Release of insulin in vitro from normal and duct-ligated rat pancreas.

Ligation of the pancreatic duct causes atrophy of the acinar cells but leaves the endocrine tissue intact. In the present study, a partial ligation of the pancreatic duct was performed in the rat, and the in vitro insulin response to glucose was compared from both the atrophic and non-atrophic portions of the pancreas. Subsequent morphological studies of the duct-tied portion of the pancreas indicated a complete lack of acinar cells and a possible neoformation of ducts, fat cells and connective tissue. However, islets were present in normal amounts and appeared well perserved. Measurements of the insulin release in vitro from this ligated pancreatic tissue showed that an increase of the glucose concentrations from 3.3 to 16.7 mmol/1 resulted in a six-fold stimulation. A further two-fold stimulation was seen after addition of theophylline to the high-glucose incubation medium. In addition, only under the latter conditions was there a significantly increased insulin release from both non-atrophic portion of the pancreas and from the pancreas of sham-operated animals. It is concluded that duct ligation does not diminish the glucose sensitivty of rat islet B-cells. Thus, the present study does not support the view proposed previously that islet tissue is functionally of a foetal nature following duct ligation.


Diagnosis of postnatal rubella by the enzyme-linked immunosorbent assay for rubella IgM and IgG antibodies.

A semi-automated enzyme-linked immunosorbent assay (ELISA) was established for the detection of rubella IgM antibodies in non-fractionated sera. A cut-off level between rubella IgM positive and negative sera was determined by a study of sera without rheumatoid factor from 200 blood donors. Testing of 12 donor sera containing rheumatoid factor showed that 5 sera gave a positive result in the rubella IgM assay. Rubella IgM antibodies were quantified by ELISA in a study of 214 serial serum specimens drawn from 16 patients with rubella during a period of up to 10 years after the infection. Peak values of the IgM antibodies were reached approximately 8 days after onset of the rash, and the persistence of the IgM antibodies ranged from 17-90 days, with the exception of one patient with a prolonged IgM response. The rubella IgG antibodies increased slowly after the rash and reached maximum levels about 50-120 days, after which a monor decrease was observed. The results of the present study indicate that ELISA is suitable as a routine procedure for the serodiagnosis of recent rubella.


Isolation of Sporothrix fungorum from a 500-year-old mummy found in Greenland.

A 500-year-old mummy of a seven-month-old Eskimo infant recently removed from a tomb north of Umanak presented problems of preservation. Among these was fungal coating on the skin, especially on the face. The fungus was isolated and diagnosed as a Sporothrix fungorum. The skin was successfully treated with nystatine. The species Sporothrix fungorum isolated is considered to be very rare, having been reported previously only from Europe and South Africa, but never from Greenland.


Gas chromatographic characterization of porcine and human strains belonging to the Mycobacterium avium-intracellulare complex.

Trifluoroacetylated whole-cell methanolysates of 23 strains designated as belonging to the Mycobacterium avium-intracellulare complex by biochemical, growth chromogenicity and chicken pathogenicity tests, were analysed by gas chromatography. Twenty of the strains were isolated from pigs and the remainder from human beings. Serological typing showed that 13 of the porcine strains, but none of the human strains, belonged to M. avium. The remaining strains, except one which showed autoagglutination, did not react with antisera to M. avium (serotypes 1-3), thus suggesting that they belonged to M. intracellulare. Five different, highly reproducible chromatographic patterns, the main peaks of which were considered as representing bacterial carbohydrates and fatty acids, could be distinguished by visual examination and by cluster analysis. The chromatographic results could not be correlated with those obtained from serotyping of the strains studied. Mycobacteria recovered from different organs of one and the same pig gave virtually identical chromatograms. The strains isolated from three human beings had a chromatographic pattern which was identical with one of those produced by the porcine strains. The present investigation indicates that the gas chromatographic analytic technique used differentiates bacteria within the M. avium-intracellulare complex, without assigning the organisms to species.


Effect of increased excretory renal mass on kidney function.

Renal function was investigated in non-hydrated normal dogs and in dogs with slight isotonic hypervolaemia before and after increasing the excreting renal mass by connecting a pair of isolated kidneys into their circulation. After connecting the isolated kidneys to the perfusor's circulation, the excreting capacity of the in situ kidneys decreased markedly in both groups, without any change in the arterial blood pressure. Their urine output calculated for 100g kidney weight dropped from 0.52 +/- 0.43 to 0.30 +/- 0.18 ml/min in the non-hydrated group, and from 2.3 +/- 1.17 to 1.33 +/- 0.96 ml/min in the hydrated one. The urine flow of the isolated kidneys was 0.29 +/- 0.12 ml/min in the non-hydrated and 1.11 +/- 0.53 ml/min in the hydrated animals. Sodium excretion displayed similar changes. The findings suggest, that the excretory capacity of the kidneys and its distribution between the two kidneys is regulated very precisely. In our opinion, one or more "natriuretic factor" may be responsible for this precise regulation. The supposed factor seems to be produced extrarenally, and is only "used up" by the kidneys. It appears to exert its effect on the tubular part of the nephron, regulating the permeability of the tubular wall and controlling in this way the reflux of sodium and water from the capillary side to the tubular lumen. The decreased excreting capacity of the kidneys is attributed to an increased consumption of the natriuretic factor by four kidneys.


Biphasic endotoxin fever in the newborn rabbit.

Rabbits aged 6-10 days responded to 20 or 50 microgram/kg i. p. or i. v. E. coli endotoxin with characteristic biphasic fever, whereas 0-3-day-old rabbits reacted with monophasic fever which coincided with the first-phase rise of the older group. In the rabbit, the mechanisms responsible for the first-phase and the second-phase febrile temperature rises appear separately in ontogenesis in the first week of extrauterine life.


Structural aspects of the permeability of the microvascular endothelium.

This article reviews recent findings and current views concerning the structural aspects of microvascular permeability. The vascular endothelium is considered as a simple squamous epithelium which has acquired a remarkably high permeability to water and water soluble solutes (including macromolecules) through a characteristic process of differentiation of its cells. In terms of cellular structures, this differentiation involves an unusually large population of plasmalemmal vesicles. The evidence so far obtained indicates that these vesicles function as (1) mass-carriers of fluid and solutes across the endothelium and as (2) generators of transendothelial channels by concomitant fusion (followed by fission) with both domains (luminal and tissular) of the plasmalemma. The endothelial fenestrae of visceral capillaries are initially transendothelial channels subsequently collapsed to minimal length. The intercellular junctions of the endothelium are not detectably permeable to tracers of diam. greater than or equal to 18--20 A in capillaries, but are focally open to probes of 50--60 A diam. in postcapillary (pericytic) venules. A correlation is attempted between transendothelial channels (and fenestrae) and the pore systems postulated by the pore theory of capillary permeability. The channels appear to function as either small or large pores depending on the porosity of their associated diaphragms and on the size of local strictures along their pathway. Two main components are recognized in the analysis of capillary permeability: 1) a basic component comparable to that of other simple epithelia and involving transport across the plasmalemma and probably along the intercellular junctions (for molecules of diam. greater than or equal to 10 A); and a differentiated component which involves plasmalemmal vesicles and their derivatives (transendothelial channels and fenestrae). The postulated pores of the capillary endothelium are part of this differentiated component. The special situation found in postcapillary venules (focally open junctions) seems to be related to the role played by these vessels in inflammatory reactions.


Combined intravital microscopy and electron microscopy of the blind beginnings of the mesenteric lymphatic capillaries of the rat mesentery. A preliminary report.

The blind beginnings (so-called terminal lymphatics) of the mesenteric lymphatic capillaries have been studied in the rat mesentery by means of intravital microscopy and electron microscopy. Intraluminal objects were observed to move slowly downstream, probably carried by the movement of the lymphatic fluid. No simultaneous changes in capillary lumen could be observed, and the subsequent electron microscope analysis of the same lymphatic capillary demonstrated the absence of smooth muscle cells in the wall of the lymphatic vessel. Interendothelial gaps were present, allowing the uptake of interstitial fluid into the blind ending of the lymphatic capillary.


The investigation of capillary permeability in single vessels.

Measurements of filtration coefficients (Lp) and osmotic reflexion coefficients (sigma) of single capillaries in the frog mesentery suggest that fluid flows through the walls of these vessels in two types of channel. One channel type (representing about 10% of Lp) appears to be exclusively available for water whereas the other channels appear available for both water and hydrophilic solutes though they severely restrict the passage of albumin (sigma = 0.81). The effects of proteins in the perfusate upon Lp and studies on the passage of ferritin into the surface vesicles of the endothelial cells, suggest that an important component of capillary permeability may reside in an endocapillary layer.


Permeability of single capillaries compared with results from whole-organ studies.

There are now two experimental approaches to capillary permeability: whole-organ studies and single-capillary experiments. It is not possible to obtain permeability coefficients in the true sense of the word from whole-organ experiments since the capillary surface area is unknown. Other limitations of whole-organ approaches are discussed. Results from 'osmotic transient' experiments are compared with those from 'indicator diffusion' experiments. 'Osmotic transient' experiments give higher values for capillary diffusion capacity than 'indicator diffusion' experiments. Reasonable agreement is obtained when the reflection coefficient is taken into account. Thus far, single-capillary experiments have only provided results from capillaries in the frog mesentery, where the potassium permeability was about 70 X 10(-5) cm . sec-1, or 10 times the value from whole-organ experiments on muscle. The discrepancy may reflect true differences between capillaries in the two tissues or may be caused by methodological limitations. There is a need for comparative studies of permeability with the whole-organ and the single-capillary technique applied to the same tissue.


Relation of capillary morphology to transport of fluid and large molecules: a review.

Transport characteristics of endothelial cell membranes, cytoplasmic vesicles, intercellular junctions (small pores and large pores) and fenestrae are presented in terms of appropriate models. Morphological differences of capillaries in different vascular beds are compared with physiological differences in permeability to water, small molecules and large molecules, and the correlation of morphologically defined and physiologically defined pathways is analyzed.


Comparison of sulpiride and chlorpromazine in psychoses. A double-blind multicentre study.

In a material of 71 patients admitted because of acute or chronic psychoses, 32 were treated with sulpiride (up to 1,800 mg per day) and 39 with chlorpromazine (up to 675 mg). Duration of treatment was from 4 to 8 weeks. The effect of the two preparations was very similar as were the type and frequency of side effects, except that sulpiride did not cause sunrash.


Serum calcitonin after renal transplantation.

A prospective study of serum calcitonin was made in 9 patients with chronic renal failure. The patients received a well-functioning renal transplant. At the time of transplantation serum calcitonin was significantly elevated as compared with the serum concentration in normal controls. During the first 3--5 weeks after renal transplantation serum calcitonin decreased. Afterwards it increased to a level of the same magnitude as the initial value. A significant relationship was found between serum calcitonin and serum phosphorus, whereas no significant correlation was present between serum calcitonin and serum creatinine or between serum calcitonin and serum calcium.


Tuberculosis and kidney transplantation.

Immunosuppressive treatment enhances the risk of pulmonary and other infections. Tuberculosis is a predictable complication in transplanted patients. The present material comprises 584 kidney transplantation patients, ten of whom had had a previous history of tuberculosis. After transplantation ten patients presented with pulmonary tuberculosis during immunosuppressive treatment. One of the patients to whom no prophylactic antituberculous treatment had been given presented with a relapsing tuberculosis. The results of routine antituberculous treatment were excellent, but graft and patient survival were disappointing among the tuberculosis patients.


Serum ferritin during infection. A longitudinal study in renal transplant patients.

In order to follow the dynamics in the reaction of iron kinetic variables to acute infection, 8 renal transplantation patients were followed with test samples every second or third day for about two months. It was found that they just as previously shown in otherwise healthy subjects, responded to acute infection with a rise in serum ferritin levels, sometimes to very high values. In most cases the ferritin elevation started within two days after the onset of fever. The peak was reached within a week, except when very high values were obtained. The fall in serum ferritin after recovery from infection was much faster than in previously investigated groups of patients: the plasma half disappearance time for ferritin in one case was but 1.5 days. Transferrin did not change in response to infection. The expected fall in serum iron during infection was often absent and sometimes obscured by unexpected, sharp peaks in serum iron, which bore a temporal relationship to episodes of transplant rejection in 7 of 12 cases.


Replication of ovine adenoviruses.

The replication of ovine adenoviruses shows intertypic and intratypic variations, e.g. the extracellular and intracellular virus yield of ORT/111, a strain related to bovine adenovirus type 2, reached its peak 40 to 46 hr postinfection, in contrast to GY/14, a strain classified as ovine adenovirus type 1, which required 52 to 58 hr to reach the highest yield. The replication cycle was not appreciably influenced either by rolling of the tube cultures or the age (between 0 and 7 days) of the supporting ovine cell culture. All the strains under study replicated at 40 degree C more rapidly than at 34 degree C or 37 degree C. There was some intratypic variation in the replication of strains at different temperatures. Ovine adenoviruses replicated well after three consecutive passages in cultured lamb testicle or secondary heterologous cells such as calf kidney, calf testicle or pig kidney cell cultures as well as the MDBK cell line and a cell line from the calf trachea. The tissue spectra of strains showed intratypic variations. As examined by direct immunofluorescence, fluorescing adenovirus antigen appeared first at 8 hr postinfection and wharacter of fluorescence are described.


Immunofluorescent studies on Candida albicans.

The indirect immunofluorescent titres of Candida albicans 0656 CBS hyperimmune rabbit serum were investigated against C. albicans antigens prepared from strains originating from mucous membranes of healthy persons and patients with thrush. Using pathogenic strains as antigens, a definitely strong fluorescent reaction was obtained with hyperimmune rabbit serum in a dilution of 1 : 2500. In the case of apathogenic strains the fluorescent reaction was either very weak or negative in a dilution of 1 : 2000. Absorption studies also seemed to reveal a difference in reactivity between pathogenic and apathogenic strains. Hyperimmune rabbit serum absorbed with apathogenic C. albicans strains showed a positive fluorescent reaction only with pathogenic ones as antigens. In the opposite case a negative reaction was obtained.


Inhibitory and mutagenic effects of sodium nitroprusside and its adenine complex on Escherichia coli.

Sodium nitroprusside and its adenine complex were found to decrease the growth rate of exponentially growing Escherichia coli cultures, and the adenine complex to exert in addition a bactericidal effect. In mutation experiments the latter compound failed to induce base-pair substitutions in the E. coli strains tested but the results do not allow to exclude other mutagenic mechanisms.


Mouse lung oedema caused by a toxic substance of Escherichia coli strains.

Some Escherichia coli strains isolated from patients and instilled into the nostrils of mice cause a rapidly developing fatal, haemorrhagic lung oedema. Lung toxic strains were found in different serogroups, with the predominance of 04, 06, and 018. The toxic material seems to be bound to the cells; the toxin yield is poor by different methods of extraction. The toxic principle causes toxic, haemorrhagic oedema in mouse foot pad test and shows cytotoxicity for AV-3 cells. The "lung toxin" is heat labile and after Sephadex fractionation has a molecular weight of about 100 000 dalton. There is a possible identity with a toxic haemolysin.


Enterotoxin production by Shigella flexneri type 2A, strain no. M42-43.

Enterotoxin produced by Shigella flexneri type 2a, strain M42-43, is similar to "Shig-like" cytotoxic enterotoxin and shares common features with that of other S. flexneri strains. On the basis of molecular filtration and neutralization experiments it is suggested that the same molecule carries these biological characters.


A cytoarchitectonic scheme for the spinal cord of the domestic fowl, Gallus gallus domesticus: lumbar region.

In Nissl stained and silver impregnated transverse sections of the chick spinal cord it is possible to subdivide the gray matter of the lumbar region into ten cytoarchitectonically discrete regions or laminae. The laminae are basically similar in both brachial and lumbar regions of the chick cord, with minor exceptions in the dorsal horn. The laminar scheme postulated for the chick cord is , with the exception of the glycogen body and orientation of laminae 1, 2 and 3 in the dorsal horn, similar to the laminar scheme proposed by Rexed (1954) for the cat.


Biochemical studies on the ionic channel of Torpedo acetylcholine receptor.

1. [3H]H12-HTX binding to Torpedo electric organ membranes is saturable and inhibited by ligands that modulate EPCs. There is a small proportion of nonspecific binding to the membrane. 2. The validity of utilizing [3H]H12-HTX as a specific label for the ionic channel of the nicotinic receptor is extablished by the good correlation between the potency of HTX analogues in reducing EPC amplitudes and their inhibition of [3H]H12-HTX binding. 3. Receptor drugs and toxins inhibit [3H]ACh binding to the ACh receptor, but do not inhibit significantly [3h]h12-htx binding to the ionic channel at similar concentrations. 4. Various drugs and toxins with different modes of action modulate EPCs and inhibit [3H]H12-HTX binding to the ionic channel of the nicotinic receptor. Most such drugs and toxins, at similar concentrations, do not inhibit [3H]ACh binding to the ACh receptor, but some do, such as quinacrine and TEA. 5. The ionic channel of the nicotinic receptor is a protein which is solubilized by cholate and retains its affinity for H12-HTX as well as its drug sensitivity. 6. The ACh receptor is separated from its ionic channel, and different conditions affect the proportion of separated molecules.


Inhibition of pepsin secretion by metiamide and atropine in the conscious rat.

The inhibition of pepsin secretion by metiamide and atropine has been studied in the gastric fistula rat and the Heidenhain pouch rat. A comparison of the effectiveness of metiamide and atropine in inhibiting pepsin secretion was made by using doses of the antagonists which produced a similar level of inhibition of acid secretion. In the gastric fistula rat both atropine and metiamide inhibited the basal pepsin output, but atropine was more effective than metiamide in this respect. In the Heidenhain pouch rat a large dose of metiamide which inhibited bethanechol-stimulated acid secretion had no significant effect on the corresponding output of pepsin. In this preparation atropine inhibited both acid and pepsin secretion. Possible reasons for the differences in the two preparations are discussed.


The pharmacological consequences of the binding of anti-rheumatic drugs to plasma proteins in the treatment of rheumatoid arthritis.

Evidence is presented that rheumatoid arthritis is a disease resulting from abnormal protein binding and that anti-rheumatic drugs act by correcting the abnormal binding.


Maladie du Roger 1879: a new translation for the centenary.

A new translation of Roger's description of the clinical and anatomical findings in uncomplicated small VSD is presented. Reappraisal of Roger's observations in the light of our present understanding confirms that only our attitudes change; diseases remain the same.


Effective treatment of supraventricular arrhythmias with acebutolol.

To evaluate the antiarrhythmic efficacy of the new beta adrenergic blocking agent acebutolol, 15 monitored patients with supraventricular arrhythmias received, in double-blind fashion, an intravenous infusion of either acebutolol or saline solution after a control period. Patients treated with saline solution demonstrated no change (P greater than 0.05) in heart rate or arterial blood pressure or conversion to sinus rhythm. After administration of acebutolol, significant (P less than 0.05) reductions in heart rate were noted at 5 minutes. Peak reduction occurred at 10 to 30 minutes and correlated with maximal acebutolol plasma concentrations, antiarrhythmic activity persisted for 24 hours. Mild reductions in systolic blood pressure were observed in the majority of patients. Two patients with atrial fibrillation and one with multifocal atrial tachycardia had conversion to sinus rhythm. Frequent premature atrial complexes noted in one patient were greatly suppressed after administration of the drug. In the nine patients with clinical evidence of chronic obstructive lung disease acebutolol was well tolerated. Adverse reactions were limited to transient dyspnea in one patient with prior heart failure and a decrease in systolic blood pressure to less than 90 mm Hg in three patients who remained asymptomatic. In the patients studied, acebutolol was an effective agent for the treatment of supraventricular arrhythmias and appeared to be of special value in those with chronic obstructive lung disease.


Innominate aterial arteriovenous fistula complicating retrograde brachial arterial catheterization.

Arteriovenous fistula of the innominate artery occurred in a patient 3 weeks after retrograde brachial arterial catheterization was performed 1 day before aortocoronary bypass surgery. Intramural dissection was noted at catheterization, and a mediastinal hematoma at operation. Exploration of the hematoma in the course of catheterization might have prevented the arteriovenous fistula, which necessitated a second operation 3 weeks after the first. To our knowlege this complication of retrograde brachial catheterization has not previously been described. We recommend that known injuries to cervical or thoracic arteries occurring just before operations requiring extracorporeal circulation be explored to prevent late complications. Recent injuries to the cervical and thoracic arteries that are not acessible to external compression should be exposed and treated during sternotomy to prevent late complications if heparinization is contemplated.


Lupus nephritis. Electron-dense and immunofluorescent deposits and their correlation with proteinuria and renal function.

Thirteen patients who had systemic lupus erythematosus were studied for the purpose of correlating the findings of light and electron microscopy and immunofluorescent studies with renal function and the presence of proteinuria. Subendothelial deposits of electron-dense material were found in all biopsy specimens, whereas mesangial and subepithelial deposits were not always present. IgG and beta 1c were constant findings in the glomerular membrane. The seven patients who were found to have extensive subendothelial deposits had moderate to massive proteinuria, and four of these patients had decreases in renal function. Most of the patients who had smaller subendothelial deposits had slight or insignificant proteinuria. Massive subendothelial deposits were mainly found in specimens showing histologic evidence of active lesions. Correlation was also found between proteinuria and the overall amount of deposits and their distribution. The prognosis was dependent on the severity of subendothelial deposits, the overall amount of deposits, and the morphologic form of lupus nephropathy.


Assay for yeast susceptibility to 5-fluorocytosine and amphotericin B in a frozen microtiter system.

A microtiter plate method for determining susceptibility of yeasts to 5-fluorocytosine and amphotericin B, which uses color indicators to detect end points, is presented. The microtiter plates can be made in advance and stored frozen for at least eight weeks. Forty-two isolates of Candida albicans, 12 of Candida tropicalis, and nine of Torulopsis glabrata were tested. Results showed good correlation with turbidity tube dilution susceptibility testing methods. The microtiter method is stable, easy to use, accurate, and reproducible. Studies with four strains of Cryptococcus neoformans showed that the organism could not be tested by this method because growth was slow and there was insufficient acid production.


Evaluation of ten anaerobic blood culture media.

Selection of an anaerobic blood culture based upon clinical findings that have compared the isolation rates of bacteremic agents from different blood culture media. No agreement has been reached as to which of the commercially available blood culture media is optimal for detection of bacteremia. The purpose of this study was to determine the rates of recovery of anaerobic microorganisms from various anaerobic blood culture media. The blood culture media were inoculated with a small inoculum of microorganisms in the presence or absence of an erythrocyte-serum mixture. The results demonstrated that the type of medium and the erythrocyte-serum mixture influenced the ability of blood culture media to support the growth of microorganisms. The majority of the media failed to support the growth of 87% or more of the microorganisms within four days after inoculation. Pre-reduced brain-heart infusion broth supported the growth of a larger proportion of microorganisms than the other types of blood culture media.


Detection by counterimmunoelectrophoresis of anti-Candida precipitins in sera from cancer patients.

Five antigen preparations from yeast-phase cells and hyphalphase cells of Candida albicans were used to detect antibodies in sera from cancer patients by use of counterimmunoelectrophoresis (CIE). Sera from uninfected patients, patients with superficial infections, and patients who had invasive or systemic candidiasis were analyzed for antibodies. A high incidence (27%) of false-negative data was obtained for patients who had systemic candidiasis. Serum titers of all patient groups were below 1:10. Of the antigens tested, cytoplasmic antigen from yeast-phase cells provided the greatest sensitivity and diagnostic value.


Comparison of two slide tests for detection of group A streptococcal antibodies.

Screening sera for streptococcal antibodies is a useful clinical procedure when recent streptococcal infection requires verification. Presently there are two test kits available that detect five (or more) of the antibodies that may be present. These two screening tests were compared using antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) titers as the reference for true streptococcal infection. All four procedures were performed on 69 sera collected from a pediatric population. Both screening tests were found to be sensitive, specific, economical, and easy to perform; however, both were more sensitive to elevated ASO titers than to elevated ADB titers. In certain clinical situations, therefore, antibody titrations may be necessary to document completely recent streptococcal infection.


Reliability of immunofluorescence of renal tissue obtained at autopsy.

A retrospective study of kidney tissues accessioned in the Department of Immunopathology was undertaken to determine the reliability of the direct immunofluorescence technic applied to necropsy tissues. Of 72 accessioned specimens, 27 were positive and showed a spectrum of immunomicroscopic patterns corresponding to different renal diseases. Only two patients whose specimens were negative by immunofluorescence had shown any clinical or light microscopic evidence of active glomerular disease. Periods from death to autopsy ranged from one to 20 hours. Positive fluorescence was found in tissues obtained as long as 20 hours after death. These findings suggest that immunofluorescent studies of autopsy-derived renal tissue yield acceptable results.


Coordinated computer reporting of microbiology data in the clinical laboratory.

The details of incorporating microbiology results into a single computerized report that also includes all other laboratory results for each patient in the hospital are described. Including the microbiology results in this way allows provision of a consolidated flow sheet of all laboratory work on each chart, replacing the myriad single-sheet reports so common to manual systems. The results are tabulated, and are easily read by clinicians after some experience. This system also enables communication of updated results daily to clinicians and monitoring of infectious diseases in the hospital.


A rapid staphylococcal coagglutination technic to differentiate group A from other streptococcal groups.

A rapid staphylococcal coagglutination technic for differentiating group A from other streptococcal groups properly classified 500 isolates of beta-hemolytic streptococci when compared with the results of a reference capillary precipitin test. Presumptive classification of the same 500 isolates by bacitracin susceptibility produced a significant number of incorrect identifications. The findings further document the inherent inaccuracy of the bacitracin susceptibility test and suggest that the staphylococcal coagglutination technic may be a simple, accurate, inexpensive alternative for identification of group A streptococci.


Group B streptococcal sepsis with osteomyelitis and arthritis. Its occurrence with acute heart failure.

In a 20-day-old female infant, bacteremia, osteomyelitis, and pyogenic arthritis developed due to infection with group B streptococcus, type Ic. She had an unusual clinical presentation with overwhelming sepsis and acute congestive heart failure.


Group B streptococcal osteomyelitis and septic arthritis. Its occurrence in infants less than 2 months old.

Nine infants less than 2 months of age with group B streptococcal (GBS) osteomyelitis or septic arthritis, or both, were seen from January 1975 through January 1978. The infants had local joint signs, usually in the absence of systemic signs. The bones and joints involved were equally distributed between proximal humerus and proximal and distal femur. An infant had involvement of the talus. Treatment consisted of two to three weeks of parenteral antibiotics, arthrotomy in infants with arthritis, and bone decompression in infants with osteomyelitis. Clinical follow-up showed normal growth and function of the affected joint. Of the organisms, five were typed: four were type III and one was type Ib. Group B streptococcal osteomyelitis and/or septic arthritis was the second most common late-onset GSB infection, being surpassed only by meningitis.


Neonatal lung abscess. A report of six cases.

Six infants 8 weeks of age or younger had lung abscesses treated in our medical center during the 20-year period of from 1957 to 1977. The duration of symptoms prior to diagnosis, the etiologic organisms, and the therapeutic approach differ from those in older children and adults. The pathogenic organisms were Escherichia coli, group B streptococcus, and Klebsiella pneumoniae, initial therapy with a penicillin and an aminoglycoside are indicated until identification and susceptibility results are available on the organism isolated from the abscess cavity. Previously undiagnosed cystic malformations of the lung were seen in two of the six patients. Surgical intervention is usually required in this age group.


Epidemiologic survey of sylvatic plague by serotesting coyote sentinels with enzyme immunoassay.

The geographic distribution and areas of high sylvatic plague activity in California were verified by using coyotes (Canis latrans) as sentinel animals. Antibody levels against Yersinia pestis were tested using the enzyme-labelled antibody (ELA) test and the microtiter passive hemagglutination and hemagglutination inhibition. A survey using the ELA test indicated that the overall antibody prevalence among 143 coyotes was 21%. By geographic regions, the highest antibody prevalence was 27% among coyotes from mountain areas on the northern and eastern borders of the state. This was followed by 19% in the central coastal area and 12% in the central valley. Areas with a high prevalence of seropositive coyotes or high antibody levels in individual coyotes matched the four areas of human plague exposures reported in 1977 and 1978. These areas included the central Sierra mountains adjacent to Lake Tahoe, southeastern Kern County, the central coastal area and Scott Valley near the Oregon border. The ELA test appears to be a promising tool for future epidemiologic studies of plague.


Sickle cell anemia as a syndrome: a review of diagnostic features.

Sickle cell (SS) disease is a complex of various genetic conditions. In some, homozygosity for the beta S gene may be present alone or in combination with the heterozygous or homozygous alpha-thalassemia-2 condition. Such combinations might ameliorate the clinical and hematological condition of the patient. The same may be true for the high levels of Hb F and F-cells observed in many Hb S homozygotes. Howeever, the chemical heterogeneity of Hb F appears not to be related to the clinical status of the Hb S homozygote. Combinations of a Hb S heterozygosity with a heterozygosity for a Hb D-type of variant, for either one of two types of beta-thalassemia, two types of alpha beta- thalassemia, and five types of HPFH are discussed, and data are compared with those obtained for Hb S homozygotes. The use of advanced laboratory procedures and family studies is often necessary for an accurate diagnosis.


Drug therapy reviews: trimethoprim-sulfamethoxazole.

The mechanism of action, antimicrobial spectrum, pharmacokinetic properties, drug interactions, adverse reactions and therapeutic uses of trimethoprim-sulfamethoxazole, a combination enzyme-specific inhibitor of bacterial folate synthesis, are reviewed. Trimethoprim-sulfamethoxazole currently is approved by the FDA for the therapy of established recurrent bacterial urinary tract infections, pneumocystosis, otitis media in children and shigellosis. Claimed advantages of the drug are synergistic activity, bactericidal activity and ability to decrease the rate of emergence of resistance to the individual components. Trimethoprim-sulfamethoxazole is the drug of choice for treatment of pneumocystosis and an acceptable oral therapy for recurrent urinary tract infections caused by susceptible bacteria. In children with otitis media, it is used as an alternative to ampicillin and amoxicillin and is preferred when these patients are penicillin-sensitive or when the infection is caused by beta-lactamase-producing Haemophilus influenzae. Hematologic reactions (anemia, thrombocytopenia, granulocytopenia, agranulocytosis) to trimethoprim-sulfamethoxazole occur rarely. Gastrointestinal intolerance and skin eruptions are the most prevalent adverse reactions. Most untoward reactions to trimethoprim-sulfamethoxazole develop within two weeks of onset of therapy, and their incidence compares favorably with that of standard agents administered for the same indications.


Clonidine overdose: a review.

The pharmacology and pharmacokinetics of clonidine and the symptoms and treatment of acute clinidine overdosage are reviewed. Clonidine, a relatively safe and effective antihypertensive agent when used at therapeutic dosages, reduces blood pressure through a centrally mediated reduction in vasomotor tone. The primary symptoms of clonidine overdosage are central nervous system depression, bradycardia, hypotension, miosis, hypotonia, respiratory depression and possibly seizures. Gastric lavage followed by administration of activated charcoal is used to decrease absorption following acute oral ingestion. Intravenous fluid therapy and dopamine infusion are recommended for severe hypotension, and atropine sulfate is used to manage persistent bradycardia. Treatment of hypotension with alpha-adrenergic blocking agents (e.g., tolazoline) is not recommended unless patients fail to respond to dopamine infusion and administration of i.v. fluids.


Drug interaction exposures in an ambulatory Medicaid population.

The incidence of selected potential drug-drug interactions (DDIs) in a population of ambulatory patients was studied using data extracted from the automated records of Medicaid drug benefit programs. The system to extract DDI data was devised to assist peer review committees in drug use review. The system yields two types of reports: (1) individual patient profiles and (2) summary reports of all potential DDIs detected within the Medicaid population being reviewed. Potential drug interactions are classified as major, moderate or minor and by route of drug administration. Three months of drug claims from two Medicaid programs were reviewed for potential DDIs involving digitalis preparations, antihypertensive agents (rescinnamine, deserpidine, guanethidine, methyldopa, reserpine, Rauwolfia serpentina extracts) and coumarin anticoagulants. The overall incidence of potential DDI exposures for the three classes was 2.7%, based on drug profiles of 333,641 patients. DDI exposure monitoring can be a useful tool in acquiring further knowledge of DDIs occurring in ambulatory patients.


The role of mucociliary dysfunction in bronchial asthma.

Abnormalities of mucociliary function in the airways of patients with bronchial asthma are suggested by the clinical observation of excessive tracheobronchial secretions which are difficult to expectorate and may contribute to bronchial obstruction. Pathologic and functional studies in animals and patients have demonstrated an impairment of mucociliary transport mechanisms, but the pathogenesis of this abnormality is still poorly understood. In patients with allergic asthma, the elaboration of chemical mediators in the lung seems to depress mucociliary function. Although pharmacologic agents which increase mucous transport rates have been identified, more potent stimulators will probably be needed to produce a clinical improvement in patients with bronchial asthma.


Rapid in vitro capsule production by cryptococci.

Four agar media (blood, corn meal, chocolate, and Sabouraud's) and four liquid media (brain-heart infusion broth, one percent peptone broth, pooled human serum, and lyophilized rabbit coagulase plasma) were evaluated for their ability to enhance the production of capsules from four strains of Cryptococcus yeast within 48 hours at 25C and 35C. The yeast in serum and plasma was washed with distilled water prior to India ink preparation in order to prevent precipitation of the ink. The rabbit coagulase plasma was the only medium which consistently produced large capsules in 48 hours. Incubation temperatures and anticoagulant made little difference.


A five-hour system for identification of bacteria.

A five-hour protocol was compared with routine methods for identification and antibiotic susceptibility determination of bacteria from clinical specimens. A total of 9551 urine, wound, sputum, and throat cultures were processed using both procedures. The identifications reported less than 24 hours after the laboratory received the specimen were comparable to those obtained by routine methods for 87 to 95 percent of the Enterobacteriaceae, 90 percent of the staphylococci and enterococci, but less than 50 percent of the unusual species such as Providencia, P. maltophilia, or Acinetobacter. Susceptibility test results were reported after five hours' incubation for 97 percent of all stains examined except for P. aeruginosa where early results were obtained for only 71 percent of the strains. This protocol allows bacteriologic identification and antibiotic susceptibility determination within 24 hours of specimen receipt; therefore, appropriate antibacterial therapy for the patient's immediate needs can be started in a shortened period.


The laboratory diagnosis of congenital syphilis: a review.

The serodiagnosis of congenital syphilis is reviewed. Maternal history is the least reliable criterion for detecting congenital syphilis. A positive maternal history may or may not be valid; a negative maternal history does not rule out the possibility of congenital syphilis. Syphilis serology performed on the infant is a better criterion for detecting asymptomatic congenital syphilis or delayed onset. Serial VDRL titers on the infants are the best diagnostic tool presently available. A decreasing titer indicates the presence of maternally derived antibodies. The FTA-ABS (IgM) is still not sufficiently evaluated and standardized for routine clinical application.


Bacterial growth inhibition by amniotic fluid. VIII. Evaluation of a radiometric bioassay for rapid, in vitro demonstration of phosphate-sensitive bacterial growth inhibitor in amniotic fluid.

A radiometric bioassay based on the continuous monitoring of 14CO2 released from labeled glucose in the presence of amniotic fluid or amniotic fluid with added phosphate has been employed to detect the presence of a phosphate-sensitive bacterial inhibitor in amniotic fluid near term. The time required for detection of the inhibitory activity is approximately 12 hours, in contrast to approximately 36 hours required for a previously reported technique. Application of this radiometric bioassay to demonstrate bacterial growth inhibition by amniotic fluid and physicochemical properties of the inhibitory activity yielded results comparable to those obtained with the older method of plate counts of viable bacteria. By the new technique it was possible to demonstrate that the inhibitory activity was phosephate sensitive, heat stable, inactivated by metal chelation, removed by bentonite, and present in a low-molecular-weight fraction of amniotic fluid.


Luteinizing hormone-releasing hormone and the human menstrual cycle.

Plasma concentrations of LHRH were measured by radioimmunoassay in daily samples obtained from 10 normally ovulating women. The normalcy of each menstrual cycle was determined by measuring luteinizing hormone (LH), follicle-stimulating hormone (FSH), total estrogen, and progesterone concentrations. Six women had consistently measurable immunoreactive LH-releasing hormone (LHRH) in every blood sample. In four, LHRH could not be detected in some of the samples, more frequently during the follicular phase. LHRH levels varied between 10 and 35 pg/ml during the menstrual cycle. At midcycle, coincident with the LH surge, the mean LHRH level (17.6 +/- 4.4 pg/ml) was not significantly different from the mean follicular or luteal phase values. The lowest LHRH level, 11.4 +/- 4.6 pg/ml, was observed on the day of the estrogen surge. A detailed evaluation was made of the specific days of the cycle. Blood samples obtained from an indwelling venous catheter every 20 minutes over a 3 or a 5 hour period during the days of the estrogen surge and the LH surge and on the following day showed no correlation between OHRH, LH, and FSH values.


The immunopathology of Mooren's ulcer.

In a 42-year-old man with bilateral severe Mooren's ulcers, results of immunologic studies were normal, with the exception of an in vitro blastogenic response of the patient's lymphocytes to corneal stroma. The histologic studies revealed vast numbers of vacuolated neutrophils with intracytoplasmic phagosomes in and about the ulcerating cornea. Although the progression of ulceration was initially unaltered by surgical and pharmacologic trials, systemic immunosuppression with methotrexate may have prevented ulceration of the lamellar tectonic graft.


Graft edema after suture removal.

Graft edema developed after removal of continuous monofilament sutures in six eyes of six patients in whom no wound dehiscence occurred. All sutures were removed at least one year after penetrating keratoplasty, and graft edema was noted one day after suture removal. In all cases, partial or total resolution of graft edema occurred after treatment with corticosteroids. In two of the grafts, the edema resolved after treatment with topical corticosteroids alone, whereas the remaining four grafts required the addition of systemic or subtenon corticosteroids, or both, for resolution. The trauma associated with suture removal may cause endothelial decompensation either by direct injury to the cornea or by a secondary iritis. To the best of our knowledge, graft edema after suture removal is a late complication of penetrating keratoplasty that has not been previously emphasized.


The effect of acid etching on the cervical region of the buccal surface of the human premolar, with special reference to direct bonding techniques.

Etching action on the cervical enamel compared to the central and incisal enamel of the buccal surfaces of premolars was investigated by using the scanning electron and optical microscopes. In SEM observations, the etched cervical enamel surface showed a pitted feature with no prism delineation, regardless of the prolonged etching time and the removal of enamel surface. The etched central and incisal enamel surface showed the characteristic prism-end structure. In optical microscopic observations, the tags formed at the cervical region were shorter and less numerous than those formed at the central and incisal enamel surfaces.


Fc-receptor-bearing macrophages isolated from hypersensitivity and foreign-body granulomas. Delineation of macrophage dynamics, fc receptor density/avidity and specificity.

Foreign-body and delayed hypersensitivity granulomas were induced in mice; and the dynamics of macrophages isolated from dispersed, 1--4-week-old lesions was delineated. The size and histologic complexity of the lesions increased as shown: adjuvant greater than schistosome egg greater than methylated bovine serum albumin greater than bead. Esterase staining, spreading on glass, and the percentage of Fc-receptor--bearing macrophages present in the various granulomas reflected the same gradient. The Fc receptors were examined by rosetting with rabbit-antibody--SRBC complex (EA). Whereas more than 90% of the population of macrophages of the dermal adjuvant granuloma contained undiminished numbers of receptor-bearing macrophages throughout the 4 weeks, the percentage of macrophages that displayed receptors in pulmonary foreign-body (40%) and delayed hypersensitivity granulomas (70%) peaked at 1 week and subsequently declined. The EA rosetting of the foreign-body and delayed hypersensitivity granuloma macrophages was strongly inhibited by monomeric IgG2a-specific and weakly by aggregated IgG2b-specific mouse myeloma proteins. Also, macrophages of the delayed hypersensitivity granulomas rosetted in higher percentages with SRBCs coupled with monomeric IgC2a than with those coupled with aggregated IgG2b myeloma proteins. Macrophages of the foreign-body lesion did not react with aggregated IgG2b--SRBC. Rosetting with monomeric IgG2a--SRBC or aggregated IgG2b--SRBC could not be cross-inhibited by the myeloma proteins. Both the monomeric IgG2a--SRBC and aggregated IgG2b--SRBC complexes were readily phagocytized. Trypsin treatment of the macrophages inhibited rosetting with EA or myeloma-protein--coupled SRBCs. The display of Fc receptors on the granuloma macrophages seems to be related to the etiology of the lesion and the intensity and duration of the inflammatory reaction.


The tumoricidal properties of inflammatory tissue macrophages and multinucleate giant cells.

Peritoneal exudate cells from C3H/HeN mice infected with bacille Calmette Guérin (BCG) and subcutaneous inflammatory macrophages from uninfected mice exhibit spontaneous cytotoxicity for tumor cells in vitro, but their tumoricidal activity can be increased by incubation in vitro with lymphokines released by mitogen- or antigen-stimulated lymphocytes. Inflammatory macrophages from these sites are only susceptible to activation in vitro by lymphokines for a short period (less than 4 days) following their initial emigration from the circulation to the site of inflammation. The expression of tumoricidal activity by activated macrophages is similarly short-lived (less than 4 days). Once the tumoricidal state is lost it cannot be restored by further incubation with lymphokines in vitro. Fusion of macrophages to form multinucleate giant cells (MGCs) accompanies the loss of tumoricidal activity and the onset of resistance to activation by lymphokines, but the fusion process is not responsible for these changes, since unfused macrophages are similarly affected. Activation and acquisition of tumoricidal properties is confined to young macrophages recruited from the circulation during acute inflammation. Older macrophages and MGCs in chronic inflammatory lesions in which recruitment of new macrophages has ceased are nontumoricidal and are refractory to activation by lymphokines in vitro. These findings are discussed in relation to the efficiency of macrophage-mediated destruction of tumors in vivo and the amplification of macrophage antitumor activity by immunotherapeutic agents.


Localization of fibronectin within the renal glomerulus and its production by cultured glomerular cells.

Fibronectin was shown in the kidney glomerulus by the use of the peroxidase-labeled antibody technique. At the ultrastructural level, fibronectin was present in greatest quantities along those cell surfaces that abut the capillary basement membrane, especially along the capillary epithelial cell foot process. Intracellular staining was also seen in the glomerulus, most notably in the mesangial cell. Fibronectin was present extracellularly in large amounts in glomerular cell culture and was also demonstrated on the cell membrane and intracellularly.


Psychological costs of bone marrow transplantation in children.

The emotional strain of bone marrow transplantation procedures on child patients, family members and hospital personnel is described, and an illustrative case history is offered. Reasons for the unusually close relationship between family and staff are considered, and the necessity of appropriate psychological support for patients, siblings, parents, and members of the medical team is delineated.


Atheroarteriosclerosis induced by infection with a herpesvirus.

Atheroarteriosclerosis closely resembling that in humans was induced in normocholesterolemic and hypercholesterolemic chickens by infection with Marek's disease herpesvirus (MDV). Four comparably sized groups of chickens were used. Each group was initially fed a diet relatively poor in cholesterol. Group I and II were inoculated intratracheally at 2 days of age with MDV. At 15 weeks, one group of virus-infected chickens (Group II) and one group of uninfected controls (Group IV) were fed a 2% cholesterol supplement for an additional 15 weeks. Group I, infected, and III, uninfected, were continued on a cholesterol-poor diet. All groups were killed at 30 weeks. Striking grossly visible atherosclerotic lesions were seen in large coronary arteries, aortas, and major aortic branches of both Groups I and II but not in those of Groups III and IV. Microscopically, arterial changes in infected animals were characterized by occlusive fibromuscular intimal thickening, which formed fibrous caps overlying areas of atheromatous change. This change closely resembled chronic atherosclerosis in humans. These results may be important to our understanding of human arteriosclerosis, since there is widespread and persistent infection of human populations with as many as five herpesviruses.


Cyclic variation of K+ conductance in pancreatic beta-cells: Ca2+ and voltage dependence.

Pulses of hyperpolarizing current were injected through the microelectrode recording the electrical activity of beta-cells in order to measure input resistance. Increase in resistance during depolarization of the slow oscillation ("burst") indicates inactivation of an outward current, probably K+. Decrease in resistance as the plateau commences suggests that the previous depolarization causes activation of an inward current, probably calcium. The postburst hyperpolarization, caused by a late activation of potassium permeability (PK), would result from the increase of intracellular free calcium. An intracellular buffering system may control this intracellular free calcium level. By restoring the silent phases, in the presence of ouabain or high potassium, injection of hyperpolarizing current shows also a voltage dependency of the PK involved in the postburst hyperpolarization. Glucose, by stimulating intracellular binding of calcium, would cause membrane depolarization at glucose levels below threshold and elongation of the plateau phase at higher concentrations.


Glucose clamp technique: a method for quantifying insulin secretion and resistance.

Methods for the quantification of beta-cell sensitivity to glucose (hyperglycemic clamp technique) and of tissue sensitivity to insulin (euglycemic insulin clamp technique) are described. Hyperglycemic clamp technique. The plasma glucose concentration is acutely raised to 125 mg/dl above basal levels by a priming infusion of glucose. The desired hyperglycemic plateau is subsequently maintained by adjustment of a variable glucose infusion, based on the negative feedback principle. Because the plasma glucose concentration is held constant, the glucose infusion rate is an index of glucose metabolism. Under these conditions of constant hyperglycemia, the plasma insulin response is biphasic with an early burst of insulin release during the first 6 min followed by a gradually progressive increase in plasma insulin concentration. Euglycemic insulin clamp technique. The plasma insulin concentration is acutely raised and maintained at approximately 100 muU/ml by a prime-continuous infusion of insulin. The plasma glucose concentration is held constant at basal levels by a variable glucose infusion using the negative feedback principle. Under these steady-state conditions of euglycemia, the glucose infusion rate equals glucose uptake by all the tissues in the body and is therefore a measure of tissue sensitivity to exogenous insulin.


Vasodilation of cat cerebral arterioles by prostaglandins D2, E2, G2, and I2.

To determine the possible role that endogenously produced prostaglandins may play in the regulation of cerebral blood flow, the responses of cerebral precapillary vessels to prostaglandins (PG) D2, E2, G2, and I2 (8.1 X 10(-8) to 2.7 X 10(-5) M) were studied in cats equipped with cranial windows for direct observation of the microvasculature. Local application of PGs induced a dose-dependent dilation of large (greater than or equal to 100 microns) and small (less than 100 microns) arterioles with no effect on arterial blood pressure. The relative vasodilator potency was PGG2 greater than PGE2 greater than PGI2 greater than PGD2. With all PGs, except D2, the percent dilation of small arterioles was greater than the dilation of large arterioles. After application of prostaglandins in a concentration of 2.7 X 10(-5) M, the mean +/- standard error of the percent dilation of large and small arterioles was, respectively, 47.6 +/- 2.7 and 65.3 +/- 6.1 for G2, 34.1 +/- 2.0, and 53.6 +/- 5.5 for E2, 25.4 +/- 1.8, and 40.2 +/- 4.6 for I2, and 20.3 +/- 2.5 and 11.0 +/- 2.2 for D2. Because brain arterioles are strongly responsive to prostaglandins and the brain can synthesize prostaglandins from its large endogenous pool of prostaglandin precursor, prostaglandins may be important mediators of changes in cerebral blood flow under normal and abnormal conditions.


A method of intrarenal blood flow measurement using xenon-133 in the intact rat.

A method is described for measuring distribution of intrarenal blood flow in anesthetized rats by a xenon-133 washout technique that avoids the trauma of opening the abdominal cavity and manipulating the kidney. Precise delivery of the tracer to the kidney and fine collimation of the radiation reduces the amount of tracer required. Washout curve analysis is achieved by a multifit computer program that accepts only count rates and time as input data.


The apprenticeship of Philippe Pinel: a new document, "observations of Citizen Pussin on the insane".

Philippe Pinel is usually pictured in histories of psychiatry and of medicine as the man who first liberated the insane from their chains. The document presented here, discovered in 1978 in the Archives nationales in Paris, reveals the crucial role of Jean-Baptiste Pussin, the "governor" of mental patients at Bicêtre. It was Pussin who initiated Pinel to psychological methods (the famous traitement moral) in dealing with hospitalized mental patients. Further, in 1797, Pussin first replaced chains with straitjackets. Pinel later obtained Pussin's transfer to the Salpêtrière to help him reorganize that huge hospital.


Philosophical foundations of French and U.S. nosology.

The author examines the philosophical foundations of French and American nosology with a view toward understanding the relatively minor influence of French psychiatry in America. Despite the excellence of its descriptive psychiatry, much of French nosological writing is based on philosophical viewpoints that are antithetical to the empirical and pragmatic traditions of American psychiatry. French nosology, which is closely involved with the metaphysical issues of existentialism, phenomenalism, and structuralism, reveals these interests in language and concepts that do not easily permit its hypotheses to be scientifically tested, a prerequisite for any American classification.


Women in midlife: decisions, rewards, and conflicts related to work and careers.

The author discusses the role of an occupation in the psychic economy of women in midlife and the diagnostic and therapeutic function of attention to work-related issues. Clinical examples are grouped according to commonly encountered patterns as these result from prevous developmental choices and as they show some of the possible repercussions during the middle years. In psychotherapy with midlife women it is important to address work-related issues in terms of the interplay among previous development, age-specific factors, and social realities and changes as well as neurotic factors.


The comparative efficacy of buspirone and diazepam in the treatment of anxiety.

In this double-blind study, 56 adult psychoneurotic outpatients with a primary diagnosis of anxiety neurosis were randomly assigned to receive buspirone (N = 18), diazepam (N = 20), or placebo (N = 18) over a four-week period. A battery of tests administered weekly indicated that buspirone, a new agent not chemically related to any currently marketed drugs, was as effective an antianxiety agent as diazepam and produced no more and perhaps fewer side effects. Buspirone showed excellent antidepressant effects as well. If further studies confirm the authors' findings and determine that buspirone does not result in tolerance and addiction, it would be more advantageous than the benzodiazepines in the treatment of anxiety.


The health impact of restricting public funds for abortion. October 10, 1977--June 10, 1978.

The Center for Disease Control (CDC), Atlanta, Georgia implemented an eight-month prospective surveillance system in 24 hospitals distributed among states with and without public funding for abortion. Out of 3,157 visits for abortion-related complications, only 10 women gave a history of non-physician or self-induced abortion and none were Medicaid recipients. The small number of hospitals located in non-funded states and the smaller numbers of women served in these hospitals than in the funded states limited the power of out study. Women living along the Texas-Mexico border appeared more likely to have complications after illegal abortions than women from other areas of the country.


Shotgun arterial injuries of the extremities.

Even though shotgun injuries are often grouped with gunshot wounds, the former are ballistically and clinically far different from gunshot wounds. Two groups of patients with shotgun and gunshot wounds of the extremities, respectively, were compared with regard to clinical features. Although the vascular wound was the most dramatic aspect in both groups of patients, associated injuries, especially to the nerves and bones, played a significant role in the ultimate rehabilitation of the patients with shotgun wounds. Shotgun injuries more frequently required the use of saphenous vein grafts than did gunshot wounds. The infection and amputation rates were much higher in patients with shotgun wounds than in those with gunshot wounds. Patients with shotgun injuries of the extremities often required secondary reconstructive procedures such as tendon transfer or bone and joint fusion. Despite these measures the outlook for the ultimate rehabilitation of the extremity after shotgun injury was dismal, whereas after gunshot wounds complete rehabilitation was the rule.


Osteoradionecrosis of the thoracic wall and its surgical management.

Four patients with disabling radiation defects of the chest involving skeletal and soft tissues were successfully treated with a one stage breast flap. Closure of the defect resulted after an uncomplicated and safe operation. Safety and reduced morbidity are hallmarks of the breast flap repair for this difficult problem. Although alternative methods can be used, the preparation of staged flaps and postoperative problems in major myocutaneous flaps increase the risk of such therapy and the hospital stay for these elderly, debilitated patients. The low morbidity of this one stage flap with a minimal hospital stay make this treatment a very viable and appealing alternative for patients whose long-term prognosis is exceedingly poor.


Penicillin hypersensitivity. Determination and classification of anti-penicillin antibodies by the enzyme-linked immunosorbent assay.

An enzyme-linked immunosorbent assay for the detection of anti-pencillin antibodies of the several Ig classes is described. The results of the ELISA in 350 sera of patients suspected of penicillin hypersensitivity are compared with those of the haemagglutination test. In 105 sera penicillin-specific IgM and/or IgG was demonstrated with the ELISA, the HA test being positive in 49 of these 105 sera. However , in another 14 sera IgM anti-penicillin antibodies could be shown only with the HA. In 10 sera penicillin-specific IgE was demonstrated with the ELISA, only four of these being also positive with the RAST. IgE was always found in combination with IgG and/or IgM. The positive correlation of the ELISA and the RAST with the intracutaneous test on penicillolypolylysine was 26.9% and 15.4% respectively. The ELISA is a simple and reproducible method for the detection of anti-penicillin antibodies, being more sensitive than the HA and the RAST.


Clinical and biochemical evaluations of premedicants. A double-blind assessment of clobazam, a new 1,5 benzodiazepine.

Clobazam is a new 1,5 benzodiazepine which differs from the 1,4 benzodiazepines such as diazepam, in that it displays a wide separation of its tranquillising or anxiolytic effects from impairment of cortical arousal and psychomotor performance. Its potential advantages as a premedicant for day-case or outpatient surgery were evaluated in a placebo-controlled double-blind study in female patients undergoing minor day surgery. Anxiety reduction was evaluated clinically and by means of plasma cortisol estimations. The clinical evaluation, using an established portocol, did not differentiate either active drug from placebo or between the active drugs; the cortisol results permitted opposing conclusions depending on the statistical approach used. Potential fallacies inherent in the methodology current used for evaluating premedicant drugs are discussed.


Atropine and hyoscine.

The drugs atropine and hyoscine are reviewed in the context of their use by anaesthetists. The results of recent studies are stressed and guidelines given for use of these drugs in modern anaesthetic practice.


Morphology of experimental spina bifida in the chick embryo.

Open malformations of the central nervous system may involve the brain or spinal cord, or both. Preliminary experiments in which a window was cut in the shell overlying early chick embryos (with removal of 2 ml of albumen) produced a range of neural and non-neural malformations. Exposure of Stage 5--10 embryos at 26 hours of incubation produced open brain and cord defects. Embryos were recovered at 11--12 days for gross examination. Open cord defects in 12 day experimental embryos could be divided morphologically into 2 types. One group showed an everted symmetrical plaque of neural tissue. In the other group the cord defect was more irregular, partly covered by skin, and often combined with rump and trunk defects. Skeletal staining showed that vertebral lesions increased in severity in a cranio-caudal sequence. Spina bifida occulta was found in the cervical and upper thoracic regions; spina bifida manifesta, associated with open cord defects, occurred from the lower thoracic to the sacral regions; vertebral deletions were almost confined to the caudal region. Spina bifida manifesta at the site of open cord defects also showed 2 distinct patterns. Regular cord defects were associated with regular spinal defects, showing loss of spinous processes, reduction of laminae and eversion of the pedicles. Irregular cord defects were associated with more irregular spinal defects showing vertebral deletions or fusions, rumplessness, and pelvic reduction. Neither group, however, showed local kyphosis or scoliosis. Early neurogenesis in the avian and human embryos is very similar with development of the spinal cord from neural plate and tail bud materials which fuse in an overlap zone. These experimental defects in the chick embryo, separable into regular and irregular types thus provide a useful model for investigation of the embryogenesis of spina bifida.


Mitochondrion-secretory granules complexes in pancreatic islet B-cells.

Mitochondrion-Secretory Granule Complexes (MSGC) are present in rodent pancreatic islet B-cells, characteristically showing fusion of mitochondria and secretory granules, absence of granule membrane and external mitochondrial membrane at place of contact, often invagination of internal mitochondrial membrane at place of contact forming an electron lucent space directly continuous with the "halo" of the secretory granules, and occurrence of potassium pyroantimonate precipitates in either or both of mitochondria and secretory granules. The MSGC are believed to possess functional significance, possibly playing a role in translocation of ions between mitochondria and secretory granules in the B-cells.


Development of T and B cell areas in peripheral lymphoid organs of the rat.

In the present study the early development of peripheral lymphoid organs (spleen, popliteal lymph node, mesenteric lymph node and Peyer's patches) is described in terms of homing patterns of T and B cells, demonstrated with immunohistoperoxidatic detection of characteristic membrane antigen in normal rats and with routine histology in neonatally thymectomized rats. In the first days after birth the peripheral lymphoid organs are almost exclusively populated by T cells. After neonatal thymectomy lymphocytes appear in the dome areas of Peyer's patches from four to six days after birth, in mesenteric and popliteal lymph nodes lymphocytes are found in the outer cortex from day 6 and day 8 respectively and in the marginal zone of the spleen from eight days onwards. These lymphocytes showed no membrane staining when reacted for T antigen with immunohistoperoxidatic techniques. The morphological evidence for considering Peyer's patches of rats as central inductive sites for the generation of B cells is poor. The discrepancy in the order of appearance of T and B cell (sub)populations in spleen compartments in normal ontogenetic development and lethally irradiated, stem cell reconstituted animals is discussed.


Structure of Retzius lines in partially demineralized human enamel.

Human third molars were partially demineralized in an acid-alcohol solution and embedded in Epon 812. Six-micron sections were cut from regions of the cervical enamel exhibiting prominent Retzius lines. The plastic was removed from the specimens by microincineration and were examined with the scanning electron microscope. The most prominent structural feature seen along the Retzius lines was the cervical translocation of some of the prisms. The scanning electron microscopic images also suggested that prisms were translocating in the transverse plane of the tooth. A series of pores, which appeared to be empty, were observed in association with the translocations occurring along the Retzius lines.


Comparison of anesthesia with diazepam and ketamine vs. morphine in patients undergoing heart-valve replacement.

Because of its analgesic and amnesic effects, ketamine has potential advantages as a primary agent for patients undergoing open-heart surgery. However, the undesirable positive inotropic and chronotropic effects associated with ketamine have deterred its use. Diazepam pretreatment appears to block these unwanted effects. Sixteen randomly selected patients were given a combination of diazepam, 0.4 mg/kg, followed by ketamine, 2 mg/kg, and nitrous oxide, 50%. The authors compared the circulatory responses to induction, intubation, and operation with those obtained in a matched group of patients who received morphine, 3 mg/kg, and nitrous oxide, 50%. All patients underwent mitral- or aortic-valve replacement. Circulatory responses were not significantly different between the two groups. In both groups, heart rate, mean arterial blood pressure, and rate-pressure product increased significantly with intubation of the trachea, incision of the skin, and sternotomy. The incidences of hypertension, hypotension, and arrhythmias, and the need for inotropic drugs were not significantly different between the two groups. No intraoperative awareness occurred in either group. It is concluded that diazepam-ketamine anesthesia is a satisfactory alternative to morphine anesthesia for patient undergoing heart-valve replacement.


Immuno-enzymatic study of IgG subclasses specific for allergen in house dust immediate hypersensitivity.

Investigation of the serum-specific IgE by the RAST technique and of the four specific subclasses of IgG in house dust allergy by an immuno-enzymatic assay was made among healthy control subjects, non-treated atopic patients and hyposensitized patients. There was evidence that the titer of specific IgE remains high in the treated patients regardless of their improvement or non-improvement clinically. A good prognostic significance, however, correlates with a low specific IgG4 titer in the serum, but the pathogenic significance of IgG4 cannot be determined until these immunoglobulins can be studied on the membrances of circulating basophils of hyposensitized patients.


Indirect fluorescent antibody test in occult dirofilariasis.

Indirect fluorescent antibody titers to Dirofilaria immitis microfilaria (IFA-mf) and peripheral eosinophilia were recorded from 15 to 52 months in ten experimentally infected dogs with occult dirofilariasis (heartworm infection without microfilaremia). Five dogs which were experimentally sensitized with D immitis microfilaria did not exhibit microfilaremia after inoculation with infective-stage larvae. In three other dogs, microfilaremia suddenly ceased after 4 to 7 months. In these three dogs, antimicrofilarial antibodies were detectable by IFA-mf test as soon as microfilaremia ended. In the remaining two dogs, which exhibited spontaneous occult dirofilariasis, antibodies were detected at the end of the prepatent period of 6 months. The presence of adult worms was confirmed by angiocardiography. Significant IFA=mf titers (greater than or equal to 1:8) persisted after successful treatment with an adulticide. Reinfection of treated dogs reestablished occult dirofilarasis. Eosinophilia was present in all dogs and peaked at about 3, 6, and 9 months after they were inoculated with infective-stage larvae. At necropsy, the ten dogs harbored gravid, reproducing adult worms in the heart and pulmonary arteries.


A rapid and simplified technique for the assay of chicken hemolytic complement.

The technique described is a modification of a qualitative hemolytic radial diffusion technique. The test involves the use of sensitized sheep erythrocytes that have been incorporated into agarose. Tube dilutions were made of chicken serum and samples of each dilution were placed into wells cut in the agarose. The test is quantitative for hemolytic complement in that the highest dilution showing visible hemolysis of sensitized erythrocytes in agarose is determined to be the endpoint for that serum sample. The test as compared with the standard tube assay was determined to be less sensitive by approximately one dilution. The advantages of speed, simplicity, and cost more than offset the decrease in sensitivity of the test.


Cyclic release of luteinizing hormone and the effects of luteinizing hormone-releasing hormone injection in Asiatic elephants.

Cyclic changes in serum concentration of luteinizing hormone (LH) were observed throughout the estrous cycle of Asiatic elephants (Elephas maximus). The increase in serum LH was correlated with a slight increase in serum estradiol concentration and the onset of behavioral heat (willingness to mate). In a second series of studies, injection of luteinizing hormone-releasing hormone after 3 days of estrone administration induced an increase in serum LH. These studies indicate that the Asiatic elephant exhibits a cyclic LH release that can be experimentally induced by estrone and luteinizing hormone-releasing hormone administration.


Potentiation of lymphocyte mitogenic responses to concanavalin A by antigen-activated peripheral blood monocytes.

Purified protein derivative (PPD)-stimulated monocytes derived from Mycobacterium bovis-sensitized cattle significantly potentiated lymphocyte mitogenic responses to concanavalin A (conA), as measured by incorporation of [3H] thymidine into cellular DNA. Monocytes were cultured for 24 hours in the presence of PPD, washed thoroughly, and mixed with purified lymphocytes; various doses of conA were added to these cultures, and the cultures were incubated for 4 days and assayed for DNA synthesis. The lymphocyte mitogenic responses to suboptimal, buy not optimal, doses of conA were significantly enhanced by the presence of PPD-activated monocytes from M bovis-sensitized cattle. Treatment nonsensitized cattle with PPD did not result in any significant enhancement of conA-induced lymphocyte mitogenic responses at any dose of conA tested.


Endotoxin absorption in hay-fed and lactic acidotic sheep.

Absorption of endotoxin from the gastrointestinal tract was evaluated in hay-fed and lactic acidotic sheep duodenally infused with 10 mg of Escherichia coli endotoxin, and in lactic acidotic sheep not infused. The effect of abomasal fluid on biological activity of endotoxin was also evaluated. Leukopenia was the criterion used for detecting endotoxemia. Absorption of endotoxin from the gastrointestinal tract was not detected in either hay-fed or lactic acidotic sheep. Endotoxin appeared to maintain its activity after incubation with abomasal fluid, and the presence of endogenous endotoxin in abomasal contents was indicated. The results indicate that endotoxin of alimentary origin may not be involved in the lactic acidosis syndrome in ruminants.


Transmissible antibiotic resistance in Salmonella isolated from random-source cats purchased for use in research.

Salmonella isolates from random-source cats designated for use in research were examined for antibiotic susceptibilities and the presence of plasmids containing R factors. The serotypes studied were Salmonella derby, S typhimurium, S anatum, S enteritidis, and S bredeney. Eighty percent of the isolates were resistant to one or more antibiotics. The greatest frequency of resistance was to streptomycin. The majority of the salmonella isolates transferred all or a part of their antibiotic resistance to an Escherichia coli K-12 recipient. Thermosensitive R factors were found in two S typhimurium isolates.


Genetic heterogeneity of hyperpepsinogenemic I and normopepsinogenemic I duodenal ulcer disease.

In a search for a genetic marker of duodenal ulcer, we measured serum pepsinogen I levels in 168 ulcer patients and 151 of their clinically normal siblings. The ulcer patients tended to have either hyperpepsinogenemia I (pepsinogen I, greater than or equal to 100 ng/mL) or a normal level on a familial basis. Further evidence supporting this separation was the finding that the mean serum pepsinogen I level in the clinically normal siblings of the hyperpepsinogenemic patients was 91.2 ng/mL, significantly higher than the mean level (63.1 ng/mL) in the normal siblings of the normopepsinogenemic I patients. In the hyperpepsinogenemic I families the results of segregation analysis of an elevated pepsinogen I were consistent with autosomal-dominant inheritance of this trait. The genetic basis of normopepsinogenemic I duodenal ulcer was also shown by the familial aggregation of this disorder. These data provide direct evidence for genetic heterogeneity of duodenal ulcer disease.


A familial occurrence of allergic bronchopulmonary aspergillosis.

A family was recently studied in which two brothers with identical HLA serotypes had allergic bronchopulmonary aspergillosis. One of the two had a normal bronchogram. A field investigation of the family residence showed that a barn was the probable source of the organism causing disease in these patients. Immunologic characterization of the family members showed a broad spectrum of response to the environmental exposure.


Circulating immune complexes in pulmonary eosinophilic granuloma.

We analyzed serum from six patients with pulmonary eosinophilic granuloma for the presence of circulating immune complexes. These levels were correlated with the pulmonary histopathology and immunofluorescence findings. Levels of circulating immune complexes were elevated in five subjects. All of the subjects had an active cellular histology. Immunofluorescent studies showed granular deposits of IgG and complement (C3) in alveolar walls and blood vessels in all five patients. One subject had no detectable circulating immune complexes and showed a predominantly fibrotic pattern by light microscopy. In addition, immunofluorescence in this patient also showed no immunoglobulin or complement deposition within the lung tissue. These findings show that circulating immune complexlike activity is present in patients with cellular disease and suggest that their formation or deposition, or both, may contribute to the pathogenesis of pulmonary eosinophilic granuloma.


Trimethoprim-sulfamethoxazole in the United States.

After approximately 5 years of clinical use in Great Britain and other European countries, trimethoprim-sulfamethoxazole in fixed-dose combination was introduced into the United States in 1973. As a result of sequential blockade in the biosynthesis of tetrahydrofolic acid, the antimicrobial activity of the combination exceeds that of either agent alone. Although the drug is approved for use in only chronic urinary-tract infection, otitis media, shigellosis, and Pneumocystis carinii pneumonia, many experimental clinical trials suggest that this agent may be useful in a number of other infectious disorders. Trimethoprim-sulfamethoxazole is generally well tolerated even with long-term administration, but its potential for hematologic toxicity and nephrotoxicity must be monitored.


UCLA conference. Circulating immune complexes: their immunochemistry, detection, and importance.

The size and molecular composition of circulating immune complexes depend on various factors, including the concentrations and valences of antigens and antibodies and the antigen-antibody ratio. The composition and biological properties of circulating immune complexes, in turn, influence their fate in vivo as well as the likelihood of their detection by various assays. Several assays clearly detect circulating immune complexes, but no single assay has yet been shown to be the most sensitive and the most specific for the entire spectrum of circulating immune complexes. Assays correlate poorly with each other, but this may be desirable if we are to determine which circulating immune complexes have diagnostic, prognostic, or pathogenic importance. Circulating immune complexes are found in numerous rheumatologic disorders and infectious diseases. Their presence in the circulation statistically correlates with disease activity; however, the assays currently used have limited value for diagnosing or aiding in therapeutic decisions. Nevertheless, the future holds promise for such uses.


Coronary artery spasm.

Coronary artery spasm is an important pathogenetic mechanism in some forms of myocardial ischemic disease. Factors that may be important in the genesis of spasm include the autonomic nervous system, prostaglandins, endoperoxides, thromboxanes, and the calcium availability to the contractile apparatus. Spasm results in myocardial ischemia with attendant chest pain and electrocardiographic and hemodynamic changes; it is the primary pathogenetic mechanism in Prinzmetal's variant angina and has been found in association with classic angina pectoris and acute myocardial infarction. Diagnosis of coronary artery spasm is firmly made only by coronary angiography. Treatment includes the use of both short- and long-acting nitrates and the slow-channel blocking agents such as verapamil, nifedipine, and perhexiline.


Interferons: rationale for clinical trials in neoplastic disease.

Interferons, cell glycoproteins synthesized in response to viral infections and various nonviral inducers, have proved therapeutically effective for viral infections in experimental models and in humans. Current evidence suggests interferons may also prove effective as antitumor agents in humans. Potent effects on cellular function result from interferons. Cell surface structure and enzyme levels are altered. Immunologic responses thought to be important in tumor immunity are augmented. Interferons have antiproliferative effects on the replication of normal and neoplastic cells. Interferons are effective in animals against tumors of both viral and nonviral origin. Clinical trials in cancer have been limited by the availability and cost of human interferons. However, results in small numbers of patients have been encouraging. This paper review experimental and clinical findings regarding the rationale for use of interferons in neoplastic disease.


Loss of plasmid-mediated resistance after conversion of a group B streptococcus strain to a stable cell wall deficient variant.

A group B streptococcus strain carrying plasmid DNA determining resistance to several drugs was converted by penicillin to cell wall (CW) defective and then to CW deficient variants (L-forms). The stable CW deficient variants became susceptible to antibiotics in study. Dye-buoyant density analysis of the DNA of CW deficient variants showed that the loss of antibiotic resistance was associated with the loss of extrachromosomal DNA.


[Gas-liquid chromatography of non-volatile fatty acid produced by "Yersinia enterocolitica" (author's transl)].

The metabolic products (non-volatile fatty acids) of 24 strains belonging to four Yersinia enterocolitica groups (typical, sucrose negative, rhamnose positive, melibiose and rhamnose positive) were examined by gas liquid chromatography. All strains produced lactic, pyruvic and succinic acids. This technique did not allow any classification for taxonomic purpose. The evolution of lactic and succinic acid production was monitored for 72 h in shaked and non-shaked cultures. The concentration of both acids increased in the first 24 h, then decreased and increased again after 38 h. Shaked culture produced a lesser amount of lactic acid than did non-shaked culture. Only traces of succinic acid were detected in shaked culture. The quantities of metabolic products of the four strains grown in five media were significantly different. These observations suggest that the composition of the medium, the bacterial growth, inoculum size, incubation technique and the incubation time are important factors in metabolic production by aeroanerobic bacteria. Only constant results in the face of such varying factors could be of taxonomic value.


Immunogenic complexes obtained from Salmonella typhi-murium and Salmonella typhi Ty2 by the bacterial acetone powder method.

An immunogenic complex was isolated from Salmonella typhi-murium and another one from Salmonella typhi Ty2. Both were prepared by the bacterial acetone powder method which eliminated the cell wall, the DNA almost completely and the membrane phospholipids. The complexes were denominated "New Vaccines". The S. typhi-murium new vaccine induced, even at doses of 0.5 microgram dry weight per mouse, a high degree of protection against the challenge of the virulent microorganism. By immunoelectrophoresis, 21 antigen-antibody systems could be detected, two of them corresponding to O antigens. The S. typhi Ty2 new vaccine induced better protection than the standard vaccine (heat-phenol inactivated typhoid vaccine) when both vaccines were compared in the relative potency test. Moreover, the new vaccine had very low toxicity when inoculated in humans at doses of 1 microgram dry weight, able to elicite a high antibody titre (1/1,790 mean of 10 sera) in 75% of the tested population, estimated by the complement fixation test. In contrast, the standard vaccine induced a low antibody titre (1/222, mean of 5 sera) in 50% of the humans inoculated with 1 X 10(8) bacterial cells. The new vaccine did not induce undesirable effects whereas the standard vaccine induced an important inflammatory process in 100% of the cases, with intense local pain in 67% after 24 h post-first inoculation as well as other less severe symptoms.


Interaction of Mycobacterium leprae and mycobacteriophage D29.

This study of the interaction between Mycobacterium leprae and the mycobacteriophage D29 showed that the viruses caused a patchy damage of cell wall structure and the accumulation in the host of internal crystalline structures. Whether the observed ultrastructural alterations were caused by the replication of D29 was not clear. Mitomycin C also caused the accumulation of crystalline structures in M. leprae.


[Fate of orally administered antibiotic sensitive "Escherichia coli" in the intestine of the newborn (author's transl)].

In an intensive care unit, 14 newborns, without antibiotic intake, received orally 1 ml of culture broth from an antibiotic-sensitive strain of Escherichia coli marked with resistance to sodium azide. The purpose was to study the fate of the E. coli administered and to determine whether an interaction was obtained between that strain and antibiotic-resistant enterobacteria in the gut flora. In 3 infants the strain administered developed and was the only enterobacterium excreted during the first week; in 4 others the strain was recovered during one week or more, in quantities greater than 10(6)/g of stools. In 6 others, the strain appeared for less than one week, and/or in quantity less than 10(6)/g of stools. In 1 child the strain could not be recovered at all. These data show what is obtained in "holoxenic" newborns in spite of challenge with many other bacteria. They have been obtained with an ubiquitus E. coli and can be used as a control for further studies.


Animal obesities.

Genetically or experimentally-produced (e.g. via lesions of the hypothalamus) obese animals have several common features such as increased hepatic lipogenesis (resulting in fat infiltration) and increased hepatic lipoprotein secretion, together, with increased adipose tissue lipogenesis. These abnormalities appear to be related primarily to hyperinsulinemia as they are reversed to or toward normal when hyperinsulinemia is corrected or, conversely, as they develop concomitantly with hyperinsulinemia. In the liver (ob/ob mice), another defect can be demonstrated, i.e. a decreased hepatic insulin clearance. This defect is also related to hyperinsulinemia and is markedly reduced upon normalizing hyperinsulinemia of obese mice. Hyperinsulinemia may thus be a key feature of the obesity syndromes, and bring about most of the abnormalities noted, including the subsequent state of insulin resistance known to exist in obese animals. The etiology of hyperinsulinemia of genetically obese animals is still unknown. Among the possible mechanisms one should cite possible primary dysfunction of the pancreas, possible primary dysregulation, by the hypothalamus, of overall endocrine pancreas activity.


Beta-lipotropin precursor of beta-MSH and beta-endorphin.

The molecule beta-lipotropin, composed of 91 amino acids (beta-LPH 1-91) has gained considerable importance in recent years. Its double role as the precursor of beta-MSH (beta-LPH 41-58) and beta-endorphin (beta-LPH 61-91) makes this peptide unique in its kind. Results are presented on the role of this molecule and on the complete characterization of two morphine-like peptides from human and sheep pituitaries. The structure-activity relationship of opiate activity is analyzed by scanning for this biological activity of many tryptic and CNBr fragments of beta-lipotropin. The unequivocal localization of one of the important synthesis sites of beta-endorphin in the pituitary neurointermediate lobe is presented. A peptide with partial sequence Met1, Leu8,15 and Lys6,11, 27, 29, 33 has been biosynthesized in large quantities and its ubiquitous nature and conservation of sequence speaks for its importance and possible presence in many living cells. This polypeptide was subsequently identified as ubiquitin, a non-histone fragment of the nuclear protein A-24.


[The problem of "Duhring-Brocq's" disease in children (author's transl)].

Inquiry in the french dermatological main centers and a survey of the literature suggest that the once described as Duhring-Brocq disease in children, may refer to three distinct bullous diseases. Taking in account clinical features, photon and electron-microscopical data, investigation for basement membrane antibodies, search for intestinal villous atrophy, effectiveness of dapsone or sulfapyridine, it is indeed possible to distinguish:1) bullous pemphigoid (very rarely); 2) dermatitis herpetiformis (not frequently), those two affections being similar to adult forms; 3) benign chronic bullous dermatitis of childhood. This last child specific disease, is the most frequently observed. Its clinical features are comparable to pemphigoids, but histopathology and immunology data are different. Its response to dapsone of sulfapyridine and to free gluten diet is note perfect and not constant, but its evolution is spontaneously favorable after a few years.


[Cell cycle time of normal epidermis, psoriasis and some epidermal tumors (author's transl)].

Cell kinetic of human epidermis has been studied with different techniques of labeling by 3H-thymidine. A review of the literature for human epidermis, psoriasis and some epidermal tumors has been performed and discussed in the light of our own studies. If the cell cycle time seems to be slightly shorter in epidermal tumors in comparison to normal epidermis, this doesn't constitute the fundamental characteristic of the neoplastic lesions. Indeed the most specific alteration in the cell cycle parameters for precancerous and cancerous tissue is a lengthening of the S phase duration. This modification of the DNA synthesis time is perhaps of reflection of the depressed state of the chromatin of neoplastic tissues.


Fifth Daniel C. Baker Jr. Memorial Lecture. Resident education: past, present and to where.

The specialties in medicine and surgery developed slowly during the later 19th century and the early decades of this century. The American boards were the focal points for sponsoring specialty societies through which these developments occurred. The resident review committees have also played an important role. Otolaryngology resident education has developed into a progressively structured educational experience so that presently otolaryngology resident education is a broad experience in head and neck oncology, plastic and reconstructive surgery, otology, laryngology, rhinology, allergy and immunology, bronchoesophagology, teaching and research. Resident education is not static. The year of 1978 can be noted as the year of change, for the Resident Review Committee in Otolaryngology recommended that resident education be of five years in duration, one year being in surgery, three years in otolaryngology and one year being elective as to content. Such programming can be highly structured to meet a candidate's present and future needs in manpower, superspecialization and general otolaryngology. In this system superspecialization can and will be recognized and awarded through channels already established in otolaryngology. Manpower and general otolaryngology will also profit.


The aetiology of colonic suture-line recurrence.

Cell viability studies have been performed on human desquamated colonic cancer cells obtained by both in-vivo and ex-vivo techniques, and on desquamated colonic cancer cells from an experimental animal model. There was no evidence of cell viability and I conclude that the hypothesis that suture-line recurrence occurs as a result of the implantation of desquamated tumour cells is of questionable validity. Field change in the colonic mucosa has been studied by examining the reactions of the mucosubstances in the goblet cells. A potential correlation between transitional mucosa at the anastomosis and the development of suture-line recurrence was found and warrants further study. The clinical problem has been investigated by the clinicopathological study of 16 patients developing suture-line recurrence in an attempt to discern the aetiology of each. In all but one the recurrence was due to incomplete excision of cancer or, in one instance, a second primary growth.


Transposition of muscle flaps for covering exposed bone in the leg.

A muscle transposition technique for reconstruction of soft tissue loss and skin defects with exposed bone in the leg is described. Reconstruction with muscle flaps and freee skin grafts is a reliable and convenient one-stage operation. The gastrocnemius and soleus muscles were used to cover the upper and middle third of the leg. The method was used in 13 patients, and there were 3 failures in the series because of the impaired vascularity of the injuried leg. In 7 cases, including one failure, the soft tissue injury was associated with compound fractures. No functional disability was observed in the leg, ankle or foot after successful transposition of the muscle flap.


[Diagnosis of strongyloidiasis using the E.L.I.S.A. test (author's transl)].

An immunoenzymatic test, the E.L.I.S.A. test is used to diagnose human Strongyloidiasis. First results show that this reaction can complete other investigational methods already in use to diagnose this affection, i.e. coproanalysis and intradermal reactions, both in epidemiological studies and individual cases. In addition, the test is a good means of assessing the effectiveness of treatment.


Tracheo-arterial erosion complicating tracheostomy.

Tracheo-arterial erosion occurred in 5 cases out of 816 tracheostomized patients, i.e. an incidence of 0.6%. The complication is serious and is nearly always fatal. In one case, treatment was successful, but the other four patients died as a result of massive haemorrhage. On the basis of these cases the factors leading to this complication and the possibilities of treatment are discussed. In one case the main cause of innominate artery erosion was the low lying tracheostomy. This patient was rapidly resuscitated, the blood volume was restored, bleeding controlled by direct finger pressure on the innominate artery and an emergency operation was performed immediately. The innominate artery was excluded from circulation and bypassed with an autogenous venous graft. The patient recovered and is doing well after a follow-up of two and half years.