Congenital generalized lipodystrophy. Report on one case, with special reference to postmortem findings. Generalized lipodystrophy (Berardinelli-Seip's syndrome) was diagnosied in a boy at the age of 8-1/2 months. Ten months later he died because of aspiration of food. Necropsy with special reference to the CNS revealed hypothalamic lesions, probably of a malformative or hamartomatous nature. The findings lend additional support to the view that hypothalamic dysfunction is responsible for the signs and symptoms of generalized lipodystrophy.


Central pontine myelinolysis. A case report. The first case of central pontine myelinolysis in Scandinavia is presented. A premortem diagnosis was established on the basis of the history of chronic alcoholism, the picture of severe electrolyte disturbance and the development of the neurological syndrome. The postmortem findings verified the clinical diagnosis. A possible aetiological mechanism is postulated. The cause is believed to be a damage to the energy dependent electrolyte transport across the cell membrane, resulting in a cytotoxic oedema and death of the oligodendroglial cells of the brainstem which are particularly vulnerable.


Some characteristics of lymphoblastoid lines derived from human astrocytomata. Two immunoglobulin-producing lines of normal lymphoblastoid cells have been established from cultures of two human astrycytomata. These had the same characteristics as lymphoblastoid lines derived from normal human lymphoid tissue or peripheral blood. It is concluded that the lymphoblastoid lines are derivates of non-neoplastic lymphoid cells (perhaps of the B series), which were present as an infiltrate within the astrocytomata. Furthermore, the slow emergence of the lymphoblastoid cells in culture, their continuing requirement for feeder cells and their production of monoclonal rather that heteroclonal immunoglobulin are attributed to an artefact of growth conditions.


Healing of a crush injury in rat striated muscle. 3. A micro-angiographical study of the effect of early mobilization and immobilization on capillary ingrowth. Vascular ingrowth into the injured area of a partially crushed gastrocnemius muscle was studied by micro-angiography 2 to 14 days after the trauma in 40 rats treated by mobilization or immobilization. In mobilized muscles, the sprouting of new capillaries occurred more rapidly and intensively than in injured muscles treated by immobilization. The sequence of events was found to be slightly delayed if mobilization was started after immobilization for two days. The speed and intensity of tissue repair, as studied histologically, was directly correlated with vascular ingrowth, especially during the first week.


Heterotransplantation of human malignant melanomas to the mouse mutant nude. In 32 experiments involving transplantation of human malignant melanomas to the mouse mutant nude, tumourtake was observed in 14 instances. The tumour tissue which took and grew after inoculation was derived from malignant melanoma metastases of the skin (10 takes from 13 transplantations), and from primary malignant melanomas of the eye (4 takes from 6 transplantations). Not one of 13 attempts to transplant primary tumours of the skin was successful. In 7 instances serial transfers of transplanted tumour were successful, the degree of success ranging from 3 to 41 passages. Some passages were wilfully interrupted but two are continuing. The transplanted tumours grow locally. Neither lymph node metastases nor organ metastases have been observed. Histological appearances of the transplanted tumours, also after serial passages, were identical with those of the original human donor material. The human tumour/nude mouse system is contrasted and compared with other heterotransplantation models.


Yersinia enterocolitica in borwn trout (Salmo trutta L.) from Norway. In this pilot study, 20 brown trout (Salmo trutta L.) from one area in Western Norway were investigated for the presence of Yersinia enterocolitica (Y.e.). Three strains were isolated from three of these trout. All strains were classified as Y.e. on the basis of biochemical properties. One of the strains showed antigenic relationship to Y.e O-serotype 17. A second strain was antigenically related both to Y.e. and Y. pseudotuberculosis: Agglutination against Y.e. O-antisera 4-33, 18, and 21, was obtained and against Y. pseudotuberculosis O-antiserum II B. The third culture was not agglutinated by our sera. The biochemical properties of the strains are presented. The capability of fish to spread Y.e. is discussed.


Studies on the central integration of excitatory chemoreceptor influences and inhibitory baroreceptor and cardiac receptor influences. Experiments were performed on cats to explore the integrated cardiovascular responses when excitatory (chemoreceptor) and inhibitory (baroreceptor or cardiac receptor) influences are simultaneously presented to the medullary cardiovascular areas. At a given sinus pressure in the low or medium pressure range, the systemic blood pressure and the vascular resistance were higher when the chemoreceptors were stimulated, while a high, pulsating sinus pressure, i.e.a strong baroreceptor stimulation, could suppress completely even an intense chemoreceptor activation. Thus, the set point and the gain of the baroreflex were increased by a concomitant chemoreceptor activation. These effects are compatible with a simple, mutual 'summation' of excitatory and inhibitory influences on a common population of central vasomotor neurons. The reflex vasodilator effects elicited via vagal cardiac afferents were found to be more effectively suppressed by a concomitant chemoreceptor stimulation than were the baroreceptor effects, provided a primary chemoreceptor response (bradycardia) was at hand, while the heart rate responses were essentially uninfluenced by the prevailing chemoreceptor activity. This chemoreceptor suppression of the reflex vasodilatation from cardiac receptors, which may be of great importance in hypoxic situations, e.g. during a dive, suggests a more complex, neuronal interaction between the two reflex mechanisms in the CNS.


Sympathetic control of cerebral blood flow in acute arterial hypertension. The cervical sympathetic chain on one side was stimulated electrically at 10-20 Hz and an acute rise in arterial blood pressure was produced by: intravenous injection of angiotensin, ligation of the thoracic aorta, or ligation of the aorta combined with injection of metaraminol. The blood flow through the cerebrum and the cerebellum was determined by using labelled microspheres. At high blood pressures there was multifocal breakdown of the blood-brain barrier in the cerebrum as indicated by leakage of Evans blue. The breakdown was restricted to the control side or much more marked on that side than on the stimulated side. Sympathetic stimulation prevented also breakdown of the blood-aqueous barrier. The blood flow through the cerebrum on the control side was higher than that on the stimulated side in all experiments. Regions with breakdown of the blood-brain barrier had flow rates which were about 10 times normal values. Cerebellar blood flow was less affected by the hypertension and did not react significantly to sympathetic stimulation. The results indicate that stimulation of the sympathetic nerves to the brain tends to prevent forced dilatation of the arterioles with a resulting regional overperfusion with blood and breakdown of the blood-brain barrier. It is concluded that one role of the sympathetic nerves supplying the brain is to extend the pressure region with autoregulation in its upper part under conditions of a general increase in sympathetic vasomotor activity.


The effect of progesterone and of insulin administration on regional adipose tissue cellularity in the rat. Female rats were given progesterone in a high and a low dose or insulin by injection. Both hormones caused hyperinsulinemia and an elevated body weight, explainable by increased fat tissue weight, which in turn was due to an increased fat cell size. There was a regional specificity of these effects for both procedures. It was therefore concluded that adipose tissue does not react as a homogenous tissue to different stimuli. Although not definitely conclusive because of difference in the degree of hyperinsulinemia the results also indicate that the effects of insulin are primarily exerted on the small fat cells of the subcutaneous region while progesterone increased the size of the larger parametrial fat cells.


The effects of estrogens on regional adipose tissue cellularity in the rat. The effects of high and low dose estrogen administration on adipose tissue cellularity and metabolism were investigated and compared with the effect of total starvation in female rats. Total starvation in female rats resulted in local fat cell size decrease which was, in different adipose tissue regions, directly proportional to the primary fat cell size. Thus, the largest fat cell size decrease was observed in the parametrial depot of adipose tissue, with primarily the smallest adipocytes. High doses of estrogen (Estradurin-120 mug/kg/month) resulted in a body and adipose tissue weight decrease after 10 weeks treatment. Contrary to the starvation effect the greatest fat cell size decrease was observed in the subcutaneous depot with primarily the smallest adipocytes. Lower estrogen dose (60 mug/kg/month) resulted, after 4 weeks treatment, in weight increase of adipose tissue. Fat cell size increased most in the parametrial depot-an adipose tissue region with primarily the biggest adipocytes. This is in contrast to the situation after insulin treatment and overfeeding which produce the largest size increase in the region with the smallest fat cells, and can be interpreted as evidence for regional specificity of the estrogen effect on fat cells.


Quantitative aspects of the vagal control of gastrin release in cats. Gastrin concentrations were measured in the gastric blood of eviscerated cats. Blood flow was recorded concomitantly thus enabling quantitative determination of the gastrin output. Electrical vagal stimulation within the "physiological" frequency range (0.5-3 Hz) did not regularly result in any detectable changes in the peripheral gastrin level but an increase in this level was always observed on stimulation with frequencies above 3 Hz. A constant gastrin release per stimulus was then obtained, as long as the total number of vagal stimuli did not exceed 2,000-3,000. A larger number of impulses resulted in rapid fatigue of the release mechanism, indicating either a rapid and sustained fatigue of the neural control mechanism or the existence of a rather small pool of gastrin for immediate release-amounting to less than one per cent of the total antral store of immunoreactive gastrin. The rate at which such a releasable pool was refilled would suffice to compensate for the depletion induced by vagal stimuli at physiological frequencies i.e. less then 3-4 Hz only. The two vagi innervate separate gastrin pools, which behave independently as far as release and refilling are concerned.


Spread of the junction potential in the T-system in hagfish slow muscle fibres. The membrane constants of the slow muscle fibres from the Atlantic hagfish were determined by analyzing the responses to sinusoidal currents at different frequencies. The apparent low frequency membrane resistance was 20-50 komega-cm2 and was not significantly altered by replacing external chloride with methyl sulphate. The low frequency capacitance was 2.1-2.4 muF/cm2 and decreased to about 1 muF/cm2 at 100 Hz. A model of the T-system consisting of a number unbranched T-tubules was fitted to the impedance locus. About 15 tubules per sarcomere with a length approximately 8 times the fibre radius gave good fit to the observed impedance locus. The electrical characteristics of the T-system allow an efficient electrotonic spread of the junction potential through the fibre cross-section.


Motor unit responses in the lateral rectus muscle of the cat: intracellular current injection of abducens nucleus neurons. Single motor units of the cat's lateral rectus muscle were activated with short intracellular current pulses delivered through an intracellular micropipette penetrating a single motoneuron, and the mechanical responses in the muscle were recorded. Lateral rectus unit responses fell within the same range as those obtained earlier with extracellular stimulation of inferior oblique units, confirming that in the latter case single and not multiple motor units had been studied. It was also found that both fast and slow contracting muscle units were connected to fast conducting, large size motoneurons. The organization of motor unit recruitment in eye movements would thus seem different from the recruitment pattern in limb muscles. Intracellular stimulation of abducens nucleus "interneurons" did not initiate contractions at the ipsilateral lateral rectus muscle. These "interneuron", therefore did not appear to have excitatory inputs to the abducens motoneurons, but may be involved in relaying information to the other extraocular muscle nuclei or to other brain centers.


A method for determining blood flow and oxygen consumption in the rat brain. Cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRo2) were measured in rats under nitrous oxide anaesthesia, using a 133Xenon modification of the Kety and Schmidt inert gas technique with sampling of cerebral venous blood from the retroglenoid vein. Extracerebral contamination of the venous blood sampled was studied by comparing the rates at which the activity of 133Xenon decreased in blood and tissues. Contamination was avoided by gentle compression of the contralateral retroglenoid vein during sampling. CBF and CMRo2 of the rat brain were 80+/-2 and 7.6+/-0.2 ml-(100g)-1-min-1, respectively. These values are about 25% lower than those previously obtained for cerebral cortical tissue under similar conditions. Induced hypercapnia (Paco2 about 70 mm Hg) or hypocapnia (Paco2 15-20 mm Hg) gave rise to expected changes in CBF but did not alter CMRo2. The CMRo2 of the rat brain is at least twice that of the human brain. This species difference, which is similar to that previously reported for the oxygen uptake of cerebral tissue in vitro, probably reflects on inverse relationship between brain weight and neuronal packing density.


Mechano-elastic properties of human muscles at different temperatures. The effect of changes in the muscle temperature on their ability to store elastic energy was studied by having 5 trained subjects perform maximal vertical jumps on a force platform, with and without counter movement, at muscle temperatures between about 32 degrees C and 37 degrees C. The results showed that the heights of vertical jumps were considerably reduced at lowered temperature, but the gain in height after a counter movement in the form of a jump down from a height of 0.4 m over the force platform, was significantly higher in the cold condition. T o test whether this was due to an increased stiffness of the muscles, experiments with imposed sinusoidal length variations at 14 Hz were performed. Delta force XDelta length-1 (i.e.stiffness) increased with isometric tension independent of muscle temperature. Experiments in which the rate of tension development and relaxation in voluntary maximal isometric contractions were measured at different muscle temperatures showed that maximal isometric tension changed by less than 1% per degree but the rate of tension development and relaxation by 3-5% and 5% per degree, respectively, in the temperature range studied (30 degrees to 40 degrees). These data may be explained by the hypothesis that the series elastic components of the active muscle are located in the cross-bridges between myosin and actin filaments. The storage of elastic energy would be enhanced if the rate of breaking of these bridges were decreased at lower temperatures.


Phenylethanolamine-N-methyl transferase (PNMT) activity and catecholamine content in chromaffin tissue and sympathetic neurons in the cod, Gadus morhua. The activity of phenylethanolamine-N-methyl transferase (PNMT) has been measured in the chromaffin tissue of the head kidney and in the sympathetic neurons of the coeliac ganglion/splanchnic nerve in the cod. The content of adrenaline and noradrenaline in these tissues and in other adrenergically innervated tissues and blood plasma was also determined. Adrenaline dominates over noradrenaline in most sympathetically innervated tissues, in the chromaffin tissue and in blood plasma, but not in the muscularis mucosae of the swimbladder. High PNMT activity was found in the chromaffin tissue in the walls of the posterior cardinal veins, and also in sympathetic neurons. It is concluded that the adrenaline found in the sympathetic nerves may originate from intraneuronal adrenaline synthesis, but also from circulating adrenaline which is taken up and stored.


Deposits in the lens and cornea of the eye during long-term chlorpromazine medication. Thirty patients on long-term treatment with chlorpromazine in moderate doses showed deposits in the lens, and the majority of the patients also showed deposits in the cornea. These deposits did not increase in the 13 patients who continued on chlorpromazine during an observation period of 31/2 years. Thus, when chlorpromazine is used in moderate doses, the deposits in the eyes seem to increase only up to a certain extent. Twelve patients who were switched over to thioridazine showed no change in the deposition in the lens and cornea after the observation period, indicating that the deposits are irreversible. After the observation period visual acuity had deteriorated somewhat in the material as a whole, presumably because of advancing age, not because of the deposits. The risk of using chlorpromazine in moderate dosage is slight.


A psychosomatic approach to the globus hystericus syndrome. Twenty patients with lump in the throat as their main subjective symptom, were examined otorhinolaryngologically, radiographically, and psychiatrically with special attention to psychosomatic aspects. The control materials consisted of matched sample subjects of the total population, and of the total patient material treated at a general hospital. A considerably greater number of psychic disturbances were found in globus patients than in the matching control material. The personality picture of the patients was markedly obsessive possibly suggesting a psychosomatic syndrome rather than a pure hysterical conversion syndrome, at least in part of the patients. The globus patients could be divided into two groups, equal in size, according to the presence or absence of psychic disturbances. The group with manifest psychic disturbances had often experienced some significant life incident prior to the appearance of the globus syndrome; they also displayed few somatic findings, which, on the other hand, were abundant in psychically healthy patients.


Social reintegration of sexual delinquents by a combination of psychotherapy and anti-androgen treatment. The high frequency of recidivism with convicted sexual perverts is mainly due to the compulsive character of perversion. The classical methods of treatment are seldom satisfactory: Surgery provokes ethical objections, psychopharmaca and oestrogens lead to disagreeable side effects, psychotherapy of any kind is unlikely to be efficacious because of the unfavourable atmosphere the nature of perversion causes it to take place in. However, the climate of both psychoanalytical treatment and suggestive and directive psychotherapy can be enhanced by a combination with an anti-androgen treatment, which eliminates the patient's fear of conviction by inhibiting his sexual urge. Two cases illustrate this combined method. On the basis of a positive disposition, which arises from the improved climate, sublimation of the sex drive and the achievement of a feeling of social responsibility is aimed at. The advantages of the combined therapy are then discussed in comparison with the existing treatments. It is concluded that this combined treatment, next to social guidance and an attempt at solving the fundamental problem of loneliness, can promote the social reintegration of the convicted sexual pervert.


Psychiatric treatment in a delimited population-with particular reference to outpatients. A demographic study. The present investigation analyses the psychiatric service available to and utilized by a population in a geogrphically delimited area, namely the Randers area with a population of 108.928. During the period 1970-74, the average yearly rate of patients admitted to the three psychiatric institutions covering this area was per 1,000: 7.9 males and 9.1 females. During 1970-71, 1.2 males and 1.8 females per 1,000 were treated as outpatients in a psychiatric clinic affiliated to a psychiatric hospital, and a psychiatric outpatient clinic in a general hospital discharged 4.1 males and 7.7 females per 1,000. It seems probable that despite outpatient treatment the number of admissions increases slightly rather than decreases, and consequently, outpatient treatment cannot replace psychiatric admission.


Male transsexuals: a long-term follow-up after sex reassignment operations. Since 1953 the Danish law permitting castration has been applied to transsexuals. Case histories are here reported on ten cases, operated up to 19 years before the follow-up. Six of these presented typical syndromes. In some of the early cases the reluctance on the part of therapists to adopt an active therapy has been too great. Two subjects had died before the follow-up investigation, but both had formerly reported satisfaction with the treatment to their therapists. One case- happily married - had emigrated with the husband. At the interviews the three others confirmed happiness and satisfaction with their female way of life. They are living in resonably good social circumstances. Three cases were not typical. A promiscuous massive sexual activity exhibited by these patients had made it very difficult to endorse a surgical solution to their strongly presented with to obtain sex reassignment. At the follow-up all three were very satisfied with their female role. After several years in their new sex role, two of these were still promiscucos. The last case presents unusually complicated sex role problems. He continues to live as a male, but he still insists 19 years after castration, that the operation saved his life. In spite of his handicap, he claims to be satisfied that he obtained the permit. None of the operated cases committed suicide, but one case - not operated but living as a female - developed a paranoid reaction resulting in suicide.


Determination of monoamine and monoamine metabolites in the human brain: post mortem studies in a group of suicides and in a control group. Different nuclei and regions of the brain from patients who had committed suicide and from controls were analysed for their content of monoamine and monoamine metabolites. There was a post mortem breakdown of 5-hydroxyindoleacetic acid (5-HIAA) which could be correlated to the time elapsed between the occurrence of death and autopsy. Homovanillic acid (HVA) and the monoamines did not decrease post mortem during the time observed (6-148 hours). There was no significant correlation between age and chemical variables in this investigation. There were no significant group differences between suicides and controls concerning dopamine, noradrenaline, 5-hydroxytryptamine, and HVA, 5-HIAA levels were significantly lower in the suicide group in six out of eight parts of the brain investigated. It was, however, also demonstrated that there was a longer time elapse between the occurrence of death and autopsy in the suicide group. The suicides came on average 48 hours later to autopsy than the controls. As there was a post mortem decrease of 5-HIAA, this time variable had to be kept constant when group differences were analysed. When the influence of this time variable was eliminated there were no longer any differences between suicides and controls. According to this investigation, there seem to be no differences in levels of monoamines and their metabolites between suicides and controls.


Lithium maintenance treatment of manic-melancholic patients: its role in the daily routine. The purpose of this study was to evaluate the desired and undesired effects of relapse-preventive lithium treatment given routinely to manic-melancholic patients who had accepted the necessity of a strict tablet regime. The evaluation was based upon case record data and various rating scales, and 76 patients took part in the investigation. Our results showed that in 24% of the patients treatment was discontinued. This was due to side effects in 16% and to insufficient effect in 8% of the cases. The suicide risk was not eliminated, and 29% of the patients were receiving additional antidepressive or antimanic treatment at the test day. On the other hand, 78% of the patients rated the relapse-preventive lithium effect as moderate to excellent. Indirect evidence was obtained in support of a stabilizing effect of lithium on the emotional control in bipolar patients. The most frequent complaints during lithium treatment were tremor and increased thirst.


Hysterical neurosis, conversion type: clinical and epidemiological considerations. This paper considers data on hysterical neurosis, conversion type from the Monroe County (New York) Cumulative Psychiatric Case Register, from the Psychiatric Case Register in Iceland, and from a psychiatric consultation service in a university teaching general hospital in Monroe County (New York) during the period 1960 to 1969. The rate of hysterical neurosis, conversion type in Monroe County during this period was 22 per 100,000 per year, whereas in Iceland it was 11 per 100,000 per year. It was highest for women, non-whites and those of low social economic status. The rate of hysterical neurosis, conversion type and "probable" hysterical neurosis, conversion type combined among patients seen in psychiatric consultation was 4.5%. The most often noted diagnostic criteria were inconsistency with somatic process and precipitation of symptoms by psychological stress. Most patients had more than one conversion symptom at the same time. Pain was the most common symptom. The majority of patients had an accompanying organic or functional illness.


Lithium treatment and weight gain.

Lithium treatment and weight gain. The problem of lithium maintenance treatment and weight gain was examined in 70 manic-melancholic patients who had been in treatment for 2 to 10 years. Their case records were reviewed and they answered a questionnaire. Out of 70 patients, 45 increased in weight with a mean weight gain of about 10 kg. The patients who increased in weight during the treatment were overweight already before the start and reached a weight about 20% higher than their ideal weight. They nearly all found themselves overweight and took measures to slim. No connection between a history of infant obesity and weight gain was found. Increase in appetite was only found in one third of the patients and had only a weak influence on the degree of weight gain. Nearly all the patients felt an increased thirst, and a very clear correlation between liquid intake and weight gain was found. It is recommended that all patients are repeatedly warned of the risks involved in satisfying their increased thirst on lithium by fluids rich in calories.


The effect of sleep deprivation on depressed patients. In this paper an account is given of the effect of single-night sleep deprivation (SD) therapy in 124 depressive patients of different diagnostic groups. Phasic depressives showed a marked improvement after treatment by sleep deprivation. Because these improvements were often of short duration, we repeated the treatments and combined them with thymoleptic drugs. In the group of neurotic depressives the therapeutic effect of sleep deprivation varied; on the whole, however, the improvement was less marked. It is pointed out that the vital symptoms and "critical time" are of importance. Sleep deprivation can be explained as a resynchronization of disturbed circadian rhythms brought about by interrupting these rhythms.


Community care and the prognosis of schizophrenia. A group of 41 schizophrenic patients were followed up for a period of up to 8 1/2 years after their first admission to a general hospital psychiatric unit. During the follow-up period one third of the patients were not readmitted, and the remainder had between one and eight readmissions. Half of the patients spent less than 5 % of the follow-up period in hospital. Twenty-one patients remained in fairly close contact with at least one of the community services. A greater degree of clinical disturbance characterized high users, as compared with low users, of these services. At the end of the follow-up two patients were in hospital, half of the original cohort was considered clinically recovered and four-fifths socially recovered. The contribution of the general hospital and of the community services to the improved prognosis for schizophrenia is disucssed.


Iron absorption in patients with chronic uremia undergoing regular hemodialysis. Gastrointestinal iron absorption has been measured by whole body counting in 17 patients with chronic uremia undergoin regular hemodialysis. Absorption was expressed as whole body retention 14 days after oral administration of 10 muCi 59Fe together with a carrier dose of 10 mg Fe2+. The percentage incorporation in the total erythrocyte mass of administered 59Fe (erythrocyte incorporation) and absorbed 59Fe (red cell utilization) was estimated as well. Geometric mean iron absorption was 14.3 +/- 2.0 (S.D.)% and significantly higher than the value obtained in a normal control group (p less than 0.03). Geometric mean erythrocyte incorporation was 11.6 +/- 2.3 (S.D.)% and arithmetic mean red cell utilization was 84.4 +/- 6.0 (S.E.M.)%. Neither of these parameters differed from corresponding values in the control group (p greater than 0.1 and p greater than 0.2, respectively). The correlation between iron absorption and erythrocyte incorporation was highly significant (r=0.94, p less than 0.001). Patients on regular hemodialysis are subjected to considerable iron loss which should be treated by iron supplementation; oral iron administration is recommended in view of the adequate gastrointestinal absorption.


The effect of indomethacin on proteinuria and kidney function in the nephrotic syndrome. In 19 nephrotic patients on a dietary intake of 20 mEq sodium/24 hours, indomethacin caused an immediate decrease in glomerular filtration rate (GFR) and urinary protein excretion, an effect completely reversible upon withdrawal of the drug. As a consequence of lower protein excretion, there was eventually a rise in GFR. It is proposed that the therapeutic effect of indomethacin in nephrotic syndrome is caused by its inhibiting action on renal prostaglandin synthesis, thereby potentiating the effect of the renin-angiotensin system on the kidney. The difference between the decrease in GFR (mean 35%) and proteinuria (mean 55%) and the more selective proteinuria during indomethacin administration may be explained by quantitative and qualitative differences in protein leakage between outer cortical and inner cortical nephron populations.


The long-term prognosis for patients with sinoatrial block treated with permanent pacemaker. Fifty patients with SA block have been treated with permanent pacing and followed up for 1-14 years. Survival after one, two, five and eight years was calculated to 94, 85, 64 and 48%, respectively. These figures indicate an excess yearly mortality in the first five years of 4-5% compared with a population of the same age and sex. Analysis of the survival curves shows that the excess mortality is caused by coexisting diseases, primarily coronary heart disease with previous myocardial infarction and valvular heart disease.


Studies on cerebrovascular strokes. II. Clinical findings and short-term prognosis in a stroke material. This paper reports the second part of an investigation of first-time cerebrovascular strokes in people under 70 years of age. The clinical data of 344 patients, together with the short-term outcome of the disease, are presented. The immediate (one month) overall mortality was 38%. The corresponding percentage for cerebral haemorrhage was 86, for cerebral infarction 20 and for cerebral embolism 28. Of the surviving patients, 111 had to be transferred to some form of institution at discharge after the acute phase; 103 were able to return to their homes. The influence of various factors upon the immediate prognosis is discussed. Of the clinical findings, the level of consciousness and a calculated score based on the neurological symptoms on admission, proved to have the highest predictive value. Using this score it was possible to predict the outcome in about 85%. Single factors very highly associated with a poor prognosis were the co-existence of cardiac disease and renal insufficiency. There was a notably high prevalence of hypercalcaemia.


Fine-needle biopsy of the liver complicated with bile peritonitis. Fine-needle biopsy has been performed on a healthy subject without any signs of liver disease, especially none of cholestasis. During aspiration, bile appeared in the syringe, and laparotomy was necessary 24 hours later. About 1.5 l bile was found in the abdominal cavity; no lesions of the biliary system could be seen. Treated with drainage, the further course was uncomplicated.


Renal function in normo- and hypertensive 50-year-old males. Renal function, measure as glomerular filtration rate (GFR), sodium excretion and osmolality after thirst, has been determined in untreated (n=35) and treated (n=22) hypertensives and in a reference group (n=80), all derived from a random population sample of 50-year-old men. Renal function was related to casual and resting BP and to relative body weight. Hypertension was defined as SBP greater than 175 or DBP greater than 115 mmHg on two separate occasions or current antihypertensive treatment. Mean GFR was 100 +/- 11.7 ml/min in the reference group and significantly lower, 94 +/- 15.7 ml/min, in the hypertension group. In the hypertension group, 20% had a reduced GFR, although the standard diagnostic procedure, serum creatinine, demonstrated only 4%. Hypertensives with reduced GFR were characterized by higher BP, lower urinary sodium excretion, reversed diurnal rhythm of salt and water excretion and a higher relative body weight, which was, however, explained by the correlation of BP to relative body weight. GFR was negatively correlated to DBP at rest and positively correlated to urinary sodium excretion. Untreated hypertensives with persistent high BP after rest and lower GFR, lower urinary sodium excretion and reversed diurnal rhythm of salt and water excretion, indicating high renal resistance. The results suggest that subjects with relatively severe hypertension as judged by BP and renal function have an increased renal vascular resistance.


Systolic time intervals in acute myocardial infarction. Systolic time intervals (STI) have been measured in 50 individuals without heart disease. Electromechanical systole (QS2), left ventricular ejection time (LVET) and preejection period (PEP), but not PEP/LVET, were correlated to heart rate (HR). Regression equations were made and used when correcting STI for HR in two groups of patients: a) 51 patients with acute myocardial infarction (AMI) b) 22 patients with chest pains, but no AMI. STI was measured on the first 4 days, on the 7th day, on the day of discharge and at a control about 60 days later. In the AMI group there was a reduction in left ventricular performance from the 1st to the 4th day, and the difference in shortening of LVET was significant (p less than 0.001), while PEP and PEP/LVET increased from the 1st to the 3rd day (p less than 0.001). Between the AMI and the control groups there were significant differences (p less than 0.001) in LVET and PEP/LVET on the 3rd, 4th and 7th day, and in PEP on the 3rd and 4th day. STI was not found to separate clinical groups with heart failure of different severity. The survivors had a lower (p less than 0.05) PEP/LVET on the 1st day than those who died. The various localization of the infarction made no difference in STI. LVET was found to be strongly correlated (p less than 0.001) to the hydroxybutyric dehydrogenase values.


Hemodynamic and electrocardiographic effects of disopyramide in patients with ventricular arrhythmia. Antiarrhythmic and hemodynamic effects of i.v. disopyramide phosphate (1.7 mg/kg b.wt. over 2 min) have been studied in nine patients, several in various degrees of cardiac decompensation, with sinus rhythm and persistent ventricular ectopic beats (VEBs). In one case with primary cardiomyopathy, with greater than 30 VEBs/min, disopyramide (DE) abolished the arrhythmia for 30 min, but precipitated brief dysponea. Other side-effects were tolerable and mainly attributable to anticholinergic effects of the drug. DE either abolished or significantly reduced the arrhythmia in all cases. For 30 min, only one patient showed VEBs, and in three patients no VEBs were seen for three hours. Changes in cardiac output and pulmonary artery (PAP) and central aortic pressures were measured in eight patients. Negative inotropic effects were indicated in seven by an increased diastolic PAP/stroke volume ratio and in seven by a decreased central aortic (dp/dt)max. Patients with high control values for diastolic PAP showed marked reductions in cardiac output, stroke volume and stroke work. In predicting myocardial depressant effects of DE, the control values for diastolic PAP seemed to be superior to central venous pressure, cardiac index and systolic time intervals. Mean arterial pressure measured 5 and 10 min after drug administration showed no significant change, indicating that vasoconstrictor reflexes were well preserved, and a pressure level significantly above the control value was reached from the 20th min. It is concluded that DE is potent in suppressing VEBs but exerts negative inotropic effects that may be of clinical importance. The optimal antiarrhythmic dose is probably lower than that used in the present study.


Malplacement of endocardial pacemaker electrodes in the middle cardiac vein. Endocardial transvenous pacemaker electrodes have been implanted in 246 patients owing to symptomatic bradycardia. The electrode was malplaced in the middle cardiac vein in 12 patients. All the patients were on stable ventricular pacing at the time of implantation. The electrodes were still in function in six patients after 5-96 months (average 55). The electrode was replaced in three patients owing to the occurrence of exit block. Three patients died during the period under study. Right-sided bundle branch block (RBBB) configuration of paced QRS complexes was observed on the ECG when the electrode was malplaced in the middle cardiac vein. As RBBB only occurs with malplacement, the ECG can be employed to ensure correct positioning of the electrode.


Enzymes and long-term survival after first myocardial infarction. The study covers 342 patients still alive one month after the acute attack of their first myocardial infarction. Daily determinations of creatinine phosphokinase (CPK), lactic dehydrogenase (LDH) and glutamic oxaloacetic transaminase (SGOT) in serum were carried out during hospitalization, so that a maximum enzyme value could be obtained for each enzyme and patient. A follow-up examination was performed after an observation time ranging from 12 to 38 months. Having calculated the mean (x) of the maximum enzyme values, a parallel relationship was found between the maximum CPK, LDH and SGOT values and the long-term prognosis in myocardial infarction, inasmuch as patients with maximum enzyme values above or equal to the mean had a significantly higher 2-year mortality than patients with values below x. In order to detect any slight difference between the three enzymes with reference to the long-term prognosis, the material was divided into four groups: one with peak values less than x-x/2 (lowest), one with values from x-x/2 to x exclusive (next lowest), one with values from x to x+x/2 exclusive (next highest) and a group with peak elevations greater than or equal to x+x/2 (highest). A tendency to increasing mortality from the next lowest to the highest maximum enzyme values was found. On the other hand, patients with the lowest peak values had a tendency to higher mortality than patients in the next lowest group. This characteristic was observed with regard to both CPK and LDH and to some extent to SGOT.


Is streptokinase useful in the treatment of deep vein thrombosis? Because of its fibrinolytic action, streptokinase is believed to reduce the severity of the postthrombotic syndrome in patients with deep vein thrombosis. A prospective and a retrospective study have been undertaken in an attempt to determine when this therapy is useful for patients with deep vein thrombosis. The prospective study included 15 patients with deep vein thrombosis: 5 were treated in the hospital with streptokinase and heparin and 5 only with heparin, 5 were treated at home with only phenprocoumon. All the patients received oral anticoagulant therapy for at least 6 months. Three to four months after the acute episode, phlebography and venous pressure measurements were carried out. Streptokinase appeared to give the best results but with more side-effects. In the retrospective study, 51 patients who had had deep vein thrombosis in 1969 were reexamined 31-47 months later. It was found that more than 50% of the patients with a thrombosis in the femoral and/or iliac vein developed a severe postthrombotic syndrome, in contrast to only 9% of those with a thrombosis in the popliteal vein or lower. It is recommended, on the basis of both the prospective and the retrospective study, that patients with a thrombosis in the femoral and/or iliac vein should be treated with either heparin or streptokinase during the early stage. It is probable that streptokinase will significantly decrease the frequency and severity of the postthrombotic syndrome in these patients in particular, although this has not yet been proven.


Streptokinase treatment of deep venous thrombosis of the lower extremity. Clinical, phlebographic and plethysmographic evaluation of early and late results. The investigation comprises 19 patients with acute deep vein thrombosis of the leg treated with streptokinase. The acute clinical symptoms rapidly subsided in 15 patients. Phlebography, performed immediately after treatment, revealed complete thrombus regression in 7 cases, restoration of venous flow but remnants of thrombi in 4 and no effect in 7. One woman was not evaluated radiologically due to pregnancy. The phlebographic restoration seemed to be correlated to the duration of the thrombotic symptoms. Follow-up examinations 6-50 months after the thrombotic incident demonstrated normal phlebograms in 8 patients, all of whom were also free from post-thrombotic symptoms. Venous occlusion plethysmography confirmed that these patients had a normal venous outflow capacity and valvular function in the relevant limbs. By contrast, the remaining 11 patients, with more or less extensive remnants of thrombi at the follow-up phlebography, were found to have plethysmographic signs of venous obstruction and sometimes also valvular insufficiency. The results indicate that thrombolytic treatment is able to give a complete and lasting anatomical and functional restitution of the deep veins after an acute thrombosis in the leg, provided that treatment is induced early enough.


Thromboembolic complications, heparin treatment in increase in coagulation factors in Cushing's syndrome. Seven of 19 consecutive patients with Cushing's syndrome demonstrated thromboembolic manifestations before or after adrenal ectomy. These were successfully treated with heparin. The mean values of coagulation factors VIII (AHF) and V as well as prothrombin were increased. There was a positive correlation between the increase in factor VIII content and the severity of disease. The possibility that these changes in blood coagulation activity reflect an increased coagulability state in Cushing's syndrome is discussed.


Leucocyte migration inhibitory activity of concanavalin-A-stimulated human lymphocytes. Modification by dipyridamole, lysine-acetylsalicylate and heparin. The in vitro effects of heparin, dipyridamole (DIPY) and lysine-acetylsalicylate (LASA) on human peripheral blood leucocyte migration and upon production/release and effect of leucocyte migration inhibitory activity (LMIA) from lymphocytes stimulated with concanavalin-A (con-A) have been studied. The final concentration of each drug was of the same order of magnitude as during clinical treatment. The leucocyte migration under agarose was significantly increased by DIPY at a concentration of 100 mug/ml. The release/production of LMIA was inhibited by DIPY at 1 mug/ml and by LASA at 0.3 mug/ml. Heparin had no influence on LMIA release, even at 10 IU/ml. The LMIA of supernatants from con-A-stimulated lymphocyte cultures was inhibited by DIPY at a concentration of 10 mug/ml, by LASA at 3 mug/ml and by heparin at 10 IU/ml. The findings suggest that DIPY and LASA could have a dual role as modifiers of inflammation: 1) the well known role as antiaggregants tending to limit and impede thrombosis, and 2) as antagonists to the lymphocyte-mediated (type IV) immune reaction through a depressive action on lymphokine production/release and activity.


Oral contraceptives.

Oral contraceptives. Variations in the side chains attached to the gonadal hormones can produce marked changes in the potency of these compounds and can even change their predominant actions. Modification of testosterone renders it less androgenic and greatly enhances its progestational effect. The antifertility action of oral contraceptives may be exerted through any of several mechanisms: supression of follicular development, suppression of ovum expulsion or changes in endometrium or cervical mucus.


The physician and the social worker.

The physician and the social worker. The professional skills of a competent social worker can be utilized by the physician to decrease the pressure created by those patients whom he would like to help if he had the time. Physicians are aware of "social problems" but few have had experience in this collaborative work. Illness-aggravating forces require the breadth of assistance that can be provided by the social worker. By this means the totality of the physician's function is increased.


The oral antidiabetic agents.

The oral antidiabetic agents. Oral antidiabetic agents can be used to lower blood glucose levels in some adult-onset diabetics who do not have acute complications and in whom control of hyperglycemia by weight reduction alone or insulin treatment is not possible. Except for their investigational use, these agents have no place in the treatment of chemical or latent diabetes, or subclinical or suspected diabetes, and they are contraindicated in patients with diabetic ketoacidosis. Findings from the University Group Diabetes Progcted and judicious use of these drugs.


Uncertainty in particle counting and sizing procedures. A method is described for calculating confidence intervals for particle or fiber concentration, and for dust collector penetration. The span of the interval depends upon the value of fiber concentration or collector penetration reported and upon the number of particles or fibres counted.


Control of particulate emissions from stationary fuel burning sources in the core area of the Metropolitan Boston air quality control region. Strategies to control emissions were investigated to develop a plan to meet secondary ambient particulate standards in Metropolitan Boston. Each strategy was evaluated for emission reduction potential, cost, and feasibility. The strategy selected by the State, a periodic inspection and maintenance plan for combustion sources, meets the goal of clean air at minimum cost.


The porosity of amosite and chrysotile asbestos. A computer program has been set up in Fortran language to calculate pore size distribution using the Cranston-Inkley method of calculation. Nitrogen adsorption isotherms were determined on amosite and chrysotile asbestos at - 195 degrees C. Size reduction had a major effect on increasing pore volumes of both asbestos materials.


Precision aerosol divider.

Precision aerosol divider. A precision aerosol divider with a 17 to 1 flow split has been designed and tested. The divider, primarily a mass monitor calibration device, collects 94.4% of the aerosol on a filter to serve as a standard and delivers 5.6% of the aerosol to the mass monitor to be calibrated.


A model for deposition of fibers in the human respiratory system. A mathematical model for estimating lung deposition of fibers is described. It is based on the aerodynamic behavior of thin straight rods. Predicted deposition values for rods of various equivalent aerodynamic diameters and lengths, for each of three tidal volumes and for each of three respiratory system compartments are reported.


A portable spectroradiometer for use at visible and ultraviolet wavelengths. To date there has been a lack of a suitable survey instrument for evaluating occupational hazards of ultra violet radiations. A portable optical spectroradiometer has been developed consisting of a miniature tandem grating monochromator with a photomultiplier detector. This instrument appears to satisfy operational requirements for an ultraviolet hazard survey meter.


Effects of physical activity on weight reduction in obese middle-aged women. Increased physical activity consisting of jog-walking 2.5 miles and 1 hr of calisthenics/week was the primary focus of a 17-week weight reduction program in 22 obese (X = 40% body fat) women ages 30 to 52, many of whom had failed at previous attempts to lose weight by dieting alone. Regular exercise was also increased substantially on an individual basis. Caloric restriction was self-determined and was generally moderate, accounting for about 60% of the total mean energy deficit. Initial and final evaluations included body composition by hydrostatic weighing, progressive multistage exercise testing, and plasma lipid and lipoprotein analyses. A mean relative body fat reduction of 5% (P less than or equal to 0.001) was achieved by a drop in fat body weight (X = 5.4 kg; P less than or equal to 0.001) which closely paralleled that of total body weight (X = 4.2 kg; P less than or equal to 0.001). Mean heart rates and systolic blood pressures at identical submaximal exercise intensities were significantly lower at the time of reevaluation. Mean plasma triglyceride and total cholesterol concentrations did not change significantly (P greater than 0.05). However, the high-density lipoprotein cholesterol/low-density lipoprotein cholesterol ratio increased significantly (P less than or equal to 0.05). Increased physical activity combined with moderate dieting is a feasible approach to weight reduction in middle-aged women.


Resistance of intestinal triglyceride transport capacity in the rat to adaptation to altered luminal environment. Previous studies have shown that the transmucosal transport capacity for tiolein is slower in distal compared with proximal regions of rat small intestine. The effect of altered luminal conditions on the relative capacities for [14C]triolein transport through different regions of intestinal wall were examined by determining the net accumulation of 14C-lipid in the mucosa during maximal steady [14C]triolein absorption. The high 14C-lipid accumulation in distal mucosa was not reduced after direct distal infusion of oleic acid and monolein for 7 days before challenge (substrate induction). No decrease in distal intestinal lipid accumulation was found 1 month after removal of the proximal 40% of intestine beyond the duodenum. Conversely, alteration of the luminal environment in the proximal intestine by 3 days of starvation or by ileal resection did not increase the tissue 14C-lipid concentration in this region during maximal [14C]triolein challenge. When proximal and distal segments were exchanged without reduction in intestinal length, by jejunoileal transposition, major 14C-lipid accumulation still occurred in originally distal segments during 3 hr of [14C]triolein infusion 1 month later. Mucosal synthesis of triglyceride was equally efficient in jejunum and ileum, suggesting that the intrinsic differences in proximal and distal lipid accumulation during maximal rate transport were related to a relatively limited capacity for chylomicron synthesis or secretion in the distal intestine.


Idiopathic enteropathy: an evaluation in rural Iran with an appraisal of nutrient loss. Idiopathic enteropathy in the rural population of Iran was investigated through evaluation of 100 randomly selected apparently normal subjects. The evaluation included quantitation of the nutrient loss, presence of malabsorption, and small intestinal morphological abnormalities. The results show that: 1) there was no significant loss of major nutrients, 2) severe malabsorption was not present, 3) an enteropathy of unknown etiology was found in nearly one-third of the subjects, and 4) abnormalities in morphology did not necessarily mean presence of malabsorption.


Effect of vitamin B6 on leucine-induced changes in human subjects. Distrubances in the tryptophan-niacin pathway seen in endemic pellagra among sorghum eaters have been ascribed to high dietary intake of leucine. Vitamin B6 plays an important role in several steps of this pathway. Therefore, studies on possible metabolic interrelations between excess dietary leucine and vitamin B6 were undertaken in normal healthy human subjects. The results indicated that vitamin B6 could successfully counteract the effects of leucine on quinolinic acid excretion in urine, and on in vitro nicotinamide nucleotide synthesis by erythrocytes, and also could correct the abnormalities of 5-hydroxytryptamine metabolism induced by excess leucine. These observations suggest that vitamin B6 nutritional status may have a contributory role in the pathogenesis of endemic pellagra.


Cholesterol contents of various tissues of chickens with exogenous or endogenous hypercholesteremia. Cholesterol contents of 16 different tissues were determined in 12 normal roosters, 12 roosters with diet-induced, exogenous hypercholesteremia, 10 actively laying hens with minimal endogenous hypercholesteremia, and 12 nonlaying hens with hereditable extreme hyperlipidemia. The tissue cholesterol contents of the normal roosters were strikingly similar to that of the corresponding tissues of the mammals except for a low cholesterol content of the brain in chickens. The hypercholesteremia in the roosters fed a 2% cholesterol diet for 2 months was associated with an increase of cholesterol content in all tissues except the brain, muscle, and adipose tissue. The actively laying hens, on the other hand, had a decreased cholesterol content in most tissues, despite the persistence of a minimal hypercholesteremia for 18 months and significant aortic cholesterol accumulation with mild atherosclerosis. The nonlaying hens developed extreme hypercholesteremia and severe atherosclerosis but only a moderately expanded cholesterol pool in most tissues. The results indicated a remarkable difference in tissue response to diet-induced exogenous hypercholesteremia and endogenous hyperlipidemia associated with laying activity in chickens and the propensity of their aortas to accumulate excessive cholesterol in the presence of either endogenous or exogenous hyperlipidemia.


The school health service as a means of entry into the inner-city family for the identification of malnourished children. Fourteen (10%) of 143 inner-city school children evaluated during the year of entry into elementary school were found to have short stature, to be underweight, and to have reduced subcutaneous fat deposition. These conditions were found to be associated with hematological characteristics of poor nutrition, and therefore, these children were considered to be "at risk" for malnutrition. Investigation into the homes of the at risk children revealed a single family in which no food was available for consumption.


The tourniquet test as a diagnostic aid for the study of telangiectasia. Telangiectasia, commonly called Rendu-Osler disease, in its uncomplicated state is a genetic trait, not a disease, which is transmitted as a dominant. It is difficult to diagnose because the identifying characteristics, which are collectively called telangiectases, are multiform. They often do not appear until adult life and frequently are secondary to extraneous or environmental factors such as alcohol, various drugs of which aspirin is an example, and, in a few subjects, exposure to sunlight. The tourniquet test is positive in a high percentage of cases. Eight patients have been selected for discussion to illustrate the application and helpfulness of this test in attaining a better evaluation of the clinical aspects of telangiectasia.


Standardization of prothrombin and activated partial thromboplastin time reagents and controls. The problems of selection and standardization of reagents, selection of quality control standards, and maintaining quality controls are ourlined and discussed. Precise technic is emphasized, and sources of error and methods for correction of errors are reviewed.


The use of teacher checklists to identify children at risk for later behavioral and emotional problems. Measures of child behavior based on teacher checklists have been shown to be reliable and valid indicators of a child's current school functioning. Such measures, however, are not very accurate predictors of behavior in other settings, or of the development of future behavior problems; they should not be used to label a child as "high risk." The primary care physician could help the teacher decide which children to refer for more thorough evaluation by providing the teacher with information on the child's development and neurologic status, home behavior, and family situation. Follow-up studies suggest that many behavioral disturbances seen in pre-school settings are transient situational disturbances that could be adequately managed through use of behavior modification techniques or simply through the passage of time.


Relationship of radial metaphyseal band width to stature velocity. A relatively radiodense metaphyseal band is present at the distal end of the radius in normally growing children. The width of this band is related to the velocity of stature growth. Though individual growth rates in height cannot be closely predicted from the width of the band in normal children and adolescents, in certain clinical conditions the band width may be a useful guide as to whether or not growth is proceeding normally. Examples are given of the effect of human growth hormone treatment on the band width in a case of isolated growth hormone deficiency and of the effect of thyroid treatment on the band width in a case of hypothyroidism.


The bedtime story and language development. Reading to children contributes significantly to their language development in general and their reading growth in particular. Children learn to comprehend and produce oral and written language through a variety of language experiences. Exposure to the world of books through a regular story time contributes to the child's knowledge store of language, concepts, and ideas. Story time also provides practice in attending to and comprehending written language and promotes a positive association with books and reading. The developmental needs of children suggest practical guidelines for the selection and evaluation of books to read to young children. Pediatricians are in a unique position to educate parents about these developmental needs as well as language acquisition. They can guide parents in providing a rich literary experience that could contribute to the intellectual, social, and emotional growth of their children.


The differential diagnosis of cataracts in infancy and childhood. The differential diagnosis of cataracts in childhood encompasses a broad and fascinating range of diseases and syndromes. Etiologic factors are catalogued according to type and character of the cataracts of infancy and childhood.


Juvenile Cushing syndrome manifested primarily by growth failure. An 11-year-old boy had Cushing syndrome with profound growth retardation, but without the associated clinical characteristics of the disease. Treatment with growth hormone failed to promote growth, suggesting that growth failure in the presence of excess glucocorticoids is due to peripheral tissue resistance to growth hormone rather than to impairment of growth hormone secretion.


Hysterical polydipsia (compulsive water drinking) in children. Two patients had entirely different clinical presentations of hysterical polydipsia: convulsions and coma in a 5-year-old boy with intrinsic renal disease and a single kidney, and abnormal behavior in a  3-year-old girl with normal kidneys. In neither case was the correct diagnosis made on initial evaluation. Physiological studies demonstrated primary polydipsia to be responsible for both clinical presentations. The differential diagnosis of polydipsia and polyuria is reviewed, and the nonuniform presentation of hysterical polydipsia is emphasized. In children with intrinsic renal disease, hysterical polydipsia may be life-threatening.


Streptococcal meningitis with an unusual port of entry. An 18-month-old boy developed meningitis due to group A beta-hemolytic Streptococcus. Despite adequate antibiotic therapy with aqueous sodium penicillin G and chloramphenicol for more than eight weeks, he showed persistent abnormal spinal fluid findings, recurrent elevations of temperature, irritability, and poor feeding. Further investigation revealed a congenital dermal sinus of the nose, with an entry into the anterior fossa that made a small opening intradurally at the level of the cribiform plate. Surgical removal of the entire sinus tract resulted in a speedy and complete recovery.


Epidemiology of influenza in the elderly: evidence of virus recycling. During the Hong Kong influenza epidemic of 1968-1969 the attack rate among persons born prior to 1890 was about one-third the rate among persons born after 1899. During an Asian influenza epidemic in the same community two years earlier there was no apparent age effect. Most persons born before 1890 had detectable pre-epidemic antibody against A/Hong Kong/68 whereas most persons born after 1899 had no detectable pre-epidemic antibody. The lower attack rate in the older age group is consistent with the hypothesis that influenza A viruses with similar or identical hemagglutinins can reemerge over time and that remote previous experience with the same or a similar strain can be protective. Also, no age group born after 1890 was found to have a high prevalence of antibody against A/England/72 or A/Dunedin/73, the successors to A/Hong Kong/68, indicating that recycling of hemagglutinin antigens is not strictly ordered.


Age-related immunity to measles, mumps and rubella in Middle American and United States children. Serum samples from 3000 1 to 15-year-old children residing in the Dominican Republic, Honduras and the Republic of Panama were analyzed for measles, mumps and rubella susceptibility. These data were compared with results obtained on sera drawn from 2221 United States children of similar ages. It was found that children in all areas usually acquired immunity to measles early in life and tended to contract mumps and rubella somewhat later. Immunity data from the urban areas of the United States closely resembled that from the urban areas of the Dominican Republic. Honduran and Panamanian children showed much higher age-related frequencies of rubella, susceptibility. When compared to the other Middle American countries studied, the rural Honduran sample showed significantly higher age-grouped susceptibility rates for measles and simultaneous triple rate revealed a consistent bias, indicating that the attack rates of the three infections are not entirely independent.


Oyster-associated hepatitis: lessons from the Louisiana experience. An outbreak of oyster-associated hepatitis occurring in Louisiana during the months of October and November 1973 has been shown to be related directly to two similar outbreaks occurring at the same time in Houston, Texas and Calhoun, Georgia. Oysters incriminated in all three outbreaks were traced to approved oyster growing areas along the east Louisiana coast. Although no entirely satisfactory explanation could be found for the mode of contamination of these oysters, the epidemiologic and enviornmental data are most consistent with the conclusion that Mississippi River flooding provided the necessary source of fecal pollution into the oyster growing areas. These data also support recent experimental evidence indicating the under natural conditions shellfish eliminate bacteria and viruses differently and may retain certain enteroviruses for as long as two months after these organisms have disappeared from surrounding waters.


Daily variation in USA mortality.

Daily variation in USA mortality. Daily variation in each of several major causes of death in the United States during the period 1962-1966 is described by annual graphs showing deaths chronologically and by frequency distribution of deaths per day. The most significant sporadic factors affecting mortality in the 5 years studied appeared to be the influenza epidemic in 1963 and the unusually hot weather occurring in mid-1966. Deaths were also studied by day of the week and by holiday. Significant and consistent variations were found for violent deaths and those due to coronary heart disease.


Community studies of lung disease in Connecticut: organization and methods. We have obtained data on respiratory symptoms, enviornmental exposures, and lung function in 3730 residents, aged seven years and over, of a rural and an urban community in Connecticut. We used newly developed computerized techniques of data acquisition. The respondents represent 66.3% of the total populations available for study in the defined geographic areas (75.2% in the rural and 54.7% in the urban community). Door-to-door surveys in defined areas within each community provided information on the nonrespondents. Data on 92% of all residents were obtained in the door-to-door survey areas. Comparisons of respiratory symptoms and smoking habits between respondents and nonrespondents in the door-to-door survey areas, and between respondents living in the door-to-door survey areas and elsewhere in the two towns, led to the conclusion that the data on the respondents are an accurate reflection of the lung disease experienced by the total populations of the two communities.


Estimability and estimation in case-referent studies. The concepts that case-referent studies provide for the estimation of "relative risk" only if the illness is "rare", and that the rates and risks themselves are inestimable, are overly superficial and restrictve. The ratio of incidence densities (forces of morbidity)-and thereby the instantaneous risk-ratio-is estimable without any rarity-assumption. Long-term risk-ratio can be computed through the coupling of case-referent data on exposure rates for various age-categories with estimates, possibly from the study itself, or the corresponding age-specific incidence-densities for the exposed and nonexposed combined-but again, no rarity-assumption is involved. Such data also provide for the assessment of exposure-specific absolute incidence-rates and risks. Point estimation of the various parameters can be based on simple relationships among them, and in interval estimation it is sufficient simply to couple the point estimate with the value of the chi square statistic used in significance testing.


Changes in fatal and nonfatal crash rates on a toll highway. Rates of crashes, crashes with injuries, and crashes with fatalities were lower during the 6 months of March 1-August 31, 1974, following a 5-15 mph (8-24 kph) decrease in speed limits on the Illinois Tollway, than the corresponding rates for any of the 6 preceding years, 1968-1973. During the same months of 1968-1974, rates of crashes and of crashes with injuries showed peaks without consistent trends, but rates and percentages of fatal crashes decreased. The data agree with the hypothesis that reducing speed limits on toll roads may lead to substantial reductions in rate of crashes and injuries.


Canine rabies in the United States, 1971-1973: study of reported cases with reference to vaccination history. From 1971 through 1973 629 reported cases of rabies in dogs, concentrated in the Appalachian area, upper Mississippi drainage, Texas, and Louisiana, were reported in the US. States bordering the Atlantic and Pacific oceans had fewer cases. There was a recurring seasonal pattern of cases with a peak in March and April and a low point in August and September. Most of the cases involved transmission from wildlife vectors rather than dog-to-dog transmission. Most of the dogs were owned (87%), unvaccinated (87-90%), and adult (72%); most demonstrated unaggressive behavior (74%) and had exposed humans (75%). A history of vaccination was reported for 60 of the dogs. There were 21 cases of apparent vaccine failure involving all the types of vaccines in use during the study period. The attack rate for unvaccinated dogs was estimated to be 14 to 19 times higher than for vaccinated dogs. Since canine rabies in the United States is predominantly a problem in owned, invaccinated pets, vaccination and licensing of dogs should be mandatory. Surveillance should be continued to ensure that any resumption of dog-to-dog transmission will be rapidly detected and to monitor efficacy of vaccines in current use.


Radiation-induced renal disease. A clinicopathologic study. Radiation injury to the renal parenchyma is an unusual cause of renal insufficiency. Light, immunofluorescence and electron microscopic studies were performed on the renal tissue from two patients in whom renal insufficiency developed within a year after they received abdominal irradiation. The glomerular lesion in both patients was similar. Mild endothelial cell swelling and basement membrane splitting were noted consistently on light microscopy. The electron microscopic examination revealed marked subendothelial expansion with electron-lucent material associated with deposition of basement membrane-like material adjacent to the endothelial cells. In some capillary loops, the endothelial cell lining appeared to be completely lost. The pathogenesis of radiation-induced renal injury is still uncertain. It is speculated that local activation of the coagulation system with consequent thrombosis of the renal microvasculature may be extremely important.


Unusual cardiac reaction to chemotherapy following mediastinal irradiation in a patient with Hodgkin's disease. A 27 year old man with Hodgkin's disease experienced three separate episodes of chest pain, each occurring on the sixth day of a cycle of mustargen, oncovin, procarbazine, prednisone (MOPP) combination chermotherapy. The first episode appeared to represent a myocardial infarction, whereas the next two were less serious. Numerous studies were performed including coronary angiography, cardiac catheterization and open pericardial biopsy. It is suggested that the patient represents an example of a previously undescribed syndrome due to chemotherapy administered after cardiac irradiation.


A new familial syndrome characterized by pigmentary retinopathy, hypogonadism, mental retardation, nerve deafness and glucose intolerance. Three siblings with retinitis pigmentosa, deafness and mental retardation were studied. Physical abnormalities included nystagmus, acanthosis nigricans and multiple keloids. The two male siblings had gynecomastia, small testes and mild subvirilization whereas the only indication of hypogonadism in the female sibling was oligomenorrhea. Testosterone levels in the males, which were in the low to low normal range, were increased by the administration of large doses of chorionic gonadotropin. The two affected males had elevated plasma luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels which were decreased by the administration of testosterone and increased by the administration of clomiphene. One sibling had mild obesity and diabetes mellitus, one had moderate obesity, normal glucose tolerance and hyperinsulinism and the third had abnormal glucose tolerance and hyperinsulinism. This familial syndrome is distinct from either the Laurence-Moon, Bardet-Biedl or Alström disorders and provides further evidence of genetic heterogeneity in this group of autosomal recessive traits.


Coronary heart disease after mediastinal irradiation for Hodgkin's disease. Attention is called to the development of coronary heart disease in two patients several years after they received mediastinal irradiation for Hodgkin's disease. One patient, a 33 year old man, died suddenly eight years after irradiation; necropsy disclosed marked narrowing of all three major coronary arteries. In addition to severe intima fibrous thickening, there also was considerable adventitial scarring of the coronary arteries. This type of coronary sclerosis is different from that seen in the usual patient with coronary heart disease. The second patient, a 42 year old man, had an acute myocardial infarction on two occasions, the first six years after mediastinal irradiation. Observations in previously described patients with coronary heart disease almost surely induced by therapeutic irradiation for Hodgkin's disease are reviewed.


The clinical spectrum of ascites associated with maintenance dialysis. Among 197 patients being treated with maintenance dialysis, six were found to have ascites. Unlike previous reported series, the cause of ascites and the clinical course were variable. Two patients responded to definitive therapy directed against the specific cause. No consistent association was found with the etiology of renal disease or therapy of uremia including the duration of hemodialysis or prior peritoneal dialysis. Nonspecific therapy attempting to alleviate ascites was unsatisfactory. Severe hypertension was not characteristic and bilateral nephrectomy did not influence the course. An extensive diagnostic evaluation is recommended along with skepticism before declaring that idiopathic, refractory ascites exists signaling progressive deterioration.


Erythropoietic protoporphyria. 10 years experience. The clinical and laboratory findings in 32 patients with erythropoietic protoporphyria as well as a review of the pertinent literature on this relatively recently described form of porphyria are presented. The disease is thought to be transmitted in an autosomal dominant fashion with variable penetrance and was characterized in these 32 patients by the onset in childhood of burning (97 per cent) and itching (88 per cent) of the skin on exposure to sunlight. This was accompanied by edema (49 per cent) and erythema (69 per cent) of the exposed areas. Vesicles, petechiae and residual scarring occurred less frequently. Associated abnormalities included cholelithiasis (12 per cent), anemia (27 per cent) and abnormal liver function studies (4 per cent). Reports of associated liver disease including nine cases of fatal hepatic failure, are reviewed. Current methods of diagnosis as well as theories of pathophysiology of the disease are presented. Nineteen of 23 of these patients recently treated with beta-carotene responded with significant increase in their tolerance to sun exposure.


Salmonella oslo. A focal outbreak in a hospital. Five patients were infected with a nontyphosal Salmonella species, Salmonella oslo. Three of the five patients had undergone endoscopy. Three possibilities existed to account for this outbreak: the positive cultures represented isolated events; there was one isolated event and a common source; or, all events were due to a common source. The results of our investigation were inconclusive, but suggested that the endoscope could have been responsible for some of the cases. Appropriate methods for sterilizing endoscopes are reviewed, including sterilization with 2.5 per cent glutaraldehyde solution and ethylene oxide gas. The organism was unusual in its resistance to chloramphenicol and ampicillin; however, it was sensitive to a sulfonamide and trimethoprim. Two patients became culture-negative for S. oslo on treatment with this combination.


The bimodal mortality pattern of systemic lupus erythematosus. The changing pattern of mortality in systemic lupus erythematosus (SLE) led to an examination of the deaths in a long-term systematic analysis of 81 patients followed for five years at the University of Toronto Rheumatic Disease Unit. During the follow-up 11 patients died; six patients died within the first year after diagnosis (group I) and five patients died an average of 8.6 years (from 2.5 to 19.5 years) after diagnosis (group II). In those who died early, the SLE was active clinically and serologically, and nephritis was present in four. Their mean prednisone dose was 53.3 mg/day. In four patients a major septic episode contributed to their death. In those who died late in the course of the disease, only one patient had active lupus and none had active lupus nephritis. Their mean prednisone dose was 10.1 mg/day taken for a mean of 7.2 years. In none was sepsis a contributing factor to their death. All five of these patients had had a recent myocardial infarction at the time of death; in four, ti was the primary cause of death. Mortality in SLE follows a bimodal pattern. Patients who die early in the course of their disease, die with active lupus, receive large doses of steroids and have a remarkable incidence of infection. In those who die late in the course of the disease, death is associated with inactive lupus, long duration of steroid therapy and a striking incidence of myocardial infarction due to atherosclerotic heart disease.


Upward subluxation of the axis in ankylosing spondylitis. A clinical pathologic report. Upward subluxation of the axis associated with cord compression and death was noted in a patient with a long history of idiopathic ankylosing spondylitis. Upward subluxation of the axis has been recognized in up to 8 per cent of patients with rheumatoid arthritis but it is an exceedingly rare complication of ankylosing spondylitis. In this patient psoriasis and then psoriatic dactylitis developed 26 years after the onset of his ankylosing spondylitis. It is tempting to speculate that the unusual destruction of the joints around the atlas might be due to an added effect of psoriasis on idiopathic ankylosing spondylitis.


Chronic lymphadenopathic toxoplasmosis. A case with marked hyperglobulinemia and impaired delayed hypersensitivity responses during active infection. A patient with lymphadenopathic toxoplasmosis characterized by prolonged symptoms and repeated relapses with isolation of toxoplasma from lymph nodes is described. As the disease persisted and progressed, striking immunologic changes occurred that ultimately resulted in a state of extreme hyperglobulinemia associated with impaired delayed hypersensitivity responses. The case in question illustrates that progressive infection may occur in the face of high antibody levels of all immunoglobulin types whereas the only demonstrable immunologic impairment was of delayed hypersensitivity.


Unresolved issues in the first five years of the rubella immunization program. Despite extensive use of atttenuated rubella vaccine during the past five years, the degree of fetal risk in susceptible women inoculated early in pregnancy is still an unresolved issue. Although there is considerable evidence of chronic vaccine virus infection of the products of gestation in aborted fetuses, congenital defects have not yet been reported in the newborn infants of susceptible vaccinated pregnant women. The normal findings in the newborn infant can be misleading with respect to the safety of the vaccines in early pregnancy, because they represent only a small selected group of reported cases. The immediate need is for more complete reporting of all relevant cases wherever they occur in order to determine without many more years of delay whether the fetal risk has public health significance or is so low as to be of negligible importance.


The effectiveness of two oral contraceptives in suppressing plasma androstenedione, testosterone, LH, and FSH, and in stimulating plasma testosterone-binding capacity in hirsute women. The effectiveness of two oral contraceptives in suppressing plasma androstenedione (A), testosterone (T), LH, and FSH and in stimulating testosterone-estradiol-binding globulin (TeBG) was evaluated in 39 hirsute women. Twenty-seven hirsute women received norethindrone 2 mg.-mestranol 0.1 mg. (Group I) and 12 received norgestrel 0.5 mg.-ethinyl estradiol 0.05 mg. (Group II). Hormone assays were performed before treatment and at the end of 3 weeks of therapy. Ninety percent of the women in both groups had an elevated plasma A and/or T. During treatment, plasma A,T, LH, and FSH were significantly reduced in both groups (p less than 0.01). In Group I, 78% of the women had a normal plasma A and T during treatment. In Group II, 83% of the women had a normal A and T during treatment. There was a greater increase in TeBG in Group I (p less than 0.01). It is concluded that these two oral contraceptives effectively suppressed the hyperandrogenism of most of the hirsute women.


Incidence of cervical cancer in perimenopausal and postmenopausal women detected by Papanicolaou smears. This paper concerns itself with the prevalence of abnormal Papanicolaou smears in women 40 years of age or older. They are considered in two groups, i.e. perimenopausal (40 through 49) and postmenopausal (50 or more). In the perimenopausal group, the incidence of abnormal smears was higher than in a central population of women of all age groups. Abnormal smears were less than half as common in the postmenopausal group. Invasive cancer was four times greater in the perimenopausal group and two times greater in the postmenopausal group.


Pregnancy with bilateral ruptured benign cystic teratomas. A case of intra-abdominal rupture of bilateral cystic teratomas in the first trimester of pregnancy is reported. Review of the literature revealed 22 cases of intraperitoneal rupture of benign cystic teratoma (1908 to 1971). In all of these cases only one ovary was involved, and the period of gestation was after the first trimester.


Effect of ampicillin administration on estradiol, estriol, and cortisol levels in meternal plasma and on estriol levels in urine. Ampicillin treatment in the last trimester of pregnancy had no significant effect on the levels of estradiol, estriol, or cortisol in maternal plasma. Urinary estriol excretion was, however, notably decreased during or following ampicillin treatment in six out of 10 patients. These results suggest that the plasma estrogen assays have greater validity than the urinary estriol assay in assessing fetoplacental endocrine function during a period of ampicillin treatment of the mother.


Human pregnancy-associated plasma proteins during the postpartum period. The plasma levels of four pregnancy-associated plasma proteins (PAPP's) and pregnancy zone protein (PZP) were studied in women after delivery of a single viable infant by gel immunodiffussion methods. Data from 89 random samples and 85 serial specimens from five women revealed that both PAPP-B and HPL (PAPP-D) disappeared within a day after delivery. PAPP-A showed a rapid drop in the first 2 or 3 days post partum and became nondetectable in 4 to 6 weeks, with a half-life of 3 to 4 days. PAPP-C had a sharp decrease by the second postpartum day and was not detected 3 to 4 weeks later, with a half-life of 1 to 2 days. None of the PAPP's was detected again during the rest of the 14 postpartum weeks studied. In contrast, the PZP showed a much slower decrease or even a temporary increase during the first 2 weeks post partum; it remained readily detectable over the entire 14 weeks studied.


The association between abnormal glucose tolerance (hyperglycemia and hypoglycemia) and estriol excretion in pregnancy. In 2,000 consecutive patients having glucose tolerance tests in pregnancy hyperglycemia (greater than or equal to ninety-fifth percentile) was associated with increased placental weight (p less than 0.01) but not with increased fetal birth weight. Patients with hypoglycemia (less than or equal to fifth percentile) were more likely to have small-for-dates babies (p less than 0.01). Perinatal death was related to maternal glucose tolerance, being reduced from 1.3% in the total series to 0.6% when normoglycemia was present (p less than 0.05); it was significantly increased in the presence of maternal hyperglycemia (p less than 0.001) and hypoglycemia (p less than 0.01). A combination of abnormal glucose tolerance and subnormal estriol excretion detected pregnancies with significantly higher incidences of fetal and placental growth retardation, major fetal malformations, and perinatal deaths. Moreover, the combination of normoglycemia and normal estriol excretion (62.3% of patients) was associated with a very favorable pregnancy outcome (0.4% perinatal death rate). Hypoglycemia was at least as significant as hyperglycemia in terms of unfavorable pregnancy outcome, especially when associated with subnormal estriol excretion.


Second-trimester spontaneous abortion, the IUD, and infection. Nineteen cases of spontaneous second-trimester abortion associated with the intrauterine device (IUD) are reviewed and compared to 30 cases of spontaneous second-trimester abortion not associated with the IUD. Fifteen of the IUD's were Dalkon shields and four were Lippes loops. 16 of the 19 IUD-associated abortions began either with prolonged rupture of membranes or signs and symptoms of infection. Infection occurred in 18 or 19 of the cases (95%) but only 30% of the comparison group. Eleven major complications occurred in eight patients in the IUD group but only 8 complications occurred among 7 patients in the comparison group. It is suggested that when the IUD remains in utero during pregnancy, it may be a causal factor in second-trimester spontaneous abortion, and that intrauterine infection is the distinguishing characteristic of such cases. Mechanisms are suggested by which the IUD might cause infected abortion.


Quantitation of uterine activity in 100 primiparous patients. An on-line technique for quantitating uterine activity by measuring the total area under the intrauterine pressure curve was utilized during the labor of 100 primiparous patients. Uterine activity was measured in uterine activity units (1 UAU=1 Torr minute). UAU's were calculated for each patient in both cumulative and noncumulative fashions. The rate of uterine activity (UAU per unit of time) increased as labor progressed, yet the total UAU's expended at each centimeter of dilatation progressively decreased with advancing dilatation. Thus, the rate of cervical dilatation increased faster than could be accounted for by the increase in uterine activity. The implication being that the efficiency of uterine contractions increases with advancing labor. It no longer appears reasonable to refer to labor in terms of elapsed time. Information regarding the "pattern of cervical dilatation" and uterine activity appears to be much more meaningful to the evaluation of progress in labor. Quantitation of uterine activity may provide useful information for the ongoing management of labor. Quantitation of UA does provide a means of evaluating the effects of specific events such as medication, anesthesia, and manipulation on UA.


Histologic characteristics of cells cultured from rat placental tissue. Laboratory animals, especially rats, have provided a comparative model for extensive research on maternal-fetal relationships. To identify individual placental cells for subsequent immunologic analysis, cultures of rat placentas were studied. Five cell types were observed, including: two histologically distinct giant cells, mononucleate and multinucleate, apparently formed by amitosis and fusion, respectively; small round cells; polygonal cells, probably cytotrophoblasts. Of particular interest are the small round cells which are phagocytic and morphologically similar to macrophages, cells known to be important in the immune response.


Luteolytic and abortifacient effects of serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha in early pregnancy. Pregnancy was successfully terminated in 8 of 9 patients 5 to 6 weeks after the last menstrual period by serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha (15-ME-PGF2alpha). In one patient the treatment induced vaginal bleeding and a drop in hormone levels, but the patient did not completely abort and the uterus had to be evacuated. Serial intramuscular injections of 15-ME-PGF2alpha appeared to have some luteolytic effect, resulting in a significant drop in progesterone and estradiol levels. However, it is uncertain if the luteolytic effect of the prostaglandin was the precipitating factor in the abortion since the administration of 15-ME-PFG2alpha was accompanied by strong uterine activity which played a role in the abortion.


Bimanual, bipolar intraocular diathermy. We performed bimanual, bipolar intraocular diathermy by using a No. 22 disposable needle and a vitrectomy instrument. The technique required a smaller wound than unimanual bipolar cautery and was combined with membrane peeling techniques. The bipolar technique limited the extent of coagulation effects better than unipolar diathermy methods.


Central retinal artery occlusion after carotoid angiography. A 4-year-old boy had a case of ischemic infarction of the retina that occurred immediately after percutaneous carotoid angiography via a femoral percutaneous approach. This appears to be the youngest reported patient with this complication.


Epidemic keratoconjunctivitis due to adenovirus type 19. A new type of epidemic keratoconjunctivitis, caused by adenovirus type 19, occurred in Oregon in 1974. Although it can be spread by tonometry, in this epidemic finger-to-eye contact appeared to be the cause.


Identification of a nonlysozymal bactericidal factor (beta lysin) in human tears and aqueous humor. An antibacterial factor, identical with or closely related to beta lysin, was measured in human tears, in human aqueous humor, and in fractions of each fluid after an absorption step involving cellulose-asbestos filters. Antibeta lysin was used to help distinguish whether bactericidal activity was due to lysozyme or beta lysin. Beta lysin activity was found in both human tears and aqueous humor in higher amounts than were present in serum; appreciable amounts of lysozyme were found in human tears but not in aqueous humor. Beta lysin is a normal constituent of human tears and aqueous humor and its role in these fluids is that of an antibacterial agent that may also act in concert with lysozyme to destroy bacteria in tears.


Correlation between degree of malignancy and the radioactive phosphorus uptake test in ocular melanomas. Twenty-nine patients who had undergone enucleation for ocular malignant melanoma were studied. The results of the radioactive phosphorus uptake (32P) tests were correlated with histopathologic observations. There was a positive correlation between the 32P test results and the histologic degree of malignancy. Mixed cell melanomas were more frequent in the patients ranked with higher 32P test results. Spindle cell melanomas occurred more frequently in patients with lower 32P test results. Mitoses per field and degree of malignancy correlated positively with 32P test results when ranked in a masked manner by two ocular pathologists. Tumor volume and clinical factors did not correlate with the 32P test results. While patients with mixed cell melanomas had higher mean 32P test results than those with spindle cell melanomas, a large variance was noted. Because of this the 32P test is unreliable in predicting the histopathology of a tumor in individual cases.


Sarcoid granulomatous cyclitis.

Sarcoid granulomatous cyclitis. Granulomatous involvement of the ciliary process in a patient with sarcoidosis appeared as semitransparent nodules in the swollen ciliary body, accompanied by granulomatous iritis, nodules in the angle, vitreous opacities, and perivascular cuffing. Inspection of the ciliary body after maximal mydriasis by gonioscopy aided in the diagnosis of sarcoid involvement in anterior uveitis.


Progressive external ophthalmoplegia and benign retinal pigmentation. A 17-year-old boy had progressive external ophthalmoplegia, normal visual acuity, and a pigmentary retinopathy. Neurologic evaluation showed an abnormal electroencephalogram with diffuse slow (theta) waves. Myasthenia gravis was excluded. Fluorescein angiography showed a normal vascular pattern with diffuse hyper- and hypopigmentation. Results of retinal testing, including color vision, visual fields, electroretinography, and dark adaptometry, were within normal limits except for a slightly subnormal electroretinogram with normal implicit times. Progressive external ophthalmoplegia may be associated with either progressive or non-progressive pigmentary retinopathies, and adequate evaluation of retinal function in these cases must be obtained.


Improved vitrectomy illumination system. To facilitate insertion of a fiberoptic light source inside the vitreous body,we developed a prototype fiberoptic light guide. The light pipes are permanently mounted on the vitrophage and the front ends are tapered.


Optic neuropathy presumably caused by vincristine therapy. A 36-year-old man with Hodgkin's disease developed symmetric optic neuropathy after treatment with nitrogen mustard, vincristine, procarbazine, and prednisone. Histopathologic sections of the eyes showed loss of ganglion cells in the macular region and atrophy of the corresponding fibers in the optic nerve. Vincristine is presumed to have been the cause of the optic neuropathy because of its recognized neurotoxicity and its temporal relation to the onset of the visual complaint.


Congenital central corneal leukoma (Peters' anomaly). Corneal buttons from three patients with congenital central corneal leukoma (Peters' anomaly) were examined by light and electron microscopy. All cases exhibited a central absence of Bowman's membrane and iris synechiae to the periphery of the leukoma. In the first patient, extensive keratolenticular adhesion with retrocorneal fibrous tissue filling the central defect of endothelium and Descemet's membrane implicated late anterior displacement of the normally developed lens as the cause of secondary endothelial degeneration. In the second patient, attenuated endothelium and abnormally composed Descemet's membrane indicated primary dysgenesis of the endothelium. In the third patient, the extensive defect of posterior stroma with anterior stromal disorganization and endothelial metaplasia suggested dysgenesis of both the keratocytic and endothelial mesoderm. Thus, although no unified pathogenic mechanism was consistently applicable, either primary or secondary dysgenesis of the corneal mesoderm must be responsible.


Diffuse congenital hemangiomatosis with infantile glaucoma. A white male infant was born with multiple hemangiomas of the skin and mucous membrane. At 7 months of age he exhibited the signs and symptoms of infantile glaucoma in each eye, but goniotomy was not possible because of vascularity in the angles. Cyclocryotherapy was used on multiple occasions to control intraocular pressure until a goniotomy could be done safely in one eye. The other eye has had good control of intraocular pressure without operation.


Trabeculectomy combined with cataract extraction. In a combined trabeculectomy and cataract extraction procedure on 17 eyes of 16 patients, there was a 50% average decrease in intraocular pressure. Visual acuity improved in 14 eyes, remained unchanged in two eyes, and declined in one eye. The postoperative complications were few and appreciable in only two cases. According to our follow-up findings, the combined technique is no more traumatic than an ordinary cataract extraction.


Variable indenter to modify indentation during biomicroscopy of the peripheral fundus. A modified scleral indentation attachment to the Goldmann three-mirror lens permitted visualization of the same area with and without indentation. Intraocular pressure increased only at the time of indentation. A plastic funnel replaced the metal one, thus reducing the entry of air bubbles between the glass and cornea.


Morphologic and morphometric analysis of the early effects of x-ray and heavy-ion irradiation of hamster lung. Morphometric methods were to used to compare the early effects of graded single doses of x-rays with accelerated heavy particle (helium or neon) irradiation of hamster lung. Increased values in the volume densities of both capillary lumina and inflammatory cells at 2 weeks postirradiation were observed. Neon-ion irradiation wes statisically different from x-irradiation at all dose levels, while helium-ion irradiation showed significant increases only at higher doses (1000 to 1500 rads). At 1 month post-irradiation, the volume densities of capillary lumina after heavy particle irradiation began to return to control values, while those in x=irradiated lungs continued to be elevated. The volume density of inflammatory cells remained increased for all types of irradiation, and the highest values were obtained in neon-ion irradiated lungs. Accelerated heavy particle irradiation would therefore appear to elicit a more intense early radiation than does x-irradiation but the chronic significance of these findings is not yet known.