[Critieria of brain death (personal opinions)]

The study reviews the literature dealing with cerebral death and raises some problems, not yet discussed in the literature, such as those in connection with the decerebrated pregnant woman, of which the following ones are stressed: 1. The pregnancy can continue in the decerebrated woman. If the answer is affirmative, development of the pregnancy represents represents a test of particular biological value in assessing the efficiency of ressuscitation therapy; 2. What are the effects of hipoxyia that led to decerebration of the mother on the psychosomatic development of the child, and the possibility to evaluate it in correlation with the age of the pregnancy; 3. What are the effects of prolonged forced ventilation and the artificial feeding on the development of the pregnancy? The study ends with concrete proposals for establishing criteria for cerebral death, stressing the need for an adequate juridical frame for organ transplantation.

[Malignant hepatoma (clinical, biological and morphological comparisons)]

The authors make an analysis of 8 cases of malignant hepatoma discovered in 20 362 surgical patients between 1965 and 1975. The analysis of these cases allowed to conclude as follows: 1). In the presence of chronic digestive disturbances, or of hepato-splenomegaly, accompanied by progressive deterioration of the general condition of the patient, and of the use of large amounts of analgetic drugs, one should consider more than usually the possibility of hepatic neoplasia. 2). The first element to be considered in the frame of diagnosis of malignant hepatomas should be the morphological one. Of practical value in the diagnostic are the following: hepatic scintigraphy, angiography and bioptic laparotomy. 3). Of the conventional biologic tests (including the immunological tests), evaluation of serum alpha-foetoprotein is the only one with an orientative diagnostic value.

[Herpetic etiology of gastric and duodenal ulcer. II. Study in humans]

By inducing experimental ulcers in the rabbit with the type 1 Herpes simplex strain, isolated from the herpes vesicles from a vagotomized patient, the authors demonstrate the protective role of vagotomy, the ulcerogenic capacity of the virus, which can be considered as an etiological factor of human gastroduodenal ulceration. They also discuss the possibilities for a new medical therapy of this disturbance.

[General anesthesia in endoscopic examination of the digestive tract]

The authors made an analysis of 165 general anesthesias applied in the digestive fibroendoscopy and they establish the technology and the indications of this method, as follows: 1) uncooperative patient (in this category should be included children, psychopaths, mentally deficient subjects and a certain category of neurotics); 2) when difficult endofibroscopies are to be expected, during which therapeutic procedures are highly probable, such as resection of polyps, coagulation of bleeding surfaces etc.; 3) lack of tolerance to local anesthetics; 4) optimal instruction conditions should be provided for the beginner anesthesist; 5) the authors recommend that all such anesthesies should be carried out in hospital only. They also suggest as the most reliable technique the intra-venous general anesthesia and the oro-tracheal intubation of the patient.

Awake tracheal intubation in anaesthesia

Endotracheal intubation in the awake patient was used on 500 occasions. Indications and results are discussed and analysed.

Pregnancy and pulmonary tuberculosis

There are 1565 premature and full-term deliveries in patients with tuberculosis at The New York Hospital included in this report. About 10% of the patients had active pulmonary tuberculosis immediately before or during gestation. The obstetric management of the patient with inactive tuberculosis is similar to that of the nontuberculous woman. In patients with active or recently active tuberculosis, delivery under regional anesthesia, with forceps when necessary to avoid excessive straining during the second stage of labor, is advised. Tuberculosis is not an indication for cesarean section. Chemotherapy is now the cornerstone of all therapy for tuberculosis; the various regimens and modifications depend on the type and extent of the disease. The best combination of drugs is isoniazid and ethambutol. Therapy in all cases must be multiple drug, continuous, and long-term. Prophylactic isoniazid is used infrequently during pregnancy and only in special circumstances. Results of treatment with the newer antituberculosis drugs show that the disease progressed in less than 1% of patients between 1957 and 1972 compared to 3 to 4% of patients from 1933 to 1956. Infants born to the 1565 tuberculous mothers reported here were of average weight, and none of the 1588 infants (23 sets of twins) had congenital tuberculosis. Patients should be carefully followed postpartum with sputum tests and x-rays. They should also be given medical and socioeconomic counseling.

[The value of non-specific general therapy of shock caused by acute pancreatitis]

The shock in general, including that of acute pancreatitis, presents, according to our conception, as an energetic disease involving primarily the cell (by the intensive catabolic processes induced by the pancreatic lesion) and secondarily the most peripheral and mobile sector, that of the hemodynamic compartment. There is no etiological treatment of pancreatitis (the exceptions are very rare), and this is the reason for which we adopt a conservative attitude, and medical treatment, in the acute stage of the disease. The basic treatment of the shock of acute pancreatitis is considered to be the re-establishment of the circulatory volume with the aid of non-colloidal isotonic solutions that are given in large amounts (8-17 liters in a 24-hour period) under continuous perfusion. This technique is called hyperhydration or transrenal dialysis. Making use of this technique in the treatment of shock occurring in the course of acute pancreatitis the death-rate recorded was as low as 2,3% and the number of complications was very low.

The synthesis of 3, 6-di-O-(2-acetamido-2-deoxy-beta-D-glucopyranosyl)-D-galactose, a branched trisaccharide reported as a hydrolysis product of blood-group substances

Protected disaccharides were the only products that could be isolated after condensation of 3, 4, 6-tri-O-acetyl-2-deoxy-2-diphenoxyphosphoramido-alpha-D-glucopyranosyl bromide or 2-acetamido-3, 4, 6-tri-O-acetyl-2-deoxy-alpha-D-glucopyranosyl chloride with benzyl 2, 4-di-O-benzyl-beta-D-galactopyranoside. On the other hand, reaction of 2-methyl-(3, 4, 6-tri-O-acetyl-1, 2-dideoxy-alpha-D-glucopyrano)-[2', 1': 4, 5]-2-oxazoline (6 moles) with the same galactopyranoside (1 mole) gave benzyl 3, 6-di-O-(2-acetamido-3, 4, 6-tri-O-acetyl-beta-D-glucopyranosyl)-2, 4-di-O-benzyl-beta-D-galactopyranoside, which was converted, by alkaline methanolysis followed by hydrogenolysis, to the title compound. This appears identical with an oligosaccharide previously obtained through degredation of a blood-group A glycoprotein from hog gastric mucin.