Dye-dilution cardiac output without blood withdrawal in the conscious rabbit.

Cardiac output can be measured in the conscious rabbit without blood withdrawal by use of a modified dye-dilution method. Blood flows continuously from the central ear artery through a Silastic catheter that passes through a modified cuvette lumen and back into an ear vein. Blood flow through this shunt was 1.5 ml/min. This modified technique was evaluated by comparison with a simultaneously performed cardiac output measurement using radioactive microspheres and by making consecutive dye-dilution measurements at short time intervals. A correlation coefficient of 0.96 was obtained when comparing dye-dilution and microsphere cardiac outputs. The difference between 11 paired measurements was 7.09 +/- 5.24% (mean +/- SD). Consecutive outputs measured within 3 min of each other by the flow-through technique had a correlation coefficient of 0.99 and a difference between the first and second determinations of 3.52 +/- 2.38%. The method permits dye-dilution cardiac output measurement in the conscious rabbit while avoiding the potential error caused by blood withdrawal from small animals.


Primary health care in an academic medical center.

In 1975-76 a one-year longitudinal study of the delivery of primary care services was carried out at all ambulatory institutional facilities in Durham County, North Carolina and in 47 of 50 community private practices covering the broad fields of surgery (including urology and orthopedics), medicine, pediatrics, and ob/gyn. The present paper focuses on the private and public clinics of Duke University Medical Center. Data were analyzed to document differentials in sociodemographic characteristics of patients attending these two systems of care. Results showed that patients attending the private clinics are predominantly white and covered by private insurance, while patients attending the public clinics are predominantly black and heavily dependent on Medicaid coverage. The potentially detrimental effects of a two-class system of care on the health of patients, as well as on the education of students, is discussed in the context of a scant medical literature on this subject.


Immunocytochemical diagnosis of alpha-1-antitrypsin deficiency.

Eight cases of liver disease associated with alpha-1-antitrypsin deficiency are described. Six of the cases, including the only childhood case, showed no evidence of lung disease. An occult but variable clinical course is defined in this disorder. A spectrum in the severity of tissue change was noted, and in some instances, extensive liver disease was correlated with relatively minor derangement in liver function. While this form of liver disease is uncommon, it should be included in the differential diagnosis of adult liver disease. Screening for alpha-1-antitrypsin globules in periodic acid-Schiff stained liver tissue sections should be considered in certain cases of cryptogenic liver disease in adults, particularly when advanced disease presents suddenly, where micronodular (portal) cirrhosis is unrelated to excessive alcohol use, or where tissue changes exceed those anticipated from serum biochemical abnormalities. In most of these cases, tissue findings from liver biopsy or autopsy, rather than clinical suspicion, led to the diagnosis. The availability of a simple and reliable immunoperoxidase technique, applicable to routinely processed tissue samples, allowed for rapid and specific diagnosis in all cases. This immunocytochemical method has proven its usefulness in the prospective and retrospective tissue diagnosis of alpha-1-antitrypsin deficiency and associated liver disease.


The Duffy blood group and resistance to Plasmodium vivax in Honduras.

To test the hypothesis that the Duffy blood group negative genotype is a factor in resistance to Plasmodium vivax, we determined the Duffy blood group, the malaria antibodies, and the slide-demonstrated infection rates with P. vivax and P. falciparum of 420 persons living in Nueva Armenia, Honduras. In all, 247 persons were Duffy negative. Demonstrated infections with P. falciparum were almost equally distributed between Duffy-positive (5,8%) and Duffy-negative (4.9%) persons. Similarly, Duffy-positive (25.6%) and Duffy-negative (28.2%) persons had equal proportions of indirect fluorescent antibody test titers suggestive of past or present P. falciparum infection. In contrast, all 14 P. vivax infections were found in Duffy-negative persons. There was no evidence suggesting that Duffy-positive and Duffy-negative persons had different exposures to malaria. The Duffy negative genotype FyFy appears to be a factor in resistance to P. vivax.


Plasmodium falciparum in culture: establishment of additional strains.

The establishment of new strains of Plasmodium falciparum in continuous culture is described. One line (FCR-2), isolated from an individual who had traveled extensively through South America, was passed initially through Aotus trivirgatus monkeys and then cultured into human erythrocytes using the flow-vial technique. A strain of P. falciparum FMG), shipped by air freight on wet ice from The Gambia, was cultured directly from a human infection into continuous culture using the Petri dish-candle jar technique, giving line FCR-3. Two other strains (6252 and FSG) were hand carried by a commercial flight on wet ice from the Gambia and were initiated into culture at the same time using the same media, sera, and erythrocytes. After 6 wk in vitro the 6252 strain became adapted as line FCR-4, whereas FSG had died out. Normal-looking gametocytes were seen in all four strains reported here. Notwithstanding their normal appearance they would not exflagellate in vitro, nor were they infective to Anopheles stephensi mosquitoes via membrane feeding. Production of new gametocytes continued for 6 mo, then gradually stopped.


Filarial infection of the breast.

The breast is a common site of filarial infection in females in Sri Lanka. We report our experience with 13 cases of filarial breast nodules, 12 containing adult worms and the other only microfilariae. In five of these cases the species was identified as Wuchereria bancrofti.


The American Association for the Study and Cure of Inebriety.

From the beginning of the American Association for the Study and Cure of Inebriety (November 1870) and throughout its history, the leadership perceived that it was at the forefront of a therapeutic social movement--the pioneer of a new medical viewpoint as well as a new medical specialty.


An analytic comparison of persons arrested for driving while intoxicated and alcohol detoxification patients.

This article presents findings on an analytic comparison of two groups of persons for whom alcohol is an identical clinical or social problem--247 patients currently under treatment in a detoxification unit in a general hospital and 118 individuals who had been arrested for driving while intoxicated (DWI) and were attending a DWI school. A systematic comparison of these two groups yielded several important, statistically significant differences and it becomes increasingly apparent that distinctions can be made that permit the identification of high-risk segments of the DWI population, facilitating early diagnosis and differential treatment modes.


Effects of acute alcohol administration on reproductive endocrinology in the male rat.

The results of the current studies further document that acute alcohol administration markedly disrupts the function of the HPG in the male. Our results indicate that alcohol depresses serum testosterone levels and, thereby, produces clinical symptoms associated with hypoandrogenization. Moreover, our studies suggest that acute alcohol administration also affects the hypothalamic-pituitary axis by reducing serum LH levels--an effect that may represent the primary action of alcohol on the HPG.


Effects of alcohol on plasma testosterone and luteinizing hormone levels.

The findings obtained in this study indicate that the major effect of ethanol on plasma testosterone levels is occurring at a peripheral (testicular) rather than central (hypothalamic-pituitary) site.


The effects of alcoholic liver disease and alcohol ingestion on sex hormone levels.

This study showed that alcohol significantly decreases plasma testosterone levels, with changes noted as early as the first day of alcohol use (loss of pulsatile secretion). This effect is due, in part, to a direct testicular action since it occurred without LH suppression and in the presence of elevated LH levels. More chronic use of alcohol resulted in a suppression of LH. Thus, alcohol use in nonalcoholic men is associated with an effect both at the testicular and hypothalamic-pituitary levels.


Ethanol increases rate of isolated atria.

Ethanol has a positive chronotropic and negative inotropic effect on isolated spontaneously beating rabbit atria. Both effects increased with increasing ethanol concentrations in the bathing medium. This response is apparently a direct action of ethanol on the myocardium and is not due to the release of catecholamines, acetylcholine, or acetaldehyde produced by the oxidative metabolism of ethanol. Ethanol is one of the few pharmacologic agents having opposite actions on heart rate and force of contraction.


Quality assurance for alcoholism treatment.

Mechanisms that seek assurance of quality care at reasonable cost include utilization review, accreditation, certification, licensure, and patient care audit. Within the social rehabilitative field, it is probably safe to say that only alcoholism has developed and implemented what might be considered the majority of the significant elements of a quality assurance program.


Legislation: regulation and strangulation or option for innovation?

Frequently, we in the health professions are reactive (or even reactionary) in response to the evolutions and revolutions in our system of health care. In fact, at times the best that can be said for us is that we are responsive (and we hope, responsible) to the need for change. I would suggest that we must be innovative in dealing with the plethora of health legislation.


PSRO--impact and implications for alcoholism treatment programs.

Since there has been recent congressional concern with claims of Medicare/Medicaid fraud and abuse and a renewed push for a national health insurance program, PSROs seem evermore closely tied to the mandate of quality health care at the lowest possible cost. Now is the time to acknowledge their being, assess their impact on health care delivery programs, and gear our efforts to supporting our common objective of quality medical services.


A medical audit of acute alcoholism and chronic alcoholism.

A medical audit for acute alcoholism was done in a large private general hospital where the cases are admitted to and treated on the general medical service. Another medical audit was done for chronic alcoholism for patients admitted to an alcoholism rehabilitation unit in a large general hospital in a teaching center.


Moving the treatment of alcoholism into the medical mainstream.

This demonstration program for the treatment of alcoholism is based on the premise that alcoholism is a disease and that the primary care physician should play the central role in the overall management of alcoholism. The context of the Health Maintenance Organization (HMO) encourages the physician to assume responsibility for the care of the alcoholic and serves as the appropriate setting for the coordination of all modalities required.


Transient suppression of growth hormone secretion after chronic ethanol intake.

Fifty-two percent of patients with chronic heavy intake of ethanol had an abnormally low growth hormone (GH) response to propranolo-glucagon. The effect of ethanol is transient, since the GH response was normal in patients studied 2 wk or more after withdrawal of ethanol. The low GH response was not due to a difference in the levels of glucose or insulin. Ethanol probably suppresses the GH response by acting on the hypothalamus or pituitary gland. Along with previous data suggesting transient ACTH deficiency in chronic alcoholic patients, our findings suggest that these patients may have multiple hypothalamic-pituitary deficiencies.


Effects of chronic ethanol treatment on rat liver mitochondrial protein synthesis.

Chronic ethanol treatment of male Sprague-Dawley rats resulted in a 50% decrease in the rate of incorporation of precursor leucine into isolated mitochondria. This decrease is manifest in a decreased labeling of three polypeptides of inner mitochondrial membranes that are the major products of in vitro mitochondrial protein synthesis under the conditions employed. Immunoprecipitation of cytochrome-c oxidase revealed that these three polypeptides are subunits 1, 2, and 3 of cytochrome-c oxidase and have apparent molecular weights of 33,000, 25,000, and 20,000. Sixty percent of the total incorporated radioactivity is associated with these polypeptides. A decrease in the contents of subunit 2 and of a second polypeptide with an apparent molecular weight of 22,000 was also noted as an effect of chronic ethanol treatment.


Effect of an acute dose of ethanol on rat liver microsomal mixed function oxygenase components and membrane lipid composition.

The lipid composition of rat liver microsomes was not altered in response to a single acute dose of ethanol relative to isocaloric glycerol-treated controls. Microsomal cytochrome P-450 was transiently elevated, the elevation paralleling blood ethanol levels. Microsomal NADPH oxidase was transiently elevated relative to the activity in isocaloric glycerol-treated controls.


[Reaction of ocular tissues to scleral-implant and encircling material: polyamide--silicone--polyester (author's transl)].

Twenty-two human eyes and one rejected Silastic sponge were examined histopathologically for the reaction of ocular tissues to buckling and encircling materials. The eyes were enucleated 22 days to 14 years following retinal detachment surgery. Silicone implants, Silastic sponges, and Mersilene bands were very well tolerated by the eye, whereas nylon threads caused a moderate and prolonged granulomatous inflammation due to their susceptability to enzymatic decomposition. This reaction, however, does not seem to be of major clinical importance, as the amount of nylon used in detachment operations is low. Atrophy of the underlying sclera can happen with any of the above-mentioned materials and depends mostly on mechanical factors of the implant and on the intraocular pressure. Even with total transcleral erosion of the buckling or encircling material, no severe histopathologic changes could be found in the overlying choroid and retina.


Metoprolol eye drops in the treatment of glaucoma. A double-blind single-dose trial of a beta1-adrenergic blocking drug.

A double-blind single-dose trial was performed on 13 patients with primary open-angle glaucoma. Metoprolol 1%, 2%, and 4% produced a median fall in IOP of 5.6, 5.4, and 6.8 mm Hg, respectively, in the treated eye. The differences in effect between the 1%, 2%, and 4% solutions were not statistically significant. There was no significant fall in IOP in the untreated eyes. There were no significant changes in blood pressure, pulse rate, or pupillary diameter. We could not detect any local objective or subjective side effects during the single-dose study. The clinical usefulness of metoprolol may be limited due to local toxic reactions after treatment with multiple doses. Furthermore, there is the problem of tachyphylaxis that could limit extended treatment with topical beta-adrenergic blocking drugs.


Demonstration isolation and identification of culturable microfungi and bacteria in horse hair and dandruff. Immunochemical comparison with allergic components.

Horse hiar and dandruff have been investigated for their content of microfungi and bacteria. Inoculation and incubation on V-8 agar containing penicillin and streptomycin, with subsequent colony counting and identification, revealed more than nine and five different genera of microfungi and bacteria respectively, in horse hair and dandruff. Isolation and cultivation of the quantitatively dominating species, and preparation of an extract of these were performed, followed by immunochemical comparison with extract of the horse hair and dandruff using crossed-line immuno-electrophoresis. As no immunochemical identity was demonstrated it was concluded that the identified microorganisms might serve as a guideline to suspected sensitizing substances when patients with a typical case history of horse allergy do not react to extracts of horse hair and dandruff.


Oesophageal/transpulmonary pressure change ratios as a guide to lung compliance. A study in rabbits undergoing IPPV.

Experimental studies in ten anaesthetised rabbits suggest that oesophageal-transpulmonary pressure ratios can be correlated with trends in lung compliance during IPPV. The relevance and limitations of this technique are discussed as an alternative method of lung compliance measurement in the sick neonate.


Ovarian cyst. An unusual cause of respiratory arrest.

Respiratory arrest in a patient with a huge ovarian cyst is described. The successful resuscitation and subsequent management of the case are outlined.


[The anatomical and histological investigation of the pancreas in the 19th century and till the discovery of insulin (1921). 1. The anatomical pancreas research from the beginning till the discovery of islets of pancreas (1869) (author's transl)].

In this investigated period are the vessels of pancreas exactly described. Further on are in the first half of the 19th century comparative-anatomical and embryological studies on pancreas carried out. The physiology and function of pancreas are also in this time investigated. The enzymatic digestion of succus pancreaticus is discovered. RUDOLF VIRCHOW has 1854 the internal secretion of pancreas postulated.


[November 2, 1928.] Endotracheal Anaesthesia. By I. W. Magill, M.B.

(1) With certain exceptions, endotracheal anaesthesia is the best method for operations on the head and neck and for any other operation in which there may be a difficulty in controlling the patient's air-way. (2) Expiration should be provided for, in endotracheal anaesthesia, either by means of a second tube or by a tube of calibre sufficient to permit to-and-fro respiration. (3) Cocainization of the upper air-passages has decided advantages in endotracheal anaesthesia. (4) "Blind" intubation through the nose renders the method possible in cases where it is impossible to use a speculum. (5) The insufflation method is not specially indicated in abdominal surgery. (6) The routine use of endotracheal anaesthesia in teaching-hospitals for every class of case is detrimental to the production of sound anaesthetic knowledge in students who are likely to become general practitioners.


Influence of alloxan administration on the blood glucose, islets of langerhans and some other tissues of the frog, Rana tigrina.

Like majority of other vertebrates, the frog Rana tigrina belongs to the alloxan sensitive group. Alloxanization at doses of 300 and 500 mg/kg caused selective degenerative changes in the pancreatic beta-cells and a deficiency of insulin, which, in turn, provoked elevation of normal plasma glucose levels. The alpha-cells retained their normal structure. With the lower dose (200 mg/kg), however, many islets remained unaffected and there was no hyperglycemia. The fatal effect of alloxan on Rana tigrina appears to be due to the nephrotoxicity and acidosis of body fluid caused by this drug.


Hypersensitivity to five non-steroidal anti-inflammatory agents: ibuprofen, fenoprofen, indomethacin, naproxen and tolmetin.

Five drugs promoted generally as safe substitutes for aspirin-sensitive individuals (ASA) were studied. All five were found capable of causing exacerbation of symptoms and increase of induced bleeding time in ASA patients with concomitant low iodide tolerance, and four of the five drugs gave positive reactions in patients tolerant to ASA but iodide intolerant.


Flunisolide nasal spray for the treatment of children with seasonal allergic rhinitis.

Forty-eight children with seasonal allergic rhinitis received either 150 microgram/day of flunisolide (a new topical steroid) or placebo. Those receiving flunisolide had a significantly shorter daily duration of sneezing, stuffy nose, runny nose and throat itch. Total or substantial control of their symptoms was reported by 67% of the flunisolide group and 25% of the placebo group.


Immediate excision of burn wounds.

Early excision and grafting of body burns is a safe and efficient means of treatment. It reduces hospital stay and probably reduces septic complications. A group of 41 patients were so treated at Miami Valley Hospital Burn Therapy Program. Their hospital stay was less than that of patients treated and reported to the National Institute of Burn Medicine.


Hypothermic pulsatile perfusion and transplantation of pediatric cadaveric kidneys into adults.

Twenty-seven adults received en block or single renal allografts from pediatric donors less than 12 years of age. Hypothermic pulsatile perfusion of these small kidneys presented no technical difficulties. Flow rates ranged between 0.8-1.2 ml/min/gm. Single pediatric kidneys from donors as young as three years were able to produce a creatinine clearance of 50 ml/min in adults by one month posttransplant. No differences in renal function were noted between en bloc or single kidneys. En bloc transplants were associated with an increased incidence of renal arterial thromboses (3/8 cases). Because of this, pediatric cadaver kidneys were transplanted as single units, and an additional advantage was that they could provide donor kidneys for two recipients. In our series, one year pediatric graft survival is less than a comparable group of adult cadaveric kidney recipients.


The current status of laetrile.

Amygdalin at various concentrations and with numerous impurities is the most common cyanogenic glycoside found in laetrile samples. Its chemical properties were first described in 1837, and pharmacologic studies have shown that ultimately it is broken down to HCN, benzaldehyde, and glucose by enzymes found in gut bacteria but not intracellularly in humans. Fatal and nonfatal toxicities to orally ingested cyanogenic glycosides have been reported worldwide. We review here the signs and symptoms of acute cyanide toxicity and its treatment. Substantial in-vitro and in-vivo testing in animal tumor systems has shown that amygdalin is entirely devoid of significant anticancer activity. Control animals often have lived longer than those treated with various doses and schedules of amygdalin. Acceptable clinical studies in humans are lacking, but such ventures would appear to be contraindicated from animal studies and observed human toxicities. We also discuss current legal-judicial aspects of laetrile therapy for cancer.


How do phagocytes eat?

Phagocytosis is a cellular function relevant for host defense against infection, tissue turnover, and other aspects of human physiology. Phagocytosis is also representative of functions wherein external stimuli activate motile events in the cell. Recognition of suitable objects by the plasma membrane of the phagocyte initiates phagocytosis. Knowledge of serum proteins that coat objects rendering them recognizable is considerable, but understanding of the chemical basis of recognition is meager. The signals activated by recognition are also not known. The work of phagocytosis that causes pseudopodia to enclose objects in vacuoles is ascribable to metabolic energy-dependent interactions between actin filaments and other contractile proteins in the peripheral cytoplasm. These interactions may also regulate the fusion of lysosomes with phagocytic vacuoles, an event important for the processing of ingested objects after phagocytosis.


[Passive haemagglutination test in serodiagnosis of syphilis. Survey of a one-year trial in a venereal diseases prophylactic center (author's transl)].

We report here a one-year study of the reliability of the Treponema pallidum Haemagglutination Test (TPHA) in the serological diagnosis of syphilis. By comparing TPHA data with the diagnosis based on a set of grouped criteria, we were able to determine TPHA accuracy. All studies were conducted at the Antivenereal Prophylactic Center, in Nice, France, on 1,775 sera. The grouped data consisted of:--Serological Test for Syphilis (STS) using cardiolipin antigen,--medical and epidemiological records;--two specific reactions; namely the Fluorescent Antibody Test (FTA) and the Treponema Immobilisation Test (TIT). Reliability is excellent in 98.58 p. 100: the TPHA either proves syphilis or eliminates this diagnosis. The TPHA was particularly useful in investigating "problem sera" for which there existed conflicts in the grouped data. The applicability of TPHA is limited, however, in that it has low sensitivity during early primary syphilis, and it cannot be used to monitor antibodies during treatment. Nevertheless, TPHA, based on a standard specific antigen, is assured of a high place among the tools of serological diagnosis of syphilis because of its high accuracy and sensitivity, its objective and easily read results, and the simplicity of its technique.


[A physician in search of glory: Joseph Clément Tissot (1747-1826)].

J.C. Tissot is one of the minor figures of the history of Medicine. Still, because of his writings on therapeutic exercises he should be better known. A part from that, he is also a human figure. Surgeon in Napoleon's Army, he goes through many misadventures, and finally dies peacefully dreaming of the past glory.


Polyhydramnion. A clinical study.

A clinical study of pregnancies complicated by polyhydramnion diagnosed at the Department of Obstetrics and Gynaecology, University of Oulu, during 1972--1976 is presented. The incidence of polyhydramnion was 0.4% and it was associated with premature delivery, multiple pregnancy, chemical diabetes, and foetal anomalies. However, there were no anomalies in 2/3 of the newborn infants. The perinatal mortality was 41.7%. Early diagnosis is important in order to give good antenatal care and to plan for the delivery. The importance of ultrasonic examination in prenatal diagnosis is stressed.


A comparison of high-dose pentazocine with pethidine and diazepam in paediatric premedication.

A comparision of a high dose of pentazocine (0.9 mg/kg), and moderate doses of pethidine (1 mg/kg) and diazepam (0.2 mg/kg) as pre-anaesthetic medication was carried out in a double-blind between-patient placebo-controlled trial in 200 children. The assessment of the drugs as pre-anesthetic medication was made by comparing the sedative effect before induction, the status of the patient at induction and the patient's behaviour in the recovery room. All the active drugs were superior to the placebo at induction of anaesthesia. Postoperatively the sedative effect of the high dose of pentazocine was superior to that of the other active drugs, presumably due to the strong analgesic effect at this dose. The rate of respiration was clearly lower after pentazocine than after the other two active drugs. Other side effects or complications did not differ between the groups. It is concluded that, in spite of its favourable sedative effect, a high dose of pentazocine should be used with caution in pediatric premedication because of the possibility of slight respiratory depression.


Tissue oxygenation in hypovolaemic shock.

Tissue hypoxia is an essential feature in the pathophysiology of hypovolaemic shock. In traumatized patients gross injury and haemorrhage may induce both general and local oxygen deficiency. Prolonged hypoxia can induce irreversible changes in tissues, inhibit wound healing, and increase susceptibility to infection. Correction of cardiac index and arterial PO2 does not necessarily ensure a normal tissue PO2, and therefore, arterial oxygen tension provides an inadequate index of peripheral tissue oxygenation. There are two methods currently available for clinical measurements of tissue gases: 1) mass spectrometry, and 2) tonometry with an implanted silicone rubber tube. These methods have shown that the tissue PO2 levels provide an excellent index of peripheral perfusion. During periods of experimentally induced low cardiac output, tissue PO2 decreases almost proportionally to decreases in cardiac output, whereas tissue PCO2 increases slightly. In experimental animals correction of short-term hypovolaemia restores tissue oxygen tensions to normal. However, in patients with multiple injury and hypovolaemic shock the tissue PO2 remains depressed for several days, despite the elevation of cardiac index above normal levels after extensive resuscitation. The poor tissue PO2 response, despite increased arterial PO2, clearly places the majority of the obstacle to oxygen delivery at the microcirculatory-cellular level.


Catecholamines in shock.

The role of endogenous catecholamines in various clinical shock and stress states is reviewed; the effects, especially on the peripheral circulation, of catecholamine secretion are the same independent of the cause. Risks of using sympathomimetic agents in the treatment of shock are evaluated. A prolonged noradrenaline activity is to be expected in surgical stress states, e.g. multiple injuries, fat embolism syndrome, burns and infections; therapeutic approaches to minimize the sympathoadrenal activity are outlined.


Posttraumatic pulmonary microembolism. Pathophysiology and treatment.

The aetiology of respiratory insufficiency in man following massive trauma, major surgery or serious illness may vary. There is, however, one special type, the pathogenesis of which remains controversial despite several clinical, autopsy and experimental investigations. Our concept of this syndrome, which is summarized in this review has been arrived at from clinical, pathologico-anatomical and experimental studies. In its pure form the syndrome is most appropriately called "posttraumatic pulmonary microembolism", because the major underlying mechanism is probably a release of thromboplastic products from injured tissues, which generate platelet and fibrin microemboli which are trapped in the lungs during a phase of fibrinolysis inhibition. Preventive measures against pulmonary microembolism include immediate restoration of the haemodynamic state to ensure good tissue perfusion, and prompt reduction and immobilization of internal fixation of long bone fractures. The cardinal feature in the treatment of impending respiratory dysfunction is early institution of volume-controlled ventilation, using positive end-expiratory pressures of between 8 and 15 cm H2O synchronously with low dose heparin treatment and administration of one or two high doses of corticosteroids.


Comparison of salbutamol and ephedrine in oral bronchodilator combinations with theophylline and hydroxyzine: their effects on asthmatics.

The efficacies of three antiasthamatic bronchodilator combinations were compared using data obtained from sixteen patients. During the trial the patients measured their peak expiratory flow (PEF) every day at 7.00 a.m., 10.00 a.m. and 9.30 pm. Six patients also measured their PEF at 1.30 a.m. The frequency and severity of symptoms and side-effects as well as the auxiliary use of isoprenaline inhalations were also recorded. This double-blind cross-over trial consisted of five four-day periods including three periods with different drug combinations and two placebo periods. By increasing the sympathomimetic activity of the basic oral drug combination of theophylline and hydroxyzine with salbutamol or ephedrine the therapeutic effect of the combination was also increased although not statistically significantly. All combinations tested differed significantly from placebo in their effect. Harmful side-effects increased in proportion to the potency of the sympathomimetic drug used in the combination; they were minimal during treatment with the basic theophylline-hydroxyzine combination. Circadian variation of bronchial obstruction was a constant phenomenon in all asthmatics participating in this trial.


Antihypertensive drug combinations: prazosin, hydrochlorothiazide and clonidine.

Fourty-six men and 6 women aged 45 years and having arterial hypertension newly diagnosed at routine medical examinations were given out-patient antihypertensive treatment with prazosin, prazosin + hydrochlorothiazide, or prazosin + hydrochlorothiazide + clonidine. The mean values of blood pressure after the 3-week placebo period were 157/109 mmHg in the supine and 160/115 mmHg in the standing position. Treatment with prazosin (1--2 mg t.i.d.) produced normotension in 4/52 patients only, yet supine diastolic blood pressure and standing blood pressure were significantly lowered within 9 weeks. The addition of hydrochlorothiazide (25 mg daily) for 3 weeks to the regimen led to normotension in 12/46 patients. The remaining 34 patients still having an average supine blood pressure of 152/106 mmHg after prazosin + hydrochlorothiazide, responded well to low doses of clonidine added for 6 weeks to the treatment. Only 7 patients having initially high blood pressure still had a diastolic blood pressure greater than or equal to 100 mmHg at the end of the trial. The subjective side-effects were frequent but mild being roughly similar during placebo and active drug periods, except that fatigue and dry mouth due to clonidine were common, yet tolerable. No "first tablet reactions" to low inital doses of prazosin were found.


Effect of calcium p-chlorphenoxyisobutyrate and calcium carbonate on plasma lipids and lipoproteins of patients with hyperlipoproteinaemia.

Since dietary calcium had been reported to reduce plasma lipids, the effects of calcium carbonate (CaCO3, 2 g/day) and the calcium salt of p-chlorphenozyisobutyrate (Ca-CPIB, 2 g/day), both singly and in combination, were studied in outpatients with primary hyperlipidaemia. Three groups of five patients were followed in a double-blind cross-over study, in which placebo and the drugs were given alternately during four-week periods. The main results were: 1) CaCO3 alone did not produce any significant changes in plasma lipids. 2) Ca-CPIB reduced LDL-cholesterol in patients with type IIa and IIb by an average of 29 and 21%, respectively. It also lowered VLDL-triglyceride by 50% in type IIb and by 48% in four out of five patients with type IV. 3) The combination of CaCO3 and Ca-CPIB reduced LDL-cholesterol by 31 and 25% in types IIa and IIb, respectively. It also lowered VLDL-triglyceride by 48-52% in types IIa and by 46% in four out of five patients with type IIb. 4) Three out of five patients with type IV had a rise of LDL-cholesterol while on Ca-CPIB alone; two of the patients had the rise while on the combination. 5) After treatment with Ca-CPIB, either singly or in combination, there was a statistically significant lowering of ESR and of plasma inorganic phosphate and alkaline phosphatase. No clinical side effects were noted.


Transcriptional and translational effects of hormones.

At present it is not possible to describe the precise sequence of post-transductional phenomena corresponding to the action of any hormone in a given target cell. It seems probable that different events at the levels of DNA replication, DNA transcription, RNA translation, and post-translational phenomena are regulated in each case in a specific sequential way. However, the possibility cannot be discarded of simultaneous and/or independent hormone actions in two or more of these type of phenomena.


Sodium clavulanate potentiation of cephalosporin activity against clinical isolates of cephalothin-resistant Klebsiella pneumoniae.

Plasmid-carrying Klebsiella pneunomiae clinical isolates with agar dilution minimum inhibitory concentrations (MIC) of 32 mug/ml or greater were tested for in vitro potentiation of cephalothin activity by clavulanic acid (BRL-14151), an inhibitor of beta-lactamases. The addition of 10 mug of clavulanate per ml caused greater than a 500-fold reduction in geometric mean cephalothin agar dilution MIC, with lesser but significant reductions resulting from clavulanate concentrations of 5 or 1 mug/ml. Clavulanate-potentiated reduction of cephalothin MICs in broth against resistant Klebsiella were comparable to reduction in agar dilution MICs as a rule. However, a low concentration (1 mug/ml) of clavulanate produced cephalothin MICs in broth several-fold higher than by the agar dilution method. Modest cephalothin-potentiating effects of clavulanate on cephalothin-susceptible strains and on cefoxitin against cephalothin-resistant Klebsiella strongly suggested that the major effect of clavulanate was beta-lactamase inhibition.


Double-blind comparison of cefamandole and penicillin in pneumococcal pneumonia.

We conducted a prospective, randomized, double-blind comparison of intravenous penicillin and cefamandole in the therapy of pneumococcal pneumonia. Patients received either 1 g of cefamandole or 600,000 U of aqueous penicillin G every 6 h. Of the 100 patients entered into the study, 96 had clinical and radiographic evidence of pneumonia. Microbial etiology was determined from the results of sputum and blood cultures and/or sputum Gram stains. Streptococcus pneumoniae was pathogenic in 49 patients, of whom 24 received cefamandole and 25 received penicillin. There was no statistically significant difference in the response or cure rate. Of the 100 patients, 93 were treated for 3 days or more and were evaluated for adverse effects and toxicity. There was no significant difference between cefamandole-treated and pencillin-treated patients in the incidence of colonization, superinfection, phlebitis, thrombocytosis, decrease in hematocrit, or elevated liver function tests. Eosinophilia occurred more frequently in patients treated with penicillin (20 of 42) than in those treated with cefamandole (11 of 42 (chi square, P < 0.05). Only one patient receiving cefamandole developed a positive direct Coombs test. No patient in either group developed meningitis. We conclude that, with the doses and route of administration employed in this study, cefamandole is as effective as penicillin in the therapy of pneumococcal pneumonia without an increased incidence of colonization, superinfection, or adverse effects.


Application of automated sequence analysis to the understanding of protein structure and function.

Application of automated Edman degradation to the covalent structural analysis of proteins has had an important impact upon the generation of structural information. The strategies involved in determining the complete sequences of proteins have been simplified such that studies of this kind can be carried out more rapidly and with less expenditure of material. Moreover, the high efficiency of the procedures in the anlaysis of intact polypeptides has allowed the convenient comparison of extensive regions of sequence at the amino-termini of proteins. Such structural studies have revealed a more detailed understanding of the function and post-translational modification of many proteins.


Bactericidal activity of cephalosporins in an in vitro model simulating serum levels.

The bactericidal activity of cefazolin, cephaloridine, and cephalothin in a simulated intramuscular study (500 mg) and a simulated intravenous drip infusion study (2 g/2 h) is reported. In both model systems, the bactericidal activity of cefazolin surpassed that of cephalothin, and there were certain differences between cefazolin and cephaloridine in the simulated intramuscular study when human serum was used as a medium. In a routine reference static system, the drug levels were constant at the simulated peak level of each cephalosporin by both routes. In this system the three cephalosporins were equal in activity. In a third experiment, the effect of drug concentrations and exposure time on bactericidal activity of the cephalosporins was studied. The bactericidal activity of cephaloridine was the strongest of the three drugs when exposure time was 2 h and drug concentration was less than four times the minimal inhibitory concentration. At concentrations above four times the minimum inhibitory concentration, all three cephalosporins were equal in activity when the exposure time was 2 h.


Enzymatic modification of aminoglycoside antibiotics: 3-N-acetyltransferase with broad specificity that determines resistance to the novel aminoglycoside apramycin.

Examination of a number of R-plasmid-containing bacterial isolates of animal origin has revealed the presence of a new aminoglycoside acetyltransferase (3-N) with a broad substrate range that includes all the disubstituted 2-deoxystreptamine antibiotics and also the novel monosubstituted antibiotic apramycin. Antibiotic derivatives acylated with hydroxyaminobutyric acid at the 1-amino position were not modified by the enzyme.


Fluorescent assay for estimating the binding of erythromycin derivatives to ribosomes.

A fluorescent erythromycin derivative was used to determine the binding of erythromycin derivatives to ribosomes. The assay is rapid, sensitive, and convenient. Because measurements are made in solution, they represent equilibrium conditions, unlike filter binding assays which perturb the equilibrium. Results correlate well with measurements made by other techniques.


[Morphological and structural variations of the human inguinal region (author's transl)].

In the inguinal region, numerous muscular and fibrous alterations are described. They are related to the unconstant position of the pubic tubercle in relation io the interspinous diameter (linea bi-spinalis). The pubic tubercle can be observed in two different locations: either high or low. The high location is characterized by the presence of the pubic tubercle at a distance of 5 to 7.5 cm below the interspinous diameter. It must be considered as normal and is found in 65% of the subjects. In the low locations, the distance between spinous tubercle and interspinous diameter reaches 7,5 to 12 cm. It is an important abnormality which interests 35% of the subjects. The lower the pubic tubercle are located, the more often morphological alterations are to be found in the following structures: obliquus externus, obliquus internus, transversus and cremaster muscles as well as fascia transversalis. Nevertheless, the pyramidalis muscle as well as the inguinal ligamentary formation, Hesselbach's interfoveolar ligament and Thompson's iliopubic tract do not follow that rule, since the important morphological variations of these deep fibrous components can never be related to the distance between pubic tubercle and interspinous diameter. The functional signification of the inguinal region and especially of the inguinal canal is modified by those ostelogical, muscular and ligamentary variations.


Development of pineal complex in Calotes versicolor.

The general plan of the development of the organ in Calotes versicolor in no way differs from that of Sphenodon and Lacerta. The lens of the parietal eye of Calotes appears at a comparatively later state of development than in Sphenodon and Lacerta. The papaphysis in the embryos of Calotes versicolor is a simple structure. Histologically all the structures resemble the wall of the brain from which they arose.


[Teratogenic effects of localized x-irradiation of branchial and aortic arches of chick embryos (author's transl)].

X-irradiation of branchial and aortic arches of 3 day old chick embryos is lethal in only a small number of cases (3-12,5%), but results in a high proportion (30-96%) of arterial malformations. The production of arterial anomalies is not random, but is related to the experimental method used and the function of the aortic arch with respect to the dynamics of circulation. Numerical and statistical studes, together with histological examination of the irradiated branchial and aortic arches, have revealed the importance of: the immediate environment of the aortic arch on its morphogenesis, the moment at which the teratogenic aggression occurs and the role of haemodynamics in the fate of the aortic arches. To explain aortic teratogenesis, we propose a hypothesis according to which all arterial anomalies are of morphogenetic origin. These anomalies can result in circulatory modifications which, in turn, cause new malformations.


[Action of DDT on colonization of the chick embryonic genital ridges, by primordial germ cells (author's transl)].

Colonization of the genital ridges by primordial germ cells was quantitatively studied, at stages 18-24, in Chick embryos issued from eggs treated with commercial DDT before incubation. The pesticide provokes, dating from the 4th day of development (stage 24), a significant reduction in the gonadal germ population. This deficit may be due to 3 different actions of DDT on the primordial gonocytes: an inhibition of their gonadic colonizing capacity, a failure of proliferation and, at last, an excessive rate of cell death. However, the DDT modifies neither the initial number of blastodermal germ cells nor their migratory capacity toward the gonadal region.


[Ultrastructural study of the germinal cells of ovary of Penaeus paulensis (author's transl)].

The ultrastructural study of the germinal cells of Penaeus paulensis was carried out on the immature (stage I), in maturation (stage II) and mature ovary (stage III). The stage I is characterized by numerous peripheral nucleolar systems which are formed by a fibrillar central portion entoured by a fibrillogranular nucleolonema. There are no yolk granules in the cytoplasm. The stage II is characterized by the onset of the vitellogenesis and a close morphological relationship exists between the endoplasmic reticulum and the systhesis and deposition of yolk. The stage III is recognized by the presence of the "peripheral bodies" in the peripheral cytoplasm of the germ cells. These structures are separated from the adjacent cytoplasm by the cell membrane and possibly represent an accumulation of extracellular material comparable to the zona pellucida.


[Systematization of the articular surfaces of the carpometacarpal joints (author's transl)].

A study, done on 100 hands, of the systematization of the articular surfaces of the carpometacarpal joints, clearly delineates the variability of circumference, dimesions, and relief of the articular facets. An attempt to draw general conclusions from this morphological study, in terms of arthrokinetics, leads to an understanding of the nature of the joints and the movements that are performed at this site.


Machine perfusion versus cold storage for preservation of kidneys before transplantation.

Machine preservation was introduced into the Groningen Transplant Group in December 1972. Thirty five of the 90 kidneys transplanted in the following period of four years were preserved on a machine. The other kidneys were preserved by the so-called cold storage method. The advantages and disadvantages of both methods are outlined. Evidence is found in the literature and in this study that cold storage is sufficient for preservation-times up to 24 hours. When the preservation time exceeds this period, then machine preservation may be an advantage. Kidneys damaged by ischaemia were found to have a higher percentage of immediate function when preserved by the machine compared to those preserved by cold storage. There was no significant difference in one-year graft survival for the kidneys preserved by either method. Machine preservation helps to select between viable and non-viable kidneys from non-heartbeating donors. This is especially important in view of the lack of kidneys for transplantation. Therefore, in the opinion of the authors, it is necessary to continue with machine preservation in selected centres and to make the facilities of these centres available to every donor hospital in The Netherlands.


Recent developments in peripheral nerve surgery. Management of open traumatic peripheral nerve lesions.

The modern technique of operative repair of traumatic nerve interruption is discussed. The results of microsurgical repair have proved to be superior to those of conventional methods. Besides the anatomy and the operative technique, the indications and timing for surgical intervention are discussed. Reference to the literature and the authors' own experience show that delayed primary repair is the method of choice.


Levamisole therapy in atopic dermatitis: randomized double-blind evaluation.

A randomized double-blind study of levamisole hydrochloride therapy in atopic dermatitis is reported. No improvement was noted in any of several assessments, which included patients' subjective impressions; physicians' clinical impressions; comparison of clinical extent and severity scores; and incidence of cutaneous infections or lessening of serum IgE levels. A trend toward improvement was seen in a majority of cases, whether treatment was with a placebo or an active drug. This study emphasizes the need for double-blind techniques for therapeutic trial in the management of patients with atopic dermatitis.


The use of levamisole in atopic dermatitis: a prospective study.

Levamisole hydrochloride, a nonspecific immunostimulant, was given to 30 children with atopic dermatitis (AD) in a double-blind manner during an eight-month period. Clinical course findings, including intradermal reactions to tuberculin, candidin, and streptokinase-streptodernase; sensitization to dinitrochlorobenzene; periphal blood T- and B-lymphocytes; in vitro lymphocyte transformation with phytohemagglutinin; and serum levels of IgM, IgG, IgA, and IgE, were noted every two months. Fifteen children completed the study. Neither the clinical course nor the immunologic values showed substantial differences between the levamisole-treated and the placebo group. Our experience with levamisole in AD is disappointing.


Immunofluorescence of biopsy specimens: comparison of methods of transportation.

Immunofluorescence findings for IgG, IgA, IgM, and C4 on biopsy specimens quick frozen and transported frozen were compared with findings on portions of the same biopsy specimens placed in holding solution and transported at ambient temperatures. A total of 52 biopsy specimens were examined from normal individuals and patients with systemic lupus erythematosus (SLE), discoid lupus erythematosus (DLE), pemphigus, pemphigoid, and dermatitis herpetiformis. Overall agreement of results was 90%: 88% in SLE; 50% to 66% in DLE, 96% in pemphigus; 92% in bullous pemphigoid; and 87% in dermatitis herpetiformis. Except for two of the 42 biopsy specimens, the combined IgG, IgA, IgM, and C4 findings were the same. In one DLE case, only the frozen biopsy specimen was positive. In one case of dermatitis herpetiformis, only the ambient temperature biopsy specimen was positive. Results indicate the holding solution at ambient temperature can be used in place of the frozen method.


Darier's disease: an immunologic study.

Darier's disease is frequently complicated by bacterial skin infections and occasionally by Kaposi's varicelliform eruption. Postulating that defective host immunologic competence might explain these infections, humoral and cell-mediated immunity (CMI) were evaluated in four patients. Humoral immunity was normal as demonstrated by quantitative immunoglobulins, isohemagglutinins, direct skin immunofluorescence, and B-cell counts. The CMI was evaluated by standard delayed type hypersensitivity skin tests, T-cell counts, lymphocyte transformation assays, macrophage inhibition factor (MIF) assays, and skin windows. Blunted lymphocyte blastogenesis, MIF, and skin window response indicated depressed CMI. Polymorphonuclear leukocyte chemotaxis and phagocytosis were normal.


Antinuclear antibodies: a simplified classification of the nuclear immunofluorescent patterns.

The key to a simplified classification of the nuclear immunofluorescent patterns is to separate out only two patterns, the speckled and nucleolar, from the nonhomogeneous particulate group (showing stained particles). There are only six categories divided into two major groups: nonparticulate and particulate. The nonparticulate group consists of the (1) peripheral, (2) homogeneous, and (3) leukocyte specific patterns. The particulate group is divided into (1) nucleolar, (2) speckled, and (3) "other particulates." The major diagnostic and prognostic values of of the test are retained by the simple expedient of separating out only two morphologically distinct and diagnostically important patterns from the particulate group, the nucleolar and speckled patterns, seen mainly in scleroderma but not in lupus erythematosus.


Usefulness of continuous positive airway pressure in differential diagnosis of cardiac from pulmonary cyanosis in newborn infants.

Differential diagnosis of cyanosis in the neonate is difficult and cardiac catheterisation may be required for a correct diagnosis. It has been suggested that the response of PaO2 to continuous positive airway pressure (CPAP) with 100% oxygen may be useful. The purpose of this study was to test further this hypothesis by studying all neonates investigated for cyanosis with a PaO2 less than or equal to 50 torr in 0-8 to 1-0 F1O2. Arterial blood samples were obtained in an F1O2 of 0-21-0-4 and 0-8-1-0, and in an F1O2 of 0-8-1-0 with 8-10 cm CPAP, and were analysed for PaO2, PaCO2, and pH, bicarbonate being calculated. The final diagnoses were congenital heart disease (CHD) 21 cases, pulmonary parenchymal disease (PD) 10 cases, and persistent fetal circulation (PFC) 3 cases. No significant difference in pH, bicarbonate, or PaCO2 was observed among the three groups or with CPAP. In the CHD and PFC infants CPAP produced no significant change in PaO2. In the PD babies PaO2 increased by an average of 33 torr (P less than 0-05). Despite thus attaining statistical significance 2 PD infants had no increase in PaO2 with CPAP. An increase of PaO2 greater than 10 torr with CPAP suggests PD, and a nonsignificant increase in PaO2 does not rule out PD. Irrespective of initial PaO2, final PaO2 in 0-8-1-0 F1O2 with CPAP greater than 50 torr suggests PD, and less than 50 torr suggests CHD. The results indicate that CPAP may be used as an adjunct in differentiating cardiac from pulmonary disease.


Group B streptococci in pharyngeal aspirates at birth and the early detection of neonatal sepsis.

The pharyngeal aspirates collected from 400 babies at the time of delivery were examined for the presence of bacteria, especially group B streptococci. Aspirates from 79 babies were found to contain viable bacteria, including 4 with group B streptococci; one of these 4 babies developed streptococcal meningitis within 24 hours. The group B streptococci were seen on a Gram-stained film of the aspirate, and were detectable by coagglutination and countercurrent immunoelectrophoresis within 4 hours and by culture after 24 hours. Examination of pharyngeal aspirates may be of value as a screening test for neonatal sepsis.


Immunofluorescence studies in reactional leprosy with relevance to treatment.

Twenty-three biopsies of skin lesions of patients with various types of leprosy, showing a recent reaction, were examined by means of immunofluorescence (IF) methods. The patients were divided into two groups according to the number of inflammatory cells, staining with various FTC-labelled anti-immunoglobulin antisera, in representative areas of the biopsies. It was found that the presence of these cells was correlated with a good response to thalidomide treatment.


Immunofluorescence studies across the leprosy spectrum.

Forty biopsies from skin lesions of untreated (24) and treated (16) leprosy patients, representing the whole leprosy spectrum, were examined by means of immunofluorescence (IF) methods. Only few or no cells staining with FTC-labelled antihuman immunoglobulin antisera were found in the lesional skin of all patients examined. Sparse IgM-deposits along the basement membrane of the epidermis were observed in a few borderline lepromatous and lepromatous patients. Complement deposits along the basement membrane of the epidermis and in the vessel walls were found in tuberculoïd as well as in lepromatous patients. Complement and in a lesser number IgG-deposits were observed around sweat glands and sometimes around sweat gland ducts and other skin appendages. Autofluorescing macrophages were noted in patients at the lepromatous side of the leprosy spectrum; approximately half of these patients showed complement deposits in an around these cells.


Double blind trial in the treatment of herpes simplex and herpes zoster with adenine arabinoside and idoxuridine.

In a double blind trial adenine arabinoside (Vidarabine) and Idoxuridine (IDU) were tested in herpes simplex and herpes zoster infections. Adenine arabinoside covered 19 patients with HSV and 6 with HZ while IDU 19 with HSV and 6 with HZ. From the statistical analysis it was found that Vidarabine acts shorter than IDU in HSV P less than 0.01, while in HZ no significant difference P less than 0.5 was found, possibly due to the small number of patients tested.


Immunological and histological study of temporal arteries.

Sixty-four temporal arteries were studied. 36 were from patients with clinically active temporal arteritis or polymyalgia rheumatica; 22 showed histological changes of temporal arteritis, 12 of which were in an active stage. 28 arteries, none of which showed histological changes, were taken at necropsy or from patients with unrelated disease. Extracellular immunoglobulin and complement deposition was seen in the artery biopsies showing active arteries and in 1 of the 10 biopsies with inactive arteritis. There was no immunoglobulin or complement deposition in the 14 patients with clinically active temporal arteritis and/or polymyalgia rheumatica, but with a normal artery biopsy. Patients with clinically active temporal arteritis were more likely to have a positive biopsy. Our results support the suggestion that the immune deposition is concurrent with an active histologically proven arteritis. Immunofluorescent examination does not appear to be a better diagnostic test than histological examination.


Estimation of IgM rheumatoid factors by fluorimetry.

Sheep red cells coated with rabbit IgG antibody may be used to detect IgM rheumatoid factors either by agglutination or microscopically by the fluorescence of antihuman IgM antibody conjugate bound to rheumatoid factors on the cell surface. By substituting for red cells the plastic surface of a filter disc coated with rabbit IgG it was possible to elute the bound conjugate and measure the fluorescence in a fluorimeter. The results of both the sheep cell agglutination test and the fluorescence test agreed quite well for the majority of sera; both tests seemed to reflect IgM rheumatoid factor concentrations in these sera. The difficulties encountered in attempting to define and measure accurately rheumatoid factor concentrations in a serum are emphasised.


Continuous and intermittent levamisole. A controlled trial.

A double-blind comparative trial showed that intermittent levamisole therapy (150 mg daily for 3 days of each week) was as effective as continuous therapy (150 mg daily) in rheumatoid arthritis and with slightly fewer side effects.


Intra-articular methotrexate. Clinical and laboratory study in rheumatoid and psoriatic arthritis.

The effects of intra-articular methotrexate (MTX) were compared with saline in 20 patients with persistent knee effusions due to rheumatoid arthritis (15) and psoriasis (5) in a double-blind pilot study. Clinical improvement was seen in most patients given either MTX or saline and was attributed to joint irrigation during arthroscopy and the placebo effects. MTX had a local anti-inflammatory effect in the psoriatic arthropathies; the percentages of polymorphonuclear cells and pyroninophilic mononuclear cells in synovial fluids fell sharply. Intraarticular hydrocortisone acetate was not anti-inflammatory in 2 psoriatic patients treated subsequently. The anti-inflammatory action of MTX in joints may resemble its effectiveness in controlling the rash of psoriasis.


Indomethacin and naproxen suppositories in the treatment of rheumatoid arthritis.

A double-blind cross-over study of 35 out-patients with rheumatoid arthritis showed that Naproxen and Indomethacin suppositories were both effective forms of treatment in rheumatoid arthritis, both being significantly superior to placebo in terms of relief of morning stiffness.


[Transport and preservation of biological specimens for microbiological processing (author's transl)].

Here you can read how to carry and preserve the biologic specimens literature speaks about and we found in many Italian hospitals. In particular we explain how to carry and preserve specimens of urine, stool, expectoration, pharyngeal exudate and we speak about the many problems of preserving isolated strains for long time.


[Microbiological specimen for anaerobic assay (author's transl)].

The most important events of the bacteriological study of the anaerobic infections are the choose of specimen, how to collect and carry it. These preliminary steps may condition the success of each further manipulation. A correct methodology requires some general rules: 1. to prepare anaerobic assay only whether the clinical data are indicative: so the laboratory could give better performances for the truly interesting cases; 2. to prevent, for what it is possible, contacts between 02 and the sample; to avoid contamination with anaerobic bacteria of the endogen flora present on human mucosa; 3. the sample must be assayed within 30--45 min after having been collected. After this time many bacterial cells are lost and the sample does not represent anymore microbiology of the septic focus. Indications about samples available for anaerobic assay, are given. It is emphasized how much preferable is a syringe collecting, while swab or biopsy present some technical difficulties and cause loss of the exigent bacteria. Some indication is at last given about the transport of specimen in the case the patient is not near the laboratory.


[Request for sampling and acquisition of biological samples for microbiological investigation (author's transl)].

On the grounds of published data and of those resulting from an investigation carried out in the Italian hospitals, the writers propose to standardize the requests for microbiological exams and the sampling procedures and the acquisition of the materials to be subjected to bacteriological examination.


[Requisition, reply forms and data recording (author's transl)].

A system for the automatic handling of laboratory data is described with particular reference to the microbiology module. The system is based on "real time" operation which permits acquisition of data as soon as they are generated; computation as soon as the necessary elements became available, production and storage of results as soon as computed.


[A computerized system for clinical microbiology (author's transl)].

A system of microbiology reporting by computer which is simple to operate and provides accurate, rapid reporting of laboratory results with provisions for permanent data storage, retrieval and other programs, is described. The system provides on efficient and reliable day-to-day service and readily accessible data for retrospective research. A brief note on the computer element of the system is also given.


[Evaluation of survival of bacteria on dry swabs and transport systems (author's transl)].

The survival of bacteria on dry swabs varied from twenty pro cent of organisms alive to no viability at four hours after the inoculation. Cotton-wool swabs highly reduced survival of bacteria; alginate or albumin swabs were less toxic for Gram-positive bacteria, charcoal swabs for Gram-negative bacteria. Transport systems allow certain organisms to remain viable as long as 24--48 hours. The quality and accuracy of any bacteriological culture depends greatly upon obtaining a proper specimen. Cotton-wool swabs are to be employed only when cultures are made immediately after collection, dry swabs--charcoal, albumin coated or calcium alginate--when cultures are made within four hours. For longer periods of time only transport systems are to be employed.


[Quality control in microbiology (author's transl)].

The microbiology quality control importance is emphasized and some particular problems that quality control presents in microbiology are also indicated. There are two types of microbiology quality control as well as for hematology and chemical chemistry: collective quality control, between more laboratories, and individual quality control, in the sphere of each laboratory. A.M.O.I. (Associazione Microbiologi Ospedalieri Italiani) and I.S.V.T. (Istituto Sieroterapico Vaccinogeno Toscano) Sclavo collaborating, have organized a collective quality control between laboratories of different hospitals during the year 1974 and 1975. The results of this control are reported. Although preliminary, they indicate practical importance of microbiology control. During 1975, in fact, the pathogens isolated have been in high percentage than 1976. At last, the future quality control's program aiming at methods's standardization and technical, methodical instructions is indicated.


[Methods for sampling, collecting, preserving and carrying materials for parasitic tests (author's transl)].

A review is made of the methods of sampling, collecting, preserving and carrying materials to search directly (by microscopical, cultural or biological tests) the most common human parasites: protozoa, helminths and arthropods, with some references of indirect, specific (immunological) and aspecific (hematological, biochemical, immunochemical) procedures to search signs of parasitoses. The aim of this paper is to propose a standardization of these procedures for protozoa, helminth and arthropod infections.


[Liquor-culture in central nervous system mycosis (author's transl)].

Several possibilities of fungous etiology for meningo-encephalitis are shortly exposed, with the literature data on the liquor characters. Methods for the identification of the most frequently met fungi in liquor are given, both on microscopical and cultural examinations. For cryptococcal meningo-encephalitis is suggested the research in liquor of the capsular polysaccharide, and a personal observation is reported.


[Preliminary considerations for blood culture (author's transl)].

Some procedures are examined that more affect blood culture reliability. Basic recommendations concern the indications for blood cultures and the training of personnel who have to collect the specimens aseptically. The following steps are considered: informations required; skin disinfection; procedures of blood collection as anticoagulant to be used, volume of blood to be drawn, dilution in culture medium; time and number of cultures to be collected.


[Bacteriological examination of cerebro-spinal fluid: suggested techniques (author's transl)].

The Authors are considering the various tests used in the bacteriological examination of the cerebro-spinal fluid and thence to try to find a simple reliable method of which they recommend the PAR-test must be an indispensable part. In the appendix they are suggesting some quick additional diagnostic test.


[Basic procedure for blood cultures (author's transl)].

The Author summarizes the basic routine procedure for blood cultures first examining different factors that can influence it (blood coagulation, antimicrobial agents, natural bacterial inhibitors of blood cell wall deficient bacteria) and then describing culture media, atmospheric conditions, incubation time, and modalities for inspection, staining of cultures and subcultures. Finally new rapid automated methods are briefly pointed out.


[Blood cultures for brucellosis (author's transl)].

The results of 77 blood cultures for Brucella in a period of 22 months in Domodossola Hospital (North Italy) are reviewed. Positive results were obtained in 54,80% of cases within the sixth day of incubation. Then of fifteen cultures from apyrectical patients were positive, like then of fifteen in patients with low and not significative titles of agglutinating antibodies. It is concluded for the usefulness of blood culture in every suspicious case of Brucella infection.


[Blood culture in the leptospiroses (author's transl)].

In the early stage of Leptospirae infection there is always blood stream invasion so blood culture is the best diagnostic test and permit precise etiologic identification. In the paper methods and selective media are suggested and the possibility of mistake so called "pseudo Spirochaetes" for Leptospirae is emphasized. Personal experience about the streght of blood culture in comparison with Martin and Pettit serumdiagnostic tests is reported.


The care of vascular endothelium in pediatric surgery.

The influence of manipulating blood vessels by clamping, drying, stretching and surgical anastomotic technique on the subsequent integrity of blood vessel endothelium has been studied in the dog. Thrombogenesis at the vessel surface was found in all specimens where loss of endothelium had exposed subendothelial tissues. Whether thrombotic occlusion of the vessel followed depended upon several local factors including the amount of surface area damaged and volume of blood flow in the vessel. All modes of vessel manipulation studied led to significant endothelial damage. To prevent this damage in the clinical setting all possible methods to avoid the exposure of subendothelial tissues should be used. Endothelial integrity is the cornerstone to success in handling blood vessels and avoiding thrombogenesis. This study suggests that clamping of blood vessels should always be done with a minimum of force, only preventing blood flow, and not crushing the vessel wall. Endothelial surfaces should never be allowed to become dry. Stretching should be avoided as it can lead to thrombosis within intact blood vessels when the endothelium is disrupted. Suture anastomotic techniques should be used which minimize endothelial trauma and thus avoid subendothelial tissue reactions which in turn may jeopardize long-term patency and growth at anastomotic sites. In pediatric cases where growth is anticipated interrupted suture technique should be used. This study suggests that many techniques currently used in vascular surgery may be compromising to short and long-term blood vessel patency.


[Neutrophil function in children with acute lyphoblastic leukemia].

Neutrophil function has been studied in 12 patients with acute lymphoblastic leukemia by means of the NBT test and bactericidal assay against E. coli. Tests have been performed before and during treatment. In untreated patients the bactericidal activity of neutrophils was normal, in spite of the decreased number of cells reducing the NBT dye after activation with immuno-complexes. In remission, those patients showed normal reduction. No correlation was observed between the bactericidal power registered after cranial irradiation and the NBT test.


[Interpretation of blood culture results (author's transl)].

The most important problem of blood culture results interpretation is represented by contaminations. The Author reviews the different criteria differentiating contamination from bacteremia. Particularly he discusses the importance of type of organism isolated; of number of blood cultures taken from each patient; of pour-plate culture results; of antibodies production towards the organism isolated.


[Blood culture results from 1967 to 1975 and drug sensitivity of bacteria isolated by blood culture in the last three years (1974-1976) (author's transl)].

The blood culture results of patients of S. M. Nuova Hospital of Florence (Italy) have been examined in a period of nine years (1967-1976). We can attest from this results that in the last years of this period we have had an increase of the number of Enterobacteriaceae from blood culture. In the meanwhile we have had a decrease of positive results that is not due to an increase of the number of blood culture; in fact it has been doubled, but this decrease is mostly due to a larger number of examinated patients that to an increase of blood culture for each patient. Introduction in the routine of a diphasic culture system (Castañeda) commercially available has allowed contaminants' decrease. Antibiotic resistance of most important bacteria isolated in the last three years (1974-1976) were carry out.


Myocardial revascularization: a rebuttal of the cooperative study.

From January 1972 through December 1974, at Saint Louis University Medical Center (SLU), 345 patients similar to those of the VA Cooperative Coronary Artery Study received CABG. Operative mortality was SLU 2.3%, VA 5.6% (p < 0.05). Perioperative myocardial infarction rate was SLU 8.4%, VA 18% (p < 0.005). One year graft patency was SLU 87%, VA 71%; all grafts patent SLU 76%, VA 54%; at least one graft patent SLU 96%, VA 89%. SLU angina pectoris relief at five years was 90%. SLU patients free of myocardial infarction five years postoperatively was 83%. Comparative cumulative four year survivals were: [Table: see text] Cumulative four-year survival in 272 SLU patients (79%) completely revascularized was 94%, compared to SLU entire group of 95%, VA medical 86% (p < 0.002) and VA surgical 85% (p < 0.002). Comparing 1972-74 SLU results to VA medical and surgical groups, CABG prolonged life in patients with double and triple vessel disease and in those completely revascularized.


Time course of effects of morphine on hypothalamic content of LHRH and serum testosterone and LH levels of morphine-tolerant and nontolerant male rats.

Time course of the effects of morphine on the hypothalamic content of LHRH in both nontolerant and morphine-tolerant male rats was investigated in relation to the temporal changes of serum testosterone and LH levels. The hypothalamic LHRH content of the nontolerant rats was increased 8 hr after the administration of morphine (100 mg/kg) when serum testosterone levels were depressed. The LHRH content of the tolerant rats was decreased during withdrawal of morphine for 48 hr when the lowered serum testosterone and LH levels had returned to within the control levels. Although the hypothalamic LHRH content does not necessarily reflect the release of LHRH, these results are in favour of the hypothesis that the release of hypothalamic LHRH is inhibited by the administration of morphine and is restored by the withdrawal of the narcotic.


Clinical effect of aerosol triamcinolone acetonide in bronchial asthma.

In a double-blind, 12-week study of corticosteroid-dependent reversible bronchial asthma, 20 of 31 (64.5%) patients receiving triamcinolone acetonide aerosol, 800 microgram daily, were able to discontinue oral steroid therapy. This compares with three of 29 (10.3%) treated with aerosol placebo. At the end of the 12-week period, the mean 8 AM plasma cortisol level had increased from 5.3 +/- 4.1 to 8.6 +/- 5.2 microgram/dl in those receiving triamcinolone acetonide. The mean percent predicted values in the triamcinolone group for forced expiratory volume in the first second rose from 44.8 to 62.4 at two weeks (P less than .005), for forced vital capacity from 64.1 to 79.9 (P less than .005), and for maximum midexpiratory flow rate from 26.7 to 46.7 (P less than .005). The improved pulmonary function values persisted while the oral prednisone equivalent daily dose decreased from a mean of 13.3 to 2.9 mg at 12 weeks. Significant oral candidiasis was detected in two patients. Aerosol triamcinolone acetonide appears to be an effective alternative to beclomethasone dipropionate for use in patients with bronchial asthma.


Renal failure with posttransplant renin-angiotensin mediated hypertension.

Ten days after receiving a kidney transplant, severe hypertension and renal failure developed in a patient with a previously functioning graft. Although moderate blood pressure control was achieved with dialysis and antihypertensive medications, the graft did not function well. A trial of sar-ala-angiotensin II (an angiotensin II antagonist) was associated with a dramatic fall in blood pressure. Subsequently, the patient's own two kidneys were removed, the blood pressure fell to normal on the operating table, and within days graft function improved. The possible explanation for the changes in graft function, including angiotensin II-mediated changes of glomerular filtration rate, are discussed.


Disseminated cryptococcosis presenting as palpable purpura.

Disseminated cryptococcosis with palpable purpura as the initial clinical manifestation developed in a patient with diffuse histiocytic lymphoma. Cryptococcal vascular injury in a thrombocytopenic cancer patient best explains this previously unreported presentation of cryptococcosis. Purpuric presentations of disseminated fungal infection are likely to increase in frequency as cancer therapy becomes more aggressive.


Chronic granulocytic leukemia in a patient with a renal allograft.

A man received a cadaver renal allograft for end-stage renal failure. After 35 months of immunosuppressive therapy with azathioprine and prednisone, he developed septicemia and a high leukocyte count. In spite of successful treatment of the infection, the leukocyte count continued to rise and a diagnosis of Philadelphia chromosome positive chronic granulocytic leukemia was made. An increased incidence of malignant disease, especially lymphoreticular malignancy, is well described in immunosuppressed patients with allografts. However, the association of chronic granulocytic leukemia and immunosuppressive therapy previously has not been reported. An additional etiological factor in this patient may have been the extensive diagnostic radiological investigations undertaken in childhood. The recent addition of allopurinol to the immunosuppressive therapy has normalized the platelet and leukocyte counts, probably by potentiating mercaptopurine.


[Distribution of the O-group of "E coli" isolated in urinary tract infections (author's transl)].

The distribution of the O-groups of E. coli isolated in urinary tract infections by several italian and foreing Authors are reviewed and compared with the distribution obtained by us in the O-grouping of 300 strains isolated during 1976 in hospital and in surgery. Our results are similar to those of above-mentioned Authors. In fact O6, O75 and O2 groups are the most frequent; besides for the first time a considerable number of "enteritogenic" groups has been isolated and the most frequent of them was the O126. According to the results, the theory of specific pathogenicity could be supported by the high frequency of the O6, O75 and O2 groups; the presence of other groups could justify the theory of prevalence.


[Pulmonary hemosiderosis in children. Immunologic study].

Circulating anti alveolar basement membrane antibodies have been detected by indirect immunofluorescence on lung rat in two out of five children presenting with pulmonary hemosiderosis. The two cases are reported and seem to be consistent with an auto-immune disease due to anti-basement membrane antibodies. Authors outline the presence of anti-reticulin antibodies in the two cases reported and the high level of IgE which seems a frequent finding in pulmonary hemosiderosis.


[Control of the technic for recovery of E coli K12 after acquisition of R factors. Tests with various culture substrates under different mating conditions].

A survey was carried out in order to ascertain the reliable conditions for the recovery of E. coli K12 after acquisition of extrachromosomial resistance from polyresistant strains of Salmonella bredeney, responsible for a hospital outbreak of gastroenteritis. In particular in this study the length of mating, the amounts of partners in the cross-cultures, the availability of different media for selection of recipient E. coli, were controlled. It was possible to conclude that the incubation of cross-cultures during 18 hours at 37 degrees C was suitable for a greater transfer, whereas the amount of donor and recipient cells in the starting cultures was of little importance. Attempts to use synthetic media for the selective recovery of E. coli which had been made drug-resistant were not successful; instead some of lactosate media which are classically employed for the diagnosis of enterobacteria (Endo agar, Mac Conkey agar, Desoxycholate Lactose agar, Brilliant Green Bile agar, Eosin Methylene Blue agar, Violet Red Bile agar, Wurtz agar) gave satisfactory results. Among these media the two last were the best because they provided good differentiation between the prevalent Salmonella colonies and the few lactose-fermenting colonies, even in the crowded growth areas of the plates.


[Sample technique in cytology (author's transl)].

Modern theory and experience question the reliability and suitability of sampling per judgment being the method for the evaluation of the percentage of cells in clinical cytology till now. For the reduction of this gap empirical studies were undertaken in order to receive proper estimates of blood smears. A simple method for the differential blood count is to take 30 or more strips of the width of the field of vision of the microscope perpendicular to the smearing direction as sampling units at random or by systemtaic selection with a random starting point. For the class of cells under consideration as well as for whole the cell population on the slide, the coefficient of variation of the mean of the cells within different strips has to be less than 0,1. Smears of a width of 10 mm instead of the usual 22 mm seems to be preferable. Under such conditions more than 1.000 cells are to be counted for a reliable estimate of the more frequent classes of cells. It is not supposed that this tedious method will be carried out by technicians but modern apparatus are presumed to give consistent estimates in such a way.


[A system of automatic image processing and possibilities of its usage (author's transl)].

Prior to the description of the hardware and the developmental possibilities of the hardware, general principles of image processing systems are explanated and the properties for the utilizing of this measuring method are outlined and delimites. Actual problems, being worked at, and hitherto existing results are reported.


Some methodical remarks on the use of impulse cytophotometry in automated cervix cytology.

Methological studies in preparation and staining of cervical cells for measurement in a flow through cytophotometer are described. Different enzymatic petreatment and fluorochromation are tested in regard to the diagnostic value of the histogram obtained.


[Epidemiology of cervical cancer (author's transl)].

There are remarkable differences of incidence and mortality from cervical cancer between countries and even within small countries. In developed industrial countries, incidence is slowly declining. Age distribution (middle--aged women are mostly afflicted) distinguishes cervical cancer from all other common malignant neoplasms. Known risk factors are: low social class, sexual activity early in youth, instable sexual relationships. Cervical cancer behaves like a veneral disease of low infectious power. Cervical cancer develops stepwise out of epithelial dysplasia and carcinoma in situ. The foundations of a cervical cancer control programme are laid: cytodiagnosis as screening method; well defined high risk groups; effective and not dangerous treatment of prephases and early stages of cancer. In the G.D.R. conditions for effective cancer control are good: cancer registration works stable for more than 20 years; it enables evaluation of effectivity. Cytologic screening can be fully integrated into basic gynecologic care. Medical care including prevention is free of fees and available for all women. The ultimate of goal of a cervical cancer control programme is primary prevention by detection and treatment of preneoplastic lesions (dysplasia and carcinoma in situ).


[Method of random selection of fields of view for pathological study of histological preparations].

A simple method for selection of fields of vision in microscopy of histological sections is suggested. The objective of the microscope is focused to any corner of the section, and values of integrator screws of the preparation driver are read. Two other diagonal corners of the section are placed under the objective and values of the integrator screws are read. Numbers of the natural series between the first and second readings of integrator screw values are taken as the numbers of fields of vision in the section examined. A random number of a field of vision is obtained from the table of random numbers in the interval of numbers obtained from values of the integrator screws.


[Experimental study of the pathogenesis of dysentery].

It was shown that experimental dysentery could be produced against the background of various pathologic conditions of experimental animals (avitaminosis, concurrent diseases, etc). The studies in vivo and in vitro showed that intraepithelial parasitising of Shigella occurred in dysentery but did not play the leading role in the pathogenesis of the disease. Macrophages played a more important role, particularly in formation of the bacterial carrier state. In order to resolve some disputable problems of the pathogenesis of dysentery it is necessary to take into account the biological properties of the causative agent which change under the influence ov various effects, as well as the state of reponsiveness of the host.


[Morphometric characteristics of fundal glands of the stomach in duodenal ulcer and pre-ulcer condition].

Biopsy material was used for morphometric study of the fundal glands in 114 patients with duodenal ulcers, 177 patients with various forms of gastroduodenal pathology but with typical signs of duodenal ulcer, and in 21 normal subjects. Three variants of the increase in the amount of secretory elements of the fundal glands were found: owing to an increase in the number of main cells (first variant), main and parietal cells (second variant), and parietal cells (third variant). These changes in the fundal glands are not specific for ulcer and pre-ulcer conditions, they are observed in normal subjects with constitutional hypersecretion of hydrochloric acid and pepsin. The patients with duodenal ulcer and pre-ulcer conditions are characterized by "hyper-pepsinogenic shift" in the epithelial formula of the fundal gland (45% and 31-38%, respectively) owing to an increase in the number of main cells.


[Early death of pancreatic A-cells after irradiation with supralethal doses].

For investigation of postirradiation reactions, of pancreatic insular cells, male Wistar rats were subjected to 1.5, 3, 7, and 15 kR  of Co60 gamma-radiation. It was found that after application of doses of 7 kR or higher, interphase death of all the insular A-cells occurred within 6 hours. The cell death was demonstrated to be characterized by chromatin pycnosis, dilatation of the endoplasmic reticulum and perinuclear space, mitochondrial swelling, and desintegration of A-granules. Macrophages took no part in resorption of the dead cells. A-cell necrosis was not accompanied by morphologically observable changes in acinar cells or insucar B-cells. Some possible explanations of the more pronounced radiosensitivity of A-cells are discussed.


[Use of mathematics in pathological anatomy].

The author discusses the possibilities of using mathematics in pathological anatomy studies on the basis of data from literature and his own studies. The information on the organization and planning of a mathematical investigation and on the features of the system approach to investigation of pathomorphology problems is presented. The main stages of the mathematical analysis of pathological changes are described with special reference to the use of likelihood and information approaches to the evaluation of the pathology of morphological systems at all levels of the structural organization. The principles of mathematical modelling and axiomatization of pathomorphological processes are outlined. The paper is illustrated with mathematical models of age dynamics of atherosclerosis and informational characteristics of the process of malignization of the stratified squamous epithelium. The general principles of further development of quantitative pathomorphology are briefly discussed.


Mathematical and experimental methods for design and evaluation of membrane oxygenators.

Three categories of membrane oxygenators are considered: passive flow, secondary flow induced by the mainstream, secondary flow induced by an external application of energy. The current status of mathematical methods for analysis of fluid mechanics, O2 and CO2 exchange for these categories are briefly reviewed. Emphasis is given to approximate methods for calculation of gas exchange. Practical methods for experimental design optimization studies are outlined; these methods are extended to evaluation of O2 and CO2 exchange in clinical operation. A new method for estimation of internal ventilation and perfusion maldistribution and diffusion resistance is described. A brief assessment of blood damage in clinical application of the oxygenator is presented from the point of view of deterioration of gas exchange performance.


Intraocular lens implantation: a review.

Intraocular lens implantation has been developing over the past 15 years in Europe and is now becoming popular in the United States. Lens materials and designs as well as surgical techniques are still being evaluated. The overall results are excellent, with a small increase in complications being the price paid for a dramatic increase in visual rehabilitation.


Engineering aspects of ECMO technology.

The primary areas of extracorporeal membrane oxygenation (ECMO) technology with engineering components are: biomaterials, oxygenator design, ECMO physiology and total system design. The evolution of ECMO has been largely empirical, with many innovations introduced directly from clinical experience and observation. Major advances are needed in both materials ans oxygenator design if current hematologic hazards are to be reduced. Optimization of ECMO systems has not been attempted in any systematic way because the basic physiology is not well enough understood to define the rationales for optimum control and management strategies. Once these strategies have been developed and tested, currently available automation technology can be applied to make the ECMO system system simpler and safer for clinical use.


Actin filaments in paramyxovirus-infected human fibroblasts studied by indirect immunofluorescence.

Fibroblasts growing on glass have microfilaments arranged in bundles. These can be demonstrated by indirect immunofluorescent technique using human antiactin serum or experimentally produced rabbit anti-actin serum. When monolayer cultures of epithelial cells and fibroblasts are infected with paramyxovirus, such as measles, mumps, Sendai and NDV, there is a striking decrease of the bundles. Rabies and adenoviruses do not seem to influence the staining of microfilaments. The microfilament decreasing effect in the cells correlates to the finding by SDS-polyacrylamide-gel-electrophoresis of actin within virions of the paramyxoviruses.


[Possibility of preserving the innervation of transplanted kidneys in dogs].

It has been stated experimentally in dogs that after classical operative denervation of the kidney, complete adrenergic and partial cholinergic denervation of the organ is achieved only in the cases were excision of ggl. splanchnicum and ggl. aorticorenale is performed simultaneously. The classical autotransplantation of the kidney, as a rule, produces complete adrenergic and partial cholinergic denervation of the organ. The surgical procedure modified by the authors contributes to preservation of intrarenal adrenergic and cholinergic innervation and the organ behaves in the same manner as after preganglionic surgical decentralization.


The characteristics of a new glucose sensor for use in an artificial pancreatic beta cell.

A new glucose sensor has been developed for the continuous extracorporeal monitoring of blood glucose concentrations in conjunction with an artificial pancreatic beta cell simulator. This sensor has a rapid ninety percent response time (less than 1 min), is stable for periods of up to 140 hours of accumulated use and can be calibrated without the use of a reference glucose analyzer. Its reliability has been confirmed in over 100 clinical studies. A comparison of this sensor to other glucose sensors designed for artificial pancreatic beta cell devices is made and the sensor is shown to be the most advanced glucose sensor presently available for extracorporeal continuous glucose monitoring in man.


[The coagulation picture and plasma clearance capacity in atherosclerotic diabetics].

An attempt is made to set out the complex question of the relations between plasma and wall factors in coagulation, platelets and lipids in atheroscderotic diabetes. The literature data show that this disease is associated the clotting and fibrinolytic systems as a result of the prevalence of thrombogenic factors and/or poor inhibitor activity. A survey is made of fibrinolysis activators and inhibitors, and of the part played by lipids in the aetiopathogenesis of thrombophilia, though the mechanisms responsible have not yet been fully established. Reference is made to De Gaetano's exposition of Walsh's views concerning the rôle of platelets in clotting. An assessment is made of the relations between platelets and lipoproteins, and hence of the importance of platelets in the pathogenesis of atherosclerosis. Reference is made to a series of atherosclerotic diabetics. Hyperaggregability was noted in 60% of 30 cases. The experimental results obtained by Bierman et al. on the relation between insulin and lipoproteinlipase and the interference of insulin with PHLA are presented in an explanation of the clarifying power of plasma in this disease. Lastly, an account is given of lipoproteinlipase values observed in a personal series of 48 cases employing a radioimmunological technique. Baselines were depressed in 24 subjects.


Alternate pathway activation of complement in a Proteus mirabilis ulceration of the cornea.

A 63-year-old patient had an extensive infiltration, ulceration, and eventual perforation of the cornea caused by Proteus mirabilis. Histopathological examination of corneal tissue that was obtained at keratoplasty disclosed that the stroma was ulcerated with a diffuse infiltration of polymorphonuclear leukocytes. Immunopathological examination of the cornea revealed prominent and diffuse staining for properdin and C3 complement. There was an absence of staining for IgG, IgA, IgM, IgE, and C4 complement. These findings suggest that the alternate pathway of complement was activated in this ulcerated cornea and that immunopathological phenomena contribute to the polymorphonuclear infiltration found with Gram-negative ulcerations of the human cornea.


Factors in the spread of salmonellas in meatworks with special reference to contamination of knives.

Immersion of knives momentarily in hot water (82 degrees C) was ineffective in destroying salmonellas on knives used in a meatworks to carry out the bung dropping operation. Laboratory experiments confirmed that knives covered with meat products required 10 or more seconds to be effectively decontaminated at this temperature. Examination of knives used for slaughtering and for dressing beef carcases showed that knives coming into contact with hides had higher counts for salmonella and a higher percentage positive than knives used for other cutting operations. Knives used for cutting the skin of the forelegs and hindlegs had the highest counts.


Subdivision of Mycoplasma mycoides subsp. mycoides from cattle and goats into two types.

Some strains of Mycoplasma mycoides subsp. mycoides, mostly isolated from goats, grow to greater turbidity in broth and form larger colonies on solid medium than does the type strain, PG1. These strains also digest casein, liquefy inspissated serum actively and survive longer at 45 degrees C and are referred to as LC (large colony) strains. Strains more closely resembling PG1 have been called SC (small colony) strains. The SC strains comprise those from contagious bovine pleuropneumonia (CBPP) and some from goats. One LC strain was isolated from a steer; all others have come from goats. Differentiation of M. mycoides subsp. mycoides into 2 types on the basis of the characteristics described may be relevant to their role in CBPP.


Binding of chloramphenicol and a fragment of aminoacyl-transfer ribonucleic acid to ribosomes and a ribosome precursor from a mutant of Escherichia coli.

During exponential growth, the mutatn strain Escherichia coli 15-28 accumulates 47S particles, which are unusual precursors to 50S ribosomal subunits. The 47S particles have little ability to bind chloramphenicol, but binding of a fragment of aminoacyl-tRNA is about half that by completed subunits. The 70S (and 50S) ribosomes of strain 15-28 and its parent (strain 15TP) do not differ in chloramphenicol binding. Although ribosomes from the mutant are less able than those from the parent to bind the fragment, this difference is not as marked as was found previously [Sims & Wild (1976) Biochem. J. 160, 721-726] for the binding of an analogue of peptidyl-tRNA and for peptidyltransferase activity. The altered activities may arise because strain 15-28 misassembles 50S subunits of altered conformation and because the few proteins that 47S patricles lack have vital functions in some of the partial reactions of protein synthesis.