[Urinary lithiasis after renal transplantation. 9 cases (author's transl)].

Nine cases of urinary lithiasis following renal transplantation are reported. They differ from 15 cases in the literature in their development late after transplantation and in that no relation with hyperparathyroidism could be clearly demonstrated. We emphasise the difficulty of the clinical and radiological diagnosis of this little-known complication. The course is essentially similar to that in non-transplant patients with lithiasis.


[Rupture of oesophagogastric varices: treatment by a new haemostatic tube (author's transl)].

The immediate arrest of haemorrhage due to ruptured oesophageal varices may be obtained only by the insertion of a haemostatic tube with a balloon. Tubes used up to the present time have been more or less discredited. Some authors consider the Sengstaken tube to be dangerous: rupture of oesophagus, asphyxia, bronchial inhalation of oesophageal secretions etc. The Lindon tube has a single grave disadvantage: cardio-oesophageal ulceration due to traction. The new tube would seem to be free of these problems since no traction is used and it is possible to suck out oesophageal secretions, thereby suppressing the risk of bronchial inhalation.


[The heterogeneity of micropolycystic ovary syndrome. 77 cases (author's transl)].

Seventy seven cases of micropolycystic ovaries were reviewed. All of the patients underwent either coelioscopy or wedge resection of the ovaries. It was thus possible to classify the patients into two groups on the basis of the size of the ovaries (MPCO-A, large ovaries, more than twice the normal size; MPCO-B, ovaries only slightly increased in size or normal). There were differences from a clinical, laboratory and therapeutic standpoint. In MPCO-A, spaniomenorrhea predominated, clinical hyperandrogenism was often absent and 17 ketosteroids lower. Response to hypothalamic gonadotrophic hormone liberation factor was explosive in luteotrophic hormone, but at 120 minutes levels were lower in MPCO-A than in MPCO-B. Wedge resection failed completely in 23% of cases of MPCO-A and in 66% of cases of MPCO-B. This study confirmed current concepts of the heterogeneity of MPCO syndrome.


The nurse as holistic health practitioner: expanding the role again.

A quiet revolution in health care is currently spreading across the country. Many nurses are actively engaged in the practice of holistic health as this model of health care delivery joins the medical model. If this new direction in health care is followed, more nurses will be re-educating themselves in a way that allows them to expand their view of the patient to include acknowledging the interaction among body, mind, and spirit. This means researching and learning about such things as energy fields of the body and methods of using one's own mind as an instrument of healing. As nurses, we will also need to rethink what the business of helping people with their health problems is all about. A holistic health model provides nurses with an opportunity to be creative and efficient in helping others heal themselves.


Lympho-glandular toxoplasmosis. A diagnosis often missed.

Lymphoglandular toxoplasmosis has a reputation for mimicking several other diseases, especially infectious mononucleosis. Thus, the correct diagnosis often is not discovered until common conditions have been ruled out and the patient has been subjected to excisional lymph node biopsy. The physician who considers toxoplasmosis early and orders appropriate serologic tests can spare the patient unnecessary surgery.


Distribution of yeast fatty acid synthetase subunits: three-dimensional model of the enzyme.

Rabbit and goat antibodies against the isolated alpha and beta subunits of yeast fatty acid aynthetase were raised and characterized. The purified IgG fractions were studied as to their capability to precipitate their antigens and the holoenzyme and to inhibit the partial reactions involved in overall fatty acyl-CoA synthesis. The specificity of the antibodies was investigated by immunodiffusion and by immunotitration. Native enzyme was crosslinked with each of the antibodies, and dimeric and oligomeric groups of IgG-crosslinked fatty acid synthetase molecules were isolated by sucrose density gradient centrifugation. Electron microscopic investigation of the crosslinked material as well as other data led us to suggest a three-dimensional model of yeast fatty acid synthetase.


Three-dimensional structure of thioredoxin induced by bacteriophage T4.

The three-dimensional structure of thioredoxin from bacteriophage T4 has been determined from a 2.8-angstrom resolution electron density map. Phase angles for this map were determined from one heavy atom derivative and anomalous differences from cadmium in the native crystals. The molecule of 87 amino acid residues is built up from two simple folding units; a betaalphabeta unit from the amino end of the chain and a betabetaalpha unit from the carboxyl end. This structure is similar to that of thioredoxin from Escherichia coli in spite of their completely different amino acid sequences. The redox-active S--S bridge is part of a protrusion of the molecule as in E. coli thioredoxin, but with quite different surroundings. The structural differences in this region have been correlated to differences in specificity towards the enzyme ribonucleotide reductase from different species.


Fertility repression of F-like conjugative plasmids: physical mapping of the R6--5 finO and finP cistrons and identification of the finO protein.

The locations of the fertility inhibition genes finO and finP of the F-like conjugative multiple antibiotic-resistance plasmid R6-5 have been determined. As found previously for that of the fertility plasmid F, the finP gene of R6-5 is located close to the origin of DNA transfer, oriT, and to the promoter-proximal segment of the tra operon. Thus, finP is close to the site of action of the FinOP fertility inhibition system. In contrast, the finO gene is located on the other side of the tra operon, greater than 35 kilobases from the finP gene; finO is very close to the origin of vegetative replication, oriV, and to cistrons encoding functions involved in autonomous plasmid replication and plasmid incompatibility. A 4.5-kilobase fragment of R6-5 DNA containing the finO gene has been cloned on the high-copy amplifiable vector plasmid pBR322. This hybrid plasmid, designated pKTO31, causes severe repression of conjugal transfer of plasmid F, indicating the production of high cellular levels of finO protein. Two independent finO mutant derivatives were obtained after mutagenesis of the pKTO31 plasmid. Comparison of proteins synthesized by minicells carrying finO(-) mutant plasmids with those carrying various finO(+) plasmids enables the finO gene product to be tentatively identified as a 22,000-dalton protein.


Construction of a recombinant bacterial plasmid containing a chick pro-alpha2 collagen gene sequence.

A recombinant plasmid containing chick pro-alpha2 collagen gene sequences has been constructed and cloned in Escherichia coli. Using partially purified collagen mRNA as template, we synthesized double-stranded DNA by the successive action of reverse transcriptase (RNA-directed DNA nucleotidyltransferase) from avian myeloblastosis virus and the Klenow A fragment of E. coli DNA polymerase I. From this complex mixture of double-stranded DNAs, a specific 200-base-pair restriction fragment was generated by cleavage with the restriction endonucleases BamHI and EcoRI. These enzymes also make unique cuts in the plasmid vector pBR322. The restriction fragment was inserted into pBR322 via these BamHI and EcoRI sites and cloned in E. coli chi1776. The cloned recombinant plasmid was shown to contain pro-alpha2 collagen DNA by its specific hybridization to chick pro-alpha2 collagen mRNA, as assayed in an in vitro translation system. Thus, a clone containing pro-alpha2 collagen DNA was constructed without first obtaining highly purified collagen mRNA.


Translational control of transcription termination at the attenuator of the Escherichia coli tryptophan operon.

We have isolated two regulatory mutants altered in the leader region of the Escherichia coli tryptophan (trp) operon. In one mutant, trpL29, the AUG translation start codon for the trip leader peptide is replaced by AUA. The other mutant, trpL75, has a G leads to A change at residue 75, immediately after the UGA translation stop codon for the trp leader peptide. In vivo, trpL29 and trpL75 increase the efficiency of transcription termination at the trp attenuator 3- to 5-fold. trpL29 and trpL75 also fail to respond fully to tryptophan starvation and other conditions that normally relieve transcription termination at the trp attenuator. The trpL29 mutation, which presumably reduces synthesis of the trp leader peptide, is cis dominant. The effect of starvation for a number of the amino acids in the trp leader peptide was determined. Only starvation for tryptophan and arginine, amino acids that occur at residues 10, 11, and 12 of the 14-residue trp leader peptide, elicits relief of transcription termination. Our findings suggest that translation of trp leader RNA is involved in regulation of transcription termination at the attenuator. A model is discussed in which the location of the ribosome synthesizing the leader peptide is communicated to the RNA polymerase transcribing the leader region.


In vitro mutagenesis of a circular DNA molecule by using synthetic restriction sites.

A method for mutagenizing circular DNA molecules has been developed that uses synthetic oligodeoxynucleotide restriction sites as mutagens. A single synthetic restriction site is introduced at random by cleaving circular DNA with a nonspecific double-strand endonuclease. The restriction site is then ligated to the ends and the molecule is subsequently recircularized. These small additions to the genome are mapped by digestion with the appropriate restriction enzyme. Rearrangements such as duplications and deletions can be engineered at will by using the added restriction sites. This technique has been used to produce a fine-structure map of RSF1050, a ColE1 derivative, 60% of which is a transposable DNA sequence encoding the TEM beta-lactamase (Tn3). A subset of the mutations, mapping within a narrow region of Tn3, result in an increased frequency of Tn3 transposition; mutations in other regions abolish transposition entirely.


Application of higher derivative techniques to analysis of high-resolution thermal denaturation profiles of reassociated repetitive DNA.

We have analyzed high-resolution denaturation profiles of reassociated repetitive DNA sequences by using a combination of higher derivative analysis and curve-fitting techniques. Procedures originally used for resolution of components in complex absorption spectra were found to be applicable to high-resolution analysis of melting profiles of reassociated repetitive DNA sequences from pea DNA. Under conditions that eliminate the base composition effect on thermal stability (2.4 M tetraethylammonium chloride), such an anlysis can distinquish "thermal classes" of repetitive DNA duplexes exhibiting different amounts of base pair mismatch. Only a single thermal class is observed in reassociated Escherichia coli DNA whereas at least five classes can be reproducibly distinguished in pea and mung bean DNAs.


Methionine analogs and cell division regulation in the yeast Saccharomyces cerevisiae.

Methionine analogs such as ethionine, selenomethionine, and trifluoromethionine all arrest growth and division of the yeast Saccharomyces cerevisiae. One analog, ethionine, caused cells of the yeast to arrest specifically within G1; reciprocal shift experiments showed that ethionine and alpha-factor arrested cells at the same step ("start"). The major effect of ethionine on synthesis of macromolecules was to reduce both the rate of appearance of 35S ribosomal precursor RNA and the rate of production of mature rRNA. Synthesis of protein was relatively unaffected by ethionine. Selenomethionine and trifluoromethionine caused cells to arrest randomly in the cell division cycle. Although treatment of cells with either selenomethionine or trifluoromethionine also reduced the rate of total RNA synthesis, each of these analogs had other effects that presumably prohibited completion of the cell cycle. We propose that the rate of rRNA production is an important regulatory event in the cell cycle.


Thy-1: a differentiation marker of potential mammary myoepithelial cells in vitro.

The rat mammary cell line Rama 25 [Bennett, D.C., Peachey, L.A., Durbin, H. & Rudland, P.S. (1978) Cell 15, 283--298] differentiates morphologically in vitro from a cuboidal form to a fusiform cell resembling myoepithelial cells. This differentiation occurs in all clonal isolates of the line. By using three different rabbit antisera specific for Thy-1, we have found that antigenic differentiation accompanies morphologic change to the fusiform state. Very few cuboidal cells had Thy-1 detectable on their surfaces in the living state; but after acetone fixation cytoplasmic Thy-1 was detected by immunofluorescence in all cells of the cuboidal type. Thy-1 specificity was established by the fact that immunofluorescence induced by rabbit anti-rat thymocyte serum was abolished by absorption with rat brain but not with erythrocytes, kidney, or liver; immunofluorescence induced by rabbit antiserum to purified Thy-1 glycoproteins from mouse lymphomas was absorbed by Thy-1 positive mouse and rat lymphomas. Surface Thy-1 provides a potentially valuable antigenic marker in the Rama 25 line for studying the differentiation of mammary myoepithelial cells.


Pituitary somatotrophs contain [Met]enkephalin-like immunoreactivity.

Serial sections from epoxy resin-embedded rat anterior pituitaries were sequentially immunostained for endorphin, [Met]enkephalin, and growth hormone, respectively. We found that [Met]enkephalin immunoreactivity was confined to the growth hormone producing cells. Corticotropin/endorphin cells in the anterior pituitary from both normal and adrenalectomized rats did not contain any [Met]enkephalin immunoreactivity. When anterior pituitary cells were maintained in monolayer culture for 10 days, [Met]enkephalin immunoreactivity was still located in the growth hormone-producing cells although the staining was weaker than in the somatotrophs in pituitary tissue fixed immediately after death of the animals. This suggested that somatotrophs synthesize [Met]enkephalin. However, this cannot be proved conclusively until biosynthesis experiments have been performed. The following conclusions were drawn from these findings. (i) Anterior pituitary [Met]enkephalin is not an extraction artifact derived from beta-endorphin with which it shares the NH2-terminal pentapeptide sequence. (ii) In the anterior pituitary, beta-endorphin is not the precursor to [Met]enkephalin. [Met]Enkephalin in somatotrophs may be of brain origin and in the somatotrophs may be bound to intracellllar receptors as has been shown for luteotropin releasing hormone in gonadotropic cells.


Cluster of ribosomal protein genes in Escherichia coli containing genes for proteins S6, S18, and L9.

A mutant of Escherichia coli K-12 isolated for temperature-sensitive growth was found to harbor an alteration in robosomal protein L9. Because the chromosomal location of the structural gene for this protein (rplI) was not known, we mapped the mutation by using various Hfr strains. The fine mapping of this gene by Plkc phage-mediated transductions has revealed that it forms a gene cluster at 94 min on the E. coli genetic map together with the genes coding for two other ribosomal proteins, S6 (rpsF) and S18 (rpsR). Furthermore, the region of the E. coli genetic map containing this cluster was found to be shorter than previously estimated by approximately 2 min.


Control of expression of a cloned yeast (Saccharomyces cerevisiae) gene (trp5) by a bacterial insertion element (IS2).

A hybrid ColE1 plasmid [pYe(trp5)1], containing a yeast DNA segment that complements auxotrophic point mutations and deletions in the Escherichia coli tryptophan synthetase gene (trpAB), has been isolated. Expression of the yeast tryptophan synthetase activity from the cloned yeast gene (trp5) is relatively inefficient in E. coli, as measured by growth rates of trpAB/pYe(trp5)1 strains on minimal media lacking tryptophan and by enzyme assays. Faster growing variants occur spontaneously at a frequency of one in 10(4)--10(5) cells plated and produce higher levels of the yeast enzyme. Plasmid DNA [pYe(trp5)2] from one of these variants was shown to contain a DNA insertion (1.3 kilobase pairs) in the cloned yeast DNA segment in relatively close proximity to the trp5 gene. This DNA insert was identified as a bacterial IS2 element, which carries a promoter for RNA transcription when inserted in the proper orientation. The spontaneous integration of a bacterial DNA insertion element into cloned eukaryotic DNA can result in more efficient expression of the foreign gene.


Temperature-sensitive Escherichia coli mutant producing a temperature-sensitive sigma subunit of DNA-dependent RNA polymerase.

A gene affecting the sigma subunit of DNA-dependent RNA polymerase is tightly linked to dnaG at 66 min on the Escherichia coli chromosome. In order to create an easily selectable marker in this region, we inserted transposon-10, which carries a gene determining resistance to tetracycline (tet) near 66 min, and the order tolC-dnaG-sigma-tet was determined. We used frequency of contransduction with tet as a criterion to screen a collection of spontaneous temperature-sensitive Escherichia coli mutants that might affect the sigma subunit. One such mutant was found to map at the sigma locus. The sigma subunit isolated from this mutant is unstable at 46 degrees C in vitro and has an altered electrophoretic mobility. The temperature sensitivity of RNA synthesis in this mutant indicates that most transcription in E. coli is sigma dependent.


Leukemia in AKR mice: a defined suppressor cell population expressing membrane-associated DNA.

Leukemic AKR mouse spleen cells suppress normal AKR anti-sheep erythrocyte antibody responses in vitro. Treatment of leukemic spleen cells with DNase I prior to coculture with normal AKR cells abrogates their suppressive ability. Treatment of leukemic cells with a wide range of DNase I concentrations has no effect on the viability of these cells as measured by incorporation of [(3)H]thymidine or by eosin dye exclusion. When the activating divalent cations required for DNase I action are functionally removed in the enzyme treatment medium by chelation with EDTA, the ability of DNase I to abrogate suppression is abolished. Furthermore, the effects of DNase I in overcoming suppression are not able to be mimicked by trypsin, Pronase, or ribonuclease. These results are consistent with the existence of a population of cells in the leukemic spleen that expresses a form of membrane-associated DNA that functions in the suppression of normal antibody responses. The existence of such a population was shown by treating leukemic spleen cells with anti-single-stranded-DNA and then passing them through an anti-immunoglobulin immunoadsorption column. Approximately 15% of the leukemic cells are retained on the column and can be specifically eluted with the normal immunoglobulin. The cells of this enriched population when cocultured with normal spleen cells exhibit a 10-fold greater suppressive ability than unfractionated cells. Thus, there exists in the spleens of overtly leukemic AKR mice a population of cells expressing a form of DNA on their surfaces that in some manner is necessary for immunosuppression.


Expression of Ia-like antigens on cultured human malignant melanoma cell lines.

Human malignant melanoma cell lines were found to bear Ia-like cell surface determinants demonstrable by hetero- or alloantisera and by direct identification of the characteristic bimolecular glycoprotein complex. Immunoprecipitation confirmed the presence of Ia determinants on the bimolecular complex. The quantity of Ia molecules determined by these methods and by absorption experiments was relatively constant for each cell line. Among different lines, however, the amount of Ia antigens ranged from a level equal to that expressed by B-cell lines to a small fraction of this amount. This variation in level of Ia contrasted with the more uniform amount of beta2-microglobulin detected on the cell surface. The Ia alloantigen specificity DRw2 was the most frequently encountered specificity. Ia determinants were also found on the surface of an epidermoid carcinoma line, but not on various other cell lines of normal or neoplastic origin.


alpha-Melanocyte stimulating hormone: immunohistochemical identification and mapping in neurons of rat brain.

alpha-Melanocyte stimulating hormone (alpha-melanotropin) immunofluorescence was observed in rat brain by means of a highly specific and well-characterized antibody. The hormone was contained in arcuate nucleus cell bodies and in varicose fibers. Dense populations of hormone-containing fibers were present in the septum, the nucleus interstitialis stria terminalis, and the medial preoptic, anterior hypothalamic, dorsomedial, and periventricular nuclei. Moderate numbers of fibers were seen in the paraventricular and arcuate nuclei, the amygdala, the region of the tractus diagonalis, the mammillary body, the central gray, the cuneiform nucleus, and the nucleus of the solitary tract. There is an interesting correlation of alpha-melanocyte stimulating hormone fibers with regions of noradrenergic axonal projections and terminal fields.


[Ambulatory phlebectomy].

Being disappointed in the failures of sclerotherapy in varicose veins, the author resorted to ambulatory phlebectomy. Through very tiny incisions (0.5 to 1 mm) the varicose veins are prepared and completely removed. The arch and the proximal part of the internal saphenous vein are left to the surgeon. This technique described 2,000 years ago by Celsus is easy, effective and innocuous, leaves no marks (no stiches or ligatures) and is also inexpensive because of asepsis, antisepsis and anesthesia. A critical review of 1000 of our cases discloses 70 per cent excellent results. The 30 per cent of accidents were benign and transitory. This technique is almost ideal : A harmless cure that improves the appearance of all type of patients with varicose vein.


Evaluation of the dorsalis pedis free flap donor site by angiography.

Six patients were evaluated by angiography for dorsalis pedis free flap transfer because the course of the dorsalis pedis artery could not be traced by palpation. Two were subsequently excluded because they showed vascular occlusions. Successful transfer depends on the dorsalis pedis artery and its branches being intact, while healing of the donor site depends on the function of the posterior tibial artery. Angiography was found to be helpful in determining both of these factors.


Gastrointestinal complications of renal transplantation in children.

Twenty episodes of serious gastrointestinal complication occurred in 14 of 85 (16%) consecutive patients less than 17 years old who underwent renal homograft transplantation. These complications consisted of small-bowel obstruction, ulceration, pancreatitis, hepatitis, ascites, and severe gastroenteritis. Only 1 patient died as a consequence of the complication--a much lower mortality rate than that reported for gastrointestinal complications of renal transplantation in adults. Radiographic findings were diagnostic in the majority of cases and aided in the prompt administration of therapy.


A clinical comparison of 99mTc-diethyl-iminodiacetic acid, 99mTc-pyridoxylideneglutamate, and 131I-rose bengal in liver transplant patients.

The relative merits of three radiopharmaceuticals for evaluating liver transplant patients were determined in paired studies. In 86% of studies both 131I-RB and 99mTc-PG gave similar information for differentiation of hepatocellular disease and billary tract obstruction. 99mTc-PG probably demonstrates the biliary tract and small intestine better early after injection (8%); 131I-RB is probably better in showing the colon at 24 hours when intestinal activity is not seen by 1 hour (6%). 99mTc-diethyl-IDA is superior in all respects when compared to 99mTc-PG. The blood retention method (20 min./5 min.) showed that none of the radiopharmaceuticals was a reliable indicator of hepatocyte function when compared to total serum bilirubin.


Evaluation of inflammatory bowel disease with 99mTc-DTPA.

99mTc-DTPA was found to localize in segments of bowel with inflammation due to ulcerative colitis, regional enteritis, and other forms of enterocolitis. The concentration of tracer was apparently related to the clinical activity of the disease process. Imaging with 99mTc-DTPA may offer an appealing, noninvasive alternative for identifying and following up patients with inflammatory bowel disease.


Production of nonsurgical portosystemic venous shunts in dogs by transjugular approach.

Intrahepatic shunts between the left portal and hepatic veins were performed in 50 dogs (20 acute, 30 chronic experiments) using the transjugular approach with Dotter's coaxial catheter system. All shunts were occluded within two days; significant complications arose only after a shunt stayed in the animal a prolonged period. The intrahepatic tract wall was completely organized and fibrosed after three weeks.


The effects of injection site, age, and body position on cervical venous reflux.

The effects of injection site, age, and body position on cervical venous reflux during carotid radionuclide angiography were studied. Adults injected via the left arm while supine were more likely to show reflux; neither the position nor the side injected was important in children. Right arm injection is preferred for adults; adults injected via the left arm should be erect if possible.


Demonstration of immunoglobulin production by tumor cells in non-Hodgkin's and Hodgkin's malignant lymphomas and its significance for their classification.

Combined application of morphologic, immunochemical, and immunologic methods has led to a reinterpretation of non-Hodgkin's lymphomas and to the establishment of the Kiel classification. In the present paper, the main Ig-producing entities are considered. These are: 1. Chronic lymphocytic leukemia of the B-type (B-CLL)--a proliferation of lymphocytes and a few so-called prolymphocytes and lymphoblasts. The mean tissue IgM value is slightly increased; the serum IgM level is normal or reduced. The tumor cells bear SIg, and a majority of them have a receptor for C3d but always lack CIg and are usually devoid of receptors for C3b. 2. Lymphoplasmacytoid immunocytoma--a mixed proliferation of lymphocytes and centrocytes, blast cells, plasma cells, or plasmacytoid cells. The tissue Ig content is most often (91%) and most highly increased in this group, whereas the serum Ig level is increased in only 20% of the cases. The tissue IgM of 17 cases was shown to be monoclonal by IEF. Most tumor cells have SIg and a variable numbear CIg. The tumor cells bear both complement receptor subtypes, only a receptor for C3b, or no complement receptors at all. 3. Centroblastic/centrocytic lymphoma--usually a follicular proliferation of abundant small germinal center cells (centrocytes) and some large germinal center cells (centroblasts). The tumor cells bear SIg and both complement receptor subtypes. The C3b- and C3d-positive cells are located in the follicles, as in nonneoplastic lymphatic tissue. 4. Centrocytic lymphoma--a purebred, diffuse proliferation of the small germinal center cells (centrocytes). These cells bear SIg and receptors for C3b and C3d but usually lack CIg. 5. Centroblastic lymphoma--a proliferation of the large germinal center cells (centroblasts). 6. Lymphoblastic lymphoma of Burkitt's type. 7. Immunoblastic lymphoma--a diffuse proliferation of large basophillic cells resembling immunoblasts. The tissue IgM content is increased in 60% of the cases. It proved to be monoclonal with IEF in all five cases studied. The cells of five cases with increased tissue Ig content bore SIg. Nearly half of the cases studied showed CIg. Besides non-Hodgkin's lymphomas, paraffin sections of 87 biopsies from Hodgkin's disease were investigated for CIg in Hodgkin's and Sternberg-Reed cells. These cells stained positively in 68 cases, most often for IgG, followed by IgD. In five cases of the lymphocyte-depleted type, the staining of the Hodgkin's and Sternberg-Reed cells was restricted to one light chain type.


Biochemical markers in Hodgkin's disease and non-Hodgkin's lymphoma.

Vertical studies indicate that, in general, acute phase reactant proteins (APRP) reflect disease activity in both Hodgkin's disease and non-Hodgkin's lymphoma. Longitudinal studies of the selected APRP profile demonstrate the following: 1. The stable profile is characteristic of remission. 2. Considerable elevation of APRPs coincides with relapsed disease. 3. An unstable profile is a feature of relapsing disease and may give early warning of relapse. 4. Patients responding inadequately to treatment frequently have unstable APRP profiles.


Upon the nature of Hodgkin's disease and the Reed-Sternberg cell.

Immunoglobulin components have been demonstrated within Reed-Sternberg cell in Hodgkin's disease using immunoperoxidase techniques. The possibility that this finding is indicative of a B-lymphocytic origin for the Reed-Sternberg cell is considered, and the implications that such a conclusion might have regarding the histiopathology of Hodgkin's disease and the relationship of Hodgkin's disease to other lymphomas is discussed.


Integration of modern data in WHO categorization of lymphosarcomas. Its value for prognosis prediction and therapeutic adaptation to prognosis.

The categorization of lymphosarcomas with immune markers has enriched the prognosis value of the WHO classification. The prolymphocytic (centrofollicular) B-type and the null lymphoblastic subtype have a good prognosis, while the (T- or B-) immunoblastic type and the T-lymphoblastic subtype have a poor prognosis.


Surface morphology of lymphoreticular cells: review of data obtained from scanning electron microscopy.

This illustrated review summarizes the current status of knowledge relating to the surface morphology of normal and malignant lymphocytes and other leukocytes, as seen by SEM, with particular emphasis on lymphoreticular disorders. Problems of interpretation of the SEM data and their significance are discussed.


Pyogenic arthritis and rheumatoid disease: the importance of the infected foot.

During a nine-year period (1968--76) 75 patients were admitted to Coventry Hospitals becaues of pyogenic arthritis. Of these patients, 22 suffered from pre-existing rheumatoid disease, and in these the foot was the most common site of primary infection. Adequate and energetic management of foot problems and associated skin sepsis in patients suffering from rheumatoid disease appears to offer the best opportunity of reducing the incidence of superimposed pyogenic arthritis.


Auditory changes associated with moderate blood salicylate levels.

Thirty patients with rheumatoid arthritis were randomly assigned to two groups: aspirin and placebo. Aspirin group subjects received five grain ASA capsules and placebo group subjects received lactose placebo for seven days. Blood salicylate level (BSL) and audiological evaluations were performed on Days 0, 3 and 7. BSLs never exceeded 21 mg/100 ml. BSLs during the seven days varied only slightly among aspirin group subjects but dropped consistently in the placebo group. Intra-subject comparison of scores on low versus high BSL days indicated significant differences between mean speech reception thresholds (SRT) scores and pure-tone air-conduction thresholds at all test frequencies for both groups, except at 2000 Hz for the aspirin group. Inter-group differences occurred on SRT and high-frequency pure-tone thresholds. The results indicate that moderate BSLs adversely affect hearing ability. These adverse effects appear to be temporary.


Local anaesthetic nerve block in the treatment of intractable pain from osteoarthritis of the hip.

Previous workers have advocated hip nerve block, with local anaesthetic, in the treatment of intractable pain from osteoarthritis of the hip. In a pilot study we obtained some degree of pain relief in only six of 13 patients. A further double-blind, controlled, randomized trial was undertaken in 31 patients, comparing 0.5% Marcain and normal saline. There was no significant improvement in pain or hip movements in either group over a six-week period.


Benoxaprofen: a clinical trial with an unusual design.

Benoxaprofen is a new nonsteroidal analgesic anti-inflammatory drug with a long half-life. Preliminary studies showed that steady-state blood levels could be achieved within 24 hours of treatment using a dose of 300 mg on the first day followed by 100 mg twice daily. A double-blind cross-over trial showed that benoxaprofen was effective and well tolerated in rheumatoid arthritis. Its analgesic effect was not apparent until the sixth day of treatment. An unusual trial design was used with treatment periods of unequal duration. This design has the advantage of allowing a new drug to be given for long enough to determine the time course of its action, while sparing patients prolonged treatment with placebo.


A comparative trial of benoxaprofen and naproxen.

A double-blind within-patient trial in rheumatoid arthritis comparing the new anti-inflammatory drug benoxaprofen with naproxen is reported. Patients received naproxen 250 mg b.d. for two weeks and benoxaprofen 200 mg b.d. for three weeks. Both drugs demonstrated efficacy. There was no statistically significant difference between them, except for grip strength which favoured naproxen. Side-effects were mild, infrequent and similar for both drugs. Evidence is presented which confirms the long duration of action of benoxaprofen, a fact which may be of clinical significance.


A clinical trial of diflunisal against aspirin in osteoarthritis.

Thirty patients with osteoarthritis of knees or hips took part in a double-blind randomized 12-week inter-group clinical trial of diflunisal 250 mg to 375 mg twice daily against aspirin 500 mg to 750 mg four times daily using the double-placebo technique. Changes were assessed in weight-bearing pain and night pain, stiffness after rest, a specified activity, and overall judgements by patient and physician, all graded on a five-point scale. Intermalleolar distance or knee flexion were measured. Side-effects and safety tests were monitored. Diflunisal produced statistically significant responses for all the criteria, when numbers of patients better or worse after 12 weeks were compared using the sign test. Neither the figures for aspirin alone, nor a comparison between the two treatment groups, reached statistical significance. Side-effects and especially dropouts were less on diflunisal. Nine patients on diflunisal but only two on aspirin wanted to continue treatment beyond 12 weeks, though still 'blind' when deciding this. Diflunisal may be a useful, less toxic and longer acting alternative to aspirin in the management of osteoarthritis.


The mechanism of endotoxin-induced hypoferraemia.

The effect of endotoxin on the processing of erythrocyte iron by reticuloendothelial cells of the liver and spleen was studied in rats using heat damaged erythrocytes labelled with 59Fe. Endotoxin did not alter the uptake of the damaged cells but markedly inhibited the subsequent early phase of iron release from the reticuloendothelial cells. The inhibition seemed to be due to both a decreased rate of labelled haem destruction and an increased incorporation of radioiron into ferritin. Although early iron release was decreased 0--2 h after endotoxin administration, the diversion of iron into ferritin was more marked when endotoxin was given 18 h before. The block in iron release was partially overcome in animals that had been kept on an iron free diet or had been phlebotomised. In these animals the decreased rate of haem catabolism remained unaltered but less iron was diverted into ferritin.


Human lysozyme (origin and distribution in health and disease).

Histochemical and in particular immunoperoxidase techniques have extended our knowledge about the cellular distribution of LZM. The enzyme has been detected in: 1. granulocytes, which synthesize LZM in bone marrow; 2. cells of the mononuclear phagocytic system, which synthesize LZM continuously; 3. various  exocrine glands, whose LZM is probably in part synthesized locally and in part derived from blood; 4. cartilage, which probably synthesizes LZM and 5. the kidney, in which LZM is serum-derived. In pathological conditions, such as inflammation and neoplasia, most LZM-positive cells at the site of disease are either granulocytes or members of the mono-nuclear phagocytic system. A notable exception are the metaplastic Paneth cells that occur along the gastrointestinal tract in inflammation and neoplasia. LZM is an antibacterial agent, but evidence is accumulating which suggests that the enzyme might have other functions as well.


Detection of monoclonal B lymphocytes in multiple myeloma by immunofluorescence tests of surface immunoglobulins.

Peripheral blood lymphocytes of 16 patients with secretory type of multiple myeloma and 5 with nonmyelomatous monoclonal gammopathy were investigated for the surface immunoglobulins on the cell by immunofluorescence. A low pH shock of cells before staining was applied to dissociate the passively absorbed immunoglobulins present on the cell surface. Increases of B lymphocytes bearing surface immunoglobulins which have the same light chains as those of monoclonal immunoglobulins produced by the plasma cells were found in 5 of 11 common secretory myeloma patients and in all of 6 Bence-Jones myeloma patients. Ratios of cells bearing light chains of kappa- and lambda-types (kappa/lambda) appeared abnormal in almost all with an exception of only 3 cases of myeloma patients, even in the cases where the number of Ig bearing cells did not increase. Increases of possible monoclonal B cells bearing IgG, in addition to IgA cells, were observed in some patients with IgA myeloma. Increases of B cells bearing certain heavy chains were also observed in all 5 patients with Bence-Jones myeloma during the course of disease. No abnormalities of B cells bearing surface immunoglobulin were found in nonmyelomatous monoclonal gammopathy. These results suggest that proliferation of monoclonal B lymphocytes, which may be progenitors to the malignant plasma cells, occurs in a majority of myeloma patients, but not in nonmyelomatous monoclonal gammopathy.


The enzyme-linked immunosorbent assay (ELISA) (theory, technique and applications).

Enzyme-linked immunosorbent assays (ELISA) are useful for measuring levels on antigens and antibodies. Both competitive and sandwich methods can be used. These assays are analogous to radioimmunoassays in format and have similar sensitivity. However, results can sometimes by read visually and even for objective readings only simple equipment is needed. ELISA has been used to measure hormones and other protein antigens and has also been used to assay antibody levels.


Polyclonal activation of human B lymphocytes in vitro by pokeweed mitogen: a simple technique for the simultaneous assessment of cell proliferation, generation of plasma cells, plaque-forming cells and immunoglobulin production.

A simple technique has been worked out for the simultaneous assessment of cell proliferation, generation of plasma cells, plaque-forming cells and immunoglobulin production from single cultures of 1 X 10(6) human peripheral blood lymphocytes stimulated with pokeweed mitogen (PWM). Kinetic studies showed that number of cells, thymidine incorporation rate, number of plaque-forming cells against fluorescein-isothiocyanate-haptenated sheep erythrocytes and concentration of IgM and IgG in the supernatant peaked on the average between day 5 and 7 of culture. This technique is particularly suitable for the analysis of hypogammaglobulinaemias in infancy.


Complement activation during subsequent stages of canine endotoxin shock.

Changes in total haemolytic complement and levels of C3, C4 and C6 were studied during subsequent stages of lethal endotoxin shock in dogs. Substantial decreases of all parameters were observed. C4 and C6 decreases showed a very similar pattern, indicating activation of complement by the classical pathway in addition to the activation of the alternative pathway known to occur in this pathological condition. The findings emphasize the role of the complement system in the pathophysiology of endotoxin shock and are consistent with the concept that complement activation has prognostic value during endotoxaemia.


IgG on human blood lymphocytes studied by immunofluorescence.

Surface immunoglobulins (sIg) on human blood lymphocytes were identified by immunofluorescence (IFL) after staining with conjugated F(ab'2) fragments of the anti-Ig antibodies. A large fraction (approximately 20%) of freshly isolated lymphocytes was found to carry sIgG. Polyclocal IgG, which was present on Fc-receptor-bearing lymphocytes, could be removed by incubation and repeated washings only at 37 degrees C. Lymphocytes treated at 37 degrees C expressed the same percentage of sIg+ cells in direct IFL when F(ab')2 fragments of the antibody was used as when undigested aggregate-free IgG antibody was used. Indirect IFL using F(ab')2 fragments in both steps yielded similar sIg+ values. However, much higher percentage of cells carried sIg when undigested antibody was included in one of the steps. The results suggest that incubation and washing at 37 degrees C and the use of F(ab')2 fragments of the antibodies are important to eliminate absorbed sIgG and to avoid absorption of IgG during the staining procedure, thus preventing overestimation of the number of sIg+ B lymphocytes identified by IFL.


In vivo and in vitro binding of IgA to the plasma membrane of hepatocytes.

IgA bound in vivo was shown by immunofluorescence on the plasma membrane of isolated hepatocytes from subjects with normal liver and patients with liver cirrhosis, chronic active hepatitis or fatty liver. IgA in sera with elevated IgA concentrations, especially from cases with alcoholic cirrhosis, was bound in vitro to isolated hepatocytes from rabbit and mouse. This was not due to the high IgA concentration per se. Moreover, polyclonal polymeric serum-type and secretory IgA, and three of ten polymeric monoclonal IgA preparations, showed similar binding properties. Conversely, purified polyclonal and monoclonal monemeric IgA did not show affinity for the hepatocytes. The binding of polymeric IgA did not seem to depend on the proportion of dimers and larger polymers, kappa- or lambda-type light chains, heavy-chain subclasses, content of J chain or affinity for secetory component. The in vivo binding of IgA by hepatocytes is probably a physiological phenomenon which in part may explain the normal clearance of polymeric IgA from serum.


B-lymphocyte colony-forming cells in the SJL/J mouse thymus graft repopulation: independence on host thymus and graft genotype.

We have studied the development of B-lymphocyte colony-forming cells (BL-CFC) in SJL and A.SW mouse thymus grafts transplanted into lethally irradiated A.SW mice protected with SJL mouse bone marrow (A.SW-SJL bone marrow chimaeras). The chimaeric state was confirmed by Ly allotype analysis. High incidence of BL-CJC was found in both the A.SW and the SJL thymus grafts, indicating that SJL bone marrow generates BL-CFC, or cells capable of generating BL-CFC, with a high affinity for homing in the thymus irrespective of the genotype of the thymus reticulum. The incidence of BL-CFC in the SJL thymus grafts, however, was approximately 20 times higher than the incidence of BK-CFC in the A.SW thymus grafts. Thus, the extensive infiltration of ageing SJL thymus glands by BL-CFC demonstrated recently is caused not only by SJL bone marrow B cells with a high affinity for thymus homing but also by the specific property of the SJL thymus environment. The extensive infiltration of syngeneic thymus grafts by BL-CFC observed in ageing SJL mice was found to occur independent of an intact host thymus function, indicating the extrathymic origin of these cells.


Amino acid sequence homology between HLA-A,B,C antigens, beta2-microglobulin and immunoglobulins.

Papain-solubilized HLA-A,B,C antigen heavy chains have been cleaved by combined acid and CNBr treatment to yield three large fragments. A 14,000-dalton peptide comprises the NH2-terminal portion of the molecule, less a five-membered peptide. The 14,000-dalton fragment is followed in the linear sequence by a 9000-dalton peptide connected through an aspartyl-prolyl bond to the COOH-terminal 11,000-dalton fragment. The 9000- and 11,000-dalton fragments contain disulphide bridges that are immunoglobulin-like inasmuch as they encompass some fifty-five to sixty amino acid residues. The NH2-terminal portion of the HLA antigen heavy chain is devoid of cysteine. NH2-terminal amino acid sequence analyses do not reveal homologies between the 14,000- and 9000-dalton fragments, beta2-microglobulin, and the constant immunoglobulin domains. However, the NH2-terminal sequence of the 11,000-dalton fragment is as homologous to beta2-microglobulin and the constant immunoglobulin domains as they are to one another.


[The work by Prince Korab. Analysis of the writings of a paranoiac].

This note concerns the analysis of a work written in the early years of the century by a discredited Polish nobleman. The book, pseudo-encyclopaedic in character and didactic in tone is cast presumably in the mould of the "Guide to the Perplexed". Among other traits it reflects a paranoiac personality. In the course of his observations the author of the article raises the question of pathography in general. After a historical and epistemological survey of the working methods employed in this field, he suggests a new critical attitude which claims to be "multi-disciplinary". Taking its stand on several different points of view - philosophical, literary, linguistic, psychodynamic. The analysis of the book by Prince Korab serves to illustrate this "non-reductive" form of approach.


Symptomatology and diagnosis in connective tissue disease. II. Evaluations and follow-up examinations in consequence of a speckled antinuclear immunofluorescence pattern.

Antibodies to soluble ribonucleoprotein (sRNP) are by definition a prerequisite for the diagnosis mixed connective tissue disease (MCTD). They are also found in 30--40% of other rheumatic conditions with a high titred speckled IFL reaction. The same is true for the most characteristic clinical features of MCTD, viz. Raynaud's syndrome and polymyositis--polymyalgia. The serological and clinical symptoms mentioned are closely associated. An association between anti-Sm and the SLE symptoms butterfly erythema, nephropathia, other visceropathias and cerebrovascular disease is confirmed by the present study. Although anti-Sm has less diagnostic specificity for SLE than has anti-ds-DNA, it is useful as a diagnostic aid in SLE cases lacking the latter antibody. The results of the present study tend to support the hypothesis that anti-sRNP may be associated with a prophylactive effect against serious vasculitis and nephropathia. When anti-sRNP and anti-Sm occur together they seem to act competitively so that the symptom associated with the antibody having the highest titre tends to dominate the clinical picture. Both anti-sRNP and anti-Sm produce speckled nuclear patterns in the indirect immunofluorescence test. Sera with immunofluorescence titres below 1/25 were not found to react against either sRNP or Sm. On the other hand all sera tested that had a speckled IFL reaction greater than or equal to 1/800 also had anti-sRNP.


Effect of a single graded dose of terbutaline tablets in patients with chronic bronchitis and bronchoconstriction. A double-blind, placebo, cross-over study.

Terbutaline, a selective beta2-adrenergic receptor stimulator was given to 10 patients with chronic bronchitis. The effects of the drug were tested by measurements of forced expiratory volume in 1 sec (FEV1), peak expiratory flow rate (PEFR), heart rate, blood pressure and blood gas analysis. The measurements were performed before and 1, 2, 4, 5, and 6 h after oral administration of placebo, 2.5 mg, or 5.0 mg terbutaline. Terbutaline caused a significant dose-related increase in FEV1 and PEFR as compared with placebo. The maximal effects were found at the 4-h measurement and were still present at the measurements performed at 6 h. Heart rate, blood pressure and arterial oxygen tension (PaO2) were not significantly affected. Four patients experienced side effects as tremor and/or heart palpitations. It is concluded that orally administered terbutaline may be an important therapeutical agent in the treatment of chronic bronchitis.


Mutagenicity of industrial compounds. VII. Styrene and styrene oxide: II. Point mutations, chromosome aberrations and DNA repair induction analyses.

The possible genetic effects produced by styrene have been investigated by means of different methodologies in several biological organisms: (a) the induction of point mutation has been investigated in Salmonella typhimurium (reverse mutation), in the yeast Schizosaccharomyces pombe (forward mutation), both in vitro and in vivo, in the host-mediated assay of mice, and in the Chinese hamster cell line grown in vitro (V-79) (forward mutation); (b) the induction of chromosome mutation has been investigated in vivo, in mice, through the analysis of the presence of chromosome aberrations in bone marrow cells of treated animals; (c) the production of DNA (deoxyribonucleic acid) damage and the stimulation of DNA repair synthesis have been evaluated from measurements of unscheduled DNA synthesis in a heteroploid human cell line (EUE) and gene-conversion produced in the yeast Saccharomyces cerevisiae treated in vitro and in vivo (host-mediated assay). All the in vitro studies have been developed by the testing of the styrene in the presence of a metabolic activating system obtained with a mouse liver microsomal preparation. Styrene oxide, one of the in vivo metabolites of styrene with electrophilic properties towards DNA molecules, have also been tested in similar systems. Styrene was not mutagenic in all the systems tested; styrene oxide, on the contrary, was shown to be an active mutagen, independently of the genetic system under evaluation.


[An enigmatic member of the family of Scrofulariaceae: Digitalis].

Digitalis still remains a source of astonishment to electrophysiologists as well as clinicians. The presently known effects on the neurovegetative system and the action potential are described, and some clinical problems which may lead to ineffective digitalization or digitalis intoxication are stressed. Clinical and ECG manifestations and some therapeutic aspects are pointed out.


[Long-term ophthalmologic follow-up after kidney transplantation].

16 renal transplant recipients underwent ophthalmological examination 11.4, 19.4 and 61.3 months after renal transplantation. The most common side effects of immunosuppressive therapy were steroid-induced cataract formation, steroid glaucoma, and recurrent subconjunctival haemorrhages. Posterior sub-capsular cataracts may develop as early as 2 months after surgery, reach their highest incidence within 2 years and may be reversible under low dosage steroid therapy. 75.5% of 57 ophthalmologically examined patients showed ocular complications or changes, but visual function was not severely disturbed. Despite hypertension in 23 cases, no hypertensive retinopathy was observed. In the light of these findings we assume that kidney transplantation has a positive influence on ocular functions, and especially on fundus changes dating from the time of regular dialysis treatment.


Chitin synthetase distribution on the yeast plasma membrane.

Purified, intact yeast plasma membranes were allowed to synthesize chitin, and the nascent chains of polysaccharide were observed either by the fluorescence produced with a brightener or by autoradiography. By both methods, it was concluded that the newly formed chitin emerged at many sites on each membrane. Thus, the synthetase that catalyzes chitin formation has a similar distribution. Since chitin synthetase is found mainly in a zymogen form, these results confirm the hypothesis that initiation of the chitinous primary septum of Saccharomyces occurs by localized activation of the uniformly distributed zymogen.


Total synthesis of a gene.

The method developed for the total synthesis of a given DNA containing biologically specific sequences consists of the following. The DNA in the double-stranded form is carefully divided into short single-stranded segments with suitable overlaps in the complementary strands. All the segments are chemically synthesized starting with protected nucleosides and mononucleotides. The 5'-OH ends of the appropriate oligonucleotides are then phosphorylated with the use of [y-32P]ATP and polynucleotide kinase. A few to several neighboring oligonucleotides are then allowed to form bihelical complexes in aqueous solution, and the latter are joined end to end by polynucleotide ligase to form covalently linked duplexes. Subsequent heat-to-tail joining of the short duplexes leads to the total DNA. The methods are described for the construction of a biologically functional suppressor transfer RNA gene. The total work involved (i) the synthesis of a 126-nucleotide-long bihelical DNA corresponding to a known precursor to the tyrosine suppressor transfer RNA, (ii) the sequencing of the promoter region and the distal region adjoining the C-C-A end, which contained a signal for the processing of the RNA transcript, (iii) total synthesis of the 207 base-pair-long DNA, which included the control elements, as well as the Eco R1 restriction endonuclease specific sequences at the two ends, and (iv) full characterization by transcription in vitro and amber suppressor activity in vivo of the synthetic gene.


Response to influenza A vaccine among high-risk patients.

In recent years, it has been recommended that "high-risk" patients receive influenza immunizations annually. During the 1976 National Influenza Immunization Program, a higher priority was given to these patients than to the general population. The present study was undertaken to compare the antibody response of high-risk patients with that of a group of individuals with no underlying disease after immunization with 0.5 ml of bivalent, split-virus vaccine containing 200 CCA units each of influenza A/New Jersey/76 and A/Victoria/75. Sera were obtained before and after immunization from 41 "healthy" volunteers and from 57 cariology, 31 hematology, 13 hemodialysis, and 16 renal transplant patients. The control, cardiology, and hemodialysis groups responded equally well to A/Victoria/75 antigen, but the hematology and renal transplant groups did not respond as well (P less than .05). Only the hematology patients responded at a significantly lower level (P less than .05) than the control group to A/New Jersey/76. The control and renal transplant groups had a significantly greater response to A/New Jersey/76 antigen than to A/Victoria/75 antigen (P less than .002). Although the same pattern was demonstrated by the other patient groups, the differences were not significant. Because hematology and renal transplant patients responded relatively poorly to influenza immunization, prophylactic administration of amantadine during influenza outbreaks should be considered in patients with renal function adequate to excrete this drug.


Incidence of infections with Salmonella enteritidis serotypes in Black and Indian children. A 16-year survey.

A 16-year survey (1960--1975) of Salmonella infections other than typhoid fever in Black and Indian children admitted to King Edward VIII Hospital, Durban, is reported. The 3,393 patients yielded 3,688 Salmonella enteritidis serotypes, mainly typhimurium, johannesburg/duval, manhattan, enteritidis, and senftenberg. Organisms were isolated from one or more of the following: stool, urine, blood, cerebrospinal fluid, liver, sputum, subcutaneous tissue, ear and bone. Patients' ages varied from 1 day to 12 years, with a median age of 8 months. The high incidence of malnutrition, other debilitating diseases and multiple pathogens isolated from many of the patients precluded firm decisions as to the role played by most salmonellae as contributory factors or causes of death.


Colonic intussusceptions in children.

There is a high incidence of primary colonic intussusceptions in infants and children in Africa. The case histories of 37 patients are reviewed. Of the varieties described, the caecocolic intussusception (16 patients) presents as an intestinal upset, often mild, with symptoms of colic and vomiting. In many of these patients there is known to be an intestinal infestation with Ascaris lumbricoides. This often leads to a delay in establishing the correct diagnosis. Colocolic intussusception (13 patients) gives rise to more acute abdominal symptoms. On clinical assessment, signs of intestinal obstruction are found and there is usually an intra-abdominal mass which can be palpated in the left colon. Further confirmatory evidence of intussusception is the finding of occult blood in stools. There is an unusually high incidence of sigmoid intussusceptions in infants (8 patients). The diagnosis of this form of intussusception is often delayed owing to inadequate clinical assessment of prolapsed bowel at the anal orifice. The length of the prolapsed bowel, the curved nature of the prolapse and the possible demonstration of a sulcus between the prolapsed bowel and the anal canal wall, aid in diagnosis.


Anaesthesia for caesarean section. An updated review of its special problems and their management.

We have attempted to update a previous review of the hazards and problems confronting the mother, fetus and anaesthetist at caesarean section. A recent survey of obstetric anaesthesia within the Republic and South West Africa indicates that a significant proportion of anaesthetic services for midwifery are provided by non-specialist practitioners in hospitals outside major population centres. We believe that both mothers and their infants will gain from the careful perusal by their doctors of this review.


[President F.W. Reitz and his health problem].

Francis William Reitz, the second last President of the Republic of the Orange Free State, resigned his office on 16 November 1895 for health reasons. He died 39 years later at the age of 89. An analysis of this health history shows his resignation to have been caused by a symptom complex quite characteristic of endogenous depression, probably precipitated by virus hepatitis, During 1896 he recovered fully, but in 1903, as an embittered man at the end of the Anglo-Boer War, he experienced a severe recurrence of depression which lasted 18 months, despite the best therapy available in Europe at the time.


Xipamide in the management of renal, hepatic and cardiac oedema.

Xipamide (4-chloro-5-sulphamyl-salicylic acid 2', 6'-dimethylanilide) is a diuretic and antihypertensive agent. A clinical trial of the drug was performed in 11 patients, 8 with nephrotic syndrome, 1 with oedema and ascites due to hepatic cirrhosis, and 2 with congestive cardiac failure due to idiopathic cardiomyopathy. The drug proved to be potent, safe and efficacious. Side-effects were similar to those encountered with other thiazide-derived diuretics, but were not of a severe nature. Wider clinical usage of xipamide would appear to be warranted.


The role of social workers in medical education: a historical perspective.

Although the number of social workers participating in medical education is increasing, there is a need to review and evaluate their roles in such educational activities. Information is needed about how social workers participate in medical education in order to plan how to make a more effective contribution. This article describes how the role of social workers in medical education evolved, and gives examples of what social workers have done in the past and are doing today.


Emotional problems of the severely burned patient.

In this article we have tried to present an overview of some of the common emotional responses and problems seen in severely burned patients. We have suggested that first consideration be given to learning what sort of person the patient is and becoming familiar with what the burned patient experiences. General preventive measures were suggested that included establishment of clear communication between patient and staff so that the patient has the best understanding possible of the nature of the injury and the treatment, allowing the patients as much control as possible in the treatment process, and providing adequate analgesic medication. We have described what may be observed when patients become anxious, fearful, angry, depressed, regressed, and psychotic, and have attempted to facilitate an understanding of what is occurring in patients showing these responses. Some common reactions of medical and nursing staff to the various emotional reactions were mentioned. In the final section we attempted to deal briefly with the responses of children and measures that can be taken with them. Most of the therapeutic measures suggested can be carried out by nonpsychiatric personnel if they are able to be empathetic and in touch with their own reactions to patients and to utilized common sense.


Closing the burn wound.

With recent advances in supportive therapy and surgical care, closure of the burn wound now can be accomplished earlier and more effectively than previously. Only by keeping the patient in a state of positive nitrogen balance, immunologically competent, and in equilibrium with the bacteria colonizing the burn wound can early wound closure be carried out with a minimal number of postburn complications.


Current status of skin substitutes.

In the current state of the art, viable human allograft is the best skin prosthesis available, but it leaves much to be desired. Characteristics of skin substitutes can be defined and measured, resulting in the rational approach to design and testing of synthetic skin substitutes. Thin silicone polymer and modified plastic membranes, collagen films, and adherent methacrylate polymer applied by a spray technique (Hydron) are the most promising materials at present.


Evidence that calcium regulates platelet function.

It is generally believed that calcium ions play a key role in regulation of platelet function. This is based on 3 types of evidence. 1. Analogies with other cells. Calcium ions are known to trigger secretion and contraction in many cells, possibly reflecting a general role for calcium in all secretion and contraction. 2. Indirect evidence. Platelet aggregation and secretion are induced by divalent cation ionophores. The response to the ionophore A23187 is identical to that induced by other potent stimuli. 3. Direct evidence. Platelet activation can be blocked by drugs (e. g. certain local anesthetics) that block release of calcium ions from sarcoplasmic reticulum; the inhibition can be overcome by addition of extracellular calcium in the presence of a calcium ionophore. While this does not constitute definitive proof, the central role for calcium ions remains an attractive hypothesis that justifies attempts to further define calcium pools and fluxes in platelets.


Movement of calcium ions and their role in the activation of platelets.

The increase of the cytoplasmic Ca-concentration plays a central role in the initiation of platelet activation. Four kinds of movements of Ca-ions are presumed to occur during this process: a) Ca-ions liberated from membranes induce the rapid shape change. b) Vesicular organelles release Ca-ions into the cytoplasm which initiate the release reaction. c) The storage organelles called dense bodies, secrete their contents including Ca-ions to the outside during the release reaction. d) At the same time a rearrangement of the plasma membrane occurs, resulting in an increase in its permeability for Ca-ions as well as in an increase in the number of Ca-binding sites. Since most processes occurring during platelet activation are reversible, the platelet must be equipped with a mechanism which removes Ca-ions from the cytoplasm. A vesicular fraction obtained from homogenized platelets indeed accumulates Ca actively. This Ca-pump is stimulated by cyclic AMP and protein kinase; it may be involved in the recovery of platelets after activation.


The platelet dense tubular system: its relationship to prostaglandin synthesis and calcium flux.

The platelet dense tubular system, an internal smooth endoplasmic reticulum membrane system occupies a pivotal position in the initiation and modulation of platelet activation. The best available evidence suggests platelet prostaglandin and thromboxane synthesis and an internal calcium store critical to platelet activation are both found in the platelet dense tubular system. Studies of the structural, physiologic and chemical properties of thromboxane A2 support the concept that this product of platelet prostaglandin synthesis acts to carry the calcium from the dense tubular system into the cytoplasm where the calcium is released to initiate contraction of the platelet contractile protein. Evaluation of platelet phospholipase A2 suggests that calcium may be critical to activation of this enzyme. Two of the steps occurring during platelet activation which appear to require calcium 1) phospholipase A2 acting as the critical carrier of calcium from one location to the other.


[Investigations into the incidence of the various causative agents of mastitis in cattle. Studies done in the ambulatory clinic of the Faculty of Veterinary Medicine, Utrecht].

The clinical and bacteriological findings in every head of cattle treated for clinical mastitis in the Ambulatory Clinic of the Veterinary Faculty of Utrecht University were recorded over a period of twelve months. Cattle affected with mastitis were classified into a number of groups, a classification based on the clinical symptoms shown by the animals. In each of these groups the incidence of the various causative agents of mastitis was determined. Another subject of study was the distribution of the causative agents over the various groups. The high proportion (34 percent) of coliform micro-organisms, isolated from animals affected with acute mastitis and showing symptoms of generalized disease was a striking feature.


[Morphology of live and dead spermatozoa of stallions (author's transl)].

Examination of 539 ejaculates of stallions of various breeds showed that approximately 60 per cent of the spermatozoa were completely normal morphologically. Of these morphologically normal spermatozoa, 13 per cent were dead. The total proportion of live spermatozoa was 75 per cent, 32 per cent being obviously abnormal (22 per cent of live and 10 per cent of dead spermatozoa). Separated heads (normal as well as abnormal) were significantly more common among dead spermatozoa. Protoplasmic droplets (both at the neck and at the end of the middle piece) were mainly present in live spermatozoa. As the stallion grow older, the total proportion of abnormal spermatozoa shows only a slight increase. Moreover, this increase is mainly due to an increase in abnormal dead spermatozoa as the live ones show a reduction of abnormal forms. Thus, the proportions of abnormal and separated heads are reduced in live spermatozoa, whereas separated heads show a marked increase in dead spermatozoa. The total number of abnormal spermatozoa is reduced by an average proportion of 4 per cent in second ejaculates, whereas it increases by 8 per cent in live (unstained) spermatozoa.


[Effectiveness of a number of anticoccidial agents. A brief survey taken in the field (author's transl)].

A floor pen trial was carried out on broilers in 1975 to compare the anticoccidial efficacy of monensin1), 3,5 dinitro-o-toluamide2), clopidol3), amprolium + ethopabacte4), amprolium + ethopabate + sulfaquinoxaline + pyrimethamine5) and robenidine6) in the presence of untreated controls. 4,200 Hybro chicks were distributed over twenty-eight pens, each initially housing 150 birds. Four pen replicates were allocated to each of the seven treatments. With the exception of robenidine, all agents used resulted in a statistically significant (P less than or equal to 0,05) gain in final weight compared with the untreated controls. The feed conversion rate showed significant (P less than or equal to 0,05) improvement in the groups treated with monensin, robenidine, amprolium + ethopabate.


Neurotensin--positive and somatostatin--positive cells in the canine gut.

By using immunoperoxidase and immunofluorescence techniques, the localization of neurotensin-positive cells and somatostatin-positive cells in the canine gut was examined on the same sections. Neurotensin-positive cells were found only in the jejunum and ileum, while somatostatin-positive cells were distributed throughout the stomach and all parts of the small intestine. These two types of cell in the jejunum and the ileum had no direct cellular contact with each other. Based on the hypothesis that somatostatin may inhibit the release of some peptide hormones through junctional complexes of cells, the possibility of functional interaction between neurotensin and somatostatin was discussed.


[Effect of the propellants O2 and CO2 on the efficacy of oral irrigation].

The therapeutical results obtained with oral irrigations when O2 or CO2 was used as a propellant air compared with those achieved with compressed air. The assessment of the therapeutical success was based on the periodontal disease index according to Kötzschke and the exsudate heights according to Egelberg. A significant improvement in the periodontal condition was stated in all three groups of patients. Though only the exsudate values for the O2 group were significantly better than those for the compressed air group, being the only difference between the groups which was significant, the greater efficiency of the O2 and CO2 application (compared to compressed air application) is, nevertheless, obvious and interpretable. The therapeutical results obtained permit the statement that a technically perfect device and the further increase of the partial pressure of O2 or CO2 in the irrigation fluid will lead to even better therapeutical results, for which purpose the suggestions given should be considered in establishing the indication. The favourable results achieved with compressed air testify to the beneficial action of each irrigation or spray treatment.


[Results of follow-up studies of surgically treated facial soft tissue lesions in children and adolescents].

During the years 1973--1976, 609 children and adolescents, aged between 4 months and 18 years, have been operated on for facial soft-tissue lesions at an oral surgery outpatient service. 451 of these patients could be re-examined. The general late sequelae and the functional and aesthetic repercussions of circatrization were scrutinized and compared with the method of treatment and the postoperative course.


[Treatment of lobar fibroses with retroauricular full thickness skin transplantations].

With a view to optimal treatment results, the reconstruction of the vestibule of the mouth by means of retroauricular full-thickness skin graft constitutes a precious contribution to the therapeutical possibilities. The imperfections of split-thickness skin transplantation are avoided by this method. The procedure is recommended for cases in which it is not possible to cover, after excision of an extended lobar fibrosis, the wound surface with a graft taken from the buccal mucous membrane.


[Contribution to familial ectodermal dysplasia].

The frequent occurrence of the clinical picture of ectodermal dysplasia in the family P. is described. The differences between subjects in symptomatology are discussed in detail. The author's experience speaks well for a great variability of the hereditary mode of this disease. Furthermore, advice is given on the detection and regular ambulatory supervision by the stomatologist.


[Evaluation of Faustan (diazepam) in the premedication of ambulatory stomatologic-surgical interventions].

The author presents the results obtained with Faustan (diazepam) in the premedication of ambulatory stomatological interventions at a university clinic of stomatology. Experience was acquired in particular with intravenous premedication in a climical study involving 340 patients. The findings from this study and the experience with hundreds of ambulatory interventions in the past several years characterize Faustan, on condition of individual dosage, as a premedicant that is well suited for stomatological interventions, does not impair vital functions, increases the patients' willingness to co-operate and is of considerable anxiolytic activity. The use of Faustan is recommended for stomatological emergency situations and risk patients.


[Hyperparathyroidism].

The overproduction of parathyroid hormone as caused by a simple hyperplasia or an adenoma leads to pathological changes in various organs which are termed primary hyperparathyroidism. The blood phosphates increase in case of long-standing disturbances of the metabolism, e.g. chronic renal insufficiency. In this way and due to other causes, the production of parathyroid hormone is increased. The resultant clinical picture is termed secondary hyperparathyroidism. Both forms are associated with osseous changes also in the maxillofacial skeleton. Tertiary hyperparathyroidism may develop from secondary hyperparathyroidism if the metabolic disorder in the renal form cannot be eliminated by kidney transplantation and if the process in the parathyroid becomes independent (autonomous hyperparathyroidism). Besides these three forms, there are two others, quaternary hyperparathyroidism and quinary hyperparathyroidism, which are described.


[The use of machine punch cards and their mode of processing in the framework of studies of large groups of patients].

The authors describe the use of machine punch cards in the framework of the examination of a great group of subjects and present a processing scheme. They advocate the use of this technique in case of abundance of informations and relatively simple questions.


Some aspects of epidemiology of resurgent malaria in Turkey.

The resurgence of autochthonous Plasmodium vivax malaria in Turkey is a matter of considerable concern. Anopheles sacharovi is the important vector but other species, notably A. superpictus, may play a role in transmission. The epidemiology is discussed in terms of factors related to the mosquito, factors related to the human host and human ecology as it affects dispersal of the parasite. Although the development of insecticide resistance is grave, the present situation is mainly attributable to operational deficiencies stemming from administrative and financial constraints.


A multidisciplinary study on bancroftian filariasis in Jakarta.

A study on bancroftian filariasis in Jakarta has indicated that one person in one year could be exposed to 223,000 bites of Culex pipens fatigans and to 1,941 infective-stage larvae of Wuchereria bancrofti. Blood surveys with 20 mm3 samples revealed a microfilaria rate of 6%. Although some cases of hydrocele (4% of 272 males examined) were found, there was little evidence of severe filarial disease in either males or females. Amongst wild-caught mosquitoes only 0.3% contained infective larvae, but much higher levels of vectorial competence were established under laboratory conditions. High daily vector mortality (30%) coupled with noticeable improvements in standards of living could have been important factors preventing an increase in endemicity.


Studies into the incidence of carriers of enteropathogenic E. coli.

Enteropathogenic Escherichia coli (EPEC) is frequently found in asymptomatic carriers. When checked over a period of two and a half months at fortnightly intervals, nine out of 20 children at a child care centre in Jamaica showed EPEC of three different serotypes in faecal smears. Four stool specimens were found to be positive in another 45 children, controlled routinely on admission to a district hospital in Jamica. None of either group had diarrhoea at the time of collection. These results confirm that serotypes should not be equated with pathogenicity. Also, current methods of detecting enterotoxin are too time-consuming and impractical for non-specialized laboratories. The place of antibiotics in EPEC diarrhoea is criticized. Initial control measures should centre on fluid and electrolyte replacement irrespective of the aetiology of the diarrhoea.


Chronic malarial infection of mice: A comparison of single and multiple infections with Plasmodium berghei following P. yoelii.

Chronic malarial infection was induced in two groups of BALB/c mice by injection of Plasmodium yoelii followed by either one or repeated injections of P. berghei. Both groups showed a continuing but fluctuating splenomegaly, and a considerably increased reticulocyte count which also varied regularly, over a period of six months. During this time many mice had a very low grade parasitaemia demonstrable by subinoculation of blood into uninfected recipients. Mice infected with P. yoelii alone did not show any of these changes. One year after the first malarial attack all the infected mice had higher fluorescent antibody titres to P. yoelii than to P. berghei, titres against which were very low. Infected mice showed an increase in plasma cell proliferation in the red pulp of the spleen. There was a significant difference between mice which had received multiple injections of P. berghei and the other infected animals; the former had many germinal centres in the spleen, while the other infected groups did not.


Successful nonsibling bone marrow transplantation in severe combined immunodeficiency.

Severe combined immunodeficiency (SCID) was diagnosed in a girl immediately after birth; her older brother had SCID and was successfully reconstituted by bone marrow transplantation from his uncle. She was isolated in a laminar air flow bench and decontaminated. The father differed by one HLA-A antigen but was HLA-Dw2 homozygous like the patient; his lymphocytes showed a slight response to the patient's cells in mixed lymphocyte culture (MLC). At the age of 2 1/2 months and again at 5 months, she was given a bone marrow transplant from the father. During the entire course the patient had no infections, and apart from a transient eosinophilia she had no signs of graft-versus-host reaction. Immunological reconstitution was nearly complete at 9 months of age, when she was recontaminated. One year later plasma immunoglobulin concentrations are in the low normal range (IgG and IgM) or decreased (IgA); tests of cell-mediated immunity are normal. Apart from slight upper respiratory infections, the patient has been healthy. Physical and psychological development have been normal.


Traffic of lymphocytes in the thoracic duct and renal lymph after allotransplantation and in immunosuppression.

A marked rise is seen in the number of white blood cells in the lymph leaving the sheep kidney after allografting; the number of lymphocytes leaving the kidney rising in direct relation to the degree of damage from acute rejection. No such rise is demonstrable in the number of lymphocytes in the thoracic duct lymph of sheep with rejecting kidney allografts. Indeed, there is an apparent decrease in the number of lymphocytes in the thoracic duct lymph of sheep with rejecting kidney allografts. Indeed, there is an apparent decrease in the number of circulating lymphocytes in the body when acute rejection is fully developed. Animals on immunosuppressive regimens show no alteration in the number of lymphocytes collected on thoracic duct cannulation, but immunosuppression appears to reduce the lymphocyte traffic through the kidney.


Effect of prior parental blood transfusions on the survival of renal allografts from a DLA-identical sibling.

Renal allografting was performed between DLA-identical beagle littermates without immunosuppressive treatment. One transfusion of 200 ml of parental blood donor to induce the formation of antibodies against non-DLA antigens that might enhance renal graft survival. Kidney graft survival times of transfused dogs were compared with the survival times of transfused dogs were compared with the survival times of transfused dogs were compared with the survival times of DLA-identical nontransfused littermates. Blood transfusions did not have a significant influence on the median graft survival time. Antibodies against the kidney donor lymphocytes were not demonstrated after blood transfusion. However, antibodies were induced in three of the six animals tested as shown by the reactivity of the sera of these animals against a lymphocyte panel. Antibodies occurred in animals with long-term as well as short-term surviving grafts.


Studies on the antigenicity of vital allogeneic valve leaflet transplants in immunogenetically controlled strain combinations.

The use of defined inbred strains of rats enables reproducible experimentation on the antigenicity of heart valve leaflet transplantation. The inbred strains CAP, F344, and LEW were used as syngeneic, weakly allogeneic (RT-1-identical) and strongly allogeneic (RT-1-incompatible) strain combinations. After heart valve leaflet transplantation, humoral and cell-mediated immune responses were investigated. The results were: (1) Allogeneic heart valve leaflets are antigenic. (2) Just one heart valve leaflet, applied intravascularly induces sensitization of the recipient. (3) In the weakly allogeneic system, sensitization is only revealed by donor-specific skin transplants, while in the strongly allogeneic group, sensitization is demonstrated humorally as well. (4) The greater the immunogenetical difference, the sooner sensitization appears. In the strongly allogeneic system, skin transplants were rejected as "white grafts".


Urinary N-acetyl-beta-D-glucosaminidase assay in renal transplant recipients.

Urinary N-acetyl-beta-D-glucosaminidase (NAG) activities were measured in 181 patients with renal allografts during a 15-month period. Activities were high immediately after transplantation but decreased rapidly in the absences of complication. Urinary NAG activities increased by 50% or more in relation to 33 of 36 (92%) episodes of acute rejection diagnosed and treated by clinicians during the first 90 days after transplantation. The increase preceded clinical diagnosis in 70% of the cases, the median interval being 1.5 days. NAG activities decreased after treatment of rejection in 90% of the cases. Chronic rejection, renal vein thrombosis, renal artery stenosis, oliguria, hypotension, and the administraion of gentamicin may also cause increased NAG activity. Urinary NAG assay is simple and inexpensive, and is a useful aid to the early diagnosis of rejection of renal transplants. Results must, however, be interpreted by the clinician, bearing in mind other causes for increased activity.


Immunoglobulin production of donor origin after marrow transplantation for acute leukemia or aplastic anemia.

Four patients with acute leukemia and one with aplastic anemia were not transfused within 90 days before marrow transplantation from the HLA-identical sibling. When studied 4 to 12 1/2 months after transplantation their immunoglobulin allotypes were those of their donors.


Phonocardiographic recording of heterotopic cardiac graft function in the rat. I. Diagnosis of rejection.

Daily simultaneous recordings of an electrocardiogram and an external thorax phonocardiogram and abdominal phonocardiogram were obtained in 24 rats with abdominal heart grafts so that rejection could be studied. The sounds recorded above the heterotopic heart are the result of a pressure differential between host and graft ventricle competing with one another. As soon as the contractility of the graft ventricle decreases below the contractility of the host ventricle, characteristic and specific changes occur in the abdominal phonocardiogram: the amplitude of the first sound becomes smaller while the timing of the second heart sound (aortic valve closure) is subsequently controlled by the host ventricle. These observations coincide with clinical and histological symptoms of rejection and are, therefore, of diagnostic value. In addition, a rough quantitative record of graft function is obtained by abdominal phonocardiography using the host's own cardiac function as a reference parameter.


Effect of lipopolysaccharide on the development of cell-mediated immunity to transplantation antigens.

Lipopolysaccharide (LPS) from Escherichia coli administered to allografted mice in a single dose of 20 microgram influenced the development of cell-mediated immunity to skin donor antigens. As an indicator of cell-mediated immunity, donor antigen-induced inhibition of cell migration from spleen explants of allografted animals was used. Cultures of spleen explants were established 16 days after grafting. The antigen-specific inhibition of migration was abolished when LPS was injected either 4 to 2 days before grafting and intensified when LPS was administered on the 2nd day after grafting.


Pretransplant lymphocytotoxins do not predict bone marrow graft rejection.

Ninety multitransfused patients with severe aplastic anemia were conditioned with cyclophosphamide and given marrow transplants from HLA-identical siblings. Thirty patients had complement-dependent lymphocytotoxins against a panel of cells from unrelated individuals immediately before transplantation while 60 did not. Lymphocytotoxins were more frequent among patients who had received more blood product transfusions, and these patients were more likely to be refractory to random platelet support. Twenty-seven patients rejected the marrow transplant while 63 had sustained engraftment. The present of pretransplant lymphocytotoxins did not correlate with graft rejection and hence does not appear to be useful as a test for identification of patients at high risk of rejection.


Endothelial monocyte antigens in man.

A group of antigens expressed in endothelial cells and monocytes, but not detectable in either T or B lymphocytes, has been the object of ongoing studies. The antibodies were not removed by absorption with platelets or B lymphocytes and were readily eliminated after absorption with monocytes or endothelial cells. Stripping with rabbit anti-human beta2-microglobulin made endothelial cells or monocytes resistant to lysis by endothelial-monocyte antibodies. Thus, endothelial monocyte antigens may be associated with beta2-microglobulin and are distinct from HLA-DR in this regard. Family studies suggest that most, but not all, monocyte-specific reactions segregated in linkage with HLA.


The role of HLA-DR antigens in transplantation--survival of skin allografts in HLA-haploidentical donor-recipient combinations.

The results of 79 skin grafts performed in haploidentical donor-recipient pairs are correlated with HLA-A, -B, -C, and -DR compatibility. A strong detrimental effect of DR incompatibilities has been demonstrated. This effect is independent from that exerted by products of the HLA-A, -B, and -C loci. An additive effect of HLA-A, -B, and -DR incompatibilities on allograft survival time has been observed.


[Antisera to individual histone fractions of the calf thymus. II. A study of the immunochemical specificity of the histones by an indirect immunofluorescence method].

Immune antisera to 5 fractions (H1, H2a, H2b, H3, H4) of calf thymus histone were assayed using indirect immunofluorescence (IIF). The analysis of such sera by this technique, as well as the data on complement fixation obtained previously, show that these antisera are highly active and specific for various test-objects: thymys, liver nuclei of rat, chicken, and calf, chicken erythrocytes, metaphase chromosomes of mouse fibroblasts. These antisera are of importance for the evaluation of species- and tissue-specificity of different histone fractions. Using the IIF reaction, a comparison was made between the nucleosome fraction H3, which is evolutionary stable, and fraction HI from calf thymus, rat and chicken liver, and chicken erythrocytes.


[Calibration of the emulsion layers in quantitative electron microscopic autoradiography].

The quantitative results in electron microscope autoradiography are affected by many factors. The principal problem of this method is a low mechanization of all the operations made. This paper gives a short review of technical improvements. The use of a calibration permits to except those factors which exert their influence on the sensitivity of the method. Tritium sources were used for the determination of the sensitivity of the method.


[Analysis of the mechanism of the fixation of membrane structures using osmium tetroxide. II. An electron microscopic and x-ray structural study of myelin frozen and lyophilized at low temperature].

Comparative electron microscope and X-ray studies were made on the frog sciatic nerve myelin after freeze-drying technique. The specimens were fixed with OsO4 before and after freeze-drying. In the latter case, osmium was used as a hydrophobic solution (OsO4 in CCl4), or in the high vacuum during osmium sublimation. The results obtained in this study do not fit in the accepted mechanism operating during osmium fixation of membranes. Another mechanism is proposed by the authors, and the problem of osmium localization within the space of the myelin repeated unit is discussed.


[Polarized ultraviolet fluorescence microscopic study of the structural changes in muscle fiber contractile proteins. V. The possible nature of the conformational rearrangements in heavy meromyosin in fiber relaxation].

The mode and degree of tryptophanyl orientation relative to muscle fiber axes within hydrophobic and hydrophylic sites of myosin macromolecule in the presence of a fluorescence quencher (acrylamide, NO-3) during rigor and relaxation of glycerinated muscle fibers were studied using the polarized ultraviolet fluorescent microscopy. It was shown that myosin tryptophanyls both in LMM and HMM are oriented with their short axes along the longer axis of muscle fiber. Tryptophanyls in LMM have a more pronounced anisotropy of orientation in comparison with the fluorophore orientation anisotropy in hydrophobic sites of HMM. During the muscle fiber relaxation, conformational changes in HMM take place owing to which a section of polypeptide chain with a hydrophilic fluorophore is probably submerged deep into the macromolecule and becomes unapprochable to the quencher.


Immunology and male infertility.

This article has attempted to review evidence that suggests that immune factors may be operative in a small but significant number of infertile men. Although our current understanding of the possible processes by which autosensitization to previously sequestered reproductive antigens occurs is incomplete, there are laboratory assays presently available that give an indication, but do not prove, that immune factors may be contributing to the infertile state. Continued research is needed to develop new assays and more purified sperm antigens, which might enhance our knowledge of the underlying immunoreproductive changes. Until these are available, the following procedures should be considered when investigating a patient with infertility of suspected immune origin. The patient's history should be taken, and a physical examination should be performed. A complete blood count, urinalysis, and complete semen analysis and culture should be taken. Next, in vivo cervical tests (Sims-Huhner) are performed, followed by sperm antibody assessment (serum, semen) and perhaps in vitro cervical mucus sperm assays (especially the crossed hostility test). After the tests have been completed, the following possibe treatments exist: 1. Treatment of underlying infections 2. Correction of obstructions 3. Corticosteroid (or testosterone?) therapy 4. Washed sperm insemination 5. First portion of fresh ejaculate insemination 6. Artificial insemination with homologous donor 7. Adoption.


Medical treatment of the subfertile male.

Specific and effective medical treatment is available for some subfertile males. Reproductive physiology should be reviewed with all patients and exposure to drugs and toxins known to impair testicular or accessory sex gland function should be terminated. Appropriate treatment of retrograde ejaculation, chronic infections of the genital tract, or gonadotropin deficiency is indicated. Accurate diagnosis and treatment of the impotent patient may restore potency and fertility. Pregnancies have been achieved in association with each of the empirical regimens; however, we believe that each must be viewed as experimental at this time, since results may be no better than those observed in the absence of treatment. It is our experience that patients with elevated serum levels of FSH, peritubular fibrosis, and hyalinization are unlikely to achieve fertility regardless of treatment; however, there are exceptions. As our knowledge of basic reproductive biology and clinical pathology increases, it is hoped that better guidelines and more rational and effective medical treatment for the subfertile male will evolve.


Vasovasostomy.

As vasectomy continues in popularity, requests for restoration of fertility increase in number. Anastomosis of the vas deferens is a demanding, technically difficult operation. The principles governing it are different from those of other anastomoses in the body. The suitably equipped surgeon can expect, with practice, to achieve a pregnancy rate of 50% or better for his patient's wife. The operation can easily be performed under local anesthesia in either an office or hospital operating room. Hospitalization is unnecessary, and merely adds unnecessary expense. Disability is minimal, and discomfort minor. The technique of Belker is recommended for practice, since it permits one to inspect the anastomosis from within afterwards.


[Combined drug treatment of far-advanced forms of breast cancer].

Seventy patients with breast cancer (stage IIIb--IV) were randomized by an "envelope" method into 2 groups, each including 35 persons. Patients of the first group were injected vincristin, 5-fluoruracil, methotrexate (once a week), cyclophosphane (3 times a week) and prednisolone daily during 3 weeks. The duration of the course of treatment was 4 weeks. The therapy course was repeated with an interval of 1--2 months. Patients of the second group in addition to the analogous treatment were subjected to ovariectomy with subsequent continuous administration of prednisolone, testosterone-propionate or synoestrol. An objective effect was noted in 24 patients of the first group (71.4%), the complete remission being gained in 4 of them. An average duration of the remission--7.6 months. An objective effect was noted in 31 patients of the second group (88.5%), the complete remission--in 4 of them. An average duration of the remission--10.7 months. Primary mammary tumors and metastases in regional lymph nodes proved to be mostly susceptible to the conducted therapy. Lung and pleural metastases were found to be less susceptible. No grave complications due to this kind of treatment were noted.


[Clinical trial of the preparation clofazolin used intravenously].

The authors studied the hypotensive effect of the Bulgarian preparation Chlophazolin in ampoules of 0,15 mg, administered i. v. The study covered 50 patients, 44 of them with hypertonic disease II and III stage and the rest (6)--with renal and renovasal hypertension. The i. v. administration of chlophazolin was established to have a marked hypotensive effect and be expedient for the treatment of hypertonic crises and hypertension with high values. In a dose of 0,15 mg i. v. the preparation leads to a sharp decrease in the first 20 min, whereas during the following hours it is kept to lower values: systolic pressure-an average decrease of 30-40 mm Hb in a lying position, to 45-50 mm Hg in an erect position; the diastolic pressure-an average decrease of 10-15 mm Hg in a lying position to 20-25 mm Hg in an erect position. The hypotensive effect is better manifested in higher initial values of the pressure. It lasts approximately more than 13 hours but in 1/5 of the patients, with higher values of blood pressure, its effect is exhausted within 6-8 hours. Side effects of the preparation were registered in 26 per cent of the cases; orthostatic disturbances, sleepiness, dryness of the mouth, nausea. I. v. administration of chlopazolin does not change the excretion of urea and creatinine, diuresis and serum levels of sodium, potassium and chlorine.


[Dynamic study of the hypothalomo-hypophyseal-gonadal axis in patients with Klinefelter's syndrome].

Detailed clinical and hormonal studies were performed in 30 male patients with Klinefelter syndrome, proved by karyotyping. Diagnostic tests with LH-RH were carried out with application of 100 microgram of LH-RH as single stimulation and as long-term application for 7 days. Plasma levels of LH, FSH and testosterone were measured by specific radioimmunoassay. Th single LH-RG application stimulated both LH and FST secretion, while testosterone level remained unchanged in patients with Klinefelter syndrome. Long-term stimulation decreased basal LH and FSH levels and pituitary response to LH-RH . became close to normal. The testosterone level increased significantly in most patients with Klinefelter syndrome. This suggests that the Leydig cells in Klinefelter syndrome improved their activity, showing some functional reserve.