The effect of concentration on vasoactivity of bupivacaine and lignocaine. In a double-blind trial bupivacaine 0.125, 0.25 and 0.5% and lignocaine 0.5, 1 and 2% were given intradermally to 31 volunteers. Vasoconstriction was observed more frequently at low concentrations of each drug, and vasodilatation at high concentrations. These observations were highly significant (P less than 0.001). Duration of action was unaffected by concentration, except in the case of bupivacaine 0.5%, the effect of which was longer lasting than that of other solutions.


The influence of three antacids on the absorption and clinical action of oral diazepam. Diazepam 10 mg given orally alone or with one of the three antacids (aluminium hydroxide 40 ml, magnesium trislicate 30 ml, sodium cirate 30 ml) was given in a single dose at random to 200 women undergoing minor gynaecological procedures. The concomitant use of aluminium hydroxide or sodium citrate hastened the onset of the soporific effect of diazepam marginally, while magnesium trisilicate tended to delay it. The estimation of plasma diazepam concentrations over 90 min in a similar series of 67 patients showed that the absorption of diazepam was increased significantly by the use of aluminium hydroxide, but there were no striking differences in the four groups. The clinical implications of these findings are discussed.


Some pharmacological factors influencing the absorption of diazepam following oral administration. Plasma diazepam concentrations were measured by gas-liquid chromatography in samples of blood from adult female patients follwing diazepam 10 mg orally, alone or in combination with metoclopramide, morphine, pethidine or atropine. Patients receiving metoclopramide had higher plasma diazepam concentrations than those in the control group, while the addition of morphine, pethidine or atropine resulted in lower plasma diazepam concentrations throughout the 90-min period of the study. In the control goup peak plasma concentrations were reached by 60 min. The addition of metoclopramide increased the rate of diazepam absorption and peak concentrations were reached by 30 min, while morphine, pethidine and atropine reduced the rate of absorption with no apparent peak being reached by 90 min.


Anaesthesia and the reticulo-endothelial system: Comparison of halothane-nitrous oxide and neuroleptanalgesia. The effect of halothane anaesthesia and neuroleptanalgesia (NLA) on the phagocytic activity of the reticulo-endothelial system (RES) was investigated with the aid of the Lipofundin clearance test. The results suggest that halothane in nitrous oxide depresses the phagocytic activity of the RES. NLA did not exert a depressant effect on the RES function. As it is essential for the body to be in a defensive condition to cope adequately with infensive condition to cope adequately with infection and cancer metastases, care must be taken to ensure that an anaesthetic procedure does not cause additional impairment of RES function. The results of the investigations suggest that NLA may have advantages in this respect.


The influence of doxapram on postoperative pulmonary function in patients undergoing upper abdominal surgery. An infusion of doxapram 250 mg in dextrose 5% compared with dextrose 5% alone in patients recovering from upper abdominal surgery was associated with a reduction in the degree of hypoxaemia after operation. This may be the result of a sparing effect on the functional residual capacity.


Screen test for patients.

Screen test for patients.


Electronics and emergency medicine: speeding help to the patient via telemetry and telephone.


Intraocular pressures after suxamethonium and endotracheal intubation in patients pretreated with pancuronium. Intraocular pressures were recorded after the administration of suxamethonium and endotracheal intubation in a series of 20 patients who had not received pancuronium 1 mg 4 min before the suxamethonium. The pressures were compared with those in a control group of 20 patients who had not received pancuronium. The increase in intraocular pressure which followed the suxamethonium and intubation, and which occurred in about 50% of the patients, was similar in both groups of patients.


A comparison of the incidence of cardiac arrhythmia during two methods of anaesthesia for dental extractions. One hundred premedicated inpatients undergoing wisdom tooth extraction were divided into two groups of 50. Group A was anesthetized by a technique based on droperidol and phenoperidine, whilst group B was anaesthetized with halothane. The e.c.g. in both groups demonstrated a similar overall incidence of cardiac arrhythmia, but analysis revealed a significantly higher incidence of ventricular arrhythmia in group B. The heart rate was significantly less in group A.


"We the People...a unique heritage for institutional ministry".


The formation and function of a quality of life committee.


Should hospitals be regulated as utilities?


A Samaritan's struggle for humane and religious care.


The hidden benefits of required planning.


Schizophrenia & rehabilitation.

Schizophrenia & rehabilitation.


Specialty distribution of physicians: congressional statement.


Executive vice president's rounds.

Executive vice president's rounds.


The effect of foster home placement on psychiatric patients; observed changes and contributory factors.


Interdisciplinary workshop recommendations regarding the community placement of psychiatric patients.


Community care services in Vancouver: initial planning and implementation.


A study of placement of the psychiatric patient.


Coast Foundation Apartment Project.

Coast Foundation Apartment Project.


Options for treatment of the schizophrenic patient.


Whither approved homes? An analytical-descriptive study of the Parkland Region Approved Home Program.


The semi-community environment and the reintegration of the psychiatric resident: present status and outlook for the future.


Mental Health/Ottawa's Group Homes Project.


Care, not treatment. A personal view from the U.S.


The AFCR--administrative ischemia.

The AFCR--administrative ischemia.


Specialization as scientific advancement and overspecialization as social distortion.


Legislation and the future of medical specialization.


Internal medicine and the functions of the generalist: some notes on a new synergy.


The primary care problem.

The primary care problem.


Ethical issues regarding case reports: to publish or perish the thought.


Psychosis. A poem written at the moment psychosis was burning out.


Productivity and motivation.

Productivity and motivation.


Drug therapy--governmental concerns.

Drug therapy--governmental concerns.


Mechanisms for developing pharmaceutical services.


The pharmacist's role in the management of hypertension.


The human side of management.

The human side of management.


The crunch cometh.

The crunch cometh.


The design and implementation of a unit-dose system.


Unit-dose in a 592-bed hospital.

Unit-dose in a 592-bed hospital.


Preventive pharmacy care.

Preventive pharmacy care.


A female case of Kallmann's syndrome.

A female case of Kallmann's syndrome. A case of 20-year-old woman with hypogonadotropic hypogonadism and anosmia is reported, since very few female cases of Kallmann's syndrome have been reported so far in Japan. Three uncles on the father's side had no children. Height was 168 cm, and arm span 165 cm. The olfactory test revealed complete anosmia. Bone age was 13 year. Chromosome was 46 XX and normal karyotype. Basal levels of serum FSH, LH and estrogens (E1, E2 and E3) were low. Serum FSH and LH levels rose slightly only after LH-RH administration, and did not increase in clomiphene test. Plasma estrogens did not increase after daily injection of 150 IU of HMG for 3 successive days. The response of serum GH to arginine infusion was normal, while that to insulin-induced hypoglycemia was poor.


The unit-dose study.

The unit-dose study.


A study of unit-dose drug distribution in four Canadian hospitals.


Review of combinations of antiasthmatic drugs by Saskatchewan Drug Quality Assessment Committee.


Guidelines--drug monitoring in the Canadian hospital.


A transient increase in renal clearance of phosphate in response to continuous infusion of salmon calcitonin in rats. The effects of intravenous carrier-free salmon calcitonin on renal clearances of phosphate, calcium, magnesium, sodium and potassium were studied in male parathyroid-ectomized (PTX) and intact rats. Both natural and synthetic hormone, when infused at constant rates (0.005 approximately 0.5 MRC U/hr), produced a rapid increase (peaking at about 60-90 min) in phosphate clearance. However, the maximal increase was transient in nature in PTX rats. In intact rats, the phosphaturic response was somewhat more pronounced and the decline after the peak was rather modest. When a large amount (4 MRC U) of calcitonin was given in divided doses, the second dose produced a lesser extent of phosphaturia in both intact and PTX rats. The phosphaturic response was accompanied by an increase in sodium and potassium clearances in PTX rats and by an increase in potassium clearance in intact rats. A fall in the apparent clearance values for calcium and magnesium occurred and was maintained throughout the infusion period of hormone in both intact and PTX rats. In conclusion, PTX rats respond to the intravenous administration of salmon calcitonin with a transient phosphaturic response which is accompanied by parallel diuresis of sodium and potassium along with sustained retention of calcium and magnesium by the kidney.


Proposed selective immunization of Canadians against A/Swine strain of influenza.


Continuity with change. 1976 Lilly lecture.


Development of the vaginal epithelium showing estrogen-independent proliferation and cornification in neonatally androgenized mice. Female mice of the C57 Black/Tw strain given 5 daily injections with 100 microng testosterone (T) or 5 alpha-dihydrotestosterone (DHT) from the day of birth showed estrogen-independent persistent proliferation and cornification of the vaginal epithelium in adulthood. The vaginal epithelium of the mice was essentially similar to that of the controls in histological structure during or shortly after neonatal injections of the androgens. In T- and DHT-mice aged over 20 days, however, a marked proliferation with or without superficial cornification took place in the epithelium lining the proximal and middle parts of the vagina (Müllerian vagina), while neither proliferation nor cornification occurred in the epithelium of the distal vagina (urogenital sinus vagina). On the second day of postnatal life in mice given a single injection with T on the day of birth, the mitotic activity in the epithelium of the middle vagina was heightened, but it dropped to the control level on the third day and remained low until 20 days. By contrast, the mitotic rates in the epithelium of the rest of the vagina in T-mice and of all parts of the vagina in DHT-mice were approximately the same as in the controls until 20 or 30 days. The mitotic rates in the epithelium of the Müllerian vagina were markedly elevated in T-mice at 20 days of age and DHT-mice at 30 days, and thereafter remained almost unchanged until 60 days of age. These results were different from the findings in mice given neonatal injections with the dose of estradiol-17 beta (E) capable of estrogen-independent vaginal cornification (Iguchi et al., 1976). The present finding seem to indicate that the mechanism involved in the induction of estrogen-independent vaginal changes by neonatal administration of androgen (T, DHT) is different from that following neonatal treatment with estrogen (E), although androgen and estrogen act directly on the vaginal epithelium of neonates.


Ultrastructural characteristics of the vaginal epithelium of neonatally estrogenized mice in response to subsequent estrogen treatment. Adult mice which had received 10 daily injections of 20 microng estradiol beginning with the day of birth were in a "persistent-estrous" state, showing ovary-independent proliferation and cornification of the vaginal epithelium. Ultrastructural changes of the vaginal epithelium in neonatally estrogenized mice was examined after a single postpuberal injection of 10 microng estradiol and compared with those seen in normal mice to estrogen. In ovariectomized normal mice, the basal cells were round. The nucleus was polygonal and contained peripheral condensed chromatin. After estradiol treatment, the basal cells became columnar. The nucleus was round to oval, containing dispersed chromatin. In neonatally estrogenized ovariectomized mice, the basal layer of vaginal epithelium consisted of round cells with polygonal nuclei, much as in normal ovariectomized mice. The nucleus occupied a large area of the cytoplasm and contained prominent nucleoli. Intercellular spaces were moderately distended. Late estradiol treatment resulted in distended intercellular spaces and in the appearance of the other cell type along with round cells in the basal layers: the columnar cells containing an oval nucleus with dispersed chromatin, resembled the basal cells in normal ovariectomized mice receiving postpuberal estrogen injection. The intercellular spaces between the columnar cells were narrow compared with those between round cells. However, the nuclei of round cells still had prominent nucleoli and peripheral condensed chromatin regardless of subsequent estrogen treatment. This fact suggests that these nuclei do not respond to estrogen. These results clearly show that the vaginal epithelium of neonatally estrogenized mice with ovary-independent persistent cornification consists of a mixed population of cells.


Occurrence of permanent changes in vaginal and uterine epithelia in mice treated neonatally with progestin, estrogen and aromatizable or non-aromatizable androgens. Female mice of the C57 Black/Tw strain were injected daily with 100 microng testosterone, 50 microng testosterone propionate (TP), 100 microng 5 alpha-dihydrotestosterone (DHT) or 50 microng 5 alpha-dihydrotestosterone propionate (DHTP), for 10 days from the day of birth. Two other groups of female mice were given neonatal injections with 20 microng estradiol-17 beta and 100 microng progesterone for 10 days, respectively. All mice were ovariectomized at 60 days of age and killed at 90 days. In 100% of neonatally estrogenized or androgenized, ovariectomized mice, the cranial part of the vagina was lined with stratified epithelium with either cornification or parakeratosis or mucification. Stratification only or stratification with superficial squamous metaplasia or cornification took place in the uterine epithelia of 18% of the TP-treated, 75% of the DHT-treated and 50% of the DHTP-treated, ovariectomized mice. In contrast, neonatally estrogenized, ovariectomized mice did not show the estrogen-independent, persistent uterine changes. Neonatal progesterone treatment failed to induce the permanent changes in the vaginal and uterine epithelia.


Radioimmunoassay for 11-deoxycortisol using iodine-labeled tracer. A simple and sensitive radioimmunoassay for 11-deoxycortisol was developed. The antiserum produced in rabbits by immunizing with a complex of 11-deoxycortisol-3-oxime and bovine serum albumin (BSA) has little cross-reactivity with other endogenous steroids. The immunoassay procedure requires only one-step ethanol denaturation of binding proteins in plasma and extraction by an organic solvent can be omitted. Furthermore, use of 125I-labeled tracer significantly simplify the counting procedure. The method is sensitive enough to detect 1 microng/100 ml of 11-deoxycortisol. Plasma 11-deoxycortisol levels measured by this method after the administration of a single dose of metyrapone ranged from 5.0 to 19.2 microng/100 ml, whereas they were 0 to 4.0 microng/100 ml in hypopituitary patients. It is concluded that this simple method is useful for the routine assay of plasma 11-deoxycortisol as a parameter of the metyrapone tests.


Clinical study on early changes in thyroid function of hyperthyroidism treated with propylthiouracil and a relatively small dose of iodide. In order to compare the acute effects of three kinds of antithyroid agents of iodide (I-), propylthiouracil (PTU) and PTU combined with iodide (PTU+I-) on thyroid function in hyperthyroid patients with diffuse goiter, serum concentrations of thyroxine (T4), triiodothyronine (T3), T3-resin sponge uptake (T3-RU) and free thyroxine index (FT4I) were employed as thyroid function parameters. In the group given iodine (1 mg/day) as iodinated-lecithine, the initial values of T4, T3, T3-RU and FT4I were 20.9 +/- 1.6 microng/100 ml (T4), greater than 740 ng/100 ml (T3), 49.5 +/- 2.3% (T3-RU) and 14.7 +/- 1.8 (FT4I). At the end of one week of therapy, they decreased clearly to 15.6 +/- 2.2 microng/100 ml, 457 +/- 87 ng/100 ml, 42.2 +/- 4.0% and 9.7 +/- 2.4. The so-called "escape phenomenon" from iodide inhibition was observed in serum T4, T3-RU and FT4I values at the end of two weeks of iodide therapy, while serum T3 continued to decrease but the value of T3 was far outside of the normal range. In the PTU group (300 mg/day), thyroid function parameters were 22.5 +/- 0.8 microng/100 ml (T4), greater than 592 ng/100 ml (T3), 54.9 +/- 1.0% (T3-RU) and 18.7 +/- 1.0 (FT4I) before treatment. They decreased continually week by week. At the end of four-week treatment with PTU, the value of each thyroid function parameter was 11.1 +/- 1.9 microng/100 ml, 229 +/- 56 ng/100 ml, 36.6 +/- 4.4% and 5.7 +/- 1.7. In the group of hyperthyroidism simultaneously given both PTU and iodide (300 mg/PTU and 1 mg/iodine), these thyroid function parameters decreased as well as in the group treated with PTU alone for more than two weeks. More rapid or significant decrease of T4, T3, T3-RU and ft4i in PTU+I- group than in PTU group was observed in the present study. These results suggested strongly that iodide alone was not an adequate therapy for hyperthyroidism as well known and they were also compatible with the idea that the concomitant administration of PTU and iodide was more effective in the early phase of therapy of hyperthyroidism than PTU alone.


Is this the year for National Health Insurance?


Five steps to expanding facilities.

Five steps to expanding facilities.


Spotlight on the staff. Food service.

Spotlight on the staff. Food service.


New responsibilities for nurses.

New responsibilities for nurses.


New use for the attitude survey.

New use for the attitude survey.


Tax free financing of a medical office building.


Controlling theft: the hidden drain.

Controlling theft: the hidden drain.


Occurrence of uncommon Salmonella serotypes in human infections.


Clinical and epidemiological studies on V. parahaemolyticus infection in Calcutta (1975).


Arbitration: alternative to litigation.

Arbitration: alternative to litigation.


Ocular leprosy.

Ocular leprosy.


Studies on human ascaris: purification of trypsin inhibitor.


Poisoning by ergoty bajra (pearl millet) in man.


Accreditation and ambulatory care.

Accreditation and ambulatory care.


T-strain mycoplasma in human genital tract infections.


The art of medicine.

The art of medicine.


Diagnosis of recurrence of rheumatic fever in rheumatic heart disease--a re-evaluation of Duckett Jones Criteria.


Medical director: man of many facets.

Medical director: man of many facets.


Medical audits: one group's practical approach.


Social class and psychiatric disturbance: a community study.


Is methemoglobin reduction test a true index of G-6-PD deficiency?


Effects of polycationic amines and streptomycin on the structure of N-ethylmaleimide treated rat liver ribosome.


Demonstration of immunological similarity between tumour antigen and tumour associated foetal antigen.


A simple apparatus and technique for crossed antigen-antibody electrophoresis.


Plaque formation of dengue viruses in Vero cell culture under carboxymethylcellulose overlay.


Observation on second heterotypic dengue virus infection in mice.


Foundations: the key to group growth.

Foundations: the key to group growth.


A study of chronic hepatitis in northern India.


Sero-epidemiological study of measles virus infection in and around Chandigarh.


Serological evidence of arbovirus activity in birds and small mammals in Japanese encephalitis affected areas of Bankura district, West Bengal.


Edwardsiella tarda in a variety of human infections.


Insecticide susceptibility studies in populations of Aedes aegypti from Maharashtra State, India.


Automated patient billing: we did it our way.


Humoral immune response during pregnancy.


Collective bargaining.

Collective bargaining.


Adrenocortical function in breast cancer.


Comparative study of fluorescent and Papanicolaou's techniques for detection of carcinoma of cervix uteri.


Influence of high dose of estradiol on ICRC mouse bearing transplanted mammary tumours.


Parathyroid preservation and transplantation.


Epidermal prostaglandin and histamine in UV-induced erythema reaction.


An endoscopic and gastric secretory study of non-ulcer dyspepsia.


Cardiac action of Tribulus terrestris.

Cardiac action of Tribulus terrestris.


Neonatal meningitis.

Neonatal meningitis.


Acquisition of immunologic capacity by human newborns.


Sensitivity of vibrio group of organisms to minocycline--a new tetracycline derivative.


Triceps skin--fold thickness during infancy.


Serum proteins with special reference to immunoglobulins in premature Indian neonates.


Morbidity due to poliomyelitis in urban and rural area of Gujarat in pediatric population--a house to house survey.


Socio-cultural factors affecting breast feeding and other infant feeding practices in an urban community. A study of infant feeding practices was carried out as part of a larger longitudinal study of an urban birth cohort in an area of South Delhi, India.  802 mothers of children over 1 year of age were selected randomly for interview.  The study group is considered to be a representative sampling of the economic, cultural, and ethnic groups within the population of all of Delhi.  Breast feeding was almost universal but for varying durations.  5.5%, 11.7%, and 22.8% of the children were breast fed for less than 1 month, 2 months, and 6 months respectively.  Literate and older mothers tended to breast feed for shorter periods of time.  Illiterate mothers, on the other hand, tended to prolong breast feeding unduly.  The sex of the infant and the duration of the urban stay of the mother did not seem to affect the duration of breast feeding.  Supplementation with liquid feeds, 50% diluted buffalo milk in the majority of cases, was begun rather early but the introduction of semisolids and solids was very often unduly delayed.  This was particularly true among illiterate mothers.  Thus, it is felt that a concerted effort to educate mothers, especially illiterate and underprivileged mothers, regarding the role of breast feeding and the benefits of supplementation feeding would improve infant nutritional status.


Malaria in Madras city.

Malaria in Madras city.


Broncho pulmonary complications of measles: analysis of 100 cases.


Pain abdomen-a clinical study.

Pain abdomen-a clinical study.


A "should" that has become an "is".

A "should" that has become an "is".


Myositis ossificans progressiva (a case report).


Congenital methaemoglobinemia (report of a case).


Aims, organization, and initial studies of the Cross-National Project. The US-UK Cross-National Project is conducting a series of trans-Atlanti comparisons of psychiatric practice and psychiatric disorders. The inital studies investigated the large US-UK cross-national differences reported in the public mental hospital statistics on adult admission rates of schizophrenia and the manic-depressive disorders. Three general strategies were adopted: (1) semi-structured interviews with hospitalized patients aged 20-59 years; (2) rating of videotapes by samples of psychiatrists; and (3) systematic examination of case records. The results showed that routine hospital diagnoses were based on differing criteria in the two countries and it was this that accounted for the reported cross-national differences in admission rates. A method of making internationally reliable diagnoses was demonstrated.


The geriatric mental status interview (GMS). The Geriatric Mental Status interview (GMS) is a semi-structured interview technique for assessing psychopathology in elderly patients. It is administered by a trained interviewer in a session of less than one hour. Between 100 and 200 question are asked and almost 500 items are rated. Twenty-one factor scores have been identified and the reliability of the ratings has been established. The interview is acceptable to the patient and is useful for making diagnostic distinctions and evaluation progress


Assessment of the older psychiatric inpatient. Instruments, whether used in psychometrics or in other fields, must have a practical application if they are to repay the care spent in their use and development. The Geriatric Mental State schedule was developed in response to the need to answer the question whether functional psychiatric disorders were being misdiagnosed as organic brain syndrome and, if so, to what extent this influenced treatment and outcome. In the hospitals studied it was found that American psychiatrists were more likely to diagnose organic brain syndrome than British psychiatrists. Although elderly patients with affective disorder were less likely to be given American patients was as good, if not better, than the outcome in the British patients.


Reliability of psychiatric assessment in older patients. A number of the causes of psychiatric diagnostic disagreement are discussed in this paper. The use of the Geriatric Mental Status interview to achieve diagnostic reliability is examined in three studies in which U.S.--U.K. Cross-National Project psychiatrists rated and diagnosed thirty-two British and twenty-one American patients. There were no systematic differences between U.S. and U.K. team members in their diagnoses; and agreement on six principal diagnostic categories was achieved in about three-quarters of the cases. The reliability fo the ratings of psychopathology that formed the basis for the diagnoses was satisfactory and is reported in detail.


Distinctions between organic brain syndrome and functional psychiatric disorders: based on the geriatric mental state interview. Discriminant function analysis was employed to study the ability of the Geriatric Mental Status interview to distinguish between patients diagnosed by the project as having an organic brain syndrome or a functional psychiatric disorder. In both New York and London, patients with organic brain syndrome scored significantly higher (p less than 0.05) than those with functional disorders on the factors of impaired memory, disorientation and incomprehensibility and significantly lower on the factors of depression and somatic concerns. Discriminant functions calculated from data on the New York and London patients separately significantly distinguished not only the patients on whom the functions were based but the patients in the other sample as well.


The usefulness of a psychological test battery. This paper discusses the usefulness of a battery of psychological tests administered to a group of psychiatric geriatric patients in New York and London, as an assessment of cognitive impairment. Two of the tests, the Paired Associate Learning Test, and the Digit Copying Test, were highly related to the diagnosis of organic brain syndrome or functional disorder made independently by a psychiatrist in a clinical interview. Prognostic predictions in disagreement cases were no better or no worse by psychiatric diagnosis than by psychological tests. Compared to a simple clinical test of disorientation derived from the psychiatric interview, psychological tests were more highly correlated to independent measures of patients' self-care capacity and duration of hospitalization, but equally related to psychiatric diagnosis. The verbal subtest proved to be the more useful of the psychological tests given. The logistics and difficulties of administering psychological tests to this specialized population are discussed, e.g. patients' physical limitations, communication problems; as well as efforts in this study to minimize these problems.


The performance test of activities of daily living. A structured-performance test requiring patients to demonstrate selected activities of daily living was designed to objectively measure the self-care capacity of geriatric psychiatric patients. The background, rational, usefulness, and specific administration and scoring procedures are presented. The test is simple to administer and promises to be a useful diagnostic and prognostic tool.


A measure of the fulfillment of health needs. Female patients, sixty-five of age and over, admitted to acute medical and psychiatric wards of a municipal hospital were observed directly and unobtrusively for a three hour time period every other day during the first two weeks of hospitalization. The behaviors of the patients and of those who interacted with them were recorded and later categorized according to fifteen activities defined as representing basic health needs. Behaviors were compared according to the outcome of hospitalization, discharge, transfer to another ward or institution, or death. Differences which distinguished patients who were discharged from those who died were found in the activities of movement, comunication, and learning. Behaviors observed at different points in time during hospitalization also were compared. This study is the first step in the development of an instrument to measure the perceived satisfaction of health needs of geriatric patients in institutions.


Axial deviations of the knee with secondary arthrosis. Correction by high osteotomy of the tibia and fibula. The authors describe a surgical technique for high tibio-fibular osteotomy used eighty seven times to correct varus or valgus deviations causing arthrosis of the knee. Osteotomy of the tibia is carried out above the tibial tuberosity. Fixation is by two nails with a compression device. This allows immediate movement of the knee, thereby preventing stiffness. After forty five days the osteotomy is usually consolidated. Of the complications, only the neuro-muscular type is of importance and the possible causes of this are discussed. The overall results are good and the technique described has proved to be effective in the treatment of mechanical arthrosis of the knee.


Surgical treatment of poliomyelitic scoliosis. Between 1968 and 1973 forty nine patients suffering from poliomyelitic scoliosis were treated surgically at the Rizzoli Institute. They were due to asymmetrical paralysis and contracture in the muscles of the trunk and limbs. Associated pathological conditions were found, such as pelvic obliquity, and vascular and trophic changes due to ganglionic lesions. The differing incidence and combination of these factors gave rise to various clinical types of spinal deformity. The average severity of curve was 39 degrees, the localisation was predominantly central, the average extent was ten vertebrae, and there was a marked predominance of right convexity (twenty nine out of thirty six). The rate of progression was maximum during puberty and almost negligible after bony maturity. It was greater in males and was unfavourably affected by the severity and asymmetrical distribution of the paralysis, by the early appearance of the disease, by high localisation of the deformity, and by the erect posture in patients who were ambulant. The most frequent visceral complications were in the respiratory system (ten patients with a deficit over 50%), followed by cardiac changes. Surgical treatment was adopted in patients with progressive curves over 60 degrees, because of the inevitable deterioration in their general condition and the tendency of the deformity to become fixed. Pre-operative correction by Halo-traction results (52% correction) than Risser plasters (38%). Posterior arthrodesis by Harrington's method was carried out in all the more recent cases (forty four). Post-operative plaster was maintained for eight months and then replaced by an orthopaedic corset. At bony maturity there was an averaged improvement of 35% in the angle of curvature, and an average improvement of 6% in vital capacity. The best corrections were obtained in patients under fourteen (42%), in dorso-lumbar scoliosis (40%) and in patients with curves above 100 degrees (38%). There was an average increase in height of 9.1 cms and a reduction in the gibbus of 3.4 cms. The complications included one traumatic pneumothorax, eight pseudarthroses, and breakage of the distraction rod in two cases resulting in complete relapse of the deformity. In six cases the upper hooks became loos and there were two cases of postoperative staphylococcal infection. In the distally sited curves our present policy is towards combining posterior arthrodesis with Dwyer's anterior interbody fusion.


A new total knee prosthesis: the "total-condylar". We have described the instrumentation and surgical technique of a new total knee prosthesis, the Total-Condylar, designed at the Hospital for Special Surgery (New York) and which we are the first to use in Italy. This prosthesis has evolved from the "sliding" prosthesis and seems to us to constitute a real step forward. The femoro-patellar compartment is completely substituted. The cruciate ligaments are removed, which markedly increases the possibility of correcting even severe deformities. The fixation of the tibial component is improved by the adoption of a short stem. The prosthesis has a certain intrinsic stability on weightbearing. The surgical technique is characterised by bone sections perpendicular to each other by the use of aligning instruments which simplify the operation. Our experience is just beginning (five cases) but our results so far are very encouraging and correspond to those reported in a very much larger series in the United States.


Gluteal fibrosis.

Gluteal fibrosis. After reviewing the literature the authors discuss the aetiology and pathogenesis of gluteal fibrosis. We believe that the condition occurs more frequently than is thought. If this is borne in mind when dealing with children from four to six years old, presenting with abnormal gaits, an early diagnosis can be made. As regards treatment, we agree with those authors who maintain that if diagnosed early the lesion can be treated successfully by physiotherapy alone. In more advanced cases, Z lengthening of the tendon is indicated.


Osteofibrous dysplasia of long bones a new clinical entity. A new clinico-pathologic entity is described. It is defined as osteofibrous dysplasia of long bones, and is based on twenty two personal observations to which are added seventeen cases from the literature. This dysplasic congenital lesion is clearly differentiated from fibrous dysplasia by clinical, radiographic and histological characteristics and by its clinical course. These features may be summarised as follows: 1) Slight predominance of the male sex. 2) Very early age of onset either at birth or in the first years of life. 3) Site almost exclusively tibial, sometimes also in the fibula. Localisation predominantly in the middle third of the tibial diaphysis, but sometimes in the distal or proximal third. In the fibula, it is always at the distal third. 4) The lesion is painless and generally causes bony enlargement. There is often slight anterior bowling and more rarely, slight varus of valgus bowing. Pathological fracture may occur; rarely there is a pseudarthrosis. 5) The radiographic appearances are very characteristic, with enlargement of the bone, intracortical osteolytic lesions with thinning or disappearance of the external cortex, sclerotic reaction on the medullary aspect, and narrowing of the medullary canal. 6) The histological features are also typical, consisting of fibrous tissue enclosing bone trabeculae lined by osteoblasts and a "zonal" architectural pattern. 7) Sometimes the lesion tends to heal spontaneously in the very early years of life; in other cases it is moderatley progressive. It relapses frequently after curettage, but such recurrences are generally non-progressive. In some cases slight anterior bowing persists permanently. 8) Surgery should be restricted to patients over the age of five in whom the lesion is extensive, with imminent or actual pathological fracture, and to the rare cases of pseudarthrosis. The results are good even in cases of relapse or pseudarthrosis. The correction of residual bowing, if indicated, can safely be carried out with one or more osteotomies at the age of ten to twelve years.


Respiratory function in severe scoliosis before and after treatment (a review of 76 cases). The authors carried out a study of respiratory function in seventy six patients suffering from severe scoliosis of different types; forty five idiopathic, sixteen poliemyelitic, ten congenital, and five neurofibromatosic. The age incidence was from a minimum of eleven years to a maximum of thirty three, with the average around fifteen years. The site of the deformity was predominantly dorsal (fifty cases), though there were also lumbar and dorso-lumbar types. The average angle of curvature (Cobb) before treatment was 110 degrees. Arthrodesis by the Harrington technique was carried out on all patients after correction with a Risser-type plaster in sixty nine cases, and Halo-traction in seven cases. The post operative period in plaster was about eight months. Spirometric tests were carried out before treatment, after preoperative correction, and two to three years after operation, always with the chest out of plaster. The results of these tests are expressed as percentage reductions in the maximum ventilation compared with the average normal values in the tables reported by Baldwin et al. (1948). The values obtained before commencing treatment showed that lumbar scoliosis even if very severe, never leads to severe respiratory deficits. There is no linear relationship between the severity of the curve and the respiratory deficit, though there is a general connection between them. Tests of respiratory function were carried out after corrective treatment, both before and after operation and at a two year follow up. There was an overall average improvement of 10% in the respiratory deficit, with a maximum of about 20% in a group of twenty two patients with the most severe deficit before commencing treatment. Follow-up three years after operation showed the improvement in respiratory fimction had been maintained. The authors conclude that arthrodesis by the Harrington technique does not diminish the respiratory gain achieved by pre-operative correction. On the contrary, it stabilises it and maintains it over the three year follow-up period of the present survey.


Reappraisal of the treatment of fractures of the calcaneus involving the subtalar joint. From our findings it appears that no one method of treatment is infallible and that functional and anatomical restitutio ad integrum of the fractured heel cannot be obtained. Each method has its advantages and disadvantages and these are not only inherent in the method itself, but also depend on how it is applied. The treatment must be chosen according to the lesion and cannot be standardised because of the variable and complex nature of these fractures. Other factors to be considered are whether it is bilateral, whether there are multiple injuries, and the general condition of the patient etc. In fractures with depressions of the mixed horizontal type the Stulz method of treatment seems to be the best.


Classification and treatment of intercondyloid fractures of the humerus. The authors describe the satisfactory results obtained in sixteen intercondyloid fractures of the humerus, thirteen of which were treated surgically. The preference for surgical treatment in such fractures is based in the assumption that, as in all articular fractures, a good functional result can only be achieved if there is the most perfect possible reconstruction of the fragments and the joint surface. A classification is therefore suggested which is based not purely on anatomical criteria, but is also related to treatment and prognosis. The slendor nature of the distal end of the humerus and the danger of metal reaction call for the use of fixation devices that are efficient but slender, such as fine screws and crossed wires. The precise method of fixation is conditioned above all by the direction of the fracture lines. More solid fixation with early mobilisation can be achieved by compression screws, and less solid fixation with longer immobilisation is achieved by fixation with crossed Kirschner wires. Consequently, the more oblique types of fracture with fragments with long beaks that allow more stable fixation with compression screws have the more favourable prognosis. In the evaluation of results, the authors emphasize the importance of using parameters which take into account the functionally useful range of joint movement.


Intraosseus lipoma.

Intraosseus lipoma. The authors present a case of intraosseus lipoma seen at the Orthopaedic Clinic of the University of Bari, bringing the total in the world literature to thirty cases. The tumour is a benign primary neoplasm of bone, made up of mature adipose tissue containing atrophic bone trabeculae. This affection is a definite entity quite distinct from parosteal lipomas arising in periosteum, fasciae and muscles which only affect the bone secondarily by compression or direct invasion. Emphasizing the extreme rarity of the tumour, the authors discuss its clinical, radiological, anatomical and pathological features. The differential diagnosis is with certain dysplasic and neoplastic lesions of bone such as: bone cyst, non-ossifying fibroma, aneurismal cyst, monostotic fibrous dysplasia, and solitary myeloma. Complete removal is followed by cure.


The case for hospital-based epidemiology departments.


The dual role of the health organization physician.


Who is running the show.

Who is running the show.


Why continuing medical education?

Why continuing medical education?


Use of an ultrasonic blood flow monitor for determining fetal viability in the rhesus monkey (Macaca mulatta). A preliminary study. Ultrasonic stethoscopy proved to be a reliable and convenient technique for determing fetal viability in Macaca mulatta. Examinations, begun at day 150 of gestation in 33 monkeys and between days 32 and 58 in four other animals, were repeated at intervals of one to seven days. The earliest time of detecting blood flow in the fetal placenta was 42 days of gestation, fetal heart sounds geing discerned later. Three types of fetal cardiac rhythms were recognized: (1) a constant rate during most of pregnancy, (2) fluctuations associated with uterine contractions during labor, and (3) sudden transient bradycardia during violent rotations of the cephalically presented fetus.


Antenal sex determination using amniotic fluid of the baboon (Papio sp.). Antenatal determination of sex in the baboon was performed by evaluating the percentage of sex chromatin bodies present in the epithelial cells of amniotic fluid obtained during or immediately following cesarean section. Female sex chromatin patterns revealed a mean of 39.2% positive sex chromatin; the mean in males was less than 5%. This procedure is accurate and simple to perform. The precentage of sex chromatin bodies present in the epithelial cells of amniotic fluid obtained from baboons during, or immediately following, Caesarean section was determined by Cresyl ECHT Violet and Cresyl Violet Acetate staining.  The lowest percentage of sex chromatin for female fetuses was 20%, with an overall mean of 39.2%, while the highest percentage for male fetuses was 8%, with an overall mean of less than 5%.  With such well-defined patterns, the possibility of overlapping or confusion in interpretation is virtually nil.  The procedure is both accurate and simple to perform.


Surface architecture of the plant cell: biogenesis of the cell wall, with special emphasis on the role of the plasma membrane in cellulose biosynthesis. Cell wall structure and biogenesis in the unicellular green alga, Oocystis apiculata, is described. The wall consists of an outer amorphous primary layer and an inner secondary layer of highly organized cellulosic microfibrils. The primary wall is deposited immediately after cytokinesis. Golgi-derived products contribute to this layer. Cortical microtubules underlie the plasma membrane immediately before and during primary wall formation. They function in maintaining the elliptical cell shape. Following primary wall synthesis, Golgi-derived materials accumulate on the cell surface to form the periplasmic layer. This layer functions in the deposition of coating and cross-linking substances which associate with cellulosic microfibrils of the incipient secondary wall. Secondary wall microfibrils are assembled in association with the plasma membrane. Freeze-etch preparations of untreated, living cells reveal linear terminal complexes in association with growing cellulosic microfibrils. These complexes are embedded in the EF fracture face of the plasma membrane. The newly synthesized microfibril lies in a groove of the outer leaflet of the plasma membrane. The groove is decorated on the EF fracture face by perpendicular structures termed "ridges". The ridges interlink with definitive rows of particles associated withe PF fracture face of the innter leaflet of the plasma membrane. These particles are termed "granule bands", and they function in the orientation of the newly synthesized microfibrils. Microfibril development in relation to a coordinated multienzyme complex is discussed. The process of cell wall biogenesis in Oocystis is compared to that in higher plants.


Nature and origin of patterns of changes in cell shape in embryos. Spatial patterns of the future elongation of cells exist in the early embryo. In the newt, such a pattern of changes of cell shape contributes to the formation of the neural plate. Regardless of where neural plate cells are transplanted, they change shape as prescribed by the pattern. Embryonic induction has a role in establishing this pattern.


Interactions of neurotoxins with the action potential NA + ionophore. Four neurotoxins that activate the action potential Na+ionophore of electrically excitable neuroblastoma cells interact with two distinct classes of sites, one specific for the alkaloids veratridine, batrachotoxin, and aconitine, and the second specific for scorpion toxin. Positive heterotropic cooperativity is observed between toxins bound at these two classes of sites. Tetrodotoxin, a specific inhibitor of the action potential Na+ current, inhibits activation by each of these toxins in a noncompetitive manner (KI=4-8 nM). These results suggest the existence of three functionally separable components of the action potential Na+ionophore: two regulatory components which bind activating neurotoxins and interact allosterically in controlling the activity of a third ion-transport component, which binds tetrodotoxin. The dissociation constant for scorpion toxin binding is increased 10-fold by depolarization of the cells with K+, suggesting that the scorpion toxin binding site is located on a voltage-sensitive regulatory component of the ionophore.


Interaction of charged lipid vesicles with planar bilayer lipid membranes: detection by antibiotic membrane probes. A technique has been developed for monitoring the interaction of charged phospholipid vesicles with planar bilayer lipid membranes (BLM) by use of the antibiotics Valinomycin, Nonactin, and Monazomycin as surface-charge probes. Anionic phosphatidylserine vesicles, when added to one aqueous compartment of a BLM, are shown to impart negative surface charge to zwitterionic phosphatidylcholine and phosphatidylethanolamine bilayers. The surface charge is distributed asymmetrically, mainly on the vesicular side of the BLM, and is not removed by exchange of the vesicular aqueous solution. Possible mechanisms for the vesicle-BLM interactions are  discussed.


Present role of teaching hospital in community health care.


Needed changes in medical education.

Needed changes in medical education.


Project Poshak--an integrated health and nutrition large-scale study for rural preschool children. Central India.


A review of the District Health Administration Research Project.


Influence of private practice on integration of health services.


Internship programme in medical education--an overview.


The health centre in Japan--past, present and future.


Significance of left anterior hemiblock--the Great West Life experience.


Corporate social responsibility in the insurance industry.


Coronary disease prevention.

Coronary disease prevention.


Medicine and the law--current perspectives.


Health care in Canada.

Health care in Canada.


The medicine man.

The medicine man.


Murmurs and mortality.

Murmurs and mortality.


Clinical uses of frozen-thawed erythrocytes in pediatrics. Frozen red cells have a definite place in the mangement of a transfusion service even if one does not include its originally intended use -- inventory control. Undoubtedly, the benefits achieved from frozen red cells can be accomplished in less expensive ways. However the growth in transsplantion and intensive chemotherapy with its concommiatant uses of granulocyte and platelet support predict a greater upsurge in the use of frozen red cells in the very near future.


Observations on morphology and significance of electrocardiographic waves of atrial fibrillation.


Comparative cytogenetic and cytologic study in malignant lymphomas. The possibility of a cytogenetic-cytologic correlation with implications in the diagnosis, evolutivity and prognosis of malignant lymphomas was studied. Cytogenetic investigations were carried out comparatively in the lymph node and spleen lymphoid cells from 25 patients with malignant lymphomas and in normal subjects or patients with malignant tumors. The dominant malignant cellular type was found to correspond genotypically to the abnormal clone. In lymphomas with more differentiated cells the chormosomal abnormalities were limited to a single chromosomal group, while in those with less differentiated cells there were many clonal chromozomal abnormalities. The pathogenic significance of an extra-chromosome in the C-group (observed in most of the cases) is discussed.


Angiotensin II. Vascular reactivity and humoral effects. The vasopressor response to angiotensin II was found useful in the differential diagnosis of arterial hypertension and for a better understanding of its pathogenesis. Sodium supply was proved to influence significantly the pressor response to angiotensin II and not that to noradrenaline thus implying the presence of arterial receptors which bind angiotensin specifically. Angiotensin caused an increase of the urinary excretion of electrolytes in hypertensive patients and a decreased electrolyte excretion in normotensives. In most hypertensive patients angiotensin was found to decrease the plasma angiotensinogen and to activate the bradykinin-bradykininogen and fibrinolytic systems. In the presence of urinary infection angiotensin increased the platelet adhesiveness and the thrombelastographic changes proved that in this condition angiotensin increases the tendency to thrombosis.


The monophasic action potentials of the intact canine heart. Monophasic action potentials were recorded in 7 mongrel dogs, endocavitarily, from heart in situ and from the epicardial surface with open chest thus revealing the characteristic configuration of the different chambers. The duration of the monophasic action potential showed a good correlation with the cycle length, demonstrated during endocavitary electrostimulation.


Results obtained with the weight reducing regimens by varying the dietary caloric values. Eleven grossely obese females were placed successively on a 4 day total fasting diet, a 4-5 day hypocaloric diet of 220 calories consisting exclusively of proteins and finally a 450 mixed calorie diet consisting of 15 g carbohydrates, 30 g proteins and 30 g lipids. At the beginning of the study and at the end of every dietary period, the weight free fatty acids, plasma glycerol, insulinemia, and growth hormone were measured and estimated. The nonsignificant changes of the biologic parameters investigated have led the authors to the conclusion that the 450 mixed calorie diet suggested by them is more favourable being better accepted by the patients and therefore more easy to maintain for a longer period of time even by out patients.


Transfer factor for the lung, airway obstruction and hyperinflation in chronic bronchitis and emphysema. The interrelationships of breath holding lung transfer factor (TCO) and transfer coefficient (KCO) with ventilatory obstruction (FEV1.0) and FEV1.0/VC) and hyperinflation (RV and RV/TLC) were studied in 37 patients with chronic nonspecific lung disease with a FEV1.0 of 1.5 litre or less classified as "bronchitic", "emphysematous" or "intermediate" according to Nash, Briscoe and Cournand (1965). No relationships could be found between TCO and airway obstruction or hyperinflation. KCO tended to decrease as RV increased (r=-0.26) and was weakly related to the FEV1.0/VC ratio in "intermediate" (r=0.34) and "emphysema" (r=0.29) patients but these relationships were nonsignificant.


Is rehabilitation of patients with chronic bronchial asthma possible. Based on his own experience and on the data in the literature the author considers that rehabilitation of adults with chronic bronchial asthma is possible at any stage of disease if there are no complications or morbid associations to prevent it. Rehabilitation of chronic asthmatic patients requires the close collaboration of several specialists such as allergologists, chest physicians, psychologists, physical therapists, balneologists, etc. Rehabilitation in asthmatic patients may only be considered successful if they resume full-time work (in case they had been in receipt of compensation), if the medical leaves are fewer and shorter and if the drug therapy is reduced or null. The author considers that since bronchial asthma in the whole population of Romania has an incidence of 2.3-2.9% rehabilitation, though costly and sometimes "desperate", is still worth while trying for its medical, economical and psychological implications.


Disturbances of cellular immunity in rheumatic fever. The alteration of cellular reactivity was investigated in 20 patients with rheumatic fever at the first rheumatic attack or in relapse with confirmed heart damage. The results obtained by studying in parallel ESR, the ASLO titer, IDR to streptococci and the degree of leukocyte migration inhibition proved that the onset of rheumatic attack was preceded by a deep disturbance of the cellular immunity. The migration inhibition values were between 50 and 60% (as compared with 10% in the normal controls) in over 85% of the patients investigated. It is emphasized that the selection of cases of streptococcal angina should be made very carefully and that sometimes it is necessary to use a more specific method for the detection of rheumatic fever in its preclinical stage.


Spontaneous aorta and coronary lesions in mountain mammals. I. The Carpathian deer (Cervus elaphus). Arterial lesions were investigated in 48 adult wild Carpathian deers (Cervus elaphus). Aortas from 36 animals and fragments from the main coronary trunks of all the animals were studied histologically and histochemically. In 44.4% of the animals the specimens studied presented gross intimal lesions in the aorta consisting histologically of fibrous plaques (especially situated in the thoracic segment) and/or intimal musculo-elastic thickenings with lipid deposits or fatty streaks (especially in the abdominal segments). In only 5 of the 48 animals the coronary arteries presented slight intimal thickenings, free of lipids. The results obtained are discussed in relation with the possible effect of natural nutrition.


Electrocardiographic diagnosis of experimentally-induced myocardial infarction during cardiac electrostimulation. The sequential ECG changes were studied by the Sodi-Pallares' method in 10 dogs before and after experimentally induced myocardial infarction of the left ventricle during right and left artificial stimulation. Right ventricular endocardial stimulation produced patterns of left bundle branch block in 9 dogs and of right bundle branch block in one, while left ventricular stimulation caused right bundle branche block patterns in 9 animals. Records during right ventricular stimulation after myocardial infarction showed in the peripheral leads myocardial necrosis only in two animals, while in the epicardial leads necrosis was certain in 2 animals (Q wave) probable in 6 (S-T segment elevation) and suggestive in 2 (T wave negativity). Myocardial necrosis during left ventricular stimulation was evident in the peripheral leads in 2 animals, probable in 6 and suggestive in one. The experimental data suggest that myocardial necrosis can be diagnosed in some cases during right and left ventricular artificial stimulation.


The mobility of the thinking process in aphasics.


A study of aminoacidemia and aminoaciduria in epileptic children.


Observations on neurasthenia and neurasthenia-like syndromes in a group of women working in textile industry.


Breathlessness and blood oxygen tension in patients with chronic bronchitis and emphysema. The dyspnea grade (MRC scale) was confronted with the arterial oxygen tension (PaO2) measured at rest in a group of 51 patients with chronic obstructive lung disease with moderate or severe impairment of ventilatory function (FEV 1.0 less than 1.5 1). For the group as a whole no correlation was found, but in the "bronchitic" subgroup (clinical-roentgenologic and biologic criteria) a tendency of PaO2 to decrease with the increase in dyspnea severity was apparent. The linear correlation coefficient did not attain the significance threshold owing to the limited number of observations (r = 0.46; p greater than 0.05).


Why don't they write about the good things?


Mandate, maintain, monitor: a model for hospital governance.


America's hospitals: what does the future hold?


The legal perspective.

The legal perspective.


Contract management: is it for your hospital?


The small hospital under multiple unit management.


Accelerating the planning and construction process: tips from a developer.


How to negotiate with consultants and architects.


Physicians for the future.

Physicians for the future.


A health information system for the management of an integrated health service.


An integrated health service. Recent trends in health service patterns.


Medical care in an integrated health service.


Integration as a basis for the functioning of health care systems in large areas.


Medical centres as an institutionalised form of integrated health service.


An integrated health service. Formation of associations in public health.


Integration of consumers and providers of health services.


An integrated health service.

An integrated health service.


The application of computer techniques in health care.


Psychiatric architecture and sociotherapy.


Psychiatry and architecture. The right to normal living conditions.


Behavioural science and the rationalisation of architectural design.


Architecture and psychiatry--what has been achieved?


Discussion group 3: psychiatry and architecture.


Control of health care in an uncontrolled environment.


Rationalising the American health care delivery system: a summary of the health planning and resources development act of 1974.


Morphological aspects of the rat kidney during compensatory growth.


Central anticholinergic syndrome in anesthetic practice. Anticholinergic agents may lead to a syndrome described by Longo as the Central Anticholinergic Syndrome (CAS). Patients with this syndrome exhibit one or more of the following: though impairement, disturbance of recent memory, hallucinations, ataxia, excitement, drowsiness of coma. We have reviewed our use of anticholinergics and tried to correlate it with the occurrence of the above symptomatology and have treated 200 cases in which the CAS was diagnosed with physostigmine salicylate (0.04 mg/kg). We also successfully treated 2 cases of apparently central anticholinergic hyperpyrexia in the same way. We would suggest that physostigmine be included in the armamentarium of every anesthetist to combat anticholinergic poisoning by the wide range of presently used anticholinergic drugs. (Act anaesth. belg., 1976, 27, 45-60).


Data processing and anesthesia in a large university hospital.


A simple, cheap, effective and safe procedure for general anesthesia. A simplified, safe and flexible technique of anesthesia, based on a limited number of relatively cheap drugs, and allowing ventilation with air, was applied to 60 patients undergoing operations of at least 60 minutes' duration. The required depth of hypnosis was produced by intravenous diazepam or gamma-OH, whilst droperidol and fentanyl provided a satisfactory degree of sedation and analgesia. Pancuronium bromide was used for muscle relaxation. Spontaneous respiration was resumed immediately after postoperative use of nalorphine and neostigmine. The anesthetic course was smooth and predictable, with cardiovascular stability and an uneventful postoperative recovery. Emphasis is laid on the suitability of this procedure on the Battle Field or in Developing Countries, and on its safety (no toxic volatile liquids). (Acta anaesth. belg., 1976, 27, 25-34).


Respiratory neurons of the ventral respiratory nucleus of the rabbit and their vagal connections. The pattern of firing and responses to electrical stimulation of the ipsilateral vagus nerve were studied in respiratory neurons near the nucleus ambiguus (NA) in the region called "ventral respiratory nucleus". In 41 (out of 77) respiratory neurons orthodromic responses were recorded; the remaining neurons did not respond to stimulation. It is concluded that the NA neurons of the rabbit are not laryngeal motoneurons. Moreover, the short-latency excitatory response of some of these neurons, and long-latency inhibition of the other, suggest that NA neurons may be involved in the processing of vagal information.


Significance of cranial circulation for the brain homeothermia in rabbits. I. The brain-arterial blood temperature gradient. The hypothalamic-arterial blood temperature gradient (THpr-TAC difference) was studied on 10 freely moving rabbits at ambient temperatures between 0 and 42 degrees Celsius. In cold environment, below 10 degrees Celsius the THpt-TAC gradient varied considerably, but some distinct correlations were found between vasomotor responses of the nasal mucosa and fluctuations of brain temperature, as well as between vasomotor responses of the ear pinnas and changes of the arterial blood temperature. Vasodilatation of the nasal mucosa or the ear pinna caused respectively a drop in brain temperature or in arterial blood temperature. Opposite changes were induced by vasoconstriction in those areas. Variations in THpt-TAC gradient resulted from oppositely directed vasomotor responses in the nasal mucosa and in the ear pinnas. At high ambient temperatures above 35 degrees Celsius thermal panting was accompanied by selective brain cooling with respect to the arterial blood. Blocking the heat loss from the nasal mucosa caused an increase of the THpt-TAC difference, and under these conditions brain temperature was determined solely by arterial blood temperature. The assumed mechanism of the selective brain cooling in rabbits is the exchange of heat through the neurocranial bottom, between the ventral brain and the spacious splanchnocranial venous lakes supplied with blood from the nasal mucosa.


Electrical stimulation of the hippocampus and acquisition of the conditioned avoidance response in shuttle-box in cats. The effects of electrical stimulation and electrolytic lesions of the posterior part of the hippocampus on acquisition of the active avoidance response (AAR) in shuttle-box were studied in 35 cats. Both weak or strong hippocampal stimulation applied simultaneously with conditioned stimulus (CS) facilitated the acquisition of AAR. After discontinuation of stimulation the level of AAR performance in response to CS alone decreased in cats trained with the use of strong stimulation. However, if the stimulation was applied before each experimental session the level of AAR performance did not differ from that observed during the final phase of training. These changes of AAR were not observed in cats trained with the use of weak stimulation. The application of hippocampal stimulation alone did not evoke AAR in shuttle-box after training independently of stimulation parameters. There were no differences in the speed of AAR acquisition between unoperated cats, implanted controls and cats with lesions in the posterior part of the hippocampus.


Significance of cranial circulation for the brain homeothermia in rabbits. II. The role of the cranial venous lakes in the defence against hyperthermia. Chronic experiments were conducted on five freely moving rabbits at ambient temperatures of 0-42 degrees Celsius. The influence of nasal mucosal thermal changes on the venous blood temperature inside the pterygoid plexus and on the temperatures at three intracerebral sites were investigated against the background of the carotid arterial blood temperature shifts. A correlation was found between: (i) the fluctuations in the nasal mucosal temperature reflecting its vasomotor responses, (ii) temperature shifts of the pterygoid plexus venous blood, and (iii) of the ventral brain. Mucosal vasodilatation caused parallel drops in both the plexal blood and brain temperatures. However, mucosal vasoconstriction was accompanied by increases in temperatures at those sites. Intracranial thermal shifts were independent of the arterial blood temperature changes. During motor activity in normothermia nasal mucosal vasoconstriction was present, and in that case brain temperatures exceeded arterial blood temperature. During rest, mucosal vasodilatation appeared and brain base cooled below the arterial blood temperature. During panting in dry heat, the brain base was cooler than the arterial blood by as much as 0.5 degree Celsius. The intensity of the selective brain cooling was directly proportional to deep body temperature. The blockade of the respiratory evaporation in heat elicited an increase of the plexal venous blood as well as brain temperatures above the arterial blood temperature. We conclude that the venous blood outflowing from the nasal mucosa exerts a cooling influence on the brain through the pterygoid plexus.


Effects of electrical hippocampal stimulation on acquisition and performance of unidirectional active avoidance response in cats. The influence of electrical stimulation of the posterior part of the hippocampus on acquisition and performance of the conditioned, unidirectional avoidance response was investigated in 26 cats. No significant differences in the speed of learning between stimulated and control animals were observed. However, electrical hippocampal stimulation with parameters 7/s, 100 microamps, 7/s, 200 microamps and 50/s, 100 microamps (1 ms square pulses of negative polarity) facilitated the performance of the avoidance response. Strong hippocampal stimulation (50/s, 200 microamps) caused inhibitory effects. Application of hippocampal stimulation before experimental sessions increased the performance level in comparison to sessions not preceded by hippocampal stimulation.


Instrumental reactions and food and water intake in medial amygdala rats. Rats were trained preoperatively to perform instrumental reactions for food and water reward on a continuous reinforcement schedule. Two levers on two opposite sides of the Skinner box were available. Each press of the first lever delivered one drop of water and each press of the second lever - one pellet of solid food. After the electrolytic lesions of the medial part of the amygdaloid complex, rats were hypophagic and hypodipsic. Most of the animals showed, however, only small decreases of total unconditioned daily water and food intake. On the other hand, the instrumental performance was markedly impaired, in particular for water reinforcement. Histological verification showed that lesions were restricted to the amygdaloid complex and involved mainly the ventral part of medial nucleus.


Effects of binocular deprivation of pattern vision on single unit responses in the cat superior colliculus. Single unit responses in the superior colliculus of cats deprived of pattern vision from birth and of normally reared cats were studied in unanesthetized pretrigeminal preparations. Collicular units of deprived cats showed a diminished direction-selectivity but a somewhat better speed-selectivity compared to normals; they also preferred lowspeed stimuli, and reacted less frequently to diffuse flash. The impairment of direction-selectivity of collicular neurons may be partly responsible for the impairment of the pursuit eye movements in visually deprived cats.


John C. Leonard Award address.

John C. Leonard Award address.


Hemispheric differences in the visual analysis of the verbal and non-verbal material in children. Five years old children, who could not read, and the same children at the aged of 7, who already knew letters, were used as subjects. A visual procedure involved presentation of single letters or a pair of letters randomly to the left or right of a central fixation point. Reaction time and number of correct identifications, showed by pressing a key, were indicators of the perception of letters. The children of five identified the letters with equal correctness, whether they were addressed to the right or to the left hemisphere, whereas the children of seven showed left hemisphere superiority.


Preparing teachers of family practice education.


Functions and responsibilities of the Liaison Committee on Graduate Medical Education.


Continuing education for competency in the smaller community hospital.


Planning CME programs that fit staff interests: patient-problem inventory.


Effects of cold-shock on blood cells in a fresh water tropical teleost, Colisa fasciatus. Immersion of the adult female fresh water tropical teleost, Colisa fasciatus, in ice water at c. 2 degrees C for one minute immobilizes the fish. It, however, recovers within two minutes when returned to warm temperature. Hematological studies at recovery time intervals, viz., 3, 15 and 27 min and, later, at intervals of 48 min up to 363 min, and at 12 and 24 h, revealed significant changes in the abundance of leucocytes and thrombocytes: an increase in the number of leucocytes (leucocytosis) was evident from 15 through 123 min and at 267 min; normal leucocyte counts, were observed at 3, 171, 219, 315 and 363 min, and at 12 h and 24 h. Lymphocytes are the major leucocyte cell type in the blood. Thrombocytopenia occurred at 15 and 27 min, and thrombocyte counts were held at normal levels at other recovery time intervals. There was no change in the abundance of erythrocytes in response to the imposed stress. Shock susceptibility of the fish for variables measured was similar in experiments performed during six different months of one calendar year. In addition, no significant seasonal or diurnal changes were recorded in the abundance of circulating blood cells. The results reported here, for the first time on a tropical teleost, do not agree with previous results obtained from temperate teleosts by other workers.


Hodgkin's disease: an evaluation of radiotherapy results.


The radiological features of cerebral torulosis.


Anomalous origin of the left vertebral artery and its significance in selective femoro-cerebral catheterisation.


The accuracy of the barium meal in the diagnosis of carcinoma of the stomach.


Amyloidosis causing right middle lobe atelectasis.


Bolus intravenous injection of contrast and sequential opacification in the diagnosis of pelvic masses.


Roentgen interpretation of ureteral deviation.


Coeliac-axis artery stenosis with aneurysmal calcification of the collateral supply.


Forearm bone destruction in leprosy.

Forearm bone destruction in leprosy.


Polycystic spleen -- an unusual cause of a left hypochondrial mass.


Further aspects of angiographic brain death.


Osteoporosis circumscripta cranii: its importance in brain scintiscanning.


Clinical investigation on splenic aneurysms and Gamna-Gandy nodules.


Tc(Sn) gluconate -- a species dependent radiopharmaceutical.


Contamination incidents resulting from the use of a 99Mo-99mTc generator.


Whole body scanning with 67Ga in the investigation of patients with lymphomas and suspected lymphomas.


Gel permeation chromatography.

Gel permeation chromatography.


Mass spectra of some intermediate compounds for the synthesis of prostaglandins.


Certain parameters of pulmonary circulation dynamics and gas exchange in the lungs and morphotic changes in lung tissue in dogs during cardiac arrest and immediately after resuscitation. The experiments were carried out in 33 dogs 60 min. to 12 hours after cardiac arrest was induced for 3-5 min by ventricular fibrillation. In 11 dogs closed chest cardiac massage was performed 30 min. and in 222 dogs defibrillation was used to restore heart function. The pulmonary and peripheral circulation was assessed on the basis of changes in arterial and venous blood pressure, cardiac output, vascular resistance, pulmonary shunting and capnographic determinations. The values of VA, VA/Vmin, V/Q, VDph, VD/VT, DuO2 and DuCO2, Pa-E'CO2, PaO2 were determined. Measurements of acid base balance, lactate and pyruvate levels and certain elements of blood clotting and fibrinolysis systems were performed. Moreover, lung biopsy was examined by light and electron microscopes. Functional determinations confirmed the presence of disturbances of lung perfusion and alveolar ventilation as well as disturbances in oxygen exchange at cellular level. The author suggests the term Resuscitation Lung Syndrome for these disturbances.


The effect of bone cement used for stabilization of endoprostheses on blood clotting system activity. The authors carried out studies of the blood clotting and fibrinolysis systems in 15 patients undergoing total endoprosthetic replacement of the hip joint with a McKee-Ferrara type of prosthesis and stabilized by Surgical Simplex Acrylic bone cement (North Hill Plastics, Ltd. London). The observations point to statistically significant changes in the blood clotting and fibrinolysis systems with a tendency towards hypercoagulation and intravascular clotting (DIC). Fibrinolysis activation associated with these changes is secondary, resulting among others, from the mechanism of the action of free fibrin monomers.


Electric stimulation in chronic headaches. Therapeutic electric stimulation in cases of chronic headaches was carried out in 150 patients. Migraine was diagnosed in 40 cases, common vasomotor headache in 63, cervical migraine in 24, Horton's neuralgia in 5 and complex headaches in 18 cases. The results are reported here, which were best in the cervical migraine syndrome, while in the typical migraine they were the least successful.


Experiences with dopamine in patients operated with the aid of extracorporeal circulation. In ten patients dopamine was used for counteracting low cardiac output during and after operations performed with aid of extracorporeal circulation. The changes of arterial and venous pressure, heart rate and one-hour diuresis were measured. In 8 cases the results of treatment were good. Particularly striking was the improvement of diuresis and lowering of the central venous pressure. The authors regard dopamine as a very effective inotropic agent.


An attempt at comparing the results of carboxyhaemoglobin level in blood and gasometric determinations in capillary blood in cases of carbon monoxide poisoning when treatment began at the place of accident. The authors observed disturbances of acid-base equilibrium and levels of carboxyhaemoglobin in 116 cases of CO intoxication. The patients were treated early -- at the place of the accident and during transport to hospital. Oxygen treatment was applied, the acid-base equilibrium disturbances were corrected, especially the metabolic acidosis by using alkaline substances. This management enabled rapid elimination of the poison from the organism and an improvement in the general condition of the patients.


Acute life endangering ethanol intoxication treated in the intensive medical care unit. Personal observations of 5 cases of acute life-endangering ethanol intoxication who were treated in the intensive medical care unit. The authors discuss the mechanism of ethanol-induced changes and the method used in the treatment of this intoxication. They also request that hospital laboratories should provide facilities for performing blood alcohol level determinations in emergencies.


Enflurane in anaesthesiological practice. Enflurane was given as the principal inhalatory agent in general anaesthesia in 75 patients aged from 17 to 55 years for gynaecological operations. Anaesthesia was conducted with muscle relaxation administering the drug in concentration of 0.2-1% vol. (mean maintenance concentration 0.6%). No cardiovascular, hepatic and renal disturbances were observed. The serum glucose level increased by a mean value of 64.8% during enflurance anaesthesia, however, it did not cross the renal threshold. Enflurane failed to ensure postoperative analgesia. The drug may be used as a valuable supplement to the presently used anaesthetic agents.


The role and the mode of action of the lubricants in tablets manufacturing.


Effects of some autonomic drugs on the electrical activity of intestinal circular muscle.


Hemispheric differences in discriminative reaction time to facial expressions: preliminary observations.


Regional assignments of the genes for fumarate hydratase and guanylate kinase on chromosome 1 and for lysosomal acid phosphatase and esterase A4 on chromosome 11.


Localization of the structural locus for cytoplasmic glutamic-oxaloacetic transaminase to region q24 leads to qter of human chromosome 10.


A preliminary analysis of the segregation of human hydroxyacyl coenzyme A dehydrogenase in human-mouse somatic cell hybrids.


Assignemnt of a gene for tryptophanyl-transfer ribonucleic acid synthetase to human chromosome 14.


Assignment of the locus determining inorganic pyrophosphatase to chromosome 10 in man.


Assignment and linear order of human acid phosphatase-2, esterase A4, and lactate dehydrogenase A genes on chromosome 11.


Retinoblastoma and chromosome 13.

Retinoblastoma and chromosome 13.


Radiation-induced segregation of syntenic loci: a new approach to human gene mapping.


Identification of a de novo chromosome rearrangement in a man-mouse hybrid clone and its bearing on the cytological map of the human X chromosome.


Localization of GOTs to the q24 leads to qter region of human chromosome 10.


Mapping the locus of the H-Y antigen.

Mapping the locus of the H-Y antigen.


Assignment of the human genes for mannose phosphate isomerase, pyruvate kinase (M2), and hexosaminidase-A to chromosome 15.


Assignment of hexosaminidase-B to chromosome 5, its segregation after diphtheria toxin selection, and the linkage of hexosaminidase-A, mannose phosphate isomerase, and pyruvate kinase (M2).


Expression of human hexosaminidase-A phenotype depends on genes assigned to chromosomes 5 and 15.


Assignment of the inorganic chromosome 10 in man.


Further data on the cytologic mapping of the human X chromosome with man-mouse cell hybrids.


Assignment of the peptidase D gene locus (PEPD) to chromosome 19 in man.


Assignment of the human gene for tryptophanyl-tRNA synthetase using human-mouse somatic cell hybrids.


Assignment of the human alpha-l-fucosidase gene locus to chromosome 1 by use of a "clone panel".


Report of the committee on the genetic constitution of chromosome 6.


Segregation of human mitochondrial thymidine thymidine kinase activity in human-mouse somatic cell hybrids.


Gene mapping by exclusion: the current status.


Linkage studies on familial hyperlipoproteinemia with xanthomatosis: normal lipoprotein markers and the C3 polymorphism.


Possible linkage between the Marinesco-Sjøgren syndrome and hypergonadotropic hypogonadism.


Linkage data on 3q11 and 15ps fluorescence markers.


Red cell glutathione reductase activity in patients with bone-marrow trisomy 8.


The Colton blood groups in monosomy 7 of the bone marrow.


The interpretation of lods in linkage analysis.


Probable linkage between essential familial hypercholesterolemia and third complement component (C3).


Chido blood group and the HLA region.

Chido blood group and the HLA region.


Rodgers blood group and the HLA region.

Rodgers blood group and the HLA region.


Gene linkage studies on glyoxalase I.

Gene linkage studies on glyoxalase I.


Further evidence for the assignment of the red cell acid phosphatase gene (ACP1) to the short arm of chromosome 2 from gene dosage effect.


A genetic linkage analysis of chromosome 6 markers Chido, HLA, and glyoxalase.


The locus for glyoxalase I (GLO) is between HLA-A and PGM3 on chromosome 6 of man.


Chromosome 6: linkage of the eighth component of complement (C8) to the histocompatibility region (HLA).


Linkage group I: the simultaneous estimation of recombination and interference.


Some lod scores concerning chromosome 1.


Bf locus and the HLA region.

Bf locus and the HLA region.


The linkage and mapping relationships of 1qh.


Family studies on esterase D and chromosome 13 in man.


A report on a family with a (1;2) translocation: cytologic and linkage analysis.


Expression of human X-chromosomal markers in man-Chinese hamster hybrids treated with isolated human chromosomes.


Human gene locations achieved by means of human-Chinese hamster (CHO-K1) auxotrophic cell hybridization.


Unreliability of the microcomplement fixation method for Xga typing of cultured fibroblasts.


Genetic linkage of a locus for erythrocyte glyoxalase (GLO) with HLA and Bf.


Chromosomal gene transfer: prospects of a new method for mapping closely linked human genes.


Mapping of genes and adenovirus-12-induced gaps using chimpanzee-mouse somatic cell hybrids.


Chimpanzee gene mapping.

Chimpanzee gene mapping.


Gene mapping by somatic cell hybridization in species other than man.


Report of the committee on the genetic constitution of the X and Y chromosomes.


Clues to homologous regions in mammalian autosomes.


Comparative gene mapping of HPRT, G6PD, and PGK in man, mouse, and muntjac deer.


Report of the committee on unassigned linkage groups.


Report of the committee on nomenclature.


The location of RN5S genes on the chromosomes of primates.


Report of the committee on the genetic constitution of chromosomes 1 and 2.


Report of the committee on comparative mapping.


Proposed banding nomenclature for the Chinese hamster chromosomes (Cricetulus grises).


The gene for the species antigen on human chromosome 11 is on the short arm.


A guarded word of welcome.

A guarded word of welcome.


Regional mapping of the X-linked gene for a human cell surface antigen, SA-X.


The crisis of custody: how a psychiatrist can be of help.


Assignment of the genes for human glyoxalase I to chromosome 6 and for human esterase D to chromosome 13.


Custody proceedings: battlefield or peace conference?


Johnnie and Suzie, don't cry: Mommy and Daddy aren't that way.


The devil's advocate.

The devil's advocate.


Federated Council for Internal Medicine. Position papers on the internist and primary care.


Legal implications of behavior modification programs.


Viewpoint: health manpower.

Viewpoint: health manpower.


Critical implications of National Health Insurance.


Government looks at clinical competence.


College Life Plan has several options.

College Life Plan has several options.


Society looks at clinical competence.

Society looks at clinical competence.


Preliminary information on antimicrobial study is ready.


Medical liability: update.

Medical liability: update.


Insurance premiums and taxes.

Insurance premiums and taxes.


Federated Council for Internal Medicine: position on an integrated health manpower policy for primary care.


Cryosurgery in removal of orbital tumors. Two cases in which medially placed retro-orbital tumors were approached transfrontally have been presented. The computerized tomographic scanner was important in the localization of both lesions. Although of different histologic types, both tumors were friable and vascular. This friability and vascularity would have caused severe difficulties in removal had it not been for the facility with which a cryoprobe froze and grasped tumor tissue. The importance of this instrument, previously unemphasized, has been pointed out.


An autopsy case of the Dandy-Walker syndrome.


Alteration of calcium metabolism in chronic pancreatitis.


A scanning electron microscopic study of rat liver sinusoids.


An autopsy case of carcino-sarcoma of the liver.


Intraocular pressure rise and secondary degeneration of the optic pathway.


Occlusion of the central retinal vein: revealing symptom of intraocular pressure-rise.


Essential tremor in Papua, New Guinea.

Essential tremor in Papua, New Guinea. The clinical features of 175 cases of essential tremor are related. This disorder is prevalent among a population of the Eastern Highlands of Papua New Guinea. It affects predominantly women in middle and old age; only 27 per cent of the cases were males. The disorder is slowly progressive and significant disability appears in elderly women when the trunk muscles are involved. Epidemiological studies have shown that the presence of tremor can be correlated with linguistic distinctions between high and low prevalence populations. Although only 30 patients reported a first degree relative with tremor, the syndrome would seem to stem from a genetic predisposition. In a number of patients essential tremor appeared to be associated with Parkinson's disease.


The diagnosis of congenital unilateral third-nerve palsy. Sixteen cases of congenital unilateral third-nerve palsies collected from the records of the Wilmer Eye Institute and The Johns Hopkins Hospital over twenty-one years are reviewed. Their aetiology, clinical features, differential diagnosis and prognosis are discussed. Their benign nature with respect to absence of associated neurological disease and the high probability of their causing amblyopia and aberrant regeneration are emphasized.


The state of the speciality.

The state of the speciality.


Defence mechanisms in middle childhood.

Defence mechanisms in middle childhood.


Pre-senile dementia presenting as a depressive illness. A case report.


Medicolegal aspects of transsexualism.

Medicolegal aspects of transsexualism.


Treatment of drug-induced psychosis with diphenylhydantoin.


Lynching : a psychiatrist's view.

Lynching : a psychiatrist's view.


Suicide and prevention centres.

Suicide and prevention centres.


Serological survey of arbovirus infection in Sri Lanka.


Empyema thoracis in infancy and childhood.


The cardinal features of the ten-year national health plan of the Republic of Zambia.


The clinical presentation of trap-gun injuries.


Meningococcal septicaemia.

Meningococcal septicaemia.


Acute respiratory distress following nitrofurantion therapy.


Transitional cell papilloma of the nose with malignant termination.


Laboratory diagnosis of syphilis.

Laboratory diagnosis of syphilis.


Murugesar Sinnatamby oration 1974. Obstetric and gynaecologic complications associated with a bicornuate uterus.


Screening for breast cancer--a report of II 654 examinations.


The selection of patients for breast cancer screening--is there a role for psychological testing?


Delay in presentation of women with breast disease.


Radical mastectomy: an analysis of 306 patients.


Intermittent compression for lymphoedema of arm.


Shoulder movement following mastectomy.

Shoulder movement following mastectomy.


Axillary recurrences after selective treatment of the axillary nodes in cancer of the breast.


The management of locally advanced breast cancer by X-ray therapy.


Metastatic carcinoma within the breast.

Metastatic carcinoma within the breast.


Concomitant androgen therapy in the management of advanced breast cancer by cyclical combined chemotherapy.


Chemical phlebitis after nitrogen mustard injection.


Predictors of drug use.

Predictors of drug use.


Effects of an oral hygiene information film.


Problems in the delivery of health care.


The psychology of violence.

The psychology of violence.


Equalities and inequalities: real and imagined.


Risks of everyday life.

Risks of everyday life.


Speech problems among children in a national survey: associations with hearing, handedness and therapy.


A solution to the problems of problems of providing refreshment at work.


Aspects of modern meat technology.

Aspects of modern meat technology.


Community roots of delinquency.

Community roots of delinquency.


The Yo-Yo Syndrome and the community.

The Yo-Yo Syndrome and the community.


Professionals in health service administration.


Aspects of hostel facilities for the mentally ill in Greater Manchester.


Microwave ovens. 1. How well do they cook?


The university environment in relation to mental health in Sudanese students.


Two-fold interindividual variation in plasma protein binding of phenytoin in patients with epilepsy. Plasma protein binding of phenytoin (diphenylhydantoin) in 63 epileptic patients was investigated with an ultrafiltration technique at room temperature using 14C-labelled phenytoin. A strong correlation was found between the total and the unbound drug concentration (r = 0.97, p less than 0.001). The unbound phenytoin fraction was 7.1 +/- 1.0% with a range of 4.9 to 10.2%. This variation is considerably less than that reported recently by different authors. Individual phenytoin binding was reproducible when the determination was repeated several weeks later. Salivary phenytoin concentrations in 33 epileptic patients were significantly correlated to the unbound (r = 0.83) and total concentrations (r = 0.82) of phenytoin in plasma. This study confirms that the clinical practice of monitoring total phenytoin plasma concentrations is sufficient, since the unbound phenytoin fraction has only a 2-fold interindividual variation in epileptic patients, provided that they do not suffer from renal or hepatic disease.


Microwave ovens. 2. Is microwave leakage hazardous?


How to buy a hearing aid. Part 1. What consumers should know.


The replacement child--a developmental tragedy: some preliminary comments. Some of the clinical and theoretical issues thought to be involved in the psychology of "replacement children" are discussed. A developmental framework is proposed within which to view such children. The replacement child is becoming an identifiable clinical syndrome, and a developmental framework is sorely needed to encourage more systematic research. A replacement child perceives his status differently on both a cognitive and emotional level within the context of each developmental phase, and the affective and associative links need to be reworked each time. We view the status of being a replacement child as a developmental interference insofar as demands are placed on the child's immature ego which he might not yet be equipped to cope with.


The well-baby clinic.

The well-baby clinic.


Neonatal prediction and outcome at 10/11 years.


Applying the guidelines of Beyond the Best Interests of the Child. Although the wisdom of the guidelines advocated in Beyond the Best Interests of the Child for making custody and visitation decisions is widely proclaimed, the realities of existing statutes and procedural systems preclude their simple application to present-day custody cases. It is the purpose of this paper to join the efforts of others in attempting to delineate how the theoretical policies and abstract strategies comprising these guidelines can be implemented under the constraints of present realities. This effort takes the form of three disguised cases to which is added the author's commentary on his interventions and recommendations.


Localization of the lactate dehydrogenase (LDH) and of the acid phosphatase (AP) in liver cells of embryos and chickens irradiated with gamma rays.


Effects of apomorphine, pimoside, theophylline, meta-tolylcarbamide and diazepam on the picrotoxin convulsive-seizure threshold.


Collagen biosynthesis in the aorta of spontaneously hypertensive rats.


Cytogenetic investigation of cells from primary kidney culture of Testudo graeca.


Histological classification of Kaposi's sarcoma. A basis for chemotherapy.


Q fever in Kenya. Serological investigations in man and domestic animals.


Reduplication of distal femur. A case report.


Urinary tract pathogens and antibiotic sensitivity patterns in Dar es Salaam.


The relationship between systemic and ear-capsule blood pressure measurement.


Pelvic inflammatory disease associated with Enterobius vermicularis in the endometrium.


Kala-azar in Ethiopia: sandflies (Diptera: Phlebotomidae) of Southwest Ethiopia.


Surgical treatment of duodenal obstruction of vascular origin.


Kala-azar in Ethiopia: survey and leishmanin skin test results in the middle and lower Awash River Valley.


Structure-activity relationship in hypertensive steroids.


Kala-azar in Ethiopia: the phlebotomid sandflies of the Awash River Valley.


Why do Tc-99m chelates work for cholescintigraphy? There are four structural requirements for substances that are excreted by the liver: 1. Their molecular weight is between 300 and 1,000. 2. They are organic anions. 3. They contain at least two ring systems in the molecule. 4. They are bound to serum albumin. All the Tc-99m chelates suggested for cholescintigraphy fulfill these requirements. For the first time a rational for their efficacy is provided.


The correlation between liver scintigraphy and serum CEA levels in the detection of liver metastases from rectum carcinoma. A retrospective study. Radiocolloid liver scintigraphy for the detection of liver metastases is widely used. Because of the known limitations of this technique we investigated the correlation between liver scintigraphy and serum CEA levels in patients with a confirmed diagnosis of primary rectum carcinoma. The serum CEA level is not suitable as a screening test for cancer, but it can be helpful as an extra parameter for the detection of liver metastases. The correlation between liver scintigraphy, the serum CEA level and the clinical findings has also been studied. A good correlation between liver scintigraphy and the serum CEA level was found. Serum CEA levels can be helpful in facilitating the evaluation of liver scintigraphy in patients with carcinoma of the rectum.


A note to "Radiochemical purity of various 99mTc-labelled bone-scanning agents".


The use of 123I labelled oestradiol in detecting the human prostate using a gamma camera. 123I labelled oestradiol was administered into patients with either benign hypertrophy or malignancy of the prostate, in order to detect the prostate. Using a gamma camera the results showed considerable radioactivity in the bladder-prostate region. The exact anatomical position of the prostate was determined by emptying the bladder and introducing 123I labelled sodium iodide into the balloon of the catheter already inserted in the bladder. The results demonstrated that the detected radioactivity in this region was in the bladder rather than the prostate. This conclusion was later confirmed by the presence of high level of the radioactivity in the urine and the extremely low concentration of the radioactivity in the prostate after the removal of the gland.


Bone imaging after total replacement arthroplasty of the hip joint. A follow-up with different radiopharmaceuticals. Bone imaging was done in patients after total replacement arthroplasty of the hip joint every 3rd month using 99mTc-HEDP and 18F. Uptake ratios were estimated over cup/normal hip and femur prosthesis/normal thigh. Ratios decline rapidly and reach a stable level 6-9 months, postoperatively. Eight cases of late infection were predicted correctly 1-3 months before any radiologic evidence was present. In four cases there had been false-positive results with 99mTc-HEDP while 18F gave always correct information except in cases of soft tissue inflammation. Here both 99mTc-HEDP and 18F ratios were elevated. The early diagnosis of late complications after replacement arthroplasty seems to be possible. The clinical significance, however, is low: only one out of eight patients with manifest infection is still on conservative treatment. Bone imaging should be done to exclude late infection as a cause of pain after total replacement arthroplasty of the hip joint only.


The assessment of time-dependent changes in human performance. This paper discribes a series of experiments to illustrate the use of various methods of time series analysis in the delineation of the effects of circadian and ultradian cycles on human performance. These experiments are concerned with measures of both human performance and physiology. They illustrate how the parameters of these time series analytic techniques can be used to postulate physiological mechanisms where time-dependent changes have been shown to be significant. The use of analytic techniques in both the time and frequency domain is illustrated.


Experimental examinations on the suitability of organoaminomethane-bis-phosphonic acids for bone-scintigraphy by means of Tc-99m in animals. Phosphororganic compounds of the general formula R2N-CH (PO(OH)2)2 were examined for their Tc-99m-labelability and suitability for bone-scintigraphy. Compared to Tc-99-m-Sn-EHDP (Hydroxyethane-1,1-diphosphonic acid), four compounds showed a better concentration in the sceleton, while three compounds remained beneath comparative values.


Circadian rhythmic aspects of human cardiovascular function: a review by chronobiologic statistical methods.