On the nature of brain stem disorders in severe head injured patients

In head injured patients changes were found in the CSF levels of metabolites of the dopaminergic and the serotonergic neurotransmission (HVA and 5-HIAA). After the fifth day following trauma a significant decrease of the HVA levels in the lumbar CSF after probenecid treatment was found. The intensity of this decrease was found to be related to the severity of the trauma (period of unconsciousness), but not to the state of consciousness. Also the probenecid-induced 5-HIAA levels in conscious patients were decreased after the fifth post-traumatic day. In unconscious patients, the period of unconsciousness, particularly in the period of 5-20 days after trauma. Between 21 and 60 days after trauma the 5-HIAA concentrations in unconscious patients decreased remarkably, but they were still significantly higher than in the conscious patients. It can be concluded that during unconsciousness serotonergic neurons have a high rate of turnover, but that both neurotransmitter systems are damaged by the direct or indirect consequences of the injury.     

Retroperitoneal germinoma marked by elevated serum lactic dehydrogenase

A case of primary retroperitoneal germinoma is presented in which markedly elevated serum lactic dehydrogenase levels were present before diagnosis, but declined to normal with abdominal irradiation. It is the first report of lactic dehydrogenase serving as a tumor marker in germinoma.     

Pathology of acute myocardial infarction with particular reference to occlusive coronary thrombi

Analysis of the pathological findings in 500 cases of fatal acute myocardial infarction showed that in 469 this was localized to one transmural area of the left ventricle; in 31 there was diffuse subendocardial necrosis. In the former occlusive coronary thrombus was found in the related artery in 95 per cent of cases. Variation in the percentage of occlusions found was noted between different prosectors and when coronary artery calcification was present. Only 4 of the 31 patients with subendocardial necrosis had recent occlusion; triple vessel disease was common in this group suggesting general failure of coronary perfusion. It is essential in necropsy studies of the relation of coronary thrombosis to myocardial infarction to be sure that muscle necrosis is present, to distinguish the two forms of myocardial necrosis, and to employ a meticulous dissection technique with decalcification of the arteries when necessary.     

The genetics of specific reading disability

Members of the immediate families of twenty children with specific reading disability were examined to determine the prevalence of reading disability within the families. A procedure was developed for identifying adults who may have compensated for a disability manifested more clearly in childhood. Forty-five percent of 75 first-degree relatives of the parents were affected and there was a significantly greater number of affected male relatives than females. No single mode of genetic transmission is evident after inspection of the pedigrees. It is suggested that the disorder is genetically heterogeneous and that subgroups of disabled readers should be looked for.     

Long-term low-dose co-trimoxazole in prophylaxis of childhood urinary tract infection: clinical aspects

Long-term low-dosage prophylaxis may be used in children with recurrent urinary tract infection to prevent reinfection of the urinary tract while the underlying cause of infection persists. Co-trimoxazole in a dose of 2 mg trimethoprin combined with 10 mg sulphamethoxazole per kg body weight daily has proved very effective: only six of 130 children receiving this treatment during a total period of 2637 months developed a reinfection. Co-trimoxazole was acceptable, compliance was good, and there were no important adverse effects. Supportive measures during prophylaxis are important. Sixty-five children were follow up after completion of their co-trimoxazole prophylaxis. Twenty-seven developed reinfections with fresh organisms, over two-thirds occurring within three months of discontinuing prophylaxis. Each one of these reinfections was sensitive to trimethoprin. The rectal flora were similarly sensitive.     

Melanoblastoma of the rectum

Vroom's (1964) expectancy theory model was used to predict older workers' choices between continued employment or immediate retirement. It was hypothesized that a person's preference for one of the two alternatives would be a function of the differences between the instrumentality of employment and the instrumentality of retirement for the attainment of outcomes, multiplied by the valence of each outcome, summed over outcomes. To test this, 290 Israeli male workers, aged 57 to 64, were interviewed. Measures included: preference for employment or retirement; valences of 35 outcomes; perceived instrumentalities of employment and retirement. The results supported the hypothesis (R = .40; p less than .01). It is suggested that further research along these lines could equip organizations with a tool for assisting older employees in the transition to retirement or for encouraging those who are still capable of making a significant contribution to remain employed.     

Ischemic therapy in thrombocytopenia from hypersplenism

Percutaneous transfemoral arterial balloon occlusion or gelatin sponge embolization of the splenic artery or both were carried out in three high-risk patients with hepatic cirrhosis to reduce splenic hyperfunction and improve severe thrombocytopenia. Although this maneuver raised peripheral platelet counts in each patient, in one patient left upper quadrant pain with splinting of the lower chest cage led to hypostatic lower lobe pneumonia, while in another septic splentitis with gas-forming organisms necessitated splecectomy. Transfemoral occlusion of the splenic artery, although an effective, noninvasive approach to control splenic hyperfunction, has at the same time potential dangers that should be viewed with extreme caution in therapeutic application.     

Differing effects of the vasodilator drugs, prazosin and diazoxide on plasma renin activity in the dog

1. The effects of intravenous (i.v.) administration of the vasodilator drugs prazosin or diazoxide on blood pressure and plasma renin activity were evaluated in the anaesthetized dog. 2. Prazosin and diazoxide both induced a rapid reduction in the mean arterial pressure to 73% and 75% of control values respectively. 3. Prazosin lowered plasma renin activity to 62% (P less than 0-025) of the control value whereas diazoxide raised plasma renin activity to 178% (P less than 0.05) of the control value. 4. The combination of vasodilatation and low renin activity observed following the administration of prazosin is unique, and may have clinical significance if these factors reduce the vascular complications of hypertension.