[Comparison of the effects of lofepramin and mianserin in depressed patients in a double blind trial].

The therapeutic efficacy of two newly developed anti-depressants lofepramine and mianserin was compared in a double-blind clinical trial in 30 depressed inpatients. During the treatment period of 4 weeks the depressive symptoms assessed by the Hamilton Rating Scale for Depression decreased in both groups. In this trial a stronger influence of lofepramine on the factor 'retarded depression' could be demonstrated (p = 0.08). In addition lofepramine showed a significantly better reduction of anxious reactions than mianserin (p less than 0.01). Concerning tolerance, no difference between the two drugs was observed.


Imparied glucose tolerance in long-term lithium-treated patients.

The oral glucose tolerance test (oGTT) was performed twice in patients under long-term lithium treatment. Blood glucose and plasma insulin were determined. The oGTT results were evaluated by three criteria (Köbberling-Creutzfeldt, WHO, and Epidemiological Study Group of the European Diabetes Association) and were compared to two representative reference studies from normal populations. The frequency of impaired glucose tolerance in the patients was three times higher than expected on the basis of the studies on normal populations. The variability of the oGTT curves between the first and second tests as well as the steepness of the time-course of the 'insulinogenic index' suggested mild disturbances of carbohydrate metabolism (mild diabetes) in some of the patients. It is considered unlikely that the impairment of glucose tolerance in the patients was a direct pharmacological effect of lithium salts. The possible role of age, sex, manic-depressive disease, additional medication, and particularly obesity in the effects of long-term lithium treatment on glucose tolerance is discussed. The authors suggest that the oGTT should be carried out periodically in long-term, lithium-treated patients over the age of 40 years in order to detect abnormalities in their carbohydrate metabolism.


[Immunologic examination methods in dermatology diagnosis].

A survey is made of current usage of immunological test systems with regard to dermatology in general, and the practical importance of these techniques for the practizing dermatologist. Humoral and cellular immune systems are outlined; immunofluorescence, and determinations of cellular immune parameters are covered in more detail.


[Circulating immune complexes and necrotizing vasculitis].

55 patients with necrotizing and with various forms of lymphocytic vasculitis were investigated for the presence of vascular deposits of immunoglobulins (Ig) and C3 by immunofluorescence testing of skin biopsies and with a 125I-Clq-binding assay for the presence of circulating immune complexes. Vascular deposits of Ig and C3 were found frequently both in patients with necrotizing and with lymphocytic vasculitis. In contrast, C1q binding activity was found almost exclusively in sera of patients with systemic necrotizing vasculitis. With one exception, all sera with C1q binding activity were from patients with vascular deposits of Ig and C3. The implications of these findings for our understanding of the development of system involvement in necrotizing vasculitis are discussed.


[Is psoriasis an autoimmunologic disease?].

DThe defective function of T-lymphocytes, which is a finding in active psoriasis, is transitional and reversible, whereas the immunological mechanism is mainly related to the formation of immune complexes consisting of stratum corneum antibodies and stratum corneum antigen, which through binding of complement and activation of chemotactic complement components is responsible for the phenomenon of "squirting papillae". The earliest lesions preceding pin point papules, called pre-pin-point papules, were induced by stripping or developed spontaneously in a marked field closely observed for several days. In the changes preceding earliest psoriatic lesions. Abundant polymorphonuclear infiltrates are present, and polymorphs seem to play an important role in a selfperpetuating of disease process. The therapeutic implications of the immunologic studies in psoriasis are: either depletion of activated polymorphs (eg. continuous peritoneal dialysis) and/or removal of the factors responsible for their activation (eg. treatment of focal infections) or external use of the drugs affecting the antigenicity of stratum corneum (tars), or inhibition of exocytosis (a probable mechanism of puva).


[A new method for serologic detection of Treponema pallidum reinfection].

Sources of error in the detection of specific IgM-antibodies against Treponema pallidum could be overcome by the introduction of a new method for precise separation of immunoglobulins. The 19-S-IgM-FTA-ABS-test apparently permits a correct diagnosis of syphilitic reinfection. This method is not only specific but also earlier reactive than the VDRL-test. The short-time persistence of 19 S-IgM production after treatment and its renewed appearance enables for the first time a differentiation between treatment failure and reinfection.


Improved method for the cyanogen bromide activation of agarose beads.

The significant new feature of the procedure is the reaction control of the BrCN activation merely by the slow transit of BrCN from a dispersed organic phase to the aqueous phase containing agarose beads in concentrated buffer. The product thus obtained was applied in a model immunoaffinity chromatographic separation. Experimental conditions are given for the control of the degree of activation and of the multiplicity of attachment of the protein ligand, for optimizing the immunological reactivity of the immunosorbent and for minimizing leakage of covalently bound protein from the resin.


[Sequential test with clomiphene and LH-RH in cases of anovulatory sterility (author's transl)].

In sterile menstruating women with anovulatory cycle, the response of plasmatic gonadotropins and urinary total Estrogens and Pregnandiol to the administration of Clomifene and LH-RH in a sequential test is studied. Five different types of response, similar to those detected in previous studies using the LH-RH test, are identified; in them, uniformity in the response of gonadotropins exists to both LH-RH and Clomifene. The results obtained seem to confirm the existence of diverse etiopathogenic mechanisms in the alterations of the Hypothalamus-Pituitary-Ovarian axis resulting in anovulatory cycle.


[Tuberculosis of the breast. A revue of the literature in connection with a personal case (author's transl)].

The authors, having had a personal case that they report, have carried out a general review of tuberculosis of the breast. It is a rare affection which usually attacks women during reproductive life, mainly because of the influence of hormones on the condition. Clinically it is difficult to differentiate it from cancer and it can present in two forms, a superficial and a deep one, a diffuse one and a circumscribed one. All the same, there is a definite feature which is fistula formation. The diagnosis depends on the biopsy, which shows specific histological lesions, and on the bacteriological examination, which shows the Koch's bacillus. Mammography is not very characteristic and thermography is of too recent appearance. Treatment consists in anti-tuberculous chemotherapy at first, surgery being reserved for residual lesions.


A description of the DAVID interactive instructional television system and its application to post-high school education of the deaf.

This describes the unique DAVID instructional system, which merges motion, color, and audio capacities from instructional television with individualized student interaction, answer analysis, immediate reinforcement, individualized lesson content, branching, and data gathering from computer-assisted instruction. DAVID (Digital And Video Interactive Device) instruction includes drill and practice, tutorial, and dialogue strategies based on existing and new TV lessons. The system was created for the National Technical Institute for the Deaf by Dr. vonFeldt and was operational in November 1977. This paper includes (1) a description of deaf student needs, which were the basis for system development; (2) description of the completed prototype (DAVID); and (3) results of preliminary testing of the system with deaf students.


Medical applications in the TANDEM-16 multiple computer system environment.

This paper addresses the question of reliability and the TANDEM-16 approach to facilitate reliable computers. Specifically, the use of the TANDEM-16 within the medical environment is described. Three current applications within the Medical Computing Resources Center at The University of Texas Health Science Center at Dallas are developed, each characterized by different reliability considerations.


Cranial defects repair by replacing bone flaps.

The Authors, after few historical remarks, discuss the indications and the contra-indications for cranioplasty. Although, in the last 30 years, various materials and techniques have been investigated and proposed, the Authors suggest, as method of choice, the reimplantation to each patient of his own volet, when possible, to repair skulls defects. This technique in fact permits to restore an almost normal physiological condition of the cranial vault functions. In the light of the recent researches on the "bone induction principle" and on the possibility of storing at a temperature of -30 degrees C in a freezer the bone flap in ideal condition before the reimplantation, this method is proposed again. The Authors report their experience on 15 patients, 13 of whom have been successful; a perfect aseptic storage, a rational choice of the patients who should be treated and a correct surgical approach are underlined as mandatory for the successful use of the technique. The mean follow up for the 13 successful patients is 15 months. In the paper the 2 unfavourable cases are discussed too: the hypothetical causes which lead to reject of the reimplants are suggested and debated.


Behavioral medicine approaches to hypertension: an integrative analysis of theory and research.

This article compares behavioral and biological approaches to hypertension, highlights some of the practical, semantic, and theoretical issues involved, and attempts a constructive, behavioral medicine integration of these approaches. The major behavioral approaches to hypertension are described, with a focus on their conceptual limitations as stimulants to research into psychobiological mechanisms. A biobehavioral systems analysis of hypertension is outlined, emphasizing the role of the central nervous system as a common pathway relating environmental and behavioral factors to cardiovascular regulatory dynamics and disease. Schwartz's concept of blood pressure disregulation is discussed, by which behavioral "feedback loops" may be included in the pathogenesis of homeostatic disorders. A detailed discussion of concepts underlying the clinical pharmacological approach to hypertension is provided; parallels are drawn between the conceptual framework and the theoretical and practical questions facing behavioral researchers concerned with hypertension. Synergistic interactive effects of drug and behavioral treatments are proposed. A biobehavioral overview, which links pressor and depressor stimulus patterns to both pathogenesis and therapy, can serve to integrate the previous biobehavioral systems analysis, the conceptual framework of clinical pharmacology, and the notion of biobehavioral disregulation of blood pressure. Implications for future behavioral medicine research in hypertension are provided.


Effect of prolonged uremia on insulin metabolism by isolated liver and muscle.

As the prolonged metabolic clearance rate of insulin in chronic uremia cannot be entirely explained by impaired removal and degradation of insulin by the kidney, we set out to determine whether prolonged uremia depresses other major sites of insulin degradation. The study was conducted with livers and skeletal muscle obtained from normal control rats and uremic rats 4 weeks after 80% nephrectomy. Despite a significant difference between renal function in the control and uremic rats (BUN, 18 vs. 46 mg/dl), there was no significant difference in the clearance of insulin by isolated uremic or control livers perfused with a bloodless medium. Similarly, the 125I-insulin degrading activity of liver homogenates was not depressed by uremia. In contrast, binding and degradation by uremic liver cell membranes was significantly reduced to 58% and 85% of the controls, respectively. Degradation by homogenates of skeletal muscle and by intact epitrochlaris muscle was significantly less in uremics than in controls. These results indicate that chronic uremia depresses skeletal muscle insulin degradation but not hepatic insulin removal or degradation despite a decrease in insulin binding and degradation by liver plasma membranes. It thus appears that depression of insulin degradation by muscle may contribute to the prolonged insulin metabolic clearance rate seen in chronic uremia. Furthermore, it is possible that the impaired binding of insulin to liver membranes may play a role in the insulin resistance of uremia.


Sodium-chloride-induced protection in nephrotoxic acute renal failure: independence from renin.

It has been shown that the severity of experimentally induced acute renal failure (ARF) is inversely related to dietary sodium chloride intake, and the effects have been attributed to the concurrent changes in renal renin. In the current study, renal renin of rats was increased by chronic sodium deprivation and decreased by chronic sodium loading and DOCA administration. In two nephrotoxic models (mercuric chloride, uranyl nitrate), giving previously sodium-deprived rats 1% sodium chloride to drink for 48 hours prior to ARF induction greatly attenuated the severity without any reduction in their high renal renin. Conversely, giving previously sodium-loaded rats tap water to drink for 4 to 5 days prior to AFR induction greatly enhanced the severity without any increase in their subnormal renal renin. Therefore, the changes in severity of ARF resulting from changes in dietary sodium are not mediated by changes in renal renin. Significant inverse correlations were found between mean peak BUN values during the follow-up period (5 to 7 days) and the 24-hour urinary sodium excretions prior to ARF induction in both models, suggesting that sodium intake and/or excretion at the time of induction is a good predictor of the severity. The effects of sodium chloride in both models were predominantly expressed during the maintenance phase, and consisted of attenuation of the severity (both models) and hastening of the recovery (mercuric chloride model). Possible mechanisms by which dietary sodium produced its effects, independently of its effects on the renin-angiotensin system, are discussed.


Glomerular deposition of complement-control proteins in acute and chronic glomerulonephritis.

Acute poststreptococcal glomerulonephritis (AGN) differed from membranoproliferative glomerulonephritis (MPGN) and lupus nephritis (SLE) in that two of the proteins that control the C3b-dependent convertase, beta 1H and the C3bC4b-inactivator cofactor (C3bC4bICo), were frequently absent from the glomerular deposits. In addition, factor B was distributed with C3 in the capillary walls in hypocomplementemic AGN patients. From this, it can be assumed that C3bBb is in the deposits, uninhibited by control proteins as would be predicted for alternative pathway activation. Factor B could not be found in normocomplementemic AGN, was rarely present in MPGN, but was usually present in SLE, most often in the mesangium. In MPGN and SLE, the control proteins were nearly always present in the glomeruli in a distribution like that of C3; IN MPGN they were particularly abundant. Complement profiles indicated an occasional transient reduction in serum C4 level early in AGN. Thus, although there is occasional evidence of early classical activation in AGN, more characteristic is a long period of alternative activation. Serum levels of control proteins did not deviate greatly from normal except for reduced serum beta 1H levels in MPGN type I.


Editorial review. Recent formulations of the urinary concentrating mechanism: a status report.

The status of the purely passive mode of solute concentration as of 1979 appears to be similar to that of the original countercurrent hypothesis 10 years ago. The passive mode concept has advanced our understanding of the concentrating process by qualitatively incorporating the permeability characteristics of tubule segments and the lack of an active transport process in the thin loop of Henle into a mechanism which has attractive economy and explanatory value. But in the final analysis some assumptions are not borne out by experimental findings (for example, the high urea concentration of fluid in the rat and hamster end-descending limb; the likelihood of net transepithelial addition of sodium chloride to the Psammomys descending limb; the removal of sodium chloride from the hamster ascending limb against an apparent electrochemical gradient under certain circumstances; and the osmotic lag between vasa recta blood and interstitium in the rat). Furthermore, when the known permeability and transport characteristics of the renal tubule are incorporated into a mathematic model of the passive operating mode, numerical simulations fail to establish a progressively hyperosmotic inner medulla. This does not rule out the applicability of the more general model (Eq. 1), particularly if evidence for some form of active transport in the inner medulla, heretofore lacking, is forthcoming.


[Concise review of progress in the management of perforating injury (author's transl)].

Improvement in the management of perforating injuries has become possible since the successful control of infection. However, the decisive step ahead was accurate suturing. The use of finer needles and of thinner, standardised suture material enabled accurate adaption of the margins and closer suturing. The anterior chamber could now be filled with air, thus preventing contact between iris and cornea. Development of new instruments enabled simultaneous management of haemorrhages and of injuries of the lens and vitreous body. Prolapse of iris without essential damage to the iris could be reduced either by limbal puncture or by intensive rinsing with fluid, proceeding from the edges of the wound. Parallel to the successful management of lens injuries a more radical form of vitreous surgery developed without significantly increasing surgical trauma. In Birmingham, during 1950--1958 45% of the patients with perforating injury of the anterior segment--including injury of the lens or iris--achieved a visual acuity of 6/12 or better. During 1971--1974 the corresponding percentage was 62% at the same clinic.


[Vitrectomy under optical observation (author's transl)].

Slit lamp biomicroscopy without contact lens is achieved by upright Gullstrand fundus microscopy. The controlled angulation of the slit beam makes it possible to measure the position of objects in the vitreous cavity by correction of object and image points. This form of stereotaxis is used for guiding the laser beam in the fundus.


Prognosis, trend and prediction in patient management.

A survey was conducted to get to know the 'state of the art' in trend prediction as a basis for optimal therapy, with emphasis on research being done in the countries of the European Community. Special areas of interest are quantitative prognosis (prognostic indices), the detection and use of trends in the patient's state, the use of models in prediction and their possible use for deciding which therapy is optimal for a specific patient. An extensive list of centres working in these fields as well as an extensive reference list is included.


Properties of epithelial cells cultured from human carcinomas and nonmalignant tissues.

Human epithelial cell cultures were examined for expression of plasminogen activator and fibronectin matrix. All of the cells examined showed ultrastructural evidence suggesting their epithelial origin, including microvilli and specialized junctions. The nonmalignant cells were also negative for endothelial cell markers (ie. they lacked factor VIII antigen, a nonthrombogenic surface and Weibel-Palade bodies). The nonmalignant lines all produced large amounts of plasminogen activator, whereas the tumor-derived lines showed a gradation of activities, ranging from lines having as much activity as the nonmalignant lines to lines having little or no activity above background. For both normal and malignant cells, addition of dexamethesone only slightly decreased the levels of plasminogen activator. By immunofluorescence microscopy, normal bladder and fetal intestine epithelial cells showed fibronectin in a globular and fibrillar matrix. In contrast, normal mammary epithelial cells had a much diminished amount of fibronectin with a punctate distribution.


The detection, immunofluorescent localization, and thrombin induced release of human platelet-associated fibronectin antigen.

Platelets are cells which develop adhesive properties following stimulation. Since fibronectin (fn) mediates adhesive properties of several cells, we sought evidence for platelet associated fn. Lysates of suspensions of washed human platelets containing less than or equal to 50 ng soluble fn/10(9) cells contained 2.85 micrograms fn antigen per 10(9) cells. The platelet fn antigen competition curve showed a similar slope to the curve for purified plasma fn suggesting antigenic identity. Immunofluorescent staining for fn was minimal in intact cells suggesting that the majority of fn antigen is intracellular. In permeable platelets, fluorescent staining for fn was seen in a punctate distribution suggesting a granule localization. Stimulation of platelet secretion by thrombin released platelet fn antigen. Suramin, a drug which inhibits platelet secretion, inhibited fn release. The apparent secretion of platelet fn, taken with the immunofluorescent data, support the localization of a portion of platelet fn antigen in a storage granule.


Growth control by cell to cell contact.

Control of cell growth by cell to cell contact is reviewed with particular emphasis on two systems--contact inhibition of growth observed with Swiss 3T3 cells and the mitogenic stimulation of Schwann cells by dorsal root ganglia neurites. In both cases the biological effect can be reproduced by the addition of surface membranes to the corresponding cells. In the case of contact inhibition of 3T3 cells, biological activity appears to correlate with membrane binding to the cells. An octylglucoside extract of 3T3 plasma membranes retains the biological activity (growth inhibition) of the original membranes.


[Endoscopic control of esophago-gastric sutures after superior polar resection. Advantages of the Lortat-Jacob reconstruction technic].

The results of superior polar resection carried out for benign and malignant lesions of the lower 3rd of the oesophagus and cardias were controlled endoscopically. Cure time, elasticity, suture function and the onset of complications were assessed in relation to the technique employed. It is known that the most important late complications in this surgery are, apart from recurrences, cicatricial stenosis, perianastomotic granulomas and, particularly, serious oesophagitis secondary to reflux. It is concluded that Lortat-Jacob valvular anastomosis gives the best immediate and long-term results because of its good elasticity and anastomosis function; there are almost never any problems connected with the presence of reflux, which is so important and invalidating for patients operated on with other techniques.


[Biliary ileus. Considerations on 7 cases].

A review of the recent literature is accompanied by the presentation of 7 cases of biliary ileus. Enterolithectomy, repair of the fistula, and cholecystectomy were carried out during the same operation in 2 cases, and it is felt that this form of management should be used more often in selected and suitably prepared patients.


Screening for rubella antibodies by a single radial haemolysis test.

A commercially produced single radial haemolysis (SRH) test for rubella antibodies was compared to the standard haemagglutination inhibition (HAI) test. There was a generally good correlation between haemolysis zone and HAI titres except for a few small and intermediate zones of haemolysis which were not dependable. The haemolysis was determined by the presence of rubella antigen. The SRH test is technically simple and can be recommended for screening programmes. IgM antibodies could not be detected by SRH.


A comparison of the in vitro activity of a new cephalosporin, cefuroxime, and cephalothin against 810 clinical isolates.

810 strains of eight species: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis, Escherichia coli, Klebsiella sp, Enterobacter sp, Proteus mirabilis and Proteus vulgaris, were tested by the disc diffusion method against cephalothin and cefuroxime. The activity of the two drugs was comparable to S aureus and S epidermidis, and a little in favour of cefuroxime regarding S faecalis. Cefuroxime turned out to be superior to cephalothin against the gram negative rods investigated. This pattern was most pronounced when Enterobacter was investigated.


[Liquid silicones in reconstructive surgery of the tendons. Experimental studies].

The results of reconstruction of flexor tendons of the hand are not satisfactory despite many operative methods. Since 70 years different surgical methods were described from which only some found application and some are tested up to day. The classical surgical methods do not prevent adhesions of tendons to the surrounding tissues. Therefore studies were undertaken to proof the usefullnes and the specific properties of silicone fluids in the reconstructive tendon surgery. Examinations were done on 48 mongrel rabbits of both sexes on surgically exposed tendon of the gastrocnemius muscle. The animals were divided into two groups. In group I the tendon of the right extremity was covered with Medical Fluid 360, and in group II - with Silol F 350. Each group was divided into two subgroups. In subgroups IA and IIA the tendinous sheath was removed whereas in subgroups IB and IIB the tendon was also cut and sutured. The silicone fluids were spread in amount up to 1 ccm, and uniform coat on tendon surface resulted. On the left tendons 0.9% natrium chloride solution was spread for control. In both groups the dissections were performed 14, 30, 90, 180 days after the operation. The following criteria were applied to evaluate the results: - the appearance of extremities, the range of motility in knee and ankle joint, wound healing, - the macroscopic appearance of isolated tendons, - the degree of excursion measured in millimeters, - the appearance and degree of adhesion between the tendon and surrounding tissues. 800 histological preparations were made. They were evaluated in biological microscope with special attention to the dimension of tissue reaction. In histological examinations the differences in tissue reaction were stated between subgroups A and B of both groups. However, no differences were found dependent from the applied silicone in groups I and II. In the early period, around the siliconized tendon poorly cellular, not significant exudative reaction was found. This reaction changed afterwards into proliferative one, which led to the development of a new tendon sheath. These changes did not discriminate distinctly the flexibility of the examined tendon. After applying 0.9% natrium chloride solution to uncovered tendon (control), adhesions of the tendon to surroundings were observed, which resulted in discrimination of tendon's flexibility. It was proved that silicone fluids applied to the sutured tendon (groups IB and IIB) did not handicap the healing process. The peritendinous adhesions were more intensive around the tendon's anastomosis than in the remaining tendon part. These adhesions were significantly smaller in comparison with the control extremities whose tendons were covered by0.9% natrium chloride solution. The application of small quantity of silicone fluids according to both up to day and own investigations do not cause local or general pathological changes...


Experimental dermatoplasty of skin defects with an absorbable bioplastic preparation.

Experimental dermatoplasty was performed with fibrin sponge preparation in the rabbit, during the course of which the whole skin thickness was substituted. The fibrin sponge was fixed to the skin-edges with surgical adhesive. The gradually absorbed fibrin was replaced by the migrating epithelium such that epithelization developed gradually. In special cases this method can be recommended for clinical purposes.


Summary of laboratory studies on the antibacterial activity of cefaclor.

Laboratory aspects of cefaclor, a new orally-effective cephalosporin antibiotic, are summarized. On the basis of data from a variety of studies, the useful antibacterial spectrum of cefaclor is shown to include all classes of bacteria that are generally susceptible to cephalothin and cephalexin. Against many Enterobacteriaceae, Haemophilus sp. and Streptococcus pneumoniae, cefaclor has a significant potency advantage over cephalexin. Bacteria that are susceptible to cefaclor are killed by concentrations at or near the inhibitory concentration. In vitro enzymatic hydrolysis experiments have shown that cefaclor is a relatively good substrate for several beta-lactamases. Orally administered cefaclor is effective in protection of mice from the lethal effects of intraperitoneal challenges with cefaclor-susceptible bacteria. The chemical instability of cefaclor, test medium composition and inoculum density influence the results of in vitro susceptibility tests with cefaclor. Methods for routine susceptibility testing are described.


Cefaclor compared with amoxycillin acute otitis media with effusion: a preliminary report.

A double-blind, randomized clinical trial comparing cefaclor with amoxycillin in the treatment of acute otitis media with effusion (OME) in infants and children is being conducted at Children's Hospital of Pittsburgh. Although the randomization code has not yet been broken, the results of treating the first 55 children are reported, since they appear to be of interest. Of the 62 ears with acute OME on which an initial tympanocentesis was performed, 41 positive cultures were isolated from the middle ear aspirates. Of the 10 ears from which Haemophilus influenzae was isolated, one had a type b strain, and of the remaining unencapsulated strains, one was resistant to both penicillin G and ampicillin. In the one ear from which Staphylococcus aureus was isolated, the organism was found to be resistant to ampicillin. However, all of the organisms were sensitive in vitro to cefaclor. In 88% of all subjects observed for the first 2 weeks, the initial symptomatic response was excellent. Six children had persistent signs and symptoms of acute OME and received a second tympanocentesis; however, none of the effusions from the repeat aspiration revealed an organism. An effusion was still present in 97% of the ears after 3 days, in 69% after 2 weeks, and in 48% 6 weeks after initiation of the study. Tympanocentesis did not appear to affect either the initial clinical response or the persistence of effusion. There were no adverse reactions to either drug in this study. Because an apparent increase in the incidence of ampicillin-resistant strains of H. influenzae is being reported, and because of the presence of ampicillin-resistant S. aureus in some ears with acute OME, a new antimicrobial effective against all the common pathogens causing acute middle ear disease would be desirable. In this respect, the preliminary findings of treatment with cefaclor from this study appear promising.


The use of cefaclor in the treatment of beta-haemolytic streptococcal throat infections in children.

Cefaclor was used as a therapeutic agent in beta-haemolytic streptococcal throat infections in children in 3 separate studies. Although the numbers of patients in these ongoing studies are too small for valid statistical analysis, cefaclor was found to be (1) an effective agent in a dose of 20 mg/kg/day, (2) as effective as phenoxymethyl penicillin at identical dosages, and (3) equally effective at doses administered twice daily or thrice daily. It was well accepted by the patients, had minimal side effects, and produced no adverse effects in the peripheral blood.


Treatment of acute bronchitis and pneumonia with cefaclor.

An open, non-comparative clinical trial of cefaclor in adults with acute exacerbations of chronic bronchitis (54 patients) or pneumonia (24 patients) is reported. The dosage of cefaclor used was either 250 mg or 500 mg taken orally three times daily. Clinical cure was obtained in 39 of 42 (93%) of patients on the lower dose and 32 of 33 (97%) on the higher dose. Side effects were minimal and the antibiotic was very well tolerated. Microbiological evaluation was possible in 32 of 75 (43%) of patients in whom potential pathogens were identified before treatment. Microbiological 'cure' was achieved in 17 of 32 (53%), the majority of whom had received the higher dose. The lack of correlation between the clinical and microbiological results cast further doubts on the value of the standard sputum culture methods in the diagnosis and management of lower respiratory tract infection. Cefaclor is useful in the management of acute lower respiratory tract infections by virtue of its excellent clinical efficacy and safety.


Comparison of cefaclor and amoxycillin in the treatment of urinary infections in a chronic disease hospital.

The clinical efficacy and safety of cefaclor, a new oral cephalosporin, was compared with that of amoxycillin in the treatment of lower urinary tract infections in 61 patients with chronic non-urinary tract disease. Thirty-six patients received cefaclor and 25 received amoxycillin doses of 250 mg every 8 hours for 7 to 10 days. The therapeutic effectiveness of cefaclor was significantly better than that of amoxycillin, and it appeared to be well tolerated and free of adverse side effects. It produced no allergic reactions in 4 patients with a history of penicillin allergy and was effective against Klebsiella strains resistant to the ampicillins. There was no evidence of any haematological, renal or hepatic toxicity from either drug at the dosage used.


Comparison of cefaclor and ampicillin in the treatment of shigellosis.

Fifty-four children with acute diarrhoea were treated orally with 50 mg/kg/day of either ampicillin in 4 divided doses, or with cefaclor in 3 divided doses for 5 days. Shigella was isolated from the stool of 28 patients, 6 of whom were hospitalized. All isolates, including ampicillin-resistant strains, were susceptible in vitro to cefaclor. For ampicillin-sensitive infections, the clinical response and clearing of Shigella from stools appeared to occur more rapidly in patients treated with ampicillin than in those treated with cefaclor. In areas where ampicillin resistance is a problem, cefaclor appears not to be a drug of choice for the treatment of Shigella.


Acute eosinophilic glomerulonephritis with Bancroftian filariasis.

A case is reported of Bancroftian filariasis and acute immune complex glomerulonephritis in a 44-year-old man. Renal biopsy showed microfilariae and large numbers of eosinophils in the glomeruli (eosinophilic glomerulonephritis). The absence of other aetiological factors suggests that the glomerulonephritis may have been of filarial origin.


Prostacyclin eliminates the bioincompatibility of charcoal haemoperfusion.

During charcoal haemoperfusion (CHP) in dogs, use of prostacyclin (PGI2) in addition to heparin reduced the loss of platelets (25 +/- 6 vs 83 +/- 2%), the formation of platelet aggregates as judged by screen filtration pressure (65 +/- 6 vs 249 +/- 25mm Hg) and fibrinogen consumption (20 +/- 5 vs 46 +/- 6%). Prostacyclin also delayed neutralisation of heparin during CHP. This improvement of biocompatibility may now allow a proper assessment of CHP in liver failure.


Vasopressin response in haemodialysis patients.

Ten patients underwent repeated haemodialysis under circumstances of manipulated change in plasma osmolaity and blood volume. Basal plasma arginine vasopressin (AVP) levels were significantly higher than in normal controls, but no linear correlation between basal plasma osmolality and AVP levels was found. In 38 of 44 studies there was an appropriate response of AVP to change in plasma osmolality or blood volume. We conclude that the quantitative response of AVP in dialysis patients is not linear and differs markedly as compared to normals. Changes in blood volume may play a more dominant role in the control of AVP release.


Hormonal response to volume depletion in non-nephrectomised patients on regular haemodialysis.

The hormonal response to volume depletion by isolated ultrafiltration has been studied in seven non-nephrectomised haemodialysis patients. The mean reduction in blood volume was 14%, and pulmonary artery wedge pressure reduction averaged 77%. No increments in heart rate were observed in any of the patients. Cardiac output decreased while systemic vascular resistance increased. Mean arterial blood pressure remained stable in all but two patients. Significant increments in plasma vasopressin concentration were only found during hypotensive episodes, while in the whole group no significant increase was found. Both plasma renin activity, plasma aldosterone and plasma cortisol increased significantly during isolated ultrafiltration. The moderate increase in systemic vascular resistance indicates that the peripheral sympathetic nervous system - at least partly - was functioning. It was, however, not correlated with changes in any of the measured hormones. Furthermore the adrenal and cardiac response appeared to be absent.


The effect of haemodialysis and transplantation on autonomic neuropathy.

Autonomic nerve function as measured by the Valsalva ratio and the blood pressure response to sustained hand grip, is impaired in chronic renal failure. Treatment with haemodialysis results in insignificant improvement in the Valsalva ratio and a trend towards improvement in the hand grip tests. Transplantation improves but does not return to normal the Valsalva ratio, whereas the hand grip test is rapidly restored to normal.


Peritoneal dialysis: physiology, current applications and future directions.

The peritoneal dialysis system is a sophisticated dialyser. It probably represents a capillary kidney regulating the number of capillaries perfused, the nature of capillaries perfused, and the overall permeability of its membranes. Its sophistication far exceeds that available with extracorporeal man-made haemodialysis systems. However, because of limited pore area and inaccessible fluid film resistances, it will never be an efficient dialyser for small solute removal. One way to overcome this intrinsic inefficiency is to utilise CAPD which trades efficiency for time. Our first two years of experience with CAPD have answered many initial questions, at least in a preliminary fashion. The future of CAPD has exciting potential, but many questions remain.


The use of linear models to investigate the "centre effect" on graft survival.

First cadaver graft survival at 90 days in six UK centres was analysed, and found to differ widely between the centres (p less than 0.0005). Linear models were used to test whether these differences could be explained by other factors known to influence graft survival, such as age of recipients, tissue typing, blood group matching or year of graft. Adjusting for these factors singly and in various combinations did not reduce the significance of the "centre effect". These results held good both when deaths with a functioning graft within 90 days were treated as exclusions and also when they were treated as graft failures.


A study of paired necro kidney grafts.

The comparison of the fate of kidney pairs originating from the same donor offers an opportunity to control variability in primary kidney graft survival due to characteristics of the donor. The present study on 1,303 pairs was made possible by combining the information in the Scandiatransplant registry and the EDTA follow-up file. The analysis showed that, contrary to expectation, the main variability in kidney graft survival is not donor dependent but rather due to post-nephrectomy factors. By the present approach it was possible to demonstrate a significant effect of presensitisation, HLA-A,B matching and recipient age. In contrast, transportation, and differences in sex and ABO blood group combinations seem to be of no importance for kidney graft survival.


Orthopaedic complications of renal transplantation.

One hundred and eighty-one patients who underwent renal transplantation between 1973 and 1979 have been reviewed. Thirty of these developed one or more orthopaedic complications. The commonest and most serious was avascular necrosis of bone and the treatment of 14 patients with this condition is described. Transplant recipients who developed this complication received twice the total dose of steroids in the six months after transplantation than a control group with no avascular necrosis. The management and pathology of patients with avascular necrosis is discussed.


The evolution of hyperlipidaemia late after renal transplantation.

We have evaluated the incidence, long term evolution and pathogenesis of posttransplant hyperlipidaemia (HL) in 88 transplanted patients without nephrotic syndrome followed for 2 to 13 years by the same staff. Incidence of HL decreased strikingly over the years from 51% at 2 years to 25% at 10 years. This fall was due solely to the return to normal of the lipid profile in 13 patients between 2 and 8 years after transplantation. This progressive decrease should be taken into account when the frequency of posttransplantation dyslipaemia is assessed. The incidence of hyperlipidaemia increases with age. Above 40 years, hyperlipidaemia is more frequent in females than in males. Obesity and reduced renal function are both associated with a higher incidence of dyslipaemia. No relationship was found between lipid disorders and either steroid dosage or fasting blood glucose levels. Dyslipaemia appears thus to be due to the interplay of several factors. Normalisation of the lipid profile occurred in 13 patients without significant decrease in bodyweight, serum creatinine or prednisone dosage. At 8 years atheromatous lesions were not more frequent in dyslipaemic than in normolipaemic subjects.


Cadaveric kidney retransplantation, is it justified?

Results of 44 second cadaveric kidney transplantations are reported and compared with the results of 149 primary cadaveric transplantations. No difference in patient survival is observed. Patients with a non-immunological first graft failure (NIF) had a better two year second graft survival (60%) when compared with patients with an immunological first graft failure (IF) (20%). This difference was not due to a higher degree of presensitisation in the IF group. The use of scarce cadaveric kidneys for retransplantation in patients whose first graft was rejected is considered questionable.


Is it really worth re-transplanting patients?

Increasingly patients whose first renal transplant fails are being re-transplanted. A study of patients in one unit was undertaken to assess whether second kidney grafts were as successful as first allografts and whether certain factors determined the outcome of secondary transplants. Second and subsequent grafting can be performed with confidence of a successful outcome provided a careful selection of patients is made. The outcome of subsequent grafts should show no significant difference from the overall results of first renal allografts.


Cadaveric graft survival, clinical course, blood transfusion, HLA (A and B) match, and DR match in adult patients transplanted in one centre.

The influence of blood transfusions, HLA, A and B, DR matching was studied in adult patients transplanted in one centre. The conclusions were: 1. Pre-transplant blood transfusion(s) are a prerequisite for graft acceptance. 2. In transfused patients with no HLA A and B mismatch, there is only 8% graft loss due to irreversible rejection. 3. In transfused patients with a functioning graft after six months, a decrease in the number of reversible rejection crises is observed in patients with no HLA A and B mismatch or with identity for HLA B7 or HLA B8. 4. Identity for HLA B7 or B8 also gives a higher chance of a late onset of the first rejection crisis.


Prolongation of renal allograft survival in DLA-tissue typed beagles after third-party leucocyte and erythrocyte transfusion.

In a dog model, both transfusion of leucocytes and of erythrocytes induced lymphocytotoxic antibodies. The results, obtained in DLA identical littermate and DLA nonidentical nonrelated beagle recipient pairs, suggest a correlation between DLA-type and lymphocytotoxic immune response. Two weeks after the last of three transfusions from different blood donors, kidneys from unrelated DLA-mismatched donrs were transplanted to the beagle recipients. A standard postoperative immunosuppressive regimen was given. No correlation between erythrocyte or leucocyte induced immune response was observed, but both erythrocyte as well as leucocyte transfusions significantly prolonged renal allograft survival as compared with nontransfused controls.


Anti-HLA immunisation in 130 haemodialysed patients.

Anti-HLA immunisation has been studied in 130 patients treated by haemodialysis between 1969 and 1978. Until 1977 blood transfusions were restricted (number of transfusions per patient averaged 3.42 units). However 50% of the patients were found to be immunised. The frequency of immunisation was higher in women patients (63%) than in men (39.7%). This difference shows a good correlation with the frequency of pregnancies (r = 0.849). The percentage of immunisation increases in parallel with the number of months of dialysis (r = 0.95). The capacity to eliminate HBS Ag seems to be related to the capacity for anti-HLA immunisation: 64% of the patients transiently positive for HBS antigen develop anti-HLA antibodies and only 26.7% when antigenaemia is persistent. Since 1977, 24 patients have been transfused with two units of whole blood once a week for three weeks, every six months. Antibodies appeared in only seven of them who had been transfused some years ago. The GLA system and transplantation play a small part. The age and the type of nephropathy seem to have no effect. A few patients developed antibodies for no apparent reason. Possibly bacterial or viral infections, or venous allografts were responsible.


Influence of the Lewis blood group system on clinical kidney transplantation.

The different Lewis phenotypes were determined retrospectively in 201 kidney transplant recipients. Transplant survival rates in Lewis compatible recipients were significantly higher (p less than 0.0005) than in Lewis incompatible recipients. The improvement of transplant prognosis by matching for Lewis antigens was confirmed by a prospective study comprising 55 donor/recipient combinations. HLA matching had little benefit on transplant survival whereas survival rates are strikingly increased by Lewis compatibility. In the Lewis compatible but HLA mismatched group, graft survival was definitely higher than in the HLA matched but Lewis mismatched group. Our data indicate that Lewis antigens play an important role in transplant prognosis. Compatibility in the Lewis system should therefore be considered when recipients are selected.


Use of thermography in kidney transplantation: two year follow up study in 75 cases.

During a period of 24 months 75 renal transplant recipients were examined by thermography according to Tricoire. Thermography is a non-invasive, quickly available and reproducible method. Because of the 92% incidence of exact diagnosis this investigation is a helpful additional test in kidney transplantation for evaluation of graft function as well as for diagnosis of pathological intrarenal or perirenal disorders. Thermography is especially recommended for patients if postoperative haemodialysis is necessary. In these cases information can easily be achieved whether postoperative oligo-anuria is caused by acute tubular necrosis or by primary vascular insufficiency of the transplant.


Cadaveric renal graft acceptance without azathioprine.

After azathioprine withdrawal serum creatinine concentrations at the end of an observation period of up to 26 months were not significantly different from the previous values in five out of seven patients with good transplant function. Patients with chronic rejection showed a constant rate of loss of transplant function, assessed by a straight line relationship between the logarithm of serum creatinine and time. After stopping azathioprine, however, there was no break in the slope of the curve in five out of six patients. Azathioprine withdrawal may be compatible with good long-term graft acceptance. Azathioprine seems to be of little value in the management of chronic renal rejection.


Low dose steroid from the day following renal transplantation.

Azathioprine combined with a low dose of steroid (20mg of prednisolone) commencing the day following transplantation has been used for immunosuppression for 151 consecutive renal transplants in 141 patients (146 cadaver grafts, 5 living related donor grafts). Immunosuppression was satisfactory as 109 grafts function from 6 months to 10 years, 17 of 42 grafts lost failed from rejection. No patient died from infection before 90 days, 4 died later from infection, 2 associated with anti-rejection therapy. Seven patients developed gastrointestinal complications, 1 died; 4 developed diabetes, all survived; only 1 patient developed avascular necrosis of bone.


Factors responsible for the functional pattern of cadaveric kidneys stored up to 25 hours before transplantation.

The functional outcome after the transplantation of 97 cadaveric kidneys stored up to 25 hours with simple hypothermia was analysed in relation to age of donor, extent of pre-agonal kidney damage, the length of warm, cold and standardised ischaemic times and the presence of multiple renal arteries. Analysis of various factors showed that the most important for function after transplantation were pre-agonal anoxic damage and the ratio of the cold/warm ischaemia time. Based on that observation, a diagram has been proposed which allows calculation of the safe cold storage time after retrieval of the kidney.


Pretransplant cytotoxic antibodies do not segregate kidney transplant recipients into responder and non-responder groups.

In a study of 687 primary cadaver transplants, we found no correlation between the degree of presensitisation and graft survival. Graft survival was adversely affected in non-transfused recipients and was significantly improved in trnasfused recipients, independent of the level of presensitisation (63%, 61%, 67% at one year for patients with 0-10%, 11-50%, and 51-100% preformed cytotoxic antibodies, respectively). Humoral presensitisation to HLA antigens does not reflect the immunoresponsiveness of the host to the renal allograft, but it may prolong the wait for a compatible donor kidney.


Endothelial antibodies in renal transplantation.

Sera of 97 consecutive transplant recipients were studied for the presence of antibodies directed against their renal allografts. A highly significant correlation (p less than 0.001) was found between irreversible rejection and donor-specific endothelial antibodies (EAb). EAb reacted not only with the endothelium of peritubular capillaries and venules, but also with glomeruli. Absorption of EAb to platelets, B- or T-lymphocytes did not remove its EAb activity or its cytotoxicity for monocytes. Furthermore, it was shown with a panel of randomly chosen donor kidneys, that EAb are directed against a polymorphic system of endothelial-monocyte antigens, which is unrelated to HLA-A, -B, -C or -D.


Pretransplant T cell levels and renal allograft survival.

Total rosette forming cell (TRFC) levels were measured in 50 paediatric patients awaiting cadaveric renal transplantation. Preliminary data show a statistically significant difference in allograft survival in patients with low TRFC levels pretransplant as compared with patients with medium or high TRFC levels. Pretransplant TRFC levels may be predictive of a non-responder status and portend a favourable renal allograft outcome.


Urinary tract stone disease.

Patients suffering from urinary stone are traditionally referred to a surgeon. Most are investigated only as far as establishing the site of the stone and its effect on renal function. Although a number of patients may require surgery, the majority pass the stone spontaneously and are discharged within a few days. If the patient has a recurrence, as most eventually have, it is not routine practice to establish the type of stone, screen for underlying disease, identify the urinary abnormalities or to institute preventive medical treatment. Although it was considered that surgery itself had something to offer in reducing the recurrence rate this is no longer generally held except in infected stone disease. Nevertheless it is still uncommon to involve a physician, and in particular a nephrologist, in the investigation and management of urinary stone-formers. Urinary stone disease still remains, to a large extent, outside the field of nephrology.


Peptide hormones: renal handling and dialysis therapy.

For uraemic diabetics the loss of insulin by dialysis with highly permeable membranes has clinical relevance. We investigated renal handling (in isolated perfused rat kidneys) of insulin and c-peptide and their dialytic clearances and sieving coefficients using cuprophan and polyacrylonitrile membranes. Rat kidney catabolic clearances were five times (insulin) and 12 times (c-peptide) greater than urinary clearances and twice inulin clearance. Cuprophan membrane was found to be virtually impermeable for both hormones. Polyacrylonitrile sieving coefficients were 0.3 (insulin) and 0.4 (c-peptide). Both hormones are filtered as well as tubularly and peritubularly catabolised in the kidney. Insulin removal during dialysis and haemofiltration with polyacrylonitrile membranes has to be considered in treating uraemic diabetics.


Handling of phosphate by the transplanted kidney.

Maximal tubular phosphate reabsorption capacity corrected for changes in glomerular filtration rate (TmP/GFR) was taken as a measure of renal phosphate handling in patients with good and stable functioning kidney allografts. TmP/GFR values were within the normal range in only one-fifth of the patients. Eighty per cent had an abnormally low renal phosphate threshold concentration. Persistent hyperparathyroidism was the causative factor of this diminished tubular reabsorption in less than half of these patients, the majority of them showing an iPTH independent phosphate leak. Although glucocorticoids, azathioprine and tubular damage of the graft in the perioperative phase may contribute to this iPTH independent phosphate wasting, no single causative factor could be identified. Cases with hypophosphataemia should be treated in order to avoid symptoms of phosphate depletion. Active Vitamin D metabolites would be the therapy of choice by suppressing the parathyroid glands ("chemical PTX") and by directly enhancing tubular phosphate reabsorption. In persistent hyperpathyroidism with hypercalcaemia, surgical parathyroidectomy must be considered. Therapy with phosphate salts is only symptomatic and should be used only as an adjunct.


The relationship between disturbed metabolism of vitamin D and bone disease in chronic renal failure.

Following the discovery that the kidney is involved in the metabolism of vitamin D, a causal relationship has been sought between defective production of 1,25-dihydroxy vitamin D3 and bone disease in chronic renal failure. This paper reviews some of the clinical evidence for and against such a relationship, and considers the possible role of other vitamin D metabolites in the pathophysiology of renal bone disease.


[Anatomy of papilla and intra-renal reflux: microradiographic and histologic investigations (author's transl)].

After a group of autoptic kidneys, taken from new-born babies, had been injected via the ureter with micronised barium at various pressures, they were examined micro-radiographically and histologically in order to observe the appearance of intra-renal reflux and the anatomical structures involved. The radiological patterns, clinically observed during cysto-uretrography, were also considered. The intra-renal reflux is tubular, when injection is carried out at a low pressure, whereas at higher pressures one can observe the erosion of the fornices of the calyces and the following sino-lymphatic and/or venous drainage.


[I.P.P.B. therapy at home in chronic respiratory insufficiency in France. I. Survey method. Description of the prescribers. 1960-1977 prescription evolution (author's transl)].

In order to assess the usage of IPPB therapy at home in chronic respiratory insufficiency in France, a mail survey has been conducted among 2,062 chest physicians and physicians involved in intensive care. The response rate was 57%. Among those caring for chronic respiratory insufficient patients, 296, i.e. 38%, have prescribed IPPB to 3,778 patients from 1960 till 1977. A study among a sample of the non-spontaneous-responders allows the estimation of about 400 physicians who prescribed IPPB on the whole for France at this time. Those who prescribed, worked more often in hospital though 4% had only a private practice. Those involved in intensive care prescribed more often than the chest physicians (47% versus 37%). The development of this therapy was different according to the different regions in France. But, in a general way, the prescription of IPPB at home particularly spread out since 1975, 65% of all the prescriptions have been done in 1975, 76, 77.


[Preliminary report and indications of assisted ventilation at home (author's transl)].

Two uses of intermittent positive pressure can be distinguished: one supports inhalotherapy and the other longterm assisted ventilation. The apparatus can be connected to the patient either through mouth-piece or by tracheostomy. The main factors involved in the indication of assisted ventilation are the number of acute failures, hypoxemia, hypercapnia, cor pulmonale. In our department, 53 patients were kept under prolonged supervision before a decision was made to use assisted ventilation or not. This attitude seems absolutely necessary. An oxygen test of several hours provides very useful information. Finally, the authors review the indication of various ventilation methods (tracheostomy, oral) in relation to different chronic respiratory insufficiency etiologies (ie., chronic obstructive broncho-pneumonia, restrictive syndrome).


[Assisted ventilation at home for chronic respiratory insufficient patients in the Languedoc-Roussillon area (357 observations) (author's transl)].

Up to May 31, 1978, 357 patients with restrictive (77 cases), obstructive (138 cases) or mixed (142 cases) respiratory insufficiency were given assisted ventilation at home. Only those patients whose PaCO2 could not be stabilized by drug therapy, physical therapy and/or oxygenotherapy, were selected. Seventy-five tracheostomized patients were ventilated endotracheally using a volume generator with fixed frequency in an 8-hour session during sleep. Two hundred and eighty-two subjects were ventilated through a mouth-piece using either a volume generator with synchronizable frequency or a pressure relaxator (self-regulated ventilation) distributed in several day-time session for a total of 4 hours daily. Six months after the onset of home ventilation, a marked decrease of PaCO2 is observed in all the groups regardless of the ventilation method. This improvement is maintained after wards. Furthermore, a decrease in the average length of hospitalization is noted. After 2 years the survival percentage is 77.7%; after 5 years it is 52.3%. The patients who benefit most from assisted ventilation are those suffering from restrictive respiratory insufficiency submitted to endotracheal ventilation (more than 70% of survivals after 9 years). Long-term results are not so good for the obstructive or mixed respiratory insufficiencies, especially when an important bronchospasm and/or a large bronchorrhea is present.


[Indications of home assisted ventilation by tracheostomy for non-paralytic chronic respiratory insufficient patients (author's transl)].

Based on a 15-year study, the indication of assisted ventilation at home is discussed. It depends on the seriousness of the C.R.I. (dyspnea, repeated acute failures, PaCO2 greater than or equal to 55 Torr). The only possible course is ventilation by tracheostomy. The best indication is represented by pure restrictive syndromes. On the contrary, the indication should be considered with extreme caution in obstructive syndromes.


[Tracheostomy for long-term ventilatory assistance. About 22 observations of severe chronic respiratory insufficiency (author's transl)].

22 patients with severe respiratory insufficiency were treated by definitive tracheostomy for intermittent ventilatory assistance. Early mortality is heavy (9/22 before three months). After three months, the respiratory condition of patients improved greatly and survival rate is good. Tracheostomy is too often delayed and realized at the bad time of a severe acute respiratory failure.


[Home assisted ventilation for patients suffering from silicosis (author's transl)].

One hundred and seventy-five patients suffering from silicosis benefitted from home assisted ventilation at the rate of 5 minutes per hour every hour. This treatment led to a decrease in hospitalizations and increased the comfort of the patients.


[Problems raised by the technique and supervision of home ventilation of chronic respiratory insufficient patients (author's transl)].

The effectiveness of assisted ventilation at home, especially in the case of tracheostomized patients, has been nearly established at the present time. The experience of various centers in France, having or not the support of an independent structured organization, shows that the setting-up and supervision of such therapy can be effectively carried out. Nevertheless, difficult choices remain. Some indications are still questionable, such as the choice of the respirator if the patient has not been tracheostomized. The type of organization is not univocal and could perhaps depend on the number of patients to be cared for. In any case, in the years to come, the experience of the different teams and the technical progress made will lead to a solution to the problems raised: a decrease in the number of hospitalizations and more comfort for the patients can be hoped for.


[IPPB therapy at home in chronic respiratory insufficiency in France. II. Indications. Technics and surveillance (author's transl)].

A survey has been conducted among French chest physicians and physicians involved in intensive care. 296 physicians have prescribed IPPB at home to 3 778 patients with chronic respiratory insufficiency between 1960 and 1977. Acute respiratory failure was the first criteria considered in the indications (57% of the patients); hypercapnia, hypoxemia and right heart failure episode frequency were the other criteria of severity the most often taken into account. Since 1960, the indications among those with airflow obstruction have decreased, whereas they have increased for those with restrictive insufficiencies, expressing the questions raised about the efficacy of IPPB in these two types. 18% of the patients have had IPPB through tracheostomy canula. 70% of the patients have used a pressure cycling respirator and 30% a volume or flow cycling respiratory. This second type was quite always used in the case of IPPB through canula. Oxygen was added for half of the patients. The physicians have regularly followed the patients. Great importance was accorded to home care surveillance.


[Technic and supervision of home assisted ventilation (H.A.V.) in tracheostomized chronic respiratory insufficient (C.R.I.) patients (author's transl)].

With 200 patients during the last 15 years the daily use of apparatus and supervision modalities, as described in the present work, has shown that H.A.V. is entirely possible in tracheostomized C.R.I. patients. Rather strict conditions must be respected (as with hemodialysis at home) if H.A.V. is to be medically and materially successful. The expenses involved can vary greatly according to the medical and material management (choice of study material, economic maintenance, minimal oxygen consumption through proper adjustment...). Finally, the use of assisted ventilation requires a choice amont several adjustment possibilities which are still subject to evolution.


[Two-year assisted ventilation at home experiment study of 15 patients (author's transl)].

Assisted ventilation at home requiring volume relaxators affected 15 patients suffering from a restrictive syndrome (cyphoscoliosis or after effects of tuberculosis). The blood gases of 8 patients who had been looked after for more than one year, at home by the physio-therapist and in hospital by repeated controls, improved (especially the PaO2). The most important fact is the noteworthy decline in the annual time of hospitalisation.


[Study of home ventilation in severe respiratory insufficient patients (author's transl)].

Results of our study of 91 cases show that many indications of ventilation at home are debatable:--Tracheostomized patients submitted to continuous ventilation with short disconnected periods;--Patients using the respiratory apparatus more than 4--6 hours per day, through a mouth-piece. The existence of a reserve closely related to the intensive care department and mobile emergency unit (S.A.M.U.) facilitates supervision and eventual technical or medical assistance. In addition, the running cost remains small because of the adaptability of the system. However, it seems of interest to point out a group of 11 patients whose treatment was interrupted either because of their improvement (physical therapy, suppression of tobacco mainly), inadequate indications, or poor cooperation.


[Application of residual positive pressure during assisted ventilation at home using pressure relaxator devices (author's transl)].

A residual postive pressure (R.P.P.) of low magnitude (1 to 4 cm of water) was used during assisted ventilation by pressure relaxator in an attempt to decrease the expiratory dynamic compression of the airways. A ventilatory test involving 80 respiratory insufficient patients (73 men and 7 women) shows that with assistance the tidal volume of half of the subjects increased by more than 20% (average gain: 32%). The patients with the highest RV/TC ratio benefitted most from the method. Finally, the arterial blood gases were not significantly modified. A longitudinal study involving 46 subjects observed for an average period of 24 months revealed a marked subjective improvement in the patients' condition without significant modification of the blood gas figures. No incident or accident was attributed to the use of R.P.P.


[Intermittent ventilatory assistance with mouth-piece (respirator of volumetric type): optical technique of reeducation (author's transl)].

The authors describe an optical technique enabling patients with chronic respiratory insufficiency, at first to get used to assisted ventilation, then to control it, to obtain an active ventilation operated by machine corresponding to a particular shape of the pressure curve and the lesser haemodynamic repercussion.


[Mode of action and results of home assisted ventilation. Study by the Association of Aid to Respiratory Insufficient Patients of Basse-Normandie from 1976 to 1978 (author's transl)].

Since 1970, 168 patients, mostly of the obstructive type, received an apparatus of assisted ventilation at home, according to the degree of their hypoxia-hypercapnia, following one or several acute failures. Oral ventilation, at a daily minimum of 90 min, distributed in 4 to 8 sessions, was continued for variable duration, from 1 to 5 years. The results, analysed statistically for 40 subjects, show a blood-gas improvement greater in patients whose PaO2, PaCO2 and RV/TC ratio were initially lower. For 17 patients controlled before and after assisted ventilation at home, a reduction in the number of days of hospitalization and acute failures was observed. The cost involved was particulary economical because of the simplicity of the equipment and the possibilities of control of patients and apparatus at the C.H.U. (20 F monthly in 1977 for 145 selected patients).


[Possible role of committees concerned with the fight against tuberculosis and respiratory diseases in home ventilatory assistance of severe chronic respiratory insufficient patients (author's transl)].

It appeared that the departmental committees involved in the fight against tuberculosis and respiratory diseases were qualified to bring assistance to severe chronic respiratory insufficient (C.R.I.) patients. This modified course of action replaces their previous struggle against tuberculosis due to its recession. In Seine-Maritime the committee has signed an agreement with the principal Social Security organizations. This agreement defines the modalities and cost of home care for severe C.R.I. patients who have been tracheostomized permanently and whose condition justifies the continuation of assisted ventilation. Contingent on certain medical and socio-family conditions, the return home of such patients is possible. Thus in 15 years we have been able to benefit 72 patients with assisted endo-tracheal ventilation at home. Thirty-two of them are actually still living.


[Technique and supervision of home assisted ventilation (author's transl)].

Based on data obtained from 260 patients ventilated through a mouth-piece, several notions concerning equipment and supervision requirements have become clear.--In our opinion, the indications should not be reserved for extremely severe patients; in their case cardiac complications are constant in spite of usual treatment. These patients, most often respiratory encephalopathic, are not very receptive to the "directions for use" of home assisted ventilation.--On the contrary, chronic hypoxia-hypercapnia, whatever its origin, accompanied by slight or transitory cardiac signs, has much more chance of being treated successfully.--The adaptation of the patient to the respirator before his release from the hospital must be worked out until a clinical and biological improvement can be obtained, at the risk of probable failure.--Supervision at home should disclose any alteration in the patient's clinical condition. It can only be carried out by the conjoined visits of the practicing doctor, nurse, technician, etc. The contacts between the practicing doctor and the hospital physician should be frequent. The ideal solution is systematic visits to the hospital.


[Mode of action and results of long-term assisted ventilation at home of chronic respiratory insufficient patients (author's transl)].

It is generally agreed that one assisted ventilation session has direct effects in chronic respiratory insufficiencies (C.R.I.) of chronic obstructive pulmonary diseases: hyperventilation where PaCO2 decreases and PaO2 increases, diminution of ventilatory work, reduction of cardiac output. Less is known, however, about the action on V and Q distribution and mechanics of breathing. The return to control values occurs quite rapidly after the end of the session. Long-term effects are much more questionable. Many publications in English have concluded that ona long-term basis, patients do not benefit from intermittent positive pressure. But, the daily assisted ventilation sessions usually lasted only a short time (1 h-1 h 30 in several sessions). According to a number of publications in French, assistance prolonged for several hours seems effective (decrease in the number of acute failures, annual hospitalization duration, more prolonged survival). However, a tracheostomy which enables assistance at night is often required. Results seem encouraging in the treatment of severe restrictive insufficiencies and particularly in the case of cyphoscoliotic patients. On the other hand, it is more difficult to draw a conclusion concerning chronic obstructive patients and further comparative studies are necessary in this direction.


[Results of home assisted ventilation of non-paralytic and tracheostomized chronic respiratory insufficient patients (author's transl)].

The following results have been obtained from a study of 118 tracheostomized patients ventilated at home: --Survival on the whole is generally prolonged. --The prognosis of tracheostomized subjects with restrictive syndrome is totally modified in length and quality when the patients are ventilated. --In the case of obstructive syndrome, the length and quality of survival are probably increased. However, it seems that assisted ventilation at home leads only to the disappearance of asphyxiating paroxysms and right cardiac failure. It does not seem to prevent the unrelenting evolution of the disease.


[Psychological aspects of ventilatory assistance for severe chronic respiratory insufficient patients (author's transl)].

A study based on psychological interviews allows the definition of the subjective effect of assisted ventilation. This effect should take into account the subjective state of patients and the obligations of the treatment. It is thus possible to consider the psychological conditions of effectiveness of home assisted ventilation.


[Long-term results of intermittent ventilatory assistance for 74 severe obstructive chronic respiratory insufficient patients (PaCO2 greater than 50 Torr) ventilated for more than a year (author's transl)].

From 1967 to 1978, home assisted ventilation (HAD) was applied to 74 severe chronic respiratory insufficient patients (67 COPD-7 restrictive). These patients used volume generators through mouth piece, except 3 of them who had a tracheostomy. The main results of this study are a highly statistically significant decrement (P less than 0,001) of the hospitalization durations and of the frequency of ARF, as well as an improvement of the survival duration in front of a non-tested group, and a significant decrease of haematocrit (less than 0,05) and P.V.R. (P less than 0,01). But blood gases and functional tests are not statistically different. Age (greater than 55 years) and delay after first ARF (greater than 2 years) when starting HAD are considered as pejorative factors.


[Nine-year study of home assisted ventilation in cases of severe respiratory handicap (author's transl)].

When other treatments fail, the prognosis of some chronic respiratory insufficient patients with frequently occurring failures improved when a tracheostomy canula was installed and connected to a respiratory for several hours a day. The even partial correction of blood gas disorders avoids a relapse in right cardiac failure and enables home care of the patient who can resume formerly abandonned activities. Home assisted ventilation greatly modifies the somatic and psychological condition of the patient and requires excellent cooperation by the family and strict technical supervision, at the risk of failure.


Taxonomy, enzymes, and clinical relevance of anaerobic bacteria.

Present systems for the classification of anaerobic bacteria have eliminated many of the problems of earlier systems. There are still a number of major problems that require attention, however. Anaerobic bacteria produce many different enzymes that are of importance in providing nutrients to the bacterial cell, as virulence factors, and in permitting organisms to colonize or survive under adverse conditions (including exposure to antimicrobial agents). Some enzymes effect several types of modifications to bile acids, neutral steroids, and corticosteroids. Anaerobes are clearly important in a variety of infections in humans and animals as well as in various other types of pathologic processes.


Bacteriophages of Bacteroides.

Sixty-eight bacteriophages specific for nine species (DNA homology groups) of Bacteroides were isolated from sewage. Four distinct morphological types were isolated, three of which had not previously been described. Attempts to use these phages to transduce Bacteroides fragilis were unsuccessful. A total of 91 phage-susceptible strains of Bacteroides were used with these phages in a study of the feasibility of developing a scheme for identification of Bacteroides species. Blind trials were performed with 10 B. fragilis-specific phages and a collection of over 200 bacterial strains, including 144 strains of B. fragilis. Of the strains of B. fragilis, 78% were identified correctly within 24 hr. A phage-carrier state, or pseudolysogeny, was observed with most of the phage-host systems, and this state was studied in detail with B. fragilis phage Bf-1. The presence of a thick capsule around some cells in a pure culture of a host strain appears to render these cells resistant to phage infection, thus perpetuating the carrier state. It is suggested that such capsules may play a role in the virulence of strains of Bacteroides.


Antibody response to anaerobic bacteria.

Anaerobes, especially the gram-negative non-spore-forming bacilli of the indigenous biota, are recognized as important agents of clinical infection; however, information regarding human antibodies to anaerobes is limited. Sporadic work, employing agglutination, gel diffusion, passive hemagglutination, and immunofluorescence, demonstrated antibody response to various Bacteroidaceae in patients with infections caused by Bacteroides or Fusobacterium. Because of the need for using homologous (autologous) isolates and the apparent antigenic heterogeneity of strains, there has been no general clinical application of these findings. Increased concentrations of antibodies to anaerobic intestinal organisms in chronic inflammatory bowel diseases have been found; however, it is unclear whether these are the effect or cause of these conditions. Natural antibodies to Bacteroidaceae, primarily of the IgM class, are widely distributed in normal humans; thus for serologic diagnosis IgG antibodies should  be sought. Radioimmunoassays and various immunoelectorphoretic methods for detection of both antibody and antigen are presently being evaluated for diagnostic use in infections due to anaerobic bacteria.


[Neurinomas of the acoustic nerve and surgery with the suboccipital approach. A study of 70 cases].

The Authors report 70 cases of medium and large size acoustic neuromas, operated on using the suboccipital approach, the only one which allows their total extirpation. Total extirpation was performed in 77% of the patients. The Authors analyze the clinical picture, the neuroradiological diagnostic procedures and the surgical techniques used in the treatment of these lesions.


Mechanisms of resistance and hypersensitivity in herpes simplex keratitis.

Laboratory studies show that systemic immunity protects the corneal epithelium against herpes simplex virus (HSV) infection, this protection probably being humoral in origin. It can be shown that hyperimmune gammaglobulin (HGG) has a similar protective action when instilled up to 2 hours after the induction of the ulcerative disease. Topical steroids enhance proliferation of HSV in epithelial disease, but at low dilutions there is some evidence that resistance is enhanced. Human studies of systemic immunity show that there is a response in cell-mediated immunity (CMI) after primary and recurrent ulcerative disease. Certain patients with severe stromal keratitis have evidence of CMI deficiency compared to controls or to patients with epithelial disease. To prevent virus spread into the stroma, early use of antiviral therapy is essential. Stromal disease does not only represent a hypersensitivity phenomenon, but is probably associated with virus proliferation in the keratocytes. Potent steroid medication will theoretically deplete immuno-protective responses, and promote further virus proliferation. Therefore the lowest possible concentrations achieving a clinical response should be employed.


Enigma of ocular cicatricial pemphigoid. A comparative study of clinical and immunological findings.

The clinical and immunological findings in 22 cases of ocular cicatricial pemphigoid are presented. Males and females were equally affected. Mucosal ulceration (both conjunctival and oral) and early involvement of the canthal structures were the most helpful clinical signs. None of the patients had circulating antibody to basement membrane determinants at presentation, but four developed typical pemphigoid antibodies during observation and three others showed an unusual "string of pearls" pattern on indirect immunofluorescence which changed to a pemphigoid pattern in one of them. Treatment of the acute ulcerative lesions with topical steroids was effective and prevented scarring, but otherwise treatment was ineffectual. The presence of antibody and its titre was not influenced by the severity of the disease or by systemic treatment.


Role of environmental factors in uveitis.

As part of a larger study undertaken to determine whether the presence of faecal Klebsiella aerogenes was significantly associated with the clinical activity of ankylosing spondylitis, thirteen patients with ankylosing spondylitis and acute non-granulomatous anterior uveitis (ANGAU) were examined. The faeces of eleven of these thirteen patients were found to contain Klebsiella aerogenes. This association shows a statistical significance of P less than 0.01, and suggests that Klebsiella aerogenes may have an aetiological role in the development of anterior uveitis in HLA B27 positive patients. The possible mechanism of this association and its potential clinical significance are discussed.


Prospects for the immunodiagnosis of ocular tumours.

Amongst other properties, malignant neoplasms are characterized by having antigenic determinants not normally found in mature healthy tissue. Consequently an immune response is usual on the part of the host and in recent years interest has centred on the twin possibilities of putting this property to diagnostic and therapeutic use. In our own laboratory we have concentrated on the diagnostic potential of immunological techniques in the investigation of pigmented tumours of the uvea. We have found that not only malignant melanomata, but also many naevi, can provoke an immunological reaction and we have shown that this is directed largely against contractile elements in the cytoplasm. Such reactions, which are not strictly tumour-specific, may be a source of diagnostic confusion and need to be excluded if immunology is to be of value in distinguishing malignant lesions of the uveal melanocytes from innocuous naevi.


Modified M-K medium for human penetrating keratoplasty.

A series of 120 consecutive human penetrating keratoplasties was performed using modified McCarey-Kaufman (M-K) medium. The medium has ben altered by changing the buffer system, adding a pH indicator, and using a different antibiotic from that originally formulated. There were no cases of primary donor failure and 95 per cent clear grafts after 1 year.


[Production and use of a nutrient medium with egg hydrolysate for monolayer reproduction of BHK 21/13 cells].

Experiments aiming to reproduce BHK 21/13 cells in Roux retorts by use of a semi-synthetic nutrient medium, based on protein hydrolyzate synthetized by the authors, were carried out. Results obtained show that the lower peptides and free amino acids found in ovarian hydrolizate meet the requirements of the cell line in respect to quality and quantity. The successfull cultivation of BHK 21/13 cells in hydrolyzate medium made possible a considerable reduction in the percentage involvement of serum, which is usually used in the classical nutrient media of the type Eagle BME intended for the propagation of diploid cell strains.


[Hemagglutinating activity and morphology of antigen K 99 in enterotoxic strains of E. coli isolated from calves].

The hemagglutination activity and morphology of antigen K 99 in enterotoxic E. coli strains isolated from calves was studied. It was proven that antigen K 99 is produced not at 18 degrees C, but at 37 degrees C. All K 99+ E. coli strains react with absorbed anti K 99 serum, showing various anti-agglutination titers. The hemagglutination activity of K 99+ E. coli strains is inhibited by absorbed K 99 antiserum. In immunodiffuse tests all K 99+ E. coli strains react by producing a single precipitation line. It is proven electronmicroscopically that on the surface of the bacterial cell of K 99+ E. coli strains is observed a filamentous structure, consisting of numerous fine fibers which give it a fibriform outlook. No such morphological structures are observed in K 99- E. coli strains.


[Myocardial infarction without coronary artery changes].

Since 1972 6 patients (4 males and 2 females) at the age from 18 to 44 years with myocardial infarctions could be observed whose coronary system in the subsequent coronarographic examinations proved to be unconspicuous. The diagnosis of the infarction was anamnestically, laboratory-chemically, electrocardiographically and partly scintigraphically ascertained. Issuing from features of infarction and pseudoinfarction, respectively, in the ECG other differential-diagnostically important cardiac and extracardiac causes could be excluded. In comparison to patients with coronary sclerosis typical symptomatology could not be delimited. Peculiarities of the clinical picture are the juvenile age, the in most cases short or lacking angina pectoris anamnesis, the frequent lack of factors of risk and the inclination to disturbances of rhythm. Up to now a satisfying etiologic clarification could not be rendered. The relevance of the different possibilities of the disturbed equilibrium between O2-offer and -need concerning the clinical course of our patients is discussed. Here on the side of the O2-offer the spasm of the big and small vessel and the disease of the small vessels are regarded as decisive factors of the development of the infarction, where as the coronary embolism with subsequent lysis is less to be taken into consideration. Other pathogenetic mechanisms, such as the pathologic Hb-O2-dissociation and the metabolic changes influencing the O2-need must be included into the causal chain of this presumably polyetiologic process. Prognostic and therapeutic aspects which closely correlate with the etiologic explanation are discussed.


[Retardation of puberty and growth].

The disturbed puberty is most frequently manifested by a retardation of sexual maturation and growth. For a correct classification of a developmental disturbance the knowledge of the endocrine processes, of the stages of puberty, tables of height and methods of the assessment of the skeletal maturity is necessary, the use of which for the population of the GDR is discussed. The large differential diagnosis of the delayed puberty and of the short stature must be above all concentrated to the causal-therapeutically influencible endocrinopathies, even though the proportion of the constitutional delayed puberty as an extreme variant of the norm with a good spontaneous prognosis prevails. In order to prevent serious psychosocial conflicts, after transgression of a critical age limit of about 16 years in sexual immaturity an adequate hormone treatment should be introduced even then, when the etiopathogenesis of the disturbance could not be completely clarified.


[Hyperprolactinemic hypogonadism--pathogenesis, diagnosis and therapy].

About 30% of amenorrhoeic women have a disturbed prolactin secretion. In about 10% the cause is a hypophyseal-suprahypophyseal tumour. Taking into consideration the degree of severity of the galactorrhoe, the amenorrhoe is connected with incontinence of milk. Also disturbances of the male potency may with partly similar symptomatology be conditioned by a hyperprolactaemia. For the development of hypogonadism the physiologic effect of prolactin gives sufficient explanations. With the introduction of dopaminergic substances which influence the disturbed regulating circle hypothalamus-hypophysis in the sense of an inhibition of the prolactin secretion new conservative possibilities for the therapy of disturbances of fertility are the result. With adequate recommendations for the radioimmunologic determination of prolactin the WHO made allowance for the central position of prolactin in the pathogenesis of hypogonadism. In particular the existence of hypophyseal microadenomas presumes a close cooperation between gynaecologists, radiologists, ophthalmologists and endocrinologists in the clarification of hyperprolactinaemic disturbances of fertility.


[Hirsutism--diagnosis and therapy].

Hypertrichosis and virilisation are to be differed from hirsutism, the increased hairiness of male type in the female. The subdivision is done according to the causes into physiologic, symptomatic, iatrogenic and idiopathic forms of hirsutism and for practice adequate to localisation into degrees of severity. In pathogenesis age, race, heredity, endocrine factors of the skin, in particular the reactivity of the hair follicles, testosteron and prestages of androgen, the sexual steroid-binding globulin as well as the oestrogen-androgen-balance play a role. Despite all progress in the analytics of hormones by the catheterism of the ovarial veins and the adrenocortical veins the inhibition and stimulation tests with determination of the steroids in the plasma or in the urine are entitled to diagnostics. The treatment is performed according to the cause operatively, medicamentously or cosmetically. The best results were gained with the antiandrogens (cyproterone acetate) and the gestagen chlormadinon acetate.


Microbiological examination of some Sudanese soils.

The composition of the microflora in different layers of four representative oil profiles of Sudan were studied. Counts of all types of microorganisms decreased significantly with depth in soil. Azotobacter, in particular, occurred in high densities; representative strains were isolated and studied for their different characteristics. Beijerinckia was detected as well, and a new method for the estimation of their numbers in pure cultures, based on the overlay agar technique, is described.


[On the contamination of the citric acid fermentation. I. The contamination by representatives of Enterobacteriaceae (author's transl)].

Among the most dangerous bacterial contaminations of the citric acid fermentation is the so-called brown contamination, which is called forth by non pathogenic representatives of Enterobacteriaceae like Escherichia coli, Aerobacter aerogenes, Enterobacter cloacae and Proteus vulgaris, while other bacteria do not produce the mentioned contamination. There is given a comprehensive characterization of the brown contamination. Enterobacteriaceae interrupt the growth of the mycelium of the mold Aspergillus niger and stop the production of citric acid, produce a characteristic repugnant smell and reduce nitrate to nitrite. In a case of weak contamination the phenomena of the brown contamination do not appear, but the yield of citric acid is rather low. The contamination may be transferred successfully within the first 24 hrs. of incubation. The effect of the bacteria is determined by their virulence and some other factors.


A clinical trial with glipizide - a relative new sulphonylurea.

Glipizide is a relatively new sulphonylurea- antidiabetic agent. 24 maturity-onset diabetics were studied to determine the dosage required to produce adequate control and the safety and tolerance of the drug. It was concluded that glipizide is a safe and potent anti-diabetic agent and a suitable alternative in those patients poorly-controlled on standard oral hypoglycaemic drugs.


[On the contamination of the citric acid fermentation. II. Sodium 5-nitrofurylacrylate as an antiseptic against representatives of the Enterobacteriaceae (author's transl)].

In context with the first communication which deals with the characterization of the so-called brown contamination called forth by Enterobacteriaceae in the citric acid fermentation of molasses, the present paper describes the screening of antiseptic substances able to suppress the contamination mentioned without damaging the normal growth of the producing mould Aspergillus niger and its ability of producing citric acid. Among the substances tested the sodium salt of 5-nitrofurylacrylic acid (5-NFA) excelled partly because of its antiseptic effect in relatively small concentrations and partly because the mould tolerates appreciable amounts of this antiseptic. Therefore there may be applied, in the presence of a heavy contamination, relatively high concentrations of the antiseptic without fear of damaging the producing mould. Usually a dose of 10 to 15 mg 5-NFA in 11 of medium was sufficient to suppress the brown contamination.


[On the antiviral effect of a triazole compound (author's transl)].

4-[Hydroxy-3-piperid-N-yl-prop-1-yl]-5-methyl-2-phenyl-triazole (HMPT) reduced the plaque formation caused by M 12, f 2, and Q beta and retarded the liberation of phages. The concentration of tobacco mosaic virus in primarily infected tobacco leaves was decreased. HMPT inhibited the development of local lesions. Free phages and TMV particles werenot influenced by HMPT.


[Combination of antibiotics with analgesic and antipyretic substances (author's transl)].

1. We suggest a combination of analgesic and antipyretic medicaments in medical treatments with antibiotics. Thus, the antibiotic is increased and microorganisms, resistant to antibiotics, are converted into sensitive forms. 2. The results of the in vitro used method (diffusion plate test) are in accordance with the results obtained using these combinations in therapy. 3. This method should not be applied to strains that are sufficiently sensitive to antibiotics, since the results would be contrary to the afore mentioned. 4. The effects of a combination are additionally synergistic in the case of strains originally sensitive. 5. This method offers great possibilities for multiplying treatments with antibiotics. We recommend to give standardized combinations of antibiotics with analgesic and antipyretic medicaments per os.


[Hormonal contraception (author's transl)].

Hormonal contraceptives will continue to be used for some time to come as the safest means by which to prevent pregnancy. This is the background against which an account is given of the forms of hormonal contraception, their safety, selection of preparations, prescription for young people, side-effects, contra-indication to prescription, and indication for discontinuation.--In the context of side-effects, particular reference is made to the effects of steroids upon fat, carbohydrate, and protein metabolism, the cardiovascular system, and early pregnancy.


The effect of azathioprine, hydrocortisone and trimethazone on the occurrence of active lymphocytes in liver of endotoxin treated rabbits.

After the administration of azathioprine, hydrocortisone and trimethazone to endotoxin-treated rabbits, the percentage of active lymphocytes (determined by means of the nucleolar test) decreased in the liver, while the lymphocytes in the peripheral blood were not affected. The assumption that in endotoxemia the liver may be a target organ for active lymphocytes and that autoimmune processes may participate in liver damage is discussed.


Comparative effects of CCK-PZ on certain intestinal hydrolases in the mucosa and in the luminal content of the hamster jejuno-ileum.

After isolation of the hamster small intestine, the effects of a continuous infusion of cholecystokinin-pancreozymin (CCK-PZ) are studied. Several enzymic activities are measured in the intestinal lumen and compared with the level found in the intestinal homogenate. During CCK-PZ infusion we observed a direct stimulation of Paneth cells associated with an increase of lysozyme activity. Furthermore this work confirms the stimulating effect of CCK-PZ on alkaline phosphatase and amino-peptidase. Maltase and sucrase levels were unaffected. The liberation of the hydrolase of the brush border in the intestinal lumen is negligible and cannot be considered as a true secretion. Only granule content of Paneth cells is actually secreted. However, biochemical data, corroborated by morphological results, suggest that Paneth cell secretion could in part be absorbed on the outer surface of the brush border.


Double blind study of meptazinol versus pentazocine and placebo in postoperative pain treatment.

The purpose of this double blind study was to evaluate the efficiency and safety of a new analgesic drug meptazinol, compared to pentazocine and placebo, in patients suffering from postoperative pain. Subjective and objective parameters were controlled. It appeared clearly that meptazinol had a potent analgesic effect with rapid onset, but rather short duration. Analgesic effect of pentazocine appeared more slowly, but persisted for a longer time. The two active drugs had no effects on the objective parameters measured.


Domperidone (R 33 812) as an antiemetic in the treatment of postoperative vomiting. A double blind comparison between two different dosages (4 mg and 10 mg).

Forty seven patients received either 4 mg or 10 mg domperidone I.V. in a double blind study after they had vomited postoperatively. The patients were then observed for six hours. If necessary, the same dose of domperidone was repeated double blind but not during the first hour. When the two groups were compared there was little difference between them for the first half hour after the initial dose, thereafter both the frequency and severity of vomiting was reduced in the 10 mg group. Also fewer patients in the 10 mg group needed a second injection. These differences were statistically significant (p less than 0.05).