Ionizing irradiation and the induction of clinically significant disease in the human thyroid gland.

Because of increasing concern over continuing medical and potential nonmedical exposure of the thyroid to radiation, risk estimates have been developed for acute thyroiditis, hypothyroidism, and both benign and malignant thyroid nodules following exposure of the human thyroid to external and internal sources of ionizing radiation. These estimates are unique in that they are based entirely on data in human subjects are included corrections for the spontaneous occurrence of thyroid disease in human populations not subjected to radiation whenever possible.


Immune suppression of hematopoiesis.

Recent evidence suggests that immune mechanisms can injure proliferating hematopoietic precursor cells in the bone marrow. These may involve either humoral antibody or cell-mediated cytotoxic mechanisms. Immune injury can result in a variety of bone marrow failure syndromes. Immunologically induced abnormalities or blood cell production may be restricted to a single series, such as erythrocyte or granulocyte precursors, or may involve several hematopoietic lines; clinical manifestations reflect the cell line or lines that are injured. Immune suppression of hematopoiesis has now been described in pure red cell aplasia, immune panleukopenia, systemic lupus erythematosus, atypical cases of aplastic anemia and miscellaneous other hematologic diseases.


Massive proteinuria and acute renal failure in a patient with acute silicoproteinosis.

Acute pulmonary silicoproteinosis, massive proteinuria and fatal renal failure developed in a 23 year old male sandblaster. Examination of the kidney by immunofluorescence revealed granular deposits of immunoglobulin M (IgM) and the third component of complement (C3) along the glomerular basement membrane. Light microscopy disclosed mild proliferative glomerulonephritis with loss of colloidal iron staining for sialoprotein, and electron microscopy disclosed an increased density of epithelial cytoplasm, altered lysosomes and endothelial cell microtubular structures. The silicon content of the kidney was 264 parts per million (ppm), but particles of silicon were not demonstrated by electron microscopy. No primary or systemic causes of renal diseases were elucidated. The renal dysfunction apparently resulted from acute renal silicon toxicity, a new complication of acute pulmonary silicoproteinosis.


Dynamic testing of hypothalamic-pituitary function in abnormalities of ovulation.

A review of 26 unusual patients indicates that a combined luteinizing hormone-releasing hormone (LRH)-clomiphene test in conjunction with an estrogen provocation test not only was helpful in identifying underlying pathophysiology of anovulation but also proved useful in the clinical management of the patients. Dynamic testing per se does not establish a diagnosis but, in conjunction with history and other laboratory findings, it does make possible further subdivisions of groups of patients who otherwise appear similar, both clinically and from routine laboratory evaluations. It, therefore, tends to pinpoint a lesion and establish the area in which further tests should be made. It is concluded that the value of such investigations will be more evident as gynecologic endocrinology moves into investigation of the supratentorial control of hypothalamic function and as hypothalamic LRH becomes available as a therapeutic agent.


Clinical relevance of research on the structure of human chorionic gonadotropin.

Human chorionic gonadotropin (hCG) has been studied extensively over the past 10 years, and some structural correlates of its chemical, biological, and immunologic properties have been defined. A review of these observations and their relevance to clinical applications of methods for detecting hCG is presented.


Transfer factor and possible applications in gynecology.

Dialyzable transfer factor (TFd) is reviewed against its historical background, preparation methods, physiochemical properties, possible mechanisms of action, pharmacology, and clinical studies, including several areas relating to gynecology. The possible role of TFd as an adjunct in the treatment of cancer is discussed. The discussion centers on gynecologic cancer in several patients who have received TFd. The difficulties and future possibilities for this modality of treatment are considered.


An ultraviolet photographic technique for monitoring plaque during direct bonding procedures.

An ultraviolet-light dental camera was used to disclose plaque in relation to directly bonded plastic orthodontic brackets. No disclosing solution was used. The reestablishment of plaque patterns 14 days after a prophylaxis and in the presence of the brackets was noted. A further cleaning after debonding removed the plaque, which returned to the base line pattern within 14 days. Small resin remnants left during debonding did not form foci for plaque growth and spread over a 6-month observation period.


Effect of chronic pentagastrin, cholecystokinin, and secretin on pancreas of rats.

Pentagastrin (1.5 mg/kg), 20% pure natural cholecystokinin (CCK, 37.5 Ivy dog U/kg) or secretin (25 microgram/kg) was given in a depot carrier subcutaneously to rats 3 times daily for 15 days. The dose of CCK and secretin was submaximal for pancreatic secretion, whereas the dose of pentagastrin was supramaximal for gastric acid secretion. The pancreatic wet weight increased by 12% (P less than 0.01) in the rats treated with pentagastrin, 57% (P less than 0.001) in those treated with CCK, and 9% (P less than 0.01) in those treated with secretin. In CCK-treated rats, the maximal protein and bicarbonate outputs in response to cholecystokinin increased proportionately to the increase in pancreatic weight, but maximal bicarbonate and protein outputs in response to secretin were unaltered. The secretin-treated rats showed a lowered basal secretion of bicarbonate and a lowered sensitivity to secretin stimulation, but the maximal bicarbonate and protein outputs to secretin and CCK were unchanged. Treatment with pentagastrin produced no significant changes in pancreatic responses to secretin or CCK. We conclude that 1) the increase in pancreatic weight produced by repeated injections of cholecystokinin was accompanied by proportional increase in functional capacity as reflected by the increased maximal bicarbonate and protein outputs in response to cholecystokinin, and 2) repeated administration of secretin decreased the sensitivity of the pancreas to secretin without altering maximal bicarbonate response.


Current concepts on the pathophysiology of acute renal failure.

In the pase decade, several experimental models of acute renal failure (ARF) have been evaluated with micropuncture and hemodynamic techniques. Five of these models have been most extensively studied: glycerol injection, renal artery clamping, intrarenal norepinephrine infusion, uranyl nitrate, and mercuric chloride administration. In the first three models, renal ischemia is the initiating insult, whereas in the two nephrotoxic models a direct effect of the agent on cellular integrity is also seemingly operative. In all of these models, renal blood flow 24--48 h after the initial insult either spontaneously returns to normal or can be elevated to this level with volume expansion but without restoration of the glomerular filtration rate. Therefore, the maintenance of ARF in these various models is due to other factors, which include tubular obstruction, leakage of filtrate across damaged tubular epithelium, and a decrease in the glomerular capillary ultrafiltration coefficient. In a given model, one or all three of these alterations may be present. Although these various models may not be completely analogous to the clinical setting, they have provided powerful tools for the study of ARF and their use has greatly increased our knowledge in this field.


Fluorescein dye-dilution technique and retinal circulation.

Using theoretical models for the flow of fluourescein dye in retinal arteries and veins, we have determined the effects of optical absorption in blood of the incident excitation light and the emitted fluorescent light on the time course of measured fluorescence intensity, I(t). Our results indicate that I(t) curves recorded from arteries adequately represent the mean time course of the fluorescein concentration (C(t)), when either a circular or rectangular light-collecting aperture is used. I(t) curves recorded from veins adequately represent C(t), but only when a circular aperture of approximately the same diameter as that of the vessel is used. A two-point fluorophotometer, which provides simultaneous, on-line measurements of arterial and venous I(t) curves is described. Typical recordings obtained with the instrument are shown and the method employed to analyze the curves quantitatively is described in detail. This method, which consists of fitting the first passage of the fluorescence intensity curve with a log-normal function, provides results that are more accurate than those obtained using the standard exponential extrapolation method.


Chemoprophylaxis and malaria in American servicemen returning from Vietnam.

Information relating to chemoprophylaxis and malaria in 49 men who served with the United States Armed Forces in Vietnam and who developed overt malaria after departure from Vietnam indicated that: 1) compliance with intended chemoprophylactic regimens was far optimal; 2) a history of recent prophylactic ingestion of chloroquine was not a reliable indicator of infection with chloroquine-resistant Plasmodium falciparum: 3) reported ingestion of half or more of an intended terminal chemoprophylactic regimen was associated with a prolongation of the time that elapsed before initial post-departure episodes of vivax malaria; and 4) such partial compliance with intended terminal chemoprophylaxis may have been associated with a decreased incidence of second post-departure episodes of vivax malaria.


Babesia microti infection in man: evaluation of an indirect immunofluorescent antibody test.

An indirect immunofluorescent antibody test was used to detect antibody to Babesia microti in human sera. Nine patients from Nantucket Island, Massachusetts infected with B. microti had serum titers greater than or equal to 1,024. Of 84 control sera from New York City residents, 246 sera from patients with possible exposure to ticks, and 36 sera from patients with suspected or confirmed tick bites, none was reactive at titers of 1:16 or above. The within-test reproducibility was within one fourfold dilution in 95% of trials. Test-to-test reproducibility was within one fourfold dilution in 33% of trials and within two fourfold dilutions in 100% of trials. Although cross-reactions among infected patients' sera and antigens of B. argentina, B. equi, B. bigemina, Plasmodium vivax, P. falciparum, and P. brasilianum were common, titers were highest to the homologous antigen.


Plasmodium falciparum: responses of a semi-immune individual to homologous and heterologous challenges, and non-infectivity of gametocytes in Anopheles stephensi.

With strict adherence to ethical guidelines, a semi-immune volunteer was exposed to homologous and heterologous blood challenges with strains of Plasmodium falciparum from Vietnam and Tanzania. On both occasions infections developed, but clinical manifestations were moderated, prepatent periods increased, and parasitemias limited. Gametocytes produced by these infections failed to infect Anopheles stephensi. Possible reasons for this are discussed.


Pathogenesis of congenital malformations. An hypothesis.

An hypothesis of neural crest injury, derived from a radiologic analysis of thalidomide deformities, is suggested as a possible pathogenetic mechanism of dysmelia and its associated visceral defects. Supportive evidence from a variety of sources is presented, and the hypothesis is shown to provide a unifying concept for a number of previously unrelated facts.


Healing of experimental colonic anastomoses. The effect of suture technic on collagen concentration in the colonic wall.

The present experimental study in rats has demonstrated a marked difference in the healing process of anastomoses in the left colon following two different suture technics: continuous and interrupted sutures. Rats having anastomoses constructed of continuous suture showed a high incidence of complications and a marked decrease of collagen concentration in the anastomosis and in the colonic wall proximal to the anastomosis during the first week of healing. In animals with anastomoses made of interrupted sutures there were fewer complications, the decrease in collagen concentration was confined to the anastomotic region, and the recovery of collagen concentration occurred earlier. The findings indicate that the interrupted suture technic is preferable for anastomosis in the left colon.


A ten year experience with cadaver kidney preservation using cryoprecipitated plasma.

Between August 1967 and January 1977, 699 cadaver kidneys were preserved and transplanted in our hospital after continuous perfusion with cryoprecipitated plasma. Overall graft survival of primary transplants was 55 +/- 2 per cent at one year and 41 +/- 2 per cent at four years. The results with ninety-six second transplants were similar. The number of HLA antigens shared and the duration of preservation did not influence graft survival. Patient survival among 426 cadaver graft recipients since September 1972, when lower dose immunosuppression was started, was 91 +/- 1 per cent at one year and 84 +/- 2 per cent at four years, significantly better than survival before then. Survival of fifty-two recipients of cadaver retransplants since September 1972 was 86 +/- 5 per cent at one year and 86 +/- 5 per cent at four years, which was better than before. The incidence of posttransplantation dialysis was 30 per cent and did not correlate with the length of preservation. Primary wound infections, primary ureteral extravasation, and vascular complications each occurred with an incidence of 1.1 per cent or less in patients treated with lower dose immunosuppression. Only four kidneys were lost because of complications, and in no instance was the need for transplant nephrectomy directly related to the method of preservation. Perfusion preservation with cryoprecipitated plasma gives excellent results compared with alternative methods.


Changing concepts of cancer surgery: surgery as immunotherapy.

Historically, the effectiveness of surgical therapy for cancer was thought to depend upon the successful removal of every last tumor cell from the patient's body. However, this view is not consistent with modern concepts of surgical oncology which suggest that successful cancer surgery depends upon how favorably it influences the patient's defenses against the cancer. Recent evidence suggests that the growing neoplasm is capable of evading immune attack by producing specific and nonspecific immunosuppression of the host's defenses to enhance tumor growth. The extent of the immunosuppression correlates with the tumor burden; immunosuppression is reversed by removing the neoplasm. Therefore, cancer surgery acts as immunotherapy because it removes the cancer cells that produce the immunodepression and allows the patient's immune response to recover.


Positive end-expiratory pressure. Immediate haemodynamic effects during artificial ventilation.

The immediate haemodynamic effects of the addition of a positive end-expiratory pressure (PEEP) of 5 cmH2O has been studied in eleven patients undergoing artificial ventilation for respiratory failure. Mean cardiac output fell from 6.0 to 5.5 litres/min. This was due to a similar decrease in stroke volume. Individual patients showed greater, though short-lived, changes. There was also a statistically significant increase in central venous pressure (from 8-9 cmH2O) and peripheral resistance (from 1280 to 1380 dyn sec cm-5) associated with the application of PEEP. Overall changes in heart rate and mean arterial blood pressure were insignificant. Arterial oxygen tension increased in the majority of patients but the mean figure was unchanged. Mean  oxygen delivery to the tissues fell from 830 to 780 ml/min.


0.125% bupivacaine for obstetric analgesia?

A prospective trial was designed to assess the effectiveness of three different concentrations of bupivacaine (Marcain) for use in obstetric epidural analgesia. The purpose of the study was to see if reduction of the concentration of bupivacaine to 0.125% would reduce the total dose of the drug given without reducing the efficiency of the epidural block. The concentrations studies were 0.125%, 0.25% and 0.375%. The trial was limited to fit primiparous patients at term with singleton pregnancies and vertex presentation. Patients with intercurrent medical disease or with toxaemia were excluded. A total of ninety-three patients were studied, and once admitted to the trial they were randomly allocated to one of the three concentrations. In general the results of the trial show that 0.125% bupivacaine had a significantly higher failure rate than either of the other two concentrations, but in those cases where 0.125% was effective and achieved total pain relief there was a significant reduction in the amount of the drug used.


United they fall, divided they stand.

The historical context of unification or separation of the academic bodies of the various branches of the profession in Great Britain and Ireland is examined.


Pituitary and testicular response to LH-RH and to a long-acting analogue (D-leu-6-LH-RH-ethylamide).

The LH, FSH and testosterone response to 50 microgram i.v. LH-RH and to 2.5, 5.0, 10.0, and 20.0 microgram i.m. D-Leu-6-LH-RH-ethylamide was studied in 6 subjects with normogonadotrophic, idiopathic oligozoospermia. All injections were given between 8:00 and 9:00 a.m. at weekly intervals. Blood samples were collected before and 30 and 45 minutes after injection of LH-RH, and before and 2, 4, 6, 12, and 24 hours after D-Leu-6-LH-RH-ethylamide injections. Serum levels of LH, FSH, and testosterone were measured by triplicate by R.I.A. LH and FSH responses to LH-RH showed peak values at 30 minutes, whereas following injections of D-Leu-6-LH-RH-ethylamide, maximal values were recorded between 4 and 6 hours and were higher than those obtained with LH-RH. A significant rise of serum testosterone levels was observed after all stimuli, with peak values 45 minutes after LH-RH and 4 to 6 hours after D-Leu-6-Lh-RH-ethylamide injections. The testosterone levels obtained following LH-RH and different doses of the analogue did not differ significantly from one another. The same sequence of maximal LH and FSH values was obtained after injections of LH-RH and of D-Leu-6-LH-RH-ethylamide, particularly at doses of 10.0 and 20.0 microgram. This suggests that the gonadotrophin response to these agents would be a true reflection of the individual mode of pituitary response.


A compromise for closed system anesthesia.

Closed system anesthesia is economical, minimally, polluting, and conserves a patient's airway heat and moisture. Yet this method of anesthesia is not widely used because it is considered dangerous by many clinicians. We review the origins of that belief and then test the application of 2 schemes for administering potent agents in a closed system with CO2 absorption. We 1st employed Lowe's square-root-of-time uptake model in 30 patients, using halothane or enflurane. We found that the model provided a good starting point for learning to use the closed system. However, anesthetic concentrations were not accurately predicted. Based on our experience with that model, we examined a simpler approach. We began each of 10 anesthetics using a semiclosed system, then closed the system. Only sufficient O2 for metabolic demand and halothane were added to the closed system. The rate of halothane administration was the same for each patient. This approach proved clinically satisfactory, and the measured halothane concentration remained relatively constant during 45 minutes using the closed system. Changing from a semiclosed to a closed system affords the advantages of the closed system 75 percent of the time, yet requires no extra tasks or equipment.


Arterio-venous shunting in renal transplant rejection.

The angiographic appearance of arterio-venous shunting has been reported in one previous case of a patient with acute severe transplant rejection. Two additional cases are presented here. In the first the arteriovenous shunting is massive, and the venous filling is within the first second of the study. In the second the shunting is less severe, and the venous filling occurs later in the arterial phase. Shunting is probably caused by multiple microscopic arterio-venous fistulae secondary to the vasculitis of rejection. We propose that the presence of arterio-venous shunting suggests renal transplant rejection and may indicate a poor prognosis for reversal of this rejection.


Chest physiotherapy: the effect on arterial oxygenation.

A prospective study of 47 patients during mechanical ventilation with positive end-expiratory pressure was undertaken to evaluate changes in Pao2 following chest physiotherapy. In contrast to other studies, we found no significant change in Pao2 following chest physiotherapy (p greater than 0.05). Different technics for physiotherapy and ventilation may have accounted for the absence of hypoxemia reported by others. Possible reasons for failure to improve Pao2 were suggested. Chest X-ray before and within 24 hours of physiotherapy showed improvement in 68 percent of patients. Chest physiotherapy was most effective in the treatment of unilobar densities and produced dramatic improvement in atelectasis of acute onset.


Pathophysiology of capillary circulation: Raynaud's disease.

Despite the frequency of Raynaud's disease in cold climates, the etiology of the condition remains uncertain. This report reviews the literature since Raynaud's original description and Lewis and Pickering's addition to the concept, and several recent observations which add to our understanding of the disease are discussed. We investigated the effect of posture and a vasodilator drug on the digital capillary circulation; digital blood flow increases as the body moves from a recumbent, through a sitting, ti an upright position. Bradilan, a vasodilator drug, increases the circulation in the recumbent and sitting positions, but has no effect in standing patients, despite symptomatic relief.


The value of thermography in peripheral vascular disease.

The value of thermography as a reliable, noninvasive, and rapid method of investigating patients with peripheral vascular disease is discussed. Thermography has great value in managing deep venous thrombosis, in estimating the optimal site of amputation, in evaluating vasoactive drugs, and correctly timing the division of pedicled skin flaps. Its use in localizing incompetent perforating veins of the leg and in monitoring patients with cerebrovascular disease after surgery to the carotid arteries is also briefly described.


Atmospheric mold spores in Tehran, Iran.

Plate method, using modified Sabouraud and Littman Oxgall agra media, was used to study atmospheric mold spores in Tehran, Iran, for a complete year. Twenty-two different genera of molds were identified and counted. Of these, yeast, Penicillium, Cladosporium, Rhodotorula, Alternaria, Stemphylium and Aspergillus were the most abundant and were seen all year 'round. Other genera were observed seasonally and in small numbers.


Controlled trial of bronchodilator-mucolytic aerosols, combined and separate.

In seven of 30 ambulatory asthmatics the inhalation of 10% acetylcysteine reduced the FEV1 by more than 10% (range: 14% to 53%). Inclusion of isoproterenol (0.05%) reversed this depression over the entire trial in six of these subjects, while the seventh responded similarly except for the last measurement. It is concluded that the addition of isoproterenol to an acetylcysteine aerosol in the above ratio can eliminate the ventilatory impairment induced by the latter and is therefore indicated for those patients with chronic obstructive lung disease who benefit from a mucolytic agent.


Long-term study comparing fenoterol and isoproterenol inhalation in asthmatic patients.

In a parallel-group, double-blind study 28 chronic asthmatic patients were treated for 90 days with metered dose inhalers of fenoterol and isoproterenol, at daily doses of 0.4 mg t.i.d. and 0.15 mg t.i.d., respectively. Fenoterol produced significant improvements in FEV1 and FEF25-75%, greater than those achieved with isoproterenol, in tests on days 1, 45 and 90; its median duration of action was two to four times longer than that of isoproterenol. Ratings for overall responses to treatment were higher for fenoterol and mean attack rates showed a greater decline than with isoproterenol.


Colibacillosis in neonatal lambs: onset of diarrheal disease and isolation and characterization of enterotoxigenic Escherichia coli from enteric and septicemic forms of the disease.

A lamb ligated intestinal segment (LIS) test was adapted to determine the enterotoxigenicity of Escherichia coli isolates obtained from fecal and blood specimens from neonatal lambs with overt diarrheal disease. The lamb LIS was distended by 28 of 80 (37%) isolates from fecal specimens from 23 affected lambs. Enterotoxigenic E coli isolations were made from 10 of the 23 lambs examined. Isolates of E coli were made from the blood of 17 of 76 (22%) animals with severe diarrheal disease. Distention of the lamb LIS was caused by 3 of 39 (7.7%) isolates from 2 of 17 lambs with E coli septicemia. All lambs (n = 266) that were born during a 4-day period in an intensified shed lambing operation and that were not given prophylactic antibiotic therapy developed diarrheal disease within 28 hours of birth. Signs of enteric disease appeared in lambs born during inclement weather in a significantly (P less than 0.001) shorter period than in those born during mild weather conditions.


Nematospiroides dubius as a vector for Salmonella typhimurium.

Salmonella typhimurium within the 3rd stage larvae of Nematospiroides dubius was shown to infect mice, evidenced by prolonged shedding of salmonellae in the feces. Numbers of S typhimurium needed to infect mice were approximately 1,000- fold less if incorporated within the 3rd-stage larvae of N dubius. Results of these experiments demonstrate that nematode parasites may act as a vector for pathogenic species of enteric bacteria.


Immune response of ponies to experimental infection with Ehrlichia equi.

Four ponies experimentally infected with Ehrlichia equi developed substantial cell-mediated immune responses, as measured by the leukocyte migration-inhibition test. Serum anti-E equi antibodies up to 1:1,280 were demonstrated by the indirect fluorescent antibody test. Cell-mediated immune responses returned to a base-line value by day 200 after primary inoculation, but serum antibody titers persisted for at least 300 days after inoculation. Two additional susceptible ponies, which were inoculated with convalescent blood or organ homogenates from ponies recovered from acute equine ehrlichiosis, treated with tetracycline, and subsequently challenge exposed with E equi-infective blood, did not develop clinical disease. This study suggested that ponies are resistant to reinfection with E equi following clinical ehrlichiosis.


An invasive procedure for in utero fetal electrocardiology: recording of fetal electrocardiograms by applying electrodes through the uterus.

An in utero technique was developed that allows direct access to the canine fetus for experimentation. This procedure reduces the need for fetal manipulation and umbilical blood flow compromise and reduces fetal fluid loss. In pregnant bitches, uterine horns could be delivered through a ventral midline incision. By manipulating the fetal membranes, and positioning the fetuses through them, electrodes could be inserted subcutaneously in the fetuses. Electrocardiograms satisfactory for interpretation were obtained from as many as 4 fetuses in a bitch for periods up to postoperative week 3.


A method for locating individual leukocytes for comparative study by light and scanning electron microscopy.

A method is presented for locating individual leukocytes and platelets in Wright's stained blood films for comparative study by light and scanning electron microscopy. The individual cells in the blood films were photographed and the field was circled with a diamond marker objective. The slide was scored and broken; pieces of the stained slide containing the numbered circles were fixed (with conductive cement) to a metal stub, air dried, and coated with metallic gold. The metal stub was placed in a scanning electron microscope, and the marked cells were readily located and photographed so that their three-dimensional surface morphology could be compared with the morphologic features of stained cells in the blood film photographed with the light microscope. Characteristics of individual cell types are discussed.


Thymectomy in preweanling kittens: technique and immunologic consequences.

Thymectomy of 5-week-old kittens was accomplished by left parasternal thoracotomy, ligation of the left internal thoracic artery, and removal of the thymus from the mediastinum by traction and blunt dissection. Thymectomy had no adverse clinical effects, and neither the response of peripheral blood lymphocytes to phytomitogens nor the proportions of circulating lymphocytes  bearing T- or B-cell markers differed substantially between thymectomized cats and nonthymectomized control cats. Skin allograft rejection times of the thymectomized cats (3 weeks after operation) were slightly longer than those of littermate nonthymectomized controls. We conclude that removal of the thymus in preweanling kittens does not have important physiologic or immunologic consequences.


Effects of atmospheric ammonia on pulmonary bacterial clearance in the young pig.

Young pigs were exposed to an aerosol of a nonpathogenic strain of Escherichia coli and then were retained in air-pollutant exposure chambers for a 2-hour clearance period. In series 1 (n = 80 pigs), 40 exposed young pigs (principals; 15.5 days of age) were placed in an atmosphere of filtered room air + 50 ppm of atmospheric NH3 during the clearance period; control pigs were exposed to filtered room air without added NH3. In series 2 (n = 24 pigs), 12 exposed young pigs (principals; 6.2 days of age) were similarly maintained, but at a lower concentration of atmospheric NH3 (75 ppm). At the end of the clearance period pigs were killed and pulmonary bacterial clearance was determined. Pigs kept in the NH3-contaminated atmospheres (either concentration) harbored more bacteria, on the average, in their lungs than did the controls. If series 1 and 2 data were combined, pigs kept in the NH3-contaminated atmospheres had 51% more bacteria in their lungs than did the controls. Pulmonic weight and ratio of pulmonic weight to body weight of pigs kept in the NH3-contaminated atmosphere were greater than those of the controls in series 1, but not in series 2. Gross and histopathologic examinations of lung tissue generally revealed no differences between controls and principals in either series 1 or 2.


Immunocompetent cells of the turkey: age and organ distribution patterns of T and B lymphoid cells.

The percentage of lymphoid cells from the bursa of Fabricius, thymus, spleen, peripheral blood, and cecal tonsils reactin with chicken antisera to turkey bursa and thymus were evaluated, using 1-day-old to 5-week-old turkeys. For this, rabbit anti-chicken globulin fluorescein isothiocyanate conjugate was used. The percentage of lymphoid cells showing immunoglobulin surface determinants from these organs also was examined, using a direct immunofluorescence test with a rabbit anti-turkey globulin fluorescein isothiocyanate conjugate. This study suggests that the bursa-specific antigen and immunoglobulin surface determinants could be used as markers for bursa-derived cells in the turkey. It also was found that thymus-specific antigen could be used as a marker for thymus-derived cells.


Rapid development of diffuse pulmonary infiltrates in histiocytic lymphoma.

A 24-year-old man with documented histiocytic lymphoma developed a nodular interstitial infiltrate, as shown by chest roentgenograms during a 10-day period of observation. He also developed fever, chills, and purulent sputum. Open-lung biopsy revealed histiocytic lymphoma without evidence of infection. This case demonstrates that lymphoma can cause rapid development of infiltrates observable by roentgenography. Because the infiltrate could be neoplastic or infectious, empiric therapy without an exact diagnosis is not warranted.


[Infantile cortical hyperostosis. A case report (author's transl)].

Authors present a case of infantile cortical hyperostosis with several clinical and radiologic unusual aspects they principally stand out the observation of hypotonia and widely split sutures, possibly never published before.


[Treatment of infantile hydrocephalus with isosorbide dinitrate (author's transl)].

Eighteen of infantile hydrocephalus have been treated with isosorbide dinitrate. Pharmacology of this compound is considered. It appears that completely dinitrated isosorbide is the major metabolite. Isosorbide may be effective in a variable proportion of various types of infantile hydrocephalus. Results of isosorbide dinitrate therapy in children with "communicating" and "noncommunicating" hydrocephalus are reported. Treatment was monitored by simple measurements, and it's toxicity proved to be scanty.


Type B hepatitis after needle-stick exposure: prevention with hepatitis B immune globulin. Final report of the Veterans Administration Cooperative Study.

Hepatitis B immune globulin (HBIG) and immune serum globulin (ISG) were examined in a randomized, double-blind trial to assess their relative efficacies in preventing type B hepatitis after needle-stick exposure to hepatitis B surface antigen (HBsAG)-positive donors. Clinical hepatitis developed in 1.4% of HBIG and in 5.9% of ISG recipients (P = 0.016), and seroconversion (anti-HBs) occurred in 5.6% and 20.7% of them respectively (P less than 0.001). Mild and transient side-effects were noted in 3.0% of ISG and in 3.2% of HBIG recipients. Available donor sera were examined for DNA polymerase (DNAP) and e antigen and antibody (HBeAg; anti-HBE). Both DNAP and HBeAg showed a highly statistically significant correlation with the infectivity of HBsAg-positive donors. Hepatitis B immune globulin remained significantly superior to ISG in preventing type B hepatitis even when the analysis was confined to these two high-risk subgroups. The efficacy of ISG in preventing type B hepatitis cannot be ascertained because a true placebo group was not included.


B-cell lymphosarcoma cell leukemia: dynamics of surface-membrance immunoglobulin. Value for differentiation from chronic lymphocytic leukemia.

Circulating abnormal lymphoid cells in patients with lymphosarcoma cell leukemia show intense fluorescence when stained with fluoroscein-labeled anti-immunoglobulin. The fluorescence is brighter than normal B cells in contrast with chronic lymphocytic leukemia cells, which have much weaker fluorescence than normal. Also in striking contrast with chronic lymphocytic leukemia cells, lymphosarcoma cell leukemia cells redistribute the surface immunoglobulin rapidly during incubation at 37 degrees C to form bright caps. In this respect they more closely resemble normal B cells than chronic lymphocytic leukemia cells. In addition, in sequential studies, the appearance of these characteristics among the circulating cells of patients with lymphoma has been shown at a time when the appearance of a leukemic phase was equivocal morphologically. Thus these cellular characteristics may be helpful in the early diagnosis of a leukemic phase of lymphoma as well as distinguishing these cells from those in chronic lymphocytic leukemia.


Asymptomatic coronary artery disease: angiography in diabetic patients before renal transplantation. Relation of findings to postoperative survival.

Twenty-one juvenile-onset diabetic patients with azotemic nephropathy underwent coronary angiography and left ventriculography before renal transplantation or chronic hemodialysis. Two-year survival of 12 patients with no coronary artery disease (group A) was 88% compared to 22% for nine patients with coronary artery disease (group B) (P less than 0.025). Each group A patient underwent renal transplantation (nine live-related, three cadaveric). Four group B patients received cadaveric allografts. Among group A patients two cadaveric allografts functioned while in group B patients no allografts were successful. In the absence of coronary artery disease, results were similar to those reported for nondiabetic persons. In the presence of coronary artery disease, 62% of the deaths were due to myocardial infarction or sudden death. These results indicate that atherosclerotic coronary artery disease is a major determinant of survival in diabetic patients undergoing chronic hemodialysis or renal transplantation.


Orofacial odontogenic infections.

Clinical manifestations of odontogenic orofacial infections are protean and are largely dictated by complex microbiota and anatomic routes of spread. Complications such as suppurative mediastinal or intracranial extension, retropharyngeal spread and airway obstruction, pleuropulmonary involvement, and hematogenous dissemination indicate the potentially serious nature of these infections. In this review we emphasize the pathogenetic mechanisms of infection, the principles of antimicrobial therapy, and the need for early surgical intervention.


Antihemophilic factor (factor VIII).

Antihemophilic factor (Factor VIII) is an agent in normal plasma that corrects the coagulative defect of classic hemophillia. The plasma of hemophiliacs contains normal amounts of a variant of antihemophilic factor deficient in clot-promoting properties. In contrast, von Willebrand's disease is usually associated with a true deficiency of this protein. In this disorder, the platelets are poorly aggregated by ristocetin, a defect ascribed to deficiency of antihemophilic factor. Structural studies of antihemophilic factor suggest that it is composed of two dissociable subcomponents, one of high molecular weight that contains the bulk of protein and sustains ristocetin-induced platelet aggregation, and another of lower molecular weight with procoagulant activity. Both subcomponents have been identified in hemophilic plasma, as if the smaller subcomponent were qualitatively abnormal. Carriers of hemophilia can often be detected because their plasmas contain a disproportionately high concentration of antihemophilic factor, measured immunologically, compared with the titer of procoagulant antihemophilic factor.


An unusual macular lesion associated with malaria.

A case of a young man afflicted with falciparum malaria is presented in which the primary ocular finding was a subpigment epithelial hemorrhage involving the macula. Previous reports in the literature concentrate on peripheral and central retinal hemorrhages, almost to the exclusion of choroidal vascular abnormalities. The value of this case lies in the recognition that the choroid can assume an important role in fundus abnormalities associated with malaria, probably on the basis of obstructive phenomena with subsequent ischemic degenerative changes, similar to the process which involves the retinal vessels and central nervous system.


Current state of transplantation of the pancreas.

Studies of pancreatic transplantation have been made using the pancreatic tail as an autotransplant model. The endocrine function of the pancreas has been shown to be relatively resistant to warm ischaemic injury. Autotransplantation of the pancreatic tail with a double arterial anastomosis technique can be achieved with 100% immediate success, the graft maintaining satisfactory glucose tolerance and insulin secretion. No important changes in glucose homoeostasis have been shown to result from diversion of pancreatic insulin secretion from portal to systemic veins.


Operative pancreatic biopsy: a survey of current practice.

The attitudes of surgeons working in Great Britain and Ireland towards pancreatic biopsy and the use of other preoperative investigations in cases of pancreatic disease are examined on the basis of replies to a postal questionnaire. The value, accuracy, and complications of pancreatic biopsy are discussed with reference to the surgical literature.


[Autoplastic closure of a persistent postoperative laryngeal fistula in a patient who had undergone previous irradiation (author's transl)].

The authors present a case of closure of a postoperative laryngeal fistula in an irradiated area, obtained after the failure of several local plastic procedures. They used a distant pediculated flap, taken from non-irradiated tissue and from an unusual site: an acromio-occipital flap, using the acromial part with secondary repositioning of the nutrient pedicle. They emphasise the excellent vitality of this flap, its healing effect in the area of radio-dermatitis despite poor general condition, and the necessity for bypass of the upper airway during the time of healing.


An assessment of effectiveness of PLATO basic medical science lessons.

The present study investigated the effectiveness of PLATO basic medical science lessons. Evidence was found that users of the PLATO lessons earned higher mean scores than non-users on subtests of basic science examinations. The findings offer encouragement that PLATO materials may be viable educational tools within a first-year basic science program.


Detecting enteropathogenic Escherichia coli strains of porcine origin. 1. Correlations between O and K antigens and the enterotoxin production in strains isolated from the newborn piglet.

A study of enterotoxin production by means of biological tests (Y1 adrenal cells and suckling mice) using 67 Escherichia coli strains responsible for diarrhea in newborn piglets, confirmed the advantages of these methods and demonstrated the correlation between antigenic specificity and enterotoxin production. In particular the presence of capsular antigen K 88 is related to the thermolabile (LT) fraction of the enterotoxin in 73.9 % of the enteropathogenic strains studied.


Intraperson variability. Magnitude, source, and influence on interpretation and diagnosis.

In a person in a steady state the set of values obtained for a test carried out on a series of samples will show fluctuation about a value (the setting). In practice a single test value is usually taken as an estimate of the setting. The general consequences of this approximation are discussed in relation to the various uses of data in diagnosis, and illustrated for the common measurements of clinical chemistry. The magnitude of these consequences depends on the proportion of the total variation in a group of persons which is caused by these fluctuations in the person--within-person variation (VarWP). When the proportion is high the aim should be to reduce VarWP. When VarWP is high because of analytical error, then improved analytical technique or replicate analysis is required. Otherwise standardised techniques and conditions for venepuncture or, as a last resort, repeated samplings are necessary. These problems are discussed in relation to the detection of hypokalaemia.


Enzyme induction by drugs. Its relevance to clinical biochemistry.

The properties of the hepatic microsomal, drug detoxicating, enzyme system are reviewed with particular reference to its inducibility. Induction is modified by various factors of which the diet is particularly important. A theoretical model system for induction has been proposed and this is discussed. There are a number of methods for assessing microsomal enzyme induction in man, none of which is ideal. Nevertheless, induction is a well recognized phenomenon in man and has a bearing on the metabolism of a number of endogenous substances. The effect of induction on steroid metabolism and the relationship between inducers, vitamin D, and metabolic bone disease is discussed. Bilirubin metabolism is affected by changes in microsomal enzyme activity and inducers have been used therapeutically in some cases of hyperbilirubinaemia. The relationship between drugs and the hepatic porphyrias is reviewed. The hepatic microsomal enzyme system is but one of many inducible enzymes and the role of induction in general in metabolic regulation is emphasised.


[Development of a method for the quantitative evaluation of microorganism sensitivity to antibiotics utilizing disks. The determination of the minimal doxycycline concentration that depresses microorganism growth using disks containing this antibiotic].

A quantitative method for estimation of microbial sensitivity to doxycycline with the use of discs containing 10 gamma of the antibiotic was developed. The antibiotic concentrations in the agar were determined at a distance equal to the radius of the growth inhibition zone with the help of a curve of the dependence of the logarithm of the doxycycline concentration in agar at the period of the average critical time of the zone formation equal to 5 hours and the distance from the disc center. The antibiotic concentration in the agar at the zone edges was almost the same as the MIC of doxycycline against the test-cultures determined with the method of serial dilutions in agar.


[Vibrion variability under the action of antibiotics].

Tetracycline, streptomycin and monomycin resistant variants of the cholera and NAG-vibrios were obtained by means of repeated passages on nutrient media with increasing concentrations of the antibiotics (114 variants V. cholerae asiaticae, 1337 variants of V. cholerae eltor and 299 variants of NAG-vibrios of the 1st Heiberg group). The highest number of the antibiotic resistant variants was obtained under the effect of streptomycin and the resistance level to it was much higher (up to 8000 gamma/ml) than that to tetracycline or monomycin (160 or 320 gamma/ml respectively). The study of the differential-diagnostic properties of the above vibrios showed that 14.8 per cent of the strains of V. cholerae asiaticae and 4.6 per cent of the strains of V. cholerae eltor became non-typical with respect to the colony morphology and fermentative properties. Their agglutinability with the species or type specific cholera sera partially decreased. Nine per cent out of 299 antibiotic resistant NAG-vibrios had changes only in the colony structure. None of them changed their fermentative properties or acquired even minor capacity for agglutination with cholera sera or lysing with specific bacteriophages. The described changes in the properties of the antibiotic resistant cholera and NAG-vibrios were not stable and disappeared after 2- or 3-fold passages on media containing no antibiotics.


[Rifampicin action on the ultrastructure of E. coli cells].

The ultrastructure of Coli bacteria exposed to rifampicin was studied. Dependence of the level of the ultrastructural changes on the antibiotic concentration and the time of incubation with the antibiotic was shown. After exclusion of the antibiotic from the medium the organism growth with normal ultrastructure was observed.


In vitro susceptibility of Nocardia asteroides to amikacin.

By drug dilution tests in agar, it has been shown that each of 27 strains of Nocardia asteroides was inhibited by 1 mug or less of amikacin per ml of medium.


Hemodialysis-associated infections: treatment with cephapirin.

Large doses of cephapirin (50 mg/kg) administered during the first and last half hours of routine hemodialysis produced effective antimicrobial serum concentrations for 48 h. Repetitive administration during five successive hemodialysis sessions did not result in accumulation or accelerated metabolism of cephapirin. Ten infectious episodes in nine patients were treated in this manner with good clinical results and no toxicity.


Development of the agar disk method for the rapid selection of cephalosporin producers with improved yields.

To screen the abilities of mutant strains of Cephalosporium to produce cephalosporin C, colonies of the organism were grown on the surface of small (4-mm diameter) disks of agar medium. After incubation of the disks for periods of up to 5 days, the antibiotic contents of the disks were assayed by placing them on agar plates of the assay organism and determining the diameters of the inhibition zones. The amount of nitrogen source in the agar disk medium was used to control the amount of antibiotic produced in the disk and, thus, the sensitivity of screening. The relation of agar disk inhibition zone diameters to log shake-flask titers was linear with short incubation times (2 to 3 days) of the disks, but shifted towards a higher order with prolonged incubation (4 to 5 days). The optimum incubation time for the disks was 4 to 5 days, and then a 15% difference in zone diameters was significant with 10 disks per sample. The minimum difference between the shake-flask titers, which could be detected by the agar disk method with 10 disks per sample, was about 30% with 5 days of incubation for the disks. The results suggest that the shake-flask culture underestimated the degree of improvement in strain productivity.


Bullous pemphigoid and other disorders associated with autoimmune phenomena.

Although bullous pemphigoid is a disease associated with autoantibodies, it rarely has been associated with other diseases associated with autoimmune phenomena. We report the occurrence of bullous pemphigoid, pernicious anemia, and rheumatoid arthritis in a patient.


Cicatricial pemphigoid and rheumatoid arthritis.

A review of our experience with cicatricial pemphigoid revealed three patients with cicatrical pemphigoid and rheumatoid arthritis and one patient with ankylosing spondylitis who had a high titer of rheumatoid factor. A comparison of these four patients with patients who had bullous pemphigoid and rheumatoid arthritis shows similarities between cicatricial pemphigoid and bullous pemphigoid in relation to the development of rheumatoid arthritis.


Plane xanthoma and multiple myeloma with lipoprotein--paraprotein complexing.

Clinicopathologic findings are reported of a woman with generalized plane xanthoma, multiple myeloma (IgG type K), and hyperlipemia with very high levels of serum cholesterol and triglyceride. Complexing of the serum lipoproteins and immunoglobulins had cryoglobulin properties and was separable by ultracentrifugation. Immunofluorescent studies of skin and bone marrow demonstrated deposits of IgG with low density lipoprotein apoprotein and IgG with beta-lipoprotein, respectively. Although immunosuppressive therapy resulted in return of serum IgG, lipid, and lipoprotein levels to normal, the patient died from the myeloma. Serum lipoprotein-paraprotein complexes have been demonstrated in at least 20 other cases of cutaneous xanthomatosis and myeloma. This interaction may result in an autoimmune hyperlipemia.


Diagnosis of acute bacterial pneumonia in Nigerian children. Value of needle aspiration of lung of countercurrent immunoelectrophoresis.

Eighty-eight Nigerian children with untreated, severe, acute pneumonia were investigated by standard bacteriological techniques (blood culture and culture of pharyngeal secretions) and by needle aspiration of the consolidated lung. Countercurrent immunoelectrophoresis (CIE) against grouped pneumococcal and Haemophilus influenzae type b antisera was carried out on serum samples from 45 patients. The aetiology of pneumonia was shown by examination of the needle aspirate in 70/88 patients (79%), by CIE in 9/45 patients (20%), and by blood culture in 4/36 patients (11%). Overall, a bacterial cause for pneumonia was shown in 73/88 patients (83%). The results of pharyngeal culture were misleading when compared with cultures of needle aspirates. The prediction of aetiology from the radiological appearance was alos inaccurate, even for labor pneumonia. Needle aspiration of the lung, with a low (5%) and minor complication rate, merits wider application in the diagnosis of acute pulmonary infections in children. Tradiational bacteriological techniques (blood culture and pharyngeal culture) are of very limited value. The place of CIE in the investigation of childhood pneumonia still needs thorough evaluation.


Rifampicin therapy in shigellosis in infancy.

Eleven infants aged 1-2 years suffering from shigellosis associated with Shigella flexneri type 6 were treated with rifampicin. All were initially treated with antimicrobial drugs to which Sh. flexneri was shown to be sensitive, but without effect. Rifampicin was effective in curing gastrointestinal symptoms and eradicating the bacilli in all infants in 5 days. The drug was given in a dose of 10-12 mg/kg per day divided into two equal parts, for 7 days. No untoward side effects were observed. Our experience should encourage the use of this agent in controlling outbreaks of shigellosis and in curing resistant Shigella spp. infections where other antimicrobial agents prove to be inefficient.


Radioisotope scanning using a gamma camera.

Sixteen outpatients with rheumatoid arthritis took part in a placebo controlled double-blind crossover study. In addition to conventional measurements, a radioactive index was measured using a gamma camera that indicated a radioactive count over the measured joints and a comparable area of normal adjacent bone. This index showed poor correlation with other conventional measurements of change in the clinical trial.


Naproxen in osteoarthrosis. Double-blind crossover trial.

In this double-blind crossover trial, naproxen (750 mg/day) was compared to placebo for the treatment of osteoarthrosis of the hip and knee. Patients were randomly assigned to treatment with either naproxen or placebo for 4 weeks and then to treatment with the alternate agent for a second 4-week period. 8 out of 9 objective and subjective measurements of drug efficacy clearly differentiated naproxen from placebo at highly significant levels (P = 0.0001 to 0.0004). Patient daily check lists of osteoarthrotic symptoms also showed a statistically significant difference between naproxen and placebo therapy. Both physicians and patients, when asked to give a 'final drug preference', showed a significant preference for naproxen over placebo. In general, the incidence of side effects was low and approximately the same for both naproxen and placebo. Laboratory assessments showed little difference between groups. The trial showed naproxen to be an effective and well tolerated drug for the treatment of osteoarthrosis of the hip and knee.


Double-blind trial of naproxen and phenylbutazone in ankylosing spondylitis.

In a double-blind double-placebo crossover study naproxen (500-750 mg daily) was found to be equivalent to phenylbutazone (400-600 mg daily) in the control of disease activity in 20 patients suffering from ankylosing spondylitis during a two times 5-week trial period. No serious side effects were observed during the trial period. Gastric complaints occurred twice as often under phenylbutazone as under naproxen.


Sulindac. Trials of a new anti-inflammatory drug.

Trials in patients with rheumatoid arthritis and osteoarthritis showed sulindac to be an analgesic with anti-inflammatory properties and at least as effective as aspirin. It was effective within 24 hours in doses of 300-400 mg daily. It had the advantages of twice daily administration and a lower incidence of gastric side effects than aspirin. Constipation, usually mild, occurred in 20-30% of cases. Like other anti-inflammatory drugs, it was effective in only a proportion of the patients.


Pulmonary infections in renal transplant recipients.

Forty-six episodes of pulmonary infection occurred in 41 patients during a seven year period in which 187 renal transplants were performed in 168 patients. Thirty-seven episodes followed 152 cadaveric transplants (24.39%), and four episodes followed 35 living related donor transplants (11.4%). Five patients had two episodes of pulmonary infection. Twenty-four patients recovered, and 17 died (41.5%). Pulmonary infections appeared from two days to three years after transplantation, but predominated in the first four months (32/46). They were caused primarily by bacterial agents (74%) with protozoa, fungi, and viruses appearing less frequently. In 35 episodes, a single etiologic agent was found, but 11 were caused by two or more agents. When compared with noninfected recipients, there was no significant difference with regard to number of rejection crises, maintenance prednisone dosage, or blood glucose. However, subnormal renal function was significantly associated with the development of infection. Azathioprine dosages were actually higher for the noninfected patients, reflecting a tendency to lower the dose of azathioprine in the presence of decreased renal function. Fever was the most common presenting symptom. Transtracheal aspiration with Gram stain and direct sensitivity plating routinely provided early and accurate identification of the organism and a guide for therapy in bacterial infections. Pulmonary infection in renal transplant recipients is associated with a high mortality rate. Early diagnosis and specific treatment are essential to successful management.


[Sensitivity to chemoantibiotic therapy of new isolated Salmonellae strains (author's transl)].

The results of chemoantibiotic sensitivity tests carried out on 626 Salmonellae strains, isolated in 1973, 1974 and 1975 at the Bacteriol. Laboratory of S. Maria Nuova Hospital, Florence (Italy), are here related. The lowest percentages of antibiotic resistance have been noted to gentamycin and colimycin. Significant differences of antibiotic resistances were observed in single tested strains: the Salmonella wien strains were polyresistant, while the Salmonella panama strains showed a very high sensitivity to all the antibiotics. The conclusion is that in order to conduct a correct and useful antibiotic therapy, the microbic sensitivity test on isolated Salmonellae strains should be always performed.


[Ulterior acquisitions regarding the salmonellosis (author's transl)].

The Authors report the results of the bacteriological researches on the incidence of the Salmonella of our zone, after a brief consideration of general aspects salmonellosis. Our observations are refered to 1005 samples of feces of which 84 cases proved positive to Salmonella. It is pointed out that morbidity, represented by Salmonella typhi, paratyphi A and B is low, while it is high for the Salmonella typhimurium and Salmonella enteritidis. The Authors conclude stating that epidemiological situation of salmonellosis still represents a problem of remarkable importance which demands the intensification and the use of efficacious measures of prophylaxis.


The association of lung distention, PEEP and biventricular failure.

Although positive and expiratory pressure (PEEP) is known to depress the cardiac output, the mechanism remains debated. Two series of experiments were designed to explore this mechanism. In the first study, the application of 15 cm H(2)O of PEEP to nine anesthetized, ventilated dogs led to a reduction of cardiac index from (mean +/- one standard error of the mean) 2.71 L/min .m (2) +/- 0.35 to 2.19 L/min m(2) +/- 0.22 (p < .05) and a drop in mean arterial pressure (MAP) from 117 mm Hg +/- 8 to 91 mm Hg +/- 11 (p < .01). The mean net (vascular minus pleural pressure) pulmonary artery pressure (MPAP) rose from 15.3 mm Hg +/- 1.2 to 20.6 mm Hg +/- 1.8 (p < .02). The mean net central venous pressure (CVP) rose from 5.2 mm Hg +/- 0.9 to 8.4 mm Hg +/- 0.9 (p < .05) and the net pulmonary arterial wedge pressure (PAWP) rose from 6.7 mm Hg +/- 0.7 to 9.5 mm Hg +/- 0.9 (p < .01). There was a nonsignificant rise in the mean net left atrial pressure (LAP). As PEEP was raised in increments from 0 to 20 cm H(2)O, both LAP and PAWP increased. The rise in PAWP was always greater than the increase in LAP. The difference between PAWP and LAP was strongly correlated with the increase in MPAP (r = 0.98). This relationship was useful in correcting the PAWP during PEEP. The problem of cardiac depression was evaluated in a second series of eight dogs. These animals underwent complete chest wall excision to eliminate any possible direct effects of increased pleural pressure on the heart and great vessels. The absence of the chest wall permitted hyperexpansion of the lungs, particularly with positive end expiratory pressure. At 15 cm H(2)O of PEEP, the mean cardiac index fell in these animals from 2.36 L/min. m(2) +/- 0.26 to 1.47 L/min.m(2) +/- 0.18 (p < .01) and the MAP fell from 105 mm Hg +/- 16.2 to 68 mm Hg +/- 4.8 (p < .001). The CVP rose from a mean of 5.5 mm Hg +/- 0.4 to 8.3 mm Hg +/- 0.6 (p < .01) and the LAP rose from 6.3 mm Hg +/- 0.8 to 8.0 mm Hg +/- 1.1 (p < .05). The MPAP rose from 18.0 mm Hg +/- 0.6 to 23.3 mm Hg +/- 1.6 (p < .01). Comparison of Group I and II showed a significantly greater depression of the cardiac output and MAP in the open-chested animals. At the same time LAP was significantly higher. These data strongly suggest that PEEP and particularly pulmonary hyperinflation induce biventricular failure.


Evaluation of wound irrigation by pulsatile jet and conventional methods.

Irrigation of wounds to remove bacteria and foreign material is an essential of wound management along with debridement. The effectiveness of saline lavage by high pressure (50 psi) pulsatile jet irrigation has been compared with conventional gravity flow and bulb syringe procedures. Experimental paravertebral incisional surface wounds in 234 randomized rats were either clean or traumatized and soiled. Wounds in 200 of the rats were seeded with E. coli (log 8.80). Swab specimens of each wound were taken at incision, after seeding, after irrigation, and at three, seven, and ten days after closure. Eulates of more than 1600 specimens were cultured. No anaerobes were found. Irrigation diminished bacterial counts in all wounds, but only pulsatile jet irrigation brought about significant (P less than 0.05) reduction of bacteria in each type of wound. After three days E. coli was significantly diminished in all wounds, regardless of irrigation or none, owing to host defense mechanisms. Nevertheless, clean contaminated wounds were infected at three days but not at seven days after lavage, while traumatized wounds remained infected at ten days except for those initially irrigated by pulsatile jet. Thus, pulsatile jet irrigation removed bacterial from experimental wounds more efficiently than conventional procedures.


Impact of blood transfusion on renal transplantation.

The relationship between transfusion of different preparations of blood, sensitization to HLA antigens and survival of subsequent kidney transplants was investigated in 90 consecutive recipients. HLA lymphocytotoxins in transplant candidates precluded or greatly delayed receipt of an allograft (p less than 0.0005). Furthermore, only 17% of such sensitized recipients had functioning grafts one year after transplantation compared to 57% survival for nonsensitized recipients (p less than .02). A small number of nonsensitized patients who were never transfused had surprisingly poor one year graft survival (25%). If frozen blood is used for transfusion rather than whole/packed RBC, the incidence of patient sensitization can be markedly reduced without subsequent compromise in transplant survival (51%). It is concluded that as a consequence of avoiding HLA sensitization by transfusion of frozen blood (processed by agglomeration), the period of hemodialysis required for potential graft recipients will be shortened and an increased proportion of potential recipients will be successfully treated by transplantation.


Hematuria in renal transplant recipients.

This study is a retrospective analysis of microscopic and gross hematuria in 127 male renal transplant recipients. The incidence of hematuria was 12%. The causes of hematuria were similar to those in the general population with inflammatory conditions predominating. Urologic malignancy was not found. Hematuria heralded rejection episodes in three instances. Complete evaluation of hematuria revealed pathology of the urinary tract in every instance.


Myocardial revascularization in patients receiving long-term propranolol therapy.

Twenty-seven patients receiving long-term propranolol therapy underwent myocardial revascularization to relieve stable or unstable angina. The patients were randomly divided into two groups, one (Group 1) in which propranolol was discontinued 48 hours prior to operation and one (Group 2) in which patients received a final dose of propranolol 1 to 2 hours prior to operation. Several physiological variables were compared, and there was no statistically significant difference between the groups except for a slower pulse rate in Group 2 patients. Although the patients in Group 1 showed a greater frequency of hypertension before bypass, the incidence of postoperative complications and perioperative myocardial infarction was the same for both groups. The findings of this study indicate that myocardial revascularization is safe even if propranolol is administered up to 1 or 2 hours before operation.


[Incidence of fecal contamination in the samples of gicens and vegetables usually eaten uncooked (author's transl)].

The presence of E. coli has been found in the 48% of the samples of gicens and vegetables usually caten uncooked. The high incidence of fecal contamination suggests the necessity to build sewage plants, to forbid the use of superficial waters for irrigation and sanitary education to avoid alimentary contamination and enteric germ transmission.


Moderate and extreme hemodilution in open-heart surgery: fluid balance and acid-base studies.

Two groups of patients underwent aortic valve replacement. Fifteen patients received moderate hemodilution (mean hematocrit, 27%) with 40% donor blood in the priming solution. Extreme hemodilution was used in 14 patients (mean hematocrit, 18%) with a nonhemic prime and withdrawal of blood at the start of operation. Both groups were given more than 7 liters of fluid during operation; donor blood was primarily used in the moderately diluted patients, and Ringer's acetate was primarily given to the other group. The diuretic response to this fluid load was much more pronounced in the extreme than in the moderate hemodilution group. Eighteen hours postoperatively, patients in the moderate and extreme hemodilution groups had an excess of about 2 and 1.5 liters of water, respectively. In the patients who had moderate dilution an average of 1,000 ml of erythrocytes disappeared from circulation; no such disappearance could be found in the other group. The moderate group showed significantly lower arterial PO2 postoperatively than the extreme group. There were, however, no differences between the two groups in mixed venous PO2 during perfusion or in acid-base and osmolality values.


Reconstructive valve surgery.

Despite continued refinement of heart valve prostheses, valve replacement carries risks of thromboembolic, mechanical, and infectious complications, and long-term success is further limited by the eventual wear of prosthetic parts. In many patients with congenital or acquired valve diseases, valve function may be improved, if not restored, by reconstructive techniques, prosthetic replacement being thereby avoided or delayed. This review examines the current status of reconstructive procedures for management of diseased valves, with emphasis on long-term results and post-operative hemodynamic studies. In many instances the choice between reconstruction and replacement of a diseased valve remains controversial. The documented success of selectively applied reconstructive techniques, however, weighs against expedient decisions for prosthetic replacement and supports a continuing search for new techniques.


Long-term blood pressure changes in renal homotransplantation.

Long-term blood pressure changes were studied in 50 patients who had undergone renal homotransplantation. Excluded were those subjects with arterial stenosis of the transplanted kidney, acute or rapidly progressive rejection, or recurrent glomerulonephritis, as well as those retaining their own diseased kidney(s). The blood pressure after the end of the first year was stable and, therefore, was utilized as the reference blood pressure for this study. One year after transplantation, hypertension was observed in 20% of the patients. Mean blood pressure was positively correlated with age (P less than .01), body weight (P less than .001), and serum creatinine level (P less than .001), and negatively correlated with maintenance dose of prednisone (P less than .01). A higher incidence of hypertension was observed in cadaver kidney transplantation than in living related-donor transplantation. The study minimizes the role of glucocorticoids and emphasizes the role of renal factors in the mechanism of the long-term blood pressure changes.


Tests for treponemal antibody in CSF.

We studied the potential usefulness of CSF treponemal tests in the diagnosis of neurosyphillis. The CSF was tested with the microhemagglutination test for Treponema pallidum (CSF-MHA-TP test) and with the CSF-FTA test by using undiluted CSF and CSF diluted in saline and in sorbent. In a prospective evaluation, of 177 nonsyphilitics, none had reactive CSF-MHA-TP tests and only one had a reactive CSF-FTA test. However, five of 15 syphilitics with no other evidence of neurosyphilis had reactive CSF-FTA tests. The CSF-FTA test reactivity appeared most likely when the titer of the serum FTA test was high. In a retrospective evaluation of syphilitics with reactive CSF-FTA tests, similar patterns of reactivity occurred in patients with and without other evidence of neurosyphilis. Without other supporting clinical or laboratory data, the diagnostic value of a reactive CSF-FTA test is unknown.


Multicenter comparison of naproxen and indomethacin in rheumatoid arthritis.

In a double-blind, crossover study, naproxen, 250 mg twice a day, naproxen, 500 mg taken at bedtime, and indomethacin, 25 mg four times a day, were compared in 132 patients with rheumatoid arthritis; six centers participated in the study. Objective indices of arthritis activity, such as number of clinically active joints, walking time, and duration of morning stiffness, were nearly identical for the three treatment regimens. Of particular interest was the observation that efficacy of a single daily dose of naproxen was comparable to that of the twice-daily dosage. Naproxen was better tolerated than indomethacin, as shown by a statistically significant difference in the incidence of CNS complaints.


Pseudogynecomastia secondary to injection of heroin into breast tissue.

A 50-year-old man who has a heroin addict developed bilateral, symmetrical swelling of the breasts as a result of injecting himself directly into the breasts for several years. Results of histologic examination of the breast tissue showed granulomatous inflammation and a foreign body reaction without gynecomastia or tumor. Liver and endocrine functions were generally normal.


[Chronic peritoneal dialysis: an alternative to iterative hemodialysis].

27 children, aged 7 months to 15 years, with terminal renal failure and no available vascular access, were treated with chronic peritoneal dialysis for 3 weeks to 9 months (mean 3 months). An indwelling silicon catheter fitted with a subcutaneous dacron felt cuff was used; the average catheter life time was 10 weeks (3 to 25 weeks). Control of uremia was satisfactory with mean serum urea decreasing from 2 to 1 g/l and creatinine from 130 mg/l to 60 mg/l after 48 hours of dialysis. No uremic complications occured. Total serum protein remained stable: mean: 62 g/l prior to treatment and 60 g/l after the treatment period. Hematocrit was higher than in hemodialysed children (17% versus 15%). Three children were directly transplanted without difficulty. However, some complications did occur. There were 27 episodes of catheter obstruction leading to 12 surgical interventions. 18 episodes of peritonitis (5% of total dialyses) occured in 12 patients, and two were lethal. The frequency of complications prohibits a recommendation of chronic peritoneal dialysis over hemodialysis in children; this technique however remains very helpful in those situations where vascular access is difficult.


[Cytological detection of a myeloic metaplasia in punctates of transplanted kidneys and their diagnostic importance (author's transl)].

In 30 patients who had undergone renal transplantations, 45 renal biopsies were carried through for a suspected acute immuno-incompatibility (rejection) during the period from 1974-1975. Of all bioptic material taken swab-preparations were made at the same time, aiming at clarifying the cytomorphological criteria of the acute transplant rejection. In 14 out of 27 cases where an acute transplant rejection was histologically diagnosed, myelocytes and normoblasts were found in the smears. In one out of two chronic cases of transplant rejection the detection of metaplasias was negative. Thus, the detection of myeloic metaplasias in renal punctates is an important criterium for the cytodiagnostics of a transplant rejection crisis.


Chemotherapy as an adjuvant to surgery for colorectal cancer. A follow-up report.

An adjuvant program of fluorouracil for patients undergoing "curative" resection for adenocarcinoma of the colon and rectum was initiated as a randomized clinical trial in January 1968. Patients were randomly assigned to an intraluminal fluorouracil or intraluminal control (saline) group and were so treated at the time of surgical resection if findings at operation indicated that all gross neoplastic disease could be resected. Those patients receiving intraluminal fluorouracil (30 mg/kg) received intravenous fluorouracil (10 mg/kg) on each of the first two postoperative days and five subsequent postoperative courses of oral fluorouracil (90 mg/kg) in each 18-day course over a one-year period. By July 1, 1975, there were 203 patients undergoing curative resection entered into the study. Survival and disease-free data, as of Dec 31, 1976, revealed no benefit from this adjuvant course of fluorouracil. These data support the need for continued randomized clinical trials of new and innovative adjuvant therapy compared with an untreated control group.


Renal allograft rupture with iliofemoral thrombophlebitis.

Spontaneous rupture of a renal allograft in the early posttransplant period is associated with tachycardia, hypotension, oliguria, swelling, pain, a falling hematocrit level, and tenderness at the transplant site. Occasionally, the ruptured allograft can be saved by control of the hemorrhage. Deep vein thrombophlebitis, a common occurrence after prolonged surgery and cortocosteroid therapy, is less common in renal allograft transplantation, but may be associated with renal vein thrombosis. The simultaneous occurrence of deep vein thrombophlebitis, renal vein thrombosis, and allograft rupture contraindicates anticoagulent therapy. We present a patient in whom ipsilateral deep vein thrombophlebitis developed eight days after a cadaveric renal allograft, followed in two days by hypotension, a falling hematocrit level, oliguria, and a painfall mass at the allograft site. Surgical exploration revealed a ruptured allograft with iliofemoral and renal vein thrombosis and profuse hemorrhage. A transplant nephrectomy was performed.


Reperitonealization and invagination of the lesser curvature of the stomach following proximal gastric vagotomy.

Lesser curve necrosis usually presents as free perforation. A case of large gastric ulcer occurring very shortly after proximal gastric vagotomy (PGV) for a duodenal ulcer that was almost certainly due to ischemic necrosis of the lesser curve is presented here. Reperitonealization and invagination of the lesser curve is recommended following PGV so that, if necrosis occurs, it will take place within the stomach and not into the free peritoneal cavity. This maneuver may also avoid possible vagal reinnervation and the formation of dense adhesions between the stomach and liver.


Electron microscope observations of the membrane surrounding polyhedral inclusion bodies of insects.

Paracrystalline inclusion bodies (polyhedra) which occlude insect viruses are bounded by two membrane units which are closely appressed. The membranes appear to be similar to those of cisternae found in the nucleus. These cisternae were observed associated with polyhedra in various stages of condensation and appression.


Preparation of projection-less particles from influenza virus and their messenger activities in prokaryotic and eukaryotic systems.

A fraction of projection-less particles was prepared from influenza A/Dunedin/4/73 and A/Victoria/3/75 (X-47) (H3N2) by detergent treatment and extraction into ether at 0 degrees C. The activity of this material in stimulating protein synthesis in vitro was studied and compared with that of isolated virion RNA using a) an RNA-dependent E. coli system, and b) a wheat germ system. In the bacterial system the purified RNA had the highest template activity, while in the eukaryotic system the disrupted particle preparation was by far the most active. Translation products were formed with immunological and electrophoretic properties similar to those of several influenza virion proteins. The experiments indicate that, when added in the form of disrupted projection-less particles, RNA from influenza A2 virus is utilized as a template by eukaryotic ribosomes.


A rapid and inexpensive procedure for the purification of adenovirions.

A procedure for the purification of adenovirions is described. About 99 per cent pure adenovirions were obtained within only eight hours by use of chloroform treatment and two cycles of simultaneous sedimentation velocity and isopycnic centrifugation through a glycerol layer into a preformed potassium bromide gradient.


[Morphology of the endocrine portion of the teleost pancreas].

Endocrine component of the crucian (Carassius carassius), carp (Cyprinus carpio), tench (Tinca tinca) and silurus (Silurus glanis) pancreas is structurally organized in the form of pancreatic islets. Gorbusha (Oncorhynchus gorbuscha) has, besides the islets, some Brockman's bodies. Endocrine component of the pancreas of Teleostei possesses A-, B-, D and acinar-islet cells "B". All types of cells are shoot-shaped and all have contacts with the capillaries. Extrusion of the hormones from the endocrine cells is carried out via emiocytosis, and in gorbusha at the time of migration--by microapocrine means. Secretory granules were observed to get into the capillaries and make hormonal storage necessary for fish migration. It was demonstrated that endocrine component of the pancreas in Teleostei is highly rich in innervation, neuronal fibers containing small granular vesicles.


[Systems disinhibition and disintegration in pathology].

Two phenomena of universal biological significance are described, namely, disinhibition of the functional structures and disintegration of the biological systems. Both phenomena are interrelated: disintegration of systems releases its component functional structures from inhibition, and the uncontrolled activity of the disinhibited (hyperactive) functional structures leads further disintegration. These phenomena are initiated by a lesion. Disinhibition of the functional structures manifests itself differently in various systems, but it is always based on the deficiency of biological control. The formation of hyperactive structures as determinants which transform physiological systems into pathological ones, as well as derepression of subsequent links of the cellular genetic apparatus are particularly important in these phenomena. Some tissue processes have been investigated with regard to the latter. Under normal conditions the controlled disinhibition (facilitation) or derepression may be physiologically important and necessary for functioning. In the paper, a class of pathological processes termed as regulation diseases resulting from disturbances in the function regulation is defined.


[Methodological aspects in studying the radiation pathomorphosis of human tumors].

The paper discusses methodological aspects of radial pathomorphism of human tumors. Its main feature is a type change of clinico-anatomical features of some nosological forms of malignant tumors under the influence of radiation therapy. Morphological manifestations of radial pathomorphism are variable, but its criteria require systematization. The development of radial changes occurs step-wisely and is characterized by structural-functional rearrangement of the tumor and circumflex normal tissues.


Selective vacuolar myopathy with atrophy of type II fibers. Occurrence in a childhood case of acid maltase deficiency.

A 12-year-old boy being examined for vague chest pains was found to be suffering from acid maltase deficiency. Unlike previously reported cases in which vacuolization was most commonly noted in type I fibers, type II fibers were selectively involved in this patient and were atrophic Type I fibers were spared, or occasionally contained one or more small globular structures consisting of large, complex aggregates of lysosomal profiles.


Epithelialization of the anterior chamber after transcorneal (McCannel) suture.

A 35-year-old woman developed epithelialization of the anterior chamber with secondary glaucoma, following the use of a transcorneal (McCannel-type) suture to repair a traumatic iridodialysis. Clinical photographs and histologic documentation illustrate the potential for this serious complication from this surgical technique.


The effect of suture depth on outflow facility in penetrating keratoplasty.

Outflow facility was measured in human eye bank eyes following penetrating keratoplasty (PKP) and cataract extraction. After measuring baseline outflow facility, a PKP and lens extraction was performed with the corneal button replaced by both interrupted "through-and-through" sutures and a conventional mid-to-deep stromal running suture. Outflow facility was unchanged from baseline with both sutures. However, following removal of through-and-through sutures outflow facility decreased 37%. This same suturing procedure was repeated in a second group of phakic eyes in which suture depth did not influence outflow facility.


[Bone concentration of a new antimicrobial agent azlocillin (author's transl)].

The literature regarding bone level concentrations of different antimicrobial agents is reviewed. The investigation using Azlocillin shows a sufficiantly high concentration in human bone to include this agent among other semisynthetic penicillins.


Detection of syphilitic hearing loss.

Syphilis can cause sensorineural hearing loss that is potentially treatable. To determine the incidence of positive serological findings in patients with sensorineural hearing loss, the rapid plasma reagin card test (RPRCT) and the FTA-ABS test were performed in a study group composed of patients with sensorineural hearing loss of obscure origin. Of the 306 patients with sensorineural hearing loss, 20 (6.5%) demonstrated a positive FTA-ABS as compared with two of 100 (2%) of the control group. Considerable variation was found in the rate of the false-negative and the biological false-positive RPRCT as performed by our hospital and state laboratories when compared with the results of the FTA-ABS test. Syphilis should be considered in any patient with sensorineural hearing loss of obscure origin, despite a negative history for syphilis. The FTA-ABS is the preferred test to exclude hearing loss of syphilitic origin.


The nasal dorsum flap.

Closure of full-thickness defects of the nasal tip and sorsum requires both a satisfactory functional and an acceptable cosmetic result. The nasal dorsum flap is particularly well suited for closure of many such defects. The basic design of the flap, as well as several useful modifications, are discussed.


Aspergillosis of the frontal sinus.

Aspergillus is the most common fungal infection of the paranasal sinuses and usually appears as a chronic disease in an otherwise healthy person. Previously reported cases have involved the maxillary sinus alone in the majority of cases. To my knowledge, isolated frontal sinus aspergillosis has not been previously reported. A frontal osteoplastic flap approach was used to expose a fungus ball in the right frontal sinus of a healthy 69-year-old man. Histologic preparations and fungal cultures showed Aspergillus fumigatus. Follow-up substantiated prior experience that surgical removal of the fungal mass with drainage of the involved sinus is the treatment of choice in healthy patients with Aspergillus involving the paranasal sinuses.


Evidence for a high proportion of inactive ribosomes in slow-growing yeast cells.

From the protein and RNA content of Saccharomyces cerevisiae growing in different media we calculate that ribosome efficiency is changed: incorporation of amino acids into protein decreases from 8.8 amino acids/s per ribosome in fast-growing cells (0.54 doubling/h) to 5.2 amino acids/s per ribosome in slow-growing cells (0.30 doubling/h). We could not detect significant protein turnover in either fast-or slow-growing cultures, so the lower ribosome efficiency does not seem to be an artifact caused by changes in unstable protein production at different growth rates. Nor is the lower ribosome efficiency due to slower migration of ribosomes along mRNA: the times required to complete polypeptides of known molecular weights are the same in slow-growing cells as those previously determined for fast-growing cells [Waldron, Jund & Lacroute (1974) FEBS Lett. 46, 11-16]. We therefore deduce that ribosome efficiency changes in yeast because the fraction of ribosomes engaged in protein synthesis falls (from 84% in fast-growing cells to 50% in slow-growing cells.


Recognition of individual Escherichia coli transfer ribonucleic acids by 1-adenine-specific methyltransferase from rat liver.

Purified 1-adenine-specific tRNA methyltransferase from rat liver preferentially methylated Escherichia coli tRNA species containing the target adenylate residue in a G-T-psi-C-G-A-A-U-C sequence. The results of methylation of various tRNA species are discussed.


Salmonella enteritidis and Arizona hinshawii isolated from wild sandhill cranes.

Salmonella enteritidis serotype Rubislaw and Arizona hinshawii were isolated from cloacal swabs of "healthy" live-trapped sandhill cranes (Grus canadensis tabida) in Indiana and Wisconsin. These respective isolations were the first reported from wild sandhill cranes.


Characterization of two acid proteinases found in rabbit skin homografts.

Two types of acid proteinase activity found in rabbit skin homografts were characterized by studying the effect of temperature, pH and polyacrylamide-gel electrophoresis. Their chromatographic behaviour was characterized on DEAE-cellulose, Sephadex G-75, G-100 and G-200, and their molecular weights were estimated by gel filtration. One of the acid proteinases in the homograft resembled cathepsin D (EC 3.4.23.5) of normal skin. The other acid proteinase differed from cathepsin D with respect to heat inactivation, pH optimum and molecular weight; it was not inactivated on heating at 60 degrees C for 60 min, its pH optimum was 2.5 and its molecular weight measured by Sephadex G-100 chromatography was 100 000. In all these respects, the heat-stable proteinase resembles cathepsin E (EC 3.4.23.5) of rabbit polymorphonuclear leucocytes.


Demonstration of chymosin (EC 3.4.23.4) in the stomach of newborn pig.

The stomach of newborn pig contains a proteinase that is immunologically closely related to calf chymosin (rennin) (EC 3.4.23.4.). None of the pepsins from the stomach of adult pig is present in the newborn pig. Pig chymosin has optimal general proteolytic activity around pH 3.5. The ratio of milk-clotting activity to general proteolytic activity is about 30--70 times higher than that of pyloric and fundic pepsins.


[Demonstrating the effectiveness of cerebroactive drugs in aged patients. Results of a randomized double-blind study of a vincamine containing special preparation].

The neuropsychiatric symptoms of old patients with disturbed cerebral metabolism or blood flow mostly lead to great individual difficulties and make those patients difficult to handle: in the family as well as in hospital such patients develop alienation, isolation and therefore adaptation to a social structure deteriorates with time. In the course of a test program for medicinal therapy of this syndrome we studied the efficacy of a vincamine containing formulation (Pervincamin forte retard or Pervincamin ampoules, respectively) on the symptoms of a chronical brain disturbance. The study was randomised double-blind. We found that under the influence of the vincamine formulation the subjective symptoms, such as lack of interest, apathy, aggressiveness, raging, psychomotoric retardation, lack of concentration, dysmnesia, decreased with a statistical significance (p less than or equal to 0.05). Also the subjective symptoms, reported by the patients, such as tinnitus and vertigo decreased significantly under the treatment with the vincamine preparation. Therefore some of the parameters important for resocialisation and revitalisation of old patients could be influenced in a favourable way. Basing on the good results of our investigations, the treatment of psychiatric disturbances in old patients with vincamine containing drugs seems to be justified.


Epizootiological investigations of colibacillosis in turkeys.

One experimental and two field studies were conducted to assess the input of the three most common pathogenic serotypes of Escherichia coli (01a, 02a, and 078) via the hatch debris, environment of turkey buildings, and feed and water supplied these turkeys. Air samples were also taken to assess the environmental load in the experimental study. These studies revealed that in one field trial the input of E. coli 02a in conjunction with mild infections of Mycoplasma meleagridis (MM) and avian influenza (AI) contributed to an outbreak of acute colibacillosis with high mortality. E. coli 02a was isolated from the infected organs. At the processing plant, airsacculitis scores revealed lesions attributed mainly to MM. Lactose-broth rinsings of whole eviscerated turkeys indicated that pathogenic E. coli 01a and 02a could be detected at the time the turkeys are marketed.


[Clinical trial of tramadol by means of the "paired card" system (author's transl)].

1. 1-(m-Methoxyphenyl)-2-(dimethylaminomethyl)-cyclohexan-1-ol (tramadol; Tramal) was administered i.v. to patients suffering from pain of various origins. Its efficacy and side effects were compared with those of metamizole and placebo. 2. Tramadol (100 mg) was as effective as metamizole (2.5 mg) and significantly more effective than placebo. 3. All three compounds showed no significant differences in type and number of side effects.


[The effect of tramadol in an open clinical trial (author's transl)].

1. The new analgesic drug 1-(m-methoxyphenyl)-2-(dimethylaminomethyl)-cyclohexan-1-ol (tramadol; Tramal) was administered to a total of 840 patients by i.m. or i.v. injection or in suppository form in an open multi-center trial. The drug was found to be an effective and well-tolerated analgesic. 2. In all three forms of administration more than 80% of the patients treated rated the therapeutic efficacy of tramadol good to very good. In most cases the analgesic effect set in within 30 min and lasted 3--7 h. Tramadol was effective in relieving pain of various origins. 3. Serious side effects were not observed. The most frequent side effect was drowsiness. Transient hot flushes and outbreaks of sweating occurred occasionally following i.v. injection.


[Treatment of Sydenham's chorea with perphenazine].

Symptomatic therapy in Sydenham's chorea has not been satisfactory. Perphenazine was tested as an alternative to diminish abnormal movements. A Syndenham's chorea comparative double-blind study (17 patients) using it, with reserpine and placebo as controls, was designed. Perphenazine was tried also in another open-study (13 patients with Syndenham's chorea). Out of the 2 groups, those which received perphenazine improved earlier and in a greater proportion than controls, with statistical significance (p is less than 0.01).


Improved immune-suppression techniques for the exongrafting of human tumours.

The transplantability of a xenografted human adenocarcinoma has been examined in mice that had been immune-suppressed by thymectomy and whole-body irradiation and the results have been compared with transplantation into athymic (nude) mice. Two alternative techniques were used to prevent marrow failure following whole-body irradiation: reconstituting the animals with a marrow graft, or protecting them by an injection of cytosine arabinoside (Ara-C) 2 days before the irradiation. The results show that the Ara-C-prepared mice were more receptive to transplantation than marrow-grafted or nude mice, and they were the only animals that developed regional metastases from implanted xenografts. Some recovery of immunity occurred in both types of immune-suppressed mice, which was evident more than 5 weeks after immune-suppression and which was more marked in females than in males. It was concluded that the immune-suppressed mice were superior to nude mice for short-term experiments but they may be less satisfactory for long-term experiments.


An in vitro colony assay for human tumours grown in immune-suppressed mice and treated in vivo with cytotoxic agents.

An in vitro agar colony technique has been developed for the growth of tumour cells taken directly from human tumours grown in immune-suppressed mice. The novel feature of the technique is the addition of a replenishable liquid phase which permits the maintenance of relatively slowly growing cells. A number of different xenografted tumours have been cultured successfully in this system, with red blood cells added to the agar and using 5% O2 in the gas phase. The technique has been used to assay cell survival in tumours treated in vivo with cytotoxic agents, and examples are given of survival curves obtained from a pancreatic tumours irradiated with gamma-rays and a colonic tumour from mice treated with cyclophosphamide. The results obtained by this in vitro method are in agreement with those from the agar diffusion chamber technique. This culture method has also been successfully used for the growth of cells taken directly from human tumour biopsy samples obtained in the clinic.


Psoriasis treated with clobetasol propionate and photochemotherapy.

Comparable lesions in 16 patients with chronic plaque psoriasis were treated with clobetasol propionate or placebo ointments for 1 week before beginning photochemotherapy. The greater improvement of the steroid treated lesions was maintained after the ointment was withdrawn and there was a mean period of 31 days before those treated with placebo showed a comparable response to photochemotherapy. By the end of the study 8 patients were completely free of psoriasis, healing being achieved after a mean of 7.2 photochemotherapy treatments on the steroid treated lesions compared with 13.5 where a placebo ointment was used. No patient had any adverse reaction to treatment.


Immunofluorescent tracing of cytoplasmic components involved in keratinocyte differentiation.

Sera with epidermal cytoplasmic antibodies (E.C.A.) produced by human subjects after bone marrow transplantation have been studied by indirect immunofluorescen on rabbit lip sections. These sections were used in order to give on a single specimen, areas of mucosa, of parakeratotic and of orthokeratotic epithelium. It has been demonstrated that E.C.A. distinguished the basal cell layer from the upper cell layers on the three areas. Moreover, E.C.A. were not found to react identically on mucosal, parakeratotic and orthokeratotic epithelium. These findings strongly suggest that the target antigens for E.C.A. are molecules involved in keratinocyte differentiation.


Pattern of amblyopia and fixation after keratoplasty.

Forty cases of clear corneal grafts in 2 groups of patients who developed corneal opacities either before or after 5 years of age were investigated for the pattern of amblyopia and fixation. A severe irreversible form of amblyopia with eccentric fixation was observed in cases of unilateral corneal opacity when the anomaly occurred before the age of 5 years and corneal grafting was delayed until the second or third decade of life. If the opacity was bilateral, although the onset was before the age of 5 years, the improvement in visual acuity after corneal grafting occurred in the relatively better eye with foveal fixation. Good visual results were seen after corneal grafting when the offending opacity occurred after the age of 5 years. Foveal fixation was also observed in most of these cases. None of the patients who had a squint preoperatively lost their angle of strabismus. Four cases in group B, however, developed an alternating squint postoperatively.


Nucleotide clusters in deoxyribonucleic acids: sequence analysis of DNA using pyrimidine oligonucleotides as primers in the DNA polymerase I repair reaction.

Pyrimidine oligonucleotides have been shown to prime the E. coli DNA polymerase I repair reaction, specifically and reproducibly. DNA molecules up to 30 nucleotides long have been obtained from the extension of oligopyrimidine primers, 9 to 11 nucleotides long isolated from the complementary (minus) strand of bacteriophage S13 RFDNA using S13 viral DNA as the template molecule. The sequences of the extended primers were determined from mobility shift following separation of partially extended primers by ionophoresis and homochromatography, and by a modification of the "plus" system of Sanger and Coulson (1975). The 3' leads to 5' exonuclease activity of E. coli DNA polymerase was utilized for the "plus" system in the presence of single dNTPs and also with two dNTPs in the reaction, to give a nearest neighbor type of analysis for sequence confirmation. The ready availability of oligopyrimidine primers from any DNA and the simplification of the "plus" method broaden the range of applicability of the primed DNA polymerase I repair reaction for DNA sequence analysis.