Responses of barnacle photoreceptors to high energy flashes of short duration.

In chromatic adapted barnacle median and lateral photoreceptors the two stable states of the photopigment (rhodopsin R and metarhodopsin M) were interconverted with intense, colored light flashes of 1 ms duration. Only after conversion of the red adapted photoreceptor in K+-Ringer solution with an intense flash the negative early receptor potential, ERP (of R) gradually appeared detected with an indicator flash. For the opposite conversion (blue adapted, R leads M) the gradual appearance of the positive ERP (M) was not measurable in the same time span. In artificial seawater all flash stimuli yielded--irrespective of color--the transient component of the late receptor potential (LRP). ERP results for the lateral photoreceptor are discussed in view of an existing kinetic model and an attempt is made to give an explanation which covers the new LRP transient and ERP results for both types of photoreceptor (appendix).


[Registration and care for multi-handicapped children in the canton of Bern].

In spite of their greatly increased needs, multi-handicapped children as a group are not assessed earlier nor are they at a disadvantage in terms of quality of care if compared with other categories of handicapped. The group is not homogenous, however. Every subgroup has to be studied separately in planning strengthened services.


[Health and handicaps in the population older than 65 years of age in Basel and Bern].

A preliminary communication is made about an epidemiological survey concerning the habits and problems of the elderly in Switzerland. Special interest is given the aspects of health and competence in the activities of daily life. Data about self-rated health status as well as degree of restriction in the activities of daily life are presented. No sex differences were found in these two dimensions. When looking at the different age groups, perceived health does not vary with age, whereas the frequency of self-rated dependency is nearly eight times higher among those aged  85 + (55.5%) compared to those aged 65--74 (7.4%). Further analyses will test hypotheses about selective mortality, sex role and adaptation to different types of handicaps.


[Effect of meteorologic and heliogeophysical factors on stroke incidence in Leningrad].

A study of the frequency of strokes in different periodical intervals during 22 years according to the data of Urgent Medical Aid Stations in Leningrad demonstrated a certain influence of environmental physical factors on the incidence rate. Certain intraannual fluctuations with a maximum increase in the winter-spring period and a drop of the incidence during summer were due to the weather influence and sun activity. The most biotropic were fluctuations of atmospheric pressure, especially its drop and sun (magnetic) perturbation. The different seasonal influence of separate physical factors are not the same. During winter there is a prevalence of biotropical significance in the fluctuation of barometrical pressure, in spring--geomagnetical perturbations.


[Characterization of Ca-uptake by a microsomal fraction from vascular smooth muscle].

A microsomal fraction was isolated from the media-intima of the bovine carotid artery; the preparation is a mixed fraction of membranal and mitochondrial debris, which is able to bind Ca-ions and to take them up in the presence of ATP. The Ca-uptake is activated within a pCa range from 7--5. The involvement of two different systems in the Ca-uptake is discussed. A Ca-stimulatable ATPase was demonstrated, whose relationship with a Ca-transport system could not be established, however. The substrate for Ca-uptake is MgATP; in addition, free Mg has a stimulating effect. The Na/Kratio has no influence on the Ca-uptake. The influence of the pH-value on the Ca-binding and Ca-uptake was studied. Phosphate increased the Ca-uptake, while oxalate did not. The investigated system is discussed as a model for the action of vaso-active drugs.


Kinetic investigation of the interaction of cibacron blue F3G-A with phosphofructokinase from yeast.

Yeast phosphofructokinase is strongly inhibited by Cibacron Blue F3G-A. The inhibition is competitive in respect to the phosphate donor. Fructose 6-phosphate and ATP are able to abolish the dye-inhibition. Replacement of the strong inhibitor ATP by ITP as phosphate donor gives qualitatively analogous effects. The influence of Cibacron Blue F3G-A on the kinetic pattern of yeast phosphofructokinase can be described in terms of the kinetic model of Freyer et al. [8] if one assumes that the dye binds to the ATP-binding sites in a competitive manner.


Electrocardiographic signs of chronic cor pulmonale in 40 376 patients with silicosis.

The records of all patients who were examined for silicosis at the Fund of Occupational Diseases between 1972 and 1976 are reviewed. In 3627 cases the mechanographical record was incomplete leaving 40 376 patients in the study. Electrocardiographic signs of chronic cor pulmonale (C.C.P.) were detected in 5.58 per cent. The severity of C.C.P. was evaluated and the prevalence of the different electrocardiographic signs was examined. The presence and severity of C.C.P. was compared to the radiological stage of silicosis, to the pulmonary function, to the duration of professional exposure to the risk of silicosis and to the use of tobacco. The value of the electrocardiographic signs of C.C.P. was evaluated. It is concluded that the mechanographical record obtained in insurance medicine is a valuable tool for statistical analysis of a disease and that C.C.P. is an infrequent and mostly late complication of silicosis.


Achilles tendon injury. Plantar flexion strength and structure of the soleus muscle after surgical repair.

Bilateral needle biopsy specimens obtained from the soleus muscles of nine male subjects one year or more after surgical repair of Achilles tendon rupture were studied by light microscopy and enzyme histochemistry. Static and dynamic plantar flexion torques were also recorded. Although all subjects were symptomless, the soleus muscle of the injured leg in five was characterized by varying degrees of primary myopathy but only in two cases did this coincide with marked hypotrophy of the calf muscles and decrease of plantar flexion strengths. Myopathy precipitated by immobilization may persist on account of active insufficiency and early pain inhibition. The relevance of objective strength assessment is emphasized.


Is the diabetogenic effect of streptozotocin in part thymus-dependent?

Following a single injection of 200 mg streptozotocin/kg BW, 25 out of 25 normal mice became diabetic, whereas 12 ( = 20%) out of 50 athymic nude mice did not develop diabetes. In a multiple dosage experiment, where the same total dose was given over a 5 days period, 14 normal and 15 athymic nude mice all became diabetic, but nude mice had significantly lower blood glucose values. These results support our previous suggestion that a thymus dependent immune reaction is, in part, responsible for the diabetogenic effect of streptozotocin.


Apex sector echocardiography in evaluation of the right atrium in patients with mitral stenosis and atrial septal defect.

Cross-sectional echocardiography utilizing the four chamber apical view was used to evaluate right atrial dimensions as a means of detecting abnormal right heart hemodynamics in 20 patients with mitral stenosis, 5 patients with an atrial septal defect and 10 patients without heart disease. Right and left atrial dimensions on apex echocardiography were 40 mm or less in control subjects. There was a good correlation (r = 0.81) between left atrial size assessed with apex sector and M mode echocardiography. In patients with an atrial septal defect, the left atrium was of normal size on apex sector echocardiography; in patients with mitral stenosis, it was larger on apex echocardiography (59 +/- 9 mm) than on M mode echocardiography (51 +/- 8 mm). The right atrium was enlarged (54 +/- 5 mm) on apex echocardiography in all five patients with an atrial septal defect, but the right ventricle was enlarged in only four. Seventeen of 20 patients with mitral stenosis had an enlarged right atrium (53 +/- 7 mm) on apex echocardiography, whereas 15 had normal right ventricular dimensions (21 +/- 9 mm) on M mode echocardiography. Right atrial size on apex echocardiography was enlarged (54 +/- 6 mm) in 10 of 11 patients with mitral stenosis and pulmonary arterial hypertension. Thus, evaluation of the right atrial dimension with apex echocardiography may be more sensitive than M mode echocardiography in detecting early right heart involvement in specific cardiac conditions.


Adult hemolytic uremic syndrome with renal arteriolar deposition of IgM andC3.

Two cases of idiopathic adult hemolytic uremic syndrome in which deposits of IgM and C3 were identified in renal arterioles showing fibrinoid necrosis are reported. Fibrin was also identified in the lumina of the involved vessels, but there was no laboratory evidence of disseminated intravascular coagulation. In both cases, serum C3 was decreased and C4 was normal, suggesting involvement of the alternate pathway of complement activation. These two cases suggest that in some instances the adult hemolytic uremic syndrome may be immunologically mediated, and that renal vascular thrombosis is a secondary phenomenon.


Phage typing of nontypable isolates of Staphylococcus aureus using the new phages 94, 95, and 96 and the heat-shock treatment.

Of 2,144 isolates of Staphylococcus aureus (from human beings in New York State) received in the authors' laboratory during 1975, 992 (46.,%) were nontypable with the use of the international basic set of bacteriophages. These 2,144 isolates were retested with the use of the recently added phages 94, 95, and 96. Nearly 60% of the isolates were lysed with one or more of these three phages, including 64% of those previously nontypable, thus reducing the percentage of nontypables to 16.5%. One hundred randomly selected isolates that remained nontypable were heat-shocked and retested with the revised basic set of phages, which includes the three new phages. Forty-three isolates were typable with the use of this procedure; all but one of these produced the exact same phage pattern in at least three of five trials.


Peritoneoscopy: an alternative approach to unresolved intra-abdominal disease.

Peritoneoscopy was performed in 49 patients with ill-defined intra-abdominal disease. The patients were classified into categories including inconclusive liver scans, jaundice, ascites, abdominal mass and staging for Hodgkin's disease. Visual evaluation of lesions and directed biopsies led to the correct diagnosis in 87% of the cases. In experienced hands, peritoneoscopy is a safe and useful technic and should be considered strongly in obscure intra-abdominal diseases.


The effect of oral contraceptive treatment on the serum concentration of dehydroisoandrosterone sulfate.

Dehydroisoandrosterone sulfate (DS), the major C19-steroid in the human circulation, was measured in serum obtained from blood samples collected daily (8 to 10 A.M.) throughout the menstrual cycles of eight normal, presumably ovulatory women and daily throughout the treatment cycles in four women taking an oral contraceptive (norethindrone, 1 mg., plus mestranol, 80 mcg.). The serum concentrations of DS in the ovulatory women ranged from 1,025 to 4,200 ng. per milliliter; mean, 2,062 +/- 137 ng. per milliliter (mean and standard error; n = 213). Serum DS concentrations during the follicular and luteal phases of the menstrual cycles of these women were similar. In women taking the oral contraceptive, the plasma DS concentrations ranged from 475 to 1,400 ng. per milliliter (mean, 895 +/- 83; n = 119). The 24 hour secretory pattern of DS was evaluated in one subject during a nontreatment cycle and again after 20 days of oral contraceptive treatment. In this subject, the mean serum DS level was 34 per cent lower during oral contraceptive treatment than the level before treatment. The decrease in the serum concentration of DS during oral contraceptive treatment likely results from a reduction in adrenal DS secretion since DS secretion by the normal human ovary is negligible and ovarian dehydroisoandrosterone secretion is small. Therefore, it is likely that the reduced serum DS levels in women taking oral contraceptives are the consequence of reduced adrenal secretion of DS resulting from reduced release of adrenocorticotropic hormone.


Study of the kinetics of conversion of maternal plasma dehydroisoandrosterone sulfate to 16 alpha-hydroxydehydroisoandrosterone sulfate, estradiol, and estriol.

The transfer constants of conversion of maternal plasma dehydroisoandrosterone sulfate to estradiol ([rho]DS-E2BU) and to 16alphaOH-dehydroisoandrosterone sulfate ([rho]DS-160HDS BU) and of maternal plasma 16alphaOH-dehydroisoandrosterone sulfate to estriol ([rho]160HDS-E3 BU) were measured in women late in pregnancy. The mean [rho]160HDS-E3 BU, 0.17, was considerably less than the mean [rho]DS-E2 BU, 0.29. However, the extent of 16alpha-hydroxylation of maternal plasma dehydroisoandrosterone sulfate was great, the mean [rho]DS-160HDS BU being 0.36.


Improving teenage attitudes toward children, child handicaps, and hospital settings: a child development curriculum for potential parents.

The recent increase in teenage pregnancies increases the risk of of low-birth-weight premature infants born to young mothers. Facilitative child-rearing practices, aimed at overcoming effects of perinatal stress, are being taught to middle-grade students before they become parents. Students participating in the program score higher than controls on measures of positive attitudes toward and knowledge of normal and handicapped children, hospitals, and child development.


Chocolate: a review of published reports of allergic and other deleterious effects, real or presumed.

Although there are specific contraindications to the ingestion of chocolate by selected individuals, these do not apply to the general population with a frequency that is suggested by the pervasive mistrust of chocolate. These contraindications and mistrusts are reviewed.


Immunofluorescence studies of lung biopsy tissue.

Thirty specimens of lung obtained by Abram's needle biopsy were examined using direct immunofluorescence. In 2 cases of Goodpasture's syndrome, linear deposits of IgG were demonstrated in alveolar walls. Diffuse deposits of IgG were found in the alveolar spaces of one patient with pigeon fancier's lung. Two subjects with cryptogenic fibrosing alveolitis had dense granular deposits of IgG in alveolar walls. Amorphous deposits of IgG were found in the pulmonary interstitium of a patient with desquamative interstitial pneumonitis. The small proportion of positive results obtained may reflect either the lack of a humoral immune background in the pathogeneses or only a fleeting involvement of humoral immunologic processes in each of the diseases studied. However, a small percentage of patients with diffuse interstitial disease do have antibody deposits demonstrable on small needle biopsy specimens. These require further investigation and may serve to define special groups. Various artifacts that were encountered led to difficulties in interpretation and these should be considered in reporting immunofluorescence studies of lung tissue. These included autofluorescence and nonspecific staining of connective tissue and cells. Nonspecific staining of eosinophils occurred frequently. The possible misinterpretation of artifacts as positive results is illustrated.


Pulmonary hypertension and right ventricular hypertrophy caused by intermittent hypoxia and hypercapnia in the rat.

This study reports the effects in an animal model of intermittent exposure to hypoxic, hypercapnic gas mixture on pulmonary artery pressure, packed cell volume, ventricular weights, and lung growth. Rats were exposed in chambers for 8 hours to an inspired O2 fraction of 0.10 and an inspired CO2 fraction of 0.06 in alternation with exposure for 16 hours to room air during 21 to 22 days. Control animals were exposed in chambers for 8 hours to compressed air at flow rates similar to those for the test animals, then for 16 hours to room air. Packed cell volume, right ventricular systolic pressure, and the ratio of the right ventricular weight to the weight of the left ventricle plus septum were all significantly greater in the test animals than in the control animals. Lung volume, alveolar number, and surface area were also significantly increased, but only when adjusted for body weight. The increase in right ventricular weight appeared to be due in part to the fact that right ventricular pressure was still increased 16 hours after removal of the hypoxic-hypercapnic gas mixture. The cause of this sustained increase in right ventricular systolic pressure is unclear.


Structure-activity relationships among the halogenated amphetamines.

p-Chloroamphetamine and various analogs influence brain serotonin neurons through multiple actions. Comparison of these compounds has permitted the distinction between short-term and long-term depletion of serotonin and among inhibition of tryptophan hydroxylation, release of serotonin, inhibition of serotonin reuptake, and inhibition of monoamine oxidase as mechanisms involved in the actions of these agents on serotonin neurons.


Nutritional and toxicological properties of some raw and modified starches.

Several food additives, including some raw and chemically modified starches, sorbitol and maltitol, cause caecal enlargement when fed to rodents. The onset of caecal enlargement is rapid and it is reversible when the additive is withdrawn. This poses problems in the safety evaluation of such additives, both in relation to the significance of the caecal enlargement and to the associated effects on food efficiency and nitrogen balance. The mechanisms of causation of caecal enlargement have been studied and will be discussed with particular reference to resistance of starches to enzymic hydrolysis, changes in intestinal microflora, osmotic load in the caecum, cell hyperplasia and rate of turnover of mucosal cells. Where deaths occur, these appear to be due to secondary effects such as impaired resporatory function.


[Cutaneous allergy to epichlorhydrine (author's transl)].

Allergies due to epichlorhydrin are seen more and more frequently. This product, which has several uses, is one of the essential components in epoxy resins. The follow-up of six cases has enabled us to determine the optimal concentration to be used in epichlorhydrin epicutaneous tests. Since this product is frequently encountered, it ought to be integrated among the other samples in current skin tests.


[Effect of the anthracycline group antibiotics, mitomycin C and bruneomycin, on the transduction of drug resistance in staphylococci].

The effect of various concentrations of antitumor antibiotics, such as carminomycin, rubomycin, adriamycin, mitomycin C and bruneomycin on transduction of erythromycin resistance from the donor strain 8325 P II/de of Staph, aureus to the recipient strain 8325-I in different transduction systems was studied. It was shown that the above antibiotics inhibited the transduction in the systems with constant presence of the drugs. Preliminary treatment of the recipient cells with the drugs in the subbacteriostatic doses did not decrease the transfer frequency. The preliminary treatment of the donor cells resulted in an increase in the phase titer and the transfer frequency in the "preliminary-treated donor + recipient" system.


Bronchial spasmolytic action of terbutaline and fenoterol compared with that of ipratropium bromide in the anaesthetized dog.

Continuous recordings of heart rate, respiration rate, minute volume and bronchial resistance were made over a period of altogether three hours in spontaneously breathing dogs anaesthetized with chloralose. At hourly intervals, before and 1 and 2 hr after the administration of bronchodilators, bronchial spasm was induced by inhalation of an acetylcholine solution. Two beta2-stimulants, terbutaline and fenoterol, were administered by inhalation in doses of 0.5, 0.16 and 0.05 mg/kg and 0.1, 0.3 and 0.01 mg/kg respectively. For comparison, an atropine derivative, ipratropium bromide, was also given by the same route in doses of 0.04 and 0.01 mg/kg. Controls received normal saline. Terbutaline and fenoterol caused an increase in heart rate, respiration rate and minute volume. Acetylcholine-induced bronchial spasm was inhibited to the extent of 10--70% for 2 hr after the administration of terbutaline, and by 15--70% after fenoterol. The acetylcholine antagonist ipratropium bromide caused only transient changes in heart rate, respiration rate and minute volume. Acetylcholine-induced bronchial spasm was inhibited by 95% and 80% for 2 hr after doses of 0.04 and 0.01 mg/kg, respectively. Fenoterol had a slightly greater central stimulant effect than terbutaline; ipratropium bromide displayed no stimulant activity.


Immune complex glomerulonephritis mediated by thyroid antigens.

Hypothyroidism, microscopic hematuria, and proteinuria developed in an 11-year-old girl. A renal biopsy specimen showed increased mesangial cells and matrix with focal glomerular basement membrane thickening. Three years later, a pronounced increase in proteinuria was detected. Elevated levels of antibody to thyroid microsomal antigen and thyroglobulin were found in the serum. A renal biopsy specimen showed a pronounced increase in mesangial cells and matrix with generalized glomerular basement membrane thickening. Electron microscopic studies demonstrated granular deposits in the capillary walls and mesangium. Immunofluorescent studies revealed granular deposits of IgG, IgM, and C3, primarily on the glomerular basement membrane. By indirect immunofluorescence, granular glomerular basement membrane and mesangial staining were detected with antibody specific for thyroglobulin and thyroid microsomal antigen. These observations suggest development of immune complex glomerulonephritis mediated by thyroid antigens.


[Morphological changes in the digestive organs during prolonged space flight on the Kosmos-782 biosatellite].

A reduction in the content of neutral mucopolysaccharides in mucous cells of the neck, a slight decrease in the activity of succinate dehydrogenase and NAD-diaphorase in parietal cells, a decrease in the DNA synthesis rate, and an increase in the area of mitochondria and cristae were detected in the gastric mucosa of rats which were in a long-term space flight. In the small intestine, an increase in the activity of glucose-6-phosphate dehydrogenase and leucine aminopeptidase were found. Morphological changes in the liver consisted in infiltrative adiposity. A similar morphological picture was demonstrated in a synchronous experiment on the earth. These changes, however, were nonspecific and reversible (25 days after rehabilitation the picture did not differ from the animal house control).


[Combined use of macro- and micrometric methods in assessing hypertrophy of the myocardial muscle elements proper].

The composite use in the study of heart hypertrophy of the method of separate weighing of the ventricles and measurement of the percentage content and average thickness of muscle fibers permits to determine their total mass and length, and on this basis to judge of the level of hypertrophy of the true muscle elements of the myocardium.


Acoustic impedance and otoscopic findings in young children with Down's syndrome.

This study sought to determine the point incidence of middle ear pathologic conditions and to ascertain the value of acoustic impedance-admittance measurements in detecting otitic pathologic conditions in young children with Down's syndrome. Pneumo-otoscopy and acoustic impedance measures were performed on 38 children (mean age, 3.1 years) with Down's syndrome. Results indicated that more than 60% of the series demonstrated otoscopic and acoustic impedance evidence of middle ear effusion, which is in keeping with results reported previously for older children and young adults with Down's syndrome. Of particular interest was the large number of normal ears that displayed absent crossed and uncrossed acoustic reflexes,which suggested that measurement of the acoustic reflex may be an unreliable parameter for confirming the presence of middle ear effusion in children with Down's syndrome. To maximize the educational potential of these children, a careful examination to detect middle ear effusion must be performed at periodic intervals. If persistent effusion is detected, appropriate surgical management should be instituted without delay.


The effect of 5-fluorouracil on abdominal wound healing in rats.

We carried out experiments to test the hypothesis that 5-Fluorouracil would retard wound healing when administration was started on the day of operation. Abdominal wounds were made in rats and closed again, and some of the animals were given daily 5-FU, the rest acting as controls. Test animals were killed three, five, seven and 10 days after operation, and the strength of their wounds was measured. At five and seven days the control wounds were 10 times stronger than those of the treated animals, and at 10 days they were four times stronger. We speculated that the difference in strength might be largely due to the observed fact that the muscle layer in the treated animals was considerably weaker than in the controls. We concluded that it would be unsafe to start giving 5-FU to patients immediately after operation.


Granulomatous and neoplastic diseases of the skin of horses.

Lesions encountered in a clinicopathological study of cutaneous lesions resembling 'swamp cancer' from horses in North Queensland included 37 cases of subcutaneous phycomycosis, 5 of which were also infected with Habronema sp larvae. In addition 9 cases of primary cutaneous habronemiasis, 58 sarcoids, 12 fibromas, 8 fibrosarcomas, 10 squamous cell carcinomas, 4 haemangiomas, 3 melanomas, 1 papilloma, 1 palpebral adenocarcinoma and 7 cases of simple granulation were diagnosed. Subcutaneous phycomycosis resulted in the most extensive lesions. These were rapidly growing and provided the poorest prognosis of all conditions studied. The incidence of phycomycosis in north Queensland was high in comparison to more temperate areas and appeared to be related to the wetter seasons. Young horses were more commonly affected. A fungus isolated from 3 phycomycotic lesions was tentatively identified as Hyphomyces destruens as no sporulation was observed.


Effects of griseofulvin on the morphology, growth and metabolism of fibroblasts in culture.

Griseofulvin was tested for its effects on the morphology, proliferation and metabolism of fibroblasts cultured from normal human skin and on established lines of mouse fibroblasts 3T3 and 3T6. In all cells treatment produced slight increases in the mitotic index compatible with transient mitotic arrest, but cultures of 3T3 and 3T6 cells also included high proportions (up to 25%) of abnormal multinucleate cells not present in human strains. The proliferation of all cell strains over a 2 or 4 day period was inhibited in proportion to dose (2--17 microgram/ml) with 50% inhibition of growth in the range of 5--11 microgram/ml. Acid mucopolysaccharide secretion was depressed by about 20% at 4--17 microgram/ml. Total protein synthesis was depressed in 3T6 and in human cells, but there was no specific effect on collagen synthesis or secretion.


A quantitative study of membrane coating granules in follicles undergoing experimental comedo formation.

Membrane coating granules (MCGs) may be required for normal keratinization. Comedone formation is associated with abnormal keratinization, and so the MCGs in sebacaous follicles were counted during experimental comedogenesis in the rabbit. During induced comedo formation with 50% oleic acid in paraffin oil, the numbers of MCGs decreased significantly; first, at the epidermis and mouth of the follicle and then later, at the follicular canal and common sebaceous duct. The maximum decrease of about 40% was reached by the 6th day in these regions. Throughout the treatment, the MCG count in the individual sebaceous ducts remained fairly constant.


Human infections with Microsporum gypseum in Denmark.

Ninety cases of Microsporum gypseum infection in Denmark during the period 1933-1977 are reviewed. The sex ratio, age distribution, and anatomical sites are started. A case of onychomycosis in a 1-year-old child is reported, and the cases of M. gypseum onychomycosis in the literature are reviewed.


Epidermolytic hereditary palmoplantar keratoderma. Report of a family and treatment with an oral aromatic retinoid.

This study describes a family of 30 people in which 14 members have hereditary epidermolytic palmoplantar keratoderma. Four patients were treated with an oral aromatic retinoid for up to 5 months. They responded in a uniform and dramatic way: 10-14 days after the onset of therapy, the hyperkeratotic horny layer was sequestered in large sheets resulting in normal appearing skin and restoration of normal surface sensitivity. Biopsies revealed that the underlying disorder of keratinization had remained unchanged. Treatment with the retinoid had to be discontinued as the sensitivity and vulnerability restricted normal function of hands and feet.


Denaturation of the tryptic fragments of the calcium (II) adenosine triphosphatase from sarcoplasmic reticulum by guanidinium hydrochloride.

Primary and secondary fragments of the Ca2+-adenosine triphosphatase from sarcoplasmic reticulum are resistant to complete denaturation by guanidinium hydrochloride, a property characteristic of many intrinsic membrane proteins. None of the fragments display a single cooperative transition from ordered structure to random coil suggesting each fragment contains several domains of differing resistance to guanidinium hydrochloride denaturation. The data suggest that the native enzyme has at least three membrane-embedded domains, with an externally accessible link between each.


Behavior of fragmented calcium (II) adenosine triphosphatase from sarcoplasmic reticulum in detergent solution.

The behavior of Ca2+-ATPase from sarcoplasmic reticulum in detergent solution was compared with that of Ca2+-ATPase which had been cleaved in half by limited trypsin digestion. Attempts to dissociate the fragments (I and II) with an excess of detergent micelles demonstrated that fragments I and II are structurally dependent upon each other, and that they must be denatured in order to be dissociated. Partial dissociation of the fragmented ATPase was found to occur in the bile salt detergents, deoxycholate and cholate, and optical data showed that there was an accompanying change in conformation. No dissociation of the fragmented ATPase was observed in nonionic detergents. The fragmented ATPase retained the same specific activity and stability as the intact ATPase under a variety of conditions when solubilized in Tween 80 or dodecyl octaoxyethylene glycol monoether. The data demonstrate that the noncovalent interactions that maintain the native conformation of the ATPase are not affected by either trypsin cleavage or solubilization in nonionic detergent solution.


Specificity of nucleotide binding sites in isolated chloroplast coupling factor (CF1).

The binding of various nucleotides to chloroplast coupling factor CF1 was studied by two dialysis techniques. It was found that the number of nucleoside diphosphate sites and their specificities for the base moiety is dependent on the magnesium concentration. In the presence of 50 micrometer added MgCl2, the protein has a single strong site/mol protein with Kd = 0.5 micrometer for ADP and high specificity (Kd greater than 20 micrometer for epsilonADP, GDP, CDP). In the presence of 5 mM MgCl2, the protein has two independent tight ADP sites (Kd = 0.4 micrometer) of low specificity (Kd approximately 0.8, 2, and 2 micrometer, respectively for episilonADP, GDP, and CDP). These results are compared with the specificity of the partial reactions for photophosphorylation.


Kinetics of nucleotide binding to chloroplast coupling factor (CF1).

Studies of the kinetics of association and dissociation of the formycin nucleotides FTP and FDP with CF1 were carried out using the enhancement of formycin fluorescence. The protein used, derived from lettuce chloroplasts by chloroform induced release, contains only 4 types of subunit and has a molecular weight of 280 000. In the presence of 1.25 mM MgCl2, 1 mol of ATP or FTP is bound to the latent enzyme, with Kd = 10(-7) or 2 . 10(-7), respectively. The fluorescence emission (lambdamax 340 nm) of FTP is enhanced 3-fold upon binding, and polarization of fluorescence is markedly increased. The fluorescence changes have been used to follow FTP binding, which behaves as a bimolecular process with k1 = 2.4 . 10(4) M-1 . s-1. FTP is displaced by ATP in a process apparently involving unimolecular dissociation of FTP with K-1 = 3 . 10(-3) S-1. The ratio of rates is comparable to the equilibrium constant and no additional steps have been observed. The protein has 3 sites for ADP binding. Rates of ADP binding are similar in magnitude to those for FTP. ADP and ATP sites are at least partly competitive with one another. The kinetics of nucleotide binding are strikingly altered upon activation of the protein as an ATPase. The rate of FTP binding increases to at least 10(6) M-1 . s-1. This suggests that activation involves lowering of the kinetic barriers to substrate and product binding-dissociation and has implications for the mechanism of energy transduction in photophosphorylation.


Light/dark labeling differences in chloroplast membrane polypeptides associated with chloroplast coupling factor o.

The fluorogenic reagent fluorescamine has been used to determine the labeling patterns of Type C spinach chloroplast membrane polypeptides. Membrane polypeptides labeled with fluorescamine were detected by scanning high resolution sodium dodecyl sulfate polyacrylamide gradient slab gels for fluorescence emission. Three membrane polypeptides show a decrease in the extent of labeling when chloroplast membranes are labeled in the light compared to when they are labeled in the dark. These polypeptides have apparent molecular weights 0f 32 000, 23 000 and 15 000. The decrease in labeling observed in the light is abolished or reduced by treatments which inactivate the light-generated transmembrane pH gradient. CF1-depleted chloroplasts show neither a light-activated pH gradient nor a light/dark difference in labeling of these three polypeptides. Both a light-activated pH gradient and light/dark difference in labeling are observed in CF1-depleted chloroplasts which have been treated with N,N'-dicyclohexylcarbodiimide. The same ammonium sulfate fractions of a 2% sodium cholate extract, which are believed to be enriched in the membrane-bound sector of the chloroplast ATPase (CFo) are also found to be enriched in the 32 000, 23 000 and 15 000 molecular weight polypeptides. The three polypeptides are believed to be components of CFo, and the light/dark labeling differences may indicate conformational changes within CFo. Such conformational changes may reflect a mechanism which couples light-generated proton gradients to ATP synthesis.


The stimulation of coupling factor 1 ATPase by tentoxin.

Tentoxin at 10--1000 micrometer causes a marked species-selective stimulation of coupling factor 1 Ca2+-dependent ATPase activity (Ka 6.3 . 10(3) M-1). This effect decreases the Km for ATP to about 0.3 mM and increases V 2.75-fold. Above 1.6 micrometer tentoxin the rate of coupled electron transport was reduced to basal without uncoupling.


Is there a plasma membrane-located anion-sensitive ATPase? IV. Distribution of the enzyme in rat pancreas.

The intracellular localization of anion-sensitive Mg2+-ATPase in rat pancreas was studied by differential centrifugation, density gradient centrifugation and by the use of inhibitors of mitochondrial Mg2+-ATPase. The anion-sensitive MG2+-ATPase appears to be localized almost exclusively in a mitochondrial (15 min, 15 000 times g) fraction which shows two peaks after density gradient centrifugation. Both peaks coincide with the highest levels of cytochrome c oxidase activity, but not with alkaline phosphatase, (Na+ plus K+)-ATPase and leucine aminopeptidase activities or RNA. They appear to be equal sensitive to inhibition by oligomycin, aurovertin D and the rat liver mitochondrial inhibitor protein, at least when 1 mM EDTA is present in the isolation media. We conclude that no significant plasma membrane-located anion-sensitive Mg2+-ATPase activity is present in rat pancreas.


Effects of lanthanum on calcium-dependent phenomena in human red cells.

Lanthanum (0.25 mM) does not penetrate into fresh or Mg2+-depleted cells, whereas it does into ATP-depleted or ATP + 2,3-diphosphoglycerate-depleted cells, into cells containing more than 3 mM calcium, or cells stored for more than 4 weeks in acid/citrate/dextrose solution. In fresh cells loaded with calcium, extracellular lanthanum blocks the active Ca2+-efflux completely and inhibits (Ca2+ + Mg2+)-ATPase (ATP phosphohydrolase, EC 3.6.1.3) activity to about 50%. In Mg2+-depleted cells Ca2+-Ca2+ exchange is inhibited by lanthanum. Ca2+-leak is unaffected by lanthanum up to 0.25 mM concentration; higher lanthanum concentrations reduce leak rate. In NaCl medium Ca2+-leak +/ S.D. amounts to 0.28 +/ 0.08 mumol/1 of cells per min, whereas in KC1 medium to 0.15 +/ 0.04 mumol/1 of cells per min at 2.5 mM [Ca2+]e and 0.25 mM [La3+]e pH 7.1. Lanthanum inhibits Ca2+-dependent rapid K+ transport in ATP-depleted and propranolol-treated red cells, i.e. whenever intracellular calcium is below a critical level. The inhibition of the rapid K+ transport can be attributed to protein-lanthanum interactions on the cell surface, since lanthanum is effectively detached from the membrane lipids by propranolol. Lanthanum at 0.2--0.25 mM concentration  has no direct effect on the morphology of red cells. The shape regeneration of Ca2+-loaded cells, however, is blocked by lanthanum owing to Ca2+-pump inhibition. Using lanthanum the transition in cell shape can be quantitatively correlated to intracellular Ca2+ concentrations.


Plasma membranes from Candida tropicalis grown on glucose or hexadecane. I. Isolation, identification and purification.

Plasma membranes from Candida tropicalis grown on glucose or hexadecane were isolated using a method based on the difference in surface charge of mitochondria and plasma membranes. After mechanical disruption of the cells, a fraction consisting of mitochondrial and plasma membrane vesicles was obtained by differential centrifugation. Subsequently the mitochondria were separated from the plasma membrane vesicles by aggregation of the mitochondria at a pH corresponding to their isoelectric point. Additional purification of the isolated plasma membrane vesicles was achieved by osmolysis. Surface charge densities of mitochondria and plasma membranes were determined and showed substrate-dependent differences. The isolated plasma membranes were morphologically characterized by electron microscopy and, as a marker enzyme, the activity of Mg2+-dependent ATPase was determine. By checking for three mitochondrial marker enzymes the plasma membrane fractions were estimated to be 94% pure with regard to mitochondrial contamination.


Mg2+-ATPase as a membrane ecto-enzyme of human granulocytes. Inhibitors, activators and response to phagocytosis.

(1) The Mg2+-ATPase of purified human granulocytes is located at the plasma membrane. Thus, no additional enzyme activity was detected when the cells were disrupted. Moreover, the Mg2+-ATPase activity of intact cells was inhibited by such poorly permeant reagents as diazotized sulfanilic acid and suramin. Finally, the enzyme activity of cell homogenates was recovered in particulate fractions. (2)The surface Mg2+-ATPase of human granulocytes had an apparent Km of 50 microns for ATP and displayed substrate inhibition. (3) The enzyme was not affected by ouabain, but was inhibited by N-ethyl malemide, sodium meta-periodate, suramin and diazotized sulfanilic acid. The enzyme was activated by cytochalasins B and D and by UDP. Activation by UDP was characterized by changes in the enzyme's apparent Km and V and by belief of substrate inhibition. (4)Internalization of surface membranes subsequent to phagocytosis of suitable particles did not result in depletion of Mg2+-ATPase from the cell surface. The enzyme activity did not decrease after exposure to several varieties of paraffin oil emulsion particles, even if the challenged cells had been pretreated with colchicine of cytochalasin B. (5) Since suramin, which inhibited Mg2+-ATPase, had no effect upon other granulocyte functions such as chemotaxis, superoxide anion generation, or phagocytosis, it is unlikely that the enzyme plays a major role in these functions.


Neurospora crassa mitochondrial transfer RNAs.

Total mitochondrial tRNA from Neurospora crassa was characterized by base composition analysis, one- and two-dimensional gel electrophoreses and reversed-phase chromatography on RPC5. The guanosine + cytidine content was about 43%, as compared to 60% for cytoplasmic tRNA. The modified nucleoside content was low and about the same as that of total yeast mitochondrial tRNA, though the G + C content is very different. We found psi, T, hU, t6A, m1G, M2G, m22G. Neither the eukaryotic "Y" base, nor the prokaryotic s4U were present. On two-dimensional polyacrylamide gel electropherograms about 25 species were separated. One species for phenylalanine, two for leucine and two for methionine could be located. Neurospora crassa mitochondrial tRNA does not hybridize with yeast mitochondrial DNA.


Laparoscopic assessment of the jaundiced patient: a review of 53 patients.

Laparoscopy in the investigation of patients with jaundice allows visualization of intra-abdominal pathology, target biopsy of intra-abdominal lesions and percutaneous fine-needle cholangiography, all to be carried out at the one procedure. Formal laparotomy can then be planned electively or avoided completely in appropriate cases. In our experience we have found laparoscopy with percutaneous fine-needle cholangiography and biopsy to be a useful procedure in the diagnosis and management of jaundiced patients.


Physician's use of laparoscopy.

The role of laparoscopy in medical practice was assessed by studying 238 consecutive laparoscopies performed under local anaesthesia by physicians in a single teaching hospital. Indications for laparoscopy were assessment of possible and known hepatic disease, possible disseminated abdominal malignancy, abdominal mass, and conditions such as ascites and splenomegaly. A definitive diagnosis was reached in 223 cases (76.5%). No organic disease was detected in 41 patients, though findings were false-negative in two of them (0.8%). The procedure failed in 15 (6.3%), mostly because adhesions from previous surgery hindered adequate visualisation. Six patients (2.5%) had complications, one of whom subsequently died. If patients are appropriately selected laparoscopy is relatively free of postoperative complications, and is an effective diagnostic procedure in abdominal malignancy and decompensated liver disease. Cost-effectiveness is an additional advantage.


Chlamydia trachomatis in gonococcal and postgonococcal urethritis.

Chlamydia trachomatis was isolated from the urethra of 38 (28.6%) out of 133 men with gonococcal urethritis (GU). During the follow up of 72 men postgonococcal urethritis (PGU) was diagnosed in 50 (69.5%) patients. More than half (30 out of 50) of these patients with PGU were Chlamydia-positive. Out of 31 patients with Chlamydia 30 developed PGU whether or not procaine penicillin, spectinomycin, or gentamicin were used. These findings are discussed in relation to present recommendations for the treatment and follow up of patients with GU.


Phase I study with neocarzinostatin: tolerance to two hour infusion and continuous infusion.

Neocarzinostatin (NCZ), an acidic polypeptide antibiotic, was given to 47 patients with cancer and leukemia, and tolerance to two schedules, a single dose given as a 2 hour infusion and a continuous infusion over 5 days was investigated. Immediate reactions, including fever, chills, rigor, hypertension and mental confusion, were dose-limiting for the 2 hour infusion schedule, occurring at 3000 U/m2 and higher. Continuous administration for 5 days eliminated the immediate reactions and then hematological toxicity--often prolonged leukopenia and thrombocytopenia--became dose-limiting. Other toxicities of NCZ at both dose schedules included anemia, fever and chills, anorexia, nausea and vomiting, hepatic dysfunction, azotemia, hypophosphatemia, aminoaciduria, stomatitis, phlebitis and/or cellulitis at the venous infusion site and pruritus. Patients with solid tumors who had received little or no prior chemotherapy and had good bone marrow reserve tolerated up to 6000 U/m2/24 hours X 5 days. One patient with previously treated acute myelocytic leukemia was induced into a good partial remission lasting 10 weeks.


Surface markers and functional properties of non-Hodgkin's lymphoma cells in relation to histology.

Cells from 32 adult patients with non-Hodgkin's lymphoma were studied with respect to surface markers and functional properties in short-term culture. Twenty-six lymphomas were of B-cell origin, including all nodular and diffuse lymphocytic lymphomas. Three tumors were of T-cell origin (one histiocytic lymphoma and two undifferentiated lymphomas). In the remaining three cases (histiocytic lymphomas) the immunological nature of the tumor cells could not be determined. All reactivity to mitogenic stimuli of cells from B-cell lymphomas was due to residual normal T cells. In follicular lymphocytic  lymphomas more reactive T cells prevailed among the malignant B cells than in diffuse lymphocytic lymphomas. Heterogeneity among B-cell lymphomas was indicated by differences in intensity of fluorescence with anti-Ig reagents and in stimulatory capacity in mixed lymphocyte culture. T-cell lymphomas were characterized by high percentages of T cells together with impaired responses to stimuli. The results of immunological studies correlated well with the histological classifications of Rappaport, Lukes and Lennert.


Symptomatic hypocalcemia following combined calcitonin and mithramycin therapy for hypercalcemia due to malignancy.

Three patients with malignant disease received the usual recommended doses of mithramycin and calcitonin, either concurrently or concomitantly, because of severe life-threatening hypercalcemia. All three patients developed severe, symptomatic hypocalcemia. The mechanisms for this phenomenon are discussed. A possible synergism between calcitonin and mithramycin may prove to be hazardous in such patients and this possibility must be kept in mind when these agents are being considered as a combination treatment for hypercalcemia.


Phase I study of pyrazofurin in refractory acute myelogenous leukemia.

Pyrazofurin was administered to 17 patients with refractory acute myelogenous leukemia in 5-day courses every 2-3 weeks. Doses ranged from 30 to 60 mg/m2/day. Severe stomatitis and dermatitis occurred at doses effective in reducing the leukocyte count (45 mg/m2). Reduction of the dose to 30 mg/m2 resulted in less toxicity and less chemotherapeutic effect. These results indicate that at tolerable doses given as described, pyrazofurin had little antileukemic activity in acute myeologenous leukemia.


Synthesis and degradation of myocardial protein during the development and regression of thyroxine-induced cardiac hypertrophy in rats.

Cardiac hypertrophy was induced in rats by daily injections of L-thyroxine (1.0 mg/kg). Regression from hypertrophy was studied 4 days after discontinuing thyroxine. Isolated, Langendorff-perfused hearts were perfused with Krebs-Henseleit buffer, glucose, insulin, and amino acids. To measure protein synthesis, left ventricular tissue was assayed for incorporation of tritiated phenylalanine into protein. Indices of rates of protein degradation were obtained by measuring the release of cold phenylalanine after blocking protein synthesis with cycloheximide. After 3 days of thyroxine (when cardiac growth was maximally increased), the rate of protein synthesis increased by 22% (P less than 0.001). After 1 week, synthesis was 8% greater than control (P less than 0.05), and by 2 weeks (when hypertrophy was stable and the rate of cardiac growth was similar to controls), synthesis had returned to control levels. In hearts regressing from hypertrophy, synthesis was reduced to 68% of control (P less than 0.001). The rate of protein degradation was decreased by 12% (P less than 0.05) after 3 days of thyroxine, but was not different from control at 1 or 2 weeks. During regression, degradation was 12% below control (P less than 0.05). Changes in the release of several amino acids that are synthesized or metabolized in heart (e.g., alanine, glycine, serine) were different from changes in phenylalanine release. In conclusion thyroxine-induced cardiac hypertrophy and regression are accompanied by changes in protein synthesis and degradation, and amino acid metabolism. The predominant change in hypertrophy is increased protein synthesis with a minor contribution from reduced degradation. Regression of hypertrophy is accompanied by decreased synthesis, not increased degradation.


Differentiation of posterior myocardial infarction from right ventricular hypertrophy and normal anterior loop by echocardiography.

The differentiation of posterobasal myocardial infarction (PMI) from either right ventricular hypertrophy (RVH) or normal subjects displaying an anterior loop (AL) by electrocardiography (ECG) or vectorcardiography (VCG) is difficult. M-mode echocardiography (echo) via the anterior and subxiphoid methods has been helpful in defining cardiac chamber size and wall motion abnormalities. We tested whether this relatively more direct method would better separate these entities compared with the other two techniques. ECG and VCG using established criteria failed to distinguish the three conditions effectively. By echo, distinguishing characteristics were observed in each of the groups. Thus, right ventricular diastolic dimension and wall thickness were significantly increased only in the RVH group, echo dimensions and wall motion were normal in the AL group and the posterior left ventricular systolic thickening response and ejection phase indices were significantly reduced only by the subxiphoid method in the PMI group. To test the specificity of the latter finding, posterior wall motion in three infarction groups (posterior, combined posteroinferior and inferior) were examined and suggested that the target of the subxiphoid beam focuses on a more superior posterobasal left ventricular segment than the anteriorly placed transducer. Echocardiography can differentiate PMI from either RVH or AL more directly than ECG or VCG, and may be of practical clinical importance.


Cardiac metabolsim: its contributions to alcoholic heart disease and myocardial failure.

Changes in cardiac metabolism in myocardial failure and after alcohol ingestion are discussed. The main effect of alcohol ingestion is loss of cardiac contractility. Since heart muscle does not contain alcohol dehydrogenase, its toxicity is probably the result of a direct toxic effect of ethanol and acetaldehyde on the myocardial cell, possibly involving various membrane systems. Alcohol inhibits mitochondrial respiration and the activity of enzymes in the tricarboxylic acid cycle, and its interferes with both mitochondrial calcium uptake and binding. Ethanol profoundly affects myocardial lipid metabolism. Acetaldehyde diminishes myocardial protein synthesis and inhibits Ca++-activated myofibrillar ATPase. In myocardial failure, a series of possibilities may be responsible for the loss of contractility. Excitation-contraction coupling could be disturbed at the level of the sarcolemma, at the sarcoplasmic reticulum, at the mitochondria, and between calcium and the regulatory proteins. Deficiencies in Ca++ delivery systems of excitation-contraction coupling on the myosin ATPase activity could be responsible for the dimunition in cardiac contractility. Mitochondrial function may also be involved, since mitochondria from failing human hearts are defective with respect to respiratory control and calcium accumulation. Under certain conditions, the relationship of mitochondria to calcium sequestration is very important in influencing contractility. The involvement of contractile and regulatory proteins in myocardial failure cannot be excluded.


Prevalence and characteristics of disporportionate ventricular septal thickening in infants with congenital heart disease.

Necropsy studies were performed in 125 infants, 2 years old or less, with a variety of congenital heart malformations. Disproportionate ventricular septal thickening (septal-to-left ventricular free wall thickness ratio greater than or equal to 1.3) was present in 31 (25%) of the 125 patients. In the majority of patients, an abnormal septal-to-free wall ratio did not appear to be a manifestation of genetically transmitted hypertrophic cardiomyopathy, since: 1) marked disorganization of septal myocardium (involving greater than or equal to 5% of the tissue section) was present in only five of the 31 patients with disproportionate septal thickening; and 2) echocardiographic studies in first degree relatives of four other patients with disproportionate septal thickening and normal septal architecture did not show asymmetric septal hypertrophy. The relatively high prevalence of septal-to-free wall ratios of 1.3 or greater in this population of infants with congenital heart disease appeared to be due in part to minor differerences in ventricular wall thicknesses (in patients with relatively thin absolute wall thicknesses) which may produce particularly large deviations from unity in septal-to-free wall ratio. Hence, 1) nongenetically transmitted disproportionate septal thickening is relatively common in infants with congenital heart diseases studied at necropsy: and 2) a septal-to-free wall ratio of greater than or equal to 1.3 cannot be used as the sole criterion for identifying associated hypertrophic cardiomyopathy in infants with other congenital heart diseases, particularly if marked absolute septal thickening is absent.


Effect of Sch1000 in allergen-induced asthma.

Carefully controlled allergen inhalation tests were carried out in twelve subjects to provoke early asthmatic responses with a mean maximum FEV1 fall of 30.7 +/- 5.2% (mean +/- s.d.). Four subjects had additional late asthmatic responses with a maximum mean FEV1 fall of 21.0 +/- 5.9%. The tests were repeated at intervals of 7 days in an identical way, following inhalation of Sch1000 (80 microgram) and placebo, each given 45 min before the onset of the early asthmatic response. This dose of Sch1000 produced a marked and uniform inhibition of methacholine-induced bronchoconstriction in the same subjects. The allergen-induced responses were reproducible in eleven out of the twelve subjects; the coefficient of variation for the decrease in FEV1 in the early responses being +/- 7% and in the late response +/- 43%. Sch1000 produced a slight and variable inhibition of early asthmatic responses (P less than 0.02) and no inhibition of late asthmatic responses. We examined the relationship between the degree of inhibition of the early asthmatic response by Sch1000 and : (a) the degree of inhibition produced by Sch1000 on histamine- and methacholine-induced bronchoconstriction; (b) the level of non-specific bronchial reactivity measured by inhaled histamine and methacholine; and (c) the degree of bronchodilatation produced by Sch1000. No relationship was found.


Hypersensitivity pneumonitis with antibodies to Cryptococcus neoformans.

Clinical and immunological studies were made in forty-two patients diagnosed as suffering from hypersensitivity pneumonitis at Osaka Prefectural Habikino Hospital between 1973 and 1977. All the sera from forty-one patients tested had high titres of antibody against Cryptococcus neoformans in indirect fluorescent antibody tests, and twelve also had precepitins against Cryptococcus neoformans polysaccharide. Only about 10% of control sera from patients with other lung diseases had low titres of antibody against Cryptococcus neoformans. Antibody against Cryptococcus neoformans was also found frequently in the sera of asymptomatic members of the families of the patients. A possible relationship of Cryptococcus neoformans to hypersensitivity pneumonitis is suggested.


Urinary excretion of a large amount of bound sialic acid and of under sulfated chondroitin sulfate A by patients with the Lowe syndrome.

Urine samples from two patients with the Lowe syndrome were analyzed for sialic acid and mucopolysaccharides. The sialic acid content, relative to the creatinine content, was 4--5 times higher in these patients' urine than in normal urine. Most of the sialic acid was found in unidentified glycoproteins of high molecular weight, but the levels of sialyllactose and free sialic acid were also elevated about 2 fold. A most remarkable finding was the excretion of undersulfated chrondroitin sulfate A without other mucopolysaccharides normally occurring in urine. It is suggested that a disorder in sulfation of mucopolysaccharides is etiologically implicated in the Lowe syndrome.


Down syndrome in two of three triplets.

This is the first report to our knowledge of trisomy 21 in two members of a set of triplets. The two with Down syndrome are monozygous; the other triplet is not identical. These triplets were born to a 22-year-old woman in whose family there have been six sets of twins (four like-sex) since 1775. Neither parent has any chromosomal abnormality. Zygosity estimates in the triplets are derived from studies of red blood cell antigens and HLA typing. Twinning has been reported in association with many different chromosome abnormalities. It has been suggested that the incidence of Down syndrome among twins is significantly higher than among singletons. It seems likely that some families have a heritable predisposition to both twinning and chromosome abnormalities.


Genetic control of susceptibility to autologous immune complex glomerulonephritis in inbred rat strains.

Twelve inbred rat strains were tested for their susceptibility to autologous immune complex glomerulonephritis (AIC) after a single injection of a primary tubular epithelial fraction emulsified in Freund's complete adjuvant. Six strains (Lewis, AS, BDV, L.BDV, AS2, L.AS2) showed high responsiveness in terms of proteinuria and immunohistological changes, which could be observed after 3 months. Strains BN, AVN and DA were completely resistant, even after 6 months of observation. An additional adjuvant (pertussis vaccine) did not break non-responsiveness in one of these strains (BN). Strains which share the Lewis strain genetic background (L.BN, L.AVN and L.WP) seemed to be at least weakly susceptible to AIC. A close association between susceptibility and the major histocompatibility haplotypes is demonstrated in segregation studies involving Lewis, L.BN and BN rats. A threshold model of AIC susceptibility, based on the action of major histocompatibility-linked genes and background genes, is suggested.


Cytogenetic abnormalities in orthopedic patients.

Patients with orthopedic problems may also have chromosomal abnormalities. Individuals who present with subtle clinical findings suggestive of a known syndrome resulting from a chromosomal abnormality, such as Klinefelter syndrome, Turner syndrome, or any of the known trisomiers, should be investigated further in order to confirm the diagnosis. In addition, those patients who have multiple congenital abnormalities in several systems should also have chromosome analysis. This should be done not only to gain new information in regard to chromosome abnormalities, but also to establish a diagnosis for the individual and thus provide proper genetic counseling for the family. If the clinical picture strongly suggests a chromosomal abnormality, and routine karyotyping does not demonstrate one, it is imperative that one or more banding techniques be utilized before a chromosomal abnormality can be ruled out.


Causes of death, right ventricular hypertrophy, and congenital heart disease in scoliosis.

Among the causes of death of 43 scoliotics were 5 directly due to complications of congenital heart disease. Over half (57.9%) of the remaining 38 died of cardiac or respiratory causes. The paralytic scolitoics tended to die of pneumonia or respiratory failure, while the nonparalytic scoliotics died of cardiac failure. Right ventricular hypertrophy was present in 65% of the 17 subjects examined postmortem. Electrocardiographic evidence of right ventricular hypertrophy correlated well with the postmortem findings. The vital capacity was less than 1.75 liters in 84% of the dead subjects. The case records of a further 719 living scoliotics were examined for evidence of congenital heart disease. This was found in: 34 (4.5%) of the whole group of 762, 6.9% of the congenital ; 3.4% of the idiopathic scoliotics; 22.7% of those with Marfan's syndrome.


Diagnostic problems in the lumbar spine.

In summary then, the diagnostic problems of the lumbar spine are myriad. They can include conditions which are congenital, tumorous, traumatic, toxic, metabolic, inflammatory, degenerative, infectious, circulatory, mechanical, or psychoneurotic. In addition many of these combinations can be found in the problem now alluded to as "spinal stenosis". Even under this condition, spinal stenosis is classified as congenital and acquired. Under the acquired forms of stenosis there are degenerative, combined stenosis, spondylotic, postoperative, posttraumatic, and miscellaneous types such as that due to Paget's disease or fluorosis. A diagnosis of these conditions can best be made by an experienced historian and examiner since they are never clear-cut and sometimes it is a "sixth sense" of the physician which helps him make the diagnosis. The diagnosis, once suspected, can best be confirmed with proper laboratory tests including myelography and tomography. The treatment, of course, depends specifically on the pathology which is diagnosed. The surgical approach to lumbar spinal stenosis and nerve root entrapment is discussed in Chapter 15. Due to the work of Verbiest and others, much has been done to elucidate this confusing diagnostic area (1, 9). However, much more needs to be learned. We do not completely understand the pain receptors for discogenic pain as well as reasons why various forms of treatment seem to have a 60% success rate no matter what is done. One of the reasons that long-term results are so difficult to come by in this type of work is the fact that these patients cannot be easily categorized by a simple method such as the study of a long bone fracture and the acquisition of a large series with one type of treatment. There are so many psychogenic factors as well as multifaceted treatment regimes used by experts throughout the world that a perfect follow-up with controls is practically impossible. Hopefully, better standardization of diagnostic procedures, nonoperative and operative treatment forms, and analysis of long-term end results may be forthcoming in the future as we elucidate this confusing problem called "low back pain".


Comparative study of iocetamic acid and calcium ipodate in the visualisation of the gallbladder and common bile duct.

Iocetamic acid (Cholebrin) and calcium ipodate (Solubiloptin) were randomly allocated to two groups of 50 patients. Each patient completed a detailed questionnaire for side effects. There was no significant difference between the contrast media in their ability to opacify the gallbladder. Cholebrin was superior to Solubiloptin in opacifying the common bile duct in the presence of abnormal liver function, but there was no difference when liver function was normal. Palpitations were significantly higher with Solubiloptin (P = 0.01) but the incidences of other side effects showed no significant differences. Unabsorbed contrast residues were noted in similar frequency with both media. A high incidence of chronic cholecystitis was found in patients with non-opacified gallbladders and in those with gallstones.


Radiology of the loin pain-haematuria syndrome.

The radiological findings in 14 female patients with the loin plain--haematuria syndrome are described. The abnormal features are found on renal arteriography, the changes being bilateral in 13 of the 14 patients. In the smaller branches of the arterial tree there are changes of irregularity, tortuosity, stasis, and occlusion. Although not all these changes are present in every patient, the nephrogram is always abnormal, with multiple small defects in the renal cortex and blurring of the corticomedullary differentiation. It is expected that this syndrome will become more widely recognised.


Contact eczema produced by a beta-adrenergic blocking agent (alprenolol).

In a pharmaceutical industry, several cases of allergic contact eczema caused by the beta-adrenergic blocking agent alprenolol (Aptin) have appeared. This report deals with 12 men and two women who developed eczema during work with the substance. In 13 of the 14 cases, the induction time for sensitization was less than 1 year. The skin reactions were very florid. After healing they could be reproduced by very small quantities of the substance. In one case, eczema could also be produced after ingestion of Aptin tablets. All the cases were transferred to other work within the factory. An intensive programme was implemented to remove dust from the working areas. Despite this, isolated new cases still appear. Some employees in contact with the substance also experienced mucous membrane symptoms. These symptoms could not be shown to have an allergic aetiology, but were considered to be irritant reactions. Alprenolol must be considered a very strong contact allergen.


Nyloprint-sensitive patients react to NN' methylene bis acrylamide.

Two patients showed occupational contact sensitization to a component present in the Nyloprint photopolymer printing plate. The component could not be identified chemically. It contains an acrylamide group. Both patients gave group-specific reactions to NN' methylene bis acrylamide. This must be a closely realted substance. Possible preventive measures are discussed. The manufacturer should have disclosed the allergic substance and instructed his customer adequately. A "philosophy" concerning this point is being developed.


Chronic alcoholic cardiomyopathy: fact or fiction?

This study was designed to ascertain whether excessive prolonged alcohol intake itself may produce chronic cardiomyopathy. We reasoned that, since alcoholic cardiomyopathy is allegedly a chronic condition, asymptomatic or early symptomatic cases should be found in a large hospitalized alcoholic population. Two groups of patients were studied. The first group consisted of 292 chronic alcoholics whose hospital records were examined for evidence of early cardiomyopathy, according to predetermined criteria. The second group consisted of eight patients who died on the medical service ward and in whom one of the diagnoses listed in the autopsy report was alcoholic cardiomyopathy. In the first group hepatic and neurological complications of alcoholism were frequent; no patient was found to have early cardiomyopathy. In the second group the post-mortem records indicated that all eight patients had other illnesses causing the abnormal findings on which the diagnosis of alcoholic cardiomyopathy was made. We conclude that the concept of chronic alcoholic cardiomyopathy caused by the direct toxic effect of alcohol may not be valid.


In vitro and in vivo inhibitory effect of dehydroepiandrosterone on respiration.

The inhibitory effect of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulphate (DHEA-S) was tested either in vitro with the use of Clark electrode combined with polarography or in vivo using the Spirolyt apparatus. In vitro, DHEA and progesterone showed a marked inhibitory effect on oxygen consumption by the rat heart liver mitochondria. A decrease of oxygen consumption was also observed with electron transporting particles (ETP). However, in both instances DHEA-S was without effect. In vivo, DHEA inhibited whole body oxygen consumption in rats, provided the steroid was injected in a dose of 50 mg kg-1 and 1--16 h before the measurement. No effect was obtained 9 h after DHEA injected in a dose of 5 mg kg-1. Also DHEA administered per os (25 mg kg-1) for six days was without effect as measured 16 h after the last dose. These data are discussed in connection with the beneficial effect of DHEA-S administered to patients with angina pectoris.


Neurochemical findings in Huntington's chorea.

Huntington's chorea is a dominantly inherited disorder that usually leads to involuntary movements in the third or fourth decade. On gross pathological examination of the post-mortem brain there is a marked atrophy of the caudate nucleus and putamen. Histological examination reveals cell loss in most regions of the brain, although the hippocampus is usually remarkably free of any abnormalities. Studies to detect a biochemical defect in patients with chorea have been largely unrewarding. Since chorea appears to be the clinical counterpart of Parkinson's disease a number of investigations on dopamine metabolism have been carried out by measuring dopamine in the post-mortem choreic brain, and HVA, a metabolite of dopamine, in the CSF of patients. Most studies have found the dopamine concentrations to be normal or sometimes decreased and the activity of the biosynthetic enzyme for dopamine, tyrosine hydroxylase, is normal. The discovery that the inhibitory neurotransmitter, GABA, and the biosynthetic enzyme GAD are greatly decreased in the post-mortem choreic brain provides some rational explanation for the uncontrolled movements in this disorder. The other significant abnormality found in many, but not all, choreic post-mortem brains has been a decrease in the biosynthetic enzyme for acetylcholine, choline acetyl transferase. The evidence that GABA receptors are intact in choreic brain provides an added stimulus for the development of useful GABA-mimetic drugs. For the ultimate eradication of this distressing disorder, however, a search must continue for the primary defect in order that this can be detected before the onset of symptoms, or hopefully in amniotic fluid.


Properties of glycolytic and related enzymes of normal and malignant human uterine tissues studied to optimise assay conditions.

The properties of 12 enzymes related to the glycolytic and oxidative metabolism of glucose were examined in normal and malignant epithelium of human uterine tissues to develop optimised assays suitable for both types of tissue and to delineate important kinetic differences that may exist between them. All assays gave acceptable long-term precision, although instability of phosphofructokinase and 6-phosphogluconate dehydrogenase prevented proper assessment; and all were linear with concentration to an absorbance change of 0.04/min, or more in the case of several enzymes. Notable differences between pyruvate kinase of normal and malignant uterine epithelium were found with D-fructose-1,6-diphosphate (FDP) which caused significantly greater activation of the latter as well as a dramatic reduction in Km for phosphoenol pyruvate; inhibition by DL-alanine was greater for pyruvate kinase of malignant than normal cervix epithelium, whereas endometrium did not show this difference. The ratio of aldolase activity with FDP to that with D-fructose-1-phosphate was greater in malignant than in normal cervix epithelium, no significant difference being apparent in endometrium.


The 5-S RNA . protein complex from an extreme halophile, Halobacterium cutirubrum. Purification and characterization.

A 5-S RNA . protein complex has been isolated from the 50-S ribosomal subunit of an extreme halophile, Halobacterium cutirubrum. The 50-S ribosomal subunit from the extreme halophile requires 3.4 M K+ and 100 mM Mg2+ for stability. However, if the high K+ concentration is maintained but the Mg2+ concentration lowered to 0.3 mM, the 5-S RNA . protein complex is selectively extracted from the subunit. After being purified on an Agarose 0.5-m column the complex had a molecular weight of about 80000 and contained 5-S RNA and two proteins, HL13 and HL19, with molecular weights (by sedimentation equilibrium) of 18700 and 18000, respectively. No ATPase or GTPase activity could be detected in the 5-S RNA . protein complex. The amino acid composition and electrophoretic mobility on polyacrylamide gels indicated both proteins were much more acidic than the equivalent from Escherichia coli or Bacillus stearothermophilus. Partial amino acid sequence data suggest HL13 is homologous to EL18 and HL19 to EL5.


Basal ganglia calcification and psychosis in mongolism.

An 18-year-old mongoloid girl (trisomy 21) of Asian descent presented two symptoms rarely associated with mongolism (Down's syndrome). (1) Brain stem calcification; the first case diagnosed in vivo in mongolism on computerized axial tomography. (2) Hallucinatory psychotic depression; the first case successfully treated, to full recovery from the psychosis, in a mongoloid child with known brain stem calcification. The psychotic depression was related to moderate environmental stress. While being treated in her parent's home, in their native land, for more than 1 year, the psychosis remained unresponsive to tranquilizers. Following hospital admission in the USA, rapid improvement was obtained within a few weeks through intensive milieu therapy.


Immune depression in trypanosome-infected mice. I. Depressed T lymphocyte responses.

Using a wide range of experimental conditions, several kinds of T lymphocyte responses in spleen cell populations from trypanosome-infected mice were studied. Lymphocyte stimulation after culture with the mitogen concanavalin A or with histoincompatible cells differing at H-2 or minor lymphocyte-stimulating loci was reduced or abolished in spleen cells from infected mice when compared with responses of spleen cells from uninfected controls. In addition, cytotoxic lymphocytes were not generated in mixed lymphocyte cultures which contained spleen cells from infected animals. Allogeneic skin grafting experiments performed with normal and infected mice showed that a decreased T lymphocyte response also occurs in vivo. The depressed immune responses were not simply due to low numbers of T lymphocytes in spleens of infected animals, but reflected a generalized immune depression which was not antigen-specific.


Cell-mediated lympholysis: examination of HLA genetic fine structure and complementation using cytotoxic lymphocytes.

Human cytotoxic lymphocytes (CTL), sensitized in vitro in one-way mixed lymphocyte cultures between two unrelated individuals, have been used to study target cell determinants. One pair of CTL shows strong cell-mediated lympholysis responses against the specific target cells as well as against third-party target cells obtained from unrelated individuals. Testing of sixty target cells shows a significant association between the two CTL with a correlation coefficient of 0.67 in the panel. The target determinant recognized by the CTL is not an HLA-A,B,C or D specificity, as defined by standard serological and cellular reagents. Segregation studies in a large family reveal that the new specificity defined by the CTL is controlled by HLA, and its recognition may be restricted by the HLA complex.


A new approach to tubal sterilization by laparoscopy.

Laparoscopic tubal sterilization has been rapidly gaining acceptance as a nonpuerperal method of permanent fertility control. A number of problems have nonetheless been associated with this technique. For example, tubal destruction often exceeds that necessary for tubal occlusions, increasing the danger of thermal injuries and possibly such dysfunctional disorders as abnormal uterine bleeding and dysmenorrhea. Furthermore, excessive destruction precludes any possibility of later tubal reconstruction. In an attempt to avoid these problems, a new low-voltage unit with a rechargeable battery was evaluated. With this unit, cautery is provided under laparoscopic view with a spring-activated hook which retracts the fallopian tube into a Teflon shield, where it is coagulated and transected. Histopathologic studies of the healthy fallopian tubes of four women in their reproductive years treated by this method while the abdomen was open prior to an elective hysterectomy demonstrated minimal destruction of the mesosalpinx, with complete tubal occlusion and a coagulated area 10 mm in length. One hundred and sixty-five patients have been sterilized successfully by this method. Indications are that it may provide safe tubal occlusion without unnecessary destruction of the fallopian tubes and surrounding vasculature.


Isolation and biochemical properties of two types of microbody from Neurospora crassa cells.

Cells of the Neurospora crassa slime mutant grown in sucrose medium exhibited low activities of glyoxysomal marker enzymes isocitrate lyase (ICL), malate synthetase (MS), and malate dehydrogenase. Transfer of the cells to a medium containing acetate as sole carbon source ("acetate medium") induced a strong increase in the activities of these enzymes in both the soluble and the crude particulate cell fraction. Soluble isocitrate lyase activity increased rapidly after a lag phase of about 45 minutes. Addition of 0.1 mM cycloheximide to the acetate medium 3 hours after transfer of the cells halted the rise of isocitrate lyase activity in either cell fraction, but the inhibition of the incorporation of ICL activity into the particulate cell fraction was delayed by 1 hour. Addition of 20 g/l glucose resulted in the immediate decrease of both soluble and particulate ICL activities. Transfer to acetate medium induced no change in the activities of other microbody marker enzymes such as catalase, uricase or D-amino acid oxidase. Resolution of crude homogenates of "slime" cells by sucrose density gradient centrifugation yielded two major protein bands: A mitochondrial band at a density of 1.180 kg/l showing maximum activites of fumarase, isocitrate dehydrogenase and cytochrome c oxidase, and a microbody-rich band which obviously consisted of two types of organelles with different biochemical properties. Maximum activities of ICL and MS sedimented at a density of 1.21 kg/l while the peaks of particulate uricase and catalase activities were recovered at 1.24 kg/l.


[Fast computer tomography for investigation of the heart--"computer cardiotomography". Methods and early results (author's transl)].

The early results in the investigation of normal and pathological hearts using fast computer tomography are presented. By means of tomographic sections of cadaver hearts, it has been shown that it is possible to distinguish the ventricular cavities and individual cardiac walls by this non-invasive method. Changes in volume of the ventricles and atria due to various forms of stress are easily distinguishable. Myocardial scars can be distinguished from other circumscribed myocardial defects. The particular advantages of this method, which is non-invasive, painless and easily repeatable, do not need to be stressed. The technique adds a significant dimension to previously available non-invasive diagnostic methods, such as ultrasound echo-cardiography.


[Prolapse of the mitral valve in coronary heart disease (author's transl)].

Two hundred angio-cardiograms of patients with confirmed myodardial infarcts or angina pectoris were analysed. Patients with rheumatic heart disease were not included. In each patient the left ventricule and coronary vessels had been demonstrated and pressure measurements taken. In 8.5% there was prolapse of a mitral valve leaflet. In two thirds of these produced mitral insufficiency.


Needle biopsies of pulmonary lesions. Precautions and management of complications.

This review is based on 5300 needle biopsies. Complications and their precaution are discussed. Pneumothorax seldom has to be treated. Hemoptysis and small local bleeding are of no clinical significance. Tumor cell spread and air embolism may occur but extremely rarely. Indications, contraindications equipment, and biopsy technique are treated. A recent technical improvement in needle biopsy is described.


Effect of glucagon on the double contrast examination of the stomach and duodenum.

We have evaluated the effect of glucagon on the quality of visualization of the gastric and duodenal mucosa in a routine tubeless double contrast examination of 418 consecutive cases. The patients received either 0.5 mg i.v., 0.25 mg i.v. or no glucagon, at radom. The use of glucagon improved the visualization of areae gastricae and produced slightly fewer gas bubbles in the stomach. Visualization of the duodenum was significantly improved. The frequency of adequate hypotonic duodenography was related to the dose of glucagon, with 0.5 mg it was achieved in 49% of cases. No side-effects ascribable to glucagon were observed. The routine use of a small i.v. dose of glucagon in double contrast studies is recommended.


[Duodenal stenosis following irradiation of the kidneys for tumours. A report of four cases (author's transl)].

Two patients who had a right nephrectomy, and two patients with left nephrectomies were irradiated with 5500 rad each. Because of subsequent upper abdominal symptoms, the gastro-intestinal tract was examined radiologically. In the patients with right-sided nephrectomies, a short stenosis of the descending portion of the duodenum was found, and in the left neprectomised patients there was a stenosis of the horozontal and ascending parts of the duodenum. The findings of a duodenal stenosis in these areas should lead one to consider the possibility of previous irradiation of the renal bed.


[The radiological differential diagnosis of small bowel disease (author's transl)].

The flow diagram of Goldberg and Sheft for the differential diagnosis of diseases of the small bowel was modified (using as its basis mucosal swelling, width of lumen, secretion). Its accuracy was then tested retrospectively in 61 patients. Examination of the small bowel was performed after the administration of a single large dose of contrast medium. A surprisingly high accuracy of 90% was found in 41 pathologically proven cases; all normal patients were correctly identified. The method therefore appears to be extremely promising. More detailed identification is not always possible because of similar reaction of the small bowel to various influences; it may be possible on some occasions, or when taking account of further radiological signs, or of the clinical and laboratory findings.


[The ultrasound diagnosis of a subcapsular haematoma of the spleen (author's transl)].

Two patients with sub-capsular haematomas of the spleen are described. In both patients the diagnosis was made by ultrasound examination. Ultrasound fills a gap in the diagnosis of splenic rupture, since sub-capsular haematoma cannot be satisfactorily demonstrated by angiography.


[Vascular complications of angiography in childhood (author's transl)].

Evaluation of 500 arteriograms in children over a period of three years revealed a complication rate of 7.4% (37 cases). In these, thrombosis occurred which had to be treated conservatively. The factors increasing the complication rate were low age, weight below 5000 grammes, exposure of the vessel, excessively large instruments and long duration of the examination. For the early recognition of thrombosis the Doppler technique is most valuable. Prophylactic measures are discussed.


[The effect of tri-iodinated contrast media on clotting. An investigation of thrombocyte aggregation (author's transl)].

In vitro investigations showed that renographic and cholecystographic contrast media reduced thrombocyte aggregation proportionate to contrast concentration. In vivo this disturbance of thrombocyte function could not be demonstrated. Other factors investigated, such as clotting time and thrombocyte counts, remained unaffected in vivo and in vitro. Age and sex and the presence of various types of pathology were also found to have no affect. These findings and their significance are discussed.


[The effect of iodine-containing radiographic contrast medium on TSH-TRH-tests (author's transl)].

In the course of an investigation of TRH-tests, 340 TSH-tests were performed in 120 patients before and after the administration of various iodine-containing radiographic contrast media in order to determine a possible effect on the TRH-tests. In addition, the peripheral thyroxin level and RIA-T3 content of the serum was determined. Mean TSH rise following TRH (delta-TSH) showed no significant difference before and after the contrast medium. Individual variations were, however, observed. In view of these results, it is concluded that the TRH-test provides reliable information after iodine exposure.


Which embolic material is best suited for which embolization procedure?

Various embolization cases are described, and these require certain embolization materials. In our experience Gelfoam particles are very well suited for gastrointestinal tract lesions. Ivalon shavings gave excellent results in congenital arteriovenous malformations with permanent occlusions. Bristle brushes are a new device for larger artery occlusion. Stainless steel coils in combination with silk tufts proved thrombosis of large AV fistuals or of aneurysms particularly of the splenic artery.


[Multiple phaeochomocytomas (author's transl)].

Multiple phaeochromocytomas represent a polytopic form of chromaffin tumours. The tumours may arise simultaneously or sequentially in chromaffin tissue, particularly in the retroperitoneal space. Malignancy can only be assumed if there are metastases to organs which do not contain chromaffin tissue. Their origin may be regarded as a dysontogenetic event. The clinical picture is dominated by the excretion of catecholamines. Laboratory tests are therefore used to determine the suspicion of the presence of a chromaffin tumour. A patient with an eight-year history is described, who had had four operations and in whom, by radiology or surgery, seven phaeochromocytomas had been found. The value of various radiological methods is discussed. The most informative method is arteriography; in view of the possibility of multiple tumours, aortography should be carried out in the first instance.


[Arteriographic findings in adrenal metastases (author's transl)].

The arteriographic findings in adrenal metastases are described on the basis of 13 cases. The problems of differentiating primary from metastatic adrenal tumors by means of angiographic criteria are discussed.


[Supra renal metastases. The rôle of angiography (author's transl)].

Fifteen cases of metastatic involvement of the adrenal glands are described. There are three groups of metastatic lesions: 1. metastases of distant tumors 2. metastases of malignant tumors of the ipsilateral kidney 3. direct extension of tumor to the adrenals Neovascularity was angiographically demonstrated in all cases. 13 of 15 patients had hypervascular metastases and 12 showed enlarged adrenal arteries. The angiographic findings are discussed and compared to those found in the literature.


[The diagnosis and differential diagnosis of benign polyps of the ureter (author's transl)].

The radiological appearances of fibro-epithelial polyps of the ureter are demonstrated by four cases and the differential diagnosis is discussed. These mesenchymal tumors are characterised by their variable position and change in shape during the course of a retrograde pyelogram; they appear as smooth intraluminal filling defects with a narrow base and occasionally a racemose pattern. In general, they do not cause ureteric obstruction--and are more common on the left and in the proximal ureter.


[A method for on-line acquisition and semi-automated reporting of unilateral clearance studies of the kidneys (author's transl)].

A four-channel scintillation counter for clearance studies has been connected on-line to a computer. A program has been written which allows the computer to calculate the total clearance rate and the relative contribution of each kidney. The results, together with a semi-automated report, are issued as a letter by teletype. The accuracy of the program has been checked by manual evaluation of the clearance curves.


[Phlebography of the testicular veins for varicoceles and their recurrences (author's transl)].

The clinical significance of varicoceles depends on their frequency and on the fact that they may produce infertility. The available operative forms of treatment are unsuccessful in about 10% of patinents. In these cases it is desirable to elucidate the very variable drainage pattern by means of transfemoral phlebography with the patient erect. The method was employed in 13 patients and demonstrated continuity of the testicular vein, or of one of its tributaries, in twelve. If the testicular vein appears to be absent, one must consider the possibility of a venous short circuit or drainage of the pampiniform plexus into the external iliac vein. In four patients out of the 13, scrotal phlebography in addition for complete definition was necessary.


[Radiation dose to the sternum during mammography (author's transl)].

Previous measurements of radiation to the sternum during mammography in the living subject have shown relatively high doses to the surface of this region. It was therefore decided to carry out measurements on a sternal phantom. The aim of the investigation was to obtain information on the dose to the sternal marrow cavity. Measurements were carried out with a thermoluminescent dosimeter. It was shown that the mean dose to the marrow amounts to about 24% of surface dose, depending on the angle of incidence. This dose cannot be totally ignored. Protection of the sternum is therefore recommended. This is easily accomplished and takes little time or effort.


[The efficiency of mammographic mass screening (author's transl)].

After commenting the assessment of the benefits of medical measures some remarks are made concerning the risk of mammography which has been discussed in detail else where. The benefit of mammography for screening asymptomatic women is estimated on the basis of figures from the literature applying four criteria; 1. Results of the HIP-study, 2. clinically occult breast cancers, 3. clinically occult cancers without axillary nodal involvement, 4. clinically occult "minimal" cancers. On the basis of 10 years-survival it follows that 7% of all breast cancers will be additionally "curable" through screening by mammography. This age-independent value has to be considered apart from risk of radiation induced cancer and benefit/risk-ratios, which are strongly agedependent. Costs of mammography and the screening of high-risk groups are briefly considered.


[The lymphographic findings in the yellow-nail syndrome (author's transl)].

Approximately 38 cases of the yellow nail syndrome have been described in the literature and one further case of this rare condition is added. The symptoms and various associated conditions are discussed. The lymphographic findings in one case are described in detail.


[Intravenous cholegraphy in acute cholecystitis (author's transl)].

In this prospective study iv-cholegraphy was performed before surgery on 152 patients by whom acute cholecystitis could not be excluded. The examination was diagnostic in 85% of the cases. Most of the patients (20/23) with nonvisualization of the biliary tract by iv-cholegraphy suffered from acute cholecystitis, the others (3/23) from acute pancreatitis. In three false negative examinations the opacification of the gallbladder was weak and in three false positive cases the cystic duct obstruction was caused by a chronic gallbladder disease. Because the preliminary clinical suspicion of acute cholecystitis even when using rigid criteria proved to be false in 30% of the cases, we consider a radiologic clarification to be indicated. Iv-cholegraphy is found to be an important examination in acute cholecystitis, practicable even at small radiologic departments with conventional equipment, and a reliable indicator of cystic duct obstruction.


[Attenuation values of normal and pathological liver tissue as a basis for computer tomographic densitometry of fatty livers (author's transl)].

Measurements of the density of normal and diffusely disease liver parenchyma show a significant difference only in the presence of fatty livers. A linear relationship between the fat content and density (g/cm3) has been demonstrated. Computer tomographic densitometry of liver tissue correlates well with physical in vitro measurements and permits measurements of fat content which are sufficiently accurate for clinical use. Other types of liver disease cannot be differentiated by densitometry.


[Cerebral and spinal angiography with metrizamide (amipaque) (author's transl)].

Metrizamide (Amipaque) has been used as the contrast medium for angiography in neuroradiological investigations. Solutions containing 280 mgI/ml. are well tolerated and produce good contrast. The most important difference from previously used contrast media is the lack of pain when injections are made selectively or super-selectively into the external carotid artery and its branches, or into the spinal arteries.


[The role of cerebral serial scintigraphy within the noninvasive diagnosis of cerebral diseases (author's transl)].

Based on findings obtained from 442 patients with various cerebral diseases by comparative evaluation of cerebral serial scintigraphy (cSS) and cranial axial compouted transmission tomography (T-CAT), a scheme is introduced which illustrates reasonable employment of cSS in combination with T-CAT in patients presumed to have (a) "intracranial tumor", (b) "cerebrovascular disease" or (c) "unspecific symptoms". Concerning group (a), T-CAT should primarily be employed; as to groups (b) and (c), cSS is recommended to be the first study.


[Disturbances in C.S.F. circulation after subarachnoid bleeds--a comparison of pneumoencephalographic and scintigraphic findings (author's transl)].

Haemorrhages into the subarachnoid space lead to scarlike changes in the leptomeninges in some patients. If these changes reach a certain severity, circulation of the C.S.F.. is compromised and absorption reduced. This eventually results in ventricular dilatation which, in severe cases, is clinically manifested by dementia, motor ataxia and incontinence. The early stages of the disturbance in C.S.F. circulation were examined scintigraphically in 165 patients with spontaneous traumatic or operative subarachnoid bleeding. In the presence of abnormal findings which suggested the need for C.S.F. shunting, air encephalography was carried out in addition. Special attention was paid to the demonstration of the extent and localisation of occlusions of the basal cisterns and of the cortical subarachnoid spaces. Typical scintigraphic and pneumoencephalographic findings are demonstrated and their diagnostic value compared.


[Post-traumatic findings in the cerebral arteries in the neck (author's transl)].

Starting from the observation of a post-traumatic thrombosis in the cervical portion of the carotid artery, with two subsequent similar findings, it is shown that angiography is of special importance in assessing these cases. Investigation of the cervical region of this artery should be considered in all cases of skull and cerebral trauma. On the other hand, the cases described by Sullivan show that the presence of a carotid lesion must be considered in all multiple injuries, just as injuries to vessels and organs must be excluded in patients with intracranial haematomas. Consultation between physician and radiologist is necessary for all injured patients in order not to omit any important steps during angiography.


[Detailed myelographic diagnosis: the spinal arteries in the amipaque myelogram (author's transl)].

In order to ascertain how much information Amipaque myelography provides regarding the normal and abnormal anatomy of the spinal arteries, 100 thoracic and/or cervical myelograms were reviewed. Partial demonstration of the anterior spinal system was noted in 78% of the thoraco-lumbar, and in 63% of the cervical myelograms. Where the anterior spinal artery was visible over several segments, it was usually possible to identify its origin. In an extensive arterio-venous angioma with complex vascularity, indirect demonstration of the vessels was definite and clear. Amipaque would seem to be the contrast medium of choice for myelograph of the entire spinal canal, including cervical myelography with puncture at the first or second vertebra. This is particularly true if it is desired to demonstrate the anterior spinal artery system with its tributaries.