Clinical and microbiological investigation of men with urethritis.

Of 377 men attending clinics for the treatment of sexually transmitted disease, 104 had gonococcal urethritis, 72 had definite nongonococcal urethritis, 53 had possible nongonococcal urethritis, and 123 had no urethritis. A purulent urethral discharge was noted in 78% and 14% of patients with gonococcal urethritis and definite nongonococcal urethritis, respectively (P less than 0.001). In contrast, 4% and 64% of men with gonococcal urethritis and definite nongonococcal urethritis, respectively, had a clear urethral discharge (P less than 0.001). Black men with urethritis were more likely to have gonococcal infection, whereas white men were more likely to have nongonococcal urethritis. Homosexual and bisexual white men with urethritis were more likely to have gonorrhea, whereas heterosexual white men with urethritis were more likely to have nongonococcal urethritis. Heterosexual men were more likely than homosexual men to be colonized with Ureaplasma urealyticum. There were no differences in the rates of colonization with Mycoplasma hominis among heterosexual and homosexual men.


Nasal colonization of infants with group B Streptococcus associated with intrauterine pressure transducers.

The rate of nasal colonization with group B Streptococcus in infants cultured at the time of discharge from the nursery rose significantly during a four-month interval. Investigation of this trend resulted in detection of group B streptococci in the domes of two intrauterine pressure transducers (IPTs). Subsequent routine sterilization of IPT domes after each maternal use was associated with a decline in infant group B streptococcal colonization to the usual endemic rate in the nursery. Retrospective evaluation demonstrated that colonization in infants born to IPT-monitored women had increased significantly during the study interval and that no increase in colonization occurred in infants born to non-IPT-monitored women. From epidemiologic evidence it appears that use of contaminated IPTs during labor was a nosocomial source of group B streptococcal colonization.


Risk factors for nosocomial infection.

Studies of nosocomial infection are difficult to evaluate because of differences in the relative susceptibility of patients to the acquisition of such infections, the use of different methods of surveillance, and the frequent failure to distinguish between measurements of incidence and of prevalence. A standardized approach to these variables has been tested at a large municipal hospital. The systematic identification of potential risk factors for nosocomial infection allows the evaluation of the individual components of risk, valid epidemiologic comparisons between hospital populations, and a more accurate estimate of the potential cost-effectiveness of activities for the control of infection. The data indicate that it is feasible to calculate the relative risk of nosocomial infection for each patient, using basic criteria obtainable at the bedside, supplemented with other generally available information. The risk of infection must be calculated per day rather than per admission to separate the effect of long hospital stay from the effect of high daily risk. Certain underlying diseases, procedures, hospital services, and categories of age, sex, race, and urgency of admission were all found to be significant risk factors for nosocomial infection.


Effect of serum on gram-positive cocci grown in the presence of penicillin.

Strains of Staphylococcus aureus, Streptococcus faecalis, Streptococcus bovis, and a strain of Streptococcus that produces filaments were grown on agar containing penicillin at concentrations of one-half to 1/10th the minimal inhibitory concentration. These penicillin-exposed organisms as well as untreated control organisms were incubated with human serum of plasma. Both serum and plasma produced a remarkable bactericidal effect on the filament-forming Streptococcus grown in the presence of penicillin, whereas the untreated control was only slightly affected. This response resembled that of gram-negative bacilli rather than that of gram-positive cocci. The growth of staphylococci exposed to penicillin was slightly inhibited in the presence of serum, whereas the growth of untreated staphylococci was stimulated. The streptococci, regardless of whether they were treated with penicillin or whether they were untreated, showed no change in growth pattern in the presence of serum.


Neutralizing and hemagglutination-inhibiting antibodies to rubella virus as indicators of protective immunity in vaccinees and naturally immune individuals.

In general, hemagglutination-inhibiting (HAI) and neutralizing (NT) antibodies to rubella virus tend to parallel one another, and the presence of either antibody has been interpreted as reflecting protective immunity. It has recently been shown that persons who have HAI antibody but lack NT antibody may be subject to reinfection. In the present study these two antibodies were compared with regard to their appearance and persistence in vaccines and in those who have experienced natural infection. NT antibody appeared more slowly following immunization with HPV77DE5 or Cendehill vaccines than after natural infection or immunization with RA 27/3 vaccine. As with natural infection, initial NT antibody responses to RA 27/3 vaccine were of higher titer and persisted at higher levels for three years than was the case with either of the other vaccines. NT testing procedures were found to differ in sensitivity, depending on several factors including the cells in which the virus was grown.


Complement-mediated phagocytosis of Pseudomonas aeruginosa.

The nature of the opsonic factors in nonimmune human serum for six blood culture isolates of Pseudomonas aeruginosa was investigated by measuring uptake of [3H] adenine-labeled bacteria by human PMNs. Normal human serum, C2- and C4-deficient sera, zymosan-treated serum, and immunoglobulin-deficient sera were used as opsonic sources. Heat inactivation of each of these serum sources markedly reduced its opsonic capacity for all Pseudomonas strains, suggesting that the serum C system was essential for opsonization. Five strains were opsonized in the absence of the classical C pathway; however, kinetic studies revealed that opsonization proceeded at a faster rate when the classical pathway was present. In spite of markedly reduced factor B and C3 levels, zymosan-treated serum retained significant opsonic activity for one of the strains tested. Four strains were poorly opsonized by immunoglobulin-deficient serum, and C activation by these strains appeared to depend upon the presence of antibodies. Two strains, however, were effectively opsonized in a relative absence of antibodies. Thus, in the nonimmune state, phagocytosis of P. aeruginosa is mediated primarily via the C system, and antibodies appear to play a role in the opsonization of some but perhaps not all Pseudomonas strains.


Adenosine deaminase activity in human diploid skin fibroblasts varies with the age of the donor.

Activities of adenosine deaminase, adenosine kinase and purine nucleoside phosphorylase were determined in extracts prepared from human skin fibroblast strains derived from 7 normal newborn males and 4 normal adult males. All strains were harvested between passages 9 and 12. Adenosine deaminase activity in adult strains, 40.80 +/- 1.76 (mean +/- S.E.) nanomoles/min per mg protein, was almost twice the activity in neonatal strains, 22.40 +/- 3.02. This difference was significant at the 99.5% confidence level. Moreover, there was no overlap between the adult and neonatal activities. In contrast, adenosine kinase and purine nucleoside phosphorylase activities did not differ with the age of the donor.


Interaction between cytochalasin B-treated malarial parasites and erythrocytes. Attachment and junction formation.

We have previously demonstrated that invasion of erythrocytes (RBCs) by malaria merozoites follows a sequence: recognition and attachment in an apical orientation associated with widespread deformation of the RBC, junction formation, movement of the junction around the merozoite that brings the merozoite into the invaginated RBC membrane, and sealing of the membrane. In the present paper, we describe a method for blocking invasion at an early stage in the sequence. Cytochalasin-treated merozoites attach specifically to host RBCs, most frequently by the apical region that contains specialized organelles (rhoptries) associated with invasion. The parasite then forms a junction between the apical region and the RBC. Cytochalasin blocks movement of this junction, a later step in invasion. Cytochalasin-treated (Plasmodium knowlesi) merozoites attach to Duffy-negative human RBCs, although these RBCs are resistant to invasion by the parasite. The attachment with these RBCs, however, differs from susceptible RBCs in that there is no junction formation. Therefore the Duffy associated antigen appears to be involved in junction formation, not initial attachment.


Differentiated B lymphocytes. Potential to express particular antibody variable and constant regions depends on site of lymphoid tissue and antigen load.

B cells have the potential to respond to an antigen by producing antibodies with a variety of variable and constant regions. We have quantitatively analyzed B-cell potential at the single cell level to determine the effect of lymphoid tissue site and antigen load on the expression of variable and constant regions. Concerning variable region expression, although the total frequency of B-cell precursors for phosphorylcholine is similar between nonimmune spleen and gut-associated Peyer's patch tissues, the proportion of cells producing non-TEPC 15 idiotypes is greater from Peyer's patch than from spleen. Oral immunization with phosphorylcholine-containing Ascaris suum increased the frequency of non-TEPC 15 B cells. Thus variation in the proportion of cells bearing different variable regions may be related to the distinct antigenic environment of cells in Peyer's patches compared to that of cells in spleen. Regarding constant region expression, although B cells from both spleen and Peyer's patches generate clones producing IgM, IgGl, and IgA singly and in all combinations, cells from Peyer's patches generate more clones secreting only IgA than cells from spleen. B cells specific for phosphorylcholine and inulin, which are found on intestinal bacteria, produce more IgA-only clones than B cells specific for the dinitrophenyl determinant. This striking correlation between IgA expression and variable region specificity for antigen implies that environmental antigens have expanded certain B cells in Peyer's patches which then have the ability to generate progeny that express only IgA. Evidence supporting the secondary nature of precursors for IgA-only clones is obtained by their ability to produce this isotype after stimulation with histoincompatible T cells. The role of gut antigens may be to clonally expand IgA precursors and perhaps to stimulate the proliferation of less differentiated cells within the unique microenvironment of the Peyer's patches, allowing them to differentiate to IgA precursors.


Prostaglandins are necessary for osteoclast-activating factor production by activated peripheral blood leukocytes.

The production of osteoclast-activating factor (OAF) by normal human peripheral blood leukocytes stimulated by phytohemagglutinin was inhibited by a series of structurally unrelated inhibitors of prostaglandin synthetase. Inhibition of OAF production by these agents was reversed by adding prostaglandins of the E series back to the leukocyte suspension. These results indicate that prostaglandin synthesis is necessary for OAF production.


The metabolism of diethylstilbestrol in the rhesus monkey and chimpanzee.

Radiolabeled diethylstilbestrol (DES) was administered to one pregnant and three normal female rhesus monkeys. One normal female chimpanzee was also included in the study. Regardless of the mode of presentation (oral versus intravenous), the urine was the principal route of excretion for each species. The urine contained no non-polar radioactivity, and Sephadex LH-20 (MeOH/EtOH-50:50) resolved the radioactivity into five fractions (A, B, C, D, E). Fractions A,B, C, and D were hydrolyzable with beta-glucuronidase, and the principal aglycones were identified with GC/MS as cis-trans DES and dienestrol. The fecal excretory products were extracted with dimethoxy methane/methanol (50:50) and the radioactivity partitioned between benzene and H2O. The polar radioactivity was resolved by LH-20 (MeOH/EtOH-50:50) into chromatographic fractions similar to the urinary conjugates. These fecal conjugates were, however, less sensitive to beta-glucuronidase hydrolysis. The primary non-polar fecal radioactivity was chromatographically similar to DES (LH-20 and HPLC) in both species, and in the rhesus monkey the principal products identified were cis-trans DES and dienestrol.


Gene complementation in the T-lymphocyte proliferative response to poly (Glu55Lys36Phe9)n. A demonstration that both immune response gene products must be expressed in the same antigen-presenting cell.

The immune response (Ir) to the random copolymer GLphi depends upon the function of two Ir genes, Ir-GLphi-beta[beta] and Ir-GLphi-alpha[alpha], mapped to the I-A and I-E/C subregions of the major histocompatibility complex, respectively. In this paper, the site(s) of expression of the products of these two Ir genes was examined by evaluating T-lymphocyte proliferative responses of bone marrow radiation chimeras. Chimeras were created in [alpha+beta- X alpha-beta+]F1 responder mice by lethal irradiation and reconstitution with a mixture of bone marrow cells from both parental strains. These chimeras failed to respond to GLphi, although they were capable or responding to the much weaker antigens, (T,G)-A--L, TEPC-15, pigeon cytochrome c, and (H,G)-A--L. This failure to respond to GLphi was shown not to be the result of a cryptic mixed lymphocyte reaction, as similar chimeras created in (alpha+beta+ X alpha-beta+)F1 mice responded well to GLphi, although they possessed almost the same potential histoincompatibility. Furthermore, the lack of response to GLphi could not be attributed to a general failure of the two parental cell types in the chimeras to collaboratc with each other, as each chimeric parental cell type could respond to dinitrophenyl conjugated ovalbumin presented on nonimmune spleen cells from the other parent. Thus, the failure of low responder parental into F1 high responder chimeras to generate an immune response to GLphi suggests that immune competence for this antigen requires at least one cell type in the immune system to express gene products of both the Ir-glphi-alpha and -beta genes, i.e. one cell must be of high responder genotype. The the antigen-presenting cell is one such cell type was shown by experiments in which GLphi-primed T lymphocytes from responder F1 mice were stimulated with antigen bound to nonimmune spleen cells. Only spleen cells from responder F1 and recombinant mice could present GLphi. Neither of the two complementing nonresponder parental spleen cell populations, either alone or mixed together, could present GLphi, although both could present purified protein derivative of tuberculin. This was shown to be the case for T cells positively selected in vitro as well as freshly explanted T cells. Thus, both Ir-GLphi-alpha and Ir-GLphi-beta gene products must be expressed in the same antigen-presenting cell to generate a T-lymphocyte proliferative response to GLphi. The implications of these findings for models of two gene complementation are discussed.


Improved preparation and structural elucidation of the tryptophan cleavage reagent 2-(2'-nitro-phenylsulfenyl)-3-methyl-3-bromoindolenine (BNPS-skatole).

Methods are described for a high yield preparation (overall yield greater than 90%) of analytically pure 2-(2'-nitrophenylsulfenyl)-3-methyl-3-bromoindolenine (BNPS-skatole). The chromatographic and spectroscopic data are given. The yield of tryptophan cleavage is considerably dependent on the degree of purity of the BNPS-skatole.


Bound and free light chains in serum from patients affected with various neurological diseases.

Six immunological parameters, of which the most important are the quantitative distribution of the free light chains, and the kappa-lambda ratios of both bound and free light chains, were investigated in serum of patients affected with various neurological disorders and compared to controls. Subacute sclerosing panencephalitis and viral encephalitis, which are diseases characterized by hyperimmunisation against definite antigens, are accompanied by a considerable quantitative increase in free light chains; in subacute sclerosing panencephalitis serum there is an increase of both free kappa and lambda chains, whereas in viral encephalitis serum the increase of free light chains were restricted to lambda chains. There is a good correlation between the kappa-lambda ratio of, on the one hand, bound light chains and, on the other hand, free light chains for controls and subacute sclerosing panencephalitis; but in multiple sclerosis, amyotrophic lateral sclerosis and viral encephalitis, the ratios for bound light chains are totally different from ratios for free light chains. A general kappa increase, which we earlier reported for bound light chains in 16 cases of multiple sclerosis, was not confirmed by the investigation of an additional 26 cases: kappa decrease was also noticed in a considerable number of cases.


Characteristics of Drosophila rhodopsin in wild-type and norpA vision transduction mutants.

The properties of the major visual pigment of Drosophila melanogaster were evaluated. The visual pigment was isolated from other protein components using acrylamide gel electrophoresis and spectral identification. Sodium dodecyl sulfate (SDS) acrylamide gels of the isolated visual pigment gave a single protein subunit with a mol wt of 37,000 daltons. The rhodopsin480 molar extinction coefficient was 35,000 liter/mol-cm (+/- 2,700 SE). The metarhodopsin580 molar extinction coefficient was approximately 56,000 liter/mol-cm. Microspectrophotometry was used to compare the rhodopsin concentrations in wild-type flies and norpA vision transduction mutants. At 2 days of age (12 h dark-12 h light cycle, 19 degrees C) all of the norpA flies exhibited a similar rhodopsin concentration (75% of the wild-type strain). By 21 days of age some of the norpA alleles showed substantially reduced rhodopsin concentrations (16-43% of normal), whereas others showed no major age-dependent decreases (68-77%). Temperature and light-dark cycle affected the reduction. Alleles with no receptor potential exhibited the largest decreases in rhodopsin concentration. The data indicate that the norpA phototransduction mutant has a defect in the system responsible for maintaining the rhodopsin480 concentration. This defect in the rhodopsin maintenance system does not appear to be the cause of the reduced electroretinogram (ERG) amplitude observed in some of these mutants, but instead is a consequence of the decrease in ERG amplitude, or the flaw(s) responsible for the decrease in ERG amplitude.


Implications for adult roles from differential styles of mother-infant bonding: an ethological study.

Ethological observations of maternal and infant behaviors of nine vervet monkey pairs (Cercopithecus aethiops sabaeus) showed the effects of differential styles of early maternal responsiveness on later infant competence. Those infants receiving the least amount of maternal responsiveness and the most time-off the mother in the first 3 months of development were more socially competent at 6 months of age. The results are discussed within current ethological "attachment" theories. The detachment or separation process of mother-infant interaction is considered as important a factor during infant development as the primary maternal bond.


Cerebral abscesses produced by bacterial implantation and septic embolisation in primates.

The degree of brain abscess encapsulation is positively related to surgical mortality and methods to enhance capsule wall formation, therefore, have therapeutic relevance. Two primate models are described which may be useful in the investigation of encapsulation of traumatic and metastatic brain abscesses. Direct intracerebral inoculation induces abscesses displaying more prominent inflammatory responses and encapsulation than does septic embolisation, despite similar abscess age and size. Cerebral ischaemia surrounding metastatic suppurative foci may retard capsule wall formation.


Urinary excretion of indican in progressive myoclonus epilepsy without Lafora bodies. The effect of sodium valproate.

Increased urinary excretion of indican was detected in earlier studies of patients with the form of progressive myoclonus epilepsy (PME) where no Lafora bodies are present in the brain and other tissues. Since then, all PME patients have been given sodium valproate and/or clonazepam. In a series of 10 patients now examined the mean excretion was on the same level as that of other epileptic and non-epileptic neurological patients (53 +/- 27 mg/g creatinine). Alternate reduction of the two drugs in one patient over a period of 24 days increased the excretion up to the high level measured earlier (96 mg/g creatinine) and caused marked worsening of the clinical condition while no remarkable changes were observed in another PME patient who received her normal medication. The highest values ever measured were found in one PME patient just before his death. In two patients who had no medication the excretion was also high but returned to the normal level during medication with sodium valproate. It is unknown at the moment whether this change is due to the improved clinical condition of the patients or to the compound itself.


Possibility of a viral etiology in recurrent aphthous ulcers and Behçet's syndrome.

The clinical signs, laboratory data, and histological features of recurrent aphthous ulcers (RAU) and Behçet's syndrome suggest a viral etiology. In fact, there are reports of adenovirus isolations in herpetiform oral ulcers and on the isolation of a filterable agent in sporadic cases of Behçet's syndrome. However, isolation studies on the major and minor aphthous ulcers and more recent studies on Behçet's syndrome have been negative. A review of the literature on the role of viruses and autoimmunity in RAU and Behçet's syndrome is presented. Biopsy specimens of ulcerative lesions were grown in vitro for up to 300 days. Those cultures, along with leukocytes and body fluids, were examined by a variety of techniques for the presence of virus or viral antigens. Although a persistent or latent virus was not detected, these negative studies cannot exclude a viral etiology. In fact, the hypothesis of an infectious and viral etiology is still reasonable.


Can therapeutic considerations provide clues to the etiology of aphthous stomatitis and Behçet's syndrome?

An attempt is made to derive clues as to the etiology of aphthous stomatitis and Behçet's syndrome from analysis of the mode of action of the various therapeutic agents which have been employed in these diseases. It is concluded that owing to the diverse and frequently contrasting modes of action of these agents, this may well be an unproductive task. There is one exception to this conclusion. Since levamisole in small concentrations given intermittently appears to act as an immunopotentiator, and in large, prolonged dosages possible as an immunosuppressor, future "diagnostic-therapeutic" trials could examine this dichotomy to determine whether aphthous stomatitis and Behçet's syndrome are infectious or hypersensitivity diseases.


Double-blind trial of tetracycline in recurrent aphthous ulceration.

A double-blind trial of a tetracycline suspension was carried out in 25 patients with recurrent aphthous oral ulcerations. A combined topical-systemic treatment procedure was used. Both the placebo and tetracycline group experienced reductions in ulcer incidence during the treatment period, whereas only the tetracycline group showed significant reductions in ulcer duration, size, and pain. Tetracylcine treatment apparently alters the severity of the ulcer, but does not appear to affect those factors responsible for recurrences. The side effects recorded in patients taking tetracycline were comparable to those in patients on placebo.


Effect of levamisole on the incidence and prevalence of recurrent aphthous stomatitis. A double-blind clinical trial.

Twenty patients with severe recurrent aphthous stomatitis were treated with a new drug, levamisole, to determine its effects upon the incidence and prevalence of recurrent aphthous stomatitis. The trial, conducted in a non-crossover, double-blind fashion, did not demonstrate any statistically significant differences when levamisole and placebo groups were compared over time either in the number of ulcers, number of ulcer-days, mean duration of ulcers, or mean number of ulcers per day. Positive subjective results were experienced by the 10 patients receiving levamisole but these were not of sufficient magnitude to affect group mean differences.


Double-blind study of levamisole therapy in recurrent aphthous stomatitis.

Forty-eight patients with diagnosed recurrent aphthous stomatitis participated in a randomized double-blind study of levamisole therapy. Each patient's response to treatment was determined by the following criteria: (1) days between attacks, (2) duration of lesions, (3) patient's self-evaluation of pain, (4) investigator's clinical evaluation of patient's subjective treatment response. Statistical analysis of the levamisole and placebo groups of criteria 1 and 2 above revealed no significant difference. In contrast to the above findings, analysis of the investigator's recordings of patient's subjective treatment response showed that 26% of the levamisole patients experienced marked or moderate improvement. None of the placebo patients were recorded as having experienced the same degree of benefit. Fourteen of 15 patients who complained of side effects were taking levamisole. The most common side effects were dysgeusia and hyperosmia.


Double-blind study of levamisole in aphthous stomatitis.

Sixty-five patients with recurrent aphthous stomatitis participated in a double-blind study to evaluate levamisole. Nineteen of 34 patients improved on levamisole and only five of 31 patients improved on placebo (P less than 0.004, chi-square with two degrees of freedom). After breaking the code and switching placebo patients to levamisole and non-responders to an alternate dosage schedule, 46 of 60 patients noted clinical improvement.


Randomized, double-blind study of levamisole in recurrent aphthous stomatitis.

A randomized double-blind study was designed to evaluate the safety and efficacy of levamisole in the treatment of recurrent aphthous stomatitis (RAS). Thirty patients, aged 9-65 years, were selected, based on a documented history of three or more episodes of RAS. Patients were instructed to take 150 mg of levamisole (or placebo) daily for 3 days at the onset of the first prodromal symptoms of an ulcer. The regimen was to be repeated for each new episode, but not more than once per week. At each episode patients were examined and evaluated as to number and duration of ulcers, interval between episodes, pain associated with ulcers, and side effects. Data on 24 patients were suitable for analysis. Of those patients receiving levamisole, six showed slight improvement and five were unchanged. Of those patients receiving the placebo, one showed a marked improvement, four slight improvement, six were unchanged, and two deteriorated. There was neither a clinical nor a statistically significant difference between the groups. It is concluded that levamisole, in this study protocol, had no effect on the incidence or severity of aphthous ulcers.


Nutritional deficiencies in recurrent aphthae.

A series of 330 patients with recurrent aphthae was screened for deficiencies of iron, folate and vitamin B12. In 47 patients (14.2%) such deficiencies were found; 23 were deficient in iron, seven in folic acid, six in vitamin B12 and in addition 11 patients had combined deficiencies. Clinical examination of the aphthae was not helpful in identifying individual patients with a nutritional deficiency although patients with an associated glossitis or angular cheilitis were more likely to suffer from such deficiencies. Screening of the patients by examination of their peripheral blood alone (estimation of haemoglobin and absolute values, and blood film examination) detected only a proportion of those with deficiencies of iron or folic acid, although in this series such screening was able to identify the small number of cases with vitamin B12 deficiency. The 33 patients with a proven nutritional deficiency who were available for follow-up showed a favourable response to corrective therapy; 23 showed a complete remission of ulcers, 11 were improved and five were not helped. The significance of these findings is discussed. It is suggested that the results indicate the need for full haematological screening of all patients with recurrent aphthae.


Immunological aspects of recurrent oral ulceration and Behçet's syndrome.

Immunological factors play in recurrent oral ulceration (ROU) and Behçet's syndrome (BS) but these cannot be distinguished by means of antibodies and cell-mediated immune responses to oral mucosal antigens. However, HLA markers seem to differentiate ROU from BS. Immune complexes have now been found in about 55% of patients with BS and fewer patients with ROU, so that the transition from the focal ROU to the multifocal BS might be mediated by immune complexes. Immunopathological studies have shown that a vasculitis is the essential lesion in BS and this might be secondary to immune complexes inducing complement activation and damage. It is not clear at present whether the increased levels of C9 and C-reactive protein are a manifestation of acute phase reactants. C9 could be involved in complement dependent lysis and C-reactive protein in modulating the cell-mediated immune responses by its effect on T lymphocytes. It seems that at least two types of damaging immune mechanisms have been identified; cell-mediated and immune complex induced reactions and these might account for the association between ROU and BS.


Ocular manifestations of Behçet's disease.

The manifestations, possible etiological factors and therapeutical modalities of ocular Behçet are outlined. The major ocular findings involve both the anterior and posterior uvea. The vasculitis retinae, the periphlebitis and the pipe stem sheathing along with the recurrent vitreous hemorrhages lead to the visual impairment. Exacerbation and remission of the ocular inflammatory processes are characteristic. However, the impairment of visual function occurring after each attack is generally irreversible. The effectiveness of the present modalities of treatment is uncertain. Chlorambucil in doses of 6-8 mg daily appears to have an outstanding beneficial effect. However, carefully monitored control studies are lacking and should be conducted before any unequivocal conclusions can be reached. It appears to us that the etiology-pathology of Behçet's disease might be a sequence of events triggered by an interaction between a virus and specific receptors on the host cell membrane (HLA determined?). This initial interaction is followed by a malregulation of the host immune mechanism leading to autoimmune phenomena which are characteristics of the disease.


Late effects of corticosteroid treatment on condylar regeneration in the monkey.

The mandibular condyles of immature baboons were used to study the late effects of intraarticular administration of glucocorticoid hormone on the regeneration of cartilage and bone. Analyses of blood and urine showed a distinct increase in the level of parathyroid hormone along with hyperphosphaturia. Regenerated condyles of animals treated with steroid showed lack of de novo formation of cartilage and severe changes in the newly formed bone. Fibrosis became the dominant feature in the newly formed bone marrow. The initial catabolic effect of glucocorticoid hormone was augmented by steroid-induced secondary hyperparathyroidism.


Vascular changes in the pterygopalatine fossa after craniofacial dysjunction surgery.

A study was undertaken to determine vascular changes and the timing of these changes after craniofacial dysjunction surgery. Ten adult male Macaca cynomulgus monkeys were studied with techniques using angiograms and vascular vinyl cast preparations before and after unilateral Le Fort III osteotomy. After surgical disruption of the maxillary artery, the flow of blood was initially maintained by anastomotic branches of the ipsilateral internal carotid artery. Stepwise reconstruction of the disrupted maxillary artery took place via numerous collateral vessels that bridged the site of disruption; continuity of the artery was nearly normal by five weeks.


Anatomical observations on the mylohyoid groove, and the course of the mylohyoid nerve and vessels.

In a study of 390 mylohyoid grooves in dry mandibles and in dissections of the region, the groove conformed to the classic description (that is, it was open along its entire length) in only 83.6% of the cases. In the remaining 16.4%, the sulcus was partially or totally converted to a bony canal by ossification of the membrane that covered it. When only partially converted, the ossification was proximal or distal, single or multiple. This ossification is explained according to the embryological origin of the membrane closing the canal from Meckel's cartilage. The practical importance of these observations in anatomical dissection and in surgical intervention in the region is discussed.


Giant central ossifying fibroma of the mandible: report of case.

A case is presented of a patient with a giant ossifying fibroma of the mandible that had been diagnosed earlier as fibrous dysplasia. Surgical resection of the tumor and involved bone was chosen as the mode of treatment because of the extent of the lesion and continued infection. Surgeons should be aware that ossifying fibroma is a very distinct possibility in large growing lesions in age groups older than is deemed compatible with fibrous dysplasia.


Histopathology of the rat liver following a single autoprotective dose of 3'-methyl-4-dimethylaminoazobenzene.

Male inbred Leeds strain rats were given single intragastric doses of 1200 mg/kg of 3'-methyl-4-dimethylaminoazobenzene, autoprotective against liver necrosis and then sacrificed at intervals up to 14 months. About 40 per cent of the animals died, apparently as a result of pancreatic necrosis, between 9 and 13 days after treatment while the remainder survived until they were killed. The liver changes induced included an early intense ductular cell reaction, presistent hepatocellular abnormalities and at later stages, cholangiofibrosis and increasing numbers of parenchymal clear cells. Although no tumours arose as a result of treatment, the observed histopathological changes are similar to those seen during liver carcinogenesis induced by a variety of carcinogens and may be due specifically to the carcinogenic action of the azo dye.


A home program of long-term total parenteral nutrition in children.

Three children--ages 4 months, 5 months, and 14 years--have been on a program of total parenteral nutrition at home for ten, 23 and 44 months respectively, as of January, 1978. Using a specially designed silicone rubber catheter, placed in the right atrium, total nutritional needs of these children were delivered nightly by family members; the children carried out normal activity during the day with the catheter line maintained by a heparin lock. Normal skeletal development and weight gain have been achieved while allowing these children normal social and psychlogic development outside the hospital. During the course of the therapy the patients had multiple metabolic abnormalities which were successfully treated by replacement therapy. The duration of catheter patency ranged from three to 22 months. Catheter sepsis or mechanical failure occasionally required catheter removal and replacement.


Glucagon suppression with low-dose intramuscular insulin therapy in diabetic ketoacidosis.

The effects of low-dose intramuscular insulin therapy on endogenous glucagon secretion in diabetic ketoacidosis were compared prospectively with a conventional regimen. Ten patients, 4 to 15 years of age, who had 13 episodes of diabetic ketoacidosis, were alternately assigned to either group. Either 0.1 unit/kg regular insulin was given every two hours im, or 1.0 unit/kg regular insulin was given, half subcutaneously and half intravenously, every 4 hours. In both groups, a significant and equal fall in both serum glucose and glucagon concentrations was observed. No complications were encountered. It is concluded that 0.1 unit/kg of regular insulin given im every two hours is as effective in correcting hyperglycemia and hyperglucagonemia of diabetic ketoacidosis as is conventional therapy, and avoids the risks of secondary hypoglycemia known to occur when the larger insulin dosages are employed.


The fine structure of elongate gametocytes of Leucocytozoon ziemanni (Laveran).

In an effort to establish comparative data within the genus Leucocytozoon, elongate gametocytes of L. ziemanni from naturally infected great horned owls (Bubo virginianus) were examined by electron microscopy. Micro- and macrogametocytes proved to be easily distinguishable at the electron microscopic level due to dramatic dimorphism at maturity and cytoplasmic and nuclear morphology. The parasite membrane architecture, number and type of cytoplasmic ribosomes of both micro- and macrogametocytes, presence and arrangement of osmiophilic bodies and electron dense spheres, mitochondrial morphology, endoplasmic reticulum cisternae morphology, mitochondria containing pocket infoldings of the nuclear membrane of the microgametocytes, and cytostome and food vacuole formation compare favorably with available information on L. simondi and L. smithi. Comparative variations exist only in that L. ziemanni gametocytes apparently lack compartmentalization of the cytoplasm by aligned unit membranes and parasite induced separations of the host cell nucleus as reported for L. simondi.


Rieger's syndrome: (oligodontia and primary mesodermal dysgenesis of the iris) clinical features and report of an isolated case.

An 11-year-old female manifested bilateral prominent Schwalbe's line, iridal adhesions, displaced and irregular pupils. She had no evidence of juvenile glaucoma. The major nonocular finding in this patient was the congenital absence of her primary and permanent maxillary central and lateral incisors. Although missing or malformed teeth may occur in other conditions such as Down's syndrome, focal dermal hypoplasia syndrome, anhidrotic ectodermal dysplasia, chondroectodermal dysplasia, and incontinentia pigmenti, the clinician should include Rieger's syndrome in his differential diagnosis in patients with oligodontia in combination with malformation of the anterior chamber of the eye. Rieger's syndrome is a rare condition characterized by ocular and dental abnormalities, namely mesoectodermal dysgenesis of the iris and cornea of the eyes and hypodontia of the dentition. This report presents a sporadic case of Rieger's syndrome in an 11-year-old female and discusses the pertinent clinical features of this condition.


Diphenylhydantoin teratogenicity: ocular manifestations and related deformities.

This patient illustrates a classical case of what many pediatricians call the diphenylhydantoin teratogenic syndrome. It suggests the possibility of an additional ocular finding of retinoschisis and optic nerve abnormalities which could conceivably have a teratogenic basis. The effects of epilepsy and diphenylhydantoin on these formations is discussed.


The role of sulcular environment in controlling epithelial keratinization.

The influence of the sulcular environment on the keratinization of the outer surface gingival epithelium was tested in three young adult Rhesus monkeys. A total of 40 mucoperiosteal flaps were raised, and inverted so as to bring the outer surface epithelium in contact with the tooth, and were sutured. The experimental time intervals varied from 1 hour to 60 days. The monkeys received H3 thymidine 1 hour prior to sacrifice. The material was prepared for histologic and radioautographic evaluation. Results indicated that the outer surface epithelium changes its morphology to a nonkeratinized epithelium devoid of deep rete pegs when in close contact with the tooth, resulting in the anatomical characteristics normally seen in sulcular epithelium. It is concluded that the sulcular environment has the capability of controlling the keratinizing potential of the outer surface gingival epithelium. It is further suggested that the constant irritation of bacterial plaque and its products may be responsible for the premature desquamation of the sulcular epithelium which in turn might not allow its full differentiation.


Peters' anomaly: dominant inheritance in one pedigree and dextrocardia in another.

Two case reports are described to illustrate the unusual occurrence of dominant inheritance of Peters' anomaly and the concomitant occurrence of Peters' anomaly with colobomatous microphthalmos and dextrocardia. Studies of additional families are necessary to determine conclusively the pathogenesis, genetic mode of inheritance, ocular and systemic associated malformations, and proper management of this complex entity.


Cell populations in the transseptal fiber region before, during and after experimental periodontitis in squirrel monkeys.

A study was designed to enumerate cell populations before, during and after experimentally induced periodontitis in squirrel monkeys. The clinically healthy gingival connective tissue adjacent to the sulcus contained populations of macrophages, plasma cells, lymphoid cells, and granulocytes, indicating that immune responses were probably in operation. Although these cell populations have been associated with tissue destruction, it is possible that they may serve to confine the antigens to the tissue adjacent to the sulcus, and reduce their spread apically. Active periodontitis was associated with the presence of granulocytes and macrophages in the transseptal fiber region. These cells are capable of causing the localized collagen degradation and bone resorption that occur during the destructive phase of the disease. Eight weeks after etiologic agents were removed, the cell populations in the transseptal fiber area returned to a level comparable with those in the pre-experimental, clinically healthy. This indicates that active periodontitis within the transseptal fiber region had ceased and repair had occurred.


Production of anterior segment ischemia.

Anterior segment ischemia changes can occur without detachment of any muscles. The most common cause of such ischemic changes of the anterior segment is the removal of too many rectus muscles in one operation. Twenty dog eyes and eight monkey eyes were subjected to the disinsertion and detachment of various combinations of extraocular muscles. They were sacrificed at intervals from 30 to 90 days. During the observation period, they were observed for gross and slit lamp changes. The enucleated eyes were studied microscopically for signs of ischemic and necrotic changes. Two patients who were studied, observed, and treated for anterior segment ischemia following muscle surgery are described. The changes which occur after muscle surgery are extensive and include corneal edema, cataract, chemosis, corneal changes, decreases in intraocular pressure, decreases in outflow or glaucoma and frank necrosis. The variables which lead to this reaction is described in detail. Also, some unanswered queries, such as the duration of the reaction and the time interval of the reaction after multiple muscle surgeries, are discussed.


Melnick-Needles syndrome.

A 10-year-old female with a generalized bone dysplasia was found to have a rare condition, Melnick-Needles syndrome. Characteristic clinical features of this syndrome include exophthalmos, hypertelorism, micrognathia, malaligned teeth, and large ears in a person with multiple bone deformities. In addition to the usual characteristic clinical findings, sclerocornea and cornea plana were also present in this patient. This is the first case of Melnick-Needles syndrome reported in the ophthalmological literature and the first case reported with ophthalmological findings other than exophthalmos and strabismus.


Ophthalmological findings in 34 patients with Waardenburg syndrome.

In the Netherlands five families with 34 previously unreported patients with Waardenburg syndrome were traced. Twenty-three patients with the syndrome including dystopia canthorum (Type I) were ophthalmologically examined and three patients with the syndrome without dystopia canthorum (Type II) were also examined. Ten of the 15 patients with pigmentary disorders of the iris also showed a shortage of pigment in the retina. Convergent strabismus occurred in an higher percentage of the examined patients (19%) than in the normal population (4-5%).


[Relationship between the phagocytic inhibition of the rat reticuloendothelial system and the anticholinesterasic effect of an insecticide, Carbaryl (author's transl)].

Phagocytic activity of the reticuloendothelial system (RES) and blood cholinesterase activity were determined in male rats after veinous administrations of carbaryl and 1-naphthol, a carbaryl metabolite. The various parameters were measured 1, 24, 48 and 72 hours after administration of the following four doses per 100 g body weight : 1.875, 3.75, 7.5 and 15 mumol. 1. Results showed an inhibition of the RES phagocytic activity (clearance of colloidal carbon) after carbaryl administration; although 1.875 mumol/100 g had no effect, the other doses inhibited RES activity, blockade time being a function of the dose given. The phagocytic function had returned to normal 72 hr after carbaryl administration. 2. Reductions in spleen weight and protein content were observed together with the RES blockade. 3. At all four doses, the anticholinesterase effect was already apparent one hour after carbaryl administration. 4. 1-naphthol, one of carbaryl's chief metabolites, had no effect either on the RES or on the different parameters studied. These results show a relationship between the phagocytic inhibition of the reticuloendothelial system and the anticholinesterasic effect by carbaryl. They suggest an inhibition of some esterases of macrophages interfering with the phagocytosis.


Muscle responses and monosynaptic reflexes in falling monkey. Role of the vestibular system.

The free fall has been used in our laboratory as a way to test vestibular function in baboons in order to quantify vestibular compensation in the hemilabyrinthectomized animal. This study presents only those results that concern the contribution of the vestibular system to muscle responses due to sudden fall. EMG activity was recorded from the fully conscious animal using chronic electrodes implanted in various muscles. Spinal monosynaptic reflexes (Hoffmann's and tendon reflexes) were studied in the soleus muscle. Baboons were seated in a special chair suspended from an electromagnet and unexpectedly dropped 90 cm. Experiments were performed in normal, unilateral and bilateral vestibular neurectomized baboons. 1. In normal baboons, results showed a first short-latency response in all tested muscles, followed by a second peak of EMG activity in these muscles. Comparison with data from bilateral vestibular neurectomized baboons demonstrates that normal vestibular function is essential for the appearance of the first peak; the second peak rapidly disappears in our experimental situation where the animal's fall is mechanically braked and interrupted, so the animal does not have to make the postural adjustments necessary for landing, It is suggested that the first peak is concerned with the automatic and reflex control of landing, the second with the voluntary breaking of landing. 2. The modulation of monosynaptic spinal reflexes is closely related to the EMG response in soleus muscle. Facilitation of the H-reflex begins just prior to the onset of the EMG activity and continues as long as the baboon is falling. The T-reflex modulation presents a similar time course except in its early phase where it is depressed. Decrease in T and increase in H-reflexes suggest that the EMG response is most likely due to direct activation of alpha-motoneurons and not by means of the gamma-loop. 3. In unilateral vestibular neurectomized baboons, EMG and reflexological data show the classical asymmetry characterized by a strong decrease of the responses on the side of the lesion, and by a pronounced increase on the contralateral side. It is concluded that this represents the imbalance between the resting discharge of the vestibular neurons, and discloses the influence of labyrinthine afferences at the spinal level. We suggest consequently the use of EMG responses and modulation of spinal reflexes to fall in order to quantify vestibular compensation.


Fine structure of human malaria in vitro.

The erythrocytic cycle of the human malaria parasite, Plasmodium, falciparum, was examined by electron microscopy. Three strains of parasites maintained in continuous culture in human erythrocytes were compared with in vivo infections in Aotus monkeys. The ultrastructure of P. falciparum is not altered by continuous cultivation in vitro. Mitochondria contain DNA-like filaments and some cristae at all stages of the erythrocytic life cycle. The Golgi apparatus is prominent at the schizont stage and may be involved in the formation of rhoptries. In culture, knob-like protrusions first appear on the surface of trophozoite-infected erythrocytes. The time of appearance of knobs on cells in vitro correlates with the life cycle stage of parasites which are sequestered from the peripheral circulation in vivo. Knob material of older parasites coalesces and forms extensions from the erythrocyte surface. Some of this material is sloughed from the host cell surface. The parasitophorous vacuole membrane breaks down in erythrocytes containing mature merozoites both in vitro and in  vivo. Merozoite structure is similar to that of P. knowlesi. The immature gametocytes in culture have no knobs.


Cytotoxicity of synthetic fuel products on Tetrahymena pyriformis. II. Shale oil retort water.

Shale oil retort water is obtained by centrifuging the oil/water emulsion produced by oil shale retorting. The ciliate Tetrahymena pyriformis was exposed to retort water; 2, 1, and 0.5% initially increased motility; longer exposures decreased motility. Three, 4, and 5% all decreased motility. Cell lysis was directly related to concentration; after 24 h, population densities were 0, 10, and 25% of controls for 2, 1, and 0.5% retort water, respectively. Oxygen consumption paralleled the motility pattern: at lower concentrations it increased initially but decreased with extended exposures while at higher concentrations it decreased rapidly. The most striking cytologic alteration of cells exposed to the toxicant occurred in the membranes; alterations of mucocysts and glycogen content were also observed, but mitochondrial changes were not. Population growth was affected at much lower concentrations than the other test indices. The growth of test populations reached a plateau at values inversely related to concentration: concentrations less than 0.4% had no effect on growth rate.


Some clinical consequences of red cell incompatibility: the Bradshaw lecture 1978.

Most deaths from red cell incompatibility are due either to the transfusion of ABO-incompatibile red cell or to Rh-haemolytic disease of the newborn; almost all the deaths are preventible. It seems that approximately 1 in 5,000 recipients receive ABO-incompatible blood, a figure which implies that donor and/or recipient may be mis-identified in as many as 1 in 1,5000 transfusions. Another serious consequence of mis-identification is the transfusion of Rh-positive blood to an Rh-negative female who has no children and is not past the age of childbearing. The need for rigorous checking procedures to ensure that patients are transfused with the 'right' blood cannot be stated too often. Some deaths from Rh-haemolytic disease of the newborn are due to the fact that the mother has not received suppressive therapy after a previous pregnancy. Wider recognition of the great importance of administering anti-D to women who might otherwise become immunised would save many lives.


Apical systolic click and murmur associated with neurofibromatosis.

In this report we describe a child who had an apical systolic click and murmur, as well as widespread cutaneous neurofibromatosis. We were not able to show an anatomical basis for the click and murmur.


Chemical and physical restraint of nonhuman primates.

Numerous publications on primate restraint and anesthesiology have appeared in recent years. This reflects the striking growth of interest in medical primatology and of efforts to improve restraint agents and methods to facilitate humane use of primates in research. For access to earlier literature, readers should consult recent textbooks [12; 29, pp. 469--474], reviews on chemical or physical restraint [3, 4, 16, 27, 30, 37], and other valuable publications on these subjects that have appeared since 1965 [1, 20, 23, 36, 40, 42]. In this brief review we consider publications, principally since 1971, that deal with chemical or physical restraint. We also present previously unpublished data on the clinical use in primates of CI 744 (Telazol), a new dissociative anesthetic that until recently has been available only for investigational use.


Timing of births and reproductive success in rhesus monkey social groups.

Analysis of six years of birth records (228 potential reproductive years) from 71 female rhesus monkeys, housed in social groups in outdoor compounds, revealed several variables which influenced the reproductive pattern. The timing of conception in this seasonally breeding species was influenced by age, parity, and reproductive outcome the previous year, but not by social rank. In contrast, high social rank did confer an advantage in higher conception and lower infant mortality rates.


Rectal probe electroejaculation of primates.

The technique of rectal probe electroejaculation has been developed to permit collection of semen using equipment proven safe, simple, and effective on the 30 primate species so far tested. This paper provides information on the construction and operation of this equipment, together with electrical parameters applicable to primate species. Seminal emission or ejaculation occurs in all species when alternating current is delivered at 0.25 mA/mm2 electrode area. The most effective frequency is 20 Hz, and the most acceptable anesthetic is ketamine hydrochloride.


Effects of intrafollicular administration of gonadotropins in two species of nonhuman primates using laparoscopy.

Direct administration of 0.5 IU of human chorionic gonadotropin (HCG) into the matured ovarian follicles of adult female Saimiri sciureus resulted in ovulation in 45% of the animals treated. When purified ovine luteinizing hormone (LH) was administered, ovulation was observed in 55% of the animals while intrafollicular injection of saline had no effect. Similar injections of HCG into matured follicles of Macaca fascicularis would not cause ovulation but did result in a 55% increase in menstrual cycle length. These results indicate that the necessity of a primate source of LH for inducing ovulation may be due to an extrafollicular mechanism.


Evaluation of caged mating behavior in Macaca fascicularis.

Studies were undertaken to characterize the basic behavioral parameters of a breeding colony of Macaca fascicularis under caged conditions. The female Reproduction Performance Index and the Success Ratio were found to correlate with mating behavior relating to cyclicity in females with cycles of less than 30 days. These evaluations proved to be useful in the selection of animals based on sexual vigor.


Persistent cloaca in a cynomolgus monkey (Macaca fascicularis).

A persistent cloaca was found to occur in a 15-year-old female cynomolgus monkey. This is the first case reported in a nonhuman primate. The embryological basis of this anomaly is discussed, and pertinent anatomical findings in this animal are reported which demonstrate the embryologic defect.


Antigenic cross-reactivity between human and marmoset zonase pellucidae, a potential target for immunocontraception.

Cross-reactivity between marmoset, chimpanzee, human and pig zona pellucida antigens was demonstrated by immunofluorescence and zona precipitation. In marmosets, anti-zona antibody prevented sperm attachment to eggs in vitro, and the antibody could be detected on zonae of ovarian oocytes following passive immunization. Use of the marmoset as an animal model in testing feasibility of the zona approach to immunocontraception is discussed.


Intrauterine fetal demise associated with consumption coagulopathy in a Douc langur monkey (Pygathrix nemaeus nemaeus).

Intrauterine fetal demise was suspected in a Douc langur monkey based on measurements of declining urinary estrogen levels. Additional clinical evaluation by fetal cardiac auscultation, ultrasonic instrumentation, radiologic examination, and amniocentesis supported the diagnosis. Blood clotting studies demonstrated deficiency of factors consistent with a diagnosis of consumptive coagulopathy, a syndrome identical to that observed in man following prolonged intrauterine fetal demise.


Mandibular function in Galago crassicaudatus and Macaca fascicularis: an in vivo approach to stress analysis of the mandible.

Single-element and/or rosette strain gages were bonded to mandibular cortical bone in Galago crassicaudatus and Macaca fascicularis. Five galago and eleven macaque bone strain experiments were performed and analyzed. In vivo bone strain was recorded from the lateral surface of the mandibular corpus below the postcanine tooth row during transducer biting and during mastication and ingestion of food objects. In macaques and galagos, the mandibular corpus on the balancing side is primarily bent in the sagittal plane during mastication and is both twisted about its long axis and bent in the sagittal plane during transducer biting. On the working side, it is primarily twisted about its long axis and directly sheared perpendicular to its long axis, and portions of it are bent in the sagittal plane during mastication and molar transducer biting. In macaques, the mandibular corpus on each side is primarily bent in the sagittal plane and twisted during incisal transducer biting and ingestion of food objects, and it is transversely bent and slightly twisted during jaw opening. Since galagos usually refused to bite the transducer or food objects with their incisors, an adequate characterization of mandibular stress patterns during these behaviors was not possible. In galagos the mandibular corpus experiences very little transverse bending stress during jaw opening, perhaps in part due to its unfused mandibular symphysis. Marked differences in the patterns of mandibular bone strain were present between galagos and macaques during the masticatory power stroke and during transducer biting. Galagos consistently had much more strain on the working side of the mandibular corpus than on the balancing side. These experiments support the hypothesis that galagos, in contrast to macaques, employ a larger amount of working-side muscle force relative to the balancing-side muscle force during unilateral biting and mastication, and that the fused mandibular symphysis is an adaption to use a maximal amount of balancing-side muscle force during unilateral biting and mastication. These experiments also demonstrate the effects that rosette position, bite force magnitudes, and types of food eaten have on recorded mandibular strain patterns.


Toxicological studies on pipemidic acid. V. Effect on diarthrodial joints of experimental animals.

Pipemidic acid (PPA) orally given in a dose of 100 mg/kg/day or more was found to cause lame gait in immature beagle dogs of about 3 months old. Their diarthrodial joints were abnormal with increased synovial fluid and blister formation under the outer layer of the articular cartilage. However, such an abnormality was not found in dogs younger than 2 weeks or older than 12 months. The blisters were formed at the joint areas bearing the body weight at a time when PPA was considered to be present there. Nalidixic and piromidic acids, structural analogues of PPA, also caused abnormality similar to PPA. The severity of the arthropathy was slight with piromidic acid as compared with PPA and nalidixic acid. The gait abnormality was almost disappeared spontaneously even if medication was continued. The incidence of the arthropathy was not or rarely observed in any young rats, rabbits and monkeys.


Transient defect in the bactericidal capacity of rabbit alveolar macrophages following sublethal shock.

The phagocytic function of alveolar macrophages obtained from rabbits after they were given sublethal shock by tumbling in a modified Noble-Collip drum was studied. As compared to the phagocytic function of alveolar macrophages from normal rabbits, tumbling produced a statistically significant reduction in in vitro bactericidal capacity for both Pseudomonas aeruginosa and Escherichia coli. However, there was no alteration in the ingestive phase. The reduced bactericidal capacity was evident within 15 minutes after the stress, but the bactericidal capacity had returned to normal in rabbits that were allowed to recover for 24 hours before the studies were performed.


Carcinom of the paranasal sinuses--a review of 158 cases.

One hundred and fifty-eight cases of paranasal sinus cancer have been reviewed retrospectively. The actuarial survival at five years for the whole group was 33%. The American Joint Committee (AJC) classification for maxillary cancer was used. T1 and T2 cases, with an actuarial survival of 44% at five years, had a significantly better prognosis than T3 cases (31%) and T4 cases (10%). Anemia of presentation and the presence of persistent disease when surgery followed pre-operative irradiation were poor prognostic indicators. The policy of combined pre-operative irradiation followed by surgery is advocated; patients with anemia should have this corrected before and during treatment.


A serologic survey of mule deer and elk in Utah.

Sera from mule deer (Odocoileus hemionus) and elk (Cervus canadensis) in central and northern Utah were tested for the prevalence of antibodies to 11 diseases communicable to man or domestic livestock. Antibodies to Francisella tularensis (at 1:20) were found in 47 of 88 (53.4%) elk and 1 of 89 (1.1%) deer. A screening slide agglutination test for titers to Brucella (at 1:20) showed two reactors in elk but none in deer sera. No positive antibody titers were obtained in tests for anaplasmosis, Colorado tick fever, Rocky Mountain spotted fever, Q-fever, psittacosis, Powassan, western equine encephalitis, St. Louis encephalitis and California encephalitis.


Parasites and associated pathology observed in cetaceans stranded along the Oregon coast.

Ten stranded cetaceans, representing five species, from the Oregon Coast were examined between 1973-1977. Fourteen genera of parasites, together with the pathogenesis and pathology associated with the presence of some of these parasites are reported.


Wildlife rabies in Zambia.

Wildlife species made up 26 (2.0%) of 1,304 positive rabies cases received between 1969 and 1976. The jackal (Canis adustus) was the predominate wildlife species involved (69%) and played a role in the epidemiology of bovine rabies in remote farm areas. Rabies appears to be absent from the intact wildlife communities in Zambia, especially the National Parks; this is considered in the light of the epidemiology of the disease in wildlife.


Pseudomonas sternotomy wound infection and sternal osteomyelitis. Complications after open heart surgery.

Pseudomonas aeruginosa sternotomy wound infections occurred in five patients who underwent open heart surgery. The initial isolate in each case was from a mediastinal chest tube routinely cultured on removal. Soft-tissue infection developed in two patients, and sternal osteomyelitis developed in three patients. Pseudomonas-typing studies showed a correlation between five isolates from chest-tube suction pumps used postoperatively and the wound isolates. Analysis of antibiograms of Pseudomonas wound isolates from the cardiac surgery ward from 1975 to 1977 showed eight of 15 with the same antibiogram as the sternotomy pathogens, compared with two of 13 isolates from other wards.


Leukemia in workers exposed to ethylene oxide.

Ethylene oxide, a gaseous sterilant extensively used within health care facilities, is known to be a mutagen in bacteria and in human lymphocytes. The Environmental Protection Agency as well as the National Institue of Occupational Safety and Health have recently stipulated certain conditions for the use of ethylene oxide despite the lack of case reports or epidemiologic studies concerning carcinogenicity. We report three cases of leukemia that occurred between 1972 and 1977 in a relatively small group of Swedish workers exposed to ethylene oxide. According to national statistics, 0.2 cases of leukemia would have been expected. The time-weighted average ethylene oxide concentration was 20+/-10 ppm.


Serious infections from Bacillus sp.

Serious infections caused by organisms of the genus Bacillus developed in seven patients. Five drug abusers had either endocarditis or osteomyelitis, one leukemic patient had necrotizing fasciitis, and one patient had a ventriculoatrial shunt infection with recurrent bacteremia. All patients recovered. Experience with these cases reemphasizes the importance of not dismissing Bacillus organisms as culture contaminants, especially when isolated from blood, body fluids, or closed-space infections.


Prophylactic antibiotics in surgery. Practices within surgical services of the Veterans Administration.

A survey of prophylactic antibiotic-prescribing habits among chiefs of surgical services of the Veterans Administration yielded a 99% response. These responses have been compared with guidelines set by an expert committee on antimicrobial use for the VA central office. Assuming that 100% concordance with the standards of the committee is a desired state, the average hospital is approximately one third away from this goal (average score, 62.4%). The majority of errors were those of overuse rather than underuse. The size of the service and the existence of a university affiliation had no influence on the results. Feedback to the chiefs of service regarding the use of antibiotics was informal and tended to be carried out on rounds rather than as a result of formal audits. Most senior surgeons indicated that they would be willing to be influenced by audit guidelines.


Low- and high-dose intravenous insulin therapy for diabetic ketoacidosis.

We compared low-dose, continuous insulin infusion with a conventional high-dose intravenous bolus method of insulin administration in 18 episodes of diabetic ketoacidosis. The average rate of reduction in serum glucose concentration was 9.5 +/- 3.8%/hr in the continuous infusion group and 10.7 +/- 4.7%/hr in the bolus group. Arterial blood pH was corrected to 7.35 by 9.9 +/- 2.6/hours in the continuous infusion group and by 10.4 +/- 3.2/hours in the bolus group. The above means are not significantly different between groups. By the time pH was corrected to 7.35, patients in the continuous infusion group had received 121 +/- 44 units of insulin, whereas those in the bolus group had received 326 +/- 152 units. The continuous low-dose insulin infusion method is as safe and efficacious as the conventional high-dose intravenous bolus method.


Effects of the tumor-promoting agent 12-O-tetradecanoylphorbol-13-acetate on normal and "preneoplastic" mouse submandibular gland epithelial cells in vitro.

The effect of the promoting agent 12-O-tetradecanoylphorbol-13-acetate (TPA) was studied on mixed primary cultures of C57BL/Icrf-at mouse submandibular gland and on slowly proliferating preneoplastic epithelial foci derived from such cultures. No cytologic alterations were noted in the TPA-treated epithelium. The development of three-dimensional epithelial ducts occurring between 30 and 60 days in vitro in untreated cultures was markedly inhibited in TPA-treated cultures. Epithelial proliferation, as shown by the [H]thymidine labelling index and mitotic index, seemded to increase during treatment with TPA and fall between the weekly treatments. Long-term TPA treatment increased the incidence of slow-growing foci in cultures previously treated with 7,12-dimethylbenz[a]anthracene but not in cultures treated with dimethyl sulfoxide. TPA had no effect on the emergence of tumorigenic cell lines at a late stage in culture or on the development of such lines from preexisting foci derived from non-TPA-treated cultures.


Serial transplantation of chemical carcinogen-induced mouse mammary ductal dysplasias.

BALB/c and (C57BL times DBAf)F1 mice were treated with 7,12-dimethylbenz[a]anthracene and urethan, respectively, to induce mammary dysplasias. Nine transplantable outgrowth lines of dysplastic tissue were established by transplantation of the primary lesions into the cleared mammary fat pads of syngeneic mice; 8 of the 9 lesions were ductal in origin. The growth and tumorigenic potentials of these 9 lines were followed over 6-9 transplant generations. Most outgrowth lines exhibited a rapid decline in growth potential and/or a progression to papillomatosis and subsequent carcinoma by transplant generation 7. The ductal outgrowth lines and mammary tumors established from urethan-induced dysplasias in hybrid mice were ovary-dependent for tumorigenesis and tumor growth. The transplantation experiments confirmed the hypothesis that ductal dysplasias have high tumorigenic potentials and can be classified as "high-risk" lesions, similar to murine mammary tumor virus-induced hyperplastic alveolar nodules.


Effects of subcutaneous administration of 3-methylcholanthrene and 7,12-dimethylbenz[a]anthracene on spontaneous reticulum cell neoplasms in SJL/J mice.

Inbred 4-week-old and 16-week-old SJL/J mice were treated sc with either 150 or 450 microgram 3-methylcholanthrene (MCA). No difference was noted in their subcutaneous tumor response related to age. Although the incidences of reticulum cell neoplasms (RCN's) were the same in the controls for the 2 age groups, more 16-week-old animals developed RCN's after carcinogen treatment than did 4-week-old SJL/J mice. More 16-week-old mice developed both subcutaneous tumors at the site of MCA injection and systemic RCN's than did mice treated at 4 weeks of age. This incidence was related to the coinciding of the chronologic age of the mice for RCN development with the latency for chemical carcinogen-induced subcutaneous tumor development. Mice treated with 7,12-dimethylbenz[a]anthracene at 16 weeks of age responded in the same way as did those treated with MCA.


[Influence of maternal antibodies on the primary and secondary immunoresponse of the juvenile organism (author's transl)].

The immunization of mice with sheep erythrocytes served as model for the materno-fetal transfer of specific antibodies. It could be shown that passively transferred antibodies are able to induce a long-lasting suppression of the primary and secondary immuno-response in the offspring. This holds true both for active immunization before pregnancy and for passive immunization shortly before term. As it can be supposed that similar effects also apply to the human organism, this phenomenon must be considered for the vaccination during pregnancy as well as for the first immunization of children.


Immunocytochemical characterization of the lymphocytes in nodular lymphoid hyperplasia of the bowel.

The immunoglobulin constituents of hypertrophied lymphoid nodules in the intestinal tracts of six patients with the variable immunodeficiency syndrome and one patient with selective IgA deficiency were evaluated by the peroxidase-labeled antibody technique. The nodules were found to contain a dense population of IgM-bearing lymphocytes and much intercellular IgM. Evidence that the cells were engaged in IgM synthesis was the presence of the immunoglobulin in the perinuclear spaces and endoplasmic reticulum. Most of the IgM lymphocytes also had surface membrane IgM, and both kappa and lambda light chains were found in lymphocytes of individual nodules. Only a few cells containing IgD, IgG, or J chain, and none containing IgA, were found. We conclude that the intestinal lymphoid nodules associated with hypogammaglobulinemic states are populated principally by IgM B-lymphocytes of polyclonal origin.


Dose-dependent alcohol elimination rates of pigtailed macaques.

A macaque having a relatively high daily consumption of alcohol during a 230-day period eliminated alcohol at a higher rate than did a macaque having a low daily consumption of alcohol and 2 control animals.


Vasodilator therapy during coronary artery surgery. Comparison of nitroglycerin and nitroprusside.

Intraoperative hypertension is a common problem in patients undergoing myocardial revascularization. Twenty patients who developed acute hypertension after sternotomy were studied. Ten patients received three doses of intravenous nitroglycerin (32, 64, and 96 mcg. per minute), and 10 patients received nitroprusside, (20, 40, and 60 mcg. per minute). All patients were anesthetized with morphine, diazepam, nitrous oxide, oxygen, and pancuronium bromide. Five patients in each group also received enflurane. The study compared the effects of nitroglycerin and nitroprusside on systemic hemodynamics, myocardial oxygen supply/demand relationships, and ischemic changes on the electrocardiogram. Both drugs decreased preload and afterload in a dose-related manner. Heart rate increased significantly only with the largest dose of each drug. Myocardial oxygen demand was decreased significantly by both drugs, while the coronary perfusion pressure was decreased more by nitroprusside. Both nitroglycerin and nitroprusside improved left ventricular performance. Nitroglycerin improved ST-segment depression in eight of 10 patients; while nitroprusside improved the ST segments in six patients, and worsened the ST segments in three patients. None of the nitroglycerin group had worsening of the electrocardiographic ST segments. These findings demonstrate that both drugs can control intraoperative hypertension and can decrease myocardial oxygen demand. Nitroglycerin was shown to improve ischemic changes on the electrocardiogram more often than nitroprusside.


[Solitary juvenile xanthogranuloma. Apropos of 3 cases].

Three cases of solitary Juvenile Xanthogranulome of the skin are reported, one of them with tumoral appearance. Histologycal pictures were characteristic, except for the tumoral form. Other few cases of this atypical form of Juvenile Xanthogranuloma are reported in the literature.


Acute leukemia following prolonged cytotoxic agent therapy.

1. Nine patients in whom acute non-lymphoblastic leukemia (ANLL) developed following prolonged alkylating agent therapy are described. Five of the patients received no radiotherapy. The conditions treated were: Hodgkin's disease (four patients), primary amyloidosis, primary macroglobulinemia, malignant lymphoma, multiple myeloma, and carcinoma of the tonsil. 2. Prior to the advent of chemotherapy, this complication was not observed in large series of patients with lymphoproliferative disorders and multiple myeloma. However, the medical literature now contains at least 125 other detailed reports of ANLL developing after prolonged cytotoxic agent therapy. 3. Multiple myeloma and Hodgkin's disease, both of which commonly have good responses to chemotherapy, predominate as the underlying diseases. However, 35% of the case reports involve patients with other illnesses, including 12 patients who did not have neoplasms. 4. More than half of the patients developing ANLL have received chemotherapy alone without radiotherapy. 5. At least half of the patients developing ANLL experienced long periods of significant cytopenia during therapy, often with documentation of bone marrow dysplasia. 6. The wide variety of drugs associated with this complication suggests that any cytotoxic agent may be leukemogenic. However, alkylating agents overwhelmingly predominate as the class of compounds which are most often associated with terminal ANLL. 7. The vast majority of patients reported in the literature with ANLL complicating underlying malignancies have received cytotoxic drugs for prolonged periods (median 3 1/2 years) and leukemia developed most commonly 3 to 5 years after the diagnosis of the underlying disease. Most of these patients benefited from therapy and survived longer (median 5 years) than historical control of untreated patients. 8. The leukemogenic potential in man of prolonged cytotoxic agents therapy, especially with alkylating agents, seems to be well established. This evidence admonishes against the prolonged use of these drugs in non-fatal disorders. 9. More accurate assessment of risk: benefit ratios awaits the results of prospective controlled studies. The results of these studies could also lead to significant modifications in recommendations for long-term maintenance therapy with cytotoxic agents.


Effects of insulin infusion on plasma phosphate in diabetic patients.

A clinical association between insulin therapy and hypophosphatemia has frequently been made but a dose-response relationship has not been reported. Furthermore, the rapidity by which hypophosphatemia may be induced following an increment in plasma-free insulin concentration is not well defined. Therefore this study compared the effects of different rates of insulin infusion on the changes in plasma phosphate concentration in ketotic, hyperglycemic diabetic man. Sixteen prospective studies were performed in four insulin-dependent ketotic diabetic subjects. Insulin was infused according to one of four different protocols: high dose (1.0 U/kg/hr), low dose (0.1 U/kg/hr), very low dose (0.01 U/kg/hr) and control (saline only). Plasma phosphate, glucose, and free insulin concentrations were measured sequentially during the 60 min infusion periods. We observed that plasma phosphate concentrations declined significantly only with low-dose and high-dose insulin infusions. The magnitude and rapidity of fall of the mean phosphate concentration were greatest with high-dose insulin infusion. Significant hypophosphatemia can be observed within 30 min following the onset of insulin therapy.


[Pyoderma gangrenosum and IgG-paraproteinemia (author's transl)].

Case history of a 68 years old patient with pyoderma gangrenosum and IgG-paraproteinemia with kappa type light chains. Paraproteins which are observed in pyoderma gangrenosum without overt myeloma could represent early symptoms of plasmocytoma.


Tryptophan genes in Rhizobium--their organization and their transfer to other bacterial genera.

R. leguminosarum trp alleles mapped by R68.45-mediated recombination were located in three distinct chromosomal regions. We isolated three derivatives of R68.45 that carried different trp genes of R. meliloti. Each of the plasmids suppressed all of the R. leguminosarum trp alleles in a particular region. The R-primes were transferred to strains of P. aeruginosa carrying mutations in different trp genes. The plasmid pAJ24JI suppressed trpA, B and F mutants, pAJ73JI suppressed trpC and D and pAJ88JI suppressed a trpE mutant. When the R-primes were transferred to E. coli trp strains they failed to suppress any trp mutants. A derivative of pAJ24JI was isolated which was able to suppress trpA and F mutants of E. coli.


A spectrofluorimetric study of the interaction between virginiamycin S and bacterial ribosomes.

Virginiamycin S (VS, a type B component of the synergistin group of antibiotics) is fluorescent in solution: the fluorescence intensity is proportional to VS concentration. The intensity of VS fluorescence was found to increase upon addition of 50S ribosomal subunits, and this variation (deltaI 416 nm) to be proportional to the concentration of 50S subunits. This new technique was, then, used to measure the binding reaction of VS to ribosomes. Similar patterns of linkage were obtained for ribosomes and large subunits, whereas very little fixation to 30S particles was detected. The binding reaction was virtually instantaneous at any temperature, and, for saturating VS, was not influenced by Mg++ concentration in the range 1 to 20 mM, nor by the replacement of 100 mM K+ with NH+4. The association constant of VS TO 50S particles was found to be KA=2.5 X 10(6)M-1, and from the Scatchard plot a v value of 0.9 was calculated, which points to a stoichiometric reaction leading to 1 mole VS bound per mole of 50S particles. Upon fixation of virginiamycin M (VM, a type A component of the synergistin group of antibiotics), the delta I of the VS-ribosome complex was increased, and a KA=15 x 10(6)M-1 was recorded for the association constant of VS to 50S particles. Such sixfold increase in the affinity of ribosomes for VS may account for the synergistic effect of the 2 virginiamycin components in sensitive bacteria.


The relationship between molecular structure and transformation efficiency of some S. aureus plasmids isolated from B. subtilis.

DNA preparations of the chloramphenicol resistance determining S. aureus plasmids pC194, pC223, and PUB112 can be fractionated by gel electrophoresis into various bands. Electronmicroscopic investigations of these various molecular species obtained with pC194 indicated that, depending on the preparations, 70 to 80% of the molecules were monomers, while the rest consisted of various classes of concatemeric and/or interlocked multimers. Measurements of the specific transforming activity of the various molecular classes indicated that the monomers had less than one thousandth the activity of the multimeric plasmic DNA. pC194 DNA of high specific transforming activity could also be obtained by ligation of HindIII generated monomers into concatemeric DNA.


Specific labelling of replicating SPP1 DNA: analysis of viral DNA synthesis and identification of phage DNA-genes.

Specific labelling of replicating bacteriophage SPP1 DNA can be achieved by infection at nonpermissive temperature of a B. subtilis strain carrying the initation mutation dnaB ts134. Under these conditions host DNA synthesis is reduced by 90 to 95%. This technique was used to identify cistrons of SPP1 involved in phage DNA synthesis and to define intermediates in SPP1 replication.


Genetic exchange in Bacillus subtilis in soil.

Genetically labelled strains of Bacillus subtilis have been shown to exchange blocks of linked genes while growing together in soil. After eight days of incubation, 79% of unselected colony-forming units exhibited a phenotype containing markers from both parents; the parental strains were not detected after the first day of incubation. High frequencies of transformation were also obtained by adding genetically labelled deoxyribonucleic acid to single-strain soil cultures. Observed linkage of genetic markers was greater in soil transformation than in standard laboratory procedures. The results indicate that transformation may play an important role in the adaptation of the Bacilli to their natural habitat.


Regional preference of insertion of Tn501 and Tn802 into RP1 and its derivatives.

The sites of insertion of Tn501 into RP1 and into derivatives of this plasmid that either lack the Tn801 (TnA) element or contain it in a different location have been determined. Similarly, the sites of insertion of Tn802 into a derivative of RP1 that lacks the Tn801 element and into recombinants of this plasmid with Tn501 were determined. 'Hot spots' for insertion were observed with both transposons; but it is clear that a particular DNA sequence is not sufficient to define a 'hot spot', since a particular region does contain many insertions when present in one plasmid but does not do so when part of another.


Murein-lipoprotein of Escherichia coli: a protein involved in the stabilization of bacterial cell envelope.

Two independent mutants of Escherichia coli lacking murein-lipoprotein have been found. One mutant whose mutation was named lpo was subjected to detailed analyses. The absence of both bound and unbound lipoproteins was shown by electrophoretic analysis of 14C-arginine labelled membrane proteins of the mutant. Nor was serologically cross-reacting material detected in the mutant by the Ouchterlony-method. Sequestering magnesium from mutant cell suspensions by ethylenediaminetetraacetic acid caused cell lysis, which was prevented in the presence of 0.5 M sucrose. Incubation in culture media at a very low level of magnesium resulted in the formation of blebs in the mutant. Examination of mutant cells by electron microscopy showed that the outer membrane of the mutant was uneven with small irregular protuberances, some of which pinched off forming vesicles of various sizes. Phosphotungstate used for negative-staining penetrated into the periplasmic space of the mutant cells. The mutants leaked a considerable fraction of their periplasmic enzymes. These physiological and morphological alterations in the lipoproteinless mutant suggest that murein-lipoprotein helps to maintain the outer envelope structure by connecting the outer membrane with murein so that the outer membrane may fulfil its physiological functions as a barrier to the environment.


Characterization of plasmid transformation in Bacillus subtilis: kinetic properties and the effect of DNA conformation.

Transformation of competent cells of Bacillus subtilis with antibiotic resistance plasmid DNA has shown that (a) competence for plasmid and chromosomal DNA develops with similar kinetics; (b) DNA linearized with a variety of restriction endonucleases does not transform; (c) CCC plasmid DNA is inactivated for transformation by a single nick; (d) T4 ligase restores transforming activity to both nicked and linearized DNA; (E) CCC relaxed DNA is fully active in transformation; (f) the DNA concentration-dependence of plasmid transformation is first order; and (g) plasmid transformation proceeds with a low efficiency, requiring the uptake of 10(3) to 10(4) DNA molecules per transformant. Based on this information, a model for the processing of chromosomal, plasmid and transfecting DNA is proposed.


rDNA magnification in D. melanogaster: state of rDNA copies following the first step.

D. melanogaster males of XYbb/O genetic constitution undergoing rDNA magnification were mated singly to XXbb+/O females, yielding XYbb/O male progeny, and to XNO- w sn bb+ females, yielding XYbb/XNO- females. The male and female offspring were scored for the bb+ phenotype. Results show that there is a higher percentage of bb+ flies in the XYbb/O male progeny than in XYbb/XNO- female progeny, in single crosses as well as in the combined data. rRNA/DNA hybridization experiments agree with this observation, by showing that the rDNA content in the progeny of premagnified flies was higher in the sons than in the daughters. These data indicate that the increase of ribosomal RNA genes is not due to a stable event such as an unequal mitotic sister exchange, whereas they do not contrast with the extracopy model.


[Postgastrectomy syndromes. Development of the aspects in past and present (author's transl)].

After gastric operations about 20 to 30% of all patients complain of an abundance of postoperative gastrointestinal and vasomotor complaints. Research into these "postgastrectomy syndromes" is carried out periodically. In the beginning of this century concepts as precipitated evacuation, dumping stomach, too narrow or too wide anastomosis predominate. In the thirties the subdivision into a so-called early and late dumping syndrome follows. The description and treatment of the afferent loop syndrome in the middle of this century suggest the introduction of functional factors into the explanation of the postgastrectomy syndromes. Next comes the recognition of the pathophysiological significance of the regurgitated duodenal contents into the operated stomach. The endoscopic biopsy gives a broad morphological basis. The postoperative alcaline reflux gastritis temporarily ends the development.


[The combination of methyldopa with pindolol in the treatment of hypertension (author's transl)].

32 patients with moderate or severe hypertension (16 men and 16 women, aged 32--75 years) were treated with alpha-methyldopa (daily dose: 750 mg) + placebo for 2 weeks, then with alpha-methyldopa + pindolol (15--45 mg daily) for 12 weeks. These patients had been under alpha-methyldopa monotherapy before the trial with unsatisfactory results. The simultaneous administration of alpha-methyldopa and pindolol considerably decreased the systolic and diastolic blood pressure, both sitting and standing, and the heart rate. The combination of methyldopa and pindolol was significantly more effective than methyldopa alone.


[Crural phleboses. Physiological, diagnostic and therapeutic aspects (author's transl)].

On standing, the crural veins are subject to increased hydrostatic pressures impairing their function as a blood vessel and blood depot. In addition to hemodynamic changes there are shifts in the balance between capillary filtration and reabsorption in the sense of an increase in interstitial fluid volume up to the development of a visible edema. These effects may be compensated partly through the function of the so-called muscle vein pump and by venoconstrictive reactions. Insufficient compensation will entail disorders of cell supply which may lead to chronic venous insufficiency. In addition to clinical investigation methods the bi-directional ultrasonic measurement of flow velocity based on the Doppler principle is relatively simple and suitable for the functional diagnosis of superficial veins. Therapy may be initiated by physicotherapeutic, pharmacotherapeutic and surgical measures.


[A new concept of the pathogenesis of medial dysplasia (author's transl)].

A unifying concept may be set out briefly in the following manner: injurious agents (such as abnormal hemodynamic and/or metabolic conditions--"risk factors for the vessel wall") leads to the transformation of contractile (k) smooth muscle cells into the metabolically more active or "modified" (m) variety leads to an increase in the number of intracellular and extracellular lysosomes (matrix lysosomes) leads to medial dysplasia. The vague concept of a "vessel wall weakness" as the cause of aneurysms, varicose veins etc. has given place to a more precise picture, following the E. M. demonstration of atypical (i.e. dysplastic) collagen fibrils and elastic fibres. The muscle cells of the vessel wall appear to react to the altered conditions with an icrease of lysosomes, and therefore of lysosomal enzymes. The E. M. has also revealed collagenolysis, elastolysis and proteoglycanolysis in the vicinity of matrix lysosomes.


[The surgical treatment of lliofemoral venous thrombosis (author's transl)].

The surgical treatment of acute iliofemoral thrombosis has shown such favorable results that it holds a firm place in the treatment plan. Improvements may possibly be achieved by combining surgical thrombectomy with streptokinase treatment. In certain cases of incomplete thrombectomy or chronic iliofemoral venous thromboses a temporary arteriovenous shunt is indicated which as far as possible should be performed at the level of the adductor canal (Brunner). As a standard method of surgical emboloprophylaxis, the umbrella filter devised by Mobin-Uddin has extensively gained ground today, since with a low rate of complications it offers great safety against recurrent embolism. Among 269 patients treated for acute iliofemoral venous thrombosis, thrombectomy has in addition to shortest hospitalization shown the lowest rate of postthrombotic syndromes and other complications in 172 patients.


[Mammary carcinoma in males (author's transl)].

About 1% of all malignant neoplasms of the mammary gland affect  the male sex. The diagnosis is simple if a general physical examination is carried out independent of the reason for the consultation. The occurrence of mammary carcinoma is more frequent in males with  primary and secondary hypogonadism and after estrogen therapy. The results of operative treatment are the same as for mammary carcinoma in women, i. e. about 45% of the patients survive the five-year limit. For metastasizing mammary carcinoma orchidectomy is recommended, for a fresh relapse, energetic estrogen therapy.


[Spontaneous rupture of a liver adenoma following many years' ingestion of an oral contraceptive (author's transl)].

The case report of a hemoperitoneum from a spontaneously ruptured liver cell adenoma with the histological picture of hepatic peliosis is presented. Clinical aspects of liver cell adenomas and the relationship between oral contraceptives and hepatomas are discussed on the basis of the literature.


[Insulin sensitivity and glucose utilization of patients after total duodenopancreatectomy (author's transl)].

Studies in 7 patients after total duodenopancreatectomy showed a raised insulin sensitivity and a prolonged effect of depot insulin. Insulinemia is not the only reason for the tendency to hypoglycemia shown by these patients, which seems rather to be due to the lack of pancreatic glucagon, which is not available to antagonize the inhibition of glucose release from the liver by insulin (and also in alcohol abuse).


[Iron substitution in postoperative anemia during thromboembolic prophylaxis (author's transl)].

After major operations in 246 patients it was shown that there was no greater blood loss with thromboembolic prophylaxis with heparin and acetylsalicylic acid and healing proceeded undisturbed in view of the demonstrated reductions of hemoglobin and hematocrit which correspond to those of the gynecological operations without thromboembolic prophylaxis, these patients also must be given longterm iron substitution.


[Trauma inflicted on a baby by shaking (author's transl)].

In a baby aged 8 months the forensic post-mortem revealed injuries to the parasagittal pontine veins without visible evidence of traumatic violence. The mother later admitted to having grabbed the baby laterally by the chest and shaken it. This had resulted in an angular acceleration of the head about a transversal axis and, by the lag of the brain due to its inertia, in the fatal vascular lesions mentioned. The twin child admitted to hospital with comparable signs rapidly developed via an acute hygroma a generalized cerebral atrophy such as is actually to be expected in senescence only.


[Effectivity control of medical postgraduate training courses (author's transl)].

A pilot study of 185 participants of a seminar congress on psychosomatic gynecology was intended to examine how far effectivity controls are feasible. The seminar assessment was age-dependent e. g. with regard to presentation of material (p less than 0.01) and practical usefulness (p less than 0.05). The assessment was sex-specific e. g. with regard to presentation of material (p less than 0.01) and congress organization (p less than 0.01). The interest in the seminar differed between gynecologists in general practice and those in clinic or hospital practice. Four fifths of the participants would agree to a detailed questionnaire on seminar assessment. Then the majority would accept effectivity controls of medical postgraduate education with social scientific methods.


[Results of ambulant treatment of vertebral syndromes (author's transl)].

Summary of a Dissertation worked out in a General Medical Practice: 255 patients with vertebral conditions were investigated in a medium-sized general practice on the edge of an industrial town. The treatment and therapeutic results were observed over 2 years. The complaints included pains in the head and neck, shoulder-arm syndrome, back and low back pains including sciatica and sensitivity disorders. The therapeutic results revealed that the general medical practice is in a position to treat vertebral conditions satisfactorily with a minimum of expenditure if the treatment is multicentric and individually designed after a previous exact diagnosis and carried out over the long term if necessary.


[Acute enteritis with "new" pathogens. Yersinia infections (author's transl)].

Infections of the intestinal tract with Yersinia enterocolitica and Yersinia pseudotuberculosis are known the world over. Post-infection reactions like arthritis, erythema nodosum, erythema multiforme, scarlatiniform exanthemata and septicemic types deserve particular clinical attention. The clinical importance of enteric yersinioses has been shown in studies with the identification of significant antibody titers against Yersinia enterocolitis and Yersinia pseudotuberculosis in 6.71 and 4.58% respectively of 4411 patients examined for the first time. It was possible to isolate Yersinia enterocolitica from 5.05% of 616 samples of stool and Yersinia pseudotubercolosis from 0.66% of 136 lymph nodes taken from 751 patients.