[A case of GM-Gangliosidosis (atypical form of the AB variant)].

A case of GM-gangliosidosis, variant AB, with some atypical feautres is reported in a male child, who died at the age of 4 years and 3 months. When he was 2 and a half years old, he showed signs of progressive cerebral disease with increasing motor and mental impairment. The clinical signs suggested a form of neurolipidosis; however the data of the enzymatic activities of the peripheral blood leucocytes did not show any deficit related to these forms. More specifically the values of the exosaminides A and B were normal, although the component A was near the lowest limit of the range. The anatomical, histological, histochemical, ultrastructural and chemical studies showed that it was a form of GM-gangliosidosis with visceral involvement. In the crude lipid extracts of various organs there was not only GM-ganglioside, but also a compound not previously demonstrated in these forms of neurolipidosis. Chemically this compound may be considered a phosphoglyco-lipid-and protein complex. From the enzymatic data in the peripheral blood leucocytes, the case may be a variant AB of the Sandhoff and al. classification (1971). However some clinical signs make our case closer to the 3th type of the O'Brien and al, classification while some histopathological aspects are similar to Tay-Sachs disease (i.e. to the variant B of the Sandhoff et al. classification; i.e. to the 1th type of the O'Brien et al. classification). These data, and the presence of an 'unknown compound', not yet demonstrated in the known forms of GM-gangliosidosis, support the hypothesis that our case may be considered as an 'atypical' form of the variant AB of the gangliosidosis GM and that further studies are necessary to reach a final nosography of these entities.


Synthesis of muscle glycogen during recovery after prolonged severe exercise in diabetic and non-diabetic subjects.

Glycogen synthesis rate in skeletal muscle studied in six juvenile diabetic and six non-diabetic males ingesting a carbohydrate rich diet during 12 h of resting recovery after exhaustive bicycle exercise. The diabetic subjects took their regular insulin. Blood samples and muscle biopsies were obtained at rest prior to exercise, immediately after cessation of exercise and after 2,4,6.9 and 12 h of recovery. A marked decrease in muscle glycogn content was observed in response to exercise in both groups of subjects. Mean glycogen utilization rate was the same in the two groups. Glycogen synthesis rate during the first 4 h or recovery was 6.4 +/- 0.6 mmol glucosyl units/kg w.w./h in the diabetic subjects and 7.2 +/- 0.7 mmol glycosyl units/kg w.w./h in the non-diabetic subjects. During the next 8 h glycogen synthesis rate was approximately 1/3 of that being 2.0 +/- 0.3 and 2.4 +/- 0.5 mmol glucosyl units/kg w.w./h in the two groups respectively. Glycogen synthetase I-activity increased markedly in response to exercise in both groups of subjects. However, no differences were observed between the groups. No significant differences in muscle glucose 6-phosphate concentrations were observed between the two groups. Plasma glucose levels were significantly higher in the diabetic than in the non-diabetic subjects. It is concluded that glycogen synthesis during recovery following prolonged severe exercise can proceed at the same rate in diabetic subjects taking their regular insulin as in non-diabetic subjects.


[Benign intracranial hypertension and thrombosis of the venous sinuses during contraceptive treatment: anatomo-clinical and neuroradiological observations (author's transl)].

The side-effects of oral contraceptives on the nervous system have been studied in 2 patients. The first case, a young woman who, after several years, of cyclic consumption of 4 mg of norethylsterone acetate and 0.05 mg of ethynilestradiol, died from a transtentorial temporal hernia due to severe intracranial hypertension. Angiography, and later autopsy, showed thrombosis of the dural venous sinuses and also of the majority of the emissary veins with C.S.F. blockage. The second case, a patient who took 1 mg of norethyndrone and 0.05 mg of mestranol for 20 months, developed a focal symptomatology (Grand Mal, global aphasia without lowering of the level of conscionsness) which cleared up rapidly. The CAT performed during the clinical illness showed mild signs of intracranial hypertension while cerebral angiography normal. It seems possible that the hormonal treatment may disturb the mechanisms of C.S.F. production-reabsorbtion and the filtration dynamics of the blood-brain barrier and perhaps, cause alteration of hypothalamic-hypophysial function. This would explain a transitory symptomatology, such as benign intracranial hypertension. However, the thrombosis of the venous sinuses (sometimes, as in our first case, massive) may be due to the venous stasis, that accompanies intracranial hypertension and to the altered blood coagulation.


Studies on renal tubular protein reabsorption: partial and near complete inhibition by certain amino acids.

Urinary excretion of albumin, free light chains of immunoglobulins and beta-2-microglobulin was measured after injection of certain amino acids and derivatives. Substances with a positively charged group located terminally in the molecule (ornithine, lysine, arginine, and the almost not metabolized epsilon-amino-caproic acid, and Cyclocaprone) proved to inhibit instantaneously the tubular protein reabsorption. Lysine is the most effective molecule tested. We hypothesize that the initial event in the normal tubular protein reabsorption is a binding between a free positive amino- or guanidino-group in the protein molecule and a negative site on the tubular cell surface. In an attempt to achieve complete inhibition of tubular protein reabsorption, large doses of lysine were injected intravenously. The maximal protein clearance rose from the exceedingly low baseline excretion to values probably representing near complete inhibition of protein reabsorption. The minimal value of albumin concentration in the glomerular filtrate was calculated to 2.6 mg/l.


Proficiency survey of serum protein analyses in Scandinavia.

A lyophilized human pool serum was distributed to Scandinavian clinical chemical laboratories for routine quantitation of different serum proteins. The analytical repertoir of the laboratories, and the methods and reference materials used, were registered. For almost all proteins the results varied considerably between the laboratories (CV 8--29%). The reasons for this variation are discussed together with possible recommendations to improve the accuracy of protein measurements.


Free light chains in serum during short course immunosuppression after corneal transplantation.

The effect of low doses of prednisone on the serum concentration oflight chains, IgG, IgA and IgM in nineteen corneal transplanted patients was investigated. Prednisone in doses of 30 mg daily for 6 days had an instantaneous effect on the concentration of light chains resulting in a mean decrease of 16.5% in relationship to the pre-treatment values. Decrease in the prednisone dose to 15 mg daily was followed by normalization of the light chain concentration. The effect of prednisone on the IgG concentration was less pronounced and more delayed. A mean decrease for IgG of 9.0% of the pre-treatment values was found. Minimum IgG concentration was found 3 weeks later than the minimum for light chains. Differences in the metabolization rate of light chains and IgG is suggested as an explanation for this. The concentration of IgA and IgM was unchanged during treatment. Correlation between corneal rejection and changes in the level of light chains or IgG was not found.


Studies on IgM polymerization: reassociation to non-covalently and covalently linked Fc5mu fragments.

Fc5mu fragments were purified from a trypsin digest of native IgM by gel filtration and isoelectric focusing. Polyacrylamide gel electrophoresis of Fc5mu fragments in sodium dodecyl sulphate disclosed a major and a minor band with molecules of 320,000 and 285,000 daltons, respectively. The mu chain fragments showed a molecular weight of 34,500. After reduction of the Fc5mu fragments to free mu chain fragments and J chain removal of the reducing agent by dialysis for 24 h under nitrogen in the presence of Zn ions gave non-covalently linked Fc5mu fragments. This shows that the non-covalent interactions operating between the mu chains of non-covalently linked native IgM are present in the C-terminal part of the mu chains. Additional dialysis in the presence of Zn and Cu ions resulted in the formation of covalently linked Fc5mu fragments.


The activity of cephalosporins on beta-lactamase-producing Neisseria gonorrhoeae.

The antibacterial activity of cephaloridine, cephalothin, cephalexin, cephradine, cefazolin, cefamandole, cefuroxime and cefoxitin was determined for six beta-lactamase-producing gonococci isolated in Great Britain and the USA. Cefuroxime was most active against small and large inocula, then cefoxitin, while cephaloridine was least active. Cefamandole was more active than cefazolin and cephalothin, but only on small inocula, and these three antibiotics, with the slightly inferior cephalexin and cephradine, all had moderate activity against large inocula. The inoculum effect (or lack of it) with cephaloridine, cefamandole, cefoxitin, and possibly cefazolin and cephalothin, may be explicable in terms of the level of their susceptibility to enzymic degradation, but this appears not to be true of the inoculum effect with cefuroxime, cephalexin and cephradine. The enzymes from the various strains had closely similar isoelectric points, apparently the same as that for TEM I from E. coli.


Pharmacological properties of diclofenac sodium and its metabolites.

Diclofenac sodium (Voltaren) is a non-steroid anti-inflammatory agent of a new chemical structure, which is animal experiments shows a high degree of anti inflammatory, analgesic, and antipyretic activity in various pharmacological models. It inhibits prostaglandin biosynthesis in vitro and in vivo, and this inhibitory effect at least partly explains the mechanism of action of the preparation. In animal experiments diclofenac sodium is characterised by a broad therapeutic range. Also, its gastrointestinal tolerability is better than that of other highly effective non-steroid anti-inflammatory agents. Two of the metabolites produced during the biotransformation of diclofenac sodium in man are also biologically active. The activity of these two metabolites, however, is very much weaker than that of unchanged diclofenac sodium and is comparable to that of phenylbutazone.


Regulative interactions between cells from different imaginal disks of Drosophila melanogaster.

The regulative behavior of cells from the imaginal wing disk of Drosophila melanogaster can be modified by interaction with cells from different disk types. Both thoracic and nonthoracic disks are able to interact, but there are major differences in the effectiveness of interaction. The finding lends experimental support to the idea that cells in different fields within the same organism use the same mechanism for specifying positional information. A similar conclusion has been reached by Wilcox and Smith based on studies of the mutation wingless.


Primate infant's effects on mother's future reproduction.

Female savanna baboons (Papio cynocephalus) had a longer postpartum amenorrhea and thereafter cycled longer before conceiving if their previous infant survived than if that infant died. Among mothers of surviving infants, differences in maternal care produced differences in age of weaning and age of independence but did not result in differences in interbirth intervals.


Thyrotoxicosis in a patient with secondary hypothyroidism.

We have described a patient with panhypopituitarism who developed thyrotoxicosis. There is a widespread belief that pituitary thyrotropin (TSH) is not a pathogenetic factor in most patients with thyrotoxicosis. Due to technical reasons, however, it has been difficult to entirely exclude the role(s) of TSH in the development of thyrotoxicosis. In this report hyperthyroidism appeared in a patient with TSH deficiency proved by the lack of response to TRH administration. This is the first known case in which TRH stimulation demonstrated total abscence of TSH before the onset of thyrotoxicosis. We cannot exclude the possibility that factors of adenohypophyseal origin play some role in the pathogenesis of thyrotoxicosis, but TSH per se does not play a role in the development of Graves' thyrotoxicosis.


National health expenditures, fiscal year 1977.

The Nation spent $163 billion for health care in fiscal year 1977 or $737 per person, according to preliminary figures compiled by the Health Care Financing Administration. This figure was 12 percent higher than spending for such purposes in the previous 12 months and represented an 8.8-percent share of the GNP. Public spending, which financed 42 percent of all health care in 1977, increased 11 percent while private spending rose 13 percent. Spending for hospital care went up 14 percent to $68.4 billion, and the total spent for physicians' services ($32.2 billion) reflected a 13-percent rise. Third-party payments financed 70 percent of all personal health care in the country.


Biliary obstruction after gastrectomy for carcinoma of the stomach.

Extrahepatic biliary obstruction occurred in 34 patients after 1,300 gastrectomies performed for carcinoma of the stomach. Metastasis to the portal nodes caused mainly by distal gastric neoplasms is the most common cause of extrahepatic biliary obstruction. The syndrome of severe unrelenting bilirubinemia with abdominal aches and a palpable liver signifies extrahepatic biliary obstruction until proved otherwise and calls for early exploration. Palliative operation can prolong survival if properly performed. Selection of the proper procedure requires operative cholangiograms. Pancreatoduodenectomy is the most successful palliative procedure. Prevention of extrahepatic biliary obstruction requires a meticulous dissection of the portal pedicle during radical gastrectomy.


Cervical myelopathy and radiculopathy secondary to ossification of the posterior longitudinal ligament.

Ossification of the posterior longitudinal ligament, despite its rare occurrence in Caucasians, is one further cause of cervical myelopathy and radiculopathy that should be included in the differential diagnosis. A recent case is reported.


Vascular dynamics of an experimental cerebral arteriovenous shunt in the primate.

An arteriovenous fistula which shunted arterial blood from the circle of Willis to the internal jugular vein was created in ten monkeys. Continued patency of the shunt was confirmed angiographically. Cerebral blood flow measurements were then obtained with the shunt both open and occluded. Flow was also determined in response to elevations of systemic arterial pressure and raised arterial carbon dioxide tensions (PaCO2), again with the shunt both patent and occluded. In addition, flow through the shunt alone was measured in response to elevations of systemic arterial pressure and PaCO2. The results suggest that flow through our arteriovenous shunt is minimally autoregulated to changes in systemic arterial pressure and is only slightly responsive to changes in PaCO2.


Correlation of spinal cord blood flow and function in experimental compression.

Focal spinal cord blood flow was measured in the left dorsal column of monkeys' spinal cords at T6 during slow balloon compression of the same segment. The physiological integrity of the spinal cord was monitored by the recording of the summated spinal evoked response (SER). In all cases, the evoked response did not disappear until the blood flow in the compressed segment was zero. In four animals, a definite phase of hyperemia occurred during compression, at which time the amplitude of the evoked response was reduced. A post-ischemic hyperemia occurred in seven animals. The evoke response returned in all animals to a varying degree within one-hour post-deflation. The results suggest that mechanical forces of compression, rather than ischemia, are mainly responsible for the loss of neural conduction in such a model. If ischemia plays a role at all in the loss of function in such a model, it appears that focal ischemia secondary to compression in the spinal cord must be profound for loss of physiologic function to occur.


Experimental spinal cord trauma, II: Blood flow, tissue oxygen, evoked potentials in both paretic and plegic monkeys.

Graded clinical motor deficits were produced in a series of Rhesus monkeys subjected to experimental spinal cord trauma from a variety of impact loads. An argon washout technique was used to measure spinal cord blood flow; tissue oxygen carbon dioxide, and somatosensory evoked potentials (SEPs) were also monitored. Each animal received a clinical grade and, after a week of study, the spinal cords were removed for histopathological grading. Blood flow in paraplegic animals was significantly decreased at two hours and seven days following injury (5 ml/min/100 gms tissue); paraparetic animals showed no significant difference from preinjury levels (14 ml/min/100 gms tissue). Animals which completely recovered demonstrated increased flow (27 ml/min/100 gms tissue). Composite tissue oxygen was generally depressed in paraplegic animals (28 mm Hg/kg) but showed no clear pattern in other groups. Only 8% of monkeys rendered paraplegic preserved a somatosensory evoked potential (SEP) at five minutes after injury. Paraparetic animals were more likely (40%) to show initial preservation of the SEP and in normal animals, the SEP always returned by three hours. Histopathological grading tended to parallel clinical grading in 92% of the cases. Although the extremes of possible postinjury deficits (complete paraplegia or recovery) can be predicted from a combination of these measurements, incomplete lesions (whether judged clinically or pathologically) present a more variable picture.


Experimental spinal cord trauma, III: Therapeutic effect of immobilization and pharmacologic agents.

A wide variety of pharmacologic agents has been suggested to serve as therapeutic adjuncts in the management of acute spinal cord trauma. The present study was conducted to determine what effect, if any, these agents have when they are added to immobilization of the spinal column, the most widely used clinical measure. Rhesus monkeys were subjected to different levels of experimental spinal cord injury with and without subsequent immobilization by means of a figure of eight ligature. In the control group, five of six animals impacted at 500 gm-cm were paraplegic. In the immobilized animals, three of four animals impacted at 500 gm-cm recovered completely and the fourth was only mildly paraparetic. Paraplegia could not be uniformly produced in this group until 800 gm-cm forces were routinely employed. In the second phase of the study, only immobilized animals were used, with and without drug therapy. No change in the force-injury curve, above and beyond that from immobilization, can be demonstrated for monkeys given dextran, phenobarbital, methyldopa, phenoxybenzamine or vasopressors. The pathophysiologic concepts upon which such agents are advocated should be reassessed. Spinal immobilization can significantly improve the clinical outcome following experimental spinal cord injury, it may also serve to control some of the variability previously observed in pharmacologic experiments.


Nitroglycerin infusion during infrarenal aortic cross-clamping in dogs: an experimental study.

The effects of an intravenous infusion of nitroglycerin on cardiac index and peripheral vascular resistance during infrarenal aortic cross-clamping were determined in normal animals and in animals subjected to low cardiac output state. Both groups of untreated animals demonstrated progressive fall in cardiac index with a rise in total peripheral resistance during infrarenal aortic cross-clamping. The infusion of nitroglycerin during the period of aortic cross-clamping prevented the increase in total peripheral resistance and therefore prevented the progressive fall in cardiac index that occurred in untreated animals. In the animals with depressed myocardial function, the infusion of nitroglycerin produced a 44% increase in cardiac index during aortic cross-clamping. The results of this study showed that the infusion of nitroglycerin during abdominal aortic cross-clamping can prevent adverse cardiovascular sequelae from occurring and should be used in patients undergoing abdominal aortic resection, especially those with impairment of left ventricular function.


Essential fatty acid deficiency in total parenteral nutrition: time course of development and suggestions for therapy.

Thirty-two patients receiving total intravenous nutrition were studied prospectively for biochemical and clinical signs of essential fatty acid deficiency. Individual constituents of the phospholipid fraction were examined consecutively and the triene:tetraene ratio was determined. All patients nourished parenterally for 4 weeks had triene:tetraene ratios of greater than 0.4. Levels of eicosatrienoic and linoleic acid were abnormal after 1 week, and arachidonic acid levels became abnormal after 2 weeks of fat-free parenteral nutrition. Skin lesions suggestive of essential fatty acid deficiency developed in two patients studied. Biochemical abnormalities responded rapidly to the intravenous administration of Intralipid.


Results of reoperation for hyperparathyroidism, with evaluation of preoperative localization studies.

During the past 3 years (June, 1974, to July, 1977), 51 patients underwent reoperation for persistent or recurrent hyperparathyroidism at the Mayo Clinica. The overall success rate for cervical reoperation was 72% and for mediastinal reoperation, was 64%. Arteriography alone provided accurate preoperative localization of missing parathyroid tumors in 11 of 17 patients at a cost per patient benefited of approximately $1,700. Selective thyroid venous sampling with parathormone assay alone correctly lateralized hyperfunctioning glands in only four of nine patients at a cost per patient benefited of approximately $1,900. When used in combination, these studies provided correct localization or lateralization of parathyroid tumors in five of seven patients at a cost per patient benefited of approximately $2,000. Three patients experienced significant neurological complications as a result of thyrocervical arteriography. There were no complications due to venous sampling. In patients who has undergone a less than thorough initial explorations due to venous sampling. In patients who had undergone a less than thorough initial exploration of the neck, the success rate for reoperation was not enhanced by obtaining preoperative tumor localization studies. However, in those patients who had had a thorough and systematic exploration of the neck at their first operations, the success rate for reoperation was almost doubled when preoperative arteriography or venous sampling (or both) was employed.


[Technical realization of a systematized radiation therapy, founded on the TNM system, of tumors in the regions of the head and neck (author's transl)].

Modern radiation therapy of tumors within the regions of the head and neck regards not only the concept of the target volume but also the probability of affection to the lymphatic chains. Frequency of spread to lymph nodes depends on the size of the primary tumor, and thus the extent of radiotherapeutic practical measures can be  conformed to the TNM system. A radiation therapy planned in view of the TNM classification may be termed, therefore, as a systematized radiation therapy. From the standpoint of these considerations irradiation techniques using a telecobalt therapy unit and a betatron have been examined considering the application to individual toumor sites and tumor volumes in the regions of the head and neck. The techniques being most appropriate for tumors of the head and neck, with regard to the various sites or volumes, and taking into account the target volume as well as the lymphatic chains concerned are here presented.


[Calculation of the dose distribution of high-energy electrons within and behind tissue inhomogeneities of any width. II. Influence of multiple scattering (author's transl)].

The algorithn proposed in 1976 to allow for the influences of tissue inhomogeneities in electron beam dose distributions has been improved. A factor adopted from Sternheimer corrects for differences in lateral displacement by multiple scattering within the inhomogeneity resp. the equivalent layer of the homogeneous medium. The algorithm has been tested by direct comparison with Monte Carlo computations for the example of cylindrical cavities in carbon at Eo=10 MeV and resulted in a very close approximation.


The unique characteristics of covalently polymerized bovine serum albumin solutions when used as antibody detection media.

Bovine Serum Albumin solutions (BSA) have been chemically polymerized to give solutions (PBSA) with superior serological properties. The new PBSA reagents are shown to contain covalently bonded dimers, trimers, tetramers, and larger polymers, the presence of which is directly related to hemagglutination by IgG antibody. Data are presented which show that reagents containing increased amounts of higher molecular weight polymers enhance hemagglutination, as demonstrated by serum albumin titrations of various antisera. Additionally, isolated polymers are shown to enhance hemagglutination as a function of their molecular weight with the high molecular weight tetramers being more effective than the trimeric form, which in turn is more effective than the dimeric and monomeric forms. The protein concentration does not play any significant role in these events. The data establish that the polymeric content of bovine serum albumin reagents is a major factor in the potentiating properties of such solutions. Additionally, it is shown that these reagents act not only on the second stage of hemagglutination as a function of the bovine albumin present, but also on the first stage of hemagglutination as a function of the ionic strength of these reagents. The polymeric content and ionic strength of albumin solutions are the major criteria in determining the effectiveness of these potentiating reagents.


Difficulty in LW typing as revealed by a family study.

A family is described in which two members of the second generation are of the phenotype LW3. In the course of the investigation the mother of the LW3 propositus was at first believed to be phenotypically LW3 as well. Eventually, it was shown that she is, in fact, phenotypically LW2 but that her R-1 (no D), LWlw, genotype had resulted in less LW being present on her red blood cells than is expected in LW2 persons. This reduced level of LW could not be detected with one example of anti-LW made by an LW3 individual.


[Dynamics of changes in the surface of normal cultivated rat cells after a single exposure to the carcinogen 7,12-dimethylbenz(a)anthracene].

Changes in the cell surface after a single treatment with 7,12-dimethylbenz(a)anthracene (DMBA) of newborn rat carcass in cell culture have been studied by means of the agglutination reaction with concanavalin A. DMBA was shown to cause alterations in the cell surface. At 0.5 mkg/ml of DMBA, the difference in agglutinability of treated and untreated cells persists for 30 days. At 0.1 mkg/ml of DMBA, the agglutinability of drug-treated and control cells was similar on the 4th day after removal of carcinogen. A prolonged culturing of control cells results in an increased agglutinability of cells with concanavalin A, and in 2.5 months it becomes indistinguishable from the agglutinability level of tumor cells with concanavalin A. In 5 months, drastic karyotypic changes are registered in control cultures.


A survey about blood bank policies and procedures.

A questionnaire about blood bank policies and procedures was prepared and sent out to 170 hospitals across the nation, 50 per cent responded. There is wide variation in both technical and nontechnical policies and procedures. Serum is separated from the original tube within 8 hours by 68 per cent of the hospitals and in 32 per cent serum is never separated from the original tube. Auto-control is included by 66 per cent of hospitals in at least one phase of the antibody testing, 34 per cent do not include auto-control in any phase. Du testing of the recipient is done in 85 per cent of the hospitals and in 15 per cent Rho type is determined by the immediate spin reactions alone. Slide type is the only method used to determine ABO group of cells of the recipients in 10 per cent of the hospitals, 18 per cent use serum-cell suspension, 10 per cent use the applicator stick method and only 62 per cent use washed saline-cell suspension routinely. Compatiblity testing between a recipient and a donor vary from a one-tube major crossmatch to a three-tube major crossmatch and minor crossmatch.


[Effect of ethylenediaminetetraacetic acid on the synapsis of polytene chromosome homologs and "supplementary nucleolus formation"].

On being added to the food of larvae of Drosophila melanogaster of various age, EDTA, within a broad scale of concentrations, does not change the frequency of asynapsis of polytene homologues. The "many nucleoli" phenomenon was observed both after EDTA treatment and without it. The frequency of this phenomenon is thought to depend on the conditions of slide preparation. Therefore many nucleoli may be probably fragments of general nucleoli.


[Heterologous transformation: search for an explantation of the high effectiveness of Bacillus subtilis transformation achieved by using Bacillus natto DNA].

A higher efficiency of B. subtilis cells transformation by B. natto DNA is true for every concentration of DNA and is not due to the helping effect known for streptococci, strain Challis. In competition experiments for DNA uptake unlabelled B. natto and B. subtilis DNAs when added to transforming H3-DNA reduced the radioactivity of the samples by a factor of three and two, respectively. A conclusion is drawn that a higher rate of B. natto DNA penetration to the B. subtilis cells results in a higher efficiency of their transformation.


Differentiation of BCG from other variants of Mycobacterium tuberculosis isolated from clinical material.

BCG isolated from clinical material may be reliably differentiated from other variants within the species Mycobacterium tuberculosis by means of a few simple cultural and biochemical tests and by bacteriophage typing. Animal pathogenicity tests may therefore be avoided.


[Structural heterogeneity of prealbumin fraction rat brain].

Biochemical and immunochemical studies were carried out to prove the structural heterogeneous and supermolecular nature of the rat brain BTB-protein. Microheterogeneity of the BTB-protein--6 subfractions--was found by disc electrophoresis in 30% gel and isoelectric focusing (pH 3-5). Two of the proteins are RNA-proteids. The presence of neurophysin in BTB-protein is suggested. Heterogeneity of BTB-protein according to its antigenic specificity was found by methods of immunodiffusion, immunoelectrophoresis and immunodisc electrophoresis. Heterofunctional complexes are supposed to exist in the nervous tissue which possesses various structural qualities and functional activities within the complex.


[On mechanism of gelatin-silver halogenide complex decomposition under the effect of Streptomyces Griseus protease].

Ionized carboxylic groups of side chains of gelatin dicarboxylic amino acids form bonds with microcrystals of silver bromide. The cleavage of peptide bonds formed first of all by aspartic and glutaminic acids as well as by glycine when hydrolyzed with Str. griseus protease causes decomposition of the gelatin-silver bromide complex and sedimentation of the latter. The sedimentation contains 56-58% of silver.


Bacillus of Calmette and Guérin and 7, 12-dimethylbenz(a)-anthracene carcinogenesis in mice.

The effects of single or repeated Bacillus of Calmette and Guérin (BCG) treatment on the onset of tumors induced by the carcinogen 7,12-dimethylbenz(a)anthracene (DMBA) injected at birth into Swiss mice were studied. Multiple doses of BCG, given at regular intervals significantly lowered the incidence of carcinogen-induced tumors. The DMBA-induced lung adenomas did not differ morphologically from the ones that appeared in mice simultaneously treated with both DMBA and BCG.


Parenteral hyperalimentation in patients with gastrointestinal cancer.

Sixty-six patients with locally advanced or diffuse gastrointestinal cancer or suffering from major complications due to surgery or radiation therapy, were treated with continuous parenteral hyperalimentation at the Istituto Nazionale Tumori of Milan for a cumulative period of 2101 study-days. Patients were divided into 4 groups: Group 1, malnourished patients with advanced gastrointestinal malignancy; Group 2, patients with gastrointestinal fistulae due to simple surgical complications or to radiation injury of the bowel; Group 3, patients with major postoperative complications; Group 4, surgical patients with gastric or colo-rectal carcinoma treated preoperatively. Mean infusional regime for the various groups included 42-56 Cal/kg/day and 1.5 to 2.4 g amino acid/kg/day, and the duration of the treatment ranged from 7 to 144 days. The results obtained show that protein calorie depletion of cancer patients may depend on malnutrition and that it can be reversed by parenteral nutrition, in patients, that are candidates for surgical treatment or those who qualify for chemotherapy and/or radiotherapy. Parenteral nutrition has a fundamental role in patients with fistulae, even if much attention must be paid to the external care of the fistula and the wound. In addition, nutritional support by intravenous feeding has proven essential for a successful outcome of patients with major postoperative complications. Preoperative protein repletion and central venous nutrition in patients who require gastrintestinal surgery represent a modern advance in the field of cancer surgery.


[Properties of immunoadsorbents prepared by antigen coupling to glutaraldehydeactivated polyacrylamide gel, BrCN-activated Sepharose and by copolymerization of antigens by glutaraldehyde].

Three types of immunoadsorbents were synthetized by antigen coupling to glutaraldehyde-activated polyacrylamide gel, BrCN-activated sepharose 4B and protein insolubilization using glutaraldehyde as a cross-linking agent. Different concentrations of rabbit gamma globulin, bovine serum albumin, soybean trypsin inhibitor and bovine ribonuclease were used as antigens and some properties of such immunoadsorbents were studied. Using 125J labelled antigens it was shown that glutaraldehyde-activated polyacrylamide gel (Bio-Gel P-300) couples 81-94% of the antigen added in a concentration of 0.5-4.0 mg.ml-1 gel and BrCN-activated sepharose 4B bounds 62-88% of the labelled antigen in a concentration of 5.0-20.0 mg.ml-1 gel. These antigen derivatives as well as those obtained by glutaraldehyde protein insolubilization permitted 54-88% of antibodies added with the immune sera to be isolated. There was a significant antigen leakage from sepharose immunoadsorbents after several antisera treatments or after half a year storage but despite of this antigen desorption all types of the immunoadsorbents studied preserved their antibody isolation capacity. Immune sera immunoglobulins nonspecific binding by immunoadsorbents was less on sepharose than Bio-Gel antigen derivatives.


An ontogenic study of the acute inflammatory response in the fetal rhesus monkey. II. The mediation of increased vascular permeability by histamine, compound 48/80 and bradykinin.

Vascular permeability as a function of age was evaluated quantitatively and morphologically in skin of fetal Rhesus monkeys given vasoactive mediators. The response was examined at 90, 120 or 150 days of gestation or at birth and compared to the response of yearling Rhesus monkeys. Skin sites were challenged with histamine, compound 48/80 or bradykinin. Evans' blue and horseradish peroxidase were used as markers of vascular integrity. Evans' blue was quantitated spectrophotometrically. Vascular permeability during fetal life was depressed. Fetal venules and capillaries had poorly formed basement membranes, an abundance of microfilaments within endothelial cells, occasional electron dense endothelial cells and infrequent deposits of extravascular peroxidase.


Bovine cryptosporidiosis: a transmission and scanning electron microscopic study of some stages in the life cycle and of the host-parasite relationship.

Transmission and scanning electron microscopy of the ileal mucosae from 12 calves infected with Cryptosporidium sp. showed cryptosporidia free in the lumen and attached to epithelium. The attached parasites were interpreted to be extracellular and adherent to the microvillous border of epithelial cells. Stages of the organism included crescentic-free merozoites, trophozoites, schizonts, gametes and oocysts. Attached parasites were detected chiefly at villous tips and all stages were present on a single villus. Attachment sites were characterized by absence or disintegration of microvilli, disorganization of the terminal web and development of a specialized attachment zone. There were increased numbers of lysosomes and irregularities in the nuclear membrane of parasitized epithelial cells. It was concluded that cryptosporidia exist in bovine intestine as extracellular parasites and cause epithelial changes that in turn probably cause or contribute to diarrheal disease.


[Antitumor activity of the bacterial walls of Br. abortus 99].

A brief chronologic survey is made of investigations that reveal that the bacterial cell walls and their chemical components exhibit antitumoral activity. Discussed is the problem which are the constituents of the bacterial wal and what is the mechanism through which such effects are produced. The conclusion is drawn that some peptides participating in the structure of the bacterial wall after their release in body stimulate the macrophages and thus confer antitumoral activity to them.


Studies on the cellular toxicity of polychlorinated biphenyls (PCBs). I. Effect of PCBs on microsomal enzymes and on synthesis and turnover of microsomal and cytoplasmic lipids of rat liver- a morphological and biochemical study.

The acute effects of the PCB (polychlorinated biphenyls) mixture (Aroclor 1254) on microsomal enzymes and on synthesis and turnover of microsomal and cytoplasmic lipids of rat liver were investigated. Six daily i.p. injections of 25 and 50 mg PCB/kg body weight resulted in increased liver weight and liver to body weight ratios. When compared to controls PCB treatment resulted in a six-fold increase in amount of cytochrome P-450. Activities of NADPH-cytochrome c reductase, ethylmorphine demethylase and inosine diphosphatase were increased whereas glucose-6-phosphatase values were decreased by PCB exposure. Analysis of liver homogenate and microsomal fraction revealed an increase in lipid in PCB-exposed animals. Phospholipids, cholesterol and triglyceride were significantly increased after PCB exposure; however, the greatest percentage increase was seen in the triglyceride pool. The finding of an increase in microsomal triglyceride to phospholipid ratios with exposure to PCB is suggestive of an increase in membrane-enclosed lipid (liposomes). Studies with labelled glycerol indicated that the PCB-induced fatty liver resulted from increased half life but not increased synthesis of liver lipid moieties. The rate of incorporation of leucine into microsomal membrane and albumin was somewhat enhanced in rats exposed to PCB indicative of increased protein synthesis. Morphological studies showed increased occurrence of lipid material, both in cytoplasmic droplets and within rough and smooth-surfaced endoplasmic reticulum. Proliferation of smooth endoplasmic reticulum and flattened Golgi cisternae with no secretion granules containing lipoprotein particles characterized the liver from animals exposed for 6 days. The increase in lipid within membranes of the endoplasmic reticulum together with the flattened Golgi lacking typical secretory vesicles indicates a defect in transport of lipoproteins from the endoplasmic reticulum to the Golgi apparatus and may be the cause of the PCB-induced fatty liver.


Human hepatocytes and aging: a cytophotometrical analysis in 35 sudden-death cases.

Alterations in the nuclear and cellular size of human hepatocytes occurring with age, and particularly in senescence, were studied by microphotometry. The material studied was obtained in 35 cases of sudden death, involving 17 males and 18 females ranging in age from 16 to 100 years. Cells of the peripheral zones of hepatic lobules were analyzed. The following results were obtained: 1. The mean nuclear area of hepatocytes remained relatively constant in subjects under 60 years of age but showed an increase in those over 60, this increase being associated with a greater standard deviation. 2. Volumetric analysis showed that the modal value included between 61 and 100% (mean 86%) of the cell nuclei examined and did not increase with age. This cell population was presumed to consist of diploid cells, the size of which remained constant. 3. An increase in mean nuclear area was due to the appearance of cells with larger nuclei which probably were the result of polyploidization. 4. Hepatocyte size increased with age. Analysis of the nucleus-to-cell sizes showed that the increase in cell size with age was more significant than the increase in nuclear size. 5. Cellular enlargement was more closely correlated with decrease in gross liver weight than with nuclear enlargement.


A macrophage chemotactic factor sharing common antigenicity with immunoglobulin G from DNP-ascaris extract-induced skin lesion in guinea-pig.

A macrophage chemotactic factor (factor a) was extracted from DNP-ascaris extract-induced skin lesions (showing a maximal macrophage reaction) in guinea-pigs and then purified by gel filtration on Sephadex G-100 and chromatography using DEAE-Sephadex and CM-Sephadex. This material was a thermolabile protein (free of nucleic acid) with a molecular weight of about 150,000. It shared commom antigenicity with serum IgG, and its chemotactic acitivity was completely absorbed by anti-IgG and anti-light chain antibodies, but not by anti-BSA antibody. In contrast to leucoegresin, this material seemed active for macrophages but not for neutrophils. Less active factors b and c were thermostable and not absorbed by the antibodies described above. The ratio of chemotactic activity of factors a, b and c in the skin extracts was roughly 60:25:15.


Plasma membrane vesiculation: a cellular response to injury.

The shedding of plasma membrane vesicles has been shown to result from exposure of monolayer cell cultures to formaldehyde and other sulfhydryl blocking agents. Incubation of cells in concentrations of these agents as low as 5 to 10 mM for intervals as brief as fifteen minutes is effective (Scott, 1976). Plasma membrane vesiculation has been shown to be an energy-dependent process that requires Ca++ and physiological temperature. Following plasma membrane vesiculation, cell monolayers appear intact by phase microscopy and show only slight evidence of cell injury by electron microscopy. In view of these observations, the question has been raised whether plasma membrane vesiculation is compatible with continued cell growth and metabolism. The experiments described in this paper were designed to answer these questions. We pulse exposed 3T3 mouse embryo cells to concentrations of formaldehyde, between 2.5 and 250 mM, for intervals 15, 30 or 60 min. Cell momolayers were then washed in a variety of different media in an attempt to reverse the effect of formaldehyde on cells. Cell monolayers were thereafter assayed for the shedding of plasma membrane vesicles and for their ability to transport 2-deoxy-D-glucose. Cells were also replated in serum-containing medium and their ability to grow was assayed over a seven day interval. The results show an inverse relationship between the shedding of plasma membrane vesicles and the ability of the cells to transport nutrients and to grow. We interpret these data to suggest that the process of plasma membrane vesiculation results from a form of cell injury which blocks cellular metabolism and growth.


Ultrastructure of human dermal blood vessels with special reference to the endothelial filaments.

The ultrastructure of endothelial cytoplasmic filaments of small blood vessels from the human dermis has been described. The material consisted of biopsies from normal abdominal and thoracic skin and also from the skin of patients with urticaria pigmentosa. Most vessels were surrounded by multiple layers of basal lamina and corresponded to the small venules of the subpapillary dermis. The wall of many vessels was composed by endothelial cells with clear cytoplasm which was rich in filaments and by endothelial cells with a dense cytoplasm which was poor in filaments. Some vessels had walls composed of clear endothelial cells only. The filaments varied in diameter between 80-120 A. Curling, recoiling and whorling of cytoplasmic filaments were obvious in endothelial cells of contracted vessels. Bulging of endothelial nuclei and nuclear indentations were seen in the skin lesion of urticaria pigmentosa. The possibility that the clear endothelial cells which are rich in filaments may be more actively involved in contraction than the dense cells, is discussed.


The effects of trichothecene toxins on the Bursa of Fabricius in day-old chicks.

The effects of T-2 toxin, Fusarenon X (FX), and Nivalenol (NV) on the bursa of Fabricius in the day-old chick were examined. After injections of 5 mg/kg of the mycotoxins into the residual yolk sac, cellular injury was limited at first to the smaller epithelial cells with coarse microvilli, which were located in the central portion of the follicle-associated epithelium. Subsequently necrosis spread out to the periphery. Degeneration and necrosis followed in the lymphoid cells in the lymphoid follicles. The other epithelial components in the follicle were relatively resistant to the mycotoxins. Both FX and NV were less potent than T-2 toxin, although the effects on the bursa of Fabricius were essentially the same. These findings suggest that the follicle-associated epithelium is clearly distinguished from other epithelial components in the bursa of Fabricius in day-old chicks.


Quantitation of particles in the freeze-fractured nuclear membrane after renal ischemia.

Changes in the number and sizes of membrane-associated particles have been quantitated in the protoplasmic (P) and exoplasmic (E) fracture faces of the outer membrane of nuclei isolated from the inner cortex following renal ischemia and reflow in the rat. No changes were observed in the inner nuclear membrane. After 20-min ischemia, the number of particles in both fracture faces decreased. With reflow, the total number of particles decreased after both 20- and 60-min ischemia. The partition coefficient (Kp = CPF/CEF) increased from 10 to 11 and 17 at 20- and 60-min ischemia then fell below control values to a Kp of 7 after 120 min. After reflow, Kp steadily decreased except after 20-min ischemia followed by 240-min reflow when Kp began to rise. The sizes of particles were predominantly 60 A in the P face of control outer membranes but became larger after ischemia. After 20- and 60-min ischemia with reflow, the size distribution became more normal. The shifts in particle numbers and sizes seem to indicate modifications within the membrane resulting from ischemia.


Ultrastructural study on the extrusion of multivesicular bodies from cardiac cells.

Cardiac conducting fibers taken from 12 dogs were studied in the electron microscope. The majority of samples contained a moderate number of multivesicular bodies (MVB's) and an extremely high number occurred in one dog. Single MVB's were found in the perinuclear region and in the cytoplasm separating myofibrils. A high accumulation of MVB's occurred at the cell periphery within cytoplasmic stalks extending into the extracellular space, in the intercalated disc, and also outside of the cell. The latter appeared to be extruded from the cell in the following way: 1) peripheral cytoplasm formed stalk-like extensions which contained MVB's; 2) the stalks detached from the cell; 3) vacuolar and sarcolemmal membranes surrounding the MVB disintegrated; 4) vesicles released from MVB adhered to the cellular surface and the coat of their membrane blended with the coat of the sarcolemma. The above pattern seems to be the same in those parts of sarcolemma which face the interstitial tissue and in the intercalated disc.


Hairy cell leukemia: a clinical, immunological and ultrastructural study. New data for the origin of the hairy cell.

Seven patients presenting with the characteristic clinical and laboratory findings of HCL were investigated mainly in order to find the origin of the HC with histochemical, electron microscopic and immunologic techniques. The results we obtained are somewhat contradictory, as in the recent literature, if the HC's are to the considered as being exclusively of lymphocytic or monocytic origin. The data however indicate that HCL is not of one cell type but two. One of these cells has characteristics of a lymphocyte. The other one, an ill defined cell, has mixed characteristics of both the monocyte and lymphocyte series. This hairy cell may represent a new cell line.


Cell proliferation in dimethylhydrazine-induced colonic adenocarcinomata following cytotoxic drug treatment.

A stathmokinetic technique was used to study cell proliferation in dimethylhydrazine-induced adenocarcinomata of rat colon following treatment with cytotoxic drugs. The rate of cell division was significantly increased three days after treatment with 5,7-dihydroxytryptamine and seven days after treatment with 5-fluorouracil. Acceleration of tumour cell proliferation following 5,7-dihydroxytryptamine treatment was inhibited by treating animals with the antiseritoninergic drug Xylamidine Tosylate. Acceleration of tumour cell proliferation following 5-fluorouracil treatment was inhibited by treating animals either with the antiseritoninergic drug BW501 or with the histamine H2-receptor blocking drug Cimetidine.


Abnormalities of the nuclear envelope in porcine muscle affected with congenital myofibrillar hypoplasia.

The nuclear ultrastructure of muscle fibres in congenital myofibrillar hypoplasia of piglets was studied in order to provide more information on the pathological changes present. In the initial stages of the disease, muscle fibres with a small reduction of myofibrils often had an increased number of nuclear pores. In the more advanced stages of the disease, the following nuclear abnormalities were observed in muscle fibres showing an extensive disintegration of myofibrils: 1) large dilations of the perinuclear cisternae, 2) small nuclear protrusions projecting into these dilations and 3) appositions of stray membranes of the disrupted endoplasmic reticulum to the nuclear envelope. The increase in the number of nuclear pores may be significant in the development of pathological changes in congenital myofibrillar hypoplasia which is thought to be a hereditary disease. The observed abnormalities of the nuclear envelope appear to be characteristic for muscle fibres undergoing degeneration.


Epithelial cell population kinetics of isolated ileal loops (thirty-vella fistulae) after 40% small in testinal resection. Autoradiographic studies in the rat.

The influence of 40% small intestinal resection on epithelial cell population kinetics of isolated ileal loops (Thirty-Vella fistulae) was investigated by autoradiography with H3-thymidine in the rat. Sixty days after resection increases were found in the size of the proliferative (0.05 less than P less than 0.1) and villous (P less than 0.01) zones. In isolated ileal loops of animals not subjected to 40% small bowel resection proliferative and villous zones were reduced in size in comparison to those of ileum in continuity in a group subjected to jejunal transection and anastomosis (P less than 0.002). The findings support the hypothesis that villous size is increased after resection by the action of a systemic factor. However, they provide only limited evidence for the influence of a systemic factor on crypt cell proliferation.


High resolution autoradiographic investigations on the mechanism of the adrenolytic effect of 7,12-dimethylbenzanthracene on the inner layers of the rat adrenal cortex.

The effects of chronic treatment with DMBA on the 3H-uridine incorporation into rat adrenocortical cells was investigated by high resolution autoradiography. It was found that DMBA significantly decreases the tracer incorporation into both nuclear and mitochondrial compartments of the zona reticularis cells. The hypothesis that the mechanism of the lytic effect of DMBA on the inner adrenocortical layers involves inhibition of nuclear and mitochondrial RNA synthesis is discussed.


[Biogenic amines and the functional state of the liver in experimental allergic encephalomyelitis and postdiphtheritic polyneuritis in dogs].

Severity of paralytic syndrome correlated with impairments in some functions of liver tissue (bile secretion, concentrating and detoxicating capacities) as well as with content of biogenic amines, lactic and pyruvic acids in liver and in blood, flowing in and out the liver tissue in dogs with experimental allergic encephalomyelitis and with postdiphtheritic polyneuritis. The alterations observed were due to development of demyelinization in the nerves and to the effects of additional factors, caused by insufficiency in external respiration.


Species differences in the biotransformation of 4-(2-methyl-3-(4-chlorobenzoyl)phenyl)butanoic acid (RU 16029).

1. 4-(2-Methyl-3-(4-chlorobenzoyl)phenyl)butanoic acid (RU 16029) is a potent anti-inflammatory and analgesic agent. In humans, its ketone group is rapidly reduced to an alcohol, whereas in rats, mice and dogs, its butanoic side-chain is rapidly oxidized to the corresponding acetic acid. 2. The extent of this oxidation was studied in eleven species. Cats, dogs, rabbits, hens and rodents readily oxidized the side-chain; humans, baboons and pigs showed only weak oxidizing capacity. 3. Species differences were also recorded in the secondary biotransformations. The acetic metabolite is excreted as an acylglucuronide in humans and rats, but as an amide-like conjugate in mice. 4. Comparison with biotransformations undergone by structurally related compounds confirms that the metabolism of a new compound in different species is unpredictable.


The influence of dose on the pattern of conjugation of phenol and 1-naphthol in non-human primates.

1. The pattern of conjugation of phenol and 1-naphthol was investigated in several primates; three Old World species (rhesus, cynomolgus, patas monkeys), two New World species (capuchin, tamarin), and two prosimians (bushbaby, tree shrew). 2. Following intra-muscular phenol or 1-naphthol (10 mg/kg), sulphation was the major conjugation in the Old World monkeys and prosimians, whereas glucuronidation predominated in the New World species. 3. In rhesus and cynomolgus monkeys, sulphation decreased as dose increased, but remained the major conjugation with both substrates at dose levels of 0.01 to 25 mg/kg. 4. In the capuchin, the conjugation pattern of phenol changed markedly as dose increased; at 0.01 and 1 mg/kg sulphation was the major conjugation, whereas at 10 and 25 mg/kg glucuronidation predominated. With 1-naphthol only small amounts of sulphate were excreted; glucuronic acid conjugation was the major metabolism at all four dose levels. 5. The importance of considering both substrate and dose when making inter-species comparisons, particularly with man, is discussed.


[Effect of parenterally administered protein hydrolysates on the secretory function of the small intestine].

The effect of intravenous infusion of proteinic hydrolysates on the secretory function of the intestines was studied in dogs with an intestinal loop isolated starting from the initial portion of the jejunum. The preparation of proteinic hydrolysates, such as the caseine hydrolysate TSOLIPK, aminopeptide and hydrolysine L-103 with their drop-by-drop infusion into the posterior vena cava to dogs on an empty stomach were found to have in most cases an effect on the periodicity of the small intestine secretory activity. The infusion of proteinic hydrolyastes failed to exert any essential influence on the secretion of the dense proportion of the juice, whereas the secretion of the liquid component of the intestinal juice increased in all experiments involving introduction of all the proteinic hydrolysates. The concentration of the total protein in the liquid part of the intestinal juice with intravenous infusion of the preparations remained unchanged. At the same time, the amount of protein secreted together with the intestinal juice at the rate of single secretory action was in the instance of the caseine hydrolysate TSOLIPK and aminopeptide infusion proved 1 1/2--3 times as great as in the tests without infusion.


The role of magnesium in protein-energy malnutrition.

The present study was aiming to explore further the variations in the levels of Mg in both serum and CSF of PEM children, hoping a better understanding revealed decreased values of both blood serum and CSF levels of Mg in PEM children which denote some abnormalities in brain metabolism. Such abnormalities add further support for assumption of the link between dietary insufficiency and subnormal mental performance in PEM.


[Exertion-electrocardiographic and hemodynamic studies with oral verapamil in chronic ischemic heart disease].

The effect of the Ca++ -antagonist Verapamil on the ECG, the haemodynamic parameters and the systolic time intervals was investigated in the long-term experiment on 12 patients with ascertained chronic ischaemic heart disease at reat and during exercise. The dosage was 3 x 80 mg/die during 4 weeks. The tolerance was not increased. The load-induced decrease of the ST-T-distance in the ECG was improved under load and in the recreation phase. The function of the myocardium, measured on the quotient LVET/ICT, improved under load with simultaneous decrease of the double product and the TTI, the pulmonary pressure, however, remained uninfluenced. Side-effects were not observed.


[Changes in several important metabolic parameters and insulin level during a 7-day total parenteral nutrition under pre- and postoperative conditions].

After the 24 hours preoperative infusion period 0.37% glucose, 0.05% fructose and 1.28% xylitol of the infused amount were excreted in the urine. Postoperatively fructose was the best metabolized energy donator before xylitol and glucose. As a sign of an undisturbed hepatic synthesis of lipoproteins the triglycerides rose up to the 5th postoperative day. During the parenteral nutrition and the additional surgical intervention the cholesterol fell from 192.3 to 128.5 mg/100 ml on the first postoperative day. The infusion solutions caused a rise of the insulin concentration from 23.2 to 46.3 U/l on the operation day. There is a positive nitrogen balance of 3.5 g/24 h on the operation day. The slight negative balance of - 1.15 g/24 h on the first postoperative day is reduced to - 0.61 g/24 h on the postoperative day. The changes of the enzymes LDH, GOT and AP were at normal range. The postoperative changes were due to the surgical intervention. Without a simultaneous change of enzymes, 5 patients had a rise of bilirubin up to 1.1 mg/100 ml. To avoid a too great loose of phosphate during a long-term parenteral nutrition period, it is important to put up a balance.


[The question of age dependence of the so-called tension index and its behavior after administration of nitroglycerin].

On 90 persons with healthy heart and circulation aged from 18 to 52 years the age dependence of the so-called tension index after Rentsch was investigated and at the same time the change of the index after application of nitroglycerin was tested. The statistical evaluation with the help of the regression analysis resulted in a significant age dependence of the tension index, which is to be takent into consideration in further examinations. The behaviour of the index after application of nitroglycerin referred to the fact that the so-called nitroglycerin test is suitable for the proof of a latent heart insufficiency on account of  a relatively frequent antidromic reaction in younger and medium age above all for patients older than forty years.


[Immunological relations between mother and child during pregnancy (author's transl)].

The relations between the maternal and foetal organisms during pregnancy are partly very complicated and remain inexplicable. Blastocyst, trophoblast, embryo and foetus have membrane antigens at a very early stage, and the immunocompetence of the foetus develops already during the second third of the pregnancy period. Many non-specific factors are involved in preventing the castingoff reaction of the foetal organism. The trophoblastic tissue is probably of central importance. The focal point of interest in trophoblast tissue research is probably the testing of the local action of HCG and HPL and perhaps also AFP, as well as the question whether cellular and nuclear fusions occur in the region of the syncytiotrophoblasts and the decidual base, or if leucocyte antibodies can block the HLA antigens or the trophoblastic surface.


[Long-term treatment of glomerulonephritis with indomethacin with special regard to quantity and selectivity of proteinuria].

In 53 patients (19 women, 34 men), of them 41 patients with an intracapillary proliferative glomerulonephritis, 9 with membranous proliferative and 3 with a membranous glomerulonephritis under an indometacin therapy examinations concerning proteinuria were carried out, partly with determination of the index of selectivity and representation of the protein clearance. In patients with a moderate proteinuria of less than 3 g a day this treatment achieved a smaller antiproteinurie effect than in patients with a large proteinuria. When a large activity of the inflammatory process was present a therapeutic success was less frequently to be proved. An unequivocal correlation between the histological course of the disease and the change of the proteinuria could not be recognized. After cautious estimation of the findings the selectivity of the proteinuria may be regarded as a certain indicator for the application of indometacin. The protein clearance, however, proved less suitable for the judgment of the treatment performed.


Production and chemical studies of protease from Bacillus subtilis (SH-6) Egyptian strain.

Bacillus subtilis (SH-6) Egyptian strain, isolated from hides, gave the highest protease activity. Luxurious growth and protease production were obtained by the use of a medium containing 8% of potato starch, 0,1 M of ammonium phosphate as carbon and nitrogen sources. Results indicate that borate buffer exerted a deleterious effect on the protease production. Comparing citrate and phosphate buffers, it was found that citrate gave lower protease activity than phosphate. There is a positive response to higher concentrations of phosphate ions. From the above-mentioned medium protease was precipitated and purified. The dried preparation of the enzyme was tested for its chemical composition. It revealed the absence of residual carbohydrate. Tests for phosphorus, sulfur, ferric, zinc, manganese, magnesium, and calcium ions were positive. Amino acids present were: L-leucine, cysteine, Dl-alanine, L-arginine, L-tyrosine, L-aspargine, L-proline, glycine, Dl-valine, L-histidine, L-glutamic, L-lysine, L-aspartic, Dl-tryptophan, L-cystine, Dl-serine and Dl-phenylalanine. Quantitative analysis of the preparation was 0.52% of ash and 14% of nitrogen.


[Recrystallization and reaction of urates in gout tophus after fixation with glutaraldehyde].

Uric acid and urates usually dissolve in the instance of routine fixation of material with formol. Bioptic confirmation of diagnosis is therefore usually very difficult if a murexide reaction test cannot be carried out concurrently. After fixation in glutaraldehyde for electron optic aims the crystals remain present in microscopic paraffin preparations for a long period of time and undergo even recrystallization which largely facilitates the microscopic diagnosis. It is assumed that a compound of the urates and diglutaraldehyde develops. It has been shown electron-optically that the crystals deposit for the most part in connective tissue or in the basic mass of cartilage without close relation to the cell elements. Underlying tissue is afflicted by necrosis, adjacent tissues show abundant fibroblasts which have however no closer contact with the crystals.


[Some aspects relating to the aflatoxin generation during the self-heating of cereals].

In a stored batch of grain which was already affected by mould-formation tests were carried out with the known aflatoxin producer Aspergillus flavus. A significantly lower aflatoxin production ensued if the mould growth was not connected with self-heating of the stored product. However, in conformity with increasing mould formation the germinating power was adversely affected and the significant signs (fatty acid number, reductive and none-reductive sugars) were influenced in the grain, irrelevently whether or not this led to self-heating. It appears obvious that as the self-heating increases in the stored product, the optimal temperature range favourable for the Aspergillus flavus is rapidly exceeding and this caused restriction to the aflatoxin formation. This leads to the conclusion that the contamination on the outer layer by mycotoxines is more significant on the outer layers than the more or less strong mould formation in the interior (so-called-mouldly pockets) which ensued through the self-heating fenomena.


Study of thyrotropic reserve in diabetics of adult type.

The thyrotropic reserves in 13 diabetics without clinical evidence of vasculopathy have been studied and compared with 11 normal subjects. TSH basal levels were found to be lowered when compared with normal ones. When their pituitary gland had been stimulated with synthetic TRH, it was observed that they had a greater response. It is assumed that the diabetics may have some kind of hypothalamic disturbance that might be responsible for the low basal levels of TSH. This, in some way, would create greater sensibility of the thyrotrops. Some borderline hypothyroidism may exist in adult-onset diabetes.


[The question of the validity of haptoglobin/G-streptococci relations in nonhuman sera].

The relationship between haptoglobin type and the agglutinability of some group G streptococci, which was observed in humans, could also be demonstrated in animal sera. In humans the haptoglobin type Hp 1-1 is correlated with a lacking or very low agglutinability. Sera of 10 rhesus monkeys showed Hp-type 1-1 and agglutinated the streptococci only to dilutions of the serum up to 1:4. The sera of 48 pigs contained an Hp 1-1 like type and a streptococcus agglutination titer of max. 1:10. Seven ahaptoglobinaemic sera gave the same values. Fifty examined sera of rabbits showed also an Hp 1-1 like pattern and did not agglutinate or in undiluted state only.


Radioimmunoassay for porcine prolactin: plasma levels during lactation, suckling and weaning and after TRH administration.

A sensitive heterologous radioimmunoassay for porcine prolactin (pPRL) has been developed. Anti-ovine prolactin antibody was raised in rabbits which allowed a final dilution of 1:500 000. The separation of free and antibody bound [125I]pPRL is based on the double antibody solid phase system. The assay is specific for pPRL. There is no cross-reaction with pLH, pFSH and pTSH; little cross-reaction (1.35%) was found with pGH. The smallest detectable amount was 0.08 ng per tube. During lactation high plasma levels are found with great fluctuations. After weaning the plasma PRL levels fall to basal within a few hours. After thyrotrophin-releasing hormone (TRH) administration plasma concentrations increase within a few minutes.


Serum lipid pattern in beta-thalassaemia.

Serum lipids, phospholipid fractions and the composition of serum lipid fatty acids were studied in 20 children presenting beta-thalassaemia major, 20 heterozygous children and 20 normal controls. Total serum phospholipids, their fractions and cholesterol were significantly lower in patients with thalassaemia major. These changes were referred to hepatic damage and to severe anaemia, respectively. Some serum lipid polyunsaturated fatty acids were significantly decreased in patients with thalassaemia major as compared to heterozygotes and normal controls. Since these alterations are a sign of lipid oxidation, the causes of this phenomenon are discussed.


'Classic' and 'acute' myelofibrosis. A retrospective study.

In a retrospective study of 38 patients with histologically proven myelofibrosis, 5 parameters (recorded on the first admission) were investigated as to their usefulness to predict the course of the disease. In 9 patients the development of 'acute' myelofibrosis could be predicted by the finding of pancytopenia, low reticulocyte counts (median 20,500/mul), extremely elevated SRE (median 125 mm) and normal serum levels of LDH and uric acid on the first admission. In 28 patients the development of classic fibrosis with  splenomegaly could be predicted by the finding of high reticulocyte counts (median 133,200/mul) and increased levels of serum LDH (median 547 U) and uric acid (median 8 mg/dl in males and 6.8 mg/dl in females) on the first admission, even when splenomegaly was initially absent. The relationship between classic and acute myelofibrosis and the significance of the mentioned parameters is discussed.


Megakaryocytic leukaemia. A case of unusual outcome.

In a 33-year-old woman with thrombocytosis, megakaryocytic hyperplasia in bone marrow, presence of megakaryocytes in peripheral blood and megakaryocyte-containing infiltrations in the liver, excellent result of Busulphan treatment (1 year full remission after Busulphan withdrawal) is reported. The authors suggest the diagnosis of megakaryocytic leukaemia.


Influence of food iron absorption on the plasma iron level in idiopathic hemochromatosis.

The relationship between food iron absorption, iron stores, and plasma iron level was studied. On a low iron diet subjects with idiopathic hemochromatosis (IH) during reaccumulation of iron after phlebotomies showed a fall in plasma iron. Fortification of the diet with 22--135 mg of iron/day for 3 days caused little or no change in the plasma iron in subjects with normal iron stores, whereas in subjects with iron deficiency a significant rise in plasma iron occurred with the addition of 45 mg of iron/day. In subjects with IH with normal iron stores, plasma iron increased with the addition of 22.5 mg/day. These studies indicate that iron absorption is an important determinant of the elevated plasma iron in IH and that the plasma iron tolerance test combined with the serum ferritin may be used to detect excessive absorption of iron.


Decreased iron and zinc absorption in Turkish children with iron deficiency and geophagia.

Oral iron and zinc tolerance tests were performed in 12 patients between 8 and 21 years of age, with iron deficiency anemia and geophagia. Decreased iron and zinc absorption were detected respectively in patients against the elevated absorption curves in control subjects. Iron and zinc malabsorption may be an additional feature of the syndrome characterized by geophagia, iron deficiency anemia, hepatosplenomegaly, hypogonadism and dwarfism observed in Turkey and Iran.


Platelet counts in children with iron deficiency anemia.

Platelet count was evaluated in 30 children with iron deficiency anemia. It was found elevated when compared with 40 normal controls. No significant difference was found between the platelet counts in patients with hemoglobin levels higher or lower than 7 g/dl. Although no relation was observed between platelet count and transferrin saturation, it was correlated with serum iron values. After oral and/or parenteral iron therapy platelet count decreased insignificantly, while reticulocytes were found to be increased.


Congenital hypoplastic anaemia refractory to corticosteroids but responding to cyclophosphamide and antilymphocytic globulin. Report of a case having responded with a transitory wave of dyserythropoiesis.

A 7-year-old male child with congenital hypoplastic anaemia (Diamond-Blackfan), having originally responded to corticosteroids, but having subsequently become refractory and erythroblastopenic since 4 years, was treated with a combination of cyclophosphamide (CY; 2.1 g) and antilymphocytic globulin (ALG; 8 g), both by the intravenous route. Erythroblastic repopulation of the bone marrow, albeit dyserythropoietic in character, reticulocytosis and erythrocytic increment took place, but only for a short period. The significance of these findings is discussed in the light of recent progress in the understanding of the disease and of its treatment.


Biological variation of immunoglobulin concentrations in normal human tears related to age and sex.

Single radial immunodiffusion method was used to measure the concentration of IgG, IgA, IgM and IgD in tears of 220 healthy individuals aged from 2 to 86 years. Relation of the values to age and sex has been evaluated statistically by regression analysis method. Mean IgA level was 30.7 mg/100 ml. IgG could be detected in 200 samples and the level was less than 1 mg/100 ml. IgM was detected in only 7 samples and the value was less than 1 mg/100 ml. IgD could not be detected in any of the sample. The IgA level in males and that in females differs significantly, the females having a higher mean value. The IgA level appears to increase in both sexes with age. No relationship with age and sex could be established in other types of immunoglobulins.


Insulin antibodies in the serum of diabetic children treated from the diagnosis of the disease with highly purified insulins.

Fifty-one diabetic children, treated with highly purified, porcine insulins from the diagnosis of the disease were studied for the development of insulin antibodies during the first years of treatment. Sera were obtained before the start of treatment and at repeated intervals thereafter. Serum insulin antibodies were measured by three methods in three laboratories. Twenty-nine children were treated with R.I. (rare immunogenic) insulins at one department and 22 with MC (monocomponent) insulins at the other department. Before the start of treatment, serum insulin antibodies were almost invariably zero or below the limit of detection. During the first year a considerable number of cases, more than that reported for adults, formed detectable amounts of antibodies, and more so in the R.I. than in the MC series. The levels were however definitely lower than those observed with the same methods in diabetic children on conventional insulins. Analysis of variance showed no differences between the various age groups. No significant correlation was found between the highest titre of serum insulin antibodies on the one hand and insulin dose or glucosuria on the other hand. The results confirm the concept that children form antibodies to insulin more actively than adults.


The use of insulin in the treatment of juvenile onset diabetes. General principles.

Insulin is a major tool in the treatment of juvenile onset diabetes in spite of the impossibility of giving it in a physiological way. Dosage must be individualized with the help of mixing short- and longacting types of non-immunogenic insulin preparations. Procedures vary with the stage of the disease, whether at the onset of diabetes, during the remission period or thereafter. Rapid normalization of blood and urine sugar is recommended in the first stage, which may partly preserve beta cell function. After the first two years of diabetes practically all patients require insulin twice daily. To achieve satisfactory metabolic control in diabetic teenagers is difficult and requires an experienced team of paediatricians, nurses, dietitians, psychologists and teachers, as well as informed, motivated and cooperative patients.


Treatment of diabetic coma in children.

A short review is given on current aspects of the low-dose insulin therapy of diabetic ketoacidosis, and briefly on the other aspects of the treatment. Frequent intramuscular administration of low doses of regular insulin leads to plasma insulin concentrations, sufficient for maximal insulin biologic activity. The intravenous and subcutaneous routes of insulin administration are suitable as well in the low-dose insulin therapy. The author described results from a retrospective study comparing the efficacy of large and small insulin doses in the treatment of diabetic precoma and coma in children (1). The i.m. administration of insulin, 0.5 U/kg initially, followed by 0.25 U/kg at intervals of 1/2-3 hours led to as rapid disappearance of the signs and symptoms of ketoacidosis as with previously used larger insulin doses. The tendency to hypoglycemia and hypokalemia was milder with the smaller insulin dose. With such a modified low-dose insulin therapy it is essential to initiate i.v. glucose administration rather early. The responsiveness to insulin may vary from one child to another, and infections may increase the need for insulin. Therefore, careful individual monitoring of the treatment is important even when using the low-dose insulin therapy.


Study on the ultrastructure and acetylcholinesterase activity in von Recklinghausen's neurofibromatosis.

The cutaneous nodules obtained from seven patients with von Recklinghausen's neurofibromatosis were investigated by electron microscopy, and ultrastructural localization of acetylcholinesterase activity was demonstrated in the nerve fibers of this tumor for the first time using Karnovsky's thiocholine method. The enzymatic activity was mainly found in unmyelinated fibers, exactly associated with their axonal membranes, the interspace between the apposing axonal and Schwann cell membrane, and some different mesaxons, which indicated their cholinergic nature. Almost all myelinated fibers and some unmyelinated fibers did not possess the activity. The relationship between axon and Schwann cell was quite similar to that of normal peripheral nervous system, but two striking alterations of the nerves existed: One is the dissociation of unmyelinated fibers, and the other is the degenerative changes of the axon and the myelin sheath. As the evidence of schwannian proliferation, onion bulb formations and collagen pockets were observed. Some signs of fibroblastic proliferation were also found. From the present study and the review of the literature, the probable histogenesis of this disease was discussed.


Dialyzable sialic acid of toad oviduct.

1. Small quantities of dialyzable sialic acid in toad oviduct were found. 2. About one-third of the dialyzable sialic acid reacts directly in the thiobarbituric acid procedure, a finding which suggests that the other two-thirds of the dialyzable sialic acid were probably derived from low molecular weight compounds containing sialic acid. 3. When a soluble fraction was chromatographed on Dowex 1-X4 column, three fractions (I, II and III) were isolated. Peak I was a material which shows identical to authentic NANA, colorimetrically as well as chromatographically. Several studies have indicated that both peaks, II and III, could be sialic acid-bound compounds of low molecular weight.


The roles of endothelium, platelets, and smooth muscle cells in intimal healing.

The continual remodeling of the artery wall significantly narrows the lumen. It contributes to the development of atherosclerotic plaque through the incorporation of lipid into the arterial intima. The steps in the repair of arterial intima include platelet accumulation followed by leukocyte attachment to denuded areas, smooth muscle migration from the media, deposition of extracellular connective tissue components, and endothelial progression seem related to re-endothelialization, platelets, the pituitary, and unidentified factors.


Vessel injury, thrombosis, and platelet survival.

Vascular injury triggers platelet reactions of adhesion, aggregation, and release, and these reactions play important roles in hemostasis, thrombosis and thromboembolism, and atherogenesis. Measurement of platelet and fibrinogen turnover rates are indicators of the relative involvement of platelets and fibrin in the thrombotic process, and also provide an objective means of assessing antithrombotic therapy. Isotopic methods are preferred over chemical methods to measure platelet survival time; 51Cr is used most widely to label platelets. Problems of analysis and interpretation of platelet disappearance curves are reviewed briefly.


Diamine oxidase activity in gastric and duodenal mucosa of man and other mammals with special reference to the pyloric junction.

In the gastric mucosa of human subjects and of various mammals methylation was accepted as the main pathway of histamine catabolism. However, augmentation of gastric acid secretion by aminoguanidine, the strong inhibitor of diamine oxidase, indicated an influence of diamine oxidase activity on this secretory process. Therefore a careful reinvestigation of the occurrence of diamine oxidase activity was started from the distal duodenum in the direction of the cardia. In all species studied, diamine oxidase activity decreased from distal duodenum towards the pylorus. In dogs, landrace pigs and in human subjects the diamine oxidase activity clearly exceeded the pyloric borderline gradually becoming zero in corpus or fundus. In rabbits, however, and especially in mini-pigs no diamine oxidase activity was found beyond the pylorus. Among individuals gastric diamine oxidase activity showed a variable prevalence and could not be found regularly in all the subjects. In one patient with prepyloric ulcer a strong influence of pathophysiological processes on gastric diamine oxidase activity could be suspected. Thus, in every alteration of the gastric mucosa under experimental or clinical conditions also an alteration of gastric diamine oxidase activity should be taken into account.


Histamine and pancreatitis: increase of plasma histamine levels in dogs with Pfeffer preparation and influence of aminoguanidine on the survival time.

Histamine release could be shown in 50% of the dogs suffering from acute haemorrhagic pancreatitis in Pfeffer's preparation. The survival time of these dogs was shorter by about 50% than that of animals without alteration of the plasma histamine levels. The powerful diamine oxidase blocker aminoguanidine diminished the incidence of severe pancreatitis in the dogs without influencing survival time. As in animals treated by saline histamine release could be shown in 50% of the aminoguanidine-treated dogs in which higher plasma histamine levels were determined than in saline-treated animals. The survival time of the dogs with histamine release, however, was not different from that of animals with normal plasma histamine levels throughtout the experiment. The actions of aminoguanidine in Pfeffer's preparation seemed to be rather complex. Contrasting effects on the development of pancreatitis and on histamine inactivation may have influenced the survival time in different directions.


Aspirin and prostaglandins: some recent developments.

The results of experiments designed to test the validity of the hypothesis that the anti-inflammatory and anti-rheumatic actions of aspirin are due to the inhibition of prostaglandin synthetase activity are reviewed.


Progress in radiology: historical review of the changing concepts of lower esophageal anatomy: 430 B.C.--1977.

Some of the classic studies on the anatomy of the lower esophagus are reviewed. In every case, the original sources have been consulted. The basis for a proposed anatomic description of the lower esophagus is established on the basis of the most modern research. The genesis of ideas on the anatomic nature of the cardia, phrenoesophageal membrane, esophageal pouches, esophageal sphincters, esophageal rings, gastroesophageal angle, flap valve, and cardiac notch is traced.


Computed tomographic diagnosis of obstructive jaundice in the absence of intrahepatic ductal dilatation.

Six patients with obstructive jaundice had computed tomography (CT) scans showing a dilated extrahepatic biliary tree in the absence of intrahepatic ductal dilatation. Dilated extrahepatic bile ducts were most easily identified by means of intravenous injection of urographic contrast material, which permitted them to be seen as low density structures. Findings in these patients emphasize that (1) demonstration of dilated intrahepatic bile ducts is not a prerequisite for the CT diagnosis of obstructive jaundice and (2) careful CT evaluation of the extrahepatic biliary tree is necessary to identify patients with isolated dilatation of the common hepatic or common bile duct.


Intrathoracic lymph node metastases from extrathoracic neoplasms.

The clinical records of 1,071 cases of extrathoracic malignant neoplasms seen over a 2 year period sere reviewed: 163 had abnormal chest films, and 25 of these showed evidence of mediastinal and/or hilar lymph node metastases. The primary malignancies which metastasized to intrathoracic lymph nodes included eight tumors of the head and neck, 12 genitourinary malignancies, three carcinomas of the breast, and two malignant melanomas. The chest films were analyzed to determine the distribution of lymph node groups involved. Unilateral lymph node enlargement occurred in eight. The most frequently detected lymph node group was the right paratracheal chain (60%), while the subcarinal and posterior mediastinal groups were rarely affected. Of the 25 cases, 10 had radiographic evidence of hematogenous or lymphangitic metastases in addition in the lungs. Metastatic disease from extrathoracic neoplasms should always be considered in the differential diagnosis of hilar and mediastinal adenopathy.


A reevaluation of intrathoracic lymphadenopathy in sarcoidosis.

Chest radiographs of 62 patients with sarcoidosis and intrathoracic lymphadenopathy were evaluated retrospectively for anatomic distribution of lymph nodes. All but two cases had bilateral hilar lymphadenopathy. Approximately 75% of the patients had nodal enlargement in the right paratracheal or aortopulmonic window regions and about 20% in the subcarinal or anterior mediastinal areas. The most frequent combination of lymphadenopathy, found in 37% of cases, included the aortopulmonic window, bilateral hilar, and right paratracheal regions. Right paratracheal and bilateral hilar lymph node enlargement was seen in only three patients. Aortopulmonic window nodes were almost always found with hilar or hilar and mediastinal lymphadenopathy. Anterior mediastinal or subcarinal involvement was never found without some combination of right paratracheal, bilateral hillar, and aortopulmonic window lymphadenopathy. We therefore conclude that aortopulmonic window, anterior mediastinal, or subcarinal lymph node enlargement often accompany the characteristic lymphadenopathy of sarcoidosis.


Congenital partial eventration of the left diaphragm.

Two unusual cases of congenital partial eventration of the left diaphragm in young infants are described. In both cases the entity appeared as a space occupying lesion in the left anterior chest and was initially thought to represent pericardial cyst, mediastinal tumor, or cardiac enlargement. The left lobe of the liver occupied the eventration in both cases; one was proven at surgery, and the other was documented with a radionuclide liver scan. The radiographic features of eventration are discussed and the role of radionuclide liver scanning in infants with chest masses is emphasized.


Gastric emphysema in infants with hypertrophic pyloric stenosis.

Gastric emphysema in unusual in infants and children. Air in the wall of the stomach can rarely occur in children with gastric outlet obstruction due to hypertrophic pyloric stenosis. The clinical features and radiographic appearance of this association are described in three infants, and the value of the lateral radiograph is illustrated. The differential diagnostic considerations, importance of correct radiologic diagnosis and results of proper therapy are discussed.


Systemic air embolism secondary to respiratory therapy in the neonate: six cases including one survivor.

Systemic air embolism has been described as a complication of respiratory therapy using positive pressure ventilation. This is usually a dire, if not fatal occurrence. The incidence of this severe complication will likely increase with the advent of more vigorous and aggressive respiratory therapy of the respiratory distress syndrome in neonates. It is important for both the clinician and the radiologist to be aware of this entity, its etiology, and its probable increasing frequency. This paper reports six cases of systemic air embolism, including one patient who revealed no clinical symptomatology, and in whom the diagnosis was made by radiographic findings only. This is the largest series yet reported and includes, to my knowledge, the first reported neonate to survive this complication.


Angiographic demonstration of complications resulting from the Waterston procedure.

The ascending aorta--right pulmonary artery anastomosis, originally introduced by Waterston as a palliative shunt to increase pulmonary blood flow in certain cyanotic congenital heart diseases, has been found to be associated with late complications in a significant number of cases. These complications include preferential distribution of most or all shunt flow to the right lung, narrowing or obstruction of the right pulmonary artery at the anastomotic site, increasing stenosis or atresia of the right ventricular outflow tract, hypoplasia of the left pulmonary artery, and obstruction of the shunt itself. A properly planned angiocardiographic study is the principal method of detection of these complications.


Recognition of splenic vein occlusion.

Radiologic findings and medical records of 27 patients with angiographic documentation of splenic vein occlusion were reviewed. The most common causes were pancreatic carcinoma, pancreatitis, and malignant lymphoma. Radiographic findings which suggest splenic vein occlusion are gastric varices without esophageal varices and collateral veins in the left upper abdomen during the vascular phase of rapid sequence pyelography. Additional features may be associated with the underlying disease, such as pancreatic calcification and upper abdominal mass lesions. The diagnosis is usually confirmed by high dose celiac or splenic angiography. Examination of the stomach with barium for the detection of gastric varices is more sensitive than has been previusly recognized; features which suggest them are described. Isolated gastric varices may be a clue to isolated splenic vein occlusion and its underlying causes.


Improved safety of splenoportography by plugging of the needle tract.

Splenoportography, a useful preoperative diagnostic procedure in patients with portal hypertension, has been largely discontinued because of the risk of hemorrhage. We have used both Ivalon and Gelfoam in particle and plug form to plug the needle tract after splenoportography. Initial studies were conducted on six dogs. Plugging of the needle tract by injection of suspensions of small Gelfoam or Ivalon particles resulted in intravasation of these particles into the splenic vein. This was demonstrated by radioactive tagging of particles and the direct collection of splenic blood during the intrasplenic injection. Plugging of the splenic needle tract with compressed Gelfoam caused immediate, complete cessation of bleeding in fully heparinized animals. Because of these experimental results, five humans with decreased platelet counts and severe portal hypertension underwent successful splenoportography without significant hemorrhage. At surgery, successful plugging of the needle tract by Gelfoam was confirmed.


131I-labeled fibrinogen in the diagnosis of deep vein thrombosis of the lower extremities.

Autologous 131I-labeled fibrinogen was administered to 17 patients during 19 episodes of suspected lower extremity deep vein thrombosis in an attempt to assess its diagnostic accuracy. Serial rectilinear scanning and probe counting of the lower extremities and pelvis were performed and compared with ascending contrast venography. The sensitivities of imaging and counting were 67% and 47%, respectively, and both had a specificity of 95%. The experience with evaluation of deep vein thrombosis of the pelvic and iliac veins was small but suggested that 131I fibrinogen will be of limited use in those vessels.


Chronic vascular reactions to steel coil occlusion devices.

Original Gianturco steel coil vascular embolization devices and two modifications were compared for their occlusive effects and for the degree of adverse reaction in the surrounding vessel wall. Modifications consisted of silk or Ivalon replacing the wool strands of the original device. Single coils were placed into the left renal artery of nine mixed breed swine and restudied 3 months later. The bare coils did not occlude the vessels nor lead to significant foreign body reaction. Wool, silk, and Ivalon coils produced prompt and sustained renal artery occlusion. Upon histologic examination of the vessel wall, foreign body and chronic inflammatory reaction was found to be strongest against wool. This reaction was less with silk and markedly diminished with Ivalon. The results indicate that silk and Ivalon coils, while having the same occlusive effect, are preferable to wool coils if less local reaction is desired.


Computed tomographic evaluation of the breast.

Experience with a dedicated breast CT scanner (General Electric CT/M) using a contrast medium enhancement technique indicates that CT is superior to mammography, thermography, or physical examination for diagnosing both benign and malignant mammary disease especially in dense, thick, or fibrocystic breasts. CT is capable of diagnosing totally unsuspected early miniature carcinomas. It can identify and differentiate potential precancerous lesions from benign fibrocystic disease, and is the diagnostic tool of choice for evaluating and following severe fibrocystic disease. CT evaluation also affords definitive diagnostic help in instances where the mammographic, thermographic, and/or physical examinations are inconclusive. It can influence immediate surgical intervention or mitigate against an unnecessary biopsy. The study not only demonstrates morphologic changes in the breast but also accurately depicts an altered iodine pool in mammary tissues.


Selective use of the oblique projection in mammography.

We reviewed the radiographs of patients undergoing negative breast biopsies on the basis of false positive mammograms. In a small number of these patients, the radiologic error was attributable to the summation effect of superimposed focal areas of normal or dysplastic breast tissue giving the false impression of a mass. This summation effect more frequently results in an equivocal radiologic impression, often with a recommendation for short interval repeat mammograms, rather than an actual biopsy. This false positive mammographic appearance can often be suspected on the basis of a discrepancy in the appearance of the suspicious area on the standard lateral and craniocaudad views. In a prospective study we identified women in whom suspicious mammograms were felt to possibly relate to this superimposition effect, and in this small selected group of patients an additional oblique projection was obtained. The oblique view frequently enabled the initially equivocal abnormality to be definitely assessed.


Differential diagnosis of pelvic masses by gray scale sonography.

An approach to the sonographic differential diagnosis of pelvic masses based on their size, location, internal consistency, and definition of borders is presented. Diagnostic schemes were derived from correlating the sonographic features with histomorphology in 170 surgically proven pelvic masses. Besides separating pelvic masses into the conventional categories of cystic, complex, and solid, gray scale sonographic features of a pelvic mass can be used to subcategorize these masses into a more useful differential diagnoses. Although the features seen on a sonographic image were specific in only two types of pelvic masses (pattern specificity greater than 85%), the sonographic information can be effectively utilized for establishing differential diagnoses of pelvic masses. Among the various sonographic patterns observed, homogenously cystic adnexal masses were the least specific pattern, whereas a predominantly cystic, extrauterine mass with internal septation was highly specific for a pseudomucinous cystadenoma. Several pelvic masses such as dermoid cysts demonstrated more than one sonographic appearance and, therefore, had to be considered in more than one diagnostic category.


Incidence of growth lines in psychosocial dwarfs and idiopathic hypopituitarism.

The presence of growth lines in the distal radius was evaluated prior to treatment in 23 psychosocial dwarfs and 25 patients with idiopathic hypopituitarism. The lines were very common in the psychosocial dwarfs and rare in the pituitary dwarfs (P = .0005). This finding can be explained by the fluctuating adverse environment to which the psychosocial dwarf is exposed and the constant lack of growth in hypopituitary patients. Therefore, in the absence of systemic disease, when growth lines are present in a patient with short stature or failure to thrive, a thorough review of the patient's psychosocial environment should be made.


Osteogenic sarcoma after the age of 50: a radiographic evaluation.

Twenty-four cases of primary osteosarcoma in individuals over the age of 50 are described. This represents 6% of all osteosarcomas and 80% of osteosarcomas occurring over the age of 50 at this institution. Radiographically, features were similar to osteosarcoma in younger individuals. Females were more frequently affected than males (2.4:1). The radiographic features are discussed in detail, and the differential diagnosis outlined.