In-home health services in California: some lessons for national health insurance.

Spiralling Medicare and Medicaid expenditures, recent revelations about unhealthy conditions in nursing homes, and pressure for national health insurance have led to increased interest in in-home health services as appropriate and cost-effective. Medicare and Medicaid provided some stimulus for development of in-home health services. Shortly after these programs went into effect, however, major policy decisions were made aimed at curbing utilization of in-home health services. California home health data for 1966-1973 document the effects of major policies that led to the development and decline of in-home health services under Medicare and Medicaid. A review of those policies, supported by the California data, indicate that in-home health services have been greatly restricted by historical underdevelopment and legislative and regulatory emphases. In addition, the study indicates the limitations of the kind of data currently collected and suggests data requirements necessary for future program evaluation and planning in home health.


[Ehlers-Danlos syndrome (1 case)].

A male patient is presented is clinical and histopathological characteristics are typical of Ehlers-Danlos Syndrome (cutaneous and articular hyperelasticity and cutaneous fragility with the presence of atrophic scars). Looking into the family history we think that other relatives had the same disease and they had died during their childhood due to internal hemorrhages. The patient we present did not have significant hemorrhages in any moment. The elastic fibers in the dermal papilla are reduced giving rise to the appearance of being increased in the middle and deep dermis.


[Stuccokeratosis].

The clinical and histopathological aspects of "Stuccokeratoses" are described. The frecuency, of the disease, the etiological aspects, nosology and differential diagnosis are mentioned. A patient with the typical clinical picture is reported. A good result with 0.5% retinoic acid solution is mentioned.


[Lichen sclerosus et atrophicus of rare location].

The authors report a case of Lichen Sclerosus et Atrophicus located exclusively in the nipples, appearing during the puberty of a male patient thereby justifying the presentation of this work.


[Immunopathological studies in herpes gestationis].

Immunologic studies were made in two patients with "herpes gestationis". Direct and indirect immunofluorescence studies lead to the following results: 1. DIF was done with antisera against IgG, IgM, IgA, IgE and C3. Only the deposit of C3 was detected on the basal membrane zone of the lesioned skin. In one of the patients the deposit was found also on healthy skin. 2. IIF did not show immunoglobulins against the basal membrane in sera but in both patients a termolabil factor (factor HG) which activates the fixation of the complement onto the basal membrane zone was detected. No correlation between the immunopathologic pattern of Herpes gestationis and that of the other bullous diseases which cause subepidermic bullae was found. However there was a significant similarity between the immunologic pattern of Herpes gestationis and Bullous pemphigoid.


[Groenblad-Strandberg syndrome. Study with scanning microscopy provided with an X rays analyzer].

A skin biopsy a 37 year old man with typical lesion of pseudoxanthoma elasticum associated with angioid striae (Groenblad-Strandberg syndrome) was examined with a scanning EM (SSM-2A) and a scanning EM provided with a X ray microanalyser. With the scanning EM (SSM-SA) it was possible to see tabular crystalline deposits with subround faces and rhombohedric tendency. The scanning EM provided with a X ray microanaliser enabled us to see crystalline deposits which in some fields adopt a star-shaped form corresponding to calcium crystals of not very well defined habit. The X ray microanalyser shows us the correspondence between the star shaped figures and a calcium salt. The potassium, sodium and magnesium analysis of the specimen permits us to verify that the pseudoxanthoma elasticum dermis is rich in K and poor in Mg.


[Analysis of delayed hypersensitivity to antibiotics].

The delayed hypersensitivity to antibiotics existing in Brazil, including the systemically administered, is analyzed. The sulphanilamide, penicillin, neomycin, oxacillin, oxitetraciclyne, chloramphenicol and kanamycin were the more positive to the contact test. We do not find any difference in the test between sex and race. The positivity was 7,5 times higher in adults than in children. In spite the high positivity in atopic patients we could not demonstrate the same in patients with other allergic procesus history.


[Desmoplastic melanoma].

Conley et al., in 1971, described a special type of melanoma characterized by a superficial melanic lesion at the onset; repeated local relapses as subcutaneous tumorations with an histological picture closely resembling an atypical fibroxantoma or fibrosarcoma. After a review of all the published material the autors presents a personal case with the clinical, histological and evolutive characteristics of this disease. The most interesting findings of the published case are the following: The special stains for the melanocytes (silver stain, Dopa, tyrosinase and cholinesterase) were all negative. There was an intense positivity for the lisosomal enzymes (non specific sterases, and acid phosphatases). The ultrastructural study of the tumoral tissues as well as the cells of cultures showed abundant cells with tumoral aspects, with prominent nucleoli somewhat dilated granular endoplasmic reticulum, myelin-like figures, lipidic vacuoles and abundant lisosomes. No melanosomes or premelanosomes were observed. Beside these tumoral cells abundant typical fibroblastic elements were found. There was a great amount of collagen fibers with periodicity superior to the normal. The conclusion is that the desmoplastic melanoma must be considered as a tumor of mesenchimatous origin intervening in its development multiple local and general factors.


Diet and sterol biohydrogenation in the rat: occurrence of epicoprostanol.

The fecal sterols from rats fed several types of semipurified or commercial diets were analyzed by a combination of thin layer and gas liquid chromatography. In rats fed semipurified diets with lard, sucrose, and casein, increasing proportions of lard (0, 8, 20, 65%) enhanced the fecal coprostanol/coprostanol + cholesterol ratio (from 0.50 to 0.85). This ratio was reduced by replacing lard with triolein or a mixture of calcium oleate and linoleate (1:1) and did not change when trierucin was substituted. No coprostanol formation was observed in rats fed a diet with tripalmitin or tristearin. The addition of sodium hyodeoxycholate (0.5%) or cholestyramine (2%) to the basal diet was without effect on the coprostanol/coprostanol + cholesterol ratio in the feces. The addition of sodium taurocholate (0.2, 0.75, and 4%) strongly reduced coprostanol formation, while a chronic bile duct ligation led to an enhancement. Cholesterol feeding (0.05, 0.2, and 0.5% in the diet) slightly increased (from 51 to 66%) coprostanol formation. Trace amounts of epicoprostanol were generally found in the feces. However, in some cases a very high proportion (up to 60%) of this sterol was observed. Possible relationships between the presence of epicoprostanol and the nature of the diet are discussed.


Hormones in breast cancer: update 1978.

The role of cytoplasmic estrogen receptor (ER) assays in determining therapeutic strategies for advanced breast cancer is certainly well established. The use of ER assays in the primary breast tumor specimen to predict for early recurrence and ultimate survival is a new finding, however, and will probably be employed in future trials of adjuvant therapy. The prevalence and significance of nuclear-bound ER still requires additional clarification. Our previous suggestion that progesterone receptor measurements might be a useful marker for hormone dependence in advanced breast cancer is gaining support and may soon have a place in routine therapeutic decision-making. The emphasis on early adjuvant therapy has hastened the search for a safe endocrine therapy that would have good patient compliance and achieve remission rates comparable to previous agents and procedures. Antiestrogens show promise of meeting these requirements. We are now beginning an era in which primary and secondary systemic therapies for breast cancer can be based on sound biologic principles. The empirical approach is outdated.


Cleaning of scanning electron microscope specimens by puncture perfusion.

Puncture perfusion method was described for elimination of blood and tissue fluid in the scanning electron microscope specimens. It was also demonstrated that the puncture perfusion is of excellent use in cleaning the small samples including the human biopsy samples, which are hardly washed by the vascular cannulation.


[Electron microscopy: A clinically useful, desirable or useless tool in kidney biopsy diagnostics? (author's transl)].

Electron microscopic investigation of renal biopsies is indispensable in cases of suspected Alport's syndrome, benign (familial) hematuria, nail patella syndrome as well as for the identification of viruses, virus-like endothelial tubular structures and crystalloid deposits in cryoglobulinemia. Additional valuable information is provided for all other glomerular nephropathies especially for exact classification of glomerulonephritis. Electron microscopy can by no means be a substitute for light microscopy or immunofluorescence, respectively. Provided that clinical-pathological cooperation is optimal, best results can be obtained by simultaneous application of all three methods.


An explanation of axonal regeneration in peripheral nerves and its failure in the central nervous system.

Nerve fibres severed within peripheral nerves are able to regenerate and reinnervate the structures they formerly supplied. Most axons severed within the mammalian central nervous system (CNS) do not regenerate in this way. Regenerative axonal growth begins to occur in the CNS but ceases about two weeks after injury. Five earlier theories purporting to explain this difference are reviewed and found not to account satisfactorily for many experimental observations. A new hypothesis is advanced in which it is held that in order for regeneration to take place, the growing tips of the axons must be surrounded by extracellular fluid containing proteins (of specified identity) derived from the blood plasma. Such proteins are thought to be imbibed by the tips of the fibres and transported retrogradely to the neuronal cell-bodies. With this hypothesis it is possible to explain the success of axonal regeneration in peripheral nerves and its failure in the CNS. It is also possible to account for the exceptional circumstances in which axons do regenerate in the CNS. Various experiments are suggested for testing the validity of the new hypothesis.


Protection of foreign DNA against host-controlled restriction in bacterial cells. I. protection of F' plasmid DNA by preinfection with bacteriophages T3 or T7.

Foreign F'lac plasmid DNA which is introduced into potentially restricting E. coli recipient cells can be protected from restriction by preinfecting the recipient cells with UV-inactivated T3 or T7 bacteriophages which express the ocr gene function. The recipient cells survive and are able to replicate themselves as well as the newly acquired plasmid.


Restoration of polarity by N-deficiency in lambda phage containing a translocated trp operon segment.

When translation of trp mRNA is terminated by a nonsense codon or by antibiotics like chloramphenicol, the amount of the mRNA distal to the blocked ribosomes is found at much lower levels ("polarity"). Polarity is alleviated when the trp mRNA is formed as part of a long transcript from the phage lambda promoter PL (Segawa and Imamoto, 1974; Franklin, 1974); but the relief of polarity is itself largely dependent on the lambda protein N. In a phage that joins the trp operon segment (trpD, C, B A) to a point distal to the N gene, lacking the tL site, synthesis of trp mRNA starting at the PL promoter continues even when translation is generally inhibited by chloramphenicol, but in the absence of functional N gene product synthesis of the mRNA can be blocked by the antibiotic. Unexpectedly, in the absence of N function, even when translation is occurring, weak termination of transcription occurs at some sites in the translocated trp operon.


Dual autogenous regulatory role of threonine deaminase in Escherichia coli K-12.

We describe the regulatory properties of two strains carrying either the ilvA624 or the ilvA625 mutations, located in the structural gene for threonine deaminase. Crude extracts of both these strains possess a threonine deaminase activity migrating on polyacrylamide gels, differently from the wild type enzyme. Growth studies demonstrate that these mutations do not cause a limitation of isoleucine biosynthesis, suggesting normal catalytic activity of deaminase. A regulatory consequence of the ilvA624 allele is a derepression of the isoleucine-valine biosynthetic enzymes, which is recessive to an ilvA+ allele. The ilvA625 mutation causes a derepression which is dominant in an ilvA625/ILVA+ diploid. We interpret these data assuming that threonine deaminase, previously shown to be an autogenous regulator of the ilv genes, lacks a repressor function in the ilvA624 mutant, while in the ilvA625 mutant it is a better activator than wild type threonine deaminase. The data are discussed in terms of a model requiring that threonine deaminase, or a precursor of it, is in equilibrium between two forms, one being an activator of gene expression and the other being a repressor.


Effect of mutations affecting lysyl-tRNAlys on the regulation of lysine biosynthesis in Escherichia coli.

When studying mutants affecting lysyl-tRNA synthetase or tRNAlys (hisT, hisW), a lack of correlation is clearly observed between the amount of lysyl-tRNA and the level of derepression of several lysine biosynthetic enzymes. This exlcudes the possible role of lysyl-tRNA as the specific corepressor of the lysine regulon. However, the level of derepression of DAP-decarboxylase, the last enzyme of the lysine pathway, is very low in the hisT mutant; this indicates that tRNAlys is a secondary effector involved in the regulation of the synthesis of this enzyme.


Packaging of ColE1 DNA having a lambda phage cohesive end site.

The mechanism of lambda phage-mediated transduction of hybrid colicin E1 DNAs of various lengths was studied, and factors influencing the formation of these transducing particles were investigated. The results were as follows: 1. The presence of a cohesive end site of lambda phage (coslambda) on colicin E1 DNA was essential for packaging of the DNA. 2. Packaging of colicin E1 DNAs, which carry coslambda with molecular sizes corresponding to 68% of that of lambda phage DNA, was observed in the absence of all known recombination functions of E. coli K-12 and of lambda phage. 3. Hybrid colicin E1 DNAs having coslambda with molecular sizes corresponding to 28% of that of lambda phage DNA were packaged within lambda phage particles as trimers; hybrid DNAs with coslambda of 40 and 47% of the length of lambda phage DNA were packaged as dimers; and those with molecular sizes of 68% of that of lambda phage DNA were packaged mostly as monomers. These results demonstrated that two factors are essential for the packaging of DNAs within lambda phage particles; the presence of coslambda on the DNA molecule and an appropriate size of DNA.


A comparison of the activities of the products of the two genes for elongation factor Tu.

The two species of Elongation Factor Tu coded for by the tufA and tufB genes were synthesized in UV-irradiated E coli infected by transducing phages bearing the separate genes. Both proteins interact similarly with EFTs, GDP, and phe-tRNA. Although the phe-tRNA.EFTu.GMP.PNP complex containing the tufA gene product binds somewhat more tightly to ribosomes, both proteins promote the complete process of binding phe tRNA to ribosomes at similar rates.


Over-synthesis and instability of sigma protein in a merodiploid strain of Escherichia coli.

We have used two different methods to study the rates of RNA polymerase subunit synthesis in haploid Escherichia coli K12, and a KLF10 rPOB, C+ merodiploid derivative, when grown in glucose-minimal medium at 37 degrees C. Our results indicate that the haploid strain produces beta, beta', alpha and sigma in the molar ratios 1.01:0.99: less than or equal to 2.90:0.26; and that all these subunits are reasonably stable during subsequent growth. The merodiploid produces alpha at the same rate as the haploid, beta and beta' at a 42% higher rate, and sigma at twice the rate. Some 40% of the newly synthesised beta and beta' is degraded within one hour; the residuum is as stable as in the haploid. Alpha is stable throughout. By contrast, sigma is subject to a marked and continuous turnover in the merodiploid. These results are discussed in terms of gene dosage and regulatory effects.


Explanations accounting for transduction by bacteriophage lambda in maltose negative bacteriophage lambda resistant mutants of Escherichia coli K-12.

Entry of DNA from lambda phages particles into lambdarMAl- mutants of Escherichia coli K-12 is shown to be due to two distinguishable processes. One, residual transduction, results from a low level expression of lamB. The other one, background transduction, is independent of gene lamB. Interpretations are presented for these results. It is propos that residual transduction is due to a weak promoter pB3 located within or near the distal part of the gene preceeding lamB in the same operon. It is proposed that background transduction is due to a secondary receptor structure for phage lambda. Finally a tentative hypothesis relatin pB3 to insertion sequences is presented.


A mutation that increases the activity of nonsense suppressors in Escherichia coli.

We have isolated a new mutation, ups, that amplifies the suppressor activity of all the nonsense suppressors we have tested so far at low but not at high temperature. The properties of ups make it a very useful tool to improve the systems of temperature sensitive suppressors thus far described. ups maps between 25 to 27 min on the E. coli genetic map (Bachmann et al., 1976) and has no suppressor activity of its own. Its effects on translational fidelity are not influenced by mutations for ribosomal drug resistance. Thus, ups is different from ram which exhibits cooperative control of translation with other ribosomal proteins. The possible functions of ups in the cell are discussed.


Transposition of a DNA sequence determining kanamycin resistance into the single-stranded genome of bacteriophage fd.

Derivatives of bacteriophages fd which transduce kanamycin resistance were selected after growth of the phage in an E. coli strain that carried transpoon 5 (Tn5). Different clones of transducing phage and their DNAs were characterized by gel electrophoresis, electron microscopy, and by their ability to multiply in the absence of helper phage. Integration of the intact transposon into the full size phage genome was correlated with an increase in size of the phage particle from 0.95 mu to 1.7 mu, and with the appearance in the phage DNA of the stem loop structure characteristic for single-stranded Tn5 DNA. In non-defective phages the site of insertion was mapped by heteroduplex analysis within the intergenic region of the phage genome. Defective transducing phages were characterized as an insertion of Tn5 into a phage gene, and/or as a partial deletion or duplication of phage and transposon DNA. The size of the transducing phage from different defective clones varied from 0.6 mu to 3.0 mu and was directly proportional to the DNA content. These results demonstrate that filamentous bacteriophage are highly capable to replicate and package very different amounts of foreign DNA.


Regional replication of the bacterial chromosome induced by derepression of prophage lambda. III. Role of the replication in escape synthesis of gal operon.

Recent evidence suggests that the escape synthesis of gal operon following derepression of the prophage lambda in Escherichia coli K12 involves transcription originating at the lambda promoter (PL) to extend through gal under the conditions in which lambda DNA replication is prevented. Whether the observed expression of gal is due to transcription initiating at PL or at the bacterial promoter for gal (Pgal) was examined in the case of lambda DNA replication being normal. The experiments are based on that two types of transcription are distinguished from each other by the following properties: 1. Pgal-promoted transcription is inhibited by chloramphenicol, while PL-promoted transcription is not. 2. PL-promoted transcription suppresses the polar effect caused by nonsense mutation in a bacterial gene, while Pgal-promoted transcription does not do so. -he results have suggested that gal escape synthesis in lambda-induced lysogen results from transcription which initiates not only at PL but also at Pgal. The Pgal-promoted transcription may be a consequence, direct or indirect, of the concomitant replication of gal DNA.


The effects of coumarin on the frequency of deletions in a duplication strain of Aspergillus nidulans.

Strains of A. nidulans with a chromosome segment in duplicate show instability resulting from deletions in either of the duplicate segments. In Dp (I, II) strains, with the terminal segment of IR attached terminally to IIR, spontaneous deletions occur most frequently, though not exclusively, from the translocated segment. Coumarin, at concentrations which did not affect viability viability or growth rate, enhanced the instability of Dp (I, II) strains by selectively increasing only the deletion class of highest spontaneous frequency. This selective action is interpreted tentatively as due to inhibition of the repair of a particular class of DNA lesion occurring spontaneously in the attachment region of Dp (I, II) strains.


Two major groups of colicin factors: their molecular weights.

Colicin factors are thought to fall into two taxonomic groups which differ in, amongst other properties, the molecular weight of the plasmid DNA and the host range of the colicin protein. This hypothesis is supported by the plasmids found in 26 colicinogenic strains. Two small Col factors may have arisen from larger factors, judging from similarities between their colicins.


Ribosomal proteins of yeast strains carrying mutations which affect the efficiency of nonsense suppression.

We have examined the ribosomal proteins of strains of Saccharomyces cerevisiae which differ in the efficiency with which ochre nonsense mutations are suppressed. The strains in which ochre suppression is poor were [psi]- or carried antisuppressor mutations; those in which suppression was highly efficient were [psi]+ or carried allosuppressor mutations. The ribosomal proteins of these strains, as judged by two-dimensional polyacrylamide gel electrophoresis, were indistinguishable from those of wild-type.


Supersuppressors in Aspergillus nidulans.

Simultaneous reversion of mutations in two different Aspergillus nidulans loci adA and metG was found to be due monogenic suppressor mutations. Preliminary evidence for the existance of supersuppressors in A. nidulans is presented.


Amplification of the lactose carrier protein in Escherichia coli using a plasmid vector.

The isolation and properties of a hybrid plasmid carrying the Y gene of the lac operon of Escherichia coli are described. The lactose carrier protein, coded for by the Y gene, is readily identified upon lac operon induction in strains carrying the plasmid. The protein comprises about 15% of the cytoplasmic membrane protein synthesized in the first generation after induction, compared with a wild type strain induced under the same conditions where lactose carrier protein comprises 1.4% of the cytoplasmic membrane protein.


Superinfection exclusion and changes in cellular transport processes in phage infected Salmonella typhimurium.

The changes induced by bacteriophage P22 in the cellular transport process(es) of the host Salmonella typhimurium (Taneja et al., 1975; Khandekar et al., 1975; Bandyopadhyay and Chakravorty, 1976) involve interactions between the superinfection exclusion system of the resident prophage and the C immunity region of the superinfecting phage. The sie A gene of the prophage interferes with the changes in the cellular transport process induced by the superinfecting phage. However, if the superinfecting phage carries active C1 and C2 genes there is no such interference. Thus the C1 and C2 genes of the superinfecting phage seem to be expressed in the sieA+ lysogen.


Construction and properties of recombinant plasmids containing the rII genes of bacteriophage T4.

The EcoRI digestion products of phage T4 DNA have been examined using a phage DNA transformation assay. A 2.6 X 10(6) Dalton fragment was found to contain the rII genes. This fragment was purified and then treated with HindIII endonuclease. The cleavage products were ligated to the vector plasmid pBR313 and viable recombinant plasmids recovered. A genetic assay was employed to demonstrate that the recombinants contained T4 DNA and to localize on the phage genetic map the EcoRI and HindIII sites cleaved during the construction of the plasmids. Preliminary characterization suggests that a fragment covering the beginning of the rIIA gene possibly contains a promotor which is active in uninfected cells.


[Haematuria in children. II. Diagnostic problems in proteinuria and the nephrotic syndrome in childhood (author's transl)].

Methods for detection of proteinuria and its causes are reviewed. Recommendations are given concerning the diagnostic procedures after detection of pathological proteinuria. The nephrotic syndrome is discussed mainly under the aspect of predictability of the histo-pathological form of the glomerular lesions from clinical and biochemical parameters.


[Construction and molecular cloning of hybrid plasmids containing specific fragments of Escherichia coli DNA].

In the paper a convenient procedure for the isolation of specific Eco RI-fragments of E. coli genome and their amplification on Km-resistance plasmid vector CKdelta11 is described. Plasmid CKdelta11 contains Col E1 replicon and has only one Eco RI site. The hybrid molecules were constructed in vitro using Eco RI-digestion followed by ligation. Then appropriated E. coli strain (polyauxotrophic strain E. coli K12 AB 2463) was transformed with ligated DNA mixture and hybrid plasmids, containing arg, leu, his and thr chromosomal markers were selected by molecular cloning and isolated from the obtained E. coli clones. The hybrid plasmids have two Eco RI sites and consist of one Eco RI-fragment of initial plasmid CKdelta11 and one Eco RI-fragment of El coli DNA. The method described allows to isolate and amplify on hybrid plasmids DNA fragments, containing any selectable genes or genes adjacent to the selectable ones.


[New method of determining parameters of oligonucleotide complex formation with nucleic acids according to the results of alkylation in complexes. Comparison with the method of equilibrium dialysis].

Binding constants of oligonucleotides with nucleic acids can be determined using data of nucleic acids alkylation with 2',3'-O-4-(N-2-chloroethyl-N-methylamino)benzylidene oligonucleotides. The latter bind to complementary sequences of nucleic acids, the binding constants of which are close to that of oligonucleotides. The extent of alkylation allows to determinate the equilibrium concentration of the binding with small corrections by an equation given, and hence to estimate the binding constants by standard modes. The binding constants of oligoadenylate and oligocytydilate derivatives with 23S RNA and rRNA have been determined at 0 degrees and 20 degrees by the method suggested and by the method of equilibrium dialysis. The binding constants are consistent of the magnitudes, as well as of the plots of the binding constants versus the oligomer and RNA concentrations and versus the oligomer length. The data obtained indicate that alkylation within the complexes of tri-hexamers with rRNA proceeds under the condition of an established equilibrium. Limits of the method suggested are evaluated.


[Haematuria in children. III. Treatment of glomerular diseases (author's transl)].

The treatment of acute Glomerulonephritis is outlined, that of the Nephrotic Syndrome discussed.


[Haematuria in children. IV. Therapie of chronic renal insufficiency in childhood (author's transl)].

The care of children with chronic renal insufficiency implies close cooperation between paediatric practitioners and paediatric units for renal disease. The children's disease must be detected at an early stage, its cause and course clarified. Adequate medical, psychological and social care during the period of compensated retention reduces complications at the beginning of dialysis- and transplant-programmes. At the moment good results in children justify the considerable expense. Many problems still remain unanswered as far as long term prognosis, growth, psychological, social, and sexual development are concerned.


[Interaction of DNA with RNA-polymerase from Escherichia coli cells infected and uninfected with T2 phage].

RNA polymerase from T2 infected E. coli has greatly reduced activity as compared to the enzyme from uninfected bacteria. Nevertheless both RNA polymerases synthesize heterogenous RNA species with the same maximum corresponding to chain length of 5600 nucleotides on T2 DNA. Rifampicin-challenge experiments suggest that these enzymes have identical kinetics of RNA chain initiation and elongation but their ability to form rapidly starting (RS) and delay starting (I) binary complexes with phage DNA are different. The temperature of I leads to RS transition on T2 DNA is 15 degrees for E. coli holoenzyme, but is 35 degrees for the RNA polymerase from infected cells. The transition temperature depends both on the core and on sigma fraction. Shift temperature technique was developed to investigate the kinetics of I in equilibrium RS complexes rearrangements and their temperature dependence. The rate of these rearrangements is strongly temperature dependent for E. coli holoenzyme, while for RNA polymerase from infected cells it is much lower and is practically temperature independent. From the kinetic data and from the temperature dependence of equilibrium RS-complexes concentration, the rate constants of RS-complexes formation and decay are calculated. The kinetic data obtained in rifampicin challenge experiments are in agreement with the data on the dissociation of DNA-enzyme complexes performed by the filter assay.


[X-ray microanalysis of Michaelis-Gutmann bodies with the use of EDAX].

X-ray microanalysis of Michaelis--Gutmann bodies in human malakoplakia (kidney and testes) and in that of rats induced experimentally by administration of endotoxin of Escherichia coli, was carried out. The presence of calcium could be revealed in every Michaelis--Gutmann body according to the lines of Kalfa and K3 as well. The amount of it was in correlation with the stage of the calcification. In the Michaelis--Gutmann bodies found in the rat kidney, fixed without OsO4 presence of P could also be demonstrated. The correlation between the weight per cent of Ca and P seems to evidence the presence of CaHPO4. Results of the X-ray microanalysis of Michaelis--Gutmann bodies found in human and in experimentally induced malakoplakia appeared to be similar.


[Mutagenic and teratogenic effects of cigarette smoke. A summary of experimental and clinical observations (author's transl)].

The mutagenic effect of compounds in cigarette smoke condensate has been demonstrated by the Ames test. A small percentage of cells is transformed into malignant cells. In animal experiments, evidence was found for the teratogenic effects of the contents of cigarette smoke. Among the published epidemiological statistical observations on the effects on humans are a reduction of the birth weight due to maternal smoking, an increase in perinatal mortality if the father smokes and twice the incidence of deformities in children of fathers who smoke heavily. The knowledge of these connections should be of significance for family planning consultation.


[Phenomenon of w-reactivation in plasmids].

An analysis of the action of the bacterial repair system on the UV-irradiated pMB9 plasmid has been carried out. It has been shown that the UV-irradiated plasmid is repaired in the bacteria similarly to the DNA of bacteriophage (lambda): the effectiveness of the UVR-system is lowered two-three times, and the postreplicativing REC system acts only at low doses of the UV-light. The phenomenon of omega-reactivation is observed both with plasmid and phage DNAs.


[Transplantation pneumonology].

The importance of the lung in graft surgery is essentially characterized by three points: infection in immunosuppression, transplantation lung and the transplant. The therapeutic reduction of endogenous defense increases the risk of infection considerably. Every hint of pulmonary infection in the patient with a transplant demands a thorough diagnostic investigation, even operative measures not being excluded in the course of clarification. The phenomenon of "transplantation lung" is probably caused by circulating antigen-antibody complexes. In lung transplantation, difficulties begin in obtaining a satisfactory organ, most donors with cerebral death cannot be considered. Immune-induced changes of the hemostasis system lead to microemboli and extravasation into the alveolar space. The risk of infection is greatest here, because the transplant is in constant communication with the outside world.


[Effect of several factors on synthesis of RNA-polymerase subunits by Escherichia coli K12].

In merodiploid cells containing a double dose of structural genes of RNA polymerase subunits--rpoB and rpoC--the rate of synthesis of beta- and beta'-subunits is 2 times higher than in haploid cells. Missense mutation rpoC1 (tsX) in the beta'-polypeptide gene accelerates the synthesis of both beta- and beta'-subunits, particularly at a nonpermissive temperature. When rpoB-rpoC operon containing mutation rpoC1 is duplicated no dose effect of these genes is observed. In the heterozygous state mutation rpoC1 produces almost no accelerating effect on the synthesis of RNA polymerase subunits i. e. is recessive with respect to the wild allele of rpoC. In the presence of rifampicin the synthesis of RNA polymerase subunits in a sensitive wild-type strain is stimulated 6-fold, the same effect is observed with cells carrying mutation rpoC1, the latter, however, itself accelerates the synthesis of these subunits 3-fold. Thus the effects of rifampicin and the mutation are synergistic indicating that these factors act independently. Similar data have also been obtained with rifampicin-treated cells of rpoB22 amber-mutant. In UV-irradiated cells, amino acid incorporation into beta- and beta'-subunits declines more rapidly than into the total protein. When either irradiated or non-irradiated cells are infected with a transducing phage lambdarifd-47 which carries rpoB gene, the synthesis of beta-proceeds at a higher rate. Irradiation of bacteria before the infection (500 erg/mm2) results in 6.5-fold acceleration of the synthesis induced by subsequent infection with lambdarifd-47 as compared to non-infected non-irradiated cells; the fraction of newly formed beta-polypeptide with respect to total protein grows 20-fold in this case. The data are considered with regard to the possible mechanisms of regulation of synthesis of RNA polymerase subunits.


W-reactivation and W-mutagenesis of gamma-irradiated phage lambda.

UV irradiation of Escherichia coli wild-type cells manifested the phenomena of W-reactivation (WR) and W-mutagenesis (WM) of phage lambda irradiated by 60Co gamma-rays in broth. WR of gamma-irradiated phage was half as efficient as that of UV-irradiated phage, although the frequency of c mutations in conditions of WR was about the same in both phages. The xthA and recBrecC sbcB mutants were practically identical with wild-type cells in respect of WR and WM of UV- and gamma-irradiated phage. As in UV-irradiated phage, WR and WM of gamma-irradiated phage were absolutely dependent on the recA+ and lexA+ genes of the host cell. WR and WM required much smaller doses of UV radiation for induction in polA1 and uvrB mutants. The lig-ts mutant, temperature sensitive in polynucleotide ligase, was deficient in WR and WM of UV- and gamma-irradiated phage at the semi-permissive temperature of 37 degrees. The uvrE502 mutant and the allelic recL152 strain were absolutely deficient in WR and WM of gamma-irradiated phage. In UV-irradiated phage WR was reduced, but not eliminated, in the uvrE mutant, and WM was entirely suppressed. This is another example of uncoupling of WR and WM which shows that several repair systems are active in WR but only some of them are mutagenic.


Colonic myoelectrical activity in irritable-bowel syndrome. Effect of eating and anticholinergics.

To determine the effect of a standard meal on colonic myoelectrical and motor activity in the irritable-bowel syndrome and to determine the effect of a single dose of an oral anticholinergic drug (clidinium bromide) on this response, we studied 10 patients. These patients showed a prolonged increase in both colonic spike (P less than 0.05) and motor activity (P less than 0.05) after eating as compared to normal subjects. Clidinium did not affect the frequency of colonic slow waves or the basal colonic spike and motor activity. However, the anticholinergic reduced the prolonged postprandial colonic spike and motor response in the patients and also reduced the postprandial increase in colonic contractions at 3 cycles per minute (P less than 0.05). These studies indicate that patients with the irritable-bowel syndrome show an abnormally prolonged post-prandial increase in colonic spike and motor activity. An anticholinergic drug reduces the duration and the magnitude of this abnormal colonic response.


A rho-dependent termination site in the gene coding for tyrosine tRNA su3 of Escherichia coli.

A set of partially overlapping DNA restriction fragments that support promoter-dependent transcription of the tRNATyr1 gene of Escherichia coli has been used to study site-specific termination in vitro. Transcription termination occurs at a specific site 224-226 nucleotides beyond the end of the structural gene and is completely dependent on rho-factor. Certain features of this site suggest differences from other termination sites previously studied. A role for specific sequence recognition is suggested.


Phase relations between a circadian rhythm and its zeitgeber within the range of entrainment.

The regular day-night changes in tissues, physiologic functions, and behavior of organisms are based on endogenous rhythmic processes which under constant conditions continue with periods slightly deviating from 24 h. These 'circadian' rhythms have properties of self-sustained oscillators. Under natural conditions, circadian rhythms are synchronized (entrained) to 24 h by periodic factors in the environment, the so-called 'zeitgebers'. In the laboratory, circadian rhythms can also be entrained to periods other than 24 h within certain limits. Data on the phase relationship between the circadian rhythm and an entraining light-dark cycle for vertebrates, insects, plants, and unicellular organisms are reviewed.


Microbial catabolism, the carbon cycle and environmental pollution.

The establishment of a carbon cycle was a necessary prerequisite for the evolution of higher forms of life. This could not have been achieved without the direct participation of oxygen gas in certain metabolic reactions. The controlled activation of oxygen is catalyzed by microbial oxygenases; in principle, activated oxygen is hazardous to all living forms but without it, the degradative segment of the carbon cycle could not operate. The degradation of aromatic compounds is not an esoteric activity of a few specialized microorganisms. It occurs continuously, accompanied by fixation and cycling of oxygen on a massive scale; but like other global biochemical processes it tends to be neglected in general biological curricula. However, knowledge of the scope and limitations of microbial catabolic enzymes is central to the development of rational approaches to many of society's environmental concerns.


Immediate and remote results of dermatoplastic operations in patients with malignant skin neoplasms.

The results of dermatoplasty made in 698 patients suffering from skin neoplasms are reported. The plastic operations do not negatively affect the course of the disease; at the same time they enable the surgeon to perform more radical resection of a tumor.


The influence of extracts from the skeletal muscle of guinea-pigs infected with Myco bovis BCG-Praha and/or with Myco fortuitum on the viability of Ehrlich ascites tumor cells.

Description of results obtained by following the influence of muscle from guinea-pigs infected with Myco bovis BCG-Praha and/or Myco fortuitum on the viability of Ehrlich ascites tumor cells is presented. The muscle extracts were prepared from the striated muscles of the upper and lower extremities as well as the sternal muscle of guinea-pigs killed on the 1st, 15th, 35th and 70th days after infection with the above-mentioned mycobacterial strains. It follows from the results obtained that only muscle extracts from guinea-pigs infected with BCG-Praha will exhibit a considerable potential inhibiting the viability of Ehrlich ascites tumor cells. This inhibitory factory could not be eliminated from muscle extracts either through saturation by a homologous mycobacterial strain or by homogenates of striated muscles gained from healthy, non-infected guinea-pigs.


Lipid disorders in renal transplant recipients.

Plasma cholesterol, triglyceride, lipoprotein and phospholipid levels were higher in 76 transplant recipients than in normal age-matched controls. 22 patients exhibited a normal lipid pattern; 12 a type IIa, 12 a type IIb, and 30 a type IV hyperlipidemia. Lipid abnormalities were not related to serum creatinine, parathyroid hormone (PTH), serum albumin, plasma glucose, transplant age, relative body weight or steroid administration schedule. Only plasma triglyceride level was related to mean prednisone dosage. In order to reduce the apparent cardiovascular risk posed by these changes in plasma lipid concentration, hypocaloric diet was administered to 16 patients with hypertriglyceridemia or mixed hypertriglyceridemia and hypercholesterolemia. With these dietary measures, plasma lipid concentrations returned to normal and remained stable during the period of observation (6--18 months).


Effect of 1alpha-hydroxycholecalciferol, 1,25-dihydroxycholecalciferol, 3 deoxy-1alpha-hydroxycholecalciferol, 24R, 25-dihydroxycholecalciferol and successful renal transplantation on calcium absorption in haemodialysis patients.

Using a 2-hour 47Ca absorption test, significant depression of active calcium absorption was demonstrated in 48 vitamin D untreated haemodialysis patients. This malabsorption of calcium could be corrected by the daily oral administration of 1--2 microgram of 1alphaOHD3 and 1--1.5 microgram of 1,25(OH)2D3. 5 microgram daily for 2 weeks of 3-deoxy-1alphaOHD3 AND 16 and 64 microgram daily for 1 week of 24R,25(OH)2D3 proved ineffective. In 32 successfully transplanted patients, restoration of normal or near normal renal function (serum creatinine less than 1.9 mg/100 ml) was not always followed by an immediate improvement in active calcium absorption. Calcium absorption, especially in female patients, was adversely affected by the required immunosuppressive prednisone therapy and improvement was slow.


Ovulation induced by LH-RH in rats made anovulatory by various experimental procedures.

The injection of LH-RH induced ovulation in constant estrous rats (CEA), made anovulatory either by frontal hypothalamic deafferentation (FHD), or by exposure to continuous light (CL), or by neonatal androgenization (NA) with 0.500 mg testosterone propionate (NA500). Rats neonatally treated with 1.250 mg testosterone (NA1250) were almost unable to ovulate. 100% of FHD-CEA rats ovulated in response to 10 ng LH-RH, which is 1/3 of the lowest dose able to determine 100% of full ovulation in control proestrous rats. NA500-CEA rats, on the other hand, ovulated in response to doses comparable to those effective in the controls, whereas in CL-CEA rats the doses required for full ovulation were 2-3 times higher than in the controls. The results of these experiments demonstrate that the pituitary glands of CEA rats respond to the stimulation by the specific hypothalamic releasing factor. The pituitary response, however, appears enhanced in FHD-CEA rats and markedly depressed in CL-CEA animals.


Pituitary responsiveness to LRF in castrated male hamsters exposed to different photoperiodic conditions.

The effect of various doses of LRF on pituitary LH and FSH release was examined in castrated adult male hamsters with different photoperiodic histories. Gonadotropin (Gn) release in response to LRF was independent of whether the animals had been exposed to a photostimulatory (LD 14:10) or a nonstimulatory (LD 6:18) light cycle for 60 days following castration. The lowest dose that caused a significant increase in serum Gns was 10 ng LRF/100 g b.w. for LH and 50 ng LRF/100 g b.w. for FSH. These results indicate that photoperiod, which is well known to exert major effects on the reproductive system of the golden hamster, does not do so by directly altering the responsiveness of the pituitary gland to hypothalamic Gn-releasing factor.


Treatment of isolated gonadotropin deficiency in men with synthetic LR-RH and a more potent analogue of LH-RH.

Six patients with idiopathic isolated gonadotropin deficiency (IGD) were treated with 100 microgram LH-RH s.c. 3 times daily, leading to subnormal increases of serum gonadotropin (Gn) and testosterone (T) levels, and promoting puberty from stage I to stage II-III of TANNER. S.c. administration of 100 microgram of the more potent and longer-lasting analogue 6-D-Leu-10-Des-Gly-ethylamide-LH-RH induced LH and FSH rises after the very first application in these patients for more than 12 h. However, long-term therapy with the analogue (100 microgram s.c./day) did not improve hypogonadism. Paradoxically, on daily treatment (8 patients) with 6-D-Leu-10-Des-Gly-ethylamide-LH-RH the FSH serum levels fell after 1 week and the LH levels after 8 weeks of treatment.


Biological and immunological luteinising hormone-releasing hormone (LH-RH) activity of the ovine pineal.

An acid extract of ovine pineal tissue inhibited luteinising hormon (LH) release in ovariectomized oestrogen and progesterone (OEP) pre-treated female rats, and did not exhibit any LH-RH-like immunoreactivity in vitro.


[Reconstruction of the facial nerve in the parotid-masseter region].

The technique and results of surgical reconstruction of different extent of the extratemporal part of the facial nerve after oncological operations and after accidental injuries are reported. Return of facial nerve function was observed in 15 out of 17 cases (87%) with follow-up over 1 year. An own modification of nerve suture is described. Attention is called to the possibility of perineural and endoneural spread of parotid malignant neoplasms.


Pulmonary pathology at necropsy.

A simple method of perfusion of the lungs at necropsy was used in a series of 293 necropsies. The lungs were examined 24-48 hours after fixation. Two hundred and eighty-eight cases (98.3 percent) showed abnormalities and 92 of them (31 percent) showed multiple pathology. Unexpected pulmonary thrombo-embolic disease was found in 38 cases (12.9 percent) and the lungs were normal in only five cases (1.7 percent). The technique is simple and is advocated as a means of investigating lung pathology at necropsy.


[Study on the use of glass ceramics in osteo-odonto-keratoplasty].

Report of preparatory investigations about the usefulness of 'glass ceramics' in keratoplasty in a modification of Strampelli's method: Under the available implantation materials, glass ceramics seem to be the best as they join strongly to the bone and to interstitial tissues. As glass ceramics are suitable to keratoplasty, the necessity of loosing a tooth in osteo-odonto-keratoprosthesis after Strampelli can be avoided. Other advantages are standardization of the whole procedure, shortening of operation time and extension of indications for the operation. Based on our results, further investigations with longer implantation times, especially in eyes, are being performed at another place.


Spectacle correction of alphakia: how aspheric do they have to be?

A comparison of spheric and aspheric cataract lenses was carried out on 28 patients with uncomplicated surgery. Lenses were evaluated with respect to eccentric acuity, visual field, ring scotoma, magnification, distortion, and subjective preferences. The results suggest that design differences can be applied to specific visual tasks, thus improving clinical lens prescribing.


Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings.

Data from the Diabetic Retinopathy Study (DRS) show that photocoagulad inhibited the progression of retinopathy. These beneficial effects were noted to some degree in all those stages of diabetic retinopathy which were included in the Study. Some deleterious effects of treatment were also found, including losses of visual acuity and constriction of peripheral visual field. The risk of these harmful effects was considered acceptable in eyes with retinopathy in the moderate or severe retinopathy in the moderate or severe proliferative stage when the risk of severe visual loss without treatment was great. In early proliferative or severe nonproliferative retinopathy, when the risk of severe visual loss without treatment was less, the risks of harmful treatment effects assumed greater importance. In these earlier stages, DRS findings have not led to a clear choice between prompt treatment and deferral of treatment unless and until progression to a more severe stage occurs.


A randomized double-blind trial of levamisole in the therapy of recurrent aphthous stomatitis.

A Controlled, double-blind study was performed to compare the effects of levamisole and placebo in eighteen patients with recurrent aphthous stomatitis. Levamisole is a drug which enhances defective cellular immune responses. It was administered in a flexible dosage schedule: 50 mg. three times daily for three consecutive days at the start of an aphthous lesion but with an interval of at least 2 weeks between courses of therapy. Placebo consisted of pills that were identical in appearance, taken according to the same schedule. Statistical evaluation showed decreased frequency of lesions, shorter duration, and diminished pain of lesions in the group receiving levamisole. Subsequent follow-up in an open trial confirmed these results.


Effect of immediate dowel space preparation on the apical seal of endodontically filled teeth.

The purpose of this study was to investigate in vitro the effect of using hot endodonic pluggers for immediate dowel space preparation on the apical seal of endodontically treated teeth filled by a chloropercha technique. The results demonstrated that, when the coronal half of the root canal filling material was removed immediately after placement with pluggers, there was a loss of the apical seal and leakage in thirteen of twenty teeth. There was also leakage in thirteen of twenty teeth in which dowel spaces were not prepared. This study did not demonstrate a significant difference statistically in loss of apical seal and leakage between teeth prepared with and those without immediate dowel space preparations with pluggers using a chloropercha filling technique. Immediate preparation of the dowel spaces had no effect on the apical seal. The chloropercha technique by itself showed evidence of very high leakage when used to fill the root canal.


The influence of anxiety and pain sensitivity on experimental pain in man.

A study was made of a number of factors that might be responsible for the unreliable results obtained in experimentally induced pain in man. In a randomised, double-blind, cross-over study on 32 healthy, male volunteers, the ischaemic pain test [14] and several psychological tests were performed. The influence of the following factors on the pain test results were examined: (a) ingestion of single, oral doses of 1000 mg aspirin (ASA) and placebo, (b) practice effect, (c) initial pain sensitivity, (d) anxiety, coping behaviour, attitude to the experiment and personality factors. The analgesic activity of ASA could not be demonstrated. An interaction between primary pain sensitivity and the sequence of drug administration was found. Furthermore, anxiety had a marked influence on the test results. Using experimental pain models reliable results are not to be expected as anxiety fluctuates intra- and interindividually in an unpredictable and uncontrollable manner.


Airway resistance in infants after various treatments for hyaline membrane disease: special emphasis on prolonged high levels of inspired oxygen.

Thoracic gas volume, airway resistance (Raw), and dynamic lung compliance (CL) were measured in 48 infants surviving after hyaline membrane disease. Some infants were found to have a small reduction in CL after recovery from the acute phase of the illness but no other abnormalities were detected, irrespective of the type of treatment received. When studied again between the ages of 4 and 10 months, CL had returned to normal, but all infants who had been treated with intermittent positive pressure ventilation (IPPV) during the neonatal period were found to have developed a raised Raw. In contrast, all nonventilated infants, including those who had received up to five days of oxygen therapy in concentrations above 80%, had normal lung function. We conclude that IPPV, and not the increased inspired oxygen concentration, damaged the airways and interfered with their growth.


Influence of Ca2+ on red cell deformability and adaptation to sphering agents.

The following results indicate the close connection between Ca2+ and red cell deformability: ATP-depleted red cells have a lowered deformability, but chlorpromazine and papaverine return the deformability to normal despite unchanged low ATP-concentrations of the cells. Both drugs are known to displace membrane-bound calcium. Without significantly decreasing red cell ATP-content, the calcium-ionophore A23187 reduces the deformability in the presence of 10(-4) to 10(-3) mol external calcium. The ionophore is ineffective in reducing the red cell deformability when the cells are suspended in a calcium-free medium. The sphering agent lysolecithin is less effective in reducing red cell deformability, when the external calcium-concentration is kept low. Without lysolecithin external Ca2+ is ineffective in reducing red cell deformability for several h. These results have been interpreted as showing a calcium-induced reduced mobility of the protein moiety in the red cell membrane.


Rat intestinal brush border enzymes release by deoxycholate in vivo.

The release of proteins, sucrase (SA), maltase (MA), leucine aminopeptidase (LA) and alkaline phosphatase (AP) activity from rat jejunum by sodium deoxycholate (DOC) was studied by an in vivo perfusion technique. In our experimental conditions, a 2 mmol/1 DOC perfusion for 30 min induced a marked and reversible release of proteins and hydrolases. When specific activities were considered, each enzyme showed a distinct release pattern. Significantly, the SA release was largely increased, the AP release was decreased and there was no correlation between the releases of SA and AP. Furthermore, the various enzymes recovered into the lumen were solubilized at different extents. SA was chiefly present in a soluble and AP in a particular form. The microscopical appearances showed a slight exfoliation of the epithelial cells from the villous tips but no specific changes when compared to the control group. The results are discussed in terms of enzymic localization in the brush border membrane; SA would be located very superficially in the surface membrane and AP buried in the membrane and less accessible than the other enzymes.


Comparison between the oxygen removal rate and the histological structure of normal and tumour tissues.

A technique has been used to measure distributions of oxygen removal rate, QR, in samples of recently excised tissue where QR is defined as the ratio of the oxygen uptake rate to the oxygen solubility. QR was measured at 91 sampling points across a cross section of tissue of diameter 5 mm. By placing markers in the tissue and using special procedures to obtain sections of the tissue samples it was possible to compare the distributions of QR with the histological structure of the tissues. The overall resolution of the system is about 1/2 mm so that structures of the order of a millimetre or more could be examined. There are considerable inhomogeneities in QR within some normal tissues, for example 4-19 mm Hg/s in rat kidney and 0.4-1.5 mm Hg/s in human cervix. Inhomogeneities in tumour tissues are also associated with the histological structure and examples for the Lewis lung mouse carcinoma show a correlation between QR and regions of viable or necrotic tissue. For a biopsy sample of human carcinoma of the cervix QR correlates with the degree of local infiltration by tumour cells.


[A new method of pancreatic transplantation. II. Double renal and pancreatic transplantation in a diabetic with renal failure (author's transl)].

A 41-year-old man who had suffered from insulin-dependent diabetes since the age of twenty and who had severe degenerative complications with chronic renal failure, underwent pancreatic transplantation. The graft was prepared by intraduct injection of neoprene in order to suppress the exocrine function of the gland. It was situated in the iliac fossa and has ensured the complete correction of diabetes for more than 10 months. This favourable situation made it possible to carry out a renal transplant which could not have been envisaged previously in this patient with very unstable and progressive diabetes who was dialysed under very difficult conditions.


[Non resectable squamous cell carcinoma of the bronchus. Study of the immunological status as prognosis factor and attempt at immunorestoration with B.C.G. (author's transl)].

Sixty-six patients with bronchus non resectable squamous cell carcinoma (stage III and 14) entered into a protocol of chemotherapy depending upon their initial immunological status. These patients with (+) skin tests to recall antigens were allocated to a chemotherapy programme; patients with initially (-) skin tests were submitted to a protocol of immunorestauration with B.C.G. After three weeks of B.C.G. applications on scarifications 17 patients out of 31 presented with (+) skin tests and were considered as immunocompetent patients. All the patients then were submitted to chemotherapy protocol. The comparison of different median of survival have demonstrated that immune status appears as the more fundamental prognosis factor; the B.C.G. is able to transitory restore the immunity of the patients without any modification of the tumour progress. The median of survival of patients with initially (+) skin tests was ten months, and only two months for patients with (-) skin tests. The median of survival of patients whom immunity was restored with B.C.G. was nine months. The results of this trial let us to propose new strategy for treatment of these patients.


[Epidemiology of Burkitt's lymphoma in tropical areas - its relationship with malaria (author's transl)].

Epidemiology of tropical Burkitt's lymphoma shows the concomitant existence of the three following characteristics in endemic areas: - fairly dense rural population with a low standard of living; - early occurrence of primary infection by the Epstein-Barr virus (whose genome is always present in all tumour cells); - stable malaria. The social and economic level of these areas accounts for the specific features of the viral infection. Climatic factors determine permanent of prolonged transmission of malaria which could be mediated through a mitogen. Eradication of malaria could be a useful way to induce a fall in Burkitt's lymphoma incidence.


[Essential hypertension: long term haemodynamic effects of a diuretic combination (cyclothiazide-triamterene) (author's transl)].

The long terme hemodynamic effect of cyclothiazide 3 mg-triamterene 150 mg was studied in 10 patients with permanent essential hypertension. Diuretic therapy induced a significant fall in blood pressure (p less than 0.001) and total peripheral resistance (p less than 0.01), without significant change in cardiac index or blood volume. The result suggests that adaptative mechanisms of the circulatory system determine the decrease of blood pressure, independently of the pharmacological effect of the drug.


[Polycystic ovary syndrome (author's transl)].

Recent developments have occurred in the understanding of the physiopathology of polycystic ovary (Stein-Leventhal) syndrome. The authors describe in particular the present bio-chemical definition of so-called type I polycystic ovary syndrome: very high and anarchical secretion of LH by the pituitary, explosive response of LH during the LH-RH test, contrasting with normal levels of FSH under basal conditions and after stimulation with LH-RH. In the polycystic ovary, positive and negative feedback exerted by oestrogens at the level of the hypothalamus are intact. In particular, the administration of clomiphene results, in the majority of cases, in ovulation in patients with this disorder. The mechanisms (ovarian hyperproduction of androstenedione, increased transformation of androstenedione into testosterone then dihydrotestosterone and into androstanediol) responsible for the development of hyperandrogenism during polycystic ovary syndrome are also analysed.


[Aneurysms of the ascending aorta; total replacement with reimplantation of the coronary arteries (author's transl)].

The replacement of the entire aorta and the aortic valve is the procedure of choice in aneurysms involving the aortic annulus. This method, which necessitate the reimplantation of the coronary arteries, is, however, sometimes difficult and carries a greater operative risk of bleeding problems. Our experience of 15 such cases lead us to propose some modifications (such the use of an independent coronary conduit and the atrial drainage of the peri prosthetic space) in order to make the operation simple and safer.


[Long-term survey of renal transplant preserved with Collins solution (author's transl)].

Collins solution is one of the world methods used for kidney preservation. A long term survey of transplanted kidneys thus preserved has never been reported. Clinical, biological, radiological and pathological data collected from 225 cadaver kidney tranplantations were analysed according to the total ischemic time (T.I.T) groupe I: TIT less than or equal to 12 hours, groupe II: TIT from 12 to 30 hours). No difference could be demonstrated between the two groups whether considering the percentage of immediate function, the serum creatinine level which was normal up to two years, the incidence of abnormal blood pressure, the pathological changes on routine biopsies performed at 6 months and 2 years and arteriographic features at 2 years. A better graft survival rate was consistently found at 6 months one year and 2 years when TIT was between 12 and 30 hours. This could be related to the higher indicence of well matched kidneys in this group of patients. The efficiency of exchange programs for compatible kidneys is thus emphasized.


[The selection and surveillance of cadaver kidney recipients. Recent development in graft immunology (author's transl)].

This study, based on results of 252 cadaver kidney transplantations, shows that some factors which reflect individual immune response capacity, such as ability to produce anti-HLA antibodies, sex and response to hepatitis B virus, appear, along with HLA compatibility, to markedly influence renal graft survival and leads us to propose the following new guide-line for cadaver kidney recipient selection: For "good responders" (i.e., patients with anti-HLA antibodies, females and HBs Ag negative individuals) a close HLA compatibility with the donor (3 or 4 antigens in common) is necessary, while this need not be observed for "non-responders" (i.e., patients without preformed anti-HLA antibodies, males and HBs Ag persistent carriers). Furthermore, review of recent methods proposed for detecting early cellular and humoral manifestations of rejection leads to proposal of the following immunological monitoring of the transplant recipient. Systematic and frequent testing for circulating cytotoxic cells and antibodies against donor antigens, regular dosage of complement factors and of the nephretic factor, and investigations for the migration leukocyte inhibiting factor and macrophage arming factor, possibly produced in vitro by lymphocytes. Both these protocols for recipient selection and immunological monitoring can henceforth be applied and may contribute to improve cadaver kidney transplantation prognosis.


Restriction endonuclease cleavage map of mitochondrial DNA from Aspergillus nidulans.

Mitochondrial DNA of the ascomycete fungus Aspergillus nidulans, a circular molecule of 31 500 base pairs, is cleaved by restriction endonucleases Eco R I, Hind II, Hind III and Bgl II into 3, 7, 9 and 5 fragments, respectively. The relative positions of the cleavage sites could be mapped by analysis of fragments obtained by double enzyme digestions of whole DNA and by complete and partial redigestion of isolated restriction fragments.


Electron microscopic visualization of tRNA genes with ferritin-avidin: biotin labels.

A method is described for indirect electron microscopic visualization and mapping of tRNA and other short transcripts hybridized to DNA. This method depends upon the attachment of the electron-dense protein ferritin to the RNA, the binding being mediated by the remarkably strong association of the egg white protein avidin with biotin. Biotin is covalently attached to the 3' end of tRNA using an NH2(CH2)5NH2 bridge. The tRNA-biotin adduct is hybridized to complementary DNA sequences present in a single stranded non-homology loop of a DNA:DNA heteroduplex. Avidin, covalently crosslinked to ferritin, is mixed with the heteroduplex and becomes bound to the hybridized tRNA-biotin. Observation of the DNA:RNA-biotin:avidin-ferritin complex by electron microscopy specifically and accurately reveals the position of the tRNA gene, with a frequency of labeling of approximately 50%.


Selective inhibition of uracil tRNA methylases of E. coli by ethionine.

L-ethionine has been found to inhibit uracil tRNA methylating enzymes in vitro under conditions where methylation of other tRNA bases is unaffected. No selective inhibitor for uracil tRNA methylases has been identified previously. 15 mM L-ethionine or 30 mM D,L-ethionine caused about 40% inhibition of tRNA methylation catalyzed by enzyme extracts from E. coli B or E. coli M3S (mixtures of methylases for uracil, guanine, cytosine, and adenine) but did not inhibit the activity of preparations from an E. coli mutant that lacks uracil tRNA methylase. Analysis of the 14CH3 bases in methyl-deficient E. coli tRNA after its in vitro methylation with E. coli B3 enzymes in the presence or absence of ethionine showed that ethionine inhibited 14CH3 transfer to uracil in tRNA, but did not diminish significantly the 14CH3 transfer to other tRNA bases. Under similar conditions 0.6 mM S-adenosylethionine and 0.2 mM ethylthioadenosine inhibited the overall tRNA base methylating activity of E. coli B preparations about 50% but neither of these ethionine metabolites preferentially inhibited uracil methylation. Ethionine was not competitive with S-adenosyl methionine. Uracil methylation was not inhibited by alanine, valine, or ethionine sulfoxide. It is suggested that the thymine deficiency that we found earlier in tRNA from ethionine-treated E. coli B cells, resulted from base specific inhibition by the amino acid, ethionine, of uracil tRNA methylation in vivo.


A rapid method for the isolation of circular DNA using an aqueous two-phase partition system.

A method of isolating circular plasmid DNA from cleared lysates of E. coli is described. Purification is achieved by virtue of the rapid re-annealing kinetics or supercoiled DNA. After a brief denaturation step, double stranded plasmid DNA is separated from denatured chromosomal DNA and RNA in a two-phase partition system using dextran and polyethylene glycol. The method is much more rapid than the conventional dye-centrifugation technique and plasmid DNA of comparable purity and yield is obtained.


Insertion of synthetic copies of human globin genes into bacterial plasmids.

Double stranded human globin cDNA was synthesized by use of viral reverse transcriptase from globin mRNA of cord blood of premature infants requiring exchange transfusions. The cDNA was introduced into plasmids and the recombinant DNA plasmids used to transform E. coli X1776. A number of transformants were obtained. Plasmid DNA from selected colonies was isolated and characterized for the type of globin cDNA it contained by three types of procedures: 1) hybridization to previously characterized 3H-labeled alpha,beta and gamma cDNA; 2) analysis of the size and nature of fragments produced by digestion of the plasma DNA by different restriction endonucleases; and 3) by rapid DNA sequence analysis of selected DNA fragments produced by restriction endonuclease digestion. Analysis by these techniques of plasmid DNA from different colonies has definitively identified the presence of human alpha, beta or gamma cDNA sequences in different plasmids.


The physician's office laboratory: how does yours measure up?

Tests results can be misleading or worthless if commonsense rules are ignored. A primary source of error or confusion relates to specimen collection and labeling.


Histamine H2-receptor antagonist in treatment of peptic ulcer.

Cimetidine promotes the healing of duodenal ulcer, but prolonged use (perhaps in low dosage) seems to be necessary in many cases to prevent relapse. H2 receptors are widely distributed in body tissue, but important effects of blockade of the extragastric receptors have not been detected. Nor has serious toxicity been noted. Cimetidine probably will become a familiar, much-used, and valuable drug.


Potassium depletion in heart failure and its relation to long-term treatment with diuretics: a review of the literature.

There have been many studies which suggest that patients with heart failure were potassium depleted. This depletion has been attributed to the use of potent diuretics, and these are now given with either potassium supplements or potassium-retaining diuretics. A detailed examination of the studies suggests that the reported decrease in body potassium compared with the results in healthy persons is not due to the diuretics. It can be partly explained by a failure to match patients and controls in terms of age, and the remaining difference can be explained by muscle wasting. There is therefore no evidence of a potassium depletion in these patients with heart failure.


[Effect of nerobol on the histophysiology of the islands of Langerhans of intact and castrated female rats].

Experiments were conducted on 250 albino female rats, 100 to 120 g in weight. A study was made of the influence of nerobol on the insular apparatus of the pancreas. A 10-day administration of nerobol in a dose of 10 mg/kg stimulated the functional activity of the insular apparatus, facilitated the course of alloxan diabetes, increased the tolerance of the beta-cells of the islets to alloxan both in intact and in castrated female rats.


[Endocrine changes in experimental hypothalamic obesity in rats].

Hypothalamic adiposity in rats developing in bilateral electrolytic damage of the ventromedial hypothalamus is characterized by a marked activation of the insular apparatus of the pancreas, enhanced biosynthesis and secretion of the somatotropin by the hypophysis, reduction of the thyrotropic function of the hypophysis and functional activity of the thyroid gland with a disturbed metabolism of the thyroid hormones in target tissues, unchanged or reduced glucocorticoid function of the adrenal glands, intensified lipogenesis, reduction of the content of cyclic 3',5'-adenosinmonophosphate in a number of organs and tissues.


[Various changes in carbohydrate and lipid metabolism and the state of the islands of Langerhans in female rabbits after long-term feeding with food rich in carbohydrates and ovariectomy].

Experiments were conducted on 21 female rabbits. Prolonged excessive feeding with food rich in readily assimilated carbohydrates (bisquits) started at immature age caused hypertrophy and hyperplasia of the insular apparatus of the pancreas, particularly in ovariectomy. The average blood sugar level on fasting stomach displayed a significant reduction in ovariectomized female rabbits. Some female rabbits displayed signs of "exhaustion" of beta-cells of the islets of the pancreas, with the development of latent diabetes mellitus in one of them. Prolonged excessive feeding with food rich in readily assimilated carbohydrates led to the intensification of atherogenesis, most pronounced in the animals with signs of "exhaustion" of beta-cells of the islets of the pancreas.


Homology-dependent cutting in trans of DNA in extracts of Escherichia coli: an approach to the enzymology of genetic recombination.

An in vitro system is described in which the cutting of crosslinked phiX replicative form (RF) I DNA molecules by the uvr system of Escherichia coli induces the cutting of homologous undamaged DNA during incubation with crude extracts of thermally induced E. coli (lambda precA+) lysogens. This reaction, which has also been observed in intact E. coli lysogens infected with lambda phages, is dependent on the presence of functional recA+ and uvrB+ gene products. Extracts from thermally induced lambda precA+ lysogens of E. coli proved to be substantially more active than extracts from nonlysogenic cells of the same strain. The results provide preliminary evidence for an endonuclease activity that cuts intact superhelical DNA in response to interaction with homologus damaged DNA. In the present paper, we describe an in vitro system in which both the endonucleolytic cutting of DNA containing crosslinks and the induced cutting of undamaged DNA can be studied without purification of the participating enzymes. Although the information obtained is fragmentary and often puzzling, we feel that this system can contribute to an understanding of the complex mechanisms involved in repair and recombination.


Fluorine-19 nuclear magnetic resonance studies of Escherichia coli membranes.

Several fluorinated fatty acids of the general structure CH3(CH2)13--mCF2(CH2)m--2COOH are incorporated biosynthetically as unsaturated fatty acid analogues into the phospholipids of Escherichia coli. Under optimum conditions an unsaturated fatty acid autotroph, K1060B5, can be grown so that 50% of the total phospholipid fatty acids are 8,8-difluoromyristate. Conditions are found for which more than 20% of the fatty acids are fluorinated before a decrease in growth rate is observed. We have used 19F nuclear magnetic resonance to examine membranes isolated from E. coli grown under the latter conditions. A comparison is made with spectra of aqueous dispersions of extracted E. coli phospholipids and model multilayer phospholipid membranes. An explanation of the 19F resonance line shape in these membrane systems and the relationship to a molecular order parameter is given. It is apparent that 19F nuclear magnetic resonance is more sensitive to the degree of ordering or fluidity of phospholipids than spin labels or fluorescent probes. For instance, a dramatic effect of membrane protein on lipid fluidity can be seen. Finally, this method can be used to measure the proportion of frozen and fluid lipid in biological membranes at temperatures within the span of the gel-to-lipid phase transition.


On the process of cellular division in Escherichia coli: a series of mutants of E. coli altered in the penicillin-binding proteins.

A series of mutants defective in penicillin-binding components (or protein) (PBCs) was isolated from a collection of thermosensitive mutants of Escherichia coli. The mutants included mutations for each PBC (1 through 4) and a mutation in the activity of D-alanine carboxypeptidase 1a (PBC-5/6). PBC-1 was resolved into two components, PBC-1a and PBC-1b, which were the products of different genes referred to as ponA and ponB, respectively. No mutation examined in ponA-- or ponB--, by itself, was associated  with a thermosensitive defect in growth. The mutants having ponB-- were hypersensitive to cephalosporins, which showed unusually high affinity to PBC-1a. Murein synthetic activity decreased markedly in cell-free preparations from the ponB-- mutant. The double mutation ponA-- ponB-- was found to be lethal. A mutant having ponAts and ponB-- revealed thermosensitivity of growth and lysed at the restrictive temperature. It is concluded that PBC-1a and PBC-1b could share a biochemical reaction necessary for cell elongation so that the function of either one may bypass the loss of the function of the other. With the series of mutants, the chromosomal locus of the gene for each PBC was mapped: ponA (PBC-1a) 73.5 min, ponB (PBC-1b) 3.3 min, rodA (PBC-2) 14.4 min, ftsI (PBC-3) 1.8 min, dacB (PBC-4) 68 min, and dacA (PBC-5/6) 13.7 min.


Interaction of mycobacterial polymethylpolysaccharides with paranaric acid and palmitoyl-coenzyme A: structural specificity and monomeric dissociation constants.

The long-chain polyenoic fatty acids alpha- and beta-paranaric acid form complexes with the 6-O-methylglucose polysaccharide from Mycobacterium smegmatis as demonstrated by an enhanced fluorescence emission of the paranaric acid. This interaction is eliminated by digestion of the methylglucose polysaccharide with alpha-amylase and glucoamylase, which removes four hexose units from the nonreducing end of the chain. Titration of the methylglucose polysaccharide with either paranaric acid isomer suggests formation of a 1:1 complex with a dissociation constant (K(d)) of 0.4 muM. The fluorescence emission of this complex is quenched by palmitoyl-CoA, which indicates that the paranaric acid can be displaced by the acoyl-CoA, a conclusion confirmed by gel filtration. The presumed polysaccharide/palmitoyl-CoA complex has a K(d) of about 0.1 muM. Acoyl-CoA derivatives with shorter fatty acid chains and free palmitic acid complete less effectively, indicating that they form weaker complexes with the polysaccharide. The methylmannose polysaccharides with 12 or 13 sugar units also complex paranaric acid strongly (K(d) approximately 0.4 muM), whereas the isomer with 11 sugar units complexes weakly.The methylglucose polysaccharide has been coupled to L-tryptophan methyl ester. The fluorescence emission spectrum of the attached tryptophan group is shifted to a shorter wavelength relative to N-acetyl-L-tryptophan methyl ester, and this effect is enhanced in the corresponding derivative made with the amylase-digested polysaccharide. The circular dichroism spectrum of the polysaccharide-tryptophan derivative shows three bands with negative ellipticity, in the 270-300 nm region, not observed in the amylase-digested derivative. These results imply that the tryptophan is in a more structured environment in the former than in the latter derivative. alpha-Paranaric acid binds to the polysaccharide-tryptophan conjugate and shows an enhanced fluorescence emission with partial quenching of the tryptophan fluorescence emission, suggestive of Förster energy transfer from tryptophan to paranaric acid.


Escherichia coli dnaB mutant defective in DNA initiation: isolation and properties of the dnaB protein.

Extracts of the DNA initiation-defective mutant Escherichia coli dnaB252 are inactive in a dnaB complementation assay but yield a ribonucleoside triphosphatase activity of native molecular weight of about 270,000 (60,000-dalton polypeptide as subunit) that can be inactivated by antibody to dnaB. On the other hand, extracts of a dnaB252(P1 bac) lysogen, in which the dnaB mutation is suppressed in vivo by the constitutive expression of the P1 dnaB analog (ban protein), are active in dnaB complementation and the activity is also sensitive to dnaB antibody. Upon further purification two proteins (with polypeptide molecular weights of 60,000 and 56,000, respectively) are found associated with each other (native molecular weight about 270,000). The larger and the smaller protein are tentatively identified as the dnaB and P1 ban protein. It is suggested that suppression of the dnaB mutation by prophage P1 bac is accomplished by a stabilization of dnaB252 by P1 ban subunit molecules in a heteromultimer.


Nascent peptide as sole attachment of polysomes to membranes in bacteria.

When membrane-polysome complexes from Escherichia coli were treated with puromycin, at various Mg2+ and K+ concentrations, the bulk of the ribosomes were released from the membrane. Moreover, many released ribosomes released ribosomes remained attached to mRNA (pseudopolysomes). These results suggest that ribosomes are attached to the membrane in bacteria solely by their nascent chain. Without a direct attachment the conformational changes associated with chain elongation on the ribosome cannot force the growing chain through the membrane, and so alternative sources of energy for the transfer must be considered.


Molecular cytochemistry: incorporation of fluorescently labeled actin into living cells.

Actin labeled with 5-iodoacetamidofluorescein has been incorporated into the functional pool of actin in Chaos carolinensis and Physarum polycephalum by direct microinjection. The functional activity of the labeled actin has been analyzed at three levels of organization as: (a) with the purified actin, (b) in motile extracts of cells, and (c) in living motile cells. The labeled actin exhibited normal polymerization and activated myosin ATPase to a similar extent as unlabeled controls. Labeled actin and endogenous actin were incorporated into contracted pellets to approximately the same extent in motile cell extracts. After labeled actin had been microinjected into single C. carolinensis cells, the fluorescent actin spread into both the endoplasm and etoplasm without forming distinct fibrils. In contrast, fluorescent bundles developed in the ectoplasm of P. polycephalum following microinjection of labeled actin. This experimental method in conjunction with fluorescence spectroscopic techniques could become a powerful tool for studying the intracellular distribution and structural changes of components in living cells.


Comutagenic effect of norharman and harman with 2-acetylaminofluorene derivatives.

Norharman enhanced the known mutagenicity of 2-acetylaminofluorene derivatives in the Salmonella test system. The mutagenicities of 2-acetylaminofluorene, 2-aminofluorene, and N-hydroxy-2-acetylaminofluorene were enhanced by norharman only when rat liver microsomal enzymes were added, whereas the mutagenicity of N-acetoxy-2-acetylaminofluorene was increased in the absence of microsomal enzymes. Harman also increased mutagenesis, althouth less so than norharman.


Affinity filters, a new approach to the isolation of tox mutants of Vibrio cholerae.

We have devised a novel plate assay method for detecting mutants of Vibrio cholerae altered in the production of cholera toxin (tox mutants). Colonies replicated from a master plate are grown on the surface of a cellulose filter disc to which ganglioside-albumin conjugates have been attached. Toxin secreted by the colonies is tightly bound to the ganglioside filters. After removal of the cells by washing, the bound toxin may be detected by treating the filters with radioactively labeled antibodies against either whole toxin or one of its constituent polypeptide chains, followed by autoradiography. Colonies producing significantly greater of lesser amounts of toxin than the parental type are easily recognized and can be shown in liquid culture to have the corresponding hypertoxinogenic or hypotoxinogenic phenotype. This method, termed "the ganglioside filter assay," is applicable to screening large numbers of colonies and should facilitate isolation of various specific classes of mutants in cholera toxin production. In modified form the method will be applicable to various systems in which mutants of secreted proteins are sought.


Hypnotic effectiveness of sodium salicylamide with short-term use: sleep laboratory studies.

Sodium salicylamide in doses of 650 and 1,300 mg was evaluated in two separate sleep laboratory drug evaluation studies of insomniac patients. Each study utilized a standard protocol of 10 consecutive laboratory nights consisting of four placebo nights for adaptation and baseline, three drug nights for short-term drug administration and three placebo nights for evaluating withdrawal. Neither dose had a clear-cut hypnotic effect in inducing or maintaining sleep. Sleep stages were not effected by drug administration or drug withdrawal. Both the objective findings and subjective estimates suggest that the 1,300-mg dose may have a slight sedative effect. However, when salicylamide is used as an ingredient in over-the-counter preparations, the usual dose is only 200-400 mg.


Hygrophotographic technique for testing local antiperspirant activity.

Bilateral stopping of plantar perspiration in the mouse was obtained by application of a cotton-wool swab soaked in a 3% solution of BRL 556 in 60% ethanol for 1--2 min to the plantar surface of its right hind paw. For humans, aerosols which are at present on the market produce a sensible reduction in palmar sweating. The effect was recorded and illustrated by a modified hygrophotographic technique in which the sweat, released in the form of water vapor, was recorded by the hygrophotographic film, without any contact with the skin. In the mouse, the recording was carried out by the application to the plantar surface of a piece of hygrophotographic film, by the aid of an adhesive tape.


One-stage repair of compound leg defects with free, revascularized flaps of groin skin and iliac bone.

The successful revascularized free transfer of a composite flap of groin skin with attached iliac bone is presented in two patients. The findings in the preliminary dissections and injection studies in cadavers are discussed, and the superficial circumflex iliac system is recommended as a stem for free flaps of groin skin and iliac bone. If iliac bone alone is required for a revascularized graft, then the deep circumflex iliac system would seem suitable for the stem. Further clinical cases are necessary to determine the indications for this procedure, and patients should be carefully selected. The need for preoperative preparation and planning on a sound anatomical background is emphasized, and preoperative angiography seems advisable. The ability to sew small vessels together reliably is one thing: the when and where is another.


The tensor fascia lata myocutaneous free flap.

The tensor fascia lata muscle and its overlying skin provide a reliable myocutaneous unit containing a large amount of soft tissue for a free flap transfer. Its anatomy is outlined, and the operative technique for transfer is detailed in a case of chronic stasis ulcer of the lower leg.


Construction of male genitalia in the transsexual, using a tubed groin flap for the penis and a hydraulic inflation device.

A technique for construction of external male genitalia in a transsexual patient is presented in detail. The McGregor groin flap is used for penile construction, and the Scott inflatable prosthesis is used to produce an erection. The shape of the penis is improved by secondary local excisions, and the clitoris is bivalved and inserted at the base of the penis to allow sexual sensation. The appearance and the function of the constructed genitalia have been deemed quite satisfactory by this transsexual patient.


The medial gastrocnemius myocutaneous flap.

Our experience with the medial gastrocnemius myocutaneous flap is presented. We have found it to be a reliable flap which can be transferred in one stage to solve difficult coverage problems about the knee and upper leg.


A transverse thoracoabdominal skin flap for closure after radical mastectomy.

For closure of radical mastectomy defects, we present a new rotation flap using thoracoabdominal skin which crosses the midline of the trunk. This allows a rapid closure without the necessity of a delay.


A modification of the dermal-flap canthal lift for correction of the paralyzed lower eyelid.

A modification of the dermal-flap canthoplasty, described by Edgerton and Wolfort for the correction of paralysis of the lower lid, is described. It has produced excellent results in our experience.


Reconstruction of the nipple-areola complex.

We present a technique for nipple-areolar reconstruction, which consists basically of hinging two quadrangular dermafat flaps together after denuding the entire area. Mucosal grafts are then applied over the whole nipple-areolar site.


"De-epithelization" and dermal pedicles.

Biopsy specimens from 38 "de-epithelized" dermal pedicles were examined microscopically. There was considerable variation in the depth of the plane among surgeons, procedures, and even between specimens from two sides of a bilateral procedure done by the same surgeon. Usually, the "de-epithelization" removed all the epidermis plus the upper layer of dermis containing the pilosebaceous apparatus. The significance of this finding as related to the future development of epidermal inclusion cysts is uncertain. Also, it brings into question the importance of "the dermal plexus circulation," which many have thought to be critical for viability of the nipple.


Effect of proteins depletion on the surviving length in experimental skin flaps.

Protein depletion appears to augment, rather than decrease, the length of a skin flap surviving in rats. We were able to document a lowering of serum viscosity in these animals. The augmentation of flap survival produced by protein depletion may even be greater than that produced by the delay phenomenon. A reduction in the total weight of flaps is present in the protein-depleted animals, and this may contribute to the augmentation of flap survival in them.


Congenital scalp defect with thrombosis of the sagittal sinus. Case report.

A case report of a congenital scalp defect, associated with thrombosis of the superior sagittal sinus, is presented. A thrombectomy of the sinus, followed by skin grafting, was successful in achieving wound closure and a healthy, normal child. We propose that thrombectomy be considered for future similar situations.


A comparative controlled trial of pimozide and fluphenazine decanoate in the continuation therapy of schizophrenia.

Evidence from a controlled, comparative trial indicates that oral pimozide is clinically at least as effective as depot injections of fluphenazine decanoate in the continuation therapy of a group of schizophrenic patients discharged from hospital. The administration of pimozide was associated with fewer unwanted effects. The implications of the findings are discussed.


Initial response to drugs in depressive illness and psychiatric and community adjustment a year later.

Three hundred and sixty depressed in-patients initially treated with imipramine, chlorpromazine or a placebo were re-evaluated a year later. Patients showing the poorest adjustment at one year were those who failed to show a good initial response to treatment and those who responded positively to a placebo.


Computed tomography in renal transplant problems.

Nineteen patients were studied with computed tomography immediately after kidney transplantation and subsequently if declining renal function was noted. Abscess formation, hematoma and lymphocele were satisfactorily demonstrated. Of 8 diagnosed abnormal densities, 5 were proved correct (abscess 2; serous collection and old blood 1; lymphocele 1; and hematoma (fresh) 1). Two were not proved but abnormalities resolved on medical therapy. There was one incorrect diagnosis: what was thought to be an abnormal fluid collection was really a markedly enlarged edematous rejected kidney. Computed tomography represents an excellent method of following the course of therapy, whether surgical or conservative.


Pain associated with peripheral angiography: is lidocaine effective?

In a double-blind study, 28 patients for peripheral angiography received contrast injection both with and without lidocaine. In 22 patients not receiving premedication, the addition of lidocaine to the contrast medium resulted in increased pain in 54.5% of patients and no difference in pain in 41% when compared to contrast alone. In patients premedicated with 5--10 mg Valium intravenously, the addition of lidocaine to the contrast medium resulted in increased pain in half the patients and no difference in the others. The physiologic mechanisms are discussed, and the importance of hyperosmolality of contrast agents in pain production is stressed.


Dose response to intramuscular glucagon during hypotonic radiography.

In a study to determine a dose response to glucagon during hypotonic duodenography, 15 male and female volunteers received placebo and 0.25 mg 1 mg and 2 mg glucagon intramuscularly, double-blind and cross-over. When 0.25 mg glucagon was given, the onset of drug effect was approximately 13--18 min: the mean duration of moderate hypotonicity was approximately 4--7 min. The larger the dose, the greater the duration of drug action. When 2 mg glucagon was given, the onset of drug effect occurred in approximately 4--7 min; the mean duration of moderate hypotonicity was 22--32 min. There were no changes in pulse or blood pressure attributable to the drug with these doses, and reports of nausea and diarrhea did not increase significantly until a dose above 1 mg was given. One mg glucagon given IM is useful in hypotonic upper Gl radiographic examinations. The onset of hypotonicity was 8--10 min with a duration of 12--27 min when this dose was given. Few reports of side effects were attributable to this dose.


The evolution of the basic concepts underlying the practice of radiotherapy from 1949 to 1977.

In his overview of the history and theoretical developments of radiotherapy, the author stresses the following concepts: (a) sensitivity is not linked to histology but to the volume of cancer; (b) the dose must not necessarily be homogeneous in the target volume but related to varying volumes of cancer; (c) the fact that irradiation may not be the sole treatment in some tumors does not mean that it does not have a place in their management; (d) as a general rule, large tumors should not be treated with irradiation only, if gross cancer can be resected simply; (e) since there is a dose-response curve for control rates and for complications, an optimum dose level must be maintained; and (f) the patient's quality of life is a major concern.


Double-blind radiographic study of dose response to intravenous glucagon for hypotonic duodenography.

This study was undertaken to determine a dose response to glucagon during hypotonic duodenography. Fifteen male and female volunteers received placebo and 0.25 mg, 0.5 mg, 1 mg, and 2 mg of glucagon intravenously, double-blind, and crossover. Onset of drug effect occurred in approximately 45 seconds, regardless of the dose of glucagon given. There was a significant (p less than 0.01) decrease in gastrointestinal tonicity with all doses. The larger the dose, the greater the duration of drug action. Satisfactory stomach, duodenal, and small bowel hypotonicity for radiography were obtained with 0.25 to 0.5 mg of glucagon given intravenously with few side effects.


Autoimmune hemolytic anemia and cold hemagglutinin disease: clinical disease and laboratory findings.

As is apparent from the length of this review, a multitude of laboratory investigations can be performed on the blood of patients with AIHA and CHD. Unfortunately, because of the considerable complexity of some of these tests, their significance is not always apparent to the physician who treats the patient. Communication gaps between the laboratory scientist and the physician at the bedside are bound to occur because of the high degree of specialization of both immunohematology and medical care. The purpose of this review has been to bridge the communication gap. The agents that cause AIHA and CHD are antibodies. Although they are often autoantibodies of complex specificity, usually reacting with all normal red cells, they nevertheless obey most of the rules explaining the action of alloantibodies that sometimes complicate transfusion therapy. By approaching AIHA and CHD as antibody-induced conditions, and by regarding autoantibodies as similar in their actions to alloantibodies, hopefully, physicians will appreciate the significance of the tests performed in the laboratory. For their part, the laboratory workers will be able not only to report test results but also to explain the findings. This review may aid in establishing the essential dialogue.