Evaluation of compounding accuracy and aseptic techniques for intravenous admixtures.

Intravenous admixtures containing potassium collected from three hospital pharmacies were analyzed for compounding accuracy, sterility and pyrogenicity. The study was performed in two stages. During stage I, pharmacists and technicians were not informed of the study, but during stage II they were informed. In each stage 10 samples were collected from each person in the two personnel groups, analyzed and the results compared between the two personnel groups and the two stages. Results of the study showed that without monitoring (stage I) pharmacists had a higher mean percent error and contamination level than technicians. With monitoring, however, pharmacists showed a lower mean percent error and contamination level than technicians. Both personnel groups showed a decline in their mean percent error in the second stage, but there were still 83 (39.5%) errors in compounding accuracy greater than +/- 6%. No positive results with the Limulus test for pyrogens were obtained. It is recommended that a planned program of quality control be instituted for the preparation of i.v. admixtures by both pharmacists and technicians.


Evaluation of pharmacist management of streptococcal throat infections in a health maintenance organization.

A program within a health maintenance organization in which pharmacists were delegated the responsibility of treating and managing adult patients whose throat culture results were positive for group A, beta-hemolytic Streptococcus was evaluated. Results of 50 patients who received diagnostic throat cultures and treatment from internists, physician's assistants and nurse practitioners were compared with results of 58 patients treated and managed by pharmacists who followed procedures defined by physicians. Six hypotheses were tested with respect to the pharmacy program: (1) provider time is saved; (2) the time between throat culture and therapy initiation is shortened; (3) there are fewer return sick visits; (4) there are more reculture follow-up visits; (5) the medication regimen which exhibits a higher rate of cure (oral vs injection) is used more often; and (6) cost savings are realized. Hypotheses 1, 2 and 6 were supported by the results, 3 and 4 were possibly supported, and 5 was not testable. Pharmacists appeared to be as effective as the other practitioners in the management and treatment of streptococcal sore throat.


Asymptomatic IgA nephropathy associated with pulmonary hemosiderosis.

A glomerular lesion identical to that of IgA nephropathy was demonstrated unexpectedly in a 17 year old boy who presented with clinical manifestations of pulmonary hemosiderosis and with no evidence of renal disease. This subclinical glomerular lesion would have remained undetected in this patient unless kidney tissue was obtained and examined by immunofluorescence or electron microscopy. It is unknown if the glomerular lesion in this case is causally related to pulmonary hemosiderosis.


Histoplasmosis in immunosuppressed patients.

Infection with Histoplasma capsulatum in 58 patients whose immune responses were suppressed (Immunosuppressed patients) (16 from the present series and 42 described previously) was analyzed. The most common underlying diseases were Hodgkin's disease (29 per cent), chronic lymphocytic leukemia (19 per cent) and acute lymphocytic leukemia (17 per cent). Sixty-three per cent of the patients had received cytotoxic drugs, and 57 per cent had taken corticosteroids. Widely disseminated infection occurred in 88 per cent of the patients, with predominant involvement of lungs and organs of the reticuloendothelial system. Localized pulmonary infection was present in the remaining patients. The most useful diagnostic method was bone marrow biopsy with microscopic examination for the intracellular yeast form of H. capsulatum. Biopsy of oral lesions, lung, liver and lymph node also proved diagnostically helpful. Growth of H. capsulatum in culture was frequently too slow to be beneficial in diagnosing histoplasmosis in ill patients. Serologic methods were of little diagnostic help in this population of immunosuppressed patients. The response to amphotericin B therapy was excellent (6.7 per cent mortality rate) in those patients in whom the diagnosis was established early and in whom a full course of antifungal therapy could be given. In contrast, the mortality rate in patients who received no antifungal therapy or less than 1 g of amphotericin B was 100 per cent.


The management of renal scleroderma: experience with dialysis, nephrectomy and transplantation.

In 25 of 100 patients with scleroderma seen over a five year period irreversible renal failure developed; renal support was instituted in 17. Ten of 17 received peritoneal or hemodialysis, one survived. The remaining seven received hemodialysis plus nephrectomy; three survived. Two of these three underwent renal transplantation; one survived. This experience is presented to encourage improvement of these and other technics to increase the survival rate in the otherwise uniformly fatal renal failure associated with scleroderma (systemic sclerosis).


Recurrence of Reis-Bücklers' corneal dystrophy in a graft.

A 46-year-old white woman had Reis-Bücklers corneal dystrophy; the disease had recurred in a corneal transplant within ten years of transplantation.


Immunofluorescent and immunoperoxidase characteristics of IgDlambda myeloma involving the orbit.

A biopsy specimen from a 59-year-old man with unilateral proptosis revealed an orbital plasmacytic tumor. In vitro immunoperoxidase and immunofluorescence studies and direct immunoperoxidase staining of Bouin's fixed, paraffin-embedded tissue sections demonstrated that the tumor consisted of plasma cells with surface and intracellular IgDlambda immunoglobulin. Systemic evaluation demonstrated multiple myeloma. A review of previously published reports combined with the case presented here suggests that IgD myeloma has a predilection for orbital involvement. Thus, while IgD myeloma accounts for only 2% of all myelomas, it may account for a significant percentage of myelomas with orbital involvement. The distinctive clinical course of IgD myeloma, particularly its poor prognosis, warrants consideration of the immunologic and serologic findings in patients with orbital involvement by myeloma. The application of immunofluorescence and immunoperoxidase techniques to the study of orbital lymphoreticular neoplasms should result in a clearer understanding of these neoplasms.


Postoperative recurrence of Reis-Bücklers' corneal dystrophy.

A 68-year-old white man with a documented family history of Reis-Bücklers' corneal dystrophy had a penetrating keratoplasty of the right eye in 1962. In 1977, vision decreased and foreign body sensation returned. Examination indicated a Reis-Bücklers' dystrophy that had appeared in the graft 15 years after the transplant.


Value of hyaluronidase in ocular surgical akinesia.

In a study of 27 cases of surgery for cataract extraction, mepivacaine 2% with hyaluronidase was found to shorten the induction times of facial nerve and retrobulbar blocks when compared to injections of mepivacaine 2% alone. The mean induction time of facial nerve blocks with hyaluronidase was 1.3 +/- 0.4 minutes. This was significantly (P less than .01) shorter than the mean induction time without hyaluronidase, 2.9 +/- 1.8 minutes. The use of hyaluronidase significantly (P less than .02) shortened the induction time of retrobulbar blocks. The median induction time with hyaluronidase was three minutes, whereas that without hyaluronidase was ten minutes. However, the use of hyaluronidase did not significantly (.25 less than P less than .50) alter the success rate of retrobulbar blocks.


Prevention by aspirin of the classic generalized Shwartzman reaction.

The classic generalized Shwartzman reaction induced in the rabbit was prevented with large doses of aspirin (250 mg/kg) when administered at the time of the first and preparing injection of endotoxin. Such a result was not observed when the drug was given at the time of the second and provoking injection of endotoxin. Our investigations on platelet and coagulation indicate that aspirin prevents disseminated intravascular coagulation through an interference with the blood coagulation and Hageman factor activation rather than by the inhibition of platelet aggregation and availability of platelet procoagulant activity.


The psychology of consciousness.

All psychologic phenomena occur in consciousness. However, "consciousness" has two meanings: the faculty and the content of awareness. Traditional psychologies have largely concerned themselves with the content, neglecting the problem of the faculty, thus, limiting our understanding of human psyche. Study of meditation is a viable approach to the exploration of both meanings of consciousness. Meditation aims at a "cleansing" of the mind to reach, thereby, a content-free and conflict-free state--pure consciousness.


Signet ring cell lymphoma. A rare morphologic and functional expression of nodular (follicular) lymphoma.

Nodular lymphomas and diffuse lymphomas of corresponding cellular composition have been shown to arise from follicular center cells. This paper describes a rare functional and morphological expression of malignant lymphomas arising from follicular center cells, namely, immunoglobulin production, an observation for which no detailed description or nanlysis is available in the literature. Furthermore, the unusual signet ring-like appearance of the lymphoma cells, which is due to retention of immunoglobulins within the cytoplasm, may result in an erroneous interpretation of metastatic adenocarcinoma or liposarcoma. Therefore, we are presenting a detailed analysis of light microscopic, histochemical, immunocytochemical, and ultrastructural observations. The lymphomas of all seven patients in our series showed nodular growth patterns; in all but one, diffuse areas were also observed. Five of the lymphomas were classified as poorly differentiated lymphocytic type and two as mixed cell type, according to Rappaport's classification. In four of the seven patients, the majority of the neoplastic cells had a clear vacuolated cytoplasm, and in three of these cases, a few of the neoplastic cells showed immunoperoxidase positivity for monoclonal IgG. This group in particular closely simulated metastatic carcinoma composed of so-called signet ring cells. In the remaining three cases, most of the neoplastic cells contained PAS-positive, Russell body-like monoclonal IgM. Ultrastructurally, the monoclonal IgG appeared as even-sized electron-dense spherules or irregular electron-dense clumps, while the monoclonal IgM appeared as membrane bound, homogeneous, electron-dense material. The implications of these findings and the morphologic features which are helpful in the identification of these lymphomas are discussed.


The father of sports medicine (Galen).

Although there were many physicians who treated athletes before Galen, I believe that he was the first to devote a major portion of his time to this field of endeavor. Furthermore, his systematic observations, his aggressive pursuit of newer and better ways of treatment, his teaching, and his publishing of his observations make him a kindred soul to the team physician and practitioners of sports medicine of today. It is for these reasons that I believe that he can justly be called the "Father of Sports Medicine."


Status inconsistency and drinking patterns among working men and women.

Previous research suggests that status inconsistents constitute a social category that is vulnerable to embarrassments and disappointments, since individuals who are of high status on one dimension and low status on another tend to respond to themselves in terms of the higher status, while other people tend to respond to them in terms of the lower one. This article extends this research to patterns of alcohol consumption and finds that status and status inconsistency are significantly associated with frequency of consumption and quantity consumed per occasion among certain groups of drinkers.


Psychiatric disturbances in drunk driving offenders referred for treatment of alcoholism.

The incidence of psychopathology in persons arrested for driving while intoxicated (DWI) has serious implications in both alcoholism treatment and in general highway safety. This study investigated the types of psychopathology, as measured by the Minnesota Multiphasic Personality Inventory (MMPI), in a sample of 116 males referred for treatment by a court diversion program.


Putative role of isoquinoline alkaloids in alcoholism: a link to opiates.

Although the isoquinoline hypothesis has stimulated and even tantalized the scientific inquiry of a small number of investigators, it has been an area of widespread controversy. For the most part, until recently, alcohol researchers would ascribe very little importance to the role played by insoquinolines in alcohol actions or in the disease state known as alcoholism. To most, there was adequate evidence that these condensation amines had potent pharmacologic properties but little was known about their biochemical and behavioral interaction with ethanol or opiates. As pointed out here, there is an increasing amount of evidence that indicates the putative role of isoquinolines as regulators of alcohol dependence. There is even evidence that suggests a possible "link" to opiates. If this turns out to be the case, then it is rational to consider the possibility that when one imbibes alcohol a central opiate-like substance is, in essence, produced. It would appear that the sum total of evidence to date supports the notion that there are common territories between the two highly addictive classes of drugs--alcohol and opiates. Although still not definite, future studies may well confirm the intermediacy of the TIQ compounds.


The synaptic properties of some tetrahydroisoquinoline alkaloids.

The ability of TIQs to alter the synaptic properties of catecholamines by interacting with receptor, transport, or metabolic mechanisms has been demonstrated.


Relationship between 3,4-dihydroxyphenylacetaldehyde levels and tetrahydropapaveroline formation.

It was demonstrated that DOPAL, the aldehyde derived from the action of MAO on dopamine, can condense with dopamine to form THP. This compound is of special interest, since it is an intermediate in the biosynthesis of morphine.


Identification of an isoquinoline alkaloid after chronic exposure to ethanol.

A rapid and simple method for extraction of biogenic amines from small tissue samples was used to examine striata from ethanol-treated mice for TIQs. The results indicate that chronic ethanol administration can induce the formation of MSAL in striatal tissue.


Inhibition of high affinity calcium binding by salsolinol.

Recently, the discovery of endogenous opiate peptides has reawakened new interest in the possibility that an endogenous chemical may mediate actions of alcohol and lead to ethanol dependence.


Tetrahydroisoquinolines in the brain: the basis of an animal model of alcoholism.

Quite surprisingly, the direct introduction of THP into the brain induces a remarkable shift in voluntary alcohol intake... Even as much as 6 mo later, with no further infusions of THP, the remarkable voluntary selection of alcohol did not abate.


Alcohol consumption in pregnant women and the outcome of pregnancy.

A prospective study of more than 9000 women shows that during pregnancy, women consuming alcoholic beverages in excess of 40 cl of wine per day have an increased risk of the following unfavorable pregnancy outcomes: (1) the risk of stillbirth is elevated, especially for death from abruptio placentae: (2) mean birth weight is lower, and the risk of a small-for-date infant is increased; (3) placental weight is also decreased. Although heavier drinkers differ from lighter drinkers in a certain number of variables that are risk factors for the outcome of pregnancy, the increase in risk with increased alcohol consumption remains evident after adjustment for these confounding variables. The increase in risk for heavier drinkers appears to be due to beer consumption, in spite of the lower average amount of ethanol consumed by beer drinkers as compared to wine drinkers.


Stability of intelligence in the fetal alcohol syndrome: a preliminary report.

A clinical sample of 17 patients with fetal alcohol syndrome was given follow-up IQ testing 1-4 yr after an initial evaluation. Although 77% of the patients had a retest IQ that was within 1 SD of their initial IQ, some individual children did manifest considerable change in scores on retest. Repeated psychologic evaluation at regular intervals is recommended for children with fetal alcohol syndrome so that appropriate educational programming can be maintained in order to promote maximum development in each child.


Naturalistic observations of newborns: effects of maternal alcohol intake.

This article deals with the question of whether offspring of social drinkers would show, to a lesser degree, some of the behavioral characteristics of infants with fetal alcohol syndrome. Another question concerned individual differences in "temperament."


Drinking during pregnancy in alcoholic women.

Assessment of specific periods of bringe drinking (including dates, duration, and amount consumed) would seem particularly important in research on the outcome of pregnancy. One study has already shown that brain malformations in stillborn and expired infants were more related to the pattern of drinking than to overall "AA score."


[Biological compatibility of polyurethan (PUR) (author's transl)].

After implantation of a disc (thickness: 0.25 mm, diam: 1.5 mm) of PUR in the anterior chamber of rabbits through a lancet incision, the reactions of iris, aqueous, and cornea were observed for six months at regular intervals using slit-lamp photography. 'Steeping' materials were as compatible as nonsteeping materials. At the place where the disc touched the iris one could see during a half-year period hyperemia iridis and foreign-substance granuloma of the iris. The cause of these reactions is a toxin in the PUR. Mechanical irritants as a cause could be excluded through the method utilized in the experiment.


The endocrine control of embryonic lung maturation in the chicken. II. Role of the hypophysis.

In order to discover whether the embryonic chick hypophysis acts upon lung maturation directly or via its corticotrophic activity, immature lung primordia were grafted into young hosts, either alone or associated with functional adrenals or pituitaries. When lung primordia were grafted alone, type II pneumocytes did not differentiate. Their differentiation was restored when lung primordia were grafted in association with either adrenals or pituitaries. This last result, which was also obtained in vitro, shows that the hypophysis is able, by itself, to promote the maturation of respiratory epithelium.


Prostaglandins and hypertension.

Evidence is presented demonstrating the role of prostaglandins in salt metabolism and on peripheral vasodilation. A number of animal studies and observations in human hypertensive subjects suggest that the prostaglandin system plays a role in the pathogenesis of hypertension. The most striking and consistent finding over many decades of investigation is the relationship between dietary salt intake and the development of hypertension. Only a small percentage of any population develops hypertension. It is suggested that those people whose kidneys have an abnormal salt-handling capacity develop hypertension when challenged by a chronic high-salt intake. The salutary effects of diuretics or low-salt diet support this concept. Hypertension then is an expression of a renal abnormality. Prostaglandins, one of the renal salt regulating factors of the kidney, amy be involved in this abnormality. Whether there is a defect in the matabolic pathways or an unresponsiveness to normal stimuli of prostaglandins has not been determined. The use of prostaglandins in the treatment of hypertension is being explored. The demonstration that PGA1 can effectively lower blood pressure and reverse hypertensive emergencies indicates that prostaglandins probably have a broader, still unidentified role in the overall management of essential hypertension.


[Alkaline phosphatase isoenzymes in human serum].

The study of isoenzymes is often of great interest in clinical biology however, as far as alkaline phosphatase is concerned, no simple method is available to evaluate the forms of bony, intestinal, hepatic or placental origin. In most cases, it is necessary to combine several technic: electrophoresis, denaturation by heat, urea or phenyl alanine. This already complex analytical problem is rendered still more difficult by the choice of reference isoenzyme to be used calibration of the technic. The interest of this determination, especially in the field of oncology and pediatrics, should however encourage the biologist to pursue this route.


[Microgallery for the identification of anaerobic bacteria].

A microgallery for the identification of anaerobic bacteria (API 20A) was used with regard to 213 strictly anaerobic strains isolated between 1.12.74 and 30.11.75 in a hospital laboratory. Furthermore, 75 strains of Bacteroides fragilis isolated previously were added to this study. All the strains were identified by traditional methods. The results of tests performed with the microgallery alone permitted the species diagnosis in 72,2% of cases. Performing simultaneously complementary tests (7 to 9 Tubes, according to the nature of the bacteria) the species diagnosis was possible in 89.9% of cases. The main interest of this microgallery was its use for the identification of glucidolytic strains for it included the presence of 17 ternary substances. Its use for the other groups of strains was thus limited.


Trace concentrations of anesthetic gases: a critical review of their disease potential.

Only high levels of anesthetics and long times of exposure cause significant histotoxicity in laboratory studies on cells and animals. The disease-provoking mechanism involves profound physiological phenomena associated with anesthesia. Trace concentrations of anesthetics produce none of these effects. Therefore, studies using high concentrations have no value in predicting the effects of trace concentrations. Laboratory studies show that none of the most commonly used halogenated anesthetics produces cancer in animals. Epidemiological studies show no correlation between anesthetics and cancer in men and only a dubious correlation in women. The epidemiological studies to date on reproductive disease are inconclusive. They have not been designed to eliminate errors of data gathering or statistics. Nor have they been designed to test the cause-effect relationship between trace concentrations of anesthetics and reproductive disease. Anesthesiologists have a lower mortality rate than physicians as a whole. Conservative environmental health standards suggest that anesthetic levels in excess of those found in unscavenged operating rooms should be nontoxic. There are no statistically sound studies which prove that trace concentrations of anesthetic gases exert harmful effects.


[Anesthesia and resuscitation in surgery for aseptic osteonecrosis in patients with renal transplants].

Aseptic osteonecrosis following renal transplantation occurs in about 20 p. 100 of cases and entails important functional consequences. 16 patients with kidney transplant and 4 patients on chronic dialysis because of previous graft rejection underwent 27 orthopaedic operations, 8 of which being hip arthroplasties. During and after the procedure the anesthesiologist had to manage with drug interaction, coagulation disorders, blood compatibility problems etc... Despite poor general condition of patients and the risk of infectious complications linked to the never interrupted immunosupressive treatment, the surgical results of our serial were good.


Anti-lung antibodies associated with human lung allografts.

Serum specimens from 4 patients who had had a lung allograft were examined for anti-lung antibodies. Two patients developed antibodies after transplantation, and in 2, the antibodies increased in titer after an allograft. The absorption of the anti-lung antibody by fetal lung cell cultures, in contrast to the failure of absorption by kidney cell cultures from the same fetus, indicates that the antibody is lung specific.


Serum IgE and IgG antibody activity against Aspergillus fumigatus as a diagnostic aid in allergic bronchopulmonary aspergillosis.

Serum IgE and IgG antibody activity against Aspergillus fumigatus was measured in 3 groups of subjects by 2 different immunologic methods. Group A consisted of 23 patients with allergic bronchopulmonary aspergillosis (ABPA). Group B was composed of 19 patients with extrinsic asthma who had marked immediate type skin reactivity to A. fumigatus (prick skin test, 3 or 4+) but no other manifestation of ABPA. Group C, the control group, was composed of 12 healthy subjects. Two immunological methods, including a solid-phase polystyrene tube radioimmunoassay and an iodine-125-labeled, A. fumigatus antigen radioimmunoassay, were used to study each patient's serum sample, so as to demonstrate IgE antibody activity against A. fumigatus (IgE-Af) and IgG antibody activity against A. fumigatus (IgG-Af). Both IgE-Af and IgG-Af were significantly greater among patients in Group A than among those in Group B and Group C, as measured by both methods (P is less than 0.001). The results of this study suggest that either method can be used as a diagnostic aid for ABPA. These methods may provide a laboratory test permitting diagnosis of ABPA in its early stages before bronchial or pulmonary destruction occurs.


Treatment of massive hemoptysis by combined occlusion of pulmonary and bronchial arteries.

Massive, life-threatening hemoptysis occurred in a patient with left upper lobe bronchiectasis secondary to old tuberculosis. Selective left bronchial arteriography showed extravasation of contrast medium in the bronchiectatic area. A marked decrease in hemoptysis occurred after selective left bronchial arterial embolization. Complete cessation of bleeding followed the inflation of a Swan-Ganz balloon catheter that had been placed in the left main pulmonary artery.


[Screening of urinary tract. infection using the dip-strip method with 770 school girls (author's transl)].

The results of a significative bacteriuria detección programme with a group of 770 girls between 6 and 14 years old using culture method of dip-strips which have to be inoculated, incubated, and read by health officers, are shown. This method has proved to be efficient in the detección of significative bacteriuria in big towns and of low cost if it is compared with other methods.


[Chemical structure of mycobacterial cell wall].

The immunostimulant properties of mycobacterial cell walls have led to a thorough study of their structure and to isolation of their components. The backbone of the mycobacterial cell wall is of a covalent structure ("covalent skeleton") made up of two polymers covalently linked by phosphodiester linkages: a arabinogalactan mycolate and a peptidoglycan. To this covalent structure are attached, in a rather ill defined manner, proteins or lipoproteins and, in pathogenic and most vaccinating strains, a partly amidated poly-alpha-L-glutamic acid. The mycobacterial cell wall also contains about 25% of free lipids, i.e. lipids which can be extracted by neutral solvents.


Mycotoxins produced by Aspergillus fumigatus isolated from silage.

Results are presented which show that Aspergillus fumigatus was one of the predominant fungi contaminating moldy silage. Growth of A. fumigatus on silage appeared to depend on a preliminary aerobic fermentation by other natural microflora in silage. The clavine alkaloid, fumigaclavine A, and a new clavine alkaloid designated fumigaclavine C were produced by A. fumigatus. The LD50 of fumigaclavine C was approximately 150 mg/kg oral dose in day-old cockerels.


[Diet imbalances and aflatoxicosis].

Generally we know influences of diet's balances or imbalances upon toxicants. Some actions appear with aflatoxins as shown by studies on rat, pig, calf, poultry, turkey and duckling. According to species considered, oral administration of aflatoxins reduces food consummation, Nitrogen balance, respiratory coefficient. Therefore those modifications may be induced by a decrease of foodstuffs ingestion. It has been underlined that hypoproteic diet increases intoxication and diet rich in lipotropic factors decreases it. The greatest number of experiments carried out are concerning vitamins A and D. Authors are recounting their own experimentations upon relationships between Ducklings, aflatoxicosis, retinol consumption and cholecalciferol deficiency. In Duckling, diet deficient in vitamin D increases aflatoxins toxicity. Some relations exist with cytochrome P 450.


Effects of aflatoxin on the cellular immune system.

Observations of aflatoxin induced thymic involution were followed by studies of other parameters of cellular immunity. Guinea pigs treated with 0.03 to 0.35 mg aflatoxin B1 for 3 to 5 weeks were tested for the development of cutaneous hypersensitivity, migration inhibition factor activity, and stimulation of lymphocyte transformation. A significant suppression of cutaneous hypersensitivity to a Nocardia asteroides sensitin in sensitized aflatoxin recipients was demonstrated. In vitro reductions in migration inhibition factor (MIF) and depressed stimulation indices (Phytohemagglutinin) of peripheral blood lymphocytes were also demonstrated in aflatoxin recipients but did not reach significant levels.


The effect of oxisuran, a selective inhibitor of cellular immunity, on the rejection of bovine corneal xenografts in rabbits.

Oxisuran, a selective inhibitor of cellular immunity, delayed the rejection of bovine corneal xenografts when it was administered intraperitoneally to rabbits. The drug produced no significnat effect on the production of humoral antibody in response to injected sheep erythrocytes.


A hypothesis on the pathogenesis of pterygiums.

All true pterygiums are attracted to a specific site at the corneoscleral junction along the 3 to 9 o'clock meridian. The pathogenesis of a pinguecula-pterygium is postulated to be due to a noninfected inflammation at the junction of the conjunctival blood vessels and Bowman's membrane where the autolytic process of inflammation results in a protein degradation amino acid mixture which has the ability of attracting conjunctival blood vessels on the cornea. This amino acid mix is hypothesized to contain a pterygium angiogenesis factor.


The capacity of histocompatibility antigens solubilized in hypertonic salt solution to induce allograft tolerance in rats.

Treatment of Fisher rats (AgB 1,26,28) with a soluble extract of histocompatibility antigens (SAE) prepared from the liver of donor August rats (AgB 5, 28, 31) associated with a few injections of anti-lymphocyte serum (ALS) provoked a specific prolongation of the median survival time of skin grafts from 27.6 +/- 11.4 days in ALS-treated controls to 55.1 +/- 8.8 days (p less than 0.01). The SAE was obtained from liver homogenates by hypertonic KCl (3M) extraction. Further purification by chromatography in DEAE-cellulose column resulted in the separation of fractions possessing a specific inhibitory activity on a Fisher anti-August cytotoxic serum that was almost 100 times higher than that of the initial SAE preparation. Analysis of the state of unresponsiveness induced by SAE and ALS showed that most of the unresponsive animals had in their serum blocking factors. On the other hand, in vitro study of proliferative and cytotoxic components of cell-mediated immunity by mixed lymphocyte reaction and cell-mediated lympholysis, respectively, showed that the proliferative reactivity remained unimpaired whereas the cytotoxic reactivity was clearly inhibited in the tested animals. These results suggest that a central tolerance to histocompatibility antigens (equivalent to those coded by the K and D end in the mouse) could have been induced in the experimental animals whereas reactivity to Ia region antigens was not affected.


Valproic acid in epilepsy: clinical and pharmacological effects.

The antiepileptic drug valproic acid was studied in an open clinical trial as adjunct medication for 23 patients with uncontrolled seizures of a generalized or partial type. Two-thirds of the patients experienced reduction in seizure frequency ranging from 25 to 100%. Extensive testing revealed no evidence of serious systemic toxicity due to the drug. Minor side effects (e.g., nausea, vomiting, or sedation) were usually transient. Sodium valproate syrup and valproic acid in capsules gave equivalent mean low (23.3 microgram/ml) and maximum (42.5 microgram/ml) serum concentrations. The drug had a relatively short half-life of 8.7 hours, necessitating administration in divided daily doses. During initiation of valproate therapy there was evidence of a decline in total serum phenytoin concentration (16.5 to 10.2 microgram/ml; p less than 0.001) while the percentage of free phenytoin increased (10.9 to 20%). The quantity of unbound phenytoin was relatively stable throughout. This observation was interpreted as a drug interaction: valproic acid competed with phenytoin for access to plasma protein binding sites.


Immunofixation following electrophoresis or isoelectric focusing for identification and phenotyping of proteins.

Immunofixation following electrophoresis or isoelectric focusing has proven to be a powerful tool for the phenotyping of plasma proteins, the identification of proteins such as M-components and the study of conversion or breakdown products of proteins such as C3. One of the major advantages is the ability to compare, side by side, the mobilities of relatively low-concentration proteins. The technique is relatively simple, can be used with most types of gels and can be enhanced when necessary by the use of enzyme- or radiolabeled antibodies. The cost is competitive with other immunochemical procedures which are more tedious but which give less information.


The fibrinogenopathies.

This paper reviews the reported clinical, functional and biochemical abnormalities associated with abnormal fibrinogens. It appears from studies on fibrinogen Detroit that a single amino acid substitution in a critical part of the molecule can lead to major functional abnormalities and clinical consequences of either bleeding or thrombosis. Functional defects observed include: abnormal release of fibrinopeptide A or B or both after incubation with thrombin, abnormal polymerization and abnormal clot stabilization.


Four-year treatment of patients with parkinsonism using amantadine alone or with levodopa.

Half of 94 parkinsonian patients improved on amantadine therapy during acute double-blind trials. In a four-year follow-up, amantadine given alone or added to a stable dose of levodopa had its greatest effect in the first month and helped few patients after six months. Levodopa either alone or added to a stable dose of amantadine had a beneficial effect lasting three years or more. The side-effects of edema and livido reticularis occurred twice as often in women. Confusion and hallucinations appeared sooner on a regimen of 300 mg of amantadine a day, but the ultimate incidence was the same on 200 mg a day. Withdrawal effects from amantadine are no less frequent or serious than from other antiparkinson medications and are not evidence that amantadine is still helping the patient. Considering the years of exposure, the morbidity and mortality do not indicate any risks peculiar to amantadine. Our mortality in all groups combined was 2.4 times that of the age- and sex-matched United States population.


The hypothalamus in Parkinson disease.

The hypothalamus was systematically examined in 30 patients with pathologically documented idiopathic parkinsonism. Using Lewy body formation as a marker for nerve cell degeneration, we observed abnormalities in every hypothalamus examined. Of the thirteen hypothalamic nuclei that could be individually identified, none were exempt from Lewy body degeneration. The tuberomamillary nucleus and the lateral and posterior hypothalamic nuclei demonstrated the highest average Lewy body counts (16, 9, and 3, respectively); they were also the most frequently involved nuclei. These findings may aid in interpretation of the autonomic and endocrine abnormalities in patients with Parkinson disease.


Amanita mushroom poisoning with recovery from coma: a case report.

The incidence of Amanita mushroom poisoning seems to be increasing in the United States. Its neurological aspects contribute importantly to morbidity and mortality. In reported series, mortality has ranged from 50 to 90%, and survival following the appearance of coma was exceptional. The cause of nervous system involvement was uncertain. In the patient presented here, clinical and electroencephalographic observations were consistent with severe hepatic encephalopathy and correlated closely with liver function abnormalities. Despite the development of coma, full recovery followed the use of thioctic acid, an experimental therapeutic agent.


Chemotherapy of non-Hodgkin lymphoma: the diffuse types.

Patients with malignant lymphoma, diffuse type, have an unfavorable prognosis when compared to those patients with modular patterns. Prior to the introduction of combination chemotherapy, 50% survival rates for MC-D or PDL-D were about 2 years, HL-D about 1 year. Aggressive combination chemotherapy for advanced MC-D or PDL-D results in complete remission rates of 22-82%, with median survivals of 1-2 years. Patients with localized HL-D are probably curable with radiotherapy alone in 75% of cases. Patients with advanced disease are best treated with intensive combination chemotherapy, achieving a long-lasting complete remission in over one-half of cases, with median survivals now at 1-3 years. Many of these patients are probably cured, central nervous system relapse may now be a concern. The results of treatment of advanced histiocytic lymphoma are now approaching the results reported for advanced Hodgkin disease.


A recent overview of chemotherapy for advanced stomach cancer in Japan.

This paper reviews the recent chemotherapy regimens performed in Japan for advanced stomach cancer. Results from the use of single agents, combination chemotherapy and arterial infusion are presented. The overall response rate to either single or combination therapy was 30-40%. The effectiveness of chemotherapy in patients with metastatic disease was dependent on the site of metastases. The overall duration of survival ranged from 2 to 6 months. Several new approaches to treatment are discussed.


Chemotherapy modalities and immune condition of the host.

It is clear that it is possible to improve the immune condition of the host and to increase its immunological reactivity by employing a range of modalities. These may involve nonspecific immunostimulation of the host, active or passive immunization, adoptive chemotherapy, alteration of tumor cell antigenicity or other types of approaches. New agents may be sought that will serve as immunostimulants or that may prevent immunosuppression by tumor growth or by chemotherapeutic agents. New analogs of the known antitumor agents may be examined to determine whether they are less immunosuppressant than the parent drug. Any means leading to the net improvement of the immune status of the host may result in diminished drug toxicity for the host, increased antitumor response, and augmentation of immunochemotherapy.


[Properties of a Candida albicans strain possessing an increased sensitivity to polyene antibiotics].

Characteristics of a mutant of the yeast-like fungus Candida albicans with increased sensitivity to amphotericin B, levorin and nystatin is presented. Increased sensitivity to the polyens in the isolate must be associated with changes in the cell wall and/or with decreased total viability of the strain. The following factors were in favour of this: presence of significant amounts of pseudomycelial cells with thinner cell walls as compared to the yeast cells in the population of the mutant strain; a higher rate of potassium liberation from the cells of the mutant strain in the presence of amphotericin B; a lower growth rate of the mutant strain on solid and liquid media; an increased death rate of the cells in the intact culture of the mutant strain as compared to the initial strain; absence of changes in the absorption spectrum of sterols isolated from the cells of the mutant strain as compared to the initial culture.


[Enzymatic inactivation of levomycetin and penicillin by cells of the plague and pseudotuberculosis microbes that contain R plasmid depending on cultivation conditions].

The activity of enzymes, inactivating levomycetin and penicillin in the cells of plague and pseudotuberculosis microbes bearing extrachromosomal determinants resistant to a number of antibiotics was studied as dependent on some cultivation parameters: population age, aeration rate and temperature. It was shown that the highest capacity for levomycetin acetylation was characteristic of the cells in the late logarithmic and early stationary growth phages. Accumulation of levomycetin O-acetothers in the incubation medium markedly increased, when the cells were grown under the conditions of intensive aeration. An increase in the cultivation temperature up to 37 degrees C was accompanied by a reliable decrease in the activity of levomycetin acetylase in the transconjugant plague and pseudotuberculosis microbes though no correlation with the resistance levels in the same strains to the above antibiotics was observed. Optimal conditions for penicillinase production were determined. The maximum levels of penicillinase were found in the cells of Y. pestis 556/106 Rn with the episotic resistance type in the early exponential developmental phase under the aeration conditions and the temperature of 28 degrees C.


[Sensitivity of clinical Proteus strains to antibiotics and their combinations].

In 1976 isolation of Proteus from wounds of patients with various purulent processes amounted to 14.5 per cent. Serotypes 0-10, 0-3 and H-3 predominated among the isolates. Sensitivity of 35 clinical strains of Proteus to 10 antibiotics, furagin and nevigramone was studied by the method of serial dilutions in liquid media. All the isolates were highly resistant to the antibiotics except gentamicin, furagin and nevigramone, the MIC of which for most of the strains was 3.12, 1.6-3.12 and 6.25-12.5 gamma/ml, respectively. The effect of 14 combinations of chemotherapeutics was also studied. The combinations of gentamicin with carbenicillin, gentamicin with ampicillin and monomycin with ampicillin proved to be most effective against the Proteus strains tested. The following combinations may be of practical value: monomycin + carbenicillin, kanamycin + ampicillin, kanamycin + carbenicillin, ampicillin + furagin, gentamicin + nevigramone. The combinations of carbenicillin with furagin and gentamicin with furagin were also rational.


[Bioavailability of tetracycline hydrochloride capsules (an in vivo study)].

Blood absorption of tetracycline hydrochloride of various dispersity levels from capsules containing tetracycline alone or in combination with additives, such as magnesium carbonate and calcium salts was studied on humans. It was found that higher dispersity levels of tetracycline hydrochloride powder in capsules was not accompanied by increased blood absorption of the antibiotic. Addition of magnesium carbonate and calcium salts to the antibiotic in the process of capsulation markedly retarded the blood absorption. Clear correlation between the antibiotic dissolution rate in vitro and intensity of its blood absorption in volunteers was shown.


[Carminomycin study in breast cancer].

Karminomycin was used for the treatment of cases with disseminated cancer of the mammary gland in doses of 5 mg/m2 of the body surface intravenously every day for 5 days (15 patients) or 6 mg/m2 twice a week for 2-3 weeks (30 patients). Partial remission or diminution of the tumor size at least by 50 per cent was observed in 26 and 17 per cent of the patients respectively. The remission duration was from 2 to 6 months. With the use of the shortperiod scheme the frequency of the direct side reactions increased. Leucopenia as a side effect was registered in 100 and 40 per cent of the patients and thrombocytopenia was registered in 18 and 3 per cent of the cases respectively.


Germ-tube formation by atypical strains of Candida albicans.

Atypical isolates of Candida albicans which failed to produce germ tubes in routine diagnostic procedures were examined for their ability to produce germ tubes in various media. Bovine serum was more effective than defined media for induction of germ tubes in the majority of isolates. A few strains formed appreciable germ tubes only in bovine serum with added thioglycollate or cysteine. One strain did not produce germ tubes in any medium. Germ-tube maturation appeared to be dependent upon mitochondrial RNA polymerase activity. The failure by an isolate to produce germ tubes, particularly in tests without strictly controlled conditions, does not preclude the possibility that the organism is C. albicans.


Inositol deficiency in Saccharomyces cerevisiae NCYC 86.

When Saccharomyces cerevisiae NCYC 86, an inositol dependent strain, is grown at suboptimal concentrations of inositol, the buds are apparently unable to separate from the parent cells. Thin sections of such cells show an irregularly thickened cell wall. These morphological features may be due to a continuation or increase in the production of glucan while the synthesis of DNA, RNA, phospholipids.and protein is greatly inhibited.


Influence of bacteriological media constituents on the reproduction of Salmonella enteritidis bacteriophages.

Three different Salmonella enteritidis phages were isolated and purified from raw sewage by agar-layer technique. The sensitivity of the host organisms toward phages was changed when they were grown on different bacteriological media. The effect of single components of the medium on phage reproduction was determined by the omission of that substance from the medium. CaCl2,MgSO4, and glycerol each had a pronounced stimulatory effect on the phage reproduction, while bile salts had a profound inhibitory effect. The inhibitory effect of bile salts on phage growth was much greater on one strain of Salmonella enteritidis than on the other.


"Bactericidal" property of seawater: death or debilitation?

Coliform colony-forming units in sewage-contaminated seawater were observed to decrease rapidly with time in water that was collected from St. John's Harbour, Newfoundland, and isolated in dialysis bags; this confirms observations made in warmer climates. Adenosine 5'-triphosphate biomass, however, did not decline, nor did the particle size distribution of radioactively labeled coliforms change. It was observed that the coliforms were not killed by seawater but were debilitated to the extent that they would not form colonies on selective media. However, they recovered and grew on nutrient agar made with seawater. The adenosine 5'-triphosphate content per cell apparently did not decline during debilitation.


Threonine production by regulatory mutants of Serratia marcescens.

beta-Hydroxynorvaline (alpha-amino-beta-hydroxyvaleric acid)-resistant mutants of Serratia marcescens deficient in both threonine dehydrogenase and threonine deaminase were isolated and characterized. One of the mutants, strain HNr21, lacked feedback inhibition of threonine-sensitive aspartokinase and homoserine dehydrogenase, was repressed for the two enzymes, and produced 11 mg of threonine per ml of medium containing a limiting amount of isoleucine. The other mutant, strain HNr59, was constitutively derepressed for aspartokinase and homoserine dehydrogenase. Its kinase was sensitive to feedback inhibition, but its dehydrogenase was insensitive to feedback inhibition. This strain produced 5 mg of threonine per ml of medium containing either a limiting or an excess amount of isoleucine. Diaminopimelate auxotrophs derived from strain HNr59 produced more threonine (13 mg/ml) than the parent strain. However, similar auxotrophs derived from strain HNr21 produced the same amount of threonine as that produced by the parent strain.


Effect of prior refrigeration on botulinal outgrowth in perishable canned cured meat when temperature abused.

Perishable canned cured meat inoculated with Clostridium botulinum spores was placed at 4.4 or 10 degrees C after manufacture. Spore germination occurred at 10 degrees C. The germinated cell count remained stable over a period of 16 to 18 weeks. During that time period the inhibitory system and residual nitrite descreased. These factors combine to make perishable canned cured meats more prone to spoilage and potential hazard if they are temperature abused after a period of refrigerated storage.


Causes of variation in botulinal inhibition in perishable canned cured meat.

Final internal processing temperatures within the range of 63 to 74 degrees C did not alter the degree of botulinal inhibition in inoculated perishable canned comminuted cured pork abused at 27 degrees C. Adding hemoglobin to the formulation reduced residual nitrite after processing and decreased botulinal inhibition. Different meats yielded different rates of botulinal outgrowth when substituted for fresh pork ham. Pork or beef heart meat showed no inhibition of the Clostridium botulinum inoculum even with a 156-microgram/g amount of sodium nitrite added to the product. This effect appears to be one of stimulating outgrowth, since residual nitrite depletion was not measurably altered.


Control of nonspecific staining in the fluorescent antibody technique for the detection of salmonellae in foods.

A fluorescent antibody conjugate, prepared from the IgG (immunoglobulin G) fraction of Salmonella polyvalent flagellar antiserum, gave better specific staining intensities and significantly lower nonspecific staining than did conjugates prepared from globulin fractions of ammonium sulfate-fractionated Salmonella polyvalent antisera. IgG was purified by affinity chromatography against protein A, a normal cell wall component of Staphylococcus aureus. Affinity chromatography yielded high-purity IgG in a one-step purification procedure. The conjugate prepared from affinity-purified IgG was compared with commercially available fluorescent antibody conjugates for the detection of salmoneallae in retail samplings of meats and poultry and gave better correlations with the cultural method than did the commercial conjugates.


Cultural and environmental factors affecting the longevity of Escherichia coli in Histosols.

The survival of Escherichia coli in organic soils (Histosols) was examined. The death rate of this organism in Pahokee muck was less than that observed in Pompano fine sand. The number of viable E. coli cells found in the muck was approximately threefold greater than that found in the sand following 8 days of incubation. The initial population of the coliform affected the death rate. The rate of loss of viability varied 100-fold when the population size decreased from 2.5 x 10(7) to 3.4 x 10(4). Other factors affecting the viability of E. coli in muck were aerobic versus anaerobic growth of the organism and moist versus flooded conditions in the soil. The greatest survival of the coliform was noted with anaerobically grown cells amended to flooded soil. That the observed decrease in E. coli viability in soil was the result of biotic factors was demonstrated with amendment of sterile soil with E. coli. When 1.1 x 10(5) bacteria per g of soil were added to sterile muck, a population of 3.0 x 10(7) organisms per g of soil developed over a 10-day period. The role of the protozoa in eradication of the coliform from the muck was indicated by a sixfold increase in the protozoan population in natural soil amended with E. coli. Higher organic matter content in a Histosol compared with a mineral soil resulted in an increased survival of the fecal coliforms. Biotic factors are instrumental in the decline in coliform populations, but the potential for growth of the coliform in the organic soil could extend the survival of the organism.


Rapid sampling culture chamber.

An all-glass chamber for culturing anaerobic and aerobic bacteria in liquid medium is described. The system permits both rapid sampling and turbidimetric measurements under controlled atmospheric conditions.


Bacterial sampling techniques on beef, pork, and lamb adipose tissue.

Two methods were used to evaluate bacterial recovery from beef, pork, and lamb adipose tissue. Higher counts were obtained with a tissue removal and fluid agitation technique (shaking) than with surface swabbing, but only when bacterial levels were low. Bacterial recovery by both methods was unaffected by specie origin of adipose tissue and differences in surface texture, sample storage time (12 versus 6 days), and duration fluid agitation (5 versus 10 min).


Autoimmunity in psoriasis. A complement immunofluorescence study.

The stratum corneum (SC) antibodies are present in all human sera as seen by indirect immunofluorescent (IF) staining. They appear to bind in vivo to the stratum corneum of psoriatic lesions. They fix complement in vitro in a two step complement IF test system using either anti C4 or anti C3 conjugates as indicators. IF tests with proper controls showed that the SC antigen in psoriatic scales is coated not only with IgG but in a majority of the lesions also with complement. In the present studies in fully developed lesions complement was detectable in 88% of the specimens studies and in about 50% of very fresh linear lesions of unintentional Köbner type. These as well as some previously published observations afford indirect evidence for the participation of SC antibodies and the ensuing fixation of complement in the development of psoriatic lesions.


Autoimmunity in psoriasis. Relation of disease activity and forms of psoriasis to immunofluorescence findings.

Immunofluorescence (IF) studies using the test providing information on the reactivity of stratum corneum (SC) antibodies and their in vivo binding have been performed in 193 cases of psoriasis and 89 cases with other dermatoses. It has been shown that: 1. Essentially all fully developed, active psoriatic lesions had IgG deposits in the stratum corneum at the sites of the SC antigen, presumably due to in vivo binding of SC antibodies. 2. In various forms of psoriasis SC antigen sites appeared to be completely or almost completely satured with in vivo deposits of IgG as seen in tests with SC antibodies. 3. In most but not all lesions complement components C3 and/or C4 was found in a comparable pattern in the SC, especially when multiple specimens of single cases were studied. Partial or complete saturation of the SC antigen could be observed by the performance of complement indirect IF tests for SC antibodies in such specimens. 4. In lesions with typical histology of psoriasis the above-mentioned immunologic characteristics appeared to be a constant finding. However, in specimens of recent lesions which had not yet developed typical histology a proportion (2 of 17) were negative both for IgG and complement deposits. In receding lesions weak deposits of IgG were present only in a few specimens and complement deposits were as a rule negative. 5. In a group of 89 control specimens of other dermatoses only occasional cases gave the psoriasiform IF pattern, but about 30% of the specimens gave positive reactions in the SC though these were usually of a different pattern.


T and B lymphocytes in vitiligo.

Lymphocyte subpopulations were studied in 38 patients with vitiligo and in 44 controls. No significant differences in the results of several immunological examinations (E-RFC, EAC-RFC, EA-RFC, IF, IF-elution) came to light results suggest that the lymphocytes are probably not implied in the pathogenesisof vitiligo.


The chemotherapy of rodent malaria, XXIX DNA relationships within the subgenus Plasmodium (Vinckeia).

The relationships between rodent malarias were examined by means of DNA buoyant density determinations and DNA--DNA hybridization data. Current views of the existence in this group of four species: Plasmodium berghei, P. yoelli, P. vinckei and P. chabaudi were confirmed. The identity of two chloroquine-resistant lines derived from P. berghei N strain was established. One of these, the NS line, was found to be a subspecies of P. yoelii; the implications of this finding are discussed.


Spondylothoracic dysostosis: report of two cases and review of the literature.

Two Puerto Rican infants, offsprings of nonconsanguineous parents, died with spondylothoracic dysostosis as characterized by widespread anomalies of the spine (malformed vertebral bodies including hemivertebrae), deformity of the thorax, and fan-like configuration of the ribs. The disease was lethal in early life in the 18 cases previously reported. An autosomal-recessive inheritance has been described. Spondylocostal dysostosis, a related entity, showed associated intrinsic anomalies of the ribs. The 17 cases culled from the literature pursued a milder course, affected mainly older children and adults, and had a different pattern of inheritance.


[A contribution to the origin of ganglia. A study of light-, immunofluorescence-, and electronmicroscopic changes (author's transl)].

10 ganglia were studied by means of light and electrone microscope and with immunfluorescence methods. The light microscopic findings in the wall of a ganglion resemble on developing hygroma. The mesenchymal cells ultrastructurally show differentiation to synovia-like cells, either surrounding the ganglion in the connective tissue wall or lining the cavity. The development of synovial tissue from undifferentiated mesenchymal cells is due to the typical mechanical stimulus affecting joints.


[Investigations of pathogenesis of reactions in circulation and respiration during the implantation of bone cements. animal experiments (author's transl)].

This paper shows the effects of the increase in pressure in the medullary cavity in the blood circulation and the respiration observed during implantation of bone cement with animal experiments. The pathomechanism is also examined. The reactions of the respiration and the circulation, when observed, resulted in the intramedullary increase in pressure. These are nerval reflexes caused by the innervation in the medullary cavity and are not reactions of the monomer, which may come into the circulation during the polimerization of bone cement. These reactions are very different from those caused by the fatal obstruction of the pulmonary blood vessels through bone marrow ingredients. This is the effect of an insufficient prevention of increase in medullary pressure during cement implantation.


Clinical renal preservation by cryoperfusion with an albumin perfusate: renal perfusion with albumin.

Eighty-six human kidneys have been preserved by cryoperfusion with an albumin-based perfusate for five to 50 hours prior to transplantation. Sixty-three of the kidneys were transplanted. The overall immediate function rate was 72% and was 100% (34/34) for kidneys with no warm ischemic damage transplanted into recipients without hypotension or prior sensitivity. The overall actuarial one-month kidney survival rate was 87%, the three-month survival was 73%, and the one-year survival rate was 65%. No kidney was discarded because of poor perfusion. Perfusion data, including flow, dastolic pressure, perfusion time, and lactate concentration were not predictive of immediate renal function. Light, electron, and immunofluorescence microscopic study of biopsy specimens showed no evidence of perfusion or immunologic damage to the kidneys. Perfusion of transplantable kidneys with albumin provides reliable preservation for up to 50 hours without producing either structural or immunologic damage to the organ.


Transplant renal artery stenosis occurring in both recipients from a single donor.

Stenosis of the renal artery is increasingly being recognized as a cause of hypertension and renal failure after kidney transplantation. To our knowledge, this is the first report of an almost simultaneous occurrence of this complication in both recipients of kidneys from a single donor. In both cases, surgical correction led to improved renal function and amelioration of the hypertension.


The comparative acute mammalian toxicity of 1-chloroacetophenone (CN) and 2-chlorobenzylidene malononitrile (CS).

The comparative acute toxicity of two peripheral sensory irritant materials, 1-chloroacetophenone (CN) and 2-chlorobenzylidene malononitrile (CS), has been investigated in several species of small mammal using solutions in polyethylene glycol 300 for intravenous, intraperitoneal and oral administration, and as pure aerosols for inhalation exposure. Additionally, the comparative potency for inducing primary contact dermatitis was studied. CN and CS were found to be about equitoxic by intravenous and intraperitoneal injection, but CS was significantly less toxic by the oral and inhalation routes and less likely to cause non-lethal tissue damage than CN.


Posttraumatic phycomycosis of the anterior segment.

Keratomycosis and infection of the anterior chamber with a Rhizopus sp (phycomycosis, mucormycosis) developed in a 24-year-old man following a perforating injury of the cornea with a soil-contaminated screwdriver. The infection was documented by positive cultures of the corneal wound and of the anterior chamber and by histopathologic studies. Phycomycosis of the eye usually occurs in the setting of systemically impaired host resistance. The patient had no underlying disease that wound predispose him to this infection but the treatment with topical 0.1% dexamethasone and triamcinolone acetonide suspension injected into the sub-Tenon's space following the injury may have impaired his local immunologic defenses. Excisional keratoplasty played an important role in the successful management of this case.


Trachomatous entropion correction. Use of orbital septum and levator aponeurosis.

The technique of removing both the scarred tarsal plate and orbital septum is described for correction in cases of severe trachomatous entropion. The procedure gave about 90% satisfactory results in a series of which 35 eyes were operated. The combined technique is simple and can be performed as an office procedure.


An illuminated grid for macular testing.

The status of the macula should be included in the preoperative evaluation of patients about to undergo keratoplasty or cataract extraction. Frequently, corneal opacities or cataracts preclude visualization of macular details. In such cases, the Amsler grid is useful in assessing macular function. This study evaluated 15 patients with opaque media. In 13 patients, the opacity was too dense to allow the patient to see the Amsler grid. However, all 13 patients could see the illuminated version of the grid. Of the three abnormal responses detected by the use of the illuminated grid, two were caused by macular pathology and one by amblyopia.


Torulopsis glabrata endophthalmitis after keratoplasty with an organ-cultured cornea.

Fungal endophthalmitis developed in an elderly woman following penetrating keratoplasty with an organ-cultured cornea. An unsuccessful search was made for the source of the infection. Modification in our sterility checks prior to surgery were made in hopes of preventing future infections.


Congenital hereditary stromal dystrophy of the cornea.

Cornea from patients in two separate pedigrees showing dominant inheritance of a congenital nonprogressvie corneal clouding were examined by light and electron microscopy. The characteristic changes of abnormal corneal lamellae were widely and rather uniformly distributed throughout the stroma. The remaining corneal layers were normal. The findings are consistent with a diagnosis of congenital hereditary stromal dystrophy of the cornea, which differs greatly on both histologic and clinical grounds from the entity known as congenital hereditary endothelial dystrophy of the cornea.


Congenital syphilis of the eye with lens involvement.

Pathological examination of a girl with congenital syphilis revealed a focal granulomatous reaction involving the anterior uvea and lens. Krajian's (silver) stain exhibited spiral forms that were morphologically compatible with Treponema pallidum within the lens cortex. These findings have been rarely reported in early congenital lues.


Corneal storage at room temperature.

Short-term eye banking is based mainly on moist chamber and McCarey-Kaufman medium (M-K medium) preservation. Both involve a controlled 4 C temperature for  storage. Warming the cornea to room temperature, however, drastically affects the endothelial viability. On enzymatic staining and histological study, the M-K medium-stored rabbit corneas had more normal endothelium than did "moist chamber" eyes when storage was prolonged for seven days at room temperature. In human corneas that were kept at 4 C for 24 hours and then exposed to a temperature of 25 C, destruction of organelles had occurred by six hours and was increased by 12 hours. Corneas that were kept in M-K medium had relatively intact endothelium after four days, but cell disruption and vacuolation was present by the seventh day. The M-K medium, therefore, affords protection to tissue warmed to room temperature, where metabolic activity is resumed.


Ossicular replacement prostheses.

To find a way of improving the results of ossicular reconstruction in ears that were rendered hard of hearing by chronic otitis media, the suitability of two biocompatible materials has been investigated. After three years' experience with Proplast and two years with Plastipore, it is concluded that for ears which lack an incus and stapes arch, these materials provide results at least as good as those previously reported with homologous materials and have the advantage of easy manipulation, timesaving, and ready availability. As with all foreign material in the chronically infected middle ear, the risks of extrusion cannot be ignored. The results so far indicate that this problem can be overcome with the use of cartilage film to separate the prosthesis from the tympanic membrane.


[The blood vessels of the posterior cranial fossa. anatomy, pathophysiology, clinic--a survey (author's transl)].

Pathophysiology and tomography of the blood vessels of the posterior cranial fossa gain clinical interest in treatment of diseases of the inner ear, complications of middle ear inflammations, tumors of the pyramid and cerebello-pontine angle. Numerous variations in the arterial venous system restrict neuroradiological procedures. Techniques to treat a thrombosis of the sinuses were developed 50 years ago. Surgical procedures to remove glomus tumors of the pyramid could be improved by new anatomical and surgical experiences. Unilateral neck dissection occasionally alters the blood flow in the sinuses of the posterior cranial fossa causing serious complications.


The integration of technical services into dental restorative procedures.

A protocol for improved dentist-laboratory relations is presented. The mutual responsibilities and obligations of dentist and technician are outlined. Each step of the procedure is developed and projected at the level of case planning and diagnostic wax-up.


Periodontology and its relevance to clinical dentistry.

The important role played by restorations and prostheses in the accumulation of plaque necessitates careful design of all contours to enable proper removal of plaque by the patient. Early diagnosis of impacted teeth is essential as well as careful design of gingival flaps preserving the maximum of attached gingiva where their removal or exposure is planned. Difficulties arising from closed bite and orthordontic treatment, the need for careful consideration to the importance of endodontic therapy, and removable partial dentures in relation to the health of periodontium, are discussed.


Testosterone in the management of cirrhosis of the liver--a controlled study.

The results of the controlled study covering 21 cases of decompensated hepatic cirrhosis are repoted. Nine controls received conventional therapy with diuretics and vitamin supplement. Testosteron 100 mg intramuscularly, on alternate days for four weeks, was administered to 12 others, in addition to the conventional therapy. Patients in the testosterone group responded with reduction in ascites and pedal edema together with a subjective feeling of improvement. Serum albumin rose at the end of the four weeks while globulin fell in those that received the hormone. The difference in respect of both serum albumin and globulin in the testosterone group became statistically significant at the end of four weeks.


The effects of enteric coating of aspirin tablets on occult gastrointestinal blood loss.

The effect of enteric coating of aspirin tablets on the gastrointestinal blood loss associated with high dose aspirin therapy was investigated in 12 patients with rheumatoid arthritis. Occult blood loss was measured after labelling the patients' red blood cells with Cr51. Three salicylate preparations were used: enteric coated tablets of aspirin ("Rhusal", G.P. Laboratories, 7 x 650 mg per day), uncoated tablet cores of aspirin from the same batch (7 x 650 mg per day) and enteric coated tablets of sodium salicylate (7 x 600 mg and 1 x 300 mg per day). Daily blood loss during a salicylate-free period was (0.7 +/- 0.15 ml, mean +/- SE). Blood loss was significantly increased during dosage with all three salicylate preparations. Daily blood loss during dosage with the uncoated tablets of aspirin (5.3 +/- 0.3 ml) was significantly greater than during dosage with the enteric coated tablets of aspirin (2.3 +/- 0.3 ml) and enteric coated tablets of sodium salicylate (2.1 +/- 0.4 ml). The bioavailability of the salicylate preparations was studied in seven of the 12 patients. Mean plasma salicylate concentration two hours after the second daily dose during dosage with the enteric coated tablets of aspirin was 118 +/- 15 microgram/ml compared to 131 +/- 16 microgram/ml during dosage with the uncoated tablets. Urinary recoveries of the daily dosage of aspirin in the two formulations were also similar.


Acupuncture analgesia. I. Review of clinical studies.

Recent clinical studies, both uncontrolled and controlled, of the use of acupuncture for the relief of chronic pain are reviewed. The success rate demonstrated by controlled trials is markedly lower than that claimed in reports of the clinical use of acupuncture in which no attempt is made to control factors which influence the placebo response. Although on balance of evidence it appears that acupuncture has a place in the management of chronic pain resistant to orthodox therapeutic measures, more research is needed both to establish objective criteria for the assessment of the effect, or lack of effect, of acupuncture on chronic pain as well as to delineate clearly the patient groups and the conditions where acupuncture analgesia is indicated.


Protection against the physiological effects of positive pressure breathing.

The degree of protection afforded by three jerkin G-suit systems (British, Canadian and Swedish) using different pressures against the adverse physiological effects produced by high levels (50 mm Hg and 70 mm Hg) of positive pressure breathing (PPB) was investigated at ground level in 10 male subjects. The British and Canadian systems were evaluated with G-suit pressure equal to breathing pressure and 3.2 times breathing pressure, whereas the Swedish system was studied only with 3.2 times breathing pressure in the G suit. The experimental design was a 10 X 10 Latin swuare. PPB produced significant increases in heart rate, peripheral resistance, and systolic, diastolic and mean arterial blood pressures, and significant decreases in stroke volume and cardiac output. These effects were directly related to the level of PPB. Our results show that the British system provides the highestdegree of protection against PPB, followed by the Swedish and the Canadian systems. It was also found that a G-suit pressure of 3.2 times breathing pressure significantly increases the degree of protection afforded by the British and Canadian systems.


Collagen in the cellular and fibrotic stages of scleroderma.

The collagen in localized and systemic scleroderma skin was studied by light microscopy with silver impregnation (50 patients), electron microscopy (14 patients), and immunofluorescence microscopy using specific antibodies against Type I and Type III collagens (12 patients). In the cellular stage, the dermis and adipose tissue revealed perivascular or diffuse cellular infiltrates (mostly lymphocytes, plasma cells, and macrophages), accompanied by deposition of Type III collagen. The lower dermis also showed an increase in Type III collagen. In the fibrotic stage, the papillary layer showed a reduction and/or clumping of Type III collagen as compared to normal skin. The lower dermis and the adipose tissue revealed compact collagen consisting exclusively of Type I collagen or a mixture of Type I and Type III collagen. The pattern of Type III collagen distribution was similar to that of reticulin, thus suggesting that at least some reticulin fibrils may represent Type III collagen.


Chemotherapeutically active nitro compounds. 4.5-Nitroimidazoles (Part II).

More than 170 1-methyl-5-nitroimidazoles substituted in the 2-position via an aminomethyl, thiomethyl, sulphinylmethyl or sulphonylmethyl group were synthesized and tested for their effect against various protozoa. In the NMRI mouse which had been i.p. infected with Trichomonas fetus 2 compounds showed an effect superior to that of tinidazole and 31 showed similarly good efficacy as that compound. In comparison with metronidazole 54 preparations proved to be distinctly more active, while 34 others lay in the range of efficacy of the standard compound. A large majority of the most active derivatives is substituted in the 2-position via a C--S bridge with heterocyclics, particularly with a pyridyl radical. An effect against Entamoeba histolytica in the intrahepatically infected golden hamster was observed much less often. Only 14 preparations developed a systemic effect comparable with that of metronidazole. In the NMRI mouse infected i.p. with Trypanosoma brucei or s.c. with T. cruzi parasitemia was clearly influenced by 11 compounds. With a few exceptions a trypanocidal effect against T. brucei occurred only at high doses. Only 3 compounds showed pronounced suppressive activity against blood forms of T. cruzi and only after prolonged treatment. The structure-activity relationship of the new 5-nitroimidazoles is discussed.


Inorganic bismuth(III) compounds in the therapy.

A survey is given of the pharmacopoeial preparations of inorganic Bi(III) compounds: bismuth subnitrate and bismuth subcarbonate. The use of these preparations, methods of preparation, qualitative and quantitative assays have been reviewed.


Multi-centered clinical evaluation of oxepinac against peripheral arthropathy particularly osteoarthritis.

Clinical evaluation in phase II of 6,11-dihydro-11-oxodibenz[b,e]oxepin-3-acetic acid (oxepinac) has been made in a single-blind trial in the treatment of osteoarthritis, 135 patients with mainly gonitis. Male 31, female 104, and the age distribution are 37--82 years and 62 years in average. Three groups of the doses, 75 mg, 150 mg, 300 mg daily, respectively, were administered for two weeks. Parameters studied included subjective relief of pain, range of joint motion, "patients preference" and biochemical studies. Oxepinac resulted in definite relief of pain compared with preceding medication and was tolerated well without serious side effect. The dose 150 mg was estimated most favourable. It is concluded that oxepinac offers an effective and well-tolerated alternative to drugs at present being used in the treatment of painful osteoarthritis.


[Morphological studies of the effects of progesterone on the adenohypophysis of the impuberal female rat].

At optical microscope and at electronic microscope it has been examined the adenohypophysis of Wistar albino impuberal female rats after administration of progesterone. It has come out that the progesterone influences in different ways the activity of pituitary gonadotropic cells (FSH and LH cells) according to the quantity and according to the way it affects either rapidly or within an extended period, on intact or on spayed animals, in the morning or in the afternoon. For what concerns the influence of the hormone, it has also come out to be variable as it may concern, according to the cases, a single or both cellular types, and it can appear with symptoms of secretion, with symptoms of excretion or with both symptoms. According to the verified data, the possible ways of action of progesterone on the hypothalamo-hypophyseal unit are discussed.


[Determination of antibodies against influenza viruses, using the ELISA method].

A microplate method of enzyme-linked immunosorbent assay (ELISA) was adapted for the demonstration of antibodies to influenza A and B in 25 paired acute and convalescent sera taken from patients with influenza A infection, in 11 single convalescent sera collected from patients with acute respiratory infection and serological evidence of influenza B infection, in 14 paired sera collected from volunteers who were vaccinated with an aqueous inactivated influenza A and B vaccine, and in 15 serum samples from normal subjects. Comparison showed that ELISA was more sensitive than the hemagglutination-inhibition test. The enzyme-immunoassay gave equally reliable and reproducible results and requires very small amounts of antigen and sera. This simple test may be suitable for use in large seroepidemiological surveys.


Electrophysiological effects of edrophonium in the innervated and the transplanted denervated human heart.

In order to determine the mechanism of action of edrophonium on the cardiac conduction system, we used His bundle recording and pacing techniques to examine the electrophysiological effect of edrophonium in 6 patients undergoing diagnostic evaluation for coronary artery disease and in 9 cardiac transplant recipients who were free of acute graft rejection. After control measures were made of sinus cycle length, conduction intervals, and conduction system refractory periods, edrophonium was administered by constant intravenous infusion, and all electrophysiological measurements were repeated. In the normally innervated patients, edrophonium significantly increased sinus cycle length from 778 +/- 21 ms to 883 +/- 36 ms (P less than 0.01), AH interval from 88 +/- 11 ms to 100 +/- 12 ms (P less than 0.01), and AV nodal functional refractory period from 351 +/- 44 ms to 391 +/- 36 ms (P less than 0.05). In the patients with transplanted hearts, edrophonium had no electrophysiological effect other than increasing the cycle length of the remnant recipient atrium from 722 +/- 21 ms to 798 +/- 31 ms (P less than 0.01). We conclude that the electrophysiological effects of edrophonium in man are mediated primarily through autonomic innervation of the heart.


Electrophysiological properties of intravenous metoprolol in man.

Electrophysiological changes produced by intravenous (0.1 mg/kg) metoprolol, a new selective beta 1-blocking agent devoid of intrinsic activity, were studied in 16 subjects with estimated normal impulse formation and conduction. The most important effects were sinus bradycardia, mild increase of sinoatrial conduction time, depression of intranodal conduction, and prolongation of AV node refractory periods. Sinus node recovery time and atrial refractory periods were unmodified. Infranodal conduction and the refractory periods of the His-Purkinje system, as well as of the bundle-branches, were unchanged. These effects are compared with those observed after intravenous propranolol, pindolol, and oxprenolol.


A comparison of the cardiorespiratory effects of continuous positive airway pressure breathing and continuous positive pressure ventilation in dogs.

Five patterns of ventilation have been compared in dogs: (1) spontaneous ventilation at ambient pressure (SV); (2) intermittent positive pressure ventilation (IPPV); (3) spontaneous ventilation at 0.98 kPa positive airway pressure, delivered from a non-rebreathing circuit incorporating a 5-litre reservoir bag and fresh-gas flow of twice the minute volume (CPAP (bag)); (4) spontaneous ventilation at 0.98 kPa positive airway pressure, with the reservoir bag replaced by a weighted bellows (CPAP (bellows)) and (5) IPPV with 0.98 kPa positive end-expiratory pressure (CPPV). CPAP significantly decreased the rate of respiration compared with SV. CPAP (bellows) resulted in a significant increase in tidal volume. Mean oesophageal pressure, right atrial pressure, pulmonary wedge pressure and pulmonary artery pressure increased during IPPV, CPAP (bag), CPAP (bellows), and CPPV compared with SV. There were no significant changes in mean systemic arterial pressure, cardiac output, PaO2, PaCO2, CaO2, (CaO2-CVO2), PAO2-PAO2) or pulmonary venous admixture. Under the conditions of this study oxygen transport was not altered by positive airway pressure ventilation.


Dr Nooth and his apparatus. The role of carbon dioxide in medicine in the late eighteenth century.

The two earliest inhalers devised for the administration of ether anaesthesia in the U.K. (Hooper's and Squire's apparatus) both incorporated the bottom part of a Nooth's apparatus. This, which was once a household object, is now remembered only as a footnote in one or two specialist histories, and Nooth himself, who was a most distinguished and respected medical man in his day, is almost completely forgotten. Yet there are many aspects of Nooth's life that are of great interest, and his apparatus was one of the very first to be designed to produce, for medicinal purposes, what may inclusively be called carbonated waters; and, surprisingly, there are strong links of coincidence between the histories of artificial mineral waters and of anesthesia, and the personalia involved in each.


Intravenous labetalol in hypertensive patients given by fast and slow injection.

1 Labetalol reduces blood pressure when given by fast or slow intravenous injection. 2 The extent of the reduction in arterial pressure is independent of the rate of injection but the rate of fall of blood pressure can be controlled by varying the rate of injection. There is little effect on heart rate. 3 These observations suggest that labetalol possesses important advantages over other vasodilator hypotensive drugs in current use.


Plasma protein binding of valproic acid in healthy subjects and in patients with renal disease.

1 Based on the Scatchard plot of the binding data of valproic acid (VPA) it is concluded that the drug is bound by two groups of binding sites with the association constants K1=40.0 X 10(-3) and K2=0.39 X 10(3), and the number of binding sites n1=1.5 and n2=6.8. 2 The binding is dependent on dialysis time, on temperature, on the drug concentration, and on the protein concentration in plasma. 3 At therapeutic plasma concentrations unbound VPA is 8.4 +/- 2.5%, but is increased to 20.3 +/- 4.7% in patients with significant impairment of renal function (P less than 0.001). 4 In patients with renal disease a good correlation is found between unbound VPA and serum creatinine, creatinine clearance, blood nitrogen and uric acid, respectively. A poor correlation is seen between unbound VPA and total protein or albumin concentration in plasma.


Continued use of non-steroidal anti-inflammatory drugs: an index of clinical efficacy.

1 A double-blind entry to a trial of an active non-steroidal anti-inflammatory drug, flurbiprofen against placebo was undertaken until 100 patients with classical rheumatoid arthritis had been allocated to each treatment. 2 Each patient was given a long-term supply of drug and was asked to vary their own dosage within simple limits, according to the severity of their symptoms. They were instructed to return immediately they felt dissatisfied with their medication either on account of side-effect or of lack of effect. 3 The length of time that patients remained satisfied with their drug was used as the sole measure of efficacy of the drug. At 2 weeks there were only 30% remaining on placebo and by 4 months no patients remained satisfied with the inactive drug. Forty-three per cent were satisfied with flurbiprofen at the end of 1 year. 4 Clearly compliance with anti-rheumatic drugs is better if the drugs are effective and there is no long-term placebo response in rheumatoid arthritis.


Disposition of sodium valproate in epileptic patients.

1 Serum levels of valproic acid have been determined at fixed intervals after the administration of single oral and intravenous doses (800 mg) to six epileptic patients receiving chronic treatment with other antiepileptic drugs. 2 Serum levels declined monoexponentially shortly after the intravenous administration. Biological half-lives averaged 9.0 +/- 1.4 h (s.d.). Volumes of distribution were 0.175 +/- 0.025 l/kg. There was a statistically significant negative correlation between volumes of distribution and serum half-lives (P less than 0.005). 3 After oral doses serum levels rose rapidly to peak values within 0.5--2 h. Biological availability was 96 +/- 9%. 4 Comparison with a previous study performed according to the same protocol in healthy volunteers showed significantly increased volumes of distribution and rates of elimination in the patients. Total serum clearance was 85% higher in the patients as compared to the healthy subjects (P less than 0.001). Possible explanations for these findings are discussed.


The use of dobutamine in myocardial infarction for reversal of the cardiodepressive effect of metoprolol.

1 Ten patients with acute myocardial infarction were infused dobutamine in increasing doses up to 15 microgram kg--1 min--1. 2 Metoprolol (total dose 15 mg) was then given intravenously to nine of these patients and the beta-adrenoceptor against effects produced by dobutamine were effectively reversed. 3 Nine patients with acute myocardial infarction pretreated with metoprolol (15 mg) were infused dobutamine 15 microgram kg--1 min--1 for 10 min. This resulted in effective reversal of the beta-adrenoceptor antagonist effects induced by metoprolol, without the occurrence of serious arrhythmias or other unwanted effects. 4 Dobutamine may be valuable in counteracting any undesirable cardiodepressive effects of beta-adrenergic receptor blocking drugs (especially the cardioselective agents) in patients with acute myocardial infarction.


Allocation of patients to treatment groups in a controlled clinical study.

In a controlled clinical study ("clinical trial") to compare 2 or more treatments for a disease, an objective method of allocating patients to treatment groups is needed. Various existing methods of allocation are described, including those which take account of patients' pre-treatment characteristics.


Microbial iron-chelators and their action on Klebsiella infections in the skin of guinea-pigs.

Preparations of catechols from ethyl acetate extracts of cultures of Klebsiellae in a low-iron medium contained iron-chelators whose potency was measured by the reversal of the bacteristasis of Escherichia coli and klebsiellae in unheated horse serum, and of the growth-inhibition of these two organisms by ethylene diamine di-orthohydroxyphenyl acetic acid (EDDA). As revealed by in situ tests of paper chromatograms, there was a multiplicity of biologically active chelators in the preparations. Catechols from strains both of high and low virulence for guinea-pigs enhanced the skin infectivity of most of the 10 Klebsiella strains tested. The enhancement was roughly proportional to iron-enhanceability with the 6 iron-enhanceable (E+) strains, though not as great as that by iron. But of the 4 (Eo) strains not enhanceable by iron, two were moderately enhanced by the catechols. The Streptomyces iron-chelator desferrioxamine B also enhanced infectivity, again roughly in proportion to the iron enhanceability of the strains; though one Eo strain was substantially enhanced. The synthetic iron-chelator EDDA did not enhance infection.


Bovine serum albumin chronic serum sickness nephropathy in rats.

We administered bovine serum albumin (BSA) 1 or 3 mg i.v. into hyper-immune Sprague-Dawley rats weekly for up to 6 months. Animals with free circulating antibody 1 h after BSA developed mesangial deposits of IgG and C-3 without proteinuria. Rats without free antibody at 1 h developed either mesangial or mesangial and glomerular basement membrane (GBM) deposits. Rats given 3 mg BSA tended to have GBM deposits, proteinuria and undetectable antibody at 1 h. By electronmicroscopy, all rats had mesangial and subendothelial dense deposits, while those with GBM lesions had intramembranous and subepithelial deposits with foot process obliteration. Light microscopic evaluation of kidney tissue revealed only mild histological changes similar to those in age-matched control rats. The present studies demonstrate that prolonged i.v. administration of BSA into rats results in the development of a chronic non-inflammatory nephropathy. Despite certain parallels to chronic serum sickness nephropathy in rabbits, species differences appear to modify the nephropathy in rats.


Stimulation of the development of bacteriostatic activity of guinea-pig milk against Escherichia coli.

The bacteriostatic activity of guinea-pig milk against various strains of Escherichia coli has been examined. Milk collected from sows suckling normal young was usually inactive, but the activity of milk from sows suckling young which had been orally infected with Esch. coli was significantly increased. The increase occurred in 2 phases: the first was found as early as 24 h after infection, suggesting stimulation via the teat canal (diathelic), but lasted only 2-3 days; the second occurred from 10 days post-infection onwards, and lasted until the end of lactation. The occasional bacteriostatic activity of milk from sows with normal young was not correlated with the presence in the faeces of naturally occurring Enterobacteriaceae, including Esch. coli.


Verrucous lesion in patients with discoid lupus erythematosus. Clinical, histopathological and immunofluorescence studies.

Seven cases of classical discoid lupus erythematosus of the face associated with hyperkeratotic, papulo-nodular lesions on the arms and hands were studied. Clinically the hyperkeratotic lesions resembled keratoacanthomas or hypertrophic lichen planus. The clinical course was marked by chronicity, an absence regression of the lesions, and resistance to treatment. Histopathologically, a lichenoid cellular reaction seemed to play a key role in the development of the hypertrophic lesions which resembled either keratoacanthomoas or hypertrophic lichen planus. Elastic fibres were prominent in the upper dermis, the lower levels of the epidermis and in the hyperkeratotic horny layer. Immunofluorescence of the papulo-nodular lesions demonstrated the deposition of IgG and IgM in a globular pattern at the dermal-epidermal junction. Discontinuous deposition of these antibodies was also seen at the basement membrane zone. On the basis of the immunofluorescence, histopathological and clinical studies, we suggest that the verrucous, hyperkeratotic lesions on the upper extremities represent an unusual, but distinct, form of discoid lupus erythematosus.


Routine administration of iron and vitamins during pregnancy: review of controlled clinical trials.

The purpose of this review was to determine whether routine administration of iron and vitamins during pregnancy had beneficial effects on birth weight, length of gestation, infant morbidity and mortality, and maternal morbidity and mortality. We searched for controlled clinical trials done in developed Western countries and reported in English, German, Finnish, and Scandinavian languages. Seventeen trials were found. In one trial, women who received vitamin B6 developed less dental caries. In another trial women receiving several different minerals and vitamins ahd fewer deliveries before the 40th week and less pre-eclampsia. In a third study, women receiving polyvitamin concentrate had less pre-eclampsia. None of the studies reported and benefit for other outcomes.


Vaginal prostaglandin E2 in the management of fetal intrauterine death.

The results of a multicentre clinical trial of prostaglandin E2 (PGE2) administered by the vaginal route in the management of intrauterine fetal death and missed abortion showed an overall efficacy of 97 per cent. The mean induction-abortion interval was 10.7 hours with a mean total dose of 60.4 mg of PGE2. Side effects were tolerated well and there was no evidence of significant alterations in hepatic or renal function.


A study of the effectiveness of propranolol in menopausal hot flushes.

A prospective, double-blind, randomized comparison of propranolol, 40 mg three times daily, and matching placebo showed propranolol to be no more effective than placebo in controlling hot flushes in a group of 25 perimenopausal women. Other menopausal symptoms, such as insomnia and palpitations, were equally unaffected. However, a very close correlation was found between the daily atmospheric temperature and the number of flushes occurring in the group.


Topical atenolol versus pilocarpine: a double-blind study of the effect on ocular tension.

Topical atenolol (a beta1-adrenoceptive antagonist), pilocarpine, and placebo were tested in a randomised double-blind crossover trial of 8 patients with ocular hypertenion. Atenolol (2% 3 times a day) caused a fall in intraocular pressure (IOP) comparable to that achieved by topical application of pilocarpine (2% 3 times a day). The decrease in IOP by each compound was demonstrable on the second day of application and was significantly (P is less than 0.05) reduced on the seventh and 14th days of treatment. The combination of 2% pilocarpine and 2% atenolol administered 15 minutes apart (3 times a day) lowered the IOP significantly from the second day of treatment, and this reduction persisted throughout the trial period of 14 days. This combined of treatment, treatment lowered the IOP more than either substance alone. However, this further decrease was statistically significant only on the 14th day of treatment (atenolol versus atenolol + pilocarpine, P is less than 0.05). No change of the episcleral venous pressure was observed after 14 days' treatment with either atenolol or pilocarpine alone, or combined.


Atenolol versus adrenaline eye drops and an evaluation of these two combined.

In a 1-day, 1-dose, double-masked, randomised trial, with each of 12 patients acting as his/her own control, atenolol drops 4% (a selective beta1-adrenergic blocker) produced a significantly greater fall in ocular tension measured by applanation than did adrenaline drops 1% (P is less than 0.01 Wilcoxon matched pairs signed ranks test). The mean differences, which favoured atenolol, between the falls in pressure produced by these 2 drugs at 1.5 hours, 3.5 hours, 5.5 hours, and 7 hours after instillation of the drops was 2.1, 4.6, 4.0, and 3.6 mmHg, respectively. Long-term studies would be required before any conclusion was justified about the relative merits of these 2 drugs in the treatment of glaucoma. There was no significant difference between the ocular hypotensive effects of atenolol-then-adrenaline and adrenaline-then-atenolol. It was disappointing that the expected adjuvant effect of atenolol's preceding adrenaline was not found-rather the reverse. Atenolol alone, however, was significantly better than atenolol-then-adrenaline (P is less than 0.02 Wilcoxon matched pairs signed ranks test), and there was also some indication that it was superior to adrenaline-then-atenolol. The response to adrenaline did not differ markedly from the response to the combination in either order.


A double blind comparison of guanethidine-and-adrenaline drops with 1% adrenaline alone in chronic simple glaucoma.

We present the results of a double-blind trial comparing the efficacy of a single dose combination of guanethidine 3% and adrenaline 0.5% with that of adrenaline 1% alone in reducing the intraocular pressure of eyes suffering from chronic open-angle glaucoma. The mean fall in ocular tension with the combined therapy was 10.67 mmHg, and with adrenaline 1% 6.31 mmHg, 24 hours after the commencement of phasing. The combined drop produced satisfactory control of ocular tension in all cases. These results indicate that a combined drop of guanethidine 3% and adrenaline 0.5% is a promising topical therapy for the control of chronic open-angle glaucoma.


Dihydrofolate reductase: the amino acid sequence of the enzyme from a methotrexate-resistant mutant of Escherichia coli.

The determination of the amino acid sequence of the enzyme dihydrofolate reductase (5,6,7,8-tetrahydrofolate:NADP+ oxidoreductase, EC 1.5.1.3) from a mutant of Escherichia coli B is described. The 159 residues were positioned by automatic Edman degradation of the whole protein, of the reduced and alkylated cyanogen bromide fragments, and of selected tryptic, chymotryptic, and thermolytic digestion products. An N-bromosuccinimide produced fragment of the largest cyanogen bromide peptide was also used in the sequence determination.