bilirubin inhibition of liver mitochondrial respiration in vitro. Ligandin, an abundant cytoplasmic binding protein of bilirubin and other ligands in liver cells, completely prevented the inhibitory effect of bilirubin on respiration and oxidative phosphorylation by isolated rat liver mitochondria. At equimolar concentrations of bilirubin and ligandin or human serum albumin, mitochondrial respiration was fully restored to control values. At greater ratios of bilirubin and ligandin or human serum albumin, the latter had a stronger protective effect. These studies suggest that ligandin may have a physiologic role in protecting mitochondrial systems against bilirubin toxicity.


Enzyme therapy. V. In vivo fate of erythrocyte-entrapped beta-glucuronidase in beta-glucuronidase-deficient mice. The use of erythrocyte entrapment as a strategy to deliver and protect exogenously administered enzymes for replacement therapy in selected genetic diseases has been evaluated in a mammalian model system. The uptake, tissue distribution, intracellular localization, and in vivo lifetime of erythrocyte-entrapped bovine beta-glucuronidase were determined by a selective thermal inactivation assay after intravenous administration into beta-glucuronidase-deficient mice. The exogenous activity was cleared from the circulation with a half-life of about 20 min and was no longer detectable at 2 hr. A concomitant uptake of the injected enzyme was observed in murine tissues, primarily the liver; approximately 30% of the bovine activity was recovered at 30 min and maximal hepatic uptake, 71% of dose, was detected at 2 hr. Hepatic recovery of the bovine activity was observed to decrease in a biphasic pattern to nondetectable levels by 5 days. The recovery of the entrapped activity was characterized by a latency of detection in hepatic tissue up to 13 hr postinjection. At each time point more than 80% (84-100%) of the recovered bovine activity was detected in the lysosomally enriched hepatic subcellular fraction. Maximal recoveries of 10% and 15% of administered dose were observed in splenic and renal tissues, respectively, soon after enzyme administration. In comparison to results obtained after intravenous administration of unentrapped bovine beta-glucuronidase, erythrocyte-entrapped activity was retained fourfold longer in the circulation, fivefold longer in hepatic tissue, and was more efficiently delivered to a variety of tissues.


Cation transport and its altered regulations in human stomatocytic erythrocytes. Cation transport in a population of stomatocytic red blood cells (RBC) is abnormal in the following respects. First, active transport against a gradient, defined as the nonisotopic net accumulation of Na+ or loss of K+ induced by 0.1 mM ouabain, is markedly elevated (7.3 and 6.3 mEq/liter cells/hr for Na+ and K+, respectively), but the Na+:K+ active transport ratio is normal. Apparent uncoupling of the Na+ and K+ isotope transport is due to disproportionately increased ouabain-sensitive 24Na+-23Na+ exchange (32.7 mEq/liter cells/hr), which is measured as a portion of 24Na+ isotope efflux. Second, cation transport is unresponsive to variations in internal Na+ concentration but decreases with decreasing extracellular Na+.


A new assay for cystic fibrosis factor: effects of sera from patients with cystic fibrosis in the in vitro electrical properaties of rat jejunum. The in vitro electrical properties of rat jejunum were utilized to assay a factor or factors in serum from patients with cystic fibrosis (CF). Sera from patients with CF were found to decrease short circuit current (SCC) and the SCC response to glucose, and to increase electrical resistance. These effects were present in all 24 patients with CF and 10 of 14 parents of CF patients and absent from the serum of 21 control subjects. This quantitative technique provides an alternative to the ciliostatic assays for the detection of the CF factor or factors.


Hospital management of patients and personnel exposed to communicable diseases. Patients and personnel who are exposed to certain communicable diseases in a hospital setting often require therapeutic or epidemic control measures which may differ from measures employed following community exposure. This paper offers guidelines for reducing the hospital spread of communicable diseases by preventive measures (admission screening procedures, immunizations for personnel), and post-exposure management of patients and personnel. It is intended as a companion to the "Hospital Isolation and Precaution Guidelines" for patients with clinically manifest infections which appeared previously.


The adaptation of parents to the birth of an infant with a congenital malformation: a hypothetical model. To determine the course of parental reactions to the birth of a child with a congenital malformation and the process of parental attachment, the parents of 20 children with a wide range of malformations including mongolism, congenital heart disease, and cleft palate were interviewed. Structured interviews took place 7 days to 60 months after birth. Despite the wide variation of malformations, analysis of the interviews demonstrated five stages of parental reactions--shock, denial, sadness and anger, adaptation, and reorganization--in dealing with a congenitally malformed child during the course of his development and care. Observations of these patients suggest that early crisis counseling in the first months of life may be particularly crucial in parental attachment and adjustment.


Basilar artery migraine in young children. Eight children with recurrent attacks of neurologic dysfunction referable to the brainstem and cerebellum are reported. The episodes occur suddenly, clear completely, and leave the patient without residua. The most frequent signs are ataxia, alternating hemipareses, and vertigo. The majority of patients are girls, and most have the onset of the condition prior to the age of 4 years. Headache was definitely present in three children, and possibly present in four. A striking history of migraine was found in seven families, accounting for 16 affected relatives. Fifteen of these were female and 14 were on the maternal side. Follow-up of the children has not provided any evidence for progressive neurologic disease. The patient followed for the longest period of time has developed classic migraine.


Renal function in obstructive nephropathy: long-term effect of reconstructive surgery. Renal function was studied in 24 children with chronic hydronephrosis and renal insufficiency. The follow-up period after reconstructive surgery was 1 to 12 years. Glomerular filtration rate (GFR) was assessed by the clearance of endogenous creatinine or inulin. Effective renal plasma flow was assessed by the clearance of PAH. Reconstructive surgery was performed during the first year of life in 12 out of 24 patients, between one and two years of life in 6 patients, and after two years of life in 6 patients. Three different patterns of evolution could be observed after relief of obstruction: (1) An improvement or a normalization of renal function only occurred in patients operated upon before one year of life. (2) A stabilization of renal function without normalization was observed in patients operated upon between one and two years of life. (3) A progressive deterioration of renal function towards terminal renal failure was observed in five out of six patients operated upon after two years of age. This deterioration could not be explained by recurrence of detectable urinary tract infection or urinary stasis. The changes in GRF in four patients with a solitary kidney followed the same pattern. We conclude that it is essential to correct severe chronic hydronephrosis associated with renal insufficiency before one year of age if a lasting improvement of renal function is to be expected.


The trisomy 9p syndrome.

The trisomy 9p syndrome. Since the first description of trisomy 9p in 1970, there has been a rapidly increasing recognition and reporting of new cases. The physical and mental features of retarded growth and development, down-turned corners of the mouth, mildly globular nose, slightly wide-set and deep-set eyes with anti-Mongoloid slant, and unusual dermatoglyphics are distinctive enough to establish trisomy 9p as a clinical chromosomal entity--one which may prove to be the fourth most common autosomal syndrome (after trisomies 21, 13, and 18). This paper includes a review and tabulation of features seen in the 20 reported cases and photographs of the faces of ten of these children. A new case included in this survey demonstrates the practical application of four types of chromosome banding identification (C, G, Q, and R). The confirmation of the chromosomal aberration in this syndrome is dependent on the use of one or more of these special laboratory techniques. Most of the clinical characteristics distinctive of the trisomy 9p syndrome are seen also in other trisomies involving more or less of the number 9 chromosome. From these observations it is determined that the crucial determinants of the classical features of this syndrome lie within the distal half of the number 9 short arm.


Familial partial trisomy of the long arm of chromosome 10 (q24-26). Two fourth cousins with a strikingly similar pattern of malformation and who have an unbalanced translocation (46, XY, -17, +t (17p; 10q) are described. From an analysis of the phenotypes of these patients and others reported with 10q trisomy, we propose that the trisomy 10q 24-26 syndrome includes: growth and mental retardation, a characteristic facies (microcephaly, flat face with spacious forehead, small nose, depressed nasal bridge, arched wide-spaced eyebrows, blepharophimosis, microphthalmia, low-set ears, bow-shaped mouth with prominent upper lip, micrognathia), palate anomalies (high-arched cleft or agenesis), congenital heart disease, and anomalies of the hands and feet. Anomalies common to the cousins, but not described in other patients with trisomy 10q, are believed to be expressions of a partial monosomy of 17p.


Trisomy 8 mosaicism syndrome.

Trisomy 8 mosaicism syndrome. Chromosome 8 is the largest autosome thus far found to be trisomic among liveborn infants. Trisomy 8 "mosaicism" syndrome (T8mS) consists primarily of individuals whose chromosome complement is mosaic for chromosome 8 (T8m), i.e., patients with a chromosomally normal cell line in addition to the trisomic 8 cell line, and a few known individuals with full trisomy 8 (T8), i.e., each cell observed contains an extra chromosome 8. Reported cases of both types share a number of common features and thus have helped to delineate a new syndrome. Common features of T8mS include mild-to-moderate mental retardation, strabismus, osseous and soft tissue abnormalities, lowset and/or malformed ears, broad bulbous nose, palate deformity, various types of congenital cardiovascular disorders, hydronephrosis, cryptorchidism, and characteristic dermatoglyphics. Since chromosomal mosaicism is often present in this syndrome it is not surprising that considerable phenotypic variation exists. The present report of one of the youngest individuals yet described with T8m adds two more physical findings (dense corneal clouding and a heretofore undescribed clavicular deformity) to the constellation of abnormalities associated with T8mS. On the basis of the phenotypic and cytogenetic findings in this and 17 similar patients previously reported it is proposed that T8mS is a distinct clinical entity.


Parental use of "positive contact" in child-rearing: its relationship to child behavior patterns and other variables. In an investigation of child-rearing styles maternal use of "positive contact" was measured by asking the mother how often she played with the child, praised the child, and the like, and combining the responses into a score. Home observations on a sample of families revealed that mothers scoring above the mean used fewer communications in the form of directives and "unmodified power" and more communication in the form of praise and social conversation than mothers scoring below the mean. The mother's use of positive contact was related to her educational level, the birth order of the child and number of children in the family, the father's use of positive contact, and to a friendly outgoing pattern of child behavior. There was no relation to the mother's use of physical punishment, her protectiveness, her tendency to comply with the child's demands, or her child-rearing ideology and other attitudes. Child care workers are in a strategic position to educate parents about the importance of this kind of contact, especially with later-born children in large families.


Sudden infant death syndrome and subsequent pregnancy. In psychological conditions of mourning and guilt, women who have lost children often attempt to quickly conceive a "replacement" child. This study examines the subsequent pregnancies of 32 women whose children died of sudden infant death syndrom (SIDS). The expected rate of infertility in a normal population is 10%. Spontaneous abortion has an incidence of 12% to 15%. Among the 32 women attempting to conceive after the loss of their child, 10 (31%) had spontaneous abortions and 11 (34%) could not conceive after attempts for at least one year. This association between psychological and biological phenomena require special recognition by physicians who are advising parents who have lost children to SIDS. The management of these families includes compassion, understanding, and regard for the psychological environment of the subsequent pregnancy.


Urbanization and differentials in white and nonwhite infant mortality. This study analyzes infant deaths in the United States, 1962 to 1967, by place of residence, to determine to what degree variations in age at death are related to degree of urbanization and race. Results of the study indicate that: (1) after one day of life infant mortality increases progressively as degree of urbanization decreases; (2) the differences between urban and rural death rates are greatest in the posthebdomadal (1 week or older) period; (3) in all age groups at all levels of urbanization, the nonwhite infant is at a marked disadvantage relative to the white infant; (4) the older the infant, the greater the disadvantage for nonwhite infants in rural areas; (5) had the white infant mortality rate prevailed among the nonwhite population over the six-year period from 1962 to 1967 an estimated annual total of 11,597 nonwhite infants would have survived their first year of life; (6) 40% of the excess deaths are in infants under 7 days and 60% in the posthebdomadal period; (7) fetal death rates increase progressively as degree of urbanization decreases, complementing a direct relationship between under 1 day mortality and urbanization resulting in a level trend for perinatal mortality.


Studies in meconium: disaccharidase activities in meconium from cystic fibrosis patients and controls. Meconium ileus represents the earliest clinical manifestation of cystic fibrosis. The differences found in the composition and amount of protein, mucoprotein, mucopolysaccharides, and reducing sugars in meconium from newborns with cystic fibrosis might be of significance relative to the pathogenesis and early diagnosis of this disease. We studied the enzymatic activity of disaccharidases (lactase, sucrase, maltase, and palatinase) in meconium of infants with cystic fibrosis and controls. We found an increase in the specific activity of these enzymes in the meconium from infants with cystic fibrosis as compared to the specific activity in meconium from normal infants. The increase in the activities, expressed as micromols per gram of protein per minute was: lactase, 100 times higher; sucrase, 18 times; maltase, 4.8 times, and palatinase, 8.9 times.


Hypercortisolism in childhood: shortcomings of conventional diagnostic criteria. Two patients are described in whom hypercortisolism occurred prepubertally as a consequence of bilateral adrenocortical hyperplasia. In contrast with the manifestations of Cushing's syndrome in adults, these children presented with obesity and reduced stature and no other symptoms. Both patients excreted amounts of urinary 17-OHCS before and during a conventional suppression test with dexamethasone (0.5 mg every six hours) which were within the usual normal range. However, when urinary 17-OHCS excretion was expressed per gram of urinary creatinine or per square meter of surface area, and when the dose of dexamethasone was tailored to body mass (20mug/kg/day) the results were clearly abnormal, as were plasma corticoids and (in one patient) cortisol secretion rate. Resumption of linear growth occurred after bilateral adrenalectomy in both patients and was associated, in the one patient so studied, by a return of hypoglycemia-stimulated increases in plasma growth hormone levels from previously suppressed values to the normal range, and by a slight increase in the fasting plasma somatomedin concentration. The observations suggest that pediatric patients with hypercortisolism are likely to be overlooked when conventional criteria for laboratory diagnosis are used, but can be recognized by the simple diagnostic modifications used in these studies.


Propranolol-augmented, exercise-induced human growth hormone release. Serum growth hormone (HGH) responses to 20 minutes of exercise 90 minutes after orally given propranolol (0.5 mg/kg; maximum, 40 mg), were assessed in 15 short but otherwise normal children, in 2 obese teen-agers, in 3 hypopituitary children, and in 8 healthy adult volunteers. In six adults HGH responses to exercise alone were also assessed one week previously. Normal children responded with a peak serum HGH concentration of 10 ng/ml or greater, except one whose peak was 7 ng/ml (normal, greater than 7 ng/ml). The obese girls showed smaller responses to exercise with propranolol (ex/prop) (peak HGH, 6 ng/ml), to hypoglycemia, and to levodopa (peak HGH, 7 and 4 ng/ml). The three hypopituitary  children did not respond to ex/prop or to two other stimuli. In the volunteer adults, the mean HGH responses were greater to ex/prop than to exercise alone, although two out of six did not have increased levels with exercise. There were also elevations of fasting serum HGH levels before exercise and propranolol on repeat testing. These results suggest that orally given propranolol improves the exercise-HGH stimulation test both in the number of responders and in the degree of response. Some individuals have an anticipatory HGH secretion before exercise due to a conditioned response.


Growth standards for infants and children: a cross-sectional study. Measurements of height and weight were collected on 1,233 Black and white infants and children attending a Child Health Clinic in Washtenaw County, Michigan. Polynomial curves were fitted to each race and sex group and, from these, estimates were made of the 3rd, 50th, and 97th percentiles for height and weight. Blacks tended to be lighter and shorter than whites in early infancy. In the second year of life, Blacks tended to exceed whites in height and weight achievement. For infants and children in the 97th percentile this change in status occurred earlier. The differences in weight and height achievement were statistically significant in the two race groups, but not between sexes. The percentile estimates differed significantly from the percentiles of local as well as the "Iowa," "Harvard," and "Tanner" (United Kingdom) standards. Differences in the racial and environmental background of the clinic population and the samples used in the development of the national standards probably accounts for the variations in the percentile estimates. It is concluded that race- and sex-specific standards are required before growth achievements in infants and children can be properly evaluated.


Death anxiety in the outpatient leukemic child. Awareness of the seriousness of their illness seems to persist with fatally ill children, even when they are not in the hospital. As did the fatally ill hospitalized children in previous studies so, too, the fatally ill outpatient children in the present study related significantly more stories that contained elements of preoccupation with threat to their body integrity and functioning than did the control group of children with non-fatal chronic illnesses. Not only did they express a greater general anxiety and greater anxiety in relating the stories, but, in contrast to their chronically ill counterparts, the leukemic children exhibited a lack of adaptability to the necessity of clinic visits, becoming increasingly more anxious about the clinic both as visits became more frequent and as their illness became of longer duration. The children continue to dwell on their illness, even when treated as outpatients.


Enhanced renal excretion of dicloxacillin in patients with cystic fibrosis. Single oral doses of 6.25 mg/kg of dicloxacillin suspension were given to ten cystic fibrosis (CF) patients and eight normal subjects. Peak serum concentrations and areas under the concentration versus time curves for dicloxacillin were variable and, on average, were 2 1/2 times lower in the CF patients. The time of occurrence of the peak serum concentration was similar in both groups and the total urinary recovery of dicloxacillin was normal or increased in the CF patients, suggesting that the intestinal absorption of the drug was unaffected by the disease. The low serum concentrations in the CF patients were caused by unusually high renal clearances of dicloxacillin which average 282 +/- 135 compared to 95 +/- 28 ml/min/1.73 sq m in the normal subjects. Creatinine clearances were also elevated in the CF patients by 55% on average, while urea clearances were normal. The serum protein binding of dicloxacillin was similar in both groups of subjects. Because the rapid excretion results in low and variable serum concentrations of the antibiotic, treatment of CF patients with dicloxacillin may warrant use of increased or more frequent doses and monitoring of serum antibiotic levels.


Diagnosis of neuroblastoma by electron microscopy of bone marrow aspirates. Three patients are reported in whom the diagnosis of neuroblastoma was made following electron microscopy of a bone marrow aspirate. The ultrastructure of neuroblastoma cells is distinctive, and they can be distinguished by electron microscopy from cells of the other tumors with which neuroblastoma is often confused by light microscopy. The rapidity with which the diagnosis can be obtained through use of this procedure argues for its adoption in any patient in whom the diagnosis is suspected and who has tumor cells in bone marrow. Early initiation of appropriate therapy is made possible, and elaborate diagnostic procedures may be avoided.


Nasopharyngitis and prolonged sleep Apnea. The effect of nasopharyngitis on the simultaneous occurrence of prolonged sleep apnea (greater than or equal to 20 seconds in duration) was studied in 26 infants managed at home on an apnea monitor. During the observation period, these infants had a total of 69 illnesses which appeared to represent an upper respiratory tract inflammatory process. In general, the daily frequency of prolonged apneic episodes was  significantly greater during nasopharyngitis when compared to comparable time intervals immediately prior to and following the illness. In addition, there was a decrease in the frequency of apneic episodes with increasing postnatal age until the episodes finally ceased to occur during the illness-related intervals. Apneic episodes ceased to occur at an earlier age for the before- and after-illness intervals than for the time interval during which there were clinical symptoms. Thus, it would appear that infants go through an age-related phase wherein prolonged apnea occurs during nasopharyngitis but not when free of illness. The implications of these results for the management of infants having prolonged sleep apnea are discussed. In view of the hypothesis that prolonged sleep apnea is part of the physiological process resulting in the sudden infant death syndrome, these results also provide for the prediction that infants who suddenly die in association with nasopharyngitis would do so, in general, at a later age than those who succumb when free of an upper respiratory tract inflammatory process.


A new method of evaluating the chemosensitivity of the respiratory center in children. Decreased ventilatory response to carbon dioxide is often present in lung disease. This can be due to a reduction in the output of the respiratory center or an inability of the respiratory pump to respond to a normal output because of the size or impedence of the pump. To separate these mechanisms we have measured the isometric force developed by the respiratory muscle during brief airway occlusion, by measuring the pressure generated at 100 msec (Pm100). We studied 43 subjects ranging in age from 6 to 50 years, and nine neonates. We found a linear rise of Pm100 with rising PAco2 during carbon dioxide rebreathing maneuvers. Our results also show that although there are wide variations in slopes of Pm100 to carbon dioxide tension (SPm100/PAco2) between individuals, in a given subject this slope remains constant even following repeated studies. It also remains constant for age and size, indicating that the neuromechanical output of the respiratory apparatus does not change with growth. In contrast the ventilatory response either assessed as Ve/PAco2 or Vt/PAco2 depended on age and lung size. The results suggest that throughout growth, comparison of Pm100/PAco2 and Ve/PAco2 can distinguish between abnormalities of neuromuscular output from other causes of ventilatory impairment.


Reduced thrombus formation with silicone elastomere (silastic) umbilical artery catheters. This report describes clinical experience with a radiopaque silicone elastomere (Silastic) umbilical artery catheter. Twenty infants, ten with polyvinyl chloride (PVC) umbilical artery catheters and ten with Silastic umbilical artery catheters, all positioned at the aortic bifurcation, had aortograms performed at the time of catheter removal. Catheter-associated thrombus formation was observed in nine of the ten infants (90%) with PVC umbilical artery catheters and in one of the ten infants(10%) with Silastic catheters. The incidence of lower extremity vasospasm associated with the two catheters was not significantly different. Aortic pressure tracing recorded through Silastic catheters were accurate, but slightly damped. Autopsies were performed on five additional infants who died with indwelling Silastic umbilical artery catheters. None of the catheters, nor their surrounding tissues, showed evidence of thrombus formation on either gross or microscopic examination. It is our experience that radiopaque silicone elastomere tubing can be used as an umbilical artery catheter and appears to have the advantage of being less thrombogenic than the standard PVC tubing currently in general use.


Live attenuated influenza virus vaccine trial in children. Thirty-four children received intranasally a live attenuated influenza A virus vaccine, and were then followed for six months to evaluate the vaccine safety, immunogenicity, and efficacy. All but one of the 31 children with hemagglutination inhibition (HI) titers less than 64 before inoculation responded with at least a four-fold rise in antibody titer to a single dose of vaccine. One child required two doses. Seven (21%) of the vaccinees also responded with production of nasal neutralizing antibody. The vaccine was well tolerated with few clinical reactions. Two vaccinees developed fever possibly attributable to the vaccine. No transmission of the vaccine virus to any of the 25 unvaccinated contact children was demonstrable. Five months after this vaccine trial an influenza epidemic due to a heterologous influenza A strain occurred in the community. During this outbreak acute febrile and/or respiratory illness occurred in 12 or 52% of the contact controls, and in six or 19% of the vaccinees. In two of these six vaccinees, influenza A infection was confirmed by at least a four-fold increase in HI titer. This study suggests this study suggests that this vaccine is safe, easily administered, highly immunogenic in children, and is protective against a heterologous strain epidemic in the community.


Studies on the pathophysiology of encephalopathy in Reye's syndrome; Hyperammonemia in Reye's syndrome. The initial acid-base status of eight survivors of Reye's syndrome was characterized by acute respiratory alkalosis (Pco2=32 mm Hg; Hco3-=22.0 mEq/liter) while that of eight children who died was associated with metabolic acidosis as well (HCO3-=10.0 mEg/liter). Arterial-internal jugular venous ammonia concentration differences on day 1 (299 mg/100 ml) and day 2 (90 mg/100 ml) reflected cerebral uptake of ammonia while those on days 3 and 4 (-43 and -55 mg/100 ml) demonstrated cerebral release. Arterial blood hyperammonemia can be detoxified safely in the brain as long as the levels do not exceed approximately 300mug/100 ml. Beyond that level lactic acidosis is observed, particularly in cerebral venous drainage. Arterial blood hyperammonemia was also related to the extent of alveolar hyperventilation. These findings are very similar to those seen in experimental hyperammonemia and support the concept that neurotoxicity in children with Reye's syndrome is at least partly due to impaired oxidative metabolism secondary to hyperammonemia.


[The Red Cross and Scandinavian disaster aid]. In 1970, the League of Red Cross Societies drew up a plan for the training of delegates in international relief work. The main tasks of the delegates can be divided into: 1) disaster relief, 2) war-time relief work, 3) assistance in organising national Red Cross societies. Special training of certain categories, e. g. doctors, is now being considered. In many relief operations it would be of value to have a doctor as an administrative delegate. It should be easier for the doctor than for a non-medically trained person to decide where and when medical aid should be administered.


[A hypophysis-absces-syndrome in cattle. II. Pathomorphological investigations (author's transl)]. The clinical description (Espersen 1975) of a hypophysis-absces-syndrome in cattle is based on a retrospective analysis of 25 cases, which all were subjected to a patho-morphological examination after death or euthanasia. The post-mortem picture is characterized grossly by purulent, sero-fibrinous or serous inflammation of meninges, brain, cerebral ventricles, and pituitary region, with accumulation of pus in the pituitary region. The purlent inflammation in the pituitary region is often progressing intracranially but extradurally and involves adjacent cranial nerves, particularly the trigeminal and optic nerves. The extraneural viscera show chronic, embolic inflammatory processes in different organs in several cases as well as acute, agonal circulatory changes in the dead animals. A histological examination of selected parts of the brain and of the pituitary region from eleven of the cases shows in ten of these a protracted meningo-encephalitis and ventriculitis with gravitational extension to the basal meninges and the infundibulum of the hypophysis. The suppuration is further involving the pituitary cleft and adjacent parts of the pituitary (cf. fig. 1--6, 8--11). In one case only a large abces in teh adenohypophysis is found, without a concominant meningo-encephalitis (cf. fig. 7).


Studies on the possible occurrence of mycoplasmas in boar semen. Having regard to the possibility that semen from conventional animals at the five Danish boar centres for artificial insemination may be used for insemination in SPF herds, raw semen from these boars (169) was examined for mycoplasmas. In addition, nasal swab samples and blood samples from 10 animals per centre were examined, respectively for mycoplasmas and antibodies against M. suipneumoniae and M. flocculare. Although the latter examinations gave evidence of a wide distribution of mycoplasmas, such were in no case recovered from raw semen. It hereafter appears that boars do not usually excrete mycoplasmas with semen, even if carrying the infection in the respiratory tract.


The effect of storage on the estrogenic effect of red clover silage. Pure red clover was selected for plant estrogen analyses from the fresh fodder crops of 1972 and 1973. The investigations were made on fresh red clover and on the same red clover after periods of storage of varying length. The red clover was stored in manilla bags in a silo among the ordinary silge fodder, use being of the "green solution method" (Farmos Oy). In the studies the estrogenic effect of the fodder was ascertained by means of bioassay, the criterion being the increase in murine uterine weight. The known plant estrogens were determined by thin layer chromatography and by liquid chromatography. The estrogenic effect of the red clover silage fodder of 1972 was greater in all the silage fodder samples than it was in the fresh red clover. The quantity of individual isoflavones and "transformed" estrogen too, was greater in many of the silage fodder samples than it was in the respective fresh red clover. The estrogenic effect of the silage fodder made from the red clover of 1973 varied considerably; in some samples it was greater but in most it was smaller than the estrogen effect of the fresh red clover. However, apart from a few exceptions, the quantity of individual isoflavones and of transformed estrogens was smaller than it was the fresh red clover.


[Plasma progesterone in mares showing oestrus during early pregnancy (author's transl)]. Sixtyfour mares were examined 3 and 6 weeks after mating. Progesterone was measured in 22 mares 3 weeks after mating in order to see if this could be of any help in the oestrous diagnosis. None of the pregnant mares had plasma progesterone below 2 ng/ml. Pregnant mares that did not show oestrus had higher levels of plasma progesterone than pregnant mares showing signs of oestrus 3 weeks after mating. Clinical findings in pregnant and nonpregnant mares 3 weeks after mating is compared, and oestrus in pregnant mares is discussed.


The effect of different calcium doses in milk fever therapy. A comparative internordic field study. In an internordic field study of the effect of the Ca dose (6, 9 and 12 g) on the therapeutic result in parturient paresis, considerably better results were recorded in Finland than in the other countries at all dose levels. In Finland a full effect was obtained with 6 g, while in all others 9 g Ca yielded a significantly better result than 6 g. Raising of the dose to 12 g produced no improvement. There was a significant difference in therapeutic results between the two Finnish breeds. A larger number of fatal cases was recorded among paretic cows with plasma Ca greater then 8.0 mg/100 ml.


[A hypophysis-abscess-syndrome in cattle III. Pathogenesis (author's transl)]. The pathogenesis of a hypophysis-absces-syndrome in cattle is discussed on the basis of clinical (Espersen 1975) and pathomorphological (Møller and Espersen 1975) investigations. It is concluded that several pathogenetic mechanisms are possible. A remarkable high incidence of the syndrome in recently ringed bulls point to the possibility of a porogenous spread from the nasal septum to the meninges and brain. The often occurring traumatic horn lesions with subsequent sinusitis suggest a porogenous spread from the sinus to the meninges and brain. On the other hand, traumatic horn lesions seem more often to occur as a secondary event and caused by automutilation, as a consequence of the pain, which is thought to accompany a primary meningo-encephalitis. The localization of the abscess in the hypophysis seems, in the majority of cases, to be a result of a primary, purulent meningo-encephalitis, with accumulation of pus from the brain ventricles to the infundibulum and pituitary cleft, due to gravitational forces. In some cases possibly as an extension from a basal meningitis. A direct, hematogenous metastasis to the frontal lobe of the pituitary is a further possibility. Ascending infection through a persistent cranio-pharyngeal duct and infection due to a primary cranial fracture represents other hypothetical, pathogentical possibilities. They have not been shown to occur. Severe clinical symptoms seem to be absent until the inflammation in the basal meninges and in the pituitary region attacks the adjacent cranial nerves, causing a paresis/paralysis.


[Mercury residues in goshawk (Accipiter gentilis) in 1966 and 1974 (author's transl)]. A comparative study of liver, muscle and kidney specimens from goshawks (Accipiter gentilis) shot in 1966 and 1974 respectively shows that a significant decrease in the mercury levels has taken place. The mean values in the liver specimens have changed from 2.27 mg/kg to 0.50 mg/kg, in the muscle specimens from 0.99 mg/kg to 0.20 mg/kg and in the kidney specimens from 3.06 mg/kg to 0.57 mg/kg. The main cause of this decrease is supposed to depend upon the recommendations since 1969 to avoid alkylmercurials as seed dressing.


Quantitative analysis of thiaminase activity in certain fish species. Thiaminase I and II activity of Baltic herring, vendace, smelt and dace was measured. All four fish species were found to contain thiaminase activity. The amounts of thiaminase activity in mug of thiamine split per 100 g of fish tissue per hour at 37 degrees C were: in Baltic herring 115 +/- 60, in dace 11500 +/- 2050, in smelt 25 +/- 25 and in vendace 30+/- 15.


[Left ventricular perforation after insertion of a mitral prosthesis. 6 cases]. The external ruptures of the left ventricule occuring in the first twelve postoperative hours and demonstrated by a disastrous haemorrhage or cardiac failure, the other traumatics accidents could be delayed and be observed during the first month, or even later. Essentially two mechanisms are implicated: -- Direct traumatism by a ball valve on the ventricular septrum. -- Sub-annular splitting in connection with the excision of a piece of calcareous valve. Two lines of approch can be offered to avoid these accidents: -- Choose a disc valve when the surgeon finds a small left ventricle below a stenosed and calcified mitral valve. -- Care in the decalcification of the mitral ring and the valvular resection, leaving in case of need a small calcified cuff for safety. The analysis of these findings clarify the main causes of left ventricular rupture after mitral replacement, rare complications, but ones which are very real.


[Hemodynamic study of pulmonary edemas due to the increase of alveolo-capillary permeability]. Hemodynamic data were collected in 42 patients with pulmonary edema (P.E.) due to altered permeability of various causes. Pulmonary artery wedge pressure (PWP) was normal, whatever the time of the study and the severity of the P.E. Pulmonary artery hypertension was present in the cases with severe hypoxemia, but disappeared with hypoxemia correction. In some cases, a hyperkinetic or a hypovolemic syndrome was found, being induced by the cause of P.E. Although within normal limits, PWP was significantly higher at the first hours of P.E. than after the 6th hour. Perfusion of colloid solutes worsened P.E., although increasing PWP by only a few mmHg. Dehydration using diuretics markedly improved the venous admixture, although PWP was previously normal. These data document the production of P.E. in many causes-such as severe sepsis, drowning, fat embolism, barbiturate overdose-by impaired alveolo-capillary permeability, PWP and blood protein content remaining within normal limits. They also demonstrate the noxious effects of overperfusion and the efficiency of dehydration in such pulmonary edemas.


[Tumoral extension by inversion of the lymphatic flow in colonic cancer]. In a patient with an adenocarcinoma of the ascending colon, the jejunal central villous lymphatics were dilated and contained tumour cells. This case, apparently the only one of its type, demonstrates the proof of a phenomenon sometimes described in connection with malignant diseases, but rarely proven; that of the dissemination of tumour cells by reversal of lymphatic flow.


[Research of an association between HL-A antigens and systemic scleroderma]. 49 unrelated subjects suffering from systemic scleroderma were typed for 28 HL-A antigens, without any particular significant association of an antigen with the disease or one of its manifestations being noted. In addition, 13 patients from the same family were genotyped for HL-A. Transmission of the disease through 4 generations does not seem to be linked to a particular haplotype and no pair of sibling HL-A identical patients were seen in the same generation. By contrast, two pairs of sibling patients were HL-A different. Nevertheless, other cases, and in particular familial, will be necessary before an association between the genes of susceptibility to S.S. and a gene in the chromosomal HL-A region may be definitely eliminated.


[The deterioration of patients with parkinsonism treated with L-dopa]. A progressive deterioration in clinical state was noted in more than half of a group of 87 patients with parkinsonism treated with dopa for 4 to 6 years. The pattern of this deterioration is often quite particular: frequency of troubles with walking, falls, predominance of akinesia in certain motor functions, inconstant recurrence of tremor or rigidity. Some intellectual deterioration is sometimes seen, more common in those patients who had suffered episodes of mental confusion. 11 patients died. It may, however, be hoped that the average life expectancy will increase.


[Acanthosis nigricans associated with diffuse esophageal papillomatosis]. Two cases of acanthosis nigricans seen in 2 women, the characteristics of which were those of malignant forms, showed oesophageal involvment, the appearance of which was quite similar to that of the mucosal localisations of the syndrome. The authors discuss the features which distinguish the oesophageal localisation of acanthosis nigricans from other types of oesophageal acanthosis or papillomata. In one case, this type of acanthosis, seven years after its onset, was not associated with any detectable malignant change and in the other the cutaneous lesions were improved following surgery at which the associated gastric tumour was not removed.


[Determination of the microcirculatory blood flow by pulp plethysmography]. A method for clinical determination of blood inflow at the tip of digit, using mercury strain gauge plethysmography with venous occlusion, is presented, including a satisfactory way of calibration of the "closed type" gauges. Theoretical considerations and experimental data allow to consider the accuracy of the method (of +/- 7 p.cent) to be of clinical value.


[Hereditary coproporphyria. 7 cases].

[Hereditary coproporphyria. 7 cases]. Hereditary coprophyria, known since 1955, is a rare variety of hepatic porphyria. The clinical picture is similar to that of acute intermittent porphyria with certain minor differences; neurological manifestations being rarer in particular. The essential biological characteristic is the massive excretion, in the urine and faeces, of coproporphyrins whilst the excretion of porphobilinogen and delta-amino-laevulinic acid is only slightly increased. As in acute intermittent porphyria, certain medications have an adverse effect, especially the barbiturates. The exact nature of the biochemical lesion is not understood but its hereditary nature has been demonstrated. 25 families have been reported in the literature up to the present time. The authors report two cases of hereditary coproporphyria with peripheral paralysis and respiratory failure, the outcome being fatal in one case. Study of the families led to the discovery of 3 other cases in the second family and 2 latent forms in the first.


Analysis of the hypotensive action of prazosin. Results of animal studies indicate that the hypotensive effect of prazosin is due to vasodilatation which is dependent on two discernible components of drug action: (1) direct relaxation of vascular smooth muscle and (2) interference with peripheral sympathetic function at a site distal to the alpha-adrenergic receptor.


Effects of prazosin on renal function and fluid-electrolyte metabolism. This study was designed to determine the effects on renal function and fluid-electrolyte metabolism of prazosin administered intravenously in a single dose and administered orally in a single dose and in multiple doses to patients with essential hypertension. The results indicate that clinically effective doses of prazosin do not observably alter parameters of kidney function. No side effects were reported by patients, all of whom followed the medication schedule as prescribed (adherence was confirmed by measurement of blood levels of the agent).


Hemodynamic changes at rest and during exercise in long-term prazosin therapy for essential hypertension. Fourteen men 30 to 50 years of age (mean, 42) with untreated essential hypertension, WHO stage I or II, and no other demonstrable disease were studied as outpatients. Oxygen consumption, heart rate, cardiac output, and intraarterial brachial pressure were recorded at rest in the supine and sitting positions and during exercise in the form of bicycling. The subjects were then treated with prazosin in a dosage of 3 to 7.5 mg/day. Eleven subjects responded well, and in 10 of these the hemodynamic study was repeated after one year. At the time of restudy, the systolic, diastolic, and mean arterial pressures were reduced about 11% at rest and during exercise. Pressure reduction was associated with a marked decrease in the previously increased total peripheral resistance of about 17% during rest and 22% during exercise. In all but two subjects, total peripheral resistance was reduced 10% or more at rest and during exercise. During exercise, the total peripheral resistance was reduced more than 10% in all subjects. Heart rate and cardiac output were not changed significantly but tended to be higher after one year of therapy. A comparison of the results with those obtained in patients treated with other antihypertensive agents shows that the reduction in total peripheral resistance was greatest in the group receiving prazosin.


Pediatrics: ridding children of common worm infections. The most common worm infection in children in the United States is pinworm infection. In second place is roundworm infection. Agents that are effective against these nematodes in a high proportion of cases are available. In hookworm disease, generally seen in older children, tetrachloroethylene treatment is being supplanted by use of drugs less likely to have adverse side effect. Visceral larva migrans is difficult to diagnose and to treat, and our best hope for control lies in prevention.


Eye disorders: common ocular injuries: assessing the severity. Any eye injruy due to blunt trauma calls for a measurement of visual acuity as part of the initial examination. Blunt trauma may result in a black eye or in a far more serious injury such as blowout fracture, hyphema, or macular edema.


Removal by dialysis of methylguanidine from body fluids. The dialysis clearance of methylguanidine (MG) was found to be lower 'in vivo' than 'in vitro' and to decrease during a haemodialysis. Its protein binding, which rises as the plasma pH rises during haemodialysis, accounts for its dialysis behaviour. The low dialysis clearance of MG 'in vivo' explains why the post dialysis percentage decrease in its plasma levels is lower than that of urea (U) and of creatinine (CR). The slow transfer of MG from tissue during dialysis, shown by direct measurements on plasma and muscle tissue of anuric dogs, accounts for its high plasma rebound level after haemodialysis. Rebounds after peritoneal dialysis were lower and the plasma MG levels 12 hr after the termination of the two dialysis procedures were not different. The dialytic behaviour of MG is different from that of U and of CR which have similar molecular weights and the conclusions drawn from the behaviour of the latter two metabolites cannot be applied to MG. On the contrary, the removal of MG from body fluids of uraemic patients by dialysis is equal with peritoneal dialysis and with the various haemodialysis schedules that ensure good clinical results, while leaving plasma U and CR concentrations in a high range.


Short dialysis schedules (SDS)--finally ready to become routine? One hundred and one patients were treated for up to two years for three hours every other day (10.5 hr/week), or four hours thrice-weekly with conventional disposable 1m2 dialysers have been investigated. Rigorous control of water balance and the maintenance of predialysis serum K and PO4 within normal limits were the main criteria for judging the adequacy of the treatment. The results regarding blood pressure, phosphate problems, haematocrit, peripheral nerve status, pericarditis and range of rehabilitation are discussed.


Clinical evaluation of patients dialysed with double Gambro 4 hours, three times per week. To reduce the hours and cost of each dialysis and/or to increase adequacy of haemodialysis treatment 14 chronic dialysis patients were dialysed with two Gambro dialysers, 4 hr for 3 days per week. General well-being, anaemia, and nerve conduction velocity improved in some patients during the study period. Increasing dialysis surface area by using two Gambro dialysers enabled reduction of hours of dialysis, which was favourably accepted by all patients and decreased cost of dialysis, mainly by increasing the capacity of a unit to dialyse more patients with the same personnel and equipment.


A mathematical single-pool model for short time haemodialysis. The objective was to reduce treatment time while the average concentration of all molecular sizes was maintained equal to that in a standard treatment. A nomogram based on the one-pool patient-dialyser system has been devised. The patient variables are presented in dimensionless forms, thus making on diagram suffice for all patients and all molecular sizes. Seven patients were first observed during a standard programme and later during an individually calculated short-time programme. The clinical parameters indicated equal treatment. The method was practical enough for clinical use.


Short time personalised dialysis: good results in spite of high levels of small and middle molecules. After almost two years of experience with 43 patients we believe that a short (3 X 4, 3 X 3 hr/week) personalised dialysis is a safe treatment that allows a high survival rate and a good rehabilitation of patients. Pre-dialysis levels of small and middle molecules, the latter only calculated, did not correlate with 5 typical uraemic parameters. Some patients, who formerly experienced standard dialysis, are now equally well or better, without evidence of increasing toxicity, in spite of their higher pre-dialysis levels of small and especially of middle molecules.


Audiometry in chronic renal failure before and after intermittent haemodialysis. In seven cases, audiometric studies were carried out immediately before and after haemodialysis. Hearing was found to be affected in all cases, and the impairment was particularly significant in higher frequency ranges. Following haemodialysis an average improvement of 20 dB was found for the highest frequencies, and in most cases a narrowing of the bone-air gap was also observed. As the improvement was reflected mainly in serum osmolality, BUN and fluid retention in the post-dialysis stage, it was thought that the mechanism reversing the hearing impairment might be due to these parameters.


Microampere electrocution during haemodialysis -- an unrecognised cause of sudden death. A case of electrocution during haemodialysis is reported. Danger of microampere electrocution via artificial kidneys is emphasized. Prophylactic measures are recommended.


Severe hypertension in chronic renal failure treated successfully with Minoxidil. In fifteen patients with severe hypertension, eight of whom had end-stage kidney disease, blood pressure could not be adequately controlled with conventional oral antihypertensive drugs. Minoxidil, an orally administered drug which lowers blood pressure by reducing total peripheral resistance, produced a substantial reduction in blood pressure in all patients who were treated, including patients who prior to its availiability would have been considered for bilateral nephrectomy.


An attempt to prevent hepatitis B in a haemodialysis unit's team utilisation of specific immunoglobulins. From November, 1972 to November, 1974 the members of the team of a haemodialysis unit were systematically given Australia antigen immunoglobulin protection. Only one case of hepatitis occurred among the 53 members treated. The value of the antibody is discussed.


Effect of haemodialysis on immune response. Uraemia depresses immune response by altering cellular reactivity to mitogenic and antigenic stimulation. One might expect that amelioration of uraemia by dialysis would improve immune responses. We have investigated the effect of haemodialysis on in-vitro parameters of cellular immunity. Our data suggest that haemodialysis leads to loss of a factor or factors from both uraemic and normal plasma essential for DNA synthesis. Our data do not suggest that measurements of celluar immunity are useful in monitoring adequacy of haemodialysis in chronic uraemic patients.


Dialysis time and the metabolism of carbohydrates and lipids. The present paper reports some aspects of glycolipid metabolism observed during and after dialysis of varying duration, and the effects of glucose content in dialysis fluid. Some substances used in dialysis interfere with glycolipid metabolism: heparin (Robinson and French, 1960; Wolff and Wolff, 1960); sodium acetate (Bloch, 1947; Ghosal et al, 1969; Mion et al, 1964); and glucose in high (Leonards et al, 1961; Mendelssonhn et al, 1967) or low concentrations (Drukker et al, 1964; Hagstam et al, 1969) or, more recently, completely eliminated (Alwall et al, 1970; Hubner et al, 1971).


Porphobilinogen and porphyrin synthesis in reticulocytes from uraemic patients. Since no information exists concerning porphyrin metabolism in uraemic patients we have measured the activities of delta-aminolaevulinic acid dehydrase (D-ALA-D) and porphobilinogen desaminase (PBG-D) in reticulocytes from uraemic patients, anaemic patients without uraemia and in healthy subjects. Despite a severe anaemia uraemic patients had the same amount of reticulocytes/mul blood. In uraemic patients D-ALA-D activity was reduced to about 20% compared to healthy subjects, PBG-D in uraemia was decreased to about 70%. It is concluded that porphyrin metabolism is altered in uraemic patients.


Histidine and iron supplementation in dialysis and pre-dialysis patients. Chronic renal failure (CRF) patients treated with histidine alone did not show any effect with respect to anaemia or protein metabolism, despite a rise in serum histidine levels. Beneficial effect of iron with regards to anaemia and protein metabolism was seen in CRF patients treated with iron alone or in combination with histidine. Patients with combination therapy showed accelerated improvement of anaemia in comparison with patients treated with iron alone. In RDT patients, who underwent basic treatment with parenteral iron, histidine failed to show any effect with regards to anaemia, despite significantly lowered serum histidine levels. But under histidine treatment a significant rise of transferrin levels occurred in RDT patients, so that histidine must be considered as a limiting factor in protein metabolism in these cases. Histidine requirements of RDT patients are more than 1-2 g/day, and are higher than the requirements of patients conservatively treated.


Delayed excretion of conjugated sulphamethoxazole in uraemia. Persistence in the serum of free and conjugated sulphamethoxazole was estimated in five normal controls and in nine uraemic patients with creatinine clearances under 20 ml/min, after a single one-gram dose of the drug. In the uraemic group delayed disappearance of the free drug was found. Conjugated sulphamethoxazole retention was 62.44% at 24 hr after the oral load, and 13.7% 19 days later. Risk of accumulation of sulphamethoxazole in uraemia is emphasised. Re-evaluation of the use of this drug in patients with impaired renal function is recommended.