[Atherosclerotic aortic aneurysm (based on observations with the scanning electron microscope)]. The inner surface of the wall of atherosclerotic aneurism represented a sort of large ulcerative atherosclerotic plaque. Its individual areas were characterised by the presence of pseudo-hypertrophy of the endothelium cell nuclei, microplaques, and desorganization of the microrelief. The inner surface of the aneurism was de-endotheliolized on a considerable area, and here there were revealed deposits of lipids in the form of millet-like formations and smooth bodies. Studies of the inner surface of the aneurism wall carried out using raster-electron-microscopy technique made it possible to identify different types of calcinosis in the form of individual and isolated plates of calcium on its inner surface. Desorganization of the microrelief and de-endotheliation of the microrelief of the aneurism wall were the leading causes of parietal thromboformation.


[Morphological study of the heart valves formed from the fascia lata femoris after their implantation because of a rheumatic defect]. Pathological anatomy of grafting artificial heart valves formed of the broad fascia of the hip in 5 patients was studied. The fate of a transplant depended upon conditions of its adaptation on a new place. In the case of an unfavourable outcome of transplantation there were observed decomposition of the connective-tissue fibres with degradation of collagen, their decomposition with formation of lacunes, inflammatory reactions, vascularization of the transplant and sclerosis thereof, which, all together, brought about deformation of a new valve. It was suggested that dystrophic and autoimmune mechanisms of destruction of the transplanted tissue were involved.


[Lysosomal hydrolases in the process of muscular atrophy and dystrophy (a histochemical study)]. Non-specific esterase, acid phosphotase, beta-glucoronidase, and N-acetyl-beta-glucosamindase were revealed using the histochemical method of asocombinations in biopsy specimens of the muscular tissue taken from 99 patients suffering from neurogenic and myogenic disorders. Biopsy specimens were taken also from 7 healthy persons. Concentrations of the granular product of the reaction correlated with autofluorescence in the same section. Some bioptic materials were investigated using electron-microscopy. It was established that activity of lysosomal hydrolases in the normal muscular tissue was low, being increased with age. Autofluorescence in the majority of cases was well noticible. In the groups of atrophic fibres in neurogenic atrophy there were observed focal elevation of the lysosomal enzymatic activity. Product of the reaction, which pointed to the activity of nonspecific esterase and acid phosphotase, was localized predominantly along the periphery of muscular fibres. Autofluorescence of the product of the reaction was considerable. On the other hand, there were extensive areas of muscular fibres in which the concentration of the reaction product did not exceed the normal level. Activity of hydrolases in cells of the mesenchyma was of a low degree. Ist type of the lysosomal activity was observed in myogenic dystrophy with an acute course of the disease; it was characterized by structural changes in the muscular tissue, activation of the all hydrolases under study, absence of autofluorescence on the areas of localization of the reaction product, participation of the mesenchyma cells in the lysosomal activation. IInd type of the lysosomal activity was noted in the muscular tissue in neurogenic atrophy. There was no difference in principle between neuro- and myogenic lesions as far as the type of lysosomal activity is concerned. Collation of the results obtained in the investigations with the data reported in available literature enabled the authors to put forward the concept of the two types of the lysosomal activity in muscular lesions: 1) diffuse elevation of the lysosome activity associated with structural changes in the muscular tissue; 2) focal elevation of the physiological activity due to formation of lipopigment.


[Effect of the multiple administration of hydrocortisone on the ultrastructure of the lymph nodes of rabbits]. The effect of dayly multiple exposure to hydrocortison in the dose 1 mg/kg on the submicroscopic structure of the mesenteric lymphatic nodes in rabbits was studied. In contrast to a single-dose administration of the hormone, no pycnotic forms of small and middle lymphocytes were observed. Prolonged application of hydrocortison led to the appearance of atypical forms of reticular cells, an increase in the number of plasmatised lymphocytes, as well as of mature plasmatic cells. Macrophages disappear almost entirely. The number of dark lymphocytes and reticular cells with the thickened matrix of the cytoplasma and great number of ribosomes and polysomes increased considerably. Mechanisms of action of single and multiple doses of hydrocortison on the cells of lymphatic nodes was not identical.


[Effect of histamine and diprazin on the course of experimental amyloidosis in mice]. In experiment on 33 mice, line C57Bl, the effect of changed vascular-tissue permeability following administration of histamine and anti-histamine preparation diprazin (pipolphen) on the development of amyloidosis was studied. It was shown that histamine stimulated the development of amyloidosis in mice, causing besides generalized vascular disorders and a pronounced mast-cell reaction with degranulation of these cells, whereas diprazin, on the contrary, inhibited amyloidogenesis in mice. Differences between experimental and control groups were identified using the morphometric method and were confirmed statistically. The difference in the degree of amyloidosis revealed against the background of administration of histamine and diprazin testified to a certain extent to the role of impaired vascular-tissue permeability in the pathogenesis of amyloidosis.


[Severe changes in the makeup of the blood after a contusion of the soft tissues complicated by sepsis]. A case of a comparatively mild trauma of a lower extremity in an 11-year-old child complicated with deep thrombophlebitis of the thigh and pelvic bone, thromboembolism of the pulmonary artery branches, sepsis, and massive systemic fat embolism is described. The development of fat embolism in combination with thromboembolic complications in the absence of injuries of the skeleton and fat tissue may be explained from the standpoint of physico-chemical theory of pathogenesis of fat embolism. A close correlation between fat embolism and the system of blood coagulation was noted.


[Bronchiolar emphysema in a child at the age of 1 1/2 months]. Bronchiolar emphysema was found in an infant of 1.5 months of age in the course of a morphological investigation of a resected 5th segment. There were noted a peculiar incompleteness of the structure of the air-passage and respiratory apparatus of the lungs, diagnosed as arrest of development at the level of respiratory bronchioles. Muscular cirrhosis was not detected.


Posttraumatic dysautonomic cephalalgia. Clinical observations and treatment. Five patients developed posttraumatic vascular headaches associated with autonomic dysfunction. The precipitating injury affected the anterior triangle of the neck, presumably involving the region of the carotid artery sheath. Disturbance of sympathetic function, characterized by excessive sweating and pupillary dilation associated with headache, was noted. Appropriate pharmacologic studies revealed evidence of partial sympathetic devervation. While headache was resistant to ergotamine preparations, prompt relief was obtained with propranolol hydrochloride, and adrenergic beta-receptor blocking agent.


Abnormal cerebrospinal fluid-blood flow dynamics. Implications in diagnosis, treatment, and prognosis in normal pressure hydrocephalus. Increased cerebral blood flow (CBF) has been proposed as responsible for the clinical improvement after cerebrospinal fluid (CSF) shunting in patients with normal pressure hydrocephalus (NPH). In order to determine any abnormal CSF-CBF pressure-flow relationships in NPH, measurements of regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) were made before and after lowering CSF pressure (CSFP) in 15 patients with NPH, and in ten patients with presumed hydrocephalus ex vacuo. Maximal reduction of rCBF and rCBV occurred in the territory of the anterior cerebral artery in NPH but no in dementia due to brain atrophy. Both CBF and rCBV increased after lowering the CSFP by lumbar puncture in patients with NPH. Patients with higher preoperative rCBF and maximal increases in rCBR and rCBV after lowering CSFP showed the most consistent clinical improvement after CSF shunting. Evidence is offered that CBF autoregulation is impaired in NPH. The CBF test assists in both diagnosis and selection of patients for CSF shunting.


Familial cerebral sarcomas.

Familial cerebral sarcomas. Four cases of cerebral fibrosarcomas occurring in two families are reported. To our knowledge, no similar cases have been reported. Evidence that a heritable factor is involved in the genesis of some brain tumors is suggested by these cases.


Neurocutaneous melanosis with malignant leptomeningeal melanoma. A case with metastases outside the nervous system. A case of neurocutaneous melanosis with malignant leptomeningeal melanoma was seen in a black man. The presence of extracranial metastases was noted, and evidence is presented favoring the central nervous system as the primary source.


Kinky hair disease. Study of copper metabolism with use of 67Cu. Metabolism of labeled Cu (67Cu) was studied in three patients with kinky hair disease (KHD). Labeled Cu was administered first intravenously and, later, orally. We determined oral absorption, excretion, and internal kinetics of this metal. Patients with KHD absorbed 11% to 13% of Cu given orally, compared to 46% by unaffected controls. Total excretion of Cu given intravenously during the first seven days after administration was greatly reduced in patients with KHD. The biological half-life of 67Cu in patients with KHD was increased by a factor of 2 to 3 over the normal control. Most of the labeled Cu was retained by the patient's liver, while in the control subject there was more rapid movement to the Cu to circulation (ceruloplasmin). Red blood cells of patients with KHD incorporated orally administered Cu preferentially, which was sufficient to prevent anemia.


Spinal cord regeneration in rats after immunosuppressive treatment. Theoretic considerations and histologic results. Some species of animals and some early developmental stages of other species are capable of central nervous system (CNS) regeneration. These species and developmental stages also have reduced or absent allergic reaction to tissue homografts. Mammals are allergic to their own brain antigens, and experimental allergic encephalomyellitis (EAE) can be produced when they are exposed to parenterally administered brain antigen. Immunosuppressive treatment will delay or prevent the production of EAE in rats. In our experiments, immunosuppressive treatment made possible the electrophysiologic study of regeneration of long descending motor tracts of the spinal cord in rats six months after spinal cord transection. Histologic evaluation showed no comparative difference in scar at the site of transection when treated animals were compared with controls. Neither was any difference noted between animals in which regeneration was shown electrophysiologically and those without such regeneration. Perhaps humoral antibodies play a role in the prevention of functional regeneration in the rat.


Myasthenia gravis and acetylcholine receptor. Effect of steroids in clinical course and cellular immune response to acetylcholine receptor. Lymphocytes from patients with myasthenia gravis (MG) were transformed when cultured in vitro with an acetylcholine receptor fraction extracted from the electric organ of an electric eel. Marked diminution of the cellular response to acetylcholine was shown in patients who improved clinically with prednisone treatment. The transient clinical deterioration during the first days of prednisone treatment was accompanied by a transient increase in lymphocyte response. These findings that an in vivo sensitization of lymphocytes to self-acetylcholine receptor may occur in MG, and that a cell-mediated autoimmune mechanism may be important in the pathogenesis of the neuromuscular block. The present observations indicate that prednisone provides a measure of immunosuppression in MG. The transient clinical deterioration during the first days of prednisone therapy may reflect an enhancement of cell reactivity by this drug.


Glucocorticoids and mammalian motor nerve excitability. Short-term treatment of cats with high doses of triamcinolone and related steroids strikingly increased the capacity of soleus motoneurons to generate posttetanic stimulus-bound repetition (SBR) and the obligatory postetanic potentiation (PTP) of muscle. The edrophonium chloride (Tensillon)-induced SBR and twitch potentiation were likewise augmented. These effects reflect an increase in the excitability of the motoneuron. This glucocorticoid effect suggests that the motoneuron is the site of the antimyasthenic action of the hormone. Certainly, the enhanced SBR is a neuronal representation of the adverse epileptogenic action of the glucocorticoids. The glucocorticoid effect on motoneuron outlasts the dosing period, suggesting an underlying alteration in the neuron. Other glucocorticoids caused the same effects, but varied in their potencies. Mineralocorticoids were less effective. The single androgen that was tested proved to be minimally effective.


Spastic eyelids. Failure of levator inhibition in unconscious states. Three patients exhibited tonic uninhibited lid elevation in unconscious states. In the two cases adequately studied at autopsy, the lesions were too large for precise localization but suggest that damage to the pons (and probably midbrain as well) can interfere with normal lid relaxation in coma and sleep.


Congenital ichthyosis with spastic paraplegia of adult onset. Two siblings had what we believe to be a unique disorder manifested by stationary congenital ichthyosiform erythroderma coupled with a slowly progressive spastic weakness of adult onset. The disorder was presumably inherited as an autosomal recessive trait. The mechanism by which a genetic mutation would mediate this multiple organ system disorder is unknown.


Corticosteroid-induced mediastinal widening in myasthenia gravis. Corticosteroid-induced mediastinal widening with simulated focal lymphadenopathy was found in a patient having myasthenia gravis. To my knowledge, this is the first report of such changes occurring in a patient having myasthenia gravis. As the use of corticosteroids in the treatment of myasthenia gravis becomes more common, this association can be expected to occur more often. Reemphasis of this phenomenon should help to avoid unnecessary surgical intervention in these patients.


Delayed hypoxic encephalopathy without cognitive dysfunction. Three days after an episode of hypoxia, a 20-year-old man developed profound motor deficit in the absence of behavioral or cognitive disturbance. Previous reviews of delayed hypoxic encephalopathy have stressed behavioral and cognitive disturbances as the initial symptoms. This patient's pyramidal tract dysfunction in the absence of higher cortical dysfunction serves to illustrate that delayed hypoxic encephalopathy is predominantly a white matter rather than a gray matter disorder.


Serotonin metabolism is pellagra.

Serotonin metabolism is pellagra. Altered mental status is common in pellagrins. We evaluated the mental status of pellagrins in relation to the neurohormone, serotonin or 5-hydroxytryptamine (5-HT). Levels of 5-hydroxyindoleacetic acid (5-HIAA), an end product of serotonin in the urine and cerebrospinal fluid (CSF), and of platelet 5-HT were determined in a group of pellagrins and in normal subjects. The results indicated that the 5-HT concentration was reduced in platelets and 5-HIAA excretion in urine was below normal levels. The 5-HIAA concentration in CSF was also reduced, suggesting a decrease in 5-HT functional activity in the brain.


End-plate morphology in amyotrophic lateral sclerosis. Intercostal muscle end-plates were measured in patients with amyotrophic lateral sclerosis (ALS) and more benign motor neuron disease (MND). The length of the intact end-plates in ALS and MND was not different from the controls. Segmented end-plates were increased in both ALS and benign MND, and the end-plate length was greatest in ALS. In individual ALS cases, no correlation was found between the end-plate abnormalities and relevant clinical variables.


Alpha-coma. Electroencephalographic, clinical, pathologic, and etiologic correlations. "Alpha-coma" denotes the conjunction of clinical coma with an electroencephalographic pattern resembling that of normal wakefulness and predominantly consisting of alpha activity. Clinical, EEG, and pathologic data from 13 patients with this syndrome were reviewed. The patients were divided into two groups, based on the pathogenesis of their conditions. The first group consisted of eight patients with brain stem strokes, and the second group consisted of five patients with diffuse hypoxic encephalopathy resulting from cardiac or pulmonary arrest. There were some differences between the EEGs of the two groups. In the first group, the alpha pattern was located more posteriorly, showed more variability and reactivity, and was more persistent in sequential recordings. In the second group, the alpha activity was transient and showed little reactivity. In both groups, this pattern indicated a poor prognosis for survival.


The electroencephalogram in subacute sclerosing panencephalitis. Electroencephalogram studies of 31 patients with proved subacute sclerosing panencephalitis (SSPE) revealed periodic high-amplitude complexes in all except one. The periodic complexes consisted of two to four high-amplitude delta waves, were usually bisynchronous and symmetrical, and repeated once in five to seven seconds. When both the clinical myoclonic jerks and the periodic EEG complexes were present, a one to one relationship existed between the two phenomena. Besides periodic complexes, several atypical EEG findings were also noted that included frontal rhythmic delta activity in intervals between periodic complexes, electrodecremental periods following EEG complexes, paroxysm of bisynchronous spike wave activity, random spikes over frontal regions, and focal abnormalities, such as spike and slow wave foci. In spite of variability of EEG findings, there is usually no difficulty in making the diagnosis of SSPE if both the EEG and clinical findings are considered.


Juvenile head trauma syndromes and their relationship to migraine. The clinical spectrum of juvenile head trauma syndromes was derived from an analysis of 50 attacks in 25 patients. Attacks were grouped into four clinical types: (1) hemiparesis; (2) somnolence, irritability, and vomiting; (3) blindness; and (4) brain stem signs. Our evidence shows that these four types are different manifestations of a common underlying process. All attacks followed mild head trauma after a latent interval, generally of one to ten minutes. Forty of the 50 attacks occurred in patients under 14 years of age. Full recovery occurred after a variable time in all but one instance. This patient, and one other, had an angiographically demonstrable occlusion of a branch  of the middle cerebral artery. In clinical and laboratory features, these attacks resemble classical migraine and presumably have a similar underlying mechanism.


The biology of childhood ependymomas.

The biology of childhood ependymomas. The biology of 74 childhood ependymomas has been retrospectively investigated in total population samples from three hospitals in two cities. Regardless of the tumor's site of origin, the prognosis is grim. No child has been cured by surgery alone. The symptom-free interval after surgery is a first-order function of the age at diagnosis. The criteria for cure are best approximated by Collins "law," in terms of which there are apparently only three cured patients in this study. Intracranial ependymomas are best treated by careful excision of the tumor and radiation of a generous area to a total dose of at least 4,500 rads over a 60-day period. Radiation of the entire neuraxis appears to be indicated only in those few cases that can be considered malignant microscopically.


Thalamic tumors in childhood. Clinical, laboratory, and therapeutic considerations. Eighteen cases of primary thalamic tumor occurring in children (ages 2 1/2 to 12 1/2 years) were studied retrospectively. Among the clinical features of this group that contrasted with adults having similar tumors were a shorter duration of symptoms before diagnosis and a higher incidence of motor abnormalities in the early illness. In several cases, symptoms and signs usually associated with cerebellar disorders predominated. Arteriography or gas encephalography or both were diagnostic in all but two cases. The electroencephalogram, abnormal in slightly more than 70% of the cases, suggested a thalamic mass in more than one third. A highly specific EEG feature was the presence of spindles while patients were awake. In 15 cases there was some evidence of ventricular dilation and nine of these later required shunts. In addition to shunting procedures, therapy included x-ray therapy alone or with craniotomy or craniotomy alone.


A syndrome of acute zinc loss. Cerebellar dysfunction, mental changes, anorexia, and taste and smell dysfunction. Oral administration of the amino acid histidine to six patients with progressive systemic sclerosis produced anorexia, taste ans smell dysfunction, changes in mentation, and cerebellar dysfunction in each patient; these changes were associated with significant decreases in serum zinc concentration and significant increases in urinary zinc excretion. Administration of zinc ion, even with continued histidine administration, returned each of the signs and symptoms to or toward normal within 8 to 24 hours in each patient at the same time that correction of the serum zinc concentration occurred. The signs and symptoms noted constitute a syndrome related to acute zinc loss.


Auditory brain stem responses in neurological disease. A sequence of seven low-amplitude (nanovolt) potentials that occur in the initial 10 msec following click signals can be recorded from scalp electrodes in human subjects using computer averaging techniques. The potentials, termed auditory brain stem responses, are thought to be the far-field reflection of electrical events originating in the auditory pathway during its course through the brain stem. We have studied auditory brain stem responses in a variety of neurological disorders and found them to be of assistance in evaluating the mechanisms of coma, the localization of midbrain and brain stem tumors, the localization of demyelination of the brain stem, and tumors, the localization of demyelination of the brain stem, and the presence of diminished brain stem circulation.


Agenesis of the corpus callosum with hypothermia. A patient with episodic hypothermia and agenesis of the corpus callosum had no direct evidence of hypothalamic-pituitary dysfunction. However, it is speculated on the basis of a recent clinicopathologic case study that selective hypothalamic involvement is the cause of the hypothermia. Electroencephalograms and treatment with antiseizure medication did not support an epileptic genesis for the episodic hypothermia. Double, simultaneous, tachistoscopic stimulation studies revealed an asymmetry of response that can be explained by either a functional disconnection of the cerebral hemispheres or bilateral independent and asymmetrical representation of speech mechanisms.


Surgical management of nonmagnetic intraocular foreign bodies. Selected nonmagnetic, intraocular foreign bodies can be successfully removed from the posterior segment by a modification of the pars plana vitrectomy technique using foreign-body forceps. Opacities of the ocular media are cleared and the foreign body mobilized using the vitrectomy instrument. The foreign body is extracted, under direct visualization, with forceps. Reflex-free illumination is provided by an intraocular, fiberoptic light source. The globe is supported with a double Flieringa ring to prevent collapse after removal of the formed vitreous. Retinal reattachment surgery can be performed during the same operation if indicated.


Therapeutic effectiveness of fluorometholone in inflammatory keratitis. During an experimentally-induced inflammatory keratitis, we measured the ability of 0.1% fluorometholone ophthalmic suspension to reduce the numbers of polymorphonuclear leukocytes that invaded the cornea. The data demonstrate that topically administered fluorometholone is an effective therapeutic agent and that it compares favorably in anti-inflammatory activity with dexamethasone and prednisolone preparations. Comparison of our results with comparable studies of dexamethasone and prednisolone formulations indicates that 1.0% prednisolone acetate ophthalmic suspension is still the most effective corneal anti-inflammatory agent that we have investigated to date. However, the decreased potential of fluorometholone to produce secondary elevation of the intraocular pressure would appear to make it the drug of choice in situations in which maximum pharmacologic suppression of inflammation is not required and in chronic inflammatory conditions that require prolonged treatment.


Clinical experience with a mobile ocular perfusion pump. The continuous delivery in fluids to the ocular surfaces of 12 patients, for a collective total of 1,500 days, was achieved by means of a mobile perfusion pump. One patient used this device intermittently for a total of 21/2 years. Severe dry-eye symptoms were ameliorated in each patient by the constant perfusion. In various situations, the following perfusion fluids have been tried: commercial balanced salt solution, commercial artificial tear solutions, acetylcysteine, and autologous and homologous serum and plasma. In spite of disadvantages related to its size and weight, the pump seems to be of considerable value, especially following severe chemical burns and after keratoplasty or reconstruction of the lids and fornices in the severely dry eye.


Spontaneous hyphema and vessel anomaly.

Spontaneous hyphema and vessel anomaly. We describe a case of spontaneous hyphema, in which results of fluorescein angiography revealed that the condition was caused by anomalous iris vessels. A cavernous hemangloma of the ipsilateral orbit was discovered. We stress the importance of performing fluorescein angiography in all cases of spontaneous hyphema.


Glaucoma in episcleritis.

Glaucoma in episcleritis. Two patients had episcleritis and a secondary open angle glaucoma. Anterior uveitis was absent in three of the four eyes. The low facility of outflow suggests that increased episcleral venous pressure was not the mechanism of the glaucoma. The response of the intraocular pressure and, in one case, the outflow facility to steroid therapy suggests that inflammation of angle structures was the pathogenesis of the raised intraocular pressure.


Angioid streaks. II. Fluorescein angiographic features. Fluorescein angiographic sequences from 31 patients with angioid streaks were evaluated. In contrast to previous reports, the streaks usually showed an early central zone of hypofluorescence. We postulated that the hypofluorescence was due to a break in Bruch membrane, causing a separation of the choriocapillaris. This resulted in an area of nonperfusion. Adjacent light-colored areas were hyperfluorescent, possibly due to abnormal retinal pigment epithelium, thickened Bruch membrane, and patent choriocapillaris. The hypofluorescence of the paired red-brown spots may have resulted from an increased pigment density. The intermittent hypofluorescent spots comprising the area of peau d'orange were thought due to focal dehiscences in Bruch membrane and the choriocapillaris. The hyperfluorescent isolated focal lesions may have resulted from an abnormal thickening of Bruch membrane and a patent choriocapillaris.


Iris nevus (Cogan-Reese) syndrome. A cause of unilateral glaucoma. Fourteen patients (ten women, four men) with iris nevus (Cogan-Reese) syndrome, all having unilateral glaucoma, were studied clinically. Many had corneal edema, and all had changes in the iris consisting of one or more of the following: iris whorls or nodules or both, atrophy of iris stroma, heterochromia (the darker iris usually involved), or ectropion uveae. All had peripheral anterior synechias. Material for histological study was available from ten patients and showed a nonmalignant diffuse nevus of the anterior surface of the iris. An overgrowth of endothelium and Descemet membrane extending onto the iris surface may be a characteristic part of the process. Patients tended to be women in middle age. Conservative treatment avoiding enucleation is advised. Whenever a patient with suspected iris nevus syndrome or essential iris atrophy is subjected to glaucoma surgery, a biopsy specimen of the iris should be obtained for histological study.


Clinicopathologic case reports: Optic nerve head metastasis. A case of tumor metastasis from carcinoma of the lung directly to the cribriform plate is described. Retina and optic nerve were involved, but there was no evidence of tumor invasion of the choroid. It is postulated that the original tumor embolus lodged in a cribriform branch of the arterial circle of Zinn or in the central retinal vessels.


Large optic nerve glioma with normal vision. When the diagnosis of optic glioma is made, the visual loss is most often mildly or profoundly impaired. We report the details of the unusual situation where central visual acuity, visual fields, and color vision were normal at the time a large optic nerve glioma was demonstrated in a young boy. To our knowledge, this is the first case report containing ophthalmologic, neuroradiologic, surgical, and histologic details illustrating the rare association of normal vision and an optic glioma.


Cicatricial upper lid entropion. Treated with banked scleral graft. Bank sclera is used as a graft in the treatment of cicatricial entropion of the upper lid. Banked bare sclera is sutured into the tarsoconjunctival layer of the entropic lid and is allowed to epithelialize spontaneously.


[Changes in bone turnover under immobilization and remobilization. Animal experiments using 45Ca and tetracycline labelling (author's transl)]. This paper presents an experimental study of rabbits immobilized in plaster of paris casts. By means of Tetracycline and 45Ca-labelling an immobilisation over 12 weeks showed a significant diminuition of bone formation. In the first stages of remobilisation the bone formation was found to be increased and became normally in a later stage. The lower dorsal spine was not sufficiently immobilized in our experiments. Therefore significant changes of bone turnover could not be observed.


[Positioning of the surgical team in clean air with laminar horizontal flow (tunnel) (author's transl)]. The position of an operation team within the horizontal flows has to be adapted to experiences of ultra clean air technique. Managing of preparations and recommended positions at respective surgical regions are described. Important principes and orders are to 0e followed in solving problems of a horizontal flow operating tunnel.


[Biomechanical investigations of osteosynthesis at metaphys area of tibia and femur with selftensed angle plates (author's transl)]. Straight pressure plates create an eccentric tension force as well as an osteosynthesis with angle pressure plates. Both kinds of plate incline to gape the osteosynthesis and/or fracture gap. Therefore an overbending or additional angle allowance is necessary. In our biomechanical investigations we showed that at average bone stability, an overbending of the angle respectively an additional angle allowance of 3 degrees is most favourable. Uniform distribution of power transmission can be achieved at the entire osteotomie level using large and small angle plates with appropriate plate thickness and plate tension force. Sufficient stability in mobilisation is guaranteed without additional cast fixation.


[Biomechanical tests on osteosynthesis with small-bone plates (author's transl)]. Plating in handsurgery has become a more frequently used method since the special instruments of the Swiss AO and the self-compression plates of Mittelmeier (made by Osteo AG) have been introduced. The results of biomechanical measurements, comparing the interfragmental compression power and tensile strength of the small-fragment-plates of the AO with the crescent-formed plates of Mittelmeier are reported. The compression power of the first reach their maximum by 8 kp, the latter an average of 20 kp. A gapping of the fracture occures under a deflection-momentum of 4 kp - cm using AO-plates and 10 kp - cm using the crescent-formed plates. The bending stiffness under deflection momentum to the off side of the plate is in the crescent plate 10 times higher. Only an angulating bending in the middle gives in both plates an all over good contact to the fragments. Finger osteosyntheses are very rigid against a deflection momentum in the level of the plate. (Regarding that, we fixe the plate sidewise on the bone.) Our conclusion is, that the better biomechanical stability of the self-compression plates--Mittelmeier-plates--is a result of the higher compression powers.


[Aetiology, therapeutics and prognosis of osteochondrosis dissecans of talar dome (author's transl)]. 1. It must be considered a fact that in the genesis of osteochondrosis dissecans of the medial as well of the lateral talar dome a traumatic event is of decisive importance. In regard to the idiopathic type of osteochondrosis dissecans, it is usually the medial talar dome which is affected, but even here the traumatic genesis is prominent. Proof of a traumatic genesis is established once the following suppositions are satisfied: a) diagnosis of an adequate trauma, b) a nearly uninterrupted anamnesis of pain, c) a process at the edges visible in the radiogram. 2. Surgical treatment is imperativ in cases of cartilage floating with the danger of blocking. Excision of the focus including the injured and necrotic subchondral spongiosa and transplantation of healthy spongiosa can ward off a dissecation and thus damage of the joint cartilage as well as a sinking of the cartilage into the focus. However, there is no imperious indication for surgical intervention. 3. Development of arthrosis is rare, even after a long follow-up period up to 25 years. Serious complaints like pain during stress or rest are eceptional. Arthrodesis of the ankle joint as suggested by Schnabert (1939), is not necessary even in cases there the talar dome appears to be totally decayed in the radiogram, since over the years there is a definite discrepancy between the findings in the radiogram and the subjective complaints. 4. We noted an enlargement of the osteochondrotic process in singular cases, and parallel to this a deterioration of the clinical picture. Restitutio ad integrum in the radiogram has never been seen even in patients who have been free of symptoms for 25 years.


[The tendon interposition plastic with partly necrosised scaphoid pseudarthrosis (author's transl)]. We have seen in 4 cases of 46 operated scaphoid pseudarthrosis aseptic bone necrosis of a fragment. According to the tendon interposition plastic of Froimson for the substitute arthrose of the saddlepoint of the thumb. We exstirpated the bionecrotic fragment of the scaphoid, splitted the tendon of the flexor carpi radialis muscle, removed a part of the tendon from the belly of the muscle, rolled it in and fixed it in the excavated cavity of the bone. After an observation time of 6 months to 1.5 years all 4 patients have not developed complications.


[Effectiveness of thromboembolic prophylaxis in major hip surgery with low doses of heparin using the radiofibrinogen test (author's transl)]. The radiofibrinogentest was applied for early diagnosis of deep vein thrombosis (DVT) in 40 patients with major hip joint operations. A high dosage of Calciumdepotheparin (3 X 1 200 IU/10 kg) administered from the evening of the first postoperative day, proved to be a better prophylaxis of DVT in this kind of operation than a low dosage of heparin that administration was started preoperatively.


[Bone stress and reconstruction of the bone at the alloarthroplasty of the upper end of the femur with cement bonding (author's transl)]. Structure and shape of the upper end of the femur are determined by direction and height according to their strain. Forces which flow from pelvis into femoral head have at first an unfavourable direction that means a non-axial direction of the femoral shaft. The mechanic task of the proximal femur (epi- and metaphysis) is to divert the forces in a way that they disperse in axial direction to the shaft (tension and pressure forces of the upper end of the femur). By replacement of the endoprosthesis, the epiphysis and a large part of the metaphysis is removed and will be replaced by metal- or bone cement. This leads to a thorough change of the mechanical stress. According to Wolff's transformation law the bone tends to adopt the changes stress throught reconstructing processes. Static and morphologic researches of the normal and endoprosthetic femur could demonstrate a conformity of bone reconstruction and changed bone stress. The spongiosa remaining after resection is not sufficient to distribute the influenced forces of the shaft of the bone. Result is a cancellous bone of the upper end of the shaft. We call this reaction "Metaphysierung". According to the unphysiologic high bending stress of the shaft in level of the lower half of the haft of the prosthesis, a hypertrophy of cortex and vault occurs. The large stress of this part of the bone can be the cause of non-infectious late loosenings of the prosthesis.


A comparison of the uptake of [75Se]selenite, [75Se]selenomethionine and [35S]methionine by tissues of ewes and lambs. The fate of selenium, given as Na2(75)SeO3, or [75Se]selenomethionine, and of [35S]methionine administered intravenously to ewes and lambs, has been examined. The main intention was to follow the incorporation of selenium into protein in a number of tissues, including liver and kidney, and to measure the extent of that incorporation of selenoamino acid, particularly with respect to the administration of selenite. The ewes chosen were lactating ewes with lambs at foot, and the lambs were animals which had been weaned on to fodder low in selenium and were recovering from white muscle disease with selenium therapy. These two experimental situations were chosen as they offered conditions under which selenium incorporation might be considered to be maximal. Entry of isotope into milk was rapid and was greater when 75Se was given as the selenoamino acid than as selenite. In both ewes and lambs greater amounts of activity, derived from selenite, were bound to plasma proteins than to the proteins of milk. This was particularly evident in samples taken some hours after administration. This ability of the plasma to bind selenium was demonstrated by alkaline dialysis. Small, though significant amounts of selenium, derived from Na2(75)SeO3, were incorporated as selenoamino acids into the proteins of liver, kidney and pancreas, as well as into the proteins of milk and plasma. In ewes, both selenomethionine and selenocystine were identified chromatographically in enzyme digests of defatted liver and kidney. Some differences occurred in the distribution of labelled compounds in organs from lactating ewes and recovering lambs. The incorporation of selenium into protein is discussed briefly in relation to the recent findings of an association between selenium and the enzyme glutathione peroxidase.


Glutathione peroxidase activities in sheep and rat muscle and some effects of selenium deficiency. The activity and distribution of the selenium-containing enzyme, glutathione peroxidase, has been determined in muscle fractions in normal adult rats and sheep. Skeletal and cardiac muscle have been examined, and in both types of muscle the major proportion of the enzyme appeared in the cytosol fraction. Enzyme activity was higher in cardiac muscle than in skeletal muscle in both species, and based on total protein present in fractions, it appears that rat muscle contains more enzyme activity than sheep muscle. In tissues from lambs born to selenium-deprived ewes the levels of enzyme were significantly depressed. Two sampling periods were selected, the first when the lambs were 2-3 weeks of age and the second at slaughter when they were 10 weeks old. Muscle, plasma and erythrocyte levels of the enzyme indicated that the most sensitive measure of selenium deficiency is likely to be that of the erythrocyte enzyme level.


Hormone studies on ewes grazing an oestrogenic (Yarloop clover) pasture during the reproductive cycle. The endocrine function of Merino and Corriedale ewes grazing an oestrogenic (Yarloop clover) pasture has been studied during the oestrous cycle, pregnancy and parturition, and the results compared with those from a study of similar ewes grazing a neighbouring grass pasture. Plasma progesterone, oestrogen and corticoids were measured using competitive protein binding assay procedures. During the oestrous cycle clearly anomalous patterns in hormone content were evident in ewes grazing Yarloop, and this related to their significantly poorer (P less than 0.001) fertility. The first mating, when ewes were 1-1/2 years of age, was particularly affected. Successful conception took place in only 27% of ewes mated on Yarloop, compared with 95% on grass. Evidence of disturbance in the normal patterns of both plasma oestrogen and progesterone was found in infertile ewes, including a shortened period of luteal function. Disturbance of endocrine function caused by Yarloop clover ingestion was also found in pregnant ewes, with the mean plasma progesterone concentrations during the latter half of pregnancy reduced (P less than 0.05) and the plasma oestrogen and corticoid levels tending to be higher in these animals. In detailed hormone studies in the periparturant period, both groups showed a similar fall in plasma progesterone and rise in plasma oestrogen prior to parturition. Where excessive time was taken for parturition (more than 30 min) this was reflected in higher plasma corticoid levels (P less than 0.05) within 8 h of birth.


Horner's syndrome in the dog and cat as an aid to diagnosis. Four cases of Horner's syndrome, two in dogs and two in cats, are described. Miosis, ptosis, and enophthalmos were present in three of the cases and in addition, protrusion of the nictitating membrane was present in the fourth case. In the two cases described in cats, there was also evidence of peripheral vasodilation in the skin of the face on the same side as the Horner's syndrome.


Immunisation of cattle against vibriosis with vaccines prepared from Campylobacter fetus subsp fetus. Subcutaneous administration of vaccines prepared from cells of Campylobacter fetus subsp fetus strain A28 to heifers gave substantial protection against infertility due to C. fetus subsp venerealis strain B6. Strains A28 and B6 had different heat-stable antigens and conformed respectively to serotype B and serotype A of Berg et al (1971). The results suggested that the protective antigens were heat-labile antigens common to both strains. Although vaccines prepared from serotype B strains of C. fetus subsp fetus could be used to immunise cattle against vibriosis, the results did not suggest that their use in preference to those prepared from C. fetus subsp venerealis would offer any advantages.


Causes of disease in two commercial flocks of laying hens. Laboratory examination of all birds that were culled or died during an eight-month period in two commerical laying flocks was performed to reveal the causes of disease and their prevalence. The average weekly total of diseased birds was greater in one flock (60-69) than the other (27-37). This resulted mainly from a high incidence in the former flock of leucoses and sarcomas, although losses due to fatty liver syndrome, prolapse and cannibalism and cage layer fatigue were also marginally greater in this flock than the second. Haemangiomas occurred more frequently in the flock with the higher disease level. A total of 273 hens of the 2,000 examined from this flock had single or multiple haemangiomas. Special features of the major causes of disease were outlined and discussed. A conclusion made from this study was that histopathological examination is necessary for accurate diagnosis of avian tumours.


The infection of merino sheep with bovine ephemeral fever virus. Four Merino sheep inoculated intravenously with bovine blood containing ephemeral fever virus showed no clinical signs of ephemeral fever. Two sheep showed a mild haematological response and developed a neutralising antibody which closely paralled that of a steer inoculated at the same time. Leucocytes harvested from these 2 sheep on days 3 and 4 after inoculation with virus reproduced ephemeral fever when inoculated into susceptible steers whilst those harvested on days 1, 2 and 5 did not. Even though this indicates that EFV can multiply in some sheep when they are inoculated intravenously, it cannot be inferred that natural infection occurs.


Congenital respiratory tract defects in lambs. One hundred and forty-seven newborn lambs with congenital defects of the respiratory tract were examined during a 3-year investigation into the causes of perinatal lamb mortality. Respiratory defects were found in 3.3% of the 4,417 lambs examined and in one-third (36.6%) of the 401 congenitally malformed lambs. All the defects were secondary to other more extensive malformations. The upper respiratory tract was involved 3 times more than the lower tract. Males were involved more than females (4:3). The upper tract defects were harelip, cleft palate, atelorrhinia, arrhinia, proboscis, fused nostrils and choanal atresia. One of the facial clefts was a rare median harelip associated with cleft palate and fused nostrils. The lower tract defects were pulmonary agenesis, hypoplasia and duplication. The 2 most common defects were choanal atresia and secondary pulmonary hypoplasia. It was concluded that primary defects of the respiratory tract of sheep are rare and that secondary defects are relatively common.


A pathological and bacteriological abattoir survey of the reproductive tracts of merino ewes in Western Australia. Macroscopic examination of 487 ewe reproductive tracts from 18 different sources was made at Perth abattoirs. Of these, 194 were examined microscopically and 217 bacteriologically. Observations were made during March to May, when ewes were not grazing oestrogenic pasture. Significant lesions in ovaries or oviducts were rare. Macroscopic cysts were found in the uterus or cervix of 159 ewes (32.7%). Microscopic lesions, including uterine or cervical cysts and squamous metaplasia or goblet cell hyperplasia of the epithelium, were observed in 76% of ewes studied. Bacteria were isolated from 59 ewes, the most common genera being Corynebacterium, Escherichia, Streptococcus and Bacillus. Escherichia coli and streptococci appeared to be the most commonly associated with endometritis. Presence of bacteria was closely associated with endometritis and with cysts in the cervix. Endometritis was observed microscopically in 48 ewes (24%) and was significantly associated with the presence of cysts in the uterus or cervix. These results suggest that there is a high incidence of clover disease lesions in West Australian ewes, and that under commercial conditions clover disease may cause functional damage to the cervix, allowing passage of bacteria and resulting in endometritis.


Biomedical cost of low-level flight in a hot environment. The physiologic and performance effects of low-level reconnaissance flying in hot environments were documented and quantitated. RF-4C pilots and weapons system operators were studied in hot and cool seasons during both high and low missions to distinguish environmental temperature from flight level effects. ECG, sternal and thigh skin temperatures, and cockpit temperature at helmet level were monitored continuously. Body weights, oral temperatures, sweat Na/K ratios, and urine electrolytes, steroids, and catecholamines, as well as sleep and fatigue scores, were measured. Mission performance was assessed using photo target acquisition scores. RF-4C aircrews are exposed to moderate heat stress and acute dehydration (1.2% over 90 min) during low-level summer flights were cockpit temperature occasionally exceeded 50 degrees C. Photo target scores indicated that the potential for crew error was increased, and that the margin of safety was accordingly decreased, during such hot missions. The RF-4C cockpit air conditioning system proved inadequate.


Psychological characteristics of deep submergence vehicle personnel. The personality and developmental characteristics of U.S. Navy Deep Submergence Vehicle (DSV) personnel, including operators and crews, were documented and compared to the characteristics of U.S. Navy divers. The results show that DSV operators (DSV Oprs) had a significantly less asocial developmental pattern than divers, while developmental experiences of DSV crews (DSV Crs) were similar to those of divers. Personality measures (EPPS) indicate that both DSV Oprs and DSV Crs are presently more sociable as adults than divers and would probably be more effective in situations involving small group interaction. The modifications which have occurred in the behavior of DSV Crs may be related to experience in the highly interpersonal DSV situation. The findings also show that DSV Oprs prefer to take fewer risks than divers, while the DSV Crs are more like divers in risk-taking behavior. The implications of this research to DSV mission effectiveness are discussed.


Body composition of mice following exposure to 4300 and 6100 meters. Male Swiss mice were exposed for 3 and 7 d to simulated altitudes of 4300 and 6100 m. Body weight losses were enhanced at the higher elevation and after longer exposure at each elevation. Carcass analyses showed the weight losses to be attributable to decrements in body water and fat content. The water decrements were a little greater than the fat decrements after all exposure conditions. At both elevations, however, fat loss increased significantly as exposure was extended from 3 to 7 d whereas water loss remained unchanged.


Accidental hypothermia: an experimental study of inhalation rewarming. Inhalation rewarming of hypothermic humans with heated, humidified oxygen was compared to rewarming by immersion in a hot bath. In 10 subjects cooled to approximately 35 degrees C core temperature, there was no significant difference in the amount of temperature "afterdrop" with the two rewarming procedures. Inhalation rewarming provided rapid commencement of increase in tympanic and esophageal temperatures, indicating effective rewarming of critical core regions, especially heart and brain. This method of core rewarming avoids the physiological hazards associated with the peripheral vasodilation which accompanies external rewarming. Moverover the simplicity of application of this method suggests its greater use in both first-aid and hospital treatment of accidental hypothermia.


Treatment of Mycobacterium ulcerans infection by hyperbaric oxygenation. Mycobacterium ulcerans causes chronic nectotizing ulcers of the skin and subcutaneous tissue and is a serious health problem in some tropical countries. Chemotherapy has not been effective, and the treatment of choice is extensive debridement followed by skin grafting. In spite of this, many infections are complicated by disfiguring scars, contraction deformities, and--rarely--amputation. There are other procedures that may promote healing (e.g., heat treatment, rifampicin), but none has been completely evaluated. In our study, hyperbaric oxygenation (HBO), an effective treatment for many bacterial diseases, including some mycobacterial infections, was used to treat mice with M. ulcerans-infected footpads. Three groups (40 mice/group) were treated daily with 100% oxygen by three different protocols: 2.5 ATA for 2 h; 2.5 ATA for 1.25 h, twice a day; and 2 ATA for 3.5 h. The degree of infection in the treated mice was compared weekly with 40 positive controls (infected, not treated). The HBO therapy was more effective in the group treated at 2.5 ATA for 1.25 h, twice a day. After 25 weeks, there had been two feet autoamputated and only 12 deaths among the mice, as compared to 18 feet amputated and 24 deaths in the control group. Thus, hyperbaric oxygenation has a beneficial effect in mice and, if used in conjunction with other therapeutic procedures in man, may be an effective therapeutic adjunct in treating M. ulcerans infections.


Heart pathology associated with exposure to high sustained +Gz. The pathology of +Gz acceleration was examined using unanesthetized adult miniature and immature "farm-type" swine, with and without anti-G suit inflation. Following single exposures of +8 or 9 Gz for 45 to 90 s--acceleration exposures that have been shown "tolerable" to man--swine were sacrificed and a detailed necropsy performed. Considering only the adult miniature swine, the endocardial area of the left ventricles showed evidence grossly of recent hemorrhage of varying severity involving both the wall and papillary muscles. The degree and location of the subendocardial hemorrhage were quantitated by grading the area of ventricle involved--1 (slight) to 4 (extensive). Of the 23 adult miniature pigs autopsied, the scores for papillary muscle hemorrhage, after one exposure to +9 Gz (45 to 90 s) ranged from a mean of 2.3 to 3.3 and the extent of ventricular wall involvement was 2.5 to 3.3. Histologically, heart hemorrhage was limited to the subendocardial area, primarily involving the space between heart muscle and the endocardium and was particularly evident surrounding Pukinje's fibers. Similar studies using immature farm-type swine (not miniature pigs) found these younger swine (4 to 5 months of age) to be less susceptible to such endocardial hemorrhage. Heart tissue recovery in these pigs following one exposure to +9 Gz for 45 s, required approximately 14 d. It appears that this lesion is similar, although less severe, than heart muscle lesions associated with loss blood volume (hemorrhagic shock) studies and may have similar physiologic bases. It was concluded that particular attention should be made of the endocardium of victims of high-performance aircraft accidents.


Medical and psychiatric aspects of accident investigation. Biomedical factors account for 80-90% of the 600 aircraft accidents each year. Mechanical failures as causative factors are 10-20%. The biomedical factors of fatalities include use of drugs and alcohol in order to cope with a possible stress, anxiety, or frustration in the aircraft. The important role of personality factors in producing stress reactions requires that stress be defined in terms of transactions between individuals and situations, rather than of either in isolation. When stress reactions are observed, it is assumed that these were brought about by stress conditions, and the accident investigator looks for them in order to understand the reaction which leads to the accident. In the field of fatal accident investigation, where the causes of the event must be sought retrospectively (that is, by looking back and reconstructing the antecedent conditions) the investigator usually assumes that the victim must have encountered severe stress to which the behavior represents a response. Since there are variations in reaction patterns in different individuals under different instances of stress, this issue turns us back to consideration of intervening processes and conditions. An individual's behavior is dependent upon the total effect of all the psychosocial variables that went into the making of this individual's life style.


Application of the Calspan scene measurement system to the investigation of aircraft accidents. Investigation of transportation accidents usually involves some measurement of physical evidence at the scene. Accurate accident scene data facilitates reconstruction of the accident events and possible determination of the cause. The Calspan Scene Measurement System combines computer technology with civil engineering to provide a useful opitcal measurement device for recording the location of physical evidence at the accident scene. The Calspan Accident Investigation Vehicle, currently under development, is designed to enable investigation teams to completely analyze the evidence and causes of automobile accidents. The concepts and equipment in this system are readily adaptable to the study of aviation accidents.


Analysis of human factors in aircraft accidents. This paper describes our current approach and accomplishments in the analysis of human factors aspects of aircraft accidents. Emphasis has been placed upon methods of analysis of Boards of Inquiry and human factors information storage and retrieval methods.


Cervicocranium and the aviator's protective helmet. An analogy based on the likenesses of the APH-6 aviator's protective helmet and the hangman's noose has some interesting relationships to aircraft accident investigation and to the associated traumatic pathology. A superficial examination of the similarities might propose that the inferior edge of the helmet, when considered part of the continuous circle completed by the nape strap and the chin strap, forms a loop which can be likened to a hangman's noose. The analogy might be extended to the comparison of lesions made about the neck by the straps or the edge of the helmet compared with abrasions and contusions that might be associated with a rope encircling the same structures. Such a hangman's noose, when the knot is at the side of the head (subaural), produces fractures of the base of the skull tending to extend bitemporally through the basisphenoid. When the knot is anterior and beneath the chin (submental), the hangman's noose causes a fracture dislocation at the axis. Characteristically, the posterior arch is fractured and, interestingly enough, the odontoid process is not involved. Many of us anticipate that a fractured, displaced odontoid process is the prototype lesion which so precariously endangers the patient with cervical cord compromise and death similar to the hangman's fracture. More recent assessments of the mortality of the odontoid fracture suggest less than 10%.


Helmets and head protection in CF ejections 1967-1973. During the period 1967-1973, helmet retention and minor head injuries were significant problems in ejections from Canadian Forces (CF) aircraft. There were 73 ejections in which Canadian-designed helmets were worn. Eight-four percent of those who lost their helmets and 38% of those who retained their helmets received minor head injuries. This paper reports on analysis of helmet loss versus air speeed and Q force. Specific problems are addressed, including the fitting and method of wearing helmets, and some guidelines for enhancing helmet retention are recommended.


Crew rest and nap-of-the-eart flying.

Crew rest and nap-of-the-eart flying. Nap-of-the-earth flying was conceived by the U.S. Army to evade enemy detection of rotary wing aircraft, requiring the stressful technique of aircraft movement only inches above the ground terrain. The 100st Airborne Division (Airmobile), Fort Campbell, Ky, tested the nap-of-the earth (NOE) concept from 12 June, 1973, to 30 June, 1974, flying 3267.6 h in NOE training. Four aircraft incidents occurred during this training period, with three of these taking place prior to 1 March, 1974. At that point, after 59.2% of the total hours had been flown, NOE pilot training was curtailed from 8 h/d to 4 h/d. Objective and subjective data infer that pilot (crew) rest and the length of the flying day are important factors in the safety of NOE flying.


Alcohol and other drugs in aircraft accidents. During the 12-year period from 1962 through 1973, there were 89 USAF aircraft accidents or incidents in which alcohol and/or other drugs were mentioned as being in some way associated with the mishap. A review of these indicates a relatively constant level of occurrence each year, with no indication that such accidents are increasing. Alcohol was by far the most prominent drug mentioned. A great variety of over-the-counter and prescription preparations were cited. There were no instances in which illicit narcotics were involved. Analysis indicates that the relationship was, in most instances, associative and not causative. In some instances, the background disease for which the medication was being taken was far more probable as a cause agency. The need for better documentation and greater cooperation between the flight surgeons and pathologists was indicated.


Alcohol associated with fatal light aircraft accidents, United Kingdom-1964-1973. A total of 86 fatal light aircraft accidents in the United Kingdom from January 1964 to December 1973 are reviewed, in which tissue alcohol determinations were undertaken on 102 pilots. Alcohol was detected in 34 cases varying from small amounts of 313 mg/100 ml. The difficulties of interpretation of post mortem tissue alcohol levels are discussed with particular reference to those cases with measured alcohols in excess of 20 mg/100 ml a level taken as possibly significant in context of accident causation. There was 12 pilots, involved in 10 of the 86 fatal accidents, considered as having ingested alcohol before flying, giving an incidence of 11.6% fatal light aircraft accidents with an alcohol involvement. Half of the pilot crashed within 18 min of takeoff, and half had less than 100 h flying experience. It is noted that five of the accidents occurred in 1973. Education of pilots to the hazards of alcohol and flying is the ultimate solution.


Error and artefact in post mortem toxicological analysis. The factors which may influence the result of a toxicological analysis on post mortem specimens are presented. These factors are discussed in varying depth and suggestions are made on ways of overcoming the problems.


Impaired pilot performance: drugs or alcohol. The circumstances leading to forced landing of a three-seat light cabin monoplane due to engine failure are described. The pilot, an airline pilot employed as a Boeing 707 captain, and one of the two passengers were killed. The liver of the pilot showed diffuse fatty changes and toxicological examination revealed a blood alcohol concentration of 149 mg/100 ml and 139 mg/100 ml in the urine. On initial screening for drugs, the presence of nitrazepam or chlordiazepoxide was suspected and the medical investigation was further complicated by the finding of chlordiazepoxide in the personal effects. Although the cause of the accident was a stall at low altitude during an attempted forced landing following loss of engine power, it was concluded that the pilot's ability to avoid onset of stall was impaired by the concentration of alcohol in his system.


What is the mechanism of carbon monoxide toxicity? The probable toxic action is CO is on the cellular respiration, in which CO competes with O2 for cytochrome a3. Our studies indicate that a relatively high concentration of COHb (50%) does not interfere with the O2-carrying capacity of the blood. The dissolved CO in plasma, which is necessary for CO to enter the tissue, probably occurs when the exchange takes place between alveolar air and the blood in the lungs. This would explain why the central nervous system could be impaired when COHb levels are below 10% and death could occur at 35%.


Application of radioimmunoassay techniques in support of toxicologic investigations of aircraft accidents. With the increased emphasis on establishing the presence or absence of drugs associated with aircraft accidents and the fact that fragmentation of tissue may be a problem in investigating these accidents, the need arises for a rapid, sensitive, and specific toxicologic means for detecting drugs that may be present in nanogram concentrations and when only extremely limited quantities of specimens are avialable for study. The use of radioimmunoassay (RIA) for the detection of drugs (e.g., amphetamines, barbiturates, opiates, and methaqualone) in selected aircraft accident cases is presented.


Coronary artery disease and preventive cardiology in aviation medicine. A review of 6,500 autopsied cases on record at the Armed Forces Institute of Pathology of deaths occurring in aircraft accidents or mishaps revealed that 816 cases (13%) had been diagnosed as heart disease other than traumatic (i.e., pre-existing at the time of the accident). Of these 816 cases (592 military and 135 civilian), 89.1% had atherosclerotic coronary artery disease (CAD). This autopsy series compared the severity of CAD, year of death, and crew position within the military 5-year age groups. CAD was found in 86.6% of the 20- to 34-year-old military group. Moderate and severe CAD was present in 17.1%. CAD in previous autopsy studies of U.S. military casualties in the Korean and Vietnam conflicts was reported as 77.3% and 45%, respectively. Study of severe and moderate CAD by year of death in the 20- to 34-year age group demonstrates 26.2% in 1965-1969 and 21.1% in 1970-74. These findings do not support the conclusion of the Vietnam autopsy study that CAD is decreasing. Preventive and predictive cardiology in aviation medicine should be instituted early and aggressively in the young aircrew population.


Inflight intravenous therapy: a new dimension. This Inflight Infusion System was designed to meet an urgent operational requirement for accurate administration of intravenous (I.V.) fluid therapy to acutely ill patients while in flight. Aircraft cabin pressure changes affect the flow of intravenous fluids. The discharge rate of I.V. fluids may become excessive during ascent to 2438 m (8000 ft) the level at which both commercial and military aircraft are commonly pressurized, or during loss of cabin pressure, such as may take place at higher altitudes. During descent, the flow rate becomes insufficient or stop until ground level pressure is reached. A method for carefully controlling intravenous fluid intake during all phases of flight with an inflight infusion system that utilizes a modified precision roller pump was developed by the USAF School of Aerospace Medicine. This technique assures carefully controlled fluid intake that is not possible by using the conventional gravity method.


Sebaceous carcinoma.

Sebaceous carcinoma. A series of 11 sebaceous carcinomas is reported. None of the tumours recurred or metastasized. Two growth patterns were observed: basal-cell carcinomas with sebaceous differentiation, and pure sebaceous carcinomas. Since both these types may occur together they are considered to be merely variants of a single tumour entity. The clinical and histological characteristics of sebaceous carcinomas of our series are compared with those recorded in the literature. It is concluded that sebaceous carcinomas originate in the epidermis, in the skin appendages, or in both.


Mitochondriosis of the hepatocytic cytoplasm in rachitic rat liver after calcitonin-treatment (a cytophotometric and morphometric study). A calcium-rich rachitogenic vitamin-D deficiency and additional doses of calcitonin cause serious changes in cell structure and metabolism, which can be demonstrated by cytophotometry and morphometry. The experiments were made with 9 male juvenile Wistar rats. 6 animals were kept on a vitamin-D deficient diet for 6 weeks and 3 of these animals got injections with salmon-calcitonin S.C. during the last 14 days every second day. The remaining 3 animals, fed with altromin-R standard diet were kept for control purposes only. The morphometric analysis of the liver parenchymal cells was based on the statements by Weibel and the cytophotometric examinations were made according to the Sandritter technique. As a consequence of the altered metabolic condition a great volume reduction of cells and cell nuclei is found in the animals with vitamin-D deficiency, which were treated with calcitonin. In comparison with the control animals the hepatocytes show hardly any tetraploid nuclei, which points to an inhibited polyploidization. The cytoplasm shows an oncocytic transformation with megamitochondria. As reason for this mitochondriopathy an extreme and abnormal growth as well as a mutation of the mitochondrial genom are under discussion. Furthermore the total endoplasmic reticulum (volume and membrane surface), the peroxisomes and the ribosomes are strongly reduced. Due to the serious cell injury the other organelles are also reduced in number and volume, which points to a chronic hypocalcemia.


An electron microscopic study of intestinal metaplasia in human gallbladder. Areas of intestinal metaplastic epithelium in gallbladders removed by cholecystectomies performed for gallstones were studied with the electron microscope. Three gallbladders contained areas of goblet cells and endocrine enterochromaffin-like cells and one gallbladder also Paneth cells. The goblet cells contained mucin granules of slightly variable size and shape and relatively great electron lucency. The intervening columnar epithelial cells contained various amounts of electron-lucent mucin granules. The round or oval enterochromaffin-like cells rested on the basement membrane, and in these cells the small, round, electron-opaque secretory granules were located in the infranuclear region. The supranuclear cytoplasm of the Paneth cells in the intestinalized epithelium contained typical large, round secretory granules. The fine structures of the various cells in the metaplastic epithelium bore resemblance to those of the cells in the intestinalized stomach mucosa.


Congenital bronchiolitis obliterans.

Congenital bronchiolitis obliterans. A case is described of intrauterine pneumonia with "Congenital Bronchiolitis Obliterans" in a premature infant who died 35 hours after delivery. The patient presented from birth with increasingly severe respiratory insufficiency. Post-mortem histological examination of the lung revealed obliterative bronchiolitis, a rare disease which the patient most probably developed in utero. Only two other similar cases of congenital obliterative bronchiolitis have been reported in the literature, both with obscure etiology. A detailed pathological description of pulmonary changes is given and the literature is reviewed.


A nephropathy occuring in rats treated with dinitrochlorobenzene and N-methyl-N-nitroso guanidine. Chronic administration of a potent oral carcinogen N-Methyl-N-Nitroso guanidine (M.N.N.G.) failed to produce gastric carcinoma in CFHB Wistar rats sensitised to 2.4 dinitrochlorobenzene (D.N.C.B.). In addition animals receiving both D.N.C.B. alone and D.N.C.B. and M.N.N.G. developed a severe nephropathy characterised by heavy proteinuria and extensive renal cortical damage. The histological features include proliferation of parietal epithelial cells and mesangial sclerosis. An association between the nephropathy and long term D.N.C.B. administration is suggested and on the basis of investigation to date direct toxicity rather than immune complex disease seems more likely.


[Arterial repair after mechanical injury by migrating fourth-stage larvae of Strongylus vulgaris in the horse (a light and electron microscopic study) (author's transl)]. Migrating fourth-stage larvae of Strongylus vulgaris, a parasite of equines, damage the intima of the anterior mesenteric artery and its larger branches and induce thrombus formation on the injured sites. As the time of larval passage through each of these branches has been exactly determined in earlier experiments, the aim of the present studies is to contribute to a more complete understanding of repair mechanisms in the process of time after thrombotic vascular injuries. five foals were separated individually to specially cleaned stables and given anthelmintic treatment till the age of one year. One foal was infected per os with 350, the second with 500 and the remaining three with 1,000 third-stage larvae of Strongylus vulgaris...


[The development of microangiopathic hemolytic anemia in the model of a transplantable hemangioendothelioma of the J 129 mouse (author's transl)]. In earlier reports we have described the morphological findings of microangiopathic hemolytic anemia (MHA) in autopsy cases. The aim of this publication is to show more exactly the close correlation between microangiopathy and intravascular hemolysis in a transplantable hemangioendothelioma of the mouse. This animal model is suitable for study of the MHA, which develops within short time, with various morphological and biochemical parameters. 100 J 129 mice (Jackson Laboratory, Bar Harbor, Me) with transplanted hemangioendothelioma and 20 healthy controls were studied. For transplantation the tumors were removed in toto from donors and mined in 0.9% sterile saline; 0.7 ml of this tumor suspension was injected subcutaneously in the lateral flank of the recipients...


[Intravital microscopy and post mortem histology of burn shock in rabbits (author's transl)]. This paper describes results of intravital microscopic observations of the mesenteric blood and lymph vessels of the rabbit. 20% of the surface of the skin of these rabbits were burned. Immediately after producing the shock, general unspecific symptoms were seen: decrease of circulatory flow, aggregates of erythrocytes. Specific alterations consisted in leukocyte sticking, platelet aggregation, hemolysis and stasis. Vascular spasm and hemorrhage were conspicuously absent. These microcirculatory features were compared with those of different forms of shock. There was a striking similarity with the characteristics of the burn shock with the endotoxin shock. On the other hand hemorrhagic and traumatic shock exhibited similar phenomena, thus forming a second distinct group of shock as seen from a microcirculatory point. Differentiation between the groups is only possible from the specific features of microcirculation failure. These results confirm the view point, that different forms of shock evoke different pathological reactions in the terminal vascular bed.


[Influence of uremia on the proliferation kinetics of a solid transplantable carcinoma (author's transl)]. Previous autoradiographic investigations revealed an impaired regeneration of epithelial tissues in acute experimental uremia. It was the aim of the present study to get information about the effect of uremia on the growth and the proliferation kinetics of a solid tumor (mammary carcinoma HB). The partly differentiated mammary carcinoma HB (Dr. C. W. Friis/Ry/Denmark) was examined in adult female mice (C3H/Tif). Acute renal failure was induced by ligation of the right ureter and by infarction of two thirds of the left kidney. A group of animals served for urea estimation during the first 7 postoperative days. A sham operation was performed in a control group. A starvation effect was avoided by additional tube feeding. Hemoglobin levels and reticulocytes were estimated in tumour bearing uremic mice and in a control group to get information about anemia in acute uremia. Calculating the tumour volume as a sphere with the geometrical mean of two diameters the tumour doubling time was derived from the growth curve. The autoradiographic experiments started on the 21th day after transplantation of the tumour (= 7th day after experimental uremia and sham operation respectively). The cell cycle was determined by the method of percentage of labeled mitoses. The growth fraction was estimated by continuous labeling method. For details of autoradiographic techniques see Fíaux de Lacroix et al. (1973. During the first 48 hours the blood urea increased to more than 230 mg% and then decreased to a level of about 133 mg% at the 7th postoperative day. The blood urea of control animals was in the range of 50 mg%. Tumor bearing mice revealed an anemia (Hb: 8.1 +/- 1.2 g%, reticulocytes 60.1 +/- 36.5%) but no significant differences in hemoglobin levels and reticulocytes counts could be detected in uremic animals (Hb 9.7 +/- 1.7 g%; reticulocytes 31.4 +/- 11.6%). The growth of the tumour was impaired by uremia. The tumour doubling time was prolonged from 7.5 days in untreated and sham operated animals to 15 days in uremic mice. This was mainly due to a lowered growth fraction (from about 50% to 20%), and on the other hand to a prolongation of the generation time (from 15.5 to 19 hours) mainly caused by a prolonged Tg1-phase. The cell loss factor remained constant (about 81% in every group). Our findings in the transplantable solid tumour of uremic mice were similar to the results observed in the epithelium of the stomach, the intestine and of the skin as well as in erythroblasts especially in regard of the changes of the cell cycle. These observations in various tissues suggest a generally impaired cell proliferation in uremia.


Intracisternal A-particles in transplantable murine teratomas. Intracisternal A-particles occur in experimental transplantable murine teratomas OTT 2466 and OTT 6050 derived from embryos of the A/He and 129/Sv strains respectively. They are present in stem cells of both tumors and in the more differentiated cell types in OTT 6050, consisting of primitive endodermal cells, cells of neuroepithelial rosettes, neuroblasts, primitive glial cells and respiratory epithelial cells. Both parent strains, A/He and 129/Sv, also contain these particles.


Congenital stalked fibromatous polyp of the superior pole of the tonsil containing hairless sebaceous glands. A polyp of the size of a small bean was discovered incidentally on the superior pole of the right tonsil of a 29-year-old man. Morphologically it bore a considerable resemblance to the immature infantile variant of the sebaceous-gland nevus, the Naevus epitheliomatosus sebaceus Wolters, but its top was mature. The polyp is viewed as a congenital dysontogenic tumor which, owing to its fibromatous basis, lack of hair, and its immature and mature sebaceous glands, may be informally classified as a "missing link" between the haired pharyngeal polyp and the pure pharyngeal fibroma.


The effect of endotoxin shock on the aortic endothelium of young rats. Aortic endothelium of normal and endotoxin treated rats (endotoxin shock) was investigated in "Häutchen" preparations by light microscopy, autoradiography, and DNA cytophotometry. In the edothelium of control animals two cell populations were found: 1. endothelial cells which were subdivided into four groups according to their different nuclear morphology and DNA contents, 2. monocytoid cells which were taken for monocytes. In the endothelium of treated animals distinct damages of endothelial cells occurred during the period of 7 hours and 2 days after endotoxin application. Small groups of leukocytes were found in the surroundings of the damaged cells. A great number of monocytoid cells was found in the endothelial layer between the second and third day after endotoxin treatment. The monocytoid cells increased the total number of cells/mm2 on the aortic surface by one third. At the same time the maximum of DNA-synthesis of endothelial cells and monocytoid cells was reached (31-fold compared with controls). This cell proliferation is attributed to the following mechanisms: 1. repair process at sites of cell injury, 2. mitogenic effect of endotoxin. In the period between the 13th and 23rd day after endotoxin treatment all changes in the aortic endothelium returned to normal.


[The cellular reaction of the rat spleen after extensive loss of liver parenchyma (author's transl)]. Autoradiographic studies were performed to investigate the changes in cellular proliferation of splenic cells after sham operation and 2/3 partial hepatectomy. 54 female Wistar rats were hepatectomized and 27 rats were sham operated. The life span of the animals ranged between 12 hours and 31 days. One hour before sacrificing, the animals were injected intraperitoneally with 3H-thymidine (2.5 muCi/Ig). Liver and spleen were embedded in paraffin and epoxy. In strippingfilm autoradiograms (Kodak, AR 10) and in semithinsection autoradiograms (Eastman Kodak, NTB 2) labeling indices of the hepatocytes and Kupgger cells of the regenerating liver and of the cells in the white and red pulp as well as in the marginal zone of the spleen were measured. After 2/3 partial hepactectomy there is a marked increase of proliferating. DNA synthezising basophilic blasts and basophilic and polychromatic erythroblasts in the red pulp of the spleen of rats during the first 5 to 10 days. After the fifth day the labeling index of the myelopoietic cells increases too. The curve of the percentages of radioactive labeled cells in the red pulp shows two peaks. The first can be observed after 24 hours and the second after 5 to 10 days. The percentages of labeled cells in the lymphatic mantle zone of the white pulp and in the marginal zone increase also during the first two postoperative days. The first maximum of labeled cells in all the zones of the spleen shows a close relationship to the maximum of proliferating DNA synthesizing cells in the regenerating liver. The second peak in the red pulp is possible caused by a nonspecific multifactorial stimulus such as operation stress, blood loss or inflammation during woundhealing. This proliferation enhancing effect in the spleen, especially on the erythropoietic cells, after partial hepatectomy, which produces a mild splenomegaly during the first 5 days, is more distinct than after sham operation, mechanical or thermical lesions on parenchymal organs.


The appearance of D-galactosamine-induced hepatitis and generalized edema in adrenalectomized rats. In adrenalectomized female rats a single dose of 375 mg D-galactosamine.HCl per kg of body weight produces both hepatitis and generalized edema with ascites. These alterations depend upon the dose and the time interval after injection of the aminosugar. The effect is specific for D-galactosamine; 2-deoxy-galactose produces only edema and no hepatitis, whereas D-glucosamine and D-galactose are without any measurable effect. In male adrenalectomized animals D-galactosamine produced hepatitis alone; fluid extravasation occurs only after additional orchiectomy. Glucocorticoids given before or simultaneously with D-galactosamine are able to prevent the animals from gettin edema and to ameliorate hepatitis, while mineralcorticoids do not show any effect on these alterations. It is evident that the effects of D-galactosamine on the hepatocyte and on the endothelial cells are independent from each other. This leads to the conclusion that D-galactosamine acts at least upon two different target organs, the liver and the reticulo-endothelial system in general.


Cellular repopulation and recovery of the phytogemagglutinine (PHA) responding cell pool in the thymus of sublethally irradiated mice. Cellular repopulation and recovery of PHA reactivity was investigated in the thymus of mice exposed to 400 R either on the whole body or with one leg protected. In the whole body irradiated cases both the cellular repopulation and the restoration of PHA reactivity in the thymus showed a cyclic pattern: an initial depression and a subsequent first recovery being followed by a secondary cellular depletion and decrease of reactivity before another recovery phase started. The phase of the secondary decrease lasted fo a similar period for both the cell number and reactivity, but was shifted in time and the reduction in reactivity began some 12 days later than that in the cell number. In the leg-shielded animals, the cellular repopulation progressed without cyclic changes, but the recovery of PHA reactivity maintained a cyclic pattern. However, due to a smaller secondary decrease, it was less pronounced than in the whole body irradiated cases. During the aging of mice from 50 to 90 day old, the cell number in the involuting thymus decreased to half of the original. The decrease in the cell population was associated with an about four-fold increase of PHA reactivity. The results were discussed in regard to the origin of the immunoreactive thymic cells. Arguments were presented in favour of the hypothesis that both the reactive and nonreactive cells originate from precursors in common, but require different lengths of time for maturation.


The failure of supplemental dietary copper to prevent cuprizone-induced alterations in mouse hepatocytes. Weaning mice were fed a powdered complete diet containing either 0.5% cuprizone, 0.5% cuprizone + 0.01% copper sulfate, or 0.01% copper sulfate. With cuprizone as the sole additive, hepatic mitochondria became greatly enlarged. When the diet contained cuprizone + copper sulfate, giant mitochondria were still present, and, in addition, numerous lysosome-like structures became evident. When only copper sulfate was added to the normal diet, the mitochondria were of normal size, but the hepatocytes contained abundant lysosomes. Dietary supplementation with cuprizone or with cuprizone + copper sulfate resulted in considerably depressed (20-50%) rates of mitochondrial oxidation. Supplementation solely with copper sulfate produced virtually no changes in oxidative activity. It may be concluded that the subcellular effects of cuprizone are not based on its ability to produce copper deficiency by chelation of copper, but on other properties of this drug.


Hormone-dependent Polyploidy in the glandula orbitalis externa and glandula infraorbitalis of animals of different age. The Glandula orbitalis externa and Glandular infraorbitalis of castrated and intact male rats were examined by morphological, chemical and cytophotometric methods after one, three, six and twelve months of life. Whereas qualitative changes in the cell nucleus (e.g. nuclear vacuolation, nuclear fusion) and cytoplasm (cytoplasmic vacuolation) can be detectedin the sexually mature control animals, these did not occur in the castrated male rats. An increase the percentage of higher ploid gland cell nuclei occurred only in the intact control animals. The possible cause this clearly hormone-dependent polyploidy is discussed.


Rhabdomyoma (adult type) of the larynx.

Rhabdomyoma (adult type) of the larynx. A rhabdomyoma successfully removed from the right false cord of a 52-year-old woman, who had been disphonic for 3 years, is reported. Histologically the tumor showed the features of the adult type rhabdomyoma. The pathologic appearance and the biologic behavior of the rhabdomyoma have been well established in the recent literature.


Thermographic patterns of lower limb arterial disease. General and local abnormalities of thermic distribution in the affected limb were related to some basic patterns. Hyperthermic pattern, localized or general: it depends on existence of collateral pathways (when main arterial branches are occluded). Hypothermic pattern, localized or general: it depends on existence of severe arterial stenosis with blood flow decrease.


Diagnosis, follow-up and prognosis of malignant melanomas by thermography. Reference was made to a series of 35 cases of malignant melanoma which had not been operated on, and contributions of thermography in the following were taken into consideration. 1. the complementary nature of clinical, thermographic and histological information, both for the tumour and the lymph nodes; differentiation between less thermogenic malignant melanomas (Dubreuilh melanosis, LMM and SSM) and the forms giving rise to extensive and intense hyperthermy (NM). 2. proposal of a prognostical classification which permits the evaluation of malignancy and, to a certain degree, the prediction of survival in a manner which is more significant than the histo-topographical classification. 3. detection of local recurrences and/or lymph-node metastases in an infra-clinical state.


Heat exchangers between body and environment. The human body exchanges heat with its environment via radiation, convection, conduction and evaporation. Each of the heat exchange terms in the heat balance equation S = M-E-(+/- W)-C-R has been described in further detail as related to environmental conditions and to the effect of clothing. Such factors as air velocity, mean radiant temperature, water vapor pressure in the air and thermal insulation and vapor permeability of clothing are factors which are considered. For dynamic conditions, or for conditions requiring consideration of specific areas of the body, the use of a dynamic mathematical model is recommended.


A mathematical simulation model of the skin for evaluation of surface temperature gradients resulting from local variations in metabolism and blood flow. A very simplified 2-dimensional simulation model of the skin and subcutaneous tissues is presented. The model is given in an annotated FORTRAN computer program with suggested numerical values for all the required constants. The model can be used to evaluate surface temperature gradients and subcutaneous thermal gradients which result from deviations of subcutaneous blood flow or heat production.


Thermal conductivity and heat transfer of the human skin. In all problems involving heat transfer in the human body or to the environment the thermal conductivity of the tissues, especially that of the epidermis, plays an important role. Quantitatively, however, regarding the  required resolutions in time and/or space, the problems associated with the overall thermoregulation are quite different from those relating to local skin circulation. This has been discussed be referring to models designed to study the thermoregulation, electrical analogs representing also local skin areas and a number of examples. It was suggested that it is worthwhile to investigate high-resolution thermography as a useful tool for calibrating locally applied probes to measure skin blood flow.


Thermographic changes following steroidal administration to patients with mammary cancer. In 27 post-menopausal patients with soft-tissue lesions of advanced breast cancer, temperature changes in skin-over tumour have been evaluated for their ability to predict response to additive hormone therapy. The thermoprofile across the tumour and its bed was selected for measuring purposes in preference to other thermographic methods. Serial measurements were carried out before and during therapy, and the observations correlated with the clinical response to therapy. Of the 14 patients who showed decrease of at least 1 degree C in the thermoprofile peak value within 2 weeks of initiating hormonal therapy, 57% showed clinical evidence of tumour regression 3 months later. Of 13 patients who did not show this change, none showed tumour regression later.


Direct calorimetry: a new clinical approach for measuring thermoregulatory responses in man. The gradient layer direct calorimeter built in Lausanne allows proportionate measurement of respiratory and cutaneous heat losses. The latter consists of evaporative and convective plus radiative heat losses, which are separately measured. Obese subjects had lower heat losses and higher thermal body insulation than controls. The decreased heat loss may contribute to their positive energy balance by decreasing the energy cost of maintaining body temperature during cold exposure. The changes in heat loss during exercise are also illustrated.


Thermography and vasomotor test.

Thermography and vasomotor test. Vasomotor tests have a great diagnostic interest in many dermatologic diseases. Histamine dihydrochloride and acetylcholine chloride in intradermal injections, a rubefacient derived from nicotinic acid in epicutaneous application, and the dermograph are commonly used and studied here. There remain many unknown and controversial factors in the interpretation of the mechanisms of the drugs used for these tests. A thermographic approach using infrared thermography and the most recent technique with liquid crystals in sheet provide a new contribution to studies on vasomotor tests; these methods have contributed to the study of the vasomotor reactions observed in different dermatological affections, in particular atopic eczema, and have introduced new data in the controversy which subsists about interpretations of 'delayed cholinergic blanch'.


Thermography and plant physiology.

Thermography and plant physiology. The temperature of a plant in a climatised room depends on the irradiation level. The use of a thermocamera is valuable for the characterisation of the complicated temperature distributions as can be found, for example, on a leaf in an assimilation chamber. Point measurements of temperature are useful only when the temperature distribution over an object is sufficiently known. The measurement of the radiation temperature of an object behind an infra-red transmitting filter is possible. The temperature distribution over a leaf depends on the gradients in irradiation and air humidity to which it is exposed, on local difference in stomatal opening and on air velocity.


Thermography in veterinary medicine.

Thermography in veterinary medicine. Thermography in veterinary medicine has hitherto been proven to be a method of great value in the detection of orthopaedic lesions in racehorses. Lesions of the musculo-skeletal system affecting tendons, joints, bones and skeletal muscle can be demonstrated and documented at an early stage thereby preventing the development of more serious lesions.


Airborne thermography or infrared remote sensing. Airborne thermography is part of the more general remote sensing activity. The instruments suitable for image display are infrared line scanners. A great deal of interest has developed during the past 10 years in airborne thermal remote sensing and many applications are in progress. Infrared scanners on board a satellite are used for observation of cloud cover; airborne infrared scanners are used for forest fire detection, heat budget of soils, detecting insect attack, diseases, air pollution damage, water stress, salinity stress on vegetation, only to cite some main applications relevant to agronomy. Using this system it has become possible to get a 'picture' of our thermal environment.


Spatial resolution of thermographic cameras. To obtain an impression of the spatial resolution of a number of thermographic cameras, a method similar to that of DODD et al. [1969] was followed: a test pattern with a series of line groups was scanned and the relative amplitude of the videosignal was plotted as a function of the spatial frequency (MTF). To make it possible to compare the various cameras directly, the spatial frequency was expressed in radians-1 and not in lines per millimeter, which makes the result less dependent on the distance. For one of the cameras, the MTF was also measured densitometrically, which yielded a lower value of spatial resolution. In practice this is of minor importance, because temperature differences are measured directly with the videosignal (isotherm mode) and not by density measurements. In contrast to Macey and Oliver [1972] who assumed that the resolution is determined by the time constant of the detector only, the resolution of the cameras investigated in our laboratory depended only on the dimensions of the detector.


Methods of thermal blood flow measurement. All techniques for measuring thermal blood flow have in common a small heat source and two temperature difference sensors placed in or on the tissue. The measured temperature difference can be quasistationary, nonstationary or constant, depending upon the heating pattern. Its extent and course, respectively the heating output in the case of pulse fluvography, are dependent upon blood flow. Conversion of the heat transport coefficient into specific blood flow is possible only if the vessels in the temperature field are predominantly capillaries. Both the sink and the pore theory make it possible to draw conclusions about specific blood flow from the measurement values obtained.


Microwave thermography: a method of detecting subsurface thermal patterns. A discussion has been given of the principles and techniques of microwave thermography. The method is analogous to infrared thermography in that it detects thermal radiation emitted by the body. It differs in that it is sensitive to temperatures several centimeters beneath the skin surface and has coarser spatial resolution. Results are shown of successful attempts to detect subsurface thermal gradients in feline and human tissue. Planned clinical evaluation is described.


Thermography in diagnosis of breast diseases. While carrying out 10,000 breast thermographic studies we have examined 4,000 palpable lesions, 1,100 of which were verified cancers. The study of these cases according to our classification into 5 categories has shown that: (1) in the benign lesions, there were 18% equivocal results and 13% 'false positives', and (2) in the malignant diseases, there were 18% doubtful thermograms, 8.5% 'false negatives' and 10% 'false positives'. Thermography allowed us to detect 10 subclinical and 56 occult cancers; in another connection we have identified a growth phase in 11% of our cancers (fast-growth forms).


Prognosis and post-therapeutic follow-up of breast cancers by thermography. Statistical analysis of approximately 800 cases of breast cancer followed up for at least 3-5 years with careful correlation between mammography, thermography and clinical data has confirmed the accuracy and indispensable use of thermography for prognosis and follow-up. Pre-therapeutic prognosis. Strong correlations exist between the thermographic class and survival for T1, T2 and T3 cancers, confirming the contribution of thermography in therapeutic decision. Thus, a T1 cancer should be treated differently depending on the thermographic findings. Post-irradiation follow-up. Correlations exist between the development of thermic anomalies and the effect of irradiation on the cancer, showing the possibility of confirming sterilization or early detection of a recurrence. This is valid only if the thermic effects of radiation on the skin and gland are recognized and discounted.