[Cerebral angiography with ioglicinate (Rayvist). A double blind study of image quality and clinical side effects (author's transl)].

The image contrast quality and the patient tolerance of two osmotically active water-soluble contrast agents were examined and compared in double blind study cerebral angiography: Rayvist (an Ioglicinate developed recently) and Telebrix (AN Ioxithalamate). In 100 direct carotid or retrograde brachial angiograms the tolerance of Rayvist was significantly better, primarily because of less subjective patient side effects and less frequent cardiovascular reactions. However, there was no significant difference in neurological complications or deterioriation of EEG-findings, both quite rare anyway.


[Radiological findings in periosteal reaction due to inflammation (author's transl)].

Presentation of radiographically apparent periosteal changes due to inflammation. Solid periosteal reaction is being distinguished from an interrupted-type reaction. Some cases of acute and chronic osteomyelitis, congenital and acquired lues, bony tuberculosis, leprosy and fungal disease serve to demonstrate the different types of periosteal reaction; and a differential diagnosis is being discussed. The diagnostic evaluation should include bone scanning in addition to routine radiography with special views and follow up examinations.


New techniques in cardiac imaging with ultrasound: state of the art.

Two-dimensional real-time ultrasonic imaging in the diagnosis of acquired and congenital cardiac lesions is reviewed. This technique provides anatomically correct cross-sectional images and demonstrates movements of valve leaflets and segments of heart walls. The imaging of blood flow through the use of ultrasonic contrast agents and the application of pulsed Doppler principles is also reviewed, and future trends are discussed.


Atherosclerosis decreased prostacyclin formation in rabbit lungs and kidneys.

Metabolism of arachidonic acid (AA) was studied in perfused lungs and kidneys of normal and atherosclerotic rabbits by determination of PGE2, PGF2 alpha and the stable metabolites of PGI2 (6-keto-PGF1 alpha) and TXA2 (TXB2). PGI2 was the main AA metabolite formed by normal lungs and kidneys. Atherosclerosis reduced the formation of PGI2 by about 50 % in both organs. TXA2 formation was similarily decreased in lungs. In kidneys, the decrease in PGI2 formation was accompanied by an increase in PGE2 formation.


Prostaglandin synthesis by fetal rat bone in vitro: evidence for a role of prostacyclin.

Prostaglandin synthesis by fetal rat bones was examined by thin-layer chromatography of culture media after preincubation with labeled arachidonic acid. Cultures in rabbit complement (non-heat inactivated serum) were compared with cultures in heat-inactivated serum or cultures treated with indomethacin. The major complement-dependent products were PGE2, PGF2 alpha and 6-keto-PGF1 alpha, the metabolite of prostacyclin (PGI2). Since PGI2 had not been previously identified in bone its ability to stimulate bone resorption was tested. Repeated addition of PGI2 stimulated release of previously incorporated 45Ca from fetal rat long bones in both short-term and long-term cultures at concentrations of 10(-5) to 10(-9)M. Because of the short half life of PGI2 in solution at neutral pH, we tested a sulfur analog, thiaprostacyclin (S-PGI2) which was found to be a stimulator of bone resorption at concentrations of 10(-5) to 10(-6)M. These studies suggest that endogenous PGI2 production may play a role in bone metabolism. Since vessels produce PGI2 it is possible that PGI2 release may be responsible for the frequent association between vascular invasion and resorption of bone or calcified cartilage in physiologic remodeling and pathologic osteolysis.


Heat-labile enterotoxin antibodies in calves.

The presence of antibodies to Escherichia coli heat-labile enterotoxin (LT) was measured in serum samples collected from 91 calves. Of these animals, 87 per cent had detectable levels of anti-LT in a seroneutralisation test performed in the Y1 adrenal cell time.


[Current status and prospects in the diagnosis and epidemiology of streptococcal infections].

In the first part of the paper the author stresses the importance, and the necessity of laboratory investigation of streptococcal infections, in view of the establishment of the clinical and of the etiologic diagnosis, for assessing the efficiency of the treatment applied, for monitoring the recovery of patients, as well as of chronic patients, and for the prevention, and detection of late complications. The complex methodology of laboratory methods of diagnosis in streptococcal infections is presented, stressing the use, and the efficiency of micromethods and of rapid techniques for diagnosis. In the second part of the paper are presented a series of data concerning the epidemiology of streptococcal infecstions in our country, as well as in other countries, with reference to various forms of the acute disease, and of late complications, stressing some particular aspects of the streptococcal infection. Morbidity indexes are presented, as well as death rates for scarlet fever, acute rheumatic fever and rheumatic cardiopathies, as well as the incidence of different serologic groups of the haemolytic type, and the fluctuation of group A serotypes, which have been prevalent over the last years in our country. In view of lowering the morbidity the author recommends an extensive surveillance, organized along the lines of a primary prophylaxis program, as well as of a secondary program of streptococcal infections in high-risk collectivities.


New bioassay for screening immunotoxic agents.

A new bioassay for evaluation of compounds potentially toxic for the immune system is described. It is suitable for the measurement of enhancement of primary antibody response and of enhancement and inhibition of memory development in vivo. It utilizes immunoenzymatic techniques which can readily be automated and thus allow the screening of many compounds at relatively low cost. It can provide answers regarding the safety or danger of each compound tested within 30-45 days.


The Crithidia luciliae test in the diagnosis of systemic lupus erythematosus.

Fluorescence of the kinetoplast of Crithidia luciliae was employed as a test to detect anti-DNA antibodies in 179 serum samples from 95 patients with various immunological diseases. The test was positive only in patients with systemic lupus erythematosus (SLE). The results confirm the high specificity of this test in the diagnosis of SLE.


[Efficacy and side-effects of long term L-dopa therapy in Parkinsonian syndromes (evaluated by CT scan as well) (author's transl)].

The evolution of symptoms and therapeutic response in a group of have been followed parkinsonian patients 81 for a period of 4 years. Hoehn and Yahr, and Webster's scales have been used. In addition CT scan, EEG, ECG, blood and urine analyses have been carried out. Treatment was carried out with L-Dopa and decarboxylase inhibitor (benserazide for 50% of cases and carbidopa for the other 50%). Anticholinergics (esp. metixene) were often required. The initial response was satisfactory for all patients except one who had hydrocephalus (with normal pressure). Four years later, the initial improvement diminished by about 1/3. Side effects occurred in 80.24% of cases in the beginning, and in 82.50% of cases after 4 years. Dyskinesias, confusional state and "on-off" phenomenon increased with time, whereas gastric trouble diminished. CT scan were obtained in all patients and atrophic changes were found in 82.7%. There were no correlations between localization and severity of anatomical lesions on the one hand, and therapeutic response and side-effects on the other. It is suggested that the severity of the disease depends mainly on the degree of neurochemical integrity in the affected area rather then to the extent of anatomical lesions.


The technical aspects of cochlear implantation.

The historical development of attempts to provide some hearing ability, in totally deaf patients, by electrical stimulation of the cochlear nerve is reviewed to the point at which single channel intracochlear electrodes were tried in patients. The results obtained with this type of prosthesis are described and discussed in terms of the possible physiological mechanisms involved. Results obtained from promontory stimulation are also presented as a means of patient selection and are compared with the results from intracochlear electrodes. Based on these findings, the approaches for the development of multichannel intracochlear electrodes and for a single channel electrode with speech processing are described. The problems involved with materials, coding, electrode isolation and transmission are considered and the current results in these areas are detailed. Such results imply that the long-term prospects of developing a prosthesis that could provide adequate speech intelligibility are good.


[Four cases of Creutzfeldt-Jakob's disease (author's transl)].

The clinico-pathological features of 4 cases of Creutzfeldt-Jakob disease, a transmissible virus dementia, are reported. The onset of the disease varied between 54 and 81 years of age: the course is dramatic and the demise occurs 1-4 months after the onset of symptoms. The clinical picture includes mental deterioration with amnesia, aphasia, apraxia and neurologic symptoms, mainly consisting in progressive rigidity and myoclonus. All cases show the typical 1/sec pseudorithmic spikes on EEG. Histological changes include severe astrocytosis of the cerebral cortex, status spongiosus and mild neuronal loss. The changes are more marked in the parieto-occipital lobes. Criteria of clinical and pathological diagnosis are reviewed. The precautions to be taken in handling biological as well as bioptic and autoptic specimens are emphasized, in order to avoid accidental transmission of the disease. It seems essential to institute a register of cases of Creutzfeldt-Jakob disease in Italy to assess the incidence and diffusion of the disease in our country.


Method for radiographic assessment of alveolar bone level at endosseous implants and abutment teeth.

A radiographic method expressing the alveolar bone level in absolute figures is presented. By means of a calibrated measuring radiographic film fixed to a magnifying viewer, alveolar bone levels were determined directly on intraoral periodic "identical" radiographs. A polyether impression was made for fixation of the filmholder in order to obtain reproducible radiographs. The method was applied to assess changes in the alveolar bone level at endosseous implants and abutment teeth. Radiographs of 23 endosseous implants and 21 abutment teeth from nine patients were examined and measurements of the alveolar bone level were performed. The mean difference between double observations on the same exposure as well as on repeated exposures was about 0.2 mm (s.d. 0.17-0.32 mm). The uncertainty of the present radiographic method was mainly due to the measurement procedure, as the radiographic technique showed a high degree of reproducibility. The method is a simple and reliable technique for longitudinal investigations of changes in the alveolar bone level at endosseous implant and tooth abutments.


Surface analysis of screwposts.

The content and distribution of metallic ions on the surface of gold-plated brass screwposts (Dentatus and MecOdont) were analyzed by X-ray microanalysis. On screwposts from one of the manufacturers the protective outer layer of gold was found to be localized to specific areas of the posts, i.e. the grooves, while unprotected Cu-Zn alloy was found on the ridges. The results are discussed with regard to results on root posts published earlier. Screwposts constructed in this way would appear to be of doubtful clinical value.


Assessment of age-at-death from mandibular molar attrition in medieval Danes.

Stages of occlusal attrition of the permanent mandibular molars were recorded in 235 Danish medieval skulls, 52 of which were in various states of mixed dentition. For the first and second molar, ages at emergence and ages at occurrence of the earlier stages of attrition were estimated from the mixed dentitions, on the assumptions 1) that the age at eruption of a given number of permanent teeth was similar in medieval and contemporary Danish children, and 2) that the rate of attrition was similar for the first and second molars. Estimation of ages at occurrence of the later attrition stages and of the age at third molar emergence was based on percentage frequency distributions of the stages of attrition using reiterative calculating procedures. Third molar emergence was estimated at the early age of 14 years. It is argued that assessments of age-at death could be made fairly accurately for the age range 5-30 years, and with decreasing accuracy until about 40 years of age.


Prevalence of malocclusion in medieval and modern Danes contrasted.

A comparison was made of frequencies of anomalies of the dentition, occlusion, and space conditions for the permanent dentition in the skeletal remains of 278 medieval Danes and in 1258 contemporary Danes. The congenital anomalies of the dentition were equally common in the samples. Extreme maxillary overjet and distal molar occlusion, deep bite, and crowding were considerably less frequent in the Middle Ages. The frequencies of mesial molar occlusion and crossbite, but not that of midline displacement, were higher in the medieval sample, especially in the older subjects. It is suggested that the observed differences in malocclusion prevalence were related to exogenous factors, primarily the pronounced dental attrition.


[Salmonella colitis].

Salmonella colitis is defined on the basis of 3 case reports and 75 well-documented cases from the literature. Salmonella colitis is an acute ulcerative colitis occurring in enteric salmonellosis. There is complete clinical and endoscopic remission within 4--8 weeks and no relapse. The disease is to be distinguished from idiopathic ulcerative colitis in a salmonella carrier state. The difficulties of this differential diagnosis are demonstrated in a further case report.


[Familial medullary cystic kidney with progressive kidney failure].

The reported case of 2 brothers suffering from medullary sponge kindeys is unique in that uremia developed in spite of the absence of urinary tract obstruction, infection or hypertension. With the exception of congenital nystagmus and psoriasis, none of the extrarenal malformations often associated with medullary sponge kidneys was observed.


Spontaneous diabetes mellitus: reversal and prevention in the BB/W rat with antiserum to rat lymphocytes.

Injections of rabbit antiserum to rat lymphocytes reversed hyperglycemia in 36 percent of spontaneously diabetic rats (Bio Breeding/Worcester) and prevented diabetes in susceptible nondiabetic controls. These findings strengthen the hypothesis that cell-mediated autoimmunity plays a role in the pathogenesis of diabetes in this animal model that mimics many morpholigic and physiologic characteristics of human insulin-dependent diabetes mellitus.


Radiation-induced sarcomas of bone.

Historically, the literature reveals that the incidence of radiation induced bone sarcomas is very low. Details related to epidemiology cannot be identified, however, because of the difficulty of identifying precisely the patient population at risk for development of the radiation induced sarcoma. The change in character of practice in cancer management with ever increasing numbers of patients receiving both radiation therapy and chemotherapy should alert physicians to the potential for increased incidence of this rare and unusual tumor.


Value of cultures in patients with acute cellulitis.

A retrospective review of blood and wound cultures obtained from adult patients admitted for acute cellulitis revealed positive culture rates of 0.77% of 86% respectively. Organisms from wound cultures were predominantly Staphylococcus aureus and Streptococcus pyogenes. The majority of our patients were otherwise healthy. Our study suggests that blood cultures are not necessary in acute cellulitis in adults without serious underlying diseases.


Relationship of neonatal pneumonia to maternal urinary and neonatal isolates of group B streptococci.

Of 1,500 consecutive deliveries, there were 41 term infants with suspected sepsis in association with a positive culture for group B streptococci (GBS) from either the infant soon after birth, or the mother's urine routinely collected three days postpartum. A statistically higher incidence of pneumonia was found in these infants as compared to matched controls. Infants born to mothers with GBS in the urine had a high incidence of suspected sepsis (43.6%) as well as a high incidence of pneumonia (38.6%). We conclude that term infants colonized at birth with GBS or born to mothers with GBS isolated from their urine are at high risk of having pneumonia.


Pemphigus vulgaris and lymphoma in a patient with scleroderma.

The coexistence of scleroderma and malignancy is well documented. The case presented here is unique, however, as it is the first report of the occurrence of diffuse histiocytic lymphoma and pemphigus vulgaris in a patient with scleroderma. Because of this unusual triad of diseases, the possibility of a common pathogenetic basis was examined. A review of the literature confirms that each disorder does have immunologic abnormalities. It is suggested that an aberrant immune response, specifically impaired T-cell function, is responsible for the emergence of disease of this patient.


Gold-induced thrombocytopenia responsive to cyclophosphamide.

Thrombocytopenia and nephrotic syndrome developed in a 51-year-old patient receiving gold therapy for rheumatoid arthritis. Marrrow findings and platelet infusion studies were consistent with a pattern of increased platelet destruction, known to occur in gold-induced thrombocytopenia. Improvement in the platelet count after therapy with dimercaprol was transient, and although steroids and splenectomy were not effective, a response was achieved with cyclophosphamide. The use of immunosuppressive drugs can be considered in refractory cases of gold-induced thrombocytopenia in which a significant hemorrhagic risk is present.


Prevention of postoperative nausea and vomiting by domperidone: A double-blind randomized study using domperidone, metoclopramide and a placebo.

One hundred and ninety-five female patients of child-bearing age were assessed for postoperative vomiting in a double-blind trial using domperidone, metoclopramide and placebo. Compared with placebo, both drugs were found to reduce vomiting in approximately half the patients who had undergone caesarean section. However, in the group of non-obstetric patients, no statistically significant difference as regards vomiting was shown.


The rapid diagnosis of urinary tract infection: a side-room method.

A controlled trial of a rapid method for microscopic examination of the urine for organisms is reported. The method achieved results as accurate as those of semi-quantitative culture, at minimal cost. It is easy enough to be learned by medically untrained staff, and results are available within 10 minutes. This rapid availability of results makes it possible to prescribe more appropriately at the initial consultation.


Medical philately: The pen and the scalpel -- the story of medicine and literature.

The medical profession has always been prominent in the cultural life of the community. Many doctors have been able to carry out their professional duties as well as actively to pursue their outside interests. Some have abandoned their medicine altogether -- they have been called 'medical truants'. Literature and medicine have always been closely associated, and a number of literary doctors who have appeared on stamps are presented in this article.


Chemotherapy and cancer of the gastrointestinal tract.

Less than 40 percent of all carcinomas of the gastrointestinal tract will be controlled by the current modalities of treatment. Early diagnosis and appropriate surgical resection are still the only rational and effective approach to the control of this cancer. The tremendous strides in cancer chemotherapy in the management of leukemia, children's solid tumors, and neoplasms of lymphoid origin have not been evident in the management of gastrointestinal carcinoma. Extensive clinical trials with single agents and various drug combinations have resulted so far in partial response rates. Adjuvant chemotherapy to surgical resection has also failed to alter the natural course of the disease and, therefore, to establish its benefits in a series of projective randomized studies. Only continued research in cancer cell biology and basic and clinical pharmacology with carefully controlled therapeutic trials with new agents will eventually lead to the more effective use of chemotherapy in management of gastrointesinal cancer.


The radiation-injured bowel.

Radiation disease of the intestine is usually iatrogenic and frequently unavoidable. The disease, its treatment, and the disability produced are formidable. There is hope that means may be found to increase the resistance of the intestine to radiation damage. Radiation enteropathy is an insidious, progressive disease that is seen with increasing frequency. Serious disabilities may develop after years of gestation. Those patients who require surgery are treated by control of sepsis, correction of metabolic abnormalities, and reversal of protein/calorie malnutrition prior to definitive surgery. The treatment of choice is resection with anastomosis, but recurrences may occur many years later in intestine grossly normal at the time of surgery.


Inhibition of Haemophilus vaginalis (Corynebacterium vaginale) by metronidazole, tetracycline, and ampicillin.

The minimal inhibitory concentrations (MICs) of ampicillin, tetracycline, and metronidazole for 71 strains of Haemophilus vaginalis (Corynebacterium vaginale) were compared by use of an agar-dilution method and an inoculum of 10(6) organisms/ml. All strains were sensitive to 1 microgram of ampicillin/ml, 70% to 4 micrograms of tetracycline/ml, and only 13% of the strains to 8 micrograms of metronidazole/ml. Under anaerobic conditions the susceptibility to metronidazole increased markedly, and 48% of the strains were inhibited by 8 micrograms/ml. In determinations of MICs in broth cultures, reduction of the inoculum size to 10(4) organisms/ml increased susceptibilities to metronidazole and tetracycline, whereas incubation of 48 hr instead of 24 hr decreased susceptibilities to these two drugs. Minimal bactericidal concentrations (MBCs) were generally two- to fourfold greater than the MICs for the three drugs. The results demonstrate that anaerobic conditions, inoculum size, and duration of incubation influence the susceptibility of H. vaginalis to antibiotics in vitro.


Sacrofixation with Marlex mesh in massive prolapse of the rectum.

Rectal fixation to the sacrum is considered the most rational operation in the surgical treatment of massive or complete prolapse of the rectum, since it eliminates the anatomic defect which is fundamental in the pathogenesis of this disease. Many techniques have been used to join the posterior wall of the rectum to the sacrum, ranging from the use of simple sutures with nonabsorbable material to prosthetic materials, such as Teflon sheets or Ivalon, polyvinyl, sponges which are placed around the rectum and attached to the sacrum. A variant consists of using Marlex mesh instead of Teflon. In an experience with 24 patients, only one patient died postoperatively. In a follow-up period of ten years, no recurrences have been observed in any of the remaining patients.


Endocrine tumors of the pancreas.

The identification and description of a widely dispersed group of cells of common origin and biochemical characteristics, APUD cells, has allowed a better understanding and classification of endocrine tumors of the pancreas. Similarly, it has enabled the relationships between the endocrine tumors of the multiple endocrine neoplasia type I syndrome and the endocrine tumors of the pancreas to be better appreciated. This has facilitated both diagnosis and management of these conditions. The pluripotentiality of the cells of the APUD system combined with the certain existence of many unidentified peptides suggests the likelihood of other undescribed pancreatic endocrine tumors. Many of these are probably part of the heterogenous group of neoplasms currently designated as carcinoids, since their secretory products and exact cell types are not known. The recognition of the physiologic characteristics and cells of origin of these peptides, amines or other bioactive agents will allow delineation of the symptom complex and the identification of further functional tumors of the pancreas. The development of plasma radioimmunoassays for the various hormones and the appreciation of the specific clinical syndromes related to each tumor have enabled earlier diagnosis. The understanding of the hormonal physiopathologic functions has led to the evolution of specific therapeutic maneuvers. Provocative tests have allowed increased precision of the differential diagnosis, while selective arteriography and pancreatic venous sampling have greatly enhanced the accuracy of topical localization. The role of operation in tumor removal is still prominent, but malignant and recurrent tumors may now also be controlled with specific pharmacotherapy or appropriate endocrine cytotoxic agents. The use of peptides with antagonistic actions or the administration of specific antibodies to the active tumor products are areas of therapy that require further exploration.


Consideration and implications of tumor antigenic expression.

This review is an attempt to simplify the myriad descriptions of tumor antigens, by considering such antigens in the perspective of their mechanisms of formation. We believe that most and possibly all tumor antigens previously described and currently under study will ultimately fit into one of the categories discussed in this article, since there are only a finite number of biochemical mechanisms for producing new antigens in any cell--cancerous or otherwise. Pragmatically, we view the vagaries of expression of tumor antigens as among their most important properties, and the search for tumor antigens has in fact opened a Pandora's box of molecular variability. Large tumor masses consisting of multiple subclones with different karyotypes, chromosomal anomalies and mutations would appear to be capable of expressing a motley group of tumor antigens. To the best of our knowledge, no tumor antigen has been shown to be necessary and causal in transformation, except in virally-induced tumors. The presence of tumor antigens appears to be coincidental and reflects dedifferentiation and karyotypic, metabolic and nutritional variations occurring in tumors. Undoubtedly, some antigens may give a tumor a selective advantage of growth, metabolism or metastatic potential, but many antigens may simply reflect the vagaries of the tumor cell. The intratumor and intertumor variations of tumor antigens, their mechanisms of origin and their rather uncanny capabilities to change their phenotype--antigen expression--secondary to environmental selection during tumor expansion or following therapy should be kept in mind when tumor antigens and immunotherapy are considered.


Thoracic duct drainage before and after cadaveric kidney transplantation.

Twenty-seven consecutive recipients of cadaveric kidneys, including five with pre-existing warm cytotoxic antibodies, were treated with thoracic duct drainage before and after transplantation. Fourteen patients who had lymph drainage for 26 to 58 days before transplantation had minor cytotoxic antibody responses after grafting, even if the antibodies had been present before therapy. Only one of the 14 recipients had any rejection during the follow-up periods of one to six months. There were two deaths. The 13 patients pretreated for 17 to 23 days exhibited stronger cytotoxic antibody responsiveness, and five of these recipients had significant rejections of which four were reversible. One of the latter 13 patients died. These clinical and immunologic studies have established the value and have defined the appropriate timing of preoperative thoracic duct drainage in kidney transplantation. They have also directed attention to the rationale andthe probable value of using other immunosuppressive methods for preparatory host conditioning instead of beginning such therapy at the time of transplantation.


Indocyanine green clearance in critically ill patients.

Forty-two consecutive patients were observed with the use of various biochemical and physiologic parameters. Attention was focused upon liver function, using serum glutamic-oxalacetic transaminase, alkaline phosphatase and bilirubin determinations as well as the plasma disappearance rate of indocyanine green. No difference was noted in serum glutamic-oxalacetic transaminase, alkaline phosphatase and bilirubin levels between survivors and nonsurvivors. However, there was a significant difference between these two groups as measured by the plasma disappearance rate of indocyanine green. A distinct cut-off point was present, and no survivor ever had a plasma disappearance rate of less than 6 per cent per minute.


Porcine heterograft dressings for split-thickness graft donor sites.

As compared with previous methods of donor site care, procine heterograft dressings allow the donor site to heal faster, require less postoperative care, are associated with a lower infection rate and eliminate virtually all of the pain of the split-thickness wound. Our experience supports that of others. We believe our modifications of this technique to be superior to previous modalities of donor site care.


Theophylline-7-acetic acid: lack of absorption and therapeutic effectiveness.

A double-blind cross-over trial was conducted to evaluate the effectiveness of oral theophylline-7-acetic acid (T7AA) in 13 asthmatic patients. Pulmonary function tests showed no difference between T7AA and placebo. No T7AA or theophylline was found in the sera of these patients or of healthy volunteers who took T7AA tablets or syrup.


VIIIR; Ag in platelets from patients with various forms of von Willebrand's disease.

Thirty patients with various forms of von Willebrand's disease were investigated for VIIIR:Ag in their platelets. VIIIR:Ag was extracted from washed platelets and measured both with electroimmunoassay and a sensitive immunoradiometric assay. Six patients had severe von Willebrand's disease, type I, with very low or no VIIIR:Ag in their plasma. None of these patients had any VIIIR:Ag detectable in their platelets. All 19 patients with mild von Willebrand's disease had VIIIR:Ag in their platelets but the values often fell below those of normal controls. Five patients with genetic variants of von Willebrand's disease also had values in their platelets corresponding to those in plasma.


Generation of a PGI2-like activity by deendothelialized rat aorta.

We have tested a platelet aggregation inhibitor in the incubation fluid of deendothelialized fragments of the rat aorta and compared it with that of "intact" fragments. Some of the properties of the aortic inhibitor, and its effects on platelet adhesion to collagen fibrils, on platelet factor-3 (PF-3) availability, and on the activated partial thromboplastin time (APTT) and thrombin time (TT) were also evaluated in comparison with similar effects exerted by PGI2. We found that the incubation fluid of deendothelialized aortic samples contained inhibitor activity comparable with that of "intact" samples. The aortic inhibitor had similar properties to PGI2. The aortic inhibitor and PGI2 slightly inhibited light transmission changes of EDTA-PRP following exposure to collagen. However, scanning electron microscopy showed no appreciable difference in platelet adhesion to collagen fibrils. PGI2 and the aortic inhibitor inhibited Kaolin-induced PF-3 availability, but did not prolong the APTT or TT.


Topical prostacyclin (PGI2) inhibits platelet aggregation in pial venules of the mouse.

Local application of prostacyclin (PGI2) to cerebral (pial) microvessels, inhibited the aggregation of platelets induced in the vessels by exposing them to a filtered mercury light source following intravenous sodium fluorescein. The inhibition was consistantly observed in venules rather than arterioles and was manifest by a lengthening of the time required for the noxious stimulus to produce an initial aggregate, and/or by a lengthening of the time required for enlarging aggregates to totally block the venule. The consistency of the inhibition diminished at doses below 100 microgram/ml. Inhibition was observed whether or not alcohol was used as the vehicle for PGI2 and whether or not the body temperature of the anesthetized mouse was permitted to fall.


Use of cyclophosphamide and enhancing serum to suppress renal allograft rejection in the rat.

Cyclophosphamide was tested for its interaction with passive enhancement in suppressing the rejection of kidney allografts in the (DA x Lewis)F1 to Lewis rat strain. Dose response studies with cyclophosphamide showed that 10 mg/kg/day for 14 days was necessary for complete suppression of rejection and indefinite graft survival. Doses of 5 and 3.5 mg/kg/day had only a marginal effect on graft function and survival, although the lymphocytotoxin response to the graft was completely or very substantially suppressed by these smaller doses. The use of passive enhancement with cyclophosphamide at the 5- and 3.5-mg/kg/day doses resulted in a favourable interaction with improved graft function and survival. Interestingly, passive enhancement in combination with 5 mg/kg/day of cyclophosphamide resulted in indefinite graft survival only if cyclophosphamide was given for 28 days. If cyclophosphamide was given for 14 days, rejection was suppressed only during the period of cyclophosphamide treatment.


Significance of HLA matching in renal transplantation. A prospective one-center study of 485 transplants matched or mismatched for HLA-A, B, C, D, and DR antigens.

Matching for HLA haplotypes as well as for HLA-A and B antigens improved graft survival in 112 living related first transplants. In cadaveric first transplants, matching for HLA-A and B antigens had a beneficial effect on the fate of 373 grafts, while matching for HLA-C antigens had no predictive value. One hundred seventeen cadaveric transplants and their recipients were prospectively typed for the HLA-DR antigens. Compatibility for HLA-DR was found to be prognostically beneficial irrespective of matching for HLA-A and B antigens, and with no difference between transfused and nontransfused patients. Matching both for HLA-A , B and D/DR was thus found to influence the outcome of renal transplantation.


Resolution and relapse of osteopetrosis in mice transplanted with myeloid tissue of variable histocompatibility.

Osteopetrotic microphthalmic mice (mi/mi) were treated by injections of suspensions of myeloid tissue, newborns i.p., and weanlings i.v. Donated syngeneic material effected permanent cure of oteopetrosis provided that the dose was large enough (10(8) cells of bone marrow). H-2-compatible allogeneic bone marrow was initially as effective, but relapse ensued in immunocompetent mice. H-2-incompatible marrow was ineffecitve except in one set of newborn tolerant mice. Total body X-radiation in sublethal doses to recipients allowed permanent cure with H-2-compatible, and, in one circumstance, with H-2-incompatible marrow in smaller doses. The best results were obtained after lethal irradiation and the smaller dose of marrow. Results were checked by chromosome assay demonstrating that cure or relapse was correlated with permanent take or rejection, respectively, of a transplant in a recipient's bone marrow. Retention of donor lymphocytes alone was not associated with effective bony resorption; the candidate cell line for effectiveness remains the haematopoietic stem cell-monocyte-tissue phagocyte.


Use of antithymocyte globulin (dose by rosette protocol) in pediatric renal allograft recipients.

Total rosette-forming cells (TRFCs) and percentage of rosette-forming cell (RFC) levels were measured in patients undergoing dialysis and in recipients following renal transplantation. The percentage of RFCs of the dialysis patients was not different from the percentage of RFCs of normal subjects, whereas the TRFCs were significantly lower in the dialysis patients. After transplantation, the percentage of RFCs and TRFCs was significantly lower in recipients treated with antithymocyte globulin (ATG) than in those of the control group; however, there was no difference in allograft survival between the ATG-treated and control recipients when using ATG in the dose by rosette protocol.


Antithymocyte globulin (ATGAM) in renal allograft recipients. Multicenter trials using a 14-dose regimen.

Antithymocyte globulin (ATG, ATGAM; The Upjohn Company) was tested for efficacy and safety in controlled studies in 358 renal allograft recipients. A total of 183 patients were treated according to protocols prescribing 14 daily doses of ATG in addition to standard immunosuppressive therapy with azathioprine and prednisone, while 175 controls received no ATG. Four ATG lots were tested; results with each lot were analyzed separately, and the data were also pooled to obtain an overall impression. ATG delayed the onset of the first rejection episode during the prescribed treatment period (2 weeks). Concurrently, less i.v. steroid was required, but the steroid dosage requirement then rebounded in the 2 weeks after the end of the prescribed treatment period. ATG did not significantly improve the proportion of patients alive with functioning grafts 6 months after transplant, except with one of the four lots.


Early anuria prevention in human kidney transplantation. Advantage of fluid load under pulmonary arterial pressure monitoring during surgical period.

In human kidney transplantation, a high blood flow established through the graft immediately upon clamp release is usually associated with immediate satisfactory renal function. One hundred consecutive kidney transplant patients were thus provided with a large volume of fluid during surgery. To avoid pulmonary edema, fluid load was given under mean pulmonary arterial pressure (PAP) monitoring, and controlled ventilation was maintained during the early postoperative period. Whether initial PAP value was within normal range or elevated, all patients required an equivalent fluid load to reach the best hemodynamic condition upon clamp removal. The mean intraoperative fluid load consisted of 2406 +/- 968 ml of water with 22.8 +/- 9.4 g of sodium chloride, 5.9 +/- 1.8 units of albumin, and 2.6 +/- 1.8 units of packed red blood cells. Immediately before clamp release patients were given furosemide and mannitol. During the postoperative period, i.v. infusions consisted of water and sodium chloride (6 g/liter) to match urine output, provided that diuresis was equal to or above 400 ml/hr. If diuresis remained or decreased below this level, diuresis replacement was associated with PAP-controlled infusion of saline, albumin, and red blood cells if needed. Furosemide was eventually given if diuresis did not increase above 400 ml/hr with fluid loading. With this protocol a good early diuresis was established in 95% of the cases. Ten patients required dialysis before the 5th postoperative day, one of them because of fluid overload and anuria. Concurrently, a decreased mortality rate and an increased graft survival rate were observed.


Anti-Kell (K1) in idiopathic thrombocytopenic purpura.

A transiently occurring anti-Kell antibody was observed in a 2 1/2-year-old child who had idiopathic thrombocytopenic purpura after recovery from an upper respiratory tract infection. The antibody was probably of the IgM class. There was no history of prior blood transfusion.


Is the strength of single HLA antigen mismatch variable in kidney transplant survival?

The survival rate among 458 cadaver kidney grafts with "full-house" four HLA-A,B antigens detected in the donor, three being identical to those of the recipient and only one mismatched, was studied specifically in relation to antigen incompatibility. At the A locus, the A3 incompatibility was associated with a lower transplant survival (44% at 2 years) than all of the others, and particularly more than the A11 (80% at 2 years) (P less than 0.003 but without significance after correction multiplying by the number of tested alleles). At the B locus, there was no significant difference in survival rate among the alleles. These results are only preliminary and need confirmation based on longer series permitting possible cross-reactions which exit between donor and recipient antigens to be taken into consideration.


Hemodialysis and kidney transplantation in a patient with glucose phosphate isomerase deficiency.

End stage failure in a patient with congenital hemolytic anemia attributable to glucose phosphate isomerase deficiency was treated successfully with maintenance hemodialysis and renal transplantation. Increased transfusion requirements, intolerance to immunosuppressive agents, and frequent infections were not encountered. Induction of the deficient erythrocyte enzyme by renal transplantation was not expected or realized.


Blood transfusions, cytotoxic antibodies, and kidney graft survival. Preliminary results of a systematic transfusion protocol.

Since pretransplant blood transfusions have been shown to prolong the survival of kidney grafts, a new transfusion policy has been started in the frame of Swisstransplant. Before surgery all patients receive at least two and, if possible, five transfusions (whole blood or packed red blood cells). The present study includes 101 recipients of primary cadaver grafts. Of these, 41 were transfused regularly according to the new protocol, 46 had irregular transfusions because of therapeutic necessity, and 14 had no transfusion before grafting. The 1-year survival rate in pretransfused patients was over 70% as compared to 45% in the nontransfused group. There was no significant association with the number of transfusions, but a slight improvement in graft survival was seen in patients deliberately transfused when compared with those transfused because of severe anaemia. A delay of more than 3 months between the last transfusion and transplantation significantly decreased graft survival at 6 months (84 versus 58%; P less than 0.02). The occurrence of cytotoxic antibodies, both antiperipheral blood lymphocytes (PBL) and anti-B cell antibodies, was investigated in relation to the number of transfusions received. Broad-spectrum anti-PBL antibodies (greater than 50% of random panel) were found in 5 of 74 patients transfused according to the protocol (7%) and in 15 of 93 patients transfused for severe anaemia (16% P, not significant). Of 71 recipients followed up for 6 months, 15 (21%) produced anti-PBL antibodies with limited specificity (less than 50%), and 4 (6%) produced broad-spectrum antibodies. Anti-B cell antibodies (less than 50%) were produced in 21 of 64 patients (33%). Six patients (9%) had broad-spectrum activity. The occurrence of these antibodies was not associated with the number of transfusions received and did not significantly influence the graft survival at 6 months. The change in transfusion policy seems to have improved graft survival without producing strong presensitization in a prohibitive proportion of the patients on hemodialysis.


The specific methods of control and eradication of schistosomiasis in Israel.

A review of the epidemiological status of urinary schistosomiasis and intestinal schistosomiasis in Israel is made. The ecology, bionomy and geographical distribution of the snail vectors were studied and research on their vectorial capacity to the imported Schistosoma strains was undertaken. Biomphalaria alexandrina, the snail vector of S. mansomi, was eradicated through ecological factors (salinity and pollution by sewage) and human activities. The elimination of snail vectors by applications of chemicals succeeded when the entire infested foci were isolated. The factors responsible for the reappearance of snail vectors after those chemical applications are described. Examples are given of successfully combined measures used for the control of snail vectors; increase of water currents to over 20 cm/sec, rapid emptying and drying up of water reservoirs, weekly deflection of infested water courses in different directions, etc. In 1951, 19 schoolchildren became infected with S. mansoni and in 1955, 97 schoolchildren became infected with S. haematobium. Since 1955 no more new infections with Schistosomiasis have been reported in Israel.


Epidemiology of Shigella dysenteriae, type 1 infections, in Dacca urban area.

A prospective study of 47 families with an index case of Shigella dysenteriae type 1 was conducted in the urban areas of Dacca. The subsequent infection rates in contacts type 1 were 30.6% and 28.3% in the age groups 0--4 and 5--9. Total secondary infection rate was 20.4% with rates in males higher than in females. Among the contacts 12.5% developed diarrhoea caused by the same serotype, but 22.1% developed diarrhoea with undiagnosed causes. For one hospitalised case there were seven symptomatic cases and 10 infections. All the infected infants age 0--4 developed diarrhoea and one fourth needed hospitalisation; but none aged over 9 needed it. Of these families 19% coincidentally had infections with other shigela types. Many factors were related with the higher infection rate. Use of open source of water was a significant factor. Multiple resistance to antibiotic was found, however, Shigella shiga was sensitive to Ampicillin, Kanamycin, Colistin and Furazolidone.


[Morphology of the microtubule system during the sphering, layering and polarization of normal and transformed fibroblasts].

The ultrastructure of the genital system (ductus seminalis, vestibulum, ductus tortuosus and canaliculus fecundans) has been studied during mating and oviposition. All these organs have a common organization and contain three parts: muscular and epithelial layer and chitin intima lining the interior surface of the female genital system. Ultrastructures of the muscular tissue and of the basal part of epidermis are similar. The luminal surface and microvilli are different in various organs of the female genital system. The ultrastructural pattern and the thickness of chitin intima may also vary, and can be used as a character for identificating different organs of the female system in ultrathin sections.


Laboratory tests in the evaluation of renal hypertension.

Renal hypertension is better understood now as a result of the development of new laboratory techniques which permit the identification of the surgically curable forms of renovascular and renal parenchymal hypertension. The rationale for and efficacy of these new advances are discussed and a practical approach to the diagnosis of renal hypertension is offered.


Techniques of renal biopsy.

The diagnostic information obtained by renal biopsy has both diagnostic and therapeutic value in patients with symptoms and signs suggestive of renal parenchymal disease. The clinician must be familiar with the indications and contraindications for the procedure, and is responsible for choosing the most appropriate technique and approach from the various methods available.


Localization of urinary tract infection.

Both the antibody-coating and LDH isoenzyme techniques theoretically fulfill the criteria for an ideal localization test. Both are noninvasive. They are relatively easy to perform and well within the capability of most clinical laboratories. Both can be done rapidly and the results can be in the clinician's hands in a matter of a few hours. The results of the antibody-coating technique do not appear to be valid for children. Since only one controlled study with comparison with other localization techniques has been done in adults, further evaluation needs to be done. The LDH isoenzyme pattern has not been studied in adults but appears to be accurate in children. A prospective comparison of both procedures in adults using either the Fairly bladder washout technique or the Stamey ureteral catheterization method to localize definitively the site of infection would be most helpful. Definitive noninvasive localization techniques could lead to therapy being initiated with the site of infection defined. This would facilitate earlier and more intensive antibiotic therapy in those patients at risk for renal parenchymal damage from upper tract infections.


New techniques for the evaluation of bladder function.

The various techniques available for the dynamic assessment of bladder function, including uroflowmetry, cystometrography, urethral closure pressure profiles, and sphincteric electromyography are presented. All of these approaches are discussed in terms of the indications for their use and their functions in evaluation.


Immunologic testing of patients with genitourinary malignancies.

The discipline and techniques of immunology have been an important part of recent advances in genitourinary oncology. Although the initial promise of tumor immunology has not been realized in man, discoveries in the laboratory are revitalizing the expectation that this field will yet be of significant assistance in the diagnosis and treatment of cancer. Already tumor immunology studies along with new immunologic assay techniques have produced clinically important tumor markers, such as alpha-fetoprotein, human chorionic gonadotropin, and prostatic acid phosphatase, and have intensified the search for other markers. Finally, research activity is increasingly focusing on the tumor cell itself, again often using immunologic methods. Although most of this activity is still experimental, analysis of blood-group antigens in transitional cell carcinoma has produced sufficient data to suggest that such an approach will soon be a part of the urologist's clinical armamentarium in his efforts to treat patients with bladder tumors.


Acid phosphatase.

Acid phosphatase is a ubiquitous lysosomal enzyme that hydrolyses organic phosphates at an acid pH. Although the postpuberteral prostatic epithelial cell contains a uniquely high concentration of acid phosphatase, cellular components of bone, spleen, kidney, liver, intestine, and blood also contain this enzyme. The discovery that prostatic carcinoma cells often retain a high concentration of acid phosphatase characteristic of the normal postpubertal gland led to the recognition of the first clinically useful tumor marker. Recognition that the serum of patients with prostatic malignancy frequently contains an increased concentration of this enzyme has resulted in persistent efforts to identify the source, to accurately quantitate the level of serum acid phosphatase, and to determine the clinical significance of those levels. A variety of enzymatic and immunologic techniques have been employed to measure acid phosphatase. In the past, various substrates and inhibitors were utilized to increase specificity and sensitivity. Emphasis has now shifted to the development of radioimmunoassay and counterimmunoelectrophoresis in an attempt to enhance those parameters. Judgment of their efficacy awaits further testing and evaluation. The clinical significance of normal and abnormal serum acid phosphatase is constantly being reevaluated. In order to maximize the value of laboratory measurements, the clinical and pathologic status of the patient, the techniques employed in obtaining and storing the blood sample and the procedures used in analysis must be known and considered. Traditionally, the serum prostatic acid phosphatase has been thought to originate in the prostatic cancer cell and has been used to stage the disease. Until recently, elevated serum values have been accepted as an indication of extraprostatic disease, and were thought to rule out lesions confined to the prostate. The elevation of acid phosphatase levels in patients with disseminated disease or the failure of elevated levels to return to normal with treatment have been assumed to indicate a poor prognosis. However, unequivocal documentation of the validity of these statements is not available. Newer immunologic techniques for measuring acid phosphatase may significantly alter our current concept of its role as a tumor marker.


A survey of calcium urolithiasis in normocalcemic hypercalciuria: possible role of nutrients and diet-mediated factors.

Three types of hypercalciuria are described; their existence and frequent association with calcium urolithiasis in humans are accepted. Various dietary factors such as minerals, electrolytes, fluids, vitamin D, carbohydrates, proteins are discussed with regard to their ability to alter the nature and the degree of calcium excretion following their ingestion. It is emphasised that at present we have only limited knowledge on the chain of events linking calorie intake and the response of the kidney.


Quantitation of response to therapy in calcium urolithiasis.

The physico-chemical basis for the action of various drugs in calcium nephrolithiasis may be described in terms of changes produced in the urinary state of saturation (APR), limit of metastability (FPR), or in crystal growth. The validation of this scheme for drug action requires further correlation of objective responses to drug therapy, described in terms of urinary crystallisation, with the clinical response.


Urease stones.

Urinary stones form as a consequence of urinary supersaturation. Supersaturation occurs as a result of elevated concentrations of urinary solutes. Dietary, metabolic, endocrine, hereditary, and infectious processes alter urinary solute concentrations. Struvite (MgNH4PO. 6H2O) and carbonate-apatite [Ca10(PO4)6CO3] stones form in urine that becomes supersaturated as a by-product of the hydrolysis of urea by the bacterial enzyme urease. Urease-induced stones manifest primarily as branched renal calculi and as bladder calculi. Conventional therapy has usually consisted of surgical removal of the stone combined with a short course of antimicrobial therapy. Such treatment is curative in about 50% of cases. Recurrent stone formation and progressive pyelonephritis occur in those who are not cured. Adjunctive medical treatment with acetohydroxamic acid or hydroxyurea lessens the risk of calculogenesis and decreases growth of residual stones in patients who are not cured by conventional therapy. Patients with urea-splitting urinary infection and renal stones have a major life-threatening disease. The morbidity and expense that result from this disease are great. Long-term (perhaps lifetime) chemotherapy with antimicrobial agents and/or urease-inhibiting drugs combined with judicious and expert surgical intervention can be expected to significantly improve the plight of these unfortunate patients.


[Laboratory tools in the diagnosis of prostatic cancer (author's transl)].

The most reliable laboratory test for prostate cancer remains prostatic phosphatase determination. With the spectrophotometric method, however, falsely negative results are to be expected in 40% of stage D lesions. In only one third of patients with localized disease results are correctly positive. This poor specificity and sensitivity can be improved by radioimmunoassay (RIA). Using this technique the prostatogenic isoenzyme is elevated in 50% of stage A and in 80% of stage B carcinoma, suggesting RIA for screening. Erythrocyte sedimentation rate or serum iron and copper are not necessarily of prognostic value. Phosphatase determination of bone marrow aspirates also requires the RIA method if differentiation of stage C and D is to be expected. Serum hormone assays are not yet introduced into routine staging programs. Serum and urinary markers such as CEA, polyamines of LDH isoenzymes are unspecific and of uncertain value in prostatic carcinoma. Measurement of urinary hydroxyproline seems a reliable method for the search of osseous spread; other bone diseases have to be excluded. In patients with prostate cancer laboratory tests still represent adjunctive measures in connection with the clinical diagnostic armamentarium of urologists.


Flushing of distal vas during vasectomy: current status and review of literature.

Vas irrigation during vasectomy, to effect immediate sterility or to shorten the interval between vasectomy and sterility, has received increasing attention in recent years. A review of the literature on vas irrigation is presented. Topics discussed include the effectiveness of various irrigants and irrigation methods, method and technical failures, and evidence of increased risks of recanalization, inflammation, tissue damage, and infection. Stored sperm and their location after vasectomy are explored. Suggested mechanisms for the action of irrigants are reviewed, and another mechanism is proposed. Variations in study results and our incomplete understanding of vas and seminal vesicle physiology during ejaculation (compounded by individual variations) require more investigation before large clinical trials are initiated.


Practical management of venous injury during pelvic surgery for urologic disease.

There is a selection of techniques (ligation, lateral suture repair, venous patch graft, end to end repair, and vein replacement graft) which can be adopted to deal with venous injury during pelvic surgery for urologic disease. Technical details of the various methods of repair are described for the benefit of the urologist who occasionally finds himself with a major venous injury and no vascular surgeon available to help.


Clomiphene citrate therapy for male infertility.

We have summarized 697 reported cases of the use of clomiphene citrate for the improvement of semen quality. Basal levels of gonadotropins are useful criteria for the differential diagnosis of hypo- and hypergonadotropic hypogonadism. Patients with an intact hypothalamic-pituitary-gonadal axis are most likely to respond to clomiphene citrate. Twenty-five mg. per day, administered in a cyclic fashion for a period of six to nine months, caused the greatest improvement. A higher dose (50 mg. per day) may be effective in men who do not respond to 25 mg. During the course of therapy gonadotropin levels and semen samples should be analyzed periodically. This drug is not currently approved for use in men; the incidence of side effects, particularly with long-term treatment, is unknown.


Effects of preliminary normothermic flushing on hypothermic renal preservation.

Flushing of harvested kidneys with hypothermic perfusates is presumed to cause inappropriate circulation due to vasospasm. Effects of initial normothermic flushing prior to hypothermic flushing and cold preservation were tested in canine kidneys. Analysis of the perfusion characteristics revealed that a brief initial flushing with solutions at 37 degrees C. eliminates vasoconstriction and even facilitates subsequent hypothermic flushing. In amounts not exceeding 100 cc. it was not deleterious to transplant function. Larger volumes of normothermic flushing were proved to cause endothelial injury and resulted in poor transplant survival.


[Effect of sodium oxybutyrate on reflex hemodynamic reactions].

Clinical examination of patients with diseases of the lungs and locomotor system during the surgical treatment and experiments in animals has shown that sodium hydroxybutyrate used as an anesthetizing drug under conditions of the neuroleptic analgesia fails to provide an effective defense against the surgical trauma. This is shown by the instability in the hemodynamic indices, metabolic shifts and the presence of nociceptive viscero-somatic reflexes.


[Acute cholelithiasic intestinal obstruction].

The paper presents the data of diagnosis, clinical picture and surgical treatment of 8 patients with acute cholelythic ileus. The authors describe the specific features of the clinical course of the disease and emphasize high diagnostic value of general rentgenography of the abdomen for the recognition of this complication. Operations in acute cholelythic ileus are characterized. Prevention of such pathology is dependent on timely surgery for such patients.


[Prevention of cicatricial deformities following surgical repair of the skin in patients with burns].

Under study was the dynamics of clinical and morphological changes of 348 portions of the repaired skin in 266 patients in different periods after plasty. Recommendations are proposed to prevent secondary cicatricial deformities.


[Hydrodynamics of the active drainage of the mediastinum using lavage and aspiration].

The results of experimental studies of hydrodynamics in acute drainage are described. Four series of experiments were carried on a transparent model filled with a liquid. The authors have revealed the phenomenon of dyraulic "strokes" which promote mechanical purification of the cavity from the purulent content. It has been established that a running-water fractional regimen of washing should be used for the cavities of more than 15--20 cm3 volume.


[Gunshot wounds of the arteries].

The surgical tactics for the treatment of gunshot wounds of vessels should depend not only on the kind of the injuring shell but also on the concrete dimensions of the injury of vessels and surrounding tissues. The vital capacity of the vessels and adjacent tissues should be determined by the same criteria as that of well-known and sufficiently studied gunshot wounds.


[Treatment of Achilles tendon injuries in athletes].

165 athletes with injuries to the Achilles tendon were under observation of the authors; 4 of them had sustained open traumas and 161 -- subcutanous ones. Surgical intervention was the main method of treatment. The G. D. Nikitin's method of autoplasty is indicated in fresh injuries, a combined autoalloplasty, according to the authors' method, -- in old ones. Late results were followed up in 141 patients, all of them showed good outcome. Primary surgical treatment of the wound and suture of the Achilles tendon are indicated in open injuries to the Achilles tendon.


Pulmonary function testing in horses.

Pulmonary function tests in horses are in the early stages of development and there will be a limit in the range of tests available since those requiring patient cooperation cannot be conducted in animals. Some tests such as blood gas analysis, A-aDo2 and delta Ppl measurements could presently be used to a greater extent under field conditions. Others that require expensive equipment and considerable technical assistance will be limited to the larger referral type veterinary clinics until the time is reached when there is adequate information to select those procedures that give a reasonable cost to benefit ratio to make their use more widespread.


Chemical mediators of immediate hypersensitivity reactions.

The investigation of the mast cell-basophil products has progressed from studies directed solely at implicating histamine or serotonin in allergic diseases to molecular definitions of pathways to target cell activation and mediator release. In addition, within the last several years the detection and molecular characterization of the many other mediators of immediate hypersensitivity have begun. This area should continue to prove a fruitful arena in the future. Identification of the physiologic importance of these mediators in the heaves syndrome or other potential equine allergic syndromes may contribute both to the basic understanding of the pathogenesis of allergy, as well as suggest possible avenues for control.


Autologous, split skin transplantation on the lower limbs of horses.

The skin grafting experiments were carried out on the cannon regions of horses to throw light on four matters relating to split skin transplantation. They were: The thickness of donor split skin that would provide good wound cover and still leave adequate tissue to permit uneventful healing at the donor site; whether split skin grafts were more readily accepted on fresh than on granulating wounds; the size of wounds that would benefit from grafting; and the maximum size of graft that would be readily accepted. The findings were: Split skin grafts 0.76 mm thickness gave the best results although grafts 0.63 mm thickness were satisfactory; split skin grafts were accepted more readily on fresh wounds than on granulating tissue; wounds which exceeded 1/10th of the skin area on the cannon region justified grafting; the upper limit in size was not established as the largest grafts used were more readily accepted than smaller grafts.


[Immunostimulating activity of certain subcellular fractions of Escherichia coli O138:K81:H19].

A 24-hour culture of Escherichia coli 0138:K81:H19 was used to isolate a soluble cytoplasmic fraction, an O antigen, and an unsolube cell ingredient. Their immunogenic action was followed up through subcutaneous vaccination of mice and the production of humoral antibodies in rabbits. It was found that the cytoplasmic ingredient was a slightly toxic protective antigen forming considerable immunity in mice and a comparatively high titer of antibodies in rabbit sera. The unsoluble cell ingredient and the O antigen proved comparatively toxic and did not produce favourable immune response. Discussed in the use of the cytoplasmic ingredient as a vaccine as well as the type of the immunoglobulins produced.


[Resoprtion of colostric immunoglobulins and serum bactericidal activity of lambs during ontogeny].

Studied were the resorption dynamics of colostrum IgG and IgM immunoglobulins in lambs of ewes vaccinated and unvaccinated against Escherichia coli and the bactericidal activity of their serum depending on the time after the first sucking as well as the resorption and the bactericidal activity as influenced by the first sucking itself. The experiment was carried out on 70 lambs of vaccinated ewes and 30 lambs of unvaccinated ewes. The period of investigation covered the time from the first to the 20th day after the first sucking, studying also the agglutinin titer, the phagocyte number and phagocyte index of the leukocytes with regard to the vaccinal strain O7 of E. coli. The specificity of IgG and IgM was studied through immunoelectrophoresis. It was found that the bactericidal activity of the blood in newborn lambs was dependent on the amount of the immunoglobulins resorbed and their specificity. A delay of 10--24 hours of the first sucking led to a drop of both immunoglobulins and bactericidal activity by about 48--65 and 20--45 per cent, respectively.


[Transmissible drug resistance in strains of E. coli isolated from birds].

A total of 97 strains of Escherichia coli, resistant either to one or to several theraupeutic agents and isolated from young and adult birds, were studied for the presence of transmissible R plasmids. Transmissible drug resistance was demonstrated with 37 per cent of the strains. The transmission of such resistance was manifested in highest percent in the case of ampicillin and chloramphenicol, followed by sulphathiazole and tetracycline. The R plasmids established in multi-drug resistant strains with three markers and more, were found to bear high percent determinants of resistance to chloramphenicol and in lower percent such to sulphathiazole and tetracycline. The same strains presented R plasmids that bore determinants of resistance to five therapeutic agents (Tc, Su, Cm, Mm, Nm) and to three therapeutic agents (Cm, Ap, Tc) and (Cm, Su, Km).


Mannitol.

Mannitol may be useful clinically both as a diuretic and as an obligate extracellular solute. As a diuretic it can be used to treat patients with intractable edema states, to increase urine flow and flush out debris from the renal tubules in patients with acute tubular necrosis, and to increase toxin excretion in patients with barbiturate, salicylate or bromide intoxication. As an obligate extracellular solute it may be useful to ameliorate symptoms of the dialysis disequilibrium syndrome, to decrease cerebral edema following trauma or cerebrovascular accident, and to prevent cell swelling related to renal ischemia following cross-clamping of the aorta. Largely unexplored uses for mannitol include its use as an osmotic agent in place of dextrose in peritoneal dialysis solutions, its use to maintain urine output in patients newly begun on hemodialysis, and its use to limit infarct size following acute myocardial infarction.


Diseases of phenylalanine metabolism.

Continuing investigation of the system that hydroxylates phenylalanine to tyrosine has led to new insights into diseases associated with the malfunction of this system. Good evidence has confirmed that phenylketonuria (PKU) is not caused by a simple lack of phenylalanine hydroxylase. Dihydropteridine reductase deficiency as well as defects in biopterin metabolism may also cause the clinical features of phenylketonuria. Furthermore, these diseases do not respond to the standard treatment for phenylketonuria.


[The serum concentration of anticonvulsants -- pharmacokinetic findings and practical therapeutic applications (author's transl)].

Routine determination of the blood serum concentration of most of the usual anticonvulsants is possible by means of an immunoenzymatic method (EMIT). Determination of the total concentration permits conclusions as to the amount of available, unbound and, thus, effective amount of the substance. Regular determination of serum values provides insight into the relevant pharmacokinetics. Metabolism of anticonvulsants differs greatly among individuals and therefore considerable individual variation exists in the relation between the applied dose and the attained serum level. The metabolic rate of the various substances is unequal and, accordingly, the time necessary to reach a steady state and the half life is very variable. Metabolism may be altered by various biological adaptations, diseases or other drugs, causing alterations in the serum level of the anticonvulsant. Results obtained to date indicate a therapeutic threshold concentration range. In a certain percentage of patients seizures are abolished or diminish in frequency only on attaining such a serum level. In more benign cases an adequate therapeutic effect may be obtained with lower ("subtherapeutic") concentrations, while on the other hand, in malignant cases, no efficient control of seizure activity can be attained even at a high serum concentration. The method should be used in all problematic patients. Up to 50% of patients with insufficient control of seizures show improvement or, even, absence of seizures if this method is included in the therapeutic concept.


[The posttraumatic osteomyelitis in guinea-pigs (author's transl)].

A model of posttraumatic osteomyelitis was developed in 120 Duncan-Hartley guinea-pigs. For this purpose the right femura of all animals were fractured surgically. In 60 guinea-pigs immobilisation of the fractured extremity was omitted, in remaining 60 the medullary space was splinted with intramedullary pin. Each of the two groups was further subdivided in three subgroups, i.s. non infected controls, staphylococcus aureus-infections and escherichia coli-infections. Comparative evaluations were based on ten follow-up studies, nine of which were scheduled for the first three postoperative months and one 12 months after surgery. The overwhelming majority of infected animals developed acute osteomyelitis. This was found to heal within the first three postoperative months in just a few of the animals without intramedullary pinning. In all other animals the condition became chronic and was still demonstrable one year after infection. Follow-up immunological studies were based on bacterial ingestion. An evaluation of opsonic activity against time revealed statistically significant deferences for all groups. Marked depression of opsonic activity within the first 35 postoperative days after intramedullary pinning constituted the most prominent immunological finding.


[Reaction of connective tissue and striated muscle tissue to implanted ashwood (author's transl)].

In former experiments it could be shown, that new bone is formed around ashwood after implantation in the tibia of rabbits, in spite of a foreign-body tissue reaction. Equally prepared ashwood half-cylinders were now implanted in the soft tissue of rats and evaluated 2, 6, 12 and 30 weeks after implantation. Around the implants a foreign-body tissue reaction developed and demonstrates the hitherto insufficient preparation of the implants.


[Experimental and clinical experiences with silicone catheters in fistulizing glaucoma surgery].

1. A historical revue of seton operations is presented, which were actually explored for the first time by Rollet in 1907. 2. The paramount importance of the selection of the appropriate material for the setons is stressed. 3. Ocular tolerance especially of silicone tubings has been investigated by animal experiments. Excellent tolerance of silicone intraocularly as well as subconjunctivally has been found. This fact confirms experimental investigations by other authors. 4. In animal experiments for the first time a surgical technique securing firm anchorage of a sole silicone tubing could be developed. Insertion of a silicone catheter was combined with thermal sclerostomy; ocular hypotony was not encountered. 5. A study exploring aqueous egress following the new surgical procedure has been conducted by means of injection of fluorescein into the anterior chamber. Various exit-sites of aqueous were recorded: diffuse outflow through the filtration cleft as well as the catheter lumen, and also via channels either within lymph vessels or secondary aqueous veins. 6. Aqueous outflow following the seton operation has also been studied by scintigraphic means; the first description of this method in glaucoma-operated eyes is presented. Applying this technique not only the existence of a filtering bleb is documented, but in addition the speed of aqueous transit through the filtering bleb was measured. This transit has been found to be a rapid one. 7. The clinical results of this type of seton operation do confirm the experimental evidence of excellent ocular tolerance of silicone tubings as well as the reliability of their firm anchorage. Postoperative tension with or without additional antiglaucomatous medication proved quite satisfactory. 8. The proposed surgical procedure is recommendable especially in patients exhibiting haemorrhagic glaucoma, were conventional methods are likely to fail in the majority of cases.


[The medical school reform of the early 18th century. On the 300th anniversary of the birthday of Johann Juncker (1679-1759)].

The 300th anniversary of the birthday of Johann Juncker gives the occasion to think of the Collegium clinicum Halense founded by him and at the same time of Juncker's versatile activities for furthering an education connected with practice. Juncker's reform of study forms the initial point for the transformation of the clinical and policlinical forms of education in favour of an increasing orientation to practice which in many place was done only at the end of the century.


[Primary pyelonephritis (the focal problem)].

On different experimental models of pyelonephritis in dogs and rabbits an experiment for the classification of the pathogenesis of this disease with the special questioning of the possible development of the so-called primary pyelonephritis was performed. A series of experiments consisted of 3 groups: 1. Injection of an E.-coli-suspension into the musculature of the urinary bladder of dogs and rabbits. 2. Injection of an E.-coli-suspension into the testicles of rabbits. 3. Injection of an E.-coli-suspension into the seminal bladders of rats. The experiments lasted 2 to 15 days and 16 to 110 days, respectively. In the second series of experiment in rats and rabbits an E.-coli-suspension was injected into the gall-bladder of rats and rabbits. Bacteriologic blood cultures and histologic investigations of the kidneys, the ureters, the wall of the urinary bladder and the adjacent lymphatic and fatty tissue as well as of the gall-bladders were performed. The results showed that the pyelonephritis developed secondarily after the infection of the other infected organs by haematogenic or interstitial dissemination of the pathogenic agents. Conclusions are drawn: 1. Every pyelonephritis, also the haematogenic, is a secondary process. 2. Therefore all must be done to find out the primary inflammatory change in the organism and to cure it. 3. Severe forms of the pyelonephritis may, on the other hand, effect as focus and evoke in inflammation of other organs on lymphogenic and haematogenic way. 4. Taking into consideration the facts mentioned perhaps the great number of pyelonephritiides having become latent might be reduced.


[Contribution to the neuropathology of stereotactic brain-operations and their fatal complications (author's transl)].

Report on the neuropathology of 6 fatal cases in 150 stereotactic operations, performed on 135 patients from 1960 to February 1978. The deceased had a hyperkinesis and a severe Parkinson's disease in 3 cases each. Only two of them had died of a complicating intracranial extracerebral haemorrhage immediately after the stereotactic operation. In our own material the longest survival time after operation was about 3 years. Biochemical and biothermical reactions and situations basing on thermocoagulation are dealt with in particular.


[A prophylactic regimen for infections in colorectal surgery (author's transl)].

Without special prophylaxis, surgery of the colon and rectum is likely to result in postoperative complications due to infection at a percentage of 30 to 50. Prophylaxis against infections in colonic operations covers preoperative influence on general body defence, a subtle operating technique and special preparation of the intestine, the latter including adequate bulkage - free diet, a special preparation of the intestine and preoperative administration of antibiotics. Preparation by means of phthalylsulfathiazol has shown no effects. A preparation programme is suggested for 3 to 8 days preoperatively.


[Stereotaxia in phantom-limb-neuralgia and causalgia (author's transl)].

Intractable pain is an important indication for stereotactic operations in deep structures of the brain. The targets are situated in primary and secondary sensomotoric regions of the thalamus, dependent or independent on cortical areas. In clinical practice it is necessary to combine two or three targets in the thalamic nuclei. In more than 25% the destruction of parts of the emotional pain-perception is necessary (ncl. dorso-medialis). The results os stereotactic operations in 32 patients with causalgia and phantom-limb-neuralgia are analysed.


[Prenatal diagnosis of an intestinal atresia by means of ultrasound - case report and discussion (author's transl)].

An intestinal atresia was diagnosed by means of ultrasonography and amniofetography in the 34. gestional week. The discussion agendas are, how far the given ultrasonogramms are typical for fetal intestinal atresia and how much part was played by sonography and amniofetography by the search of diagnosis; further, whether already antenatal diagnosed intestinal abnormality justifies a fetal indicated cesarean section, which could be important for timing of the surgical performance and for the betterment of the perinatal situation.


Mode of action of colicins Ia, E1 and K.

Addition of colicins Ia, E1 or K to sensitive Escherichia coli leads to inhibition of macromolecular synthesis and an uncoupling of electron transport from active transport. Recent results indicate that these colicins affect energy metabolism by interacting directly with the cytoplasmic membrane. This results in a transmembrane flow of ions leading to membrane depolarization. It is proposed that the function of the outer membrane colicin receptor is to mediate access of the colicin molecule to the cytoplasmic membrane.


Comparative evaluation of immunofluorescent (IgM and IgG) and complement-fixing antibodies in influenza A infection.

The indirect immunofluorescent (FA) tests for detection of IgG and IgM antibodies to the internal antigens of influenza viruses were performed using single cell suspensions of baby hamster kidney cells. The IgG-FA test showed a good correlation with the complement fixation (CF) test performed with purified ribonucleoprotein (RNP) as antigen than the CF test with whole virus antigen. Sera which were positive only in the IgM-FA test did not react in the RNP-CF test. A rapid diagnosis of influenza was not possible alone by detection of RNP specific IgM as relatively low titers were obtained in the IgM-FA test.


[Changes in the progress of infectious diseases caused by changes of natural resistance and of the steroid metabolism (author's transl)].

It is demonstrated that it is possible to change the stereotyped reaction of the steroid metabolism to infection by means of external influences. The progress of infectious diseases can be detoriated and the average duration of life can be shortened by rearing a special strain of test rabbits or by lack of protein in the diet, by blocking the RES, by cortisol, estradiol and thyroxin, by glucose and by polyvinylpyridin-N-oxid. - The time of survival is prolonged by testosterone, dehydroepiandrosterone and cyproterone, also by cystein, aristolochia acid and treatment with pyrifer. - No effect whatever on the progress of an infectious disease is produced by the vitamines A, B1, B6, D, E and especially ascorbinic acid, also an extract of thymus gland, spleen, insulin, a preparation with STH, and Norgestrel, DMSO and treatment with B, bifidum and with omnadin.


The concept of bacteriocins.

After a short description of the discovery of bacteriocins, especially the colicins in this review the following points are discussed: the classification of colicins especially with the aid of resistant mutants of sensitive indicator strains, the bacteriocin-receptors, the bacteriocin-specificity, and the possible ways of transport of colicins across the outer membrane.


Colicin receptors and the mechanisms of colicin uptake.

This review deals in detail with the nature, synthesis, physiologic functions, and the regulation of colicin receptors, which represent components of transportsystems, as well as with the two mechanisms of the colicin uptake within the groups A and B of colicins.


Immunoelectron microscopic localization of T proteins in the cell wall of Streptococcus pyogenes.

T proteins of Streptococcus pyogenes (group A streptococci) were localized by means of immunochromatographical isolated anti-T-antibodies. For the electron microscopical detection both the direct and the indirect immunoferritin techniques were used. The arrangement of the ferritin particles showed, that the T proteins are evenly distributed on the whole cell surface. They are immediately bound to the outer layer of the cell wall or to only short filaments. On isolated cell walls the T protein was detected only on the outer surface.


[Isolation of a carbon dioxide-dependent strain of E. coli from the urine of a patient with chronic pyelonephritis (author's transl)].

Since anaerobic culture techniques were introduced into bacteriological routine laboratories reports increase about Enterobacteria, which doesn't grow under normal culture conditions. We recently isolated a carbon-dioxide dependent strain of E. coli, which didn't grow aerobically even on optimized culture mediums. Though the species was at first isolated in an anaerobic jar further investigation showed optimal growth in an atmosphere containing 20 per cent oxygen enriched with (10 per cent) carbon dioxide. There are some indications that the mutant developed under chemotherapy. A serological grouping wasn't possible.


Discrepancies Between strong immunochemical relations of S. typhimurium and S. kentucky and their behaviour "in vivo".

Proteins from S. typhimurium and from S. kentucky strongly cross-precipitated against sera prepared in rabbits with the respective strains; agglutinations paralleled the precipitations. The related antigens were, however, not involved in "in vivo" cross-protections. Mice immunized with proteins from S. kentucky resisted the toxicity of the homologous strain and that of a concentration of S. emek which killed the controls but did not survive the infection with 1LD100 of S. typhimurium. There was a long delay in the death of those mice infected with S. typhimurium while the mice immunized with S. typhimurium proteins were killed by the toxicity of 1LD100 S. kentucky, like the controls, within 20 hours. The results strikingly underline the specificity of host-parasite relations and the need for circumspection when involving common antigens in either virulence or toxicity.


The numerous common antigens of enterobacteriaceae.

A mosaic of proteins is synthesized by each of the Enterobacterial species grown on artificial media (tryptose-agar, Difco). Their existence was proven with the help of sera prepared in rabbits with proteins from: S. enteritidis, S. typhi, S. typhimurium, S. paratyphi C, E. coli, and Sh. sonnei. The induced antibodies, strongly precipitated numerous heterologous Enterobacterial proteins. The proteins of Sh. dysenteriae 4, although reacting against the heterologous sera, were poor immunogens and induced, mainly, homologous antibodies. Comparative agar-gel diffusions of the same proteins against the antiproteinic sera and corresponding antibacterial sera proved that the bacteria induced fewer antibodies against a reduced number of heterologous antigens. Thus, it is evident that a competition among the numerous antigens of a bacterium takes place when whole bacteria are used for immunizations. The differences in the degree of relatedness of Salmonellae, Shigellae, and E. coli are illustrated by their reactions in agar-gel against homologous and heterologous sera. The serological activity of heated proteins (1 hr at 100 degrees C) against the antiproteinic sera differed according to the intrinsic qualities of the analysed materials.


The prevalence of anaerobic bacteria in suprapubic bladder aspirates obtained from pregnant women.

The incidence of asymptomatic bacteriuria due to aerobic, facultative anaerobic and strictly anaerobic bacteria during pregnancy was determined in 185 patients admitted for complications of pregnancy, using suprapubic bladder aspiration. Anaerobic bacterial counts of 103 per ml urine or higher were detected in 6.4 per cent of the specimens. The incidence of anaerobic bacteriuria seems comparable to that of bacteriuria due to aerobic and facultative anaerobic micro organisms. In our group of patients the incidence of the latter was 5.4%. The presence of anaerobic bacteria was not confined to the occurrence of a particular species. Peptostreptococcus species, Veillonella species, Bacteroides species, Eubacterium species, Clostridium species and Bifidobacterium species were isolated from specimens in concentrations of more than 103 per ml. Consequences of asymptomatic bacteriuria during pregnancy are totally uncertain. Further investigation is necessary to obtain insight into the effect of bacteriuria due to anaerobes upon the outcome of pregnancy.


Blood cultures with the BACTEC 225 radiometric microbial growth detection system.

The BACTEC 225 automated radiometric blood culture system was compared with a conventional blood culture bottle method for its ability to improve the rapid laboratory diagnosis of bacteremia in cancer patients. The BACTEC 225, in combination with routine blind subcultures and smears of radiometrically negative culture vials, detected two thirds, of all positive cultures within 24 h and shortered the detection time generally by 24-48 h. With the recommended growth index setting of 30, radiometrically false-positive findings are rare and are usually due to leukocytosis resulting from infection or leukemia.


Isolation of Francisella tularensis from mites Haemogamasus nidi and Laelaps hilaris in western slovakia.

Isolating of F. tularensis from gamasid mites H. nidi parasitizing on the bank vole (Cl. glareolus) and L. hilaris on the common vole (M. arvalis) are reported. The epidemiological significance of this finding is discussed.


Different appearance of parasitized erythrocytes in blood between normal and toxoplasma-infected rats after infection of Plasmodium berghei.

When normal rats were infected with Plasmodium berghei (Pb), both IgG and IgM immunofluorescent antibody titers were found to rise in the 1st week with increase of parasitaemia. After reinoculation of P. berghei into Pb-immune rats, IgG titer was further increased remarkably, although no parasitaemia was observed. No elevation of IgM titer was found. In rats infected with Toxoplasma gondii (Tg), IgG and IgM antibody activities were demonstrated in the 1st to the 3rd week postinfection but only IgG titer was maintained to the 16th week. The challenge with T. gondii to Tg-immune rats stimulated the further increase in IgG titer but not in IgM. When Tg-immune rats were infected with P. berghei, little or no parasitaemia appeared. In infection of P. berghei in Tg-immune rats which were treated with anti-rat thymocyte serum (ATS) beforehand, highly increased parasitaemia was usually found in the rats as compared with that in ATS non-treated rats. Pb-immune macrophages were more effective in phagocytosis of Pb-parasitized erythrocytes in vitro than normal or Tg-immune macrophages. When Pb-parasitized erythrocytes were preincubated with fresh Pb-immune serum, the phagocytosis rate of macrophages was clearly heightened. It was observed that the phagocytic activity of normal macrophages to Pb-parasitized erythrocytes was stimulated by addition of the supernatant (lymphokines) taken from the incubation of Tg-immune lymphocytes with Tg-antigen or Pb-antigen.


Fundamental studies on macrophage migration inhibitory factor(s) in the supernatant from spleen cells in mice infected with Toxoplasma gondii.

When migration inhibitory factor (MIF) assay in vitro was conducted on the lymphokines (LKs), it was observed that the percentage of MIF activity was greatly increased from the 3rd to the 4th week postinfection. On the succeeding weeks there was a noticeable decrease in the MIF activity noted on the 8th week postinfection of Toxoplasma. MIF activity was examined at 1, 6, 12, 18, 24 and 48 hours in non-immune spleen cells as well as Toxoplasma immune spleen cells in the 2nd week after the final challenge inoculation. MIF activity in Toxoplasma immune spleen cells were 2, 21, 29, 54, 70 and 93 percentage, respectively. The MIF activity of hyperimmunized spleen cells produced an activity of approximately 50% at 18 hours as compared to the non-immune spleen cells. Characterization of the MIF was performed using Sephadex G-100 and DEAE Sephadex A 50. Two distinct peaks of MIF were identified and separated by Sephadex G-100 gel filtration, calculating molecular weights between 30,000 to 40,000 and 3,000 to 5,000, respectively. When the fast peak by Sephadex G-100 was eluted again in DEAE Sephadex A 50, the peak was separated into 4 units, all units showing MIF activity.


Serological cross-reactions between toxoplasma and hammondia.

Toxoplasma and Hammondia infected mice, dogs, rabbits, and pigs were tested for Toxoplasma antibodies by means of 5 serological methods. All Toxoplasma infected animals showed Toxoplasma-specific antibodies. Only sera of Hammondia infected mice and dogs showed positive serological reactions with Toxoplasma antigen in the SFT, CFT, and ELISA. IFAT and IHA, however, proved to be Toxoplasma-specific. The influence of Hammondia infections on the Toxoplasma serology is discussed.


Babesia microti: morphology, distribution and host relationship in Germany.

A short review has been given about recent studies on Babesia microti in natural animal host's near Munich (Southern Germany). An infected area has been studied in order to elucidate the outdoor relationship between the local strains and their preferred hosts, the European field vole Microtus agrestis. The seasonal variation of the parasites prevalence in voles shows a rise in the early summertime (71% of the catches infected). Roundish forms predominate in the erythrocytes. Multiplication never takes place by binary fission, but in "Maltese cross" form or budding-like. Normally the parasite is enveloped with a simple elementary membrane only, as shown by electron microscopy. The arthropod host is still not identified, infections of human beings not observed. This is the first finding and full description of B. microti in Germany.


[Microbial emission, immission and changes in the germ count in the cooling water during operation of wet cooling towers III. communication: laboratory tests for the determination of the reduction kinetics of Escherichia coli in cooling tower plumes (author's transl)].

The present paper reports on laboratory tests for the determination of the reduction rate of micro-organisms. The investigations were carried out with a pure culture of E. coli, a germ type from the enterobacterial group. By a suitable variation of the thermodynamic parameters it was possible to simulate the conditions through which the cooling tower plume passes inside the chimney of the cooling tower and when it mixes with ambient air. The results allow the following changes in the germ counts in the plume of a wet cooling tower to be expected: 1. As long as the cooling tower plume contains droplets, the capacity of the carried germs to form colonies does not change materially. 2. In the case of unsaturated plumes we must distinguish between two situations: a) The tests in which the germ suspension was sprayed into unsaturated air without any admixture of secondary air, did not demonstrate any dependence of the reduction rate on the relative humidity. b) In contrast to this, the tests in which the germ-carrying droplets were evaporated by admixing a stream of unsaturated secondary air, showed that the capacity to form colonies clearly decreased with diminishing relative air humidity. Case b) is of importance for the dissemination and immission of germs from cooling towers, because here, too, the visible plume initially laden with drops is dried by the admixture of unsaturated ambient air.


The smoB mutation suppressing cell filamentation and ability to support the multiplication of phage P22 in Salmonella typhimurium.

Isolation and properties of a Salmonella typhimurium mutant smoB are described. The mutation maps at unit 99 of the S. typhimurium chromosome between pyrB and deoC. It suppresses cell filamentation and temperature sensitivity of histidine-constitutive mutants, but does not restore the normal regulatory pattern to the histidine operon. Strains carrying the mutation have greatly reduced ability to support the growth of phage P22, but not of ES18 or Felix O.


On the different response of Salmonella typhimurium hisG46 and TA1530 to mutagenic action of base analogues.

Various mutagens are known to induce more his+ revertants in TA1530 than in hisG46 strain. To test whether the mutator effect shown by TA1530 is limited to the his mutation, the lysA8 marker was introduced into both the TA1530 and hisG46 strain, and its reversibility, after induction by N4-hydroxycytidine, was estimated. The ability to reverse the lys marker was tenfold higher in the TA1530/lysA8 transductants than in the hisG46/lysA8 transductants or in the donor for lys, the lysA8 strain.


Properties of cysK mutants of Escherichia coli K12.

Triazole and azaserine resistant mutants of E. coli K12 affecting cysK gene coding for O-acetylserine sulphydrylase were isolated. The cysK gene in E. coli is located in the same region of chromosome as the cycK gene in Salmonella typhimurium. All azaserine and some triazole resistant mutants require cysteine for growth at a normal rate. The cysK mutants have reduced sulphate uptake. Stability and transfer by conjugation of triazole resistant phenotype were checked. Differences in sulphate metabolism between closely related organisms E. coli and S. typhimurium are discussed.


Effect of temperature and 4,6'-diamidine-2-phenylindole on restriction of supercoiled Col E1 DNA by Eco RI endonuclease.

Supercoiled Col E1 DNA is split by Eco RI endonuclease at 37 degrees C without intermediate formation of open circular DNA. Accumulation of this restriction product is observed at low temperature. The fluorescent dye, 4,6'-diamidine-2-phenylindole (DAPI) inhibits restriction by Eco RI endonuclease. This effect is due to the DAPI:DNA rather than to the DAPI:Eco RI interactions.


Integration of F factor and cryptic LT2 plasmid into a specific site of the Salmonella typhimurium chromosome.

Suppression of dnaA mutation by F'lac and cryptic LT2 plasmid was used for selecting clones containing these plasmids integrated into rfa and galK genes.


Acute myocardial infarction: coronary care unit, hospital ward or home management?

The need of admission of all patients with acute myocardial infarction in a CCU is questioned by some british authors. A critical review of their publications stresses the most important methodological problems they could not overcome; consequently they cannot allow any valuable comparison. There are no randomized trial related to the comparison of general ward to CCU care, but the available data obtained by studies based on bed availability show a definite advantage of the CCU. At the present stage of our knowledge, admission in a CCU must be recommended to all  patients seen in the first hours after the presumed onset of the disease; after some delay (12 h?) systematic admission is not justified any more and the decision should be taken according to each case, in relation to the clinical status and familial or social conditions.