Effect of genetic and nongenetic factors on chemical composition of individual milk samples from dromedary camels (Camelus dromedarius) under intensive management.

The aims of the present study were to monitor the changes in gross chemical composition of individual dromedary camel milk over a 5-yr period, to provide reference values, and to determine the effect of genetic and nongenetic factors influencing camel milk composition under intensive management. A total of 1,528 lactating dromedary camels were included in the study. Animals were fed a constant diet and were milked twice a day in a herringbone parlor. Milk samples were collected at monthly intervals using a sampling device and then fat, protein, lactose, total solids (TS), and solids-nonfat (SNF) concentrations of raw camel milk were determined with an automatic milk analyzer. For each milk sample, production parameters were recorded and quantities (grams) of milk constituents were calculated. The overall mean quantity and fat, protein, lactose, SNF, and TS concentrations of the morning milk were 4.0 kg, 2.58%, 2.95%, 4.19%, 8.08%, and 10.46%, respectively. Milk quantity showed a positive correlation with lactose and a negative correlation with all other components. Parity exerted a strong effect on all milk parameters. Primiparous dromedaries (n = 60) produced less milk with higher concentrations of components than did multiparous animals (n = 1,468). Milk composition varied among the 7 breeds tested, but none of the genotypes was found to be superior to the others in this respect. We detected a significant, yet small calf sex-biased difference in milk yield and composition. Stage of lactation and season strongly influenced milk yield and all milk components. We also found a significant interaction between month postpartum (mPP) and month of the year. The concentration of all milk components decreased from 1 to 5 mPP. Later, lactose concentration and quantity continued to decrease parallel with decreasing milk production. The concentration of other components showed a temporary increase in mid lactation, from 6 to 11 mPP, and in late lactation, from 18 to 23 mPP. Mean fat, protein, SNF, and TS concentrations showed a high seasonal variation (9.5 to 28.7%), with the lowest and highest values being measured during summer and winter, respectively. This seasonal variation was independent of nutrition and may reflect an endogenous circannual rhythm. We observed a noticeable variation among years. Dromedary camels could provide a useful in vivo model to study the homeorhetic regulation of mammary cell function by endogenous and environmental factors.

Effect of pregnancy and embryonic mortality on milk production in dromedary camels (Camelus dromedarius).

The main objective of the present study was to compare milk production in pregnant versus nonpregnant dromedary camels. In addition, we described the effect of embryonic mortality on lactation and measured serum progesterone levels until d 60 to 90 of gestation. Twenty-five multiparous camels were selected in midlactation for 2 studies in consecutive years. Camels were mated naturally when the size of the dominant follicle reached 1.2 to 1.5cm. Pregnancy was diagnosed by ultrasonography and progesterone determination. In the first experiment (Exp 1), 8 of 11 animals conceived at 284±21.5d postpartum. Three pregnant dromedaries were given PGF2α to induce luteolysis and pregnancy loss on d 62 and spontaneous embryonic loss was detected in 2 camels (on d 27 and 60). Animals were allotted to 3 groups retrospectively: nonpregnant camels (group 1, n=4), pregnant camels (group 2; n=3), and camels with embryonic loss after d 55 (group 3; n=4). In the second study (Exp 2), 14 dromedaries were mated during midlactation. Seven of them failed to conceive (group 1) and 7 became pregnant (group 2). No embryonic loss was detected in Exp 2. Turning points in milk production were identified by change point analysis. In nonpregnant dromedaries (group 1), milk decreased slowly over time without significant change point. In pregnant camels (group 2), a gradual decline until 4 wk after mating was followed by a sudden drop, and the change point model resulted in one breakpoint at d 28±7 and 35±3 of gestation in Exp 1 and Exp 2, respectively. In camels with embryonic mortality (group 3, Exp 1), milk yield started to decline similarly as in pregnant animals, but milk production increased gradually after embryonic loss and reached similar levels as in their nonpregnant herdmates. Change point analysis for group 3 resulted in 2 turning points at 30±4 and 48±4d after conception. Mean length of lactation was shorter by 230 (34.2%) and by 249d (37.6%) and mean total lactation production was decreased by 1,532 (31.6%) and 2,151 kg (44.3%) in pregnant compared with nonpregnant camels in Exp 1 and Exp 2, respectively. We concluded that the calving interval can be shortened by mating during midlactation. However, pregnancy has a strong negative effect on milk production as dromedaries stop lactating by the fourth month of gestation. Following embryonic mortality within 3mo of conception, milk production is restored.

Microbiological quality and somatic cell count in bulk milk of dromedary camels (Camelus dromedarius): descriptive statistics, correlations, and factors of variation.

The objectives of the present study were to monitor the microbiological quality and somatic cell count (SCC) of bulk tank milk at the world's first large-scale camel dairy farm for a 2-yr period, to compare the results of 2 methods for the enumeration of SCC, to evaluate correlation among milk quality indicators, and to determine the effect of specific factors (year, season, stage of lactation, and level of production) on milk quality indicators. The study was conducted from January 2008 to January 2010. Total viable count (TVC), coliform count (CC), California Mastitis Test (CMT) score, and SCC were determined from daily bulk milk samples. Somatic cell count was measured by using a direct microscopic method and with an automatic cell counter. In addition, production parameters [total daily milk production (TDM, kg), number of milking camels (NMC), average milk per camel (AMC, kg)] and stage of lactation (average postpartum days, PPD) were recorded for each test day. A strong correlation (r=0.33) was found between the 2 methods for SCC enumeration; however, values derived using the microscopic method were higher. The geometric means of SCC and TVC were 394×10(3) cells/mL and 5,157 cfu/mL during the observation period, respectively. Somatic cell count was >500×10(3) cells/mL on 14.6% (106/725) and TVC was >10×10(3) cfu/mL on 4.0% (30/742) of the test days. Both milk quality indicators had a distinct seasonal pattern. For log SCC, the mean was lowest in summer and highest in autumn. The seasonal pattern of log TVC was slightly different, with the lowest values being recorded during the spring. The monthly mean TVC pattern showed a clear difference between years. Coliform count was <10 cfu/mL in most of the samples (709/742, 95.6%). A positive correlation was found between log SCC and log TVC (r=0.32), between log SCC and CMT score (r=0.26), and between log TVC and CC in yr 1 (r=0.30). All production parameters and stage of lactation showed strong seasonal variation. Log SCC was negatively correlated with TDM (r=-0.35), AMC (r=-0.37), and NMC (r=-0.15) and positively correlated with PPD (r=0.40). Log TVC had a negative correlation with AMC (r=-0.40) but a positive correlation with NMC (r=0.32), TDM (r=0.16), and PPD (r=0.45). The linear mixed model with stepwise variable selection showed that the main sources of log SCC variation were PPD, TDM, PPD × season, and season. For log TVC, the same factors and year contributed to the variation.

Quantitative Phase-Contrast MR Angiography to Measure Hemodynamic Changes in Idiopathic Intracranial Hypertension.

BACKGROUND AND PURPOSE: Idiopathic intracranial hypertension is a syndrome of raised intracranial pressure of unknown etiology. Few MR imaging-based studies have investigated arterial and venous blood flow in these patients. Results are inconclusive, and to our knowledge, no comparison of the hemodynamic parameters before and after CSF pressure reduction has been published. The aim of this study was to assess the short-term effects of normalizing CSF pressure on intracranial flow to better understand the pathophysiology of idiopathic intracranial hypertension. MATERIALS AND METHODS: In this study, we performed quantitative MR imaging-derived flow measurements of brain-supplying arteries and draining veins/dural sinuses to visualize hemodynamic changes in patients with idiopathic intracranial hypertension before and after therapy by lumbar puncture in comparison with a healthy control group. RESULTS: We found differences in patients before and after lumbar puncture in the calculated resistance and pulsatility indices in the superior sagittal sinus. Venous pulsatility showed a negative correlation with CSF pressure in untreated patients. Additionally, there was a trend toward lower flow in the superior sagittal sinus in patients compared with healthy controls. Flow in the internal jugular veins was significantly reduced by lumbar puncture, and the resistance and pulsatility indices differed in patients and controls. The arterial flow was not influenced by pressure normalization. CONCLUSIONS: The results of the present study indicate that venous but not arterial blood flow differs in patients compared with controls and that calculating resistance and pulsatility indices may contribute to assessing short-term hemodynamic changes in patients with diagnosed idiopathic intracranial hypertension before and after CSF diversion.

Sleep disordered breathing in medically stable patients with myasthenia gravis.

We investigate sleep and breathing in clinically stable myasthenia gravis (MG) patients and ask weather sleep disordered breathing (SDB) is causally linked with MG. Nineteen MG patients with a mean disease duration of 9.7 years underwent sleep studies in two consecutive nights. The primary outcome measure was the respiratory disturbance index (RDI) in terms of snoring and apneas/hypopneas. Further outcome measurements were total sleep time, sleep stage distribution and the number of arousals. A clinically relevant SDB in terms of obstructive sleep apnea (OSA) (defined as RDI > 10/h) was found in four patients. There were only a few central apneas (central apnea index: 0.19 +/- 0.4/h). We did not find a relationship between maximum inspiratory pressure and SDB (r = -0.03). There is no evidence for a causal relationship between medically stable MG and SDB in terms of OSA. The extent of respiratory muscle weakness failed to correlate with SDB. Furthermore, our study does not confirm the high occurrence of central respiratory events during sleep in patients with well-controlled MG.

Physical characterization of the stratum corneum of an in vitro human skin equivalent produced by tissue engineering and its comparison with normal human skin by ATR-FTIR spectroscopy and thermal analysis (DSC).

An in vitro human skin equivalent may be obtained by culturing human keratinocytes on a collagen gel containing fibroblasts. The anchored skin equivalent cultured at the air-liquid interface closely resembles human skin and is acceptable for in vitro percutaneous absorption. However, it is still more permeable than human skin. Since intercellular lipids have been recognized to play an important role in skin permeability, infrared spectroscopy and differential scanning calorimetry were performed on the stratum corneum of bovine or human skin equivalents grown at different days of air-liquid culture. The symmetric and asymmetric CH(2) stretching vibrations suggested that for all days observed, the intercellular lipids were less organized than those in human skin, irrespective of whether bovine or human collagen was used. Different culture conditions were also tested and the medium without serum and no epidermal growth factor at the air-liquid culture showed results significantly more comparable to human skin. Actually, the thermal behavior of in vitro stratum corneum showed transitions at lower temperatures than human skin. The transition around 80 degrees C, in the form of a lipid-protein complex, was absent. These results showed that the structural arrangement of intercellular lipids and their thermodynamic properties hold a crucial role in the barrier function of the stratum corneum.

Diffusion of rat atrial natriuretic factor in thermoreversible poloxamer gels.

Concentrated poloxamer 407 solutions display a negative thermorheological behaviour, resulting in a higher viscosity at body temperature than below. This could be exploited for various controlled delivery applications including the nasal delivery of peptides. The rheology of the gel and the diffusion of ANF were studied as a function of temperature. A theory is proposed, according to which a temperature rise creates an intermicellar network resulting in a viscosity increase. The diffusion of the drug appears limited only by the presence of micelles which lengthens the diffusion pathways and is not significantly influenced by the formation of this network.

Mechanical properties of glass-ceramic A-W-polyethylene composites: effect of filler content and particle size.

Composites which comprise a bioactive filler and ductile polymer matrix are desirable as implant materials since both their biological and mechanical properties can be tailored for a given application. In the present study three-point bending was used to characterise biomedical materials composed of glass-ceramic apatite-wollastonite (A-W) particulate reinforced polyethylene (PE) (denoted as AWPEX). The effects of filler volume fraction, varied from 10 to 50 vol%, and average particle size, 4.4 and 6.7 microm, on the bending strength, yield strength, mode of fracture, Young's modulus and strain to failure were investigated. HAPEX, a commercially used composite of hydroxyapatite and polyethylene, with a 40 vol% filler content, was used for comparison. Increasing the filler content caused an increase in Young's modulus, yield strength and bending strength, and a decreased strain to failure. When filler particle size was increased, the Young's modulus, yield and bending strengths were found to be slightly reduced. A transition in fracture behaviour from ductile to brittle behaviour was observed in samples containing between 30 and 40 vol% filler.

Changes in regional cortical tissue oxygen tension and cerebral blood flow during temporary middle cerebral artery occlusion in baboons.

Cortical tissue oxygen measured by a platinum cathode, and cerebral blood flow recorded by a hydrogen clearance technique, were measured in 13 baboons before, during and after temporary occlusion of the middle cerebral artery. Mean control pO2 was 23.8 +/- 14 mm Hg and mean flow 51.3 +/- 12 ml/100g/min. During the occlusion, there was a gradation in pO2 from values in the opercular area of 3.6 +/- 5.9 mm Hg, to values in the high parietal area of 11.9 +/- 11.7, these being statistically different (P less than 0.05) from each other. The corresponding flow values were 5.5 +/- 7.5 (opercular) and 22.3 +/- 21.7 ml/100 g/min parietal (P less than 0.01). Following removal of the MCA clip, between 20% and 30% of the electrodes registered an early hyperoxia and hyperaemia, which lasted up to 5 min. A late and prolonged hyperoxia, with less evidence of hyperaemia, was also noted in about 20%. The mean tissue pO2, however, at 5-min intervals up to 40 min following the removal of the clip only reached 60-80% of control values in the most ischaemic areas. Only the parietal region showed a mean pO2 above control levels. The mean flow data were uniformly reduced in all regions to about 80% of control values. During and after a second occlusion in 6 animals, similar changes were noted but with even fewer instances of hyperoxia. The mean oxygen and flow results were lower than with the first occlusion, but the reduction was not significant. There was no overall effect of hypercapnia on cortical tissue pO2 during the control period, but there was a significant (P less than 0.05) reduction during the same procedure after the period of ischaemia. An increase in pO2 during hypercapnia could be observed if there were arousal responses of blood pressure "spikes".

Measurements of oxygen tension in the cerebral cortex of baboons.

A polystyrene-covered platinum electrode (100-150 mum diameter) has been used to measure cortical tissue oxygen tension in baboon brains. The method of preparation, calibration, and the importance of small residual current (less than 40 nA) as an attribute of a reliable electrode, are described. With electrodes of this size, there was a large (16 +/- 12nA/torr) and linear current output with pO2 changes. The effect of avrious gases in addition to oxygen is described; halothane inhalation increases the apparent pO2 and hydrogen, used for blood flow estimations, reduces the recorded pO2. In 48 separate electrode placements in 13 baboons, the mean cortical qo2 was 23.8 +/- 12 mm Hg, with a range from 1-79 mm Hg; following occlusion of one middle cerebral artery, 37 electrodes recorded a pO2 of less then 5 mm Hg pO2 Oscillations were invariably noted in control conditions, independent of blood pressure; these waves disappeared during MCA occlusion and appeared to be augmented following release of the clip. Blood pressure "spikes" produce immediate and synchronous changes in all electrodes entirely different from the spontaneous waves. Such blood pressure changes may mask the true effect of hypercapnia on tissue pO2 and, if ignored, may lead to erroneous assumptions regarding local neural control of the circulation, the increased pO2 secondary to hypertension being regarded as evidence of regional vasodilation. A SUdden change in inspired pO2-the "air test"-was performed in control conditions and following the ischaemic insult, and the rate of change of cortical pO2 compared. The gradient was significantly greater (P less than 0.05) following ischaemia, suggesting a changed ratio in the tissue's flow to oxygen requirements and/or a persisting vasodilatation.

Contralateral approach to bilateral and ophthalmic aneurysms.

In a previous survey, we found a high incidence of fatal rupture of an unclipped aneurysm in patients with multiple aneurysms. To deal with this problem, we introduced a more vigorous technique that accesses aneurysms previously considered unapproachable during one operating session. Attempts were made to clip middle cerebral and ophthalmic aneurysms contralateral to the operative exposure. We have successfully clipped contralateral aneurysms of the posterior communicating artery when bilateral aneurysms were present. We have also used this contralateral approach successfully with single ophthalmic and proximal carotid aneurysms that pointed medially. We review the cases of 39 patients with 43 intracranial aneurysms operated from the contralateral side and present the surgical technique in relation to the angiographic findings.

Bonding strength of the apatite layer formed on glass-ceramic apatite-wollastonite-polyethylene composites.

Bioactive glass-ceramic apatite-wollastonite (A-W) has been incorporated into polyethylene in particulate form to create new bioactive composites for potential maxillofacial applications. The effects of varying the volume fraction of glass-ceramic A-W filler and the glass-ceramic A-W particle size were investigated by measuring the bonding strength of the bonelike apatite layer formed on the surface of glass-ceramic A-W-polyethylene composites. The bonding strength was evaluated via a modified ASTM C-333 standard in which a tensile stress was applied to the substrate and the strength of the bioactive layer was compared with that formed on commercially available hydroxyapatite-polyethylene composite samples, HAPEX. The composites demonstrated greater bonding strength with increased filler content and reduced filler particle size (maximum 6.9 +/- 0.5 MPa) and a marginally greater bonding strength as compared with HAPEX (2.8 +/- 0.5 MPa), when glass-ceramic A-W-polyethylene composite samples with the same filler content were tested. The higher bonding strength of the apatite layer formed on the A-W-polyethylene composite samples suggests that, in addition to maxillofacial applications, these composites might also be utilized in applications involving higher levels of load bearing.

New method for the preparation of cyanoacrylic nanoparticles with improved colloidal properties.

The purpose of this study was to prepare nanoparticles with a size significantly smaller than 0.1 micron. It was shown that when sulphur dioxide was dissolved in the cyanoacrylic monomer at a high concentration, subsequent anionic polymerization in an aqueous phase produced particles as small as 10 nm. Moreover, the obtained particles displayed an important negative charge which improve their stability against aggregation. Finally, nanoparticles were successfully prepared in double-distilled water, thereby avoiding the use of dextran which can induce anaphylactoid reactions.

Multistep production of bioengineered skin substitutes: sequential modulation of culture conditions.

Many studies are being conducted to define the role of growth factors in cutaneous physiology in order to add cytokines in a timely fashion for optimal tissue engineering of skin. This study is aimed at developing a multistep approach for the production of bioengineered skin substitutes, taking into account the effects of various growth factors according to the culture time. The use of a serum-supplemented medium throughout the whole culture period of skin substitutes was compared to the sequential use of specific additives at defined culture steps. Histological analysis revealed that serum was necessary for keratinocyte proliferation and migration on dermal substitutes during the first 2 d after their seeding. However, the serum-free medium presented some advantages when supplemented with different additives at specific culture steps. Interestingly, ascorbic acid added to the dermal substitutes before and after keratinocyte seeding maintained their cuboidal morphology in the basal epidermal layer. In the absence of serum, collagen matrix degradation slowed down, and a better multilayered epidermal organization was obtained, notably with retinoic acid. Stratum corneum formation was also enhanced by fatty acids. Thus, sequential addition of exogenous factors to the medium used to produce skin substitutes can improve their structural features and functional properties in vitro.

A clinico-pathological study on the correlation of immunosuppression and multiple primary malignant neoplasmas.

At present it is obvious that the incidence of second malignancies in patients with malignant diseases increases after prolonged treatment with immunosuppressive, or antineoplastic agents. The occurrence of such additional malignant diseases was analysed in our five-years autopsy material. During this period 7670 autopsies were performed. Malignant diseases were observed in 1707 cases (22.1%) and among them in 58 cases were proved multiple primary malignant neoplasms (3.3%). The average time between the occurrence of initial and second tumors was 29 months. The frequency of second tumors in patients with leukemias (mainly chronic lymphocytic leukemia) were four times higher than in patients with tumors of epithelial origin. Hepatocarcinomas arose in cirrhotic livers and astrocytomas were often followed by new malignancies. In consequence of successfully applied surgical, radiological and combined immunosuppressive, antineoplastic therapy the survival of cancer patients lengthened, so among different side-effects of the used therapy the oncogenesis cannot be left out of account. The danger of subsequent malignant tumors makes it imperative that immunosuppression should only be applied when strictly indicated.

Influence of proportional assist ventilation on diaphragmatic activity in normal subjects.

In six awake healthy adults we studied the physiological effects of mechanical unloading of the respiratory muscles during increased ventilatory demand. We were interested in whether respiratory muscle activity is down regulated and if this is mainly a consequence of chemical factors, i.e. CO2-reduction, or non-chemical neuromuscular inhibition. With 33 mmHg inspiratory CO2 we induced modest hyperpnea of 24.4 +/- 3.9 L/min. Proportional assist ventilation (PAV) was applied with flow-related assist of 2.5 cm H2O/L/s and volume-related assist of 6 cm H2O/L. Respiratory muscle activity was measured by transdiaphragmatic pressure. Unloading caused a 57 percent reduction of the inspiratory transdiaphragmatic pressure-time product (p<0.05), while tidal volume, breathing frequency, and breathing pattern did not significantly change. These observations suggest that during increased ventilatory requirements, PAV results in down regulation of respiratory muscle activity and that this effect is mainly a consequence of neuromechanical inhibition.

Lymphocyte activation and the increase of nuclear birefringence.

Nuclear birefringence of neutral red or rivanol stained cell suspensions from rat spleen has been investigated. Polyclonal or monoclonal mitogens produced an increased birefringence of the nucleus following 30 min in vitro stimulation at 37 degrees C. The nuclear birefringence increased by 62.2% [p less than 0.001], when the cells were incubated in the supernatants of a previously phytohemaglutinin stimulated culture. Amantadine, a potent phytohemagglutinin inhibitor, was unable to prevent the effect of the supernatant, but heating for 1 h at 56 degrees C destroyed its activity. The results suggest that increase in nuclear birefringence is mediated by a soluble factor which is released in the course of lymphocyte activation. The nuclear birefringence of surviving cells from human spleens obtained within 6 to 24 h post mortem increases after in vitro stimulation.

Factors affecting plasma progesterone concentration and the retrospective determination of time of ovulation in cyclic mares.

Factors influencing plasma progesterone concentration were investigated in seven mares. Two-phase logistic curves were fitted (r=0.98) to plasma progesterone concentrations of blood samples collected once daily. In addition to the effect of time (P<0.001), there were differences (P<0.01) among mares in the peak height of the progesterone plateau and in the (area under the curve) AUC. Plasma progesterone concentrations were higher (P<0.001) after a multiple versus single ovulation. There was an effect of season (P<0.001), but no significant effect of luteal morphology. The retrospective determination of time of ovulation was carried out using a linear model on the seven mares and 25 additional mares. Linear regression on the measured values or on the ratio to the average concentration from D5 to D10, was calculated with the day of cycle between D0 and D4. The ovulation date was then calculated using both of these equations, whether blood sampling was performed twice or thrice weekly on 25 postpartum mares. The accuracy to predict day of ovulation (+/- 1 day) ranged from 88 to 97%. In conclusion, the retrospective estimation of time of ovulation in mares was possible, although the technique had some limitations.

Factors influencing ovarian activity and sexual behavior of postpartum mares under farm conditions.

Management of the postpartum period is one of the most important factors of stud farm medicine. In horses, owing to the long gestation period, the time from parturition to repeat conception needs be short to maintain an optimal yearly foaling interval. For this reason the features of postpartum ovarian activity and sexual behavior were studied under farm conditions. During 2 consecutive breeding seasons, 107 mares on 5 commercial horse farms were monitored after parturition by regular teasing, transrectal ultrasonography and blood sampling for progesterone. Foalings took place from January 1 to June 15. Body condition scoring was carried out within 5 d and at 60 to 65 d after parturition. The first ovulation occurred within 20 d after foaling in 84.1% (90/107) of the mares. The mean intervals from foaling to the first and second ovulations were 17.8 +/- 1.6 d (+/- SEM) and 40.9 +/- 2.7 d (+/- SEM), respectively. The mean intervals from parturition to the first and second ovulation (P < 0.001), the interovulatory interval (P < 0.01), the second follicular phase (P < 0.001), and the time until the first overt estrus (P < 0.01) were significantly longer in mares foaling before the vernal equinox. In the beginning of the breeding season the intervals from parturition to the first ovulation (P < 0.01), to the second ovulation (P < 0.01), and to the first overt estrus (P < 0.001) were significantly longer for primiparous mares than for multiparous animals. There was a tendency for an increased interovulatory interval and for a longer second follicular phase in mares with decreased body condition after parturition (P = 0.069, P = 0.089, respectively). Suckling and breed had no effect on postpartum ovarian activity. We concluded that under field conditions the resumption of cyclic ovarian activity and sexual behavior in mares after foaling are strongly affected by the season of parturition and parity. In some cases, body condition change and other factors may also play a role in influencing postpartum reproductive function.

Early surgery for ruptured cerebral aneurysm.

Preliminary experience with 150 consecutive cases of ruptured cerebral aneurysms operated on within 48 hours is reported. The rationale of this emergency procedure is to prevent early rerupture and also to prevent neurological ischaemic consequences of the subarachnoid haemorrhage likely to develop in the first week after a rupture. The acceptable outcome of the surgically treated cases (87% excellent and good outcome) has been favourably matched to those of a group of equal number of consecutive cases seen in suitable condition for surgery within 48 hours by medical personnel but that remained unoperated for various reasons. The incidence of delayed neurological ischaemia as the definite cause of death is lower in the group operated on in the acute stage than those with delayed surgery, although the overall incidence of clinical vasospasm does not seem significantly lower than in the delayed surgery group.