Proceedings of the workshop on quantitative evaluation of periodontal diseases by physical measurement techniques.

Most of the participants agreed that the destruction of connective tissue is the single most significant criterion for assessing the severity of periodontal disease. Members were equally divided between favoring a measure of bone height or density and a measure of soft tissue destruction, such as attachment level or pocket depth. A measure of the rate of destruction of bone at the time of examination was considered to be especially useful. Opinion was equally divided as to the second most important parameter related to periodontal disease, either measures of gingival inflammation or measures of dental plaque. Measurements of gingival fluid and measures of tooth mobility were less favored by the group as a whole, but each measurement area was favored by strong proponents.


An antisera for the fluorescent labeling of mouse amelogenesis.

Embryonic mammalian enamel extracellular matrix is immunogenic. Antisera has been produced in New Zealand white rabbits using 5-day-old (post-natal) C57B1/6J mandibular and maxillary incisor and molar tooth organs as immunogens. The expression of secretory amelogenesis in mouse molar tooth organs was studied from the "cap stage" (circa 17-day fetus) to the fifth day of postnatal odontogenesis using indirect immunofluorescent microscopy. The specificity of the antisera for enamel matrix secretion was unequivocal. Secretory amelogenesis was observed in molar tooth organs as early as day-2 postnatal age. These reagents and methods provide a significant strategy in studies of epithelial-mesenchymal interactions during tooth development.


Tooth enamel: current state of the art.

Important progress has been made relative to the growth, structure and function of enamel. Better understanding of the epithelial mesenchymal interactions during odontogenesis has been gained through tissue culture, and the predominant role of the dental papilla has been established. Differences between rodent and human amelogenesis have been demonstrated. With radioautography and cytochemistry, a significant amount of new information has been obtained on the metabolism of the ameloblasts, concerning the synthesis of proteins, glycoproteins and proteoglycans, as well as calcium transport. Numerous biochemical investigations have been devoted to developing and mature enamel matrix. The organic components of human adult enamel are mainly constituted of lipids and proteins, but further investigations are still needed to elucidate their precise nature. The so-called key-hole configuration of adult enamel can be questioned when amelogenesis is considered since the tissue does not develop in a prismatic head-tail fashion. The most important results have probably been obtained in the field of individual enamel apatite crystals shape and ultrastructure as well as in the description of the precise patterns of their carious dissolution which bears great similarities to the dissolution of synthetic apatites in acids.


Enamel protein chemistry--past, present and future.

Past progress in the chemistry of enamel proteins is reviewed and the current state of knowledge assessed. The matrix of young enamel is a complex system in which some 20 distinct components with molecular weights in the region of 3,000 to 16,000 are in dynamic equilibrium with much larger aggregates. During maturation, most of these components are selectively lost, more or less completely, from the enamel. 'Amelogenin' components rich in proline and histidine are removed first and 'tuft protein', characterized by high serine and glycine, is often partially retained in mature enamel. Some components have been isolated in a state approaching purity and a measure of agreement has been reached between laboratories concerning their characteristics. Partial amino acid sequences are known for two components, which contain phosphoserine. Though the mechanisms of mineralization and protein removal are not known, various possibilities are discussed. The essential unsolved problem is the nature of the overall protein system.


Immunofluorescent evidence for the similarity of amelogenins in calf, mouse and pig teeth.

Antiserum was prepared to fetal bovine enamel matrix and was used to localize the amelogenins in developing bovine molars by immunofluorescent microscopy. Amelogenins could be identified to preameloblasts, secretory ameloblasts, stratum intermedium cells, and the newly deposited enamel matrix. Mature enamel matrix did not fluoresce except in a thin line along the DEJ and adjacent to the ameloblasts. Immature enamel matrix of murine and porcine teeth fluoresced when treated with antiserum to bovine enamel matrix. No other portions of tooth buds or other tissues reacted with the specific antiserum.


Present role and future prospects for radiotherapy in the management of malignant melanomas.

Malignant melanomas are not very radiosensitive neoplasms. Therefore, the prime management of such lesions is surgical. However, there are certain circumstances in which radiation therapy has been used and should be considered as useful. This article provides an overview of the literature on radiotherapy of primary and metastatic malignant melanomas in man. In addition, some unconventional methods like the use of radiation sensitizers, oxygen-independent radiation therapy, radiation combined with hyperbaric oxygen, and high-dose-perfraction irradiation are discussed. The beneficial responses to radiation that have been reported in the literature and that we have personally observed suggest that a prospective study to determine the proper role of radiation therapy in the management of all forms and stages of malignant melanomas is warranted.


A scanning electron microscope comparison of three methods of bonding resin to enamel rod ends and longitudinally cut enamel.

Taglike projections of resin into the etched enamel surface and longitudinally cut enamel were studied under the SEM. Three methods of bonding, including the use of a bonding agent and a primer, were compared. Freshly extracted teeth were pumiced, rinsed, and dried. The enamel surface was etched for a minute with phosphoric acid. Adaptic with bonding agent, Simulate with primer, and Simulate without primer were then applied to the etched enamel. After the teeth were sectioned, the enamel was etched with phosphoric acid and viewed under the SEM. The resin projections into the etched rod ends at the enamel surface were 5 to 10 mu in length, with similar cuplike and coneline patterns of tags for the three methods of bonding. Troughlike and ridgelike projections into the longitudinally cut enamel were 3 to 5 mu in length; patterns of tags were similar for the three bonding methods. No observable differences in length and pattern of tags were noticed among the three bonding methods.


The use of relaxation and distraction to reduce psychological stress during dental procedures.

Relaxation and distraction techniques designed to reduce stress during operative dental procedures were evaluated with a number of different measures. The results indicate that both techniques can be effective in alleviating anxiety and reducing stress. Some findings suggested that relaxation was more effective with women than with men whereas distraction may be more effective with men than with women. Further research is needed to refine these techniques that should be readily adaptable to dental practice.


Home health care: the dietitian's role.

Nutritional services are an important part of the home care program. Medicare, Medicaid, and other third-party mechanisms do not reimburse providers for such services, even though the cost for home care is lower than for institutional care. Recognizing the need for nutritional services, the Veterans Administration has included the dietitian as a member of the home care team. Skills and guidelines developed by The American Dietetic Association for home and ambulatory care were adapted and utilized in developing a dietetic home care procedure which helps to avoid institutional care and provides a better quality of life at home. Nutritional services should be an integral part of all home health care programs. Because most home care programs do not have funds for a dietitian's service, legislative and/or regulatory action is needed to provide reimbursement for nutritional home care services.


Professionalization and the dietitian.

Professionalization as a process is reviewed and characteristics an occupation acquires as it becomes professionalized are outlined. Those attributes include founding a professional association with membership requirements to exclude the unqualified; control of education and admission to the profession by current members, frequently working through the professional organization; possible licensure or certification as a prerequisite to practice; a name change to provide enhanced status or prestige; and elaboration of an altruistic, service-oriented code of ethics. Relevant developments in dietetics and the history of The American Dietetic Association are then compared with this model. Advances have been and continue to be made in the above areas as the professionalization of dietetics and the dietitian progresses.


Clinical stereopsis testing: contour and random dot stereograms.

Stereopsis testing has received renewed interest because of its relationship to strabismus and amblyopia. This paper discusses clinical implications of stereo responses on traditional line stereograms and on newly developed random dot stereograms in normals, strabismics and amblyopes. Random dot stereograms are computer generated which when binocularly fused give rise to stereoscopic depth.


The case for James Mills Peirce.

This paper presents a circumstantial, but convincing, case that James Mills Peirce (1834--1906), professor of mathematics and first dean of the Graduate School of Harvard University, was the author of a strong defense of homosexuality, which was published anonymously in 1897.


The effects of cognitive and behavioral control on coping with an aversive health examination.

The effects of cognitive and behavioral control on coping with an aversive health examination were tested in a 2 x 2 factorial design. Cognitive control was represented by sensory or health-education information; instruction or no instruction in abdominal relaxation constituted the levels of behavioral control. The study was conducted in the natural setting of a family-planning clinic with 24 young women who were undergoing a routine pelvic examination. Subjects who received sensory information prior to the examination showed less distress, as indicated by overt distress behaviors and pulse rates, than did subjects who received health-education information. Cognitive control did not show a significant effect on self-report of fear. No significant effects were demonstrated for the factor of behavioral control. The results suggested that cognitive control information, which emphasizes the sensory experiences typically accompanying an aversive event, limits reactivity to aversive stimuli. The reduction in reactivity is thought to result in an increased ability to cope with aversive events.


Escherichia coli in gastroenteritis of children in London and Jamaica.

The jejunal and stool flora of children with gastroenteritis in London and in Jamaica was examined. Although bacterial colonization of the small bowel was commonly detected, it was unusual to find the same serotype of E. coli in both jejunum and stool, and none of the jejunal strains of E. coli produced either heatlabile or heat-stable enterotoxin. Some strains of E. coli causing infant gastroenteritis are neither toxigenic nor invasive, and other mechanisms must be sought to account for their pathogenicity.


Comparison of oral sucrose and glucose electrolyte solutions in the out-patient management of acute gastroenteritis in infancy.

Seventy-three children under the age of 18 months presenting with acute gastroenteritis were given an electrolyte mixture with added sucrose or glucose in a randomized double-blind trial. The time taken to recovery in those sucessfully treated as out-patients was identical. However, of the 34 who received glucose, 11 (32%) required admission compared with 7 (18%) of the 39 who received sucrose. There was a wide range of osmolality of the made-up feeds, indicating inaccuracy in diluting the solutions as prescribed, but this did not in general correlate with need for admission. Sucrose-electrolyte solution is at least as effective as a glucose-electrolyte solution for the out-patient management of acute gastroenteritis in infancy. The cheapness and easy availability of sucrose commends its use in developed and developing countries.


Lymphocytes binding and T cell mitogenic properties of group A streptococcal lipoteichoic acid.

We previously reported that lipoteichoic acid (LTA) of group A streptococci binds spontaneously to mammaliam cell membranes via lipid moieties ester-linked to the LTA molecule. We now describe biochemical and immunologic evidence that LTA binds to human and murine lymphocytes as an early event in the induction of mitogenesis in T lymphocytes. The biochemical studies showed that binding of radiolabeled LTA to lymphocytes was lymphocyte-concentration, and temperature dependent, and it reached a maximum in 15 min. Binding was reversible and specific with a dissociation constant of 89 micrometer for adult lymphocytes and 57 micrometer for cord blood lymphocytes. Immunologic studies showed that the LTA was mitogenic only for T lymphocytes. Dose response curves of lymphocyte mitogenesis induced by LTA and the binding of LTA to intact lymphocytes were shown to be related. The results suggest that LTA binds to specific receptor sites on T lymphocytes to trigger the mitogenic response.


Presence of alpha-1-antitrypsin on mitogen-stimulated human lymphocytes.

Human lymphocytes that have undergone concanavalin A-induced blastogenetic transformation demonstrate surface alpha-1-antitrypsin by immunofluorescence when examined after 72 hr of culture, whereas unstimulated cells do not. These results may indicate a role for alpha-1-antitrypsin in lymphocyte blastogenesis.


The in vitro suppression of spontaneous erythrocyte autoimmune responses with lymphocytes activated with concanavalin A.

When normal mouse spleen cells are cultured in vitro, large numbers of cells develop that produce antibody toward antigens found on bromelain-treated mouse erythrocytes (BrMRBC). The in vitro culture also generates T cells that mediate DTH toward these antigens. We have suggested that under in vivo conditions, suppressor T cells maintain these immune responses at a low level but that this suppression wanes when the cells are cultured in vitro. The present study examines the effect of concanavalin A (Con A) on the in vitro development of humoral and cell-mediated immunity to Br-MRBC. Mitogenic concentrations of Con A prevented the development of both the PFC and TDTH responses toward BrMRBC. The Con A-induced suppression was due to the induction of suppressor T cells; thus the addition of Con A-activated cells to fresh spleen cell cultures prevented the development of both the  PFC and TDTH response against BrMRBC.


Passive enhancement of mouse skin allografts by alloantibodies is Fc dependent.

The capacity of F(ab')2 fragments of alloantibodies to enhance mouse allografts was studied in B6AF1 recipients of B10.D2 skin grafts. F(ab')2 obtained by digestion of B6AF1 anti-B10.D2 antibodies was purified by means of affinity chromatography, with anti-subclass antisera and protein A. The degree of contaminating IgG was less than 0.02%. Administration of F(ab')2 with an antigen-binding capacity similar to the IgG from which it originated, inhibited acute antibody-mediated graft rejection but was unable to induce enhancement. Even a dose that was 130 times the molar amount of the minimal enhancing dose of undigested IgG2 was ineffective. We conclude, therefore, that passive enhancement of mouse skin allografts by alloantibodies requires the Fc part.


Binding of antigen-bearing fluorescent liposomes to the murine myeloma tumor MOPC 315.

Small unilamellar lipid vesicles bearing the DNP-hapten on their surfaces and containing the water-soluble fluorescent dye carboxyfluorescein were formed by sonication. These vesicles were incubated with cells from the murine myeloma tumor MOPC 315, which secrete and also bear on the cell surface an immunoglobulin with affinity for the nitrophenyl hapten. At 0 degrees C the cells bound an average of several thousand vesicles at saturation. This binding was specific for the nitrophenyl hapten on the vesicle since it was abolished by an excess of soluble nitrophenyl derivative, by omission of the hapten from the vesicle, or by substitution for MOPC 315 of a tumor lacking receptors for the nitrophenyl hapten. Specific binding of vesicles was greater when cells were incubated at 37 degrees C. The study suggests that ligand-bearing vesicles can be a useful marker for cell surface immunoglobulin. However, in spite of the ability to "target" vesicles to cell surface determinants, binding did not result in increased delivery of vesicle contents to the cytoplasm.


Idiopathic paraproteinemia. II. Transplantation of the paraprotein-producing clone from old to young C57BL/KaLwRij mice.

Transplantation experiments in the C57BL/KaLwRij mouse model of idiopathic paraproteinemia (IP) showed that an IP-producing clone can be further propagated in young, lethally irradiated mice and also equally as well in nonirradiated recipients by a bone marrow and/or spleen cell transfer. The latency period before the original paraprotein was detected in the sera of recipients varied in different experiments between 1 and 9 months after transplantation. With subsequent transplantations, the "take" frequency gradually decreased. Propagation of IP for three to four generations seems to be the final limit. In comparison to age-matched seems to be the final limit. In comparison to age-matched control groups, no substantial influence of the transplanted IP on the survival of the recipients was observed. In contrast, transplantation of cells from mice with a B cell lymphoma or a myeloma led to continuous propagation of the malignancy, with a high "take" frequency, progressive development of the paraproteinemia, and a shortened survival time of the recipients. These findings indicate that IP represents in its final stage in the aging C57BL mice an intrinsic cellular defect within the affected B cell clone, which is, however, different from that found in B cell malignancies.


Characterization of a congenitally LPS-resistant, athymic mouse strain.

C57BL/10ScN (nu/nu) mice have B cells and macrophages unresponsive to a phenol-water extracted preparation of Escherichia coli K 235 LPS. This unresponsiveness was demonstrated in vitro by the inability of spleen cells to incorporate 3H-thymidine after a 48 hr incubation with LPS (Ph) and by the inability of LPS (Ph) to inhibit macrophage phagocytosis of 51 Cr-labeled, opsonized sheep erythrocytes. Furthermore, macrophage cultures stimulated with LPS (Ph) produced low levels of LAF and PGE2 when compared with macrophages from the LPS-sensitive C3H/HeN and C3H/HeN (nu/nu) strains. Therefore, the C57BL/10ScN (nu/nu) strain is similar in its LPS unresponsiveness to the well-characterized C3H/HeJ and C57BL/10ScCR strains. The combination of endotoxin unresponsiveness and the athymic nature of this mouse strain may provide a powerful new tool for studying the cellular events mediating endotoxicity.


Transplantation in miniature swine. V. Characterization of Ia antigens.

The complexity of the I region analog associated with the MHC of miniature swine has been probed by sequential antibody precipitation studies of Ia antigens. Treatment of solubilized lymphocyte preparations from MSLA homozygotes of the DD haplotype with excess AA anti-DD alloantiserum led to precipitation of only a portion of the total Ia antigens, as determined by secondary precipitation of the remaining material with CC anti-DD serum. The presumed I region of miniature swine must therefore code for more than one Ia antigen-bearing polypeptide chain. In addition, certain mouse alloantisera that had previously been shown to react with rat Ia antigens were tested for reactivity with swine Ia antigens. Anti-Iak mouse alloantisera precipitated Ia molecules from every swine extract tested, regardless of MHC type, precluding genetic mapping studies. However, sequential precipitation studies demonstrated that the cross-reactive mouse alloantisera reacted only with a subclass of swine Ia antigens, again suggesting genetic complexity of the pig Ia locus.


In vitro sensitization of human lymphocytes against histiocytic lymphoma cell lines. III. The activity of culture-induced suppressor cells.

Normal PBL were sensitized in vitro against an allogeneic diffuse histiocytic lymphoma cell line and their activity was measured by radiolabel release from target cells. We have reported earlier that a non-T cell population, found among the PBL, was responsible for inhibiting in vitro sensitization. In the present work we found that culturing PBL in vitro caused the induction of radioresistant suppressor cells which affected the sensitization phase of the in vitro response. The culture-induced suppressor cells had macrophage-like characteristics. The activity of the suppressor cells depended on an additional helper population that was adherent to nylon wool, but did not adhere to plastic and was non-phagocytic. The cooperation of these two different cell populations was required for the expression of suppressive activity.


A micromethod for in vitro assay of lymphocyte proliferation in mouse whole blood.

A microplate culture system to assay the in vitro proliferative responses of mouse peripheral blood lymphocytes to phytohaemagglutinin is described. The method utilises whole blood, a gamma-emitting isotopic label and semi-automated harvesting. Data are presented to show the effects of several variables on the culture system. The technique is suitable for serial study of the in vitro phytohaemagglutinin response in individual animals.


Antibody-coated protein A-bearing Staphylococcus aureus: a versatile and stable immune reagent.

The human beta2-microglobulin antigen-antibody system was used as a model to illustrate the versatility of a microradioimmunoassay technique using protein A-bearing Staphylococcus aureus Cowan I strain (SACI) bacteria as a non-specific immunoadsorbent in place of a second antibody. Experimental conditions are described for a sensitive microassay which makes it possible to process large numbers of samples more rapidly and with minimum handling. Furthermore, SACI coated with specific antibodies by mixing with unfractionated antisera are a versatile reagent not only for radioimmunoassays but also for use as molecular probes to characterize cell surface antigens. Antibody-coated SACI could be lyophilized and proved extremely stable in storage thus providing a unique advantage for use in binding inhibition assays and as versatile reagent for clinical and investigative immunology.


Hapten-sandwich labeling. IV. Improved procedures and non-cross-reacting hapten reagents for double-labeling cell surface antigens.

New procedures are presented for preparation of hapten-antibody conjugates with the bifunctional amidinating reagent methyl-p-hydroxybenzimidate (HB). Conjugates with improved solubility are effective for hapten-sandwich labeling of cell surface antigens with high sensitivity and specificity. Several non-cross-reacting hapten-antihapten antibody systems are described which are well-suited for simultaneous labeling of different surface antigens.


Biochemistry of the elastic fibers in normal connective tissues and its alterations in diseases.

The elastic fibers present in various connective tissues of the body are responsible for physiologic elasticity of the organs. These fibers consist of 2 distinct components, elastin and the elastic fiber microfibrils. Controlled synthesis and balanced interaction of these 2 components are essential for normal fibrillogenesis. The intracellular biosynthesis of elastin by connective tissue cells, such as smooth muscle cells, involves assembly of the polypeptide chains on the membrane-bound ribosomes, hydroxylation of some prolyl residues to hydroxyproline, and secretion of the polypeptides packaged in Golgi vacuoles. In the extracellular space the elastin molecules assemble into fiber structures which are stabilized by the synthesis of complex covalent cross-links, desmosines. Recently, aberrations in the structure or metabolism of elastin have been detected in a variety of heritable and acquired diseases affecting skin and other connective tissues. These conditions include pseudoxanthoma elasticum, cutis laxa, and elastosis perforans serpiginosa, as well as arteriosclerosis and other degenerative changes of the vascular connective tissues.


Regional variation in the deposition of subepidermal immunoglobulin in NZB/W F1 mice: association with epidermal DNA synthesis.

We have previously reported that aging NZB/W F1 mice develop irregular immunoglobulin deposits along the dermalepidermal junction similar in appearance to those seen in the visibly normal skin of systemic lupus erythematosus patients. In this report we have extended this observation by showing that the frequency of these deposits varies from site to site in the skin of these animals. This regional variation in frequency of deposits was found to correlate positively with regional differences in rates of epidermal basal cell DNA synthesis as determined by autoradiography. These findings provide an explanation for the observed regional variation in frequency of subepidermal immunoglobulin deposition that occurs in human systemic lupus erythematosus.


A reappraisal of the relationship between subepidermal immunoglobulin deposits and DNA antibodies in systemic lupus erythematosus: a study using the Crithidia luciliae immunofluorescence anti-DNA assay.

The relationship between normal skin subepidermal Ig deposits (subepi. Ig) and disease activity in systemic lupus erythematosus (SLE) is controversial. For this reason we have compared certain qualitative and semiquantitative aspects of subepi. Ig in skin biopsies from uninvolved flexor forearm skin to an objective measure of disease severity in SLE, i.e., serum antibodies to double stranded DNA (anti-dsDNA) as determined by the Crithidia luciliae indirect immunofluorescence assay. We have found that both the number of subepi. Ig classes present and the subepi. Ig fluorescence intensity correlate positively with the presence and amount of circulating anti-dsDNA. The group of patients with subepi. IgM alone had anti-dsDNA no more frequently than the group without subepi. Ig; whereas, the group who concurrently had subepi. IgG, IgA, and IgM frequently had high titers of anti-dsDNA. There were some exceptions to these findings in individual patients, however. These findings illustrate the importance of carefully defining the immunofluorescence findings in SLE normal skin.


Protective studies with group A streptococcal M protein vaccine. III. Challenge of volunteers after systemic or intranasal immunization with Type 3 or Type 12 group A Streptococcus.

Alum-precipitated and soluble, purified M protein vaccines were prepared from type 3 and type 12 group A Streptococcus. Adult volunteers were assigned to one of three groups: group I received placebo by both parenteral and intranasal routes; group 2 received vaccine parenterally (either type 3 or type 12) and placebo intranasally; and group 3 received placebo parenterally and vaccine intranasally (either type 3 or type 12). Subjects were inoculated three times at montly intervals. Thirty to 50 days after the last dose, all subjects were challenged with homologous streptococci applied to the oropharynx. Six subjects (30%) vaccinated subcutaneously had definite illness, three (15%) had probable illness, and 11 (55%) had no illness. In the group vaccinated intranasally, four (14%) had definite illness, two (7%) had probable illness, and 22 (79%) had no illness. Fifteen controls (42%) had definite illness, and 21 (58%) had no illness. The rate of colonization was significantly lower in recipients of intranasal vaccine. Average clinical scores and vaccine side effects were also decreased in subjects vaccinated intranasally. Induced serum antibody as measured by passive hemagglutination was not a reliable predictor of resistance to streptococcal pharyngitis. Penicillin was administered to all subjects five days after challenge. No sequelae of streptococcal infection or other complications occurred. Thus, local immunization with M protein apparently may reduce both colonization and clinical illness after challenge with homologous streptococci.


The pyrogenicity of the synthetic adjuvant muramyl dipeptide and two structural analogues.

The pyrogenic efect of the synthetic adjuvant N-acetylmuramyl-L-alanine-D-isoglutamine, also known as muramyl dipeptide (MDP), was studied in rabbits. MDP induced biphasic fevers in rabbits, but two structural analogues, N-acetylmuramyl-L-alanine-D-glutamic acid (MDPA) and the dimethylester of MDPA, were 10 times less pyrogenic. This finding was supported by studies in which MDP and its analogues released leukocytic pyrogen (LP) from rabbit phagocytic cells in vitro. In addition, MDP released LP from human phagocytes. Human phagocytes, however, required a 10-fold greater concentration of MDP than did rabbit cells. The structural analogues were similarly less effective than the parent molecule in releasing LP from human cells. All preparations of MDP were negative in the limulus amebocyte lysate test and failed to show pyrogenic cross-tolerance with bacterial endotoxin. Thus MDP, which is a pyrogenic molecule, is also able to release LP from rabbit phagocytes and to a lesser degree from human phagocytes, but does not cause gelation of limulus amebocyte lysate.


Bacteriuria in a population-based cohort of women.

A survey for bacteriuria was conducted in a community-wide, unselected population of women 16--69 years old. The overall prevalence of bacteriuria was 3.5%. The prevalence of bacteriuria increased with age with a linear trend, but with a significant nonlinear component as well. Bacteriuria was associated with parity after correction for the effects of age. Current symptoms of dysuria and a history of previous urinary tract infection were slightly but significantly more common in women with bacteriuria. The population described should serve as an adequate base for continuing studies of the possible consequences of bacteriuria.


Bone and joint infections due to Salmonella.

A search of the records at the New York City Department of Health and the charts of patients at Columbia Presbyterian Hospital identified 37 cases of bone infection and nine cases of joint infection due to Salmonella between 1964 and 1978. Factors that apparently contributed to the development of either osteomyelitis or septic arthritis in 23 of the patients included hemoglobinopathy, previous trauma or surgery, connective tissue disorder, and lymphoma. Salmonella typhimurium and Salmonella enteritidis were the most common serotypes involved with bone infections, whereas members of the C1 serogroup were the most common cause of septic joint infections. Isolates of C1 serogroup Salmonella were represented in both bone and joint infections with frequencies (24% and 67%, respectively) disproportionate to the numbers of Salmonella isolated from other sources during this period. Therapy for joint infections was usually successful, with minimal residual damage. Therapy for acute osteomyelitis was unaccountably inadequate, with many patients (47%) developing chronic infections. Use of inappropriate therapy or an insufficient period of therapy were the most important factors contributing to poor outcome.


Duration of hospitalization for bacteremic infections at Boston City Hospital during 12 selected years between 1935 and 1972.

In survivors of both community-acquired (CA) and hospital-acquired (HA) bacteremic infections at Boston City Hospital during 12 selected years between 1935 and 1972, the mean hospital stay fluctuated widely from one selected year to the next, but it was generally shorter and early discharges were more frequent in the years when effective antibacterial agents were used. The greatest reduction in hospital stay occurred by 1941. The size of the fluctuations and reductions also varied with the causative organism. The average duration of hospitalization of all survivors of HA bacteremic infections after the first positive blood culture was 10.5 days longer than the total hospitalization of survivors of CA infections. The reduced length of hospital stay after 1935 is attributed to the successful use of effective antibacterial drugs, and the greater effect in CA than in HA cases is attributed to more frequent infections in the latter with organisms resistant to those drugs.


Renal cell turnover studied by Y chromosome (Y body) staining of the transplanted human kidney.

To address questions about turnover between human renal cell populations and extrarenal cells, we studied kidneys that had been transplanted between sexes. By staining frozen sections with acranil and enumerating Y bodies, we could distinguish between male and female tubular and glomerular cells in control nontransplant kidneys. We studied 12 kidneys that had been transplanted from females to males, including seven which had mesangial cell hyperplasia in the transplant. There were virtually no Y body-positive nuclei in the glomeruli or tubules of the 12 kidneys. Thus there was no evidence for an extrarenal cell contribution to either normal or proliferative mesangial cells or to other renal cells. Two of these 12 kidneys had cellular glomerular crescents. Y body-postive extrarenal cells were present in the crescents. Interstitial infiltrates in female-to-male transplants were also Y body-positive.


The role of subregions of the rat major histocompatibility complex in the rejection and passive enhancement of renal allografts.

The laboratory recombinant haplotype H-1acl of the Norway rat has been used in studies of the rejection and passive enhancement of kidney allografts. While the full H-1a haplotype provoked acute rejection, neither of the isolated subregions, H-1Aa and H-1Ba, did so. It was also found that alloantisera raised against either the H-1Aa or the H-1Ba antigens would enhance the grafts. It is suggested that both MHC subregions contain a histocompatibility locus (i) for kidney (as they do for skin) and that in the genetic combinations studied only incompatibility for both provokes a response sufficient for rejection. In other combinations, however, single region incompatibilities may be sufficient.


The influence of contaminants on the mutagenic activity of dibromochloropropane (DBCP).

This study investigates the possible role of impurities in dibromochloropropane in inducing mutations, and discusses the importance of contaminants in mutagenicity and carcinogenicity testing. A technical grade sample and a pure sample of DBCP (no epichlorohydrin added) were assayed in Salmonella typhimurium TA1535, with and without S-9 activation, using agar overlay procedures and dessicator procedures. Assays performed with both technical and pure DBCP without metabolic activation resulted respectively in an increase in revertants with increasing dose (0-1600 microgram/plate) when the technical grade was tested, and no substantial increase in revertants over the same dose range when the pure DBCP was tested. Distillation of technical grade DBCP yielded an initial fraction containing high amounts of epichlorohydrin (verified by GC-MS) which was highly mutagenic. The amount of epichlorohydrin in the technical DBCP sample was calculated for each dose level tested, and the number of revertants obtained in tests of the technical DBCP sample could be attributed solely to the calculated amount of epichlorohydrin in each test dose. Tests of pure and technical DBCP using a dessicator technique produced a similar differential between the technical and pure compounds in mutagenicity. Activation of both technical and pure DBCP with S-9 from Aroclor pre-treated rats resulted in high mutagenic responses, of equal magnitude, from both preparations.


Mutagenicity and antibacterial activity of mycotoxins produced by Penicillium islandicum Sopp and Penicillium rugulosum.

Twelve mycotoxins produced by Penicillium islandicum Sopp and Penicillium rugulosum in solid-state fermentation on grains were purified and tested for mutagenicity and antibacterial activity in Salmonella/mammalian microsome assays. The mutations studied were reversions of histidine auxotrophs to prototrophy in strains TA98 and TA100 and forward mutations to 8-azaguanine resistance (8AGR) in strain TM677. Rubroskyrin, (+)rugulosin, lumiluteoskyrin [a photoproduct of (-)luteoskyrin], and simatoxin [a new water-soluble metabolite of unknown structure] induced 8AGR mutations in strain TM677 but not histidine reversions in strains TA98 and TA100. Mutagenic potency was reduced by rat-liver microsomes. The carcinogens (-)luteoskyrin and cyclochlorotine were antibacterial but not mutagenic. (+)Rugulosin, rubroskyrin, lumiluteoskyrin, and high concentrations of simotoxin were also antibacterial. Antibacterial activity but not mutagenicity was observed with pibasterol and skyrin. Chrysophanol, islandicin, iridoskyrin, and emodin were inactive as mutagens or as antibacterial agents.


Immunological properties of hyaluronidases associated with temperate bacteriophages of group A streptococci.

The antigenic relationships of hyaluronidases, bound and free, associated with temperate bacteriophages of group A streptococci were examined with antibody against purified whole phage and with antibody against phage-bound enzyme released by urea and purified to homogeneity. Studies performed by double diffusion in agar (ouchterlony) with antibody against the homologous purified enzyme from a temperate phage of a type 49 streptococcus indicated that the bound and free enzyme gave a single line of identity and that the free hyaluronidase activities in induced lysates of four strains of M type 49 streptococci were immunologically indistinguishable but different from the enzyme in induced lysates of a heterologous type. The four M type 49 strains were from widely different geographical or temporal sources and of different phage subtypes as determined by lyxic patterns. These findings were confirmed in studies that employed a functional assay of enzyme neutralization. An immunoglobulin preparation of antiserum against the purified enzyme as well as one against homologous purified whole phage neutralized the hyaluronidase activity produced by induction of the M type 49 strains and present either phage-bound or soluble in phage-free lysates. These immunoglobulin preparations had little effect on the hyaluronidase activities present in phage-lysates of other M types of group A streptococci. Inhibition of propagation of temperate phages by antibody against the purified phage hyaluronidase paralleled the neutralization of phage-associated enzyme activity by this antibody, indicating that antibody to the purified enzyme can inhibit phage infection. Antibody preparations against the purified phage-bound enzyme or against purified whole phage did not neutralize the extracellular hyaluronidase in the supernate of an uninduced culture of M type 4 streptococci. A human serum strongly inhibitory for the extracellular enzyme of this strain or on the purified phage enzyme from an M type 49 strain. The results support the view that the hyaluronidases associated with the temperate bacteriophages from various M types of group A streptococci do not share common antigenic determinants but that an immunological specificity exists that parallels the serologic specificity of the M protein of the host strains.


Effects of N-nitrosodiethylamine on murine hepatic mixed-function-oxidase activities.

Administration of N-nitrosodiethylamine (diethylnitrosamine, DEN) to mice caused a loss of cytochrome P-450 and a corresponding depression in the activities of aminopyrine demethylase and aniline hydroxylase. Maximum effects were achieved 24 hr. after a single dose of 100 mg/kg. In chronic experiments, similar effects were achieved after animals had been drinking water containing 50 ppm of DEN for 12 weeks. The effects of DEN on aminopyrine demethylase could not be reproduced by collecting microsomes, from homogenates which had been treated with DEN in vitro. Homogenates prepared from livers of mice treated chronically with DEN were used to activate compounds to mutagens in the Salmonella/microsome test of Ames. Activation by these homogenates was not lower than activation by homogenates prepared from control animals. In fact, activation of aflatoxin B1 was enhanced by use of homogenates from DEN-treated animals as source of activating enzymes.


Extracellular cytolysis by activated macrophages and granulocytes. I. Pharmacologic triggering of effector cells and the release of hydrogen peroxide.

Lymphoma cells were rapidly lysed by activated macrophages and granulocytes in the presence of PMA. Release of 51Cr from lymphoma cells correlated closely with their destruction as viewed by scanning electron microscopy, and with reduction in the number of trypan blue-excluding cells. The standard assay involved 51 Cr release measured at 4.5 h, but injury appeared to be complete in 1 h. Of eight different types of effector cells tested, only those releasing abundant H2O2 in response to PMA were effective, that, is BCG-, C. parvum-, or casein-activated macrophages, or thioglycollate-elicited granulocytes. Normal macrophages, J774 cells, or macrophages elicited with thioglycollate broth or proteose-peptone were ineffective. BCG-activated macrophages and granulocytes caused 50% specific release of 51Cr from P388 lymphoma cells at E:T ratios between 1.4 and 4.5, and from mouse erythrocytes at E:T ratios of 0.017 to 0.025. 10 types of target cells varied widely in their susceptibility to lysis by reagent H2O2, with one-half maximal lysis occurring at H2O2 concentrations ranging from 3.63 X 10(-6) M to 3.85 X 10(-5) M. Effector cells were expected to generate approximately that much H2O2 during the period of injury. Susceptibility of the target cells to lysis by PMA-triggered granulocytes correlated closely with their sensitivity to H2O2 (r = 0.98). The membrane-active agents LPS and digitonin, which did not trigger H2O2 release, did not trigger cytotoxicity. The dose-response curve for triggering of H2O2 release by PMA was identical to that for triggering cytotoxicity. These results provided strong circumstantial evidence for the importance of H2O2 in extracellular cytolysis by activated macrophages and granulocytes when pharmacologically triggered.


The occurrence of a protein in the extracellular products of streptococci isolated from patients with acute glomerulonephritis.

The present report compares the extracellular proteins of streptococci by sodium dodecyl sulfate polyacrylamide electrophoresis. A marked variation in the streptococcal extracellualr proteins (SEP) of different strains was detected, even in strains of similar serotypes. It was possible, however, to identify a single protein band that occurred predominantly in the SEP of strains isolated from patients with acute poststreptococcal glomerulonephritis (APSGN). This protein was generally not produced by streptococci obtained from patients without this disease. It appears to be immunologically similar in the various serotypes of streptococci isolated from patients with APSGN and can be demonstrated by immunofluorescence techniques to be present in the glomeruli of these patients.


Do psychiatric patients fit their diagnoses? Patterns of symptomatology as described with the biplot.

Systems of psychiatric diagnosis have been regularly criticized for their low reliability and their inability to fit accurately the kinds of patients coming for treatment. To explore the reasons for these problems, this study utilizes a new method, the biplot, for defining groups of similar patients and the relationships of these groups to key symptom clusters. Using this technique to analyze data from a representative sample of first admissions for psychiatric disorder, results showed: a) symptom clusters representing the classical diagnostic categories, mania, schizophrenia, neurotic depression, and psychotic depression, were readily identified; b) however, only a few patients were clustered near these traditional syndromes. These findings suggest that although syndromes do exist that fit traditional diagnostic categories, the vast majority of patients fall between these syndromes, having characteristics from several of them. For most patients, forcing the diagnostician to choose among the categories requires an arbitrary decision that may contribute to dissatisfaction in the diagnostician who recognizes how misleading the diagnosis can be.


Nicolaus A. Friedreich's description of peripheral facial nerve paralysis in 1798.

In 1798, Nicolaus A. Friedreich of Wurzburg published a detailed clinical account of three patients with idopathic peripheral facial nerve paralysis. His astute observations of onset, physical findings, natural course, treatment, and recovery preceded those of Charles Bell by 23 years.


Distribution of S-100 and 14-3-2 proteins on neuronal cell membranes.

The distribution of nervous tissue specific S-100 and 14.3.2 proteins was studied over the total surface of isolated, intact nerve cells by immunofluorescence microscopy. The distribution of the antigens was different on the front and back of the cells, indicating complicated S-100 and 14.3.2 patterns. A partly overlapping in membrane pattern of S-100 and 14.3.2 proteins was observed, although S-100 protein dominated with respect to membrane areas covered. At higher resolution the specific fluorescence appeared as conglomerates and islets. The neuronal membrane patterns of S-100 and 14.3.2 antigens, including synapses suggest that nerve cell membranes are functionally differentiated, thus greatly increasing the capacity for identification of incoming stimuli.


Total treatment planning for esthetic problems of the face: a team approach.

Oral and maxillofacial surgeons now have the capabilities to plan a total treatment for the entire face. In some instances, a team may be formed to deal with ancillary areas of expertise. Patients may be directed to members of the team who are cognizant of each other's capabilities. In this manner, the most complete type of treatment plan may be suggested to the patient.


Surgical correction of infraorbital-maxillary deficiency.

Patients who have a maxilla that is retruded or hypoplastic, or both, but who have a mandible of normal position and size, will have degrees of flatness in the middle third of the face. Using systematic clinical evaluation and cephalometric skeletal analysis, a clinically recognizable facial deformity manifested by retrusion or hypoplasia, or both, of the maxilla, anterior zygoma, and infraorbital rims has been recognized. This deformity has been classified as infraorbital maxillary deficiency. The purpose of this paper is to describe an infraorbital-maxillary osteotomy for correction of this dentofacial deformity and to give a rationale for its use. The design of this osteotomy is determined by the skeletal deformity and can be classified as either low or high. The objective is to produce simultaneously a functional occlusion and facial harmony. Two of eight cases corrected by this surgical treatment are described.


Induction of macrophage DNA synthesis in vitro by non-immunological inflammatory exudates: effect of irradiation and thymus or bone marrow cell reconstitution.

An acute inflammatory exudate possesses mitogenic activity in that it is able to induce both DNA synthesis and proliferation of macrophages in vitro. This activity is reduced however if the inflammatory exudate is obtained from irradiated rats (900 r). Transfer of bone marrow syngeneic cells into irradiated rats does not reverse this reduction. On the contrary the decrease of mitogenic activity is more pronounced. On the other hand transfer of thymic syngeneic cells not only restores the mitogenic activity of inflammatory exudate from irradiated rats but increases it. Transfer of both types of cell together fully restores the mitogenic activity of inflammatory exudate. It is postulated that the mitogenic activity of inflammatory exudate could be related to thymic cells and that T lymphocytes may be involved in non-specific inflammatory reactions.


A prospective randomized study to determine the efficacy of steroids in treatment of croup.

We evaluated the use of dexamethasone in the management of acute laryngotracheobronchitis (croup). Thirty patients, ranging in age from eight to 60 months, were evaluated in a prospective, double-blind study. Patients received dexamethasone, 0.3 mg/kg at the time of admission and a similar dose 2 hours later, and were compared with a placebo group receiving saline. Sixteen patients received dexamethasone and 14 patients received the placebo. Severity of each group was scored by a standardized system. Patients receiving dexamethasone had a mean admission score of 8.46 points; patients receiving placebo, 8.14. Twenty-four hours after admission the patients in the treatment group had a mean score of 1.19 as contrasted with a score of 5.58 for the placebo group (P less than 0.01). We concluded that dexamethasone when administered in adequate dosage by an intramuscular route hastens the recovery of infants and children with acute uncomplicated croup.


Honey and other environmental risk factors for infant botulism.

Infant botulism results from the in vivo production of toxin by Clostridium botulinum after it has colonized the infant's gut. Epidemiologic and laboratory investigations of this recently recognized disease were undertaken to identify risk factors and routes by which C. botulinum spores might reach susceptible infants. Clostridium botulinum organisms, but no preformed toxin, were identified in six different honey specimens fed to three California patients with infant botulism, as well as from 10% (9/90) of honey specimens studied. By food exposure history, honey was significantly associated with type B infant botulism (P = 0.005). In California, 29.2% (12/41) of hospitalized patients had been fed honey prior to onset of constipation; worldwide, honey exposure occurred in 34.7% (28/75) of hospitalized cases. Of all food items tested, only honey contained C. botulinum organisms. On household vacuum cleaner dust specimens and five soil specimens (three from case homes, two from control homes) contained Clostridium botulinum. The known ubiquitous distribution of C. botulinum implies that exposure to its spores is universal and that host factors contribute importantly to the pathogenesis of infant botulism. However, honey is now an identified and avoidable source of C. botulinum spores, and it therefore should not be fed to infants.


Sodium bromide and sodium valproate: effective suppressants of ethanol withdrawal reactions in mice.

Mice were made physically dependent on ethanol by a 3-day alcohol inhalation regimen, using pyrazole to stabilize blood ethanol concentrations. After withdrawal, convulsions elicited by handling were scored repeatedly for 30 hr as a measure of central nervous system hyperexcitability. Administration of sodium bromide, 0.2 to 2.0 g/kg i.p., suppressed the convulsions in a dose-related fashion. Bromide was effective at subsedative doses. However, bromide increased the postwithdrawal mortality. Bromide may act at chloride channels, as gamma-aminobutyric acid does. Valproate and its amide temporarily suppressed the withdrawal reaction at doses that caused some sedation. Muscimol and beta-alanine had no effect.


Systemic response to mydriatic eyedrops in neonates: mydriatics in neonates.

During routine dilation of 48 newborns, systemic responses and pupil dilation were monitored. Both 10 percent aqueous and viscous phenylephrine caused blanching around the eyes and produced considerable rise in blood pressure. Dilatation average 4.7 mm. In a double blind study, a 2.5 percent solution caused no skin blanching and no change in pressure or heart rate. Average dilation was 4.5 mm. No blood pressure changes were observed with either one percent cyclopentolate or one percent tropicamide. Average dilatations were 5.0 mm and 5.3 mm respectively. The above agents, used individually for a total dosage of three drops in each eye did not provide adequate dilation for a thorough funduscopic examination. Our protocol at United Hospitals Medical Center is a safe combination of drugs and provides excellent dilatation averaging greater th an 7 mm. No skin blanching or change in heart rate was observed.


Prostacyclin effects on renal hemodynamic and excretory functions in the rat.

Blood pressure, renal blood flow, glomerular filtration rate and urine composition and flow rate were measured, and renal vascular resistance was calculated, before and during infusion of prostacyclin (PGI2) i.v. or i.a. just proximal to the origins of 250 ng/min, PGI2 caused a significant but slight (13%) reduction in renal vascular resistance, but did not consistently increase renal blood flow. Given at the highest infusion rate which could be sustained without reducing blood pressure, PGI2 did not alter glomerular filtration rate or urine composition or flow rate. Intravenous PGI2 infusion caused reductions in systemic blood pressure and renal blood flow at a dose of 50 ng/min; infusion into the abdominal aorta produced equal reductions in pressure and flow at a dose of 500 ng/min. Although PGI2 is the only prostaglandin shown to reduce renal vascular resistance in the rat, it does not appear to be sufficiently specific for the renal vasculature or potent enough to justify suggesting a physiological role in regulation of renal function in the rat.


Vital root retention in humans: an interim report.

A protocol based upon findings in laboratory animal studies was established for the retention of vital roots for overdenture support in humans. Ten patients with a mean age of 54.5 years and a postsurgical mean time of 11.1 months had 45 vital teeth buried submucosally under complete overdentures. Of the 45 teeth, 37 remained vital, seven were endodontically treated due to acute pulpal response following surgery, and one tooth has been extracted. A mean interproximal bone loss of 1.1 mm had occurred at the time the data were tabulated for this report. This project included a cross section of patient types, tooth selection, and surgical and prosthodontic management that varied slightly from the methods utilized in earlier patient treatment. The inclusion of maxillary teeth, the increased thoroughness of root surface roundings, and the utilization of root canal therapy with subsequent reburying of apulpally involved teeth expanded the scope of this research. A final report on this project will be forthcoming when all patients have been followed for a 24-month period.


Occlusal force transmission by overdenture attachments.

This investigation utilized a composite photoelastic model to examine the load-transfer characteristics of several overdenture attachments. Tissue bar (Hader and King Connector) and stud (extracoronal) attachments (Rotherman, Gerber, and Ancrofix) were studied. The following observations may provide guidelines for the selection of overdenture attachments. 1. The more retentive tissue bar and extracoronal attachments produced higher stress concentrations. 2. Of the tissue bars tested, the Hader Bar produced less torquing forces on the abutment teeth. 3. The Ancrofix appeared to share the forces of occlusion between abutments and the posterior edentulous regions. 4. It must be emphasized that several other factors will also influence the choice of overdenture attachments, such as the judgment of the dentist, economics with respect to the patient, and the availability of laboratory expertise.


A comparison of the casting accuracy of base metal and gold alloys.

The casting accuracy of three alloys was compared, and statistically significant differences in the dimensions of each alloy were demonstrated when the frameworks were compared to their respective master casts. There are certain problems with the accuracy of each alloy studied; thus framework try-in appointments and wrought wire clasps soldered to the finished framework are advocated.


Occlusal considerations for the partial mandibulectomy patient.

The occlusal scheme fabricated for a patient with a mandibular defect varies extensively from patient to patient, with some limitations in occlusal efficiency. Some patients may expect little or no occlusal efficiency if the defect is large and if the associated mandibular deviation and the lack of muscle control and excessive. If the continuity of the mandible can be restored by secondary surgical management (Fig. 10, A), most of the problems of the discontinuity defect can be resolved. Whether the teeth in the region of the defect are replaced or not may be dependent on other factors, but the mandible can be treated as a stable entity within itself, and the prosthodontic approach can be similar to that discussed for the continuity defect (Fig. 10, B). The mandibulectomy patient is difficult to manage because the prosthodontist is limited in his ability to provide a reasonable and practical occlusal scheme. However, these patients need the definitive clinical and psychological support of the prosthodontist. Most patients recognize the limitations of their rehabilitation and are appreciative of the prosthodontic therapy that enhances their rehabilitative progress.


Application of various removable partial denture design concepts to a maxillary obturator prosthesis.

A patient with a relatively minor yet common acquired maxillary defect was provided with three obturators of differing design. His subjective evaluations and the relative merits of the designs were discussed.


Sequential palatal expansion and premaxillary retrusion for cleft palate infants.

This article has described a technique to achieve maxillary orthopedics for the infant with a bilateral cleft lip, protruded premaxilla, and intact palate. Both maxillary expansion and retraction of the premaxilla can be accomplished with the same prosthesis.


One-step border molding of complete denture impressions using a polyether impression material.

A technique has been described which uses a polyether impression material for border molding of complete denture impressions. It has the following advantages: 1. There is simultaneous molding of all borders of either the maxillary or mandibular impression. 2. Border molding can be accomplished with one insertion of the tray. 3. Functional movements performed by the patient are used in border molding. 4. The technique is easily mastered.


Simplified denture repair technique.

The use of a cyanoacrylate adhesive to accurately and easily assemble the fractured segments of a denture is advocated. The repair can then be accomplished quickly without the need to pour a stone cast so that the patient does not remain without the prosthesis for extended periods. In addition, dentures once deemed unrepairable by conventional methods because they were broken into many pieces can now be salvaged.


Competition among serologically different clones of Trypanosoma brucei gambiense in vivo.

When different antigenic variant clones are injected in equal numbers into white mice one variant clone always replaces the other. This phenomenon appears to be a predictable one, even under conditions analogous to a chronic infection. It is hypothesized that a constant ratio is approached between the number of cells of different antigenic serotypes present in a single population, in such a manner that there is always a major antigenic variant and minor populations of different antigenic variants. It is further suggested that these ratios can undergo rapid changes in response to changes in the environment, e.g. nutritional status of the host, changes in body temperature, antibody synthesis, etc. The changes in these ratios are discussed in relation to the mechanism(s) of antigenic variation.


Double blind trial of clonidine in the treatment of migraine in a general practice.

The value of clonidine (;Dixarit') for the prophylaxis of migraine has been assessed by a double blind cross-over trial. A dose of up to 0.15 mg daily was used. No effect on the frequency of the headaches could be detected over and above the 60 per cent reduction observed with a placebo. Severity, assessed subjectively by the patient, when it varied between placebo and clonidine, was less with clonidine (p<0.01). There was also some evidence that headaches lasting more than 12 hours were less common during treatment with the drug.


The immunoglobulin class of anti-DNA antibodies: detection by a fluorometric immunoassay: clinical and pathological correlations in SLE.

The relationship of the immunoglobulin class of anti-double stranded DNA antibodies to the histological and clinical evidence of glomerulonephritis was examined in patients with systemic lupus erythematosus using a quantitative solid-phase fluorometric immunoassay. Patients with anti-DNA antibodies of the IgG class had more severe histologic changes on renal biopsy, more clinical evidence of active renal disease and lower hemolytic complement levels. The class of anti-DNA antibodies in the serum did not always correspond with the class of immunoglobulin deposited in the glomeruli of renal biopsy specimens.


Bacteriophage MS2 RNA: a correlation between the stability of the codon: anticodon interaction and the choice of code words.

The non-random distribution of degenerate code words in Bacteriophage MS2 RNA can be explained partially by considerations of the stability of the codon-anticodon complex in prokaryotic systems. Supporting this hypothesis we note that wobble codons are positively selected in codons having G and/or C in the first two positions. In contrast, wobble codons are statistically less likely in codons composed of A and U in the first two positions. Analyses of nucleotides adjacent to 5' and 3' ends of codons indicate a nonrandom distribution as well. It is thus likely that some elements of RNA evolution are independent of the structural needs of the RNA itself and of the translated protein product.


Comparison of light-microscopic methods for visualizing horseradish peroxidase granules in stained and unstained tissue.

This study was directed toward a comparison of the effectiveness of three different light-microscopical methods for identifying and studying the features of cells that contain horseradish peroxidase (HRP) granules. The cells studied were located in the trigeminal ganglia and were labeled after the injection of HRP solutions into single, maxillary, canine teeth. The tissue was examined with light field, dark field, and differential interference optical systems. The results indicated that differential interference optics were especially useful in revealing the presence of intracellular HRP granules in both unstained and stained tissue, particularly when cells only contained small amounts of HRP. It was also noted that a wide variety of quantitative analyses could be performed with differential interference optics, even when using unstained tissue.


Comparison between moist swab and tissue biopsy methods for quantitation of bacteria in experimental incisional wounds.

The relationship between tissue-associated and wound fluid-associated levels of bacteria in closed, healing experimental incisional wounds seeded with Escherichia coli was examined in 200 rats. Tissue specimens and moist swab specimens were taken simultaneously and cultured by a single plate serial dilution method. Colony counts of approximately 10(5) bacteria/gm of tissue were found to be equivalent to colony counts of 10(3) bacteria/ml of specimen obtained on a moist swab. Moist swab sampling of an incisional wound therefore offers a direct and simple method of ascertaining infection (defined by others as greater than 10(5) bacteria/gm of tissue). Moist swab sampling obviates the necessity of surgical manipulation of the patient and subsequent weighing and grinding of tissue in the laboratory.


The fractured cervical spine rendered unstable by anterior cervical fusion.

Anterior interbody grafts are prone to displacement if there is posterior instability or gross deformity of the vertebral body. Twenty-one patients treated with anterior interbody fusion for cervical vertebral fractures and dislocations were studied. Twelve of the fractures were considered unstable preoperatively, and 50% of this group treated with anterior stabilization had graft migration postoperatively. If anterior fusion is used in unstable cervical fractures then posterior stabilization or complete bed rest with effective external stabilization (i.e., tongs or Halo-thoracic brace) for 4 weeks is mandatory. The other alternative is posterior stabilization before anterior decompression. In the presence of posterior instability, anterior interbody fusion alone cannot be recommended as the treatment of choice for cervical fractures.


[Mandibular hemangioma].

A complete review of the literature, since 1849 up to the present, was done. An additional personal case report describes an eight year old girl with radical resection and reconstruction, using an autogenous bone graft from the tibia. The diagnostic and therapeutic problems associated with this type of lesion are presented. The possibility of hemangioma must be considered in front of osteolytic lesions of the mandibule.


Foreign body perforation of the esophagus initiating traumatic pericarditis in an Australian fur seal.

Postmortem examination of a juvenile Australian fur seal, Arctocephalus pusillus doriferus, washed ashore on Philip Island, Victoria, revealed traumatic fibrinous pericarditis and hemothorax. A foreign body lodged in the right ventricle was identified as the barbed spine of the ray Urolophus paucimaculatus. A small puncture wound through the esophagus indicated the initial perforation site.


Rapid identification of infectious pancreatic necrosis virus in infected cell cultures by immunoperoxidase techniques.

Direct and indirect immunoperoxidase (IP) techniques were evaluated for their potential in identifying infectious pancreatic necrosis (IPN) virus. Both techniques were shown to offer a relatively simple, rapid and efficient means for the specific identification of IPN virus in infected cells. The direct IP method resulted in less nonspecific staining; however, the indirect method was clearly specific and utilized commercially available reagents.


Osteomyelitis and arthritis caused by Salmonella typhimurium in a crow.

Salmonella typhimurium was isolated from an arthritic elbow joint of a crow (Corvus brachyrhynchos) which also had bilateral osteomyelitis of proximal tibias. The prevalence of Salmonella organisms in wild birds is reviewed briefly.


Prevention of Russian influenza by amantadine.

We tested the effectiveness of amantadine hydrochloride in prevention of illness and infection caused by Russian (h1n1) influenza. The trial lasted seven weeks and was double-blind and placebo controlled. The dosage used was 200 mg daily. Efficacy in prevention of serologically confirmed clinical influenza was 70.7%. Efficacy in prevention of infection, symptomatic or asymptomatic, was 39.4%. Side effects seen were all mild, began within two days of the start of the trial, and terminated rapidly on cessation of prophylaxis. The withdrawal rate attributable to use of amantadine was 6.2%. Those who continued to receive prophylaxis for the remainder of the trial did not exhibit excess side effects. It is concluded that amantadine is safe and effective in prophylaxis of H1N1 strains, as has been shown previously for other subtypes of A influenza.


Salmonella typhimurium. Transmission by fiberoptic upper gastrointestinal endoscopy.

During a four-month period, Salmonella typhimurium developed in seven persons within five days of fiberoptic upper gastrointestinal (GI) endoscopy. A retrospective cohort study confirmed the association between S typhimurium infection and fiberoptic upper GI endoscopy. Salmonella typhimurium was cultured from the endoscopic equipment and the accessory suction equipment. The Salmonella isolated from the endoscopic and accessory suction equipment was identical to that recovered from the seven patients with salmonellosis by serotype, antimicrobial susceptibility pattern, and bacteriophage lysis pattern. Salmonella transmission was attributed to inadequate disinfection of the endoscope and accessory equipment between procedures. The original source of the contamination was not discovered.


Hypertension following renal transplantation. Causative factors and therapeutic implications.

During a five-year period, we studied 21 of 319 renal transplant recipients who were admitted for evaluation of refractory hypertension. For comparison we examined 93 consecutive patients in the renal transplant clinic. Hypertension, which was noted in 47% of the outpatients, occurred with greater frequency following renal transplantation from cadaveric donors and was associated with a decline in renal function. The 21 inpatients had higher blood pressures and were studied at an earlier stage than their outpatient counterparts. Fourteen of the inpatients had underlying stenosis of their transplant artery nd revascularization of the transplanted kidney was possible in the majority of these patients. Stenosis of the transplant artery was suggested by the occurrence of severe hypertension during the first year following transplantation, a bruit in the transplant region, and increased levels of peripheral plasma renin activity.


Ampicillin prevents intrapartum transmission of group B streptococcus.

Early-onset group B streptococcus (GBS) disease in the infant is acquired by vertical transmission from the mother colonized with GBS. Thirty-four women colonized with GBS were treated with intravenous ampicillin sodium during labor. None of their infants were colonized with GBS at birth or within 48 hours. Twenty-four women colonized with GBS received no antibiotic therapy; 14 (58%) of their infants were colonized with GBS at birth or by 48 hours. This difference was highly significant. Mechanisms by which this may have occurred were temporary suppression of GBS vaginal and rectal colonization, high concentration of ampicillin in the amniotic fluid, and transplacental transport of the antibiotic to the infant. In areas where GBS disease is prevalent, we recommend screening pregnant women (34 to 36 weeks' gestation) and treating those colonized with GBS (with no history of penicillin hypersensitivity) with intravenous ampicillin during labor.


Antimicrobial vs placebo prophylaxis in noncardiac thoracic surgery.

A prospective, double-blind evaluation of the efficacy and safety of prophylactic cephalosporins was done in 57 patients undergoing noncardiac thoracic surgery. Twenty-eight received cephalosporin therapy, and 29 received placebo. Overall, the incidence of postoperative infections was the same; infections developed in five (17.8%) of the 28 patients in the cephalosporin group and in five (17.2%) of the 29 patients in the placebo group. Of the five deaths attributable to infection, three occurred in patients receiving placebo and two in patients receiving cephalosporin therapy. No differences were noted in WBC counts, fever, duration of hospitalization, hypersensitivity reactions, or abnormal liver functions. However, drug fever, phlebitis, and abnormal renal function occurred more often in the patients receiving cephalosporin therapy.


A comparative study of bronchodilator effects of carbuterol and ephedrine.

The bronchodilator effect of carbuterol hydrochloride, a new adrenergic agonist, was compared with that of ephedrine sulfate in 12 patients with bronchial asthma. A 2-mg dosage of carbuterol hydrochloride, three times daily, was used in comparison with a 25-mg dosage of ephedrine sulfate, three times daily. The drugs were orally administered for ten-day periods in a double-blind, randomized manner. After carbuterol therapy, the mean increases in forced expiratory volume in one second and midmaximal expiratory flow rate were significantly greater in a four-hour period than those noticed with ephedrine. A decrease in bronchodilator response to both drugs was noticed on the tenth day. No side effects were noticed with carbuterol at the aforementioned dosage. The results of our study indicate that carbuterol is a safer and more effective bronchodilator than ephedrine.


Vitamin C prophylaxis in marine recruits.

A prospective, randomized, double-blind study was carried out to determine whether vitamin C prophylaxis, 2.0 g/day, vs placebo prophylaxis would reduce the incidence or morbidity of the common cold and other respiratory illnesses in 674 marine recruits during an eight-week period. Whole-blood ascorbic acid levels measured six weeks after initiation of the study were significantly higher in the vitamin C group. There was no difference between the two groups in the incidence or duration of colds. The vitamin C group rated their colds as being less severe, but this was not reflected in different symptom complexes or in fewer sick-call visits or training days lost. This study and the literature do not support the prophylactic use of vitamin C to prevent the common cold.


Respiratory therapy. Current practice in ambulatory patients with chronic airflow obstruction.

The role of respiratory therapy in treating ambulatory patients with chronic obstructive pulmonary disease is becoming more clearly defined. Oxygen therapy on a continuous basis is needed for patients with arterial PO2 values below 45 mm Hg and should be considered for patients with arterial PO2 values between 45 and 55 mm Hg who have chronic cor pulmonale, erythrocytosis with hematocrit value greater than 55%, and disturbances of cognition and sleep. Concentrated bronchodilator and corticosteroid aerosols have established roles in therapy; the place of bland aerosols is less clear They may increase ease of expectoration and should be given by simple compressed-air nebulizer systems; their administration by brief periods of intermittent positive-pressure breathing is rarely justified. Three-positional, postural drainage with chest percussion and vibration may be helpful in mobilizing secretions in patients with severe disease.


Maternal positions for childbirth: a historical review of nursing care practices.

The basis of maternity care practices related to maternal position for childbirth is analyzed historically in a review of the American periodical nursing literature from the early 1900's to the present and of contemporary maternity nursing texts. The factors of 1) concomitant obstetrical practices, 2) the prerogative of the physician, and 3) the evolving and predominantly supportive role of the nurse are identified as the major influences on these nursing practices. Historical aspects of the development of the current role of the nurse in maternity care are identified. While nurses are currently questioning care practices related to the positions of women for childbirth and offering more explicit rationale, the need for research related to features of physical care and a more assertive professional role for nurses is emphasized.


[Human milk--some recent aspects of breast feeding].

New data on the quality and quantity of protein and nor-protein nitrogen in human milk are discussed in the first part of this review. The second part presents a short review of current knowledge on immunologically important components of human milk (secretory IgA, Lactoferrin, ligands for folic acid and vitamine B-12. Lysozyme, cells, induction of breast milk flora in the intestine). There are very good reasons to enhance breast feeding also in developed countries.


The origin of glomerular crescents in experimental nephrotoxic serum nephritis in the rabbit.

The origin of glomerular crescents and diffuse hypercellularity was investigated in rabbits receiving a single intravenous injection of nephrotoxic serum. Experiments to demonstrate local glomerular proliferation included mitotic counting at intervals after nephrotoxic serum and autoradiography of kidneys 1 hour after pulse-tritiated thymidine labeling. There was an increase in local endocapillary proliferation between days 4 and 6 when severe diffuse hypercellularity developed. From days 8 to 13 during crescent formation there was considerable local epithelial proliferation. To assess the role of infiltrating bone marrow cells a new technique of renal transplantation in rabbits was developed. Kidneys from unlabeled donors were transplanted on either day 4 or day 9 into recipients prelabeled with tritiated thymidine, and labeled cells were sought in glomeruli of transplants 1 to 4 days later. Large numbers of labeled cells appeared on days 5 to 6 in areas of endocapillary hypercellularity in glomeruli of animals given transplants on day 4 indicating a significant influx of bone marrow cells. In contrast, in kidneys transplanted on day 9, few labeled cells were present in crescents on days 10 to 11. Autoradiographic labeling of mononuclear phagocytes in carrageenan granulomas and interstitial renal infiltrates in recipients were used as positive controls of bone marrow cell labeling. We conclude that in the early phase of diffuse hypercellularity there is considerable blood monocyte infiltration, whereas crescents which develop later are principally the result of glomerular epithelial cell proliferation.


Granular dense deposit disease.

During a retrospective study of dense deposit disease, we observed in three patients, unusual granular electron-dense deposits in the glomerular basement membrane in a laminar pattern. However, the distribution of these electron-dense deposits was similar to the distribution of the homogeneous, extremely electron-dense deposits of dense deposit disease. By light microscopy a membranoproliferative glomerulonephritis was demonstrated in two patients. The other patient had multiple myeloma with glomerulopathy and intratubular protein casts with histiocytic giant cell reaction. By immunofluorescence microscopy the presence of granular deposits in the glomerular basement membrane and mesangium was revealed in only one patient, with anti-human IgM and complement (C3). By electron microscopy was demonstrated the thickening of the glomerular basement membrane by densely packed small granular aggregates of varying sizes, ranging from 100 to 800 A in diameter. Similar electron-dense deposits in a laminar pattern were present in the Bowman's capsule and renal tubular basement membrane of two patients. The specific nature of these small electron-dense deposits is unknown.


Distribution of heterologous antiperoxidase antibodies and their fragments in the superficial renal cortex of normal Wistar-Munich rat: an ultrastructural study.

The distribution of serum proteins in the superficial renal cortex of normal Wistar-Munich rats was studied using a new technique. Heterologous antiperoxidase antibodies (160,000 daltons), their F(ab')2(100,000 daltons), and Fab (50,000 daltons) fragments were injected intravenously and then demonstrated by incubation with free peroxidase after in situ fixation. This technique offered several advantages including easy and uniform detection of the proteins, even in tubular cells, and a high degree of specificity and accuracy. Four findings emerged from this: (1) The glomerular filtration barrier was found to be complete for IgG and incomplete for (ab')2 and Fab fragments. (2) This barrier for IgG was localized in the lamina densa. (3) The filtered proteins were found to be reabsorbed and degraded in the proximal tubule. (4) The three proteins were diffusely detected in the interstitial tissue and in tubular intercellular spaces up to apical tight junctions.


Immunohistologic demonstration of hepatitis B viral antigens in liver with reference to its significance in liver injury.

Indirect immunoperoxidase stainings for hepatitis B core and surface antigens (HBc&s Ag) were applied to formalin-fixed paraffin sections in 113 liver specimens from 56 patients. Many cytomorphologic staining characteristics of HBc&s Ag were illustrated, and the percentages of the cellular population positive for HBc&s Ag were estimated for all specimens in order to provide the basis for general analyses. The quantitative expressions and the topographic distribution of HBc&s Ag were assessed with respect to their significance and implication in histopathologic reactions. A definitive relationship or relevance was neither established nor completely excluded due to the size of samples. However, cytomorphologically the membranous expression of HBc&s Ag was shown often in association with acute lobular hepatitis and chronic active hepatitis. This observation supports the concept that the membranous expression may be the prerequisite for immune mediated hepatitic injury in viral hepatitis. In this study we also carried out indirect immunoferritin and immunoperoxidase electron microscopy for HBc&s Ag on formalin-fixed liver specimens. The results assured the validity of the light microscopic immunohistologic procedures. The immunoelectron microscopy confirmed the presence of core antigen in the Dane particles formation that takes place in the cisternae of endoplasmic reticulum. The significance of the cytoplasmic core antigen and the possible role of immunoelectron microscopy in the elucidation of mechanisms of hepatitic injury were discussed.


Comparison of the handling of ferritin and ferritin-protein conjugates by the glomerular mesangium: kinetic studies in the rat.

Kinetic studies on the uptake and elimination of ferritin and ferritin-protein conjugates in the rat glomerular mesangium are reported. Ferritin was prepared from horse spleens and conjugates were prepared using either human IgG or albumin. The degree of mesangial uptake was dose dependent and a competitive effect with the reticuloendothelial system was observed. Maximal mesangial fluorescence occurred at a lower dosage with conjugate than with native ferritin. In addition, conjugate persisted for months within the mesangium as compared to a matter of days in the case of ferritin alone. The disappearance of native ferritin from the mesangium paralleled that seen in the circulation. Conjugate, however, disappeared far more rapidly from the circulation than from the mesangium. At a point in time when the mesangium still contained conjugate but the blood was negative, rabbit antiserum to ferritin was injected and was observed to deposit in the mesangium. This demonstrated the accessibility of mesangially sequestered antigen to circulating antibody. This system provides a model for long term studies on the effect of immune reactions occurring in the mesangium.


Glucocorticoid and antibiotic effects on hepatic microcirculation and associated host responses in lethal gram-negative bacteremia.

Liver changes and associated host responses were evaluated in four groups of male rats, weighing 300 +/- 20 gm., which received intravenous injection of 2.2 times 10(9) live Escherichia coli. This bolus was given either without additional treatment (group A) or prior to the following regimens: intramuscular injection of gentamicin sulfate, 5 mg. per kg. (group B); intravenous injection of methylprednisolone sodium succinate, 40 mg. per kg. (group C); and intramuscular injection of gentamicin immediately after methylprednisolone sodium succinate treatment (group D). Rats given injections of saline or methylprednisolone sodium succinate served as controls. Survival rates at 10 and 20 hours were 25 per cent and 4 per cent for group A; 44 per cent and 28 per cent for group B; 94 per cent and 70 per cent for group C; 98 per cent and 98 per cent for group D, respectively. In rats of groups A and B, killed at 1, 2, 4, and 6 hours, progressive liver changes included intravascular sequestration of rapidly degranulating leukocytes, fibrinous deposits, and platelet aggregates in sinusoids as well as in spaces of Disse adjacent to subendothelial collagen, and extensive Kupffer cell disruption in association with severe midzonal necrosis. These alterations were accompanied by progressive hypoglycemia and elevations of serum enzymes, glutamic pyruvic transaminase, lactate dehydrogenase, and glutamic oxaloacetic transaminase. Hematologic studies revealed that E. coli bacteremia results in rapid leukopenia and disseminated intravascular coagulation primarily due to activation of the intrinsic coagulation pathway. All above reactions were delayed and markedly reduced in rats treated with methylprednisolone sodium succinate. The results indicate that antibiotic treatment of lethal, Gram-negative bacteremia is effective only in conjunction with early steroid treatment. The protective effects of glucocorticoids on the liver microcirculation and polymorphonuclear leukocytes appear to play a basic role in preventing the early development of disseminated intravascular coagulation, hepatocellular necrosis, and associated major host responses, thereby attenuating lethality of gram-negative septic shock.


Selective neuronal, dendritic, and postsynaptic localization of viral antigen in measles-infected mice.

The pathology of acute disease produced by intracerebral inoculation of hamster neurotropic strain of measles virus was studied in adult BALB/c mice using immunolabeling techniques at a light and electron microscopic level. Brains of animals with acute disease showed an abundance of viral antigen but no inflammatory cells, giant cells, or inclusions. Infection was limited to neurons which were rarely necrotic, indicating that the process was not cytolytic. Mapping of infected neurons identified a consistent predilection to the rhinencephalon, other components of the limbic system, and the striatum. Ultrastructural examination revealed similar findings in all of the involved areas. No evidence of viral assembly at the cell membrane was found. Viral antigen was identified in neuronal perikaryon with somatofugal spread into dendritic and synaptic sites. Unlabeled smooth nucleocapsid and labeled tubular structures were detected both in the cytoplasm and nucleus of neurons. Dendritic labeling when present was occasionally associated with the neurotubules. The most remarkable and frequent finding was identification of viral antigen in postsynaptic endings. This consisted of clumps of viral antigen and occasional staining of the postsynaptic density. This localization of viral antigen may create dysfunction of synaptic transmission, and in the absence of overt pathology, may account for clinical disease.


The influence of therapeutic irradiation of blood and peripheral lymph lymphocytes.

This paper reviews the changes of blood and peripheral lymph lymphocytes induced by therapeutic irradiation as given for a variety of lymphoid and nonlymphoid neoplastic diseases. The irradiation brings about an abrupt reduction of the numbers of blood B and T lymphocytes. The number of lymphocytes seems to be restored within a few months after irradiation, while at least 3-5 years appear to pass before the number of blood T lymphocytes is restored. The pattern of recovery seems to be the same whether the thymus has been included in the fields of irradiation or not. In the adult organism, considerable differences apparently exist between the capacities for reproduction of B and T lymphocytes. The number of lymphocytes in peripheral lymph is also much reduced in the irradiated patient and remains so for a long period. This is compatible with the concept that migration from blood to peripheral lymph is a feature quite specific for T lymphocytes. These results are discussed in relation to the immune defense against infection and autologous tumor, and also in relation to the influence of radiotherapy on the immune defect in Hodgkin's disease.


Severe infection due to Streptococcus pneumoniae in asplenic renal transplant patients.

The medical records of 293 patients who underwent renal transplantation were analyzed for the occurrence of Streptococcus pneumoniae and Haemophilus influenzae infections in relation to splenectomy. Splenectomy was done in 236 (81%) graft recipients before or concomitant with transplantation. Bacteremia developed in five and fulminant sepsis in two from 3 to 32 months after splenectomy. No serious infections with these organisms occurred in the nonsplenectomy group. These results suggest that asplenia may be an additional factor predisposing transplant patients to serious infection. Prevention of these serious pneumococcal infections may be possible with polyvalent pneumococcal vaccine.


Flaps used for nasal reconstruction: a perspective based on 180 cases.

Flap reconstruction of the nose is historically one of the earliest surgical operations. In spite of this long experience, little has been reported on the viability and durability of the various flaps and the time involved in the reconstruction, including the number of operative procedures required for total reconstruction of the nose. One hundred eighty patients were involved in this retrospective study dating from 1940. The midline forehead flap, used for partial nasal reconstruction, was specifically excluded from this study and will be reported separately later. The arm flap (Tagliacozzi), the total forehead flap, the sickle flap, and the acromiopectoral flap are reviewed in terms of the complications encountered, the total number of operations required, and the time involved in the complete reconstruction. The various nasal defects have been classified into five types, and the flaps usually used for reconstruction have been correlated with these defects. Eighty percent of the patients were treated because of a cutaneous malignancy of the nose. However, because these malignancies are currently being treated earlier and more efficiently, there is a significant decrease in present-day experience with this type of surgery.


Reflux nephropathy.

The whole subject of reflux nephropathy, which may affect 1 in every 300 of the white female population, and is the second most common disease of the kidney in the young, is still bedevilled by a lack of information regarding many of its important aspects, and the absence of any coordinated action to obtain it. What is required above all else is a means of its early detection in very young children, so that it may be prevented, at least in its more severe forms. Its financial cost can only be surmised, but the treatment of its end-stages is likely to be in the region of a hundred million dollars a year. The cost in wastage involving, as it does, young people, particularly females, is incalculable.


Secondary hyperparathyroidism in chronic renal failure. Pathophysiology and treatment.

The secondary hyperparathyroidism of chronic renal failure is a result of many factors which result in chronic stimulation of parathyroid hormone secretion and secondary hyperplasia of the parathyroid glands. The secretion and metabolism of parathyroid hormone and its fragments in chronic renal failure are complex and only partially understood. Constant elevated levels of PTH contribute to bone disease and other clinical features of chronic renal failure. Calcium supplementation, high calcium dialysis, control of plasma phosphate and judicious use of the vitamin D metabolites can, to a large extent, prevent or control the development of secondary hyperparathyroidism. Subtotal parathyroidectomy or total parathyroidectomy with autotransplantation is indicated in certain cases, sometimes on an emergency basis. Prevention of postoperative hypocalcemia requires careful management. Successful renal transplantation is usually associated with gradual healing of the bone disease and slow, but sometimes incomplete involution of the parathyroid hyperplasia.


Endocrine abnormalities associated with chronic renal failure.

It is evident that chronic renal failure has far-reaching metabolic consequences because endocrine aberrations are common. Uremia may alter endocrine function through its effect on the hypothalamopituitary axis, the individual end organs, and the peripheral metabolism of various hormones. Deficiency of some hormones and excess of others coexist in patients with renal failure. Since the physiologic effects of many of these abnormalities are still not well defined, no treatment is necessary with the exception of true deficiency states such as testosterone deficiency. In the latter instance, exogenous hormonal supplementation is recommended.


Hematologic complications of chronic renal failure.

Uremia interferes with erythropoiesis, granulocyte, platelet, and immune functions. As a result, uremic patients are almost invariably anemic, and have a high incidence of infections and hemorrhagic complications. The anemia of renal failure, which is caused primarily by damage to the site of erythropoietin production is often complex, and complicated by hemolysis from a variety of mechanisms, iron deficiency, and so forth. Although hemodialysis ameliorates some of the hematologic complications to a variable degree, they remain a serious hinderance to the well being of this group of patients. Progress in understanding the mechanism of these problems and their therapy has been reviewed here.


[Benign circinated pityriasic erythema in children].

The case is report of a boy aged 6 months whose dermatosis had set in suddenly 15 days before in the form of large round circinate patches on the face, thorax, abdomen, dorsum and extremities. These patches were limited by a slightly elevated erythematous border, the inside of which was constituted by collarette-like epidermal desquamations with central parakerotosis. The patches impairment was observed in the child's general condition. A histopathological study was carried out.


[Contact dermatitis caused by ethylene oxide].

A case of contract sensitization to the ethylene oxide by a mask sterilized with this substance is reported. The mask was correctly sterilized but the ethylene oxide was not completely evaporised. The path tests were positive in the patient but negative in 25 control subjects. The patch tests with the international series and with all the elements of the mask were negative. The possible troubles of ethylene oxide and the sterylisation methodes of this substance are reviewed.


[Eosinophilic pustular folliculitis (Ofuji syndrome)].

The first observation in Occident of "eosinophilic pustular folliculitis (Ofuji)" is reported. The condition is characterized by pruritic follicular sterile papulopustules on indurated erythematous plaque in the face. They extended centrifugally and the plaque proceeds with remission and exacerbations with leukocytosis and numerous eosinophils. Histological features are pustular folliculitis from the ostium to the sebaceous gland, chiefly composed of polymorphs and many eosinophiles. The treatment are corticosteroids by long-term. It is the first case studied by electron microscopy.


[Pemphigus with eosinophilic spongiosis].

A bibliographic review of a new subject-pemphigus with eosinophilic spongiosis accomplished: Three clinical courses are recognized: a) pemphigus in its initial phase, b) pemphigus markedly seborrheic, which presents during its evolution, some morphologic anomalies, c) pemphigus that appear like an authentic Duhring in its initial phase and during part of its evolution. On studying the histopathology three aspects are observed; 1) pure eosinophilic spongiosis with two modalites: diffuse or vesiculate; 2) mixed eosinophilic spongiosis and, 3) alternate eosinophilic spongiosis. The review report the study of this new observation and discusses the nosological situation as well as its pausible causation.


[Multiple eccrine spiradenomas. Apropos of 2 cases in 2 sisters].

Two cases of multiple eccrine spiradenoma were studied, representing respectively up to the present time the 7th and 8th registered cases in the world literature. These cases two are siblings, a fact that had never been observed before. The histogenesis of the tumour has been the subject of controversy. The presence of multiple lesions in each patient and the incidence in siblings are two important points in favour of the naevic character of eccrine spiradenoma. Among other therapeutic measures we wish to draw attention to the excellent result we obtained with small doses of radiotherapy (1,500 rads divided in ten applications). It should be kept in mind that remission of the disease may only be temporary.


[Macular amyloidosis].

Fifty-five patients with presumptive macular amyloidosis were investigated for the presence of amyloid in dermal tissue. In twenty-six of these patients the diagnosis could be confirmed by the demonstration of amyloid deposits by optical and/or electron microscopy. In this paper attention is called to the frequency of oligosymptomatic forms of macular amyloidosis, which are often overlooked in spite of the usual existence of itching. These inconspicuous forms are termed "minor macular amyloidosis", and they consist of tenuous brown macules on the upper back, irregularly interspersed with the normal skin and with speckles of whitish discoloration. The diagnosis must be verified by the finding of dermal deposits of amyloid. For that purpose the electron microscopy is a much more reliable procedure than conventional methods or thioflavine T.


[Therapy with transfer factor in a case of recidivating herpes with polymorphous erythema].

A young woman had recidivating herpes with erythema multiforme for several years. When conventional therapy failed to correct this condition she was treated with Transfer Factor (TF). Immunologic anomalies which had been registered previously became normal after the first application of TF. The skin lesions disappeared after the fourth dose. Six months later a new skin manifestation with immunologic alterations became apparent. They disappeared after two doses of TF. A year and a half later the patient has no lesions and the immunologic parameters, which were monitored throughout this period, are normal.