Enhancement of intestinal sucrase activity in experimental diabetes: the role of intraluminal factors.

Experimental diabetes alters intestinal mucosal function in a variety of ways including the enhancement of both active transport processes and the activity of brush-border hydrolases. These effects could result from changes in either intraluminal factors (food, bile, pancreatic enzymes) or extraluminal factors (blood flow, hormones, nervous impulses). To determine the role of intraluminal factors we studied the effect of diabetes on segments of jejunum completely excluded from luminal continuity, but with intact blood and nerve supply. Three weeks after construction of Thiry-Vella fistulas in rats, diabetes was induced with streptozotocin. Five days later sucrase activity was measured in both the excluded segment and in the proximal jejunum. Exclusion alone resulted in a 77 per cent decrease in mucosal protein content with no change in sucrase specific activity suggesting simply a diminished number of mucosal cells. Diabetes increased the specific activity of sucrase from 0.0643 mumoles per minute per milligram of protein plus or minus 0.0077 (SEM) to 0.1074 plus or minus 0.0182 (P smaller than 0.05) in the proximal jejunum and from 0.0467 plus or minus 0.0047 to 0.1040 plus or minus 0.0191 (P smaller than 0.02) in the excluded segment. These results provide conclusive evidence that the diabetic enhancement of sucrase activity is independent of intraluminal factors and must be the consequence of extraluminal changes.


Ultrastructural changes in rat optic nerve associated with hyperphenylalaninemia induced by para-chlorophenylalanine and phenylalanine.

The morphologic effects of hyperphenylalaninemia induced by treatment with para-chlorophenylalanine (PCP) plus phenylalanine on optic nerve were studied in developing F344 rats. PCP and phenylalanine were infected daily between days 5 and 20 days of life. At 20 days optic nerve of treated animals, as compared with saline-injected controls, showed enhanced neuroglial activity with broad astrocytic septae and debris-laden oligodendrocytes. In specimens obtained long after treatment with PCP and phenylalanine, continuing gliosis with evidence of focally abnormal myelination and axonal degeneration were observed. The results are consistent with a metabolic insult sustained in early development by astrocytes and oligodendrocytes, and are considered in relation to other work in experimental hyperphenylalaninemia and to human phenylketonuria.


Chymopapain treatment of intervertebral disc disease.

In the first of a two-part study, the authors review the known biochemical, pharmacological, toxicological, and experimental data concerning chymopapain and the intervertebral disc. They describe the action of this proteolytic enzyme, which apparently disrupts the protein mucopolysaccharide component of disc material, most marked in the nucleus pulposus. A rapid conversion to collagen causes a loss of disc space height; toxicity appears to result from alteration of bonding between capillary endothelial cells that in turn produces hemorrhage. Part 2 reviews significant reported results and complications of clinical chemonucleolysis.


Inadequacies and hazards of chymopapain injections as treatment for intervertebral disc disease.

Chymopapain chemonucleolysis was performed on 100 patients with primary lumbar intervertebral disc disease. The results were compared with those of 174 patients who underwent laminotomy, foraminotomy, and discectomy. Primary lumbar intervertebral disc disease was arbitrarily divided into degenerative, complex, previous surgical, and simple disc syndromes. No difference was seen between chemonucleolysis and surgery in the first three divisions; between 55 percent and 60 per cent of patients responded successfully to treatment. In the simple disc division 89 per cent of the surgical and 60 per cent of the chemonucleolysis patients had successful results.


Intervertebral bone implants following excision of protruded lumbar discs.

The authors describe a technique whereby a portion of the lamina removed during exposure of an intervertebral lumbar disc protrusion is implanted in the intervertebral disc space following disc excision. An analysis of 456 consecutive cases operated on by this technique and followed from 1 to 10 years is presented. Of the 418 patients followed, 92 per cent indicated they were able to return to their normal activities and were satisfied with the result. Thirty percent of the patients indicated they had required some conservative treatment for recurrent episodes of back or leg pain. Ten patients had subsequent back surgery; only one implant has dislocated.


The compensation experience of patients with chronic beryllium disease.

The experience of patients with chronic beryllium disease seeking workmen's compensation indicates that the system does not meet its intentions of providing for relief of workers for job-related illness. In the instance of beryllium disease there is undue delay in adjudication of the compensation. This delay has its origin in part from litigation over the diagnosis and disability on the part of private insurers and in part on failure of the IAB to press for findings. Moreover, the process of litigation and delay may produce significant psychological distress. For others the compensation for a chronic disability is inadequate. Whether compensation acts as a system of relief depends on whether the patient has a working husband or wife. Among the women here with beryllium disease, the system worked only to the extent that they could rely on their husbands. Compensation benefits should be provided in accord with rises in the cost of living index. Compensation boards should press for prompt settlement of claims.


Successful separation of Xiphopagus-conjoined twins.

The successful separation of xiphopagus-conjoined twins is described. Such an experience is of course a very gratifying and exciting surgical adventure.


The nature of the transport adenosine triphosphatase-digitalis complex. VIII. The relationship between in vivo-formed (3-H-ouabain-Na+, K+-adenosine triphosphatase) complex and ouabain-induced positive inotropism.

Ouabain interaction with a possible pharmacologic receptor, Na+, K+-adenosine triphosphatase (Na+, K+-ATPase), has been assessed by continual perfusion of canine hearts with various concentrations of both unlabeled and 3-H-ouabain. A positive dose-related correlation between enzyme inhibition, increased contractile force and drug binding to the enzyme has been established. The complex formed between 3-H-oubain and Na+, K+-ATPase in vivo appears to have the same characteristics as that formed in vitro, suggesting that the nature of both complexes is the same. These data are consistent with the concept that Na+, K+-ATPase may be an important pharmacologic receptor for cardiac glycosides.


Ethanol metabolism and liver oxidative capacity in cold acclimation.

Exposure of rats to an ambient temperature of 5 degrees C for 4 to 6 weeks led to a 30 to 80 percent increase in the rate of oxygen consumption and a 50 percent increase in the rate of ethanol oxidation by liver slices, a 50 percent increase in mitochondrial alpha-glycerophosphate oxidase activity of liver, and a 100 percent increase in Na++K+-activated adenosine-triphosphatase, activity. Ouabain, an inhibitor of the Na++K+-activated adenosine-triphosphatase, completely blocked the extra respiration and ethanol oxidation. Dinitrophenol, which increases oxygen consumption and ethanol oxidation by liver slices from normal rats, was ineffective with slices from cold-exposed animals. Ethanol disappearance rate in vivo was also increased by cold acclimation, even though liver alcohol dehydrogenase activity was reduced. It is suggested that increased hydrolysis of ATP by the sodium pump system is responsible for the increased oxygen consumption and ethanol metabolism in the livers of cold-acclimated animals.


Motor control of nuclear bag and nuclear chain intrafusal fibres in isolated living muscle spindles from the cat.

1. The behaviour of nuclear bag and nuclear chain intrafusal fibres in isolated cat muscle spindles was studied by direct observation during repetitive stimulation of the muscle nerve at different stimulus strengths. Contraction of intrafusal fibres and stretch of sensory endings was recorded on film. 2. Tenuissimus spindles are usually operated by a total of four or five fusimotor axons, and the individual action of all of them was studied in many cases. 3. The great majority of fusimotor axons produce activity at one spindle pole only. 4. In about 60% of spindles nuclear bag and nuclear chain intrafusal fibres are selectively controlled by different fusimotor axons, while in one third of these spindles the individual nuclear bag fibres are themselves controlled independently. The remaining 40% of spindles, in addition to some selective innervation, receive one non-selective axon which operates both nuclear chain and nuclear bag fibres though usually only one of the nuclear bag fibres is involved. Selective control is demonstrated in photographs. 5. The thresholds of fusimotor axons selectively innervating nuclear bag and nuclear chain fibres, and of non-selective fusimotor axons are not significantly different. 6. It is suggested that in spindles in which the nuclear bag fibres are controlled by the same axon, it is a 'dynamic' gamma, or occasionally beta, axon. Where one nuclear bag fibre is operated along with the nuclear chain fibres it is controlled by 'static' gamma axon(s), and the other nuclear bag fibre is selectively controlled by 'dynamic' gamma, and perhaps beta, axon(s). Where two nuclear bag fibres are separately operated one may be controlled by 'dynamic' axon(s) and the other by 'static' gamma axon(s). Nuclear chain fibres are always controlled by 'static' gamma axons.


Changes with age in the occurrence of C19 steroids in the testis and submaxillary gland of the boar.

After extraction from the testes of boars of different ages, C19 steroids including 16-androstenes were determined by gas-liquid chromatography. Similarly, 16-androstenes were determined in the submaxillary glands of these boars. A high concentration of testosterone was found in the testes of 84-day-old fetuses, and this might be significant in the differentiation of male behaviour. The amount of testosterone exceeded that of androstenedione during postnatal development, and dehydroepiandrosterone and 5-androstenediol as free and sulphates were found in high concentrations particularly in postpubertal boars, suggesting that the 5-ene pathway for the synthesis of testosterone might be important. There was a change in the predominance of individual 16-androstenes in the testis during development, which closely paralleled the sequence for the biosynthesis of these compounds proposed from previous studies in vitro. Whereas the amount of 5alpha-androst-16-en-3beta-ol exceeded that of 5alpha-androst-16-en-3alpha-ol in post-pubertal testes, 5alpha-androst-16-en-3alpha-ol was predominant in the submaxillary glands at all ages. The high concentration of 16-androstenes found in the mature boar, are discussed in relation to their release as pheromones and as factors responsible for taint in boar meat.


Reciprocal translocations in man. 3:1 Meiotic disjunction resulting in 47- or 45-chromosome offspring.

Five cases of chromosome imbalance resulting from 3:1 disjunction of reciprocal translocations are described. A review of the literature suggests this phenomenon is more common than has previously been recognized.


Estimation of the age at onset of Huntington's disease from factors associated with the affected parent.

In an attempt to relate the age at onset of Huntington's disease to parental factors, the effects of parental onset-age (Po) and the age of the transmitting parent at the birth of a subsequently affected child (Pc) have been examined in a sample of cases ascertained from Victorian kindreds. There was a significant positive linear regression of onset-age on the variable Po-Pc; the result was independent of the sex of affected parent or child. It is suggested that the pathogenetic process is activated in individuals at a fixed time before their genetically determined onset-ages and need not commence at birth. Somatic gene mutations accumulating with age may interact with modifiers activated at initiation of pathogenesis and favour the transmission of genes determining early onset. An important conclusion for genetic counselling is the desirability of parents at risk who intend to have children to plan their families early in life so that the illness will tend to appear in late adulthood in their affected children. The regression equation may also be applied to estimate the risk of inheritance of the disorder and, by taking interfamilial variation into account, appears to have an advantage over the esisting method based on the distribution of onsettages.


A family with apparently sex-linked optic atrophy.

A family is described in which a probable new form of sex-linked optic atrophy was found in eight individuals. Some additional neurological abnormalities were noted. Results of studies of the Xg blood group excluded close linkage between the optic atrophy and Xg genes. As a probable coincidence, Huntington's chorea was found in a side branch of the family.


Phosphorylation of component a of the human erythrocyte membrane in myotonic muscular dystrophy.

Endogenous membrane protein kinase activity in fresh erythrocyte ghosts is altered in myotonic muscular dystrophy. Phosphorylation of erythrocyte Component a, which migrates with an apparent molecular weight of 90,000 to 100,000, is significantly reduced compared to age- and sex-matched controls. The difference in endogenous membrane protein kinase activity in fresh RBC membranes lends confirmation to the suggestion that myotonic dystrophy is a disease of widespread membrane alterations.


Disparity of mixed lymphocyte reactivity to cultured cells of human T and B lymphoid lines.

Repeated attempts with difference assays and experimental conditions failed to detect significant peripheral blood lymphocyte reactivity in one-way mixed lymphocyte reactions to irradiated or mitomycin C-treated cells of the "leukemic" T lymphoid line RPMI 8402. In contrast, consistently high levels of peripheral blood lymphocyte reactivity were obtained with cells of six B lymphoid lines established from the same blood sample used to initiate this T lymphoid line. Although attempts to define the reason why these cultured T cells did not initiate a mixed lymphocyte reaction were not successful, evidence indicates that this inability may be an intrinsic characteristic common to three other T lymphoid lines (MOLT-4, CCRF-CEM, and CCRF-HSB-2), also established from patients with relapsed acute lymphoblastic leukemia.


Effects of sera from tumor-bearing mice on mitogen and allogeneic cell stimulation of normal lymphoid cells.

The mitogens concanavalin A (Con A) and bacterial lipopolysaccharide (LPS) stimulated normal spleen cells of DBA/2J, CBA/J, and BALB/c mice about equally in the presence of either isologous or homologous serum. This system revealed that sera from mice with five different methylcholanthrene-induced rhabdomyosarcomas inhibited mitogen stimulation of normal spleen cells. Sera from mice with a mammaryadenocarcinoma and spontaneous rhabdomyosarcoma were similarly suppressive. In contrast, sera from mice with melanoma were not inhibitory and often enhanced stimulation. Sera from tumor-bearing animals had the same effects both qualitatively and quantitatively on cells from the strain carrying the tumor and on cells from the other two strains. The mixed lymphocyte response of CBA/J times BALB/c spleen cells was affected exactly as were the responses to mitogen by the various sera. Stimulation by mitogen of mouse lymph-node cells and spleen cells with macrophages removed, as well as that of guinea pig spleen cells, was also inhibited by sera from mice with rhabdomyosarcoma and mammary adenocarcinoma.


Comparison of the cardiac output measurements with electromagnetic flowmeter and dye-dilution technique in dogs, with a note on the comparison between radiocardiography and ear-dye method in man.

There are relatively few studies and opinions are still divided as to the agreement between the electromagnetic flowmeter and dye-dilution technique in measurements of cardiac output in animals. Of 22 pairs of cardiac output measurements performed with an electromagnetic flow probe applied to the root of aorta in open-chest, anesthetized dogs and with peripheral venous injection of indocyanine green dye and an arterial cuvette, the measured points fell within the range of plus or minus 20% on both sides of the line of identity in 19 instances. Studied on 8 human subjects with radiocardiography and ear-dye method performed simultaneously with peripheral venous injection of a mixture of R131ISA and indocyanine green, cardiac output given by ear-dye method was higher than that given by radiocardiography by an average of 9 plus or minus 11 (SD)%. Agreement and disagreement in cardiac output measurements given by electromagnetic flow probe, dye-dilution method with arterial cuvette, dye-dilution method with ear-piece densitometer and radiocardiography were discussed.


Congenital left atrial enlargement. A case report with special reference to myocardial fine structure.

A case of intrapericardial congenital left atrial enlargement was reported. The patient is an asymptomatic 3 year-old girl with abnormal cardiac silhouette seen on a chest roentgenogram. Angiography showed marked left atrial enlargement, and the diagnosis of intrapericardial congenital left atrial enlargement was confirmed on operation. Specimens of the atria were electron microscopically examined. Myocardiocytes of the left atrium showed marked increase of the mitochondria and decrease of myofibrils. Abnormal Z bands and disarrangement of myofibrils were often observed. Atrial specific granules in the left atrium were increased in size and number. The right atrium also showed same changes. The pathogenesis of this condition was discussed.


Postmyocardial infarction syndrome.

PMIS can be regarded as a diagnostic entity, although it requires further investigation to reach the conclusion that its nature is immunological.


[Delayed diagnosis of congenital membranous stenosis of the duodenum (author's transl)].

A 12 year old boy with Down's syndrome is described who had a congenital membranous duodenal stenosis. Although the boy had been vomiting from birth and normal feeding was impossible, the diagnosis was made only at the age of 6 years when radiographs were taken because he had swallowed foreign bodies. The malformation was not suspected and no treatment undertaken. Because vomiting increased he was admitted at the age of 12 years to a department for surgical pediatrics. At operation stenosis of the duodenum was confirmed, some coins were removed which had settled proximal to it, the membrane was excised and the duodenum, plit longitudinally, sutured transversely. The postoperative course was smooth and now the boy is very fit.


[Hemodynamic compensatory mechanisms of impaired left ventricular contraction in coronary artery disease (author's transl)].

The effect of chronic coronary insufficiency on the hemodynamics, the geometry and muscle mass of the left ventricle were studied in 30 patients and compared to 13 controls. In these patients the cardiac output was normal in spite of impaired contractility and left ventricular wall movement. The impaired cardiac performance was compensated by 1. hypertrophy and 2. dialatation of the left ventricle. In one-vessel disease of the the coronary arteries left ventricular muscle mass was modestly, but not significant increased. Hypertrophy decreased from +20% in one vessel disease to +10% in three vessel disease. In contrast, left ventricular dilatation increased from +23% in one vessel disease to 43% in two vessel disease and to 70% in patients with sclerotic lesions in three vessels. Left ventricular dilatation seems to be the main hemodynamic compensatory mechnism resulting in a relative increase of the pump function of the heart compared to non dilated hearts. However, dilatation leads in the end-phase to left ventricular failure. By increased wall tension in the presence of impaired coronary blood flow dilatation bears the risk of deterioration of left ventricular function.


Mycoplasmosis in specific-pathogen-free and conventional guinea pigs.

Normal female guinea pigs were examined for organisms of the order Mycoplasmatales. Thirty-nine isolations were made from nose or vagina of 108 guinea pigs. Seven isolates were identified as Mycoplasma caviae, 9 were unidentifiable mycoplasmas, and 23 were identified as nonsterol-requiring acholeplasmas.


Multiple vascular and gastric cannulation of swine for studies of gastrointestinal, liver, and peripheral tissue metabolism.

The implantation of multiple chronic indwelling vascular cannulas and of a gastric cannula into swine was described. Technics for housing, care, and handling of the animals pre- and post-surgically were established to reduce the incidence of infection and to allow collection of urine and feces in metabolic studies. This regimen has been used in 20 gilts to study absorption, tissue distribution, metabolism, and excretion of nutrients. On the average, the cannulas remained patent for 4 wk.


Fibrous long spacing type collagen fibrils in the glomeruli of experimental amyloidosis in rabbit.

Fibrous long spacing type collagen fibrils were observed in the glomeruli of experimental amyloidosis induced by either injections of casein or prolonged sensitization of Arthus type tissue antigens in the rabbit. These fibrous long spacing type fibrils were admixed with amyloid fibrils which accumulated both in nodular and diffuse deposition, but they were observed also in irregularly thickened capillary basement membranes and mesangial areas, where amyloid did not deposit. The periodicity of these fibrous long spacing fibrils was approximately 1200 , and nine symmetrical intraperiodic bands were obviously discerned within each period.


Repeated pulmonary thromboembolism in rabbits.

Ten rabbits received 24 to 76 intravenous injections of finely divided thrombi prepared by a modification of Chandler's apparatus. Eight rabbits were killed soon after the last injection (group A) and two rabbits were allowed to survive for 4 months after the last introduction of thrombi (group B). Ten rabbits received repeated saline injections only, and six animals underwent no manipulation whatever. Six test rabbits and six control rabbits underwent catheterization of the pulmonary artery. The pulmonary arteries of each lung received injections of radiopaque material and were x-rayed; multiple blocks were selected from each lobe of each lung, cut, and stained with Weigert's elastic Van Gieson's stain, which permitted measurement of arterial medial thickness. Sections were also stained with hematoxylin and eosin and Martius scarlet blue. The results of catheterization showed that only mild pulmonary hypertension had been induced. Histologically, thromboemboli had become incorporated into the wall of the arteries. Concentric intimal thickening included an "onionskin" arrangement and was more prevalent than eccentric configuration. Medial hypertrophy of almost all vessels was found. The onionskin arrangement in an occasional precapillary vessel was also encountered. More severe histologic grades of pulmonary hypertension were not seen. The two group B animals showed recent thrombi, which suggested that once intimal thickening had occurred the process of fresh thrombotic superimposition continues, resulting in progression of the lesions. The experimental findings were compared with 13 patients (thromboembolic pulmonary hypertension (eight) and primary pulmonary hypertension (five)) and with 181 patients reported in the literature. Features such as the onionskin type of intimal thickening in muscular arteries and precapillary vessels have been suggested as points of distinction between these two conditions. These features have been reproduced in these experiments. Despite the fact that more severe histologic grades of pulmonary hypertension were not produced, it is suggested that these experiments lend support to the concept that primary pulmonary hypertension may have a thromboembolic etiology in at least some patients.


[Exploration of parotid saliva proteins by means of one-and-two-dimensional immunelectrophoresis, immunodiffusion and discelectrophoresis (author's transl)].

The protein composition of human parotid saliva was explored by means of one- and two-dimensional immunelectrophoresis as well as by a modified Ouchterolony-technique and discelectrophoresis, where usually at least 14 components of parotid-saliva-proteins can be differentiated. According to the results of immunelectrophoresis and discelectrophoresis, the kind and number of protein components are interindividually constant, yet, there are great interindividual differences concerning the concentration of the single components.


[Toluidine blue staining in laryngeal diseases (author's transl)].

The authors present the results of 83 consecutive in vivo stainings with toluidine blue in various laryngeal diseases. Thirty one (86%) of the 36 malignant tumors showed positive staining. (95% confidence limits: 70-95.) It is concluded that malignant tumors will nearly always fix the dye, and that a negative staining test seems to be evidence against cancer. (Predictive value of negative test: 0.89, 95% confidence limits: 76-96.


[Cyano-acrylate glue in tracheal surgery (author's transl)].

Butyl-2-Cyanoacrylate-glues are a valuable addition to the usual suture materials. Uner strict observance of the instructions (Contzen 1968) and application of small amounts which must not enter the wound, these glues can be successfully used in combination with suture material for the adaptation of flaps, the closure of stitch canals or for securing of suture lines. The successful use in surgery of the lung and trachea confirms our results (v. Windheim 1968, 1969, Häring 1968, Heiss 1968).


[Leeches in the respiratory system (author's transl)].

The leech as a foreign body and parasite in the human respiratory tract occurs principally in the Mediterranean countries, in Africa and Asia. It reaches the respiratory tract when water is drunk directly from rivers, lakes, etc. Ignorance of this fact may cause diagnostic difficulties leading to errors in treatment. Anaemia and respiratory obstruction due to leeches cause danger to health and life, especially in children. Fatalities have been known. Treatment consists of endoscopic removal of the parasite, which may be technically difficult, especially when the leech is in the region of the larynx and thus presents dramatic conditions for the procedure. A series of 120 cases treated in Algeria between 1962 and 1971 is presented.


[Tympanoplasty after previous mastoidectomy (author's transl)].

Suppuration in ears suffering from a central perforation of the ear drum can frequently be stopped by mastoidectomy. This previous operation prepares ears for later tympanoplasty. 64 ears (55 patients) were treated by this way. Suppuration ceased in 47 ears. Spontaneous closure of the perforation could be seen in 7 cases. 23 ears underwent tympanoplastic procedures, always during a second intervention, 17 patients did not want further operations after the suppuration of their ears had stopped. Another 17 ears continued to reveal suppurative secretion in spite of mastoidectomy, mostly because of severe infection (resistant bacteria) or of insufficient mastoidectomy.


[The concept of endaural tympanoplasty for severe congenital atresia auris (author's transl)].

The recommendation of a strictly endaural approach to the tympanic cavity in congenital atresia is based on a series of 26 cases of severe malformations (grade II and III). Two bony ridges at the lower edge of the atresial plate and the deep auricular artery served as landmarks. A bony posterior canal wall was always conserved or reconstructed. There was no collision with the facial nerve. The reobliteration of the new external auditory canal was avoided by four means: sufficient resection of both overlying soft tissue and the parotid gland, insertion of auto- or homologous cartilage into the anterior canal wall, Z-plasty of the buccal skin, and delayed implantation of split skin. The average gain of air conduction was 19 dB IN 14 controlled ears.


[The operative cavity in the treatment of congenital atresia (author's transl)].

In the treatment of the various malformations of the external and middle ear (atresia of the bony canal, malformed ossicles, reduced volume of the middle ear in varying degrees, atypical course of the facial nerve), the indirect approach to the middle ear via the antrum appears to be the safest operative procedure for a tympanoplasty in cases of congenital atresia. A wide open external canal is required for a permanently successful hearing result. A special double plasty using skin and periosteum for the anterior canal wall has proved to be the method of choice.


[Evidence of viral aetiology in exudative otitis media in childhood (author's transl)].

Many clinical observations point to a primary viral cause in exudative otitis media. This seromucinous inflammation may then develop into a purulent inflammatory phase as a result of subsequent bacterial infection. The aetiology of otitis media may thus be viral, viral bacterial or bacterial. Viruses and bacteria multiply in a different manner within the organism. They also give rise to different defence reactions and physical signs of their different pathogenic effects. Viral otitis is characterised by proliferative tissue changes, such as telangiectatic granulations, adhesions, cholesteatomas and limitation of pneumatisation of the mastoids. Destructive tissue damage is predominant in bacterial infections, e.g., tympanic perforations and bone destruction. 100 children were examined virologically during acute exudative otitis media and in the presence of a cholesteatoma. Viral aetiology was proved in many cases and viral antigens were demonstrated in the cholesteatomatous material.


[Spontaneous bilateral carotid-cavernous-fistula (author's transl)].

There is reported about the rare case of a spontaneous bilateral carotid-cavernous-fistula. We have to deal with a 61-aged woman with insignificant troubles taking a good-natured course. The bilateral carotid-cavernous-fistula-cases stated in the literature has got assembled, where it is remarkable that 60% of these cases occured spontaneously. In the contrary the spontaneous unilateral carotid-cavernous-fistulae are present in 16-23% of cases.


[Light and electron microscopy of human vocal muscle in recurrent laryngeal nerve paresis (author's transl)].

In longstanding recurrent laryngeal nerve paresis with parmedian fixation of the vocal cord the fine structure of the vocal muscle is surprisingly well preserved. Though there are in part bundles of atrophic muscle fibers and increased connective tissue, the normal ultrastructure of the remaining muscle and of the myelinated nerves remains always intact. It is assumed that the vocal cord is prevented from regaining its motility both by the increased connective tissue which misdirects the nerve fibers and by irreverisble changes of the cricoarytaenoid joint. The results are discussed in relation to attempts of reconstructive surgery of the recurrent laryngeal nerve as well as various problems in the neurophysiology of the laryngeal muscles.


[Quantitative distribution of the protein fractions in human parotid saliva before and after gustatory stimulation in disc electropherograms of various polyacrylamid gel systems (author's transl)].

Discelectrophoresis was carried out with unstimulated and stimulated human parotid saliva from 11 healthy persons at the age between 27 and 61 years. Electrophoresis was made in alkaline and in acidic gel systems. Twenty-two protein peaks were found in the electrophoretic patterns. The quantitative evaluation of Disc Electropherograms was effected by means of microdensitometric analysis with integration. No significance of electrophoretic patterns between unstimulated and stimulated human parotid saliva was observed.


Ultraviolet-inactivation of conidia from heterokaryons of Neurospora crassa containing uv-sensitive mutations.

The effect of three UV-sensitive mutations of Neurospora crassa, upr-I, uvs-4 and uvs-6, on the ultraviolet-inactivation of conidia from two-component heterokaryons was investigated. In two-component heterokaryons with wild-type sensitivity to radiation inactivation, all three conidial fractions exhibited similar ultraviolet-inactivation curves. Each UV-sensitive mutation studied uniquely modified the ultraviolet-inactivation curves of conidia from two-component heterokaryons. In heterokaryons heterokaryotic for upr-I, the upr-I mutation was recessive and the repair function determined by the wild type allele was functional to some degree in homokaryotic upr-I conidia. All three conidial fractions of heterokaryons containing upr-I in both components showed increased sensitivity to ultraviolet light. The uvs-4 mutation was recessive and resulted in conidia with increased UV-sensitivity only when included in both components of a heterokaryon. Homokaryotic uvs-4 conidia, which arose from heterokaryons containing both uvs-4 and wild-type components, exhibited wild-type survival. Therefore, as with upr-I, there was a carryover the repair capability to conidia which were genetically UV-sensitive. The uvs-6 mutation, when included in one component of a two-component heterokaryon, resulted in increased UV-sensitivity of both heterokaryotic and homokaryotic uvs-6 conidia. When both components contained uvs-6, the UV-sensitivity of all three conidial fractions was increased and all showed similar inactivation curves. Thus, as with upr-I and uvs-4, there was a carryover of the wild-type repair capability to genetically uvs-6 conidia. Heterokaryon tests for complementation between two non-allelic UV-sensitive mutations showed that in heterokaryotic conidia, complete complementation occurred between upr-I and uvs-4.


Evolutionary implications of different types of microbial enzymology for L-tyrosine biosynthesis.

Several patterns of enzymology for L-tyrosine biosynthesis exist in modern microorganisms, each differing in the apparent degree of regulatory efficiency. The extent of pathway evolution in a particular organism may reflect the relative selective pressure for regulation encountered in different ecological niches.


Laparoscopy: routine pneumoperitoneum via the posterior fornix.

To induce pneumoperitoneum for laparoscopic examination, a transvaginal route and a modified Verres needle were used in an effort to reduce the failure rate of the subumbilical route and to avoid some of its dangers. The technic not only reduces the rate of complications, but its precision and simplicity make it easier to learn and execute.


Development of Na+-K+-ATPase in neonatal rat brain synaptosomes after perinatal protein malnutrition.

Four protein dietary groups of rats were used in this study, namely: 27% casein diet fed throughout gestation and lactation (group C-C); 27% gestation, 10% lactation (group C-D); 10% gestation, 27% lactation (group D-C); 10% throughout gestation and lactation (group D-D). Mean body weight of group D-D at warning was 19 g compared with 59 g for group C-C. The specific activity of Na+-K+-ATPase in isolated synaptosomes from cerebral and cerebellar tissues increases throughout the lactation period. At 1 and 7 days of age no differences in Na+-K+-ATPase activity are noted in the brain regions of Groups C-C and D-D. At 14 and 21 days, however, the specific Na+-K+-ATPase activity was significantly reduced in isolated synaptosomes from both brain regions of the protein-deprived group. ATPase activity in cerebellar synaptosomes from dietary exchange groups (C-D and D-C) developed to the same extent as that of the control group (C-C) after 21 days of lactation. ATPase activity in the cerebral synaptosomes of the dietary exchange group (C-D) did not develop to the same extent as that in the control group (C-C) and the other dietary exchange group (D-C).


Contractile and histochemical properties of regenerating cross-transplanted fast and slow muscles in the rat.

The soleus (SOL) or extensor digitorum longus (EDL) muscles of month-old rats were denervated for 14 days and then cross-transplanted so that the fast muscle was placed into the bed of the slow muscle and vice versa. At 17, 30, 60, and 90 days the transplants were tested for certain contractile and histochemical properties. By 90 days the cross-transplanted SOL showed complete conversion of the full contraction time and nearly complete conversion of the half relaxation time to those of the normal EDL. In contrast, the contraction and relaxation times of the cross-transplanted EDL became considerably slowed, but did not attain the values of the normal SOL. Histochemical staining for ATPase and SDH activity demonstrated similar transformations of fiber types. The degree of transformation of twitch and histochemical characteristics in cross-transplanted muscles was greater than the values reported after cross-innervation of the same muscles. The cross-transplantation model has certain advantages over nerve cross-union experiments because the cross-transplanted muscle is placed in the normal functional environment of the other muscle.


Genetic evidence on the organization and action of the qa-1 gene product: a protein regulating the induction of three enzymes in quinate catabolism in Neurospora crassa.

The first three reactions in the catabolism of qainic acid in Neurospora crassa are under the genetic control of the qa gene cluster. This cluster consists of three structural genes encoding three inducible enzymes plus a regulatory gene (qa-1+) whose diffusible product apparently acts in a positive fashion to initiate coordinate synthesis of the three enzymes when an appropriate inducer is present. Genetic and biochemical evidence for both complementing and temperature-sensitive qa-1 alleles indicates that the product of the qa-1+ gene is an oligomeric (multimeric) protein. On the basis of cis-trans tests of appropriate double mutants (plus genetic mapping data for temperature-sensitive mutants), at least certain constitutive mutants (which produce all three qa enzymes in the absence of an inducer) are mutants in the regulatory gene and not in controlling elements such as initiators. The detection of stable (non-revertible) qa-1 intralocus deletion (multisite)mutants provides additional evidence for positive regulation in the qa system. Extensive genetic recombination data provide evidence that the two types of qa-1 mutants--slow-complementing (qa-1-s) and fast-complementing (qa-1-f)--map in discrete, non-overlapping segments of the qa-1 locus. These two distinct types of mutants are hypothesized to produce altered regulatory protein molecules that fail to interact either with a DNA initiator site (qa-1-s types) or with an inducer (qa-1-f types). The striking similarities between the qa system in this lower eukaryote and certain prokaryote operon systems are discussed.


Enhancement of somatomedin titers of normal and hypopituitary sera by addition of L-triiodothyronone in vitro at physiological concentrations.

Somatomedin potencies of sera were assayed by following sulfation of mucopolysaccharides in chick embryo sterna in vitro. Apparent potencies of sera from hypophysectomized rats, maintained on a low-iodine diet, were restored to levels above normal by addition to the incubation medium of L-triiodothyronine at 10-7 mol/liter of serum. The potencies of normal rat, human, and fetal calf sera were raised 1.3- to 3-fold by addition of triiodothyronine at 10-9-10-7 mol/liter of serum. L-Thyroxine was about 10 times less effective than triiodothyronine. Triiodothyronine alone did not stimulate sulfation to nearly the same extent as triiodothyronine plus serum, even at higher concentrations. Serum could not be substituted in this system by any of six purified hormones, nor by trace metals or amino acids not included in the incubation mixture. It is concluded that triiodothyronine, in combination with a factor in serum, causes a rapid stimulation of sulfation in chick embryo cartilage, and that thyroid hormones may be involved in the action of normal serum on this tissue.


Induction by RNA of inositol independence in Neurospora crassa.

The effect of purified wild-type RNA (allo-RNA) on genetic reversion of inositol-requiring mutant 89601 of Neurospora crassa is described. The mutant (inos minus) strain, on treatment with the wild-type RNA preparation, was found to revert to wild type (inos+) in significant numbers. RNA from the mutant (iso-RNA) and allo-RNA digested by RNase were ineffective in causing genetic reversion at the inositol locus. The allo-RNA-induced revertants were stable and showed a Mendelian transmission of the inos+ character.


Effect of estrogen treatment on DMBA-induced mammary tumor growth and biochemistry in intact and diabetic rats (38535).

Sixty percent of DMBA-induced mammary tumors in Sprage-Dawley rats regress after the animals were made diabetic by treatment with streptozotocin. Administration of estradiol valerate, 1 mg/wk/animal, caused regression of 75% of tumors in intact rats but regression of all tumors in diabetic rats. Estrogen treatment appeared to enhance the effects of diabetes, which by itself resulted in decreased activities of glycolytic enzymes. A role of insulin in growth of DMBA-induced mammary tumors may be warranted.


Capillary resistance and back pain.

A rapid clinical and epidemiological method of grading Capillary Resistance (CR) based on the appearance of petechiae following negative pressure on the skin of the forearm is described, and the results of testing 469 postmen aged 22 to 63 years are given. CR is shown to be increased in men who have had back pain within 24 hours of testing and no difference was found between men who had had back pain in the past and those who denied ever having had back pain. A separate series of 35 post-laminectomy patients examined at least 10 months after operation and who were shown to have disc disease at operation and/or on myelogram were found to have low CR. This work suggests that the changes involved in disc disease are not limited solely to the discs, but may involve collagen/elastic tissue or ground substance elsewhere as for example in this case when detectable in a test on the forearm. Secondly, it is suggested that CR grading could be a helpful discriminating test for 'disc disease' among those presenting with back pain of undetermined diagnosis.


[Side effects of antibiotics].

The clinically severe and newer forms of antibiotic side effects are reviewed. The study covers the following antibiotics: penicillins, cephalosporins, aminoglycosides and polymyxins, tetracyclines, chloramphenicol and thiamphenicol, macrolides and lincomycin, rifamycins and sulfonamides. Special reference is made to (1) hematologic side effects, and (2) general evaluation of drug reactions. The relationship between reaction time and clinical symptoms is of particular practical significance.


Scalded skin syndrome: Diagnosis, differential diagnosis, and management of 42 children.

The bacteriologic, epidemiologic, clinical, and diagnostic findings and management of the scalded skin syndrome (SSS) in 42 children are reported SSS may present in one of three ways: (1) Ritter's disease in infants, characterized by an acute, generalized bullous dermatitis simulating the appearance of scalded skin, followed by exfoliation; (2) Lyell's disease, or toxic epidermal necrolysis (TEN), in children or adults, with scalded skin and bullae followed by extensive exfoliation; or (3) a nonstreptococcal scarlatiniform eruption, or staphylococcal scarlet fever, manifested by a generalized scarlatiniform erythema ans subsequent minimal to moderate fine desquamation. Staphylococcus aureus was isolated and implicated as the causative agent in 32 of the 42 children; nine of the other ten children had received a drug or vaccine preceding their rash. SSS in children has increased in frequency recently, is usually due to S aureus infection with potential epidemic aspects, can be recognized easily by its unusual clinical features, and has an excellent prognosis with appropriate management.


Tinea capitis in Pondicherry (South India).

Amongst 125 cases of tinea capitis, representing 12-5% of dermatomycosis, about 9% showed kerion-like lesions and 13% had tinea corporis and/or tinea unguium. Eighty four percent cases were mycologically positive, yielding Trichophyton violaceum (84%) or T. tonsurans (16%).


Late complications of surgery for coarctation of the aorta.

The problem of the patient who has had one operation for coarctation of the aorta and who then requires another because of a late complication at or near the coarctation site is a demanding one. The safety of aortic cross-clamping at the second operation depends on the adequacy or otherwise of the collateral circulation, and this in turn depends on the presence or absence of residual or recurrent aortic obstruction. Three illustrative cases are described in which there was complete, incomplete, and no aortic obstruction respectively at the time of reoperation, two of the cases presenting the additional complication of local aneurysm formation. The various aspects of management of such individuals are discussed, and the relevant literature has been reviewed in an attempt to provide a systematic approach to these difficult patients. The methods for assessing collateral circulation are both clinical and radiological with trial clamping of the aorta and pressure measurement as the most reliable ultimate test. A pressure of 50 mmHg in the distal aorta is accepted as indicating an adequate peripheral circulation, but it is recommended that the trial clamping should always include both the left subclavian artery and any particularly large local collaterals. The use of a perfusion technique to sustain the distal tissues is also recommended, although local bypass shunts have a place when their use is dictated in the interests of safety for the patient.


[Polychlorodibenzo-p-dioxins (author's transl)].

Polychlorodibenzo-p-dioxins (chlorodioxins) appear most frequently by heating of chlorophenols in alkaline solution specially when producing organic derivatives. Consequently chlorodioxins may contaminate several industrial chemical products largely used, for instance, as pesticides. Occasionally, chlorodioxins are also synthesized from chlorophenols or their derivatives in situ during industrial processes. Chlorodioxins are the cause of chloracne and chick edema which killed thousands of broiler chickens in the U.S.A. Furthermore chlorodioxins seem to be foetotoxic possible even for man. The present paper is the first part of our work. It is a review of the chemical and toxicological properties of chlorodioxins. We hope to publish later a review of analytical methods and the results of our analyses.


Short-term oral and dermal toxicity of MCPA and MCPP.

The herbicieds 2-methyl-4-chlorophenoxy acetic acid (MCPA) and 2-(2-methyl-4-chlorophenoxy) propionic acid (MCPP or mecoprop) were tested for 90 days in rats. The compounds were added to the diet at levels of 0, 50, 400, and 3200 ppm. Growth, food intake, mortality, haematology, blood and liver chemistry, organ weights and histopathology were used as criteria. The main effects of both compounds were growth retardation and elevated  relative kidney weights at levels of 400 ppm and more. The 50 ppm dose level can be considered as a no-toxic-effect level in the 90-day study. In subacute dermal studies in rabbits during 3 weeks the dosages were 0, 0.5, 1.0 and 2 g MCPA or MCPP per kg body weight. Therafter followed a recovery period of 2 weeks. Growth, mortality, skin reaction, haematology, organ weights (MCPP) and histopathology were recorded and determined. Both compounds caused slight to moderate erythema at all dose levels, whereas elasticity of the skin was decreased. In both experiments the skin returned to normal during the recovery period. Weight loss was observed at all dose levels. In the MCPA experiment high mortality and histopathological changes in the liver, kidneys, spleen and thymus were recorded at the two highest dose levels. The cause of this could have been either the treatment with MCPA or a dysbacteria infection which developed during the experiment. Oral and intraperitoneal acute toxicity of MCPP for the rat were found to be 1210 and 402 mg/kg, respectively. After a single oral or dermal application of MCPA to the rabbit, the compound was excreted unchanged in the urine.


Ultrastructural studies on the myocardial capillaries of the experimentally lathyritic rat, protective effect of certain flavonoids.

The ultrastructure of rat myocardial capillaries was studied in the course of experimental lathyrism. Endothelial cells were hypertrophic, with a sinuous profile of the plasma membrane facing the lumen and with a consistent increase of pinocytotic vesicles; the nuclei were irregular in shape; ATPase activity was no more demonstrable. Therefore, various and well distinct structural endothelial mechanisms seem to be primarily involved, causing an alteration of the dynamics of transcellular exchanges and of the permeability of the vascular wall. Simultaneous treatment with certain flavonoids, (O-(beta-hydroxyethyl)-rutosides and Na(+)-epicatechin-2-sulfonate), resulted in a less pronounced alteration and a more rapid recovery. The possibility of the existence of a common site of action of lathyrogens and flavonoids is raised in the discussion.


[Finding of ganglion cells in the mucosa of the colon, sigmoid flexure, and rectum (author's transl)].

The ectopic position of the ganglion cells of Meissner's plexus in the basal and central portions of the mucosa in the colon descendens and sigmoid flexure, as they were found by Stöhr in humans, by Ohkubo in monkeys, and by Meier-Ruge in neuronal colon dysplasia, can be considered a relatively frequent finding. The present authors also observed the cells in human biopsy material. The same position in the rectal mucosa, frequently seen in Morbus Down, seems to be a rare occurrence. The clinical relevance of an ectopic position of ganglion cells is not yet known.


[Insulitis and peracute diabetes mellitus (author's transl)].

We report on the case of a 10-month-old infant with Down's syndrome and acute insulin-dependent diabetes mellitus, who died of hyperosmolar diabetic coma 4 days after admission to the hospital in spite of intensive therapy. Characterizing this disease, a lymphocytic infiltration of the islets of Langerhanns with destruction of the islets was found. The specific localization of the inflammatory infiltrates as well as the histological findings correspond with experimental immune-insulitis in aminals, suggesting that immunological mechanisms play an essential pathogenic role. Virus etiology, diagnostic procedures, and therapeutic approaches are discussed.


[Studies on tryptophan metabolism in untreated phenylketonuric patients].

The products of the oxidative degradation of tryptophan via the kynurenine pathway were quantitatively determined in the urine of ten untreated patients with phenylketonuria, aged 4--35 years. All the patients were sevrely mentally retarded. The results of the analysis suggest a division of the patients into two groups, A and B. The patients of group A showed a basal urinary excretion of kynurenine, kynurenic acid, 3-hydroxykynurenine and xanthurenic acid which lies in the lower part of the normal range. The increase in excretion of tryptophan metabolites under tryptophan loading was, however, significantly less than in controls. On the average, only 0.63 % of the load was excreted in the form of these assayed metabolites; in contrast, the control value is 1,13 %. In group B, the rate of excretion was higher than normal under basal and loading conditions. The post-tryptophan excretion was four times greater than that of controls (4.64 %). 3-hydroxyanthranilic acid could only be detected in group B after loading. The metabolite 8-hydroxyquinaldic acid, which is supposed to be an abnormal metabolic product of tryptophan, was excreted in milligram amounts. The analysis of the metabolites of 3-hydroxyanthranilic acid showed that the excretion of N1-methylnicotinamide and N1-methyl-2-pyridone-5-carboxamide was within the normal range. The excretion of nicotinic acid and its amide was sporadic in both the patients and controls. Other theoretically possible metabolites in the pathway could not be found. A number of unidentified metabolites could be detected by thin-layer chromatography in the basal state. The excretion of these metabolites was greatly augmented after tryptophan loading. Other substances which were not detectable in the basal state became evident on loading. A number of these metabolites are characteristic either of group A or B. The structural identification of one of the new products has been hindered by its instability. A stable cleavage product was identified as omicron-aminoacetophenon by mass-spectroscopy. This metabolite its typical for group B. The possible influence of the blood phenylalanine on the metabolism of tryptophan in phenylketonuria is discussed.


[Study of 2 strains of viruses isolated from black-tailed gulls in the Primorsk region in autumn 1972].

Two virus strains identified as paramyxoviruses have been first isolated in the Premorskiy region from Larus crassirostris feeding on food wastes from a fur farm.


[Status of herd immunity to poliomyelitis in children in the Moscow region].

The paper presents the results of 3-year observations of the status of herd immunity to poliomyelitis in 7 towns of the Moscow region. In individual years antibody for poliomyelitis virus of 3 types was found in 63-74% of the examined children and from 2.7 to 7.5% of children were triple-negative. Insufficient levels of herd immunity to poliovirus types I and III were found. Some factors are analysed which could have some influence on the decline of herd immunity.


[Serological study of nontriturated fleas following preliminary cultivation of the plague microbe].

Under experimental conditions there was shown a possibility of serological study of nontriturated fleas for the presence of Past. pestis. Hottinger's broth with gentian-violet ((0.0003%) sodium sulfite (0.03%) and a surfactant--O (see article)-7 (3%) served as the growing medium. After the nontriturated fleas were grown for 48 hours at 37 degrees C the capsular antigen was detected with the aid of the passive hemagglutination and antibody neutralization tests. Detection of the capsular antigen in the growing medium pointed to the presence of Past. pestis in the fleas. To test the serological method of study the nontriturated fleas, the insects were collected in the colonies of Rhombomys opimus Licht. at the epizootic territory. The collected fleas were divided into portions (each portion contained not more than 20 fleas). Half of the portions of each collection was studied after trituration by the usual bacteriological method, and another--by serological method without trituration of the insects. In examining the parallel portions (a total of 2400 portions, about 32 000) it appeared that positive results were obtained by both methods with about the same frequency.


[Clinical study of the efficacy of staphylococcal anatoxin in relation to the phage group to which the staphylococcal strains--the causative agents of infection--belong].

In comparing the bacteriophage group reference of the strains of pathogenic staphylococci isolated in case of postoperative complications from children given staphylococcus toxoid for prophylactic purpose and from control group it was found that prophylactic vaccinations of staphylococcus toxoid created the most intense immunity against staphylococci of the I bacteriophage group. There was found no significant association between the efficacy of the therapy and bacteriophage reference of staphylococci--the causative agents of the infection.


[Epidemiology, terminology and statistical classification of intestinal infections].

On the basis of critical survey of literature data and analysis of morbidity of intestinal infections in 5 towns of Donbass for 20 years and also of studying 5148 case histories an attempt is made of rational explantation of the causes of growth during the last years of the incidence of Sonne dysentery salmonelloses, escherichioses and other diseases caused by conditionally-pathogenic microorganisms. The importance of improvement of nomenclature and of statistical classification of intestinal infections was demonstrated.


[Results of typing staphylococci isolated from cows and their milk products using the basic set of phages and local phages].

The basic set of phages recommended for typing staphylococci from cattle and also of local phages were approbated. Staphylococci cultures (950 in all) isolated in various regions of the Soviet Union from milk, milk produce and from cows suffering from mastitis were studied. Percentage of cultures typed by the phages of the basic set proved to be 78.3. Thirty different phage patterns were revealed among staphylococcal cultures lysed by phages. Lytic activity was the greatest in phages of group IV of the basic set. It is suggested that local phage 34k can be used as an additional phage permitting to subdivide the prevailing phage types within group IV into a number of new ones.


[Serologic studies in viral hepatitis].

Comparative studies of sera from 710 patients with viral hepatitis and contacts were made during the 1958-1973 period for hepatitis antigens (Au antigen and the Botevgrad antigen). The percentage of virus hepatitis in patients positive for the Au and the Botevgrad antigens varied in different years. The percentage of those positive for the Au antigen ranged from 50 in 1958 to 8.8 in 1970-1971, while for the Botevgrad antigen--it ranged from 32.6 in 1962-1963 to 6.1 in 1966. In case of contacts, mostly in the 7-14 age group the sera positive for the Au antigen were found in a low percentage (2.09 percent) of cases; as to the Botevgrad antigen, 20 persons were found positive during various epidemics (55 percent). Simultaneous presence of both antigens was found in 4 of the 710 patients with virus hepatitis (0.56 percent), and in 2 of 431 contacts (0.46 percent).


[Isolation of A. boydii from the soil of the Tadzhik SSR].

The authors present a detailed description of a pathogenic strain of Allescheria boydii Shear, isolated from a soil sample obtained from the karst cave in the vicinity of the Iskan derkerev lake, the Tajik SSR (the morphology of the conidial and ascosporic stages of the fungus, its physiological and biochemical activity and experimental pathogenicity). Data on the existence of this causative agent as a saprophyte in the soil of various continents are also given. A conclusion was drawn that A. boydii was an unpretencious geophilic fungus readily adaptible to the environmental conditions, much more widespread in nature than believed formerly.


[The epidemiologic significance of tuberculosis mycobacteria of the avian type].

Reaction to intradermal injection of tuberculin from Mycobacteria tuberculosis of the avian type proved to be negative in all the 505 students examined who never came in contact with fowl farms. Of 738 local residents it was found to be positive in 23.8% and of 320 workers of fowl farms--in 54.5% of cases. In response to the injection of Koch tuberculin and PPD-L the number of positive reactions in all the mentioned groups constituted 69-80%. A conclusion was drawn on the epidemiological danger of Mycobacteria of the avian type for the workers of fowl farms and, to a certain degree, for the surrounding population.


[Factors influencing transduction of genetic determinants of penicillinase activity and pathogenicity in staphylococcus aureua. II. Antiphage activity of acridine derivatives].

Acridine dyes examined earlier (acrichine, acridine orange, proflavine and rivanol) and newly-synthesized preparations (acridines No. No. 37--40) were studied in the capacity of nonspecific agents influencing the lytic cycle in development of staphylococcus phages. Acrichine and acridine No. 37 failed to prevent lysis of the indicator staphylococcus cultures (strains 16/160 and 8325) by bacteriophages; proflavine, rivanol, acridines No. No. 39--40 produced a marked inhibitory effect; acridine orange and acridine No. 38 inhibited the staphylococcus lysis completely. Some preparations could be used to investigate the transduction phenomenon.


Ontogeny of immunity in man.

We have reviewed selected aspects of recent findings in the ontogeny of immunity in man. For obvious reasons, constraints placed on experimental work with human subjects, albeit deceased foetuses, limit the work to in vitro studies. Nevertheless, a number of novel and important concepts have emerged. First, as in lower animals, lymphoid development of the foetal thymus in general precedes the development of immunocompetence in peripheral lymphoid tissues. A striking exception to this rule is the finding of cells in early foetal liver which respond to allogeneic cells in the mixed lymphocyte culture some weeks before lymphoid organization of the thymus. In addition, the response of foetal cells to allogeneic cells in the mixed lymphocyte reaction (MLR) precedes the response to phytohaemagglutinin (PHA), a stimulant with relative T cell specificity. The use of markers for T cells to map the emergence of this class of lymphocytes correlates well with various functional attributes of T cells in in vitro culture systems. B cells emerge first in foetal liver at about 9 weeks' gestation, but formation of immunoglobulin by the foetus occurs at very low levels until after birth. There is a suggestion that progression from IgM to IgA synthesis occurs during human foetal lymphoid development. Taken as a whole, these data suggest a rather remarkable and perhaps unexpected degree of cellular and potential humoral immunocompetence at early stages of feotal development in man.


Myocardial biopsy in a case of cardiomyopathy and partial alpha-a antitrypsin deficiency with liver engagement.

A case of partial alpha-1 antitrypsin deficiency with liver engagement and a biopsy-verified congestive cardiomyopathy is reported. The possibility of a connection between these two diseases is discussed in view of recent literature.


Erythrodermia sézary with immunological deficiency and antibodies against human albumin.

A case of erythrodermia Sézary, in which lymphocyte stimulation tests and quantitation of T and B lymphocytes were performed, is reported. The patient developed during 10 years of evolution an immunological deficiency with low IgA, IgG and IgM values. Passive hemagglutination techniques showed an antibody titer of 1:8000 against human serum albumin.


Isolated valvular aortic stenosis. Clinico-pathological findings in an autopsy material of elderly patients.

In a review of 2557 autopsy reports from a general hospital 20 patients, aged 65 or above, have been found to have severe isolated valvular aortic stenosis. The diagnosis was made or suggested clinically in only 5 cases. The clinical findings were often atypical, e.g. the BP amplitude was above 50 mmHg in 9 patients and 4 had a systolic BP of 180 mmHg or more. Left ventricular hypertrophy as evaluated by ECG was, however, present in all examined cases but one. The main cause of death was cardiac in 17 cases, of whom 2 died suddenly and 4 following non-cardiac surgery. At autopsy significant coronary arteriosclerosis was found in all but 2 patients. In 9 patients acute myocardial infarction was demonstrated--in 2 cases only through a macroscopic enzyme test (Nitro-BT method).


Identifiying inherited disease through the family history.

The family pedigree record must be carefully recorded and reviewed on an annual basis. Review allows a continuting opportunity to identify new genetic risk factors. Physicians should be familiar with the pedigree patterns of autosomal dominant inheritance, sex-linked dominant inheritance, autosomal recessive inheritance, sex-linked recessive inheritance and polygenic inheritance. This understanding provides the basis for genetic counseling, prenatal diagnosis and improved therapy.


Gonorrhea--recommended treatment schecules, 1974.

Gonorrhea, the nation's second most frequently reported communicable disease, will affect more than a million persons this year. The following is the latest treatment schedule issued by the USPHS Center for Disease Control, Atlanta.


The allergic child.

Allergies may cause gastrointestinal symptoms such as diarrhea, vomiting and pain, dermatologic manifestations, asthma and rhinitis. The most common offender among the foodstuffs is milk. Elimination diets are designed not only to remove the offending food but to identify it and to prevent new sensitizations. Canker sores, foul breath and even enuresis may occasionally be related to allergies.


Postoperative hemodynamic and electrophysiologic evaluation of the interatrial baffle procedure.

Hemodynamic and electrophysiologic studies were performed in 11 children with dextrotransposition of the great arteries an average of 26 months after the interatrial baffle procedure and, in 2 patients, additional closure of a ventricular septal defect. All children are clinically well. Right to left shunts ranging from 28 to 63 percent of systemic blood flow were found at the superior vena caval-baffle junction in four children. The superior vena caval-baffle gradient averaged 7 mm Hg (range 0 to 22). Right ventricular stroke work index averaged 39 g-m/beat per m2 and right ventricular end-diastolic pressure 9 mm Hg. These values were not significantly different from the values for the systemic left ventricle in a comparable group of normal children (average left ventricular stroke work index 45 g-m/beat per m2 and average left ventricular end-diastolic pressure 8 mm Hg). Cardiac index, heart rate and arteriovenous oxygen difference were also normal. No child has complete heart block. His bundle recording demonstrated normal H-V intervals (range 27 to 40 msec); 4 of the 11 had a prolonged A-H interval. Left ventricular systolic pressure was less than 40 mm Hg in all but two children who had significant subpulmonary stenosis. Pulmonary vascular resistance averaged 1.9 units and was decreased in all children. We conclude that up to 37 months postoperatively, despite some residual abnormalities, the clinical and hemodynamic condition of these children is excellent.


Combined hyertrophic subaortic stenosis and calcific aortic valvular stenosis.

A well documented case of combined hypertrophic subaortic stenosis and calcific aortic stenosis is reported. Detection of multilevel involvement in cases of left ventricular outflow obstruction requires a high index of suspicion and precise hemodynamic and angiographic documentation. Careful analysis of the total data base is necessary for proper management of the patient. The pathogenesis of this combined lesion is unclear: Asymmetrical septal hypertrophy may occur as a consequence of the valvular stenosis, or it may be that abnormal leaflet motion in patients with hypertrophic obstruction produces leaflet thickening, calcification, deformity and stenosis.


The clinical response of 328 private patients to acupuncture therapy.

It is the attempt of this study to determine the efficacy of response to acupuncture at 24 hours, one week, and three week intervals at the end of a series of treatments in 328 patients. Treated for a variety of disorders, approximately 60% had satisfactory responses of up to 3 weeks duration. The 328 patients were classified into 13 categories of problem disorders: headaches, cervical pain, lumbar pain without radiation, lumbar pain with radiation, isolated sciatica, parathoracic pain, knee pain, elbow pain, shoulder pain, gereralized musculoskeletal pains (rheumatism), neurological disorders, and a general miscellaneous category. The problem disorders were then arranged into etiological categories. In general for each problem disorder, except for neurological, the average response ranged in the 60-65% range at the third week interval.


Clinical and microbiologic surveillance of neonatal staphylococcal disease. Relationship to hexachlorophene whole-body bathing.

Neonatal staphylococcal disease occurred in the nurseries of a university hospital three weeks after discontinuation of routine, daily, whole-body bathing of newborns with hexachlorophene. Of 16 infants who had clinical manifestations within a two-week period, 11 cases were confirmed bacteriologically. Shortly after onset of the outbreak, daily clinical and microbiologic surveillance and control measures on all infants and personnel were inaugurated. Clinical surveillance after the outbreak did not yield any new case. Average incidence of cultures positive for coagulase-positive Staphylococcus aureus was highest (13% per week) during the first three weeks of microbiologic surveillance (when hexachlorophene was not used). This is lower than that reported in most previous studies. These findings indicate the importance of scrupulous hand washing before and after handling each infant and of enforcement of other basic nursery techniques.


Measles mortality. Analysis of the primary cause of death.

Four hundred fifty-four death certificates showing measles as the cause of death were analyzed. These represented 35.4% of the recorded deaths due to measles from 1964 through 1971. Respiratory or neurologic complications of measles or both were noted as the primary cause of death on nearly 90% of the certificates reviewed. In younger children, death was most frequently attributed to respiratory problems, while encephalitis and other neurologic sequelae of measles accounted for a larger percentage of deaths in the 10- to 14-year-olds. Nearly 17% of the persons who died had some underlying disease at the time of death, the percentage increasing with age. The majority of this group were physically or mentally retarded, or both.


Longitudinal development of object permanence in mentally retarded children: an exploratory study.

Monthly testing on a series of Piaget object tasks was carried out on 1- to 6-year-old profoundly, severly, and moderately retarded children. Forty nine subjects were followed for 1 to 1.5 years or to criterion; 18 subjects were followed for shorter periods. Three general patterns occurred among the noncriterion subjects with approximately equeal frequency: (a) little or no change, (b) marked variability, and (c) relatively steady upward change from month to month. Criterion and upward subjects skipped certain substages about one-half of the time. Degree of retardation, CA, and diagnostic concomitants of these observations were discussed.


A quantitative study of the face in Down's syndrome.

The large number of persons with Down's syndrome among the group of physically and mentally retarded demands that continuing study be directed toward its causes and effects. Much conflicting data are reported in the literature concerning the facial and cranial effects of this syndrome. The cephalic proportions, in profile, of a group of male Caucasian trisomic Mongoloids were compared with the proportions of a control group of male Caucasians of similar age range. Using the areas of the midface, mandible, and endocranium obtained from cephlograms of the two groups, the following ratios were studied: (1) midfacial area/endocranial area (2) mandibular area/endocranial area, and (3) midfacial area/mandibular area. A significant degree of deficiency in midfacial area, mandibular area, and endocranial area was found in the Mongoloid group. In studying the facial proportions, we found that the Down's syndrome group's ratios were significantly smaller in all three areas. The magnitude of the deficiency in the Mongoloid midface, both in gross area and in relation to endocranial area, remained nearly constant with age. The ratio of midfacial area to mandibular area in Mongoloids was much more comparable to that of the normal group than the other two ratios studied. In both groups the ratio of the midfacial area to the mandibular area became smaller with age. The decrease was more rapid in the Down's syndrome group. The findings of this study imply that all areas of the face and skull are deficient in persons with Down's syndrome. The data point to the possibility that the characteristics of this syndrome and the deficiencies described are polygenic in origin. Also, contrary to the majority of reports in the literature, the mandible and the midface grow in approximately the same proportion in both study and control groups


Critical tests of suspension, paste, and pellet formulations of cambendazole in the horse.

Three formulations of cambendazole were evaluated for anthelmintic activity by critical testing method in 21 horses. Cambendazole suspension was administered via stomach tube at the dose rate of 10 mg/kg to 3 horses and at the dose rate of 20 mg/kg to 3 horses. Cambendazole paste was given intraorally to 8 horses, and the pellet formulation was fed to 7 horses at the dose rate of 20 mg/kg. Anthelmintic activity of cambendazole was similar for all dose rates and formulations. Gasterophilus intestinalis, Gasterophilus nasalis, Draschia megastoma, Anoplocephala perfoliata, and Anoplocephala magna appeared to be refractory. The 3 formulations removed (1) 100% of Parascaris equorum and mature Oxyuris equi, (2) 82 to 100% of Strongylus vulgaris, (3) 80 to 100% of Strongylus edentatus, (4) 85 to 99% of small strongyles, and (5) 79 to 100% of immature Oxyuris equi. Probstmayria vivipara was present in only 1 horse and removal was 99%. There was some evidence of activity on Habronema muscae. Toxicosis was not observed.


Occurrence of gastrointestinal parasites in Georgia cattle.

A survey of gastrointestinal nematodes in Georgia cattle was conducted from 1968 through 1973 from actual worm counts from viscera of 145 slaughtered beef cattle or from egg counts made from fecal samples from 3,273 beef and 100 dairy cattle. Beef cattle were grouped as calves, yearlings, and cows. Dairy cattle were grouped as calves, replacement heifers, and cows. Results of fecal examinations positive; 99.5, 99.3, 99.6, and 41.2% of the calves, yearlings, drylot calves, and cows, respectively, were infected with nematodes. Seventy-four percent of the eggs counted were of the Cooperia-Ostertagia - Trichostrongylus complex (C-O-T) and 21% were of the Haemonchus-Oesophagostomum complex (H-O). Sixty-nine percent of the infective larvae recovered from coprocultures made from composite samples were of Ostertagia ostertagi. Moniezia (tapeworm) eggs were seen in 16% of all the samples, more predominantly in the calves (24%) and less in the cows (smaller than 1%). Oocysts of Eimeria spp were detected in 61% of the cattle, more predominantly in younger cattle. All cattle necropsied were infected with O ostertagi. Other nematodes present, in order of decreasing frequency, were Trichostrongylus axei (97%), Haemonchus placei (66%), Cooperia punctata (63%), Cooperia oncophora (61%), Oesophagostomum radiatum (61%), Bunostomum phlebotomum (55%), Trichostrongylus colubriformis (36%), Cooperia pectinata (28%), Trichuris spp (17%), Nematodirus spathiger (9%), and Capillaria bovis (4%). Tapeworms were also recovered from 19% of the cattle at necropsy. Seventy-eight percent of the dairy cattle were positive; 98% of the calves, 80% of the heifers, and 58% of the cows. Cooperia-Ostertagia-Trichostrongylus eggs were detected in 78% and H-O eggs in 38% of the cattle. Eimeria oocysts were detected in 71% of all the dairy cattle, and Moniezia eggs were in 10% of the calves and 7% of the heifers.


Aerosol Sch 1000. An anticholinergic bronchodilator.

Atropine is known to be an effective bonrchodilator. We studied the effectiveness of aerosol Sch 1000, a derivative of atropine, in relieving bronchoconstriction in asthma. A single dose of drug was effective within 5 min, and the effect had a duration of 4 hours. No side effects were noted. The major effect of the drug appeared to be in large airways.


Bronchoconstrictor effects of a deep inspiration in patients with asthma.

A deep inspiration from functional residual capacity to total lung capacity, performed at a low flow rate by a group of 40 unselected adult patients with asthma, yielded an immediate and transient increase (71 per cent, P smaller than 0.001) in specific airway resistance. In 2 of the 40, deep inspiration provoked an attack of asthma. The effect of deep inspiration can be attributed to a vagal bronchoconstrictor reflex, because it was prevented or decreased in most of the cases by inhalation of an anticholinergic drug. Beta-adrenergic blockade by propranolol potentiated in a minority of subjects the bronchoconstrictor response to deep inspiration. Deep expiration also induced a bronchoconstrictor effect, which was weaker than that of deep inspiration. It follows that functional studies of asthmatics may be biased if the technique requires maximal respiratory maneuvers.


Femorofemoral bypass graft: choice or compromise?

Thirty-one femorofemoral crossover graft procedures were performed in 27 patients who had unilateral limb ischemia either due to unilateral aortoiliac occlusive disease of due to thrombosis of one of the limbs of a previously placed aortic bifurcation graft. There was no operative mortality, and only two patients required late amputation. There have been two late deaths. Thrombosis of the femorofemoral graft occurred in five patients. Four patients had a second femorofemoral graft, three of whom have long-term patency. Grafts are patent in 23 of 25 surviving patients. The femorofemoral graft procedure is relatively simple and is associated with a low operative mortality and morbidity. Its late patency rates are comparable with those following conventional aortic bifurcation graft procedures. Therefore, we believe the indications for femorofemoral graft should be broadened to include all patients with unilateral aortoiliac occlusive disease where anatomic conditions are favorable and there is unilateral occlusion of an aortic bifurcation graft.


Management of massive abdominal wall defects.

Patients with acute losses of large portions of the anterior abdominal wall are discussed. Management is divided into the acute or immediate phase in which initial wound control is paramount, and then a subacute period in which coverage with skin is accomplished. Many weeks later during the chronic phase, reconstructive procedures are done if needed. Methods of handling these defects are presented.


Amebic pericardial effusion: a rare complication of amebic liver abscess.

Two rare cases of amebic pericardial effusion as a complication of amoebic liver abscess in the left lobe are described. The pericardial amebiasis should be suspected in a patient presenting with signs and symptoms of pericardial effusion with an evidence of hepatic abscess (in the left lobe) or in a patient with pericardial effusion of uncertain etiology. Aspiration of "anchovy sauce" pus from both the pericardial cavity and the liver should be regarded as confirming the diagnosis of amebic pericarditis secondary to amebic liver abcess because demonstration of Entamoeba hystolytica is seldom possible. Removal of pericardial pus and metronidazole intake were markedly effective in treating our patients.


[Mycosis fungoides].

The classical characteristics of Myocsis Fungoides are discussed. 1) The clinical characteristics of the three forms: tumour from the start, erythrodermic and polymorphic forms of Alibert-Buzin. 2) Histological characteristics : dense dermal infiltrates or epidermotropic infiltration, or around a more or less malignant histiocytic reaction, there develops a host reaction, resembling a granuloma. During the course of the disease, one may observe lymphocyte depletion, whilst delayed hypersensitivity tests become negative. The various types of lymphadenopathy are analysed, the possibility of visceral lesions confirmed. However, knowledge of Sezary's syndrome makes his concept of the disease doubtful. A pathological picture similar to Mycosis Fungoides may be observed during Sezary's syndrome, with circulating giant cells. The presence of small Sezary cells, Lutzner-Flandrin variety, is common in the dermal infiltrate, and even more common in the lymph node visceral infiltrates of Mycosis Fungoides. Thus, one is led to the concept according to which the primary phenomenon is probably pathological proliferation of abnormal T lymphocytes (large and small Sezary cells), the histiocytic proliferation would then simply be a secondary reaction. This theory is then discussed.


[Familial pericentric inversion of y chromosome and Down's syndrome].

A boy with Down's syndrome is presented. Karyotipe showed a 47,XY,+21,inv Y(p+q--) constitution. The father had the same Y anomaly. A review of pericentric inversions of Y chromosome and its possible relation with Down's syndrome is made.


Temperature regulation.

The general way of looking at short-term temperature regulation has not fundamentaly changed since 1968. Some points nevertheless have been developed and deserve special attention: 1. The influence of water on the skin surface inhibits sweat secretion (55, 106). This fact may be the explanation of sweating fatigue and of discordant conclusions regarding the functioning of the regulator, particularly during exercise in man. 2. Since a large number of studies have shown that appropriate behaviors occur in response to all the stimuli that activate autonomic responses, behavior itself should be considered as an integral part of the thermoregulatory system (1, 2, 16, 18, 19, 21, 23, 25, 31, 32, 34-36, 48, 88, 89, 98, 99, 122, 126, 127, 137). 3. The description of the peripheral input for the control of sweating with regard to mean skin temperature (104) and time dependence (159) has been improved. Among internal temperature sensors those of the spinal cord have been extensively studies (25, 27, 32, 36, 42, 59-63, 71-75, 82, 83, 86, 113-115, 121, 150, 158) and demonstrated to have a sensitivity equal to that of the hypothalamic sensors (73, 75). 4. New hypotheses have been proposed describing the overall mechanism responsible for a constant temperature in the core (58, 96, 97, 135). These stimulating theories have been discussed briefly herein. Mechanisms for the defense against heat and against cold can be dissociated completely from one another. In the same way the control of autonomic responses can be dissociated from the control of behavioral responses. This suggests that temperature regulation is brought about by multiple independent feedback loops. The overall system is well described, in the author's opinion, by the theory of the adjustable set point with proportional control (47).


Use of the Doppler ultrasonic flowmeter for pedicle flaps.

Summary--The Doppler ultrasonic flowmeter is presented as a method to help in flap outlining, transfer and return. When a directional flowmeter is added, this machine is extremely valuable for returning a flap at the earliest possible time. The Doppler is a safe, inexpensive, atraumatic, reliable instrument that can be learned in a very short time. We have found the Doppler to be very helpful in head and neck flaps.


[Study of the antibiotic sensitivity of the Shigellae, pathogenic Escherichia, Proteus and Staphylococcus isolated from young children in Tbilisi with acute intestinal diseases].

Sensitivity of Shigella, pathogenic Escherichia, Proteus and Staphylococcus isolated from children with acute intestinal diseases was studied with respect to antibiotics widely used in medical practice: streptomycin, levomycetin, tetracycline, chlortetracycline, oxytetracycline and neomycin. The antibiotic sensitivity was determined with the method of indicator discs. It was found that sensitivity of shigella was: 44 percent to streptomycin, 69.5 per cent to levomycetin, 18.5 per cent to tetracycline, 18.5 per cent to chlortetracycline, 23 per cent to oxytetracycline and 94 per cent to neomycin. Sensitivity of pathogenic Eschericia was 28, 33, 14, 14, 25 and 74 per cent, sensitivity of staphylococci was 46, 56.5, 21, 21, 31.5 and 89.5 per cent, sensitivity of Proteus was 15, 31.5, 3.5, 3.5, 7.5 and 52.5 per cent respectively. Cross resistance with respect to tetracyclines was found in all the microbes studie. Intragenera differences in the antibiotic sensitivity were observed among Shigella and pathogenic Escherichia.


Acne mechanica.

The term acne mechanica designates local exacerbations due to pressure, friction, rubbing, squeezing, or stretching. Examples are given of various physical traumata that provoke lesions in acne patients. The precipitating causes of stress are diverse, they include articles of clothing (tight straps and belts), recreational accouterments (football shoulder pads), or occupational pressure (rubbing of back in truck drivers). Sealing acne-bearing skin under adhesive for two weeks regularly induced new inflammatory lesions, which derived from the rupture of microcomedones that are not visible to the naked eye.


The community paediatrician in an integrated child health service.

A concept of Community Paediatrics has been described comprising clinical care to individual children including identification, diagnosis, and care of the handicapped child, expertise in preventive paediatric techniques, and the provision of investigation and advice in connexion with social and educational proboems. Its relationship to Community Medicine, General Practice, and Consulting Paediatrics has been discussed and a long-term training scheme is outlined. In the immediate future the deployment is envisaged of senior clinical Medical Officers now employed by Local Authorities.


Noncoronary collateral myocardial blood flow.

This study shows that noncoronary collateral flow occurs in normal hearts after chronic coronary occlusion and with left ventricular hypertrophy in variable amounts (0.2 to 16 ml/100 gm/min). Luminal--left ventricular flow is greatest when the heart is arrested by aortic cross-clamping, falls significantly when perfusion pressure is lowered to 50 mm Hg, and increases slightly when blood viscosity is reduced (hemodilution). Our findings indicate that the heart which is arrested by aortic cross-clamping may not be anoxic.


Surgical treatment for anomalous origin of left coronary artery from pulmonary artery.

Anomalous origin of the left coronary artery from the pulmonary artery carries a poor prognosis; most patients die early in life from myocardial infarction and congestive heart failure. During a 12-year period at the Texas Heart Institute, 13 patients with this congenital malformation ranging in age from 1 to 24 years underwent operation. The anomalous coronary artery was sutured or ligated, or both, close to the pulmonary artery in 3 patients, 2 before 1965. Aortocoronary bypass was performed in the remaining 10 patients, using an autogenous saphenous vein graft in 9 and a Dacron tube in 1. More recently a distal end-to-side anastomosis has been employed and is not the preferred method. If necessary, a pump oxygenator may be used to complete the procedure. The only death was that of the first patient in the series who underwent ligation of the left coronary artery and mitral annuloplasty for severe mitral insufficiency; Of the 12 patients available for long-term follow-up study, all but 1 were asymptomatic. Follow-up angiographic studies showed the graft to be patent in 7 patients; the longest period of graft patency was 8 years. Definitive operative therapy is preferable to simple ligation because it eliminates the left-to-right shunt from the right coronary artery to the pulmonary artery and establishes a double coronary artery system.


Anomalous origin of the left coronary artery from the pulmonary artery. Definitive surgical treatment by saphenous vein interposition in a 17-month-old child.

A 17-month-old child underwent successful operative correction of anomalous origin of the left coronary artery from the pulmonary artery by saphenous vein interposition. The clinical, hemodynamic, and angiographic features of the anomaly are presented. Three months after the operation, cardiac catheterization and angiography revealed a patent graft with good antegrade flow and improvement in left ventricular function.


Successful treatment of transection of aortic arch and innominate artery.

A patient was seen with a widened mediastinum following rapid deceleration injury. A retograde angiogram showed rupture of the transverse aortic arch and occlusion of the origin of the innominate artery. At operation cardiopulmonary bypass with systemic, cerebral, and myocardial preservation were used to provide a safe approach for inserting a graft to successfully restore normal circulation.


[Left ventricular function of the coronary patient: relation between ventricular kinetic disorders and alterations of myocardial contractility].

The left ventricular kinaetics of 29 coronary patients (pure angina and with sequela of myocardial infarction) was studies by biplane angiocardiography. Their contractility was assessed by measurement of the Vmax and VECmax indices derived from the relationship between contractile elements shortening speed-overall wall tension, in isovolumetric phase. An excellent relationship links the hypokinaetic area with decrease of the ejection fraction (SV/LSV): when the hypokinaetic area exceeded 20% of the overall endocardial surface, the ejection fraction deveased below 0.40, and signs of cardiac failure were manifest. Pure anginal patients at rest kept normal kinaetics, late diastolic volume, ejection fraction and myocardial mass. A myocardial hypertrophy develops in the areas adjacent to the fibrous scar. In some cases (group I) it compensates for the ventricular dysfunction; in other cases, it is not sufficient to compensate for the ejection fraction reduction. One must then admit the presence of diminished contractility in the areas adjacent to the fibrous scar, as is suggested by the increase of the late diastolic pressure, the decrease of the externel work of the left ventricle and of the contractility indices. Analysis of both the natural and post-operative courses in these patients shows that Vmax the ejection fraction and the hypokinaetic areas afford excellent criteria for prognosis and operability.


The decompensated back.

There is no single circumstance or combination of circumstances which precipitate all clinical instances of back discomfort. This simple statement should be so obvious that one must question the finality and accuracy of the diagnostic effort in those reports which relate to large series of patients treated by one method. There is no thought of impugning the basic honesty of the reporting physician in this statement, but rather of raising the fair question of whether the "slipped disc" (or whatever the etiological diagnosis) is all that happened to produce the symptoms, and whether its removal (or whatever) is all that occurred in accomplishing clinical cure improvement. If there is doubt that the answer to both questions is in the affirmative, then serious consideration must be given to those other factors, if the medical profession is ever to be a science instead of a trade. The back structures are different from comparable structures elsewhere in the body, principally in their neurological organization and controlmthere is the specific, discrete, segmental arrangement of both sensory and motor functions of muscular and nonmuscular structures via the posterior primary rami of the spinal nerves. Coupled with this is a different mechanism of segmental innervation of the vascular and nonmuscular structures which line the vertebral canal, via the sinu-vertebral nerves. Both are modulated by higher level influences. The sinu-vertebral nerves, through the sympathetic chain, may provide an additional avenue of response which may avoid or alter the influence of higher levels. The Melzack-Wall hypothesis would seem to provide an acceptable explanation for the need to modulate nociceptive afferent stimuli before they evoke pain perception and response. Since this modulation mechanism decompensates under numerous conditions, pain perception and responses do occur. Among those responses are the alterations in normal function of the low back structures, perhaps the disastrously effective one of which is decompensation of the muscular strength necessary to accomplish the demands of daily use. This problem is not so simply solved by a handout sheet of exercises. The primary consideration is to modify or relieve pain by a careful evaluation of its source and the employment in combination of those therapeutic efforts which a logical treatment plan indicates.  If these be accomplished, the final and most important consideration, then, is the improvement of neuromuscular function to the level compatible with normal activities by a carefully guided activity program. There is no method for instant reversal of the status of the decompensated heart--nor the decompensated back.


[Ultrasound as a diagnostic aid in psoas abscesses (author's transl)].

In 2 cases of psoas abscesses ultrasonic tomograms have been made in addition to the routine examinations. The experiences of these results show that the implication of this method seems to be of great help for a more exact preoperative diagnosis.


Aortic regurgitation from infective endocarditis in Fallot's tetralogy and pulmonary atresia.

Three cases of aortic regurgitation acquired as the result of bacterial endocarditis complicating Fallot's tetralogy and pulmonary atresia have been described. One also had mitral regurgitation from a 'jet lesion' of the anterior cusp of the mitral valve. Surgical treatment of all abnormalities with aortic valve repair or replacement was undertaken in each patient and was successful in two. Difficulties in diagnosis and surgical treatment are discussed.


Toxic effects of 2,3,7,8 tetrachlorodibenzo 1,4 dioxin in laboratory workers.

The toxic effects on three young scientists who had transient minimal exposure to 2,3,7,8 tetrachlorodibenzo 1,4 dioxin (dioxin) are described. Two of them suffered from typical chloracne. Delayed symptoms about two years after initial exposure occurred in two of the scientists. These symptoms included personality changes, other neurological disturbances, and hirsutism. All three scientists were found to have raised serum cholesterol but no other biochemical disturbances, and no porphyrinuria nor liver damage was demonstrated. The question whether the unusually delayed physiological effects were in fact due to the initial dioxin exposure is discussed. Although conclusive evidence is lacking, it seems likely that these delayed effects were in fact due to dioxin intoxication.


Occupational absorption of tellurium: a report of two cases.

Industrial uses of tellurium are limited, and reported cases of tellurium absorption of occupational origin are rare. Two such cases are reported here. Both showed typical signs and symptoms of intoxication; in particular, the stench of sour garlic was noted on breath and from excreta. An unusual feature was the bluish-black discoloration of the webs of the fingers and streaks on the face and neck. Full hospital investigation was negative. No permanent damage resulted and each patient made a spontaneous recovery without treatment.


Studies on coagulation and fibrinolysis in blood from puerperal women with and without oestrogen treatment.

Coagulation and fibrinolytic studies were made on 25 women who had a normal puerperium and breast fed their babies and on 32 otherwise healthy women who had lactation suppressed by diethylstilboestrol. In the untreated patients the fibrinogen, Factors VIII and IX, platelet count, and antifibrinolytic activity increased, and the levels of Factors  II, VII, and X and of plasminogen and plasminogen proactivator decreased. The incidence of cold activation of Factor VII decreased slowly from the 5th postpartum day onwards. The concentration of antithrombin III which was depressed in pregnancy, increased in the puerperium and was the only observed change that counteracted an increased coagulation potential. Oestrogen treatment produced further increases of Factors II, VII, and X, platelet count, and the cold activation of Factor VII while it decreased the concentration of antithrombin III. These changes favoured coagulation but were possibly to some degree counterbalanced by an increased concentration of plasminogen and decreased antifibrinolytic activity.


Regulatory proteins of lobster striated muscle.

The regulatory proteins of lobster muscles consist of tropomyosin and of troponin. Troponin contains a 17,000 chain weight component, two closely related components of about 30,000 and a 52,000 chain weight component. In addition to troponin, tropomyosin is required for the inhibition of the magnesium activated actomyosin ATPase activity in the absence of calcium and for the reversal of this inhibition by calcium. Lobster tropomyosin interacts with rabbit actin and lobster troponin interacts with rabbit tropomyosin. The 30,000 doublet component corresponds to the troponin-I of rabbit and inhibits the ATPase activity of actomyosin both in the presence and in the absence of calcium. The 17,000 component corresponds to the troponin-C of rabbit; it binds calcium and reverses the inhibition of the ATPase activity by troponin-I in the presence of calcium. No more than 1 mol of calcium is bound by a mole of troponin-C or by troponin. The 52,000 component interacts with tropomyosin and has been tentatively identified as troponin-T; however, it has not been demonstrated as yet that this component had a role in the regulation of lobster actomyosin.