Comparative study of cefaclor and amoxicillin in treatment of urinary tract infection.

Cefaclor or amoxicillin was given to 51 randomly assigned patients with urinary tract infections. Inclusion in the study required two pretreatment urine cultures yielding the same organism (susceptible to both antibiotics) in concentrations greater than or equal to 10(5)/ml. Both drugs were administered as 250 mg. orally every eight hours for ten days. Cefaclor was given to 27 patients and amoxicillin to 24. Most patients in both groups had negative urine cultures at five to nine days and four to six weeks following therapy. One patient in each group was unsuccessfully treated. Relapse or reinfection occurred with similar frequency in both treatment groups. Both antibiotics were well tolerated. minimal inhibiting concentrations (MICS) of cefaclor, amoxicillin, cephradine, and cephalexin were determined by an agar dilution technique for the 44 available pretreatment isolates (41 Escherichia coli and 3 Proteus mirabilis). Mean MICs (micrograms./ml., +/- SD) were 2.2 +/- 1.4 for cefaclor, 4.4 +/- 2.0 with amoxicillin, 8.1 +/- 4.2 for cephradine, and 5.7 +/- 3.0 with cephalexin. Cefaclor is highly active in vitro against those gram-negative bacteria which are commonly isolated from urine. Cefaclor is as effective as amoxicillin when administered three times daily for the treatment of urinary tract infection.


Epididymitis as cause of antibody-coated bacteria in urine.

The antibody-coated bacteria (ACB) immunofluorescence test has emerged as the preferred noninvasive technique to distinguish reliably between pyelonephritis and cystitis. Investigators have recently correlated a positive test with chronic bacterial prostatitis and cystitis complicating a bladder tumor or stone. We present data that appear to prove that acute bacterial epididymitis associated with bacteriuria can also evoke a positive ACB determination.


Monitoring for bacteriuria in spinal cord-injured patients on intermittent catheterization. Dip-slide culture technique.

Spinal cord-injured patients on intermittent catheterization underwent careful scrutiny of daily bacteriuria using the dip-slide culture technique. Comparison with conventional bacteriologic streaked plates revealed good correlation for quantitating low-density bacteria as well as 10(5) organisms. The technique serves as a useful tool in screening for urinary tract infection among patients with neurogenic bladder.


Intestinal defence of the neonatal pig: interrelationship of gut and mammary function providing surface immunity against colibacillosis.

The neonatal requirements for maternal passive immunity and the lactation immunobiology with regard to sow immunisation for neonatal protection are reviewed. A vaccination protocol which combines oral and parenteral antigen administration to produce antibody activity mediated mainly by IgM is described. Its efficacy in affording protection to neonatal piglets was tested against a lethal oral infection with a virulent strain of Escherichia coli "Abbottstown". Piglets suckled on vaccinated or non-vaccinated sows were exposed to an infective challenge in the gastrointestinal tract and the relative pathology in test and control groups observed over the neonatal period. Death ensued in 76 per cent of piglets suckled on control sows and 26 per cent of piglets suckled on sows vaccinated by two intramuscular injections. Litters suckled on orally vaccinated sows were able to resist a similar infective challenge, there being only one fatality out of 42 piglets.


[Differential diagnosis of esophageal cancer by using mathematical decision rules].

It is suggested to use the medico-mathematical "decisive rules" for the differential diagnosis of esophageal cancer in non-specialized medical institutions. As the first step the examination cards were written, based on the data of 1195 patients with verified diagnosis. The "decisive rules" were worked out basing on the examination cards of 597 patients (in 267--esophageal cancer and in 330--benign lesions: cardiospasm, benign tumors, cysts, burn and scarring strictures, esophagitis, diverticulum). The suggested "decisive rules" using 63 and 87 clinical signs were tested elsewhere for a retrospective diagnosis in 167 patients. Using the "decisive rules" with 63 clinical signs esophageal cancer was recognized in 96% of cases, non-cancer--in 92%, while using 87 signs--in 92 and 94% accordingly. The rule comprising 63 signs-questions is recommended for practical purposes.


[Ultraviolet-induced effect of N-nitrosamines on the in vitro parameters of DNA fusion].

The results of studies have shown the UV-induced decrease of melting temperatures of the DNA of E. coli and chick erythrocytes under the influence of simple N-nitrosamines (NDMA, NDEA, NDPA). Either UV or nitrosoamines separately failed to effect the DNA, or their action was insignificant. It is suggested that this effect may be partly due to the action of UV on DNA.


[Echoscopy in the diagnosis of focal hepatic lesions].

Echograms obtained with a national apparatus UDA-871 were examined in 150 patients including 41 cases with primary hepatic cancer, 29--with metastases and 14--with echinococcosis. Echograms aid in differentiating nodular, massive (and also diffuse) and cavitary forms of primary hepatic cancer.


[Immunofluorescence method of determining HBc-antibodies in the blood sera of serum hepatitis type B patients].

The indirect immunofluorescent procedure was used to examine blood sera from 68 patients with serum hepatitis having HBsAg. HBcAb were found in 85% of the specimens. Formalin-fixed paraffin sections of autopsy livers pretreated with enzyme and containing HBcAg in hepatocyte nuclei were shown to be a useful tissue substrate. HBcAb were found in patients in a wave-like manner. The presence of HBcAb was found to be connected with the active phase of serum hepatitis.


[Autologous cancellous bone grafting in rabbits using a fibrinogen adhesive system (author's transl)].

The changes in remodelling of autologous cancellous bone after reimplantation using a fibrinogen adhesive system (FAS) consisting of highly concentrated fibrinogen, thrombin and factor XIII were investigated in 23 rabbits. A 5 x 6 mm sized piece of bone was removed from the iliac crest and reimplanted in the same place with and without FAS. Histological, tetracycline fluorescence and radiological evaluation were carried out after 3, 6 and 9 weeks. The control group (without FAS) showed considerable breakdown of the bony trabeculae due to regression of the osteocytes in the centre of the reimplanted bone after 3 weeks, whereas in the FAS group bone was being built on to the vital trabeculae. After 6 weeks the reimplant in the FAS group was still clearly advanced in relation to the non-FAS group. The difference had almost disappeared after 9 weeks. Acceleration of remodelling and lack of regression of the osteocytes in the centre of autologous reimplants after the use of FAS indicates an earlier recommencement of nutrition as compared with the control group. New bone formation in autologous reimplants was clearly accelerated by the use of FAS.


[Causes and consequences of long term consumption of phenacetin-containing analgesics, from the urologist's point of view (author's transl)].

In the last two decades reports concerning analgesic nephropathies have been presented from most industrial countries. Today, there is no doubt concerning a causal association between long-term consumption of analgesics and renal failure. In a group of 274 urological patients, the reasons and consequences of long-term intake of phenacetin-containing compounds are herewith demonstrated. The reason for chronic consumption of analgesics is mainly headache, due to psychosomatic causes which had not been adequately treated. After an average latency period of 20 years, renal (papillary necrosis, chronic interstitial nephritis) and extrarenal manifestations appeared. Despite slow progression and low gradient symptoms, severe alterations could be determined at the first examination. Course and prognosis primarily depend on a successful cessation of analgesics and the elimination of the accompanying infection. In the last decade, an increase of transitional cell carcinoma induced by analgesics has been observed. 22 of our patients presented a tumor of the urothelium (i.e. 8%). A further increase of these specific cases is expected.


[Disorders of the arterial blood supply in the upper extremities].

Arteriopathies of the upper half of the body may lead to considerable functional disturbances of the arm and severe deficits on the part of the central nervous system. Due to good comparison they scarcely cause or do not cause any complaints in a no unconsiderable part. The clinical material consisting of 4,162 patients from five annual courses had in 9.2% occlusion and stenoses localized in the supraaortic and brachial region. The in most cases systemic angiopathy here explains the frequently combined appearance with arterial processes in the pelvic and the leg region. According to the height of the occlusion we clinically differ types of carotis, shoulder girdle, upper arm and peripheral-acral obliteration, which in each case show differences concerning frequency, age of manifestation, etiology, distribution of sex and clinical degree of severity. The angiological basic diagnostics is based on the inspection, palpation of the arteries, auscultation of the vessels, bilateral measuring of the blood pressure after Riva-Rocci and functional examinations, such as fist closure test and Allen test, as well as clinical proofs or exclusions of neurovascular syndromes of the shoulder girdle. The special apparative angiological methods comprise the oscillo-, rheo- and vein occlusion plethysmography, the Doppler ultrasound technique, estimations of the ophthalmic pressure, isotopic methods and angiographic exploration. --The individual angiological examination methods are of different importance according to the height localisation of the angioorganopathy. --The incomplete syndrome of the aortic arch is taken into consideration. In short the author adopts a definite attitude to the demands of therapy.


[Long-term course of aortic arch syndrome caused by arteriosclerosis].

The course of the extracranially conditioned cerebrovascular disease is characterized by a worse prognosis in comparison with the average population of the GDR (11 years older) and by increased cardiovascular complication rate (every fifth patient suffered a myocardial infarction, every fourth patient suffered an apoplexy). Younger age of manifestation and increasing number of concomitant diseases form the basis of a course which is altogether endangered by complications, which, however, compared with peripheral and coronary arteriosclerosis, is more favourable. Operative reconstruction of the path of a vessel leads to an enduring improvement of the picture of the complaint. The total prognosis corresponds to the so-called spontaneous course. Under permanent treatment with anticoagulants a retardation of the general progressing of arteriosclerosis and improvement of the survival rates is to be proved.


[Stimulation for a "personal history of behavior modification" as well as further thoughts].

The intention of this article is not to make a contribution to the historical analysis of the complex structure of conditions which eventually led to the development of the many techniques of Behavior Modification. Due to the increasing interests -- especially recently -- for the real and true fathers, grand-fathers and great-grandfathers of Behavior Modification this article tries to provide a first concept of a "Personality-History of Behavior Modification". In other words; it is the very first attempt to take Eysenck's demand seriously: "Credits should be given where it is due." (Eysenck 1975 b, S. 72.).


[Primary manifestations of immunoblastic lymphoma in the area of a resected lymphedema].

A patient's trauma in childhood leads to a chronic lymphoedema requiring a Charles' operation in adult life. Eight years following the operation the primary manifestation of a malignant lymphoma is observed within the operated lymphoedema. The aetiology of the tumour remains unknown.


[Pathomorphology and indications in plastic surgery of the breast].

The pathohistological features of two breasts with implants coated with polyurethane are described.--The first case with an implant of 4 months shows a capsule with cellular collagen tissue and triangular and rectangular polyurethane particles with foreign body reactions. The second case, an autopsy of a female artist, revealed a mammary augmentation in both breasts in situ. The prothesis were surrounded by a regular capsule tissue without inflammation.--The different reactions in the connective tissue of the breasts surrounding the implants are described: Silicone implants by Cronin and polyurethane coated implants by Ashley. Complications of breast prothesis are discussed. The constrictive fibrosis is initiated by local chronic inflammation and foreign body reactions. The subcutaneous mastectomy with implantation of prothesis is performed today in cases of fibrocystic diseases with atypical epithelial proliferations, in cases with recurrend fibrocystic disease, with non-invasive ductal carcinoma and lobular carcinoma in situ. The subcutaneous mastectomy is therefore a prophylactic and a therapeutic method.


[Cancellous bone grafting for fingers and metacarpus].

Bone grafting using cancellous bone is a reliable method treating fresh and old fractures. In the period 1974-1977 the Department of Plastic Surgery of the University Hospital "Bergmannsheil Bochum" treated 39 cases of finger- and metacarpal-bone injuries and bone diseases successfully by cancellous bone grafting. Indications, technique and results of our methods are described.


[Antiseptics and aseptics in changing times].

The history of wound healing is a series of errors not to be understood today. Historical aspects of anti- and aseptis are dealt with; the merits of Ignaz Semmelweis, Joseph Lister and Robert Koch are stressed; conclusions for the time being are drawn.


[Necrectomy in full thickness burns (author's transl)].

54 necrectomies of 10 to 25% have been performed in full thickness burns covering up to 50% body surface. The optimal time for the procedure is between the 5th to 9th day after the accident. The loss of blood is considerable and should be substituted during the operation. After removing the necrotic tissue the wound surface should be immediately covered with autogenous oder homogenous skin using the mesh graft technique. Necrectomy is a very traumatising operation and its extent has limitations depending on the patient's age.


[Meralgia paraesthetica (author's transl)].

For transplantation of autologous bone the chips are mostly taken from the crista iliaca respectively the os ileum. Besides haematoma and seroma sometimes a specific kind of pain follows the operation. 5 patients with this neuralgia out of a total of 84 were observed.


[Continuous cervix measurement (author's transl)].

A new technique has been devised for high-continuity recording of cervical dilatation during labour. The measuring principle is based on Hall's effect. The sensor is superior to conventional methods by its smaller dimensions and weight and the possibility of on-line processing. The new method is used in conjunction with cardiotocography to test the action of medicaments upon cervical behaviour and labour.


[Survey of antibiotic resistance in gram-negative bacteria using the cross product ratio].

Antibiotic resistance pattern in clinical isolates of selected gram-negative bacteria at Groote Schuur Hospital during two three-month periods with a ten year interval were investigated. The antibiotic resistance is represented by means of the cross product, or odds ratio, using the log-linear model. This was found to be a simple method of monitoring the change or increase of antibiotic resistance, and enabled an overall analysis, catering for antibiotic and organism effects, to be performed


Leptospires colonial variations.

Six of 12 relatively freshly isolated and museum strains representing serovars mozdok, monjakov, kazakhstanica I and patoc were heterogeneous in colonia morphology. Recloned colonial variants of one and the same heterogeneous population did not exhibit any differences in antigenic properties in cross reactions of microagglutination and absorption of agglutinins. Along with it among the clones with various colonial types of the two relatively freshly isolated strains of serovar mozdok distinctions in virulence (LD50) for hamsters were marked. Moreover for the clones one of them differences in the level of renal infection (ID50) and in morphology of the cells (hooked and straight) were found. In a solid Tween-80 albumin medium in populations of two colonial variants (serovars monjakov and kazakhstanica I) colonial mutants appeared without any changes in antigenic properties, virulence and cell morphology with frequency of 10-9-10-8 per one bacterium per one generation.


[Experimental studies on the pathogenicity of tetanus spores regarding eucaryotic cell systems (author's transl)].

After injection of known numbers of viable tumour cells admixed with tetanus spores into the subcutaneous tissue between the shoulder blades the sigmoidal tetanus lethality curves of mice can be quantitatively analysed following the underlying growth of tetanus clostridia and tumour cells. We suggest that the "driving force" for exponential clostridial growth and toxin synthesis are oxygen-consuming clones of tumour cells. Our experimental data are in good accordance with a stochastic mathematical model which allows for computing the cloning probability of one single spore on the basis of a 1-mitosis-1-clostridium division-principle.


The detection of nasal carriers of salmonella and other enterobacteria amongst young farm animals.

An investigation was conducted to detect the presence of Salmonella nasal carriers amongst young farm animals (Cow-calves, buffalo-calves, lambs, kids, piglets and foals) on farms having a previous history of Salmonellosis. Salmonella could be isolated from nasal swabs of 1.2% of the cow-calves and 2.9% of the piglets studied but not from other young animals. Isolated strains included S. typhimurium and S. weltevreden from cow-calves and piglets, respectively. Other members of family Enterobacriacteeae isolated from nasal passages of these animals were: E. coli (O106:H27 and O153:H12), Serratia rubidiae, Klebsiella spp., Enterobacter spp. and Citrobacter spp. One of the Citrobacter strains from piglet faeces which appear to be a new Citrobacter serotype had Salmonella 45(1), 45(3), 45(5) 'O' antigens. The results indicated that the upper respiratory tract of animals carried Salmonella and other potentially pathogenic enterobacteria which might contribute to the spread of corresponding infections among man and animals.


[Seasonal and periodic rhythms of infectious diseases (author's transl)].

The causes of epidemics are plainly not the pathogens alone as was initially assumed by Koch's school, predisposition and constitution of the population proved to be equally important. Ever since ancient times problems linked with the "constitutio epidemica" have been topical; the "physis", the "natura hominis" and the invironment of man play an increasingly important role in the symptomatology of disease, as can be gathered from such early documents as the "Corpus hippocraticum". Fracastoro distinguished between contagious and non-contagious epidemics. The casual organisms were considered to be miasmas -- noxious emanations -- or "contagia" i.e. likewise toxic substances. Questions concerning the origin of these miasmas turned attention to the environment (air, soil, water) and even led to astrological medicine. Not until the Renaissance were attempts made to differentiate the usual global words for epidemic, such as "loimos", "lues" and "pestis" with the result that a symptom was used more and more to designate a disease. For example, the symptom fever led to the designation "three-day fever" or "four-day fever", "typhus fever". This terminology made a differential diagnosis difficult to establish, thwarted selection measures to check epidemics and the medical world was thus helpless in explaining the causal agents and the phenomena of epidemics. This is illustrated by some epidemiological examples (ergotism, scurvy, yellow fever, English sweat, diphtheria and malaria). In this connection the "morbus novus", the transformation of the pathogen and the change of the pathogen is discussed. Many questions still left unanswered regarding the seasonal incidence, the fluctuation and disappearance of epidemics over decades or even centuries lead more frequently to sociomedical considerations with respect to the victims of epidemics, their predisposition, constitution and environment exposure term "hospital gangrene" with the modern term "hospitalism", we are not dealing with a transformation but a change of the pathogen. The impressive effects produced by antibiotics resulted in carelessness and along with the unprecedented advances in medicine and engineering we forgot to bear in mind that almost all great steps forward have an adverse side. Hygiene and practical medicine have only made a modest beginning in establishing the contact which should indeed be a matter of course in the hospital.


[Travellers' diarrhoea. I. Field study on frequency and causes in German tourists (author's transl)].

Even after successful localization of dangerous epidemics, infectious diseases represent a troublesome accompaniment of growing tourism to warm countries. Classical pathogens of diarrhoea are subjected to a worldwide control network to prevent this disease at least from being spread. Close surveillance has shown that, additionally, less clearly defined pathogens exist which affect a high percentage of tourists and cause a usually harmless but nevertheless often very annoying diarrhoea. In a tropic insular state a field study was carried out with voluntary assistance of German flight passengers in order to investigate the qualitative and quanitative importance of travellers' diarrhoea and to supplement American observations mainly gained in Mexico. In a first study we found that pathogens were detected only in six out of 173 stool samples: the pathogens were Salmonellae which had caused clinical symptoms in two cases only. With respect to diarrhoea with different origin which affected some 20 per cent of our examinees we will inquire into the importance of E. coli as pathogen, which is generally classified harmless but liable to interfere considerably with holidays and recreation.


[The influence of short-term lead exposure on the bacterial clearance of the lung (author's transl)].

The experiments describe the effects of short-term application of low concentrations of lead on the elimination of bacteria in the lungs of laboratory animals. On five subsequent days over a period of three weeks female mice of the NMRI strain were exposed for one and three hours, respectively, to a lead aerosol (mean concentration 13,14 micrograms/m3 lead chloride). Then the animals inhaled FITC labeled non pathogenic bacteria of the species Serratia marcescens. The lungs of the animals examined were analyzed for: a) free fluorescent bacteria in the pulmonary tissue, in the alveoles, bronchioles and bronchi; b) phagocytising alveolar macrophages; c) non-phagocytising alveolar macrophages. The following results have been established: 1. Under the given test conditions a three hour inhalation of lead chloride induces a significant reduction in the elimination of the bacteria. A one hour inhalation causes differences between the mean values of the test group and a control group on nearly all the days of experiments. On the 10th, 13th and 14th day of inhalation a signifcant difference between both groups could be established. The number of bacteria fluctuates largely from one day of test to the next, including a weekly rhythm. 2. Comparing the test group with the control group with respect to the parameters "phagocytising alveolar macrophages" and "free bacteria" as well, one can notice for the one hour lead chloride inhalation particularly high numbers obtained on weekends. The number of phagocytising alveolar macrophages tends to increase after a one hour lead chloride inhalation period during the third week of the experiment. This indicates a reactive increase of phagocytosis stimulated by the increased uptake of bacteria. Contrary after a three hour inhalation period of lead chloride during the third week from the 11th to the 15th day of testing, no further reactive increase in the number of phagocytising alveolar macrophages can be established. . A comparison of the number of non phagocytising alveolar macrophages did not reveal any differences between the mean values of the test groups for one hour and three hour inhalations compared to the control groups.


[Investigation on the presence of salmonella in drinking water from water supplies and distribution systems in Togo (author's transl)].

Bacteriological drinking water examination of samples from water works and wells as well as from their distribution systems revealed that from 26 samples, where Salmonella organisms could be isolated, in 16 cases E. coli- and coliforms could not be found and that in 9 of these cases even the colony count was below 100 colonies per ml at 20 degrees C and 37 degrees C incubation temperature. The common reasons for such contaminations are technical deficiencies, mostly faulty well-heads or broken covers of reservoirs. Rainbow lizzards (Agama agama), very common in these regions, can thus easily gain access to wells and reservoirs and pollute the groundwater. Rainbow lizzards do not posses a constant and uniform microbial flora of the intestine. Among lizzards which excrete Salmonella organisms in great numbers, relatively often individuals could be found which harbour either no E. coli- and/or coliforms at all or only in very reduced numbers. In the light of these results an efficient primary protection of all water supplies by a secure covering of well-heads and reservoirs in particular seems to be of paramount importance in tropical countries. This is very much in contrast to the situation most commonly seen in these areas. The necessary measures would have to be accompanied and supplemented by alterations of the installations in the house where the creation of open reservoirs must be avoided.


Micrococcaceae isolated from meat and dairy products (taxonomic study).

149 Micrococcaceae strains (35 reference strains and 114 strains isolated from meat and dairy products) have been studied using 61 biochemical microtests. Numerical taxonomy has distinguished two main biochemical groups which may be characterized by their varying ability to use heteroside compounds. -- A small number of biochemical tests in each group enable the differentiation of 17 taxa corresponding to diverse origins. The wild strains of Micrococcaceae found in foods are very different from reference strains in collections. -- With regard to the present study, it seems that a central biotype exists which may be represented by the taxa 13, 14, 15 and 16 in Fig. 1. -- Given this central biotype, various biochemical differences may be considered as ecological adaptability. Group I corresponds to meat orgin -- Taxa No. 1, 2, correspond to collection strains -- Taxon No. 12 corresponds to cheese origin -- Taxa No. 8, 9 and 10 correspond to milk origin.


[Restoring the continuity of severed peripheral nerves. Indications and surgical technics].

The detailed literature is critically examined, especially with regard to the questions of the time of the operation, technique of the intervention, use of transplantation, suture under tension, etc. The author recommends the following operating tactics: (I) Smoothly separated nerves without any defects or larger side-injuries are subject to primary care. Mono- to oligofascicular nerves are loosely coapted by epineural sutures; the protruding contents are not excised. For polyfascicular nerves one uses endofascicular guiding sutures and coaptation by epineural sutures. In case of a clear group structure, interfascicular coaption is used. (2) Early secondary care according to plan gets to the stumps from the healthy material and uses interfascicular transplantation for every tension occurring. In case of polyfascicular nerves without group structure, the corresponding sectors are connected with each other. (3) The late secondary care follows the rules for the early secondary care. (4) Re-operations are carried out if regeneration does not set in, testing is mainly carried out by means of the Hoffmann-Tinel sign. Sometimes intraneural neurolysis will be sufficient in these cases; more often than not, parts of the whole cross-section must be resected or bridged again by transplantation.


[The hypophysis and haemoblastoses].

In necropsies of 165 patients with malignant haemoblastoses, infiltrates in the pituitary were found in 38 cases (23%). The most frequent occurrence was found in lymphoblastic leucosis (33.3%) and in non-Hodgkin lymphomas (29%). Hypophyseal manifestations were found in 21% for myoblastic leucosis and in 5.5% in case of Hodgkin lymphomas. As regards the location, the capsula showed an affection of 55.2%, the anterior and posterior lobes together one of 21.1%, the neurohypophysis one of 15.8% and the anterior lobe one of 7.9%. There are different opinions with regard to the development: exclusively metastatic processes or local formation of the infiltrates. The latter opinion is favoured by the frequent detection of cells of exemplary haemopoiesis between the Dorsum sellae and the outer layer of the hypophyseal capsule (Stratum periostale) in patients without haemoblastosis as well as by the fact that in half of the patients the clinical picture of meningosis leucotica only developed in the stage of haematological full remission, that is, when there were no longer any blastomatous cells in the blood.


Gastrin response to insulin in patients with cirrhosis of the liver.

Fasting gastrinemia in cirrhotics (48.35 +/- 2.77 pg/ml) was higher than in normal controls (32.93 +/- 0.75 pg/ml; P less than 0.001). After insulin-induced hypoglycemia, the mean increase of gastrin above basal level was 42.29 +/- 1.92 pg/ml in controls and 10.85 +/- 5.05 pg/ml in cirrhosis (P less than 0.001). BAO was 2.53 +/- 0.36 mEq/h in controls and 0.42 +/- 0.004 mEq/h in cirrhotics (P less than 0.001). After i.v. insulin, TAO was 8.42 +/- 0.72 mEq/h in controls and 3.06 +/- 0.26 mEq/h in cirrhotics (P less than 0.001). The authors suggest that the lack of an adequate gastrin and acid response to the hypoglycemic stimulus in cirrhotics might be accounted for by a decreased insulin sensitivity.


Postoperative arterial oxygen tension after peroperative PEEP-ventilation.

Forty otherwise healthy patients (29 women and 11 men), undergoing elective cholecystectomy, were randomly allocated to be ventilated during the operation either with a positive end-expiratory pressure of 1 kPa (10 cmH2O) (PEEP group) or with intermittent positive pressure ventilation without PEEP (control group). During the operation the mean arterial oxygen tension (PaO2) in the PEEP group increased from 14.6 to 16.5 kPa, while no changes occurred in the control group (13.5 and 13.6 kPa). On the first postoperative day, PaO2 decreased by 12% of the preoperative values in the PEEP group; the decrease was 20% in the control group. On the third postoperative day, the PaO2 in the control group was still 9% below the preoperative values, but on the fifth day, both groups had reached their preoperative PaO2 values. In the postoperative period, no statistically significant difference in PaO2 could be demonstrated between the groups. Determinations of the forced vital capacity and forced expiratory volume in the first second showed no difference between the groups pre- or postoperatively. The present study demonstrated no clinically relevant beneficial effect of peroperative PEEP ventilation on the postoperative arterial hypoxaemia after an upper abdominal laparotomy.


Scanning electron microscopy of epiplexus macrophages responding to challenge by bacillus Calmette-Guerin.

The present investigation examined the morphological characteristics of epiplexus macrophages following a single intracisternal injection of the antigen, bacillus Calmette-Guerin (BCG). Three days following injection of BCG (0.5 - 4.0 X 10(8) viable microorganisms), mongrel dogs were perfused with buffered aldehydes. The choroid plexus of the lateral and third ventricles was removed and routinely prepared for scanning or transmission electron microscopy. Choroid plexuses from normal animals (no BCG injection) were similarly prepared. Macrophages of normal animals possessed smooth cell surfaces with usually one to three cytoplasmic processes. Following BCG injection, a 10-fold increase in the epiplex macrophage population was observed. Furthermore, the majority of these cells presented an abundance of cell surface microappendages; including blebs, ruffles and microvilli. Cell processes and microvilli frequently mediated contacts between widely separated macrophages. These associations may play a role in the initiation and/or maintenance of the cellular immune response to BCG.


Uncommon case of type II glycogenosis.

The authors report an uncommon case of type II glycogenosis. An 8-year-old boy developed a slow progressive myopathy. Biopsy of skeletal muscle showed scarce lesions under the optic microscope but in 50% of the fibers the presence of vacuoles filled with glycogen under the electron microscope. Ultrastructural analysis of fibroblasts in culture showed numerous vacuoles filled with glycogen, characteristic of type II glycogenosis. Enzymatic analysis revealed that acid-alpha-glucosidase activity was normal in muscle tissues but deeply deficient in leukocytes and fibroblasts in culture. This is, as far as we know, the first case with such a discrepancy in the distribution of the enzymatic activity, and it underlines the necessity of investigating several tissues in atypical cases.


Complications of cerclage.

The published results of cervical cerclage are almost invariably good and there is little mention of complications. Forty per cent of 52 pregnancies, with 38 early "prophylactic" and 14 late "therapeutic" operations, ended after 260 days' gestation. In 73 per cent a viable infant was born. The most frequent complication was premature rupture of the membranes (12 cases) followed by slipping suture (7) and premature delivery (6). Intra-uterine infection was fairly common. The implications and possible causes of this high rate of complications are discussed.


The unilateral vestibular hypofunction.

The presentation of the report "THE UNILATERAL VESTIBULAR HYPOFUNCTION" has been placed in the scope of the treatment technique, which resulted from the findings and experiences of the author could obtain by his investigations in the clinical cases with unilateral vestibular hypofunction. After having emphasized some main concepts concerning correct evaluation of unilateral hypofunction, which is the central theme of the report, the author indicates how these experiences led him to the conception of this treatment technique: THE VESTIBULAR HABITUATION TRAINING. It is intended for this category of dizzy patients, who usually were so resistant to be alleviated from their dizziness, viz. the cases with provoked or positional dizziness. The fundamental bases of this treatment are exposed. A survey of the literature concerning the various concepts and techniques of vestibular revalidation is followed by the description of the personal technique and the presentation of the first results.


Electron microscopy of treponemes subjected to the Treponema pallidum immobilization (TPI) test. I. Comparison of immunoimmobilized cells and control cells.

The ultrastructure of cells of T. pallidum Nichols subjected to the TPI test was studied in negatively stained specimens. Cells incubated in basal medium to which was added either human syphilis serum or heated guineapig serum (GPS) showed a normal morphology. This was also the cause for cells incubated with basal medium to which was added either human syphilis serum and heated GPS or normal human serum and unheated GPS. By dark-field microscopy cells obtained from these different incubation mixtures were found to be motile. In contrast, cells incubated in basal medium to which was added human syphilis serum and unheated GPS were all immobilized, and in the electron microscope they presented a morphology strikingly different from that of normal cells. The immunoimmobilized cells were swollen and their surface was completely covered with a layer of fuzzy material. The nature of this material and its possible role in rendering the treponemes immobile is discussed.


Demonstration of the non-identity between the Fc receptor for human IgG from group A streptococci type 15 and M protein, peptidoglycan and the group specific carbohydrate.

After electrophoresis of an alkaline extract of type 15 group A streptococci, three main precipitation lines were obtained in diffusion experiments against commercial human polyclonal IgG (lines 1, 2 and 3). Nineteen of 23 sera (83%) from apparently healthy human individuals gave line 3, while 6 of them (26%) gave line 1. The sera giving line 1 did also give line 3. Line 2 was obtained with 2 sera only, also giving lines 1 and 3. Line 3 was caused by a streptococcal Fc-receptor for human IgG, since the line could be displaced by addition of Fc-fragments, but not Fab-fragments of pooled human IgG. Line 1 was shown to be different from line 3, since (1) line 1 was suppressed in contrast to line 3 on absorption of a human serum or commercial polyclonal human IgG with S. aureus; and (2), line 1 was suppressed by Fab-fragments but not Fc-fragments of polyclonal human IgG. Line 2 could be inhibited by addition of peptidoglycan to commercial polyclonal human IgG or a human serum investigated. Another line, 4, obtained in diffusion experiments involving electrophoretically separated alkaline extract of type 15 group A streptococci was type-specific as shown by rabbit antisera to streptococci type M1, M8, M15, and T44, and disappeared on trypsinization of the extract. The component responsible for line 4 in the streptococcal extract, judged to be type-specific M protein, had a mobility different from the component responsible for line 3 in electrophoresis.


Endotoxin and prostaglandin fever of newborn guinea pigs at different ambient temperatures.

At an ambient temperature (Ta) of 30 degrees C, injection of 0.2 micrograms E. coli endotoxin into the lateral cerebral ventricle (icv) of three-day-old or younger guinea pigs was followed by a biphasic febrile rise in body temperature (Tc) and oxygen consumption (VO2), interrupted by a transient fall. At Ta 20 degrees C the change in Tc and VO2 was still biphasic, the first rise was similar as that seen at Ta 30 degrees C, but the subsequent fall was more pronounced. Thus, Tc became lower than before endotoxin and remained below the pre-injection level during and after the second rise. Injection of 10 ng PGE1 icv caused sustained monophasic hyperthermia at both Ta-s. Icv injection of 0.9% NaCl did not affect Tc and VO2 at either Ta. Accordingly, prostaglandins might contribute to, but cannot account for, the whole febrile response to endotoxin.


[The anodically moving thermolabile antigen (ATA) of Gram negative bacteria. Protection of mice by immunization with ATA (author's transl)].

Mice are protected against lethal doses of Salmonella typhi-murium by vaccination with ATA extracted from Providencia. No protective effect is observed when the S. typhi-murium strains are enterotoxigenic. Thus protection is antibacterial, but not antitoxic.


Effect of deep freezing on the result of blood cultures.

From citrated blood samples left to stand in the deep freeze at -20 degrees C for 12--14 hr prior to culturing, Staphylococcus aureus was recovered more effectively than from the control cultures.


A scanning electron microscopic (SEM) study of the re-endothelialization of the carotid end-to-side anastomosis in the rat.

A carotid end-to-side anastomosis was made on 25 male Wistar rats (mean weight 197.8 g). At different time intervals, from 0 to 21 days after the operation, the animals were sacrificed. The anastomosis was exposed, the aorta was cannulated, and the animals were perfused at a constant pressure of 80 mm Hg with a 2 1/2% glutaraldehyde solution. The anastomoses were taken out for further SEM and light microscopic (LM) study. The SEM results indicate that after the acute platelet-fibrin reaction in the first 48 hours the suture line itself becomes reendothelialized after 4 days. On the stitches, however, (EthilonR 11 X 0, 2871 G, BV7 needle) after two days a cellular population was seen, consisting of leucocytes transforming into flattened cells. The morphology of these cells and their role in the regeneration of endothelium is discussed. This study gives evidence to the possibility of a blood-borne genesis of endothelial cells in vivo.


Opto-chiasmatic arachnoiditis: a review of traditional neuroradiological diagnosis (82 cases, 1951--1976).

A retrospective appraisal of traditional neuroradiological techniques (such as direct röntgenograms, cerebral angiography RISA-cisternography, and pneumo-cisterno-encephalography, as opposed to the "new" technique of computer-assisted tomography) was carried out in a series of 82 cases of opto-chiasmatic arachnoiditis, all surgically verified. It is concluded that none of these examinations can provide a reliable diagnosis of opto-chiasmatic arachnoiditis, which preoperatively can only be a tentative diagnosis that becomes final only when confirmed by surgical findings. In the presence of certain progressive neuro-ophthalmological symptoms and signs, a negative neuro-radiological investigation should not deter the neurosurgeon from exploring the chiasmatic region. Computer-assisted tomography, of which the authors have no personal experience in these cases, may hold the future answer to the diagnostic problem.


The magazine picture collage: its clinical use and validity as an assessment device.

To contribute to an understanding of the magazine picture collage as a clinical assessment device, experienced psychiatric staff from various disciplines were asked to distinguish the collages of hospitalized psychiatric patients from those of paired controls, to note whatever descriptive and dynamic features about the individual that could be inferred from the collage, and to document what specific aspects of the collage were used in drawing the inferences. The raters, on the basis of the collage, were not able to distinguish the patients from the controls but were able to derive highly accurate inferences. The results were taken to indicate that, while the collage is best used as a means of assessing psychological processes as contrasted with assigning a diagnosis or predicting behavior, more rigorous research is needed to relate collage factors to personality factors.


The physiological consequences of wearing industrial respirators: a review.

The American Industrial Hygiene Association (AIHA) and American Conference of Govermental Industrial Hygienists (ACGIH) Respiratory Protective Devices Manual, published in 1963, has as its primary source of physiological background the work of Silverman and co-workers performed during World War II. The adoption of permanent OSHA standards governing work tasks requiring workers to use respirators has created a need for further evaluation of the physiological effects of wearing a respirator. This review was undertaken to meet the need of an in-depth evaluation of the currently available psychophysiological data. It was concluded that it was of the utmost importance to develop a physiological and psychological medical screening examination to determine the capability of the worker to use a respirator.


Stresses involved in wearing PVC supplied-air suits: a review.

A side effect of the growth and development of industrial technology is the ever increasing number of hostile environments encountered by man. This situation has resulted in the development of impermeable clothing as a barrier protection against the external environment. Unfortunately, although specific government standards concerning the design and engineering requirements of the impermeable suit have been stated, little or no standardized evaluation of the majority of available suits has been attempted. This review was undertaken to provide an in-depth summary of the physiological effects of a PVC protective suit while working. It was concluded that it was necessary to develop a standardized performance test to determine the protective and stressful characteristics of the individual manufacturer's designed suit. Recommendations of specific criteria for the test were obtained.


Alimentary hypoglycemia: a new appraisal.

The clinical evaluation and the results of oral glucose tolerance tests in patients with alimentary hypoglycemia, reported previously or studied as part of our group of 24 patients with this disorder, suggest that alimentary hypoglycemia may differ from other reactive hypoglycemias in clinical presentation and importance. Unlike other reactive hypoglycemias, alimentary hypoglycemia may be associated with severe or permanent neuropsychiatric complications. Subtle, "neuroglycopenic" symptoms of hypoglycemia may occur, instead of "typical," "adrenergic" symptoms. Glucose ingestion, by causing early hyperglycemia and provoking the release of insulinotropic enteric hormones appears responsible for this disorder. Therefore, therapy with diets low in simple sugar, but unrestricted in complex carbohydrate and fiber are now advocated.


A comparative study of greek and chinese alchemy.

According to an herbal cult of immortality in China, about 200 B.C., certain plants could make man immortal. Greek alchemy, the earliest record of which dated about 200 A.D., presents a similar version, was originally Chinese and was introduced by the Arabs who brought herbal drugs of longevity to Alexandria. The name of these drugs, Chin-I, dialectal Kim-Iya, was Arabicized as Kimiya and transliterated Chemeia by the Copts. Other terms were later influenced by Indians (Chumeia, 100 A.D.) and more directly by the Chinese (Chrusozomion, 200 A.D.). The 3 terms signify herbal elixirs of gold and the art related to them. Both early Chinese and Greek alchemies were not concerned with the making of bullion gold. In China the development of alchemy has been ruled by two theories: first, as like makes like, a perennial plant can make human life perennial: likewise, certain substances can prolong human life as they are rich in Life-force or Soul-content. From here, Blood was equated to Soul and later Redness to Soul. Jade, Cinnabar and eventually gold, more precisely Red-gold or Cinnabar-gold, a colloidal gold, became the ideal drug of immortality. Finally, alchemy can be defined as the art of making metal colloids as panaceae.


Myelomatous pleural effusion: clinical course and immunologic characterization of the pleural fluid cells.

Multiple myeloma is a disease that infrequently involves nonreticuloendothelial tissues and rarely causes pleural effusion. A 59-year-old woman had pleural effusion as the major manifestation of multiple myeloma. Light microscopy of her pleural fluid with Wright stained preparations showed all cells to be bizarre and often multinucleated plasmacytes. Electron microscopy confirmed these results. Intracellular immunofluorescence revealed IgG-kappa immunoglobulin (Ig) in greater than 90% of these cells. Surface immunofluorescence using anti-Ig sera was seen on less than 5% of the pleural fluid cells. 3H leucine incorporation into Ig in vitro was measured for these cells, and secretory curves were obtained that have the typical secretory kinetics of bone marrow plasmacytes. This demonstrates that such cells are viable and are able to synthesize and release immunoglobulin. Treatment of our patient with prednisone, melphalan, and cyclophosphamide resulted in symptomatic improvement and complete resolution of her pleural effusion. Pleural effusion is an unusual but important complication of multiple myeloma and does not necessarily carry the grave prognosis implied in previous reports.


Gastroenteritis due to enteropathogenic, enterotoxigenic, and invasive Escherichia coli: A review.

Escherichia coli that produce diarrhea can be divided into three groups: 1) enteropathogenic, 2) enterotoxigenic, and 3) enteroinvasive. The mechanism of disease production by enteropathogenic E. coli is unknown, but these strains are not presently known to be inherently pathogenic, although they may be important as a cause of gastroenteritis in infants. The two known mechanisms of disease production are elaboration of enterotoxin and mucosal invasion. Heat-labile toxin-producing E. coli are the main cause of diarrhea in travelers while heat-stable toxin-producing E. coli are a cause of scours among new-born swine and cattle. Enteroinvasive E. coli have not been shown to be an important cause of diarrhea in the United States. Enteropathogenic, enterotoxigenic, and enteroinvasive E. coli that currently are associated with diarrhea worldwide may each consist of relatively few serotypes different from those associated with out-breaks of diarrhea in the past. This implies a possible new role for sero-typing of E. coli.


Determination of serum hCG levels by radioreceptor assay in the clinical laboratory.

The radioreceptorassay (RRA) has been used for measuring human chorionic gonadotropin (hCG) in sera from 751 individuals. The RRA is shown to be sensitive (98 percent) and specific (99.8 percent) in detecting hCG in a wide variety of conditions, including normal pregnancy and threatened or missed abortions. As a rapid qualitative or semiquantitative assay for hCG, the RRA is a valuable adjunct in the laboratory to less sensitive tests for hCG. Variation among different quantitative assays for hCG is examined, and it is concluded that the same assay system should be used for monitoring hCG LEvels in a single individual over a period of time in order to avoid inconsistent results. Application of the quantitative RRA for hCG in detecting the midcycle luteinizing hormone surge in infertility is also presented.


A short history of human genetics in the USA.

The practicing physician discovered human genetics primarily as a result of two events. The use of the atomic bomb generated a vast amount of attention because of the fear of genetic hazards of radiation. Next, the discovery that the Down syndrome resulted from the presence of an extra chromosome finally focused the vision of the medical profession on human genetics as an area of importance in disease. It was also necessary that the erroneous fatalism about the impossibility of treating genetic diseases had to diminish before medicine would find human genetics attractive for research in therapeutic techniques. All of these things have come to pass and human genetics cannot help but enjoy a distinguished and extremely useful future.


An association between chronic eosinophilic pneumonia and histiocytic lymphoma.

An association between chronic eosinophilic pneumonia and non-Hodgkin's lymphoma previously has not been reported in adults. We describe a woman with chronic eosinophilic pneumonia documented by chest roentgenogram, elevated total eosinophil count, and transbronchial biopsy demonstrating eosinophilic pneumonitis. The illness was controlled with corticosteroids for ten months after which time lymphadenopathy appeared and diffuse, histiocytic lymphoma was diagnosed.


Ocular toxoplasmosis in wallabies (Macropus rufogriseus).

We initiated a pathologic investigation of ocular disease in wallabies. Of 21 animals examined, the eyes were investigated histologically in 11; in four of these animals the brains were also available for section and the sera were investigated in three. In ten animals only sera were received. Histologic studies showed bilateral or unilateral cataract in five animals. Eight animals, with or without cataracts, showed various degrees of keratitis, uveitis, choroidoretinitis, or endophthalmitis. In three animals Toxoplasma cysts were found within the retina or brain, or both. Of the 13 cases examined serologically 11 were positive for toxoplasmosis; three reached high titers.


Keratoplasty in Fuchs' dystrophy and bullous keratopathy.

We studied the results in six cases of penetrating keratoplasty in Fuchs' dystrophy and bullous keratopathy. The prognosis has improved considerably in the last decade because of the advances and improvements in the fields of anesthesia, new drugs, better instrumentation, more refined surgical techniques performed under microscopic control, more meticulous selection of the graft, better knowledge of biologic mechanisms, and progress in the prevention, diagnosis, and management of complications.


Instrumentation and techniques for corneal microsurgery.

We developed two additions to a new system of microsurgery for corneal cutting and grafting: a 10-mm contact lens corneal cutter and a stereotaxic donor disk chuck and frame.


Current techniques of adjustable strabismus surgery.

Adjustable strabismus surgical procedures provide the opportunity to reposition a surgically altered muscle position, which is often necessary for nonaverage cases of strabismus correction. The usual surgical procedure is extended into the postoperative period (same hospitalization) so that the surgeon may satisfactorily monitor the total end result (by cover test and rotations) at the time of adjustment. Adjustable techniques should be considered whenever a desired goal is unlikely to be reached in one surgical session. Recent technical improvements allow satisfactory globe position control during the adjustment stage for ease of recession or resection adjustment. Globe stabilization is attained during surgery and the postoperative adjustment by means of a scleral loop handle, placed near the corneoscleral limbus. Millimeters of adjustment are easily estimated by means of a sliding suture knot technique.


A decision-making schema for the detection of glaucoma.

A schema is proposed for management of optometrical patients who may have glaucoma or any of 22 risk factors of glaucoma. The assessment system has established decision points and management pathways based on risk factors in glaucoma which employ only clinical procedures appropriate to current optometrical practice. This schema is particularly designed to permit diagnosis of early angle-closure glaucoma while the disease is in the symptomless phase, prior to chronic elevation of intraocular pressure and the development of damage to the optic disc and visual fields. A recommendation is made for inclusion of the Van Herick test as routine and in the assessment of patients entering the schema. Gonioscopy should form part of the diagnostic workup, but an alternative pathway is established for use when this technique is omitted.


A selected review of current retinal research and study.

This paper presents a digest of 50 retinal research projects reported in one British and two American journals from July 1976 through June 1977. The articles reviewed report recent developments pertaining to effects of excessive light on retinal tissue in newborn rats, pathogenesis of cotton-wool spots, control of the blood-retinal barrier in diabetes, infections, macular diseases, variations in retinal pigment epithelium, and retinal detachment.


Immunologic reaction of psychotic patients to fractions of gluten.

Production of a leukocyte migration inhibition factor by peripheral blood lymphocytes in response to challenge with gluten fractions was studied in hospitalized patients with schizophrenia and other psychoses compared with normal individuals and with children and adolescents with celiac disease. The schizophrenic and other psychotic patients could be subdivided into two groups, one that responded in the leukocyte migration inhibition factor test as the celiac patients did and one that responded as the normal control subjects did. The psychotic and schizophrenic patients did not show any evidence of malabsorption. The authors speculate that gluten may be involved in biological processes in the brain in certain psychotic individuals.


Factors associated with increased dental care utilization in five urban, low-income areas.

Survey data were used to measure change in dental utilization in five urban low-income areas as a result of increased financial (Medicaid) and facility (community health centers) access to dental care. The average annual dental visit between the baseline and follow-up surveys showed a dramatic increase in four of the five survey areas. With the exception of Roxbury, Massachusetts, where the rate was already high in the earlier survey, the dental visit rate in the remaining areas increased 33 to 80 per cent compared to an increase of only 7 per cent nationally between 1969 and 1975. Both CHC and Medicaid programs made important contributions to increased dental care. Among persons who saw a dentist in the year in these areas, 25 per cent reported CHC as their usual source of dental care and 46 per cent reported that their dental care costs in the year were borne by Medicaid. In spite of recent increases, however, the average annual dental visit rate was only 1.0 in the five areas compared to 1.6 nationally, which is 60 per cent higher. The generally low dental utilization levels among persons covered by Medicaid or served by CHCs may indicate that much of the increased dental utilization which occurred in these areas was limited to taking care of existing dental problems while neglecting preventive dental care.


Cohort maternal mortality: New York, 1917-1972.

Data on New York State maternal mortality, 1917-1972, are analyzed and show that the cohort patterns of age-specific maternal mortality are mainly a reflection of the pattern of period declines in age-specific maternal mortality.


Ascaris and growth rates: a randomized trial of treatment.

Three hundred forty-one Tanzanian preschool children were randomly assigned to levamisole or placebo treatment given at three-month intervals. Weights and heights were measured at the tri-monthly treatment visits for a period of one year. Among the 273 children who were seen and weighed at the one-year follow-up visit, the rate of weight gain was 8 per cent greater for those receiving levamisole than for placebo-treated controls (p = .06). In 78 children known to be infected with Ascaris at baseline, the rate of weight gain was 21 per cent greater in children treated with levamisole than in those receiving placebo (p = .03). The rate of height gain was no different for treatment and placebo groups.


The role of hemoglobins C, S, and Nbalt in the inhibition of malaria parasite development in vitro.

The host cell competence of hemoglobin C (HbC)-containing erythrocytes for Plasmodium falciparum was studied by in vitro culture. HbC homozygous red cells did not support the growth of the intracellular parasite. Heterozygous cells, however, were competent. In addition, HbC increased the resistance of sicle cell hemoglobin (HbS) red cells when present in the double heterozygote, SC, cultured at low oxygen tension. This effect most likely resulted from the ability of HbC to enhance the sickling of HbS-containing red cells. Oxygenated SC cells were indistinguishable from normal and AS cells in host cell competence. Another double heterozygote, SNBalt, showed decreased sickling and decreased resistance to malaria parasite growth. The evolutionary significance of these results is discussed.


Demonstration of dengue antibody complexes on the surface of platelets from patients with dengue hemorrhagic fever.

By the direct immunofluorescent technic, dengue antigen, human immunoglobulins, and beta 1C globulin were detectable on the surfaces of platelet suspensions from 48% of patients with dengue hemorrhagic fever. The percentages of positive-staining platelets were not related to the severity of thrombocytopenia, which was marked on the day after the patient developed shock or subsidence of fever. It is suggested that an immunologic mechanism is one of the factors associated with the thrombocytopenia caused by increased platelet destruction.


Drug-resistant falciparum malaria among the Mayongong Indians in the Brazilian Amazon.

In April of 1977 an outbreak of falciparum malaria occurred among the Mayongong Indians, located at Uauaris in the Territory of Roraima, Brazil. Blood specimens from 157 Indians were examined for Plasmodium; 62 were found to be infected. In three cases the infection was not cured with chloroquine but responded favorably to the drug combination of sulfadoxine and pyrimethamine (Fansidar).


Pectoralis major musculocutaneous flap: a new flap in head and neck reconstruction.

The pectoralis major musculocutaneous flap described by Ariyan has great potential in single stage reconstructions of the head and neck. The advantages of the flap are greater length, improved vascularity, bulk, and one-stage reconstruction of oropharyngeal defects. The flap was used successfully in eight patients to reconstruct large defects in the head and neck area. Experience to date indicates that this flap has greater versatility than the deltopectoral flap in one-stage head and neck reconstructions.


Use of microvascular flaps including free osteocutaneous flaps in reconstruction after composite resection for radiation-recurrent oral cancer.

Fourteen patients underwent microsurgical free flap procedures for reconstruction after composite resection of radiation-recurrent oral cancer. The use of attached metatarsal bone in nine patients for mandibular reconstruction is in our view a significant advance in this field. Two failures occurred, one due to sepsis and one to delayed thrombosis. Our experience indicates that this procedure deserves a place in the surgical treatment of patients afflicted with oral malignancy.


Experimental fibrogenesis: enhancement by chronic ethanol administration.

The authors have presented a new, simple, and reproducible model of fibrogenesis and have shown that chronic alcohol treatment clearly stimulates the production of fibrous tissue in this model.


The photochemical action spectrum of the microsomal ethanol oxidizing system.

The inhibition of the microsomal ethanol oxidizing system (MEOS) by carbon monoxide (CO) can be reversed by illumination with lights of differing wavelengths. The authors determined the efficiency of this reversal as a function of the illuminating light. Maximum efficiency was obtained in the wavelength band around 440-450 nm, which is near the absorption of the reduced cytochrome-P-450-carbon monoxide complex. When the experiment was repeated with microsomes prepared from ethanol-fed rats, the wavelength for maximum efficiency shifted towards higher values.


Effect of disulfiram on cognition, subjective response, and cortical-event-related potentials in nonalcoholic subjects.

The effect of 0.5 g of disulfiram per day for 2 wk on a battery of cognitive and cortical-event-related potential tasks was studied in healthy, nonalcoholic volunteers.


Disulfiram-induced disturbances in hypothalamic-pituitary function.

This report indicates that disulfiram at clinically useful doses is capable of altering the hypothalamic-pituitary-gonadal function of normal men.


The metabolism of zinc and selenium in cirrhotic patients during six weeks of zinc ingestion.

Zinc metabolism in cirrhotic patients was studied, indicating some improvement that did not alter the abnormalities of zinc metabolism significantly and showed no evidence of correlation of abnormalities with the clinical improvement or lack thereof in the patients studied.


Influence of chronic ethanol vapor inhalation on hepatic parenchymal and Kupffer cell function.

This report evaluates the influence of chronic ethanol vapor inhalation on various facets of liver function as well as induction of hepatic and pulmonary pathology in rats. Chronic ethanol inhalation is associated with minimal hepatic dysfunction, but pronounced induction of metabolic tolerance.


Similarity of effects of alcohol and sensory stimulation in post-alcoholics and controls.

Derived from the hypothesis that many alcoholics would experience autonomic "arousal" and craving for alcohol under conditions of high sensory stimulation, this study does not support prior findings.


Result of a low-cost follow-up study of discharged alcoholics.

This paper describes a simple procedure for determining which variables in treatment programs are related to treatment outcome.


Genetics and alcoholism simulacra.

The author explores the role of genetic techniques in developing simulacra for eventual use as models in alcoholism research.


A method for the determination of "free" acetaldehyde in plasma.

A new method for measuring "free" acetaldehyde in plasma, the author's procedure avoids the precipitation of protein and almost completely eliminates the spontaneous formation of acetaldehyde from ethanol.


Normocapnic anaesthesia with trichloroethylene for intraocular surgery.

Measurements of intraocular pressure (IOP) by applanation tonometry in twelve patients undergoing lens extraction showed that a normocapnic anaesthetic technique using 0.4% trichloroethylene with controlled ventilation of the lungs (IPPV) with large tidal volumes (14 ml/kg) reduced IOP by 13--20%. There was only a small reduction in arterial pressure. Normocapnia was easy to achieve by use of the single-limb co-axial Penlon (Bain type) anaesthetic breathing circuit in conjunction with an electrically-driven, small and inexpensive lung ventilator. The anaesthetic technique described using trichloroethylene is suitable for lens extraction surgery when it is desired to avoid a halothane anaesthetic for any reason.


Congenital diaphragmatic hernia.

A description of the pathology, clinical presentation and management of congenital diaphragmatic hernia is given together with the results obtained in Newcastle during the last seven years. Some suggestions are made for improved management.


[Experimental studies about the origin of the "wedge-blood" in partially atelectatic lungs of mongrel dogs (author's transl)].

We measured in 8 experimental studies the oxygen and carbon dioxide partial pressure in systemic arterial, mixed venous and wedge-blood. The results were: 1. In healthy mongrel dogs with controlled intermittent and continuous positive pressure ventilation (FIO2 0,21 and 1,0) paO2 greater than pwO2 greater than pvO2 and pwCO2 less than paCO2 less than pvCO2. 2. During experimentally produced left-sided atelectasis of the lung and positioning of the catheter in the pulmonary artery a) in the ventilated lung we found pwO2 greater than paO2 greater than pvO2 and pwCO2 less than paCO2 less than pvCO2 b) in the atelectatic lung we found paO2 greater than pwO2 greater than pvO2 and paCO2 less than pwCO2 less than pvCO2. According to these findings the sample of highly saturated mixed venous blood from a catheter in the pulmonary artery should be a hint that pulmonary capillary blood is mixed with central venous blood.


[I.M.V.-ventilation-techniques. Special considerations and problems of their application (author's transl)].

The clinical significance of I.M.V.-technique with or without C.P.A.P. are shown. The influence of different I.M.V.-technique on spontaneous respiration and lung ventilation is analyzed. Patient-synchronized techniques especially S.-I.M.V. or E.S.-I.M.V. prooved to be superior. Respiratory-physiological and technical recommendation for I.M.V.-arrangements are given and common devices of the literature analyzed. By these examples individual as well as commercially available devices can be critically evaluated for practical use and safety.


Instrument sterilization in orthodontic offices.

1. Three different quaternary ammonium compound solutions remained bactericidal against specific vegetative bacteria in three orthodontic offices over a ten day working period. However, no spore formers or viruses were tested. 2. Bacterial contaminants were cultured on pliers and scalers at the chair at least once in each of three orthodontic offices sampled twice a day for ten working days. 3. Sampled chairside instruments wiped with an alcohol sponge only, between patients, were contaminated an excessive 32.5% of the time, too frequently to be seriously considered for routine disinfection of pliers. 4. Chairside instruments, sampled regardless of other means of disinfection or sterilization used, were contaminated from 3.5 to 15% of the time. Therefore, storage and handling of orthodontic instruments must be evaluated and upgraded to prevent recontamination of previously sterilized instruments. 5. Staff personnel need courses in sterilization and disinfection procedures to prevent cross contamination from patient to patient and to protect themselves. These courses should be related specifically to orthodontic practice procedures.


[Therapy of fungal septicemia and bounds (author's transl)].

The authors present the results of therapy in 26 cases of fungal septicemia occurring in a 2,471 patients population with 169 septicemia, over a 9 year period in a surgical intensive care service. An analysis of the etiology, clinical and paraclinical factors confirms the notions classically described in the literature. Three points are particularly insisted upon: 1) The effectiveness of preventive measures; 2) The monitoring of the therapy and its tolerance by means of a simple protocol; 3) The eventual possibility of an haematologic toxicity by flucytosine, the primary and secondary resistances to this anti-fungal agent. The strict application of preventive measures seems to reduce the incidence of fungal septicemia but not to eradicate them. The prognosis of these states remains grave.


[Anesthesia for primary excision and grafting in the severely burned patient (author's transl)].

Through a retrospective study of 81 anaesthesias for primary excision with immediate grafting (performed within the first 72 hours after burning), the authors, using in most of the cases an anaesthetic procedure including neuroleptanalgesia and nitrous oxyde, with controlled ventilation, tried to determine: --the incidence of such a type of anaesthesia on the patient condition, --the period during which anaesthetic risk is the least. Studies of hemodynamic, respiratory and thermic changes, related with anaesthesia, and a study of coagulation changes, related with surgical procedure, have been performed. It appears that neuroleptanalgesia is a method available for primary excision with immediate grafting and that the elective period for anaesthesia and surgical procedure is situated within 12 hours after burning.


Candida tropicalis: a major pathogen in immunocompromised patients.

Of 89 consecutive patients undergoing treatment for hematologic malignancies or undergoing allogeneic bone marrow transplantation, 60 were colonized with Candida albicans and 25 with C. tropicalis. However, of the 18 disseminated infections caused by Candida species, 15 infections in 14 patients were caused by C. tropicalis and only three infections in three patients by C. albicans. The setting in which the infection occurred, skin lesions, polyarthralgias, or polymyalgias, and the unexplained deterioration of renal function were features suggestive of the diagnosis. Defervescence occurred in 10 of the 14 treated patients with C. tropicalis infections in 1 to 6 d (mean, 2.5 d) after initiation of therapy, even though all continued to be granulocytopenic. Resolution occurred in eight of the 15 C. tropicalis infections. In one case outcome was indeterminate, four patients died due to the infection, and two died from other causes but with the infection unresolved.


Recurrent urinary tract infections in men. Characteristics and response to therapy.

All men with recurrent urinary tract infections entered into a study had a positive antibody-coated bacteria test, and 52% had evidence for prostate infection. Escherichia coli infection was present in 74% and urinary tract symptoms in 57% of those randomized. Thirty-eight patients were randomized in a double-blind clinical trial to receive either 10d of treatment with trimethoprim/sulfamethoxazole or a 12-week course of the drug. The cure rate in patients receiving 12 weeks of therapy (nine of 15) was higher than that in patients receiving a single 10-d course (three of 15); difference was marginally significant (P = 0.06). Recurrences were usually with the same organism, and most (78%) occurred within 4 weeks of discontinuing therapy. This study indicates that a standard 10-d course of therapy usually fails to cure men with recurrent urinary tract infections with a positive antibody-coated bacteria test.


Hyperlipidemia after renal transplantation: natural history and pathophysiology.

Twenty-five patients had their lipid profile monitored sequentially for up to 3 years post-transplant. All patients had a good graft function throughout the study. Forty-four percent remained hypertriglyceridemic. The lipid level was not due to diet or excessive weight gain. Triglyceride turnover studies showed that overproduction was the predominant defect in patients receiving massive steroids to reverse rejection and in stable long-term recipients. Repeat metabolic investigations in the latter group, after changing to alternate-day, equal-dose steroid therapy showed improvement in both the absolute triglyceride concentration and the triglyceride production rate. The correlation observed between basal insulin level and triglyceride concentration suggests the drug may act through this hormone, stimulating hepatic triglyceride production. A change to alternate-day steroid therapy should be considered in post-transplant patients who are hyperlipemic while receiving minimal daily prednisone therapy.


Molecular genetics of human hemoglobin synthesis.

Molecular analysis of normal and abnormal human globin genes and their gene products has recently provided information on the precise genetic events that result in hemoglobinopathies. In the case of structurally abnormal hemoglobins, the following mechanisms can be invoked: single nucleotide base substitutions leading to amino acid replacement or chain termination variants; nucleotide deletions (or additions) leading to deletion and frameshift variants; and nonhomologous crossing over leading to the production of fused globin chains. The molecular basis of the thalassemia syndromes, disorders characterized by absent or decreased synthesis of alpha- or beta-globin chains, is quite heterogeneous. In some cases globin gene deletions have been demonstrated; whereas in others there is probably either a defect in globin gene transcription or a defect in nuclear globin messenger RNA (mRNA) processing, mRNA transport or globin mRNA stability. In one form of beta(0)-thalassemia a nonsense mutation has recently been demonstrated, and other cases are also associated with some as yet undetermined functional abnormality of beta-globin mRNA.


[Theoretical analysis of potential variations of "Escherichia coli" K12 cultures in presence of an electron carrier (author's transl)].

Oxygen consumption and reductive hydrogenation of lipoic acid, linked to the exponential growth of Escherichia coli in a "minimal" medium containing a non-limiting amount of glucose, produce reproducible and intelligible variations of the electric potential between a gold electrode and a reference electrode. A simple quasi-stationary mathematical model leads to analytical expressions of the electric potential in function of the experimental conditions and of time. The effects of active or passive transport of lipoic acid are distinguishable. An experimental method results in detecting and following bacterial activity.


[Phage-typing modifications induced by in vitro transfer of R plasmids. II. -- Phage-typing of Shigella sonnei (author's transl)].

Forty-two antibiotic resistance plasmids and twelve metabolic plasmids have been transferred to a strain of Shigella sonnei. The phage-typing modifications have been investigated after transfer of the different above described plasmids. Eleven of the R plasmids and five of the metabolic plasmids affect phage sensitivity. These modifications are not specific for any compatibility group.


[Risk of contamination by pipetting bacterial culture broth with "Pasteur pipettes" (author's transl)].

Our experiments have shown that the cotton plug located at the top end of a "Pasteur pipette" allows aerosol to escape upon aspiration of a bacterial culture broth and may be the cause of contamination. In the following, we propose the use of a bacteriological filter system which insures greater safety.


[The various functions of steroids on the yeast metabolism in grape must during fermentation: the notion of survival factor (author's transl)].

The physiological effects of steroids supplied to the yeasts in grape must is complicated. These substances may function as inhibitors, as growth factors or survival factors. The steroids have a "survival factor" action when they act on aerobically cultivated yeasts, fermenting under anaerobic conditions, in grape must of high sugar concentration. In this case, the substances have no effect on the cellular multiplication but they maintain viability and fermentation activity in the resting cells. Consequently, a greater quantity of sugar is consumed and the content of secondary products is modified by the end of the fermentation. Certain growth conditions during fermentation affect the survival factor action of steroids: high temperature, low pH, vitamin deficiency, low amount of inoculum, insufficient aeration, excessive sugar concentration.


[Production of interferon after infection by various doses of "Plasmodium berghei" in mice (author's transl)].

Groups of mice were inoculated with either low or high intraperitoneal doses of Plasmodium berghei infected erythrocytes (PIE). The course of infection was observed daily by counting new PIE which appeared in the red blood cells (RBC) of infected mice. At the same time, circulating interferon (IF) was tested. When low doses of infecting PIE were used (400 per mouse), circulating IF was first detected on the 5th day after inoculation. It increased to a maximal rate, when 5% of RBC were affected. It disappeared on the 8th day despite of a continuous rise of PIE. With high doses of PIE (60,000 per mouse), IF was detected on the 3rd day, when only 0.5% of RBC were parasitized. The maximal rate was observed on the 5th day when 20% of the RBC were affected. It disappeared on the 7th day, though the PIE rate would continue to rise. Treatment of mice by chloroquine (0.01 per g), at the time of first PIE appearance after Plasmodium infection, rapidly reduced the amount of PIE. In this case, no IF production was observed. Splenectomy resulted in an increased resistance of mice to the lethal effect of Plasmodium infection. IF production in such splenectomized mice was less important than in control. It was concluded that P. berghei was a good inducer of circulating IF at the beginning of the active disease, soon after infection. The fact was proven by the striking lowering effect of chloroquine and splenectomy that both reduced Plasmodium development and IF production.


Serological diagnosis of Mediterranean spotted fever.

Complement fixation and indirect micro-immunofluorescence (IF) tests were compared for specificity and sensitivity in detection of antibodies against Rickettsia conorii, in acute and convalescent human sera. Purified particulate rickettsial antigens were used. Good agreement between these two tests was found. Use of specific anti-IgG and anti-IgM sera in parallel IF tests made it possible to differentiate between recent and past infections.


[Numeration of bacteria in seawater: variability and dubiousness (author's transl)].

Authors tried to determine some factors of incertitude in the anlaysis of the bacterial contamination of seawater. Such analysis depends on the reliability of the methods used for bacterial numeration, and on the heterogeneity of water in the investigated area. The general numeration of organisms (GNO) and the numeration of coliforms (NC) were taken into account. The turbidity of the sample, and the operator's manner were shown to be factors of variation for the GNO. An interaction between the operator and the amount of the anlaysed sample seemed to influence NC. In a natural environment, variations with time were the most important. They were partly due to hydrological and meteorological fluctuations, but sometimes seemed to be random. During a day cycle, the bacterial contamination trended to decrease when the solar radiance was maximum. Influence of short scale variations in the location of sampling was generally random, yet with a slight increase of contamination in the more stagnant waters.


Bilateral optic neuropathy due to combined ethambutol and isoniazid treatment.

The case of a 40-year-old patient who underwent an unsuccessful cadaver kidney transplantation and was treated with ethambutol and isoniazid is reported. A bilateral retrobulbar neuropathy with an unusual central bitemporal hemianopic scotoma was found. Ethambutol was stopped and only small improvement of the visual acuity followed. Isoniazid was discontinued later, followed by a dramatic improvement in the visual acuity. The hazards of optic nerve toxicity due to ethambutol are known. We emphasize the potential danger in the use of ethambutol and isoniazid.


[Micromethod for rabies antibody detection by immunoenzymatic assay with Staphylococcus protein A (author's transl)].

The rabies virus and its glycoprotein are used as antigens in a microimmunoenzymatic assay (IEA). Human rabies antibodies are detected and titrated using anti-human antibodies and staphylococcus protein A conjugated to peroxidase. Several mammal antirabies sera are tested by this method with protein A. The results are compared to those obtained by seroneutralization in mice, which is the standard method for rabies antibody detection.


[Genetics of hereditary cutaneous diseases associated with digestive tract involvement].

Most of cutaneous hereditary diseases are associated with digestive symptoms but only four groups have a predominated digestive symptomatology: I. Hereditary disease with intestinal polyposis. II. Vascular dysplasias with intestinal haemorrhage. III. Connective tissue discover in hereditary diseases. IV. Acrodermatitis enteropathica with diarrhoea. Though very different with one another, Peutz-Jeghers syndrome and Gardner's syndrome are transmitted according to autosomal dominant trait. Only bi- or unigenic origin is still controversed. Rendu-Osler's disease and blue rubber bled naevus also transmit according to autosomal dominant trait. Pseudoxanthoma elasticum is very likely transmitted according to autosomal recessivity. But the main forms of Ehlers-Danlos disease are autosomal dominant conditions, the other form being either autosomal recessive or sex-linked (type V). Acrodermatitis enteropathica is transmitted according to autosomal recessivity but the gene has a very variable penetrance so that the mutations are very common.


[Spectacle-frame acanthoma. Review of the literature and histopathological diagnosis versus chondrodermatitis nodularis helicis (author's transl)].

Five cases of spectacle-frame acanthoma are reported; four were retro-auricular (three unilateral; one bilateral) and one was present on the left side of the nose. Clinical aspects of the lesions are described by the light of all the other cases that have been previously reported in the literature. Histopathological features are compared to those encountered in chondrodermatitis nodularis helicis for which a frictional origin may also be suspected. In the vast majority of cases, spontaneous resolution is obtained when responsible spectacle frames are removed whereas a few lesions persist indefinitely despite of the fact that corrective measures are applied, on the contrary to what has been reported in previous papers. Apart from removing spectacles, these few cases needed surgical excision for a complete cure. Anatomo-clinical confrontations seem to indicate that those persistent lesions are completely fissured acanthomas.


[Bowen disease of the nail apparatus. Report of 5 cases and review of the 20 cases of the literature (author's transl)].

Five cases of Bowen disease of the nail apparatus were studied and the 20 cases published to date reviewed. The lesion was characterized by either periungual redness with scaling and erosions, whitish cuticle, hyperkeratotic or papilomatous process, fissure or crusted ulcer in the lateral nail fold or the nail bed with eventual partial or total destruction of the nail plate and sometimes soreness on the pressure. The key of the diagnosis is the histological picture, identical with that of Bowen diseases of other skin areas. Among the 25 cases, Bowen disease was found mainly in males (20 out of 25 patients) on the left fingers (17 out of 25 finger lesions) with particular involvement of the 1st, 2nd, 3rd finger nail. Hallux was concerned twice. The clinical picture can be protean and mimic verrucae, onychomycosis, paronychia, eczema, pyogenic granuloma, verrucous tuberculosis, subungual exostosis, glomus tumor, dermatitis vegetans, amelanotic malignant melanoma, kerato-acanthoma and of course squamous cell carcinoma. Treatment of choice is complete removal of the tumor by plastic surgery otherwise microscopically controlled excision following chemical fixation (Mohs) or fresh tissue technique.


[Nucleolar, homogeneous and peripheral fluorescence of epidermal nuclei in direct immunofluorescence: 4 cases (author's transl)].

Epidermal nucleolar IgG deposition on direct immunofluorescence of covered normal skin was found in two patients with scleroderma and high serum concentrations of antibody to nucleolar antigen. Epidermal homogeneous and peripheral IgG deposition was also observed in two patients with systemic lupus erythematosus, antinuclear antibody of homogeneous staining pattern, but without antibody to extractable nuclear antigen. Epidermal nuclear IgG deposition in a speckled, nucleolar, homogeneous or peripheral pattern appears to correlate with high titer serum antinuclear antibody giving on immunofluorescence the same staining pattern. These immunopathologic findings cannot be considered as being specific of a subset of connective tissue disease.


Clinical implications of cell function in osteogenesis. A reappraisal of bone-graft surgery.

Although fresh cancellous bone autografts are considered to be the best material for clinical bone grafting, there are times when there is insufficient, or it is undesirable to use this source, for the bone replacement required. There is a need for a 'bone bank'. On the basis of printed reports, clinical observation, and experimental studies it is argued that bone formation can be stimulated and controlled using easily prepared and stored 'bone-bank' materials in combination with living cells from the recipient requiring bone formation.


The muscle content and contractile capability of the common bile duct.

The supraduodenal portion of the human and canine common bile duct has been shown by indirect immunofluorescent staining with anti-actin sera to contain scattered bundles of smooth muscle arranged predominantly in a longitudinal direction with respect to the axis of the bile duct. Isolated strips of canine common bile duct in vitro can contact in response to stimulation with cholecystokinin. The force of contraction in a longitudinal direction is about three times that in a transverse direction but only 3% of that produced by isolated gallbladder strips. There appears to be a roughly proportional relationship between the amount of muscle demonstrated and the force of contraction in response to cholecystokinin.


[Visceral mycosis of tropical freshwater fishes (author's transl)].

Fourteen cases of a systemic mycosis in ornamental fresh-water tropical fishes are recorded. Clinical signs, cystic lesions in the liver and spleen, recall those of an infection by the fungus Ichthyophonus, or Ichthyosporidium hoferi. The possibility that the fresh-water fishes' parasite might be of a different species is discussed. Morphological aspects of the yeast-like fungus in culture are described.


[Experimental protective action of kanamycin, ampicillin and their combination with methyluracil and pyrogenal].

Efficacy of kanamycin, ampicillin and their combinations with methyluracyl and pyrogenal in experimental Coli infections was studied. The antibiotics were administered an hour after the infection. Methyluracyl and pyrogenal were used according to 2 schemes. Scheme No. I: the drug is used daily for 7 days in increasing doses, the last dose is administered 24 hours before the infection. Scheme No. 2: the drug is used once at the moment of the infection. The methyluracyl doses were: 0.5, 1.0, 2.5 mg and 5 mg and 5 mg per a mouse during the following 4 days. The pyrrogenal doses were: 5, 10, 15, 25, 30 and 35 minimum pyrogenic doses. 5 mg of methyluracyl and 35 minimum pyrogenic doses of pyrogenal were used according to scheme No. 2. The most pronounced increase in the efficacy of kanamycin, ampicillin and their combination was observed in the animals treated simultaneously with methyluracyl and pyrogenal according to scheme No. 1. The efficacy of kanamycin and ampicillin increased 3 and 2.68 times respectively. ED50 of kanamycin and ampicillin used in combination in the animals treated with methyluracyl and pyrogenal was lowered 4 and 2.9 times respectively as compared to that in the animal groups treated only with the antibiotic combination and 21 and 15.2 times respectively when the antibiotics were used alone. Sanation of the animal organs was also rather successful. A single administration of methyluracyl and pyrogenal simultaneously with the infection (scheme No. 2) had a lower effect on the efficacy.


[Effect of prodigiozan and pyrimidine derivatives on the effectiveness of the antibiotic therapy of experimental infections].

The effect of prodigiozan and pyrimidine derivatives, such as methyluracyl, oxymetacyl and 2-methyl-4-amino-6-hydroxypyrimidine on the efficiency of antibiotic therapy of experimental infections caused by Staph. aures and E. Coli under conditions of immune depression due to levomycetin, prednisolone, 6-mercaptopurine and ionizing radiation was studied. The effect of prodigiozan on the efficiency of the antibiotic treatment of staphylococcal infection in the presence of the immune depression due to 6-mercatopurine, levomycetin and prednisolone was higher than that of pyrimidines. The combined use of prodigiozan and pyrimidines usually was not more effective than the use of every drug alone. The efficiency of the drugs in radiation disease was the same. After prednisolone administration prodigiozan increased the host resistance to the infection without the antibiotic use.


Importance of medium in demonstrating penicillin tolerance by group B streptococci.

A total of 30 clinical isolates of group B streptococci were studied for penicillin tolerance in vitro. Minimal inhibitory and bactericidal concentrations of penicillin were determined simultaneously in three test media which have been used for group B streptococci, tryptose phosphate, Mueller-Hinton, and Todd-Hewitt broths, using a logarithmic-phase inoculum of 10(5) colony-forming units per ml. Minimal inhibitory concentrations in the three media did not differ significantly. However, minimal bactericidal concentrations were significantly higher in tryptose phosphate broth (mean, 1.04 mug/ml) than in Mueller-Hinton broth (0.22 mug/ml) or Todd-Hewitt broth (0.15 mug/ml). Similarly, ratios of minimal bactericidal to minimal inhibitory concentrations were significantly greater in tryptose phosphate broth than in Mueller-Hinton or Todd-Hewitt broth. After incubation in tryptose phosphate broth for an additional 24 h, the minimal bactericidal concentration consistently fell to levels which were only twice or equal to the minimal inhibitory concentration. This study illustrates the importance of the medium in the demonstration of penicillin tolerance and of controlling laboratory variables in the susceptibility testing of group B streptococci with penicillin.


Persistence of plasmid-carrying tetracycline-resistant Escherichia coli in a married couple, one of whom was receiving antibiotics.

This paper describes an extension to an earlier account of the coliform flora carried by a married couple, one of whom was taking tetracycline for prolonged periods. The latter phase of this study was notable for the following: first, certain tetracycline-resistant Escherichia coli O antigen types persisted in one of the participants for several weeks after tetracycline was withdrawn; second, a course of ampicillin led to replacement of the tetracycline-resistant flora by one that was ampicillin resistant, but the end of the ampicillin course led to the reappearance of the tetracycline-resistant line, even though no tetracycline was being taken; and third, the tetracycline-sensitive O75 E. coli, which appeared toward the end of the survey, had not lost their plasmid but carried a derivative in which the tetracycline resistance gene(s) had been inactivated by the insertion of an extra piece of deoxyribonucleic acid with a molecular weight of about 1 megadalton.


Decrease of drug resistance in Salmonella in the Netherlands.

Since 1974, tetracycline resistance in salmonellae of human and porcine origin has decreased nation-wide in The Netherlands. This decrease has coincided with the ban on incorporation of tetracycline in animal feeds.


Comparison of EC broth and medium A-1 for the recovery of Escherichia coli from frozen shucked snow crab.

Two variations of the multiple-tube fermentation technique were used to enumerate fecal coliforms in commercially processed, frozen crab meat. These were the EC confirmation test and a more rapid method that requires medium A-1. The method with medium A-1 was more specific than the EC confirmation test for detecting Escherichia coli type 1. E. coli was isolated from 84% of the positive medium A-1 tubes, whereas it was isolated from only 64% of the positive tubes of EC broth. When samples of crab meat were inoculated with known amounts of E. coli, better estimates of the known numbers were obtained by the medium A-1 method. Several species of nonfecal coliforms were isolated from cultures in EC broth. These belonged to the genera Klebsiella, Citrobacter, Enterobacter, and Serratia. Apparently these strains were naturally adapted to growth at an elevated temperature because the majority were able to grow at 44.5 degrees C when retested in EC broth. Fewer species of nonfecal coliforms were isolated from medium A-1. Those that were isolated belonged to the genera Citrobacter and Enterobacter.


Evidence that bacteria can form new cells in airborne particles.

Serratia marcescens incubated for 8 h at 31 degrees C in a chemically defined medium contained in shake flasks was aerosolized into rotating-drum aerosol chambers at 30 degrees C and saturated humidity. Cells furnished tryptone (Difco) and glycerol just before aerosolization increased (in viable numbers and countable cells) almost twofold within 1 to 2 h after becoming airborne, whereas cells not furnished additional tryptone decreased in viable numbers at a faster rate than the number of particles removed by gravitational settling. Limited tests with a Coulter Counter showed that cell volume changes occurred in growing cells that did not occur in the nongrowing population.


Comparison of Limulus assay, standard plate count, and total coliform count for microbiological assessment of renovated wastewater.

The Limulus endotoxin assay was compared to the standard plate count and total coliform count for assessment of the bacteriological quality of reclaimed wastewater. A total of 48 water samples from an advanced waste treatment plant in Dallas, Tex. were examined by the three techniques. Limulus assays were technically simpler to perform and provided results much sooner than conventional culture methods. However, the endotoxin values did not correlate extremely well with determinations of viable bacterial numbers. This lack of correlation may have been due to alterations in the normal ratio of viable gram-negative cells to endotoxin caused by water reclamation procedures.


Repair detection procedure for enumeration of fecal coliforms and enterococci from seafoods and marine environments.

The repair detection procedure of Speck et al. (Appl. Microbiol. 29:549-550, 1975) was adapted for the enumeration of coliforms, fecal coliforms, and enterococci in seafood and environmental samples. Samples were pour plated with Trypticase soy agar, followed by a 1- to 2-h incubation to effect repair; the plates were then overlaid with the selective medium and incubated. Violet red bile agar and an incubation temperature of 45 degrees C were used as the selective conditions for fecal coliforms, and KF streptococcal agar was used for the enumeration of enterococci. The method was more efficient than the standard most-probable-number method for fecal coliform enumeration and also allowed enumeration of the injured cells, which might have remained undetected when selective medium in the most-probable-number method was used. The repair detection method effectively recovered the injured portion of the population of enterococci capable of growing on KF streptococcal agar. The repair enumeration method was not suitable for coliforms in marine samples because associative marine bacteria mimicked coliforms in violet red bile agar plates incubated at 35 degrees C. The marine bacteria did not grow at 45 degrees C and therefore did not interfere with fecal coliform enumeration.