Evaluation of a simplified microchromatographic technique for hemoglobin A2 determination.

The simplified Hb A2 determination based on microchromatography in Pasteur pipets filled with DEAE-cellulose with glycine-KCN-NaCl as developers [14] is compared with a reference Hb A2 determination procedure based on starch-block electrophoresis. The utility of microchromatography as a routine Hb A2 assay and as a screening method to detect beta-thalassemia trait carriers and patients with iron deficiency anemia was investigated. Day-to-day variation of a control hemolysate and the correlation between the values obtained with the two methods and between determinations in duplicate on the same sample are given. The mean values obtained with both methods for the different groups do not differ significantly but the standard deviations and the coefficients of variation observed by the microchromatography are generally higher. Microchromatography in Pasteur pipets tends to overestimate low and normal Hb A2 concentrations and to underestimate high Hb A2 concentrations. The results of microchromatography are more significant for the diagnosis when Hb A2 concentrations are expressed in weight hemoglobin per volume of blood and not in percentages. The microchromatographic procedure was recently marketed. The results obtained with the commercial columns were in good correlation with those obtained with starch-block electrophoresis, but commercial columns give a 18% overestimation of the Hb A2 concentrations.


Thrombocytopenic episodes in patients with well-functioning renal allografts. Inverse relationship between platelet count and platelet size pointing to intermittent platelet destruction.

20 out of 50 patients with well-funcioning renal allograft displayed at least one platelet count below 110 X 10(9)/1 (mean -2 SD of controls). For estimation of platelet production during thrombocytopenic episodes, the percentage of large platelets in the peripheral blood was determined which revealed an inverse relationship (p less than 0.01) to the platelet count, indicating that these thrombocytopenias were due to increased platelet consumption. Immunosuppressive treatment as well as rejection processes could be excluded as major pathogenetic factors whereas anti-platelet autoantibodies may contribute to this phenomenon.


Hematological and hemoglobin synthesis studies in a family with deltabeta-thalassemia trait.

A Basque Spanish family with heterozygous deltabeta-thalassemia is described. Patients with this anomaly usually present hematological findings observed in classical beta-thalassemia, but clinical conditions and unbalanced chain synthesis are less severe. Our propositus, however, presented clinical and biosynthetic data similar to those described in thalassemia intermedia. A family study was also performed.


Hb Bart's and its significance in the South African Negro.

The haematological indices of cord bloods from 430 South African Negro babies were determined by electronic cell counting and their haemoglobin (Hb) patterns examined by alkaline cellulose acetate electrophoresis. A fast-moving, anodal band, identified as Hb Bart's, was found in 7 (1,6%) of the specimens, this being the lowest incidence of the variant yet found in an indigenous African population. The levels of Hb Bart's ranged from 1.3 to 5.5% of the haemoglobin. These findings were confirmed by alkaline-starch gel electrophoresis and at the same time absence of the slow-moving haemoglobin, Hb Constant Spring was established. Subsequent follow-up of 4 of the infants at 4 months of postnatal life showed that the abnormal component had disappeared. The babies with Hb Bart's had a marked microcytosis and low mean corpuscular haemoglobin levels whilst their parents showed no haematological or electrophoretic signs of alpha-thalassaemia. The significance of these findings is discussed in the light of previously reported studies on various Negro groups.


Occurrence of haemoglobin Norfolk (alpha2 57 (E6) Gly leads to Asp beta2) at the level of 33% in an Italian family from Calabria.

An abnormal, fast-moving haemoglobin was observed in 5 healthy subjects of a family from Calabria (southern Italy). In all these carriers the abnormal haemoglobin, which structural studies identified as Hb Norfolk (alpha2 57 (E6) Gly leads to Asp beta2) [4], occurs at a level averaging 33% of the total haemoglobin. Biosynthetic studies showed no evidence for unbalance of the globin chain synthetic ratio. In order to account for the observed percentages of Hb Norfolk, current concepts about the alpha-globin chain genetic system are reviewed, and different genic arrangements which would be in agreement with the experimental findings are discussed.


Inherited bleeding syndromes in Jordan.

This paper presents data on the occurrence and pattern of inherited bleeding syndromes (IBS) in Jordan, a hitherto unexplored problem. In 1978, during the first 12 months of a prospective study at a major medical center, 91 patients from 51 families were diagnosed as having IBS. All patients were referred because of moderate-to-severe bleeding diatheses; they included 52 hemophiliacs, 27 patients with von Willebrand's disease, 4 with hemophilia B (IX-deficit), 2 with afibrinogenemia, 1 with prothrombin deficiency, and 4 were thought to have platelet dysfunction. The clinical and laboratory features of the patients observed in Jordan do not seem to be significantly different from those of patients in Western Europe or North America.


Amydopyrine pancytopenia: detection of leucocytotoxic antibodies by a 51Cr-release test.

Amydopyrine is known to cause agranulocytosis by an immunological mechanism [2]. However, pancytopenia due to amydopyrine is extremely rare and usually mild and transient [3]. This report describes a patient with severe pancytopenia presumably due to amydopyrine sensitivity. Granulocytotoxic and lymphocytotoxic antibodies were detected in the patient's serum using a 51Cr-release test.


The preparation of 59Fe-labelled transferrin of high radioactivity for ferrokinetic studies on small laboratory animals.

A modified method of Cavill for the separation of the complex of isotopically labelled iron and transferrin from unbound iron residues is described. The method employing an ion exchanger permits to obtain preparations with a high radioactivity per volume unit of solution, which is necessary for carrying out ferrokinetic studies on small laboratory animals.


Primary plasmacytoma of lymph nodes. A case report.

Most plasmacytomas of lymph nodes are secondary metastases from myeloma or from primary plasmacytoma of the upper air passages. Primary plasmacytomas of lymph nodes are very rare. A case of primary plasmacytoma of mediastinal, cervical and para-aortic lymph nodes is reported. Bence Jones proteinuria of 8 g/24 h was present. Repeated bone marrow examinations were normal. When the patient died, 17 months after the first symptoms, the bone marrow was still not involved.


Platelet dysfunction in patients with vitamin B12 deficiency.

10 cases of pernicious anaemia are reported in which 6 had abnormal aggregation with epinephrine, 3 with fibrinogen, 2 with ADP, and 2 with ristocetin. 5 patients had thrombocytopenia and 3 of these had a prolongation of the bleeding time. These abnormalities were normalized after vitamin B12 treatment. After treatment, platelet size changed toward a smaller diameter, but platelet size, however, was not significantly different from the normal platelet size distribution.


Diagnostic value of leucocytic acid-phosphatase isoenzymes in determining cytological types of non-lymphoid acute leukaemias.

The normal isoenzymatic pattern of leucocytic acid-phosphatase based on the study of 150 haematologically normal individuals is reported. The different pathologic patterns of the leucocytic acid-phosphatase isoenzymes occurring in non-lymphoblastic acute leukaemias are presented and correlated with the subdivisions of acute leukaemias established by the French-American-British (FAB) Co-operative Group. This study is considered to be especially useful in identifying pure acute monocytic leukaemias corresponding to subtype M5 of the FAB as well as acute erythraemias with unusual cytological and cytochemical features.


A long-term follow-up study in essential cryoglobulinemia.

In a case series of 56 patients with essential cryoglobulinemia, 35 were followed-up for 4-13 years (mean 7 years). A membranous proliferative glomerulonephritis, which in about half the cases showed a progression to renal insufficiency, was the commonest complication, observed in more than one third of the patients. In 2 patients hepatic cirrhosis became manifest after a completely asymptomatic period and in 2 others a lymphoproliferative disease appeared 2 and 8 years after the onset of purpura. In 51% of patients the intial clinical pattern did not change. In searching for a correlation between the development of nephropathy and cryoglobulin characteristics, none was demonstrated studying the cryoglobulin level, the presence of autoantibody and the complement components.


Catalases and peroxidases histochemical detection; techniques suitable to discriminate these enzymes.

By using the benzidine reaction, on filter paper strips loaded with catalases, peroxidases, porphyrins, haemic iron compounds and iron salts, it was possible to establish 2 histochemical techniques able to detect and discriminate catalases and peroxidases. Spot test analytical studies show that only peroxidases oxidize benzidine in presence of a 0.0015 M H2O2 final concentration into the incubation medium. If a 0.0035 M H2O2 final concentration is used both peroxidases and haemic iron were able to oxidize benzidine. At a 0.01 M H2O2 final concentration the oxidative property of catalases become apparent and therefore at this H2O2 concentration either peroxidases or haemic iron, as well as catalases could be detected. By increasing the H2O2 concentration into the incubation medium, when a 4M concentration was chosen to detect histochemically catalases without any peroxidases interference. Using 0.0015 M and 4 M H2O2 final concentrations into the incubation medium it is possible to discriminate histochemically catalases and peroxidases. Several inhibitors of catalases and peroxidases were used as an attempt to try a specific inhibition of only one of these enzymes. It  was demonstrated that the use of inhibitors does not help the histochemical discrimination between catalases and peroxidases.


[Pulse cytophotometrical investigations about the resistance of DNA against acid hydrolysis influenced by ageing and cortisol (author's transl)].

The resistance of nuclear chromatin against acid hydrolysis with hydrochloric acid was studied in cell nuclei of different organs from young and old rats and after application of cortisol. Suspensions of cell nuclei from liver, spleen, kidney, heart muscle and mucosa from small intestine were stained with ethidium bromide without and after hydrolysis. The relative fluorescence intensity (FI) of every pair was measured by flow through cytophotometry. Always the FI of the diploid peaks of the hydrolysed samples was diminished. The resistance against hydrolysis was greater in old animals than in young. After application of cortisol in vivo in all organs, except in the liver, the resistance against hydrolysis was increased. Only the nuclei of liver from old animals showed a diminution of resistance after cortisol. It is assumed, that the greater resistance in age is due to the diminished functional ability of the nuclear chromatin. In the most organs, the inhibitory activity of cortisol to the cell metabolism is known, only in the liver cell it stimulates the synthesis of RNA and protein. This is in agreement with our findings.


Topochemistry of trace metals in nasal mucosa. Potentialities of some histochemical methods and energy dispersive X-ray microanalysis.

Histochemical methods and energy dispersive X-ray micro-analysis (EDX-analysis) were evaluated in model experiments and on tissue sections for their usefulness in detecting traces of metals in biological tissue. The goal for this study was to establish a method for localization of nickel deposits in the nasal mucosa, where it has been found in concentrations between 1 and 40 microgram/g in nickel exposed individuals. The histochemical methods tested were staining with dimethylglyoxime, rubeanic acid and dithizone, the Turnbull and Prussian blue methods and TIMM'S sulphide silver procedure. In model experiments nickel-, cobalt-, copper-, zinc- and ironsalts were applied to thin-layer chromatography sheets (TLC-sheets) and stained by the histochemical methods. Spots containing 500 and 50 ng of these metals represented the smallest amounts that could consistently be detected in these experiments, except for the sulphide silver method which seemed a little more sensitive. With the latter method, moreover, zinc was detected in 40 micrometer thick cryostat sections of gelatine made up with 1 microgram/g of the metal. For nickel the corresponding figure was 10 to 50 microgram/g. On specimens of nasal mucosa from nickel-exposed workers, a faint colour was obtained in 40 micron thick cryostat sections from specimens that had been immersed in dithizone, but the colour was too weak for histological analysis. None of the other coloured chelating agents caused noticeable staining when applied to blocks or to cryostat sections. TIMM'S sulphide silver method caused strong staining of the basal layers of the surface epithelium and of fibroblast-like cells in the underlying connective tissue. This staining pattern is described in more detail in a separate report. Rat liver tissue was analyzed by atomic absorption before and after araldite embedding. Blocks of gelatine made up with nickel, copper, zinc and iron were embedded in epoxy resin and analyzed by atomic absorption. Large changes in the metal concentrations, usually an increase, were found after embedding. Ultrathin sections from this material were used to test the sensitivity of the EDX-equipment. Referring to the concentrations determined by atomic absorption in the embedded material, iron was detected at 1215 microgram/g and 362 microgram/g (gelatine standards) but not at 167 microgram/g (rat liver). Similar values could not be determined for nickel, copper or zinc, because of background radiation resulting from the presence of these metals in the instrument. We did not succeed in establishing a procedure for detecting nickel deposits in nasal mucosa with any of the methods which were tested. The most sensitive but least specific of the tested methods for visualizing heavy metals in the nasal mucosa, was TIMM'S sulphide silver procedure. The preparation of tissue for this method is discussed.


[The catecholaminergic connections of the visual system of the albino rat (author's transl)].

By using the glyoxylic acid method of DE LA Torre and Surgeon (1976), occurrence, distribution and origin of catecholamines were investigated in the visual system of the albino rat. A dense network of green fluorescent terminals and preterminals could be detected in the dLGN. The spreading of terminals of catecholaminergic fibres had been observed in laminae I and II of the visual cortex. Investigation of lamina I with the Golgi-Kopsch method showed axons the thickness of which was below 1 micron, and with varicosities with a distance of approximately 3.5 micron, having a diameter of 2 to 4 micron. These axons might be identical with the fluorescent-histochemically represented terminals. Taking into account the course of catecholaminergic axons it can be concluded that the pyramidal cells of the neocortex, the spiny dendrites of which are heavily branched in the lamina I, are affected. After application of horseradish-peroxidase in the dLGN labelled cells have been found in the locus coeruleus (A6) only. After application of the enzyme in the visual cortex, labelled cells have been observed in the nuclei A 6 and A2. The pathway of catecholaminergic axons from the nucleus of origin to the terminal regions was investigated using the "false transmitter" 6-OH-DA. The results can be seen in a diagram.


The distribution of disulfide-groups in Descemet's membrane, lens capsule, and zonular fibers.

Zonular fibers contain large quantities of disulfide-groups which histochemically can be demonstrated after thiosulfation or reduction with sodium thioglycollate. Zonular fibers share these staining behaviours with oxytalan fibers and elastic fiber microfibrils. Smaller amounts of disulfide-groups can be demonstrated when visualized by means of the thioglycollate/ferric-ferricyanide method. Diffusion of acidic staining solutions seems to be limited in Descemet's membrane and in the lens capsule: only surfaces of these membranes become reactive after thiosulfation. It is assumed that the distribution of disulfide-groups in Descemet's membrane and in the lens capsule shows the distribution of type IV collagen.


[Effects of 5-hydroxytryptamine creatinine sulfate on development of the in vitro cultivated explants of the cerebrocortex of neonatal rats (author's transl)].

Explants of the cerebrocortex of neonatal rats were cultivated up to 15 DIV in addition to 5-hydroxytryptamine creatinine sulfate at the final concentration of 0.1 mM. Fluorescence histochemical investigations were accomplished with a modified glyoxylic acid "heat reaction" according to Lindvall and Björklund (1974). Depending on the duration of the cultivation and/or influence of the 5-hydroxytryptamine creatinine sulfate in varied fiber and cell elements of the explants varied effects were found. The retardation of the growth was striking. Yellow-greenish fluorescence is interpreted as a fluorescence of the metabolic substances of the serotonin. Cells with a brownish-yellow fluorescence typical of 5-hydroxytryptamine after treatment with glyoxylic acid in the centre of the explants were found. Analogous to the findings of the neuroembryology in different species in situ the results were interpreted with respect to role of the neurotransmitters as modulators of the neurogenesis.


[The immunhistochemical investigation of trypsin and trypsin-like-activity in the small intestine, pancreas and isolated Langerhans islets. A light-, fluorescent- and electron microscopic study (author's transl)].

By means of the indirect immunofluorescence and immunenzyme technique trypsin and trypsin-like activity in fixed cryostate sections of pancreas and gut and pellets of isolated pancreatic islets respectively were investigated using specific antiserum against trypsin. The enzyme was demonstrated in the cytoplasma of the acinus cells, the epithel cell of the intercalated ducts and the excretory (interlobular) ducts of the exocrine pancreas. By light and fluorescence microscopy we could also localize a high activity in pancreatic islets. Results taken from electron microscope show the enzyme in the region of the peripheral endoplasmatic reticulum, the surface of the mitochondria, the zymogen granules of the acinus cells and in the region of the membranes of the endoplasmatic reticulum and in the granules of the B-cells of the pancreatic islets. These results are discussed in correlation with biochemical data concerning the importance of trypsin/trypsin-like activity in the specific conversion of prohormones into hormones.


Tetrahydrofolate dehydrogenase in blood cells and in hematopoietic organs of different vertebrate species.

Some general aspects in cytochemical demonstration of the tetrahydrofolate dehydrogenase, concerning the final reaction product, are studied. Steady and variable factors are detected in a comparative study of Vertebrate hemopoiesis: the enzyme exhibits peculiar features in different cell types. The reactivity progressively decrease in the erythropoietic series, in concomitance with hemoglobin synthesis.  Conversely an increase in the intensity of reaction is found in the granulocytopoietic series; the correspondence of positive material with the specific (eosinophil and heterophil) granulations can be discussed. The thrombocytopoietic series is also labelled by this reaction.


Nuclear pore complexes in cells of the developing mouse cerebral cortex.

The nuclear pore complexes of cells of the superficial layers of the cerebral cortex of mice were studied by freeze-etch technique. The nuclear membrane was found to be randomly penetrated by typical octagonal pore complexes in all age groups studied. The density of pores (per micron2) amounted to 7.8, 14.0, 17.0, 18.1 and 14.1 on the 18th to 20th embryonic and the 8th, 15th, 50th and 180th postnatal day respectively. The total number of pores per nucleus increases 5.2 times from the 18th to 20th prenatal to the 15th postnatal day and then decreases toward the 180th postnatal day (1257, 6582 and 3385 pores per nucleus respectively). The density of pores in cells of brain cortex, found in young adult mice is relatively high, if compared with other cell types.


[Some notes on the specifity of the fluorescence histochemical demonstration of GABA (author's transl)].

The distribution of the GABA in the Purkinje cells of the rat cerebellum was demonstrated by means of modified fluorescence histochemical method according to WOLMAN (1971). Three types of Purkinje cells, with respect to their fluorescence intensity and GABA distribution, were evident. The GABA-fluorescence was strikingly by pharmacological pretreatment. Isonicotinic acid hydrazide, Penicillamine and Chlorpromazine cause a granulation and marked reduction of the fluorescence compound, being normally homogeneous.


Testing of the course of neurogenesis and gliogenesis in the germinative zones of the CNS of embryonal and early postnatal rats by means of the gel reaction for the histochemical demonstration of the thiamine-pyrophosphatase. Histochemical and autoradiographical study.

Using the histochemical reaction for the demonstration of TPPase the shape and distribution of the Golgi apparatus (GA) of the ventricular zones of the CNS of rats was studied during embryonal and postnatal development. In the cells of the ventricular zone of the spinal cord, the Hypothalamus, the Thalamus, the N. caudatus and the Cerebral cortex two forms of GA can be distinguished: Form 1 GA has the shape of small rods or grains placed in the ventricular process of the cell at various distances from the nucleus. In the spinal cord and the Hypothalamus the 1st form correlates with the period of neuroblastic production, and the same correlation probably exists in other regions of the CNS also. Form 2 GA is in sequence with form 1; it is characterized by a large beam shape, situated supranuclearly near to the nucleus. The relation of form 2 to gliogenesis is discussed. In the alar region of the spinal cord only form 1 GA occurs. The GA of cells of the subventricular zone has on average a lower enzymatic activity than that of the ventricular zone. By day 18 intra uterinam the subventricular cells have the shape of very small grains (1 micron) or are not visible. From day 18 intra uterinam cells with a large GA begin to appear and steadily grow in number until postnatally they form the majority of the subventricular layer. Autoradiographical investigation and a comparison with published data showed that cells without GA and with discrete GA are stem cells and those with a large GA are glioblasts. Glioblasts are arranged in the subventricular zone with the GA pointing in the direction of migration. According to the ratio of glioblasts and stem cells topographical regions can be divided into early, transitional and permanent phases of glioproduction. The gel method of demonstrating TPPase is highly suitable for study of the differentiation of the CNS and for observing the progress of glioproduction.


Measurement of reference values for certain proteins in cerebrospinal fluid.

Reference values are presented for certain cerebrospinal fluid proteins and related indexes, based on determinations carried out on 46 patients with diffuse lower back pain using radial immunodiffusion and electroimmunoassay. A sex difference was noted in total protein and albumin values. The electroimmunoassay method with its sensitivity enhanced by the use of Coomassie Blue staining and optimal antiserum concentrations enabled a reference value to be determined for IgA in cerebrospinal fluid.


Serum concentrations of thyrotropin, thyroid hormones and thyroid hormone-binding proteins during acute and recovery stages of idiopathic respiratory distress syndrome.

A total number of 27 premature infants with idiopathic respiratory distress syndrome (IRDS) and 52 healthy controls with comparable gestational age and body weights were studied during the first month of life. In infants with IRDS a reduced thyrotropin (TSH) response to birth was suggested, as serum TSH was lower in IRDS patients than in controls during the first two days of life. Low serum concentrations of thyroid hormones were found in the acute stage of IRDS reaching minimal values by day 3--5. After that period an increase in thyroid hormone levels occurred. The serum T2 increased to the level of healthy prematures by day 6--10, whereas the serum T4 increased to normal levels by day 21--30. Serum concentrations of thyroxine-binding globulin (TBG) were significantly lower in IRDS patients than in healthy controls; a gradual increase to normal levels occurred during recovery. Serum prealbumin (TBPA) levels in IRDS infants increased rapidly after birth and exceeded levels of healthy infants. Serum albumin values were not significantly different in the two groups of infants. The serum T4/TBG ratios were low during recovery from IRDS.


Capillary permeability measured by bolus injection, residue and venous detection.

Kinetic analysis of residue and outflow curves of gamma-emitting indicators such as chromium-51-EDTA and iodide-131-thalamate from skeletal muscle gives the possibility to determine the extraction fraction and the plasma flow, and from these two values the capillary diffusion capacity can be calculated (Sejrsen 1970, preliminary report). This is possible both for the transport from blood to tissue and from tissue to blood. THis alternative method has been compared in the autoperfused cat gastrocnemius preparation with the indicator diffusion method based on venous registration of a diffusible test indicator and an intravascular reference indicator (Chinard et al. 1955, Crone 1963). The results of the five independent measurements show good agreement. Calculation of the permeability Pd based on a capillary surface area of 7 000 cm2/100 g of tissue gives values of 1.05 . 10(-5), 1.10 . 10(-5), and 1.16 . 10(-5) cm/s, which is in agreement with results obtained by other investigators. The permeability was equal in both directions, and thus the capillary membrane seems to function as a symmetrical membrane. Using an area of 5 000 cm2/100 g which presumably is more realistic at the plasma flow range used gives Pd values around 1.5 . 10(-5) cm/s. The effective pore area is calculated to constitute 1/50 000 of the capillary surface area. Calculation of volumes of distribution in the muscle tissue gave intravascular plasma volumes of 1.5 to 2.0 ml/100 g, an extravascular volume of 12.4 and 15.2 ml/100 g and a final monoexponential component constituting a compartment of 5.4 and 7.0 ml/100 g from residue and venous curves, respectively. The last mentioned compartment constitutes nearly 50 per cent of the extravascular space, and it is suggested, that it is located inside the sarcoplasmic reticulum, which anatomically constitutes about 50 per cent of the interstitial space. The total area of contact between the longitudinal and the transversal tubules in this subsystem, which is the membrane of the lateral saccus, is estimated to about 6 times the capillary surface area at a plasma flow of 15 ml/100 g . min which gives a permeability about 60 times lower for this membrane compared to the capillary membrane.


Angiographic definition of critical coronary artery stenosis.

In summary, it is hazardous to rely solely on coronary angiography to define critical coronary stenosis. Clinically, the physiologic significance of a narrowing observed at coronary angiography can best be evaluated by obtaining additional evidence of myocardial ischemia, i.e. stress testing with ECG monitoring, resting and exercise isotope perfusion studies or ventriculographic studies. However, when evaluating coronary angiograms for critical coronary stenosis, several points are worth considering. First, a long narrowing will decrease coronary blood flow more than a short narrowing of the same severity. Second, sequential narrowings will decrease coronary blood flow more than a single narrowing of the same total length. Third, a long narrowing can be estimated more accurately than a short narrowing. Fourth, caliper measurements of coronary artery narrowings are more accurate than subjective estimation, and fifth, coronary artery dilators may increase the percentage narrowing in some cases. The complex effects of percent stenosis and length of stenosis on the physiology of coronary blood flow must always be considered when evaluating angiograms. In addition, the angiographic or photographic artifacts produced by short narrowings tend to overestimate the percent stenosis and, thus, calipers should be used to measure percent stenosis, especially in the short narrowings.


Further evidence for a role of secretory component (SC) and J chain in the glandular transport of IgA.

These studies support the transport model depicted in Figure 3: Incorporation of J chains into dimeric IgA induces a configurational fit allowing complexing of IgA with SC available in the plasma membrane of serous secretory epithelial cells. This complexing on the surface of the cell stimulates pinocytosis, and the completed secretory IgA molecules are transported in cytoplasmic vesicles to the gland lumen. The same transport model can be applied for the external translocation of IgM.


Antigens of Streptococcus mutans implicated in virulence--production of antibodies.

The present studies assayed antibody activities in serum and saliva of animals immunized by different routes, with cells of S. mutans or cell-free preparations containing GTF, FTF, LTA and/or dextranase synthesized by S. mutans. The results show that the type of immunogenic preparation and the route of its administration can elicit different antibody response and may in part explain the disparity of results achieved by different investigators. The results further emphasize the need to use standardized preparations and carefully described protocols for vaccination.


Passive immunization with antisera to Streptococcus mutans in the prevention of caries in rhesus monkeys.

1) The immunological mechanism of protection against dental caries has been investigated by passive immunization with antisera to S. mutans in the rhesus monkey. 2) Passive immunization with separated IgG, IgM and IgA from sera of immunized monkeys supports the concept that IgG, unlike IgA or IgM antibodies are protective. 3) The role of cell-mediated immunity has been explored by the use of transfer factor. This showed that protection against dental caries can be elicited by passive transfer of whole immune serum and cellular immunity, but not by cellular immunity or immune serum alone. 4) The results of active and passive immunization suggests that immuno-regulation of T and B cell interactions plays an important part in the effector mechanism of opsonization, phagocytosis and killing of S. mutans.


Effect on rat IgA synthesis by isotypic suppression with an anti-rat delta heavy chain serum.

It is highly probable that IgA precursor cells have IgD receptors during their ontogeny, however isotypic suppression with anti-delta serum did not demonstrate this possibility at least in our experimental conditions. Moreover, isotypic suppression with anti-delta serum seems ineffective in diminishing the serum levels of Ig classes other than IgD under these conditions, as IgM, IgE and IgG serum levels were relatively unaffected, at least during the first month of the rat life.


Preliminary results in the immunization of Irus monkeys against dental caries.

Twelve Irus monkeys were divided into four groups which were immunized with placebo, two cell wall preparations and one vaccine containing a glucosyltransferase preparation of S. mutans. After 310 days of challenge by a cariogenic diet, the caries score in all the immunized animals was below that of the controls. Furthermore, the protected animals were characterized by a high specific serum titer against the antigens used for immunization and the extension of plaque seemed to be smaller when compared with the controls.


Adjuvant arthritis in young copper-deficient rats.

Adjuvant arthritis has been studied in young copper-deficient rats and a very strong inhibition of the disease following 60 days of deficient diet (0.4 ppm of copper) was found. No difference in lung prostaglandin synthesis and in rat stomach strip and colon reactivity to exogenous prostaglandins was noticed between controls and copper-deficient animals. These results are briefly discussed.


Complement and coagulation: causative considerations in contrast catastrophies.

Earlier studies suggest that adverse reactions to injected radiographic contrast media are idiosyncratic. In an attempt to gain a better understanding of pathophysiologic events underlying these reactions, rabbit models injected with lethal dose ranges of a cholangiographic contrast material were studied. These animals showed activation of both the complement and coagulation systems. Externally applied heat potentiated complement consumption and increased mortality. Depleting complement components C3-C9 by cobra venom factor did not prevent activation of coagulation or diminish mortality. However, depleting fibrinogen diminished complement activation and markedly diminished mortality. Heparin, administered at several hourly intervals after contrast challenge, also diminished mortality. These studies suggest that the adverse effects of contrast media in this model system are mediated chiefly by the coagulation system, and that complement, if it participates deleteriously, must involve components up to, but not including, C3. A logical role for the inhibitor of C1 esterase in adverse contrast reactions is considered.


Percutaneous transhepatic portography. I. Technique and application.

Percutaneous transhepatic portography with selective catheterization of the portal vein and its tributaries was performed on 120 patients, of whom 71% had cirrhosis of the liver. The technique was improved by ultrasonically guided puncture, and the procedure was successful in 96% of the examinations. Collateral veins were visualized in 81% and esophageal or gastric varices in 69% of the patients with portal hypertension. The procedure was performed with little risk and discomfort, and portograms of high quality were obtained. Other applications of percutaneous transhepatic catheterization of the portal vein system are discussed.


Percutaneous transhepatic portography. II. Comparison with splenoportography in portal hypertension.

Percutaneous transhepatic portography and splenoportography were compared in 67 patients with portal hypertension. Portograms were evaluated without knowledge of the identity of patients. Factors evaluated included technical success of the examination; visualization of the portal vein, splenic vein, and other tributaries; contrast medium density, portal blood flow direction; presence and type of collaterals and varices; and liver size and configuration. Percutaneous transhepatic portography proved superior with regard to delineation of the portal venous system and esophageal varices. A definite diagnosis of portal vein thrombosis was possible only with the transhepatic approach.


Infusion hepatotomography for evaluation of obstructive jaundice.

Total body opacification with high doses of a urographic contrast agent demonstrated dilated intrahepatic biliary ducts as branching or rounded lucencies in all of 18 patients with obstructive jaundice. Dilated extrahepatic ducts were seen as tubular lucencies in 11 of 16 patients with distal common bile duct obstruction. In seven patients with nonobstructive jaundice and in a control group of 25, the biliary ducts were either normal or not seen. Gallbladder size was also evaluated. The site of obstruction could be predicted by the size of the gallbladder and visualization of the biliary ducts.


Significance of the nonopacified gallbladder in endoscopic retrograde cholangiography.

Failure to visualize the cystic duct and gallbladder during endoscopic retrograde cholangiography, while obtaining satisfactory opacification of the rest of the biliary system, is a radiographic sign of undetermined meaning. The diagnostic implication of this finding was analyzed in 63 patients with pathologically proven diagnoses. One patient was normal at surgery. Three groups of abnormal patients had: (1) obstructing lesions of the distal common bile duct (35 patients); (2) primary lesions of the cystic duct or gallbladder (19 patients); or (3) obstructing lesions about the common hepatic/cystic duct junction (8 patients). The results indicate that obstructing lesions of the distal common bile duct may cause stasis of bile within the biliary system, increased biliary pressure, and sludge formation that prevent the flow of contrast material through the cystic duct and into the gallbladder, which can cause nonopacification. If the extrahepatic biliary system is of normal caliber without evidence of an obstructing process, nonfilling of the cystic duct and gallbladder is highly predictive of pathology.


Predictability of rectal incontinence on barium enema examination.

The aim of this study was to determine if digital assessment of anal sphincter tone predicts whether a rectal balloon is needed to prevent incontinence during a barium enema examination. During an 8 month , 306 patients scheduled for barium enema examination were evaluated. Immediately before each examination as good, fair, or poor. The barium enema was then performed in a conventional manner. Leakage of even small amounts of barium was scored as rectal incontinence. Ability to retain the barium enema correlated closely with the strength of rectal bone, regardless of patient sex or age. For different sphincter tones the incidence of rectal incontinence was: good, 2%, fair, 30%; and poor, 90%. From these findings it is recommended that, irrespective of patient age and sex, the use of rectal balloon catheters be limited to patients with poor or fair rectal tone.


Ultrasonographic evaluation of pericholecystic abscesses.

Pericholecystic abscess formation is a serious complication of cholecystitis that develops after gallbladder perforation and is usually associated with acute inflammatory signs and symptoms. Ultrasonographic findings in three surgically proven cases of pericholecystic abscess are reported. The findings ranged from a well defined band of low-level echoes around the gallbladder to multiple, poorly defined hypoechoic masses surrounding an irregular, indistinct gallbladder outline. The former situation correlated with a well encapsulated pericholecystic inflammatory process, while the latter was associated with extensive abscess formation resulting from gallbladder rupture. Cholelithiasis was identified in two of the three cases. Ultrasound for preoperative detection of pericholecystic abscess is discussed.


Ultrasonic appearance of the falciform ligament.

In transverse liver scans an echogenic focus was commonly encountered at the junction of the right and left hepatic lobes. This finding was variable in prominence, but could be identified in 22 of 25 patients with otherwise normal livers in whom it was specifically sought. Correlation of ultrasound and CT examinations indicate that these echoes represent the falciform ligament. This normal anatomic structure can be differentiated from an intrahepatic mass by attention to its consistent location and alteration of its configuration by experimenting with the transducer axis during the examination.


Calibrated leak balloon microcatheter: a device for arterial exploration and occlusive therapy.

In quest of an endarterial treatment for intracranial arteriovenous malformations and fistulas, a microcatheter which can be flow-guided into third- and fourth-order branches of the intracranial arteries was developed. This permits controlled deposition of a vascular occlusive polymer (isobutyl-2 cyanoacrylate). Goals and experimental techniques are reviewed and clinical experience on the first 25 patients is presented. Complications included one stroke and three catheters glued in place, but refinements in technique have permitted avoidance of complications over the 14 months before this report.


CT detection of demyelinated plaques in multiple sclerosis.

CT images and anatomic slices of two brains containing numerous demyelinated plaques were correlated. Demyelinated plaques smaller than 0.7 cm were not detected by CT. Some larger plaques were misinterpreted as normal structures. These and other considerations suggest that chronic cerebral demyelination cannot be excluded by negative nonenhanced CT scan.


Computed tomography of intracerebral leukemic masses.

Five patients with differing types of leukemia had clinical symptoms of a localized intracerebral leukemic mass. Computed tomography (CT) demonstrated a mass of equal or increased density relative to normal brain; a zone of surrounding edema was variable. In each case, the mass showed evidence of relatively uniform contrast enhancement. CT appearance of leukemic masses is consistent and quite different from the findings in other central nervous system complications of leukemia and its aggressive treatment.


Unsuspected aortic dissection: the chronic "healed" dissection.

Of all aortic dissections, 10% are chronic. Typically they arise distal to the left subclavian artery and have reentry points into the true lumen. Pain may be minimal or absent and patients often present with cardiac failure. Chronic dissections are more likely to appear radiographically as atherosclerotic aneurysms on a chest film than are acute dissections. Four cases of chronic dissections found incidentally during angiography are presented.


Observer variation in the interpretation of lower limb venograms.

After agreeing on diagnostic criteria and after a pilot study, two experienced radiologists twice independently reviewed 40 lower limb venograms performed by a standard technique in patients suspected or known to have venous thrombosis. The observers reviewed 20 examinations at a time, their analysis requiring separate identification of 11 major veins. At each site observers stated whether thrombus was  "absent," "doubtful," "presumed," or "definite," or declared "no opinion possible." They then rediscussed criteria of diagnosis and, using the same experimental design, examined another 40 venograms. To correct for agreement expected by chance, data were analyzed by using the kappa statistic. In general, levels of agreement were higher than those reported for many other clinical and radiologic investigations, probably because of refinement of criteria after the pilot study. Nonetheless, observers disagreed about the probable presence or absence of thrombus at some site in the limb in about 10% of examinations. Observer variation should be considered when venography is used as a reference standard to evaluate other methods of diagnosing thrombi.


Computed tomography in the diagnosis of adrenal disease.

A series of 63 patients with suspected adrenal disease was evaluated by computed tomography (CT). In 15  additional patients CT diagnosed unsuspected adrenal disease. The CT results were correlated with surgical, postmortem, or compelling clinical data. In those patients with adequate visualization of both adrenals, CT correctly identified all adrenal masses subsequently proven at surgery or postmortem examination. CT accurately predicted the presence or absence of a unilateral adrenal neoplasm in patients with Cushing's syndrome and primary aldosteronism. Unsuspected primary or metastatic neoplasms of the adrenals were occasionally detected in patients scanned for other reasons. CT is a safe and accurate method of evaluating patients with suspected adrenal disease.


Scapular defects: a normal variation.

Sharply marginated defects were observed in the scapulae of five patients. In all cases the defects were benigh in appearance and unrelated to symptoms. These patients have been observed up to 5 years without change in the radiographic appearance. Recognition of the benign nature of these defects is important to avoid confusion with pathologic conditions.


Ultrasonic demonstration of myometrial contractions in intrauterine pregnancy.

An incidental finding associated with ultrasound examination of early intrauterine pregnancy is transient thickening of a limited region of the myometrium, which we interpret as a localized contraction. Contractions were demonstrated in nearly all 881 patients examined and were shown to significantly change in configuration within a 30 min period. In all except one patient, the contractions were completely asymptomatic, and they seem to be of no discernible clinical significance.


Simple, rapid thyroid function testing with 99mTc-pertechnetate thyroid uptake ratio and neck/thigh ratio.

To avoid the technical difficulties and errors inherent in the measurement of early thyroid uptake of 99mTcO4-,techniques which are independent of absolute uptake, neck extrathyroidal background and dose standards were evaluated in a series of 108 patients. After intravenous injection of 2 mCi 99mTcO4-,  radioactivity was recorded over the neck and thigh. Thyroid uptake ratios were calculated as the ratios of activity over the neck at two times. A neck/thigh ratio was calculated from the recorded activities at 15 min after injection. Examination of these parameters showed that a combination of the 15 min neck/thigh ratio and the 10'/2' thyroid uptake ratio best served to discriminate thyroid function: 92% of hyperthyroid cases were correctly identified by a neck/thigh ratio above 4.7 and 95% of hypothyroid cases were identified by the combination of a neck/thigh ratio below 3 and a 10'/2' thyroid uptake ratio below 1. Correct classification of euthyroidism was 84% but with the exclusion of patients previously treated with 131I, this rose to 91%. The accuracy of the 99mTc procedure is comparable to that of the standard 24 hr 131I uptake run concurrently in this series and duplicates the accuracy of computer assisted determinations of absolute thyroid 99mTcO4- uptakes. The procedure provides a convenient method for the evaluation of thyroid function as an accompaniment to 99mTcO4- thyroid imaging.


Carcinoma of the supraglottic larynx.

Retrospective review of 160 patients with carcinoma of the supraglottic larynx was accomplished for the period 1964 to 1974. The majority were treated by low dose preoperative radiation and conservation surgery and the rest by preoperative radiation and total laryngectomy or radiation alone. Relapse-free and actuarial 5 year survival for all patients was 71% and 45%, respectively. Of primary and neck failures, 85% occurred within 2 years. Primary, nodal, and distant failures occurred in 11%, 21%, and 14% of all patients, respectively. Of 40 T and/or N failures, 33 (83%) occurred in the neck and three T and six N failures (23%) were surgically salvaged. Voice was preserved in 71% of the patients. Major complications were noted in 16% and minor complications in 26% of surgically managed patients; operative mortality was 4%. The presence of microscopic lymph node metastases best predicted those who would later develop T and/or N failure and distant metastases. Second primary tumors occurred in 26% and the leading cause of death was tumor.


Exertional angina pectoris caused by coronary arterial spasm: effects of various drugs.

In four patients with exertional angina induced by arm exercise, coronary arteriograms taken before, during and after the attack demonstrated that spasm appeared in the large coronary artery supplying the area of myocardium shown to be ischemic in the electrocardiogram during the attack. The spasm disappeared with subsidence of the attack after administration of nitroglycerin. Anginal attacks induced by treadmill exercise were not suppressed by propranolol, 60 mg orally, in two of the four patients. However, such attacks were suppressed in all patients by oral administration of diltiazem (90 mg, four patients) or nifedipine (20 mg, three patients) or intramuscular injection of phentolamine (0.2 mg/kg body weight, three patients). It is concluded that coronary arterial spasm can be induced by exercise and can cause exertional angina in some patients. Diltiazem and nifedipine, calcium antagonistic drugs, prevent spasm.


Studies on hepatic and extrahepatic lipoprotein lipases in protein-calorie malnutrition.

Postheparin serum lipolytic activities (hepatic and extrahepatic), serum free fatty acid, and triglyceride levels were measured in 16 kwashiorkor, 14 marasmic, and 14 control children. The results showed that the reduction in total postheparin lipolytic activity in kwashiorkor was in the activity of hepatic origin. In marasmus, the total postheparin lipolytic activity, hepatic and extrahepatic activities, were within normal range. The was no evidence for the presence of inhibitors of postheparin lipolytic activity in the serum of kwashiorkor or marasmic children. Fasting serum-free fatty acid level was significantly elevated in kwashiorkor, while the level in marasmus was not significantly different from control value. The serum triglyceride levels in both conditions showed no significant differences from the control value. These findings suggest that the defective production of hepatic lipoprotein lipase, as well as increased influx of free fatty acid into the liver, could account for the accumulation of fat in the liver of kwashiorkor and not in that of marasmic children.


Antiscorbutic activity of ascorbic acid phosphate in the rhesus monkey and the guinea pig.

Rhesus monkeys fed an ascorbic acid-free, purified liquid diet, developed scurvy in 70 to 105 days as evidenced by loss of weight, anemia, bleeding gums, inflamed palate, diarrhea, and inability to stand. Oral administration of either 10 mg/kg body weight of ascorbic acid or an equimolar amount of the magnesium salt of 1-ascorbic acid phosphate cured all symptoms of scurvy. Similarly, oral administration of 1-ascorbic acid phosphate cured all symptoms of scurvy in the guinea pig and resulted in liver ascorbate levels equal to those of animals feed ascorbic acid. It is concluded that ascorbic acid phosphate is a readily available source of ascorbic acid activity in vivo.


Thiamin and pyridoxine requirements during intravenous hyperalimentation.

Studies were undertaken to determine rational dosages of vitamin B1 and B6 during long-term intravenous hyperalimentation, using more sensitive techniques than formerly used to evaluate B1 and B6 status. A standard vitamin combination, type A, (usually commercially available products) has been used up to now because of convenience, disregarding the effects of long-term administration. This combination lacks biotin, folic acid, and vitamin E and contains from 10 to 100 times the dietary allowances of such vitamins as B1, B2, B6, B12, and C. In response to the possibility of vitamin overdose, two new vitamin combinations, type B (from commercial products) and type C (a convenient and easily administered combination produced at the hospital) were developed in order to provide the normal dietary allowances and at the same time eliminate any harmful side-effects. From the results obtained, 5 mg/day for thiamin HCl and 3 mg/day for pyridoxine HCl in type B and type C were found to be a sufficient and safe level as opposed to 55 mg/day for thiamin HCl and 102 mg/day for pyridoxine HCl in type A.


The pattern of severe protein-calorie malnutrition in Sudanese children attending a large hospital in The Sudan.

One hundred fifty patients suffering from severe protein-calorie malnutrition, admitted in 1 month to the Pediatric wards of Wad Medani Hospital, Sudan, were classified according to the Wellcome classification. Marasmus was the prevailing type. It was common in the 2nd year of life, while kwashiorkor occurred mainly under the age of 12 months. Anthropometric measurements showed that kwashiorkor was an acute disease while marasmus and marasmic kwashiorkor were more chronic. The triceps skinfold was unexpectedly low in kwashiorkor. Of the simple measurements and ratios used for assessing the nutritional status, the head/chest ratio applied ot children over 1 year was not found to be reliable and the weight for head circumference correlated poorly with deficits in other variables. Non of the major clinical features was found to be pathognomonic of any type of severe protein-calorie malnutrition. Megaloblastic anemia was common.


Progressive effects of protein-calorie malnutrition on serum free amino acids in infant and young adult nonhuman primates.

Serum amino acid profiles have been known to change when dietary protein restriction is instituted in animals and in man. In the present study, significant alterations were noted in infant monkeys observed over 14 weeks. Impressive but less dramatic changes were apparent in protein-restricted young adult monkeys observed over a much longer period. In general, essential amino acids were depressed (especially the branched-chain group) while nonessential amino acids tended to rise (especially glycine and alanine). Changes were most acute within the first 3 to 4 weeks of dietary restriction. Improvement in dietary protein content provided to young adults led to resumption of normal serum amino acid patterns. Level of available dietary protein and age of the animals clearly dictated the severity of amino acid imbalance observed.


A radiographic method of quantifying protein-calorie undernutrition.

Estimation of midarm adipose tissue and muscle by the anthropometric technique is based on the idealized assumption that the arm and its muscle compartments are circular, and that fat is distributed evenly around the arm. We examined the validity of these assumptions by computerized axial tomography of the midarm in 21 subjects ranging from 65 to 255% of ideal body weight. Computerized axial tomography identified three errors inherent in the anthropometric method: 1) The arm and its muscle compartment were rarely circular, but resembled instead an ellipse and "cloverleaf", respectively; 2) fat was distributed asymmetrically around the arm, and furthermore when triceps skinfold was less than 5 mm, no fat was radiographically detectable, and 3) muscle are calculated by the anthropometric method includes bone area. Since bone area was not influenced by nutritional status, anthropometric "muscle area" underestimated the degree of muscle atrophy in undernutrition. Despite these limitations, in subjects 60 to 120% of ideal body weight anthropometric estimates of midarm muscle area (MAMA) and fat area did not differ greatly from the radiographic values. Anthropometric MAMA was consistently greater than the radiographic value by 15 to 25%, while midarm fat area agreed within +/- 10%. The error in the anthropometric MAMA could be nearly eliminated by two types of correction: expressing MAMA as a percentage of normal, and correcting for bone content by subtracting midarm bone area (6.3 and 4.7 cm2 for men and women). In subjects greater than 150% ideal body weight, however, anthropometric estimates of MAMA and midarm fat area differed from the radiographic values by greater than 50% even after the above two types of correction. Midarm computerized axial tomography scan provides an accurate alternative to the anthropometric method for estimating midarm muscle and fat in these obese individuals.


Immunoblastic sarcoma following Waldenström's macroglobulinemia.

Immunoblastic sarcoma has been observed in association with, or subsequent to, chronic immune stimulation, connective tissue disorders, and immunoblastic lymphadenopathy. A case of Waldenström's macroglobulinemia progressinng after a few years into immunoblastic sarcoma is reported. Splenectomy led to disappearance of hemolytic anemia and of pulmonary infiltrates, as well as to marked reduction of macroglobulins. Although immunoblastic sarcoma usually terminates fatally within two or three months, complete remission was induced by combination chemotherapy. It is speculated that Waldenström's macroglobulinemia, immunoblastic lymphadenopathy, and immunoblastic sarcoma are related disorders reflecting a clonal nature of immunoblastic lymphoma cells and the plasmacytic cells.


In-vitro methods for determining minimal lethal concentrations of antimicrobial agents.

To determine the minimal lethal concentration of an antimicrobial agent, broth dilution tests may be performed and then a sample from each tube showing no visible growth may be subcultured onto a drug-free agar medium. By counting the number of viable cells recovered from each tube, the minimal concentration of drug required to kill 99.9% of the cells in the initial inoculum can be determined. Studies were undertaken to determine the circumstances under which false-negative tests could occur as a result of continued inhibition of growth by the antimicrobic carried over in the sample. Drug carryover did significantly reduce the number of viable cells recovered from broth containing relatively high concentrations of antimicrobic: the larger the sample, the greater the effect of drug carryover. The effect was minimal with samples of 10 microliter or less. Furthermore, the effect of drug carryover was reduced by spreading the sample over the surface of an agar medium. The relative precisions of four methods for performing subcultures with such small-volume samples were determined; coefficients of variation were 16-25%. Sampling errors inherent in the procedure for subculturing broth tubes should be taken into consideration when interpreting results of individual tests, and replicate subcultures will improve the reliability of the colony counts.


Multiple nutritional deficiencies in infants from a strict vegetarian community.

Severe nutritional deficiencies developed in four infants from a new vegan religious community. They had received breast milk until the age of 3 months; thereafter, breast milk was supplemented with or replaced by extremely low caloric-density preparations. All of the infants had profound protein-caloric malnutrition, severe rickets, osteoporosis, and vitamin B12 and other deficiencies. One infant died, while the three others had an uneventful recovery. After discharge of the infants from the hospital, the community responded well to a modification of the infants' diet, which did not violate their vegetarian philosophy. However, they refused to give their infants vitamin B12 on a regular basis.


The role of total parenteral nutrition in the treatment of inflammatory bowel disease.

Indications for the use of total parenteral nutrition (TPN) in the treatment of inflammatory bowel disease include improvement of nutrition in the pre- and postoperative periods, management of gastrointestinal fistulas and as an adjunct to medical therapy. In general, patients with Crohn's disease respond better than those with ulcerative colitis. TPN is supportive and does not lead to a long-lasting cure in most cases.


Jejunal diverticulosis with massive hemorrhage.

A case of a relatively uncommon disease, jejunal, diverticulosis, is reported. The case presented an unusual complication, massive melena. The patient was successfully treated and cured by resection of the involved portion of jejunum. In the management of gastrointestinal hemorrhage in the elderly one must always have in mind this infrequent pathological entity, especially when the small bowel is suspected as the site of bleeding.


Potency and stability of extemporaneous nitroglycerin infusions.

The potency and stability of extemporaneous intravenous nitroglycerin (NTG) solutions prepared according to methods currently used in three hospitals were studied. Intravenous NTG solutions were prepared and packaged according to three hospitals' protocols. The NTG solutions varied in concentration (32 microgram/ml); source (one of two manufacturers' sublingual NTG tablets or 10% NTG adsorbate in lactose); and storage (ambient room temperature or refrigerated). The concentration of NTG in the i.v. solutions was determined spectrophotometrically. Nitroglycerin was found to be stable for at least 70 days when stored in glass containers, regardless of source, diluent (5% dextrose in water or normal saline) and storage temperature. The loss of NTG from solution, after storage for seven days in plastic i.v. bags, was greater when stored at room temperature (55%) than when refrigerated (30%). Adsorption was shown to be responsible for this phenomenon because intact drug was completely recovered from the plastic i.v. bags after methanol elution. The results of this study allow formulation of recommendations regarding the extemporaneous preparation of i.v. NTG solutions.


Stability of penicillin V potassium in unit dose oral syringes.

The stability of reconstituted penicillin V potassium (PVK) when stored in 6-ml plastic oral syringes at various temperatures and protected from light was studied. One batch of PVK was reconstituted with distilled water according to manufacturer's directions (label claim: 125 mg/ml). Samples of 5 ml were stored in plastic oral syringes at 4 C, 25 C, 41 C, 60 C or 75 C and assayed spectrophotometrically and microbiogically at various times. From an initial concentration of 113% of label claim, PVK stored at 4 C (refrigerated) reached 90% of manufacturer's label claim in 11.5 days (95% confidence level). PVK stored at 25 C (room temperature) was unstable after storage for less than 37 hours. PVK degradation followed a first-order process. No significant difference was found between the spectrophotometric and microbiological assay (p less than 0.05). Manufacturer's stability data for storage of reconstituted PVK in the original bulk container should not be applied to PVK repackaged in plastic oral syringes. The pharmacy department developed guideliness designed to prevent the administration of subpotent PVK.


Stability of oral liquid penicillins in unit dose containers at various temperatures.

The effect of freezing on the stability of reconstituted, unit dose packaged oral amoxicillin trihydrate and ampicillin suspensions and penicillin V potassium solutions was studied. Powders for suspension or solution of the three penicillins were reconstituted according to manufacturers' directions to yield a concentration of 250 mg/5 ml. Samples of 5 ml then were stored in amber, screw-cap, glass vials at 25 C, 5 C, 0 C, -10 C or -20 C for 5, 10, 20, 30 or 60 days. The concentration of active constituents remaining after storage was determined spectrophotometrically. All three penicillins retained at least 90% of their original activity for at least 60 days when stored at -20 C. Ampicillin and pencillin V potassium retained at least 90% of their activity after 60 days of storage at -10 C but amoxicillin concentration decreased to 88% and 87% of initial concentration after 60 days storage at -10 C and 0 C, respectively. Degradation appeared to be by a zero-order process for amoxicillin and ampicillin and by a first-order process for penicillin V potassium. It appears that oral solutions of amoxicillin, ampicillin and penicillin V potassium can be effectively stored for at least 50 days in a freezer at -10 C with little loss of activity.


Essential fatty acid deficiency: a consequence of fat-free total parenteral nutrition.

A case of essential fatty acid deficiency (EFAD) associated with fat-free total parenteral nutrition (TPN) therapy in a 53-year-old white male is reported. The patient's tube feedings (Sustacal) were discontinued and a fat-free TPN solution of 25% dextrose injection, 4.25% amino acid injection (Freamine II) and appropriate electrolytes, vitamins and minerals was started when an upper GI study showed complete obstruction of his esophageal-colonic anastomosis. After nearly 1.5 months of fat-free TPN therapy, a diffuse scaly rash appeared on the patient's elbows, groin, arms and legs, and plasma fatty acid analysis showed a gross fatty acid deficiency. One liter of 10% soybean oil emulsion (Intralipid) then was added to 3 liters of TPN daily; linoleic acid accounted for 12% of the total calories of this solution. After 14 days of Intralipid therapy, the patient's skin lesions had cleared and plasma fatty acids had returned to normal. The patient was discharged on tube feedings of Sustacal providing sufficient linoleic acid (8.4% of calories) to prevent recurrence of EFAD. The pathophysiology, diagnosis and treatment of EFAD, and the role of linoleic acid in the disease are reviewed. TPN protocols should include recommendations for administration of linoleic acid to all patients receiving continuous infusion of fat-free TPN.


Hypoxemia following the administration of sublingual nitroglycerin.

Nitroglycerin, 0.6 mg sublingually, was given to 27 nonasthmatic subjects with varying degrees of airways dysfunction to determine the effect on arterial oxygenation. In six normal subjects, the partial pressure of oxygen in arterial blood (Pao2) transiently decreased by 9 mm Hg (p less than 0.05) and in eight subjects with only small airways dysfunction, the Pa02 decreased by 14 mm Hg (p less than 0.0001). The alveolar-arterial oxygen gradient on oxygen increased by only 11 mm Hg indicating that the decrease in room air Pao2 was primarily due to worsening ventilation-perfusion mismatch and not to an increase in shunt. Thirteen subjects with advanced obstructive or restrictive lung disease experienced a much lesser decrease in Pao2 of 4 mm Hg. Data are presented on xenon perfusion studies of a dog model of unilateral alveolar hypoxia that suggest the worsening ventilation-perfusion ratio seen in the human subjects after the administration of nitroglycerin could be due to loss of the lung's ability to vasoconstrict in regions of alveolar hypoxia and shift perfusion to better ventilated regions of the lung.


Case report: intestinal clearance of calcium and protein in Waldenstrom's macroglobulinemia.

A 63-year-old man with Waldenstrom's macroglobulinemia had severe steatorrhea, marked protein-losing enteropathy, and excessive endogenous fecal calcium clearance. The malabsorption and protein loss resulted in weight loss and hypoalbuminemia. In contrast, the striking enteric calcium loss was completely compensated by an increase in calcium absorption resulting in a positive calcium balance.


Phenylethylamine in rhesus monkeys: interactions with alpha-methyl-para-tyrosine and l-dopa.

Rhesus monkeys, pretreated with alpha-methyl-para-tryosine (AMPT) and subsequently injected with phenylethylamine (PEA), did not demonstrate the characteristic amphetamine-like PEA effects. However, when AMPT pretreatment was followed with l-dopa and then PEA injection, PEA effects were restored. These results are compatible with a dopamine theory of schizophrenia.


Effects of written drug information on patient knowledge and compliance: a literature review.

The prospect of patient-oriented prescription drug labeling has focused increased attention on the effectiveness of written information for the consumer. Studies which have evaluated the effects of written prescription drug information in a patient population are reviewed. Several studies indicate that written information can be effective in improving patient compliance with regimens for antibiotic therapy. However, for drugs used on a long-term basis, written information as a sole intervention has not been shown to be sufficient for improving patient compliance. Patient knowledge of less commonly known information, such as precautions, side effects, or special directions is frequently improved by written information. Listing a drug's side effects has not been shown to increase the reported experience of side effects; however, one study suggests that patients may be more willing to report side effects to a health professional if they are listed in the written information. The trend for recent studies has been to focus on the "milieu" in which written information is provided or to systematically vary structural features of the information in order to improve the quality of drug communications.


Freeze-fracture replica of the primate lens fibers.

Using freeze-fracture techniques, we studied the fine structure of monkey lens fibers, with special reference to intercellular junctions. Gap junctions were frequently observed at the 'ball-and-socket' interdigitations, the 'tongue-and-groove' interdigitations, and between cortical lens fibers, while tight junctions were never apparent.


Absence of indoleamine-accumulating neurons in the retina of humans and cynomolgus monkeys.

Indoleamine-accumulating neurons have previously been detected in cats, rabbits, goldfish, chicken, pigeons, and Cebus monkeys, and were therefore also looked for in humans and in Old World monkey. Cynomolgus irus. The monkey eyes were injected intravitreally with 50 microgram 5,6-dihydroxytryptamine, 5 microgram alpha-methylnoradrenaline, or both drugs simultaneously. The human retinas were incubated in either drug. Previous observations on the distribution of dopaminergic neurons were confirmed in the two species, but no indoleamine-accumulating neurons were detected. The result emphasizes the similarity between human and Old World monkey retinas and contrasts them with the retina of the New World monkeys.


[The structure of the nasopharyngeal duct of Tupaia glis (Diard 1820). A comparison with primates and European insectivores (author's transl)].

The nasopharyngeal duct of Tupaia glis was studied and compared with other Primates and some Insectivores. In T. glis as in other Primates the ductus nasopharyngeus is separated by the septum nasi into two parallel passages whereas in Insectivores it is a simple undivided duct.


Experimental studies of acute anterior cruciate ligament injury and repair.

Ten dogs and six rhesus monkeys underwent transection and repair of the anterior cruciate ligament. One-half of the procedures involved the femoral end, the other half involved the tibial end of the ligament. Seven of the 10 canine and all of the primate ligaments, that had been transected and repaired, did heal. Functional and clinical instability was demonstrable in all repaired knees. The monkeys developed fewer degenerative changes with more grossly normal appearing ligaments after the repairs than did the dogs. Failure testing on an Instron materials testing machine revealed maximum strength of the repaired ligaments to be 10.4% for the repairs at the femoral end and 2.0% for repairs at the tibial ends in dogs when compared with the contralateral control knees. In monkeys the femoral repairs were 46.8% and the tibial repairs were 62.6% of the control knees. Inadequate immobilization and early stress were believed to be principal causes of the poorer results in dogs. The observations in monkeys support the suggestion that injured anterior cruciate ligaments that can be repaired, should be repaired.


The number and distribution of mast cells in monkey lungs.

We estimated the number of mast cells in monkey lungs by both quantitative histologic examination and measurement of total lung histamine, and showed that monkey lungs contain between 10(7) and 10(8) mast cells, with approximately 83% of these being located in conducting airways, and 17% in the parenchyma. The number of mast cells found in each airway generation increased from approximately 60,000 in the trachea to 8 million in the terminal bronchioles. In airways from different generations the number of mast cells superficial to the basement membrane in the epithelium and lumen (EMC) was compared to the number of mast cells found in the submucosa between basement membrane and cartilage and to the number of those found outside the cartilage. The number of EMC varied between animals and ranged from 0-0.4% of the total number of mast cells in the trachea, to 0-27% of the total in the terminal bronchioles. On the average, EMC accounted for 12% of the total number of mast cells in conducting airways, where we calculate that there is approximately one EMC for every 100,000 epithelial cells. Eosinophils were distributed in close relation to mast cells in the mucosa and submucosa, but were rare outside the cartilage. We conclude that the number of mast cells increases from central to peripheral airways and that this may account for the marked peripheral airway response observed after antigen challenge.


Occurrence of immunoglobulin G-alkaline phosphatase complexes in human serum.

We studied three patients in whom all or part of their serum alkaline phosphatase circulated as a complex with immunoglobulin G (IgG). Serum alkaline phosphatase isozymes were visualized by their electrophoretic (in agar, agarose, and starch gel and on cellulose acetate), gel filtration, and electroimmunodiffusion behaviour. The alkaline phosphatase-IgG complex was of the liver type (two cases) and bone type (one case). The reaction pattern of alkaline phosphatase with different human tissues and with sera of heterologous origin suggests that the complex is of the antigen-antibody type. A direct genetic mechanism seems unlikely since in one patient the IgG-alkaline phosphatase complex was not present in previous serum samples. The presence of this complex has no apparent correlation with the observed abnormalities. Alkaline phosphatase linked to immunoglobulin G must be considered in the interpretation of increased serum alkaline phosphatase.


Similar responsiveness of diabetic ketoacidosis to low-dose insulin by intramuscular injection and albumin-free infusion.

We compared low-dose insulin regimens in a prospective randomized trial in 30 patients with diabetic ketoacidosis. One group received a loading dose of 0.44 U/kg body weight of regular insulin half intramuscularly and half intravenously followed by 7 U/h intramuscularly, whereas the other group received a loading dose of 0.44 U/kg intravenously followed immediately by a constant infusion of 7 U/h in albumin-free saline. The time for metabolic control of the ketoacidosis was not significantly different in the two groups. Five patients in each group developed mild hypokalemia (serum potassium, 3.0 to 3.4 meq/litre). No patient became hypoglycemic, and there were no deaths within the follow-up period (24 h). In the treatment of diabetic ketoacidosis, low doses of insulin administered by the priming dose-intermittent intramuscular route are as effective as the constant infusion method.


Invasive aspergillosis in acute leukemia: correlation with nose cultures and antibiotic use.

Aspergillosis in cancer patients is a problem. Because not all patients can undergo invasive procedures, we sought other methods for diagnosis. We reviewed the data from all patients with acute nonlymphocytic leukemia treated at our center during a 3-year period. Of 125 patients, 18 had invasive aspergillosis (cases). Eleven patients had nose cultures growing Aspergillus flavus or A. fumigatus; 10 of these 11 had aspergillosis, whereas only eight of 114 without such nose cultures had invasive disease (P less than 0.000001). Thus, A. flavus on nose culture appears "predictive" for aspergillosis. Absence of such a culture does not preclude infection. Of 125 patients, 61 had sterile nose culture(s) and 14 of the 18 cases had such a sterile nose culture. Only four of the 64 patients without sterile nose cultures developed aspergillosis (P less than 0.008), suggesting a relation between sterile nose culture and aspergillosis. Carbenicillin was used for a longer period among cases and patients with predictive nose cultures than among patients without aspergillosis. These data may help identify patients at risk of aspergillosis and help determine antifungal therapy when invasive procedures are contraindicated.


Enteral hyperalimentation: an alternative to central venous hyperalimentation.

Severe protein-energy undernutrition is a frequent finding among chronically ill patients. Its causes are anorexia, hypermetabolism, and malabsorption. Adverse consequences include impaired cell-mediated immunity increased susceptibility to infection, poor wound healing, weakness, and death. Spontaneous oral intake is inadequate in patients with this disorder, and therapeutic maintenance or repletion alimentation is needed. Enteral hyperalimentation is the method of choice, if tolerated. A successful treatment program usually requires a small-bore, flexible nasoenteral tube, appropriate feeding solution, and constant flow delivery of nutrient. If only partial dietary requirements are tolerated enterally, peripheral intravenous nutrient solutions can often supply the deficit. Although not suitable for all patients, enteral hyperalimentation is more physiologic, safer, easier, and more economical than central venous hyperalimentation. It would be well tolerated by many patients who now receive nutritional repletion by the latter method.


[The emergency treatment of a recent burn of the oesophagus (author's transl)].

The emergency treatment of an oesophageal burn consist of: -- avoidance of a certain number of measures which may be considered to be dangerous or useless: gastric lavage, emetic agents, neutralising agents or oesophageal antacids; -- the treatment of shock and of oesophageal and gastric complications, in cases of massive ingestion in which the prognosis may be improved only by active, thorough and prolonged intensive therapy; -- attempting to prevent the development of subsequent stenosis following massive ingestions. The majority of authors are in agreement concerning the usefulness of early assessment by oesophagoscopy. There exists a certain amount of discord concerning the use of a calibrating oesophageal tube and the usefulness of corticosteroid therapy.


[Long term results of dilatation using the tube-bougie method in stenosis following caustic oesophagitis (author's transl)].

The tube-bougie methode suggested by the authors ten years ago for dilatation of oesophageal stenosis is based upon the fact that the instrument dilates only in the oesophagus itself and that it consists, on the one hand at the level of the stomach and secondly at the level of the nose and pharynx of a tube a small calibre which makes it possible to leave the dilating instrument in place for far longer periods (24 to 48 hours) than conventional bougies, increasing the interval between dilatation sessions. This technique has been used several hundred times for various indications, but only 6 cases of caustic oesophagitis (with a total of 440 dilatations) each patient being followed up for more than three and a half years, have been studied in order to determine the effectiveness of the method. Amongst the causes of recurrent stenosis or of an imperfect long term result, the authors stress the role of the reflux of gastric fluid and above all of progressive fibroinflammatory mediastinitis.


Cross-foot flap for ankle coverage.

The usual cross-leg flap procedures to cover composite wounds involving exposed ankle joint or bone require awkward positioning of the extremities with resultant complications. This is especially true in young, muscular patients with thick legs. A dorsalis pedis flap from the uninjured foot used as a cross-foot flap has been reliable and successful in our experience. A representative case history and the multiple advantages of this technique are described. We believe that this flap is an excellent alternative to the free-flap technique for coverage around the ankle area, especially in hospitals in which facilities for free-flap technique are not available.


[Considerations on the genus Nycteria (Haemoproteidae) parasite of African Microchiroptera with the description of 4 new species (author's transl)].

5 species of Nycteria from Central Africa (Gabon and Congo-Brazzaville) were studied. They can be divided into two distinct groups: the parasites of Nycteris with gametocytes "en cocarde": N. medusiformis, N. houini n. sp. and N. eradi n. sp.; the parasites of Rhinolophus with gametocytes of the "diffus" type: N. gabonensis n. sp. and N. krampitzi n. sp. The characteristics of the genus Nycteria and its place amongst the other Haemosporidia are analysed.


Genetic variants of carbonic anhydrase in the Asian-Pacific area.

The results of extensive surveys of red cell carbonic anhydrase phenotypes in the Asian-Pacific region are presented together with data on the occurrence of three new polymorphisms present only in Australian Aboriginals. Two of these systems are widespread right across the Australian continent, while the remaining one is restricted to members of a single linguistic group in Arnhem Land. Further examples of CA1 3-1 Guam are reported, and also CA1 3-1 Singapore which has an electrophoretic mobility indistinguishable from that of CA1 3-1 Guam. Included in the tabulations are data on other populations outside the Asian-Pacific area and, for completeness, information already published on variants of both CA1 and CA2. In an effort to simplify the nomenclature of carbonic anhydrase variants, a new system is suggested, using numerals rather than letters to distinguish the variant isozymes. Modifications of the electrophoresis buffer system which enhances the very small mobility differences existing between several of the products of the CA1 alleles are also described.


[Kinetics of the serological response in the experimental primary hydatid disease of mice infected with Echinococcus granulosus embryophores (author's transl)].

A serological response kinetics study was carried out in CF-1 mice orally infected with Echinococcus granulosus embryophores using immuno-electrophoresis, double diffusion, latex agglutination and passive hemagglutination. Starting from the 76th day after the infection, serum antibodies reach the minimum detectable level by immunoelectrophoresis test. Band number 5, now considered as specific for E. granulosus, was proved to be the first precipitating system exhibited in this test. Double diffusion, latex agglutination and passive hemagglutination tests developed positive results later (125--144 days after infection). Correlation between serologic and anatomo-pathologic findings suggest that hydatid cyst fluid presence in the cysts is necessary for circulating antibodies production.


Plasma somatomedin activity in protein calorie malnutrition.

Somatomedin activity was assayed in the plasma of children suffering from protein calorie malnutrition by a bioassay using rat cartilage and expressed as sulphate uptake ratio. The sulphate uptake ratio was particularly reduced in kwashiorkor. In marasmus there was a slight reduction and the levels were still in the normal range. Plasma growth hormone (GH) levels were raised in kwashiorkor but were in the normal range in marasmus. Reduction in sulphate uptake ratio was observed only when plasma albumin levels were less than 2.5 g/100 ml (25 g/l). A rise in plasma GH was also observed but only below this threshold level.


[Comparison of the effects of phentolamine and trinitrine in the treatment of left ventricular failure during the acute phase of myocardial infarct].

Two groups of 10 patients with left ventricular failure during the acute phase of myocardial infarction were studied. One group were given phentolamine, the other trinitrin. The infusion rate was regulated so that the heart rate was not increased by more than 10 beats per minute, and to obtain a pulmonary arterial diastolic pressure less than 18 mmHg with a mean systemic arterial pressure remaining greater than or equal to 80 mmHg. The dose of phentolamine was 5 +/- 3 mcg/kg/mn, but using trinitrin the initial optimal dose of 0.39 +/- 0.22 mcg/kg/mn had to be progressively increased during the first 24 hours. The haemodynamic study done before treatment and after an hour at the optimal infusion rate showed that, for a similar reduction in the pulmonary arterial diastolic pressure, the mean systemic arterial pressure was reduced less by trinitrin than by phentolamine, while the stroke work index was not appreciably altered by either drug. In patients with low systemic arterial pressure, trinitrin appears to be preferable and warrants use after the possible setting up of circulatory assistance by aortic counter-pulsation.


[Transitional carcinoma in congenital diverticulum of the bladder].

The author presents a case of an urothelial tumour in a vesical diverticle of an adult 64 years old man. The rareness which justifies its publication is based on the fact that it was the question of a congenital diverticle (admitting that the presence of a complete muscular stratum ratifies such character). In spite of a clearly radical surgery the fast dissemination of the tumor which caused the patient's death in a few months could not be avoided. The special pathogenic and evolution characteristics of the tumorations in this localization are briefly analyzed.


[Coronary angiography in the preoperative exploration of non-ischemic acquired valve diseases].

One hundred and fifty-nine patients with aortic valve disease (86 cases), mitral valve disease (58 cases) or mitral and aortic disease (15 cases) underwent a pre-operative haemodynamic study, including coronary arteriography either as a routine (age greater than 50 years) or because of chest pains. Coronary arteriography is easy to do during left heart catheterisation and nowadays carries minimal risk. In the cases of chest pains, it showed stenotic lesions of the coronary vessels in 22% of patients with aortic valve disease and in 35% of those with mitral disease. In the absence of angina, coronary arteriography showed no evidence of coronary artery disease in the cases of mitral regurgitation and of aortic valve disease. In contrast, it showed stenotic lesions in three cases of mitral stenosis. In the whole of the series, coronary artery disease proved a contra-indication to surgery in three cases, and was an indication for aorta-coronary by-pass grafting, in addition to valve surgery, in seven other cases. In the absence of angina, coronary arteriography has only a slight influence on the decision to operate. It does however give additional security, which justifies its routine use in patients over 50 years of age, particularly those with mitral valve disease.


[Restricted myocardial infarction. Coronary angiographic and ventriculographic findings. Comparison with acute coronary insufficiency and transmural infarction].

The findings at coronary arteriography and ventricular angiography in 52 patients with a restricted myocardial infarct were compared with those of 106 patients with acute coronary insufficiency and 100 with transmural infarcts. Certain features place restricted myocardial infarction in an intermediate category when compared with the two other syndromes. The percentage of coronary occlusions was significantly higher in transmural infarction (23.5%) and in restricted infarction (16.6%) than in acute coronary insufficiency 6.8%). Study of the vessel beyond a tight stenosis (greater than or equal to 75% was particularly effective in clearly separating the three groups. As a result, 63% of patients with coronary insufficiency, 40% of these with restricted infarcts, and only 23% of patients with a transmural infarct could be referred for surgery. Ventricular angiography showed a close relationship between restricted infarction and acute coronary insufficiency because ventricular function appeared normal or subnormal (localised hypokinesia) in 69% and 81% of cases respectively, compared with 4% of cases of transmural infarction. Restricted myocardial infarction appears to resemble coronary insufficiency, but shows elevation of enzymes and often more marked disease of distal vessels.


[Results of mitral-aortic valve replacements].

Seventy-five combined mitral and aortic valve replacements were done between 1970 and 1976 with a minimum follow-up of 12 months and a mean of 3.72 +/- 17 months using à Björk prosthesis in the aortic position and the Starr 6120 prosthesis in the mitral position. The early post-operative mortality was 5.3% and the late mortality 8.4%. The actuarial survival curve projected a mortality of 16% at 6 years, including the operative mortality. The survival at 6 years did not differ from that of mitral valve replacement alone during the same period, though it was less than the survival of aortic valve replacement for aortic regurgitation. Among the post-operative complications only 3 embolic complications were seen. Surprisingly, the degree of heart failure, the radiological heart size, and the haemodynamic data showed no satistically significant influence on the post-operative mortality. All of the survivors except one showed a functional improvement. Haemodynamic checks in 13 patients showed a significant reduction in mean pulmonary arterial pressure, in mean capillary wedge pressure and in arteriovenous oxygen difference, but not in the cardiac index. The radiological heart size was significantly reduced but this reduction was usually limited.


[Stimulation with automatic radiofrequency scanning in the long term treatment of tachyarrythmias].

A pacemaker is described which uses radiofrequency signals for synchronisation and pacing, and seeks automatically the phase of the cycle at which the tachycardia may be interrupted. The patient himself can activate the pacemaker. The programme of the external transmitter, which scans nearly all the R-R cycles of the tachycardia, may be pre-set to transmit one or two synchronised stimuli, with a progressive delay of 5 or 10 ms. If the tachycardia is interrupted the pacing stops automatically. The implantable unit of the device may be connected to a normal endocardial electrode, has no batteries and is of small size and weight. The method has been used with success in 4 patients with reciprocal junctional tachycardia (3 of these patients had the Wolff-Parkinson-White syndrome), and in one case of chronic recurrent ventricular tachycardia. All of them were refractory to conventional therapy.


[Left auricular myxoma. Apropos of 9 cases. Study of echocardiographic and morphologic aspects. Familial inquiry].

A study was made of 9 cases of left atrial myxoma with emphasis on the echocardiographic, haemodynamic and anatomical aspects and on the main clinical features. An epidemiological enquiry was made regarding the possibility of recurrences or familial cases. It was negative, suggesting that such cases are rare. The echocardiographic signs of left atrial myxoma are inconstant. The mitral diastolic EF slope is variable, the delay in appearance of the tumour echo behind the mitral valve in diastole is not constant, and the atrial "a" wave may be preserved. The echocardiographic features are a function of the size and shape of the myxoma, as well as the length and site of implantation of its pedicle.


[Distomatosis and cardiac disease. Apropos of 2 new cases. Trials of classification and pathogenetic hypotheses].

The authors report two new cases of cardiac disease associated with distomatosis: one case of biventricular fibroblastic parietal endocarditis affecting mainly the left side in a young female of 26 years, and one case of cardiomyopathy with atrial endocardial fibrosis, affecting especially the left ventricle in a man of 47. Bearing in mind the five cases reported in the literature, the authors propose a classification of cardiac disorders supposed to be due to distomatosis using three groups (endocardial fibrosis, cardiomyopathy, myocarditis) and relate them to a common pathogenesis based on immuno-allergic theory.


[Severe coronary insufficiency in a young woman after mediastinal radiotherapy].

Three years after radiotherapy to the mediastinum for Hodgkin's disease, a 28 year old female presented with incapacititating angina. The presence of severe disease in the proximal arteries on coronary arteriography, with obliteration of the anterior descending artery and, of the right coronary artery, together with an unstable collateral circulation, constituted an indication for a double aorto-coronary bypass graft. A review of the literature suggests that early development of atherosclerosis may be produced by the synergistic action of radiotherapy and lipid disorders. Fifteen similar cases have been described, eight of them in patients of less than 40 years of age; three were discovered at post-mortem examination in patients aged under 21.


The new asylums in the community.

One-hundred and one residents of a board-and-care home housing psychiatric patients were studied. Of these, 92% were diagnosed as psychotic; 42% have lived there five years or more; and 32% have overt major psychopathologic characteristics. Nine of ten have never lived alone or failed in their last attempt. A relationship was found between use of a community social rehabilitation program and its distance and provision of transportation. Sixty-one percent have had contact with community vocational rehabilitation but only 12% are still involved. Half of them have no goals for changing anything in their lives; 95% use community facilities, mostly eating places and supermarkets. Board-and-care homes offer an asylum from life's pressures, a degree of structure, and some treatment, especially medication supervision. For many long-term patients they have taken over the functions of the state hospital.


Female homosexual behavior in Macaca mulatta.

Homosexual activity among adult females in a heterosexual group of rhesus monkeys (Macaca mulatta) is documented and discussed. The mounter was usually in the follicular stage of the menstrual cycle and the mountee was in the ovulatory period. Activity during the luteal phase was low for all animals. Female mounting did not appear to be a preparation or substitute for heterosexual activity. Ritualized solicitation patterns among the females were intense and varied, strongly resembling those for heterosexual pairs. Dominance, partner preference, sexual stimulation, reproductive state, individual characteristics, and past experience are discussed in the framework of multiple factors influencing the homosexual relationship.


Carbamazepine vs phenytoin. A controlled clinical trial in focal motor and generalized epilepsy.

The antiepileptic effects of carbamazepine and phenytoin were compared in a double-blind crossover trial studying patients with primary and secondary generalized seizures and partial seizures with motor symptoms. Each treatment period lasted ten weeks. The patients were seen every two weeks, and doses were adjusted according to plasma levels. It was attempted to keep levels in the optimal plasma range, ie, 10 to 20 and 4 to 10 mg/liter for phenytoin and carbamazepine, respectively. Twenty-three patients entered and 19 completed the study. No statistically significant differences were found between carbamazepine and phenytoin with regard to seizure control and acute side effects.


The prediction of posttraumatic epilepsy. A mathematical approach.

Simple mathematical equations can be used to estimate the probability of posttraumatic seizures. Risk factors and time since the injury are taken into consideration in the calculations. The equations are based on a constant probability model derived from published data. When these formulae are applied to data from a variety of published studies, the predicted incidence of posttraumatic epilepsy based on the mathematical model agrees well with the incidence observed in the study groups.


Rapid metabolism of phenytoin: a method of calculating proper dosage.

The optimal dosage of phenytoin can be accurately determined by a pharmacokinetic method. By plotting the rate of administration of phenytoin acid against the apparent plasma clearance rate, we estimated the maximum rate of metabolism and the serum concentration at which the rate of metabolism was one half the maximum rate for phenytoin and then applied the Michaelis-Menten equation to optimize the dosage of phenytoin in a 48-year-old man with uncontrolled idiopathic generalized seizures and increased metabolism of phenytoin. The patient became seizure free on a regimen of 650 mg of phenytoin daily and experienced no side effects of phenytoin over-dosage. The pharmacokinetic technique described is simple to use and can be applied in an outpatient clinic.


Bacillus cereus endogenous panophthalmitis.

A case of severe suppurative endogenous panophthalmitis caused by Bacillus cereus resulted from intravenously administered medications. This is the first, to our knowledge, well-documented case of endogenous endophthalmitis associated with this organism. It is recommended that if on Gram's stain of the anterior chamber fluid, Gram-positive rods are seen, chloramphenicol should be administered in addition to penicillin because of the possibility of B cereus infection.


Double phakomatosis.

In the phakomatoses--von Recklinghausen's disease, the Sturge-Weber syndrome, tuberous sclerosis, and von Hippel-Lindau disease--pathologic changes in the eye are often evident. Most cases are described as a single entity. The following is a case report of concomitant Sturge-Weber syndrome and von Recklinghausen's disease in which both conditions involved the eye.


The mechanism of disc pallor in experimental optic atrophy. A fluorescein angiographic study.

Ascending optic atrophy was produced in 13 eyes of owl monkeys (Aotestrivirgatus) by retinal photocoagulation. Color fundus photography and fluorescein angiography were used to study and document the evolution of nerve head abnormalities. The optic nerve heads were also studied histopathologically. Except in certain instances of early transient (relative) filling defects, normal disc fluorescent patterns were preserved, despite clinically apparent optic nerve head pallor. Sectorial defects did not persist into the later phases of the angiogram. These findings may suggest a reduced blood flow, but neither angiographic nor histopathologic studies detected a reduced vascularity in the atrophic optic nerve. Pallor of the optic nerve head seems to result from alterations in the tissue reflectance and translucency following axonal loss and glial reorganization rather than from a decreased microvascular bed.