Correlations of immunologic markers with histologic features of human non-Hodgkin's lymphomas.

Twenty-five lymph nodes from patients with non-Hodgkin's lymohomas were evaluated by immunologic technics applied to cell suspensions and tissue sections. Malignant lymphomas with cytologic characteristics similar to those of neoplastic cells were found to be immunologically heterogeneous. The distribution as well as the number of neoplastic cells with distinctive immunologic surface markers could not be related to the cytologic type of malignant lymphomas. The number of malignant cells simultaneously expressing the T- and B-cell markers was increased in malignant lymphoma nodes. Cells positive for the triple markers (Ig+, EAC+, T+, where Ig = immunoglobulin, EAC = erythrocytes sensitized with antibody and complement, and T = T marker) represented the predominant population in these nodes, and the distributions of these cells were useful in diagnosis. Monoclonal immunoglobulins were detected in all lymphoma cells but not in the patients' sera. The tissue distribution of EAC-positive cells may have a prognostic significance. The paucity of cells with the Fc receptors was a characteristic feature of all lymphoma cells studied. Evaluations  of immunologic markers on lymphoma cells in conjunction with the histologic characteristics may provide a sounder basis for diagnosis.


Pituitary microadenoma and primary lymphoma of brain associated with hypothalamic invasion.

A case of primary histiocytic lymphoma involving the left temporal lobe and hypothalamus is presented. This lesion was associated with a pituitary microadenoma shown immunohistochemically to contain prolactin and with lactational changes in the breasts. The interruption by the neoplasm of neural pathways from cells producing prolactin inhibitory factor in the hypothalamus and increased production of prolactin by the pituitary are suggested as the probable mechanism. The association of lactational changes in the breasts with primary lymphoma of the brain has not been reported.


Algorithm-derived, computer-generated interpretive comments in the reporting of laboratory tests.

The volume of laboratory and other data that physicians encounter daily is more than most can mentally process without oversight or error. Routine use of computer-generated reminders is one solution to this problem that is now widely suggested. We report our experience with the daily use of a user-written program of algorithm-derived, computer-generated comments in the reporting of chemical profiles and routine thyroid function tests in a busy medium-sized privately owned independent clinical laboratory.


Small-colony forms of enteric bacteria after exposure to aminoglycosides.

Small colony forms of enteric bacteria were isolated in vitro after exposure of near-lethal amounts of aminoglycosides. These small-colony forms were several times more resistant to all aminoglycosides than the parent clones. A small form of Escherichia coli was isolated directly from a clinical specimen, along with a more sensitive larger colony.


Late deoxyribonuclease activity of Salmonell enteritidis.

As a result of chance observations, the authors studied for deoxyribonuclease activity 16 strains of Salmonella, including six fresh isolates and ten stock cultures, with positive results in 13. Reactions characteristically occurred at 48 hours or later, with the majority being manifest at 72 hours and the latest at six days. No other positive reaction was observed among approximately 7,000 Enterobacteriaceae tested, except for Serratia species and Proteus vulgaris. Deoxyribonuclease screening plates for Serratia should be read at 24 hours, and positive results encountered after that time should be interpreted with caution to ensure that H2S-negative strains of Salmonella will not be confused with other genera of Enterobacteriaceae.


Fluorescent Vi antibody test in the screening of typhoid carriers.

The comparative efficacies of direct bacterial agglutination and immunofluorescent antibody for the estimation of serum Vi antibody were determined in the detection of typhoid carriers. Sera from all 12 typhoid carriers gave significant titers of 1/10 or more in the direct bacterial agglutination test; however, 26 of 119 (21.8%) sera from culture-negative individuals were also falsely positive. In the fluorescent Vi antibody test, 11 of 12 typhoid carriers showed significant serum antibody levels, while only two of 119 (1.7%) culture-negative subjects had significant antibody titers. In view of the much lower false-positive rate, the immunofluorescent Vi antibody test is considered to be superior to the direct bacterial agglutination test in the screening of typhoid carriers.


Congress (and evaluators) ought to pay more attention to history.

In 1935, in 1965, and in 1972, the original Social Security Act and amendments to it were used by states to deinstitutionalize. In each instance a private, profit-making nursing home and board and care industry was stimulated. Poor care in such facilities was an unintended consequence of the legislation. Neither the Congress nor evaluators have clear concepts of what constitutes a life of decency and dignity for the chronically dependent. Behaviorally oriented social scientists and legislators have in common the difficulty of dealing with soft variables such as decency and dignity. In the absence of clear goals, care drifts below a lower threshold of acceptability and is corrected to some extent following public scandal. Social scientists need to learn to develop concepts and measurements suitable to monitoring the implementation of humane ideals.


Disseminated intravascular coagulation and related syndromes: etiology, pathophysiology, diagnosis, and management.

Disseminated intravascular coagulation (DIC) is being recognized with increased frequency and not only are newer diagnostic modalities becoming available for this syndrome, but newer, some controversial, methods of management are also being recognized and may prove to increase survival in DIC. In addition, several syndromes classically considered separate, definitive disease entities, may actually share similar or identical pathophysiology to DIC. This review summarized current, as well as controversial aspects of etiology, pathophysiology, clinical and laboratory diagnosis, and management of DIC. In addition, a brief discussion of syndromes which may share similar or identical pathophysiology to DIC is included.


A simplified [3H] serotonin release assay for the detection of platelet antibodies.

The [3H] platelet serotonin release assay is a sensitive means for detecting antiplatelet antibodies. We have found that by using prelabeled frozen platelets which have been treated with the cryoprotective agent dimethyl sulfoxide (DMSO) the performance of this assay can be facilitated without interfering with its sensitivity. There was 100% correlation between the standard [3H] platelet serotonin release assay using fresh platelets and the modified assay using prelabeled, frozen, cryopreserved platelets when sera from 12 patients with known antiplatelet antibodies were tested. When normal serum samples (n = 111) were tested against ten platelet donors, a false-positive rate of 3.9% was observed. This modification provides a simple means for quickly screening large numbers of potential platelet donors at one time.


Emil Heitz and the concept of heterochromatin: longitudinal chromosome differentiation was recognized fifty years ago.

The work of Emil Heitz (1892--1965) laid one of the keystones of cytogenetics. Using a new in situ method, he established between 1928 and 1935 the longitudinal differentiation of chromosomes in euchromatin (genetically active) and heterochromatin (genetically inert). He recognized the association of satellited chromosomes with the formation of the nucleolus, co-discovered the giant salivary chromosomes of diptera, and arrived at a cytological and genetic concept of chromosome structure that has been found essentially correct to date. Yet, Emil Heitz did not gain due recognition by his contemporaries, suffered from the political disturbances of his time, and spent almost a lifetime in isolation, bolstered only by the conviction that his scientific work was significant.


The biochemical genetics of the hexosaminidase system in man.

Tay-Sachs disease and related GM2 ganglioside storage disorders result from the absence of one form of hexosaminidase, HEX A. The persistence of a second major hexosaminidase isozyme, HEX B, does not protect against the lethal accumulation of GM2 ganglioside in the central nervous system. Using immunologic and biochemical techniques, it has been demonstrated that the two major isozymes of hexosaminidase, HEX A and HEX B, share a common subunit, the structure of HEX A being designated (alpha beta)n and the structure of HEX B being designated as (beta2)n. The minor isozyme, HEX S, is an alpha chain homopolymer designated (alpha2)n, and HEX C seems unrelated to the HEX A, B, S system. The structures of other minor isozymes have not been totally resolved, but HEX I1, I2, and P (which may be identical to I2) appear to represent forms of HEX B.


Drug therapy reviews: antirheumatic agents.

The pathophysiology, symptoms and drug treatment of rheumatic disease are reviewed. Antirheumatic drugs reviewed are salicylates (including aspirin, sodium salicylate, choline salicylate, choline magnesium salicylate, salsalate), phenylpropionic acid derivatives (fenoprofen, ibuprofen, naproxen), indole derivatives (sulindac, tolmetin and indomethacin), pyrazolone derivatives (phenylbutazone, oxyphenbutazone), gold compounds, penicillamine, antimalarials mefenamic acid, corticosteroids and immunosuppressives. Simple analgesic therapy (acetaminophen, aspirin, propoxyphene) is used in the early stage of the disease. As the disease progresses, aspirin remains the drug of choice for antiinflammatory activity but the phenylpropionic acid or indole derivatives may be preferred in patients unable to tolerate salicylates. If such nonsteroidal antiinflammatory agents are not effective, parenteral therapy with gold compounds or oral penicillamine usually is indicated. Indomethacin or phenylbutazone, then antimalarials, are resorted to next. Corticosteroids or immunosuppressives are reserved for patients who are unsuccessfully controlled or who have major side effects with the other drugs. Mefenamic acid occupies a very secondary place in rheumatoid arthritis treatment.


An evaluation of diabetic and pseudodiabetic glomerulosclerosis.

Diabetic glomerulosclerosis must be either a primary manifestation or a secondary consequence of the metabolic abnormalities of diabetes. Several earlier reports have attempted to support the former hypothesis by describing cases of pathognomonic renal lesions in nondiabetic subjects; however, the clinical and pathologic data in these reports are inconclusive. We have reviewed our experience at the University of Virginia Hospital with 447 percutaneous renal biopsies performed over a period of four years from July 1973 through July 1977. Of these cases, only two appeared to represent diabetic glomerulosclerosis occurring in nondiabetic subjects. Upon further investigation, one case provided to be light chain disease demonstrated by immunofluorescence staining. The other case, on repeat renal biopsy, proved to be membranoproliferative glomerulonephritis. We conclude that a diagnosis of diabetic glomerulosclerosis must be viewed with suspicion in nondiabetic subjects. Suspected cases should be labeled pseudodiabetic glomerulosclerosis and investigated further.


Mucocutaneous candidiasis and thymoma.

The clinical, pathologic and immunologic features of 27 patients with chronic mucocutaneous candidiasis and thymic tumors are reviewed. This form of chronic candidiasis is unique in that the infections do not occur until after the third decade and, in contrast to patients in whom candidiasis develops during infancy or childhood, it is not accompanied by failure of endocrine organs. Instead, the patients have the disorders that often accompany thymoma, such as myasthenia gravis, hypogammaglobulinemia, and abnormalities of the bone marrow and circulating blood elements. Evidence of impaired cell-mediated immunity was found in 16 of the 21 patients in whom studies were made. The pathogenesis of the immunodeficiency in these patients is unknown. Immunosuppressive activities in the plasma of four patients were found, but none of the five patients in whom the appropriate studies were made was found to have suppressor cells. The features of this disorder are unique enough that it should be considered a syndrome, and patients in whom candidiasis develops during their adult years should be studied for the presence of thymoma.


Optimum dosage of an oral contraceptive. A report from the study of seven combinations of norgestimate and ethinyl estradiol.

A statistically designed study was carried out to determine an optimum combination of norgestimate and ethinyl estradiol as an oral contraceptive, based on efficacy, safety, and side-effect patterns. A total of 1,991 patients were studied for more than two years while they were receiving various dosage combinations of these steroids. There were seven dosage combinations studied as part of a statistically orthogonal experimental design, augmented by three combinations near the center. The data arising from these studies were used to fit approximate functions relating the amount of norgestimate and ethinyl estradiol to the rate of spotting and breakthrough bleeding, gastrointestinal disturbance, and pregnancies. These functions, in turn, helped to identify an optimum dosage (0.125 mg. of norgestimate plus 0.035 mg. of ethinyl estradiol) in the entire range of combinations studied.


Effect of dexamethasone on gonadotropin responsiveness to luteinizing hormone-releasing hormone and clomiphene in women with secondary amenorrhea.

We have studied the effects of administration of dexamethasone, 2 mg orally every 6 hours, for 5 days on the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) induced by luteinizing hormone-releasing hormone (LHRH) in six women with secondary amenorrhea and on the release of these gonadotropins induced by clomiphene citrate in 10 women with secondary amenorrhea. Dexamethasone suppressed baseline serum levels of LH and FSH and blunted the LHRH-induced release of LH and FSH in six women. Following dexamethasone administration, the LH and FSH response to clomiphene citrate, which competes for gonadal steroid receptor binding sites in the hypothalamus, resulting in increased release of LHRH, was blunted in the 10 women studied. The data indicate that short-term administration of pharmacologic doses of glucocorticoids suppresses the secretion of LH and FSH by a direct effect on the anterior pituitary and possibly by an effect at the suprahypophyseal level with inhibition of release of LHRH.


The impact of hospitalization on the aerobic fecal microflora.

Quantitative bacteriological analysis of the aerobic fecal microflora of 75 patients indicated that, at the time of admission to hospital, Escherichia coli were the predominant fecal aerotolerant bacteria. Subsequent fecal samples showed a progressive supplantation of E coli by Klebsiella, Enterobacter and Proteus. At the end of 21 days of hospitalization, E coli remained predominant in only 30 patients. None of the patients had received antibiotics, undergone surgery or been subjected to x-ray studies of the gastrointestinal tract. The cause of the change of fecal flora in these patients is unknown, and no change of flora was observed in a control group of nonhospitalized persons, also studied for 21 days. The appearance of Klebsiella, Enterobacter and Proteus as predominant in the fecal flora of hospitalized patients may be an important factor in the natural history of hospital-associated infections.


The efficacy of prophylactic antibiotics in cesarean section.

The objective of this investigation was to determine the effectiveness of cefazolin-cephalothin administration as a prophylactic regime in patients undergoing cesarean section. The study was to randomized, double-blind, placebo-controlled investigation. Cefazolin, 1.0 gm or placebo was administered intramuscularly on call to the operating room, and cephalothin, 2.0 gm, or placebo was administered intravenously at 6, 12, and 24 hours postoperatively. Ninety-five patients were included in the study with 49 in the placebo group and 46 in the drug group. Nineteen patients developed 28 infections in the placebo group while eight patients developed eight infections in the drug group (P = less than 0.05). Eight patients in the placebo group developed infections at two or more sites whereas no patient in the drug-treated group developed multiple infections. No infant developed infection and no overgrowth of bacteria occurred. This study supports the concept of preoperative antibiotic administration being beneficial to the obstetric patient.


The use of exchange transfusions: a potentially useful adjunct in the treatment of fulminant falciparum malaria.

Fulminant falciparum malaria with greater than 500,000/mm3 parasites in the peripheral blood portends a poor prognosis. We recently managed a patient who had greater than 1.2 million/mm3 parasitized erythrocytes in her peripheral blood, following initially inadequate antimalarial therapy, with exchange transfusion in addition to conventional chemotherapy. This patient recovered from her disease despite severe cerebral involvement and acute failure. We feel that exchange transfusion was a useful adjunct and should be considered in patients with life threatening falciparum malaria when conventional measures fail to control the disease.


Abnormalities among offspring of oral and nonoral contraceptive users.

An analysis of 223 children born between 1961 and 1965 to 5,465 women in a controlled experiment at the University of Puerto Rico School of Medicine, regarding the use of oral and nonoral contraceptives, failed to reveal any statistical differences in birth weight and physical abnormalities between the two contraceptive groups. The mean birth weight for the oral group was 7 pounds, 4.1 ounces, whereas for the nonoral group it was 7 pounds, 5.4 ounces. Abnormal physical findings were 10.7% for the oral group and 16.7% for the nonoral group. A comparison is also made between the two groups with respect to incidence of abnormalities by socioeconomic class and by sex of the child, as well as by the number of pregnancies and age of the mother. No significant differences were noted between the groups as an indication of the effect of oral contraceptives.


An evaluation of enucleation in the management of uveal melanomas.

Uveal melanomas are slow growing tumors that may infiltrate out of the eye, mainly following ciliary vessels or nerves, or invade blood vessels, but only rarely do they produce metastatic disease before discovery and treatment. There are, however, large gaps in our knowledge of the frequency and rate of growth of small tumors to those of moderate or large size. We have estimated the mortality from untreated uveal melanomas to be 1% per year or less. Almost all information concerning prognostic factors has been gained from studies based on cases treated by enucleation. The same information is not necessarily applicable to untreated tumors. A study of deaths from metastatic uveal melanomas reveals a striking relationship to enucleation, regardless of whether one deals with cases in which the eye had been symptomatic for a long or short time. Following a low preoperative mortality of 1% or less, the annual mortality rises to about 4% during the first year and then peaks at 8 to 12% during the second year, tapering off during the next three to five years to return to a remarkably constant level of 1 to  2% thereafter. We postulated that this relationship of peak mortality to enucleation is attributable mainly to an often overwhelming dissemination of tumor cells taking place during surgery or to a lowering of the host's immunologic defense mechanisms as a consequence of the operation, or both. We urge the pooling of all available information gained from clinical studies made on untreated tumors and recommend prospective studies of a variety of other methods of treating uveal melanomas in addition to the standard enucleation.


Reconstruction of the medial eyelid.

We used a free tarsal-conjunctival grate from the upper eyelid and a nasal-based pedicle skin-muscle flap for reconstruction of the medial aspect of the lower eyelid. This had the advantage of confining the reconstruction to the local area and eliminated the need for a temporal flap or an eyelid sharing procedure that necessitates occluding the fissure for several weeks.


Effect of bilateral and unilateral grafts on the incidence of rejections in keratoconus.

We studied results of 124 keratoplasties in 100 keratoconus patients; 61 men and 39 women varying in ages from 11 to 69 years with an average age of 30 years. Twenty-four patients had bilateral grafts with a 27% incidence of rejection, and 76 patients had unilateral grafts with a 13% incidence of rejection (P less than .01). Data analysis of the first year after the graft of first eyes and subsequent years after the graft of first and second eyes, however, revealed a nearly fourfold increase of rejections following second grafts, with a 17% increased chance of rejection for the first graft after the second was implanted. Only two of the bilateral and two of the unilateral grafts were irreversibly lost because of graft reaction. The major complication was the formation of posterior subcapsular cataract, which occurred in approximately 32% of the patients. The final postkeratoplasty visual acuities were significantly improved. In the patients who did not develop a cataract, 86% achieved visual acuity of 6/12 (20/40) or better. In the patients who did develop cataracts, 68% achieved visual acuity of 6/12 (20/40) or better.


Virus-simulating structures in the optic nerve head in Creutzfeldt-Jakob disease.

A 68-year-old man was treated for and died of Creutzfeldt-Jakob disease. At autopsy we found multiple virus-like particles in the optic nerve head, but saw no similar structures in the cornea. Although these particles were morphologically similar to those previously reported in brain, we believe that they are not virions but unrelated cellular structures. We speculate that the causative agents may be naked membrane bound nucleic acids rather than true viruses. We found no optic atrophy or other specific pathologic changes in the eyes; severe occipital cortical degeneration was responsible for the patient's visual loss.


Review of the literature on intraocular lenses 1976--1977.

This paper reviews the advantages, indications, and contraindications of intraocular lenses. The common complications of cystoid macular edema, endothelial corneal dystrophy, and pseudophakic pupillary block glaucoma are discussed. Advantages of inserting the intraocular lens some time after the cataract extraction are enumerated.


Enamel decalcification in orthodontic treatment.

One hundred twenty previously extracted premolar teeth were used in this study. Teeth were divided into five groups of twenty-four each. The first group was treated with Copalite, the second with Portrait Veneer, the third with a polymeric adhesive coating material (Protecto), the fourth group with Nuva-Seal, and the fifth group served as a control. Orthodontic bands were selected and cemented to each tooth. The cement seal was then broken and teeth were thermocycled to simulate an in vivo condition. All teeth were then submerged in a decalcifying gelatin for 21 weeks. Every group was further broken into three equal subdivisions. Division A was to be submerged for 7 weeks, Division B in each group was to be submerged for 14 weeks, and Division C was to be submerged for 21 weeks. At each time interval, teeth were cleaned and examined for decalcification. Data were recorded and analyzed by means of the chi-square test. It was found that acid-etching materials protect the teeth against decalcification best. Among the acid-etching materials used, Nuva-Seal proved to be the best at protecting the teeth against decalcification for 21 weeks with this experimental design.


Bioblock therapy.

An orthopedic treatment philosophy has been presented. Attention is drawn to the fact that the facial bones of both experimental animals and human beings respond extensively to physiologic and pathologic forces, and it is suggested that these could be mimicked to advantage. A system of appliances designed to achieve this is described. Some case reports which appear to show induced skeletal change are presented, but it will be some time before the real contribution of bioblock therapy can be assessed scientifically. Meanwhile, we should perhaps look more closely at our patients' faces and consider treating them at an earlier age.


Direct bonding to porcelain: an in vitro study.

Three different force strengths were tested to investigate the effect of Fusion in direct bonding of brackets to porcelain. The resistance values of shear, tensile, and rotation strength forces are acceptable in the range of forces commonly used in orthodontics. The mean shear strength had greater resistance values to breaking than two other groups. The roughness of glazed porcelain and the fit of brackets to contoured porcelain teeth seems to be of great importance in the bonding effects. The role of Fusion in direct bonding is comparable to that of other sealants which are commonly being used in direct-bonding systems. It is claimed that Fusion creates a chemical bond with acrylic or composite resins to porcelain. The technique could be summarized as follows: (1) Glaze is removed in the area which is supposed to be bonded directly. (2) Fusion is applied over the roughened surface. (3) Acrylic or composite resin is mixed and applied on the mesh part of brackets. (4) The bracket is pressed against the porcelain teeth by moderate pressure until final polymerization.


Studies on experimental pulmonary granulomas. I. Detection of lymphokines in granulomatous lesions.

Granulomatous reactions were immunologically induced in guinea pigs by several procedures, including intravenous injections of Bacille Calmette Gúerin (BCG) into animals immunized with complete Freund's Adjuvant and an intravenous injection of agarose beads linked to a specific antigen (dinitrophenylated bovine serum albumin) into immune animals. The tissue extracts obtained from lungs at various stages of granuloma formation were examined for macrophage migration inhibition (MIF) activity. The activity was found in a high incidence during the early stages of the granulomatous response. In contrast, MIF activity could be detected only rarely in granulomatous spleens and not in granulomatous livers. Chemotactic factor activity and mitogenic factor activity were only sporadically detectable. The MIF activity was associated with fractions showing chemical heterogeneity. One fraction was physicochemically indistinguishable from conventional lymphocyte-derived MIF; the other was a substance of large molecular weight. These results demonstrate the presence of biologically active mediators in immune granulomas, which may be related to early events involved in the induction or enhancement of such reactions.


Induction of diabetes in animals by parenteral administration of ferric nitrilotriacetate. A model of experimental hemochromatosis.

Rats and rabbits parenterally treated with a large daily dose of ferric nitrilotriacetate manifested diabetic symptoms such as hypergycemia, glycosuria, ketonemia, and ketonuria after approximately 60 days fo treatment. The blood insulin response to oral glucose loading was poor. Heavy iron deposits were found in liver parenchymal cells and in pancreatic exocrine cells, although some iron was deposited in the macrophages and reticuloendothelial cells of the organs. Faint iron staining was found in some pancreatic islet cells, with a reduction in beta granules and weak zinc staining. Cirrhotic liver changes and skin pigment deposition were not observed. Repeated blood withdrawals from ferric-nitrilotriacetate-treated animals resulted in disappearance of hypergycmia, glycosuria, ketonemia, and ketonuria; disappearance of iron from the liver and pancreas; and restoration of islet beta granules to the control level.


Location of brown recluse venom attachment sites on human erythrocytes by the firritin-labeled antibody technique.

Brown recluse spider (loxosceles reclusa) venom has been demonstrated by a ferritin-labeled antibody technique to attach to human erythrocyte cell membranes. The number of individual attachment sites per cell is proportional to the concentration of the venom used to sensitize the erythrocytes. Structural changes in the red cell membrane are associated with the venom attachment. These sites may be related to the red cell hemolysis which sometimes occurs in the human as a result of the spider bite.


Symptom formations and character changes due to upheavals of war: examples from Cyprus.

This article offers a review of the psychoanalytic and psychiatric literature on symptom formation and individual and collective character changes triggered by war or by similarly violent civil upheaval. It is suggested that each such event should be studied by itself since many different circumstances can bring man to acts of aggression. The effects of the war on Cyprus, where group narcissism developed to compensate for hurt, constitute a case example of such focused study.


The enzyme-linked immunosorbent assay (ELISA) for the immunodiagnosis of schistosomiasis.

The enzyme-linked immunosorbent assay (ELISA) done with soluble egg antigens (SEA) of Schistosoma mansoni was utilized for the detection of infections with schistosomes. The method readily detected experimental infections in NIH outbred, New Zealand black, and New Zealand white mice by 6-10 weeks post-exposure to S. mansoni cercariae. In addition, the test was negative when the sera from 11 Puerto Rican normal controls were examined and was positive in 8 of 10 serum samples from humans with schistosomiasis mansoni. However, extensive cross-reactivity was seen when using serum from humans with fascioliasis, trichinosis, cysticercosis, and echinococcosis. Thus the ELISA test done with SEA as antigen lacks immunologic specificity. For the method to be an effective seroepidemiological tool in areas where these parasites are endemic further purification of the antigen and more extensive understanding of its components are needed.


Class specific antibodies and fluorescent staining patterns in acute and chronic forms of schistosomiasis mansoni.

Sera from 40 patients with acute (10) and chronic (30) forms of schistosomiasis mansoni were studied in order to correlate class specific circulating antibodies with fluorescent patterns developed in sections of both worms and liver granulomata. At the acute stage of the infection, IgA antibodies were present, IgM titers were high (about 10 times those found in the chronic stage), and IgG, IgM, IgA, and IgE antibodies were shown by focal fluorescent staining of worms and granulomata. At the chronic stage, IgA antibodies were absent and IgG antibodies showed mostly a diffuse staining pattern in both kinds of sections. The relevance of these observations to diagnosis in clinical cases or epidemiological surveys is discussed.


A comparison of the complement fixation, indirect fluorescent antibody, and microagglutination tests for the serological diagnosis of rickettsial diseases.

Three techniques for the serological diagnosis of Rocky Mountain spotted fever were compared by testing 417 sera from 178 patients who very probably did not have rickettsial infections and 88 sera from 41 patients who very probably had Rocky Mountain spotted fever (SF). The techniques were complement fixation (CF), indirect fluorescent antibody (IFA), and microagglutination (MA). To avoid possible degradation during unnecessary purification, the antigens were prepared by methods that were as simple as possible. In the CF tests of 417 sera from patients with nonrickettsial diseases there was only one titer of 8 and none at higher dilutions, whereas with the IFA and MA tests 4-8% of the sera reacted with SF antigens and 4-20% reacted with murine typhus (MT) antigens; the evidence indicated that these reactions were not caused by specific rickettsial antibody. With the SF sera, it could be seen that the IFA test was the most sensitive and the MA test was the least sensitive at each interval after infection. Moreover, the IFA results showed the least number of confusing cross-reactions with MT antigens and the MA test showed the most. The relative advantages of the three tests in serodiagnosis of rickettsial diseases are discussed.


Therapeutic use of exchange transfusion in malaria.

In the case reported here, a patient with severe Plasmodium falciparum infection with 20% of erythrocytes parasitized was cured by exchange transfusion in conjunction with classical drug therapy.


Comparative efficacy of prophylactic cephalothin and cefamandole for elective colon surgery: results of a prospective, randomized, double-blind study.

Thirty-four patients undergoing elective colon resection or anastomosis received either intravenous cephalothin or cefamandole prophylactically and were observed for evidence of intraabdominal or wound infection, or both, postoperatively. The infection rates were 31 and 33 per cent, respectively. Infections were caused predominantly by cephalosporin resistant aerobes and anaerobes. All four bacteremias were caused by members of the B. fragilis group. The overall infection rate (32 per cent) and the frequency of anaerobic bacteremia (12 per cent) observed in this study were much higher than previously reported after cephalosporin prophylaxis for colorectal surgery.


Changes in the pathogenesis and detection of intrahepatic abscess.

A comparison of two distinct 11 year time periods at our institution demonstrated a change not only in the cause of intrahepatic abscess but also in the procedures used to diagnose this condition. Significant improvement in the methods of detection of intrahepatic abscess permits earlier diagnosis and therapy and thus a significantly improved prognosis.


Obturator foramen bypass in the management of infected vascular prostheses.

Seven patients with infected vascular prostheses in the femoral region were treated by removal of the prosthesis and extraanatomic reconstruction by way of the obturator foramen. Because the operation avoided entry into the infected area, it was considered the best surgical treatment for these patients. Although catastrophic hemorrhage and systemic sepsis were averted, amputation was eventually necessary in five patients, usually because of severe arteriosclerotic disease in distal arteries. Short-term benefit was gained by only two patients. The prevention of infection demands intensive preoperative preparation using prophylactic antibiotics and meticulous operating room technic.


Use of an autogenous hypogastric artery patch graft for living related donor kidneys with multiple renal arteries.

A kidney with triple renal arteries was removed from an HLA identical donor and transplanted to her brother using the donor hypogastric artery as an autogenous graft. The kidney was preserved by hypothermic, hyperkalemic, hyperosmolar washout solution while the three separate renal artery-hypogastric artery autograft anastomoses were being performed in an ex vivo position. Subsequently, the end to side autogenous hypogastric artery patch graft to external iliac artery anastomosis was completed. Prompt renal function occurred and after 18 months the serum creatinine level remained unchanged.


Disseminated histoplasmosis in renal transplant recipients.

Five cases of disseminated histoplasmosis complicating renal transplantation are reported. Nine previously reported cases from the literature are reviewed. In this setting disseminated histoplasmosis usually presents as a nonspecific systemic febrile illness that may be fulminant or more subacute. Five of 14 patients presented with skin lesions; only one patient presented with primary pulmonary symptoms of cough and dyspnea. Three of our patients and three others previously reported on survived the infection and maintained good function in the transplanted kidney despite prolonged therapy with amphotericin B. Immunosuppression was the only predisposing factor that could be identified with certainty in the five patients reported on herein. However, in two of the five patients the onset of disseminated histoplasmosis coincided with a well documented cytomegalovirus infection; the viral infection may have been a factor predisposing to infection in these two cases.


Microbial colonization of indwelling central venous catheters: statistical evaluation of potential contaminating factors.

A prospective study of 390 indwelling central venous catheters placed by way of the subclavian route identified bacteremia and tracheostomy as the only significant variables associated with the colonization of the catheters by pathogenic microorganisms. Catheter-related sepsis was likely in only 3 of 33 episodes of proved bacteremia. Detailed statistical analyses of other potential contaminating factors revealed no significant correlations.


Intraperitoneal povidone-iodine in experimental canine and murine peritonitis.

In dogs with appendicitis-peritonitis, intraperitoneal povidone-iodine caused death more rapidly than the instillation of saline solution. The bacterial content of canine peritoneal fluid increased with time. Although fewer bacteria were found in fluid from povidone-iodine-treated dogs, the differences were not statistically significant. Qualitative chemical analysis of peritoneal fluid revealed iodide, but not free iodine, 15 to 30 minutes after instillation of povidone-iodine. Iodine was present in the peritoneum at 2 hours but not at 3 or 6 hours. The antibacterial effect of povidone-iodine was demonstrated in mice challenged intraperitoneally with lethal doses of Escherichia coli. Povidone-iodine diminished mortality when injected immediately (p less than 0.005) but not when given 1 to 3 hours later. Immediate injection of povidone-iodine into mice lowered the number of E. coli by 3 logs. Injection of povidone-iodine 3 hours after bacterial challenge lowered the number of E. coli by only 1/3 log. This lesser bactericidal effect in mice is attributed to greater dispersal and sequestration of bacteria throughout the peritoneal cavity with time and with inactivation of povidone-iodine by reduction to iodide in vivo. In dogs with appendicitis-peritonitis, the more rapid death after treatment with povidone-iodine was not associated with differences in peritoneal microflora but with peritoneal absorption of excessive amounts of iodide.


Surgical therapy for venous stasis: results of a modified Linton operation.

Bipedicled flaps in the natural skin lines permit ligation of offending perforating and communicating veins of the postphlebitic leg with stasis change. This technic affords safer immediate postoperative healing and durable long-term results. The indications for operation have been extended to include more elderly patients as well as selected patients with ulcerations due to combined venous stasis and arterial insufficiency.


Mites in house dust in the Stockholm area.

Today there is no doubt that mites (and especially species within the Pyroglyphidae family: Dermatophagoides pteronyssinus and Dermatophagoides farinae) are an important agent in dust allergies. The author reports on a study of the occurrence of mites in house dust in the environment of allergic persons in the Stockholm area. 201 private homes, 13 farmers' houses and two hospitals have been studied. In 12% of the homes several different types of mite were found in dust in relatively small numbers, while pyroglyphids occurred in only 1.5% of the dwellings. The frequency of mites in dust from farmers' homes was three times higher and that of pyroglyphids ten times higher than in other dwellings. Mites were most often found in floor dust and very infrequently in bed dust. All hospital beds were free from mites; in floor-dust samples from a hospital for long-term therapy several species of mite were found. The author draws the conclusion that the conditions of climate and humidity within the geographical area studied are adverse to the development of an allergologically significant mite population in indoor dust, but that small numbers may spread from potted plants, work premises and outdoor flora.


Epicutaneous testing.

The patch test and chamber test are the ordinary methods for detecting delayed type contact allergies. The method, test substances and criteria of positive reactions are already well standardized. Open testing is also used for problematic chemicals such as strong topical medicaments, emulsifiers and propylene glycol. The many problems of standardization are still unresolved in photocutaneous testing. Some chemicals are applied to the skin without occlusion, though the chamber test or patch test methods are used with most of them. The composition of the vehicle and occlusion time vary greatly from one photosensitizing substance to another. A xenon arc is recommended for screening any photosensitizers but fluorescent black light tubes are sufficient for routine clinical use. Type I contact allergies are far more common than was previously believed, especially among people allergic to birch pollen. This type of reaction and other forms of contact urticaria can be examined using the scratch chamber or scarification chamber techniques as well as with an open test on diseased or scratched (scarified) skin.


Intravenous regional analgesia using bupivacaine. A double blind comparison with lignocaine.

A double-blind comparison of bupivacaine and lignocaine for intravenous regional analgesia (Bier's block) was carried out in seventy-two patients presenting for upper limb surgery. Thirty-eight patients received lignocaine and thirty-four received bupivacaine. Onset of analgesia and recovery times were similar for the two drugs. The degree of both analgesia and muscle relaxation was significantly better in the bupivacaine group. Adverse effects were seen only in patients who had received lignocaine and these were unrelated to the tourniquet time.


Atropine versus glycopyrrolate. A study of intraocular pressure and pupil size in man.

Following control observations of intraocular pressure and pupil size, in doses suitable for pre-anaesthetic medication, glycopyrrolate (0.004 mg/kg) and atropine (0.01 mg/kg) were given intramuscularly to healthy volunteers in a randomised, cross-over fashion. No significant change in either intraocular pressure or pupil size was noted 45 min after drug administration.


Accidental hypothermia.

The physiological changes associated with accidental hypothermia are considered. Current methods of management of the hypothermic patient are reviewed.


Synergism between halothane and labetalol.

A patient in chronic renal failure, who was receiving large doses of the combined alpha- and beta-blocking agent, labetalol, was selected for renal transplantation. A low concentration of halothane was used for induction and maintenance of anaesthesia, but severe myocardial depression occurred which proved unresponsive to atropine or isoprenaline, although it responded to a dopamine infusion. Synergism has already been reported between labetalol and high concentrations of halothane, but this case suggests that, in patients with previous myocardial damage, much lower concentrations of this inhalational agent may prove fatal.


Postoperative analgesia using papaveretum and orphenadrine. A preliminary trial.

The action of orphenadrine when given towards the end of a general anaesthetic is described. It is shown to delay the need for postoperative analgesia and extend the analgesic action of papaveretum.


IPPB and hypercapnia in respiratory failure: the effect of different concentrations of inspired oxygen on arterial blood gas tensions.

Fourteen patients with acute exacerbations of chronic bronchitis and hypercapnia received two treatment periods with Intermittent Positive Pressure Breathing, the ventilator being driven by gas containing about 24% or about 45% oxygen. Arterial PO2 and PCO2 were measured before, during and after each treatment. The results demonstrated that increasing hypercapnia did not, as a rule, occur when 45% oxygen was used as the driving gas. When hypercapnia did occur it appeared to be independent of the inspired oxygen concentration. The importance of short treatment periods, correct ventilator settings and supervision of the patient during and after treatment is emphasised.


Renal function and cardiovascular responses during positive airway pressure.

The authors determined cardiovascular, renal, and hormonal responses to increased airway pressure during continuous positive-pressure ventilation (CPPV) and continuous positive airway pressure (CPAP). Nine healthy, hydrated laboratory swine had appropriate catheters placed to allow for measurement of intrapleural, aortic, inferior vena caval, and left ventricular end-diastolic pressures; cardiac output; and urinary flow. Samples of arterial blood were analyzed for oxygen and carbon dioxide tensions, pH, plasma vasopressin, osmolality, and creatinine and sodium concentrations. Urine was analyzed for osmolality and creatinine and sodium concentrations, and volume was recorded. Intrapleural pressure was subtracted from left ventricular end-diastolic pressure to calculate transmural pressure, a reflection of left ventricular filling pressure. Glomerular filtration rate and urinary free-water and osmolal clearances were also calculated. Expiratory left ventricular filling  pressure was decreased equally by CPAP and CPPV. However, inspiratory left ventricular filling pressure and cardiac output were decreased by CPPV only. Urinary flow and glomerular filtration rate were decreased equally by CPAP and CPPV. Sodium excretion was decreased and plasma vasopressin increased by CPPV, but not by CPAP. Urinary free water and osmolal clearances were not changed by either ventilatory pattern. Although many of the renal-function variables were affected similarly by CPPV and CPAP, these alterations were not influenced solely by cardiac output or vasopressin, because only CPPV depressed cardiac output and increased vasopressin levels.


Treatment of cardiac and renal effects of PEEP with dopamine in patients with acute respiratory failure.

The hemodynamic and renal effects of mechanical ventilation with positive end-expiratory pressure (PEEP) were studied with and without continuous dopamine administration in ten patients who had acute pulmonary failure. The application of 20 cm H2O PEEP during mechanical ventilation resulted in improvements in arterial blood oxygen tension, from 63 +/- 6 to 81 +/- 12 torr (mean +/- SE), and intrapulmonary shunt fraction, from 29 +/- 3 to 21 +/- 3 per cent, whereas cardiac output, systemic oxygen transport and renal function were impaired by 20, 19 and 47 per cent, respectively. Dopamine infusion at a rate of 5 +/- 0.05 micrograms/kg/min reversed the deleterious effects of PEEP on cardiovascular and renal function: cardiac output increased from 4.5 +/- 0.3 to 6.0 +/- 0.51, urinary output from 1.0 +/- 0.3 to 1.7 +/- 0.4 ml/min, sodium excretion and creatinine clearance by 50 per cent. Systemic oxygen transport was improved from 680 +/- 44 to 925 +/- ml, arterial oxygen tension from 81 +/- 12 to 102 +/- 14 torr, and total deadspace to tidal volume ratio from 0.49 +/- 0.02 to 0.44 +/- 0.03 with dopamine. The authors conclude that the depression of cardiovascular and renal functions that may occur in patients who need high levels of PEEP for the treatment of acute pulmonary failure can be treated successfully with dopamine infusion. This represents a valuable alternative to expansion of blood volume for the improvement of systemic oxygen transport and arterial blood oxygen tension in critically ill patients.


Protective action of phenytoin in cerebral ischemia.

Thirty-six rabbits were subjected to 15-minute periods of stagnant cerebral hypoxia while blood flow to the rest of the body was preserved. After this ischemic interval the animals, divided into three groups, received either saline, phenytoin, 15 mg/kg IV, or thiopental 10 mg/kg IV and 10 mg/kg IM. Histologic examination of tissue sections of the brains, 72 hours after ischemia, indicated that phenytoin afforded significant protection (p less than 0.001) of neurons in the hippocampus and in the dentate nucleus when compared to saline, while the findings noted after thiopental were not statistically significant when compared to placebo. No statistically significant difference was noted between the two drugs. Neuron destruction was seen only in rabbits receiving either saline (92%) or thiopental (50%).


Comparison of positive end-expiratory pressure and inspiratory positive pressure plateau in ventilation of rabbits with experimental pulmonary edema.

We investigated the effects of an inspiratory positive pressure plateau produced by a high (4/1) inspiratory-expiratory (I/E) ratio in rabbits with pulmonary edema induced with oleic acid. With an inspiratory pressure plateau, intrapulmonary shunt was significantly reduced compared to a standard 1/2 I/E ratio. Reduction in shunt was also obtained when positive end-expiratory pressure (PEEP) was added to the 1/2 I/E ratio ventilatory pattern. Since the improvement in shunt could have been caused by either recruitment of alveoli or by maintenance of lung volume at end exhalation we measured tidal volume and thoracic gas volume to distinguish between the two. With both patterns, improvement in shunt was associated with an increase in thoracic gas volume. The increase in thoracic gas volume was greater with PEEP than with 4/1 for an equivalent increase in mean airway pressure. The results suggest that an inspiratory pressure plateau improves gas exchange in pulmonary edema, but that this improvement occurs because of an increase in end-expiratory lung volume. Positive end-expiratory pressure is a preferable method of increasing end expiratory lung volume because a greater increase occurs for the same change in airway pressure.


[Latex reaction with toxoplasma antigen].

The author describes the latex fixation test (LFT) with Toxoplasma antigen. The main parts of this technique are as follows: the sensibilization of latex particles and incubation of the sensitized particles with sera examined in an icebox (overnight) followed by spinning at 5000 G 10 minutes.--The sera giving negative results with LRT reacted also in 78,3% with complement-fixing test (CFT) in 79.3% and with indirect fluorescent test (IFAT) in 61.8% and with microprecipitating test (MPT) in 100% negatively.--The sera reacting strongly positively with LFT reacted also with CFT in high titers (titer 160 and higher) in 60.9% and in 55% with IFAT (titers 128 and higher).


Two doses of triprolidine for treatment of allergic rhinitis.

Two doses of triprolidine (2.5 mg t.i.d. and 1.25 mg t.i.d.) were compared with placebo in 32 patients suffering from allergic rhinitis. Triprolidine 2.5 mg t.i.d. was statistically significantly better than placebo (p less than 0.05) in reducing the symptoms of sneezing and eye irritation. Neither dose of triprolidine produced significant drowsiness during the second week of treatment.


Diagnosis and management of hereditary angioedema (HAE).

In summary, HAE is a dominantly inherited form of angioedema which is manifested by nonpainful, nonerythematous, nonpruritic and nonpitting swelling of the extremities, face, gastrointestinal and respiratory tracts unaccompanied by urticaria. These patients have deficient activity of the C1 INH and the laboratory diagnosis can be easily made by finding low C4 and C1 inh levels during an attack. Effective and specific therapy is now available that prevents the clinical syndrome and corrects the serologic hallmarks of the disease.


IgE antibodies to peptic and peptic-tryptic digests of betalactoglobulin: significance in food hypersensitivity.

The sera of 20 atopic patients, 10 with hypersensitivity symptoms upon ingestion of milk and 10 without such symptoms, were tested by a radioimmunoassay for the detection of IgE antibodies to whole bovine milk, betalactoglobulin (BL), enzymatic digests of BL and fractions thereof. While only 4/10 patients had IgE antibodies to undigested BL all 10 patients had IgE antibodies to BL digests. All controls gave negative results. These findings suggest that enzymatic digestion of BL may yield antigenic fractions which elicit IgE antibodies and that these antibodies would be missed if the undigested food protein were to be used solely in testing.


An updated assessment of the critical environmental factors involved in the prevention of allergic disease.

The effects of climate, as well as outdoor and indoor pollution, on allergic respiratory symptoms are herein explored. Also, measures utilized in modifying the susceptible individual's milieu are examined. Finally, the potential for ameliorating or preventing the development of allergies in genetically ""predisposed'' children is discussed.


Bovine tuberculosis in the United States and Puerto Rico: a laboratory summary.

Mycobacteria were isolated from 14.3% of the tissues submitted to the National Veterinary Services Laboratories over a 5-year period (July 1, 1972, to June 30, 1977). The isolates were identified by drug susceptibility, and biochemical and serologic tests. Mycobacterium bovis isolated from tissues of cattle originating in 32 states and Puerto Rico accounted for 78% of the acid-fast isolations. Of the Mycobacterium bovis isolates, 4% were from tissues in which no microscopic tuberculous granulomas were observed on examination of tissue sections. Of the 119 Mycobacterium avium isolates, 18 were serotype 1, 44 were serotype 2, and 45 isolates represented 12 other serotypes.


Suppression of specific lymphocyte blastogenesis after intravenous tuberculin injection in Mycobacterium bovis-sensitized cattle.

Intravenous injection of 1.0 ml of old tuberculin (OT) in 4 calves previously sensitized to Mycobacterium bovis resulted in suppression of specific lymphocyte blastogenic responses to purified protein in vitro. Suppression of in vitro blastogenic responses occurred within 24 hours after injection of OT and persisted for up to 96 hours. Lymphocytes from these calves, cultured with concanavalin A, did not show any suppression of the lymphocyte blastogenic response in vitro. Suppression was temporary and in all calves was preceded by rapid febrile responses. Rectal temperature responses ranged from 40.1 to 41.6 C as early as 6 hours after tuberculin injections. Three control animals, M bovis-sensitized but not given OT, remained lymphocyte stimulation-positive throughout the study and served as controls for laboratory fluctuations.


Evaluation of various methods for the detection of enteropathogenic Escherichia coli in diarrheic calves.

Evaluation of the Escherichia coli population in the small intestine of diarrheic calves was performed by estimating the number of colony-forming units and the observation of direct gram-stained smears of mucosal scrapings. Enterotoxigenicity of the isolates was determined by the infant mouse test and the ligated intestinal segment in calves. The influence of various broth culture media on the production of enterotoxin was also studied. Serologic characterization of the E coli isolates was performed. A total of 190 cases of diarrhea in bovine neonates was studied and it was found that enteropathogenic E coi was not responsible for more than 20% of the cases. A practical approach for the recognition of enteropathogenic E coli in a routine diagnostic laboratory is proposed.


Allergic bronchopulmonary aspergillosis-like syndrome consequent to aspergilloma.

Two patients who represent the first well-documented cases of an allergic bronchopulmonary aspergillosis-like syndrome developing consequent to an aspergilloma are reported. These patients experienced both subjective and objective evidence of improvement after the initiation of corticosteroid therapy. Literature relevant to the combined occurrence of aspergilloma and allergic bronchopulmonary aspergillosis and their immunology is reviewed.


Nasal airway inspiratory resistance.

The relationship between transnasal pressure and nasal flow is markedly curvilinear during tidal breathing in man, and there is poor agreement among the results of various methods used to define this characteristic with a single number. We used Rohrer's equation (P = K1 V + K2 V2), where P = pressure and V = flow, and calculated values for K1 and K2 from 474 nasal inspiratory pressure/flow curves obtained from 34 human subjects by a standard method of posterior rhinometry. Nasal airway inspiratory resistance at an air flow of 0.4 liter per sec (NAIR0.4) was also calculated. Rohrer's equation was found by regression analysis to fit each curve well (0.86 less than r less than 0.9999; mean, 0.983). There was a strong correlation between NAIR0.4 and K2: NAIR 0.4 = 0.91 K2 + 0.39 (r = 0.97). Nasal congestion induced in 7 normal subjects with histamine resulted in larger changes in K2 and NAIR0.4 than K1. Patients given  an intranasal corticosteroid aerosol (beclomethasone dipropionate) in a double blind crossover trial showed symptomatic improvement in nasal congestion (P less than 0.01) and significant decreases in K2 (P less than 0.02) and NAIR 0.4 (P less than 0.05), but no change in K1 (P greater than 0.2).


Quantitative bacteriology in wound care.

Quantitative bacteriology in the management of wound sepsis provides an objective way to monitor the success or failure of wound care. The clinical appearance of a wound requiring skin grafting may be misleading. Grafting wounds that appeared clinically ready was unsuccessful when analysis showed bacteriological counts of 10(5) or greater organisms per gram of tissue. A rapid and simple method for quantitative tissue culture is described. Three cases are described illustrating the value of the results of the method.


Hexachlorobenzene-induced stimulation of the humoral immune response in rats.

Rats were fed diets containing 0, 500, 1000, and 2000 mg HCB/kg during a 3-week period. Marked weight increases of spleen, popliteal and mesenteric lymph nodes and of the liver were found. Histologically, the white pulp in the spleen was enlarged because of an increase in size of marginal zones and follicles. In addition, there was an increase of extramedullary hemopoiesis. In the lymph nodes, the number of high endothelial venules was increased at all dose levels. The number of neutrophils, basophils and monocytes in the peripheral blood was significantly increased, whereas peripheral lymphocyte counts were slightly higher. Total serum IgM levels were markedly increased, but IgG concentrations were unaltered. On the basis of this experiment, the 1000 mg HCB/kg diet level was chosen for the different function studies that were carried out after a 3-weeks dietary regimen. Regarding the humoral immunity, IgM antibodies to LPS were unaltered, whereas primary and secondary IgM and IgG antibody titers to tetanus toxoid were increased approximately three-fold. HCB did not significantly alter the cell-mediated immunity, as shown by the following parameters: resistance to Listeria monocytogenes infection, rejection of skin transplants, and delayed-type hypersensitivity to tuberculin. The phagocytizing capacity of macrophages was studied by measuring the blood clearance of carbon particles. HCB did slightly depress the phagocytic index, but the difference with control animals was statistically not significant. The in vitro responsiveness of thymus cells to the mitogens PHA, Con A, and PWM was not changed by in vivo HCB-treatment. On a cell-for-cell basis, the responsiveness of spleen cells was increased when cultured in the presence of LPS. On a whole organ basis, the response to PHA, Con A, PWM, and LPS was markedly enhanced because of an increase in the number of nucleated spleen cells. Regarding peripheral lymphocytes, only the response to the mitogen Con A was higher. On the basis of these studies it is concluded that HCB stimulates the humoral immune response in the rat, enhances the in vitro responsiveness of spleen cells to the different mitogens mainly as a result of an increase in the number of splenic lymphocytes, but does not alter the cell-mediated immunity as shown with in vivo tests. This result contrasts with data in the literature that show that HCB suppresses the humoral and cell-mediated immunity in mice. Finally, HCB pretreatment only marginally increased the susceptibility of rats to endotoxin, whereas mice have been shown to be 20-fold more susceptible to the lethal effects of bacterial endotoxin.


Nonfamilial anterior corneal dystrophy.

A 31-year-old woman with subepithelial corneal opacification and numerous clear round or oval areas of epithelial edema confined to the palpebral fissure underwent a penetrating keratoplasty. The clinical appearance was similar to that of a severe Meesmann or Stocker-Holt dystrophy. The prominent histopathologic features were thickening and excrescences of the epithelial basement membrane, intense basal cell edema, but no intraepithelial cysts. The basement membrane changes are compatible with those seen in Meesmann, Stocker-Holt, and map-dot-fingerprint dystrophy, but the lack of intraepithelial cysts is not characteristic of these dystrophies. This case represents a variant of the known anterior corneal dystrophies which have an overproduction of epithelial basement membrane.


Corneal transplantation with associated histopathologic description in xeroderma pigmentosum occurring in a black family.

Three cases of xeroderma pigmentosa in Bantu patients with corneal opacification are presented. The histologic appearances of the corneae following corneal transplantation is given.


Levator tucking.

Nine cases of ptosis were repaired by levator tucking. There were 4 postoperatuve complications. Tucking seems to offer no advantage over levator resection or the Fasanella-Servat procedure in the lesser degrees of ptosis. A new firmer tucking procedure is suggested for those who wish to try this technique.


An analysis of corneal transplantation: I--graft clarity.

A retrospective review has been undertaken of the clarity results of 378 keratoplasties performed by 6 Toronto corneal surgeons between January 1970 and December 1974. Lamellar keratoplasties were included in the data related to herpes simplex only. In herpes simplex penetrating grafts gave better vision than lamellar grafts. The following factors were statistically important with respect to graft clarity: age of recipient, type of corneal disease, peroperative corneal vessels, first or subsequent graft, pre- and/or postoperative glaucoma, postoperative anterior synechiae, combined procedure, vitreous loss, previous cataract surgery, and follow-up time. The following factors were statistically unimportant with respect to graft clarity: donor age, time from death to enucleation (median 2.8 hours), time from enucleation to use (median 24 hours), sex of donor and recipient, interrupted or running suture, use of microscope, penetrating or lamellar graft in herpes simplex, postoperative astigmatism, and division of postoperative anterior synechiae. Silk (compared with nylon), larger grafts and combined procedures all increased the incidence of graft rejection. Repeat grafts were associated with more preoperative corneal vascularization.


An analysis of corneal transplantation: II--postoperative astigmatism.

An analysis of 153 penetrating keratoplasties was undertaken. The same surgical technique was used in all cases. Three factors had a statistically significant effect on postoperative astigmatism, as measured by keratometry. (1) Astigmatism decreased with increasing follow-up time (P less than 0.05). (2) Vitreous loss at the time of the keratoplasty increased the amount of postoperative astigmatism (P less than 0.05). (3) Females had more postoperative astigmatism than males (P less than 0.05), but this was probably related to a tendency for females to have a greater incidence of postoperative anterior synechiae (P just greater than 0.05), and the fact that all 6 cases of vitreous loss were in females. There was an almost significant trend toward postoperative anterior synechiae being associated with increased astigmatism (P just greater than 0.05), and there was also a trend toward the division of these synechiae reducing the amount of astigmatism. Fifteen of the 153 penetrating grafts were done in cases of herpes simplex. These were compared with 11 lamellar grafts done for herpes simplex, and there was a statistically insignificant trend toward more postoperative astigmatism in penetrating grafts.


Detached pacing electrode tip as a pulmonary embolus.

Forceful extraction of an Elema unipolar endocardial pacing electrode caused accidental detachment of the electrode tip. The tip migrated from the jugular vein into the central venous circulation and after some delay finally passes during the night into a pulmonary artery branch. Transient pleural irritation was the only sequel.


Positive end expiratory pressure ventilation, renal function and renin.

Positive end expiratory pressure (PEEP) during respirator therapy can impair renal function by altering renal haemodynamics or by increasing the secretion of the antidiuretic hormone. In the present study, the effect of the commonly used 10 cm H2O PEEP for two hours on renal function and on plasma renin activity was studied in eleven intensive care patients. During the examination period, the patients received analgesic, sedative, and muscle relaxant drugs, but no diuretics. PEEP decreased the mean urinary output by 21%. Urinary specific gravity and osmolality increased. Urinary sodium excretion decreased along with urinary volume. The creatinine clearance decreased slightly, but free water clearance became less negative suggesting reduced ability of tubules to concentrate urine during PEEP. The plasma renin activity was not altered significnalty by PEEP, nor did the urinary sodium/potassium ratio change. This may indicate that the water retention induced by PEEP is not caused by the increased secretion of aldosterone. The results suggest that 10 cm H2O PEEP impairs renal function in critically ill patients and causes mainly water retention.


Pulmonary infections after renal transplantation.

The prevalence of pulmonary infections has been assessed in a series of 93 patients who succumbed after renal transplantation. Pneumonia was considered to be the immediate cause of death in 15 patients; microscopic examination revealed further 10 cases, with pneumonic foci in the lungs. Consequently, the prevalence of pulmonary infections was 27%. Pneumonia was diagnosed on chest X-ray in only 48%, with "uraemic lung" as the most common confounding diagnosis. Clinical microbiology disclosed pathogenic bacteria in the sputum in 40% of the cases. It is concluded that the diagnostic yield would be enhanced by more frequent chest X-rays and presumably with more invasive methods of acquiring specimens for microbiological studies. It is also possible that the application of more stringent criteria for the use of high-dose intravenous steroids for supposed rejection will lead to less pneumonia in patients with renal transplants.


The fixed combination of propranolol and bendrofluazide in the treatment of hypertension.

The antihypertensive effect of Inderectic, a new combination capsule of propranolol 80 mg and bendrofluazide 2.5 mg, given twice daily was investigated in 21 hypertensive patients using a double-blind randomized crossover method. Inderectic was compared with either agent used alone and with the same combination given as separate tablets. It gave a greater fall in mean lying and standing systolic and diastolic blood pressure than either agent alone. There was no statistically significant difference for the effect on these variables between the free combination and combined formulation. Only minor side-effects were recorded, no patient having to be withdrawn from the study and no biochemical changes were observed.


Vibrio alginolyticus wound infection: case report and review.

Vibrio alginolyticus was associated with a littoral wound infection in an Arizonan injured near the Sea of Cortez. While this is the first instance from this estuary, the relatively recent increase in the number of isolates suggests both that most coastal waters are a natural habitat of the organism and that probably many previous isolates were incorrectly identified in the past. Mischaracterization most likely results from a gram-negative work-up routine deficient for the isolation of halophilic organisms. The morbid course of this case was in part predictable owing to the organism's resistance to several first choice antibiotics. The laboratory characteristics of V. alginolyticus and others in the Vibrio genus associated with maritime disease are reviewed.


Presystemic drug elimination.

The presystemic elimination of a large number of compounds is clearly established and represents a common and unavoidable cause of reduced bioavailability. The liver, intestine, and lungs have been identified as potential organs contributing to this effect but only in the case of the liver are sufficient data available for comprehensive analysis. More information on intestinal and pulmonary metabolism is clearly needed. Simple methods of kinetic analysis already exist, however, to assess the relative importance of these organs in presystemic elimination, especially in relation to the pre- and postabsorptive types of elimination that may occur.


Toxic fungi.

Much progress in the areas of identification of active components and elucidation of the toxic mechanisms for the principal poisonous mushrooms has been made in the past decade. This affords a more rational approach to therapeutic management which has consequently resulted in a decrease in the morbidity and mortality associated with these species. However, the effectiveness of a large number of adjuvants for Amanita phalloides poisoning still needs critical laboratory evaluation. The current status of knowledge concerning the toxic potential and contituents of many mushroom species, including the gastroenteric irritants, is inadequate. The problem of geographic variation or genetic strain in the concentration of toxins of many species also requires further investigation. The recent awareness and interest in the pharmacology and toxicology of uncultivated mushrooms in North America and Great Britain should encourage continued active research.


[Effect of biologically active substances on Escherichia coli chloramphenicol acetyltransferase activity].

The chloramphenicol acetyltransferase activity is mainly localized in the membrane fraction of E. coli 103. Protamine hydrochloride, chlorhexidine, a cationic detergent, and to a less extent nitrofurans lowered the level of the antibiotic inactivation by this strain. Protamine hydrochloride decreased the enzyme activity in both the cell culture of E. coli 103 and the suspension of the membranes isolated from the cells, while chlorhexidine suppressed only induced biosynthesis of chloramphenicol acetyltransferase.


[Dynamics of the change in sensitivity of shigellae to gentamycin and cephaloridine in vitro].

The dynamics of the changes in the Shigella sensitivity to gentamicin and cephaloridin was studied in vitro using liquid nutrient media with gradually increasing concentrations of the drugs. 50 passages were performed. It was found that Shigella flexner and sonnei decreased their sensitivity to gentamicin to a little extent and remained middle sensitive. Sensitivity of Shigella flexner to cephaloridin also changed to a little extent, while Shigella sonnei became moderately resistant.


[Level and nature of the drug resistance of Shigella flexneri].

Characteristics of antibiotic resistance of 300 strains of Shigella flexner 2a isolated from patients within 1976--1977 in the regions where these bacteria were very rare for a long period of time were studied. It was shown that most of the isolates were resistant to chloramphenicol (88.1 per cent), tetracycline (94.8 per cent), streptomycin (89.1 per cent), polymyxin M (82.4 per cent) and others. 46.5--61.6 per cent of the isolates were resistant to neomycin antibiotics. A high level of the resistance was also noted: the bactericidal effect was registered in 52.0-74.0 per cent of the cultures at a dose of 500--1000 microgram/ml. 91.4 per cent of the strains possessed multiple dug resistance, 78.8 per cent of them being simultaneously resistant to 4--7 drugs. Transmissive R-plasmids were found in 68.8 per cent of the isolates. After exposure to acridine dyes the plasmid nature of the resistance was confirmed in 72.3 per cent of the cultures. Variability of the r-determinant sets in r-plasmids was noted. Strains (64.9 per cent) carrying r-determinants Tc, Cm, Sm and Tc, Cm were more frequent. Strains with one transmissive r-determinant were usually solitary.


Flow cytometric determinations of cellular substances in algae, bacteria, moulds and yeasts.

The practical use of flow cytometry is shown in several microbial assays. Recent technical improvements in the optics and electronics of flow cytometric systems as well as in staining techniques permit the measurements of minute cellular components such as the cellular DNA and the protein content of bacteria, algae, moulds and yeasts. Single cell ingredients can be measured by this assay according to their specific stainability. The cell DNA was stained by propidium iodide while the cell protein was fluorochromed by fluorescein-iso-thiocyanate. The DNA synthesis of Saccharomyces cerevisiae and Saccharomyces pastorianus runs discontinuously while the protein content increases continuously during the vegetative growth. The different stages of DNA synthesis of yeast cells can be divided into two 'gap' phases, a synthesis and a mitosis period, corresponding to Howard and Pelc's model of DNA synthesis. Living and dead cells can be counted differentially after staining with Erythrosine B. The red fluorescence of the chlorophyll in algae can readily be used to determine the chlorophyll content of these cells.


Inositol deficiency in yeast: metabolic, enzymatic and autoradiographic studies.

The addition of inositol to starved cells of Saccharomyces cerevisiae NCYC 86 resulted in an initiation of growth. Inositol was incorporated into phosphatidyl-inositol and after a lag period RNA was the first macromolecule with a rate of synthesis departing from the rate observed in deprived cells. Pulse chase experiments showed that inositol was first incorporated into phosphatidylinositol and later into more polar lipids. Finally it appeared to be excreted into the surrounding medium. When S. cerevisiae NCYC 86 was grown in suboptimal concentrations of inositol (0,5 microgram/ml), alterations in the level of some membrane-bound enzymatic activities were detected; these might reflect structural modifications of the cellular membranes due to a different composition of phospholipids. High-resolution autoradiography showed that inositol was probably first incorporated into internal membranes and later transferred to the plasma membrane. Analytical experiments carried out with inositol-deprived cells showed that inositol was released into the surrounding medium in that case. The unbalanced growth detected in S. cerevisiae NCYC 86 under inositol deprivation might be due to an abnormal functioning of the cell membranes as a consequence of the deficiency in inositol-containing phospholipids.


Antibodies to phospholipids in experimental nocardiosis.

Live Nocardia asteroides injected intraperitoneally into guinea pigs produced antibodies to phospholipids of Nocardia whereas antibodies were not detected in animals injected with heat-killed N. asteroides. The antibody titer was found to be related with the degree of infection; a significant decrease was noted after sulfadiazine treatment suggesting that antibodies were produced in response to an increasing bacterial load that occurred as the infection progressed.


Characterization of motile and acetoin-negative Klebsiella pneumoniae strains by DNA: DNA by hybridization.

Hybridization studies were carried out to determine the extent of divergence between different members of the Enterobacteriaceae and group D, previously described by numerical analysis of phenotypic characters, and comprising strains isolated from surface waters. This group, apparently belonging in or related to the genus Citrobacter on the basis of the IMViC tests differs from this taxon by numerical analysis and DNA base composition. Our work reveals a DNA relatedness of 81-89% between the centrotype strain of this group and the genus Klebsiella. Although strains of group D show positive motility and negative Voges-Proskauer reactions, a comparison of their phenotypic characters leads us to consider that the strains with a high level of hybridization within this group belong to K. pneumoniae. These results suggest a complete revision of the traditional classification scheme of the genus Klebsiella.


Taxonomy of coagulase-negative staphylococci: a comparison of two widely used classification schemes.

In a comparative study 351 strains of Micrococcus subgroups 1-3 (Baird-Parker, 1963, 1965, 1974) were classified according to the Kloos and Schleifer scheme (1975b). The results showed that Micrococcus subgroups 1, 2 and 3 are heterogeneous groups in the Kloos and Schleifer scheme. Strains belonging to Micrococcus subgroups 1 and 2 were mostly classified by the Kloos and Schleifer criteria as Staphylococcus hominis, Micrococcus subgroup 3 strains from the skin as S. cohnii, while Micrococcus subgroup 3 strains from urinary infections were classified mainly as S. saprophyticus. The correlation of novobiocin resistant S. saprophyticus biotype III (Baird-Parker, 1974) with S. saprophyticus (Kloos and Schleifer, 1975a, 1975b) when isolated from urine, was 80%. Although the Kloos and Schleifer scheme provides more information about biochemical characters, doubts are expressed about the validity of some of the species so delineated.


Position of the medial internal capsular border in relation to third-ventricular width.

The position of the medial internal capsular border (lateral thalamic border) in relation to the width of the third ventricle is of considerable importance to stereotactic surgeons. Close estimation of its position from anteroposterior roentgenograms diminishes the possibility of multiple brain penetrations in an attempt to find it by electrophysiological methods. By correlating the position of the medial capsular border found by a stimulation technique, with the width of the third ventricle, in a series of 130 patients, reliable ranges of its position were obtained.


Induction of mutation in Escherichia coli by freeze-drying.

The effect of freeze-drying on phenotypic reversion of amino acid auxotrophy to prototrophy was studied in Escherichia coli. In a radioresistant strain, E. coli H/r 30 (uvr+ exr+), which can repair the deoxyribonucleic acid damaged due to freeze-drying, an increased mutation frequency from auxotrophy to prototrophy was observed with increased time of freeze-drying of the cells. On the other hand, in a radiosensitive strain, E. coli NG 30 (recA), which cannot repair the damaged deoxyribonucleic acid due to a lack of repair enzyme system, no significant reversion occurred, although the survival rate was very low. The rate of phenotypic reversion dut to freeze-drying in both E. coli RIMD 0509109 (uvr+ exr+) and RIMD 0509115 (uvr exr+) was almost the same, indicating that the phenomenon is independent of the uvr character. From these results it is concluded that mutation was induced in E. coli cells during the rehydration when the damaged deoxyribonucleic acid was repaired by exr character of the cells. Thus, we propose that a serious consideration should be paid to the freeze-drying technique to preserve bacterial cells.


Vivo clearance of enteric bacteria from the hemolymph of the hard clam and the American oyster.

American oysters, Crassostrea virginica, and hard clams, Mercenaria mercenaria, were experimentally contaminated with Escherichia coli, Salmonella typhimurium, and Shigella flexneri either by intracardial injection or via the natural route of ingestion. Bacterial inactivation in the hemolymph was monitored for 72 h after exposure to these enteric pathogens at 20 and 6 degrees C. At 6 degrees C, both mean bacterial uptake by ingestion and subsequent clearance was singificantly lower that at 20 degrees C. However, substantial bacterial clearance from the hemolymph occurred for both shellfish at each temperature. At 20 degrees C, viable bacteria were no longer detectable after 24 h in hemolymph of either clams or oysters after exposure to contaminated water containing 4 x 10(3) bacteria per ml.


Automated electrical impedance technique for rapid enumeration of fecal coliforms in effluents from sewage treatment plants.

Fecal coliforms growing in a selective lactose-based broth medium at 44.5 degrees C generate a change in the electrical impedance of the culture relative to a sterile control when populations reach 10(6) to 10(7) per ml. The ratio of these changes was measured automatically, and the data were processed by computer. A linear relation was found between the log10 of the number of fecal coliforms in an inoculum and the time required for an electrical impedance ratio signal to be detected. Pure culture inocula consisting of 100 fecal coliforms in log phase or stationary phase were detected in 6.5 and 7.7 h, respectively. Standard curves of log10 fecal coliforms in wastewater inocula versus detection time, based on samples collected at a sewage treatment plant over a 4-month period, were found to vary from one another with time. Nevertheless, detection times were rapid and ranged from 5.8 to 7.9 h for 200 fecal coliforms to 8.7 to 11.4 h for 1 fecal coliform. Variations in detection times for a given number of fecal coliforms were also found among sewage treatment plants. A strategy is proposed which takes these variations into account and allows for rapid, automated enumeration of fecal coliforms in wastewater by the electrical impedance ratio technique.


Rapid, single-step most-probable-number method for enumerating fecal coliforms in effluents from sewage treatment plants.

A single-step most-probable-number method for enumerating fecal coliforms in sewage treatment plant effluents is described. The method requires the use of only one lactose-based medium and a single incubation temperature of 44.5 degrees C, and it can be completed in 18 h or less, as compared with up to 72 h for the standard most-probable-number method. The appearance of growth is the sole criterion used for designating positives, which can be determined either by increases in the electrical impedance ratio of inoculated medium, as compared to an uninoculated control using a Bactometer model 32, or by visual examination of inoculated medium for turbidity. In trials with 53 samples of unchlorinated sewage treatment plant effluent, fecal coliform counts by the single-step most-probable-number method, throughout a range of less than 10 to almost 10(7) fecal coliforms per 100 ml of effluent, were in excellent agreement with counts abtained by the standard most-probable-number procedure. Similar agreement was obtained in comparative trials with 31 chlorinated effluent samples from two sewage treatment plants. Overall, 87% of 452 positives were confirmed as containing fecal coliforms. The applicability of the single-step most-probable-number method to automated sewage treatment plant operations is discussed.


Chlorine injury and the enumeration of waterborne coliform bacteria.

Injury induced in Escherichia coli cells by chlorination was studied from a physiological standpoint. Predictable and reproducible injury was found to occur rapidly in 0.5 mg of chlorine per liter and was reversible under nonselective conditions. There was an extended lag period in the growth of chlorinated cells not seen in control suspensions followed by the resumption of logarithmic growth at a rate equaling that of control cells. The aldolase activity of cells chlorinated in vivo was equivalent to that obtained for control cells. Oxygen uptake experiments showed that chlorinated cells underwent a decrease in respiration that was not immediatedly repaired in the presence of reducing agents. This effect was more pronouned in rich media containing reducing agents. Uptake of metabolities was inhibited by chlorine injury as shown with experiments using 14C-labeled glucose and algal protein hydrolysate.


Demonstration of invasiveness of Vibrio parahaemolyticus in adult rabbits by immunofluorescence.

To determine possible pathogenesis of Vibrio parahaemolyticus-host-organ system interactions, studies of invasiveness were made by a direct fluorescent-antibody method. Broth cultures of live cells isolated from seafish or symptomatic humans were inoculated separately into ligated ileal loops of young New Zealand white rabbits. After suitable incubation, rabbits were sacrificed, and ileal loops and tissue specimens were aseptically removed. Ileal loops were prepared and stained with specific fluorescein-tagged antibody, and organ specimens were cultured for isolation of the inoculated Vibrio strain. All strains tested penetrated into the lamina propria of the ileum and were isolated from the cultured tissue specimens, indicating that the organism is capable of more than a superficial colonization of the gut. The presence of Vibrio in cultured tissue specimens suggests invasion of deeper tissue by either the lymphatic or the circulatory system.


Mutagenicity of the mycotoxin emodin in the salmonella/microsome system.

The mycotoxin emodin was found to be a frameshift mutagen for Salmonella typhimurium strain TA 1537 after metabolic activation in a mammalian microsome system.


Determination of lipopolysaccharide by a bioluminescence technique.

The determination of the lipid A content of bacterial lipopolysaccharide by using a dim mutant of the luminous bacterium Beneckea harveyi is described. The luminous bacteria emitted light upon the addition of an acid hydrolysate of lipopolysaccharide which contained myristic acid, thus making it possible to detect as little as 1 ng of lipopolysaccharide. By converting the 3-OH-myristic acid to myristic acid, it was possible to further increase the detection sensitivity and to establish a basis for a specific and highly sensitive bioassay for the detection of lipopolysaccharide.


Prophylactic and preventive antibiotic therapy: timing, duration and economics.

Previous studies have demonstrated that administered antibiotics must be active against major anticipated pathogens and must have reached sufficient concentrations in the tissue or body fluid at risk by the time of bacterial challenge if prophylactic therapy is to be maximally effective in reducing the infection rate of potentially contaminated surgery. The need for continuing antibiotic prophylaxis beyond the day of operation, however, has been uncertain. In a prospective, randomized, double-blind study of 220 patients undergoing elective gastric, biliary or colonic surgery, perioperative administration of cefamandole plus five days of placebo was compared to perioperative plus five days of postoperative antibiotic therapy; no significant difference was found between the groups in the rate of infection of wound (6 and 5%, respectively), peritoneum (2% each) and elsewhere (6% and 5%). In another prospective, randomized, nonblind study of 451 determinant cases of 1,624 patients undergoing emergency laparotomy, cephalothin was instituted preoperatively but after peritoneal contamination had occurred (i.e., abdominal trauma, etc.); continued postoperative antibiotic again failed to reduce further the wound and peritoneal infection rates, as noted on comparing perioperative therapy alone (infection rates 8 and 4%, respectively) with perioperative plus 5-7 days of postoperative treatment (10% and 5%, respectively). Analysis of these data, as well as of the extra expenses incurred by 463 patients because of infection in a previous prophylactic antibiotic study, revealed an average additional expenditure of $2,686.00 for each instance of postoperative infection of the wound and/or peritoneum; whereas savings of $300.00 per patient at risk were obtained whenever appropriate prophylactic antibiotic had been given.


Coarctation of the abdominal aorta: pathophysiologic and therapeutic considerations.

Coarctation of the aorta is the most frequent cause of hypertension in infants and children. Ninety-eight per cent of coarctations occur in the descending aorta near the ligamentum arteriosus. Five patients are presented with the relatively rare problem of coarctation of the abdominal aorta. The anatomic,pathophysiologic and clinical aspects in these patients cover a range of variants. Clinical and laboratory studies of the genesis of hypertension in coarctation are reviewed in chronologic outline. An experimental model of abdominal coarctation with hypertensive and renin-angiotensin II correlations suggests but does not prove a renal mechanism for the hypertension. The same conclusion must be drawn from study of the clinical cases.


Effects of pulsatile perfusion pressure and storage on hearts preserved for 24 hours under hypothermia, for transplantation.

Canine hearts preserved for 24 hours under hypothermic pulsatile perfusion at a systolic pressure of 25 mm Hg had better perfusion and transplantation survival results than hearts perfused at 50 or 80 mm Hg. Also, hearts perfused at a systolic pressure of 25 mm Hg did better than simple hypothermically stored hearts or fresh allografts. These findings indicate that hearts are adequately perfused for 24 hours under hypothermia for transplantation at a systolic pressure of 25 mm Hg.


A new method of sternal reclosure.

A new method is described for stabilizing dehiscence or instability of median sternotomy incisions using stainless steel retention sutures. The method has been used successfully in patients who had disruption of the sternum following open-heart surgery and resulted in no complications. It is recommended also as a preventive measure for closure of the sternum in elderly, debilitated patients with a fragile sternum and with prolonged low cardiac output after operation.


A simple method for closure of patient ductus arteriosus in elderly patients.

A relatively simple and safe method for closure of the patient ductus arteriosus in the elderly patient is described. It has been done successfully in 4 patients.


Surgical treatment of aneurysms of the sinus of Valsalva.

From 1962 to 1976, 15 patients with aneurysms of the sinus of Valsalva underwent operative correction. All patients survived operation. Follow-up has been carried out for as long as fifteen years (median, six years) after operation. There have been no late deaths and no recurrences. Aortic insufficiency, present in 2 patients before and in 2 after operation, remained well compensated and required no further aortic valve procedure. A double approach, that is, through both the aorta and the involved cardiac chamber, is recommended for sufficient correction.


Rupture of postcoarctation mycotic aneurysms of the aorta.

Sudden and usually fatal rupture is a common complication of postcoarctation mycotic aneurysms. Prompt operative treatment is always indicated, and can be performed using one of three techniques depending on the adequacy of the collateral circulation and the presence or absence of active bacterial infection. Renal dysfunction commonly is associated with bacterial endarteritis and is secondary to an immune-complex glomerulonephritis. The patient reported here was treated successfully by the placement of an emergency axillofemoral bypass graft, removal of the infected portion of the descending thoracic aorta, and delayed intrathoracic reconstruction.


Radical enlargement of the aortic root and outflow tract to allow valve replacement.

A method of radical enlargement of the aortic root and outflow tract is described. The technique consists of incising the aortic annulus, the anterior mitral leaflet, and the superior aspect of the left atrium. Valve replacement is then possible, with patch reconstruction of the resulting defects.


Late complications following surgical repair of total anomalous pulmonary venous return below the diaphragm.

Between May, 1975, and June, 1977, we surgically repaired an infracardiac total anomalous pulmonary venous return in 4 infants under deep hypothermic cardiac arrest. All patients had pulmonary hypertension and a patent ductus arteriosus. All survived operation and required positive end-expiratory pressure with mechanical ventilation. Late complications included patent ductus arteriosus not visualized at initial catheterization, breakdown of an oversewn atrial septal defect repair, and pulmonary venous obstruction despite an anastomosis diamter of 1.5 to 2.5 cm. At reoperation, there was scarring and contraction at the junction of the pulmonary veins and left atrium. One infant with these complications died post-operatively. In another patient, there was kinking of the left lower pulmonary vein at its juncture with the left atrium. In view of these complications we currently recommend the following: ligation of the ductus arteriosus regardless of catheterization findings; a right-sided approach to avoid pulmonary vein kinking; prosthetic patch closure of the atrial septal defect to avoid excessive tension on suture lines and to maintain maximum left atrial size; stellate anastomosis to provide the largest possible drainage channel; awareness that an unusually high positive end-expiratory pressure may be required postoperatively; and early recatheterization.


Classic shunting operations as part of two-stage repair for tetralogy of Fallot.

One hundred forty-nine consecutive patients with tetralogy of Fallot, with or without pulmonary atresia, underwent Blalock-Taussig or Waterston operation for initial palliation. Of these patients, 45 were less than 6 months old, and 63 were less than 1 year old. The type of shunt, and the presence or absence of pulmonary atresia did not have a significant effect (p greater than 0.2) on hospital mortality. Parametric analysis showed a significant effect of age (p = 0.03), the risk of hospital death being 6% at 1 month of age, 4% at 3 months, 3% at 6 months, and 2.5% at 12 months. No late deaths occurred before the age of 3 years. Six patients (4.2% of the hospital survivors) required another operation before they were 3 years old. Severe arm ischemia occurred after a Blalock-Taussig shunt in 1 infant with Down's syndrome.


The use of internal and external vascular conduits for correction of D-transposition of the great arteries and double-outlet right ventricle with pulmonary atresia.

Between 1967 and 1978, an 11-year-old boy had undergone 3 separate systemic-pulmonary artery shunt operations. Two of the 3 shunt operations failed. The patient was restudied because of progressive cyanosis and was diagnosed as having D-transposition of the great arteries and double-outlet right ventricle with pulmonary atresia. Repair was successfully accomplished with the use of an internal vascular conduit and an external vascular conduit with a glutaraldehyde-treated porcine valve. Four months after the corrective procedure, the patient's exercise tolerance had improved dramatically.


Ventricular septal defect following myocardial infarction.

Review of the literature since 1970 revealed more than 200 patients who had a ventricular septal defect following myocardial infarction and underwnet operation. Pathogenesis and diagnosis are discussed. The primary therapy is operative repair, which is considered from the standpoint of approach, timing, technique, concomitant coronary artery bypass, mortality, and long-term survival. Operative mortality in those patients operated on less than 3 weeks following perforation remains high (40%) but when it is possible to wait 3 weeks, there is a marked decrease in mortality (6%). Several general principles have evolved for the care of these patients. (1) Operation should be deferred until 3 weeks after infarction if possible. (2) The intraaortic balloon allows preoperative evaluation of the patient with clinical hemodynamic deterioration in the early postinfarction period. (3) The incision should be placed through the infarct. (4) Associated coronary artery or mitral valve disease should be repaired as well.


Hydrochlorothiazide-induced pulmonary edema. Report of a case and review of the literature.

Immediately following the initial ingestion of hydrochlorothiazide, acute pulmonary edema developed in a patient who previously used bendroflumethiazide. Unlike previously published reports, we studied the patient from immunologic and pulmonary function aspects. Using standard techniques, no significant immunological mechanisms could be demonstrated. The pulmonary function testing disclosed a widened alveolar-arterial oxygen gradient and mildly decreased diffusing capacity that cleared on serial testing. We believe that this demonstrates a rare idiosyncratic reaction that apparently is seen specifically with hydrochlorothiazide and not with other thiazide medications.