.I 234
.C
3
.W
cortisone and atypical pulmonary /epithelial/ hyperplasia further       
studies including electron microscopy, tissue culture, animal           
transplantation and long term observations .                            
  previous work in rabbits showed that there was a proliferation of     
cells within pulmonary alveoli following intratracheal injection of     
nitric acid and that the proliferation was greatly enhanced by the      
administration of cortisone to the animals .                            
  electron microscopic observations indicated that these were           
morphologically large alveolar lining cells . tissue culture studies of 
damaged and normal lung with and without cortisone showed no evidence   
for a direct effect of the drug on the proliferation of these cells .   
  this observation, together with the knowledge that fibrosis was       
delayed in the cortisone treated animals, support the thesis that the   
cortisone effect is an indirect one . transplantation of damaged lung   
tissue to hamster cheek pouch failed to reveal evidence of growth .     
within the period of observation (99 to 420 days) there was evidence    
that the proliferation subsided considerably and no neoplasms developed 
.I 263
.C
8
.W
significance of blood groups in homotransplantation of marrow in the dog
  ten dogs were given 1,500 r whole-body irradiation and an infusion of 
allogeneic marrow from a donor matched with respect to six erythrocyte  
antigens . methotrexate was given to reduce secondary syndromes . four  
dogs survived . in a similar experiment with 10 dogs, in which no effort
was made to match donors and recipients, three dogs survived . it was   
concluded that matching of donor and recipient for these six red cell   
antigens did not increase significantly the longterm survival rate of   
lethally irradiated dogs with allogeneic marrow grafts .                
.I 264
.C
8
.W
radioautographic studies of bone marrow lymphocytes in vivo and in      
diffusion chamber cultures .                                            
  radioautography with tritiated thymidine has been utilized to examine 
the turnover rate and origin of small lymphocytes in the bone marrow of 
the guinea-pig .                                                        
  very few marrow lymphocytes were initially labeled by a single        
injection of tritiated thymidine, but thereafter the number of labeled  
lym phocytes rapidly increased to high maximum levels at 3 days .       
analysis of the labeling curves and grain counts indicates that the     
population of marrow lymphocytes is maintained in a dynamic steady state
with an average turnover time of 3 days or less .                       
  suspensions of bone marrow cells were isolated from the circulation   
within intraperitoneal diffusion chambers after short-term labeling with
tritiated thymidine in vivo . although very few small lymphocytes were  
labeled when introduced into the diffusion chambers, a considerable     
percentage became labeled during the subsequent culture period .        
  tritiated thymidine was also administered intravenously whilst        
excluded from one hind limb by the application of an occlusive          
compression bandage for 20 minutes . very few labeled small lymphocytes 
were found after 72 hours in the tibial marrow of the initially occluded
limb, whereas the normal high percentage was labeled in the control     
tibial marrow .                                                         
  these experiments do not demonstrate any large-scale influx of small  
lymphocytes from the blood stream into the marrow parenchyma . they     
suggest that newly formed small lymphocytes appear in the marrow as a   
result of the division of locally situated precursor cells, but the     
mechanism of intramedullary lymphocytopoiesis is uncertain .            
/transitional/ cells, intermediate in morphology between blast cells and
small lymphocytes, synthesize dna and are actively proliferative, but   
they do not appear to account fully for the rate of lymphocyte          
production .                                                            
  certain large, undifferentiated labeled cells appeared in the bone    
marrow as a result of hematogenous migration . some implications of     
these findings are discussed .                                          
.I 265
.C
8
.W
autoradiographic study on the origin and fate of small lymphoid cells in
the dog bone marrow.. effect of femoral artery clamping during in vivo  
availability of h3-thymidine .                                          
  the origin and fate of small lymphoid cells in the dog bone marrow    
were studied autoradiographically by observing the effect of clamping of
the femoral artery during in vivo availability of h3-thymidine . heavily
labeled small lymphoid cells appeared in the bone marrow of the clamped 
leg 3 hours after injection of the tracer and increased in number up to 
6 days . the labeling indices of these cells, however, were             
significantly lower than those of control marrow . a possible           
interpretation is that dog bone marrow contains two populations of small
lympho id cells, one migrating into the marrow via the blood stream, the
other originating from local precursor cells within the marrow . there  
was no evidence for a transformation of migrated small lymphoid cells   
into erythroblasts during the first 48 hours after injection of         
h3-thymidine .                                                          
.I 266
.C
8
.W
the lymphocyte in guinea-pig bone marrow .                              
  the structure and distribution of lymphocytes in the bone marrow of   
normal 400 g guinea-pigs have been studied by means of light microscopy,
electron microscopy, and radioautography . the study of structural      
organization by all three techniques confirms the morphological identity
of the marrow small lymphocytes with small lymphocytes in other         
situations and affords added proof of the presence of a series of cells 
transitional in appearance between small lymphocytes and blast cells .  
unlike the small lymphocytes, transitional cells show evidence of dna   
synthesis . marrow small lymphocytes and transitional cells are         
diffusely scattered throughout the parenchyma, often situated in close  
proximity to the sinusoidal endothelium . they are also found           
characteristically concentrated within some of the sinusoids,. this is  
termed /lymphocyte loading/ .                                           
  the findings are discussed with particular reference to the possible  
origin, interrelationship and fate of these cells .                     
.I 271
.C
9
.W
the response of dogs to perfusion and arrest of circulation at near zero
cerebral temperatures .                                                 
  1. twenty-six dogs were cooled by a whole body, closed chest perfusion
technique to end perfusion brain temperatures of 14.1 to 0.2 c.         
inclusive .                                                             
  2. there were no deaths in the group of six dogs in which the end     
perfusion brain temperature was 10.0 c. or higher .                     
  3. in the 17 dogs cooled to brain temperatures of 5.0 c. or less there
were nine deaths, of which five occurred quickly from cardiovascular    
failure, while four resulted from gross neurologic disturbances .       
  4. there was no evidence of aortic incompetence during whole body,    
closed chest hypothermic perfusion .                                    
  5. the lower the temperature of the brain at the end of the cooling   
perfusion, the greater was the passive transfer of heat from the        
environment .                                                           
.I 272
.C
9
.W
effects of graded hemorrhage on cardiopulmonary functions of hypothermic
dogs .                                                                  
  experiments were conducted on anesthetized dogs subjected to moderate 
hypothermia (28 c.) and then bled in percentages of the estimated blood 
volume . respiratory work was not influenced by the degree of hemorrhage
pulmonary ventilation, respiratory rate and tidal volume were not     
influenced significantly as a result of blood withdrawal . physiologic  
dead space as a percentage of tidal volume increased with hemorrhage .  
oxygen consumption decreased as the hemorrhage was made more severe,    
whereas carbon dioxide production was unchanged, indicating a shift in  
the respiratory exchange ratio . cardiac output decreased 78 per cent   
from control level when 35 per cent of the estimated blood volume was   
withdrawn . systemic arterial pressures decreased markedly but heart    
rate was not changed as a result of blood withdrawal . comparison of    
responses to hemorrhage in hypothermia and normothermia is discussed .  
.I 273
.C
9
.W
hypothermia in management of acute renal failure .                      
  1. prolonged hypothermia begun in the period immediately following the
infusion of epinephrine into the renal artery appears to give partial   
protection against renal damage .                                       
  2. shorter periods of hypothermia do not appear to be beneficial .    
  3. prolonged hypothermia at 28 to 30 c. has a mortality rate of 50    
percent
to 60 percent .
.I 276
.C
3
.W
1161. electron microscopy of the bovine lungs  lattice and lamellar structures
in the alveolar lumen
in an electron microscopic study of samples
from the lungs of 20 normal cattle,
and from 4 with high mountain disease, lattice
and lamellar structures were obser-
ved free in the alveolar lumens in 25% of the
normal cattle and in 100% of those with
high mountain disease.  in one specimen, a
lattice and lamellar structure was ob-
served in a vacuole within an alveolar epithelial
cell.  all others were extracellular.
the shape and dimensions of these lattice and
lamellar structures were similar to
those described by other workers in experiments
involving intratracheal injections
of silicon and oleic and linoleic acid.  this is the
first report of the structures free
in the alveolar lumens of apparently normal cattle.
.I 277
.C
3
.W
1162. electron microscopy of the bovine lungs  the blood-air barrier in acute
pulmonary emphysema
electron microscopic studies of experimentally
induced acute pulmonary emphy-
sema in 2 cows yielded the following findings
alveolar epithelial edema and cyto-
lysis, endothelial 'thinning' and cytolysis,
excessive elastic and collagenous alveo-
lar wall fibrosis, hyperplasia of alveolar
wall smooth muscle, numerous intra-
alveolar lattice and lamellar bodies, hyaline
membrane formation, hypertrophied
endothelial perikaryons, numerous alveolar
macrophages, and alveolar epithelial
secretion of an electron-dense amorphous mass.
it was postulated that the lattice
and lamellar bodies were a result of degenerating
alveolar epithelial cells.
.I 279
.C
3
.W
1685. differentiation of exfoliative broncho-alveolar disease from desquamative
interstitial pneumonia
three cases are presented of the pulmonary
disease described by liebow and asso-
ciates and named by them desquamative
interstitial pneumonia.  the cases support
the existence of the entity and the contention
that it had not been previously described.
a differential diagnosis between exfoliative
bronchoalveolar disease and desquamative
interstitial pneumonia is submitted.  clinical,
roentgenologic and histopathologic mani-
festations are tabulated for each condition
and the differences between them are em-
phasized.  additional symptoms, changes
and phenomena not previously recorded are
introduced.  the most distinctive differences
between the 2 diseases were found in
the histopathologic manifestations.
.I 282
.C
3
.W
617. maturation of postnatal human lung and the idiopathic respiratory distress
syndrome
maturation and pathologic alterations of the lung
in 19 newborn infants who died of idiopathic respiratory
distress syndrome were studied by light-and electron
microscopy.  normal lungs from 6 fetuses and 11 new-
borns served as controls.  in all infants with idiopathic
respiratory distress syndrome, respiratory bronchio-
les and alveolar ducts usually presented the histologic
pattern of mature lungs, i.e. they were predominantly
lined by type i cells, which also formed the epithelial
component of most blood-air barriers.  well expanded
alveoli exhibited a similar pattern, whereas collapsed
alveoli were lined by numerous type ii cells which par-
ticipated in the formation of poorly developed blood-air
barriers.  the capacity of type ii cells to produce in-
clusion bodies seemed to increase with survival beyond
the 14th hr of age.  secretion of inclusion bodies and
presumably surfactant into alveolar spaces did occur
but only in the lungs of infants older than 2 days.  how-
ever, this process was not accompanied by reduction
in the number of type ii cells per alveolus as in the nor-
mal lung.  the distribution of pathologic changes in idio-
pathic respiratory distress syndrome appeared to be
determined by the degree of maturity of the air sacs.
structurally mature air sacs were associated with da-
mage of epithelial lining and hyaline membrane forma-
tion.  in contrast, collapsed alveoli revealed an intact
epithelial lining and marked septal edema but were free
of hyaline membranes.  the findings of this study sug-
gested that transudation of plasma through well develop-
ed blood-air barriers was responsible for epithelial
damage and hyaline-membrane formation in air sacs.
they also suggested that alveolar collapse and presuma-
bly lack of surfactant were related to abnormal matura-
tion of the epithelial lining and to septal edema.
.I 283
.C
3
.W
903. lattice structures and osmiophilic bodies in the developing
respiratory tissue of rats
osmiophilic inclusions have been observed in the
lungs of rats particularly in the 20-day rat embryo and
newborn up to 3 days post partum.  these inclusions
are present in the large alveolar cells as dense lamin-
ated structures of variable size and configuration.  they
generally consist of concentrically arranged membranes
and have the appearance of myelin figures, usually with
a dense center.  these osmiophilic inclusions are fre-
quently seen in direct contact with the cell membranes
and the alveolar space.  the alveolar space contains
numerous osmiophilic myelin figures which are thought
to originate from the intracellular osmiophilic inclu-
sions.  they may extrude through a channel formed in-
side the cell or by rupture of the cell membrane.  secre-
tion materials may occasionally be seen in the cyto-
plasm of the large alveolar epithelial cells.  these cells
appear to be in the process of degeneration.  their cell
surfaces are disrupted and the cytoplasm is continuous
with materials in the air space.  the lattice structure
in the alveolar space may originate from the cytoplas-
mic secretion material.  the cytoplasmic secretion ma-
terial in the cell and the lattice structures in the air
space disappear after the rats are 3 days old.  (i,t*)
.I 287
.C
3
.W
1688. surface phenomena in lungs in health and disease
in summary, the authors have attempted
to bring together the multiple observations
which seem germane to the understanding
of surface phenomena in lungs in health
and disease.  to this end, the contributions
of anatomists and pathologists on the
fine structure of alveolar cells and their
lining are fundamental.  the concepts of
alveolar stability required the special
insights of physiologists who were concerned
with the causes of bubble stability as
they related to the particular problems posed
by a lung of several millions of bubbles
arranged in parallel.  soon the contributions
of the chemists became significant as
methods of identification and assay of the al-
veolar lining material were of interest.
clinicians asked what relevance these studies
had to atelectasis as it occurs in disease,
and soon the question of when the surfac-
tant appeared in development occurred to
those concerned with premature infants.
students of metabolism began to focus on
the lung as a site of phospholipid synthesis,
and their tools seem most promising at
this time in unearthing possible errors in
metabolism which may express themselves
in disease.  surgeons who undertake per-
fusion of the isolated lung ask the
requirements of that organ with respect to the
nutrients and environment of the alveolar
cells, and anesthesiologists inquire into
the possibilities of mechanical injury
to the alveoli during artificial respiration.
the problems posed to the reviewers
of a subject which touches so many disciplines
are obvious.  doubtless some pertinent
studies have been omitted although uninten-
tionally; others may have been
misinterpreted through lack of qualifications as spe-
cialists in all specialties.  the
authors hope they have provided evidence that the
forces of surface tension cannot
be ignored in an organ with an air-liquid interface
of some 70 m2.  they further hope
they have described some of the properties of
the film at the alveolar-air interface
which operate to produce stability of the alveoli.
they hold the belief that study of the
metabolism of the alveolar lining layer will
further their understanding of a number
of disease processes in which it may be
altered.  and lastly, they hope for much
closer communication between workers in
many disciplines who can elucidate this
remarkable subject best through cooperative
studies.
.I 294
.C
2
.W
82. central nervous system lesions in rats
exposed to oxygen at high pressure
adult female rats paralyzed by repeated exposures
to oxygen at high pressure were found to have cns le-
sions of 2 types  (1) focal necrosis of individual neurons
within certain nuclear groups, and (2) complete or partial
necrosis of nuclear groups with frequent damage to mye-
lin, axons, and glia in the area involved.  both types
were usually bilateral and symmetrical.  lesions of the
first type were found consistently in the superior olivary
complex, ventral cochlear nuclei, and nuclei of the spinal
tract of cranial nerve v.  lesions of the second type were
found consistently in the substantia nigra and globus pal-
lidus, were frequent in the rhinencephalon, and never
occurred in the neocortex.
.I 296
.C
2
.W
3384. adrenergic effects in splenic po2 of rats in air or oxygen
at 5 atmospheres
oxygen tensions have been measured
in the spleens of rats breathing air and during
exposure of the animals to 5 atm abs
of oxygen (hpo).  the response of splenic po2
to compression was complex, usually
reaching a peak value immediately after com-
pression, then falling to a lower value.
this form of response has been termed a
hump response.  after adrenalectomy
or bretylium tosylate injection the hump res-
ponse of po2 after compression was
almost abolished, and the values of splenic po2
at 5 atm were considerably higher
than in control animals.  a combination of adrena-
lectomy and bretylium tosylate also
markedly reduced the number of hump responses,
but unexpectedly significantly lowered
splenic oxygen tensions, both when the ani-
mals were under ambient conditions
or at 5 atm of oxygen.  cardiac rate and blood
pressure were studied in an attempt
to find the explanation of this latter effect, and
while blood pressure was the same
in adrenalectomized rats and control rats after
bretylium injection, adrenalectomy
potentiated the bradycardia produced by brety-
lium tosylate.
.I 300
.C
2
.W
7839.cortical ph and the blood-brain barrier
a method was described for measuring
the ph, dc and ac potentials concurrently
on the cerebral cortex of the adult cat,
under conditions of controlled ventilation.
kittens and rabbits were also studied.
the cortical ph response to i.v. nahco3
was acidic and was accompanied by a
dc negativity, while the blood became alkaline.
such an acidic response was present in
the rabbit and kitten.  it was not present
in a number of other tissues in the cat,
including the dura.  the cortical acidic
response was not affected, qualitatively,
by i.v. acetazolamide, prolonged hypoxia
or 10% (v/v) co2.  it was reduced reversibly
by 20% (v/v) co2.  it was not affected
by removal of the arachnoid membrane.
the cortical ph response to an i.v. nh4+
salt solution was complex.  nh4c1 did not
produce an alkaline response.  the cortical
ph response to an alkaline or an acidic
sodium phosphate solution was augmented
but not changed in its direction following
treatment of the cortex with n-butanol.
the results were interpreted in terms of
a restriction of hco3- by the blood-brain
barrier, through which co2 can pass.  this
restriction is probably non-specific for
inorganic ions, and perhaps for other
substances.  it does not appear to be related
to a low cerebral extracellular space,
and is independent of substantial oxidative metabolism.
.I 301
.C
2
.W
7083. brain damage and paralysis in animals exposed to high pressure oxygen -
pharmacological and biochemical observations
single exposures of high pressure oxygen
(ohp) at 30-66  gauge pressure caused
cns damage and paralysis in rats and mice
but guinea-pigs, rabbits, and man did
not show such sequelae.  the cns damage
in rats was greatly increased by cns-de-
pressant drugs (pentobarbital, paraldehyde,
n2o and phencyclidine) given before ex-
posure to ohp.  the cns lesions were also
potentiated by raised respired pco2, by
acetazolamide and by nh4c1, whilst protection
was afforded by methaemoglobinae-
mia by tham, by 2 4-dinitrophenol and by
serotonin against the barbiturate and
co2 potentiation of ohp brain damage.
ohp-induced brain damage was not modified
by hypothermia (cp2), electroconvulsive
shock treatment during ohp, cerebral x-
irradiation, adrenalectomy or cortisone,
slow decompression rates, spinal block
with local anaesthetic, 'conditioning' of
rats to ohp, hyper- and hypoglycaemia, or
alterations in tissue histamine levels.
the results are discussed in relation to pos-
sible biochemical mechanisms and
theories of oxygen poisoning.
.I 303
.C
2
.W
5407. hypoxic-hypercapnic interaction in subjects with bilateral
cerebral dysfunction
to analyze cerebral influences modifying
autonomic respiratory responses, the
authors compared normals and patients
with bilateral pyramidal tract disease for
their ventilatory response to hypoxia and
hypoxia-hypercapnia.  during eucapnia,
the 2 groups showed similar hypoxic
responses.  during hypercapnia, the ventilatory
response to hypoxia was greater in the
brain-damaged subjects.  this apparent aug-
mentation, however, was due entirely
to anoxia interacting with an abnormally fa-
cilitated carbon dioxide sensitivity
compared with normals, brain-damaged patients
at pao,90-100 mm hg showed an 85%
greater co2 response, and at pao,50mm hg
showed a 79% greater co2 response.
since cerebral dysfunction facilitated the ven-
tilatory response to hypoxia-hypercapnia
combined but not the response to hypoxia
alone, the results imply that the 2
respiratory stimuli interact centrally rather than
peripherally.
.I 309
.C
6
.W
3204. interventricular septal defects with aortic insufficiency
sanchez f.-villaran e.
the coincidence of these 2 malformations
permits their diagnosis provided that a
careful evaluation is made of the hemodynamic
and oximetric data, on the basis of
specific auscultatory features.  even then, a
differentiation from other cardiopathies
patent ductus arteriosus with/without pulmonary
hypertension, aortopulmonary sep-
tal defect, interventricular communication,
truncus arteriosus, aneurysm of the
sinus aortae ruptured into right cavities - is
not simple.  for this an analysis of the
course of the syndrome together with the
information supplied by phonocardiography,
catheterization, angiocardiography, radiology
and ecg (in this order of importance)
are indispensable.  an analysis is made of 5 cases
in which, in the absence of ana-
tomical confirmation, concrete data were obtained
on which to base the diagnosis.
.I 320
.C
6
.W
1831. postoperative aneurysm of the right ventricle
twelve patients with postoperative aneurysm
of the right ventricular outflow tract
after corrective surgery for pulmonic valvar
stenosis, ventricular septal defect and
tetralogy of fallot are reported.  the literature
is reviewed and the pathogenesis is
discussed.  different diagnostic tests are evaluated
stressing the role of roentgen
examinations and the importance of careful follow-up
by intercalative chest roent-
genography.
.I 321
.C
6
.W
1991. ventricular septal defect with aortic regurgitation.
medical and pathologic aspects
thirty-four patients with ventricular septal defect
and aortic regurgitation, repre-
senting less than 5% of the patients with ventricular
septal defect, are discussed.
a loud, systolic murmur, characteristic of ventricular
septal defect, is noted dur-
ing infancy, whereas evidences of aortic regurgitation
(protodiastolic murmur and
wide pulse pressure) does not usually appear until some
time between 2 and 10
years of age.  clinical and catheterization data indicate
that the principal hemody-
namic load is aortic regurgitation, whereas the
ventricular septal defect does not
usually result in a large pulmonary blood flow or
high pulmonary arterial pressure.
in about 50% of the patients, a significant pressure
gradient across the right ven-
tricular outflow tract exists.  detailed pathologic
studies indicate that the ventricular
septal defects are high and anterior and encroach
to a greater or lesser degree on
the membranous bulbar septum.  the right coronary
cusp is the one most severely
involved, and, by its prolapse, causes aortic
regurgitation; the noncoronary cusp
is always less severely affected.  the anatomic basis
of the pressure gradient ob-
served across the right ventricular outflow tract is
not always clear.
.I 323
.C
6
.W
1021. left ventricular angiocardiography in the study of ventricular
septal defects
sixty-five cases of ventricular septal defect
were studied by left angiocardiography.
the left ventricle was entered by retrograde
arterial catheterization with a catheter
having a j-shaped tip.  this procedure appears
to be little, or no more, hazardous
than right-sided angiocardiography.  ventricular
septal defects may be divided into
5 types, depending on their location in the ventricular
septum.  the anatomic and
radiological features of the septum and septal defects
are described.  selective in-
jection of contrast material into the left ventricle
opacifies the blood passing through
the defect in the septum and permits preoperative
localization of the defect in rela-
tion to identifiable anatomic landmarks.  multiple
defects of the septum are well de-
monstrated.  such information may be of
considerable value to the surgeon under-
taking repair of the septum.  left ventriculography,
often combined with supraval-
vular aortography, has been used, when indicated,
to differentiate between mitral
insufficiency and ventricular septal defect and in
the detection of other cardiac ano-
malies whose manifestations are marked by those
of the septal lesion.  this tech-
nique is well suited to the postoperative study of
patients following repair of the
septal defect and for follow-up studies in patients
not operated upon to clarify the
natural history of defects in different portions of
the ventricular septum.
.I 325
.C
5
.W
95. changes in serum non-esterified fatty acid levels in spon-
taneous and in oxytocin induced labour
the nonesterified fatty acid (nefa)
concentration of serum rises progressively
during the course of normal labor.
the rise appears to be related to the duration
of labor.  the use of oxytocin to induce
and stimulate labor does not alter the normal
pattern of rise in nefa provided it is
given in physiologic dosage.  the levels of
nefa in the umbilical vein and the
umbilical artery at delivery are comparable and
always significantly lower than the
maternal level.  the maternal/fetal ratio varies
between 1.7 1 and 3.9 1 in this series.
following delivery the nefa levels begin
to fall almost immediately.  the rate
of fall is 10-30% of the delivery value in the 1st
hour, 30-50% within 18 hr. and 50-70% within 36 hr.
.I 326
.C
5
.W
1545. the effect of combined glucose and insulin infusions on
the lipoid and carbohydrate metabolism of the parturient
woman and of the fetus
the infusion of glucose with insulin during delivery
was used by the authors pri-
marily in order to determine, whether the utilization
of glucose can be enhanced
under these conditions.  they wanted to investigate,
whether the increase of unesteri-
fied fatty acids in the cord blood which takes place
after a sole glucose infusion in
the mother, could be caused by the low capability
of glucose utilization in the fetus.
the infusion during delivery which consisted of the
application of 500 ml of 10%
glucose and 16 u of insulin over a period of 30 min.
brought about a greater decrease
of unesterified fatty acids in the parturient woman
as compared with the infusion of
glucose exclusively.  the reason for this result
is thought to be due to a better utili-
zation of glucose which is favorably influenced
by insulin.  during the infusion of
glucose with insulin, an increase in the values
of lactic and pyruvic acid took place
in the parturient women; this was probably due
to an accelerated glycolysis and an
increased production of lactic acid, but not
caused by a higher share of the anaerobic
metabolism.  in the cord blood, there were
likewise increased values of lactic and py-
ruvic acid as a reflection of the higher values
of these substances in the mother.  the
formation of these products of metabolic
breakdown by the fetus, however, was not
significantly increased.  after infusion of
glucose with insulin, the other investigated
parameter values, including those of the levels
of unesterified fatty acids are found
in the cord blood in similar amounts as after
infusion of glucose alone.  these re-
sults cannot reliably prove the passage of
insulin through the placenta especially
after a continued study of the metabolic values
in newborns.  as a proof of the passage
of insulin through the placenta could not be
established, it is possible that after an
intake of insulin the increase of unesterified
fatty acids in the cord blood could be
caused by a relative insufficiency of the insular
apparatus of the fetus.  the most
probable reason for the increase of unesterified
fatty acids is the different depo-
sition and metabolization of unesterified fatty
acids in the course of intrauterine
life.
.I 327
.C
5
.W
1547. glucose and nonesterified fatty acid levels in maternal
and cord plasma
the authors established in 44 healthy women
at the moment of delivery the contents
of glucose and free fatty acids in the blood
of the mother and of the umbilical cord.
the concentration of both substances was
significantly higher in the mother than in
the infant.  the relation for free fatty acids
was 1.7 1, that for glucose 1.3 1.  the
relation glucose fatty acids in the mother was
significantly different from that in the
infant.
.I 329
.C
5
.W
766. a lipid-mobilizing substance in the serum of pregnant wo-
men, of probable placental origin
a substance capable of inducing free fatty
acid (ffa) release was found in the sera
of 12 from 13 pregnant women.  the rat
epididymal fat pad was used for bioassay.
this substance circulates in late pregnancy
and disappears within 5 days post partum.
it is present in crude placental extracts and
is removed by their deproteination.  it
is nondialyzable.  application of pituitary
extraction procedure to placentae yielded
active fractions where pituitary growth
hormone is usually found.  in accordance with
these facts a hypothesis concerning a part
of metabolic changes occurring during preg-
nancy was pronounced as follows.  the
described substance diminishes maternal glu-
cose consumption through the elevation of
plasma free fatty acids, or by direct in-
hibition of glucose uptake, or both.  this
permits a preferential shunting of glucose
to the fetus.  at the same time, increased
plasma free fatty acid levels would serve
as the alternative maternal energy substrate.
elevated maternal insulin levels during
late pregnancy stabilize the degree of maternal
lipid mobilization.  the contrainsulin
properties of a substance capable of mobilizing
free fatty acids and inhibiting mater-
nal glucose utilization would pose a diabetogenic
challenge, and in the face of com-
promised maternal insulin reserves, provoke
overt or worsen existing diabetes
mellitus.
.I 330
.C
5
.W
3682. metabolism of free fatty acids during perinatal life of lambs
there is a rapid rise of free fatty acids
in blood plasma after birth in newborn
lambs.  this study confirms this rise,
caused by an augmented mobilization of these
acids from the tissues.  norepinephrine
easily mobilizes free fatty acids in adult
ewes.  in newborn lambs this special effect
is lacking, though cardiovascular re-
sponses are clearly demonstrable.  blocking
the sympathetic nervous system in
newborn lambs inhibits the rapid rise of free
fatty acids after birth.  this is com-
patible with the concept, that increased activity
of these sympathetic nerves after
birth is an important factor for free fatty acids
mobilization.  during intrauterine
life there is an ample study of carbohydrates
and the organism uses them as an
energy source.  hypoglycaemia resulting from
sudden carbohydrate deprivation at
birth, demonstrates with rising free fatty acids
the change-over to (tissue) fat as
main source of energy.
.I 331
.C
5
.W
1163. the effect of glucose infusions on the lipoid and the
carbohydrate metabolism of the parturient woman and
the fetus
in 20 parturient women who were given glucose
infusions during the expulsive stage
of labor, the authors were able to observe an unusual
hyperglycemia and a decrease
in unesterified fatty acids (uefa).  the uefa-level
usually increases regularly
during delivery.  likewise, the values of esterified
fatty acids (efa) showed an in-
crease above the normally present levels in women
who had received a glucose in-
fusion during the expulsive stage of labor.  the
results show that during delivery
both hyperglycemia and the increase in lipoids
are predominantly due to the energy
demands of the organism.  however, there is also
evidence that other, hitherto un-
known factors may play a role.  in the fetus,
the infusion of glucose leads to an in-
creased glucose retention.  the infusion, however,
does not bring about a decrease,
but, contrary to the expectations, an increase
in the uefa-values.  in general,
such a reaction is not found in any of the
subsequent periods of life.  further inves-
tigations were conducted in order to find an
explanation for the paradox uefa-
reaction.  as shown by an analysis of the lactic
acid and the pyruvic acid values, the
increase in the uefa can most probably not be
attributed to an impairment in the
fetal metabolic conditions.  the administration
of physiological saline infusions to
10 parturient women under equal conditions
revealed that the cause for the uefa-
increase can apparently neither be found in
hemodynamic changes due to the infusion
nor in changes of the electrolyte balance, but
rather in an adaptation insufficiency
of the fetal islet cells, respectively in a different
fat mobilization or fat deposition.
.I 332
.C
5
.W
1320. the plasma free fatty acid composition and blood glucose
of normal and diabetic pregnant women and of their new-
borns
the blood glucose and plasma ffa content
and composition of the newborns of
normal women, gestational diabetics, and
insulin-dependent diabetics were analyzed.
normal maternal ffa levels were twice the
fetal values; by 2 hr of age ffa in-
creased 4-fold over initial values in normal
infants, while infants of gestational
diabetics had a 3-fold rise, and those of
insulin dependent diabetics only 2-fold.
blood sugar at the same time decreased and
there was an inverse relationship be-
tween blood glucose in the normal infants and
ffa.  this relationship is altered in
the infant of the diabetic mother.  gas
chromatography of plasma indicated a higher
ratio of unsaturated to saturated ffa in
mothers compared to infants.  no pattern
differences were noted between the normal
and diabetic mothers, except that the
latter had higher oleic acid.  in the initial 2
hr of life, the patterns changed, although
no differences were noted between infants
of diabetic mothers and normals.  the
observations suggest  (1) the metabolic
interrelationships of glucose and ffa in
the normal infant are different from those
in the infant of the diabetic mother, the
latter infant having a state of physiologic
hyperinsulinism; (2) plasma ffa in the
fetus is derived from both fetal fat synthesis
as well as placental transfers; (3) the
infant of the diabetic mother does not differ
from the normal as regards ffa com-
position.
.I 333
.C
5
.W
3107. lipids of human placenta
the chloroform-methanol-soluble
components of 4 human placentae were isolated
by rubber membrane dialysis and gas
chromatography, and analysed.  two thirds
of the total lipids consisted of phosphatides
with lecithin as the main component
(22.5%), colamine cephalin (13%)
and sphingomyelin (7.5%).  free cholesterol form-
ed 14% of the total lipids, while
cholesterol esters accounted for 6% and trigly-
cerides for 13%.  investigation of
the phosphatide fatty acids by gas chromatography
showed a content of 60% saturated,
27% simple unsaturated and 12% polyunsaturated
acids.  the fatty acids of the triglycerides
consisted of about 50% saturated and
25% each of simple and polyunsaturated
acids.  the polyenoic acids (30%) of the
cholesterol fatty acids had a high content
of linoleic acid, about one quarter that
of the total acids.
.I 338
.C
17
.W
1013. hand eczema
the clinical aspects of 106 cases of hand
eczema are reviewed.  the clinical
types are defined  nummular eczema, nickel
allergy, atopic dermatitis,
hyperkeratotic dermatitis of the palms, hand
eczema post partum, mycotic eczema,
contact dermatitis, occupational eczema and
idiopathic eczema.  the results
of the patch tests, the influence of
psychological and psychiatric factors,
the effect of water and cleansers, the
diagnosis, treatment and prognosis are
discussed.  in 39% no significant causative
factor could be found.  in
many cases where causative factors could
be identified these were probably
no more than contributory, superimposed
upon an underlying idiopathic eczema.
.I 339
.C
17
.W
670.  steroid aerosol spray in contact dermatitis.
prophylactic use with
particular reference to nickel hypersensitivity
proper use of topical aerosol dexamethasone
(decadron) spray affords complete
protection to patients with nickel sensitivity.
this clinical result is
confirmed by the results of patch testing
nickel-sensitive patients with a
5% nickel sulfate solution and nickel coins.
a combination of dexamethasone and
an isopropylmyristate film is necessary
for successful prophylaxis; the
individual components alone do not protect
these patients.  clinical and patch
test results indicate that a moderate degree
of protection is afforded to
patients with paraphenylenediamine sensitivity.
patch test results indicate
that the spray does not protect against
poison ivy and ragweed oleoresin,
potassium dichromate, certain rubber accelerators,
and monobenzyl ether of
hydroquinone.  it affords a moderate protection
against formaldehyde.  no tests
were done with patients with formaldehyde
hypersensitivity.  a fair degree of
protection was obtained by the use of the spray
in housewives eczema presumably
due to irritants present in soap and detergents.
.I 340
.C
17
.W
2078. the pathogenesis of contact eczema due
to detergents for domestic use
the thesis is maintained that eczema due
to household detergents is
pathogenically linked with allergic contact
sensitization to metallic salts,
especially chromium and nickel.  in a series
of 20 cases of contact eczema
attributable to detergents, the existence of
sensitization to these metals was
demonstrated by the patch test.  likewise,
in the analysis of 9 samples of
different detergents used for washing,
in all of them chromium and nickel were
found to be present in a proportion which,
for either of these metals, varied
between 1 and 5 p.p.m.
.I 341
.C
17
.W
4010. studies of nickel carcinogenesis.
the subcellular partition of nickel
in lung and liver following inhalation of nickel carbonyl
wistar rats were exposed by inhalation to
nickel carbonyl either once only
at a concentration of 80 ppm for 60 minutes
(0.60 mg ni(co)4/l.air), or
repeatedly at 4 ppm (0.03 mg ni(co)4/l. air)
for 30 minutes 3 times weekly
for 1 year.  they were killed 24 hours after
(the final period of) exposure.
nuclear, mitochondrial, microsomal and supernatant
fractions were isolated
from lung and liver homogenates and measurements
of the nickel, nitrogen
and rna-content of each subcellular fraction
were made.  the greatest ratios
of nickel to nitrogen were in the nuclear
fractions of both liver and lung,
but increased amounts of nickel were also found
in the microsomal and
supernatant fractions of both liver and lung
and in the mitochondrial
fraction of lung.
.I 342
.C
17
.W
188. studies of nickel carcinogenesis;metastasizing pulmonary tumors in rats
induced by the inhalation of nickel carbonyl
in a combined series of studies, 6 out of 409 rats (n.b. only 195 survived for
more than 3 wk.) exposed to nickel carbonyl developed pulmonary carcinoma
with metastases.  the lesions included the common types of pulmonary cancer,
squamous cell carcinoma, adenocarcinoma and anaplastic carcinoma.  all of
the pulmonary lesions were found between 24 and 27 mth. after the initial
exposure to nickel carbonyl.  the amount of nickel found capable of inducing
lung cancer in the rat was comparable to the amount of nickel inhaled by
persons smoking less than 15 cigarettes per day for a period of a year.  the
mean weight of rats chronically exposed to nickel carbonyl was found to be
consistently less than that of the control rats throughout the entire 3-year
period of study.
.I 346
.C
17
.W
3446. effect of nicl2 on an isolated ranvier node
an attempt was made to explain the extreme prolongation of the nodal
potential by 0.1-1.0 mm nicl2 in terms of the ionic theory.  the effects of
nicl2 at room temperature are similar to those of temperature reduction
decreased maximum rate of rise of the action potential, lengthened action
potential duration, elevated threshold, increased tendency for repetitive
activity; in addition, the amplitude of the action potential is slightly
increased.  the long-lasting plateaus of the responses obtained under the
combined influence of nicl2 and temperature reduction are shortened by cathodal
polarization, strong anodal polarization and decrease of (na)0.  the plateau
can be prematurely terminated by short anodal pulses of critical amplitude;
short cathodal pulses reduce the duration of the plateau gradually with
increasing pulse strength.  increased (k)0 prolongs plateau duration; the
steep repolarization phase which normally terminates the plateau is
replaced by a long lasting after-depolarization with stepwise potential
decline.
the amplitude of k-depolarization is not influenced by nicl2 or temperature
reduction.  1.0 mm nicl2 changes the relation between maximum rate of
rise and steady-state polarization; the potential change required for 50%
sodium inactivation is +8mv in normal ringer's solution and +16mv in the
presence of 1.0 mm nicl2 (22 c.).  1.0 mm nicl2 increases the time constant
of delayed rectification as measured in na-poor solutions at 4 c. by a factor
of about 2.  the decrease of action potential under cathodal polarization is
slightly delayed by nicl2.  it is concluded that prolongation of the nodal
action potential by nicl2 is due to delayed and reduced inactivation of na
permeability and delayed increase of k permeability; part of the nicl2-effect
could be explained by assuming competition between ni++ and ca++ for specific
sites at the membrane.
.I 348
.C
17
.W
12083. generation of action potentials in single ranvier's nodes of isolated
frog nerve fibres under the influence of nickel and cadmium ions (russian)
by experimenting on single ranvier's nodes of frog isolated nerve fibres it
was shown that, along with a marked prolongation of the repolarization
phase of the action potential (ap), ni and cd ions also caused a rise of
the critical membrane depolarization level and an increased ap amplitude
with somewhat reduced steepness of its ascending phase.  ni and cd ions
restored the ap generation in the nodes of ranvier altered by a 0.01% procaine
solution, by an excess of potassium ions 00mm/1. of kcl) or by slight
mechanical injury during dissection.  it was only with a reduced na
concentration in the medium that the restoration of ap could be achieved.
ni and cd ions considerably slowed down and weakened the cathodal rise of the
critical level and the ap reduction.  cysteine (10 -2 to 10 -3 m)
eliminated all the effects of the mentioned ions.  a suggestion is made that by
binding the sh-groups of the nerve fibre proteins, nickel and cadmium reduce
the rate of inactivation and the increase of potassium permeability in
depolarization and also weaken the initial inactivation and the increase of
potassium permeability in depolarization, as well as weaken the initial
inactivation of the membrane (i-h), whenever this happened to be raised by
previous influences.
.I 353
.C
15
.W
387. ophthalmic manifestations of bilateral non-occipital cerebral lesions
twelve patients are described with neuro-ophthalmic symptoms resulting from
bilateral cerebral lesions in areas other than the occipital lobes.  the
symptoms and signs are categorized as follows  group i  those showing
predominant disturbances in visual object recognition (visual agnosia) and
disturbances of visual spatial localization.  group iia  those having defects
in voluntary control of eye movements (ocular motor apraxia).  group iib  those
with persistent palsies of conjugate gaze.  although these symptoms may be
present to some extent with unilateral lesions, they are much more profound
and less able to be compensated with bilateral lesions.  the evidence in the
present cases suggests a biparieto-temporal localization for the lesions
causing visual agnosia, disturbances of spatial localization, and ocular motor
apraxia, and a more frontal localization for the lesions causing prolonged
paralysis of conjugate gaze.
.I 355
.C
15
.W
1303. the problem of visual agnosia
this is a critical assessment of the ancient and modern theories on visual
agnosia.  an original description of the subjective world of these patients is
also given.  visual agnosia is a rare disorder, but it has led to comprehensive
discussions, for instance, by the fact that the problem of normal visual
perception is always involved.  bay's view, which denies the existence of
agnosia as a separate phenomenon in perception disorders, is especially dealt
with.  it is affirmed that no case has been described in the literature
in which visual agnosia is decidedly a pure and isolated phenomenon.
mostly there are also disturbances in the intellectual interpretation of visual
data.  often there is metamorphopsia or asthenopia.  there is no localized
prestriate gnostic center for visual impressions.  the older concept of higher
and lower levels of perception and perception disorders is also criticized.
visual perception is not a passive, but a very active process, in which
neurophysiological and psychological aspects are involved.
each of these can be
disturbed, leading to various degrees of visual perception disturbance.
.I 356
.C
15
.W
2496. dysbarism among hyperbaric personnel
a survey of the effects of hyperbaric exposure on 62 medical personnel exposed
to 1,516 compressions and decompressions revealed no case of permanent ill
effect.  pain in the ears or sinuses was the most common symptom but could
often be ameliorated or avoided by the valsalva technique of forced
insufflation with the nostrils occluded.  the most serious symptoms
encountered were 3 episodes of transient homonymous hemianopsia.  the
classic symptoms of decompression sickness
extremity pains (the 'bends'), pulmonary or
substernal distress (the 'chokes'), and skin dysesthesias occurred only rarely,
and were so mild or so fleeting as to require no treatment.  a further
reduction in symptoms without increase in decompression time may be
obtained by the inhalation of 100% oxygen during decompression stops at
pressures below 26.8 pounds per square inch gauge (psig).
.I 357
.C
15
.W
2996. visual static agnosia with special reference to literal agnosic alexia
this is a report of 2, right-handed adults who had 'visual agnosia (with
predominance of literal alexia)'.  recognition of letters was poor or
nonexistent when the patient simply viewed the material (static method) but
if the letter was slowly developed for them, they were able to identify it
(dynamic method).  one patient had vascular pathology which was considered
to involve both occipital lobes and the 2nd patient had the surgical removal of
the left occipital lobe for an angioma.
.I 358
.C
15
.W
1388. optic agnosia  semeiological and pathogenetic aspects
the authors discuss the classical concept of agnosia and make a survey of
pathogenetical factors which determine its phenomenology.  the original and
traditional concept of such a term implied the loss of the capacity to
recognize objects, when the functions of sense organs are undamaged.  the
psychological studies on perception and the modern physiology of
vision allow to avoid the dichotomy between sensation and perception and
to affirm their identity.  cortex and recptors are closely bound and
function in unison.
every cortical alteration is thus reflected in sensorial functions; it is
therefore that on practical semeiological grounds it is possible to obtain a
congruous information of the corresponding cortical functionality through an
exploration of sense organs carried out by suitable means.  since we are
confronted with functional changes, exploration methods must be fit to evaluate
dynamic aspects of perception in connection with the temporalization and
spatialization of stimuli.  such methods are now quite numerous and often
complex  a particular stress is laid on local adaptation, flicker fusion, and
tachistoscopy on account of their significance and suitability.  by such
methods it is possible to show those functional deficits or pathological
disturbances of sensorial functions which are also behind the pathology of
visual recognition.  fluctuation, extinction, alteration in the perception of
movement, both real and apparent, changes in adaptation to light and
darkness are all phenomena which can be detected instrumentally and which,
at the same time, may be of determinant importance for the onset of 'agnosic'
behaviour.  the complexity of the latter, on the other hand, cannot always
be explained by sensorial disturbances only  other mechanisms, with a function
complementary but not less indispensable to the dynamics of perceptive
processes, may intervene and interfere in it.  on the basis of the latest
neurophysiological data the attention is called to ocular motility and
proprioceptivity, centrifugal innervation of sensorial receptors, and
vestibular afferences.  a particular clinico-pathogenetical significance is
attached by the authors to the association of lateral visual disturbances with
altered proprioceptive and kinesthetic information from the corresponding
half-body  such association in fact is nearly always present among the factors
responsible for the most strictly 'spatial' errors of 'agnosic' pathology.  in
the light of these pathogenetical considerations as well as of suitable
semeiological findings, the authors deem it convenient to divide their cases
into 3 categories with distinct clinical features  (a) cases in which altered
visual behaviour may be related to changes of the visual function and of its
complementary mechanisms; (b) cases in which hemianopia is associated with
a homolateral deficit of somatic proprioceptivity; (c) cases in which the
changes in behaviour are chiefly, but not only, due to a dissolution
of the symbolic sphere.
.I 359
.C
15
.W
2568. clinical observations on hemianopia (japanese)
the clinical findings in 19 cases of hemianopia were analyzed.  hemianopia was
caused most frequently by vascular lesions of the central nervous mianopsia,
and by tumors.  wilbrand's prism sign, which is generally taken as evidence
of an optic tract lesion, was positive in one case with a parietal lesion.  no
case showed a cogwheel movement of the eyeball.  optokinetic nystagmus was
positive in 3 cases, one of which proved to have a parieto-occipital aneurysm.
the etiological factor could not be identified in the remaining 2 cases.
macular sparing was found to be symptomatic of an occipital lobe lesion.
incongruity of the 2 fields was observed in 2 cases with an occipital lobe
lesion.  as for the prognosis, hemianoptic field defects remained stationary in
cases of vascular lesions.  on the other hand perfect recovery of the visual
field defect occurred in cases with an occipital lobe tumor and in hypophyseal
hypertrophy caused by pregnancy.  the visual acuity of hemianoptic patients was
fairly good and no deterioration occurred during the observation period of
about 4 years.  only one patient out of the present series died.  these results
suggest that a favorable vital prognosis can be accorded to hemianoptic
subjects.
.I 361
.C
15
.W
375. hemianopsia and glaucoma
after a discussion of the bibliographic references to the few observations on
the simultaneous occurrence of hemianopsias and glaucoma the author states on
the basis of his experiences the following points  homonymous hemianopsias
occasionally take place in glaucoma, although no direct relation can be
established between the former and the glaucoma.  it has to be pointed out,
however, that in other older patients, for example in those with retinal
detachment, neuritis, etc. who are likewise subjected to repeated and exact
perimetry, such hemianopsias do not occur, or are to be found at a lesser rate
than in glaucoma.  a homonymous hemianopsia has to be taken into consideration
also in the event of a sudden impairment of the visual field in a glaucomatous
patient or when the hemianopic defect supervenes in addition to the visual
field defect due to glaucoma.  in cases of binasal hemianopsia, the
simultaneous presence of glaucoma is not a rare incident.  whether the
binasal hemianopsia is the result of the gradual development of a
glaucomatous visual field with nasal defects or whether it constitutes an
independent symptom to a certain extent, cannot always be clarified
in the individual case.  obviously the condition of the basal cerebral
vessels plays a certain role in the development of glaucoma, even if
this role cannot be clearly defined as yet.  in cases of
binasal hemianopsia, a glaucoma has to be ruled out before radical diagnostic
and therapeutic measures are carried out.
.I 362
.C
15
.W
1131. disorders of oculomotor functions in lesions of the optic pathway at the
parieto-occipital level and their significance in topical diagnosis
paresis of ocular movements to the hemianopic side is described in 9 patients
with acute vascular lesions in the parieto-occipital region.  in 7 cases the
paresis was of the dissociated type with inability to follow the moving finger,
while ocular movement in a verbally stated direction was quite normal.  in the
remaining 2 patients in whom the oedema extended into the frontal region there
was complete paresis of all conjugate movements.  conjugate paresis receded
hand-in-hand with the parietal symptomatology even if the hemianopia
persisted.  the oculomotor disorders referred to have never been observed in
lesions which did not extend beyond the occipital region.  conjugate
paresis has in all cases drawn attention to the presence of hemianopia
unobserved by the patients and this has led to a more accurate topical
diagnosis.
.I 363
.C
15
.W
2333. binocularity in anomalous retinal correspondence
patients with anomalous retinal correspondence demonstrate complete bitemporal
or binasal hemianopia when tested for binocular vision; exotropes have a
binasal suppression and esotropes a bitemporal suppression.  this is contrary
to the prevailing concept of the function of the peripheral retina in
anomalous retinal correspondence.  6 references.
.I 365
.C
12
.W
2469. the nature of collagen disease, particularly of systemic lupus
erythematosus (sle), with special reference to renal lesions (japanese)
from the results of examination of 161 autopsy cases of collagen diseases,
rheumatic fever and polyarteritis nodosa (pn) are considered as diseases of
hyperergic nature, showing pronounced specific manifestation in particular
organs.  as the reactivity becomes lower, this specific localization becomes
less significant and many organs become affected in sle.  it may accordingly be
supposed that sle is not a disease of hypersensitivity but one occurring in
a state of exhaustion of reactability after prolonged sensitization.  moreover,
a sle-like syndrome arises not only in the end stage of parasepsis, nephritis,
nephrosis and some cases of prolonged sensitization by myco.tb but also in
pn,pss,dm and rheumatism.  it may therefore be conceivable that sle is
a syndrome rather than a separate entity.  it is most important to consider
whether sle-like symptomatology may be regarded as a process equal to
an auto-immunization and whether the key to morphological elucidation of the
auto-immune phenomenon may lie hidden in this problem.
.I 366
.C
12
.W
420. therapy of lupus nephropathies by 6-mercaptopurine
corticosteroid therapy improved the general prognosis of sle, but has no
detectable effect on the nephropathy and this is actually the main cause of
death.  a new therapeutic method is presented using 6-mp purinethol (leupurin)
which produced 2 remissions in 6 consecutive cases total and in 4 cases
with severe nephropathy definite remission.  it should be emphasized that 5 of
the cases reported had definite npn elevation, accordingly they are considered
hopeless.
.I 367
.C
12
.W
2475. lupus erythematosus with fatal hemorrhage into the liver and lesions
resembling those of periarteritis nodosa and malignant hypertension.
immunocytochemical observations
a firmly established case of lupus erythematosus with histologic
characteristics of periarteritis nodosa and fatal hemorrhage is presented.
immunocytochemical studies were done to explore the possibility of the vascular
lesions being immunological in type.  by immuno-fluorescent techniques
y-globulin, human serum complement, albumin and fibrinogen were demonstrated in
the vascular lesions.  y-globulin in the renal glomeruli was associated only
with complement.  the conclusion is that lupus erythematosus is primarily an
immunological disease with complex auto-immune mechanisms operative.
.I 389
.C
7
.W
2717. the value of quantitative radiocardiography in the study
of hemodynamics
six normal subjects and 7 patients with mitral
stenosis were studied.  quantitative
radiocardiographic investigations (rihsa) were
performed according to donato's
method.  the stroke volume as well as the cardiac
output were found to be decreased
in mitral stenosis, the right ventricular evacuation
ratio diminished, and the pul-
monary circulation time prolonged.  the results
pertaining to diastolic right ventricu-
lar capacity, right ventricular resting blood volume
and pulmonary blood volume
proved inconclusive.
.I 390
.C
7
.W
3056. the localization of aortic shunts developed by a precordial
registration of i 131 injected into the aorta at different levels
a technique for localizing shunts of aortic origin
is described, based on the analysis
of precordial records of i 131 injected at different
aortic levels.  seven patients with
patent ductus arteriosus (pda), 1 with a
coronary av fistula, 2 with ventricular
septal defect (vsd), 1 with atrial septal defect
(asd), 3 with mitral regurgitation,
2 with aortic regurgitation and 2 with systemic
hypertension were studied.  retro-
grade arterial catheterization by seldinger's
technique was performed in all the
patients, as well as right-sided catheterization
in those with congenital cardiopathies,
and transseptal catheterization in those with
valvulopathies.  a dose of 5-15 uc of na
i 131 was injected at the levels of the aortic root,
the ascending aorta, the aortic arch,
the origin of the left subclavian artery (ductus
level) and the descending aorta (post-
ductus level).  precordial curves were obtained by
means of a 2-inch thallium-acti-
vated nai crystal focused over the 3rd left intercostal
space at the sternal margin.
the shunt outlet can be detected by obtaining
simultaneous venous dilution curves
from the right chambers and the pulmonary artery.
the latter technique was used
in 2 patients with pda, 1 with coronary av fistula
and 1 with vsd.  these curves
were obtained by continuous withdrawal of blood which
had flowed through a well
scintillation counter.  the crystal pulses were carried
to ratemeters which worked
with the following time constants  0.01-0.15 sec for the
precordial curves and 0.5
sec for the venous curves.  a direct recorder with a
5-mm/sec paper speed was
used.  normal precordial curves after injecting above
the aortic valve were obtained
in patients with arterial hypertension, mitral regurgitation
and asd and vsd.  a
swift downslope which fell down near the baseline level and
the recirculatory area
was observed.
.I 391
.C
7
.W
1671. the use of 99m tc pertechnetate in cardiac scanning
technetium 99m pertechnetate has been utilized
in the aas' laboratory for scanning the
cardiac blood pool.  the delineation of the heart
pool and surrounding vasculature
is comparable to that obtained with the standard
131 i compounds now in use.  in the
authors' hands 99m tc had the following advantages
since they routinely utilized
99m tc for brain and thyroid scans, it is available,
eliminating the purchase and
shelf decay of other materials.  three to 5 mc quantities
may be administered
with relatively low patient radiation dosage.  the
associated high count rate permits
rapid scanning.  the identification of pericardial effusions
is enhanced by the radio-
activity in the stomach which in some cases becomes
abnormally separated from
the cardiac blood pool.
.I 392
.C
7
.W
2012. the use of technetium 99m as a clinical tracer element
the physical properties, metabolism and
radiation dose of tc 99m are discussed and
compared with those of i 123, i 125, i 131 and i 132.
it is shown that with tc 99m the highest
'in vivo' counting rates are obtained for a
given internal radiation dose, so that mea-
surements of high statistical accuracy may
safely be made.  the y-ray energy is near
optimum for scanning and the observation of
transients allowing light-weight collima-
tors to be used.  while tc 99m tagged albumin
is considered superior to risa for ap-
plications such as brain scanning, placentography
and the measurement of cardiac
output, i 123 if it becomes available will be preferable
for thyroid scanning.
.I 393
.C
7
.W
2626. a study of central arteriovenous shunts by
precordial recording of radioalbumin dilution curves
precordial dilution curves of 185 patients were
studied, 56 of them without cardio-
vascular disease, 48 with central arteriovenous
shunts and 45 with various cardiac
diseases.  collimation was not used, allowing only
minimal quantities of radioactive
material (0.5-2.2 uc. of i 131-tagged albumin) to be
utilized.  the precordial focusing
zone was a critical factor in this technique.  the
application of different discrimina-
tion factors, among them the ratio between the
minimal concentration and the latter
-an index proposed here - made possible the
diagnosis in 46 of the 48 patients with
shunts.  this method was shown to be as sensitive
as classical oximetry done during
cardiac catheterization.  the curves in pure valvular
stenosis do not show similar
changes to the shunts.  on the other hand, these
changes are shown in certain val-
vular regurgitations.  this fact becomes the most
important limiting factor in the
diagnosis of central arteriovenous shunts.  cardiac
failure does not preclude the
diagnosis, providing one can exclude valvular
regurgitation by other means.  the
method is thus, in spite of its limitations, of extreme
value in diagnosing central
arteriovenous shunts, especially when the results are
analyzed together with clinical
.I 397
.C
4
.W
1378. microcinematographic study of the mechanism of cancerous
invasion in cultures of normal tissue combined with malignant cells
normal myocardium of newborn c3h mice was
cultivated in vitro in contact with
homologous sarcomatous cells (strain n1 and
strain nctc) and studied by micro-
cinematography for 22 days.  it was found that
the tumor cells tend to move apart,
and with more vigorous and rapid movements
some of them called 'commando's'
make their way into the group of normal
cells but are arrested wherever they meet
a compact group of these cells.  this then
demonstrates, on the one hand, direct
aggresivity of the tumor cells and, on the
other, the 'group' defence of the normal
cells.
.I 399
.C
4
.W
3748. four separate tumour clones derived from a transplantable pleo-
morphic carcinoma of the lung in a heterozygous mouse
a metastasising pleomorphic adenocarcinoma
in the lung of an untreated hetero-
zygous male mouse was successfully
transplanted to 4 brothers by the 'plating'
technique of henderson and rous.  by
'plating' multiple small grafts in air bells in
the subcutaneous tissues of the new hosts
it was possible to select 4 different clones
of transplantable tumour for further study.
the histological peculiarities of
different parts of the original tumour
were reproduced in the different clones a i,
ii, iii, and b.  retrospective study
of the primary tumour and of its metastases
provided some interesting clues to routes
of metastasis and the selective survival of
malignant cells.  it is concluded that by
the cloning of transplantable cells, at the
first serial passage, valuable information
about the histogenesis and potential
malignancy of the primary tumour can be
obtained.  lastly, the highly malignant
character of 4 clones of tumour cells apparently
derived from the familiar clinically
benign adenoma of the mouse lung may
be of some interest, from the point of
view of prognosis based on histology.
.I 400
.C
4
.W
2379. in-vitro culture of pulmonary tumors in hamsters caused by adenovirus 12
it is known that the adenoviruses 12 and
18 provoke malignant tumors in the
new-born hamster.  the authors made a study
of the histogenesis of these tumors and
examined the specific changes brought about
in the cells by the virus infection
malignancy, presence of viral antigen, reactions
to superinfection.  when new-born
hamsters were inoculated in the chest with
adenovirus 12, malignant tumors
developed in one or two months, in 16 animals
out of 22.  these tumors presented
an epithelial aspect and were of bronchiolo-alveolar
origin.  they were transplant-
able in vivo; if they were cultured in vitro,
they consisted in the first few cultures of
macrophages, fibroblasts and epithelium.
in subsequent passages, there was a
progressive disappearance of the macrophages
and fibroblasts.  in some cases, the
culture after seven passages was of a purely
epithelial nature, and when it was
reimplanted into hamsters at this time it
gave rise to the rapid development of an
epithelial tumor.  in the tumor cultures,
no adenovirus could be demonstrated.
nor could cultures of the pulmonary tumors,
or cultures of normal hamster lung be
infected with adenovirus.  it appears that the
lung of the hamster in an organotyp-
ical culture constitutes a means of choice
for the malignant transformation of
adenovirus 12.
.I 404
.C
4
.W
142. trials of heterotransplantation of human cancer in rabbits
and kleisbauer a.
trials of transplantation of human
tumours (some 20, almost all carcinomas) in
the pleural cavity of large rabbits
(6 months old flanders, weighing 3 kg.) gave
negative results also when cortisone
treatment was associated with it, though in
the cortisone treated animals the
necrosis of the tumours was less massive.
examination of the grafted tumour
was carried out at different times (from 8 to
365 days after transplantation) and
was also controlled by radiographic examina-
tions.  detailed description of the
giant cell reactions around the tumours and in
the adjoining lung.
.I 405
.C
4
.W
1207. solitary mast cell granuloma (histiocytoma) of the lung.
a histopathologic, tissue culture and time-lapse cinemato-
graphic study
a pulmonary histiocytoma in a 57-year-old
woman was studied intensively histo-
pathologically and by other techniques.
abundant mast cells were found within the
lesion, a previously unreported finding.
tissue culture studies suggested that the
process is reactive rather than neoplastic.
some plasma-cell granulomas of the
lung may be mast cell histiocytomas.
.I 406
.C
4
.W
2773. the value of fluorescence cytology for the cytodiagnosis
of pulmonary cancer
the paper discusses the test results
of 527 tissue samples sent in for the cytodiag-
nostics of lung cancer and compares
the method of ao-fluorochromation with other
methods of preparation.  by means of
applying ao-fluorochromation, the rate of er-
roneously positive findings could be
reduced.  the rate of erroneously negative find-
ings was somewhat higher but the total
diagnostic precision of 93% was 3% higher
than in all other methods applied.
.I 408
.C
4
.W
4396. effects of arginine deprivation, ultraviolet radiation,
and x-radiation on cultured kb cells.  a cytochemical and
ultrastructural study
cultured kb cells (derived from a
human oral carcinoma) grown in monolayers
were injured by one of three agents
starvation by arginine deprivation or treatment
with high doses of either ultraviolet
radiation or x-radiation.  the different agents
produced changes in nucleolar structure
and varying accumulations of triglyceride
and glycogen.  all three agents produced
an increase in number and size of lyso-
somes.  these were studied in acid
phosphatase preparations, viewed by both light
and electron microscopy, and, occasionally,
in vital dye, esterase, and aryl sul-
fatase preparations.  ultrastructurally,
alterations in lysosomes suggested that
'residual bodies' developed in a variety
of ways, i.e., from the endoplasmic retic-
ulum, multivesicular bodies, or autophagic
vacuoles.  following all three agents,
the endoplasmic reticulum assumed
the form of 'rough' or 'smooth' whorls, and,
after two of the agents, arginine
deprivation or ultraviolet radiation, it acquired
cytochemically demonstrable acid
phosphatase activity.  near connections between
the endoplasmic reticulum and lysosomes
raise the possibility that in kb cells, at
least when injured, the endoplasmic
reticulum is involved in the formation of
lysosomes and the transport of acid
phosphatase to them.
.I 409
.C
9
.W
1106. the simultaneous use of extracorporal circulation and hypothermia in the
surgery of the heart
the operative technique of cardiac
surgery under conditions of deep hypothermia with
simultaneous use of a pump oxygenator
and cardiopulmonary bypass is described.  in
the majority of cases the patients were
cooled with water at 2 c. and the perfusion
volume was reduced by more than 50%
during hypothermia.  in others, a gradient of
10 c. between blood and water was
maintained and the perfusion volume was reduced
by less than 50%.  the data presented
show that neither technique leads to hypoxic
changes in the cerebrum and internal
organs, provided the mean arterial pressure
is kept between 70 and 90 mm. hg during perfusion.
the overall mortality in the
authors' 168 cases - most of which
had congenital heart disease - was 14.8%.  in 53
cases of tetralogy of fallot - most
of them cyanotic - the vsd was closed by taking
a flap of tissue from the crista supraventricularis.
in this group mortality was 24.5%.
.I 412
.C
9
.W
1593. bleeding tendencies associated with profound-hypothermia technics in
neurologic surgery
forty-three patients with bleeding intracranial
aneurysms were operated on under
deep hypothermia and with the aid of extracorporeal
circulation.  the open-thorax
method was used in 18 cases and the closed-thorax
method in 25.  the following
points are made  (1) the closed-thorax method
is considered superior to the open-
thorax method in several respects; (2) meticulous
hemostasis is essential to control
the oozing that occurs during extracorporeal
circulation under profound hypothermia
until the heparin antagonist can become
effective and body temperature can return
to normal; (3) significant thrombocytopenia
may develop during extracorporeal cir-
culation, and inhibition of the thrombin-fibrinogen
reaction by factors other than
heparin may cause a major coagulation defect
and may also, by mimicking the he-
parin effect, lead to the excessive use of
heparin antagonists; (4) pathologic changes
in microcirculation during extracorporeal
circulation may be determinants of a
hemorrhagic tendency.
.I 415
.C
9
.W
948.cardiac activity in cranio-cerebral hypothermia
the onset of hypothermia rarely alters the heart
rate.  as it deepens to 35-32, the
rate slows, and at the level of 30-29 it usually
amounts to only half its original va-
lue.  at 28 or below, the development of
bradycardia is observed.  after warming
to 32 the normal heart rate is restored.
during operations on the abdominal organs
the heart rate is only slightly modified.
the appearance of solitary extrasystoles is
rare and is usually associated with stimulation
of the diaphragm.  the most marked
changes in the heart rate are observed during operations on the heart,
especially if
it is excluded from the circulation.  an
idioventricular rhythm may develop before
the heart stops beating.  after removal of the
ligatures from the venae cavae the nor-
mal rhythm is restored.  as the temperature
falls, the excitability of the myocardium
increases.  conduction is more resistant.
areflexia continues even during direct sti-
mulation of reflexogenic zones.  in the surgical
stage of cranio-cerebral hypothermia
it is clear that no significant degree of energy
or hemodynamic insufficiency deve-
lops, whether in experimental conditions or
during operations on patients.  at opera-
tion a well-marked stabilization of the contractile
power of the myocardium may be observed.
.I 420
.C
9
.W
1139. optimal coronary flow in the bypassed normothermic and hypothermic heart
a series of experiments were conducted in dogs
in which bypass flow, temperature,
and direct coronary perfusion pressure were varied.
coronary flow, coronary ven-
ous saturation, myocardial oxygen consumption (mvo2),
and coronary vascular re-
sistance were assayed.  coronary flow as a percentage
of total bypass flow did not
vary appreciably at varying levels of bypass flow.
induction of hypothermia, when
total bypass flow is constant, results in decreasing
coronary flow.  induction of hy-
pothermia when maintaining a constant bypass pressure
results in an increasing
coronary flow with temperatures down to 22 c.
further cooling causes a reduction
in flow.  using isolated coronary perfusion at 100 mm. hg,
coronary flow fell and
resistance rose during the first 15 min. of bypass.
using isolated coronary perfu-
sion at 100 mm. hg, induction of moderate hypothermia
(25 c.) caused an increase
in coronary flow and venous saturation and a decrease
in cardiovascular resistance
and mvo2.  under the same conditions, induction of
hypothermia to 18 c. produced
similar changes but caused myocardial hemorrhage
and ventricular fibrillation.  pro-
found hypothermia probably leads to excessive
fragility of the capillary bed.  reduc-
tion of perfusion pressure to 50 mm. hg at near
normothermia reduced coronary
flow and slightly reduced venous saturation
and mvo2.  the same reduction of perfu-
sion pressure at 18 c. produced similar but
less marked changes.  reduction to 25
mm. hg at 18 c. markedly reduced coronary flow,
venous saturation, and mvo2
initially, but with partial recovery later.  from this
data of acute experiments in
dogs, coronary perfusion using moderate hypothermia
(about 31 c.) and 50 mm.
hg, slightly pulsatile mean pressure appears optimal.
.I 421
.C
9
.W
974. extracorporeal hypothermia without thoracotomy.  an ex-
perimental study in the use of cold for neurosurgery and
cancericidal perfusions
this paper includes minor clinical notes
on open heart surgery and cancer perfusion
but contains no experimental information
on neurosurgery or cancer perfusions.  a
method of closed-chest hypothermic perfusion
in 30 dogs is reported.  the authors
utilize drainage of superior and inferior cavae
by gravity.  the volume of venous
drainage sometimes enhanced by transfusions
or 12.5% low molecular weight dex-
tran determined the flow rate.  cooling was
maintained for quite variable periods
apparently generally to an unspecified
esophageal temperature.  perfusion time va-
ried from 30 min. to 4 hr.  animals with
low flows were perfused longer, had a high-
er incidence of ventricular fibrillation,
and a very low survival rate.  eleven ani-
mals survived.  all had pre-cooling flow
rates above 40 ml./kg./min., good flow
rates during the perfusion, and only 3 had
ventricular fibrillation.  flow rates and
survival were increased in animals receiving
low molecular weight dextran.  four-
teen of 15 animals with ventricular fibrillation
were defibrillated electrically, 8 re-
gained 'adequate' cardiac function, but only 3
survived.  some interesting data on
regional cooling of the lower half of the body
is presented.  the authors conclude
without sufficient evidence that the most
important factor in the mortality in hypo-
thermic perfusion is the ability to maintain
'a flow rate approaching the estimated
normothermic cardiac output of the animal'
.I 422
.C
9
.W
2406. profound hypothermia
the aim of hypothermia is protection of vital
cerebral structures from hypoxia
during aneurysm repair; profound hypothermia
is also valuable in operating on
certain cardiac defects which cannot be repaired
even with whole body perfusion.
since the time needed for aneurysm repair often
exceeded the safe limit of 8 to 12
minutes without circulation afforded by surface
hypothermia of 29  to 30  c., the
authors have investigated the drew (open-chest)
technic, the closed-chest method,
and isolated cerebral perfusion.  the drew technic
consists of substituting two
pumps for the heart while the patient's lungs act
as the oxygenator.  because of its
disadvantages (the large amounts of blood needed
and the morbidity due to intra-
cardiac cannulation and median sternotomy), a
closed-chest method was developed,
using a mayo-gibbons vertical-sheet pump-oxygenator
to provide the perfusion and
extracorporeal cooling without requiring thoracotomy.
in cerebral perfusion, blood
is taken from one artery, pumped through a heat
exchanger, and returned to another
artery.  the authors describe anesthetic technics,
offer comparisons of the three
methods, give instructions pertaining to the production
of hypothermia, and list the
problems encountered in the management of these cases.
.I 445
.C
11
.W
28029 enzymic synthesis of steroid
sulfates.  ii. presence of steroid sulfo-
kinase in human mammary carcinoma
extracts
extracts of human primary and secondary
mammary carcinomas were shown to
contain steroid sulfokinase(s) in every case
examined.  examination of normal
breast tissue surrounding the tumors revealed
very weak steroid sulfokinase
activity in some instances.  this was thought to
be due to the fibrous nature and
poor cellularity of the normal breast tissue.
normal ovarian tissue specimens,
obtained from cancer patients undergoing
oophorectomy, did not generally
contain the enzyme, but trace levels were detected
in 1 of 5 specimens examined.
steroids, without necessarily showing conversion
to steroid sulfate, were observed
to increase the incorporation of s35-sulfate into
one of the products formed enzy-
mically on incubating breast tissue extracts
with s35-adenosine-3'-phosphate-5'-
phosphosulfate.
.I 446
.C
11
.W
3752. steroid excretion in early breast cancer
patients with advanced breast cancer
who subsequently fail to respond to adrenalec-
tomy or hypophysectomy have been
found to excrete abnormal amounts of the
urinary metabolites of androgen and
cortisol.  when similar measurements are
carried out on patients with early breast
cancer, it is found that approximately half
the cases presenting for mastectomy are
also excreting abnormal amounts of these
steroids.  subsequent follow-up shows that
these cases tend to have a poor progno-
sis, and a trial had therefore been started
in which the abnormality is being cor-
rected.  in addition, it seems possible that
the deficiency in adrogen excretion may
precede the onset of the disease.  this
problem is being investigated in a trial
involving urinary steroid estimations in
5000 normal women.  the measurements
are being compared with the subsequent
development of breast cancer.
.I 447
.C
11
.W
2365. the excretion of oestrone, pregnanediol
and pregnanetriol in breast
cancer patients.  i. excretion after spontaneous
menopause
the urinary excretion of oestrone, pregnanediol and
pregnanetriol was determined
in a series of postmenopausal breast cancer patients
receiving no endocrine treat-
ment.  the steroid excretion was studied
both in relation to the age of the patients
as well as in relation to the time elapsed
since the last menstrual cycle.  the results
indicate that after an initial slow decrease
from the age of the menopause onward,
the excretion of oestrone and preganediol
increases again.  a new maximum was
found in the group 10-15 yr. after the
menopause.  the excretion of pregnanetriol
however, remains relatively constant
after a more rapid fall during the first few
years after the menopause.
.I 448
.C
11
.W
2366. the excretion of oestrone,
pregnanediol and pregnanetriol in breast
cancer patients.  ii. effect of ovariectomy,
ovarian irradiation and corticos-
teroids.
the urinary excretion of oestrone,
pregnanediol and pregnanetriol was determined
in breast cancer patients at different
stages of their endocrine treatment.  the
results demonstrate that corticosteroids
in substitution doses (cortisone 50 mg. daily
or prednisone 10 mg. daily, divided in 4
daily doses) are very effective in depressing
the excretion of all 3 steroids in postmenopausal
patients.  this is in agreement with
the clinical impression that these easily tolerated
small doses of corticosteroids have
the same therapeutic effect as adrenalectomy in
patients with breast cancer.  the
results indicate that the ovaries may contribute
to the production of oestrogens for
many years after the menopause, and that this
production is depressed by ovarian
irradiation.  this is in agreement with the clinical
observation that ovarian irra-
diation has a therapeutic value in postmenopausal
women with breast cancer.
.I 451
.C
11
.W
5062. urinary ii-deoxy-17-oxosteroids
in british and japanese women with
reference to the incidence of breast cancer
japanese women excrete more andosterene
(5a) relative to aetiocholanone (5b)
than do british women living in tokyo.  the
mean 5a/5b ratio in the former is 1.3
and in the latter 1.0, and these means differ
significantly.  the ratio is markedly
affected by thyroid function, and thyroid
disease has been reported to affect the
incidence of breast cancer which in japan is
only one eighth of that in white women
in north america or great britain.
.I 452
.C
11
.W
5318. the plasma 17-ketosteroids and
17-hydrocorticosteroids in women
with breast cancer
in 100 women in the menopause with breast cancer
the mean level of plasma 17-
ketosteroids (17-ks) and 17-hydroxycorticosteroids
(17-ohcs) was significantly
higher than in normal women of equivalent age.
in 67 young women only the
level of the plasma 17-ohcs was significantly higher
than normal.  in menopausal
women with breast cancer whether treated or not
there is no correlation between
the level of the plasma 17-ks and that of 17-ohcs.
.I 461
.C
14
.W
1837. development of amylosis in less than 2 months in the course of a primary
tb infection
the case is reported of a previously healthy
young north-african male, in whom
a post-primary ulcero-infiltrative tb in less
than 2 mth. led to the development of
visceral amyloidosis, which could be confirmed
by biopsies of the kidney and liver.
during treatment with antibiotics,
the hepatic amyloidosis regressed parallel with
the improvement of the tb, and the
biological signs of the renal amyloidosis dis-
appeared with the exception of a
pronounced proteinuria, the persistence of which
renders the long-term prognosis highly doubtful.
.I 463
.C
14
.W
4417. value and significance of the prednisolone test in diseases of the kidney
twelve normal subjects, 18 cases of
tubulo-interstitial nephropathy, 12 cases of
glomerular nephropathy and 17 cases
of other renal disorders were investigated.
all patients were given a prednisolone
test, with urine culture before and after the
test, and in many instances determination
of the urinary osmolarity; the urinary
sediment was examined with the sternheimer
and malbin staining technique and
with the peroxydase stain to investigate the
urinary cytology.  with the criteria
adopted, the test was negative in the normals
and was positive in 61.1% of the cases
of chronic pyelonephritis and in 12.1% of the
remaining cases of unequivocally non-
infectious renal disease.  the increase of the
urinary bacterial count after cortico-
steroid administration, and investigation of the
various components of the urinary
sediment also supplied useful diagnostic
information.  on the contrary, the stern-
heimer-malbin stain for the urinary
sediment proved of little use.
.I 466
.C
14
.W
3535. electron microscopic study of six cases of human renal amyloidosis
this study is particularly concerned
with  (a) the basal membrane in the different
stages; and (b) the intercapillary spaces
in the early stages.  the conclusions may
be put as follows  (1) the amyloid substance
seems to have a fibrillar structure
from the start.  (2) when the walls of the
peripheral capillary loops are thickened
by voluminous amyloid deposits, the
hyaline aspect of the primitive basal membrane
persists, but its structure is altered by
the presence of multiple amyloid fibrils.
(3) on the other hand, in the initial stages,
amyloid fibrils cannot be seen in the
'lamina densa' of the basal membrane; they
only appear on the epithelial and endo-
thelial surfaces of the membrane.  this suggests
that amyloidosis represents an
abnormal precipitate of extrinsic origin, rather
than a transformation 'in situ'
of the basal membrane.  (4) in the very early stages
of amyloid infiltration into the
glomeruli the fibrillar substance is found first in
the intercapillary spaces, only
later does it reach the peripheral capillary walls.
.I 467
.C
14
.W
3544. morphology and development of infectious-toxic affections of the kidneys
in pulmonary tuberculosis (russian)
the kidneys of 75 patients dead from tb of
the lungs and of 30 rabbits with pulmonary
tb were examined.  the first lesions develop
in the glomeruli, followed by changes
in the stroma and tubules.  infectious-toxic
affection of the kidneys is a complex and
prolonged process involving organic immune
reactions, lymphostasis, venous stasis
and finally nephrosclerosis.  infectious-toxic
lesions were found in one third of the patients
who died of pulmonary tb.  these changes had
produced clinical manifestations, on the
basis of which the following affections had been
diagnosed  nephritis, nephrosis, amyloi-
dosis.  antibacterial therapy of the pulmonary
process reduced the renal lesions.  how-
ever, severe infectious-toxic affection of the kidneys
may develop after recovery from
pulmonary tb.
.I 468
.C
14
.W
3553. diffuse nodular amyloidosis of the lungs
in a 59-year-old man, who 12 yr. previously
had ceased working in an aluminium
factory and who had died from respiratory
insufficiency, the postmortem examination
revealed disseminated nodules in the lungs.
the nodules were sharply defined, of
a greyish color and of a doughy consistency
and could easily be removed from their
capsules.  the diagnosis of amyloidosis was
made on the basis of the histological
findings, the staining qualities of the material,
its intraseptal and periarteriolar
localization, and the existence of plasmocytic
infiltrates and foreign-body giant-cell
granulomas.  amyloid deposits were also found
in the spleen, kidney and some
coronary branches.  in regard to the pathogenesis,
it is suggested that the exposure
to aluminium products for more than 10 yr. might
have constituted a predisposing
factor.
.I 474
.C
13
.W
906. molecular mechanism of genetic recombination in bacterial transformation
the mechanism of dna incorporation into
the recipient cell chromosome was in-
vestigated in a b. subtilis transformation
system.  the recipient cells were auxo-
trophic for 2 linked markers.  hybrid dna
used for transformation was heterozy-
gous for one of these markers.  no differences
in transformation activity were found
when the effect of native and hybrid dna was
compared.  according to the authors
this observation is easily explained if we accept
that each of both complementary
strands of the donor dna can be incorporated
into the recipient chromosome with
equal probability.  the results on the segregation
of genetic characters in the pro-
geny of transformed cells are also consistent
with the model of independent incorpo-
ration of both dna strands.  some calculations
were done on the probability of the
integration of a single dna strand carrying a
particular genetic marker, and on the
probability of recombination leading to double transformants.
.I 475
.C
13
.W
1520. multiplication of bacteriophages
the reproduction of bacteriophages requires
the participation of bacterial metabol-
ism.  synthesis of the viral protein components
is accomplished by the same me-
chanism as ordinarily produces bacterial
proteins; however, for the synthesis of
nucleic acids (dna or rna) enzymes may
be required which are not present in non-
infected bacteria; their formation is then
induced by the virus itself.  the fundamental
biological processes of replication, transcription
and translation are discussed in
this context.
.I 477
.C
13
.W
1362. the synthesis of phage and host dna in the establishment of lysogeny
a method of extraction is described which
prevents excessive fragmentation of bac-
terial dna.  the larger bacterial dna can
then be separated from the phage dna
on sucrose gradients.  the relative amounts
of phage and host dna made at various
times during infection of s. typhimurium
with phage p22 leading to lysogeny have
been determined.  phage-specific dna
synthesis begins at about 4 min, continues
to increase for 2-4 min, and then decreases
until complete repression is attained
at 16 min.  autonomous phage dna synthesis
remains repressed from then on.  bac-
teria-specific synthesis proceeds at a
decreasing rate until about 16 min, when
almost complete inhibition is reached.
when dna synthesis recovers in the in-
fected cells, only host-specific material
is made.  a new species of dna, which is
made only when phage dna is synthesized,
has been detected.  the possible implica-
tions of these findings in the understanding
of the lysogenic interaction is discussed.
.I 478
.C
13
.W
438. lag period characterizing the entry of transforming deoxyribonucleic acid
into bacillus subtilis
the kinetics of appearance of transformants
as a function of time of exposure to
dna has been studied.  a short lag period
of approximately 1 min at 37 c is evi-
dent when the transformation is terminated
with deoxyribonuclease.  the length of
this lag is independent of the genetic trait
transferred.  moreover, the lag is unaf-
fected by transforming dna concentration,
by the presence of homologous unmarked
dna, and by shearing and cross-linking of
the transforming dna.  the lag shows
a strong inverse temperature dependence.
the energy of activation is 13.9 kcal.
the lag is abolished when the transformation
is terminated by washing instead of
by addition of deoxyribonuclease.  these results
are taken to indicate an immediate
adsorption of dna to cells, followed by a
deoxyribonuclease-sensitive period of
1 min, during which time the genetic trait
is entering the cell.  these results make
feasible an investigation of the configuration
assumed by the dna molecule during
entry into the cell.
.I 479
.C
13
.W
439. configuration of transforming deoxyribonucleic acid during entry into
bacillus subtilis
a correlation was obtained between map
distance and the length of the lag period
preceding the appearance of pairs of genetic
traits after the addition of dna to a
competent culture of b. subtilis.  the results
are taken to indicate that dna enters
competent cells in lengthwise fashion.
the smallest length of transforming dna
which can participate in a recombination
event, and the number of nucleotide pairs
which enter the cell per unit time, have
been estimated.  the evidence indicates
that only part of the lag period is devoted
to the transport of dna into the cell.
the significance of these results with
respect to the mechanism of entry of dna
into the cell is discussed.
.I 481
.C
13
.W
2565. separation of the transforming and viral deoxyribonucleic acids of a
transducing bacteriophage of bacillus subtilis
the authors used the transducing b. subtilis
phage ps 10 and present the fol-
lowing experimental data  dna isolated from
ps 10 is effective for transformation
of competent b. subtilis cells.  ps 10 dna is
distinguishable from b. subtilis dna
by its higher density in a cs2so4 gradient and
its lower thermal denaturation
temperature.  the transforming activity present
in dna from ps 10 denatures at
a temperature characteristic of b. subtilis dna
rather than of viral dna.  the
transforming activity of ps 10 dna bands in a
cs2so4 gradient with bacterial dna.
this data indicated that bacterial dna is
incorporated into phage ps 10 without
being integrated in the viral dna.  this incorporated
bacterial dna is involved
in transduction.
.I 483
.C
13
.W
1451. the biosynthesis of 5-hydroxymethyldeoxyuridylic acid in
bacteriophage-infected bacillus subtilis
when phage  e, which contains
5-hydroxymethyluracil in its dna in place of thymine,
infects b. subtilis, enzyme changes
occur in the host organism which can account
for the synthesis of the abnormal base.
deoxycytidylate deaminase increases at
least 90-fold and the product of its action,
deoxyuridylic acid, is converted directly
into the deoxynucleotide of 5-hydroxymethyluracil
by a hydroxymethylase enzyme.
the activity of thymidylate synthetase, which also
uses deoxyuridylic acid as
substrate, decreases rapidly after phage infection.
.I 490
.C
16
.W
2953. the death of a parent
in the case of depressive illnesses the death
of either parent prior to the child reach-
ing the age of 15 seemed to be correlated
as a significant contributory factor.  with
this exception, statistical studies suggest
that it is the death of a mother in the first
7 yr. of a child's life, as opposed to that
of a father, that is potentially an etiologi-
cal factor for the future development of
psychoses, delinquency and psychoneuroses.
the case histories of 6 boys who had lost
their fathers were given.  in each instance
there was distinct evidence that the psychological
symptoms and behavioral disturb-
ances were to be attributed in large measure
to the effect of the death upon the child,
and that in some cases the symptom choice was
to be correlated with specific cir-
cumstances surrounding the death of the father.
in some cases it was the unresolved
grief reaction in the mother which helped to
perpetuate the disorder in the child.  re-
solution of this in the mother during therapy
led to improvement in the child's func-
tioning.  in other instances improvement
occurred especially when the child ceased
to be preoccupied with a close identification
with the dead father.  those boys who
were involved most closely in their mother's
grief reactions were the ones who were
most disturbed.  the brief treatment given
these boys and their mothers appeared
to be responsible for the considerable
amelioration of symptoms that resulted.  ther-
apeutic intervention is worthwhile,
especially in those instances where there is an
unresolved grief reaction in the mother.
.I 492
.C
16
.W
1849. mother child interaction during separation individuation
after a stage of normal autism during the
1st weeks of extrauterine life, the infant
passes into a symbiotic phase, gradually
emerging from this stage of dual unity at
the end of the 5th mth and during the 6th mth.
just before this, the next phase
separation individuation begins.  four
characteristic subphases of this separation
individuation process are described
differentiation, the practicing period, association
and a stage, characterized by unfolding
of complex cognitive functions.  the relation
of mother and child throughout these
subphases are studied and illustrated by clinical
material.  a poor relation between mother
and child in 1 subphase does not necessarily
or usually preclude impressive changes
for the better in the next subphase.
.I 493
.C
16
.W
2736. the emotional needs of children in hospital
hospitalization of a child for physical
reasons brings with it separation from pa-
rents, siblings and familiar surroundings,
as well as the probability of subjection
to frightening and painful procedures.
unless steps are taken to prevent or modify
the resultant stress, behavioral
disturbances may arise and may result in per-
manent damage to the developing personality.
.I 495
.C
16
.W
9787. changes in developmental quotient under two conditions of maternal
separation.
developmental scales were
administered to 2 groups of infants during and sub-
sequent to a temporary period of institutionalization.
although both groups experienced maternal separa-
tion, only 1 group was subjected to deprivation, in
that it received very much less stimulation than the
other.  results from a longitudinal testing program
show that the scores of the deprived group during
the period of separation were significantly lower than
those of the nondeprived group, no progressive de-
terioration of scores took place in the course of
institutionalization, immediately following return
home, while the scores of the nondeprived group re-
mained constant, those of the deprived infants jumped
to the level of the other group.  3 theories regarding
the mechanism underlying the association between
deprivation and developmental retardation are exam-
ined and it is suggested that an explanation in moti-
vational terms best fits the results obtained.
.I 499
.C
1
.W
1463. investigations of lens protein and microelectrophoresis of
hydrosoluble protein in senile cataract
the investigations on lens protein and
on agar-microelectrophoresis of hydro-
soluble protein in normal lenses and in those affected with senile cataract re-
vealed the following facts  (1) in opaque
lenses, a diminution of the total protein
and the soluble protein takes place, as
well as an increase in the amount of in-
soluble protein.  the decrease in the
quantity of soluble protein is higher than the
increase of insoluble protein which does
not only point to a transformation of the
soluble protein into the insoluble variety,
but also to the disappearance of a protein
fraction from the lens.  changes in the
quantity of soluble protein are accompanied
by the decrease of protein in slow fractions
of the electropherogram and even by
the disappearance of these fractions and
the increase of the amount of protein in
fractions of medium velocity.  with the
development of cataract and the mature
phase of cataract, all these processes
become more and more distinct.  in this
respect, a strong parallelism exists between
the protein changes and the clinical
picture of senile cataract.  (2) qualitative
and quantitative changes which occur in
the protein of normal lenses with advancing
age show a character similar to those
in senile cataract, however, they are less
pronounced.  in this instance, the de-
crease in the quantity of soluble protein is
likewise closely associated with the
diminution of the protein content in the slow
fractions of the electropherogram.
(3) the changes in the soluble protein content
of the lens and the alterations of
the protein amounts in the slow fractions which
always accompany the former,
play the principal role in the aging process
of the lens and in the development of
senile cataract.  (4) the investigations
seem to indicate that the aging processes,
of lenses as well as the development of
senile cataract are of a similar character,
but of different intensity.  (5) undoubtedly,
the processes of transition from slow
fractions of soluble protein into faster ones
and the transformation of part of the
soluble protein into insoluble protein which is
likely to be associated with these
processes as well as the partial disappearance
of total protein from the lens seem
to play a very important part in the mechanisms
pertaining to the development
of cataract.
.I 500
.C
1
.W
1949. studies on the soluble proteins of bovine lens.  immuno-
chemical analyses of protein fractions
the lyophilized soluble lens proteins
were dissolved in 0.005 m phosphate buffer
at ph 6.8 and the solution was subjected to
column chromatography on deae (die-
thylamino ethyl) cellulose.  elution was
accomplished by changing the ph and ionic
strength of the eluting buffer.  the components
were fractionated by stepwise elu-
tion.  the lens proteins were separated into
17 fractions by column chromatogra-
phy.  these fractions were compared with
a, b and y crystallines for electrophore-
tic mobility, and the antigenic purity of each
fraction was examined immunochemi-
cally.  the results showed that while the
fractions were not completely pure they
were purer than the a, b and y crystalline
fractions, and that f-1-a, b, c and d
corresponded to y crystalline, while
f-2-a, b, c, d, e and f corresponded to b
crystalline and f-3, 4, 5, 6, 7, 8 and
9 to a crystalline.
.I 501
.C
1
.W
3107. studies on y-crystallin from calf lens.  ii.  purification and
some properties of the main protein components
four proteins belonging to the y-crystallin group
were purified by chromatography
on sulphoethyl-sephadex and phosphate-cellulose
columns.  the proteins were homo-
geneous in gel and immunoelectrophoresis
experiments and could be crystallized.
their molecular weights, n-terminal amino
acid sequences and antigenic structures
were all similar, but their amino acid
compositions and the sulphydryl groups con-
tained showed certain dissimilarities.  it
is probable that the 4 proteins possess
small differences in their primary structure,
which are not associated with the
antigenic sites and which may have arisen
from mutations during evolution.
.I 502
.C
1
.W
3105. studies on the subunits of a-crystallin and their recombi-
nation
earlier investigations have shown that, in
the presence of high concentrations of
urea, a-crystallin from bovine lens is split
into a number of subunits with apparent-
ly different electrophoretic mobilities but
similar molecular weights.  the recom-
bination of these subunits after removal of
the urea has been studied by ultracentri-
fugation and immunoprecipitation techniques.
it was found that maximal recombina-
tion was obtained when the ionic strength
during the removal of the urea was high
(>0.2), whereas at low ionic strengths a
molecule with only half the molecular weight
of native a-crystallin and a much lower
sedimentation coefficient was obtained.  a
complete recovery of the structure of
native a-crystallin was never obtained, even
at high ionic strengths, as was evident
from electrophoretic and quantitative preci-
pitin analyses.  the subunits were
fractionated by chromatography on deae-cellu-
lose in the presence of 7 m urea.
the purification was followed by polyacrylamide-
gel electrophoresis.  after removal of
the urea at high ionic strength, 2 of the
fractions obtained showed reactions of
only partial identity with native a-crystallin
in immunodiffusion tests, but all other
fractions showed complete identity.  the
differences in the electrophoretic
mobilities of the fractions in the presence of
urea persisted after removal of the urea.
all fractions had much higher sedimen-
tation coefficients in the absence of urea
than in its presence, although the values
for urea-treated unfractionated a-crystallin
obtained after removal of the urea
were not reached even at high ionic strengths.
the amino acid composition of the
fractions was found to differ.  these
observations suggest that a-crystallin is com-
posed of a number of chemically different,
but related, subunits of approximately
the same size, which are bound together
by nonspecific, noncovalent bonds, pos-
sibly hydrophobic bonds.  moreover,
when isolated, these subunits have the ability
to associate and form molecules of
high molecular weight.
.I 503
.C
1
.W
3106. fractionation of b-crystallin from calf lens by gel fil-
tration
b-crystallin was isolated from calf lenses
by a combination of gel filtration on
sephadex g-75 and vertical-column zone
electrophoresis.  it was subdivided into
4 fractions by subsequent gel filtration on
dextran gels with low cross-linkage.
each fraction showed only 1 major peak in
the ultracentrifuge, the sedimentation
coefficients of which were 13.6, 9.6, 4.9 and
4.2 s for fractions i-iv, respectively.
however, all 4 fractions contained some
additional minor components, as revealed
by sedimentation and immunoelectrophoretic
analyses.  the fractionation procedure
may be of value as a first step in the isolation
of individual proteins of the b-crystal-
lin group.
.I 504
.C
1
.W
195. properties of a cold-precipitable protein fraction in the
lens
a soluble protein fraction which precipitates
in aqueous solutions at temperatures
below 10  c has been isolated from the rat
lens.  this fraction appears to be re-
sponsible for the reversible 'cold cataract'
which has been seen to develop when
young mammals are exposed to temperatures
below 10  c.  as the rat ages, the
concentration of this protein fraction
decreases, but the fraction does not com-
pletely disappear, even from the lenses
of 3-year-old rats.  although the molecular
species comprising this fraction appear to
be homogeneous in the ultracentrifuge,
disc electrophoresis and immunodiffusion
have shown that they are a heterogeneous
mixture of a-, b- and y-crystallin subunits.
the ability of the cold-precipitable
protein (ccp) fraction to precipitate in the
cold depends upon its concentration and
the ionic strength and ph of the solvent.  in
solutions of ph 4.0, some aggregation
of the 4 s cpp occurs to form a 17 s component,
which no longer precipitates in
the cold.  the ability of this protein fraction to
precipitate in the cold may depend
on hydrophobic bonding and its influence on the
conformation of the protein.
.I 506
.C
1
.W
465. conversion of a-crystallin of bovine lens into insoluble
protein in vitro
a-crystallin can be converted into an insoluble
form by treatment with alloxan and
to a very small extent with iodoacetate.
other reagents such as hcl, naoh, reduced
glutathione, hydrogen peroxide,
mercaptoethanol, were not able to convert a-crys-
tallin into an insoluble form.  the
alloxan treated insoluble a-crystallin could be made
soluble by treatment with 7 m urea.
the product thus made soluble had the same
electrophoretic mobility as a-crystallin,
but showed cross reaction with a-crystallin
in ouchterlony plate and did not have
proteolytic activity.  alloxan was effective in
producing cataract of rabbit lens when very
small amounts were injected into the
aqueous.
.I 507
.C
1
.W
1972. structural studies of a-crystallin
a-crystallin has been isolated from the cortex
of ox lens by isoelectric precipitation
followed by chromatography on deae-cellulose.
the amino acid composition is in
agreement with that reported for a-crystallin
prepared by a different method.  there
is one thiol group/20,000g. of protein
(20,000 is the order of magnitude of the sub-
unit molecular weight), and disulphide
bonds are absent.  the thiol group has been
alkylated with radioactive iodoacetate
in the presence of urea.  partial acid hydroly-
sis of the alkylated protein gives,
according to the conditions, mainly 3 radioactive
peptides or nearly exclusively one
radioactive dipeptide.  the dipeptide is n-seryl-
(s-carboxymethyl) cysteine, ser-cmcys.
the 2 other peptides are probably the tri-
peptides related to ser-cmcys.  the
simplest interpretation of these results is that
the sequence around the cysteine residue
is a common structural feature of the sub-
units of a-crystallin.
.I 508
.C
1
.W
1751. on the subunits of a-crystallin
a-crystallin was isolated from total
water-soluble lens extract by preparative zone
electrophoresis on starch or pevikon
c870 blocks and purified by density gradient
centrifugation and sephadex chromatography.
these preparations were treated with
urea or sodium dodecyl sulphate and
submitted to electrophoresis on polyacrylamide
gels containing either urea or sodium
dodecyl sulphate.  whereas in 7 m urea a large
number of zones was detected, only
three bands were observed in 1% sodium dodecyl
sulphate.  on the other hand, the
sedimentation coefficient had the same value in both
media.  the authors re-investigated the
n-terminal amino acid content in the starch block
preparations and compared the result
with that obtained from the preparations isolated
according to their new procedure.  the
concentration of dinitrophenyl-glutamic acid
was lower in the purified samples.
urea-treated samples had the same concentration
of n-terminal glutamic acid whereas
the concentration of the 'trace' end-groups did
not change.  sedimentation-diffusion
equilibrium in the analytical ultracentrifuge
revealed a slight heterogeneity in the
purified samples.  electron micrographs of
electrophoretic and of further purified
samples were very similar.  at neutral or
slightly alkaline ph they showed almost
uniform spherical aggregates in which a
substructure was observed.  at acid ph,
coiled filaments rather than small globules
could be demonstrated.
.I 510
.C
1
.W
1745. the deaggregation of bovine lens a-crystallin
sedimentation equilibrium studies of lens
a-crystallin at neutral ph indicate that
this material is composed of a number
of different sized species.  a study of the
effect of alkali upon a-crystallin indicates
a progressive deaggregation of the ma-
terial with increasing ph.  sedimentation
equilibrium studies were performed at ph
12.8 as well as in guanidine hydrochloride,
7 m urea, and with succinylated material.
under all of these conditions a molecular
heterogeneity was observed.  the data
indicate that independent species coexisted
under most dissociating conditions.  the
weight average molecular weights of the
succinylated, and of the alkali-, urea-,
and guanidine hydrochloride-treated
material were found to have an integral relation-
ship of 8 4 2 1, respectively.  since a
constant ratio of m2 mw was found, it was
concluded that the same spread of
distribution of molecular species occurred for
each of the deaggregating conditions.
the results in guanidine hydrochloride could
not be evaluated in this manner because
of a small concentration dependence.  these
conclusions imply that not only the
weight average molecular weight in 7 m urea
but the actual molecular weight of
each individual species in urea was one-half of
the value to be found in alkali and
one-quarter that of the succinylated material.
.I 511
.C
1
.W
1747. the problem of albuminoid
albuminoid is the main constituent of the
insoluble fraction of the lens proteins.
albuminoid from the cortex of ox lens has
been fractionated on deae-cellulose in
7 m urea; peptide maps of the fractions
are very similar to those from the corre-
sponding fractions from a-crystallin.
albuminoid can be regarded as an insoluble
a-crystallin.  an undiluted ground lens
is clear but becomes turbid on dilution.  if
albuminoid is present in the normal lens,
it does not cause turbidity even when the
cellular structure is disrupted.  it is
perhaps more likely that the albuminoid is
formed on dilution of the lens mush.
the high concentration of proteins in the lens,
especially in the nucleus, entails a high
degree of order, which will be destroyed
on dilution  this phenomenon may well be
connected with the precipitation of the
albuminoid.
.I 513
.C
1
.W
2627. chicken lens development  epithelial cell production and
migration
in the earliest stages of chicken lens
development, cell division occurred over the
entire lens.  cell division first stopped
in the posterior side of the lens vesicle, as
the cells differentiated into primary lens
fibers.  after the annular pad developed,
cell division occurred, for the most part,
in the anterior surface epithelial cells.
shortly after hatching and thereafter, a
germinative zone, consisting of a narrow
band of epithelial cells adjacent to the
annular pad developed.  the cells from the
germinative zone migrated slowly and
differentiated first into annular pad cells and
then into lens cortex fibers over an
estimated 2-year period.  this slow migration
of cells in the lens is discussed in
relation to the failure of the adult chicken to de-
velop radiation cataracts.
.I 524
.C
18
.W
1142. sodium selenate toxicosis  pathology and pathogenesis of sodium
selenate toxicosis in sheep
the pathogenesis of selenium toxicosis was studied in 30 ewes fed subtoxic to
toxic levels of sodium selenate for 1 to 5 mth.  seventeen of the 30 died of
selenium toxicosis.  the most severe and consistent pathologic changes were
found in the myocardium and lungs.  myocardial alterations were focal to
diffuse degeneration, necrosis and early replacement fibrosis.  pulmonary
changes, consisting of edema and interstitial hemorrhages, were typical of the
degenerative processes which characterize passive congestion of the lungs
resulting from left ventricular insufficiency.  atrophy of lymphoid centers
in the spleen and lymph nodes was common.  degenerative changes were
occasionally found in liver, kidneys, and gastrointestinal tract.
.I 525
.C
18
.W
1143. sodium selenate toxicosis  the distribution of selenium within the body
after prolonged feeding of toxic quantities of sodium selenate to sheep
the distribution of selenium in the body tissues of adult sheep fed subtoxic to
toxic quantities of sodium selenate daily for 1 to 5 mth. varied with the
tissue
type and with the level and duration of selenium consumption.  selenium
concentration was highest in the liver, followed by (in descending order)
the kidneys, lungs, spleen, myocardium, skeletal muscles, and brain.
.I 526
.C
18
.W
1172. studies on selenium toxicity and chondroitin sulfate and taurine
biosynthesis in the chick embryo
fourteen-day-old chick embryos were used in in vivo experiments.  a toxic
selenite treatment did not cause a reduction in the extent of sulfate-s
incorporation into chondroitin sulfate or into taurine or a reduction in the
observed tissue levels of these metabolites.  rather, the taurine level was
significantly greater with the embryos which received selenium.  the extent of
the incorporation of selenite-se into the metabolites was low or not
significant.
.I 527
.C
18
.W
843. reactions of seleno- and sulfoamino acids with hydroperoxides
reactions of methionine, cystine and their selenium analogues with
hydrogen peroxide and organic peroxides have been studied.  methionine reacts
most rapidly with hydrogen peroxide but selenocystine causes the most
decomposition; both react much more slowly with organic peroxides.  the results
suggest that selenocystine may act as a biological antioxidant.
.I 528
.C
18
.W
2127. selenium toxicity in domestic animals
the article, with an extensive bibliography, is a compendium of available
information on selenium toxicity in domestic animals.  literature reveals
evidence of organically bound se being more biologically active, when given
orally to domestic animals, than inorganic se salts.  there is also variation
in toxicity of organic se analogs.  when exposed to ruminal digestion, there is
considerable reduction of se salts to the relatively biologically inactive
elemental se; which may result in fecal excretion of se, as such, to as much
as 40% of a single oral dose.  fluorine, molybdenum, chromium, vanadium,
cadmium, zinc, cobalt, nickel and uranium increase se toxicity.  arsenic and
tungsten give some protection against it.  bromobenzene, benzene, and
napthalene
mobilize tissue se and stimulate its excretion.  since se preparations designed
for topical application in treatment of skin disease have been available for
use
in both man and dogs, the literature has reported cases of poisoning from
misuse
of such preparations.  selenium, properly used, can be a valuable therapeutic
agent, though certain salts of se must be regarded as potentially toxic.
however, there is considerable latitude between therapeutic and/or nutritional
and toxic doses of these salts.
.I 535
.C
10
.W
1848. antigen analysis of sera from patients with malignant
tumors by immunodiffusion methods
immunoelectrophoresis and ouchterlony's
method were used for the antigen analy-
sis of sera from 320 cancer patients; 250
normal or non-tumorous cases served as
controls.  immunoelectrophoresis showed
abnormal precipitin lines which could not
be demonstrated in normal sera.  most of
the abnormal antigens were demonstrated
in the a2- and b1-globulin fractions.  the
distribution of these antigens differed in
individual cases and was not related to the
histopathological classification and site
of the tumors.  however, these antigens
increased in parallel with growth of the
tumors and disappeared or markedly
decreased after surgical removal of the tumor
tissue.  almost all sera of patients with
myeloma, leukemia, and malignant lymph-
oma formed one characteristic line in
the b2-globulin region and they could be dif-
ferentiated from the patterns in cases of carcinoma.
.I 537
.C
10
.W
2371. participation of 7s and 19s antibodies in enhancement and
resistance to methylcholanthrene-induced tumours
serum factors responsible for enhancement
and resistance to methylcholanthrene-
induced tumors in a syngeneic system in mice
were studied.  they were found to be
part of the serum immunoglobulin system.
the active components of specific anti-
tumor serum were always contained in the
7s (y-2) and 19s (y-1m) fraction, while
no activity was detected in the 4s fraction.
in sera which in the given dose enhanced
growth of the tumor graft, enhancing activity
was present in both the 7s and 19s
fraction of the serum and was higher in the
former.  in sera which in the given dose
influenced the interaction of the organism with
the tumor by producing resistance
to the tumor graft, both fractions were again
active, the activity of fraction 19s
being higher than that of fraction 7s.
.I 538
.C
10
.W
2372. the effect of immunity against sex-antigen on a tumour
graft containing sex-antigen
the tumor bp 1 induced by benzpyrene in c57bl
male mice contains sex-antigen.
sex-antigen is not lost during growth of tumor
against immunity directed against
this antigen.  the tumor, however, becomes
more resistant to immunity and the
content of sex-antigen is decreased.
.I 539
.C
10
.W
2373. factors influencing the induction of enhancement and re-
sistance to methylcholanthrene-induced tumours in a syn-
geneic system
active immunological enhancement of the
growth of methylcholanthrene-induced tu-
mors was demonstrated in a syngeneic
system in mice.  enhancement was detected
3-5 wk. after preimmunization with
irradiated tumor suspension and was succeeded
after the 6th wk. by the development of
resistance to the tumor.  analysis by means
of adoptive and passive transfer showed
these to be true immunological phenomena.
enhancement and resistance were transferred
by serum and by the lymph node cells
of preimmunized mice.  threshold doses of
tumor cells were found to be the most
satisfactory for the detection of resistance
and enhancement in this system.
.I 540
.C
10
.W
5512. antigenic properties of human tumours
preliminary studies on the antigenic
properties of human tumours have been
carried out using heterologous antisera,
prepared in rabbits, against a number of
different cancerous and normal tissues.
after repeated absorptions, antisera
were obtained which reacted only with
tissue antigens.  some antisera, after ab-
sorption with normal tissues, reacted only
with tumours.  seventy-two tumour and
31 normal tissue extracts were studied
by means of the ouchterlony agar gel
double diffusion technique.  the results
showed the presence of an antigen or
antigens in some human malignant tumours
which were not detectable in normal
tissues, in foetal tissues, or in hela cells.
in addition, there was some loss of
normal tissue antigens from tumours.
attempts are being made to isolate and
characterize these tumour and normal
tissue antigens.
.I 541
.C
10
.W
5514. the incorporation of sv40 genetic material into adenovirus 7 as
measured by intranuclear synthesis of sv40 tumor antigen
the l.l. strain of adenovirus 7, free of
detectable infectious sv40 virus, induced
sv40 tumour antigen, demonstrable by
fluorescent antibody staining, in green mon-
key kidney, rabbit kidney, hamster embryo
and human embryo kidney cell cultures.
in green monkey and human cell cultures
there was a cytopathic effect and more
cells contained the sv40 tumour antigen
than in the other types of culture.
adenovirus 7 viral antiserum neutralized
the sv40 tumour antigen inducing
ability of the l.l. strain virus but anti-sv40
monkey serum and serum from sv40
tumour bearing hamsters did not.  an
adenovirus 7 preparation propagated
exclusively in human tissue did not induce
the sv40 tumour antigen.  the sv40
tumour antigen was entirely localised within
the cell nuclei and appeared to be
transmitted to daughter cells during mitosis.
.I 542
.C
10
.W
264. fluorescent antibodies to human cancer-specific dna and
nuclear proteins
specific antigens have been demonstrated
in certain cancers.  in this study they were
obtained from an adenocarcinoma of the
colon and an ewing's sarcoma.  homogenates
were prepared and male rabbits were
immunized.  the animals were bled to death
10 days after the last injection.  testing
included fluorescent antibody methods and
agar-gel horizontal double-diffusion precipitin
test.  the pattern of reaction of these
antibodies against various cancers seems to
be dependent upon the source of the
cancerous dna-bound proteins and the salt
concentration used in their isolation.
human cancer-specific cross nuclear antigens
seem to be cross reacting rather
than identical in structure.  the cancer-specific
antibodies could be removed only
with absorption of the immune globulins with
cancerous tissues.  salt-soluble human
dna-bound proteins from an adenocarcinoma
of the colon and an ewing's sarcoma
induced the formation of cancer specific
antibodies which showed positive fta re-
actions (to a maximum titer of 1/128) against
95% of the cancerous tissues studied.
these cancer-specific antibodies gave
similar fta reactions with cell nuclei of
normal appearing liver parenchyma
adjacent to metastatic carcinoma of colon, nor-
mal appearing colon near to metastatic
carcinoma of the colon, normal appearing
colon near to carcinoma of the colon,
and a long-standing case of chronic ulcerative
colitis.  evidence is shown that this finding
possibly may represent a serological
detection of an early or latent cancerous
change in morphologically normal cells.
these cancer-specific antigens have been
identified as rounded, intranuclear dna-
bodies and nuclear proteins which can be
specifically destroyed by dnase trypsin.
.I 543
.C
10
.W
266. immunology of the cancer cell: tumour-specific antigens
after a broad historical survey of immunological
studies of cancer, a review is given
of the evidence showing that antigens present in
normal cells are missing from the
malignant cells that arise from the same tissue.
this evidence is considered in con-
junction with the deletion hypothesis of carcinogenesis,
and the author emphasizes,
that in his view, the key event in carcinogenesis
is enzymatic deletion.  antigenic
gain and intensification in the course of spontaneous,
chemical, and viral carcino-
genesis is reviewed, together with experiments
demonstrating the existence of
tumour-specific antigens.  the question is then
posed: if tumours have specific anti-
gens, why is evidence for their rejection so scanty?
the occasional spontaneous re-
gression points to host resistance but its rarity
suggests that tolerance generally
develops.  consideration is given to the
application of immunological methods to
therapy and although current achievement
in this field is limited, new immunological
stratagems might yet transform the picture.
finally a plea is made for the integra-
tion of the disciplines of immunology and
cellular differentiation.  the prospect is
raised that through a synthetic and holistic
approach we might discover the suscepti-
bility of the cancer cell to re-differentiation
and re-recognition.
.I 658
.C
22
.W
further observations of the lymphomas
of african children
during 1963, cytopathogenic, filtrable agents were frequently encountered in
cultures of embryonic human kidney cells following their inoculation with
supernatant fluids from primary human amnion cultures which had previously been
exposed to extracts of tumors and other specimens from east african children
with malignant lymphomas of the kind described by burkitt and others.  the
results seemed noteworthy because they suggested an intimate association
between the agents and the disease, and also because of the nature of the
isolations which involved two phenomena, an initial induction of a peculiar
spindling and twisting of the amnion cells
(fig. 1) and subsequently destructive changes
in kidney cells inoculated with fluid from such altered amnion cultures.  the
direct inoculation of embryonic kidney cells with extracts of tumors or bone
marrow never caused cytopathogenic effects nor did the isolated, transmissible
agents have the capacity to induce the amnion lesions.  nevertheless,
the two effects were closely associated and clearly related to the specimens.
the cytopathogenic agents were later cultivated on protein-rich media and
found to have the characteristics of mycoplasma.  they failed to induce
tumors in a variety of animals, and serologic tests in which they served as
antigen gave suggestive but inconclusive evidence of a relationship to the
disease.  the mycoplasma also failed to induce the amnion lesions caused by
the specimens.
.I 659
.C
22
.W
mycoplasma species of man
at present, six distinct species of mycoplasmas
are known to infect man.  certain biological and
ecological properties of these agents have been
defined.  one species, m. pneumoniae, has been
definitely shown to be an important respiratory-
tract pathogen, and another species, m. hominis
type 1, may play a role in respiratory-tract and
genital-tract disease.
.I 660
.C
22
.W
pleuropneumonia-like organisms
despite their small size, the pplo carry
the full complement of the chemical com-
pounds and enzymes contained in larger
bacteria and in cells.  they contain both
dna and rna, and in their independent
metabolism they are essentially like other free
living cells in contrast to the viruses which
have no independent metabolism outside the
living host cell.  several strains of pplo have
been cultivated from the mucous membranes
of apparently normal human subjects, espe-
cially from the respiratory and urinary tracts.
until recently, however, definite evidence of
the association between the pplo and clear-
ly defined clinical disease in the human sub-
ject was lacking.  in 1962 it became evident
that the so-called eaton "virus," originally
isolated by eaton and his associates in 1944
from patients with primary atypical pneu-
monia, was in reality a pleuropneumonia-like
organism.  typical pplo colonies are pro-
duced on a cell-free agar medium which is
enriched by the addition of blood serum or
yeast.  a number of strains of pplo has now
been identified, and in recognition of their
unique characteristics, they have been classi-
fied in a separate order, the mycoplasmatales,
genus mycoplasma.
.I 739
.C
27
.W
the periodicity of microfilariae
ix. transfusion of microfilariae (edesonfilaria) into
monkeys at a different phase of the circadian rhythm
this paper reports experiments in which microfilariae at one phase of their
circadian rhythm were transfused into a host at another phase of the circadian
rhythm, in an attempt to analyse the relative importance of the rhythms
inherent in the microfilariae and of those in the host for the production of
the well known periodic migrations.  the experiments were performed with
edesonfilaria malayensis (yeh, 1960) present in a macaca monkey from thailand.
.I 769
.C
27
.W
linfangiografia no estudo da filariase linfatica
in the first part of the present paper a study is presented
of the lymphangiogram of the normal african; the author has
noticed that it is coincident with the one of the white indi-
vidual.
the second part includes the lymphangiographic examina-
tion and the observation of lymph circulation (via risa)
during the several stages of lymphatic filariasis.
even during the asymptomatic stage, lymphangiography
shows ganglial hypertrophy with a slight fibrosis and occa-
sional discreet alterations of the lymphatic trunks.
in the symptomatic stage, the lymphangiographic aspects
vary according to the disease's different stages and there is
not always a relationship between the duration period of the
symptoms and the changes observed.
in lymphangites, there are frequent alterations of the
lymphatic trunks, i.e., increase in caliber, extensive and seg-
mentary dilatations, numerical decrease with visualization of
anastomoses and higher permeability.  circulatory trouble evi-
dences itself not only by a decrease in the rate of the lymph
flow, but also by a very marked ganglial retention.
in adenites, in spite of the marked ganglial hypertrophy
due to intense sclerosis, there may be no considerable altera-
tions in the lymphatics, but risa already shows clear circula-
tion troubles leading to lymphatic stasis.
in adenolymphoceles, the obstruction at the primitive-iliac
level causes the lymph flow to deviate through the pre-sacral
anastomoses and reflux to the inguinal glands, thus causing
their dilatation and the formation of varicosities in the affe-
rent lymphatics.
in lymphedemas, our lymphangiographic results together
with risa's allow us to assume that the pathogeny is chiefly
influenced by three factors: lymphatic obstruction due to lym-
phangitis, insufficiency of the collateral ducts, and ganglial
sclerosis.
.I 853
.C
29
.W
a genetic study of neonatal obstructive jaundice
58 children with extrahepatic biliary atresia, 7 with intrahepatic
biliary atresia and 50 with 'neonatal hepatitis' were analysed
concerning diagnostic criteria, natural history, familial, clinical
and pathological data.  in extrahepatic biliary atresia, there is no
evidence of a familial tendency, influence of maternal age, birth
order or disturbance of foetal development.  in 'neonatal hepatitis',
there were 4 consanguineous parents, suggesting a mutant
autosomal gene in homozygous form.  some infants with the genotype
for 'neonatal hepatitis' may manifest a very mild or a very severe
form, so, a diagnosis was not made.  an apparent excess of males
over females may be another evidence of failure of manifestation of
the genotype.  but 'neonatal hepatitis' may be a manifestation of
more than one disease.  in 'neonatal hepatitis' the birth weight
shows a marked decrease, perhaps as a sequence of disturbed liver
function in the foetus.
.I 858
.C
19
.W
the isolation of thyrocalcitonin and study of its effects in the rat.
   the thyroid secretes a
polypeptide hormone (thyrocalcitionin)
which is effective
in lowering plasma calcium
and phosphate.  the hormone
can be extracted from
the thyroid of the rat, dog,
pig, goat, ox, and monkey.
the isolation of the hormone
from pig thyroid by a combination
of salt fractionation
and gel filtration is described.
one microgram of
the pure material is very
active in the rat.  thyrocalcitonin
remains effective after
parathyroidectomy, after
nephrectomy, after overdosage
with vitamin d, during vitamin
d deficiency, and during
calcium or magnesium deficiency.
its action is not prevented
by prior administration
of actinomycin d.  a
single injection does not change
soft tissue calcium but
infusion for 12 hr lowers cardiac
muscle calcium.  it is
concluded that this new thyroid
hormone acts on bone
and that it probably plays an
important role in normal physiology.
.I 859
.C
19
.W
the effect of actinomycin d on parathyroid-induced
change in bone and kidney.
actinomycin d (amd), an antibiotic known to
inhibit dna-directed rna synthesis,
was used to study parathyroid-induced changes
in ca mobilization in vivo and in vitro
as well as renal excretion of ca and phosphate
in rats.  intact and parathyroidectomized
rats subjected to peritoneal lavage were
administered amd, and changes in
ca, p, and mg in lavage and serum were
examined.  amd consistently lowered the
ca transfer into the peritoneal rinse in both
the intact and parathyroidectomized animals,
although the drop in ca was more acute
if the animals were pretreated by subcutaneous
injections of amd than if amd was
administered as a component of the
rinse.  pretreatment of lavaged animals with
amd prevented the expected increase
in osteoclast numbers in the distal metaphysis
of the femur but had no effect if administered
as a component of the peritoneal rinse.
the incubation of femora removed
from both intact and parathyroidectomized
animals resulted in media ca levels that
were significantly lower after 4 hr. incubation
when amd was added in vitro.  however,
transfer of recently injected ca into
the incubation medium from animals
treated with amd was increased.  in addition,
parathyroidectomy of animals subsequent
to administration of amd still resulted
in expected changes in ca and p in the
urine although amd significantly increased p
excretion in both intact and parathyroidectomized
animals.  it was concluded that
endogenous parathyroid hormone requires
the continuous production of enzymes ultimately
responsible for its action on bone
and kidney, but that this action is not necessarily
related directly to the production
of m-rna.
.I 860
.C
19
.W
inhibition by actinomycin d of bone resorption
induced by parathyroid hormone or vitamin a.
actinomycin d inhibits cell proliferation in
control cultures of embryonic rat bone
and prevents the stimulation of bone resorption
by parathyroid horome (pth) or vit.
a.  with a dose of 0.004 /ml. of actinomycin
d, pth effects are only partially inhibited
and this inhibition can be overcome
by increasing the dose of pth.  these
findings suggest that these agents act competitively.
.I 861
.C
19
.W
j. clin. endocr. 1965, 25/4 (457-464).
antagonism between parathyroid extract and adrenal
cortical steroids in man.
metabolic balance studies were done in 2
patients with hypoparathyroidism who
received hydrocortisone of prednisone
during the administration of parathyroid
extract.  administration of prednisone was
associated with phosphate retention,
decreased urinary ca, decreased serum
ca, citrate and glycoprotein concentrations,
and increased serum phosphate.
excretion of parathyroid activity in the
urine of 1 patient was uninfluenced by the
administration of prednisone.  it is concluded
that the antagonistic effect of the
adrenal cortical steroids was expressed
at the biochemical sites of action of the
parathyroid extract in bone and kidney,
that the steroids reduce parathyroid secretion
but that their administration probably does not
result in degradation or inactivation of
the hormone.
.I 862
.C
19
.W
tissue distribution of electrolytes, ca and mg in experimental
hyper- and hypoparathyroidism.
the effects of experimental hyper- and
hypoparathyroidism on plasma and tissue
distribution of electrolytes and tissue
exchangeability with ca and mg were studied
in dogs following acute renal pedicle
ligation.  in hyperparathyroidism, plasma concentrations
of mg and inorganic p as
well as ca were increased.  a greater accumulation
of ca occurred in some tissues
and a lesser accumulation in others than
in acute hypercalcemia of comparable
severity and the fractional rate of exchange
of tissue ca was 30% more rapid than
in control and acute hypercalcemic dogs.
bone exchange of ca was not significantly
increased.  cell mg concentrations were
not appreciably altered by hyperparathyroidism
except for a significant 9% decrease
in myocardium, but the fractional rate
of exchange of tissue mg was increased.
acidsoluble p concentrations were decreased
in 3 tissues and na and c1 concentrations
were decreased by 10 to 25% in 4 tissues.
in hypoparathyroidism, in addition to a
decreased plasma ca, the increment
in plasma inorganic p that usually occurs
after renal pedicle ligation was 75% less
than in control dogs.  cell ca concentrations
were decreased by 10-40% but the
fractional rate of exchange of tissue ca was
unaltered.  although cell mg concentrations
were unaltered a 40% increase occurred
in the exchangeability of skeletal muscle
mg.  tissue na and c1 concentrations were
decreased by 20% in 2 tissues.  it has been
previously reported that hypercalcemia
increases cell ca concentrations by raising
the extracellular ca concentration gradient.
evidence has also been presented that
hypercalcemia directly inhibits cell
influx of mg and na and cell efflux of k.
with altered parathyroid activity, 2 types
of effects are observed: those which are
dependent upon an abnormal extracellular
ca concentration and those which appear to
be due to intrinsic effects of parathormone
on cell cation transport.  the present
data are compatible with the hypotheses
that parathormone stimulates bidirectional
transport of cell ca and p, stimulates
cell influx of mg and opposes the effects of
hypercalcemia on cell transport of univalent ions.
.I 864
.C
19
.W
sudden hypocalcemia in normal and hypoparathyroid subjects.
   serum calcium concentration was suddenly decreased
in 10 normal and 4 hypoparathyroid subjects
by the infusion of 50 mg/kg of disodium edta over a
30- to 45-minute interval.  the return rate to pre-infusion
values of the serum calcium concentration was the
same in both groups.  serum phosphate showed a marked,
transient decrease 30 min after the infusion in normal
individuals, but not in those with hypoparathyroidism.
the hypophosphatemia was followed by a marked
increase in phosphate clearance in the normal group and
a decrease in the hypoparathyroid group.  urine phosphate:
urine creatinine x 10 (up:uc x 10) and urine
phosphate: urine osmolality x 10 (up:uo x 10) ratios
also reflected an increased phosphate excretion in the
2 groups.  a simple clinical measure of parathyroid
function is suggested by determining the up:uo x 10
or the up:uc x 10, or both, ratios before and 3 to 6
hr after intravenous infusion of disodium edta.
.I 865
.C
19
.W
parathyroid function in chronic renal failure.  a statistical survey
of the plasma biochemistry in azotaemic renal osteodystrophy.
   a collection has been made of 134 personal and
published cases of azotemic osteodystrophy in which
adequate information was available concerning the
pathological state of the bones.  measurements were
available of the plasma calcium, plasma phosphate, and
blood-urea-nitrogen in all cases, and of plasma bicarbonate
and plasma proteins in a representative sample.
the plasma levels of calcium and phosphate in the whole
series of 134 cases were not related reciprocally but
were correlated directly.  these data were further analyzed
by allocating each case to either of 2 sub-groups,
according to the type of pathological lesions present in
the bones.  in one group there was evidence of defective
mineralization of skeletal tissues, in the form of either
rickets or osteomalacia, and the plasma-calcium was
found to be statistically sub-normal.  in the other group
there was no primary defect of mineralization but the
lesions of generalized osteitis fibrosa were present and
the plasma calcium was statistically normal.  there was
no significant correlation between the plasma levels of
calcium and phosphate in either sub-group; and the plasma
phosphate was significantly higher in the group with
the higher plasma calcium levels.  the data indicate that
in patients with renal osteodystrophy, contrary to general
belief, the plasma calcium varies independently of the
plasma phosphate.  since these results imply differences
in parathyroid function among patients with azotemic
osteodystrophy, a survey has also been made of
the recorded parathyroid weights in chronic renal failure.
generalized osteitis fibrosa and the accompanying normal
levels of plasma calcium are associated with greater
parathyroid hypertrophy than is found in most cases
of chronic renal failure or cases with defective mineralization.
the various data are interpreted in relation
to the known metabolic disturbances and natural history
of azotemic osteodystrophy.  by analogy with states of
simple vitamin d deficiency, it is suggested that hypocalcemia
and relative unresponsiveness to the calcemic
action of parathyroid hormone are related to an acquired
resistance to vitamin d.  the group of cases with statistically
normal plasma-calcium prove that the parathyroid
glands can function effectively in some patients
with chronic renal failure, irrespective of the level of
the plasma phosphate.  the size of the glands and the
effects of sub-total parathyroidectomy in patients of this
group suggest that the normal plasma calcium results
from an increased production of parathyroid hormone.
the more advanced renal failure in the normocalcemic,
as compared with the hypocalcemic, cases could mean
that the development of an effective degree of secondary
hyperparathyroidism is a function of the duration of the
renal disease.  it seems likely that when the parathyroid
response is sufficient to overcome the effects of the vitamin
d resistance it also entails the development of generalized
osteitis fibrosa, healing of the defect of mineralization
and increased liability to metastatic calcification.
.I 866
.C
19
.W
albright's hereditary osteodystrophy.  report of a family with studies
of bone remodeling.
   two members of a single family, each representing
different forms of albright's hereditary osteodystrophy,
have been presented.  the kindred pattern is
similar to those of other reported families and is consistent
with a sex-linked or autosomal dominant mode of
inheritance.  the importance of a course of intramuscular
parathyroid extract for proof of parathyroid hormone
resistance is emphasized.  biopsy specimens of rib,
labeled in vivo with tetracycline, were studied microscopically.
these new observations indicated cellular
defects in bone remodeling shared by the propositus and
case 2, which may explain the low rates of bone turnover
found in each.  immunologic studies established the
presence of a substance antigenically similar to parathyroid
hormone in the parathyroid tissue of the propositus.
the pathogenesis of albright's hereditary osteodystrophy
and atypical forms of parathyroid hormone
resistant hypocalcemia is discussed.
.I 867
.C
19
.W
acute hyperparathyroidism: a surgical emergency.
   acute hypercalcemic crisis of hyperparathyroidism
is a surgical emergency.  diagnosis is often difficult
because of the polymorphous character of the
symptoms.  the variable clinical features of the syndrome
are described emphasizing the frequent occurrence of
gastrointestinal symptoms, especially duodenal ulcer of
recurring pancreatitis in the antecedent history as well
as the better known occurrence of renal and skeletal
manifestations, which precede the crisis in all but a few
cases.  despite the variability of the clinical manifestations,
the total syndrome forms a distinctive pattern
which should be recognizable once it is known.  previously
reported cases have been reviewed and an additional
case reported.  the differential diagnosis, aids
in identification of the tumor and prospects for more
effective control of the hypercalcemia are discussed.
at the present time, early surgical removal of the tumor
is the only effective treatment.
.I 870
.C
20
.W
a comparison of human placental lactogen (hpl) and human growth hormone
(hgh) in hypopituitary patients.
   the conclusions based on the studies reported are
that placental lactogen (hpl) at a dose level of 200 mg./
day did not induce a positive nitrogen balance in two hypopituitary
subjects.  in addition, lactogen does not augment
the nitrogen retaining effect of growth hormone
when given in a dose of 200 mg./day.
.I 871
.C
20
.W
radiation necrosis of the brain in acromegaly.
radiation therapy of pituitary tumors can
cause necrosis of the brain (4 cases are reported),
particulary if a carefully considered schedule of
dosimetry is exceeded.  the error can be due to
repeated courses of treatment or too rapid administration.
the cerebral lesions develop after a
latent period of months and are progressive and
often fatal.  appropriate pituitary surgery is preferable
to multiple treatment with radiation.
.I 872
.C
20
.W
   experiences with hgh treatment of twelve hypopituitary
dwarfs for periods varying from 6 to 41 months
are reported.  all the patients were considered to have
hypopituitarism from birth, four of them of the hereditary
type, four possibly due to traumatic birth or neonatal asphyxia,
and four from an unknown cause.  in six
patients detailed information concerning growth during
the first year of life could be obtained.  all of these patients
had a degree of growth retardation before one
year of age.  we consider this to be the rule rather than
the exception in pituitary dwarfism.  the most important
diagnostic evidence was a marked degree of growth retardation
accompanied by a pronounced delay in skeletal
maturation, and, in most cases, signs of secondary
hypothyroidism, increased insulin sensitivity, and a
poor response to metopyrone administration.  none of
the patients who had passed the normal age of puberty
had maturated sexually.  all twelve patients responded
well to hgh therapy.  during the first year of treatment
the average height increment was 10 cm. ('catch-up' growth).
with continued treatment a normal rate of
growth, about 6 cm./year, was obtained.  there was no
disproportionate acceleration of skeletal maturation in
any of the patients.  none of them has so far become resistant
to hgh administration.  the oldest patient has
reached normal height.  whether this will be possible
not only in the moderately severe, but also in the most
severe cases of pituitary dwarfism, can not yet be stated.
the possibility of using human gonadotrophic hormones
in an attempt to produce sexual maturation in
these patients is discussed briefly.
.I 873
.C
20
.W
treatment of retarded growth with human growth hormone.
results of treatment with human growth hormone
in the following 3 cases are discussed:
female hypopituitary dwarf of 17 yr.,
who grew 10 cm. in 20 mth.; a boy
of 14 yr. with constitutional retarded growth,
in whom the growth rate increased;
and in a case of primordial dwarfism in a girl
of 10 yr. in whom the growth curve
was unaffected by the treatment.
.I 874
.C
20
.W
genetic pituitary dwarfism with high serum concentration of growth
hormone new inborn error of metabolism?.
   a description is given of three siblings with hypoglycemia
and other clinical and laboratory signs of growth
hormone deficiency but with abnormally high concentrations
of immunoreactive serum growth hormone.  since
exogenous growth hormone was active in these patients,
the endogenous secretion of an abnormal growth hormone
molecule is postulated.
.I 875
.C
20
.W
growth-hormone deficiency in man:
an isolated, recessively inherited defect.
   a deficiency of human growth hormone not associated
with other pituitary deficiencies was observed in
midgets with sexual ateliosis, a form of dwarfism inherited
as an autosomal recessive trait.  body proportions,
sexual development, birth weight, and postpartum lactation
are normal in this syndrome.
.I 876
.C
20
.W
treatment of short stature in children and adolescents
with human pituitary growth hormone (raben).  experience
with thirty-five cases.
human pituitary growth hormone (raben) was
evaluated by longitudinal study of
growth as a therapeutic agent in the treatment
of short stature.  clinically significant
increases in growth rate were achieved in 11
of 13 hypopituitary patients.  no significant
improvement in linear growth rate was
noted with a dose of 2 mg 3 times
weekly in children whose short stature was due
to other conditions.  no adverse reactions
were noted; thyroidal, adrenal or gonadal
activation was not observed.  growth
was stimulated, probably without an undue increase
in bone age, though this point
demands continued scrutiny.  owing to the limited
supply of this material it is recommended
that it be used only in cases of documented
growth failure, and a protocol
for evaluation of therapeutic response is discussed.
though not a panacea for treatment
of short stature, human growth hormone
fulfils a unique and invaluable role
in replacement therapy for the hypopituitary dwarf.
.I 877
.C
20
.W
the development of bilateral adenomatous adrenal hyperplasia
in a case of cushing's syndrome of eighteen years' duration.
a case of cushing's syndrome of 18 years'
duration is presented.  the disease
began when the patient was 8 years old and
was partially controlled by pituitary
radiation when she was 13.  however, clinical
evidence indicate low grade but continuous
adrenocortical activity for the next 13
years.  the probable suppression
of gh secretion by the increased steroid levels
during her growth period provides
a reasonable explanation for the dwarfism of
the patient.  the administration of 8 mg
of dexamethasone per day failed to decrease
urinary steroid excretion.  bilateral
nodular hyperplasia was found at surgery.
it is suggested from the evidence presented
that this patient's disease began first
as a primary pituitary process but
during the long duration of the acth secretion
it evolved into one of autonomously
functioning bilateral nodular hyperplasia.
.I 878
.C
20
.W
hypopituitarism: a study of growth
hormone and other endocrine functions.
   pituitary function was evaluated in 25 adults with
evidence of hypopituitarism or enlargement of the sella
turcica.  growth hormone secretory function was measured
by radioimmunoassay of plasma samples taken
before and after insulin-induced hypoglycemia in a standardized
test of growth hormone reserve.  all patients
exhibited significant defects in growth hormone secretion,
as indicated by the failure of this hormone to rise
to normal levels in response to hypoglycemia.  the order
of frequency of hormonal loss was: growth hormone,
gonadotropin, adrenocorticotropic hormone, thyroid
stimulating hormone.  no pattern of deficiency was characteristic
for any particular etiology of hypopituitarism.
one patient with asymptomatic enlargement of the sella
turcica (accidentally discovered) had an isolated loss
of growth hormone secretory capacity.  two patients in
the series demonstrated intrinsic deficiency of thyroid
as well as pituitary secretion, and both had elevated
liters of antithyroid antibodies.  this study represents
the first direct evaluation, by radioimmunoassay of
growth hormone function in a series of hypopituitary
adults.  it demonstrates a remarkably high prevalence
of growth hormone loss, and suggests that the growth
hormone response to hypoglycemia may be one of the
most sensitive tests for the diagnosis of hypopituitarism.
.I 879
.C
20
.W
hypoglycemia and dwarfism associated with the isolated
deficiency of growth hormone.
the authors have studied a 7-year-old dwarfed
boy with a history of severe, recurrent
hypoglycemic episodes since age 1 and
retarded bone age.  hepatic, adrenal,
and thyroid function were normal.  he demonstrated
fasting hypoglycemia with blood
sugars of 30-40 mg./100 ml.  he was not sensitive
to l-leucine but showed insulin
sensitivity and hypoglycemic unresponsiveness.
glycogenolysis in response to both
adrenaline and glucagon was appropriate.  fasting
plasma gh levels were less than
1 m g./ml. (normal 1-3), and no rise was seen
after insulin-induced hypoglycemia.
similarly, these low gh levels did not rise 3-6
hr.  after a glucose tolerance test.
treatment with hgh reversed the alterations
in carbohydrate metabolism.  it is
concluded that the patient suffered from an isolated
gh deficiency which resulted in
dwarfism and alterations in carbohydrate metabolism.
.I 880
.C
20
.W
the effect of growth hormone in hypothalamo-pituitary
dwarfism. i. the metabolic effects of human growth hormone.
human growth hormone, isolated by raben's
method, was given in 2 to 5 mg. daily
doses over periods from 1 to 12 days to 7 patients
with pituitary-hypothalamic dwarfism.
the metabolic effects were as follows:
nitrogen retention with a variable
reduction in blood urea.  the plasma amino-acid
concentration did not alter after
i.m. injection of the hormone during fasting.
an accompanying retention of intracellular
components, in such proportions required
for protoplasm formation.
isotonic expansion of the extracellular compartment,
without change in the plasma
electrolyte concentrations.  retention of phosphorus,
sometimes a rise in plasma
phosphate; increased intestinal calcium absorption,
hypercalciuria, no alteration
in plasma calcium; an increase in plasma citrate
and citrate urinary excretion;
the calcium and phosphate retention was reversed
on stopping treatment.  mobilisation
of fat stores with lipid catabolism: this
was accompanied by a well marked
increase in nefa concentration for some hours
after hormone injection in the
fasting state, after a period of hypoglycaemia
and low nefa levels.  a complex,
biphasic action on glucose metabolism.  fasting
blood sugar levels are altered,
as are the glycaemia in various tests such as
fasting, insulin injections, tolbutamide
administration, intestinal hyperglycaemia.
acceleration of intermediate
metabolism with increased blood citrate
concentrations and 24 hours urinary
excretion of  -ketoglutaric acid.  in one test
during fasting the blood citrate increased
4 hours after hormone injection.  after
an oral load of sugar the blood citrate
and  -ketoglutaric acid concentrations
did not alter.  a progressive gain in
weight has been found during treatment, partly
reversible on stopping treatment,
correlating with the intracellular nitrogen retention
and expansion of the extracellular
space, despite mobilisation of fat reserves.
.I 883
.C
20
.W
plasma growth hormone concentration in the rat determined by
radioimmunoassay: influence of sex, pregnancy, lactation, anesthesia,
hypophysectomy and extrasellar pituitary transplants.
   the assay used is described in detail.  several experimental
conditions were studied, both to validate the
method and to determine factors which regulate gh secretion
in this species.  in fasting sprague-dawley rats
weighing 150-200 g, mean plasma gh concentration in
females was 94.2 17.3, and in males, 54.9 12.0 m g/ml.
gh levels in lactating rats were determined to be in
the normal range for females, thereby providing evidence
that this assay does not detect prolactin.  gh levels were
not elevated in pregnant rats.  hypophysectomy led to a
fall below detectable levels of gh.  intraocular pituitary
transplants failed to raise gh levels in hypophysectomized
hosts.  gh levels in male, but not in female, rats
are depressed by brief periods of ether anesthesia.  these
findings and the results of pituitary transplantation experiments
are further evidence that the nervous system
is involved in the regulation of gh secretion.
.I 888
.C
21
.W
the applicability of individualized programed instruction
in the education of deaf children.
verbal behavior is learned behavior and as
such is guided by the same principles
as any other learned behavior.  the parents'
role is mainly to help the young deaf
child conceive of language as a socializing
process and to help shape language behavior
toward the use of verbal symbols.
the teacher's role in the deaf child's
progress as a language user includes (1) helping
the child discover how the structure
of his language operates and (2) guiding
him in the process of acquiring clear
concepts.  the learning of a language is a highly
individualized process and requires
thousands of hours of practice.  efficiency
in language teaching to the deaf
has not been generally achieved by traditional
methods.  the teacher of the deaf
needs extra help in order to provide the individualistic
kind of teaching to insure
verbal over-learning by the child.  self-tutoring
programed materials offer this
help.  programs are so constructed that a child
proceeds through the program step
by step with a probability of maximum success
because of constant feedback as to
correctness of his responses.  for younger
children the use of a machine seems
desirable while for older children the program
may appear in book form, on film
strip, and any other visual medium.  well constructed
programs should be correlated
with classroom instruction.
.I 890
.C
21
.W
the oral language performance of premature children and controls.
fifty-one premature children born in 1955
and 1956 were compared with 55 normally
born subjects with birth weights over
2,500 grams.  they were tested on
tapped patterns, auditory memory span,
auditory discrimination, word recognition,
language comprehension, articulation,
resistance to articulation disintegration,
word finding, story telling, number of words
used, mean length of 5 longest sentences,
sentence elaboration, grammatical
errors, definitions and categories.
the mean age of both groups was 5.8 and the
premature children's performance
was inferior to that of children born at term.
.I 891
.C
21
.W
speech and reading problems in childhood.
the following communicative disorders
have been discussed: functional articulation
defects, delayed speech development,
stuttering, hearing loss, cleft palate,
neurological disorders, and reading disorders.
these disorders rarely have a
single cause.  they are the result of an
intermingling of many factors, some physiological
and some psychological, some
residing within the child and some in the
parents and environment in general.  delayed
or defective speech is a cause for
great concern to most parents and teachers.
the public health worker who listens
with an attentive and sympathetic ear may
allay some of this anxiety and thus help
foster healthy emotional development in
the child.  the existence of a more serious
condition underlying the presenting communication
problem, even if sensed by the
parents, is frequently denied.  the public
health worker can assist the parents in
the painful process of facing up to their
fears.  a child with a communication problem
is still a child and the public health worker
by simply reflecting this to the parents
and advising them on normal child-raising
practices can, again, be of help to the
child.  children with speech deviations are
exposed to an overabundance of well-intentioned
speech correction at home.
most of it is ineffective; some of it, unfortunately
is harmful.  while the worker
may not be in a position to offer specific
advice on a particular child, the manner
in which the parents and teacher are handling
the child's communication problem
can be explored and damaging practices
possibly eliminated.  the fact that there
may be a diagnostic and treatment center
to which the child can be referred does
not vitiate the public health worker's role.
the public health physician and public health
nurse have a valuable contribution
to make in helping the parents, school,
and child accept the chronic nature of the disorder.
.I 892
.C
21
.W
disorders of communication in young children.
the normal development of spoken language is
outlined.  the causation, differential
diagnosis, individual assessment and management
of developmental disorders of
communication in young children are briefly discussed.
.I 893
.C
21
.W
acquired aphasia in children.
this report concerns the cases of 21 boys
and 11 girls studied over a period of several
years while rehabilitation was carried
out.  the general conclusions fall under
3 headings: (1) symptomatology as compared
with that of aphasia in the adult; (2) the
course of the disorder; (3) prospects of the
level of intellectual performance in the
future of the children.  in 13 cases, cerebral
damage had resulted from traumatic
contusion; in 10 cases from an intracranial
nontraumatic hematoma (vascular malformation,
aneurysm or angioma); in 2 cases
the aphasia followed operation for a
cerebral astrocytoma; in 2 further cases
occlusion of the left middle cerebral artery
had occurred; and in the remaining 5 cases
no precise diagnosis was made.
.I 894
.C
21
.W
the causes of delayed development of speech.
speech develops parallelly and simultaneously
with psychophysical development of
the child, arising from internal need and
under the influence of external factors.  not
all children are given the chance to develop
in favorable conditions and to pass through
all the phases of development without some
injury.  the various possibilities when a
child may be injured and hampered in the
development of speech are discussed.  the
testing of the sense of hearing in children
with a cleft palate is also included-out of
181 cases of cleft palate, in 72 cases there
was decrease of the sense of hearing exceeding
30 db.  this additional injury of
the child with a cleft palate, if remaining unnoticed,
may make the treatment of speech
abnormality difficult.  the necessity of
diagnostic team investigation and the treatment
of children with speech disturbances
are emphasized.
.I 895
.C
21
.W
concept learning in culturally disadvantaged children as
a function of verbal pretraining.
while research indicates that verbal pretraining
has a positive influence on the discrimination
learning performance of subjects
of normal intelligence, a comparable
influence has not been shown for other types
of conceptual tasks for retarded subjects.
the purpose of this experiment was
to investigate the effects of stimulus
pretraining on concept learning by subjects
who had a 'high risk' of being classified
as mentally retarded at some future time.
a group of 27 'higher risk' and 27 'lower
risk' subjects was randomly divided into
3 pretraining groups: verbal label, attention,
and control.  subsequent to pretraining on
the stimuli used for transfer task 1, subjects
in each group were presented with a
concept learning task (transfer task 1).
after reaching the criterion of learning on
transfer task 1, subjects were presented
with a second, new, concept learning task.
analysis of the data revealed that there
were no significant performance differences
between risk groups and that pretraining
had a significantly positive effect on performance.
.I 896
.C
21
.W
concept development and language instruction.
the author describes factors related to,
and the errors that may occur in concept
development in children.  the contributions
of language for the deaf child's conceptual
development are stressed.  included
are a review of what concepts are, psychologically,
and an example of how concepts
may be presented, educationally, in the classroom.
.I 898
.C
21
.W
cerebral dominance and speech acquistion in deaf children.
in examining the prediction that left cerebral
dominance, as indexed by hand and
sighting preference, should be a positive accompaniment
of speech learning in individuals
whose cerebral speech areas are likely
to be in the left hemisphere, it was
found that over a 10-12 year period of formal
education right-handed-right-sighting
deaf students consistently earned higher speech
grades than their right-handed-left-sighting
and right-handed-mixed-sighting counterparts
matched on the basis of
hearing loss.  this finding supports the hypothesis
that the cerebral mechanisms
relevant to speech acquisition are simplified,
facilitated, and/or less prone to
interference when control of speech, hand, and
eye is localized primarily in 1
hemisphere of the brain.
.I 899
.C
22
.W
a color test for the measurement of antibody to the non-acid-forming
human mycoplasma species.
   a metabolic inhibition test
for the measurement of
growth inhibiting antibodies to
the non-acid producing
human mycoplasma species is
described.  the test is
based upon the ability of these
organisms to metabolize
arginine with a resultant alkaline
shift in the ph of the
medium.  the alkaline shift is
inhibited by specific antiserum.
labile accessory factor(s)
present in unheated
guinea pig serum potentiates
the inhibitory effect of antiserum.
the test is sensitive
and specific for the measurement
of antibody to mycoplasmas
in rabbit immune
and human convalescent serum.
.I 900
.C
22
.W
serologic epidemiologic studies with m. pneumoniae. i. demonstration
of an hemagglutinin and its inhibition by antibody.
   a new direct, specific
hemagglutination reaction
with live m. pneumoniae is described.
this requires the presence of a natural antibody
for the red cell in the
horse serum employed in the
diluent.  although vervet
monkey erythrocytes generally
have been employed,
human and rabbit cells may be
used.  hemagglutination
can be inhibited by specific antibody
but heat inactivation
of the sera is required,
whether they be human or
animal in origin.  antibodies
persist for many years and
are passively transferred to
the fetus.  a micro variation
has been devised.  the test
is useful for diagnostic
and epidemiologic studies and,
in reverse, can be utilized
for the rapid serologic
identification of new isolates.
the method is limited,
at present, to m. pneumoniae.
.I 901
.C
22
.W
serologic epidemiologic studies with m. pneumoniae. ii. prevalence of
antibodies in several populations.
   the prevalence of antibodies
for m. pneumoniae
was determined in 6 populations
by means of a new
serologic test.  among members
of a population of 'normal'
families, no one under
age 15 had antibodies.
none of the latter acquired an
infection during the following
year.  of 67 children in
a home, only 3 had antibodies.
the 7 cottage mates
of one of these children
who had acquired an infection,
remained uninfected.  in
a group of 124 elderly persons,
65 (53%) had antibodies.
a similar proportion of 76 persons
attending a rheumatic
fever prophylaxis clinic
was positive.  in this population
it was demonstrated that
antibodies could persist
in undiminished titer for at least
10 yr.  of 169 point
barrow residents, 68% had
antibodies.  above age 15
the rate was approximately
90%.  two companies of
naval recruits who had similar
positive antibody rates
at the beginning of training,
acquired antibodies in
rather divergent patterns, 63%
in one and 26% in the
other.  m. pneumoniae infections
seem to be sporadic
and to produce epidemics only
infrequently in civilian
populations.
.I 904
.C
22
.W
a note on the taxonomic status of strains like 'campo',
hitherto classified as mycoplasma hominis, type 2.
the classification of strains similar to
mycoplasma strain pg 27 of 'campo' as
myc. hominis type 2 should be withdrawn.
these strains have now been identified
as myc. arthritidis.
.I 907
.C
22
.W
respiratory virus vaccines. ii. mycoplasma pneumoniae (eaton agent)
vaccines.
   purified and concentrated formalin-killed vaccines
were prepared from m. pneumoniae propagated in
serum-free artificial medium.  the vaccines were
aqueous or were incorporated in alum or emulsified
peanut oil (adjuvant 65) adjuvant.  two or 3 different
concentrations of mycoplasma were included in each
preparation.  serum neutralizing and cf antibody responses
were measured in hamsters, monkeys, and in
institutionalized persons following 1,2,3 and sometimes
4 vaccinations.  all of the preparations were
highly antigenic in animals and in man.  alum vaccines
were better than aqueous vaccines and those in adjuvant
65 appeared to give best results although the bleeding
times were not always optimal for demonstrating
maximal effect.  persons who were without detectable
antibody initially and thus would be most vulnerable to
infection gave better responses to the vaccine than did
those with pre-existing antibody.  alum vaccine is an
acceptable formulation for use in man, and only 2 doses
of such vaccine were necessary to induce neutralizing
antibody in 90% of the persons who were initially without
detectable antibody.  no local or systemic reaction
of clinical consequence was noted in any of the persons
vaccinated.  recent unpublished findings, which indicate
a high degree of effectiveness of the alum vaccine
in stimulating antibody in preschool children and in
protecting children and adults against the natural disease,
are mentioned.
.I 914
.C
23
.W
long-term prognosis and the response of schizophrenic children
to drug therapy: a controlled study of trifluoperazine.
   it is evident from this study that treatment and
control groups must be matched for severity of illness,
since this affects the responsiveness to pharmacological
as well as to other types of treatments.  the use of
the double-blind technique does not of itself guarantee
a well-controlled study; the comparison of 2 or more
treatment regimes may be misleading if the groups are
not matched, or if the matching is not based on critical
factors.  in this study, both the response to the nonpharmacologic
aspects of treatment and the type of
response to the drug itself were related to the initial
severity of language impairment.  thus the major developmental
defect which determines long-term outcome
for schizophrenic children in this group also predicted
the immediate responsiveness to treatment.  within the
2 major prognostic subgroups of young schizophrenic
children, those with speech and those without, are children
with different profiles of disordered development
and different patterns of assets and handicaps.
.I 915
.C
23
.W
the long-term treatment of a psychotic child in a psychiatric hospital.
   description of one phase of the long term psychotherapy
of a 6 yr. old psychotic boy, within the framework
of a mental hospital.  the first part deals briefly
with the lay-out and the structure of a new unit for emotionally
disturbed children.  underlining the well-known
importance of the therapeutic milieu in the treatment
and care of the mentally ill particularly important when
the patients are children.  the child presented was diagnosed,
when admitted, as a case of severe childhood
psychosis, of the autistic type.  the unusually rich data
at disposal were obtained through non-verbal communication,
because the child has no language.  nevertheless,
he can express himself clearly through play and gestures.
the analysis of this precious clinical material focuses
the discussion on the existence and the quality of
an object-relationship preceding the psychosis, the importance
of the 'early unusual sensitivities' in the formation
of a premature and fragile ego and the method
of choice in the treatment of childhood psychoses.
.I 916
.C
23
.W
comments on a case of infantile psychosis.
an account is given of a case of infantile
mutism which depended not so much upon
a true autism as on a withdrawing into
himself as a defence against a dangerous and
threatening environment.  there was a
spectacular and unusual improvement of the
symptomatology with psychotherapy.
.I 917
.C
23
.W
the problems of infantile autism and psychiatric nosology.
in psychiatric literature the syndrome of
early infantile autism has been divided
into several subgroups (as, for instance,
the subgroup of kanner and the subgroup
of asperger) and has been assigned to
different mental conditions (schizophrenia,
psychopathy, neurosis).  these distinctions
and classifications are thought to be
controversial, so long as the etiology of
early infantile autism is unknown.  nor
should any 'psychiatric school' claim to
have the 'right' concept of schizophrenia,
since the etiology of schizophrenia, too,
has not yet been discovered.  in this particular
'pre-scientific' situation of psychiatry
it seems more promising to analyze
the individual mental case and to concentrate
on clinical symptomatology instead
of discussing arbitrary 'nosological entities'.
.I 918
.C
23
.W
families of children with early childhood schizophrenia.
emotionally disturbed children were divided
into 3 groups on the basis of their
diagnoses of: (1) autism or symbiosis,
(2) chronic undifferentiated schizophrenia,
and (3) other forms of emotional disturbance.
the 3 groups were compared statistically
on the following demographic measures:
(1) educational level of parents; (2)
occupational level of father; (3) prevalence
of broken homes; (4) male-female ratio
in each patient group; (5) ordinal position
among siblings; (6) ordinal position
among siblings of same sex; and (7) age of
parents at birth of child.  results indicated
that families of children diagnosed
as autistic or symbiotic show many
similarities to those with the diagnosis of
chronic undifferentiated schizophrenia.
in general, the parents in these 2 groups
were better educated and were employed
in more highly rated occupations than parents
of otherwise disturbed subjects.
broken homes were prevalent in the group
of disturbed nonschizophrenic children,
but not in the autistic or chronic undifferentiated
schizophrenic groups.  the male-female
ratio was not significantly different
among the 3 groups; in the autistic
group, specifically, it was 2.8:1.  the data
revealed no trend in ordinal position.
.I 919
.C
23
.W
childhood psychosis.
a description is given of the diagnostic criteria
put forward by creak and her associates
in 1961 for what they have called
'schizophrenic syndrome of childhood'.
psychotic reactions in childhood are grouped
into: (1) childhood schizophrenia, (2)
organic states with psychosis, (3) mental
subnormality with psychosis, (4) sensory
deprivation, (5) neurosis, and (6) manic-depressive
psychosis.  it is suggested that
the generic term 'psychosis' is the best
available, and a classification is presented
and discussed.
.I 921
.C
23
.W
modification of autistic behavior with lsd-25.
   lsd-25 appears to offer a useful adjunct to the
psychotherapy of autistic children because of its positive
effect in areas which are closely related to the process
of psychotherapy.  a pair of identical male autistic twins
was periodically administered 50 of lsd-25 and
observed for behavior changes.  control and drug observations
were made while the subjects were placed in a series
of standard test situations referred to as the socialization
test, social isolation test, peek-a-boo, pat-a-cake,
face-to-face, hand-holding and following tests.
diverse behaviors were recorded in the areas of self-stimulatory
behavior, social interaction and affect.
recordings were made using an esterline angus multiple
pen recorder.  all behaviors were measured in total time
appearance and plotted as percent time in appearance.
consistent behavioral changes resulted after lsd in that
the subjects demonstrated an increase in eye-to-face
contact, an increase in laughter and smiling behavior
and decrease in self-stimulatory behavior.
.I 922
.C
23
.W
the influence of organic and emotional factors on the origins, nature
and outcome of childhood psychosis.
a group of 65 children diagnosed as 'child
psychosis' (or one of its synonyms)
was followed up for an average of 15 yr.
none of the parents were schizophrenic;
6 (10%) had a parent who had psychiatric
treatment for neurosis.  only 2 children
had a sib with transient autistic episode.
none had sibs with the adult type of
schizophrenia.  these findings are felt to
militate against the view that child
psychosis is part of the schizophrenic group.
among the 65 children: 40% had an
i.q. below 50, 40% between 50 and 80 and
only 20% above 80.  the i.q. was found
in general to be a good predictor of later
performances.  mental retardation is
regarded as a primary component of the
clinical picture.  evidence of brain damage
was conclusive in 15 children (24%) who showed
epileptic attacks (developing in 10
of them during the follow-up).  speech disorders
were the most outstanding manifestation.
five children had confirmed receptive
aphasia and 14 others show some
evidence of it.  in 75% of the speaking children
echolalia was noted; 11% had abnormalities
of delivering spoken words.  the
view that reduction of speech is due
to social withdrawal is rejected.  psychogenic
factors and parental attitude were
not found to be relevant to the etiology.  the
psychosis is not considered primarily
emotional in origin, although emotional
relationships as well as educational management
have considerable influence on the
outcome of the disease.
.I 923
.C
23
.W
compliance and resistance in the conditioning of autistic children:
an exploratory study.
twelve autistic children between 4 and 9 yr
of age were asked to choose red objects
and square objects from a stimulus array.
ten subjects made correct choices
significantly less often than chance, that is,
they avoided emitting correct responses.
the subjects were given 60 conditioning
trials in which choices of either red or
square objects were reinforced.  those who
attained either concept subsequently
performed perfectly when asked to produce
both red and square concepts; the other
subjects continued giving fewer-than-chance
correct responses.  thus, conditioning
trials elicited in some subjects an increased
tendency to comply with the experimenter's
instructions.  the results suggest
that more attention should be paid to
the distinction between responses that
autistic children are unable to make and
responses that they are unwilling to make.
.I 924
.C
23
.W
the etiology of autistic syndromes of children.
examination and treatment of 92 children
and youths with the autistic syndromes
of early childhood over a period of ten years
led to the impression that these
disorders are a primary organic syndrome
of manifold etiology.  this view is
supported by many relevant clinical
experiences and data, which are discussed
in detail.
.I 927
.C
23
.W
treatment of childhood schizophrenia.  a three-year comparison of day
and residential treatment.
   a carefully designed study of 13 day-treatment
children matched individually with 13 residential children
is presented.  in each case the diagnosis of schizophrenia
was carefully confirmed on the basis of impairment
in human relationship, disturbance in personal
identity, resistance to change, unusual preoccupations,
perceptual and cognitive disorders, and panic reactions.
the ages ranged between 6 and 11.  the children were
selected, as the result of matching, with regard to age
of onset, culture, and family organization.  intactness
of the family structure was required.  residential treatment
implied round-the-clock therapeutic interaction
with the child for 7 days each week, 12 mth of the year.
day treatment consisted of 9 a.m. to 4:30 p.m. care
5 days a week for 9 mth of the year.  staff distribution
was identical in the 2 groups, but in the day-care group
the teacher assumed a larger relative position in the
world established for the child.  all children were matched
in ego status at the beginning of the experiment
by means of the wisc and psychiatric evaluation,
changes in this status being measured by the wisc and
the metropolitan achievement test series.  the results
indicated no significant improvement in either day or
residence in those schizophrenic children who, on admission
had unscorable wisc tests and who were the
most severely impaired in ego structure.  among the
children scorable on the wisc, the organic groups in
day and in residential treatment showed equivalent degrees
of progress, the non-organic children in residence
gave evidence of more improvement than did the
matched children in day treatment.
.I 928
.C
23
.W
visual versus tactual receptor preference in normal and schizophrenic
children.
   receptor preferences between visual or tactual
stimuli were measured in schizophrenic and normal
children; 4 pairs of standardized choice situations between
visual or tactual stimuli were used, with the time
of engagement with either stimulus constituting the
preference measure.  schizophrenic children between the
ages of 7 and 9 were compared with same aged normal
children.  a group of retardates were used for ma control.
schizophrenics were significantly lower in visual
preference than the same aged normals, and an age trend
for increased visual preference was found in the normal
sample.  retardates showed greater visual preference
than schizophrenics of comparable ma.  some implications
for theory of schizophrenia were discussed.
.I 935
.C
24
.W
a study of induced renal hyperplasia using autoradiography.
to establish a base line for future
autoradiographic investigations, compensatory
renal hyperplasia was studied using tritiated
thymidine.  labelled cells were infrequent
in the tubular tissues of control kidneys.
in the kidneys remaining after unilateral
nephrectomy there was a 5- to 6-fold
increase in the cortex and a 12- to 13-fold
increase in the medulla of labelled tubular
cells over the numbers seen in control
tissues.  the findings obtained here are in
agreement with the observations made in
earlier investigations with routine methods
of staining and mitotic observation.
.I 936
.C
24
.W
compensatory structural and functional changes in the kidney.
the radiographic assessment of the renal
size and the factors influencing renal
hypertrophy are discussed.  the importance
of compensatory hypertrophy and its
prognostic significance is emphasised.
the changes are correlated with renal function
as measured by the glomerular filtration
rate and renal plasma flow.
.I 938
.C
24
.W
the effect of nortestosterone phenylpropionate on compensatory
hypertrophy of the remaining kidney after unilateral nephrectomy.
forty-eight hr. after unilateral nephrectomy,
both in non-castrated and in castrated
male mice the relative dry weight of the
remaining kidney increased significantly.
this compensatory hypertrophy was significantly
stimulated as early as 96 hr. after
operation by treatment with 19-nortestosterone
phenylpropionate (= npp) at the
time of operation.  the percentual increase
of the kidney weight was approximately
the same in non-castrated as in castrated
mice.  the absolute initial values as well
as the resulting values 96 hr. after operation
were higher in non-castrated male
mice than in castrated animals.  the number
of cells and the dna concentration per
g. tissue decreased during the period of
non-stimulated compensatory hypertrophy
in both groups of animals.  npp caused a still
further decrease.  the concentration
of dna per cell did not change.  following
non-stimulated compensatory hypertrophy,
there was no change in the rna concentration
per g. tissue or per cell in castrated
mice.  in non-castrated mice the concentration
increased.  npp caused approximately
the same percentual increase of rna
concentration in non-castrated as in
castrated animals during the period of compensatory
hypertrophy.  the difference between
both groups of mice in the rna
concentration in the remaining kidney
following stimulation of the compensatory
hypertrophy by npp was statistically significant.
.I 940
.C
24
.W
the influence of thyroid hormone on renal function during the course
of compensatory hypertrophy.
during the course of compensatory hypertrophy
of the kidney, glomerular filtration
and renal plasma flow increased to a less
extent in thyroidectomized animals than
in control animals.  the secretory capacity
of the renal tubules of thyroidectomized
animals increased insignificantly during
compensatory hypertrophy, but increased
markedly after administration of thyroid hormone.
.I 941
.C
24
.W
kidney cell proliferation after unilateral nephrectomy as related
to age.
   the effect of unilateral nephrectomy on the
number of cortical kidney cells undergoing dna
synthesis and mitosis was measured by tritiated
thymidine autoradiography in both weanling and
adult rats.  among the unoperated control animals,
the weanling rat group showed a base line labeling
index of 0.59%, and the adult animals, one of 0.11%.
the response to unilateral nephrectomy resulted
in a peak value of 3.6% in the weanling animals and
1.2% in the adult animals, both occurring at 36 hr.
mitotic indices were 0.056% in the weanling control
animals and 0.0062% in the adults, with a peak
of 0.30% and 0.088%, resp., at 36 hr. separate
counts of tubule and stromal cells in the cortex
revealed that the maximum increase in % labeled cells
occurred later in the stromal cells than in the
tubule cells; the stromal cells not reaching a
maximum until 57 hr after nephrectomy.  the findings
indicate that, although the relative proliferative
activity is much lower in adult animals, a similar
response, qualitatively, is obtained in both groups
after unilateral nephrectomy.
.I 942
.C
24
.W
influence of the adrenal glands on dna synthesis in normal
and compensating kidneys.
the role of the adrenal glands in controlling
the synthesis of dna in normal and
compensating kidneys of rats given saline
drinking fluid was studied using tritiated-thymidine
and radioautography.  adrenalectomy
alone increased significantly the
labeling of the renal cortex and medulla of
otherwise intact rats.  two days following
unilateral nephrectomy of rats with intact
adrenal glands, the number of labeled
nuclei in the remaining kidney increased by
factors of about 4 and 2.5 in the cortex
and the medulla, respectively.  adrenalectomy
moderately decreased the hyper-plastic
response of the cortex of the remaining
kidney, but increased still further
the labeling index of the medulla.  by 5 days
after unilateral nephrectomy of rats
with intact adrenal glands, neither the cortex
nor the medulla of the remaining kidney
exhibited a marked hyperplastic response.
in adrenalectomized animals, also,
unilateral nephrectomy caused only slight
increases in the labeling indices of the
cortex and the medulla of the remaining kidney.
.I 943
.C
24
.W
auto-radiographic studies of the protein metabolism of the single
kidney in the nephrectomized rat.
rats were subjected to unilateral nephrectomy,
following which the protein metabolism
of the other kidney, which exerted
a compensatory activity, was studied
with h-labelled l-phenylalanine, at different
intervals (3hr. to 7 wk.).  two
phases of enhanced incorporation of amino-acids
into the cells of the convoluted
tubules were found, with one maximum
after 6 hr., at which time the uptake is
limited to the cytoplasm, and a 2nd maximum
on the 4th day, when the nucleus is
equally involved.  in the course of the 2nd
phase of enhanced amino-acid uptake,
there is also an increased mitotic index
of the epithelia of the tubules.  in the
collecting tubules, there was only one phase
of enhanced amino-acid uptake, with a
maximum on the 4th day, also coinciding
with an increased mitotic index.  the
increase of the number of cells of the kidney
was determined by a study of the variations
of the mitotic index.  the mean
multiplication factor in the beginning amounts
to 1.6.  the protein metabolism is increased
1.3 times.  the increase of the volume
(factor 1.3) and the increase of the protein
metabolism per unit of volume (factor 1.3)
of the hypertrophic kidney result in a
total increase of the protein metabolism
of 2.1 times, once the adaptation process
is complete, so that the residual kidney
has approximately the same protein
metabolism as 2 normal kidneys.
.I 949
.C
25
.W
the antidiuretic effect of angiotensin in diabetes insipidus.
   the effect of angiotensin (val-5-hypertensinii-asp- -amide)
was studied in 2 children with diabetes
insipidus (a 9 yr old boy with diabetes insipidus neuro-hormonalis
and a 4 yr old girl with diabetes insipidus
renalis) in whom the clearances of inulin, pah, na and
urea and the osmolar and free-water clearances were
examined.  angiotensin produces a prompt antidiuresis
which is combined with a gross decrease of the na-clearance.
the osmolality of the urine is increased only slightly
and the free-water clearance does not become negative,
both effects being contrary to those seen with vasopressin.
the antidiuresis and antinatriuresis can be produced
in salt-loaded and salt-deprived states.  furosemide
reverses the effects of angiotensin.  the clearance of
urea is not changed by angiotensin as long as the glomerular
filtration rate remains normal.
.I 951
.C
25
.W
treatment of diabetes insipidus: synthetic lysine vasopressin
nasal solution.
twenty patients with vasopressin-deficient
diabetes insipidus were treated with a
nasal solution of synthetic lysine vasopressin.
use of the nasal spray 2 to 8 times
daily controlled polyuria in all patients
without recurrence of the side effects
occasionally observed with posterior pituitary
preparations of animal origin.  one
pregnant patient was well controlled to term
without undesirable uterine stimulation.
because of its ease of administration,
the absence of significant water
retention (if used judiciously) and the freedom
from potentially serious allergic
reactions to foreign protein, this synthetic
preparation is recommended for clinical use.
.I 952
.C
25
.W
synthetic lysine vasopressin nasal spray in the treatment
of diabetes insipidus.
thirteen patients with diabetes insipidus
were satisfactorily and conveniently
treated with synthetic lysine vasopressin
nasal spray, the material being administered
3 to 5 times per day in a total daily
dosage ranging from 35 to 125 u.  a
transient decrease in effectiveness was noted
during periods of upper respiratory
infection or allergic rhinitis.  the only adverse
effects of the nasal spray consisted
of minor nasal irritation in 3 patients and
increased frequency of bowel movements
in one child after he increased the dose in
an effort to concentrate and restrict
urine volume.  in hydrated normal subjects,
lysine vasopressin administered s.c.
is 7.4 times as effective as the nasal spray preparation.
.I 953
.C
25
.W
diabetes insipidus treatment with 8-lysine vasopressin in a nasal spray.
synthetic 8-lysine vasopressin administered
as a nasal spray to 3 patients with diabetes
insipidus resulted in excellent control
in one.  in the other 2 it was of some
value as therapy supplemental to pitressin
tannate in oil.  the patient who was
adequately controlled with 'spray therapy' alone
required the sprays every 3 hr. during
the day, but none during the night.
.I 954
.C
25
.W
salt and water distribution in hereditary and in induced hypothalamic
diabetes insipidus in the rat.
salt and water metabolism and the distribution
of na, k, and water in gastrocnemius
and in aorta were measured in spontaneous
hereditary hypothalamic and in surgically
induced diabetes insipidus in the rat.
the degree of severity in the 2 types of the
disease was estimated in terms of salt
and water handling.  water turnover in 24 hr.
was about equal to body weight in the
hereditary disease and about 60% of body weight
in the induced disease.  skeletal muscle
na increased more than 20% in the familial
disease, and the gain involved both cells
and environment.  there was no corresponding
loss of k.  similar changes of
lesser degree were noted in the induced
disease.  the degree of na accumulation
appears to be partially dependent on the
duration of the disease.
.I 955
.C
25
.W
antidiuresis induced by saluretics in diabetes insipidus.
in hypothalamus-pituitary and less regularly
in nephrogenic diabetes insipidus some
diuretics cause a fall in diuresis mainly
due to reduced excretion of free water.
this adh-like action, not correlated with
the extent of the natriuretic action or with
salt depletion, depends on a direct effect
of the drug on water permeability in the
distal tubule and is suppressed by cortisone.
it is maximal for the thiazide
derivatives and diminishes progressively
with mercurial compounds, spirolactones
and triamterene in that order and is absent
for acetazolamide.  the reduction in
glomerular filtration and increased proximal
reabsorption of na following salt
depletion induced by the diuretics is of less
importance and irregular in appearance.
.I 956
.C
25
.W
congenital hydronephrosis.
histological study of the renal parenchyma
in cases of hydronephrosis is a guide for
surgical treatment.  if the renal parenchyma
is reduced in thickness to 3 mm. or less
it leads to complete atrophy.  but if the
thickness is more than 3 mm. conservative
procedures are justified.
.I 958
.C
25
.W
familial renal diabetes insipidus.
renal diabetes insipidus has been known
for 20 yr. only.  the first german report
on such a case appeared in 1957.  nevertheless
this disease appears to be more
frequent, also in germany.  a report is
given on 4 infants from 2 families with a
verified diagnosis.  in the one family there
were 3 other cases with the features
of the disease (polydipsia, polyuria, low
sg of the urine).  in the other family
anamnestic studies revealed 5 such cases.
.I 964
.C
26
.W
pneumoencephalographic changes in the cavum septi pellucidi and their
clinical significance.
the pneumoencephalographic appearances and
clinical problems associated with
communicating and non-communicating cavum
septi pellucidi are discussed on the
basis of 11 cases.  non-communicating csp
may lead to intermittent headaches due
to variations of intracranial pressure and
obstruction to the flow of csf.  in rare
cases, representing a special etiological
group, the foramina of monro and the
aqueduct may be narrowed.  a communicating
csp is generally associated with mild
to moderate symmetrical internal hydrocephalus.
in the author's opinion this is in
most cases a direct result of the cavum, since
fluid continues to be formed in the
cavum after communication with the rest of
the ventricular system has been established.
the conditions resemble those in
hypersecretory hydrocephalus.  for these
reasons the author rejects the view that a
communicating csp is of no clinical
significance.  in some cases the possibility of a
combination of a cavum with a cerebral
malformation must be considered.
.I 965
.C
26
.W
posterior scalloping of vertebral bodies in uncontrolled hydrocephalus.
two cases of extensive posterior scalloping
of the vertebral bodies are presented
in men aged 17 and 23 years, having
long-standing hydrocephalus.  two
additional cases with scalloping of only one
lumbar vertebra when partially controlled
hydrocephalus has been present for a shorter
time are also noted.  no previous
association between these entities has been
recorded.  it is supposed that the increased
intraspinal pressure which must have
been present in the first 2 patients for
many years, was present near the time of
closure of the epiphysis at the junction of
the arch and the bodies and caused not only
widening of the spinal canal but also
excavation of the vertebral bodies.  scalloping
of vertebral bodies has been described
in: (1) neoplasms (neurofibromas,
meningiomas, gliomas, hemangio-endotheliomas,
hemangiomas, lipomas): (2) intraspinal
cysts (intradural arachnoid cysts,
tarlov's perineural cysts, thoracic extradural
cysts in kyphosis dorsalis juvenilis):
(3) congenital anomalies of the spine and
cord (fusion defects, myelodysplasia,
hydromyelia, absence of a single vertebral
pedicle, meningoceles): and
(4) neurofibromatosis (with or without a thoracic meningocele).
.I 966
.C
26
.W
electroencephalographic picture of the infantile hydrocephalus.
in 50% of 33 cases of congenital hydrocephalus
the eeg examinations were normal.
asymmetry of the eeg recording was the
most common abnormality encountered
both in congenital and in acquired hydrocephalus.
none of the children examined
revealed any focal neurological symptoms.
it is concluded that eeg examinations could
be useful in differentiating congenital from
acquired hydrocephalus, because a normal
eeg recording suggested the congenital
nature of the condition.
.I 967
.C
26
.W
consecutive hydrocephalus.  report of 2 cases.
two patients, each with 3 consecutive hydrocephalic
newborns, are reported.  consanguinity
was present in both families.  a
genetic basis for the hydrocephalus is suggested.
.I 968
.C
26
.W
fanconi's anaemia with hydrocephalus and thyroid abnormality.
a case is described in a girl who suffered
from dwarfism due to congenital hypoplasia
of the pituitary and from other congenital
malformations.  the pancytopenia
manifested itself at the age of 2 yr. and was
resistant to a combined corticosteroid-testosterone
treatment.  unusual findings in
this case were congenital hydrocephalus,
hypoplastic spleen, and hypoplasia of thyroid
together with persistently high pbi
serum levels but without apparent changes
in thyroid function.
.I 969
.C
26
.W
dandy-walker-taggart 'syndrome' (a case report).
dandy-walker-taggart 'syndrome' in a
6-month-old girl has been substantiated by a
correlation of clinical and pathological
features.  all 3 exit foramina of the 4th
ventricle have failed to open, resulting in
severe cystic dilatation of the ventricle and
hypoplastic distortion of posterior midline
cerebellar structures.
.I 970
.C
26
.W
hydrocephalus due to smallpox occurring in the fetal period.
out of 450 cases of hydrocephalus in the years
1959-1962, 15 were found whose mothers
had contracted variola after the 3rd
month of pregnancy.  based on these personal
cases and the sparse data in the literature,
the clinical, epidemiological,
radiographical (skull), biological and histopathological
aspects are presented (2 fatal
cases were histopathologically examined).
it could be demonstrated that the hydrocephalus
occurred as a manifestation of a disease
involving the fetus and was caused
by a variola infection during gestation; inferences
are given from the eeg and examination
of the liquor.
.I 972
.C
26
.W
two cases of dandy walker's syndrome.
dandy walker's syndrome refers to a particular
kind of malformative hydrocephaly
characterized anatomically by association with
a more or less considerable agenesis
of the cerebellar vermis and with an imperfection
of the foramina of luschka and magendie.
the dysgenetic nature of this picture is
obvious, but the pathogenesis of the
hydrocephaly is not simple and the etiology remains
obscure.  the malformation is
compensated more or less quickly in the life of
the subject.  the clinical picture is
that of a hydrocephaly by a tumor of the posterior
fossa.  the diagnosis can and must
be carried out by x-ray examination, the ventriculographic
images being pathognomonic.
the extreme ease of surgical restoration of
the passage of flow and the effectiveness
of timely operation emphasize the interest
of this syndrome, which turns out to
be a rare kind of curable malformative hydrocephaly.
the authors report 2 unpublished
cases in respect of 3-yr.-old children.  the first,
already going back several years
(1945) had unfavorable postoperational results.
the second (1962) recovered completely,
without sequelae, after resection of the
posterior wall of the cyst.
.I 973
.C
26
.W
incidence and treatment of post-meningitic hydrocephalus in the newborn.
the incidence of meningitis in the first
few weeks of life is higher than in any comparable
period of life, even if cases associated
with spina bifida cystica are excluded.
the gravity of the prognosis even since
the introduction of many powerful antibiotic
drugs has been frequently emphasized.
among the 7 cases which occurred in a maternity
unit, 5 eventually made a complete
recovery.  in a group of 19 infants who developed
postmeningitic hydrocephalus and
were referred either with still active meningitis
or the postmeningitic state, only 1
infant could not be treated by a ventriculocaval
shunt.  this infant and 4 others died
later.  of the 14 survivors, 7 recovered
without sequelae, in spite of extreme hydrocephalus
which was demonstrated by air
studies before operation.  the degree of
hydrocephalus, no matter how severe, is no
contraindication to operation.
.I 975
.C
27
.W
filariasis in its relation to a a bo, mn, kell, duffy and rhesus blood
groups and secretor factor.
603 filariasis patients have been studied for
a a bo blood groups; 281 for duffy,
kell and rhesus blood groups; 178 for secretor
factor; and 503 for mn blood groups,
to find out if there is any association between
filariasis and these blood groups.
no association, whatsoever, has been found
between the blood groups studied and
filariasis.
.I 977
.C
27
.W
some observations on the effects in vivo of varying ambient temperatures
on filarial worms of snakes.
new information was obtained on the biology
of filarial worms from experiments
using constrictor constrictor mexicanus
boas, infected with macdonaldius oschei
worms.  the microfilariae of m. oschei are
aperiodic with respect to the light cycle,
but fluctuate sharply in density from day
to day.  maximum minimum levels occur
approx. 2 days apart.  the microfilariae
are larger and more variable in size on
the days of maximum density than on the
days of minimum density.  it is suggested
that the smaller microfilariae on the days
of low parasitemia are those that have
been born recently and that they enlarge
during the following 48 hr. before they enter
the peripheral capillaries.  low ambient
temperatures have little effect upon m.
oschei.  exposure of the host to ambient temperatures
above 36 c for a period of
24-48 hr. appears sufficient to kill adult
m. oschei.  all microfilariae apparently die
within 144 hr. at this temperature, and in
slight infections.  they disappeared from
the blood altogether within that period.  microfilariae
from an infection 20 times
more severe, however, were not eliminated
from the circulation prior to the death
of the host after 288 hr., although all those
observed were either decomposed or
distorted and apparently dead.  the indication
that the temperature serves as a limiting
factor for the parasite at a point several
degrees lower than that postulated for
the host species, is probably correlated
with the nocturnal habits of the host.
.I 980
.C
27
.W
pathology of schistosoma japonicum in the taiwanese monkey
(macaca cyclopis).  i.  comparison of formosan and japanese strains.
ii.  effect of passing the formosan strain through japanese snails.
i.   nearly equal recovery rates of adult worms
from taiwanese monkeys (macaca
cyclopis) infected with formosan or japanese
strains of sch. japonicum were recorded.
worm recovery rates from the monkeys
were low when comparison was
made with the highly susceptible laboratory
rabbit, signifying only partial susceptibility.
formosan strain granulomas in
the liver contained fewer eggs but
were considerably more severe and extensive
than japanese strain granulomas.
the possibility that the large, atypical granulomas
could be reactions to young,
degenerating formosan worms is discussed.
an alternative hypothesis to explain
the dissimilar reactions, that formosan strain
eggs are stronger tissue irritants
than those of the japanese strain, is proposed.
ii.   the formosan strain of sch. japonicum
was passed through the japanese snail
intermediate host (oncomelania nosophora)
for 4 consecutive generations.  progressively
rising rates of snail infection and
mortality were recorded.  the resultant
laboratory strain of formosan schistosome
was used to infect taiwanese
monkeys.  monkeys infected with the natural
formosan strain and natural japanese
strain served as controls.  worm recovery
rates were similar in the 3 groups.
granulomatous responses in the liver produced
by the laboratory strain were compared
with the large atypical granulomas of
the natural formosan strain and the
conventional granulomas of the natural japanese
strain.  the new formosan strain
appeared altered toward characteristics possessed
by the japanese strain.
.I 984
.C
27
.W
filariasis in mountain province, luzon, republic of the philippines.
an endemic focus of w. bancrofti in mountain
province, luzon (calaccad valley),
is discussed.  an 11% microfilaremia rate
was found.  the parasites were probably
brought into this area in the original human
migration, as recent immigrants came
from non-infected areas.  no infection was
found in children under 12 yr. of age,
which correlates with spraying of the area
since 1953.  however, some people live
in unsprayed houses, and children may
become infected.  with coming road development
and urbanization, culex p. fatigans
will move in and undoubtedly increase
transmission.  currently anopheles minimus
flavirostris is the most important
local vector.  aedes (finlaya) niveus was
probably also a vector.
.I 991
.C
28
.W
regional chemotherapy by prolonged arterial infusions in head and neck
tumors.
methotrexate was injected into the superficial
temporal or superior thyroid artery
by perfusion: 100 mg./1. (20drops/min.)
every day for 8 days.  the area to be irrigated
was decided on by preliminary perfusion
of patent blue violet 11%.  results
in 54 inoperable patients were: deaths 7,
failures 19, improvements 28, total regressions 3.
pain was relieved in 3/4 of the patients.
.I 992
.C
28
.W
intra-arterial infusion emphasizing treatment of malignant neoplasms.
this review of the english medical literature
summarizes most of the significant
papers concerned with intra-arterial infusion.
this technique of cancer therapy is
effective for palliation of many advanced primary
and recurrent cancer patients.
head and neck cancer patients form the largest
group of patients that have been treated
because of the easily accessible arteries.
however, almost any involved organ
can be infused by external approaches to the
femoral, brachial and common carotids.
most oncolytic chemotherapeutic agents can
be given via the intra-arterial route at
notably increased dosages with the exception
of 5fudr.  partial and complete regression
of many tumors can be obtained with
present day chemotherapeutic agents
for 1 or 2 mth.  the best therapeutic results
have been in patients with head and neck
and pelvic tumors.  currently infusion techniques
using small mobile pumping units
permit the patient to be ambulatory during course
of anti-tumor therapy.  complications
from intra-arterial infusion are usually
minor but serious complications do
occur such as embolic phenomena to the cns
with internal carotid infusion; aplastic
bone marrow from drug toxicity, hemorrhage
from tumor degeneration.  technical
complications of the infusion may not be life
threatening but frequently prematurely
terminate the therapy.  continued interest in
this form of therapy appears inevitable.
.I 993
.C
28
.W
prolonged intra-arterial chemotherapeutic infusion in cancer therapy;
its indications and limits.
in this review article (48 references) the principles
of cancer treatment using continuous
intra-arterial chemotherapy are described.
selection of patients, operative
technique and complications are dealt with.
two cases are presented which have
been infused with methotrexate (1050 and 1600 mg.)
with partial or complete objective
remission: a woman of 72 with a carcinoma
of the amygdaloid fossa, and a man
aged 27 with a reticulosarcoma of the rhinopharynx.
.I 994
.C
28
.W
intra-arterial chemotherapy for cancer metastatic to liver.
twenty-two patients with cancer metastatic
to the liver were treated by the intra-arterial
infusion of cancer chemotherapeutic
agents.  the drugs were introduced
directly into the hepatic artery in 10 patients
and into the aorta to the level of the
celiac axis in 12 patients.  no significant differences
in results were observed in the
2 groups.  of the 10 patients who received cancer
chemotherapy via the hepatic artery,
one remains alive 2 mth. after treatment;
3 died in the immediate posttreatment
period; 7 survived from 1-17 mths after
treatment, an average survival of
6.1 mth.  all 12 patients who were treated by
the intra-aortic administration of cancer
chemotherapy have died; 3 patients died
in the immediate posttreatment period; the
survival time of the remaining 9 averaged
3.7 mth.  an objective significant shrinkage
of the metastases in the liver was
observed in 6 patients (3 treated by the intra-hepatic
artery route and 3 via the aorta);
this lasted from 1-10 mth.  subjective palliation
was observed in 12 patients (5
treated by the intrahepatic artery route and 7
by the intra-aortic route).  the major
complication noted was leukopenia; to a lesser
degree, hepatic failure.  in those patients
with poor metabolic reserve and in
those who had received chemotherapy,
irradiation or both in the immediate past,
the complications were severe.  the need
for critical screening for the proper selection
of patients as candidates for cancer
chemotherapy is discussed.
.I 995
.C
28
.W
cancer chemotherapy by continuous intra-arterial infusion.  experience
of the veterans administration surgical adjuvant cancer chemotherapy
infusion study group.
two hundred fifty-one patients with advanced
cancer have been treated with 365
courses of intra-arterial cancer chemotherapy.
this technique and its complications
and results are analyzed and discussed.
objective response was obtained in
57% of the patients treated.  the best results
were obtained in epidermoid carcinoma
of the head and neck and the poorest
in primary brain tumors and intra-abdominal
adenocarcinomas.  ten per cent
of all patients receiving at least 1 course
of therapy and available for evaluation obtained
worthwhile palliation for 6 or more
months.  ten patients have had satisfactory
results for periods of 12 to 28 months.
it is concluded that arterial infusion
chemotherapy may be of benefit in
the palliation of patients in whom other more
conventional methods have failed or
are contraindicated.  the frequency of serious
complications suggests that at present
this form of therapy should be used only
by individuals and groups with special
interest and experience in chemotherapy.
much further study of this type of cancer
treatment is needed and various areas of
investigation are suggested.
.I 996
.C
28
.W
treatment of cancer by bacterial toxins.
the initial experience with toxin therapy for
sarcoma and melanoma is reported in
3 groups of patients: toxins used as an adjunct
to operation in potentially curable
patients, palliative treatment for metastatic
tumor and toxin therapy supplemented
by radiotherapy for localized symptomatic
tumor masses.  the experience has not
been encouraging in the first 2 groups.  in 6
of 8 patients in the 3rd group there was
marked objective remission of tumor subsequent
to irradiation.  further study is
indicated in the use of radiotherapy following
'priming' with bacterial toxin injections.
.I 997
.C
28
.W
radiotherapy of malignant rectal and anal tumors.  methods and results
in 271 cases.
the results are given of the treatment of
271 patients (9 cases of anal and 262 of
rectal carcinoma) with conventional deep
therapy and ultrahigh kilovoltage irradiation.
the total 5-year survival rate
was 14%.  with surgical treatment it is,
according to a survey of the literature made
by reifferscheid, 19.9%, according to
guleke 20-25%, and according to ottenheimer
21.3%.  a total of 39 patients
received irradiation after questionable radical
surgery, and 11 patients received
palliative irradiation after palliative surgery
(in most of these cases an anus praeter
was performed).  altogether 48 patients
received palliative irradiation without
surgery, and 45 patients received irradiation
because of recurrence after apparent
radical surgery; 11 patients received irradiation
because of metastases after apparent
radical surgery and 6 patients because
of metastases after palliative surgery.
ultrahigh kilovoltage radiation treatment
showed better results than conventional
deep therapy.  irradiation with 1,200-1,600 r.
on the site before surgery in stage
c cases gives higher 5-year survival rates,
according to dukes (henschke;stearns et al.).
.I 999
.C
28
.W
evaluation of ileal conduit as a palliative procedure.
during the 6.5 yr. period ending july 1963,
107 ileal conduit operations were performed
at the city of hope medical center in
the treatment of carcinoma of the bladder
and other pelvic organs.  the character
and extent of the lesions are described
in detail.  the details of the surgical procedure
are discussed.  complications including
pyelonephritis, uremia, enteric and urinary
fistulas, wound infections, and thrombophlebitis
were common.  twenty-eight of the
107 patients died during the postoperative
period.  fifty-nine of the 79 surviving
patients are known to have died, mostly
as a result of recurrent, uncontrollable carcinoma.
the procedure was considered
palliative in 39 patients.  in 12 of these patients
the lesion was removed and the conduit
established in one stage; 2 patients died.
in only 1 of the surviving 10 patients
was the tumor under control.  the average term
of survival was 8.5 mth.  the procedure
was carried out in 2 stages in 4 cases;
2 patients died after the 2nd stage.
the 2 surviving patients lived 1.5 and 4 3/4 mth.,
respectively.  an ileal conduit
alone was established in 23 patients, 8 of whom
died after the operation.  the average
time of survival was 4.5 mth.; 1 patient
was alive after 11 mth.  it is concluded
that an ileal conduit in conjunction with total
cystectomy in 1 stage is indicated as
a palliative procedure but only when severe intractable
symptoms exist and only when
patients are carefully selected.  the procedure
is poorly tolerated in older persons.
.I 1000
.C
28
.W
cancer chemotherapy by continuous intra-arterial infusion of
methotrexate.
continuous intra-arterial infusions of methotrexate
were used in the treatment of
45 patients with malignant disease of the
head and neck, 16 patients with advanced
cancer of pelvic organs, and 7 with malignant
lesions of the lower limb.  in 4 patients
with epidermoid lesions of the head
and neck there was complete regression
of the local tumor.  thirty-three other patients
benefited from treatment for varying
periods of time, but the remaining 30
showed no response.  eight patients died
during or immediately after treatment; all
had advanced cancers of the head-and-neck
region.  the mean total dose of methotrexate
given in the patients with no response
was significantly less than in those
with partial regression of the tumor.
this suggests that the greater the total dose
of methotrexate tolerated, the greater
the chance of beneficial response.  the role
of continuous intra-arterial chemotherapy
in the management of malignant disease
is discussed.
.I 1001
.C
28
.W
management of advanced ovarian carcinoma.
the life graph is presented for the purpose
of illustrating the results of treatment
for patients with ovarian carcinoma who
eventually died from their disease.  it includes
all patients regardless of initial stage
of disease, histology of the tumor, or
therapy employed.  the series is a selected
one because of the type of patient referred
to the medical oncology service, and
it demonstrates that almost 2/3 of the patients
died within 2 yr. of diagnosis.  all
patients received active, aggressive anti-tumor
as well as supportive therapy, although
there was no formal protocol for patient
management.  it might be possible, employing
a standardized therapeutic approach-irradiation
when indicated to the entire
abdomen in the dose range of 3,500
rads, followed by judicious use of currently
available anticancer drugs when the
disease recurs-to produce a modest increase
in the 2-year survival figures.  since
most series show that approximately 75%
of patients with ovarian carcinoma are in
stage iii of iv when first diagnosed, more
attention might be directed to earlier
diagnosis.  while it is an important field for
investigation, methods of facilitating
early diagnosis are not apparent at the moment.
controlled trials of adjuvant therapy
for stage i and ii disease in which approximately
40% of recurrences are seen
should be expanded.  this might consist of
instillation of radioactive or chemical
agents into the abdominal cavity, the use of
systemic chemotherapy during or immediately
after operation, or infusion of drugs
into the abdominal aorta.  for stages
iii and iv controlled trials of drugs alone,
sequentially, or in combination with or
subsequent to irradiation seem indicated.
finally, efforts to find more effective
anticancer drugs must continue.
.I 1002
.C
28
.W
liver resections for embolic metastases from cancer of the colon and
rectum.
   two patients, who underwent resections of the
left lobe of the liver for embolic metastases from primary
cancers of the colon and rectum, are reported.
the internal anatomy of the liver, as it relates to the
technic and terminology of resections, is reviewed.
cases of liver resection performed for embolic metastases
from cancer of the colon and rectum, found in an
extensive review of medical literature, are classified
and the results are analyzed.  resection of either half
of the liver (hemihepatectomy) for embolic metastasis
from cancer of the colon or rectum, so rarely cures
the patient and carried such a high operative mortality
rate, that it is seldom, if ever, justifiable.  the lesser
operations (left lobectomy or right-lobe metastasectomy)
often can be performed simultaneously with the primary
operation and are occasionally followed by freedom from
recurrence for periods of 5 yr or more.  they are justifiable
if the metastasis is situated favorably in the liver
for complete removal, and if the primary lesion appears
to be curable.
.I 1003
.C
28
.W
palliative treatment of nonresectable lung cancer by upper hemibody
perfusion of chlorimine (short-acting alkylating agent).  experience
with five cases.
   a method is discussed for providing palliative treatment
for patients with nonresectable lung cancer by
means of administering a short-acting alkylating agent
to the upper half of the body while temporarily occluding
the circulation to the lower half of the body.  with proper
selection of patients and an awareness of the potential
complications, the procedure appears to be safe and effective.
.I 1004
.C
29
.W
congenital extrahepatic biliary atresia.  a successful operated case on
ductus hepaticus obstruction.
the author briefly reviews the history and
the anatomical manifestations and the
genesis of congenital extrahepatic biliary atresia,
and its associations with other
abnormalities.  he collected 957 cases in the
literature from ladd's first successful
operated case up to the end of the year 1961.
in publications he found 177 theoretically
correctable cases and 124 which were
recovered.  in 1 of 2 personal cases
he performed successfully a hepatico-duodenostomy
in a 7-week-old girl.  four
years later the girl had developed normally
and she was absolutely without symptoms
and signs.  the author, discussing the
differential diagnostic problems, stresses
the diagnostic value of the gradually increasing
direct serum bilirubin, proposing
the term 'ex juvantibus differentiation' alluding
to the differential diagnostic evaluation
of the time which passes until the surgical
exploration; he also emphasizes the
need of early-latest up to the age of 8 weeks
performed-surgical exploration.
according to him the administration of vit. k
is advantageous.  he supposes the cause
of the postoperative dehiscence of the operative
wound lies in the metabolic changes
as a result of icterus.  the author in his own
case, the relieved drainage of the
bilio-digestive anastomosis solved by the help
of a polyethylene nasal tube and
which could be most safely removed by the
surgeon.  with statistical data of other
authors and personal cases, the author points
out that the correctable cases occur
in 19.8% of all the cases.  one may hope for
successful operations on an average
in 10.2% of all the cases and 50.8% of the correctable
ones.  fatal complications,
the author believes, can be reduced by early surgery.
.I 1006
.C
29
.W
the importance of steroid hormones in hyperbilirubinemia, and icterus
of the newborn.
administration of naturally occurring steroids
(estriol, pregnanediol, cortisone)
between the 7th and the 11th day of life increases
the bilirubin level of these newborns.
administration of the same steroids
or of progesterone to nursing mothers
results in hyperbilirubinemia of their infants.
these facts explain the pathogenesis
of neonatal jaundice.  interpretation of the
experimental and clinical findings leads
to the conclusion that the high amount of
steroid hormones which must be excreted
during the neonatal period in conjunction
with the relative insufficiency of the neonatal
liver is responsible for the inability
to conjugate bilirubin with glucuronic acid.
the steroid hormones probably compete
with bilirubin for the enzyme and substrate
necessary for conjugation.  the functional
capacity of the neonatal liver is
not high enough to conjugate both bilirubin
and steroids.  only after excretion of the
placental steroids does sufficient conjugation
of bilirubin become possible.  furthermore,
pregnanediol appears to inhibit the
enzyme glucuronyl transferase.  these
mechanisms show the importance of steroid
hormones in the pathogenesis of neonatal
jaundice and their importance as an
aggravating factor in the development of
jaundice due to erythroblastosis.  these newly
developed concepts may have therapeutic
implications on which the author will
report at a later date.
.I 1007
.C
29
.W
problems in neonatal obstructive jaundice.
a critical analysis of 57 cases of neonatal
obstructive jaundice led to the conclusion
that proper diagnosis can be determined
by study of liver biopsy.  the very
low percentage of surgically correctable lesions
among patients with neonatal obstructive
jaundice and the seriousness and
high mortality of the cases of hepatitis
treated with a hazardous operation are stressed.
conservative management is recommended
until 3 mth. of age and even later
if a serial fall in bilirubin is noted.
.I 1008
.C
29
.W
clinical study and histological study of the liver in hepatitis in
infants.  i.  classification and findings of clinical study and
histological study of the liver in hepatitis in infants (japanese).
clinical observations and histological studies
by liver biopsy on hepatitis in infancy,
i. e. obstructive jaundice of unknown cause in
infants, were made.  histologically,
hepatitis in infancy was divisible into 3 types:
(1) no giant cell formation was observed.
in general, slight degeneration of liver
cells, necrosis and inflammatory
changes with stasis of bile were characteristic.
(2) the so-called giant cell hepatitis
was characteristic.  (3) specific type, presenting
the picture of cholangiolitis.
histological changes in the liver other than biliary
stasis were scanty.  no specific
changes which could clinically differentiate the
3 types were found.  in each type,
serum bilirubin, sgot and sgpt activities had
slight characteristic points in clinical
and laboratory studies.  in type 1, the values
were relatively low, while in type
2 they were markedly high.  in type 3, sgot activity
was within normal range.  histological
characteristics of the liver of type 1
were necrosis of liver cells, formation
of acidophilic granules and balloon cells,
cellular infiltration in glisson's capsule,
and biliary stasis in the liver cells and
fine bile ducts.  morphologically, findings
of viral hepatitis were observed.  in type
2 liver tissue was replaced by many
multinuclear giant cells.  extreme distortion
of cords of liver cells and cellular infiltration
in glisson's capsule and lobules were
noted.  there was marked biliary
stasis in the capillary bile ducts and liver cells.
it was characteristic that proliferation
of bile ducts and bile plugs were not found,
which was consistent with giant
cell hepatitis of craing-landing.  in type 3, degeneration
of liver cells, necrosis
and inflammatory changes were slight.  biliary
stasis in the hepatic lobules was conspicuous.
histological findings similar to cholangiolitic
hepatitis due to drug poisoning
were observed.
.I 1009
.C
29
.W
the pathology of 'giant cell hepatitis' in early infancy.
a 1-month-old male infant was admitted to
hospital because of acute cardiac and
circulatory failure.  autopsy revealed macronodular
liver cirrhosis with splenomegaly,
left ventricular dilatation of the heart,
hydrothorax, and ascites.  histology
of the liver showed a giant cell hepatitis.  the
portal areas were widened, with foci
of erythropoiesis and histiocytic infiltrations.
the liver cells showed vacuolar and
degenerative changes.  the giant cells, present
in the margin of the regeneration
areas, as well as in the degenerated lobules
has irregular borders and varied in
size from 45-60 ft.  their nuclei were large,
sometimes bizarre.  their basophile
cytoplasm showed granules of iron pigment
which was also found in some normal
hepatic cells, in the prominent kupffer cells
and in the connective tissue.  in the
spleen there were proliferation of connective
tissue and scattered areas of erythropoiesis,
as well as pigment deposits in the pulpa.
iron pigment was also found in the
pancreas and salivary glands.  the islets of
langerhans were hyperplastic.  the etiology
of giant cell hepatitis is still unknown.
its pathogenesis may be due to a malformation,
immunologic response to some type
of antibody, inborn errors of iron
metabolism and viral infection.  it is suggested
that the giant cell transformation is
a response of the immature liver cell to a variety
of stimuli.  this case is of interest
for the predominance of giant cells with 1 or
2 nuclei, presumably it is an intermediate
stage or a variant of hepatitis.
.I 1010
.C
29
.W
the surgery of infantile obstructive jaundice.
the results of suruga-yamazaki's procedure
in 14 cases of congenital biliary duct
atresia are reported.  postoperative anorexia,
diarrhea, or edema due to circulatory
disturbance in the upper extremity have
not been found after this operation.  the operation
is technically difficult.  postoperative
fat, protein, and electrolyte metabolism
is a problem.  in order to obtain better
results this disease should be differentiated
at an early period.  a long-term follow-up
and continued study of this problem
is required.
.I 1012
.C
29
.W
hepatitis virus in neonatal liver disease.
liver-biopsy specimens from 3 babies with
neonatal hepatitis, and 3 with extrahepatic
biliary atresia, were studied for the presence
of hepatitis virus.  culture yielded
positive results in all 3 babies with neonatal
hepatitis and in 1 of the infants with
biliary atresia.
.I 1013
.C
29
.W
neonatal hepatitis: liver biopsy findings and clinical features.
on 22 infants with a clinical diagnosis of neonatal
hepatitis, histologic examination
of the liver was made by needle biopsy and
its relation to the clinical course was
investigated.  histologic findings were classified
provisionally into 3 types: type i
showed no giant cells but only slight damage
to hepatic cells with prominent intracellular
cholestasis; type ii was characterized
by occurrence of numerous giant
cells; the specific type was characterized by
centrolobular cholestasis without inflammatory
reaction.  laboratory examinations
revealed that increases in serum
transaminases and bilirubin were greater in
type ii than in type i, and in the specific
type there was no increase in serum transaminase
but there was a direct hyperbilirubinemia.
as to histologic sequelae,
the results of serial biopsy revealed that
in type i hepatic damage healed almost completely,
and that in type ii giant cells
disappeared within 1 yr and, in some cases,
hepatic cirrhosis resulted.  the prognosis
of neonatal hepatitis may be said to
be good in type i, poor in type ii, and
undetermined in the specific type.
.I 1015
.C
29
.W
neonatal hepatitis or familial neonatal obstructive jaundice?.
four siblings all of whom were boys with
chronic obstructive jaundice are described.
the onset of the jaundice varied from 1 day
to 4 weeks after birth.  two other boys
and 2 girls in the same family are healthy.
although in one of the 4 cases pathological
findings were the same as in neonatal hepatitis
('giant cell hepatitis'), other possibilities
could not be excluded.  what has been
described hitherto as giant cell hepatitis
appears to be only a morphological picture,
for which there must be several causes.
it is concluded from the findings in the 4 patients
that one of the possible causes of
so-called giant cell hepatitis is an inborn
error of metabolism.
.I 1016
.C
29
.W
hypoplasia of the intrahepatic bile ducts.
a description of 2 cases: (1) a boy of 13 days
old had atresia of the small intestine
and pneumonia, and a slightly enlarged liver
with faint green coloration.  histological
examination revealed numerous collapsed
bile ducts which had solid ductular
cell sprouts reaching the liver cells;
the minor and smallest bile ducts were
empty.  (2) a girl of 1 yr and 4 mth had increasing
jaundice since birth.  autopsy
revealed a hypoplastic common bile duct,
which was, however, open to probing,
and marked green coloration of the liver.
also in this case, the bile ducts were
very narrow and had solid ductular cell sprouts
reaching the liver cells.  this
type of bile duct corresponds to a stage in
ontogenesis and does not show signs
of proliferation.  it may be considered a form
of hypoplasia, as the size and number
of the primordial bile ducts is reduced.  when
present the anlage shows a regular
connection with the liver cells.  this hypoplasia
is to be distinguished from an
atresia.  the long survival of the second case
can be explained by the great
compensatory capacity of the liver.
.I 1017
.C
29
.W
fetal and neonatal hepatitis and its consequences.
the author reports on 18 fatal cases observed
in infants from 3 weeks to 1 year old.
in all cases, jaundice appeared just after birth
or during the first days of life, and
was persistent.  the stools were sometimes
discolored.  there was no blood incompatibility.
the picture was similar to that
of congenital biliary atresia.  pathological
study revealed 2 groups: (1) with pathological
changes of hepatitis (11 cases).
the liver is enlarged, flabby and icteric.  microscopy
shows dissociation of the cell
cords and polymorphism of the hepatic cells
(necrotic cells, balloon cells, giant cell
transformation).  some of the giant cells show
vacuoles, erythrocytes, lipids and
acidophilic material in their cytoplasm.  there
are signs of regeneration, collapse
of the stromal framework, proliferation of the
mesenchymal cells and bile retention.
cells of the erythrocytic series are scattered
in the periportal spaces with eosinophilic
leucocytes, lymphocytes and histiocytes.
(2) with fibrosis and cirrhosis (7
cases).  the liver is green, firm, with a nodular
or granular surface.  the extra-hepatic
biliary tree is normal.  the spleen is
enlarged.  microscopy shows bile stasis,
pericholangiolitic fibrosis, and proliferation
of bile ductules.  the periportal, interlobular
and intralobular fibrous tissue is increased,
and shows cellular infiltrations.
the architecture of the liver is disturbed by
the presence of pseudolobuli in the regeneration
areas.  it is suggested that these cases
are due to a congenital viral hepatitis,
which is not only the result of an intrauterine
infection, but also a feature of
fetal hepatitis, with secondary pericholangiolitic
or post-necrotic liver cirrhosis.
the neonatal giant cell hepatitis is to be considered
as the result of a cytotoxic action
of the virus.  the author considers also
the possibility of a viral etiology in
cases of biliary atresia on the basis of their
morphological similarity with congenital
viral hepatitis.
.I 1024
.C
30
.W
some bone lesions in the course of blood diseases with special reference
to the formation of bony callus and to the treatment of fractures in
patients suffering from blood diseases.
after some preliminary remarks on the embryology
and physiology of the bone
marrow and on the mechanism of coagulation
of the blood, the authors pass on to
a consideration of the genesis of bony callus,
and the treatment of fractures in
patients suffering from blood diseases.  an
account is given on the basis of some examples
of pathological fractures, and also
of some traumatic fractures in subjects
affected by various kinds of blood diseases
such as solitary myeloma, polyosteotic
plasmocytoma, waldenstroem's syndrome,
the coagulopathic syndrome
from a structural defect of the fibrin coagulum,
and hemophilia.  fractures in patients
with blood diseases are characterized
by an abnormal course, and, for an
effecient cure, it is necessary to make an
accurate diagnosis with regard to the
pre-existing blood diseases and to re-establish
hemostasis when this has been
changed, to prevent hemorrhages, and to correct
any plasma defect that may be
present and which are reflected in the formation
of the bony callus.
.I 1026
.C
30
.W
tumor-like bone lesions in hemophilia.
this report deals with the clinical and radiologic
findings in a hemophilic pseudotumor
of the femur observed over a period
of 10 yr.  the pathogenesis, treatment
and radiologic differential diagnosis are
discussed.
.I 1027
.C
30
.W
concurrent hemophilia and christmas' disease in one family.
a study is presented of a number of generations
of a family in whom two members had
christmas' disease and three hemophilia a.
it is suspected that the preceding generations
must have been afflicted with hemophilia
ab, or a mutation in x-chromosome genes
which are responsible for both types of hemophilia
must have occurred in the grandmother's
family.  in her daughters the genes
responsible for hemophilia ab segregated
so that their children and grandchildren inherited
only one type of hemophilia i.e. hemophilia
a or christmas' disease.  relevant genetic
considerations are briefly reviewed.
.I 1032
.C
30
.W
femoral neuropathy in hemophilia.
   six new cases of femoral neuropathy in hemophilic
patients are described.  the syndrome begins with severe
pain in the groin, in the inferior aspect of the thigh,
and deep in the hip region.  this is followed by a pronounced
contracture of the hip in flexion and external
rotation.  a tender swelling appears in the iliac fossa and
groin with a depression in the center corresponding to
the inguinal ligament.  finally, a flaccid paralysis of
the quadriceps femoris and diminution or absence of sensation
in the anteromedial aspect of the thigh and proximal
portion of the leg, with a depressed or absent
patellar reflex, is discovered.  the authors propose that
this syndrome is the result of hemorrhage in the iliopsoas
muscle at the musculotendinous junction beneath
the iliacus fascia and that the femoral nerve becomes
compressed beneath the unyielding inguinal ligament
superiorly and the iliopectineal ligament medially.
treatment consists in bed rest, analgesics, and freshfrozen
plasma during the acute phase.  during the convalescent
phase, a hessing long brace is used to protect
the knee from hemarthrosis until functional return
of the quadriceps femoris has occurred.  to date, the
validity of the theory that the femoral-nerve palsy is
the result of iliopsoas hemorrhage at the musculotendinous
junction and compression of the femoral nerve beneath
the inguinal ligament has not been verified.  the
authors anticipate some day seeing a non-hemophilic patient
with a traumatic iliacus hemorrhage and femoral
neuropathy.  should such an opportunity present itself,
exploration beneath poupart's ligament may show the
femoral nerve to be compressed and thus confirm the
proposed cause of the clinical picture.
.I 1033
.C
30
.W
hemorrhagic episodes in hemophilia: a 5-year prospective study.
   medicosocial studies of hemophilia are of
particular clinical importance in allowing an assessment
of the likely course of the disease at different
ages and for differing grades of severity, and in
providing knowledge of which complications cause
the most disability, loss of education, and earning
capacity.  they also overcome the distorted clinical
impression of the disease which arises from the
recurrent admission of the same few severely affected
hemophiliacs.  owing to the considerable individual
variation in the number and severity of complications
in different hemophiliacs an accurate individual
prognosis can never be given.  in general,
however, the number of spontaneous episodes per
year decreases with age, while the severity of individual
episodes tends to increase, at least until
the age of 21 yr.  there is general agreement that
the bulk of hospital hemophilic admissions are due
to hemarthroses and that hemophilic arthropathy
involves the knee more than it does any other joint.
the increased time spent in hospital per episode in
later life is in part at least due to the development
of relatively unstable weight-bearing joints due to
hemophilic arthropathy and associated muscle atrophy.
thus the correct management of individual
hemarthroses in childhood is of considerable importance,
and at the present time too little is known
of the best possible treatment for these episodes.
little is known of the pathological mechanisms of
hemophilic arthropathy and whether it is the presence
of blood or its presence under tension which
leads to joint destruction.  thus opinions differ concerning
the routine admission of all hemarthroses
to hospital regardless of severity and also about the
advisability of joint aspiration in an attempt to avoid
the development of destructive arthropathy.  because
of the individual variation between patients, the
changes in the pattern of the disease with age, and
the difficulty of obtaining suitable control patients
these questions can be answered only by further
longterm prospective medicosocial studies.
