[Unusually high iodine excretion in hyperthyroidism in an iodine-poor area]. In 27 thyrotoxic patients and in 177 healthy controls from the area of Essen we studied the total urinary iodine excretion. Whereas the iodine excretion was only 43.7 +/- 27.3 mug iodine per g creatine in the controls, the corresponding average value was significantly higher in thyrotoxic patients. It amounted to 193.3 +/- 201.7 mug iodine per g creatinine. This finding can not be explained by selection of patients with autonomous adenomas and contamination with iodine. Possible causes are an increased daily iodine uptake by increased dietary intake or iodine containing drugs that might not be remembered by the patients and increased renal clearance of iodine. Strong evidence for a contamination with iodine is the finding of increased differences between measured and calculated PBI, the latter being derived from T4 (D). The differences averaged in both groups 5.3 and 3.2 mug/100 ml. Our data can not exclude a basedowification of preexisting goiters. This unexpected finding gives rise to corresponding investigations in other thyroid centers.


[Comparative study on the question of systemic chemoprophylaxis following gynecological surgery]. The incidence of delayed wound healing and urinary tract infections was studied in 2 randomized groups of post-operative gynecological patients, one of which was given systemic antibiotic prophylaxis and the other not. 143 women were given Bactrim in a standard dose of 2 x 2 tablets or ampoules daily, commencing preoperatively during and continuing until the eighth postoperative day. The control group received placebos parenterally and orally for the same period. The incidence of complications in wound healing, of subfebrile and febrile states, urinary tract infections and micturition difficulties following removal of the catheter was significantly lower in the group who had undergone antibiotic therapy. 83% of this group, compared with 68% in the control group, were discharged after the normal hospital stay. In 51% of the control group a chemotherapy or antibiotic course had to be given secondarily to combat infection, the commonest indications being urinary tract infections or pyrexia for several days. The drawbacks were side effects of the systemic chemoprophylaxis, such as skin eczema (6%) and gastrointestinal disturbances, as well as a tendency to infections with problem bacteria requiring treatment with reserve antibiotics. It is concluded that routine postoperative antibiotic prophylaxis, despite its favourable effect on infections morbidity as a compromise between optimum treatment for the individual and general medical interest, must be prescribed on an individual basis.


[Acute polyradiculitis. Experiences in an intensive care unit]. 30 patients with acute polyradiculitis treated in an intensive care unit between 1960 and 1974 are described. Intensive care in these patients was indicated mainly for respiratory problems necessitating tracheotomy and, frequently, artificial ventilation. The main complications encountered are described in detail: they are infections of the respiratory and urinary tracts; cardiovascular problems (mainly instability of blood pressure and sinus tachycardia, and sometimes lifethreatening arrhythmias); frequent thromboembolic complications in patients not on anticoagulants; and bleeding (especially from the gastrointestinal tract) even in the absence of anticoagulants. A careful search should be made for glomerulonephritis, "Schwartz-Bartter-syndrome" or difficulties in regulating calcium metabolism. The prognosis is independent of the time course of the disease. The mortality of 23% in this seriously ill group of patients is fairly low, but the results as far as healing is concerned are less good. In only 23% was there complete rehabilitation, whereas 34% had minor and 20% major residual symptoms.


[Trends in the nuclear-medical diagnosis of thrombosis]. Use of the 125I-fibrinogen-uptake test for detection of freshly developing thrombi is well known. The administration of radiofibrinogen to detect preformed thrombus - the retrospective variant of the 125I-fibrinogen-uptake test - allows the diagnosis of established thrombosis. The correlation with ascending phlebography is 90%. 125I-Fibrinogen cannot be used for scanning, due to its low energy, while 131I-fibrinogen if used involves a high radiation dose to the patient. First experiments with new radiopharmaceuticals for detection of deep vein thrombosis are proposed. Indication lists for the retrospective variant of the 125I-fibrinogen-uptake test are given.


[Catamenial pneumothorax].

[Catamenial pneumothorax]. Including the case herein recorded, 33 cases of spontaneous pneumothorax occurring concurrently with menses (catamenial pneumothorax) have now been reported. The pathogenesis of the pneumothorax is not understood; it appears to occur exclusively on the right side. In 27 patients who underwent exploratory right thoracotomy, pleural or diaphragmatic endometriosis was found in 8 cases. 11 patients had clinical or histologic evidence of pelvic endometriosis.


[Juvenile colonic mucosal polyps in adults]. The histology of all intestinal polyps removed endoscopically during the last 30 months has been reviewed. Among the 90 patients with a total of 154 polyps, 3 cases of juvenile polyps were found. All three were male adults who were aged 29, 34, and 50 years. In two patients the lesion was solitary, while one had polyposis with about 100 polyps. Macroscopically the juvenile polyps cannot be distinguished from adenomatous polyps, but their histologic appearance is typical. They are considered to be hamartomas and have no tendency to become malignant. Thus, juvenile polyposis does not represent a precancerous lesion as adenomatous polyposis does, and must therefore be treated differently. Therapy consists of endoscopic removal of all polyps. In order to differentiate juvenile from adenomatous polyps with certainty, histological examination of at least one polyp is necessary. This differential diagnosis is the indispensable precondition for appropriate therapy.


[Booster vaccination with a diphtheria-tetanus vaccine for dermo-jet with low diphtheria toxoid content]. Indications are provided on how the organization of polyvaccinations against tuberculosis, poliomyelitis and diphtheria-tetanus in school collectivities can be rationalized. 19 persons aged 19-20 years were vaccinated intradermally with 1.5 Lf diphtheria toxoid and 15 Lf tetanus toxoid (contained in 0.1 ml) by means of a single injection with a jet injector (Dermo-Jet). In cases which had not previously been immunized, vaccination with the toxoid doses employed did not induce detectable antitoxin titers. In all cases which had previously been immunized the antitoxin titers after the booster injection were at least 400 times higher than the protection threshold for diphtheria and 1700 times higher than the protection threshold for tetanus. This was also the case in preimmunized cases which had no detectable antitoxin titer before the vaccination. The increase in antitoxin titer was inversely proportional to the prevaccinal titer in the manner of a logarithmic exponential function. It may be concluded from these results that the benefit of a booster vaccination is particularly high in poorly immunized persons whereas it is clearly limited in cases showing a high prevaccinal titer. The well tolerated intradermal vaccination with the jet injector (Dermo-Jet) can be considered as equivalent to the subcutaneous technic. From the point of view of organization (time consumption, problems of sterilization) this method is much preferable to intramuscular or subcutaneous vaccination.


[Rotor syndrome. A long-term study].

[Rotor syndrome. A long-term study]. A patient with Rotor syndrome has been followed up for 28 years. The subject was in good health and exhibited marked jaundice due to a hyperbilirubinemia ranging between 5 and 8 mg bilirubin per 100 ml, about 70% of the bilirubin giving direct van den Berg reaction. The liver was slightly enlarged and of normal color. Histologically it showed traces of a brown pigment and marked siderosis in the hepatocytes. In addition, mild hypersideremia and hypercholesteremia were observed together with increased amounts of bilirubin and urobilinogen in urine. Menthol glucuronide formation was normal. Hepatic excretion of bilirubin, sulfobromophthalein and radio-opaque dyes was impaired. There was no change in liver histology of biopsies taken at an interval of 6 years, the siderosis in particular remaining constant. During the observation a moderate increase in the activities of serum transaminases occurred but no longer recurred when physical and dietetic stress was avoided.


[Sudden death from ventricular fibrillation after voluntary inhalation of chlorothene in a mechanics apprentice]. In a 20-year-old apprentice mechanic who had deliberately inhaled chlorothene (1,1,1-trichloroethane) an episode of vomiting was followed by ventricular fibrillation with fatal outcome despite intensive care in hospital. Autopsy revealed no anatomical cause of death. This is the first case reported in Switzerland of "sudden sniffing death syndrome".


[The problem of hypertension in Switzerland. Analysis of a blood pressure study in 21,589 persons]. Blood pressure measurements (Phyiometrics SR1) were performed on 21 589 persons visiting the Swiss Trade Fair in Basel in 1974. Diastolic pressures were found to be greater than or equal 110 mm Hg in 3%, greater than or equal 100 mm Hg in 7% and greater than or equal 95 mm Hg in 12% of the screened population. Including those under antihypertensive treatment, the prevalence of high blood pressure (diastolic pressure greater than or equal 95 mm Hg) amounted to 19% of the adult population. In 68% of the hypertensive screenees the condition was already known, 49% were under treatment and 35% were controlled (i.e. diastolic pressure less than 95 mm Hg). In other words - and here lies the unsolved problem - 32% of hypertensives are as yet undetected, 19% of the known cases are not treated, and 14% are inadequately treated. Of the hypertensive population 35% are adequately treated and 30% have mild hypertension. The remaining 35%, with diastolic pressure greater than or equal 100 mm Hg, require urgent attention and action. In Switzerland this problem can be tackled and solved by the general practitioner, who already play the major role in detection and treatment.


[The value of lung scintigraphy in the staging of bronchial carcinoma. Prospective study for the determination of TN stages]. A prospective study has been conducted to determine the clinical importance of lung scintigraphy in the work-up of patients thought to have bronchial carcinoma (i.e., accuracy of the scintigraphic diagnosis, data concerning spread of the primary tumor [=T] as well as the possibility of metastases to the lung hilus and mediastinum [=N]). Ninety-four patients, all of whom were hospitalized for suspected bronchial carcinoma, were examined by 133Xenon i.v., 133Xenon gas inhalation,, and 99mTc-MAA i.v. (macroaggregated albumin or microspheres of human albumin). The suspicion was confirmed in 77 patients. Central and peripheral bronchial carcinomas were kept separate in the evaluation. A normal lung scintigram practically rules out a central bronchial carcinoma. Where the scintigraphic finding prompts suspicion of central bronchial carcinoma, this suspicion must be confirmed by other examinations and preferably those which cytologically and histologically directly demonstrate the tumor. The diagnostic reliability of lung scintigraphy is drastically reduced in patients with bilateral ventilation disturbances. Because of its 27% rate of false negative findings, bronchoscopy is a less suitable means of ruling out bronchial carcinoma than scintigraphy. The peripheral bronchial carcinoma displays no characteristic scintigraphic signs; thus, a normal scintigram does not rule out peripheral bronchial carcinoma. Bronchoscopy was negative in all these patients. Spread of the primary tumor was exactly predicted with bronchoscopy in 11% and with scintigraphy in 42% of cases. When the scintigraphic criteria for hilar or mediastinal involvement are ful filled, it is practically certain that the patient is no longer radically operable. This assertion is valid when mediastinoscopy is normal. Lung scintigraphy possesses the same accuracy in the diagnosis of mediastinal involvement both with peripheral lung tumors and with centrally located tumors.


[Paralysis after tetanus prevention].

[Paralysis after tetanus prevention]. A rare case is presented of isolated paralysis of the left dentatus muscle in a 29-year-old woman following antitetanus vaccination by adsorbed toxoid injection in the left shoulder. In the light of a literature review the peculiarities of this case are pointed out and the risk factors which emerge from the patient's history are stressed. The discussion centres on the most favorable site for injection of toxoid, the controverted etiology of the affection and the desirability of some form of treatment.


[Urinary mercury excretion in professional users of an antiseptic soap containing 0,04% phenylmercury borate]. Concentrations of mercury and of creatinine were measured under blind conditions in 84 samples of urine from 48 regularly using a liquid soap containing 0.04% phenylmercuric borate plus 3% hexachlorophene for hand disinfection ("users"), and in 138 urine samples of 80 subjects disinfecting their hands with a soap containing only hexachlorophene ("controls"). The concentration of mercury in the urine of users was 27+/-3 mug/1 (mean +/- SE), and in controls 8+/-1 mug/1; calculated total 24 h urinary mercury excretions were 27+/-2 mug/24 h users and 9+/-1 mug/24 h in controls. Women excreted slightly more mercury than men both in the user group and the control group. In both controls and users from whom a second urine sample was obtained after a 2-week interval the concentration of mercury was consistently lower in the second sample. No correlation was found between urinary excretion of mercury and frequency of handwashings or reported intake of mercury-containing food. No difference was found in the numbers of different types of urinary cells or urine pH as between users and controls. It is concluded 1) that regular hand disinfection with a liquid soap containing 0.04% phenylmercuric borate enhanced urinary excretion of mercury indicating an increase in total daily absorption of 30-100 mug Hg/24 h, 2) that the absorption of mercury from the phenylmercuric borate-containing soap occurred partly by transfer from the hands to the oral cavity, 3) that, though nontoxic in themselves, the additional amounts of mercury absorbed through the use of mercury contained in skin disinfectants are potentially dangerous due to as yet unknown interactions with other toxic or pathogenic factors.


[Therapy of refractory ventricular tachycardia in congenital diverticulum of the left ventricle. Clinical aspects and surgical therapy of a rare malformation]. True congenital diverticulum of the left ventricle is an extremely rare lesion, usually associated with defects of the pericardium and the diaphragm. It is defined as a finger-like extension of the ventricular chamber with its wall consisting of all three layers of a normal heart-wall and with the ability to contract properly. Additional cardiac malformations may lead or contribute to early death; if not, the patients die from rupture of the diverticulum. To our knowledge the isolated form without pericardial defect has been reported only once before. The findings are described in an adult who presented with ventricular tachycardia at the age of 43 years. Complete normalization was achieved by resection of the diverticulum with the aid of cardiopulmonary bypass. The literature is reviewed for comparable cases. Etiological considerations are presented and the clinical features are discussed.


[Organization of mobile intensive care in Zurich]. A mobile intensive care unit (Kardiomobil) has been in operation in the Zurich area (600 000 inhabitants) since March 27, 1972. This unit is staffed by a doctor and a nurse experienced in coronary and intensive care and two ambulance drivers. Although primarily designed for pre-hospital coronary care, it is equipped and operated as a "mobile intensive care unit".


[The prehospital phase of the acute myocardial infarct and its treatment in the mobile intensive care unit]. Mortality in the early phase of an acute myocardial infarction is high. Approximately two thirds of coronary deaths occur before the patients reach hospital, and if this mortality is to be reduced the prehospital phase must be shortened. For this purpose, mobile intensive care units are in use in many places with good results. The delay during the prehospital phase of acute myocardial infarction in Zurich has been analyzed prospectively (1) in a study performed in 1971/72 prior to the institution of the mobile intensive care unit ("Kardiomobil"), and (2) during the first year of Kardiomobil service. In 180 patients with acute myocardial infarction admitted to hospital by Kardiomobil the prehospital phase was considerably shorter (median delay 2 h 11 min) than in 216 with myocardial infarction in the same period not transported by Kardiomobil (7 hr 11 min) and in the 196 patients of the pre-Kardiomobil study (5 hr 55 min). Not only was the delay due to transport shorter in the Kardiomobil group but also the patient's and doctor's delays.


[Experiences with a mobile intensive care station (Kardiomobil) after 1 year's test operation in Zurich]. The Zurich mobile intensive care unit (Kardiomobil) admitted 502 patients in the first year of operation. 191 patients with confirmed acute myocardial infarction were seen. The Kardiomobil proved a success in shortening the total median delay between onset of symptoms and coronary care by 50%. Ten patients resuscitated outside the hospital were eventually discharged from hospital. 240 episodes of arrhythmia were observed in 182 of the 502 patients. 98 arrhythmias were successfully treated in this group, the best results being obtained in ventricular arrhythmias: 16 out of 26 patients with ventricular fibrillation were successfully defibrillated (61%), while 47 out of 53 episodes (89%) of frequent premature ventricular beats and all 9 episodes of ventricular tachycardia were corrected with lidocain and procainamid.


[Reanimation outside the hospital by the mobile intensive care station in Zurich]. Of 502 patients handled by a mobile intensive care unit, 70 were resuscitated: 20 immediately, 9 within 3 min and 41 later than 3 min from onset of cardiac or respiratory arrest. There were 9 temporary and 10 longterm survivors among the 29 patients who underwent resuscitative measures within 3 min of collapse. First-aid training programs in resuscitation methods are a necessary supportive measure to the operation of mobile intensive care units.


[The problem of malignant recurring goiter]. In a total of 29,060 autopsies at the Institute of Pathology, University of Zürich, between 1961 and 1973, 164 (0.56%) primary thyroid malignomas were diagnosed. 13 of these 164 patients with thyroid carcinoma showed a status post earlier strumectomy, representing 0.45% of the autopsies. On average 4.5% of the patients in our autopsy material had been previously thyroidectomized. The calculated chance combination of malignant thyroid tumor with status post earlier partial thyroidectomy is consequently 0.25%. This seems to suggest that malignomas develop nearly twice as often in previously operated thyroids, but histological review of these cases revealed that in 5 cases the primarily resected tumor had in fact to be reclassified as carcinoma. A further case probably belongs to the same group. Only in 7 cases (0.24%) did the carcinoma develop after partial strumectomy for a benign lesion. These percentage figures agree with the calculated probability of thyroid malignoma coinciding with previous strumectomy. Accordingly, these statistics lend no support to the contention that strumectomy predisposes the patient to thyroid malignoma.


Characterization of an episode with elevated ozone concentrations. A detailed analysis has been made of a seven day period in 1973, during which elevated ozone levels were observed at Ottawa. In addition to the ozone data, results are also presented for oxides of nitrogen, carbon monoxide, methane, total hydrocarbons and particulate matter. The particulates were analyzed for seven constituents, including the cations ammonium, calcium, sodium, potassium and lead and the anions sulfate and nitrate. Also measured were several other properties of the particulates, including the size distribution. It was found that none of the other gaseous pollutants showed any increase in concentration when high ozone levels were present. In contrast, the particulate matter did increase and several constituents, notably ammonium and sulfate, showed a dramatic rise. A comparison with ozone data from Toronto and upper New York state showed that the high ozone concentrations were widespread. A meteorological analysis showed that elevated ozone levels were associated with a Tropical air mass with a moderate southwesterly flow of air. Trajectory calculations were carried out to show the origin of the air over Ottawa before, during and after the period of increased ozone.


Evolution of repeated DNA sequences by unequal crossover. It is often supposed that highly repetitious DNA's arise only as a result of unusual mechanisms or in response to selective pressure. My arguments and simulations suggest, by contrast, that a pattern of tandem repeats is the natural state of DNA whose sequence is not maintained by selection. The simulations show that periodicities can develop readily from nonreptitious DNA as a result of the random accumulation of random mutations and random homology-dependent unequal crossovers. The lengths of these periodicities, and the patterns of subrepeats within them, would fluctuate in evolution, with the probability of a given pattern being dependent on the unknown exact nature of the crossover mechanism. Qualitatively, then, unequal crossover provides a reasonable and uncontrived explanation for the prevalence of highly repeated sequences in DNA and for the patterns of periodicity they evince.


Brain acetylcholine: control by dietary choline. Acetylcholine concentrations in whole rat brain or in various brain regions and free choline concentrations in blood serum and brain vary with dietary choline consumption. The increases in brain acetylcholine after treatment with physositigmine (an inhibitor of actylcholinesterase) or after consumption of a diet high in choline are additive, suggesting that choline acts by increasing acetylcholine synthesis.


Prolonged ethanol consumption increases testosterone metabolism in the liver. Male alcoholics often suffer from features of hypogonadism related to abnormal metabolism of sex steroids. Since the activity of testosterone reductases is rate limiting for testosterone metabolism in the liver, the effect of prolonged ethanol consumption by rats and human volunteers on the activities of these microsomal and cytosolic enzymes was studied. In rats, long-term ethanol ingestion doubled microsomal 5alpha-testosterone reductase activity, a major pathway for testosterone metabolism, while in human volunteers the activity was increased two- to fivefold. These changes may play a role in the altered androgenic activity of the chronic alcoholic.


Experience modifies the plastic properties of identified neurons. Crickets (Acheta domesticus) were reared in the presence of continuously repeating tone pulses. The responses of large abdominal interneurons to similar tone pulses were then compared. The giant interneurons of treated specimens are more resistant to habituation than those of control specimens.


Consequences of a nationwide ban on spray adhesives alleged to be human teratogens and mutagens. A report of an association of chromosome breakage and birth defects with spray adhesive exposure resulted in a ban on the sale of these products and nationwide publicity warning exposed women. Six months later the ban was removed; the association could not be confirmed. Replies to questionnaires sent to medical genetics centers throughout the United States revealed that more than 1100 inquiries had been received and more than 1200 working days were expended because of the issue. Eleven exposed women underwent diagnostic amniocentesis, and on elected to abort her fetus. Eight other women who were exposed also elected to do so, but without first undergoing diagnostic amniocentesis. The episode illustrates some of the unexpected and unnecessary consequenes that can arise from the false identification of an environmental agent as a mutagen or teratogen.


Carotid body in the sudden infant death syndrome. Sixty-three percent of victims of the sudden infant death syndrome had a subnormal volume and 23 percent an enlarged volume of glomic cells in their carotid bodies. Evidences of antecedent chronic alveolar hypoxia and hypoxemia were found in both groups but were more severe in the victims with enlarged glomic tissue.


Proviral DNA of Moloney leukemia virus: purification and visualization. Closed-circular proviral DNA of Moloney leukemia virus has been purified from a 10(7) excess of cellular and mitochondrial DNA. The DNA can be visualized in the electron microscope and has the contour length of a molecule with a moleculecular weight of about 5.5 + 10(6). Electron microscopic observation of a hybrid between viral RNA and this circular DNA confirms the viral origin of this molecule.


Antileukemic principles isolated from euphorbiaceae plants. Extracts of Euphorbia esula L. and Croton tiglium L., two members of the Euphorbiaceae which have been used widely in folk medicine for treating cancers, showed antileukemic activity against the P-388 lymphocytic leukemia in mice. Systematic fractionation of the extract of Euphorbia esula L. led to characterization of a major antileukemic component as the new diterpenoid diester, ingenol 3,20-dibenzoate. Similar fractionation of Croton oil led to characterization of phorbol 12-tiglate 13-decanoate as an active principle.


Amphibious behavior of  Alligator mississippiensis: roles of a circadian rhythm and light. Juvenile American alligators in outdoor pens moved out of and into the water at sunrise and sunset, respectively. When the natural light cycle was extended with artificial illumination, these movements gradually shifted into phase with the altered light cycles; therefore, the amphibious behavior was modulated by a circadian rhythm cued by light. Movement between land and water was characterized by a decrease in body temperature, which suggests that it is was not simply a proximate heat-seeking response. After the movements had been in phase with the altered light cycles for a time, they spontaneously shifted back into phase with the natural light cycl. A changing response to light is viewed as an adaptation to seasonal changes in heat availability.


Binocular interaction in strabismic kittens deprived of Vision. Artificial strabismus in kittens decreases the proportion of binocularly driven units in area 17 of the cortex. This change in the binocular interaction of cortical cells also takes place if the kittens are deprived of vision from the day in which the strabismus is surgically produced to the day of the electrophysiological recording. Thus, altered motility of the eyes per se is sufficient to affect binocular interaction in the neurons of area 17 of the cortex.


Theory of photochemical reactions.

Theory of photochemical reactions. Although the great number of electronic states available to an excited molecule might seem to preclude a coherent picture of photochemical reaction mechanisms, it is possible to bring out some basic features common to a great many reactions. The electronic states of the primary diradical intermediates, surface crossings, topicity, and avoided surface crossings have been shown to be essential components of the electronic theory of photochemical reactions. Diradicals have four important electronic states. Knowing these states, and making a simple electron count, it is possible to draw state correlation diagrams. Some diagrams show a typical surface crossing of the ground singlet state with the lowest (singlet, triplet) pair of excited states, with clear-cut consequences of quantum yields under various conditions. In other reactions the surfaces stay apart. The critical discriminating feature that determines the type of correlation diagram is the topicity. Photochemical reactions can be classified according to topicity, which is useful in interpreting their mechanisms (53). Avoided surface crossings can also be classified into different types. Figure 7, which illustrates the interplay of a covalent and an ionic surface responsible for photochemical electron transfer, is a typical multidimensional representation of a photochemical reaction. The chemical behavior of the excited zwitterionic states of common intermediates, such as twisted ethylene or diallyl, reflects the quantum mechanical nature of photochemical processes. In these states, for perfectly symmetric systems, charge oscillates back and forth between two symmetry-equivalent sites. Slight geometric perturbations can create a sudden polarization of the excited molecule, with localization of almost a full charge at one end of the molecule. A photon is transformed into an electrical signal thanks to an appropriate molecular distortion. Nature may have used this simple process in the N-retinylidene visual chromophore to trigger an electrical response to vision.


Surface predominance of trace elements in airborne particles. A number of minor and trace elements including Be, C, Ca, Cr, K, Li, Mn, Na, P, Pb, S, Tl, V, and Zn present in coal fly ash are found to be preferentially concentrated on the particle surfaces. Environmentally effective concentrations of these elements are thus much higher than indicated by conventional bulk analyses.


Demonstration of kinetoplast DNA in dyskinetoplastic strains of Trypanosoma equiperdum. 4,6 Diamidino-2-phenylindole (DAPI) forma a highly fluorescent complex with DNA which allows detection of mitochondrial DNA (K-DNA) in normal and dyskinetoplastic strains of Trypanosoma equiperdum. The K-DNA DAPI complexes in the dyskinetoplastic cells, cells lacking detactable K-DNA by other cytochemical methods, are not restricted to a single region of the organism as in the normal strain, but are seen as a row of particles. These observations support the hypothesis that the K-DNA is retained in dyskinetoplastic cells.


Nicotinic acid reduction of plasma volume loss after thermal trauma. Intravenous administration of nicotinic acid to the anesthetized dog prior to thermal trauma reduced plasma loss at 10 minutes after burn from 7 milliliters per kilogram to less than 2 millimeters per kilogram. During the next 50 minutes plasma loss was the same in treated and untreated animals. An additional dose of nicotinic acid 30 minutes after burn prevented this further loss.


Human newborns differentiate differing concentrations of sucrose and glucose. One- to three-day-old infants who sucked to obtain flavored water revealed a precisely graded tongue movement which was sensitive to the gustatory properties of the flavored water. Stronger concentrations of sucrose and glucose elicited movements of greater amplitude than did weaker concentrations; sucrose was effective at lower concentrations than was glucose. These results correspond well with the relative sweetness adults attribute to these solutions in psychophysical studies.


Californium-252 plasma desorption mass spectroscopy. We have shown that 252Cf-PDMS is capable of producing mass spectra of quasi-molecular ions for a wide variety of compounds, including amino acids, moderately large peptides, nucleotides, and natural products. Positive and negative ion mass spectra can be obtained, and in many cases quasi-molecular ions are observed in both. The method is nondestructive, as only a relatively few molecules are used and samples can be recovered after the measurement is made. Fragmentation patterns are obtained which can yield structure information. The present sensitivity of the method is at the nanogram level and there are possibilities for reducing this to picograms. The mass resolution is sufficient to give elemental identification up to mass 500. This may be extended to higher masses with improved time-of-flight techniques. There are indications that 252Cf-PDMS may extend the mass range of molecules that can be studied to as high as 3000 or more.


Field evaluation of benzopyrene hydroxylase induction as a monitor for marine petroleum pollution. Fish from petroleum-contaminated sites in the marine environment have elevated levels of benzopyrene hydroxylase activity in liver and gill tissue. This sublethal response appears to be a practical biological monitor for marine petroleum pollution.


H blood types in pigs as predictors of stress susceptibility. At least two genotypes in the H system of blood groups in pigs are responsible for blood types associated with the porcine stress syndrome (PSS), and at least three genotypes are responsible for blood types associated with freedom from PSS. Two blood types, each of which apparently may result from more than one genotype, are associated with PSS in some pigs and not in others.


Coordinated activities of middle-ear and laryngeal muscles in echolocating bats. The middle-ear muscles and laryngeal muscles of the little brown bat (Myotis lucifugus) are highly developed. When the bat emits orientation sounds, action potentials of middle-ear muscles appear approximately 3 milliseconds after those of the laryngeal muscles; this activity of middle-ear muscles attenuates the vocal self-stimulation and improves the performance of the echolocation system. When an acoustic stimulus is delivered, both types of muscles contract; action potentials of the laryngeal muscles appear approximately 3 milliseconds after those of the middle-ear muscles. These two groups of muscles are apparently activated in a coordinated manner not only by the nerve impulses from the vocalization center, but also by those from the auditory system.


Perceptual illusion of rotation of three-dimensional objects. Perspective views of the same three-dimensional object in two orientations, when presented in alternation, produced an illusion of rigid rotation. The minimum cycle duration required for the illusion increased linearly with the angular difference between the orientations and at the same slope for rotations in depth and in the picture plane.


Fishes in oxygen-minimum zones: blood oxygenation characteristics. Teleosts living in some mid-water pelagic regions of the Pacific are hypoxic or anaerobic during most of the day and become aerobic only during their diurnal migrations to and from the sea surface. The blood oxygen capacities of these fishes are among the lowest ever reported, and the oxygen dissociation curves show a very low affinity for oxygen.


Epoxide to olefin: a novel biotransformation in the rumen. Studies with an insect juvenile hormone mimic and the insecticide dieldrin have shown that enzymatic processes in the rumen reduce the epoxide moiety in these compounds to an olefin. This reaction is apparently microbial in origin and does not involve an observable intermediate. Epoxide reductions in the digestive tract of ruminants and possibly other mammals may be important in the detoxication of biologically active epoxides, including pesticides, alkylating agents, and carcinogens.


Antagonism of stimulation-produced analgesia by naloxone, a narcotic antagonist. Analgesia produced by focal electrical stimulation of the brain is partially reversed by the narcotic antagonist naloxone. The absence of complete reversal does not appear to be caused by inadequate doses of naloxone since doses higher than 1 milligram per kilogram of body weight did not increase the antagonism. It is suggested that stimulation-produced analgesia may result, at least in part, from release of an endogenous, narcotic-like substance, such as that recently reported by other investigators.


Horizontal cell potentials: dependence on external sodium ion concentration. The membrane potential of the horizontal cell of the axolotl is highly dependent on the extracellular concentration of sodium. Experimental results reported here are consistent with the suggestion that in the dark the receptors release a synaptic transmitter which increases primarily the sodium conductance of the postsynaptic membrane. Externally applied aspartate or glutamate depolarizes the horizontal cell membrane and eliminates the light response of the horizontal cell. However, it appears to increase the conductances of the postsynaptic membrane to several ions rather than just to sodium ions.


Selenium in fly ash.

Selenium in fly ash. Selenium, at concentrations exceeding 200 parts per million (ppm) (dry weight), has been found in white sweet clover voluntarily growing on beds of fly ash in central New York State. Guinea pigs fed such clover concentrated selenium in their tissues. The contents of the honey stomachs of bees foraging on this seleniferous clover contained negligible selenium. Mature vegetables cultured on 10 percent (by weight) fly ash-amended soil absorbed up to 1 ppm of selenium. Fly ashes from 21 states contained total selenium contents ranging from 1.2 to 16.5 ppm. Cabbage grown on soil containing 10 percent (by weight) of these fly ashes absorbed selenium (up to 3.7 ppm) in direct proportion (correlation coefficient r = .89) to the selenium concentration in the respective fly ash. Water, aquatic weeds, algae, dragonfly nymphs, polliwogs, and tissues of bullheads and muskrats from a fly ash-contaminated pond contained concentrations of selenium markedly elevated over those of controls.


Bioluminescent countershading in midwater animals: evidence from living squid. Midwater squid respond to overhead illumination by turning on numerous downward-directed photophores; they turn off the photophores when overhead illumination is eliminated. The squid are invisible when the intensity of the photophores matches the intensity of the overhead illumination. These results strongly support the theory of ventral bioluminescent countershading.


Egg transport in the rabbit oviduct: the roles of cilia and muscle. Ciliary ovum transport through the oviductal ampulla was investigated, in vivo, by blocking smooth muscle activity. Isoproterenol eliminated rapid muscle-induced egg movements, yet the egg and its surrounding cells reached the site of fertilization within normal time limits. The role of cilia in ovum transport thus seems more important than that of the smooth muscle.


Segmentation in cinema perception.

Segmentation in cinema perception. Viewers perceptually segment moving picture sequences into their cinematically defined units: excerpts that follow short film sequences are recognized faster when the excerpt originally came after a structural cinematic break (a cut or change in the action) than when it originally came before the break.


Brain wave components of the contingent negative variation in humans. In a contingent negative variation paradigm with two stimuli paired at an interstimulus interval of 4 seconds, two distinct waveforms having functional and topographic differences are observed. An early wave is maximal over the frontal cortex and is elicited by the warning stimulus. A later wave, maximal over the motor cortex, precedes the imperative stimulus and is identified with preparation for motor response.


Autonomous erythropoiesis induced by a virus. In this communication, data are presented on a virus-induced murine polycythemia (FV-P) that might serve as a useful model in providing information toward an understanding of autonomous erythropoiesis. In addition, the virus that induces this autonomous erythropoiesis is defective and requires a leukemia virus to manifest the spleen focus formation and polycythemia. An analysis of the defectiveness of FV-P has not only increased our understanding of the relationship of FV-P and leukemia helpers but has also shown that this defective virus system may be exploited to detect and characterize any virus isolate or component involved in human polycythemia.


The evolution into and the treatment of late stage polycythemia vera. The onset of postpolycythemic myeoloid metaplasia or spent polycythemia has been recognized for many years. As the result of many different series, the development of postpolycythemic myeolid metaplasia might be expected in from 15%-20% of patients with postpolycythemia vera. It appears that an etiologic role for sodium phosphate 32P may exist in this evolutionary pattern. About 70% of patients with PPMM will have symptoms with the onset of the syndrome. The major mechanisms producing symptoms result from (1) anemia, (2) pressure from massive splenomegaly, and (3) bleeding problems. Iron deficiency is a frequent cause of anemia in patients with PPMM. The major mechanism of anemia in these patients, however, relates to ineffective erythropoiesis and shortened red cell survival. Androgen trials for ineffective erythropoiesis seem worthwhile, although data on this point is too limited to draw any firm conclusions. A steroid trial for those patients with major hemolytic episodes is indicated. In those patients in whom adrenal steroid therapy fails to control major hemolysis, a consideration for splenectomy exists. Pressure-related manifestations secondary to massive splenomegaly have been treated with radiation therapy and oral alkylators. Although there is data to document amelioration of painful symptoms with associated shrinking of the spleen, long-term control of this problem has not been forthcoming. Again, patients who are medical failures in control of pressure-related manifestations may be considered for splenectomy. Bleeding problems may arise with PPMM secondary to thrombocytopenia, thrombocythemia, or qualitative platelet dysfunction. Adrenal steroids have met with some success in improving platelet counts in patients with life-threatening thrombocytopenia. Those patients who are medical failures with adrenal steroids in terms of thrombocytopenia might be candidates for splenectomy. Control of thrombocythemia has been observed with oral alkylator therapy and chlorambucil may have a special role in managing this complication. Qualitative platelet defects leading to severe bleeding are best managed with fresh platelet transfusions. Patients with PPMM in contrast to patients with agnogenic myeoloid metaplasia have a more lethal syndrome and shortened survivorship. Causes of death in patients with PPMM include cardiac problems, transition to acute leukemia, hemorrhage, and infection.


Use of Roux-en-Y diversion of duodenal secretions in the treatment of reflux gastritis. Animal experiments and clinical studies suggest that duodenal secretions may be harmful to gastric mucosa after the antrum has been resected. Reflux of duodenal secretions into the gastric remnant after operation for ulcer disease may lead to the symptom complex of reflux gastritis. The injurious agent in the duodenal secretions has yet to be identified. Its relationship to altered gastric mucosa has not been fully elucidated. Diversion of the flow of duodenal secretions away from the stomach may relieve symptoms. Of several surgical procedures used, the Roux-en-Y limb has consistently afforded the best clinical result. Presented are 15 patients who had Roux-en-Y diversion for postoperative reflux gastritis. All patients showed marked improvement after this procedure. Twelve patients also had associated esophagitis. All original procedures were for benign ulcer disease. Three of the patients, who had Henley jejunal loop interpositions, continued to have symptoms which were relieved after conversion to a Roux-en-Y limb.


Current views on the management of obesity. In the last five years, much information has been gathered about the efficacy of several technics for managing obesity. Hospitalization with fasting, surgery, drugs, weight reducing clubs, and behavior modification methods have proven efficacious for select groups of obese individuals. Methods of behavior modification appear to offer some of the most promising management technics, since results are good, and cost and discomfort to the patient are minimal.


Subluxation of the carpal navicular bone. A review of seven cases of subluxation of the carpal navicular indicated a vast discrepancy in result between those surgically reduced within five weeks and those that persist at two years unrecognized. Perilunal dislocations universally produced subluxations that required open reduction of subluxed naviculo-lunate articulation. With an appreciation of normal radiologic navicular relationships, one should recognize a subluxation early, correct it by open reduction, and thus prevent a chronic disability to a wrist. Late attempts at relocating and remodeling the navicular seemed only partially rewarding, since patients continued to have considerable disability.


Ipsilateral fractures of the elbow and forearm. One hundred and fifty-one patients with distal humeral fractures admitted to three major hospitals in Atlanta were studied retrospectively. Of these, 15 (10%) also had a fracture of the ipsilateral forearm. These appeared to be more severe injuries with a history of greater trauma and more displacement in the elbow fractures. The incidence of complications was the same in both groups with the exception of a higher incidence of cubitus varus among patients with combined fractures.


Convulsive toxemia of pregnancy (eclampsia). A retrospective study investigated the epidemlologic characteristics of eclamptic patients seen at the University of Mississippi Medical Center. Between January 1955 and June 1973, 194 patients were discharged from our hospital with the diagnosis of eclampsia. Although our incidence of severe forms of toxemia of pregnancy has decreased from 6.8 per 1,000 deliveries from 1955 to 1960 to 4.8 per 1,000 deliveries from 1970 to 1973, it is still three times higher than for the United States overall. Our patients generally were young, unmarried, and without adequate prenatal care. Primary therapy for severe preeclampsia and eclampsia consists of bed rest and administration of magnesium sulfate until stable, and then delivery. Therapy for the eclamptic patient includes control of the convulsions, administration of magnesium sulfate, and delivery when the patient's condition has stabilized. Antihypertensives and diuretics are used for cardiovascular indications.


Anesthesia and hepatic artery ligation.

Anesthesia and hepatic artery ligation. Hospital and anesthesia records of 39 patients who had hepatic artery ligation for severe hepatic trauma were analyzed retrospectively to acquire information on any relationships between choice of anesthetic, preoperative physical condition of the patient, type and incidence of complications, and mortality. Patients who had lost the most blood received neuroleptanalgesia, ketamine, or cyclopropane; those with more stable cardiovascular status received halothane; those in severe circulatory compromise received only oxygen and muscle relaxants. Trends in results of postoperative liver function tests were not related to type of anesthesia. Of the 12 deaths, seven were due to massive bleeding, three to septicemia, one to multiple complications, and one to hepatorenal failure 18 days postoperatively. Choice of anesthetic agent appeared to have no significant influence on postoperative morbidity and mortality; rather, the choice of anesthesia depended on the preoperative physical (especially hemodynamic) status of the patient, which in turn reflected the apparent blood loss estimated at induction.


Methylphenidate: a review.

Methylphenidate: a review. Methylphenidate is a useful, proven method for the effective treatment of minimal brain dysfunction (MBD). Dosage should be titrated individually for each patient, and it is best to start with small doses given at least 15 to 30 minutes before meals. Toxicity, side effects, and drug abuse are not major problems. Unfortunately it is not yet possible to determine in advance who will and will not benefit from drug therapy; not all patients do. Treatment of MBD requires a multidisciplinary approach, for no one discipline alone can satisfactorily solve the problems involved. We believe, however, that medicine is the primary therapy in most instances.


Effect of fluoroscopic tube placement on basal gastric secretion collections. To determine whether fluoroscopic positioning of nasogastric tubes is useful in the measurement of basal gastric acid output, four subjects were studied six times each and two subjects ten times each. Fluoroscopic positioning was used or not used according to random sequences. No more gastric juice was obtained in the collections after fluoroscopic positioning of the nasogastric tube than after blind placement. The results suggest no routine need to use fluoroscopic tube placement in the absence of prior gastric surgery.


Clear corneal section and cataract extraction. The technic of clear corneal cataract extraction was used in 365 cases, and the visual and postoperative results are reviewed. Visual acuity of 20/30 or better was obtained in 71% of cases, and there was corneal astigmatism of one diopter or less in 33%. Hyphema and shallow anterior chamber were encountered in less than 2% of cases. No instance of epithelial downgrowth was encountered. A renewal of interest in this technic of cataract extraction is encouraged.


Cholegraphy-induced acute renal failure: its relation to subsequent surgical therapy. The cases of three patients who developed acute renal failure shortly after receiving oral or intravenous cholegraphic agents are analyzed, and the pertinent literature is reviewed. Two patients required subsequent surgical intervention: one had cholecystectomy and common bile duct exploration; the other had right hemicolectomy and cholecystectomy for coexistent gangrenous cholecystitis and appendicitis. The third patient had chronic active liver disease. In all three, the cholegraphic agents were given while the patients were dehydrated. Two patients required hemodialysis. In all three, renal function returned to normal and was not altered by the subsequent surgical intervention. The cause of this complication remains uncertain but hepatic dysfunction and the combination of uricosuria and dehydration are possible factors. Awareness of its occurrence should result in proper hydration of patients prior to the administration of cholegraphic agents. Surgical intervention, if necessary, can be performed safely, preferably after renal function has returned to normal.


Electromyographic studies in peripheral nerve injuries. In every aspect of management of peripheral nerve injury, needle electromyography and nerve conduction velocity studies can give the clinician valuable objective information to supplement clinical findings. Comprehensive EMG studies in the fourth week after injury are helpful in diagnosing nerve injury, in localizing the site of injury, and in estimating the extent of injury. (In medicolegal situations, the first EMG study should be done within the first five days.) To assess the need for surgical exploration in cases of severe nerve injury, another EMG evaluation should be done eight weeks after injury. If there is no clinical and electrophysiologic evidence of improvement, surgical exploration is recommended. At exploration, the simple study of nerve potential on the exposed nerve in continuity will help the surgeon decide between neurorrhaphy and neurolysis. To assess regeneration, EMG study eight weeks after repair is recommended. When objective evidence of clinical improvement is desirable, serial EMP studies at intervals of four months are in order. To assess the recovery or residual effects of a lesion, final EMG study is recommended 18 months after injury or repair.


Life stress and psychiatric clinic referral. A "life stress" scale is applied to the antecedent events motivating 179 patients to seek outpatient psychiatric help. Intake evaluation reports of patients who kept their appointments at the Adult Psychiatric Outpatient Clinic of Vanderbilt University Hospital over a three-month period were reviewed. Almost half of the consecutive new patients indicated that a marriage-related or family-related problem had led them to seek an appointment at the clinic. "Life stress" scales, particularly those developed by Holmes and Rahe and by Paykel, invariably rank undesirable marital and family life events as having high stressful impact. Previous studies have examined life events antecedent to various medical and psychiatric illness, but not the events motivating a patient to seek psychiatric help.


Transsexualism: A selective review.

Transsexualism: A selective review. Progress in evaluating and treating the patient who seeks a change of sex is reviewed. The causes of transsexualism and the clinical differentiation of transsexualism, transvestism, and homosexuality are discussed. Criteria for selecting candidates for sex reassignment surgery are given, and preliminary results of work at Vanderbilt University are reported.


Edwardsiella tarda bacteremia.

Edwardsiella tarda bacteremia. Presented are two case reports of patients with Edwardsiella bacteremia who survived after chloramphenicol and gentamicin therapy in one case and cephalothin and kanamycin therapy in the other case. Of four previously reported patients, only one survived. One of our two patients presented with subarachnoid hemorrhage associated with bacterial endocarditis and, to our knowledge, this is the first reported case of E tarda endocarditis. The clinical and laboratory features of disease due to this unusual pathogen are reviewed.


Persistent brow presentation: a new approach to management. When the fetal vertex is extended on the spinal column and the brow becomes the presenting part, it is termed "brow presentation." Persistent brow presentation occurs when there is no spontaneous conversion after the onset of active labor. Since there is a risk in the vaginal delivery of such fetuses, it should not be attempted where there is known maternal disease or evidence of acute or chronic intrauterine fetal distress. During labor, cesarean section is indicated if there is cephalopelvic disproportion, if the fetal head is not in the frontoanterior position, if there is abnormal labor, or if there is evidence of fetal distress. Continuous lumbar epidural anesthesia should be given, and only manual conversion is used. The fetus is monitored continuously.


Effects of monitoring the usage of antibiotics: an interhospital comparison. Use of selected systemic antimicrobial agents at Boston City Hospital (BCH) has been monitored by requiring that choice of those agents be justified to a member of the Infectious Diseases Unit before the agent is dispensed for use in a patient. The amounts of various antimicrobial agents and classes of agents used at BCH in 1972 differed considerably from amounts used in other hospitals where restraint was not employed. Whether these differences in usage led to better care for the patient could not be determined from the data presented. These aspects must be studied in greater detail to determine the benefits, if any, that may be derived from such surveillance and control, especially in view of recent proposals for implementation of "peer review" in this as well as other areas.


A state-wide survey of drug issues in industry. A state-wide survey of 268 industries within the Commonwealth of Virginia indicated that industry appears to have a problem particularly with alcoholism and that the climate concerning the continued employment of persons who were undergoing treatment and the hiring of persons who have successfully completed a drug treatment program appears very positive.


Genital cytologic abnormalities in patients having therapeutic abortion. In the three years 1971-1973, 1,032 patients had therapeutic abortions at the Duke University Medical Center. Of these 99 (9.59%) had abnormal cervical cells on routine preabortion Papanicolaou smears. The patient who presents for therapeutic abortion appears to be at high risk for early cervical neoplasia. Therefore, it is mandatory that evaluation of the preabortion patient include adequate genital cytologic studies with means for proper follow-up.


Large state hospitals: problems and a solution. Periodic outcries have focused attention on gross deficiencies in our large state hospitals. Shortages of psychiatrists, commonly attributed to insufficient funding, also may be due in part to lack of prestige and power, disadvantages of public practice and unrewarding relationships with involuntary patients. In spite of discouraging experiences for more than three decades, we continue to ask what can be done to improve large state hospitals and persist in thinking that a workable formula will be found. Logically this is most unlikely, and a better approach might be to raise a different question. I have suggested that we ask, "What can replace large state hospitals?" and to this question I have offered an answer.


Renal angiomyolipoma.

Renal angiomyolipoma. An unusual case of a patient with tuberous sclerosis who presented initially with renal symptoms is presented. Electromicroscopic observations showed the smooth muscles to contain myofilaments and an unusual amount of glycogen. Although the response of the tumor vessels to epinephrine in angiomyolipoma is considered similar to that of renal cell carcinoma in that no vasoconstriction occurs, the reverse occurred in our case. A thin, lucent cleavage line around portions of the periphery of the angiomyolipoma was also noticed. Isolated angiomyolipoma in patients without tuberous sclerosis is difficult to differentiate from renal cell carcinoma; therefore, radical nephrectomy is usually the treatment of choice. Angiomyolipomas associated with tuberous sclerosis are easier to diagnose and are multiple and bilateral; therefore, a more conservative approach usually is indicated.


Acute meningococcemia without meningitis in association with influenza-like illness. An outbreak of meningococcal disease in a family of six resulted in four simultaneous cases of meningococcemia without meningitis. Although no definite explanation for this unusual collection of meningococcemia cases could be identified, a preceding influenza-like illness in the family may have increased their susceptibility to meningococcemia.


Cruveilhier-Baumgarten disease.

Cruveilhier-Baumgarten disease. An unusual case of portal hypertension in an asymptomatic 33-year-old man is presented. The findings of splenomgealy, esophageal and gastric varices, a patent umbilical vein with associated venous hum, and three normal liver biopsies qualify him for the diagnosis of Cruveilhier-Baumgarten disease. Possible etiologic explanations of his portal hypertension are discussed.


A rare case of spontaneous rupture of the urinary bladder. An extremely rare case of spontaneous intraperitoneal rupture of the urinary bladder, caused by a combination of a tumor of the vesical wall and an impacted urethral stone, is reported. The patient's symptoms suggested a perforated hollow viscus. Under general anesthesia the urethral stone was removed, while at laparotomy a diffuse peritonitis with blood-stained purulent fluid emerging from the ruptured bladder was found. The vesical wall was repaired and the peritoneal cavity was drained. In spite of the patient's advanced age and debilitated condition and the generalized peritonitis, the postoperative course was uneventful and the patient recovered promptly. Although spontaneous rupture of this kind is rare, one needs to consider unsuspected bladder rupture in any acute abdomen, especially if the patient is in the prostatic age group or has voiding problems.


Trauma of the arterial supply to the brain visualised by angiography. The radiographic appearances of some of the many changes that occur within the arterial supply to the brain after trauma are discussed.


The aetiology and management of idiopathic sudden hearing loss. Idiopathic sudden hearing loss is discussed with particular reference to aetiology and management. A scheme for rational diagnosis and treatment, based on the authors' experience and recent findings of other workers, is proposed.


Pulmonary embolism in the Rhodesian Black. Pulmonary embolism is less frequent in Blacks than in Whites. Deep vein thrombosis is probably not uncommon in Blacks, but relatively few of them develop pulmonary embolism. Postoperative pulmonary embolism in Blacks is probably far less common than in Whites. We are dealing with a relatively young Black population, compared with the White one, and therefore more cases might be expected among the Black population as its life expectancy improves.


A comparative study of tuberculin tine and Mantoux tests. The tuberculin tine (old tuberculin) and the Mantoux (stabilised purified protein derivative-PPD) tests were compared by using them in two simultaneous skin tests on patients with tuberculosis. The tine is sterile, disposable, and easy to administer and the agreement between the two tests was satisfactory. The tuberculin tine test is recommended as a useful screening test when tuberculosis is suspected.


The heart in rheumatoid arthritis: an echocardiographic study. An echocardiographic study of 44 patients with active rheumatoid arthritis was carried out by means of a Picker ultrasonic laminograph. A posterior pericardial effusion was found in 14 patients (32%) and pericardial thickening in 5 (11%). The maximum amplitude of the anterior cusp of the mitral valve was reduced in 18 patients, and the diastolic (EF) slope was abnormal in 17 patients. The posterior cusp movement and left ventricle diameter were normal. The over-all incidence of cardiac involvement in these patients was 73%. The incidence of heart abnormalities given by echocardiographic diagnosis of cardiac manifestation of rehumatoid arthritis correlates well with the incidence derived from postmortem studies.


Comparison of transverse and vertical skin incisions for Caesarean section. A comparison is made of the transverse and the vertical skin incision for Caesarean section. The advantages of the transverse incision are clearly demonstrated and discussed.


The value and dangers of gynaecological cytology. The value of gynaecological cytology is briefly summarised, possible pitfalls from the viewpoint of the clinician and the laboratory are enumerated, and the importance of quality control and the necessity of research to validate mass screening programmes are emphasised.


The nephrotic syndrome in children.

The nephrotic syndrome in children. Fifty-one children (30 Black and 21 Indian) with the nephrotic syndrome were studied. Renal biopsies were done on all. There were marked histological differences between the two racial groups. In the Black group membraneous and membranoproliferative nephropathies were commonest and no patient with minimal change was encountered. In the Indian group minimal change nephropathy was commonest.


Viable pregnancy after prolonged periods of secondary infertility. Case records of 206 pregnant patients who had not had a viable pregnancy for 10 years or more, are presented. In the antenatal period, 59.7% of patients went through their pregnancy with no complications. The commonest complications were pre-eclampsia and non-proteinuric hypertension. Labour was essentially normal in the majority of cases, and of the 183 patients who were allowed to labour, 171 (93.4%) were delivered vaginally. Caesarean section was performed in 17% of cases, which is 3 times the over-all Caesarean section rate for the hospital during the same period. The indications for Caesarean section are appreciably less restricted in these patients. There was a two-fold increase in the incidence of breech presentation. This may be partly explained by the higher incidence of premature births found in this group of patients. The over-all risk to the infant is increased, mainly because of prematurity, but also owing to a slight increase in the number of congenital abnormalities.


Intraspinal lipoma. A case report.

Intraspinal lipoma. A case report. A case of intraspinal lipoma is reported. The condition is discussed, the literature reviewed and the method of treatment described.


Adriamycin in the treatment of cancer.

Adriamycin in the treatment of cancer. Adriamycin is a new anticancer antibiotic with a wide spectrum of activity against solid tumours. The results obtained with this agent in 159 patients with histologically confirmed advanced metastastic malignancies are reported. Encouraging results were obtained in patients with sarcomas of bone and soft tissue (12/22). Response was also seen in mesothelioma (3/9) and lung cancer (5/15). A variety of other neoplasms was also treated and results obtained in neuroblastoma, testicular tumours, stomach carcinoma, breast cancer and nephroblastoma are reported. Treatment is discussed, with reference to response rates and toxicity. Results in 72 patients with advanced breast cancer, who received adriamycin in combination with other chemotherapeutic agents, are presented. Seventeen patients with primary liver cancer were also treated with adriamycin. To date, this is the only chemotherapeutic agent that appears to significantly improve survival times in patients with this resistant form of cancer. The prophylactic use of adriamycin against osteogenic sarcoma is also discussed.


The use of intra-aortic balloon pumping in cardiac surgical patients. Experience in the use of intra-aortic balloon pumping for moribund cardiac surgical patients over a 10-month period is presented. Of the 11 patients reported, 5 survived and have left hospital. The mechanism of diastolic augmentation of the circulation is discussed and the details of its clinical use are outlined.


Acute renal failure. Experience with 52 patients treated at Livingstone Hospital. Fifty-two cases of acute renal failure at Livingstone Hospital were studied. Twenty-two cases were obstetric, 10 surgical and 20 medical. The aetiological factors are tabulated and the pathophysiology is reported. Clinical features and biochemical abnormalities are presented. Infection was the commonest associated factor, followed by hypotension and volume problems, coagulation disorders, jaundice and hepatic failure, respiratory failure, pancreatitis and typhoid fever. In 7 of the medical cases the aetiology was unknown and was assumed to be toxic. A case history of a patient with leptospirosis, acute renal failure, liver failure and pancreatitis is presented. The mortality in this series was 32%.


An evaluation of Urovist S in urography. In 200 adult patients, urography with Urovist S (50 ml sodium diatrizoate 50%) achieved good or satisfactory visualisation of the urinary tract in 80-90%. The medium was generally well tolerated. Reactions, which were mostly mild, occurred in 13% of patients.


Renal uptake of 131I-rose bengal in biliary atresia. A case report. Renal uptake of radio-iodinated rose bengal was studied in a 5-month-old infant, who was later found, at operation, to have biliary atresia. Prominent renal uptake, which could easily be mistaken for radioactivity in the bowel, was noted. While this pitfall in diagnosis has previously been described, it is thought worth while to stress this possible cause of misinterpretation.


People, not cases.

People, not cases. While attempting to find out why so many of our elderly patients could not be discharged from hospital, we again observed the value of a knowledge of the patient's social background. Not only was it of great help in making a diagnosis and planning therapy, but it also stimulated our interest in the patient as a person, and was thus of mutual benefit to doctor and patient.


The hypothenar hammer syndrome.

The hypothenar hammer syndrome. The hypothenar hammer syndrome is manifested as digital ischaemia. It is caused by trauma to the ulnar arteries in workmen who use their hands as a mallet, and is not a rare disease. The pathophysiology of the disease is reviewed, with illustrative cases. The hypothenar hammer syndrome should be considered as a compensable injury.


A simple method of measuring total respiratory system compliance in newborn infants. A new method of measuring the static compliance of the respiratory system in the awake, non-paralysed infant is described. The static compliance was measured by this method in 12 healthy premature infants aged from 1 day to 30 weeks. In addition, the dynamic compliance was measured by the oesophageal balloon technique. The static compliance was significantly higher than the dynamic, and this difference was related to the respiratory rate. These infants therefore demonstrated frequency dependence of dynamic compliance.


Bone lesions in early congenital syphilis. A radiological study of bone changes in 112 children with congenital syphilis was undertaken. A similar number of normal children acted as a control group. Radiological examination of 5 syphilitic children showed that their bones were normal. Combined metaphyseal and periosteal lesions were the commonest bone disorders seen and are thus the most convincing radiological evidence of congenital syphilis. Transverse metaphyseal lucencies occur early in the disease, and with Wimburger's sign they are the prime evidence of pathology in syphilitic bone. Other radiographic changes are probably owing to minimal trauma in fragile disorganized bone. The occurrence of periosteal lesions alone has also been evaluated.


A family with partial and total deficiency of complement C3. A young White girl was found to have no detectable complement C3 or C1q. She suffered repeated attacks of pneumococcal meningitis and pneumococcal pneumonia. Her parents, and some of her siblings, had half the normal level of C3; other siblings were normal. She also had decreased IgG levels and increased IgM concentrations. These findings are correlated with a dysmorphic state of the germinal centres of the peripheral lymphoid tissues, seen after death.


Perforated appendix in situs inversus viscerum. A case report. A patient with situs inversus viscerum and a perforated left-sided appendix is reported. The embryological anomalies which result in a left-sided appendix are mentioned. Although the viscera are transposed, it is thought that the components of the nervous system which supply the affected organs are not reversed. Diagnostic difficulties are mentioned.


Acid secretion in Zulu and Indian patients with duodenal ulcers. Pentagastrin-stimulated maximal acid output (MAO) was measured in 337 male patients with duodenal ulcers, 209 of whom were Indian, and 128 of whom were Zulus. The mean MAO standard deviation (SD) value for Zulu patients with uncomplicated ulcers was 36,2 +/- 10,5 mEq/h. In the patients with complicated ulcers, the maximal acid output was 38,5 +/- 6,3 mEq/h in patients with pyloric stenosis, 31,5 +/- 13,7 mEq/h in patients with haemorrhage and 42,9 +/- 9,2 mEq/h in patients with perforation. A statistically significant difference was obtained only in the group with perforation (Pless than0.05). The mean MAO +/- SD value for Indian patients with uncomplicated ulcers was 29,2 +/- 17,0 mEq/h. In those with complicated ulcers, the MAO value in pyloric stenosis was 30,5 +/- 5,5 mEq/h in those with haemorrhage 22,0 +/- 13,7 mEq/h and for patients with perforation, 27,8 +/- 7,5 mEq/h. A statistically significant difference in values was not obtained in Indian patients. In the Zulu patients, 77,6% had MAO values above the upper limit of normal (mean + 2 SD), while in Indian patients only 17.6% had MAO values above the upper limit of normal. The difference between the 2 percentages is highly significant (Pless than0,0001). The proportion of male patients with stimulated acid secretion measurements above the upper limit of normal in other reported series is 30-50%.


Resection and immediate reconstruction for patients with "inoperable" recurrent head and neck cancer. An approach to the patient with a recurrent head and neck cancer following prior combined radiation, surgery, and possibly, chemotherapy has been outlined. Following a detailed evaluation of the patient's symptoms, the local extent of the recurrence, and the search for distant disease, resection of the recurrent tumor with immediate reconstruction of the resulting defect is advocated. Although reconstructive efforts may be taxing because of prior use of optimal tissue, imaginative planning and improvisation will allow functional and cosmetic restoration in many cases. Illustrative cases have been included to demonstrate the efficacy of this approach in treating patients with recurrent cancer of the head and neck.


Esophageal malignancies. Experience with 110 cases. At present radical esophagectomy is the operation of choice whenever resection can be achieved with hope of long-term survival. In patients with extensive node or liver metastases, the palliation achieved by standard resection is superior to that obtained by other methods of treatment such as radiation, bypass, or intubation. Radical resection appears to offer the only current avenue towards improving long-term survival rates in this most difficult of neoplasms. The role of anticipated advances in chemotherapy or immunotherapy on carcinoma of the esophagus remains to be defined, but en bloc resection of the tumor with adequate margins will remain the cornerstone of treatment, hopefully to be improved by new types of adjuvant therapy.


Evaluation of renal masses including retrograde renal brushing. 1. The evaluation of renal masses has become an increasingly important topic because of the increasing incidence of kidney cancer, the improved cure rate of renal carcinoma with the proper preoperative diagnosis, and the proliferation in renal mass diagnostic methodology. 2. A variety of benign entities can produce an abnormal renal mass with attendant difficulties in being distinguished from malignant neoplasms. Among these benign lesions are: simple renal cysts, polycystic kidneys, congenital variations in renal size and shape, segmental renal hypertrophy, renal infarcts, intrarenal hematomas, renal hamartomas, renal leiomyomas, renal adenomas, renal angiomas, renal fibrolipomatosis, hydronephrosis of a duplicated collecting system, renal abscesses, and xanthogranulomatous pyelonephritis. 3. Nephrotomography, nephrosonography (ultrasound), adrenalin renal arteriography, selective magnification renal arteriography, renal venography and cavography, lymphangiography, renal scintillation scanning, abnormal levels of enzymes in blood and urine, immunologic studies (circulating antibodies and tumor-associated antigens), percutaneous needle aspirations, and retrograde renal brushing have all increased the diagnostic accuracy of determining the etiology of renal masses. None of these diagnostic procedures is infallible. A judicious combination of procedures gives the most reliable diagnostic results. 4. A search continues for (a) chemical agent(s) or a chemical profile in the blood or urine which is (are) specific for renal carcinoma, but as yet this is an investigational area and not a practical clinical reality.


Recent developments in radiation-induced carcinoma of the thyroid. At the University of Chicago Hospitals, 40 per cent of patients with a history of irradiation to the neck and a palpable thyroid abnormality have been found recently to have carcinoma of the thyroid at operation. In a study of 100 unselected patients with a history of neck irradiation, 26 had palpatory abnormalities and seven of 15 who were operated upon had carcinoma of the thyroid. Five of these lesions demonstrated evidence of local invasion or lymph node metastases. This prevalence rate of carcinoma of at least 7 per cent in irradiated patients is the highest yet reported. These facts have led us to take a very aggressive position in the treatment of these patients. All patients must be examined carefully. When any palpatory abnormality is present which cannot be explained convincingly by thyroiditis, the patient should be operated upon. Total or near-total thyroidectomy should be performed in each patient by a qualified neck surgeon. In cases of proved carcinoma, a modified radical neck dissection should be added if cervical lymph nodes are clinically involved with tumor. Postoperative thyroid hormone suppression is mandatory and ablation of any residual iodine uptake in the neck or elsewhere by radioactive iodine is advocated. If treatment is aggressive, an excellent prognosis can be expected. However, deaths do occur from this disease. It is imperative that each of us be aware of this disease entity and that we treat these irradiated patients appropriately.


Desmoid tumors of the abdominal wall.

Desmoid tumors of the abdominal wall. Four cases of desmiod tumors of the anterior abdominal wall recently treated at the University of Chicago Hospitals and Clinics are presented. From our experience we conclude: 1. Inadequate excision of desmoid tumors results in local recurrence. 2. Adequate excision of desmoid tumors ot the abdominal wall sometimes necessitates creation of an abdominal wall defect too large for primary closure. 3. Marlex mesh has been used successfully in reconstruction of the abdominal wall following adequate excision of desmoid tumors. 4. One patient (Case 4) with an abdominal wall desmoid tumor associated with familial polypisis and mesenteric fibromatosis has benefited greatly following wide excision of abdominal wall and reconstriction using Marlex mesh, despite the fact that the mesenteric fibrous tumor was unresectable.


Lung cancer: An immunologic viewpoint and the prospects for immunotherapy. The size of the lung cancer problem and the dismal results of conventional therapy justify close attention to the possibilities of immunotherapy. Lung cancer patients, like other tumor patients, are often relatively immunosuppressed although an immune response directed against autochthonous tumor cells can usually be demonstrated. All conventional forms of therapy, surgery, chemotherapy, and particularly radiation therapy, are further immunosuppressive, which, there is reason to believe, jeopardizes a successful outcome. Immunotherapy seeks to counteract this either by nonspecfic immunoenhancement or by enhancing reactivity to tumor specific antigens. The results of immunotherapy trials in lung cancer patients suggest that survival can be prolonged and survivorship increased by immunotherapy, although the benefit is inconclusuve at present. Optimal conditions for immunotherapy, as presently understood, are outlined. Practical questions about the optimal use of current immunotherapy regimens need to be answered, but a more aggressive approach to lung cancer therapy when combined with immunotherapy seems justified. Im pariicular, the criteria for operability will need to be redefined, particularly as regards oat cell cancer and large tumors which cannot be completely resected but in which "debulking" may contribute to the success of subsequent radiation and immunotherapy. Possible future immunotherapy regimens applicable to lung cancer are proposed, with the reservation that their success is likely to be directly related to their practicability.


Mechanical circulatory assistance for the treatment of complications of coronary artery disease. Surgery has become an accepted method of treatment for coronary artery disease and its complications. Revascularization results in significant improvement in symptoms for patients with angina pectoris. Occasionally, patients requiring surgery for angina pectoris will sustain reversible ischemic damage during operation; such patients can be successfully weaned from cardiopulmonary bypass with full recovery when intra-aortic balloon counterpulsation is used. Arrhythmias associated with ischemic damage to the myocardium also can be controlled when IABCP is used for physiologic assistance. Patients in cardiogenicshock of pulmonary edema after acute myocardial infarction have an ominous prognosis. When decompensation occurs, IABCP may be used to stabilize the patient and to allow study and corrective surgery if possible. The prognosis is better for patients with ventricular septal defect, although selected patients without a mechanical defect of the myocardium can be salvaged if the response to IABCP is favorable. Counterpulsation has also been shown to be useful in achieving pulsatile cardiopulmonary bypass and in assisting high-risk patients through operation. External pressure circulatory assist (EPCA) is less effective than IABCP in assisting the failing myocardium; however, the external device is noninvasive and may be a useful adjunct in situations where IABCP is not feasible.


Treatment of toxic megacolon.

Treatment of toxic megacolon. From 1970 to mid-1975, we have operated on 25 consecutive patients with toxic dilatation of the colon with no mortality. This report deals with the principles of management which we follow; primary emphasis is given to aggressive diagnosis and resuscitation, followed by early operative intervention. We prefer total abdominal colectomy with ileostomy and sigmoid mucous fistula for cases of toxic megacolon not complicated by hemorrhage.


A twenty-two year review of elective resection of abdominal aortic aneurysms. The clinical presentation and history of abdominal aortic aneurysm has changed little in the last 22 years. The improved results of elective resection of these lesions have occurred subsequent to advances in various aspects of treatment of this disease as well as increased experience in surgical management. The operative mortality associated with elective resection of abdominal aortic aneurysms has dropped to such a level that elective intervention is reinforced as the treatment of choice for this lesion. It is hoped that, with the continued improvement in the diagnostic phase resulting in earlier detection and surgical intervention, there may be a further reduction in the incidence of rupture of abdominal aortic aneurysms and further prolongation of life in those patients in whom such lesions develop.


Surgical management of radiation injury to the small intestine. A survey of the literature and of the present series demonstrate a distinct difference in surgical mortality and intestinal morbidity in the immediate postoperative periods. Resection of the intestine with anastomosis has a significantly higher complication rate than does bypass. In this study, the over-all advantage in resecting radiation injured small intestine with reference to reducing severe chronic intestinal signs and symptoms has not been demonstrated.


Hyperparathyroidism in the maintenance dialysis patient. At least one component of the secondary hyperparathyroidism of end stage renal failure is hyperphosphatemia. Since 1968, 101 patients were treated definitively in a home dialysis program, and 78 of the patients remain active. Despite maintenance of the serum phosphate level below 5 milligrams per cent, one-fourth eventually had progressive hyperparathyroidism develop, primarily manifested by bone disease. Serum calcium levels were generally normal and, except at the extremes, were not predictive. The incidence of hyperparathyroidism was not influenced by the age of the patient, but it increased with duration of dialysis. Hyperparathyroidism developed in 13 of 15 patients with serum parathormone levels greater than 500 but in only six of 56 patients with values less than 500. The single most important manifestation was progressive bone disease. Of 16 patients treated by subtotal parathyroidectomy, all had large hyperplastic parathyroid glands. All of the patients who were observed for longer than six months had progressive improvement in the bone disease. Hyperparathyroidism is a significant problem in the dialysis patient, despite phosphate control. Progressive bone disease and elevated serum parathormone levels are the most important indicators. The incidence is directly influenced by duration of dialysis. Subtotal parathyroidectomy is effective in reversing the bone changes.


Comparison of colposcopy directed biopsies and cold knife conization in patients with abnormal cytology. One hundred patients with abnormal cytology were evaluated by colposcopy, and histologic material was obtained by directed biopsies, cold knife conization and endocervical curettage. The colposcopy directed biopsies provided the diagnosis in 94 per cent of the patients, and the colposcopic impression was accurate in 89 per cent of the patients. Cold knife conization was performed in 98 patients, since two patients had invasive carcinoma on colposcopic directed biopsy. In 75 patients, the histopathologic finding on cone biopsy was in complete agreement with the directed biopsies. In 11 patients, the directed biopsies were a degree higher than on cone biopsy, and in six patients the histopathologic findings were a degree lower. In six patients the colposcopic directed biopsies missed the diagnosis of dysplasia. No patients with carcinoma in situ or invasive carcinoma were missed by the colposcopic directed biopsies.


Ischemia of the colon.

Ischemia of the colon. Ischemic colitis is a disease complex that presents as a continuum of mucosal and submucosal hemorrhage, late stricture formation and frank gangrene. The exact form depends upon the degree, site and duration of the vascular occlusion, the presence of collateral vessels and the intraluminal pressure in the colon. In a study group of 19 women and seven men, the majority of whom were in the seventh to eighth decades of life, most frequent symptoms were crampy abdominal pain and abdominal distention associated with bloody diarrhea. Ischemic colitis occurred with increased colonic intraluminal pressure, generalized decreased vascular flow and embolic phenomenon. The predominating predisposing causes were atherosclerosis, shock and congestive heart failure as well as leukemia. The results of barium enema studies showed a pathognomonic condition that included thumbprinting, mucosal ulcerations and sacculations. Arteriography, generally, was not helpful, and results of sigmoidoscopy were invariably negative, since the rectum seldom is involved in ischemic colitis. Conservative treatment should include intestinal rest, low molecular weight dextran and antibiotics. Early operative intervention is recommended when conservative therapy fails or signs of peritoneal irritation become evident.


Effect of acute hemorrhage on gastrin secretion rate and blood levels of gastrin and insulin in normal dogs and in dogs after vagotomy. Ten dogs were used to study antral gastrin secretion in hemorrhagic shock. Dogs that had a vagotomy were compared with normal dogs. Acute hemorrhage, imposed upon operative stress, produced increased gastrin secretion in normal dogs but not in dogs after vagotomy. During the acute hemorrhage, the level of circulating gastrin in normal dogs increased to about 50 to more than 100 per cent of the control values. The concentration of gastrin in the dogs having a vagotomy was essentially unchanged in the face of acute hemorrhage. Results of this study suggest that the increased concentration of circulating gastrin in normal dogs subjected to severe stress may play a role in the development of a stress ulcer.


Transport of oxygen and carbon dioxide by hemoglobin-saline solution in the red cell-free primate. This study was undertaken to investigate the respiratory properties of hemoglobin-saline solution. Eighteen baboons were exchange transfused with either 6 per cent dextran or 6 per cent hemoglobin-saline solution. All of the hemoglobin-saline solution treated baboons survived three hours at a zero hematocrit reading. All the dextran treated animals died when the hematocrit level fell below 6 per cent. Oxygen consumption and carbon dioxide production remained unchanged from base line during the zero hematocrit interval. It is concluded that the respiratory capability of hemoglobin-saline solution is sufficient to maintain life in the absence of erythrocytes.


Immunostimulation with intraperitoneally administered bacille Calmette Guérin for advanced malignant tumors of the gastrointestinal tract. Thirty-five patients with advanced malignant tumors of the stomach, pancreas, biliary tract or colon were treated intraperitoneally with bacille Calmette Guérin and, subsequently, were given orally booster doses of bacille Calmette Guérin and one of two schedules of cytotoxic drugs. Patients with all types of tumors responded, but this was most marked in patients with metastases to the liver from primary carcinoma of the colon.


Clinical management of acute cholangitis. In a series of 78 patients with acute cholangitis, 48 were associated with common duct stones, and in one-third of these, the stones were believed to be primary common duct stones. Even though the clinical presentation of acute cholangitis can be nonspecific with a remarkable absence of physical signs, almost all patients had elevations of serum bilirubin, transaminase and alkaline phosphatase levels, an indication of disease of the biliary tree. Initially, all of the patients were treated with antibiotics and most responded rapidly. Escherichia coli and klebsiella were the organisms involved in more than 85 per cent of the positive cultures, and penicillin and an aminoglycoside are recommended as the drugs of choice in acute cholangitis. Diagnostic procedures were then performed, and laparotomy was often not carried out for several days after admission. Eleven of the 78 patients died. Six of the 11 deaths in this series were from continuing or recurrent sepsis, and at postmortem examination, a retained stone or inadequately treated stricture was found. This points out the need for adequate diagnostic procedures prior to exploration.


Heparin-lock maintenance with ten units of sodium heparin in one milliliter of normal saline solution. A rapid increase in use of heparin-lock to maintain patency of established intravenous pathways for intermittent and emergency intravenous injections of drugs has given rise to questions concerning the necessary heparin-saline solution concentration to prevent coagulation and minimize or avoid systemic effects of heparin on blood clotting. A series of experimental and clinical studies followed by clinical observations and evaluation have shown that a concentration of 10 U.S.P. units of sodium heparin per milliliter of normal saline solution will maintain patency of heparin-locks without affecting the clotting time, prothrombin time or activated partial thromboplastin time. A procedure of flushing the heparin-lock with 1 milliliter of the recommended heparin-saline solution following each intravenous injection of medication or every eight hours, if medications are not given more frequently, is suggested.


Acute gastroduodenal lesions related to severe sepsis. To determine the incidence of acute gastroduodenal lesions during severe sepsis, prospective endoscopies were performed in two groups of critically ill patients. The criteria of selection ruled out the incidence of other factors, such as shock, acute renal or respiratory failure. Evaluation of sepsis by clinical and bacteriologic criteria and endoscopic examination were performed in a double blind study. In the group of 14 patients with sepsis, 19 fibroscopies showed abnormalities of mucosa in all of them. In the group of 16 patients with sepsis, 23 fibroscopies showed either superficial lesions or normal mucosa. The difference between the incidence and the severity of acute lesions in the two groups studied was highly significative, p less than 0.001. Besides, gastroduodenal lesions became worse when sepsis prolonged, while they improved dramatically when focal infection and septicemia were eradicated. These data strongly suggest that severe sepsis per se can provoke acute digestive damage.


Evaluation of forequarter amputation in malignant diseases. Twenty-one forequarter amputations were performed at our institute during a 15 year period for soft tissue sarcoma, osteosarcoma, recurrent malignant melanoma and epidermoid carcinoma. Two patients in this group who have had recurrent carcinoma of the breast with a painful, edematous and ulcerated upper extremity were palliated and had significant relief. The over-all five year survival rate following this procedure for curative intent was 25 per cent. There were no five year survivors of unclassified sarcoma, myosarcoma and recurrent malignant melanoma. Thus, we do not recommend this procedure for recurrent malignant melanoma, although it can be performed as a palliative measure. Since most of the patients with malignant bone tumors, unclassified sarcoma and myosarcoma have systemic metastasis develop within two to eight months after this procedure, new methods should be explored to detect early metastasis before undertaking this psychologically traumatic procedure. Adjuvant chemotherapy and other modalities of adjuvant therapies are recommended in this group with poor prognosis. A local recurrence after this amputation in patients with unclassified lesions and myosarcoma should be considered as an indication of systemic metastasis.


Regional lymphadenectomy and tumor immunity. This study sought to determine if tumor immunity was impaired by regional lymphadenectomy when performed at different stages of tumor growth. Regional lymphadenectomy significantly reduced tumor specific immunity when performed soon after tumor inoculation. However, removal of the regional lymph nodes later but before the tumor was clinically detectable did not affect the development of tumor immunity. Similarly, regional lymphadenectomy after the tumor was palpable did not decrease tumor immunity. Therefore, prior to the time that the tumor is clinically detectable, immunologic sensitization has become a systemic phenomenon and is no longer confined to the regional lymph nodes.


Evolvement of a new treatment for perforated duodenal ulcer. Treatment of 157 patients with perforated duodenal ulcer has been evaluated. The condition of the patient dictated that 40 be treated by simple closure. In the remaining patients, vagotomy and drainage and vagotomy and hemigastrectomy were performed in a randomized, prospective study. These patients were observed postoperatively for an average of four years. There was one operative death after vagotomy and hemigastrectomy and none after vagotomy and drainage. There were no instances of incapacitating diarrhea in either group, and the frequency of postoperative gastric complaints was essentially the same in both groups. Reoperation was required in three patients after vagotomy and hemigastrectomy. The anticipated advantage of decreased gastric complaints after vagotomy and drainage compared with their frequency after vagotomy and hemigastrectomy in the definitive treatment of perforated duodenal ulcer was not apparent from our study. To provide protection against further ulcer disease and, at the same time, reduce postoperative gastric sequelae, parietal cell vagotomy without drainage was performed and evaluated in 13 patients with perforated duodenal ulcer. The longest follow-up period of these patients was two years. There was no diarrhea, dumping or other significant gastric complaint. Gastric emptying was normal, and no ulcers have recurred. The results were excellent in 11 patients and good in two. Early results suggest this method of treatment may be a satisfactory compromise between the use of simple closure that does not protect patients against recurrent ulcer and the use of vagotomy and hemigastrectomy and vagotomy and drainage which impose increased morbidity and death rates on those patients who might not have had further ulcer disease.


Femoral shaft fracture with injury of the superficial femoral artery in civilian accidents. Eight patients with a fracture of the shaft of the femur and a concomitant lesion of the superficial femoral artery are presented. Six patients had a viable leg; one patient, a below knee amputation, and one, an above knee amputation. Early recognition of this relatively rare combination is of paramount importance. In our experience, internal fixation of the fracture followed by grafting of the artery through separate incision works best.


Cheilognathoschisis in Texel sheep.

Cheilognathoschisis in Texel sheep. In view of the birth of abnormal Texel lambs sired by a single ram, experimental matings were carried out to determine the extent to which the malformations shown by the lambs were clear-cut inherited defects and, if so, which was the mode of hereditary transmission. From investigations on six abnormal lambs and a study of the literature it was concluded that these were inherited defects not previously described and marked by cheilognathoschis which was almost invariably associated with an unduly light birth weight, brachycephaly and cardiac septal defects. The placenta of one of the abnormal lambs, which was studied, showed marked changes. The proportional numbers showed that, when the more complicated inheritance patterns are not taken into account, the defect is transmitted by a recessive autosomal gene.


Observations on the effect of shortening the dry period on milk yield, body weight, and circulating glucose and FFA levels in dairy cows. The effect of shortening the dry period from 60 to 30 days in dairy cows was studied. For this purpose 18 pairs of dairy cows were matched, one member of each pair serving as a 60-day dry-period control. Singificant post-parturient differences between the two groups were observed: in the experimental group body weight and blood glucose levels did not decrease significantly, while significant decrements were observed in the control group, unlike FCM production trends during that period. In the experimental group monthly FCM production varied less than in the control group. It appeared that ante-parturient conditions programmed post-parturient energy partition.