Withdrawal from positive end-expiratory pressure.

A retrospective review was carried out involving 82 patients who required positive end-expiratory pressure (PEEP) therapy for acute respiratory insufficiency. One third of the attempts at reducing the level of PEEP were unsuccessful and led to reinstitution of the original or an increased level of PEEP. Premature lowering of PEEP resulted in significant deterioration in oxygenation which persisted for more than 24 hours after reinstitution of PEEP in a significant number of patients. In addition, one half of these patients required increased levels of PEEP (above prelowering levels) to achieve adequate oxygenation. PEEP lowering attempts were categorized as either successes or failures. A comparison was made between the prelowering respiratory measurements of these two groups. The discriminant criteria produced were (1) an improving oxygenation index (rising (PaO2/FIO2) and (2) a stable or improving effective compliance. Using these prelowering criteria, it was possible to distinguish between the successes and failures in 95% of cases. Based on the data collected, proposed guidelines for PEEP lowering are presented.


Pediatric cadaver kidneys for transplantation.

A group of 24 kidneys from donors ranging in age from 1 1/2 to 10 years were transplanted singly into adults and were compared to a group of 44 adult cadaveric kidneys transplanted into adults. There were no vascular complications in either group. There were two urological complications in the 24 pediatric donor cases and none with the adult donor cases. During the first month after transplantation, the mean creatinine clearance was lower in the pediatric donor group; later the function of the pediatric donor kidneys was at least as good as the function of the adult donor grafts. In the group of pediatric donor kidneys, the outcome using kidneys from donors younger than 3 years of age was less satisfactory than for donors 3 to 10 years of age. These data suggest that transplantation of a single pediatric kidney into an adult, particularly if the pediatric donor is at least 3 years of age, will provide satisfactory renal function.


Pancreatic autotransplantation following resection.

A patient with recurrent pancreatitis was treated by near-total pancreatectomy. The tail of the pancreas, together with the splenic artery and vein, was transplanted into the thigh, with anastomoses of the splenic vessels to the femoral vessels. Two months after operation simultaneously drawn blood samples from both femoral veins showed elevated insulin on the grafted side. Two years after operation the patient is free of symptoms and is not diabetic.


Daily monitoring of the immune response to various allografts in rats.

The appearance of activated lymphocytes and antibodies in the circulation of rats was monitored following allogeneic kidney, skin, or combined skin-spleen transplants. Lymphocyte activation was measured by 3H-thymidine incorporation, and antibody by a hemolytic assay. These assays have been developed so that small samples of blood could be used, thus maintaining recipient survival and allowing for daily correlation between the response observed and the fate of the graft. These responses were detected after allogeneic transplantation in two recipient strains, but not following isogeneic renal or skin transplantation in either strain. The relative levels, time of onset and persistence of lymphocyte proliferation and of hemolytic antibody were found to differ substantially for the three different kinds of allografts. In general, these studies have demonstrated the validity of using the lymphocyte proliferative and humoral responses together as indicators of a current immune response against allogeneic renal transplants.


[Topographical changes in the labial fornix in the endentulous mandible due to the insertion of dentures].

The evaluation of 278 lateral teleradiographs obtained from 139 full denture wearers with and without their prostheses permitted to measure the position of the lavial vestibule in the mandible. In contrast to significant sagittal changes in position, no vertical ones were detected after insertion of the denture. Due to these findings, the author is very cautious in assessing  the possibility of targeted deepening of the alveololabial sulcus in the region of the labial vestibule by functional impression taking or by shaping the labial border of the denture.


Cell mediated and humoral immunity in experimental Plasmodium berghei infection.

Adoptive passive transfer of immunity to Plasmodium berghei infection has been investigated in an inbred strain of Swiss mice. The mice were made hyperimmune by repeated passage of 10(3) parasites and subsequent therapy with an antimalarial drug. Immune sera and cells obtained from thymus, spleen and peritoneal exudate were transferred to normal animals which were subsequently challenged with standard doses of P. berghei. It was observed that: (a) immune serum in high doses (0.5 ml/mouse) enhanced parasitaemia; when used in smaller doses (0.1 ml/mouse), it afforded a considerable degree of protection; (b) viable immune lymphocytes obtained from thymus and lymph node afforded protection; (c) the mixed population of cells obtained from spleens of immunized mice, as well as peritoneal exudate, protected mice against challenge inoculum; (d) glutaraldehyde-treated spleen cells and material obtained after freezing and thawing the same number of spleen cells, macrophages and lymph node also afforded protection. These findings confirm that, under these experimental conditions, immunity against P. berghei is mediated through (i) specific antibody which is dose-dependent, (ii) cell-mediated immunity and (iii) effective response to processed antigen.


Toxocaral larva migrans: the use of larval secretory antigens in haemagglutination and soluble antigen fluorescent antibody tests.

Toxocara larval excretions and secretions collected from in vitro culture were used as antigen in passive haemagglutination and soluble antigen fluorescent antibody tests for the diagnosis of visceral larva migrans in experimental animals and man. Antibody to toxocaral secretions was detected in rabbits within 13 days of light Toxocara infection (ten larvae per kg) and within four days of heavy infection (10(4) larvae). Antibody was not detected following infection with 10(4) Ascaris suum larvae. In human sera, antibody was detected at low titre in 1% of 100 healthy adults and in 2% of 50 children. High titres were observed in one third of 170 patients with suspected visceral larva migrans and in 23 of 27 such patients presenting with an eosinophilia greater than 20%. In 25 patients with ocular lesions of an undiagnosed nature, four showed significant levels of anti-Toxocara antibody.


Treatment of intestinal amoebiasis and vaginal trichomoniasis with panidazole and its comparison with metronidazole.

A dose range study in 18 patients suffering from intestinal amoebiasis and treated with doses of panidazole between 1.0 and 2.0 g per day for six days revealed that the best therapeutic results were obtained with the higher dose. This dose was then compared with metronidazole, at the same dose, in a clinical trial in 100 patients with intestinal amoebiasis. Cure rates were 68% and 80% for the two drugs respectively. In 100 cases of vaginal trichomoniasis treated with panidazole at the dose of 1.0 g per day for seven days in half of the patients and for 10 days in the other half, we obtained 50% and 60% cure rates. The results of our studies with both amoebiasis and trichomoniasis were not superior to those obtained with metronidazole and other nitroimidazole derivatives. Side effects were found in 74% of the patients treated for amoebiasis and in 46% of the cases treated for trichomoniasis. No toxic effects were revealed by haematological, biochemical and renal function tests nor by cardiovascular studies.


Plasmodium falciparum gametocytes: The effect of chloroquine on their development.

Asexual erythrocytic parasites of Plasmodium falciparum are killed by chloroquine, whilst mature gametocytes are not. The gametocytes of P. falciparum take 10 days to develop to maturity and their sensitivity to chloroquine during this time was studied in vitro to investigate when the switch from susceptibility to insusceptibility occurred and to compare the responses of asexual and immature sexual parasites to the drug. 45 to 50% of asexual parasites and immature gametocytes less than one day old survived in 0.1n. mols of chloroquine per ml but 0.3n. mols of drug per ml was lethal to both. Chloroquine at 1.0n mols per ml was lethal to developing gametocytes during their first six days of growth probably due, at least in part, to the drug disorganizing the parasite's digestion of host erythrocyte haemoglobin. The drug clumped the pigment of developing gametocytes. Only immature gametocytes in the final stage of development (stage 4) survive in high chloroquine concentrations.


A study of the conversion from paid to altruistic blood donors in New Mexico.

We investigated the recent conversion of the New Mexico blood supply from a donor recruitment base which depended almost entirely upon paid, responsibility fee, and insured donors to 100 per cent reliance upon altruistic donors. Blood Services of New Mexico (BSNM) effected this change. The local Red Cross played a key role in interpreting the change to the community and in providing entree for BSNM recruiters to the right places in the community, resulting in the enlistment of an almost entirely new group of donors who had never been asked to give blood before. The sequence of decision making is identified in relation to the detailed results during the transition. Altruistically donated blood did not significantly alter the incidence of HBsAg in the New Mexico blood supply. The supply of blood was not interrupted or diminished, the range and quality of blood services improved and the cost of blood service to the patient was reduced. The New Mexico community responded magnificently, although focal responsibility for the success of this project rests with a small number of key individuals. New Mexico now has an altruistically donated blood supply.


[Mechanism of the reaction of substrate phosphorylation in the tricarboxylic acid cycle].

The suggested sequence of the reactions differs from those presented in literature and includes the following compounds as intermediate ones: the complex of enzyme having 2ATP and two residues of phosphoric acid; the complex of enzyme having four residues of phosphoric acid; the complex of enzyme containing two residues of phosphoric acid and two residues of succinic acid. Sequences of the reactions suggested in literature involve as intermediate compounds a phosphorylated derivative of the enzyme (E--P), phosphorylated derivative CoA linked with the enzyme (E.CoA--P), a high-ergic compound of the enzyme with CoA (E.CoA) and succinyl phosphate linked with the enzyme (E.succinyl--P).


[Urinary infection and vesicorenal reflux after renal transplant (author's transl)].

Worldwide experience shows that a urinary infection can endanger a renal transplant. Our experience with vesicorenal reflux and its possible complications led gave us to check randomly selected patients with renal transplant. In 3 out of 4 patients with chronic or relapsing infections, reflux was found. Four out of 23 patients with no reflux had a chronic urinary infection. In our opinion a ureter implantat with antireflux mechanism in the bladder should be given closest attention.


[Occult reflux (author's transl)].

Level diagnosis repeatedly performed in patients without roentgenologically demonstrable reflux demonstrated bladder bacteriuria in 80% of the cases. The remaining 20% had supravesical bacteriuria. We called this occult reflux, if reinfection was demonstrated. Contamination of the upper tract by occult reflux can, but must not induce pyelonephritis. Bilateral antireflux surgery frequently eliminates occult reflux of bacteria, so this seems a debatable method of treatment.


Serum antibody titers in treatment with trimethoprim-sulfamethoxazole for chronic prostatitis.

A comparative study of the clinical, bacteriologic, and serum antibody titer response of 22 men who received therapy with trimethoprim-sulfamethoxazole for chronic prostatitis due to various strains of Escherichia coli was done. Of the 7 patients who were cured by therapy on the basis of clinical and bacteriologic data, 6 of 6 patients who had elevated serum antibody titers prior to treatment demonstrated a decrease to normal range of serum titers during follow-up, confirming disappearance of the bacterial antigen. Of the 15 patients who were not cured on the basis of clinical and bacteriologic data, 12 of 12 patients who had elevated serum antibody titers prior to treatment demonstrated no change in serum titers throughout the study, confirming persistence of the bacterial antigen.


Solitary infected renal cyst: report of 2 cases and review of literature.

Two cases of suppuration in solitary renal cyst are reported. The clinical history of acute pyelonephritis, avascular mass lesion of the kidney with ipsilateral pleural effusion (triad) seen in a female patient of child-bearing age is characteristic of this condition. Surgical management is satisfactory. Our Case 1 is the first reported case of solitary infected cyst that ruptured retroperitoneally, clinically mimicking a subphrenic abscess.


[Methods of anastomosis in anterior resection of the rectum].

For the second row of anastomosis sutures in anterior resection the authors employed the technic of "enlarging rectosigmoid anastomosis", which is formed by two running sutures. The second row of sutures is put prior to the withdrawal of the apparatus KTs-28, which is used for pulling the stoma into the wound and turning of both anastomosed intestines to provide an adequate access to the anastomotic line. The experience with the initial II operations seems to be fairly promising. No stricture of the anastomosis develops while using this technic. Indications to the anterior resection of the rectum for cancer are discussed.


Pathological changes in the small intestine of neonatal calves with enteric colibacillosis.

Three neonatal calves, protected from colisepticaemia by intravenously administered immunoglobulin M, were infected orally with Escherichia coli type 0101 K?(A). All calves developed severe enteric colibacillosis. When they were 4 days old stunting and fusion of villi were seen in the distal half of the small intestine and were associated with adhesion of the challenge organism to the mucosa. Two uninfected control calves kept under similar conditions, did not develop diarrhoea and had no lesions.


[Immunogenicity in Salmonella gallinarum-pullorum irradiated with gamma rays].

Studied with the imunogenicity of Salmonella gallinarum-pullorum bacteria treated with 1, 10 and 20 MR gamma rays or killed with acetone. Bacterial cultures were irradiated with a LMB-gamma M device, having a 137Cs source, single doses being of a 3,252 R/min power Biozzi's clearance test was employed to determine the changes in the immunogenic properties of the irradiated bacteria. The results obtained with both the clearance test and the protection test spoke of a considerable drop in the immunogenic capacity of the irradiated bacteria, using rates of 10, and especially of 20 MR gamma rays as compared to those killed with acetone. Protection was manifested best by bacteria treated at the rate of 1 MR gamma-rays, which pointed to the possibility of their practical use in the immunoprophylaxis of pullorum disease in birds.


[Biochemical and serological studies of the E. coli strains isolated from cows with subclinical mastitis].

Studies were serologically and biochemically a total of 17 strains of Escherichia coli isolated from mastitis-affected cows in the districts of Sofia, Varna, and Plovidiv. Demonstrated were the serogroups 0125, 0111, 086, 025, 026, 055, and 0128, which were pathogenic for humans too. Via the milk they were shown to reach both newborn animals and children and to cause severely expressed colienteritis. All investigated strains attacked glucose and manite, reduced nitrates into nitrites, and gave a positive reaction with methyl red but did not ferment starch, insulin, sucrose, and maltose; neither did they produce hydrogen sulfide and liquefaction of gelatin. They gave a negative Voges-Proscauer reaction. Single strains were negative with regard to lactose and indole, and the strains' activity with regard to sorbite, inosite and adonite varied.


[Clinical and experimental studies of suppurative surgical infection in cattle].

Investigated were a total of 30 cattle 6 of which had experimental surgery infection and 24 showed spontaneously developing suppurative infection. The animals were studied in terms of general status, blood picture, quality of urine and synovia, and rumen content. The dynamis was followed up of the development of sepsis and purulent artritis. It was found that in case of suppurative surgical infections in cattle the general status was invariably affected, the severity of the process depending on its localization and developmental phase. Changes were observed also in the eye fundus and in the urinary and the digestive system. There were anemia and leukopenia which alternated with leukocytosis, and transient changes in the values of the erythrocyte sedimentation rate and the blood electrolytes. The SGOT values almost constantly increased, and the hemoculture was not positive in all cases.


[Use of an immunoadsorbent in differentiating B and D salmonelloses in poultry].

An immunoadsorbent was obtained from a lipopolysaccharide of Salmonella gallinarum-pullorum, employing the method of Eskenazy. It was used to adsorb the O agglutinating antibodies against S. gallinarum-pullcorum, S. enteritidis, S. heidelberg in blood sera of birds. Adsorption of sera was carried out at room temperature for 40 min. It was demonstrated that the product was highly specific. It fully and specifically found the O agglutinating antibodies in the sera of birds infected with S. gallinarum-pullorum and S. enteritidis and in the sera of birds coming from a flock with pullorum infection, however, did not bind the O agglutinating antibodies induced by the O antigens 4 and 5 characteristic of Salmonella heidelberg, resp., group B. A following investigation of the sera, using a S. heidelberg test-antigen, specified the sera of birds infected with S. heidelberg only. The application of the immunoadsorbent makes it possible to speed up the adsorption of the O agglutinating antibodies, and thus, for one or several hours within a single working day the differentiation is carried out of B and D Salmonella infections in birds.


[Change in the quantity of coliform and Proteus bacteria during the ripening of raw, nonperishable meat products].

Studied were the changes in the amount of coliform and Proteus bacteria in the production of raw-dried and raw-smoked unperishable meat products, employing model testing procedures of experimentally contaminated meat products with Escherichia coli and Bacterium proteus, through following up the changes in the counts of coliform and Proteus bacteria in batches of regular production, and by the investigation of raw meat samples of varying moisture content. The studies were carried out at eight enterprises working under different technologic conditions. A total of twenty series of model experiments were carried out with artificially contaminated batches of products as well as twenty-one series of experiments with batches of regular production, and some 93 meat products, dried to a various extent, were sampled. Results showed that during the ripening process with unperishable meat products the reduce in the numbers of coliform bacteria is more intense than the decrease in the Proteus organisms. The process of smoking did not change the amount of these microbes. In unperishable raw meat products that meet the requirements of the Bulgarian State Standard coliforms are found in 43 per cent of the samples, and Proteus bacteria are not present.


[Immunodepressive activity of cell fractions of Escherichia coli O138:K81:H19].

A soluble cell fraction (cytosol), an O-antigen (endotoxin), and an unsoluble cell ingredient were isolated from a 24-hour culture of Escherichia coli O138:K81:H19. Their immunosuppressive action was determined by using the tuberculin test and the survival rate of the allographts. It was found that: 1. Cytosol appears to be a slightly toxic preparation with well expressed immunosuppressive action. 2. The endotoxin is highly toxic, producing the same effect as cytosol. 3. The unsoluble cell ingredient is a comparatively toxic preparation, producing an undependable immunosuppressive effect. Discussed is the mechanism of the immunosuppressive activity of the investigated subcellular fractions. It believed to be due to a certain injurious action on the function of the T-cells.


[Problems of the amino acid content in the blood plasma and their absorption in the intestines in chronic lead poisoning].

As against controls essential differences in the amino acids content were disclosed largely in patients with a well-marked form of poisoning, i. e. a fall in the level of 7 from among 17 amino acid under examination (valine, glycine, leucine, lysine, serine, tyrosine, phenylalanine). After a peroral administration of 100 gm of an amino acids mixture the increment in the amount of amino acids in the blood of these patients proved lower than in controls both after a lapse of 30 and 60 minutes. In patients with a mild form of poisoning a fall of the serine, tyrosine and phenylalanine level in the blood was ascertained. The amino acids loading revealed a lesser accretion of amino acids in the blood on expiration of 60 minutes. The specific D-penicillinamine medication had no effect on the amino acids content in the plasma and their absorption in the intestines.


[Hepatitis b infection in renal transplant recipients (author's transl)].

During a period of 4 1/2 years the incidence and clinical course of endemic hepatitis B infection was studied in 43 renal transplant recipients with an observation time of 3 to 47 (average: 26.3) months after surgery. During the investigation period 27 out of 43 patients (62.8 per cent) had hepatitis B infection. In 8 patients HBs antigenaemia persisted after chronic dialysis treatment. After surgery HBs antigenaemia was detected for the first time in 7 patients. Recurrence of HBs antigenaemia was noted in one patient. In 7 further cases with HBs antigenaemia after transplantation regular controls of HBsAg and HBsAb were not available before transplantation. In 2 patients HBs antibodies were detectable at the time of transplantation; 2 further patients developed HBs antibodies postoperatively. Hepatitis B infection showed a mild and persistent clinical course. 6 out of 7 icteric patients simultaneously had other severe mycotic and viral infections. Therefore, the conclusion was drawn that in patients with coexisting multiple infections liver damage is not necessarily attributable to HBs antigenaemia.


[Experimental lung transplantation: functional studies of the graft compared with a normal and a pathological contralateral organ (author's transl)].

After a short description of the technique of experimental lung homotransplantation, the function of the graft is investigated both from the haemodynamic and respiratory point of view. Perfusion of the transplant was studied in acute and chronic experiments. The haemodynamic rate can be normal even when there are signs of rejection. In the first week there was always a decrease in the perfusion ratio. Lung function tests revealed adequate functional capacity of the graft, capable of sustaining life of the animal, as long as rejection is kept under control. Normal values as obtained with a healthy organ were not achieved, however. Studies in dogs with pathological changes in the contralateral lung showed that the graft is able to tolerate the total cardiac output and to provide adequate respiratory function. In animals with an emphysematous contralateral lung, no ventilation-perfusion imbalance resulted in the homotransplanted organ even when unilateral papain instillation had induced severe emphysematous changes in lung structure of the contralateral organ.


Corticosteroid therapy of intrathoracic sarcoidosis stages I and II--results of a controlled clinical trial.

It is difficult to evaluate the efficacy of sarcoidosis therapy. There are high rates of spontaneous remission, frequently pushing course and tendency to relapses after treatment. 280 patients with histologically confirmed mediastino-pulmonary sarcoidosis in stage I and II without extrapulmonary manifestations have been admitted until now in a controlled clinical trial. More than 150 of them have been analysed after a follow-up of 3 to 5 years, in 40 cases already to 7 years. The patients have been treated by prednisolone and isoniazide for six and 12 months respectively and compared with a non-treated control group. 6 and 12 months after the start of observation X-ray regression has been more often observed in the treated than in the non-treated patients. However, the results after 3 and 5 years were nearly similar in all groups: improvement in 75% and complete resolution in 60% respectively. It seems to us therefore that prednisolone shows only an effect on the early stage of sarcoidosis but is without any influence on the late X-ray results. In consequence corticosteroid therapy is clearly indicated only in patients with progressive course of the disease.


[Effect of training in sports on the cardiovascular system of children and adolescents].

In a review the specific reaction of the cardiovascular system of children and youth to actual athletic stress and on a staying power training is dealt with. The present knowledge is imperfect because the medicine had a cautious opinion of the maximum stress of the infantile heart till recent times, and children training systematically were exceptions. The examination of the cardiovascular system of training children is complicated as far as the effects of training are mostly equal in direction like growth, maturing, and development effects. But it is evident that the infantile circulation system is well adaptable to staying power results. During training a cardiac enlargement surpassing the growth rate is arising. Under the condition of rest the heart of the trained child is more subjected to vagal control with the appropriate functional consequences. By submaximum stress an economization of the function can be observed. During stress a stronger inotropia with increased stroke volume and better oxygen absorption is stated. The post-stress phase is characterized by an accelerated return of the deflected functions to the zero level. Furthermore statements are made about the specific ECG of sporting children, about the problems of sports at heart diseases, about acceleration and retardation as well as about the transformation of physiologic knowledge into methodical conceptions for training.


[Controlled trials of premedication of fiberendoscopy (author's transl)].

In four controlled studies on 771 consecutive patients we tested the value of premedication before passing a fiberendoscope. Following local anaesthesia of the throat, 10 mgs of diazepam in patients less than 60 years and 5 mgs in those over 60 years quickly injected intravenously caused a sufficient premedication for fiberendoscopy. Premedication with diazepam is better than placebo. We fell that omission of premedication is not justifiable. Flunitrazepam, for premedication, in doses of 1-2 mgs did not prove to be suitable. 20 patients were radiologically controlled for signs of aspiration following premedication and endoskopy. They showed no signs of aspiration.


["Hepatogenic ulcer": theories and facts (author's transl)].

A review of literature is given concerning the incidence, pathogenesis and clinical relevance of peptic ulcer in chronic liver disease. 1. Today there is no doubt about a highly significant incidence of peptic ulcer in chronic liver diseases, especially in cirrhosis of the liver. Therefore it seems reasonable to use the term "hepatogenic ulcer". 2. Assuming a relation between chronic liver disease and peptic ulceration several theories are discussed with regard to the causality and etiology. Most investigators suppose the diseased liver as "primum movens" in peptic ulceration by means of conditioning different ulcerogenic factors. 3. The clinical finding of increased frequency of peptic ulcer in cirrhotics despite of reduced gastric acid output is no contradiction. It can be explained by relative disturbance of the balance between aggressive and protective mechanism, the latter being diminished. Although a dysfunction of gastric mucus is recently assumed, the specific pathogenetic factor is not clear up to now. 4 Nevertheless, there is no doubt about the clinical relevance of this type of ulcer, given by diagnostic and therapeutic problems and pitfalls.


[A critical analysis of the present state of recognizing the fetal hazard in pregnancy, via hormonal determinations (author's transl)].

The experience published in medical literature on the pregnancy hormones HPL and estrogens, is subjected to a critical review. The reported studies are examined in detail, first of all, with regard to the performance of the pregnancy hormones in fetal risk situations, taking certain pregnancy complications into account. The ranking of these paremeters in arriving at obstetric decisions in fetal emergency situations, is then described. This is followed by an assessment of the importance of the pregnancy hormones as prognostic parameters for forecasting fetal hazard in cases where pregnancy appears to have taken an uneventful courese, basing on few results available to date. All findings indicate that biochemical monitoring during pregnancy contributes toward individualization of the obstetric decisions.


[Hemodynamics in patients with coronary heart disease under conditions of physical exercise before and after mepindolol-sulfate (author's transl)].

The effect of exercise upon hemodynamic variables was investigated in seven patients with coronary artery disease during an eight-week double blind cross-over study with placebo and with mepindolol-sulfate, a new beta-receptor blocking agent. 1. The first hemodynamic sign of myocardial ischemia during exercise was an increase of pulmonary capillary pressure in parallel with ST-segment depression in the Ecg. 2. Angina was accompanied by a fall of the stroke volume and an increase of the peripheral resistance. 3. During beta-receptor blockade with mepindolol-sulfate angina was compensated,  the unfavourable hemodynamic effects seen during placebo did not occur. 4. No signs of congestive heart failure were found during mepindolol-sulfate-therapy. 5. Mepindolol-sulfate showed a pronounced blood-pressure lowering effect.


Arthritis: an ancient disease yields to research.

The author traces the history of arthritis, noting at least one instance when it affected the course of history, and describes the significant contributions to the understanding and treatment of the disease of the American Rheumatism Association and its Foundation.


[Significance of physico-chemical procedures and biochemical methods for uremia detoxification and construction of modern artificial kidneys].

1. The most well-known principles of artifical kidneys (those which are already in use as well as those which are being developed) and the principles of the partial kidneys are subdivided into a sequence of ordinal numbers. 2. Here these methods are critized partly more briefly, partly more detailed. 3. The author deals with some details of the A-coal-adsorption, in which case the uraemic detoxication is particularly taken into consideration. 4. Then the essential advantages of the use of adsorbents in the uraemic detoxication and in the removal of toxines in general as well as their significance for the construction of modern artificial kidneys are compiled.


[The roux-en-y-loop (author's transl)].

78 patients were operated on from 1st July to 31th December 1976 according to the method of Roux-en-Y-loop under several indications concerning primary and secondary reconstructive procedures in abdominal surgery. The experiences made are good. We recommend this method.


[Effectiveness of cervical suture in the prophylaxis of premature deliveries (author's transl)].

Results of surgical treatment of cervical insufficiency according to McDonald's method in 150 pregnant women are discussed. The diagnosis was based upon anamnesis, examination of the vaginal segment of the uterus and the behaviour of cervix throughout the gestation period. The results depended upon the extent to which uterine cervix dilated before operation. Sutures were inserted in 150 pregnant women, and positive results were obtained in 119 cases (79%). In pregnant women with obstetric history of incompetence a prophylactic application of cervical sutures seems to be justified.


[Circular suture of the cervix in placenta praevia].

In the accidents of placenta praevia a modified cervixcerclage was used to 25 women during gestation period of 20 to 35 weeks. The circulare suture goes under the bundles of uterine oessels. This inables to escape the lesions of oessels and dystrophy of the cervix uteri. The circulare suture helps to reduce a number of premature labours. The labours were delayed for 23 days and fetal mortality reduced to 10,53%. Cervixcerclage is indicated. Fetal mortality to prevent fetal mortality and to prolonge the pregnancy.


[Echinococci of the spinal canal].

The authors present a 51-year-old patient who was admitted to the neurosurgical department of the hospital because of paraparesis and vegetative disturbances. Myelography showed a complete lumbosacral stop. During surgery, large masses of Echinococcal cysts were removed from the extradural space. 20 months after the intervention, another operation became necessary because of a relapse. The fact is stressed that in spinal hydatidosis late relapses must be expected.


[Current status of diagnosis of the cerebrospinal-fluid space using Amipaque (metrizamide)].

A report is given on 73 examinations using Metrizamide (8 thoracolumbar myelographies, 18 ventriculographies, 47 suboccipital myelographies) under consideration of the latest literature. Subsequent systematic EEG-controls were carried out in 52 patients. Exact observance of the indication, adequate dosage, optimum preparation and after-treatment of the patients as well as a appropriate operation technique can limitate the vegetativ side-effects and avoid rarely occurring serious complications. Publications in the literature as well as our own experiences stress the excellent representation of the details of the ventricular system and the spinal subarachnoid space.


[Acute intestinal diseases in Northern Africa].

Analysis of morbidity of dysentery and the rest diarrheal affections according to the books for primary recording of patients at one of the large administrative territories of the Northern Africa showed that official statistics reflected only 1/13 of dysentery patients who applied for medical aid (18.2 and 236.3 per 100 000 residents, respectively). Morbidity index of the rest of diarrheal affections constituted 2424.5 per 100 000. The mean lethality in diarrhea affections (including dysentery) was 1.7%. The fact that in the examination of 439 persons who came in contact with the patients suffering from typhoid fever the causative agents of dysentery were isolated in 19 (4.3%) indicated their wide circulation among the population.


[Mapping of the genetic locus determining the degree of natural resistance to erythromycin in Salmonella].

The locus which determines ordinary (natural--ery or) level of resistance to erythromycin in Salmonella has been mapped. According to the results of conjugation mating and the analysis of the properties' transfer gradient this region is localized next to his--locus, the gene order being; trp--his--eryor. However, no contransduction of eryor--locus with his--gene has been demonstrated. An assumption on a possible mechanism of alteration of natural level of erythromycin resistance in S. typhimurium mutants Er-4 and Es-1 (received earlier) has been made. This mechanism is connected with alterations in cell permeability.


[Anaphylactogenic, antigeni and avid properties of the antibotulin serum from the blood of various animal species].

It was shown that purified and concentrated by the "Diaferm" method antibotulin sera from horse and cattle blood failed to differ by anaphylactogenic properties; at the same time in sensitization of the organism to protein of one animal species the use of the sera of another species provided a lesser reactogenicity of the preparation. The antigenic activity of the purified and concentrated sera from the blood or horses and cows in testing on rabbits was identical, but in response to cow alpha-globulin the animals responsed by a more intensive production of precipitins. The activity of cow and horse antibotulin serum (determined by the rate and stability of their association with the corresponding toxin) proved to be identical.


[Ways of determination of the intensity of the epidemic process in Shigella sonnei dysentery].

Proper view on the true prevalence of Sonne dysentery characterised by polymorphous clinical picture in which many cases coursed in subclinical form could be reached only by using additional active methods for detecting the infection rate of the population. For this purpose the authors applied passive hemagglutination test which permitted to reveal the response of the organism to the antigenic stimulation in the course of two months after the sustained sickness. Over 12 000 persons were examined. According to the results of passive hemagglutination test seasonal activization of the epidemic process occurred one month earlier than it was revealed by recording of the incidence of the disease. The results of the mentioned test also showed infection rate of the population with Sonne dysentery to be as a rule greater than established by the official statistics.


[Bacteriocinogenic properties of Proteus].

As revealed, bacteriocinogenia was widespread in bacteria of the Proteus genus (85 +/- 3.87%). Proteus cultures isolated from various sources failed to differ by the number of bacteriocinogenic cultures and by bacteriocinogenic activity. Bacteriocinogenic cultures were mostly revealed among the Proteius mirabilis strains.


[Submicroscopic study of bacteria and spores under the effect of peracetic acid and various aspects of the mechanism of its action].

Microbial cells (E. coli and staphylococcus) and B. cereus spores were used in this work. Peracetic acid in a concentration of 0.005% caused the death of 99% of the microbes in 20 minutes, and 0.1% peracetic acid caused the death of 99% of the spores in 45 minutes. Changes in the surface and internal structures of the cells were revealed on the ultrathin sections of microbial cells and spores after the action of the preparation. The noted changes were explained by disturbance of permeability barrier and a high reactogenic capacity of the activated oxygen of peracetic acid.


[Abolishment of allogeneic inhibition of colony formation with the aid of various RNA classes].

The authors analysed the capacity of various temperature fractions of RNA isolated from the spleen of donors of the bone marrow cells (of mice C57BL/6I) and recipients--hybrids (CBA X C57BL/6I) F1 to abolish the depression of colony formation in the nonsyngenous organism. In the administration of bone marrow cells of mice of parental genotype C57BL/6I of the irradiated recipients F1 there is observed a sharp depression of the number of colony forming units in the spleen F1. This depression can be eliminated by preliminary incubation of the bone marrow cells of mice of parental genotype with a 63 degrees fraction of the recipient's RNA. Preliminary inculation of the bone marrow cells of mice of parental genotype with 85 degrees and cytoplasmic fractions of recipient's RNA led to a partial restoration of colony formation only. The 45 degrees and 55 degrees RNA fractions of the recipient's RNA produced no restoring action. None of the temperature RNA fractions of the RNA of donor bone marrow cells were capable of abolishment of the colony formation depression in the nonsyngenous organism. It is supposed that restoration of the colony forming capacity in the nonsyngenous organism was connected with the activity of matrix RNA of the 63 degrees fraction obtained from the recipient's spleen.


[Central hemodynamics in the late, poststroke period in hypertension].

The authors studies the state and changes in the CNS and ECG in 92 patients (43 males and 49 females) with hypertensive disease, sequalae of strokes and patients with lesions in the basin of internal carotid arteries. The observed contingent demonstrated 2 types of circulation: hyperkinetic and hypokinetic. According to the ECG data, the latter form was characterized by an expressed ischemic cardiopathy, with developed preclinical insufficiency of circulation. Repeated studies of the hemodynamics following 2 years detected in some of the patients with a high dyastolic pressure a transition of the hyperkinetic type of circulation into a hyperkinetic. Unlike the patients with a high dyastolic pressure, the hyperkinetic type of circulation with a low dyastolic pressure, according to primary and repeated examinations of hemodynamics and the ECG were characterized by relatively benign changes.


[Complications of kidney transplants].

Increasingly more publications are reported on reassuring results after kidney transplantation. After some initial difficulties promising results were achieved on three patients who now live with a transplanted kidney. The importance of improving diagnostic possibilities and the reduction of damages caused by immunosuppressive drugs is stressed and the possibility of altering if necessary the combination of drugs is suggested.


Short-term regulation of LH and FSH secretion in cyclic women. I. Altered pituitary response to a second of two LH-RH injections at short intervals.

The effects of two iv 25 microgram LH-RH injections (180 tests) at different intervals (30 min to 24 h) on radioimmunoassay serum LH and FSH levels were investigated in 30 women in the midfollicular or midluteal phase of the menstrual cycle. The pituitary LH and FSH response to the second LH-RH injection at time-intervals of 30 and 360 min was significantly lower than the response elicited after the first injection. The second response was significantly higher at 60 to 180 min intervals. The maximum increment occurred at 120 min. No significant differences between the two pituitary responses to LH-RH were found at intervals of 240 min and 24 h. A theory with regard to intracellular processes of hormone synthesis and degradation is proposed to explain these time-dependent differences in the pituitary LH and FSH response.


Fertile eunuch syndrome versus classic hypogonadotrophic hypogonadism.

The functioning of the hypothalamo-pituitary-target organs axis was assessed in 3 patients with 'fertile eunuch' syndrome (FE) and 6 patients with 'classic' hypogonadotrophic hypogonadism (HH) with or without hyposmia. Both groups of patients did not differ from each other with regard to basal serum prolactin levels, pituitary growth hormone and thyrotrophin reserve and the thyroid or adrenal gland function. Both groups differed, however, with respect to the hypothalamo-pituitary-gonadal function: 1. the pituitary LH response to exogenous LH-RH was (low)-normal in FE and blunted in HH; 2. the basal FSH levels were normal in FE and undetectable in HH; 3. the basal LH levels were normal in FE and 3/6 patients with HH and low in the remaining three; 4. the basal and HCG stimulated plasma testosterone concentrations were significantly higher in FE than HH. The data suggest that FE represents a less severe form of LH-RH deficiency, rather than a distinct disorder.


Variation of blood glucose and serum growth hormone, prolactin and insulin in subjects with insulin-dependent diabetes, after OGTT and pretreatment with 2-Br-alpha-ergocryptine.

In insulin-dependent diabetics high GH values are usually observed. The OGTT does not modify these levels. It was observed that CB 154 (2-Br-alpha ergocryptine) seems capable of lowering GH in acromegalics. We thought it pertinent to check whether or not CB 154 could reduce GH also in diabetics. OGTT was performed in insulin-dependent diabetic patients; 5 days later the same test was repeated after pretreatment with 2.5 mg of CB 154. Serum IRI, GH, hPRL levels and blood glucose values were checked during the test. Significant GH and hPRL variations were not observed after OGTT in the diabetic subjects examined; IRI was always absent, and glycemia followed the model of the diabetic curve. On the contrary, after pretreatment with CB 154, we observed: 1) hPRL reduction; 2) GH increase, sometimes as early as 30 min after OGTT; 3) IRI was never present and blood glucose levels were lower than the values observed with glucose alone. Contrary to what is observed in acromegalics, CB 154 is unable to lower the increased GH levels normally present in insulin-dependent diabetics. After pretreatment with CB 154, OGTT seems to release GH, which is not observed after glucose alone. This can be accounted for only by postulating an antagonism at the hypothalamic level between the adrenergic and serotoninergic pathways of GH stimulation.


Insulin release, insulin content, and glucose utilization in isolated mouse islets maintained in tissue culture.

To elucidate the remission phase in juvenile diabetics the insulin release, insulin content, and glucose utilization were measured in isolated Langerhans' islets from mice maintained for 6 days in a tissue culture at a glucose concentration of 278 mmol, followed by a culture period of 4 days at 6.1 mmol glucose. These experiments revealed that the ability of the islets to store and secrete insulin during glucose stimulation decreased considerably during incubation at high concentrations of glucose. When the glucose concentration in the incubation medium was reduced, these properties could be re-established. Basal as well as glucose-stimulated glucose utilization increased greatly during incubation at high glucose concentrations. However, it was not possible to normalize the glucose utilization during 4 days' incubation at 6.1 mmol glucose. The results indicate that unphysiologically high concentrations of glucose may induce long-lasting changes in the function of Langerhans' islets.


Development of the insulin secretory defect in genetically diabetic (db/db) mouse.

Genetically diabetic mice (C57BL/KsJ-db/db) were used as a model to study the development of defects of insulin secretion in relation to common metabolic indicators (body weight, serum glucose and insulin, and islet insluin contant). Consistent with the idea of a protective effect of oestrogen on the pancreatic beta-cell, the female diabetic mice survived longer than the males. In males, while serum insulin decreased in the later stages of the disease, serum glucose increased progressively with age. Perfusion of the diabetic pancreases revealed a rise and subsequent fall with age of the basal insulin released at 3 mM glucose. Despite previous reports of beta-cell hyperplasia, progressive impairment of the insulin response to 20 mM glucose, or to 20 mM glucose and 1 mM 3-isobutyl-1-methylxanthine, was seen with increasing age in experiments with perfused pancreas or microdissected islets. Islet content of insulin also decreased progressively with age in the diabetic animals.


Trial of the prophylactic effect of diazoxide in the treatment of familial periodic hypokalemia.

Five patients suffering from familial periodic paralysis with hypokalemia (FPP) were exposed to standard paralysis induction trials which elicited total paralyysis and hypokalemia. In all cases the serum potassium fell to or below 2.6 mmol/1. After being pre-treated with diazoxide for 72 h, the same five patients were exposed to the same standardized paralysis induction procedure. None of them developed any demonstrable symptoms or signs of paralysis. In one the serum potassium dropped to 3.2 mmol/1, but in all the others the levels were higher. The serum glucose level was significant higher (P less than 0.01), the serum insulin level was significant lower (P less than 0.01) when induction of paralysis was attempted under diazoxide cover than during the untreated stimulation phase. Three patients were put on prophylactic diazoxide medication. After a few months, without paralytic episodes or other prophylactic drugs, adaptation to the diazoxide occurred and the previous, frequent paralytic episodes returned in unchanged severity. This experimental prophylactic effect of diazoxide supports the hypothesis that the glucose deposition in muscles is a major step in eliciting the parese attacks in FPP.


Viral meningoencephalitis and head injury.

Among 162 children referred with head injury (in a 3-year period) a viral meningoencephalitis was proven to be present in seven cases. Only one patient showed symptoms of infection before the accident. On admission classical signs of viral meningoencephalitis were absent or mixed with the complications of head injury. A diagnosis of viral meningitis/meningoencephalitis was documented by immunofluorescent demonstration of viral antigens in CSF cells and/or pattern of CSF cytology and/or conventional serological methods. Whether the trauma and the infection are coincidental or causally related can not be decided definitively. A hypothesis is presented suggesting diminished alertness in subclinical viral meningoencephalitis, leading to accident proneness.


Osteogenesis after bone and bone marrow transplantation. II. The initial cellular events following transplantation of decalcified allografts of cancellous bone.

An experimental study was done in rabbits to investigate the fate of allogeneic iliac cancellous bone, both non-decalcified and decalcified with hydrochloric acid, transplanted to a muscular site for up to 14 days. Some of the treated allografts were impregnated with autologous bone marrow cells, obtained from the femoral medulla by aspiration, and each was compared with allografts alone. Combined myelo-osseous grafts produced bone after 7 to 8 days implantation, as did marrow autografts alone. In addition non-decalcified implants stimulated the production of multinucleated giant cells. Three different types of wash solution were used but these did not inftical events in bone formation after transplantation occur less than 8 days after tho the clinical aspects of bone grafting.


Double blind evaluation of extradural methyl prednisolone for herniated lumbar discs.

A double blind study was carried out in 51 patients suffering from lumbar root compression syndrome of 12 days to 36 weeks duration. All patients had signs, symptoms and radiological abnormalities related to a herniated lumbar disc. Each patient received an extradural injection of either 2 ml (80 mg) methyl prednisolone or 2 ml normal saline solution. Neurological examination and interview of the patients with the aid of a questionnaire before and after extradural injection failed to demonstrate any statistically significant difference in outcome between the two groups. At follow-up 14 +/- 6 months after extradural injection 58.3 per cent of the patients in the control group and 51.9 per cent of the patients in the treatment group had undergone surgical treatment with laminectomy. Our results indicate that a single extradural injection of methyl prednisolone (80 mg) is no more effective than a placebo injection in relieving chronic symptoms due to myelographically demonstrable lumbar disc herniation.


Haemophilus influenzae meningitis. A comparison between chloramphenicol and ampicillin therapy with special reference to impaired hearing.

131 patients suffering from meningitis due to Haemophilus influenzae or parainfluenzae were re-examined after 1-15 years, using hospital records, questionnaires, and audiological examination, especially to compare chloramphenicol and ampicillin therapy. Mortality was 3.8%. Subdural effusions occurred in 14.5% of cases uni- or bilaterally. There was deafness in 2.3%, and moderate hearing loss in 8.4%. Convulsions appeared later in 6.9%. The final outcome was good in 60%. The most important factors in prognosis seemed to be the severity of the symptoms and the condition of the patient on admission to hospital. No clear difference was seen between the results of chloramphenicol and ampicillin therapy, but total loss of vestibular function was found in 3 cases in the ampicillin group, and in none in the chloramphenicol group. In mortality and deafness, the differences in outcome were similar, although not statistically significant. As these observations show, the therapy used in Haemophilus influenzae meningitis needs re-evaluation.


Dialysis and renal transplantation of children in Europe, 1975.

The number of new paediatric patients accepted for treatment by regular dialysis and transplantation increased more slowly than in previous years. Survival in children above 10 years appeared to be better with all modes of therapy than in younger children. The only improvement in survival noted among the different treatments was in patient and graft survival of living donor transplants. A quarter of all children transferred to home dialysis were less than 10 years of age. Nephronophthisis and Henoch-Schönlein nephritis emerged as major primary renal diseases. In 1975 the proportion of retransplants in children rose and living donor grafts from fathers were more common than from mothers. Evening dialysis was practised more frequently in both hospital and home dialysis and rehabilitation in these patients seemed to be better than for those dialysed at other times. Renal osteodystrophy was present in at least half of all children dialysed for more than 1 year. The degree of grouth retardation was affected by sex, chronological age and the primary renal disease. Body height on dialysis and after transplantation progressively reduced in the majority of children. Growth seemed to be more impaired in boys than in girls on dialysis. Bone age advanced faster than height age especially in girls. The pubertal growth spurt was usually delayed and depressed on long-term dialysis and the development of genitalia and pubic hair as well as menarche was retarded.


The role of local gas composition in pathogenesis of maxillary sinus empyema.

An impaired ostial function may be of importance in the pathogenesis of the maxillary sinus empyema due to changes of the antral gas composition. Oxygen is usually not demonstrable in purulent sinus secretion while carbon dioxide accumulates. In vitro, pneumococci were able to create a similar gas environment, provided that the gas exchange between the medium and the atmospheric air was reduced. It is suggested that heavy antral growth of facultative anaerobes, such as pneumococci, is related to the antral ventilation, which when impeded facilitates bacterial growth.


Prognosis of neonates with symptomatic respiratory insufficiency surviving with the aid of ventilator therapy.

Twenty-one survivors representing all survivors of neonatal symptomatic respiratory distress treated with intermittent positive pressure ventilation have been follow-up at an age of 2.9 to 7.0 years. The chance of survival proved to be relatively favourable in infants ventilated for perinatal pneumonias and unfavourable in infants ventilated for haemorrhagic diseases and respiratory insufficiency secondary to surgical conditions. At the follow-up half of the children presented with neurological symptoms but only 10% were found severely handicapped. One infant had a tracheostomy due to a laryngeal stenosis, while none developed broncho-pulmonary dysplasia. The late prognosis seemed unfavourable when the children had suffered from severe birth asphyxia and in infants ventilated for prolonged recurrent apnoeic spells. The relation between the clinical indications for ventilator therapy and later outcome is obscured however, by a vase number of complicating perinatal events.


Long term prognosis of infants with severe idiopathic respiratory distress syndrome. I. Neurological and mental outcome.

76 out of 77 children surviving IRDS with the aid of intermittent positive pressure ventilation have been followed-up by the age 2.6-7.6 years together with 68 matched controls. Moderate or severe neurological, developmental or mental abnormalities were present in 17% of all IRDS survivors. Statistical comparison of the matched pairs of IRDS survivors and controls revealed no significant differences in the prevalence of abnormalities. In the IRDS survivors the occurrence of cerebral palsy related to prematurity while the development of psycho-motor and mental retardation related to low birth weight and low milk intake during the first week suggesting that both prenatal and postnatal growth retardation may have been of importance. Statistical analysis of a number of preventilatory and ventilatory parameters did not show significant differences between these groups of IRDS survivors and the remainder. Ventilator treatment is recommended as a promising adjunct to the therapy of severe IRDS in centers where the necessary experience and equipment is at hand.


The early vascularization of an autogenous bone inlay into an artificial defect in the rabbit mandibula.

The revascularization of two different autogenous bone grafts to an artificial defect in the rabbit mandibula was studied by means of microangiography, using Indian ink infusion into the carotid artery. The revascularization was compared between a longitudinally split autogenous humeral full thickness bone graft in 19 rabbits and autogenous full bone grafts from the iliac crest in 14 rabbits. The vascular pattern and ingrowth was followed at weekly intervals right to the end of the first month postoperatively. A progressive revascularization was found in both grafts investigated. The periosteum of the humeral graft was earlier and more completely revascularized than when an iliac graft was used. The penetration and downgrowth of capillaries were on the other hand more complete within the iliac graft. The vascular pattern is discussed with special reference to the osteogenesis in the bone grafts.


A clinical pilot study on preformed autologous ossicles. I.

The study is part of a project aimed at obtaining an autologous, preformed transplant for reconstruction of a defect ossicular chain. In animal experiments we found that bone could be produced in a titanium mould placed in the tibia of the rabbit and dog. To find out whether this observation was applicable in man, 5 patients with ossicular defects were selected. A titanium mould containing two chambers was placed in the proximal tibial metaphysis for 6 months. When the moulds were extracted bone was found in 7 of the 10 chambers. In 2 of these the bone was stable and suitable for ossiculoplasty. On histological examination the same picture as in the animal experiments was found, an outer layer of cortical bone surrounding a system of spongy bone with marrow and haematopoietic cells. Microradiological examination verified the presence of mineralized bone tissue.


Long term prognosis of infants with severe idiopathic respiratory distress syndrome. II. Cardio-pulmonary outcome.

75 out of 77 children surviving IRDS with the aid of intermittent positive pressure ventilation have been followed up by age 2.6-7.6 years together with 68 matched controls. The morbidity of lower respiratory tract illnesses was significantly higher in IRDS survivors than in controls affecting a total of 48%, half whom were admitted to hospital on at least on occasion. Only 3 IRDS survivors had pneumonias beyound their third year, however. One child suffered from a moderate stridor due to a partial laryngeal stenosis and one from some dyspnoea at function caused by broncho-pulmonary dysplasia. Thoracic X-ray changes were found significantly more often and more marked in IRDS survivors but on the whole the changes were discrete. Neither the occurrence of pneumonia nor X-ray changes in the IRDS survivors were statistically relatable to a number of neonatal or therapeutical characteristics. Measurements of heart volume, respiratory frequency, oxygen saturation and acid-base values did not differ between the groups. Ventilated IRDS survivors, even with some degree of radiographic demonstrable residua, thus seem to have a good long-term prognosis with regard to lung function, irrespective of a preliminary high morbidity of lower respiratory tract illnesses.


Hypophyso-gonadal function in the diabetic child.

14 diabetic boys (five with a family history of diabetes and nine without) and 29 "short normal" boys were studied. A gonadal function test (2.000 IU of hCG i.m. for 3 days and plasma testosterone assay before and after the hCG administration) as well as an LH-RH test (50 microgram i.v.) were carried out. While basal testosterone level turned out to be similar in the two groups of children, it was significantly lower (p less than 0.01) after hCG than the mean value of the control group. This difference was mainly observed in those patients with a family history of diabetes. In the diabetic children, basal LH level was normal and the pituitary LH reserve was lower than in the control group. Both basal FSH level and FSH pituitary reserve were lower than in normal children. These data show that an alteration in the hypothalamus-pituitary-gonadal function is already evident in the diabetic child.


Papaverine in the prophylaxis of migraine and other vascular headache in children.

A daily dose of papaverine (5--10 mg per kg body weight) was administered on a double-blind basis for two months to 42 successive child patients suffering from migraine or other vascular headache attacks not less than twice a month. Thirty-seven patients received the drug for the whole period of two months and 31 of these could be followed for a period of one to 10 months (mean 4.5 months) after the cessation of the treatment. Nineteen received papaverine and 18 placebo. Six out of 19 papaverine patients and none of 18 placebo patients were completely free from attacks during the treatment. Altogether 11 patients in the papaverine group and 5 in the placebo group experienced a 75--100% reduction in attack frequency which was accompanied by lower intensity and shorter duration of attacks. The results were best in cases with classical migraine. An "excellent" or "good" drug effect was experienced by 58% of papaverine patients and 17% of placebo patients.


Hydrops fetalis, hydramnios and hepatic vascular malformation associated with cutaneous hemangioma and chorioangioma.

A premature baby presented with severe hydrops fetalis due to a multifocal angiomatous malformation of the liver. There were two other small vascular tumors: hemangioma of the skin and chorioangioma. Hydramnios and placental edema were also present. The association of severe hydrops fetalis and hydramnios with angiomatous malformation of the liver was not found in reviewing the literature.


Primary intracranial malignant lymphomas with particular reference to their pathogenesis.

During the past 6 years we have experienced a total of 6 cases of malignant lymphomas, which originated primarily in the central nervous system. The most reliable diagnostic criteria will be a "perivascular cuffing" by silver impregnation with further spreading of tumor cells to the periphery, a "starry-sky" appearance consisting of numerous histiocytes with foamy cytoplasm intermingled with tumor cells, and cytological features of the imprint preparation. Since there is a close histologic similarity to extracerebral malignant lymphomas, we would like to propose that these tumors should be regarded as primary malignant lymphomas of the central nervous system instead of mere reticulum cell sarcoma-microglioma, and also would like to regard the brain to be not an exceptional site other than visceral lymphomas for occurrences of malignant lymphomas. For the pathogenesis of primary intracranial malignant lymphomas, the hypothesis, proposed by FEIGIN, of the possible existence of multipotential stem cells in the brain was discussed.


On the diagnosis of coagulase-negative staphylococci with emphasis on Staphylococcus saprophyticus.

This study concerns the diagnosis of coagulase-negative staphylococci, with special emphasis on novobiocin-resistant species, vis S. saprophyticus, S. cohnii and S. xylosus. Disc diffusion tests for novobiocin were found useful in the differential diagnosis of coagulase-negative staphylococci isolated from urine specimens, but not from pus and blood cultures. We report on the resistance of S. saprophyticus to nalidixic acid and the use of this characteristic in the diagnosis of coagulase-negative staphylococci known to be novobiocin-sensitive, but which have subsequently acquired resistance to novobiocin. The results of different tests for betalactamase production in S. saprophyticus are presented. "Clover leaf" tests suggested such a production in about half of the strains studied, while no strain produced betalactamase as indicated by tests using chromogenic cephalosporin or benzylpenicillin in capillary tube tests. -The failure of tests for nitrate reduction, glucose consumption and of cultrues of urine on MacConkey's agar in the diagnosis of urinary tract infections caused by S. saprophyticus, is documented. The concept "significant bacteriuria" in the diagnosis of S. saprophyticus infections of the urinary tract above the bladder neck is also considered.


Bacteria and bacterial antigen in the kidney in human chronic renal disease. Bacteriological and immunofluorescence Studies.

Kidneys obtained by nephrectomy from 85 patients with chronic nephropathy were examined by bacterial culture and by immunofluorescence for a content of E. coli antigen. A panel of 10 E. coli 0-antisera, representing the strains most commonly causing urinary tract infection, and antiserum against common enterobacterial antigen (CA), were used. Bacteria could be cultured from the nephrectomy specimens in 24 cases, mainly in cases of obstructive chronic pyelonephritis, analgesic nephropathy and congenital renal disease. By immunofluorescence, type-specific 0-antigen was found in whole bacteria and amorphously in macrophages, CA only in whole bacteria. Whole bacteria could be visualized in 12 cases, macrophages only in two cases. Amorphous bacterial antigen was no observed outside phagocytizing cells. On the basis of these results, it seems unlikely that progression of the renal lesions in chronic renal disease is due to persistant bacterial antigen in the absence of viable bacteria. Chronic pyelonephritis, defined as an interstitial nephritis due to the effects of bacterial infection in the renal parenchyma and pelvic mucosa, appears always to be a secondary manifestation following obstruction or primary renal disease, such as analgesic nephropathy or congenital renal disease.


Bacteriuria and renal infection in kidney-transplant recipients.

In 64 patients who had undergone renal transplantation, later on followed by bilateral nephrectomy, bacterial growth culture was performed from the original kidneys. The presence of bacteria in the nephrectomy specimens was compared with the occurrence of significant bacteriuria before transplantation and in the period between transplantation and nephrectomy. Bacteria could be cultured from the nephrectomy specimens of 18 (28.1 per cent) of the patients, almost exclusively confined to cases of obstructive chronic pyelonephritis, analgesic nephropathy and congenital renal disease. Before transplantation, bacteriuria had been recorded in 34.4 per cent of the patients, most frequently in the three groups of diseases just mentioned. Between the transplantation and nephrectomy, bacteriuria occurred in 75.0 per cent of the patients. Patients with E. coliuria before transplantation were particularly liable to have E. coliuria also after the transplantation and to E. coli in the nephrectomy specimens, whereas patients in whon E. coliuria did not occur until in the post-transplantation period were less susceptible to E. coli infection involving the kidneys. Probably the presence of bacteria in the nephrectomy specimens is related to the primary disease rather than to immunosuppressive and antiobiotic agents administered in the post-transplantation period.


Antibodies against E. coli O-antigens and common enterobacterial antigen in kidney-transplant recipients. Comparison of antibody findings with evidence of urinary tract infection.

Using indirect haemagglutination, sera from 45 patients who had undergone renal transplantation were examined for 0-antibodies against 10 selected uropathogenic E. coli strains, and against common enterobacterial antigen (anti-CA). Bilateral nephrectomy was carried out, usually less than three months after transplantation, and serum from the time of nephrectomy was examined. The aim was to correlate antibody findings with evidence of urinary tract infection (UTI), as assessed by significant bacteriuria or growth of bacteria from the nephrectomy specimens. All the sera contained antibodies against several of the E. coli strains, mostly in titres less than or equal to 160, but titres up to 5120 occurred. No statistically significant correlation was found between the occurrence of high titres of type-specific 0-antibodies to E. coli and evidence of E. coli UTI. In contrast, anti-CA-present in the sera of 19 patients, mostly in titres of 10-40-occured with significantly increased frequency in patients with E. coliuria before transplantation and in patients with growth of E. coli from the nephrectomy specimens. It is concluded that anti-CA-even in low titres-appeared to give a better serological parameter of E. coli UTI than screening for antibodies against the selected uropathogenic E. coli strains.


Humoral and cell-mediated immunity to hepatitis B virus antigen in a haemodialysis-renal transplantation unit.

Hepatitis B surface antigen (HBsAg), the corresponding antibody (anti-HBs), the antibody to hepatitis B core antigen (anti-HBc), and the cellular immune response to purified HBsAg (leucocyte migration inhibition test: LMT-HBsAg) were determined in 19 staff members, 11 long-term haemodialysis patients, and 22 renal transplant patients in a haemodialysis-renal transplantation unit. Past or present infection, as expressed by the presence of circulating anti-HBs or HBsAg, was found in 30 cases (58 per cent) (11 staff members, six dialysis patients and 13 transplant patients). Anti-HBc was found in all the ten HBsAg positive cases--all patients--and in 15 out of 20 anti-HBs positive cases. Four staff members and seven patients had positive LMT-HBsAg; of these only one patient had HBsAg, whereas seven cases had anti-HBs. Neither the antibody determination nor the leucocyte migration inhibition assay disclosed any significant difference between patients and staff which could explain the different course of the hepatitis B virus infection in the two groups.


Human leucocyte migration: studies with an improved skin chamber technique.

An improved skin chamber technique has been developed for the study of localized leucocyte mobilization (LLM). Uniform "windows" of denuded dermis were produced by a suction device applied to the forearm skin, eliciting delineated areas of epidermal separation by blister formation. The acellular blister fluid, roof and basement membrane were removed, and the blister base was covered with a rubber chamber containing autologous serum as leucocyte attractant. Duplicate chambers were harvested at prescribed intervals during the first 24 hours. In 15 healthy individuals, virtually no cells were observed after 2 hours, a median of 1.9 X 10(6) after 4 hours, increasing to 3.8 X 10(7) after 24 hours. Subnormal LLM was demonstrated in three of seven patients with severe bacterial infections and in three of seven leukaemia patients. LLM was normal in eight patients with other malignancies. Ninety to 98 per cent of the cells were polymorphonuclear neutrophils and less than 1 per cent were erythrocytes. In the chamber neutrophils, vacuolization of the cytoplasm was prominent, bactericidal capacity reduced and nitroblue tetrazolium reduction increased, thus indicating functional derangement of emigrated cells compared to peripheral blood neutrophils. Simplicity and good reproducibility should make this method a valuable tool in the study of leucocyte migration.


Immunoglobulin class of antilymphocyte antibodies in systemic lupus erythematosus patients and their families.

Antilymphocyte antibody (ALA) in systemic lupus erythematosus (SLE) was studied using an indirect immunofluorescent technique with air-dried, acetone-fixed lymphocytes. Ninety-four per cent of patients with SLE and 65 per cent of their relatives had ALA. The ALA response in SLE patients involved antibodies of all classes. However, the ALA in their relatives was primarily of the IgM class. Restriction of the class of ALA in asymptomatic relatives is analogous to that seen with anti-RNA antibodies and suggests that the switch to production of autoantibodies of the IgG class may be important in the pathogenesis of SLE.


The effect of nitrazepam on manual skill, grip strength, and reaction time with special reference to subjective evaluation of effects on sleep.

The effects of 5 and 10 mg oral nitrazepam doses on manual skills, grip strength, and reaction time 8 hours after ingestion of the drugs were studied in 34 healthy female volunteers aged 19-22 years. 5 mg nitrazepam caused a slight but insignificant decrease in psychomotor skills. With 10 mg psychomotor skills were influenced significantly. Grip strength and reaction time were not influenced either by the 5 or 10 mg doses. The investigators corroborate the value of the established effects of nitrazepam as a hypnotic, but recommend that caution should be excercised in prescribing the drug as a hypnotic (especially in doses exceeding 5 mg) to work-aged subjects as there is a risk of significant effect on the psychomotor skills. Furthermore, the drug may cause fatigue.


A quantitative study of the insulin release induced by vagal stimulation in anesthetized cats.

Insulin was released by vagal stimulation in anesthetized and eviscerated cats. The plasma insulin concentration and blood flow in the portal vein were determined concomitantly and the insulin output was calculated. Stimulation of either the right or the left cervical vagus released the same amount of insulin, whereas bilateral stimulation released twice as much. Following a stimulation that depleted the "vagally-releasable pool", a recovery period of 15--20 min was needed before the same maximal output could be obtained again. With shorter interstimulatory periods  the amounts of insulin released were reduced. When less than 2--3 00 impulses were applied during a stimulation period, the amount of insulin released per impulse was constant. Atropine (0.2--2 mg/kg) did not reduce the vagally-induced insulin release.


Prostaglandin content in blood and lung tissue during alveolar hypoxia.

The aim of the present work was to investigate whether prostaglandins (PGs) are synthetized and released from isolated blood-perfused rat and cat lungs secondary to vasoconstriction induced by alveolar hypoxia. The lungs were perfused with autologous blood with constant volume inflow via the pulmonary artery in a recirculating system. They were ventilated with constant volume positive pressure, and acute alveolar hypoxia was induced by ventilation with a gas containing 2% O2. A superfusion bioassay technique was used to measure PG-like activity in the perfusate from the lungs, the blood being re-oxygenated before reaching the assay tissues. The oxygenator prevented the perfusate hypoxia induced by ventilation hypoxia to affect the bioassay tissues. The assay tissues were rat stomach strip, rat colon and chick rectum. They were sensitive to calibrating doses of 0.5--1 ng/ml PGE2 and 1--2 ng/ml PGF2alpha. In another series of experiments PGs of the F-series were measured in lung tissue from normoxic and hypoxic lungs with radioimmunoassay technique. No increase in PG-like activity could be detected in the venous effluent by means of bioassay during hypoxia, nor was the lung tissue content of immunoactive PGF increased by hypoxia. The present findings indicate that alveolar hypoxia does not stimulate PG-synthesis in lungs, refuting that PGs are important mediators of the pulmonary vasoconstrictor response to alveolar hypoxia. It is concluded that PGs play no significant role in producing the pressor response to alveolar hypoxia.


Angiography of the testicular artery. III. Testis and epididymis analysed with a magnification technique.

The resolving capacity of magnification testicular angiography, as related to the known vascular anatomy of the testis and epididymis, was analysed on the basis of 9 normal angiographies and 8 cases of hydrocele with proven normal status of the testis and epididymis. The intratesticular vascular arrangement was demonstrated remarkably well, but of the epididymal vascularity only that in the head of the epididymis. The vascular anatomy of the testis as resolved by angiography may be utilized in the diagnosis of the location and nature of intra- and extratesticular mass lesions.


The diagnostic value of protein clearances in rejection of human renal allografts.

The relative clearances of transferrin, haptoglobin, IgG, and IgA were used as a diagnostic test for detection of acute rejection episodes after renal transplantation, using an automated immunoprecipitin reaction. Thirty-six out of 40 rejections were predicted by 0--5 days. The sensitivity and specificity were 90% and 98%, respectively. The predictive value of a positive diagnostic test was 86% and of a negative 99%. False positives caused by fever and urinary obstruction could probably be excluded by the finding of an increased urinary excretion of beta2-microglobulin prior to the increased relative clearance of transferrin, haptoglobin, IgG and IgA. This would improve the predictive value of a positive test to 95%. Daily or more frequent protein clearance determinations should be performed in renal transplant patients, since the method used was easy, rapid and suited for sequential analysis, and the procedure was without risk for the patient.


Comparative natriuretic and diuretic efficacy of theophylline ethylenediamine and of bendroflumethiazide during long-term treatment with the potent diuretic bumetanide. Permutation trial tests in patients with congestive heart failure.

The additive natriuretic and diuretic effects of theophylline ethylenediamine and of bendroflumethiazide have been compared in permutation trial tests in patients with advanced congestive heart failure receiving long-term treatment with the highly potent diuretic, bumetanide. Statistical analysis of renal water and electrolyte excretion revealed that theophylline ethylenediamine, 400 mg orally, and bendroflumethiazide, 5 mg orally, had very similar effects, both quantitatively and qualitatively. The mechanism of action of the supplementary diuretics is discussed. It is concluded that theophylline ethylenediamine represents a useful alternative to thiazide diuretics when supplementary natriuretic treatment is considered in patients with congestive heart failure during long-term treatment with potent diuretics. The significance of maintaining the potassium balance during such a combined regimen is stressed.


Noble metal complexes in cancer chemotherapy.

Platinum coordination complexes form a new class of active anticancer agents in animals and man. Cis-dichlorodiammineplatinum (II), the most widely investigated drug, is now in experimental clinical use against a wide variety of cancers in man. The dose-limiting toxicity in man is renal tubular damage. Hydration of the patient and the use of osmotic diuretics have minimized this effect and allowed higher doses with largely improved responses. Combination chemotherapy with the drug has also produced significant response rates in a variety of cancers. The mode of action of the drug is not yet clear, but most likely involves a primary lesion on nuclear DNA and the stimulation of a host reaction to the cancer. So far, only square planar and octahedral complexes of platinum, with a variety of inorganic and organic ligands, have shown marked activity in animal studies.


Iodine and mammary cancer.

From laboratory studies presented, iodine appears to be a requisite for the normalcy of breast tissue in higher vertebrates. When lacking, the parenchyma in rodents and humans show atypia, dysplasia, and even neoplasia. Iodine-deficient breast tissues are also more susceptible to carcinogen action and promote lesions earlier and in greater profusion. Metabolically, iodine-deficient breasts show changes in RNA/DNA ratios, estrogen receptor proteins, and cytosol iodine levels. Clinically, radionuclide studies have shown that breast atypia and malignancy have increased radioactive iodine uptakes. Imaging of the breasts in high-risk women has localized breast tumors. The potential use of breast iodine determination to determine estrogen dependence of breast cancer has been considered and the role of iodide therapy discussed. In conclusion, iodine appears to be a compulsory element for the breast tissue growth and development. It presents great potential for its use in research directed toward the prevention, diagnosis, and treatment of breast cancer.


Noncardiac pulmonary edema.

Several mechanisms leading to noncardiac pulmonary edema have been reviewed. Common features are damage to and increased permeability of vascular endothelium, interstitial and alveolar edema fluid high in protein content, increased pulmonary vascular resistance and pressure, nondependent distribution of the edema and normal left atrial or wedge pressure. The available evidence suggests that in some instances the sites of leakage are the pulmonary arterial walls and, perhaps in some, overperfused, damaged capillary beds. Therapeutic obestives differ from those in cardiac pulmonary edema in that efforts are directed toward a reduction in pulmonary blood flow and pulmonary arterial pressure during the period that endothelial healing is taking place.


Heredity of the choroidal dystrophies.

Sorsby's pseudo-inflammatory dystrophy and choroidal sclerosis are autosomal dominant, while gyrate atrophy of the choroid and retina is autosomal recessive and choroideremia intermediate sex-linked.


Visual field defects, cup-disc ratio and fluorescein angiography in glaucomatous optic atrophy.

Fluorescein angiography was carried out in 150 glaucoma subjects. Among them 94 subjects were selected to evaluate the correlation between functional loss and the findings of fluorescein angiography in the optic disc. The intensity of fluorescence was assessed in the superficial reticular capillaries and radial epipapillary capillaries. Functional loss was estimated by the visual field defects and cup-disc ratio. A marked decrease in the capillaries was seen in accordance with the increase in the cup-disc ratio. Also, the intensity of fluorescence in the optic disc paralleled the change in the visual field: the greater the deterioration in the visual field, the fewer the capillaries in the optic nerve head and vice versa. The fluorograms of 94 subjects were placed in one out of six groups, i.e. (1) normal, (2) arcuate scotoma, (3) superior or inferior nasal defects, (4) superior or inferior defects, (5) central residue or (6) temporal residue. The common factors correlating the fluorescein angiography in the glaucomatous optic disc with visual field loss were explored in 94 subjects, and it was possible to predict the visual field change from the capillary distribution in the glaucomatous optic disc.


Vascular events in inflammation.

Seven topics of vascular events in inflammation are discussed independently: (1) It is pointed out that too frequently generalizations have been made of vascular phenomena registered in one specific situation, and evidence is given that the existence of a characteristic vascular reaction pattern in the inflammatory processes is doubtful. (2) Considering the results of recent experiments, it is suggested that the role of the nervous system in inflammation should be reassessed. Although its influence seems to be of a minor nature in many "laboratorial" situations, it is of primary importance when nerves are stimulated by electric antidromic excitations and may be relevant in injuries sufficiently severe to damage peripheral nerves. (3) Attention is called to the diversity of vascular leakage types. (4) The dissociation between vascular permeability, oedema and diapedesis is presented and discussed. (5 and 6) The ultrastructural features and the role of endothelial vesicles and junctions are updated and commented upon. (7) The barrier effect of the basement membrane in vascular permeability alterations is discussed and an alternative hypothesis is suggested: the basal lamina does not usually retain particles or blood cells and the temporary halt of elements in the ground substance may be due to the pressure and flux differences in and outside the vessels.


Carnitine metabolism in human subjects. II. Values of carnitine in biological fluids and tissues of "normal" subjects.

Carnitine values in "normal" or "control" human subjects are assembled in the second part of this review. Data were found on blood, skeletal muscle, urine, heart muscle, and semen. Factors that affect these measures are related to the data.


Fiber, intestinal sterols, and colon cancer.

It has been postulated that dietary fiber's protective effect against the development of colon cancer, diverticular disease, and atherosclerosis may be due to the adsorption and/or dilution of intestinal sterols such as bile acids and neural sterols and their bacterial metabolites by component(s) of fiber. Dietary fiber is made up of four major components-cellulose, hemicellulose, lignin, and pectin. There is evidence that hemicellulose and pectin may induce an increase in fecal bile acid excretion in man which may be accompanied by a decrease in serum cholesterol. Natural fibers, such as rolled oats, alfalfa, guar gum, and Bengal gram have been shown to have hypocholesterolemic properties of alfalfa, wheat straw, and some other fibers found considerable amounts of bile acids in vitro. On the other hand, wheat bran, oat hulls, and all the synthetic fibers tested bound only negligible amounts of bile acids under the same conditions. Vegetarians in the United States have lower plasma lipids and different plasma lipoprotein patterns than those of comparable control populations on regular mixed diet. They also have smaller daily fractional turnover rates of cholic acid and deoxycholic acid pool size. In addition, populations on a mixed Western diet, where the rate of large bowel cancer is high (North American, English, Scottish, etc.) degraded and excreted cholesterol and bile acid metabolites to a greater degree than populations where the rate of colon cancer is comparatively low (Ugandan, Japanese, etc). It cannot be denied that the fiber theory linking fiber deficiency with the development of colon cancer and other diseases, is simple, attractive and appears to be firmly based in common sense. When subjected to research studies, however, the situation appears much more complex than expected. Although some progress is being made, the data are often contradictory and confusing, probably due to lack of adequate documentation of fiber intake (e.g., use of dietary fiber instead of crude fiber) and/or the absence of detailed information on the chemistry of the fiber itself.


The role of the microbiology laboratory in surveillance and control of nosocomial infections.

The microbiology laboratory's rapid and consistent identification of nosocomial pathogens is a keystone in the surveillance and control of hospital-acquired infections. In addition, the laboratory serves as a source of expert consultation for clinicians and infection control personnel and as an "early warning center" for infection problems. In making its contributions to infection control most effective, the laboratory must recognize its capabilities and limitations, must insure that the materials and methods it uses and the specimens it processes meet high standards, must provide retrievable records, and must have a good working knowledge of microbiologic technics used to evaluate both endemic and epidemic infections. Moreover, because laboratory workers come into contact daily with potentially infectious specimens and isolates, the laboratory's contributions to infection control should also include the prevention and surveillance of laboratory-acquired infections.


A hemolytic plate method for alternative-pathway complement activity assay.

A new hemolytic plate method for the functional assessment of alternative-pathway complement activity is described. The plates are easy to prepare and the method simple to perform. Analysis of 23 normal serum samples showed a mean lysis diameter of 4.1 +/- 0.2 mm (1 standard deviation).


Comparison of a commercial identification kit and conventional biochemical tests used for the identification of enteric gram-negative rods.

A comparison between 11 Minitek biochemical tests and corresponding conventional tubed media was undertaken with 1,089 isolates of enteric gram-negative rods. Overall correlation between Minitek and conventional biochemicals was 97.4%. Minitek proved to be a time- and space-saving miniaturized biochemical system that can be used effectively for the identification of enteric gram-negative rods.


"Fruiting bodies" of aspergillus on the skin of a burned patient.

A case of a young man with an extensive total-body-surface burn complicated by wound infection is presented. One of the fungal organisms in the cutaneous burn wound had morphologically characteristic and diagnostic features by development of conidiophores ("fruiting bodies") pathognomonic of Aspergillus spp.


Yersinia enterocolitica septicemia.

Yersinia enterocolitica was recovered from the blood of an infant with sepsis and fever but with few gastrointestinal symptoms. The age of this patient was unusual as septicemia owing to this organism has most frequently been seen in adults. Because of the absence of digestive symptoms, it is uncertain what the portal of entry of the organism might have been. Yersinia enterocolitica is not often recognized, either because of difficulties in identification or because it may not be recognized as a human pathogen.


Monocyte functional capacity in chronic neutropenia.

The bactericidal activity of monocytes from a child with chronic benign granulocytopenia who has had virtual absence of neutrophils yet minimal infections since birth was examined against Escherichia coli and Staphylococcus aureus and compared with that of monocyte and neutrophils from 20 control subjects. Studies on monocyte function in this patient with no neutrophils revealed normal monocyte kill of both organisms when compared with control monocytes. Monocyte and neutrophil killing of both organisms was similar in control subjects at bacteria to phagocyte ratios of 1:1. When ratios of 3:1 were employed, however, control neutrophils were more effective than control and patient monocytes in reducing the number of viable organisms. These findings support the neutrophil as the more effective blood phagocyte but stress the importance of monocyte functional capacity in patients compromised by granulocytopenia or neutrophil functional defects.


Botticelli demonstrates the Babinski reflex more than 400 years before Babinski; pediatrics in art.

Botticelli, one of the greatest painters of the Italian Rennaissance, demonstrated the Babinski reflex more than 400 years before the publication of Babinski's first description of this reflex.


Viruses and diarrhea--a review.

A critical analysis of the literature shows that only a few viral agents have been proved by accepted criteria to cause acute gastroenteritis. Rotavirus, of the RNA family reoviridae, is the cause of most childhood gastroenteritis. The parvovirus-like agents (Norwalk, Hawaii, MC, and W) are proved agents of epidemic gastroenteritis. There is good evidence that the Marcy, FS, and Niigata agents were the causes of gastroenteritis outbreaks. Thirty percent of all acute gastroenteritis episodes in large investigations are still etiologically unaccounted for. Much work remains to be done on define the pathogenesis and immunology of viral gastroenteritides.


Gastric analysis in selected populations. Improvement of its clinical usefulness.

Little doubt exists concerning the limited usefulness of gastric analysis as a screening test in unselected populations. Reliable tests, such as those for glycemia, are also of limited value when performed blindly on the general population. When, however, gastric analysis is performed on an adequate preselected population, it has a valuable role in the diagnosis and management of several gastroduodenal diseases. Highly satisfactory results can be obtained when the proper population is selected because errors are minimized due to an increased prevalence of diseases. We have verified the reliability of two types of gastric analyses: the conventional method of gastric analysis based on measurement of acid output alone (CGA) and the so-called gastroionogram (GIG), in 100 consecutive gastric analyses using the method proposed by Kronborg. Gastroionogram increases specificity (even at the risk of decreasing sensitivity) and provides an excellent predictive value of the test. With the same conditions CGA is less useful because of the overlapping among normal and diseased groups. It is useful, however, for separating patients into three groups of normal secretors, hyposecretors and hypersecretors.


Acute digoxin poisonings: review of therapy.

Acute digoxin poisoning, its recognition and management, are reviewed. The uses of syrup of ipecac, gastric lavage, activated charcoal, cholestyramine, colestipol, edetate sodium and cathartics as measures to terminate the drug exposure are discussed. Measures to hasten digoxin elimination, such as the use of furosemide, hemodialysis and digoxin-specific antibodies are reviewed. Supportive management may include treatment with atropine, phenytoin, lidocaine, propranolol, glucose, insulin and sodium polystyrene sulfonate. Proper management of digoxin poisoning involves the use of standard decontamination procedures (emesis or gastric lavage). Activated charcoal is strongly recommended, followed by rapidly acting cathartics. Antiarrhythmic therapy usually involves atropine sulfate and phenytoin sodium.


Drug therapy reviews: dietary fiber and fiber supplements in the therapy of gastrointestinal disorders.

Dietary fiber and fiber supplements are reviewed, with particular emphasis on their sources, composition and properties; physiological actions on gastrointestinal functions; and uses in gastrointestinal disease states (functional bowel disease, diverticular disease and other conditions). Adverse effects and contraindications, and the hypothesis of diet's effect on colon cancer also are discussed. Dietary fiber supplements may relieve symptoms of constipation, spastic colon, and diverticular disease; in the two latter disorders, colonic pressure relationships are altered. It is concluded that current evidence does not support other therapeutic uses for dietary fiber sonstituents, except possibly in patients with anal fissures and hemorrhoids, which can be helped by the passage of a softer stool.


Chromosomal aneuploidy in a patient with hypereosinophilic syndrome. Evidence for a malignant disease.

A patient with rapidly fatal hypereosinophilic syndrome and a bone marrow chromosomal abnormality, 49,XYY,t(3:5),+8,+mar, is described. Scanning and transmission electron microscopy of eosinophils failed to reveal any significant abnormalities. Previous cytogenetic data on patients with hypereosinophilic syndrome have been deficient in that few studies have been performed with banding technics. These technics may help in the classification of hypereosinophilic syndrome and predict which patients will have a rapidly fatal course.


Circulating proinsulin in patients with maturity onset diabetes.

The contribution of proinsulin to the total serum immunoreactive insulin (IRI) was measured in 59 patients with maturity onset diabetes (23 being treated with diet alone and 36 with oral sulfonylurea agents) and compared to that in 44 control subjects. The percentage of proinsulin was increased in 11 patients and correlated with plasma glucose, but not with IRI. There was no difference between the drug-treated group and diet-treated group, or between patients taking different sulfonylurea agents. Sequential studies in one patient showed normalization of the proportion of proinsulin following lowering of the plasma glucose level. It is probably that the increased circulating proportion of proinsulin in hyperglycemic diabetic patients is secondary to beta cell exhaustion with release of less mature granules.


Pulmonary disease caused by Candida species.

Candida species are often found in sputum specimens. Their role as a possible cause of pulmonary disease is a frequent consideration, particularly in patients receiving immunosuppressive or long-standing antimicrobial therapy. At Memorial Hospital and New York Hospital, 30 patients with histologic evidence of Candida pulmonary infection were identified over a two year period. These infections reached the lungs by hematogenous spread in 10 patients and by aspiration in 16 patients. Most the patients had malignant neoplastic disease. The Candida pulmonary disease appeared to be significant clinical factor in only three cases. Experience from our institutions and from the literature indicates that Candida species rarely cause significant pulmonary disease. When such involvement is extensive, the patient is usually terminally ill from multiple other factors.