Reconstruction of mammary hypoplasma associated with chest wall deformities. Three young women who had significant unilateral hypoplasia of the breast, accentuated by marked rib deformities and hypoplasia of the pectoralis muscle, were treated by two-staged reconstructions. A custom-made chest wall implant and a breast prosthesis were used. In the absence of cardiorespiratory compromise, these are simpler operations than rib osteoplasties and the cosmetic result is better.


Replantation of severed ear parts.

Replantation of severed ear parts. We have used a technique whereby a severed ear part is sutured back into place on "shaved" areas on the medical surface of the remaining ear and on the corresponding retroauricular area. After 4 to 6 weeks, the ears are freed and the raw surfaces are skin grafted. We think that replantation of severed ear parts is justifiable, and we recommend this method whereby the supply of blood vessels is increased.


The re-do pharyngeal flap.

The re-do pharyngeal flap. Twelve patients with persistent hypernasal speech after a previous pharyngeal flap operation had a second pharyngeal flap operation performed by the high-attached technique. Six of them achieved complete or near complete correction of hypernasality in connected speech. Four showed speech improvement of a lesser degree. Two patients had no significant improvement.


Use of extensor pollicis longus tendon as a distal extension for an opponens transfer. We describe the use of the extensor pollicis longus tendon as an extension of the motor unit in an opponens transfer. Its advantages, and its successful application in 4 cases, are illustrated. To the best of our knowledge, this method has not been described before. We believe it to be a satisfactory addition to the other methods described.


A scanning electron microscopy study of micro-arterial damage and repair. The effects of microvascular clamps on the femoral vessels of rats were studied, using the SEM. The early changes observed were (1) local fusiform dilatation of the area secondary to necrosis of the muscular wall, (2) flattening of the longitudinal ridges in the endothelial (3) loss of laminar flow, (4) endothelial sloughing, (5) platelet aggregation, and (6) leukocyte adherence and diapedesis. The repair of the endothelium occurred by an early replication of the adjacent undamaged endothelial cells -- with their subsequent migration across a platelet bed. The coverage was complete in one week, although reorientation of the neo-endothelial cells took longer. On the basis of this study and our clinical experience, we think the ideal microvascular clamp would possess the following characteristics: small size, light weight, mechanical simplicity, flat jaws (one to two mm in diameter) coated with a non-slip surface, and calibrated to produce a pressure less than 30 gm per mm2. In addition the clamp should be unaffected by blood, autoclaving, or repeated use. No such clamp is commercially available now, but we hope that one will be available in the near future.


Cell size and growth characteristics of cultured fibroblasts isolated from normal and keloid tissue. No differences in appearance or in cell size distribution were observed between cultured fibroblasts derived from normal skin, mature scars, or keloids. Artifactual differences in cell size distributions between strains can result when populations are compared at different cell densities. Keloid derived fibroblasts remain euploid in culture, and they have the same growth rate and same degree of density-dependent growth inhibition as cultured normal human fibroblasts.


Congenital urethral fistula. Case reports. Two new cases of congenital urethral fistula are reported, and the literature on the subject is reviewed. The embryology is discussed and applied to the recorded examples of the abnormality in an attempt to understand the mechanism of their formation.


Nasolabial cyst. Case report.

Nasolabial cyst. Case report. We present a case of nasolabial cyst. The clinical and histological aspects are discussed and a new concept of the embryology of the nasolabial cyst in described.


Sideburn relationship in the male face lift. The importance of preserving the non-hairbearing preauricular skin in a male face-life is described and illustrated.


The "crown" excision of facial skin lesions. We present a method for local excision of facial skin lesions adjacent to the esthetic boundaries of the face.


More accurate removal of the hump in rhinoplasty. We present a technique to help remove the precise amount of nasal hump at exactly the previously determined level.


The effect of chronic self-administration of d-amphetamine on food intake, locomotor activity, and C14-leucine incorporation into cerebral cortex protein. Rats had free access to 0.02% d-amphetamine solution instead of water for 23 days. The daily amphetamine consumption was found to increase from 16 mg/kg on day 1 up to 47 mg/kg on day 23. Tolerance to the anorexic effect of the drug was apparent on day 11. The initial depression in body weight persisted throughout the experiment. The hyperactivity of rats remained at the same level despite the daily increase in amphetamine intake. The incorporation of C14-leucine into cerebral cortex proteins was initially increased and returned to control level after 2 weeks of treatment. No direct correlation between hyperactivity and brain cortex protein synthesis was observed.


Effect of morphine antagonists on drug-induced hypothermia in mice and rats. Since it has been reported that the narcotic antagonist analgesic, cyclazocine, has thymoleptic activity in man, certain neuropharmacological properties of this compound have been retrospectively analysed in rodents using diprenorphine, naloxone and RX 336-X 336-M (7,8-dihydro-5',6'-dimethylcyclohex-5'-eno 1',2',8',14 codeinone) as reference narcotic antagonists and morphine, desmethylimipramine and d-amphetamine as standard psychotropic agents. From interactional studies with alpha-methylparatyrosine (alpha-MT) in rats, and apomorphine, oxotremorine or reserpine in mice, the calorigenic activities of each compound were compared. Diprenorphine, naloxone and morphine (each at doses ranging from 1-30 mg/kg, s.c.) had no significant calorigenic effect in any test. Evidence of potential antidepressant activity for cyclazocine was based on a high dose (30 mg/kg, s.c.) preventing the development of reserpine-induced hypothermia. RX 336-M (0.5-16 mg/kg, s.c.) reversed established hypothermia in the reserpine and alpha-MT tests. Since this calorigenic action was not antagonised by naloxone it was concluded that narcotic receptors were probably not involved in the mediation of the effect. Although RX 336-M resembled desmethylimipramine and d-amphetamine in the reserpine (reversal) and apomorphine tests, contrasting data from the reserpine (prevention), oxotremorine and alpha-MT tests indicated possible psychotropic activity based on different neurochemical mechanisms.


Pre-trial cocaine and performance in rat. Cocaine injected pre-trial (10 mg/kg i.p.) improves performance in naive and high-performance (HP) and low-performance (LP) trained rats. When the effect of cocaine is removed, the number of conditioned responses decreases and equals that of drugless sessions. Cocaine favors only performance, not retention.


Current determination of lithium-induced minimum sodium requirement in rats. Lithium administration raises the minimum sodium requirement of the organism. Lithium treated-rats drink spontaneously a hypertonic sodium chloride solution and thereby protect themselves against the toxic effects of lithium. In the present paper it was studied whether the consumption of sodium chloride can be used as a quantitative measure of the sodium requirement. Rats given different amounts of lithium with food for about 2 months were given free access to water and a 0.46 M NaCl solution, and the 24-h intake of the latter was followed. It was found that the consumption of hypertonic sodium chloride increased with the lithium dosage and the serum lithium level. The consumption showed the following characteristics: (a) It was sufficient to prevent death from lithium poisoning. (b) When access to hypertonic chloride was discontinued for 48 h, the rats lost body weight; the body weight was reestablished within 1 h when the rats again had access to sodium chloride solution. (c) When sufficient amounts of sodium were given with the food, the lithium-treated rats drank no more sodium chloride solution than did the control rats. (d) When lithium administration was discontinued, the consumption of sodium chloride solution fell within 10 days to the control level. (e) The lithium-treated rats developed polyuria, but this was not the cause of the extra intake of sodium chloride. (f) The lithium-treated rats did not drink more of the hypertonic sodium chloride solution than was necessary to cover the minimum sodium requirement. The results indicate that the intake of hypertonic sodium chloride solution can, in fact, be used as a measure of the minimum sodium requirement in lithium-treated rats.


Evaluation of the psychotropic effect of etifoxine through pursuit rotor performance and GSR. Six volunteer normal subjects, aged 18-25 years, were selected from a university student population to compare the psychotropic effects of Etifoxine, d-amphetamine and placebo. All of them received Etifoxine 300 mg, d-amphetamine 5 mg and placebo in a double-blind randomly crossover design involving a single dose weekly. The criteria studied were the GSR and performance on the pursuit-rotor. The subjects were tested before (TO), 2 (T2) and 6 (T6) hrs after drug administration. At T2, both the GSR and pursuit-rotor performance obtained with each drug differed significantly from placebo, but not between drugs. The effects of Etifoxine were similar to those of d-amphetamine in reducing the GSR and improving pursuit-rotor performance.


Direct measurement of the effect of film miniaturization on diagnostic accuracy. A method for directly measuring the reduction in diagnostic accuracy incurred by altering original radiographs was applied to evaluate a 35 mm film system. A total of 4,290 readings of 2,145 proved cases were collected. Analysis of the results indicate that the 35 mm system reduced diagnostic accuracy by about 2.3% +/- 2.4% at a 95% confidence level. The same method can be used to evaluate other photographic reduction systems, television displays, enhancement schemes, or even the importance of clinical data in roentgenographic interpretation.


Cardiac rotation in left lower lobe collapse. "The flat waist sign". Some cases of left lower lobe collapse show slight right anterior oblique rotation of the heart, manifested by loss of the concavity of the left heart border on a perfectly symmetrical posterior-anterior or anterior-posterior projection. This is a useful differential diagnostic sign, because it is not present when the left lower lobe is compressed secondary to left upper lobe emphysema.


Spontaneous closure of traumatic arteriovenous fistula. A case of spontaneous closure of traumatic arteriovenous fistula with large false aneurysm is reported. The diagnosis was proved by follow-up angiographic study. The closure of the aneurysm is explained by thrombosis followed by fibrosis with occlusion at the venous orifice.


Tuberculosis of the colon simulating carcinoma. A case of tuberculosis mimicking carcinoma in the distal colon is reported. The difficulty in diagnosing a solitary tuberculous colonic lesion, a review of the literature, and a differential diagnosis are presented.


The normal endoscopic pancreatogram.

The normal endoscopic pancreatogram. Pancreatograms of 102 patients with proved normal pancreatic status were reviewed to establish normal standards of pancreatic ductal morphology, and precise details of ductal course, position, length, caliber, and variant anatomy were analyzed. The ampulla was found at the level of the second lumbar vertebra in 75% of cases, while the pancreatic duct crossed the spine at L1 in most cases. Mean ductal diameters were 3.1, 2.0 and 0.9 mm in the head, body, and tail of the pancreas, respectively.


Slowing of hepatic blood flow by halothane: angiographic manifestations. Extreme slowing of hepatic arterial flow occurred in 2 children who had angiographic examination under general anethesia with halothane. The incidence of this striking angiographic "halothane effect" was 32%. It was thought to be caused by a specific increase in hepatic vasomotor tone at the arterial, sinusoidal or venous level. The functional significance of the effect is unclear and its role in the production of hepatic dysfunction or massive hepatic necrosis is conjectural. No untoward effects were noted in our patients.


Segmental renal vein sampling for renin. Segmental renal vein sampling was performed in 25 hypertensive patients. In those with no arteriographic abnormalities or stenosis of only the main renal artery, renin levels from segmental veins were the same as those from the ipsilateral main renal vein. In patients with an infarction of a renal segment or stenosis of a segmental renal artery, the renin level from the corresponding segmental vein was often much higher than that from the main renal vein. Segmental vein sampling may reveal a significant source of renin production not apparent in samples from the main renal vein.


Subchondral resorption of bone in renal osteodystrophy. In a radiographic-pathologic study of the spine and several axial joints in a cadaver with renal osteodystrophy, subchondral resorption of bone is described as an important mechanism of osseous abnormality. Widening and irregularity of the sacroilliac and sternoclavicular joints and symphysis pubis are related predominantly to trabecular destruction beneath cartilage surfaces, substitutive fibrosis, and new bone formation. Subperiosteal abnormalities at these locations produce juxta-articular erosions. The presence of osteitis fibrosa cystica about multiple Schmorl's nodes within the thoracic vertebral bodies suggests that subchondral resorption beneath the cartilage end-plates of the spine may be associated with disk protrusions and represents one further example of hyperparathyroid joint disease.


A unified radiological approach to the detection of skeletal metastases. Radiographic bone surveys and radionuclide images, the principal methods of detection of skeletal metastases, have traditionally been treated as separate entities. Since their interpretation is reltaed, we attempted to determine the practicability of a unified radiological approach which employs both methods. All consultation requests for "skeletal surveys" or bone scans were reviewed, and an appropriate examination was "tailored" for each patient. During the inital four-month period, 141 patients were examined. Comparison of the final "tailored" examination with the original consultation request indicated that, without radiological guidance, excessive (18%), and inappropriate or inadequate (27%) examinations were ordered in many cases. The unified approach has proven to be feasible and desirable, resulting in a significant reduction of inappropriate examinations.


The effect of angiography on the electrophysiological state of the spinal cord. A study in control and traumatized cats. The tonic vibration reflex (TVR) and evoked cerebral potential (ECP) were used to evaluate the effects of aortic injections of Renografin- 76, saline, and a mixture of sodium and sucrose on the spinal cord in 7 control cats and 12 which were recovering from trauma. Results showed that Renografin-76 produced different toxic effects in control and traumatized spinal cords as measured by the TVR. The disappearance of either ECP or TVR following the Renografin injection in 4 cases exemplifies the enhanced risk of injecting angiographic materials into traumatized spinal cords during recovery. The TVR shows promise as an electrophsiological criterion of minimal toxic effects of angiographic contrast agents on the spinal cord.


Air-fluid levels in the sphenoid sinus in epistaxis and nasal packing. Air-fluid levels in the sphenoid sinus have been described in association with skull fracture, cerebrospinal fluid rhinorrhea, and sinusitis. The authors have observed this sign in the absence of significant trauma in patients with epistaxis and nasal packing. The fluid is probably normal sinus secretion retained due to prolonged recumbency, although other explanations for its accumulation are discussed.


The inclined lateral projection: a new view in temporal bone tomography. Radiographic findings in the inclined lateral projection are presented. This view provides detail of the malleus and incus which is not provided on any other view and also preserves the visualization of temporal bone anatomy seen by routine lateral projection. The frequent occurrence of ossicular pathology in inflammatory and traumatic diseases of the ear requires the meticulous radiographic examination of the ossicles provided by this projection. Patient positioning is uncomplicated and comfortable.


The sella turcica in Nelson's syndrome.

The sella turcica in Nelson's syndrome. Abnormalities of the pituitary fossa were observed in 22 patients who were noted to have increased skin pigmentation after bilateral adrenalectomy for Cushing's syndrome. Radiographs of the skull revealed sella abnormalities in 13 of the 22 patients. In the remaining 9, hypocycloidal tomography demonstrated sella abnormalities. In 8 of these 9, localized bulging involved the anterior inferior wall of the sella turcica; in 1, the posterior inferior region was involved.


Persistent basilar/middle meningeal artery anastomosis. Three cases of a basilar/middle meningeal artery anastomosis are demonstrated angiographically. No reference to previous angiographic demonstration of this vascular anomaly has been found in the literature, and only one similar case with an anatomical description has been located. An embryological explanation of this rare anastomosis is presented.


Gallium-67 scintigraphy of pulmonary diseases as a complement to radiography. Gallium chest scans of 575 patients were analyzed for their clinical usefulness in conjunction with chest radiographs. The series included patients with pulmonary carcinoma, lymphoma, tuberculosis, sarcoidosis, pneumoconiosis, and interstitial fibrosis. Gallum scintigraphy does not aid in the differential diagnosis of pulmonary diseases but is helpful in determining (a) the degree of activity of a known disease process: (b) treatment response, dosage, and duration; (c) the spatial extent of the disease; and (d) the presence of unsuspected disease foci hidden radiographically in the mediastinum, behind the heart, or in pleural or parenchymal scars.


Bilateral breast uptake of 99mTc polyphosphate in a patient with metastatic adenocarcinoma. Bilateral breast uptake of 99mTc polyphosphate was found in a patient with metastatic adenocarcinoma from the rectum. The metastatic breast lesion showed no radiographic evidence of calcification.


Radiological localization of the ampulla of Vater in an infant with duodenal atresia. The authors describe an infant with a duodenal diaphragm in whom preoperative radiographs localized the ampulla of Vater within the medial wall of the diaphragm. This frequent close association must be kept in mind in order to avert surgical injury to this vital structure.


Simultaneous echocardiographic recording of the semilunar valves in patients with normally related great arteries. On the echocardiograms of 2 infants with normally related great arteries, both semilunar valves were recorded simultaneously, a finding previously thought to be specific for d-transposition of the great arteries. Neither patient had d-transposition; in both cases the diagnosis was proved by cardiac catheterization.


Ultrasonic cholangiography. Gray-scale B-scan evaluation of the common bile duct. Gray-scale B-scanning permits evaluation of major portions of the bile ducts, especially those with significant dilatation. Injection of contrast material containing microscopic air bubbles through a T-tube with simultaneous ultrasonography detected multiple echoes filling in the previously echo-free area which represented the common bile duct, outlining both the duct and portions of the major tributaries. Reflections could be obtained from stones  within the duct. Follow-up examinations after surgery could be used to demonstrate shrinkage of the duct. Jaundice due to extra- or intrahepatic obstruction was successfully differentiated noninvasively.


Echographic evaluation of splenic injury after blunt trauma. In a significant number of patients with blunt abdominal trauma, the diagnosis of ruptured spleen is not readily apparent. Is is in these cases that echographic evaluation appears to aid significantly in diagnosis. Seventy patients with blunt abdominal trauma were studied by echography. Results indicated 61 true negative cases, 1 false negative, 4 true positives, and 4 false positives. Criteria for splenic rutures are set forth. Ultrasound is considered to be an excellent screening procedure for suspected splenic rupture.


B-mode ultrasonic evaluation of scrotal swellings. Fourteen consecutive patients with scrotal swellings were examined to determine the feasibility of a B-scan examination. All 14 cases were correctly diagnosed prior to surgery, the majority being hydroceles. Four representative cases are offered, one of which was a hernia with air-filled intestine.


Mammography of the definitively irradiated breast. The role of mammography in evaluating tumor response was examined in 27 patients undergoing definitive radiation therapy for breast cancer. Radiographic changes observed after treatment included progressive skin thickening, fibrosis of the subcutaneous tissue, and breast retraction. The persistence of a mass more than six months after irradiation suggests treatment failure. Serial mammography may be particularly important in the evaluation of patients with locally advanced disease who require extensive radiation therapy and in whom physical examination is inadequate for the assessment of tumor response.


Herpes zoster in children with stage I-III Hodgkin's disease. Herpes zoster infection developed in 12 (52%) of 23 children with Stage I-III Hodgkin's disease but had no prognostic significance. Of these 23 patients, 22 are presently alive without evidence of active Hodgkin's disease. The authors conclude that a combination of factors is important in the high incidence of herpes zoster, including more aggressive staging as well as more aggressive irradiation and chemotherapy, and that the results in their series would seem to justify continuation of this approach to staging and treatment in such cases.


Comparison of the image quality of 105mm film with conventional film. The contrast, resolution, geometric, and motion unsharpness, mottle, and overall impression of 105mm film were compared to these quantities in conventional spot film. It is believed that conventional filming is superior for low contrast objects and cooperative patients whereas with uncooperative, obese patients, the 105mm filming modality would decrease motion unsharpness.


Comparison of radiographic and optical magnification techniques for objects in arbitary orientations relative to the film plane. Radiographic and optical magnification techniques for objects lying in planes at arbitrary angles with respect to the film plane are compared. It is shown that there is no significant advantage of one technique over the other with respect to the degree of magnification achieved.


Repair of potentially lethal radiation damage in acute and chronically hypoxic tumor cells in vivo. The ability of animal tumor cells to repair potentially lethat damage was studied in vivo. Fifth-generation isotransplants of a spontaneous mouse squamous-cell carcinoma were irradiated under tourniquet-induced hypoxia or in air. Tumors were removed either immediately or 6 hours after irradiation and dose-response curves were determined by TD50 assays. Repair was attributed to cells in the hypoxic cell component for animals irradiated in air. Extensive repair was also noted for those irradiated under typoxic conditions. Implications of these results are discussed.


Predicting tomographic levels for urography. Based on a retrospective and prospective analysis of more than 200 consecutive patients undergoing excretory urography, the authors formulated a chart for determing optimum tomographic levels using the anteroposterior abdominal distance as a criterion. the renal contour was visualized satisfactorily in 93% of cases.


A retractable, multi-view gas delivery apparatus. The author described a radioxenon gas delivery apparatus which permits ventilation imaging of the lung in multiple positions during the rebreathing (equilbrium) phase following the administration of a single dose of tracer. A single, rapid check for gas leakage is outlined. This can be done before xenon is introduced into the system thus minimizing the chance of xenon escaping. The unit is suspended from the ceiling and retracts out of the way when not in use. A parts list is included.


The routine use of graphic data handlers in a radiotherapy department. Graphic data handlers are helpful in routine dosimetry. The authors describe a computer program using a graphic digitizer which facilitates determination of the equivalent square of an irregularly shaped field. The digitizer can also be used together with an incremental plotter to produce patterns by which Styrofoam molds can be cut for field-defining blocks. Both programs are designed to be used at a remote time-sharing computer station.


Hypotomic cholangiography with glucagon. Hypotonic cholangiography was performed with intravenous glucagon in 12 patients who demonstrated complete nonspecific obstruction of the distal common bile duct during postoperative T-tube or transhepatic cholanglography. In 8 cases (67%), a diagnostic result was obtained. Abolition of smooth-muscle spasm at the choledochal sphincter by glucagon-induced hypotonia appears to be a useful adjunct to roentgenography of the bile ducts.


The Amster grid test in radiotherapy.

The Amster grid test in radiotherapy. The author reports on the use of the Amster grid test to document and quantitate the results of radiation therapy. The test can be done by the patient at home and requires him to indicate on a piece of graph paper which lines appear distorted as he looks at the centered dot in the grid. It is rapid, inexpensive, and allows the therapist to compare various regimens and dosage schedules.


An inexpensive photographic strip-chart recorder for use with a commercially available ultrasonic scanner. A simple arrangement for producing strip-chart records using moving 70mm film and a commercially available motor-driven film magazine is described. The quality of the records is excellent and the cost is about $500. It is necessary to modify the ultrasonic B-mode scanner slightly by connecting the verticle deflection plates of the oscilloscope to one another through an on-off switch.


A molded acrylic applicator guiding the peroral X-ray beam. An intraoral acrylic mold technique to guide and maintain beam direction during oral roentgen therapy is described. It is used in combination with the treatment cone and a lead tube and protective diaphragm for collimation of the beam.


Proper shielding method for dynamic vertex cranial imaging. The shielding requirements for dynamic vertex cranial imaging with a scintillation camera have led to the development of a new shielding device which eliminates Compton scattered false counts by shielding both the camera detector and the cranium from extracranial activity and has proved to be effective and easy to use in actual clinical practice.


Fluid restriction before excretory urography. Despite a lack of hard evidence, many radiologists continue to support the use of fluid restriction before urography. Based on increasing the urinary contrast medium concentration, this has been shown to be a poor index for renal opacification. The usual overnight restriction produces no significant change in urine osmolality or opacification. Effective fluid restriction may produce a just detectable increase in pyelographic density but the nephrogram in unaffected, even by active hydration. Fluid restriction may occasionally result in inadvertent dehydration with serious or fatal reactions. Since it is ineffectual in improving the urogram and potentially hazardous, it should be abandoned.


Nuclear imaging: a new dimension.

Nuclear imaging: a new dimension. Tomographic techniques used in radiology have also found an application in nuclear medicine. Longtitudinal tomography blurs but does not eliminate structures outside the plane of interest. Transverse tomography eliminates out-of-plane structures, making accurate imaging possible. Positron imaging devices are well suited for transverse tomography because of their high spatial resolution and depth-independent response, but devices using a scintillation camera can visualize large volumes and are not restricted to the use of positron emitters.


Pulmonary videodensitometry in the diagnosis of carcinoma of the lung. Pulmonary videodensitometry permits the detection of vascular pulsations of the lung caused by the incremental blood flow to the lung associated with systole. These pulsations may be diminished or absent in a segment of the lung affected by carcinoma. Of 46 patients evaluated, 12 had carcinoma. The technique is discussed and representative amplitude changes are demonstrated. This technique should prove useful in the detection of processes which alter the pulmonary vascular pulsations.


Pseudopneumobilia.

Pseudopneumobilia. Demonstration of a lucent tubular shadow projected over the liver on plain films of the abdomen would suggest air in the common hepatic and bile ducts. Occasionally, however, the normal periductal fat which surrounds and follows these ducts like a sleeve can simulate pneumobillia. Intravenous cholangiography should confirm the true nature of the entity.


Lipoma of the diaphragm. Report of a case. A lipoma of the diaphragm was found at surgery in a 69-year-old man. Postmortem examination offered an unusual opportunity for radiological/pathological correlation. Diaphragmatic lipomas are usually asymptomatic and present radiographically as smooth, rounded masses which generally arise from the posterolateral portion of one hemidiaphragm. They may appear less radiopaque than would be expected of a lesion that size. Certain features of this case suggest that the lipoma may have been the result of chest trauma.


Evaluation of the gastrocolic space in 100 cases of acute pancreatitis. The frequency of the main radiological signs found in plain films of the abdomen is presented in 100 cases of acute pancreatitis. The authors believe that this is the first statistical analysis of the gastrocolic separation sign. It is most useful to recognize the gastrocolic sign because of its high incidence (49%) and to understand the physio-pathological alterations that contribute to its formation.


An evaluation of the Nissen fundoplication. The characteristic radiological findings which follow a Nissen fundoplication are reviewed. The esophagus may be narrowed but is intrinsically normal. A pseudotumor at the medial aspect of the fundus is generally present. The history and radiographic findings can normally differentiate this defect from neoplasm or a nonoperated hiatal hernia. Postoperative clinical evaluation has shown this procedure to be very valuable in the amelioration of symptoms.


Effects of some water-soluble contrast media on the colonic mucosa. Enemas of various solutions were administered to rats to determine if Gastrografin was specifically irritating to the colonic mucosa. Gastrografin was found to cause considerably more inflammation than Hypaque-25, or barium sulfate. Further studies with hypertonic sorbitol, Renografin-76, and Tween 80 suggested that (a) neither hyperosmolality nor the diatrizoate compound itself were damaging to the colon, and (b) Tween 80 most likely plays a major role in Gastrografin's inflammatory effect.


Hemobilia complicating needle liver biopsy. A case report with arteriographic demonstration. Massive hemobilia secondary to a needle liver biopsy developed in a 16-year-old boy with Hodgkin's disease. Cholecystectomy and common bile duct drainage failed to control the condition and the patients bled massively; management of the hemobilia was effected with left hepatic artery ligation. A review of the literature is presented, with a brief discussion of the clinical picture, pathophysiology, diagnosis, and management of this condition.


Renal fascia in urinary tract disease.

Renal fascia in urinary tract disease. The renal fascia is rarely detected on excretory urograms. When seen, it is usually associated with disease processes such as focal renal scarring, acute renal infection, renal calculi, and intrarenal and perirenal masses. In all cases of normal appearing kidneys with visualization of the renal fascia, undetected renal disease should be suspected.


Percutaneous nephropyelostomy in the management of acute pyohydronephrosis. Percutaneous nephropyelostomy using the posterolateral approach was employed together with antibiotics and other supportive therapy as the initial step in the treatment of acute pyohydronephrosis, with gratifying results. Percutaneous nephropyelostomy is recommended as the procedure of choice for this specific clinical emergency.


Use of excretory urogram information in the solution of the renal cyst/tumor/cortical nodule problem. A decision analysis was made of the choice of angiography or needle aspiration to solve the cyst/tumor/cortical nodule diagnostic problem. With a test panel of 43 proved cases, the urogram diagnoses and decisions made at the time of actual patient management were compared with those made by a radiologist viewing the test panel as unknowns. The test panel radiologist based his recommendations on his subjective probability estimates of the three diagnoses in each case. Results indicate that the use of subjective probabilities increases the frequency of specific diagnoses and decreases inappropriate choice of angiography or aspiration.


Angiographic appearance of the renal vein in a case of fibromuscular dysplasia of the artery. Renal venography was performed in a patient suffereing from hypertension due to fibromuscular dysplasia of the renal artery. The venogram revealed morphological changes in the renal veins similar to those seen in fibromuscular dysplasia of the arteries. Histological examination of the veins showed fibrosis of the medial wall layer.


The incidence and clinical importance of hysterographic evidence of cavities in the uterine wall. Filling of cavities in the uterine wall during hysterography was observed in 54 of 320 surgically excised specimens in which metal threads had been inserted at different levels for identification. Adenomyosis may have accounted for these cavities in 24%. Cavities secondary to adenomyosis in one part of the uterus coexisted when cavities not etiologically related to the disease in another part. Adenomyosis is generally not involved in the pathogenesis of cavities in the lower half of the uterus and does not account for cavities of more than 5 mm in diameter.


Tuberculosis of the breast.

Tuberculosis of the breast. Tuberculosis of the breast is rare and very difficult to differentiate from breast cancer both clinically and radiologically. The authors summarize the clinical and radiographic characteristics of the disease on the basis of 6 cases.


Periostitis and pseudoperiostitis.

Periostitis and pseudoperiostitis. Increased metabolic activity with the periosteum is demonstrated radiographically by the presence of a linear shadow of bone paralleling the cortex, most commonly reflecting increased osteoblastic activity and thus representing periosteal new bone. This is frequently seen in psoriatic arthritis and Reiter's syndrome. A similar picture occurs with increased osteoclastic activity and reflects rapid demineralization, simulating periostitis. This change must be recognized as a reflection of osteoporosis, lest the condition be misdiagnosed as inflammatory disease.


Precise biopsy localization by computer tomography. The ultimate accuracy of percutaneous needle aspiration and core biopsies is directly related to localization of pathology and of the needle tip. Localization methods currently in use include fluoroscopy, ultrasound, and angiography. The authors believe that localization by computed tomography is the single most accurate method for performing biopsies.


Computer tomography: the "resolving" intracerebral hemorrhage. Two patients with a total of 4 intracerebral hemorrhages were examined by serial computer tomography (CT) over a period of up to 6 months, revealing a progressive decrease in lesion volume and density which eventually became less than that of the surrounding brain tissue. These changes were interpreted as complete clot resorption with cystic residue. However, postmortem examination revealed residual hematomas with no evidence of recent bleeding. Three of these correspond in size to those noted on the initial CT scans. Intraparenchymal hemorrhages have stages of organization and resolution which may simulate normal brain density without significant volumetric alteration.


Angiographic features of subdural empyema. Subdural empyema, a relatively rare intracranial suppurative disease, is a surgical emergency and requires early diagnosis in order to ensure patient survival. Subdural empyema should be considered with one or a combination of the following in conjunction with an extracerebral collection: (a) an irregular border of the extracerebral collection; (b) a thickened vascular wall of dura; (c) a semilunar avascular zone on the lateral view; (d) spasm of the large arteries at the base of the brain with or without segmental arterial dilatation; (e) multiple peripheral arterial occlusions; and (f) enlargement of the anterior falx artery. Four verified cases are presented.


Anomalous communication of the external carotid and vertebral arteries. Persistence of the proatlantal artery. Persistence of the proatlantal artery is reported as a rare anomalous communication between the external carotid and vertebral arteries. The embryology of the anomaly is briefly discussed.


Pontine arteries in brainstem glioma.

Pontine arteries in brainstem glioma. Five cases of brainstem tumor are presented. In each case, hypertrophied and stretched transpontine arteries could be identified in the Towne projection of the vertebral angiogram. The abnormal pontine vessels clearly indicated the transverse enlargement of the brainstem. The identification of enlarged transpontine arteries indicates a brainstem mass and helps to exclude extrinsic lesions even when confusing paradoxical vascular displacements are present.


Adult arteriosclerotic moyamoya.

Adult arteriosclerotic moyamoya. Progressive idiopathic distal internal carotid artery occlusion in children and young adults associated with the development of bridging channels and tortuous, plethoric intracerebral arterial networks has been termed moyamoya or Nishimoto's disease. It is now generally recognized that this unusual angiographic patten results from collateral supply pathways and is not a primary angiomatous process. The authors describe 2 middleaged patients with intracranial arteriosclerotic occlusive lesions demonstrating secondary collateral patterns angiographically identical to moyamoya.


Percutaneous spinal cord puncture and myelocystography. Its role in the diagnosis and treatment of intramedullary neoplasms. Three patients with cystic tumors of the cervical spinal cord were evaluated with percutaneous cord puncture and myelocystography. This procedure gives relief of symptoms and permits delineation of the extent and character of the cystic mass.


Pulmonary distribution of an inhaled radioaerosol in obstructive pulmonary disease. Pulmonary distribution of an inhaled radioaerosol was analyzed in 20 cases of chronic obstructive pulmonary disease (COPD) and 8 of other OPD. Nonciliary/ciliary partition of the distribution correlated with the severity of airway obstruction and approximated 3:1 in mild and 1:3 in very severe obstruction. In nuclear images, the distribution featured contrast abnormalities of hyperdeposition and hypodeposition. Intense hyperdeposition most commonly occurred in hilar and perihilar large airways. In isolated instances, hyperdeposition almost certainly occurred focally at sites of partial bronchial obstruction and diffusely by expiratory trapping; hypodeposition occurred distally to bronchial obstruction and in areas of parenchymal loss.


Duodenojejunal atresia with "apple-peel" small bowel. A distinct form of intestinal atresia. Prenatal occlusion of the superior mesenteric artery results in a distinct type of distal duodenal or proximal jejunal atresia in which the dorsal mesentery is absent and the distal small bowel assumes a spiral configuration around its vascular stalk, strongly resembling an apple peel. In some instances the condition is transmitted genetically as an autosomal recessive disorder. The mortality rate is much higher than in either simple duodenal or jejunal atresia because of deficient collateral circulation to the small intestine. The authors tell of 2 patients who died of necrotizing enterocolitis, a disease related to vascular insufficiency.


Radiographic features of colitis associated with the hemolytic-uremic syndrome. Four cases of colitis associated with the prodromal phase of the hemolytic-uremic syndrome are presented. Abnormalities demonstrable on barium enema examination consist of prominent filling defects, marginal serrations, and mucosal edema. Segmental bowel dilatation and areas of stenosis may also be present. Although nonspecific in itself, this appearance of the colon when correlated with the clinical history and peripheral blood smear should enable the radiologist to suggest the diagnosis of hemolytic-uremic syndrome.


Total anomalous pulmonary venous connection to the left vertical vein. A plain-film sign useful in early diagnosis. Total anomalous pulmonary venous connection to the left vertical vein often may be recognized on the plain postero-anterior chest radiograph by the characteristic supracardiac shadow. This "snowman sign" is useful in older patients but rarely is apparent in infancy. In such young patients the authors have discovered a density anterior to the trachea on the lateral chest radiograph. This finding is present prior to the appearance of the snowman sign and should prove useful in the early diagnosis of this anomaly, facilitating prompt, appropriate treatment. Five representative cases are tabulated and developmental and clinical aspects are reviewed.


Multicystic kidney: a sonographic pattern. Preoperative B-mode ultrasonography was performed on 7 infants who subsequently were surgically proved to have multicystic kidney disease. Five of the 7 showed a characteristic pattern consisting of a predominantly cystic mass containing septa which divided it into cysts of varying sizes. It is concluded that ultrasound is a reliable method of detecting unilateral multicystic disease of the kidney.


Massive edema of the ovary.

Massive edema of the ovary. Ovarian edema is a newly recognized clinicopathologic entity. A case of massive ovarian edema is presented in which a huge abdominal mass was considered to be an ovarian cyst roentgenographically and clinically. However, ultrasound revealed the mass to be solid. Five previously reported cases in which ovarian edema simulated a fibroma are reviewed.


Medial deviation of the ureters secondary to psoas muscle hypertrophy. Bilateral medial deviation of mid and distal portions of the ureters can occur as a normal finding in patients with psoas muscle hypertrophy. Two groups of patients are presented, both composed of young, healthy males. In 13 patients, the distance between the ureters at the narrowest point averaged 3.7 cm. Psoas muscle hypertrophy was evident radiographically and confirmed by ultrasound. In 20 patients with normal psoas muscles, the average minimum distance between the ureters was 7.1 cm. The importance of this observation is to avoid overdiagnosis of retroperitoneal disease in this group of young, muscular men. The differential diagnosis and severe examples of this normal variant are presented.


Changes in mouse blood pressure, tumor blood flow, and core and tumor temperatures following nembutal or urethane anesthesia. Female CBA and WHT mice with tumors transplanted into the right leg were immobilized in insulated capsules. Tumor blood flow, blood pressure, and core and tumor temperatures were monitored prior to and during anesthesia with either Nembutal or urethane. Nembutal caused a 5 degree C drop in both core and tumor temperatures in 20 minutes. Urethane induced a small fall in temperatures. Urethane initially caused a small drop in blood pressure followed by recovery; Nembutal caused a steady fall in blood pressure to 50% of resting value.


The effect of x-ray spectra from molybdenum and tungsten target tubes on image quality in mammography. The measured x-ray spectra from a molybdenum anode Senographe mammography unit and a tungsten anode unit were used to calculate the x-ray energy spectra transmitted through various thicknesses of fat and water (breast-equivalent materials). The dependence of subject contrast and patient exposure on (a) x-ray spectra, (b) attenuation properties of two breast-equivalent materials, and (c) thickness of breast-equivalent material was predicted. Radiographs of resected breast tissue confirmed these predictions and demonstrated the general relative effects of x-ray beam quality on image contrast in mammography.


An evaluation of screen-film speed characteristics. The relative speeds of six commercially available screen-film combinations were evaluated. There is a nonlinear relationship throughout the kVp range between the calcium tungstate, barium strontium sulfate, and rare earth screens. The speed of the last two types falls off considerably at lower kVp levels.


Performance evaluation of phototimers.

Performance evaluation of phototimers. Phototimers detect x rays impinging on or emerging from an x-ray film cassette and terminate the exposure after a predetermined amount of radiation has been received by the film. A phototimer must provide reproducible film exposures over a wide range of target-to-film distances, patient thicknesses, and technique variables. A method is needed which verifies that the phototimer is functioning properly and identifies exposure techniques and practices which are compatible with its use. Several techniques are presented for evaluating phototimer performance, and data accumulated during application of these techniques to the use of three spot-film phototimers are presented.


Compliance characteristics of angiographic guidewires. Although the manufacturers' specifications may be identical, brands of widely employed straight, long-paper angiographic guidewires vary considerably in performance. Because guidewire flexibility is a key factor in performance, we investigated the characteristic compliance patterns of similar guidewires (using an apparatus of our own design) from four different manufacturers. The brands were found to differ significantly in compliance at the tip, in rate of change in compliance, and in overall length of taper.


Percutaneous needle endoscopy of renal cysts. Direct visualization of the interior of renal cysts by means of an endoscope inserted through an ultrasonically guided needle in the flank has been performed satisfactorily in 12 patients. Useful information was obtained in all cases. While the procedure is still experimental, it appears promising and worthy of further evaluation.


A special treatment couch for irradiation of a large body volume. A special treatment couch has been designed for deployment of a greatly extended treatment distance for irradiation of a large body volume, particularly an irregular one which requires shielding. The basic unit is a commercial hydraulic lift table to which an appropriate plywood top and small wheels were added. Its advantage is its capacity to transfer very ill and disabled patients quickly and safely from a wheelchair, portable hospital litter, or bed.


Jugular venous reflux in cerebral radionuclide angiography. Jugular venous reflux was observed in six routine cerebral radionuclide angiograms. Repeat studies during a Valsalva maneuver failed to reproduce the reflux. In one case the reflux appeared to be related to the arm position; but in the other five cases, the cause remains unknown. Such reflux may be mistaken for superior vena cava syndrome or asymmetric carotid blood flow.


A simple method of femorocerebral catheterization. A method of catheterizing the cerebral vessels by the femoral route which does not require seating the end hole prior to guide wire introduction has been devised. The orifice of the desired vessel can be localized fluoroscopically via contrast material injections without undue manipulation prior to guide wire introduction.


How large the umbrella?

How large the umbrella? The move to McCormick Place invites a new look at the direction and expanding problems of the RSNA, not only in relation to size but to fundamental questions concerning roles, expectations and our ability to meet them. Although our exhibits, both scientific and technical, attest to our continued interest in and support of basic research and development, our major objective must continue to be the service of our community radiologists. To help us in this effort, many teachers give long hours of preparation and course work to the Meeting, sometimes at considerable loss of income. Should some return be made by the Society? Also, logistics have increased the burdens of the many committeeman who have given so much time and effort to see the Meeting through. A meeting manager should be appointed to relieve our members of some of these chores.


Out of the frying pan into the fire?

Out of the frying pan into the fire? During the last 10 years or so, many departments of therapeutic radiology have lost their medical and fiscal independence by administrative incorporation into "departments of oncology." The author feels that the aims of oncology centers, viz., consolidation of cancer-related activities, promotion of the image of a functioning cancer center, and the multidiscipline care of cancer patients, do not justify the radiotherapist's loss of identity within such a complex.


The morphological principles of anorectal continence. Anal continence is depending on the rectum, the anal skin, the external anal sphincter and the levator ani as well as the corpus spongiosum of the rectum and the internal anal sphincter. Continuous contraction of a sphincter without fatigue can only be accomplished by smooth muscles. The internal anal sphincter in man does not contain any ganglion cells. It differs from the gastro-intestinal tract by not containing the so-called p-fibres. This electron microscopic difference between the internal anal sphincter and the rest  of the gastrointestinal tract can also be demonstrated pharmacologically. Cholinergic and adrenergic fibres will both produce contraction of the internal sphincter. Comparative anatomical studies also show the uniqueness of this sphincter. For instance in the kangaroo the internal anal sphincter is the main sphincter of the anus. The sphincter system, like all other systems, is unable to regenerate and is therefore more than adequately provided for. For instance continence will be maintained even when the greatest part of the ring musculature has to be divided in patients with high ano-rectal fistulae.


Operations for the improvement of faecal incontinence. Experiences and results are reported of Pickrell's gracilis sling transplantation in 30 cases. 24 cases could be followed up. In 21 of these there was definite improvement of continence. The favourable results are attributed to the contractibility of the muscle after transplantation. After high anal and rectal atresiae, a maturation of anorectal structures and a belated rectal adaption reaction may be observed, which can be attributed to the gracilis sling operation. It seems, therefore to be sensible to perform the operation earlier than has been practised hitherto.


Genetic counselling in cases of anal and rectal atresia. The familial occurrence of anal and rectal atresia is investigated in literature including a material of 169 patients of children's hospitals in Munich. Positive family history was found for only one of 169 patients. The mode of inheritance in those families with more than one affected member is generally considered to be autosomal recessive, although several families with X-chromosomal recessive inheritance have been described. In approximately 50% of the cases, anal atresia is associated with other malformations. Twin studies indicate that genetic factors play only a minor role in the etiology. The genetic risk in cases of isolated anorectal atresia is estimated to be well below 1%.


Electric stimulation of the bladder and the anal sphincter - a new way to treat the neurogenic bladder. The experiences gained with the intravesical electrostimulation of Katona in 14 children with neurogenic bladders have shown that it is possible to rehabilitate children with neurogenic bladder damage. All these children had never experienced the urge to micturate and it was possible to produce in each of them the sensation of the urge of micturition. In four patients with total incontinence, continence lasting 1 to 1 1/2 hours could be achieved. In 6 patients with a retention overflow bladder micturition leaving no residual urine, a sterile urine and the ability to remain continent for up to 2 hours was achieved. In children with retention overflow bladders which are resistent to therapy, a combinatuon of electrostimulation and resection of the pudendal nerves in girls or external perineal sphincterotomy in boys has provided its value. Anal incontinence can also be cured by direct stimulation of the anal region as we have shown in four patients. These results as well as the results reported by Katona [18] encourage us to recommend electrostimulation in a large number of cases. Should this treatment fail, it is still possible to carry out urinary diversion.


Abnormalities of function and faecal water following the modified Soave operation for Hirschsprung's disease. Fourteen out of 18 patients (78%) had abnormal function 32 months after the modified Soave pull-through procedure for Hirschsprung's disease. The abnormalities were loose stools [9], perianal excoriation [7], soiling [11] and rectal prolapse [7]. Excoriation was caused by stools containing an excess of water, particularly in the "extractable" phase, with raised Na+ and Cl- concentrations, osmolality and hydrogen ion (pH) but normal concentration of K+. A deficiency of dry stool solid was also demonstrated. Abnormalities were most marked in patients who had high inferior mesenteric artery ligation and residual proximal left colon. Faecal water abnormalities are due to failure of complete water and electrolyte re-absorption by the pulled-through bowel. Manometric studies indicate that post-Soave patients have a small, "spastic" rectum with poor reservoir capacity which leads to soiling. Perianal excoriation occurs when faecal composition is abnormal. Four patients were improved on small doses of oral Ispaghula husk fibre. Clinical improvements were associated with alterations in stool composition.


Primary rectal ectasia. A quantitative study of smooth muscle cells in normal and hypertrophied human bowel. The quantitative study showed that, in the normal human colon, smooth muscle cells increased both in size and in number in the first three years of life. Then the cell size remained relatively constant, having an anverage value of 4,260 cubic microns, while the cell number increased further with age. In the secondary megacolon in children with Hirschsprung's disease, both hypertrophy and hyperplasia of smooth muscle cells were found as a response to the obstruction. Release of obstruction by a defunctioning colostomy was followed by a reduction in size of the hypertrophied smooth muscle cells, but the increased cell number persisted for more than three months. The specimens of megarectum and megasigmoid colon associated with congenital rectal fistulae were different in their muscle cell dimensions according to the age after birth when the quantitation was undertaken. When examined weeks or months after birth, the walls of the enlarged viscus were thick, the muscle cells were hypertrophic and the numbers were greater than normal. Faecal masses, when present in the defunctioned obstructed bowel, probably induce hypertrophy and hyperplasia of muscle cells. When, however, the specimens of the large rectosigmoid confluence were obtained for quantitation within a few hours after birth, they were found to exhibit localized expansions with abrupt change to nearly normal calibre, the dilated bowel being thin-walled and containing muscle cells in normal or smaller than normal size and numbers. It is probable that some of those obtained later were at birth similar in their muscle cell dimensions to those examined at birth, but that hypertrophy and hyperplasia had developed secondarily. The muscle cell dimensions of the viscus at birth indicates that the enlargement was not caused by the stimulus of increased work load prior to birth. Those enlargements present at birth are presumably developmental aberrations of expansion or overgrowth of the cloaca when the vesical component is also enlarged, or of its posterior component when the rectum alone is enlarged. When the rectum is abnormally large at birth and is subsequently used in reconstructive surgery of the associated anorectal deformities, it may lead to a large "terminal reservoir" with overflow incontinence which does not respond to aperient or bowel washout treatment. If recognized on the newborn pre and post colostomy radiography, reconstruction should include excision or perhaps trimming, of the dilated segment. The term primary rectal ectasia was recommended as the connotation for this special entity as distinct from megarectum developing to secondary obstruction.


The association and embryogenesis of tracheo-oesophageal and anorectal anomalies. Thirty-one patients with combined oesophageal and anorectal anomalies were studied. They comprised 10% of 328 consecutive foregut malformations and 246 anorectal deformities. Twenty-three of this series also exhibited at least 3 of the VATER defects. There was a very high incidence particularly of associated vertebral, urological and musculoskeletal anomalies. This high incidence of addditional lesions is presumably a reflection of generalized early damage to the mesenchymal tissues at the fourth week of gestation. Similar embryological mechanisms may take place and be affected similarly in both foregut and hindgut systems. The concept of a two-component septum dividing the foregut and hindgut is proposed to explain the formation and malformations in these regions. Disturbances of alignment, direction and extent of these component septa induced by hyperflexion of the foregut and hindgut, and intrinsic septal defects presumably account for most of the malformations. Hyperflexion may also account for malformations of other systems and for the high incidence of associated anomalies in the 31 patients with oesophagorectal deformities.


The identification and management of anorectal anomalies. The factors ensuring continence. In this paper, anorectal anomalies are classified according to a scheme devised at an international conference of 200 paediatric surgeons in 1970 in Melbourne, Australia. The classification is based upon the pathological anatomy of each type in relation to the sphincters available for reconstruction. A diagnostic plan of identification of each type is presented; this is based upon accurate observations of the external clinical appearance, the site and type of orifice, and the presence or absence of meconium in the urine. Extension of the detailed diagnosis is obtained with radiological studies - gas shadows in the inverted position and radio-opaque dye studies in the various orifices. The errors of interpretation of these investigations are discussed. The objective of surgery is a continent anus. The achievement of continence depends on several factors: (i) accurate pre-operative assessment of the anomaly and the available sphincters, with their nerve supply (ii) an operative technique which positively identifies the sphincters, and preserves them intact and undamaged (iii) supervision of the post-operative management, including gentle dilatation of the puborectalis muscle, avoidance of constipation, and advice on training. The various operative techniques for both high and low anomalies are described.


Radiological diagnosis of anorectal malformations. With the help of a few examples, it has been shown that radiological investigations of anorectal malformations with or without a fistula depend on the momentary state of contraction of the muscles of the pelvic floor. If this is not considered, mistakes will be made.


The problem of anorectal continence.

The problem of anorectal continence. Anorectal continence depends on the rectum, the muscles of the pelvic floor, and the anorectal sphincters. The function of the rectum is to delay the passage of the intestinal contents by adapting itself to propulsive waves. A pressure gradient in an oral direction allows stool to be pushed back into the more proximal intestinal segments. The puborectalis muscle is the most important muscle of continence because of its sensitivity as well as its motor activity. In contains sensatory receptor organs which trigger off the rectal sphincter reflex mechanism and produce a feeling of fullness. From the motor point of view, its contraction which the assumption of the erect posture will cause the anorectal angle and with it the reflex and voluntary contractions of the puborectalis. The association of reflex and voluntary contractions depends on muscle fibres with different biochemical and histochemical properties. The internal anal sphincter is the most important factor in maintaining the anorectal barrier to pressure at rest. At the same time, relaxation of the internal sphincter will initiate defecation. The ambivalent properties of the internal sphincter can be explained by the different electrical, pharmacological and histological properties of this sphincter. Relaxation depends on an inhibition of electric activities initiated by stimulation of the tension receptors in the parapuborectal tissues and transmitted via the lowest rectal ganglion of the mesenteric plexus to the non-adrenergic inhibiting P-neurons of this sphincter.


Associated malformation with anal and rectal atresiae. A survey of the frequency of associated malformations occurring with anorectal anomalies reviewing a large number of cases has been carried out. The urogenital tract, the extremities and the skeleton are most commonly involved. Esophageal atresia and hypospadias are the most important associated malformations. It was impossible to classify the associated malformations according to the sex of the patient or the level of the anorectal atresia.


Inhibition of secondary osteophyte formation in rheumatoid arthritis. Using radiographically demonstrated joint narrowing as an index of joint damage, a reduced incidence of osteophyte size and number as a measure of osteoarthritic change in the PIP and knee joints of patients with RA as compared to DJD has been demonstrated. The possible pathogenetic factors discussed include reduced joint use in RA, increased resilience of juxta-articular bone associated with osteoporosis in RA and the possibility that products of inflammation in the RA joint act locally or via juxta-articular vascular mechanisms to inhibit the secondary changes of DJD. Further study of the possible pathogenic mechanisms including the roles of joint stress, juxta-articular osteoporosis, and possible effects of the inflammatory reaction of the rheumatoid joint on intra-articular structures and juxta-articular vascular phenomena are needed.


The suppressing effect of indomethacin on articular cartilage. Indomethacin in pharmacological doses was given to rabbits with papain-induced degenerative arthrosis of the knee. The cartilage lesions healed between the 35th and the 70th day of the experiment. The healing was unaffected by indomethacin. However, autoradiographs showed a significantly reduced 35SO4 uptake in the articular cartilage of the animals receiving the indomethacin in both arthritic and control knees.


Serological changes in progressive systemic sclerosis. Sera from 37 patients with scleroderma were studied for the presence of auto-antibodies. Rheumatoid factors and antibodies to smooth muscle and thyroid were seen in some patients. Ten of 31 patients (32%) had antibodies to nuclear antigens. They were not related to the extent or severity of disease but were often associated with other complications or coincidental diseases. These serological changes only occurred in the patients with progressive systemic sclerosis and did not occur in morphoea. Antibodies to double-stranded DNA were found in only one case, and neither clinical nor serological overlap with systemic lupus erythematosus were seen in this group of patients.


[Indications for pacemaker therapy of the heart (author's transl)]. During the last few years the indications for pacemaker therapy could be extended in step with the lowering of the frequency of complications and the effort required of doctors and departments. Now one does not only aim at prevention of dangerous Adams-Stokes attacks but increasingly at improvement of the range of cardiac function. If there is no pharmacologic alternative there are no absolute contraindications. Pacemaker therapy is indicated also, if only temporary symptomatic improvement can be expected.


[Indications for coronary arteriography and left ventriculography in coronary heart disease (author's transl)]. Coronary- and LV-angiography in coronary heart disease are indicated I) to clarify whether or not surgery is required (e.g. aorto-coronary-bypass operation, aneurysmectomy) in 1) drug resistent angina pectoris, 2) myocardial aneurysms (or the suspicion of), 3) VSD following myocardial infarction and/or 4) as preoperative investigations in mitral regurgitation or 5) other valve lesions. II) These investigations are furthermore indicated in the under-50-yr.-old considering their prognosis and diagnosis 1) following myocardial infarction 2) to clarify a pathological exercise test with or without angina pectoris 3) in the differential diagnosis of myocardial diseases and 4) occasionally in patients with a number of risk factors or exposed to particular occupational hazards or from families with a high incidence of early deaths from heart disease. Coronary- and LV-angiography are contraindicated in 1) generalized stenosing atherosclerosis, 2) acute myocardial infarction, 3) failure from other organ-systems (e.g. kidney), 4) drug resistent endogenous risk factors and/or relevant obesity, 5) biological age over 60-65.6) continued nicotine dependence. In many cases the specific diagnostic investigations will include the assessment of coronary flow at rest and during maximal drug induced coronary dilatation. This enables us to estimate the coronary reserve and to diagnose coronary insufficiency in patients with normal coronary angiograms.- Instructive morphological and/or functional results illustrate this presentation.


[Coronarography, technique and results (author's transl)]. Coronary angiography is a radiologic special technique with its place in the diagnosis of coronary disease. It demands much equipment and time. Evaluation, particularly in coronary sclerosis, is valuable, since it makes subtile differential diagnosis possible. This in turn is the basis for modern individual therapy.


[Selective coronarography (author's transl)]. Advantages and disadvantages of coronographic techniques known so far are described. Disadvantages can be removed by the technique of premedication proposed by the authors which renders possible injection of contrast medium into the coronary vessels without reaction. The advantages of Theophyllin-premedication are described in detail. This technique is more reliable and provides better information in greater detail.


[The new radiologic units of measurement gray and becqerel (author's transl)]. The general conference on weights and measures in June 1975 introduced the new names of units, the Gray (for ionizing radiations) and the Becqerel (for activity of a radioactive substance), on an international level. The reasons for this change--the units hitherto valid are the Rad and the Curie--and the international efforts at durability of the new regulations are reported.


[Roentgenographic findings in patients with pacemakers (author's transl)]. Early roentgenographic documentation of the position of an implanted pacemaker by roentgenograms in two planes and fluoroscopy establishes the necessary basis for the roentgenographic examinations in identifying pacemaker malfunction. Early and late causes of pacemaker malfunction in 250 patients are described. Early complications arise at the tip of the electrode: displacement with or against the direction of blood flow, penetration or perforation of the myocardium and false implantation into the coronary sinus. Later causes of pacemaker failure have to be searched mainly in the electrode itself and the battery: damage to the cable or displacement of the battery. The problems of radiologic assessment of the state of charge of the battery are discussed.


The effect of chronic intragastric alcohol ingestion on the pancreatic secretion of the rat. The effect of chronic intragastric ethanol ingestion on the pancreatic secretion of rats was studied. The rats received 1 ml of 20% alcohol per 0.1 kg of body weight with gastric intubation five times weekly, and the total duration of ingestion was 10-12 weeks. Pancreatic juice was collected by cannulating the pancreatic duct under ether anesthesia; basal secretion was collected during 15 minutes, after which a further 15-minute secretion was stimulated with pancreozymin. The volume and the content of proteins, proteolytic enzymes, and trypsin inhibitors were studied. The secretion of proteins decreased significantly, while the amount of active proteolytic enzymes was increased in the pancreatic secretion of the alcohol rats. No active trypsin could be noted in either group. The amount of trypsin inhibitors decreased in the pancreatic juice of the alcohol rats compared with that of the control rats, but the decrease was relative to the decrease in the secretion of total proteins. No significant differences could be noted in the volume of the secreted pancreatic juice between the alcohol rats and the control rats. Pancreozymin increased the secretion to about twofold values, and the response to panreozymin was similar in the two groups.


Abolishment of oral trypsin inhibitor stimulation of the rat exocrine pancreas after duodeno-jejunal resection. The effect of long-term oral trypsin inhibitor administration on the exocrine pancreas was studied in unoperated rats and in rats operated on by a 30% proximal small intestinal resection. The following observations were made: in unoperated rats sacrificed 18 hours after the last trypsin inhibitor ingestion there was an increase of the wet weight of pancreas, increase of the pancreatic protein, and an increase of pancreatic and intestinal trypsin(ogen) and of pancreatic amylase by comparison with the controls. In operated rats, treated and examined in an identical way, no influences on the exocrine pancreas were found. It is suggested that the abolishment of the trypsin inhibitor effects on the exocrine pancreas in operated rats reflects the removal of the site of production of one or more intestinal hormone(s) or factor(s) responsible for these effects. In unoperated rats examined 4 hours after the last trypsin inhibitor ingestion a reduction of the pancreatic trypsinogen and amylase and an increase of the intestinal amylase were found, indicating a secretory response of the pancreas to the intraluminal trypsin inhibitor; the low values of intestinal trypsin found in these rats probably reflect inhibition of rat trypsin by the bovine lung trypsin inhibitor.


Salivary amylase in duodenal aspirates.

Salivary amylase in duodenal aspirates. Salivary and pancreatic isoamylases in duodenal aspirates obtained during assessment of pancreatic function after test meal stimulation were separated by agarose gel electrophoresis. Salivary amylase was found to be a constituent of the duodenal aspirates in more than 75% of the tests. The mean relative contribution of salivary amylase to the total amylase activity of the aspirates varied from about 15% in normals to about 40% in patients with chronic pancreatitis and pancreatic carcinoma. The amount of salivary amylase varied widely not only between the individuals but also within the samples of the same test series. Specific determination of the pancreatic isoamylases instead of determination of the total amylase increased the discrimination between normals and patients with pancreatic dysfunction.


Inhibition of sulpiride on the cephalic phase of gastric acid and gastrin secretion in duodenal ulcer patients. In 13 patients with duodenal ulceration psychic stimulation with food resulted in a significant rise in gastric acid secretion and in serum gastrin. This rise was abolished when the patients were pre-treated with sulpiride, a non-sedative neuroleptic acting on the hypothalamus. These findings suggest that sulpiride, by virtue of its inhibitory effect on the cephalic phase of acid secretion, may be a useful adjunct in the treatment of duodenal ulcers.


The clinical significance of classifications of cirrhosis. A comparison between conventional criteria and numerical taxonomy. Classification of patients with cirrhosis serves the clinical purpose of selecting patients for adequate therapy. A material of 441 patients from a randomized clinical trial of prednisone treatment were classified according to different criteria, and the effect of this therapy was assessed by comparing the survival curves of controls and treated patients in the groups. Six classifications based on single criteria were studied, viz. females vs. males, alcoholics vs. non-alcoholics, compensated vs. decompensated cases, active vs. inactive cases, manifest vs. latent cases, and non-primary biliary vs. primary biliary cirrhosis. The latter group was too small for further analysis. Furthermore, the material was classified by numerical taxonomy, based on 56 clinical symptoms and signs and histological and serological changes. The taxonomical classification showed interdependence with all the clinical classifications, except that of primary biliary cirrhosis. Three clinical classifications, viz. those based on sex, alcoholism, and compensation, and one taxonomic class showed a significant therapeutic relevance. Combination of these criteria revealed that female patients with compensated non-alcoholic cirrhosis, previously demonstrated to benefit from prednisone treatment, showed a markedly greater prednisone effect if they belonged to the taxonomic group than if they did not. According to clinical, histologic, and laboratory data, the latter group was characterized as less severe cases than the former one. Whereas this discrepancy between clinical severity and therapeutic effect cannot be fully explained, the data do suggest that clinical criteria may not be ideal for selection of patients with cirrhosis for steroid therapy, and that numerical taxonomy may provide clues for more clinically significant classifications.


Cellular immune reactions against common antigen, small intestine, and colon antigen in patients with Crohn's disease, ulcerative colitis, and cirrhosis of the liver. Patients with ulcerative colitis showed in 71-93%, patients with cirrhosis of the liver in 64-91%, cellular immunity against Common Antigen (CA) and human fetal intestinal antigens as measured by the leucocyte migration test (LMIT). Patients with Crohn's disease exhibited cellular immune reactions to a lesser degree - from these only patients without immunosuppressive therapy differed significantly from normal controls (p less than 0.05). Approximately 30% of patients with Crohn's disease and ulcerative colitis had elevated antibody titers against intestinal antigens and CA. A high percentage of patients in both diseases showed a reciprocal relationship between cellular and humoral immunity. It was concluded that Crohn's disease and ulcerative colitis can be separated in most cases using intestinal antigens and CA in the LMIT. The occurrence of cellular immunity against these antigens cannot be interpreted as being the only pathogenetic principle in these two diseases. It is also concluded that there appears to be only a weak immune tolerance against intestinal antigens. The high percentage of cellular immune reactions in patients with cirrhosis of the liver demonstrates that this group may have an impairment of the physiological elimination of antigens by the liver.


Ultrastructure of parietal cells before and after proximal gastric vagotomy in duodenal ulcer patients. In order to examine whether the reduced acid secretion observed after proximal gastric vagotomy (PGV) is accompanied by intracellular changes in parietal cells, the ultrastructure of parietal cells before and after PGV has been studied in four duodenal ulcer patients. A stereological analysis of electron micrographs shows that after PGV there is a reduction in the volume density of microvilli and the surface density of canalicular membranes. Ten days after PGV there is a temporary increase in the surface density of tubulovesicular membranes. However, 3 months after the operation most of this membrane material has been removed so that the surface density of tubulovesicles at this late stage is only insignificantly higher than before the operation. The relative volume of dense bodies is more than doubled 3 months after PGV, and the observed removal of tubulo-vesicular membranes between the 10 days and the 3 months stage may therefore be due to lysosomal activity.


Susceptibility of the liver and biliary tract to anaerobic infection in extrahepatic biliary tract obstruction. II. Liver function and morphology of the liver and biliary tract--an experimental study in rabbits. Biliary tract infection with anaerobic bacteria (B. fragilis or Fusobacterium mortiferum) was produced in rabbits by common duct ligation (c.d.l.) 3 days prior to intravenous bacterial inoculation. Animals were investigated 1, 4 or 7 days after inoculation. Histopathological investigations included the liver, the common duct, and the gallbladder, while liver function was evaluated by bilirubin, alkaline phosphatase (AP), and L-alanine aminotransferase (GPT) in serum. Rabbits with c.d.l. and biliary tract infection were compared to rabbits with c.d.l. in which bacterial inoculation failed to produce infection, to inoculated rabbits without c.d.l., and to uninoculated rabbits with c.d.l. Anaerobic biliary tract infection in rabbits with c.d.l. caused a significant increase in liver abscesses, a significant increased infiltration with granulocytes in the gallbladder, and a significant increase in serum levels of bilirubin, AP, and GPT, but failed to produce signs of cholangitis in the liver and intramural abscesses in the gallbladder. A material is presented of normal values for bilirubin, AP, and GPT in serum in rabbits.


Focal nodular hyperplasia of the liver. Five cases. Focal nodular hyperplasia (FNH) of the liver is a benign tumour with a cirrhosis-like appearance. The tumour is rare, but it is a relevant differential diagnosis in young patients with a hepatic mass. Radiologically and grossly FNH cannot be distinguished from malignant tumours. Biopsy with frozen section usually provides the diagnosis. There is no evidence that FNH is premalignant. Only a few patients have symptoms requiring treatment (pain, loss of appetite, nausea, and vomiting) and complications (weight loss, portal compression) are extremely rare. The preferred treatment for symptomatic tumours is removal. In patients without symptoms FNH can be left untreated without any undue risk.


Marrow cell uptake by megakaryocytes in routine bone marrow smears during blood loss. In studying smears of marrow aspirates, we have encountered the presence of normal appearing haemopoietic cells within megakaryocytes. We have then searched routine marrow smears from 125 patients seen in our service during 3 years. The presence of marrow cells (granulocytic, erythroid, and lymphoid cells) within megakaryocytes was seen in 16 cases of whom 9 had documented bleeding and 5 had carcinoma. 3 patients  were suspected of bleeding but this was not documented. 56% of patients with bleeding and 83% of patients with carcinoma seen during this period displayed this pehnomenon. A search for this phenomenon in routine marrow smears may reveal unsuspected blood loss.


Coagulation profile and the ethanol gelation test with special reference to components consumed during coagulation. In 753 consequtive blood samples (from the same number of patients) routinely examined for coagulation abnormalities, a positive ethanol gelation test was found in 160. In 7 samples with plasma fibrinogen below 150 mg/100 ml and a positive test, other laboratory signs of consumption coagulopathy (low thrombocyte count, low factor V, low antithrombin III, large amounts of FDP in serum and great discrepancies between Normotest and Thrombotest) were regularly observed. Also at normal or high fibrinogen levels, a positive ethanol gelation test was more frequently associated with low thrombocyte counts, low factor V and Normotest/Thrombotest discrepancy than was a negative test. In 46% of the samples with a positive test, fibrinogen was higher than 500 mg/100 ml (versus 4% in those with a negative test). In one-third of these samples, all other parameters gave normal results.


Foamy histiocytosis of the spleen in patients with chronic thrombocytopenia. In 17 of the 64 spleens removed from patients with chronic thrombocytopenia lipid-laden histiocytotes were demonstrated. No correlation was found between these pathological findings and the age of the patients at diagnosis or splenectomy, the duration before splenectomy of therapy with glucocorticoids, the period with thrombocytopenia or the platelet count. 7 of the patients, who relapsed after splenectomy had  lipid-laden histiocytes in their spleens i.e. 58% of the patients with relapse, compared with 10 patients with foamy histiocytosis and without relapse i.e. 19% of the patients without relapse. At follow up, 3 of the 17 patients with splenic histiocytosis still had thrombocytopenia, compared with 1 of the 47 patients without foamy cells. Foamy histiocytosis of the spleen from a patient with chronic thrombocytopenia may indicate a dubious prognosis.


Evaluation of prophylactic replacement therapy in haemophilia B. Prophylaxis replacement therapy has been assessed for a period of 12 months in 10 patients with severe haemophilia B showing a high incidence of spontaneous bleeding episodes. Two different schedules of administration of a freeze-dried factor IX concentrate were randomly evaluated: according to scheme A, 7.5 U/kg were administrated biweekly, whereas scheme B was based on the weekly infusion of 15 U/kg. On prophylaxis the frequency of bleeding episodes was significantly reduced (P less than 0.005) when compared with that observed in one-year period preceding the trial. Biweekly infusions were superior to weekly infusion (P less than 0.01), and the benefit appeared to be related to the higher number of days in which measurable levels of factor IX were attained in plasma. Range of motion, which was redeced at the start of the trial in 26 joints, was found to have improved in 23. Favourable changes of the joint radiological picture were observed in 6 cases. Hepatitis and factor IX inhibitors did not develop during the trial period. Side effects were rare and mild.


Hormonal control of erythropoiesis in canine cyclic haematopoiesis. The results of erythropoietin (ESF) studies in dogs with cyclic haematopoiesis are presented. Even though the dogs were exposed to a constant stimulus of hypoxia, cycles in the plasma ESF levels occurred at 11 to 12 day intervals. In some dogs, minor midcycle peaks were observed and the amount of ESF produced varied with the different animals. The peaks of ESF characteristically appeared approximately five days after onset of neutropenia. A hypothesis is presented to explain the known facts concerning canine cyclic haematopoiesis. It suggests that a poietin controlling factor is produced and that this assumed factor then stimulates the production of specific factors leading to increases of reticulocytes, platelets, and monocytes. The monocytes in turn produce more colony stimulating factor (CSF) leading to the formation of granulocytes. Such a sequence of events would explain the apogee of reticulocyte, platelet, and monocyte counts at a time when the nadir of granulocyte counts is reached.


Testicular function after combination chemotherapy for Hodgkin's disease. Fertility was estimated by sperm counts and hormone assays in 8 patients treated for Hodgkin's disease with at least 6 courses of combination chemotherapy. This consisted of an alkylator (mechloretamine or cyclophosphamide), a vinca alkaloid (vinblastine or vincristine), procarbazine and prednisone. Azoospermia was found in 7 of the 8 patients on examination 12-29 months after termination of chemotherapy. In 1 patient semen quality improved gradually, and a sperm count of 5 mill/ml was found at 21 months. Serum FSH levels were increased in all but 1 patient who was, nevertheless, azoospermic. The levels of testosterone and LH were generally within normal limits. Thus, the germinal tissue is seriously damaged by this type of chemotherapy. The resulting infertility seems to be complete and of long duration. Partial recovery of spermatogenesis may, however, sometimes take place after prolonged unsustained remission.


Reptilase clot retraction induced by electrical stimulation. Retraction of platelet rich plasma clotted by reptilase is induced by electrical stimulation. Optimal retraction is obtained by stimuli, applied for more than 4 min, with the following characteristics: intensity = 150 volts, duration = 50 msec each, frequency = 10/sec. Electrically induced reptilase clot retraction is shown to be inhibited by EDTA, EGTA, methyl-xanthines, PGE1, acetylsalicylic acid, indomethacin, but not by apyrase or by phosphoenolpyruvate-pyruvate kinase and MgCl2. The results indicate that electrical stimulation induces retraction of PRP clotted by reptilase by triggering off an increased availability of Ca2+ in the intracellular space.


[Development of drug, alcohol and tobacco consumption. Comparison between 2 studies from 1971 and 1974 in the canton Zurich]. Consumption of drugs, alcohol and tobacco has been compared in two populations of 19-year-old men, of 1971 (2785) and 1974 (1617), drawn from three different geographical regions of the Canton of Zurich. The hypothesis that the percentage of drug users has risen over the last three years was not confirmed: as previously, 25% have had experience of drugs. As expected, however, there was more regular and heavy drug users in 1974 than in 1971. Also, there is a more marked trend towards extension of drug consumption to rural areas than in 1971. The percentage of cigarette smokers has remained stable, but per capita cigarette consumption has increased. Contrary to expectation, alcohol consumption showed the sharpest rise in all three regions. The study suggests that drug consumption is not to be considered in isolation but in conjunction with the use of alcohol and tobacco.


[Aneurysm of the arteria lusoria. Report on 4 cases]. Four cases of arteriosclerotic aneurysm of the arteria lusoria are described. In one patient a tumor of the superior mediastinum was suspected, the chief signs of which are dyspnea and irritative cough. In a further patient, enlargement of the left superior mediastinum was noted in routine fluoroscopy. Clinical investigation revealed an aneurysm of the arteria lusoria. In the third patient, dysphagia, slight cough and torticollis were interpreted as symptoms of a neoplasm of the esophagus or larynx. The fourth patient, in whom aneurysm of the arteria lusoria was discovered by chance at autopsy, displayed no clinical or radiological signs. Abberrant right subclavian artery (arteria lusoria) is a relatively frequent finding in autopsies. Aneurysm of the arteria lusori is apparently also a typical complication.


[The gastric surface carcinoma (early carcinoma)]. Gastric surface carcinoma or early cancer is defined as carcinoma limited to the mucosa or submucosa of the gastric wall. It has an excellent prognosis. Enormous progress in detection and histological diagnosis of early gastric carcinoma has been made with fibre-optic gastroscopy and guided biopsy. Macroscopic types and histological pattern of 18 cases of early cancer are described (16 mucosal and 2 submucosal carcinomas). The endoscopic biopsy allows the diagnosis "carcinoma" in most cases, if 5-6 biopsies are taken for examination. Definite diagnosis warrants throughout histological examination of the resected specimen showing the carcinoma limited to the superficial layers of the stomach wall. In 11 of our 18 cases the surface carcinoma was localised to the antrum and the angulus. The size of the carcinoma was less than 2 cm2 in 7 of 18 cases. 6 of 18 cases showed a multicentric origin. The good prognosis of early gastric cancer as compared to deeper infiltrating carcinomas justifies a more aggressive diagnostic approach. Problems concerned with diagnosis, surgical procedures and tissue preparation for histology are discussed.


[Biological availability of potassium from a sustained release preparation]. The bioavailability of potassium from a sustained-release KC1 preparation has been compared in 10 healthy volunteers with that of a non-sustained-release KC1 coated tablet by means of urinary elimination data. From the 40 mEq KC1 additionally administered, 35.2 mEq (88%) and 35.5 mEq (88.8%) respectively were eliminated by the kidneys. On the evidence of this elimination data the sustained-release potassium preparation showed the same bioavailability as the non-sustained-release KC1 tablets. The retard form was excellently tolerated.


[Destructive arthropathies associated with articular chondrocalcinosis. Clinical and metabolic study of 16 cases]. Sixteen cases of severe destructive arthropathy in elderly persons (13 females and 3 males) suffering from articular chondrocalcinosis are described. The knee is the most commonly affected joint, followed by the hips, shoulders, wrists, elbows and feet. One joint is destroyed in seven patients, 2 joints in five, 3 joints in one and 4 joints in three patients. In 13 subjects the onset of the arthropathy was insidious, whereas 2 had only a history of previous recurrent pseudogouty attacks. Associated endocrine, neurological or metabolic diseases were ruled out by clinical examination and laboratory tests. Repeated determinations of serum calcium and phosphorus, as well as of plasma immunoreactive parathyroid hormone, were within normal limits. The possibility of hyperparathyroidism was thus an unlikely explanation for this destructive arthropathy. Its etiopathogenesis remains unclear.


[Functional diagnosis of laryngeal and tracheal stenoses]. In 20 patients with upper airway obstruction in the region of the larynx and the extrathoracic and intrathoracic trachea, inspiratory and expiratory resistance, FIV1, FEV1 and total and vital capacity were determined. In patients with obstruction in the larynx and the extrathoracic trachea FIV1 is generally below FEV1. So-called "dynamic" obstruction, depending on flow and direction of flow, leads to a considerable descrepancy between FIV1 and FEV1. Impairment of respiration can be assummed if, in the adult, airway resistance during spontaneous breathing is higher than 6 cm H2O/l/sec during inspiration and/or expiration. After successful surgical correction airway resistance and FIV1 and FEV1 are restored to normal values.


[Late results after zero calorie diet therapy in adiposity]. Patients treated for obesity by total starvation were followed up after a period ranging from 7 to 60 months. Starvation treatment had been carried out 12 times in women and 7 times in men. Weight regain was less than 33% of weight loss in 5 women and 5 men and the regain was 40% in 1 man. Weight increase was higher than 50% of weight loss in 7 women and 1 man. The weight of one of these women exceeded the prestarvation weight. In view of these poor long-term results, therapeutic starvation should be carried out only in selected cases. Our experience indicates a better prognosis for men than for women. There is some indication that long-term results of therapeutic starvation are more favorable in patients with previous myocardial infarction or with somatic conditions which may improve after weight reduction.


[Bilateral fractures of the proximal end of the femur]. 72 patients with bilateral non-contemporary fractures of the proximal end of the femur are reviewed. This group is compared with 203 similar unilateral lesions. A statistical analysis is performed. The age of the patients, when sustaining the first of bilateral fractures and in the control group is similar. The second fracture occurs sooner in men than in women; The mortality for the second fracture does not differ from that in the control group in spite of the higher average age of the bilateral group. Fractures of the proximal end of the femur appear to occur more often in isolated subjects, The second fracture preferentially affects the same site (cervical or trochanteric region). An individual who sustains bilateral noncontemporary fractures of the proximal end of the femur is not distinguishable by poor general condition but has a weak point in the cervical or trochanteric region.


[Treatment of essential hypertension with Transicor 80 and Esidrex K under medical practice conditions]. This study was designed to obtain information under general practice conditions on the efficacy and tolerability of a fixed combination of the beta-blocking agent oxprenolol 80 mg (Trasicor 80) and hydrochlorothiazide + KCl (Esidrex-K) in the treatment of moderate essential hypertension. Patients with a diastolic pressure of 100 to 130 mm Hg were covered by the study. The dosage of Trasicor was kept relatively low and at a constant level, i.e. one tablet twice daily throughout. In the group of 370 patients whose record had been completed according to the treatment plan, the systolic and diastolic pressures fell on the average by 28 and 17 mm Hg respectively. After 10 weeks of therapy, the diastolic pressure was normalized (i.e. below 95 mm Hg) in 226 patients. The mean decreases in pressure were statistically significant after two weeks' treatment. The mean pulse rate fell from 79 to 73. Tolerance of the regimen was very good in 75% of patients; 57 patients were withdrawn from the study for various reasons.


[Riolan's arcade: hemodynamic importance--therapeutic deductions]. The hemodynamic significance of the arcade of Riolan has been analysed. This arterial arcade provides an anastomosis between the territories of the superior and inferior mesenteric arteries. The arcade is only clearly visible on arteriography when an obstacle is present at one of its extremities or when it is being used for revascularization of the lower limbs. The discovery during surgery or on X-ray of a dilated arcade of Riolan presents a hemodynamic problem when the continuity of a digestive artery must be reestablished. In addition, when a patient known to suffer from arteritis has to undergo surgery involving the rectosigmoid area, a preliminary arteriography is necessary: the presence of a hypertonic arcade of Riolan requires special therapy since untimely ligature of this artery would provoke lethal ishcemia of the colonic wall. Examination of the arteriogram affords the surgeon some indication of the state of the splanchnic circulation, and he can then take the necessary precautions to prevent any risk of postoperative development of necrosis of the left colon.


[Stenosis of the small intestine of ischemic origin in the adult (segmental and transmural lesions)]. Focal ischemia of the small intestine does not always lead to necrosis and perforation, but may induce fibrous stenosis which is evidenced clinically by acute or chronic intestinal occlusion. Among 8 intestinal stenoses 5 were revealed by the presence of an intestinal occlusion whereas the others were manifested by intestinal occlusions complicated by subsequent perforation of the intestinal wall. Annulo-tubular stenoses of ischemic origin are frequently accompanied by inflammatory mesenteric adenopathies due to mucosal ulcerations in the septic environment of the intestinal lumen. Their aspect is reminiscent of Crohn's disease or annular carcinoma. Histological examination of the resected loop frequently reveals the primary oschemic origin of the stenotic lesion, characterized by the presence of macrophages loaded with hemosiderin in the thickened inflamed mucosa. The tissue alterations observed resemble those found in myocardial infarction, but the inflammatory response is more pronounced due to the septic medium. Although such stenoses are relatively rare, they should be distinguished from other lesions provoking a narrowing of the intestinal lumen, since their treatment calls for certain therapeutic precautions. In some cases, angioplastic intervention is required in order to improve perfusion of the vascular bed irrigated by the superior mesenteric artery following resection of the stenotic loop and termino-terminal anastomosis. Furthermore, during any operation requiring revascularization of the mesenteric vessels for intestinal angina, it is important to carry out a very careful examination of the state of the small intestine.