[Tumours of the parotid gland--results of their treatment and some peculiarities (author's transl)].

148 cases of parotid gland tumours which had been treated during the last 15 years were analysed histomorphologically: There was found in 54.1% mixed tumour (pleomorphic adenoma), 11.5% epithelial malignant tumour, 4.1% sarcoma, 7.4% primary metastasis, 22.9% other benignant tumours. In 2.5% of 80 cases of mixed tumour a malignant degeneration was revealed. Some cases of double tumours and more seldom tumours as for instance lymphoepithelioma and malignant papillary cystadenoma are presented. A critical appraisal of primary sarcomas is following, but also a comment to the problem of primary metastasis in the parotid gland. The author's opinion is now: favourable therapeutic results can be reached in cases of small and modestly enlarged mixed tumours by means of the so-called "extracapsular" or "extended extracapsular" removal on the understanding that a critical casuistic choice was made and a skilled surgical procedure was applied. On this way relapses have been observed in 2.6% of the author's cases till now. A five years survival time of epithelial malignant tumours was found in 17.7% (88.2% of all epithelial malignant tumours had been treated at stage III and IV). All patients suffering from a sarcoma died within a period of 1/2 to 3 1/2 years after therapy except a case of Hodgkin's sarcoma (8 1/2 years). Primary metastasis in the parotid gland in cases of malignant tumours of head and skull sometimes was discovered in the author's cases, the infavourable prognosis of which was similar to primary malignant tumours at all.


[Unusual concrement in the submandibular gland (author's transl)].

After a short general view about the diagnosis and therapy of the sialolithiasis of the gland an extremely big sialolith, which weighs 42 g, which is 5.2 cm long and shows a thickness of 2 cm is reported.


[On the secretion of BAEE-esterase activity (kallikrein) in normal human parotid glands in rest and under stimulation (author's transl)].

Kallikrein is an important mediator in microcirculation. Therefore, this work has been concerned with the excretion of kallikrein from human parotid glands. In 40 healthy persons kallikrein concentrations in resting parotid saliva were estimated. Subsequently, the glands were stimulated either by ascorbic acid or by subcutaneous injection of pilocarpin and the changes in BAEE-esterase activity were measured. The results show a significant increase of excreted enzyme on stimulation. Continuous stimulation, however, leads to exhaustion of the capacity of the glands within 40 min. After cessation of stimulation basal secretion rates are restored in the next 15 min. Kallikrein secretion is compared to the secretion of total protein, lysozym and immunglobulin A.


[On the classification of pathological timbres of the voice by hearing (author's transl)].

This is a form to diagnose as well healthy as pathological voices by hearing; it is meant to be practically experienced and criticized. It could by applied by laryngologists in future times who examine the voice of young people who intend to start the training for a job which mainly causes them to use their voice. You will find some groups of adjectives: two of them in juxtaposition and others which are in some close relation to one another. Thus we have got a set of instruments to fix the main audible differences of the voice and its changes, e.g. during some medical treatment. The complete structured list of adjectives concerning possible characteristic features of the voice is meant to help the laryngologist to classify those vocal impressions which seem typical to him.


[The actual stage of objective audiometry (ERA) (author's transl)].

Evoked Response Audiometry (ERA) comprises a few electrophysiological tests utilizing acoustic evoked potentials as a audiometric criterion. Some potentials with different latencies (early, late and very late potentials) which are mainly used in routine audiometry are reviewed, the practical procedure of the tests (Electrocochleography, Cortical Audiometry and CNV-Audiometry) as well as their results are discussed. Today objective audiometry should be a clinical routine examination which can provide additional and more information than conventional audiometry.


[Experiences gained with Békésy audiometry (author's transl)].

477 Békésy audiograms were classified according to Jerger, and the percentage rates of the individual types were juxtaposed as concerns the frequency-sliding and frequency-constant methods. By means of the frequency-constant method a higher percentage of pathological conditions can be demonstrated. In two patients with retro-cochlear defects (pontine-angle tumor) the defect cannot be pinpointed at all by means of the frequency-sliding method. The results are demonstrated to depend on the frequency in the case of the frequency-constant method.


[Electrocochleography as a neurootological tool (author's transl)].

A series of 13 patients where surgery confirmed retrocochlear lesions in the cerebellopontine angle was tested preoperatively by electro-cochleography. The following conclusions can be drawn: 1. Compound action potentials (CAP) of the acoustic nerve could be registered by electro-cochleography in all patients regardless of the fact whether hearing on the side of the lesion could be demonstrated in pure tone audiometry or not. 2. The threshold latency for the 2 kHz sinustone-burst elicited compound action potential was within the normal range if hearing on the side of the lesion could be shown in pure tone audiometry. Threshold latency for 2 kHz CAP was shortened pathologically when hearing on the side of the lesion was absent in pure tone audiometry.


[Longitudinal audiometric studies concerning progression of noise induced hearing loss (author's transl)].

The development of occupational hearing loss is very important for the recommendation to change the work place. 1960 Dieroff has described a phasic development of noise induced hearing loss. After ten years in noisy environment no further development of hearing impairment was determinable. Recent investigations point to a logarithmical respectively linear dependence of noise induced permanent threshold shift on the duration of exposure to noise. During our observation over a period of two years of employees working on noisy jobs, no stay of noise induced permanent threshold shift proceeding could be stated after ten or twenty years. As the raiting sound level of the working places, which we have studied, had only approx. 60 to 100 dB(A), it can be assumed, that under these conditions the noise induced hearing loss developes delayed and the noise induced permanent threshold shift increases as long as it must be worked under noisy conditions. The noise induced hearing loss depends on the intensity of noise exposure of the different groups. Also the group of storehouse- and court personnel as well as the drivers, being exposed only to a raiting sound level of approx. 65-75 dB(A), showed a significant higher noise induced permanent threshold shift than the group of administrative employees.


[A proposal for a method of precalculation of hearing losses (author's transl)].

Three well-known procedures for the determination of auditory noxiousness from noise level and time of exposure are discussed and the theoretically expected 4 kHz hearing losses in selected textile and metal workers exposed to noise are compared with the measured PTS values. The method after Kraak showed the best correlation between noise load and hearing loss. On the basis of these results a noise level table with intervals of 2-3 dB between 85 and 110 dB(A) was developped, from which the noise load after 1 to 40 working years can be read off in figures. After evaluation of 256 noise opinions a method for determination of maximum noise doses is proposed. The table presented may be used in the determination of characteristic coefficients.


[The problem of severe noise induced hearing loss (author's transl)].

It can be observed that even after severe and long-lasting occupational exposure to noise the hardness of hearing caused by that noise is usually only low or medium-grade. Therefore the question is being examined whether there are any particular causal conditions for those rare cases in which the hardness of hearing caused by noise is more than medium-grade. High noise levels and high frequencies, together with continual constrained physical posture during work, seem to be such conditions according to the statistical evaluation of a wide range of observation data. In such cases the expert is required to assume a highly critical attitude. The diagnosis and in particular the simulation and aggravation tests call for improvement by way of an objectification.


[Remarks about tympanoplastic (personel methods) (author's transl)].

A valuable aeration of the middle ear from the Eustachian tube to the aditus ad antrum is realized by the implantation of a one inch long part of the Vena saphena magna. A tube of polyethylene introduced in the ostium of the Eustachian tube maintains the vein in position during 3-4 weeks, the intima of the vein is an empeachment for synechia with the promontorium. By a special incision the deeper tissues of the ear are formed to a pediculated flap. The splitting of this flap enables the formation of a superficial thin flap, which includes the skin of the external auditory conduct. Applicated on the fascia, a consolidated and fixed neotympanon is realized, the deeper, thicker flap is filling the excavation of the bone. The cartilage of the concha is a valuable substitute of the bridge and the posterior wall of the external auditory conduct.


[A contribution to the radiological diagnosis of adenoids (author's transl)].

In 164 children we found a high grade correlation between radiological size of adenoids and intraoperativ findings. This is underlining the importance of X-ray diagnosis for adenoids compared to other examinations.


[The arthritis of the cricoarytenoid joint, a rare postintubation complication and its novel treatment (author's transl)].

A case of aphonia following a long-time endotracheal intubation is presented. The paramedian position of the left and the incomplete adduction of the right vocal cord were caused by a complete, respectively partial ankylosis of the cricoarytenoid joints. The ankylosis was the result of an arthritis during the intubation period. A nearly normal mobility of the vocal cords and a normal voice was achieved by translaryngeal injections of Fludrocortisone and Hyaluronidase into the cricoarytenoid joints and by their passive mobilisation.


[Comparison of the effectiveness of antivertiginous drugs by double blind procedure. The effect of diazepam, dimenhydrinate and sulpirid on the human vestibular spontaneous nystagmus (author's transl)].

The effect of Diazepam (Valium), Dimenhydrinate (Vomex A, Novomina, Epha Retard), Sulpirid (Dogmatil) and Placebo has been investigated in regard to the intensity of pathological vestibular spontaneous nystagmus by application of the double blind method on 50 patients with peripheral vestibular (n = 37) and central vestibular (n = 12) diseases, as well as on a case of spontaneous nystagmus of undefined origin. Since by acute vestibular disease the intensity of spontaneous nystagmus is generally closely related to the severity of vertigo, the influence on a pathological spontaneous nystagmus by antivertiginosa seems to be a dependable criterium in the evaluation of their effectiveness. Dimenhydrinate (2 mg/kg KG) and Sulpirid (2.86 mg/kg KG) led to a statistically significant reduction, however not in the case of Diazepam and Placebo. Nevertheless, the effectiveness of Dimenhydrinate and Sulpirid is not definitely predictable in individual cases: in 2 out of 10 patients the preparations were without effect. Characteristics and areas of indication of Dimenhydrinate and Sulpirid are described in greater detail.


[The laryngeal cyst of the new born (author's transl)].

Only 30 cases of cysts of the ventricular cord in the new born baby have been published. Because of the respiratory stridor one third of the cases died soon or later. The other 2/3 were treated by endolaryngeal procedures. With a case of a new born suffering from a large cyst of the ventricular cord the author demonstrates the possible danger and inefficiency of different endolaryngeal procedures. Only the external operation through the thyrohyoid membrane with complete removal of the cyst - without tracheotomy--resulted in permanent cure.


[Histiocytosis X and its importance in Otorhinolaryngology (author's transl)].

Histiocytosis X is an entity of neoplastic diseases of unknown etiology and pathogenesis. In the own case material, half of the patients presented with clinical symptoms originating in the head and neck areas (7/14). With respect to the clinical course, localized histiocytosis X should be distinguished from acute-disseminated and chronic-disseminated disease, the three corresponding with the classical eosinophilic granuloma, Hand-Schüller-Christian's and Abt-Letterer-Siwe's disease; transitional forms are well-known. Therapy is surgical in cases of localized eosinophilic granuloma and cytostatic in cases of disseminated disease; in the latter Vinca-alkaloids and corticosteroids are preferably used. Any kind of treatment, however, has to be individualized and modifications result from the thorough observation of the clinical course, which is unpredictable for the individual case. Planning an individual concept of therapy for each patient is most important and should be done by surgeons together with the pediatric oncologist.


[Lipomas of the neck (author's transl)].

Histological particularities, clinical details, diagnosis, malignant transformation and therapy of adipose tissue tumors of the neck are demonstrated. This will be completed by the discription of two cases, concerning this problem.


[Coagulation abnormalities in the patients with malignant tumours of the larynx and pharynx (author's transl)].

In 8 of 41 examined patients with larynx tumour and in 6 of 7 those with pharynx tumours we found hypercoagulability using specific coagulation test. In two of our patients laboratory tests pointed out on the disseminated intravascular coagulation, that became clinically manifest just during radiotherapy. The routine coagulation tests cannot detect the coagulation abnormality in the majority of cases and therefore in the patients with malignant tumours specific tests for discovering the ICF (intravascular coagulation and fibrinolysis) syndrom are to be made.


[Schmincke carcinoma of the nasopharynx (author's transl)].

92 patients suffering from malignant nasopharynx tumors have been examined. They were classified according to their histological diagnosis and compared in point of view clinical particularity and prognosis. The lymphoepithelial carcinoma (LEC) is the most common malignant tumor of this organ. It differs clearly in its clinical behaviour from all other tumors of the nasopharynx. Particularly striking is the early and - apart from rare exeptions - regular involvement of the regional neck lymphnodes. This fact allows an early recognition of the small primary tumor - with its consealed site and poor clinical symptoms - and improves consequently the 3-year-survival-rate of the LEC decisively. By combination of radiological and surgical treatment of the involved neck lymphnodes, the prognosis of the LEC can be further improved. Following our own findings and recent results from the tumor virus research we want to point out that LEC has to be considered as a special disease with its proper etiology and clinical appearance.


[Singer and actor under medical attention of the laryngologist].

Singers and actors offer special problems to the laryngologist as far as their personality is concerned as the individual intensity of their vocal usage. A successful therapeutical approach requires that the doctor is able to involve himself into the physical and psychic conditions of an artistic usage of the voice; he also should be as well open to singing as to music in general. Knowledge in pathophysiology of larynx and voice, experiences in phoniatry and psychological interests will enable the larngologist to solve such medical problems which occur when working on diseases of the voice of singers and actors. Based on these few remarks, the report deals with the following short chapters: doctor and singer, the most frequent causes of vocal disorders, the "dry throat' of the singer, coughing out of custom, vocal nodules, the prevention of damages of the voice, the singer's voice under endocrine influences, possible damages of the voice in connection with operations and - the actor with an ill voice.


[Collapse of nasal ala].

The enlargements of the inner valve is achieved by dividing the upper lateral cartilages from the septum and the coverage of this defect by a flap from the cranial border of the lower lateral cartilages. The usefullness of the so-called low lateral osteotomy and the implantation of a cartilagegraft into the ala is stressed.


[Reconstruction following surgical removal of extensive malignant tumors of the mouth and pharynx].

Large tumors in the oral and hypopharyngeal areas require wide surgical excision with closure either by simple direct means or with replacement of soft tissue and the use of local mucosal flaps, regional skin flaps or visceral transplantation. Five examples have been chosen to explain the proposed methods of treatment with special emphasis on the use of the Bakamjian flap. A detailed description of a combined procedure using part of the colon as an oesophageal replacement is given.


[Functional results of tracheoplasties].

There is a direct correlation between airway resistance and residual tracheal lumen in tracheostenosis. Airway resistance has been recorded in 185 patients with tracheostenosis using body plethysmograph. High grade stenosis of the trachea is better diagnosed with body plethysmograph compared with direct inspection, a pertinent observation mainly in bordering cases. Tracheoplasties were performed in 74 patients using the body plethysmograph. Postoperative courses and functional results were observed. The average tracheal diameter was 8-9 mm at the end of our study with corresponding airway resistance of 24-34 mm H2O/l u. sec. These functional results reflect a good tolerance to average labour impound.


[Our results with partial vertical laryngectomies].

The method of covering a broad endolaryngeal defect following extensive partial surgery of the larynx by means of the fascia of the sternohyoid muscle is presented. Of 71 cases of vertical and combined vertical and horizontal partial laryngectomy recurrence was seen in 15 cases, nine of them died. The fascia showed resistance to all postoperative complications and there was not a single case of rejection. In only 4 cases it was not possible to carry out decannulation because of postirradiation complications in the form of oedema, stenosis or fixation of the cricoarythenoid joint.


[Functional results after radiation therapy and chordectomy for carcinoma of the vocal cord].

A report is given on the results of comparative clinical, stroboscopical and sonagraphical investigations in 40 patients who were treated on account of vocal cord carcinoma in the T1-T3 stages at the E. N. T. clinic of Jena during 1956-1973. The therapeutic treatment was institial irradiation, chordectomy, or irradiation only. Clinicomorphological changes of the healthly vocal cord were observed with nearly all procedures used. The incidence was considerably higher with iradiated patients. The best functional late results appeared after institial irradiation and irradiation. The vocal rehabilitation after chordectomy may be considered promising, too. From the results obtained we can conclude that when deciding on the selection of further medical procedure the analyses of functional late results should be taken into account, considering, of course, the stage of the disease and the greatest remedial success. The group of people mentioned should be given in any case together with tumor aftertreatment in a phoniatric follow-up, since the psychological stress present may be considerably reduced for the benefit of optimal rehabilitation.


[Functional results obtained by radium contact irradiation of the glottic carcinoma].

45 patients having been treated with radium contact irradiation on account of a glottic carcinoma were continually checked up with a view to ascertaining the functional results obtained. By means of indirect and direct laryngoscopy as well as by stroboscopy vocal organ and vocal quality were tested for a period of few days up to 3 years 6 months. The findings were systematically compiled in a schedule, analized and discussed.


[Preoperative irradiation of larynx and hypopharynx carcinoma].

30 patients with carcinoma of the larynx or hypopharynx were irradiated preoperatively with a dosis of 1,500 to 4,500 rads. The results are compared with those of an identical group of patients who were only operated. The operation was mostly partial (20 cases). In laryngeal cancer the cure rate after two years was 69% and 47%, in hypopharyngeal cancer 43% and 28% respectively.


[Value of clinical history, skin testing and nasal allergen challenge in the diagnose of perennial rhinopathia].

In 64 out-patients suffering from perennial and partly from additional saisonal rhinopathia correlations between clinical history, skin testing (prick test) and nasal provocation tests were investigated. Most patients showed several positive skin tests to common allergens particular to grass pollen, house dust and mites (Dermatophagoides pteronyssimus). 123 nasal provocation tests were done. The correlation between history and skin test or nasal challenge was very strong for grass pollen (agreement in 78%), but very unsatisfctory for house dust and mites. Even in patients with positive skin tests to house dust and mites the history was only  positive in 50-60%. Therefore the diagnose of perennial rhinopathia due to house dust and/or mites is only relevant if the nasal provocation gives a positive result. But if skin test are negative, nasal allergen challenge seldom showed positive reactions. For practical purpose nasal provocation is unneccessary if the skin test is negative. But the nasal provocation test don't give an absolutely right diagnose, because neither the environmental concentration nor the nasal threshold generally are known. Therefore, it is difficult to decide in many cases, if a reaction is positive because of testing a relevant allergen or because a latent allergen was overdosed. Finally the investigations show that simple and reproducible methods like the nasal forced expiratory volume in one second are sufficient to detect a positive nasal reaction.


[Percent distribution of B-Lymphocytes in human tonsils at various ages].

B-Lymphocytes of the classes G, M and A were determined by use of heavy-chain-specific fluorescent antisera from 67 children between 2 and 14 years of age and from 15 adults up to 60 years of age. Tonsils from which viable cell suspensions were investigated for B-Cells were classified histologically, according to their degree of lymphatic hyperplasia and inflammation. With increasing age, a statiscally significant decrease in percent G- and M-cells was observed while A-cells remained unchanged. With increasing severity and extent of inflammation and lymphatic hyperplasia, there occured a mild increase in percent M-cells. G-cells did not exhibit major changes under such conditions. It is suggested, that the tonsil may represent an early and fast reaching immunocompetent organ primarily determined for the production of large molecular IgM and IgA of less specificity.


[Chronic headache: experiences of 5 years interdisciplinary work].

Inspired by the work of Bonica (Seattle, USA), the university clinic of Mainz has formed a study-group (existing since 5 years) which deals not only with the problems but also with the interpretation and treatment of chronic pain. Through the interdisciplinary co-work between collegues from different branches, 618 patients afflicted with chronic headache were examined and therapeutic plans were developed. These therapeutic plans have in general proved to be very successful compared to single, limited treatments by the different branches of medicine. Important experiences for the otolaryngologist as well as the general work to the organisation are discovered in detail.


[The proteincomposition of human parotid saliva in acute and chronic parotitis. Quantitativ densitometry of single protein-fractions in comparison to normal secretions].

By means of acrylamidgelectrophoresis parotid secretions of patients with acute and chronic parotitis were examined. Thereby significant changes in protein patterns of electrophoretic separation were found. Especially two bands are described in detail. One in the cathodal near gel region, the isoamylases, and the otherone in the anodal part of the gel, identified as albumin. In rest and under stimulation these bands show signficant changes compared to normal secretions. Furthermore information about the capacity of the parotid gland parenchyma is won by observing the changes of amylase bands in rest and under stimulation in chronic parotitis without actute exacerbations. The amylase shows a remarked decreased secretion in chronic parotitis under stimulation corresponding to parenchymalteration. The same happens with the albuminexcretion as parameter for ductlesions. In chronic parotitis albmuninexcretion goes parallel to duct changes in sialography. Therefore by discelectrophoretic separation of native parotid saliva a helpful mean for diagnostic use is given, besides sialography and scintigraphy.


[The influence of sclerosing medicaments on the tissue of the nasal septum An experimental examination].

A vessel schlerosing medicament is being injected submucously into the septum cartilage of the rabbit. The reaction of epithelium, of vessel wall and cartilage surface is being investigated light-microscopically and intravital-microscopically. The result is a firmly compressed tissue connective with circular narrowed vessels.


[A new evaporation-apparatus for the artifical climatisation in intensive care on the field of ENT].

Description of a new air-humidifying apparatus working on the basis of evaporation and thus imitating the humdifying mechanism of the nose. The checked data of efficiency are optimal. The device is suited for using with tracheotomies and laryngectomies during the first post-operative phase. It simplifies post-operative care and diminishes the risk of bronchial infection.


[Noise risk due to dental turbines].

Sound level measurements and frequency analyses were carried out on dental turbines in order to assess the risk of hearing defects due to the noise caused by such turbines. The measured values were related to other factors (exposure time, noise pauses) and the overall situation was evaluated. A major leasion of the auditory organ due to the noise caused by dental turbines seems unlikely.


[Analyses of objectifiable ear noises].

The clinical aspects and therapeutical possibilities are presented for two extremely different cases of objectifiable noises in the ears. A specific experimental method (earphones and bone conductor served as microphones) permitted a stereophonic recording. After several amplifications it was possible to tape the noises. By means of two-ray-oscillography and time extension it was possible to analyze the structure of the noises in various ways (oscillogram, synchrony, etc.) Furthermore, sonagraphic analyses of the traditional type as well as isobar sonagraphy were performed. The results achieved were surprising and completely new: It was possible to clearly present, besides typical sound superimpositions, partial tones of varying intensity in sine form up to the 1,5000 Hz range.


[Biophysical considerations of laser surgery and the application in otolaryngology (author's transl)].

In the paper biological mechanisms of laser radiation on tissue are summerized. The specific features of different types of lasers are considered, e.g. wavelength. Focussing problems to rise the power density are described. The advantages and disadvantages of laser surgery are discussed. It is shown that the laser is well suited for an otolaryngological microsurgery. The present applications in otolgaryngology consist of about 25 papers which are evaluated and concentrated. Later surgery of the larynx is of special interest. Many clinical applications have been performed. Further experimental work exists in the region of the oral and nasal cavities, of the face and the neck. Some basic research without clinical application has been performed on the cochlea and the semicircular canals. The advantages of laser surgery are e.g. lack of blood, high precision, good healing of the wound.


[Rupture of the round window membrane (author's transl)].

Five cases of round window membrane rupture were described and under went surgery with gelfoam and/or adipose tissue repair. Short term post-operative follow-ups for a period of three to five months showed complete recovery of vestibular function yet only slight to moderate recovery of the cochlear. The clinical complex of sudden S.N. hearing loss, tinnitus with or without vertigo and ataxia is not uncommon and often presents a diagnostic problem. The patient is anxious to prevent further attacks and yearning for a cure from this relatively disabling condition. Among other causes, viral labyrinthitis and labyrinthine vascular occlusion have been blamed. R.W. membrane rupture, whatever is its underylying factor, as a cause of this clinical complex is well established. A well-planned management i.e. bed rest and/or properly timed exploratory tympanotomy with round window membrane tissue grafting may lead to a partial or total cure.


[Rupture of the round window membrane after slight head injury with flush of perilymph probably caused by large opening of aquaeductus cochleae (author's transl)].

A ringing deaf ear was noticed after slight head injury without loss of consciousness nor fracture of the skull. After performig tympanotomy a ruptured round window membrane with excessive flush of perilymph was found. We might rightly assume that this was induced by a large opening of aquaeductus cochleae combined with the force of inertia of the cerebral liquor and the direction of the push to the round window (blow behind the left ear).


[Nomenclature of tympanoplastic and stapes surgery (author's transl)].

Suggestions are made regarding the nomenclature of middle ear surgery which is partially based on previous terminology. By means of this nomenclature, reconstructive procedures can be defined shortly and precisely by a single term both from an anatomical and a functional point of view thus facilitating a statistical analysis.


[Clinical, pathological and therapeutic aspects of cholesteatoma in children (author's transl)].

Middle ear cholesteatoma in childhood is discussed on the basis of 117 operated cases. Early diagnosis was rare, even after fetid otorrhea of long duration; occassionally they presented as acute mastoiditis. The cholesteatoma occurred mostly in older children (90%) and extended to the antrum (73%) or beyond it (54%), with destruction of the ossicles (77%); the hearing often remained normal. Tympanic membrane perforations were usually small, relatively often they were central. More than 50% of the children had normal mastoid pneumatization, usually there were no typical radiological signs of cholesteatoma. Tympanoplasty was most frequently type III (68.5%), the postoperative hearing gain in this group was 47.3%. Residual or recurrent cholesteatoma occurred in 8.5%.


[Successful decompression of the acoustic nerve after postarachnitic hearing damage (author's transl)].

Arachnitic adhesions of the pontine angle can damage the VIIIth cranial nerve to complete hearing loss. If there exists only a circumscript damage of the myeline sheet, this functional loss is reversible after decompression of the nerve. Preoperatively, the electrocochleography and the cisternoscopy discover this type of nerve damage and so, the probability of the postoperative hearing recovery is quite predictable.


[Improved prognosis of malignant oropharynx tumors by preoperative therapy (author's transl)].

Reference is made on 142 malignant tumours of the tongue and tonsils inclusively, separated in two groups. Group A consists of 46 patients treated with sandwich X-ray therapy and radically operated in between. Group B resembles 96 patients subjected post operatively to a noninterrupted radiotherapy course. The 5 years minimal survival rate (MSR) of all tumourpatients is only 12 per cent due to the high amount of T3 stages with mostly fixed unilateral and sometimes contralateral metastase in the regional lymphnodes. If one, however, opposes the MSR of A and B, there is a significant meliorated prognosis for patients, who have been operated in connection with a systematically applied X-ray therapy according to the sandwich method.


[Possibilities and problems in the synchronization therapy of malignant tumours (author's transl)].

New cell kinetic research results promise successful possibilities in conservative tumour therapy. The sensitivity towards radiation and many cytostatic agents is phase dependent so that the possibility must be found to receive a homogenous cell population. Following partial synchronization a cell phase specific tumour therapy can be initiated. We use the synchronized radiation therapy since 4 years. The results in 24 patients treated up to now are not significant. The basic priniciple is clear, but there are still many unsolved problems.


[Diagnosis and therapy of the nasoethmoidal encephaloceles (author's transl)].

Two typical cases of nasoethmoidal encephaloceles with liquorrhoea, which were operated on by neurosurgeons, are demonstrated. In one case, polyposis of the nose had been operated on twice in childhood, due to the ignorance of the cause with the result of a liquorrhoea. The second patient showed recurrent meningitis with nasal liquorrhoea and turricephaly. The tentative diagnosis of a nasoethmoidal enceplaocele which was suspected by x-ray-tomography and radio-isotopetest could be certified by the aid of detail-angiography. The neurosurgical technique of intracranial, intradural resection of the encephalocele and closure of the liquor fistual with an acrylic flap is shown.


[Malignant lymphomas and immunosialadenitis (author's transl].

Immune sialadenitis with or without clinical symptoms of Sjögren's syndrome represents an inflammation of the salivary duct system with considerable proliferation of the immunoactive lymphoproliferative system. By prolonged stimulation the immune system can turn into malignant lymphoma, mainly of immunocytoma or immunoblastic sarcoma type. In four out of 77 cases from the salivary gland register of the Institute of Pathology, University of Hamburg, showing myoepithelial sialadenitis, malignant lymphomas associated with chronic myoepithelial lymphadenitis were observed. According to the new "Kiel-classification" (Lennert) of malignant lymphomas two of the cases represented a diffuse germinoblastoma (lymphoblastoma Brill-Symmers), one a immunocytic lymphoma and one a immunoblastic sarcoma (reticulum cell sarcoma). From literature 16 further observations of malignant lymphoma occuring in the area of the major salivary glands in association with immune sialadenitis (Sjögren's syndrome) were collected, likewise 25 other cases with lymphomas outside of the major salivary glands and Sjögren's syndrome. It is suggested that the above average frequency of malignant lymphomas in immune sialadenitis may result from a secondary malignant transformation of immune cells due to prolonged stimulation. Local rapidly appearing tumorous alterations of the salivary glands in chronic immune sialadenitis are, therefore, always be suspicious of the development of a malignant lymphoma and demand adequate therapy.


Puncture of the gallbladder during peritoneoscopy - technique and diagnostic relevance (author's transl).

Peritoneoscopic puncture of the gallbladder for transvesical cholecysto-cholangiography and for aspiration of bile for chemical and bacteriological analysis is performed rather rarely because of a seemingly high rate of complications. The risk however is low if an appropriate technique is used. In our series the gallbladder was punctured in 110 cases; a local peritonitis subsiding under conservative treatment occured as a complication in only one case. Peritoneoscopic puncture of the gallbladder is indicated in the following conditions: extrahepatic occlusion of the bile duct system of unknown origin, nonvisualization of the gallbladder during cholangiography, biliary dyskinesia, typical biliary colics with normal X-ray findings. In addition, gallbladder puncture should be done if any suspicion of gallbladder disease arises during peritoneoscopy. The procedure as well as technical variations for cholecysto-cholangiography and for X-ray investigation of the pancreatic duct system are described.


[Peritoneoscopy with 2 optical devices: reduced risk - better diagnostic results (author's transl)].

Peritoneoscopy with 2 optical devices was performed in two cases; the technique of this procedure is described. The method allows inspection of areas, which cannot be seen during routine peritoneoscopy, especially of the anterior abdominal wall and of intraabdominal organs covered by adhesions. In addition, this method allows to find out, whether the anterior abdominal wall and vessels in it were injured by the troikart; the risk of the procedure is reduced thereby. Using a second optical device allows to visualize areas, which cannot be studied during routine peritoneoscopy because of intraabdominal adhesions. Thus better diagnostic results can be achieved with this method as compared to the routine technique.


The response to acupuncture therapy in patients with chronic disabling pain.

Twenty-one patients had acupuncture treatment for chronic, disabling pain. Ten (47.5%) thought they had obtained worthwhile relief by the time treatment was completed. Six (30%) had no or negligible benefit and five (25%) had some aggravation of their pain at some stage of the procedure. In this group of patients, with the technique we describe, we were unable to achieve the high degree of short-term success claimed by other workers.  Until further scientific studies can confirm the value of acupuncture in medical practice, we urge caution in the use of this procedure.


The anatomy of the lumbar intervertebral disc syndrome.

Four elements of the nervous system may be involved in the production of the lumbar intervertebral disc syndrome. These are the lumbosacral nerve roots, the spinal nerves, the dorsal rami and the sinuvertebral nerves. Each nerve is associated with a particular group of pathological conditions which may irritate the nerve and produce symptoms. The anatomy of each nerve determines which particular conditions may irritate it. Moreover, one or both of two mechanisms may be involved in symptom production. The type of nerve irritated determines which mechanism is involved. In the first mechanism, low back pain and referred lower limb symptoms are produced when afferent fibres from dorsal and ventral rami are stimulated where they pass in common through spinal nerves or nerve roots. In the second mechanism, dorsal rami or sinuvertebral nerves are stimulated. This directly produces low back pain, but referred pain is produced by reflex mechanisms in the spinal cord.


On a possible connection between deficiency of cervical and Bartholin secretion, the use of vaginal lubricants and the incidence of Down's anomaly.

The rate of mongolism is well known to increase with maternal age and has been suggested by German to be connected with the frequency of intercourse. The occurrence is discussed in relation to the possible use of vaginal lubricants as a consequence of deficient cervical and Bartholin secretion. The implications of this idea are discussed.


DNA homologies among homothallic, pseudo-homothallic and heterothallic species of Neurospora.

Highly purified DNAs from three homothallic species Neurospora africana, N. dodgei and N. lineolata; three reference strains representing authentic heterothallic species, N. crassa, N. intermedia and N. sitophila; and two strains of pseudo-homothallic species N. tetrasperma were characterized by spectrophotometry and DNA reassociation using hydroxyapatite chromatography. All of these known species are closely related on the basis of DNA characteristics such as base composition and thermal denaturation profiles of major DNA components. Minor components of ascospore DNA was, however, only 5-7% of total DNA instead of 15-20% minor component DNA shown by mycelial DNA. Species belonging to same group were not distinguishable morphologically, but all of these species were distinguishable by DNA:DNA homology studies. Greater DNA homology was noticed between DNAs of heterothallic species and DNAs of pseudohomothallic species than DNA of true homothallic species. Difference on DNA-nucleotide sequences among homothallic species was very little. Pseudo-homothallic species N. tetrasperma was found to be distinctly different from homothallic species but closer to heterothallic species based on such studies.


[The induction of chromosome loss and gain by colchicine (author's transl)].

The fruit fly Drosophila melanogaster is one of the standard systems used for mutagen screening. The colchicine-containing drugs Colchicum-Dispert and Colchysat Burger were fed at extremely low concentrations (1:300 000 and 1:50 000 respectively) to Drosophila females. Among their offspring a remarkably high frequency of aneuploid individuals (XO and XXY flies) were found. These aneuploids correspond karyotypically to the human Ullrich-Turner (XO) and Klinefelter's (XXY) syndromes and result from chromosome loss (XO) and chromosome gain (XXY). The maximum aneuploidy frequency observed after colchicine feeding was 24 times the control value. Depending on their size the aneuploidy frequencies are as great as those obtained by X-irradiation with some hundred or some thousand R.


[Histochemical investigations in scleroderma (author's transl)].

The behavior of proteoglycanes was examined by histochemical methods in excised particles of skin from patients with progressive (n = 24) and circumscribed (n = 74) scleroderma. A method described by Ishikawa was principally used. An increase of the proteoglycanes was shown preferentially in the vascular and perivascular regions in progressive scleroderma and in the interfibrous space of the connective tissue in circumscribed scleroderma. While the vascular sclerosis is prominent from the clinical point of view in progressive scleroderma, the disease processes are found in collagen connective tissue of the corium in morphea.


Mutation induction by rodent liver microsomal metabolities of aflatoxins B1 and G1 in Neurospora crassa.

The mutagenic activities of aflatoxins B1 and G1 were studied in the ad-3 test system of Neurospora crassa by treatment of conidia with aflatoxin and liver homogenate for 2 h. No significant increase in the ad-3 mutation frequency over the spontaneous frequency was observed when either aflatoxin or mammalian liver homogenate was omitted from the test system. The ad-3 mutation frequencies increased to between 29 and 87/10(6) survivors, which is a 73- to 217-fold increase over the average spontaneous ad-3 mutation frequency (0.4/10(6) survivors), after conidia of N. crassa were treated with 0.67 mM aflatoxin B1, hamster liver homogenate, and a NADPH generating system. A 9- to 15-fold increase in the mutation frequency over the spontaneous mutation frequency was found when 0.67 mM of aflatoxin G1 instead of aflatoxin B1 was used in the test system. Treatment of conidia with 0.44 mM aflatoxin B1 mice liver homogenate and a NADPH generating system caused a small, but significant increase in the ad-3 mutation frequencies. No significant increase in the mutation frequency was found when a single sample of human liver homogenate was used in the test system. These studies show that metabolic activation is necessary for the expression of the mutagenic activity of aflatoxins B1 and G1 in N. crassa.


Assessment of the role of laparoscopic ovarian biopsy.

Seventy-four patients with either endocrine and/or infertility problems were subjected to laparoscopic ovarian biopsy. The patients were divided into 4 categories: those with primary amenorrhea, secondary amenorrhea, ovarian androgenic hyperfunction, and infertility. The results were critically examined to evaluate the procedure in the investigation and treatment of each of these disorders. It was concluded that laparoscopic ovarian biopsy is most helpful in primary amenorrhea but justified in secondary amenorrhea only if a histologic diagnosis of premature ovarian failure is though to be essential. Patients with ovarian androgenic hyperplasia should not be candidates for the procedure as the laparoscopic appearance of the ovaries offered equally valuable information and the hazards of biopsy in this particular group of patients outweighed its diagnostic and therapeutic usefulness. The ovarian biopsy offered very little benefit for the infertility patients.


Nonelectric laparoscopic sterilization. Experience with a silastic band.

In an attempt to avoid the serious complications of electrosurgical sterilization via laparoscopy, specially designed applicators have been used to apply a silastic band to the fallopian tube, thereby occluding it. Two hundred and eighty cases have been performed, 70 of which have been followed for more than 1 year. There have been no pregnancies. The technic is relatively simple. Complications result when the tube is excessively thickened, when the tube is fixed in position by adhesion, or when the tube is grasped too close to the cornua or too rapidly. These complications have been relatively few and can be easily avoided.


[Responsiveness of lymphocytes to stimulation by pha and autologous blasts in acute lymphatic leukemias during remission (author's transl)].

The paper deals with the question how far the lymphocytes of acute lymphatic leukemia patients in remission can be stimulated by PHA and autologous blasts in the MLC-Test. The lymphocyte stimulation by PHA showed considerable variation dependent on the phase of therapy. A significant reduction of the responsiveness to PHA stimulation was found during the prophylactic reinduction treatment with Vincristin and Prednisolon compared with the results during maintenance therapy. The examination of lymphocyte stimulation by conserved autologous blasts in the mixed lymphocyte culture-test yielded positive results in one of three children at the beginning of remission and in 2 of 3 children during the consolidated remission period.


[Special problems of pacemaker-therapy in infants and children (author's transl)].

The special problems of pacemaker-therapy in infants and children are reported and compared with those of adults. The possibilities of application of pacemakers and the indications for temporary or permanent use are discussed. Special attention is paid to the disadvantages of presently available pacemakers for children due to electro-physiologic and hemodynamic facts. Complications of pacemaker-therapy and wishes in regard to technical improvements of pacemakers are discussed too. The possibilities of checking pacemaker patients are also mentioned. The therapeutic value of pacemaker for pediatric patients is analysed, using the results of the literature and an own experience with an infant, which is discussed in detail.


Transplantation of Hymenolepis diminuta into naive, immune and irradiated mice.

Almost 100% of 7- to 10-day-old Hymenolepis diminuta became established when surgically transplanted from donor mice into the duodenum of naive recipient mice. Transplanted tapeworms survived 8-12 days, by which time they had survived much longer in total than they would have done in the donor. Mice previously immunized by a primary infection rejected transplants within 4 days. Sub-lethal irradiation (550 rad) delayed rejection by immune mice but such mice still rejected worms much more quickly than did naive mice. Surgery was shown to delay by 2-3 days the rejection of worms by naive mice, and the importance of circumventing surgery by administering the worms per os is emphasized. Prospects for reconstituting irradiated immune mice are considered vis-à-vis work with nematodes, and the differences which, on present knowledge, appear to exist between nematode and cestode rejection are briefly discussed.


Liver plasma membrane enzyme activities following glutaraldehyde fixation.

The Wachstein-Meisel ATPase histochemical method has been previously used to demonstrate the ultrastructural localization of this enzyme in both whole liver and isolated plasma membranes following fixation in glutaraldehyde. In the present study biochemical assay, of liver plasma membrane enzymes following fixation in cold 2.5% glutaraldehyde showed that approximately 40% of Mg2+-ATPase, but only 4% of (Na+-K+)-ATPase activity remained in membranes from either control or ANIT-treated rats. In addition, 5'-nucleotidase activity was almost abolished by fixation. The present results indicate that the Wachstein-Meisel method, when applied to biliary canaliculi, can reliably be used to demonstrate the ultrastructural, histochemical localization of Mg2+-ATPase but not that of (NA+-K+)-ATPase. Furthermore, the method permits a valid comparison to be made of the relative Mg2+-ATPase activity in normal and chemically damaged biliary canaliculi.


The invalid passenger and air transport.

I have shown some of the problems which can arise when invalids are transported by air. There is no doubt that they are all fully manageable provided there has been adequate planning. Anyone with a problem in this field should contact the relevant airline medical department, or one of the organizations specializing in aeromedical evacuation. In the United Kingdom these are:- (1) Europ Assistance Limited, 269-273 High Street, Croydon, Surrey (telephone: 01-686 0102). (2) St. John Ambulance, Aeromedical Section, I Grosvenor Gardens, London SWI (telephone: 01-235 5231). (3) Transcare Limited, Group House, Woodlands Avenue, Acton, London W3 (telephone: 01-992 5077).


Myosin-paramyosin cofilaments: enzymatic interactions with F-actin.

The interaction between paramyosin and myosin has been studied by enzymological methods. Clam adductor paramyosin inhibits the actin-activated, Mg2+-requiring ATPase of both clam adductor and rabbit skeletal muscle myosins. Myosin and paramyosin must be rapidly coprecipitated for this inhibition. Incubation with F-actin in the absence of ATP does not alter this effect. This inhibition follows a hyperbolic function with respect to paramyosin concentration. Slow precipitation by dialysis of myosin and paramyosin together leads to copolymers with actin-activated ATPase equivalent to that of slowly formed myosin filaments. Both kinds of slowly formed filaments have enzymatic properties distinct from those of the rapidly precipitated proteins. Paramyosin is competitive with F-actin for their effects upon myosin. The apparent affinity of myosin for F-actin is markedly reduced by association with paramyosin, but the extrapolated maximal velocity of actomyosin is unaffected. The specificity of this inhibition is strongly suggested by marked quantitative differences between native and cleaved paramyosins. No inhibition of intrinsic myosin ATPase by paramyosin is seen. These studies suggest that at least two types of condition-dependent association between myosin and paramyosin are possible. One class of interactions is associated with enzymic inhibition in rapidly coprecipitated filaments, whereas slowly formed cofilaments exhibit catalytic activity similar to that of identically treat-d myosin and have a characteristic 14.5 nm axial repeat.


Restoration of oxidative phosphorylation by purified N,N'-dicyclohexylcarbodiimide-sensitive latent adenosinetriphosphatase from Mycobacterium phlei.

The N,N'-dicyclohexylcarbodiimide (DCCD)-sensitive latent adenosinetriphosphatase (ATPase) (EC 3.6.1.3; ATP phosphohydrolase) from Mycobacterium phlei has been purified to homogeneity and used to resotre oxidative phosphorylation to detergent-extracted membranes. The phosphorylation was inhibited by DCCD any by tetraphenylboron and valinomycin. The enzyme was solubilized from the membrane vesicles by treatment with cholate followed by extraction with Triton X-100. After partial purification on a sucrose gradient, the enzyme was purified to homogeneity by affinity chromatography on Sepharose coupled to ADP. The DCCD-sensitive latent ATPase of coupling factor from M. phlei consists of two components, the latent ATPase (Bcf4), which is insensitive to DCCD, and an intrinsic membrane component, BCF0. This hydrophobic portion of the DCCD-sensitive ATPase was partially purified on a sucrose gradient after solubilization with detergents from membrane vesicles that had been first depleted of the BCF4 by washing with 0.25 M sucrose. When BCF0 was combined with purified BCF4, the latent ATPase of the resulting complex was sensitive to DCCD. Moreover, like the purified DCCD-sensitive latent ATPase, the combined BCF4 and BCF0 restored coupled phosphorylation to detergent-extracted membranes.


Differences among sulfated proteoglycans synthesized in nonchondrogenic cells, presumptive chondroblasts, and chondroblasts.

The sulfated proteoglycans synthesized by definitive chondroblasts in cultured 10-day chick vertebral or epiphyseal cartilages were characterized by their sedimentation profile in a sucrose gradient and their susceptibility to chondroitinase ABC (EC 4.2.2.4; chondroitin ABC lyase). These sulfated proteoglycans were indistinguishable from those synthesized by definitive chondroblasts that emerge from older cultures of somites plus notochord or in older cultures of limb buds. The sulfated proteoglycans of these definitive chondroblasts are readily distinguished from those synthesized by their mother cells, the presumptive chondroblasts, or those synthesized by dedifferentiated or bromodeoxyuridine-suppressed chondroblasts. However, the sulfated proteoglycans synthesized by presumptive chondroblasts or by dedifferentiated or bromodeoxyuridine-suppressed chondroblasts cannot be dintinguished by these techniques from those synthesized by (i) blastodisc cells, (ii) fibroblasts, (iii) spinal cord cells, or (iv) skeletal, cardiac, or smooth muscle cells. Addition of glycosaminoglycans or collagen to the medium did not induce somite or limb presumptive chondroblasts to synthesize the chondroblast-unique sulfated proteoglycans. Cells moving from the presumptive chondroblast compartment into the chondroblast compartment acquire not only the option to initiate the synthesis of chondroblast-unique collagen chains, but also the capacity to synthesize chondroblast-unique sulfated proteoglycans.


Inhibition of erythrocyte sickling by cystamine, a thiol reagent.

Incubation of sickle cells with cystamine, a thiol reagnet, resulted in the formation of an intracellular S-ethylamine derivative. The rate of the reaction was dependent upon the cystamine concentration, the temperature, and the duration of the incubation. The cystamine-treated cells demonstrated a marked inhibition of sickling under hypoxic conditions, a decrease in their mean corpuscular hemoglobin concentration, and a significant increase in their oxygen affinity. The oxygen affinity of these cells was less dependent on their mean corpuscular hemoglobin concentration than that of untreated sickle cells. The minimum gelling concentration of S-ethylamine doxyhemoglobin S was slightly increased. Cystamine did not affect the intracellular pH nor the 2,3-diphosphoglycerate level. The exact contribution of the interrelated factors in cystamine inhibition of sickling (changes in oxygen affinity, mean corpuscular hemoglobin concentration, and minimum gelling concentration) has yet to be determined.


Congenic strains of mice susceptible and resistant to mouse hepatitis virus.

A congenic strain of C3HSS mice, which is histocompatible with C3H mice but differs from them in susceptibility to mouse hepatitis virus (MHV), has been developed by introducing the gene for susceptibility to the MHV-PRI virus from the PRI mice. This was accomplished by continual back-crossing of the hybrids to the C3H mice, but at the same time by selection of susceptibility by use of macrophage culture tests. After 20 back-crosses, a strain homozygous for susceptibility was produced by brother-sister mating of individual mice whose potential for carrying the recessive gene for resistance was tested in progeny. Since the original choice of mice for breeding was based on in vitro macrophage susceptibility, and since highly susceptible mice were developed on the same basis, it seems evident that macrophage susceptibility is an integral aspect of mouse susceptibility. The continued production of almost 50% susceptible mice in the back-crosses is further evidence of the dominant one-locus explanation of genetic susceptibility to this agent. Incomplete penetrance may also be present in 8 and 9 week old mice of the C3HSS strain since there was a sharp decrease in susceptibility of these mice even though their macrophages in culture maintained full susceptibility.


Effects of experimental diabetes on intestinal strontium absorption in the rat.

Control and streptozotocin diabetic rats were studied at 5 and 12 days after induction of diabetes. Strontium absorption was measured by in situ perfusion of duodenum and ileum. Duodenal absorptive capacity (absorption per unit length) and absorptive specific activity (absorption per gram of dry weight mucosa) were depressed. Depression was present both at 5 days, when mucosal growth is similar in controls and diabetics, and at 12 days, when mucosal growth is 50% greater in diabetics. Effects of diabetes on ileal absorption were minimal in comparison with effects on duodenum. This depression of duodenal strontium absorption in the diabetic rat is analogous to effects of diabetes on calcium absorption and may be mediated by abnormal vitamin D metabolism.


Circulating factors controlling cell proliferation.

Dipolid human fibroblast-rich tissues contain a macromolecule with a molecular weight between 30,000 and 50,000 daltons which will inhibit the proliferation of fibroblasts in the G1 phase of the cell cycle (i.e., inhibit both 3H-thymidine uptake as well as the normal increase in cell number). The inhibitor is destroyed by trypsin but not by ribonuclease or deoxyribonuclease, and it is thermolabile. It has an acid IEP. It is not cytotoxic, and its inhibitory activity appears to be completely reversible. This fibroblast endogenous inhibitor does not interfere with the proliferation of DNA synthesis by human lymphocytes, bronchial carcinoma cells, or HeLa cells. The activity does not appear to be species specific. Therefore, we suggest that it is quite possible that the control of fibroblast proliferation resides in a fibroblast chalone. Diploid human fibroblasts, in contrast to chicken or mouse fibroblasts or heteroploid fibroblasts in general, stringently require serum for their proliferation. All of this mitogenic activity of calf serum can be concentrated in a molecular weight range around 100,000 daltons by ultrafiltration. All of the mitogenic activity within this molecular weight class can be concentrated at a pH of 5.2 via isoelectric focusing, and all of the activity at this isoelectric point can be concentrated in one peak on preparative polyacrylamide gel electrophoresis. This latter material is homogeneous at three different pH's in analytical gel electrophoresis as well as in SDS electrophoresis. This purified serum mitogen for diploid human fibroblasts in vitro also works in vivo and represents as much as 0.5% of calf serum protein, albeit there is much less of this protein in adult cow or horse. It is composed of two equal subunits weighing about 60,000 daltons each and contains about 2 moles of sialic acid, one S-S bond, and 6 moles of hexose per subunit. There is a reciprocal relationship between the biological activity of fibroblast inhibitor and serum mitogen, but there is no apparent direct interaction between these two proteins. Addition of pure serum mitogen to diploid human fibroblasts in vitro results in the release of commensurable chalone activity into the medium and a reciprocal loss of mitogen from the medium. Therefore, we propose that serum contains a single macromolecule which competes with endogenous chalone on the surface of diploid human fibroblasts and that this functions as an anti-chalone for the fibroblast.


Stimulation of a specific drive (predatory behaviour) by p-chlorophenylalanine (pCPA) in the rat.

In contrast to wild rats the percentage of animals showing predatory behaviour is very low among laboratory rats. Stimulation of this specific drive by systemic drug application has been mentioned only for pCPA and delta9-tetrahydrocannabinole. As detailed investigations concerning this stimulating property of pCPA are not published, the effect was studied in selected non-biting rats (without starvation and isolation) regarding dose- and time-dependence after single and repeated drug administration; further, D- and L-isomers of pCPA were included in the investigation. After single oral application of 200 to 3200 mg/kg DL-pCPA a dose-dependent stimulation of predatory behaviour was found. Smaller doses (200 or 400 mg/kg p.o.) given repeatedly on 3 consecutive days showed effects comparable with those after single administration of much higher doses (1600 or 3200 mg/kg p.o.). With repeated oral application of 50, 100 or 200 mg/kg on 10 consecutive days no difference was found between D- and L-pCPA concerning efficacy and time course of drug effect. Both after single and repeated administration in all series of tests the effect reached its maximum not before several days and faded almost completely in the drug-free after-period. D-methamphetamine HCl, investigated comparatively as a CNS stimulant, provoked no predatory behaviour in a wide dose-range (0.125 to 8.0 mg/kg p.o.) with repeated administration on 10 consecutive days. Within the control groups (total number of rats = 100) no animal showed predatory attach during an observation-period of at least 3 weeks.


Parachlorophenylalanine potentiates facilitatory effects of mescaline on shuttlebox escape/avoidance in rats.

Acute parachlorophenylalanine (pCPA) pretreatment (150 mg/kg, i.p., 24 h beforehand) potentiated facilitatory effects of mescaline (39.6 mg/kg i.p.) on shuttlebox escape/avoidance in hooded rats, tested in two different situations: 1. during aquisition of avoidance behavior (Experiment 1); and 2. in stable pretrained poor avoiders (Experiment 2). pCPA alone did not influence avoidance behavior in either situation. Mescaline, with pCPA pretreatment, may be associated with long-term behavioral effects; all rats treated with this combination were later found to be poor avoiders, unable to achieve a stable baseline of good avoidance. pCPA significantly depleted brain norepinephrine and dopamine, as well as serotonin, measured after testing in the second situation.


Acute increases by p-chlorophenylalanine of apomorphine-induced stereotyped behavior in the rat.

The stereotyped behavioral syndrome induced in the rat by apomorphine was enhanced by acute systemic administration of PCPA. This effect was dependent on the dose of PCPA and half-maximal at approximately 150 mg/kg, i.p.; it occurred within 30 min, was greatest between 1 and 5 h and had nearly disappeared by 24 h after an acute dose of PCPA. A similar effect was not found at 24 or 48 h following 3 repeated doses of PCPA of 300 mg/kg/day. This effect of PCPA was not reversed by 5-HTP or by high doses of a decarboxylase inhibitor. PCPA alone did not produce stereotyped behavior, although it produced some behavioral excitation in high doses following inhibition of monoamine oxidase. This acute behavioral effect of PCPA to potentiate apomorphine-induced stereotyped responses is unexplained. It does not seem to be due to depletion of 5-HT or to the formation of an amine as an active metabolite. We suggest that PCPA can have behavioral excitatory actions independent of its 5-HT-depleting action.


Tape test as a simple new method for the study of compounds increasing the problem-solving ability of the rat.

A simple new method, the "tape test" has been developed for studying the enhancement of learning by drugs in "learning-dull" rats. A piece of adhesive tape is pressed on the left front pad of the rats. The time of tape removal by the animal, i.e., the problem-solving time is measured. In our experiments the selected learning-dull rats were used which were unable to remove the tape within 60 s observed on 3 consecutive days. The problem-solving ability of the rats was studied on 4 consecutive days, by posttrial administration. The problem-solving ability was found to be increased after treatment with different drugs such as para-chlorphenylalanine (PCPA), pemolin, orotic acid, vitamin B12. The stimulatory effect of vitamin B12 could be inhibited by vincristine.


[Are we pushing the disabled intellectually into a ghetto? (AUTHOR'S TRANSL)].

Disabled people not only encounter barriers in their physical environment (in the form of steps which social rehabilitation is making efforts to level, remove or overcome through ramps) but also in the intellectual and emotional fields (in the life and thinking habits of our society, in expressions, song texts, etc.) i.e. basic expressions which seem to be applicable to the lives of the non-disabled but which prevent the disabled's access to life in the community. The examples given are: "What you are depends on what you have", "the world is beautiful", "everything will turn out all right". These expressions are, at least, as detrimental to full integration as the steps at the entrance to the post-office. The elimination of these sayings would not be beneficial to the disabled alone, but to all people: our life would become more honest and less strained. Phrases of the Biblical Message serve as the example for a thinking model which could give the impetus to a common learning process of tension release. Efforts to lessen the restraint (that is to correct the cited expressions) are called "weltanschauliche Rehabilitation", but whether this should rather be understood as a part of social rehabilitation or its parallel is a question which still remains unanswered.


[Youth work with the disabled--a contribution to social rehabilitation (author's transl)].

It is particularly the disabled children and adolescents who suffer most from marginal group life in our society. For a sound social and emotional development they need interaction with their peers. Youth group activities as carried out in the Federal Republic of Germany, for instance by the Georgspfadfinder, provide the disabled young people with living space which enable them to train social skills and come to terms with the environment. These wide-ranging, common activities can help to change the attitudes of all participants, thus enhancing the process of social integration.


[Socio-economic aspects of rehabilitation (author's transl)].

Rehabilitation must not only be identified as the total services provided for disabled persons, but also in relation to its effects on society as a whole. In addition to the general interdependency between socio-political measures, prime emphasis is placed on the principal social and economic relationships. In particular, attention is drawn to the specific characteristic of human work as an expression of personality, investment in human beings, productivity of rehabilitation efforts, and aspects of operating efficiency.


[Therapy with the help of a horse - attempt at a situational analysis (author's transl)].

With December 31, 1974 being the target day, the Kuratorium für Therapeutisches Reiten carried out a questionnaire survey amongst its members. Of these questionnaires, 89, predominantly completed by physical therapists, were usuable. As a result of this study it was possible for the first time to collect a number of facts relevant to hippotherapy and therapeutic riding based on a total of 154 415 registered equistrian therapies. Amongst other things, the survey provided informative details regarding physicians' and physical therapists' assistance in hippotherapy and therapeutic riding, its practical implementation, indications and accident risks involved.


[The problem complex of the disabled and the marginal group theory - socio-scientific approaches designed to explain the social discrimination of the disabled (author's transl)].

The position of disabled people in societies such as the Federal Republic of Germany, is characterised by the status of marginal groups in the sense of social discrimination. As can be demonstrated by the discrimination shown towards the disabled in employment, there are two different paradigms of the socio-scientific marginal group theory suitable for explaining this fact. According to the socio-psychological approach, vocational discrimination is understood as a sort of social punishment for the violation of norms and values. The socio-economic approach, on the contrary, considers the unfavourable job situation of the disabled a by-product of a general development towards underemployment and the de-manning programme in capitalistic systems. In some respect, the theoretical approach seems to be more resonable, but to comprehend adequately the marginal group status of the disabled, it is necessary to integrate both the socio-economic and socio-psychological theory components.


[Organisational pre-requisites for the improvement of the social integration of disabled children by means of sport (author's transl)].

Physical education of physically handicapped and sensorily imparied children - with its general goals and, especially, its efforts to improve social integration - is understood as an essential part of rehabilitation. The pre-requisites, possibilities and limits of setting up sports teams are discussed on the basis of the types of disabilities suffered by the team members. In addition to homogenous and non-homogenous teams, sports teams should be developed in which the disabled are active alonside the non-disabled. More than ever, sports will be for those disabled who are able to participate - a means of enlarging social contacts. The personality of the sports teacher, who must have a broad knowledge of the methods applied in sports for the disabled, is considered a decisive factor on whom success or failure depends. The given examples are based on experiences gained by the author and his colleagues. The setting up of such sports teams should be followed by new approaches in the clubs and associations activities, as well as in the financing of sports for the disabled. Suggestions are made on how this can be realised.


[On the problem of tolerance tests as final measure of medical rehabilitation (author's transl)].

Work load evolvers from objectively describable and measurable tasks, which can be adjusted in intensity or duration. These tasks must be performed by different people; showing identical loads, as a rule, produce different effects on different people. This fact, i.e. different persons - different effects with identical loads, is, in ergonomics, operationally called strain (Laurig, W. 1975). Hence, strain is not only the consequence of work load, but also dependent upon the differences inherent in persons under the same load. In addition to the independent of the operations to be performed, there can occur further loads, i.e., physical environment influences. Hence the purpose of testing the work load of the disabled is to assess wide-ranging types of physical and psycho-mental loads with respect to their individual strain intensity and to develop, on the basis of the findings, appropriate proposals for career plans.


[Attitudes towards the disabled: how is a change possible? (AUTHOR'S TRANSL)].

On the basis of short definitions of the terms "attitudes" and "prejudices", a report is made on important studies carried out under the aspects of "lack of information", "social distance" and "social labelling". Available evidence indicates that the functional problems of prejudices towards the disabled and, consequently, the reasons for their origin have not been sufficiently examined. Overall societal approaches based on the Marx theory cannot yield satisfactory results. On the basis of an interactive approach, prejudices are characterised by manifestations of disturbed interpersonal communication and interaction. The consequences of these facts, which are relevant to the change of attitudes, are summarised in ten theses. These should be evaluated in a practical adult education programme.


[Disabled children in the federal republic of Germany in 1974 (author's transl)].

Within the scope of an additional micro-census inquiry--carried out in 1974--the Federal Statistical Office in Wiesbaden assessed the number of physically, mentally and psychologically impaired children. The results are differentiated according to the types of disability and therapy, age, in-patient treatment and special school attendance. Furthermore, the estimated results are compared with earlier surveys of the Federal Statistical Office and other estimates.


[Considerations on the selection of training programmes in vocational training centres for disabled adolescents (author's transl)].

Professional workers in vocational research are often asked what kinds of vocational training will be made available in the future for certain groups of people. An answer can be provided neither by demand prognoses nor by analyses carried out to determine the tendency of chance on the labour market. All the more so as today's scientific methods make it almost impossible to obtain reliable data on future vocational structures. When disabled adolescents chose their careers it becomes especially evident that permanent vocational resettlement is only possible when professionals from the various disciplines are closely co-operating in the selection and structuring of the different training programmes. On the other hand, the above considerations reveal the research gaps which have to be bridged if vocational training centres are to provide the disabled adolescents with an equilibrated selection of vocational training programmes. These considerations are presented here to a larger group of professionals from whom the author would appreciate incentives and critical comments.


[Psychological rehabilitation as social learning process--on the application of the communication therapy in rehabilitation (author's transl)].

As, from the socio-psychological point of view, disability constitutes a communication problem, it was studied in how far the principles of communication therapy - originally developed for the treatment of marriage and family problems - can be applied to the psychological rehabilitation of the disabled. The author and her colleagues are of the opinion that the communication therapeutic approach can essentially improve the rehabilitation process, especially through the direct involvement of everyday social partners.


[Industrial therapy 1975 (author's transl)].

The transition to industrial therapy following a preparatory period in a handicraft work therapeutic unit constitutes for the patients a decisive step from rehabilitation in a hospital to other rehabilitation facilities. Described are work principles, time of practice, payment, projects, social protection of labour, patients, working time, transitional period, assessment, theoretical instruction and work under real working conditions.


[On the problem complex of the new act on the severely handicapped with respect to the workshop for the disabled (author's transl)].

One group of the disabled, i.e., the most severely handicapped, will not be able to benefit from the improvements brought about by the new Act on the Severely Handicapped, if the statutory orders of the Federal Government and the provisions of the Federal Employment Office are implemented as planned. In this event it would become extremely difficult for the severely physically handicapped to participate in the life of the community. The article demonstrates how a sheltered workshop for the disabled which, in part, looks after the most severely handicapped needing special care: - will not achieve recognition under 55 of the Act on the Severely Handicapped, - will not benefit from either institutional or individual support provided by the organisations of - the labour administration, - will not obtain contracts from either industrial or public enterprises because the orders cannot be set off against the equalisation payment, - cannot help their disabled employees to become eligible for social security benefits. This development which for the most severely handicapped represents a step backwards must be removed from those who are the most afflicted. It must not happen that efforts made at school to promote and integrate the disabled terminate in segregated facilities (nursing homes), which are run under different subsidy regulations. What is needed is a concept for appropriate care and support of the most severely handicapped and their integration into suitably equipped small groups within workshops for the disabled.


Effects of tranylcypromine on 5-HT uptake and its interaction with PCPA on rat brain 5-HT.

The effect of p-chlorophenylalanine-treatment in rats receiving chronic treatment with tranylcypromine on brain serotonin and 5-hydroxyindoleacetic acid levels was examined. This treatment schedule was similar to that followed in depressed patients undergoing treatment with the monoamine oxidase inhibitor. PCPA completely obviated the elevation in serotonin and further reduced 5-HIAA levels of animals treated chronically with tranylcypromine. These effects correlated with PCPA-induced reversal in the clinical improvement achieved by tranylcypromine. In in vitro studies, tranylcypromine was found to inhibit 5-HT uptake into synaptosomes with a minimal action on the spontaneous release of the amine.


[Importance of the virology laboratory in the diagnosis of virus diseases].

Introduction. Principles of the Modern Diagnosis in Virology--isolation of the causative agent;--histologic and electronoptical diagnosis;--serologic. Efficiency of the viral diagnosis. Modern and Rapid Diagnostic Methods--progress in the technology of cell cultures and immunofluorescence;--new serologic methods.


[Circulating Salmonella serotypes isolated in the territory served by the Sanitary-antiepidemic Center of Covasna County].

During the 1967-1973 period, the authors followed up the circulation of various Salmonella serotypes and found new serotypes linked to the particular epidemiologic aspects recorded within a small district, without highly populated centers. The results showed a steady increase in the strains isolated during the last 3--4 years. Among the total 2103 strains isolated, S. panama, S. typhimurium and S. bredeney were predominant. The number of serotypes isolated varied between 10 (1968--1969) and 16 (1972). Salmonella strains were incriminated in the etiology of a fairly high proportion of the acute digestive disorders.


[Evolution of enterobiasis demonstrated by the action of active and passive detection with a (modified) NIH method in Oradea].

The incidence of enterobiosis in the infantile population of Oradea was followed up by a modified NIH laboratory method. Active detection revealed an incidence of a latent state of enterobiosis of 21.9% in 1970, which fell to 3.9% in 1973. By passive detection, enterobiosis was found to decrease from 22.6% in 1970 to 16.1% in 1973, owing to the efficiency of the investigations and treatment applied.


[Evolution of immunity to Toxoplasma gondii in an apparently healthy human population].

In order to detect the evolution of the immune background in infections with T. gondii, investigations were carried out by the indirect immunofluorescence test in 231 apparently healthy subjects, belonging to different age-groups, from three rural localities in Moldavia. A second serologic test was performed after various intervals (6 months, 16 months, 5 years). The results showed that:--The evolution of the immune background appears to be conditioned by the factor time, significant variations only being recorded after longer intervals (5 years).--The immune background is relatively stable and durable; the state of individual immunity, however, although durable appears to be limited in time.--Serologic conversion per age-groups differs, new cases appearing in principle in the 5--9 years age-group and the negative results being obtained in the 10--14 years age-group and after the age of 15 years.--The 5--9 years age-group presents a particular reactivity, evidenced by the high proportion of ascending titers.


[Improvement of rapid laboratory methods for the diagnosis of streptococcal infections].

In 1975, clinical and epidemiological investigations were carried out on streptococcal infections, affecting 261 persons in a children's community. Rapid laboratory tests were used, employing commercial sodium amyl polyethylen microtablets. Of the total persons investigated 24.5% (64) presented primary streptococcal infections and 0.3% (1) complications. Environmental complications was 5% greater in the communities with scarlet fever foci than in the intact communities. The absence of late manifestations in the 1--4 year-old children attests to the effectiveness of the preventive measures taken.


[Diagnostic value of blood fibrinogen in leptospirosis].

A study was carried out on the value of the presumptive diagnosis of fibrinogenemia in the uncharacteristic forms of leptospirosis, during the first eight days of the disease, in 42 cases, as compared to that of erythrocyte sedimentation rate. The results of fibrinogenemia determinations were more suggestive of the diagnosis at the beginning of the disease.


[Observations of a histochemical nature on the walls of the cerebral arteries of human subjects of various ages].

It has been studied the mucopolysaccharides in some arteries of the circle of Willis in someone subjects from few months to 85 years. The mucopolysaccharides are localisated mainly in the intima and media tonaca and they tend to increase, quantitatively, until to 50 years; the mucopolysaccharides are in all the vasal layers, particularly in the membrane elastica interna and in the tonaca media placed shelter. These mucopolysaccharides tend to increase with aging.


[Further comparative anatomical observations on some histochemical aspects of the salivary glands of rodents in the course of development. II].

The PAS and protein reaction positive secretion can be found in the parotid and inframandibular gland of rabbit on the 22nd pregnancy day only in the perinuclear zone. On the contrary during the last developmental phase it is localized in the apical zone of the cells and after the birth in all the cytoplasm with the exception of the terminal tracts of the inframandibular gland, which are always PAS negative but positive to the reaction to MPS sulfurated acids. Assumptions are made about the presence of the secretion in the gland cells during the fetal period.


Erythrocyte enzymes in myelomatosis.

The activity of the erythrocyte enzymes: glucose-6-phosphate dehydrogenase, pyruvate kinase, glutathion reductase and ATPase were measured in 8 patients with untreated myelomatosis. Glucose-6-phosphate dehydrogenase was significantly increased. Glucose-6-phosphate dehydrogenase values were negatively correlated with the glomerular filtration rate as measured by 51Cr-EDTA clearance. The results support the existence of a shortened red cell survival in peripheral blood related to the degree of renal insufficiency.


Insulin allergy: an approach to therapy.

Insulin can evoke local and systemic hypersensitivity responses after injection. Many individuals receiving commercial insulin preparations experience local reactions, usually of short duration. A case of severe, persistent insulin-induced skin allergy and the use of therapy, including hyposensitization, to alleviate symptoms are discussed.


[Structure of hospitalization of an urban population in cases requiring resuscitation and intensive therapy].

Data on the structural characteristics of the hospitalized and regularities governing the factors underlying the need among residents of the cities of Novokuznetsk, Ryazan and Novgorod for reanimation and intensive therapy in connection with accidents, poisonings and traumas, as well as circulatory disturbances and diseases of digestive organs are presented. More than one half of all cases of hospitalization in connection with cardiovascular diseases involve myocardial infarction and lesions of the cerebral vessels. The greatest number of hospitalization cases with diseases involving the organs of digestion had as their cause gastroduodenal ulcer and cholelithiasis.


[Effect of industrial and socioeconomic factors on morbidity levels with temporary work loss among workers and employees of specialized state farms].

Specialization of the agricultural industry at state farms brings changes into conditions of work, affects the disease incidence involving temporary incapacitation among state farm workers. The sick-rate among those of them who are engaged in dairy and vegetable-growing state farms is higher that among workers of the cattle breeding ones. A higher level complex mechanization of labour-consuming processes in cattle breeding and plant growing mitigates the influence exercised by specialization of the state farm agricultural production. The disease-incidence with temporary incapacitation is affected not only by occupational, but also by non-occupational factors.


[Analysis of work input of the department heads of central regional hospitals].

Organization of the work performed by 59 medical department heads who concurrently act as off-staff district specialists was studied. Investigations were being carried out over the years 1972 through 1974 in 14 central district hospitals of the Tula region serving as a base. The bulk of the time spent by the department heads was found to be devoted to the work at the inpatient department (67-88 per cent of the total time), with that spent at the polyclinic comprising merely 7.3-13.6 per cent and extrahospital work taking up 3.8-7.7 per cent of the total time. The main shortcoming in the organization of their activities is the absence of a precise planning of the hours accorking to the types of activity, with only 18.6-50.7 per cent of the available time spent in discharging their primary functions, while desk work and other kinds of activity, as well as interruptions and management chores taking up 28.5 to 47.1 per cent of the working time. This forms a reserve for broadening the basic activity of the department heads and for improving the quality of diagnosing and treating the patients. The article carries a number of recommendations for rationalization of the work performed by department heads.


[Age and professional characteristics of loss of work time by middle medical personnel].

Wast of working time and distraction from basic duties over a period of one year in different age and professional groups of the paramedical personnel were studied in 2 regions and 1 territory of the RSFSR. The investigation showed that on all occasions and on account of all causes the waste of productive time and distraction from primary duties occurred among the personnel of young age. In senior age groups this figures were noted to be on decline. Essential age-specific features common to the frequency and duration of lost working time and distraction from basic duties were found to be associated with temporary incapacitation, leaves of absence due to pregnancy and confinement, care of children, etc. The existence of a definite connection of the factors under study and posts occupied by paramedical workers was established.


Progression of popliteal aneurysmal disease following popliteal aneurysm resection with graft: a twenty year experience.

Multifocal occurrence of peripheral atherosclerotic aneurysm is well known. However, little attention has been directed to subsequent progressive aneurysmal development adjacent to sites of previously resected and grafted popliteal aneurysms. During a 20 year follow-up study of 79 patients with 115 popliteal aneurysms, we have observed the development of six atherosclerotic femoropopliteal aneurysms adjacent to the original aneurysm site in four patients, occurring 5 months to 10 years (average, 5 1/2 years) after the initial operation. Operative repaire was accomplished successfully of five of the six aneurysms; one popliteal aneurysm has not been operlateral popliteal aneurysm (46 percent). Fifty-seven patients (72 percent) presented with complications of the aneurysm, including 35 with thrombosis. As initial therapy, 69 grafting procedures were performed on 58 patients; nine extremities had sympathectomy only; four aneurysms were ligated or resected without grafting; and four extremities required amputation as the only procedure. Among patients with grafts, nine subsequent amputations were necessary in the early postoperative period, all occurring in patients presenting with thrombosed aneurysms. No patient who developed pedal pulses in the period immediately after operation required amputation. In addition, two patients developed aneurysmal degeneration in popliteal homografts. These data demonstrate the progressive nature of popliteal aneurysmal disease and emphasize the need for regular and life-long follow-up.


Cardiac surgery in geriatric patients.

From June, 1960, to January, 1976, 157 patients 65 years or older had elective operations with cardiopulmonary bypass. Ninety-three patients had one or two valves replaced, 47 had coronary artery surgery, and 17 had both. The operative mortality rate was 22.6 percent (21 of 93), 19.1 percent (nine of 47), and 5.8 percent (one of 17), respectively. The over-all mortality rate was 19.7 percent (31 of 157). The mortality rate of patients of 65 to 69 years of age was 20 percent (22 of 110) and 19 percent (9 of 47) in patients 70 years or more. Ninety-four of these operations were performed within the last 3 years, with a reduction in patients' mortality rate to 9.6 percent (nine of 94). A retrospective study revealed a significant correlation between operative mortality rate and preoperative heart size. We could find no correlation between operative mortality rate and diabetes, smoking history, or hyperlipidemia. The major causes of death were myocardial infarction (68 percent-21 of 31), pulmonary complications (35 percent-11 of 31), infections (29 percent-nine of 31), and renal failure (29 percent-nine of 31) or combinations thereof. The patients who died had 2.5 times the number of complications of the survivors. Ninety percent of our patients in the past 3 years have survived their operation. Therefore, elective cardiac operations can be performed with an acceptable mortality rate in patients over the age of 65 years.


Cerium nitrate: a new topical antiseptic for extensive burns.

The wounds of 60 burned patients were treated topically with cerium nitrate, which was applied either as a cream or in aqueous solution. Cerium nitrate has a potent antiseptic effect in human burn wounds, especially against gram negative bacteria and fungi. Pseudomonas aeruginosa was recovered from the wounds infrequently and never predominated. Fungi were practically never found. No patient treated with cerium developed a necrotizing wound infection. Analysis of the detailed bacteriological data indicated that, in contrast to previous results with use of the nitrate or sulfadiazine salts of silver, when gram negative species predominated, the flora tended to be predominantly gram positive when cerium was used. Therefore, some patients were treated simultaneously with cerium nitrate and silver sulfadiazine; this resulted in an even more efficient suppression of the wound flora than was observed previously with either cerium alone or silver salts alone; results with the simultaneous topical therapy in patients with injuries that previously were uniformly lethal were excellent. No toxicity attributable to the use of cerium was observed, although one instance of methemoglobinemia due to nitrate was documented. The adsorption of topically applied cerium essentially is nil. The use of cerium nitrate was associated with a nearly 50 percent reduction in the anticipated death rate. Cerium nitrate is a promising new topical antiseptic agent for the treatment of burns, particularly when it is used in combination with silver sulfadiazine.


Extra-anatomic bypasses for aortoiliac disease in high-risk patients.

A series of 75 patients, with an average age of 65 years, underwent the following extra-anatomic bypasses involving the crossover femorofemoral principle: femorofemoral (F-F), 54 patients; aortofemorofemoral (A-F-F), 12 patients; common iliac-femorofemoral (CI-F-F), six patients; and axillofemorofemoral (Ax-F-F), three patients. Fifty eight of the 75 patients (77 percent) initially presented with rest pain or gangrene. The operative mortality rate in this high-risk group of patients was 4 percent. Analysis by the life-table method showed the graft patency rate to be 91.1 percent at one year and 87.4 percent at 18 months. There have been no graft failures or deaths in the series of 20 patients followed longer than 18 months. Two amputations followed graft failures and nine of the remaining 11 amputations were done in patients with patent grafts during the same period of hospitalization, reflecting the severity of their gangrene upon admission. High-risk patients who are not suitable for crossover F-F grafts without an inflow procedure may be suitable for a CI-F-F or A-F-F bypass before being considered for an Ax-F-F bypass.


Preparation of antisera specific for human B cells by immunization of rabbits with immune complexes.

Three rabbit antisera are described which are specific without absorption (titer 1:100) for separated human B cells, as measured by complement and non-complement fixing assays. The method of production of these sera involved injections of rabbits with precipitin lines formed between 10mul of three separate detergent solubilized membrane preparations and 4mul aliquots of rabbit antisera to human B cells. In addition to being B cell specific, the three sera block the MLC reaction, inhibit aggregated IgG binding to B cells, and show differential degrees of B cell lysis when tested on a panel of separated B and T cells. These and other properties suggest that the target specificities of the antibodies are the human equivalent of the murine Ia antigens.


Pooled stimulating cells as a "standard stimulator" in mixed lymphocyte culture.

Lymphocytes from normal unrelated donors were pooled and used as stimulating cells in mixed lymphocyte culture (MLC). Different pools, each consisting of cells from 20 or 30 different donors, stimulated approximately the same amount of 3H-thymidine incorporation by a given responder, and this "plateau level" of incorporation was different for different responders. Stimulation by pools of 20 cells was highly correlated with the general "responsiveness" of responding cells as measured by their mean response to a large panel of stimulating cells. Such pools may be useful as "standard stimulators" in quantitating MLC stimulation, and perhaps also in evaluating lymphocyte responsiveness of patients.


Antibody-dependent cellular cytotoxicity and chronic renal allograft rejection.

Antibody-dependent cell-mediated cytotoxicity (ADCMC) was studied retrospectively in 20 long-term (1.3-11 years) renal allograft recipients. The serum of all seven patients having persistent proteinuria greater than 1 g/24 hr exhibited positive ADCMC activity to donor lymphocytes. All 11 patients having a negative ADCMC test had normal levels of urinary protein (mean + 0.28 +/- 0.06 (SE) g/24 hr). Two patients had a positive ADCMC test but had normal urinary proteins and no evidence of chronic rejection. In the ADCMC positive group, the mean serum creatinine values were significantly higher and the mean creatinine clearance values were significantly lower than in the ADCMC negative group. There was no significant positive correlation between the presence of ADCMC and the number of HL-A mismatches identified or the response to donor lymphocytes in mixed lymphocyte culture tests in the two groups. Two patients had transplant nephrectomy and histologically showed both glomerular and arterial lesions of chronic rejection. Post-transplant ADCMC activity showed a significant correlation with proteinuria, decreased creatinine clearance, and elevated serum creatinine, and suggests that the chronic rejection syndrome may be related to ADCMC activity in the recipient.


Suppressor mechanisms in neonatally acquired tolerance to a Gross virus-induced lymphoma in rats.

Tolerance to a highly immunogenic Gross virus-induced tumour in Wistar/Furth rats (C58NT)D was produced by neonatal infection of the rats with the virus. These rats failed to reject the tumours when challenged 8 weeks after virus inoculation and to mount the appropriate cell-mediated immune response to the tumour. The mechanisms involved were studied in vivo by adoptive transfers into sub-lethally irradiated rats of tumour cells mixed with spleen cells and/or sera from normal, tolerant, or tumour immune rats, and in vitro by a 51Cr release assay involving similar mixtures. The results indicate the presence of a suppression mechanism which is sensitive to irradiation and abolished by trypsinisation. Weak blocking factors can also be detected in serum. An interpretation in terms of the release of virion proteins from infected cells is proposed, although participation of suppressor lymphocytes has not been excluded.