The definition of "Cheyne-Stokes rhythms".

The review of the literature on Cheyne-Stokes respiratory periods reveals enormous variation of the opinions expressed. The original description concerned periodicity characterized by rhythmic changes of respiratory phases and respiratory pauses in a relation of 60 : 15 seconds. In the respiratory phase there were 30 respirations of increasing depths and frequency at the beginning of the phase and decreasing depths and frequency at the end of the phase. Literature data about Cheyne-Stokes respiration comprise a multiplicity of all rhythymic forms. The duration of respiratory cycles varies between 12 and 130 seconds. The relation of the respiratory phase and respiratory pause between 6 : 4 or 75 : 70 seconds, and the number of breaths between 3 and 30 during one respiratory phase. Cheyne-Stokes periods were observed in health subjects as well as in patients with neurological, neurosurgical, cardiac, pulmonary and paediatric diseases. Cheyne-Stokes periods were explained as sequel of prolongation of circulation time between pulmonary alveoli and respiratory centre, through increased sensitivity of the respiratory centre to CO2, diminished sensitivity of the respiratory centre to CO2 and O2-deficit, local blood flow disturbances, section of pathways in the brain stem with disinhibition of basic rhythms, brain immaturity, alterations of consciousness, and respiratory obstructions. Rhythmic changes of the heart beat, of excitability of the heart muscle, of blood pressure, of EEG and of neurological and mental signs were observed. In spite of numerous observations detailed analysis of the respiratory cycle was performed in only a few cases. Major studies are lacking.


Effects of site and size of septum lesions on feeding and drinking behavior in the cat.

Lesions involving most of the septum caused in cats a reduction in drinking milk and eating cereal. Only the lesions involving a part of the posterior one-third of the septum increased consumption of milk and solid food. Changes of drinking behavior were usually more pronounced and permanent. In some cases the normal ratio of drunk fluids to solid food eaten was disturbed, that is either the amount of the consumed milk or cereal changed; in some animals these changes were more or less parallel. Increase or abolition of effects caused by lesions involving areas playing a similar or an opposite role in these functions were observed very often. This indicates how important it is in such investigations to produce precise lesions of strictly determined site and size.


The effect of positive end-expiratory pressure (PEEP) ventilation in neurogenic pulmonary oedema. Report of a case.

The effect of positive end-expired pressure ventilation (PEEP) on mean systemic arterial pressure, mean pulmonary arterial pressure, mean pulmonary wedge pressure, mean intracranial pressure (ICP), and cerebral perfusion pressure (CPP), in a case of neurogenic pulmonary oedema (NPO) is presented. PEEP improved oxygenation, reduced, and finally stopped clinical pulmonary oedema. In this patient PEEP produced severe systemic hypotension. As a consequence of this, CPP was impaired.


Keratoconus and the operating microscope.

The slit lamp microscope is widely used in assessing patients pre-operatively and post-operatively with conical cornea which is a less sophisticated form of operating microscope. It is operative in terms of being used constantly in the surgeon's consulting rooms for the assessment of the patients pre- and post-operatively and therefore occupies a large proportion of the time involved in the treatment of these people. The management of these patients involves not only their local corneal disease but often more important the management of their emotional and medical problems particularly when there are associated atopic problems of eczema and asthma. Unfortunately there is no microscope or easy method in the control of these problems.


Combined simultaneous cataract glaucoma surgery.

This relatively small series supports the accumulating evidence that a combined cataract extraction and trabeculectomy procedure gives satisfactory results in both respects.


Long-term use of the major anticonvulsant drugs.

The specific type of epilepsy must be identified. The history and the EEG provide the evidence. Drug selection is then based on the classification of the patient's epilepsy. Major drugs used in the management of epilepsy are phenytoin, phenobarbital, primidone, carbamazepine, ethosuximide and valproic acid. The physician should know their kinetics, interactions and side effects, and the value of monitoring blood levels of these anticonvulsant agents.


Centenary of the first correct antemortem diagnosis of coronary thrombosis by Adam Hammer (1818--1878): English translation of the original report.

William Heberden (1710--1801), in 1768, described angina pectoris, the classic symptom of ischemic heart disease, 150 years after the discovery of the coronary circulation by William Harvey (1578-1657). Another 110 years had elapsed before the first antemortem diagnosis (confirmed at autopsy) of coronary thrombosis was reported by Adam Hammer in 1878. The patient was a 34 year old man who died some 19 hours after a sudden collapse. Although the patient's clinical features were atypical (such as the absence of angina and the presence of complete heart block) and the autopsy showed vegetative aortic endocarditis that appeared to be causally related to the thrombotic coronary occlusion, Hammer's astute and carefully reasoned bedside diagnosis was history-making and deserves to be so recognized.


Cytology and distribution of secretory cell types in the mouse hypophysis as demonstrated with immunocytochemistry.

Since differential chemical staining has been unsatisfactory for demonstration of specific secretory cell types in the hypophyseal pars distalis of the mouse, the objective of this study was to determine whether the peroxidase-antiperoxidase immunocytochemical procedure might be more effective. Accordingly, representative sections from the hypophyses of 17 female and 15 male adult mice of the Swiss-Webster strain were immunostained, 16 antisera to 5 pituitary hormones or their subunits being utilized. Five secretory cell types were demonstrated. Somatotropes were ovoid to spheroidal and distributed quite generally in the gland except for the "sex zone" where they were scarce. Somatotropes were larger and more numerous in the male than in the female. Mammotropes were polyhedral and also generally distributed in the gland except for the "sex zone" where few were observed. Mammotropes were larger and more numerous in the female than in the male. Corticotropes were small, stellate and few. They were most common near the ventral surface of the gland and formed bilateral centromedial groups in the lateral wings. Thyrotropes were usually large and polyhedral. They were restricted almost solely to the ventral region of the pars distalis. Gonadotropes were polyhedral, and generally distributed, except for aggregation in the cephalomedian "sex zone." Most gonadotropes appeared to contain both luteinizing hormone and follicle-stimulating hormone. Thus, all secretory cell types recognized in other species can be demonstrated readily in the mouse hypophysis with immunocytochemistry.


Immunocytochemical localization of renin in the submandibular gland of the mouse during postnatal development.

The localization of renin in the developing mouse submandibular gland was studied immunocytochemically using the unlabelled antibody-enzyme method of Sternberger ('74). Bouin-fixed submandibular glands of mice of both sexes were examined at 5-day-intervals from birth (day 0) to 50 days of age. At all stages studied, only granular convoluted tubule (GCT) cells stained immunocytochemically for renin; such cells were first seen in glands of 30-day-old males and of 30-day-old females. The size and number of renin-containing GCT cells increased rapidly in males, attaining adult status by 50 days of age. In females, differentiation of GCT cells immunoreactive for renin was slower and less regular than in males, and at 50 days of age the GCT segment had not yet reached adult conditions with respect to the distribution of renin. Renin appears in GCT cells at later ages than other GCT cell products (e.g., EGF and amylase), suggesting the existence of independent developmental control for the expression of various biologically active substances in the GCTs.


Selective binding of antibody against gizzard 10-nm filaments to different cell types in myogenic cultures.

Antibody against the intermediate-sized filaments from gizzard smooth muscle was used to determine the presence or absence of reacting 10-nm filaments in different cell types. The antibody against gizzard 10-nm filaments reacted with filaments in cultured smooth muscle cells, skeletal myotubes and postmitotic skeletal myoblasts. It did not bind to the 10-nm filaments present in replicating presumptive myoblasts and fibroblasts, or the 10-nm filaments in spinal ganglion cells.


Cerebral localization of insulin by immunofluorescence.

An immunohistochemical procedure was used to detect cells which appear to bind insulin in the mouse brain. Strong fluorescence was observed in the cell bodies and processes of tanycytes lining the third ventricle and in the choroid plexi. These findings suggest that insulin enters the central nervous system, and indicate a route for its possible transport. This adds credence to earlier observations that the hypothalamic ependymal cells and processes form a highly organized and functional system, with different cells selectively absorbing (or sensing) particular substances from the systemic and ventricular circulations and transporting them (or information about them) to specific neuron receptors in the hypothalamus.


Somatostatin-containing neurons in the rat brain: widespread distribution revealed by immunocytochemistry after pretreatment with pronase.

Immunocytochemical staining after controlled proteolytic treatment of the sections with pronase revealed widespread distribution of neuronal cell bodies with somatostatin-like immunoreactivity (SLI) in the rat forebrain. SLI-positive neurons were found in regions of the neocortex, the pyriform cortex, the cingulate cortex, the striatum, the olfactory tract and tubercle, the nucleus accumbens, the septum, and the hypothalamus. These results are consistent with previous radioimmunoassay findings and suggest the presence of large somatostatin-like (possibly precursor) molecules in the neurons stained for SLI after pronase treatment.


Treatment with essential amino acids in patients on chronic hemodialysis: a double blind cross-over study.

Patients on chronic hemodialysis may suffer from a latent protein deficiency, and therapy with essential amino acids has been recommended. In a double blind cross-over study, 13 hemodialysis patients received orally 15.7 g of essential amino acids daily over a 3-month period. Patients were on a liberal diet, containing 1 g of protein per kilogram of body weight per day. Hemodialysis was adequate. Therapy resulted in an increase in urea, uric acid, C3 c complement factor and a fall in C4. Lysine levels increased and phenylalanine fell. Malnutrition could not account for the observed metabolic changes, which are more likely due to uremic metabolic disturbances. A liberal diet of 1 g of protein per kilogram of body weight appears sufficient for patients on hemodialysis. Treatment with essential amino acids offers no advantage.


The defined antigen substrate sphere system with direct immunohistoperoxidase for detection of soluble dengue antigen in sera of patients with dengue hemorrhagic fever.

The defined antigen substrate sphere system is a simple method for detecting antigen or antibody in the circulation. The technic is based on the coupling of antigen or antibody with Sepharose 4B beads that have been activated by cyanogen bromide. In this study the activated beads were exposed to dengue antigen in the serum from a patient with dengue hemorrhagic fever and then stained with antidengue antibody conjugated with horseradish peroxidase. The positive reaction showed brown beads by light microscopy, whereas the negative reaction gave colorless beads. The authors examined 134 specimens from 91 cases. The results were positive in 53.85%. The dengue antigen appeared in the sera on the day before shock or subsidence of fever. The percentages of sera containing soluble dengue antigen were greatest on the day of shock or subsidence of fever (33.33%) and on the fifth day of fever (28.07%). The highest titers of soluble dengue antigen (1:40 to 1:80) appeared in the sera of patients who had Grade III disease on the day of shock. The dengue antigen appeared most often in sera that had high titers of dengue antibody. It is postulated that this detected dengue antigen may be a part of soluble immune complexes formed during the hyperimmune stage of the immune response, and plays a significant role in the pathogenesis of dengue hemorrhagic fever and shock syndrome.


Coexistence of two lymphomas with distinctive histologic, ultrastructural, and immunologic features.

The unusual coexistence of two distinct lymphomas in 44-year-old woman is described. Nodular, poorly differentiated lymphocytic lymphoma and diffuse histiocytic lymphoma were present in separate sites and were readily distinguished both histologically and ultrastructurally. In addition, the lymphocytic lymphoma was shown to be derived from complement receptor B lymphocytes of follicular center cell type, whereas the histiocytic lymphoma cells were devoid of complement receptors, receptors for IgG (Fc receptors), and surface immunoglobulin. Despite intensive chemotherapy and radiation therapy, the patient died within eight months of the initial diagnosis. Although histiocytic lymphoma was widely disseminated at autopsy, lymphocytic lymphoma was not found. Presumably the histiocytic lymphoma was refractory to therapy, in contrast to the lymphocytic lymphoma, which was selectively eradicated.


Coccidioidomycosis in a patient with lymphoma. Spherulation in human pleural fluid medium.

In a Caucasian woman who had had a giant follicular lymphoma for 21 months a small lesion developed in the upper lobe of the left lung. Excision, histologic study, and culture of the lesion were performed. Of the many stained sections, only one revealed endospore-containing spherules within the caseous necrosis of a granuloma, and only four spherules were identified. On agar medium the same tissue yielded a fast-growing fungus that produced arthrospores alternating with empty cells, typical of Coccidioides immitis. The arthrospore suspension was inoculated intraperitoneally into a mouse and into a medium of human pleural fluid at 40 C. Spherules containing endospores developed in the internal organs of the mouse and in the pleural fluid medium. The phylogeny of C. immitis is briefly discussed.


Performance of enterobacteriaceae identification systems. An analysis of College of American Pathologists Survey data.

Commercial systems designed and marketed for evaluation of Enterobacteriaceae are used in many clinical microbiology laboratories. Evaluations of these systems have been reported from several large laboratories. Identifications with one or more of these systems were compared with those obtained by conventional methods with many strains of organisms. The Microbiology Resource Committee of the College of American Pathologists designed two surveys to evaluate the performances of commercial systems with identical strains of organisms submitted to a large number of participants. The surveys used were the Special Bacteriology Survey D-D and the Comprehensive Microbiology Survey B-D submitted during 1975--1976. Single strains of Klebsiella pneumoniae and Serratia marcescens in pure culture were submitted in the Comprehensive Survey and the same strains of these organisms plus one strain each of Pseudomonas stuartii and Citrobacter freundii in the Special Survey. The data obtained from participants permitted comparisons to be made between the API-20E, Enterotube, and r/b systems. These comparisons included individual biochemical test results shared by at least two systems as well as the ability of each to identify the unknown organisms to genus alone and to both genus and species. The results are presented and subjected to statistical analysis.


Congenital cystic adenomatoid malformation of the lung.

Ten cases of congenital cystic adenomatoid malformation of the lung are presented, together with a review of the literature. Two infants were stillborn; the others died shortly after birth. Eight had hydrops, and in eight the pregnancy was complicated by hydramnios. Grossly, one or two lobes of the lung were affected, the remaining lobe(s) and the opposite lung being hypoplastic. The lesions were solid, or cystic. Apart from a solitary cutaneous hamartoma, there was no associated anomaly. Microscopically, two patterns were seen--solid and mixed. "Mucigenic epithelium" was seen in six cases. The pathogenesis of this lesion, together with that of the hydrops and hydramnios, is discussed. It is concluded that congenital cystic adenomatoid malformation of the lung is a distinct pathological entity; its prompt recognition and surgical correction should result in normal survival.


Clinical trial of a new bleeding-time device.

The authors report a clinical trial comparing a new bleeding time device (Simplate II) with the Mielke Template. Bleeding times were determined at the same time on the same arm using the two devices. Subjects of the study were 24 healthy volunteers, before and two hours after ingestion of 975 mg aspirin, and 28 patients. For the normal subjects the mean pre-aspirin bleeding times were 4.75 +/- 1.42 minutes (1 SD) with the Simplate II and 3.65 +/- 1.22 minutes with the Mielke Template. The mean bleeding times two hours after ingestion of aspirin were 7.86 +/- 2.76 minutes with the Simplate II and 7.84 +/- 2.94 minutes with the Template. The pre- and the post-aspirin values with the two devices were not significantly different from each other, nor were the bleeding times obtained in the patients with the two devices. The extents of scarring were similar with the two devices. The results were highly reproducible by both methods. The new device was simpler and more rapid to use.


Multivariate approach to predictive diagnosis of bone-marrow iron stores.

The authors constructed a computer-assisted multivariate data analysis system that finds the subset of a group of laboratory tests (i.e., experimental variables) best able to discriminate between previously identified subpopulations. A Bayesian decision-analysis algorithm was devised for predictive diagnosis by the use of sample means and standard deviations of those identified tests. This approach was used on a set of nine hematologic laboratory tests to find a subset capable of efficiently predicting the presence or absence of bone-marrow iron stores. This identified subset proved to have a diagnostic efficiency of 0.90. The success of this system suggests the feasibility of such an approach in finding a "best" subset of loosely related variables.


Pyridoxine inhibition of a symbiotic streptococcus.

A symbiotic, alpha-hemolytic streptococcus that showed satellitism about a Staphylococcus aureus was recovered from blood cultures of a patient with endocarditis. Previously reported as being required for growth of symbiotic streptococci, pyridoxine hydrochloride was found to inhibit the growth of this organism.


A reliable method for electron microscopic examination of specific areas from paraffin-embedded tissue mounted on glass slides. Am J Clin Pathol 70: 697--699, 1978. A method to embed and cut tissue mounted on ordinary glass histologic preparations for electron microscopic observations is described. The cover slip is removed by immersing the slide in xylene for a few minutes to several hours. After the cover slip is removed, the tissue is fixed in osmium tetroxide, dehydrated, and embedded in epoxy resins by inverting a BEEM capsule filled with the resin on a selected area of the slide. After polymerization, thin sections are obtained and observed with the electron microscope with good results.


Community-acquired bacteremic Achromobacter xylosoxidans type IIIa pneumonia in a patient with idiopathic IgM deficiency.

A man was hospitalized with bacteremic Achromobacter xylosoxidans type IIIa pneumonia. The authors are aware of no previously reported similar infections caused by this bacterium. A clinical cure was achieved with a combination of carbenicillin and kanamycin therapy. Microtiter susceptibility testing revealed that carbenicillin was the antibiotic to which A. xylosoxidans IIIa was most sensitive (minimal inhibitory concentration, 1.6 microgram/ml) and that synergy between carbenicillin and kanamycin existed. During the patient's hospitalization, deficiency of IgM (21 mg/dl) was found. Specific serum activity against A. xylosoxidans IIIa was detected by the agglutination method. Specific anti-A. xylosoxidans IIIa IgG, but not IgM, was detected by indirect immunofluorescence. It appears that a defect in immunologic recognition of A. xylosoxidans IIIa as an invasive bacterium, a defect in synthesis of specific IgM, or both, contributed to this patient's infection.


Phencyclidine intoxication: a literature review.

The history, symptoms, diagnosis and treatment of phencyclidine hydrochloride (PCP) intoxication and the pharmacology of PCP are reviewed. Intoxication with low to moderate doses of PCP (5-20 mg) resembles an acute, confusional state generally lasting four to six hours. High doses (greater than 20 mg) may cause serious neurologic and cardiovascular complications and the patient is often comatose for several days. Treatment involves supportive psychological and medical measures. Evacuation of the stomach with activated charcoal and a saline cathartic may be indicated and succinylcholine chloride may ease intubation. Diazepam and chlorpromazine may be used to control the combative patient and the "PCP psychosis" patient, respectively. Antihypertensive agents are not usually needed, but diazoxide and hydralazine hydrochloride have been used to treat hypertensive crises. Diazepam and phenytoin have been used to treat seizures. Ion-trapping by continuous gastric suctioning and by urine acidification with ammonium chloride may increase clearance of PCP. Forced diuresis with furosemide in conjunction with acidification may further increase PCP clearance. Use of physostigmine is based on conjecture.


Paraquat poisoning: a review.

The pathophysiology, symptoms and treatment of paraquat intoxication, primarily from oral ingestion, and the pharmacology and pharmacokinetics of paraquat are reviewed. Toxicity has occurred after topical application, oral ingestion or inhalation of paraquat. Systemic toxicity has not been reported from smoking of paraquat-contaminated marijuana but heavy abusers of contaminated marijuana may experience coughing, hemoptysis and mouth irritation. Following ingestion of 30 mg/kg or 50 ml of a 21% (w/w) solution of paraquat (as the base), hepatic, cardiac or renal failure or death may occur. Smaller doses (greater than or equal to 4 mg/kg of paraquat base) may cause respiratory distress, renal dysfunction or, occasionally, jaundice or adrenal cortical necrosis. When paraquat ingestion is suspected, the drug should be removed immediately from the gastrointestinal tract by gastric lavage or by whole-gut irrigation. Adsorbents such as Fuller's earth, bentonite or activated charcoal may be used during gastric lavage. Combined use of forced diuresis (with furosemide, mannitol and i.v. dextrose in water or normal saline), hemodialysis or hemoperfusion is recommended until the compound cannot be detected in body fluids or the dialysate. Immediate and effective treatment is necessary to prevent systemic toxicity or death from paraquat intoxication.


Acute promyelocytic leukemia. A review of literature.

Acute promyelocytic leukemia is a form of acute myeloblastic leukemia characterized by hemorrhagic episodes, severe thrombocytopenia and infiltration of the marrow with "hypergranular" promyelocytes, often with multiple Auer bodies. Ultrastructurally. the promyelocytes show many splinter granules and Auer bodies with characteristic hexagonal arrangement of tubules with a periodicity of 250 A. Serum vitamin B12 and B12-binding proteins, in particular, transcobalamin I, are abnormally high. Karyotypic abnormalities include pseudodiploidy and partial deletion of the long arm of chromosome 17. Coagulation profile during bleeding episodes is usually consistent with disseminated intravascular coagulation. Greatly improved prognosis in recent years as a result of aggressive chemotherapy and anticoagulation emphasizes the need of early recognition of this clinical entity.


Evidence for a prostaglandin-independent defect in chloride reabsorption in the loop of Henle as a proximal cause of Bartter's syncrome.

Maximal free-water clearance was measured in five patients with Bartter's syndrome and in five patients with the hypokalemic alkalosis of persistent psychogenic vomiting. Hypokalemic alkalosis, hyperreninemia, hyperaldosteronism and excessive renal production of prostaglandin E2 were present in the patients with both disorders. Maximal free water clearance was abnormally low, in association with a high clearance of chloride, in all the patients with Bartter's syndrome; it was normal in all the patients with psychogenic vomiting. In the patients with Bartter's syndrome, apparent distal delivery of proximal tubular fluid was inversely related to glomerular filtration rate and was excessive only in those patients with a low glomerular filtration rate. Patients with psychogenic vomiting showed mean distal fractional chloride reabsorption of 0.92 +/- 0.04 (standard error [SE]). In the patients with Bartter's syndrome, distal fractional reabsorption of chloride was 0.49 +/- 0.08 and was the same (0.46  +/- 0.06) during inhibition of prostaglandin synthesis with indomethacin therapy. Thus, a prostaglandin-independent defect in chloride reabsorption in the loop of Henle is the most proximal cause for the abnormalities in Bartter's syndrome thus far identified.


Natural history of asymptomatic coronary arteriographic lesions in diabetic patients with end-stage renal disease.

Arteriosclerotic heart disease is a major cause of death in insulin-requiring juvenile diabetic patients treated for end-stage renal disease. Eleven consecutive diabetic patients without clinical evidence of coronary artery disease underwent complete cardiac evaluations, including coronary arteriography, as part of transplant recipient work-ups. Seven were women and four were men; their mean age was 32 (21 to 50 years). Angiographically, every patient had multifocal atherosclerotic coronary disease. Four of seven patients tested had positive-stress electrocardiograms. In this group of patients followed for a mean of 19.8 months, eight died. Of these deaths, six were due to coronary heart disease and another due to a stroke. In two patients who became clinically symptomatic, serial angiograms revealed progressive disease of the coronary circulation; in one case, despite normal renal allograft function and serum lipid levels. The mode of end-stage renal disease treatment, serum lipids or blood pressure control could not be linked to mortality. It is concluded that arteriosclerotic heart disease is common in diabetic patients with end-stage renal disease even when angina is absent. The natural history in this high risk population is an important consideration in the selection of patients for end-stage renal disease treatment.


Drug prescribing during pregnancy. A controlled study of Tennessee Medicaid recipients.

The effect of pregnancy on prescribing was assessed in a population of pregnant Medicaid recipients and two matched groups of control women. Of the 2,528 gravidas, 62 per cent received systemic legend drugs (excluding dietary supplements) during their pregnancies. White women and women 30 years of age and older were most likely to receive these medications. Systemic anti-infectives were the most frequently prescribed category of drugs (excluding dietary supplements). One fourth of the women received a narcotic-containing drug and 13 percent of the women received psychotropic drugs, most frequently diazepam. Barbiturates and narcotic-containing drugs were often "hidden" a fixed combination medication. In general, prescribing did not decrease as a result of pregnancy. This study and other studies reviewed here emphasize the need for comprehensive drug-use guidelines for physicians who care for pregnant women.


Vulvovaginal candidiasis treated with clotrimazole cream in seven days compared with fourteen-day treatment with miconazole cream.

Clotrimazole 1 per cent vaginal cream administered daily over a seven-day period was compared with miconazole nitrate 2 per cent vaginal cream administered daily over a 14 day period for the treatment of vulvovaginal candidiasis in a double-blind study of 65 women with clinical symptoms of this condition,, for whom treatment was randomly allocated. When efficacy of treatment was evaluated in 44 of these patients, a success rate, based on both clinical and mycologic criteria, of 75 per cent was found in the 20 patients treated with clotrimazole for seven days as compared with a 63 per cent success rate in the 24 patients treated with miconazole for 14 days. Of the 65 women enrolled in the study, two of the miconazole-treated patients experienced burning sensations, whereas the clotrimazole-treated patients experienced no adverse reactions. Thus, in this group of patients clotrimazole 1 per cent vaginal cream was shown to have a slightly, but not significantly, better efficacy than the miconazole nitrate 2 per cent vaginal cream, with no adverse reactions and in half the treatment time.


A comparison of the effects of timolol and epinephrine on intraocular pressure.

We conducted a double-masked, six-week crossover study comparing bilateral twice-a-day therapy with timolol maleate (0.1%, 0.25%, and 0.5%) and epinephrine hydrochloride (0.5%, 1.0%, 2.0%) in 36 otherwise untreated patients. Increasing concentrations of each drug were administered until an arbitrary level of control was achieved before each of the six-week follow-up periods. Seventeen patients were controlled by both drugs and four patients were controlled by neither drug. Timolol, but not epinephrine, was effective in ten patients, whereas epinephrine, but not timolol, was effective in two patients. Three patients did not complete the study. The mean decrease in intraocular pressure from baseline was significantly greater with timolol than with epinephrine both before crossover and overall at both the lowest and highest concentrations of drug used. Significantly toxicity was produced in four patients during treatment with epinephrine, but in no patients during treatment with timolol.


The incidence of HLA antigens in black primary open-angle glaucoma patients.

We compared the HLA antigen frequencies in black primary open-angle glaucoma patients to those in black non-glaucomatous patients; normal, nondiseased black persons; and nondiseased North American blacks. We found no statistically significant alteration in HLA antigen frequencies in black open-angle glaucoma patients as compared to a control population.


Prognostic factors of intraocular pressure after aphakic keratoplasty.

In 68 consecutive patients who had undergone aphakic keratoplasty and keratoplasty combined with cataract extraction, patients with pressure problems during the first postoperative week were likely to have chronic pressure problems whether glaucoma was suspected preoperatively or not. Furthermore, those with preoperative glaucoma, even though pressures during the first week were relatively normal, were likely to have reoccurrence of their glaucoma. The preoperative pressures did not indicate which patients would develop persistently increased postoperative pressures. The only patients spared pressure problems were those who had no evidence of glaucoma preoperatively and who also had normal intraocular pressure during the first postoperative week.


Stapling technic for esophagogastrostomy after esophagogastric resection.

A technic of esophagogastrostomy is described for constructing an end-to-side, back-to-front anastomosis using stapling devices. Twelve consecutive cases are reported with no deaths and no anastomotic leaks.


Immediate reconstruction of oral cavity and oropharyngeal defects using microvascular free flaps.

Eighteen patients underwent immediate reconstruction of defects involving the oral cavity and oropharynx with free groin and dorsalis pedis flaps. One partial and four complete failures occurred. In the successfully reconstructed patients, the functional results were equal to conventional flaps while the cosmetic improvements were dramatic.


A randomized trial of preoperative radiotherapy in cancer of the oropharynx and hypopharynx.

One hundred patients with stage II and stage III cancer of the oropharynx and hypopharynx were treated under a protocol in which they were randomly selected for treatment by surgery alone or by combined preoperative radiotherapy and surgery. The schedule of preoperative radiation therapy chosen was 2,000 rads from a cobalt 60 machine delivered in five days. Eighty-six of the patients were evaluable at three years; there was no difference in the outcome of the treatment of the two groups. A similar study is urgently needed to determine the value of postoperative radiotherapy in the management of similar cancers.


Platysma myocutaneous flap for intraoral reconstruction.

Fourteen patients were treated for intraoral epidermoid carcinoma with a single stage reconstructive technic employing a myocutaneous flap based upon the platysma muscle. This flap carries on its distal tip a portion of isolated cervical skin to be used for intraoral replacement of the resected tissue. The flap has proved to be highly reliable and has significant benefits over many other technics commonly employed for head and neck reconstruction.


The development of cholecystography: the first fifty years.

Visualization of the gallbladder by x-ray was first achieved in 1923 by the intravenous introduction into the body of a halogenated compound which was excreted by the liver into the bile ducts and gallbladder [1--4]. This was the first time that visualization of an organ had been accomplished by introducing a substance into the body and obtaining a roentgenogram after the substance had been metabolized and localized primarily in one organ. Previously, visualization of an organ had been achieved only by introducing a substance opaque to the x-ray directly into the lumen and obtaining a roentgenogram to outline its inner wall. By 1925 visualization of the gallbladder had also been accomplished by the oral administration of halogenated compounds [5,6]. The drugs employed for intravenous and oral cholecystography had been synthesized specifically for that purpose based on earlier experimental work of other investigators. The following account describes in detail the experimental background of cholecystography, its origin, and its development and use during the ensuing fifty years.


Administration of beta-aminopropionitrile to human beings with urethral strictures: A prelimary report.

(1) No toxic signs or symptoms and no unusual laboratory determinations were observed in five patients with posterior urethral strictures treated by dilatation of the urethra and administration of 1 gm per day of beta-aminopropionitrile (BAPN) for twenty-one days. (2) Patients treated with 1 gm daily of BAPN for twenty-one days showed an increase in cold saline-extractable and acid-extractable collagen in proplast sponge-collected and dermal scar tissue comparable with that reported previously after doses of 3 to 5 gm of BAPN daily. (3) Significant reduction in the breaking strength of newly synthesized connective tissue was observed in patients treated with BAPN. (4) None of the patients in this study showed abnormalities in net collagen synthesis or in synthesis of noncollagenous protein. (5) The difference in the results of this study and two previous trials of BAPN in human beings which were discontinued because of toxic and or hypersensitivity signs and symptoms is hypothesized to be the result of development of highly purified BAPN fumarate.


Rehabilitation profile of kidney transplant patients.

The rehabilitation of 132 patients with functioning grafts six months to ten years post transplantation was examined by review of self-report questionnaires. The patients were divided into three groups according to when they underwent transplantation. Results showed 62 per cent of patients in group A (transplant received between July 1, 1973 and December 31, 1973), 69 per cent in group B (transplant received between January 1, 1971 and June 30, 1973), and 90 per cent in group C (transplant received between January 1, 1964 and December 31, 1970) were productively active in July 1974. Nearly all attained productively active rehabilitation scores by twelve months, but one-third reported they were functioning at a lower level than before their illness, and a significant number of patients with physically strenuous jobs before illness acquired sedentary jobs post transplantation.


"Paratransplant" hernia. Three patients with a new variant of internal hernia.

Three cases of bowel obstruction due to internal hernia caused by entrapment of bowel or omentum through a defect in the peritoneum covering the transplanted kidney are described. All three patients survived due to early surgical intervention and reduction of the hernia and/or resection of necrotic bowel or omentum. In view of the high mortality of peritonitis in transplant patients, early surgical treatment is indicated in all cases of intestinal obstruction to avoid the sequelae of bowel infarction. This "paratransplant" hernia represents the newest type of internal hernia described.


Outpatient excision and primary closure of pilonidal cysts and sinuses.

A procedure for outpatient excision and closure of pilonidal cysts and sinuses under local anesthesia is described. The operation is designed to reduce hospital expenses and loss of work time. It utilizes the low tissue friction properties of polypropylene sutures to effect full dead space obliteration and a home care regimen to minimize the incisional tension produced by sitting. Of thirty-two procedures performed, follow-up data were available for twenty-eight, with a mean postoperative time of twenty-four months. Full primary healing was obtained in all cases with a single early wound disruption. There have been no late recurrences.


The hepatoprotective effect of oxygen during halothane anesthesia.

The effects of halothane anesthesia on liver function, as reflected by postanesthetic changes in serum glutamic pyruvic transaminase (SGPT) levels, were evaluated in 2 groups of 40 patients. All patients had 2 halothane anesthetics. In 1 group, both anesthetics were administered at 1 atmosphere pressure with 30% O2 in the inspired air. In the 2nd group, both anesthetics were administered at 2 to 3 atmospheres (absolute) of pressure with 97 to 98% O2 in the inspired air. While the SGPT levels remained within the normal range in all cases, there was a significant rise in SGPT levels in patients undergoing surgery under 1 atmospheric pressure. Patients undergoing surgery at 2 to 3 atmospheres pressure (absolute) had SGPT levels which remained at low normal values. The difference in response of SGPT in the 2 groups was statistically significant. We conclude that increased O2 tensions alter the normal response of SGPT to halothane anesthesia and that increased O2 tensions appear to protect the liver from possible adverse responses to halothane or its metabolites.


Bacterial studies of leg ulcers.

--Bacteriologic studies of 30 chronic leg ulcers were studied in 18 adult patients before and after treatment with a local cleansing agent, Debrisan.--Results show that all ulcers, whether clinically inflamed or not, are secondarily infected.--The majority of ulcers grew more than 1 type of organism, up to 6 different types in 1 single ulcer.--The use of Debrisan reduces the types of organisms and colony counts in ulcers, allowing healthy granulation and epithelialization to proceed normally.--Control of infection reduces surrounding local edema and erythema.--By reducing types of organisms and colony counts in chronic leg ulcers successful skin grafting was readily achieved.


The therapy of peripheral vascular ulcers--surgical management.

Venous ulcers are a common malady of the civilized world. The etiology and its pathogenesis has been presented for a better understanding of its appropriate therapy. A conservative and surgical approach is necessary for effective treatment, of which the final goal is to reduce ambulatory venous hypertension and the prevention of venous ulcer formation. An effective regime of elastic support, periodic leg elevation and surgery for incompetent perforators is highly rewarding. The good results in the use of dextranomer for highly exudative ulcers have also been presented as another adjunct in the local care of venous ulcers.


Noninvasive assessment of arteriovenous fistula.

Noninvasive diagnostic techniques permit objective assessment of the presence, location, and hemodynamic alterations associated with congenital or acquired arteriovenous fistulas. Doppler ultrasound may be used to assess abnormal velocity signals and directional blood flow in afferent and efferent limbs of the fistula, as well as abnormal pressure gradients in the involved extremity. Plethysmography permits graphic qualitative assessment of pulse wave form alterations before and after compression of the fistula. In addition, venous occlusion plethysmography permits quantitation of limb or digit blood flow before and after fistula. In addition, venous occlusion plethysmography permits quantitation of limb or digit blood flow before and after fistula compression. Illustrative cases of congenital and acquired arteriovenous fistulas demonstrate the utility of these noninvasive techniques in the objective assessment of patients.


The relationship between frequency of ventilator circuit changes and infectious hazard.

The relationship between frequency of ventilator circuit changes and risk of ventilator-associated pneumonia was studied using 2 independent approaches. The first was an in-use aerosol contamination study with patients on 8-hour, 16-hour, or 24-hour ventilator changing schedules. The second approach was a study comparing the incidence of pneumonia in patients on ventilators for 2 one-year periods when the ventilator circuit changing time differed. In-use aerosol sampling of 513 ventilator treatment periods showed bacterial contamination greater than 100 organisms per aerosol in 1.8 per cent of 8-hour cycles, in 2.5 per cent of 16-hour cycles, and in 5.4 per cent of 24-hour cycles. These differences were not significant. The incidence of ventilator-associated pneumonia was the same for one-year periods when ventilator circuits were changed either every 8 or every 24 hours. It was concluded that changing ventilator circuits every 24 hours provides adequate protection from ventilator-associated pneumonia.


Clinical evaluation of 1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamide (ribavirin) in a double-blind study during an outbreak of influenza.

1-beta-D-Ribofuranosyl-1,2,4-triazole-3-carboxamide (ribavirin) at a dosage of 300 mg/day, or disguised placebo was administered to patients in a closed population during an epidemic outbreak of influenza in Mexico City. Treatment consisted of capsules given three times daily for 5 days beginning with first signs of disease. The study was conducted in a double-blind fashion. Clinical manifestations of the disease, as well as in titer of recoverable virus and in specific serum antibody titer were significantly reduced in the ribavirin-treated group. None of the individuals in the study had any sign of toxic effects attributable to the drug. In the study, 21 patients received the drug and 24 received placebo.


The effect of 1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamide on acute viral hepatitis.

We studied the effect of 1-beta-ribofuranosyl-1,2,4-traizole-3-carboxamide (ribavirin) on 66 patients with acute viral hepatitis, by a double-blind study. Thirty-three of these patients received the active drug and the other 33 received a placebo. The effect of ribavirin was evaluated by the clinical picture and by the changes in both direct and total serum bilirubin and in the activity of serum glutamic-pyruvic and glutamic-oxaloacetic transaminases. There was a significant decrease in serum bilirubin, SGOT, and SGPT from the 5th to 10th day of treatment in the ribavirin group. In the placebo group such a decrease was observed but was not statistically significant.


Clinical experiences using the antiviral 1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamide (ribavirin) in Mexico.

Follow-up of the use of ribavirin in 390 human patients in Mexico indicates the drug has been used to treat a variety of virus infections. No toxic manifestations of the drug were reported, and the subjective results suggest possible antiviral efficacy. A double-blind, placebo-controlled study using topically applied 5% ribavirin in ointment base against herpes zoster in cancer patients indicates definite efficacy against this specific disease.


Effects of microbial activity on aquatic pollutants.

Bacteria and fungi present in estuarine and marine water and sediment accomplish significant degradation of crude oil, refined oils, polychlorinated biphenyls, and organomercurials, with the rate and extent of degradation varying with species, geographic source, temperature, and other biologic and environmental parameters. Our biodegradation studies have been extended to determine if physical weathering and/or microbial degradation of oil by microorganisms present in Chesapeake Bay water and sediment produces potentially carcinogenic substances. Water and sediment from an area in Chesapeake Bay that receives heavy input of oil and from a relatively nonpolluted site have been assayed for mutagenic ability by use of the Ames method, which is a bacterial assay and is highly sensitive. Preliminary findings indicate the presence of mutagenic substances in samples collected from the polluted site. Extracts of oil subjected to microbial degradation under controlled laboratory conditions did not yield detectable mutagenic activity. In situ studies are in progress.


Occurrence and fate of organic and inorganic contaminants in marine animals.

Most chemical contaminants occur in highest concentrations in coastal waters, often maximized in very localized areas. In general, this situation represents the exposure pattern for marine animals. However, the availability of contaminant to an organism depends not only on its concentration but also on its chemical nature, its physical state, and whether the source of exposure is the surrounding seawater or the diet. Depending on the type of exposure, uptake occurs across absorptive surfaces, such as those of the respiratory apparatus or gastrointestinal tract, where selectivity may occur, even among neighboring homologs. Deposition in tissues, accumulation, degradation, or depuration depends on tissue type, metabolic processes, detoxification mechanisms, and the adaptive status of a particular animal. This hypothesis is examined briefly for hydrocarbons, pesticides, other miscellaneous organic contaminants, heavy metals, and radionuclides. It is concluded that most data relate to occurrence and distribution. Considerably less information is available on the underlying biochemical processes.


Evaluation of drug treatment in mild hypertension: VA-NHLBI feasibility trial. Plan and preliminary results of a two-year feasibility trial for a multicenter intervention study to evaluate the benefits versus the disadvantages of treating mild hypertension. Prepared for the Veterans Administration-National Heart, Lung, and Blood Institute Study Group for Evaluating Treatment in Mild Hypertension.

A feasibility trial to investigate the practicality of determining the advantages and disadvantages of prompt pharmacologic treatment for mild hypertension was jointly funded by the Veterans Administration and the National Heart, Lung and Blood Institute. Its clinical phase has been completed, and it demonstrated 1. that the required relatively young asymptomatic population could be enrolled in the study and 2. that it could be persuaded to adhere to the protocol for 2 years; however, it was evident that intensive efforts would be required in both areas. The feasibility trial screened almost 120,000 potential subjects over a period of 16 months to randomize about 1,000 subjects at four clinical centers. These men and women were 21 to 50 years old, had diastolic pressures from 85 to 105 mm Hg as outpatients, and had no evidence of cardiovascular renal abnormalities. They were randomized in double-blind fashion into active drug therapy and placebo groups. Stepped care therapy involved 50 mg chlorthalidone (Step 1), 100 mg chlorthalidone (Step 2) and 100 chlorthalidone plus 0.25 mg reserpine (Step 3). Death, myocardial infarction, stroke, angina pectoris, and congestive heart failure were the "major" morbid events that were looked for; also recorded were "minor" morbid events consisting primarily of electrocardiographic arrhythmias. The development of significant hypertension was considered a treatment failure. Side effects were carefully tabulated in both active drug and placebo groups. The study revealed an average drop in diastolic pressure of almost 12 mm Hg for active drug group and less than half of that for the placebo group; once established 6 months after randomization, the new pressure levels persisted almost without change throughout the study. Although the feasibility trial was not designed to answer the primary question regarding the benefits of treatment, the events were tabulated for each group. A total of 12 placebo-treated subjects developed significant hypertension and were put on active drug. There was not a significant difference between the two groups in the incidence of "major" morbid events; a total of eight active and five placebo patients developed myocardial infarction or died suddenly. There, however, was an excess of arrhythmias among the active drug subjects (17 in the active group versus 8 in the placebo group on the basis of preliminary data). Finally, there were twice as many side effects and 20 times as many chemical abnormalities among the active as among the placebo subjects. A protocol for a full scale study of the benefits of pharmacologic therapy in mild hypertensives has been prepared and is ready for implementation as needed; it involves relatively minor modifications of the protocol tested in the feasibility trial.


Complications of mild hypertension.

The complications of mild hypertension especially involve progression to moderate or severe hypertension, coronary events, strokes, and congestive heart failure. Less often, other complications such as rupture of a dissecting aneurysm, retinal hemorrhages, hypertensive encephalopathy, and renal failure may occur. Total mortality clearly rises with progressive increases in systolic or diastolic blood pressures even in ranges previously considered acceptable. It should not however be overlooked that some complications may be iatrogenic.


Nutritional improvement of food proteins by enzymatic modification, especially by plastein synthesis reaction.

The present paper reviews our recents studies on the plastein reaction applied to improve nutritional quality of conventional and unconventional proteins, with special emphasis on the papaincatalyzed incorporation of essential amino acids (used in ethyl ester form) into the proteins : L-methionine into soybean protein, L-lysine into wheat gluten and L-tyrosine into fish protein (after removal of phenylalanine). The paper deals also with an attempt to improve proteins extracted from the photosynthetic microorganisms, Spirulina maxima (a blue-green alga), Rhodopseudomonas capsulatus (a non-sulfur purple bacterium) and Trifolium repens L. (a type of white clover) by way of incorporating simultaneously the three amino acids, L-methionine, L-lysine and L-tryptophan. This process, when properly carried out, can produce plasteins whose essential amino acid patterns have approximated the FAO/WHO suggested pattern (1973). Besides the plastein reaction, its novel modification has been developed, which will be more conveniently applied to a larger-scale process for the amino acid incorporation. A brief discussion is added in this regard.


[Ultra-flash sterilization of fluid food by friction].

The ATAD process without heat exchange nor steam mixing allows the sterilization in a very short time. With milk, the sterility has been attained regularly at 140 degrees C/0,54 seconds. Only small changes occurred in nitrogen distribution. An homogeneizing effect upon fat emulsion is noticeable. The amino-acid composition of isoelectric fraction is not that of casein owing to the coprecipitation of a part of whey protein at pH 4,6, but they do not reveal any degradation. The enzymatic digestion of proteins (pepsin + Pancreatin) is a little improved by this treatment; the availability of lysine, measured by dinitrophenylation or guanidination, is hardly modified. All the blocked forms of lysine (Maillard reaction, lysino-alanine reaction, peptidoïd boundings) occurs only under more drastic conditions. The beta-lactoglobulin-kappa-casein complex formation slightly hampers the enzymatic clotting of sterilized milk. The forms of calcium are not seriously disturbed and such a milk is suitable for cheesemaking; we can obtain cheese with very few non-lactic bacteria.


[Oral treatment of great ichthyotic disorders by ethylester retinoid (author's transl)].

Observations of 3 different great ichthyotic disorders, no longer responding to local keratolytics and to oral vitamin A are reported: a case of erythrokeratoderma variabilis, one of ichthyosiform erythroderma, and one of bullous ichthyosiform hyperkeratosis. After a week of oral treatment by the ethylester retinoid (Ro 10-9359), the hyperkeratotic component of each disease already improved dramatically. A maintenance treatment had to be continued. With equal or superior keratolytic effects, the retinoid has lower toxicity and less important side-effects than retinoic acid itself. The ethylester retinoid is nowadays the choice oral treatment in these great hyperkeratotic disorders.


[Herpes gestationis. Ultrastructural and immunologic data, about two cases (author's transl)].

Herpes gestationis, a rare vesiculobullous dermatitis of pregnancy and the postpartal period, can be more easily identified today thanks to recent immunologic and ultrastructural researches. Comparing two new case reports with the data provided by the literature, underlines the individuality of the disease, in spite of the analogies it shows with bullous pemphigoid. Clinically, the illness only appears during pregnancy or the postpartal period and generally responds well to vitamin B6. Histologically the bullae at the dermal-epidermal junction are accompanied by extra- and intra-cellular epidermal edema and vacuolation of the basal cells. Ultrastructural examination shows that the initial alteration affects the plasmatic membrane of the basal cells. The immunologic mechanism of the disease is specific as the usual indirect in vitro immunofluorescent methods cannot reveal factor B.


[Effectiveness of antibiotics in bovine staphylococcal and streptococcal mastitis].

The present knowledge of the efficiency of antibiotics against bovine mastitis has been reviewed. Criteria for the choice of papers are given, together with tabulated results of treatments with one antibiotic or two. Results are discussed in relation to the time of treatment and the pathogenic agent involved, and a classification of the antibiotics into three groups is proposed: recommended; not advised; not sufficiently studied.


A comparison of carticaine and lidocaine in spinal anaesthesia.

The effects of Lidocaine and the new local anaesthetic carticaine in spinal anaesthesia were compared in a double blind study in 120 elderly male patients scheduled for small urological procedures. The variables investigated were: analgesia examined by pin prick method, loss of tactile sensation, motor block, and skin temperature on the big toe. Both local anaesthetics seem to act similarly, but the loss of tactile sensation and motor block began somewhat earlier with carticaine. The differences have hardly any clinical significance. The incidence of hypotension and postanaesthetic headache was similar in each group.


Coronary bypass surgery. An overview.

During the ten year history of coronary bypass surgery the initially unacceptable high operative mortality has dropped to 1--2%. Of the twin targets of the procedure, alleviation of disabling angina and improvement in the prognosis, the former seems to have been achieved and is universally accepted. Several series with repeated exercise tests show that about 70% of the patients gain definite benefit; a high proportion of these patients become entirely asymptomatic. Reestablishment of effective coronary perfusion via the grafts seems to be the key factor in this response. However, several other factors, such as perioperative infarction, psychogenic effects, cardiac denervation, and changes in left ventricular function, are also involved. There is still disagreement about the effect of bypass surgery on life expectancy. It is not, in fact, known with certainty whether prognosis is improved, although coronary bypass surgery does not appear to be inferior to medical management in terms of prolonging life span. It has also been established that there is an improvement in prognosis after bypass surgery for patients with obstruction of the left main coronary artery, while the fairy favourable prognosis of patients with single vessel disease can hardly be improved. Available data from randomized series consisting of the whole range of patients with coronary heart disease are either quantitatively or qualitatively insufficient by present standards. Accordingly, new data will eventually afford the evidence needed for drawing firm conclusions about the final value of coronary bypass surgery in improving the prognosis of coronary heart disease.


Ultrastructural analysis of renal arteriolopathies in glomerular and tubulointerstitial diseases.

This communication describes the electron microscopy (EM) study of the small arterial vessels in renal biopsies from 32 patients with a variety of glomerular and tubulointerstitial diseases. With the possible exception of lipoid nephrosis, all types of glomerular and tubulointerstitial diseases were associated with abnormal arterial vessels. The vascular abnormalities included variable thickening and irregularity of the basement membranes (sclerosis), excessive elastic tissue and collagen fibers, atrophic or necrotic smooth muscle cells, and electron-dense deposits. The EM of glomeruli and tubules from the same biopsy specimens often revealed similar features, i.e., sclerosis, necrotic changes and electron-dense deposits. The pathogenesis of the arteriolopathies, like that in many glomerular and tubulointerstitial diseases, remains unclear. Hypertension was considered a factor, but only 15 percent of the patients were hypertensive. Furthermore, vascular lesions in patients with hypertension were no worse than those without it. Whatever may be the pathogenesis of these arteriolopathies, the similarities between the renal arteriolar and glomerular abnormalities and between arteriolar and tubular lesions suggest a common mechanism of inducement of the lesions.


[Lysis of the cellular walls of Streptococcus group A by enzymes produced by actinomycetes].

More than 80 cultures of actinomycetes belonging to different taxanomic groups were studied with a purpose of screening actinomycetes actively producing enzymes lyzing the cell walls of group A streptococci. 31 strains of the actinomycetes producing enzymes which lyzed the cell walls by 20-50 and 60-80 per cent within 1 and 4 hours respectively were selected. The proteolytic activity of the enzymes produced by these strains was also studied. It was shown that 4 cultures, i.e. Actinomyces albus, strains 6 and 9, Actinomyces levoris, strain 29 and Actinomyces gibsonii, strain 42 were of interest as organisms producing enzymes which lyzed the streptococcal cell wall without impairing its antigenic components.


[In vitro diagnosis of penicillin and streptomycin allergy. The specific leukocyte alteration reaction using luminescence microscopy].

The method of fluorescent microscopy was used for studying the diagnostic value of the reaction of the leucocyte specific alteration (LSA) in patients with different syndromes of hypersensitivity, allergy in the anamnesis and without hypersensitivity to penicillin and streptomycin. It was found that only markedly positive results of the LSA reaction (independent of the sensibilization type) were of diagnostic value, the results of the reaction being stated in half of the patient with hypersensitivity in the anamnesis and in 3/5 of the patients with allergy. Simultaneous use of other tube immunological or skin tests was recommended for the other patients with lower levels of the positive results of the LSA reaction with a purpose of etiological diagnostics or revealing latent sensibilization before treatment with the antibiotics. The LSA reaction is recommended for practical use in complex with other methods of allergological examination.


Nonvalue of neomycin instillation after intermittent urinary catheterization.

This study evaluated weekly urine cultures of patients with neurogenic bladder disease who underwent intermittent urinary catheterization for bladder retraining. One group of 53 patients in 1974 received regular instillations of 0.1% neomycin after each catheterization. A similar group of 55 patients in 1975 did not receive neomycin and constituted a control group. Distribution of age, sex, diagnosis, and duration of bladder retraining was comparable in both groups. Quantitative bacterial colony counts of 10(4) to 10(5) or greater per ml of urine were considered significant. There was no difference in the incidence of bacteriuria between the neomycin-treated group and the control group (53 versus 49%, respectively), and most patients in each group had colony counts >10(5)/ml. Escherichia coli was seen less frequently in neomycin-treated patients (43.4 versus 62.5%), but a greater percentage of infections due to Pseudomonas aeruginosa, group D streptococci, and yeasts was noted in the neomycin-treated group than in the control group (41.5 versus 22.5%).


Effects of radiopharmaceuticals on radioenzymatic assays of aminoglycoside antibiotics: interference by gallium-67 and its elimination.

Radionuclides currently used in clinical medicine were evaluated for their possible interference with radioenzymatic assays of aminoglycoside antibiotics. Of the radiopharmaceuticals tested, only (67)Ga citrate interfered with the radioenzymatic assay of gentamicin. Radioenzymatic assay of serum samples obtained from patients receiving (67)Ga yielded gentamicin concentrations falsely elevated by more than 1 mug/ml for approximately 1 week after (67)Ga administration. A procedure was developed to eliminate (67)Ga interference with radioenzymatic assays of aminoglycoside antibiotics. After (67)Ga citrate was spotted onto phosphocellulose filter disks, the filters were immersed in 7.2 N HCl, and radioactivity was removed by successive extractions of the acid phase with diisopropyl ether. After three extractions, less than 0.1% of the original radioactivity remained. Similar extraction of disks containing (14)C-adenylylated gentamicin or tobramycin or (14)C-acetylated amikacin had no effect on (14)C radioactivity. The concentrations of aminoglycosides in serum standards supplemented with (67)Ga citrate were determined accurately by radioenzymatic assays followed by extraction with diisopropyl ether. Concentrations of gentamicin in six serum samples from patients injected with (67)Ga during gentamicin therapy, as determined by radioenzymatic assay and extraction, were within 9% of the results obtained by reassay of the same samples after the decay of (67)Ga.


Purification and the ultrastructure of a bacteriocin produced from Shigella sonnei strain 100052.

A bacteriocin produced by strain 100052 of Shigella sonnei (shigellacin 52) was purified about 80-fold from a mitomycin C-induced culture supernatant. The purified preparation gave a single band on sodium dodecyl sulfate-gel electrophoresis with an approximate molecular weight of 10,000. The negatively stained electron micrograph of the purified bacteriocin preparation revealed the existence of three different particles. They were a small cylindrical tube (4.2 by 6.0 nm), a ring-shaped particle and a filamentous structure. The molecular weight calculated from the shape of the small tube was approximately 50,000. The latter two particles appeared to be constructed from subunits which were morphologically similar to the cylindrical tube. These results suggested that the morphological subunit of shigellacin 52 consisted of five chemical subunits with molecular weights of 10,000 each, and it assembled into two types of polymers, a ring-shaped particle and a filamentous structure, which seemed to be the main components of the purified shigellacin 52 preparation.


Flow microfluorometry study of diauxic batch growth of Saccharomyces cerevisiae.

Flow microfluorometry reveals complex changes in types and relative numbers of different Saccharomyces cerevisiae cell forms during glucose-limited diauxic batch growth.


Disappearance of patulin during alcoholic fermentation of apple juice.

Eight yeast strains were used in three typical American processes to ferment apple juice containing 15 mg of added patulin per liter. Patulin was reduced to less than the minimum detectable level of 50 microgram/liter in all but two cases; in all cases, the level of patulin was reduced by over 99% during alcoholic fermentation. In unfermented samples of apple juice, the concentration of added patulin declined by only 10% when the juice was held for 2 weeks, a period equivalent to the time required for fermentation.


Toxicological model for a two-acid system.

Lactic and acetic acids were determined to be slightly synergistic in their inhibitory interrelationship against Salmonella typhimurium with the use of a modified toxicological model.


Technique and technical problems associated with implantation of neuroaugmentive devices.

The effectiveness of implantation of depth electrodes for pain control in (a) the primary thalamic relay nuclei, and (b) the periventricular gray matter or periaqueductal gray matter is reviewed. In a series of 39 patients, 14 achieved relief with no further need for medication, 16 were able to reduce their drug intake and 9 experienced no relief. These results are compared to those for a series of 76 patients reported on by an international study group of neurological surgeons. 61 patients in this series were considered to have had a successful result immediately after implantation of the electrode, but at the time of follow-up only 42 were still in this category. The implantation of depth electrodes requires a technique that fulfills the following criteria: (1) the procedure must be performed in a fully awake, cooperative patient; (2) a precise stereotactic technique must be employed, and (3) the effects of stimulation must be evaluated before the implant is made permanent. The most common complication was infection at the implantation site; this can be reduced by the use of Teflon-insulated percutaneous leads. Other complications include erosion of the hardware through the scalp and internal migration of the electrodes.


Prophylactic diazepam or phenobarbitone in febrile convulsions: a prospective, controlled study.

After their first episode of febrile convulsions, 195 previously healthy children, aged 6--30 months, were given either diazepam or phenobarbitone for a year. Each child was assigned at random to one of the two medications: children admitted on even days were given a suppository containing 5 mg diazepam every 8 hours when the rectal temperature was greater than or equal to 38.5 degree C. Children admitted on odd days were given treatment with phenobarbitone, 3.5 +/- 1 mg/kg per day. 156 children completed treatment and outpatient control for a year, 83 in the diazepam and 73 in the phenobarbitone group. The rate of recurrence was independent of the prophylactic and 15--16 % of the children in both groups had new febrile convulsions within a year. The recurrence rate after 6 months was also similar, 11% in the diazepam group and 9%  in the phenobarbitone group. New convulsions were of similar duration and severity in both groups. In both groups 6% of all febrile episodes led to new convulsions. Long-term treatment with phenobarbitone thus offered no advantage over intermittent diazepam.


[Tumors of the soft parts of the radix of the thigh].

A case of complex structured mesenchymal neoplasia of the root of the thigh is reported. After a review of the literature and discussion of the anatomo-clinical aspects of the case in point, a common identity between tumours of the root of the thigh and mesenchymal tumours of the retroperitoneum is suggested, on the basis of anatomo-histogenetics.


Treatment of end-stage renal failure in a defined geographic area.

The treatment of end-stage renal failure was studied in southern Connecticut from 1967 to 1975 by (1) calculating survival rates for center and home dialysis patients and cadaver and living related donor transplant recipients and (2) assessing the quality of life with structured interviews and psychological tests. While the survival rate for our home dialysis and transplant recipients were similar to previously reported data, mortality for our center dialysis patients was slightly higher than previously reported. Quality-of-life testing, disclosed that dialysis patients had a substantial impairment in all parameters. Transplant recipients achieved a better degree of rehabilitation. Physicians and patients should be aware of the problems that they are likely to face; otherwise, expectations and goals may be raised to unreachable and ultimately frustrating levels.


Detection of urinary fibrin-fibrinogen degradation products in kidney transplantation.

Several techniques are used to detect rejection episodes in renal transplants; complexity renders these tests impractical for clinical use in most cases. This paper reports the results obtained in the study of urinary FDP, by counterimmunoelectrophoresis, in 50 healthy subjects and in 360 consecutive samples from 18 renal transplant recipients; urine specimens were examined daily for periods of time of up to 60 days post transplant. Endogenous creatinine clearance levels were also quantified. Our findings show that while in normal subjects negative tests were always obtained in kidney transplant patients, increased FDP excretion was found, with peak levels observed at least 24 hours before the decrease of glomerular filtration rates and clinical manifestations of acute rejection which subside with immunosuppression. Finally, urinary FDP excretion in the oliguric phase of post transplant acute renal failure was similar to that of patients where kidney transplants functioned without any evidence of rejection.


Hepatic ultrastructure in congenital syphilis.

The ultrastructural changes in the liver in a case of congenital syphilis were studied. Treponema organisms were easily demonstrated in 1-micrometer sections stained by toluidine blue, as well as in electron micrographs. Most organisms were extracellular, but some were identified within hepatocytes.


Leukocytic function in malakoplakia.

Leukocytic functions were studied in a patient with malakoplakia that involved the urinary tract and retroperitoneum in whom recalcitrant infections due to Escherichia coli developed. Polymorphonuclear leukocytic functions and monocytic chemotaxis were normal. Killing of E coli and Staphylococcus aureus by the patient's monocytes was impaired. This defect persisted after the infections were successfully treated and the treatment with antimicrobial agents was discontinued. Stimulated nitro blue tetrazolium reduction by the patient's monocytes was normal, suggesting that the microbicidal defect was not in the oxygen-dependent microbicidal system. Total lysozymal content of patient's monocytes was normal. Thus, the basis for this microbicidal defect is still undefined.


Side-to-end colorectal anastomosis with monofilament stainless steel wire.

Anastomotic separation after anterior resection of the rectum remains a major problem, although the frequency of anastomotic dehiscence after anterior resection varies. Monofilament stainless steel wire suture is an inert suture, has excellent holding power, and is associated with a low probability of wound infection. Side-to-end coloproctostomy for anastomotic reconstruction after anterior resection has proved to be a satisfactory alternative to the usual end-to-end anastomosis. A combination of wire suture with side-to-end coloproctostomy was performed in 60 consecutive anterior resections in which there were two clinical anastomotic leaks and no deaths attributable to anastomotic dehiscence. Simultaneous loop transverse colostomy was performed in 13 cases (22%), and all colostomies were subsequently closed without difficulty. This technique is recommended for reconstruction of bowel continuity after anterior resection of the rectum.


[Urgent problems in the study of pyelonephritis in children].

The literature data and own observations concerning the features of patho- and morphogenesis of pyelonephritis in children are presented. Particular attention is given to the importance of renal tissue and intrarenal blood vessels dysplasia in the genesis and development of pyelonephritis as well as to the pathogenetic role of inflammatory processes in urinary tract wall in obstructive uropathies. The importance of morphological studies in diagnosis, prophylaxis and treatment of pyelonephritis in children is emphasized.


A clinical evaluation of benzydamine hydrochloride.

A double-blind clinical trial of the effects of the use of benzydamine hydrochloride for patients undergoing the surgical removal of impacted lower third molar teeth showed no significant effects on swelling and trismus between control and experimental groups, although a significant reduction in the post-operative consumption of analgesics was noted.


The prevalence of the maxillo-septal syndrome in Anglo-Saxon and Romano-British skulls and foetal specimens.

Seventy-three pre-medieval British skulls were examined and the maxillo-septal syndrome was found in 42. Ten foetal specimens of crown rump length greater than 40 mm were also examined and the syndrome was found in three specimens. Deflection of the nasal septum was present in 56 specimens.


A review of modern impression materials.

A number of new elastic impression materials have been developed over the past few years. The working time, setting time, elasticity at set, permanent deformation, dimensional change on setting and long-term stability were determined for several of these impression materials. The new addition type silicone impression materials proved superior to the other materials tested, but all materials were capable of giving good clinical results.


Burs, teeth and hand instruments.

Scanning electron microscope studies demonstrate deficiencies in the surfaces of cavity preparations made with conventional cutting instruments. Better surface preparation can be achieved by using appropriate shaped tungsten rotary instruments, and by sharp hand instruments used with a scraping action. The direction of rotation of the cutting alters the quality of the enamel margin. The SEM image should not be interpreted as the sole criterion of clinical success.


The influence of design and production on the structural integrity of tensile test specimens and stated values for mechanical properties.

Two sizes of tensile test specimens were produced, the smaller of them by several techniques each incorporating a particular casting variable. All castings were subsequently subjected to radiographic evaluation and mechanical testing. An attempt has been made to relate the application of each variable to the degree of metal integrity produced in the specimens and ultimately to mechanical behaviour.


The temporomandibular joint: some biological considerations.

The physiological mechanisms operating through the temporomandibular joint in the perception of changes in the position of the mandible can determine extremely small discrepancies in the final occlusal position. Some observations on the pathways of neural control and reflexes are discussed and their importance in clinical situations noted.


Control of concanavalin A receptor mobility by cytoplasmic actin in human tumour cells.

Tissue culture monolayers of seven human intracranial tumours comprising 2 astrocytomas, 3 meningiomas, 1 secondary squamous cell carcinoma and 1 secondary adenocarcinoma were examined by a double immunofluorescent staining technique to demonstrate Concanavalin A (Con A) surface receptors and cytoplasmic actin in the same cell. Tumour cells, treated with fluoresceinisothiocyanate-labelled Con A (FITC-Con A) showed staining in cell margins or in a random distribution over the cell surface. Incubating the cells with FITC-Con A at 37 degrees for increasing periods of time resulted first in staining of clusters and later of perinuclear globules. Cells, pretreated with 4% paraformaldehyde at 4 degrees for 10 min or with cytochalasin B at 37 degrees for 30 min showed staining restricted to cell margins. In the cytochalasin B-treated cells, the peripheral staining was in the form of coarse clusters. Double fluorochrome studies showed that the anti-actin antibody (AAA) staining occurred in sites closely related to those stained by FITC-Con A both in untreated as well as in cytochalasin B-treated cells. The findings suggest that Con A receptors, as an example of a stable cell membrane determinant in human tumour cells, are associated with actin and that their mobility on the cell surface is dependent on an intact cytoplasmic actin system.


The scintigraphic diagnosis of splenic cysts.

In four patients, each of whom had a different type of splenic cyst, 99mTc-sulphur colloid images revealed non-specific, intrasplenic "cold" lesions. The rim of splenic tissue surrounding the cyst was incomplete in three out of four patients and caused appearances similar to those of splenic infarction. Repeat spleen imaging with 99mTc-RBC revealed an additional cyst in one out of four patients. 113m indium blood pool images provided preoperative information on lesion vascularity. The scintigraphic diagnosis of splenic cysts should ideally combine 99mTc-sulphur colloid imaging, 99mTc-RBC imaging, and 113m Indium blood pool imaging.


Characterization of pepsin-solubilized bovine heart-valve collagen.

Collagens extracted from heart valves by using limited pepsin digestion were fractionated by differential salt precipitation. Collagen types were identified by sodium dodecyl sulphate/polyacrylamide-gel electrophoresis, amino acid analysis and cleavage with CNBr. Heart-valve collagen was heterogeneous in nature, consisting of a mixture of type-I and type-III collagens. The identity of type-III collagen was established on the basis of (a) insolubility in 1.7 M-NaC1 at neutral pH, (b) behaviour of this collagen fraction on gel electrophoresis under reducing and non-reducing conditions, (c) amino acid analysis showing a hydroxyproline/proline ratio greater than 1, and (d) profile of CNBr peptides on sodium dodecyl sulphate/polyacrylamide-gel electrophoresis showing a peak characteristic for type-III collagen containing peptides alpha1(III)CB8 and alpha1(III)CB3. In addition to types-I and -III collagen, a collagen polypeptide not previously described in heart valves was identified. This polypeptide represented approx. 30% of the collagen fraction precipitated at 4.0 M-NaCl, it migrated between beta- and alpha1-collagen chains on sodium dodecyl sulphate/polyacrylamide-gel electrophoresis and its electrophoretic behaviour was not affected by disulphide-bond reduction. All collagen fractions from the heart valves contained increased amounts of hydroxylysine when compared with type-I and -III collagens from other tissues. The presence of beta- and gamma-chains and higher aggregates in pepsin-solubilized collagen indicated that these collagens were highly cross-linked and suggested that some of these cross-links involved the triple-helical regions of the molecule. It is likely that the higher hydroxylysine content of heart-valve collagen is responsible for the high degree of intermolecular cross-linking and may be the result of an adaptive mechanism for the specialized function of these tissues.


The effect of sugars on (pro)insulin biosynthesis.

Rates of incorporation of [4,5-(3)H]leucine into insulin plus proinsulin, designated ;(pro)insulin', and total protein in rat pancreatic islets were measured. Glucose stimulates rates of total protein and (pro)insulin biosynthesis, but (pro)insulin biosynthesis is stimulated preferentially. Mannose and N-acetylglucosamine also stimulate (pro)insulin and total protein biosynthesis; inosine and dihydroxyacetone stimulate (pro)insulin biosynthesis specifically. Fructose does not stimulate (pro)insulin biosynthesis when tested alone, but does so in the presence of low concentrations of glucose, mannose or N-acetylglucosamine. Many glucose analogues do not stimulate (pro)insulin biosynthesis. Mannoheptulose inhibits synthesis of (pro)insulin and total protein stimulated by glucose or mannose but not by dihydroxyacetone, inosine or N-acetylglucosamine; phloretin (9mum) inhibits N-acetylglucosamine-stimulated (pro)insulin biosynthesis preferentially. The data are in agreement with the view that the same glucose-sensor mechanism may control both insulin release and biosynthesis, and ;substrate-site' model is suggested. The threshold for stimulation of biosynthesis of (pro)insulin and total protein is lower than that found for glucose-stimulated insulin release; moreover the biosynthetic response to an elevation of glucose concentration is slower than that found for insulin release. The physiological implication of these findings is discussed. Caffeine and isobutylmethylxanthine, at concentrations known to increase islet 3':5'-cyclic AMP and potentiate glucose-induced insulin release, were without effect on rates of glucose-stimulated (pro)insulin biosynthesis.


Use of doxapram as an arousal agent in outpatient general anaesthesia.

In a double-blind study of 100 outpatients receiving an anaesthetic sequence of methohexitone, nitrous oxide and halothane, significant shortening of recovery time was produced by the i.v. administration of doxapram hydrochloride at the end of anaesthesia. Comparable recovery times were obtained following the administration of 80 mg to female patients and 95 mg to male patients. There was no evidence that the administration of doxapram caused cardiac arrhythmia.


Comparative assessment of fenoprofen and paracetamol given in combination for pain after surgery.

In a double-blind study of patients suffering from pain after surgery, fenoprofen 200 mg and paracetamol 500 mg was compared with each drug given separately and with a placebo. There was a significant difference between the combination and the placebo, whereas, separately, the drugs were only marginally better than the placebo in relieving pain. There was a significant linear trend indicating a better clinical result as the number of active components in the regimen was increased.


A study of the comparative efficacy of diflucortolone valerate 0.3% ointment and clobetasol propionate 0.05% ointment.

Three hundred and fifty-four patients with symmetrical dermatoses took part in a multicentre, doubleblind, half-side study in order to compare the efficacy of a new topical steroid, diflucortolone valerate 0.3% (Nerisone Forte) against that of an established, potent topical steroid, clobetasol propionate 0.05% (Dermovate). The assessment of overall response, as judged by the physicians' preference for one side or another, showed no difference between the two compounds. However, when the results were examined by separate diagnostic category, the number of preferences was greater for diflucortolone valerate 0.3% in eczema, and for clobetasol propionate 0.05% in psoriasis, although neither of these differences reached levels of statistical significance. The graded assessments of response indicated that both compounds were highly effective, potent, topical steroids. Eighty-one percent of all patients showed marked improvement or healing with diflucortolone valerate 0.3%, and 84% showed marked improvement or healing with clobetasol propionate 0.05%. This difference was not statistically significant. Analysis of response, either by diagnosis or grade of severity, showed no statistically significant differences between the two compounds. No significant differences in the incidence of severity of side-effects were observed. It was concluded that the two compounds were of equal clinical efficacy.


Plasma cortisol values after topical application of diflucortolone valerate (0.3%) or clobetasol propionate (0.05%) in psoriatic patients.

A double-blind randomized study to compare the plasma cortisol values at both 9.00 a.m. and 12 midnight following topical application fo 10 g daily for 7 days of either diflucortolone valerate 0.3% (Nerisone Forte) ointment or clobetasol propionate 0.05% (Dermovate) ointment in 20 hospital inpatients suffering from severe psoriasis, showed that clinically both compounds behaved as potent, highly active topical preparations and caused rapid clinical improvement. Diflucortolone valerate 0.3% caused only slight and non-significant depression of mean plasma cortisols. On the other hand, clobetasol caused an immediate, persistent and statistically significant depression of the 9.00 a.m. coritsol values, which appeared to recover towards normality only on the third day after therapy had been withdrawn. the difference between these 2 compounds was found to be statistically significant (P less than 0.05). From these observations, it is concluded that diflucortolone valerate 0.3% ointment suppresses adreno-cortical function to a significantly lesser extent than clobetasol propionate 0.05% ointment.


Bullous pemphigoid and primary biliary cirrhosis.

The occurrence of multiple autoimmune conditions in an individual and in families is well known. We wish to report the simultaneous occurrence of bullous pemphigoid and primary biliary cirrhosis in an individual who also suffered from vitiligo. The association adds to the documentation of bullous pemphigoid co-existing with other autoimmune disorders.


An immunofluorescence study of pityriasis lichenoides.

In a study of 27 patients with pityriasis lichenoides IgM and C3 have been observed on direct immunofluorescence of fresh lesions. Other immunoglobulins and complement components were not observed. Immunofluorescence was seen in 31 (72%) of 43 fresh lesions. It occurred in the walls of superficial dermal vessels and along the dermal-epidermal junction. This pattern of immunofluorescence appears to be characteristic of the disease. Uninvolved skin showed the immunofluorescence less frequently and old scaly lesions none. The concept that pityriasis lichenoides is an immune complex disorder is discussed.


Complement and immunoglobulin deposits in the skin of patients with atopic dermatitis.

The immunofluorescent patterns of uninvolved and involved skin biopsies from eight patients with atopic dermatitis were studied, using direct immunofluorescence techniques to identify deposits of the immunoglobulins G, A and M as well as the complement factors C1q, C3, C4, C5, factor B and properdin. Immunoglobulin deposits (mainly IgG) were found in five patients, complement deposits in three patients in the basement membrane zone. In three patients the immunofluorescence was positive for C3, in two patients for C1q, C4 and C5. Regarding the factors of the alternative pathway of the complement system, two patients showed deposits of properdin, one of factor B. The changes were not confined to the eczematous lesions, but were found in uninvolved skin too. The most prominent changes were observed in patients with severe disease.


Hodgkin's disease: ultrastructural localization of intra-cytoplasmic immunoglobulins within malignant cells.

An immunoperoxidase technique has been applied to the detection of intracellular immunoglobulins at the light and ultrastructural levels in three untreated cases of Hodgkin's disease. The results are compared with those obtained in three treated cases. In both groups, 20-90% of malignant cells had intra-cytoplasmic immunoglobulins. There was no correlation between the percentage of immunoglobulin-containing cells and the histological type or the stage of the disease. At the ultrastructural level, immunoglobulins were constantly localized on cytoplasmic ribosomes, the later being either free in the cytoplasm or bound to the endoplasmic reticulum and to the external envelope of the perinuclear space. In addition, a very few malignant cells exhibited immunoglobulins within their perinuclear space and their endoplasmic reticulum. These results demonstrate that immunoglobulins in Hodgkin's malignant cells are present on the cellular sites of protein synthesis. They appear to be retained in their cytoplasm, and to be secreted only very occasionally. The significance of these findings as to the cellular origin of malignant cells in Hodgkin's disease is briefly discussed.


A comparison of salbutamol and ethanol in the treatment of preterm labour.

Intravenous salbutamol and ethanol were compared as treatments for preterm labour, 42 patients being assigned randomly to salbutamol and 46 to ethanol. There was no statistically significant difference in outcome between patients in the two groups, the mean delay in delivery achieved being 15 days with salbutamol and 20 days with ethanol. Neither treatment was very effective since only 10 patients given salbutamol and 14 given ethanol had their delivery postponed to 37 weeks or later. Salbutamol was more rapidly acting than ethanol but produced more cardiovascular side effects.


Comparison of placebo and bromocriptine in the treatment of patients with normoprolactinaemic amenorrhoea.

Fourteen women with normoprolactinaemic amenorrhoea were treated with bromocriptine (2.5 mg twice daily) for a period ranging from 4 to 17 weeks, while a matched group fo 19 amenorrhoeic women were treated with a placebo (one tablet twice daily) for 4 to 12 weeks. About half of the patients in both groups had at least one episode of vaginal bleeding during treatment. There was no clear difference in the menstrual and ovulatory pattern between placebo and bromocriptine groups.


Group B beta haemolytic streptococci in the female genital tract: a study of four clinic populations.

The carrier rate of group B beta-haemolytic streptococci (GBS) was assessed in pregnant and non-pregnant women attending four clinics. Multiple sites were sampled and standard methods were used to isolate GBS. Colonization rates were highest in patients attending a venereal disease clinic but were not associated with other sexually transmitted diseases. Higher colonization rates were detected when multiple sites were sampled. Serotypes II and III occurred most frequently.


Contractile proteins in retinal endothelium and other non-muscle tissues of the eye.

The present study is the first investigation to demonstrate, by employing the combined approach of immunologically and electron microscope methods, the presence of actin-like contractile proteins in the mammalian retina, the corneal epithelium and endothelium, the iris, and the ciliary body, and to confirm their presence in lens epithelium. This is also the first report to demonstrate by these methods the presence of microfilaments and intermediate filaments in retinal vascular endothelium. Since we have shown that actin filaments are especially abundant in immature retinal endothelial cells, the question of their function arises, and we have discussed their possible relevance to the closure of immature retinal vessels when exposed to hyperoxia.


Nuclear magnetic resonance studies of inorganic phosphate binding to yeast inorganic pyrophosphatase.

Yeast inorganic pyrophosphatase is a dimer of identical subunits. Previous work (Rapoport, T.A., et al. (1973) Eur. J. Biochem. 33, 341) indicated the presence of two different Mn2+ binding sites per subunit. In the present work, the binding of inorganic phosphate to the Mn2+-inorganic pyrophosphatase complex has been studied by 1H and 31P nuclear magnetic resonance. Two distinct phosphate sites have been found, having dissociation constants of 0.24 mM and 18 mM. The Mn2+-31P distance from tightly bound Mn2+ to phosphate bound in the low affinity site (6.2 A) is consistent with outer sphere binding. Binding to both phosphate sites can be simultaneously inhibited by the pyrophosphate analogue, hydroxymethanebisphosphonate, providing evidence for the physical proximity of these two sites. The weaker Mn2+ site is apparently far from both phosphate sites. From the magnitudes of the dissociation constants found for both phosphate and analogue binding and the recent work of P.D. Boyer and his co-workers (private communication) on enzyme-catalyzed phosphate-water exchange, it appears unlikely that the hydrolysis of enzyme-bound pyrophosphate is the rate-determining step in the overall enzymatic catalysis of pyrophosphate hydrolysis, at least when Mn2+ is the required divalent metal ion cofactor.


Metabolism of prostacyclin in rat.

Following a single intravenous administration of [11-3H]prostacyclin in rat, 77% of the administered dose was excreted within 3 days with 33% in urine and 44% in feces. Urinary metabolites were accumulated by chronic intravenous infusions of [11-3H]prostacyclin for 14 days. The drug was extensively metabolized and the structures of seven metabolites were elucidated by combined gas chromatography and mass spectrometry. The urinary products include the dinor and 19-hydroxy dinor derivatives of 6-keto-PGF1alpha and 13,14-dihydro-6,15-diketo-PGF1alpha, omega-hydroxy and omega-carboxyl dinor derivates of dihydro-6,15-diketo-PGF1alpha, and a dihydrodiketotetranordicarboxylic acid. The metabolic pathways of PGI2 in rat are similar to that of PGF2alpha.


Physical properties of Artemia salina ribosomes.

Eukaryotic ribosomes were isolated from the cryptobiotic embryos and from the further-developed free-swimming nauplii of the brine shrimp Artemia salina. Analytical boundary sedimentation and photon correlation spectroscopy yielded, respectively, the standard sedimentation and diffusion coefficients at infinite dilution, s degrees 20,w = 81 +/- 1 S and D degrees 20,w = (1.41 +/- 0.02) x 10(-7) cm2/s, for the unfixed and formaldehyde-fixed ribosomes from different developmental stages and for ribosomes attached to a messenger RNA fragment. Also, the density increment was determined, from which the partial specific volume was derived (0.63 +/- 0.01 cm3/g). Combination of the different measured parameters gives accurate values for the molecular weight (3.8 +/- 0.1) x 106 and for size and solvation parameters. These results are compared with their counterparts for the smaller ribosomes from the prokaryote Escherichia coli.


Detection of the homology among proteins by immunochemical cross-reactivity between denatured antigens. Application to the threonine and methionine regulated aspartokinases-homoserine dehydrogenases from Escherichia coli K 12.

The two isofunctional enzymes aspartokinases-homoserine dehydrogenases I and II from Escherichia coli K 12 are compared using immunochemical techniques. The antibodies raised against one of these two proteins when in its native state can only recognize the homologous antigen, whether it is native or denatured. Contrarily, the antibodies raised against one of these two proteins when in its denatured state can recognize both the homologous and heterologous denatured antigens. The existence of this cross-reaction only between the two denatured aspartokinases-homoserine dehydrogenases suggests that these two enzymes have some similarity since such a reaction is not detected with several other denatured proteins. The regions involved in this similarity are buried inside the native proteins, and become exposed only upon denaturation. The same results, the existence of a cross-reaction between denatured species and none between the native ones, is obtained with proteolytic fragments derived from these two proteins and endowed with homoserine dehydrogenase activity. This resemblance between the two aspartokinases-homoserine dehydrogenases suggests that these proteins derive from a common ancestor. It is also proposed that such a cross-reaction between two denatured proteins is evidence for an homology between their amino acid sequences, and that the use of denatured proteins as both immunogens and antigens could be useful in detecting sequence homologies.