[The frequency of the e-antigen in acute and chronic hepatitis (author's transl)]. Five groups of patients were studied: (a) 88 HBsAg-positive cases of acute viral hepatitis (AVH) who completely cured within 90 days; (b) 75 cases of acute HBsAg-negative hepatitis with early resolution; (c) 15 AVH patients who became chronic; (d) 94 HBsAg-positive cases of chronic hepatitis (CH) and liver cirrhosis; (e) HBsAg-negative cases with CH. The e-antigen was investigated in every patient and was found in 9 of the AVH cases with favorable evolution, and in 8 of the AVH patients evolving to chronicity. Amont the CH and cirrhosis group, 48 of the HBsAg carriers were positive while e-antigen could not be detected in any of the HBsAg-negative ones. The high incidence of e-antigen carriers among patients with chronic hepatitis and liver cirrhosis as well as among those with AVH who later entered the chronic stage of the disease, deserves especial consideration. A possible role of e-antigen in the evolution to chronicity and a prognostic significance is suggested.


[Immune phenomena in chronic gastritis, coincidental or pathogenetic? (author's transl)]. The role of autoimmune processes in the pathogenesis of atrophic gastritis, be it with or without pernicious anemia, is described on the basis of literature data. Various findings in cases of atrophic gastritis favor such a role, e.g. histological findings, the high incidence of autoantibodies against gastric mucosa, a high specificity of gastric antigens in cellular immune reactions, the concomitant occurrence of other auto-immune diseases, the favorable effect of immunosuppressive therapy. On an experimental basis transfer of autoimmune gastritis by lymphocytes from the ductus thoracicus lymph of sick animals to non-immunized animals does support this hypothesis.


[Immunopathology of ulcerative colitis and granulomatous colitis (author's transl)]. There is no convincing evidence as yet for a key role of immunological processes in the pathogenesis of unspecific colitis. However clinical findings as well as immunological data do support the hypothesis that immune reactions are involved primarily or secondarily in the pathogenesis and the clinical course of ulcerative colitis and granulomatous colitis. In such patients a specific adaptation of humoral and cell-bound immune reactions against antigenic material from the colon and other tissues has been found in peripheral blood, lymphatic tissue and bowel wall. In this context it seems to be especially noteworthy, that lymphocytes taken from patients with colitis lead to disintegration of colon epithelial cells in vitro. This cytotoxic effect of the lymphocytes is lost after colectomy or remission of the disease. Ulcerative and granulomatous colitis do have many clinical and immunological peculiarities in common. This makes one think, that possibly the same noxious factors induce differential local reactions because of different hereditary disposition.


Health and the Groote eylandter.

Health and the Groote eylandter. Concepts of health in traditional Groote Eylandt culture are examined, and the difference between these and European concepts are described. The importance of magic as a causal factor in serious illness is noted along with the absence of any specialist medical role. The community basis of health care is highlighted, and the implications of this for the development of more adequate health care measures are discussed.


The setting for unsatisfactory health and nutritional standards in Australian aborigines. In an Aboriginal community living in a country town in south-west Australia, dietary patterns were worst on the Aboriginal Reserve, somewhat better amongst those living in "transitional" houses and best in those living in standard government houses. The social background in these three groups is quite different in terms of their ages, educational backgrounds and sources of income. These factors help determine nutritional standards and should not be ignored in preventive health programmes.


Tuberculosis in indigenous Australians.

Tuberculosis in indigenous Australians. A comparative study of tuberculosis in Aboriginal and white Australians is presented. There is a much higher prevalence of disease in the Aboriginal population than in the white. From a study of the clinical features and response to treatment in paired cases, disease in the Aboriginal is found to be more acute, more extensive and more frequently non-pulmonary. As this disease pattern is unfamiliar to many Australian doctors, tuberculosis should enter into the differential diagnosis of all ill Aborigines.


[Experiences of control measures against hospitalism (author's transl)]. Infection caused by gram negative germs in hospitals increased 14-fold since 1957 and measures today 66p.c. of hospital infection. The following causes are mainly responsible for this fact: inadequate hygienic measures, increased antimicrobial chemoprophylaxis and-therapy, changing pattern of antibiotic resistance, increased degree of severity of operations, and the mounting number of intensive care unit patients. 13 letal pneumonias and 1 peritonitis caused by klebsiella were observed in the Department of Surgery of the University of Tübingen Hospital. Search of the source of infection as well as control measures are described. Limitation of application of antibiotics to absolutely necessary cases (5%) and strict observation of hygienic measures are requested. A full time hospital hygienist is needed for supervision.


[Clinical experiences with a new multi-effective penicillin "spectacillin", gained in the gynecological and obstetrical therapy (author's transl)]. With the new semi-synthetic ampicilline-derivate, we treated 28 female patients of gynecological, and 22 of obstetrical indications. Owing to bacterial infections by grampositive/gramnegative germs, in these cases an antibiotic therapy was indicated. The target therapy was based on clinical findings, the germ analysis and the antibiogram. Considering the degree of disease, the intravenous (3 x 2 grams per day) or the oral treatment (4 to 6 grams a day) has been effected during 6 days at least and 13 days as a maximum duration. The evaluation of the therapeutical results was made by means of the clinical cours as well as the germ findings. These two parameters showed the reliable effectiveness of "Spectacillin", whereas the low exanthemic rate must be emphasized.


[Activation of the fibrinolytic system by furosemide (author's transl)]. Intravenously administered furosemide induces besides its well known diuretic effect a significant activation of the fibrinolytic system. This fibrinolytic effect, however, is only seen in persons with an intact renal system, not in nephrectomized patients and not in patients with chronic renal insufficiency. From this finding the conclusion is drawn that furosemide needs for its fibrinolytic effect the intact renal tissue. It is discussed that the beneficial therapeutic value of high-dose furosemide in acute renal insufficiency following shock or septic abortion might at least partially be due to furosemide-induced fibrinolysis of the microthrombi of the glomerula.


[Chronic renal failure in bourneville-pringle's disease (author's transl)]. In a 38-year-old woman the process of developing chronic renal failure in Bournevill-Pringle's disease is described. The diagnosis is based on the typical skin lesions as well as the familiary affliction concerning four generations. Only in the fourth generation a brain involvement is detectable. In the presented case cystic mixed tumors of the kidneys are responsible for the renal insufficiency, combined with consecutive pyelonephritis. According to the changing clinical expressivity of this congenital disease it can be deduced, that Pringle's disease is in this case an abortive form of tuberous sclerosis. The basic lesion of tuberous sclerosis is hamartomatous tissue change. The brain, skin, bones and kidneys are the most commonly affected sites.


[Neurophysiologic control during treatment of cerebral ischaemia with danaden retard (author's transl)]. After a three month treatment with Danaden retard (Encephabol + nicotinic acid) a group of patients suffering from cerebral ischaemia showed (in contrast to an untreated group) a significant reduction of slow waves in the EEG, a significant improvement of the audiogram, a reduction of the optic and acoustic reaction time and of the peak latency of the visual evoked potentials.


[Early diagnosis of arterial occlusive disease of the lower extremities. A comparison of various nonbloody methods for vascular investigation]. In 13 patients suffering from arterial occlusive disease of the lower limbs (ages ranged from 47-74 years) and in two control groups of 13 healthy young (range 20 to 39 years) and 20 healthy elder people (range 40-65 years) vascular investigations were made. We used the electronic pulse-oscillography as well as the blood-flow-measurement by applying an airfilled plethysmographic technique and the simultaneous systolic blood-pressure-measurement at the equilateral ankle and forearm by means of a plethysmographic resp. Riva-Rocci method. Comparing the different methods and parameters of physical tests, we found that the determination of the "cruro-brachial pressure gradient" is usefull to distinguish exactly healthy persons from sick ones. In cases without coarctation of aorta and of patent arm arteries, systolic ankle blood-pressure less than 9 mmHg in comparison with the equilateral forearm blood-pressure is evidence of a hemodynamic effective stenosis in the arteries of the legs and/or the aorto-iliac vessels.


Some characteristics of in vitro 3H-estradiol binding by the rat posterior hypophysis. The binding capacity for estradiol in the cytosol and nucleus of the rat posterior hypophysis was demonstrated in vitro. The maximal 3H-estradiol binding took place at 37 degrees C in both fractions; but when time experiments were performed, the most binding occurred at 30 min in the cytosol and at 90 min in the nucleus. Administering exogenous estradiol to spayed rats shifted the site of maximal binding from the posterior hypophysis' cytosol to the nucleus. Both fractions showed a low capacity for 3H-estradiol binding; we studied the presence of a macromolecular component(s) that bind(s) estradiol with high affinity in the cytosol. The number of binding sites in the whole posterior hypophysis was determined in spayed and estradiol-treated rats. In the latter group, the protein context of the posterior hypophysis increased.


Development of Rathke's pouch tissue transplanted into adult hypophysectomized female rats. Rathke's pouch tissue, from rat embryos of 11-15 days' gestation, was microsurgically removed and transplanted into the hypothalamus of hypophysectomized adult females. The hosts were sacrificed 4 weeks later; brain and target organs were preserved for histological examination. Plasma samples were taken for the radioimmunoassay (RIA) of follicle stimulating hormone (FSH) and luteinizing hormone (LH). The implanted tissue invariably developed along certain lines. Undifferentiated primitive cells were found associated with nervous tissue, dense connective tissue, cartilage and glandular cells. In every age group, some implants became invasive, forming massive growths in the brain. These tumorous properties were principally associated (p less than 0.05) with tissue from 12-day embryos. Pituitary primordia from all ages demonstrated the ability to develop into functional adenohypophyseal tissue. Target organ stimulation indicated a secretion of corticotropin, thyrotropin and somatotropin. FSH and/or LH were detected by RIA in the plasma of 61% of the test animals. We suggest that this system offers unique opportunities for future investigations into the mechanisms that determine whether embryonic epithelial tissue will remain under normal growth control or will become tumorous or even cancerous.


Effect of five dopaminergic drugs on plasma growth hormone levels in acromegalic subjects. The effect of 5 dopaminergic drugs, 2-Br-alpha-ergocryptine (CB 154), L-dopa, 1-(2-pyrimidyl)-4-piperonylpiperazine (Piribedil), amantadine and 1,3-dimethyl-5-amino-adamantan (d 145), on human growth hormone levels (hGH) was studied in 38 acromegalic subjects. Acute administration of CB 154 (2.5 mg p.o.) in 34 patients was followed by a significant and sustained fall in plasma hGH levels; in 19 cases (55.6%) the observed fall was clearly below the +/- 2SD of the mean GH changes present in the same subjects after placebo. In patients previously shown to be responsive to CB 154, Significant GH falls were also present following the single administration of L-dopa (500 mg p.o.) (9 patients) and Piribedil (100 mg p.o.) (5 patients), although CB 154 exhibited a more frequent, striking (reduction of up to 1-2 ng/ml) and long-lasting (4 h more) effect. In contrast, amantadine (200 mg p.o.) or D 145 (20 or 50 mg p.o.) did not induce significant changes in hGH levels (7 patients). These results broaden and corroborate previous findings on the hGH-lowering effect of dopaminergic stimulation in acromegaly. The possible reason(s) for the difference in hGH response with different dopaminergic compounds is discussed.


Inhibition of ADH release in the rat by narcotic antagonists. The diuretic action of two new narcotic antagonists, oxilorphan and butorphanol, was studied in rats heterozygous for hereditary hypothalmic diabetes insipidus. Both drugs caused a prompt increase in urine volume and a decrease in urine osmolality with an associated decrease in urinary ADH excretion. The effects appeared to be dose related and of short duration. Tolerance to butorphanol administration was evident on repeated daily injections. The diuretic effect was not associated with alternation in creatinine excretion, but butorphanol resulted in decreased osmolal, sodium and potassium excretion. Butorphanol prevented the expected rise in urine osmolality and ADH excretion due to 31 h of dehydration. Oxilorphan did not interfere with the ability of administered ADH to cause an antidiuresis. The data indicate that these narcotic antagonists cause a diuresis by inhibiting ADH release from the neurohypophysis.


Hypothalamic norepinephrine: concentration and metabolism during pregnancy and lactation in the rat. Both norepinephrine (NE) and its major metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG), were assayed in rat hypothalamus during selected stages of pregnancy and lactation. No changes were observed in the concentration of either NE or MHPG at 5, 15 or 21 days' gestation. However, with 8-15 h after parturition, the concentration of NE decreased sharply while that of MHPG showed a correspondingly sharp increase. The possible significance of such change in hypothalamic catecholamine activity was considered in relation to parturition, postpartum estrus and onset of maternal behavior.


Effects of hydrocortisone on biogenic amine levels in the hypothalamus. Implants of hydrocortisone acetate (HCA), cholesterol or empty tubing were placed in the hypothalamus of rats. Corticoid implants elevated serotonin levels in the basomedial hypothalamus compared to the other two groups, but norepinephrine levels were unchanged. Adrenal and serum cortcosterone, as well as adrenal weight, were lower in animals with hydrocortisone implants. These data support the hypothesis that hypothalamic serotonin is involved in negative feedback control of adrenal steroid secretion. Biogenic amines in the medial hypothalamus were determined at 30 days in rats neonatally treated with HCA. Both norepinephrine and serotonin levels were elevated significantly in the treated group in comparison to controls, but dopamine levels failed to change.


Dissociation of adrenocortical secretory responses to cyanide and philocarpine in dogs with hypothalamic lesions. In dogs with hypothalamic lesions as well as in intact and hypophysectomized dogs, adrenal venous blood samples were collected and analyzed for 17-hydroxycorticosteroids (17-OHCS). In intact dogs a marked increase in adrneal 17-OHCS secretion was observed following the i.v. infusion of cyanide as well as after the i.v. injection of pilocarpine; this was completely abolished by hypophysectomy. The adrenocortical response to pilocarpine was markedly impaired and that to cyanide partially suppressed after lesioning of the anterior median eminence. However, after lesioning of the posterior median eminence, the adrenocortical secretory response to pilocarpine was almost the same as in intact dogs, whereas the response to cyanide was markedly impaired. Thus, a dissociation of adrenocortical secretory responses to cyanide and pilocarpine was demonstrated in dogs with hypothalamic lesions.


Psychiatric diagnosis and EEG-evoked response relationships. This study was conducted to determine whether the patterning of EEG and somatosensory evoked response (SER) variables, as determined by the correlations between them, differs with respect to psychiatric diagnosis. Subjects were 43 nonpatients and 90 psychiatric inpatients. SER modified recovery function recordings provided 36 variables, reflecting amplitude and its variations with different stimulus conditions. A 10-min left parietal EEG was quantitatively analyzed to give mean amplitude and frequency and variability measures. Correlations between EEG and ER variables were compared both for unmatched groups of nonpatients, schizophrenics, psychotic depressions, and nonpsychotics and for smaller age and sex-matched diagnostic groups. The results revealed a number of correlation differences between clinical groups. The nature of the differences suggested diagnostic specificity for EEG-ER patterning, which may provide a new, psychiatrically relevant electrophysiological variable.


EEG techniques in the measurement of the severity of depressive syndromes. Previous results from our laboratory support the hypothesis that measurements of EEG mean integrated amplitude (MIA) are correlated with the depth of depression as assessed by a rating scale, and also with the degree of memory impairment during depression. Moreover, it could be shown that there occurs, during severe depression, a more pronounced involvement of the dominant (DH) than of the non-dominant (NDH) brain hemisphere. A similar interhemispheric difference has also been found in a previous study of visual averaged evoked responses (V.AER). A new series comprising 51 untreated depressed patients has been investigated for both MIA and V.AER to extend the previous findings. In agreement with previous results a significant negative correlation between the within patient variance (WPV) of the MIA and depression scores was found. Moreover, a statistically significant negative relationship between the amplitude of the first two V.AER and depression scores was obtained. Since DH is most important for verbal functions, it is assumed that the degree of involvement of the DH is more pronounced in retarded depressed patients with pronounced speech disturbances.


Effect of peripheral decarboxylase inhibition on HVA and 5HIAA in cerebrospinal fluid of depressed patients. The effects of benserazide on the level of homovanillic acid and 5-hydroxyindoleacetic acid in CSF have been investigated in 1 manic and 11 depressed patients. Benserazide induced no change on both metabolites. This negative result supports the view that monoamine metabolites in CSF, in the absence of loading with an exogenous precursor, originate mostly from brain parenchyma, without significant contribution of the metabolism in capillary walls.


Associative changes in hospitalized schizophrenics during a 16-year period. After a mean test-retest period of 16 years a sample of 39 initially chronic as well as acute/subacute schizophrenic patients showed a statistically significant normalization of associative performance. This finding was corroborated by a cross-sectional comparison between the same 39 patients and a sample of chronic schizophrenics (n = 26)) tested 16 years ago. The findings were attributed to effects of psychotropic drugs and improved psychiatric treatment.


A clinical and family history comparison of good outcome and poor outcome schizophrenia. The use of strict criteria for the diagnosis of schizophrenia is quite predictive of a bad prognosis. Should the patient not meet such strict criteria, a family history of remitting illness may be helpful in suggesting a better outcome. In this latter group, the subtype diagnosis of catatonic schizophrenic carries with it a better prognosis.


Bilateral inheritance as evidence for polygenicity in functional psychoses. Among 1,678 functional psychoses followed up, 35 had parents, uncles, aunts or grandparents with 2 or more cases diagnosed as schizophrenic psychoses, or 2 or more secondary relatives diagnosed as non-schizophrenic psychoses. Comparisons of unilateral and bilateral inheritance suggest that the schizophrenic and endogenous affective psychoses have polygenic transmission, while this is not the case for reactive psychoses.


Behaviour and social characteristics of young associal alcohol abusers. In the present study all available young social alcohol abusers in the capital of Iceland are compared with a control group matched for age and intellectual level. Certain behaviour and social characteristics were found to occur more often during childhood among the abusers. Boys showing these characteristics should be regarded as being at high risk of developing asocial alcohol abuse. In order to prevent this they and their families should be offered social, psychiatric and medical help.


The bipolar unipolar dichotomy and the need for a consistent terminology. A division of the major psychotic affective disorders into a bipolar (true manic-depressive) and unipolar (recurrent depressive or recurrent manic) group represents a clear advance in the classificatory work of affective illness which had been suffering from stagnation. Several investigations have already contributed provocative findings which support the heuristic value of this distinction. However, to be reliable a separation of bipolar from unipolar affective disorders must rely upon clear-cut definitions of the labels to be used in order to avoid inconsistency in terminology hampering the reliability of our findings.


Growth hormone release during sleep and with thermal stimulation in depressed patients. The pattern of human growth hormone (HGH) release was studied in depressed patients during sleep under EEG control and employing high temperature exposure. The patients were free of drugs and were compared with corresponding control groups. In the sleep study (6 depressed patients), 2 patients showed no definite increase in HGH plasma concentration, and 3 patients showed an increase in HGH only in the second half of the night, independent of slow wave sleep (SWS). But sleep disturbances were present in all 5 patients. A correlation between SWS and HGH release was found in only 1 patient. One nondepressed control, without SWS, showed a delayed HGH response. Exposure to high temperature in normal subjects induced an acute HGH release. 8 of the 13 patients studied had a deficient HGH RESPONSE. All were depressive, with psycho motor retardation and marked vital and neurovegetative disturbances. These findings support the idea that, at least in a high percentage of depressed patients, there is a disturbance of the hypothalamic pituitary function.


Multivariate analyses of anthropometric and psychometric variables in probands with affective disorders and their families. Data on 121 subjects, probands with affective disorders, their spouses and first degree relatives, are analyzed by multivariate methods to determine the relationships between physical types and propensity to illness. 56 variables are used: 39 anthropometric measures, age, sex, and 15 psychometric scales. In a canonical analysis between the anthropometric measures and the psychiatric scales, each canonical variable is found to be largely identified with a single psychometric component, as found in a principal components analysis of the psychometric scales. The two major anthropometric components, size and linearity, do not have any clear relationship with the psychometric components. However, a discriminant analysis that takes each individual as being in one of four clinical groups, normal, unipolar depressed, bipolar affective disorder or other, indicates a clear relationship between the anthropometric measures and mental illness; wide face and deep chest are associated with patients who have bipolar affective disorder. Half of the variables studied are sufficient to give virtually the same amount of discrimination as all 56 variables.


[Jejunal leiomyoma as a cause of neonatal intestinal occlusion]. Intestinal occlusion with the characteristics of an atresia proved to have been caused by leiomyoma of the jejunum.


[Appendicular ovarian endometriosis with a clinical picture of acute abdomen]. Reference to the literature is made in an account of extragenital external endometriosis, with particular attention to intestinal varieties. A case of ovarian and appendicular endometriosis with the clinical picture of acute abdomen is presented. Lastly, an evaluation is made of the views put forward concerning the aetiopathogenesis of this conditions.


[Monitoring of intracranial pressure].

[Monitoring of intracranial pressure]. An account of the significance of intracranial pressure is followed by a review of the various sites in which it can be recorded (spinal canal, lateral ventricles, subarachnoidal spaces, operation cavity, other sites). Monitoring of ventricular pressure is discussed in detail; this deals with the classic site and its technique has become part of clinical practice. The utilisation and interpretation of the data in the form of pressure levels and their changes in the course of time are also discussed. The clinical indications for monitoring are noted.


[So-called spontaneous rupture of the esophagus or Boerhaave's syndrome]. A typical case of spontaneous rupture of the oesophagus (Boerhaave's syndrome) successfully operated at the Surgery Division of the Lodi Greater Hospital is presented. An account of the aetiopathogenetic, anatomopathological and clinical problems involved is followed by an examination of the possibilities of diagnosis. It is felt that early surgical management is the only way of obtaining the best results. It is also suggested that the term "rupture following effort) be used instead of the normal "spontaneous rupture", since the pathogenetic dynamics behind the lesion is better expressed in this manner.


[Morphological specifications on the anatomy of the vagus nerve in the mediastinum]. The intrathoracic vagosympathetic relations in man are discussed, and attention is drawn to certain small nerve branches connecting the orthosympathetic ant the hypobronchial portion of the oesophageal plexus.


[Value and limitations of intravenous cholangiography in the diagnosis of the main bile duct diseases. Studies in 209 cases controlled surgically]. The value and limits of i.v. cholangiography were appraised in the light of the surgical picture in 209 patients. Exact preoperative diagnosis was possible in many cases, while no more than dilatation of the main bile duct was demonstrable in others. False negatives mainly concerned lithiasis of the common duct without jaundice, whereas false positive lithiasis was primarily observed in papilitis and cephalopancreatitis.


[Hypnosis in labor].

[Hypnosis in labor]. The aetiology of labour pains remains obscure and it is not certain that improper conditioning is the cause. Fear of pain is innate, while other fears are acquired. The employment of hypnosis during labour is discussed and it is pointed out that the paucity of qualified hypnologists makes its systematic use problematical.


[Respiratory autogenic training in preparation for labor (RAT method)]. Preparation for childbirth with the R.A.T. method involves two therapeutic steps. The first concerns a conditioning relaxation technique derived from hypnosis. Schultz's T.A. and reflexology. There is a series of seven exercises, each of which is supplemented by a revision exercise. The central training exercises coincide with the achievement of sleep breathing, followed by physical deconditioning to external stimuli and semantic deconditioning to uterine contractions. The second step involves a form of analysis designed to examine the mechanism of emotions in a particular situation, marker by the loss of connection between the Ego, the body and the environment, as occurs during group autogenous relaxation.


[Bimanual antalgic maneuver on the parturient conditioned with hypnosis: delivery without medical assistance]. A personal bimanual antalgic manipulation on hypnotized parturient is proposed as a normal method of delivery assistance since it is quicker and takes less emotionally out of the physician than "delivery under hypnosis". The question of "childbirth without medical assistance" is also discussed, reference being made to an exceptional case of post-hypnotic control. This compared to all those cases of patients who deliver without the preparatory hypnotist being present.


[Hypnosis and moral doctrine].

[Hypnosis and moral doctrine]. Patients undergoing hypnosis are free subjects in the sense that they possess a particular dignity and entitlement to respect. They are, in fact, "not available" for examination except insofar as there is an expected or auspicable improvement in their personal condition. This means that they are open to "experiment" solely to the extent that the following conditions are respected: certain control if situations involving risk to the person arise, "consent" of the patient (this may be only assumed in certain instances), the adoption of a "prudent" and "scientific" manner that avoids any suggestion of a spectacle or cheap publicity.


[Our experience in pancreatic injuries]. Eight cases of pancreatic traumas are considered and the literature reviewed. Personal cases include: 1 contusion treated nedically; 2 cases of complete rupture (1 of which primary treated with double jejunal pancreatic anastomosis); 1 associated with splenic rupture, treated with distal pancreatectomy and splenectomy; 1 contusion of the head associated with hepatic lesions treated with suture of the lesions external derived and cholecystostomy; 4 contusions without lesion of the duct associated with other visceral lesions (stomach, duodenum, spleen, liver), treated surgically by suture of the lesion, and drainage of the omental bursa. As regards diagnosis, the only pathognomonic examination is amylasaemia. Paracentesis proved important in cases of haemoperitoneum. Long-term results were observed by scintigraphy and through starch and maltose load curves. Scintigraphy pointed to the presence of functional deficiency in areas which seemed to be only contused or actually normal. It is therefore concluded, especially in cases of complete rupture, that therapy should be kept as conservative as possible (Duodenal pancreatic anastomosis). The purpose of this is to prevent fistulas of the residual stump, fostered by the pressure in Oddi's sphincter, and to lease the pancreatic tissue as operative as possible. This is particularly important if patients are young.


[Results of lumbar gangliectomy interventions. Report of cases and current indications]. The role of lumbar gangliectomy is examined by analysing cases of vascular interventions on the aorto-ilaco-femoral sector at the Department of Surgical Clinical Medicine II and at the Department of Surgical Anatomy and Surgery Studies of the University of Milan during the period 1966-1973. The steady, marked decrease in the incidence of operations on the Vegetative Nervous System, parallely with a notable rise in reconstructive operations is noted. The extension of indications to reconstructive operations alters the attitude to be assumed with regard to lumbar gangliectomy. Analysis of long-term results of indirect operations, however, confirms the validity of the method as a function of the restrictive attitude of present-day indications.


[Correlations between angiography and thermography using liquid crystals on a plate in Raynaud's syndrome]. The problem of the correlation between angiography (surgical) and thermography using liquid crystals on a plate (non-surgical, easy, low cost, quick and repeatable) is examined on the basis of a small series. Presuming clinical history is adequate and examinations have eliminated typically surgical cases, the results of thermography appear to coincide with angiographic pictures; long-term follow up can, however, only be carried out by means of nonsurgical means such as thermography and photoplethysmography. These pinpoint the improvement and consolidation of therapy, or any worsening which demands diagnostic and therapeutic surgical or parasurgical measures.


Increased vascular permeability evoked by mechanical trauma and haemarthrosis in synovium of the rat. Increased vascular permeability was studied in the synovium of the rat's stifle joint following mechanical trauma and haemarthrosis. The abnormal permeability was detected by injecting colloidal carbon intravenously and examining the synovial vessels for intra-mural deposits of carbon. The effects of rotational and stretch injuries were minimal except when accompanied by intra-synovial haemorrhage. Injection of autologous whole blood into the joint evoked a marked venular permeability response which persisted for 24 hours. These findings indicate that the major factor in the formation of traumatic joint effusions is haemorrhage into the articular cavity or the adjacent tissues.


The detection of hepatitis B surface antigen by radioimmunoassay. A comparative study was performed to assess the sensitivity and specificity of counterimmunoelectrophoresis (CIEP) and radioimmunoassay (RIA) for the detection of hepatitis B surface antigen. The 8,823 sera examined included selected reference panels and sera collected from populations with low, moderate and high rates of chronic antigen carriage. Overall, hepatitis B surface antigen was detected in 265 sera by CIEP and in 376 by RIA. As well as detecting 46.4% additional positives, the RIA test detected all CIEP-positive sera; i.e., there were no false negative results. However, 150 sera (1.8% of the total tested) gave a positive result by RIA which was not repeatable on retesting. The explanation for this phenomenon appeared to lie in inadequate washing of the antibody-coated tubes.


Antibiotic sensitivity of bacteria from urine. Bacteria isolated from the urine of 400 hospital inpatients and 483 outpatients were identified and the in vitro sensitivity of these organisms against 12 antibacterial agents currently used in the treatment of urinary tract infections was determined. There was little difference in the distribution of organisms between the two groups. Escherichia coli was predominant, accounting for 58% of the inpatients and 66% of the outpatients. Klebsiella was present in 15% of the inpatients as against 7% in the outpatients. Proteus mirabilis 9% inpatients and 8% outpatients and Enterococcus, 7% inpatients and 5% outpatients made up most of the remainder. The different organisms showed varying sensitivity patterns to the antibiotics tested. The commonly used antibiotics with the broadest spectrum were cephalexin and cotrimoxazole.


The mast cell: distribution and maturation in the peritoneal cavity of the adult rat. In the peritoneal cavity of the adult rat mast cells at the four stages of progressive maturation (and corresponding increase of sulphation of granules) are best demonstrated in free peritoneal fluid. Of the 0.1-0.2x10(6) cells in the free fluid, 26% are at stage 1 of maturation (all granules are stained by Alcian blue). 24% at stage 2 (majority of granules are stained by Alcian blue, minority by safranin), 20% at stage 3 (majority of granules are safranin-positive), and 30% at stage 4 (all granules are safranin-positive). Peritoneal washings yield a mean of about 1.3-1.8x10(6) mast cells of which 16% are at stage 1, 24% at stage 2, 34% at stage 3 and 26% at stage 4. The greater number recovered by washing, compared with the number in free peritoneal fluid, suggests that a substantial number of mast cells lie on the surface of the peritoneal membranes.


Studies on phospholipids in the action of a lupus coagulation inhibitor. Plasma from a patient with early manifestations of disseminated lupus erythematosus, a prolonged partial thromboplastin time with kaolin, mildly prolonged prothrombin time, and a circulating inhibitor affecting the assay of several clotting factors was investigated. The most sensitive test for the inhibitor was found to be the Russell viper venom time without phospholipid. A decrease in phospholipid concentration as well as decreased sodium chloride levels both significantly enhanced the effect of the inhibitor in several coagulation tests. Of various phospholipid substitutes tested phosphatidyl ethanolamine was the most effective in partially correcting for the inhibitor. The inhibitor was not localized to the patient's platelets, which were also found to partially neutralize its effect. Since lupus erythematosus is sometimes accompanied by thrombocytopenia the coagulation disorder may be aggravated by such a deficiency of phospholipid. The inhibitor appears to act by preventing binding of phospholipid to the Xa/V/thromboplastin complex. It was characterized as a gamma globulin of mixed class.


[Assay of serum creatine phosphokinase in primary hypothyroidism. Comparison with other thyroid gland function tests in 32 cases. Value of isoenzyme studies]. Serum-creatine phosphokinase levels were measured in 32 cases of primary hypothyroidism in adults and compared with the results of other thyroid function test. C.P.K. elevation appeared to be almost completely uniform (31 out of 32 cases) and marked, reaching six times the normal value. This elevation is more marked in 18 myxoedematous patients than in 14 with those with hypothyroidism of mixed aetiology. Close correlation does not seem to exist between the elevation of C.P.K. and the lowering of serum thyroxine. The elevation of C.P.K. above the upper limits of normal seemed more constant than lengthening of the achilles reflex time, a rise in serum cholesterol, or a rise in other enzymes of muscular origin, such as the glutampopyruvic and glutamo-oxalocetic transaminases, lactodehydrogenase and hydroxybutyric dehydrogenase. In 8 cases of hypothyroidism, the isoenzymic study of serum C.P.K. by electrophoresis on cellulose acetate confirmed that the molecular structure was of the muscle type MM. The advantage of such a study shows that a structure MB found in the case of myocardial infarction in a patient with hypothyroidism deserves to be stressed.


[Prognostic value of bone and bone marrow lesions of primary myeloid metaplasia]. This study of the history of 117 cases of agnogenic myeloid metaplasia with myelofibrosis underlines the importance of anatomo-pathological and radiological parameters for prognosis. Histological staging of bone and bone marrow lesions at time of diagnosis enables one to confirm long survival of cases with hyperplasia (Group I) and more severe prognosis for advanced myelofibrosis (that is both groups II and III considered together) but does not enable to establish a significative difference between medium survival of cach group II and III considered separately. Those medium survivals estimated are the following: 82 months for group I; 60 months for both groups II and III. Thus, it is logical to consider together these two groups among which one can distinguish two anatomoclinical forms. One is characterized by bone marrow hyperplasia with reticulin myelofibrosis and is usually associated with large spleen and even in some cases with polycythemia but without radiologic bone lesions; the other is characterized by bone marrow of medium or hypoplasic constitution fibrosis, with or without osteosclerosis and with radiologic bone lesions of mode-rate or important extension (respectively 16.9 p. cent of cases) and is usually associated with pancytopenia.


Effect of prolonged administration of L-leucine-4-anti-pyrineamide dihydrochloride on certain organs and blood formation system in rat. Newly synthesized L-leucine-4-antipyrineamide shows the biological effect of aminopyrine. In contrast, it does not cause any adverse effect on the growth of rat, and induces neither degeneration of the parenchymal organs nor agranulocytosis.


Clinical and morphological correlations in mesangial glomerulonephritis in children. The present series comprises 36 cases of mesangial glomerulonephritis in children aged from six months to 14 years. On the basis of morphological criteria, types with considerable and slight mesangial proliferation were distinguished. Slight mesangial proliferation was more typical of younger children. Clinically they showed more often the nephrotic syndrome (sometimes difficult to differentiate from lipoid nephrosis). Older children developed mesangial proliferation rather of greater intensity: renal insufficiency and erythruria predominated in this group.


On pure motor hemiplegia (Fisher's syndrome). The authors described three cases of so-called "lacunar strokes" with pure motor hemiplegia. Clinical diagnosis in all three cases was middle cerebral artery thrombosis. In cases 1 and 2 small post-malacic lacunes were found in the basal part of the pons. In case 3 the lesion was located in the pyramidal tract within the pons and medulla. In all cases advanced arteriosclerotic changes were observed. "Lacunar stroke" can result from a lesion of both the pons and the medulla. The clinical syndrome may be engendered also by selective lesion of the pyramidal tract.


Studies on the cumulation of the toxic effect of indomethacin. The cumulative toxicity of alpha and gamma forms of crystalline indomethacin was studied on Wistar rats treated with these compounds in increasing doses for 24--32 days. The toxic effect of alpha and gamma forms is significantly cumulative. When administration of indomethacin is many times repeated doses 3--4 times lower than those applied once are sufficient to cause death. Indomethacin causes ulcers of small intestinal and cecal mucosa, with perforation. The alpha and gamma crystalline forms of indomethacin did not differ in the degree of cumulation of the toxic effect and intensity of morphological lesions.


Spasmolytic effect of 4-valeryl 4-(3-chlorophenyl) 1-[3-(4-methylpiperazine)-propyl)-piperidine trihydrochloride. The purpose of this work was to check the effect of 4-valeryl 4-(3--chlorophenyl) 1-[3-(4-methylpiperazine)-propyl]-piperidine, a new synthetic piperidine derivative, on the activity of smooth musculature of guinea pig isolated intestine. Direct and indirect myolytic action of this compound was found.


Uremic lung lesions as a form of chronic edema. Biochemical uremia lasting two weeks was developed in five dogs. It appeared light and electron microscopically that the uremic pulmonary lesions consisted in atelectasis and edema and were more advanced in the inferior paravertebral and parahilar parts of the lung. On the basis of electron microscopic findings it could be assumed that the peripheral respiratory segments (alveolar saccules) are the first to be involved in the process. In partially aerated alveolar ducts condensed edema fluid was found on the surface of recently produced edema fluid of low electron density. This condensed layer seems to originate from more peripheral segments and to be pushed passively upwards. Such processes can be interpreted as a preliminary stage of hyaline membrane formation in experimental uremia.


Effect of phenytoin on succinic dehydrogenase activity in rat cerebellum. Phenytoin was asministered to rats per os in the dose 110 mg/kg for 6 months in order to check its effect on cerebellar succinic dehydrogenase activity. The latter appeared to be unchanged, even in those cerebellar structures which showed features of alteration.


The lumen of iliac arteries in normal and pathological conditions. Two hundred corrosion preparations of iliac arteries were made with polyester resins of known polymerization contraction. The measurements were taken with the accuracy of 0.1 mm, at the initial and final segment of the cast of the studied vessel. Because of the oval shape of the vascular lumen the greatest and smallest sizes were measured at the same level. The lumen of normal iliac arteries appeared to be almost round, the surface of the cast was even and smooth and the vessels ran a straight course. The lumen of pathologically changed arteries showed abnormalities of shape, constrictions and dilatations, the course of vessels was tortuous. The size of the lumen of common and external iliac arteries gradually increases with age, being always larger in men than in women. No such relationship was found as regard the internal iliac arteries. These results may be useful in the interpretation of angiograms and in establishing of indications for surgery.


Immunoglobulin levels in SFD newborn babies. The IgG, IgA and IgM levels were determined by the technique of radial immunodiffusion of Mancini et al. in 40 SFD and 30 normal control newborn infants. The mean value of IgG concentrations was found to be raised but without statistical significance when compared with control. On the contrary the increased mean amounts of IgM were statistically significant.


Lymphocytotoxines frequency and HL-A typing in "small for date" children. Nineteen mothers and their children, aged from 1--24 months born as "small for date" (SFD) were investigated. The lymphocytotoxicity test performed in the SFD mothers showed in comparison with the control group differences near the borderline of statistical significance. HL-A-1, or A-l with A-10 was more often found in SFD, than in control children.


Pharmacological properties of a new derivative of piperidine: 4-acetyl-4-(3-chlorphenyl)-1-(3'-dimethylaminopropyl)-piperidine dihydrochloride, designated S1. The effect of 4-acetyl-4-(3-chlorphenyl)-1-3'-dimethylaminopropyl)- -piperidine dihydrochloride on central nervous system, cardio-vasculary system and isolated organs of experimental animals was checked. Its analgesic and spasmalotytic properties were evaluated and the acute toxicity -- determined.


Electron microscopic studies on cells isolated from aorta of newborn and adult rabbits. Cells from aortas of newborn and adult rabbits were liberated by digestion with trypsin and collagenase. More than 90% of them were viable at the end isolation. Isolated cells were used for electron microscopic examination. In the material obtained from aortas of newborn rabbits endothelial cells, fibroblasts and smooth muscle cells were present. In material from adult rabbits two kinds of endothelial cells, fibroblasts, several varieties of myocytes, fat-laden macrophages and typical foam cells were found. Various forms of myocytes seem to represent different functional stages or specialized kinds of these cells. The presence of fat laden macrophages and foam cells in the aortas of healthy adult rabbits may support the view that these cellular changes so far considered as typical of atherosclerosis are common and may be treated as an exponent of natural process of aging of vascular wall.


Multiple immune serum injections in prevention of murine "L-1210" leukemia growth. Adult BDF1 and DBA/2J mice were inoculated i.p. with "L-1210" leukemia cells and then received i.p. control or immune sera raised in C27B1/6 and BALB/c mice. Undiluted sera were administered in single or multiple doses ranging from 0.2 to 0.4 ml/mouse on day 0., resp. 0., 2-4, and 7. In BDF1 hybrids permanent survivals (greater than 150 days) and distinct prolongation of the mean survival time (MST) after multiple injections were observed. However, normal serum derived from non-immunized C57B1/6 donors was also demonstrated to provide protection when injected three times. In DBA/2J recipients no permanent survivals were observed. In this mouse strain control sera proved ineffective. On the contrary, immune sera enabled the recipients to survive longer and this prolongation proved to be statistically significant (p less than 0.02). Partial natural immunity against "L-1210" leukemia in BDF1 hybrids must be, therefore, postulated. It is probably due to H-2-locus incompatibility versus "L-1210" cells, inherited from the C57B1/6 ancetor-line. Unknown factors which are present in normal serum seem to potientiate this natural resistance. In compatible DBA/2J mice normal serum constituents were ineffective, on the other hand, however, the effectiveness of specific immune factors directed against target cells of the tumor could be demonstrated in them


Ultrastructure of rat myocardium after feeding a diet with low--erucic acid rapeseed oil. Electron microscopy was applied to study the myocardium of rats fed a diet with sunflower oil (group I), low-erucic acid rapeseed oil (group II), or high-erucic acid rapeseed oil (group III). The most severe lesions were found in group III. The rats fed sunflower oil showed slight lesions in the form of dilated channels of endoplasmic reticulum and the presence of a few lipid droplets. Similar abnormalities were found in group II, they were followed, however, after four and eight weeks of experiment by considerable mitochondriosis with compression and atrophy of sarcomeres. In group III considerable myocardial fatty degeneration (numerous lipid vacuoles) was found already after the first week of experiment, after four and eight weeks, however, the number of lipid vacuoles gradually decreased with time. Like group II group III showed considerable mitochondriosis with atrophy of contractile elements.


Ultrastructure of the capillaries of the reproductive system in female rabbits with alloxan diabetes. Capillaries of the reproductive system of non-pregnant female rabbits with experimental alloxan diabetes show a slight but extensive thickening of the basement membrane. It seems to be the consequence of diabetes. The observed vascular lesions may influence the function of the reproductive system.


Effect of exercise on the lipid content, lipid fatty acid composition and morphology of myocardial and skeletal muscles in rat. The effect of exercise on the morphology of the myocardial and skeletal muscle, total lipid content and lipid fatty acid composition was checked in rats fed a rapeseed oil-containing diet. The graded exercise was found to reduce the growth rate of animals. Myocardial fatty degeneration was less intense and erucic acid content lower in trained rats fed a diet with 50% kcal of rapessed oil than the untrained ones. The opposite was true when rapeseed oil supplied 30% of calories. Histiocytic granulomata were more numerous in trained rats. Exercise failed to affect the accumulation of erucic acid in skeletal muscle.


Studies on acute lung lymphatic edema.

Studies on acute lung lymphatic edema. The outflow from lymphatic vessels running along with the right cardinal bronchus was interrupted in six dogs by the removal of the corresponding hilar lymph nodes. After 6-8 days the right lung showed slight subpleural areas of atelectasis and edema. Edema of endothelial cells of the lung septal capilaries was observed electron-microscopically. This lesion is similar to the findings in cases of mitral stenosis.


Non-homogeneity of serum leucine arylamidase (LAP) activity in hepatocellular and obstructive jaundice. In 40 patients with hepatocellular and obstructive jaundice and in 20 healthy subjects the pattern of serum leucine arylamidase (LAP) isoenzymes was determined. Polyacrylamide gel electrophoresis was used for demonstration of enzyme non-homogeneity. It was found that the main enzyme activity in healthy subjects was connected with postalbumins. In some healthy subjects and additional zone of activity was observed in beta lipoproteins. Only exceptionally 3- and 4-fraction enzymograms were found in healthy subjects. Additional activity zones were present in these subjects in the alpha2 macroglobulin region or in the region of slowly migrating haptoglobins. In hepatocellular jaundice, i.e. in viral hepatitis, the total serum LAP activity increased slightly. In the enzymogram this increase was localized in the postalbumin fraction and caused also appearance of additional, sporadically occurring isoenzymes migrating with rapidly moving haptoglobins. In obstructive jaundice of benign or malignant etiology the total serum enzyme activity rose strikingly. In most patients a 6-fraction enzymogram was found. The activity of postalbumin isoenzyme was particularly increased, while no changes were observed in the remaining activity zones sporadically occurring in healthy subjects and in hepatocellular jaundice.


Quantitative angiocardiography--evaluation of left ventricular function in mitral stenosis. Investigations of left ventricular function were carried out in 59 patients with mitral stenosis and 8 healthy subjects by means of one-plane quantitative angiocardiography. A statistically significant increase of the left-ventricular systolic volume was observed in patients (x=74.9 +/- 29,8 ml) as compared with the control group (x=35.2 +/- 12,7 ml), the systolic ejection fraction decreased (patients: x=49% +/- 12, controls: x=74% +/-3), similarly as the stroke volume (patients x=74.8 +/- 29.6 ml, controls: x=104 +/- 42 ml). The diastolic volume of the left ventricle was similar in both groups (patients: x=143 +/- 43 ml, controls: x=134 +/- 47.9 ml). A significant decrease of the systolic ejection fraction and an increase of the systolic volume of the ventricle were observed with higher grades of mitral stenosis evaluated according to the classification of the New York Heart Association. A negative correlation was demonstrated between the systolic volume of the left ventricle and the systolic ejection fraction (r=-0.707) and the work of the left ventricle (r=-0.237). On the other hand, a positive correlation was found between the left-ventricular work and the systolic ejection fraction (r=+0.227). The results indicate unequivocally impairment of left ventricular function in mitral stenosis and a considerable role played in it by the myocardial factor.


Non-homogeneity of serum alkaline phosphatase activity in certain diseases of the liver and bile ducts investigated by polyacrylamide electrophoresis. In 47 patients with hepatocellular or obstructive jaundice and 20 healthy controls the alkaline phosphatase isoenzyme pattern was determined by means of electrophoresis on polyacrylamide gel. It was demonstrated that the main activity of alkaline phosphatase (AP) in healthy subjects was connected with beta globulins while beta lipoproteins contained only traces of this activity. In hepatocellular jaundice during viral hepatitis only a slight rise was found of the activities of isoenzymes present in healthy subjects, and no zones of additional activity were found. In obstructive jaundice of benign as well malignant etiology the beta lipoprotein zone increased also significantly, moreover an additional activity zone was revealed moving in the gel together with alpha2macroglobulins. In 40% of cases of obstructive jaundice caused by metastatic malignant neoplasms in the liver a 4-fraction isoenzyme pattern of AP was demonstrated with additional activity in the haptoglobin zone.


Lung scanning using microspheres labeled with radioactive isotopes in the diagnosis and evaluation of therapeutic results in pulmonary malignant neoplasms. In 25 patients with malignant pulmonary neoplasms 38 scintiscanning investigations were carried out using the method of albumin microspheres labeled with 131I, technetium -99 m, or indium -113 m and macrocolloids of ferric hydroxide labeled with 113mIn. In 10 patients with infiltration of the main or lobar bronchi scintiscanning demonstrated in 9 cases complete absence of perfusion of one lung. In these cases routine radiological investigations demonstrated normal perfusion and aeration of lung parenchyma in the involved lung. Among 13 cases of carcinoma situated in segmental or subsegmental bronchi the areas with absent perfusion were in 7 cases larger than changes observed during radiological examination. Scintiscanning investigations were used also for evaluation of therapeutic results of synchronized chemotherapy in malignant neoplasms of this organ. Scintiscanning is a method well tolerated by the patients and it may be performed repeatedly in the same case for evaluation changes in perfusion disturbances caused by malignant lung neoplasms. It may be helpful in choice of a proper method of treatment.


Preliminary results of examination of the large bowel with the colonoscope. In 20 patients the colon was inspected with a CF-LB "Olympus" coloscope. The most frequent indication for colonoscopy were doubtful radiological changes in the colon requiring differential diagnosis. Thirteen patients were examined trying to inspect the whole colon and in 9 cases the cecum was reached after 10 to 60 min. In 3 cases colonoscopy demonstrated presence of colonic carcinoma (two tumors located in the cecum), and in 4 other cases this possibility was ruled out and it was possible, thus, to avoid exploratory laparotomy.


Rashkind's operation in treatment of complete transposition of the great vessels in the newborn and infants. The study is a result of many years investigations of a large pediatric team consisting of physicians from various specialities on the methods of management in cases of transposition of greater arterial vessels. Trials of surgical treatment requiring thoracotomy in the newborn with severe cardiorespiratory failure gave no good results. In recent years 65 operations of atrioseptostomy without thoracotomy were carried out during cardiac catheterization. In nearly half the cases improvement of the general condition was obtained with survival for several months or even over one year, but close supervision was required and the children were being prepared for more radical cardiosurgical operations.


Effect of asparagine and arginine on the repair of isoprenaline-damaged myocardium of rat. The effect of asparagine and arginine on the repair of isoprenaline-damaged myocardium was studied. In group I (treated with isoprenaline) the rats developed large foci of myocardial damage filled by connective tissue after 14 days. Similar changes were observed in group II (isoprenaline + asparagine). In group III of rats treated with isoprenaline and arginine the number of foci of injury and their size were smaller, and only a few small foci fibrosis were found after 14 days. Arginine seems to protect the rat myocardium from isoprenaline-induced damage. The repair by connective tissue is supplemented by compensatory hypertrophy of muscle fibers.


Value of polycardiographic investigations as compared with direct methods in evaluation of left ventricular function in ischemic heart disease. In 69 patients with ischemic heart disease the left ventricular functional state, especially contraction disturbances, was assessed by means of direct methods and polycardiographic measurements. The patients were divided into groups depending on the number of vessels affected by atheromatosis. In direct measurements the following values were determined: the rate of rise of intraventricular pressure--dP/dt max., the interval t-dP/dt max, the index (see article). In polycardiographic determinations the isovolumetric contraction time (ICI), the pre-ejection period (PEP) and the coefficient consisting of PEP in the numerator and ejection time (ET) in the denominator (PEP/ET) were calculated. The degree of changes in direct and polycardiographic parameters depended on the number of vessels affected by the atherosclerotic process. The index (see article) was most sensitive to changes in the contractility. The correlation was statistically significant for all parameters compared in the group of patients with lesions in three coronary arteries and myocardial infarction. In the remaining groups the correlations differed and a statistically significant correlation was demonstrated between particular parameters. The correlation was best between direct measurements and ICT and the PEP/ET index.


Plasma renin activity in patients with chronic cor pulmonale syndrome. In 22 patients with chronic cor pulmonale syndrome plasma renin activity (PRA) was determined at rest and after stimulation by means of intravenous injection of furosemide. In 50% of cases PRA was raised exceeding 250 ng/100 ml/3 hours. The systemic arterial pressure in these patients was normal. The degree of PRA increase after stimulation was lower than in healthy subjects.


Cardiac and aortic lesions in chronic experimental poisoning with mercury vapors. The nature of the toxic influence of mercury and its effect on the cardio-vascular system are not well understood. In chronic poisoning with metallic mercury and its compounds, circulatory disorders have been observed in patients. The problem whether metallic mercury damages the endocardium and myocardium directly or indirectly through vascular changes or vegetative system stimulation remains unsolved. A study was undertaken in which a group of experimental rabbits was exposed to the chronic action of mercury vapors by inhalation and compared with a control group. Before the experiment and towards its end, ECG were taken and 24-hr urinary excretion of mercury was determined in both groups. After 3 months the animals were autopsied, and fragments of myocardium, papillary muscles, endocardium and ascending aorta were taken for histopathologic investigation. In the poisoned animals, the ECG tracings showed bradycardia. Morphologic lesions had the character of thrombosis in small and medium-caliber blood vessels, necrotic foci, thickening of the endocardium of the papillary muscles and perivalvular region and endothelial proliferation with inflammatory foci. The results indicate that, besides influencing the vegetative system, mercury vapor damages the endocardium directly and produces vascular lesions resulting in myocardial changes.


Regeneration of crushed skeletal muscles in experimental animals and the effect of leucine on the course of this process in white rat. The dynamics of regeneration of crushed skeletal muscles in rabbits and rats were studied. In both species the course of regeneration was similar, leading to partial reconstruction of muscle tissue. Experiments on the influence of leucine on regeneration of skeletal muscles in white rats showed that this amino acid stimulates and shortens the process of regeneration.


Insulin secretion in patients with chronic hepatitis treated with lipostabil. In 12 patients with chronic hepatitis the carbohydrate tolerance and insulin secretion after intravenous and oral glucose loading were determined before and after lipostabil treatment. A significant rise of fasting insulinemia and hypersecretion of insulin after intravenous glucose loading were observed. After oral glucose loading the rise of insulinemia was significantly lower in patients than in healthy controls, despite a greater increase in glycemia. Administration of lipostabil for 2 weeks failed to exert any significant effect on carbohydrate intolerance and disturbances in insulin secretion, which were present in patients with chronic hepatitis.


Free adrenaline, noradrenaline and vanilylmandelic acid excretion with 24-hour urine in patients with chronic circulatory failure. The purpose of this work was to study the excretion of free adrenaline (A), noradrenaline (NA) and vanilylmandelic acid (VMA) in 24-hour urine in patients with chronic circulatory failure. The investigations were carried out in a group of 152 patients (61 women and 91 men) with rheumatic valvular heart disease (61 cases), chronic cor pulmonale syndrome (23), atherosclerotic myocardial degeneration (68). A and NA urinary excretion was normal in cases with grades 1 and 2 of hemodynamic disturbances. In cases with grades 3 and 4 the excretion of catecholamines was significantly raised, especially that of NA. With regression of circulatory failure the excretion of catecholamines decreased even to normal level. Increased VMA excretion was observed only in cases with grade 4 hemodynamic disturbances. The only factor influencing the function of the adrenergic system and excretion of catecholamines was the degree of circulatory failure. Stimulation of adrenergic system in chronic circulatory failure counteracts the effects of hemodynamic disturbances caused by circulatory failure.


Correlation of liver function and morphological abnormalities in mitral stenosis. In 50 patients with mitral stenosis in the stage of maximal clinical improvement a correlation between the functional state of liver and the morphological changes was estblished. For this purpose the serum total bilirubin concentration was determined together with the serum total protein, albumin and globulin levels, serum alanine aminotransferase, aspartate aminotransferase, cholinesterase, leucylaminopeptidase, and alkaline phosphatase activities. The bromsulphalein test, provoked hypoprothrombinemia test, and histological examination of liver biopsy specimens were made. It was found that with increasing liver morphological lesions there is a gradual but not parallel impairment of function. The most sensitive index of hepatic functional disturbances was the test of provoked hypoprothrombinemia according to Kirchmayer and Bromowiczowa. For full assessment of the degree to which the changes in the congested liver have advanced it is necessary to perform liver function tests in combination with histological examination of the organ.


Electron microscopic lesions of the myocardium of rats fed a low-magnesium diet. Electron and light microscopic examination of the myocardium of rats fed a low-magnesium diet showed swelling of mitochondria with disintegration and degeneration of the mitochondrial cristae, focal fragmentation of the myocardial fibers, their focal fuchsinophilia and necrosis. These abnormalities were associated with deposition of calcium salts in the degenerated muscle fibers, their mitochondria as well as in the ground substance of connective tissue.


[Pleural biopsies: complications and current value of Abram's needle biopsy. Apropos of 1,000 samples. Value of pleuroscopic biopsy]. The frequency of incidents resulting from Abrams needle biopsy is very low provided certain contraindications are respected : pneumothorax, 3.1% of cases ; hemorrhages, 1.3% ; neoplastic contamination of the bioptic tract, 1.9%. Serious accidents are rare. We only observed 2 serious hemorrhages, one in 1964, the other in 1968. In the latter case, the pleural hemorrhage caused a very serious respiratory insufficiency. The delayed functional reaction is still not well known. However the occurrence of immediate accidents could reflect on radiological sequelae. The value of this examination seems today to decrease slightly at the same time as the frequency of pulmonary tuberculosis decreases. Indeed pulmonary tuberculosis is the main indication for this method because of the history and because of the possibility of culture on Loewenstein medium. In cancer, needle biopsy has two drawbacks, that of being blind and yielding only small samples, while pleuroscopy is free of them. In a series of 77 examinations including 45 cancers, the positivity reached 80%. In only 2 cases did pleuroscopy give a falsely positive result. In the remaining cases there was no neoplastic invasion of the pleura.


Primary pulmonary hypertension--a study of disturbances in circulatory hemodynamics and ventilatory function of the lungs. Investigations of the hemodynamics of pulmonary circulation, right and left heart venticle and ventilatory function of the lungs were carried out in a group of 12 patients with primary pulmonary hypertension. The results were discussed in the light of data obtained in a group of 16 patients with chronic cor pulmonale syndrome and 16 healthy subjects. It was found that patients with primary pulmonary hypertension show a markedly raised pressure in the pulmonary artery mean pressure x = 60.3 +/- 24.2 mm Hg, in the right ventricle (systolic pressure x = 90.6 +/- 27.9 mm Hg, end-diastolic pressure x = 11.7 +/- 4.3 mm Hg), very high total pulmonary vascular resistance (x = 1571 +/- dynes. sec. cm-5) and increased work of right ventricle (x = 2.3 +/- 1.5 kgm/min/m2). In patients with chronic cor pulmonale syndrome the load on the right ventricle was much lower. The indices determining left ventricle function as a pump indicated that this function was impaired, with lower cardiac index (x = 2.1 +/- 0.8 1/min/m2), stroke volume (x = 41.7 +/- 17.2 ml) and left ventricular work (x = 2.7 +/- 1.1 kgm/min/m2). These changes might, however, be due also to impaired blood flow into the left ventricle. In contrast to patients with chronic cor pulmonale syndrome, the indices of ventilatory function of the lungs were normal or only slightly decreased. No significant correlations were observed between hemodynamic indices of pulmonary circulation and right ventricle and the parameters of the ventilatory function of the lungs.


Sphincterotomy and postsurgical mortality after operations on the common bile duct. In the light of an analysis of 692 operations on the common bile duct performed at the Department of General Surgery, Bielański Hospital in Warsaw, the author evaluated the postoperative mortality after these operations. Association of sphincterotomy with other procedures on the bile ducts does not increase the postoperative mortality, but the causes of death in cases with incision of the sphincter of the hepatopancreatic ampulla are connected mainly with the operation while in the remaining operations these causes are connected with more general factors. Acute postoperative pancreatitis takes the first place as the cause of death after sphincterotomy.


[Pleural puncture needle biopsy].

[Pleural puncture needle biopsy]. Two hundred and thirty patients with pleurisy had pleural biopsy done by Castelain needle. This examination was positive in 85.7% of cases in tuberculous pleurisies and in 50% of cases in neoplastic pleurisies. The yield of needle pleural biopsy is higher in these two cases than in bacteriology and pleural cytology. The low rate of incidents and accidents (5.5%) widens the scope of needle pleural biopsy in non purulent pleurisy.


[Pulmonary biopsy with Steel's needle. Practical value]. Eighty-seven biopsies were performed on 76 patients with the pneumatic trephine of Steel: -- 87% of biopsies were interpretable; -- 22% of fragments revealed only unspecific lesions or normal lung tissue; -- 65% of samples gave a credible histological diagnosis. Occurring incidents were mostly pneumothorax (41%) usually minor ones. In only 2 patients was drainage necessary. The superiority of the Steel method over the others arises from its usefulness in diffuse pneumopathies and its being better tolerated.


The course of treatment in schizophrenia in relation to the presence of affective disturbances. The frequency and type of affective disturbances developing in schizophrenia were evaluated and their relationship to the course of the disease and results of treatment was analyzed. The studied material comprised 67 patients with the diagnosis of schizophrenia, treated in hospital in 1973. The depressive and paranoid scores of Jaroszyński were used for evaluation of patients. Affective disturbances were found in nearly all cases, depressive symptoms being most frequent. The development or increasing intensity of depression could only partly be attributed to the action of neuroleptic drugs. No difference was found in the clinical pattern of affective distrubances between paranoid and cyclic schizophrenia. In the paranoid-depressive syndromes the best therapeutic results were obtained in cases with decreased complex activities and psychic inhibition. Neuroleptic drugs possessing some thymoleptic properties were used in treatment of these cases, sometimes in combination with tricyclic antidepressants. The results were in cases with significant anxiety, inhibition and depressive attitude towards the prevailing situation. Paranoid productive symptoms appeared in this group sometimes during treatment with tricyclic antidepressants.


[Indications for mediastinoscopy].

[Indications for mediastinoscopy]. Mediastinoscopy is a surgical examination exploring the anterior and superior mediastinum for diagnosing and localizing lesions, after taking such precautions as the elimination of vascular lesions. The indications are : interbronchial and intertracheobronchial opacities ; polylobulated mediastinal opacities ; the isolated opacity (in case of inconclusive mediastinoscopy, operate straight away) ; pulmonary lesions : to look for mediastinal node untraceable on X-ray. In the particular case of a broncho-pulmonary cancer, if it is anaplastic, mediastinoscopy is useful to determine diagnosis and contra-indications ; in other bronchial cancers, there are contra-indications in the case of bilateral invasion and blocking of mediastinal organs. Surgery is advised in case of hypertrophied though negative lymph nodes.


Cytogenetic investigations in cases of multiple developmental anomalies in children. The authors studied 59 children including 48 with multiple developmental anomalies and 11 with disturbances of sexual development. In 11 cases (18.6%) the following chromosomal abnormalities were found: in 5 cases of Down's syndrome, 3 cases of full trisomy G, 1 case of 46XX/47XYG+ mosaicism, and in 1 case translocation 46XYD--G--t (DqGq)+. In 3 cases Turner's syndrome was present, with 45XG in 2 cases and 45XO/46XX in the 3rd case. Klinefelter's syndrome was disclosed in 1 case (47XXY), true hermaphroditism with mosaicism 45XO/46XX in one case, and Edwards' syndrome in 1 case with 47XYE+. Multiple chromosome breaks were found in 2 children. In the remaining 46 cases cytogenetic investigations of lymphocyte cultures stained (without using the banding technique) failed to demonstrate any differences in the number and structure of the chromosomes. The following groups were isolated in this material: 8 cases (13.6%) of gene mutation determining systemic defects (homocystinuria, chondrodystrophy, and two cases of intestinal polyposis, adrenogenital syndrome and hereditary osteocartilagineous exostoses each), 6 cases of malformations of hereditary origin (10.2%)-- and 32 cases with negative family history (54.2%). In 12 cases of the last group (37.2%) a history of various teratogenic factors acting during pregnancy was elicited (viral and protozoan infections, drugs and other chemicals, quantitative and qualitative malnutrition, hypoxia, mechanical trauma, vibration).


Clinical manifestations and genetic aspects of true microcephaly. Thirty-five cases of true microcephaly were found in a group of 3192 children with severe mental retardation in special institutions. In comparison to the general population the individuals with this congenital anomaly have not only much smaller dimensions of the cerebral cranium but also of the splanchnic cranium, although in a less significant degree. Body height and weight were found to be smaller as well. The neurological findings included, most frequently, slight abnormalities, in some cases hemiparesis was present. In the radiological findings an evident disproportion was observed between the cerebral and the facial parts of the cranium. A constant finding was mental retardation which was either profound or severe. True microcephaly is inherited as a recessive autosomal trait. The incidence of this condition in the Polish population is 28526 X 10(-6). The incidence of mutation of this gene is 14262 X 10(-6).


[Results of mediastinoscopy].

[Results of mediastinoscopy]. The authors study the results of a series of 536 mediastinoscopies performed by P. Humbert. Out of 239 mediastinal tumours, 206 had a history done. Out of 200 bronchial cancers, 123 pathological diagnosis were made. The recommendation of mediastinoscopy in bronchial cancers is discussed. Joining their experiences. P. humbert and H. Longefait report a positive percentage of 86% out of 902 examinations.


[Surgical biopsies of the lung].

[Surgical biopsies of the lung]. Open-chest biopsy performed by an experienced team is a safe way of obtaining samples of suitable size. It is recommended in diffuse pulmonary diseases whose etiology could not be identified by the usual diagnostic means. Pulmonary needle biopsy is a blind method not without risks and should always be performed in the vicinity of a chest surgical unit. Nevertheless it can be considered an initial diagnostic step, followed if unsuccessful by an open-chest biopsy.


[Open chest pleuro-pulmonary biopsies. Study of optimal conditions for sampling (apropos of 141 cases)]. One hundred and fourteen pulmonary biopsies were performed to diagnose diffuse pulmonary diseases. Diagnosis was made in 98% of cases. Biopsy requires very methodic rules for the sampling and its utilization. These rules are reported.


Intellectual efficiency and symptoms of the schizophrenic process. The purpose of this work was to determine the influence of psychosis on the intellectual efficiency in psychotic patients. The scores obtained by schizophrenics tested according to the Wechsler-Bellevue scale were correlated with psychopathological symptoms established during psychiatric examination. The group included 55 patients (18 women and 37 men). The results were subjected to statistical analysis. The following correlations were disclosed: 1) a correlation between the results of Wechsler scale scores and sex as well as the educational level, 2) a more pronounced correlation between the presence of psychotic productions and the results of the performance scale (in relation to verbal scale), 3) higher variability of scores in the verbal scale than in the performances scale, 4) lack of correlation between the age, the age of onset and the results.


[Surgical pulmonary biopsy under local anesthesia and its results (based on 93 cases)]. The authors report 93 observations during which OCB were performed under local anesthesia. They insist on the validity of the method which can be used on fragile patients or on those with respiratory insufficiency for whom an exploring thoracotomy would be contra-indicated. Incidents were minor and momentary (pneumothorax, pleural reaction). It is mostly in diffuse lesions of miliary and fibrotic nature that this technique was used to identify various lesions : silicosis, sarcoidosis, tuberculosis, histiocytosis, etc... In a third of the cases, lesions were not specific and could not be definitely identified in parieto-alveolar fibrosis or inflammatory alveolitis.


[Note on the complications of pleural needle biopsy: neoplastic seeding of the wall (apropos of 300 effusions and 440 puncture biopsies)]. Out of 440 pleural biopsies done with Abrams or Castelain needle, performed over 11 years in 300 pleural effusions, only 14 incidents of accidents occurred. There were 9 minor ones (intrapleural bleeding, subcutaneous emphysema, pneumoserosa by aspiration). Neoplastic graft along the biopsy tract was observed in 5 cases, of which 4 were primitive malignant mesotheliomas and one a primitive appearing neoplastic pleurisy. The risk of parietal neoplastic seeding runs high in malignant mesothelioma, considering that 11 such cases were included in this series of biopsied patients. This risk is not specific to plaural biopsy and can be encountered in simple thoracentesis. This complication therefore is not a contra-indication to needle biopsy as it is only observed in diseases beyond surgical redemption.


[Biopsies in pneumology].

[Biopsies in pneumology]. The techniques of different bioptic and cytological examinations performed in pneumology are presented. The various indications for these biopsies in pulmonary, pleural and mediastinal pathology are considered. Interpretation of results leads to a precise diagnosis and to diagnostic information on lesions otherwise difficult to define. In some cases conclusions cannot be reached because of the insignificant changes observed on too small samples.


[Biopsies in pneumology: pleuroscopies-biopsies]. From already published cases and from those recently obtained (511 in all) the authors recollect their experience in lung biopsy : in 426 cases, a precise diagnosis was made by different methods. After having statistically analyzed the validity of pleuropulmonary multipuncture by comparison with pleuroscopy-biopsy, they underlined the necessity to use, in the latter technique, a flexible fibroscope, much used in bronchoscopy. They conclude in classifying the indications for each method in relation to the topography and the type of disease.


[Pulmonary needle biopsy in children].

[Pulmonary needle biopsy in children]. Pulmonary biopsy done with a needle of circular bore, can be performed on very young children. A sample of tissue, big enough to establish a precise diagnosis in 2/3 of cases, can be obtained. The main complication is pneumothorax occuring about once in five. Hemoptysia or hemorrhage has never been observed. A proposed indication of premortem biopsy accelerated the death of a child with congenital pulmonary fibrosis. The search of a diagnosis in diffuse pulmonary diseases is the major indication for pulmonary biopsy in the child.


[Pleural biopsies].

[Pleural biopsies]. The author reports his experience in needle pleural biopsies performed on 106 patients, confirming the value of this examination for pleural tuberculosis.


Visual complications of polymyalgia rheumatica (polymyalgia arteritica). Four case histories are reported in which patients with polymyalgia rheumatica (polymyalgia arteritic) developed evidence of cranial arteritis (in one case two years and in one six months) following withdrawal of steroid therapy after apparent cure. In three cases partial or complete loss of sight has resulted. Steroid therapy should not only be introduced rapidly at appropriate dosage levels as soon as the diagnosis is made but should not be reduced or discontinued prematurely.


Phenylbutazone and anticoagulant control. Three patients in whom serious haemorrhagic complications occurred as a result of interaction of phenylbutazone with warfarin are described. A suggestion as to how this could be avoided is put forward.


[Investigations of the working capacity of children 7 to 10 years old (author's transl)]. The investigations performed have aimed at explaining how the adaptation of the cardiovascular system to exertion occurs in 7 to 10 years old children, and whatthe level of working capacity in this age group is in girls and boys, and also what relationship there is between the level of working capacity and such morphological parameters as body weight, body height and body surface area, and to elucidate whether systematic swimming, instead of traditional physical education lessons, exerts an influence on the level of working capacity of children in this age group. All 7 to 10 years old female and male pupils of the Primary School No. 183 in Warsaw were examined. In total 131 children were examined, among them 67 boys and 64 girls. Only healthy children were examined. The examinations were carried out in the school premises from November 1971 to February 1972. 30 boys were examined with greater accuracy at the Academy of Medicine. The examinations were carried out on ergometer bicycle assessing the adaptation to exertion and physical work capacity during three various submaximal exercises. The working time during each exercise depended on the achievement of a steady state and lasted 6-8 minute on average. The magnitude of the load burden was ajusted individually for every child according to its working capacity. The adaptation of the cardiovascular system to exertion was assessed by virtue of the analysis of the course of the changes in heart rate and the arterial blood pressure. The adaptation of the respiratory system to exertion was assessed by virtue of measuring the number of respirations, minute lung ventilation and the respiratory quotient, determined during three submaximal exercises in an open system. Physical working capacity was determined according to Sjostrand-Wahlund's method (PWC170). In all children examined the changes in the cardiovascular system during work were linear. To the same amount of work the boys reacted by a lower heart rate than girls. The children responded to the work performed by a low increase in systolic pressure and a small decrease of diastolic pressure. In the fifth minute of the rest after work the heart rate resumed rest values or was lower than these values. At the same time the systolic arterial pressure resumed the initial state, but a slight decrease of the diastolic pressure was maintained for over five minutes of rest.


[Radiodiagnosis of the rupture of the meniscus of the knee. Auxiliary maneuver without contrast medium. Preliminary report (author's transl)]. Some times the diagnosis of injuries of the semilunar cartilages of the knee joint is very difficult and special studies are required like arthrography or arthroscopy needing previous training. The author states a simple manouver to obtain anteroposterior simple X-rays with valgus and varus forced position on the knee joint. Its possible to observe some times intraarticular gas in the knee joint (vacuum image) and this represents a tear of the meniscus as confirmed by surgery.


[Cytohormonal picture of the vaginal epithelium in girls with premature pubic hair (author's transl)]. The study has aimed at assessing the cytohormonal picture of the vaginal epithelium of girls in whom the appearance of "pubarche" before the period of physiological sexual maturation was first perceivable symptom of disease or of the influence of the influence of exogenous hormones. The observation involved 16 girls hospitalized at the Pediatric Clinical Department or the Oncological Clinical Department or were remaining under the care of the Endocrinological Dispensary of the National Research Institute for Mother and Child, in whom "pubarche" appeared at the age of 1-7 1/2 years. Vaginal smears were the material for the present study. The estimation of the cytohormonal pictures of the vaginal epithelium together with the clinical symptoms and the laboratory analyses enabled the author to draw the following conclusions: 1. There may be diverse causes of the appearance of premature pubic hair. 2. In girls, in whom "pubarche" was the first symptom of precocious sexual maturation induced by the central nervous system, in most cases pituitary gonadotropins were found in the urine and the cytohormonal picture of the vaginal epithelium showed an oestrogenic reaction. 3. In the case of premature pubic hair of unexplained etiology the cytohormonal picture of the vaginal epithelium was always atrophic. The cytohormonal smears taken from the vaginal epithelium of girls with with premature pubic hair may be a valuable test for establishing the diagnosis.


[Evaluation of the gastrocolic space in 100 cases of acute pancreatitis (author's transl)]. From 152 cases of acute pancreatitis treated at the intensive care unit of the Hospital General de México, the authors selected 100 in which they found radiological evidence of acute pancreatitis in fact to correlate those signs lonely or associated and to investigate their frecuency. The fundamental radiological signs found by the authors were: 1. Gastrocolic separation in simple abdominal X-ray film. 2. Sign of colon interrupted. 3. Centinel handle. 4. Stomach displaced, and 5. Generalized peritoneal reaction. The authors concluded that the simple abdominal X-ray film is of great aid because its positiveness in 90% cases. This is the first time in which the mentioned signs are shown statistically. In this paper are presented illustrative outlines and different X-ray films of clinical cases confirmed by surgery or post-mortem examination. It is enfatized the value of the gastrocolic separation in the diagnosis of acute pancreatitis.


[Reactivity of peripheral blood lymphocytes in children with pituitary dwarfism treated with human growth hormone (author's transl)]. The study has aimed at investigating the blastic transformation of peripheral blood lymphocytes in patients with pituitary dwarfism before, during and after the treatment with human growth hormone. The reactivity of lymphocytes in vitro was studied in cultures stimulated with phytohemagglutinin-M of the Difco Company (PHA), in cultures stimulated with human growth hormone (HGH), and in cultures non-stimulated in vitro. The investigations were carried out in 34 patients with pituitary dwarfism at the age of 7 to 19 years. The control group was made up of 16 healthy children, 8 to 15 years old who had never been administered HGH. The patients were divided into groups according to the circumstance whether it was the first or the subsequent contact with HGH, and according to the periods at which the blood samples were collected during after therapy. It was found that the capability of lymphocytes to blastic transformation after stimulation with a specific stimulus (HGH) in patients with pituitary dwarfism in comparison with the reaction of healthy children is reduced (Fig. 2). The ability of the transformation of lymphocytes in this case shows selectivity towards the stimulus because the inhibiting of the response was noted only after the stimulation with HGH, but not after stimulation with PHA. During the treatment with HGH, allergization of the body appears; this is evidenced by the increase in the percentage of blastic cells in autotransformation (Fig. 1).


[Thrombosis of the suprahepatic veins (Budd-Chiari syndrome) (author's transl)]. The suprahepatic veins occlusion or Budd-Chiari syndrome is an infrequent disease which etiology is very hard to obtain. In this paper the authors present the clinical case of a 26 years old female with epigastric pain, ascites, and vomite, iniciated just one month after her parturition and of six months evolution. 28 days after the admission the patient died and the post-mortem study showed complete obstruction of the suprahepatic veins by well organized thrombi. The authors point-out that the interrelation between this syndrome and the parturition is more frecquent than with the use of oral contraceptive drugs.


[Congenital heart diseases in newborns and infants; early detection, differentiation and accuracy of clinical diagnoses (author's transl)]. In order to facilitate for the general physicians the making of a suitable selection of babies who are in the most urgent need of specialized treatment at cardiac centres, simple methods for diagnosing and qualifying congenital cardiovascular diseases were elaborated. The following "minor" criteria were taken for suspecting a CHD: 1) cardiorespiratory distress following birth, 2) sequentially repeated Apgar score below normal, 3) "pneumonia" symptoms with respiratory distress, dyspnoea and cyanosis, attacks of unconsciousness, 4) feeding difficulties, failure to thrive, inexplicable irritability, 5) presence of other congenital anomalies. The almost certain presence of serious heart disease should be recognized in children, showing the following "major" symptoms: 1) permanent cyanosis, pallor or greyish colour, 2) cardiorespiratory failure (resembling usually symptoms of pneumonia), 3) ECG patterns indicating ventricular hypertrophy signs, 4) other significantly abnormal ECG patterns (e.g. AV and intraventricular conduction disturbances), 5) cardiac enlargement and lung vascularity abnormalities in chest X-rays, 6) weak, or impalpable arterial, particularly femoral pulses, femoral arterial pressures significantly lower, than at upper extremities, bounding pulses and high-pressure amplitude in arms and legs, 7) abnormal heart sounds and pathologic heart and vascular murmurs. A diagnostic "key", based upon evaluation of the "major criteria" facilitates the diagnosis and differentiation of the most important CHD's at neonatal and infantile age. When using this "key" one should keep in mind the relative frequency of incidence of particular lesions. The initial diagnoses by the above "key" were verified in 354 patients by cardiovascular catherisation, angiocardiography, surgical exploration, and for by autopsy. The diagnoses were perfectly accurate in 83.6% cases, in further 11.3% cases being also accurate but were supplemented by some details, and had to be corrected in only 5.1% cases.


[Early detection and differentiation of congenital heart diseases (author's transl)]. Observations have been carried out on 116 neonates and infants with congenital heart malformations, and cardiomyopathies; 75 of them died. The initial diagnosis was made at Maternity Hospitals or at Infants' Wards, mainly in county hospitals of the province of Gdańsk. Afterwards these children were sent to the pediatric cardiology ward of the Pediatric Institute in Gdańsk, where the diagnoses were verified. Catheterisation and angiocardiography were performed in 29 children; 18 patients were treated surgically due to operable heart malformations. Rashkind's balloon atrioseptostomy was performed in three infants. The diagnosis based on physical ECG and X-rays was correct in only 42% of cases, and was most accurate in children with transposition of the great arteries, syndrome of Fallot, coarctation of the aorta and ventricular septal defects. The greatest difficulties were caused by the cases with hypoplastic left heart syndrome, double outlet of the right ventricle, single ventricle. They suggested that the initial clinical diagnosis should be confirmed by hemodynamic data and angiocardiography.


[Cardiac catheterisation and angiocardiography in evaluation of congenital heart anomalies (author's transl)]. The material presented here was collected during 18 months since the Pediatric Institute in Poznań was opened. 252 children with congenital heart diseases were admitted to this institution. 152 children were over 12 months, and 100 were under 12 months old; 34 of them were less than 6 months old. 82 children were admitted for cardiac catheterization, angiocardiography or cine-angiocardiography. Below the age of 6 months the condition of the infants, endangering their life, was an indication for cardiac catheterization. In this age group catheterization and especially angiocardiography was not well tolerated by the small patients, but it was necessary to perform ballon septostomy in the transposition of the great arteries, or to establish definite indications for surgery. 5 children of this group died 48 hours after cardiac catheterization. The authors suggest that, in order to obtain better results, infants with cardiac malformations and in a condition endangering their life should be admitted as early as possible to hospitals where diagnostic and surgical services are working on continuous duty. This is not always possible because of technical and personnel difficulties.


[Mortality of children and adolescents in Poland caused by congenital cardiovascular system malformations, in 1961-1971 (author's transl)]. Congenital cardiovascular system malformations (including more than 90 per cent of heart malformations) constitute the largest group among patients with congenital malformations. The high mortality of children with these malformations in the first year of life (with the greatest threat in the first month of life) subsequently diminishes. The mortality rates of infants from congenital cardiovascular system malformations high in Poland and are exhibit no tendency to decrease. In opposition to countries with a generalized, efficient cardiological, particularly cardiosurgical treatment (Table I). The rate of occurrence of congenital circulatory system malformations amounts to 8 per 1000 live-born children. Consequently about 4300 children are born annually in Poland with cardiovascular malformations. With the present development of surgical and anesthesiological technique, and according to the kind of heart malformation, the indications for cardiosurgery include some 1,400 children annually with congenital heart and great arteries annually. In the last years annually some 200-250 cardiac operations and surgery of great arteries in children are performed in Poland; this amounts to 15 per cent of the present need.


[The analysis of complications and mortality rate of children with congenital heart diseases (author's transl)]. The highest mortality rate among 75 newborns and infants observed has been noted in children with hypoplastic left heart syndrome, transposition of the great arteries, double outlet of the right ventricle and single ventricle. In the newborn period the mortality rate was 96%, and later on it decreased. Cardiac failure complicated by pneumonia was the most frequent cause of the infant's death (47 cases), then anoxic spells and sudden death (12 cases), diagnostic and surgical procedures (10 cases). The causes of death of six children were apparently not related to the heart disease.


[Congenital cardiovascular malformations and concomitant complications as a cause of early infantile mortality (author's transl)]. The authors have presented the clinical history of 130 infants with congenital cardiovascular malformations, analysing the causes of deaths in this group of cases. Severe cardio-respiratory failure, related first of all to haemodynamic disturbances, was the most common direct cause of decreases in all age groups. Although the complicating pneumonia undoubtedly enhanced the unfavourable effects of the haemodynamic disturbances, it was rarely considered to be the direct cause of death of children with CHD's.


[A post-mortem analysis of 712 cases of congenital heart disease (author's transl)]. Congenital cardiovascular malformations were found in 712 cases (32.1%) out of 2159 autopsies, performed on children less than 16 years old, at the Department of Pathology of the Institute of Pediatrics in Warsaw since 1959. A detailed retrospective analysis of all the cases was performed. The author's own classification of congenital heart diseases was used in this analysis. The incidence of particular heart malformations or syndromes was presented. The most frequent ones were: transposition of the great arteries, tetralogy of Fallot and ventricular septal defects, in a decreasing frequency. An analysis of the age distribution of various cardiac malformations and a short analysis of the causes of death was made. The incidence of congenital heart diseases accompanied by other congenital malformations was analysed.