[Case report of a primary pericollagen amyloidosis (author's transl)]. The authors report about a female patient, 59 years old, who was suffering from a stenosis of the cardia. A malignant process was suspected and an operative treatment was planed. During the preoperative internal examinations a low voltage in the ECG was found so that an amyloidosis was suspected. This was proved by biopsy of the mucosa of the rectum. A chronic suppurative disease could not be found, it was then assumed that the patient is suffering from a "primary pericollagen amyloidosis". Because a splitting of the stenosis through the esophagoscope the biopsy showed no malignancy, but congo-red positive material around collagen tissue. This seldom disease, the differential-diagnosis and the possibilities of treatment are discussed. Under symptomatic therapy the patient is doing well 2 years since.


A probabilistic approach to safety design: the two-element environment. The immediate electrical surroundings of the hospitalized patient are comprised of elements which may or may not be powered by electricity. Four electrical "operators"--G, E, T, and C--indicate respectively the status of the grounding of elements, the electrical leakage of elements, the electrical contact of one element with another, and the electrical contact of the patient with the elements. The operators are considered as mutually stochastically independent indicator random variables. The operators are utilized to formulate the probability of electrical danger in a basic environment of 2 elements. Grounding concepts of electrical safety are questioned as the operators, when supplied with probabilities, demonstrate a range of situations over which an ungrounding strategy may provide more safety than one of grounding. The probablisitic model calls for the collection and analysis of electrical data from which estimates of probabilities may be obtained and with which electrical models may be refined.


Prolonged open-chest total cardiopulmonary bypass in calves. Utilizing currently popular techniques for clinical cardiopulmonary bypass on 10 consecutive 70- to 80-kg calves, open-chest total cardiopulmonary bypass was carried out for 4 hours with 100 percent survival. However, all animals demonstrated serious intraoperative and postoperative alterations in blood gas, blood chemistry, and hematology parameters, grossly abnormal cardiovascular hemodynamics, and altered renal function. Therefore, a modified bypass technique and procedural protocol was developed, based on observations of more than 2000 clinical human and experimental canine bypass procedures, plus selected pilot experiments on calves. These modified techniques were then utilized in 12 consecutive 70- to 80-kg calves for 8 hours of open-chest total cardiopulmonary bypass. There were no deaths, and all physiologic parameters tested remained in a satisfactory (near normal) range during and after the prolonged bypass procedure. Details of the technique and the specific data collected during and after bypass are presented. The data suggest that important fallacies may exist in currently popular concepts about the harmful effects of cardiopulmonary bypass, particularly as they relate to steady flow arterial perfusions, methods of extracorporeal oxygenation, techniques of heparinization, and etiology of oozing tendencies associated with prolonged perfusions and dilution perfusions.


A technique for localized heating in tissue: an adjunct to tumor therapy. Increasing evidence of the beneficial effects of hyperthermia in the treatment of tumors, particularly when combined with radiation therapy or chemotherapy, has created the need for practical methods of localizing heat in arbitrary tissue volumes. Heating superficial transplanted animal tumors in hot-water baths has been of considerable importance in research, but the method has very limited clinical application. Microwave diathermy and ultrasound diathermy are capable of greater penetration than external conduction heating, but are also generally limited to the heating of superficial tissue volumes. A more direct method for localized tissue heating is proposed: localized electric current fields produced with carefully specified electrode configurations. This technique, although often quite invasive, offers the possibility of heat localization in almost any treatment volume specified by the therapist. Variations in electrical and thermal properties of tissues can be exploited to improve the architecture of the treatment plan. Several electrode configurations are illustrated. Limitations of the technique are discussed.


Lymphocyte blastoid transformation assay by cytofluorography. This rapid, automated, micromethod quantitates blastoid transformation using a supra vital stain, acridine orange, in quantitating the ribonucleic acid (RNA) and deoxyribonucleic acid (DNA) before and after cell stimulation. Only 0.2 ml of culture containing 1.0 X 10(5) to 1.5 X 10(5) lymphocytes is required to obtain results every 5 minutes. These results include a total cell count and cell counts of the populations with increased RNA (I-RNA), and increased DNA (I-DNA). The I-RNA and I-DNA lymphocyte populations, as determined by the cytofluorometric method, correlate well with the accepted H3 uridine and C14 thymidine uptake methodology. The phytohemagglutinin dose response measurements by the 2 methods also correlate well. Blast cell counts, by Wright-Giemsa staining, showed near identity to the I-RNA cell population.


[Familial hemolytic anemia and terminal renal failure (author's transl)]. We report about a patient with corpuscular hemolytic anemia and chronic glomerulonephritis in the state of terminal renal failure. The hematocrit decreased to 11% gradually with the progression of uremia. The hematological studies revealed the typical signs of hemolytic anemia. We found a splenic destruction of 51-Cr labelled red cells combined with an extremely short red cell life of 7 days. After splenectomy hematocrit improved to 32%. A complete normalisation could not be expected because of the chronic renal failure leading to anemia itself.


[Control of the heparin induced bleeding risk in haemodialysis patients (author's transl)]. Partial-Thromboplastin-Time (PTT) has been used as a bedside-method to control the dosage of heparin in haemodialysis patients at a high bleeding risk. The practical procedures and the advantages of the method as compared to current coagulation controls are outlined. As a result a technique of "minimal intermittent heparinization" has been developed which effectively prevents bleeding in the heparinized patient on haemodialysis.


[A fourth possibility treating chronical uremic patients: the satellite dialysis station (author's transl)]. It is possible to reduce the lack of dialysis places by establishing so-called satellite-dialysis-stations. Carrying out the normal dialysis treatment the satellite-station shows certain advantages in comparison to the dialysis center. There are presented the results of 21 patients in a satellite-dialysis-station. On average the systolic blood pressure before dialysis was 132,1 +/- 17,7 mm Hg, the diastolic blood pressure 83,5 +/- 14,9 mm Hg, serum creatinin 9,9 +/- 1,5 mg/100ml, hemoglobin 12,4 +/- 3,2 g/100 ml and the hematocrit 34,4 +/- 5,3%. 16 patients are still working. During the first 12 months of treatment in the satellite-dialysis-station the hematocrit of the patiens was raised on average by 6,4%. Concerning the results of the therapeutic and psychic situation of the patients the satellite-dialysis-station is comparable to the home dialysis treatment.


[Effect of nicotine on the production of gastric acid (author's transl)]. 15 test persons underwent intravenous injection of nicotine hydrogen tartrate. The acute effect on secretion rates and ionic composition of gastric acid was determined. Submaximal stimulation of gastric mucosa was reached with 50 mg/hr histalog applied intravenously. Nicotine hydrogen tartrate application of 0.012 to 0.020 mg/kg body weight in non smokers and of 0.022 to 0.034 mg/kg body weight in smokers caused the following changes: increase of concentration of hydrogen and chloride ions, decrease of ionic concentration of sodium and potassium in the gastric juice as well as slower secretion of sodium ions per time unit. A stomach stimulated intravenously by infusion of 2 mg/hr histalog per kg body weight is affected by intravenous injection of nicotine hydrogen tartrate  in amounts of 0.018 to 0.032 mg per kg body weight in non smokers and of 0.033 to 0.048 mg per kg body weight in smokers by a significant increase of concentration and secretion rates of hydrogen ions as well as a decrease of ionic potassium concentration in the gastric secretion. The increased gastric acid concentration caused by nicotine under maximal stimulation with histalog is discussed as promoting factor of ulceration and as retarding factor for the healing process.


[Hepatitis BS-antigen and hepatis BS-antibodies in partners of HBSAg-positive patients with chronic liver diseases. A contribution to the contagiousness of hepatitis B]. By radioimmuno-assay we found HBSAg in 4.2% and HBS-Antibodies in 60% in a group of 120 partners of patients with HBSAg-positive chronic liver diseases. The high incidence of HBS-antibodies in the group of partners is supposed to be due to a transmission of very small amounts of HBSAg containing material in a way of occult immunisation. There were no significant relations to the sex of the partners nor the age of the patients or the activity and duration of the disease. Our clinical investigations do not support demands for a strict isolation of patients with positive HBSAg findings nor do they imply that health-care workers should change their professions in case of HBS-antigenemia.


[The diagnostic value of the intraatrial ECG to recognize digitalis induced atrial arrhythmias (author's transl)]. A case is reported in which a Digoxin intoxication led to irregularities in atrial rhythm. This case, which was diagnosed by an intraatrial cardiogram, shows the usefulness of this method which is easy to practise and leads to special therapeutic aid.


Interspecies transfer of mitochondria in Paramecium aurelia. Erythromycin-resistant mitochondria from species 1, 5 and 7 of P. aurelia were injected into erythromycin-sensitive paramecia of each of the same three species. Mitochondria from species 1 and 5 were successfully transferred to all three species, but species 7 mitochondria failed to develop in species 1 and 5. Minor differences were indicated in the frequency of successful transfers of species 1 mitochondria into species 1 and 5 cells. From studies on the transferability of mitochondria from "hybrid" cells, containing mitochondria from one species and nuclei from another, it was concluded that mitochondrial compatibility was mainly under control of the nuclear genome, with a possible minor control also by the mitochondrial genome.


Altered cotransduction frequencies exhibited by HT-mutants of Salmonella-phage P22. Phage P22-mutants with increased transduction ability (HT-mutants) show in comparison to wild type 22, different frequencies of contransduction for markers on two different transducing fragments of the Salmonella chromosome. The data are interpreted as indicating that host DNA to be packaged is cut by HT-mutants at sites different from those cut by wild-type phage, due to an altered specificity of the nuclease responsible for this step.


On the synthesis of viral ribonucleic acids and ribonucleoproteins in the submitochondrial system completely free of interfering cytoplasmic contaminations. The synthesis of virus-specific macromolecules was studied in the reconstituted system containing inner membrane-matrix fraction from rat liver mitochondria and infectious RNA of Venezuelian equine encephalomyelitis (VEE) virus. In a series of preliminary experiments it was shown that isolated submitochondrial fraction was completely free of interfering cytoplasmic contaminations and particularly, of cytoplasmic 80S ribosomes. VEE RNA when added to submitochondrial system caused significant stimulation of RNA and protein synthesis. These processes were resistant to actinomycin D which inhibited profoundly the synthesis of proper mitochondrial macromolecules. The stimulating effect of VEE RNA in experiments with submitochondrial system was about three times higher than that with intact mitochondria. The stimulation of 14C-amino acid incorporation increased as a function of incubation time; a certain lag-period being observed. The newly formed virus-specific RNA's and ribonucleoproteins were identified with the aid of sedimentation analysis. In particular, radioactive RNA's with sedimentation coefficients 40S and 26-18S were isolated from the incubated system. These RNA's are similar respectively to VEE genome RNA and double-stranded VEE replicative RNA. In double labelling experiments with 3H-uridine and 14C-amino acids it was shown that VEE RNA induced synthesis of ribonucleoproteins containing newly formed RNA and protein. These RNP possessed sedimentation coefficients 60-80S, 140S and 300S in sucrose gradient and buoyant densities 1.32 and 1.50 g/cm3 in cesium chloride gradients. These properties of ribonucleoproteins synthesized de novo in submitochondrial system are close to those of RNP intermediates of VEE virus reproduction in the infected cells. We concluded that viral RNA could program virus-specific synthesis in the submitochondrial system under conditions that eliminated the contribution of cytoplasmic ribosomes.


Chloral hydrate mediated inhibition of cell division and of proton synthesis. Chloral hydrate (along with other anaesthetics and hypnotics) is an inhibitor of cell division. We have shown that chloral hydrate is also an inhibitor of protein synthesis. This inhibition is unlikely to be a result of either of the disruption of cell division or of interference with the function of microtubules. The ability of chloral hydrate to inhibit cell division may result from its ability to inhibit protein synthesis.


Experimental uveitis induced by prostatic antigens. Experimental uveitis was induced in male rats following their repeated systemic and intravitreous immunization with prostatic antigen and CFA. The ensuing uveitis was proved histologically. Heteroimmunized rabbits and female animals showed less response and the level of antibodies detected was lower. Anti-prostatic antibodies were determined by the TRC flocculation and PCA techniques. Ouchterlony's method gave positive results not only for prostatic but also for other ocular antigens when tested against the same test sera.


Immunological study of the aqueous humor in ocular herpes simplex. (1) Isolation of herpetic virus and immunological studies of the serum and aqueous humor are two complementary methods of investigation in the diagnosis of ocular herpes simplex infection, their relative value depending on the clinical situation. (2) Of the different immunological techniques that of antibody titration by the hemagglutination method is an easy, sensitive test, but only if the Goldmann-Witner ratio is calculated. By this technique, the diagnosis of herpetic infection can be made in unusual clinical presentations or old cases in which all specificity had disappeared.


The third component of complement (C'3) level in patients with uveitis. In 23 cases of endogenous uveitis the third component of the complement (C'3) system was determined by the immunodiffusion method. No statistical difference was found in uveitis patients as a whole in comparison with the normal controls; although a rather high value of C'3 was found in six cases of Eales' disease and in three cases of Behçet's disease. The significance of these results is discussed.


Lymphocyte transformation test in uveal pathology. Comparative studies of skin tests and in vitro lymphocyte transformation tests were found to be fruitful with the following antigens: tuberculin and PPD, Streptococcus, vaccine and protein M of Streptococcus, candidin, herpes antigen, Brucella antigen, antigen from autologous saliva. Three types of response occur: (1) positive skin test with syndromic ocular reaction and positive LTT: the diagnosis of hypersensitivity is certain; (2) positive skin test without syndromic reaction but positive LTT in vitro; less sensitive than the in vivo test but enhancing the value of the latter; the diagnosis is presumptive, and (3) skin test positive or negative  and LTT negative: indicates that the in vitro test is less sensitive than the in vivo one. Practical interest of this comparison stems from those cases in whom skin testings is contra-indicated because it is considered to be dangerous (macular choroiditis, Eales' disease). Specific desensitization treatment was carried out on most of the cases and seemed to be effective in several of them.


Immunological studies on Behçet's and Harada's diseases. I. Cell-mediated immunity in Behçet's and Harada's diseases. II. HL-A antigens associated with Behçet's disease. Behçet's and Harada's diseases were studied for cell-mediated immunity, utilizing leukocyte migration inhibition test (agarose droplet method). Patients with Behçet's disease during an attack showed cellular hypersensitivity to their aqueous humor, vitreous humor, and synovial fluid, but not to the normal tissue extracts of humans, such as oral mucous membrane, skin, retina and uvea, nor to their peripheral blood leukocytes. The patients with Harada's disease, in whom uveitis was recurrent and depigmentation present in various parts of the body, showed cellular hypersensitivity to bovine uveal extract. It is probably that in Behçet's disease cellular hypersensitivity is the result of inflammatory processes rather than being an important pathogenic mechanism, whereas in Harada's disease it is implicated in the pathogenesis of the disease process.


Experimental immune retinitis: induction by isolated photoreceptors. An antigen prepared from the outer limbs of the photoreceptors failed to produce retinal lesions within 3 months by systemic immunisation alone in the rabbit. Intra-vitreal injection of the antigen in a pre-immunised rabbit resulted in an Arthus type response. Repeated systemic immunisation for over 1 year after an intravitreal injection produced retinal degeneration in the uninjected eyes of two rabbits. Anti-visual cell antibodies were not shown to be cytotoxic to organ cultures of retina. Possible reasons are discussed in relation to in vitro studies of thyroid, kidney and spinal cord.


Immunosuppressive treatment of uveitis.

Immunosuppressive treatment of uveitis. Ten out of 31 cases of severe corticosteroid-resistant uveitis showed a good clinical response to systemic chlorambucil therapy. Cases of Behcet's syndrome, sympathetic ophthalmia, chronic cyclitis, and rheumatoid sclerouveitis seem to be in the most favorable categories to be considered for cytotoxic-immunosuppressive therapy.


Immunosuppressive treatment of Behcet's disease. Thirty patients with Behcet's disease were treated with immunosuppressive drugs, 25 with Imuran, 5 with Leukerin and 2 with both these drugs. Daily administration of 50-75 mg of Imuran over a period of 1 year alleviated the ocular symptoms in 16% of patients, was slightly effective in 20%, and ineffective in 64%. Imuran therapy was also seen to alleviate the extraocular pathology, such as stomatitis, erythema, and arthralgia. Leukerin proved difficult to prescribe over a long period because of severe side effects.


Experimental allergic uveitis: induction by retinal rod outer segments and pigment epithelium. EAU was produced in strain 13 guinea pigs after immunization with purified guinea pig retinal rod outer segments and with retinal pigment epithelium in mycobacterial adjuvant emulsion. The lesions of EAU appear as inflammatory infiltrates of the iris and ciliary body followed by choroidal inflammation, often with retinal photoreceptor degeneration. Specific antibodies are detected in the serum of a majority of the animals with clinical disease. Immunohistochemical staining of normal and inflamed eyes with serum from the immunized animals with uveitis demonstrates specific antigens localized in the outer segments. All immunized animals demonstrate delayed-type hypersensitivity characterized by skin reactions of mononuclear cells, by the in vitro inhibition of migration of peritoneal macrophages from the sensitized animals in the presence of specific antigen, and by antigen-specific lymphocyte stimulation. More pronounced delayed-type hypersensitivity reactions occurred during uveitis and indicated that cellular immunity correlates with clinical EAU, whereas no correlation was found with serum antibody. Successful experiments at transferring clinical disease passively with sensitized lymphocytes from animals with uveitis to normal recipients were conducted via the intravenous as well as intravitreal routes. No inflammatory reactions occurred after similar transfer of nonsensitized lymphocytes. The recipients of the passively transferred cells demonstrated both humoral and delayed type hypersensitivity to the retinal antigens. These findings suggest that the retinal rod outer segments and pigment epithelium are the sourve of significant antigens in autoimmune uveitis and retinitis.


Humoral and cellular immunity to retinal antigens in guinea pigs. Cellular and humoral immunity was studied in pigmented guinea pigs after one injection in the two hind footpads of extract of bovine retina or crude suspensions of rod outer segments (ROS) with complete Freund's adjuvant. In vitro macrophage migration inhibition experiments showed that the antigens which give rise to cellular immunity are mainly located in the pigment epithelium-photoreceptor layers and are devoid of species specificity. With the complement fixation method, the evolution of serum antibodies in anti-ROS guinea pigs was compared with clinical and histological data during the course of the ocular disease. Antibodies appeared in the 2nd week, slighly before the lesions, reaching their maximum level at the 4th week and decreased pari passu with the clinical ocular inflammation, while choroidal cellular infiltration and retinal alterations persisted for several months. Attempts to transfer the disease passively with concentrated serum from enucleated donors were successful. The immune sera were injected locally by different routes. Repeated subconjunctival injections - the less traumatic way - induced severe chorio-retinal lesions.


The propensity of different strains of guinea pigs to develop experimental autoimmune uveitis. We compared the propensity of several strains of guinea pigs to develop autoimmune experimental uveitis and autoimmunity following immunization with retinal-uveal antigens in complete Freund's adjuvant. The Hartley and NIH strains developed the disease more frequently and more severely than the strain 13 animals. The strain 2 guinea pigs did not develop the disease at all. In addition, the strain 2 did not make as much delayed hypersensitivity or as much antibody as the Hartley and NIH strain animals. NIH guinea pigs lacking the fourth component of complement made as much disease as those with that enzyme.


Sensitizing capacity of syngeneic, allogeneic and xenogeneic ocular tissue. Effect on intact and injured rat eyes. Experimental allergic uveoretinitis could not be induced by the following procedures in a total of 87 rats of four different inbred strains; intramuscular or intraperitoneal immunization with syngeneic, allogeneic or xenogeneic native ocular tissue (up to 80 eyes, treatment up to 15 months); intramuscular and subcutaneous application of complete Freund's adjuvants and Bordetella pertussis vaccine followed by perforation (induction of uveal and lenticular lesions) of the left eye.


Cell-mediated and humoral immune response after lens injury. The authors carried out immunological investigations on lens antigen in 21 injured patients, when only the cornea and the lens were involved. Circulating anti-lens antibodies were found by means of passive haemagglutination technique in 5 out of 16 cases. The cellular immune response was examined in 5 injured patients by the leucocyte migration inhibition test. The cellular immune response to the lens antigen was also demonstrable. The pathogenic role of the humoral and cellular immune response against the 'foreign' antigen was evident.


Evaluation of genetic risks of alkylating agents. II. Haemoglobin as a dose monitor. The degree of alkylation of haemoglobin was determined at different times after treatment of mice with one directly active alkylating agent, ethylene oxide, and one agent that requires metabolic activation, dimethylnitrosamine. Because of the random alkylation of red blood cells of various ages and the stability of alkylated haemoglobin, the amount of alkylated amino acids in haemoglobin decreases linearly with time, reaching the value zero after about 40 days, the life-span of erythrocytes in the mouse. This provides a basis for the use of haemoglobin as a monitor for integral doses of genotoxic environmental chemicals.


Lack of synergistic effect between X-ray and UV irradiation on the frequency of chromosome aberrations in PHA-stimulated human lymphocytes in the G1 stage. PHA-stimulated human lymphocytes in the G1 stage were irradiated with UV radiation and X-rays, and the cells were analyzed for chromosomal aberrations in the first mitotic division. The frequency of dicentric chromosomes after single X-irradiation in the G1 stage was about twice the yield in the G0 stage. No increase in the yield of dicentrics was observed after combined irradiation with UV and X-rays. This is contrary to the finding for G0 lymphocytes, where a 2-fold increase of chromosome aberrations was observed. UV irradiation of G1 lymphocytes induced chromatid-type aberrations whereas no significant yield of dicentric chromosomes was observed. This is in agreement with previous findings in Chinese hamster cells in the G1 stage [7]. Irradiation of G0 lymphocytes with UV radiation induce a low frequency of dicentric chromosomes. Thus, the present data indicate that the ratio between chromosome-type and chromatid-type aberrations is different in the G1 and G0 stages in human lymphocytes irradiated with UV radiation.


The use of correction factors in the determination of mutant frequencies in populations of human diploid skin fibroblasts. The need and validity for using a number of correction factors in the determination of mutant frequencies in human diploid skin fibroblasts was investigated. Resistance to the purine analogue 8-azaguanine was used as selective system. It appears that, under the conditions used, there were no effect of the cell density on the cloning efficiency. Therefore observed mutant frequencies need to be corrected for cloning efficiency. The reliability of using Lesch-Nyhan cells as a prototype mutant in the estimation of the efficiency of mutant recovery was investigated and found to hold true. The relation between the efficiency of mutant recovery and cell density, which reflects the degree of inter-clone metabolic cooperation, was measured. The use of this relationship enhances the accuracy of the estimated mutant frequencies. With these correction factors the mutation rate was estimated to be 5.7 - 10(-6) per cell per generation. The influence of intra-clone metabolic cooperation was determined and found to be small if present.


Chromosome rearrangements from spermatogonial chronic neutron irradiation in mice. Adult male mice were given a range of neutron doses at 80 +/- 20 mrad/h from a plutonium-beryllium source. Cytogenetic analysis indicated that chronic spermatogonial exposure to a mean total dose of 10, 30, 52, 98 or 150 rad produced translocations, sampled in spermatocytes four months later, amounting to 0.32, 0.99. 1.69, 1.91 and 1.65%, respectively. The dose response for the 0-52 rad range was linear. For higher doses, a better fit to the data was an expression with dose exponent above unity.


Mutagen specificity and position effects on mutation in T4rII nonsense sites. In 14 sites in the T4rII region, spontaneous and induced interconversions of ochre (UAA) and opal (UGA) alleles, as well as the reversion of the nonsense sites to r+, were studied. The mutagens employed were 2-aminopurine (2AP), 5-bromouracil (5BU), N-methyl-N'-nitro-N-nitrosoguanidine (NTG) and hydroxylamine (HA). With the test system employed, mutagen specificity (i.e., the preferential induction of A: T  leads to G: C or G: C leads to A: T mutation at a given site) can be studied. Simultaneously, the response of similar base pairs at various locations in the same or in different nucleotide triplets throughout the rII region, to a given mutagen, can be compared. 2-Aminopurine can induce transitions of both A: T and G: C base pairs at high rates. This mutagen shows no preference for either direction. Furthermore, there is a correlation between the response to 2AP of an A: T pair occupying a given site, and that of a G: C pair occupying the same site. NTG and HA induce G: C leads to A: T transitions almost exclusively. However, there is a correlation between the low rates of A: T leads to G: C transition induced in each of the various sites by these mutagens and those of G: C leads to A: T. 5-Bromouracil induces transitions from G: C to A: T more readily than from A: T to G: C. With 5BU-induced mutation, there is no correlation between the rates of G: C leads to A: T transitions and those of A: T leads to G: C. In UAA sites, all three adenine:thymidine paris respond to 2AP mutagenesis in a similar pattern, In each position in the triplet, response to 2 AP is correlated with that to 5BU. In UGA sites, there are correlations among the spontaneous as well as the 2AP-, HA- and NTG-induced transition rates. 5BU-induced transition rates are usually not correlated with those induced by other mutagens or with the sponatneous ones.


The cytogenetic effect of an X-ray contrast medium in Chinese hamster cell cultures. Chinese hamster cell cultures were treated with different concentrations of Joduron, a water-soluble iodized X-ray contrast medium. The cytogenetic effect was analysed for a treatment period of 2 or 16 h. Jorudron primarily acts on the mitotic apparatus of the cell. The type of damage ranges from different forms of initial "C-mitosis" to unpolarized stathmokinesis. Additionally, structural chromosome damage, mainly of the chromatid type, was observed, especially after a Joduron treatment for 2 h.


A search for storage effects on chromosome aberrations induced in human normal type- and xeroderma pig-mentosum fibroblasts by tetra-ethylene-imino-1,4-benzochinon and n-acetoxy-n-2-acetylaminofluorene. Normal human foreskin fibroblasts in stationary phase were treated with tetra-ethylene-imino-1,4-benzochinon. Treated cells were stored for 0, 1, 2 or 3 weeks on special storage medium and then analyzed for induced chromosome aberrations. The results showed that there was a decrease in the frequency of chromosome aberrations with increasing storage times rather than an increase. These observations may indicate that, (1) a storage effect of the type observed in Drosophila, Neurospora and barley (i.e. increase of genetic damage with duration of storage) does not occur in human cells in culture, or (2) the effect is masked by cell selection and/or repair processes. To inquire whether the absence of a storage effect might have been, at least in part, due to the interaction of repair processes and the effect sought, xeroderma pigmentosum cells in stationary phase were treated with N-acetoxy-AAF. This experiment likewise provided no evidence for a storage effect.


Incorporation of (3H)thymidine stimulated by ultraviolet radiation into human fibroblast cultures. We studied DNA repair synthesis after ultraviolet irradiation in human fibroblasts cultured in vitro by measuring the ultraviolet-stimulated incorporation of [3H]thymidine into cells in which the semi-conservative DNA replication was inhibited by hydroxyurea. Experiments performed with five fibroblasts lines derived from healthy donors showed a relatively fast initial process ( that is completed within 1 h for 100 erg/mm2 and within 2 h for 500 erg/mm2) and a subsequent slower process, evident between 2 and 6 h after irradiation. The repair capacity of normal cells is expressed by the difference between the values of incorporation (in presence of hydroxyurea) of irradiated and control cells. The pattern of repair was similar in all five cell lines: repair capacity was positive and the amount of repair synthesis increased with incubation time after UV irratiation. Similar experiments were performed with fibroblasts derived from five patients with the classical xeroderma pigmentosum (XP) and from one patient with the De Sanctis-Cacchione syndrome. Normal and XP cells could be distinguished according to whether they displayed a positive or negative value of repair synthesis and/or according to the degree of the slope of the repair synthesis curve as a function of the incubation time after irradiation. We conclude that the technique used in our experiments can demonstrate in a rapid and simple way a defect in the repair capacity in fibroblast cultures; the data are in good agreement with those obtained in the same XP cell lines by other authors [9], who have measured unscheduled DNA synthesis in autoradiographs and repair replication after addition of BUdR.


An evaluation of the mutagenicity of the cutting oil preservative Grotan BK. The micronucleus test in rats was used to investigate the mutagenic potential of Grotan BK, a preserving agent used in industrial cutting oils. The test compound was administered either by intragastric intubation, dermal application or subcutaneous injection. CFHB (Wistar) rats were given two equal dosages separated by 24 h to provide total dosages of 15,60,240 or 960 mg/kg. In addition, as a positive control, benzidine at a total dosage of 409.6 mg/kg was administered similarly by the dermal and subcutaneous routes. Bone marrow preparations were screened for the presence of micronucleated cells in 2000 polychromatic erythrocytes. No increase in the incidence of micronucleated erythrocytes was observed for any group given Grotan BK by any of the three administration routes, or at any dose level. Benzidine induced high incidences of microcucleated erythrocytes following both dermal application and subcutaneous injection.


DDAVP in the treatment of central diabetes insipidus. DDAVP, 1-desamino-8-d-arginine-vasopressin, is a synthetic analogue of vasopressin with increased antidiuretic activity and decreased pressor activity. Whereas the antidiuretic-to-pressor ratio of arginine vasopressin is 1, the antidiuretic-to-pressor ratio of DDAVP is 4000. When administered as an intranasal spray, 5 to 20 mug of DDAVP produced eight to 20 hours of antidiuresis in patients with complete central diabetes insipidus. The minimum recommended therapeutic dose resulted in a maximum antidiuresis in most patients. No side effects of the drug were noted in clinical trials. DDAVP thus gives promise of becoming the standard treatment of severe central diabetes insipidus.


Detection of anti-acetylcholine receptor factors in serum and thymus from patients with myasthenia gravis. Since the blood and thymus of patients with myasthenia gravis may contain inhibitors of neuromuscular transmission that affect acetylcholine receptors of striated muscle, we used denervated rat muscle to test for inhibitors in 43 serums and 18 thymus glands from such patients. Seven per cent of serums inhibited the binding of 125l alpha-bungarotoxin to triton-solubilized receptors; 65 per cent interfered with binding of toxin-labeled receptors to concanavalin-A coupled to Sepharose gel, and 85 per cent formed IgG-receptor complexes detectable by immunoprecipitation. Serum inhibitory activity varied widely among patients with similar clinical manifestations and was not correlated with duration of myasthenia gravis or thymectomy. Among thymus extracts, 44 per cent were inhibitory in the concanavalin-A binding assay, whereas 72 per cent contained anti-receptor IgG. Thus, serums from patients with myasthenia gravis contain more than one anti-receptor factor.


Interaction of quinidine with anticonvulsant drugs. Drug-disposition studies of orally administered quinidine in four normal healthy volunteers indicated that phenobarbital and phenytoin reduced the half-life of quinidine by approximately 50 per cent (control, 3.0 to 6.1 hours, and with anticonvulsants, 1.6 to 2.6 hours). Alterations of similar magnitude in the apparent plasma clearance of quinidine after oral administration (control 20.0 to 32.0 liters per hour; with anticonvulsant 44.0 to 94.0 liters per hour) suggest that this effect is probably due to an increase in the rate of metabolism of quinidine, although decreased absorption cannot be entirely ruled out. In two index patients the concomitant use of anticonvulsant drugs resulted in inadequate blood levels of quinidine with standard dosages of that drug.


Perinatal care of low-risk mothers and infants. Early discharge with home care. A family-centered perinatal-care program featuring collaboration by nurse practitioners, obstetricians, pediatricians, and paramedical personnel was developed to enhance family participation and achieve a shorter but safe hospital stay. Discharge from the hospital was permitted as early as 12 hours after delivery. A perinatal nurse practitioner made daily home visits. The program's safety, feasibility, and acceptability to patients was studied by comparison of 44 patients so treated (study group) with 44 receiving traditional care (controls). Twenty-one study families, but no controls, went home within 24 hours. The study and control groups had no significant differences or trends in numbers of types of morbidity during hospitalization or the six-week post-partum period. The expense of the program is approximately equaled by hospital costs saved through early discharge. The results indicate that early discharge with home-care follow-up observation as described is safe, economically feasible, and well accepted by patients.


Violence, television and the health of American youth. In 1973, 18,032 young Americans, 15 to 24 years of age, died in motor-vehicle accidents, 5182 were murdered, and 4098 committed suicide. The death rate, for this age group, was 19 per cent higher in 1973-74 than it had been in 1960-61, owing entirely to deaths by violence. The largest rise in deaths from homicide during the past two decades was at the ages of one to four. For a considerable proportion of American children and youth, the "culture of violence" is now both a major health threat and a way of life. One contributing factor is television's massive daily diet of symbolic crime and violence in "entertainment" programs. After numerous studies of televsion influence on real-life violence, including two major government commissions, the industry is experimenting with a 7 to 9 p.m. "Family Hour" (6 to 8 p.m. Central Time) from which violence, along with sex, has been largely banished. Three industry unions claim censorship and are suing. The medical profession is urged to concern itself with this serious and complex health hazard.


Urea-cycle enzyme deficiencies and an increased nitrogen load producing hyperammonemia in Reye's syndrome. Assay of urea-cycle enzymes in liver tissue showed ornithine transcarbamylase activities of 18 to 72 per cent of the normal mean in eight patients with Reye's syndrome, below the range of normal in seven of eight, and, in six cases, as low as those in females with X-linked deficiency of this enzyme. Carbamyl phosphate synthetase activities were less than 32 per cent of controls in two patients. Argininosuccinate synthetase and lyase activities were normal in seven patients. Arginase was normal in two biopsy specimens, but below normal in four of five autopsy specimens. The Km's for ornithine and carbamyl phosphate, pH optimum, and heat lability of ornithine transcarbamylase were normal. Two patients excreted 0.64 and 0.58 g per kilogram per day of urinary nitrogen at the peak of hyperammonemia, in spite of peritoneal dialysis. The hyperammonemia of Reye's syndrome apparently results from excess waste nitrogen that overwhelms the ability of reduced ornithine transcarbamylase (and occasionally carbamyl phosphate synthetase) to detoxify the ammonia load.


The serum digitalis concentration--does it diagnose digitalis toxicity? We propose that an investigation of the serum digitalis concentration as a test for digitalis toxicity should (1) study patients with similar toxic manifestations, (2) obtain control concentrations from nontoxic patients with symptoms suggesting toxicity, (3) define criteria for toxicity and nontoxicity, (4) select representative patients, (5) describe the study population and (6) analyze how much diagnostic information the serum digitalis concentration provides that cannot be inferred from other observations. To determine if available evidence validates the digitalis concentration as a test for toxicity 27 reports were reviewed. No investigation employed symptomatic controls. Of five studies most consistent with points 1-5 only three demonstrated higher mean serum digitalis concentrations in toxic patients. Whether knowledge of the digitalis concentrations was diagnostically more useful than knowledge of the digitalis dosage, renal function, serum potassium concentration and cardiac status was not determined in any study. The usefulness of the serum digitalis concentration as a test for digitalis toxicity is therefore not established.


Influence of training and experience on selecting criteria to evaluate medical care. To determine whether training and experience affect the selection of process criteria for evaluating medical care, three groups of physicians (family physicians, general pediatricians, and pediatricians specializing in infectious disease) were sent a questionnaire asking their opinions about various clinical actions in 125 clinical situations concerning respiratory infections in infants. Five hundred and twenty-four (54 per cent) physicians returned completed questionnaires. The three groups agreed in 93 (74 per cent) situations, especially about history taking, physical examination, and follow-up observation. Disagreements occurred most often regarding antibiotic use. Of the three groups, the family physicians selected the most extensive list of recommended actions including the greatest number of indications for antibiotics. The general pediatricians selected the fewest situations requiring history taking, physical examination and diagnostic tests. The infectious-disease pediatricians felt the greatest necessity to record history and physical-examination items but were the most restrictive in recommending antibiotics and other drugs.


The structure of the protein disk of tobacco mosaic virus to 5A resolution. An electron density map of the TMV disk at 5A resolution has been obtained using isomorphous replacement and non-crystallographic symmetry. The polypeptide chain can be traced with little ambiguity. The axial contacts between protein subunits are unlike those in the virus, the disk being a more open structure apparently designed for rapid interaction with the RNA.


Bursal dissections and gill pouch hormones. The terrestrial survival of birds and mammals depends on evolutionary chantes in cloacal bursae and gill pouches. Comparative dissections of these pouches provide insight into the coordinated functions of cervical endocrine organs, especially as they affect lymphoid tissue.


Quantitative assessment of carcinogenic risks associated with 'hot particles'. We have examined the hot particle problem in terms of the number of irradiated cells and the doses to which they are subjected, assuming both linear and nonlinear dose-response functions typical of those reported in the radiobiological literature. We assess the risk associated with point sources of alpha, beta and gamma activity compared with uniform irradiation, as well as the effects of fractionation of a single particle, and the change in risk if the particle moves. Finally, although the biological data are insufficient for firm estimates, we have tentatively attributed absolute carcinogenic risks in these various situations.


Aspects of the dosimetry of plutonium in bone. After animals have been exposed to plutonium it eventually becomes distributed unevenly throughout the bone tissue. There is therefore a need to study the dosimetry of plutonium, particularly 239Pu, as a function of its depth of burial in bone. This article discusses a simple approach to the problem, and the magnitude of some of the possible errors involved.


The role of long range forces in ordered arrays of tobacco mosaic virus. We examine the role of electrostatic repulsion and van der Waals' attraction in determining interviral spacings in 'equilibrium' gels of tobacco mosaic virus. The observed spacings are inconsistent with a force-balance model. Experimental probes of the role of forces are suggested.


Reiteration frequency of the gene for tissue-specific histone H5 in the chicken genome. Chicken erythroid cells contain a tissue specific histone known as H5 in addition to the five major histone species found in other organisms. The mRNA coding for this histone has been isolated by indirect immunoprecipitation from immature, non-dividing reticulocytes in which this is the only histone synthesised. The mRNA has been modified by the enzymatic addition of a 3' polyadenylic acid tract, and transcribed into complementary DNA (cDNA) using the RNA-dependent DNA-polymerase from avian myeloblastosis virus. Studies on the hybridisation of this cDNA indicate that the gene coding for the H5 histone is reiterated 10 times in the chicken genome.


Organisation of the genes coding for 5S RNA in the Chinese hamster. Hybridisation of iodinated mouse 5S RNA with Chinese hamster DNA fractionated on a CsCl gradient, identifies two separate DNA components that hybridise with the labelled probe. One component is slightly, and one considerably heavier than the main band DNA. This suggests that the gene coding for 5S RNA in the Chinese hamster may constitute two distinct populations differing in G + C content of their adjacent spacer regions.


Glomerular lesions and final outcome in children with glomerulonephritis of acute onset. 131 children with nephritic syndrome of acute onset were studied by renal biopsy and were followed clinically from 2 to 13 years.  87 patients (66%) with proliferative endocapillary glomerulonephritis all recovered. 21 (16%) had focal extracapillary and diffuse endocapillary glomerulonephritis. Eleven (52%) of these recovered. Six patients (5%) had diffuse extra and endocapillary glomerulonephritis, 13 (10%) had membrano-proliferative glomerulonephritis and four had diffuse glomerular fibrosis. All 23 patients of the latter groups progressed to renal insufficiency. A correlation between morphology and prognosis was apparent in this study.


Influence of extracorporeal dialysis on parathyroid hormone secretion in patients with acute renal failure. Serum immunoreactive parathyroid hormone (iPTH) was estimated in 30 patients with renal failure before and after haemodialysis. All patients were anuric or oliguric at the time of the investigation. Pre-dialysis iPTH values were significantly elevated (3.4 ng/ml) as compared with normal subjects (less than 0.5 ng/ml). Simultaneously, a significant hypocalcaemia (4.15 mEq/litre) was confirmed which was negatively correlated with iPTH levels. After 7-8 h of haemodialysis using a calcium concentration of 4.0 mEq/litre in the dialysate, a significant drop of iPTH level to 1.8 ng/ml was noted.


Observations on the pathogenesis of low pressure hydrocephalus. Analysis of 25 cases. Over a period of three and a half years 25 cases of L.P.H. were observed. An analysis was attempted on thirteen of these, which did show a particular interest, from pathogenetic point of view. All thirteen had been operated upon with very good results.


Perangiographic rupture of a right posterior communicating artery aneurysm. Contrast material was seen to extravasate twice from a posterior communicating arterial aneurysm during injection of the internal carotid artery under local anesthesia. The patient made full recovery. The aneurysm was then successfully clipped. The authors review related reports. The increase in distal arterial pressure is thought to be the cause of the aneurysmal rupture.


Fibromuscular dysplasia of the basilar artery. Report of a case. A case of fibromuscular dysplasia (FMD), mostly involving the basilar artery, associated with an intracranial aneurysm, is presented. Although the patient was symptomatic, the typical angiographic pattern is felt to be in this case an incidental finding. However the potential for FMD to produce severe neurological impairment is emphasized. The case is used as a basis for discussing shortly the incidence, the characteristic radiological appearance, the relationship with the presence of intracranial aneurysms and the therapeutic problems of FMD.


[Intraoperative demonstration of the neoplasm cavity in open transsphenoidal pituitary gland surgery using dimer X]. The problems of the complete removal of pituitary fossa tumours by transsphenoidal approach and its risk of producing a rhino-liquorrhea are well known. Concerning these difficulties a control of the operative procedure by intrasellar application of contrast medium is recommended.


The occult intrasacral meningocele.

The occult intrasacral meningocele. Three cases of occult intrasacral meningocele, one of them with an intrasacral and presacral neurofibroma, are reported. The literature is briefly reviewed. Pathogenesis, clinical picture, radiological findings and surgical treatment are discussed.


[Acute diffuse bullous epidermal necrolysis (Lyell's syndrome). Etiopathogenic aspects and therapeutic contribution]. A case of Lyell's syndrome in a patient of paediatric age is presented complete with iconography organized according to the chronological sequence of skin manifestations. The aetiopathogentic aspects are discussed, from the importance of pharmacotoxic factors to that of bacterial or viral agents and unknown factors. The possible immunological or genetic mechanism that may play a part are also examined. The histological picture is described and the personal therapeutic approach is commented on. This is suitable for everyday clinical practice and consists of local dermato-oculo-protective treatment, rehydration and antishock treatment, and anti-infective and nutritional measures.


[Ultrasonics in diagnosis of the upper abdomen]. On the basis of seven cases of suspected liver pathology, an albeit modest contribution has been made to the significance and diagnostic possibilities of ultrasonographic investigation of the upper abdomen. In four cases, ultrasound findings were confirmed by scintigraphy and in three cases by necropsy and histological reports.


[Notes on a case of clinostatic chyluria]. A clinical case of clinostatic chyluria of unknown non-parasitic aetiology, is reported. Ascending pyelography showed the presence of lymphatic communications between right renal pelvis and homolateral lumbo-aortic lymph nodes. Aetiology, pathogenesis, prognosis and diagnostic tools of use in the syndrome are discussed. The problem of the possible lymphatic origin of benign proteinuria, in relation to anatomic considerations and to quality and quantity resemblances between individual protein fractions in chyluria and benign proteinuria encountered in the present case, is also discussed. In order to clarify the problem, emphasis is laid on the advisability of simultaneously studying urinary protein composition in postural chyluria and lipid composition in benign proteinuria.


[Scintigraphic diagnosis of tumors in infancy]. The availability of short-life, low energy isotopes has enabled scinti-scanning to be usefully applied in paediatrics. A personal series relating to its employment in the diagnosis of tumours in young infants is presented. Illustrative cases in which the technique gave better indication of the site and extent of neoplasia in the brain, lung, kidneys, liver, spleen and skeleton are described. The advantages of the techinque are explained. The amount of radiation absorbed by the part examined and other radiosensitive areas is so small that there is a complete absence of danger, even in small children.


[Erythrocyte changes of membrane proteins in some hemoglobinopathies]. The electrophoretic behaviour of red cell membrane proteins was studied in thalassaemia major and minor and in sickle-cell anaemia. Protein amino acid composition was also determined following hot hydrolysis of the stromas. Experiments with various solubilisation methods, electrophoresis supports and buffers showed certain changes in these three diseases, accompanied by alterations of the percent ratio of some amino acids.


[Analogies and contrasts of familial enviornment in juveniles attempting suicide and in toxicomania]. The family situation of the young addict and the young person who has attempted suicide features anomalous relatives rather than psychiatric pathology as such. These relatives condition disturbed interpersonal relations within the family and these are responsible for the abnormal behavior of the patients. In both groups under examination, the family nucleus proved to be disturbed. Rather than the external structure of the family, the decisive factor was the communication between the various members, namely family cohesion proved to be only partial or actually inexistent in about 70% of cases. A substantial difference between the two groups was the father's affective behaviour towards his wife; the addict's father showed a prevalence of a parasitic attitude, while the mother was more hyper-protective with a tendency to establish a relationship of ambiguous dependence with the child, the young person finding it hard to release himself from this.


[Relations between atmospheric pollution and the respiratory tract]. After mentioning the close relationships between enviornmental pollution and the respiratory system, the various polluting compounds, from solid particles to fumes and gases, are reviewed, special attention being paid to the commonest types (sulphur and nitrogen compounds). Attention is called to two other polluting factors, asbestos and radioactivity, both of which are important in neoplastic pathology. The complexity of the air pollution problem in relation to respiratory pathology is stressed while stating that the most important problem remains that of prevention.


Station of the fetal presenting part. VI. Arrest of descent in nulliparas. The specific labor aberration of arrest of descent was investigated in 253 nulliparas. It was found to be associated with fetopelvic disproportion in 52%. Delivery outcome was adversely affected by such factors as high fetal station at time of arrest and long duration of arrest. Arrest of descent occurring during the administration of oxytocin infusion was particularly ominous, no patient subsequently delivering vaginally. The best delivery prognosis was seen in those cases in which apparently causative inhibitory agents, including peridural anesthesia and sedation, were allowed to abate expectantly. Neither immediate operative delivery nor expectancy (other than in the specific abatement cases) was determined to be an appropriate approach to resolving this problem. Postarrest progression, especially if at a rate that was the same as or greater than prearrest descent, proved to be a favorable sign for delivery outcome. Neonatal depression and birth trauma were closely correlated with midforceps procedures, especially when done in conjunction with forceps rotation. Cephalopelvic disproportion yielded poor perinatal results, particularly among those delivered vaginally by instrumental means. Uterotonic stimulation of labor to correct the arrest problem therapeutically also had an adverse effect on the fetus when followed by operative delivery. Based on these observations a program of management was evolved for treating patients with arrest of descent.


Significance of neutrophils and bacteria in the amniotic fluid of patients in labor. Amniotic fluid specimens from 110 patients in labor were examined for neutrophils and bacteria. Patients with neutrophils in their amniotic fluid had significantly higher fever indices than patients with clear amniotic fluid. The highest fever indices were found in those patients who delivered by cesarean section after neutrophils were present in their amniotic fluid. Febrile morbidity was significantly reduced in a group of 24 such patients by giving prophylactic antibiotics.


Oxytocin challenge test in high-risk pregnancy. Seven hundred sixty-seven oxytocin challenge tests (OCT) were performed on 333 high-risk maternity patients. All of the patients had pregnancies complicated by diabetes mellitus, suspected postmaturity, preeclampsia, intrauterine growth retardation, hypertension and other disorders. In conjunction with OCT, 24-hour urinary estriol determinations were performed. Negative OCT's were reassuring for fetal well-being. There were 26 positive OCT's on 24 patients. A positive test was significant in identifying endangered fetuses existing in a markedly unfavorable environment. In our experience, we found the OCT more reliable and more predictable than urinary estriol determination. The oxytocin challenge test proved to be significant in the successful management of these 333 high-risk patients.


Postpartum hemolytic uremic syndrome.

Postpartum hemolytic uremic syndrome. Postpartum hemolytic uremic syndrome is characterized by the findings of renal failure and microangiopathic hemolytic anemia in the puerperium. The case reported and literature reviewed demonstrate the need for early recognition and aggressive therapy in this rare and generally fatal condition.


In vitro steroidogenesis by human corpora lutea of pregnancy. Effects of human chorionic gonadotropin and prostaglandin F2alpha. Human corpora lutea of pregnancy obtained at 5 to 11 weeks of gestation were incubated in vitro in the presence of various concentrations of human chorionic gonadotropin (hCG) and prostaglandin F2alpha (PGF2alpha). Progesterone (P) and 17beta-estradiol (E2) released into the medium during incubation were measured by radioimmunoassay. Pieces of the corpora lutea were also examined ultrastructurally before and after incubation. Release of P and E2 into the medium was significantly increased by the addition of hCG and PGF2alpha in some cases. However, the response to hCG and PGF2alpha appeared to vary according to the age of the corpus luteum. Ultrastructurally, the lutein cells were well maintained with respect to the appearance of the smooth endoplasmic reticulum and mitochondria after 120-min incubations. On the basis of these observations, the following conclusions have been reached: 1) This incubation system seems to be suitable for investigating the direct effects of chemicals on lutein cells in vitro. 2) Both hCG and PFG2alpha directly stimulate steroidogenesis in the human corpus luteum of pregnancy, demonstrating their luteotropic actions in vitro. 3) Observed variations in P and E2 secretion might have been due to the different activities of aromatizing enzymes at different stages of gestation.


Serum human chorionic somatomammotropin in unaborted hydatidiform mole. Serum human chorionic somatomammotropin (hCS) was measured in 35 patients with intact unaborted hydatidiform mole by a rapid radioimmunoassay using 70% dioxane in water to separate the bound from unbound fraction. Serum hCG was measured by a hemagglutination inhibition method. Serum hCS ranged from 250 to 5900 ng/ml, while serum hCG ranged from 60 IU/ml on unaborted molar pregnancies. Serum hCS in hydatidiform mole increases from a mean +/- SE of 650 +/- 88.5 ng/ml at 7 to 9 weeks' gestation to 1986.7 +/- 859.3 ng/ml at 22 to 25 week's gestation. There was a significant correlation between uterine size and serum hCS in molar pregnancies (correlation coefficient r = +0.5183; P = 0.0025). There was no significant correlation between serum hCS and serum hCG. Serum hCS in a patient with molar pregnancy who subsequently developed choriocarcinoma was not significantly different from that in patients who did not. The findings indicate: 1) that peripheral hCS increases with increased gestational age in molar pregnancies, 2) that the amount of peripheral serum hCS is related to the mass of molar tissue present and not dependent on serum hCG level, and 3) that the serum hCS level in unaborted hydatidiform mole was a poor index for predicting malignant sequelae.


Pathogenesis of microglandular hyperplasia of the cervix uteri. Microglandular hyperplasia of the cervix has commonly been associated with pregnancy and oral contraceptive use. In a review of 22 cases seen over the last 10 years, 6 of the cases were not associated with hormonal changes. The idiopathic presentation of this lesion is reviewed. Microglandular hyperplasia of the cervix mimicking clear cell carcinoma of the cervix occurred in a 26-year-old woman with a history of in utero stilbestrol exposure who was taking an oral contraceptive. The differentiation of these two unusual lesions of the cervix is discussed.


Electrocoagulation diathermy for the treatment of cervical dysplasia and carcinoma in situ. This report presents further experience in the use of electrocoagulation diathermy for the treatment of patients with cervical intraepithelial disease. By means of the colposcope it was possible to select a group of nonpregnant patients, in whom a proven noninvasive lesion was located entirely within range of the colposcope. This group, comprising 450 patients, has been treated by means of electrocoagulation diathermy, and with followup, only 28 patients have shown evidence of a residual lesion; in 8 of these the residual lesion has been eradicated subsequently by repeat diathermy treatment. Significant complications following electrocoagulation diathermy occurred in 13 patients (3%). The overall apparent cure rate for electrocoagulation diathermy was 95.4%.


Adenocarcinoma of the endometrium in women taking sequential oral contraceptives. Abnormal bleeding while taking oral steroidal contraceptives has been managed by changes in pill or addition of estrogen or progestin moieties. Diagnostic procedures, classically indicated, are universally not undertaken or postponed. Three cases of adenocarcinoma of the endometrium in relatively young patients using sequential oral contraceptives for cause are presented to reiterate the need for tissue diagnosis when abnormal bleeding occurs as a common side-effect of contraceptive therapy.


Absence of bacteremia after insertion or removal of intrauterine devices. A prospective study of the risk of bacteremia in 84 women having insertion and in 16 women having removal of intrauterine devices was performed. Bacteremia was not found in any of these 100 women at 1 to 3, 15, or 30 minutes after the procedure or in any of 57 women studied again 1.5 hours later. Because of the remote risk of bacteremia, the presence of congenital or valvular heart disease need not be an absolute contraindication to the use of an intrauterine device for contraception in an otherwise healthy young woman. Prophylactic antimicrobial therapy during insertion or removal of an intrauterine device appears to be unnecessary in the absence of evident pelvic infections. The risk of bacteremia during removal of an intrauterine device from an infected uterus cannot be determined from this study.


Pharmacologic influences on human ovarian contractions. Spontaneous motility in whole ovarian follicles, as well as in strips from the stroma and capsule of ovaries isolated from premenopausal and menopausal women, was explored. The pharmacologic contractile reactivity of these ovarian structures to different smooth muscle-stimulating agents, ie, prostaglandins E1, E2, F2alpha; norepinephrine; 5-hydroxytriptamine; acetylcholine, phenylephrine; and phentolamine, was also studied. Strips from the capsule and stroma of isolated ovaries showed spontaneous motility in both menopausal and nonmenopausal preparations. The addition of phenylephrine, norepinephrine, acetylcholine, 5-HT, or PGF2alpha induced a sustained tonic contractile tension, whereas PGE1 elicited the opposite influence. Stromal strips from nonmenopausal women showed more reaction to norepinephrine than those from menopausal ones. Ovarian follicles did not exhibit spontaneous motility but responded to added norepinephrine. This influence was blocked by phentolamine, indicating the eventual participation of alpha-adrenergic receptors. Acetylcholine, PGF2alpha and, to a smaller extent, PGE2, also increased follicular resting tension. On the contrary, PGE1 was clearly inhibitory both upon the spontaneous basal tone and the PGF2alpha-induced sustained contractions.


Menstrual function in Turner's syndrome. This report describes 2 patients with menstrual dysfunction associated with a 45,X0 karotype. One patient had 2 pregnancies before becoming oligomenorrheic. The other had dysfunctional uterine bleeding associated with excessive estrogen production by her streak gonads.


Transient asymptomatic hydrothorax in pregnancy at term. Two cases of transient asymptomatic hydrothorax during pregnancy are reported. In both cases the effusions resolved completely within a week of the termination of pregnancy. No apparent pathologic explanation could be found for this finding.


Midgut volvulus following cesarean section. Total midgut volvulus and gangrene due to a congenitally elongated mesentery in a 27-year-old primipara occurred 3 days after cesarean section. All of the small bowel distal to the duodenum except for 12 inches of jejunum was resected, and the patient survived. This case and the literature concerning volvulus in pregnancy are reviewed here, and suggestions for prevention and treatment are made.


Diagnosis of a supernumerary ovary with human chorionic gonadotropin. The preoperative diagnosis of ectopic ovarian tissue has been reported only once in the literature. In the present case, differential ovarian and adrenal testing was used to diagnose and aberrant ovarian source of persistently elevated plasma estrogen in a patient who had undergone bilateral oophorectomy and adrenalectomy for metastatic breast carcinoma. The ovarian source was diagnosed by stimulation with human chorionic gonadotropin (hCG), and treatment with human menopausal gonadotropin (hMG) prior to surgery was used to facilitate its location at laparotomy.


Outpatient diagnostic aspiration curettage. A series of 250 patients underwent aspiration curettage; 206 of the 250 underwent the procedure in the office without anesthesia. Patient acceptance of the method was good. Hysterectomy or follow-up dilatation and curettage within 24 hours in 97 patients revealed that the diagnosis was correct in 91% of the cases. The method provides an excellent endometrial specimen for histologic examination, has little risk for the patient, and saves considerable time and cost.


Management of endometriosis with oral medroxyprogesterone acetate. Efficacy of oral medroxyprogesterone acetate (MPA) was assessed in 35 women with an established diagnosis of endometriosis (33 pelvic and 2 abdominal). MPA was given in a dosage of 30 mg daily for 90 days. Results indicated improvement or remission in all cases, even though breakthrough bleeding occurred in 8. Twenty-six were treated for associated infertility. Twelve of these became pregnant following treatment. Pregnancy rate in those women whose husbands were fertile was 90%. Side effects included spotting and breakthrough bleeding. The patients usually remained amenorrheic and anovulatory while receiving MPA. Posttreatment resumption of ovulation was prompt. The findings indicate that oral MPA is a useful therapeutic agent in the management of minimal to moderate endometriosis, particularly when it is associated with infertility.


The effects of cholinergic agents on ovarian contractility in the rabbit. Cholinergic nerves have been recognized in the ovaries of several species. Smooth muscle fibers have also been demonstrated within the ovary, and it has been suggested that these elements are involved in the ovulatory process. Ovarian contractility was investigated in 49 ovaries from 25 rabbits in in vivo and in vitro systems and correlated with the time of hCG-induced ovulation. Effects of 6 cholinergic drugs on ovarian contractility were recorded at various intervals from 6 to 20 hours after administration of hCG. Cholinergic agents were administered via the abdominal aorta in the in vivo preparations and added to the bath for in vitro studies. In general, acetylcholine, bethanechol and pilocarpine exerted variable effects. Atropine depressed ovarian contractile activity. No definitive pattern of altered sensitivity to cholinergic drugs could be identified as the time of ovulation was approached; however, a relationship was observed between the amount of cholinergic drug administered and effects on ovarian contractions.


Cervical incompetence. A diagnostic and prognostic scoring system. Recognition of the incompetent cervical as a cause of midtrimester abortion and prematurity has led to the development of surgical methods of repair. Diagnosis of the condition has generally relied on clinical findings and historical information from the patient. A scoring system based on clinical and historical criteria is suggested for selection of patients for surgical correction. Thirty-one cases of cervical incompetence tested surgically over the past 10 years are reviewed. Patients who had higher scores had a higher postoperative pregnancy success rate than the patients with lower scores. The scoring of patients preoperatively appears useful for selection of patients as well as prognostically.


Prenatal sex determination by observation of the X-chromatin and the Y-chromatin of exfoliated amniotic fluid cells. Using direct smears of amniotic fluid cells fixed by the flame drying technic, the validity of sex determination by X-chromatin and Y-chromatin counts has been examined. In 112 cases, the sex determination by examination of the X-chromatin was correct in 109 (97%) and was correct by the Y-chromatin technic in 111 (99%). It is concluded that prenatal sex determination by examination of the X-chromatin or the Y-chromatin from fresh amniotic fluid cells is a valuable, rapid, practical method of prenatal sex determination.


Glucagon, insulin and glucose levels in maternal and imbilical cord plasma with studies of placental transfer. Plasma immunoreactive glucagon, as well as insulin and glucose levels, was measured in 62 women and their infants following a term gestation vaginal delivery. Simultaneously obtained samples were drawn from the maternal antecubital vein (MV), umbilical vein (UV), and umbilical artery (UA). Forty-seven of these subjects were untreated (control) and 15 had received a maternal intravenous injection of 1 mg of glucagon within 40 minutes of delivery. It was shown that the umbilical cord glucagon levels were not different from the maternal levels in the control subjects (mean MU, 181.0; UU, 191.9; UA, 161.0 pg/ml). There was no correlation between the maternal and umbilical glucagon levels or the UV glucagon levels and the insulin or glucose concentrations. Neither the fetal sex, placental weight, or infant weight were correlated with the MV or UV glucagon concentration. Following the glucagon injection, the maternal plasma glucagon levels rose significantly, whereas the umbilical blood values did not change. These results suggest that glucagon does not significantly pass through the human term placenta.


Amniotic fluid embolism with survival.

Amniotic fluid embolism with survival. Well-documented amniotic fluid embolism with survival is an uncommon occurrence. A case is reported with characteristic clinical findings in addition to electrocardiographic evidence of acute right heart strain, disseminated intravascular coagulation, and amniotic fluid debris in central venous blood. The impact of this complication on maternal mortality is emphasized. Aggressive therapy with attention to the basic principles of supportive care offers the best chance of survival.


Thrombin clottable determination of plasma fibrinogen in pregnancy. Plasma fibrinogen is known to be elevated in pregnancy and with certain disease processes. This report establishes norms at 2-week intervals throughout pregnancy. A calculated slope by trimester reveals a more rapid elevation during the first trimester. A thrombin clottable method that is rapid and accurate is evaluated.


Routine phenobarbital for prevention of neonatal hyperbilirubinemia. In a parallel study conducted over a 1-year period, involivng 460 private prenatal patients, the effect of routine prenatal phenobarbital for the prevention of neonatal jaundice was evaluated. The incidence of significant jaundice (bilirubin levels greater than or equal to 10 mg/100 ml) occurred in 4.1% of the 221 test patients compared to 16.3% of the 239 control patients. No significant complications resulted from the drug therapy, and the newborn infants demonstrated no adverse effects attributable to the phenobarbital. Mothers who were given prophylactic phenobarbital took their infants home earlier, less often brought infants back to the hospital for photo-therapy, and spent fewer dollars for their total medical care than their control conterparts. Routine phenobarbital prophylaxis was found to be a safe, effective, and economic method of preventing hyperbilirubinemia in the newborn.


Sarcomas of the vagina.

Sarcomas of the vagina. The clinical and patholgic features of 16 cases of vaginal sarcoma are assessed. There were 5 embryonal rhabdomyosarcomas, 5 leiomyosarcomas, 2 reticulum cell sarcomas, 1 malignant schwannoma, 1 müllerian stromal sarcoma, and 2 pleomorphic sarcomas that could not be classified as to cell type. The rhabdomyosarcoma occurred exclusively in infants and children, and all 5 patients died of their disease with locally infiltrative recurrences and/or disseminated metastases. The commonest sarcoma in adults was leiomyosarcoma, there being 5 examples in the series. Three of the 4 patients with survival information were clinically free of disease 2 years, 4 years, and 8 years after diagnosis and treatment. Two patients with reticulum cell sarcoma succumbed to their disease within a few months. Local recurrences were common for all types of sarcoma in this series, suggesting that more aggressive initial treatment is mandatory if recurrences are to be prevented and the survival rates improved. In general, the vaginal sarcomas in adults pursued a less aggressive course than the rhabdomyosarcomas of infancy and childhood.


Gonadoblastoma in a true hermaphrodite with a 46,XX karyotype. Gonadoblastomas arise in dysgenetic gonads of individual possessing a Y chromosome in their karyotype. This is the first report of a gonadoblastoma in a 46,XX true hermaphrodite.


The Marfan syndrome and pregnancy.

The Marfan syndrome and pregnancy. The patient described had the Marfan syndrome complicated by a 22-week pregnancy. Because pregnancy potentiates the cardiovascular complications of aortic aneurysm or dissection and there is a 50% risk of having a child afflicted with the disorder, this pregnancy was electively terminated by hysterotomy along with a bilateral tubal ligation. The risks of pregnancy to a woman with the Marfan syndrome are reviewed. The rationale for the method of pregnancy termination chosen is discussed.


Dislocated IUD and intrauterine ectopic pregnancy with uterine rupture. A case of uterine rupture due to an ectopic pregnancy in the uterine fundus is presented. A Lippes Loop was found rotated in the uterine cavity. A possible relation between implantation and the dislocated intrauterine device is proposed.


Accidental insertion of multiple IUDs.

Accidental insertion of multiple IUDs. Data are presented for 7 women, each having two IUDs in utero. Five of these patients developed symptoms of abnormal bleeding and/or pelvic pain and 2 were asymptomatic. Three women had received the second IUD because it was assumed the first one had been expelled when the filaments were no longer palpable or visible. Other causes, as well as the prevention, diagnosis, and potential danger of this complication, are discussed.


A reevaluation of amniography.

A reevaluation of amniography. The indications for and the results of 446 anmiographies have been reviewed. The procedure was found to be simple, safe, and highly accurate in the diagnosis of certain types of pregnancy abnormalities. While in some diagnostic problems, such as intrauterine fetal death, fetal malformations, and hydatidiform mole, the method appeared superior to its alternatives; in others, including placenta previa and evaluation of uterine scars after previous cesarean section, its usefulness appears to depend on careful assessment of the clinical situation and the availability of possible alternative technics.


So-called "central retinal vein occlusion". I. Pathogenesis, terminology, clinical features. Pathogenesis of occlusion of the central retinal vessels, based on experimental and clinical findings, is discussed. It suggests that the so-called "central retinal vein occlusion" represents not only occlusion of the central retinal vein but also retinal arterial ischemia. Based on this pathogenesis the following terminology is recommended for central retinal vascular occlusion: (a) Ischemic retinopathy is due to occlusion of the central retinal artery. (b) Venous stasis retinopathy is due to occlusion of the central retinal vein alone. (c) Hemorrhagic retinopathy is due to occlusion of the central retinal vein associated with retinal ischemia. Clinical findings of (b) and (c) are compared which indicate that the two conditions are distinct entities and unfortunately so far have been dumped under a common heading of so-called "central retinal vein occlusions". Such a distinction is extremely important before any attempts are made to evaluate their natural history or effects of any therapy on them.


Acute rhino-orbito-cerebral mucormycosis. Report of the typical clinical course and pathological findings in acute rhino-orbito-cerebral mucormycosis following diabetic coma. Invasion of orbital nerves by the fungus with neural and perineural changes may contribute to the neuroophthalmological symptoms in this disease besides the predilection for blood vessels with consequent thrombosis.


So-called "central retinal vein occlusion". II. Venous stasis retinopathy. 28 patients (29 eyes) with venous stasis retinopathy (VSR) were studied. This study indicates that VSR is a self-limited, chronic and comparatively benign condition as compared to hemorrhagic retinopathy. No patient with VSR progressed to hemorrhagic retinopathy. The main complication which required management in VSR was the deterioration of central visual acuity (VA) due to development of macular edema which, if untreated, ended in cystoid macular degeneration and permanent central scotoma. Thus the indication for treatment in these cases was the fall of central VA. Ten eyes showed no deterioration of vision throughout follow-up (group I) and hence required no treatment. The remaining 19 eyes developed deterioration of vision: 5 eyes (4 patients) amongst these were not treated (group II) while the other 14 eyes (group III) were treated by systemic corticosteroids, to control the macula edema starting with a dose of 40-60 mg of oral prednisolone daily and gradually tapering to a maintenance dose. The results of group III cases strongly suggested that adequate doses of systemic steroids have a distinct beneficial effect on the VA -they help to prevent deterioration of vision and in the recovery of deteriorated vision. However, these patients require therapy for months or even longer during the course of VSR; on stopping the therapy, poor VA recurred in ten of these eyes. This factor may limit the usefulness of this therapy, if contraindications to such prolonged steriod therapy or serious side-effects of steroid therapy exist in a patient. In such cases one may be confronted with the dilemma of either not treating them and running a fairly high risk of permanent loss of central vision, or treating them with adequate doses of systemic steriods, retaining good VA but running the risk of side effects. While evaluating the effectiveness of steroid therapy, the improvement in VA should be the primary criterion because the fundus appearances almost always show no significant improvement for weeks although the VA rapidly returns to a normal level.


I[In vivo measurements of the lumen of Schlemm's canal in chronic simple glaucoma]. "In vivo" measurements of lumen of Schlemm's canal were performed on 38 eyes with trabeculotomy made for chronic simple glaucoma. The mean value of lumen was 542 mum, much higher than the mean values measured on cadavers and quoted in literature. Contraction due to fixation and dehydration may be the main cause of those differences.


[Increase in the lumen of Schlemm's canals with increase in ultraocular pressure]. The lumen of Schlemm's canal increases "in vivo" and in experiments on cadaver eyes, with the increase of intra-ocular pressure. It is accepted that the trabecular structures are extended with the raise of inra-ocular pressure. The relation of "in vivo" measurements of the canal with the intra-ocular pressure does not allow any conclusions to be drawn about localisation of outflow obstructions. The viriations of the obtained values is an expression of structural differences in the canal lumen.


A new photostimulator and videopupillograph for quantitative neuroophthalmological studies. A new photostimulator and an infrared videopupillograph are described. The light output from the photostimulator is quantitatively variable, and the beam of light is focused in the plane of the pupil to a spot smaller than the narrowest pupil, thus affording open loop conditions. The videopupillograph gives a direct and continuous measure of the area of the pupil. The importance of these features in quantitative neurophysiological studies is discussed.


Sector retinitis pigmentosa: a fluorescein angiographic study. Flourescein angiography has been proved to be of value in the study of the chorioretinal abnormaliteis in sector retinitis pigmentosa. The findings from two patients, one being in an early and the other in a more advanced stage were analyzed. The pigment epithelium was found to be disturbed in a larger area than visible by ophthalmoscopy. In the impaired quadrant the retinal vessels were narrowed showing delayed and slow dye transit. Through the discolorated pigment epithelium leaky choriocapillaries were disclosed. Moreover, in the severly affected patient, areas missing choriocapillar perfusion and retinal circulation were also detected.


Electroretinographical study of the hypoplasia of the optic nerve. Out of 22 sporadic cases of hypoplasia of the optic nerve, 16 were bilateral and 6 unilateral. The sex distribution was equal in the bilateral cases, while all our unilateral cases were females. Visual impariment was severe in all our cases. There was total blindness or only light perception. The pupillary reflexes were absent or very slow. Only one case had a rather good visual acuity (1/10) with a constricted visual field. In addition to the typical aspect of hypoplasia of the optic disc, some cases showed an obvious or suspected retinal degereration, such as a marked choroidal pattern with pigmentary dystrophy of the posterior pole. The ERG was normal in most cases, and showed no modification with increasing age. No supranormal recordings were obtained. Out of 36 eyes, 12 had a subnormal response. Seven showed an involvement only of the scotopic response, one only of the photopic response and four of both responses. The reduction of the ERG amplitude was rather mild in most cases. The ERG was never extinguished. The temporal characteristics were normal in all our cases with two exceptions.


Squamous cell carcinoma of the limbus with intraocular invasion. A case of squamous cell carcinoma of the limbus with intraocular invasion is described. The tumour penetrated the eye at the limbal region, involved the anterior chamber angle, iris and ciliary body and extended as far as the choroid.


[Does a legasthenia-syndrom exist? (author's transl)]. Legasthenia means today mainly the pedagogic definition of different forms of reading and writing deficiencies. Closer investigations on children with these symptoms prove however, that beside reading and writing impediments some physical and psychological symptoms can be found. This cluster of symptoms corresponds in some aspects with the so-called Minimal Brain Dysfunction and the Hyperkinesia-Syndrom. In the clinical and psychological investigations of this syndrom we found a high rate of left-handed patients. We suppose, that the pressure to write with the right hand and to read from the left to the right might be one of the reasons of Legasthenia.


[Renal vein thrombosis in childhood (author's transl]. The disease of renal vein thrombosis in children is presented on the basis of own observations and literature, whereby frequency, etiologic factors, and the age of manifestation are mentioned. The clinical symptoms are dependent on the localisation and the intensity of the thrombotic changes in the renal vein system which can be proven by the histological findings. The main symptoms of a renal vein thrombosis are hematuria, palpable enlargement of the kidney and pathological findings in the intravenous urography. Occasionally symptoms of an obliteration of the vena cava can appear, and in the complex disease picture a consumption coagulopathy can occur. The possibilities in therapy are pointed out, and above all, the question of the optimal time for a nephrectomy the most important point is discussed. In a self-observed newborn baby with unilateral renal vein thrombosis a relatively early nephrectomy-on the fifth day of life-a complete recovery could be achieved. The different opinions of thrombectomy are presented.


[Value of serum iron in anemia of childhood (author's transl)]. A comparison of the serum iron of 3814 children with anemia is made, in order to show the value of this parameter. 2908 children proved to have a serum iron factor below standard. 2376 of them suffered from anemia caused by lack of iron while 332 others got their anemia caused by infection. For 489 children the anemia resulted in a serum iron above its normal value. Those children suffered from hypoplastic and hemolytic anemias or were children (27) with an iron deficiency which had been treated unknown to the hospital primary to their admission there. 417 children with anemia showed a normal serum iron. By this allocation we succeeded to prove the high diagnostic value of serum iron tests, which nevertheless demand the additional analysis of transferrin and transferrinsaturation together with other specific tests.


[Serum levels of LH and FSH in patients with adreno-genital syndrome (AGS) (author's transl)]. Serum levels of LH, FSH, testosterone and 17beta-estradiol were estimated by radioimmunoassay in 13 children suffering from AGS. Hormone levels were determined during and after substitution therapy and were compared with values registered in normal subjects. After therapy was stopped a statistically significant rise of testosterone and 17beta-estradiol was observed, but no changes in the serum levels of LH and FSH was noted. The discrepancies between the two observations are discussed.


[Psychological and social aspects of overweight children (author's transl)]. If children who were originally fully capable and active according to their respective age groups, remain more than 50% overweight for a period of more than 3 years, develop a significantly lower motor, intellectual and social activity. They tend to develop an anxious auto-aggressive behavior, because it is difficult for them to transmit to others the social pressures to which they are subject. The probability of a permanent therapeutic success diminishes as the duration of the period of overweight increases. Only physically and emotionally orientated therapy is rational as 78% of our overweight children come from neurotically disturbed families. Overweight can often be due to lack of love where intensity of affection is wrongly applied.


[Anxiety of hysterical exaction (author's transl)]. Fear in childhood is a quite common symptom and varies in importance according to age and stage of development. Intelligence, psychic constitution and special sensibility influence and coin the readiness and reasons for fear. Fear, however, can also be learned by reinforcement, imitation and identification. The reaction of the environment, in particular that of the parents, may fix physiological fear reactions of the child and these may be used in order to derive advantage. By means of several cases the reader is shown that fear in childhood is not rarely the expression of hysterical exaction. This publication wants especially to point to this kind of child neurosis because of the fact that even physicians and pedagogues submit to this exaction of pity and instead of demanding adequate work treat the child with indulgence or advise to do so. In this way the wrong attitude of the child becomes even more fixed. By his reception at a psychiatric ward for children this circulus vitiosus is usally soon interrupted. If the success of this therapy is to last, the treatment and advise of the whole family must begin synchronously and must often be continued for a long time.


[Interview - technique of art (author's transl)]. Interview is defined as "action-like discussion by medium of dialogue with a diagnostic object in view" (SCHRAML), at the same time the importance of the dialogue-purpose and of the motivation of the subject is pointed out. Several methods may be used for conducting the dialogue, their selection being mainly dependent on the vocational training of the investigator. The personality of the investigator plays an important role when interviewing. The interviewer has to take into account the ever present subjectivity to prevent diagnostic mistakes. On the other hand this subjectivity enables the interviewer to get a special diagnostic access when his own ability of empathy and intuition is consciously used. The knowledge of difficult interviewing-techniques is not sufficient, only an integrative coherence awards the single results from the dialogue and simultaneously observation of the subject the adequate position, this makes an interview to an art, whose command is only given to a few.


[Longterm observation of latent diabetes mellitus in a prepubertal girl (author's transl)]. In a girl with latent diabetes mellitus, glucose tolerance and insulin release were regularly examined from 6 to 12 years of age. Under diet height and weight increased normally, the glucose intolerance disappeared, and the hypoinsulinism turned into hyperinsulinism with reactive hypoglycemia. This observation demonstrates that in a longitudinal study, the same patient may present in one period with glucose intolerance (latent diabetes) and insulin deficiency and in another period with normal glucose tolerance (prediabetes) and insulin excess.


[Heilpdagogische station der Universitäts-Kinderklinik-special position and integration (author's transl)]. Constructional, organizational and personal matters but also the mutual diagnostic and therapeutic supplementary position of the Heilpädagogische Station is demonstrated in the frame of the University-children-clinic. The problematic nature of psychiatric diagnostic is shown through a single case history. Prof. ASPERGER must be given full credit for the fact that, while being a special area within paediatrics this work done on the Heilpädagogische Station also gains general paediatric significance.


[Consultation, pedagogy and therapy].

[Consultation, pedagogy and therapy]. In child psychiatry the discrepancey between the diagnostic and therapeutic possibilities can often be disappointing, and thus, especially the young people involved demand education in approved psychotherapeutic techniques. This seems to be more important than education in common diagnosis and consultation, but the term psychotherapy is much too restricted and its possibilities not as practical as assumed. On the other hand the importance and possibilities of parental consultation and of orthoeducation is underestimated as an aid in decisions envolving changing the environment. Classical psychotherapy and family therapy have to be restricted to severe child neuroses - mostly for financial reasons - although the knowledge thereof in addition to clinical experience and routine is important. Training in these therapeutic techniques thus can not be the main goal in education in child psychiatry. Experience in diagnosing, consulting and pedagogy make effective aid possible and are available to more children and families.


[Minimal cerebral palsy neuropaediatric analysis of 81 cases (author's transl)]. The term "minimal cerebral palsy (MCP)"  is discussed, and the importance of its recognition according to a neuropediatric approach is stressed. The spectrum of causes, symptoms and signs of MCP in 81 cases is presented. MCP was diagnosed mainly in boys between their seventh and eleventh year of life. The history indicates a high frequency of pathological conditions of the newborn, especially prematurity (symptoms of risk). A tendency to a late onset of walking unaided, speaking and successful toilet training is noted. Characteristic signs of MCP are as follows: Asymmetries of skull and face, left handedness caused by neurological dysfunction of the right hand, disorders of vision and speech. It is important to search for MCP among children with learning disabilities and behavioural disturbances.


[Respiratory therapy in childhood asthma. Part 1 (author's transl)]. The therapeutic approach in childhood  asthma can be substantially supported by various forms of respiratory therapy. Objective improvements and increased well-being have been demonstrated by different authors. The physiology of correct and defective breathing are outlined briefly. The major aim of respiratory therapy is the return to normal breathing patterns including normalized clearing functions of the lung. If successful even moderately severe attacks of bronchial asthma may be averted. Personality changes in the form of increased self-confidence and loss of fear of dyspnoea are important. Part 1 outlines physicial treatment forms such as postural drainage and percussions of the chest.


[Overflow incontinence (author's transl)]. The encopresis of faecal impaction is a paradoxical incontinence found with constipation or faecal retention due to somatic or psychic causes. Normal continence comprises the possibility to delay passages of stools and the avoidance of leakage of stool in the meantime. Continued delay of defaecations causes faecal impaction and paradoxical leakage of stool. It is necessary to break the vicious circle by emptying the rectal ampulla and to avoid further constipation by means of laxatives and diet. Uderlying psychological disturbances must be recognized and treated. Two individual cases among our patients illustrate various aspects of the problem.


[Reduction of expected height in excessively tall boys (author's transl)]. 4 boys with familial tall stature aged 119/12-153/12 years were treated with Testosterone for reduction of definitive height by accelerating epiphyseal fusion. Body height at the beginning of therapy was 3,2-5,4 standard deviations over the mean, the height prediction was 199-205 cm. In therapy oral Methyltestosterone was used in the beginning and therapy was later continued with Testosterone oenanthate i.m. as depot preparation. The average duration of treatment was 14 months; in this time bone age was accelerated 2,3 times: a mean reduction of 8,9 cm from the predicted height was the result. No severe side effects could be observed.


[Metabolic alkalosis and secondary hyperaldosteronism in cystic fibrosis (author's transl)]. The prolonged use of a salt restricted infant formula (1.9 mEq Na/kg/day and 1,4 mEq C1/kg/day) in a child with undiagnosed cystic fibrosis led to a life threatening metabolic disturbance. The main features were hypochloraemic alkalosis due to massive loss of electrolytes in the sweat. Urinary electrolyte excretion, however, had been lowered to a minimum due to aldosteron induced reabsorption. Plasma aldosterone levels were initially high, but returned to normal after addition of salt to the feeds. Prior to admission a sweat test had been negative. The patient clearly demonstrates the unique metabolic feature of cystic fibrosis of the ability to retain electrolytes in the tubulus and at the same time the inability of the sweat glands to reabsorb sodium and chloride. Contrary to present experience severe prolonged salt restriction is believed to be able to diminish sweat electrolytes to subpathological values.


[Clinical aspect and therapy of BCG-lymphadenitis (author's transl)]. BCG-Lymphadenitis is a local complication of BCG-vaccination. The rate of complication depends on the kind of vaccine used, the dose and the used technique. In the last 9,5 years 32 infants with BCG-Lymphadenitis complicated with suppuration or perforation have been treated surgically. For 6 patients the treatment included a pre- and postoperative tuberculostatic therapy, for 11 patients included antibiotics. In 15 cases only surgical treatment was performed. In all 3 groups satisfactory results have been achieved, therefore tuberculostatic therapy seems not to be necessary and an antibiotic therapy ought to be reserved for cases with secondary miscellaneous infection. There is no doubt that it is possible to shorten the duration of this disease through early extirpation and to achieve a favourable cosmetic result too.


[Aerophagia - case history and differential diagnosis (author's transl)]. Meteorism is a nonspecific symptom and it is difficult to exclude organic causes. In one of our patients, a 6 years old girl, the accumulation of gas had caused changes of the normal abdominal situs. Finally psychogenic aerophagia could be detected by exact analysis of the case history and the daily rhythm of meteorism. The situation within the family could be revealed as trigger mechanism and there an successful therapy was started.