[External cephalic version in the management of breech presentation near to term (author's transl)].

External cephalic version was tried in 58 from 146 cases of breech presentation after the 36th week of gestation and was successful in 55 per cent. The incidence of breech delivery was reduced from 5.3 to 4.2 per cent. With increasing weeks of gestation there was no rise in the failure rate. External version was more successful in multiparas than in primigravidas and in patients with high or low weight than in patients with normal weight and a thick muscular abdominal wall. The most frequent causes of failed versions were a thick muscular abdominal wall, extended legs and an already fixed breech in the pelvic inlet. 76 per cent of the deliveries took place within 10 days after the attempt of version. The weight of the newborns was except one over 2500 g, the average weight after successful version was 3250 g and after failed version 2930 g. Different severe fetal complications were seen after failed version but none when the attempt had been successful. On account of our own examinations and a critical analysis of the literature we came to the result that external cephalic version near to term should only be done after careful taken indication with a very precautioned technique, a thorough obstetrical examination, hospitalization and delivery shortly after.


[Medico-genetic study of the population of Uzbekistan. III. Phenotypical assortativity as a factor in population structure (using palmoplantar hyperkeratosis and vitiligo as examples)].

The article comprises the examples of homophenogamic marriages between persons with a rare hereditary dominant character, hand-palm and foot-sole hyperkeratosis, leading to the increase of inbreeding intensity in the population. On the contrary, homophenogamic marriages between persons with vitiligo, a considerably more widespread character, lead to the decrease of the degree of inbreeding in a population, since they take place between partners coming from different districts of the region.


[Medico-genetic study of the population of Uzbekistan. IV. Medico-genetic description of the population of 4 villages of the Urgut district of the Samarkand region].

The data about the incidence of hereditary diseases and those with genetic predispositions which received after subtotal medico-genetical examination of the inhabitants of 4 villages in the Urgut district of the Samarkand province are presented. 848 inhabitants (348 adults and 464 children aged 7--16 years) are examined. The nosological profile of the morbidity and spectrum of the Mendelian diseases in the population is evaluated. The integrative estimate of load of the detrimental (non-lethal) genes is about 0.166 per individual.


A developmental assessment chart for non-institutionalized Down syndrome children.

This prospective study was undertaken to present a test form utilizing the same test items as the Denver Developmental Screening Test in categories of personal-social, fine motor-adaptive, language, and gross motor attainment comparing the performance of an individual Down Syndrome child with that of similar children on whom the items were standardized. A developmental assessment chart was constructed based on 96 consecutive home-reared Down syndrome children (2 months to 8 years). This chart can be easily administered and the developmental status of a particular Down syndrome child evaluated.


Immune status in Crohn's disease. 2. Originally unimpaired primary cell mediated immunity in vitro.

One-way mixed lymphocyte cultures (MLC) were performed with peripheral blood lymphocytes of 21 patients with Crohn's disease (CD) not receiving salizylazosulphapyridine, steroids or azathioprine, seven patients with inflammatory bowel disease other than CD and ulcerative colitis, and 46 age- and sex-matched normal control subjects. The group of CD patients consisted of 11 patients with newly diagnosed, short-standing and so far untreated CD (group CD 1) and 10 patients previously treated with drugs and with mostly long-standing CD (group CD 2). Results showed that the MLC responsiveness was similar in all Crohn's disease groups, normal subjects and diseased controls. While there was no correlation between MLC responsiveness and either disease activity or disease duration when compared singly, those CD 2 patients who had highly active and/or very long-standing disease did exhibit a depressed MLC responsiveness as compared with that of normal subjects (p less than 0.001), CD 1 patients who had both inactive and short-standing disease (P less than 0.05), and diseased controls (0.1 greater than or equal to P greater than 0.05). The stimulatory capacity did not differ significantly between the CD groups and normal subjects or diseased controls; the latter, however, stimulated poorly compared with normal subjects (P less than 0.05). In accordance, an inverse relationship between the magnitude of the stimulatory capacity and the disease activity was found in the CD patients as a whole. These data suggest that there is no depression of the in vitro primary cell mediated immune response as a predisposing factor for CD or as an early event associated with the pathogenesis of CD.


Value of laparoscopy in the diagnosis and management of pancreatic carcinoma.

Our experience with laparoscopy in the diagnosis and staging of 23 cases of pancreatic cancer is reported. This endoscopic procedure has proved useful in the diagnosis of the disease, in the assessment of operability, and in the retrieval of material for histological and cytological confirmation of pancreatic cancer. An infra-gastric laparoscopic method for inspection of the body and tail of the pancreas is described and the technique may allow the earlier detection of neoplasms in this region.


Effect of colchicine and vinblastine on rat intestinal water transport and Na-K-ATPase activity.

The hypothesis that colchicine and vinblastine, which are commonly used for therapeutic purposes and known to cause diarrhoea, decrease intestinal water transport by inhibition of Na-K-ATPase activity was tested in rats. Net fluid transport by jejunal segments was measured four hours after intraperitoneal injection of either 0.15 M NaCl (0.5 ml/100 g), colchicine (0.5 mg/100 g b.w.), or vinblastine (1.0 mg/100 g b.w.). Colchicine and vinblastine decreased net fluid transport: 3.0 +/- 0.9 (SE) and 4.6 +/- 0.4 (SE) respectively, as compared to that transported by segments from rats injected with 0.15 M NaCl, 8.6 +/- 0.7 (SE) g fluid/hour/g. Methylprednisolone (3.0 mg/100 g b.w.) abolished the inhibitory effect of cholchicine and vinblastine on fluid transport. Colchicine and vinblastine were found to decrease significantly mucosal Na-K-ATPase activity, 18.2 +/- 4.9 (SE); 25.2 +/- 2.4 (SE) respectively, as compared to that measured in rats injected with saline 40.6 +/- 3.4 (SE) mumol/mg protein/hour. Pretreatment with methylprednisolone prevented the decrease in enzyme activity observed in rats injected with colchicine and vinblastine. The degree of inhibition in intestinal Na-K-ATPase activity was similar to that observed in fluid transport following colchicine and vinblastine. It is thus suggested that colchicine-induced inhibition of water transport is caused by inhibition of Na-K-ATPase activity, an effect which can be prevented by pretreatment with methyl-prednisolone.


[Meningioma of the tentorium cerebelli: computer tomographic and angiographic aspects (author's transl)].

The relationship of a meningioma to the tentorium is of great significance for the choice of treatment. In order to evaluate the role of computer tomography and angiography for elucidating this problem, 21 cases were examined (all had angiograms, 13 had computer tomography). In most cases the tumour was attached to the tentorium. In 18 patients it was possible to compare the results of radiology with operative findings. It was found that computer tomography and angiography are complementary; indirect involvement of the tentorium by tumour passing through the tentorial hiatus can nearly always be demonstrated by computer tomography, whereas demonstration of direct involvement is best achieved by selective or super selective angiography. Extension of tumour to both sides of the tentorium is accomplished most easily by computer tomography or angiography, if the meningioma is in the mid-line.


[Frontal and half axial projection for cranial computer tomography (author's transl)].

The introduction of second generation computer tomographic apparatus has made it possible to obtain frontal and half axial projections. This is particularly important for lesions at the skull base, the ventricular system, the tentorium, the scalp and the epicranium. The appropriate positions are described in detail.


[A comparison of various diagnostic methods in 491 cerebral tumours (gamma encephalography, cerebral angiography, pneumo-, electro-, echoenecephalograph and plain films) (author's transl)].

Isotope and neuroradiological methods were evaluated in the diagnosis of 491 surgically confirmed cerebral tumours seen between 1966 and 1973 (July). They were analysed in terms of region, type and size. The accuracy of various techniques was investigared and their value when used in isolation and in combination with other methods was calculated.


[Combined deformity of the brain and cerebral vessels (congenital hydrocephalus) in a 3-year-old child: dandy-walker syndrome, arteria primitiva trigemina and haemangioma (author's transl)].

In a 3-year-old child, a rare combination of a Dandy-Walker syndrome, a primitive trigeminal artery and a facial haemangioma was found. These multiple dysplasias originate from different germinal layers and result from disturbances of different periods of gestation.


[Radiation to the orbits during computer tomography with the emi scanner ct 1010 (author's transl)].

Radiation dose to the lens during examinations with the EMI scanner CT 1010 depends on the region examined, on the angle of swing, duration of scan and the plane of the examination. In the most common position (horizontal, 180 degrees and 60 seconds) lens dose during examination of the orbit is about 900 mR., and for examination of the skull about 300 mR. Longer durations of scan and greater swings may increase the dose to the lens to 9 R. Even in the most unfavourable cases, the dose to the lens is less than would be obtained from skull tomography and skull angiography in two planes. Nevertheless, axial computer tomography used under certain conditions, and particularly when repeated, will have to be considered as a possible cause of damage to the lens.


[Radiological-densitographic examinations of the skull injuries of the pharoah Seqenenre (author's trasl)].

Skull radiographs of the pharaoh Seqenenre-Ta'a II with special densitographic techniques have shown that he survived a perforating skull injury. The technique is described and its use in medical history and archaeology is discussed.


[Tomographic findings in C.S.F. fistulae (author's transl)].

The majority of C.S.F. fistulae are of traumatic origin and in order to avoid the threat of meningitis, they require operative closure. For the demonstration of the fronto-basal defects, multi-dimensional tomograms in various planes have proved very valuable. In 28 patients examined in the Radiological University Clinic (Münster), defects were most common in the cribriform plate. In addition to a break in its contour, one can find displacement of fragments, step formation, opacification of the adjacent nose or sinuses or intracranial air. 88% of defects could be localised in this way. The tomograms were not helpful in two very small fronto-basal fractures.


[Xerosialography (author's transl)].

The authors performed xerosialography on 41 patients with various diseases of the salivary glands. In 38 patients this provided positive information. Each of eight submandibular sialograms was abnormal; of the 33 parotid examinations, three benign salivary tumours could not be demonstrated radiologically. Xeroradiography is a useful method for the examination of the major salivary glands. It is superior to the traditional film method.


[Quantitative functional analysis of the left ventricle in coronary heart disease. An evaluation of current methods. II. Correlation of results. Global and regional contractility parameters (author's transl)].

In the first part of the present paper, the basic methods for quantitative angiocardiography are described. In the second part, a variety of results are tabulated and discussed, derived from selective coronary arteriography, laevocardiography, left ventricular pressure measurements and heart size as seen on conventional chest X-rays. Various correlations have been derived from these. It was not possible to find an quantitative relationship between coronary sclerosis and myocardial function. The reason for this depends on the fact that the parameters derived from laevocardiography represent integrated global function. The significance of regional contractility is stressed.


[The early urogram in experimental acute stenosis of a renal artery (author's transl)].

1. Renal excretion as seen in the urogram does not parallel changes in blood flow. The significance of the early urogram as a test of function is therefore very limited. 2. Following acute stenosis of one renal artery, there is simultaneous excretion by both kidneys until flow is reduced to 60%; exretion is delayed, with values of 0.5 to 7.5 minutes, following reduction to 30 to 60% of the original; there is no excretion below 30%. 3. Unilateral delay in excretion occurs at about the level of "critical occlusion pressure". 4. Delayed excretion is observed at the level of the so-called "critical stenosis" of the renal artery. A reduction of flow above 20% follows a reduction of the artery in excess of 66%, corresponding with a reduction of the lumen of more than 90%. 5. These findings indicate that delayed excretion in the early urogram is to be expected only as a result of severe stenosis of the renal artery and represents a late feature of renal vascular disease.


[Percutaneous nephro-pyelostomy applications and results (author's transl)].

The use of percutaneous nephro-pyelostomy with a fine needle is described after 90 examination in 70 patients. Fine needle pyelography is used for antegrade demonstration of suspected ureteric obstruction when there is no renal excretion. Percutaneous nephro-pyelostomy can be used to assess the recovery of renal function after decompression, as well as for pressure measurements pre-operatively before carrying out plastic operations (Whitaker). Percutaneous nephropyelostomy offers the possibility of temporary or permanent urinary diversion in the presence of obstruction. In our own experience, the percutaneous method has almost totally replaced operative nephrostomy whenever supravesical drainage is necessary. In addition, it can be used for treating fistulas, antegrade splinting of the ureter or percutaneous removal of stones. Complications of renal puncture consisted of two small perirenal haematomas and two patients with short-lived haematuria, as well as one case of septicaemia with rapid recovery.


The phlebographic diagnosis of phaeochromocytomas.

The diagnosis of phaeochromocytomas is based on the clinical features and on the hormone findings in the peripheral blood. Localisation, however, depends on radiological methods. Pneumoperitoneum was abandoned, because of its low accuracy, in favour of arteriography; lately, suprarenal phlebography has been available for the localisation of phaeochromocytomas. Our experience in nine patients with operatively confirmed phaeochromocytomas is described. Together with venous sampling from the caval system and the suprarenal veins for catecholamine estimations, it was possible to localise all tumours correctly. One tumour lying in the sympathetic chain in the thorax was correctly localised by hormone estimation. Our experience suggests that suprarenal phlebography represents a reliable method for localising phaeochromocytomas which carries a low risk and is to be preferred to arteriography.


[New radiological aspects of tuberose sclerosis (author's transl)].

Amongst the various lesions of tuberose sclerosis, involvement of the kidneys is of particular importance and has special significance in determining the prognosis. Radiological investigations are important for diagnosing the presence and extent of these lesions, for observing their progress and for deciding the appropriate time for treatment. It is difficult to determine whether the tumours are benign or malignant. The value of renal angiography with electronic harmonisation is stressed.


[The sonographic-radiological diagnosis of abdominal abscesses (author's transl)].

The sonographic-radiological diagnosis of abdominal abscesses is discussed; these are divided into intraparenchymal, extra-parenchymal-intraperitoneal and extraparenchymal-extraperitoneal lesions. The results of grey scle sonography are most informative and are correlated with the radiological and scintigraphic findings in 25 patients. In addition to the advantages of economy and of a non-invasive method, ultrasound permits aimed fine-needle aspiration of pathological abdominal processes such as abscesses.


The accuracy of tc-scan in the diagnosis of retroperitoneal metastases of malignant testicular tumours.

Based on the investigations carried out on 18 patients with testicular tumours, the results of CT-scanning are compared with the findings of conventional radiological examination and with lymphography in particular. At the actual state of technical evolution, the study reveals that CT-scanning does not possess sufficient spatial resolution to permit the diagnosis of very small lymph node metastases and all the more of a specific diagnosis of these metastases. Nevertheless, it remains a fact that CT-scanning obviously is a preferable method with respect to the visualisation of the exact extent and size of large involvements and the effects upon the surrounding tissues. CT-scanning is proposed as the screening-procedure with regard to patients suffering from testiscarcinoma, and allows, in a great number of cases, to make more invasive techniques superfluous.


[The radiographic density of plastic materials (author's transl)].

The relative radiographic densities of the basic ingredients and commercially available plastic materials were studied with the help of a water phantom. Surprisingly, the relative radiographic density showed a wide spectrum from 0.25 to 7.0, as is shown in an extensive table. Particles with a relative radiographic density of greater than 4.0 can be identified over the lumbar spine. Particles with a density of less than 0.5 as well as greater than 1.5 can be seen in the soft tissues of the hand at 50 kv. All known plastics have higher radiographic transparency than the barium sulphate suspensions used for gastro-intestina examinations.


Screening for granulopoiesis inhibitors (chalones) by different assays.

The suitability of various granulocyte chalone sources was examined; for this purpose rat ascites fluid and the conditioned media of ascites and bone marrow cells were fractionated by ultrafiltration and Sephadex gel filtration. To evaluate different assay systems, the ability of the fractions to inhibit the growth of granulocytic and T-lymphocytic colonies in agar capillaries, as well as to inhibit the uptake of [3H]thymidine in bone-marrow cells, T- and B-lymphocytes, was tested and compared. Three granulocyte colony inhibiting fractions were obtained that contained apparent chalone activities, but showed different elution parameters with molecular weights well below 10 000. Comparison of the test systems revealed that the granulocyte colony assay may detect inhibitors different from those found by the [3H]thymidine bone-marrow assay; the validity of the latter test is seriously questioned, however. The need for precisely defined assays to screen for the apparently various inhibitors is emphasized by these studies.


[Immediate type allergy to insulin (author's transl)].

Allergic reactions of the immediate type to insulin are known since its introduction of the treatment of diabetes mellitus. After the development of the chromatographically purified insulins they are to be found significantly reduced, though still particular cases are observed. The simultaneous occurrence of insulin allergy and insulin resistance seems to be not too rare. The immediate type allergy to insulin is mostly released by the presence of IgE-antibodies. Another but not at all rare allergic reaction is the Arthus phenomenon, released by IgG-antibodies. For diagnosis of these allergic states intradermal skin tests with various insulins are used. Also specific IgE-antibodies are to be measured radioimmunologically lately. There is a strong correlation between the outcome of the allergic reactions and the definite degree of the specific IgE-antibodies. Low levels of specific IgE are found in insulin treated diabetics without any visible allergic reactions to insulin. This fact proves that the hormone, though being a clean insulin of a very high degree, is the antigen itself. Not only immunologic mechanism, but also other exogenic influences cause allergic reactions of the immediate type to insulin.


Identification and characterization of guinea-pig antibodies that contrasensitize in mice.

Immunological enhancement is a form of active immunoregulation in which humoral antibodies suppress primary sensitization or block reaction in sensitized animals. In mouse serum the antibodies that suppress sensitization in mice (allogeneic enhancement) are predominantly 7Sgamma1 and those that block reaction 7Sgamma2 globulins. But little is known about the identity of xenogeneic enhancing antibodies, e.g. guinea-pig antibodies that can suppress sensitization in mice. We have studied these here as specifically effective against induction of tuberculin-typed delayed hypersensitivity to chicken conalbumin antigen. Guinea-pigs required prolonged and intense immunization with conalbumin to produce readily measurable titres of such antibodies. Their capacity to suppress mouse sensitization was antigenically specific. Of the three major classes of antibodies separated from the immunosuppressive guinea-pig antisera, the IgG2 globulins were the most effective. These antibodies lost immunosuppressiveness if digested to either F(ab.)2 or Fab fragments that retained antigen-binding capacities. Thus, we provide here an example of xenogeneic antibody-mediated contrasensitization, show that only intact antibody molecules are effective, and demonstrate that immunosuppressiveness is concentrated in different immunoglobulin classes for xeno- and allogeneically used antisera.


Two small lymphocyte subpopulations in human peripheral blood. II. Functional characterization in vitro.

Two small lymphocyte subpopulations from human peripheral blood were produced by rosette sedimentation procedures, and tested for in vitro functions by stimulation with mitogens, PPD and allogeneic lymphocytes, and for effector capacities in ADCC. The non-T, non-Fc subpopulation had previously been found to be a SmIg+ fraction which did not aquire new surface markers during unstimulated culture, did not respond to mitogens, PPD or allogeneic cells but were potent MLC stimulators. In addition, they were poor ADCC effector cells. The non-T, non-B ('Null') cells, which showed varying surface marker profiles from donor to donor, were able to respond to mitogens and PPD, but were weak MLC responders. Potent ADCC effector capacity was, however, found to be exhibited by this subpopulation.


Close association of human mixed lymphocyte culture antigen, Ia-like antigen and Fc receptor.

The effects of aggregated human IgG, human anti-Ia-like antibody, and anti-beta2-microglobulin on mixed lymphocyte culture (MLC) were studied. Aggregated human IgG inhibited both stimulatory and responding activities in MLC. When Fc-receptor-bearing cells were removed from responding cells, the inhibitory activity of aggregated IgG was markedly reduced. The result suggested that the inhibition of MLC by aggregated IgG is primarily based on the blocking of Fc-receptor-bearing cells contained in the stimulator cells. In addition, the removal of Fc-receptor-bearing cells from stimulatory cells resulted in the loss of MLC response. Anti-Ia-like antibodies contained in anti-HLA sera and B-cell-specific human alloantisera also inhibited stimulatory activities in MLC. Rabbit antiserum against human beta2-microglobulin showed inhibitions of both stimulatory and responding activities. These results suggested the close association of human MLC stimulator site with Fc receptor and Ia-like antigen and also some relation of beta2-microglobulin with MLC reaction.


Does smoking kill workers or working kill smokers? OR The mutual relationship between smoking, occupation, and respiratory disease.

Evidence accumulated since 1964 appears to show that occupation, not cigarette smoking, may be the primary cause of lung disease, especially of cancer and chronic obstructive disease. Comparisons of groups of individuals who smoke more with those who smoke less actually serve to contrast groups with a high proportion of blue-collar workers exposed to toxic fumes and a low proportion of professionals, managers, and proprietors with groups having lower proportions of blue-collar workers and higher proportions of professionals, managers, and proprietors. Thus, many diseases associated with smoking actually may be of occupational origin. Indeed, more than a dozen recent investigations of lung cancer epidemics among industrial workers have failed to find smoking to be a major cause (in some, not even a contributing cause). This evidence is strengthened further by shifts in the incidence of lung cancer that follow in time shifts in industrial employment patterns. Yet a worker's past smoking habits seem to play a key role in decreasing compensation awards for injuries that actually may be due to occupational exposure rather than personal habits. Thus, the relationship between smoking, occupation, and disease needs serious clarification. Smoking appears to have been used to divert attention away from the effects of occupational and environmental exposures to toxic substances.


The prevalence and severity of major disabling conditions--a reappraisal of the government social survey on the handicapped and impaired in Great Britain.

This paper re-examines the data gathered for the Government Social Survey on the Handicapped and Impaired in Great Britain. The underlying cause of disablement is considered in conjunction with severity and prevalence. When these are taken together a picture emerges in which stroke, arthritis, and circulatory disorders are the most frequent cause of severe disability in the community. An attempt is also made to examine the way in which the survey might be biased by the non-inclusion of those in institutions.


Cutaneous manifestation of internal malignancies (II): the sign of Leser-Trélat.

Leser-Trélat Sign refers to a sudden showering of seborrheic keratoses and its possible relationship to internal malignancy.


Presence of an actin-like protein in mycelium of Neurospora crassa.

Addition of ATP, CaCl2, and KCl to supernatants prepared from mycelia of Snowflake (strain 507), a morphological mutant of Neurospora crassa, results in the formation of filaments 70 nm in diameter. The "decorated" appearance of these filaments after incubation with heavy meromyosin from rabbits suggests they are actin-like.


Huntington's Chorea and dimethylaminoethanol (deanol).

Huntington's Chorea has multiple neurologic and psychiatric manifestations, and its treatment has been the subject of much debate. It appears that no single agent is effective for all patients with Chorea. Furthermore, different biochemical substances may be lacking in various Huntington's patients, i.e., gamma aminobutyric acid (GABA) in some, or a deficiency of acetylcholine (ACH) receptors in others. We approach this disease as a possible "spectrum illness," characterized by a relative deficiency of one substance, or a relative excess of another. If patients do not respond to one family of drugs, they may still benefit from  a trial with another drug group.


Albuminated dacron protheses as improved blood vessel substitutes.

An improved vascular graft was achieved by treating knitted Dacron prostheses with cross-linked albumin. Eight segments, each six centimeters in length, were coated and implanted in the canine thoracic aorta for periods ranging from 24 hours to six months. The results were compared with the eight untreated grafts implanted for similar periods as control experiments. Albumin coating resulted in a faster healing : cells appeared earlier and collagen development was greater. The most beneficial effect of that treatment was the reduction in embolization, as shown by the considerable decrease in kidney damage.


The effect of lithium and potassium on the transient state kinetics of the (Ca + Mg)-ATPase of cardiac sarcoplasmic reticulum.

KCl or LiCl, when added in 100 mM concentrations to cardiac sarcoplasmic reticulum incubated at 17 degrees C with 5 micron [gamma-32P]ATP, 1 mM MgCl2, and 9.1 micron M Ca2+, increased the apparent phosphorylation rate constant from 14.5 s-1 to 23.8 s-1 (100 mM LiCl) or to 44.1 s-1 (100 mM KCl). These same monovalent cations also increased the apparent rate constant for the hydrolysis of the phosphorylated sarcoplasmic reticulum from 0.51 s-1 to 1.12 s-1 (100 mM LiCl) or to 1.71 s-1 (100 mM KCl). Although there was a small burst in Pi production, rate constant of 0.97 s-1, when 100 mM KCl was added, the burst when LiCl or no monovalent cation was added was either nonexistent or so small as to make its detection unreliable. KCl thus appears to induce an intermediate which is either nonexistent when omitted or in such low concentration as not to be readily detected.


Identification of a tyrosine residue at a nucleotide binding site in the beta subunit of the mitochondrial ATPase with p-fluorosulfonyl[14C]-benzoyl-5'-adenosine.

The mitochondrial F1-ATPase is irreversibly inactivated by the adenine nucleotide analogue, p-fluorosulfonylbenzoyl-5'-adenosine. This inactivation is partly prevented by the presence of bound adenine nucleotides. Inactivations of the ATPase with p-fluorosulfonyl[14C]benzoyl-5'-adenosine were most efficiently accomplished with the nucleotide-free enzyme at pH 7.0, in a buffer containing 20% glycerol. Under these conditions, 4.2 g atoms of 14C are incorporated per 350,000 g of enzyme when the ATPase is inactivated by 90% by its reaction with 2 mM p-fluorosulfonyl[14C]benzoyl-5'-adenosine. Isolation of the component polypeptide chains of the labeled ATPase showed that all of the radioactivity was associated with the two largest subunits. The isolated alpha subunit contained 0.45 g atom of 14C/mol and the isolated beta subunit contained 0.88 g atom of 14C/mol. Hence, the inactivation can be correlated with the incorporation of 14C into the beta subunit. This suggests that the hydrolytic site of the enzyme resides on this subunit. The majority of the radioactivity in a tryptic digest of labeled beta subunit is contained ina tryptic peptide that has the following amino acid sequence: Ile-Met-Asp-Pro-Asn-Ile-Val-Gly-Ser-Glu-His-Tyr-Asp-Val-Ala-Arg, where Tyr is the radioactive derivative of the tyrosine residue that was sulfonylated during the inactivation.


Membrane cooperative enzymes. High molecular specificity for blocking action of thyroxine on triiodothyronine effect in rat erythrocyte and Escherichia coli systems.

The molecular specificity for the blocking action of thyroxine on the triiodothyronine effect in the cooperativity of membrane-bound rat erythrocyte acetylcholinesterase and Escherichia coli Ca2+-ATPase was analyzed. Changes in the values of n (Hill coefficient) were obtained at strict physiological levels of these hormones. The structural requirements of the thyroid hormones to modify the membrane-bound systems were studied using various analogues of these hormones. In the erythrocyte system, a very high molecular specificity for triiodothyronine and thyroxine actions was found. The L-alanine side is essential to carry out both the allosteric desensitization and the blocking effects. The blocking ability of thyroxine is characterized by the presence of iodine in the 5' position. The bacterial system presented only specificity for the triiodothyronine allosteric desensitization. A system of membrane-bound enzymes for the study of the actions of thyroid hormones, is presented here.


The isolated heavy chain of an Acanthamoeba myosin contains full enzymatic activity.

Acanthamoeba myosin IB is a single-headed enzyme containing one heavy chain of 125,000 daltons, one light chain of 27,000 daltons, and one light chain of 14,000 daltons. The 125,000- and 27,000-dalton polypeptides are consistently found in a molar ratio of 1:1. The content of the 14,000-dalton peptide is usually only 0.1 to 0.2, and always less than 0.5, relative to the other two chains and might be a contaminant or a degradation product of one of the other chains. The specific activities of the Ca2+-ATPase, (K+, EDTA)-ATPase, and (after phosphorylation of its heavy chain by a specific kinase) actin-activated Mg2+-ATPase of Acanthamoeba myosin IB are similar to those of rabbit skeletal muscle myosin. After treatment of the enzyme with 2 M LiCl, the 125,000-dalton heavy chain of Acanthamoeba myosin Ib can be obtained, by chromatography on Sephadex G-200, essentially free of the 14,000-dalton peptide and more than 90% free of the 27,000-dalton peptide. This isolated heavy chain has the same specific ATPase activities as the original enzyme. Therefore, the heavy chain of Acanthamoeba myosin IB contains the ATPase catalytic site, the actin-binding site, and the phosphorylation site and is fully active enzymatically in the absence of light chains.


Structure of alpha-polymer from in vitro and in vivo highly cross-linked human fibrin.

Peptides derived from plasmic and cyanogen bromide (CNBr) cleavage of highly cross-linked fibrin were isolated and characterized by sodium dodecyl sulfate-gel electrophoresis, amino acid analyses, cyanoethylation, and NH2-terminal analyses. Extended plasmic digestions of human fibrin containing four epsilon-(gamma-glutamyl)lysine cross-links per molecule produced a peptide of alpha-chain origin (Mr congruent to 21,000) which was comprised of a small donor peptide cross-linked to the acceptor site peptide from the middle of the alpha-chain. CNBr cleavage of highly cross-linked in vitro fibrin or of fibrin from a spontaneously formed in vivo arterial embolus produced about three cross-linked species of molecular weights 30,000 to 40,000, each of which contained the largest CNBr fragment (Mr = 29,000) from the alpha-chain. The predominant cross-link-containing CNBr fragments derived their donor group from the near COOH-terminal region of the alpha-chain as judged by difference amino acid compositions and NH2-terminal analyses. Additionally, cross-linked fragments of molecular weights 68,000 to 70,000 which appeared to contain two acceptor site peptides (Mr = 29,000) were detected in minor amounts in the CNBr digests of fibrin formed from whole plasma or from purified, plasminogen-free fibrinogen. No larger polymeric cross-linked CNBr fragment was generated from any of the highly cross-linked fibrin preparations examined. A model for the predominant mode of alpha-chain polymerization is proposed.


Endothelial cell culture on dacron fabrics of different configurations.

The growth of tissue-cultured aortic endothelial cells from the calf using 12 different configurations of Dacron polyester (U.S. Catheter and Instrument Co.) as substrates was studied. Scanning electron microscopy showed maximum cell coverage on tightly knit configurations, whereas loose knits and velours did not support cell growth.


Cervical-spine instability in children with Down syndrome (trisomy 21).

Eighty-five children with Down syndrome, between sixteen months and eighteen years old, were evaluated for instability of the cervical spine at the atlanto-axial joint. The mean atlas-odontoid process interval was three millimeters in flexion and two millimeters in extension. Ten patients (12 per cent) exhibited abnormal intervals (4.5 millimeters or more) during either flexion or extension. The configuration of the odontoid process was considered normal in eighty patients and abnormal in another five patients (6 per cent). The correlation between the thickness of the interval and the degree of ligament laxity was statistically significant, as was the correlation between ligament laxity and age. Of the ten patients with an increased atlas-odontoid process interval, neurological deficit (hyperreflexia and clonus) developed in only one after a one-year follow-up.


Cation-induced attachment of ciliary dynein cross-bridges.

Isolated, demembranated Unio gill cilia that have been activated and fixed for thin-section electron microscopy in the presence of 2 mM MgSO4 have 87% of their outer dynein arms attached to an adjacent B subfiber. The distribution of attached arms is uniform with respect to doublet position in the cilium. When both 0.1 mM ATP and Mg++ are added to the activation and fixation solutions, the frequency of bridged arms is reduced to 48%. At the same time, the distribution of the attached arms appears to have been systematically modified with respect to doublet position and the active bend plane. Those doublet pairs positioned in the bend plane where interdoublet sliding is minimal retain a greater number of bridged arms than those doublet pairs positioned outside the bend plane where sliding is maximal. These observations imply a functional coupling of the Mg++-induced bridging of the dynein arms and the subsequent binding and hydrolysis of ATP that results in a force-generating cross-bridge cycle.


Successful replacement of the interventricular septum following excision of a large intramural fibroma.

Successful removal of tumours of the heart involving the ventricular septum is uncommon. Review shows that of thirty endocardial fibromata reported, only six involved the septum. We wish to report another case, in which a large endocardial fibroma had replaced the ventricula septum and was removed, necessitating the reconstruction of this septum.


Synthesis of plasmalemmal glycoproteins in intestinal epithelial cells. Separation of Golgi membranes from villus and crypt cell surface membranes; glycosyltransferase activity of surface membrane.

The relationship between Golgi and cell surface membranes of intestinal cells was studied. These membranes were isolated from intestinal crypt cells and villus cells. The villus cell membranes consisted of microvillus membrane, a Golgi-rich fraction, and two membrane fractions interpreted as representing lateral-basal membranes. The villus cell microvillus membrane was purified by previously published techniques while the other membranes were obtained from isolated cells by differential centrifugation and density gradient velocity sedimentation. The two membrane fractions obtained from villus cells and considered to be lateral-basal membranes were enriched for Na+,K+-ATPase activity, but one also showed enrichment in glycosyltransferase activity. The Golgi membrane fraction was enriched for glycosyltransferase activity and had low to absent Na+,K+-ATPase activity. Adenylate cyclase activity was present in all membrane fractions except the microvillus membrane but co-purified with Golgi rather than lateral-basal membranes. Electron microscopy showed that the Golgi fraction consisted of variably sized vesicles and cisternalike structures. The two lateral-basal membrane fractions showed only vesicles of smaller, more uniform size. After 125I labeling of isolated intact cells, radioactivity was found associated with the lateral-basal and microvillus membrane fractions and not with the Golgi fraction. Antibody prepared against lateral-basal membrane fractions reacted with the surface membrane of isolated villus cells. The membrane fractions from isolated crypt cells demonstrated that all had high glycosyltransferase activity. The data show that glycosyltransferase activity, in addition to its Golgi location, may be a significant property of the lateral-basal portion of the intestinal villus cell plasma membrane. Data obtained with crypt cells support earlier data and show that the crypt cell surface membrane possesses glycosyltransferase activity.


Myosins of secretory tissues.

Myosin has been purified from the principal pancreatic islet of catfish, hog salivary gland, and hog pituitary. Use of the protease inhibitor Trasylol (FBA Pharmaceuticals, New York) was essential in the isolation of pituitary myosin. Secretory tissue myosins were very similar to smooth muscle myosin, having a heavy chain of 200,000 daltons and light chains of 14,000 and 19,000 daltons. Salivary gland myosin cross-reacted with antibodies directed toward both smooth muscle myosin and fibroblast myosin, but not with antiskeletal muscel myosin serum. The specific myosin ATPase activity measured in 0.6 M KCl was present. Tissues associated with secretion of hormone granules contained substantial amounts of this ATPase, rat pancreatic islets having 4.5 times that of rat liver. Activation of low ionic strength myosin ATPase by actin could not be demonstrated despite adequate binding of the myosin to muscle actin and elution by MgATP. The myosins were located primarily in the cytoplasm as determined by cell fractionation and were quite soluble in buffers of low ionic strength.


Successful correlation of type C complete atrio-ventricular (A-V) canal in infancy.

Herein, a successful repair of Type C complete A-V canal in infancy is reported. With a better understanding of anatomy as well as improved perioperative care it appears the primary repair is more reasonable approach than the high risk palliative operation (pulmonary artery banding), when surgery is required in such disease.


Seborrheic keratosis: an acantholytic variant.

Two elderly women with seborrheic keratoses on the abdomen are reported on because of the peculiar histologic appearance characterized by prominent acantholysis. Although the basic histologic architecture was a papillomatous acanthoma corresponding to that of seborrheic keratosis, the upper portion of the lesions showed extensive acantholytic changes and dyskeratotic cells. Differentiation from seborrheic keratosis with focal acantholytic dyskeratosis, warty dyskeratoma, keratosis senilis and acantholytic squamous cell carcinoma could be made on the basis of clinical as well as histological features. Although the histogenesis is uncertain, it seems logical to propose that this is a rare variant of irritated seborrheic keratosis.


Studies on calcium-stimulated adenosine triphosphatase in the albino rabbit dental pulp. Its subcellular distribution and properties.

The subcellular distribution of calcium-stimulated adenosine triphosphatase in the albino rabbit dental pulp was studied. The purity of the microsomal fraction was examined by measuring the marker enzymes and by electron microscopic observation. Some properties of calcium-stimulated adenosine triphosphatase were investigated.


Organ weights in nonagenarians.

The main organs in a series of 39 nonagenarians were weighed at autopsy. The weights varied widely from subject to subject. Compared with average weights in younger subjects, the brains, livers, spleens, kidneys and lungs weighed less than usual in the majority of nonagenarians examined. However, the hearts often were heavier than normal and many of them were hypertrophied.


Reproduction in mice treated with crufomate: effects of dermal treatments on female mice and on their progeny.

Dermal treatments with crufomate 100 or 50 mg/kg or crufomate vehicle 100 mg/kg were applied to mice either on days 35 and 21 before mating or on days 70, 56, 35, and 21 before mating. Two, but not four dermal treatments, with both doses of crufomate reduced the mating reponse and conception rate in mice. The mice either did not produce a litter or the litter died before the age of 7 days. Four treatments with crufomate 100 mg/kg, but not with 50 mg/kg, reduced the weaning weight of progeny weaned at the age of 21 days. The vehicle had no effects on reproduction and increased the weights at maturity of female and male progeny of mice given two and four treatments, respectively.


Acomparative histochemical mapping of ATPase and 5-nucleotidase in the medulla oblongata, spinal cord and cerebellum of mouse.

In the present contribution a comparative study of histochemical mapping of the distribution of adenosine triphosphatase and 5-nucleotidase in the hind brain of mouse has been made. There are many similarities and dissimilarities between the distribution of these two enzymes in various nuclei, tracts and fiber bundles. The noteworthy differences are as follows:--1. The AP, NDNV, NI, NNH, NOAD, NOAM, NOI NPC, TS and SG are very intensely positive for ATPase whereas, in 5-NUC study none of these nuclei demonstrates intensity of such degree. 2. Nucleus ambiguus is intensely positive for ATPase and is completely negative for 5-NUC. 3. The nucleus n. facialis is intensely positive for ATPase and is moderately positive for 5-NUC. 4. NC, GN, PN, PCI and TC are completely negative for 5-NUC. In ATPase preparations only GN is negative and the rest of the areas demonstrate intensity of various degrees. Along with these differences, similarities in the intensity of both enzymes in various nuclei, tracts and fibrous bundles also exist. An attempt has been made to correlate all the aforesaid differences and similarities in the distribution of these two enzymes with the functional nature of the various areas of hind brain of mouse.


Cell-mediated cytotoxicity against virus-infected target cells in humans. II. Interferon induction and activation of natural killer cells.

The mechanisms by which human lymphocytes lyse virus-infected allogeneic fibroblast cultures were analyzed with particular consideration of the role of anti-viral antibodies and interferon. Human cells infected with viruses were able to induce high levels of interferon upon contact with human lymphocytes. Interferon, whether produced by lymphocytes after direct infection with virus or induced upon exposure of lymphocytes to virus-infected fibroblasts, appeared to be responsible for enhancing the cytotoxic efficiency of the natural killer cell against the infected target. Activation of cytotoxic lymphocytes occurred as early as 6 hr after addition of interferon and increased up to 24 hr. Antibody-dependent cell-mediated cytotoxicity (Ab-CMC) could be easily induced by sensitization of infected target cells with antiviral antibodies and could be detected at 4 hr from the beginning of the cytotoxic test, before the effect of interferon on the natural killer cell was evident. However, the antibody-dependent effector cell was inactive after 4 hr of incubation. F(ab')2 fragments of rabbit anti-human IgG completely inhibited Ab-CMC but did not at all affect the spontaneous cytotoxic activity of the effector cells against virus-infected target.


Human lymphocyte responses are enhanced by culture at 40 degrees C.

In vitro responses of human peripheral blood lymphocytes (PBL) were found to be markedly enhanced by culture at 40 degrees C rather than at the conventional temperature of 37 degrees C. We studied proliferative responses of lymphocytes by activation by phytohemagglutinin (PHA) concanavalin A (Con A), pokeweed mitogen (PWM), and allogeneic lymphocytes in mixed lymphocyte culture (MLC) and found enhancement of DNA synthesis at the higher temperature. Cytotoxic T cell responses to allogeneic cells were also enhanced when MLC was done at 40 degrees C. These enhanced immune responses appear to be due in part to increased numbers of participating cells. If in vitro lymphocyte responses correlate with in vivo responses, then fever associated with infection or tumor may be beneficial whereas that associated with autoimmune disorders may have a detrimental effect.


Depletion of monocytes from human peripheral blood leucocytes by passage through sephadex G-10 columns.

Passage of human peripheral blood leucocytes through Sephadex G-10 columns results in a complete depletion of monocytes. Microscopic examination and ingestion of latex particles failed to reveal any monocytes in the column-passed cells. The study of surface markers shows a slight enrichment of T-cells and a decrease of B-cells that is more pronounced in the IgG- and IgA-bearing lymphocytes. No changes were seen in the Fc receptor-positive cells. Con A-induced activation was significantly affected. Pokeweed mitogen activation was reduced 50% at optimal doses of mitogen whereas the response was unaffected at suboptimal doses. Mixed leucocyte reactions (MLR) were greatly depressed when monocytes were removed from either the responder or the stimulator cells, indicating an important role of monocytes both in the elicitation of the response and as auxiliary cells in the mixed leucocyte culture.


Mediating systems in inflammatory disease.

This article reviews the mediation systems participating or potentially participating in inflammatory disease, especially in immunologic injury of the glomerulus. Mediator systems are separated into 3 mechanisms: the first involves complement and neutrophils; the second involves systems unrelated to neutrophils and complement components from C3 to C9; and the third involves blood monocytes. Major emphasis is given to an analysis of factors that potentially participate in the second mechanism. These include humoral factors such as the coagulation system and Hageman factor systems and cellular factor such as platelets or cells resident in the glomerulus. Studies on a role of vasoactive amines are presented. The importance of separating neutrophil-dependent and -independent mechanisms in these studies is emphasized. A review of current knowledge of the biochemical mechanisms involved in the Hageman factor system is presented because of the potential role of these components in the development of inflammation.


Cryoglobulins in acute experimental immune complex glomerulonephritis.

The relationship between cold-insoluble complexes, or cryoglobulins, and renal disease was studied in rabbits with acute serum sickness produced with BSA. The onset of serum creatinine elevation correlated well with the appearance of cryoglobulins. The average interval between the appearance of cryoglobulins and the elevation in serum creatinine was 0.87 day. In no animal did creatinine elevation precede cryoglobulinemia, even though immune complexes were detectable much earlier by other methods. The level of cryoglobulin correlated significantly with the level of serum creatinine (r = 0.71, p less than 0.01). Cryoglobulins may be of immunopathologic significance in acute experimental immune complex glomerulonephritis.


Patterns of abnormal histochemical fibre type differentitation in human muscle biopsies.

The histochemical profile of individual human skeletal muscle fibres was analysed by correlating mitochondrial oxidative enzyme activity and that of myofibrillar ATPase at pH 9.5 and after pre-incubation at pH 4.3 and pH 4.6. In normal control muscle, only a small percentage of fibres did not conform to one or other of the normal variants of Type I and Type II fibres. In biopsies from early cases of Werdnig-Hoffmann disease, the denervated fibre populations contained many abnormal Type I and Type II fibres, including "IIc" fibres, but the basic distinction between Type I and Type II was preserved. However, in infantile spinal muscular atrophy patients aged two years and over, this distinction was progressively lost, leading to the total dedifferentiation of the atrophied fibres. In the Kugelberg-Welander form of spinal muscular atrophy, many of the constituent fibres of re-innervated groups displayed normal or near-normal histochemical profiles, but chronically denervated fibres became totally dedifferentiated. In Duchenne dystrophy, the spectrum of histochemical types appeared to be more continuous due to the emergence of fibres with properties intermediate between those of the normal variants, but the basic distinction between Type I and Type II fibres was preserved in the majority of cases. The percentage of severely abnormal fibres was higher in Type II than Type I and probably contributed to the observed decrease in the overall proportion of Type II fibres. Although very small atrophied fibres were observed in biopsies from cases of Becker and Duchenne dystrophy, these did not show the total dedifferentiation seen in the chronically denervated fibres in cases of spinal muscular atrophy.


Neuropathic form of arthrogryposis multiplex congenita. Report of 3 cases with complete necropsy, including the first reported case of agenesis of muscle spindles.

In 3 infants with arthrogryposis multiplex congenital (AMC) complete necropsy, including removal of the entire spinal cord, was performed. Histologically, spinal type (neurogenic) atrophy of skeletal muscles in conjunction with spinal motor neurone depletion, unaccompanied by noticeable gliosis, were the most preminent features common to all cases. In addition to these, one infant (Case 1) showed total absence of muscle spindles as evident from the examination of several hundred step-serial paraffin sections covering 11 different levels in 36 samples taken from a wide range of skeletal muscles of both upper and lower extremities. This is believed to be the first published case of agenesis of muscle spindles.


Prophylaxis of the laminectomy membrane. An experimental study in dogs.

Sixty laminectomies were performed in dogs to investigate the prevention of the laminectomy membrane and its side effects. These operations were distributed in six groups of 10, one was a control group, and in the others the bone defect was protected with different materials (Oxicel, Silastic, Dacron, methyl methacrylate, and Kiel bone graft). After a survival of 2 months, suboccipital myelography was performed, immediately after which the animals were sacrificed and the operated spinal slice obtained. The different radiographic densities of the tissues of each slice were calculated and the diverse histological nature identified by hematoxylin and eosin, periodic acid Schiff, Masson's trichrome, and Gomori's reticulin strains. Only the acrylic plastic and the Kiel bone graft prevented expansion of the scar tissue inside the spinal canal and adhesions between the dura and the cicatrical overlying muscles. Therefore, the authors suggest that a solid barrier is necessary to effectively prevent the so-called "laminectomy membrane."


A composite general anesthesia technique using ketamine for pediatric outpatients.

A study of 43 pediatric oral surgery patients was conducted in a clinical environment. The anesthetic regimen of a minimum dose of ketamine hydrochloride, nitrous oxide-oxygen, and a local anesthetic was tested for recovery time and degree of acceptance by parents and patients. With this regimen, the average recovery time from completion of the procedure was 30 minutes. The combination of these drugs provided a rapid, smooth induction, additional time while the ketamine-induced anesthesia was dissipating, no major complications, and good acceptance by parents and patients.


Chronic immune complex disease: behavioral and immunological correlates.

Using a fear avoidance paradigm, behavioral effects were seen in Sprague-Dawley rats in which chronic immune complex disease was induced. These effects were related to changes in urine protein that developed during the course of the experiment. Experimental animals also had glomerular deposits of rat gamma globulin and BSA as determined by immunofluorescence; C3 deposits were observed in half of these animals. BSA and/or rat gamma-globulin, but not C3, was seen in the choroid plexus of half of the experimental animals. This is the first study to report behavioral changes associated with the induction of chronic immune complex disease in experimental animals.


Essential fatty acid deficiency in infants receiving parenteral nutrition.

The clinical and biochemical features of essential fatty acid deficiency are described in an infant with gastroschisis who required long-term (6 mo) parenteral nutrition. The deficiency responded to therapy with Intralipid, topical sunflower oil, and breast milk. In a prospective study of three infants with gastroschisis, biochemical essential fatty acid deficiency developed in each during the first week of lipid-free parenteral nutrition; clinical signs of the deficiency were absent. The biochemical features were progressive in the one patient followed for 19 days, and were associated with a decrease in weight gain. Both the deficiency and weight gain were corrected by Intralipid. Biochemical essential fatty acid deficiency did not develop in three other gastroschisis infants who were given prophylactic Intralipid (two patients) or topical sunflower oil (one patient). We conclude that all infants on parenteral nutrition should receive a source of linoleic acid to prevent essential fatty acid deficiency.


Congenital duodenal atresia associated with a separate duodenal diaphragm.

A case of a complete duodenal diaphragm associated with a separate duodenal atresia is described. This association has not been previously reported.


[Effect of thyrocalcitonin on the functions of the intact and hypertrophied myocardium].

Examination of 20 individuals without any pathological conditions of the cardiovascular system and 8 patients with myocardial hypertrophy has shown that the hypocalciemic hormone of the thyroid gland thyrocalcitonin has a certain negative inotropic effect and does not possess chrono- and dromotropic affects. The mechanism of the cardiac effect of thyrocalcitonin is evidently due to its effect on the metabolism of calcium and its transportation in the myocardial structures.


Thiamine deficiency encephalopathy in a specific-pathogen-free cat colony.

Thiamine deficiency encephalopathy occurred in a specific-pathogen-free cat colony where the diet consisted exclusively of commercially canned diet. This product was described by the manufacturer as a complete diet for cats. The clinical diagnosis was confirmed by the demonstration of bilaterally symmetrical hemorrhage and microvascular fibrinoid necrosis in the brain and low erythrocyte transketolase levels. Treatment of clinically ill cats with vitamin B complex was followed by recovery within 24 hours.


Laboratory medicine. Series on clinical testing. 2. Fractionation of urinary ketosteroids. Procedure and clinical significance.

Ketosteroids, the excretory metabolities of adrenal and gonadal steroids, can be analyzed individually in urine by a simple extraction procedure followed by separation and quantitation by the use of gas/liquid chromatography. The ketosteroids quantitatively detected by the technique are androsterone, etiocholanolone, dehydroepiandrosterone, 11-hydroxyandrosterone, 11-hydroxyetiocholanolone, 11-ketandrosterone, and 11-ketoetiocholanolone. Other steroid metabolities detected are pregnanediol, pregnanetriol, delta5-pregnenetriol, and 11-ketopregnanetriol. In comparison with concentrations of these steroids observed in urine specimens collected from healthy individuals, abnormal results occur in specimens from patients with testicular disease, Cushing's syndrome, adrenal hyperplasia, and several types of female hirsutism. Characteristic profiles for each of these diseases are presented.


Paying for medical care: the burden on the disabled. The relationship between the distribution of income and the distributions of medical services and payments.

The study measures the economic vulnerability of disabled persons whose impaired health interfered with their earning ability. This population segment, about one sixth of the total population, represents the extreme both in terms of sensitivity to health problems and losses in economic power. The major findings are given in a nutshell. 1) Inadequate income did not bar the disabled individuals from contact with the medical care system except in the case of the weakest among the weak, the aging women without husbands. This finding suggests that the restraining effect of income can become strong enough to overcome the concern with ill-health, although the inhibiting effect of economic constraints weakens when the concerns with health problems intensifies. (2) Once contact with the health care system had been extablished, there was no evidence to suggest that lack of means to pay for medical services had restricted the quantity of services rendered to the disabled, although inability to pay might have affected the setting in which care was provided. 3) The needed medical care was obtained at a considerable financial sacrifice. As Table 6 shows, the level of direct out-of-pocket payments imposed a heavy burden on low and moderate income households, and this burden eased gradually as household income-levels increased.


Levamisole: lack of immunopotentiation in a controlled trial.

The immunopotentiating effect of levamisole was assessed in a double-blind trial in two comparable groups of patients with Down's syndrome, with which the immunodeficiency and susceptibility to infection are known to be associated. One group was given levamisole continuously and at the same dose for 16 weeks, and the other group was given placebo tablets. A checklist was designed to record the type, frequency, and duration of all infections which occurred in the patients, and delayed type hypersensitivity responses to various antigens were measured. There were no differences between the two groups in body weight, number of intercurrent infections, duration of illness, nor was there any change in degree of depression or cutaneous delayed-type hypersensitivity. These findings, taken with claims of success in some patients and failure in others, suggest that levamisole is not a general immunopotentiating agent, although it may have a specific site (or sites) of action on the immune system. If levamisole is to be used more selectively, this action needs to be characterized.


Myocardial infarction in the Kathmandu Valley: relation to two ethnic groups.

The incidence of 57 cases of acute cardiac infaraction in two major ethnic groups living in the Kathmandu Valley, Nepal, under similar cultural and socioeconomic conditions is reported. Although there was no statistically significant difference in the age distribution in the two groups, a higher incidence of cardiac infarction was found in the Indo-Aryan ethnic group.


Nonsystemic treatment of metastatic tumors of the liver--a review.

Hepatic metastasis is usually quite resistant to conventional systemic chemotherapy. Nonsystemic treatment of metastatic tumors of the liver include surgical resection; infusion of chemotherapeutic agent(s), either via hepatic artery or portal vein; ligation of hepatic artery; radiotherapy; and other more investigative approaches (isolation perfusion, cryosurgery, liver transplantation, etc). The relative applicability, results, and limitations of each of these therapeutic modalities are reviewed.


In vitro comparison of six commercially available thermodilution cardiac output systems.

Six commercially available thermodilution cardiac output catheter-and-computer systems were evaluated over a variety of simulated clinical conditions using a fixed-output pulsatile-flow pumping unit. Simultaneous testing was performed at pumping rates of 60, 80, and 120 beats per minute and over an output range of 1.57 liters/min to 14.11 liters/min under normothermic, hyperthermic, and hypothermic conditions. Precision within each thermodilution system, as measured by the standard deviation (S.D.) of serial determinations, was acceptable with an overall S.D. range between 0.015 and 0.588 liters/min. When averaged over all experimental situations, the mean percent deviation of five or ten serial measurements was within 10 percent of the known pump output for all systems and maintained a fairly constant relationship above or below the pump output. In this in vitro test, iced injectate did not consistently improve precision or accuracy above that obtained with room-temperature injectate. Features other than performance should also be considered when selecting a particular unit to fulfill a clinical or research need.


In vivo transfer of the ti-plasmid of Agrobacterium tumefaciens to Escherichia coli.

The Ti-plasmids are naturally self-transmissible from their normal host Agrobacterium to E. coli. They are however unable to stably establish themselves as a replicon in E. coli. It is nevertheless possible to study the Ti-plasmids in E. coli with the help of Ti::RP4 cointegrate plasmids that transfer and maintain themselves very efficiently in E. coli. An E. coli harbouring such a Ti::RP4 plasmid is unable to catabolize octopine and unable to induce crown-gall tumours on plants.


Inhibition of 5-hydroxytryptamine uptake by tetrahydronorharmane in vivo.

Injection of tetrahydronorharmane (THN) elicited a dose-dependent increase of the level of 5-hydroxytryptamine (5-HT) and a fall of 5-hydroxyindoleacetic acid in the rat brain whereas noradrenaline and dopamine levels remained unchanged. The effect on indoles was shortlasting which may be explained by the short half life of THN or its metabolization to 6-OH-THN. The 5-HT depleting action of parachloro-N-methylamphetamine (CMA) was used to study uptake inhibition in vivo. The results support the notion that THN acts as an inhibitor of the reuptake of 5-HT in vivo. Further evidence for this hypothesis was obtained by intraventricular injection of radiolabelled 5-HT. The disappearance of (3H)-5-HT from brain tissue was reduced by THN. Thus, THN may exert its central 5-HT-like effects in pharmacological experiments by preventing 5-HT from being removed from the synaptic cleft.


Serotonergic stimulation of pituitary-adrenal activity in the mouse.

Female CF1 mice were given L-5-hydroxytryptophan (5-HTP), quipazine, or  6-methoxy-1,2,3,4-beta-carboline (6-MeO-THBC) in conjunction with various serotonergic drugs to determine if the pituitary-adrenal stimulation produced by the former compounds is serotonergically mediated. Corticosterone (CS) responses to 5-HTP were uninfluenced by pretreatment with a tryptophan hydroxylase inhibitor, p-chlorophenylalanine (PCPA), but were significantly potentiated by a serotonin (5-HT) reuptake inhibitor (Lilly 110140), attenuated by two 5-HT receptor blockers, cyproheptadine and methergoline, and almost completely abolished by 2 extracerebral aromatic L-amino acid decarboxylase inhibitors, MK 486 and a low dose of Ro 4-4602. It was also established that L-tryptophan could stimulate pituitary-adrenal activity in animals pretreated with the monoamine oxidase (MAO) inhibitor pargyline. Serotonergic drugs were generally not as effective in modulating the responses to quipazine and 6-MeO-THBC. It is concluded that (1) 5-HTP stimulates pituitary-adrenal activity in mice by being converted to 5-HT and acting on 1 or more groups of serotonergic receptors; (2) these receptors are located either in an area of the brain outside of the blood-brain barrier such as the median eminence or in a peripheral tissue(s); (3) tryptophan-derived 5-HT can stimulate these receptors, but only if allowed to accumulate by inhibiting its catabolism; and (4) it is not yet clear whether pituitary-adrenal responses to quipazine and 6-MeO-THBC are mediated by a serotonergic mechanism.


Huntington disease: normal lipid composition of purified neuronal perikarya and whole cortex.

This is the first report of the lipid composition of human neurons. Neuronoal perikarya were isolated from frozen samples of the cerebral cortex of persons with Huntington disease and two normal controls. These were analyzed for total lipid, individual lipids, and gangliosides. No differences were detected between diseased and normal cells. In addition, gray matter samples from the same patients, and one additional patient and control sample, were analyzed and found not to differ. Thus the ultrastructural abnormalities seen in cortical biopsies are not reflected in the concentration of the major lipid classes.


[Cholinergizing treatment in hyperkinesis].

Hyperkineses are a clinical and pathogenetic counter-part of parkinsonism (MP). Their underlying cause is increased activity of the dopaminergic system or insufficiency of the cholinergic system. Treatment inhibiting the dopaminergic system, similarly as anticholinergic treatment is of little effectiveness in MP. A trial of substitutive treatment was undertaken activating the cholinergic system with a precursor of acetylcholine (dimethyl-amino-ethanol-deanol--Bimanol) with simultaneous inhibition of cholinesterase with prostigmin. The results of this treatment were compared with previously applied antidopaminergic treatment (Haloperidol) and with the effects of L-dopa. This treatment was given to 11 patients with Huntington's chorea (ChH), 4 with faciolingual dyskinesis (DFL), 3 with torticollis spasmodicus (TS), 3 with maladie des tics (MT) and 8 with dyskinesia following treatment with L-dopa (MP). Cholinergizing treatment gave better results than antidopaminergic treatment in TS and ChH, and worse in MT. In dyskinesia following L-dopa cholinergizing treatment gave also no effects reported by others. Differences in the results of cholinergizing and antidopaminergic treatment may indicate non-homogenous pathological mechanism of these hyperkineses. Cholinergizing treatment in hyperkineses is based on a similar principle as L-dopa treatment in MP and this approach seems to be proper but more effective preparations should be sought for.


[Dynamic geometry of the left ventricle. Relaxation and elasticity indices].

A study was made of 34 patients with valve defects or arterial hypertension and a haemodynamic picture of left ventricle pressure or volume load. Echocardiography and haemodynamic investigated-established the size and mass of the left ventricle and also enabled its indices of contractility, relaxation and distensibility to be determined. The series was divided in accordance with the dynamic geometry of the left ventricle. In concentric hypertrophy, telediastolic rigidity increased in proportion to ventricular thickness and mass. In eccentric forms and ventricular dilatation, diastolic distensibility was reduced in cases with a high filling pressure. The relaxation values bore no relationship to distensibility and telediastolic compliance. The relaxation rate in protodiastole diminishes in proportion to functional depression of the left ventricle.


A simple device for double Falope-Ring application.

A simple principle of interrupting the complete approximation of the operating slide to the thumb ring was utilized to apply the Falope-Ring to each fallopian tube with one introduction of the Falope-Ring applicator already loaded with two rings, thus eliminating the process of withdrawal, reloading, and reinsertion. This procedure has been performed with the use of a simple device on 46 patients with good success. It seems to be technically easy and shortens the operating time by avoiding the possibility of fogging the optics during the process of withdrawing the scope for reloading.


[Penile plastic induration].

Plastic induration is briefly described and its similarity to Dupuytren's disease is discussed in an attempt to detect a common origin. Results obtained in histochemical investigation of this question appear to suggest that changes in the polysaccharide components of the fundamental substances of the connective tissue are involved.


The steroid profile of a virilizing ovarian tumor.

A case report of a 25-year-old female with a sex cord stromal virilizing ovarian tumor is presented. The pathway of ovarian steroid secretion in this tumor is elucidated with the dominant elements being pregnenolone, 17-hydroxypregnenolone, 17-hydroxyprogesterone, androstenedione, and testosterone. The tumor primarily made testosterone (T) with lesser elevations of androstenedione (A), dehydroepiandrosterone (DHEA), and dihydrotestosterone (DHT). Expert pathologic opinions differed whether this neoplasm was a Sertoli-Leydig tumor or a virilizing granulosa tumor; therefore, it was probably a gynandroblastoma. A unilateral salpingo-oophorectomy was performed and the patient promptly resumed normal ovarian function with ovulation.


Laparoscopic sterilization with therapeutic abortion versus sterilization or abortion alone.

Records of 606 therapeutic abortions performed by suction curettage, 693 interval laparoscopic sterilizations, and 442 combined procedures were analyzed and compared. The following conclusions were obtained: 1) Abortion alone and abortion with laparoscopic sterilization are similar in rates of postoperative morbidity (4.3 and 7%, respectively) and early complications (3.3 and 2.9%, respectively). 2) The risks in laparoscopic sterilization alone are significantly lower for postoperative morbidity (2.2%) and early complications (0.9%) than for abortion alone or for the combined procedure.


Congenital X-linked adrenal hypoplasia.

Fetal adrenal hypoplasia should be considered in pregnant patients with family histories of the condition and/or following observation of drastically reduced maternal estriol excretion. Antepartum diagnosis is important in the clinical management of these infants since deteriorating adrenal function frequently follows an asymptomatic period during the early neonatal life. Antepartum and neonatal diagnostic studies can identify fetal adrenal hypoplasia.


Trisomy 21 in one of twin fetuses.

Both the detection of twins and the successful execution of a double amniocentesis pose significant technical problems in prenatal diagnosis. A case is reported in which one of twins fetuses had trisomy 21 and the other was chromosomally normal. Following counseling, the family chose to continue the pregnancy. At term, the mother was delivered of a healthy infant and a severely macerated fetus with stigmata suggestive of Down's syndrome.


Gastro-cutaneous fistula following anterior gastropexy.

Two patients are described who developed a gastric fistula to the anterior abdominal wall following anterior gastropexy. Both fistulae closed spontaneously without any specific treatment. It is suggested that the fixation of the stomach to the anterior abdominal wall allows the fistula to discharge externally thus preventing peritoneal contamination with its serious consequences.


Alternate reasons for atherogenesis in uremia.

The key to symptomatology in uremia is nitrogen retention leading to amidination and transmidination of a variety of substrates. The product of this activity is a series of guanidino acids which are methyl receptors converting S-adenosylmethionine to adenosine and homocysteine. Adenosine is a potent inhibitor of the enzyme ATPase and, in this way, contributes to the anemia, the bleeding diathesis and the CNS symptoms of uremia. Homocysteine is an inhibitor of pyridoxal phosphate-induced reactions and contributes to the angiitis and thromboembolism so unexpectedly encountered in chronic uremia.


[Monolayer culture of pancreatic beta cells of newborn rats: Insulin secretion in vitro and attempt at beta-cell transplantation in experimental diabetes].

Partially purified beta cell monolayer cultures were prepared from the pancrease of neonatal Wistar rats by dissociating the cells with a trypsin-collagenase solution. The cultures were grown in medium 199 containing a 10% fetal calf serum and 100 or 300 mg/100 ml glucose. Insulin release from the primary cultures during 12 days was 15 to 20 microunit/culture/day when the cells were grown in the medium containing 300 mg/100 ml glucose. When glucose concentration in the medium was decreased from 300 to 100 mg/ml insulin release fell to 2--5 microunit/culture/day. Theophylline stimulated insulin release in a short-time experiment. Transplantation of a 6--8-day culture in diabetic rats reduced the blood glucose concentration for 1 to 2 days.


An in vitro study of how much methylprednisolone is needed to produce immunosuppression.

An in vitro assay system (MLR-LMC) was used to study the optimal time-concentration characteristics of methylprednisolone as an immunosuppressive drug. Our data suggest that low doses of methylprednisolone (less than 40 mg) most probably contribute little to immunosuppressive therapy and that high doses (15 to 30 mg/kg) are most probably excessive. Clinical trials are necessary to establish the validity of these conclusions and to establish the optimal dose schedule for the administration of steroids to patients undergoing renal transplantation.


Molecular structure of membrane vesicles from Escherichia coli.

The molecular architecture of membrane vesicles prepared from Escherichia coli ML 308-225 has been studied by using crossed immunoelectrophoresis, and a reference pattern of 52 discrete immunoprecipitates has been established. Progressive immunoadsorption experiments conducted with untreated control vesicles and with physically disrupted vesicles demonstrate that the membrane-associated immunogens fall into two categories: (i) those immunogens typified by ATPase (ATP phosphohydrolase, EC 3.6.1.3) and NADH dehydrogenase [NADH: (acceptor) oxidoreductase, EC 1.6.99.3] whose expression is minimal unless the vesicles are disrupted; and (ii) immunogens such as Braun's lipoprotein that are expressed to similar extents in untreated and in disrupted vesicles. A mathematical relationship between the peak area subtended by an immunoprecipitate in the crossed immuno-electrophoresis system and the quantity of vesicles used in the adsorption process has been derived. This relationship allows quantitation of the degree to which specific membrane immunogens partition between exposed and unexposed surfaces of the vesicle membrane. The results demonstrate conclusively that >95% of the membrane in the vesicle preparations is in the form of sealed sacculi with the same polarity as the intact cell. Moreover, the findings provide a strong indication that dislocation of immunogens from the inner to the outer surface of the membrane during vesicle preparation does not occur to an extent exceeding 11%.


Relationship between somatic mutation and neoplastic transformation.

Somatic mutation and neoplastic transformation of diploid Syrian hamster embryo cells were examined concomitantly. Mutations induced by benzo[a]pyrene and N-methyl-N'-nitro-N-nitrosoguanidine were quantitated at the hypoxanthine phosphoribosyltransferase and Na(+)/K(+) ATPase loci and compared to phenotypic transformations measured by changes in cellular morphology and colony formation in agar. Both cellular transformations had characteristics distinct from the somatic mutations observed at the two loci. Morphological transformation was observed after a time comparable to that of somatic mutation but at a frequency that was 25- to 540-fold higher. Transformants capable of colony formation in agar were detected at a frequency of 10(-5)-10(-6), but not until 32-75 population doublings after carcinogen treatment. Although this frequency of transformation is comparable to that of somatic mutation, the detection time required is much longer than the optimal expression time of conventionally studied somatic mutations. Neoplastic transformation of hamster embryo cells has been described as a multistep, progressive process. Various phenotypic transformations of cells after carcinogen treatment may represent different stages in this progressive transformation. The results are discussed in this context and the role of mutagenesis in the transition between various stages is considered. Neoplastic transformation may be initiated by a mutational change, but it cannot be described completely by a single gene mutational event involving a dominant, codominant, or X-linked recessive locus. Neoplastic transformation induced by chemical carcinogens is more complex than a single gene mutational process. Thus, this comparative study does not give experimental support to predictions of the carcinogenic potential of chemicals based on a simple extrapolation of the results obtained from conventional somatic mutation assays.


Induction of ouabain-resistant mutations in C3H 10T1/2 mouse cells by ultraviolet light.

Ouabain-resistant mutants were induced in C3H mouse embryo 10T1/2 fibroblasts by exposure to ultraviolet light, thus making available an in vitro system for studying mutagenesis and oncogenic transformation in parallel. 86Rb uptake studies showed that biochemical mutants at the plasma membrane Na+,K+ transport ATPase (EC 3.6.1.3) locus were being selected for in this system. The optimal expression time for the mutants was found to depend on the dose of ultraviolet light, as was the induced mutation frequency. The ratio of transformation to mutation frequencies was found to be on the order of 10 for four different doses, suggesting that the target size in the cellular genome for transformation may be approximately 10 times the size of the Na+,K+ ATPase gene. We propose that both transformation and mutation induction can now be quantitatively studied in this single system.


Failure of autologous mixed lymphocyte reactions between T and non-T cells in patients with systemic lupus erythematosus.

Normal human T cells proliferate vigorously when stimulated with autologous non-T cells. This autologous mixed lymphocyte reaction (MLR) between T and non-T cells was defective in patients with active systemic lupus erythematosus (SLE). In contrast, T cells and non-T cells from active SLE patients behaved normally as responding and stimulating cells, respectively, in the allogeneic MLR. The etiology of the impaired autologous MLR was further examined by studying the functional capacity of subsets of stimulating or responding cells. B cells, L cells, and monocytes from active SLE patients failed to stimulate autologous T cells but these cells effectively stimulated allogeneic T cells. Fc(IgG)+ T cells from active patients were unable to respond in both the autologous and allogeneic MLR; their Fc(IgG)-T cells responded well in the allogeneic but not in the autologous MLR. The Fc(IgG)+ T cells, but not the Fc(IgG)- T cells, from inactive SLE patients also failed to respond in the both autologous and allogeneic MLR. These studies indicate that patients with SLE have functionally defective Fc(IgG)+ T cells and a defective autologous MLR, both of which may contribute to impaired regulation of immune functions.


A comparison of two developmental instruments in evaluating children with Down's syndrome.

Twenty-one children with Down's syndrome were given both the Bayley Scales of Infant Development and the Gesell Developmental Schedules. Mental and motor developmental lags measured on the Bayley Scale were found to be significantly larger than comparable lags measured on the Gesell Schedules. Further, developmental lags for the mental and motor portions of the Bayley were not significantly different. For the Gesell, however, mental lag was significantly larger than motor lag. Finally, mental and motor lags increased with chronologic age on the Bayley, but only mental lag increased with age on the Gesell. These discrepancies indicate that for this population of infants the Bayley and the Gesell are not interchangeable assessments because they do not yield the same developmental patterns.


Inhibition of mitochondrial ATPase by Hg++ ions.

1. Maximum heart mitochondrial ATPase activity is displayed in the presence of an ATP/Mg++ ratio of 0.6--1.2. Under these conditions, mercury ions inhibit ATPase activity of both the mitochondria and the isolated enzyme. In both cases, inhibition occurs within concentration limits of 1--1.5X10(-4) M. 2. The inhibitory effect of free Hg++ ions can be abolished by converting them to a complex with ethylenediaminetetraacetic acid [EDTA]. 3. The inhibitory effect of Hg++ ions on mitochondrial ATPase can be attributed to their nonspecific action on functional groups of the active centre or to breakdown of the quaternary structure of the protein molecule of the enzyme.


Comparison of life span of erythrocytes in some inbred strains of mouse using 14C-labelled glycine.

The erythrocyte life span in four inbred strains of mice--C57BL/10ScSnPh, B10.LP, BALB/c and CBA/JPh--was determined by means of erythrocyte labelling with 14C-glycine. Experimental data [decrease of 14C-activity of washed erythrocytes], corrected for blood loss, reincorporation of the label and delay in label incorporation during the initial period, were treated by a novel mathematical procedure based on the death probability function of the form: mu [t] = a + btlambda. The mean erythrocyte life span calculated using this function was, in the given sequence of strains, 42.1 +/- 0.6, 41.3 +/- 1.2, 39.3 +/- 0.9 and 38.6 +/- 0.6 days respectively. The rate of "random" destruction of erythrocytes was 1.20, 1.31, 0.70 and 0.63% of the total number of erythrocytes per day and a "mean potential" erthrocyte life span was found to be 58.9, 59.9, 46.2 and 44.5 days respectively. All the given parameters have similar numerical values in related strains and are apparently genetically conditioned. The erythrocyte life span determined simultaneously using DF32P labelling in the C57BL/10ScSnPh strain was 47.4 +/- 1.0 days. The implications of the results yielded by these two techniques is discussed.


Effect of Trisetum flavescens P.B. on calcium and phosphorus metabolism in rats. Experimental evidence for the principle actively affecting phospho-calcium homeostasis.

After reviewing the literature on the vitamin D3-like activity of certain plants [Solanum malacoxylon, Cestrum diurnum and Trisetum flavescens], the authors present results of experiments in which dried Trisetum flavescens was administered perorally to rats. The addition of 2.5% dried Trisetum flavescens to the standard laboratory diet caused a drop in blood phosphate levels and a simultaneous marked increase in the calcium and phosphorus content of bones of the experimental animals. The mechanism of the action of Trisetum flavescens on phosphocalcium metabolism is discussed.


Papulosquamous diseases.

The papulosquamous diseases have certain common morphologic appearances which may at times lead to confusion in diagnosis. They do not have any common etiologic factor. The most common diseases in this category are psoriasis, seborrheic dermatitis, lichen planus, pityriasis rosea, and secondary syphilis. Exfoliative erythroderma is included here since it rarely may be a complication of a pre-existing papulosquamous disease such as psoriasis, seborrheic dermatitis, and lichen planus.


Drug eruptions.

Although any drug may cause any dermatitis, it is possible to categorize a relatively few types of dermatitis and a relatively small number of drugs in such a way as to afford a practical approach to a sometimes confusing problem. These problems are generally clinical ones not requiring laboratory work and an experienced clinician will probably be able to manage most of these cases without extensive consultations.


Chest pain in the nontraumatized patient.

The radiologist plays an important role in the examination of nontraumatized patients with chest pain presenting in the emergency room. In some instances, a diagnosis can be made on the basis of the initial radiograph. In others, consultation with the referring physician may either make the diagnosis or indicate a need for additional view or other imaging procedures. In this discussion, medical conditions associated with various radiographic appearances of the chest have been considered. We have not attempted to be encyclopedic, but have confined ourselves to the more common or distinctiive radiographic findings. Obviously, chest pain can occur from many other causes including primary disease in the neck, abdomen, and skeletal system.


The use of echocardiography for quantitative evaluation of left ventricular function.

Echocardiography is a valuable technique for the diagnosis and serial follow-up of patients with impaired cardiac function. It is subject to certain limitations due to the assumptions inherent in deriving ventricular volume from a one-dimensional measurement and must be interpreted with caution in cases of suspected regional abnormalities of contraction. Given these caveats, echocardiography is valuable in the quantitative assessment of cardiac size and the level of compensation in patients with primary myocardial disease, valvular heart disease, and left ventricular hypertrophy. It can detect abnormal contraction in some patients with ischemic heart disease and provides an accurate method to serially follow changes produced as a result of drug or surgical therapy. Finally, two-dimensional techniques promise to provide a new perspective on the evaluation of patients with regional wall motion abnormalities.


Echocardiographic evaluation of the mitral valve.

In its developing years and during the esthetically unappealing polaroid era, echocardiography was employed, in parallel, with invasive studies. Its worth was being scrutinized; it had to be tested and verified. Although the technology continues to advance, with real-time imaging still to be refined, single-element M-mode echo, displayed as a strip chart recorder, should be allowed to stand on its own and to replace invasive studies in most patients with valve disease. More can be learned about valve function, and as much about ventricular function, from the echo than from catheterization and angiography.


[Causes of death in road traffic injuries. A comparison between 1970 and 1976 (author's transl)].

Despite an increase in road traffic, the number of those injured in the Canton of Geneva decreased by 37 p. 100 in 1976 compared with 1970, but the number of deaths in the Hospital was the same. The death rate has therefore increased. The authors have studied the reason for this increased rate in relation to age, sex and cause of death. The number of deaths from cardio-pulmonary insufficiency had decreased but the number resulting from infection had increased dramatically. The severity of lesions was measured using the Injury Severity Score of Baker. There was a close relation between the I.S.S. and mortality. This study has led to the establishment of a more accurate prognosis.


[Desmoid fibroma of the limbs (author's transl)].

The authors have treated nineteen cases of desmoid fibroma of the limbs of which two were intraosseous. The severity of the lesion was greater when sited proximally in the limbs. In many patients, the tumours grew slowly and gave little incapacity. A large number of recurrences were found after surgical excision. The treatment, however, must be based on surgical excision which should be as extensive as possible. Radiotherapy should only be used after the tumour has recurred several times. In view of reports of spontaneous healing, hormone therapy was tried but no conclusions could be drawn from these trials.


[Traumatic dislocation of the knee treated by early surgical repair (author's transl)].

The authors have treated twelve traumatic dislocations of the knee. Three were treated conservatively with one satisfactory result. Nine were treated by early surgical repair with seven satisfactory results. The technique of ligamentous repair is described. The authors emphasise the frequency and severity of associated vessel and nerve damage. They found acute lesions of the popliteal artery in five cases, three of which had to be operated upon immediately with arterial suture or graft. In one case, ischaemia appeared four days after dislocation and the thrombosed artery was repaired by a venous graft. In one case a lesion of the lateral popliteal nerve which did not recover was treated by palliative surgery. In one case, secondary skin necrosis was treated by skin flap transplantation using micro-surgical technique with a satisfactory result. It is concluded that ligamentous and vascular repairs should be undertaken at the same procedure after arteriography.


The surgical treatment of fractures of the upper end of the humerus by blind pinning (author's transl).

During a period of five years, the authors have treated 250 fractures of the upper end of the humerus. Fifty-one were treated by blind pinning. Six to eight Kirschner wires are passed up to the head of the humerus under X-ray control through a hole made on the posterior aspect of the lower end of the humerus just above the olecranon fossa. The functional results were satisfactory in 70% of cases. The indications for pinning were for severely displaced fractures, comminuted fractures, either impacted or not, or slipping of the upper humeral epiphysis. The results were less satisfactory in cases with an elevated greater tuberosity. The technique cannot be applied to fracture-dislocations.


[Treatment problems in old and recent rupture of the lateral knee ligament].

The authors have treated 31 fresh ruptures of the lateral ligament and 104 cases of chronic instability of the lateral side of the knee. In recent ruptures the results obtained after surgical repair were not as gratifying as those obtained after injuries of the medial ligament. The cases operated upon were tears of the lateral ligament associated with ruptures of one or both cruciate ligaments. The frequency of rupture of the popliteus tendon is emphasized. The authors recommend, when necessary, a double surgical approach both laterally and posteriorly and plaster cast immobilization for more than 6 weeks. Tendon transfer in recent lesions have been done when suture of a cruciate ligament was impossible. The results of several procedures for chronic instability were analysed; transposition of the patellar ligament, transposition of the head of the fibula, or tightening of the lateral structures of the knee (capsule, ligament, popliteus tendon). Associated lesions of the cruciate ligament were treated by tendon transfer. Poor results were obtained in those presenting with fixed varus deformities. The authors conclude that such deformities should be corrected by osteotomy.


Effects of pre and perinatal malnutrition on muscle fibres from fast and slow rat muscles.

Pre and perinatal malnutrition of rats was effected by means of limiting the mothers' food intake by 50% during pregnancy and lactation. Male offspring were sacrificed at 36 weeks of age and the anterior tibialis (ANTIB) and soleus (SOL) muscles were prepared for histochemical demonstration of Type I, IIA and IIB muslce fibre types using myosin ATPase and succinic dehydrogenase activity. Muscle weights and mean muscle fibre area determinations showed greater decreases in ANTIB than SOL, SOL muscle fibre areas being relatively unaffected by the undernutrition regimen. The proportions present of the muscle fibre types differed in ANTIB and to a small extent on SOL. In the former muscle, some decreases in area in certain of the fibres were associated with increases in the percentages present, showing a tendency to maintain the physiological cross-sectional area of the muscle.


Correlation between mixed lymphocyte culture in compatibility and cadaver kidney graft rejection.

One-way mixed lymphocyte culture reactivity of recipient lymphocytes against the donor lymphocytes was measured in 11 recipients of cadaver kidneys. Peripheral blood was drawn from donors and recipients before the transplantation and lymphocytes isolated and frozen down for later typing. In one experiment, the lymphocytes from 11 recipient-donor pairs were thawed and the reactivity of the lymphocytes of the recipient towards the irradiated lymphocytes of the donor was estimated. Two unrelated controls were included, and the results were expressed as stabilized relative response taking into account both variations in responder- and stimulator capability of the lymphocytes. Four patients with a high relative response (above 50) had rejection episodes during the first month of transplantation in contrast to seven patients with a low relative response, who had no rejection episodes during the first month (p = 0.003). At six months, three of the four high responders had lost their graft compared to two of the seven low responders.


Inhibition of bone formation during space flight.

Parameters of bone formation and resorption were measured in rats orbited for 19.5 days aboard the Soviet Cosmos 782 biological satellite. The most striking effects were on bone formation. During flight, rats formed significantly less periosteal bone than did control rats on the ground. An arrest line at both the periosteum and the endosteum of flight animals suggest that a complete cessation of bone growth occurred. During a 26-day postflight period, the defect in bone formation was corrected. No significant changes in bone resorption were observed.


Two and a half years of acupuncture in Alabama.

From the data presented it appears that acupuncture helped in more than 50% of the patients by either completely or partially controlling pain from certain disorders. Patients helped by acupuncture received 8.55 treatments on the average, while patients not helped by acupuncture only received 4.75 treatments. There is difference between the male and female patients as to the response to acupuncture. However, we noticed that the younger the patient and the shorter the duration of their of problems, the better the response. Patients who had not had surgery to treat the pain syndrome responded better than those who had had previous surgery. Patients with backache who had previously had laminectomy showed better response to acupuncture than patients who had had spinal fusion. It appears that good general health plays an important role in favorable response to acupuncture treatment. Acupuncture may be a valuable extension of a conventional pain clinic and an alternative in patients who are desperate to obtain relief from pain which they failed to obtain from other methods.


Double loop mass closure technique for abdominal incisions.

The technique of double loop mass closure of vertical abdominal incisions converts a vertical incision into a physiologic incision by converting distracting muscular stress into an opposing force. Use of the closure in a small series of high risk patients has demonstrated it to allow closure of vertical incisions with subsequent wound healing without hernia, dehiscence or invasive wound infection.