Chance, ambiguity, and psychological mindedness. The inability to believe in chance occurrences and an intolerance of ambiguity in the external world are often the outward manifestations of poor psychological mindedness. Such attitudes are frequently accompanied by beliefs in the occult and the mystical. It is suggested that these factors be considered when an individual is being evaluated for analytic treatment.


On the concept and consequences of the primal scene. The concept of the primal scene is in need of redefinition and clarification. The primal scene is not identical with its regressive transformations or later derivatives. Because of the different implications for normal development and for psychopathology, the primal scene as a universal fantasy should be differentiated from the primal scene as real experience. The effects of exposure to the primal scene are considered in relation to the developmental level of the child, other problems in the parent-child relationship, and cultural attitudes.


Mental transitional spheres.

Mental transitional spheres. The human being may be considered to have mental transitional spheres in which the sifting, transforming, intensifying, and inhibiting of stimuli are initiated. Stimuli essential to the development of the psychic apparatus are converted in the mental transitional spheres into a form that will enable them to exert the appropriate influence on the ego. Optimal ego development cannot take place without the proper functioning of these spheres. Thus, the mental transitional spheres are essential for the development of psychic functions and defenses.


Skin conductance responsivity during acute episodes of schizophrenia as a predictor of symptomatic improvement. Skin conductance responses to a series of tones were measured in 41 patients during an acute episode of schizophrenia before they received treatment and after 4 weeks of treatment with either alpha-flupenthixol, beta-flupenthixol or placebo. Patients who did not habituate to the tones prior to treatment tended to show no symptomatic improvement during the course of treatment. Patients who habituated and also showed an acute onset of their current symptoms ('Feighner negative' patients) showed a marked improvement even without active medication. Skin conductance responsivity did not change with improvement in symptoms alone, but decreased in patients on active medication (alpha-flupenthixol). Non-habituation of skin conductance and insidious onset (i.e. fulfilment of the Feighner criteria) were found to be independent predictors of poor outcome. Taken together, these criteria may define a group of patients with particularly poor prognosis.


Corticosteroid and growth hormone responses to methylamphetamine in depressive illness. It is suggested that, if depressed patients have deficient noradrenergic function at central alpha-adrenergic receptors, then they will also have impaired corticosteroid responses to methylamphetamine but unaltered growth hormone responses. This prediction has been confirmed when the responses of a group of patients with endogenous depression were compared with the responses of a group of patients with other functional psychoses, a group of patients with reactive depression, and a group of patients with other psychiatric diagnoses. These findings support the hypothesis that there is a functional deficiency of noradrenaline at some central alpha-adrenergic receptors.


Multicompartmental analysis of amino acids. III. Tyrosine in affective disorder. Multicompartmental studies of tyrosine in patients suffering from affective disorders and controls gave estimates of 2 major pools of amino acid, together with the associated fractional clearance rates and fluxes. The 2 pools were considered provisionally to represent extracellular and intracellular tyrosine. The concentration of tyrosine in plasma (representing the extracellular pool) and fractional clearance rates from this compartment were normal in ill and recovered patients. The observed abnormalities were confined to the intracellular compartment and consisted of low concentrations of tyrosine in both depressed and recovered patients. In addition, fractional clearance rates from the intracellular compartment were raised in the depressed patients but had returned to normal after recovery. A comparison of these data with those of a similar study of tryptophan described previously suggested that alterations in compartmental volume or dietary differences could not explain the 2 sets of findings. The disturbances in tryptophan metabolism in unipolar affective disorder had led to reduced amounts of this amino acid in the extracellular space. In contrast, the concentration of tyrosine in this compartment was normal, presumably as a result of a metabolic adjustment to the lower amounts found in the intracellular pool. The presence of illness-dependent and illness-independent alterations in tyrosine metabolism in unipolar affective disorder, together with the earlier findings for tryptophan, may have a bearing on the aetiology of the illness.


A scaled version of the General Health Questionnaire. This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.


The use of the Visual Analogue Mood and Alert Scales in diagnosing hospitalized affective psychoses. A consecutive series of 90 admissions of functional patients was examined with the Present State Examination (PSE). Based primarily on PSE findings together with previously published diagnostic criteria, we identified 11 clear or index cases of schizophrenia, 12 of affective psychoses, and 12 of neurotic/personality disorders. All patients were given daily 2 analogue scales, one measuring mood and the other alertness. Among the index cases, the depressives were distinguished by low scores on both scales and the manics by high scores. There was little overlap in the distribution of the scores among the diagnostic groups, suggesting that these scales might be effective psychological markers of clear affective versus clear non-affective functional disorders. Among the undiagnosed cases, those with low or high scores on both scales resembled index affectives phenomenologically, clinically, and demographically. The scores of the 'affective-like' patients overlapped little with those of the 'non-affective-like' patients. The scales therefore might be practical diagnostic aids.


Psychiatrists' models of mental illness and their personal backgrounds. Seventy-nine junior psychiatrists at the Maudsley Hospital answered 16 biographical questions and a 68-item questionnaire measuring attitudes to the psychoanalytical, biological, social, behavioural, and anti-medical models of mental illness. The psychoanalytical model was the most clearly defined and its adherents the most dogmatic, while those supporting the social model were the most eclectic. Sex, social class, education and political sympathy proved a poor guide to the orientation of the respondent. Individuals who had decided on a career in psychiatry before entering medical school were the most critical of the biological model. Biologically minded psychiatrists were older and, in contrast to Kreitman's findings, there was a shift from a psychoanalytical to a biological preference with increasing psychiatric experience. The importance of scientific attitudes in psychiatry was endorsed by biologically and behaviourally inclined psychiatrists but denigrated by supporters of the analytical approach. Adherents of the psychoanalytical model had as many academic qualifications as the biologically inclined, but had fewer publications and were less active in research. It appears that interest in psychoanalysis is antipathetic to the development of scientific attitudes conducive to research.


The question of hormonal influences on intellectual development: growth hormone. Contrary to expectations based on findings of enhanced brain development and learning in rats after prenatal growth-hormone administration, a sample of patients with growth-hormone deficiency of early onset did not show impairment of mental abilities when tested with standard intelligence tests. We conclude from our findings, as well as from other clinical reports, that growth-hormone deficiency of onset does probably not interfere with normal human brain development.


Reduced caloric intake following small bowel bypass surgery: a systematic study of possible causes. Food intake, appetite and a variety of feelings were measured pre- and post-operatively in obese patients undergoing jejuno-ileal bypass surgery. Decreased food intake correlated closely with the amount of weight loss at both 4 and 30 months after surgery. Malabsorption correlated with weight loss at 4 months but not 30 months post-operatively. The cause of the decreased food intake is unknown and cannot be completely explained by either depression, nausea, malabsorption, liver disease, an attempt to avert diarrhoea, or decreased appetite.


Psychological aspects of dialysis: a semantic differential study. As a consequence of technological advances over the last 15 years, patients suffering from terminal renal failure are now being kept alive for considerable periods of time, either by renal haemodialysis or, where appropriate and possible, by renal transplantation. The former necessarily imposes restrictions on the patients' lives which may be manifest at various levels. The basic aim of the study to be reported was to conduct an exploratory investigation of the psychological impact of dialysis on such patients, together with some of the factors that may influence their reactions to it. Using a Semantic Differential technique, 21 patients on dialysis were compared with a group of 21 healthy control subjects in terms of the personal meaning of selected concepts. Both groups were then subdivided on the basis of age, sex and, in the case of the patients, in terms of length of time on dialysis. Subgroup comparisons were then conducted. The findings suggest various hypotheses which have both theoretical and clinical implications.


The prognostic significance of psychological factors in the management of chronic bronchitis. Eighty-three chronic obstructive bronchitic patients were psychologically assessed before being randomly allocated to 1 of 3 management regimes. The following measures were taken: psychiatric disturbance, personality, social-desirability response set, vocabulary, expectations about treatment, attitudes and beliefs about bronchitis, effect of patient's bronchitis on the family, work, self, physical exercise, smoking, and general health. Outcome was assessed after one month and again one year later, and the measures included physiological tests of lung functioning, an exercise tolerance test, reported symptoms, time off work, drop-out, and death. Contrary to expectations, it was found that psychological variables had some prognostic significance for outcome assessed by medical measures of illness severity. More important was the finding that, in bronchitics under retiring age, weeks off work during the year of the study could be predicted by psychological variables but not by physiological measures of illness severity.


Psychophysiologic disorders: a critical appraisal of concept and theory illustrated with reference to the irritable bowel syndrome (IBS). The concept of psychophysiologic disorders and the major theories invented to account for such disorders are critically reviewed. The Irritable Bowel Syndrome (IBS) serves to illustrate the application of each theory and provides a vehicle for their appraisal. The tendency to think of 'physical' and 'psychological' as separate entities rather than separate languages has led to attempts to make a categorical distinction between disorders caused by 'psychological' factors and those caused by 'physical' factors. Some of the theories developed to account for psychophysiologic disorders are unscientific and none can adequately account for all the features of IBS. It is concluded that the concept of psychophysiologic or psychosomatic disorder is outmoded.


Angiographic ablation of parathyroid adenomas. Six mediastinal parathyroid adenomas were stained by infusing contrast agent through a catheter wedged in the feeding artery. Adenomas in the first three cases were stained unintentionally with small volumes of dilute contrast media and hypercalcemia recurred within 3 to 6 months. In the next three patients, adenomas were deliberately stained with larger doses of concentrated contrast media and these patients have remained normocalcemic from 2 to 18 months following staining. The permanency of parathyroid ablation following deliberate staining with contrast media has not been established.


Reflux esophagitis: radiographic and endoscopic correlation. Although the value of endoscopy in reflux esophagitis is accepted, the role of radiology has not been well defined. The radiographic and endoscopic findings in 75 patients were correlated. A grading system was employed to stage the severity of involvement. Thirty-five appeared normal on endoscopy and 40 had esophagitis of differing stages of severity. The results indicate that radiography is insensitive in mild degrees of inflammation but that its sensitivity and accuracy improves in more severe grades of esophagitis.


Desirability of roentgen esophageal examination immediately after pneumatic dilatation for achalasia. Although infrequent, esophageal rupture is a serious complication of pneumatic dilatation for the treatment of achalasia. Because of an experience with delayed recognition of esophageal perforation in a patient with achalasia, we now examine the esophagus using a water-soluble contrast medium immediately following every pneumatic dilatation. This technique allows immediate detection of esophageal perforation.


Duodenal tuberculosis.

Duodenal tuberculosis. Duodenal tuberculosis is a very rare disease and is usually associated with active pulmonary tuberculosis. These patients may present with symptoms and initial radiographic findings of pyloric canal obstruction. Hypotonic duodenography may reveal a submucosal mass with no other specific changes. The lesion is unpredictable. It may respond to medical therapy but it may also progress and require surgical intervention.


Noncalcified echinococcal liver cyst.

Noncalcified echinococcal liver cyst. A large echinococcal cyst containing clear fluid was seen as a lucent defect within the liver on the plain radiograph. It had no fatty or calcific contents. No similar cases could be found in the literature.


Percutaneous cholecystostomy and cholangiography in patients with obstructive jaundice. Direct puncture and drainage of the gallbladder were found to be feasible in a patient with obstructive jaundice. The technique appears to be safe and free of major complications, even in patients considered to be extremely poor surgical risks.


Effects of furosemide on renal venous plasma renin activity. A control study comparing plasma renin activity (PRA) in the renal vein and the inferior vena cava was performed in 50 hypertensive patients before and after furosemide stimulation. In unilateral renal arterial stenosis, furosemide was found to stimulate secretion by the normal kidney more than by the ischemic kidney. When a renal venin PRA ratio of 1.5 or higher was used for lateralization, rates of 30% false-negatives and 60% false-positive resulted. Acute stimulation of renin by furosemide does not increase the predictive value of renal venous renin measurements and may actually result in a higher percentage of false-negatives.


Percutaneous iliofemoral angioplasty via the contralateral femoral artery. Using a flexible balloon catheter, transluminal angioplasty of the lower extremities may be performed via a puncture of the contralateral extremity. Five cases which illustrate the usefulness of this technique are presented. It provides access to lesions not amenable to ipsilateral puncture, avoids the need to compress the dilated artery, and decreases the risk of significant hematoma formation.


Percutaneous transluminal angioplasty with the Grüntzig balloon catheter. The results of an ongoing five-year study of percutaneous transluminal angioplasty for the treatment of peripheral vascular disease are presented. A balloon catheter was used for iliac and superficial femoral and popliteal artery dilatation. Forty out of 43 procedures performed were considered to have initial success, with iliac angioplasty showing a greater success rate (96%) than superficial femoral angioplasty (90%). Complications requiring surgical intervention occurred in only 3 patients. Advantages of this technique include local anesthesia, early ambulation, reduced hospital stay, and reproducibility.


Angiography of the hemophilic joint.

Angiography of the hemophilic joint. Angiography in the hemophilic patient is a safe and reliable procedure for recognition of surgically treatable vascular abnormalities. When untreated, these abnormalities can cause repeated bleeding and progressive joint destruction.


Posterior lumbar apophyseal fractures.

Posterior lumbar apophyseal fractures. The radiographic findings in 4 patients with fractures of the lumbar vertebral ring apophysis are reported. All patients had a bony ridge or fragment projecting into the spinal canal, usually from the lower border of L4; a defect in the postero-inferior aspect of the vertebral body; and either an anterior extradural impression or complete blockage on the myelogram. Computed tomography was performed on one patient and appears to be helpful in demonstrating bone within the spinal canal. Preoperative diagnosis can facilitate selection of the appropriate surgical approach.


The relationship of patient waiting time to capacity and utilization in emergency room radiology. The relationship between patient waiting time and capacity and utilization is quantified. By deciding upon the average acceptable and maximum allowable waiting times, the required capacity and resulting utilization rate are fixed. The data needed for analysis include waiting time, patient volume, time required for specific types of examinations, and technologist and equipment capacity. Cost reduction is achieved without adversely affecting waiting time if volume variability can be reduced. Steps to increase productivity should also be considered as a means of reducing cost per examination, given the cost structure in emergency room radiology and the personnel costs.


The barium-enema examination and rectal manometry in Hirschsprung disease. Barium-enema studies and rectal manometry were clearly shown complementary in diagnosing Hirschsprung disease. Of 27 patients studied, 19 had positive barium-enema and rectal manometric studies and were proved histologically to have Hirschsprung disease. Three had positive barium-enemas but normal rectal manometric studies in the first 10 days of life; later manometric studies were positive, and all 3 were subsequently proved to have Hirschsprung disease. Three patients had negative barium-enema and positive manometric studies and were proved to have low segment Hirschsprung disease. If both studies indicate the disease, rectal biopsy is not necessary before surgery.


Intestinal pseudo-obstruction in mucocutaneous lymph-node syndrome. Mucocutaneous lymph-node syndrome (MCLS) is an acute exanthem with specific clinical features, sometimes complicated by involvement of internal organs. Two patients with MCLS had clinical and radiographic evidence of mechanical small-bowel obstruction, probably on the basis of focal vascular insufficiency, as anatomic obstruction was not documented in either instance. The cases indicate that intestinal involvement in patients with MCLS can simulate intestinal obstruction, and conservative management of such patients is appropriate.


Factors affecting the measurement of renal length. The variation in kidney length between the 1-minute radiograph (centered over the kidney) and the 5-minute study (centered over the mid-abdomen) was evaluated on 100 random excretory urograms. When both kidneys were measurable, the change in kidney size was discordant in 40%. Most such changes are due to changes in geometry, differences in centering, or changes in the angle of the kidney with respiration. These alterations are of much greater magnitude than the reported swelling of the kidney due to contrast medium. Since there is practically no relation between the time of injection and changes in renal image size, it makes no difference whether the 1-minute or 5-minute radiograph is selected for measurement.


Midline circular defect of the sternum.

Midline circular defect of the sternum. A case of a midline circular defect of the sternum is presented. This may represent a localized fusion anomaly.


Tracheal compression by a normal aorta associated with right lung agenesis. A case of tracheal compression by a normal aorta deviated to the right with a shift of the heart due to right lung agenesis is presented. The condition was diagnosed by chest fluoroscopy and corrected surgically. The increased mortality associated with right versus left lung agenesis may be due to tracheal compression by a normal aorta in some cases.


Intracranial cysts.

Intracranial cysts. While CT scanning is useful for diagnosis of hydrocephalus and fluid-containing intracranial cysts, air studies are often necessary to determine whether the cysts communicate with the ventricular or subarachnoid space. When obstructive hydrocephalus results, decompression of the cyst is normally adequate. Hydrocephalus not caused by a cyst still requires decompression, but in addition the cyst has to be treated. Until the exact pathways of absorption of water-soluble contrast media such as metrizamide are fully understood, it may be advisable not to administer them into the ventricles in patients with obstructive hydrocephalus. A combination of CT and air studies may offer information not obtainable with either modality alone.


Computed tomography of arachnoid cysts.

Computed tomography of arachnoid cysts. The typical CT appearance of intracranial arachnoid cysts may obviate additional neuroradiological procedures. Ventriculography using water-soluble contrast media may differentiate a suprasellar arachnoid cyst from a dilated third ventricle. Twelve cases are presented.


Metrizamide and radionuclide cisternography in communicating hydrocephalus. Simultaneous 111In-DPTA and metrizamide CT cisternography correlated closely in the qualitative imaging of cerebrospinal fluid (CSF) dynamics in 9 normal patients and in 11 patients thought to have communicating hydrocephalus. CSF clearance of both tracers was similar; significant absorption occurred in the spinal dural sac. Although delayed elevated serum iodine levels correlated highly with abnormal persistent ventricular penetration (detection at 48 hours), these levels cannot be used to predict abnormal ventricular stasis. The pattern of ventricular and cortical sulcus enlargement on the plain CT scan did not indicate whether the dynamic metrizamide cisternogram would be normal or abnormal.


Computed tomography of craniocerebral injury in the abused child. Computed tomography (CT) was performed in 26 infants and children with craniocerebral trauma related to abuse during a 41-month period. The pattern of brain injury differed from that seen in the nonabused traumatized infant or child. Parieto-occipital acute interhemispheric subdural hematoma (AIHSH) with associated parenchymal injury was the most frequent finding (58%). Follow-up by CT in patients with AIHSH demonstrated infarction in half and cerebral atrophy in all.


Normal cord in infants and children examined with computed tomographic metrizamide myelography. Computed tomographic metrizamide myelography (CTMM) was performed on 25 infants and children and 2 adults with normal spinal cords. Both the cord and the cauda equina were precisely outlined. The most detailed information was obtained with a small window setting, with the image subsequently magnified and color-reversed. Hounsfield-unit measurements alone were inaccurate. Advantages of CTMM include: high accuracy in demonstrating the intrathecal contents of the spine; less need for general anesthesia; and the need for a smaller amount of water-soluble contrast material than in conventional myelography. In selected cases of intraspinal abnormality in children, CTMM is recommended.


Computed tomography in the diagnosis of renal carcinoma complicating Hippel-Lindau syndrome. Four patients on long-term follow-up for Hippel-Lindau syndrome (HLS) are presented. All had undergone nephrectomy for renal carcinoma; in 2, carcinoma subsequently developed in the remaining kidney. Because of the tendency of these tumors to develop bilaterally, wide local resection is preferable to radical nephrectomy if the tumors can be diagnosed when small and noninvasive. CT is currently the most accurate method of regularly screening patients with HLS for asymptomatic renal carcinoma.


Inferior vena cava duplication: demonstration by computed tomography. Two cases demonstrating the computed tomographic (CT) appearance of inferior vena cava (IVC) duplication are presented, and the embryological, clinical, and radiological significance are discussed. Knowledge of caval anomalies can prevent misinterpretation of mediastinal masses, iliac occlusion with venous collaterals, or paravertebral lymph node enlargement. A duplicated IVC can be distinguished from para-aortic lymphadenopathy either by recognition of renal vein drainage or through intravenous contrast enhancement of the venae cavae.


Computed tomographic evaluation of para-aortic hematoma following translumbar aortography. Computed tomography provides an objective means of studying needle passage and para-aortic hematoma formation following translumbar aortography (TLA). CT scans from the puncture site to the aortic entry site were done in 13 patients before and after catheter removal to evaluate the incidence and extent of hematoma formation. Eleven (87%) demonstrated para-aortic hematomas following TLA; 8 were confined to the left para-aortic area and 3 involved both sides. The catheter passed through the left kidney in one patient; however, no hematoma was observed.


Ultrasonic detection of myocardial infarction by amplitude analysis. Myocardial infarctions were produced in dogs by occluding the left anterior descending artery; the dogs were killed at varying times, from 30 minutes to 8 days. Prior to sacrifice, Thioflavin S was injected intravenously. The excised heart was scanned by a B-scanner interfaced with a computer that permitted quantification of signal amplitude. The heart was sectioned, photographed, and studied pathologically. Infarcted myocardium showed high ultrasonic reflectivity with average amplitudes 1.4--2.6 times that of normal muscle. Perfusion-histomorphologic evidence of infarction correlated best in infarcts of 24 hours or less; older infarcts were generally underestimated. Tissue changes, sources of false-positive and false-negative findings, signal processing, and potential clinical utility are discussed.


Ultrasonography of the diaphragmatic crura. The diaphragmatic crura are being recognized with increasing frequency on routine sonograms. In a study of 100 random patients the right crus was seen in parasagittal scans in 50% of patients and in transverse scans in approximately 90%. The left crus was not specifically identified on parasagittal scans, but was visible in about 50% of patients on transverse scans. Longitudinal coronal approaches can significantly improve visualization of the crura.


Portal and hepatic veins: accuracy of margin echoes for distinguishing intrahepatic vessels. One hundred randomly selected sonograms were retrospectively reviewed to determine the accuracy of employing the margin characteristics of intrahepatic venous radicals to distinguish portal from hepatic veins; 99% of intrahepatic portal veins demonstrated high amplitude acoustic margins. However, one or more hepatic veins also had high amplitude acoustic margins in 29% of patients in whom intraparenchymal hepatic veins were identified. The authors conclude that an intrahepatic venous structure without an echogenic border is almost invariably an hepatic vein, although other anatomical features should be considered for proper classification of intrahepatic venous structures which demonstrate high amplitude echoes surrounding the lumen.


Ultrasonic demonstration of the pancreatic duct: an analysis of 41 cases. Ultrasonically visualized pancreatic ducts seen in patients over two and a half years were reviewed. Pancreatic ducts ranging from 2 to 16 mm were identified in 41 patients. All proved to have pancreatic disease. Of these, 25 had inflammatory disease, including acute pancreatitis, chronic pancreatitis, and pancreatolithiasis, and 16 had ampullary or pancreatic head tumors. There was no correlation between the pancreatic duct diameter and the underlying pathology. A careful search for tumor must be made in all patients in whom the pancreatic duct is demonstrated, using current gray-scale instrumentation.


99mTc-IDA hepatobiliary imaging following upper abdominal surgery. Bile flow patterns were studied with serial 99mTc-IDA images in 19 patients with cholecysto- and choledochointestinal anastomoses, gastroenteric bypasses, and combinations of the two. Complications such as anastomotic, afferent, and efferent loop obstruction and bile leakage were readily detected even in the presence of jaundice. This noninvasive technique warrants further investigation to determine its indications and weaknesses.


Krypton-81m: a better radiopharmaceutical for assessment of regional lung function in children. Krypton-81m, an inert, radioactive gas with a physical half-life of 13 seconds was used to evaluate regional lung ventilation in 25 pediatric patients. The results suggest that Kr-81m has several advantages over previous methods employing xenon-133. These include: more favorable physical characteristics for imaging with present scintillation cameras; ease of performance of the examinations; improved resolution and multiple views with better detection and localization of abnormalities; and a much lower dose to the patient.


Diffuse pulmonary uptake of Indium-111 chloride in idiopathic myelofibrosis. Unusual indium-111 accumulation and extramedullary hematopoiesis in the lungs of a patient with idiopathic myelofibrosis are described. The bone marrow scan taken 24 hours after intravenous injection of 111InCl3 faithfully depicted the abnormal distribution of marrow elements as assessed histologically at autopsy, thereby supporting the usefulness of 111InCl3 for marrow imaging.


Multiple regions of absent bone mineral and marrow function in a patient with chronic renal failure. 99mTc-methylene diphosphonate bone mineral and 99mTc-sulfur colloid bone marrow studies were performed on a patient with chronic renal failure. Multiple regions of absent deposition of both radiotracers were noted, involving the right ilium, multiple ribs, and the manubrium. Radiographs of these bones were normal. The findings suggest absent regional perfusion of the involved bones.


67Ga-citrate uptake by the parotid glands in sarcoidosis. Bilateral accumulation of 67Ga-citrate by the parotid glands was observed in 9 of 27 patients (33%) with sarcoidosis and in a subgroup of 12 with systemic symptoms such as fever or clinically acute, progressive disease (75%). Asymptomatic patients or those with probable sarcoidosis associated with hilar and/or paratracheal adenopathy will not have parotid uptake. Similarly, uptake seldom occurs in normal patients or in those with untreated lymphoma or Hodgkin disease. If other inflammatory or granulomatous processes such as tuberculosis can be excluded, and if there is no history of head and neck irradiation, then this finding in acutely ill patients suggests sarcoidosis.


Radiation therapy of pineal tumors.

Radiation therapy of pineal tumors. The case histories of 58 patients irradiated for pineal tumors were reviewed to assess indications and radiotherapy techniques. The survival rates were 61% at five years and 58% at 10 years in all cases. The five-year survival rate was 85% for 21 patients with germinoma, 69% of 26 with tumors not histologically confirmed, and zero for patients with glioma and teratoma. Doses ranging from 1,500 to 1,699 rets with or without decompression definitely improve the prognosis in pineal tumors. Field size and changes in CT scans during radiotherapy are also discussed.


X-ray absorption, speed, and luminescent efficiency of rare earth and other intensifying screens. Seven new and two conventional screens were investigated. Measurements were performed at different energies of the photon fraction interacting in the screens, and energy losses due to escape of K-fluorescent radiations were calculated. The speed of the screens was dependent on the energy; this was primarily due to the fact that x-ray absorption is dependent on energy. Rare earth and other new screens absorb a maximum of 1.5 times as much energy and emit twice as much light as comparable calcium tungstate screens. Reabsorbed K-fluorescent radiations might contribute to image unsharpness in the new screens.


Absorbed doses to patients and personnel from endoscopic retrograde cholangiopancreatographic (ERCP) examinations. Radiation doses to the skin, bone marrow, and gonads were determined during endoscopic retrograde cholangiopancreatographic examinations. Average patient entrance doses were 7.5, 4.9, 17.5 and 2.7 rads to the abdomen, back, and left lateral and right lateral positions, respectively. Mean active bone marrow dose was 0.4 rads and average gonadal dose was 0.2 rads. Spot radiographs and fluoroscopy provided equal contributions to patient dose. Patient entrance dose was less than that from abdominal angiography, and comparable to that from a typical upper-gastrointestinal series. The pancreatic dose was comparable to that from a radionuclide scan. Dose to personnel was negligible.


Dosimetric evaluation of a computed tomography treatment system. Pixel-by-pixel correction for tissue inhomogeneities was performed with a CT-interfaced treatment planning system. The CT number for each pixel was converted to a physical density. Comparison of the resulting data with dose measurements in a RANDO phantom shows that pixel calculation overestimates dose by 5--7% at locations adjoining the lung, where loss of scatter is not taken into account by the algorithm. However, the new system does have some advantages over conventional treatment planning systems.


Late radiation damage to pig skin.

Late radiation damage to pig skin. The severity of skin contraction in a previously delimited treatment field has been used as a measure of late radiation damage to pig skin. Total treatment doses were given as 6, 14, and 30 fractions over 39 days or as 6 fractions over 18 days. Iso-effect curves for severe linear field contraction showed that no simple mathematical formula could be used to calculate safe "tolerance" doses when fractionation regimes were modified. The results do indicate that for a given level of acute damage, late damage was increased by changing from 5 to 2 fractions per week. These findings are similar to those obtained from surveys in man.


Efficacy of the lateral view mammogram in the detection of breast malignancy. Previous studies suggest that single-view lateral mammography alone results in a small decrease in detection of malignancies. Detection rates for lateral view only and two-view examinations in 200 cases (100 malignant, 100 nonmalignant) were compared. Four to six per cent of cases originally found positive were reinterpreted as negative in both situations. Preliminary findings suggest that the lateral view alone is sufficient, provided a second view is requested in suspicious cases.


Computed tomographic cavo-urography: lower-extremity contrast infusion simultaneous with computed tomography of the retroperitoneum. Successful opacification and distention of the inferior vena cava was obtained simultaneously with computed tomography by contrast infusion through a lower-extremity vein. Images obtained by this method displayed retroperitoneal anatomical relationships to better advantage, permitting more accurate interpretation of the upper retroperitoneum, particularly in lymphoma.


Axial radiography of the spine: a projection for evaluation of the neural arches in children. The axial projection of the spine is a useful view for evaluation of possible neural arch defects in children. The projection is easy to perform and allows visualization of the arches without confusing overlap by other structures.


An accessory patient table for multidirectional CT scanning. An accessory patient table has been built to take better advantage of the 90-cm gantry opening of the Varian whole-body scanner. Coronal and sagittal scans of the head can be made routinely and comfortably.


Clear plastic cerebral manifolds. A replacement for opaque three-way stopcocks. A Morse coronary manifold was modified for cerebral angiography. The modified unit permits easier identification of foreign particles which could form emboli. It also expedites the procedure by simplifying continuous irrigation and facilitating reloading of the injector.


Let us not lose echocardiography.

Let us not lose echocardiography. Despite the unquestioned value of echocardiography in the diagnosis of valvular disease, pericardial effusion, cardiomyopathy and many other cardiac conditions, few residency programs in radiology are offering training in echocardiography. Echocardiograms of the last 100 consecutive patients in a small community hospital demonstrated a surprising breadth of clinical material. Echocardiography should be included in every residency program lest our role in this technique is lost altogether.


The big rib sign: localization of basal pulmonary pathology in lateral projection utilizing differential magnification of the two hemithoraces. Basal pulmonary pathology which silhouettes the hemidiaphragm in lateral view may not be detectable in routine postero-anterior projection. In such cases, correct lateralization of pathology to the left or right hemithorax depends on accurate identification of the silhouetted left and right hemidiaphragm in lateral view. A prospective analysis of the sensitivity and accuracy of five techniques for identifying the left and right hemidiaphragms in more than 100 patients revealed that the most accurate method for lateralizing juxtadiaphragmatic pathology was the "big rib" sign, a technique based upon the relative difference in magnification between the left and right ribs. Techniques based upon the visceral gas bubble or upon obscuration of the anterior portion of the left hemidiaphragm by the heart proved less useful. Techniques based upon the position and configuration of the major fissures or upon higher and lower position of the two hemidiaphragms were ineffective.


Normal sellar variations in frontal tomograms. Frontal tomograms of 100 normal sellae were examined. The sellar floor was usually flat or had a smooth central depression of less than 2 mm. Six per cent had a marked central depression. In such cases, the lateral angles of the sellar floor, usually rounded, may be sharp, so that the diagnosis of intrasellar lesions cannot be based on such alterations. Where one or more septa divided the sphenoid sinus asymmetrically, sellar floor configuration was modified in 21% of cases. The normal sellar floor may have a slope of up to 8 degrees, making analysis of subtle contour variations difficult.


The sella turcica in primary end organ failure. Pituitary hyperplasia, or adenoma, may result from end or target organ failure as seen in primary hypothyroidism and hypogonadism. Associated enlargement of the sella turcica and contour alterations without significant increase in volume may be seen. A review was made of 12 patients with end organ failure demonstrating the spectrum of radiologic changes within the sella turcica. Recognition of pituitary enlargement resulting from end organ failure may eliminate unnecessary surgery.


The value of computed tomography in evaluating patients with prolactinomas. The use of computed tomography (CT) in 28 patients with surgically proved prolactinomas is described. The authors' experience suggests that in evaluating patients with galactorrhea-amenorrhea syndrome, CT in combination with pluridirectional tomography usually provides sufficient information to make further invasive studies unnecessary. In selected cases with low-density areas within the sella as seen on CT, pneumoencephalography is still advisable to distinguish between the empty sella and the necrotic tumor. Angiography is still necessary to exclude vascular causes for suprasellar and parasellar masses such as aneurysms and meningiomas.


Rapid high dose (RHD) contrast computed tomography of perisellar vessels. The diagnostic accuracy of CT scanning in the sellar area can be improved by using a rapid high dose (RHD) contrast technique which visualizes the supraclinoid carotid arteries, cavernous sinus and vascular plexus of the infundibulum. The RHD technique is briefly described and the pertinent anatomy discussed and illustrated.


Factors governing the course of emboli in the therapeutic embolization of cerebral arteriovenous malformations. Many factors are involved in the therapeutic intra-arterial management of cerebral arteriovenous malformations (AVMs) by embolization. If these factors could be better defined, the suitability of patients for embolization could be more accurately predicted. In 59 embolization procedures, the diameters of feeding arteries of AVMs were analyzed, and a critical diameter found below which emboli are likely to stray into normal vessels and above which embolization can be carried out with a greater chance of success. Neurologic complications occurred on 20 occasions, but most were temporary; in only 1 of 34 patients did a permanent incapacitating complication occur.


Intrapetrous carotid artery branches: radioanatomic analysis. Intrapetrous carotid artery branches were analyzed angiographically and anatomically. Such branches appeared in 23% of normal carotid angiograms and 38% of microsurgical dissections. These branches included the vidian artery and small periosteal arteries. The caroticotympanic artery was not clearly defined in either analysis. The vidian artery contributed to two separate vascular anastomoses: the first was within the mucosa of the posterior-superior nasopharynx, the latter was in the anterior nasopharynx via the artery of the pterygoid canal.


Prolonged injection angiography for diagnosing intracranial cavernous hemangiomas. A case of intracranial cavernous hemangioma displaying feeding arteries, tumor stains, and venous pools is presented. Tumors of this type may simulate avascular masses on angiography; however, when surgically excised, they bleed profusely. A correct preoperative diagnosis can help avoid unnecessary incisions. Prolonged injection angiography clearly depicts the tumors and their venous pools, which may be pathognomonic of cavernous hemangiomas.


Computed tomography of masses in the lacrimal gland region. Twenty patients with mass lesions in the lacrimal gland region were evaluated with computed tomography (CT). The extent of the mass and its relationship to the globe, optic nerve, and extraocular muscles were clearly seen. The CT appearance on plain scan and the presence or absence of contrast enhancement, bone involvement, and cystic components often suggested the specific pathological diagnosis. Although orbital ultrasonography and CT were frequently complementary, ultrasonography was more definitive in inflammatory diseases, while CT demonstrated better extraorbital extension.


Computed tomographic localization for fine needle aspiration biopsy of orbital tumors. Fine needle aspiration biopsy techniques have recently been applied to the evaluation of orbital masses. Ultrasound and CT examination have been useful in accurately localizing and characterizing such lesions prior to biopsy. Small retrobulbar tumors may be difficult to biopsy using blind needling, despite accurate localization. Preliminary studies on cadaver orbits confirmed that successful biopsy of the normal optic nerve could be accomplished using direct CT guidance. The technique was applied to 2 patients with monocular blindness due to small infiltrating optic nerve tumors and a histologic diagnosis was obtained in each case. This low morbidity procedure though applicable to only a small group of patients may spare them the morbidity of an orbitiotomy or craniotomy.


Tethered spinal cord following meningomyelocele repair. Of 16 consecutive patients with tethered spinal cord studied, most had undergone repair of a meningomyelocele. All were evaluated using somatosensory evoked potentials at 6 to 12-month intervals. Other possibilities include tethered filum terminale, lipomeningocele, membrana reuniens, and miscellaneous conditions (diastematomyelia, neurenteric cysts, etc.). Metrizamide myelography with polytomography was superior to gas myelography in showing a low-lying cord, obtuse nerve root angles, and a thin subarachnoid space between the cord and the dorsal meninges cephalad to the tether. Surgery is generally helpful in these patients.


Intraspinal metastases from retinoblastoma. Cerebrospinal fluid seeding is a well-known mode of metastasis for intracranial neoplasms such as medulloblastoma, ependymoma, and glioblastoma; however, retinoblastoma is not usually considered. The route of spread appears to be by direct extension into the optic nerve from the retina and into the meningeal spaces by extension from the choroid, or along the central retinal vessels to the subarachnoid space. Four cases are presented.


The radiographic appearance of complications following Nissen fundoplication. Seventy patients had an upper gastrointestinal examination following Nissen fundoplication for reflux esophagitis associated with hiatal hernia. Thirty-nine were asymptomatic and the fundoplication appeared normal. Of the 31 patients with symptoms (dysphagia, pain, or vomiting), 15 had spontaneous relief and demonstrated a normal postsurgical radiographic appearance of the stomach. The other 16 had both persistent symptoms and radiographic abnormalities, including 5 stenoses, 3 recurrent hernias, and 8 pouch deformities of the fundus. The roentgenographic features and etiology of these surgical failures are discussed and the importance of the radiographic examination in discerning successful surgical repair from failure despite similar postsurgical symptoms is stressed.


Diagnostic ultrasound: effects on the DNA and growth patterns of animal cells. The effects of diagnostic levels of ultrasound on DNA of HeLa cells included: increased immunoreactivity to antinucleoside antibodies in G1 cells, strongly suggestive of unwinding of the helix or single-strand break induction, and low levels of non-semiconservative synthesis in logarithmically growing cells treated with hydroxyurea, indicating repair synthesis. In the C3H mouse cell line 10T-1/2, Cl 8, loss of contact inhibition with a criss-crossed growth pattern was seen. In one experiment, tumors developed in syngeneic mice at the site of injection of ultrasonically treated cells. Ultrasound in the diagnostic range appears to cause detectable effects on DNA and growth patterns of animal cells.


Noninvasive diagnosis of prosthetic mitral valve malfunction. A patient with a Kay-Shiley mitral prosthesis had abnormal intermittent systolic tilting of the prosthetic disc by cinefluoroscopy. Echocardiography revealed an abnormal "atrial emptying index" consistent with mitral obstruction. Catheterization revealed mitral regurgitation without stenosis. At surgery, there was no prosthetic orifice obstruction. It was concluded that the atrial emptying index may be abnormally low in prosthetic mitral regurgitation without stenosis.


The central uterine cavity echo: a useful anatomic sign in the ultrasonographic evaluation of the female pelvis. The frequency with which the central uterine cavity was seen during gray-scale ultrasonography was evaluated both retrospectively (100 patients) and prospectively (20 patients). In the retrospective study, the echo was seen in 90% of patients; in the prospective study it was demonstrated 100% of the time. Of 30 patients with intrauterine pregnancies between three and twelve weeks fetal age, the echo was not seen on any scan. The demonstration of this echo can be diagnostically useful in excluding an intrauterine pregnancy or identifying the uterus when confusing pelvic pathology is present.


Ultrasonic evaluation of abdominal gastrointestinal tract duplication in children. Ultrasonographic evaluation of a suspected abdominal mass in children is becoming routine. Recognition of a rare congenital anomaly known as duplication of the gastrointestinal tract might aid in diagnosis and obviate the need for an extensive workup. Two cases are presented that clearly demonstrate the ultrasonographic spectrum of findings in this condition, ranging from a sonolucent cyst to an echogenic mass. An echogenic inner rim seen ultrasonographically is highly suggestive of the diagnosis.


Fetal pseudoascites.

Fetal pseudoascites. A sonolucent band (pseudoascites) was retrospectively identified beneath the fetal abdominal wall in 39.7% of 141 normal obstetrical sonograms. In 12.6% of the examinations, the band was wide enough to be potentially confused with actual ascites. Pseudoascites was unrelated to fetal age or position, placental location, or equipment used. It was not reliably present on sequential examinations. The origin of this artifact remains unclear.


Antepartum ultrasonic detection of multicystic kidney. A multicystic fetal kidney was detected antepartum with gray-scale ultrasound. This appears to be the first proved case.


Single injection thallium-201 stress and redistribution myocardial perfusion imaging: comparison with stress electrocardiography and coronary arteriography. The efficacy of single injection thallium-201 exercise stress and rest redistribution imaging in the evaluation of myocardiacl ischemia was compared with stress electrocardiography and coronary arteriography. Thallium-201 imaging was interpreted at two levels of sensitivity in order to define the circumstances under which it best serves as a screening modality for coronary arteriography. With the prevalence of coronary disease usually found in patients referred for coronary arteriography (75%), unprocessed thallium-201 imaging is as good as stress electrocardiography in identifying patients apt to show coronary artery abnormalities, but not much better than stress electrocardiography in delineating those patients unlikely to show coronary artery disease. In contrast, processed lesion enhanced images showing normal results virtually eliminate the possibility of significant arteriographic findings. With this screening technique, many patients may be spared unnecessary coronary arteriography.


Parameningeal rhabdomyosarcoma.

Parameningeal rhabdomyosarcoma. The records of 27 patients with rhabdomyosarcoma involving the parameningeal area (nasopharynx, paranasal sinus, and middle ear) treated from 1961 to 1976 were reviewed. Due to the location of the primary tumor, radiation and chemotherapy were used but surgery was limited to simple biopsy. In the literature, spread of tumor from these primary sites to the meninges has been as high as 26-35%. In this series, meningeal disease developed in only 2 of the 27 patients (7%).


Compton soft-tissue imaging and its capability expanded by direct magnification and Shinozaki color TV system. To improve the spatial and density resolution of Compton radiography, the authors utilized direct magnification with a pin-hole collimator and contrast magnification with the Shinozaki color TV system, a digital color display. Great improvement was attained in spatial resolution. Contrast magnification resulted in sharp delineation of soft-tissue lesions including cancer and its infiltrations into normal surrounding breast tissue. It is expected that in the future, Compton radiography will have wide raiological application with reduced radiation dosage.


The selection, acceptance testing, and quality control of radiotherapy treatment simulators. The critical aspects of selection, acceptance testing, and quality control of a radiotherapy treatment simulator are discussed. The selection of a simulator involves consideration of: (a) motions and readouts, (b) safety features, (c) x-ray and imaging systems, and (d) mechanical tolerances (including guarantees). When considering motions, it is important to ascertain the extent of each motion, motorization and speed, control location, and the location accuracy, and type of scale. Important questions in x-ray system selection concern (a) x-ray generator ratings and phase, and (b) details of the x-ray tube and image intensification system.


Ceruletide-assisted cholecystography: a clinical assessment. The cholecystokinetic effect of ceruletide, a synthetic decapeptide similar in action to cholecystokinin, was examined in both a randomized and nonrandomized study in 81 patients scheduled for routine oral cholecystograms. Intramuscular injection of ceruletide in a dose of 0.3 microgram/kg resulted in a mean maximum contraction of the gallbladder of 68% and a mean time until maximum contraction of 28 minutes. Visualization of the cystic duct occurred in 57 patients (70%); the common duct was seen in 67 (83%). Ceruletide demonstrated superior gallbladder contraction when compared to fatty meals and demonstrated no interference with a subsequent upper gastrointestinal series.


Small electron beams in radiation therapy. The use of lead cutouts to produce small beams in electron therapy results in a reduced dose to the patient. The authors investigated this effect for beams with energies less than 8 MeV and diameters of 3 cm or less. Dose measurements were obtained using film and an ionization chamber. Based on these values, corrections were established to account for dose reduction due to cutout spaces and air spaces between the end of the electron cone and the skin surface. Data were also obtained on the dose increase due to backscattering from internal eyeshields.


A mathematical index of uniformity (IOU) for sensitivity and resolution. The authors define a mathematically precise index of uniformity (IOU) and show that the IOU is a convenient tool to quantitate uniformity of sensitivity and resolution response for any given area of interest on the detector face. They also show that the IOU is an appropriate factor for weighing the mean values of sensitivity and resolution for nonuniformity of response; these weighted sensitivity and resolution factors are used to derive a weighted figure of merit which takes into account, in a single parameter, the nonuniformities of response inherent in the determination of sensitivity and resolution.


Use of color display for selection of left ventricular regions of interest. Scintigraphic images of the cardiac blood pool were displayed in color, with red indicating tracer distribution during diastole and green indicating systole. This display permits easy identification of vascular structures.


Use of the Simmons "Sidewinder" femoral-cerebral catheter for abdominal angiography. The authors describe a single catheter system which allows rapid, routine abdominal angiography. Selective and subselective studies are easily performed, and the catheter can be used without modification for Pitressin infusion and embolization.


New fine needle for cholangiography with optional sheath for decompression. A 45-cm Chiba needle with a 20-cm sheath at the hub end has been used successfully for percutaneous transhepatic cholangiography in 10 patients, including chronic decompression in one patient. This method permits localization of the biliary tree, vascular structures, cysts, cavities, pelvocalyceal system, and tumors with a 22 gauge needle and allows placement of a larger catheter for drainage or a larger needle for biopsy if required. No complications were observed.


Angiography of the femoral bifurcation: prediction of the correct oblique projection. Evaluation of the origin of the deep femoral artery is important in planning treatment of ischemic disease of the lower extremity. While arteriography in the ipsilateral anterior oblique projection will adequately demonstrate the femoral bifurcation in 91% of cases, the posterior oblique projection will be necessary in 9%. Selection of the most useful oblique projection can be done by studying the AP arteriogram.


Use of a programmable pocket calculator in radiotherapy treatment planning. Software packages for a programmable pocket calculator have been developed for use in dosimetry. Using a field equation and a mathematical model of the beam profile, one can find the dose delivered to any point within the irradiated volume. Use of these programs for simple field calculations allows the radiologist to concentrate on more complex treatment plans.


Improved radioaerosol administration system for routine inhalation lung imaging. An improved radioaerosol administration system has been developed to reduce the number of droplets larger than 2.0 micron in diameter which have caused abnormal hyperdeposition of inhaled aerosols in the large airways. The new system has achieved this goal by interposing a reservoir-setting bag in the aerosol delivery line between the nebulizer and the patient. The components are inexpensive, commercially available and easily assembled in any nuclear medicine service.


Real-time computer verification for radiation therapy treatment machines. A computer based verification system which monitors the operation of a 4-MV linear accelerator is described. Fourteen parameters can be checked for proper alignment prior to irradiation. A training simulator was also built to minimize interference with treatment schedules and to provide technicians with experience in using the system during the developmental stages of the project.


The radiologic diagnosis of pituitary adenoma: an overview. The author reviews the literature on the radiologic diagnosis of pituitary adenoma, including the studies by Bruneton et al., Danziger et al., and Dubois et al. in this issue. Computed tomography is the definitive radiologic diagnostic tool in large pituitary adenomas (1.5 cm or greater). Precision radiographic studies, endocrine correlation, and an understanding of the effect of sellar variations on radiographic images can yield a very high incidence of accurate recognition of pituitary microadenomas. Computed tomography portends an even greater diagnostic sensitivity.


Breast parenchymal patterns: prevalent and incident carcinomas. Breast parenchymal patterns can be divided into four groups: N1, P1, P2 and DY. Although there is evidence that the P2-DY group favors the development of cancer, the risk classification changes when one considers prevalent vs. incident breast cancers. In a purely incident series, a gradual diminution will be seen in the number of N1-P1 cancer cases and a corresponding rise in cancer patients from the P2-DY group.


The radiologic and clinical aspects of calcified hypernephroma. The radiologic, pathologic, and clinical findings were reviewed in 18 patients with calcified hypernephroma and 6 with calcified benign renal lesions. Our results suggest: (a) that the pattern of calcification in a renal parenchymal lesion is of little assistance in diagnosis; in this series, many hypernephromas had peripheral curvilinear calcifications, and most benign renal lesions had internal amorphous calcifications; (b) that no distinct angiographic pattern exists in calcified hypernephroma, and a spectrum ranging from avascular to hypervascular may be identified; and (c) that these tumors may behave more benignly than uncalcified hypernephroma (5-year survival 78%).


Systemic venous blood return via the portal vein. The patterns of collateral circulation which develop following obstruction of the inferior vena cava have been classically divided into three groups depending upon the level of obstruction, i.e., infrarenal, middle caval, and upper caval. The portal vein can play an active role at all three levels. Multiple potential routes to the portal vein are described and 6 cases are presented.


Radiological evaluation of composite aortic grafts. Aneurysm of the ascending aorta with aortic regurgitation is most commonly caused by cystic medial necrosis. Replacement of the aortic valve and diseased aorta with a composite graft and re-implantation of coronary arteries is the surgical treatment of choice at the authors' institution. The most important late complication of this procedure is hemorrhage at the anastomotic sites. Radiology plays an important role in the management of these patients. The angiographic appearance of cystic medial necrosis and the radiological features and postoperative complications of composite grafts in 15 patients are described.


Percutaneous transluminal angioplasty for treatment of renovascular hypertension. Four patients with typical renovascular hypertension due to atherosclerotic stenosis (3 patients) and near occlusion (one patient) were treated with percutaneous transluminal angioplasty (PTA). Two patients had malignant hypertension by clinical standards. All had significant reduction in blood pressure following angioplasty, resulting in either a normotensive state, or management with significantly less antihypertensive medication. Patency and normal renin levels were achieved within two months in 2 patients. Clinical follow-up documented continued reduction in blood pressure. Advantages of the procedure include local anesthesia, relatively little discomfort, repeatability, and the fact that surgery is not precluded if angioplasty is unsuccessful.


Epinephrine renal venography in pseudotumors consisting of normal renal tissue. Epinephrine renal venography was used to study mass-like enlargements of normal renal tissue in 4 kidneys (3 with prominent septa of Bertin and 1 with marked lobation) in 3 patients. Normal veins penetrating the pseudotumor were always present; the septa of Bertin also caused stretching of the interlobar veins. No encased or obstructed veins were observed. This technique may be of value in cases of suspected pseudotumor where arteriography and noninvasive procedures do not permit an unequivocal diagnosis.


The "ring sign" of necrotic pheochromocytoma. Pheochromocytomas are usually hypervascular tumors exhibiting dense stain during angiography. The cystic nature of the neoplasm or tumor necrosis can result in failure of opacification of the mass or a central lucent area. Four cases of pheochromocytoma are described where a central avascular zone was surrounded by a dense rim of contrast, giving a "ring sign." Since this appearance is best seen in the capillary and venous phases, delayed films are essential.


Pedal venous pressure: correlation with presence and site of deep-venous abnormalities. A prospective study of the predictive value of pedal venous pressure (PVP) in 100 consecutive cases is discussed. Deep-venous thrombosis is strongly suggested when PVP exceeds 31 cm of saline. The higher the PVP, the more proximal in location is the occluding thrombus.


Supine pedal venous measurement in patients with venous disease. The measurement of supine pedal venous pressure as a screening test for deep venous thrombosis is re-evaluated. In 83 extremities studied in 50 patients, the false-positive rate was 62%, the false-negative rate 8%. Chronic venous disease, whatever its etiology but particularly in association with the post-phlebitis syndrome, can be a source of error in relying upon this measurement.


Osteomyelitis in a neonatal intensive care unit. Neonatal osteomyelitis presents with few clinical signs despite multiple sites of involvement. Four cases of osteomyelitis due to Staphylococcus aureus or Candida albicans were encountered in a neonatal intensive care unit. Three were unsuspected clinically and were detected as incidental radiologic findings. The fourth presented with soft-tissue abscesses. Long bone metaphyses were most frequently affected. Other sites included iliac bones, clavicles, and spine. On follow-up the bones healed, but one patient was left with hip deformity secondary to destruction of the cartilaginous femoral heads and another patient developed obstructive hydrocephalus due to Candida ventriculitis. Complete skeletal survey is indicated in any infant with osteomyelitis at one site to seek additional silent areas of involvement.


Normal variants of the sella turcica.

Normal variants of the sella turcica. Complete study of the sella turcica requires multidirectional tomography. The authors have studied 200 radiographs of normal adults and noted the percentage of variants of each anatomical feature on both standard radiographs and tomograms. The greatest drawback of the standard radiograph is the difficulty in objectively evaluating the effect of pneumatization and/or a septum of the sphenoid sinus on the sellar floor. In this series the floor was concave in 58% of patients, flat in 32.5%, and convex in 9.5%. Lesions which simulate erosion of the posteromedial part of the lamina dura correspond to thinning of the central portion of the base of the dorsum sellae.


["General special education" - defining a questionable area of theory, action and research (author's transl)]. Special education is characterized as an integral part of education in general, and of the interdisciplinary field of rehabilitation. Its close relationship to social work/social education and its dependence on relevant related disciplines are pointed out. The establishment of a "general special educational theory" is regarded as problematic and theoretically impossible, as concrete and differentiated educational statements must always be made in relation to quite definite groups of pupils and/or educational needs. Theoretical reflections and practical actions in the field of special education are, therefore, necessarily directed towards persons with certain types of disabilities and/or specific special educational needs. While "General Special Education" (or "Education of the Handicapped") is rejected as an intermediate field of theory between general education and specific special educational theories, the importance of interdisciplinary and comparative actions in the area of special education and some other overlapping tasks in this field are emphasized.


[Standard requirements for electric wheelchairs (author's transl)]. Electric Wheelchairs are driven on public roads. Neither an operating license, liability insurance nor special driving license is necessary according to Road Traffic and Road Licensing Regulations. Statutory regulations prescribe that these wheelchairs must be fitted with two independent brakes and adequate lighting equipment. Safety can be increased by: Totmann brake system - battery servicing - improved battery chargers and technical safety tests. Maintenance of the wheelchair prolongs its life. Social security agencies should allow a large number of the most severely handicapped people to benefit from medically prescribed wheelchairs.


[Creative works of the mentally ill as a problem for art (author's transl)]. The article "Creative Works of the Mentally Ill as a Problem for Art" attempts to analyse this complex field from a more art-theoretical viewpoint. In addition to the difficulties involved in identifying the causing factors of schizophrenia there is the problem of not having a uniform definition of art. Wölfli's example substantiates the evidence that the artistic works of the mentally ill display the same characteristics as far as creativity is concerned as those of mentally healthy artists and hence there is no reason for disqualifying their works. Some artists who had already achieved general recognition did not lose it after becoming afflicted with mental illness later in their lives. Does this mean that recognition depends on social status and not on the work itself?


Plasma amino acid response to single test meals in humans. IV. Four low-cost protein supplements evaluated by chemical analysis, rat bioassay and plasma amino acid response. For supplementary weaning foods, Faffa (Ethiopia), Incaparina (Guatemala), Superamin (Egypt) and Sekmama (Turkey), were studied with regard to protein quality. Three different methods for protein quality evaluation were used. 1. Chemical analysis of the essential amino acid content. Amino acid scoring of the results indicated that the sulphur-containing amino acids were limiting in Faffa (77%); lysine, threonine and isoleucine in Incaparina (77--75%); threonine in Superamin (80%) and threonine and the sulphur-containing amino acids in Sekmama (90%). 2. Standardized nitrogen balance procedure using laboratory rats. The net protein utilization of the four weaning foods were all in the range 56--70%. Methionine supplementation (1 g/100 g protein) did not significantly improve the biological value of the test diets, but resulted in marked decreased levels of blood urea nitrogen (except for Incaparina), and decreased urinary excretion of urea nitrogen compared to total nitrogen excretion (except for Superamin). 3. Single meal plasma amino acid responses in healthy young adults. The responses of the essential amino acids after test meals with the four weaning foods were all within a range considered to indicate a well balanced supply of dietary amino acids, except for marginal deficits of methionine after the Faffa test meals, and isoleucine after the Incaparina test meals.


Plasma amino acid response to single test meals in humans. V. Ethiopian preschool children given lowcost protein supplements. The plasma amino acid response to single test meals was studied in preschool children, aged 9 months--5 years. The amount of protein given in each test meal was 1 g per kg body weight, which represented one-third of the daily intake of the children who were recovering from protein-energy malnutrition. The test meals given was gruels made from wheat mixed with a supplementary weaning food (Faffa or Superamin) or fish protein concentrate (FPC). The plasma amino acid responses were evaluated both as PAA ratios (a modification of the Longenecker and Hause method), and as deltaMR% (percentage change in the postprandial essential amino acid molar ratios according to Graham and Placko). Both evaluation models indicated that lysine, threonine and methionine were the limiting amino acids in the Faffa/wheat diet, and that lysine and threonine were limiting in the Superamin/wheat diet. All essential amino acids seemed to be supplied in adequate amounts in the FPC/wheat diet. These results were in close agreement with the amino acid score of the diets (based on chemical analysis).


Renal tubular ferritin-uptake, a consequence of the increased glomerular permeability, during the benign and malignant course of renal hypertension in rats. Tubular uptake of ferritin given intravenously was studied in the right and left kidneys of 74 Goldblatt-hypertensive rats. Previous observations pointed out the pathologically enhanced permeability of glomerular barrier as the cause of the phenomenon. It was assumed, that the extent of tubular areas taking up ferritin, refers to the number of damaged glomeruli. The process was characterized semiquantitatively by planimetric measurements and determination of the non-hemin iron concentration in the renal cortical tissue. A more frequent and extensive tubular ferritin-uptake (and glomerular damage) was bilaterally recorded in the kidneys of malignant hypertensive rats in comparison to the benign ones. The development of the phenomenon in the clamped kidneys, being defended from high blood pressure, suggests a humoral factor behind the enhanced glomerular permeability. Saline intake has a beneficial effect on the glomerular damage similar to the hypertensive angiopathy.


The influence of pre- and perinatal malnutrition on sulphated glycosaminoglycans in rat brain. Pre- and perinatal malnutrition of rats was achieved by restricting the intake of food to 50% during lactation and pregnancy. After 40 days offspring were injected with Na2(35)SO4 before being killed. Lipid-free brain material was now hydrolysed with papain and glycosaminoglycan samples chromatographed on DEAE-cellulose. After chemical characterisation studies 2.5 times more chondroitin sulphate was detected in tissue from the ill-fed animals. Little variation in heparan sulphate content was observed. The marked increase in the concentration as well as qualitative changes in sulphated glycosaminoglycans during pre- and perinatal malnutrition as compared to the normal are discussed in relation to brain maturation.


[The influence of glucocorticoids on the physiological cell renewal of gastric and intestinal mucosa (author's transl)]. The influence of Methylprednisolone (1.2 mg/kg body weight daily for 14 days) on the physiological cell renewal of gastric and intestinal mucosa was examined autoradiographically by determination of the 3H-labelling index and the cell cycle of the regenerating epithelial cells. Macroscopical or microscopical changes of the gastric or intestinal mucosa could not be observed. The labelling index was not significantly altered compared to the controls. Against this the determination of the cell cycle showed a clear inhibition of epithelial cell proliferation in all parts of the gastrointestinal tract with a prolongation of the postmitotic phase, a small inhibition of the DNA synthesis and a corresponding prolongation of the mean generation time.


Binding of copper to mucosal transferrin and inhibition of intestinal iron absorption in rats. 1. The chromatographic elution patterns on Sepharose 6B of the supernatant from mucosal homogenates prepared 10 min after administration of copper into duodenal segments in vivo, indicate that copper is bound preferentially in the fraction of mucosal transferrin. 2. In iron deficiency the amount of 64Cu-copper taken up into the duodenal mucosa is more than two times higher and the amount bound to proteins of the supernatant is also increased to approximately the same degree whereas the amount transferred into the body is diminished to one fourth. 3. In the iron deficient group 64Cu-copper was also bound to a fraction which contains probably metallothionein. 4. The distribution of copper in the supernatant was changed due to a simultaneous administration of iron; the amount of copper bound in the transferrin fraction decreased in favor of the metallothionein fraction and another copper binding fraction was eluted between the transferrin and the metallothionein fraction. 5. Copper in a tenfold molar excess inhibited the iron absorption; simultaneously, the iron bound in the iron binding fractions of the supernatant was remarkably diminished. 6. The results suggest that the affinity of copper to two mucosal iron binding proteins, transferrin and metallothionein, is at least partly responsible for the inhibitory effect of copper on iron absorption in iron deficiency.


The influence of some metabolic inhibitors on phagocytic activity of mouse macrophages in vitro. The action of different metabolic inhibitors on phagocytosis by macrophages from mouse peritoneal exudate cultured in vitro was studied. The following metabolic inhibitors were tested: sodium iodoacetate, sodium fluoride, sodium fluoroacetate, sodium malonate, 2-4-dinitrophenol, sodium azide, ouabain and cycloheximide, all at the concentration of 10(-3) M. Iodoacetate caused a strong inhibitory effect on phagocytosis; this observation confirms that glycolysis is the main source of energy for the phagocytic process. On the contrary, fluoride, although it is an effective inhibitor of glycolysis, did not exert any effect. This difference may be explained by the fact that sodium fluoride blocks anaerobic glycolysis only in vitro at an unphysiological temperature (0 degrees C). Fluoroacetate and malonate, two compounds which interfere with the Krebs cycle, did not inhibit phagocytosis, but it is known that the Krebs cycle activity is poorly developed in the macrophagic cells. Sodium azide and 2-4-dinitrophenol, two inhibitors of oxidative phosphorylation, showed an effect on phagocytosis only after 3 h of contact with the cell cultures. Ouabain blocks Na+ and K+ transport across the plasma membrane and, probably, it inhibited phagocytosis by interfering with the movements of the cell membrane. Finally, the mode of action of cycloheximide on phagocytosis is uncertain. This compound inhibits the protein synthesis and, perhaps, it can act by preventing the renewal of the cell membrane.


Evaluation of lymphocyte production in mesenteric lymph nodes. In normal young pigs two labeling procedures were evaluated to study the production of lymphocytes in mesenteric lymph nodes. Tritiated thymidine was injected either into the superior mesenteric artery or directly into the lymph nodes. There was a high rate of lymphocyte production and a considerable export of newly-formed small lymphocytes. The distribution to lymphoid organs and the appearance of labeled lymphocytes in the blood were comparable after both techniques. The intranodal labeling resulted in a more selective labeling and thus was found to be the superior method for quantitative studies.


[Value of computerized tomography in diseases of liver and spleen]. A survey has been given regarding the position of the CT as a examination method of liver, gallbladder - bile duct system and spleen. A fast scanner of the third generation has been used and has been compared with results of a slow CT of the first generation.


[Radiation dose in abdominal examinations with whole body computer tomography (author's transl)]. The somatic and genetic radiation exposure in abdominal CT examinations with Delta 50 and Delta 50 fast was measured via thermoluminescent dosimeters and compared with the exposure in conventional methods of x-ray diagnosis. With Delta 50 fast, the dose surface product for on examination of the pancreas is about 2900 Rcm2, and for an examination of the kidneys about 3400 Rcm2. It is thus comparable with a gastrointestinal examination or a urogram. The gonadal doses determined for CT are lower than those received from standard x-ray examination.


[Craniofacial tomography in tumours of the nasal fossa and the paranasal sinuses (author's transl)]. Craniofacial tomography of 55 patients with tumours of the nasal fossa and the paranasal sinuses were examined retrospectively. Only those tomograms were considered which had been taken before surgical or radiological treatment. The clinical classification of the tumours resulting from the tomographic findings shows, that these are, in most cases, advances tumours, which have already invaded neighbouring regions. Depending on their original site, the tumours will preferably spread in certain directions. In some cases, the opacity is not caused by the tumour itself, but by accompanying inflammations. The tomogram will always show up intra-operatively established tumourous bone destructions. However, the appearance of bony cortex on x-ray film without any clearly defined outline, may represent pseuodefects, especially when the adjacent tumour shadow is very dense or if the bony cortex is not situated approximately perpendicular to the tomographic level.


[Uterus duplex and unilateral agenesies of the kidney in two sisters (author's transl)]. The article describes uterus duplex and unilateral agenesis of the kidney in two sisters. Although this combined malformation has been described in literature in about 100 cases, it would seem that it occurred in one and the same family in only one case, namely, in mother and daughter. If agenesis of the kidney or a malformation of the uterus is found in a patient, the physician should look for a combined malformation in other members of the family.


[Lumbar myelography with methylglucamine-iocarmate (dimer-x). A critical review of neurological complications (author's transl)]. A critical literature review is presented on the basis of our own clinical experiences with complications and distressing side effects of the lumbar Dimer-X myelography. Severe Complications such as spinal and conuscauda-symptoms, epileptic seizures, amnestic episodes and late palsies of the Abducens nerve in literature range between 1 and 9%. Unspecific side effects which cannot clearly be differentiated from pure post-lumbal puncture complaints are reported to occur in up to 28%. The probably underlying pathogenetic mechanisms are discussed together with former animal experiments which revealed a local toxity of the contrast medium at the central nervous tissue and the surrounding membranes.


Venous drainage of the femoral neck in various stages of activity in Perthes' disease. The venous drainage of the femoral neck in 73 children with Perthes' disease was analyzed from intraosseous venography films. 55 contralater symptomless hips were used as controls. In active stages of Perthes' disease, i.e. initial and fragmentation stage, the venous drainage was pathological in 46/55 hips (82%). In the restitution stage the finding was pathological in 7/18 (39%) and in healed Perthes' the venous drainage was normal in all six cases. Two out of the 55 symptomless hips showed pathological venous drainage. The disturbances in the venous drainage of the femoral neck seem to correlate with the stage of activity of Perthes' disease. Along with clinical and radiological signs of restitution the venous drainage seems to return to normal.


Zonography: method of choice in urography. Using zonograms in urography instead of the ordinary films and tomograms makes it possible to visualize the caliceal system as well as the renal contours with 1--2 exposures and limit the total number of exposures to 3--4 and thus markedly reduce the gonad radiation dosis.


Clinical evaluation of different fluid-filled systems for oesophageal manometry. In a clinical study of oesophageal manometry with fluid-filled catheters, both a non-perfused system and a perfused system with a syringe pump have been compared to a system with a low-compliance perfusion pump, which served as a reference. Significantly lower values of motility amplitudes, motility derivatives, and partly of LES pressures, and a time delay of up to 0.5 sec of the amplitude maximum were obtained with the non-perfused system and the system with a syringe pump in comparison to the low-compliance system. Since the oesophageal function can be erroneously evaluated by use of a non-perfused system or a perfused system with a syringe pump, such systems cannot be recommended for clinical use.


Reflex suppression of gastric motility during laparotomy and gastroduodenal nociceptive stimulation. The effects on gastric motility of laparotomy or of nociceptive stimuli directed to the antro-duodenal area were studied in anaesthetized cats. A diathermic lesion of the duodenal or gastric antral wall induced pronounced gastric relaxation, which could either fade off within 0.5--1.5 h or persist for several hours. This gastric relaxatory response persisted after administration of antiadrenergic and anticholinergic drugs but was eliminated by vagotomy or cold blockade of the vagi. Vagotomy performed during the relaxed gastric state after diathermy immediately resulted in a more or less complete recovery of gastric tone. Blunt mechanical stimulation of the duodenum also caused a prompt gastric relaxation, which showed the same characteristics as the response to diathermy as regards the effects of nerve-blocking drugs and vagotomy. The laparotomy incision per se caused temporary inhibition of rhythmic gastric contraction, but this effect was largely abolished if atropine or guanethidine had been given. It is concluded that nociceptive stimuli against the gastric or duodenal wall induce, besides a sympathoadrenergic reflex inhibition of gastric motility, a profound long-lasting gastric relaxation via a reflex activation of the vagal nonadrenergic inhibitory fibres. This vagally mediated relaxation of the stomach is likely to contribute to the suppression of gastric motility seen in 'paralytic ileus'.


Influence of anticholinergic treatment on rat pancreatic protein and amylase concentrations. Pancreatic protein and amylase concentrations were measured after subcutaneous administration of an anticholinergic drug (Pro-Banthine to rats in different doses. In doses comparable to those given in acute pancreatitis an increase of both pancreatic protein and amylase concentrations was found. If pancreatitis is indeed caused or maintained by proteases released from the acinar cell, anticholinergics--giving rise to an accumulation of enzymes within the pancreas--may do more harm than good in the treatment of acute pancreatitis.


Meal-stimulated gastric acid and gastrin secretion before and after jejuno-ileal shunt operation in obese patients. A preliminary report. Meal-stimulated gastric acid secretion was measured by intragastric titration before and after jejuno-ileal bypass operation in five obese patients. Acid secretion was significantly reduced after the operation, particulary during the late phase of the acid response, suggesting that stimulation of acid secretion may be elicited from the upper small intestine by a composite meal. Serum gastrin concentrations remained unchanged after the operation.


A cyto-physiological study of the G-cell secretory cycle in the antrum mucosa of the hamster and of the rat. The secretory cycle of the antral G cell in the golden hamster and in the Wistar rat has been investigated, using classical techniques of optical and electron microscopy associated with special methods (such as goniometry, densitometry, immunohistology, morphometry) and with radioimmunoassay for gastrin. This paper confirms the secretory cycle of the G cell after refeeding. It clarifies the nature of granule polymorphism and suggests a particular mechanism of emiocytosis with sequential granule fusion. Furthermore, our investigations show some dissociations between the G cell, the parietal cycle, and the seric immunoreactive gastrin in the late phase of the secretory cycle (2 to 6 h after refeeding).


A seven-year follow-up of proximal gastric vagotomy. Clinical results. During a 7-year period proximal gastric vagotomy (PGV) was performed in 565 patients. Of these, 210 patients with duodenal ulcer and 14 with dyspepsia without demonstrable ulcer at the time of operation were followed for 5--7 years. Sixty-six percent are symptom-free (Visick I), 23% have no complaints when they take certain dietary measures (Visick II), 3% are improved but still have periods of dyspepsia (Visick III), and 8% are failures because of recurrent ulcer (Visick IV). There were 4 duodenal, 3 pyloric, 5 prepyloric, and 7 lesser-curve gastric recurrences. There were one operative death (0.2%) and one major complication (0.2%). The side effects after PGV are mild, infrequent, and seldom of any significance to the patients. Diarrhoea and dumping are virtually eliminated. Body weight was stable during the whole period of study, and blood chemistry did not disclose any deficiency in haemoglobin, serum iron, or vitamin B12 which might be attributed to PGV. It is concluded that 5--7 years after proximal gastric vagotomy for duodenal ulcer there is a 10% recurrence rate, but the low risk of death and of severe complications and the lack of significant side effects more than outweight the high recurrence rate.


The effects of mepyramine and cimetidine on the motor responses to histamine, cholecystokinin, and gastrin in the fundus and antrum of isolated guinea-pig stomachs. Guinea-pig stomachs were isolated in organ baths, and recordings made of fundal and antral responses. Cholecystokinin (CCK-PZ), 0.38 U/ml, gastrin, 0.05 microgram/ml, and acetylcholine, 10(-4)M, produced typical responses: raised base line in the fundus and increased amplitudes of rhythmic contractions in the antrum. The antral responses to gastrin were too small to quantitate. Both fundal and antral responses to 5 x 10(-4)M histamine consisted of an increase in base line without an alteration in amplitudes. Mepyramine, 3.2 x 10(-5)M, reduced the spontaneous activity in the fundus. It also inhibited fundal responses to gastrin and responses to histamine and CCK-PZ in both pouches. The fundal response to acetylcholine was unaffected by mepyramine, but the antral response seemed to be partially reduced (p less than 0.06). Cimetidine affected neither spontaneous activity nor motor responses. The results indicate that the motor response to histamine is mediated via H1-receptors and that these receptors may also be involved in the fundal response to CCK-PZ and gastrin. The inhibition of the antral responses by mepyramine may be due to unspecific anticholinergic action.


The effect of parietal cell vagotomy and selective vagotomy with pyloroplasty on body weight and dietary habits. A prospective randomized study. Body weight and dietary habits were studied in 32 male patients in a consecutive randomized series of parietal cell vagotomy (PCV) and selective vagotomy with pyloroplasty (SV + P). There were 16 patients in each group. One month after surgery all patients had lost weight. During the first 2 postoperative years following PCV most patients regained their preoperative weight. SV + P led to an impaired ability to gain weight. Following PCV the consumption of fat was reduced but the carbohydrate consumption increased, leading to an unchanged total daily energy intake. The daily energy intake decreased following SV + P in spite of an increased consumption of protein-rich foods such as meat, fish, and eggs. The decreased energy intake was due to a reduced intake of fat, sugar, and milk following SV + P. It is concluded that dumping is a contributory cause of the reduced energy intake following SV + P.


Pressure responses to OP-CCK compared to CCK-PZ in the antrum and fundus of isolated guinea-pig stomachs. To document that the previously demonstrated excitatory effects of cholecystokinin-pancreozymin--about 20% purified and containing approximately 500 U/mg (CCK-PZ 20%)--on isolated guinea-pig antrum and fundus are caused by the hormone itself, and not by impurities, the effect of the synthetic C-terminal octapeptide (OP-CCK) was tested and compared with that of CCK-PZ 20%. The qualitative effects were similar for the two hormones, characterized by increased amplitudes of rhythmic activity in the antrum and by elevated basal tension in the fundus. The calculated maximal responses were about the same for the two substances, but OP-CCK was 3--6 times more potent than CCK-PZ 20%. Atropine and tetrodotoxin markedly reduced the antral response to OP-CCK, while the fundal response was only slightly, but significantly, reduced. This indicates that the antral response to OP-CCK is mediated mainly through local neural cholinergic pathways, while the fundal response is less dependent on these, corresponding to our previous results for CCK-PZ 20%. While previous reports indicate that OP-CCK shares the pharmacological characteristics of partially purified CCK-PZ with regard to its effect on other organs, the present study confirms a corresponding relationship between OP-CCK and CCK-PZ 20% on gastric motility in guinea-pigs, suggesting that the actions of CCK-PZ 20% are displayed by the hormone itself, and not by impurities.


Physiological significance of secretin in the pancreatic bicarbonate secretion. II. Pancreatic bicarbonate response to a physiological increase in plasma secretin concentration. The pancreatic response to physiological concentrations of secretin obtained after minute boluses of exogenous secretin was studied in 16 normal volunteers. Output of bicarbonate into the duodenum was measured by duodenal aspiration in 5 subjects and by endoscopic cannulation of the pancreatic duct in 11 subjects. Pure natural porcine secretin was injected intravenously in doses of 125, 250, and 500 fmol x kg-1 body weight (0.0013, 0.0027, and 0.0054 clinical units x kg-1). All three doses of secretin increased plasma secretin concentration, duodenal bicarbonate concentration, and duodenal bicarbonate output significantly. The bicarbonate output measured by the two techniques did not differ significantly. The increments in median plasma secretin concentration were 1.6, 3.0, and 6.4 pmol x 1(-1) after secretin, 125, 250 and 500 fmol x kg-1, and the corresponding 15-min bicarbonate output 283, 442, and 1435 micromol, respectively. The concentrations of secretin in plasma found after these doses of secretin are of the same order of magnitude as the secretin concentrations found during physiological conditions in man. It is concluded that the physiological concentrations or secretin influence pancreatic bicarbonate secretion.


Renal and cerebral blood flow in experimental liver failure in the pig. The renal and cerebral blood flow was measured in six pigs after total devascularization of the liver. The animals died 21 to 26 h after the operation, with biochemical and electroencephalographic changes compatible with liver failure. The renal blood flow increased slightly, from 2.12 to 2.61 ml.g-1.min-1, throughout the period of observation but did not differ significantly from that of the controls. Conversely, the cerebral blood flow decreased 38%, from 1.30 to 0.80 ml.g-1.min-1, p less than 0.05. The results failed to confirm a simultaneous decrease in cerebral and renal blood flow due to false neurotransmitters in liver failure, as previously suggested. The results do not support the suggested hypothesis that a substance produced by the liver is essential for renal function and perfusion, nor can they confirm that vasoactive material from the gut is responsible for the renal hypoperfusion in liver failure. The absence of renal hypoperfusion in the present preparation might be due to the exclusion of the failing liver from the circulation, giving indirect evidence to the theory that the vasoactive agent(s) responsible for the renal hypoperfusion in liver failure originates in the failing liver itself.


The effect of calcium on hyperoxaluria following jejunoileal bypass in morbid obesity. In order to investigate the effect on urinary oxalic acid excretion, ten patients with jejunoileostomy for morbid obesity were treated with oral calcium. We found a statistically significant decrease. The investigation suggests that the oral administration of calcium alone is not sufficient, in a dosage of 900 mg daily, to normalize the urinary oxalate excretion. The indications for calcium therapy in this group of patients is discussed.


Characteristics of anaemic women. The population study of women in Göteborg 1968-1969. Anaemic women (Hg concentration less than 120 g/l) who participated in a population study of women in Göteborg, Sweden were compared to the women in the population sample as a whole. Due to the way of sampling and a high participation rate the sample was representative of women in Göteborg in the ages studied (age strata between 38 and 60). In the same way the anaemic women were representative of anaemic women in the same general population. Iron deficiency was found to be the main reason for the anaemia in the ages of 38-50 years. Except for big menstrual blood losses in anaemic women no reason for iron deficiency could be found. History of infectious diseases was about as common in anaemic women as in women in the total population sample. Sleeping habits, time off work and physical activity at work and during leisure time were similar in anaemic women and in women in the general population. The proportion of women who reported subjective feeling of tiredness was also similar.


Beneficial effect of granulocyte transfusions in patients with defects in granulocyte function and severe infections. A 3-year-old boy (patient A) with a congenital and a 24-year-old man (patient B) with an acquired granulocyte function defect received supportive granulocyte transfusions for the management of severe infections. The boy had suffered from recurrent infections since bith. His granulocytes showed in vitro almost no chemotactic responsiveness, an impaired phagocytosis and reduced intracellular killing of Candida albicans. Family studies suggested that it was an inherited autosomal recessive defect. The child developed a Pseudomonas pneumonia at the age of 3 years, which did not respond to antibiotic therapy. Granulocyte transfusions were then started and soon after the fever and pneumonia disappeared. Patient B showed the haematological signs of a preleukaemic state. He had 3 recurrent episodes of furunculosis which led each time to cellulitis and septic temperatures accompanied by symptoms of an enterocolitis. Tests of granulocyte function in vitro showed reduced intracellular killing of Staphylococcus aureus. Granulocyte transfusions were started, since no clinical improvement could be attained by antibiotics. With transfusion therapy, fever, cellulitis and enterocolitis disappeared each time.


Factor VIII concentrate prepared from DDAVP stimulated blood donor plasma. Human fraction I-0 (AHF-Kabi) was prepared from plasma from blood donors who had received an i.v. injection of DDAVP (0.2 microgram per kg b.w.) and tranexamic acid (0.01 g per kg b.w.) 15 min before collection of the blood. The factor VIII preparation from such plasma contained twice as much VIII:C,VIIIR:Ag, and VIIIR:RFC as normal fraction I-0. Normal fraction I-0 and DDAVP fraction I-0 were given to 2 patients with severe haemophilia A. The in vivo response of the DDAVP fraction I-0 corresponded to the in vitro values. No differences in survival time were seen. Hence, it is possible to produce factor VIII concentrates with at least double the yield by increasing the factor VIII level in blood donors by i.v. injection of DDAVP.