[Indication and significance of radiological measurement methods in diseases of the spine (author's transl)]

The most informative and valuable measuring methods in vertebral body disease have been reviewed and their usefulness in orthopaedic and radiological problems analysed. The methods described here are useful to assess the severity and progress of spinal disease.

Effects of very low versus standard dose acetyl salicylic acid, dipyridamole and sulfinpyrazone on platelet function and thromboxane formation in man

The effects of three conventional antiplatelet regimes, dipyridamole 3 X 75 mg/day (D), sulfinpyrazone 4 X 200 mg/day (S), acetylsalicylic acid 3 X 330 mg/day combined with dipyridamole 3 X 75 mg/day (ASA + D), and very low dose acetylsalicylic acid 100 mg/day (ASA) on platelet function were studied in man following 4 days of treatment. D and S slightly increased mean minimal ADP concentration for irreversible aggregation (n.s.), S reduced aggregation and thromboxane (TXB2) formation on low dose collagen (2P less than or equal to 0.05), ASA and ASA + D increased platelet count (2P less than or equal to 0.05), increased bleeding time (n.s. for ASA, 2P less than or equal to 0.05 for ASA + D), abolished irreversible aggregation on ADP, suppressed TXB2 formation on all (2P less than or equal to 0.001) and aggregation on lower concentrations of collagen (2P less than or equal to 0.01) and abolished aggregation and TXB2 formation on arachidonic acid (2P less than or equal to 0.001). Very low dose ASA suppresses platelet aggregation and TXB2 formation on several stimuli of possible physiologic significance. In the light of a recently proposed critical balance of vascular antiaggregatory prostacyclin and platelet proaggregatory TXA2 very low dose ASA might offer advantages over conventional dosage of ASA and should be evaluated in thromboembolic disorders.

Complications of cervical discography

Two unusual cases of complications following discography are reported. In the first case cervical discography was performed because of recurrent shoulder-arm-syndrome. The examination was performed on an outpatient basis. Acute cervical spondylodiscitis developed 48 hours later and some symptoms persisted for a 15 months period. In this case the bacterial aetiology of discitis was very likely. In the second case quadriplegia developed within seconds after injection of the contrast medium into the intervertebral space. During the injection the patient reported severe pain in the arm. During the operation sequestrated parts of the intravertebral disc were found in the spinal canal, dorsal to the posterior longitudinal ligament. Most likely additional sequestrated parts of the degenerated disc were pushed into the spinal canal during the examination. Slow recovery of neurological defects took place after the operation.

Air conditioning systems

There are some basic requirements for air conditioning systems in operating theatres. 1. Obviously the regulation of temperature and humidity is necessary, but cleaning of fresh air and circulating air is much more important. 2. Concerning cleaning, a high standard of filtration of air is demanded to avoid contamination of wounds. 3. So far only HEPA-filters, a technical description, give security and safety. They filter particles down to under 1 micrometer and have a filtration rate of more than 99.9%. 4. The ventilation rate is directly related to the germ concentration in the air. The higher the ventilation rate the cleaner the air during working. 5. To avoid turbulences unidirectional or uniform flow is necessary. This technique has become popular as the laminar flow technique. To get such a flow an air flow velocity of 0 45 +/- 0.1 m/s is necessary. 6. The arrangement of the different working places in an operating theatre is very important. Instrument tables and the operation field itself have to be in the zone of first air. 7. One of the commonest germ dispersion sources is the human body. Proper dressing and behaviour have to be observed. The airflow behind a person (in laminar cross flow) or under a person (in laminar down flow for instance when the neurosurgeon bends his head over the operating field) has to be regarded as contaminated. 8. Hygienic controls must be made in the operation theatre when unused and also under working conditions, in a sophisticated manner. If all these points are respected a real clean room technique is possible with considerable lowering of the risk of infection for the patient. Obviously all the other rules of hygiene, i.e., asepsis and antisepsis, elaborated since the days of Lister, have to be strictly respected.

[Methotrexate resistance in acute lymphatic leukemia treated intrathecally]

During intrathecal methotrexate therapy of meningeal manifestations of acute lymphatic leukemia, renewed occurrence of lymphoblasts in the cerebrospinal fluid cell picture developed in two women. Prompt clearance could be attained by application of cytosine arabinoside. Methotrexate-resistance as one reason is discussed. The value of differentiated cerebrospinal fluid cell investigations for diagnosis and treatment of meningeal leukemia is pointed out. Neuralgic pain syndrome due to neoplastic neuropathy by direct infiltration of peripheral nerves are discussed, therapeutic measures pointed out.

Clinical and Endocrinological findings in ectopic pinealoma and spongioblastoma of the hypothalamus

Cystic spongioblastoma and ectopic pinealoma occurring simultaneously were found in a 16-year-old male patient, and produced destruction of the hypothalamus. The clinical course extended for over four years. The clinical picture was characterized by a defect of osmo- and thermoregulation and by defective function of diencephalic nuclei and the sympathetic nervous system. The releasing factors for ACTH, TSH, LH, and FSH were lacking and produced corresponding disturbances of pituitary function. Because of the lack of hypothalamic inhibiting factors the prolactin level was increased, and the HGH level was stimulated by arginine loading and inhibited in the glucose test. The intact neurones in the ventromedial nucleus of the hypothalamus could be seen on microscopical examination. Clinical and endrocrinological findings were more suggestive of the diagnosis than the radiological ones. Computerized tomography showed multiple "tumour" localizations without any displacement signs. The occurrence of ectopic pinealoma and spongioblastoma in the same case would suggest, from the pathological point of view, a common dysontogenetic origin developing from the local elements of the nervous tissue.

[Intracranial pressure increase following treatment nalidixic acid in a child aged 3 1/2 years (author's transl)]

Neurological symptoms developed in a girl aged three-and-a-half years during treatment with nalidixic acid. The symptoms progressed even after the preparation had been discontinued, and culminated in the development of a transient intracranial pressure increase.

Cytostatic treatment of meningeal blastoses

Intrathecal treatment with MTX was attempted in patients with diffuse meningeal blastoses. As a rule, symptoms and clinical findings improved rapidly. As objective parameters, the differential cell pictures of the CSF showed dissimilar results during therapy (25 mg MTX weekly i.t.). In leukoses (n = 10) and malignant lymphomas (n = 12), the CSF could be cleared with three exceptions which concerned differentiated tumors. The success was similarly good with meningeal dissemination of a seminoma. Meningeal carcinoses with mammary carcinoma (n = 7) and melanoma (n = 2) showed dissimilar results. No alteration of the cytograms of four bronchial carcinomas and one colon carcinoma was demonstrable. Besides the growth form, the degree of differentiation appears to be decisive for the success of therapy. The labeling index appears to be a useful indicator. Since symptoms and clinical findings often markedly improve even when a success cannot be objectively detected cytologically, an attempt at therapy is always to be recommended.

Effects of calcium, lanthanum, and bicarbonate ion on epinephrine modification of insulin release in vitro

The role of calcium flux in mediating epinephrine modification of insulin release was investigated by using lanthanum, an inhibitor of calcium flux, in the in vitro perifusion system. Lanthanum inhibits insulin secretion stimulated by glucose and by acetylcholine to basal levels. Epinephrine and lanthanum have additive effects in inhibiting insulin secretion to glucose stimulation. The effect of epinephrine prestimulation on insulin secretion to subsequent glucose challenge varies markedly, depending on the presence or absence of bicarbonate ion: epinephrine priming is reversed in the absence of bicarbonate, and effect possibly related to reduced calcium uptake. In the presence of bicarbonate, lanthanum blocks the priming effect of epinephrine on insulin secretion. The data further support the postulated role of calcium in adrenergic effects on beta cell function.

[Morphometry and histology of the eye of Callimico goeldii (Thomas 1904, callimiconidae primates) (author's transl)]

The histologic anatomy of the eye of Callimico goeldii is described and histometric data are communicated. The retina is treated with special attention. The eye of Callimico features all characteristics of a visual organ adapted to diurnal activity as is known from many higher primates and man. The well-differentiated Fovea centralis and the numerical relations of the three retinal neurons, which are clearly reduced from the periphery towards the center of the retina, indicate a particularly high degree of centralization ("Zentralisationsstufe" sensu Rohen). Similar numerical relations are found in the taxonomically related families Cebidae and Callithrichidae. A high degree of centralization is understood to facilitate a good visual resolution. The eyelid apparatus is differentiated like in other higher primates. The eye muscles contain extraordinarily many nervous-muscular entities that are interpreted to serve as nervous regulatory functions. The histologic results relate well with certain behavioral phenomena of this species.

Familial basal cell nevus syndrome

The basal cell nevus syndrome is characterized by multiple basal cell nevi and basal cell carcinoma, cysts of the jaw, anomalies of ribs and spine, abnormal calcifications, and additional anomalies of the facial skull. A German family is described with manifestations of the syndrome in the mother and her three daughters. Expressivity was variable, in part due to age effects. The observation conforms to the assumed autosomal dominant mode of inheritance with high penetrance.

Variability of the respiratory phase, respiratory pause, and numbers and durations of respirations during periodic breathing

The analysis of cycles of periodic breathing (Cheyne-Stokes rhythms) in 35 patients showed wide variability of mean values of respiratory phases. The respiratory pauses are usually shorter and the scatter of the mean values is smaller. Only in four cases were respiratory pauses longer than respiratory phases. The duration of the respiratory phase becomes extended through the increase of number of single respirations. The latter also shows a very small scatter. The respiratory rate in 32 out of 35 patients was higher than normal and is to be considered as tachypnoea.

The stress at the human atlanto-occipital joint. I. the development of the occipital condyle

The development of the occipital condyle has been observed in human fetuses, neonates, children, and juveniles. In contrast to some authorities, the authors believe the occipital condyle to originate from the basioccipital and the exoccipital of the occipital bone. The bony parts of the condyle are divided by the synchondrosis intraoccipitalis anterior. The rostral area on the basioccipital occupies about one-fourth to one-seventh of the surface of the subchondral bone. The sequence and mode of ossification of the synchondrosis intraoccipitalis anterior has been investigated. A causality between the synchondrosis and the occasionally observed subdivisions of the articular surface in the adult does not exist.

Duration of the respiratory periods of uniform respiratory rhythms in 35 patients with neurosurgical diseases

Analysis of uniform respiratory rhythms in 35 neurosurgical patients showed that the mean duration of respiratory periods was between 8.60 and 71.51 seconds. The scatter around the mean value increases with the increase of the duration of the respiratory period. For an individual patient there is a one-peak distribution of the duration of respiratory periods. The duration of respiratory periods increases with age. There is a group of patients in whom the respiratory periods last over 40 seconds. This group is difficult to classify. There are no correlations between the acid-base values, blood gas values, and the duration of respiratory periods. Analysis of 10 autopsy cases showed lesions in the brain stem without any particular prevalence.

The definition of "Cheyne-Stokes rhythms"

The review of the literature on Cheyne-Stokes respiratory periods reveals enormous variation of the opinions expressed. The original description concerned periodicity characterized by rhythmic changes of respiratory phases and respiratory pauses in a relation of 60 : 15 seconds. In the respiratory phase there were 30 respirations of increasing depths and frequency at the beginning of the phase and decreasing depths and frequency at the end of the phase. Literature data about Cheyne-Stokes respiration comprise a multiplicity of all rhythymic forms. The duration of respiratory cycles varies between 12 and 130 seconds. The relation of the respiratory phase and respiratory pause between 6 : 4 or 75 : 70 seconds, and the number of breaths between 3 and 30 during one respiratory phase. Cheyne-Stokes periods were observed in health subjects as well as in patients with neurological, neurosurgical, cardiac, pulmonary and paediatric diseases. Cheyne-Stokes periods were explained as sequel of prolongation of circulation time between pulmonary alveoli and respiratory centre, through increased sensitivity of the respiratory centre to CO2, diminished sensitivity of the respiratory centre to CO2 and O2-deficit, local blood flow disturbances, section of pathways in the brain stem with disinhibition of basic rhythms, brain immaturity, alterations of consciousness, and respiratory obstructions. Rhythmic changes of the heart beat, of excitability of the heart muscle, of blood pressure, of EEG and of neurological and mental signs were observed. In spite of numerous observations detailed analysis of the respiratory cycle was performed in only a few cases. Major studies are lacking.

Testing the mutagenic potency of chemical substances in a linear host-mediated assay. I. Experimental microbiological basis

By the use of the mutagenic substance hydrazine sulphate it is shown that the currently used single determination method for determining point mutations in host-mediated assays with calculation of mutation frequencies can lead to erroneous results. The microbiological basis for a linear-method is presented in which the population growth of the auxotrophic and substance-induced mutants used int he test can be described mathematically during their logarithmic growth phase with regression lines.

Notes on reproduction in captive squirrel monkeys (Saimiri sciureus)

Over a 6-year period, a colony of Saimiri was established for experimental behavioral research. Heterosexual pair housing prevailed, and a number of offspring was produced. Females apparently underwent a lengthy adjustment process, inasmuch as viable infant production was infrequent until the female had been paired for three breeding seasons. Males required only a short period of adjustment, if any, to become effective breeders. Breeding was seasonal and births occurred during the summer. The mean maximum gestation for five females who delivered in one year was 162.6 days (range 152-168 days, n = 5). The short gestations for some of these females relative to those previously reported by other investigators suggest a broad range of variability in gestation for this species. The possibility that some of these five females conceived very soon after being paired with males is discussed with regard to social and coital influences on ovulation.

Giant cell aortitis in a South American monkey (Callimico goeldii)

Changes consistent with those of giant cell arteritis were found in the ascending aorta of a mature male South American monkey, Callimico goeldii. The essential change was necrosis of the tunica media with associated granulomatous inflammatory reaction. There also were compensatory fibroelastic thickening of the tunica intima and lymphocytic-plasmacytic cellular infiltrations of the tunica adventitia. The animal presented clinical signs of a respiratory infection 8 weeks before it died from circulatory insufficiency.

Goeldi's monkey Callimico goeldii Thomas 1904 preying on snakes

Two wild-born adult Callimico males showed a skillful performance in killing a small eastern ribbon snake (Thamnophis s. sauritus); in both instances the snake was eaten; to date only capuchins (Cebus spec.) were known to kill and eat snakes. The killing action was very similar to the killing of lizards but differed from preying on frogs. This gives us evidence that small snakes may represent relationship a source of protein for some Callimico in the wild. At the same time a new aspect of the relationship between snakes and noahuman primates is indicated.