Characterization of the nucleoside triphosphate phosphohydrolase (ATPase) activity of RNA synthesis termination factor p. II. Influence of synthetic RNA homopolymers and random copolymers on the reaction.

The ability of various kinds of RNA molecules to activate the ATP hydrolysis reaction catalyzed by the p transcription termination factor from Escherichia coli has been studied. The most active RNA polymers are those containing cytidylate residues and very little ordered structure. Free poly(C) is the most active homopolymer; it is 45 times more active than poly(U), which is the only non-cytidine containing RNA that has detectable activity. Poly(C) has no activity when complexed with poly(I) or when the chain lengths are shorter than 22 nucleotides long. Although cytidylate residues are important they need not be frequent; a random copolymer of uridine and cytidine nucleotides with as few as 1 cytidylate residue out of 20 is as active as poly(C). The extent of activation with poly(C) depends on the ratio of p to poly(C). Poly(C) becomes saturated with p at a ratio of 1.8 ng of p/pmol poly(C), which is equivalent to one p monomer/27 nucleotides. A further increase in this ratio leads to a reduction in p activity. Decreasing the length of the poly(C) does not alter the observed saturation value but does decrease the rate of ATP hydrolysis when the RNA is in excess. The possible relevance of these results to p termination activity is discussed.


Reaction of cardiac myosin with a purine disulfide analog of adenosine triphosphate. I. Kinetics of inactivation and binding of adenylyl imidodiphosphate.

Bovine cardiac myosin ATPase activity was rapidly inactivated by the purine disulfide analog of ATP,6,6'-dithiobis(inosinyl imidodiphosphate). Kinetic investigations showed that this analog acted as a site-specific reagent at 0 degrees with a Ki of 130 muM and a half-life of 8.2 min at saturating inhibitor concentrations. Concentrations (50 to 500 muM) of ATP, adenyl-5'-yl imidodiphosphate (AMP-PNP), or ADP that saturated the active site caused an enhancement in the rate of inactivation, indicating the purine disulfide analog was not reacting at the active site. Under these conditions saturation kinetic data were still observed with Ki values remaining unchanged (120 muM) but with the half-life of inactivation decreasing to 6.0 min (ATP) and 4.6 min (AMP-PNP) at saturating inhibitor concentrations. At concentrations greater than 0.5 mM ATP, AMP-PNP, or ADP there was a decrease in the rate of inactivation, implying protection by these nucleotides. However, saturation kinetics of inactivation could no longer be demonstrated, implying a change in the mechanism of inactivation. A comparison of the inactivation of the Mg2+, Ca2+, and EDTA-ATPase activities of cardiac myosin after modification by the purine disulfide analog showed that the Mg2+- and Ca2+ATPase activities plateaued at approximately 60% and 40%, respectively, while the EDTA-ATPase activity continued to decrease to below 10%. This evidence supports the suggestion that the purine disulfide analog was not reacting at the active site. Equilibrium dialysis experiments were used to measure the binding of [8-3H]AMP-PNP to native cardiac myosin, the thiopurine nucleotide-modified myosin, and the derivative formed by displacing the thiopurine nucleotide by cyanide (thiocyanato-myosin). Native myosin bound a total of 2.1 mol of AMP-PNP with a binding constant of 6.0 X 10(6) M-1. There was a 15 to 40% decrease in the number of AMP-PNP binding sites in the enzyme derivatives, but the active sites appeared not to be blocked since the association constants remained essentially unchanged (KA=3.9 X 10(6) M-1 for thiopurine nucleotide-myosin and 12.0 X 10(6) M-1 for thiocyanato-myosin). The kinetic studies and the binding experiments indicate that the purine disulfide analog reacts at a specific site other than the active site but do not offer support to earlier suggestions from skeletal myosin studies that this site is a possible ATP control site.


Reaction of cardiac myosin with a purine disulfide analog of adenosine triphosphate. II. Stoichiometry and subunit location of labeling.

The reaction of bovine cardiac myosin with the site-specific purine disulfide analog of ATP, 6,6'-dithiobis (inosinyl imidodiphosphate), was studied to determine the stoichiometry of labeling and subunit location of the reactive cysteines. The analog inactivates myosin by forming a mixed disulfide between the thiopurine nucleotide and certain key cysteines. The thiopurine nucleotide was displaced quantitatively by 14CN to form the more stable thiocyanato-enzyme derivatives. In cardiac myosin, the reactive cysteines could be categorized into three classes, nonessential, critical, and noncritical. The modification of the critical cysteines (two per myosin) inactivated the EDTA and Ca2+ ATPase activities, the latter to a lesser extent. The nonessential cysteines (two to three per myosin) and the noncritical cysteines (two per myosin), differentiated by their rates of reaction, had no effect on the ATPase activities after modification. Thiocyanato-modified myosin was analyzed by sodium dodecyl sulfate gel electrophoresis to determine the distribution of 14CN in the subunits. The critical cysteines were found on the 21,000-dalton light chain (LC1) and the noncritical cysteines on the heavy chains. More specifically, the critical cysteine modified in cardiac LC1 (determined from the products after cyclization and chain cleavage at the thiocyanatoalanyl residues) was shown to be the thiol residue whose surrounding amino acid sequence is homologous to that of the single cysteine of the skeletal myosin alkali light chains, confirming the likely similar structure and function of these light chains in the two different muscle types.


Myelinogenesis in optic nerve. A morphological, autoradiographic, and biochemical analysis.

Morphological, autoradiographic, and biochemical methods were used to study the time of appearance, distribution, and nature of sulfated constituents in the developing rat optic nerve. Electron microscope studies showed that myelination begins (6 days postnatal) shortly after the appearance of oligodendroglia (5 days postnatal). Over the ensuing 3 wk, myelination increased rapidly. During the 1st postnatal wk, mucopolysaccharides and glycoproteins were labeled with 35S and autoradiographs showed grains over arachnoidal cells, astroglia, and the glia limitans. These results indicated that astroglia synthesize sulfated mucopolysaccharides of the glia limitans. After the onset of myelination, however, the major portion of [35S]sulfate was incorporated into sulfatide. Autoradiographs showed a shift of radioactive grains from astroglia and arachnoidal cells to myelin, indicating that actively myelinating oligodendroglia incorporate [35S]sulfate into myelin sulfatide; there was a concomitant increase in the activity of cerebroside sulfotransferase. In addition, the increasing amounts of proteolipid protein and myelin basic protein corresponded with the morphological appearance of myelin. These results point to a strict correlation between the structural and biochemical changes occurring during myelination. This system provides a useful model for studies designed to evaluate the effects of various perturbations on the process of myelination.


Action of FdUrD and dCyd on the incorporation of BrdUrd in chinese hamster somatic cell DNA and the isolation of auxotrophic mutants.

Chinese hamster somatic cells grown in the presence of bromodeoxyuridine, deoxycytidine and fluorodeoxyuridine incorporate more bromodeoxyuridine in the DNA than cells grown in the presence of bromodeoxyuridine alone. Thus they become more sensitive to light irradiation. Our data suggest that 0.05 mM--0.2 mM bromodeoxyuridine, 0.05 mM deoxyctidine and 10 mmug/ml fluorodeoxyuridine is one of the best possible combinations for the selection of Chinese hamster somatic cells mutants. Auxotrophs for proline, inositol or both were thus isolated at high frequency.


Virilizing adrenal tumor in a child suppressed with dexamethasone for three years. Effect of o,p'-DDD on serum and urinary androgens.

Extensive hormonal evaluation was performed in a girl with adrenal carcinoma during the primary tumor stage, following adrenalectomy, during the period when metastases were evident and while on treatment with o,p'-DDD. At the age of 14 months a diagnosis of congenital adrenal hyperplasia was made and treatment with dexamethasone (0.125 to 0.25 mg/day) resulted in a fall-off in growth rate, normal advancement in bone age, decrease in virilization and suppression of 17- ketosteroid excretion which continued until 4 3/12 years of age when virilization increased. At five years of age elevated serum and urinary androgen levels unsuppressible with dexamethasone were noted. Following removal of a large right adrenal carcinoma, serum and urinary hormone levels returned to normal. There months following surgery, liver metastases were documented associated with elevated levels of serum androgens. With o,p'-DDD treatment, serum dehydroepiandrosterone sulfate (DS) and urinary 17-ketosteroid (17-KS) excretion fell rapidly while there was a delay in the fall of free androgens. The persistence of free steroid secretion with decreased formation of DS suggests that the o,p'-DDD may have altered sulfatase activity before causing tumor necrosis and total decrease in steroidogenesis.


Thyroid function in adults with Down's syndrome.

The thyroid status of 82 institutionalized adults with Down's syndrome has been assessed. Compared to age and sex matched control subjects, these patients had significantly lower mean total serum thyroxine (T4) and triiodothyronine (T3) concentrations (T4; 69.1+/-22.2 nmol/1; (mean+/-SD) vs. 100.1+/-19.1, P less than 0.001; T13; 1.61+/-0.47 nmol/1 vs. 1.76+/-0.34, P less than 0.025), lower free thyroxine index (FTI), (FTI; 66.1+/-22.4 vs. 95.1+/-20.2, P less than 0.001), and higher basal serum thyrotrophin (TSH) concentrations (TSH; 7.6+/-10.7 mU/1 vs. 3.8+/-1.5, P less than 0.001). These changes were not related to age or sex. Abnormalities in one or more test of thyroid function were demonstrated in at least 38 (46%) of the 82 patients. Two main patterns of abnormality were defined: 1) subnormal T4, FTI and elevated basal TSH levels (primary hypothyroidism) in 13 (16%). All seven of the 13 patients in whom TRH tests were performed showed the expected exaggerated TSH response, and seven out of the 13 patients (54%) had positive thyroid antibodies, 2) Subnormal T4, subnormal or low normal FTI, and basal TSH levels within the normal range in 18 (22%). The mean basal TSH concentration was, however, significantly higher than in patients with normal T4 and FTI levels, suggesting a minor degree of thyroid failure. Only two of the 18 patients (11%) had positive thyroid antibodies. Of the 17 patients in the group tested, 13 showed a normal TSH response to TRH, three an exagerrated response (all females), and one had an impaired response. Other patterns of abnormal thyroid function were observed occasionally: one female patient had biochemical T3 toxicosis; another had the biochemical pattern of subclinical hypothyroidism, four patients with normal basal T4, FTI and TSH levels showed an exaggerated TSH response to TRH and one patient had an impaired response. These data indicate that htyroid dysfunction, in particular hypothyroidism, is common in adults with Down's syndrome, though specific tests are usually required to make the diagnosis. The general reduction in thyroid function in Down's syndrome may be due to impaired development of the thyroid gland. However, frank chemical hypothyroidism may occur only when thyroiditis is superimposed on preexisting diminished thyroid reserve.


Thyroid-induced alterations in myocardial sodium-potassium-activated adenosine triphosphatase, monovalent cation active transport, and cardiac glycoside binding.

The effects of thyroid hormone on guinea pig myocardial NaK-ATPase activity, transmembrane monovalent cation active transport, and cardiac glycoside binding were were examined. NaK-ATPase activities of left atrial and left ventricular homogenates of control and triiodothyronine (T3)-treated animals were determined, and compared to activities of skeletal muscle and liver. T3 administration was associated with a significant increase of 18% in left atrial and left ventricular NaK-ATPase specific activities. This increment was less than that noted in skeletal muscle (+42%) and liver (+30%). To determine if enhanced NaK-ATPase activity was accompanied by increased monovalent cation active transport, in vitro 86Rb+ uptake by left atrial strips and hemidiaphragms was measured. Transition from the euthyroid to the hyperthyroid state resulted in a 68% increase in active 86Rb+ uptake by left atrium, and a 62% increase in active uptake by diaphragm. Passive 86Rb+ uptake was not affected in either tissue. Ouabain binding by atrial and ventricular homogenates of T3-treated animals was increased by 19 and 17%, respectively, compared to controls, in close agreement with thyroid-induced increments in NaK-ATPase activiey. Taken together, these results are consistent with enhanced myocardial NaK-ATPase activity and monovalent cation activt transport due to an increase in the number of functional enzyme complexes.


Detection of aortic insufficiency by pulse Doppler echocardiography.

Sixty-five patients were studied for the presence of aortic insufficiency by auscultation, conventional M mode echocardiography (echo), range-gated pulse Doppler flowmeter (Doppler), and supravalvular aortic angiography. Aortic insufficiency was demonstrated angiographically in 49 patients, of which eight (16%) were missed by auscultation. Echo missed 20 (41%), and Doppler missed seven (14%). Only two (4%) were missed by auscultation and Doppler combined. All methods were highly specific, but the combination of auscultation and Doppler was the most sensitive noninvasive method for detecting aortic insufficiency.


A curriculum for primary care dentistry.

This paper is a discussion of curricular planning with respect to primary care dentistry. It is meant to be anticipatory, although the proposals contained are transitional and evolutionary rather than abrupt. It is intended to be suggestive rather than authoritarian and exemplary rather than definitive. Many of the recommendations and suggestions are already operative in dental education, albeit in limited or experimental form. An overview of both the content and the process of a primary care dental curriculum is presented, and several specific recommendations for curricular change are submitted. Among the more salient recommendations are (1) changing the admissions process to attract to dentistry those most qualified for primary care; (2) moving the basic sciences into the predental curriculum during the initial phase in the development of primary care dentistry; (3) substantially increasing the amount of behavioral science in the dental curriculum; (4) placing curricular emphasis initially on diagnosis and expanding the competence of the primary care dentist in endodontics, periodontics, pedodontics, orthodontics, and prevention; (5) initiating student group practice as the vehicle for patient care; (6) including intradisciplinary and interdisciplinary training as integral components of primary care curricula; (7) extending the curriculum; (8) establishing general practice or primary care residencies either as an intracurricular experience or as a postdoctoral requirement; (9) reorganizing dental school clinics and clinical training to reflect primary care curricular goals; (10) making more rational use of existing auxiliaries, the eventual goal being auxiliaries who perform most of the routine functions; and (11) ultimately integrating dentistry into medicine so that the future primary care practitioner receives both medical and dental training. It is obvious that the extent to which any of these recommendations will be implemented depends on a great deal more than what happens within a dental school. There are many putative countervailing forces which can make implementation difficult; on the other side of the ledger, these same forces might be propitious. As an illustration, the staggering financial constraints imposed on the dental schools can cause us to throw up our hands in despair or can impel us to look carefully at what we are doing, ask why we are doing it, and by building on what is sound and discarding the antiquated and irrelevant, reassemble our curricula to meet public need better than we have been doing...


Mithramycin fluorescence for quantitative determination of deoxyribonucleic acid in single cells.

The use of the antibiotic drug mithramycin for cytoflurometric assessment of deoxyribonucleic acid in single cells has been studied in smears of a standard cell population of rat thymocytes. The optimal staining conditions have been determined including the influence of fixation (freeze-drying, formalin and ethanol). The drug equilibration time has been estimated in relation to the concentration of the mithramycin and to Mg++ was found to enhance the fluorescence intensity produced by the mithramycin-deoxyribonucleic acid interaction. The stability and the reproducibility of the fluorescence reaction are discussed.


Ultrastructural localizations of adenosine triphosphatase activity in resting mammary gland.

Adenosine triphosphatase (ATPase) activity was localized at an ultrastructural level in the resting mammary glands of female BALB/c mice. A Mg++ dependent ATPase was localized in the plasma membranes of both the epithelial and myoepithelial cells of the mammary tubules. A second type of ATPase activity that was not Mg++-dependent but that was Na+ and K+ dependent was localized primarily in the plasma membranes of the myoepithelial cells. Preincubation with either ouabain or N-ethylmaleimide decreased the quantity of reaction product, indicating that both types of ATPase activity were sensitive to these inhibitors. Control media, containing adenosine triphosphate and Pb(NO3)2 without cations, demonstrated that the amount of nonezymatic hydrolysis was negligible. These differences in the cationic requirements for plasma membrane ATPase activity can be used to distinguish histochemically the epithelial from myoepithelial cells in mammary tissue.


Scaling of life changes: differences between three diagnostic groups and between recently experienced and non-experienced events.

Myocardial infarction (MI), neurosis, and lower back pain patients, and matched control subjects estimated the subjective importance of 46 life change events. They estimated (1) the degree of effort necessary in adjusting to them, and (2) how upsetting they were. The estimates of "adjustment" were on average higher than those of "upset". The neurosis patients gave higher values than their controls. Total life change scores were calculated (1) according to the subjects' estimates of recently experienced life events, and (2) according to their estimates of recently non-experienced events. It was found that the first type of scores discriminated better between the two groups than the second type. The results indicate that different forms of psychological scaling may be used to improve the predictive value of life change data.


Suppression of the humoral immune response by plasmacytomas: mediation by adherent mononuclear cells.

Mice bearing plasmacytomas have a severely impaired ability to mount a primary immune response; T cells from these mice, however, appear by both in vivo and in vitro criteria to function normally. This unusual pattern of immunodeficiency appears to be mediated by a regulatory cell found in the spleens and peritoneal cavities but not in the lymph nodes or thymuses of mice bearing plasmacytomas. The number of cells with suppressor activity in the spleens of plasmacytoma-bearing mice is directly proportional to the size of the subcutaneous tumor borne by the host. These cells are capable of suppressing antibody production in in vitro cultures of normal spleen cells but have no demonstrable effect on the ability of normal spleen cells to proliferate in vitro in response to phytohemagglutinin or 8-Br-guanosine-3', 5'-monophosphate (T and B cell mitogens, respectively). Characterization of the suppressor cell population on the basis of its cell surface properties, its radioresistance, its morphology, and its ability to adhere to various solid matrices suggest that these cells are adherent mononuclear cells. These data support the concept that plasma cell tumors indirectly induce an impairment in the humoral immune response of their hosts by stimulating the expression of regulatory functions in a population of splenic and peritoneal macrophages.


A comparison of the kinetics of the macrophage electrophoretic mobility (MEM) and the tanned sheep erythrocyte electrophoretic mobility (TEEM) tests.

In this study the macrophage electrophoretic mobility (MEM) test was modified by using tanned sheep erythrocytes in place of guinea pig peritoneal macrophages as the indicator cells of lymphocyte sensitization to antigens. This modification is named the tanned sheep erythrocyte electrophoretic mobility (TEEM) test, and a comparison of the kinetics of the two systems allowed the following conclusions to be made: 1) Treatment of freshly drawn sheep red blood cells with a concentration of 1/40,000 tannic acid produced optimum results in the TEEM test. 2) Lymphocyte-antigen and lymphocyte-number response curves show similarity in the two test systems. 3) A plateau response with slowing factor is achieved at a lower dilution in the TEEM test than in the MEM test. 4) Whilst similarity in the first stage reaction was found in the two systems, in the second stage of the test (at 37 degrees C) tanned sheep red cells gave a plateau response after 45 min instead of the 60 min found in the MEM test. 5) The two slowing factors showed similar gel filtration patterns with molecular weights between 13,000 and 15,000 daltons, and had equivalent activity in both test systems. 6) The disadvantages of the guinea pig macrophage as an indicator cell are discussed. 7) The TEEM test seems simpler to perform than the MEM test and may be widely applicable in clinical immunology for the estimation of lymphocyte sensitization.


The effects of experimental denervation and reinnervation on skeletal muscle fiber type and intramuscular innervation.

Porcine muscle has a unique grouped arrangement with 3-70 Type I fibers occurring in clusters surrounded by Type II fibers. The deep medial portion of the porcine semitendinosus exhibits a regular pattern of extensive Type I grouping whereas the superficial or lateral portion of the muscle exhibits Type II predominance. Mean values for terminal innervation ratios were 1.00 +/- 0.01 and 1.02 +/- 0.01 in normal superficial and deep semitendinosus respectively. Subterminal axons, therefore, do not branch intramuscularly and innervate only one muscle fiber in normal porcine muscle. Following nerve crush and subsequent reinnervation, fiber type conversion occurred which resulted in a fiber type grouping pattern dissimilar to the normal grouped arrangement. Significantly (P less than 0.01) elevated terminal innervation ratios (1.45-2.15) were measured in reinnervated muscle as a result of extensive branching of subterminal axons, but the percentage of Type I and Type II muscle fibers was unchanged. It was concluded that: (1) nerve crush causes distal nerve degeneration, loss of the normal fiber type pattern, and extensive collateral ramification of subterminal axons; (2) collateral reinnervation imposes a neuronal influence on muscle fibers which dictates transformation of all muscle fibers innervated by a single subterminal axon to a uniform histochemical profile; and (3) the type grouping observed in normal porcine muscle is not a result of neuronal influence mediated by collateral branching of subterminal axons.


[Histochemical, quantitative and ultrastructural maturation of human fetal muscle].

Histochemical studies of muscle specimens from human fetuses showed: (a) a uniform fiber type population having the properties of Type IIC fibres up to 19 weeks of development; (b) a progressive appearance of Type I fibres after that age; (c) a decrease in number of Type IIC fibres during the last 3 months of pregnancy, accompanied by the appearance of Type IIB and Type IIA fibres; (d) the presence after the myotube stage of fibers with a light peripheral halo in sections stained for mitochondrial dehydrogenases. Electron-microscopic examination of the muscle fibres confirmed the existence of a peripheral halo devoid of myofibrils and mitochondria and showed: (a) scarcity of myofibrils in comparison with mature muscle fibres and (b) irregularity in shape of the myofibrils. In addition, quantitative studies demonstrated an important variation of the fibre diameters up to 21 weeks and the increase of the mean diameter after this age. It is suggested that the persistence after birth of some features of immaturity identical to those described in this work may be considered as a pathological finding.


Allergic contact dermatitis from ultraviolet cured inks. Allergic contact sensitization to acrylates.

Eight men employed in the manufacture of ultraviolet cured inks developed allergic contact dermatitis predominantly on the exposed areas. Patch testing revealed sensitization to trimethylol propane triacrylate in seven employees, to 1,6-hexanediol diacrylate in six employees, to pentaerythritol triacrylatylate in four employees and to epoxy acrylate oligomers in three employees. Either cross-sensitization or concomitant sensitization may have accounted for the multiple reactions in several employees. One sensitized employee was patch tested with four different commercially available epoxy acrylate oligomers and reacted only to two, suggesting that variations possibly in chain length between these oligomers are important variables in the allergic reactions. The polyfunctional acrylic monomers and certain epoxy acrylate oligomers should be handled carefully to avoid the development of allergic contact dermatitis.


The effects of grayanotoxin I and alpha-dihydrograyanotoxin II on guinea-pig myocardium.

We have demonstrated recently that grayanotoxin I (GTX I) produces a positive inotropic effect in isolated guinea-pig atria. In order to determine whether this effect of GTX I is related to the reported action of this compound to increase the sodium permeability of cytoplasmic membranes, the effect of GTX I and alpha-dihydrograyanotoxin II (alpha-2H-GTX II) on electrical and mechanical properties and transmembrane cation movements were studied in guinea-pig myocardium. In electrically driven guinea-pig left atrial preparations, both grayanotoxins produced a slight depolarization and appear to decrease the upstroke velocity of the action potential, with a concomitant increase in isometric contractile force in the presence or absence of propranolol. Pretreatment with propranolol shifted the dose-response curves for the inotropic effect of both grayanotoxins slightly to the right. The magnitudes of changes in the electrical and mechanical properties induced by GTX I and alpha-2H-GTX II were similar. The rate of development and subsequent washout of the positive inotropic effects, however, was faster with alpha-2H-GTX II than with GTX I, consistent with a previous report that the action of alpha-2H-GTX II to increase membrane sodium permeability develops more rapidly than that of GTX I. At higher concentrations, both grayanotoxins produced arrhythmias. Arrhythmias induced by GTX I were characterized by extrasystoles whereas those induced by alpha-2H-GTX II were characterized by initial extrasystoles followed by a failure of the atria to follow electrical stimulation. Positive inotropic and arrhythmic effects of both grayanotoxins were reversible after the washout of the drug. Both types of arrhythmias produced by either GTX I or alpha-2H-GTX II were reversed by tetrodotoxin, an agent which has been demonstrated to antagonize the action of the grayanotoxins to increase membrane sodium permeability. Although both grayanotoxins had no marked effect on partially purified Na+, K+-adenosine triphosphatase, they produced dose-dependent increases in ouabain-sensitive 86Rb uptake of ventricular slices under conditions in which the intracellular sodium concentration determines the rate of active monovalent cation transport by the Na+, K+-adenosine triphosphatase system. These data suggest that the positive inotropic effects of grayanotoxins are due to an increased membrane sodium permeability and are consistent with a hypothesis that alterations in transmembrane sodium movements result in an altered myocardial contractility.


An estimate of the secondary spindle receptor afferent contribution to the stretch reflex in extensor muscles of the decerebrate cat.

1. Vibration or stretch of the medial gastrocnemius muscle in the decerebrate cat each caused a significant increase in the tension of a synergist, the lateral gastrocenmius. 2. Simultaneous vibration and stretch of the medial gastrocnemius resulted in a substantial increase of lateral gastrocnemius tension which was greater that that produced by medial gastrocnemius vibration alone. The size of this force increase was proportional to the amplitude of medial gastrocnemius  stretch, for the limited range of amplitudes examined. 3. Since the discharge of the medial gastrocnemius I a afferent fibres was held constant by vibration, the additional tension in lateral gastrocnemius provoked by medial gastrocnemius stretch must have resulted from the activation of an excitatory pathway separate from the I a afferent system. The secondary spindle afferent pathway was considered to be the most likely candidate. 4. The contributions of the Ia afferents and the additional stretch induced excitation to the stretch reflex were compared. The Ia potency was calculated from the ration of tonic vibration reflex force and the vibration frequency. The total Ia contribution to the stretch reflex, which was estimated from the product of this ratio and the primary ending stretch sensitivity, seemed modest, and was consistently smaller than the proposed secondary contribution. 5. The medial gastrocnemius nerve was subjected to anodal blockade at a strength sufficient to eliminate Ia transmission. Under these conditions, the lateral gastrocnemius excitation produced by medial gastrocnemius stretch or vibration was largely eliminated. When lateral gastrocnemius vibration was superimposed, the excitatory effect of medial gastrocnemius stretch was partly restored suggesting that some central facilitation by group Ia afferents may be necessary for group II pexcitatory effects to be manifested. 6. Although the additional excitatory actions of medial gastrocnemius stretch were examined exclusively in a synergist, it is suggested that similar effects are likely to occur in the homonymous stretch reflex.


Age of onset in Huntington's disease: lack of parental age effect.

In a recent publication Brackenridge and Teltscher (1975) concluded that the age of onset of Huntington's disease was in part a function of the age of the transmitting parent at the time of birth of a subsequently affected child. Their analysis suggested that the younger the parent was at the time of birth of the subsequently affected child, the later in life symptoms of disease would appear in the child. The data of Brackenridge and Teltscher have been statistically reevaluated here, and this analysis fails to support their conclusion. Consequently it would be irresponsible to counsel persons at risk for Huntington's disease to plan families early in life.


Abnormal chromosome 22 and recurrence of trisomy-22 syndrome.

Trisomy-22 was confirmed with both Q- and G-banding in two sibs. Growth and mental retardation plus various dysmorphic features of this syndrome are described and compared with previous reports. Cytogenetic studies reveal a morphologically atypical No. 22 in cells of the phenotypically normal mother (46,XX) and in both affected children. The variant G chromosome is identified as No. 22 by Q- and G-banding and is interpreted as a product of a pericentric inversion on the basis of general length, arm ratio (1.4), and anomalous satellite association frequency. Repeated nondisjunction for No. 22 is considered to have resulted from asynapsis caused by interference of an inversion loop configuration which, though short, comprised a major part of chromosome 22.


Confirmation of trisomy 22 by trypsin-giemsa staining.

A small-for-dates male infant with mental retardation, microcephaly, malformed ears, preauricular sinuses, epicanthal folds, micrognathia, congenital heart diseases, micropenis, and micropolygyria of the parietal and occipital lobes of the cerebral cortex was shown to have a 47,XY,+22 karyotype by trypsin-giemsa banding. Review of reported cases confirms that there may be distinctive trisomy 22 syndrome.


A case of twin chimerism.

A case of twin chimerism is presented and shown by cytogenetic studies, red cell grouping, and white cell HL-A typing. The sex of each twin is confirmed by examination of buccal smears and their chimeric state is confirmed by non-reactivity in the mixed lymphocyte culture system. The results of these investigations are discussed.


A fluorescence polymorphism associated with Down's syndrome?

Fluorescence polymorphism frequencies have been determined for a group of 85 Down's syndrome cases and 164 controls. For one class of polymorphism, that of positive satellites of chromosome 21, the frequency in the Down's cases was significantly higher than in the controls; the distribution of positive satellites in the mongols indicates that in the majority the extra chromosome arose by first meiotic non-disjunction. The possibility that positive satellites on chromosome 21 could be a causative factor in Down's syndrome is discussed, and the implications of this possibility on the assessment of the risk of producing a Down's child are examined.


Cell-mediated immune responses of breast cancer patients to autologous tumor-associated antigens.

Lymphocyte proliferation assays with autologous tumor material in mixed leukocyte-tumor interactions (MLTI) were employed to monitor tumor-associated cell-mediated immune responses of peripheral blood lymphocytes from patients with carcinoma of the breast. In addition, leukocyte migration inhibition (LMI) assays were employed to compare reactivity to autologous breast-tumor extracts versus allogeneic breast-tumor extracts. Positive lymphoproliferative responses to tumor-associated antigens (TAA) were observed in the MLTI assay with the use of either intact autologous tumor cells or crude extracts (in mug and ng quantities) in 12 of 34 (35%) breast cancer patients studied. Positive reactivity to tumor, but not to normal tissue of reactive patients, was observed in repeated assays. Finally, patients demonstrating positive MLTI responses to autologous tumor extracts likewise responded in LMI assays to these same autologus extracts as well as to allogeneic breast-tumor extracts, but not to non-breast-tumor extracts. Thus breast tumors appeared to possess common TAA among both male and female patients.


Immunologic studies in chronic lymphocytic leukemia: defective stimulation of T-cell proliferation in autologous mixed lymphocyte culture.

Peripheral blood leukocytes from untreated patients with chronic lymphocytic leukemia (CLL) and normal age- and sex-matched control individuals were tested for the ability to respond with increased DNA synthesis after mixed lymphocyte culture (MLC) with allogeneic and autologous lymphocyte fractions. We performed these tests using, as responder cells, unfractionated mononuclear cells and T-cell-enriched populations obtained after nylon-wool column filtration. The results showed that nonadherent T-cell-enriched populations from both CLL patients and normal controls responded to allogeneic stimulation and that adherent cell fractions from normal individuals, and often from CLL patients, provided a stronger stimulus in MLC than did nonadherent cells. T-cell-enriched populations from normal individuals showed increased DNA synthesis after autologous mixed lymphocyte culture (AMLC) with adherent cells, but this phenomenon was uniformly lacking when the same experiment was performed with cell populations from CLL patients. This lack of response after AMLC was not due to serum factors or to short-range factors produced by inactivated CLL cells in culture. Possibly AMLC represents a recognition phenomenon between autologous T- and B-cells, and thus it may reflect the interaction of T-helper or suppressor cells and B-lymphocytes. The lack of autorecognition in CLL may reflect the monocional nature of the B-cells in this disease or a defect in helper or suppressor T-cells.


A study on vectorcardiographic criteria for evaluating right ventricular hypertrophy in chronic obstructive pulmonary disease.

Vectorcardiographic analysis was mainly made on the basis of hemodynamic findings through right heart catheterization in COPD. From the results obtained in the present study, the authors proposed the following quantitative VCG criteria as a mean for clinical recognition of right ventricular overload in patients with COPD. (I) Individual parameters of the criteria are: i) The QRS loop; (a) P/A (posterior force/anterior force) greater than or equal to 2.8 (b) R/L (rightward force/leftward force) greater than or equal to 0.6 (c) P/6 (posterior force/leftward force) greater than or equal to 1.8 ii) The P loop; Ap/Pp (anterior force/posterior force) greater than or equal to 1.8 (II) Criteria i) "RVH (right ventricular hypertrophy)" should satisfy more than 3 of the above individual parameters. ii) "RVH suspected" should satisfy 1 or 2 of them. iii) "RVH negative" should not satisfy any of them. The recognition rate for RVH by the present VCG criteria was higher than the conventional ECG criteria and there was good correspondence with autopsy findings.


Vectorcardiographic study on left ventricular hypertrophy in spontaneously hypertensive rats.

To observe cardiac changes in spontaneously hypertensive rats (SHR) functionally, the vectrocardiographic approach was tried, applying the Takayasu lead system to rats. This vectrocardiogram (VCG) was shown to be sufficiently good to detect left ventricular hypertrophy (LVH) in SHR. VCG in SHR showed specific features, some of which were left upward deviation of the maximum QRS vector in the frontal plane, an increased magnitude of the maximum spatial QRS vector, and prolongations of such indices as the QRS duration, time to the maximum spatial QRS vector and QT interval with abnormal ST-T changes. The P wave of SHR in the X scalar electrocardiogram, lower and wider than that of Wistar-Kyoto rats may also be a significant feature of LVH in SHR. The angle of the maximum QRS vector in the horizontal plane was not proven to be a suitable index of LVH in SHR. Most of the histometrical findings were closely correlated to blood pressure. Some of the vectrocardiographic findings were significantly correlated both to blood pressure and to some of the characteristic findings of LVH, such as the weights of the heart and the left ventricle and so forth. This experiment also indicated that LVH in SHR was not limited only to quantitative myocardial hypertrophy. It also seemed to be related to reversible or irreversible qualitative changes of coronary arteries or myocardium, such as myocardial fibrosis. This vectrocardiographic method was shown to be useful in obtaining various information about the cardiovascular system in rats, especially in SHR, and it seemed to be helpful for further understanding hypertensive cardiac diseases in humans.


Transabdominal mucosal transection of the esophagus for the treatment of esophageal varices.

Transabdominal mucosal transection of the esophagus was applied to 20 patients with esophageal varices. The operative procedure involves a longitudinal incision of the muscular layers which follows transection and reanastomosis of the denuded mucosa. With the preservation the muscular structure, postoperative complications such as anastomotic leakage, stenosis or regurgitation, have been minimized. The effect of this procedure on the varices proved satisfactory.


Diagnosis and treatment of pelvic inflammatory disease and gonorrhea in the emergency department.

One hundred emergency department charts on cases of suspected pelvic inflammatory disease (PID) were reviewed to determine method of diagnosis and treatment. Seventy-three gonococcus smears, 60 gonococcus cultures, and 53 VDRL tests for syphilis were done. Of these, 20 smears, 19 cultures, and 1 VDRL were positive. All 100 patients were treated for gonorrhea with either spectinomycin, tetracycline, ampicillin or penicillin. The author concludes there is no need to procure VDRL tests on all patients with suspected gonorrhea, nor do gonococcus cultures on all patients with suspected PID. Also, since only 39% of patients had a positive gonococcus smear or culture, penicillin may not always be the appropriate treatment.


[Diagnosis of cardiomyopathy].

The problems of diagnosis of cardiomyopathies are discussed. Among 13 patients who died in the clinic, a correct diagnosis was made in 10. The observations permit to believe that cardiomyopathy is seen more often in males aged 41 to 55 years. The course of the disease is chronic recurrent, its onset being different in individual cases: rhythm disorders, cardiac pains, recurrent pulmonary infarctions, cerebral circulation disorders. The outcome of the disease consisted, as a rule, in progressive total cardiac insufficiency refractory to therapy. In all the cases cardiomegaly was observed, not so much at the expense of hypertrophy, but rather of dilatation of the cardiac chambers. The anatomic signs included, apart from the cardiac dilatation, moderate hypertrophy with a relative bi- and tricuspid valve insufficiency, also mural thrombi in the heart chambers.


Effects of chronic choleretic infusions of bile acids on the membrane of the bile canaliculus. A biochemical and morphologic study.

To determine whether choleretic infusions of bile acids modified the function or structure of the membrane of the bile canaliculus, sodium taurocholate (NaTc) or dehydrocholate (DHC) was infused into male rats at a rate of 80 mumoles per hour over an 18-hour period. Bile was collected by fistula and phospholipid and cholesterol content was measured in bile, liver homogenates, and isolated liver plasma membranes (LPM) enriched in bile canaliculi. Na+, K+-ATPase, Mg2+-ATPase, 5'-nucleotidase, and alkaline phosphatase activities were also measured in LPM. NaTc infusions enhanced cholesterol and phospholipid output in the bile in association with a significant increase in phospholipid in both LPM and liver homogenate. Although DHC infusions resulted in a comparable excretion of bile acid, phospholipid and cholesterol output in bile did not increase from control values and the concentration of these lipids in LPM and liver homogenate also did not change. However, LPM Na+, K+-ATPase significantly increased after DHC infusions compared to NaTc-infused animals or controls. Neither bile acid altered the activities of Mg2+-ATPase, 5'-nucleotidase, or alkaline phosphatase. Both bile acids increased the diameter of the lumen of the bile canaliculus as assessed by scanning electron microscopy and produced irregularities and outpouchings in the canalicular membrane. Diverticuli and loss of microvilli were most prominent with DHC infusions whereas canalicular side branching and the density of microvilli, either remained unchanged or increased following NaTc infusions. Although the morphologic findings are qualitative, the results of these studies indicate that chronic choleretic infusions of NaTc and DHC have divergent effects, not only on enzyme activities in liver plasma membrane, but on phospholipid composition and 3-dimensional structure. These findings suggest that bile acids may after biliary secretion not only through their osmotic effects, but by modifying lipids and enzymes in the membrane of the bile canaliculus.


[Comparative evaluation of studies of the action of different levels of hypoxia on the human immunobiological status].

The effect of hypoxic hypoxia on the specific factors of immunity of 16 test subjects was studied during their 30-day exposure to an altitude of 2100-4200 m above the sea level in the area of the Elbrus mountain. In order to differentiate the effect of hypoxia per se from that of other factors typical of highlands, five runs of altitude chamber experiments were carried out. In each run the test subjects were 10 times lifted to altitudes of 3200 m, 4200 m and 5200 m. The chamber experiments were performed on 28 test subjects, aged 26-46. During an exposure to an altitude the test subjects did two or three times exercises of 450-900 kgm/min on a bicycle ergometer. The experimental findings show that hypoxic hypoxia brings about consistent changes in the immunobiological status of man that are directly correlated with the level of hypoxia. These changes include a decline in the acquired antiviral and antitoxic immunity activation of the autoimmune process and an increase in the phagocytic activity of neutrophils. Our results suggest optimal profiles of the hypoxic effect to which test subjects should be exposed during mountain training for a specific occupational activity.


Surgical correction of types II and III truncus arteriosus.

In truncus arteriosus types II and III, one or both pulmonary arteries arise independently from either side of the truncus. In the surgical correction of this anomaly, we have utilized on operative technique in which the essential features are as follows: ventricular septal defect (VSD) closure, which directs left ventricular outflow into the truncus: (2) anastomosis of a Dacron tube containing a glutaraldehyde-preserved procine aortic heterograft to the right ventriculotomy: (3) removal of a circumferential band of the truncus containing both pulmonary artery orifices; (4) tailoring of the band of truncus tissue into a generous cuff which is anastomosed to the distal end of the valved Dacron conduit; and (5) restoration of aortic continuity with a tubular Dacron graft. Since 1971, 4 children ages 2 to 9 years have undergone successful correction of truncus arteriosus types II or III by this technique. In one patient with marked pulmonary hypertension and congestive heart failure preoperatively, the pulmonary vascular resistance had reverted to normal by 3 years after the operation. In one patient in whom bronchial collaterals to the right pulmonary artery were present, postoperative left ventricular failure required reoperation for ligation of the collaterals. All 4 patients are asymptomatic and fully active 5 to 60 months postoperatively. None has evidence of stenosis or insufficiency of the heterograft valve.


The behavior of infected arterial prostheses of expanded polytetrafluoroethylene (Gore-Tex).

In 11 dogs the bacteriologic and morphologic reaction of arterial prostheses made of expanded polytetrafluoroethylene (Gore-Tex) to an induced Staphylococcus aureus septicemia at time of graft implantation was evaluated and compared to that observed with Dacron grafts in 10 dogs. Graft infection developed in all dogs, manifested by positive blood and graft cultures. Grafts, however, could be clearly classified as either histologically infected or uninfected with a marked difference in the pattern of positive blood cultures. Histologically uninfected grafts in general demonstrated the tissue ingrowth and neointima formation which characterize Gore-Tex despite positive graft culture. The appearance of overt histologic infection was correlated with failure of a neointima to develop. Gore-Tex did not loose its structural integrity despite frank injection. The use of the Gore-Tex in the face of overt infection cannot be supported.


[Staphylococcal epidermal exfoliation (Ritter's disease)].

According to the authors the best designation of Ritter's disease would be "staphilococcic epidermal exfoliation" SEE. The physiopathological and agnoslogical basis for this denomination could be the following: 1st The "S. aureus" is the ehtiological agent of the SSE in man. The Koch postulates necessary to confirm this hypothesis have been accomplished. 2nd "Staphylococcus aureus" produces a thermostable toxin that is active indepently of the staphilococcus and gives rise to the separation of the cells of the stratum granulosus of the epidermis and eventually exfoliation in suckling babies and in the newborn mouse. 3rd The "Staphylococcus aureus" may be present on the skin or in other localisations such as the bowel or pharinx. 4th The viable "S. aureus" when administered subcutaneously to the adult mice gives rise to lesions clinically and histologically similar to the impetigo observed in children. 5th The "S. aureus" killed by means of autoclave (that is, the staphylococcic toxine by itself does not give rise to any lesion when administered to the healthy adult mouse). Neijther has the SEE been observed in healthy adult man. The authors reach the conclusion that the SSE and the toxic epidermal necrolysis are basically different according to the histopathology therapeutic response and prognosis and they must be considered as independant entities.


[Immunological study of acute forms of acne].

In severe forms of acne (grade IV) there is probably an inmunological alteration consisting of: 1) Alterations in the IgG. 2) They may be produced in small quantity or destroyed more rapidly. 3) Cellular immunity is normal using PHA and diminished with habitual tests. 4) It is necessary to normalize these globulin levels before or during specific medication, with antibiotics or sulfa drugs. 5) Essential aminoacids should be given so as to raise the inmunoglobulins to normal levels. The administration of commercial inmunoglobulins should be avoided, because, for genetic reason, they could produce autoimmunity or isosensibility and diminished the levels one is trying to raise.


[Clinic and therapy of idiopathic hemochromatosis. Report of 51 cases (author's transl)].

Idiopathic hemochromatosis is a genetical defect leading to continuous accumulation of iron. Symptomatology is caused by iron deposition in different organs. Phlebotomy is by far the most efficient therapy. Case reports are given of 51 cases in different stages of the disease, all of which were proved by biopsy. Taking into account data of these cases some aspects of heredity, history and clinical symptomatology of this metabolic disease are discussed; histological and peritoneoscopic findings during the course of the disease under management by phlebotomy are demonstrated. On 46 patients treated in this was 25 were freed of iron deposits and 5 improved. In most cases there was a reduction of collagenous tissue in the liver. In some, and even in far advanced cases, almost complete anatomical and clinical normalization could be reached. Prognosis depends upon early diagnosis and consequent long-term treatment by phlebotomy.


Increased mobility with an articulated lens in gynecologic endoscopic photography.

A new device in endoscopic photography, called an articulated lens, allows a video or movie camera to be separated from the laparoscopic endoscope, thereby removing the camera from the operating field and allowing the laparoscopist improved maneuverability during photographed procedures. By forming a segmented optical link between the telescope and the television or movie camera, the lens allows the two units to be separated by as much as 3 ft and permits the endoscope to move easily in all planes, horizontally, vertically and diagonally. This improved video and cinematographic technique enchances the teaching of surgical procedures and provides the means for keeping permanent records of such procedures.


Surgical "correction" of transposition of the great arteries: a review of 100 consecutive cases.

A review has been made of 100 patients having repair of transposition of the great arteries during a six-year period. The overall hospital mortality was 12%. In uncomplicated cases with an intact ventricular septum it was 7%. Late complications have presented a significant problem and include caval inflow stenosis, pulmonary venous obstruction, dysrhythmias and tricuspid incompetence. The changes in operative techniques to overcome them are discussed.


Preclinical and clinical testing of laparoscopic sterilization techniques.

Testing laparoscopic instruments for sterility should be conducted according to a three-phased program: Phase I: A basic judgment needs to be made by a panel of clinicians familiar with sterilization as to whether or not a new technique is truely different from standard and documented techniques so as to warrant preclinical animal studies. If this is warranted, these studies should include at least 10 test animals with no pregnancies, compared to 10 control animals where a normal pregnancy rate of 70 to 80 percent is documented. Phase II: After theoretical efficacy of a new technique is documented or accepted, the developer of the technique should test it on at least 50 patients for unexpected clinical difficulties or difficulties in maintenance of equipment. Phase III: At least five prototypes of the sterilization device should then be distributed to experienced clinicians for their evaluation on atleast 100 patients each, with a prospective collection of complications and pregnancy rates in a follow-up of at least 90 percent by the end of a 1-year period. Ideally, the number of such patients should be 1000. A judgment can then be made by an appropriate panel as to the relative hazards and benefits of the technique in comparison with standard rates of safety and efficacy.


[Vibravenös in infections of the biliary and respiratory tracts (author's transl)].

The clinical results of a European Vibravenös multicentre trial are reported as far as 227 patients with infections of the biliary tract and 185 patients with infections of the respiratory tract--mainly pneumonia--are concerned. In 203 of the 227 cases with biliary tract infections (=90%) and in 142 of the 185 cases with respiratory tract infections (=77%) the overall clinical result was good or very good. Toleration of Vibravenös was usually very good, only 4 patients had to be withdrawn from the trial because of side effects: in 3 cases an allergic skin reaction or pruritus occurred and in 1 patient local phlebitis developed at the injection site. Bacteriological tests performed on 71 patients showed that after broad usage doxycycline has an excellent antibacterial activity.


[HBs-antigen induced extrahepatic immune-complex disease (author's transl)].

A 62-year old patient was hospitalized with fever, polyarthritis and exanthema. All bacteriological, virological and biochemical findings were normal. The immunological analysis showed initially the HBs-antigen in the serum. No irregular antibody was found. Chemotherapy was failing, but application of corticosteroids was followed by a dramatic improvement. Nine weeks after the onset of the disease the patient was healthy again. Antibodies against HBs-antigen were found 3 months later. The data suggest an immune-complex disease like serum sickness based on an infection with hepatitis-B-virus without involvement of the liver.


Two new laparoscopic instruments: bipolar sterilizing forceps and uterine manipulator.

Two new instruments have been found useful in laparoscopic surgery. One is a bipolar forceps used primarily for sterilization operations performed on the Fallopian tube with which discrete lesions can be made. The bipolar principle avoids electrical trauma at distant sites. The other, an intrauterine manipulator, permits better uterine positioning during the procedure without the need for an assistant. Tubal lavage can also be performed with this instrument.


Use of the Doppler flowmeter in stroke prevention.

The directional Doppler flowmeter can be used to identify collateral patterns of extracanial arterial blood flow that are associated with hemodynamically significant lesions of the internal carotid artery. The use of this non-invasive technique can identify accurately those patients who are candidates for angiographic confirmation.


Instrumentation for laparoscopic tubal sterilization.

The numbers and results of laparoscopic tubal sterilizations performed between 1971 and 1975 show widespread public and professional acceptance of this operation. The need for safe and effective laparoscopic equipment led to the development of three types of sterilization viewing systems: the viewing laparoscope, the operating laparoscope, and the needlescope. A number of operative procedures have been developed. The instruments currently being used for tubal destruction via electrocoagulation and endocoagulation are described. Advances in externally applied mechanical occlusive devices are also mentioned. Experimental work with intraluminal stents is noted. The criteria that must be met to ensure worldwide acceptance of these operations are discussed.


The locomotion laboratory as a clinical assessment system.

As a routine clinical tool the locomotion laboratory has been a long time evolving. This paper reviews the development, successes and failures of locomotion assessment systems. A detailed picture of the state of knowledge of normal gait is presented along with some suggested directions regarding needed technological development as well as some criticism of the lack of biomechanical modelling. As examples of clinical applications, four major gait pathologies are reviewed: amputees, hemiplegia, cerebral palsy and joint replacement. The state of knowledge of each of these patient populations is presented along with a critique of the assessment methods and conclusions. It is hoped that this paper will provoke discussion regarding the real purpose of a clinical locomotion laboratory, and put some perspective on the cost in terms of equipment, space, newly trained or retrained personnnel and computer systems.


[Explorative laparoscopy or laparotomy? (author's transl)].

Explorative laparoscopy is an endoscopic examination of the abdominal cavity which, with the modern endoscopy tables, permits a considerably improved survey than formerly. Within one year, 105 patients were examined and a suspected tumor was confirmed 20 times in 57 patients. Metastases were sought 23 times in patients known to have a primary tumor, and demonstrated 11 times. The differential diagnosis of cholestasis was made 18 times, 6 times a negative cholecystogram required further clarification. Two of these showed an inoperable, infiltrating, growing carcinoma of the gall bladder. For the purpose of classification of lymphogranulomata, laparoscopy shows the advantage over laparotomy of careful magnifying observation of the surface of the liver which can be repeated as often as desired.


[Explorative Laparoscopy or Laparotomy (author's transl)].

Explorative laparoscopy is an endoscopic examination of the abdominal cavity which, with the modern endoscopy tables, permits a considerably improved survey than formerly. Within one year, 105 patients were examined and a suspected tumor was confirmed 20 times in 57 patients. Metastasis were sought 23 times in patients known to have a primary tumor, and demonstrated 11 times. The differential diagnosis of cholestasis was made 18 times, 6 times a negative cholecystogram required further clarification. Two of these showed an inoperable, infiltrating, growing carcinoma of the gall bladder. For the purpose of classification of lymphogranulomata, laparoscopy shows the advantage over laparotomy of careful magnifying observation of the surface of the liver which can be repeated as often as desired.


Mechanism of inhibition of catecholamine release from adrenal medulla by diphenylhydantoin and by low concentration of ouabain (10(-10) M).

Catecholamine (CA) release was studied in rat adrenal incubated in vitro. Inhibition of (Na + K)-ATPase either by omission of K+ from the incubation medium or by addition of a high concentration of ouabain (10(-3) M) caused increased release of CA from the adrenal. Diphenylhydantoin (DPH) (10(-5) M) inhibited the spontaneous as well as the acetylcholine (10(-4) M)-induced release of CA. However, in K+-free medium or in the presence of 10(-3) M ouabain, DPH had no significant effect on CA release. A low concentration of ouabain (10(-10) M) caused a significant inhibition of spontaneous and of acetylcholine-induced release of CA. In a K+-free medium ouabain (10(-10) M) had no effect on CA release. DPH (10(-5) M) and a low concentration of ouabain (10(-10) M) caused a significant activation of (Na + K)-ATPase in a membrane fraction of the adrenal medulla. It is suggested that DPH and low ouabain concentrations inhibit CA release from the adrenal by activation of the sodium pump. The possible mechanism involved is discussed.


Studies on the anti-dyskinesia effect of apomorphine in man.

In man, central dopamine (DA) is thought to underlie the production of choreoathetotic movements (CAM) that occur in a variety of neurological disorders. We have reported that apomorphine (APOM), a direct DA receptor stimulant, attenuates CAM in man. To investigate the mechanism by which APOM diminishes dyskinesia, we administered levodopa (4.5-6 gm/day, up to 10 munths duration) and subsequently haloperidol, up to tolerated doses, to a group of patients afflicted with CAM of various etiologies in whom we first had observed lessening in CAM with injected APOM. Levodopa produced no consistent change in CAM and haloperidol effectively reduced the CAM in all patients. The effect of APOM, then, upon the dyskinesia in these patients, paralleled that of haloperdol, a strong DA receptor blocking agent. Cholinergic agents can attenuate CAM in man and it has been suggested that the anti-CAM effect of APOM is a cholinergic one, medicated through its tetrahydroisoquinoline or its piperidine monties. We administered physostigmine i.v. (1.0-2.0 mg) to six patients in whom APOM had been shown to antagonize their CAM. In only one case a moderate reduction in CAM was noted. It is concluded that the anti-dyskinetic effect of APOM is mediated by an anti-DA effect, which may result from direct stimulation of presynaptic DA receptors, which has been shown to reduce the impulse flow and release of DA from nerve endings of dopaminergic neurons or perhaps from the accumulation of an antidopaminergic metabolite on DA receptors.


Gastroschisis: case report and comment.

A case of a premature infant born with gastroschisis, a congenital defect in the abdominal wall is described.


Working with parents of handicapped children: the role of the medical profession.

The experiences of 94 Canterbury families with young handicapped children are reported as these impinge on the medical and nursing professions. Some suggestions for the improvement of medical counseling services are made in the light of the findings and the literature.


Laparoscopy and hysterosalpingography in the assessment of tubal patency.

Laparoscopy was performed after hysterosalpingography in 409 patients complaining of infertility. Despite the use of general anesthesia and continuous screening technics during hysterosalpingography, conflicting diagnoses were made in 77 of the 117 patients where an abnormality of patency was detected by one or another technic. Peritubal adhesions were detected by hysterosalpingography in only 18 of the 54 cases where they were demonstrated by laparoscopy. Laparoscopy gave much useful information either at variance with or in addition to that yielded by hysterosalpingography.


The effect of ouabain and ethacrynic acid on ATPase activities in the inner ear of the rat and guinea pig.

The effect of ethacrynic acid on ATPase activities in the stria vascularis of rat and guinea pig inner ear was studied. Both Na-K- and Mg-activated ATPase activities were inhibited non-selectively only at very high concentrations of ethacrynic acid, in contrast to the selective inhibition of Na-K-ATPase activity by ouabain. It is suggested that the deleterious effect of ethacrynic acid on the inner ear may be due to its effect on the general metabolism of the cell rather than on the ionic transport system.


Palmar crease variants and their clinical significance: a study of newborns at risk.

An analysis of palmar crease variants was carried out in a group of "at risk" newborns, without any evident congenital anomalies. This group consisted of 108 prematures, 74 infants who were small for gestational age, 62 newborns with history of gestational complications, and 46 newborns with a history of intrauterine methadone exposure. A system of classification was developed based on observations of 500 normal newborns as control subjects, 466 normal mothers, and 200 normal children. The palmar crease variants can be divided into four main groups, schematically presented as normal variants, simian crease and its variants, Sydney line and its variants, and another group of unusual variants which do not fit into the other groups. A study of these groups revealed that familial components, race, sex, and age are factors that can influence the expression of palmar crease patterns. There is an increased frequency of abnormal creases in each of the groups of "at risk" newborns. Moreover, there is an apparent association of interrupted transrerse creases and intrauterine methadone exposure.


Experimental lead poisoning and intestinal transport of glucose, amino acids, and sodium.

Juvenile rats fed a diet containing 1% lead acetate for 7 weeks, in addition to an impaired growth rate and renal function derangements, suffered malabsorption of glucose and certain amino acids, as assessed by an in vivo perfusion technique. The reduction in glucose absorption ranged between 10% and 31% when the carbohydrate was pumped in concentrations of 2-80 mM. This alteration was compatible with a noncompetitive type of transport inhibition. The intestinal absorption of glycine, lysine, and phenylalanine were, respectively, decreased 22, 18, and 15% when these amino acids were present at 1 mM levels. Sodium transport was severely reduced (57.6 +/- 17.9 (SEM) vs. 124.2 +/- 17.4 muEq/min-cm) and intestinal mucosa (Na+-K+)-ATPase was concomitantly lower in the lead-intoxicated rats (186.4 +/- 19.0 vs 268.4 +/- 29.8 nmol P/min-mg protein). However, this enzyme was not altered in liver and kidney. Furthermore, intestinal mucosa fructose-1,6-diphosphatase, succinic dehydrogenase, pyruvate kinase, and tryptophan hydroxylase were not different in experimental and control animals. These studies substantiate the presence of functional and biochemical abnormalities in the intestinal mucosa of young rats when fed substantial amounts of a soluble lead salt. It is, therefore, reasonable to accept the possibility that physiologic damage occurs in tissues directly subjected to high and persistent levels of a toxic agents, as it occurs in other organs, underscoring the parallelism between transport mechanisms at the renal and intestinal levels.


[Susceptibility of laboratory animals to Trichinella from synanthropic and natural foci of the northern Caucasus].

Laboratory animals were infected with larvae of four species of Trichinella. The tests have whown that T. pseudospiralis is highly infectious for golden hamsters and guinea pigs. Rats are relatively resistant to T. pseudospiralis but highly susceptible to T. spiralis. T. nelsoni turned out to be little infectious to rodents which were used in the experiment. T. nativa is little infectious for rats but more infectious for golden hamsters and guinea pigs as compared to T. nelsoni.


[Morphological characteristics and certain biological problems of the representatives of the genus Apiosoma (Infusoria, Peritricha) from the young of predatory fishes].

13 species of Apiosoma were recorded from the young of Esox lucius, Lota lota and Perca fluviatilis. 7 species were reported from Lota lota, 9 species-from Esox lucius and 6 species--from Perca fluviatilis. Apiosomes were found mainly on the body surface and fins of fishes and move seldom on their gills. Under changing conditions the transition of parasites from one organ to another is possible. Great morphological variability of Apiosoma is reflected in variability of shape and size of the body and mutual arrangement of micro--and macronucleus. The solution of the variability problem is necessary for the classification of the genus Apiosoma. A new species, Apiosoma lotae, and subspecies, Apiosoma piscicola percae, are described.


Transient tricuspid insufficiency of the newborn: a form of myocardial dysfunction in stressed newborns.

Fourteen term newborn infants have been recognized as having transient tricuspid insufficiency associated with significant perinatal stress. Five of these infants underwent cardiac catheterization for presumed congenital heart disease, but had only massive tricuspid valve insufficiency. The other nine infants were diagnosed on the basis of a murmur characteristic of tricuspid valve insufficiency and on other clinical grounds. All had a history of significant perinatal stress in the form of asphyxia with or without hypoglycemia. Frequently, congestive heart failure, persistent cyanosis, and ECG evidence of myocardial ischemia were present. Twelve of the 14 survived, and in each of them all cardiac signs and symptoms, including the murmur, spontaneously resolved. The two patients who died had histopathologic evidence of necrosis in the anterior papillary muscle of the tricuspid valve. The constant features of perinatal stress, ST-T wave abnormalities on the ECG, and spontaneous resolution of the transient tricuspid insufficiency strongly suggest that this syndrome is secondary to a reversible form of myocardial dysfunction, perhaps by affecting papillary muscle specifically. We believe that hypoxia with or without hypoglycemia precipitates the events leading to this clinical syndrome which is distinguishable from other cardiac abnormalities in the newborn by the history, distinctive murmur, and the ECG abnormalities.


Establishing a normal peer as a behavioral model for developmentally delayed toddlers.

The present investigation demonstrated a systematic teaching procedure for establishing a normal toddler as a peer-model for three children showing delayed development, each one under 27 mo. of age. For each delayed subject, training consisted of adult-directed prompting and social reinforcement contingent upon the delayed children's imitations of material use and motor responses emitted by a normal peer. Within-subjects multiple-baseline designs across responses were used to demonstrate intrasubject control over imitative responding. Indices of stimulus and response generalization were assessed through having the peer-model present the trained responses along with untrained responses in a situation free of adult prompting and social reinforcement for imitative responding. Results indicated that the training in peer-imitation was successful for establishing the peer-model's behavior in a stimulus control relationship with the imitative responding of the delayed children. Moreover, the findings generally demonstrated transfer of training across stimulus situations and responses. Implications for educational programming with developmentally delayed children are discussed.


Newer antibiotics: guidelines for use.

The number of antimicrobial agents available for use has increased significantly since the introduction of penicillin in the mid 1940s. Consequently, choosing among them has become an increasingly complex problem. In selecting an antibiotic, careful consideration must be given to the status of the patient and to the organism isolated. In addition, the physician must have detailed knowledge about the specific characteristics of each agent and must apply basic guidelines of antimicrobial therapy in order to make a rational choice.


Effects of alpha methyltyrosine and parachlorophenylalanine on open field behavior in rats given tranylcypromine stereoisomers and lithium carbonate.

Parachlorophenylalanine (PCPA) and alpha methyltyrosine (AMT) were used to study the roles of serotonin and catecholamines in hyperactivity produced by the stereoisomers of Tranylcypromine (d-Tc and 1-Tc) in male Wistar rats fed a normal diet (control groups) or a diet containing lithium carbonate (lithium groups). Components of locomotor activity were measured in an open field. Lithium decreased ambulation. d-Tc increased ambulation and caused jerky side-to-side movements. PCPA and AMT prevented the effects of d-Tc on ambulation while only PCPA prevented the effects of d-Tc on movement. 1-Tc increased ambulation. The effects of 1-Tc on ambulation were potentiated by PCPA and prevented by AMT. Rearing was increased by 1-Tc and d-Tc in rats given lithium. PCPA and AMT prevented the effects of 1-Tc and d-Tc on rearing in lithium groups. The findings suggest that the roles of serotoninergic and catecholaminergic mechanisms differ for components of open field behavior in control  rats and rats given lithium.


Biochemical actions of sympathomimetic drugs which overcome cycloheximide-induced amnesia.

Earlier investigations of sympathomimetic drugs overcoming the amnesic action of cycloheximide (CXM) in day-old chickens were extended to biochemical studies in vitro. The effects of amphetamine, norepinephrine, alpha and beta noradrenergic stimulants and receptor blockers on Na+/K+ ATP'ase activity in total homogenate of chicken forebrain were investigated. Norepinephrine and the beta stimulant, isoprenaline significantly stimulated the activity of this enzyme, while the beta blocker, propranolol inhibited activity. Amphetamine, the alpha stimulant, methoxamine and the alpha receptor blocker, piperoxane had no effect  on Na/K+ ATP'ase activity in total homogenate. In a purified synaptosomal preparation, both amphetamine (5 X 10(-5) M) and norepinephrine (1 X 10(-4) M) produced a slight stimulation of Na+/K+ ATP'ase activity. A similar concentration of amphetamine (1.12 X 10(-4) M) did not inhibit 14C-leucine uptake or incorporation into protein in the synaptosomal fraction. Nor was it able to alleviate CXM inhibition of 14C-leucine incorporation into synaptosomal protein. The results are interpreted in terms of amphetamine (via release of norepinephrine) norepinephrine and isoprenaline stimulating and maintaining the labile, sodium pump-dependent, phase of memory formation for a sufficient length of time until protein synthesis inhibition by CXM wears off.


Effects of bumetanide on sodium transport of the isolated frog skin and on renal Na-K-ATPase.

The effects of bumetanide, a new potent diuretic, on net sodium transport of the isolated frog skin and on rat renal Na-K-ATPase were studied. A dose-related decrease in short-circuit current and potential difference with increased electrical resistance was observed when bumetanide was added to the corial side of the skin. Addition to the epithelial side resulted in enhanced net sodium transport with decreased electrical resistance. When applied to the corial side it abolished vasopressin- and aldosterone-stimulated transport. Present in the epithelial bath ouabain-inhibited transport was unaffected by this drug, while triamterene-induced inhibition of sodium transport was completely abolished. In vitro, no significant effects on Na-K-ATPase were noted. It is concluded that bumetanide shares properties of both furosemide and ethacrynic acid and excerts its effects on epithelial sodium transport by altering membrane permeability and possibly by inhibition of some step in the active transport mechanism for sodium.


Biological ion exchanger resins. X. The cytotonus hypothesis: biological contractility and the total regulation of cellular physiology through quantitative control of cell water.

Actin-like (A-L) fraction from normal E. coli was compared with the protein from a potassium-transport mutant strain, and the cell-swelling reaction of both strains was studied. Findings were: (a) The membrane fraction of the mutant by SDS electrophoresis is deficient in the A-L fragment relative to normal whereas the soluble supernatant contains an excess. (b) Important catalytic differences exist between the A-L fractions of the two strains. The parent strain accumulates potassium in low K+ and the A-L fraction polymerizes in low K+. But the A-L fraction from the mutant fails to polymerize in low K media in the K+ concentration region where the mutant fails at K+ uptake. (c) The parent cell swells during low K+ uptake whereas the mutant does not. It is constructed from this that the differences in the characterization of A-L fraction relative to normal are related to the loss of cell-swelling in the mutant and hence to the loss in alkali cation selectivity. Thus two physical mechanisms, one macroscopic and dependent on the Gregor relation for swelling equilibria in ion exchange resins, and one more microscopic based on the dielectric dependence of the coulomb force between ion pairs, could underly regulation of ion selectivity by cell swelling. A similar proposal is made for the regulation of electron transport and oxidative phosphorylation in mitochondria. These findings and interpretations justify a new hypothesis to the effect that cell hydration is regulated by contractile proteins. The hypothesis fits together important observations hitherto unexplained, to wit: (1) The "missing link" as to the role of intermediate metabolism in biological ion exchange. (2) The swelling of bacterial protoplasts and its relation to (Mg2 + Ca2+)ATPase activity. (3) The swelling-contraction cycles of mitochondria and their role in electron transport. (4) The role of ATPase's in transport. (5) The significance of actomyosin fibers in nerve endings. (6) The significance of altered actomyosin structures in the cancerous cell.


[Ways of biosynthesis of dehydroepiandrosterone sulfate in the virilizing tumors of human adrenal glands].

A study was made of the ways of transformation of pregnenolone into sulfated androgens in the virilizing tumours of the human adrenal glands. Formation of sulfates of pregnenolone, 17alpha-on-pregnenolone, dehydroepiandrosterone, delta5-androsten-3beta, 17beta-diol, and testosterone was revealed in the tissue of the adrenal gland tumours. The principal sulfate forming in the tumour tissue was dehydroepiandrosterone-sulfate (DEAS). Analysis of the time changes of the pregnenolone label in the sulfates under study and in the corresponding free compounds showed that DEAS formed chiefly through the free dehydroepiandrosterone. Formation of sulfates of 17alpha-on-pregnenolone, delta5-androsten-3beta, 17beta-diol, testosterone coursed along the route of the both sulfated and free precursors.


Histophysiological studies of prostaglandin F2alpha on isolated organs. I. Effect of prostaglandin F2alpha on the heart.

The physiological and histochemical effects of PGF2alpha on isolated rabbit hearts were examined. The results showed a positive inotropic effect. The coronary flow increased. From the histochemical studies, adenosine triphosphatase (ATP-ase) and succinic dehydrogenase activities were increased while that of alkaline phosphatase was decreased. Glycogen granules were depleted. These findings were discussed on a histophysiological basis.


[Clinico-epidemiological statistical analysis and surgical considerations in Hodgkin's disease].

Following a discussion on the new acquisitions in the field of medicine and surgery concerning the malignant lymphogranuloma, the authors present a clinico-epidemiological study of 228 patients. Thus a series of known elements are confirmed, while others are infirmated by statistical data presented. More ample discussions are necessary to be carried out on this basis, concerning the real benefit of surgical possibilities when aplied in the treatment of this disease.


[Orthopedic treatment of Scheuermann's juvenile kyphosis].

The authors establish some indications, depending on several criteria, of the treatment of cases of juvenile kyphosis of the Scheuermann type. These are based on their experience acquired in the therapy of 26 cases of juvenile kyphosis in which orthopaedic procedures have been applied -- plaster cast for recovery in two stages, followed by an orthopaedic corset and careful follow-up for at least one year after the end of the treatment. The criteria suggested as being important are: the severity of the kyphosis, the mobility of the spine, the severity of the kyphosis, the mobility of the spine, the severity of the vertebral structural lesions and the bone age. In cases of kyphosis under 40 degrees with a mobile spine, with minimal radiological lesions, detected before the end of growth, kinesitherapy is indicated and repeated clinico-radiological follow-up. The progression of the kyphosis under treatment or the existance of important vertebral structural lesions make necessary the performance of an orthopaedic treatment, the same as the severe cases of kyphosis, over 40 degrees, with median or severe vertebral lesions.


[Surgical reoperation after vagotomy].

In 39 cases of re-interventions carried out after vagotomy (of which 31 were patients hospitalized in the Clinic and represent 8,6% of the total 358 vagotomies performed), the experience, the viewpoints and the recommendations of the authors are presented. Early re-interventions were necessayr because of complications which are common to abdominal surgery and only in a much lower degree to accidents that can be attributed to vagotomy or the associated intervention. Late re-interventions (26 cases) were necessary in 20 cases for ulcer recidives (13 for vagotomies performed in the Clinic and 7 for vagotomies performed in other units) while late-re-interventions for dumping syndrome, cholelythiasis, etc. represented only isolated cases in these statistics.


[Therapeutic management of neoplastic occlusions of the colon].

The authors present their experience in 39 cases of occlusions occuring in a number of 142 neoplasies of the colon hospitalized between 1965 and 1973. The major attention was given to the treatment of the occluding complication. In cases where the occlusions are due to neoplasies of the right colon, right hemicolectomy should be carriet out in preference, while in cases with neoplastic occlusions of the left colon the attitude will be differentiated. The authors are not partisans of the emergency left hemicolectomy.


[Pyoroplasty with "cruciform" incision of the pylorus].

In cases when the pylorus area is significantly modified by the presence of the ulcerative lesions, frequently associated with hypertrophy of the pyloric sphincter, which does not allow to carry out in satisfactory conditions pyloroplasty of the Heinecke-Mikulicz type, the author introduces an improvement of the above mentioned technique by adding anterior sphincterectomy, obtained by a "cross like" incision of the pylorus. The final suture of the pyloroplasty is exclusively of the transversal type, in a single or in a double layer, when the lumina of the pylorus allows for such a suture.


[Surgical management of post-caustic prepyloric stenosis. The Y-V intravascular segmental antrectomy (considerations on 71 cases)].

The author presents 71 cases of gastric stenoses following caustic lesions, of which 20 were located in the stomach and 51 also involved the oesophagus (oesophagian stenosis). In cases with limited antrum stenoses the author performed antrectomy and gastro-duodenal anastomosis. In the pre-pylorus stenoses, when these were located at 3--5 cm from the pylorus the author recommends the conservation of the denevated pylorus by double pylorotomy and anastomosis with the entire gastric section. He describes a personal procedure which he calls: The Y--V intravascular segmental antrectomy". In cases with extensive gastric stenoses (over 75% of the area), as well as in evolutive corrosion lesions the author recommends Y-jejunostomy, of the Maydl type.


[Operated esophageal atresia of late diagnosis, with postoperative survival].

The authors present two cases of oesophageal atresia with oeso-tracheal communication that, although they have been diagnosed in the 2-nd and the 4-th day of life, have been operated successfully. Both children, investigated at the age of one and one and a half years respectively, are in perfect health.


[General anesthesia in endoscopic examination of the digestive tract].

The authors made an analysis of 165 general anesthesias applied in the digestive fibroendoscopy and they establish the technology and the indications of this method, as follows: 1) uncooperative patient (in this category should be included children, psychopaths, mentally deficient subjects and a certain category of neurotics); 2) when difficult endofibroscopies are to be expected, during which therapeutic procedures are highly probable, such as resection of polyps, coagulation of bleeding surfaces etc.; 3) lack of tolerance to local anesthetics; 4) optimal instruction conditions should be provided for the beginner anesthesist; 5) the authors recommend that all such anesthesies should be carried out in hospital only. They also suggest as the most reliable technique the intra-venous general anesthesia and the oro-tracheal intubation of the patient.


[Therapeutic considerations on a case of post-transfusion intravascular hemolysis].

A case is presented of intravascular hemolysis following incompatible transfusion of 500 ml hetero-group blood in a patient aged 29 years that had undergone emergency surgery for intra-abdominal hemorrhagic syndrome. Stress is laid on volemic therapy, on osmotic treatment and on the administration of alkalines in the first hours following the accident.


[Total uretero-ileoplasty for extensive stenosis of the ureter, unresolved by pyeloplasty and ureterocalycostomy].

A case is discussed, of extensive ureteral stenosis that could not be solved by uveal intubation, neither by two ureterocalycostomies, in which total ureteroileoplasty gave immediately good results.


[Unusual aspects of colo-esophagoplasty in post-caustic esophageal stenosis].

The author presents 7 cases illustrating various particular aspects of coloesophagoplasty performed in cases of post-caustic esophageal stenoses. In pharyngolaryngeal stenoses the author recommends a personal technical variant of the oro-pharyngeal anastomosis. In one such case he performed a double pharyngocolic anastomosis in "Y". In two cases the author has successfully carried out retro-sternal transposition "of necessity", at 6 months and 4 years after coloesophagoplasty in the pre-thoracic variant. Intra-thoracic strangulation of the colic tube, occuring in two cases at 1 and 3 years respectively following initial surgery was resolved by colectomy of the intra-vascular type ("of verticalization").


[Recurrent renal lithiasis].

The author discusses, on the basis of 457 cases of recidivating renal lithiasis (representing 16% of the total number lithiasis cases hospitalized over a period of 28 years in the "Panduri" Hospital of Bucharest), the problem of false recidives, the causes that lead to recidive, the chemical composition of the stones, evolution aspects and therapeutical indications.


[Changes in the iridic circulation during shock treated with phenoxybenzamine (experimental and clinical)].

Irian circulation was studied in the course of shock and following injection of phenoxybenzamine. It is concluded that the drug induces an improvement of the irian vasculature, an increase in the number of open vessels and an increase in their diameter.


[Massive hemorrhage during major orthopedic surgery. Metabolic consequences].

Orthopaedic operations such as procedures for spinal deformity or operation for septic or loose total hip prosthesis are often associated with massive haemorrhage. Electrolyte analysis in 44 cases showed a low level of potassium. Rapid transfusion with stored blood appeared to have little effect on cardiac efficiency unless dilute calcium chloride was added. Alkaline preparations were used in patients with circulatory deficiency. Abnormalities of blood clotting were prevented by the use of fresh blood. Hypothermia and pulmonary complications also occurred and were eventually prevented by the use of assisted ventilation during the post-operative period.


[Nailing according to Ender. Biomechanical study and results of 120 cases].

The authors have conducted a clinical and biomechanical study of blind nailing of trochanteric fractures by the Ender's technique. The nail is introduced through the medial femoral condyle. The study was based on 120 operations. From the biomechanical standpoint, the authors studied the forces exerted in the medullary canal of the femoral shaft and the grip of the nail in the head and neck of the femur. In most of the cases the technique allowed immediate walking with weight-bearing. The results are compared with those obtained after nail-plate fixation. They were superior on three counts--less infection, less breakage of inserted material and less non-union, but the technique produced more mal-union. For this reason, the authors consider it to be an excellent technique but to be reserved for older patients.


[Nailing according to Ender in metastatic femur fractures. 13 cases].

Thirteen metastatic fractures and metastasis of upper extremity of the femur have been treated by Enders' blind nailing in the Orthopaedic Surgery Department of Strasbourg University Hospital. Either very bad general status or major bone destructions made any other surgical care impossible. The author's purpose of relieving of pain and easy nursing was always obtained and some patients were able to walk after radiotherapy.


[Fibula aplasia and associated malformations. 62 cases].

The authors have studied 62 cases of aplasia of hypoplasia of the fibula. They note that developmental abnormalities affect the whole of the lower limb. They describe the evolution of the bony deformities and of anomalies of the soft tissues. They conclude that discrepancy in limb length is the major factor in the prognosis and that it increases uniformally. Surgery is indicated even when a definitive prosthesis is planned. The possibility of leg lengthening must be approached with caution.


[The working place of the disabled as a social, ergonomic and safety problem (author's transl)].

Considering the disabled's role from the societal point of view and the necessity to re-integrate him to the fullest possible extent into the working process, the author raises the question in how far the (see article) 90/91 of the Works Constitution Act is also relevant for this group of employees. The results of these considerations is the initiation of a work science focusing on the disabled, or the resolute application of work scientific findings to the disability sector. Some ergonomic and safety related considerations strengthen the claim for social integration of the disabled. They should be included - together with a number of systematic job analyses in part already carried out by the author of this article - in the training programmes of job analysists for industrial firms.


Observation on the remarkable stability of transmissible mink encephalopathy virus.

Transmissible mink encephalopathy (TME) virus retained biological activity after prolonged storage in formalin (about three and a half years) and in paraffin tissue blocks used for histologic preparations (about six and a half years). Thus, TME tissues in formalin and in paraffin blocks should be handled as contaminated materials.


[Contribution of the microbiology laboratory to renal and urinary studies. Bacteriological examination of urine].

A. General considerations: 1. Microbiological condition of the normal urine and urinary tract; 2. Infections of the urinary tract. B. Possibilities of the laboratory of microbiology in renourinary investigations: 1. Detection and significance of pathogenic microorganisms in the urine; 2. Quantitative uroculture: a. The significance of urocultures in asymptomatic bacteriuria; b. The significance of bacteriuria in clinical diseases of the urinary tract. 3. Other diagnostic possibilities in urinary tract infections. 4. Possible microbiologic localization in urinary infections. a. Washing the urinary bladder; b. Urethral catheterism; c. Evidence of bacteria-antibody complexes in the urine; d. Bacteriologic localization pattern in bacterial urethritis and prostatitis. 5. Testing against antibiotics. C. Bacteriologic examination of the urine: 1. Collecting the urine for bacteriologic examination: a. Collecting from the middle jet: I) from women II) from men III) from imobilized patients IV) from children b. Collection by suprapubic puncture 2. Screening methods and tests 3. Methodology and diagnostic tests in urinary tract  infections. a. Cultures; b. Follow up of the results. c. Reporting the results.


[Current aspects of infectious mononucleosis].

The authors discuss present aspects in infectious mononucleosis, with reference to the cases admitted to the Clinic of communicable Diseases of Cluj-Napoca, i.e. 115 cases during the 1954--1973 period (3 to 13 cases a year). In most cases the clinical symptomatology was mild and the laboratory tests typical not giving rise to any diagnostic difficulties. However, 28 cases (25%) presented jaundice, with positive hepatic tests, so that a differential diagnosis was established with viral hepatitis. In 9 cases nervous manifestations were reported: 4 encephalitis, 1 neuritis of the hypoglossal nerve, 2 facial paralysis, 2 benign serous meningitis cases, all of which fully recovered. The Paul Bunnel-Hăngănuţiu test was positive in titers of 1 : 40 -- 1 : 1280, in all the cases. Corticotherapy was applied with good results in 24 cases. All the cases ran a favourable course. On admission, 45% of the patients came with a diagnosis of infectious mononucleosis; the others were admitted with a diagnosis of : diphteric angina, viral hepatitis, influenza, German measles, mups, typhoid fever, prolonged febrile syndrome.


[Comparative evaluation of risk factors in acute generalized tetanus].

The investigations included a group of 26 patients with acute generalized tetanus, cared for in the Clinic according to a unitary method. A number of 17 prognostic, clinical and laboratory criteria were analyzed from the viewpoint of the pathogenic and clinicoevolutive incidence and significance. According to the severity, lethal course of the disease the following sequence was established in order of gravity: serum sickness, kypokaliemia, hyperpyruvicemia greater than an incubation of less 6 days, invasion within less than 24 hours, hyperlactacidemia greater than age over 60 years, persistent hypertension and tachycardia, hyperazoltemia, hyperglycemia, frequent paroxysmal contractions (before sedation) greater than late admission to hospital, associated cardiopulmonary pathology, hyponatriemia insufficient dressing of the wound and rural environment. The importance of the biological indices is emphasized, both as elements of prognosis and as orientative criteria for the treatment of the case.


[Dynamics of the immune response in a familial focus of toxoplasmosis].

Immunoepidemiological investigations were carried out in a family in which a child with congenital toxoplasmosis was born in 1972. The following were determined: total fluorescent antibodies and their G and M fractions and G and M serum immunoglobulins. The results showed: --the existence of a familial focus if infection with T. gondii, the risk of infection in the course of pregnancy and its consequences on the product of conception; --the normal evolution of the following pregnancy in the presence of anti-T. gondii fluorescent antibodies and the birth of a normal child; --value of the indirect immunofluorescence test for the diagnosis of congenital toxoplasmosis and of the longitudinal immunologic investigation; --determination of the antibody M fraction and serum immunoglobulins did not prove as useful as expected; --persistance of fluorescent antibodies in significant titers over a long period in the absence of a clinical symptomatology or with clinical manifestations of another etiology might lead to a false diagnosis of toxoplasmosis -- hence the necessity of a test for differentiating the carrier of specific antibodies from the toxoplasmosis patient.


[Typhoid bacilli resistant to chloramphenicol and multiresistant to antibiotics isolated at the beginning of 1971].

The sensitivity of chloramphenicol (C) of 286 S. typhi strains, isolated during the last 15 years in Moldavia, was tested. The minimum inhibitory concentration (MIC) of C with regard to most of the strains ranged between 1.5 and 3 mcg/ml. The following stains were identified: strain W isolated from the feces of a carrier in 1971, with a ACKSSuT-Cl2Hg resistance spectrum transferable to E. coli K12(MIC of C less than or equal to 200 mcg/ml), 2 strains (phage type A and C1, isolated from patients, one from the feces in 1972 and the other haemoculture in 1973) with a non-transferable CSu resistance spectrum (MIC of C less than or equal to 6 and less than or equal 12 mcg/ml respectively), and 18 strains (13 phage type D9, 3 phage type Ci and 2 phage type A), isolated from 3 epidemic foci, which proved to contain variants selectable in vitro by C (MIC up to 50 mcg/ml). The resistance spectrum of the variants was not CSU transferable. Conclusions are drawn concerning the necessity of a restricted utilization of chloramphenicol.