The relationship of growth failure (chronic undernutrition) to the prevalence of clinically severe protein-energy malnutrition and to growth retardation in protein-energy malnutrition.

A total of 72 of 276 children from a rural Mexican village were chronically undernourished as judged by their growth failure between 6 and 36 months of age. Fourteen of the 72 and five of the remaining 204 children developed clinically severe protein-energy malnutrition (PEM) as judged by clinical signs other than weight or length. This amounted to an 8-fold higher prevalence of  PEM in the group of children with growth failure. When children were grouped into quartiles of length at 6 months by sex, quartile was not related to the subsequent occurrence of PEM or to the age when PEM developed. However, analysis indicated that the growth of children with PEM and growth failure had slowed relative to their quartiles before PEM developed; they were also retarded according to the Harvard standards. The children with PEM were then compared to others with a similar growth history (growth failure, no growth failure) who never developed PEM. PEM children did not differ significantly in over weight or length and displayed a significant difference in upper arm muscle circumference at only one age. The 14 with growth failure and PEM had poorer overall growth, including arm muscle circumference, than the five with PEM and no growth failure.


Nasogastric hyperalimentation through a polyethylene catheter: an alternative to central venous hyperalimentation.

We performed nasogastric hyperalimentation with polyethylene catheters and appropriate feeding solutions in 12 cachectic patients who had been referred as candidates for central venous hyperalimentation. Most patients had primary gastrointestinal disease. The duration of hyperalimentation averaged 31 days. Seven patients obtained rapid weight gain (average 0.3 kg/day) with the nasogastric hyperalimentation alone. An additional two were successfully repleted with the addition of parenteral fluids via peripheral veins. In the nine repleted patients, serum albumin rose by average 19%, 24-hr urine creatinine by average 21%, and triceps skinfold by average 46%. The nature of the weight gain in the nine successful cases was analyzed by the metabolic balance study technique. Average composition of the increment in weight was: 50% protoplasm, 48% extracellular fluid, 19% adipose tissue, and less than 1% bone. We conclude that nasogastric hyperalimentation can replace central venous hyperalimentation in a substantial proportion of patients now receiving the latter type of treatment.


Effect of an episode of severe malnutrition and age on lactose absorption by recovered infants and children.

The degree of which the ability to absorb lactose can be regained after recovery from an acute episode of severe malnutrition is in doubt. Lactase activity was indirectly assessed by means of a standard lactose tolerance test (2 g lactose per kilogram of body weight) in 71 Peruvian Mestizo infants and children (age 5 to 55 months) who had suffered such an episode. All were studied just before discharge after several months of hospital rehabilitation, during which linear growth and weight gain had accelerated and signs of significant malabsorption of other nutrients had disappeared. Only 39% of the total group had a positive test (delta blood glucose greater than 25 mg/dl); there was a decreasing proportion of positive responders with increasing age. No difference in response attributable to type or severity of malnutrition was found. Comparison of the present data with previous data from children in the same community who had never been acutely malnourished suggests that acute malnutrition may hasten the permanent decline of lactase activity normally expected later in life.


The measurement of antibodies to extractable nuclear antigen.

By the use of a combination of Ouchterlony immunodiffusion and hemagglutination, it was found that 30 of 81 sera (37%) from patients who had systemic lupus erythematosus (SLE) had antibodies to the ribonucleoprotein component of extractable nuclear antigen, and 37 (46%) had antibody to the Sm antigen. Immunodiffusion was more sensitive for detection of anti-ribonucleoprotein, while hemagglutination detected more anti-Sm. Both technics are necessary to define qualitatively the types of antibodies present in SLE sera.


Low-dose intravenous insulin in the treatment of diabetic ketoacidosis.

Continuous slow intravenous infusion of insulin was used in 52 episodes of diabetic ketoacidosis. No complications of therapy, ie, hypoglycemia, induced hypokalemia, insulin resistance, or cerebral edema, were encountered. Potassium phosphate was given to 47 of the 52 patients. Sodium bicarbonate was administered to only one patient. The hyperglycemia frequently resolved more rapidly than the systemic acidosis; this was managed by adding glucose to the intravenous fluids when the blood sugar concentration decreased to approximately 250 mg/dL; insulin infusion, however, was continued until the acidosis was corrected (venous standard bicarbonate greater than 14 mEq/L). We have found this method of treatment to be safe and simple to administer, and we believe it is the preferred treatment of patients with diabetic ketoacidosis.


Detection of hunter heterozygotes by enzymatic analysis of hair roots.

We have developed a procedure for testing iduronate sulfatase, the enzyme deficient in Hunter syndrome, in single hair roots. Beta-Hexosaminidase was used as the reference enzyme. The ratio of iduronate sulfatase to beta--hexosaminidase, expressed in arbitrary units of activity, is near zero for Hunter patients and greater than 0.6 in almost all roots of normal individuals. Hair roots of Hunter heterozygotes show a characteristic continuum of activity ratios, ranging from totally deficient up to and including the normal range. The results are consistent with the origin of hair roots from a small number of progenitor cells which obey the Lyon hypothesis. The proportion of roots with low activity can be used to discriminate between normal and heterozygous individuals.


Visual compatibility of 30 additives with a parenteral nutrient solution.

The visual compatibility of 30 drug additives with total parenteral nutrient (TPN) solutions (4.25% amino acids, 25% dextrose injection) was studied. For each drug additive, three TPN solutions were mixed; two were stored for 22 hours at 4 C then allowed to equilibrate to room temperature for two hours. Two 25-ml samples from each TPN solution were examined immediately or after 25 hours for visual appearance, particulate matter levels and pH. A microscope was used to count and measure particles filtered from samples on a 0.8-micrometer filter. Only the TPN solutions containing amphotericin B showed any visual discoloration or precipitation. All amphotericin B samples and the 25-hour ampicillin sodium samples exceeded USP particulate matter specifications. Individual particulate matter levels of the other TPN solutions varied but met USP specifications. With the exception of tetracycline hydrochloride, which dropped the TPN solution's pH 0.9 units, the additives had little effect on pH of the TPN solutions (pH 6.45). Amphotericin B and ampicillin sodium were considered visually incompatible with TPN solutions. All other drug additives tested were visually compatible with TPN solutions.


Identification of multiple antibodies: a case study.

A 55-year-old man was admitted to the hospital with a hemoglobin of 8.5 gm/dl. Two units of blood were ordered. The patient's antibody screening was positive in albumin and antiglobulin phases, and crossmatches were incompatible in those same phases. An antibody identification panel was performed and nine of ten cells were positive. The multiple antibodies were identified by special antigen typing of the patient's cells, heat absorptions of the patient's serum with special cells, and tests of the patient's serum against a selected cell panel.


Bacteriology of acute pelvic inflammatory disease. Suboptimal survival of Neisseria gonorrhoeae in a nonbuffered transport system.

In our earlier study, Neisseria gonorrhoeae was infrequently isolated while Bacteroides fragilis was totally absent from cul-de-sac aspirates of patients with acute pelvic inflammatory disease (PID). Twenty additional women were studied to further elucidate the bacteriology of this disease. Recovery rate of N. gonorrhoeae from cul-de-sac aspirates collected in selective transport medium (Transgrow) was 25 per cent among patients with gonococcal PID, compared to only 8 per cent when specimens were collected in a nonselective transport system (Anaport). In vitro studies confirmed a detrimental effect of the Anaport for survival of N. gonorrhoeae during transport. This suboptimal survival was primarily related to low pH of the transport system under prereduced conditions, and could be corrected when pH of the transport vial was preadjusted and maintained between 6 and 7. B. fragilis was again absent from the cul-de-sac in all patients, while streptococci, peptococci, and peptostreptococci remained the most predominant isolates. These data may explain the empiric observations that penicillin and tetracycline are effective in most cases of acute PID.


Significance of phosphatidylglycerol in amniotic fluid in complicated pregnancies.

In normal pregnancy lecithin/sphingomyelin ratios correlate with gestational age. In complicated pregnancies biochemical maturation of fetal lung may be accelerated or delayed, depending upon maternal, fetal, or placental conditions. Surfactant contains other phospholipids besides lecithin, including phosphatidylglycerol (PG), the second major component of mature surfactant. Ninety phospholipid patterns in amniotic fluid were studied by two-dimensional thin-layer chromatography. In uncomplicated pregnancies PG was absent until 37 weeks' gestation, then increased there after. In complicated pregnancies (pre-eclampsia, diabetes Classes D, F, and R, premature rupture of membranes) PG was identified before 35 (as early as 29 weeks' gestation. These results verify accelerated lung maturation in certain complicated pregnancies. No newborn infant developed respiratory distress syndrome in the presence of PG.


Terminal course of nerve supply to Müller's muscle in the rhesus monkey and its clinical significance.

Electron microscopic, histochemical fluorescence, and pharmacologic evidence suggested that, in the rhesus monkey, Müller's muscle was not totally denervated either by cutting the levator palpebrae superioris muscle or by a Fasanella-Servat procedure. We examined the terminal course of the sympathetic nerve supply and the potential for preserving Müller's muscle in blepharoptosis surgery.


Pseudomonas orbital cellulitis.

A 3-month-old infant being treated for bronchitis developed a rapid onset but otherwise typical orbital cellulitis. Because gram-negative infections and septicemia are common occurrences in the newborn nursery, this patient was given systemic gentamicin and ampicillin. Sinus x-rays were not attempted. Two days after treatment the eyelids were opened. A strikingly large corneal ulcer with perforated globe and endophthalmitis was found. Pseudomonas aeroginosa was cultured from the blood, conjunctiva, and throat. A diagnosis of Pseudomonas orbital cellulitis with secondary corneal perforation and endophthalmitis was made. The source of infection was believed to be the respiratory tract.


Optic chiasmatic glioma in children.

We reviewed the records of 29 patients with optic nerve or chiasm glioma, or both, seen from 1955 to 1966. Sixteen patients were girls and 13 were boys. At the time of diagnosis, 14 patients were less than 2 years old. Optic atrophy was the most frequently seen physical finding, present in 26 of 29 patients. Twelve patients had diencephalic syndrome (41%). Proptosis was seen in eight. Eleven patients (38%) had associated neurofibromatosis. Pneumoencaphalogram was done on 26 patients and was abnormal in 23. The diagnosis was confirmed at surgery in 27 patients. All tumors were astrocytomas. Eighteen patients underwent radiotherapy. Surgery and radiotherapy were used as treatment for optic-chiasmatic glioma with diencephalic syndrome.


Experimental and postexperimental effects of posteriorly directed extraoral traction in adult Macaca fascicularis.

The experimental, postexperimental, and postretention effects of continuous high-pull headgear force application to the maxilla were evaluated in four adult, nongrowing Macaca fascicularis monkeys. Force was applied at 450 grams per side to face-bows attached to cast maxillary splints with an implanted occipital plug for anchorage. The active experimental phase lasted from 84 days to 205 days, and its effects were documented histologically, cephalometrically, and with dry skull preparations. Postexperimental, retention, and postretention responses were documented cephalometrically. The findings of the present investigation lead to the following conclusions: 1. The termination active sutural growth is of little significance to the remodeling potential of the sutural articulations and the morphologic adaptability of the facial skeletal complex. 2. The length of time necessary for resorptive remodeling of the sutural bony projections is partially responsible for the slower rate of detectable skeletal movement in adult animals. 3. The sutural ligament in adult animals is initially less responsive to the effects of extraoral force application, possibly because of a diminished level of cellular activity at older ages. 4. Increases in age do not appear to affect the osteogenic potential of the periosteal envelope. 5. Retention aids in establishing a maintainable equilibrium following experimentally induced sutural and skeletal remodeling, but it is of little importance in maintaining the altered position of the denition. 6. The amount of postexperimental skeletal reorientation following force application to the maxilla may be related to the force level and the duration of force.


Experimental and postexperimental response to anteriorly directed extraoral force in young Macaca nemestrina.

An anteriorly directed extraoral force was applied to the maxillas of four healthy young M. nemestrina monkeys. Experimental, retention, and postretention alterations were evaluated through a combination of cephalometric, histologic, and gross techniques. In view of the results of the present study, the following conclusions can be made: 1. Skeletal remodeling occurs in all circummaxillary sutures following the application of an anteriorly directed extraoral force to the maxilla. The amount of remodeling appears to be proportional to a suture's distance from and orientation to the applied force system. 2. The maxillary complex exhibited a marked anterior positioning with a small amount of counterclockwise rotation during the experimental period. 3. The application of an extraoral force to the maxilia produces compensatory deposition and resorption of bone, not only at the sutural margins but also at the external surface of the bones themselves. 4. It is possible that the experimental appliance transmits its effect to the facial bones adjacent to the maxilla through an alteration in the skull's periosteal envelope. 5. A substantial reorientation of the maxillary complex occurs following the termination of active force, and the degree of relapse or reorientation is directly proportional to the length of stabilization. 6. The dentition, through the periodontal ligament, undergoes approximately four times as much relapse as do the facial bones through their sutural articulations, following a minimal period of stabilization. 7. Extraoral forces applied to the craniofacial complex are transmitted through the maxilla and related midfacial bones, resulting in changes in such deep cranial structures as the cartilaginous synchondroses of the sphenoid bone. 8. Anterior displacement of the maxilla by extraoral traction appears to have a minimal effect on the mandible and the temporomandibular joint. 9. The number of sinusoidal vessels in the sutural ligament tends to increase in those sutures subjected to a tensional force.


Possible roles for microtubules and microfilaments in ADH action on toad urinary bladder.

Intramembranous particle aggregates in the luminal membrane of toad bladder granular cells after vasopressin stimulation have been found to correlate closely and specifically with induced alterations of water permeability. Roles for microtubules and microfilaments in mediating the latter response have been proposed on the basis of studies involving colchicine and cytochalasin B, respectively. In the present investigation the effects of these agents on both initiating and sustaining vasopressin-induced osmotic water flow and the particle aggregation phenomenon were studied. The results indicate that during initiation the aggregation and water flow responses to vasopressin are each colchicine- and cytochalasin B-sensitive and that these sensitivities can be wholly additive. However, after full vasopressin stimulation is established, the same responses demonstrate sensitivity only to cytochalasin B, not to colchicine. The findings, therefore, suggest that microtubules and microfilaments may be independently necessary for the initiation of the aggregation and water flow responses to vasopressin, and that microfilaments, but not microtubules, are required for their maintenance.


Carbonic anhydrase-dependent bicarbonate reabsorption in the rat proximal tubule.

The extent to which bicarbonate reabsorption in the rat proximal convoluted tubule depends on carbonic anhydrase has been examined by in vivo microperfusion and the measurement of total CO2 concentration by microcalorimetry. Tubules were perfused with an ultrafiltrate-like solution at 13 nl/min, and volume reabsorptive rate (JV) was measured using [14C]inulin. Addition of either 800 or 100 microM acetazolamide to the perfusion solution completely inhibited the reabsorption of total CO2. The control total CO2 reabsorptive rate (JtCO2) was 147 +/- 23 pmol/mm.min, and acetazolamide reduced JtCO2 to -3 +/- 5 pmol/mm.min. Acetazolamide reduced JV by 65% from a control of 2.3 +/- 0.4 to 0.8 +/- 0.1 nl/mm.min. The dose-response curve for acetazolamide showed that the I50 for inhibition of JtCO2 was 4 microM. The inactive congener of acetazolamide, t-butyl acetazolamide, did not reduce JV or inhibit bicarbonate reabsorption, indicating that the effect of acetazolamide on JtCO2 was specific for carbonic anhydrase inhibition. Since bicarbonate reabsorption was completely blocked by carbonic anhydrase inhibition, there is no need to postulate either carbonic acid recycling or carbonic anhydrase-independent bicarbonate reabsorption.


Decreased renal blood flow in the baboon during mild dynamic leg exercise.

Twelve chair-restrained baboons (Papio cynocephalus) were conditioned with operant techniques and a food reward to perform 4 min of dynamic leg exercise. During the last minute of exercise, blood flow through the left renal artery, measured by an electromagnetic flow transducer, was decreased 19 +/- 2% SEM with respect to the minute of rest preceding the exercise. This response occurred within 1.5 min, was maintained throughout the exercise, and recovered to control within 2 min. Mean arterial blood pressure rose 17 +/- 2%; renal vascular resistance, 46 +/- 6%; heart rate, 42 +/- 4%; and whole-body oxygen consumption, 233 +/- 19%. Behavioral situations simulating the arousal and feeding components of the exercise task, but not requiring muscular exertion, did not alter renal blood flow. In four animals, blood flow to the contralateral but surgically denervated kidney was measured; it increased transiently at the onset of exercise, but returned to control by the last minute of work. Thus, the baboon, like man, shows a decrease in renal blood flow during exercise. This response has a rapid onset and recovery and is primarily neurally mediated.


Hypothalamus-pituitary-thyroid axis interactions with pineal gland in the rat.

We examined in the rat several possible relationships between the pineal gland and the hypothalamus-pituitary-thyroid axis. The pineal gland, the retina, and the hypothalamus exhibited a diurnal rhythm in thyrotropin-releasing hormone (TRH) content with peak values occurring around 1200 h. This rhythm in the hypothalamus was abolished by constant light but was not affected by pinealectomy. Nor did pinealectomy affect hypothalamic TRH content, pituitary content of thyroid-stimulating hormone (TSH) or prolactin; serum levels of (TSH), triiodothyronine (T3), or thyroxine (T4), or serum free-thyroxine index; or free-triiodothyronine index. Melatonin did not affect TSH or prolactin release from the anterior pituitary or TRH release from the hypothalamus in vitro. Isoproterenol did not affect the TRH content of pineal glands in vitro; nor did TRH or T3 affect basal or stimulated activities of serotonin N-acetyltransferase, the presumed controlling enzyme in melatonin production. We found no evidence for significant interactions between the pineal gland and the hypothalamus-pituitary-thyroid axis.


Effects of electrochemical gradients on active sodium transport in toad urinary bladder.

To determine the concentration dependence of active sodium transport in toad urinary bladder, bidirectional fluxes of sodium were measured at three mucosal sodium concentrations (Cm) (114, 27, and 3 mM), before and after addition of sufficient ouabain to eliminate active transport. The results permit estimation of E, the electromotive force of the sodium pump, and its conductance, ga. E averaged 137 mV and was unaffected by depolarization or by reduction of Cm; ga fell by only 40%, suggesting that a Cm of 3 mM was still above the half-maximal value for the sodium pump. However, net open-circuit transport was estimated to become zero at Cm = 6 mM, owing to backflux through the shunt path, which did not vary with Cm. The flux ratio in the active path exhibited the type of abnormality first described as "single-file pore diffusion," which is attributed to relatively tight coupling between transport and metabolism.


Seasonal changes in malnutrition and diarrheal disease among preschool children in El Salvador.

The nutritional status of preschool children in a rural El Salvadoran population was assessed quarterly for 1 year using height, weight and arm circumference measurements in order to define seasonal changes in malnutrition. Seasonal patterns in the incidence of reported malnutrition and diarrheal disease from the local clinic serving the study population and on the national level for EL Salvador were also assessed and were compared with field measurements. Results indicated a similar seasonal increase in both measured malnutrition and in the reported incidence of malnutrition and diarrheal disease occurring at the onset of the rainy season. The results confirm the existence and indicate the magnitude of seasonal changes in malnutrition and diarrheal disease in a preschool population.


Cost of snail control.

In the last 10 years, there has been general agreement that niclosamide (bayluscide) is the preferred molluscicide for control of the snails transmitting Schistosoma mansoni and Schistosoma haematobium. This chemical has been widely tested in pilot projects and is in use in expanded control projects in Brazil, Puerto Rico, Egypt, Iran, and other countries. A comparison of the results from six pilot projects in these countries was analyzed with particular attention to the costs of the programs, since the benefits were fairly similar in terms of rapid snail control. It was shown that costs were generally related to simple geographic parameters such as volume of snail habitat and distance between habitats. The annual costs in 1972 prices ranged from a minimum of US $1 per 100 m3 of snail habitat treated for dry regions with large irrigation systems, to a maximum of US $40 per 100 m3 treated in areas of high rainfall with only a few scattered, natural waterbodies. Use of the reported data for estimating the cost of current programs was demonstrated by projecting costs for Puerto Rico and the Sudan in 1978 prices.


Experimental transmission of Wuchereria bancrofti to monkeys.

Infective larvae of Wuchereria bancrofti from laboratory-raised Culex pipiens fatigans and Aedes togoi mosquitoes fed on human volunteers in Jakarta, Indonesia (J strain) and Kinmen Island, China (K strain) were introduced into Taiwan monkeys (Macaca cyclopis) by subcutaneous inoculation, by foot puncture, or by permitting infected mosquitoes to feed weekly on the monkeys. Some animals were splenectomized and others were treated with varying regimens of immunosuppressants. Necropsy was done on monkeys that died or were killed and the entire bodies were examined for worms. A total of 78 monkeys (43 males and 35 females) were exposed to infection and parasites were found in 29% of the females and 63% of males. In infections of 38 days or less worms were recovered from the testes of males and the pelt, carcass and lymph nodes of both sexes, but after 42 days of infection most worms were in the testes of males, and a few were recovered from lymph nodes and carcasses of females. Worms recovered at 8-11 days were third-stage, those found between 14 and 38 days fourth-stage, and ones found between 42 and 103 days were young adults. After 148 days most were adults and microfilariae were seen in the uteri of female worms at 160 days and later. The parasites continued to grow in size with time. Microfilariae were detected in the blood of nine monkeys between 8 and 18 months and the patent period varied from 5-21 months. Microfilarial densities were low and erratic, and periodicity could not be determined. The effectiveness of methods of administering infections and the value of various treatment regimens seem uncertain; monkey antilymphocytic sera, however, appeared to have some influence. Parasites were found in 36% of the Taiwan monkeys given the J strain and 54% of those given the K strain. A limited number of M. mulatta (3), M.irus (fascicularis) (3) and Aotus trivirgatus (4) were also given infective larvae and adult W. bancrofti were recovered from the testes of one male M. mulatta and one male M. irus; uterine microfilariae were found in one female worm from the latter monkey. A. trivirgatus were negative. Low numbers of infective larvae recovered from mosquitoes fed on patent monkeys were introduced intermittently into seven clean monkeys and one became microfilaremic between 11 and 17 months postinoculation.


Serological differences between acute and chronic schistosomiasis mansoni detected by enzyme-linked immunosorbent assay (ELISA).

Sera from patients with acute and chronic schistosomiasis mansoni, and from laboratory-infected monkeys, were examined by an enzyme-linked immunosorbent assay technique using antigens prepared from eggs, cercariae, and adult worms. Sera from patients with acute schistosomiasis and from monkeys 2 months post-infection reacted more positively to cercarial antigen than to adult worm antigen whereas sera from both patients with chronic schistosomiasis and monkeys infected for longer than 4 months reacted more positively to adult worm antigen. These differential responses to antigen serologically differentiated between acute and chronic schistosome infections.


The association of neurofibromatosis and hyperparathyroidism.

Two patients with coexisting neurofibromatosis and hyperparathyroidism are described, bringing the total number of such cases in the world literature to seven. Other more classic examples of the association of tumorous conditions of neuroectodermal and entodermal origin are discussed to support the suggestion that the association of these two diseases may be another variant of multiple endocrine neoplasia type 2 (MEN2b). It may be clinically profitable to investigate all patients with either disease in order to uncover their coexistence.


[Taste buds in the epithelium of the plica sublingualis of New World monkeys (author's transl)].

The Plica sublingualis of new world monkeys was studied microscopically. In Ateles there are approximately 1700 taste buds in the epithelium of the Plica sublingualis, they are fewer in number in Alouatta, Lagothrix, Aotus and are absent in Saimiri and Cebus. The taste buds are situated consistently at the tip of the Plica sublingualis and near the orifices of the submandibular and sublingual salivary glands. From this topographical coincidence it is inferred that the function of the taste buds at the Plica sublingualis might permit a comparison between the fresh saliva with the general saliva in the cavum oris along a gradient.


Studies on allergenic algae of Delhi area: botanical aspects.

To study distribution of algae in and around Delhi aerobiological surveys were undertaken for two consecutive years (September, 1972, to August, 1974). The surveys were accomplished by (a) slide exposure method and (b) culture plate exposure method. A total of 850 slides were exposed using Durham's gravity sampling device. Of these, 560 slides were exposed during 1973 (272 slides at two meter and 288 at ten meter height) and the rest (290 slides) were exposed during 1974 at ten meter height. A total of 858 culture plates were exposed (276 for one hour and 282 for two hours) during 1973 and the rest (300 culture plates) were exposed during 1974 at ten meter height for two hours duration only. Air was found to be rich in algae flora during the months of September to November. The dominant forms of algae present were all blue greens. This might be due to the relative greater resistance of blue green algae to unfavorable conditions.


[Comparison of two methods of antibiotic sensitivity test: gel diffusion and automatic method using ABAC apparatus. II. Study on 399 strains isolated in hospital (author's transl)].

The authors compared for routine use, the results obtained on 399 strains of Gram negative bacilli by two technics of antibiotic sensitivity: the technic of gel diffusion with imprenated discs and an automatic method (ABAC apparatus). Among the antibiotics used as a routine in our laboratory by the diffusion method and the 16 studied with the ABAC apparatus, 11 are common to both methods and were compared. The concordance of the results was greater than 90% for colistine (94.5%), oxolinic acid (93.5%), tobramycin (91.7%). It lies between 80 and 90% in the case of carbenicillin (89.1%), nalidixic acid (87.5%), kanamycin (87.2%). It is less in the case of gentamicin (77.9%), ampicillin (77.3%, chloramphenicol (76%), streptomycin (70.3%), minocycline with 55.9% gave the lowest results. The percentage of uninterpretable responses by ABAC was 0.7% for all 11 antibiotics. The correlations were good for the Enterobacteriaceae: Serratia (75.4%), Eschericia coli (87.5%). They are less in the case of Pseudomonas aeruginosa (71.6%). The ABAC makes sensitivity test automatic and appears a reliable method.


Growth hormone releasing activity of small peptides: effect of pyroglutamyl-seryl-glycinamide and thyrotropin releasing hormone on rat pituitaries.

Growth hormone (GH) releasing activity of pyroglutamyl-seryl-glycinamide (PSG) and of thyrotropin-releasing hormone (TRH) was assayed on rat pituitaries in vitro, by radioimmunoassay of the GH released into the incubation media. TRH was found to be a partial agonist, producing maximal effects (at ca. 600 ng/ml) that were below the maximum response of the system to hypothalamic extract. The responses to a higher TRH concentration (1500 ng/ml) were smaller than that obtained at 600 ng/ml. PSG also behaved as a partial agonist producing maximum response at 150 ng/ml. The results are discussed in relation to possible structural similarities between the physiological GHRF and the tripeptides TRH, PSG and MIF (MSH release inhibiting hormone).


Aromatic substrate specificity of browning by cultures of the Legionnaires' disease bacterium.

When the Legionnaires' disease (LD) bacterium is grown on supplemented Mueller-Hinton agar, brown pigmentation of the medium occurs. Since this browning may result from tyrosinase-mediated formation of melanin, we supplemented yeast-extract agar with various aromatic precursors of melanin and inoculated it with eight strains of the LD bacterium. Browning occurred with growth of each LD strain of the bacterium on yeast-extract agar enriched with 2.5 mmol/L of L-phenylalanine or L-tyrosine but not without such enrichment. Equimolar D-phenylalanine or D-tryosine in yeast-extract agar did not enhance browning. The LD bacterium may possess L-phenylalanine hydroxylase activity, but it does not use D-aromatic amino acids effectively in pigment production.


Resistance of normal or immunized guinea pigs against a subcutaneous challenge of Brucella abortus.

Guinea pigs were inoculated subcutaneously into a hind footpad with Brucella abortus. Unimmunized guinea pigs had little capacity for barring brucella from spreading to their spleens: the inoculum dose needed to infect 50% of the spleens one month after inoculation was about 10 brucella. When the size of the challenge inoculum reached approximately 5 x 10(3) ID50 a previous immunization with killed or virulent brucella: --did not prevent the challenge bacteria from reaching the lymph nodes near the inoculation site, but reduced the level of infection in these, --barred or reduced the spreading of brucella throughout the remainder of the reticuloendothelial system. Immunization with a small number of virulent brucella was more effective than immunization with a higher number of killed bacteria to produce such modifications of the repartition of challenge brucella.


A solid-phase radioimmunoassay for the determination of bacterial-specific antibodies within different immunoglobulin classes: application to bovine Brucella abortus antibodies.

A solid-phase radioimmunoassay (RIA) has been developed for quantitation of class-specific antibodies against bacteria. Brucella abortus cells were used to sensitize glass tubes after sedimentation, drying and methanol fixation. Bovine antibodies that attached to the bacteria were detected by binding of a rabbit antiserum specific for each class or subclass of bovine immunoglobulins followed by binding of 125I sheep anti-rabbit immunoglobulin reagent. This three-step method was adapted as it was very sensitive (less than 0.3 picogram antibody/ml), gave the best discrimination between sample and background counts and elminated the need for several labeled rabbit anti-bovine immunoglobulin class-specific antisera. Parameters affecting quantitation of the assay were investigated: nature and preparation of the test tube, quantity and fixation of Brucella, temperature and incubation time, incubation volume, concentration of reagents. The RIA and the complement fixation test (CFT) were applied to sera obtained at repeated intervals from seven heifers experimentally infected with Brucella abortus during gestation. Rabbit antisera specific for bovine IgG1 were used in the RIA because of antibodies of this subclass are the predominant type implicated in the CFT. The kinetic of appearance of Brucella specific antibodies were very significantly correlated for the two tests (r = 0.056, P less than 0.01) demonstrating the validity of the proposed RIA. This test was 10,000 times more sensitive than CFT.


Stapedectomy. Postmortem findings.

Histological studies were made of 16 temporal bones of 13 subjects who had stapedectomy operations. Photographs of the prostheses in situ are a special feature of the studies. It was found that prostheses which overlap the margins of the oval window cause incomplete closure of the air-bone gaps. Fibrous adhesions were a common consequence of trauma to the mucous membrane of the middle ear. Gelfoam implantation promotes the formation of thin oval window membranes which tend to bulge out of the oval window. Most incudes show small areas of cortical bone resorption. In at least half the cases the surgical technique of stapedectomy, as judged from these studies, was less than ideal. Surgeons who perform stapedectomy should be cognizant of the relevant surgical pathology and adopt methods which will optimize functional results and minimize complications.


Localization of hypophysiotropic peptides and other biologically active peptides within the brain.

Immunohistochemical analysis of hypophysiotropic and other neuropeptides reveals unique and striking neural perikarya, axons, and terminals containing specific peptide immunoreactivity. The hypophysiotropic peptides are most highly concentrated in nerve terminals in the external layer of the median eminence. From this site they may be released and carried via the portal circulation to the adenohypophysis. The occurrence of hypophysiotropic peptides in other areas of the nervous system suggests that they may act, at these sites, as neurotransmitters. Enkephalins, SP, angiotensin II, and cholecystokinin-like immunoreactivity are also found in nerve terminals in the external layer of the median eminence of some species. Although these peptides have not been considered hypophysiotropic hormones, the location of their terminals in the median eminence suggests that they participate indirectly in regulation of anterior pituitary hormone release. This control may be accomplished via axo-axonal influences of terminals containing these peptides upon the terminals containing the genuine hypophysiotropic peptides. An analogous interaction is thought to be exerted by dopamine terminals upon LHRH terminals in the median eminence (39). All of the neuropeptides discussed above are found within neuronal structures in the hypothalamus. Most of these peptides are also found, at least to a limited extent, in the brainstem, spinal cord, and deep nuclei of the telencephalon. Few peptides have been localized in neurons of the cerebral cortex. These include SOM, VIP, and cholecystokinin-like immunoreactivity. The cerebellum, to date, has not been shown to contain significant immunoreactivity for any of the presently identifiable neuropeptides. The demonstration of the coexistence of neuropeptides (SOM and SP) in some monoaminergic (adrenergic and serotonergic) neurons raises questions about the one-neuron-one-transmitter hypothesis. It is presently unknown whether or not such coexistence is widespread in the mammalian nervous system. For those neurons that contain two neuroeffector substances, it will be important to determine whether or not both substances play an active role in the function of the neuron. Finally, the details of the morphological interactions of peptidergic elements with other neuronal systems offer the possibility to understand more completely the circuitry of many regions of the central nervous system.


[Physiological role of fats in the process of penicillin biosynthesis].

The level of penicillin production in the presence of whale oil was shown to be higher. The stimulating effect of the oil was connected with accumulation of large biomass rather than with its specific effect on the biosynthesis. At the beginning of the process the oil eliminated the biomass accumulation lag-phase connected with beta-galactosidase repression by glucose. During the second part of the fermentation process the oil acclerated the culture growth in the presence of lactose. The rate of the oil consumption calculated for carbon was higher than that of the lactose utilization. The presence of the oil in the medium did not prevent the lactose consumption.


Conversion of 2,4,6-trinitrophenol to a mutagen by Pseudomonas aeruginosa.

A strain of Pseudomonas aeruginosa reduced 2,4,6-trinitrophenol (picric acid) to 2-amino-4,6-dinitrophenol (picramic acid) under anaerobic conditions. Mutagenic assays of picric acid and picramic acid were carried out with histidine-requiring strains of Salmonella typhimurium. Picric acid (10 micrograms per plate) demonstrated mutagenicity (both frame shift and base substitution-gype mutations) only after activation with a rat liver homogenate preparation. Picramic acid (1 microgram per plate) induced both base pair substitution and frame shift-tupe mutations without activation by the rat liver preparation.


Stability and viability of Neisseria gonorrhoeae in various solutions and buffers.

The stability and viability of Neisseria gonorrhoeae WP (T4) was tested in a variety of buffers and solutions, many of which are commonly used in gonococcal research. Each solution was tested at room temperature for its ability to maintain stability and viability of gonococci in concentrated suspensions and to maintain viability of gonococci in dilute suspensions. The 14 buffers and solutions tested could be divided into four groups based upon these criteria. Only a few solutions satisfied all three criteria. Of those tested, Gey salt solution and bovine serum albumin (0.01%) and proteose peptone (1%) in saline were the only two in which the gonococci retained viability in dilute suspensions for 25 min. Most of the solutions were not able to maintain viability of gonococci in dilute suspensions, even when the same solution was capable of maintaining stability and viability in concentrated suspensions.


Iron and the antibotulinal efficacy of nitrite.

Combination of nitrite, isoascorbate, and ethylenediaminetetraacetic acid were compared for their antibotulinal efficacy in perishable canned cured meat. A dose response relationship of available iron to the antibotulinal efficacy of nitrite was demonstrated.


Cutaneous T-cell lymphoma in association with a monoclonal gammopathy.

Monoclonal gammopathies and other abnormalities of immunoglobulin production may characterize or frequently be associated with B-cell lymphoproliferative disorders. We describe a patient with a T-cell cutaneous lymphoma, expressed clinically as Sézary's syndrome, in association with an immunoglobulin A type kappa M-component monoclonal gammopathy. No evidence for the coincident presence of a malignant plasma dyscrasia was found. This clinical association may lend clinical support to the concept that Sézary's syndrome is a T-helper-cell malignant proliferation. A colonic carcinoma was also present, possibly representing a second manifestation of a functionally abnormal cellular immune system.


Transpyloric feeding in the very low birthweight (1500 g and below) infant. One year's experience in an intensive care neonatal unit.

The success of transpyloric feeding in a group of babies weighing 1500 g or less was evaluated. This method was successful for most well babies but for many of those who required respiratory assistance (usually by face mask) it was not.


Gold and penicillamine: a proposed mode of action in rheumatoid arthritis, based on synovial fluid analysis.

Although in common use, there is still controversy as to the way in which gold and penicillamine act in rheumatoid arthritis (RA). In this study, synovial fluids from 4 groups of patients have been compared: (1) RA patients on gold/penicillamine, (2) RA patients on non-steriodal anti-inflammatory drugs (NSAID) only, (3) osteoarthritis patients, and (4) patients with sero-negative arthropathies. The parameters measured were differential agglutination titre (DAT), total haemolytic complement (CH50), total protein, total white cell count, and immunoglobulins. RA patients on gold/penicillamine have lower synovial DAT levels and higher CH50 levels than RA patients on NSAID only, and total and cryoprecipitable IgM levels very close to those found in the sero-negative joint fluids. The non-specific inflammatory parameters, ie, white cell count and total protein are unchanged after good/penicillamine therapy. In a second study, the serum DATs of patients in total remission after gold/penicillamine were compared with similar patients on NSAID only. The DAT falls significantly in the former group (P less than 0.001), but not in the latter suggesting that fall in DAT is a consequence of therapy rather than remission. The parameters altered by gold/penicillamine in the synovial fluid are those that distinguish RA from non-rheumatoid arthropathies suggesting the drug's primary effect is to render the disease sero-negative. The results support the hypothesis that both drugs have a common mode of action based on their active thiol groups, and that the fall in DAT is due to the reduction of the antigenicity of the IgG complexes.


HLA B27 and the genetics of ankylosing spondylitis.

One hundred and twenty-eight of 145 patients with ankylosing spondylitis (AS) were found to be HLA B27 positive. Five patients had evidence of a sero-negative peripheral arthritis resembling peripheral psoriatic arthritis and 3 of these were B27 negative. One further B27 negative patients had a sister with ankylosing spondylitis and ulcerative colitis and a mother with ulcerative colitis. There was evidence of a somewhat later age of onset of symptoms in B27 negative patients. These findings are interpreted as suggesting some degree of clinical and genetic heterogeneity in ankylosing spondylitis with genes for psoriasis and inflammatory bowel disease being important in some individuals, particularly those who are B27 negative. Twenty-five first-degree relatives with ankylosing spondylitis were all B27 positive. The only instance of disassociation of B27 and spondylitis in a family was where the proband had ulcerative colitis as well as spondylitis. Of 13 B27 positive fathers 3 could be diagnosed as having definite ankylosing spondylitis (23%). These findings are thought to provide evidence against the concept that the gene for ankylosing spondylitis is not B27 but a closely linked gene and favour the occurrence of an environmental event affecting approximately one-fifth of B27 positive males to result in disease.


Demonstration of protein AA in subcutaneous fat tissue obtained by fine needle biopsy.

Polarisation microscopy of material obtained by fine needle biopsy of subcutaneous tissue and stained with Congo red is a simple and reliable method for the diagnosis of systemic amyloidosis. It cannot, however, be used to differentiate histologically between different forms of amyloidosis. In the present study extracts of material obtained by fine needle biopsy of subcutaneous fat tissue from 13 patients were examined by double immunodiffusion with an antiserum against protein AA, a unique protein which forms a major part of the fibrils in secondary amyloidosis. Five of the patients showed amyloid deposits round the fat cells by conventional microscopy. In 3 of these, all with rheumatoid arthritis, protein AA was detected. Eight patients without amyloidosis and 2 with myelomatosis and amyloidosis showed no reaction with antiprotein AA antiserum. Thus the material obtained by fine needle biopsy of subcutaneous tissue could be used not only for the histological diagnosis of amyloidosis but also for a classification of systemic amyloidosis into secondary or primary based on the type of amyloid fibril protein involved.


Use of quantitative bacteriologic techniques to diagnose catheter-related sepsis.

A case of polymicrobial sepsis occurred in a patient who had a permanent indwelling hyperalimentation catheter. Because it was undesirable to remove the catheter, quantitative bacteriologic techniques were used to determine whether the catheter was the source of sepsis. Blood drawn from a peripheral vein had 25 colonies per milliliter whereas blood drawn through the catheter had more than 10,000 colonies per milliliter. On the basis of these results, the catheter was removed. The catheter tip was found to be infected with the same organisms that were present in the blood. Quantitative bacteriologic techniques may prove useful in diagnosing catheter-related sepsis when it is undesirable to remove the catheter.


[Permanent intra-hisian atrioventricular block induced during right intraventricular exploration].

A 47 year old patient underwent endocavitary electrophysiological investigation for recurrent syncopal episodes occuring three years after an inaugural enterior myocardial infarction. Syncopal ventricular tachycardia was induced during the investigation when the bipolar catheter was in contact with the Bundle of His and several external electric shocks were required for its reduction. During cardioversion a complete intra-hisian atrio venticular block was observed and remained permanently although the values of the conduction intervals had previously been normal. This complication of defibrillation is thought to be the result of an induction phenomenon.


[Technical development in aortocoronary bypass: multiple outlet saphenous vein graft].

The technique of multiple outlet saphenous vein grafting with one or several alternating lateral anastamoses was used in 43 patients over a one year period; over half the patients had triple vessel disease, one third had double vessel disease; a total of 128 coronary arteries were revascularised 2.9 arteries per patient, with 60 side to side anastamoses, 1.4 per patient. The technique of this type of bypass necessitates paying particular attention to avoid kinking or twisting of the graft. The blood flow through multiple outlet graft is on average significantly greater than in the classical types of graft, and is one of the main points in favour of this technique and in keeping the graft permeable in the long term. The short term results of this technique are good with a hospital mortality of 4.6% and a peri-operational infarction rate of 6.9%, figures which are comparable with the results of classical bypass grafting techniques in multivessel coronary artery disease.


[Changes in the exercise electrocardiogram after aortocoronary bypass. Long-term results in 50 patients].

A comparative study of exercise electrocardiogrammes before and after aorto-coronary bypass surgery was carried out in 50 patients over a 2 year period. Coronary arteriography was used to assess the chirurgical results qualitatively ((electrocardiographic appearances) and quantitatively (work capacity and effort tolerance) with respect to the coronary lesions and permeability of the aorto-coronary vein grafts. Exercise electrocardiography has a place in the follow up of patients with aorto-coronary bypass grafts but it only gives information on the permeability of the grafts if all the significant stenosis are bypassed at surgery.


[Epidemiological profile of patients with myocardial infarction and normal coronary arteriography].

Of a total of 4,800 coronary arteriogrammes, 1,280 of which were carried out after myocardial infarction, 25 cases of proven infarction with normal coronary arteriography, confirmed by several "blind" interpretations, were retained. The interval between acute infarction and coronary arteriography was usually less than 6 months. The average age of the patients was 36.9 years, affecting more women than in classical coronary artery disease. The acute infarction was nearly always the first symptom. Cigarette consumption and hormonal factors is women were coronary risks factors of note. Ventricular sequellae were frequent, cardiac failure exceptional, exercise testing nearly always negative and occupational rehabilitation usually normal. It would seem that this affection is less serious than classical myocardial infarction due to atheroma probably because the non-infarcted myocardium is healthy, but the true prognosis of this type of coronary accident will only be revealed by long term studies. In the meantime the most useful investigations and the management of these patients are discussed.


[Clinical and angiographic study and pathogenic mechanism of Prinzmetal's angina. Apropos of 31 cases].

31 patients presenting with Prinzmetal variant angina were divided into three groups according to their angiographic appearances. Group I comprised 9 patients with normal or coronary arteries with lesions less than 50% narrowing. Group II comprised 12 patients with single vessel disease. Group III comprised the other 10 patients with significant lesions on two or all three principal arteries. No clinical or electrocardiographical differences were found between the groups as to age, sex or the clinicapresentation of the chest pain. Most patients with normal or nearly normal coronary arteries had normal electrol cardiogrammes between attacjs (8 out of 9) and electrical changes mainly over the inferior wall (8 out of 9). Exercise electrocardiography reproduced ST elevation in 4 of the 9 patients but, in contrast to the patients in the other two groups, never ST depression. However, these features are not specific for patients in Group I as they were observed in 4 patients in the other two groups. Spontaneous or induced coronary spasm were observed in 27 patients, confirming its role as the mechanism of Prinzmetal angina, whatever the anatomical appearance of the coronary tree.


[Methyl-ergometrin maleate test during coronary arteriography in spontaneous chest pain].

This coronary spasm provocation test with methyl-ergometrine maleate was carried out during coronary arteriography in 47 patients presenting with spontaneous chest pain. Coronary spasm was triggered in 16 cases, reproducing the chest pain in 11 patients, and accompanied by electrical changes in 15 cases, 12 subepicardial ischaemias and 3 subendocardial ischaemias. This test is not without danger to the patient as arrhythmias and conduction defects were recorded in 6 cases although the spasm was readily reversible on injection of intravenous glyceryl trinitrate. Of 7 patients with Prinzmetal variant angina, the test was positive 6 times, in three of which on pre existing severe organic lesions, so confirming the mechanism of this syndrome and the reliability of the test. Of 40 patients presenting with spontaneous chest pain, 10 had a positive test. In 2 of these cases the chest pain was subsequently observed with subepicardial ischaemic electrical changes, so confirming the screening value of this test. In the 7 cases where coronary spasm gave rise to electrical changes with or without pain, the logical diagnosis would appear to be spastic angina. In the 30 cases where the test was negative the subsequent outcome did not provide any proof in favour of a coronary origin of the chest pain.


[Conduction disorders after aortic valve replacement. Apropos of 200 cases].

The following points become apparent after the study of 200 cases of aortic valve replacement:--Conduction defects are very common after this type of surgery, affecting one in three patients in this series;--Above all, the frequency of conduction defects of the left bundle branch (2/3 cases) must be underlined. They are much more common than complete atrioventricular block, bifascicular block or isolated right bundle branch block;--Diagnosed immediately after operation in almost all cases, regression is common (50%) especially of left anterior hemiblock;--The long term prognosis is good. There was no long or short term mortality due to this cause in this series;--Apart from traumatic lesions which are difficult to avoid when the aortic orifice is calcified, ischaemia of the conduction pathways due to insufficient myocardial protection probably plays a role in the aetiology of these conduction defects.


[Recording and data processing of electrical signals of the specific atrioventricular conduction pathways in man].

Signals of the electrical activity of the specific atrioventricular conduction pathways were recorded with an unipolar lead to obtain an exact time reference. The amplifier used had special characteristics: high gain settings (up to 300,000), very low noise levels, and wide filter range (2 Hz - 1,600 Hz). The low amplitude of the signals under study, of the order of a microvolt, and the wide filter range of the amplifier necessitated placing the patient in a Faraday cage. The signals recorded on magnetic tape were treated by a system of analysis for signal treatment. The method of averaging was used to extract the signal from background noise especially that arising from somatic muscle. The amplitude of the Hisian signal was much larger than that usually obtained with other methods. The intervals were determined with precision of the order of 1 millisecond. Frequential analysis of the signals gave another representation of the information contained in the time signals. This new representation seems to give better discrimination of the different zones of activation of the specific atrioventricular conduction pathways.


[Hereditary conduction defect in the His system: a dominant autosome disease].

An oriental family with over 265 living descendants of a polygamous ancestor known to have had a slow pulse and syncopes was studied. Many examples of conduction defects, mainly right bundle branch block, left anterior hemiblock, bifascicular block and artioventricular block were detected. The transmission of the genetic defect was autosomal dominant, the incidence 43%, the penetration very variable, apparently affecting the male descendants predominantly, the expression probably congenital, but with complete heart block presenting at 75 years of age in one case. The localisation of the conduction defect is discussed: the distal extremity of the His bundle after the origin of part or all of the left posterior fascicle. This study, in its clinical and epidemiological context, demonstrates an inherited disease with both typical and "forme fruste" expressions. Compared with other series, it suggests the diverse nature of hereditary and familial conduction defects.


[Electrophysiological effects of anti-arrhythmia agents in man. Attempt at classification].

The electrophysiological effects of anti-arrhythmic drugs in man may be classified in three groups: -- Group I: comprising drugs whose characteristic action is on the AV node (beta blockers, verapamil, digitalis) The nodal conduction time (A-H interval) and refractory periods are increased. -- Group II: comprising drugs acting on the His-Purkinje system, the AV nodal conduction staying unchanged. This group has two sub-groups. Sub-group A: these drugs delay the His-Prukinje conduction (increased H-V interval). Examples are quinidine, procainamide, disopyramide, ajmaline, chloro-acetyl-ajmaline. In addition these drugs usually increase the atrial refractory periods and those of accessory pathways. Sub-group B: the His-Purkinje conduction is unchanged but the refractory periods are modified: lengthened (bretylium tosylate) or shortened (diphenylhydantoin, lignocaine, mexiletine). -- Group III: which includes amiodarone and aprindine whose effects are mixed: on the one hand AV nodal depression, and on the other, alteration of the His-Purkinje conduction manifested by an increased H-V internal (aprindine) or refractory periods (amiodarone). These preparations also increase the refractory periods of accessory AV pathways and amiodarone increase the refractory periods of the atria. This type of classification could help towards a more rational clinical approach to the use of anti-arrhythmic drugs.


[Systemic arterial spasms. Ergotamine tartrate].

The problem of the toxic effects of ergotism is raised by two cases of acute lower limb ischaemia observed in young patients. Although commonly encountered up to the 20th century, the problem is now reappearing sporadically from iatrogenic causes. The clinical features and treatment of ergotism are discussed. Prophylaxis is based on two main principles: the respect of contraindications, the most important being hypertension, coronary insufficiency, arteriopathies, acrocyanosis and thrombophlebitis, and less importantly, the association of tetracycline type antimicrobials, triacetyloleandomycin and phenothiazine; on the other hand, attention must also be paid to the instructions on its use, particularly with respect to the maximum dosage, 4 mg/day per os, 10 mg/week per os. The treatment should be given intermittently and not continuously. Full knowledge of the composition of composite drugs is required as many drugs are commercialised with their ergotamine content masked. This justifies, if there is still need, constant pharmacovigilance.


[Contraception using a progestagen-only minipill in cardiac patients].

The choice of method of contraception in cardiac patients is often peremptory, as combined oestrogen-progesterone preparations and intra uterine devices are often contraindicated. A pure progesterone mini-pill, lynoestrenol (500 microgram) has been used in our department for several years, and would appear to be a possible solution. Its daily, uninterrupted administration for 6 to 30 months in 40 cardiac patients, many considered to be high risk cases (28 cases), has confirmed its contraceptive action: totally effective, excellent reversibility and satisfactory acceptability despite definite menstrual changes. Above all, it was almost totally innocuous, an essential factor in cardiac patients. No haemodynamic, hypersensitive or thromboembolic side effects were observed in any pateint. No changes were observed in glucose or lipid metabolism, hepatic function or blood coagulation after 3 to 6 months, in 6 to 14 patients at high risk. Platelet aggregation, factors II, V, VII and X, fibrinogen and anti thrombin II were normal. Although this is a small series of patients, the use of microdosage lynoestrenol seems an acceptable method of oral contraception for cardiac patients, providing they collaborate and are closely followed up from the cardiac point of view.


[Detection of coronary artery spasm by the methylergometrin test. Technic. Results. Indications].

Methylergometrine (Methergin) was given intravenously (0.4 mg) to 118 patients undergoing coronary arteriography. The electrocardiogramme and intraaortic pressure was continuously monitored whilst coronary arteriography was performed, 1,3, and 5 minutes after the injection of the ergot alkaloid. The test was positive if: 1) coronary spasm was observed; 2) if ST segment elevation was recorded with or without pain. Positive tests were obtained in 13 out of 14 patients with Prinzmetal angina. The test was negative in the other patients. However in 3 patients with Prinzmetal angina, the test produced typical coronary spasm without electrocardiographic changes. In Prinzmetal angina the sensitivity of this test was 93 p. 100 with a high specificity: 96-100 p. 100 depending on whether or not electrocardiographical changes associated with spasm are considered. Taking into account current therapeutic methods of treating Prinzmetal angina the indications of this test of coronary spasm are: 1) patients presenting with resting angina whatever the state of their coronary arteries; 2) patients with documented Prinzmetal angina with "angiographically normal" coronary arteries.


[Study of shock with normal pulmonary capillary pressure caused by right ventricular failure in acute myocardial infarction].

Of 698 cases of acute myocardial infarction (AMI), 65 cases of cardiogenic shock underwent haemodynamic study. 25 cases had pulmonary capillary pressures (PCP) less than 14 mmHg, 15 of which responded favourably to vascular filling. None of these cases died in a state of shock. In comparison with cardiogenic shock with PCP equal to or greater than 14 mmHg, these 25 patients showed the following features: 1) electrocardiography usually showed posterior or inferior infarction; 2) a higher incidence of right ventricular (RV) involvement; 3) left ventricular (LV) function was relatively unaffected; 4) haemodynamic criteria of RV infarction were demonstrated in most cases. In the absence of causes of hypovolaemia, AMI involving mainly the RV may lead to circulatory failure with normal LV filling pressures and responds favourably to vascular filling. When diagnosed and treated correctly this form of cardiogenic shock has a much lower mortality than usually associated with cardiogenic shock caused by AMI (28 p. 100 compared to 87.5 p. 100 in our series).


[Permeability of venous aortocoronary bypass 5 years later].

47 consecutive patients who had undergone aorto-coronary venous bypass surgery (mean: 1.6 graft per patient) have been investigated after a mean follow-up period of 5 years and 9 months (range: 44-108 months). 52 grafts out of 73 were found to be patent (71 p. 100), the best patency rate being shown by grafts on the LAD artery (27/32 = 85 p. 100). Long-term graft patency may be associated with an improved left ventricular ejection fraction; 77 p. 100 of the total patients experienced a lasting clinical benefit from the operation.


[Correlations between effort tolerance and the severity of coronary disease. Influence of myocardial lesions].

The influence of coronary and myocardial lesions, defining the severity of the coronary artery disease on effort tolerance was studied in 51 patients. The appearances of the coronary arteriography and ventriculography were compared with the parameters of exercise tolerance: electrocardiographic changes, maximal charge (Cw), total work (TW), maximal systolic arterial pressure (SAP), maximal heart rate, percentage of the theoretical maximal heart rate, double product, exercise capacity index (CEI). The results showed that exercise tolerance (Cw, TW, ECI) and the exercise SAP are mainly affected by the myocardial lesions: patients with very reduced left ventricular ejection fractions and double or triple artery disease have very low indices: average Cw of 60 watts, TW less than 20,000 joules, ECI approximately 50. The SAP only rises slightly. On the other hand, patients with normal or subnormal ejection fractions have much higher indices whatever the state of their coronary arteries; Cw over 80 watts, TW over 30,000 joules, ECI over 80. In addition, major left ventricular dysfunction is associated with ST segment elevation during exercise.


[Pulmonary capillary pressure and the exercise test].

In the present work with radiocardiography the change of pulmonary capillary pressure as well as cross correlations of stroke index, cardiac index, pulmonary blood volume, pulmonary arterial pressure and pulmonary dispersion volume which reflects pulmonary capillary volume have been studied during muscular exercise. With increase in cardiac output the mathematical estimation showed decrease in pulmonary capillary pressure while stroke index, pulmonary blood volume and pulmonary dispersion volume increased. The pulmonary arterial pressure also rose but this increase was insignificant. The estimated decrease in pulmonary capillary pressure might be due to decreased resistance, a consequence of recruitment of new capillaries and of increase of cross sectional area of pulmonary vasculature. The radiocardiographic method used here appears to be suitable in exercise studies, and it may further be applicable in clinical studies, e.g. in evaluation of left ventricular failure.


[Value of continous electrocardiography (Holter monitoring) in mitral valve prolapse].

Twenty three patients with mitral valve prolapse underwent ambulatory 20 to 24 hour electrocardiography to study the incidence and severity of ventricular arrhythmias. These arrhythmias were found in 20 cases (87 p. 100). Ventricular extrasystoles were usually grouped (14 cases) causing doublets in 8 cases and bursts of ventricular tachycardia in the 6 others. The importance of the information obtained by Holter monitoring should not detract from the value of the standard resting electrocardiogramme. In fact, there appears to be a good correlation between the severity of the ventricular arrhythmia and the presence of ST changes over the postero-inferior zones. These abnormalities were never present in patients without ventricular extrasystoles but on the other hand they were observed in 5 of the 6 patients with ventricular tachycardia. From a practical point of view this may represent a simple means of identifying patients at high risk of dangerous arrhythmias.


[Bidimensional echocardiography in evalulation of mitral and aortic stenosis].

The aim of this study was to compare the results of unidimensional and cross-sectional echocardiography and cardiac catheterisation in the assessment of mitral and aortic stenosis. 21 patients with mitral stenosis, 21 patients with aortic stenosis and 21 patients without valvular disease were studied by unidimensional and cross-sectional echocardiography and cardiac catheterisation. Although unidimensional echocardiography in the external cardiac investigation of choice for the qualitative diagnosis of mitral stenosis, a better assessment of the severity of the stenosis is obtained with cross-sectional echocardiography. The valve surface measured by cross-sectional echocardiography correlates well with the value obtained by catheterisation with the application of the Gorlin formula (r = 0.85). Cross-sectional echocardiography is therefore an important advance in the external assessment of mitral stenosis. The aortic valve can only be measured in one third of cases of aortic stenosis with unidimensional echocardiography, whilst this measurement can be performed in 90 p. 100 of cases with cross-sectional echocardiography. The values obtained in 9 patients with severe aortic stenosis were 3.7 +/- 0.7 mm/m2, in 7 patients with moderate aortic stenosis: 5.4 +/- 0.8 mm/m2 and in 5 patients with mild aortic stenosis: 6.8 +/- 1,2 mm/m2. There is a clear demarcation between the different groups if the average values are compared. Therefore cross-sectional echocardiography gives reliable semi-quantitative assessment of the severity of aortic stenosis.


[Treatment of mitral insufficiency by Wooler-Reed annuloplasty. Remote results].

The outcome of 67 patients operated on between 1963 and 1971 for pure mitral regurgitation due to dilatation of the mitral ring (group I: 25 cases), papillary muscle dysfunction (group II: 11 cases) and valvular and/or subvalvular lesions (group III: 31 cases) was analysed with an average follow up of 9.1 years (range 4 to 12 years). Eleven patients (16 p. 100) died in the late post-operative period (average 4 years). The main cause of death was cardiac failure related to the valvulopathy (8 cases). 11 patients were reoperated (16 p. 100) (on average 5 years after operation). The opeartive findings, besides early technical errors (2 cases), showed deterioration to be less often related to secondary dilatation of the mitral ring (1 case) than to progression of the valvular and subvalvular disease (7 cases). The patients followed up at present have shown symptomatic improvement (39 out of 40 cases) although the cardiothoracic ratio has generally remained unchanged. Average pulmonary capillary and arterial pressures were lower than the preoperative findings in 9 control cardiac catheterisations. Thromboembolism (2.6 p. 100), infection (2.6 p. 100) and haemolysis (0 p. 100) were less frequent than in patients with prosthetic valves. The survival curve is also better in patients having undergone reconstructive surgery. This study showed the best results in the group with pure mitral regurgitation secondary to mitral ring dilatation. The results were less favourable in groups II and III. This surgical technique would seem best reserved for young people, when anticoagulant therapy carries unacceptable risks, and when the following anatomical conditions are respected: pure mitral regurgitation with a normal valvular and subvalvular apparatus.


[Heart valve prosthesis and pregnancy].

Sixteen pregnancies were followed up in 13 patients with prosthetic heart valves: 8 pregnancies went to term under oral anticoagulation, 4 under heparin and 4 without anticoagulation. 9 healthy normal children were delivered; there were 2 still births and 5 abortions. On the maternal side 3 haemorrhages and thromboembolic episodes which involved 2 patients on heparin, one of whom died, were observed. The following points are apparent from our observations and a review of the existing medical literature: --the risk of thromboembolism is not increased. The marked clotting tendency of maternal blood post-partum contraindicates the withdrawal of anticoagulants during this critical period; --haemorrhagic complications are common with anticoagulants; --foetal loss is greatly increased; --the teratogenecity of vitamin-K antagonists is certain, but the risk is small. The problems of anticoagulation are discussed; theoretically heparin should be given during the 1st trimestre and from the 38th week to the second post-partum week. The patients should be closely supervised by both obstetrician and cardiologist and hospitalisation is advised for the last month of pregnancy. Normal vaginal delivery is usually possible.


[Value and limitations of sequential technetium 99m angiocardiography in the detection, localization and quantification of left-right intracardiac shunts apropos of 110 cases].

A comparative study of the diagnosis of intracardiac left-to-right shunts by isotope radiography on the one hand and oxymetry, abnormal catheter trajectory and angiocardiography on the other, was performed on  a series of 110 patients, comprising 12 normals, 46 valvulopathies or cardiomyopathies without shunts, 23 ASDs, 22 VSDs, and 7 other shunts. Intravenous injection of Technetium 99 m with scintigraphic imagery and interpretation of time-activity curves detected even small left-to-right shunts and appeared to be more sensitive than oxumetry. The estimation of the size of the shunt correlated well with oxymetry for VSDs but not for ASDs. The localisation of the shunt was more difficult. The atrial level of the defect was detected in some but not the majority of cases. The isotopic technique appeared unreliable in the presence of severe haemodynamic disturbances. The isotopic method is a quick means of detecting left-to-right shunts without measurable risk, particularly useful in the investigation of children and young adults thought to have left-to-right shunts.


[Estimation of coronary disease mortality and morbidity in France from epidemiological data].

The incidence of coronary heart diseases in France is estimated from three sources of information. Mortality statistics underestimate the number of deaths from coronary heart diseases. An evaluation of this number is proposed, but with a rather important lack of precision; for example, between 10 and 20% of male mortality between age 45 and 64. These French coronary death rates are inferior to those of numerous other European or Anglo-Saxon countries, but are comparable with those of some mediterranean countries. The incidence of coronary heart diseases measured in the Paris Prospective Study is inferior by half to that of the Framingham Study and is also inferior to those of several male populations from the 7 Countries Study, in the same age limits. Three French registers give similar results about the incidence of acute myocardial infarction. This incidence is equal to the lower limit of those measured in 21 foreign registers. These concording data suggest that the incidence of coronary heart diseases is relatively moderate in France. Etiological hypotheses are planned and the interest in a surveillance of French sanitary data is reminded.


[Detoxification of tetanus toxin].

Reported in this paper are experiments conducted to compare formaldehyde, glyoxal, malondialdehyde, succindialdehyde, glutardialdehyde, adipindialdehyde, beta-propiolacton, and pyrocarbonic acid diethylester for their toxifying properties. Tetanus toxin, 1.5 million dlm/ml or 120 binding units, was used. Glutardialdehyde proved to be the most favourable compound and was followed by formaldehyde against the background of the experimental arrangement used, that is determination of concentrations for inactivation and antigenic properties of the toxoids. Glyoxal, malondialdehyde, succindialdehyde, and beta-propiolactone followed in some distance, whereas no inactivation at all was obtained from adipindialdehyde and pyrocarbonic acid diethylester.


[Familial glomerulonephritis and hereditary deficiency of C2].

The association between glomerulonephritis and hereditary C2 complement deficiency has been found in 4 out of 8 children of a family. The hemolytic complement (CH50) was much decreased in homozygot subjects and slightly decreased in heterozygot. C1q, C4, C3, C5, C1s INA were normal, the C2 was found at an intermediate or null rate; CH50 could be reconstitued by purified human C2. The C2 deficiency genes were associated with HLA A10 B18 (father) and HLA A29 B18 (mother) haplotypes but HLA D allels were different on the 2 haplotypes. The C2 deficiency appears to lead to an increased susceptibility to immune-complexe diseases, specially to glomerulonephritis.


[The child in digestive resuscitation].

Twenty one children who had total parenteral nutrition followed by a constant infusion into the gastrointestinal tract between the 10th and 90th day of life were studied. When normal feeding is resumed the difficulties are related to the lengths of hospital stay, separation from the parents and the lack of contact with adults more than to the techniques of feeding themselves.


TRH (protirelin) in depressed alcoholic men. Behavioral changes and endocrine responses.

Chronic alcoholics with secondary depression were treated with protirelin in a double-blind, placebo-controlled study. Behavioral data, collected only during the acute alcohol withdrawal state, indicated a beneficial effect of protirelin three hours after injection, but not during subsequent days. Injections caused only mild and infrequent subjective side effects and no cardiovascular effects. Endocrine data were recorded in the acute withdrawal state and after clinical remission. Findings in the acute state suggested thyroid activation and increased central dopaminergic activity, as evidenced by elevated baseline levels of growth hormone, low baseline levels of prolactin, and blunted thyroid-stimulating hormone (TSH) response to protirelin. The first two abnormalities returned to normal levels in the remission state. A blunted TSH response was observed in both the acute and the remission states. Partial persistence of this finding suggests that TSH blunting may not be solely state-dependent. In the acute withdrawal state, TSH blunting was associated with favorable behavioral responses to protirelin.


IgG subclasses of anti-Rh antibodies in pregnant women.

IgG subclasses of anti-Rh antibodies in the sera of 65 pregnant women were determined. The frequency of subclasses was: IgG1-87.6%, IgG2-23.0%, IgG3-56.9% IgG4-7.7%. In different cases of Rh incompatibility, no correlation was found between the intensity of the hemolytic disease of the newborn and the pattern of IgG subclasses in maternal antibodies. On the basis of the whole material analysis it was observed, however, that the more pregnancies with fetomaternal incompatibility the women had and the more severe the course of the hemolytic disease was in their babies, the more frequently the IgG3 sublcass was present in the pattern of antibodies and the less frequent were the IgG2 and IgG4 subclasses. We have put forward the hypothesis that at the time of strong stimulation of the immunological mechanisms, antibodies are produced by many cell clones and that their activity may decline and disappear with progressing development of clones specifically producing anti-Rh antibodies of the subclasses IgG1 and IgG3.


In vitro reactions of anti-Rh antibodies depending on the pattern of IgG subclasses.

In 47 serum samples obtained from 31 women immunized with D antigen of the Rh system the level of anti-Rh D antibodies was measured by the papain and antiglobulin tests and the IgG subclasses of anti-Rh antibodies were determined. If the antibodies were of the IgG1 subclass or if this subclass prevailed in the IgG subclass pattern, the antibody level determined by the papain test of Löw was higher or equal to their level found in the antiglobulin test. In all cases, in which the antibodies titer was higher in the antiglobulin test, the antibodies were either of the IgG3 subclass exclusively, or this subclass prevailed quantitatively. This was due to partial inactivation of antibodies belonging to the IgG3 subclass by papain added to the serum in the Löw's test. In the test with papainized erythrocytes (called two-stage test) the IgG subclasses could not be differentiated, and the results obtained then were always higher than in the antiglobulin test. The differences in the reactions of antibodies performed routinely for diagnostic purposes can be explained by differences in immunoglobulin subclasses produced during immunization.


Trials of rosette test application for determination of immune response to antigen D from the Rh system in blood donors immunized with human erythrocytes.

Periodic control examinations of Rh-negative blood donors sensitized with human Rh-positive erythrocytes were performed to establish the differences in the levels of T and B lymphocytes and their correlation with the production of anti-Rh D antibodies. The investigations were carried out on 10 healthy blood donors in the initial period of immunization and 8 blood donors who had received multiple injections of these erythrocytes and who were producing anti-Rh antibodies. The control group included 10 non-immunized blood donors. The percentage of T and B lymphocytes was calculated on the basis of the rosette tests (E, EA, EAC) while the level of antibodies produced in serum was determined by serological methods. During immunization of blood donors no significant differences were observed in the level of T lymphocytes, while the level of B lymphocytes increased, especially in the 3rd week after the 1st or 2nd injection of erythrocytes and this was not correlated with the production of anti-Rh D antibodies in later period.


Treatment in Rh incompatibility.

In a material of 300 cases of Rh incompatibility the effectiveness of treatment was analyzed. An unfavourable effect of induction of premature labor was found in the cases with insufficient maturity of the newborn. A very high mortality of newborns with severe anemia (42.3%) was found. The results of treatment with intrauterine transfusions are described suggesting that they should be done before induction of labor in cases with probable high-grade anemia. The method of performing of the first exchange transfusion in the most severe cases is presented. The necessity of organization of therapeutic center of serological incompatibility all over the country is stressed.


The course of hemolytic disease of the newborn in Rh incompatibility.

In a material of 300 cases of Rh incompatibility the clinical course of the hemolytic disease of the newborn was analyzed together with the complications of this disease and perinatal mortality. It was found that the intensity of icterus and the number of necessary exchange transfusions depended mainly on the grade of anemia at the time of birth. Prematurity caused no worsening of neonatal icterus but increased the frequency of complications and mortality. The high mortality of children born with severe anemia points to the necessity of hemotherapy of the fetuses before labor.


Prognosis in Rh incompatibility.

The study was done on a material of 300 cases of Rh incompatibility. A relative correlation was found between fetal damage and newborn damage and the titer of antibodies. It was shown that production of anti-Rh antibodies was lower in feto-maternal ABO incompatibility. Coexistence of anti-Rh D antibody with other antibodies of the Rh system worsened the prognosis. Two prognostic tables are presented: one based on a comparison of antibody titers with history data, and the other which was a modification of Liley's method, containing additionally determination of antibodies, which increased the accuracy of prognosis. The best prognosis of fetal damage was obtained using the new pregnostic table and assessing the successive spectrophotometric investigations in the risk zone IIB.


Immunoglobulins in maternal serum and in amniotic fluid in pregnancy complicated by rhesus alloimmunization.

The concentration of IgG, IgA, and IgM immunoglobulins was checked in sera of Rh-immunized and nonimmunized pregnant women. The amniotic fluid of immunized women was also investigated. The significant decrease of IgG, accompanied by significant increase of IgA immunoglobulin was revealed in the sera of immunized patients. In non-concentrated amniotic fluid only IgG and IgA immunoglobulins were found.


The evaluation of extended analysis of serum, amniotic fluid and cardiotocography in the management of pregnancy complicated by immunization in Rh or Kell antigens.

The estimation of protein and bilirubin concentration together with checking the activity of LDH, AspAT, AlAT and Ech in maternal serum and amniotic fluid was performed with intention to improve the accuracy of antenatal prediction in hemolytic disease of newborns. With the same intention, the cardiotocography was introduced. After study on forty-six pregnancies, the usefulness of estimation of optical density, protein and bilirubin concentration in amniotic fluid and calculation of bilirubin/protein ratio was confirmed. The other investigated methods appeared useless.


The use of plasmapheresis in pregnancy with antenatal prediction of a serious hemolytic disease due to Rh immunization.

Plasmapheresis was performed on twelve women with antenatal prediction of severe hemolytic disease due to Rh or Kell alloimmunization. No complications in mothers or newborn infants due to this treatment were observed neither during pregnancy nor in post-deliver period. In two patients the increase of antibody titer was not prevented. In four cases the fetus was not saved.


Isolation and immunochemical properties of burn toxin.

Human skin and the skin of some laboratory animals was minced, scalded and homogenized. The preparation from scalded human skin (the "crude burn toxin") revealed to be highly toxic to mice after i.v. administration. It was found by immunodiffusion and immunoelectrophoresis, that the urea and buthanol extracts of the crude "toxin" contain tissue antigens which were absent in a control preparation from a native (non scalded) skin.


Some biological and immunological properties of extracellular slime from Pseudomonas aeruginosa.

Extracellular slime from 8 different Pseudomonas aeruginosa strains was extracted and purified. All slime-preparations exhibited immunogenic properties in rabbits vaccinated with detoxified or not detoxified slime. The antisera of both groups of immunized animals possessed strong hemagglutination activity against homologous slime. Immune hemagglutinins were present in the IgM and IgG fractions of serum globulins. The high value of these antibodies was found in rabbit's sera short after injection of slime-extract. The hemagglutinins quickly reached the peak value and maintained in serum over 60-70 days. Biological properties of lyophilized slime-preparations were defined in rabbit-skin test, local Shwartzman test, pyrogenic reaction and measured as LD50 for mouse. Intravenous injection of slime elicited marked changes in the number of leukocytes in the peripheral blood of rabbit. The animals responded to slime either with leukopenia passing into leukocytosis or with leukocytosis without leukopenia.


Characterization of peptides found in human biological fluids in macroglobulinemia IgM.

Excessive production of IgM in macroglobulinemia is accompanied frequently by secretion of proteins and peptides which are normally absent from biological fluids. These proteins and peptides are probably secreted by cells producing IgM. Three types of peptides were isolated and their basic properties are described. One peptide showed calcium-binding properties, and the other two peptides were bound to secreted IgM immunoglobulin.


The effects of lipids from Listeria monocytogenes on bacterial and fungal infections in mice.

Investigations were made on the influence of lipids from Listeria monocytogenes upon the course of infections induced by bacteria and fungi. Chloroform-methanol extract of the lipids was given to animals in various doses and at various intervals before and after infection. Mortality of mice and elimination rate of bacteria from the blood and organs were estimated. It was observed that the lipids markedly increased natural immunity of the animals against bacterial and fungal infections. The mortality rate of mice was decreased and the elimination of bacteria and fungi from the tissues was accelerated. Our suggestion is that the observed effect of lipids probably depends on the stimulation of mononuclear phagocyte system.


Tissue specificity of antinuclear antibodies in scleroderma.

Studies of antinuclear antibodies (ANA) were carried out in 39 cases of systemic scleroderma and for comparison in 19 cases of systemic lupus erythematosus (SLE) using indirect immunofluorescence (IF) methods under standard conditions. The results on three different substrates--monkey esophagus, guinea pig lip and rat liver--are reported. In 48.7% of scleroderma cases ANA showed a substrate specificity. The highest percentage of positive results in scleroderma was obtained on monkey esophagus (97.4%) and the lowest on rat liver (61.5%). In SLE, in contrast, only about 13% of the sera displayed such specificity. If only sera with substrate specificity are considered, the positive results on monkey esophagus and rat liver are 94.7% and 21.1%, respectively. Titers of sera reacting positively on 2 or 3 substrates were mostly in agreement, although some sera both in systemic scleroderma and SLE showed higher titers on monkey esophagus. The IF pattern was usually the same regardless of the substrate. Tests for ANA in scleroderma should be performed on at least 2 substrates simultaneously.


Mineral metabolism of the healing arterial wall.

The mineral metabolism of healing arterial walls was studied by measuring the accumulation of several radioisotopes at the site of vascular repair in rats. Each rat was subjected to a 1-cm full-thickness aortotomy and then immediately injected by tail vein with c 5 muCi of one of the following radioisotopes: chromic chloride Cr 51 or sodium chromate Cr 51; ferrous chloride Fe 59 or ferric chloride Fe 59; manganous chloride Mn 54; selenious acid Se 75; strontium chloride Sr 85; or zinc chloride Zn 65. At intervals of 1, 2, 4, 6, and 10 days after operation and injection, groups of four rats for each radioisotope were killed, aortas dissected, and the specific radioactivity of healing vascular tissue compared with that of adjacent normal artery. There were sharp and statistically significant differences in the preferential accumulation of the radioisotopes in healing compared with normal aorta. Zinc appeared to be the element most involved in vascular repair, followed by selenium and chromium.


Indium 111 autologous tagged leukocytes in the diagnosis of intraperitoneal sepsis.

We report the results of a new test, indium oxine in 111 scanning, in the diagnosis of postoperative infection. Indium 111 was used to label autologous polymorphonuclear leukocytes, which when reinjected migrate to sites of infection, inflammation, or both. Standard scintigraphy localizes the labeled inflammatory cells at these sites. Sixty-six scans were performed in 43 surgical patients. Thirty-seven scans were categorized as true-positive; 19 scans were categorized as true-negative. Therefore, the accuracy rate was 85%. Two scans (3%) in one patient represented false-positive results. Two scans (3%) were positive for inflammation but there was no infection present; this group was denoted as equivocal. Six scans (9%) were false-negative; false-negative scans are more likely in old lesions with poor blood supply and in areas that overlap regions of normal uptake. The noninvasive nature of the test, high accuracy rate, and ease of administration make it a potentially useful tool in the diagnosis of postoperative infection.


Albumin-coated Amberlite XAD-7 resin for hemoperfusion in acute liver failure. Part I: adsorption studies.

Platelets adhere to most foreign surfaces. As a result, polymers and albumin have been suggested as possible coatings to improve the blood compatibility of such surfaces. Amberlite XAD-7 has a high affinity for human serum albumin (HSA) and several protein-bound toxic metabolites. In the present study it is shown that HSA can be tightly bound to Amberlite XAD-7 without the use of chemical coupling agents. Optimal binding was achieved at pH 5.0 and the adsorption conforms to Langmuir's isotherm. Theoretical analysis of data and absence of a residual surface coating visible with scanning electron microscopy suggest a monolayer of albumin. The amount of HSA eluted from the resin under severe flow conditions was negligible (approximately 1%). Furthermore, in stirred batch studies with human plasma, the HSA coating did not decrease the adsorptive capacity of XAD-7 for bile acids and bilirubin.


Parenteral nutrition in intractable diarrhea.

Twelve infants with protracted diarrhea, unmanageable by the usual procedures, were treated with Total Central Parenteral Nutrition. Eleven of them were less than six months old. Two infants died in the course of treatment; the other ten recovered. The authors discuss the indications of this procedure, the technique used and, the possibility of performing it in centers not specialized in Nutrition.


The application of immobilized enzymes in an artificial liver support system.

A novel method of extracorporeal support for fulminant liver failure is reported whereby the most important detoxification processes of the liver are reproduced in an enzyme reactor. Most of the endogenous toxins involved in hepatic coma can be deactivated directly by conjugation with a hydrophilic residue such as glucuronic acid or glutathione, or by the neutralization of active groups through structural modification by methyl transfer. The enzymes responsible for these processes have been isolated and purified from rabbit liver, and covalently bound onto a hemocompatible form of agarose matrix. This system has been shown to be capable of catalyzing the desired reactions with endogenous toxins such as phenols and mercaptans in vitro, and phenols in rabbits in vivo.


Spinal cord evaluation by cortical evoked responses.

In ten monkeys, selective segmental lesions of the dorsal columns at the upper thoracic and middle cervical levels resulted in almost total attenuation of the cortical evoked potential responses to peripheral nerve stimulation. Conversely isolated segmental dorsal column preservation showed intact transmission of the evoked responses at rostral spinal cord, nucleus ventralis posterior lateralis, and cortical levels. Responses recorded from the intralaminar thalamic nuclei in the region of nucleus centrum medianum were unaffected by dorsal column ablation, but were markedly attenuated following bilateral ventral column ablation.


Imbalanced protein and appetite.

Free amino acid concentration in the plasma of rats fed on different diets were compared. The diets contained 7 g protein/100 g furnished by: casein, or common corn, or opaque 2 corn, or eggalbumin, or gelatin. A protein free diet was also included. The results showed that imbalance of the protein diet influenced the appetite; whenever the NE/E aminoacid ratio increased, body development, appetite and plasma albumin decreased. An inverse correlation between the NE/E of free aminoacids of the plasma and voluntary intake was observed. The results also show that the plasma aminogram did not reflect the composition of the protein in the diet. The results obtained are discussed.


Surgical treatment of hypopharyngeal (Aenker's) diverticulum.

Twenty-six patients underwent surgical repair of a pharyngoesophageal diverticulum at Ochsner Clinic, New Orleans, from 1957 through 1977. The majority of the patients (22) had a one-stage excision with intraluminal packing of the diverticulum and esophageal closure after excision. Of the 22 patients whose diverticula were treated by this method, 16 reported they were asymptomatic postoperatively, and six stated their symptoms improved. There were three complications: two wound infections and a temporary recurrent laryngeal nerve paresis. During long-term follow-up, recurrent diverticula developed in two patients. The addition of packing to the diverticulum and the resection and closure over Maloney's dilator have proven to be important aids in this surgical approach.


Impedance audiometry in the squirrel monkey. Effect of transection of crossed olivocochlear bundle.

Acoustic reflex thresholds in squirrel monkeys did not show any statistically significant change following midline section of the crossed olivocochlear bundle. Lack of agreement with the results reported by Borg in rabbits is most probably due to the species difference.


Acute subdural hematoma and intracerebral hemorrhage. Rare complications of rhinocerebral mucormycosis.

Rhinocerebral mucormycosis is a short-term and often rapidly lethal fungal disease. It is generally seen in uncontrolled cases of diabetes with ketoacidosis. This case exhibits many of the features of a typical fulminating rhinocerebral mucormycosis. However, the fatal complications of acute subdural hematoma and massive intracerebral hemorrhage due to rupture of aneurysm, as demonstrated by angiography, are unique clinical manifestations of patients with rhinocerebral mucormycosis.


The use of parenteral nutrition in the management of external gastrointestinal tract fistulae.

Malnutrition is common in patients with gastrointestinal tract fistula, and is an important cause of the high mortality seen with this surgical complication. A prospective review of three years' experience in the management of fistulae with parenteral nutrition was undertaken, and the results obtained were compared with those in a group of patients treated prior to the introduction of this form of therapy. The use of parenteral nutrition resulted in a reduction of the mortality from 63% to 23% in unselected cases. The mortality was zero where parenteral nutrition was used in patients under 65 years of age with non-malignant disease. With parenteral nutrition therapy, the fistulae in almost all cases closed spontaneously, in contrast with a high proportion requiring operation (20 in 38 cases) where parenteral nutrition was not used. It is concluded that all patients with significant gastrointestinal fistula should be given appropriate parenteral nutrition as their prime mode of therapy.


The organization, methods, and experience of a parenteral nutrition service.

Malnutrition is an important component of prolonged illness. Parenteral nutrition can improve nutritional status, and its use is now common practice in certain disease states. In this paper the methods used by a parenteral nutrition service are described. The indications for, results from, and complications of, this form of therapy are also documented. This has been done on the basis of results obtained from a prospective survey of the use of parenteral nutrition in a major hospital over a one-year period.