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Two Chinese brothers who underwent sex-change surgery to female status are described. Early life experiences of the two siblings differed from those of their non-transsexual brothers and sisters. The pre-transsexual males were raised primarily by the maternal grandmother, whereas the others were reared by their parents. Feminine role orientation began during childhood and continued through adolescence. Sex-change surgery was performed during adulthood in two stages, and both patients are currently living as women. With the exception of another article in this journal issue, there are no other reports of transsexualism in male siblings.

A study of treatment practices of pediatric centers managing hereditary fructose intolerance and a review of recent literature on this subject were undertaken in an attempt to establish the degree of dietary liberalization allowable with age and the acceptability of foods containing trace amounts of fructose. The information was needed to plan optimal therapy and thus avoid the consequences of the disorder, namely intestinal dysfunction, metabolic imbalance, and hepatic and renal damage. Fifty responses to 113 letters to centers in Canada and the United States, as well as data from The Hospital for Sick Children, Toronto, Ontario, identified only 29 affected children and provided information on their care, including food lists and literature references. Major principles of treatment were similar, but the approach to allowing and quantifying dietary fructose differed. In response to the apparent need for standardization of treatment, the authors formulated improved recommendations for the control of dietary fructose (less than 1.5 gm/day). Only a few foods of vegetable origin are allowed, including a limited selection of vegetables and cereal products from grain endosperm. Repeated dietary counseling is advocated with regard to allowed foods, sweeteners, and medications to ensure long-term dietary compliance.

The results of the treatment of 89 consecutive cases of Pott's paraplegia admitted to care in Korea are reported. Eighty-five patients were treated conservatively. Four patients underwent costo-transversectomy, three of them in the later stages of treatment without apparent benefit. All patients were followed-up for more than one year, 22 (25%) of them for five years or more. 75 patients (84%) recovered sufficiently to walk unaided. 74 patients (83%) returned to normal life and full activity. 64 of these (72%) were neurologically and functionally completely normal and, at the end of follow-up, the other ten (11%) had minimal persistent neurological signs not affecting life and activity. 54 patients (61%) spent less than six months in hospital and 56 (63%) returned to normal activity within one year of the start of treatment. There were two deaths. 41 patients (46%) deteriorated neurologically during the first two months of treatment, but 37 of these recovered completely. The place of chemotherapy as the basis of the treatment of Pott's disease is emphasised. A comparison is made with the published results of other series. The place of operative intervention is discussed and it is argued that the case for urgent early surgical intervention in the treatment of Pott's paraplegia may have been overstated.

This paper analyses the early postoperative complications after 285 pancreaticoduodenectomies performed during the past 15 years in the Surgical University Clinic, Mannheim. There were 235 partial (Whipple) and 52 total pancreatectomies performed for pancreatic and periampullary tumors (181 patients) and complicated chronic pancreatitis (104 patients). A total of 92 complications requiring relaparotomy in 42 patients ended fatally in nine patients. The overall operative and hospital mortality rate was 3.1%. The most frequent and most dangerous were complications at or around the pancreaticojejunal anastomosis, which occurred 25 times with five deaths. Postoperative hemorrhage was seen in 16 patients; endoscopic treatment in four patients and operation in 12 patients was successful in stopping the bleeding in all but one patient. Eight biliary fistulae either ceased spontaneously (3 patients) or after operative reintervention (5 patients) without any mortality. Control of these complications depends on four lines of approach: (1) before operation: optimal preparation of the jaundiced patient including endoscopic transpapillary decompression of the common duct; (2) during operation: a meticulous and standardized technique is mandatory; (3) after operation: continuous observation in the surgical intensive care unit is essential for the timely detection of possible complications; and (4) early reintervention can salvage the great majority of these patients with deleterious complications.

During 1974-1977, 158 infants of birth weights less than 801 gm were referred from outlying hospitals. The survival rate was 25% for the whole group and 35% for those weighing 700 to 800 gm. Many were in a poor condition on arrival. One hundred and nineteen died. The most common causes of death were intracranial hemorrhage (39), RDS (26), and infection (13). Thirty-seven of the 39 survivors were followed until 18 months postterm. Growth failure was common--57% were below the third percentile in weight, 37% in length, and 17% in head circumference. Three had retrolental fibroplasia. Five children (14%) had major neurologic sequelae. Eight were severely handicapped with a Bayley score of less than 70 and ten were moderately handicapped with a Bayley score between 70 and 84, resulting in a neurodevelopmental handicap rate of 49%. Significant factors correlating with survival and intact outcome were birth weight greater than or equal to 700 gm, gestation greater than or equal to 26 weeks, the absence of asphyxia, and good condition on arrival at the NICU. There was no intact survival below 700 gm birth weight. The handicap rate of survivors between 700 and 800 gm was only 39%. Although intensive care in a referral unit may not be justified for those less than 700 gm, every effort should be made in the care of those 700 to 800 gm.

Circular, full-thickness dermal burn- and freeze-produced wounds were produced in rats to compare the difference in healing between the two types of thermal injuries. Contraction did not occur in wounds (n = 30) caused by freezing, while burn wounds (n = 30) contracted to less than one-third of original size by 21 days after injury. If the centers of the freeze-produced wounds (n = 12) were excised, contraction would then occur and proceed at the same rate as an open wound. Histologically, the degree of initial tissue destruction by the two types of injuries was similar. The burn wound contained only half the amount of collagen found in the freeze-produced wound. There was a greater and more rapid replacement of collagen in the burn wounds. With both injuries, the highest concentration of collagen was found on the fifteenth day and returned to normal by the twenty-eighth day. The burn wound contained three times the amount of collagen in normal skin, while the freeze-produced wound contained only 1 3/4 times the amount in normal skin. Contraction does not seem to occur in the healing of the freeze-injured skin because the slow removal and replacement of the residual matrix prevents contraction.

A syndrome of supravalvular pulmonary stenosis and an abnormal facial appearance is described in 15 children. The auscultatory findings suggest stenosis of the pulmonary valve. The presence of an abnormal facial appearance consisting of hypertelorism, a flat nasal bridge, a prominent upper lip, and low-set ears should suggest the correct diagnosis. Angiocardiography shows a constant, thin, “diaphragm-like” radiolucency in the main pulmonary artery. Physical retardation and left-axis deviation on the electrocardiogram are frequently present. Additional cardiac defects were also noted in one third of this group of children. No etiologic factor could be determined.

SUMMARY The developing hard tissues of the teeth of Echinus esculentus are described and figured, and it is noted that calcification occurs in two forms. Attention is drawn to a structural analogy which appears to exist between these two calcified tissues and the primary tissues of vertebrate teeth, despite certain differences in the chemical analysis. This is considered noteworthy in view of the fact that true teeth are generally associated only with the vertebrates.

A modified double lumen perfusion method has been used to study dibasic amino acid absorption in human jejunum. Results using this method have been compared with those from oral load studies. Using the perfusion method, kinetic constants (Kt and Vmax) for lysine were: Kt 4.9 mM; V max 51.3 μmoles min-1 30 cm and for arginine were: Kt 3.8 mM, V max 46.3 μmoles min-1 30 cm Lysine absorption was compared in normal and cystinuric subjects. A significant difference was seen between these groups when studied by perfusion but not using the oral load method. Furthermore, oral load studies using mixtures of lysine, ornithine, and arginine showed a difference between the groups for arginine but no difference for lysine and ornithine. All three dibasic amino acids appeared to be well absorbed in the cystinuric patients. Possible explanations for these differences and the failure of oral tolerance tests to demonstrate the known transport defect in cystinuria are discussed.

In discussing comparative abortion incidence care must be taken in defining abortion and expression and interpreting statistical data. prevalent in urban than rural areas. gal and illegal abortions and between use of abortion and contraception are very complex and not easily analyzed. Japan Hungary and Britain show that a decline in birthrate is due to pre- and post-conceptive control of fertility. computer analysis of a model population using reversible contraception has shown that at least 25% of couples will have one unplanned pregnancy. ion. sterilized after attaining desired family size. es of legal abortion increases with the duration of pregnancy. Morality rates of illegal or clandestine abortion are difficult to establish. le that the death rate for illegal abortion is approaching 1% whereas in developed countries the rate may be 1 in 1000 or less.

Pulmonary capillary blood flow(Qpc) was measured in 24 term infants (5 hours to 14 days of age) using the infant plethysmograph and nitrous oxide (N2O). The method is a modification of the Lee and DuBois technique, the deep inspiration being replaced by a brief period of rebreathing 60% N2O and 40% O2 from a 100 ml bag. The rate of uptake of N2O is divided by the mean alveolar N2O concentration and the solubility in cord blood to give Qpc. There was a significant increase in Qpc with increasing age from 173 ml/kg/min at 24 hours to 230 ml at 14 days (p < 0.0l). As the method does not measure any shunted blood this change could represent decreasing fetal shunts, but as there was a significant increase in heart rate (125/min at 24 hours to 168/min at 14 days) this seems unlikely. It is suggested that this increase in Qpc follows the known increase in metabolic rate in the newly born infant. In two anesthetized dogs tile mean difference between Qpc measured with this method and pulmonary arterial flow measured directly from a chronically implanted electromagnetic flowmeter was -2.6% S.E.±3.6%.

Effective pulmonary blood flow was measured in 32 normal infants by an indicator gas technique. To check the accuracy of this technique in the absence of shunts, we obtained 39 pairs of measurements of pulmonary blood flow in anesthetized rabbits by the gas technique and dye dilution. The results showed a high degree of correlation between the two methods of measurement (r = 0.986). Effective pulmonary blood flow was 1.1% less than total pulmonary flow (p < 0.005); this difference was attributed to venoarterial shunting through non- ventilated parts of the lung. Measurements of effective pulmonary blood flow in normal newborn infants increased with age. Before 24 hours of age, mean effective pulmonary flow averaged 138 ml/min/kg or less and gradually rose to a mean value of 166 ml/min/kg (±25.6 SE) at a mean age of 81 hours. It is possible that our measurements of effective pulmonary blood flow before 24 hours of age were falsely low because of the presence of clinically undetectable left-to-right shunts.

Epidermoid inclusion cysts are a relatively common finding following superficial trauma. Inclusion cysts have previously been reported following rhinoplasty, but these have been mucosal cysts and one case of a paraffinoma. A case of multiple recurrent epidermoid inclusion cysts, developing in relation to rhinoplasty, is presented.

cytes forming rosettes with sheep erythrocytes and HTL antigen negative lymphocytes interacting with antigenantibody-complement complexes, Clin EXp lmmunol 14:319, 1973. 2. Yata J, and Tsukimoto I: Maturation of cell surface structure of human B. lymphocytes, Lancet 2:1435, 1972. 3. Darzynkiewicz Z, and Jacobson B: HEPES-buffered media in lymphocyte cultures, Proc Soc Exp Biol Med 136:387, 1971. 4. Lar~dolt RF: Das Knochenmark bei Pertussis, Helv Med Acta 2:153, 1945. 5. Morse SI: Studies on the lymphocytosis induced in mice by bordetella pertussis, J Exp Med 121:49, 1965. 6. Morse SI, and Riester SK: Studies on the leukocytosis and lympbocytosis induced by bordetella pertussis. II. The effect of pertussis vaccine on the thoracic duc~ lymph and lymphocytes on mice, J Exp Med 125:619, 1967. 7. Morse S!, and Riester SK: Studies on the leukocytosis and lymphocytosis induced by bordetella pertussis. I. Radioautographic analysis of the circulating cells in mice undergoing pertussis-induced hyperleukocytosis, J Exp Med 125:401, 1967. 8. Miale J B: Laboratory medicine: Hematology, ed 4, St. Louis, 1972, The C. V. Mosby Company, p 906.

The effect of positive end-expiratory pressure (PEEP) on PaO2 during collapse of a single pulmonary lobe was investigated in seven dogs. Increasing PEEP to the ventilated region of lung increased the proportion of cardiac output flowing to the collapsed lobe and decreased PaO2 and pH. PaCO2 increased at the onset of lobar collapse but was not significantly altered by changes in PEEP. In impaired lungs, the benefits of PEEP may be offset by an increase in blood flow to the unventilated region and hence lead to a decrease in PaO2.

Acupuncture is of no use, or for the optimist of perhaps marginal use, in sensorineural hearing loss, contrary to what is popularly described in China. 5% or less of patients with tinnitus are helped. It is of moderate help in certain types of vertigo, acute labyrinthitis and some aspects of Meniere's disease, whilst it is of great benefit in motion sickness.The treatment is of moderate benefit in ‘nasal catarrh’, sinusitis and recurrent tonsillitis. It is the treatment of first choice in most forms of headache.May I take this opportunity to endorse the critical commentary of Dr. Beagley and his colleagues of the Rawson Report as expressed in your Journal and Hearing and also in the B.M.J, I will add a few of my own comments concerning what are, in my opinion, yet further deficiencies of this otherwise informative and well written report.

Oil pollution has been causing damage to bird populations for half-a-century. Owing to increasing precautions that are being taken, it is not clear that despite a vast increase in traffic the position is any worse now than it was before World War II. Information on the full scale and character of the damage is still inadequate, however, and the first need is for many more data. Meanwhile it seems very doubtful whether any bird species in northern Europe is threatened with reduction in numbers on more than a local scale, although locally the damage may be severe. It is argued that the most effective way of combating such reduction is by the further control of pollution and by conservation of the breeding stock to enable it to repair the damage—rather than by the rehabilitation of oiled birds, as it seems doubtful whether this can ever be carried out on a sufficient scale to influence the outcome markedly. The main argument for rehabilitation appears to be a humanitarian one, for the relief of suffering and to avoid the unnecessary slaughter of birds that could be saved. It is suggested that if birds are rehabilitated it is unsatisfactory to release them immediately, when they have become tame and accustomed to be fed, and that the best method of disposal for them may be not to attempt to return them directly to the wild state but to try to establish breeding populations of tame semi-captive birds in protected situations, where they might provide useful objects for study and an ornament to the countryside.

This paper reviews the epidemiology of lung cancer in uranium miners in northern Ontario whose cumulative exposure was relatively low and who were exposed only for a short period of time. The development of the "epidemic" is demonstrated chronologically and in terms of latency. An apparent difference between the effects of short-term and of more prolonged radiation is shown. A dose-response effect is demonstrated at all levels. Analysis of tumor type suggests that there may be a difference in dose-response between the two principal types encountered. The relationship of the geographic location of exposure to the final residence at death is reviewed.

Up till now, leukocytes obtained from blood donations have been the main source of human interferon for clinical use. Production from these has been undertaken almost solely by Cantell and his colleagues in Finland, who have devised a highly efficient process (1). However, to make a large amount of this type of interferon entails that buffy coats are handled from many individual donors, which is laborious and expensive, and makes control relatively difficult. If interferon proves to be of value in even some of the clinical trials that are at present underway, then other sources will have to be found if the demand for interferon is to be met.

The term "late metabolic acidosis" is generally used to define a population of apparently healthy LBW infants who fail to grow and have a base deficit in excess of 5 mEq/l (CO2TOT less than 21 mM). A relationship between hypobasemia and the lack of appropriate growth was postulated. This conclusion was reached, however, in the absence of adequate information regarding the distribution of acid-base variables in healthy LBW infants. The results of this study demonstrate that the CO2TOT of LBW infants (n = 114) rises between birth and three weeks of life from a mean of 18.6 to 20.3 mM. The frequency distribution of CO2TOT values did not show any significant deviations from normality, and 2 SD included values as low as 14.5 mM. No difference in the rate of growth was detected between "hypobasemic" infants given a solution of bicarbonate calculated to bring their blood CO2TOT to greater than 21 mM and those given similar amounts of isotonic saline solution. The ability of the LBW infants to excrete an ammonium chloride load was not related to their acid-base status and was comparable to that of term infants. It is apparent that the definition of late metabolic acidosis needs to be reconsidered.

The sera of 20 random human heart transplant recipients, drawn before the administration of immunosuppressive medications, were screened for the presence of factors that might inhibit the mixed lymphocyte reaction. The donors for the lymphocyte cultures were unrelated both to one another and to the heart donor and recipient. Inhibition was defined as a reduction of the number of transformed cells produced in vitro to less than one-third of that produced in autologous serum. It appears that patients who have had previous heart surgery on bypass fare better with heart transplants than those who have not had surgery. This may indicate some change in the overall physiology of the former class of patients resulting in better acceptance of the transplant. In turn, this could be due to the development of a serum factor or an impairment in the patients' cellular immune systems. In the series of recipients studied, the majority possessed serum inhibitory factors possibly non-specific by-products of their heart failure. The precise nature of these factors has yet to be determined. Future research is planned to determine whether bypass surgery is responsible for the stimulation of new immuno-depressive factors or if in some way it boosts the titer of pre-existing factors.

Since 1953, attempts have been made to develop radioactive drugs. Preparations of tritiated menadiol sodium diphosphate (T-MNDP) of high specific activity showed a definite, though limited, but sometimes useful effect in the treatment of certain patients with advanced tumors, especially adenocarcinoms of the colon and of the pancreas and malignant melanoma of the skin. The next step was to use a much more effective isotope. 6- 125 I-iodo-2-methyl-1,naphthoquinol bis (diammonium phosphate) - abbreviated 6- 125 I-iodo-MNDP- has been synthesized, and in laboratory studies appears more promising. 125 I provides radiations which behave predominantly like high LET radiation, despite the accompanying X and gamma radiations. The astatine analogue, 6- 211 At-astato-2rmethyl-1,4-naphthoquinol bis (disodium phosphate) has also been synthesized. Confirming and greatly extending the earlier findings with T-MNDP, n vitro experiments showed that 6- 125 I-iodo-MNDP is concentrated selectively in the cells of some human malignant tumors by a factor of about 15 to 20 or more in relation to the cells of normal origin that were studied. Macrodosimetric considerations and comparison with clinical treatments with T-MNDP' suggest practical dosage. A typical treatment for a patient of body weight 70 kg with localized inoperable carcinoma of the colon could be 8 intravenous injections each of approximately 120mCi of 6- 125 I-iodo-MNDP to a total of 0.97 Ci in 25 days. Risks of late carcinogenesis and leukemogenesis are calculated to be less than 1 %. Clinical indications are discussed briefly. Animal experiments are in progress and further preclinical studies are required.

A double-blind, parallel group, 7-centre trial was carried out to compare the clinical efficacy and patient acceptability of two formulations of sodium cromoglycate for inhalation in patients suffering from asthma. Each single-dose capsule for use in a breath-actuated inhaler contained either a blend of sodium cromoglycate (20 mg) plus lactose (20 mg) or a lactose-free pelletized formulation of sodium cromoglycate (20 mg). Data were summarized from 529 asthmatic patients who had been using the blend formulation for at least 3 months previously. Two hundred and sixty-five patients then received pelletized sodium cromoglycate and 264 patients remained on sodium cromoglycate plus lactose for at least 3 months. Regular assessments were made by patients and clinicians during the trial period of treatment effectiveness. No clinically significant differences were observed between the two formulations after 3 months on test treatment. After a treatment period of 6 months, the pelletized formulation was shown to have some advantages over the blend formulation which were not observed at 3 months, with a significantly higher proportion of 'very effective' assessments being recorded by both patients and clinicians. The capsules of pelletized sodium cromoglycate required significantly less inhalations to empty compared to the capsules of the blend. No differences were observed between the two formulations with regard to the incidence of transient cough and throat irritation after inhalation.

Fibrous dysplasia is an uncommon bone condition with characteristic radiologic features. It is well known that there is increased uptake of Tc-99m hydroxymethylene diphosphonate (HMDP) and methylene diphosphonate (MDP) in fibrous dysplasia. There are no reports of uptake of Ga-67 citrate by fibrous dysplasia. A case is reported in which positive Ga-67 uptake was seen in a patient with polyostotic fibrous dysplasia.

Otosporin and Gentisone HC ear drops were inserted twice daily for 3 weeks into the external auditory meatuses of guinea pigs. An intraperitoneal injection of vincristine (1 mg/kg.) was given to each animal three hours before it was killed. Temporal bones and attached external auditory meatuses were dissected, tissues were fixed in 10 per cent buffered formalin, decalcified in EDTA, and embedded in JB4 plastic for sectioning at 4 μm. The proliferative activity in the epidermis of the bony meatus and in the lateral surface of the tympanic membrane was obtained by deriving the mitotic indices. After both types of ear drops there was a statistically significant reduction in mitotic indices, the values being about half the control values. The proliferative activity in the tympanic membrane was too low to permit statistical analysis, but no differences were apparent between the groups. The thicknesses of the epidermis and dermis of the bony canal, and of the tympanic membrane, were measured using a Kontron MOP-AM03 analyser. Although the dermis was thinner as a result of the administration of ear drops, both the epidermis of the bony meatus and that of the tympanic membrane were thicker, all these changes being statistically significant.

The concentration of chromium in the hair of thirty-three normal children and nineteen children with juvenileonset diabetes mellitus was measured by atomic absorption 8pectropholometry. The geometric mean for the group of normal children was 0.85 μg./gm.; range (mean ± 2 SD) 0.36 — 1.87 μg./gm., and for the diabetic children, 0.56 μg./gm. (range, 0.26 — 1.19 μg./gm.). Comparison of these results revealed a highly significant difference (p < 0.001) between the two groups.