Effects of endotracheal tube leaks on functional residual capacity determination in intubated neonates.

The present study evaluates a new closed circuit helium (He) dilution technique for determination of endotracheal (ET) tube leakage and functional residual capacity (FRC) in neonates with ET tubes. By analytically relating the fall in He concentration due to mixing with that due to leakage, it is possible to predict the final equilibration concentration of He and, therefore, correct for ET tube leaks. The system (120 ml) contains an air pump, He meter, breathing bag in cyclinder, a strip chart readout, and solenoid valve. Continuous positive airway pressure (CPAP) or ventilator pressure can be applied during testing. FRC measurements were performed on 13 neonates (799--4500 g) on CPAP with ET tubes. Leak rates were significantly higher (P less than 0.001) on 3 cm H2O CPAP compared to O cm H2O CPAP. The mean measured FRC was 53.5 ml at 3 cm H2O and 46.3 ml at 0 cm H2O CPAP. If gas leakage had not been considered in FRC calculations, the error in FRC could have been as high as 39% at 3 cm H2O CPAP and 18% at 0 cm H2O CPAP.


Inhibition by indomethacin of the renal response to an acute saline load in the dog.

The kidneys of sodium-loaded dogs, treated by indomethacin before their transplantation to the neck vessels of sodium-depleted animals, lose their ability to increase the fractional excretion of sodium following an intravenous infusion of saline; they behave similarly to the kidneys of sodium-depleted dogs. Moreover, they become unable to potentiate the response of the kidneys of the sodium-depleted perfusors. The experimental conditions exclude a direct effect of the drug eo ipso. The results indicate that renal prostaglandins are involved in the adjustment of the renal response to saline loading, depending on the previous dietary sodium balance, and that they are related with the potentiating factors released into the blood by the kidneys of sodium-loaded animals.


Influence of calcium and ionophore 23187 on tubular phosphate reabsorption.

In previous studies it has been demonstrated that a decline of plasma calcium concentration accounts for the decrease of phosphate reabsorption in thyroparathyroidectomized (TPTX) rats undergoing phosphate loading. Microinfusion studies were performed in TPTX rats in order to discriminate between a systemic effect of calcium an a direct renal effect. Thyroparathyroidectomized animals were infused with a phosphate solution continuously. When plasma calcium concentration fell below 1.30 mmol/l, proximal convoluted tubules were microinfused with a phosphate tracer solution for 42 min. After 18 min a calcium chloride-containing solution was applied superficially (superfused) to the area of the microinfused tubule. This elevation of peritubular calcium concentration led to an immediate increase of phosphate reabsorption up to 12% of the microinfused phosphate load within 24 min. In another series of experiments, the calcium specific ionophore A23187--a substance which is known to increase intracellular calcium--was superfused on the microinfused tubule. This resulted again in an increase of fractional phosphate reabsorption of about 15% after 24 min. In contrast, when calcium chloride-free as well as ionophore-free solutions were superfused fractional phosphate reabsorption decreased (7%). From these data we conclude that 1. calcium has a direct renal effect on phosphate reabsorption in the absence of parathyroid hormone and 2. intracellular calcium appears to be a major parameter in the regulation of renal phosphate transport under these conditions.


A fiberoptic reflection densitometer with cardiac output calculator.

A catheter-tip densitometer for indocyanine green is described consisting of a cardiac catheter containing optical fibers, an incandescent light source, a light detection unit and a processing unit. Half of the optical fibers guide the light to the blood at the tip of the catheter, the other half the back-scattered (reflected) light to the detection unit. In the detection unit the light is measured by two silicium barrier layer photocells after it has been split into two beams by a beam splitter. In the measuring channel the light passes an 800 nm filter before reaching the photocell. When fiberoptic catheters with glass fibers are employed, the other channel, used for compensation of non-specific effects such as blood flow variations, contains no filter, thus measuring light in a broad spectral band. It is shown that in this way compensation of flow effects may be about two times better than when a 920 nm filter is used. When using plastic optical fibers a 950 nm filter must be used, because above lambda = 850 nm plastic fibers transmit only a band around that wavelength (950 nm). At zero dye concentration the densitometer output or ratio of compensating and measuring photocell output R/R800 is almost insensitive to changes in haemoglobin concentration. When the blood contains dye, however, the influence of haemoglobin concentration is considerable. The densitometer output R/R800 is linearly related to dye concentration up to 50 mg . 1-1, the output R920/R800 up to 30 mg . 1(-1). The output R/R800 decreases with decreasing oxygen saturation; the slope of the calibration line, however, appears to be unaffected. The processing unit also contains an analog cardiac output calculator consisting of an integrator and a divider. Central dye dilution curves recorded from the pulmonary artery after injection of dye into the right atrium or a caval vein come down to the baseline. At this moment the reading of a digital voltmeter displaying the divider output calibrated in 1 . min-1 can be held and the reading taken.


A method for subtraction of the extrarenal "background" in dynamic 131I-hippurate renoscintigraphy.

Using a Toshiba GC-401 gamma camera with MDS computer Trinary a new method was developed for subtracting the extrarenal (extracanalicular) "background" from the count rate recorded over the kidneys after intravenous administration of 131I-hippurate. Mean subtraction factors of the "blood" activity curve were calculated from a study of 27 patients who were given 51Cr-HSA for purposes of conventional renography with "background" subtraction. The values of the mean subtraction factors FR,L for the right and left kidney, by which a blood count rate should be multiplied amounted to 0.86 +/- 0.12 and 0.79 +/- 0.13, respectively. A comparison of the coefficients of variation of the pure renal signal when mean vs. individually determined subtraction factors were used, and the verification of the method in unilaterally nephrectomized patients have demonstrated that determination of the factors, FR,L, for each patient individually is not required and sufficient precision can be obtained by using the method and factors reported in this study.


[Quantitative sacroiliac joint scintigraphy? (author's transl)].

Methodological aspects and clinical value of digital sacroiliac joint scintigraphy area are described. Preinformation of the observer affects the value of the uptake ratios significantly. A data processing is presented which reduces this effect. Nevertheless there is insufficient discrimination between normal persons and patients with acute inflammation. Routine bone scanning can therefore not be used to exclude "inflammatory changes".


The unprejudiced basis of bias.

The results of a study can be invalid if the study population is not chosen properly. Four hypothetical examples show how unintentional selection bias can occur and how to recognize it in both prospectiveand retrospective studies.


[Suggestion for the investigation of eosinophilia caused by filaria Onchocerca volvulus].

It is proposed to search if by immunological means it is possible to distinguish eosinophilia produced by the filaria Onchocerca volvulus from other eosinophiliae. The proposed methods also seem to allow the detection of the presence of the specific antibodies in other hematic cells.


A model for the cardiac-associated changes of the thoracic electrical impedance in man.

A simple mathematical model has been developed which is able to fit the impedance waveform produced by normal and abnormal subjects throughout the cardiac cycle with reasonable precision. Contributions from both the aorta and vena cava are significant. Fitted values of model parameters offer potentially useful clinical information. Estimates of the stroke volume obtained from the model correlate will with values derived from the maximum rate of change of the thoracic impedance during systole, but are in poorer agreement with values obtained using tracer dilution techniques.


The effects of reserpine on microcirculatory flow in rat flaps.

A model flap was developed in the rat which allowed us to quantitate microcirculatory blood flow within a flap, and to correlate the flow with the length of flap eventually surviving. A critical flow of 0.02 and 0.03 ml/min/gm (measured during the first 24 hours after flap elevation by radioactive microspheres) appears to be necessary for tissue survival. Reserpine, in a dose of 5 mg/kg, did not increase blood flow in the flap or the length of flap surviving in this model.


Justinian II and Carmagnola: a Byzantine rhinoplasty?

The Carmagnola statue, although undoubtedly a Byzantine Emperor, still holds its secret as to who it actually represents, and how his nose got that way. Our tentative conclusions concerning the possibility of Justinian's Indian nasal reconstruction only raise other questions. If Justinian Rhinometos did have a nasal reconstruction, how was the knowledge of the technique transmitted from northern India to the Byzantine Empire by the end of the 7th century? And if Justinian did have his "rhinokopia" surgically corrected, would this represent the first case of nasal reconstruction in the western world, 900 years before the triumphs of Tagliacozzi?


Uses of the trapezius and sternomastoid myocutaneous flaps in head and neck reconstruction.

Both of these myocutaneous flaps can supplant forehead and deltopectoral flaps, in certain indications. They are additional arterialized flaps for the armamentarium of the reconstructive surgeon, and can be useful in many repairs in the head and neck region.


The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck.

A compound flap is described that utilizes skin from the anterior chest on a narrow segment of pectoralis major muscle, with its underlying axial neurovascular bundle. This flap has been used successfully to reconstruct large defects in 4 consecutive patients. Our experience with this flap suggests that it may be more versatile than the deltopectoral flap.


Experimental work with isoxuprine for prevention of skin flap necrosis and for treatment of the failing flap.

The administration of isoxuprine intraperitoneally resulted in the complete survival of abdominal island skin flaps in rats that otherwise underwent a standard pattern of necrosis. The drug was effective when administered for two weeks before and one week after raising the flap, or when administered afterwards alone. The mechanisms of its action were investigated and are described.


Free toe-to-fingertip neurovascular flaps.

Six cases of free toe-to-fingertip neurovascular flaps are presented. The principal advantages of this procedure over rotation island flaps are (1) achievement of better two-point discrimination, (2) an acceptable donor defect, (3) no cortical reorientation is necessary, and (4) there is minimal tension on the nerve.


One-stage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap.

The sternomastoid muscle has 3 blood supplies: the occipital artery superiorly, the superior thyroid artery in the middle, and the thyrocervical trunk below. We report the use of a myocutaneous flap consisting of a "paddle" of skin on the end of a pedicle of sternomastoid muscle--with the latter based either on its superior or inferior blood supply. Fourteen such flaps have been used successfully in 13 consecutive patients for one-stage reconstructions of defects of the oral cavity and oropharynx. Although there was partial epithelial loss of the skin "paddle" in 7 cases, in each case the surviving dermis became resurfaced with epithelium.


The locking loop tendon suture.

The locking loop tendon suture is suggested as an effective method for suturing tendons where tension is likely during the early post-operative period. The relationship of the intratendinous parts of the suture to each other is critical to the resultant tensile strength. Experimental work has confirmed its strength and its lack of interference with the intrinsic vasculature of the tendons. Our results from this clinical repair of 72 tendons by this method have been better, in general, than we obtained with other currently popular methods.


Latissimus dorsi myocutaneous flaps in head and neck reconstruction.

We have found the latissimus dorsi myocutaneous flap, when used as a "pedicled island flap," to be an adaptable and dependable alternative flap for repairs after major resections in the head and neck. The long vascular pedicle, containing large vessels, provides a means to transfer a large bulk of tissue into the head and neck for the repair of major through-and-through defects.


Angiography of the iliofemoral arteriovenous system supplying free groin flaps and free hypogastric flaps.

The circulatory anatomy of the iliofemoral region was elucidated by doing detailed angiography in 50 cases, and we classified the vessels into 4 types. In most cases, the s.c.i.a. predominated over the s.i.e.a. Therefore, it is probably better to plan free flaps supplied by this artery. This vessel usually arises approximately two or three fingerbreadths inferior to the intersection of the femoral artery and the inguinal ligament, and the skin flap should be designed in the area inferior and parallel to the inguinal ligament.


Evaluation of anastomotic techniques in the experimental transfer of free skin flaps.

Vascularized groin flaps were transferred to the contralateral side by various microvascular anastomotic techniques. There was no statistical difference between the results of end-to-end and end-to-side anastomoses, when the same sized vessels were compared. However, significant differences existed when vessels smaller than 0.5 mm in diameter were anastomosed.


Case report: Reconstruction of the mid-face in an adult, after gangrenous destruction in infancy.

We report a case of an adult mid-face reconstruction for a deformity occurring in infancy, using a Le Fort III advancement first to restore the contour of the skeleton. This was followed by a scalping forehead flap for the nasal reconstruction, and a fleur-de-lis Abbe flap for reconstruction of the lip and nasal vestibule.


Case report: Use of skin grafting to keep a scleroderma patient ambulant.

A case of scleroderma is presented in which there was extensive skin involvement with contractures, but without any systemic manifestation. This patient has been kept ambulatory by repeated skin grafting. The grafts were taken from the few areas which were not involved with the disease. The grafting was successful, and so far the skin grafts have remained free of disease.


Renin, cortisol, and aldosterone during transcendental meditation.

The effects of transcendental meditation (TM) on plasma renin activity (PRA) and plasma concentrations of aldosterone, cortisol, and lactate were studied by measuring these variables before, during, and after 20--30 min of meditation. Subjects, who rested quietly rather than meditating, served as controls. There were no differences in the basal values for these variables between meditators and controls, but controls, in contrast to meditators, showed a significant increase in cortisol between the first (A) and second (B) samples of the control period. PRA increased slightly (14%) but significantly (p less than 0.03) during TM, but not during quiet rest in controls. Cortisol decreased progressively (after sample B) throughout the experiment to the same degree in both groups. Aldosterone and lactate did not change. The data do not support the hypothesis that TM induces a unique state characterized by decreased sympathetic activity or release from stress, but do suggest that meditators may be less responsive to an acute stress.


Premature labor and indomethacin.

Administration of indomethacin to 29 women in the 26th--37th week of gestation with premature labor contractions was followed in 26 by a significant decrease of uterine activity. The effect of therapy was monitored by serial external tocometry recordings and by plasma concentrations of estriol, h.P.L., alpha-fetoprotein, and estriol/creatinine ratio in urine. The labor was monitored by cardiotocography; the new born infants were examined by the pediatrician. Following oral indomethacin treatment (25 mg every 6 Hours for 5 days) no untoward effects was observed on maternal and fetal wellbeing during pregnancy and labor. Four out 29 newborn infants, all appropriate for gestational age of 36--40 weeks, had one-minute Apgar scores less than 7, cyanosis, tachypnea, hypoxemia and serious oxygen dependency for several days. All the infant survived. These abnormalities may be due to short-term exposure to indomethacin and consequent inhibition of cyclo-oxygenase, impairement of prostaglandin-dependent physiological regulation of vessel tone during fetal life and circulatory disorders at birth.


Possible role for prostacyclin in human parturition.

Human amnion, chorion, decidua and placenta produced 6-oxo-PGF1alpha when superfused in vitro. Furthermore amnion, an avascular tissue, produced more 6-oxo-PGF1alpha after labour than all other tissues investigated and its production of 6-oxo-PGF1alpha was significantly greater after labour than before the onset of labour. These findings suggest that prostacyclin production by foetal membranes may have a role in the mechanisms controlling human parturition. Moreover, this is the first evidence for the production of prostacyclin by an avascular tissue.


[An epidemiological study of foci of S. mansoni bilharziosis in Minkana and Nalassi (Lekie Division, Cameroun) (author's transl)].

The epidemiological survey involved the examination of the total population of the two villages as well as the investigation of the freshwater snails in the neigbouring waters bodies. Biomphalaria camerunensis and Biomphalaria pfeifferi were found to be the intermediate hosts of Schistosoma mansoni. The cassage of eggs in the stools was more frequently observed in two groups, those aged 10-19 years and in the elderly women. The study of the prevalence of the disease by means of the indirect immunofluorescence technique on frozen sections of S. mansoni revealed that already in childhood the percentage of subjects with circulating antibodies is high. This percentage remains elevated in subsequent age groups. The geometrical mean reciprocal titers show an age and sex pattern similar to that found for prevalence. Both the percentage of positive indirect immunofluorescence tests and their respective titers were higher in patients with eggs in their stools. The immunological reaction using homologous S. mansoni antigen is more sensitive than that with heterologous S. haematobium antigen.


Pathologic effects of oral contraceptives.

The pathologic effects of oral contraceptives have been described in this paper and in other reviews [1, 5, 23, 35, 44, 48, 59, 80, 103, 114]. Approximately 10 million women currently use oral contraceptives in the United States. These drugs are beneficial both to the users and for population control. It is their effect on the health status of women who take them that must continue to have well-organized investigation so that more meaningful conclusions concerning their safety will permit continued use. In some instances, the pathologic effects of oral contraceptives make it necessary that new methods of contraception be found. Intensive research in this area is needed and judiciuos use of oral contraceptives must be maintained. A national registry should be formed to record and investigate the cases of women who die or have adverse reactions while taking these agents. A registry might identify associations no previously known to exist in patients taking oral contraceptives. It would serve to concentrate the data in one area so that more material would be available for the study of pathogenetic mechanisms. It would heighten patient and physician awareness of the untoward effects and increase the responsibilities of the women who take them to monitor their own health.


[Reconstructive microsurgery in use of CO2-laser (author's transl)].

CO2-Laser is presented for application in reconstructive operations. At cornua uteri and urine bladders of rabbits excisions were undertaken. The free wound edges were approximated and coagulated by laser irradiation. After these operations 70% (uterus) respectively 90% (urine bladder) of the organs remained fully functionable.


Detection of Border disease antigen in tissues of affected sheep and in cell cultures by immunofluorescence.

An account is presented of the distribution of fluorescence in cryostat sections of tissues from eight lambs with Border disease (BD). In young lambs fluorescence was observed in almost every organ, indicating a generalised infection with BD virus. Fluorescence was most prominent in the secretory glands of the alimentary and respiratory tracts, the basal cell layers of the epidermis and mucous membranes, and in the medullary rays of the kidneys. Abomasum, pancreas, kidneys, testicles and thyroid were most consistently affected. Although the number of fluorescing tissues decreased with age, viral antigen could still be detected in two sheep of 22 and 52 weeks old. Border disease viral antigen was demonstrated in cell cultures derived from the brain, kidney and testicle of six out of seven lambs despite the presence of neutralising antibody against bovine virus diarrhoea virus in three of them. The presence of the virus in the skin, the vascular walls and the endocrine system is discussed in relation to the aberrant development of fetal hair follicles, periarteritis and growth retardation respectively.


Lymphocyte unresponsiveness to PPD tuberculin in badgers infected with Mycobacterium bovis.

Lymphocyte transformation tests using phytohaemagglutinin and concanavalin A showed that both T and B lymphocytes are functional in tuberculous badgers. Dose response curves indicated that purified protein derivative sensitised lymphocytes were suppressed when cultured in the presence of the antigen.


Immunosuppressive effect of Trypanosoma congolense and Trypanosoma vivax on the secondary immune response of cattle to Mycoplasma mycoides subsp mycoides.

Trypanosoma congolense and T vivax infections in cattle were shown to have a suppressive effect on the secondary humoral immune response to M mycoides. The trypanosome infections caused an involution of the thymus. The secondary response was biphasic in nature and was unrelated to infection with trypanosomes.


[Value of different diagnostic tests for Micrococcaceae and their implication in pathology].

A number of 1431 products were examined and 200 coagulase-negative micrococcaceae strains were isolated and identified. On the basis of morphological aspects, enzymatic reactions and behavioural testing to antibiotics 18 strains (9%) were listed as Micrococcus and 182 (91%) as Staphylococcus strains. Efficient among the tests used for differentiating between the two genera were : microscopic aspects, pigmentogenesis, resistance to ClNa, anaerobic glucose fermentation, glycerol fermentation in the presence of erythromycin, reduction of nitrates to nitrites, and testing to novobiocin. Other tests, due to their variability, could only be used conjointly, and, finally, a further category had no diagnostic value, such as oxidase and catalase tests or the rhamnose fermentation reaction. Both the Micrococcus and the Staphylococcus strains were isolated from pathological cases and from healthy carriers, and can therefore be listed in the group of potential pathogens.


Prophylactic effect of cimetidine in gastric ulcer patients.

Nineteen patients entered a double-blind randomized trial of the prophylactic effect of cimetidine in gastric ulcer disease. The diagnosis of gastric ulcer had been established endoscopically prior to the trial, but at the time of entry the patients were symptom-free and their ulcers had healed. The patients received either cimetidine, 400 mg twice daily or inactive tablets. Ten cimetidine-treated patients completed 12 months' treatment without suffering a recurrence of symptoms, whereas 5 of 9 placebo-treated patients suffered a symptomatic relapse after 7 to 18 weeks (P less than 0.025). In 4 of the 5 patients an ulcer was found at gastroscopy. It is concluded that maintenance treatment with cimetidine helps to prevent symptomatic relapses in gastric ulcer patients.


Comparison of glucagon, atropine, and placebo as premedication for endoscopy of the upper gastrointestinal tract.

The effects of 0.5 mg glucagon and 0.5 mg atropine given intravenously as premedication in upper gastrointestinal endoscopy have been examined and compared to those of placebo (0.9% NaCl) in a double-blind study involving 36 patients and 1 endoscopist. The results showed no difference between atropine, glucagon, and placebo with regard to vomiting, opening of the pylorus, feeling of discomfort, or the success of the examination. Glucagon significantly reduced peristalsis compared with both atropine (p less than 0.01) and placebo (p less than 0.01). The reflux was also significantly reduced by glucagon compared with both atropine (p less than 0.01) and placebo (p less than 0.01). No difference was found between glucagon and atropine with regard to secretion, but both drugs reduced the secretion compared with placebo (p less than 0.05). Glucagon also reduced the secretion of mucus compared with placebo (p = 0.05). No adverse effects occurred.


Serum concentration of trimipramine (Surmontil) and gastric secretion of acid and pepsin following peroral administration of the drug in healthy humans.

Previous blind studies have shown an increased rate of healing of both duodenal and gastric ulcers following 4 weeks peroral administration of 50 mg trimipramine. The present study shows the effect of 50 mg trimipramine perorally on gastric secretion in relation to that of 25 mg of the drug and placebo. At regular intervals blood specimens were obtained for determination of the serum concentration of trimipramine. In 9 healthy young students it was found that the estimated stabilized values of volume and acid output following 50 mg trimipramine, 33 ml and 3.9 mmol/15 min, respectively, were significantly lower than those following the smallest dose, 37 ml and 4.6 mmol/15 min, respectively. On the other hand, no significant changes of gastric secretion were observed following the peroral administration of 25 mg trimipramine when compared to placebo. Following 50 mg trimipramine the output of pepsin was reduced by about 25%. The values of serum concentration of trimipramine were about 200 nmol/1 at 100 min after administration of 50 mg trimipramine and decreased gradually, whereas the values following the smaller dose were about half of those after the larger one. The results indicate that about 50 mg trimipramine is needed for obtaining a reduction of gastric secretions. Future studies may show whether 25 mg trimipramine, which does not suppress acid secretion when given perorally, is able to promote peptic ulcer healing.


Scanning electron microscopy of exudative macrophages in malignant lymphoma.

The possible value of scanning electron microscopy (SEM) of skin window preparations in the clinical situation has been investigated with reference to 48-hour macrophages in 26 patients with malignant lymphoma. The preparations were processed for SEM using critical point drying and sputter coating. Identification of macrophages was made with reference to light microscopy both of parallel preparations and of specimens already studied by SEM. Distinctive SEM appearances were present in most of the patients. Although many macrophages were similar to those from normal subjects, the majority showed a more variable morphology including the presence of ruffles and coarse ridge-like profiles. Highly significant differences were found on statistical analysis. It is suggested that immaturity of the 48-hour macrophages is present in some patients with malignant lymphoma (perhaps reflecting the macrophage dysfunction already described in these diseases). The findings indicate the potential clinical application for this technique.


A new pre-irradiation conditioning regimen which protects against radiation injury and facilitates engraftment of xenogeneic bone marrow.

Administration of a large number of xenogeneic (rat) bone marrow cells before lethal, total body irradiation in mice (preconditioning regimen) results in powerful protection from radiation damage, remarkable prolongation of their survival, facilitation of marrow engraftment and induction of rat chimerism. This protective effect is not exerted by thymus or spleen cells and does not depend on specific immune mechanisms. The preconditioning regimen is more efficient when the bone marrow cells are viable and when the cells are inoculated intravenously a few hours before irradiation.


Antigenic analysis of Mycobacterium leprae.

About twenty distinct antigenic components have been demonstrated in Mycobacterium leprae (M. leprae) by crossed immunoelectrophoresis against a rabbit antiserum produced by immunization with concentrated M. leprae antigen. This system allows a more detailed analysis of the antigenic relationship between M. leprae and other mycobacteria and a better characterization of the antigenic content of various M leprae preparations than with previously available anstisera of the antigenic content of various M. leprae preparations than with previously available antisera which reacted with far fewer components. The antibody activity in sera of patients with lepromatous leprosy was studied by incorporating the sera into the intermediate gel of the M. leprae reference system. Antibodies were found against only seven of the components. Since those compared are all known to be cross-reacting widely with antigens of other mycobacteria, it is speculated that cross-immunization may influence the antibody response in lepromatous leprosy.


A comparative, double-blind study on tolfenamic acid in the treatment of rheumatoid arthritis.

Sixty patients with diagnosed rheumatoid arthritis were treated at random with tolfenamic acid, a new nonsteroid anti-inflammatory analgesic, in a daily dose of 600 mg, or with phenylbutazone 300 mg or acetylsalicylic acid 1,500 mg daily. Both the patients and the physician found that tolfenamic acid had a clearly better effect than phenylbutazone or the low-dose acetylsalicylic acid used as a control. Tolfenamic acid and acetylsalicylic acid were well tolerated. Serious side-effects (leukopenia and thrombocytopenia in one case, hematemesis and melena in another) only occurred in those patients who received phenylbutazone.


A comparative clinical study of a new antirheumatic agent, tolfenamic acid (Clotam), and phenylbutazone in rheumatoid arthritis.

A double-blind crossover study was carried out in 33 patients with rheumatoid arthritis using a new anthranilic acid derivative, tolfenamic acid, and phenylbutazone. Each drug was given in doses of 100 mg 3 times daily. Both periods of treatment lasted 3 weeks. Objective and clinical studies of the antirheumatic effect showed no significant difference between the two forms of treatment. On phenylbutazone treatment, however, there were significantly greater numbers of, and more serious, side-effects (especially dyspeptic symptoms and fluid retention) than on tolfenamic acid treatment.


Tolfenamic acid in the treatment of rheumatoid arthritis.

In an open trial of three months' duration the clinical effect of tolfenamic acid, a new nonsteroid anti-inflammatory analgesic, was found to be good in 85 patients suffering from rheumatoid arthritis. Both subjective and objective parameters clearly improved, and corticoid therapy could be abandoned by 21% of the patients. Tolfenamic acid was for the most part better than or as good as, the previous medication by which the disease had been brought to a stabile state. Side-effects were mild, no severe adverse reactions were observed which could be definitely attributed to tolfenamic acid.


IgG-, IgM- and IgA-rheumatoid factors in healthy adults and rheumatoid patients determined by an indirect immunofluorescence method.

Sera from 173 healthy adults and 55 rheumatoid patients were studied for IgG-, IgM- and IgA-rheumatoid factors (RFs) by a modification of Este's indirect immunofluorescence method. Rabbit IgG bound to smeared sheep red cells was used as antigen. With each serum tested a smear on non-sensitized cells was used as control antigen. Anti-IgG of the sera studied, binding to the antigen, was demonstrated by fluorescein-conjugated antisera, monospecific for gamma, mu and alpha chains, and not containing antibodies to sheep erythrocytes or rabbit IgG. Positive reactions were obtained with IgG as antigen, but not with the F(ab')2 fragment. The sera tested were treated with dithiothreitol before they were assayed for IgG-RF, in order to abolish false-positive reactions due to IgM-RF activity. The detection limit for IgM-RF was 1 IU per ml. IgM-RF titres of 9 occurred in 7% of healthy adults and 73% of rheumatoid patients, titres greater than or equal to 18 in 3.5% and 67% respectively. IgG-RF titres of 9 occurred in 9% of healthy adults, 21% of seronegative and 24% of seropositive rheumatoid patients. Titres of 18 occurred in 3% of healthy adults and in 14% of seronegative rheumatoid patients. Titres of greater than or equal to 18 occurred in 22% of seropositive rheumatoid patients. IgG-RF was correlated with an involvement of more than 20 joints. IgA-RF was found in 83% of seropositive, 11% of seronegative rheumatoid patients and in none of the healthy adults (serum dilution 1:9).


Double-blind placebo-controlled evaluation of levamisole in chronic rheumatoid arthritis.

Thirty-three out-patients with rheumatoid arthritis completed the study intended to compare under double-blind conditions, 50 mg levamisole tablets with placebo. Patients were given the double-blind medication at a dosage of one tablet t.i.d. for 3 months, and at a dosage of one tablet t.i.d., on 2 consecutive days every week for the next 3 months. Pain score, duration of morning stiffness, articular index and E. S. R. were recorded at the start of treatment, after 3 months of treatment and at the end of treatment. The levamisole patients made significantly better progress than did the placebo patients: for E.S.R. after 3 months of treatment, and for E.S.R., pain and morning stiffness by the end of treatment. Ten levamisole patients and 5 placebo patients reported adverse reactions. These were mainly gastrointestinal symptoms in the levamisole-treated patients.


Cystic fibrosis compared with the immotile-cilia syndrome. A study of mucociliary clearance, ciliary ultrastructure, clinical picture and ventilatory function.

Patients with cystic fibrosis (CF) were investigated for mucociliary clearance (with and without stimulation by terbutaline), clinical picture, ventilatory function and ultrastructure of cilia. The results were compared with those of patients with congenitally immotile cilia (immotile-cilia syndrome). Mucociliary clearance could be demonstrated in all the seven CF patients who succeeded in inhaling the test aerosol. Ciliary ultrastructure from a deceased CF patient was normal. Patients with the immotile cilia syndrome had no substantial clearance and defective cilia. The CF patients coughed more during the clearance measurements than any other group studied earlier, and their coughing was effective. One patient succeeded in avoiding coughing in both measurements and had faster clearance when he got terbutaline than when he got the vehicle. Although younger, the CF patients tended to be more obstructed in their lungs and more handicapped than the patients suffering from the immotile-cilia syndrome. The latter patients had more discomfort from rhinitis, sinusitis and otitis than had the CF patients. An impairment of the mucociliary transport rate is hence unlikely to be a primary pathogenic factor for the respiratory tract disease in CF patients.


Long-term trial of an alpha adrenoceptor blocking drug (Indoramin) in asthma. A preliminary report.

Eight patients suffering from both asthma and migraine underwent a clinical trial for 3 months of indoramin, an alpha adrenoceptor antagonist with antihistamine and antiserotonin activity. Patients were told indoramin was prescribed for migraine prophylaxis. In three asthmatic patients there was a marked increase in airflow meter (AFM) readings which were recorded daily, the remaining five showing no significant change or a decrease in AFM readings. Indoramin did not appear to potentiate the action of the beta sympathomimetic aerosols. It is suggested that a small population of asthmatic patients may derive therapeutic benefit from an alpha adrenoceptor antagonist. Seven of the eight patients experienced a 50% decrease in the frequency of their migraine headaches.


Prolongation of rat cardiac allograft survival by donor pretreatment. Impact of dose and timing of drug administration.

We investigated the effect of two variables, the time interval between drug administration and transplant removal and the dosage of the drug, on the prolongation of rat heart allograft survival via donor pretreatment. A maximal or near-maximal survival-prolonging effect was recorded when the drug was given at least 6 hours before removal of the transplant; extension of pretreatment beyond that time had relatively little effect on the outcome of the graft. A maximal survival prolonging effect was obtained with all of the test drugs, cyclophosphamide, methotrexate, hydroxyurea, busulfan and procarbazine, in doses of LD-50. The therapeutical margin was small, however, as doses of 0.5 x LD-50 and 2 X LD-50 were clearly inferior in their effect.


Mechanical and conventional manual sutures of the bronchial stump. A comparative study of 298 surgical patients.

A U.S.-made TA-30 model stapling device was utilized to close the bronchial stump in 146 patients, while conventional manual suturing with chromic catgut was performed for the same purpose in 152 patients. The two groups were comparable in respect of pre-operative status and operative diagnosis. Patients, in whom the stapler was utilized, showed a decreased incidence of bronchial fistula (1% vs. 3%) and empyema without fistula (1% vs. 3%). The stapler, compared with conventional manual sutures, allows a simpler and swifter suture of the bronchial stump, reduces the contamination of the operative field, achieves uniform and tighter closure of the bronchus, leaves a better preserved terminal blood perfusion of the stump and utilizes a more tolerated sewing material with less resultant tissue inflammation.


[Long-term, complete remission in non-Hodgkin's lymphoma following high-dosage combination therapy with or without autologous bone marrow transplantation].

22 patients with malignant non-Hodgkin lymphoma resistant to conventional chemotherapy were treated with high-dose combination chemotherapy followed in the first 12 patients by infusion of their cryopreserved autologous bone marrow. The next 10 patients received chemotherapy alone. Four patients died shortly after chemotherapy. Four patients remain in unmaintained remission 40, 30, 20 and 8 months after treatment. Patients receiving cryopreserved marrow recovered leukocyte, granulocyte and platelet function significantly faster and had significantly fewer febrile days than did controls. These findings demonstrate that high dose combination chemotherapy may benefit some patients unresponsive to conventional chemotherapy, and that cryopreserved bone marrow can speed hematopoetic recovery and be of clinical benefit to the patient.


[Atenelol and bendrofluazide in the treatment of medium and severe hypertension (preliminary report)].

In 15 patients with moderate to severe hypertension (WHO II--III) atenolol was evaluated against a thiazide diuretic (bendrofluazide) in a single blind crossover study. Systolic blood pressure values were lowered more efficiently by the diuretic, while diastolic pressure values were significantly better controlled by atenolol. Atenolol and bendrofluazide, by mere addition of the pressure effects of the single components, clearly afforded the best pressure control. Side effects of atenolol were frequent but mild, never causing major concern with the patients or a dropout from the study. Although the pressure response to atenolol was significantly better in the normal and high renin group of patients, there was no statistically significant correlation between the reduction in plasma renin and blood pressure induced by atenolol. In turn, the pressure response to the diuretic was significantly better in low renin than in normal and high renin patients.


[Experiences with a new hypouricemic diuretic (tienilic acid): comparison with hydrochlorothiazide].

A new hypouricemic diuretic (tienilic acid) was compared with hydrochlorothiazide in a double-blind study in 8 patients with mild essential hypertension. After a two-week placebo period the patients received either 250 mg tienilic acid or 50 mg hydrochlorothiazide in a single daily dose for 3 weeks. After a second placebo period of 2 weeks the patients received, in a crossover design, either tienilic acid or hydrochlorothiazide for a further 3 weeks. The reduction of blood pressure and of body weight was similar for both drugs. When treatment was started diuresis and natriuresis increased with tienilic acid and with hydrochlorothiazide. Whereas serum sodium levels showed only minor variations, serum potassium levels fell with both diuretics and urinary potassium excretion increased. Urinary calcium excretion decreased and serum calcium levels slightly increased under both treatments. Both diuretics induced similar increases of plasma renin activity, plasma aldosterone concentration and aldosterone-18-glucuronide excretion. Blood urea nitrogen and, to a lesser extent, serum creatinine levels were raised slightly under both drug regimens. Whereas the serum uric acid level rose and remained elevated for the duration of hydrochlorothiazide treatment, it fell significantly and remained lowered during treatment with tienilic acid. Uric acid clearance was about twice as high with tienilic acid as with hydrochlorothiazide. Tienilic acid therefore appears to be a therapeutic alternative to thiazides and other hyperuricemic diuretics in hypertensive patients in whom hyperuricemia should be avoided or corrected.


Medical treatment of duodenal ulcer.

Recent controlled clinical trials have shown that acute episodes of duodenal ulcer can be treated successfully with either anti-secretory (cimetidine), mucosa-protective (carbenoxolone, organic bismuth preparation) or antacid drugs. For prevention of recurrence, only cimetidine has thus far proved effective. A critical review is presented of the advantages and disadvantages of these drugs in conservative ulcer therapy.


Angiography in the diagnosis and therapy of acute upper gastrointestinal bleeding.

The value of angiography in the diagnosis and therapy of acute upper gastrointestinal bleeding is discussed. Based on experience with diagnostic angiography in over 350 acute gastrointestinal bleeders and therapeutic interventional angiography in more than 150 of them several principles are illuminated. Angiography should be used after emergency endoscopy and a trial of medical therapy. Selective vasoconstrictive therapy is highly effective in controlling bleeding from superficial mucosal lesions although less effective for bleeding from major arteries as is seen in peptic ulcers. Selective transcatheter occlusive therapy is a fast and effective method for controlling arterial bleeding in appropriates cases. For variceal bleeding low dose intravenous infusion of vasopressin is as effective in decreasing portal pressure and blood flow as is selective superior mesenteric infusion. Direct selective occlusion of gastroesophageal varices by the transhepatic approach is a new and exciting method of treatment for variceal bleeding.


[Cimetidine treatment of reflux esophagitis: results of a double-blind study].

The effect of cimetidine on healing of reflux esophagitis was investigated in a double blind study in which 16 patients received 1.6 g cimetidine/day and 20 patients placebo. After 6 weeks endoscopic healing or amelioration of the esophagitis was observed in 10 of 20 patients on placebo (50%) and in 9 of 16 patients receiving cimetidine (56%). Continuation of double blind therapy in 24 patients for another 6 weeks led to improved healing in 12 cimetidine patients but not in 10 placebo patients. In only 4 of 16 cimetidine patients there was complete healing of esophagitis at the end of the study. The cimetidine patients had fewer symptoms to a statistically significant degree after 6 and 12 weeks, respectively. It is concluded that, despite its statistically significant effects on esophagitis and reflux symptoms, cimetidine therapy of reflux disease is not satisfactory. If cimetidine therapy appears to be indicated, it should be continued for at least 12 weeks.


[Cimetidine prevention of stress ulcers].

A study of 2015 cases from an intensive care unit shows that prophylactic administration of cimetidine and antacid produces a statistically significant decrease in stress ulcer, as compared with antacid alone or sulpirid and antacids.


[Therapy of duodenal ulcer with cimetidine, pirenzipine and placebo: report on a double-blind randomized study].

A double-blind randomized controlled study with pirenzepine (75 mg/day), cimetidine (1 g/day) and placebo was performed in 50 consecutive out-patients with duodenal ulcer. The patients also received an antacid containing aluminium hydroxide. Pirenzepine, cimetidine and placebo had similar effects on the 4-week healing rate. Dryness of the mouth was more frequent with pirenzepine than with the other two types of treatment. The incidence of other side effects did not differ in the three groups. A tendency towards more rapid disappearance of subjective symptoms in the patients treated with pirenzepine was not statistically significant. In conclusion, pirenzepine and cimetidine were not superior to placebo in the treatment of duodenal ulcer.


[Viral hypothesis of multiple sclerosis: new aspects].

A review is presented of the epidemiological and serological data on which the viral hypothesis of multiple sclerosis is based. Recent experiments investigating the capacity of viruses to establish chronic infections are presented as a model to explain the clinical course of the disease. Finally, studies of the molecular interactions of vaccinia virus with the myelin membrane serve as a basis on which to discuss the problem of the mechanism of demyelination.


[BCG sepsis as a fatal complication of BCG vaccination].

Fatal septicemia with Bacillus Calmette-Guérin (BCG) following BCG vaccination is always caused by an underlying defect of immunologic mechanisms. At the Children's Hospital, University of Berne, two cases of BCG septicemia were recently observed. The clinical picture, course, and pathogenesis of the illness are discussed. The harmless complications of BCG vaccination are summarized, and a review of the literature on fatal disseminated BCG infection stresses the different type of immunologic mechanism defect and clinical course. Therapy with antituberculous drugs is ineffective. Other therapeutic measures are mentioned. Immunologic tests must be performed rapidly when fatal disseminated BCG infection is suspected, in order to organize genetic counselling as soon as possible. The question whether newborns should still be vaccinated in spite of the numerous complications is discussed and answered in the affirmative.


[Cross-over double-blind study using neophylline oral (proxyphylline and diprophylline) in bronchial asthma].

In a double-blind crossover trial 16 asthmatic patients were given placebo or 4 or 8 tablets of Neophyllin (each tablet containing 56 mg proxyphylline and 84 mg diprophylline) on two consecutive days. Very slight bronchodilatation independent of the oral dose and plasma level was observed 90 minutes after taking Neophyllin. However, when a betastimulator was inhaled (0.5 mg salbutamol) prior to taking 8 tablets of Neophyllin, surprisingly marked Neophyllin-induced bronchodilatation was observed after 60 and 90 minutes (p less than 0.05 and p less than 0.025). This bronchodilatation was about half that with 4 slow release coated tablets of Neo-Biphyllin (75 mg teophylline in each tablet). When Neophyllin was taken only proxyphylline caused bronchodilatation (no correlation between plasma diprophylline levels and bronchodilatation). The threshold value of plasma proxyphylline was about 13 microgram/ml plasma. Below this level proxyphylline is ineffective (likewise no correlation between plasma proxyphylline levels and bronchodilatation). An oral dose of about 600 mg proxyphylline (in Neophyllin) is needed to reach an effective plasma level within 90 minutes.


[Blood picture changes in patients hospitalized in an internal medical department].

One quarter, i.e. 810 of 3621 patients admitted to a medical department showed quantitative abnormalities of the blood picture even when leukocytosis is excluded. In contrast, only in 113 cases were hematological diseases the main diagnoses on the hospital charts. 18% of the patients hospitalized for the first time had anemia. On analysis of blood changes according to their causes, 28% were found to be of either iatrogenic or toxic origin, the two causes exhibiting roughly the same frequency. The incidence of iatrogenic and toxic blood changes was equal to that of blood abnormalities due to malignant disease including hemoblastoses. Alcohol and phenacetin were the most frequent exogenous toxins, while anticoagulant, immunosuppressant and ulcerogenic drugs were the most frequent iatrogenic causes of abnormalities.


[Autologous bone marrow reimplantation in children with advanced tumor. First experiences of feasibility].

In three children with metastatic tumor uncontrollable by conventional chemo- and radiotherapy, bone marrow was obtained under general anesthesia and cryopreserved according to a carefully developed protocol. The autologous bone marrow cells were reinfused after intensive cytostatic therapy and total body irradiation (2 patients). After an aplastic phase of 7--14 days the peripheral blood leukocyte and thrombocyte count began to recover. The toxicity of the intensive treatment preceding the autologous bone marrow transfusion, and the autologous bone marrow cells themselves were well tolerated. The aplastic phase was easily controlled by the use of granulocytes, thrombocytes and erythrocytes. Except for fever and mucosal ulcerations observed during the phase of extreme leukopenia, the general condition of the patients during partial isolation lasting 26--34 days was astonishingly good. One child died 13 weeks after returning home due to a local relapse. The other two patients survived for 6 + and 11 + weeks and are in complete and partial remission respectively. A further evaluation of the clinical significance of autologous bone marrow reimplantations appears to be feasible in pediatric oncology.


[New aspects of liver circulation: effects and consequences for the portocaval shunt therapy in liver cirrhosis].

Hepatic circulation, which is of essential importance in supplying the liver cells with oxygen and substrates needed for securing metabolic homeostasis of the organism, is characterized by well-regulated mechanisms of intrahepatic arterial, portal and hepatovenous interaction. Furthermore, the hepatic circulation is integrated in the systemic and splanchnic hemodynamic as interposed in a high, or respectively low, pressure system. Beside these hemodynamic mechanisms there are also specific morphologic features in the hepatic vascular bed responsible for regulating liver blood flow. For hepatic nutritions and trophics, and for the metabolic homeostasis of the organism, portal blood is of greater importance than arterial. In porto-caval shunt surgery it is recommended that any remaining portal flow to the liver be preserved to the greatest extent possible.


[Movements of the supporting teeth in Kennedy-Applegate class III and IV restorations].

Two types of restoration of the class III and two types of the class VI have been tested on a test bench. These restorations react differently to vertical forces than to oblique ones. The fixed bridge reacts best to vertical forces. On the other hand it is the bilateral prosthesis with four Akers clasps which is more favorable to oblique forces. The enclosed saddles function, in this case, as a brake. When the global results (vertical and oblique forces) of induced movements are compared for the two types of class-III restoration (four Akers clasps or two Dolder bars) the differences are insignificant.


Potential halogenated industrial carcinogenic and mutagenic chemicals. I. Halogenated unsaturated hydrocarbons.

The halogenated aliphatic hydrocarbons represent one of the most important categories of industrial chemicals from a consideration of use categories, production volume, environmental and toxicological considerations, and hence most importantly, potential population risk. The major unsaturated hydrocarbons reviewed, primarily in terms of their synthesis, utility, stability, distribution and levels of exposure as well as their reactivity, carcinogenicity, mutagenicity and metabolism, include: vinyl chloride, vinylidene chloride, trichloroethylene, perchloroethylene, chloroprene, trans-1,4-dichlorobutene, hexachlorobutadiene and allyl chloride.


Potential halogenated industrial carcinogenic and mutagenic chemicals. II. Halogenated saturated hydrocarbons.

The halogenated saturated hydrocarbons analogously to the previously considered halogenated unsaturated hydrocarbons (Part I) possess considerable utility in a broad spectrum of applications including; solvents, dry-cleaning fluids, refrigerants, fumigants, degreasing agents, propellants and intermediates in the production of other chemicals, textiles and plastics. Methyl chloride, methylene chloride, chloroform, carbon tetrachloride, methyl chloroform, 1,1,2-trichloroethane, hexachloroethane, ethyl chloride and fluorocarbons were reviewed principally in terms of their synthesis (or occurrence), areas of application, stability, distribution, reactivity, levels of exposure, populations at risk, carcinogenicity, mutagenicity and metabolism.


Determination of halogenated organic compounds and mutagenicity testing of spent bleach liquors.

The content of organohalogenated compounds in spent bleach liquor from different bleaching stages in a sulphate and a sulphite plant has been determined by a combination of glass capillary gas chromatography, gas-liquid chromatography/mass spectrometry and neutron activation analysis. Several compounds which have not been reported before have been identified including halogenated derivatives of dimethyl-propylnaphthalenes and alkylated catechols. The unconcentrated effluents, non-polar and total extracts were tested for mutagenic activity with Ames' Salmonella test. Spent bleach liquors from most bleaching stages as well as the total effluents contained mutagenic compounds. Addition of liver microsomes for metabolic activation reduced the mutagenic activity in all stages except for the first chlorination stage in the sulphate plant. Two isomers of chloro-, bromo-, and dichloro-p-cymene previously determined in effluents from bleaching plants were synthesized from the parent molecule. Both bromo- and dichloro-p-cymene exhibited weak mutagenic activity in the Salmonella test system. Liver microsomes reduced the effect slightly. The chlorinated cymenes were found to account for up to 18% of the total organically-bound chlorine in the non-polar extracts.


Pituitary-brain vascular relations: a new paradigm.

Vascular casts of the pituitary gland have demonstrated a paucity of veins extending from the adenohypophysis to the systemic circulation and have suggested that some adenohypophyseal venous blood returns to the neurohypophysis. The neurohypophyseal capillary bed may function as a vascular switch and in this article a series of 14 questions are proposed regarding the vascular dynamics of the pituitary. Together these questions raise the larger question, namely, whether pituitary hormones are transported directly to the brain to modify brain function?


"Sontaneous" neoplastic transformation in vitro: a form of foreign body (smooth surface) tumorigenesis.

Explants of subcutaneous connective tissue from adult BALB/c mice into plastic petri dishes were serially subcultured and tested for tumorigenicity in two ways: by the subcutaneous implantation of cells attached to plastic plates (1 by 5 by 10 millimeters), and by the subcutaneous injection of cells suspended in saline. Cells grown in vitro for 18 or more days before being implanted attached to a plastic plate (2.4 x 10(4) to 3.4 x 10(5) cells per plate) formed tumors after 24 to 79 weeks. The latent period before tumor appearance correlated inversely with the time spent by the cells in tissue culture. Cells inoculated in saline suspension (10 to 100 times the above number per plate) did not form tumors until after 84 days in vitro; plates alone did not induce tumor formation within more than 1 1/2 years of implantation. The tumors arising from the plate-attached cells were transplantable without plates and histologically appeared to be undifferentiated sarcomas. It is well established that smooth-surfaced foreign bodies, regardless of their chemical composition, will produce sarcomas when transplanted subcutaneously in rodents. We interpret our data, particularly the decrease in tumor latent period with time spent in tissue culture, as indicating that a smooth surface was acting as a carcinogen first in vitro (the surface of the tissue culture dish) and then in vivo (the surface of the plastic plate).


Split genes and RNA splicing.

A number of genes in higher organisms and in their viruses appear to be split. That is, they have "nonsense" stretches of DNA interspersed within the sense DNA. The cell produces a full RNA transcript of this DNA, nonsense and all, and then appears to splice out the nonsense sequences before sending the RNA to the cytoplasm. In this article what is known about these intervening sequences and about the processing of the RNA is outlined. Also discussed is their possible use and how they might have arisen in evolution.


Identifying environmental chemicals causing mutations and cancer.

Damage to DNA appears to be the major cause of most cancer and genetic birth defects and may contribute to aging and heart disease as well. The agents that cause this damage must be identified. Many of these agents are natural chemicals present in the human diet as complex mixtures. The tens of thousands of man-made chemicals that have been introduced into the environment in the last few decades must also be tested for their ability to damage DNA. Existing animal tests and human epidemiology alone are inadequate for this task because of time, expense, and the difficulty of dealing with complex mixtures, Newly developed short-term tests, most of them assaying for mutagenicity, are discussed as key tools in identifying environmental mutagens and carcinogens.


Traumatic hemobilia: coordination of roentgenographic, scintigraphic, and angiographic findings.

This report proffers a diagram of radiologic procedures to aid in the diagnosis of traumatic hemobilia and updates the most important radiologic findings of hemobilia to demonstrate the value of the coordinated use of liver scintigraphy and angiography. According to the diagnostic schema, evaluation of biliary tract hemorrhage progresses from plain films through liver scintigraphy and angiography. Depending on the procedure yielding positive results, logical termination or progression is possible at any stage of the work-up.


Primary dysmenorrhea treated with indomethacin.

Primary dysmenorrhea is a difficult entity to treat, and therapy is usually directed at relieving symptoms. There is some indication that this disorder is caused by an increase in prostaglandin F2alpha. Therefore, logically the treatment may include antiprostaglandin agents. We have studied 32 women with the diagnosis of primary dysmenorrhea in a randomized double-blind fashion using a placebo and indomethacin. Both agents were taken three times a day over four cycles, and therapy was begun two days before the usual onset of pelvic pain. Only two of 16 patients in the placebo group were significantly improved in the four-month treatment cycles while all 16 in the treatment group showed some improvement, 11 having cessation of pain. In the six months following the study period, all patients were given indomethacin. The original treatment group did not change significantly. However, all in the placebo group when switched to indomethacin had some relief, 12 of the 16 showing complete cessation of pain. Gastric irritation was the main side effect and was present in 18% of the treatment group and 12% in the placebo group. Indomethacin appears to effectively relieve primary dysmenorrhea and does not appear to be associated with a high incidence of side effects.


Cost containment: medical system rehabilitation or reform.

Cost containment is considered the premier goal for improvement of the medical care system. Before any other steps can be taken to improve availability, accessibility, or quality, or before introduction of any governmental programs for the removal of economic obstacles to obtaining medical care,--in other words, before any effort to make the medical care system more equitable--the rapid hyperinflation of medical care costs must be arrested. It is argued here that the defects of the system as currently operating are such that no cost control effort can be effective without radical change and reorganization of the system itself: methods of practice, methods of reimbursing providers, and methods of assuring accountability and supervision. And it is further argued, that if only cost control measures are instituted, not only will inflation not be stemmed, but it will be further aggravated and at the same time, the poor and minorities now suffering the consequences of an inadequate, ineffective, and unresponsive medical care system will be further deprived.


Intravenous metronidazole therapy for Bacteroides fragilis meningitis.

A 69-year-old man developed meningitis due to Bacteroides fragilis and Streptococcus MG-intermedius, which progressed during chloramphenicol and nafcillin therapy to the extent that he seemed near death, with frank pus covering the spinal cord at surgery. Treatment with intravenous metronidazole and penicillin G was curative. After multiple trauma, a 20-year-old man developed meningitis due to Escherichia coli and B fragilis. He failed to respond to chloramphenicol alone, but responded to combined treatment with chloramphenicol and metronidazole. The right frontal sinus and epidural space abscesses were drained and a right frontal lobe abscess was excised. Metronidazole may be a uniquely effective agent for treatment of meningitis due to susceptible strains of Bacteroides fragilis.


Clearance of falciparum parasitaemia with a single dose sulfadoxine-pyrimethamine in Vientiane, Laos.

A total of 49 semi-immune Laotians aged 3 to 49 years, with falciparum malaria were treated with a single dose of sulfadoxine pyrimethamine (1500 mg, 75 mg, adult dose), in Vientiane, Laos. On day 7 after treatment the 49 cases were asymptomatic with complete disappearance of patent asexual parasitaemia. The result is compared with that obtained from treating 48 similar cases with a standard dose of chloroquine over 3 days.


Caffey's disease in Cape Town.

Six cases of infantile cortical hyperostosis or Caffey's disease are presented, with opinions as to its prevalence, incidence and origin.


Bioautographic visualization of aminoacylase-1: assignment of the structural gene ACY-1 to chromosome 3 in man.

A bioautographic assay was developed for the visualization of aminoacylase-1 (N-acylamino acid aminohydrolase, ACY-1; EC 3.5.1.14) after zone electrophoresis. Bioautography and species differences in electrophoretic mobility of ACY-1 made it possible to investigate the chromosome assignment of the gene for human ACY-1 using human--mouse somatic cell hybrids. Human ACY-1 segregated concordantly with beta-galactosidase-A (beta GALA; EC 3.2.1.23) but showed discordant segregation with 32 other markers representing 23 linkage groups. The beta GALA gene has been previously assigned to chromosome 3. From this evidence and confirming chromosome analyses, ACY-1 has been assigned to chromosome 3. A genetic polymorphism in the electrophoretic mobility of ACY was observed in mouse strains, demonstrating that this enzyme can be mapped in genetic crosses of Mus musculus.


Experience with the Russian model 249 suture gun for anastomosis of the rectum.

The Russian Model 249 circular suturing device used for rectal anastomoses in 62 patients undergoing high or low anterior resection or colectomy and ileorectal anastomosis was technically easy to use. The 38 high anastomoses were all shown to be intact by a Gastrografin, meglucomine diatrigoate, enema study 14 days after the operation. Of the 24 low anastomoses, six demonstrated small, 5 to 10 millimeters, dehiscences, two of the latter being evident also upon clinical examination. At least six of the low anastomoses were made at levels too low for hand suture from the abdomen. In three patients, moderate hemorrhage from the anastomotic site during the first two or three days complicated the situation; in all, it ceased spontaneously. In two patients, strictures developed, one of which rectified itself once the fecal stream was restored to the rectum on closing the transverse colostomy, the other was submitted to instrumental dilation, perhaps unnecessarily. The Model 249 circular suturing device provides colorectal anastomoses that are at least as secure as those done by hand suture and, sometimes, enables an anastomosis to be made at a lower level than would be possible by the conventional suture technique through the abdomen. Bleeding from the anastomotic site and subsequent stricture formation are rare complications of this technique.


Surgical correction of longitudinal median or paramedian incisional hernia.

A new surgical technique for the correction of longitudinal median and paramedian incisional hernia uses the hernial sac itself, a tissue of good resistance and healing properties, to cover raw areas, remake the abdominal wall anatomy, propitiate tensionless sutures and render unnecessary the use of prosthetic material, even in the largest hernia.


Extracorporeal perfusion without anticoagulation and the response to endotoxin.

The results of this study show that an extracorporeal perfusion system without anticoagulation can be established in the dog under certain conditions. The exact mechanisms merit further investigation. It also points to a model to study the effects of endotoxin without heparin interference and as another model for studying the canine blood coagulation system.


Results of simple scar excision and layered repair with elevation in facial scars.

Spreading tension across scars is curtailed when revised by simple scar excision and layered repair with elevation of wound margins. The procedure has reduced the width and leveled the scar to the surrounding skin in all our patients. Hairline scars result more frequently in scars of less width preoperatively.


Parathyroid transplantation: fate of a long-term allograft in man.

Previously our group reported clinical, histological, and biochemical evidence of parathyroid allograft survival in a patient transplanted sequentially with renal and parathyroid tissues from the same donor. After 30 months of function, both grafts were concomitantly rrjected. The prolonged parathyroid allograft survival described in certain experimental animals has been attributed to the tissue's being "immunologically privileged." Our current clinical observations do not support this hypothesis.


Abnormalities in organ blood flow and its distribution during positive end-expiratory pressure.

Current evidence is inconclusive regarding the possibility that positive end-expiratory pressure (PEEP) redistributes flow and may be directly responsible for systemic organ dysfunction. This study tests the hypothesis that PEEP may induce abnormalities in the distribution of cardiac output (CO). Eight anesthetized dogs were studied during (1) 0 cm H2O PEEP (Z1), (2) 15 cm H2O PEEP  (P), (3) Z2, and (4) bleeding (B) to reduce the CO to the same level as P. At each of the four periods, a different 15 mu radiolabelled microsphere was injected into the left atrium. Another four dogs were used to varify that each type of microsphere had the same flow distribution. CO fell from 3.1 liters/min to 1.9 during P (P smaller than 0.01) and to 2.0 during B (P smaller than 0.01). Mean arterial pressure (MAP) declined from 102 to 83 mm Hg (P smaller than 0.01) and 86 mm Hg (P smaller than 0.01(, respectively. Left atrial pressure (LAP) rose from 5.0 to 7.9 mm Hg during P (P smaller than 0.01) and fell during B to 2.7 mm Hg. c0 and its distribution were the same during Z1 and Z2. P caused selective reductions in hepatic (52%), adrenal (25%), and bronchial (24%) blood flows (P smaller than 0.01). In contrast, total flow to these  organs during B was the same as during Z. Total renal flow was unchanged by P or B, but the cortical:medullary flow ratio increased during P from 24 to 49 (P smaller than 0.01) and was unchanged by B. P induced a decrease in fundal nucosal flow as compared with Z (P smaller than 0.01). Total coronary flow fell from 100 to 64 ml/min during both P and B (P smaller than 0.01). P led to a selective fall in subendocardial flow (67 ml/min X 100 gm) as compared with B (82.5 ML/MIN X 100 gm, P smaller than 0.01) as well as in the subendocardial:subepicardial flow ratio (1.069 vs. 1.112 ml/min X 100 gm, P smaller than 0.05). It is likely that the higher left ventricular filling pressure (LAP) during P as compared with during B compressed the endocardium and induced relative ischemia. Similarly the high airway pressure during P may have impeded bronchial mucosal flow. The causes and consequences of the other P-induced variations in flow are speculative.


Valentine Mott (1785-1865), the father of American vascular surgery: a historical perspective.

Valentine Mott was one of the most eminent physicians of the first half of the 19th century. Recognized as a pioneer vascular surgeon, he is credited with having performed at least eight original surgical procedures. Included within his lifetime operative record are ligations of the innominate artery, the common and external carotids, the right subclavian artery, the common, external and internal iliac arteries, the femoral artery, and the popliteal a;tery for the treatment of aneurysmal disease. In addition, he was highly regarded for his innovative approach to venous problems. This is most remarkable in that all of this work was done prior to the discovery of anesthesia, antisepsis, and the use of transfusions. Through research, utilizing primary archival and secondary source material in the form of previously unpublished manuscripts, correspondence, and background information, a biography of his life is presented. When his many surgical successes are placed in proper historical perspective, Valentine Mott can truly be called the Father of American Vascular Surgery.


Management of of arteriosclerotic aneurysm of the innominate artery.

Arteriosclerotic aneurysm of the innominate artery is an unusual lesion. A review of the literature has revealed many approaches to this problem in the past, but the mortality rate has remained significant and serious complications have been frequent. Computerized axial tomography and noninvasive cerebrovascular methods can be useful in managing this lesion. Vein grafts from the ascending aorta to the common carotid and subclavian arteries were used to revascularize a patient following resection of an innominate aneurysm.


Results of renal transplantation using pediatric cadaver donors.

In order to determine the results of transplantation using pediatric cadaver donors, a retrospective analysis of a series of 502 renal transplant recipients was carried out. Methods of procurement, preservation, recipient selection, and immunosuppressive regimen were similar for all patients. Sixty-five recipients were approximately equally divided into three groups whose donors were younger than 5 years of age, 6 to 10 years old, and 11 to 15 years. These three groups then were compared with each other and to a randomly selected representative group of recipients whose donors were adults (16 years or older) for the following parameters: actuarial graft and patient survival, causes of graft failure and patient death, level of serum creatinine in currently functioning grafts, and recipient age. There were no statistically significant differences between groups for any parameter except that the mean age of recipients was approximately 16 years for the donors up to 5 years of age and was between 31 and 36 years for the other donor age groups (P = 0.01). These results support the contention that brain-dead pediatric patients of any age should be considered to be potential cadaveric kidney donors. Exclusion of these patients is very wasteful and also is unnecessary since results of transplantation equal to those obtained with adult donors can be expected. Technical graft failures should not be more frequent than with adult kidneys, and there is no need to modify the basic surgical technique for small kidneys in order to achieve this.


Abdominal aortic salmonellosis.

A recent example of Salmonella mycotic abdominal aortic aneurysm is presented together with a review of the 24 other cases in the literature. Emphasis is placed on common modes of presentation, diagnosis, and surgical management. A review of current theories of etiology is presented along with a new, more descriptive classification of mycotic aneurysms.


The therapy of otitis externa.

The clinical findings following the instillation of an aqueous solution containing natamycin, neomycin and hydrocortisone into the ears of dogs exhibiting the signs of otitis externa are described. Out of a total of 143 cases, 50 were also examined microbiologically both before and after treatment in order to evaluate the antibacterial and antifungal properties of the solution. The severity of the complaint appeared to be of little significance as far as the respons is concerned. A favourable response was noted clinically in 95% and microbiologically in 86% of the cases treated.


Alveolar macrophage function in nickel dust exposed rabbits.

8 rabbits were exposed to metallic nickel dust (2 mg/m3, of which about half was respirable) for 4 weeks. The lungs were lavaged and the macrophages were collected. In comparison with 8 control rabbits, a significant increase was noted in the nickel exposed rabbits as concerned the weight and density of the lungs, the size variation of the lung cells, the phagocytosis of silver coated particles, and the metabolic activity as measured by NBT reduction. The last mentioned increase was recorded during basal conditions as well as during phagocytosis. The NBT reduction during phagocytosis was significantly correlated with the degree of phagocytosis of silver coated particles in both control and exposed rabbits. It is suggested that the exposure to nickel dust has unspecifically activated the macrophages perhaps by increased production of phospholipids.


[The value of the gingival cytogram for the evaluation of hormonal contraceptives].

The results obtained from the cytological examination of gingival smears taken during one cycle demonstrate that the effect of the depot contraceptive Deposiston on the gingivae is measurable.


[Evaluation of therapy with removable cast partial dentures. 2. Faulty design as a cause of therapeutic failure].

On the basis of follow-up examinations in patients with removable cast partial prostheses, the author points to ill-designed construction forms that are conspicuous above all by their supporting elements and denture bases.


[Inlays as support for removable cast partial dentures].

On the basis of follow-up examinations in patients with removable cast partial prostheses, the author emphasizes the necessity of placing inlays as interlocks on abutment teeth, and he gives advice on inlay designs which are in conformity with prosthetic therapy.


[The prosthesis hygiene index--a method for documentation and health education].

The microbial plaques retained in the unphysiological space between oral mucosa and denture base in case of unsatisfactory denture cleaning are always an inflammation factor that is of particular importance from the viewpoints of pathogenesis and therapy. The described denture hygiene index has been developed for the objective evaluation of denture uncleanliness and of the efficacy of hygiene measures.


[New aspects of therapy for alveolitis with Grisaldon].

In the GDR, Grisaldon has been used in alveolitis therapy since 1974. The results from the bacteriological testing of this preparation and the diluting and rinsing effects of saliva and blood on it arouse doubts about its antibacterial efficiency. Thrombelastographic studies demonstrated the clotting-accelerating and the marked fibrin-stabilizing effect of pure acetylsalicylic acid. In contrast to other publications, it was stated that the p-hydroxybenzoic acid propyl ester is absolutely indifferent. Histological studies on animals have shown that Grisaldon is detectable in the alveolus as a foreign body even 28 days after application, and that it decelerates wound healing.


[The effect of hormones on the periodontal condition--clinical studies on 300 female patients].

In this study 300 women (100 pregnant women, 100 women taking contraceptives and 100 women without contraceptive medication) were examined, recording the periodontal condition (using a computer-orientated chart) and the periodontal index according to Kötzschke. The values for the total index and the superficial and deep components of the index according to Kötzschke, the pocket depth and the degree of tooth mobility (determined for each tooth) were significantly higher in women under contraceptive medication than in the control subjects.


A bibliography of suicide notes: 1856-1979.

A bibliography of suicide notes, arranged chronologically, from 1856 to the present (1979) is presented without comment.


Aphakic glaucoma.

The cause of aphakic glaucoma should always be determined because treatment must be directed towards the aetiological mechanism. We have defined early aphakic glaucoma as that occurring within the first 6 postoperative weeks and late aphakic glaucoma as occurring at any later time. Of the various causes of glaucoma in each category, among the most serious and challenging to treat are pupillary block and angle closure. These emanate from postoperative shallow or empty anterior chambers which are associated with wound fistula, choroidal detachment, or a combination of both. Other mechanisms producing aphakic glaucoma are inflammation, alpha chymotrypsin, epithelial downgrowth, and iris cysts. Pressure elevation unrelated to aphakic glaucoma may also result from intraocular tumours, recurrence of glaucoma secondary to uveitis, and undiagnosed preexisting primary glaucoma.


Management of trauma of the anterior segment.

Since the introduction of the operating microscope the technique of wound repair has improved from purely reconstructive to preventive principles. In dealing with severe injuries of the anterior segment, the performance of vitrectomy seems to be the main problem. Secondary damage of the vitreous base has to be avoided, especially in children and juveniles. Prophylactic measurements against retinal detachment has proved to be useful. Using a light interference technique, the mode of action of different cutting instruments in the vitreous can be demonstrated. The guillotine technique seems to have the least distant effect. The scheme of surgical treatment has to be adapted to the individual situation and to the capability of the surgeon.


Ocular penetration of hydrocortisone and dexamethasone into the aqueous humour after subconjunctival injection.

The concentration of steroids in the aqueous humour was measured at various intervals after subconjunctival injection in a series of 130 patients of both sexes who came to cataract extraction. Both hydrocortisone acetate (0.5 ml of 2.5 per cent solution) and dexamethasone sodium phosphate (0.5 ml of 0.4 per cent solution) attained a peak concentration in the aqueous of 214.4 and 268.0 micrograms/ml respectively within 10 minutes. Dexamethasone was from 30 to 47 times more effective than hydrocortisone for up to 24 hrs, but the latter provided a reasonably high concentration for up to 7 days.


Primary repair of eyelid lacerations.

A brief outline of the principles of repair of eyelid wounds is given. The undesirable consequences of inexpert primary repair are contrasted with the near normal function and cosmesis obtained after repair carried out with the author's 5-layer suturing technique described here for the first time. It is emphasized that, provided there is no ocular perforation, waiting up to 48 hours to obtain optimal conditions for the operation does not affect the outcome.


Specific and nonspecific cytotoxicity of leukocytes from human renal allograft recipients against donor fibroblasts.

A microcytotoxicity assay was used to search for cell-mediated cytotoxicity, serum-blocking factors, and antibody-dependent cell-mediated cytotoxicity (ADCC) against fibroblasts of donor origin in 19 human renal allograft recipients. Peripheral mononuclear cells (PMC) were frequently cytotoxic when they were obtained within 6 days prior to rejection, following sustained rejections, and within 1 month after removal of rejected grafts, but the toxicity was usually nonspecific. Recipient PMC were noncytotoxic when they were obtained within 6 days after the onset of an acute reversed rejection and during quiescent intervals when there was no evidence of rejection within 6 days before or after the assay. These data suggest that, regardless of its lack of specificity, there is some relationship between cytotoxicity of recipient PMC and allograft rejection. In none of 69 post-transplant serum samples was ADCC against donor target cells detected with the microcytotoxicity assay.


Antibodies directed against antigens on the endothelium of peritubular capillaries in patients with rejecting renal allografts.

This study was undertaken to examine the humoral immune response against endothelial antigens of the donor kidney in human renal allograft recipients. Sera from 61 transplant recipients who received 62 grafts were studied for the presence of circulating endothelial antibodies (CEAb) using an indirect immunofluorescence technique with a pretransplant biopsy of the graft as a substrate. IgG antibodies directed against the endothelium of peritubular capillaries were found in the sera of 6 of the 10 patients with graft rejection within 7 weeks after transplantation, whereas these antibodies were not found in the absence of rejection (P less than 0.001). Immunofluorescence studies of post-transplant biopsies showed IgG along the endothelium of peritubular capillaries only in the grafts of patients with CEAb. Eluates from these grafts contained IgG antibodies that bound to the endothelium of the donor as shown by the indirect immunofluorescence technique. Absorption of endothelial antibody (EAb)-positive sera with human platelets or Wistar strain rat erythrocytes showed that the EAb were not directed against serologically defined HLA antigens or against heterophile antigens on rat erythrocytes. We conclude from this study that the presence of antibodies directed against endothelial antigens is associated with poor graft prognosis and that these antibodies may be responsible for the rejection process.


Tolerance to non-H-2 histocompatibility antigens. Transplantation tolerance to the H-4 and H-7 histocompatibility antigens.

There have been several reports of observations which suggest that transplantation tolerance may be a result of positive immunoregulation rather than simply unresponsiveness attributable to a lack of competent effector cells. In particular, several investigators have reported that tolerance of the H-Y and H-1 histocompatibility antigens is mediated by a population of thymus-derived lymphocytes. In a companion report, we have presented evidence that supports the existence of a suppressor cell to the H-Y antigen. Furthermore, we have observed that female mice rendered tolerant of the H-Y antigens by neonatal exposure to male lymphoid cells or by multiparity accept male skin grafts indefinitely, but inactivate male peritoneal exudate cells (PEC) in a second-set fashion. This observation has led us to investigate whether tolerance of other non-H-2 antigens is controlled by a similar mechanism. Using mice congenic with C57BL/10 at the H-4 and H-7 loci, we have shown that mice rendered tolerant of the H-7a and H-4b antigens by neonatal exposure to histoincompatibe lymphoid cells are incapable of rejecting either skin or peritoneal cell allografts, suggesting that identical histocompatibility antigens are present on skin and peritoneal cells. Tolerance induced in neonatal mice to the H-4b and H-7a antigens could not be adoptively transferred to syngeneic recipients. These results suggest that tolerance involving the H-4 and H-7 antigens is most likely because of a clonal inactivation of alloantigen-reactive cells as a consequence of neonatal exposure to antigen.


Cryopreservation of human lymphocytes: a brief review and evaluation of an automated liquid nitrogen freezer.

Successful cryopreservation of human lymphocytes has been previously described. Cryopreserved lymphocytes are useful for a variety of in vitro immunologic studies. This study was performed to determine the applicability and/or advantages of using a programmable freezing system, and compares glycerol versus dimethyl sulfoxide (DMSO) at varying concentrations on post-thaw viability, E-rosetting and immunoglobulin fluorescence. Prefreeze T and B lymphocyte percentages were determined. Cells were then frozen in varying concentrations of glycerol and DMSO. Optimum cryoprotectant type and concentration was determined. Lymphocytes from seven individuals were frozen by the batch method in a mechanical freezer and with the automated liquid nitrogen injection system. Data on post-thaw T and B percentages and viability revealed 10% DMSO and liquid nitrogen control freezing method at 1 C/minute as the best conditions for lymphocyte preservation as reflected by post-thaw in vitro testing.


Long-term cadaver allograft survival in the recipient with a positive B lymphocyte crossmatch.

Over a 2 1/2-year period, prospective standard, T, and B lymphocyte crossmatches were performed in 45 cadaver renal transplants using the microlymphocytotoxicity technique. Twenty-three of the 45 recipients had a positive B lymphocyte crossmatch. Cumulative graft survival rates did not differ between recipients with a positive and negative B lymphocyte crossmatch. High levels of presensitization in routine lymphocytotoxic antibody screening or transplant number did not adversely affect graft survival in recipients with a positive B lymphocyte crossmatch. Five recipients had moderately positive standard crossmatches which were attributable to anti-B lymphocytotoxicity. Four of these five grafts are presently functioning with normal serum creatinine levels 9 to 14 months post-transplant. A positive B lymphocyte crossmatch is compatible with good long-term cadaveric renal allograft survival. In addition, a weakly positive standard crossmatch is not a contraindication to transplantation when the positive crossmatch is attributable to anti-B lymphocyte antibody.


Adverse presensitization to renal transplants. Detection by utilization of a D locus antigen-defined lymphoblastoid cell panel as targets in antibody-dependent cell-mediated cytotoxicity assays.

Sera obtained before transplantation from 52 consecutive renal allograft recipients were tested for antibody-dependent cell-mediated cytotoxicity (ADCC) and for complement-dependent cytotoxic antibodies (CDC). A D locus antigen-defined lymphoblastoid cell panel (B lymphoblastoid cell panel) was used as targets for the ADCC, and a peripheral blood lymphocyte (PBL) panel from 40 donors was used as targets for the CDC. Of the 343 ADCC assays, 118 of 168 performed with pretransplant sera from 24 recipients with early graft loss were positive, whereas only 81 of 175 performed with pretransplant sera from 25 recipients with a successful graft outcome were positive (P less than 0.001). A significantly greater degree of presensitization to the B lymphoblastoid cell panel was found in the group that lost their grafts as compared to the group with successful grafts (69% versus 49%, P less than 0.001). Sera from all six recipients with hyperacute rejection were positive in the ADCC before and after absorption with pooled platelets. In contrast, pretransplant CDC results were not predictive of ultimate graft outcome. Utilizing any level of cytotoxicity against the PBL panel as an index of adverse presensitization, no significant correlation between pretransplant CDC results and graft outcome was observed. These results suggest a prognostic role for ADCC using a B lymphoblastoid cell panel as targets to screen and identify high-risk potential graft recipients.


[Ultrastructural characteristics of the "light" and "dark" B-cells in the pancreatic islets of rats].

The ultrastructure of B-cells in the rat pancreatic islets has been studied under various experimental conditions (thyroidectomy, continuous thyroxine treatment, regeneration after partial pancreatectomy, thyroidectomy with partial pancreatectomy, partial pancreatectomy, partial pancreatectomy with continuous thyroxine treatment). Five types of B-cells have been distinguished. It has been supposed that "light" B-cell 1 is related to the stage of secretory granule extrusion, "light" B-cell 2 reflects the extrusion of secretory material and the early stages of secretory granule synthesis; "dark" B-cell 1 is involved in the intensive synthesis, formation and extrusion of secretory material, and "dark" B-cell 2 in the intensive secretory granule synthesis, formation and storage.


[Irreversibility of intestinal epithelium stem cell conversion into semi-stem enterocytes and the ability of the latter to reproduce themselves].

The analysis of literature experimental data on cell kinetics of the generating intestinal epithelium of rats and mice suggested the irreversibility of transformation of intestinal epithelium stem cells into non-stem proliferating enterocytes and the ability of the latter for self-reproduction. This property of half-stem enterocytes enabled us to assume that the daughter cells immediately after their appearance are always in the G1-phase of the mother cell mitotic cycle.


[Ultrastructural and autoradiographic analysis of the cellular reactivity of the exo- and endocrine epithelium of the frog pancreas under the action of cobalt chloride].

The frog pancreatic epithelium was studied using morphometry, autoradiography and electron microscopy during the treatment with cobalt chloride (10 mg/100 g body wieght). In response to this treatment, generative changes in some exocrine cells were revealed. At the same time, those of cells, whose nuclei were in the state of DNA synthesis, increased in number. Cobalt chloride resulted in endocrine A-cells damage. A compensation of the broken endocrine A-cell function was maintained in a transformation of the exocrine epithelium into endocrine A-cells and in the appearance of intermediate acinar-islet cells, as well as in islet A-cell hyperplasia.


[Cytofluorimetric study of the glycogen content in hepatocytes of varying ploidy in adult rats].

A combined method, that allows measuring glycogen and DNA contents in one of the same cell, was applied for quantitative determination of these in mono- and binucleate hepatocytes with different ploidy obtained from adult rats. The mean glycogen content was shown to increase proportionally to the genome number within the changes of the hepatocyte ploidy from 2 to 8c.


[Effect of histological processing on the nucleic acid, free nucleotide and protein content in the cranial cervical sympathetic ganglion].

By means of biochemical techniques, the stability of free nucleotide contents has been demonstrated in the rabbit sympathetic node fixed in the Carnoy solution for 1--2 hours at 4 degrees C. A 2 hour fixation at room temperature and at 37 degrees, however, results in a considerable loss of free nucleotides--of the total amount in the fresh ganglion tissue, resp., 66.6 and 74.5%. According to these data, the Carnoy solution can be successfully used for a quantitative precipitation of free nucleotides. A histological treatment of this Carnoy fixed sympathetic ganglion (for 2 hours, at 4 degrees) causes no losses of nucleic acids, free nucleotides or protein, does not affect RNA, DNA or protein contents, but leads, however, to a remarkable loss of free nucleotides--up to 45%.


[Nonhomogeneity of the distribution of the absorbing substance in cytophotometry].

Results of two-wavelengths cytophotometry may be used to calculate m--the quantity of light absorbing substance, and gamma--the degree of non-homogeneity of distribution of the substance on a preparation. Formula (1) is almost free from any distributional error. Optical density limits of applicability of formula (3) for gamma are shown on fig. 2. An algorithm for calculation of gamma at higher optical densities is proposed.


Nontraumatic rupture of renal allografts.

Eight cases of nontraumatic renal allograft rupture were identified in 237 renal transplants performed at UCLA Medical Center. Careful clinicopathologic studies in these patients suggest three principal underlying causes: major graft vessel occlusion, hyperacute or accelerated rejection, and acute rejection. The clinical and pathologic features of these various categories are compared and contrasted.


Use of pre-existing ureterocutaneous anastomosis as conduit in renal allotransplantation.

This report details 2 patients with unusable bladders whose renal allografts were anastomosed to an existent end cutaneous ureterostomy. The literature on renal allotransplants into intestinal conduits is reviewed. Use of existent, mature end cutaneous ureterostomies is suggested as an alternative to an intestinal conduit in patients with unusable bladders who require renal allografts.


Genitourinary leiomyomas.

Leiomyomas may originate from any anatomic location of smooth muscle in the genitourinary system but are uncommon neoplasms. Five unusual cases of leiomyomas arising from the renal pelvis, bladder, spermatic cord, and glans penis are presented. The leiomyoma arising from the glans penis in a three-year-old boy is the first case of a leiomyoma in that location noted in the literature. A review of leiomyomas from each genitourinary structure of origin is presented.


[Open dislocations and fracture-dislocations of the hand and their treatment].

The authors have studied the results of the treatment of 16 cases with fractures and fracture-dislocations of the hand. The indications for an early and delayed surgical treatment are set forth. The surgical tactics and methods of treatment depending on the type of injury are described.


[Use of a rotation flap from tissues of the preauricular region and lateral surface of the neck for closing a penetrating defect of the cheek].

The authors use the rotational flap tranfered from the lateral surface of the neck, with one-stage epithelization of the wound surface from the side of the mouth cavity with a split skin graft, to correct the postoperative penetrating defect of the cheek. The necessity of a thorough fixation of the skin graft on the wound surface emphasized.


[Role of prolonged peridural anesthesia in the complex of therapeutic measures after operations on the gastrointestinal tract].

On the grounds of an analysis of 577 observations over postoperative longlasting peridural anesthesia its favorable effect upon the gastrointestinal function and upon the prevention of postoperative pulmonary complications has been shown. The importance of an individual approach to the indications of peridural anesthesia in the postoperative period is emphasized.


[Disorder of the rheological properties of the blood as a risk factor in interventions on the abdominal aorta and its branches].

102 patients with abdominal aorta and its branches atherosclerotic injuries of various forms and localization have been studied. The patients have showed significant disturbances of the rheologic blood properties which aggravate during the surgical treatment and play a big part in the development of postoperative thrombotic and microcirculatory complications. An outline of the correction of hemorheologic disorders allowing to diminish the number of complications and to improve the results of the treatment of this pathology is devised and set forth in this work.


[Errors in the treatment of combined injury to the flexor tendons nerves of the fingers and hand].

An analysis of errors in the treatment of combined traumas of the flexor tendons and nerves of the fingers and the hand in patients admitted for the restorative therapy of the Kazan Scientific Research Institute of Orthopedics and Traumatology within the period from 1969 to 1977 is presented. All the errors are subdivided into diagnostic errors, those due to the surgical technique, and connected with the rehabilitation period. A number of organizational suggestions are set forth on the grounds of the obtained findings.