A systematic approach to severe hand ischemia.

Because severely symptomatic hand ischemia is not common and because there are a wide variety of clinical conditions which can cause arterial insufficiency of the upper extremity, a retrospective study has been done to determine the efficacy of various diagnostic manipulations used in managing 65 patients with severe hand ischemia at the Northwestern University McGaw Medical Center, Traumatic, thermal, and iatrogenic causes of hand ischemia were diagnosed by simple history taking, as was advanced uremic arteritis. Doppler ultrasound and digital arterial pressure recording were confirmative, rather than diagnostic. These aided in defining precise degrees of ischemia and identifying proximal arterial occlusions. Invasive total extremity angiography clarified atherosclerotic, atheroembolic, and other chronic occlusive lesions while serum electrophoresis and immunoelectrophoresis defined the polyclonal and monoclonal gammopathies. When digital necrosis was present, organic arterial occlusions usually were found. These responded best to direct arterial reconstruction down to the mid-palm level. Transpleural, transthoracic sympathectomy was useful as an adjuvant or as definitive treatment for distal digital arterial occlusions. Selective vasodilator therapy was used as dictated by the cause of ischemia and its eventual outcome.


Familial cancer: implications for surgical management of high-risk patients.

Knowledge of familial/genetic information about cancer risk involving at least 100 disorders could be utilized profitably by surgeons in their daily practice. Familial cancer of the breast, ovary, and colon, malignant melanoma, and testicular feminization syndrome, and masculinizing Turner's syndrome are discussed. Biological markers, an area of emerging research interest, have been considered for their cancer control potential. Prophylactic surgical implications for certain familial cancer have been given.


The Institute of Ophthalmology of the University of London.

With the technological revolution in medicine that occurred between the two World Wars came awarness of a need for an ophthalmic institution that would combine clinical and basic scientific research, professional training, and patient services. The history of the Institute of Ophthalmology of the University of London is reviewed by Sir Stewart Duke-Elder, who was instrumental in the foundation and development of the Institute and who currently serves as its President.


The acute mammalian toxicology of dibenz(b,f)-1,4-oxazepine.

Dibenz(b,f)-1,4-oxazepine (CR), a potent peripheral sensory irritant material, has been shown to have a very low acute lethal and sub-lethal toxicity by intravenous, intraperitoneal, oral, percutaneous and inhalation routes to several species of laboratory mammal. There was no organ-specific pathology. Comparison of the acute toxicity of CR with that of two other peripheral sensory irritants, 1-chloroacetophenone (CN) and 2-chlorobenzyl-lidene malononitrile (CS), shows CR to be significantly less toxic than either of them. Pyrotechnically generated CR smoke was more toxic than pure (thermally generated) aerosols of CR; this was due to the presence of pyrotechnic decomposition products in the atmosphere from the burning of the smoke generating composition. However, the median lethal toxicity of pyrotechnically generated CR smoke was very significantly less than that of either pyrotechnically generated CN or CS smokes. Short-term cumulative toxicity did not occur following multiple oral dosing with CR. The acute toxicology of three ether intermediates encountered in the synthesis of CR from 1-chloro-2-nitrobenzene and sodium phenoxide (2-nitrodiphenyl ether, 2-aminodiphenyl ether and 2-formamidodiphenyl ether) was investigated; all three ethers were found to be less acutely toxic than CR itself.


Incidence of astigmatism after cataract surgery. Comparison of continuous and interrupted sutures.

In spite of the increased use of intraocular implants and contact lenses, the majority of cataract cases require spectacles after operation. Too great an amount of astigmatism will cause distortion and spoil an otherwise perfect operation. It is clear that the amount of astigmatism depends upon how the section is made and how it is sutured. In a series of cases employing different kinds of section and different methods of suturing, the postoperative astigmatism for each combination was recorded. A comparison was made between direct sutures and continuous suturing with 10.0 monofilament. Some suggestions are made as to the best method of keeping astigmatism to a minimum.


Combined keratoplasty and cataract extraction.

A short film showing our technique of combined penetrating keratoplasty and intracapsular cataract extraction was shown, and the postoperative results in 72 eyes after an average of 3 years were reported.


Adult toxocariasis. Uniocular retinal lesions in the 20- to 50-year age group.

Uniocular posterior polar lesions thought to be characteristic of suspected adult ocular toxocariasis have been observed in a group of eight patients whose ages ranged from 20 to 50 years. Six patients had positive fluorescent antibody tests for Toxocara species, whereas control serological studies showed that only 4% of healthy adults in the same age group had positive fluorescent antibody responses. All the patients with clearly defined progression of their retinal lesions had positive fluorescent antibody tests. In two patients positive tests reverted to negative within 2 years.


Experience with pilocarpine Ocuserts.

Those patients who accept Ocuserts are likely to benefit from better intraocular pressure control. In the occasional patient episodic pilocarpine-induced myopia may be prevented.


Management of chronic glaucoma with pilocarpine Ocuserts.

This paper presents a clinical assessment of the Ocusert pilocarpine therapeutic system in 22 patients. Severe patients were 'wearing failures' and one was a 'therapeutic failure'. In the remaining patients intraocular pressure were controlled satisfactorily by a small daily dose of pilocarpine and there was relief from the burden of regular drop administration and the transient myopia which follows each instillation. This study confirms a place for the 'Ocusert' system in the management of some patients with chronic glaucoma.


The Duffy blood group and malaria prevalence in Gambian West Africans.

Erythrocytes from 1,168 donors, comprising almost the entire populations of two rural Gambian villages, have been tested for Duffy blood group antigens using antisera to both Fya and Fyb. All tests were negative. Blood film examination of the same samples showed complete absence of Plasmodium vivax parasitaemia, but infections with P. falciparum,P. malariae and P. ovale were observed. The findings are consistent with the view that the Duffy-negative phenotype, FyFy, constitutes the basis of innate resistance towards infection with P. vivax but not towards infection with the other plasmodial species.


Immunofluorescent reactions with microfilariae: 1. Diagnostic evaluation.

Microfilariae have been evaluated as antigen for the indirect immunofluorescent test in the diagnosis of filariasis. Sonicated, unlike whole, microfilariae present no problems in handling on a slide. The cytoplasmic antigen that is exposed by sonication, unlike the sheath or cuticular antigen, reacts with filariasis sera irrespective of whether or not there is a detectable microfilaraemia. The cytoplasmic antigen of microfilariae of various species was marginally superior to Dirofilaria adult worm as antigen for diagnostic immunofluorescence in respect of both sensitivity and specificity. The microfilariae extruded from the uterus of an adult D. immitis were a useful source. But the best results were obtained with the sonicated microfilariae of Brugia pahangi, with which it was possible to utilize both cytoplasmic and sheath antigens simultaneously, giving a positivity rate of 95% for filariasis infecions as a group. This test is thought to be the best available at present for the sero-diagnosis of filariasis, in spite of some lack of specificity. For individual filarial infections a homologous microfilarial antigen is probably the deal.


The treatment of severe falciparum malaria.

In severe falciparum malaria there is a pathophysiological cascade beginning with changes in the parasitized red blood cells which induce intermediate effects, in turn contributing to dysfunction of several organs. A low serum albumin is a common but often unrecognized finding which may contribute to oedema especially in the lung and brain. The only irreversible complication in falciparum malaria is the acute respiratory distress syndrome, manifested by cyanosis and rapid breathing, basically distinct from acute pulmonary oedema caused by therapeutic overhydration. The pathophysiology of falciparum malaria may be complex but the treatment is simple. Drugs, other than antimalarials, are rarely needed. Guidelines for cholorquine or quinine dosage in severe disease are proposed; each drug is given at a dose of 5 to 10 mg/kg in 10 ml/kg of fluid as an intravenous infusion in four hours at a frequency of dosing every 12 to 24 hours. When the disease has been brought under control the treatment should be changed from the intravenous to the oral route.


Trypanosoma brucei: detection of low parasitaemias in mice by a miniature anion-exchanger/centrifugation technique.

A method is described for the detection of trypanosomaemia in mice using the samples of about 55 microliter of blood which can be readily obtained from mice by puncture of the retro-orbital plexus with heparinized glass microhaematocrit tubes. The samples, mixed with an appropriate diluent, are passed through small (2 ml) anion-exchanger columns by means of peristatic pumps and the eluates collected in tubes which can be centrifuged so as to concentrate any organisms in the terminal part of the tube, of calibre about 200 micrometer, for microscopical examination. Evidence is presented to show that the method is more sensitive than other methods in use. It is also quick, requiring only some five minutes per mouse examined.


The resistance to human plasma of Trypanosoma brucei, T. rhodesiense and T. gambiense: III. Clones of two plasma-resistant strains.

Tests for resistance to human plasma were made on six clones of a stabilate of Trypanosoma rhodesiense (LUMP 10) which was calculated to contain about 3,000 resistant trypanosomes per million. Two of the clones were not resistant and four were only subresistant. Tests were also made on 12 lines (clones) of a stabilate of polymorphic trypanosomes isolated from tsetse flies. One of them, ETAT 10, had infected a laboratory worker and was found to be fully resistant to human plasma; the other lines showed only low or moderate resistance. Resistance of a strain to human plasma often depends upon a small minority of resistant trypanosomes. Strains of polymorphic trypanosomes may be classified as fully resistant, moderately resistant, subresistant, or sensitive to human plasma, if they contain respectively, all, some (e.g. one per hundred), very few (e.g. one per million) or no individuals which are resistant.


Role of antiserum and complement in the acute antibody-mediated rejection of mouse skin allografts in strain combinations with increasing histoincompatibility.

Acute antibody-mediated rejection (AAR) of mouse skin allografts was studied in nine donor-recipient combinations with increasing histoincompatibility ranging from an H-Y to a complete H-2 plus on-H-2 disparity. AAR was induced by the injection of specific alloantiserum along with a heterologous complement on day 7 after grafting. Sera from rabbits, guinea pigs, and from a human volunteer were used as complement sources. The recipients were treated with antilymphocyte serum on days 0, 2, and 4 to postpone cell-mediated rejection. With increasing histoincompatibility the mean survival time of untreated grafts decreased, the in vitro cytotoxic activity of the alloantiserum rose, and AAR could be induced with lower amounts of antiserum. The higher efficiency of rabbit complement compared with guinea pig complement and human complement, that is known to exist in in vitro cytotoxicity, was also found in vivo. Rabbit complement could induce AAR in combination with relatively weak histoincompatibility (H-2K, H-2D, or non H-2 differences), where guinea pig complement and human complement were ineffective. All three complement species elicited AAR if there was a disparity for H-2D plus non-H2 H-2K plus non H-2, H-2, or H-2 plus non-H2. The rules for immunogenicity of the different histocompatibility loci as they have been described for cell-mediated graft destruction also apply to this humorally mediated rejection process.


Bone marrow transplantation after lethal chemotherapy in "nude" mice.

Isogenic bone marrow transplantation was performed in "nude" and normal C3H mice after lethal doses of dimethylmyleran (DMM), meso-DMM, and (+/-) DMM were given. Nude mice were not more sensitive to DMM or its isomers than normal mice. With adequate cell doses in the range of 3 X 10(6) to 30 X 10(6) bone marrow cells or 10 X 10(6) to 30 X 10(6) spleen cels, the survival rate after lethal chemotherapy was not significantly different between nude mice reconstituted with a graft from nude donors and normal mice reconstituted with a graft from normal donors. Only with suboptimal cell dose (1 X 10(6) bone marrow cells) was survival superior in normal mice. Thinsic factor. Nude mice accepted also bone marrow grafts from allogeneic nude donors.


Canine and human liver preservation for 6 to 18 hr by cold infusion.

Forty-one dog livers were preserved with cold, lactated Ringer's, plasma, or intracellular (Collins) solutions. Consistent survival was obtained with all three solutions for 9 hr. After 18 hr, the plasma and Collins solutions permitted survival, with the Collins solution having a slight overall advantage. The method using Collins solution has been used to  preserve seven human livers in Los Angeles, to transport the organs to Denver, and to transport them as orthotopic grafts from 6 hr, 45 min to 10 hr later.


The effect of hepatitis B antigenemia on long-term success and hepatic disease in renal transplant recipients.

The records of 192 cadaver renal allotransplants were reviewed in order to evaluate the role of the hepatitis B antigen (HBsAg) carrier state on graft function, patient survival, and the incidence of severe hepatic dysfunction. Twenty-one allografts were placed into patients with hepatitis B antigenemia. After follow-up ranging from 1.5 to 8 years (mean 4.7), graft and patient survivals were not statistically different from antigen-negative patients. In addition, the acquisition of HBsAg after grafting did not seem to affect the rate of graft failuue or death. Neither cirrhosis not fatal hepatic failure developed in the HBsAg carrier group, whereas five HBsAg-negative recipients died of hepatic disease. Among HBsAg-positive recipients, nine with functioning renal allografts and five with graft failures, there was a low incidence of e antigen, suggesting low infectivity. This may explain the lack of correlation of the surface antigen with serious liver disease. Severe hepatic disease developing in renal graft recipients is most likely attributable to causes other than hepatitis B infection. The presence of hepatitis B antigenemia alone should not be a deterrent to renal transplantation.


The reversal of established enhancement in rat cardiac allografts.

Established enhancement in rat cardiac allografts was challenged in a variety of ways in an attempt to provoke rejection. Incompatible skin grafts, injections of sensitised lymphocytes, and the administration of the macrophage-stimulating agent Corynebacterium parvum proved ineffective. However, levamisole, which stimulates both macrophages and sensitised lymphocytes, caused rejection in four of a group of six AS rats bearing enhanced (August X AS)F1 hybrid heart allografts. A combination of C. parvum and levamisole provoked rejection in all four animals in which it was used. The results suggest that an increased activity of both lymphocytes and macrophages is required to break established enhancement.


The use of antilymphoblast globulin in the treatment of renal allograft rejection: a double-blind, randomized study.

A randomized, double-blind study comparing horse antilymphoblast globulin (ALG) (25 patients) with human IgG (20 patients) in addition to standard antirejection therapy was performed in recipients of first kidney transplants having their first rejection episodes. Patients received ALG (20 mg/kg/day) for 10 days, and a control group was given human IgG (20 mg/kg/day) for 10 days in addition to standard therapy. The groups were comparable with respect to HLA matching, age, time to onset of first rejection episode, and number of diabetics. The number of patients requiring transplant nephrectomy and/or dialysis, having a second rejection episode, having good late function, or dying did not differ in recipients of related kidneys receiving either ALG or human IgG. Recipients of cadaver kidney grafts had fewer (0.05 less than P less than 0.06) second rejection episodes if they received ALG during their first rejection episode. However, the number of patients requiring transplant nephrectomy and/or dialysis, having late good function, and dying did not differ significantly for recipients of cadaver kidneys. We conclude that ALG does not add significantly to standard antirejection therapy for the treatment of first rejection episodes.


Transplantation in patients with primary renal malignancies.

Seventy-three patients with primary renal neoplasms underwent kidney transplantation. Three distinct groups were identified. Thirty-four patients (group 1), who underwent antineoplastic therapy 1 year or less before transplantation, developed metastases or recurrences in 53% of the cases. In contrast, none of 15 patients in group 2 had this problem. All of these patients had a waiting period of at least 15 months between nephrectomy and transplantation. These findings emphasize the value of a lengthy waiting period between treatment of the neoplasm and performance of transplantation with its associated immunosuppressive therapy. Group 3 also had a favorable outcome. All had incidentally discovered renal malignancies, in 18 patients during the work-up of chronic renal failure or after bilateral nephrectomy in preparation for renal transplantation, and in 6 several months after transplantation when the recipient's own kidneys were removed or autopsy examination was performed. None of these 24 patients developed recurrences or metastases.


The effects of transfusion of frozen-thawed deglycerolized red cells on renal graft survival.

In patients that received transplants of cadaver kidneys, prior transfusion improves the prognosis for graft survival. Patients receiving frozen-thawed red cells have better 1-year survival rates than patients given other forms of red cells. The effect of prior transfusions is minimal in patients that recieved transplants of kidneys from living related donors.


Persistent immunoglobulinuria in irreversible renal allograft rejection in humans.

To evaluate the extent of injury in short- and long-term renal allografts, the urinary excretion of IgG, IgA, and IgM was observed during acute rejection crisis. In reversible rejection, treatment resulted in prompt correction of immunoglobulinuria, whereas in irreversible crisis urinary immunoglobulin levels continuously increased in spite of the same antirejection treatment. A good prognosis in long-term allografts was shown by low levels of immunoglobulinuria; unstable graft function had higher levels. Immunoglobulinuria can be used as an additional test to evaluate the reversibility of acute rejection, and also has significance in the long-term situation.


Enhancement of cardiac allografts in rats. Comparison of host responses to different treatment protocols.

Immunological responses to heterotopic (L X BN)F1 cardiac allografts placed in untreated L rats were compared with those grafts enhanced by different treatment regimens. Host pretreatment by antigen and antibody (Ag-Ab) 11 and 10 days before transplantation, respectively, was the most effective treatment regimen for prolongation of graft function; active or passive immunization alone increased survival only modestly. A late dose of antiserum administered to Ag-Ab-pretreated animals significantly shortened graft survival. Patterns of cellular responsiveness were measured serially by lymphocyte-mediated cytotoxicity; humoral immunity by Ab-lymphocyte-mediated cytotoxicity, capillary hemagglutination, and complement-dependent cytotoxicity. Allograft rejection in animals of all groups was heralded in vitro by increasing immunological activity. All cellular and humoral responses were depressed consistently in Ag-Ab-pretreated recipients. Cellular but not humoral responses were decreased in Ag-pretreated hosts, while humoral but not cellular responses were decreased in Ab-treated animals. The results suggest that the in vitro determinants of immunological activity used in this study generally followed clinical patterns of rejection or enhancement of cardiac allografts in the rat. Recipient pretreatment with Ag and Ab is more effective in graft prolongation than treatment with Ag or Ab alone, and in vitro data suggest an additive effect of these two regiments.


Radiosensitivity of suppressor cells in neonatally tolerant rats.

Specific suppressor cells were demonstrated in rats that had carried tolerated skin allografts for long periods of time after being rendered tolerant at birth. These suppressor cells were able to transfer tolerance to sublethally irradiated syngeneic recipients and to inhibit cytotoxic antibody production in normal syngeneic recipients. Suppressive activity of these cells was shown to be radiosensitive. The presence of suppressor cells in tolerant animals was attributable to neonatal tolerance induction and not to skin grafting of neonatally treated animals. In some cases spleen cells from tolerant animals transferred adoptively or induced permenent tolerance to skin grafts, which suggests a long-lasting active mechanism of tolerance.


Reactivity of autolymphocytotoxic antibodies from dialysis patients with lymphocytes from chronic lymphocytic leukemia (CLL) patients.

Autolymphocytotoxic antibodies are found commonly in dialysis patients and these autoantibodies may be directed against T and B lymphocytes or just B lymphocytes. However, these autoantibodies react with a low frequency or not at all against chronic lymphocytic leukemia cells, and are not absorbed by autologous erythrocytes. Thus, a number of positive crossmatches between donor and recipient may be attributable to autoantibodies. Six renal transplants have been carried out in the presence of such a positive crossmatch against donor B lymphocytes, including one against donor T lymphocytes, with a successful graft outcome. Thus, the indications for renal transplantation in the presence of a positive crossmatch between donor and recipient are becoming better defined.


Tick-borne diseases of domestic animals in northern Nigeria. II. Research summary, 1966 to 1976.

During the first 10 years of its existence, the Department of Parasitology and Entomology of the Faculty of Veterinary Medicine, Ahmadu Bello University in Zaria, Nigeria, confirmed or described for the first time the occurrence of 25 different tick-borne parasites of domestic animals in the northern part of the country. Most of these organisms occur as inapparent infections but may serve as complicating factors in any adverse host condition. The transmission of Babesia bigemina by Boophilus decoloratus, Cowdria ruminantium by Amblyomma variegatum, and Borrelia anserina and Aegyptianella pullorum by Argas persicus was confirmed under Nigerian conditions.


A study of two twice-weekly and a once-weekly continuation regimen of tuberculosis chemotherapy, including a comparison of two durations of treatment. 2. Second report: the results at 36 months.

The final results of a controlled clinical trial of 3 chemotherapeutic regimens in pulmonary tuberculosis in Czechoslovakia are presented. Two of the regimens were based on a twice-weekly continuation regimen of streptomycin plus isoniazid, preceded by 6 weeks or 13 weeks of initial daily triple chemotherapy with streptomycin, PAS and isoniazid; the third regimen was once-weekly streptomycin plus isoniazid preceded by 13 weeks of the daily triple combination. Patients in each regimen were allocated to a total duration of treatment of 12 months or 18 months. At 3 years, the twice-weekly continuation regimen was highly satisfactory, 97% of 93 patients receiving 13 weeks of initial daily triple chemotherapy and 98% of 82 receiving 6 weeks having a favourable response. The once-weekly regimen was less satisfactory and this was largely due to the rapid acetylators of isoniazid of whom 78% of 37 had a favourable response compared with 97% of 60 slow acetylators. There was no advantage in the longer course of chemotherapy, for 95% of 129 patients receiving chemotherapy for 12 months had a favourable response compared with 95% of 143 patients receiving it for 18 months.


A fluorigenic substrate for the rapid differentiation of Mycobacterium fortuitum from Mycobacterium chelonei on the basis of heat stable esterase activity.

A fluorigenic substrate, 4-methylumbelliferyl butyrate, enables mycobacterial esterase activity to be easily and rapidly detected and quantitated. By use of this substrate, the esterase activity of Mycobacterium fortuitum was found to be significantly more heat resistant than that of M. chelonei. On this basis, a rapid, simple and inexpensive test for the differentiation of these two species has been developed.


The incidence of tuberculosis in Lechwe (marsh antelope).

Of the 238 specimens of tissue collected from 70 lechwe (marsh antelope) 79 yielded M. bovis, 1 yielded a mixed growth of M. bovis and an 'atypical' mycobacterium and 6 yielded 'atypical' mycobacteria; the 'atypical' mycobacteria were probably contaminants. Of the 63 lechwe killed as a 1 in 10 random sample from four herds, M. bovis was obtained from 21 animals, indicating that 33% of wild lechwe are infected with tuberculosis.


Experimental bacterial prostatitis in dogs.

Bacterial prostatitis was successfully induced in 30 dogs by the injection of E. coli into a branch of a prostatic artery. Inflammation was proven histologically in all cases and by the appearance of E. coli in the prostatic secretion in all but two dogs. In these two dogs cultures from prostatic tissue were positive for E. coli. The pH changes in the prostatic secretion were inconclusive, and the zinc levels increased slightly in the acutely inflamed gland. Antibody coating of the bacteria could not be demonstrated by immunofluorescence.


Calving rate following fixed time insemination after a 12-day progesterone treatment in dairy cows, beef cows and heifers.

Farm trials were carried out to determine if cows and heifers could be inseminated on a fixed time basis following a 12-day treatment with progesterone coils and an injection of 5 mg oestradiol benzoate and 200 mg progesterone at the start of treatment. The retention rate of the coils was significantly higher (P less than 0.05) when a 5.5 cm diameter was used compared with a diameter of 7.0 cm. Calving rate was similar in treated cows bred at a detected oestrus, at 56 + 74 hours after treatment or at 56 hours after treatment and injection of 100 microgram gonadotrophin releasing hormone 20 hours previously and in control cows bred at oestrus. Fertility to the first repeat oestrus was also similar in treated and control cows. Significantly (P less than 0.05) more synchronised cows calved following fixed time AI compared with the calving rate in control cows inseminated for a 24-day experimental period. In beef suckler cows, calved at least 50 days, and dairy heifers weighing over 280 kg, calving rate was similar in treated animals bred at 56 and 74 hours after treatment compared to calving rate in control animals bred at oestrus.


The bactericidal activity of a teat dip containing chlorhexidine and cetrimide.

Using an in vivo test on teat skin the disinfectant activity of a teat dip containing chlorhexidine and cetrimide was compared with two iodophor solutions, one containing the recommended concentration of 0.5 per cent available iodine and the other a 10-fold dilution of this (0.05 per cent iodine). The test organisms used were Staphylococcus aureus and Escherichia coli and for both species the 0.5 per cent iodophor was significantly more bactericidal than either the diluted iodophor or the chlorhexidine/cetrimide teat dip (P less than 0.01). In the test against S aureus, chlorhexidine/cetrimide and the 0.05 per cent iodophor showed similar bactericidal activity, but the iodophor was significantly more bactericidal against E coli (P less than 0.01). It is argued that due to its low bactericidal activity this formulation of chlorhexidine/cetrimide is likely to be inferior to 0.5 per cent iodophor solution as a disinfectant teat dip.


Studies on the immunity of the calf to colibacillosis--VII: the experimental reproduction of enteric colibacillosis in colostrum-fed calves.

Eight newborn calves were challenged orally with a known enteropathogenic strain of Escherichia coli 0101 K?(A) and two to six hours later each calf was fed a minimum of three pints colostrum. All calves suffered from acute diarrhoea of varying severity within 24 to 48 hours of infection. Immunofluorescent and histological examination of the small intestine demonstrated adherence of the challenge organism to the epithelium and the presence of pathological lesions similar to those seen in colostrum-deprived calves with enteric colibacillosis. It was concluded that in order to be effective prophylactically, colostrum must be fed prior to infection.


Bovine cystic ovarian disease: plasma hormone concentrations and treatment.

Ovarian function in 91 dairy cows with cystic ovarian disease was assessed by rectal palpation and by plasma hormone analysis before and after treatment. Plasma analysis showed that 84% of the cysts were correctly classified clinically and only these cows are considered further. Luteinised cysts occurred in 59 cows whereas only 18 had non-luteinised cysts. The mean plasma concentrations of luteinising hormone (LH), follicular stimulating hormone (FSH), progesterone, oestradiol and testosterone were not significantly different when compared with values at relevant stages of the oestrous cycle in normal cows. Success of treatment with progesterone, a synthetic prostaglandin, human gonadotrophin (HCG), or gonadotrophin releasing hormone (GnRH) was not dependent upon prior hormone concentrations, except for the prostaglandin which required active luteal tissue. LH and FSH concentrations in cows with luteinised cysts were not significantly different before and after successful treatment with GnRH or progesterone. Normal luteal function was not always established after treatment of non-luteinised cysts with GnRH.


[Virulence and biochemical activity of Aspergillus fumigatus strains isolated from cow fetuses].

Tested was the virulence of 20 strains of Aspergillus fumigatus isolated from cow fetuses. All laboratory mice injected with them died, and the pregnant guinea pigs aborted. It was demonstrated that these strains contain exogenic and endotoxic substances which are extracted effectively with alcohol and ether. The mould cultures showed proteolytic, amylolytic, cellulose, and organic acid activity. The biochemical and pathogenic potential of the strains were of great importance for causing abortion.


[R-factor distribution and characteristics of the E. coli isolated from pigs].

Studied was the occurrence of the R-factors in Escherichia coli isolated from pigs. It was demonstrated that in 73.3 per cent of the cases drug resistance could be transmitted to Citrobacter. In this instance an occasional drop-out of the markers of resistance to kanamycin, neomycin, ampicillin, tetracycline, and chloramphenicol was observed. In the author's experiments no transmission of the marker of resistance to furazolidon was established. The transmission of the signs of resistance to kanamycin and niomycin as well as to erythromycin and oleandomycin occurred always simultaneously. The possibility of transmitting the drug resistance markers of Escherichia coli to Salmonella typhimurium LT-2 made it reasonable to believe that this is one of the routes for spreading the R-factors among Salmonella organisms. No essential differences were observed between the minimal inhibitory concentration of the donor strains and the level of the acquired resistance with the recombinations. The transmission frequence of the resistance markers proved comparatively high, and ranged from 0.6.10(-3) up to 3.10(-4).


[Follicular lymphoma].

Follicular lymphoma is regarded as reticulosarcoma in situ. Tumor nodules are represented by neoplastic foci of the tumor tissue. They can show the structure of lymphoblastic, reticulocellular and polymorphocellular reticulosarcoma. The Maximov cambial lymphocyte is assumed to be the most reliable cell source. The Willis teaching on tumor field holds good of the morphogenesis of follicular lymphomas. The problem of the differential diagnosis between follicular lymphomas and follicular reactive hyperplasia is discussed.


[Treatment of bladder cancer recurrences].

Chemical antitumor drugs employed by the authors failed to render any cytostatic effect on bladder cancer recurrences. Only surgical treatment might provide a short-term remission. The best results of treatment for recurrent bladder cancer were gained in the combination therapy (surgery and radiotherapy) and also while using distant gammatherapy.


[Effect of methylcobalamin and fluoralkylcobalamins on E. coli 113/3 cell growth and on a primary human embryonic fibroblast culture].

Comparative analysis of the functional activity of several fluoralkylcobalamines was carried out using E. coli 113/3 strain deficient in vitamin B12 and methionine. Difluoro chlor methylcobalamine (CF2Cl-Cbl) exhibited the most distinct inhibitory effect on growth of bacterial cells in the medium with cobalamine. Effect of methylcobalamine and CF2Cl-Cbl on the proliferative activity of human embryonal fibroblasts was studied in media of various composition. The proliferative activity of fibroblasts was distinctly increased in the medium with methylcobalamine at various periods of cultivation; the fraction of 3H-thimidine labelled cells and the mitotic index were increased. The distinct decrease in amount of cells, synthesizing DNA, and in their mitotic activity was observed in medium with CF2Cl-Cbl. The data obtained suggest that difluorochlor methylcobalamine affects the cell proliferation as the antagonist of methylcobalamine in experiments with bacterial cells and the primary culture of human embryonal fibroblasts.


[Analysis of the cobalamin coenzymes in mouse splenic tumor cells].

Coabalamine coenzymes were studied in tumor spleen cells of mice with La leukosis. Endogenous cobalamines in the cell extracts were separated by two-dimensional thin-layer chromatography and by bioautography. Analysis of the cobalamines ratio was carried out using bioautochromatographic technique. 5-deoxyladenosyl- and methyl cobalamines were found in extracts of the tumor cells.


[Results of using dibunol in bladder tumors].

Intravesical instillations of 10% dibunol liniment were used for the treatment of 132 patients with bladder tumors. An objective improvement was noted in 62.4%, including considerable lessening of the tumor size in 20% and its disappearance in 8.8% of patients. An efficacy of the treatment was considerably greater in bladder cancer in stages T1--T2 than in stages T3 and T4. The frequency of bladder cancer recurrence is found to be lowered following surgery associated with application of dibunol, also the manifest antiinflammatory activity of the drug is emphasized. No side effects relative to the toxic action of dibunol were observed. The use of dibunol seems to be rational in patients with bladder tumors of early stages, especially if associated with surgical therapy, and in tumor recurrences, and also with the symptomatic purposes in inoperable patients.


[Antitumor action of Ser. marcescens nuclease covalently bound to soluble dextrans].

The antitumor effect of Ser. marcescens nuclease, modified by covalent binding using the method of diazocoupling with m-aminobenzyloxymethyl dextran of molecular weight 20 000, 40 000, 60 000, exceeds 3--4 times the antitumor effect of the native enzyme in relation to Ehrlich ascites carcinoma in contact tumor cells exposure. In intramuscular injection of the enzyme the nuclease preparation modified by dextran of molecular weight 40 000 showed the greatest antitumor activity against Ehrlich carcinoma and sarcoma 37.


[Comparative study of the biological activity of a toxin isolated from burned skin using physicochemical and immunosorption methods].

Highly specific isolation of a toxin from an extract of burned skin was achieved by means of antibodies immobilized on nonsoluble carrier (immunosorbent). The stability of the pure toxin distinctly decreased on storage. The interrelations were studied between manifestations of the biological activity of the toxin preparations and immunochemical purity of the toxin as well as addition of serum albumin.


[S35 lipoic acid distribution and its effect on pyruvate dehydrogenase activity in rats with Walker carcinoma].

S35-lipoic acid injected intraperitoneally in rats with Walker carcinosarcoma in a dose of 250 mg/Kg is accumulated in their organs and tissues to much higher concentrations compared with normal animals during all terms of the observation (15 min, 1 hour, 24 hours). Differences were especially great after 24 hours. Pyruvate dehydrogenase activity in tumor rats organs was considerably reduced when calculated per 1 Kg of tissue, but it is practically unchanged when calculated per 1 mg of protein, which amount in 1 g of tissue in them is distinctly lower than in normal animals. Single injections of lipoic acid in tumor-bearing rats do restore the enzyme activity to normal (in 1 hour), while repeated ones (10 days)--prolong animals lifeterms by 25%.


[Effect of a polyvalent proteinase inhibitor from the lungs of a bull on the state of the kinin system in burn shock and acute burn toxemia].

Effect of a polyvalent inhibitor of proteinases from bovine lungs (industrial preparation -- ingitrile, commercial grade -- conntrical) on the state of kinin system was studied in blood serum of patients with extensive burns at shock periods and in acute burn toxemia. Decrease in content of kallikreinogene, which is typical for shock and acute, toxemia and which reflects the activation of kallikrein-kinin system, was less distinct in patients, treated with the inhibitor, than in patients, which were not treated with ingitrile. The early and rapid restoration in kininogene content and distinct inhibition of the total arginine-esterase activity were observed in blood serum after treatment with the inhibitor. The inhibitor did not affect the phase alterations in the carboxypeptidase N activity within the first 3 days after the burns; the distinct decrease in the enzymatic activity was confirmed within the first period of the burn shock. Within 24-48 hrs after the burns content of alpha1-antitrypsin was distinctly increased in patients treated with ingitrile as compared with the untreated group. The data obtained suggest that the polyvalent proteinase inhibitor causes a decrease in activity of the kallikreinkinin system in blood plasma and affects the enzymes participating indirectly in formation of kinins in burned patients. The data obtained are in agreement with the distinct clinical effect of the inhibitor. The doses of the inhibitor used in these studies did not cause normalizing effect on the activity of the kinin system components and on the clinical state of patients only in extremely severe cases of burn shock and in acute burn toxemia with letal outcome within the few days after the injury.


Creatine phosphokinase-MB (CPK-MB) and the diagnosis of myocardial infarction.

Creatine phosphokinase-MB (CPK-MB) is the most sensitive and the most specific indicator available for the diagnosis of an acute myocardial infarction. With the exception of after-cardiac surgical procedures, the degree and the duration of CPK-MB elevation in serum approximates the extent of an acute myocardial infarction, although a variety of factors may affect the reliability of such an index. Differences in the fractionation and assay methods for the creatine phosphokinase isoenzymes have produced conflicting documentation as to the presence of CPK-MB in tissues other than myocardium and the release of CPK-MB under conditions other than an acute myocardial infarction. The embryological development of the CPK-MB isoenzymes, as well as the various conditions involving increased CPK-BB serum activity, also deserve attention.


Acute myocardial infarction: clinical application of technetium 99m stannous pyrophosphate infarct scintigraphy.

Acute myocardial infarction is being recognized as a spectrum of clinical subsets. This appreciation has been brought about to a large degree by the development of several new tools that can be applied clinically to aid in evaluation of patients with acute infarction, and in some cases to provide short and long-term prognostic information. In the realm of noninvasive methods, several tests utilizing radiopharmaceuticals and scintillation cameras have emerged and are rapidly becoming reliable diagnostic parameters in patients with coronary disease and infarction. Technetium 99m (stannous) pyrophosphate (TcPYP) scintigraphy, one of the first of these techniques to find clinical use, has been shown to be an accurate indicator of acute transmural myocardial infarction and provides added sensitivity and specificity to the diagnosis. Increased diagnostic accuracy, the dimension of visible localization and the potential for infarct sizing promise physicians better understanding of a patient's clinical presentation and a more rational approach to management.


[Results of the Austrian myocardial infarction study on the effects of streptokinase (author's transl)].

A multicentre study of cases of acute myocardial infarction was undertaken at 27 departments at teaching and non-teaching hospitals throughout Austria over a period of three years. Altogether 3397 patients were investigated. On classification of the patients according to the number of shock indicators, two comparable groups (B and C) of "mild" infarction with 0, 1 or 2 signs of shock were obtained. These low-risk groups comprised 728 patients. The mortality in group C ("mild" infarction, no streptokinase) was 17.3%, significantly higher (p less than 0.01) than the corresponding figure of 10.5% in group B ("mild" infarct, streptokinase therapy). The decrease in mortality by streptokinase therapy applied both to monitored patients as well as to those who were not monitored. Haemorrhage was a very rare complication, but somewhat more frequent in the streptokinase-treated cases, as expected. The incidence of complications such as stereocardia, asystole, and cardiac insufficiency, as well as the conversion of "mild" cases into a "severe" symptomatology was markedly reduced in the streptokinase-treated group.


[Advances in the diagnosis of renal function with radionuclides (author's transl)].

Nuclear medicine offers the possibility of quantitative (clearance techniques) and semiquantitative (sequential gamma-camera studies) renal function studies, which can be done with minimal discomfort to the patient at a low radiation exposure. Scintillation cameras with data-storing and computer systems are used after administration of labelled chelates (99mTc-DTPA, 111In-DTPA, 51Cr-EDTA) and labelled contrast media excreted by glomerular filtration (131I-Iothalamate, 131I-Hypaque) and after injection of 131I-ortho-iodo-hippuric acid (131I-Hippuran). The use of 99mTc gives further information on regional renal perfusion, which can be supplemented by exact data after injection of 133Xe into the renal artery. The described methods have proved to be valuable in the diagnosis of renal artery stenoses, in the follow-up of inflammatory kidney disease, in the assessment of hypertensive patients, in the differentiation of renal lesions with destruction of parenchyma, in the follow-up of urinary tract obstruction and in the follow-up of patients with transplanted kidneys over many years. The correlation of nuclear medicine data with chemical and clinical parameters is excellent. Studies of renal function by radionuclides have, thus, acquired an important role in the evaluation and follow-up of nephrological and urological patients.


[Serum lactate dehydrogenase activity after renal transplantation (author's transl)].

Regular 4-weekly follow-up controls of serum lactate dehydrogenase activity in 23 renal transplant recipients revealed a constant rise in serum LDH activity during the early postoperative months. During the first post-transplant month serum LDH activity increased from 150.0 +/- 48.2 mE/ml to 195.5 +/- 84.8 mE/ml, serum enzyme activity being highest (329.1 +/- 143.2 mE/ml) 6 months after surgery. Since serum creatinine levels remained relatively constant, it seems unlikely that renal rejection played a major pathogenic role in the production of increased LDH activity. Since the pattern of lactate dehydrogenase isoenzymes was ithin normal limits, the pathogenesis of increased LDH serum activity following renal transplantation is not yet clear. Possible causes such as liver damage due to hepatitis B, macrocytosis induced by immunosuppressive therapy and myopathy to steroids are discussed.


[Illness due to mycoplasma pneumoniae in childhood (author's transl)].

Mycoplasma pneumoniae infection could be found in 16 from 92 children treated for respiratory disease in a Hungarian hospital. It was verified by growth inhibition test or by culturing germs from bronchial secretions. Seroology proved to be more effective than culture for identification. Illnesses due to Mycoplasma pneumoniae seem to be more frequent in the age group 0--3 years in Hungary than they are in western countries in the same age group. The authors assume that this high frequency is caused because children in this country are earlier admitted to community facilities (crèche, kindergarten, hospital) than in western countries. Therefore mycoplasma pneumoniae infection must be paid attention to also in acute respiratory diseases in the first 3 years of life, when children are admitted to community facilities.


[The value of lymphography as supplemental examination in thoracic diseases (author's transl)].

A literature review about the significance and incidence of lymphography in intrathoracic diseases (lymphogranulomatosis, reticulum cell sarcoma, lymphosarcoma, chronic lymphatic leukemia, giant follicular lymphoma, pulmonary sarcoidosis) is given. Intrathoracic manifestations of malignant lymphomas are absolute indications for lymphography. With the proof of retroperitoneal lymph node involvement alterations in staging of the disease and therapeutical consequences are emerging. In benign lymph node diseases, such as pulmonary sarcoidosis, lymphography will be also helpful for staging, but therapeutic consequences do not ensue, an absolute indication for lymphography is not validated. Lymphography is valuable for the diagnosis of diseases and injuries of the thoracic duct. The existing methods of lymphographic visualization of intrathoracic lymph nodes are not yet satisfying and need further research.


[Pathophysiology and therapy of anemia in chronic renal insufficiency].

During a chronic renal insufficiency obligatorily an anaemia develops, which shows a statistically highly significant non-linear correlation to the degree of the impairment of the renal function. The pathogenetic points of view are very diverse and include disturbances of the formation of erythrocytes and a shortened life span of the erythrocytes. The necessary treatment of anaemia, above all in patients on the chronic dialysis programmes must consider these pathomechanisms and will be in most cases identical with a polypragmasy.


[The influencing of laboratory diagnosis through drugs].

An extensive literature on influencing laboratory diagnostics by drugs gave rise to uncertainty in interpretation of clinico-chemical results. However, a critical revision of primary literature shows that at this time only a relatively small part of asserted influence is secured and relevant for the therapeutic situation in human being. In interest of the interpretation of the results as well as of the early diagnosis of biochemically conceivable side-effects of drugs and poisonings systemic clinico-pharmacological and clinico-chemical investigations are necessary. For a rough orientation in patients some tables were added in extracts taking as a basis a critical selection of hitherto existing literature on such influences.


[Use of nuclear-medicine technics in the differential diagnosis of anemias].

The use of nuclear-medical methods is especially described for the diagnostic of anaemias with different etiology. For the diagnosis of the chronic haemorrhagic anaemias the determination of the blood losses through the gastrointestinal tract with the help of the 51Cr-method and for the course of the acute haemorrhagic anaemias the automatized determination of the blood volume are emphasized. For the proof of a latent haemolysis often the knowledge of the apparant half survival time of the erythrocytes is necessary. Also in manifest haemolysis this investigation method gives differential-diagnostic references. For the megaloblastic anaemias a diagnostic routine programme and a differentiated investigation scheme are reported by Hoffbrand. For the clarification of the anaemias by insufficiency of the bone-marrow and ineffective erythropoiesis the radio-iron-kinetic investigations have proved. They should also be taken into consideration for the indication of the transplantation of the bone-marrow.


[Use of a computer for the preparation of medical history screening in cardiovascular diseases].

Questionable data may be regarded as significant indicators for a screening. It is the aim of our investigations to develop a screening standard anamnesis in form of a questionaire which allows on the scale of larger groups of population to establish the number of endangered persons and patients who probably suffer from cardiovascular diseases but of the quantity of apparantly healthy persons. In order to recognize regularities of the diagnostics coordination of the individual patient by his answers on the questionnaire the data of 400 diagnostically clarified persons (model experiment) underwent a discriminancy analysis. When the data of unknown test persons are given in, on account of the well-known functions of discriminancy a classification in the groups persons with heart and circulatory diseases or with a healthy heart and circulation or a group diagnosis can be performed, respectively. The evaluation of the data of unknown test persons of a pilot study in 96% resulted in a correct classification in patients with heart and circulatory diseases or persons with healthy heart and circulation, the classification in the above mentioned groups of diagnosis was performed on an average to 57%.


[Experience in the use of Smith's ECG evaluation program].

After the experiences with the use of the programme of Pipberger concerning the automatised ECG-analysis in clinic, outpatient department and factory public health, which were made at the Medical Academy Erfurt during the last years, at this time comparative examinations with the ECG-analysis programme of Smith were performed. The intake of data (3 orthogonal leads) is done by means of a data establishing unit developed by us. For the analog-digital-changing, the pretreatment of data and the transmission of the ECG-data on the digital magnet tape a process-calculator TPA-i is used. The analysis is performed by the computer Robotron 21. The evaluation of the results shows that, when a great number of patients is examined, normal curves are correctly estimated at 100%. The recognition rate of pathological curves has with 79.5% about the same size as the visual judgment. The deficiencies of the diagnostic programme of Smith must be essentially found in the relatively high proportion of falsely negative findings, the insufficient differentiation of the changes of the chamber variation, in the sometimes incorrect formation, why the classification of the curves in individual groups was performed. On account of the certain centage of falsely negative ones the programme is well recognition of normal findings and the tolerable pernotion of the diagnosis and the sometimes lacking insuited for screening examinations.


[In memoriam Emil Abderhalden (1877-1950) (author's transl)].

The 100th anniversary of Emil Abderhalden's birthday gave occasion to remember life and work of this great physician. Abderhalden's contributions to physiological chemistry then determined the profile of this speciality and at the same time they also fertilized other subjects--for instance internal medicine. Apart from the activity in the closer speciality Abderhalden's life-work is characterized by social-medical activities and activities in the field of communal politics, the details of which are presented in this study.


[Universal measurement site for the processing-oriented recording of cardiovascular data].

A measuring place is described for the registration of standardized, evaluable by means of the computer deviations of bioelectric signals (parameters of heart and circulation, peripheral pulse curves and rheogramms). The high demands which concern the adequate establishment measuring places with regard to quality and comfort of attendance and condition corresponding technical solutions are explained. At the instance of the rheogram the mode of function is described. A short prognosis on the trend of development in the recognition of biological measuring values is given.


[Use of automatic picture processing in clinical-morphological diagnostics].

The use of the automatic elaboration of pictures for the evaluation of microscopic pictures gives the possibility to automise histological and cytological routine examinations and to improve the recognition of morphological findings by quantitative investigations in the medical morphological diagnostics. The effective practical use of the method is bound to certain device-technical prerequisites which are mentioned in short. At the same time a survey of the principal possibilities in the medical morphological diagnostics is given. By the analysis of the digitalised pictures of cells, cell organelles and other tissue structures reproducible quantitative data on outline and texture as well as on the special arrangement of the objects present in the picture are obtained. On the basis of these characteristics it is possible to identify cells, to find perhaps existing subgroupings in cell populations or to perform an automatic preselection of the material to be investigated. At the instance of the normal white differential blood picture the modern possibilities and limits of the method are described.


[Automatic processing of laboratory data using a process computer at the Dresden Medical Academy].

The prerequisites for the use of electronic data processing apparatuses in the laboratory diagnostics are explained and principal demands are formulated which are to be made to a laboratory organisation system supported by electronic data processing on the side of the clinic. The description of the project "LOL 2" practised at the Medical Academy Dresden deals above all with the demands of the laboratory, the establishment of findings referred to series and patients and their transmission to the requirer using the teleprinting technics. The first step of the practical use of this project is also used in the district hospitals Cottbus and Görlitz. The aim of this development is a comprehensive information system for the communication process between ward and laboratory.


[Use of a process computer in nuclear medicine].

The picture processing of scintigrammes (scintillation scanner and scintillation camera) has become possible only by use of process calculators. In the processing of individual static pictures by means of mathematical filtration methods, underground subtraction and formation of classes the perceptibility of details is improved. The evaluation of dynamic photographs of the scintillation camera (to 10 pictures/s) presumes the genuine time working of a process calculator. Out of the sequel of pictures the temporary course of activity in marked picture regions (organs, parts of organs) can be calculated as function curve. Using a small computer system KRS 4,200 (Robotron) in the Radiological Clinic of the Leipzig Karl-Marx-University the temporary and logical course of measuring is regulated in nuclear-medical measuring places. Acceptance and processing of the measuring values is performed by 5 working places in genuine time work. Furthermore, organizational tasks of the course of work are treated by computer.


[Intra-articular therapy of chronic arthritides].

The intraarticular therapy with the aim of the direct influence on the pathologically changed synovial membrane increasingly gains significance. On the basis of own results as well as literary data the present possibilities of the local treatment of chronic arthritides are described. After discussion of the advantages and disadvantages of the individual usable preparations a scheme of therapy elaborated for the use of local therapeutics in chronic synovialitis is described. Exact indications for the use of the intraarticular as well as operative methods for therapy of chronic synovialitis must still be established.


[Benign monoclonal gammapathies].

Monoclonal immunoglobulins (= paraproteins) in zone electrophoretic separation on paper, cellulose acetate foil or agar are demonstrated as narrow base gradients, which refers to the homogeneity of the molecules of the immunoglobulins. In unselected population they are observed in 0.1 to 1.2%, in which cases they more frequently appear with growing age, in persons older than 70 years they were established in 3%. The cause in question is only in a small part a plasmocytoma or another lymphoreticular disease. In the majority of cases, particularly in the cases with insignificant concentration of M-gradients the appearance of monoclonal immunoglobulins is the only deviation from the normal in an examination, which led to the notion essential benign monoclonal gammapathy. A therapy of this benign gammapathy is not necessary. For the demarcation of an early form of a plasmocytoma long-term controls with measuring of the concentration of the monoclonal immunoglobulin shall be carried out, since a permanent increase of the paraproteinaemia is the most reliable sign of a malignant gammapathy. Clinical observation and experimental investigations on animals make probable that the causes for the appearance of a benign monoclonal gammapathy are to be traced back to a special antigen stimulation in genetic disposition.


[Immunoglobulin E--formation, determination and significance].

The detection of class E of immunoglobulins 10 years ago led to a decisive progress in the pathogenesis and diagnostics of allergic diseases. In the literary survey several essential findings concerning the structure of the IgE and concerning the quantitative and qualitative recognition of the total IgE and the allergen-specific freely circulating or cellularly fixed IgE-antibodies are cited. Diagnostically usable changes of concentrations of the level of total IgE are described.


[Progressive multifocal leukoencephalopathy as a complication of immunosuppression in kidney transplantation].

The progressive multifocal leukencephalopathy is mostly observed as paraneoplastic complication of malignant lymphoproliferative systemic diseases. It may develop also under the influence of a long-term immunosuppressive therapy, as it is necessary in the rejection treatment of recipients or organ transplantations. It is reported on a 44-year-old man in whom a progressive multifocal leukencephalopathy with exitus letalis developed 6 months after a kidney transplantation and following immunosuppressive therapy. In the oligodendroglia of the marginal region of leukodystrophic foci in the centrum semiovale of the right cerebral hemisphere by means of electron microscopy paracrystalline situated virions of the type Papova were proved in most cases.


[Renal failure during liver disease--The significance of endotoxins (author's transl)].

In cirrhosis and fulminant hepatic failure acute renal failure may occur both without ("functional renal failure") and with tubular necrosis, the two probably being the ends of a spectrum. The underlying pathophysiological change is an intense renal and intra-renal vasoconstriction. Evidence is presented that this is due to systemic endotoxaemia resulting from failure of the liver to filter endotoxins absorbed from the gastrointestinal tract. Acute renal failure complicating obstructive jaundic has also been related to endotoxaemia, but in contrast to cirrhosis and fulminant hepatic failure this is usually due to an associated gram-negative infection and the renal failure almost invariably has the features of acute tubular necrosis. Endotoxins have two major effects on the kidney: (i) renal vasoconstriction, and (ii) glomerular and peritubular fibrin deposition. The nature of the renal failure depends on the balance between these variables which may be profoundly altered by the underlying liver disease.


Comparison of treatment schedules for Plasmodium vivax infections in the Solomon Islands.

A total of 26 patients infected with Solomon Islands strains of Plasmodium vivax was treated with one of three regimens of cloroquine-primaquine, in an attempt to determine the relapse patterns and the response to treatment of the local strains of parasite. The results suggest that the standard course of chloroquine-primaquine provides a radical cure for the strains of Plasmodium vivax from the Solomon Islands, provided that strict supervision of drug administration is enforced.


[Review on nonessential constituents of vegetables. II. Cruciferae (Brassica vegetables, radish, turnip, rutabaga, horse-radish) and gramineae (onion, leek, chive, garlic, asparagus) (author's transl)].

In this paper the hitherto known constituents of the titled vegetables except proteins, carbohydrates, triglyceride-fatty acids, and vitamins are reviewed, especially the volatiles, organic acids, phenolics, carotenoids and lipids.


[Tumours of the skin (author's transl)].

Clinical oncology as an interdisciplinary subject demands as intensive cooperation in the treatment of tumours of the skin between the dermatologist, the radiologist, and the surgeon. A survey is presented on the systemic order of tumours of the skin especially regarding the differential diagnosis and the surgical treatment of malignant skin tumours.


[Incidence and significance of yeasts in carcinoma in situ and invasive carcinoma of the uterine cervix].

It is reported on mycological studies in 290 patients with preinvasive and invasive neoplasms of the cervix uteri. The yeast infestment of the vagina was 18,3%, by which we succeeded in demonstrating the yeast in the carcinoma in situ in 20% and in the cervix carcinoma of the stages Ia to IV in 17,7% of the cases. This infection rate corresponds with those of randomly selected patients. All increase in pathogen species of yeasts could be demonstrated through observations of the course of the disease in 20 patients under intensive therapy. The clinical significance is discussed.


[Bacteriological studies of the human amniotic fluid in repeated amniocenteses].

The amniocentesis to gain increasing importance ought to be examined whether an alteration of the bacterial flora of the amniotic fluid was caused by repeated amniocentesis. 128 samples of amniotic fluid selected by abdominal amniocentesis were placed in microbiological cultures. Bacteria was isolated in 30 cases, originated predominantly by pollution. Under the circumstance of strong sterile conditions the amniocentesis proven even when repeated a diagnostical way of procedure which does not represent any danger to mother nor child.


[Urinary and serum o-antibodies in patients with chronic pyelonephritis (author's transl)].

Urine (24-hour-specimen, 100-fold concentrated) and serum samples from adults with chronic pyelonephritis have been investigated for O antibody against the strain isolated from the urine by means of the indirect hemagglutination and indirect immunofluorescence technique. Using the hemagglutination technique about one third of the urine showed the presence of O antibody. The highest titer demonstrated was 1:16. O antibody determined by the immunofluorescence technique could be demonstrated in 54.9% of the urine samples. Titers up to 1:256 were found. Serum O antibody corresponded to those found in adults with chronic pyelonephritis. In general there was no correlation between urine and serum O antibody. The diagnostic and prognostic value of the results is discussed.


Gentamicin assay by enzymatic adenylylation and the application of a double osmotic shock procedure to prepare gentamicin adenine mono-nucleotide transferase.

The release of gentamicin adenine mono-nucleotide transferase (GAdT) during single cold osmotic shock treatment of E. coli K12 W677/HJR66 is not always maximal. The yield of GAdT could not be improved by using E. coli harvested at different stages of growth, by prolonging the exposure to the different steps of the shock procedure, by changing the sucrose concentration, or the magnesium chloride volume. The quantity of GAdT in osmotic extracts could be increased when a double shock procedure was performed. Using an aliquot (30 microliter) of the extract, an accurate and quick assay for gentamicin, sisomicin and tobramycin in microvolumes of serum (30 microliter) can be accomplished. To avoid high background activity in the assay, the extracts should be prepared from E. coli grown in gentamicin-free medium.


Immunochemical relations of salmonella paratyphi C with the salmonellae of group B.

Agar-gel precipitations of proteins from S. paratyphi C, S. paratyphi B and S. typhimurium against homologous and heterologous antibacterial sera, prepared in rabbits, demonstrated a strong relatedness between these species belonging to different serogroups. The findings explain and substantiate previous experiments in which high cross-protections were obtained in groups of mice immunized with proteins from these species and subsequently infected with S. typhimurium or its "in vivo" related S. paratyphi B and S. paratyphi C.


[Fibrinogen level and fibrinolytic activity of plasma euglobulins from rabbits infected with different types of Salmonella (author's transl)].

In 84 rabbits, fibrinogen behaviour and fibrinolytic activity of the plasma euglobulins were evaluated in the course of experimental salmonellosis caused by S. typhimurium, S. choleraesuis, and S. agona. 10 healthy animals with pseudoinfection served as controls. Disturbances of hemostasis expressed by a use of the fibrinogen level and inhibition of plasma-euglobulin fibrinolysis were established. An analysis of these changes and evaluation of the lethality among the animals used in the experiment revealed that the course of the disease is depending, inter alia, upon the type of Salmonella involved.


[Comparison of efficacy of 14 procedures for the hygienic disinfection of hands (author's transl)].

The efficacy of 14 procedures for the hygienic disinfection of hands mostly with commerical preparations was tested by a new experimental model developed at the Institute of Hygiene of the university Vienna (1,3). The disinfectant power was clearly dependent on the duration of treatment as well as on the kind of alcohol used in the preparation (n-Propanol better than iso-Propanol better than Ethanol). After one minute the efficacy of all preparations containing one of the three alcohols as active agent was well comparable to that of the standard procedure which according to our proposal (5) uses iso-Propanol 60% (ml/ml) for 1 minute. For preparations with n-Propanol as the main active agent (Satinazid and Sterillium) this was true even after treatment for a period as short as 0.5 min. In our opinion disinfecting detergents are out of place for hygienic disinfection of hands. One preparation representing this group (Versuchspräparat A) was far less effective than the standard procedure.


[Characteristics of the deletion mutant of plasmid R6K].

Deletion plasmide R6Kdelta with the mol wt of 17.2.10(6) dalton isolated from the E. coli chi 925 (R6K) is described. This plasmide expresses no resistance to streptomycin, is replicated in the E. coli K12 under relaxed control and is resistant to the treatment with the eliminating agents. Analysis of plasmide DNA with the aid of electrophoresis in agarose gel demonstrated that R6K delta has one site attacked by restriction endonucleases Eco. RI and Bam HI. These data were confirmed by the determination of the transforming activity of the corresponding DNA restrictors. It is supposed that the isolated plasmide was identical with plasmide RSF1040. A possibility of using R6K delta as a genetic vector for obtaining recombination DNA molecules in vitro is discussed.


[Bacteriophage induction in cultures of C1. botulinum type A].

The authors describe the mitomycin induction of bacteriophages in strains No. 4/2, 98, and 345 of Cl. botulinum, type A. All the strains under study produced phages of the same morphology with a head and a process capable of contraction. The phages detected by electron microscopy failed to express any lytic activity on the strains of type A and other Cl. botulinum types neither in the fluid nor in the hard nutrient media. The data obtained supplemented and widened the view on the incidence of phage carrier state in the cultures of botulism causative agent.


[Preparation of a standard for antinuclear antibodies].

The authors prepared a laboratory standard of antinuclear antibodies from the serum pool of patients suffering from systemic lupus erythematosis. This standard was tested in respect to normal human serum and an international standard of antinuclear antibodies BRS ANA 66/233. A possibility of quantitative determination of the usefulness of the sera of patients suffering from systemic lupus erythematosis for the preparation of the standard was demonstrated.


[Assessment of the diagnostic effectiveness of antigenic preparations from Sonne shigellae].

The authors studied the diagnostic possibilities of 4 diagnistic agents from Sh. sonnei. A total of 1500 from 1122 persons were investigated. Specificity and sensitivity of the diagnostic agents from Sh. sonnei were determined. Methodical priciples  of the objective assessment of the diagnostic efficacy of the antigenic preparations in the controlled epidemiological trial were elaborated. A possibility of establishment of the etiological diagnosis of Sonne dysentery in the passive hemagglutination or blast agglutination tests by the results of testing with the diagnostic agents of the serum obtained from the patient once or by determining the dynamics of the antibody titre rise in coupled serum portions was not great.


[Results of treatment of dysentery patients with streptomycin-dependent vaccine in comparison with other methods of treatment].

Comparative study of various methods of treatment was carried out on 777 patients suffering from acute dysentery with a bacteriologically confirmed diagnosis. To assess the therapeutic efficacy, along with consideration of clinical signs of the disease, immunoglobulin level was examined in the blood and coprofiltrates; also the state of reparative processes in the mucosa was appreciated by the histological examination of the biopsy material. Results of the work carried out indicated the inexpediency of the treatment of this disease with a combination of levomycetin and phthalazol. The use of live streptomycin-dependent dysentery vaccine was indicated in protracted torpid dysentery and was of no avail in acute form of the disease. A good therapeutic effect was observed with the application of pathogenetic therapy alone.


[Transmission of the R-plasmids and expression of their genes in Proteus mirabilis].

Resistance markers to individual antibiotics are transmitted in E. coli with the same frequency in the shape of a uniform linkage group, and in Proteus mirabilis--with a different one. Possibly in Proteus mirabilis plasmide R6 dissociated, this being expressed in a different incidence of transconjugates, characterized by a different set of antibiotic resistance genes. Tetracyclin resistance gene can be transmitted in P. mirabilis without being bound with other resistance determinants and with the functioning Tra-operon. The expression of individual antibiotic resistance genes of plasmide R6 in P. mirabilis differed, i.e. tetracycline resistance was inducible, and to kanamycin and chloramphenicol--constitutional. The level of expression of the gene controlling the tetracycline resistance was in noninduced condition in P. mirabilis, lower than in E. coli, P. mirabilis containing no R-factor possessed an inducible resistance mechanism to tetracycline, as in case of P. mirabilis strains containing R-factors.


[Study of the mechanism of reduction of the virulence in the Shigella flexneri strains resistant to streptomycin].

Streptomycin-resistant mutations in donor strains of E. coli K12 Hfr AB 313 and AT-13 are not associated with the action of the strA-gene limiting the suppression. Shigella mutations str-r obtained by the method described in this paper also failed to limit the suppression. Changes in the virulence observed in transmission strA region from the str-r strains of E. coli and shigellae used in this work were not connected with mutations limiting the suppression (with competent mutations).


[Detection of F-like plasmids in serologically typed E. coli by the reactions of the donor-specific phage titre increase].

The authors studied 130 strains of serologically typed E. coli for the capacity to provide reproduction of donor-specific phages MS2, Qbeta, and f1; positive increase of the donor-specific phages reaction was found in 12 cases. Some of the detected L-like plasmides bore determinants of colicinogenicity or drug resistance. Such plasmides were transmissive and capable of inhibiting donor properties controlled by factor F'-lac+, i.e. they served as plasmides of type fi+.


[Current problems of medical microbiology: Achievements, tasks and perspectives].

Two important problems of current medical microbiology are discussed in this paper: 1) a change of etiological structure of infectious morbidity-elevation of the incidence of infections caused by conditioned pathogenic causative agents, and 2) postvaccinal complications. In the light of these problems the tasks of microbiological investigations for the immediate future are discussed. Tasks and prospects of study of the molecular structure of the pathogenicity factors of importance for the creation of chemical vaccines and genetic investigations which would provide construction of strains and preparations useful in practice are formulated.


[Highly specific agglutinating O- and OK-immunoglobulins for identification of Escherichia in the agglutination test on glass].

Escherichia agglutinating O- and OK-immunoglobulins of class G were obtained by the method of ion exchange chromatography; in studying with live and heated O- and K- cultures of the test strains from the International escherichia collection these immunoglobulins proved to be diagnostically highly specific and useful for the identification of escherichia strains in the express agglutination reaction on glass.


[Postvaccinal dysentery immunity studied on the model of ligated loop of the small intestine of rabbits].

Chemical (detergent) antigens administered intraintestinally or intravenously to rabbits were applied to reproduce postvaccinal immunity to experimental shigellosis. There was noted an increase of the antibody level in the serum, an intensification of its preventive proerties, and the absence of dilatation of the isolated loops of the small intestine after the administration of the corresponding dysentery culture. Oral immunization of rabbits with the detergent antigen sorbed on ionexchange resin also led to immunity.


[Characteristics of microbial cultures in bacteriuria and various data on the immunological reaction in children with pyelonephritis].

A study was made of 268 cultures isolated from the urine of 263 children suffering from pyelonephritis. Of the total number of different cultures E. coli constituted 79.3 percent; the percentage of the rest varied from 5.2 to 0.4. Examination of 87 urinocultures of E. coli isolated from sick children with the specific immune response showed that the majority of bacterial signs (urease activity, capacity to produce alpha-hemolysin to utilize saccharose and raffinose, to synthesize colicine) failed to correlate with their pyelopathogenicity. The reference to individual serological groups also failed to serve as a sufficient foundation for the separation of these microbes into individual nephropathogenic or pyelopathogenic groups. In experiments with 3H-glucose labeled bacteria there was revealed a marked adhesive capacity in 94 percent of E. coli strains towards the epithelial cells of the RH strain. A positive radioactive label failed to correlate with the presence in E. coli of common pili and with the bacterial agglutinability with the sera K88, K99, and KH-III. The latter pointed to the presence of a factor of unknown nature in the nephropathogenic E. coli strains imparting adhesive properties to bacteria.


[Clinico-immunological characteristics of dysentery in persons with different blood groups].

The authors studied the frequency of distribution of the ABO system blood groups in 392 adults and 322 children suffering from acute dysentery. X2 criterion and double-factor dispersion analysis were used for statistical analysis. Deficiency of persons with B III and AB IV blood group. Phagocytosis indices were decreased in them with the elevated neutrophil damage index.


[Phage conversion of the antigens in Escherichiae and Shigellae. 2. Conversion of the somatic antigen in Shigella flexneri with the moderate E. coli 0129 phage].

The authors studied the converting activity of the moderate EF5 phage isolated from the lysogenic E. coli 0129 strain. It was shown that this phage converted the O-antigen with the detection of the type antigen V in the strains of Sh. flexneri of the serological type la and y-variant. The converted cultures contained the type antigen V and were identical by the antigenic properties to one another and the Sh. flexneri of the serological type 5 and E. coli 0129. A conclusion was drawn that phages converting the antigens of Sh. flexneri could be encountered in escherichia and could modify the antigens in Sh. flexneri and escherichia possessing the antigenic factor 3,4.


[Statistical analysis of non-uniform data obtained in several experiments with unequal experimental and control groups].

The author suggests a method of calculation of mathematically unbiased difference between the means of combined experimental and control groups and their calculated statistica-significance. Non-uniformity in the results of measurements between individual experiments is admissible. The coefficients adjusting the number of observations in the experimental and control groups to each experiment separately were found by minimizing the square of the mean error of the mentioned difference. Experimental results were united after the correction by means of the coefficients found.


[Viral encephalitis (etiology, pathogenesis, classification)].

The existing classifications of viral encephalitis are based on mixed, heterogenous principles. The author on the grounds of comparing modern data, related to the etiology, pathogenesis, predilectiveness, gives his suggestions as to a new classification of viral encephalitis. This classification is structured according to the pathogenetical principles, with a consideration of the different variants of the dynamics and polymorphism of separate nozological forms, depending upon the interrelationships of the viral and the immunity factors.


The onset of hemoglobin synthesis in spleens of irradiated mice after bone marrow transplantation.

Messenger RNA (mRNA) for globin was isolated from spleens of irradiated mice in which erythroid differentiation was induced by a bone marrow graft. The globin mRNA was isolated either by means of sucrose gradients of reticulocyte polysomal RNA or by affinity chromatography of total spleen RNA on poly (U)-sepharose. The globin mRNA was tested in a wheat embryo cell-free system. The appearance of mRNA in the spleen erythroid colonies was correlated with other parameters of erythroid differentiation such as globin synthesis, activity of delta-aminolevulinic acid synthetase and iron uptake. Poly(A) containing mRNA did appear already on the 3rd day after grafting. However, significant translational activity of globin mRNA could be demonstrated only one day later together with the increase in globin synthesis and delta-aminolevulinic acid synthetase and enhanced iron uptake. In the second part of this study mouse spleen cells rich in erythroid elements were incubated with a specific heme synthesis inhibitor (isonicotinic acid hydrazide, INH) and the synthesis of 9 S RNA was estimated. It was found that a 40-minute incubation with INH reduced uridine incorporation into 9 S RNA fraction by about 40%.


Relations between ion shifting, ATP depletion and lactic acid formation in human red cells during moderate calcium loading using the ionophore A 23187.

Keeping constant cellular magnesium an A 23 187 mediated moderate calcium loading of human red cells causes isoosmotic cell shrinkage, potassium efflux, slight decrease of cellular pH, ATP depletion connected with an increase of AMP, ADP and Pi and enhanced lactic acid formation. The calcium loading and accompanying effects can be abolished by EGTA or by extracellular magnesium, the latter kept more than two orders of magnitude above that of calcium which was 30 micrometer. Inhibition of the (Mg2+ + Ca2+)-dependent ATPase by ruthenium red or lanthanum decreases the calcium stimulated lactic acid formation after a lag phase. However, the ATP depletion proceeds faster and is much more pronounced under these conditions. (Mg+2 + Na+ +K+)-dependent ATPase, hexokinase, phosphofructokinase and cell shrinkage are ruled out, too, as mediators of the ATP depletion. This suggests that an unknown ATP consuming reaction, apparently not being related to the calcium pump, causes the calcium induced ATP depletion.


[The innominate artery syndrome].

During to the peculiar morophology and symptomatology of the haemodynamic disturbance following occlusion of the innominate artery, the anonyma syndrome ought to be treated as an independent type of the cerebro-vascular syndrome. The anonyma syndrome is generally a part-symptom of obliterating arteriosclerosis of multiple localization and has therefore an unfavourable prognosis. After a brief survey of the literature the clinical data of patients operated for innominate artery occlusion are reported together with the surgical results.


Dose-response study with a new LH-RH analogue, D-Ser (TBU)6 LH-RH 1-9 (EA)10 during the follicular phase of the menstrual cycle.

D-Ser (TBU)6 LH-RH 1-9 (EA)10 (HOE 766) a highly active LH-RH analogue, was studied with regard to its effects on the release of follicle stimulating hormone (FSH), luteinizing hormone (LH) and oestradiol-17beta (Oe2) during the follicular phase of the menstrual cycle. Forty-two regularly menstruating women were allowed to five different treatment groups with different doses (1.25 microgram; 2.5 microgram; 5.0 microgram; 10.0 microgram; 20.0 microgram) of HOE 766 given as intravenous bolus injections and the plasma concentrations of FSH, LH and Oe2 were measured up to 24 h after injection using specific radioimmunoassays. In the majority of cases, peak values of both FSH and LH occurred 4 h after injection being significantly different from pre-injection levels (P less than 0.02 in the 1.25 microgram treatment group, P less than 0.005 for the other treatment groups). Statistical analysis of maximum values as well as the absolute and relative increase in the different treatment groups revealed a dose-dependent effect of HOE 766. Maximum values of Oe2 occurred 8 h after injection and were found to be significantly different from pre-injection levels (P less than 0.005). However, no dose dependent effect was observed. It was concluded that HOE 766 is a potent and long-acting stimulator of FSH, LH and OE2 release in women. The effect of HOE 766 is dose dependent for FSH and LH but not for Oe2.


Impaired responses of growth hormone and blood eosinophils to L-dopa in atopy.

In order to assess whether response to the natural precursor of catecholamines in the nervous system is impaired in atopy, 500 mg L-dopa was administered to 13 atopic patients with bronchial asthma or hay fever and 13 sex-and-age-matched control subjects. The blood eosinophil count and growth hormone (GH) levels were then determined periodically over a 4-h period. The eosinophil count rose significantly 30 and 60 min after L-dopa in healthy subjects, but not in the atopic patients. The mean rise in GH 30 and 60 min after L-dopa was significantly lower in atopic patients as compared with controls. Injection of apomorphine 0.75 mg elicited increase in GH in nine of the 10 control subjects, but only in six of the 11 atopic patients. These results indicate that central dopaminergic stimulation is often impaired in patients with atopy. In testing GH release, atopy should be considered among the causes of failure to respond.


Clinical evaluation of high-frequency positive-pressure ventilation (HFPPV) in laryngoscoy under general anaesthesia.

A technique for automatic ventilation during laryngoscopy under general anaesthesia was evaluated in a lung model and in 5 patients (3--57 y) submitted for routine laryngoscopy. this technique has been given the name laryngoscopic HFPPV and utilizes an insufflation frequency (f) of 60 per min and a relative insufflation time (t%) of 22%. Ventilation is given via a nasotracheal insufflation catheter. Laryngoscopic HFPPV permits laryngeal surgery with a virtually unobstructed surgical field under complete muscular relaxation. The alveolar ventilation of the patient may be controlled by adjustment of the pressure of the anaesthetic gas mixture and there is no air entrainment through the larynx during insufflation. This makes possible use of O2/N2O mixtures and the oxygenation of the patient may be controlled by adjustment of the oxygen concentration of the anaesthetic gas mixture. As there is a continuous upward has flow through the larynx, blood or pieces of loose tissue are not sucked down into the trachea. A simple ventilation nomogram for clinical use is proposed. Adequately used, this nomogram guarantees safe ventilation during laryngoscopic HFPPV. An Fio2 of 0.3--0.4 gives adequate arterial oxygenation.


High-frequency positive-pressure ventilation (HFPPV) in neonates and infants during neuroleptal analgesia and routine plastic surgery, and in postoperative management.

The low pulmonary compliance, the high airway resistance and the "rapid" breathing pattern of neonatal and paediatric patients make it necessary to design special ventilators to match the pulmonary physiology of infants. A ventilator system which also in small children has a negligible compression volume was evaluated in a lung model and during repair of cleft lip and palate in 16 patients under general anaesthesia and in two other infants during other operations. High-frequency positive-pressure ventilation (HFPPV) was given with an insufflation frequency (f) of 60 per min and a relative insufflation time (t%) of 32%. In addition, two neonates treated postoperatively with HFPPV are reported. Despite the "open" character of the ventilator system both intra- and postoperative ventilation were uneventful in all patients. The arterial oxygenation was good in all cases, as judged from clinical signs or blood gas analyses. Postoperative ventilation required conventional clinical observation and intermittent analyses of blood. HFPPV has been shown to depress, or abolish, spontaneous respiration via reflex mechanisms. In all patients in this investigation respiratory movements were absent at normo- or slight hyperventilation during HFPPV.


Phrenic and vagal nerve activities during spontaneous respiration and positive-pressure ventilation.

Afferent vagal nerve activity from stretch-receptors in the lung and efferent phrenic nerve activity were recorded during spontaneous respiration and during positive-pressure ventilation with three different types of ventilators. During spontaneous respiration the efferent phrenic nerve activity slightly preceded the afferent vagal nerve activity. Volume-controlled ventilation did not alter the phrenic nerve activity when the ventilation was set at a rate equal to that during spontaneous respiration, but afferent vagal volleys increased in duration. At higher frequencies of insufflation spontaneous inspiration was inhibited. An increase in afferent vagal nerve activity and a concomitant slight decrease in efferent phrenic nerve activity were obtained during animal triggered pressure-controlled ventilation. High-frequency positive-pressure ventilation (HFPPV) gave rise to basal, non-grouped activity in vagal afferents, causing inhibition of inspiration. During HFPPV, spontaneous respiration can take place on activation of other afferents to the respiratory centre. Clinical aspects of respirator treatment from a neurophysiological standpoint are discussed.


Intracerebral displacement of basal ganglia following septal cannulation.

The effects of septal cannulation on the displacement of basal ganglia form the basis of the present communication. In experimental rats, in which a cannula is chronically implanted for 30 days between the medial and lateral septal nuclei by stereotaxic procedures, considerable shift of the basal ganglion is always observed on the operated side. The displacement takes place along the long axis of the ganglion either rostrally or caudally. Besides gross asymmetry in their relative sizes, no histological differences are observed between the ganglia of the two sides. Control animals, in which the cannula is withdrawn immediately after the septal lesion, manifest similar, but less pronounced movements of the basal ganglia. The probable underlying mechanisms for such intracerebral shifts are discussed and the role of indirect mechanical forces is outlined. The extraordinary degree of plasticity of the subcortical nuclear masses in terms of mobility is also emphasized.


Prophylactic treatment of migraine with clonidine. A controlled clinical trial.

In a double-blind crossover trial of two 12-week treatment periods with a 4-week treatment free interval, to which 21 patients were admitted, there was no statistically significant difference between clonidine 75 microgram twice daily and placebo in the total number of headache days, migraine indices, duration of attacks, number of severe attacks and consumption of acute attack treatment. However, there was a marked reduction in number of headache days, migraine indices, duration of attacks and consumption of acute attack treatment during the second treatment period compared to the first treatment period, regardless of the treatment regime. This was presumably a result of prolonged treatment and frequent attention and not an effect of the active drug. 32 patients entered the trial, but 11 dropped out. Of the 21 patients completing the trial, 16 were women; the median age was 34 years (range 17-54 years) and the median duration of headaches 12 years (range 1-40 years). Only mild side-effects were registered and no laboratory abnormalities were seen.


Metabolism of histamine in myotonic dystrophy a dual pattern of inactivation of intestinal histamine.

The catabolism of orally and subcutaneously administered 14C histamine was studied in myotonic dystrophy patients. No definite abnormalities were observed as for subcutaneously administered histamine. The catabolism of orally administered histamine followed two distinct patterns: In patients with a relatively low endogenous urinary conjugated histamine excretion at the time of testing, small quantities of radioactivity were excreted in the stools (mean 0.25 per cent), whereas the quantity of exhaled 14CO2 was in the control range (mean 14.4 per cent), and the exhalation curve diphasic as in controls. In patients with a relatively high urinary conjugated histamine excretion, the catabolic pattern differed: There was a relatively high faecal excretion of radioactivity (mean 20.1 per cent), whereas the exhalation of 14CO2 was markedly reduced (i.e. mean 0.5 per cent, versus a mean control level of 8.9 per cent). Diphasicity of the exhalation curve was not present in these patients. It has previously been demonstrated that a patient with myotonic dystrophy may shift between being a normal and a high conjugated histamine excretor. It is thus possible that all patients with myotonic dystrophy may pass through phases with abnormal catabolism of intestinal histamine.


Treatment of posttraumatic clavicular pseudarthrosis.

Six patients with posttraumatic pseudarthrosis of the clavicle were treated during 1973 and 1974 with an operative technique consisting of trimming of the bone ends, placement of a cortical bone transplant posteriorly and metal plate anteriorly, and fixation of the plates with screws. At examination 10-23 months postoperatively complete healing had been achieved in all cases.


Levamisole versus placebo as an adjunct to primary therapy of laryngopharyngeal epidermoid carcinoma. Evaluation of the immune status.

Twenty-four patients, with a biopsy-proven laryngeal or hypopharyngeal carcinoma, received as an adjunct to their primary treatment (surgery and/or radiotherapy), levamisole (150 mg daily during three consecutive days, every fortnight) or placebo, following a single-blind, but randomized method. At the end of the follow-up, an investigation of the immune status was done, and compared with that of a healthy control-group. It is concluded that the immunity is disturbed in patients with laryngo-pharyngeal cancer, but that this disturbance does not clearly correlate with the clinical state of the disease. Also, the immunological measures did not appear relevant to the significantly favourable effect of levamisole on the prognosis.


Circulatory reflex responses during the initial stage of feline endotoxin shock.

Cardiovascular and autonomic nervous responses to an injection of E. coli endotoxin were followed for up to 15 min. in cats anesthetized with chloralose and given artificial respiration. Within 60 seconds, endotoxin induced a drop of aortic pressure, with simultaneous cardiac acceleration and slight central venous hypertension. There was an associated, almost complete cessation of the aortic arch baroreceptor afferentation. The cardiac sympathetic efferentation increased up to 1.4 times the control level at its maximum. The splenic sympathetic efferentation increased up to 10.6 times the control level at the end of the 15 min period, when the other parameters studied showed a trend to control level. The sympathetic autonomic system seems to be activated through cardiovascular receptors sensing hemodynamic changes touched off by endotoxin-induced release of vasoactive substances.


Polypharmacy among psychiatric patients.

The purpose of the present study is to determine the frequency of polypharmacy among psychiatric patients in Helsinki, and to ascertain whether this practice is supported by clinical trials. The drugs prescribed in 1 day to a sample of patients (n = 694) in mental hospitals and outpatient clinics in Helsinki were studied. 69% of patients received more than on psychotropic drug in 1 day (61% received "proper" psychotropic drugs). On the average there were 2.1 different psychotropic drugs per patient, and the maximum was 6. A review of controlled clinical trials on the simultaneous use of more than one proper psychotropic drug in psychiatric diseases (excluding fixed combinations) revealed 14 trials. In only three trials was the combination better than its single components or placebo. Thus, there seems to be no evidence from clinical trials defending the frequent polypharmacy. A radical reduction in the number of psychotropic drugs prescribed for psychiatric patients is apparently desirable.


To be or not to be a Jew? A dilemma of Sigmund Freud?

The paper presents the position that Freud was not torn by the conflict "To be or not to be a Jew" as some have contended, but, rather, that he had resolved upon "to be ...", and did not long to reject his Jewish identity. What is maintained here is that evidence cited in support of supposed ambivalence regarding Jewish identity is better interpreted in terms of Freud's life-long ambivalence toward his father, his drive to denigrate and destroy him. Evidence is brough that it is his father, rather than himself, whom Freud identifies with the Moses figure - and the consequences of his identification are used to explain both his obsession with the Moses theme and his seeming digressions into Bible-analysis in "Moses and monotheism". The latter, which Freud described as a sequel to "Totem and Taboo", is seen as the acting out of the wish for parricide described in that work.