[Radiotherapy of cerebral tumor in the adult with the exception of hemispheric glioma]. The results obtained in this series of 120 patients with brain tumors, excepting hemispheric gliomas, appear particularly comforting. Radiosensitiveness of medulloblastomas, pinealomas and to some extent of ependymomas, was of course known. On the contrary, the radio-sensitiveness of some astrocytary processes, or supposed astrocytomas, well or moderately differentiated (gliomas of the IIIrd. ventricle, opto-chiasmatic gliomas, gliomas of the brain stem) appears to have been appreciable and it has been possible to obtain numerous stabilizations equivalent to cures. An histologic chek-up prior to roentgentherapy appears to authors as strictly necessary and might be easily enough obtained thanks to the stereotaxic procedures. Authors are not of mind that the present series will be burdened with radio-necrotic like complications. They think that the tumoral doses might be increased of 5 p. 100 and even of 10 p. 100, while maintaining the same protraction and a fractioning of the same order: treatments of 5 to seven weeks consisting in 5 to 6 sessions per week). It is presently too soon for valuing the efficiency of an adjuvant chemotherapy.


Lymphoid cell responses in parasitic helminth infections. The cellular responses during experimental ascariasis provide a mechanism whereby effector systems are mobilized rapidly and locally, resulting in the prompt response which is evident on reinfection. It is proposed that the products of activated "T" lymphocytes facilitate local accumulation of lymphoid cells which, later, as specific antibody-producing cells provide the mediators (e.g. opsonizing antibody) responsible for mechanisms which destroy the parasite. While the mechanisms causing death of the parasite are still unknown, our present studies will provide an explanation of events that prepare for this event.


[Effect of the photoperiod of the site of oviposition of Aedes mariae (Diptera,Culicidae)]. The overwintering biology of Aedes (Ochlerotatus) mariae (one of the sibling species of the mariae complex) was studied in populations from the Tyrrhenian coast of Central Italy (Sperlonga and Formia). Ae. mariae has in this zone several generations per year and its larvae are commonly found from March to October exclusively in rock pools along the coast. Field and laboratory observations show in these populations an embryonic winter diapause induced by short-day photoperiods (9-12 hours). The photoperiod acts primarily on the parental females during their preimaginal life. The expression of diapause is influenced by temperatures and photoperiods experienced by the embryos. Full embryonic diapause is observed when the eggs are incubated at relatively low temperatures (less than 16 degrees C) and at short photoperiods. Short-day photoperiods also induce a remarkable change in the oviposition behavior of Ae. mariae. Laboratory observations show that the adult females readily oviposit on water surfaces when originating from larvae reared at long-day photoperiod while they are very reclutant to oviposit in the same situation when reared at short day photoperiod. Choice experiments involving four alternative oviposition sites (see Plate 1) demonstrate a preference for outside free water in long-day mosquitoes and for inside moist surfaces in short-day mosquitoes. The behavioral difference persists in successive gonotrophic cycles and it is not apparently affected by the photoperiod acting on the adult females. The above evidence together with recovery of overwintering eggs in holes and crevices of rock pools suggest that the shift in oviposition site shown in the laboratory reflects a similar shift occurring in nature. Such photoperiodically induced change in oviposition behavior seems to have an important adaptive significance in providing more constant microclimates to the diapausing eggs and in protecting them from the mechanical action of winter storms.


[Observations of fleas of small mammals at the Gran Paradiso National Park (Italian Occidental Alps)]. The Siphonaptera of small mammals (nearly 200 rodents, insectivora and mustelids) of the Parco Nazionale del Gran Paradiso (Western Italian Alps) have been collected and studied during the years 1973-75. All the animals have been captured at altitudes ranging from 1570 to 2400 m during different seasons. Twelve genera and sixteen species have been identified, namely: Chaetopsylla (C.) homoea homoea from Mustela erminea; Hystrichopsylla (H.) talpae talpae from Clethrionomys glareolus; Rhadinopsylla (A.) integella integella from Clethrionomys glareolus and Microtus nivalis; Ctenophtalmus (C.) agyrtes verbanus from Pitymys multiplex (collected by Beaucournu); Ctenophthalmus (C.) solutus solutus from Apodemus flavicollis and Apodemus sylvaticus; Ctenophthalmus (Medioctenophthalmus) nivalis nivalis from Clethrionomys glareolus, Microtus nivalis and Pitymys multiplex; Doratopsylla dasycnema cuspis from Sorex araneus and Clethrionomys glareolus; Palaeopsylla soricis rosickyi from Sorex araneus; Leptopsylla segnis from Apodemus sylvaticus and Mus musculus; Peromyscopsylla bidentata bidentata from Clethrionomys glareolus and Microtus nivalis; peromyscopsylla fallax from clethrionomgs glareous; Amphipsylla sibirica ssp. from clethrionomys glareolus and microtus nivalis; Malaraeus (Amalaraeus), penicilliger kratachvili from Clethrionomys glareolus, Microtus nivalis and Mustela erminea; Myoxopsylla laverani from Eliomys quercinus; Callopsylla saxatilis from Apodemus flavicollis, Microtus nivalis and Mustela erminea. Species of fleas not yet described in Italy are: Chaetopsylla (C.) homoea homoea; Rhadinopsylla (Actenophthalmus) mesa; Ctenophthalmus (Medioctemophthalmus) nivalis nivalis; Callopsylla saxatilis. The genus Callopsylla is identified for the first time in Italy. New identification of hosts for the species of fleas already described in Italy are: for Rhadinopsylla (Actenophthalmus) integella integella: Clethrionomys glareolus; for Ctenophthalmus (C.) solutus solutus: Apodemus flavicollis and Apodemus sylvaticus. All the 15 male specimens of M. laverani from E. quercinus captured in the Parco Nazionale del Gran Paradiso have characters more similar to M. l. traubi than to M. l. laverani: only one long and a much shorter spine in the superior half of the movable process, a distinct tooth in the anterior margin of the movable half of the movable process, a distinct tooth in the anterior margin of the movable process, crochets of phallosome shorter and more gradually tapered, apex of fixed process very acuminated. To the contrary the shape of the movable process is similar to that of M. l. laverani. A point of particular interest is to be found also in 2 specimens of Amphypsilla of the sibirica group, respectively collected from Mustela erminea and Microtus nivalis. They have a very atypical distribution of the spine in an abnormally shaped movable process: the reasons of the abnormality are due to castration, probably of parasitic origin (absence of phallosome, tendons, etc.).


[Radiosensitivity curve of different stages of spermatogenesis of Anopheles atroparvus (Diptera:Nematocera)]. In order to obtain a dose-hatchability curve for irradiated spermatogenetic stages of Anopheles atroparvus, we have irradiated with the same dose "4500 r" young fourth larval stages, old fourth larval stages, nymphae and adult males. Those different stages represent different phases of spermatogenesis. The peak of radiosensitivity for embryonic mortality, was found in spermatids, lowest appeared in spermatogonies.


[Propensity for feeding on blood under laboratory conditions and chromosomal polymorphism in Anopheles stephensi]. Propensity to blood feeding under laboratory conditions was studied in females of A. stephensi carriers of different arrangements of a polymorphic paracentric inversion of chromosome 2R (+/+, +/b, b/b). One hour experiments were performed at various hours of the day, in continuous light, with temperature between 26 and 28 degrees C and relative humidity between 65 and 75%, using unfed mosquitoes 4-5 days old and guinea pigs as hosts. The frequency of blood fed females was found to be constantly much lower in the +/+ homokaryotypes, than in the other two karyotypes. Smaller differences in biting activity were observed between the heterokaryotypes and the b/b homokaryotypes, the latter appearing significantly more active at least during the scotophase hours. The evidence of a lower activity of the +/+ homokaryotypes was confirmed when the mosquitoes were stimulated by a human arm. Such marked and constant behavioural difference is tentatively considered as the expression of a diversified response to the environmental conditions whose deterrent effect on biting activity would be more pronounced on the +/+ homokaryotypes than on the carriers of the 2Rb arrangement.


[Epizoology of leishmaniasis in the province of Foggia: leishmaniasis in the dog]. The authors value the sensibility and the advantage of the different serological tests for the diagnosis of canine leishmaniasis (immunodiffusion, complement fixation and immunofluorescent tests) and give the results obtained from an epizoological survey carried out on dogs in the province of Foggia (Italy). The immunofluorescent test, whose positivity sera titre has fixed at the diluition of 1:10, resulted the most appropriate. In more than 400 animals examined, all from the 50 communes of the province of Foggia, the infection level of the dog by leishmania resulted to be 7.42%. If the three geographical zones, in which the province has been subdivided, are considered, this level varies from 10.21% for the subjects from the Gargano promontory, to 6.89% for those of the Subapennine Dauno, and to 5.55% for those of the Apulia plateau.


[Tyrrhenia blennii g.n. sp. n. (Hemiurata : Halipegidae Poche, 1925) parasite of Blennius gattorugine and Blennius sanguinolentus]. Trematodes recovered from Blennius gattorugine and Blennius sanguinolentus from the Gulf of Gaeta, Italy, are described and figured as Tyrrhenia blennii g.n. sp.n. The new genus differs from other members of the Arnolinae Skrjabin and Guschanskaja, 1958 (Halipegidae Poche, 1925) chiefly in having acetabulum equatorial, receptaculum seminis uterinum present and eggs without filaments. The diagnosis of the new genus Tyrrhenia and a key to genera of Arnolinae are given.


[Diffusion of pulmonary Nematoda in the steinbock (Capra ibex) and the chamois (Rupicapra rupicapra) at the Gran Paradiso National Park and the di Valdieri Reservation]. The results obtained in a survey on the diffusion of pulmonary nematodes in 13 steinbocks (Capra ibex) and 71 chamois (Rupicapra rupicapra) of the Parco Nazionale del Gran Paradiso, and 49 chamois of the Riserva di Valdieri, Italian Western Alps, are reported. The following species of nematodes were identified: Spiculocaulus austriacus, Protostrongylus rufescens, Protostrongylus hobmaieri in steinbocks; Protostrongylus rupicaprae, Protostrongylus hobmaieri, Protostrongylus refescens,Protostrongylus sp., Spiculocaulus austriacus and Dictyocaulus filaria in chamois. The study of two species, viz. Spiculocaulus austriacus and Protostrongylus sp., is still in progress because these nematodes show morphological peculiarities never previously described.


Pyloro-duodenal atresia. A report of three families with several similarly affected children. Seven patients born with pyloro-duodenal atresia are reported, one had an additional atresia of the small and large bowel, and another had a pneumoperitoneum probably secondary to rupture of the stomach. All patients had the same radiological findings and had no air distal to the pylorus. Consanguinity was elicited in four and a familial incidence of an identical malformation in siblings in six. 6 of the 7 patients were operated on and 4 are living and well 6 months to 5 years later. This report raises the total number of published cases of pyloro-duodenal atresia to 46, and provides further evidence for an autosomal recessive mode of inheritance.


Xanthogranulomatous pyelonephritis in childhood. Urographic, arteriographic and B-mode echographic findings in a four-year-old girl with tumefactive xanthogranulomatous pyelonephritis are reported. Review of our case and those that preceded it illustrates that when a localized mass in a functioning kidney is encountered radiographically in a child, xanthogranulomatous pyelonephritis should be included in the preoperative differential diagnosis. Nephrectomy may then be avoided.


Renal parenchymal radiographic measurement in infants and children. An analysis of the urograms of 433 pairs of normal human kidneys performed on patients ranging from birth to 80 years was carried out with the object of relating the mass of the renal parenchyma to the overall size of the kidney at different ages. Statistical analysis of the results showed that there was a highly significant difference in the ratio of mass to overall size in the age periods of 0-5 and 5-10 years, with a significant difference in the third quinquenium. Adult proportions are not reached until the latter half of the second decade of life. Recognition of this aspect of the process of maturation of normal kidneys is essential if radiographic measurement is to be used as a means of estimating kidney damage in the very young.


Abnormalities associated with orificial insufficiency of prostatic ducts in infants and children. 48 boys examined with urethrocystography on all together 129 occasions and shown to have orificial insufficiency of prostatic ducts were studied for associated for associated abnormalities. In 44 cases the insufficiency could be attributed to urinary infection complicating urethral obstruction or neurogenic dysfunction of the urinary bladder or to any one of these three abnormalities alone. The age at which the insufficiency occurred, the time it persisted, and the extent to which it involved the prostate were also studied.


[Experimental research on the biological cycle of Phyllodistomum elongatum Nybelin, 1926 (Digenea: Gorgoderidae Looss, 1901)]. Experimental infection of Tinca tinca and Carassius auratus have demonstrated that Cercaria duplicata von Baer, 1827 is the larval form of Phyllodistomum elongatum Nybelin, 1926 and that the life-cycle occurs between Anodonta cygnea (intermediate host) and Tinca tinca or Carassius auratus (final host) without a second intermediate host. The life-history experimentally completed in the laboratory occurs in the following way: -- adult in the ureters of Tinca tinca and Carassius auratus; -- mother sporocyst and daughter sporocyst of Phyllodistorum elongatum in Anodonta cygnea give rise to the large-tailed rhopalocercous cercaria; -- metacercaria encysted within transformed tail in water.


Strain gauge plethysmography for blood flow measurements in the legs of children. The arterial resting flow, the arterial peak flow after 3 minutes of circulatory arrest to the leg, and the venous emptying rate were studied by strain gauge plethysmography in the calves of 85 children between 3 and 16 years of age. Most of the children had heart disease; therefore the values obtained can be regarded as reference values only for this type of patient.--The reproducibility of the results of the flow measurements was favourable and equal to that found in the examination of adults and of children using water-filled plethysmographs. --All of the flow functions investigated were significantly higher in the younger children and--but not always significantly--higher in boys than in girls. There was no difference between sides as regards arterial flow, whereas the venous emptying rate was significantly lower in the left calf. --Strain gauge plethysmography is recommended for assessment of circulatory complications after vascular catheterization in children aged 4 years or older.


[New parasite identified in Blennius sanguinolentus Pallas, 1811: Schikhobalotrema longivesiculatum sp. n (Haplosplanchnidae Poche, 1925)]. Schikhobalotrema longivesiculatum sp.n from Blennius sanguinolentus Pallas, 1811 at Gulf of Gaeta (Italy) is described, figured and compared with other species of the genus Schikhobalotrema Skrjabin et Guschanskaja, 1955. Schikhobalotrema longivesiculatum differs from Schikhobalotrema obtusa (Linton, 1916) Skrjabin et Guschanskaja, 1955, especially for sucker ratio, lobed ovary, seminal vesicle coiled and in larger size of eggs; from Schikhobalotrema pomacentri (Manter, 1937) Skrjabin et Guschanskaja, 1955 for lobed ovary, elongated seminal receptacle, smaller vitelline follicles and coiled seminal vesicle; from Schikhobalotrema sparisomae (Manter, 1937) Skrjabin et Guschanskaja, 1955 for elongated seminal receptacle, coiled seminal vesicle and extent of escretory vesicle.


Radiological manifestations of the Cornelia de Lange syndrome. This paper describes the radiological findings obtained in 20 patients with the Cornelia de Lange syndrome. The pattern profiles of the hand skeleton were studied in these patients, using the method described by Poznanski et al. This study revealed a short first metacarpal bone, combined with relatively long third and fourth metacarpals, to be the most characteristic feature of the syndrome. No radiological characteristic was found to be pathognomonic of the syndrome, but the combination of a deformed proximal metaphysis of the radius with the above mentioned abnormality in the pattern profile of the hand is described as highly suggestive of the Cornelia de Lange syndrome.


The radiological pattern associated with the trisomy of the short arm of chromosome No 4. A fairly constant constellation of roentgen anomalies has been detected in the skeleton of 9 patients with the trisomy of the short arm of chromosome No 4. The more common changes involve the skull, spine and pelvis, while the limbs, as well as the internal organs, are less affected. Microcephaly, hypertelorism, small and closed sella, malocclusion, scoliosis, "square" vertebral bodies, narrow iliac wings, wide iliac angles and narrow acetabular ones, coxa valga, medial recumbency of the proximal tibial epiphysis and retarded bone age are usual findings.


[Seasonal variations in microfilarema and effects of ambient temperature in dogs parasitized by Dirofilaria repens]. 1 - Dogs infected with Dirofilaria repens from Italy were found to show seasonal variations in the number of microfilariae in the peripheral blood. 2 - The rise in the number of microfilariae occured in August and September and is coincidental with the higher probability of trasmission. 3 - Rise and fall of microfilaraemia was induced experimentally by exposure of the host to high and low temperatures respectively. 4 - The importance of such variations in microfilaraemia is stressed in relation to the evaluation of the infection from a clinical, pharmacological and epizoological point of view.


[A new Acanthocephala Breizacanthus ligur sp. n. (Palaeacanthocephala: Arhythmacanthidae Yamatugi, 1935) parasite of some species of benthic fishes from the Ligurian Sea]. Breizacanthus ligur sp.n. is described and figured from several benthic fishes from the Ligurian Sea. The host species are: Argentina sphyraena, Chlorophthalmus agassizi, Gadiculus argenteus, Phycis blennoides, Coelorhynchus coelorhynchus, Capros aper, Callionymus phaeton, Helicolenus dactylopterus. The parasites were considered as belonging to the family Arhythmacanthidae Yamaguti, 1935 and to the genus Breizancanthus Golvan, 1969. Breizancanthus ligur differs from the only two known species of the genus B. irenae and B. chabaudi for the number of longitudinal rows of hooks and-or numbers of hooks in each longitudinal row, arrangment of cement glands, length of body and lenght of male genital apparatus ratio, lenght of female genital apparatus and shape of embroyophore.


Selective adrenal venography in an infant with virilizing adrenal cortical carcinoma. Selective adrenal venography in a 10 month old infant with adrenal cortical carcinoma and virilizing symptoms demonstrated grossly dilated, irregular tumor veins. This was an unexpected finding as at aortography no adrenal arteries which would allow selective catheterization, and only very small neoplastic vessels were seen.


The value of barium enema in establishing nature and level of intestinal obstruction. In cases with obscure abdominal symptoms, potentially obstructive in nature, barium enema constitutes a valuable supplement to the routine abdominal plain film examination. The method, extended to include a reflux examination of the distal part of the small bowel, offers an important alternative to the frequently employed follow through examination, whenever the indications for immediate surgical exploration remain conditional. In the hands of radiologists accustomed to hydrostatic reduction of intussusception, the procedure yields a fast and safe differentiation between adynamic and mechanical ileus.


Spinal cord injury in the newborn infant. Birth injury to the spinal cord secondary to traction forces during delivery is a common but frequently undiagnosed disorder. The injury usually affects the cervicodorsal junction, with both extradural hematoma and direct cord damage at that level. Clinical findings of a paraplegic infant with abdominal breathing are sometimes obscured by secondary pneumonia and/or hypoxia. Radiologic manifestations  include a bell shaped chest indicative of loss of the external muscles of respiration; spinal roentgenograms are usually normal. Myelography in neonatal spinal injury demonstrates a block in the subarachnoid space; infrequently localized cord atrophy may be identified.


The diagnosis of vitamin D deficiency rickets. A clinical, radiological and biochemical study of 300 Cape coloured out-patients in order to clarify the diagnosis of rickets and to establish its incidence in the specific ethnic group selected, is presented. 95 Cases (31.6%) were diagnosed as suffering from rickets. Analysis of the results indicates that radiological examination is necessary to confirm or exclude the clinical diagnosis. The most useful biochemical parameter is the serum level of alkaline phosphatase.


Delayed hemopericardium following penetrating foreign body into the aorta. A four and a half year old girl with delayed appearance of traumatic hemopericardium, detected radiologically despite misleading clinical manifestations, is presented. The presence of cardiomegaly and a needle in the right upper mediastinum on the chest roentgenogram and its partial motion together with diminished cardiac pulsations at fluoroscopy led to angiocardiography. The radiological demonstration of hemopericardium due to the needle penetrating the aortic root, enabled successful surgical intervention.


Renal enlargement associated with infectious mononucleosis. A 5 1/2 year old boy developed severe infectious mononucleosis (I.M.) with fever and hepatitis persisting for eight weeks. The diagnosis of I.M. was confirmed serologically by the development of a heterophile antibody and an ox cell hemolysin. During the acute illness, bilaterally enlarged kidneys were noted by intravenous urography even though the patient had no significant clinical or laboratory evidence of renal disease. Fifteen months following discharge, clinical and laboratory findings were normal and the kidneys had decreased markedly in size.


The 'septation sign' in multicystic dysplastic kidney. The case report is presented of a neonate with a unilateral multicystic dysplastic kidney. An intravenous pyelogram revealed septations throughout this kidney with late pooling of contrast media within the cystic structures. The pathological data stresses the presence of normal appearing glomeruli interspersed between the dysplastic cystic parenchyma. The possible etiologies for the septation sign and pudding phenomenon are discussed.


Comparative assessment of clinical, roentgenological and anatomicopathological pulmonary findings in prematures and newborns. The clinical, roentgenological and pathologicanatomical findings in 101 deceased premature and newborn infants, delivered in the years 1968-1971, have been studied by transferring the data on to punch cards for the purposes of comparison and analysis. A full or partial conformity of the X-Ray findings with the pathologic-anatomic diagnosis was found in 72 cases. It has been concluded that a distinct radiomorphologic substrate is often caused by a combination of various pathologic-anatomical changes.


Radiological manifestations of lung echinococcosis in children. Echinococcosis of the lung should always be kept in mind when evaluating masses seen in the chest radiograms of children, since the disease is not a rarity. The radiological signs and its differential diagnosis are considered, emphasizing the possibility of the masking of a hydatid cyst by a superimposed pneumonia. The importance of verifying the presence of echinococcosis before deciding on puncture of the lung is stressed.


Radiographic findings in esophageal atresia with proximal pouch fistula (type B). Patients with esophageal atresia and proximal pouch fistula have plain films that simulate esophageal atresia without fistula. Clinical suspicions of the existence of the proximal pouch fistula may occur when marked aspiration of barium occurs following outlining of the proximal pouch, or by choking spells during irrigation of the proximal pouch. Outlining of the fistula from the pouch requires some form of continuous imaging, either with T.V. tape, cine or 70 mm. spot films. Of interest is the fairly long distal esophageal segment found in the three cases reported, as opposed to the usual short segment of the distal esophagus seen in infants with esophageal atresia without fistula.


Supralevator imperforate anus with unusual associated anomalies: colonic ureteral ectopy, intraluminal calcified meconium. This case illustrates a complex of congenital ano-rectal and renal abnormalities not previously reported. Colonic ureteral ectopy, an extremely rare occurance, was also found in this patient and an explanation of the probable embryogenesis is proposed. The roentgen pattern of intraluminal calcified meconium is also illustrated.


Congenital megalourethra.

Congenital megalourethra. Congenital megalourethra, an anomaly of the penile urethra, is discussed, and 15 cases from the English literature are reviewed. The relationship of this anomaly to other abnormalities of the genitourinary system is stressed.


Cerebral abnormalities in the oral-facial-digital syndrome. This is a report of three cases of the oral-facial-digital (OFD) syndrome with accompanying severe cerebral abnormalities. Among 150 reported cases of this syndrome, 16 had accompanying documented cerebral anomalies including porencephalic cysts, agenesis of the corpus callosum, and cortical hypoplasia. Although mental retardation is a prominent feature of this syndrome, neuroradiologic workup is infrequent. In view of the frequency of associated cerebral abnormalities (13%) of OFD syndrome, neuroradiologic evaluation is valuable as a guide to prognosis and therapy for these children.


The skull in metaphyseal chondrodysplasia type Jansen. For some reasons skull findings in Jansen's Metaphyseal Dysplasia have been largely neglected. A survey of the seven known cases (three of them being primarily observed and described by two of the authors) disclose important and constant alterations, namely pronounced basilar thickening and sclerosis, prominent supraorbital and zygomatic arches, underdevelopment of the paranasal sinuses with sclerosis of the adjacent bone, and hypoplasia of the mandible. These alterations give rise to distinct and fairly specific features. The relationship to other craniotubular disorders, such as craniodiaphyseal dysplasia, craniometaphyseal dysplasia, and frontometaphyseal dysplasia is discussed.


Retrosternal density: a sign of pulmonary hypoplasia. An anterior increased density, that parallels the posterior border of the sternum, was noted on the lateral radiograph of two children who were at first thought to have an accessory diaphragm. After a long follow-up and further investigations, it is now felt that this sign is solely due to upper lobe hypoplasia.


Congenital oesophageal stenosis distal to oesophageal atresia. Two cases with both oesophageal atresia and stenosis in the lower part of the oesophagus are reported. --The stenoses are congenital and most likely can be classified as malformations. --The stenoses had no clinical significance until the children began to eat solid food. Foreign bodies, which had been arrested in the oesophagus above the stenosis had to be removed several times. The importance is stressed of always including the distal oesophagus at the roentgenologic investigation of children with troubles after operation for oesophageal atresia.


Cysts of the omentum.

Cysts of the omentum. Omental cyst is a rare lesion occurring primarily during childhood and young adulthood. It is closely related to mesenteric and retroperitoneal cysts, all conditions most likely being of congenital or benign neoplastic lymphatic origin. Omental cysts usually present as abdominal distention of long duration, less frequently as a palpable abdominal mass. Rarely they cause an acute abdominal surgical crisis clinically resembling appendicitis with peritonitis. Two cases are reported, one with acute and one with chronic symptoms. The clinical and radiologic features of omental cyst are reviewed in order to increase awareness of this entity.


Subepithelial hemorrhage in the renal pelvis and ureter simulating pyeloureteritis cystica. Two children are presented with similar appearing small urographic defects in the ureter and renal pelvis similar to pyeloureteritis cystica. In one patient with aplastic anemia who died the abnormalities represented areas of subepithelial hemorrhage. Another child had clinically diagnosed Henoch-Schonlein purpura and the defects were probably due to subepithelial hemorrhage.


Relationship between urinary infection and orificial insufficiency of prostatic ducts in infancy and childhood. A review of the radiographs obtained at 200 unselected micturition urethrocystographies in boys revealed orificial insufficiency of prostatic ducts (OIPD) in 29. Urinary infection had been demonstrated in 131 these cases including all of the boys with OIPD except one, who had neurogenic dysfunction of the urinary bladder. --In one boy OIPD was discovered at the age of 7 weeks following treatment first for neonatal sepsis and then for urinary infection, both caused by the same phage type  of Staphylococcus aureus. Bacteriologic examination of the blood and urine had suggested recovery, but further investigated disclosed survival of the bacteria in the prostate.


The severe recessive form of pseudoachondroplastic dysplasia. Genetic and clinical heterogeneity within the category of pseudoachondroplastic dysplasia is discussed. Clinical and radiological findings are presented in a family where 4 out of 7 siblings, aged between 3 and 10 years, had a severe form of the condition. The parents had short stature without any signs of pseudoachondroplastic dysplasia. Inheritance in this family appears to be recessive, with a possibility that the abnormal allele may be partially manifest in heterozygotes.


The aspect of trauma in the bone changes of congenital lues. A prospective study of 112 children with syphilis showed changes more typical of trauma in 35 children than the usual radiographic findings ascribed to congenital lues. No similar changes were present in a control group. 'Battering' as such seems to be excluded, but the survey suggests luetic bones are more fragile, and part of luetic bone disease is traumatic in origin.


Liposarcoma of the renal capsule in a 7 year old girl. An unusual case is reported of a liposarcoma of the renal capsule in a 7 year old girl. Initial radiological studies revealed a fatty tumor related to the lower pole of the kidney. Selective renal angiography located the tumor to renal capsule and demonstrated its malignant nature.


Tuberous sclerosis: a case report with aortic aneurysm and unusual rib changes. An unusual case of tuberous sclerosis with thick sclerotic ribs, thoracic and abdominal aortic aneurysms and sacrococcygeal chordoma is described. The patient has been followed for 17 years and the radiographic features of the ribs and especially the aortic aneurysms are unusual features of this condition.


Percutaneous catheterization of the femoral vessels in children. I. Influence on arterial peak flow and venous emptying rate in the calves. The influence of percutaneous catheterization of the femoral vessels on the arterial peak flow (APF) and the venous emptying rate (VER) of the calves was studied with strain gauge plethysmography in 112 children 2-16 years of age, who underwent arterial (49 cases) or venous catheterization, mostly because of heart disease. The conditions on the catheterized side were compared with those on the other side, and the pre-catheterization values were compared with those obtained after completed catheterization. The catheterization procedure was proved to have no general influence on APF or VER, although it may have an effect in individual patients. APF was not affected at arterial or venous catheterization in children older than 8 years of age. In the younger children, APF was slightly decreased on the catheterized side after arterial as well as venous catheterization. This was considered to be caused by arterial spasm. On the following day APF was normal. A few patients in this age group had a marked reduction in APF caused by intense spasm or thrombotic occlusion after arterial catheterization. These patients will be accounted for separately. VER on the catheterized side was not significantly influenced after venous or arterial catheterization, irrespective of the age of the patients.


Congenital left posterolateral diaphragmatic hernia with previously normal chest x-ray. Three patients who presented with left congenital posterolateral diaphragmatic hernia at the ages of six months, two years and six years and who had a normal chest x-ray earlier in life are reported. In two children the late onset of symptoms and previously normal radiographic appearance might be explained by the spleen acting as a plug in the diaphragmatic defect. A normal chest x-ray in early infancy does not exclude the diagnosis of congenital posterolateral diaphragmatic hernia.


Benign lymphoid polyps of the rectum.

Benign lymphoid polyps of the rectum. Benign lymphoid polyps are a rare histologic entity and should not be confused with malignant disease of the colon and rectum. Although retention polyps are the single most common type of colonic polyp in children, the presence of multiple clustered polyps in the rectum should alert the radiologist to the possibility of benign lymphoid polyps. A representative case is described and a review of the pediatric experience with this entity is discussed.


Renal hypoplasia and dysplasia: a radiological and pathological correlation. Forty-nine cases of congenitally small (hypoplastic) or maldifferentiated (dysplastic) kidneys have been reviewed. From a detailed consideration of the radiological and pathological data in these patients a classification of renal hypoplasia and dysplasia has been derived which is based not only on the abnormalities in the kidney, but also on the associated anomalies seen in the ureters and in the lower urinary tract.


Angiographic and ultrasonographic appearance of renal cortical and medullary necrosis in the newborn. Renal cortical and medullary infarction are 2 of the severe complications of perinatal asphyxia and shock. The angiographic and ultrasonographic findings in these conditions have not been described previously. They demonstrate nephromegaly, a nonhomogeneous nephrogram, and internal echoes. Similar findings may be seen in renal vein thrombosis, hydronephrosis, and polycystic kidneys.


Stickler syndrome. Report of a second Australian family. Three cases of Stickler Syndrome (hereditary progressive arthro-ophthalmopathy) in a family are described. This disease is caused by a dominant gene with incomplete penetrance, and shows variability in its symptomatology and clinical and radiographic findings among members of the same families. The radiographic appearances, although seldom diagnostic, are often suggestive of the disease or supportive in doubtful cases.


Malformation of the iliac bone associated with intraspinal abornalities. Two cases of intraspinal abnormalities combined with a characteristic unilateral protuberance of the iliac bone are reported. A search of the literature revealed only 2 other examples of this condition, but analysis of the associated findings in all 4 cases suggested a specific syndrome consisting of the iliac protuberance, other ipsilateral osseous abnormalities, and occult spinal dysaphism including intraspinal lipoma.


Upper oesophageal web in childhood.

Upper oesophageal web in childhood. Two cases of upper oesophageal web in childhood are described. The importance of distending the upper oesophagus with barium for the demonstration of these lesions is stressed.


Percutaneous catheterization of the femoral vessels in children. II. Thrombotic occlusion of the catheterized artery: frequency and causes. The frequency of, and the conditions which contribute to a reduction of the arterial peak flow to the calves after percutaneous catheterization of the femoral artery were studied by strain gauge plethysmography in 98 catheterizations of children aged 2-16 years. Marked, rapidly disappearing flow reduction, considered to be caused by intense spasm in the femoral artery, occurred in about 5 per cent of cases. Flow reduction under these conditions was generally less marked than at thrombotic occlusion. Thrombotic occlusion of the femoral artery appeared in about 5 per cent of cases, mainly in the younger children and principally in those exposed to catheterizations involving increased risk of intimal trauma. This led to the conclusion that intimal damage is the primary cause of thrombotic occlusion of the femoral artery after catheterization. However, an increased haematocrit value may possibly also promote thrombosis. The arterial blood flow at rest was not abnormally decreased in cases with thrombotic occlusion of the femoral artery. The length of the stay of the catheter in the artery does not seem to be of importance for thrombotic complications. The results indicate that the best way to avoid thrombotic occlusion of the artery at catheterization is to take measures to reduce intimal damage.


Experiences of postoperative chylothorax in children. Eight cases of postoperative chylothorax in children are discussed. The age of the patients varied between 5 hours and 18 months. Chylothorax was diagnosed between 3 and 14 days after operation. In 6 cases chylothorax was certainly due to damage to the thoracic duct, or other big lymph vessels in the lungs or mediastinum. These patients had no typical pulmonary changes before chylothorax developed. In 2 cases there was probably no damage to the lymph vessels, but the venous pressure in the upper part of the body was elevated by constriction of the superior caval vein. The anatomical prerequisites for chylothorax in these cases is discussed. In these patients, before chylothorax, pulmonary changes appeared in the radiograph interpreted as widened lymph vessels and caused by altered lymph flow at the periphery. If pulmonary changes of this kind appear in patients with elevation of pressure in the superior caval vein, this may be a sign that chylothorax may develop. The importance of early diagnosis is stressed. Drainage of the pleura with continuous suction has proved to be the therapy of choice. Direct operation has not been necessary in any of our cases.


Accessory diaphragm. Report of 6 cases and a review of the literature. Six cases of accessory diaphragm, associated with respiratory symptoms are reported and of them two have so far been proved, by operation and autopsy, respectively. The described 15 cases in the medical literature are reviewed. The accessory diaphragm consists of a fibromuscular membrane separating the affected hemithorax into two cavities and in three cases a nerve supply has been reported. The diagnosis can be made by simple frontal and lateral roentgenograms of the chest. Typically they show a small lung with shift of the mediastinum to the affected side, an area of increased hazy density, lack of sharpness of the mediastinal structures and the cardiac border on the affected side and a characteristic strip of increased density paralleling the sternum in the lateral view. Roentgenologic differential diagnosis includes lobar atelectasis and pulmonary hypoplasia. There is a high incidence of associated pulmonary maldevelopment of the ipsilateral side and of vascular and cardiac malformations. Improper timing in the interaction of lung buds and septum transversum with the development of a double diaphragm possibly is responsible for this rare congenital anomaly. Usually it is encountered on the right side. Since pulmonary maldevelopment maintains repeated or chronic respiratory infections, recognition and operative therapy are essential.


The significance of lung scintigraphy in anomalies of the pulmonary vascular bed. Aplasia, hypoplasia and stenosis of the pulmonary artery showed, on scintigraphic investigation, unilateral, homogenous decreased in lung perfusion. In 3 of 4 children with pulmonary sequestration there was a difference in blood flow between the two lungs, or in one part of the lung. Isolated anomalous drainage of pulmonary veins does not produce deviations from the normal distribution of blood flowing from the right ventricle into the lungs. Analysis of scinitigraphic findings in 1450 children with cardiopulmonary disease has shown that with an otherwise unexplained marked homogeneous unilateral decrease in flow, we can with great certainty diagnose a developmental defect of the pulmonary vessels. Differences in lung area, judged from the scintigram, are a sensitive indicator of associated disturbances of development of the lung parenchyma. In 26 of 42 such developmental anomalies of the pulmonary vascular bed this finding was demonstrated. Pulmonary scintigraphy is a very valuable complementary method, because of its simplicity and relative safety for the patient, in the diagnosis of congenital anomalies of the pulmonary vasculature, especially in infants and young children.


Absence and retention of small bowel gas in infants with midgut volvulus: mechanisms and significance. The radiographic pattern of high intestinal obstruction--gastric and duodenal distension with absence of small bowel gas (ASBG) or a completely gasless abdomen--may be present in infants with midgut volvulus. In most instances, ASBG is associated with viable small bowel. However, when associated with abdominal distension and tenderness ASBG usually reflects strangulated midgut volvulus and bowel necrosis. In some patients with midgut volvulus there is a radiographic pattern of low small bowel obstruction; this is generally associated with necrotic bowel. These seemingly opposite observations can be explained by reviewing the dynamics of gas absorption in normal bowel and in closed loop intestinal obstruction. Impaired blood supply can result in either gaslessness or gaseous distension under differing conditions. Key words: Infant, intestinal tract, intestinal gas, intestinal obstruction, intestinal volvulus, malrotation, gasless abdomen.


Perinatal haemorrhagic necrosis of the adrenal gland. A clinical and radiological evaluation of 24 consecutive cases. Up to 1970 only13 fully verified and successfully treated cases of neonatal adrenal haemorrhage were on record. As uniform diagnostic and therapeutic guiding principles are still lacking, our experience of 24 consecutive cases appears worth presentation.--The most frequent clinical signs were a palpable mass in 21 cases, jaundice in 14 patients and urinary infection or sepsis in 10 neonates.--Intravenous urography revealed the diagnosis with a reasonable degree of reliability in all our cases. No additional information of significance was obtained at aortography, employed in 2 of our cases.--Surgical exploration with drainage of the haematoma or adrenalectomy was performed in 18 cases, 6 were treated conservatively.--Recovery was uneventful in all but for one conservatively treated patient. In this case death was caused by a second profuse bleeding, which proved fatal in spite of all life saving efforts.


Measuring the kidneys-practical applications using a growth and hypertrophy chart. A graphic and practical method for displaying renal growth utilizes a growth-hypertrophy chart. It is best suited for following renal growth on sequential intravenous urograms in patients with urinary tract infection, reflux and problems in which renal growth reflects the efficacy of therapy. The chart uses established standards for normal kidney length, and rates of growth and hypertrophy, and enables one to tell at a glance whether the renal growth is normal. Pitfalls both in the method of measuring the renal lengths and in the interpretation of the measurements are discussed.


Pre- and postoperative urographic findings in posterior urethral valves. In a series of 65 male infants and children, all with the diagnosis of posterior urethral valves, pre- and postoperative urographic findings were reviewed. In addition changes occurring in the bladder, and the implication of vesico-ureteral reflux were assessed.--Preoperatively diagnosed impairment of kidney function and concommitant dilatation of the upper urinary tract, with some exceptions. Remained fairly unchanged at postoperative examinations In the case of marked vesico-ureteral reflux, permanent kidney function annihilation was significantly commoner than with slight or no reflux.--Although, as a rule, both the upper urinary tract and the bladder were affected, there were cases of posterior urethral valves with a normal appearing bladder. As the intravenous urography do not exclude the urethral abnormality, voiding cysto-urethrography has to be included in the primary radiological exploration of all cases with urological problems. Key words: Intravenous urography, non-functioning kidney, upper urinary tract dilatation, voiding cysto-urethrography, posterior urethral valve, bladder outflow obstruction.


Pseudotumor of the nasal fossa secondary to mucoid impaction in choanal atresia. An intranasal mass was discovered during evaluation of unilateral choanal atresia. Radiologic investigation of the lobulated cystic mass showed no communication with the central nervous system or any other bony abnormalities. During surgery for the choanal atresia, the mass proved to be a mucous impaction. The case illustrates the need to utilize decongestants and aspiration prior to instillation of contrast agent.


Congenital localized stenosis of the pulmonary veins. One case of localized stenosis of the extrapulmonary portion of pulmonary veins is reported in a 3 years old child. The chest X-Ray showed a rounded and pulsatile opacification over the right hilum and on angiocardiography the right superior pulmonary vein looked very dilated. 20 other cases of segmental stenoses of pulmonary veins were collected from the literature.


Mediastinal esophageal duplication cyst associated with a partial pericardial defect. A two-year-old girl with a mediastinal esophageal duplication cyst is the twelfth example of a thoracic cyst of foregut origin or pulmonary "sequestration" (bronchopulmonary foregut malformation according to the expanded definition of Gerle et al.) that has been associated with a partial pericardial defect on the same side, suggesting that anomalous thoracic masses of several morphologic types have a similar pathogenesis.


[Duration of relaxation in the laryngeal and forearm muscles after succinyldicholine administration (author's transl)]. During laryngeal surgery with succinyldicholine relaxation it was noticed that the effects of the drug faded most quickly in the laryngeal muscles. To substantiate this observation an electromyographic study was made in 36 patients. 116 comparable action potentials were simultaneously recorded from the interarytenoid and flexor carpiulnaris muscles on a 4-track magnetic tape. An analysis of the recordings showed that action potentials in the larynx always re-appeared before those in the arm muscles. These results are different from those obtained by Spillmann who recorded action potentials in the tongue and arm. The time-lag between resumption of electrical activity in the larynx and the arm averaged 58 seconds. Possible causes of this difference are discussed. Succinyldicholine becomes effective 30 seconds after intravenous injection and its effects last 60-90 seconds. Recording the action potentials in the larynx during anaesthesia allows the accurate timing of further doses of muscle relaxants.


[Retrograde venography by catheter approach of the internal jugular vein for analysis of the cerebral venous blood (author's transl)]. Many problems arising during anaesthesia and intensive care therapy can be solved by an analysis of the cerebral venous blood. Retrograde venography of the internal jugular vein to the superior bulb was performed in 35 patients. The technique of catheterization, the radiological control of the position of the catheter, the anatomy of the cerebral venous system are described. The advantages of this technique over direct puncture of the superior bulb and the maximum time the catheter can be safely left in the vein are discussed.


[Organized emergency medical aid (author's transl)]. The decision to have medical attendance at accidents has changed the structure of the entire accident rescue service. Standardization (DIN) has provided the basis for efficient equipment and new legislation regarding the special training of orderlies as ambulancemen has ensured an highly expert emergency service personnel. The manifold duties of the emergency service physician are outlined. To perform them competently he needs not only a thorough knowledge of the various branches of medicine, especially of resuscitation and maintenance of vital function, but he must also be acquainted with techniques for the rescue and extrication of casualties and with radio-communication. Suggestions are made for the training of emergency medical personnel.


[An unusual type of airway obstruction during endotracheal anaesthesia (author's transl)]. Cases of airway obstruction during endotracheal anaesthesia are analysed as to the causal factors. A case of airway obstruction  is reported which was due to twisting of the inflating tube. This resulted in over-distension of the cuff and finally led to compression of the endotracheal tube.


[Clinical investigations of the temperature effects of ketamine and halothane in children (author's transl)]. In 68 from 1- to 14-years-old children rectal temperature was measured in Ketamine and Halothane anesthesia and with room temperatures ranging from 22-25 and 26-28 degree centigrade, while orthopedic repair operations were performed on the extremities. Independent of the quality of the premedication, which consisted either of Ketamine (Atropine or Thalamonal) Atropine a significant rise in temperature of 0,4 to 0,5 degrees C. was found within one hour of Ketamine anesthesia, but only with room temperatures of 26-28 degrees C., while with lower room temperatures (22-25 degrees C.) rectal temperature remained unchanged. The rise in temperature occurred both in Ketamine monoanesthesia with spontaneous respiration and in Ketamine-N2O-O2 anesthesia with respiration controlled.


[A bacteriological study of the air in a surgical intensive care unit (author's transl)]. The air in a surgical intensive care unit was analysed with the view of ascertaining the influence on the bacterial content of the air of such medical and nursing procedures as intubation, X-ray examination, bladder washout, massage, physiotherapy, bedmaking. By means of a Casella slit sampler, placed in the middle of the room, it was established that the activities mentioned above caused the bacterial count to rise by 35-310 percent above the hourly determined normal level. In some cases the count did not return to normal until 30 minutes later. Simultaneous determinations of the dust content of the air by means of a Royco particle counter showed fairly close correlation between changes in the number of particles (over 5 mu) and in the number of bacteria in the air. Petri plates exposed near the patient showed a definite relationship between medical or nursing activities involving that particular patient and the number of bacteria deposited on the plate. Continuous disinfection of the air by air-conditioning - cum-ultraviolet ray equipment succeeded in reducing the average bacterial count by 50 per cent although the figures varied in different parts of the ward.


[Parameters of trauma at posterior subglottic region by long term translaryngeal intubation (author's transl)]. The mechanical lesion is the beginning of inflammation and destruction in the posterior subglottic region in some cases of long term translaryngeal intubated patients. Beside movement of the tube, it is the pressure upon the posterior cartilage which is dangerous. The circumstances of that danger are studied. Practical proposals for reduction of subglottic complications are discussed.


[Soft tissue calcification - a complication in intensive care patient (author's transl)]. In this paper two cases of soft tissue calcification in patients suffering from severe head injuries are reported. The pathologic physiology of calcium and phosphate metabolism and possible causes of soft tissue calcifications are discussed. The value of prophylaxis is emphasized. If treatment by aluminum hydroxide or Na2SO4-infusions does not lead to success surgical treatment will be necessary. Presently therapy by vitamin D, diphosphonates and thyreocalcitonin is under clinical investigation.


[Tracheo-bronchial aspiration of foreign material by the unconscious patient (author's transl)]. 180 cases of head trauma were classified according to the degree of impairment of consciousness, clinical and neurological symptoms and EEG patterns. Based on the radiological and clinical findings and blood gas analyses a study was made of the incidence and extent of aspiration of blood, vomit or debris into the tracheo-bronchial tree and of the resultant pulmonary complications. As loss of consciousness became more complete the incidence of aspiration and the amount of material inhaled increased. Clinically and radiologically proven aspiration occurred in 60 per cent of cases of severe head trauma. A comparison of two groups after they had been given first aid and artificial respiration showed that the paO2 values were significantly lower in patients with radiologically proven aspiration and infiltration of the lungs than they were in those with normal chest radiograms. These observations point to the relationship between the quantity of material inhaled and the extent of intra-pulmonary shunting. There was no difference in the incidence of aspiration between persons who had been intubated and those who had not been intubated prior to admission to hospital. Although in many cases of head trauma aspiration of blood immediately after the accident can not be prevented prompt intubation is the only measure that will mitigate the consequences of aspiration and prevent its recurrence. As the latter is a very real risk in the unconscious person intubation in these cases is a "must". The study also showed that aspiration of foreign material into the tracheobronchial system and the resultant pulmonary complications can be successfully treated even if the head trauma is very severe. In none of the cases studied was death attributable to these causes. Apart from intubation and bronchial toilet artificial respiration with oxygen-enriched gas mixtures has a decisive influence on the course of the aspiration-induced pulmonary complications.


[The profitability of various methods of desinfection for anaesthetic equipment (author's transl)]. This is a presentation of the three most utilized methods of desinfection - steam, acethylenoxide aldehyde solution - for anaesthetic equipment as to their costs. During series of tests the wear and tear has been checked. The desinfection by aldehyde solution is worth the price as to the investigation, the current costs and the wear and tear.


[Clinical experience with ethrane anaesthesia in children (author's transl)]. There was no difference between ethrane and halothane in respect of anaesthetic technique, except that on account of its physico-chemical properties induction and recovery was quicker with ethrane. Anaesthesia with this agent is, therefore, more easily controlled. Induction in children was rapid and non-irritating. The marked muscle relaxing effects of the drug carry some risk of impaired gaseous exchange in the spontaneously breathing patient. At higher concentrations ethrane, like all inhalation anaesthetics, is liable to cause respiratory depression. The cardiovascular system remained remarkably unaffected provided induction was slow, i.e. the concentration of ethrane was not too suddenly raised. The blood chemistry appeared to be unaffected, but the electroencephalogram showed certain changes the clinical significance of which has so far not been established.


[Electroencephalographic changes during ethrane anaesthesia in children (author's transl)]. Continuous electroencephalographic recordings were taken in 25 children who had ethrane-nitrous oxide anaesthesia without a basal anaesthetic. The recordings confirmed the repeatedly reported occurrence of certain abnormal wave patterns distinctive of seizures during ethrane anaesthesia. Although these dysrhythmias were more frequent and more pronounced at higher ethrane concentrations and during hyperventilation, sharp spikes began to appear already at concentrations of 1.0/p.c. without hyperventilation and at moderate depths of anaesthesia. In no case did the usual criteria for assessing depth of anaesthesia provide an indication of over-dosage. Although in the individual case there was a close relationship between the concentration of ethrane in the inhaled mixture and the electroencephalographic changes, the differences between the cases were too great to allow any prediction as to the concentration of ethrane that would bring on the dysrhythmia. Considering that increased cerebral oxygen consumption has been observed to accompany the abnormal wave patterns ethrane is not recommended for use in epileptic children or those with a familial history of epilepsy.


[Regional anaesthesia in the small child age (author's transl)]. A plexus anaesthesia in a 6 hour operation by a 2.5 years old child is reported. The advantages of the regional anaesthesia in connection with a strong sedation in the age of young children are emphasized.


[Computerized patient-monitoring in the O.R (author's transl)]. The routinely performed data-aquisition and its analysis by means of a computerized patient-monitoring-system will reduce the repetitive and often monotonous task of data collection accompanied by accuracy and objectivity as much as possible. Another and equally important point for the anesthesiologists is to remove some of the pencil-and-paper burden, reduce the possibilities of human errors in reading instruments and note-taking and the rapid retrieval of monitored and stored data for the purpose of trend analysis. In detail this paper deals with two major systems (department of anesthesia, Latter-Day-Saints Hospital, Salt-Lake City, Utah, and the department of anesthesia, Center of System Research, Stanford University, Palo Alto, Calif., U.S.A.) where the computer is used to extend present monitoring capabilities and frees the staff of those tasks which can be done more efficiently by a machine. It is shown that the more experienced the computer center and the less complex the programming will be, the more liable the anesthesiologist trapped in the routine work will profit from this device. The System in Salt-Lake City proved to be a reliable tool while the system in Stanford so far has shown only to be valid in the remote surveillance of nurse anesthetists in the OR.


[The injured child in the intensive care unit (author's transl)]. For children the circumstances of the intensive care unit (ICU) indubitably present a particular psychological stress. For a child awaking from a state of traumatic unconsciousness in the ICU, and who has to be further treated there, this is an even more powerful psychological extreme situation. Extreme situation of this kind is liable to provoke a particular abnormal psychic "emergency reaction". This reaction can follow the pattern of a faigned-death reflex and in a such a way mime a coma vigile (apallic state). The circumstances and the interaction of factors responsible for the arise of such a primitive reaction are discussed. With the help of a representative case the clinical manifestations, course and treatment of the pseudo-apallic syndrome ("Sleeping Beauty syndrome") are presented. The important role of ICU staff for the prevention and treatment of such reactive disturbances are emphasized.


[Anaesthesia and cerebral hypoxia (author's transl)]. The effects of intravenous and general anaesthesia on the cerebral circulation and metabolism are reviewed. The various anaesthetic agents differ both quantitatively and qualitatively in their action on the brain. The pathophysiology of raised intracranial pressure is discussed and the risks involved in the use of certain anaesthetic agents in cases of reduced intracranial compliance are emphasized. Details are given of the safe limits for induced changes in pCO2 and arterial pressure.


[The effect of ketamine on haemodynamics and myocardial oxygen consumption in anaesthetized dogs (author's transl)]. Ketamine is an induction agent. This experimental study was designed to investigate the immediate effects of ketamine upon haemodynamics, inotropism and myocardial oxygen consumption during induction. In a circulatory steady state of a piritramide - nitrous oxide - oxygen basic anaesthesia normoventilated dogs (n = 8) received intravenous injections of 5.0 and 10.0 mg/kg ketamine within 30 sec at random. Immediately after administration of 10.0 mg/kg ketamine the cardiac output (thermo dilution method) rose (27%) on account of tachycardia while the total peripheral resistance (40%) and the mean arterial pressure (23%) decreased. The decrease in stroke volume (37%) and the inotropic parameter dp/dt max (42%) as well as the increase in the end-diastolic left ventricular pressure (31%) and in the pressure of the pulmonary artery (11%) suggest considerable myocardial depressor properties of ketamine. The change in haemodynamics was paralleled with an increase in myocardial oxygen consumption (47%), which was initially met by an increase in coronary blood flow (25%) and an additional oxygen utilization (20%). The increase in arterio-coronary venous oxygen difference is believed to be due to a constriction of the coronary arteries after ketamine. Since external cardiac work remained unchanged,while myocardial contractility and myocardial wall tension (Psyst) decreased, the increase in heart rate (63%) explains the rise in myocardial oxygen consumption. The efficiency of cardiac work, which is defined as the ratio of myocardial displacement work to myocardial energy demand, decreased (31%) and illustrated the uneconomic work of the heart under the influence of ketamine. The clinical utilization of the data obtained from this study are discussed.


[Ketamine - a cardiovascular stimulating agent with direct cardiodepressant action (author's transl)]. Induction anaesthesia with 2 mg/kg of ketamine causes the well-known increases in heart rate and blood pressure. Simultaneous registration of the systolic-time-intervals (PEPI, LVETTI, PEP/LVET = Q), however, reveals a biphasic effect of ketamine on these contractility-parameters: an initial increase of PEPI and Q, representing a cardiac depressive effect of ketamine, is followed by a decrease of PEPI and Q, indicating a positive inotropic action of ketamine. Injecting the same dose of ketamine during the steady-state of a halothane-N2O:O2-anaesthesia, that causes a depression of the central and peripheral sympathetic activity, however, results in an increase of PEPI and Q, only. Thus, ketamine is a cardiac depressive agent, this effect, however, usually being overlapped by a centrally-induced cardiac stimulation.


[The reaction of the cardio-circulatory system during the introduction of the modificated NLA (AUTHOR'S TRANSL)]. The hemodynamic effects of Etomidate are examined during the introduction of a modificated NLA. The following parameters are registrated: Heart Rate, Arterial and Mean Arterial Pressure, Pulmonary and Mean Pulmonary Pressure, and Cardiac Output. The Total Periphere Resistance and the Tension-Time-Index are calculated. Apart from a short moment during and immediately after intubation a remarkable constancy of all parameters is found. The alpha-receptor-blocking effect of Etomidate and DHB and the resulting decrease of the Total-Periphere Resistance are compensated by infusion of a colloidsolution. Myoclonias are not observed. Etomidate may be regarded as a drug with few effects on the circulation. It may be thinkable, that by means of Etomidate even in shock a careful introduction is possible.


[Gaschromatographic examination of the expired air after anaesthesia with halothane, enflurane and methoxyflurane (author's transl)]. The concentration of anaesthetic gases in the expired air was studied for up to 17 days in patients who had been anaesthetized with methoxyflurane, enflurane or halothane. The estimation were made by means of gaschromatography. The rate and duration of elimination of the anaesthetic via the lungs depends on the fat stores of the patient (as calculated by the body weight/stature ratio), the length of anaesthesia and the Lutz index (calculated average concentration of the inhaled anaesthetic). The concentration of anaesthetic gases in the expired air fell steeply during the first 12 hours after anaesthetic and then decreased more gradually. The drop in concentration during the first 24 hours was steepest for methoxyflurane, followed by halothane and enflurane in that order. The results are in fair agreement with the rate of metabolization of the three anaesthetic agents. The investigation showed that during the first after anaesthesia appreciable quantities of anaesthetic gases are eliminated via the lungs and, consequently, released into the air of the recovery room.


Influence of chemical stimulation of central dopaminergic system on the open field behaviour of rats. Influence of some substances known to selectively modify the brain levels of dopamine, was studied on the Open Field behaviour in rats. Of the agents studied, I-dopa, benztropine and amantadine showed some similarity with amphetamine in exhibiting a high degree of complex stereotyped behaviour in rats. The complex stereotyped behaviour due to amphetamine and the similarity shown by these antiparkinsonian agents has been explained on the basis of brain dopamine levels. On the other hand apomorphine depressed the Open Field behaviour and produced a typical stereotyped biting in rats. Since 6-hydroxydopamine significantly prevented this biting behaviour, it has been suggested that the action of apomorphine is dependent on the presence of (i) functional state of catecholamine neurons and (ii) a separate receptor, responsible for the behavioural actions of apomorphine.


[The Eppendorf mood and drive scale (author's transl)]. A self rating scale to reflect the course of manic-depressive psychosis. The subject of this report is the development of a self rating scale which assists in performing time series analysis of the course of manic-depressive illness which does not lead to a global depressivity score but generates both a mood score and a drive score. This instrument is designed to compile long-range series and to study the situation of manic-depressive mixed states (mood and drive separation).


[Psychotropic agents and pathological ECG changes (author's transl)]. 1. An epidemiological research programme was carried out on a collective of 1752 psychotic patients from eight psychiatric hospitals during the period from October 1970 until February 1973. The possible relationships as to the intensity of pathological ECG changes and such factors as sex, age, the administration of tricyclic and non-tricyclic psychotropic agents with or without the combination of glycosides, the potency of neuroleptics and their clinical structure, were investigated. 2. No statistical significance could be established between pathological ECG changes and such factors as administration of tricyclic and non-tricyclic psychotropics with or without the combination of glycosides, or the potency of neuroleptics and their chemical structure. With a higher age the frequency of ECG changes increases independent on psychotropics. 3. The difficulties of interpretation, in particular regarding a generalisation of the results, are discussed.


[The problem of animal models for psychiatric conditions, as illustrated by the immobilization reaction (catalepsy) in the rat (author's transl)]. According to Venables the span of psychotic processes extends from a low level of arousal with an increased reactivity toward sensory stimuli to a high level of arousal with a reduced reactivity toward sensory stimuli. The level of arousal and the degree of reactivity, or breadth of attention, are apparently controlled by a regulatory mechanism which increases the threshold for sensory input in threatening situations. Any factor producing an electroencephalographic arousal reaction leads to a narrowing of attention. Underestimation of the size of a given object is an expression of such a reduction in the span of attention. Various authors have found a reduction in size-constancy in schizophrenics, in particular in patients exhibiting a merkedly reduced contact with their environment. A model is described in which a strong sensory stimulus induces a state of immobilization in rats treated with a low dose of morphine. Electroencephalographic recordings show that the initial state of arousal induced by peripheral stimulation is replaced by high-amplitude slow-waves and spindles as the state of immobilization develops. The current results suggest that the sensory stimulation leads to excitation of the ascending reticular formation and via the Centrum medianum and the Nucleus centralis, to activation of the striatal system, resulting in catalepsy. It would thus appear that the reticular formation and the striatum alternate in excercising a control function over the state of arousal. This would be a logical way of limiting over-reaction, which can be demonstrated most simply on the motoric response. It seems justified, therefore, to assume a relationship between catatonic stupor and the immobilization induced by stimulation. This concept is supported by the observation that of all the compounds investigated only clozapine is capable of inhibiting the immobilization in the rat model. Clozapine is a powerful antipsychotic agent with a pronounced inhibitory effect both on the reticular arousal reaction and on the schizophrenic catatonia.


[Therapeutic effect and plasma level of thioridazine in schizophrenic patients (author's transl)]. 1. In 18 Patients the plasma concentration of the neuroleptic drug thioridazine was measured twice a week by a fluorometric method during a period of treatment lasting for an average of 27 days. At the same time the psychopathological findings were recorded by means of the AMP system. 2. A significant correlation was found both between dosage per kg body weight and plasma level, and between age and plasma level. No connection with the sex of the patient could be demonstrated. 3. A curve-linear correlation appears to exist between plasma concentration and remission of symptoms. 4. In the course of the trial the plasma concentrations of thioridazine declined though the dosage was kept constant. This observation indicates an increased metabolism of the drug probably brought about by enzyme induction. In two cases where previous liver damage could be assumed, the plasma concentrations were found to be above the average level.


Renal lithium, sodium, potassium and water excretion and plasma renin activity in rats in the cold. A rise in urine volume and in the urinary excretion of lithium and sodium but not of potassium was observed in rats exposed to a cold environmental temperature (4 degrees C) for 3 hours. The level of plasma renin activity after the clerance test was correlated to the urine volume, but not to the electrolyte composition in the urine. The observed changes in the renal elimination of electrolytes and water corresponded to the effect that a cold environmental temperature has on kidney function in man. The results suggest that renal lithium clearance might be elevated in humans during exposure to cold.


Mental illness and simulated driving: before and during treatment. By use of a car simulator we have tested the driving behaviour of 46 inpatients before and during treatment. On the basis of the presence of psychotic symptoms the patients were divided into a psychotic and a non-psychotic group and matched according to age, sex, and driving experience. Before treatment the psychotic group had a statistically significant prolongation of brake time in such a way that their performance deteriorated more markedly over trials. During treatment there was no statistically significant difference between the two groups, indicating that antipsychotic drugs given to psychotic patients do not impair their driving, but on the contrary increase the vigilance.


[Blockade of the dopamine receptor: a possible mechanism of action of antipsychotic drugs (author's transl)]. Antipsychotic drugs of various types inhibit dopamine-sensitive adenylate cyclase (EC 4.6.1.1) while structurally related drugs that were not clinically effective as antipsychotic drugs were almost inactive. These results are discussed in relation to the suggestion that antipsychotic activity may be related to the blockade of dopamine receptors in the brain.


Oral diazepam in hospitaized anxiety patients (with observations on concentration-effect-relationships). The anxiolytic efficacy of oral diazepam, 30 mgs. daily, was investigated in newly admitted psychoneurotic patients, suffering from an anxiety syndrome. A double-blind cross-over design against placebo was used. Ratings were performed weekly using the Hamilton scale for anxiety and other scales. Diazepam was shown to be significantly more effective than placebo for the abatement of the global anxiety syndrome, as objectively and subjectively rated. The symptoms most sensitive to its action are: anxious mood, psychic tension, behavioural unrest, insomnia and respiratory complaints. Side effects were few. Using Spearman rank correlation coefficients (rs) a significant concentration-effect-relationship was found for diazepam (d) and desmethyl-diazepam products (dd). (rs (d) = .35; p less than .02; rs (dd = -.29; p less than .05).


Therapeutic usefulness of hallucinogenic drugs as a function of their chemical structure. D-lysergic acid diethylamide (LSD) displays (1) the phenylethylamine pattern present in mescaline, cyclazocine and catecholamines and (2) the 4-substituted tryptamine structure of psilocybin which is a serotonin analog. Hence (a) Naloxone--a blocker of the LSD-like side effects of cyclazocine--should (and does) block effects of LSD, and (b) cross-tolerance may be present between LSD and cyclazocine but not between mescaline and psilocybin. Even though LSD binds subcortically, its effect on regional perfusion of the brain and, presumably, function is primarily cortical and, since the perfusion shifts evoked by psilocybin are confined to subcortical regions, we assume that other compounds with the phenylethylamine structure such as mescaline, also may selectively affect cortical activity.


[Clinical effects of moderate and high doses of carpipramine (author's transl)]. An open trial of Carpipramine which chemically is a synthesis of a tricyclic antidepressant and the side chain of a butyrophrenone has been performed in 75 acute and chronic schizophrenics over a period of 30 days. The daily dose was 400-800 mg exeeding the recommendations of the manufacturer. The psychopathological changes were documented and evaluated by means of the AMP and the AMPAS-system. In 50 of the patients the trial could be completed. Only the productive symptoms and disturbance of sleep showed a significantly decreased frequency before day 10. It seems remarkable that the symptom of somatic hallucinations responded very rapidly under treatment with Carpipramine. Significant sedative or extrapyramidal side-effects were not observed; anticholinergic effects were moderate. There seems to be evidence of a slight centrally stimulating component. The substance cnnot be classified as a typical neuroleptic nor as an antidepressant drug. A differential action depending on the initial syndrome constellation is discussed.


[The use of the brief psychiatric rating scale (BPRS) by overall and gorham for the diagnosis of acute paranoid psychoses: evaluation of a german translation of the BPRS (author's transl)]. A German translation of Overall and Gorham's "Brief Psychiatric Rating Scale" (BPRS) has been used to select patients with acute paranoid psychoses for a drug trial and to evaluate the results of the treatment. The BPRS proved very useful in screening, and as a reliable method to judge the global therapeutic outcome. The total score showed a high degree of interrater reliability; it also reflected a marked decrease of psychopathological symptoms at the end of the trial. Interrater correlation coefficients were lower than 0.7 in 9/16 items. This may be due to the somewhat unprecise and ambigous formulation of several items. The average BPRS profile of patients with "paranoid-hallucinatory schizophrenia" were similar to those published by French authors for the corresponding diagnosis.


[Oral glucose tolerance test in schizophrenics under long-term neuroleptic treatment (author's transl)]. The oral glucose tolerance test was carried out in 58 schizophrenics under long-term treatment with different neuroleptic drugs. 74% of the patients showed hyperglycemic reactions. The results did not show any correlation to the age of the patients. The oral glucose tolerance test using 100 g of glucose is recommended as routine procedure instead of the unreliable results of the fasting blood sugar determination. Several hypotheses related to the action of neuroleptics on glucose metabolism are discussed. The authors suggest that glucose tolerance tests and body weight controls should be carried out regularly under long-term neuroleptic treatment.


Monoamine oxidase and free tryptophan in human plasma: normal variations and their implications for biochemical research in affective disorders. A methodological study of healthy subjects was conducted to investigate factors influencing plasma free tryptophan and platelet monoamine oxidase (MAO) activity. The following changes were found during the menstrual cycle: free tryptophan was lower during the "ovulatory" phase than during the "premenstrual" phase, MAO activity was 20% lower during the "premenstrual" phase as compared with the "neutral" phase (days: menses-24 to -1). During pregnancy MAO activity was also lower than the values found six weeks postpartum. MAO activity in women was significantly higher than in men and exhibited greater variability. A circadian rhythm for free tryptophan was observed (minimum at midday, maximum at midnight). No diurnal variation in MAO activity could be established. Preliminary data from untreated endogenous depressive patients showed no difference in free tryptophan concentrations at 8 a.m. or 4 p.m. from control values.


The rate of excretion of VMA in depressed patients before and after the administration of methionine. The results of a previous experiment in which the relationship between VMA-excretion in the 24-hr-urine and a depressive syndrome was found were examined on the basis of the following hypothesis: 1. The patients of the present study show an increased VMA-excretion, because there are more depressed patients than in the previous experiment. 2. The amount of excreted VMA correlates positively with the degree of severity of their depression. The mean value of the VMA-excretion in the urine of 20 depressive patients of the present study corresponds to that obtained from the depressive patients in the previous exploratory experiment. The degree of severity of depression of the patients correlated with the VMA-excretion. Patients with an increased VMA-excretion were significantly more often treated with antidepressive drugs than those with normal VMA-values.


Clinical pharmacology and the prescription of psychotropic medication. There are many reasons why once a day oral dosage may be advantageous in administration of psychotropic drugs to mental patients, such as convenience for the patient, avoided side effects, ease of remembering, all of which contribute to reliable dosage as well as cost savings. This paper illustrates cost data, pharmacokinetics of psychotropic drugs, and suggests a basis for determining adequate pill size for unit dosage. On a cost per milligram basis, there is economic savings if medication is prescribed in the largest size the patient can conveniently take. Pharmacological data support a rationale for higher unit dosage. They indicate a dose response relationship between dose and therapeutic effectiveness and probably a blood level relationship. The long half-life indicates that once-a-day medication is a reasonable dosage schedule. The most important evidence for once-a-day medication, however, is the empirical evidence that it works, and is safe. Dosage information from double blind investigations provides a basis for determining adequacy of pill size for antipsychotic therapy.


Higher unit dosage of psychotropic drugs. The realities of the marketplace dictate that pharmaceutical companies seek to develop higher unit dosage forms. Technical problems not infrequently hinder such development. In low doses once-a-day medication with psychotropics is possible and practical. The potential for adverse reactions frequently renders it desirable to divide higher daily doses into two separate doses, one given in the morning and the other in the evening.


Higher unit dosage of psychotropic drugs. The questions involved in higher unit dosage of psychotropic drugs are made concrete in writing the Dosage and Administration Section of package inserts for drugs. The author outlines a number of problems in recommending specific changes in conventional dosage regimens. He suggests that a major reason for reluctance to adopt new regimens using less frequent dosing is the relative paucity of data demonstrating that less frequent, higher dosing is as effective as conventional regimens. Intrinsic methodological and pharmacological problems make it difficult to generate such data for psychotropic drugs. Nonetheless, recommendations for less frequent, higher, psychotropic dosage regimens will become more common in package inserts.


Obstacles in implementation of higher unit dosage of psychotropics drugs. Practitioners, nurses, pharmacists and patients themselves must be considered in a discussion of higher unit dosage of psychotropic medication. Physicians need postgraduate education to overcome their reluctance to prescribe higher unit dosages. Nurses need in-service training regarding principles in clinical pharmacology to comply with changing prescribing practices. Higher unit dosage leads to less medication error and frees considerable nursing time. Pharmacists face a problem in inventory costs, therefore are reluctant to stock a variety of dosages. Patients taking multiple medications in high dosages hesitate to take large numbers of low dosage pills, thus patient compliance is enhanced with higher unit dosage. Blood level data on formulations of higher unit dosage should be the basis of FDA considerations, rather than treating a higher unit dosage as a new drug. The final responsibility in providing higher unit dosage rests with the pharmaceutical companies. However, the introduction of higher unit dosage should not be used as a justification to increase cost per milligram of the same medication. Utilization of a different salt to introduce a higher unit dosage should be done only if there is substantial difference between the new salt and the one already available.


[Are neuroleptic drugs anticarcinogenic? (author's transl)]. Statistical methods seem to confirm the impression that a connection exists between the administration of neuroleptic drugs and a lowered cancer mortality rate. However, further analysis shows that the neuroleptic group and the controls represent two distinct populations which cannot be compared with each other.


[Psychometric effects of perphenacine below the "neuroleptic threshold" (author's transl)]. The extrapyramidal-motorical side effects of neuroleptic drugs are preceded by subtle symptoms, the assessment of which is dependent on the methods used. For the evaluation of several such methods of assessment we compared the results of the handwriting test (Haase, 1969) with EMG-measurements of the silent period and psychometric measurement of aiming-, tapping-, and reaction-time-tests. Twenty normal subjects were tested four times in a double blind study in order to control the short- and long-term effects of a low dosage of perphenacine. Slight but significant drug-dependent changes were found, such as decreases of steadiness and of the speed of arm-hand-movements. From the theoretical point of view these results support a dimensional approach rather than an explanation in terms of a categorial approach as it is suggested by the commonly used notion "neuroleptic threshold".


Spectral maps of the Liege-physiognomies of the neuroleptics. Spectral mapping is a classification technique that has been applied to the Liege physiognomies of the neuroleptics. The method makes use of a special projection that separate potency from spectral information. Principal component analysis revealed a dominant component resembling a bipolar incisive/sedative scale. A second antimanic/antiautistic scale is apparent in the revised. Liege physiognomie. Spectral mapping allows to compare observations on neuroleptics in different frames of reference and from different methodologies (e.g. clinical and pharmacological).


[Mother-child relations in epilepsy].

[Mother-child relations in epilepsy]. 30 mothers of epileptic children and a control group of 30 mothers of healthy children were tested with the 'Semantic Differential' regarding their attitudes towards the concepts 'Mentally III', 'Epileptic', 'Diabetic' and 'My child' in relationship to the concept 'A person I like' as a clearly positively charged affective variable. The social distance to the disease carriers was, in opposition to equal-ranking tendencies of the various concepts of disease in both groups, smaller for the experimental group than for the control group. Regarding the atitude of the mothers to their own children, mothers of the experimental group demonstrated the following defense mechanisms: rationalization, denial and reaction formation. Specific attitudes in the areas of child rearing and anomalies in family relation were also revealed with help of the PARI scales. The approval of an active and positive child-rearing method was found to be in opposition to hostile tendencies with regard to their children.


Enduring effects of modified ECT on the cerebral circulation in man. A computerized study by cerebral impedance plethysmography. The response of the cerebral circulation to modified ECT was monitored by computer programmes in 18 psychotic patients using cerebral impedance plethysmography. Each patient was recorded daily prior to, during and following the course of ECT. Results indicated that ECT was accompanied after 2 h by a marked increase in cerebral blood flow (CBF) in depressed patients; the schizophrenics showed a decrease in CBF. Patients whose blood flow had improved tended to return to previous levels progressively during the first week.


Blood flow and oxidative metabolism of the brain in patients with schizophrenia. 55 patients with schizophrenia were divided into three groups according to the clinical symptoms: (1) productive schizophrenias, i.e. patients with hallucinations, catatonic excitation and stupor; (2) paranoia and schizophrenia simplex, and (3) non-productive schizophrenias, i.e. patients with schizophrenic defects and hebephrenia. Total cerebral blood flow (CBF) and the rates of cerebral oxygen, carbon dioxide, glucose and lactate metabolism were investigated. Patients with productive schizophrenias displayed a significant increase in CBF (to an average of 101.4 ml/100 g min), CMR oxygen (to an average of 6.26 ml/100 g min) and CMR glucose (to an average of 12.11 mg/100 g min), i.e. CBF and CMR oxygen nearly doubled and CMR glucose more than doubled in comparison with normal findings. In patients with paranoia and schizophrenia simplex CBF and oxidative metabolism did not vary much and were within the normal range. Non-productive schizophrenias showed a significant decrease in CBF (to an average of 36.7 ml/100 g min), CMR oxygen (to an average of 2.20 ml/100 g min) and CMR glucose (to an average of 3.86 mg/100 g min) in comparison with both other groups of schizophrenias and the group of healthy young men. The results demonstrated variations in CBF and oxidative metabolism of the brain in patients with distinct types of schizophrenia. It was possible to find a correlation between the mental state of the psychosis on the one hand and CBF and metabolism on the other. The high CBF and metabolic rates of the brain in productive schizophrenias might be due to disturbances in the cerebral metabolism of biogenic amines.


Clinical treatment of post partum delirium with perfenazine and lithium carbonate. Despite the development of psychopharmaceutical therapy, post partum delirium was difficult to treat. The patients remained psychotic for long periods and the course was of the disease capricious due to the many relapses. A comparative study of two groups, one consisting of 6 patients and the other of 13, all with a typical post partum delirium was carried out. The symptomatic treatment of this syndrome with a combination of perfenazine and lithium carbonate produced relatively favorable results in our clinic. For the time being, at any rate, it seems to be the medication of choice.


[Presentation of information for the diagnostic-therapeutic decision of the psychiatrist]. So far, little systematic work had been done to investigate how information regarding psychiatric cases should best be presented in order to facilitate important medical decisions. For each of three groups of diseases: (a) schizophrenic reaction, paranoid, (b) manic-depressive, depressed, and (c) anxiety neurosis, we have described four different cases, systematically varying both quantitatively and qualitatively the information in each description. Categorical judgement was given by 15 psychiatrists on a nine-step rating scale with regard to three dimensions. In order to investigate the constancy of the judgements, the method of scaled pair comparisons was used according to the law of comparative judgement. After examination of the adequacy of the scaling models, the following results, among others, were obtained from the scale scores: the discrimination of the two cases of psychoses was highly significant, that of the anxiety neurosis was not significant.


[Induced "acarophobia"].

[Induced "acarophobia"]. Although only ablut 240 cases of 'acarophobia' are on record in zoological and medical literature, it can be seen that this delusional syndrome without doubt leads to psychoses of association more frequently than any other mental disturbance. The literature contains many references, and the author can give two examples from personal esperience. At least every sixth patient suffering from delusions of parasitosis 'infects' relations. This really remarkable tendency to spread by psychological contagion on one or more dependent persons has been ignored by many writers. The supposition that such occurrences are very rare proves to be false. Sometimes the associated who acquired the symptons in an absolutely identical fashion seem to be more worried by the vermin they hallucinate than the initiators are. The number of patients constituting an affected group is following a Neyman distribution. Emphasis is laid on the finding that the proportion of consanguineous persons within the sample of patients who showed an induced delusion of parasitosis is by far less high than in other psychopathological forms of communicated insanity.


[Latentiation of therapeutic drugs. VI. Preparation of l-amino-4-naphtylazoic ambonates of schistosomicides]. With the purpose of obtaining latent forms, with prolonged action and less toxic, of four schistosomicidal 1-amino-4-naphthylazoderivatives synthesized early, embonates of these compounds were prepared by reacting disodium and tetrasodium embonates with hydrochlorides of the four naphthylazoderivatives. The eight embonates thus obtained were sent for biological assays.


[Latentiation of naphthylazoderivatives by polymerarization]. Five naphthylazoderivatives (of sulfadiazine, sulfamethazine, sulfathiazole, sulfamethoxazole, and sulfamonomethoxine) -- the first four displaying schistosomicidal activity -- were latentiated, in the form of polyamides of acrylic and methacrylic acids, by reacting those compounds with these polymers. In biological tests in mice experimentally infected by Schistosoma mansoni, the new nine compounds were found to be inactive. However, the original method of latentiation described in this paper has possibilities of wide application, owing to its favourable features: versatility of the reactive group of the polymer, lability of the bond (easily hydrolyzable) formed between drug and polymer, greater viability of reaction between the polyanhydride and the drug, and solubility in water of the polymers thus formed.


[Synthesis and biological trial of 1-methylene-4-naphthylazo polymer derivates]. With the purpose of preparing latent forms of six naphthylazoderivatives (five of them are schistosomicidal agents), polymers of these chemotherapeutic agents were synthesized in a two-step reaction. First, polymeric 1-methyleneaminonaphthalene (II) was synthesized by condensing 1-naphthylamine with formaldehyde. Subsequently, coupling of II with five sulfonamides (of which four are moieties of schistosomicidal agents) and 5-aminouracil (which is a part of another schistosomidical agent) yielded polymeric 1-methyleneamino-4-naphthylazoderivaties (IIIa-f). In bioligical tests in mice experimentally infected by Schistosoma mansoni, the six new polymers were found inactive.


[Contribution to food microscopy of Anacardium occidentale L, Carica papaya L and Myrciaria cauliflora (Martius) Berg]. With a view towards food microscopy the authors present an anatomical study of the pseudofruit of Anacardium occidentale L., the fruit of Carica papaya L., and the fruit of Myrciaria cauliflora (Martius) Berg. Drawings illustrate the text to facilitate identification of the corresponding hystologic elements found in industrialized products.


[Bromatological characteristics of pecan nuts (Carya illinoensis Koch) cultivated in Brazil]. The A. studied pecan nuts cultivated in Brazil: two samples represented North American varieties and three others Brazilian hybrids. The comparison between physical classification and chemical composition, specially amino acid contents pointed to non significant differences, all beeing useful for commercial purposes. The A. stresses the importance of the culture of pecan nuts in Brazil.


[Evolution of the total volatile basis and trimethylamine in fish and their use as an indicator of its quality]. The authors followed trimetylamine (TMA) and Total Volatile Basis (TVB) evolution in some Brazilian fishes during ice storage at 4 degrees C for 15 days. The fishes studied were: Micropogon furniere, Umbrina canosai, Centropomus undecimalis, Cysnoscion acoupa; samples were taken and analyzed each 48 h. Each species was stored eviscerated (E) or not-eviscerated (NE) in order to estabilish a possible advantage of on board evisceration. The results showed a log. relation between TVB or TMA percentage in the fish tissues and the days of storage; Mathematical models were established for predicting "storage life" for each fish out the basis of its amine content. Evisceration, immediatly after capture retarded deterioration and seem to be a useful practice.


[Zur beruflichen Rehabilitation schizophrener Patienten]. The article reports on the results of vocational rehabilitation efforts in 399 schizophrenic patients. The criterion for assessing the rehabilitation outcome was a regular job for at least three months after discharge from the hospital - which was achieved in 51% of the schizophrenics as compared to 63% of the control group. In the majority of cases good rehabilitation results could be achieved only by placement in a job which, compared with the previous position, required less skills. In analysing the rehabilitation success in its relation to different variables it was noted that the diagnostic assignment to paranoid types of schizophrenia was positive whereas the opposite was found in the cases of hebephrenic courses and defective conditions. As a rule, better success could be achieved with older patients, which is attributed to vocational stabilisation before the onset of the disease. More effective than the correlation with diagnostic and psychopathological data was the examination of the relationship between success and the variables 1) social background and 2) attitudes. Very negative factors turned out to be social origin and milieu conditions, economic and family situations, the states of unemployment at the time before admission and an insufficient adjustment to the training programme. No correlation could be found between success and a longer history of employment. Social isolation could be largely eliminated through the therapeutic family milieu offering identification possibilities. In addition, the study revealed the importance of a continuous psychosocial follow-up care.