Ovarian cancer. Effective treatment after alkylating-agent failure.

Combination chemotherapy consisting of hexamethylmelamine and cisplatin, alone or with doxorubicin hydrochloride, was given to 27 patients with advanced ovarian cancer who had disease progression with therapy including alkylating agents. Eighteen (67%) had greater than 50% regression of measurable disease or disease that could be evaluated but not measured, for a projected median duration of seven months. The projected median survival for all patients is nine months from the time of entry into the study and 33 months from the time of diagnosis of ovarian cancer. The treatment could be readily administered on an outpatient basis with a regimen of hydration and diuresis that nearly completely prevented platinum-induced renal tubular damage. Myelosuppression was severe in 11 patients (40%), but there was no treatment-related deaths. Agents of such high activity should be considered as components of initial therapy for stage III and IV cancers.


Proton radiation as boost therapy for localized prostatic carcinoma.

A 160-MeV proton beam has been modified to irradiate patients with localized tumors by using convention treatment schedules. This proton beam has the physical advantage of megavoltage x-rays of reducing the radiation dose to normal tissues adjacent to the tumor volume. A perineal proton technique used as boost therapy (2,000 to 2,500 rads) was evaluated in the definitive irradiation of 17 patients with localized prostatic carcinoma. This technique allows repeated daily treatment of the carefully defined target volume with a precision of +/- 2 mm. Total dose to the prostatic tumor, but not to the posterior rectum, has been increased by 500 to 700 rads. After 12 to 27 months of observation, no noteworthy rectal reaction has developed in a patient, easily managed urethral strictures have developed in two patients, and all but one are locally controlled.


Differential diagnosis and therapy of hyperketonemic state.

Detection of ketone bodies in the urine or plasma may be used as a rapid, inexpensive diagnostic approach. Understanding the causes of hyperketonemia can lead to identification and appropriate therapy for the underlying cause. At least one urinary ketone measurement should be a routine procedure in all severely ill patients in whom a complete understanding of the underlying pathological processes is not present.


A novel Tetrahymena sp. with unusual membrane lipid composition, with special reference to iso fatty acyl chains.

A novel Tetrahymena sp. is similar in appearance to four classical strains (WH-14, GL, W, NT-1) of T. pyriformis except for a larger width. The phospholipid and acyl chain compositions of membranes of this novel species are significantly different from those of other strains. The Tetrahymena sp. has a much higher content of ethanolamine phosphoglyceride and a lower level of glyceroaminoethyl phosphonate. Major fatty acids of this strain are iso 15:0 and iso 17:1, which are, if present, usually minor components in the classical strains of T. pyriformis.


[Toxicity of 1,1,1-trichloroethane (author's transl)].

Recent reports on the toxicity and metabolism of 1,1,1-trichloroethane are reviewed. Problems studied include transformation of this substance in the body and in the environment, its short and long term toxicities in animal experiments and human experiences, possible teratogenicity and tumorigenicity, and hazards due to contact with the skin and mucosae. Presumable modification of toxicity by inhibitors and other chemicals as well as physical conditions are also briefly discussed.


Advanced Trauma Life Support laboratory: pilot implementation and evaluation.

Selected invasive diagnostic and therapeutic techniques were taught to emergency physicians through modular Advanced Trauma Life Support (ATLS) animal laboratory courses presented in the fall of 1977. Thirty-seven emergency physicians participated in the four pilot ATLS laboratories in which the average trainee:animal:instructor ratio was 2:1:0.75. The animals consisted of 15 large baboons and five large rhesus monkeys. Cost accounting on these pilot ATLS courses revealed that the total program cost was $15,581.86, for an average of $3,895.46 per trauma laboratory course and $421.13 per emergency physician trained. The ATLS concept is ready for development into a nationally-standarized ATLS series.


Relationship between amount and type of dietary fat in promotion of mammary carcinogenesis induced by 7,12-dimethylbenz[a]anthracene.

Female Sprague-Dawley rats were fed semipurified diets containing various fats, either alone or in combination, to provide different amounts of dietary fat and linoleic acid. One week before commencing the diets, each rat received an intra-gastric dose of the carcinogen 7,12-dimethylbenz[a]anthracene. Rats fed diets containing mixtures of 3% sunflower seed oil and 17% of either tallow or coconut oil developed twice as many tumors as those fed 3% sunflower seed oil or 20% of either saturated fat alone. Tumor yields in the rats fed these mixed-fat diets were comparable to those in rats fed a 20% lard diet, which provided about the same amount of linoleic acid. No further increase in tumor yield was observed in rats fed a 20% sunflower seed oil diet that contained more than five times as much linoleic acid. These results show that a certain amount of polyunsaturated fat, as well as a high level of dietary fat, is required to promote mammary carcinogenesis.


Effects of donor age on neoplastic transformation of adult mouse bladder epithelium in vitro.

Neoplastic transformation of C57BL/lcrf-a' mouse bladder epithelium was induced in long-term primary cultures by a single 24-hour treatment with 7,12-dimethylbenz[a]anthracene on day 2 of culture. Transformed foci appeared earlier (40--60 days) and at a higher frequency (28%) in cultures from old donors (28--30 mo) compared with 100 days and 0.9% in cultures from young adult donors (5--7 mo). After transplantation into syngeneic mice, transformed cells produced carcinomas. Spontaneous epithelial transformation occurred in dimethyl sulfoxide-treated old cultures after the same interval (40--60 days) as in the carcinogen-treated cultures but at a lower frequency (5.3%). Spontaneous epithelial transformation did not occur in cultures from young donors.


[The use of computerized axial x-ray-tomography (EMI-scan) in ophthalmology (author's transl)].

There now exist protocols for specific scanning which make it possible to obtain tranverse sections of a few millimetres in thickness of the orbits and their contents, with minimum sweep and with a very low dose of radiation for the lens. Normal scanner anatomical findings in the orbit may thus be defined for the eyeball (outer coats, vitreous, lens) as well as retrobulbar structures (optic nerve, oculomotor muscles in particular). Intraocular tumours (e.g. retinoblastoma) are visible on enlarged scan films. The value of scannings lies above all in the determination of the site, size and shape of orbital lesions and, where applicable, their relations with neighbouring extra- and intra-cerebral structures. In addition, certain conditions such as exophthalmos during hyperthyroidism have characteristic scan findings. It nevertheless remains difficult to attempt to predict a histological diagnosis on the basis of scan findings, the risk of a false positive being particularly significant. Particular emphasis must be placed upon the contribution of techniques of treatment of the films obtained (enlargement, contrast media,  histograms, lateral views) as well as the complementary use of other methods of radiological investigation (in particular arteriography and phlebography) which scanning cannot replace but which it should usually precede since it is atraumatic and non-invase.


Retinal pigment epithelium. Interrelations of endoplasmic reticulum and melanolysosomes in the black mouse and its beige mutant.

By cytochemistry (acid phosphatase and tyrosinase activities) GERL, a specialized hydrolase-rich region of endoplasmic reticulum (ER), can be visualized in the cells of the mouse retinal pigment epithelium. Previously catalase cytochemistry permitted us to identify microperoxisomes, with numerous continuities to the ER. The present report reveals the extensive continuities of the ER to pigment granules in various stages of maturation. When the pigment granules, which we consider to be "melanolysosomes," first appear they consist of electron-opaque grains within dilated areas of the ER. As the dilations enlarge, fine fibrils appear in the ER cisternae. Thicker fibers develop from the fibrils; these fibers are generally obscured when melanin deposition occurs. At all stages, the melanolysosomes appear to be connected to the ER.


Neural uptake of catecholamines and their molecular structures: a histopharmacologic study.

Using ultrastructural and histofluorescence methods, we investigated the uptake mechanism of catecholamines by the nerve terminals in the cutaneous smooth muscles of stump-tailed macaques (Macaca arctoides). This in vivo approach ultilized the observed cytotoxic effects of 6-hydroxydopamine on these catecholamine-containing terminals and the protective effects of simultaneous treatment with catecholamines (dopamine, norepinephrine, and epinephrine), their 3-0-methylated derivatives (metanephrine and normetanephrine), and catechol acids (3,4-dihydroxymandelic acid and 2, 4, 5-trihydroxymandelic acid). Both catecholamines and 3-0-methylated derivatives protected these nerve terminals from destruction by 6-hydroxydopamine, but catechol acids did not. However, the 3-0-methylated derivatives were less effective than the catecholamines. The degree of protection afforded by these amines depended largely on their concentration. Only catecholamines intensified the electron density of the intravesicular mass or the fluorescence in the nerve terminals; therefore, 3-0-methylated derivatives may inhibit 6-hydroxydopamine uptake at axoplasmic membrane sites, but not inside the axon. These observations led to the discovery that these are two sites for the catecholamine uptake process. One site is the axoplasmic membrane. The terminals are protected by catecholamines and their 3-0-methylated derivatives from 6-hydroxydopamine uptake and thus destruction. The other site is the intraaxonal compartments. Here competitive binding between the vesicular protein and both 6-hydroxydopamine and the catecholamines plays a main role.


Cost effectiveness analysis: some problems of implementation.

Cost benefit analyses in the health sector frequently deal with situations in which the money value of the benefits is either difficult or impossible to measure. This paper asserts that the use of cost effectiveness analysis as a means of escaping the need to place a dollar value on benefits does not escape the need for appropriately discounting these benefits when they accrue in different periods over time. The choice of an appropriate discount rate is discussed, and the benefits of elective hysterectomy are used to demonstrate that a serious bias can result from ignoring the need for discounting.


Perinatal care and cost effectiveness: changes in health expenditures and birth outcome following the establishment of a nurse-midwife program.

Estimates of infant health status and expenditures for perinatal care are presented for periods of time before and after implementation of a nurse-midwife program in rural Georgia. As the program developed, the infant mortality rate of the four counties served by the program showed a decrease. Similarly, the target population (pregnant women of low to moderate income who had no private physician) experienced decreases in the rate of neonatal mortality, low birthweight, and short gestational age. Estimated expenditures for perinatal care in the four counties decreased as well. These results are examined from the perspective of the National Health Planning and Resources Development Act of 1974 and the utility of using an epidemiologic approach for estimating the output of health services in terms of health status is emphasized.


The evolution of the PSRO hospital review system.

Over the past several years, the PSRO hospital review system has evolved to such an extent as to merit re-examination of its objectives, accomplishments and potential, as well as the obstacles to success that still remain. The combination of review experience, political and funding pressures has reshaped the hospital review system. There is still controversy concerning the relative emphasis of the program on quality or costs, but there is no longer any question about the priority goal of the program for the remainder of this decade--to reduce the excessive use of hospital care and services that exists throughout the country. There is widespread and growing evidence of significant variation in hospital practice patterns from region to region and hospital to hospital. Elimination of much of the variation would benefit the quality of patient care and help to contain costs. Improvements in PSRO hospital review, particularly profile analysis and medical care evaluation studies, make possible the exposure of apparent local problems in hospital quality and utilization and the precise definitions of their causes. Many PSROs have made substantial progress in the application and refinement of these techniques. The current state of the art is described in detail. Still to be determined over the next several years is the extent to which PSROs will be able to succeed in correcting these problems and whether the support and cooperation PSROs need form sister agencies and the political process will be adequate.


[Congenital diverticulum of the left ventricle (author's transl)].

A case of congenital diverticulum of the left ventricle associated with probable mitral and tricuspid prolapses is presented. The authors comment on the absence of symptomatology in patients affected with this disease and point out the electrocardiographic, radiologic, and phonomechanocardiographic data. The importance of the left ventriculography in the diagnosis and classification of this disease stands out, as does the value of echocardiography (mode-M) in the diagnosis of mitral and tricuspid valvular prolapses which were associated in the present case. The classifications given by various authors in connection with this anomaly are reviewed and lastly the appropriate therapeutic approach is discussed. There is a surgical possibility for young asymptomatic patients, taking into account the little experience we have at present on the natural history of this disease.


[Treatment of malignant tumors of the conjunctiva with strontium-90 (author's transl)].

Although there are relatively few cases in our series of tumor of the conjunctiva, they represent most frequent histopathologic varieties for this localization. It is difficult to treat these patients in such a way as to cure the tumor while preserving intact the eye and vision. Surgery is recommended only in well differentiated cases that are diagnosed early. The excellent physical properties of strontium-90 make it particularly useful for this type of localization. High doses of radiation can be applied to the tumors with little danger to the deep and sensitive structures of the eye. With fractional doses we have been able to control conjunctival tumors of considerable size and thickness which would not normally have been considered tributary to this type of therapy.


[Gm1 gangliosidosis types 1 and 2 (author's transl)].

Two cases of gangliosidosis due to aggregates of Gm1 are described. The first patient was a female infant with noticeable retardation in psychomotor development, coarse facies, hepatomegaly, and X-rays showing skeletal anomalies in the large bones, vertebral column, cranium and ribs. She died at the age of 10 months of a septic condition. The second patient was a male infant; deterioration in psychomotor development was first noticed 8 months after birth and this progressed slowly to arrive at a vegetative state with convulsions and myoclonus. The child died at the age of 4 years. There were no signs of enlargement of visceral organs but a cherry red stain was observed in the ophthalmologic examination. In the first case, necropsy revealed the presence of a deposit substance in the histiocytes of the hepatic sinusoids, spleen, pancreas, thymus, septi and pulmonary alveoli, intestinal lamina propria, epithelial cells of the renal glomeruli, and in the neurons and glial cells of the brain. The same deposits were observed only in the neurons and glial cells in the second case. Ultrastructural examination showed the presence of typical cytoplasmic membranous bodies in the central nervous system of both patients. The beta-galactosidase activity in the urine of both patients during life was zero. There was a higher than normal total amount of gangliosides in brain tissue samples from both (1906.7 and 2459.9 NANA/g respectively) as compared with normal values (724.0). This increase was proportional to the rise in Gm1 ganglioside (76.8 and 89.6 percent molar respectively) as compared to control (27.0). These clinical, morphologic, and biochemical data characterize both types 1 and 2 of gangliosidosis due to Gm1 aggregates.


[Treatment of inoperable lung carcinoma by means of concentrated radiotherapy: results from 361 cases (author's transl)].

In the present work the results of a radiotherapy protocol for the treatment of inoperable lung cancer are examined. The study was carried out on two groups of patients treated successively; the first of 140 patients by means of cobalt therapy at the normal rate, up to a dose of 4,500 to 5,000 rads in 5 weeks; the second of 221 cases by means of concentrated radiotherapy in two series of 2,000 rads in five sessions, separated by 3 weeks of rest. The results show a more rapid regression of the symptomatology in the second group of patients and a clear superiority in respect to the survival rate. The patients treated at the normal rate showed after 6 months a survival rate of 40 percent as against 60.5 percent in the second group. This difference became more evident when comparing the histologic types: 9 and 57 percent respectively for anaplastic carcinomas. The survival rate after 1 year shows a difference between the two groups which is statistically significant (16 and 21 percent respectively) (p less than 0.05). In no case did we find complications of the type of esophagitis, pericarditis or transverse myelitis. The treatment in two sessions was better tolerated both from the physical and the psychic point of view by all the patients because of the 3 weeks of rest. The superiority in regard to survival, the rapid disappearance of the symptomatology, as well as the reduction in the therapy time, justify the use of concentrated radiotherapy in the treatment of this type of tumors even in the more advanced stages of the disease.


Vasodilator therapy of pump failure complicating acute myocardial infarction.

In patients with pump failure complicating acute infarction, vasodilating drugs, by reducing impedance to left ventricular outflow and venous return to the heart, improve cardiac performance without affecting myocardial contractility. Sodium nitroprusside currently is the vasodilator of choice in most patients with both elevated left ventricular filling pressures and reduced cardiac output. Patients with accompanying mechanical defects, such as acute mitral regurgitation or ventricular septal rupture, are particularly amenable to vasodilator therapy. Some patients may require combined therapy, with inotropic catecholamines or mechanical assistance devices together with vasodilators, in order to avoid undesirable hypotension. Side effects and toxicity are rare when patients are carefully selected and monitored. It is uncertain whether vasodilators reduce ischemia or salvage jeopardized myocardium, but they appear to improve the initial prognosis of some patients with severe pump failure. The long-term prognosis of these patients remains poor, however, and therefore a more aggressive approach to their chronic management seems warranted.


The cost of cancer.

In the last 30 years medical science has developed an array of new technologies such as cell cytology, radio-isotopic scanning, soft tissue X-rays (mammography and computerized tomography), etc., which have potential for the early detection of cancer, and when coupled with current or future therapeutic techniques may lead to improved rates of cure or prolonged survival of patients with cancer. Whenever preliminary evidence of efficacy is developed, considerable public pressure mounts both within and outside the medical community to implement screening programs on a widespread basis. Advances in screening and treatment, however, are coming at a time when there is serious nationwide concern over the total amount now being spent for health care in the nation and the rate of inflation that has occurred almost every year. In the medical literature, the little existing identification of the costs and economic benefits of screening (and of disease control programs in general) is often presented in a fairly simplistic fashion. Yet, just as many of the biologic issues in cancer screening are complex, so too are the economic ones. This paper will begin to identify: 1. the economic approaches to evaluating screening, 2. the problems in specifying costs, 3. the issues involved in selecting benefit measures, and 4. how these interact in the formulation of screening policies. In addressing these issues, new data on cost of cancer treatment, based on the third National Cancer Survey, will be presented. These data include hospital and nonhospital costs, disaggregated by source, cancer site and stage.


Cost-benefit ratio in our search for cerebellopontine angle tumors.

There is agreement that the morbidity and mortality of CPA tumors are directly proportional to the size of the tumor. The diagnostic difficulty, however, is indirectly proportional to the size: the large tumors are diagnosed with little difficulty, the smaller ones with considerable challenge. In the search for these tumors, it is apparent that the incidence of all sizes is low. To arrive at the diagnosis, efforts must be pursued in any patient with unilateral sensorineural hearing loss, unilateral tinnitus, or vertigo. In the past 12 years, 19,000 new patients were seen in the office of the Pittsburgh Otological Association. In this new patient population, 120 tumors were proven by surgery. Six others (bilateral tumors) were diagnosed but not operated on, and four others were diagnosed but were operated on elsewhere for a total of 130 patients. An estimate of the cost of diagnosing these tumors is presented. Consideration is given to the cost-benefit ratio of diagnosing those diseases which must be considered also in the differential diagnosis when the above symptoms are present. These are: congenital changes, trauma, metabolic neuropathies, Meniere's disease, noise-induced hearing loss, lues, sudden hearing loss, and unilateral symptoms of undetermined etiology.


Tympanostomy tubes, their use, abuse, and cost-benefit ratio.

Tympanostomy tubes are employed when middle ear ventilation is indicated, particularly when other forms of treatment have failed. Few other uses have broad acceptance. Any other insertion of a ventilating tube implies abuse, either through error in diagnosis or deliberate misapplication. Hard statistical data relating to abuse are impossible to obtain, but ample illustrations can be cited. The cost-benefit ratio is difficult to assess. Cost of a myringotomy and tube versus the cost of a tympanomastoidectomy was determined in four geographic areas. These figures, however, do not reveal how many ears were spared and how much hearing was conserved by tympanostomy tubes. Informed, diligently aggressive use of tympanostomy tubes offers greater potential to avoid serious middle ear disorders and complications than any other single modality.


Therapy of iatrogenic subglottic stenosis: a steroid/antibiotic regimen.

The authors have evaluated the efficacy of a medical regimen, consisting of systemic antibiotics and steroids, in the management of acute iatrogenic subglottic stenosis. The study consisted of the infliction of a standardized subglottic injury to three groups of five dogs: Group I animals were placed on prednisone 1 mg/kg/24 hours and potassium phenoxymethyl penicillin 50 mg/kg/24 hours from the day of the trauma. Group II were placed on a similar regimen from the eighth day after subglottic trauma. Group III received no medical therapy at all. Therapy was continued in treated Groups I and II for five weeks. At the end of the study the dogs were sacrificed and the final degree of subglottic stenosis evaluated, at which time the laryngotracheal complexes were submitted for pathological evaluation. A significant difference was found between the degree of stenosis attained in the three groups. The study suggests that the introduction of a steroid/antibiotic regimen has a beneficial effect in developing subglottic stenosis and that the timing of such therapy is of importance.


Radiation-associated disease: disease incidence and cost effectiveness of follow-up.

The organization, costs and outcome of a metropolitan area-wide recall campaign for patients irradiated for benign disease is documented. The campaing resulted in an increase in the number of thyroid malignancies discovered in both the irradiated and the nonirradiated population. The organization of the campaign cost $100,000. An estimated excess of 100 thyroid carcinomas were found in the 17 months following the campaign compared to the 17 months prior to the campaign in the Pittsburgh Standard Metropolitan Statistical Area. Of 150 patients who were radium exposed as infants and remained in the Pittsburgh area, 60% knew of their exposure only by direct hospital contact and were not reached by media public education. Seven of those 150 patients had thyroid carcinoma on 35 year follow-up, and 30% had some benign or malignant tumor.


High frequency transformation of Bacillus subtilis protoplasts by plasmid DNA.

A highly efficient method for transformation of Bacillus subtilis by plasmid DNA is reported. The procedure, which involves polyethylene glycol-induced DNA uptake by protoplasts and subsequent regeneration of the bacterial cell wall, yields up to 80% transformants with an efficiency of 4 x 10(7) transformants per microgram of supercoiled DNA. Plasmids constructed by in vitro ligation or endonuclease-generated fragments of linear plasmid DNA can also transform PEG-treated protoplasts, but at a lower frequency.


Polyethylene-glycol induced fusion of bacterial protoplasts: direct selection of recombinants.

Direct selection for recombinants by supplemented minimal media from polyethylene-glycol (PEG)-induced fusion of protoplasts of polyauxotrophic strains of B. megaterium revealed striking physiological influences on the yield of recombinants. Cytoplasmic state of the protoplasts to be fused, rather than genetic events, determined the number of colonies obtained on the selection media. It is suggested that the physiological effects primarily influenced the ability of the fused protoplasts to revert to bacillary form.


Mapping of genes determining nonpermissiveness and host-specific restriction to bacteriophages in Bacillus subtilis Marburg.

Bacillus subtilis Marburg is nonpermissive for the multiplication of bacteriophages SP10 and phi NR2. A permissive mutant was derived from the Marburg strain, and the genetic determinants of non-permissiveness were analyzed by PBS1 transduction. The simultaneous presence of two genes as mutant alleles, nonA and nonB, was necessary for permissiveness. The gene nonA is linked very closely to rfm (cotransfer: 95%); nonB is located between dal and purB (cotransfer of nonB and purB6 : 48%). The genetic determinant of host-specific restriction intrinsic to the Marburg strain (hsrM) was found to be identical or very closely linked to nonB. The segregation on nonB and hsrM has never been observed in the course of transduction analysis. The mutation, hsrM1, diminishes the restriction activity, but not the host-controlled modification.


Host-controlled modification and restriction in Bacillus subtilis: Bsu 168-system and BsuR-system in B. subtilis 168.

A Bsu168-specific restriction deficient (r168-) mutant of Bacillus subtilis Marburg 168 was transformed to be BsuR-specific restriction proficient (rR+) with B. subtilis R DNA as efficiently as the Bsu 168-specific restriction proficient (r168+) parental strain (hsrM+, hsdR-). We constructed rR+ mR+ r168+ m168+ strain (ISMR 4), rR+ mR+ r168- m168+ strain (ISR 11) and rR+ mR+ r168- m168- strain (ISR 6) from strain 101 (r168+ m168+), strain 1012 (r168- m168+) and strain RM125 (r168- m168-), respectively by transformation with B. subtilis R DNA, and tested their restriction and modification activities on phage phi 105C. The results show that the sites recognized by Bsu168-specific restriction and modification enzymes and the sites recognized by BsuR-specific ones are not overlapping. We conclude that the Bsu168-modification and restriction system and the BsuR-modification and restriction system are controlled independently by two distinct sets of genes in the rR+ mR+ transformant of r168+ m168+ strain B. subtilis 168.


Bacteriophage lambda-E. coli K12 vector-host system for gene cloning and expression under lactose promoter control: I. DNA fragment insertion at the lacZ EcoRI restriction site.

Bacteriophage lambda vectors, derived from lambda plac5 were constructed. Their genomes have only one EcoRI restriction site, located near the end of the beta-galactosidase gene. Recombinants, constructed in vitro, having a DNA fragment inserted in the EcoRI site, are lac- and can be easily recognized. Expression of such foreign genes is then under the control of the lac promoter. Mutations Qam73 and Sam7 greatly increase the amount of beta-galactosidase synthesized by the vector bacteriophage. The lambda ZEQS vector has been certified B2 (EK2) by the French control commission "Recombinaisons génétiques in vitro".


Bacteriophage lambda-E. coli K12 vector-host system for gene cloning and expression under lactose promoter control. II. DNA fragment insertion at the vicinity of the lac UV5 promoter.

Bacteriophage vectors derived from lambda plac5 have been constructed. Their genomes have one EcoRI restriction site which is located at the very beginning of the lac Z gene. The major part of this gene was deleted by an in vivo intramolecular recombination. These vectors allow the fusion of a gene or an operon with the beginning of the lac Z gene, placing them under the control of the lac promoter, which carries the UV5 mutation. Some of these vectors (lambda Y) also include the lac Y gene and it too is under the control of the lac promoter. The lambda YEQS, which carries the Qam73 and Sam7 mutations, as safety mutations, has been certified as a B2 (EK2) vector by the French control commission "recombinaison génétique in vitro".


[Validity of scintigraphic and endocrinological methods in classifying autonomous adenomas of the thyroid (author's transl)].

The validity of various scintigraphic and endocrinological methods was assessed in order to classify confirmed autonomous adenomas (AA) and to differentiate AA from euthyroid and hyperthyroid goitres. Methods used included: Measurement of 131J-uptake 6, 24 and 48 hours after 131J-application, before and after suppression by T3, thyroid scanning, count-rate measurement in the AA and the paranodular tissue, and determination of T4. All patients received 131J-therapy (40,000 rads). In 8 out of 30 scintigraphically compensated autonomous adenomas (CAA) there was no TSH response to TRH. 12 cases showed a subnormal TSH response and 10 patients had a normal TSH response. T4-values were increased in only 2 cases. Out of 73 decompensated autonomous adenomas (DAA), 66 cases (90%) had no TSH response and 7 cases showed only a subnormal response. In 48% of DAA T4-levels turned out to be in the hyperthyroid range. Both, scintigraphic and endocrinological tests were found to agree in most cases of DAA. However, the diagnosis of CAA could only be proved on the basis of a scintigraphically confirmed suppressive effect of T3 on the paranodular tissue. Thus, in the individual case, separation of CAA from DAA turned out to be impossible using the results of TRH-test alone.


[The efficacy of spa treatments (author's transl)].

Spa treatments have up to now been offered too often, with too little exactitude of indication and too extravagantly. For many diseases success is not to be expected from the beginning from spa treatment. Patients who have themselves endagered their earning capacity through a way of life injurious to health should only be sent for spa treatment if they have already proved at home that they are capable of changing permanently to a rational way of life. Four accurately definable spheres of activity are proposed for an efficient, independant spa treatment (connected spa treatments, other spa treatments for specifically selected patients only, practising health education and behavior therapy methods, development of spa holiday systems for annual leave).


[Industrial medicine in theory and research for practice (author's transl)].

The university teacher in industrial medicine is guided by an autonomous self-responsibility to public interests protected by the fundamental law of the German Federal Republic. For the medical student about 8 hours practical work and an examination in the second clinical professional examination is prescribed. The teaching of the mutual relationships between industrial work and health is divided into: prevention and clinical aspects of industrial diseases, industrial hygiene, toxicology, industrial physiology (ergonomics), industrial psychology, rehabilitation and knowledge of giving expert opinion. The following are discussed as examples of research related to practice: the constant revision of the list of maximal concentration of work places, studies on the synergism of inhaled poisons, research into the causes of chronic bronchitis, pneumoconioses due to organic dusts and the discovery of aggresive antigens in work places previously considered safe.


[Effectiveness of a preventive mass examination for cardiac risk factors (author's transl)].

18 months after a mass examination for coronary heart disease risk factors in employees of a large industrial firm, 75% of the subjects examined at that time were re-interviewed and measurements of blood pressure and weight repeated. Despite an altogether inadequate longterm control of the risk factors detected, a part of the subjects examined had drawn consequences regarding their way of life by reducing weight, changing smoking habits and increasing physical activity, thus proving the effectiveness of information and advice received in a screening investigation. In about 40% of the overweight subjects a reduction in weight and in half of the hypertensives a lowering of blood pressure to values below 160/95 mmHg was noted.


[Treatment of adult diabetes with semi-euglucon (author's transl)].

Results of Trial in General Practice: Semi-Euglucon was tested in a field study by 366 general practitioners in a total of 2037 adult diabetics. The patient collective included primarily first stabilizations (56.5%), i. e. diabetics not previously treated with drugs, then transfers from sulfonyl ureas of the tolbutamide type (26.0%) and from biguanides (17.5%). During the trial period there was a significant improvement in the metabolic condition. The mean daily dose was 1.3 tablets Semi-Euglucon, small differences occurred depending on the nature of the previous treatment. After changing from the sulfonyl ureas glibornuride, glisoxepide or gliquidone the same mean daily dosage of 1.5 tablets/day was required as with the sulfonyl ureas mentioned--with considerable improvement in the metabolism.


[Stress in journalists (author's transl)].

The stress problems of 227 Swiss journalists with a mean age of 43 years (189 men) and 39 years (38 women) were recorded by means of questionnaires (76% returns). About 90% of all those questioned admitted suffering from stress at the present time. However 88% of the juniors and 96% of the seniors enjoy their work. 20% of all those questioned were anxious about their livelihood. 97% of the total live under pressure of deadlines, only one in 3 has regular working hours. Half the younger and two fifths of the older men admitted some form of family stress, usually in connection with their occupation. 76% of the younger and 70% of the older journalists questioned have a hobby. 70% of the juniors occasionally take exercise, as do 48% of the seniors. About 50% of both the men and women are smokers. The general state of health is stated to be good by 80% of younger and 70% of older subjects. A comparison of the results according to occupational stress, work stress, deadline stress, stress of livelihood, stress of recognition, family stress and stress to health shows that only a very differentiated manner of consideration is permissible.


[Eliciting factors and clinical picture of hepatic coma in 152 patients with cirrhosis of the liver (author's transl)].

Exogenous hepatic coma was found 102 times (group A) and a combination of exogenous and endogenous hepatic coma 50 times (group B) in 152 patients with hepatic coma. The most frequent eliciting factors in group A were too high a protein supply and gastrointestinal hemorrhage and diuretics, in group B necrotic exacerbations and infections, 2/3 of them having severe portal hypertension with ascites and esophageal varices at the same time. A typical fetor hepaticus was found in only 25% of group A and 50% in group B. 10% had a primary liver cell carcinoma. The prognosis depends largely on the stage of the coma and the treatment of the eliciting factors. Altogether 50 of the 152 hepatic coma patients died. The most frequent complication was a terminal renal failure which no longer responded to therapy.


[Urinary excretion of porphyrins and their precursors. Longterm observations in acute intermittent porphyrias (author's transl)].

On the basis of many years of examination and supervision of 26 patients with acute intermittent porphyria three different types of excretion behavior in the urine can be distinguished. 1. After porphyric crises the urinary porphyrin content is completely normalized. 2. Even after the crisis the excretion levels for porphyrins remain very high. 3. The urinary porphyrins return to normal levels but the increases in precursors such as delta-aminolevulinic acid and porphobilinogen still persist. 4. In the diagnosis true acute coproporphyria and increased of excretion of precursors must be differentiated as well as increased coproporphyrin resulting from liver diseases, exogenic, toxic influences and secondary disorders of porphyrin metabolism.


[Suicide in schoolchildren (author's transl)].

Suicides by 66 children aged from 9 to 16 years (47 boys, 19 girls) and attempted suicides by 22 children (8 boys, 14 girls) are reported. Poisoning by mouth and hanging are the most common forms of suicide. The provocation for suicide may be trifling whereas the motivation, not always explicable even in children, is a multifactorial problem. 12 children wrote farewell letters, 5 announced their intention of suicide but were not taken seriously and 9 had already attempted suicide before succeeding. Most of the children (56 = 70%) lived with their parents at the time of the act, 14 (10%) had already shown behavior disorders before the act. Announcements of suicide should be taken seriously, even with children; they could perhaps be prevented by correct adult behavior.


[Skateboard injuries (author's transl)].

Following the introduction of skateboards into Germany in 1976 an increasing number of accidents and injuries have been noted, affecting mainly children 10 to 14 years of age. The causes were lack of experience and the careless use of the boards on public streets. More than 30% of injuries were fractures mainly affecting the upper limb. Because of the frequent involvement of the epiphyseal plates the post-accidental growth may be seriously disturbed. Severe and sometimes fatal head or abdominal injuries have been reported, mainly after collision with cars.


[Vaccination: I. What has proved useful? (author's transl)].

There is no doubt that vaccinations against smallpox, poliomyelitis, measles, German measles and mumps have proved their value. The pocks seem to have been actually eliminated by the WHO eradication program. A vaccination law would seem to be no longer necessary. Poliomyelitis vaccination and those for German measles, measles and mumps should be publicized. Also every child should be given an effective tetanus vaccination three times in the first or second year of life with a booster vaccination at the age of 10 or 12 at the latest. A liquid vaccine (TD) would be desirable as a booster for adults. Up to the 4 year TD and Polio booster vaccinations are recommanded.


Evidence for a mutagenic effect of the narcotic antagonist, naltrexone, in germ cells of Drosophila.

The narcotic antagonist, Naltrexone, was tested for mutagenicity in Drosophila. The frequency of sex-linked recessive lethals at a non-toxic dose of 10 mg/ml was 0.43% (42 lethals in 9697 X-chromosomes tested) and 0.16% (19/11536) in the controls. The difference is statistically significant (P less than 0.001). Results from large-scale experiments testing for chromosome breakage and nondisjunction were negative.


Evidence for the absence of a mutagenic effect of methadone in germ cells of Drosophila melanogaster.

The compound, methadone, used as a modality in the treatment of heroin addiction, was tested for mutagenic activity in germ cells of Drosophila. Results were negative in tests for sex-linked recessive lethals using feeding and injection procedures. Similarly, results from tests for chromosome breakage and nondisjunction failed to provide evidence of a mutagenic effect.


Mutagenic activity of selenium compounds.

The mutagenicities of selenate (SeO2/4-) and selenite (SeO2/3-) were determined by two bacterial assay systems: Kada's rec-assay and Ames's Salmonella test. In both assays, these compounds were found to be weak mutagens. In the Salmonella test, selenate (0.05 revertants/nmole) and selenite (0.2 revertants/nmole) gave rise to base-pair substitution.


A trial of minocycline given after exposure to prevent gonorrhea.

In a prospective evaluation of antibiotic prophylaxis against gonorrhea, 1080 men were given 200 mg of oral minocycline or placebo after sexual intercourse with prostitutes in a Far Eastern port. Later, at sea, gonococcal infection was detected in 57 of 565 men given placebo and 24 of 515 men given minocycline (P less than 0.001). Minocycline prophylaxis completely prevented infection by gonococci susceptible to 0.75 microgram or less of tetracycline per milliliter, reduced the risk of infection or prolonged the incubation period in men exposed to gonococci susceptible to 1.0 to 2.0 micrograms per milliliter, but did not prevent infection or prolong incubation in men exposed to gonococci resistant to 2.0 micrograms. Minocycline did not increase the proportion of asymptomatic infections. Minocycline prophylaxis would probably have limited effectiveness as a public-health measure because of the tendency to select resistant gonococci.


[Semiessential and nonessential amino acids in parenteral feeding].

With reference to a critical study of the relevant literature and to results from their own investigations, the authors emphasize the importance of the semi-essential and non-essential amino acids arginine, histidine, tyrosine, cystine and glutamic acid for the completion of essential amino-acid mixtures destined for parenteral feeding. MADDEN'S assumption that intravenously applied glutamic acid is intolerable was not supported by the authors' experiments in dogs. As evidenced by the increase of blood urea, the glutamic acid-containing amino-acid mixture was well utilizable. When glutamic acid is present, proline and alanine are obviously superfluous in amino-acid mixtures for parenteral feeding, since they are easily formed from glutamic acid by intermediary metabolism.


Immunologic functions and in vitro activation of cultured macrophage tumor lines.

Five murine monocyte of macrophage tumor lines adapted to culture were characterized for differentiated properties. They ingested zymosan and latex beads, bore receptors for immunoglobulin and complement, synthesized lysozyme (most of which was secreted), and produced granulocyte colony-stimulating activity, either spontaneously or inducibly. Some of the lines also mediated phagocytosis and exocytosis of red blood cells (RBC) and lysis of tumor targets, dependent on the presence of specific antitarget sera. All the lines were growth inhibited by zymosan and Mycobacterium bovis BCG, but not by latex beads. Other macrophage-activating agents, dextran sulfate and lipopolysaccharide (LPS), as well as tuberculin purified protein derivative (PPD), inhibited most of the lines. Except for Fc and C receptors, most of the above properties were not found with other types of hematopoietic tumors in culture. In attempts to activate the macrophage lines in vitro to the "angry" state, we found that preincubation with concentrations of LPS and PPD cytostatic to the cells stimulated antibody-dependent RBC lysis, but not antibody-independent or tumor cytolysis. A classification of monocyte-related tumors and normal cells is proposed based on functional activities and differential sensitivity to immunostimulating agents.


Expression of antibody genes in tissue culture: structural mutants and hybrid cells.

Detailed information on the nature and frequency of somatic mutations has been derived from studies of the clonal diversification of the myeloma MOPC 21 in tissue culture. A screening procedure is described that permitted the isolation of four spontaneous mutations at the gamma1 structural gene locus. These originate from four mutation events. Two seem to be point mutations: a "nonsense" and a "mis-sense." Of the other two, one is a frameshift leading to mistranslation and early termination, the other a large deletion due to perhaps an intrachromosomal translocation or a mitotic recombination. Fusion between myeloma-producing cells has shown that variable and constant region genes cannot be scrambled. Differentiation from stem to plasma cells seems to involve changes in the primary sequence of the DNA. Fusion between myeloma cells and spleen cells from immunized animals is a satisfactory method for the derivation of permanent tissue culture lines producing specific antibody. The hybrids express the myeloma as well as the specific antibody light and heavy chains. By subcloning and selection, one can derive lines that selectively lose individual chains. Lines that no longer express the myeloma components can thus be derived. The use of appropriate defective variants of the myeloma parental line is another way of avoiding the presence of the myeloma components.


Clinical application of immunodiffusion assay for prostatic acid phosphatase.

The biochemical and immunologic characterization of acid phosphatase in serum and bone marrow was described as well as the clinical application of the immunodiffusion assay for prostatic acid phosphatase.


M components and cancer.

Intention of this study was to prove or exclude in patients with different neoplasms some M components which can escape routine electrophoretic analysis or immunoelectrophoretic analysis with polyvalent antiserum. All serum samples from 606 patients were investigated also with monospecific antisera against heavy chains--alpha, gamma, mu and delta--and in suspicion of abnormality also with antisera against light chains. Patterns similar to those found in cases of heavy chain diseases were absent in all patients. M components of IgD class were not found, as well. As to M components of usual types a relatively high incidence was found in lymphoproliferative malignancies excluded myelomas or Waldenstroöm's macroglobulinemias (5.61% in adults and 2.32% in children). On the basis of results the importance of immunoelectrophoretical analysis with monospecific antisera in all these cases is pointed out; not only in attempt to discover additional subjects of heavy chain diseases but also to detect mild "macroglobulinemic" abnormalities which may not be so far detected on electrophoretical pattern.


Association of tritium-labelled estradiol, progesterone and 17 alpha-hydroxyprogesterone with the proteins of the serum and cerebrospinal fluid in the rhesus monkey.

The electrophoretic profiles of the proteins in the serum and cerebrospinal fluid (CSF) of the rhesus monkey were studied by polyacrylamide gel electrophoresis. The association of tritium labelled estradiol (3H-E), progesterone (3H-P) and 17 alpha-hydroxyprogesterone (3H-17OHP) with these proteins was studied under in vitro and in vivo conditions. The CSF was found to contain, besides albumin, at least 4 globulins with similar electrophoretic mobilities as those found in the serum. The electrophoretic mobilities of these globulins were Ralb 0.4, 0.6, 0.8 and 0.9. The electrophoretic profiles of the monkey serum and CSF proteins were found to be similar to those described for human serum and CSF. 3H-E and 3H-P were respectively associated with serum globulins of Ralb 0.4 and 0.8 both in the in vitro and in vivo studies. The respective Ralb of these 2 globulins were similar to the testosterone-estradiol binding globulin and cortisol binding globulin in human serum. 3H-17OHP was found to be associated with several globulins under both in vitro and in vivo conditions. In marked contrast to the in vitro studies, radioactive products were found to be associated with albumin in vivo. It is presumed that these products may be steroidal conjugates derived from the systemic metabolism of the administered steroids. No radioactivity was associated with the CSF protein after in vitro incubation with any of the three 3H-steroids. In the in vivo studies, however, radioactivity was associated with such of the CSF proteins that were similar to those found in the serum and with which the administered steroids were associated.


A quantitative study of the glia of the Purkinje cell layer of the cerebellum in mammals.

The cerebella of fourteen mammals have been examined and the number of each DNA class of glial cell, within the Purkinje cell layer, counted. Diploid glial cells were present in all species and related in number to the surface area of the Purkinje cell. It is likely that they assist in the maintenance of the physiology of this latter cell type. Tetraploid glial cells, however, occur in significant numbers only in the human and chimpanzee and possibly play a part in the establishment of certain learned patterns of co-ordinated movement peculiar to these species.


A case of myoclonic epilepsy with unusual presentation.

A case of stimulus-precipitated myoclonic jerks is presented. Besides spontaneous jerks, auditory, stimuli striking the palms, abdominal pressure or distension, evoked the jerks. Intermittent stroboscopic stimulation did not precipitate the attacks. The child had spontaneous recovery which is maintained, clinically and EEG wise for the last one year.


Economics, health, and post-industrial society.

Increases in medical resources, and access to care, do not lead to comparable decreases in either morbidity or mortality in modern nations. The number of years of schooling, rather than level of income, emerges as the surest correlate of good health, although progress in medical science and changes in productivity remain powerful influences. Family, religion, and especially government, are examined as institutions serving competing goals of security, freedom, and equality.


Special report: scarce resources in health care.

The assumption that a centrally planned national health care system could match resources to needs has proved to be a chimera. Shortages are inherent in any system that is more or less "free at the point of access" while it still permits unlimited scientific innovation for its patients. Rationing by science is as unsatisfactory as is political or economic rationing: equality in health care cannot be in balance with uncontrolled technological innovation.


[Studies of the incidence of healthy carriers of "pathogenic strains" or potentially pathogenic strains in the hospital environment].

An investigation has been carried out on healthy carriers of "positive Staphylococcus coagulase" and "occasional pathogenic" strains among kitchen, canteen and dispensary staff in the IVth Geriatric Division and First Aid Clinic of the Bologna "M. Malpighi" Hospital. All stains of "positive Staphylococcus coagulase" and "occasional pathogens" considered (Pseudomonas aeruginosa and Citrobacter) were put through antibiotic and chemotherapeutic sensitivity tests. The results are reported in detail.


Localization of neurons supplying the temporalis muscle in the rat and monkey.

Following injection of horseradish peroxidase (HRP) solution into the rat and monkey temporalis muscle, a similar pattern of nuclear representation was found in the motor trigeminal nucleus. Labelled neurons were seen throughout the rostro-caudal extent of the ipsilateral motor trigeminal nucleus, in its dorsal, intermediate and ventral portions and its dorsomedial, ventromedial and ventrolateral corners. In addition to the motor trigeminal nucleus labelled neurons were also found in the ipsilateral trigeminal ganglion and mesencephalic trigeminal nucleus. The results were discussed.


Ultrastructural alterations in experimental lingual leukoplakia and carcinoma.

Epidermoid carcinomas, preceded by dysplastic leukoplakic lesions, were produced on the right lateral borders of the tongues of Syrian hamsters by the application, three times per week, of DMBA in acetone after the area had been scratched with a root canal broach. Animals were killed at 12 to 13 weeks and 15 to 16 weeks. Electron microscopic studies of both the dysplastic leukoplakic lesions and the well-differentiated epidermoid carcinomas revealed clumping of tonofilaments and widening of intercellular spaces, in addition to the cellular pleomorphism, altered nuclear-cytoplasmic ratio, and prominent nucleoli observed with the light microscope. In the carcinomas, there were variations in the morphology of mitochondria, with tubular forms in evidence. The basal lamina in the carcinomas was discontinuous. Pseudopodia arising from basal cells were seen in areas of basal lamina discontinuity.


Pulp reaction to a tricalcium phosphate ceramic capping agent.

A porous form of tricalcium phosphate ceramic has been shown to stimulate new bone formation around the implant. The purpose of the present study was to evaluate this material in a powder form as a pulp-capping material. It was found difficult to cover a pulp exposure adequately with Synthos ceramic powder alone. Histologic sections showed dentinogenesis around those particles which were forced into the pulp proper, demonstrating the nonirritating potential of Synthos. Because of the bacterial infection in so many of the specimens, this study is inconclusive with respect to the use of this material as a capping agent. A similar study, employing a rubber dam to protect the exposure, is recommended.


Antigenic analysis of sequential erythrocytic stages of Plasmodium knowlesi.

The antigenic composition of sequential erythrocytic stages of Plasmodium knowlesi has been compared by crossed immuno-electrophoresis using a pool of immune rhesus monkey antiserum. Eleven major parasite antigens have been identified; 9 are stage-independent, and 2 stage-dependent. Differences in the relative amount of the stage-independent antigens have been demonstrated and quantified. The distribution of antigens between parasites and schizont and infected red cell membranes has been examined. Only 6 of the 11 parasite antigens were exhibited by a schizont membrane preparation, all these antigens were also expressed by the intracellular parasite. Antigens exclusive to the schizont membrane were not demonstrated.


Development of infectivity in Hyalomma detritum (Schulze, 1919) ticks infected with Theileria annulata (Dchunkowsky and Luhs, 1904).

The time-course for the development of infectivity was studied in Hyalomma detritum ticks fed as pre-imagoes on calves infected with Theileria annulata. Unfed adults derived from infected nymphs were non-infectious when inoculated into susceptible calves, whereas ticks of both sexes that had fed for 2-3 days or longer on calves or rabbits were always infectious. Some adults fed for only 1-2 days were infectious, whereas others were not. As few as 2 ticks were capable of infecting susceptible calves.


Interpretation of serum and red cell folate results. A comparison of microbiological and radioisotopic methods.

Serum folate and red blood cell folate levels were measured in 167 patients using a microbiological method (Lactobacillus casei) and a commercial 125I radioassay kit. The results of the two methods were compared and related to the clinical findings to see which method more truly reflected the physiological folate status of the patient. There was a good linear correlation between the methods for both serum folate and red cell folate over the whole range encountered and the mean results obtained with each method were nearly identical. Both methods seemed to perform equally well in distinguishing low serum folate levels, but when the red cell folate results were compared to the clinical and other laboratory findings, the radioassay more closely related to the folate status of the patient. The study again emphasized the high number of low serum folate levels found in hospital patients and the importance of measuring the red cell folate.


Immunoradiometric and electroimmuno assay of increased ferritin and apoferritin levels in serum.

Ferritin in serum from patients with increased serum ferritin levels has been studied both quantitatively and qualitatively. All techniques utilized in these studies are suitable to be used as routine screening tests for large numbers of patients. Electroimmuno assay (EIA) has been compared with the solid phase immunoradiometric (IRMA) assay as a technique to determine serum ferritin concentration (r = 0.99) and is suggested as a useful alternative when determining ferritin concentrations above 500 microgram/l. Iron stained EIA gels have been used to indicate the iron content of the ferritin molecule in sera. This simple screening test has demonstrated that apoferritin is found more often than iron-rich ferritin in the serum of patients with elevated serum ferritin levels. Immunoelectrophoresis precipitin bands suggest the heterogeneity of ferritin in serum from different patients.


Multiple bladder diverticula in Williams "Elfin-Facies" syndrome.

Twenty-three children with Williams "elfin-facies" syndrome were reviewed. A striking incidence of multiple bladder diverticula was found (8 children of 14 who had voiding cystourethrograms). The diverticula were usually not identifiable on excretory urography. Children generally have a low incidence of bladder diverticula (excluding "Hutch" diverticula), especially multiple diverticula; thus one should strongly consider the diagnosis of Williams syndrome and other connective tissue diseases when multiple bladder diverticula are identified.


Pyruvate carboxylase and phosphoenolpyruvate carboxykinase activity in leukocytes and fibroblasts from a patient with pyruvate carboxylase deficiency.

Normal values are given for the activities of pyruvate carboxylase (E.C.6.4.1.1), mitochondrial phosphoenolpyruvate carboxykinase (E.C. 4.1.1.32, PEPCK), and citrate synthase (E.C. 4.1.3.7) in fibroblasts, lymphocytes, and leukocytes. Also given are values for these enzymes in the leukocytes and fibroblasts from a severely mentally and developmentally retarded patient with proximal renal tubular acidosis and hepatic, cerebral, and renal cortical pyruvate carboxylase deficiency. In normals, virtually all of the mitochondrial PEPCK and pyruvate carboxylase activity was present in the mononuclear leukocyte fraction of whole venous blood. Cellular fractionation studies with human lymphocytes and fibroblasts demonstrated that all of the PEPCK activity in these cells is mitochondrial. Normal values for pyruvate carboxylase in leukocytes were 0.092 (0.070--0.208) mU/mg protein (n=5), in lymphocytes 0.154 (0.092--0.262) mU/mg protein (n=5), and in fibroblasts 1.36 (0.778--2.19) mU/mg protein (n=5). The patient with hepatic, renal, and cerebral pyruvate carboxylase deficiency had no detectable activity (less than 0.009 mU/mg protein) in his leukocytes and 0.018 mU/mg protein in his fibroblasts. Data from an assay for pyruvate carboxylase activity in the patient's fibroblasts show that the activity observed is significant but very close to the lower limits of the assay. Values for PEPCK in normal lymphocytes were 1.42 (0.824--1.88) mU/mg protein (n=5), in leukocytes 1.68 (1.64--1.72) mU/mg protein (n=2), and in fibroblasts 5.49 (3.94--6.33) mU/mg protein (n=6).


Alteration of cartilage glycosaminoglycan protein acceptor by somatomedin and cortisol.

The effect of somatomedin and cortisol on embryonic chick cartilage in vitro indicates that somatomedin stimulates 35SO4 uptake while cortisol decreases it with no effect on glycosaminoglycan turnover. Xylosyltransferase activity is increased in crude fractions of somatomedin-treated cartilage but decreased in cortisol-treated cartilage. By using a Smith-degraded proteoglycan as an exogenous acceptor, xylosyltransferase activities from both treatments were equivalent, suggesting that the enzyme was not rate limiting. The results of xylosyltransferase assays conducted by mixing enzyme and endogenous acceptor from control, cortisol-treated and somatomedin-treated cartilage, suggest both effects to be at the level of the acceptor protein.


Comparison of auras and triggering factors in epilepsy.

Case reports of five patients are presented, each with a specific aura at the onset of the seizures. All of these patients' had seizures during the waking state. Their auras were carefully replicated and presented to the patients under various conditions. The presentation of the auras evoked neither clinical nor EEG evidence of seizures. A sixth patient had seizures only when asleep which were preceded by vivid nightmares. Since the seizures occurred only when the patient was asleep, we considered that the seizures could be reflex in nature and evoked by a dream. Replication of the dream, however, did not evoke clinical or EEG evidence of epilepsy. The dreams, therefore, were auras or a part of the seizure complex.


Effects of increasing arterial pressure on cerebral blood flow in the baboon: influence of the sympathetic nervous system.

The influence of stimulation of the cervical sympathetic chain on the response of cerebral blood flow to hypertension induced by the intravenous infusion of angiotensin was studied in anaesthetised baboons. Cerebral blood flow was measured by the intracarotid 133Xenon injection technique. Possible lesions of the blood-brain barrier were studied by injecting Evans blue towards the end of the experiment and ischaemic brain damage was assessed following perfusion fixation. In a control group of five baboons blood flow increased by 53 +/- 9% (mean +/- S.E.) from the base line values in the arterial pressure range 130-159 mm Hg. In four baboons subjected to unilateral sympathetic stimulation flow increased by 16 +/- 4% in the same pressure range. In three baboons subjected to bilateral sympathetic stimulation there were no significant increases in flow until the arterial pressure had increased above 159 mm Hg. Disruption of the blood-brain barrier in the parietooccipital regions was only seen in the control animals but not in the stimulated baboons. Ischaemic brain damage was not observed with the exception of one small lesion in a single stimulated baboon. These findings provide strong support for the observations of Bill and Linder (1976) that activation of the cervical sympathetic can modify the level at which breakthrough of cerebral blood flow occurs in association with systemic hypertension.


[Reliability and limitations of total and divided renal clearances as determined with a partially shielded whole-body counter (author's transl)].

Error and reproducibility of the total and divided renal clearance determination was investigated, using a partially shielded whole-body counter. The error of the total renal clearance determination using ortho-131I-hippuran (OIH) depends primarily on the downslope of the whole-body curve, i.e. on renal function. The error is as low as +/- 6% for clearance values of more than 100 ml/min and increases slowly with clearance values decreasing about 35 ml/min. The error of clearance values below 25 ml/min is higher than 50%. The error of the divided renal clearance using OIH is the same as the error of the total renal clearance. The reproducibility of the total OIH-clearance in single clearance periods was found to be +/- 6% and in repeated determinations +/- 12% (r = 0.97). The reproducibility of the divided renal OIH-clearance with scintillation probes showed an average deviation from the mean of +/- 10% (r = 0.87). The substitution of the scintillation probes by a scintillation camera and the use of regions of interest should diminish this error considerably. The results were compared with literature data on standard PAH- and inulin clearances.


[Anabolic effects of steroid hormones in rabbits (author's transl)].

The anabolic effect of steroid hormones was investigated in rabbits by measuring the skeletal accumulation rate of 85Sr following the continuous administration of estrogens, androgens and corticosteroids over a period of eight weeks. Androgenic hormones did not influence the accumulation rate of 85Sr, whereas following castration and prolonged administration of estrogens an increase of 85Sr accumulation was found. There was no correlation of the changes observed with serum calcium levels, since the latter remained stable throughout the observation period during long-term administration of various hormones.


[Effect of some amino acids on the biosynthesis of glucoamylase by cultured Endomycopsis species].

The effect of amino acids (glutamic, aspartic, beta-alanine, phenylalanine, methionine) on the glucoamylase biosynthesis by Endomycopsis species 20-9 was studied. Monoaminodicarboxylic acids produced a stimulating effect on the glucoamylase synthesis. Their addition at optimal concentrations of 0.2 to 0.4% increased by 54--69% glucoamylase activity of Endomycopsis sp. 20-9 upon submerged cultivation on the medium containing 3% maize extract and 1% starch. An application of this amino acid nutrition during cultivation did not produce a significant effect on the microbial glucoamylase activity.


[Preparation of extracellular ribonuclease from Bacillus subtilis].

The paper describes a method for isolating alkaline ribonuclease from the culture liquid Bacillus subtilis KP 349 which involved: submerged cultivation of the producer on complex and synthetic nutrient media with optimized  RNase activity, acid treatment of the total culture liquid, and filtration through perlite. Further treatment may include either spray drying of the culture liquid filtrate or its concentration in a vacuum evaporator, dialysis of the concentrate against distilled water, and dialyzate lyophilization. As a result, commercial RNase preparations with activities of 30--60 thous. and 160--300 thous. units/g, respectively, were obtained. The enzyme purification was carried out by chromatography and rechromatography on phosphocellulose columns. The resultant RNase of Bac. subtilis had a specific activity of 41--44 thous. units/mg protein, contained no nonspecific phosphodiesterase, DNase, acid or alkaline phosphomonoesterases.


Radical scavenging as the mechanism for stimulation of prostaglandin cyclooxygenase and depression of inflammation by lipoic acid and sodium iodide.

Certain radical-trapping reducing agents have been shown to stimulate prostaglandin biosynthesis in vitro (1--6) and to depress phorbol myristate acetate-induced mouse ear edema (16). The increased prostaglandin synthesis resulted from influences on the cyclooxygenase. To ascertain whether these alterations were due to direct interaction with the enzyme or to indirect scavenging of the oxidant released during PGG2 reduction, we report the effects of lipoic acid and sodium iodide. Both of these agents stimulated the enzymatic oxygenation of arachidonic acid, increased the reduction of PGG2 to PGH2, quenched the EPR signal induced by arachidonic acid and depressed mouse ear edema. In addition to discovering two unusual antiinflammatory agents, we have confirmed that materials with entirely different structures can have identical effects on the cyclooxygenase, suggesting indirect stimulation of this enzyme due to trapping of the oxidant.


Prostacyclin biosynthesis in activated, stimulated and normal mouse peritoneal cell populations.

Nonspecific resistance to infectious and neoplastic disease can be enhanced by administration of "immunomodulators". The levels of enhancement can be monitored by following in vitro function of cells of the lympho-reticuloendothelial system. To gain a better understanding of the physiological and biochemical nature of this enhancement, the metabolism of prostaglandin endoperoxide PGH2 was followed in mouse peritoneal cells (PCs). Homogenates of PCs from normal, unstimulated mice yielded primarily prostacyclin (PGI2) when incubated with PGH2. Homogenates of PCs from mice injected with the immunomodulators C. parvum, levamisole HCl, pyran copolymer, or thioglycollate yielded less PGI2. Reductions ranged from 73% for C. parvum to 32% for levamisole. A statistically significant inverse correlation existed between the level of macrophage "activation" and ability of cellular homogenates to produce prostacyclin. The results suggest that prostacyclin may be involved in modulation of nonspecific resistance.


Survival of transplanted normal hepatic cells in bilirubin UDP-glucuronyl transferase deficient Gunn rat liver.

The survival of H3 thymidine labelled normal rat hepatic cells after transplantation into the Gunn rat liver has been investigated. It was found that 0.9% of the cells survived at least 12 weeks after transplantation. This suggests that the observed uridine diphosphoglucuronyl transferase (UDPGT) activity in the genetically deficient Gunn rats after transplantation of normal liver may be partially due to these cells. Time required for the transplantation procedure has a profound effect on the survival of such cells in the recipient liver.


The effect of Prussian blue and sodium-ethylenediaminetetraacetic acid on the faecal and urinary elimination of thallium by the dog.

After oral administration of sublethal doses of thallium (lower than 10 mg/kg) to dogs, 75.5 +/- 3.9 per cent of the dose was eliminated from the body--47 per cent faecal and 28 per cent urinary. Cumulative excretion reached 50 and 70 per cent after 10 and 25 days respectively, and was almost complete after 75 days. This was slightly lower at higher doses. The total body-burden of thallium, calculated from the cumulative excretion, decreased exponentially for at least the first 40 days with a half-time (T 1/2) of 6.5 days. Oral doses of Prussian blue after 10 days resulted in an acceleration of the thallium elimination from the body (T 1/2 2.5 days), an increase of the faecal (49 per cent) and a decrease of the urinary excretion (18 per cent). Nevertheless, the cumulative faecal and urinary thallium excretion was not influenced. Minor transitory influences of Prussian blue on the faecal thallium excretion could be observed up to day 26. After 40 days, Prussian blue could no longer influence the faecal thallium excretion. At no time did sodium-ethylenediaminetetraacetic (Na2EDTA) acid significantly change faecal or urinary thallium excretion.


Non-specific agglutination of Corynebacterium ovis by precolostral and young lamb sera.

An agglutination reaction, relatively coarse compared to that obtained with immune sera, was observed when Corynebacterium ovis cells were incubated with lamb sera collected before and after ingesting colostrum. The reaction did not appear to involve immunoglobulin since it was not affected by treatment of precolostral lamb serum with rivanol, mercaptoethanol or rabbit antisheep serum. IgM was detected in only three of 10 precolostral samples with agglutinating activity and immunofluorescence studies showed that it was not specific for C ovis. In view of the non-specific clumping factor, tests which detect antitoxin would be preferable for immune surveys in young lambs.


[Progressive myoclonic encephalopathy in dialysis patients. Clinical, electroencephalographic and neuropathological study. Pathogenetic discussion].

Clinical and Neuropathological data on sixteen cases of progressive myoclonic encephalopathy are reported. This neurological syndrome appears after an average duration of thirty two months of haemodialysis and leads to death in four and a half months, and is characterized by myoclonus, speech disorder, epileptic seizures, and mental-status changes. At first, clinical signs and symptoms are related to haemodialysis, later they become permanent. An early diagnosis is based on EEG which is the only useful laboratory test, demonstrating bisynchronous slow-wave bursts. The caracteristic histopathologic findings are neuronal depopulation, lipofuscin accumulation, and appearance of Neurofibrillary degeneration, especially in Motor cortex, red nucleus and dentato-olivary systems. It seems to be justified to attribute P.M.D.E. to aluminium chronic poisonning; the source of the aluminium intoxication is not aluminium containing phosphate-binding gels but intravenously administreted tape-water. The intracellular binding of aluminium is shown from a histochemical study employing fluorescent stain Morin.


[2 familial cases of Lafora disease. Clinical, electroencephalographic and pathologic study].

Three children born of consanguineous parents had Lafora's disease and two of them had been studied clinically, pathologically and biochemically. The autosomal recessive transmission of the disease is confirmed by the familial study and the parents present no phenotypic anomaly of the disease. Electroclinical data are discussed with regard to the early differential diagnosis between this entity and idiopathic generalised epilepsy and myoclonic epilepsy without Lafora's bodies. Iodine spectrum of the cerebral and hepatic abnormal deposits suggest that Lafora's bodies mainly consist of long chains glycogen similar to amylopectin.


[Fluorine osteosis caused by a very long-term niflumic acid treatment in 2 cases of rheumatoid arthritis].

An osteosclerosis opacifying the axial skeleton and affecting in particular all of the spine, was observed in two women aged 75 and 42 years who had been suffering from a rheumatoid arthritis developing between 15 and 26 years. It was traced to a chronic fluorine intoxication, stemming from the regular taking, for 10 years and 8 1/2 years, of a non cortisone, anti-inflammatory niflumic acid. This fluorine product has 3 atoms of fluor in its molecule (50.0 mg for a tablet of 250 mg). Its administration to control subjects proved the production of ionized fluor by way of the metabolism, and the accumulation of fluor in the organism. Rheumatoid polyarthritis and the prolonged corticotherapy (10 mg of prednisone per day for 21 years) cannot be dismissed as the origin of the severe demineralization of the limbs observed in the second patient, but the role of fluorine seems marked in the occurrence of this peripheral involvement with problems of mineralization and secondary hyperparathyroidisms. On the other hand, the absence of an intervertebral narrowing in the 2 patients, despite the very prolonged taking of cortisone (5 mg of prednisone per day for 15 years, for the 75-year-old patient) is perhaps a result of the fluorine.


[Induction of macrophage activation with bacterial products for potentiation of resistance to some chronic infections].

Adult mice of the consanguine A2G strain received two intraperitoneal inoculations of 0.5 mg Listeria monocytogenes phospholipid extract at 30 days interval. In the treated animals and the controls, the capacity to develop a humoral immune response was tested 24 hours after the second inoculation, following antigenic stimulus with sheep red blood cells; phagocytizing in vitro of labelled germs by peritoneal macrophages and the response of lymphocytes to mitogenic and allogenic stimuli were likewise tested. The bacterial phospholipid extract activated the phagocytic function of the macrophages and the reactivity of the allogenically stimulated lymphocytes.


Study of plasma osmolarity during the treatment of diabetic ketoacidoses.

Analysis of 610 cases of diabetic ketoacidosis, of which 210 severe cases, showed that before beginning the treatment 6.2% of the patients presented hypoosmolarity, 41.4% normoosmolarity (dysosmolarity) and 52.2% hyperosmolarity. In predominantly hypernatremic hyperosmolarity (5.9% of cases) the authors recommend weak alkaline hypotonic electrolytic solutions (222 mOsm/l). 5% glucose solution and insulin in small doses less than 5 U/h; in predominantly hyperglycemic hyperosmolarity, weak alkaline isotonic electrolytic solutions (309 mOsm/l) and insulin in medium doses (6--8 U/h); in exclusively hyperglycemic hyperosmolarity, hypertonic electrolytic solutions (395 mOsm/l) associated with sufficient insulin dosis (8--12 U/h).


Fat-induced jejunal inhibition of gastric acid secretion and release of pancreatic glucagon, enteroglucagon, gastric inhibitory polypeptide, and vasoactive intestinal polypeptide in man.

The effect of intrajejunal (i.j.) infusion of fat on meal-stimulated gastric acid secretion and release of pancreatic glucagon (PG), enteroglucagon (EG), gastric inhibitory polypeptide (GIP), and vasoactive intestinal polypeptide (VIP) was studied in seven healthy volunteers. I.j. fat markedly inhibited meal-stimulated acid secretion as compared to a control study with i.j. saline infusion. The acid inhibition was accompanied by augmental plasma concentrations of EG, GIP, and VIP but not of PG, suggesting that EG, GIP, and VIP may be among mediators of fat-induced jejunal inhibition of acid secretion. Concentration-time relationship makes it unlikely that the observed inhibition could be ascribed to any single peptide studied.


Common bile duct pressure and Oddi sphincter pressure in patients with common bile duct stones with and without juxta-ampullar diverticula of the duodenum.

Resting common bile duct pressure and Oddi sphincter pressure were measured in 16 patients with common bile duct stones, 8 having in addition a juxta-ampullar diverticulum. Pressure measurements were performed with an infused catheter introduced through an endoscope under direct vision. No significant differences in fasting common bile duct pressures were observed between the two groups. The Oddi sphincter had a phasic activity, and the peak pressure was similar in both groups.


Nonsecretory IgD-kappa multiple myeloma in a patient with Gaucher's disease.

A patient with Gaucher's disease and non-secretory multiple myeloma is described. The presence of typical Gaucher and myeloma cells was confirmed by transmission and scanning electron microscopy. The immunological studies established the diagnosis of 'non-secretory' type of multiple myeloma.


Immunoglobulins G, A and M in normal and pathologic human sera determined with the spot immunoprecipitate assay (SIA) in multi-assay plates.

A simple rapid spot immunoprecipitate assay (SIA) is presented. The antigen--antibody reaction takes place in a field of alternating current; small amounts of specific antisera are used, and the influence of diffusion or electromobility of the antigen is avoided. Determinations of IgG, IgA and IgM in sera from healthy individuals correlated highly significantly with radial immunodiffusion (RID) results. The reaction conditions in SIA, particularly the availability of a sufficiency of specific antibodies, may permit more accurate estimates of monoclonal forms of Ig than in RID, where the combination depends on diffusion of one reactant. The precision of SIA quantitation of IgG and IgA was within +/- 10% and +/- 13% for IgM. Working ranges of the standard curves were from about 25--150 ng for G and A and 75--300 ng for IgM; least squares regression coefficients for four sets of standards on three SIA plates were 0.995 for IgG, 0.969 for IgA, and 0.986 for IgM. IgA at 7.5 ng in a 2.5 mg/l dilution was at the lower limit of demonstrability. Photometric registrations and estimates made by visual inspection compared highly significantly (P less than 0.001), differing by +/- 3%.


The long-term treatment of the aged. An assessment method.

The aim of this investigation was to construct three parameters and assess their value as admission criteria for long-term institutional care of the aged, viz. medical dependence, nursing dependence, and dementia. The material consisted of 200 applicants, of whom 150 were admitted to institutions. The need for personal care was measured by means of a test method developed at the Wasa Hospital, Gothenburg, Sweden, and the dementia test comprised five subtests, each of which measures a distinct field of mental function. Both dementia and nursing dependence were found to increase with age, and there was a highly significant correlation between nursing dependence and age. There was also a highly significant correlation between nursing dependence and degree of dementia. The changes in nursing dependence 3 and 6 months after admission showed a significant correlation with the test scores for dementia. The nursing dependence of the moderately or severely demented persons had increased in 6 months after admission by approximately 100%. The test results of dementia were used as the sole, decisive criterion in 24% of admissions; medical dependence alone decided the choice of institution in 22% and nursing dependence in 15%. Two or three parameters were used in 39% of admissions--all indicating the same type of institutional care. The simultaneous use of the three assessment criteria provides an extensive body of information as to the general need of care, and by means of this information the appropriate placement of the old will be made possible.


[Intestinal lactase and milk consumption before and after gastrectomy].

Intestinal lactase assays before and after a Billroth II procedure for chronic duodenal ulcer did not reveal a significant difference. Postoperative lactose intolerance is due to the loss of pyloric function, causing entrance of lactose into the jejunum at a rate exceeding the hydrolytic capacity of the mucosa if the lactase level is low.


[Therapy of senile osteoporosis using sodium fluoride--continuous and intermittent long-term therapy].

To evaluate a therapeutic effect, biochemical parameters of bone metabolism and photonabsorption densitometry have been compared in patients with senile osteoporosis under long-term continuous or intermittent sodium fluoride treatment. A comparable increase of trabecular bone density is found after continuous and intermittent therapy for at least one year. The well-known effect of defective mineralization under long-term continuous therapy with sodium fluoride corresponds to a statistically significant increase in urinary hydroxyproline and calcium excretion and a trend towards a rise in serum alkaline phosphatase in this study. Similar findings cannot be observed in patients on intermittent sodium fluoride treatment. The increase in bone density without concomitant changes in biochemical parameters suggests a beneficial therapeutic effect without biochemical evidence for defective mineralization.


[Anti-D hyperimmunoglobulin, a study of Swiss requirements].

Owing to the introduction of postpartum Rhesus prophylaxis with anti-D hyperimmunoglobulin, a very small number of Rh-negative women become sensitized against the Rhesus factor at birth. Accordingly, the number of naturally immunized women suitable for the collection of anti-D plasma is decreasing. Currently, the demand for anti-D plasma in Switzerland is covered by plasma donations of spontaneously immunized women. The relation between production of and demand for anti-D hyperimmunoglobulin is expected to improve in the coming years due to better registration of anti-D-carrying women. Large areas of Switzerland are poorly exploited with regard to female anti-D donors and represent substantial reserves with regard to anti-D hyperimmunoglobulin production. It is expected that anti-D production from plasma collected from naturally sensitized women will cover demands up to the year 2000 without difficulty. Active immunization of Rh-negative volunteer donors will not be needed before the end of the century.


Uncoupling agents distinguish between the effects of metabolic inhibitors and transport inhibitors.

In studies with toad bladders, the uncoupling agent 2,4-dinitrophenol (DNP) reversed the inhibition of CO2 production produced by direct inhibition of transport. In contrast, DNP did not reverse the inhibition of CO2 production brought about by metabolic inhibitors. Therefore, the response to DNP distinguished between inhibition of transport and metabolism; this approach may be useful for the investigation of factors that regulate active transport.


Seaweed dermatitis: structure of lyngbyatoxin A.

A highly inflammatory and vesicatory substance, lyngbyatoxin A, has been isolated from the lipid extract of a Hawaiian shallow-water variety of Lyngbya majuscula Gomont; its gross structure was determined from chemical and spectral data. Lyngbyatoxin A is closely related to teleocidin B, a poisonous substance associated with several strains of Streptomyces.


Thalamic and cortical afferents differentiate anterior from posterior cingulate cortex in the monkey.

The anterior cingulate cortex receives thalamic afferents mainly from the midline and intralaminar nuclei rather than the anterior thalamic nuclei. In contrast, the posterior cingulate cortex receives afferents primarily from the anterior thalamic nuclei and from extensive cortical areas in the frontal, parietal, and temporal lobes. These contrasting afferents may provide a structural basis for pain-related functions of the anterior cingulate cortex.


Prolongation of islet allograft survival following in vitro culture (24 degrees C) and a single injection of ALS.

Isolated rat islets remain morphologically and functionally intact during a 7-day period of in vitro culture at 24 degrees C. In vitro culture of islets at 24 degrees C for 7 days prior to transplantation, in conjunction with a single injection of antiserum to lymphocytes into the diabetic recipient, results in islet allograft survival of 100 days when the islets are transplanted across a major histocompatibility barrier.


Inhibition of gonadotropin by delta9-tetrahydrocannabinol:mediation by steroid receptors?

Competition assays for estradiol receptors in cytosol preparations of uteri from rhesus monkeys and humans showed that delta9-tetrahydrocannabinol (THC) does not compete with estradiol for intracellular estrogen recptors. Although isotopically labeled THC bound to macromolecules in uterine cytosol from the rhesus monkey, the binding was not displaced by unlabeled THC, diethylstilbestrol, estradiol, progesterone, cortisol, or 5 alpha-dihydrostestosterone. Scatchard analyses indicated that high-affinity saturable binding of THC to cytosol did not occur. Thus the inhibitory effect of THC on gonadotropin and steroid secretion in primates is not mediated by the interaction of THC with intracellular steroid hormone receptors.


Membrane effects of thyrotropin-releasing hormone and estrogen shown by intracellular recording from pituitary cells.

The effects of thyrotropin-releasing hormone and 17 beta-estradiol on the electrical membrane properties of a prolactin-secretin pituitary cell line (GH3/B6) were studied with intracellular microelectrode recordings. Of the cells tested, 50 percent were excitable and displayed calcium-dependent action potentials when depolarized. When injected directly on the membrane of an excitable cell, thyrotropin-releasing hormone and 17 beta-estradiol induced action potentials within 1 minute. The spiking activity was preceded by a progressive increase of the input resistance without any detectable change in the resting membrane polarization. The results reveal a rapid effect of both substances on the membrane of GH3/B6 cells. In the case of thyrotropin-releasing hormone, which has both a short-term effect on release of prolactin and a long-term effect on its synthesis, the induced electrical activity may be associated with the stimulation of prolactin production. The physiological implication of 17 beta-estradiol-induced, calcium-dependent spiking activity remains to be elucidated.


Multiple representations of the body within the primary somatosensory cortex of primates.

Microelectrode mapping experiments indicate that the classical primary somatosensory cortex of monkeys consists of as many as four separate body representations rather than just one. Two complete body surface representations occupy cortical fields 3b and 1. In addition, area 2 contains an orderly representation of predominantly "deep" body tissues. Area 3a may constitute a fourth representation.


Gene exchange and natural selection cause Bacillus subtilis to evolve in soil culture.

Strains of Bacillus subtilis exchange linked blocks of genes when growing together in soil; such exchange leads to extensive reorganization of the genotypic structure of the population and to the appearance and eventual dominance of a single phenotype. This process illustrates how recombination and selection lead to adaptive changes in populations.


Renin aldosterone system and potassium levels in chronic lead intoxication.

Renin activity and aldosterone were evaluated relative to potassium levels and lead intoxication in 33 patients with a history of "moonshine" ingestion. Patients were divided into three groups: I, lead intoxicated with hyperkalemia; II, lead intoxicated without hyperkalemia; and III, not lead intoxicated without hyperkalemia. Those in group I demonstrated suppressed plasma renin activity, baseline and after furosemide, and blunted aldosterone responsiveness to furosemide. Plasma renin activity was not different in groups II and III, whereas aldosterone responsiveness was less in group II than in III. Group I patients tended to be older, had lower creatinine clearances, and six of nine had mild hyperchloremic acidosis. Diabetes and cortisol insufficiency were not present. Chronic lead intoxication due to illicit alcohol ingestion is associated with hyporeninemic hypoaldosteronism and hyperkalemia which appear to develop as the lead nephropathy progresses with duration and/or aging.


Schistosomiasis japonica in Barrio San Antonio, Basey, Samar in the Philippines: II. Quantitative fecal examination and circumoval precipitin tests.

An improved quantitative stool examination technique (MFCT) and two variations in the performance of the circumoval precipitin test, one using whole serum (SCOPT) and the other employing the eluate from finger prick blood dried on filter paper (FPCOPT), were evaluated in a field study to detect infection with S. japonicum among residents of an endemic barrio in Samar. The sensitivity of SCOPT was above 90%, that of MFCT was between 80 to 90%, while that of FPCOPT was only about 50%. Intensity of infection as judged by fecal egg excretion and duration of infection as indicated by age were shown to be determinants of serum reactivity (and hence sensitivity of the two serodiagnostic tests). The relative insensitivity of FPCOPT observed in this work, also evident in some published data of previous workers, puts to doubt the wisdom of using this technique as the procedure of choice in epidemiologic surveys in the Philippines as currently favored in that country. Atypical positive reactions in circumoval precipitin tests using whole serum were detected which may make the differentiation of relatively recent from old infections possible.


Rickettsia tsutsugamushi infections in chiggers and small mammals on a mature oil palm estate.

An epidemiological study in a mature oil palm estate in Peninsular Malaysia has demonstrated a low prevalence of R. tsutsugamushi infection in small mammals. The direct fluorescent antibody technique for assaying infections in chiggers proved more sensitive than mouse inoculation. Most infections in both chiggers and rodents were caused by the Karp strain.


Enteric infections in Singapore with special reference to typhoid.

A review of the epidemiological features of the more important enteric infections in Singapore was given. Enteric fevers (typhoid and paratyphoid), Salmonella gastroenteritis and Shigellosis remained endemic at a rather constant level in spite of vast improvement in environmental sanitation, but amoebic dysentery showed marked decline. Vibrio parahaemolyticus is an important cause of food poisoning since it was first reported in 1973. El tor cholera is believed to be introduced through regional trade and travel. Control measures directed mainly at typhoid include detection of typhoid carriers in the community responsible for transmission of infection, control and licensing of public food handlers and health education.


Age differences in health care spending, fiscal year 1977.

This report of health care spending in fiscal year 1977 reveals that of the $142.6 billion spent by the Nation for personal health care in fiscal year 1977, 29 percent was spent for those aged 65 or older, 59 percent for those aged 19-64, and 13 percent for those below age 19. The average health bill reached $1,745 for the aged, $661 for the intermediate age group, and $253 for the young. Public funds financed 67 percent of the health expenses of the aged, with Medicare and Medicaid together accounting for 61 percent. More than two-thirds of the health expenses of the young and 71 percent of the expenses of those aged 19-64 were paid by private sources. Third-party payments met 68 percent of the health expenditures of all those under age 65.


Expression of human hepatic genes in mouse hepatoma--human amniocyte hybrids.

Human liver-specific gene products are expressed by hybrid cells resulting from the fusion of human amniocytes with mouse hepatoma cells. Amniocytes grown from human amniotic fluid have no detectable levels of secreted human albumin, transferrin, alpha-1 antitrypsin, or ceruloplasmin, while the mouse hepatoma line, HH--, secretes several mouse liver-specific gene products including transferrin and albumin. Fifty-five hybrids were isolated and analyzed for the expression of serum proteins by Ouchterlony double diffusion and Laurell immunoelectrophoresis. All hybrids continued to express mouse albumin and transferrin, and 29 hybrids from this series were found to express one or more human serum proteins. Activation of the human amniocyte genome provides a model for prenatal diagnosis of serum protein abnormalities.


A vest for ambulatory patients receiving hyperalimentation.

There have been no significant complications related to the use of this ambulatory hyperalimentation vest. The potential positive impact that increased use of this vest at home might have upon hospital stay and cost containment is obvious. It is further anticipated that, as advances are made in the technology of plastic bags, tubing, miniature pumps and microprocessors, ambulatory or home hyperalimentation delivery systems exemplified by this vest will achieve a much higher degree of sophistication, practical application, economy and favorable clinical results.


A simple technique to estimate severity of stress.

A simple procedure to estimate stress has been developed based upon 24 hour urine urea nitrogen excretion. This catabolic index partitions total urea excretion into that resulting from dietary protein intake and obligatory urea excretion and that due to an increase in endogenous protein catabolism: catabolic index equals 24 hour urine urea nitrogen excretion - (0.5 dietary nitrogen intake + 3 grams) where an index of less than zero represents no significant stress; an index of zero to 5, moderate stress, and an index greater than 5, severe stress. In 111 persons, significant differences were noted in the catabolic index, reflecting varying degrees of stress, nutrient intake and nutritional status. The catabolic index may have useful diagnostic and treatment applications.


Unusual metastasis in carcinoma of the cervix uteri.

In six patients, unusual metastases developed after definitive therapy for carcinoma of the cervix; three cutaneous, two biliary and one duodenal. The prognosis when such metastases develop is grave, although one patient is alive and well without evidence of carcinoma two and one-half years after the detection of the cutaneous lesion. Although the surgical approach is usually not curative, it is worth while for relief of symptoms.


Frequency and fate of human renal allografts contaminated prior to transplantation.

Bacterial cultures were done from donor ureter and/or graft perfusion fluid on 92 of 112 patients who had renal transplantations during 1977. Three samples of perfusion fluid and 14 samples of donor ureter contained bacteria. In nine cases there was a gram-positive organism, and in 10 cases a gram-negative rod was (among) the contaminant(s). There was no difference in the rate of graft survival, patient survival, or in the frequency of major postoperative complications between the two groups. Only in two instances could the urinary tract infection following transplanation be traced to the contaminating organism. Except for one case in which a urinary fistula may have been linked to the graft contamination, there were no clinically significant  sequelae from the contaminated allografts.