Autonomic and pharmacological control of oxygen autoregulation mechanisms in brain tissue. The effect of several agents active on autonomic nervous system functions was tested on brain oxygen autoregulation parameters. It was found that atropine, propranolol and isproterenol had no influence on the measured parameters. Phenoxybenzamine, tolazoline and dibenamine all suppress autoregulation. In an additional experimental series, a phenoxybenzamine infusion was given during O2 breathing. The infusion induced a marked rise in TpO2. It is concluded that an alpha-adrenergic mechanism is part of the autoregulation process, and its pharmacological blockade could be used to raise TpO2 levels in brain with O2 breathing at normal atmospheric pressure. Also, the increase in brain TpO2 induced by 95% O2 - 5% CO2 breathing seems to be blocked by alpha-adrenolytic drugs.


A new approach to the experimental measurement of mean tissue PO2.


Studies on retinal oxygenation.

Studies on retinal oxygenation.


The O2 supply of the isolated cell-free perfused rat kidney.


Effect of vasopressors and hemorrhage on intrarenal oxygenation.


Renal tissue oxygenation during hypoxic hypoxia. No evidence was found to support the existence of changes in the intrarenal flow pattern among the different areas or of a compensatory redistribution of microcirculation in the renal cortex under hypoxia induced by breathing 10 % oxygen. It seems that under these conditions the kidney is able to preserve its basic metabolism by diminishing its oxygen consumption.


Corneal oxygen supply conditions.

Corneal oxygen supply conditions.


Cellular oxygen concentration.

Cellular oxygen concentration.


Pulmonary tissue oxygen requirement.

Pulmonary tissue oxygen requirement.


Evidence against local control of intestinal tissue oxygenation by myogenic mechanisms.


Oxygen delivery and utilization in hypoxic dogs made acidemic and alkalemic.


Effect of ionizing radiation on liver microcirculation and oxygenation. Platelet aggregation and adhesiveness, as well as TPO2 responses to hypoxia were measured as microcirculation parameters in beagle dogs subject to Co60 ionizing radiation to a dose of 4600 rads in 5 weeks. Simultaneously, changes in blood chemistry and coagulation were also determined. Marked changes in all studied parameters in the post radiation period lead to the conclusion that radiation liver damage is at least in part mediated through microcirculation disturbances.


A factor in lingitudinal tissue gradients: red cell carriage.


Effects of dopamine and epinephrine on intestinal blood flow and oxygen uptake.


Kryomicrophotometry as a method for analyzing the intracapillary HbO2 saturation of organs under different O2 supply conditions.


Solution of the diffusion field equation of substrate concentration in the intercapillary region considering the decrease in substrate consumption in the unsaturated region of cancer cell glycolysis and respiration.


Mesenchyme theory on the increase in resistance experienced during repetition of cancer therapy processes.


Computation of glucose and O2 concentration distribution in the intercapillary region of intact tumor tissue considering the decrease in substrate consumption in the unsaturated region of cancer cell glycolysis and respiration.


Studies on the ability of the tumor respiration in vivo to fulfill its physiological functions.


Oxygen distribution in tumours: influence on cell proliferation and implications for tumour therapy.


Preliminary observations of oxygen levels in microcirculation of tumors in C3H mice.


Spontaneous oscillations of PO2 in muscle tissue.


Mechanisms of circulation metabolism coupling in skeletal muscle.


The distribution of oxygen consumption rates in some tissues before and after x-irradiation.


Tissue PO2, VO2, venous PO2 and perfusion pressure in resting dog gracilis muscle perfused at constant flow.


Tissue blood flow and oxygenation during large vessel surgery.


Mechanisms of increased tissue oxygen delivery following release of arterial occlusion in canine skeletal muscle and skin.


Mean myoglobin oxygen tension during exercise at maximal oxygen uptake.


Oxygen transport in skeletal muscle: capillary geometry in longitudinal section.


Control of electrode aging by a periodic anodization technique.


Continuous PO2 and heart rate recording in the human newborn.


The measurement of myocardial microflow and its reaction to hypoxia and hypercapnia.


Oxygen uptake of the guinea pig at decreased and increased maternal placental blood flow.


A comparison of transcutaneous and arterial PO2 in sick neonates.


Effect of umbilical artery catheters on oxygen supply to extremities.


Fetal and placental O2 consumption and the uptake of different metabolites in the ruminant and horse during late gestation.


Oxygen fields induced by recessed and needle oxygen microelectrodes in homogeneous media. Computer simulations of the operation of both the recessed and conically-shaped needle type microelectrodes were developed. The accurate portrayal of their geometries was greatly facilitated by the use of specialized three dimensional orthogonal coordinate systems with coordinate surfaces coincident with the geometry of the problem. From the simulations, calculations were made of the induced PO2 fields, oxygen sensitivities, stirring artifacts, measurement errors, and time constants.


The influence of MgCl2 on the O2-Hb-binding curve of human hemoglobin under intracellular conditions.


Intra-articular treatment of arthritis in race-horses with sodium hyaluronate.


Toxoplasmosis in sheep. Toxoplasma gondii in muscular tissue, with particular reference to dye test titres and haemoglobin type.


Toxoplasmosis in sheep, the reliability of a microtiter system in Sabin and Feldman's dye test.


Toxoplasmosis in sheep. The prevalence of toxoplasma antibodies in lambs and mature sheep from different parts of Norway.


Toxoplasmosis in sheep. The relative importance of the infection as a cause of reproductive loss in sheep in Norway.


Single cell protein in the diets of pigs and chickens. Effects on the activity of DNASE in intestinal contents.


Studies of transferrin polymorphism in Swedish cattle using agarose gel electrophoresis.


An improved bacteriological method for the detection of sulfonamide residues in food.


Vaccination of pigs against hog cholera (classical swine fever) with a detergent split vaccine.


Pasteurellosis in reindeer in northern Norway. A contribution of its epidemiology.


5 alpha-androstenone and testosterone in peripheral plasma of the boar during and following copulation.


A comparison of serum concentrations of penicillin after intramuscular injection and subcutaneous and deep injection into the dewlap in cattle.


Heat stable nuclease in mastitic milk.

Heat stable nuclease in mastitic milk.


Chemotherapy of helminthiasis among wild mammals. II. Baylisascaris transfuga (Rudolphi, 1819) Sprent, 1968 infection of polar bear. Effective chemotherapy by Mebendazole of Baylisascaris transfuga infection of five polar bears is reported and a control measure programme directed towards limiting the infection under the prevailing condition is discussed.


Further observations relating to Trixacarus (Caviacoptes) Caviae Fain, Hovell and Hyatt, 1972 in guinea-pigs (Acarina: Sarcoptidae). Three cases of sarcoptic mange in guinea-pigs were found to be due to Trixacarus (Caviacopties) caviae FAIN et al. The history and lesions of each case are described together with a method of treatment.


Yersiniosis in the Bristol Zoo (1955-1974). Ninety one cases of Yersiniosis occurred betwen 1955 and 1974 at Bristol Zoo. Species affected included a range of primates and birds, a rodent (Capybara) and a carnivore (Caracal Lynx). The incidence of the disease was highest in the winter months. There were variations in the annual incidence of Yersiniosis, with peaks occurring at intervals of 4-6 years. Common pathological findings included miliary focal necrosis and abscess formation.


Hemoccult detection of fecal occult blood quantitated by radioassay. Results from the quaiac slide or Hemoccult (HO) test for fecal occult blood were compared with quantitative determinations of gastrointestinal loss after intravenous administration of 51Cr-labeled red cells. Subjects were 80 consecutive patients, without dietary restriction, who were referred because of clinical suspicion of gastrointestinal blood loss or complex anemia. A total of 555 stool specimens analyzed for 51Cr loss were graded negative, trace, or positive by the HO method. Of 338 specimens containing 0-2 ml/day by isotope assay, 7.4% were positive to the HO qualitative test. Loss of at least 10 ml/day in 51Cr equivalent was necessary to assure that the majority of HO reactions would be positive. Of specimens containing more than 30 ml/day, 93% were positive. The ratio of 51Cr-labeled red cell equivalents to stool volume and the percentage of positive HO reactions increased together. When this ratio exceeded 10%, two thirds of the HO responses were positive.


Influence of pregnancy on the development of various gastric lesions in rats. The influence of pregnancy, and to some extent lactation, on various gastric lesions in rats were studied. Shay ulceration and gastric lesions induced by cold-restraint stress and ulcerogenic agents, such as acetylsalicylic acid (ASA), reserpine, or epinephrine, in rats were significantly aggravated by pregnancy (day 20 of pregnancy). Gastric hypersecretion, which was observed during pregnancy in pylorus ligation preparation, appears to contribute to the mechanism of aggravation of gastric lesions. ASA induced a marked back-diffusion of acid in pregnant rats which might resulted in the aggravation of ASA-induced gastric lesions. In contrast, histamine-induced gastric lesions were markedly inhibited according according to the progress of pregnancy but after 10 days' lactation returned to the level seen in nonpregnant rats. The histaminase inhibitor aminoguanidine strongly aggravated the histamine-induced gastric lesions in pregnant rats as compared with the non-pregnant ones.


Inhibition of water absorption by ricinoleic acid. Evidence against hormonal mediation of the effect. In three dogs, each with a jejunal and an ileal Thiry-Vella loop, the isolated segments were perfused with isotonic electrolyte solutions (control) for 90 min. One loop was then perfused with 5mM ricinoleic acid for an additional 90 min, while the other loop was perfused with the control solution. Loops perfused with ricinoleic acid all showed reduced fluid absorption. Perfusion of one loop with ricinoleic acid produced no changes in fluid absorption from the loop perfused with the control solution. In other experiments, 4 Ivy dog units (IDU) per kg per hr of cholecystokinin (CCK) produced no change in water movement in loopd perfused with control solution or recinoleic acid. These experiments suggest that the effect of ricinoleic acid on intestinal water transport is not mediated through the release of a circulating humoral substance.


Effect of chronic antacid ingestion on serum gastrin and gastric secretion. Basal gastrin and acid secretion, and histamine- and food-stimulated acid secretion were examined before and after 6 weeks of regular antacid consumption by 20 normal volunteers, in order to test the hypothesis that regular use of antacids produces gastrin cell hyperplasia, altered gastrin inhibition by acid, and gastric hypersecretion. We found no differences in fasting serum gastrin, basal or maximal histamine-stimulated acid, or acid output in response to a protein meal after consumption of commercial antacids with or without calcium carbonate. The results suggest that normal subjects do not acquire functional hyperactivity of the gastrin mechanism after a period of regular antacid use.


Leukoplakia of the anal canal.

Leukoplakia of the anal canal. Two cases of leukoplakia of the anal canal are presented, with illustrations of the typical gross and microscopic appearance. The lesions were asymptomatic, and were discovered by routine rectal examination. Histological findings included hyperkeratosis and acanthosis extending cephalad from the anal verge to the dentate line. Followup after 3 and 15 years revealed no evidence of dysplastic changes, and a review of the literature did not uncover any reported cases with dysplasia or with documented evolution to malignancy. There is little evidence that leukoplakia of the anal canal is premalignant but patients should be followed carefully, since the natural history of this rare lesion is unknown.


The role of metoclopramide in peroral jejunal biopsy: a controlled randomized trial. Metoclopramide is known to enhance gastric emptying and stimulate duodenal and small-intestinal peristaltic activity. The effect of the drug on peroral jejunal biopsy was examined in a controlled, double-blind, randomized trial. Forty-nine patients (24 females and 25 males) who required jejunal biopsy for diagnostic purposes were admitted to the study. All the biopsies were performed by the same operator using the Quinton multipurpose suction biopsy tube and applying the same technique. Twenty-four patients ranging in age from 18 to 67 years (mean 44.5) received placebo intravenously (sodium metabisulfite), and 25 patients from 16 to 73 years old (mean 39.9) received 10 mg of metoclopramide intravenously prior to the jejunal intubation. Objective parameters of the study were (1) time in minutes required for the intubation at the biopsy site, ie, the area at the ligament of Treitz, and (2) fluoroscopy time. Intubation time in the placebo group was 22.3 +/- 1.9 min (mean +/- SEM) vs 11.3 +/- 1.4 min in the metoclopramide group (P less than 0.001). Fluoroscopy exposure time was 2.47 +/- 0.25 in the placebo group vs 1.40 +/- 0.12 min in the metoclopramide group (P less than 0.001). Subjective clinical evaluation of the operator's assessment of the procedure was based on a 0-4 scale (much easier = 0, easier = 1, average = 2, harder = 3, and much harder = 4). Metoclopramide administration resulted in a significantly easier performance of the procedure (P less than 0.001) but did not influence patient tolerance. Three patients who received metoclopramide and one receiving placebo developed mild to moderate drowsiness of short duration. The results of this controlled trial indicate that metoclopramide significantly shortens the time required for jejunal biopsy and reduces fluoroscopy exposure. Its regulatory action on gastrointestinal motility contributes to the easier performance of a valuable diagnostic procedure.


Fecal occult blood testing.

Fecal occult blood testing.


Fulminant hepatic failure secondary to congestive heart failure. An elderly female with an acute episode of congestive heart failure, unaccompanied by any periods of hypotension, developed fulminant hepatic failure with an accompanying coagulopathy. Attempts to establish an etiology for her acute hepatic insufficiency, other than cardiac failure, proved negative. Fulminant hepatic failure as a consequence of congestive heart failure, without prolonged periods of hypotension preceding alteration in hepatic function, has not heretofore been described. Liver function is adversely effected in congestive heart failure. Hepatic ammonia clearance is impaired in cardiac failure and may be diminished to the point of resulting in hepatic encephalopathy. Coagulopathy is a frequent concomitant of fulminant hepatic failure. Establishing a clear etiology for a coagulopathy in the face of concomitant liver disease is difficult, thus making any therapeutic intervention fraught with peril.


Sororal occurrence of diffuse esophageal spasm. In this report, we have described two sisters with classical symptoms, radiological appearances, and manometric features of diffuse esophageal spasm. To the best of our knowledge, familial occurrence of this disorder has not been documented previously.


Aspirin and prepyloric ulcer.

Aspirin and prepyloric ulcer.


Effect of carbenoxolone on electrolyte output of salivary glands during nasogastric intubation. The effect of carbenoxolone on the output of salivary electrolytes stimulated by a nasogastric tube was studied in healthy volunteers. Mean +/- SE values for volume and electrolyte concentrations in control studies were volume 121 +/- 19 ml/hr, pH7.39, Na+19 +/-5, K+20 +/- U, Cl-20 +/- 3, HCO3-18 MEq/liter and osmolality 71 +/- 8 mOsm/kg. Mean +/- electrolyte outputs were quite large, Na+ 2.4, k+2.4, Cl-26, and bicarbonate 2.2 mEq/hr. Our control data indicate that in the course of gastric secretory testing the indwelling gastric tube stimulates salivary electrolyte output sufficient to interfere with accurate assessment of gastric ionic fluxes and gastric acid analysis. Therapeutic doses of carbenoxolone (100 mg three times daily) given orally for 3 weeks had no effect on salivary volume, electrolyte output, or concentration. We conclude that carbenoxolone has no minerallocorticoid effect on mixed salivary secretion. Attention to salivary secretion is recommended in all gastric secretory studies and is mandatory where low acid output is suspected.


Lysine-vasopressin: hemodynamic effects in the anesthetized dog. Vasopressin (ADH) is known to reduce secretin-stimulated pancreatic exocrine secretion. The present study attempts to relate this inhibitory effect to the vasoconstrictive potency of ADH. Regional blood flow in most of the vascular areas. The greatest reduction in blood flow was seen in the gastrointestinal area especially in the left gastric artery, cranial and caudal pancreaticoduodenal arteries, as well as the cranial and caudal mesenteric arteries. Renal blood flow was not altered by those concentrations of ADH that reduced gastrointestinal blood flow. ADH reduced pancreaticoduodenal blood flow in concentrations comparable to those concentrations that reduced pancreatic secretory flow. The reduction of gastrointestinal blood flow was due to increased impedance and not to diminished cardiac inotropy.


Colonic cancer--hypotheses of causation, dietary prophylaxis, and future research. Colonic cancer is rare in primitive populations. In western populations it was uncommon in the past, but now accounts for about 3% of all deaths. The cause almost certainly lies with dietary changes. Probably, alterations in bowel milieu interieur, from interaction between metabolites and microbacteria, promote carcinogenesis. Changes in intakes of protein, fat, sugar, refined cereal products, and crude fiber have been advanced as predisposing or causative factors. Evidence suggests that (i) fall in fiber intake, but (ii) rise in fat intake, in their ability to increase fecal concentrations of bile acids and sterols (possible precursors of carcinogens) are most likely to be culpable. As preventive measures, a significant rise in fiber intake is practicable only from regular bran ingestion. A major reduction in fat intake is grossly unlikely. Even were rigorous dietary changes implemented, an early fall in colonic cancer incidence is highly improbable due to the long-term character of the disease. Future research must include characterization of the diet, metabolism, and disease pattern of segments of western populations who have low colonic cancer mortality rates; also, elucidation of the bearing of various intakes of different food components on the biochemistry and microbiology of the feces.


Gastric secretory function in patients with chronic renal failure undergoing maintenance hemodialysis. Gastric secretion was evaluated in 9 male patients with chronic renal failure on maintenance hemodialysis. Five secreted low or normal quantities of acid and 4 exhibited hypersecretion, 2 of whom had associated peptic ulcer disease. Serum gastrin responses to a protein meal were comparable to control subjects. Calcium infusion in two basal hypersecretors depressed acid secretion. The only statistically significant correlation observed was between basal acid output ans serum levels of parathormone. These studies suggest that while acid secretory abnormalities vary in patients with chronic renal failure on hemodialysis, there is no apparent sensitivity of the gastrin-secreting cells to protein or calcium ion which might account for acid hypersecretion. Secondary hyperparathyroidism may influence the occurrence of acid secretory abnormalities.


The effects of acute and chronic ethanol administration on canine bile secretion. In 9 conscious dogs (4 of whom were alcohol-fed for 24 months with 50% intragastric ethanol), provided with gastric and duodenal fistulae (Thomas cannula), the effects were studied of an acute iv ethanol infusion (1.3 g/kg) on hepatic bile secretory plateau levels after emptying of the gallbladder was induced by a continuous perfusion of secretin (0.5 CU/kg/hr) plus CCK-PZ (8 Crick-Harper-Raper U/kg/hr) and sodium taurocholate (0.62 mumol/kg/min). Acute iv ethanol infusion in nonalcoholic dogs reduced hepatic bile flow rate (29%), bile salt concentration (55%) and output (67%). In alcohol-fed dogs, acute iv ethanol reduced only the rate of flow (25%). Hepatic bile salt concentration and output plateau values were significantly higher in the alcohol-fed than in the nonalcoholic dogs. There were no significant differences between the two groups of dogs in the rate of evacuation, bile salt output, or lipid composition of gall bladder bile following a single iv injection of CCK-PZ.


Fibropolycystic disease of the hepatobiliary system and kidneys. This complicated case of fibropolycystic disease of the hepatobiliary system and kidneys was ably and incisively analyzed by Professor Sheila Sherlock. Her clinical acumen was revealed by her ability to differentiate congenital hepatic fibrosis, Caroli's disease, and adult polycystic disease of the liver and kidney. Interesting histologic features of this case included hepatic fibrosis with intact limiting plates anc central veins and the presence of bile plugs in the ducts, but the absence of bile statsis in the parenchyma. A percutaneous transhepatic cholangiogram demonstrated the dilated intrahepatic and extrahepatic ducts. Washing out the "gunk" from the biliary tract by T-tube drainage has great limitations in this type of case. Therefore, Dr. Adson suggested irrigation of the biliary ductal system using tubed placed transhepatically, plus a wide choledojejunostomy. Dr. Sherlock questioned this surgical approach. The use of chenodeoxycholic acid for this "gunk" was suggested. In spite of the dilated ducts and pathologic changes in the liver, the patient was not jandiced and did not have stones in her biliary tract. The genetics of this patient's problems was discussed.


A small strain gage for measuring intestinal motility in rats.


Giardiasis: an overview for the clinician. Since the clinician confronting a case of giardiasis may find the current literature confusing and weighted towards rare immunoglobulin deficiency syndromes, a classification is proposed to answer questions pertinent to understanding and managing this infection. Current thinking of giardiasis must involve the realization that (1) asymptomatic carriers exist; (2) that the majority of symptomatic patients have no structural disease explaining their symptoms; and (3) that those patients with anatomic lesions and giardiasis probably have an underlying predisposing condition. A short review of the association of giardiasis and immunodeficiency will then be presented, along with current concepts of diagnosis and therapy.


Corn-on-the cop: treat or treat.

Corn-on-the cop: treat or treat.


The natural history of liver disease in former drug users. Three hundred and twenty drug-free former narcotic addicts were studied with regard to persistence of abnormalities of liver function and morphology, and their relation to hepatitis B infection. Hepatitis B antibody was present in 52.4 per cent, while HBs antigen was detected in only 6 per cent. Transaminase abnormalities, initially present in 39 per cent, were found in 22 per cent six months after cessation of drug abuse. Abnormalities tended to persist thereafter, although there was some continued return to normal levels. Liver biopsy findings of chronic persistent and aggressive hepatitis correlated with persistence of HBs antigenemia and transaminase elevation. Follow-up liver biopsies in seven subjects showed decreased inflammatory reaction in five. None showed progressive liver disease. We conclude that: (1) 15 to 20 per cent of former narcotics addicts have chronic persistent hepatitis or chronic aggressive hepatitis after cessation of drug absuse for six months or more; (2) serologic evidence of exposure to HBs antigen is frequent, and rapidly develops after the start of needle use; (3) although histologic ad chemical abnormalities usually persist, progression did not occur, and some individuals demonstrated spontaneous improvement.


An increase in urinary catecholamines of renal origin in patients with "borderline" hypertension. Plasma and urinary catecholamines (norepinephrine and epinephrine) and urinary dopamine excretion were studied in 45 essential hypertensive patients subdivided into borderline (labile) and stable hypertension. Borderline hypertensive patients had a higher mean fractional renal clearance of catecholamines (the clearance of catecholamines relative to creatinine clearance) than both control subjects and stable hypertensive patients. A significantly positive correlation between the renal clearance of catecholamines and urinary dopamine excretion was also found in those with borderline hypertension, but not in control subjects or those with stable hypertension. These data indicate that patients with borderline hypertension have a relatively exaggerated renal catecholamine release. They probably reflect an increased sympathetic discharge to the kidney in "borderline" hypertension, occuring to a lesser degree in stable hypertension and control subjects. Thus, urinary catecholamine measurements do not specifically reflect the level of circulating catecholamines, particularly in borderline hypertension.


Strabismus measurements in the Siamese cat. Anatomical and neurophysiological studies suggest a relationship between "abnormal" visual pathways and strabismus found in the Siamese cat. A telephotographic method for measuring eye positions in these cats reveals that newborn Siamese cats have a conspicuous exotropia appearance. Adult animals appear to have esotropia, orthophoria, or exotropia, which can be intermittent.


Instrument myopia--microscopy.

Instrument myopia--microscopy. Looking through optical instruments stimulates the eye to accommodate more than would be necessary for naked eye viewing; this increased near power is called instrument myopia. The amount (up to -5 diopters) varies with the observer and the conditions of viewing. Using microscopes produces -1.5 to -2 diopters of instrument myopia. More instrument myopia is found with low-power magnification, inexperienced users, and when focusing form minus blur to sharp image. Physiologically, the instrument myopia appears to be associated with an accommodative equilibrium position and, psychologically, with a sensing of proximity.


Does stereopsis change with age?

Does stereopsis change with age? Stereopsis thresholds were measured on 242 subjects with normal visual acuity and ranging in age from 8 to 46 years. The results showed no trend with age and no significant sex difference. The log-second threshold mean was 0.74+/-0.21 with a test-retest reliability coefficient of 0.70+/-0.05.


A new electrode for electroretinography. Clinical electroretinography is an uncomfortable, disquieting experience for a patient because of the contact lens electrodes used. Such electrodes are either expensive to buy or difficult to make. An aluminized Mylar electrode performs satisfactorily, elicits minimal patient apprehension or discomfort without topical anesthesia, is simple to make, and is disposable.


Meningioma associated with parathyroid adenoma. A woman hospitalized because of attempted suicide with diazepam tablets was found to have hypercalcemia and other signs of hyperparathyroidism. Electroencephalogram indicated a brain lesion which was confirmed by a brain scan and angiogram. The hypercalcemia persisted after removal of the meningioma and serum levels of calcium returned to normal only after a parathyroid adenoma was removed during an additional intervention. This association of meningioma with hyperparathyroidism is unique in the literature. The difficulties of diagnosis resulting from the neuropsychiatric symptoms common to the two disorders are discussed.


Biofeedback reinforcement in the training of limitation of gaze: a case report. A 22-year-old patient having a history of congenital strabismus with surgery at age 6 and again at age 14 suffered from a limitation of dextroversion following 2 surgical procedures with diplopia initially experienced beyond 18 degrees. Ten sessions of treatment by traditional visual training methods and biofeedback reinforcement were compared in extending the deficient range of dextroversion. Biofeedback was found to be significantly better than conventional approaches in this treatment.


Epidemiological considerations in predicting regional vision health care needs. The use of crude practitioner to population ratios when age-specific ratios are more appropriate can lead to significant errors in estimates of the need for health care manpower. A comparison of these 2 methods is made using age-specific data for Florida as an example. A brief survey of other epidemiological factors affecting clinical manpower projections is given.


Purtscher's retinopathy in acute pancreatitis. A patient who became blind following an episode of alcohol-induced pancreatitis is described. The clinical appearance of this patient's retinal changes corresponds most closely to post-traumatic (Purtscher's) retinopathy. The etiology of the retinopathy is best explained by retinal vascular occlusion due either to fat embolism or thrombosis.


Vibrio fetus endocarditis in a patient with systemic lupus erythematosus. Vibrio fetus endocarditis occurred in a patient with systemic lupus erythematosus receiving azathoprin and prednisone. Blood cultures required 14 days to become positive. The fastidious growth requirement of this organism is reviewed because lack of appreciation of these may result in failure to make the diagnosis. This is the first reported case of Vibrio fetus endocarditis occurring in the setting of a connective tissue disorder and immunosuppressive therapy.


Effects of non-contact tonometry on refraction. The spherical component of refractive error was measured subjectively before and after noncontact tonometry in 19 eyes and also on the fellow (control) eyes without tonometry. No significant change in this measure of refractive error was found after tonometry. The tested group could not be distinguished from the control group.


Polycythemia vera in an anephric man.

Polycythemia vera in an anephric man. The effect of renal failure and bilateral nephrectomy on erythropoiesis and plasma erythropoietic activity was observed in a patient with polycythemia vera. For eight years the patient's hematocrit was maintained between 45 and 50 per cent by phlebotomy and in spite of the development of renal failure the hematocrit did not decline. Following rejection of a renal transplant, the hematocrit fell to 18 per cent but rose to 40 per cent with oral iron therapy. Following bilateral nephrectomy, the hematocrit fell to 29 per cent but subsequently increased to 37 per cent. After an episode of gastrointestinal bleeding the hematocrit was 21 per cent but subsequently rose to 32 per cent. Erythropoietin could not be detected in the plasma either before or after nephrectomy. In addition, erythropoietin failed to stimulate 59Fe incorporation into heme in vitro in the patient's marrow cells. The data incidate that, in polycythemia vera, erythropoiesis does not require erythropoietin.


Effective degree of mydriasis with phenylephrine and tropicamide. The mydriatic effects of several concentrations of phenylephrine and of tropicamide were studied in 84 young adults for 90 min following topical instillation. Pupillary diameter was estimated (a) under ambient photopic illumination and (b) when illumination was increased to that associated with direct ophthalmoscopy. Evaluation was made of the "degree of mydriasis," i.e., the difference in pupillary diameter between the eye receiving the mydriatic agent and the contralateral control eye when the pupillary light reflex was stimulated. In subjects with light or hazel irides, phenylephrine caused maximal dilatation in 60 to 75 min, mean values being 5.6 mm with 1 drop of 2%, 6.0 mm with 2 drops of 2.5%, and 7.1 mm with 1 drop of 10%. Maxiumum degrees of mydriasis were 3.0 mm with 2 drops of 2.5% and 3.1 mm with 1 drop of 10%. With 0.5% tropicamide, maximum diameter was 8.0 mm in 30 min in subjects with light, hazel, or brown irides, and the maximum degree of mydriasis was 5.0 mm. It is concluded that when a mydriatic agent is used to facilitate intraocular visualization, neither specification in terms of (a) maximum diameter under ambient illumination nor (b) degree of mydriasis provides optimal characterization. It is suggested that the "clinically effective diameter," i.e., pupillary diameter under illumination corresponding to that to be used during examination, would be the most useful specification.


Dynamic and static violations of Hering's law of equal innervation. Hering's Law of Equal Innervation treats the double eye as a single organ. Normal humans often execute saccadic eye movements that are dynamic violations of Hering's Law. These infractions are produced by differences in the neural controller signals sent to each eye and are exemplified by monocular movements, such as dynamic overshoot, glissades, and double saccades; these dynamic violations occur more frequently in fatigued subjects. In contrast to dynamic violations, static violations of Hering's Law are usually indicative of pathological conditions.


Survey of student research in behavioral and developmental optometry. Behavioral and developmental optometry are in need of research. Studies conducted by optometric students can provide a major contribution. The present paper reviews selected student research studies conducted at the Illinois College of Optometry. The topics include: trends in developmental vision, phenomena in binocular vision, and techniques in diagnosis and treatment.


Cardiac tamponade in primary myxedema and review of the literature. A case of cardiac tamponade secondary to primary myxedema is described. The nature of the patient's pericardial fluid and clinical course compared with other cases in the literature is reviewed. The patient had no recurrence of cardiac tamponade. Complete resolution of the pericardial effusion occurred 10 months followint initial pericardiocentesis and L-thyroxine therapy.


The relationship between eye dominance and monocular acuity: an additional consideration. Multivariate techniques  were used to explore the relationship between ocular dominance and asymmetries in visual acuity or acuity dominance. The convergence distance under which the acuity testing takes place was found to affect the relationship between these two variables.


Acuity measurements-- do they indicate how well a partially sighted person functions of could function?


"Pseudo-giant P-waves" and pericardial friction rub following chlorpromazine therapy. A patient is presented who manifested two previously undescribed complications of chlorpromazine therapy: a transient pericardial friction rub and "pseudo-giant P waves". After slowing of the heart rate, the "giant P-waves" proved to be superimposed U and P-waves. His history demonstrates the protean and at times unusual complications of chlorpromazine therapy and illustrates the dramatic therapeutic effects diphenhydramine may have in reversing some of this toxicity.


Hageman factor deficiency in ataxia telangiectasia. Ataxia-telangiectasia is clinically characterized by the presence of cerebellar ataxia, choreoathetosis, and oculocutaneous telangiectasia. Humorocellular immune deficiency may be associated with the disease. So far, no coagulation abnormalities have been reported in patients with ataxia-telangiectasia. Presence of Hageman factor deficiency in our patient could merely be a coincidental occurrence of two rare independent disease states. Since this coagulation abnormality in Hageman factor deficiency is rather subtle and not usually associated with clinically significant bleeding, this defect can be easily overlooked.


Reconstruction after pharyngolaryngectomy-esophagectomy. Seventeen patients with carcinoma of the hypopharynx and/or cervical esophagus who require total pharyngolaryngectomy-esophagectomy are presented; Twenty-one different reconstructive methods were applied in the seventeen patients. An overall two year survival rate of 35 per cent was attained with effective palliation in 65 per cent of the patients. The Wookey and free jejunal transplantation procedures were unsuccessful as primary means of pharyngoesophageal reconstruction, although the Wookey principle was occasionally useful in salvaging failures of other procedures. The reversed deltopectoral flap was successfully employed in a small number of patients with only minimal extension below the cricopharyngeus but was found to be unfeasible in several other instances because of the extent of esophageal resection required. Transposition of the entire stomach was successfully employed in a number of suitable patients and is an excellent method of esophageal replacement in relatively healthy patients. The reversed gastric tube esophagoplasty was useful in more debilitated patients, with resection and reconstruction performed in separate stages.


Squamous cell carcinoma of the oropharynx: why we fail. The squamous cancers of the oropharynx in 384 patients were staged according to a T and N system. Three hundred seventy-one of them were treated for cure at a time when modern surgical and radiotherapeutic technics were available. The patient records were analyzed in regard to five year survival, factors influencing treatment failure, and the effect of new primary cancers. Failure to eradicate the cancer at the primary site remains the largest reason for the patients' demise, but as aggressive local and regional treatment becomes more successful, greater numbers of patients survive only to become victims of distant metastases and second primary cancers.


Carcinoma of the hypopharynx.

Carcinoma of the hypopharynx. The data in this study suggest that radical surgical treatment offers the best chance for control of disease in patients with cancer of the hypopharynx. The cervical lymph nodes are at a very high risk for early involvement by metastatic disease. Elective treatment of cervical lymph nodes must be considered in initial treatment planning to obtain better control of regional disease.


Surgical exploration in asymptomatic hypercalcemia. The use of the serum auto-analyzer (SMA-12) has resulted in a marked increase in the diagnosis of hyperparathyroidism. Seventy-five patients with asymptomatic hypercalcemia were explored: sixty-eight with solitary adenomas, six with multiple adenomas, and one with diffuse hyperplasia. Postoperatively, all patients reverted to normocalcemia. Surgical exploration of asymptomatic hypercalcemia is advocated to reduce surgical morbidity and mortality and to prevent the development of renal and osseous complications of hyperparathyroidism.


Management of recurrent salivary gland tumors. The management of 129 patients with recurrent tumors of the salivary glands is analyzed, Principles of approaching recurrent tumors and guidelines for their management are outlined in detail. Age distribution, symptoms, time to recurrence, cases that showed possible malignant degeneration, and complications are reviewed. The surgical procedures, recurrence rate, and survival rates are recorded.


The malignant "cold" nodule of the thyroid. From 1958 to 1976, 910 patients with cold nodules of the thyroid underwent thyroid surgery (714 females, 196 males). Thyroid carcinoma was present in 202 patients (22.2 per cent) (149 females, 20.9 per cent; 53 males, 27 per cent). Rate of malignancy in an age group was greatest in patients older than seventy years (19 of 47 patients, 40.4 per cent) followed by patients twenty-one to thirty years of age (37 of 125 patients, 29.6 per cent); 90 per cent of all patients were from twenty-one to seventy years of age. Blacks had a lower rate of thyroid carcinoma than Caucasians. Data from the Cancer Surveillance Group also showed age-adjusted incidence rates in blacks in Los Angeles County to be lower than that of Caucasians.


The undelayed Mütter flap in head and neck reconstruction. Twenty-one mastoid-occiput-based shoulder flaps have been used to reconstruct patients with head and neck cancer. When the tip of the flap does not extend beyond the midclavicle, this flap can safely be elevated and transferred into its final position without delay procedures. Not requiring secondary sectioning and implantation, the Mütter flap can successfully be used to reconstruct multiple defects within its arch. Its utility thus rivals the more commonly used medially based deltopectoral flap and forehead flap.


Results of BCG adjuvant immunotherapy for melanoma of the head and neck. The present study was performed to determine if postoperative systemic BCG adjuvant immunotherapy would improve survival in patients with pathologic stage II melanoma of the head and neck. Seventeen of twenty-five (68 per cent) patients treated with BCG are free of disease, whereas only seven of seventeen (40 per cent) patients treated by radical neck dissection alone are free of disease. Clark's technic for determining the level of invasion of the primary lesion was used to predict the presence of metastatic tumor in regional lymph nodes. Results indicate that patients with pathologically confirmed lymph node metastases from melanoma of the head and neck benefit from postoperative BCG adjuvant immunotherapy.


Analysis of survival and disease control in stage I melanoma of the head and neck. From 1958 through 1969, 357 patients were treated for melanoma of the head and neck. Of these, 166 had invasive, clinical stage I disease. All patients had wide local excision of the primary. Elective regional node dissection was performed in sixty-nine patients and in the remaining ninety-seven observation only was elected. Retrospective analysis of these 166 patients considered (1) survival and disease control, (2) sites and timing of failures, and (3) the effect of sex, site, type of biopsy, skin grafting, and regional node dissection on disease control and survival. More than 80 per cent of the local recurrences developed within the first twenty-four months. Similarly, in the patients not undergoing initial neck dissection, 80 per cent of those who subsequently had clinically positive regional nodes did so within twenty-four months. In the sixty-nine patients undergoing elective regional node dissection, the survival rate was 33.5 per cent at five and ten years in those with histologically positive nodes. Those patients with elective neck dissections having histologically negative nodes had a survival rate of 75.8 and 67.1 per cent at five and ten years, respectively.


Advanced and recurrent squamous carcinoma of the lower lip. The results of aggressive surgical treatment of primary lip cancer and advanced and recurrent carcinoma of the lip are illustrated and discussed. Early detection of involved lymph nodes before capsular penetration occurs and careful and complete dissection of the submental and submandibular regions are advocated as possible ways to prevent persistent upper neck disease, the main killer of these patients.


Carcinoma of the palatine arch.

Carcinoma of the palatine arch. 1. Carcinoma of the palatine arch is part of a regional diathesis of carcinoma of the mucosa of the upper aerodigestive tract and this concept has a definite influence on the choice of treatment. 2. Surgery has an important role in the management of both the primary tumors and the regional metastatic nodes. 3. Radiation therapy is indispensible in the management of carcinoma of the tonsillar crypts, stage IV tumors of the palatine arch, and primary tumors of the palatine arch with certain specific extensions. 4. Comprehensive management of carcinoma of the palatine arch requires careful evaluation of each patient and his disease, vigorous application of the chosen method of treatment by either the surgeon or the radiotherapist, and continuous follow-up study and supportive treatment for the rest of the patient's life.


Carcinoma of the oral cavity. factors affecting treatment failure at the primary site and neck. A retrospective review of the clinical records of patients with carcinoma of the oral cavity was undertaken, and several parameters were studied in terms of comparing two groups of patients: those who were controlled at the primary site and neck and others who failed locally or regionally following initial treatment. A comparative statistical analysis of the factors studied revealed that female patients who had a higher T status, a higher N status, and thus a higher stage of disease did poorly in terms of local and regional control of disease. Those patients whose primary tumors manifested deep invasion and those who had positive margins after surgical resection at the primary site had also a significantly high incidence of local/regional failure. Presence of extracapsular extension of disease in cervical lymph nodes and involvement of soft tissues in the neck as well as involvement of multiple lymph nodes at multiple levels also put the patients in a high risk category. We urge that these factors be considered as prognostic criteria and be used to select patients for treatment by additional modalities on an elective basis in hope of achieving better local and regional control of disease and perhaps better cure rates.


Treatment of carcinoma of the oral tongue by radium needle implantation. Forty-nine patients had a radium implant for carcinoma of the oral tongue. In thirty-four of the forty-nine (70 per cent), local three year control of the cancer was achieved. Three patients in whom the radiation failed were rescued by subsequent surgery. The five year absolute survival in this series was 63.8 per cent. In conclusion, we believe that improved survival rates without functional and cosmetic defect can be obtained by closer cooperation between surgeons and radiotherapists.


Clinical staging of cancer of the head and neck: a new "new" system. A revised clinical staging system for cancers arising in head and neck sites has been prepared. It utilizes a uniform N classification for cervical node metastases. The T classifications describing the extent of the primary tumor are generally similar but differ in specific details for each site. Although the present system makes use of past field trials and more recent clinical studies, it cannot be considered final. Clinicians managing cancer in head and neck sites are encouraged to test the system with their own patient data to elicit further areas for improvement.


Applications of the Karapandzic principle of lip reconstruction after excision of lip cancer. The number and variety of technics available for lip reconstruction has suggested to some authors that no method is ideal. In fact, excellent results can be obtained under proper circumstances by any one of several procedures. The principle of innervated myocutaneous flaps adds yet another tool to the surgeon's armamentarium, but it does not relieve him of the responsibility to select the most appropriate procedure in each case. As Karapandzic has stated (or understated), "This obviously is not a technique suitable for all lip defects, but in selected cases it gives a very satisfactory result."


Combined radiation-methotrexate therapy in preoperative management of carcinoma of the head and neck. Fifty patients with primary carcinoma of the head and neck were treated preoperatively with 2,000 r and 500 mg/m2 of methotrexate. This combination reduces the tumor size in more than 90 per cent of patients, converts many of the tumors to a more manageable state, and appears to indicate that improved survival will occur.


Immediate repair of the Commando defect by cervical and pectoral flaps. A ten year experience with immediate cervical flap repair of the Commando defect is reported in a selected series of more than seventy patients with clinically negative neck-nodes. Preoperative radiotherapy of 2"000 and 3,000 r to the neck and primary tumor has not interfered with wound healing. The cosmetic and functional result is highly commendable.


Changes in some metabolic effects of isoprenaline and glucagon in normotensive and spontaneously hypertensive rats.


General and cerebral hypothermia in the treatment of intractable epilepsy. A report of 3 cases.


The current management of malignancy--V tumors of the gastrointestinal tract.


Gonorrhea control in Alaska.

Gonorrhea control in Alaska.


President's page.

President's page.


Training in anesthesiology.

Training in anesthesiology.


Cardio-respiratory changes during pneumoencephalography. Carbon-respiratory changes associated with changes in posture and injection of intrathecal oxygen were studied in fifeen patients undergoing pneumoencephalography in a Phillips isocentric chair, while breathing spontaneously and anaesthetised with halothane in oxygen. Haemodynamic changes associated with changes in posture were of a minor nature. A rise in PaCO2 occurred in the prone position in two obese patients. There were significant rises in blood pressure following injection of more than 5 ml of oxygen as a bolus into the subarachnoid space.


Electrocardiographic studies during hypotensive anaesthesia using sodium nitroprusside. Multiple lead electrocardiographic recordings from 20 patients were studied before, during and after a period of induced hypotension with sodium nitroprusside. Although small changes in ST segment and T wave were observed in 9 patients, none of these persisted into the postoperative period. Other significant changes were confined to a temporary disturbances of cardiac rhythm in 2 patients, both of whom spontaneously reverted to sinus rhythm during the anaesthetic. Our findings indicate that there are no permanent ischaemic myocardial changes associated with induced hypotension using sodium nitroprusside.


The administration of metoclopramide with atropine. A drug interaction effect on the gastro-oesophageal sphincter in man. The effects of intravenous atropine 0-6 mg alone, metoclopramide (Maxolon) 10mg alone and atropine 0-6 mg and metoclopramide 10 mg in combination, on the lower oesophageal sphincter (LOS) were studied in three groups of normal human volunteers. Atropine decreased the LOS pressure by an average of 8 cm H2O (P less than 0-001), whereas metoclopramide increased the LOS pressure by a mean of 29 cmH2O compared to basal values (P less than 0-001). In contrast, no change in sphincter tone was noted following injection of atropine-metaclopramide mixture. These findings are relevant to the pre-operative preparation of patients presenting for emergency anaesthesia, since gasgro-oesophageal reflux and pulmonary aspiration of acid gastric content continues to be a significant cause of morbidity and mortality.


Anaesthetic records in Great Britain and Ireland. A survey of anaesthetists and their use of anaesthetic records was carried out in Great Britain and Ireland. An analysis of 206 different record sheets from 175 hospitals or groups showed that, although many features were similar, important aspects were omitted in some, while others had too many options which were not necessarily relevant to the administration of an anaesthetic. No attempt has been made to offer an ideal design for an anaesthetic record, but the information may assist those anaesthetists wishing to change the current practice in their hospital or group.


The reliability of a linear analogue for evaluating pain. A linear analogue for rating pain with 10, 15 and 20 cm lines is significantly less variable than a 5 cm line (mean error of 15 cm line is 0-19%, 95% confidence limits for the group +/- 2% and an inood correlation between repeated ratins of a recalled pain distant in time. The variance of the rating is significantly less than the repeated rating of a random mark. The linear analogue rating of a constant pain stimulus is reproducible and changes in rating are likely to be real changes of opinion. Pethidine 150 mg intramuscularly had no significant effect, tested 30 minutes after the administration, on the accuracy or reproducibility of the analogue rating. A linear analogue seems a suitable method of recording the patient's opion of a severe pain such as that of labour.


Multiple sclerosis and surgery.

Multiple sclerosis and surgery. Five patients with multiple sclerosis showed deterioration following operation and anaesthesia. In every case the change was associated with pyrexis due to infection. No correlation was found between aggravation and any anaesthetic agent used.


A safety block for scavenging systems.

A safety block for scavenging systems. A safety block is described which protects the patient from expiratory obstruction when using scavenging systems, and provides the anaesthetist with a visual and auditory check on the functioning of the system.


Hyperbaric oxygen in acute ischaemia due to allergic vasculitis. A case of a child with allergic vasculitis to penicillin is presented. The patient received successful treatment with hyperbaric oxygen (HBO) therapy. The pathophysiological mechanism of acute peripheral anoxia and the infleunce of HBO treatment on it is described.


Air embolism during anaesthesia for arthography in a child. An infant aged 5 months, weighing 6 kg and suffering from congenital dislocation of the hip joint, was subjected to air arthrography of the right hip joint under general anaesthesia. Air embolism occurred following injection of air into the joint. The clinical management is described. Resuscitation was successfully accomplished and the patient was discharged from hospital without untoward sequelae.


The Lack anaesthetic system. An assessment during spontaneous ventilation. The Lack anaesthetic system is a coaxial modification of the Magill circuit. The resistance of the system was found to be unacceptably high. When air was administered through the system to spontaneously breathing trained volunteers, marked evidence of rebreathing was present when fresh gas flow equalled minute volume. It is suggested that a fresh gas glow equal to one and a half-times minute volume would be required to prevent rebreathing of alveolar gas.


A light for anaesthetists.

A light for anaesthetists. A new type of lighting device is incorporated into the ether screen cross-bar, enabling better illumination of the patient's face. A 12-V, DC power supply is used. The temperature, with vacuum-assisted cooling, should not cause burns to an unconscious patient. Assessment of patient colour was evaluated and found to be reliable. The lamp must not be used with flammable anaesthetic agents.


Removal of catecholamine-secreting chemodectoma. The use of neuroleptanaesthesia, adrenergic blockade and sodium nitroprusside. A case of catecholamine-secreting chemodectoma of the neck in a 47-year-old male who also had temporal lobe epilepsy is described. Details of presentation, diagnosis and successful treatment are given. He was fully alpha blocked with phenoxybenzamine and given neuroleptic drugs but his blood  pressure rose to dangerous levels when the tumour was handled and did not respond to intravenous phentolamine. Sodium nitroprusside was successfully used to achieve blood pressure control.


The effects of deliberate hypotension and foot down tilt on the incidence of deep vein thrombosis during plastic surgical operations: a pilot survey. The incidence of postoperative deep  vein thrombosis (DVT) has been investigated in a group of 88 patients undergoing plastic surgical operations on the head and neck, and upper limb. Fifty-two cases were operated upon in the foot-down tilt position and 36 were horizontal. With the effects of blood pressure ignored as a possible contributory factor, the incidence of thrombosis in the latter group was 8-3% and was slightly higher in the tilted group (11-5%). Of those who were hypotensive, 3 developed DVT out of 41 (7-3%) who were tilted; whilst in the 11 who were normotensive and tilted 3 developed DVT, an incidence of 27-3%. Of those who were normotensive and operated flat the incidence of deep vein thrombosis was 8-0%, while in those subjected to a foot-down tilt it was 27-3%. The hypothesis has been advanced that frequent inflation and deflation of the cuff used for monitoring blood pressure in the hypotensive patients may release fibrinolytic activity and explain these differences. Age, sex and operative duration were not found to have an effect. It is concluded that the incidence of postoperative deep vein thrombosis in patients undergoing plastic surgical operations is lower than that found in general surgery, and is not worsened by deliberate hypotension.


The immediate use of antimicrobial agents. The use of antimicrobial agents in the surgical period is discussed with reference to the role of the anaesthetist in prophylaxis against the spread of infection in the patient, the treatment of established infection, the protection of the anaesthetist against infection from the patient and of the patient against the side-effects of the antimicrobial agents themselves.


The epidural sieve and MBC (minimal blocking concentration): an hypothesis. Certain painful stimuli-of which those associated with placental abruptio and impending rupture of a uterine scar are examples-can penetrate an apparently well-established lumbar epidural block. As a possible explantation of this anomaly, it is suggested that, when used in the concentrations currently employed, the local anaesthetic reaches nerve axons only slightly above the minimal blocking concentration (MBC) of the drug, and that a more powerful stimulus can provoke an impulse which may be conducted through the "blocked" segment of axon. The beneficial aspects of the "epidural sieve" should be welcomed and no attempt made to eliminate the phenomenon.


A method of anaesthesia for fractional coagulation of the Gasserian ganglion. Intermittent anaesthesia with propanidid. A method of anaesthesia is described for fractional coagulation of the Gasserian ganglion. The surgical procedure demands short periods of anaesthesia alternating with periods of full consciousness, during which sensory testing is carried out. In spite of the rare possibility of a hypotensive reaction, propanidid is considered to be the drug of choice for this technique. 31 patients wih typical trigeminal neuralgia have been treated with immediate relief of symptoms, whilst 3 (10%) have been successfully re-treated after recurrence of pain paroxysms. Two patients developed lung emboli, from which they recovered, in the post-operative period, and a third patient had a non-fatal myocardial infarct a week after treatment. Alternative approaches to the problem of intermittent anaesthesia, with and without intubation, are discussed.


Improved method for the determination of acrylamide monomer in water by means of gas - liquid chromatography with an electron-capture detector.


Elimination of ionic interferences in the determination of sulphates in water using the lead-sensitive ion-selective electrode.


An ultraviolet spectral and polarographic study of nitrofurantoin, a urinary-tract antibiotic.


Semi-automated determination of lead by hydride generation and atomic-absorption spectrophotometry.


Determination of residues of oxamyl in crops and soils by gas - liquid chromatography.


Rapid assay of proteinase activity in papain by measuring the increase in opalescence of a casein solution during hydrolysis.


The development of the intramural nerve plexus of the gastro-intestinal tract. The chicken intestinal tract from the 6th day of breeding until the 20th day after hatching was examined histochemically for acetylcholinesterase activity. The enzyme was detected first in the perikarya and subsequently also in the ganglion-cells processes. The appearance of the acetylcholinesterase reaction deposit was observed first in the stomach and duodenum and later in the rectum. The histogenetic development of the intramural plexus in the small gut proceeds caudad, but in the colon in the opposite way, i.e., craniad. In the duodenum and colon the nervous development is complete in chicken embryos of 11-12 days and in the rest of the small intestine in embryos of 13-14 days of breeding. In the human embryo of 60 mm CRL the development of the intramural plexus is already completed.


The onset of ossification in the human calcaneus. A (silver) radiographic and microscopic study of the onset of ossification in the calcaneus of 177 human fetuses between 49 and 150 mm C.-R. length has revealed the presence of two independent and developmentally different ossific sites. A lateral locus, intramembranous (parachondral) in origin and precocious in appearance, was observed in slightly over 16% of the fetuses examined between 93 mm (the first appearance of this bone) and 150 mm C.-R. It occupied the vascular connective tissue within the anterior portion of a distinct groove on the inferolateral wall of the cartilaginous calcaneus between the retrotrochlear eminence anterosuperiorly, and the lateral process of the tuber posteroinferiorly. A centrally situated, primary ossific centre, endochondral in origin, was detected in only 11% of the fetuses between 118 mm (the initial appearance of this centre) and 150 mm C.-R. It was situated in the centre of the anterior third of the cartilaginous calcaneus in relation to the sustenaculum tali medially and to a distinct cartilaginous prominence on its lateral surface. Only four fetuses possessed both ossific sites (lateral and central): at 122, 143, 145, and 150 mm C.-R., and in only one of these was continuity established between them. One fetus (122 mm) possessed two independent endochondral centres (superior and inferior).


In vitro elastic fiber formation by aggregated arotic cells of newborn rabbits. Cells isolated enzymatically from the aortas of newborn rabbits were aggregated and grown in organ culture. Bundles of microfibrils, some of them with an amouphous core (elastin), were evident in 3-day-old aggregates. Furthermore, droplets of elastin surrounded by darker dots and short filaments, corresponding to the elastic units were observed. In 6-day-old aggregates the number of elastic fibers composed of bundles of microfibrils with deposited elastin increased. Elastic elements which probably resulted from a coalescence of elastic units were also present. These two ways of elastic fiber formation in aggregates are compared with those described in papers on aortic development.


Assessment of methods of anaesthesia used for total alloplasty of hip joint with application of bone cement. The authors analyse 151 cases of anaesthesia for total hip joint alloplasty. Fifty-three patients had general anaesthesia and in 98 cases epidural analgesia was performed. Although the statistical analysis of correlations between the fall of the arterial blood pressure and the age of patients failed to demonstrate significant differences between both types of anaesthesia the authors regard local analgesia as superior.


Iontophoretic blockade in treatment of carotid sinus syndrome. The author describes the results of treatment by his own modification of carotid sinus blockade with lidocaine electrophoresis in 17 patients. The results confirmed the effectiveness of the method and demonstrates its simplicity and safety.


The effect of bone cement used for endoprosthesis stabilization on the activity of lysosomal enzymes in peripheral blood granulocytes. The effect of bone cement used for stabilization of hip joint endoprosthesis on the activity of lysosomal enzymes in peripheral blood granulocytes was studied. The operations were carried out under balanced, non-toxic, endotracheal anaesthesia using muscle relaxants. The blood for tests was obtained from an antecubital vein before and during anaesthesia, before application of bone cement, and 10 min., 1 hour and 24, 48 and 72 hours after endoprosthesis implantation using bone cement. The activity of acid phosphatase, acid protease and neutral protease was determined by calculating it in relation to protein level in the studied fractions. During anaesthesia as well as during the operation when bone cement was applied no statistically significant differences were found in the activity of lysosomal enzymes. On the other hand, after the operation statistically significant changes were found in the activity of lysosomal marker enzymes. Lability of lysosomal membranes appeared with permeation of hydrolases into supernatant. These results confirmed the importance of lysosomal proteins in the processes of wound healing and general postoperative course.


The costo-uterine muscle of the guinea-pig: a smooth muscle attaching the uterus to the last rib. A conspicuous smooth muscle (of transverse sectional area comparable to that of the taenia coli) situated in the suspensorium ovarii and in the ligamentum ovarii proprium of the guinea-pig is described. The muscle is attached to the last rib, it reaches the medial side of the ovary, to which it is loosely attached; it passes beyond the caudal pole of the ovary (from which it receives additional muscle bundles), it approaches the oviduct, passing ventral to it, then it spreads around it and eventually reaches the distal end of the uterus; this muscle (which is here indicated as costo-uterine muscle) is in direct continuation with, or transforms itself into, the longitudinal outer coat of the uterus.


A human embryo of 28 mm crown-rump length with cerebral, esophagotracheal and cardiovascular malformations. The following malformations were observed in a human embryo of 28 mm crown-rump length obtained at operation for tubal rupture in a case of extrauterine pregnancy: 1. Secondary anophthalmia with dysplasia and in part aplasia of the diencephalon. Rudiments of both eyes and eyestalklike proliferations within the diencephalon. No lenses and on the left side only a palpebral fissure. Hypoplasia of the right telencephalic hemisphere and of the right side of diencephalon, mesencephalon and proximal parts of the medulla oblongata. Pseudotumorous proliferations in the diencephalon, in the alar plate of the medulla oblongata (protruding into the fourth ventricle) and in the arachnoid. Hypoplasia of the right internal, middle, and external ear. Dysplasia and in part aplasia of facial osseous elements (cebocephalia). 2. Proximal esophageal atresia with distal tracheoesophageal fistula. 3. A Fallot's tetralogy with right-sided aortic arch and regressive right-sided ductus arteriosus, tricuspid atresia, hypoplasia of the right ventricle with excessive hypertrophy of its wall, and hypoplasia of the pulmonary trunk. Single left superior vena cava and abnormal, semicircular course of the stems of both coronary arteries.


Distribution of retinal ganglion cells in five mammalian species (pig, sheep, ox, horse, dog). In order to ascertain shape and location of the central area, the distribution of ganglion cells was measured in whole mounts of the retina from pig, sheep, ox, horse, and dog. Although exact comparison of corresponding points of measurement in different animals was not possible, the measurements allowed the mapping of retinal ganglion cell density, typical for the particular species. In all ungulates a streak of high cell density extends along a straight horizontal line, dorsal to the optic disc. As a rule a maximum of ganglion cell density is found close to the temporal end of the visual streak. In the dog a well demarcated oval portion of the streak continues into a short temporal (variable) and a long nasal linear arm. The functional significance of these findings is discussed.


The cancellous structure in the calcaneus and its relation to mechanical stressing. The structure of the cancellous bone in the calcaneus is comparable to a three-dimensional trajectorial system, best adapted to resisting bending stresses. This can be seen from the curve trend of the tensile fascicles. Since stressing takes place mainly in the sagittal plane, the adaptation of the structure must be examined in this plane. The photoelastic experiments prove that similar trajectorial patterns result from different types of loading (e.g., standing with and without muscular contraction, the transmission of forces before and after the fusion of the tuber apophysis); and therefore the stresses remain the same. The trajectorial patterns, already established from the experiments, correspond with those of the cancellous structure, which indicates that a state of adaptation exists. Using the definition given in Roux's "maximum-minimum" law, this means that the bone achieves maximum resistance with a minimum of material. The photoelastic experiments can also be successfully applied to a short, skeletal element, which has been stressed in a complex manner. Furthermore, the theory of causal histogenesis in the supporting tissues can be proved, since the position of the epiphyseal center coincides with that of a singular poing (hydrostatic pressure) in the trajectorial pattern. A division of the trajectorial pattern, into lateral and medial fascicles (as described by T. von Lanz and W. Wachsmuth) cannot be seen in the bone sections and consequently cannot be regarded as being factual.


The distribution of intercellular gap junctions in the developing retina and pigment epithelium of Xenopus laevis. The distribution of gap junctions in the developing retina and pigment epithelium of Xenopus has been examined from optic vesicle to photoreceptor outer segment stages. In the retina and pigment epithelium walls of the optic vesicle gap junctions are found between ventricular cells in the apical contact zone and close to the outside wall; a neural tube type of distribution. Optic cup formation brings the retina and pigment epithelium into contact and gap junctions form between them. After the stage of retinal specification gap junctions, previously more numerous dorsally, are more often found in the ventral retina and pigment epithelium. They continue to be found in the retinal centre between ventricular cell processes in the apical contact zone and near the vitreal basement lamella above the ganglion cell layer until stage 35. Gap junctions are occasionally made by ganglion cells and their axons, providing possible pathways initiating cell differentiation. After stage 35 gap junctions seem to be confined to the peripheral rim of the eye cup where new cells are formed throughout larval life. The observed distribution suggests that gap junctions may provide intercytoplasmic pathways for retinal specification intrinsic to the retina and pigment epithelium.


The embryological development and cytodifferentiation of the pars distalis of the golden hamster (Mesocricetus auratus). A light and electron microscopic study. The embryological development of cytodifferentiation of the hamster pars distalis was investigated using light and electron microscope techniques in order to obtain basic information for comparison with pituitary development in other mammalian species. The normal chronological events in the development of the hamster pars distalis closely paralleled the pituitary organogenesis of other laboratory rodents. Rathke's pouch formed and touched the infundibulum at 8 1/2 days of gestation and separated from the stomodeum 3 days later. Penetration of vascular elements from the developing hypophysial portal system into the pars distalis occurred at 12 1/2 days gestation. This was also the first day that small secretory granules were seen in any of the parenchymal cells. Further cytodifferentiation during the following prenatal, and first few postnatal days of life revealed granulated cells which, in most cases, could not be identified using morphological criteria or granule size as may be done in the adult. An orderly sequence of inductive and morphological events appears to take place in the developing hamster adenohypophysis paralleling similar events observed in other animals.


The radiographic evaluation of 105 consecutive children with Hodgkin's disease.


Ten-year experience with childhood rhabdomyosarcoma. The ten-year (1965-1975) experience of the Pediatric Tumor Clinic with 14 cases of proven CRM was reviewed. Seven cases seen prior to 1970 acted as control. They were treated by surgery and X--ray therapy alone (one received one chemotherapeutic agent). Seven other cases seen after 1970 adhered to a strict protocol of therapy. After surgery (resection or biopsy), roentgenological and hematological survey for diagnosis and staging, they received curative radiotherapy locally in doses of 5,200 r to 6,000 r. Concomitantly a regimen of multiple chemotherapeutic agents (vincristine, dactinomycin and cyclophosphamide) was administered according to the protocol followed at the M.D. Anderson Hospital, Houston. Only one of the seven controls is alive and free of disease for 9 years. Only one of the seven cases who adhered to the protocol died. The other six are alive and free of disease for periods of one to two and a half years (one has a 4 months follow-up so far). One of the six cases presenting with a solitary pulmonary metastasis had a lobectomy 2 and a half years after start of treatment, as no new metastasis developed. Another, presenting with a local recurrence after excision is alive and free of disease 2 years after the star of treatment with the protocol. The results of treatment of CRM with the protocol adopted show a significant improvement in terms of local recurrences, distant metastasis and survival rates.


Teratomas in childhood.

Teratomas in childhood. Of 109 teratomas in children 86 were benign and 23 malignant. Sacro-coccygeal and pelvic teratomas predominated 52 cases, and these fell into three groups, post-sacral, dumb bell and pre-sacral. The 34 purely posterior tumours were always congenital and benign whilst the incidence of malignancy in dum bell and pre-sacral teratomas increased as the tumour became more internal. Other sites affected in order of frequency were: the gonads, head and neck, retroperitoneal anterior mediastinum and the central nervous system. Malignant teratomas were carcinomas usually containing glandular, capillary and clear cell areas, and metastases were similar. Immature tissues in benign teratomas were usually neural or connective tissue. They did not give rise to neuroblastomas or sarcomas and did not indicate a worse prognosis. Only two originally benign teratomas later developed malignancy.


Medulloblastoma of the cerebellum.

Medulloblastoma of the cerebellum. On the base of 77 medulloblastomas of the cerebellum, it is a point out the actual management of children with medulloblastoma which can be summed up as a combination of surgery to relieve pressure and remove as much of the tumor as possible, para-operative vincristine, radical treatment of the whole C.N.S. by radiotherapy followed by maintenance chemotherapy of B.C.N.U. and vincristine.


Investigations of red cell glyoxalase in recombinant families. The polymorphism of the red cell glyoxalase (GLO), which has recently been found to be linked with the major histocompatibility complex (HLA) in man, was investigated in a number of selected families showing various recombinations between HLA-A, HLA-B and the third locus of the phosphoglucomutase (PGM3). In two families with a recombination between HLA-A and HLA-B, the GLO allele travels with the HLA-B locus fragment of the chromosome, indicating that GLO is located on the side of the HLA-B locus. In other families, recombinations occurred between HLA-A and B on one side and GLO and PGM3 on the other side, demonstrating that GLO and PGM3 are located on the same side of HLA. Other recombinations separated PGM3 from GLO so that it can be assumed that GLO is located between HLA-B and PGM3. Thus the immunogenetic linkage group on human chromosome C6 has been increased by yet another outside marker gene to include now the following genes in this order: HLA-A--HLA-C--HLA-B--Bf--HLA-D--GLO--PGM3.


Auto-ophthalmodynamometry.

Auto-ophthalmodynamometry.


Central retinal vein occlusion: life and sight implications. Central retinal vein occlusion is an ophthalmic disease with both life and sight threatening implications. Treatment should be aimed at the underlying ophthalmic or systemic disease. Questionable modes of therapy (ie, anticoagulation) may injure the patient as a whole without offering any really better results for the ophthalmic condition.


Fluorescein angioscopy: techniques of partial fluorescence, permanent drawing record and photocoagulation. Fluorescein angioscopy with the indirect ophthalmoscope might be the preferred technique for evaluating and treating certain lesions, particularly those in the retinal periphery. Three techniques which are helpful in extending the advantages of angioscopy are described. (1) Partial fluorescence is achieved with careful adjustment of the cobalt blue filter which relates the fluorescence to retinal landmarks, ie, color angioscopy. (2) A permanent record of angioscopy in different phases can be made with tracing paper over the retinal drawing. (3) Correct localization of lesions to be coagulated is achieved with blue filters over the coagulator beam following fluorescein injection. The filter is removed during coagulation.


Vitreoretinal and anterior segment surgery through the pars plana: Part II.


Assay of parathyroid hormone in human serum and its uses. The assay of parathyroid hormone has contributed greatly to our understanding of calcium metabolism in health and disease. The most important clinical application of the assay is in the differential diagnosis of hypercalcaemia, which is an increasing clinical problem. PTH assays are of little or no value in the absence of other biochemical data, especially accurate determinations of plasma calcium and phosphate.


Hypercalcaemia and malignancy.

Hypercalcaemia and malignancy.


A mapping function for human chromosomes. The available simple mapping functions are surveyed, and a new mapping function that provides for positive interference within chromosome arms and no interference across the centromere is proposed, together with the corresponding formula for centromeric linkage. This new function is derived by assuming that all chromosome arms except the short arms of acrocentric chromosomes hav an obligatory chiasma, and that the remaining chiasmata are distributed at random; assumptions which may correspond reasonably well to reality. A method for the comparison of the goodness of fit of mapping functions with family data is given. Low levels of interference seem to be indicated, although as yet insufficient human data is available to allow interference to the specified. Interference has a considerable effect on the estimation of map distances between loci from 3-point lod scores as is shown by the linkage group Rh, UMPK, PGM1, Amy, 1qh, Fy, on chromosome 1.


Cytogenetics and infertility in man. II. Testicular histology and meiosis. Within a group of 207 subfertile men, selected for testicular biopsy, histological investigations were made successfully in 194 chromosomally normal and 7 chromosomally abnormal individuals. Fifty-two per cent of men with a normal karyotype showed normal testicular histology, 31% showed a general depression of spermatogenesis and 8% showed deficiency in the late stages. Ten per cent had only Sertoli cells in the testis. The range of testicular conditions seen in the chromosomally abnormal men was similar to that found in the chromosomally normal. Meiotic studies carried out on 118 chromosomally normal individuals gave a mean chiasma count of 48-9 per cell. There was a positive correlation between high numbers of cells at diakinesis/metaphase I showing X and Y univalents and low numbers of cells reaching metaphase II. Meiosis was studied in 3 translocation heterozygotes, one 47, XYY male, one 47, XY+mar individual and one patient with a ring Y chromosome.


Estimating distances from the centromere by means of benign ovarian teratomas in man. Under the assumption that benign ovarian teratomas in man arise parthenogenically from a germ cell by suppression of the second meiotic division, the distance of a gene from its centromere can be estimated from the observed proportion of heterozygous teratomas collected from heterozygous hosts. The frequency of heterozygous teratomas of heterozygous hosts is equivalent to the frequency of second division segregation at the gene locus which has been used for centromere-related mapping in fungal genetics for more than 40 years. Mapping functions useful for teratoma-based mapping in man are presented.


A restriction on the space of genetic relationships. It was pointed out by Trustrum (1961) that even for non-inbred pairs of relatives it is possible for all four cross-parental kinship coefficients to be non-zero, and hence that the expression often assumed for the correlation between such relatives is not completely general. Van Aarde (1975) has recently made the same comment. We derive a restriction on the space of attainable Cotterman coefficients for a relationship between two arbitrary non-inbred relatives. This restriction implies that the form of the expression for the correlation is in fact general, although the components cannot always be interpreted as parental kinships.


The testing of dominants for heterozygoisty. A simple method of estimating the frequency of heterozygotes among the dominants by test-making has been described; and then a maximum likelihood estimate is obtained by an iterative counting procedure. Eearly results of Haldane have been review and modified. Methods of estimating the gene frequencies, their ratio, and the inbreeding coefficient from test-mating results have also been given.


The secondary sex ratio in the United States 1969-71: association with race, parental ages, birth order, paternal education and legitimacy. The simultaneous effects of several variables on the secondary sex ratio have been examined using data from over 5,000,000 births which occurred in the United States during 1969-71. The previously described negative association of birth order and sex ratio has been confirmed. For legitimate and illegitimate births combined, maternal age and paternal age are unimportant factors once account is made of birth order. This pattern obtains for both blacks and whites. The sex ratio for legitimate and illegitimate births is equivalent but the fact of legitimacy or illegitimacy may affect the association of the ratio with birth order and the parental ages. Paternal education is not significantly related to the ratio, but the highest probability of a male birth is found among fathers with intermediate levels of attainment. Even though the association between sex ratio and order of birth is highly significant in the statistical sense, the proportion of male births changes less than 2% over the extreme values of birth order. Furthermore, it is emphasized that the association accounts for only a very minor (less than 10%) proportion of the total variation in the ratio.


The fitness of human translocation carriers. A simple method to estimate the mean fitness of human translocation carriers is described. The method is based on information about the inheritance pattern of the translocations. This kind of data can be obtained from the surveys of the chromosome constitutions of new-born babies. The following fitness estimates are obtained: D/D translocation carriers, 0-94; D/G translocation carriers, 0-83; and reciprocal translocation carriers, 0-67. The estimates are rather uncertain due to the scarcity of information, but they are consistent with the expected results. More accurate estimates will be obtained in the future when more data on translocation carriers are available and the cytological classification of the different translocations becomes more exact.


Limits of the general two-allele single locus model with incomplete penetrance. A graphical method is presented that allows an investigator to find the mathematical limits of the general one locus two allele genetic model for any trait whose population prevalence is known. It is seen that while the model is quite flexible in its ability to fit family data, there remains a large area where the model cannot be fitted. Specific sub-regions corresponding to particular hypotheses (e.g. underdominant v. intermediate v. overdominant) can be found, thereby limiting the area that needs to be searched by other more complicated techniques. Moreover, knowledge of where a set of observations lies can enable an investigator to frame and test specific subhypotheses.


Asymptotic behaviour of the mean of a phenotypic diffusion process. Asymptotic genotypic frequencies are evaluated as functions of selection parameters and initial conditions of a phenotypic diffusion process. On the basis of asymptotic relations between genotypic frequencies some analytic results about equilibrium are obtained.


Two-sided assortative mating for a single locus. Most models previously considered for assortative mating were such that no change in gene frequencies occurred, or that one-sided assortative mating was occurring. Two-sided assortative mating is more realistic for human populations, and in this paper a model of two-sided assortative mating is analysed for two autosomal alleles with dominance, an important case for human genetics. The concept of a relative probability of matin between two phenotypes is used, and this variable can take into account factors such as different propensities for assortment in the various phenotypes and so forth. It is shown that the gene frequency may vary from generation to generation and conditions for the establishment of a stable polymorphism are given. For instance, Stanton (1947) has considered a special case of two-sided assortative mating with two autosomal alleles and a constant correlation between mates, where the value expressed by the heterozygote is numerically exactly half-way between the values exhibited by the two homozygotes. Also he has considered a special form of assortative mating, where the probability of occurrence of matings between the same homozygotes has been increased in each generation by the same constant factor as the probability of occurrence of matings between different homozygotes has been decreased. The probability of occurrence of matings involving heterozygotes remains the same as if mating were random. For this particular model the frequency of the genotypes in those who mate in generation t is the same as for the general population in generation t, but the genotypic frequencies change from generation to generation, reaching an equilibrium value. Stark (1976) has also considered a similar model to Stanton's (1947), the major difference occurring in the construction of the mating frequencies, which in this case occurs according to the canonical decomposition of the 2-way table of mating frequencies. Stark shows the correspondence between the results for this model and those given by Malécot (1939, 1948). The results for all these models depend on the particular values assigned to the genotypes. Also these models could be extended as outlined in this article for the case of two autosomal alleles with dominance.


Equilibrium centrifugation of proteins in acid solutions. Ovalbumin in aqueous acetic, propionic, and butyric acids.


Effects of hormones and of ethanol on the fructose 6-P-fructose 1,6-P2 futile cycle during gluconeogenesis in the liver.


Acyl coenzyme A dehydrogenases and electron-transferring flavoprotein from beef hart mitochondria.


Studies on histidine-rich polypeptides from human parotid saliva.


Formation of deoxycytidine diphosphate-diglyceride by nuclei isolated from HeLa cells.


Studies on the mode of sugar-phosphate product inhibition of brain hexokinase.


Creatine amidinohydrolase of Pseudomonas putida: crystallization and some properties.


Multiple forms of rat liver mitochondrial DNA polymerase.


Progesterone induction of lysozyme and peptidase activities in the porcine uterus.


Incorporation of (3H) leucine into the nucleoli of previtellogenic and early vitellogenic oocytes of Xenopus laevis: a high resolution autoradiographic study.


Clearance of lysosomal hydrolases following intravenous infusion. Kinetic and competition experiments with beta-glucuronidase and N-acetyl-beta-D-glucosaminidase.


Synthesis of 24S and 24R-hydroxy-[24-3H]vitamin D3 and their metabolism in rachitic rats.


Hepatic heme metabolism in selenium-deficient rats: effect of phenobarbital.


Metabolism of polyadenylic acid sequences during germination of blastocladiella emersoni: Zoospores.


Influence of trypsin and concanavalin A on sponge cell aggregation.


Maternal diabetes mellitus and congenital malformation. Survey of 205 cases. Twenty-five out of 205 (i.e. 12%) babies born to diabetic mothers in the Birmingham Maternity Hospital in the period 1969-1974 were malformed as against 6% in a control group. The incidence was highest in the group where mothers were on insulin at the time of conception (17 out of 117, i.e. 15%). No correlation was observed between major malformation in this group and age of onset or duration of the diabetes, progressive vascular complications, maternal age, or parity. Cardiovascular malformations were over-represented.


Exercise-induced bronchocontriction, skin sensitivity, and serum IgE in children with eczema. Forty-two children with eczema were studied for exercise-induced asthma (EIA), skin sensitivity to prick testing, blood eosinophil count, and immunoglobulins. 29 had a fall in peak expiratory flow rate after exercise greater than 20% and of these, 23 had symptoms of wheezing. 13 of the eczematous children showed a fall of less than 20%. The children with EIA showed greater cutaneous sensitivity (p less than 0.001) and a higher total serum IgE (p less than 0.025). 3 of the group with a fall of less than 20% had allergic rhinitis with skin sensitivity to grass pollen. The remaining 10 had no clinical evidence of allergic disease, other than eczema and skin sensitivity, and total IgE fell within the normal range. It is suggested that in a proportion of chilren with eczema there is little evidence of reaginic allergy.


Investigation and management of long-standing chronic constipation in childhood. The anorectal physiology of 106 children with long-standing chronic constipation, who had failed to response to a trial of medical treatment, was assessed. 10 (9%) were shown to have ultrashort-segment Hischsprung's disease, later confirmed on histology, The remainder showed evidence of hypertrophy of the internal sphicter on anorectal manometry and had a vigorous anal dilatation (to accept 4 fingers) under general anesthesia. After this, 38% were able to be weaned off all medication and most of the remainder improved. Further anal dilatation and internal sphincterotomy allowed a further 10 children to stop laxative, bringing the total to 48%.


Clinical and subclinical vitamin D deficiency in Bradford children. A survey of the vitamin D status of Bradford schoolchildren was carried out in April 1973, employing conventional biochemistry, radiology, and measurement of 25-hydroxycholecalciferol levels. Biochemical evidence of rickets was present in 45% of the Asians. When re-examined in September, several children showed spontaneous biochemical resolution; nevertheless, radiological abnormalities were present in 12% of the original sample. No evidence of rickets was detected in the smaller White sample. Minor biochemical abnormalities were present in 9 of the 40 West Indian children. A study of admissions of Bradford hospitals in the 4 years 1969-1972 inclusive confirmed that clinical vitamin D deficiency was confined to Asians except for a few cases of infantile rickets in White children. The probability that one Asian child in 40 may require admission during the period from birth to adolescence emphasizes the urgent need for the introduction of prophylactic measures.


Vitamin deficiencies and neural tube defects. Serum folate, red cell folate, white blood cell vitamin C, riboflavin saturation index, and serum vitamin A were determined during the first trimester of pregnancy in over 900 cases. For each of these there was a social classes I + II showed the highest levels which differed significantly from other classes, except for serum folate. In 6 mothers who gave birth to infants with neural tube defects, first trimester serum folate, red cell folate, white blood cell vitamin C, and riboflavin values were lower than in controls. In spite of small numbers the differences were significant for red cell folate (P less than 0-001) and white blood cell vitamin C (P less than 0-05). These findings are compatible with the hypothesis that nutritional deficiencies are significant in the causation of congenital defects of the neural tube in man.


Measurements of muscle strength and performance in children with normal and diseased muscle. A study has been made of two simple means of measuring muscle power in children with normal and diseased muscle. In one the length of time that the leg and the head could be held at 45 degrees above the horizontal was measured with the child supine. In the second, measurements were made of the isometric strength of six muscle groups with the newly developed Hammersmith Myometer. In the timed performance tests only 5 (8%) of a group of 61 children known to have muscle disease achieved the minimum expected values for their ages. Myometer readings of the isometric power of the children with muscle disease also have values which were below those of a comparable group of normal children. The reproducibility of muscle strength measurements in young children has been shown to be good, whereas the timed performance tests, though able to differentiate normal children from children with muscle disease, did not show sufficient reporducibility for this test to be recommended for sequential measurements.


Analysis of 100 children with severe and persistent hypertension. In 100 children with persistent hypertension seen over the past 5 1/2 years the commonest causes of hypertension were chronic glomerulonephritis, reflux nephropathy, coarctation of the aorta, and obstructive uropathy, accounting for some 70% of cases. 17 children have died, but in the remainder hypertension has been controlled by surgery, chronic haemodialysis, or by the use of pharmacological agents. Methyldopa was the commonest drug used, and the children appeared relatively resistant to the side effects of this and of other drugs, even when large doses were used. The improvment is the prognosis of severe hypertension in childhood indicated in this survey is largely due to the availability of chronic haemodialysis and transplantation for end-stage renal disease, but the advances in diagnositc methods and surgical techniques and the introduction of new drugs have also contributed.


Quantitative morphological studies of developing human cerebellar cortex in various disease states. A quantitative morphological assessment was carried out of the cellularity and staining properties of the cells of the layers of the human cerebellar cortex, both in the normal child and in 41 children suffering from a series of disorders including mental retardation. A computerized image analyser and highly standardized procedures were used. All of the cases of mental retardation and some cases with congenital cardiac anomalies showed abnormal cell concentrations and staining properties. 3 cases of 'cot death' also showed abnormal results. These findings are presented as a new measurable aspect of brain disease, and as a indication for further study.


Motor nerve conduction velocity in spinal muscular atrophy of childhood. The ulnar and posterior tibial conduction velocities were measured in 29 children with spinal muscular atrophy, 14 of whom had the servere form of the disease. The ulnar nerve velocity was slow in 12 of the 14 severely affected infants, but normal or fast in 11 of 14 children less severely affected. The corresponding results for the posterior tibial nerve were slow velocities in 11 of 12 infants in the severe group and normal or fast in all 11 infants less severely affected. The difficulty in distinguishing infantile spinal muscular atrophy from peripheral neuropathy is emphasized.


Failure to thrive and death in early infancy associated with raised urinary homovanillic and vanillylmandelic acids. A case of failure to thrive in an infant with persistently raised urinary levels of homovanillic and vanillylmandelic acids is descirbed. No neural crest tumour was discovered at surgical exploration or at necropsy. The relation of this biochemical abnormality and failure to thrive is unclear.


Childhood actinomycosis. Report of 3 recent cases. Three cases of childhood actinomycosis are reported, 2 with the commonest presentation of cervicofacial abscess and the third with a rarely reported superficial chest wall abscess. The importance of prompt bacteriological diagnosis and adequate treatment with surgical drainage and chemotherapy is stressed. Though in adults males are affected more frequently than females, the sexes are probably equally affected in childhood.


Rapid assessment of gestational age at birth.


Duchenne muscular dystrophy: early diagnosis, and screening.


Treatment of hereditary hypophosphataemic rickets.


Nutritional deprivation during protracted diarrhoea after acute gastroenteritis.


Criteria for diagnosis of temporary gluten intolerance.