The effects of nutrition and treatment of cancer on host immunocompetence.

Conventional approaches to therapy for cancer, such as chemotherapy, operative therapy and radiation therapy, can produce profound changes in host immunity. The effects of chemotherapy upon immune responses are related both to the dosage and duration of therapy and are readily reversible. Operative therapy likewise suppresses both humoral and cell-mediated immunity for two to three weeks, as manifested by in vitro and in vivo tests of these functions. Radiation therapy, however, seems to decrease host immune responses for more prolonged periods of time, up to ten years. Nutritional status may also affect both limbs of the immune system, and malnutrition is being recognized with increasing frequency as a clinical problem in patients with advanced primary malignant or metastatic disease, especially during antineoplastic therapy. Intravenous hyperalimentation is a safe and effective method for correcting nutritional deficits in patients with cancer; moreover, immunocompetence may be enhanced during adequate nutritional rehabilitation.


Preservation of the pancreas for transplantation.

Twenty-four hour hypothermic bloodless pulsatile perfusion of the canine pancreas did not have any detrimental effect on the survival rate of minimally immunosuppressed recipients. On the contrary, there was a favorable trend toward improved long term survival of perfused and transplanted pancreas. Fresh grafts or those stored under hypothermia survived for shorter periods of time than did the perfused grafts. Apancreatic dogs survived only for a few days after pancreatectomy. Hypothermic pulsatile perfusion appeared to be a better method of preservation than hypothermic storage of pancreatic allografts.


Late cerebral radionecrosis.

Seventy-eight cases of late cerebral radionecrosis gathered from the literature are reviewed and three personal cases reported. The difficulties in making pre-and intra-operative diagnoses, the efficacy of surgical treatment in cases of circumscribed lesions, and the very poor prognosis of diffuse lesions are emphasized.


The inhibitory effect of aspirin on human endothelial cells.

Human endothelial cell monolayers prepared from umbilical veins have been incubated with aspirin (1--2 mM) dissolved in Hepes modified solution and in platelet-rich plasma. They have also been incubated with plasma prepared from subjects before and after intake of aspirin giving a mean plasma concentration of 0.5 mM. The effects of the endothelial cells on ADP and collagen-induced platelet aggregation and malondialdehyde production in platelet-rich plasma have been tested. The endothelial cells had a spontaneous inhibitory effect on all three parameters. This effect was abolished when the cells were incubated with aspirin dissolved in MHS for 20 min and the increase in effect observed when platelet-rich plasma was incubated with endothelial cells for a period of 30 min was similarly inhibited when aspirin was dissolved in plasma or when plasma prepared from subjects who had taken aspirin were used. Aspirin had no inhibitory effect on prostacyclin (PGI2) with regard to the effect of PGI2 on platelets. On the contrary, the two compounds had an additive inhibitory effect on platelet aggregation induced by ADP and collagen. These findings should be considered with regard to the use of aspirin as an antithrombotic agent.


The effect of ICI 55,897 and clofibrate on platelet function and other tests abnormal in atherosclerosis.

There is considerable evidence that the quantity or quality of plasma lipids influences platelet function tests, and clofibrate reduces high plasma lipids and alters some platelet tests. Clofibrate was accordingly given to patients with vascular disease who were at risk of thrombosis. The heparin thrombin clotting time (HTCT), initially short and thus possibly reflecting increased activation, was regularly returned to normal after about a month's delay. The fibrinogen was also normalized but the initially abnormal anti-thrombic activity became more abnormal. ICI 55,897, an analogue of clofibrate, also normalized the HTCT and the fibrinogen and had no adverse effect on the anti-thrombin levels. This compound has no effect on plasma lipids. If it can be shown that the correction of abnormal tests conveys clinical benefit these findings suggest that ICI 55,897 might clinically be more beneficial than clofibrate. However, direct comparison of clofibrate and ICI 55,897 suggests that clofibrate is more effective in normalizing the HTCT. The mechanism underlying these drug-induced changes are unknown but they cannot be directly related to lipid changes.


[Incidence of Clostridium botulinum in the rumen contents and faeces of cattle fed brewers' grains naturally contaminated with Clostridium botulinum (author's transl)].

The number of Clostridium botulinum type B organisms excreted by cattle fed brewers' grains in which these organisms were found to be present and the period for which they were excreted, were studied. Large numbers (10(5) - 10(7) per gramme) of these organisms were detected in the rumen contents and faeces of the animals. When feeding brewers' grains was discontinued, Cl. botulinum type B was still detectable in the faeces for a considerable period (greater than eight weeks). There was evidence to suggest that the number of Cl. botulinum organisms multiplies in the gastrointestinal tract of cattle.


Surface replicas of pulmonary endothelial cells in culture.

Pulmonary endothelial cells possess a variety of enzymes on their surface. However, the topographical distribution of these enzymes is not known. In this report we describe a simple technique for the preparation of surface replicas of pulmonary endothelial cells using an unmodified critical point drying apparatus and a high vacuum freeze-etch unit. The technique should be applicable for use with all cells in monolayer culture. Endothelial cells grown on glass slides or coverslips were washed thoroughly, fixed and dehydrated. The monolayers were then critical point dried. Surface replicas were prepared in a Balzer's freeze-etch unit. The advantages of surface replicas are that they can be examined with the resolving power of the transmission electron microscope and can be used to examine whole cells. The potential for the surface replica technique may lie in mapping specific enzymes, receptors and cell surface factors. Therefore, to provide a basis for such studies, we have described the appearance of pulmonary endothelial cells in surface replicas.


Current status of prophylaxis of retinal detachment.

Our indications for prophylaxis may be summarized as follows: (1) All symptomatic holes. (2) All holes in aphakic eye. (3) All holes in fellow eyes. (4) Lattice degeneration in fellow eyes, even when holes are not present. (5) Holes in snail-track degeneration. (6) The fellow eye of one with a giant tear. (7) Asymptomatic holes in myopic eyes except those within the vitreous base. (8) Some large asymptomatic holes in non-fellow or aphakic eyes.


"Dye/light" Dye-induced photosensitization of herpes virus. A clinical trial on humans.

A series of 21 patients with herpetic corneal ulcers was treated by photodynamic inactivation (using a single application of neutral red 1 per cent solution followed by a 15-min exposure to a 40 watt light of 440--550 nm), carbolization, or idoxuridine (IDU) ointment. No significant difference was found in the number that healed, the mean healing time, or the number of recurrences after any of the three treatments.


A comparison of sampling techniques for domestic populations of Triatominae.

Six methods of sampling domestic populations of Triatoma infestans (Klug in Brazil have been studied. The results suggest that where bug densities are low, the Gomez-Nuñez box may be used, but with higher bug densities withdrawal or removal collecting allows a direct estimation of the size of the bug population. The number of samples to be taken in removal collections depends upon the density of the bug population and the degree of accuracy required.


Standardization of the indirect fluorescent antibody test for malaria.

Methods are described whereby results of malarial immunofluorescence tests can be evaluated objectively. The IFA test was quantitated by standardizing the physical system against a fluorescent standard and preparation of biological standards of malarial antisera and fluorescein labelled conjugates. Using these known standards the reactivity of antigens was characterized. It was found that antigen preparations are best when they include mature schizonts, and keep best when they are stored in a dry condition at or below -20 degree C. However, even under carefully controlled conditions of storage, antigens showed considerable variation of reactivity between individual batches.


Detection and measurement of species-specific malarial antibodies by immunofluorescence tests.

Species-specific serodiagnosis of malaria could be made by means of the standardized indirect fluorescent antibody test, either by determination of the usual end-point titres or by fluorescent intensity measurements on antigens. The malarial antibody levels could also be measured by the fluorescent intensity measurements at a single serum dilution. Thus the fluorescent intensity measurements could effectively replace the end point titre determination, with the advantages of standardization and saving in technician time.


An ultrastructural study of the sporogonic development of Plasmodium falciparum in Anopheles gambiae.

This paper describes the fine structure of the sporogonic development of Plasmodium falciparum in its natural vector Anopheles gambiae (Species A) as seen by scanning and transmission electron microscopy. The parasite was derived from naturally infected volunteers and the vector maintained under natural conditions at the MRC Laboratories, Fajara, The Gambia. Sporogonic development of P. falciparum is similar to that described for other Plasmodium spp. There are however greater similarities between P. falciparum and the avian malaria parasites, than those mammalian (primarily rodent) species described to date--particularly with respect to mitochondrial development, crystalloid morphology and nucleolar organization. Nuclear development is similar to that of the murine malaria parasites, but reconstruction of complete mitotic spindles from serial sections suggest the haploid genome of P. falciparum contains 14 chromosomes compared to eight to ten in the murine plasmodia. Sporoblast formation involves a unique process of cleft formation based on the expansion of the cisternal space of the endoplasmic reticulum. Sporozoite budding is almost exclusively confined to these inner membrane surfaces and results in a characteristic sporozoite distribution in the oocyst. High resolution scanning electron microscopy of free sporozoites provides the first surface view of the micropore of Plasmodium.


The use of ELIEDA (enzyme-linked-immuno-electro-diffusion-assay)) in the study of humoral antibodies in human schistosomiasis.

In order to improve the sensitivity of immuno-electrodiffusion (IED) we have developed a technique of treating the precipitated immune complexes with enzyme-labelled antibodies. This technique we term ELIEDA (Enzyme-Linked-Immuno-Electro-Diffusion-Assay). The enzyme-labelled antibodies can be made monospecific for each class of immunoglobulins found in patients with schistosomiasis and which precipitate with schistosome antigens. We believe that this sensitive technique will prove valuable in studying the sequential development of antibodies in human and experimental schistosomiasis.


[The indirect immunofluorescent antibody test with paraffin-embedded histological sections as antigen in experimental echinococcosis (author's transl)].

A modification of the indirect immunofluorescent antibody test for the diagnosis of infections with metacestodes of Echinococcus multilocularis is described. Formol alcohol was used as fixative mixture for the antigen materials; as embeding medium served paraffin. In positive reactions the peripheral protoscolex-layers showed a bright yellow-green fluorescence. Specificity and sensibility in the animal model experiment are to be expressed as very good.


Eperythrozoon ovis. II. Prevalence studies in sheep in Nigeria using the indirect immunofluorescent antibody test.

A serological survey of Eperythrozoon ovis infection in sheep was carried out in the main sheep farming areas of Nigeria, using the indirect immunofluorescent antibody test. Out of a total of 402 animals surveyed, 145, representing 36 per cent, were found to be serologically positive. Approximately 90 per cent of the sero-positives were sheep kept under intensive or semi-intensive systems of management indicating that close contact facilitated spread of the parasite. Microscopic examination of representative blood smears revealed E. ovis in only 12 of the serologically positive sheep. It was concluded that endemic stability explains why the parasite has not been reported earlier in Nigeria.


Abortive development of Wuchereria bancrofti in a West African strain of Culex pipiens fatigans.

The detailed morphology of the larvae of Wuchereria bancrofti developing in a refractory strain of Culex pipiens fatigans from Liberia, West Africa, has been described. The abortive development of the parasite in the thoracic muscles of the mosquito was characterized mainly by: (i) retardation or complete failure of initial division of the G-cell, (ii) partial or complete encapsulation of developing larvae, especially at the anal and excretory vesicle areas of late first-stage, (iii) breakdown of the forming internal structures with formation of clusters of DNA-and RNA-positive material, and (iv) anomalous development of some larvae in which extra-corporeal growth of internal tissues took place.


Dynamics and intensity of Wuchereria bancrofti transmission in the savannah and forest regions of Liberia.

In four villages in the savannah and in the rain forest of Liberia, regular assessment of the biting activity and infection rates of anthropophilic mosquitoes have been carried out through full annual cycles. The microfilaremia rates in the localities in the savannah were 18.3% and 20.0% and in those of the forest 10.3% and 12.5%. The all-night catches were performed inside ordinary inhibited houses at monthly or fortnightly intervals. Presence of infective larvae of Wuchereria bancrofti proved Anopheles gambiae, A. funestus and A. nili to be the local vectors. Biting densities were high in the savannah, and low in the forest. From the mosquito catches and the results of their dissections for filarial larvae it could be estimated, that during the observation year a person in the savannah villages would be bitten annually by 18,165 and 36,450 vector mosquitoes respectively, and would receive 236 and 536 infective bites with 570 and 1211 infective larvae. In the two forest villages the number of vector bites per person per year was calculated to be in the order of 6120 and 1102 of which 64 and 8 would be infective bites transmitting 101 and 8 larvae. The findings of considerable differences in transmission intensities between villages of the same bioclimatic zone and of comparable microfilaremia rates indicates instable epidemiological conditions in at least some of the localities investigated.


[Histochemical study of zinc].

A comparative pattern of zinc distribution in cells of verious organs is given, investigated under various experimental conditions, changing the functional state of cells. Topochemical interrelations of zinc, and the main histochemical components (nucleic acids, protein, enzymes etc.) are studied.


[The value of direct localization studies for the surgical treatment of urinary tract infections (author's transl)].

Techniques to localize an upper urinary tract infection--the bladder wash-out test and the ureteral catheterization method--are described. Case reports are given to demonstrate the usefulness of these methods when surgical treatment of urinary tract infections seems to be indicated.


A study of soluble Lewis and P1 substances produced for use in immunohematology.

We have investigated a new source of commercial Lewis and P1 soluble blood group substances produced for use in immunohematology. Our tests show them to be potent, specific, stable and suitable for use in antibody inhibition procedures. They should make a useful contribution to antibody identification studies in hospital blood bank laboratories.


[The biochemical role of selenium in animal orgamisms].

Data on the biochemical function of selenium in animal and human organism are generalized from the view point of its participation in the active centre of glutathione peroxidase and its general anabolic effect. Now it is assumed that many chronical human diseases such as cancer, cardiovascular insufficiency, atherosclerosis, pancreas insufficiency and other may be connected with selenium deficiency in human nutrition. A problem is considered on ecological and endogenous factors controlling the availability of selenium in animals. Among them the dominant role of neurohumoral regulation is emphasized and several problem, particularly in the direction of well grounded application of its low-toxic preparations to medicine, is stressed.


[Experimental verification of several assumptions and methods of statistical genetics. II].

The applicability of A. S. Serebrovsky's formulas and N. A. Sobolev's methods was investigated for a dihybrid cross. It was shown that Serebrovsky's formulas do not always lead to a correct estimation of the minimal number of genes by which the parents are distinguished. In the case of gene interaction this estimation sometimes proved to be exaggerated 2-4 times. A test of Sobolev's method demonstrated that this method cannot be considered as reliable for work. Most of his estimations are not correct. Various estimations of the same phenomenon are often contradictory.


An evaluation of the efficacy of oxfendazole against the common nematode parasites of the horse.

In a controlled trial in naturally-infected young ponies, oxfendazole administered orally at dose-rates of 10 mg per kg and 50 mg per kg resulted in complete elimination of Trichostrongylus axei, Parascaris equorum, Oxyuris equi and adult Strongylus vulgaris. Also, all migrating Strongylus edentatus larvae recovered from the subperitoneal tissues of the flank were found to be dead. Minimum efficiencies of 99.8 per cent and 99.1 per cent were obtained against adult small strongyles (Trichonema spp) and 97.6 per cent and 100 per cent of developing small strongyle larvae at dose-rates of 10 mg per kg and 50 mg per kg respectively. Although the arterial lesions caused by migrating S vulgaris larvae were less severe in the treated compared with the untreated animals, reductions in mean larval numbers over controls were only in the region of 49 to 59 per cent.


[Elimination of multiple drug resistance of intestinal bacteria in white mice in vivo with proflavine and rimactan].

Albino mice, infected with 0.4 cu. cm of 10(10) microbial cells (S. Heidelberg), were treated with proflavin (0.4 cu. cm of a 0.3% solution) and rimactan rifamycin SV (0.4 cu. cm of a 0.4% solution). Proflavin was given singly and four times, daily, in the course of four days, and rimactan was applied four times. Given in a single dose proflavin was found to prolong twice as long the life span of albino mice infected with S. heidelberg. When injected four times it lowered considerably the mortality rate among the animals, the percent of survivals being 62. It was shown to hinder the transmission of multidrug resistance to the normally existing intestinal microflora. It also eliminated the multidrug resistance that intestinal bacteria had acquired in the course of the first several days of drug application. The action of rifamycin proved stronger: 83% of the albino mice treated survived. It eliminated the markers of resistance--both the acquired ones and those carried by the normal recipients (intestinal bacteria)--that substantiated multidrug resistance as well as some of the markers of the donor itself (S. heidelberg).


[Transmissible drug resistance in E. coli isolated from calves].

The study of 30 strains of Escherichia coli, isolated from calves on various farms of the district of Haskovo, revealed that 70.0% of them manifested resistance to drugs. The capacity of calf E. coli organisms of being donors of resistance factors pointed to the episomal nature of their polyresistance. The comparatively readily effected transmission of drug resistance from E. coli isolated from calves was shown to be potential clinical and epizootic hazard. Such animals proved to be carriers and a source of R+ Escherichia coli organisms. It was found that the transmission of drug resistance was not coupled with the transmission of chromosomal inheritance. A high frequency of the drug-resistance transmission phenomenon was established.


Carcinoembryonic antigen in patients with breast or colon cancer.

The rationale and results of clinical use of carcinoembryonic antigen (CEA) tests in patients with carcinoma of the breast and colon deserve review. Plasma CEA levels have been found to correlate with the extent of tumor invasion and site of metastatic spread, and CEA titers have diagnostic and prognostic value. Although postresectional serial CEA testing is not as useful in cases of breast carcinoma, in cases of carcinoma of the colon it may indicate recurrence or progression of the lesion. However, there are limitations and CEA results should be interpreted in conjunction with other clinical information.


The obesity-hypoventilation syndrome.

The triad of obesity, hypoventilation and inordinate hypersomnolence characterizes the obesity-hypoventilation syndrome. The reasons for daytime hypoventilation appear related to decreased chemical drives to breathe combined with the added physical impediment of extreme obesity. When the physiology of sleep was investigated in patients with this syndrome, intermittent nocturnal obstructive apneas were documented that produced blood gas abnormalities, arrhythmias and serious elevations of both pulmonary and systemic pressures. The obstructive apneas are due to intermittent loss of muscle tone of the tongue resulting in its prolapse against the posterior pharynx. The special importance of the obesity-hypoventilation syndrome lies in its being an example of a disorder of sleep and breathing that can appear in widely different clinical settings. Therapeutic measures include weight loss, progestational agents or permanent tracheostomy.


[Alimentary factors in the genesis of atherosclerosis].

A peroxidized model of atherosclerosis devised by the authors and the results of using antioxidants in these conditions as well as of literature sources on the deficiency of the antioxidant action substances in the current ration, on the peroxidation syndrome in this illness in man and animals, all this allowed the following concept to be formulated. Overeating, continued deficiency of antioxidants in natural products and hypodynamia contribute to the derangement of the physiological antioxidant system. An intensified free-radical oxidation calls forth decomposition of the beta-lipoproteids, lipoid infiltration of the intima, destruction of the elasticity, fibrosis and calcinosis. An alimentary prophylaxis of atherosclerosis should repose on the utilization of food mixtures representing complexes of the antioxidants of the direct and indirect action and trace elements entering the composition of the antiperoxidized enzymes.


[The omovertebral bone--new possibility of preoperative examination by computed axial tomography (author's transl)].

After a brief review of literature a case of congenital high scapula with omovertebral bone is presented by conventional X-ray films (plain X-ray and a. p. tomography). The additional computed axial tomography is of great diagnostic value, giving the surgeon a good deal of preoperative information on the anatomy of the bony connection between cervical vertebrae and scapula. The possible pitfalls of this new diagnostic technique are discussed as well as its limitation.


[Surgery of genuine Perthes' disease (author's transl)].

134 children between 3 and 13 years of age (average age 6.4 years) were treated at the Orthopaedic Clinic of the Karl-Marx-University at Leipzig between 1955 and 1977, for genuine Perthes' disease. The treatment consisted of bolting the capitular epiphysis (head) of the femur with a homologous bone chip. Anatomical healing was achieved in 50% of the cases. In almost 15% the results were good. The shape of the head was normal or almost normal, and there was merely a slight medium upward displacement of the trochanter without any functional significance. In 30% of the patients, the head was definitely no longer completely round, and there was a coxa vara symptomatic which, in three cases, was the reason for a surgical displacement of the trochanter. In 5--10% of the hip joints, the deformation had resulted in an incongruence of the head and acetabulum. The average treatment period was 17.1 months. The stage of the disease at the time of surgery did not exercise any influence on the duration and results of the treatment. Likewise, the position of the tip of the bone chip did not exercise any definitely appreciable influence.


[Spinal lesions in early man (author's transl)].

Through palaeopathological studies several traumatic spinal lesions in early man became known. In other cases spondylotic and spondylitic changes were found.


[Mitotic behaviour and proliferation metabolism in allogenic kidney transplants of the rat, in the first 6 days afer recirculation (author's transl)].

Comparative experiments were carried out on 41 allogenic kidney transplants of the rat to determine the mitotic behaviour and proliferation metabolism (application of H3 thymidine) in the first 6 days after recirculation. 3 days after transplantation DNA synthesis in the epithelium of cortex and medulla reached its peak. After this time the H3 labelling index for these cell nuclei dropped until on the 6th day, it had a value equivalent to that of the first day. The estimation of the decline of DNA synthesis in the epithelial cell nuclei and the increase of the lymphocyte proliferation in the interstitial tissue of cortex and medulla of the transplants from the 4th day on are signs of rapidly advancing transplant rejection. The changes in proliferation metabolism of the epithelial cell nuclei precede the mitotic changes by a few hours. The transplant changes caused by primary postischemic and secondary tissue rejection can be made comprehensible by the determination of the average cell density of H3 labelled cortex, medulla and epithelial cells.


[Influence of haloperidol on the 3H-leucine incorporation in incretory organs of the mouse (author's transl)].

The 3H-leucine incorporation in proteins of incretory organs of the mouse, the exocrine pancreas, and the renal tubuli was studied autoradiographically after administration of therapylike doses of the neuroleptic drug Haloperidol. With exception of the pancreas, a dosage of dependent increase of the 3H-leucine incorporation was observed in the treated animals. In our opinion, the results reveal an activation of the hypothalamus-hypophysis-adrenocortical system due to a 10-days administration of Haloperidol. These results are in conformity with former ones in brain and liver.


Microbial investigation in the water of the Lagoon Amir Kolayeh.

1. Microbiological investigations were carried out to fix the bacterial population of the water of the Lagoon Amir Kolayeh in a wild life reserve district. 2. The total numbers of aerobic heterotrophic microorganisms in the water samples of 23 stations were nearly identical in spring and in winter. In summer they increased and reached a very high maximum in fall. 3. Coliform bacteria showed a similar behaviour, but the ascent in fall was much lower. 4. The increase in summer was found to be due to the seasonal rise of temperature. There was a great nitrification activity. 5. The maxima in fall are the effect of immense flights of birds of passage. There were more coliforms of the fecal type in fall than in spring. 6. Between the stations of the fishing ground and those situated in the outside area, reliable differences could not be secured.


Streptococcal protein T induced hyperdelayed sensitivity and lymphocyte stimulation.

T protein was isolated from Streptococcus pyogenes types 1 and 12 by application CNBr-sepharose-trypsin and purified by ion exchange chromatography. It was indicated that purified T1 and T12 proteins have lymphocyte transforming activity. It was also observed that T12 protein induces immediate and delayed type hypersensitivity in guinea pigs previously sensitized with T12 antigen emulsified with complete FREUND's adjuvant.


Chemotactic activity of polymorphonuclear leukocytes to Streptococcus pyogenes.

Influence of two different streptococcal group A type 12 strains on chemotactic activity of polymorphonuclear leukocytes (PMN) was investigated in vitro and in vivo. The strains differed only in presence of M protein. In both conditions, the inhibition of the chemotaxis of the PMN after their treatment with M positive strains was observed. These results suggest that M protein of streptococci inhibits chemotaxis of PMN and therefore they can weaken defensive mechanisms of infected organism.


Paracoagulation of fibrinogen in vitro and in vivo by protein T of Steptococcus pyogenes.

Protein T was isolated from type 12 Streptococcus pyogenes cell wall by digestion with CNBr-sepharose linked trypsin and purified by ion exchange chromatography on QAE Sephadex A-50. Homogenous and not contaminated with other streptococcal proteins, antigen T, possesses paracoagulating activities similar to the effect of protamine sulphate. Protein T, applied intravenously to mice, accumulated mainly in kidneys and resulted in deposition of fibrinogen and its derivatives.


[An exceptional human relationship (Michael P. Kierkegaard, Søren Kierkegaard)].

There were a father and a son, Michael and Sören Kierkegaard, both highly talented, imaginitive, witty, humorous, especially interested in shrewd dialectrical dialogues respectively debates, both profound melancholy ponderers. But according to very own individuality their congeniality wasn't absolute. The father, being under a questionable rigorous opinion of sin, suffered from undeserved divine grace since early childhood. And Michael Kierkegaard made Sören anxious with the religious experience of original sin. This anxiety moved (touched or affected) the sensitive son mighty. Nevertheless he should not despair hopelessly like his unlucky father. On the contrary: Sørens incomparable melancholy, mental agony and anxiety (fear or anguish) forced the faith, existing independently of them, in a radical refining. That is why Sören Kierkegaard succeeded in sublimation of all psychological and philosophic (al) attitudes (or opinions) in the sphere of religiousness. And the result? A novel philosophy of life: Christian existentialism.


Acquisition of multiple antibiotic resistance by Salmonella dublin from the gramnegative hospital flora, in a kidney allograft recipient.

The case of a kidney allograft recipient, who suffered from several episodes of Salmonella dublin sepsis following massive immunosuppressive therapy to overcome a transplant rejection crisis, is presented. The focus of sepsis was the chronic inflamed gallbladder. The Salmonella dublin strain isolated from the blood during the last episode was found to exhibit multiple resistance to antimicrobiol drugs. Because the resistance phenotype was characteristic for the gramnegative flora of the university hospital, it was suggested that transfer of a resistance plasmid, frequently found in gramnegative enterobacterial isolates, to the Salmonella strain had occurred in the patient. The comparative examination of a Klebsiella pneumoniae strain, representing the hospital flora, and Salmonella dublin revealed that both strains produced the aminoglycoside 3'-phosphotransferase type 1, the 2''-nucleotidyltransferase and the 3''-adenylyltransferase, enzymes responsible for resistance to aminoglycoside antibiotics. Furthermore, in both strains a TEM type beta-lactamase was found to render the organism resistant to penicillins and cephalosporins. Transfer experiments showed that the host ranges of the R-plasmids of both strains were identical. Furthermore, both plasmids were found to be the fi+ type. These data support the view of in vivo transfer of an R-plasmid from the enterobacterial hospital flora to a potential pathogen in a patient.


On the metabolic characteristics of hybrids Shigella flexneri x Escherichia coli, devoid of their ability for intracellular multiplication in the epithelial cells. IV. Growth characteristics in the presence of some tricarboxylic acid cycle intermediates.

The dynamics of avirulent xyl-str and xyl + hybrids Sh. flexneri was investigated in minimal medium in the presence of some tricarboxylic acid cycle intermediates (succinate, malate, fumarate) and pyruvate. It was established that the hybrids with a replaced xyl-str or xyl-region show a considerably lower rate of multiplication in artificial media than the virulent recipient strains.


[Occurrence of Aspergillus fumigatus in West Berlin - contribution to the epidemiology of aspergillosis (author's transl)].

The increasing incidence of human A. fumigatus infections particularly such of the respiratory tract has led to this study of the epidemiological situation. During the period between October 1968 and December 1977, A. fumigatus was isolated from clinical material in 425 cases. These findings which were established at the Mycology Unit, Robert Koch Institute, Federal Health Office, exhibited the following distribution by regions of the body or type of specimen: respiratory tract 277 (65.1(); venous blood 58 (13.6%); urine 3 (0.7%); stools 9 (2.1%) and others 78 (18.3%). Approximately two thirds of these findings were made during the period from October to March and about one third between April and September. The presence of A. fumigatus in the air both indoors and outdoors and also in the environment of patients suffering from aspergillosis was studied with the aid of the sedimentation-method. This method was chosen because the occurrence of A. fumigatus conidia in the air is of epidemiological interest. The number of isolations of A. fumigatus from outdoors samples was low, so the search for inhalative conidia concentrated upon sites near A. fumigatus habitats. These studies revealed that aspergillosis patients, clinical material sampled from them, decaying plant material (agriculture, horticulture), and used clothes and linen may form foci for the spread of A. fumigatus conidia. The control of aspergillosis in the hospital environment involves in particular a control of aspergillosis patients by means of culture and serology (preferably by ghe immunodiffusion test). Numerous recommendations are made on how to prevent A. fumigatus infections in hospitals, at the working site, and in the laboratory.


[Immunochemical findings about the high molecular weight surface antigens of Shigella sonnei].

The authors studied immunochemical properties of the high molecular fraction of surface soluble antigens obtained by extraction with salt solutions from Sh. sonnei (virulent strain 1041) dried with acetone. The high molecular fraction was isolated by gel-filtration on Sepharose-4B. Along with the O-somatic antigen, this fraction contained thermostable and thermolabile antigens resistant to trypsin and RNA-ase treatment, and also protein-containing antigens disintegrated by trypsin. In difference from the O-somatic antigen, one of the thermostable components was completely precipitated with 50% alcohol.


[Classification of neurotic and psychopathic states].

On the basis of a general clinical assessment of 204 patients they were divided into 2 groups: with neurosis (80 cases) and psychopathy (124 cases). In a classification with the aid of a computer, the most informative differential signs appeared to be not the genetical, but situational and clinical: incomplete homes, neurotical and psychopathical traits in childhood and in the premorbid personality, explosive and hyposocial traits in the mental state. Treatment with tranquillizers increased the mistake in an automatical classification.


Isolation of DNA from Aspergillus nidulans.

A procedure for isolation of DNA from Aspergillus nidulans on a preparative scale is described. Mechanical disruption of lyophilized material in high-salt medium and treatment with proteinase K, followed by sedimentation of the lysate into saturated CsC1 solution yielded pure, highly polymerized DNA.


The significance of noncondylomatous wart virus infection of the cervical transformation zone. A review with discussion of two illustrative cases.

The clinicopathologic features are described of two patients whose cervical cytology smears showed features which were thought initially to indicate dysplasia, but which were later considered to be those of condylomata acuminata. One patient was an immunosuppressed renal transplant recipient, the other was a routine gynecologic clinic patient. No condylomas were recognizable clinically, and colposcopy showed only a flat but atypical transformation zone. Biopsy in each case showed a noncondylomatous warty lesion and wart virus particles were demonstrated by electron microscopy. These cases highlight the clinical, colposcopic, cytologic and histologic diagnostic difficulties which are encountered with cervical transformation zone wart virus infections, which are commoner than formerly realized. The possible relationship of wart virus infection to cancer of the cervix is also discussed.


Automated hierarchic decision structures for multiple category cell classification by TICAS.

TICAS-PROBE, a computerized system has been developed to generate hierarchic decision structures with little human intervention. It has been tested with several tasks, and the results are comparable, if not better, than those produced by human designers. Additional methods of generating the individual elements will be included in the near future.


Serum fasting gastrin levels after short-term treatment with cimetidine in patients with duodenal ulcer.

The behaviour of serum gastrin fasting levels was studied in 39 randomized patients with proven duodenal ulcer, 21 receiving cimetidine (1 g/day) and 18 placebo for 28 days. No significant variations of gastrin fasting values were found, but in four patients given cimetidine a relevant increase was observed at the end of the treatment. One out of 6 patients, previously treated with placebo, showed a marked increase of fasting gastrin levels after a second trial of cimetidine. No increase of G-17 was observed in the patients showing fasting hypergastrinemia after cimetidine. The present study seems to confirm some previous observations and it seems to suggest the possibility that in some patients cimetidine could induce hypergastrinemia.


An automated device for the production of cell preparations suitable for automatic assessment.

A set of preparatory steps has been developed for the processing of clinical samples from the female genital tract onto microscopic slides suitable both for machine assessment and for regular microscopic evaluation. These steps involve the depositing of the cell sample in a collection fluid, the semi-automatic adjustment of cell concentration to about 30,000 cells per milliliter through a combination of transmittance and light scatter measurements, the dispersion of the sample by syringing, and the deposition of the cellular content onto microscope slides by centrifugation. These steps were designed so as not to allow loss of cells--except the lysis of erythrocytes--with the understanding that this condition entails the presence of 4--10 per cent cell aggregates in the final preparation.


Ellipse test for the reduction of false positive signals in automated cytology.

One of the major problems in automated cytology is the elimination of false positive 'abnormal cell' alarms caused by objects such as overlapping cell pairs, leukocyte clusters, etc. The paper describes an algorithm for the separation of images of abnormal cell nuclei and non=nuclear objects in computer image analysis systems for automated cytology. The algorithm involves the measurement of the agreement between the object outline and a computer ellipse of equal area, aspect ratio and orientation. Results obtained with the CERVISCAN experimental computer image analysis system show that the algorithm gives good discrimination between abnormal cell nuclei and typical non-nuclear objects found in cervical scrape specimens prepared specially for automated analysis.


Effect of bovine pancreatic polypeptide on gastric acid and pepsin output in man.

Bovine pancreatic polypeptide was infused intravenously in 16 healthy volunteers at a mean dose of 218 pmol/kg/hr, producing plasma levels similar to those after meals. Basal and pentagastrin-stimulated acid and pepsin outputs and plasma gastrin concentrations were unchanged by BPP. Pancreatic polypeptide is unlikely to be an important physiological modulator of these secretions in man.


Treatment of respiratory insufficiency in infants using nasal CPAP and a gas jet.

A light-weight system for continuous positive airway pressure (CPAP) based on a nasal vestibular cannula and a miniature gas jet has been tried out in 29 newborns with severe idiopathic respiratory distress syndrome (IRDS) and nine infants suffering from respiratory insufficiency caused by lower respiratory tract infections. In infants with IRDS, a permanent effect was achieved in 20% when the birth weight was below 1501 g, and in 74% when the birth weight was higher. The infants with lower respiratory tract infections all recovered without further ventilatory support. Significant complications occurred in only two infants, both of whom developed pneumothorax. The system forms a simple and safe alternative to existing nasal CPAP systems suitable for use in newborns as well as older infants with lung diseases resulting in alveolar collapse.


Arterial oxygenation during artificial ventilation. The effect of airway closure and of its prevention by positive end-expiratory pressure.

Airway closure and arterial blood gases were measured in 11 healthy subjects both before and during anaesthesia with artificial ventilation, prior to routine surgery. The functional residual capacity was then increased by positive end-expiratory pressure (PEEP), so that ventilation took place at a lung volume where no airway closure was present, and the effect on arterial oxygenation was again investigated. A significant increase in alveolar-arterial oxygen gradient occurred in the group of seven patients in whom airway closure within a tidal breath could be demonstrated during anaesthesia, but there was no significant change in the four patients in whom airway closure could not be demonstrated. There was no improvement in arterial oxygenation on increasing functional residual capacity (FRC) in either group. It may well be that this failure to improve oxygenation was due to a deleterious effect of PEEP on the circulation, even though the PEEP was the minimum required to abolish airway closure.


Diagnostic cytologic sample profiles in patients with bladder cancer using TICAS system.

Computer analysis of digitized cell images was applied to consecutively encountered, well preserved urothelial cells in the urinary sediment of 12 patients with bladder cancer. It was shown that the composition of the cell sample, and notably the proportion cells classified in the ATY II and POS (malignant) categories, were of diagnostic significance. This work indicated that a computer-generated diagnosis based on the cells in a urinary sample could probably be achieved with a relatively small number of urothelial cells. The study also suggested that computer-generated cytologic profiles of patients with non-papillary carcinoma in situ can be distinguished from other forms of urothelial cancer. The atypicality indices computed for all cells from each patient provided important information but were per se insufficient for diagnostic purposes. This preliminary study, based on a small group of patients, suggests that high resolution scanning offers a promising approach to automation of cytology of the urinary sediment.


Indices of cell atypia in urinary tract cytology.

A sample profile based on assessment of digitized cell images of normal (NEG), malignant (POS) and two classes of atypical (ATY I and ATY II) urothelial cells was established. Data distributed in a multidimensional feature space were projected into a two-dimensional display space using linear discriminant functions as composite features. Fitting of a polynomial led to the derivation of an atypicality index for each cell and to statistically clearly significant differences in the atypicality values for the four groups of urothelial cells. The application of these findings to patients' profiles will be examined in a subsequent communication.


Ripening of the uterine cervix and induction of labour at term with prostaglandin E2 in viscous gel.

In order to achieve ripening of the uterine cervix or induce labour in patients at term with an unfavourable cervical state, 1 mg of prostaglandin E2 (PGE2), suspended in a viscous gel, was instilled into the cervical canal. In a pilot study, 41 patients received the PGE2-gel. Twenty-three of these, (56%), went into labour, and delivery occurred without further stimulation within 15 hours. In the remaining 18 patients, there was a marked improvement of the cervical state, which changed from an average (modified) Bishop score of 2.5 to 6.1 within 24 hours. In a double-blind study comprising 20 nulliparae, 10 received gel containing PGE2 and 10 gel without prostaglandin. Cervical state did not change significantly (Bishop score 3.6 and 4.0) after 24 hours in patients receiving placebo gel. In those receiving PGE2 gel, 8 went into labour and were delivered without further induction within 13 hours. Two patients showed an increase in Bishop score from 3 to 6 and 7, respectively, after 24 hours. They were then induced by oxytocin and delivery occurred after 8 and 10 hours. The results suggest that administration of PGE2 intracervically can induce ripening of the cervix in patients at term with an unfavourable cervical state, and thus facilitate delivery.


Computer discriminant analysis of atypical urothelial cells.

Prior computer studies of digitized cell images by the TICAS system have shown that the category of urothelial cells classified visually as atypical may be composed of 2 subgroups, one clustering mainly with benign cells and the other with malignant cells. As a consequence, a visual review of the group of atypical cells was conducted and tested by computer discriminant analysis. The computer classification confirmed the visual reclassification and subdivision of atypical urothelial cells into 2 subgroups, ATY I and ATY II. This is yet another example of feedback from computer diagnosis to visual assessment of cells. The significance of these observations in terms of diagnosis will be the subject of subsequent communications.


Vulvovaginal candidiasis in pregnancy treated with clotrimazole.

An open trial of local clotrimazole therapy in 56 pregnant women with vulvovaginal candidiasis is reported. The diagnosis was confirmed by mycotic culture. The patients were given one vaginal tablet daily and cream was applied to the vulva 2 or 3 times daily. Their male partners were treated with cream only. The duration of therapy was 6 days. Fifty of the patients (89.3%) were clinically cured after 6 days of therapy. Six patients (10.7%) had slight complaints and 10 (17.9%) without symptoms or signs of infection harboured Candida albicans or other yeast species in the genital tract. Six of the patients were given a second treatment with clotrimazole and their remaining symptoms subsided. Candidiasis recurred later in pregnancy in 4 of the 56 patients studied. The implications of the presence of Candida in the genital tract are discussed. It is concluded that clotrimazole is an effective antimycotic agent which can be used for vulvovaginal candidasis during pregnancy without causing side effects. Two of the patients had trichomoniasis concurrently. One of these was cured with clotrimazole.


The effect of urokinase on central corneal thickness and vitreous haemorrhage.

Thirteen patients with vitreous opacities were treated by intravitreal injection of urokinase. The central corneal thickness was measured daily on both eyes. Determination of visual acuity and ophthalmoscopy were done before treatment and at each following attendance (longest period of follow-up was seven months). The central corneal thickness increased after urokinase injection and the maximum thickness was reached on the second day. On the 6th day a secondary rise in corneal thickness occurred. The possible relation to the fibrinolytic system is discussed. There was an effect on the vitreous opacities in 8 out of 13 eyes. Only in 3 of the 13 eyes did visual acuity increase. This relative poor result as regards visual acuity in most cases was due to membranes in the vitreous.


Management of late corneal graft problems.

Immediately after an operation the corneal graft is taken care of by the surgeon, but after a certain period of time the control lies in the hands of the general ophthalmologist. Examples of the management of different kinds of postoperative complications are presented. Early correct treatment of any graft problem is of decisive importance. Careful slit-lamp examination and measurement of graft thickness is stressed and the prompt use of systemic and subconjunctival steroids is recommended for incipient graft failure. Systemic tranexamic acid may also be useful.


A double-blind study on the influence of tranexamic acid on the intraocular pressure and the central corneal thickness after trabeculectomy for glaucoma simplex.

The influence of tranexamic acid on the intraocular pressure and central corneal thickness has been examined by means of a double-blind trial in patients with glaucoma simplex. The material comprised 28 patients (14 pairs) who had all been operated on for glaucoma in one eye by trabeculectomy. Tranexamic acid was found not to influence the intraocular pressure, neither in the operated eye nor in the opposite eye. The possible antifibrinolytic effect on the outflow of the aqueous humour is discussed. As in previous studies an effect of tranexamic acid on the central corneal thickness was found in both the operated and in the non-operated eye. A possible mechanism behind this is discussed.


Interactions of nutrition, infection and immune response. Immunocompetence in nutritional deficiency, methodological considerations and intervention strategies.

Clinical and epidemiologic data point to a causal interrelationship between nutritional deficiency and infectious illness. Both are major contributors to childhood morbidity and mortality, particularly in underprivileged population groups. Energy-protein undernutrition and deficiencies of iron, folates and pyridoxine, depress a variety of immunity functions. Delayed hypersensitivity and number of T lymphocytes are consistently reduced. In small-for-gestation low birth weight infants, cell-mediated immunity may remain depressed for several years. B lymphocytes, immunoglobulin levels and antibody responses are generally normal, but secretory IgA-antibody is reduced. Serum complement components are low and there is evidence of in vivo consumption of complement C 3. Neutrophil phagocytosis of bacteria and fungi is intact but the next step of intracellular killing is impaired. There are changes also in the production of lysozyme and interferon. Infection per se results in nutrient losses, either actual or by sequestration, and produces immunosuppression. The correction of postnatal nutritional deficits and/or infection is associated with reversal of immunological functions to normal. The interplay of nutrition, immunity and infection, and its biological implications are described.


The inhibitory effect of salt, cyanide and chloramphenicol on the uptake of streptomycin by Escherichia coli K 12.

The uptake of tritium-labelled streptomycin by cells of Eschericia coli K 12 was shown to be only partly and transiently inhibited by the reported antagonists cyanide and chloramphenicol. After a lag, uptake of streptomycin took place in the presence of cyanide, although at a decreased rate. The lag was absent when cells were treated with cyanide some time before streptomycin. The cyanide-resistant transport system showed the same sensitivity to salt as the normal system. By increasing the salt content of the complex medium used, the uptake rate was decreased and several different phases in the uptake became detectable, including an early saturation phase of unknown nature. Uptake in a mineral salt medium was compared with that in complex medium, and differences in uptake were found explainable by differences in salt content. Chloramphenicol, in a concentration of 50 microgram/ml, was shown to permit an uptake rate (after a lag) of about one-fifth of the normal uptake rate in the complex medium. When the last rapid uptake phase, coincident with killing, was delayed by salt or cyanide, chloramphenicol had little or no effect on uptake. At higher concentrations, it enhanced the uptake and caused lysis of the bacteria. Based on the inhibition pattern produced by the inhibitors mentioned above, both alone and in combination, a hypothesis for the uptake of streptomycin by Escherichia coli is submitted.


"Runde" virus: further characteristics and a method for purification.

Neither BHK 21/c13, BSC-1, Vero nor GMK cells were of use for quantification of "Runde" virus. The titres were low and difficult to reproduce. Infected newborn mouse brains gave considerably higher yields than any of the cell cultures. The growth curve in BHK 21/c13 cells showed a slow increase in both intracellular and extracellular virus until maximum titres of about 10(6) baby mouse LD50 were reached at 48 and 72 hours post-infection (p.i.). During the following 24 hours, the infectivity dropped by about 1 log10 unit and was then unaltered until 196 hours p.i. Infected BHK 21/c13 cells did not haemadsorb chicken erythrocytes, although the culture media contained haemagglutinins. Resistance to BUdR indicated an RNA genome. Concentrated and purified virus preparations were produced by polyethylene glycol 6000/NaCl "precipitation" and hydroxylapatite column chromatography. Treatment with a colloidal silica gel widened the spectrum of agglutinable erythrocyte species.


The microbiological swab sampler--a quantitative experimental investigation.

The aim of the investigation was to give an in vitro experimental account of the commonly used cotton swab as a sampler for quantitative determination of bacteria in operation wounds. The transfer of staphylococci with the swab from an inoculated to a non-inoculated agar culture plate was used as a model, and three different ways of swab handling were tested. A direct transfer of 19 per cent staphlococci from the inoculated to the non-inoculated plate was found. When the swab was rinsed in a small volume of saline and the rinsing fluid was plated, 39 per cent were transfered. When the swab was kept in a Stuart transport medium, as is the usual procedure in clinical practice, only 4 per cent were transfered. Quantitative wound swab cultures depend on a thorough sampling of the wound and an efficient recovery of bacteria from the swab. It is concluded that the use of a Stuart transport medium would appear to hamper quantitative determination, and a rinsing procedure should be preferred.


Enzyme-linked immunosorbent assay for determination of rubella IgG antibodies.

A rubella virus antigen suited for enzyme-linked immunosorbent assay (ELISA) was grown in cultures of BHK/21/13 cells and purified and concentrated by membrane and ultrafiltration. This antigen was used in a semi-automated ELISA for determination of rubella IgG antibodies. The ELISA and the haemagglutination-inhibition (HI) test were compared in a study of 825 human sera. A close correlation was found between the results obtained by the two methods. Antibodies were, however, detected with ELISA in approximately 15% of the sera found negative in the HI test. The presence of antibodies was confirmed by the results of HI tests of the serum fractions of 19 sera separated by rate zonal ultracentrifugation. The EISA procedure employed in the present study was highly sensitive and allowed a precise quantitation of the antibodies by examination of one single serum dilution. ELISA was less time-consuming than the HI test and suited for routine laboratory use.


Insulin production by pancreatic islets of obese-hyperglycemic mice cultured for one week in different glucose concentrations.

Culture of pancreatic islets isolated from obese-hyperglycemic mice (gene symbol ob) for one week in media containing widely different concentrations of glucose (3.3, 5.6 or 16.7 mM) was found to markedly influence the functional behaviour of the islet B-cells. Thus, the insulin content of islets cultured at 3.3 or 16.7 mM glucose (subphysiological or supraphysiological glucose concentrations respectively) was markedly reduced. Islets cultured in 5.6 or 16.7 mM glucose displayed a normal insulin secretory response when stimulated with glucose, whereas islets cultured in a subnormal glucose concentration (3.3 mM) showed a reduced insulin response to glucose stimulation in batch type incubations and also lacked a second phase of insulin secretion in islet perifusion experiments. The rate of insulin biosynthesis of non-cultured ob/ob islets was higher than that of islets from their lean siblings but culture for one week in 3.3 mM glucose induced a pronounced impairment of the insulin biosynthesis in islets of obese as well as lean mice. The present data indicate that the hyperfunction of the islets of the ob/ob mouse at least in part is a reversible phenomenon, suggesting that inherent properties of islet B-cells do not act as "primary" factors in the development of the obese-hyperglycemic syndrome.


Potential for the use of germinated wheat and soybeans to enhance human nutrition.

Wheat and soybeans are the major agricultural exports of the United States. The U.S. sells more of each crop than any other nation. Soybeans are the main staple in China, but the U.S. sells more soybeans than China grows. For hundreds of millions of other people, wheat is the main staple. And yet, most Americans eat whole grains of neither wheat nor soybeans. In the United States, many nutrients of wheat and soybeans are lost in processing or are fed to animals. A highly significant share of the wheat nutrients are lost from the main foodstream when the germ and bran (with aleurone) portions are separated. Whole soybeans are carefully processed for food by only a handful of Americans.


A reappraisal of the mechanisms of hypocholesterolemic action of therapeutic agents.

The most commonly used methods to study the mechanisms of hypocholesterolemic action of therapeutic agents generally determine the turnover of total (exchangeable) cholesterol pools in the body. This approach is based on the view that whatever increases the total load of cholesterol in the body will increase the levels of plasma cholesterol, and vice versa. Despite the importance of this assumption it has never been tested, and there is no evidence to indicate that it is valid under all conditions. This "overload" hypothesis dates from the times before the importance of plasma lipoproteins was recognized and their role in the transport of lipids was well understood. However, it is becoming increasingly clear that the levels of plasma cholesterol are determined more directly by the "transport" of cholesterol into and out of plasma compartment by lipoproteins than by the synthesis, absorption and elimination of cholesterol from the total body pools. Any effects that the latter parameters of cholesterol metabolism have on the levels of plasma cholesterol must be mediated through changes in synthesis and the subsequent metabolism of plasma lipoproteins. In other words, in any equation relating changes in the levels of plasma cholesterol to the changes in synthesis, absorption and elimination of cholesterol from the body pools we must consider the "transport" of cholesterol by lipoproteins and their metabolism.


Drug effects on platelet adherence to collagen and damaged vessel walls.

The interaction of platelets with damaged vessel walls leads to the formation of platelet-fibrin thrombi and may also contribute to the development of atherosclerotic lesions because platelets adherent to exposed collagen release a mitogen that stimulates smooth muscle cell proliferation. The first step in thrombus formation, platelet adherence to an injured vessel wall, can be studied quantitatively by the use of platelets labeled with 51chromium. In these investigations, rabbit aortas were damaged by passage of a balloon catheter and segments of the aortas were everted on probes that were rotated in platelet suspensions. Collagen-coated glass cylinders were also used. Adherence was measured in a medium containing approximately physiologic concentrations of calcium, magnesium, protein and red blood cells. Conditions of testing influence the effect of non-steroidal anti-inflammatory drugs, sulfinpyrazone, and dipyridamole on platelet adherence. Aspirin and sulfinpyrazone were not inhibitory when tested in a medium with a 40% hematocrit; this indicates that products formed by platelets from arachidonate probably do not play a major part in the adherence of the first layer of platelets to the surface, although they may be involved in thrombus formation. Indomethacin, dipyridamole, prostaglandin E1, methylprednisolone and penicillin G and related antibiotics did inhibit platelet adherence although the concentrations required were higher than would likely be achieved in vivo upon administration to human patients. None of the non-steroidal anti-inflammatory drugs inhibited the release of granule contents from adherent platelets. Pretreatment of the damaged vessel wall with aspirin increased platelet adherence, presumably because it prevented the formation of PGI2 by the vessel wall. Platelet adherence to undamaged or damaged vessel walls was enhanced by prior exposure of the wall to thrombin. Platelet reactions with aggregating agents and platelet survival can be modified by changes in dietary lipids but there is very little evidence concerning the effects of lipids on platelet adherence. If some forms of dietary fat damage the endothelium, platelet interaction with the damaged area and release of the mitogen for smooth muscle cells would contribute to the development of atherosclerotic lesions.


Aprindine.

Aprindine is a long-acting antiarrhythmic agent, effective when administered orally or intravenously in the treatment of ventricular arrhythmias of varying etiologies. It may be especially useful in the treatment of the Wolff-Parkinson-White syndrome. To a lesser extent, it may be useful in the treatment of atrial arrhythmias. Side effects can be minimized by careful titration of the dose of aprindine. If the frequency of such serious side effects as cholestatic jaundice and agranulocytosis remains low enough, aprindine should prove to be a useful addition to currently available antiarrhythmic drugs.


Sampling and analytical methods for antimony and its compounds - a review.

A review of sampling and analytical procedures for antimony and its compounds is presented. Emphasis has been placed on those methods which have application to personal air or biological samples in industrial hygiene. Two analytical techniques in particular have been used most frequently--colorimetric and atomic absorption. A need for research to develop satisfactory solid sorbent sampling techniques for stibine and other volatile antimony compounds is evident.


Epidemiological insights on malnutrition: some resurrected, others restructured, a few retired.

In its modern sense, epidemiology has progressed from a classical concern of causality as expressed within biological limits to recognition that a variety of social factors have proportionate significance in the origin and behavior of human nutritional disorders. Basically an analytical process, nutritional epidemiology has grown to include, among objectives for prevention and control, a synthesis of plans for intervention; the monitoring of action programs introduced; and again a parallel analytic mission to evaluate such accomplishments as programs bring forth. Nutritional epidemiology, so employed, becomes a general scientific discipline, widely purposed and incorporating objectives beyond public health: measures concerned with social welfare, economic growth, political stability, and behavioral compatibility with fellow humans and other living things. Specifically, nutritional epidemiology comprises a branch of knowledge utilizing human ecology to solve problems in three broad dimensions--a defined causality, a prescribed intervention (planning, operations) and an evaluation of results, concurrently made and terminally. The groundwork is medical ecology, the approach holistic. A population of pregnant mothers and their newborn children is accorded first priority among fields of interest, past any single disease entity or technical method of control. Community programs enlarge from that base.


Cytology of serous effusions. An investigation into the usefulness of cell blocks versus smears.

Approximately half of 351 body-cavity effusions from 263 patients were examined prospectively in paraffin-embedded cell blocks and in smears, while the other half were examined in smears alone. The number of suspect and positive fluids obtained with the combined cell block-and-smear technic was double that of specimens examined in smears only. No false-positive case was found. Tumors were subsequently demonstrated in 38% of the patients who had negative or atypical cytologic reports. Smears stained with the Papanicolaou technic generally have good definition of malignant cellular changes, wheras cell blocks are particularly useful when the cytologic abnormalities are misleading, such as in reactive mesothelial cells, or obscure, as in occasional well-differentiated adenocarcinomas. It is recommended that both cell blocks and smears be used in evaluating all fluids submitted to the cytology laboratory.


The taxonomy and antimicrobial susceptibility of Haemophilus species in clinical specimens.

Organisms of the Haemophilus group isolated from nonrespiratory and respiratory sources were studied taxonomically. All biotypes of Haemophilus influenzae and Haemophilus parainfluenzae were encountered. However, nearly all H. influenzae from cerebrospinal fluids belonged to biotype I, while nearly all of those from conjunctivae belonged to biotype II. Only two of the 78 biotypable strains of H. influenzae produced beta-lactamase, but there was no other substantial difference in antimicrobial susceptibilities among biotypes of H. influenzae. Biotypes of H. parainfluenzae were less susceptible to penicillins and cephalosporins than those of H. influenzae.


Identification of Proteus morganii and distinction from other Proteus species.

The identification of Proteus morganii in the clinical laboratory is complicated by the differences in incidence of hydrogen sulfide (H2S) production recorded by different sources. Since this quality appeared to be a frequent feature of strains of P. morganii at the author's center, all isolates of this species were studied over a six-month period. During this time, 12 of 21 were found to produce scant H2S in Kligler's iron agar (KIA) and triple-sugar iron (TSI) agar butts. The strains were, in every respect, biotypical, and were easily distinguished from other species of Enterobacteriaceae by biochemical study. They also possessed the features of high resistance to cephalothin and ampicillin and relative sensitivity to tetracycline, unlike strains of Proteus mirabilis. It is concluded that weak H2S production in TSI or KIA medium is a frequent normal characteristic of P. morganii, and its presence should not deter microbiologists from correctly identifying isolates manifesting this quality.


Laboratory evaluation of a multitest system for identification of gram-negative organisms.

Seventy-two oxidase-positive or nonfermentative organisms, or both, all of which could be identified with reasonable certainty by alternative means, were used to challenge the OXI/FERM tube. There was 91% concurrence of identification between the two methods. Three observers, working independently, agreed upon the interpretation of each of the tests in the OXI/FERM system from 91% to 100% of the time. Duplicate OXI/FERM tubes inoculated with the same strain yielded identical interpretations 95% of the time for all tests except citrate utilization (89%). The OXI/FERM tube thus appeared to be an accurate identification method and yielded test results that were easily interpreted and adequately reproducible.


Distribution of alpha and alpha mating types of Cryptococcus neoformans among natural and clinical isolates.

Survey revealed that the mating type alpha is predominant among natural and clinical isolates of Cryptococcus neoformans regardless of the serotype. The ratio of alpha and a type was about 40:1 among 105 natural isolates and 30:1 in 233 clinical isolates.


Effects of induced hyperopia.

Hyperopia of 1.00, 1.50, and 2.00 D was induced in 42 subjects by means of concave lenses. A significant decrease in performance on a standard intelligence test occurred with the highest-power lenses. Symptoms induced indicate that the results are applicable to hyperopia. Prescriptions and vision screening criteria for hyperopia are indicated.


The effect of various pretreatment methods of the enamel in bonding procedures.

Thirty-eight pairs of premolars, extracted for orthodontic reasons, were tested for the effects of various pretreatment methods of the enamel in bonding procedures. Etched enamel surfaces and inner bracket surfaces facing the etched enamel were studied with the scanning electron microscope. The results were based on a pair-by-pair evaluation of 650 photographs. The degree of surface irregularities indicating the quality of microretentions was evaluated. A scale from 0 to 3 was used; 0 represented a smooth surface, and 3 represented optimum irregularities. Scores for bracket inner surfaces were always higher than those for corresponding etched enamel surfaces. Future SEM comparative investigations, therefore, ought to be based on replicas of etched enamel surfaces. One-minute etching with an acid gel had the same effect as etching with an acid liquid for the same time. Furthermore, mechanical pretreatment procedures, such as diamond grinding and aluminum oxide grinding, as opposed to pumicing did not improve the effect of the acid. Chemical pretreatment of the enamel with organic solvents such as 8 to 12 percent sodium hypochlorite did not improve the effect of the acid. Fluoride pretreatment with a fluoride varnish, Duraphat, did not have any negative effect on the etching results.


Disorders of the red cell membrane: a reclassification of hemolytic anemias.

Many studies have been performed recently on the structure, function, and composition of the red cell membrane in health and disease. This work is reviewed here and a new classification of hemolytic anemias is proposed.


Enamel loss during orthodontic bonding and subsequent loss during removal of filled and unfilled adhesives.

1. The techniques required in the removal of highly filled composite adhesives at the end of orthodontic treatment on an average cause more loss of enamel than removal of an unfilled polymethylmethacrylate adhesive. 2. The amount of enamel lost during the removal of either adhesive may be of clinical significance because of the removal of a major part of the protective fluoride-rich layer of enamel. 3. The use of zirconium silicate on a rotating bristle brush may cause considerable abrasion of enamel.


Symbiosis and confirmation between father and schizophrenic.

Projective test and interview data indicate that both schizophrenics and their fathers view fathers of schizophrenics as tending to be neither bonded symbiotically to, nor adaptive to the viewpoint of their schizophrenic offspring. Comparisons to fathers of nonschizophrenic mental patients and fathers of normal controls are reported.


Spinal cord compression in lymphoma.

A retrospective analysis of 59 patients with diffuse histiocytic and diffuse poorly differentiated lymphocytic lymphoma was performed to determine the incidence and characteristic features of patients developing spinal cord compression. Spinal cord compression occurred in 6 of 59 (10.2%) patients. All were females despite a 1:1 male: female ratio in the entire group. The mean age of females with spinal cord compression was significantly lower than the mean age of females with lymphoma without this complication. These findings suggest that young females with diffuse histiocytic or diffuse poorly differentiated lymphocytic lymphoma represent a subgroup at high risk for spinal cord compression.


Quantitative ultrastructural analysis in cardiac membrane physiology.

Quantitative measurements on electron micrographs of heart muscle can yield information useful for cellular physiologists and at present not obtainable in other ways. These methods are subject to preparative artifact, sampling problems, and problems inherent in the mathematical description of ultrastructure. Nevertheless they provide the best available data for membrane areas of the plasmalemma and its components, as well as for membrane areas of the sarcoplasmic reticulum and mitochondria. Morphometric methods can be used to study growth of membranes. Changes in the volumes of intracellular membrane-limited subcompartments can also be measured. Quantitative analysis of freeze-fractured membrane replicas can be carried out either by a statistical approach or by optical diffraction. In this way, physiological perturbations or developmental events leading to changes in membrane permeability can be studied for correlated changes in membrane structure.


Insulin secretion in fetal and newborn sheep.

The relationships between arterial plasma insulin, glucose, and fructose concentrations during the fed and fasted state were studied in seven fetal lambs and their mothers. A significant correlation between insulin and glucose concentration was noted in all fetal lambs and in their mothers. Fetal sensitivity to glucose, as measured by the slopes of the insulin-response curves, was equal to that of the adult although the fetal response was shifted to the left of the maternal. Glucose infusion in four fetal lambs caused significant insulin elevations but no early insulin response (phase I). Maternal fasting caused no alteration in glucose-induced response in the fetus. Similar glucose infusions in newborn and 1-mo-old lambs demonstrated significant early-phase insulin secretion. Basal insulin to glucose ratios were consistent with an adult pattern as early as 3 days after birth.


Relationship of plasma levels of chlordiazepoxide and metabolites to clinical response.

The authors report on the relationship between the antianxiety effects of chronically administered chlordiazepoxide (CDX) and plasma levels of CDX and two of its metabolites, desmethylchlordiazepoxide (DMCDX) and demoxepam (DMX). Fifteen subjects with moderate to severe anxiety were studied in a double-blind, placebo-controlled, crossover design. Significant correlations were found between anxiety reduction and DMCDX and DMX plasma levels. No such correlation was observed between anxiety reduction and CDX levels. These data suggest that in chronically treated subjects, DMCDX and DMX have significant antianxiety properties which surpass those of CDX itself.


Einstein's creative thinking and the general theory of relativity: a documented report.

A document written by Albert Einstein has recently come to light in which the eminent scientist described the actual sequence of his thoughts leading to the development of the general theory of relativity. The key creative thought was an instance of a type of creative cognition the author has previously designated "Janusian thinking," Janusian thinking consists of actively conceiving two or more opposite or antithetical concepts, ideas, or images simultaneously. This form of high-level secondary process cognition has been found to operate widely in art, science, and other fields.


1978 anniversaries.

The author recalls 1978's anniversaries of events and individuals prominent in the history of medicine, psychiatry, and psychology and examines their practical and theoretical contributions.


The running meditation response: an adjunct to psychotherapy.

The physical technique of slow, long distance running and the mental centering devices of T. M. are combined, using hypnosis in some cases, to enhance a "peak experience," or altered state of consciousness. Indications and contraindications to this technique are described for various psychiatric, psychosomatic and somatic syndromes, and its use as an adjunct to formal individual and group psychotherapy is discussed.


The Duffy blood group phenotype in American blacks infected with Plasmodium vivax in Vietnam.

We determined blood group phenotypes of 13 blacks who were infected with Plasmodium vivax in Vietnam. All were Duffy blood group positive as compared to 40--50% Duffy positive in surveys of black blood donors in the United States. The probability that 13 of 13 were Duffy positive by chance alone was P less than 0.001. All other blood groups occurred at the expected frequency. This study is further support for the hypothesis that the Duffy negative genotype (FyFy) is the basis for resistance of blacks to P. vivax.


Babesiosis in Long Island. Host-parasite relationships of rodent- and human-derived Babesia microti isolates in hamsters.

The effects of splenectomy and size of inoculum on response of hamsters to three isolates of Babesia microti (two rodent- and one human-derived) from Long Island were studied. Splenectomy of hamsters did not enhance susceptibility to the rodent isolates of B. microti at a dosage of 5 X 10(7) parasites. Larger parasite inocula produced shorter prepatent periods and slightly shorter duration of infection in intact hamsters. Inoculum size was not contributory to mortality of hamsters or to pathogenesis. Hamsters showed profound anemia with depressed hematocrit and hemoglobin values and erythrocyte counts. Moderate leucocytosis was seen just prior to peak parasitemia, with immature polymorphonuclear cells predominating. Infections in hamsters lasted for 14--17 weeks. As determined by the parameters studied, the three isolates appear to be identical.


Concentration from continuous culture of erythrocytes infected with trophozoites and schizonts of Plasmodium falciparum.

Gelatin, from readily available sources, at specified concentrations in RPMI 1640 medium enhances sedimentation rates of suspensions of Plasmodium falciparum-infected erythrocytes from continuous cultures, resulting in an enrichment of the trophozoite- and schizont-infected cells to parasitemias of 75% or more with no deleterious effects to the parasites.


Gastrin cell populations after highly selective vagotomy in the dog.

Highly selective vagotomy was performed on five dogs. Postoperatively, gastrin cell (G cell) hyperplasia occurred in all dogs. Mean preoperative G cell numbers increased from 350 to 530/cm mucosal length (p less than 0.02). Antral tissue gastrin also increased by 100 per cent (6.7 x 10(6) to 13.7 x 10(6) pg/gm tissue, p less than 0.05). Basal and stimulated serum gastrin were unchanged following highly selective vagotomy. The cause for G cell hyperplasia is not clear, but is probably multifactorial.


Endoscopic electrohemostasis of active upper gastrointestinal bleeding.

Emergency esophagogastroduodenoscopy for active upper gastrointestinal bleeding was performed in 160 patients. Endoscopic electrocautery for control of bleeding was considered in the last ninety patients and performed in seventy-one patients. All lesions except esophageal varices were candidates for electrohemostasis. The indications for endoscopic electrocautery were active hemorrhage and precise identification of the bleeding point. The preendoscopic blood loss ranged from 1,500 to 6,000 ml. All seventy-one patients had initial hemostasis and sixty-five (92 per cent) had permanent hemostasis after one treatment. Six patients rebled, and four of these had permanent hemostasis after a second endoscopic electrocauterization. Only two of seventy-one patients had emergency operations for bleeding. There were no complications. Endoscopic electrohemostasis is still an experimental technic which requires further laboratory study and testing before broad general clinical application. This clinical trial suggests that endoscopic electrocautery is an attractive method of controlling active upper gastrointestinal bleeding because it can be safe, effective, and rapid, and is available in most medical communities.


Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: results of controlled clinical trial. A Veterans Administration cooperative study.

Data obtained from a survey of the membership of the Society for Surgery of the Alimentary Tract and the American Society of Colon and Rectal Surgeons indicated that concomitant administration of oral neomycin-erythromycin base and systemic cephalothin, together with mechanical colon cleansing, was the most popular method of colon preparation. We designed a prospective double blind clinical trial to compare administration of intravenous cephalothin, oral neomycin-erythromycin base, and the combination of both the intravenous and oral antibiotics. Intake of patients to the intravenous cephalothin group was stopped because the data indicated that this method of prophylaxis resulted in significantly higher numbers of septic complications. The incidence of wound infection was 30 per cent and the overall incidence of septic complications was 39 per cent in patients receiving only intravenous cephalothin combined with mechanical colon cleansing. The incidence of wound infection and the overall incidence of septic complications was only 6 per cent in the comparison group, and the differences are highly significant.


A controlled clinical trial of whole gut lavage as a method of bowel preparation for colonic operations.

In a prospective randomized clinical trial, whole gut lavage was evaluated against conventional mechanical cleansing for colonic operations. The lavage took less time to perform, was better tolerated by patients, and resulted in more satisfactory preparation as judged by frequency of collapsed intestines. There was no difference in the outcome in the two series as measured by wound infection rate and length of hospitalization. It is concluded that whole gut lavage is as good as conventional mechanical cleansing but surpasses the latter in logistic advantages.


Ultrastructural identification of type I and II collagen in the cornea of the mouse by means of enzyme labeled antibodies.

Following reaction with peroxidase-coupled IgG antibodies, collagen of both type I and type II can be demonstrated light and electron-microscopically in the cornea of the mouse by means of purified, type-specific antibodies against collagen. Both type I and type II collagen seem to be evenly distributed in the cornea, with the amount of type I exceeding that of type II.


Allogeneic corneal grafting in inbred strains of rats. Histology of graft reaction.

Histological studies of interlamellar keratoplasty in different inbred strains of rats (CAP, LEW) without additional sensitization--i.e. first-set reactions--are described. The corneas of 65 eyes, after allogeneic or syngeneic grafting, were examined from the 3rd to the 90th day--every 2nd day at the beginning of the reaction and later every 5th day. After syngeneic grafting (LEW leads to LEW) a non-specific healing-reaction (only slight vascularization of the graft bed, edema, granulocytic infiltration) reached its climax on the 6th day and subsided by the 10th day. After allogeneic grafting (CAP leads to LEW; RtH-1-incompatible) the non-specific-healing reaction progressed into a second phase, namely the specific reaction: increasing infiltration of the host cornea and the graft with small lymphocytes, blast cells and macrophages, directly followed by severe vascularization, reaching its climax about the 14th day. A third, phagocytic phase succeeded the infiltration leading to elimination of the donor cells, but leaving the donor stroma undamaged. All these alterations had almost completely disappeared after 35 days. Thus, the corneal allograft reaction is discussed as a typical immunological reaction leading to the destruction of transplantation-antigen-bearing cells and permitting observation of the different reaction phases more clearly than in most other tissues.


Pain pathways and mechanisms.

The current concepts of the anatomy of the pain pathways have been described and the mechanism by which they function has been discussed.


Secretagogue-mediated discharge of nerve growth factor from granular tubules of male mouse submandibular glands: an immunocytochemical study.

Submandibular glands of male mice were stained for nerve growth factor by light microscopic immunocytochemistry. Nerve growth factor (NGF) was present in the granules of granular tubule cells, with the immunoreactive material often concentrated at the periphery of granules. Administration of the alpha-adrenergic agent, phenylephrine, to animals resulted in a marked depletion of NGF-containing granules from granular tubules. Some release also occurred following administration of the beta-adrenergic agent, isoproterenol. Cholinergic stimulation (pilocarpine) did not result in appreciable loss of immunoreactive granules from these cells. In vitro results were not as clear cut, immunocytochemically, as those obtained with intact animals. It is concluded that discharge of NGF from male mouse submandibular glands is mediated predominantly by alpha-adrenergic activation, and that this phenomenon is readily demonstrated in the intact animal.


Salmonella serotypes encountered in animal feed additives in Lebanon.

Animal feed-additive samples (n = 300) were examined for the presence of salmonellae, using the selenite-F broth-enrichment method followed by subculturing on Salmonella-Shigella and brilliant green agar with sulfadiazine selective agar plates. Samples consisted of a variety of feed additives: 119 bone meal samples, 77 meat meal samples, 40 fish meal samples, and 64 miscellaneous meal samples. Results of examination found 49 (41.2%) of the bone meal samples, 6 (7.8%) of the meat meal samples and 2 (5%) of the fish meal samples contained salmonellae. Of 57 isolates representing 24 serotypes, 4 most frequently isolated serotypes were Salmonella meleagridis (35.1%), Salmonella tennessee (7%), Salmonella chester (5.2%), and Salmonella senftenberg (5.2%). This study shows a high Salmonella-contamination rate of bone meal compared with meat meal and fish meal samples. Of 12 known positive bone meal samples that were examined, 100% of 25-g samples, compared with 70% to 100% of 2.5-g samples and 30% to 90% of 0.25-g samples and 30% to 90% of 0.25-g samples, were positive for salmonellae.


["Yersinia pseudotuberculosis" in a case of mesenteric lymphadenitis (author's transl)].

An eleven-year old girl's case of an inflammatory process of the right lower abdomen is described, with a positive agglutination reaction to "Y. pseudotuberculosis", serotype I-A. The surgical operation disclosed a normal coecal appendix as well as a mass of clustered ganglionar adenopathies, exclusively located in the ileo-coecal junction. Histologic findings were a pulpar and follicular hyperplasia with mastocytes accumulation and metachromatic staining of capsule and connective tissue. From homogenized ganglionar mass an agent was isolated, further identified as "Y. pseudotuberculosis" type I-A. A comment follows on the frequency of mesenteric lymphadenitis as cause of inflammatory processes of the lower right abdomen in children and the rarity of isolation of "Y. pseudotuberculosis" as etiological agent as compared with the more common "Y. enterocolitica".


Autoradiographic study of retrocorneal membranes.

Fibrous membranes in the posterior cornea occur in failed transplants. The purpose of these studies was to investigate the role of corneal endothelium in the formation of these membranes. The corneal cellular components of rabbit corneas were labeled with tritiated thymidine. Labeled rabbit corneal stroma was replaced with unlabeled tissue (pre-Descemet's lamellar graft), leaving only labeled endothelium. Weeks later small unlabeled penetrating grafts, without endothelium, were placed inside this lamellar graft. The surrounding labeled host endothelial cells were found in a fine retrograft membrane and in the scar of grafts. The experiment demonstrated that host endothelial cells participate in the formation of retrograft membranes, but it does not exclude other origin of fibroblasts.


Corneal graft rejection associated with anterior iris adhesion: case report.

A patient's corneal graft rejection arose at the site of an anterior iris adhesion and was reduced by removal of the adhesion.


Intraocular effects of lint particles from disposable drapes.

Fragments of lint from a disposable paper head drape were implanted into the anterior chamber of 9 rabbit eyes. Eyes were removed at varying intervals after implantations and sectioned for microscopic examination. A localized inflammatory response appeared as early as day 1 and increased in severity during the first 10 days. The reaction began to abate, however, by the 14th day. Control eyes with sham operations failed to show any such reaction. Daily monitoring for cell and flare reaction was negative in all eyes.


The reminiscences of a plastic surgeon during World War II.

The experiences of the author while an Officer in the South African Medical Corps are related. During the battle of Britain he was attached to the R.A.M.C. and observed the work of pioneers in modern military plastic surgery. On his return to South Africa, he set up the Brenthurst Military Red Cross Hospital for Plastic Surgery and dealt with many thousands of allied battle casualties--South African, British, French, and Polish. The injuries treated included aircraft and tank burns, facial destructions (particularly the nose and eyes), extensive facial fractures, and limb amputations. Various procedures are mentioned. The first plastic surgical journal in English, The Brenthurst Papers, was produced describing these innovations.


An improved septoplasty: the microsurgical suture technique.

An improved septoplasty procedure has been performed on 204 patients, 49 in combination with rhinoplasty. There were 2 minor complications: 1 small perforation and 1 septal hematoma. The use of septal sutures avoids the necessity of postoperative intranasal packing or splints. Magnification, proper lighting, and improved instrumentation have simplified the technique, and a nontraumatic anatomical dissection can more easily be performed on the most complicated septal deformities. By dispensing with intranasal packing, a one-stage septorhinoplasty can be done without fear of producing a widened dorsum from outward pressure of the packs. The sutures also increase the stability of the septum by preventing displacement of the caudal portion during the healing process. Postoperative patient discomfort is minimized, as the airway is not blocked by packs; painful removal of the packs is also eliminated.


Cervical lifts: the value of platysma muscle flaps.

Patients and physicians who are not satisfied with the results of cervical lift procedures that rely on skin tension alone frequently complain of persistent or recurring neck longitudinal bands; of lack of pleasing concave contours; or of lack of definition of the mandibular border. Platysma muscle bands can be eliminated with long-lasting improvement in the neck contour if the objectionable bands are completely incised and the platysma muscles are transformed into a deep-layer supportive neck sling. The techniques described utlilize platysma muscle flaps to eliminate vertical platysma muscle bands and folds, to achieve pleasing concave neck contours, and to produce definition of the mandibular border.


Muscle repair in unilateral cleft lip, based on findings on electrical stimulation.

The appearances, distribution, and direction of muscle in the unilateral cleft lip as indicated by electrical stimulation are described. The findings differ from those reported by Fara and associates in their dissections in that functionally the fibers do not appear to parallel the margin of the cleft. Based on these findings, a method of layer-by-layer, step-by-step closure of the unilateral cleft lip is described that attempts to split the orbicularis bulge and advance the lateral muscle into the philtrum to a position more nearly imitating the direction and extent of the muscle in a normal lip.


Lengthening of the short columella associated with bilateral cleft lip.

Operations for lengthening the columella can be classified into three groups on the basis of source of material: lip, nose, or ear. When seen in profile, the middle of the lip provides one-fourth to one-third of the forward projection of the columella as compared with the level of the alar bases. Complete bilateral cleft lips usually benefit from columellar lengthening, but symmetrical, incomplete clefts rarely require it. Ancillary procedures, such as correction of a retruded maxilla by Le Fort I osteotomy or by contour build-up, can enhance the overall result. Our experience with advancement of skin from the floor of the nose and ala [15], skin from the alar margins at the tip [7], prolabial advancement flaps, fork flaps, and composite earlobe grafts is reported.


George David Pollock and the development of skin grafting.

George David Pollock, F.R.C.S., convinced the world of the efficacy of skin autografting and homografting. Previous studies on the priority of skin grafting are reviewed. The life of Pollock, including a glimpse of the surgical world of the Victorian era is described. A detailed analysis of the roles and relationships of Pollock, Reverdin, and Gosselin is given.


The world of William L. White: a macro-view.

On May 14, 1977, a group of colleagues and former trainees gathered in Pittsburgh to honor Dr. William L. ("Willie") White, Chief of the Section of Plastic Surgery at the University of Pittsburgh School of Medicine, on the occasion of his retirement after 18 years as program director. Participating in the festivities were Drs. Henry H. Bahnson, Robert M. Goldwyn, Salvador Castanares, Victor HayRow, Frederic Rueckert, Richard P. Jobe, Dwight C. Hanna, George S. Richardson, Dennis J. Hurwitz, Garry S. Brody, Ronald J. North, Ross H. Musgrave, and Robert A. Chase. These are the remarks made by Dr. Robert M. Goldwyn at the commemoration for Dr. White.


Repositioning of prominent ears.

An operation for the repair of prominent ears is presented that includes the best features of the cartilage incision and cartilage suturing techniques. By using the best of several procedures, an operation has been developed which gives consistent, reproducible results in the treatment of prominent ears; and which is easily adaptable for children.


Hyperbaric oxygen in the treatment of burns.

Since 1972, over 800 burn victims have been treated with hyperbaric oxygen at the Burn Center of Sherman Oaks Community Hospital in Los Angeles. HBO is used only as an adjuvant to standard resuscitation and is not intended to replace current accepted therapy. The results of the first three-year study program show definite changes in burn care delivery. There has been a definite decrease in the mortality as compared with our own predictions and statistics and with those of the N.B.I.E. In addition, a marked improvement in morbidity and a reduction in hospital stay were noted.


Quantitation of thermoregulatory impairment in patients with healed burns.

The basis of our study lies in the clear demonstration that rectal temperature in cool and comfortable environments is a function of the metabolic load but that once a critical level of environmental warmth has been exceeded, the rectal temperature increases above the metabolically controlled level. This effect forms the basis of the presently suggested limits for healthy individuals during heat exposure in industry. We show that impairment of thermoregulation due to extensive burns makes such environmental limits unacceptable. Our experiment was aimed at demonstrating certain tolerance limits above which the extensively burned patient (40% deep second- or third-degree burns) cannot realistically be expected to function under the workload employed. Nine subjects with varying degrees of anhidrosis were subjected to standard workloads under carefully controlled environmental conditions. We found a dramatic diminution in heat tolerance in patients with healed burns covering more than 40% of their body surface area.


Plastic surgery in the twentieth century.

Plastic surgical operations are among the oldest and have been developed increasingly from ancient times down to the present. However, the age of medical specialization did not begin until the latter part of the nineteenth century, and the specialty of plastic surgery is largely a child of the twentieth century. Most of the operations we do today have been created by plastic surgeons with the past 50 years, but were made possible only by the rapid developments in other surgical specialties and in all of medicine and science. The relationship with other specialties has been an interdependent one, and this is likely to be the pattern of the future. Plastic surgery, bridging the anatomical specialties as it does, must continue to draw bits of information here and there from them and to synthesize these into major contributions of great benefit to all. The specialty will grow in direct proportion to the success of the innovators within it in fulfilling their crucial role.