[Participation of gonads in pulmonary silicosis].

A survey is given on the participation of endocrine glands in the pulmonary silicosis. At the same time a new clinical and experimental contribution to the question of the appearance of a hypogonadotropic hypogonadism is given. The frequency of this hypogonadism increases with the severity of the pulmonary silicosis. The immunological opinions as well as the neuroergonal ones concerning the pathogenesis of pulmonary silicosis gave the possibility of a better explanation of the mechanisms, by means of which also other organs may be attacked in pulmonary silicosis. The neuroendocrine system gives a defensive answer to the aggressive silicotic pulmonary process, which in general slowly progresses, but which may also be certain hormones from the group of the glucocorticosteroids in the adrenal cortex. The intervention into the axis hypothalamus-hypophysis-adrenal cortex has been provided in all defence processes of the organism against every aggression. By the functional or organic damage of the neuroendocrine system, by the immediate toxic effect of silicium dioxide or the monosilicium acid as well as by the effect of the secondary hypoxia in pulmonary silicosis an insufficiency in the stimulation and excretion of certain hormones develops. The origin of this insufficiency is found in the hypothalamo-hypophyseal centres, and the effects extend to all endocrine glands which depend on the system hypothalamus-hypophysis. This mechanism is made responsible for the appearance of a hypogonadotropic insufficiency of gonads in the course of a pulmonary silicosis and is proved clinically and experimentally in the cases investigated by the authors


[Antibody titers--curse in patients with recurring Herpes simplex virus infections under vaccination with heat-inactivated Herpes viruses].

Follow-up studies of antibody-titres in patients suffering from recidivations of herpes labialis and progenitalis treated with herpes virus vaccine inactivated by heat. It was stated by several authors that patients suffering from recidivations of herpes labialis and progenitalis can be successfully treated with a herpes virus vaccine inactivated by heat (Lupidon G/H). Nothing is known, however, about the mechanisms diminishing recurrences. We have studied 11 patients and 3 control persons whether there were changes in specific antibody titres after repeated vaccinations. Skin reactions following intradermal injections were also tested. Serum samples studied over a period of 8 weeks until 9 months showed that the antibody titres found by complement-fixation and neutralization tests remained practically constant. Skin tests were always negative. Therefore it merits further study to find out the mode of action of this clinically successful treatment.


Immunoglobulins under the influence of nonspecific factors. III. Immunoglobulins, pertussis antibodies and lysozyme in three child populations exposed to different air pollution.

The levels of IgG, IgA, IgM, lysozyme, agglutinins against B. pertussis and B. parapertussis were followed in the blood serum of 306 children 9--10 years old in 3 areas of Central Bohemian region. In children dwelling in areas with more polluted air significantly higher levels of serum lysozyme and of parapertussis antibodies were found by the t-test. The distribution of these values shows significant differences between more polluted areas in comparison with lower-pollution area also in Kolmogorov-Smirnov test. The average levels of Ig approached statistically critical values but did not reach them, but significant differences in the distribution of values of IgG and IgA were shown by the F-test and chi2-test between lightly and heavily polluted areas. The values of immunological reactions in polluted areas were always higher than in the non-polluted group. This provides evidence for a hypothesis about a stimulatory effect of polluted air on immunological mechanisms in child population. The higher values of IgM observed recently by other authors in women were shown in girls of 9--10 years.


Local and systemic opsonic adherent, hemagglutinating and rosette forming activity in mice induced by respiratory immunization with sheep red blood cells.

The humoral response in mice after intranasal (IN) instillation of sheep red blood cells (SRBC) was compared to that produced by intraperitoneal route of immunization. Study of opsonic adherent (passive indirect cytophilic) and hemagglutinating antibody levels in serum and bronchial washings after repeated challenge with SRBC showed that serum antibody titers following respiratory immunization does not differ from the general pattern of a humoral antibody response. The bronchial wash antibody titer was higher than the serum titer as calculated per globulin unit. In contrast, the appearance of measurable antibodies in the bronchial washings after repeated intraperitoneal immunization was delayed and in low titer. B. pertussis vaccine administered in conjunction with SRBC was found to be an excellent adjuvant in the intranasal route of immunization. A single administration of SRBC-Pertussis evoked a considerable adjuvant effect as measured by hemagglutinating and opsonic adherent tests. Monospecific anti-mouse IgG nullified the hemagglutinating and opsonic adherent activity of the bronchial washings, while monospecific anti-mouse IgM had no effect in either activity. Lung and spleen cells capable of forming rosettes with SRBC of intranasally immunized and control mice were counted. Mean response on day 14 was 6 X 10(3) rosetes per million lung lymphoid cells in comparison with less than 10(3) in control mice. No difference was found in the number of rosette-forming cells in the spleen of control and intranasally immunized mice.


Identification of collagen-anticollagen immune complexes by collagenase-digestion.

A method for the detection of collagen-anti-collagen immune complexes using collagenase of bacterial origin is described. Anti-collagen-titers are determined in passive haemagglutination before and after collagenase digestion of samples containing preformed immune complexes. An increase in anti-collagen titers following the enzymatic treatment suggests the presence of collagen-anti-collagen immune complexes. Both solbule and carrier-bound collagenase proved to be equally effective in the digestion of complex-bound collagen, if in vitro prepared collagen-anti-collagen complexes were investigated. Original titers of partially or totally inhibited antisera to collagen could be completely restored by this method.


Indirect EPR evidence for the production of singlet oxygen in the photosensitization of nucleic acid constituents by proflavine.

EPR spectroscopy is used to analyse the influence of D2O and NaN3 on the free radicals induced in frozen aqueous solutions of 5'-thymidine monophosphate photosensitized (lambda greater than 320 nm) by proflavine at 205 K. The results can be explained if the production of singlet oxygen during the process is assumed.


[Hidradenoma of the skin. Synoptic reveiw of syringeal hidradenoma, eccrine epithelioma and eccrine basalioma (author's transl)].

An ulcerating and sclerosing skin tumour on the temporal forehead region is described. Histologically the tumour is composed of different structures as cystic hidradenoma, syringoma, ductal hidradenoma and sclerres as cystic hidradenoma, syringoma, ductal hidradenoma and sclerosing basalioma arranged in layers. The tumour appears to be a distinct and diagnosable entity. It exists a major similarity to such tumours reported as syringeal hidradenoma, eccrine epithelioma or eccrine basalioma.


Coupling factor adenosine-5'-triphosphatase from Rhodospirillum rubrum: a simple and rapid procedure for its purification.

When photosynthetic membranes from Rhodospirillum rubrum, devoid of loosely bound small molecules and proteins, were passed through a French-pressure cell, the enzyme adenosine-5'-triphosphatase (EC 3.6.1.3.) (ATPase) was released into the soluble fraction. The solubilized ATPase was purified to homogeneity. In many respects it behaved like the enzyme purified by other workers, but it also hydrolyzed Mg-ATP with a small, but significant rate. Furthermore, it was much more stable. Maximal restoration of photophosphorylation in ATPase-depleted membranes was achieved by addition of about 1 mg purified ATPase per mg bacteriochlorophyll. For reconstitution of NAD+-photoreduction, about half of this amount was saturating.


[Indications and technics for esophagoduodenostomy].

From 1961 to 1974 19 esophagoduodenostomies have been performed after total gastrectomy. One patient died postoperatively because of pulmonary embolism. The mean survival rate was 16,4 months. In far advanced gastric carcinomas an elongation and dilatation of the duodenum favours this kind of anastomosis. In low risk patients, in the aged and for palliative gastrectomy we suggest to prove the possibility for performing an esophagoduodenostomy.


[Arrhenoblastoma with following pregnancy].

The emergence, the morphology, the characteristic symptoms, the treatment and prognosis of a rare tumour of the ovary, arrhenoblastoma, is dealt with in this article. This is followed by the writer's own experience of the case of a 24 year old patient who had a normal pregnancy and birth 2 years after the existirpation of a tumour on the left side, which, having been detected by change, proved to be a non-malignant arrhenoblastoma. The symptoms of virilism so typical of the tumour had disappeared. The normal female characteristics had returned. The patient has now been free of symptoms for 10 years. In cases of increasing virilism differential diagnostics should consider the possibility of this rare tumour.


Synthesis and electron spin resonance study of spin-labelled compounds related to tumour-growth inhibitory nitroarylaziridines.

Three stable free radicals have been prepared which are akin to 5-aziridino-2,4-dinitrobenzamide (CB 1954); these compounds all contain a nitroxide function. The metabolism and excretion of two such compounds in mice has been monitored by electron spin resonance (ESR) spectroscopy and compared with that of the simpler nitroxide, 4-keto-2,2,6,6-tetramethylpiperidino-1-oxyl (tempone).


MO calculations of some thymine radicals at the INDO level.

The results of MO INDO calculations of some thymine radicals are presented. These include as well as the hydrogen addition radicals the hydroxyl addition radicals to C5 and to C6 of the C5=C6 double bond of the thymine molecule. The radicals resulting from hydrogen abstraction from the methyl group and from the nitrogen N1 are also studied. Except for radicals where the main spin density is localized on nitrogen atoms, the agreement between experimental and theoretical couplings is satisfactory.


[Ultrastructure of B. pertussis using cryoultramicrotomy].

The authors pointed to a possibility of using the method of cryoultramicrotomy in studying the ultrastructure of Gram negative B. pertussis bacteria under the following conditions: a) fixationwith a 5% glutaraldehyde on cacodylate buffer (pH 7.5) for 30 min; b) replacement with a 30% dimethylsulfoxide in distilled water with a subsequent embedding of the material into tissue-tek; c) freezing in fluid nitrogen for 5 min; d) cutting at a temperature of -- 90% degrees C and at the temperature of glass knife of -- 40 degrees C, the knife angle of alpha = 45 degrees, beta = 6 degrees, and the cutting velocity of 5 mm/sec; e) placing of sections on copper grates covered with a 0.1% moulding membrane; d) contrasting with a 2% phosphotungstic acid queous solution (pH 7.5) for 5 sec and with a 3% uranil acetate on water for 5 min. Use of the mentioned method pemitted to detect structures localized in B. pertussis cytoplasm and also to trace the dynamics of their formation.


[Comparative characteristics of antigenic peculiarities and several other properties of stable long-term cultures of salmonella L-forms].

Enzymatic properties, sensitivity to antibiotics and peculiarities of the antigenic structure of stable L-forms of S. paratyphi B (L-115), S. typhimurium (L-71a-16) and S. typhi (L-5761) were studied. In difference from the initial strains, the L-form under study possessed a high penicillin and ampicillin sensitivity, and also a marked sensitivity to polymyxin and detergents; this characterized them as L-forms of protoplastic type. All the L-variants differed considerably by the enzymatic properties from the initial strains, and, in the majority of cases, retained the antigenic components and the species-specificity characteristic of the initial parental cultures. Despite the loss of the cell wall the synthesis of O-antigen in the L-forms under study was undisturbed. The 6-forms contained an antigenic component not found in the initial cultures and apparently causing the neutralizing activity of the L-antiser.


[Morphology of Halprowia (Chlamydia) isolated in Reiter's syndrome].

Morphology and ultrastructure of Halprowia arthritidis, strain SR-1 (HSR), isolated from the synovial fluid of a patient with Reiter's syndrome, was studied in the membranes of the yolk sacs of the developing chick embryos and the L-cell culture. In acridine orange staining for light and fluorescent microscopy there was revealed intracellular cytoplasmic inclusions containing HSR structures at various stages of its reproduction characteristic of halprowia (chlamydia). The direct immunofluorescent method demonstrated the presence of a characteristic HSR antigen not only in the developed inclusions, but also at the early stages of infection, when the morphological HSR structures could not be found by light microscopy. The ultrastructure of the HSR inclusions and forms in the cycle of development (of the initial  and elementary bodies) of the SR-1 strain was typical of other halprowia. A peculiar structure of a complex of cell wall and cytoplasmic membrane of the elementary body was described. Taking into consideration the biological characteristics of HSR revealed earlier it can be considered to be a typical representative of Halprowiales s. Chlamydiales. The data obtained on other halprowia, pointing out the fact that criteria of compactness and diffuseness of inclusions, the presence of absence of glycogen in the inclusions could not serve as taxonomic signs in classification of halrpowia, were confirmed on a model of the SR-1 studied.


[Discharge of myeloperoxidase from neutrophils during bacterial sorption].

A study was made of conditions and dynamics of discharge of myeloperoxidase (MPO) from rabbit neutrophils in case of encounter with staphylococci. The discharge began not later than 9--12 minutes after the administration of Staph. aureus into the neutrophil suspension, i. e. as early as the stage of bacterial sorption, and reached the maximum by the 30th minute. The contact of neutrophils with individual bacteria was an adequate signal for the beginning of the discharge. The greatest discharge was with the ratio of 5 bacteria per one neutrophil. The discharge was retarded when this ratio reached 80: 1. A hypothesis on the "avalanche" switchingon of the system of MPO discharge: a single bacteria injection mu/ml a discharge from an individual neutrophil of MPO and cation proteins; the latter switch on discharge from several other neutrophils, without any participation of bacteria. Cation proteins intensified the MPO discharge in the concentration of the 10--20 switch on. Biolgical significance of the phenomenon of early discharge of antibacterial factors no directed to the provision of phagocytosis is discussed.


Insulomas and multiple endocrine neoplasia.

Seventy-eight patients with insuloma diagnosed between 1959 and 1968 in Sweden were studied for neoplasia in other organs. Twenty-one patients had beta-cell islet tumors, 14 Zollinger-Ellison's syndrome and non-beta-cell islet tumors, while no endocrine activity was demonstrated in 43 patients. Of the last-mentioned group, 9 patients had co-existing disease of other endocrine organs. In 10 patients, non-endocrine organs were found to be affected by malignant diseases. It appears probable that the tissue of the pancreatic islets, like parathyroid tissue, can react with hyperplasia with a later development of adenoma, secondary to tumors in other organs.


The unique cytologic picture of oat cell carcinoma in effusions.

Characteristic and unique patterns of the tumor cell population in pleural effusions in oat cell carcinoma have been described in detail. This pattern is constituted by rows of tumor cells or cell layers forming "vertebrae like" figures and "onion like" formations. A distinct pattern of this kind was only found in oat cell carcinoma. A distinct "oat cell carcinoma pattern" was also found in one quarter of the patients in a series of oat cell cancer with cytologic analysis of sputum. This fact may be of importance for the accurate typing of small cell undifferentiated cancer in sputum and bronchial secretions. Identical formations were also found in a histologic series of oat cell cancer. The study indicates that in small cell carcinoma of the lung it is possible by cytologic analysis of positive effusions not only to make a diagnosis of carcinoma, but also to confirm the histologic type and, thus, the origin of the tumor.


Cytologic differential diagnosis of bronchiolo-alveolar carcinoma and bronchogenic adenocarcinoma.

In order to estimate the possibility of a cytologic differential diagnosis of bronchiolo-alveolar carcinoma and bronchogenic adenocarcinoma, 121 histologically proven cases of these two types of lung cancer were studied. Certain features of the tumor cells were used as differential diagnostic parameters. By means of these features it was possible to correctly type 90% of the bronchiolo-alveolar carcinomas and 72% of the bronchogenic adenocarcinomas. The most striking characteristics of bronchiolo-alveolar carcinoma was the uniformity of cells, the occurrence of such cells in tightly packed clusters, the absence of prominent nucleoli and also the scarcity of single tumor cells. Thus, it seems possible to make a correct cytologic differential diagnosis between these two types of lung tumors with high accuracy.


Evaluation of needle aspirates and tissue sections as prognostic factors in mammary carcinoma.

The prognostic influence in operable mammary carcinoma of morphologic predictors evaluated in smears of needle-biopsy aspirate and in tissue sections and of clinical stage was investigated. Size of nuclei in smears of aspirate was found to convey prognostic information of the same order of importance as the variables tubule information and mitotic frequency in tissue sections. The combination of clinical stage with variables in smears  and in sections enhanced the explanatory value.


Oncornavirus-like particles in biopsy material from a glandular erosion of the human uterine cervix.

Virus-like particles have been detected electron microscopically in biopsy material from a glandular erosion of the human uterine cervix. Morphologically, the particles resemble immature and mature type C virus particles. The significance of the oncornavirus-like structures remains unknown.


Different effects of exogenous cyclic adenosine monophosphate and its dibutryl derivative on plasma growth hormone, glucose, insulin and cortisol.

The effects of the infusion in four different dosages (0.001, 0.005, 0.02 and 0.2 mg/kg/min during 60 min) of cyclic 3',5'-adenosine monophosphate and of its dibutyryl derivative on plasma growth hormone and on glucose, immunoreactive insulin and cortisol were studied in 38 normal subjects and in 10 patients with idiopathic hypopituitarism. In normal subjects cyclic 3',5'-adenosine monophosphate provokes an increase in plasma growth hormone levels (only when a dosage of 0.2 mg/kg/min is used) without any changes in plasma glucose, insulin and cortisol. The maximal value of the means is observed 75 min after starting the infusion. Dibutyryl cyclic 3',5'-adenosine monophosphate (0.2 and 0.02 mg/kg/min) provokes a dose-related rise in plasma growth hormone levels which is always preceded by hyperglycaemia and hyperinsulinaemia. The peak of the mean growth hormone levels occurs at 135 min after initiation of the infusion. In all but one hypopituitary patients the nucleotides do not promote growth hormone secretion. It is concluded that exogenous cyclic 3',5'-adenosine monophosphate and its dibutyryl derivative may not be considered as analogous and that both compounds may contribute to study growth hormone release in normal subjects and in patients with growth abnormalities.


Pulmonary blastoma: cytopathologic and histopathologic findings.

A case of pulmonary blastoma has been presented with a description of the pulmonary cytology and review of the literature. Recognition of the two cell patterns of the tumor, carcinomatous and sarcomatous elements, in the cytologic specimen may lead one to the correct diagnosis of a mixed tumor. Ferruginous bodies and microliths were also associated in this case.


Demonstration of a pituitary gonadotrophin hormone activity in the male foetal mouse.

The testosterone production by 18-days-old foetal mouse testis was measured in an organ culture system, by RIA in the culture medium. This production was time-dependent, and could be stimulated by ovine LH and age-matched foetal pituitary. The gonadotrophin activity derived from foetal pituitary appeared to be released into the culture medium as a limited reserve. These data clearly show that a biologically active gonadotrophin material is present in the pituitary of the 18-days-old mouse foetus.


Comparison of circulating glycoprotein hormones and their subunits in patients with oat cell carcinoma of the lung and uraemic patients on chronic dialysis.

It has recently been suggested that the measurement of the glycoprotein hormones and their subunits in human serum may serve as biochemical markers of non-endocrine tumours. Using radioimmunoassays for LH, FSH, HCGbeta-, LHbeta- and the common alpha-subunit, significant differences in the levels of these substances could not be detected between patients with oat cell lung tumours and patients with chronic renal failure. However, compared to normal subjects the alpha-subunit levels in serum were elevated in 12% of the male and 30% of the female patients with oat cell carcinoma of the lund and in 80 and 50% of the male and female patients, respectively, with chronic renal failure. The LHbeta-subunit concentration was normal in all tumour patients and none of these patients had detectable (less than 4 ng/ml) levels of HCGbeta-subunit. While such measurements may be of value in relationship to particular neoplasms, it appears that raised levels of glycoproteins and their subunits may be found in other disease states.


Pituitary-thyroid interrelationship in rats exposed to different environmental temperatures.

The present work intended to show interrelationships between triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) and cyclic adenosine 3'5'-monophosphate (cyclic AMP) in both the pituitary and the thyroid. Experiments were carried out on animals exposed to 0 and 37 degrees C for 4 days and to 34 degrees C for 21 days. Control animals were maintained at 22 degrees C. T4 serum levels of 2.6, 4.0 1.1 and 0.42 mug/100 ml serum, and T3 levels of 95, 135, 65 and 36 ng/100 ml serum were recorded at 22, 0, 34 and 37 degrees C, respectively. The observed serum TSH levels were 265, 192, 237 and 182 mug/100 ml serum in rats exposed to 22, 0, 34 and 37 degrees C, respectively. Pituitary TSH content was similar at 22, 0 and 34 degrees C whereas the content in the 37 degrees C exposed rats was twice that of controls. Thyroid cyclic AMP levels were not significantly different among the various experimental groups. The content of cyclic AMP in the pituitary was higher at 34 degrees C by 125% and 37 degrees C by 240%, and lower at 0 degress C by 56% with regard to the control. These results suggest that the 0 and 34 degrees C exposed rats reach a new steady state in the control of thyroid hormones secretion rate. However, at 37 degrees C, the TSH-Thyroxine interrelationships seem to break down.


Cells of the adenohypophysis of the mink (Mustela vison) identified by immunohistochemical and functional criteria.

Six cell types were described in the adenohypophysis of the mink, and a putative function was assigned to each type. These cells are the two types of gonadotrophic cells, a thyrotrophic hormone (TSH) cell, a somatotrophic (STH) cell, a prolactin (PRL) cell and a corticotrophin-producing (ACTH) cell. Gonadotrophic cells were identified by an immunolocalization technique using antisera to ovine LH. TSH cells and ACTH cells were identified by ablation of respective target organs and observation of the subsequent hypertrophic cells in the pituitary, as well as comparison with published descriptions in other species. STH cells were identified by comparison with published reports. PRL cells were observed in lactating animals and animals in lactational withdrawal.


[Functional morphology of the theca interna of the vesicular follicle in human ovary].

A study of histological serial sections of human ovaries and histochemical reactions established that several cell types differentiate in the theca interna during the formation and development of tertiary follicles (2nd growth period). This leads, in turn, to triple-layering of the theca interna in follicles of the 2nd resting period. The inner thecal layer consists of fusiform cells from the basement membrane, which are apposed to the membrana granulosa and show a strong positive reaction to alkaline phosphatases. A tropic function for the follicular epithelium must be assigned to this layer. The middle layer consists of epitheloid thecal cells, which show a strong positive reaction to 3beta-ol-steroid hydrogenase. These represent the estrogen glands of the follicle. The outer layer of the theca interna, whose transition to the theca externa is indistinct, also has fusiform cells, which are available as reserve material for the differentiation of further epitheloid thecal cells to pre-ovulatory follicles in later periods of development.


Histochemistry of normal and diseased human lymph nodes.

Gomori's metal precipitate technique was used to demonstrate the phosphatase activity of the human cervical lymph node in health and disease, using four different phosphate esters (sodium beta-glycerophosphate and adenosine triphosphate at pH 9, riboflavin 5'-phosphate at pH 9.2 and 5'-monophosphoric acid at pH 8.3). In fetal lymph nodes, using 5'-monophosphoric acid, an outstanding positive activity was noticed in the lymphatic follicles. With the other three substrates there was either no nodular reaction or just a narrow rim of positive activity around the follicles, the internodular tissue being negative with all four substrates used. With chronic non-specific lymphadenitis the enzyme hydrolysing the three substrates (beta-glycerophosphate, riboflavin 5'-phosphate and adenosine triphosphate) began to make their appearance. It seems that with lymphadenitis, a qualitative change of the phosphatase activity takes place. A special characteristic pattern of phosphatase activity has been described in both 'early' and 'caseating' tuberculous lymphadenitis. In malignant lymphomas it was noticed that no activity was encountered with any of the four substrates in reticulum cell sarcoma. However, in lymphosarcoma a positive activity was obtained when either beta-glycerophosphate or adenosine triphosphate substrates was used, to the extent that one can depend upon this characteristic phosphatase activity in differentiating between reticulum cell sarcoma and lymphosarcoma. However, no enzymatic activity was obtained when the other two phosphate esters were used.


[Influence of immobilization on spermatogenesis].

The author investigated the influence of immobilization stress on spermiogenesis in rats. After 96 h immobilization, histological changes began to manifest in the form of a practically complete disappearance of the cell population of the wall of seminiferous tubule as well as a markedly increased number of cells with pathologic mitoses. Enzymological investigations have shown in particular groups (24, 48 and 96 h immobilization) various changes of activity (of acid and alkaline phosphatase, nonspecific esterase and glucose-6-phosphatase) which, after temporary negativity, became positive again in the last group.


Electromyographic changes in automechanics with increased heavy metal levels.

Twenty automechanics possessing increased whole blood values of one or more of the following heavy metals; chromium, copper, lead, manganese and nickel, were studied for peripheral nerve affection by means of electromyography (both sensoric and motoric nerve potentials were recorded). The heavy metal contents were related to the findings of denervation, distal motor latency, distal sensory latency, motoric and sensoric conduction velocities. Apart from two workers, in whom only lead was assayed, the remaining group of 18 were assayed for all heavy metals under study. Six workers showed increased distal motor and/or sensory latency and seven decreased nerve conduction velocity (four motoric and three sensoric affections). Of the workers with nerve affection, three showed increased levels of lead (nickel and chromium also raised). Four workers showed increased lead, nickel and chromium and one of lead, chromium and manganese. All in all, 10 out of 20 workers (50 percent) with elevated lead levels showed definite signs of peripheral neuropathy and seven out of 14 with raised nickel values showed these signs but they could all be accounted for by the increased lead levels. All except seven workers with raised lead levels in the whole group showed values above the critical limit of 80.0 mug/100 ml in whole blood. The data argue for the highly toxic effect of lead and other heavy metals on the peripheral nervous system and stress the diverse toxic exposure which automechanics undergo during their work. The possibility of there being a synergistic action between heavy metals and components of mineral oil and petroleum is discussed.


Anterior horn cell changes in a case of neurolathyrism.

Light and electron microscopic studies were made of the anterior horn cells in a case of neurolathyrism. Eosinophilic inclusions were observed at the light microscopic level. Fine structural study revealed the presence of two types of cytoplasmic inclusions. The first were aggregates of filaments, approximately 80-100 A in width, arranged in small bundles. The second were crystalloid structures composed of elongated elements, about 800 A wide, with hexagonal cross sections. The relationship to each other and the significance of these inclusions are unknown.


Ultrastructural study of so-called curvilinear bodies and fingerprint structures in lymphocytes in late-infantile amaurotic idiocy.

Peripheral lymphocytes of 6 patients with late-infantile amaurotic idiocy were examined with the electron microscope for the occurrence of curvilinear bodies and fingerprint structures. In 3 of the patients predominantly curvilinear bodies were found; in 1 case they contained some fingerprint profiles. In the remaining 3 patients curvilinear bodies were relatively scarce, whereas fingerprint structures prevailed. Moreover, pleomorphic bodies with rectilinear profiles and parallel tubular inclusion bodies were present. No lymphocytes with vacuoles were observed in any of the patients. The sural nerve biopsies of all patients revealed curvilinear bodies. This tissue consequently may be considered to give more reliable information in comparison with the lymphocyte. The likelihood of transition of one type inclusion body into another, the specificity of the curvilinear body and, to our mind, the rigid classification of the amaurotic idiocy into a curvilinear and a fingerprint type, are discussed.


[Infantile generalized ceroid-Lipofuscinosis (type Hagberg-Santavuori). A new case and a retrospective study of two observations (author's transl)].

Three post mortem studies of cases of infantile generalized ceroid-lipofuscinosis are reported: two of them were published under other classifications but our retrospective study warrants their inclusion in the infantile group of ceroid-lipofuscinosis. The children died at the respective ages of 4, 5 8/12 and 8 years and this allows interesting morphological comparisons: 1 degree there is an increasingly severe loss of cortical neurons, of Purkinje cells and of neurons in the griseum pontis with age. Intracytoplasmic inclusions mainly of a granular osmiophilic nature were found in all other neurons and glial cells; 2 degrees the involvement of the visceral organs is especially striking and permits an easier diagnosis under light microscopy, unlike the late infantile and juvenile forms of ceroid-lipofuscinosis. Electron microscopy supports the observation by Anzil et al. (1975) concerning the relative pleiomorphism of the inclusions; 3 degree the diffuse accumulation of inclusions in the skin and its appendages ensures a rapid diagnosis by skin biopsy.


V. a new method for the assessment of skeletal maturity- the mat- method (mean appearance time of bone stages).

By means of probit analysis of the age at the appearance of the various bone stages according to Tanner-Whitehouse and using a logarithmic time concept (logarithmic conceptional age), a new approach to the evaluation of skeletal maturity has been elaborated. The maturity score of each bone stage corresponds to th4 mean maturity level of the observation of being within each stage. The individual maturity level is calculated by averaging the maturity scores of the stages of the various bones and is then evaluated is standard deviation scores by comparing with teh Gaussian fitted distribution of averages maturity scores of the age of the child examined. Special conditions apply for the scoring of a first and a last bone stage in a sequence, which will introduce less bias in the estimation of individual skeletal maturity with the MAT-method than with the TW-method. Ossification during early infancy can be evaluated and sequence polymorphism be detected by using the bone stage chart of the MAT-method.


IV. skeletal development from birth to 7 years.

The skeletal development of 212 randomly selected Swedish urban children has been investigated as part of a prospective longitudinal study of growth and development. Radiograms of the hand and wrist were taken at specified ages. Up to the age of seven years 2.191 radiograms were assessed. When comparing the timing of the first ossification of the various bones in the present study and an older Swedish investigation a secular trend was found. In contrast to a North-American growth study, there was a striking similarity of the pattern of the first ossification in the two Swedish investigations for both sexes separately. However, the relative sex differences of the ossification were quite similar in the North-American growth study and the present investigation. In comparison with British children the skeletal development of Swedish children was advanced at all ages, the advancement being greater for epiphyseal bones than for carpal bones.


Tumor growth of the reticuloendothelial system.

From the author's hitherto studies on the reticuloendothelial system (RES) it was concluded that the RES is not a single cell system of identical origin, morphology and function but is a group of several types of cells of different origin. From this point of view the heterogeneity of tumors of the RES was studied to reveal the following results. Tumors of the "Reticuloendothel" (Aschoff) reveal pictures of endothelioma, while tumors of histiocytes in connective tissue show findings of fibrohistiocytoma. Histiocytes and reticulum cells of lymph nodes are respectively independent cells, and reticulum cells do not partake in the in the development of histiocytosis or histiocytic sarcoma. Follicular lymphoma is a neoplastic growth of reticulum cells having desmosomes in lymph follicles, and tumor cells of the majority of reticulum cell sarcoma are similar to the cells forming the lymph node anlage in the early fetal stage (lymphoreticular cell). Ewing's sarcoma is considered to be a kind of angiopericytoma.


Malignant fibrous histiocytoma of bone.

Existence of an entity called malignant fibrous histiocytoma of bone was emphasized, based on two of our own cases experienced recently and on previous reports related to this tumor. Histologically the tumor resembles markedly the malignant fibrous histiocytoma originating in the soft part. In addition, an attempt was made to clarify its biological behavior, histological subclassification and criteria to be malignant and differential diagnoses from several other bone diseases which sometimes mimic this malignant bone tumor.


The inability of a diabetogenic virus to induce diabetes mellitus in athymic (nude) mice.

The effect of a known diabetogenic M-strain encephalomyocarditis (EMC)-virus in athymic nude mice (lacking the thymus-dependent lymphocyte system), and in heteroxygous littermates and homozygous normal mice of the background strain (C57/B16) was investigated. While by 3 weeks 4 out of 4 surviving virus-inoculated littermates and 9 out of 9 inoculated normal mice developed diabetes mellitus, none of the 7 surviving virus-inoculated nude mice became diabetic. Virus was isolated from all inoculated animals, including non-diabetic nude mice. It is concluded that it is the response of the thymus-dependent lymphocyte system evoked by the virus rather than the virus itself that leads to damage to the insulin producing cell.


Clofibrate in type II hyperlipoproteinemia.

As a part of a double-blind randomized study, the safety and the lipid- and uric acid-lowering effect of clofibrate have been evaluated in 28 patients with type II hyperlipoproteinemia (HLP). A highly significant reduction of serum cholesterol occurred in type IIa and of serum triglyceride and choelsterol in type IIb HLP throughout the 60-week observation period (p less than 0.01). Of the patients with types IIa and IIb HLP, 65% had at least a 25% reduction of serum cholesterol. Uric acid was significantly reduced only during the first period of treatment (p less than 0.05). In the laboratory measurements concerning safety, a persistent, slight reduction was observed in Hb, hematocrit and alkaline phosphatase. No significant clinical side-effects were noted. Clofibrate is considered effective as a lipid-lowering agent in many cases of type II HLP.


Selective removal of hypersecreting pituitary adenomas? An analysis of endocrine function, operative and microscopical findings in 101 cases.

The aim of this study of 101 pre- and postoperatively controlled hypersecreting pituitary adenomas (80 acromegalies, 15 Cushing's diseases, 6 Nelson's syndromes) was to establish in what cases a selective adenoma extirpation by the transnasal route is possible and advisable. In primary operations on acromegalics with small and medium size tumours 92% were postoperatively GH normal. Eighty five per cent of these had intact pituitary function. The results with larger tumours were worse (72%). During a control period of 1.5-5.5 years a renewed elevation of GH levels was observed in three cases, all in the first year, but never after clearly selective adenomectomy. These results, and the anterior lobe biopsies, which showed no GH cell hyperplasia, favour selective adenoma extirpation. In contrast to acromegaly, nodular ACTH cell hyperplasia in the anterior lobe was found in most cases of Cushing's disease, and therefore complete hypophysectomy was performed. The cortisol levels became either normal or, in most cases, lower than normal. A selective operation was performed on 6 Nelson tumors. The ACTH values became normal in about 50% of the patients but there was a tendency towards recurrence. Our experiences with Cushing's disease and Nelson's syndrome lead us to recommend total hypophysectomy.


On the prosthetic groups of L-tryptophan 2,3-dioxygenase from Pseudomonas: evidence for noninvolvement of copper in the reaction.

The amounts of copper present in highly purified preparations of L-tryptophan 2,3-dioxygenase from Pseudomonas fluorescens have been shown to be negligible by six different methods of copper determination. It has also been demonstrated that, during the purification, the heme content of enzyme preparations increased in parallel with the specific enzyme activity, whereas that of copper decreased. These results, together with the finding that the inhibitory effects of copper chelators on the enzyme could be attributable to some other action of these chemicals rather than to their chelating properties, indicate that copper is not an essential component of L-tryptophan 2,3-dioxygenase.


Binuclear copper clusters as active sites for oxidases.

Binuclear cupric ion clusters have been established in: human ceruloplasmin, hemocyanin, and mushroom tyrosinase. Substantial evidence makes it very probable that fungal laccase and zucchini ascorbate oxidase contain this cluster. Some evidence makes it possible that copper clusters function in the catalytic cycles of cytochrome oxidase (mammalian) and dopamine-beta-hydroxylase. These studies throw light on the criteria which must be employed to establish the existence of functional binuclear copper clusters in enzymes: (1) Stoichiometric Criteria: binding of O2 and CO with Cu/ligand = 2; redox titrations with n = 2; (2) Physical and Chemical Criteria: magnetic evidence of diminished paramagnetism of cupric centers, EPR evidence of broadened or absent absorptions, EPR evidence of magnetic dipolar interactions among cupric ions; absorption bands characteristic of Cu(II)-Cu(II) complexes; laser resonance raman scattering characteristic of peroxidic dioxygen in the oxyforms.


The biological role of ceruloplasmin and its oxidase activity.

Ceruloplasmin (ferroxidase) the blue Cu-protein of vertebrate plasma, possesses significant oxidase activity towards Fe(II) and numerous aromatic amines and phenols. Its ferroxidase activity has led to the discovery that it is a molecular link between copper and iron metabolism. Ceruloplasmin mobilizes iron into the plasma from iron storage cells in the liver. An additional role of Cp may be as a contributor to the regulation of the balance of biogenic amines through its oxidase action on the epinephrine and the hydroxyindole series. Ceruloplasmin also serves as a major copper transport vehicle, comparable to transferrin for iron. Evidence is presented that the copper atoms of Cp are a prerequisite for copper utilization in the biosynthesis of cytochrome oxidase. The ability of Cp to release copper at specific cellular sites is believed to be related to its broad substrate spectrum of biological reducing agents. Thus Cp is a serum protein with several important functions, all of which are directly related to its oxidase activity.


The iron-sulfur centers and the function of hydrogenase from Clostridium pasteurianum.

Hydrogenase from C. pasteurianum is an iron-sulfur protein containing at least two tetrameric iron-sulfur centers. Information on the structure of the remaining iron atoms must await future investigation. Although the EPR spectra of dithionite-reduced hydrogenase and eight-iron Fd showed some similarity, the CD spectra clearly indicated a difference. The tetrameric iron-sulfur centers of hydrogenase were shown to undergo redox changes when hydrogenase was oxidized or reduced. However, no evidence is now available to support a role for the tetrameric Fe-S centers, responsible for the EPR spectrum A, as the primary site for H2 binding and activation. Because we have found that the [Fe4S4(SR)4]-containing ferredoxins do not have hydrogenase activity, it is conceivable that the additional iron atoms and/or certain amino acid residues of hydrogenase also contribute to the unique catalytic properties of this enzyme. Chemical synthesis of Fe-S clusters with different peptide environments and with hydrogenase function would lead to the identification of these functional groups. X-ray diffraction studies on hydrogenase will certainly complement the other approaches. Knowledge of the structure of the active site of hydrogenase will certainly accelerate research into: (1) the synthesis of a stable catalyst to replace hydrogenase in systems designed to produce H2 by coupling this catalyst to a photoreducing system; and (2) the elucidation of the active sites of more complicated iron-sulfur enzymes such as nitrogenase.


Studies on histamine-retaining granules obtained from isolated rat mast cells.

Histamine-retaining granules were isolated from rat mast cells after sonication in either sucrose of Ficoll-Hypaque media. The preparations obtained were compared in regard to recovery and spontaneous loss of histamine. The effect of agents known to release histamine from intact rat mast cells (antigen, compound 48/80, decylamine, the ionophores A23187 and X537A as well as ATP) was studied on the granules. Antigen and compound 48/80 did not release histamine. Decylamine and X537A induced a pronounced release independent of the presence of divalent cations. ATP caused a small, but significant release, which showed an absolute requirement for magnesium. A23187 released histamine only in the presence of either calcium or magnesium, and this release was unaffected by certain agents known to inhibit histamine release from intact rat mast cells. The results seem to exclude the possibility that agents known to induce release of histamine from intact rat mast cells by a calcium-and energy-dependent process would exert this action through a direct effect on intracellularly localized granules.


Pyophosphate-induced inflammation: an in vivo study of the interrelationship of intracellular cyclic AMP and cyclic GMP.

The changes in leucocyte concentrations of cyclic AMP and cyclic GMP were monitored during pyrophosphate-induced pleurisy in rats. A classical 'Yin Yang' relationship was demonstrated.


The neurologic complications of alcoholism.

Neurologic complications may appear before the primary disease, alcoholism, is recognized. The common syndromes are polyneuropathy, the withdrawal syndrome and the combination of Wernicke's encephalopathy and Korsakoff's psychosis. Other conspicuous clinical pictures include ataxia of cerebellar origin, convulsions, acute hallucinosis, myopathy and coma. Rarer disorders are Marchiafava-Bignami disease and central pontine myelinolysis.


Effects of ethanol on bile acid and cholesterol metabolism.

The effects of ethanol on plasma lipid and lipoprotein concentrations and on the fecal excretion of neutral sterols and bile acids were studied in three patients with ethanol-induced hyperlipidemia and in four normolipidemic men. In the three patients, plasma triglyceride and cholesterol concentrations were much higher with ethanol than during periods when ethanol was isocalorically substituted with either carbohydrate or both fat and carbohydrate. In the normolipidemic subjects, plasma lipids especially in very low density lipoproteins, were higher with ethanol consumption only in comparison with a balanced diet but not when compared with carbohydrate-rich diets. Triglyceride enrichment of low density lipoproteins occurred uniformly with ethanol. Total sterol excretion, measured by isotope dilution and chemical assay, was similar during ethanol and control periods in two out of the three hyperlipidemic subjects. However, the proportion of bile acids was increased in all three hyperlipidemic subjects but in only one normolipidemic subject while on ethanol. Since cholesterol turnover did not appear to be necessarily influenced by ethanol, as judged either by total endogenous sterol excretion or from the slope of the plasma cholesterol specific radioactivity-time curve, the ethanol-induced increase in bile acid excretion amy not be analogous to other clinical disorders in which increased bile acid excretion and hypertriglyceridemia are associated with raised sterol production.


Mechanism and site of small intestinal uptake of vitamin D3 in pharmacological concentrations.

The site and mechanism of initial uptake of 1,2-3H vitamin D3 pharmacological concentrations was investigated using everted rat small bowel sacs incubated in a micellar medium. The mean +/- SE uptake rates of the vitamin at 300 muM incubation solution concentration by proximal, medial, and distal small bowel segments were 6.7 +/- 0.26, 7.8 +/- 0.54, and 3.3 +/- 0.20 nmole/min/100 mg tissue, respectively. Incubation with the addition of 10(-3) M 2,4-dinitrophenol, or 10(-3) M KCN, or under nitrogen atmosphere did not change (P greater than 0.05) the above rates of absorption. Incremental increases in the concentration of vitamin D in the incubation medium up to 1200 muM resulted in a linear increase in the uptake rate indicating lack of saturation kinetics. In all the above experiments, greater rate of uptake of the vitamin occurred in the proximal and medial small bowel than the distal small bowel (P less than 0.01). The above experiments indicate that vitamin D3 in this range of concentrations is taken up by enterocytes by a nonsaturable passive diffusion mechanism showing no evidence for carrier mediation. The rate of intestinal uptake is highest in the proximal and medial segments of the small bowel.


Improvement in jejunal enzyme adaptation in obese adult-onset diabetic patients following a 30-day fast.

The adaptive responses of gastrointestinal enzymes, glucose tolerance, and plasma insulin to diet, folic acid, and insulin of five obese adult-onset diabetic patients were studied before and after a 30-day fast. Their data were compared to the adaptive responses of gastrointestinal enzymes to diet, folic acid, and insulin of 15 normal male volunteer subjects, ages 18 to 24. Each group during each testing period received a carbohydrate diet (50% calories as carbohydrate consisting of 1/2 glucose and 1/2 fructose) and a noncarbohydrate diet (70% of calories as corn oil and 30% as sodium caseinate) each without and with folic acid (5 mg three times per day). The effect of insulin was studied only on the carbohydrate diet plus folic acid. Our data demonstrate that obese adult-onset diabetic patients have an impaired adaptive response of jejunal carbohydrate-metabolizing enzyme activities (hexokinase, pyruvate kinase, fructose-1-6-diphosphate aldolase, fructosediphosphatase) to dietary carbohydrate, oral folic acid, and insulin when compared to normal subjects and nondiabetic obese patients. Following a 30-day fast, the obese diabetic patients showed an improvement in glucose tolerance, hyperinsulinemia, and the adaptive response of the jejunal carbohydrate-metabolizing enzyme activities to dietary carbohydrate, folic acid, and insulin. The greatest improvement in the adaptive response of the jejunal enzyme activities occurred on the carbohydrate diet.


Pseudohomozygous and pseudoheterozygous type II hyperlipoproteinemia.

A 4-year-old boy had typical features of homozygous type II hyperlipoproteinemia with planar xanthomas, a plasma cholesterol level greater than 600 mg/dl, and an estimated beta-lipoprotein cholesterol concentration greater than 500 mg/dl. Both he and his sister, who had the biochemical features of the heterozygous state, responded unusually well to a diet low in saturated fat and cholesterol content. These features, combined with the finding of normocholesterolemic parents, are highly suggestive of a newly described syndrome. pseudohomozygous type II hyperlipoproteinemia.


Effects of 13-nle-motilin on salivary, gastric, and pancreatic secretions in man.

Salivary, gastric, and pancreatic secretory responses to intravenous 13-norleucine-motilin (13-nle-motilin), a synthetic analog of motilin and biologically equivalent to the natural polypeptide, were studied in healthy volunteers. 13-nle-Motilin in doses of 100 ng/kg body wt/hr significantly stimulated gastric pepsin output, while H + secretion and serum gastrin levels remained unchanged. Enhanced pepsin secretion was not accompanied by an increase in gastric secretion of cyclic 3', 5'-adenosine monophosphate, nor did gastric mucosal levels of the cyclic nucleotide rise. A dose of 13-nle-motilin, which stimulated gastric pepsin output, did not exert any significant effect on salivary and pancreatic secretions.


Diagnosis of cytomegalovirus pneumonia in compromised hosts.

Sixteen patients with cytomegalovirus pulmonary infection are described. In 11 the diagnosis was made antemortem by lung aspirate or biopsy, and in five the diagnosis was made at postmortem by typical lung histology and positive viral lung cultures. All patients were immunosuppressed by both their underlying diseases and treatment with corticosteroids and other chemotherapy. Although other pathogens were identified at lung biopsy in most patients (73 per cent), primarily Pneumocystis carinii, evidence is offered to demonstrate that cytomegalovirus can cause significant pulmonary disease alone, leading to respiratory failure and death.


Clinical and laboratory evaluation of elderly patients with heterophil-antibody positive infectious mononucleosis. Report of seven patients, ages 40 to 78.

Clinical, hematologic, biochemical and serologic data are recorded in seven patients aged 40 to 78 years with heterophil-antibody positive infectious mononucleosis (HA+IM). Clinical observations included fever of 22 to 30 days' duration (five of seven patients), sore throat (six of seven patients), myalgia (five of seven patients) and prominent lymph adenopathy (two of seven patients). Initial blood smears revealed significant numbers of atypical lymphocytes in only five of seven patients; however, or serial testing, in the remaining two patients Downey cells developed to a degree seen in most young adult patients with infectious mononucleosis. Comparison of liver function data from these and younger patients suggests that abnormalities tend to be more marked in those in the older than in those in the younger age range. Serologic tests confirmed primary Epstein-Barr virus (EBV) infections in all seven patients based on detection of IgM antibodies to EB viral capsid antigen in specimens obtained early, but not late, in the course of the infection, transitory antibody responses to the D (diffuse) component of the EMB-induced early antigen complex, and the initial absence and later development of antibodies to the EBV-associated nuclear antigen. Thus, the serologic data did not differ from those seen in younger patients. These results show that infectious mononucleosis should be included in the differential diagnosis of fever, sore throat and myalgia with or without significant cervical adenopathy in elderly persons.


The effect of trigeminal nerve and ganglion manipulation on recurrence of ocular herpes simplex in rabbits.

Latent herpes simplex virus (HSV) has been demonstrated in the trigeminal ganglia of experimentally infected rabbits between episodes of spontaneous ocular recurrence. In three experiments reported here, the normal pattern of recurrence was modified by manipulation of the trigeminal nerve and ganglion. Temporary retrobulbar disruption of trigeminal nerve function in chronically infected animals significantly decreased the number of ocular HSV isolations obtained during the 20 weeks immediately following surgery. Stereotaxic interruption of intracranial trigeminal nerve function prior to initial HSV infection dramatically reduced the incidence of peripheral recurrence of HSV. In chronically infected animals, stereotaxic stimulation of the trigeminal ganglion caused a marked increase in positive cultures within 2 days. These studies provide additional evidence for the theory that the reservoir for latent ocular HSV in rabbits is the trigeminal ganglion. Moreover, the studies suggest that the transmission of latent HSV from the trigeminal ganglion to its infectious form in the peripheral tissues involves the trigeminal nerve. We have shown that mechanical and stereotaxic stimulation of the trigeminal ganglion is a reliable and rapid means of precipitating peripheral ocular shedding of HSV on command, a finding which should prove most productive in future research.


Antibodies to adeno-associated satellite virus and herpes simplex in sera from cancer patients and normal adults.

The ecologic aspects of the distribution of adeno-associated satellite virus (ASV) in the human population are of great interest because of its unconditional defectiveness and dependence on adenovirus for full and herpesvirus for partial complementation. Adenoviruses and herpesviruses are extremely common and persistent infections in man. We have developed immunofluorescent procedures for detecting the presence of satellite virus antibodies in human sera. The percentage of sera with antibodies to the ASV 2-3 complex was significantly higher in the normal group than in the cancer patients whereas there were no significant differences in herpes antibodies between the groups. The low incidence of satellite antibodies was particularly striking in patients with genital malignancies. The role of ASV's in human disease is not known. Their role in possible abrogation of oncogenesis mediated through adenoviruses or herpesviruses is worthy of further investigation.


The significance of measurement of human placental lactogen, human chorionic gonadotropin, and carcinoembryonic antigen in patients with ovarian carcinoma.

Human placental lactogen (HPL or HCS), the beta subunit of human chorionic gonadotropin (beta-HCG), and carcinoembryonic antigen (CEA) were measured by a specific radioimmunoassay in plasma of 65 patients with ovarian cancer. Fifty-one patients had epithelial tumors, while 14 had germ cell tumors. It was found that 47 patients (72 per cent) had high levels of plasma HPL, 29 patients (45 per cent) had high levels of plasma beta-HCG, and 34 patients (52 per cent) had high levels of plasma CEA, but there was no correlation between these protein marker levels in different patients. Twenty of these patients were studied before and after operation and during chemotherapy and/or radiotherpy. There was no consistent correlation between these marker levels and the course of the disease. These data suggest that measurement of HPL, beta-HCG,  and CEA in sera of patients with ovarian cancer is not of value in assessing the clinical status of the patients or in determining the effect of therapy.


Spontaneous rupture of the liver in pregnancy: a report of eight cases.

Seven cases of ruptured subcapsular hematoma and one case of ruptured hepatoma are reported. Six of the patients died, four following an unsuccessful operation. One patient survived following an operation, and another patient survived without surgical intervention. Both survivors were treated with a gravity suit to control internal hemorrhage.


An in vitro model of pancreatic carcinoma. Morphology and in vivo growth.

Pancreas rudiments from 13-day rat embryos were cultured in the presence of dimethylnitrosamine (DMN) for up to 10 weeks. Pancreas morphogenesis and differentiation occurred during the first week of culture. Acinar cell degeneration and necrosis began on the fifth day of culture and resulted in almost complete loss of acinar cells, islet cells, and fibroblasts by the end of the third week. This was associated with proliferation of cells without zymogen granules (centroacinar, ductal, or undifferentiated?). Theses cells formed glandular structures which extended to the surface of the explant. By the end of the fourth week, explants resembled ductal hyperplasia with foci of carcinoma in situ. The distribution pattern of neoplasia in 343 explants examined after 10 weeks of DMN treatment was as follows: 79% resembled ductal cell carcinoma; 9%, ductal hyperplasia; and 3%, acinar cell carcinoma. Nude mice injected with cell suspensions prepared from 10-week-old culture developed subcutaneous nodules. These nodules resembled duct cell carcinoma with desmoplastic reaction.


Identification of T and B lymphocytes in human breast cancer with immunohistochemical techniques.

Cryostat sections of 50 breast cancer specimens and several lymphoid organs were investigated with antisera against human T-lymphocyte antigen, human lymphocytes, and human immunoglobulins using the immunofluorescence technique and the immunoperoxidase technique. These methods proved to make it possible to discriminate between T and B cells in lymphocytic infiltrates in tissue sections. In nearly all mammary carcinomas studied, T cells were found to predominate in and around tumor cell nests. Only the intraductal carcinomas of this series contained a substantial number of B cells in addition to T cells. The presence of T cells indicates that the host-tumor interaction in vivo mall-mediated immune reaction. The role of the B cells found in the lymphocytic infiltrates of the intraductal carcinomas is still a matter of speculation. Moreover, these findings enhance the value of established histologic classifications. These classifications may have to be modified to provide them with a more functional basis.


Metabolic activity of brown adipose tissue in T3-treated hamsters.

Triiodothyronine (T3) treatment induced marked hypertrophy of the brown adipose tissue (BAT), similar to that observed in cold-acclimated animals, although partly due to fat deposition. Similar to cold acclimation, T3 treatment also increased the oxidation of succinate by tissue slices without concomitant increase in isolated mitochondria. It is therefore suggested that thyroid hormones, like cold acclimation, effect conformational changes in the mitochondria, leading to greater expression of the succinic oxidase in the tissue. T3 treatment was not followed by any change in the respiratory activity of tissue slices in the presence of alpha-GP. Likewise, no change was found either in other oxidative activities tested in isolated mitochondria (e.g., NADH and cytochrome oxidases) or in the concentration of the components of the electron transport chain in the mitochondria.


Hormone-stimulated glycogenolysis in isolated goldfish hepatocytes.

Hepatocytes isolated from the liver of the common goldfish Carassius auratus L. with crude bacterial collagenase maintained ATP levels for at least 2 h. Glycogenolysis was maximally activated by 1 X 10(-6) M epinephrine and 5.8 X 10(-9) M glucagon. In liver cells incubated in calcium-free buffer containing 1 mM ethylene glycol-bis-(beta-aminoethylether)-N,N'-tetraacetic acid, basal glycogenolysis was enhanced by the addition of 1-4 mM calcium but the elevation of cyclic AMP and glycogenolysis due to epinephrine was unaffected by calcium. The divalent cation ionophore A23187 did not alter basal or hormone-stimulated glycogenolysis. Isoproterenol was approximately as potent as epinephrine but phenylephrine was glycogenolytic only at very high concentrations. l-Propranolol competitively inhibited the increased glycogenolysis due to catecholamines but phentolamine was ineffective as a blocking agent. Isoproterenol and epinephrine stimulated glycogenolysis at lower concentrations than those required to elevate cyclic AMP accumulation. Phenylephrine was without effect on cyclic AMP. Propranolol competitively inhibited both epinephrine- and isoproterenol-stimulated cyclic AMP accumulation, but phentolamine did not block either response. Catecholamine-stimulated glycogenolysis in goldfish liver is apparently a beta-adrenergic effect. However, low concentrations of epinephrine enhance glycogenolysis without affecting total cyclic AMP.


Intestinal mucosal cyclic GMP: regulation and relation to ion transport.

Stimulation of alpha-adrenergic and muscarinic cholinergic receptors in rabbit ileal mucosa in vitro produced 5- to 15-fold increases in cyclic GMP (cGMP) concentration that were maximal within 2 min and gone within 30 min. Cholecystokinin octapeptide and insulin caused similar increases in cGMP. None of these agents affected cAMP. The epinephrine-induced increase in cGMP was blocked by atropine at 100 but not at 1 muM concentration. Epinephrine stimulates active NaCl absorption and decreases short-circuit current (SCC) in vitro, the latter effect due to inhibition of HCO3 secretion. Atropine (100 muM) blocked the former but not the latter effect of epinephrine. In vitro additions of several concentrations of cGMP and 8-bromo-cGMP did not decrease SCC or alter Na fluxes. Thus, changes in cGMP concentration have been directly correlated with changes in active absorption of NaCl, but a causal relationship has not been proven.


Hyperpolarization of thyroid cells in vitro by thyrotropin and cyclic AMP.

With the use of microelectrodes, membrane potential (MP) was measured in mouse thyroid glands in vitro. A basal resting MP of about -39 mV was confirmed. The initial effect of feeding a low-iodine diet (6-12 days) was hyperpolarization, up to -47 m V; chronic low-iodine diet led to depolarization. Low concentrations of thyrotropin (less than 3 mU/ml superfusate) caused hyperpolarization and high ones (greater than 10 mU/ml) led to depolarization. Cyclic AMP (10(-3) M), dibutyryl cyclic AMP (1.2 X 10(-4) M or 1.2 X 10(-3) M) and theophylline (10(-2) or 10(-3) M) caused similar hyperpolarization: D- and DL-propranolol (5 X 10(-5) -5 X 10(-4) M) produced depolarization and inhibited hyperpolarization by thyrotropin. Conclusions are that hyperpolarization is a consequence of short-term increased secretion of thyrotropin in vivo or of low (near physiological) concentrations in vitro; these effects are probably mediated by cyclic AMP. The relationship to and mechanism of depolarization resulting from chronic enhanced endogenous secretion or high in vitro concentrations of thyrotropin are unknown.


Effect of colchicine on urinary phosphate and regulation by parathyroid hormone.

The possible role of cytoplasmic microtubules in the renal handling of phosphate and its regulation by parathyroid hormone (PTH) was evaluated with colchicine, a microtubule-disrupting agent. Colchicine-treated rats were thyroparathyroidectomized (TPTX) and subsequently infused with PTH. Treatment with a total dose of 1 mg colchicine had no effect on glomerular filtration rate or fractional excretions of sodium and potassium. Fractional excretion of phosphate in colchicine-treated TPTX rats was significantly higher compared with TPTX controls. After PTH infusion, control rats responded with increases in fractional excretion of phosphate and urinary cyclic AMP but colchicine-treated rats had variable and insignificant changes in both parameters. Fractional excretion of sodium and potassium did not change significantly after PTH. Renal cortical activities of cyclic AMP phosphodiesterase, soluble alkaline phosphatase, cytochrome oxidase, leucine aminopeptidase, or basal adenylate cyclase were not significantly affected by colchicine treatment. On the other hand, stimulation of adenylate cyclase by a submaximal dose of PTH was markedly decreased in colchicine-treated rats, and the activity of membrane-bound alkaline phosphatase was also significantly decreased. The binding of radioactive colchicine in renal cortical extracts from rats treated with colchicine was significantly diminished. These results suggest that disruption of cytoplasmic microtubules in renal cortical cells interferes with phosphate transport and its regulation by PTH.


RENAL HANDLING OF CITRATE DURING HEAT-INDUCED HYPOCITRICEMIA.

A model of steady-state hypocitricemia, characterized by hypocitraturia and reduced kidney cortex citrate, has been demonstrated in the rate chronically exposed to environmental heat. The renal citrate extraction ratio remains unchanged. The physiological mechanism that brings about the reduction in circulating citrate has not been determined. Hypocitraturia likely results from a decreased filtered citrate load. Although it is generally contended that filtered citrate load. Although it is generally contended that alkalosis increases and acidosis decreases renal excretion of citrate, observations of mild alkalosis and hypocitraturia during heat exposure suggest that factors other than pH can alter renal handling of citrate. Kidney mitochondrial function, as determined by in vitro measurements of citrate-stimulated respiratory rates and specific activities of isocitrate dehydrogenase, succinate dehydrogenase, malate dehydrogenase, and cytochrome c oxidase, appears to be unaffected by environmental heat.


Agonist and antimineralocorticoid activities of spirolactones.

To investigate the mechanism of action of antimineralocorticoids, a series of spirolactone analogues was evaluated for both mineralocorticoid antagonist and agonist activity. Antagonist activity was assessed by inhibition of aldosterone stimulated sodium transport employing toad bladder short-circuit current (SCC) measurements. Agonist activity was assessed in the same system by the direct effect of spirolactones on SCC. Opening of the gamma-lactone ring of a spirolactone dramatically decreased antagonist activity in the compound studied. Several C-7 chi-substitutions resulted in either enhanced or diminished activity, whereas deletion of the C-10 methyl group (i.e., 19-nor compound) had only minimal effects on antagonist potency. Agonist activity was demonstrable for three of the analogues studied: the 19-nor compound, and those containing a C-7 chi-substitution with a carboxyl isopropyl ester or a C-6-7 cyclopropyl linkage. The functional activity in toad bladder was compared to previous measurements of the relative binding affinity of the same spirolactones for mineralocorticoid receptors in rat kidney. Although there was some correlation between binding to rat kidney receptors and antagonist activity in the toad bladder, the results did not coincide in the case of the three spirolactones that possessed partial agonist activity. Some of the discrepancy may have resulted from differences between mammalian and amphibian receptors; however, intrinsic agonist activity limits antagonist potency and thus may cause a divergence between binding and functional studies limited to antagonist activity alone. Binding affinity, although indicative of total activity, fails to distinguish agonist from antagonist potency.


Effect of norepinephrine and hypertonicity on K influx and cyclic AMP in duck erythrocytes.

Cyclic adenosine 3',5'-monophosphate (cAMP) accumulation and cation transport were measured in duck erythrocytes after stimulation by norepinephrine (NE) or shrinkage induced by exposure to hypertonic media (S). Previously both NE and S were shown to initiate a similar transport process in this cell. NE elicited a rapid rise in cellular cAMP and 42K influx. Both effects were eliminated by propranolol. At concentrations of NE below 3 X 10(-8) M (the concentration at which 42K influx saturates), there was good correlation between the magnitude of the permeability change and the increment in cAMP. In contrast, medium hypertonicity, at a level which stimulated K influx to the same extent as a near-maximal norepinephrine response, did not alter cAMP content. The data are discussed in terms of a model in which S and NE activate a final common transport pathway by different mechanisms, which in the case of S does not involve cAMP.


Compensatory adrenal growth: a neurally mediated reflex.

The responses of young rats to left adrenalectomy or left adrenal manipulation were compared to surgical sham adrenalectomy in which adrenals were observed but not touched. At 12 h right adrenal wet weight, dry weight, DNA, RNA, and protein content were increased (P less than 0.05) after the first two operations. Left adrenal manipulation resulted in increased right adrenal weight at 12 h but no change in left adrenal weight. Sequential manipulation of the left adrenal at time 0 and the right adreanl at 12 h resulted in an enlarged right adrenal at 12h (P less than 0.01), and an enlarged left adrenal at 24 h (P less than 0.05), showing that the manipulated gland was capable of response. Bilateral adrenal manipulation of the adrenal glands resulted in bilateral enlargement at 12 h (P less than 0.01). Taken together with previous results, these findings strongly suggest that compensatory adrenal growth is a neurally mediated reflex.


High dose urography: incidence and relationship to spontaneous peripelvic extravasation.

A prospective study was undertaken to determine the incidence of spontaneous extravasation of contrast in 82 patients with acute renal colic. The extravasation rate among 37 patients receiving 75 ml of contrast was 8.1%, while the rate among 45 patients receiving either 300 ml of 30% solution by infusion or a 140 ml bolus dose was 24.4%; overall the rate was 17%. Thus the incidence of extravasation was shown to increase with higher doses of contrast media. The primary dose in acute renal colic or other forms of obstructive uropathy should be in the low range (20-25 g 1-); reinjection after screening can be undertaken if necessary.


Autonomous hyperparathyroidism in patients on maintenance home dialysis.

Ninety-nine patients with end-stage renal failure treated by maintenance home dialysis whose calcium and phosphorus balance was carefully controlled were studied for radiographic evidence of hyperparathyroidism. A total of 43 showed evidence of hyperparathyroidism despite excellent medical management. In 23 the abnormality was stable and the patients were asymptomatic with regard to the skeleton. The other 20 showed progressive bone disease. Sixteen of these patients were operated upon, and 14 were relieved of their symptoms by parathyroidectomy. Following operation, the radiographic evidence of bone disease halted dramatically, and a decided return toward normal was documented on subsequent films. Thus parathyroidectomy can control the skeletal deterioration and bone pain of hyperparathyroidism in patients who develop this complication. Serial radiographic studies are a reliable indicator of this circumstance.


Therapeutic vascular occlusion utilizing steel coil technique: clinical applications.

The stainless steel coil has been utilized for permanent intravascular occlusion of the proximal portion of the renal, hepatic, splenic, and internal iliac vessels. This therapeutic approach has been successful in the management of renal arteriovenous fistulas, renal carcinomas, neoplasms of the liver, giant cell tumors of the sacrum, and in hypersplenism. The techniques involved and clinical uses are discussed.


Embolic control of hypertension caused by segmental renal artery stenosis.

Renovascular hypertension was controlled in a 15-year-old boy by total infarction of the renal parenchyma behind a segmental renal artery stenosis. Two separate embolizations were required to occlude the branches distal to the stenosis. Blood pressure did not return to normal until after the second procedure. This approach may be useful in patients with intrarenal arterial stenoses who would be difficult to approach operatively without sacrificing a significant portion of the kidney.


Aneurysms secondary to pancreatitis.

In a review of arteriograms of 72 unselected consecutive cases of pancreatitis, seven patients were found to have arterial aneurysms involving branches of the peripancreatic vessels. During the same period, arteriograms of 84 cases of carcinoma of the pancreas were reviewed and no aneurysms of any of these vessels were found. The demonstration of aneurysms of the peripancreatic arteries in pancreatitis is an important differential feature from carcinoma of the pancreas. Both carcinoma of the pancreas and chronic pancreatitis can cause encasement of the arterial vessels and obstruction of the splenic or the superior mesenteric vein, therefore resulting in a similar angiographic appearance. Thus an aneurysm seen in such a patient is a helpful distinguishing feature. In addition, these aneurysms are an important source of hemorrhage and mortality in pancreatitis.


Radiologic and pathologic characteristics of the WDHA syndrome.

A case of a non-beta islet cell tumor of the pancreas that produced the WDHA (watery diarrhea, hypokalemia, and achlorhydria) syndrome is presented. An enlarged body-tail region of the pancreas is demonstrated on transaxial views; multiple fluid-filled loops of small and large bowel are also noted. The angiography of the tumor is similar to other non-beta islet cell lesions consisting of a large hypervascular mass with hypertrophied feeding vessels and a persistent, dense capillary stain. The demonstration of elevated levels of vasoactive intestinal polypeptide in both tumor and plasma and the ultrastructural description of endocrine granules may help to explain the pathophysiology in this case.


Fine needle transhepatic cholangiography: a new approach to obstructive jaundice.

Transhepatic cholangiography performed with a newly introduced fine caliber (0.7 mm OD) "Chiba" needle produces a significantly higher success rate of biliary duct opacification with fewer complications than conventional needle or flexible cannula techniques. Distinct advantages over endoscopic retrograde cholangiography are also apparent, including more frequent bile duct opacification, ease of performance, and lower overall cost. In a group of 50 consecutive patients examined with the fine needle puncture technique, duct opacification was achieved in 92%, including 33 of 33 (100%) of patients with surgically obstructed ducts and 14 of 17 (82%) with normal caliber or narrowed ducts. Fine needle hepatic puncture is recommended as the preferred approach for direct biliary duct opacification in jaundiced patients.


Percutaneous transhepatic cholangiography with selective catheterization of the common bile duct.

Percutaneous transhepatic cholangiography was performed in 86 patients with juandice in whom the diagnosis could not be established by conventional means. Selective catheterization of the common bile duct was employed and cholangiograms of high quality were obtained. In cases of obstruction of the biliary passages, the catheter was left indwelling centrally in the biliary passages for external bile drainage. Thus immediate postcholangiogram surgery was not required in these patients. The procedure was successful in all 60 patients with obstructive jaundice. In 26 patients the possibility of obstruction was ruled out. Complications occurred in four patients but were not exclusively due to the procedure. The incidence of complications may be maintained at an acceptably low level if the technique is meticulously followed.


Jaundice from impacted sediment in a T tube: recognition and treatment.

Encrustation of bile sediment in the proximal limb of an indwelling T tube may occlude the luman and cause jaundice. The cholangiographic appearance of this phenomenon is described. Insertion of a torque cable under fluoroscopic control can successfully disimpact the occlusion, restoring patency and relieving the jaundice.


The aberrant gallbladder: angiographic and radioisotopic considerations.

There are four types of aberrant gallbladder: (1) intrahepatic, (2) left-sided, (3) transverse, and (4) retrodisplaced. Five cases of the first three types are illustrated. In three of the five patients the aberrant gallbladder produced false positive liver scans which were correctly diagnosed by hepatic angiography; in one it caused the hepatic angiogram to be misinterpreted. The importance of identifying the gallbladder at hepatic angiography by observing the cystic arteries in arterial phase and the gallbladder wall stain in hepatogram phase is stressed.


Electrical stimulation for anal sphincter control in barium enema examinations: an extended trial.

The routine use in 500 consecutive patients of a barium enema cannula incorporating stimulating electrodes is described. Barium retention was improved by the electrically maintained contraction of the anal sphincter. The cannula was connected to a battery-powered control unit which provided the stimulus; pulse width was 1 msec and frequency was 20 pulses/sec. The pulse amplitude, adjusted for each patient, was in the range of 5--17V. A standard procedure was adopted throughout the trial without the use of colonic relaxants (such as anticholinergic drugs). The barium suspension and water were in stilled at body temperature. A comparison with a control series of 200 patients showed a significant reduction in the failure rate from 20% to 4%. No unpleasant side effects were encountered apart from a tingling sensation in the anal region which was expected. The principal factors contributing to failure were fecal impaction and diverticular disease.


Radiographic evaluation of endotracheal tube position.

A malpositioned endotracheal tube is a potential hazard to the intubated patient. Ideally, the tube tip should be 5+/-2 cm from the carina when the head and neck are in neutral position. In 92 of 100 patients studied, the carina overlay T5, T6, or T7 on portable radiographs. Therefore, even when the carina is not visible, it can be assumed that a tube tip positioned at the level of T3 or T4 is safe. The degree of neck flexion or extension at the time of radiography may be determined by evaluating the position of the mandible relative to the vertebral bodies.


Further observations on pulmonary venous varix.

Pulmonary venous varix is a well known radiographic entity. Case reports are presented to illustrate the following unusual aspects of this lesion. 1. Hypoplasia of a major pulmonary vein results in increased pulmonary blood flow through the remaining normal ipsilateral pulmonary vein. This may result in variceal enlargement of the normal vein. 2. A pulmonary venous varix may be visualized during angiocardiography but not in a routine chest radiograph. This is most common in children. 3. Elevated pulmonary venous pressure causes dilatation of the central pulmonary veins. Sudden formation of a pulmonary venous varix in a patient with mitral valvular disease may be evidence of a sudden elevation of left atrial pressure.


Pulmonary metastases from benign-appearing smooth muscle tumors of the uterus.

A 42-year-old woman was found to have multiple pulmonary nodules 7 years after hysterectomy for leiomyoma. Thoracotomy revealed multiple well differentiated smooth muscle masses containing epithelial inclusions. This patient is similar to others previously reported as examples of "multiple pulmonary fibroleiomyomatous hamartoma" on the basis of slow-growth, benign-appearing histology, and the presence of epithelial elements. Evidence is presented which suggests that these cases represent metastasis from well differentiated leiomyosarcomas. There is a frequent association with uterine smooth-muscle tumor, cases with equally benign-appearing histology have shown lymph node metastasis, the nonmesenchymal elements have been shown to represent engulphed bits of adjacent pulmonary tissue, and the histologic di-ferentiation of benign from malignant mesenchymal tumors is known to be unreliable in some cases. Unlike more anaplastic leiomyosarcomas, this condition may be associated with few symptoms and prolonged survival despite widespread disease.


Radiology of knee joint replacement.

As total knee replacement becomes more successful due to advances in surgery and bioengineering, a greater number of patients will be offered this procedure as a viable alternative to arthrodesis. Radiologic consultation will be sought for evaluation of proper alignment as well as postoperative complications such as loosening, instability, dislocation, limitation of range of motion, fracture, and infection. This evaluation may be accomplished by plain films and arthrography. Radiographic aspects of these features are discussed and illustrated.


Traumatic lesions of the discovertebral junction in the lumbar spine.

Lumbar discovertebral abnormalities thought to be due to endogenous or subclinical trauma were evaluated in 22 cases. These consisted of predominantly lytic areas due to intrabody disc herniation in five cases, broad zones of vertebral body sclerosis due to reactive osteitis in 11, and destruction of the vertebral endplates surrounded by diffuse sclerosis in six. Spinal biopsy and negative bacterial cultures were consistent with the diagnosis in eight cases. Follow-up roentgenograms and further clinical evaluation in the remaining 14 showed either no progression or changes consistent with trauma. Only four cases had a history of exogenous trauma. Intrabody disc herniations usually affected the upper vertebral body with characteristic sparing of the adjacent endplate. The sclerotic lesions tended to occur in the anterior portion of the vertebral body, with the inferior aspect of L4 most frequently involved. These may be confused with osteoblastic metastases, particularly if adjacent disc narrowing is minimal. The lack of progressive vertebral fragmentation helps to distinguish this condition from neuroarthropathy. Lesions characterized by destruction of the vertebral endplates and reactive sclerosis simulate infection; absence of a soft tissue mass and clinical signs of sepsis as well as lack of progression are important differential features.


Congenital dislocation of the knee.

Four cases of congenital dislocation of the knee are presented. The incidence, associated congenital anomalies, presentation, and etiology are discussed with particular attention to the roentgenographic findings.


The os incae.

The The os incae is an integral feature of reptilian and various mammalian skulls which demonstrate intramembranous ossification centers behind the parietal bones. In man, the interparietal portion of the occipital squamosa arises in membrane from a single ossific focus. Normally it fuses with the supraoccipital segment of the occipital squamosa. Occasionally there are multiple ossification centers in the interparietal bone which fail to fuse, resulting in one of several varieties of os incae.


A new radiographic technique for fractures of the orbit and maxilla.

A variant oblique posture of the head is described which eliminates most superimposition in radiographic examination of the orbit and maxilla. The position is simply attained without extraordinary equipment, is comfortable for the patient since there is no pressure on injured parts, and often obviates the need for planigraphy. The following injuries are demonstrated best: displacement at the frontozygomatic suture; deformity of the orbital floor and its distance from the anterior orbital rim; degree of depression of the anterior zygoma, antral wall, and alveolus; and vertical displacement of the zygomatic arch.


Computed tomography and brain scintigraphy in ischemic stroke.

Radionuclide and computed tomographic (CT) scans were reviewed in 215 patients with ischemic stroke. The findings vary depending on the site of vascular occlusion. In middle cerebral artery occlusion, four distinct patterns may be seen on the scintigrams. The CT scans show little variation in appearance. The tentorial confluence sign is an important finding on scintigrams of patients with occipital infarction; the absence of this signs should suggest another diagnosis. During the first week and after the fourth week following an ischemic stroke, the scintigram is usually negative, whereas the lesion is visible by CT. However, there are a significant number of false negative CT scans; therefore, both examinations are advocated in difficult cases.


Normal variants and congenital anomalies in the region of the obelion.

A number of anatomic bony variants and several congenital anomalies are known to occur at the level of the obelion, that is, in the posterior interparietal region of the head, a short distance in front of the lambda. Among them are: (1) remnants of the embryonic parietal incisura, including parietal fissure, small and large parietal fontanelle, obeliac bones, persistant midline parietal foramen, and small and large parietal foramina; (2) encephalomeningoceles and related defects, including true encephaloceles, herniation of midline intracranial cysts (diencephalic and Dandy Walker cyst), epicranial arachnoid cysts, and scalp defects with ectopic glial tissue; and (3) congenital scalp and skull defects (cutis aplasia congenita). A review of these defects is presented with some illustrative examples not previously reported.


The destiny of brachytherapy in oncology.

At the invitation of the American Radium Society, Pierquin reviews his very large experience with continuous low dose rate irradiation of cancer. The target volume is treated with 6,000-7,000 rad in 3-10 days at a dose rate of 30-100 rad/hr. Preference for continuous low dose rate irradiation is based on the earlier work of Jean Pierquin, Georges Richard, Claudius Regaud, and Ralston Paterson with radium sources. Afterloading techniques with iridium-192 have been substituted allowing safer and more precise placement. An accumulated experience with 5,000 patients over the past 15 years permits conclusions that the techniques are safe, easy, inexpensive, and effective for tumors accessible to direct instrumentation. Dosimetry is based on the Paris system. Standardizing upon a dose of 7,000 rad, Pierquin concludes there is an isoeffect of continuous radiation at low dose rates of 25-100 rad/hr. The differential effect on tumor versus healthy tissue is impressive even when large volumes are irradiated, as in neck adenopathy. Stemming from this experience, three trials have been carried out of low dose rate teletherapy with cobalt-60 sources in oral cavity and oropharynx tumors, delivering 7,000 rad at rates of 90-100 rad/hr. Pierquin hopes for the same very high local control rates (in the order of 95%)achieved by iridium-192 endoradiotherapy of accessible T1, T2, T3, and T4 cancers.


Subtotal mastectomy and radiation therapy in the definitive management of localized breast malignancy.

Between 1961 and 1974, 51 women with primary carcinoma of the breast were treated by external radiation following surgery that was limited to diagnostic biopsy. All patients tolerated therapy well with minimal long term morbidity. While the reported follow-up periods are brief (most patients at risk for less than 3 years), 29 patients remain alive, 25 of whom show no evidence of persistent or recurring disease. These data suggest that local-regional control rates match those obtained following mastectomy. Definitive statements as to local failures and long term survival rates are not yet available.


Postoperative irradiation in the prevention of keloids.

Low dose superficial x-irradiation to the incisional site after surgical excision of a keloid prevented keloid or hypertrophic scar formation in 31 of 35 patients evaluated (88%). The clinical manifestation of keloids, physiology of wound healing, pathophysiology of keloid formation, and the radiation technique utilized are presented. This study shows that the method is well tolerated, easily administered, and efficient in inhibiting recurrence of keloid or hypertrophic scar formation.


Parametrial calcification in cervical carcinoma patients treated with radioactive gold.

A unique appearance of soft tissue calcification in the pelvis which may be specific for patients treated with parametrial injection of 198Au colloid is described. The calcification appears in the area of maximum radiation dose and can appear within 5 years of treatment. It is significant because it occurred in approximately one-half of the cases radiographically reviewed and may be confused with calcification from other etiologies.


Nodular lymphoid hyperplasia of the colon associated with dysgammaglobulinemia.

A case of dysgammaglobulinemia associated with nodular lymphoid hyperplasia of the colon is reported. The patient had typical immunoglobulin deficiency, diarrhea, recurrent respiratory infections, Giardia lamblia in the stool, and lymphoid hyperplasia of the small intestine. His barium enema showed diffuse submucosal nodules. Rectosigmoid biopsy confirmed nodular lymphoid hyperplasia. The similar findings on barium enema in this entity and in lymphosarcoma are stressed.


Massive enlargement of the ileocecal valve due to lymphoid hyperplasia.

Two children with unusual infiltration of the ileocecal valve by lymphoid tissue are described. The large filling defect identified on barium enema may suggest a number of conditions. Operative resection will exclude the possibility of a malignant process and will reduce the chance of recurrent intussusception.


Unilateral dysplasia of the superior articular facet of the axis.

A case of unilateral dysplasia of the superior articular facet of the axis due to incomplete or delayed ossification is described in a child. This may result in asymmetry of the articular surfaces of the axis in adult life and be a cause of torticollis. To our knowledge, no similar case has been reported.


Arteriographic findings in hyperergic granulomatosis and vasculitis of a kidney.

A case with a probable diagnosis of a limited form of Wegener's granulomatosis is presented. Arteriography of an involved kidney revealed arterial occlusions and stenoses with infarcted parenchymal regions and a distinct collateral circulation. Compared to the renal changes in other collagenous diseases, the renovasographic findings in this case were more prominent, more centrally located, and of segmental distribution.


Interim report: mammographic exposures at the breast cancer detection demonstration project screening centers.

In the interests of uniformly high radiological physics standards at ACS-NCI Breast Cancer Detection Demonstration Projects, measurements were made at 29 breast cancer screening clinics. These measurements were made throughout the country with equipment calibrated with standards traceable to National Bureau of Standards. Histograms which indicate the frequency distribution of exposures to the surface of a 6 cm breast for various machine/receptor combinations were prepared.


Double-blind test of metronidazole and tinidazole in the treatment of asymptomatic Entamoeba histolytica and Entamoeba hartmanni carriers.

One hundred and fifteen persons with asymptomatic Entamoeba histolytica or E. hartmanni infection, or both, were given metronidazole (750 mg three times daily for 5 days), tinidazole (1 g twice daily on 2 consecutive days), or a starch placebo. Three post-treatment stools were examined in the 2 weeks following initiation of treatment. Cysts of E. histolytica reappeared in the stools of 37% of 30 given metronidazole, 62% of 34 given tinidazole, and 70% of 31 given placebo. Cysts of E. hartmanni reappeared in the stools of 46% of 24 given metronidazole, 69% of 16 given tinidazole, and 90% of 10 given placebo. Rapid absorption and short duration of treatment make both drugs ineffective for the treatment of ameba carriers.


Seroepidemiology of amebiasis in the Orang Asli (Western Malaysian aborigine) and other Malaysians.

The indirect hemagglutination test was used to study antibody titers to Entamoeba histolytica in different Malaysian populations. Eighty-seven percent of Orang Asli (western Malaysian aborigines) adults and 79% of Orang Asli children with acute amebic dysentery were seropositive. However, significantly fewer children (39%) with amebic dysentery had high titer responses (titer greater than or equal to 1:1,280) than did adults with amebic dysentery (76%). No correlation between proctoscopic severity and amebic titer was found. Forty-four percent of asymptomatic family members were seroresponders. Satak, an Orang Asli village located near towns, had significantly more seroresponders (32%) than did the isolated, deep jungle village, Belatim (4%).


Persistence of virus-specific IgM and clinical recovery after Japanese encephalitis.

We have searched for evidence of a chronic Japanese encephalitis virus (JEV) infection in six Thai patients convalescing from acute Japanese encephalitis (JE) in whom JEV-specific IgM antibody was last detected 116 to 350 days after their acute illness. These six patients were compared with 94 other JE patients matched for age, sex and serological response and in whom JEV-specific IgM was either short-lived (less than 90 days) or not tested. All patients were evaluated for the presence or absence of seven abnormal neurological signs over a 1- to 2-year period. During the first 30 days of illness the mean numbers (+/- S.E.M.) of abnormal signs per patients for the IgM and control groups were 3.8 +/- 0.3 and 2.3 +/- 0.1, respectively (P less than 0.01). After 1 year the six IgM patients still had significantly more abnormal neurological signs than controls (1.3 +/- 0.3 and 0.6 +/- 0.1, respectively [P less than 0.01]). By 2 years, the IgM group showed no neurological impairment; examination of cerebrospinal fluids revealed no evidence of subclinical viral infections. The recovery of the six IgM patients between 1 and 2 years after their relatively severe acute illness suggests that IgM antibody persistence was related to acute virulence rather than chronicity of the JEV infection.


[Acupuncture and pain mechanisms (author's transl)].

Three modulating mechanisms of the "gate-control theory" provide a plausible explanation of how acupuncture analgesia works. In particular, the inhibitory effects of the brainstem reticular formation on the transmission of pain signals in the spinal cord or at higher ttransmission levels seems to provide a powerful explanatory concept. Intense stimulation through acupuncture needles could activate this inhibitory brainstem system, thereby closing the gate to pain signals.


Leukocyte cyclic-3', 5'-nucleotide phosphodiesterase activity in human bronchial asthma.

Changes in cyclic-3', 5'-nucleotide phosphodiesterase activity of the peripheral blood leukocytes were investigated in patients with bronchial asthma. Leukocyte phosphodiesterase activity was significantly elevated during asthmatic attacks. Elevated activity was seen in most active asthmatics irrespective of the drug treatment. The ratio of the adenyl cyclase activity to the phosphodiesterase activity of the same leukocyte decreased to less than 1.0 during asthmatic attacks.