Immunoreactive serum opsonic alpha 2 sb glycoprotein as a noninvasive index of RES systemic defense after trauma. Reticuloendothelial system (RES) depression has been correlated with diminished resistance to trauma, shock, and sepsis in man and animals. Previous studies have related the depression of RES hepatic Kupffer cell phagocytic function after trauma to diminished bioassayable opsonic activity. The present study determined if the loss of biological activity and RES alteration correlated with immunoreactive serum opsonic alpha 2 SB glycoprotein levels after trauma. Serum opsonic activity was measured by liver slice bioassay, and immunoreactive opsonic protein was measured by rocket electroimmunoassay. RE function was determined by colloid clearance over a 24-hour post-trauma period. Anesthetized rats (250-300 gm) subjected to sublethal or severe (greater than LD50) whole-body NCD trauma were the shock models investigated. Immunoreactive levels in 63 rats prior to injury were 518 +/- 24 microgram/ml. Neither biological nor immunoreactive levels were altered over 24 hours in anesthetized sham-traumatized controls. Temporal alteration in the initial decrease and recovery pattern of biologically active and immunoreactive opsonic protein levels significantly correlated following both sublethal and severe injury. Moreover, the patterns of immunoreactive levels of the opsonic protein correlated with the functional phagocytic activity of the RES as determined by vascular clearance of a test dose of blood-borne radiolabeled particulates. This glycoprotein falls after trauma, and the magnitude and duration of the decline increases with severity of injury. Immunoreactive opsonic alpha 2 SB glycoprotein appears to be an accurate measurement of circulating opsonic activity and RE Kupffer cell function after trauma, especially with respect to clearance. Thus, immunoreactive opsonic protein warrants clinical consideration as a noninvasive measure of reticuloendothelial systemic defense in patients after trauma and burn.


The work of the health service commissioner.


Poisoning 1978--a medical problem, or a social lesion.


Oxygen consumption in canine skeletal muscle following massive saline infusion. To study the effect of interstitial edema on tissue oxygen transport, we infused buffered isotonic saline solution at a rate of 200 ml/kg/hr into mongrel dogs for two hours, measuring oxygen delivery and consumption in a skinned, innervated hindlimb. Hematocrit dropped gradually to 10.8 +/- 3.9%. Muscle water content increased 13% (P less than 0.05). However, oxygen consumption did not change significantly from control of 0.228 +/- 0.029 ml/min/100 gm. Femoral venous oxygen tension fell from control of 62.6 +/- 2.6 mm Hg to 31.4 +/- 2.3 mm Hg. Mean arterial flow increased to nearly twice the control level of 12.5 +/- 1.1 ml/min/100 gm and fell gradually, with the sustained 50% drop in vascular resistance largely explained by expected decreases in blood viscosity. We conclude that interstitial edema did not cause a significant defect in canine skeletal muscle oxygen utilization.


Photocoagulation as treatment for severe diabetic retinopathy.


Comparison of the organization of legal medicine and of medical law in the Anglo-Saxon countries and in the countries whose laws are influenced by the Roman law. The situation in the United Kingdom.


The principles or organization of the forensic medical service in the clinical centre of Novi Sad (Yugoslavia).


Clinical spectrum of iatrogenic lung disease.


Transfusion lung.

Transfusion lung.


Acute and late changes following irradiation of the lung.


Pathological pulmonary changes on an iatrogenic basis.


Lung diseases caused by "drug"-abuse. Pulmonary complications of drug-abuse.


Neardrowning in seawater (Curacao).

Neardrowning in seawater (Curacao).


New diagnostic and therapeutic developments in lung diseases. Computed tomography scanning of the mediastinum in the staging of bronchogenic carcinoma: a prospective radiologic-pathologic study. A preliminary report.


Could he have aspirated? Mendelson's syndrome.


Value of gallium 67 scan in the evaluation of mediastinal involvement in lung cancer.


Effect of negative aero-ions on patients with chronic obstructive lung diseases.


Depressed cell-mediated immunity in chronic dermatophytic infections. The immune response was studied in ten patients with benign dermatophytosis, and in five patients with a severe affection. At the humoral level no deficiencies were observed in both groups. However, all patients showed a marked and constant increase in IgE level. Skin test response in various concentrations of antigens as well as studies of activation of lymphocytes by specific and non-specific mitogens in vitro have demonstrated a depressed cell-mediated immunity. This anergy, however, is not an "all-or-none" phenomenon; it varies and there seems to be a direct relationship between the state of anergy and the severity of the cases. Furthermore, certain discrepancies were observed between the in vivo and in vitro responses suggesting that defective cellular immune reactions in dermatophytosis may be symptomatic of a lack of some humoral factor and do not necessarily reflect an intrinsic cellular defect. Finally, among these 15 patients, 7 were brothers and sisters from 3 separate and unrelated families, suggesting an autosomal hereditary influence.


Rehabilitation in the Federal Republic of Germany.


Rehabilitation medicine in the Sudan.

Rehabilitation medicine in the Sudan.


Rehabilitation of the handicapped in Mexico.


Somatic recombination and mosaic structure of immunoglobulin genes.


The stages of recovery from severe head injury with special reference to late outcome. Ten years research into the physical and psychosocial consequences of severe brain damage in adults has revealed substantial information about the process of recovery. The main features are evidence that the greater part of physical and mental recovery occurs within six months of injury and that in most cases the mental consequences of injury outweigh the physical ones and place the greater burden upon the injured person's relatives. Impairment of memory is the most common cognitive disorder and alterations in personality often occur also and are the most taxing of the mental deficits for all concerned. The process of recovery has three stages, in the first the patient is unconscious, in the second he or she regains full consciousness signified by the end of the period of post traumatic amnesia and continues to show evidence of rapid improvement in basic physical and mental functions. The rate of recovery shows within six months of injury in most cases and this represents the end of the second stage. In the third stage, which may last for many months, both the patient and his or her relatives adapt to the residual disabilities of the former. Methods of managing the three stages should include physical, psychological and social techniques and the way in which they may be linked to the patients' differing physical and psychosocial needs during the three stages of recovery are briefly discussed.


Psychological consequences of blunt head injury. 89 severely closed head injured cases were tested on measures of verbal learning, and verbal and nonverbal intelligence, and their performance was compared with that of 30 orthopaedic cases. Head injured cases had severe deficits on all the tests. Severity of injury (judged by post-traumatic amnesia duration) was significantly related to poor performance on the learning and nonverbal intelligence tests, but not on the verbal intelligence test. The effect of injury on the family was studied in a further group of 35 head injured cases, showing that family burden within six months of injury was related to the presence of childish behaviour and loss of interest in the patient, together with other behavioural and affective changes. Physical deficits were not significant in this respect.


Cognitive recovery during the first year after severe blunt head injury. Cognitive recovery was examined in 24 severe closed head injured patients tested at 3, 6 and 12 months after injury, and 12 patients tested, in addition, at one month. A retested non-head injured control group was used, and where appropriate, alternative test forms were employed to control for practice effects. Tests of intellectual, perceptual/constructional skills, linguistic and memory functions were used, showing that by 12 months the only statistically significant differences between head injured and control patients were on learning and constructional tasks. Individual patients showed widely varying recovery patterns which made prediction of recovery difficult.


Recovery curves: uses and limitations.

Recovery curves: uses and limitations.


Orthopaedic surgery in the rehabilitation of geriatric patients.


Recovery curves in a visual search task. A visual search task was administered to eighteen neurosurgical patients and fourteen control subjects on four occasions over a period of six months. Improvement occurred during the first five postoperative weeks but there was evidence of persistent impairment when patient performance was compared to control performance - the comparison makes use of a simple mathematical model.


Rehabilitation medicine in Sweden. Part 2 - Education and research.


Management of rheumatoid arthritis in the community.


An examination procedure for cavo-adducto-varus. This examination is used in cava-adducto-varus feet to determine the primary areas producing the secondary forefoot pathology. Table I is a compilation of the data and shows by means of an asterisk those pathologies possible with an additional primary deformity. The fold face test parts, when indicated in the exact order, are diagnostic. Once the primary areas have been elucidated, the remaining components are secondary, and the prognosis of biochemical and specific surgical treatment can be made. The specific treatment procedures and their rational use will be discussed in a future presentation.


Compression screw fixation in proximal first metatarsal osteotomies for metatarsus primus varus: initial observations. Many methods of fixation have been used after proximal abductory metatarsal osteotomies for the correction of metatarsus primus varus. The methods include external immobilization and the application of devices such as stainless steel wire, Kirschner wires, staples, and compression plates. We have combined external immobilization with compression screw fixation across the osteotomy site. Two different types of screws were used: 1) an AO screw 3.6 mm. wide and 26 to 28 mm. long and 2) a standard Woodruff screw 3.5 mm. wide and 31.8 to 44.4 mm long. Twenty-two procedures were reviewed. When we compared the results, we found the AO screw to be superior in the degree of rigid fixation which it provides, as judged by the extent of postoperative callus formation.


Congenital metatarsus adductus: clinical evaluation and treatment. Congenital metatarsus adductus, a deformity at the tarsometatarsal joints in which the metatarsals are deviated internally in relation to transverse plane, predisposes to "pigeon-toed" gait. Treatment is aimed at achieving normally balanced foot by overcorrection at the deformity sites. The most common problem after treatment is pronation deformity, which can be avoided by carefully positioning the heel at the time of casting. The sooner conservative measures are instituted, the more easily and rapidly the deformity will be corrected. If conservative casting does not result in improvement, then soft tissue surgery is indicated.


Alternative approaches to replacement of lesser metatarsal heads.


Frostbite: its diagnosis and treatment.

Frostbite: its diagnosis and treatment. The treatment, diagnosis, and outcome of frostbite victims is by no means an exact science. As this presentation shows, most authors agree that the key to control and treatment of cold injury comes from a reversal of the damage to the microvasculature (19). The methods of diagnosis of the extent of damage are all based on determination of vascular status whether it be tissue or bony structures. Treatment varies widely but rapid rewarming of the affected tissues is by far the most successful treatment to minimize tissue loss. As in the case study presented here, when surgical amputation is necessary, one must take mechanical function into account as well as the line of demarcation in order to give a functional limb for rehabilitation and to prevent the possibility of subjecting the patient to unnecessary repetitive surgical procedures.


Surgical correction of metatarsophalangeal joint dislocation and arthritic deformity: the partial head and plantar condylectomy. The partial head and plantar condylectomy has been presented as a procedure indicated in the correction of dislocated metatarsophalangeal joints. Although there may be a number of causes of dislocation, the surgical correction is the same. A skin plasty is useful in preventing a cocked-up toe, and this is performed at the plantar aspect of the base of the toe. A V-osteotomy, or other metatarsal dorsiflectory procedure, is recommended when the neighboring metatarsal is only slightly plantar flexed or greater. This prevents the occurrence of transfer lesions so commonly associated with this procedure. Two case studies have been presented demonstrating successful results when the procedure is performed on both the second and third metatarsophalangeal joints. We contend that the partial head and plantar condylectomy is a valuable procedure in reconstructive surgery of the foot.


Hallux amputation: a case report.

Hallux amputation: a case report.


Sural nerve entrapment: an unusual case report.


Non-joint destructive procedure for long great toe with abductus deformity (a retrospective study). Excessive great toe length may be attributed to an unusually long first metatarsal, proximal phalanx, distal phalanx, or a combination of two or all three components. The procedure proposed here is not recommended for deformity existing in conjunction with a long first metatarsal or a pathologic first metatarsophalangeal joint. It has been used in mild to moderate hallux abductus or abductovalgus associated with intact first metatarsophalangeal joint cartilage and a long great toe.


Psychiatry in Egypt to-day.

Psychiatry in Egypt to-day.


The problem of typifying schizophrenia guided by the Egyptian Diagnostic Manual DMP-I.


Experiences with group psychotherapy in the Egyptian culture: the public hospital setting.


Family structure of the Egyptian asthmatics.


Diagnosis of schizophrenia in Egypt: a within national comparison.


Epithelioma of the anus in sisters.

Epithelioma of the anus in sisters.


Sequelae of mid-trimester abortions induced by extra-amniotic drip infusion of normal saline. The results of a survey conducted in a group of 60 women, three years after they underwent induction of mid-trimester abortion by extra-amniotic infusion of isotonic saline solution, are presented. The aim of this method for induction of abortion can affect the patients' fertility and the outcome of their subsequent pregnancies and deliveries. In the group we recorded 39 pregnancies, of which 9 were undesired. Of the 30 women who wished for another pregnancy, 29 became pregnant without difficulty and one after treatment for intrauterine adhesions. Twenty-four (80%) of the pregnancies ended with spontaneous deliveries, five of which (16.6%) were premature deliveries, 4 (13.3%) by spontaneous abortions and in one case (6.7%) a cesarean section was performed. The results obtained using our procedure are similar to those reported for other methods for induction of abortion, and especially by the intra-amniotic infusion of hypertonic saline. In our series we have recorded no immediate complications. All patients received preventive antibiotic treatment and in all of them a manual exploration of the uterine cavity was performed in order to avoid the formation of intrauterine adhesions.


Omental transplantation for chronic occlusive arterial diseases. Problems of surgical indication and technique for the treatment of chronic occlusive arterial diseases remain unresolved, especially in the cases which show poor angiogram run-off. To establish the surgical technique of omental transplantation, anatomical findings of the omental vessels were studied. The anatomical findings of the omentum were classified into two types. Type I (single layer) and Type II (double layer), and subdivided into seven subtypes according to the number of omental arterial branches. Omental transplantation was performed in our clinic in 19 cases (20 limbs) and surgical results were satisfactory. The examination of microscopic findings of the implanted omentum and the ischemic muscle of the implanted limb by consecutive serial sections suggested that the vessels of the omentum might invade the ischemic muscular tissue and supply blood to the muscle. Omental transplantation should be considered one of the most useful surgical techniques in cases with poor angiogram run-off.


Psychosexual attitudes in the female following sterilization. This study represents a three year follow-up, summarizing the psychosexual attitudes of 120 patients who were sterilized with tubal occlusion by one of three methods: culdoscopy, laparoscopy or postpartum laparotomy. The results indicate that most patients had a favorable impression of the procedure with little significant change in their sexual habits. Eight per cent of patients expressed regret at not being able to have more children. The frequency of coitus remained largely unchanged.


Post-hysterectomy morbidity after previous punch cervical biopsy plus diagnostic curettage. The post-operative morbidity of 70 patients who underwent total abdominal hysterectomy five to thirteen days after punch-biopsy of the cervix uteri and diagnostic curettage was compared of that of a control group of patients, with hysterectomy alone. It was observed that the sequence punch-biopsy hysterectomy presented a significantly higher post-operative morbidity. This increase was mainly due to higher parametritis, excessive vaginal discharge and wound infections rates. The interval between the two operations was also found to influence the post-hysterectomy morbidity, which seems to decrease with longer intervals.


Cesarean section for the delivery of the second twin.


Wertheim hysterectomy: a ten year experience. This study covers 230 Wetheim operations. Sixty-seven patients had Stage II carcinoma (29.17%), and 163 patients had Stage I carcinoma (70.80%). Until 1968, x-ray treatment was used after the Vienna Wertheim operation, but since then the approach has changed. Tele- and brachio-cobalt therapy is now included. The operative death-rate was 0.96%. One patient died of peritonitis, another of renal uremia. In the Vienna Wertheim group, ureteric fistulae occurred in 7.23% of patients. With the introduction of mesentery and the ureter roof into the Wertheim procedure, ureteric fistulae have currently disappeared from the material examined (133 cases), although the operation was more radical than the classical Vienna Wertheim technique. Urography examination shows that changes are twice are frequent, and later anatomical changes in the urinary system are more than twice as frequent, with the Vienna Wertheim technique. A considerable number of early hydronephroses were found to have disappeared during the first year. Urography examination has shown that the mesentery of the ureter also has a beneficial effect on the flow of urine. It serves in the prophylaxis of fistulae, and prevents greater displacement of the ureter in the parametrial vacancies.


Perinatal rupture of genital varicosities.


Multicentricity of breast carcinoma: a case against partial mastectomy. One hundred and seventy-three mastectomies for carcinoma of the breast during a two-year period were reviewed for multicentric foci in the pathologic specimen. There was a total of 38 cases of multicentric carcinoma, comprising 22%. Sixty-two percent of all carcinomas presented as clinical Stage A and B, of these, 21% were multicentric. It is our opinion that except for certain extenuating circumstances, the procedure of choice for carcinoma of the breast is either a modified or standard radical mastectomy.


Stress fracture of ribs in late pregnancy.


Traumatic ventricular septal defect: a case of early repair and review of the literature. We present a case of traumatic ventricular septal defect following a stab wound of the heart. The patient was operated on within the first 24 hours after being injured, because the hemodynamic situation had deteriorated; he is well 31 months postoperatively. From the literature reviewed, it is apparent that most of such lesions should be corrected early, since these patients are exposed to the continued risk of symptomatic cardiac dysfunction, and repair offers an excellent prognosis with minimal morbidity.


Pulmonary resections with staplers.

Pulmonary resections with staplers. The use of mechanical stapling devices for closure of the bronchus, pulmonary arteries and veins and lung parenchyma in twenty-six consecutive patients undergoing various types of pulmonary resection is presented. There have been no complications.


Wedge osteotomies for correction of hallux abducto valgus with case histories.


Aberrant pancreatic tissue in the wall of the gallbladder: report of a case simulating gallstone disease.


Surgical treatment of thrombotic occlusion of pelvic veins. During a three-year period, 20 patients were operated on for acute thrombosis of the pelvic veins. Seventeen of them underwent a thrombectomy and the remaining three had a femorofemoral bypass after Palma. As regards long-term results in 18 patients, between one and four years postoperatively, phlebography in the thrombectomized group revealed ten open and five occluded vessels. Two patients died. In the group with bypass, two grafts were open. The relatively good results in spite of delayed intervention (in some cases eight or nine days after occlusion) suggest that even if performed after the generally accepted six day deadline, it is worthwhile to attempt an operation. The importance of an early diagnosis is stressed; among the many characteristic symptoms "heaviness" of the affected limb is an early complaint which aids diagnosis.


Leg pains in athletes.

Leg pains in athletes.


Septisol foam antiseptic.

Septisol foam antiseptic.


Economic planning in clinical medicine.

Economic planning in clinical medicine.


Adrenalectomy for disseminated breast cancer. Forty-three patients (two males and 41 females) were submitted to bilateral adrenalectomy for disseminated mammary carcinoma. Several factors were considered for their prognostic value in predicting the response to endocrine ablation. The age of the patients, the treatment of the primary lesion, the free interval, the location of metastases and the involvement of regional lymph nodes did not affect the response to adrenalectomy. Response to therapeutic castration was directly correlated to the response to adrenalectomy (P less than 0.01); this is a valuable predicting factor that should be taken into consideration before proceeding to bilateral adrenalectomy. A statistically significant variation in survival between the responders and nonresponders was found (P less than 0.05). Finally, the high response rate to the operation (53.4%) can be attributed to the complete removal of the adrenal tissue during the operation.


Colonic cancer and associated diverticulitis. In a total group of 385 cases of colonic cancer, there was evidence of associated diverticulitis in 42 cases. Of these, 92% of the patients were over 60 years of age. In 45% of the cases the coexisting lesions were located in the sigmoid colon. It is suggested that cancer of the colon contributes to the development of diverticulosis and diverticulitis; this is confirmed by the finding of 52.8% of the total group of diverticulosis (98 cases) complicated by diverticulitis. Signs of diverticulitis may mask the presence of cancer, and the diagnosis of associated lesions is sometimes difficult. The patient's history and repeated radiographic studies play an important role in the detection of associated cancer. The final diagnosis is confirmed by pathologic examination.


The significance of the os trigonum.

The significance of the os trigonum.


Podiatric surgery on the elderly.

Podiatric surgery on the elderly.


Use of labor graphs in a community hospital. The large series reported by Friedman have established the importance of the time factor in relation to cervical dilatation and station of the presenting part during labor. Variations of the rate of dilatation and descent may be evident using a graph with the upper values of normal. This study was conducted in a Community hospital with an average of 200 deliveries a month. The attending physician followed labor as usual, unaware of the graphic recordings. The outcome of the labors with normal and abnormal graphic patterns were compared. There was a correlation between the abnormal labor pattern, arrest of cervical dilatation, with abdominal deliveries and lower apgar scores. The recognition of abnormal labors does not require a profound understanding of labor nor the range of normalcy.


Early surgical intervention for Freiberg's infraction: autogenous epiphysiodesis.


Keratoacanthoma: case presentation and discussion. Keratoacanthomas are rather common, rapid growing skin tumors, in which may occur as solitary lesions or in the form of multiple lesions. Multiple forms involve the palms of soles, and their source is unclear. On area where hair grows, these lesions originate from the infundibular areas. Many environmental and traumatic influences are implicated as potential etiologic factors. Keratoacanthomas should be differentiated clinically and histologically from squamous cell carcinomas, prurigo nodularis, and chronic paronychia. Treatment varies according to the type of lesions, but solitary lesions should be excised in toto.


Replacement of vertebral body with acrylic in plasma cell myeloma.


Accessory abductor hallucis: a case report.


Naviculo-cuneiform coalition: a case report.


Talectomy leading to an ankle fusion: a case history.


Squamous cell carcinoma: case report.

Squamous cell carcinoma: case report.


Benign stromal fibromatosis on the dorsum of the foot: a case report.


Surgical correction of severe hammer digit syndrome: a case report. Survivors of a stroke are forever in a battle for complete recovery. Signs and symptoms of the initial stroke may remain. Patients who has had a stroke may retain some of their initial manifestations, e.g., hemiparesis. Limbs that were initially paralyzed will usually retain signs of upper motor neuron damage. This patient demonstrated such a situation, and we felt that the proper treatment in this case of severe hammer digit syndrome was modified Lambrinudi fusions.


Prevalence of HBs-Ag in schistosomiasis. (A) general aspects. Nine hundred and sixteen schistosomal patient together with 97 non-schistosomal controls were examined for the presence of HBs-Ag and anti-HBs in their sera by counter-immunoelectrophoresis (CIEP). The results are reported and statistically analysed. HBs-Ag, anti-HBs and the exposure rate were found significantly higher in schistosomal patients than in controls. The frequency of HBs-Ag was not significantly different in the active and inactive schistosomal groups, while the anti-HBs was significantly higher in the inactive group. S. mansoni-infected cases showed significantly higher frequency of HBs-Ag and anti-HBs than cases with S. haematobium. The prevalence of HBs-Ag was highest between 20-39 years of age in the schistosomal group, while the anti-HBs was maximum at the age of 30-39 years. There were no sex differences in the prevalence of HBs-Ag and anti-HBs in both schistosomal and control groups. However, a significantly higher frequency of anti-HBs was found between male patients and male controls. The same was true for females. Patients with history of parenteral anti-bilharzial treatment and blood transfusions were accompanied with significantly higher percentage of HBs-Ag and anti-HBs. The importance and significance of the results are discussed.


Prevalence of HBs-Ag in schistosomiasis: B-frequency in various stages of schistosomiasis. The study included 916 schistosomal patients and 97 controls. The prevalence of HBs-Ag and anti-HBs was significantly higher in the bilharzial patients compared to controls. Their frequency was higher in the ascitic than the hepatosplenic group, and the difference between each and the simple group was highly significant. Cases with current jaundice showed highly significant frequency of both HBs-Ag and anti-HBs compared to those with no history or manifest jaundice at the time of study. In addition, cases with raised bilirubin, SGPT and SGOT showed significantly higher frequency of HBs-Ag and anti-HBs compared to cases having normal levels. On the other hand, the frequency was not affected by the level of serum alkaline phosphatases. As regards liver pathology, cases with mixed pathologic picture showed significantly higher frequency of both HBs-Ag an anti-HBs compared with those having pure schistosomal lesions.


Distal splenorenal shunts (Warren's operation) B-mode and real time ultrasonographic assessment. B mode and real time ultrasonography have been used in a trial to demonstrate the patency of distal splenorenal shunt done in Warren's operation. Thirty seven patients with portal hypertension, and bleeding oesophageal varices were the subject of this study. Using B-mode ultrasonography in 70% of cases (26 patients), the splenic, left renal vein and the site of anastomosis were demonstrated. In 8% (3 patients), both splenic and left renal veins were seen patent, but the site of anastomosis was not detected. In the remaining 22% (8 patients), neither the left renal vein nor the site of anastomosis could be demonstrated. Using the Real-time two dimensional ultrasound, 9 of the 37 patients were examined. The patency of both veins and the site of the shunt was demonstrated in 90% (8 patients).


Serum calcium, magnesium and phosphate in bilharzial hepatic fibrosis. Serum calcium, magnesium, phosphate and albumin were estimated in 74 bilharzial patients and 14 normal individuals as control. A significant hypocalcaemia and hyperphosphataemia was found in bilharzial patients with liver fibrosis and ascites. The authors suggest that these changes may be due to hypoparathyroidism. Both ascitic and non ascitic patients showed hypomagnesaemia. This hypomagnesaemia was more obvious in the ascitic group. The hypomagnesaemia is probably due to excess aldosterone secretion in these patients, combined with hypoparathyroidism in the cirrhotic patients with ascites.


Delayed hypersensitivity to specific antigen and hetrologous PPD antigen in patients infected with Schistosoma mansoni and/or Schistosoma haematobium. 181 cases with schistosomiasis were skin tested with S. mansoni antigen and tuberculin (PPD) after complete clinical and parasitological examination. Their results were compared to a control group of 89 non bilharzial cases. The positivity of tuberculin reaction was found to be less frequent in schistosomiasis (37.5%) when compared to non schisto. controls (55.0%). This low reactivity was more manifest in the advanced stages of the disease. The delayed skin reaction with S. mansoni antigen was seen in 52.4% of schisto. cases while non of the control showed any positivity. There are more delayed skin test positives with the advance of the disease.


The feasibility of echometric detection of cancer in the lower gastrointestinal tract. Part II.


Infertility: investigation and treatment.


Chemotherapy of bacterial and virus infections.


"Therapeutics symposium: which is the best buy?". "Antidepressant".


"Therapeutics symposium: which is the best buy?" Anti-inflammatory agents.


Glaucoma.

Glaucoma.


Diabetic retinopathy.

Diabetic retinopathy.


The aetiology of optic neuritis.

The aetiology of optic neuritis.


Stroke: 1980. The third killer: prevention, treatment and cure.


Uveitis is a systemic disorder.

Uveitis is a systemic disorder.


Cholangiography--the old versus the new.


Established versus new investigative techniques--which should we choose? "Barium meal or endoscopy?".


Computed tomography of the body.

Computed tomography of the body.


The alcohol debate.

The alcohol debate.


Management of the geriatric patient in a general hospital.


Management of the geriatric patient in a general hospital. Age-related differences in the presentation of sickness: thyrotoxicosis as a paradigm.


Management of the geriatric patient in a general hospital. Introduction.


Management of the geriatric patient in a general hospital. Communication and polypharmacy: drugs and the elderly.


Depression in the elderly: research directions in psychopathology, epidemiology, and treatment.


A couples therapy group on a geriatric service.


The pansigmoidoscope: one year's experience in a gastrointestinal diagnostic unit. Since May 1976, the Olympus pansigmoidoscope has been available for routine use at the University of Oregon Health Sciences center. Two hundred sixty-five examinations were performed over the next year. The average distance examined was 49 cm. Time per examination ranged from 3 to 15 minutes, with an average of 8 minutes. Preparation consisted of one or two tap water enemas, except in known inflammatory bowel disease where no preparation was given. No patient received sedation and there were no complications. Small biopsy (2.8 mm), large biopsy (4.0 mm), "hot biopsy" and polypectomy were performed when indicated. The procedure was most helpful for the following indications: 1) differential diagnosis and follow-up of inflammatory bowel disease, 2) hematochezia, 3) evaluation of abnormal barium enema, 4) left-sided polypectomy, 5) diarrhea with normal barium enema, and 6) guaiac-positive stools. It was of no value in patients with abdominal pain with normal barium enema. Comparing the frequency of examinations this year with last year we found a 50% decrease in use of the rigid (25 cm) sigmoidoscope (538 to 270 exams) and a 98% decrease in use of the MB2 (100 cm) colonoscope (80 to 2 exams).


Long-term prognosis for patients with ulcerative proctosigmoiditis (ulcerative colitis confirmed to the rectum and sigmoid colon). Despite its frequency, ulcerative proctosigmoiditis is poorly recognized and its prognosis is not well understood. This study reviews experience at the Cleveland Clinic from 1960 through 1972, with a 97% follow-up. A total of 359 patients with a diagnosis of ulcerative proctosigmoiditis were followed for a mean of 11 years (range 3.2--17.7 years). There were 219 men and 140 women. Mean age at diagnosis was 40.6 years. All had rectal bleeding, typical proctosigmoidoscopic findings of diffuse granularity, mucosal ulcerations and friability, and normal findings above the rectosigmoid on barium enema. The major complaint in all patients was rectal bleeding, and there were few other symptoms. Perianal disease was absent. On the whole, the patients were older than the usual patients with ulcerative colitis; 37 were older than age 61 at diagnosis. The disease remained localized and the prognosis accordingly was good for 90% of the patients. Extension to the proximal colon developed in 10% (36) of patients, and operation was required in 8% (29), two for toxic megacolon. Operation was carried out a mean of 5.6 years after diagnosis: 2.2% (8) of the patients died during the period of follow-up, six after operation. One patient had carcinoma of the sigmoid colon 12 years after diagnosis. Only one patient was subsequently found to have Crohn's disease. Thirty-nine patients died from causes unrelated to colitis. This study suggests that ulcerative proctosigmoiditis as defined by typical sigmoidoscopic appearance and a normal barium enema is relatively common, that proctosigmoidoscopic findings are identical with those of universal ulcerative colitis, but that the outlook is much better. Ulcerative proctosigmoiditis is rarely confused with Crohn's disease, and carcinoma is rare. Recurrences do occur, however, and proximal extension develops in 10% of patients, usually within 5 years after the diagnosis is first made.


The cost of not doing medical research.

The cost of not doing medical research.


Thyroid and associated polyglandular neoplasms in patients who received head and neck irradiation during childhood. One hundred fifty-one patients with a history of childhood irradiation to the head, neck, and thorax had neck explorations (142 for "cold" thyroid nodules and 9 for hypercalcemia). Fifty-nine of the patients had thyroid carcinoma, and associated glandular tumors were found in 20 others. In addition, 6 female patients developed breast carcinoma; 4 of these women also had thyroid carcinoma. In this series, 48.6% of the patients irradiated for acne and 36.4% with tonsil and adenoid irradiation developed thyroid carcinoma, but only 10.5% with thymic irradiation did so. It is suggested that the workup on these patients include not only complete thyroid and parathyroid testing, but also a careful examination of all salivary glands, both major and minor. Women should have thorough breast examinations and should perhaps be followed as if they were in the potentially high-risk breast group. When thyroid surgery is performed, a total thyroidectomy is recommended.


Laryngeal keratosis and subsequent carcinoma. The frequency with which carcinoma develops in laryngeal keratoses is a controversial subject. A study of 92 cases of laryngeal keratosis with a minimum of five years' follow-up resulted in identification of three patients (3.26%) who developed laryngeal carcinoma. A reviews of the literature reveals that, in series of keratoses defined by stringent pathologic criteria, subsequent laryngeal carcinoma develops in 3.33%-4.31%. These findings support a low but predictable frequency of conversion to malignancy in laryngeal keratosis. A grading system for keratosis is presented and discussed with reference to clinicopathologic correlation.


Therapy of antibiotic-associated pseudomembranous colitis. Seven patients treated with oral cholestyramine for antibiotic-associated pseudomembranous colitis are reported. Response was variable with only one patient having a totally satisfactory clinical outcome. Five of seven patients had continued systemic signs with fever and leukocytosis throughout the course of cholestyramine. Two observations were relatively consistent. First, six of the seven patient had a decrease in the number of daily stools during therapy. Second, all patients showed persistence of the cytopathic toxin in stools obtained after three to seven days of cholestyramine therapy. Six patients who were subsequently treated with oral vancomycin had a prompt clinical improvement and clearance of the cytopathic toxin in the stool.


A double-blind study of radiologic accuracy in diverticulitis, diverticulosis, and carcinoma of the sigmoid colon. A review of the barium enema studies in 73 patients with diverticular disease of the colon and with and without associated neoplasm leads to the conclusion that the correct radiologic recognition of an associated neoplasm in a colon with diverticulitis or diverticulosis can be made only about half the time. The limitations of the radiographic method and radiologic findings in distinguishing diverticulitis from carcinoma should be more clearly recognized by the clinician.


Anatomy of the pancreas by grey scale ultrasonography.


Embolization techniques in vascular tumors of the head and neck. Surgical excisions of vascular tumors of the head and neck are frequently associated with difficulties because of the potential of operative blood loss. The technique of selective percutaneous embolization before surgery has emerged as a valuable adjunct-and even alternative-to surgery in the management of such lesions. By reducing the blood flow to a vascular tumor or arteriovenous malformation, embolization techniques can be greatly facilitate surgical excision. The participation of a qualified invasive radiologist is essential. If cases are carefully selected and procedural details strictly adhered to this technique can be quite valuable to surgeons treating vascular lesions of the head and neck.


Interstitial-implant radiotherapy in upper-aerodigestive-tract malignancy. In the treatment of upper-aerodigestive-tract malignancy, interstitial-implant radiotherapy differs in several physical and biologic respects from conventional external-beam therapy: unlike external-beam therapy, it can deliver a high central dose with a rapid fall-off, which overcomes the central hypoxic resistance effect and yet greatly improves normal tissue tolerance. External-beam and interstitial-implant therapy can also be combined to the patient's benefit; in many cases, this combination offers advantages over external-beam therapy alone, preoperative external-beam therapy, or aggressive surgery. The recent upsurge of interest in this modality has come about because of three developments: more suitable radioactive sources, after-loading, and computerized dosimetry. The early results in upper-aerodigestive-tract malignancy, both as primary and as salvage therapy, are promising; but the precise role of this treatment in our therapeutic armamentarium remains to be established.


Studies in clinical liver disease.

Studies in clinical liver disease.


Importance of the columellar-labial junction in rhinoplasty. Concentration on tip positioning may draw a surgeon's attention away from modifying positions of the nasofrontal angle and of the columellar-labial junction. All three landmarks are, however, vital to the establishment of desirable profiles. This article emphasizes that changes in the positioning of the columellar-labial junction may (1) eliminate certain hazards involved in changing tip position, (2) make it possible to produce aesthetic effects that cannot be achieved with tip positioning alone, and (3) make rhinoplasty safer and more predictable in certain difficult cases. Also presented are techniques that have been found to work most satisfactorily in changing angle and position. A few patients selected from among several thousand rhinoplastic cases are analyzed to underscore the significance of this area in rhinoplastic planning. Follow-up varied from several months to several years.


Diagnosis of infratemporal fossa tumors using percutaneous core needle biopsy. Three patients with infratemporal fossa carcinomas presented with severe, unrelenting facial pain, weight loss, and 5th cranial nerve deficit. Erosion of the base of the skull at the foramen ovale was present in two of these patients. Histologic diagnosis of infratemporal fossa malignancy was obtained by needle biopsy of the foramen ovale region; the technique is described. This approach to the infratemporal fossa is preferred to the more complicated external surgical approach with its greater risk of morbidity. Surgical approaches to the infratemporal fossa are also reviewed. Two of the patients were treated with radiotherapy; the third refused further therapy. Supravoltage radiotherapy with curative intent is the recommended treatment because of the difficulty of an en bloc tumor resection in the infratemporal fossa. Radioactive gold seeds may be implanted through an external surgical approach to boost the local dose.


The current state of gastroenterology in Argentina.


Computed tomography of the normal larynx. A computed tomographic analysis of normal laryngeal anatomy was undertaken using cadaver larynxes. This was part of a larger project in which patients with laryngeal carcinoma were routinely evaluated in the computed tomographic (CT) body scanner. The appearance of normal laryngeal anatomy had to be delineated before disease processes of the larynx were evaluated, and this was accomplished using a computed tomographic technique with 5-mm slice thicknesses and a 3-mm overlap. The scan slices were then compared with anatomic sections taken at the same levels. The comparisons demonstrate an ideal level of accuracy that can be approached in the in-vivo larynx only with use of the latest-generation scanners. However, CT scanning is of immediate usefulness in the diagnosis of laryngeal pathology.


Surgeons as etiologists: the opportunities of nasal cancer.


Embryonic development of the head and neck: part 2, the branchial region. The embryology of the branchial (pharyngeal) region is reviewed in terms of the embryonic pharynx, branchial apparatus and derivatives, tongue, larynx, and trachea. Derivatives of the branchial pouches, grooves (clefts), and arches are analyzed in relation to each other and to the first arch syndrome. Other common head and neck defects attributable to abnormal development of the branchial region are also discussed, particularly those defects involving the incomplete degeneration or the abnormal migration of branchial tissues.


Mandible stabilization between ablative and reconstructive surgery. The biphase external skeletal-fixation splint (Morris splint) for mandibular stabilization has been used in cases of ablative surgery. It is a practical approach to stabilization for patients whether or not they undergo reconstruction, either immediate or delayed. The Morris splint can be applied without increasing the time required for major resection. It can be left in place for prolonged periods, but it still allows easy surgical access and easy postoperative care and observation. While not a new tool, it has been little used by the head and neck cancer surgeon, probably because it has not been presented for this purpose but rather for treating fractures. A practical approach to the use of the Morris biphase splint is presented, as well as the indications for its use and some results of our experience with this tool.


Transition from diffuse esophageal spasm to achalasia. A 19-year-old man first presented with clinical, radiological, and manometric features of diffuse spasm. Within a year his motility disorder progressed to "vigorous" and, finally, classic achalasia. After pneumatic dilatation and subsequent long myotomy, the features of classic achalasia disappeared and he again exhibited radiological and manometric evidence of "vigorous" achalasia. The evolution of this patient's disease provides evidence that diffuse spasm and achalasia are different stages of the same disease and lie at opposite ends of a spectrum of related esophageal motility disorders.


Fine-needle cholangiography (FNC) in the nonjaundiced patient. Fine-needle cholangiography (FNC) in the jaundiced patient is well established, but its role in the diagnostic work-up of nonjaundiced patients has not been emphasized. We present 44 consecutive nonjaundiced patients with a serum bilirubin level of 2.4 mg% of less who underwent FNC. The indications were recurrent RUQ pain (77%), painless cholestasis (16%), and relapsing pancreatitis (7%). In all but two patients, one or more inconclusive techniques [oral cholecystography, ultrasonography, intravenous cholangiography, or endoscopic retrograde cholangiography (ERC)] had been employed prior to FNC. Biliary tract opacification was successful in 35 of 44 (80%). In nine of 35 (26%) choledocholithiasis and/or cholelithiasis was present. In four (11%) a significant extrahepatic biliary stricture was noted. More than five needle insertions were often required for successful entry. No complications occurred. Indications for FNC should be extended to include nonjaundiced patients with RUQ pain or painless cholestasis in whom oral cholecystography, ultrasonography, and intravenous cholangiography have been of no diagnostic help. The relative ease and low cost of FNC make it preferable to ERC in these patients.


Trichoepithelioma: report of an unusual case and review of the literature. Trichoepitheliomas are benign and uncommon skin tumors presenting in the head and neck region. Although they can be solitary, they occur more frequently as multiple lesions with an autosomal dominant inheritance. To the surgeon, they often present the problem of clinical differentiation from basal-cell carcinoma. An unusual case is described, and experience in the treatment of 19 patients is reviewed.


Local duodenal metastasis from colonic carcinoma. The clinical and radiologic appearance of an isolated metastasis to the duodenum may mimic a primary pancreatic or duodenal cancer. As lymphatics from the right colon drain to periduodenal lymph nodes, lymphatic spread from right colon cancer can cause enlargement of the duodenal loop, with ulceration or distortion of the mucosa on the medial aspect of the duodenum. We present three patients with ulcerating metastases in the duodenum from colon cancer whose cases exemplify the problems of diagnosis and management.


Oxalate and intestinal disease.

Oxalate and intestinal disease.


Ultrasound diagnosis of pancreatic pathology.


Keeping up-to-date: some current surgical and radiologic procedures. Surgical advances often call for close radiologic scrutiny to assess their success or complications. At the same time, diagnostic radiology is also constantly developing new approaches. It is for this reason that we describe the radiographic analysis of several current surgical and radiological procedures which should be of interest to the practicing clinician. The current surgical procedures considered are gastric bypass for morbid obesity and continent ileostomy. The current new radiologic procedures include techniques for performing small bowel enema, per-oral ileal and colonic examinations with retrograde air insufflation, and improved evaluation of the postantrectomy stomach using double-contrast techniques.


Gastrointestinal disease in Southern Africa.


Depression, cancer, and guilt--what is the connection?


Etiology of inflammatory bowel disease.

Etiology of inflammatory bowel disease.


Long-term prognosis of ulcerative colitis with onset in childhood or adolescence. From 1955 through 1974, 336 patients with ulcerative colitis diagnosed before age 21 years were studied. In 93 patients (29%), a blood relative had ulcerative colitis, one case of Crohn's disease being found. The total colon was involved in 63% of patients; the entire colon or all but the rectal stump was removed in 35%. Eighteen patients died, nine of carcinoma of the colon. Sixty-five percent of patients had symptoms for longer than 6 months before the diagnosis of ulcerative colitis. If the diagnosis was delayed more than 24 months, there was a statistically significant correlation with increased rate of operations and complications and less good quality of life. When the 20-year study period was divided into two 10-year periods, the operative and complication rates were significantly different. Early diagnosis and treatment appear to improve the long-term prognosis of young patients with ulcerative colitis.


Management of toxic megacolon: the significance of early recognition in medical management. Twenty-seven patients with acute toxic dilatation of the colon (TM) as a complication of inflammatory disease of the colon are reported. To emphasize the importance of early recognition and therapy, we separated the patients into two groups: 19 were receiving care by the authors (series A) before the development of TM, and eight were seen in consultation after its onset (series B), TM subsided with medical therapy in 13 episodes among 19 patients in series A and two of eight B. The others underwent surgical therapy. There were no deaths in either group. The differences in management and mortality from other reports suggest a program of surveillance and therapy for this life-threatening situation.


Esophageal roentgenographic "abnormalities" in patients without esophageal symptoms. Esophageal roentgenographic studies were done on 100 persons with no esophageal symptoms to determine the range of normal anatomy and motor activity. Sixty-three persons had at least one "abnormality." Fifty-eight had an hiatal hernia, 42 had rings of one sort or another, and 21 had motor disorders. The high incidence of rings which can be demonstrated by maximal distention of the lower esophagus is of special interest in view of the recent additions to knowledge of the anatomy of this area. The range of what should be considered normal roentgenographically should be widened, and the physician should interpret with caution reports of esophageal abnormalities in asymptomatic persons.


Pneumatic dilation under general anesthesia after unsuccessful cardiomyotomy for achalasia. A 12-year-old girl with achalasia was treated successfully under general anesthesia with pneumatic dilation after she had experienced two unsuccessful surgical procedures. The Mosher dilator was passed into the stomach by threading it over a guide wire. Our experience suggests that pneumatic dilation can be performed in children or adults after surgical failure and that general anesthesia may be employed.


Mechanical and neurogenic factors in postvagotomoy dysphagia. Postvagotomy dysphagia (PVD) has been attributed to either periesophageal obstruction or failure of the lower esophageal sphincter (LES) to relax, presumably from interruption of preganglionic, contraction-inhibiting vagal fibers--a postvagotomy achalasia (PVA). This report describes a patient with periesophageal fibrosis which was successfully treated with dilation, and a second patient with an achalasia-like pattern on esophageal manometry after unilateral high, transthoracic vagotomy. The second patient is the first manometrically documented example of achalasia in a human subject related to proximal vagotomy. Most, if not all, PVD is due to esophageal obstruction and PVA is rare.


Ureteropelvic junction obstruction.

Ureteropelvic junction obstruction. Physicians sometimes forget nongastrointestinal causes of abdominal pain. Yet, abdominal pain was the major complaint of three patients with ureteropelvic junction obstruction (UPJ). Definitive diagnosis can be made either by a "hydration" intravenous pyelogram or by an intravenous pyelogram during an attack.


Pelvic neoplasia in Peutz-Jeghers syndrome. A cervical adenocarcinoma, a left ovarian granulosa cell tumor, and a right ovarian sex cord tumor with annular tubules developed in a woman with Peutz-Jeghers syndrome. This apparent first report of three different pelvic tumors occurring in a patient with Peutz-Jeghers polyposis suggests a possible link between pelvic tumors and the Peutz-Jeghers syndrome.


Effects of halogenated analogues of cortisol and progesterone upon hair growth in castrated mice. Several synthetic analogues of cortisol and progesterone were compared to cortisol in their effect of inhibiting the hair growth waves in castrated male C3H/Ep mice. This inhibitory effect was enhanced by fluorination at C-9 alpha and by methylation at C-16 alpha; it decreased by hydroxylation at C-17 alpha and C-21, by removal of hydroxyl group at C-11 and by the addition to bromine to C-12 alpha; it was not modified by oxidation of the hydroxyl group at C-11 or by the delta 1-4 substitution. There was a correlation between the glucocorticoid and hair inhibiting potencies in the cortisol analogues, but some progesterone analogues with very low glucocorticoid activity have marked hair inhibitory effects. No relation was found with the mineralocorticoid effects.


Digital interface for bioelectrical data acquisition system. The action potential digitalized and stored by means of a fast solid state electronic waveform recording system (Digitalizer) can be directly read out on a printer or in a computer for further processing. It has been designed a digital interface allowing the automatization of these bioelectrical data acquisition and printing process.


Urate-oxidase in liver of oxonic acid treated mice. Following a single intraperitoneal injection of oxonic acid, urate-oxidase inhibitor with optical and chromatographic properties of the injected drug was found in the supernatants of mouse liver homogenates. Maximal inhibitory activity of 40 000 g-20 minutes supernatants against Sigma urate-oxidase was found 30 minutes after injection, and it almost disappeared after six hours. In whole homogenates, urate-oxidase activity was found 50% inhibited at 30 minutes, and it returned to normal levels between 3 and 6 hours following injection. Urate-oxidase activity of resuspended nuclei-free 40 000 g particles from these homogenates showed a significative increase of activity over controls during the first three hours after injection, and it returned to a normal level between 3 and 6 hours after injection. There was, instead, no increase of activity in 40 000 g-20 minutes particles suspensions when these were separated from homogenates prepared from untreated mice and incubated with oxonic acid.


Digitalizer system and memory for electric transients. It was designed a fast solid state electronic waveform recording system (Digitalizer), which can record, store and display action potentials or any type of event, either single pulse or repetitive, as a function of time. Above all, its capacity to record fast transients and to give the output in analog and digital form, makes this electronic device more convenient that conventional recorders or single trace oscilloscope systems.


Effect of electrical stimulation of lateral septal area on blood pressure in anesthetized and unanesthetized rats.


Water intake in rats affected by addition of nicotine to drinking water.


Functional pharmacological and morphological characteristics of two regions of rat uterine horns. A histological, physiological and pharmacological study of two regions of the isolated uterine muscle of the rat., i.e., the myometrial one (a zone close to the mesometrial insertion) and the linea uteri (the antimesometrial zone) was performed. From the histological point of view the linea uteri (LU) is characterized by the presence of small bundles of longitudinal smooth muscle fibers (20 to 50), closely packed and clearly surrounded by a connective tissue, whereas in the myometrial zone (M) the smooth muscle fibers are less closely packed and the connective tissue is surrounding a greater number of them. The spontaneous oxytocin or electrically-induced initial tension developed by the LU or the M, was similar. Also the stability with time did not differ between both regions. Atropine depressed consistently the isometric developed tension of M strips, either spontaneously active or driven by oxytocin or electrical stimulation, but had no action on the mechanical activity of preparations from the LU. A pretreatment with hemicholinium also inhibited the spontaneous as well the oxytocin-induced motility of M strips, without affecting those of LU. Pharmacologic evidences suggest that acetylcholine may play a "facilitating" role in M strips for the conduction of coordinate contractions. This does not appear to be the case in the LU, which has the required characteristics to be recognized as a conductive like tissue.


Participation of the anterior hypothalamus in the regulation of arterial blood pressure. Bilateral electrolyte lesions of the Anterior Hypothalamus (AH) were placed in rats to determine the extent to which this area participates in the regulation of Arterial Blood Pressure (ABP). Experiments were performed in two groups of rats; in one ABP was measured continuously for 44 hr subsequent to the lesion, and in a second group ABP was measured 24 hr after the placement of the lesion. The destruction of this area results in a rapid development of arterial hypertension, hypermotility and hyperexcitability. 24 hr later these effects are attenuated. We conclude that arterial hypertension is probably due to a disinhibition of sympathetic activity through central interruption of baroreceptors reflexes.


Temperature effects on the properties of the Hodgkin-Huxley propagated action potential model determined by computed solutions and phase-plane analysis. The equation for membrane potential (V) of the squid giant axon or some muscle cells, which is the heart of the Hodgkin-Huxley model for the action potential, can be written in three ways: first, as a partial differential equation in time and space; second, as an ordinary differential equation in time, assuming uniform wave propagation for the action potential, and third, as an even simpler ordinary differential equation for the potential at a point, so-called "space clamp" conditions. Solutions were computed for the first two of these equations, at three different temperatures, and the results compared. Temperature dependence of the appropriate parameters was calculated from a simple exponential relationship. Significant changes in the quantitative predictions of the model were found as the temperature was changed from 6.3 C to 18.5 C. Phase-plane (V v V, I v V) analysis has been used to examine the nature of these differences.


The measurement of bile acid-dependent and independent fractions of rat bile. Bile flow and bile acid secretory rate in rate in rats with interruption of the enterohepatic circulation had a biphasic decay with the second slower slope less marked for bile flow. A direct relationship between both parameters was observed in these animals. by knowing the choleretic efficiency of bile acids calculated from the regression line, the total bile acid output and the volume of bile collected, the fraction of bile produced by other way than bile water carried by bile acids was estimated. This fraction was found to be about 65 percent of the total bile formed.


Glucocorticoid action on rat spleen cells. I. Action of cortisone on antibody forming cells. Corticosteroid action on rat spleen tissue was studied in order to determine the action of the hormone on cells involved in the early phase of the immune response. A significant reduction of plaque forming cells (PFC) was observed when the steroid was administered simultaneously with the antigen and even had some effect when injected up to three days immunization. Inasmuch as it can be assumed that at a period of 72 hr or less a great number if not all the cells are challenged by the antigen, results indicate a lympholytic action of the hormone on the already stimulated cells.


Effect of drugs on the force of spontaneous mechanical activity in rat portal vein. A study was made on the force of spontaneous mechanical activity in the rat portal vein. Prostaglandin inhibitor, sodium meclofenamate, phosphodiesterase inhibitors, aminophylline and dipyridamole, adenosine and blockade of calcium entry by isoptin all reduced the force of spontaneous activity in a concentration-dependent manner, while imidazole enhanced it. Low concentration of aminophylline (10 microM), dipyridamole (6 microM) and meclofenamate (10 microM) depressed the spontaneous contraction of the vein by about 50% without modifying the response to noradrenaline. At higher concentration of these drugs, spontaneous mechanical contraction was reduced further and the response to noradrenaline antagonized. Low concentration of isoptin also reduced the mechanical activity without affecting maximum response to noradrenaline. A common mechanism of action for the drugs tested, namely the limiting of Ca2+ availability for muscular contraction, is discussed. Adenosine markedly reduced the spontaneous mechanical activity of the rat portal vein. Its relaxation effect could be due to the activation of a specific adenosine receptor.


Studies on the tissue specificity of a circulating renotropic factor. In 1970, it was found that sera removed from rats 24 hr after unilateral nephrectomy stimulate the incorporation of 3H-Thymidine into the DNA of incubating rat renal cortex. The same sera did not influence isotope incorporation into the DNA of incubating liver, spleen, and lung tissue. Later, a substance was described in renal tissue that enhanced the action of the renotropic factor in sera. It was proposed that this tissue factor activated the circulating renotropic substance and that lack of this activator in other tissues was responsible for the specificity of the circulating renotropic substance to renal tissue. The present study suggests that this is the case as the addition of the renal tissue factor and sera from uninephrectomized rats can stimulate 3H-Thymidine incorporation into the DNA of rat liver slices.


Fluid pressure and fibrinolytic activity in implanted subcutaneous and intramuscular capsules. Using the capsule implantation method, the relationship between the intracapsular fluid pressure (IFP) and fibrinolytic activity of the intracapsular fluid was examined in subcutaneous and intramuscular capsules. When IFP was positive, the sterility test was positive (indicating infection), the fibrinolytic activity was enhanced, and the response of IFP to volume change or hypertonic solutions was poor. On the other hand, when IFP was negative, the sterility test was negative, the fibrinolytic activity was weak, and the response of IFP to volume change or hypertonic solutions was good. Also, the more negative the IFP, the weaker was the fibrinolytic activity in the intracapsular fluid (r = 0.60, p less than 0.01). The ratio of the intracapsular fluid fibrinolytic activity to the plasma fibrinolytic activity showed a good correlation to the intracapsular fluid pressure (r = 0.68, p less than 0.01). When the fibrinolytic activity was activated by injection of streptokinase and human plasma, the IFP showed a tendency to increase. These results suggest that the fibrinolytic system plays some role in the maintenance of local fluid balance.


Influence of temperature on isometric contractions of rabbit atria during inotropic interventions. Inotropic effects on strips of left atria promoted by 1-epinephrine, increase in frequency, post-extrasystolic potentiation, and by increase in extracellular calcium concentration were studied at 28 C and 36 C. The results show that at lower temperature the resulting changes in temporal parameters (activation time, deactivation time and duration above 10% of maximum force) are greater than those at the higher temperature. AT 36 C inotropic interventions have more prominent effects on the tension development and its first derivative, while changes in temporal parameters become less conspicuous. It is concluded that the inotropic interventions regulate the strength of contraction more effectively at 36 C and the temporal aspects of contraction more effectively at 28 C.


Phase plane determination of the mechanical properties of the myocardium. A phase-plane diagram, obtained by plotting force versus the rate of force during isometric contractions, was used for determination of the mechanical properties of rabbit left atria. Considering the muscle as a two component mechanical analog we found: (a) the initial slope of the phase-plane diagram (m1) is proportional to the product KVmax, where K is the stiffness of the series elastic component, and (b) the final slope of the phase-plane diagram (m3) is equal to the product -Kb, where b is a constant with dimensions of velocity, and may be related to the absolute rate of energy liberation. It is shown that m1 increases with positive inotropic interventions (frequency increase, epinephrine, post-extrasystolic potentiation, elevation of calcium and increase in temperature) but does not change as a function of muscle length. The final slope M3 increases with frequency, temperature and epinephrine; decreases with calcium and stretch, and does not change with post-extrasystolic potentiation. The results also suggest that the change in m3 depends on the particular inotropic intervention. This supports the idea that separate mechanisms are responsible for the process of contraction and relaxation.


Pseudoconditioning as a control procedure for aversive learning: effect of the number and density of footshocks on pseudoconditioned responses in a shuttle-box.


Sulfobromophthalein metabolism in isolated perfused rat liver. Factors determining the applicability of the model. Sulfobromophthalein (BSP) was used to test the applicability of the isolated perfused rat liver in the study of drug metabolism. Flow of perfusate through the liver averaged 35 ml per min and the bile flow rate was 0.75 microliters per min per g of liver. BSP was delivered into the system as a single dose of 4.7 to 9.5 mumoles. Samples of perfusate from the pre and posthepatic circuits and bile samples were obtained at different time intervals. The following parameters were elimination half life, mean hepatic clearance, mean intrinsic clearance, time course of hepatic and bile concentrations and percent dose excreted into bile. The results demonstrated that bile flow and BSP biliary excretion depended on hepatic blood flow. Time course of hepatic concentration decay and mean intrinsic clearance were a reflection of the inherent ability of the liver for BSP elimination into bile. The parameters tested and their correlations gave overall information on isolated liver function that may be applied to the study of other exogenous or endogenous compounds.


The handling of bilirubin and sulfobromophthalein by the isolated perfused rat liver. The isolated perfused rat liver was used for the study of the characteristics of bilirubin transfer from perfusate to bile in comparison to those of sulfobromophthalein (BSP). The parameters estimated included mean extraction ratio, removal half life, hepatic clearance, intrinsic or metabolic clearance rate of biliary excretion, hepatic concentration and biliary concentration for both compounds. The results obtained favoured the conclusion that bilirubin was less efficiently handled than BSP by the isolated rat liver.


The effect of the anticonvulsants phenobarbital and diphenylhydantoin on intestinal absorption of calcium. The effect of anticonvulsant drugs (phenobarbital and diphenylhydantoin) on the metabolic balance of calcium and on its intestinal absorption, as measured by an in situ intraluminal perfusion method, was studied in rats. The administration of these drugs produced: (a) an increase of the fecal excretion of calcium,. (b) a decrease of the intestinal absorption of calcium (45Ca). Both effects were more intense in rats treated with phenobarbital. There is evidence to suggest that the anticonvulsant drugs affect the intestinal mechanism of active transport of calcium.


Pitfalls in kinetic studies of multiexponential decay processes with special emphasis on desaturation curves of arterial Na. The purpose of this study was to detect and solve apparently trivial methodological flaws in experiments of the decay type which can invalidate any fitting procedure or compartmental analysis. The problems dealt with consisted in maintaining the steady state conditions defining the "true" starting time of the efflux and its optimal duration, determining the number of exponential terms and finding how many data points are necessary to identify them. The solutions proposed include avoidance of tissue blotting prior to the efflux, running a separate non effluxed sample, stopping the washout when the log plot of remaining and effluent counts becomes parallel, use of the optimization if the correlation coefficient for curve fitting and adequate the frequency of counting to the decay rate. Errors resulting from the failure to comply with these requirements are illustrated with samples.


On the psychology of the aging woman. Introduction.


On the psychology of the aging woman. Depression in late mid-life: change or repetition? Another chance for working through. A woman of 58 came for psychotherapy for the first time suffering from a depressive reaction precipitated by two mid-life events: the marriage of her daughter and the realization that her own cherished marital dream would never be fulfilled. She had postponed coming to terms with the disappointments of her marriage as long as she had had other objects. When these objects were lost, and the distance she had maintained to handle her feelings was threatened, she sought help. There was suggestive evidence that a collusive marital system had sustained an unsatisfactory relationship for 35 years. Her husband was described as an obsessive-compulsive character. His traits were both needed, feared, and resented by the patient, representing the rejected part of herself and aspects of her hated grandmother. Mrs. A. had character traits and a developmental history which supported a diagnosis of primitive hysterical personality. (This type has been described by Zetzel (1968) as "the so-called good hysteric.") The paucity of object relationships in her life, her poor work habits, her inability to tolerate affects were striking. The patient had identified with a pathological mother in a family dominated by rejecting and depreciating attitudes. The patient's use of the defense mechanisms of splitting, projection, and withdrawal as ways of dealing with ambivalence significantly interfered with her self-object differentiation and her capacity for intense emotional or physical intimacy. She could only love men whom she rescued or protected, a pattern consistent with the fact that she could not relate to equals or superiors. Yet she was unable to draw on a good identification with a nuturing mother, so as to really be able to give. There was too much hurt and uncontrolled anger when she was in the superior position with the kind of man who could not meet her dependency needs. Feeling unprotected, she had married a "strong" man, who she expected would meet her narcissistic and dependency demands. He was inhibited and controlled and could neither need nor be needed by her during his active work life. This led to immediate disappointment of her conflicting conscious and unconscious expectations. She wanted him to be strong and ideal, yet to need her and never oppose her. Hence, there was a failure to establish a mature or satisfying marital relationship. She turned to her children for comfort, particularly her daughter, becoming depressed when her daughter married. She found gratification by staying busy tutoring and teaching underprivileged children. In the course of treatment her depressive symptoms disappeared. She felt hopeful, capable of being believed in, and able to cope as a result of the therapist's functioning as her uncritical ally. After she resumed living with her husband she began to acknowledge an ambivalence toward her cherished, confidante daughter and in some ways reversed her previous splitting of husband and daughter. The mean husband became a kindly saint and the darling daughter became a critical, spiteful queen...


On the psychology of the aging woman. Mid-life marital issues: renewal or regression?


Strategies of dynamic psychotherapy with the wide range of older individuals. Until recently contributions to geriatric psychotherapy tended to be limited to the consideration of the special problems of the most debilitated of the elderly, neglecting the vigorous majority of aging persons. The reluctance of psychoanalysts to treat individuals past 45 or 50 years of age by classical technique may have impeded the application of psychodynamic principles to the psychotherapy of older people. Gradually, a number of analysts and dynamic therapists reported favorable responses of the middle aged and elderly to such treatment and established some of its technical parameters. In this paper, distinguishing characteristics of the aging and of the debilitated aged are examined in order to clarify the techniques of geriatric psychotherapy. Six case vignettes illustrate the treatment aims of structural change, reinstatement of optimum functioning, and basic support in these two categories and in an intermediate group of those experiencing an emotional crisis. The application of psycho-therapeutic principles (promotion of insight, adaptive intervention, general supportive methods) is described. Psychological management is compared with psychotherapy in the debilitated aged. Treatment of emotional crises in older persons is illustrated. A sample of patients treated by means of psychotherapy--aging, in crisis, or debilitated--is examined with regard to diagnoses, precipitating stresses, the aims of therapy, and the involvement of their families in the treatment.


Effect of high tibial and double osteotomy on osteoarthritic and rheumatoid deformity of the knee.


Intrastriatal regulation of DA release from dopaminergic terminals.


Cerebellar control of catecholaminergic activities implications for drug therapy of movement disorders.


The relationship of the basic intellectual endowment of the Parkinson patient to the long-term effect of L-dopa.


Levodopa-induced dopaminergic hypersensitivity in the pathogenesis of psychiatric and neurologic disorders.


Neurotransmitters--control of growth hormone (GH) and prolactin (PRL) secretion: the adrenergic and serotoninergic modulation of GH and PRL in man.


Should you treat a minor without the parents consent?


What to do when a patient refuses treatment.


'Rita' tries her ruse on me.

'Rita' tries her ruse on me.


Will test tube babies spawn legal problems?


Life support. Who decides? and how?

Life support. Who decides? and how?


FDA proposes patient package inserts for most drugs.


What figures in your decision to discharge a patient?


How do you handle the problems that crop up when you examine someone who's involved in litigation?


Is the FDA packing a surprise for you?

Is the FDA packing a surprise for you?


MD loses license over insurance claims.

MD loses license over insurance claims.


Outrage gains in suits against MDs.

Outrage gains in suits against MDs.


Facing an age-old problem.

Facing an age-old problem.


Why is a State court setting standards of care?


AMA promises court fight over FTC ruling on advertising.


Why Chad Green died in Mexico.

Why Chad Green died in Mexico.


What should you do when a patient threatens to leave against medical advice?


Helling doctrine buried.

Helling doctrine buried.


What's your bet on national health insurance?


Hypnosis of witness becomes focus of murder defense.


California MDs see beyond malpractice relief.


Push to contain costs could make second opinions part of your routine.


Defensive medicine is offensive practice.


Defensive medicine is good practice.

Defensive medicine is good practice.


Can you break free of your Blue Shield fee schedule?


You may not be as bad an insurance risk as you think.


Doctor-owned companies succeed at making your risk their business.


Your telephone. A timesaver or troublemaker?


'I persuaded a judge to protect my patient's secret'.


You may face a nightmare in the newborn nursery.


Your state's cutoff date on malpractice suits may not be cut and dried.


How your fees will fare under the frontrunning national health plans.


How long should you keep your patients' medical records?


Effect of in vivo administration of 5 alpha reductase inhibitors on epididymal function. Progesterone, epitestosterone (4-androstene-17 alpha-ol-3-one, EpiT) and 4- androstene-3-one-17 beta-carboxylic acid (COOH), three known in vitro inhibitors of 5 alpha reductase, were injected daily for 30 days to male rats to study their effect on some parameters of epididymal function. Progesterone at the dose of 750 and 2000 micrograms/day decreased fertility by 59% and 50% respectively. EpiT at a dose of 1500 micrograms/day decreased fertility by 74%. These treatments did not change the sperm counts in the cauda epididymis. Treatment with COOH did not decrease fertility. Progesterone at 750 and 2000 micrograms/day and EpiT at 750 micrograms/day decreased the weight of the epididymis, prostate and seminal vesicles. None of the compounds tested produced variations in body weight or in the weight of liver and testis. The 5 alpha reductase activity of epididymis, testis and liver was diminished by progesterone treatment, while EpiT decreased only that of testis and liver.


Neonatal androgen effects on conditioned emotional response extinction of adult rats under various hormonal regimens. Intact male rats and spayed female rats received 0.5 mg testosterone propionate in the first 24 hours after birth. They were divided into different groups, administered peanut oil, progesterone, oestradiol benzoate and testosterone propionate in adulthood. The animals were conditioned to fear with a shock paired sound. The experimental test consisted of investigating the conditioned emotional response (CER) extinction. It was verified that as to conditioned emotional response extinction, neonatally androgenized males were different from control males; neonatally androgenized females, testosterone propionate treated in adulthood were also different from control females. There was no significant difference between neonatally androgenized females oestradiol benzoate treated in adulthood and their control group. In comparing neonatally androgenized females having different hormonal treatment in adulthood, we verified that testosterone propionate treated females were significantly different from those treated with progesterone. On the other hand, neonatally androgenized females treated with oestradiol benzoate in adulthood were different from those that have had the same hormonal manipulation in neonatal period, but that were injected with progesterone in adulthood. It was concluded that conditioned emotional response extinction is facilitated by neonatal androgenization in non-oestrogenized male and female rats.


Transcriptional features of fractionated human breast tumor chromatin. By means of controlled mechanical shearing it was possible to fractionate human breast tumor chromatin in "active" and "inactive" species, according to their in vitro template activity, using Escherichia coli RNA polymerase. The "active" molecules can be resolved in three well defined regions in an exponential sucrose gradient, showing approximately 300 times the efficiency for synthesizing ribonucleic acid, relative to the chromatin which migrated fastest. This technique could provide the initial tool to isolate eu-and heterochromatin from native human chromatin.


Modification by rumen of vitamin D-like activity of Solanum malacoxylon in rats. The biological activity of aqueous extracts of Solanum malacoxylon (SM) and of extracts preincubated with ruminal fluid (SMRF) on calcium and phosphate metabolism in vitamin D depleted rats was compared. The responses in intestinal 32P and 45Ca absorption, measured in an isolated duodenal loop in situ after a single oral dose, were qualitatively similar to that of 1,25-OH2-vit.D3. However, the effects elicited by SMRF were significantly higher than those caused by SM. Both extracts were equally effective in promoting bone resorption when administered orally or subcutaneously. These results provide a basis to explain the greater effectiveness of SMRF to produce calcinosis in rats. The hypothesis is advanced that biologically active steroidal metabolites with predominant action on intestine, are formed during incubation with rumen.


Acute effects of three natural corticosteroids on the acid-base and electrolyte composition of urine in adrenalectomized rats. In acute experiments, aldosterone (aldo), 18-hydroxycorticosterone (18 OH B) or corticosterone (B) were administered to adrenalectomized rats and parameters related to acid-base balance measured in urine samples collected for 3.5 hours after injection. Aldo reduced sodium excretion but did not affect pH nor the outputs of K, NH4+, CO3H-, phosphates nor titratable acidity. 18 OH B increased the excretion of titratable acidity and reduced drastically that of CO3H-. The lowest effective dose (3 micrograms) promoted Na excretion while the highest dose employed (6 micrograms) reduced pH and Na excretion. B increased the excretions of phosphates and ammonium, the former drastically. Potassium output either increased or did not change, and pH augmented marginally. It is postulated that a) 18 OH B is a naturally occurring steroid eliciting urine-acidification not necessarily accompanied by sodium retention; and b) at least B and 18 OH B in the rat, possess hormonal roles according to which the latter promotes the presence of protons, and the former, that of acute proton-acceptors in the lumen of tubuli.


Carbohydrate utilization by the avian oviduct during the laying cycle. In the present work the carbohydrate utilization by the avian oviduct during the egg formation was studied. The pattern obtained for total hexose, fucose, hexosamines, sialic acid, fructose and sulphate demonstrated that in the domestic fowl's oviduct the isthmus and the shell gland secrete the precursors for the protein carbohydrate substance of the mammillae and shell matrix and may contribute during the shell formation with the substrates necessary for the metabolic energy of the organ. The infundibulum only participates as a donor for the metabolic energy.


Influence of the subfornical organ on water intake induced by septal lesion. Rats bearing lesions in the septal area (SA), or in the subfornical organ (SFO) or simultaneously in both regions were submitted to various thirst-eliciting procedures. The rats with hyperdipsia induced by lesion of the SA drank more water than either normal rats or SFO-lesioned animals under the same thirst-eliciting or angiotensin-liberating stimuli (polyethyleneglycol, isoproterenol, water deprivation and ligation of the inferior vena cava). The overdrinking elicited by SA lesions was blocked after SFO lesions. Neither hypovolemia, nor hypotension or water deprivation could elicit increased water intake in SFO-lesioned animals even after destruction of the SA. Animals with SFO lesions did not show increase of the water intake after cellular dehydration. The results obtained suggest that the SFO acts as the main structure in the regulation of water intake elicited by angiotensin with two opposite effects: one direct, facilitating water intake and the other indirect inhibiting the SA. The SA has an inhibitory effect on the SFO and on water intake.


Nuclear steroid binding in rat adrenal gland.


International Society for Experimental Hematology: seventh annual meeting. Chicago, Illinois, USA, 27-31 August 1978.


The management of carotid-cavernous fistulae.


BCG at the cross roads.

BCG at the cross roads.


International Society for Experimental Hematology. Eighth annual meeting. Rotterdam, The Netherlands, 20-24 August 1979.


Medicine in China.

Medicine in China. This article, based on the author's visit to China in 1978 as part of a medical delegation, describes China's impressive health care system.  The article focuses on 3 specific health care issues:  cancer, epidemiology, and family planning.  Mass screening, involving exfoliative cytology, for esophageal cancer was carried out in 1971-76 among 40,000 residents over 30 years of age.  Cancer mortality is calculated by means of retrospective studies of death certificates.  All methods of contraception are used in China; however, abstinence for those under 25 years of age and IUD use are favored.  Gossypol has been tested on thousands of male volunteers and has been found to reduce the sperm count by 99%.  On the other hand, there is concern that gossypol is a potent mutagen and studies on the incidence of cancer in gossypol acceptors are being conducted.


Dilution techniques for optimum recovery of cryopreserved bone marrow cells. Bone marrow granulocyte progenitor cells (CFU-C) were assayed in methyl-cellulose prior to cryopreservation in Dimethylsulfoxide (DMSO) and after thawing and diluting the DMSO. The time of dilution from 10% to 1% DMSO and the temperature of the sample and diluting media were studied. Compared with samples diluted at 0 degrees-4 degrees C, samples which were diluted at 24 degrees C were more viable by Trypan Blue exclusion (p less than .01) and had greater CFU-C growth in vitro (p less than .01). There was no advantage to prolonging dilution time from 10 minutes at a constant rate to 40 minutes using stepwise technique. Recovery of CFU-C at 24 degrees C ranged from 40% to 114% with a mean +/- S.D. of 67% +/- 19.5%. There was evidence that clonogenic cells were selectively preserved under the conditions described.


Collection and purification of stem cells and monocytes.


A comparative study of technitium--99m and iodine--131 uptakes as diagnostic tests of thyroid function.


Some areas of the law relevant to family planning in medical practice: an analysis from a comparative perspective.


Bilateral pneumothorax following rupture of pneumatocoeles in kerosene aspiration.


Mobilization of murine hemopoietic stem cells (HSC) by Pyran Copolymer. Pyran Copolymer, divinyl-ether maleic anhydride increases the concentration of circulating pluripotential stem cells in mice by a factor of 15 to 30. Maximal mobilization occurs five days after Pyran Copolymer injection with synchronous peaks of CFU-S and CFU-C. When Pyran fractions of defined molecular weight from 12,000 to 52,000 are injected into mice, mobilization of CFU-S and CFU-C parallels molecular weight. Hemopoietic stem cells are mobilized from bone marrow into peripheral blood and subsequently trapped in the spleen.


In vitro proliferation of hemopoietic stem cells in long-term marrow cultures: principles in mouse applied to man. The continuous in vitro marrow culture system for proliferation of mouse pluripotent hemopoietic stem cells (CFUs) and granulocyte-macrophage progenitor cells (CFUc) as initially described by T. M. Dexter, depended upon a 25% concentration of special lots of horse serum and addition of fresh "recharging" marrow after 3-4 weeks. This system has been modified to permit longer hemopoiesis in non-recharged cultures over 25-30 weeks. Addition of 10(-7)M hydrocortisone sodium hemi-succinate during weekly feeding and switch from horse to 25% fetal calf serum with corticosteroid at week 4, maintains stability of the adherent marrow stromal cells, decreases lipogenesis (which is deleterious after 10 weeks) and increases proliferation of hemopoietic cells over longer duration. Stem cells removed from 8 week old primary NIH/Swiss marrow cultures reconstituted hemopoiesis in lethally irradiated mice. While 16 week old cultures produced total numbers of CFUc equivalent to 8 week cultures, these cells could not prevent marrow death following similar total body irradiation. Thus, stem cells moved progressively from a pluripotent to a committed CFUc compartment between weeks 8-16. Human femur marrow required thyroxine in addition to hydrocortisone for sustained CFUc maintenance over a shorter 8 week period. Improved technology for mouse long-term marrow cultures should further aid in developing a usable human "Dexter-system".


Lack of genetic damage in mammalian cells after cryopreservation at -196 degrees C. Mammalian tissue culture cells when cryopreserved according to standard procedures do not show gross chromosomal changes as evidenced by the formation of micronuclei. Cryoprotective agents used in this study included dimethyl sulfoxide (DMSO), glycerol and polyvinylpyrollidone (PVP) in combination with serum and using freezing and thawing rates normally employed in cryopreservation studies. In preliminary experiments, point mutations as evidenced by oubain resistance were not observed. These results are discussed in relation to previous studies indicating genetic stability after freezing and thawing.


The use of stem cell assays to monitor the proliferative potential of bone marrow cells. A number of assays exist for hematopoietic stem cells in both humans and mice, but the appropriate stem cell assay for the repopulating potential of human marrow is not clear. Two murine models suggest that these assays may not always predict marrow proliferative potential. In vivo diffusion chamber culture growth of CD1 marrow depleted of pluripotent stem cells (CFU-S) by exposure to mouse-brain antisera plus complement was equivalent to or greater than that of normal serum treated control marrow. Furthermore, CF1 mice repeatedly injected with endotoxin had markedly stimulated granulopoiesis with increases in the number of marrow CFU-S and the % in S phase but no changes in the number or proliferative status of marrow CFU-C. However, inbred BDF1 mice chronically injected with endotoxin although also showing striking increases in granulopoiesis had no significant alteration in their marrow CFU-S or CFU-C number or cell cycle status relative to saline injected controls. Both models present examples where conventional stem cell assays do not provide insight into marrow cell production and suggest that in vitro clonal assays of human marrow cells may not always predict for the potential of marrow to repopulate a human transplant recipient.


Recovery following massive exposure to methyl bromide.


Beyond kinetics: the study of DNA damage and repair in bone marrow cells. The response of the bone marrow to cytotoxic agents is a prime determinant of differential toxicity in cancer chemotherapy. Previous attempts to characterize drug effects on the bone marrow have largely been concerned with the proliferative status of the marrow cells. The DNA alkaline elution technique has recently proven to be a simple, sensitive technique for the study of drug-induced DNA damage and repair. The potential for applying this technique to mechanisms of bone marrow toxicity is discussed.


Antitumor agents--dose response curve clinical and experimental considerations.


Dose limiting extramedullary toxicity of high dose chemotherapy. Autologous marrow support may allow higher doses of myelosuppressive chemotherapy administration with the hope of improving tumor responses. The approach will be limited by the extramedullary toxicities of the drugs employed. This paper reviews some of these toxicities for selected drugs, and gives examples of techniques which could be used to reduce their incidence.


Collection and cryopreservation of mononuclear blood leukocytes and of CFU-C in man. For bone marrow reconstitution after hemopoietic failure as a consequence of the action of a variety of etiological factors, hemopoietic stem cells are needed. These have been derived in the past mainly from bone marrow. This report describes studies and their results that indicate that granulocytic progenitor cells, measured in cell culture systems as "colony forming units in culture - CFU-C", can be collected in large quantities from the peripheral blood of human blood donors by continuous flow leukapheresis. They can be stored at ultra-low temperatures. Their recovery rate after thawing and washing is better than 85%. In a canine model, evidence was obtained that the presence of CFU-C in a suspension of mononuclear blood leukocytes is also indicative for the presence of pluripotent hemopoietic stem-cells. Therefore it is suggested that stem cells can also be collected from human blood as an alternative source for bone marrow reconstitution.


Erythroid progenitor cell numbers in human marrow - implications for regulation. Marrow specimens were obtained from 34 different individuals (mainly stage I or II Hodgkins or Lymphomas) and evaluated for their content of erythropoietic and granulopoietic progenitor cells using conventional colony assay procedures and a standardized set of re-agents. Frequency distributions showed that the data for all types of progenitors appeared to be log normally distributed. Estimates of compartment size (i.e. no. of progenitors per 2 X 10(5) buffy coat cells) were 107 CFU-E, 70 BFU-E (37 classified as mature, 12 classified as primitive) and 64 CFU-C. The ratio's of CFU-E: mature BFU-E: primitive BFU-E numbers in vivo correspond well to those predicted by their proliferative capacity in vitro. Interestingly the spread of values obtained for each erythropoietic compartment was not the same but decreased with progressive differentiation, suggesting that stringent regulation of red cell output may not occur until the latter stages of erythroid cell maturation. The ratio of total BFU-E: CFU-C numbers was 1.25 +/- 0.15 suggesting that on average the probability of stem cell commitment to either the erythropoietic or granulopoietic pathway may be roughly equal.


Telltale trails left by overprescribers lead to peer pressure.


Can you spot the games patients play to get pills to pop?


Why hospitals are getting tougher about your privileges.


Father in delivery room wins decision that could land you in court.


Why can't we decide what's best for our mentally ill patients?


How to avoid confusion when you consult.


Must you tell all you know?

Must you tell all you know?


Medical expert testimony--every doctor's concern.


Courting--how to do it.

Courting--how to do it.


What makes an expert an expert witness.

What makes an expert an expert witness.


Record access rising.

Record access rising.


How far can you go in treating emotional problems?


The LDH virus: an interfering biological contaminant.


Planning and evaluation: the roles of the public and voluntary sectors.


Child abuse--an illness or a crime?

Child abuse--an illness or a crime?


Use of videotape feedback with severely disturbed adolescents. A year of group therapy using videotape feedback with seriously disturbed adolescents offers evidence that such feedback facilitates the correction of these youngsters' distorted body images, low self-esteem, lack of capacity for self-observation, and poor peer relationships. The conscious use of videotape also played an integral part in the group process. It seemed to serve as a third therapist, with considerable amounts of resistance and transference focused on the equipment as it went through the process of being monster, toy and useful tool. An additional benefit was provided to the cotherapists in terms of supervision, and in teaching other staff the techniques of group therapy.


Treatment of child abuse by behavioral intervention: a case report.


A survey of the current use of filtration leukapheresis.


Leukocyte donor and recipient reactions with filtration leukapheresis: their character, frequency, and management. Neutrophil collection by filtration leukapheresis can be recommended chiefly on the basis of simplicity, low cost and efficiency. The disadvantages of the FL technique include a slightly increased incidence of adverse donor reactions, an increased risk of donor bleeding complications due to the large doses of heparin employed and a marked increase in the incidence recipient reactions, chiefly in the form of fever and chills. Because of these disadvantages, alternative methods of neutrophil collection should be considered when possible. The recently described technique of gravity leukapheresis is one such alternative which does not require investment in expensive new equipment and could be undertaken in any center familiar with plasmapheresis procedures (5).


Filtration leukapheresis: review and re-evaluation.


Filtration leukapheresis--a reference procedure.