[Complications after pacemaker-implantation and their treatment (author's transl)].

Of the 1050 pacemaker-implantations in the German Heart Centre in Munich from April 1974 to December 1977 complications arose in 229 cases necessitating a renewed surgical intervention. In accordance with the literature the dislocation of electrodes was the most frequent complication in the first days and weeks after implantation in our patients wil 11,1%. In cases of electrode dislocation the repositioning of the electrode is necessary; in certain cases an epi-myocardial electrode must be substituted for the usual transvenous electrode. Essential causes of complications were disturbances in woundhealing, necrosis of the skin and infection of the pacemaker-system, which were seen in 3,7% of all cases. In the case of infection of therapy of choice is the explntation of the pacemaker and the implantation of a new system in another position. Technical complications due to material are electrode fractures and battery defects. Complications due to material defects necessitate the exchange of the pacemaker or the electrode. Rare indications for reoperation were increase in threshold, muscle stimulation and allergi reactions caused by pacemakers.


[Contribution of Achille Breda to the understanding of American mucocutaneous leishmaniasis].

The majority of Parasitology textbooks and reference lists on Leishmaniasis do not quote the name of Achille Breda. This Italian dermatologist (1850-1934) however must be considered the first who clinically identified and carefully described the American muco-cutaneous Leishmaniasis, a disease for which some scientists proposed the name of "Breda's disease" (Jeanselme, 1910). Breda studied at the University of Padua, attending as postgraduate the famous Hebra's school of Wien. He became professor of "Syphilodermatopathology" in 1878 and during 47 years taught in Padua. He never was in South or Central America, but studied the illness in Padua itself, in 18 Italian emigrants who had come back ill from the São Paulo region, Brazil. At that time the agents of yaws, cutaneous and muco-cutaneous leishmaniasis and syphilis had not yet discovered and there was great confusion about the granulomatous lesions of the skin and mucosae seen in tropical areas. In this situation he exactly differentiated the condition from syphilis, yaws and lupus and could affirm, with the security of a highly skilled observer that it was an autonomous, different illness, peculiar to some rural areas of Brazil, non contagious directly, appearing in determinate season of the year but lasting for years and often conducting the subjects to the cachexia. His description of the symptomatology, post-morten anatomy, histology and his epidemiological observations, even nowadays represent one of the most accurate and complete pictures of this illesss. Breda's life and works are here reviewed and some passages of his papers on mucocutaneous leishmaniasis reported.


[Proteolytic activity of blood plasma and hemolysed blood in dogs after acute chlorophos poisoning].

On dogs under Eunarkon anesthesia (0,03 ml Eunarkon/kg body weight) after one intramuscular lethal injection of phoschlor (500 mg/lg body weight = LD100) the proteolytic activity (APR) was estimated in the blood plasma at pH 3,5-APR-3,5 and in the hemolyzed blood at pH-7,4-APR-7,4. The results showed that heavy poisoning with phoschlor led to metabolic disturbances in the proteolytic system of the blood plasma and blood, the expression of which was increasing in the course of time a statistically important increase (alpha = 0,001) of APR-3,5 and APR-7,4. APR induction in blood is not a result of direct activation of enzymes by pesticides. It takes place outside the circulation system.


[Activity of various enzymes in the blood, liver, intestines and kidneys in spontaneous colibacteriosis of piglets].

The purpose of the studies was to determine the activity of enzymes in the serum and pig organs with colibacteriosis in the form of oedema and stomach-intestines disease playing a diagnostic role in the determination of the organ damage degree. Studies were carried out on 29 pigs. The activity of LAP, GPT, GOT, AM, FDPA, Lp, AP and AcP was determined in the serum liver, empty intestines and kidneys of the diseased and control pigs. It resulted from the experiments that in the serum of all the diseased animals the activity of FDPA and GOT was considerably increased and that of AP decreased. So, activity determination does not allow to differentiate both forms of colibacteriosis. AM activity increases only in the serum of oedema pigs. In colibacteriosis of pigs the determination of FDPA activity is the most sensitive enzymatic test. In both diseases the activity of this enzyme increases considerable in the serum and all the studied organs. The activity of the studied enzymes shows that in both forms of collibacteriosis of pigs liver, intestines and kidneys are damaged.


[Determining levels of bacteria present in urine by means of a gauged loop (author's transl)].

The loop method permits determining of bacteriuria without the necessity for serial dilution, and with a precision greater than that of the dip inoculum test. Results indicate that the method allows us to establish the level of bacteria present in infected urine (approximately 10(5) germs/ml) quite precisely, and furnishes reliable evaluation of high levels. Due to the small quantity removed by the loop, the possible presence of strong concentrations of chemobiotics does not influence the results, as subinhibiting concentrations easily occur with diffusion.


[Preliminary results of postoperative trial therapy of epidermoid cancer of the lung (European Organization for Research on the Treatment of Cancer, Bronchus Group. Protocol 08741)].

650 patients entered the study between 5/74 and 4/79 and are currently evaluable. Prior to entry, all underwent complete resection of squamous cell bronchial carcinoma. Patients were initially randomized to receive radiotherapy versus no radiotherapy. Following that a second stage randomization ascribed patients to chemotherapy, immunotherapy, immunochemotherapy and observation. Current analysis of results shows that : 1. Patients with negative nodes did not benefit from post-operative radiotherapy; on such patients, survival was significantly shorter following radiotherapy. 2. In patients with positive nodes, post-operative radiotherapy prevented local recurrence, but did not prolong survival. The data from the second stage randomization are currently being analyzed.


A double-blind comparison of two bulk laxatives on geriatric patients.

Bulk laxatives have been said to have a good effect in normalizing both hard and loose stools in geriatric patients as concluded from some open studies. In a double-blind study Vi-Siblin, Lunelax and placebo were compared in the six weeks treatment of 29 patients (8 patients on Vi-Siblin, 8 patients on Lunelax, 13 patients on placebo). Two weeks prior to the study and the two last weeks of the study defecation frequency, consistency of stools and the use of additional laxatives were registered by the personnel. Results showed no significant differences between groups or between substances. From this controlled double-blind study it is not possible to draw any definite conclusions regarding the efficacy of bulk laxatives on geriatric patients.


The contribution of medical missionaries to tropical medicine. Service-training-research.

Medical missionaries, historically the pioneers in introducing Western medicine into many tropical countries, are today responsible for a significant proportion of health care in several of those countries. Illustrating his theme with references to personal experiences in the former Belgian Congo, the author enlarges on the organization of a church-related comprehensive health care programme based on a chain of rural health centres and satellite dispensaries that brought curative and preventive medicine to the whole population within the area covered. Trypanosomiasis was eradicated, yaws and tuberculosis controlled, cerebral malaria eliminated, worm-loads reduced and nutrition improved. Leprosy was treated within the integrated service as soon as the sulphones became available. Medical auxiliaries and nurse-midwives were trained practically to tackle the local problems. Students from many missions over a wide area went into government, mission and company employ after training. Research concentrated mainly on the solution of pressing local problems, such as onchocerciasis and leprosy, but incidentally investigated interesting clinical phenomena.


Studies on human filariasis in Malaysia: immunoglobulin and complement levels in persons infected with Brugia malayi and Wuchereria bancrofti.

Levels of immunoglobulins G, A, M and E as well as complement components C3c and C4 have been determined in populations in various endemic areas in Peninsular Malaysia and also in filariasis patients. High immunoglobulin levels were seen. In the microfilarial-negative group IgG was 2009 mg% while IgE was 3967 I.U./ml. In the filariasis group, Wuchereria bancrofti patients had significantly higher levels of IgG, IgM and IgE, namely, 3314 mg%, 804 mg% and 18400 I.U./ml respectively. The significance of these levels is discussed.


Falciparum malaria and pregnancy.

During pregnancy an increase occurs in the prevalence and density of Plasmodium falciparum malaria. The increase relative to non-pregnant women remains fairly constant with age though there is an over-all decrease in prevalence and density in both groups with age. The increase is at a height relatively early in pregnancy and declines after mid-term. At the height of the malaria season in The Gambia less antimalarial antibody appears in cord bloods than in the early dry season when transmission is lower. Infants show an increase in malaria prevalence and density in the early dry season as compared to the mid-wet season while the remainder of the population shows a decrease.


Relative cervical incompetence in twin pregnancy. Assessment and efficacy of cervical suture.

A total of 88 women with a twin pregnancy who had elective cervical suture were compared with 76 women with a twin pregnancy who had cervical assessment between the 13th and the 28th weeks of gestation but received no active treatment. The incidence of spontaneous onset of labour before 36 weeks was higher in the cervical suture group, and 53.4% of them sustained cervical damage.


[Hemolysis after combined azathioprine and allopurinol therapy].

In a 37 year old renal transplant woman haemolytic anaemia was observed in the course of a combined azathioprine-allopurinol therapy. Azathioprine is converted to 6-mercaptopurine, which then catalyzed by xanthine oxidase is oxidized to 6-thiouric acid. When allopurinol and azathioprine are administered simultaneously, high 6-mercaptopurine concentrations in plasma may be expected because of inhibition of xanthine oxidase activity by allopurinol. We assume that elevated plasma 6-mercaptopurine concentration could possibly be responsible for haemolytic anaemia in this renal transplant patient.


[Endotoxin recognition with myelopoiesis of monocytes and macrophages].

Cells from the monocyte-macrophage pathway release colony-stimulating factors. The release of colony-stimulating activity is increased upon endotoxin activation in the presence of fresh serum. Heat-inactivation of serum (56 degrees C, 30 minutes) abolishes the endotoxin-mediated activation of macrophages. Decomplementation with zymosan, iodipamide and the use of commercially serum deficient in C3 provide indirect evidence for a complement dependence of the endotoxin-macrophage interaction, which leads to release of colony-stimulating activity.


[Ixoten therapy in malignant lymphomas].

Clinical experience with Ixoten (trofosfamide), a derivative of cyclophosphamide, is reported in 29 patients with malignant lymphomas. Daily doses of 150-300 mg p.o. and 6.000-200.000 mg total dose respectively, resulted in an 80% complete or partial remission. In addition to a dose dependent haematotoxicity, other side effects (gastrointestinal and/or hair loss) were almost negligible.


The Ligurian coast: an example of data processing.

An attempt of computer data processing carried out on microbiological analysis of marine coastal waters is reported in the present paper. The Ligurian coast was chosen because of the extensive analyses executed by the Laboratori Provinciali di Igiene e Profilassi. These have supplied us with their results concerning the marine environment. The elaboration performed discriminates between those stations constantly polluted and the punctual pollution phenomena that seldom affect more than one station. Data obtained could be utilized for a correct management of the coast and of the adjacent land.


Shellfish quality standards.

Total coliforms, faecal coliforms, enterococci and heterotrophic bacteria were determined in shellfish samples collected both in the marine environment (at Bacoli and Coroglio in the Bay of Naples) and from the local market. The same bacteriological analyses were carried out on water samples obtained from the shellfish growing areas. The results are considered in relation to standards applied in Italy and elsewhere to shellfish and shellfish cultures.


[Serodiagnosis of 2,438 cases of toxoplasmosis by immunofluorescence at the Pasteur Institute of Algeria. Epidemiological and clinical corollaries].

2 438 sera from patients suspected of having toxoplasmosis, were tested by indirect immunofluorescence at the Pasteur Institute of Algeria between 1969 and 1973. 53,2% of the sera tested were shown to be positive. Although geographically limited, this investigation reveals the frequency of toxoplasmic infection in the Algiers region with a predominance of the polyadenopathic benign form. Moreover, the causative role of toxoplasmosis in repeated abortions is confirmed.


[Bullous varicella. Association of varicella and a childhood scalded-skin syndrome].

A boy, aged 18 months, presented with bullous chickenpox due to simulutaneous skin infection with varicella and staphylococci. Two strains of staphylococci phage type II were identified. The child was treated with strict asepsis and antistaphylococcal therapy. Systematic steroids are contra-indicated.


[Current developments on the physiology of the cardiac atrial pacemaker an excitation conduction of the left atrium].

According to recent developments the atrial pacemaker area and the right atrium show a peculiar morpho-functional organization, i.e.: 1) The pacemaker area is formed of clusters of cells containing relatively few myofibrils and showing embryologic characteristics. Such cells are known as nodal cells and between these and the atrial muscles are in general situated transitional cells. Each cluster is separated from the other by collagenous boundaries. The resistance of the membranes to the current flow seems to be relatively low between the cells of the same cluster but the collagenous boundaries are, according to TRAUTWEIN e UCHIZONO (1963), very poor conductors. The pacemaker activity seems to originate inside the various clusters. 2) The functional relationships between the sinoatrial node and the atrioventricular node as well as the interatrial relationship would take place through preferential pathways. These pathways corresponding approximately to the tracts described by JAMES (1966) (anterior, posterior and middle internodal tracts) and to the interatrial or Bachmann bundle, seems to show a higher velocity conduction. In general the fibres of which the tracts are composed are neither morphologically nor functionally isolated from the atrial muscle. The functional consequences of the above mentioned nodal and atrial organization seems to be: a) The possible conditioning of the pacemaker functions by the various clusters activity i.e. the dominance of one cluster over another. b) The shifting of the pacemaker activity from one cluster to anothr due to the arrival of nervous stimuli or chemical substances, etc. According to some Authors as a consequence of the shift the pacemaker area can sometimes move out side the nodal tissue and settle inside an area belonging to the internodal pathways. c) Another consequence of the shift can be the different involvement of the conducting pathways which can lead to a change in the dynamics of the atrial invasion by the excitement.


Inhibition and potentiation of T lymphocyte response to mitogens. Studies using two mitogenic stimuli simultaneously.

Rat thymocytes were stimulated with phytohaemagglutinin (PHA), Concanavalin A (Con A), pokeweed mitogen (PWM) and lipopolysaccharide (LPS) or with mixtures of two of these mitogens, added simultaneously to in vitro cultures. Four-five concentrations of first mitogen were matched with four-five concentrations of second mitogen, in all possible combinations. Synergistic effects were observed with LPS plus PHA and LPS plus PWM and inhibitory effects with PHA plus Con A and LPS plus Con A. The hypothesis is discussed that an inhibitory effects occurs when two mitogens react with identical or very similar receptors on the lymphocyte surface, while a synergistic effect is produced by two mitogens reacting with different receptors.


Relaxation therapy for essential hypertension: a Veterans Administration Outpatient study.

Twenty-nine patients who had been treated with antihypertensive medication for at least the preceding 6 months were randomly assigned to (1) therapist-conducted, face-to-face progressive, deep-muscle relaxation training for 10 weekly sessions, or (2) progressive deep-muscle relaxation therapy conducted mainly by home use of audio cassettes, or (3) nonspecific individual psychotherapy for 10 weekly sessions. No differences between the groups were found immediately after therapy; however, the therapist-conducted relaxation therapy group showed the greatest changes: -17.8 mm Hg systolic, -9.7 mm Hg diastolic at 6 months follow-up. Some significant trends in results among the three therapists were also found. No correlation existed between blood pressure changes and changes in dopamine-beta-hydroxylase (DbH) levels.


Psychological development of the child with leukemia: a review.

With improvements in prognosis for children with leukemia, there has been a corresponding increase in degree of adverse psychological effects on the patient and his family. This review considers (1) the methods of coping adopted by parents, siblings, and the patient and (2) the possibility of damage to normal intellectual growth following the type of medical treatment involved. Implications of previous research in terms of practical help for the families and theoretical issues regarding normal brain development are discussed.


[Research methods of R factors (author's transl)].

After having outlined the routine methods for the study of drug resistance plasmids used at highly specialized centres such as the London Enteric Reference Laboratory, the AA. examine the most practical methods of a pure and simple way of discovering R factors in enterobacteria. A brief reference is made to some of the in vivo transfer techniques before reducing the various possibilities of in vitro survey to essentials. The experimental conditions realized by some AA. for mating in liquid media which represent the most commonly used method for the study of R factors in enterobacteria are pointed out as an example. Finally, a brief reference is made to other technique such as the mating possibilities on membrane filter in solid media and "facilitated mating" in the cellophane device according to Chabbert.


[Anticytogram (author's transl)].

In the last few years in an attempt to solve problems of antiblastic chemotherapy, the anticytogram has been developed to test in vitro sensitivity of human neoplastic cell cultures to antiproliferative agents. This method, although not without limitations and criticism, can be considered valid in particular tumor forms where these exists a histological type standardization and possibility of comparison with other known specifically active drugs. It may also be justified in the preclinical pharmacological phase, as the first stage in validity testing of new anticytoproliferative substances.


[The incidence and variation of transferable antibiotic-resistance in Salmonella strains isolated in Modena in the years 1975-1977 (author's transl)].

The antibiotic-resistance of 450 strains of Salmonella isolated by the Microbiology Unit of the hospital of Modena during the years 1975-1977 was examined. During the study, the following antibiotics were assayed: ampicillin, kanamycine, tetracycline, chloramphenicol, streptomycin, sulfonamides, trimethoprim, tobramycin, gentamicin and nalidixic acid. The transfer capacity of antibiotic-resistance was measured by the double conjugation of E. coli K-12. During the period studied, a remarkable reduction was noted in those strains with multiple resistance (3 or more elements) decreasing from 72.9% in 1975 to 23.5% in 1977. These phenomena are due to the decrease of the serum-type wien during the years under study. Antibiotic-resistance demonstrated itself most frequently to streptomycin and tetracycline; and chloramphenicol-resistance showed the highest transfer capacity (97.2%).


[Drug resistance of Shigella strains isolated in Central Italy during 1969-1976 (author's transl)].

Only ninety-three strains of Shigella, eightyseven of which have been identified as S. sonnei and six as S. flexneri were collected during 1969-1976 at the Pathogen Enterobacteria Centre of Pisa in Central Italy, as evidence of an epidemiological situation marked by a rare occurrence of syndromes related to these organisms. The collected strains were tested with disks of nine antibacterial drugs in common use: the survey detected sensitivity of all the strains to cephaloridine, ampicillin, carbenicillin, kanamycin and gentamicin, whereas a fair percentage of resistance appeared to streptomycin, tetracycline, chloramphenicol and cotrimoxazole. Both within multiresistant strains and those characterized by single resistances (forty-three of them in all), were present strains capable of transferring different drug resistance patterns to E. coli K-12, as evidence of being under extrachromosomial genetic control.


[Bacterial resistance in the infections from gram-negative bacilli in a long-term hospital (author's transl)].

After considering the different reasons that make the problem of bacterial resistance of Gram-negative bacilli to antibiotics of great interest in a long-term hospital, the AA. present their cases. They point out how the strains isolated by them offer an antibiotic resistance which is decidedly superior to the one described in other researches. One thing seems to be noteworthy in their opinion: the bacterial resistance of the germs isolated from the urine is bigger than the one of the germs isolated from the respiratory apparatus.


["S. wien" and "S. bredeney" plasmidic resistance to disinfectant agents and antibiotics (author's transl)].

Several antiseptic and disinfectant compounds have been investigated for their minimal inhibitory concentration (MIC) against antibiotic multiresistant strains of S. wien and S. bredeney as well as S. typhi and S. typhimurium strains characterized by wide spectrum of antibiotic sensitivity. The MICs of AgNO3, merthiolate, NaN3, phenol, Zephiran and Desogen were not substantially different for the former and the latter strains; on the contrary, the HgCl2 minimal inhibitory concentration was significantly higher against S. wien and S. bredeney than against the other strains. The mercury resistance appeared plasmid controlled and transferable to E. coli K-12, always associated with antibiotic resistance. The findings, which confirm the results of other AA., seem unrestrictive of the use of HgCl2, because its not probable selective role in the hospital environment.


[Correlation between antibacterial activity of some cephalosporins and pharmacokinetic properties "in vitro" (author's transl)].

A new apparatus is described which can be used to investigate the in vitro antibacterial activity of antibiotics as a function of different concentration-time curves. The apparatus can be adjusted to simulate the biexponential serum level curves observed in vivo after oral or intramuscular administration. Preliminary studies were carried out with cefazolin against an E. coli strain simulating initial concentrations of 5, 10 and 20 micrograms/ml that decreased exponentially with half-lives of 30, 60 and 120 min. In all the situations tested there was an initial phase of rapid bactericidal activity followed by a phase of bacteriostatic activity, whose length depended on the drug elimination rate but was relactively independent of the initial concentrations. Bacterial regrowth occurred when the antibiotic concentration fell below the minimum inhibitory concentration (MIC) of the drug. The antibacterial activity of cefazolin, cephacetrile, and cephradine against an E. coli strains was also investigated, in a medium containing 4% human albumin, simulating the serum level curves observed in humans after an intramuscular dose of 1 g. The results obtained confirm that, for cephalosporins, the dosage schedule should be adjusted taking into account the potency of the drug (MIC) and its rate of elimination.


[Serological typing and antibiotic resistance in urinary "E. coli" (author's transl)].

The distribution of the O-groups of E. coli isolated in rivers (Arno, Serchio) and other surface waters is compared with the distribution of those isolated in urinary tract infections. The "chi square" test indicates a good correlation between the observed and expected frequencies in these two distributions, for all the O-groups, but six. Two of these (08 and 019) are significantly more frequent in the waters than in urinary isolates and four (02, 01, 018 and 075) viceversa. The O-group 6 its the most frequent in both, however the observed frequency in urine is greater than the expected one as regards the frequency in water isolates. These results would confirm, with the mentioned exceptions, the prevalence theory. The different patterns of resistance to the antibiotics suggest us to research a possible correlation between the antibotic resistance and the most frequent isolated O-groups. But no evidence of such correlation is demonstrated.


[Continuing Education Course of the Swiss Society for Psychiatry. Biological aspects of psychiatry. Introduction].

The author traces the prestigious history of the Burghölzli, cradle of Swiss psychiatry. He also describes the outstanding role played by Zurich as the city in which integration took place between the developing psychiatry, psycho-analysis, psychodynamics and biological research. The author shows how psychiatry, which had been faced with the mechanistric and philosophical dilemma of an epoch, could disengage from the dangers of a reductive approach thanks to Freud's influence, as well as the knowledge produced by biological and psychopathological discoveries. A new equilibration was, thus, found and a multidimensional model came into being. Today psychiatrists may choose to become either clinicians, or psychoanalysts, or devote themselves to research. Contract has become essential as well as the recognition of these different domains, this in order to improve the understanding of mental disorder.


Comparison of three assay procedures for theophylline determination.

We examined 50 serum samples, submitted to our laboratories for theophylline levels, by the Enzyme Multiplied Immuno Technique (EMIT), by a radioimmunoassay procedure, and by a high pressure liquid chromatographic assay. All three procedures classified patients similarly into subtherapeutic, therapeutic, and toxic levels. Precision and recovery values showed no significant differences between the three procedures. Precision ranged from 3.24 to 13.66%, while recovery values were from 98.6 to 110.0%. Significant differences were observed in the cost per assay and rate of throughput. The EMIT procedure was most costly and required the greatest amount of time. The excellent correlation between the Syva EMIT assay and the other two procedures makes this a desirable method for those laboratories which lack the more expensive instruments required for the other two procedures.


Results of a quality control scheme for the assay of theophylline in serum.

Twenty-eight laboratories in the United Kingdom, Europe, and Australia participated in pilot study to assess interlaboratory variability in determining serum theophylline levels. Each laboratory received two samples of pooled serum containing theophylline each month and was asked to report their results and method to us. Data obtained over a period of 12 months were collated, enabling certain conclusions to be drawn. Five methods of analysis were used: high pressure liquid chromatography (HPLC), gas--liquid chromatography, EMIT, thin-layer chromatography, and ultraviolet spectroscopy (UV). All of these methods, with the exception of UV, were found to be satisfactory, with HPLC marginally superior. Several laboratories improved their assay techniques over the period of operation of the scheme, and all found the scheme helpful in assessing the performance of their methods.


High pressure liquid chromatography for simultaneous analysis of anticonvulsants: comparison with EMIT system.

We present a new high pressure liquid chromatography (HPLC) method for the simultaneous analysis of primidone, phenobarbital, phenytoin, and carbamazepine in serum. The chromatographic separation is carried out using an Altex model 110-A pump, a 250 times 4.6 mm column containing 5 mum Spherisorb ODS particles and a variable wavelength ultraviolet detector set at 197 nm. The mobile phase is a mixture of acetonitrile, distilled water, and 1.75 M phosphoric acid (27:72.8:0.2). The flow rate is 1.5 ml/min, and the analysis time is 17 min. A 200 mul aliquot of serum is buffered at pH 5 and extracted with dichloromethane. The extract is evaporated to dryness and dissolved in methanol for chromatographic analysis. Cyclopal is used as the internal standard and quantification is achieved using peak height ratios. This HPLC method is evaluated for precision and accuracy with reference to the EMIT system. The least-squares regression analysis of comparison data for the drugs shows a favorable correlation. Also, a paired t-test indicates no significant difference for the HPLC and EMIT values for primidone, phenobarbital, phenytoin, and carbamazepine. From this study we conclude that this HPLC method could be successfully used for the simultaneous therapeutic monitoring of the four anticonvulsants.


Comparison of radioimmunoassay with homogeneous enzyme immunoassay for the determination of theophylline concentration in serum.

The homogeneous enzyme immunoassay (EMIT) and radioimmunoassay (RIA) procedures for the quantitation of theophylline concentrations in serum were evaluated and compared. Both methods exhibited curves linear over the therapeutic range (range of concentration, 2.0-33.0 microgram/ml). Precision was acceptable for both methods with the coefficient of variation being less than 8.3%. The RIA procedure was found to be slightly more precise. The correlations between the EMIT and RIA procedures was found to be sufficient to allow the procedures to be used interchangeably. This would facilitate the test availability on a 24 hr, 7 day basis.


[Vitamin C and phagocytic system: present status and perspectives (author's transl)].

Host defence mechanisms against microbial invasion requires an adequate number and function of phagocytic cells. There is evidence that vitamin C, which has been claimed to play a role in several aspects of host defence mechanisms, is involved significantly at least in phagocytic function. Vitamin C has been shown to interfere with oxidative metabolism, bactericidal power and chemotaxis of neutrophil granulocytes. The authors present evidence that, in vitro, vitamin C stimulates the true chemotactic response of normal human granulocytes. In addition the results of clinical trials in patients with recurrent infections and primary deficiencies of neutrophil function are presented. In such patients vitamin C therapy induced the restoration of impaired functions. A significant clinical improvement was also seen in the majority of cases. Vitamin C represents the specific therapy for primary defects of phagocytic function in patients with recurrent infections.


The incidence of oral candidiasis with use of inhaled corticosteroids.

The incidence of thrush occurring among patients receiving inhaled corticosteroids as reported by various investigators is presented. The data were standardized according to diagnostic criteria, duration of treatment and size of patient population. Although proper assessment of the relative risk of thrush incurred with the use of aerosolized corticosteroids must await large-scale randomized, blind, comparative trials, these results of past studies give a general indication of what may be expected.


Hyposensitisation in the management of recurring vaginal candidiasis.

Hyposensitisation with a commercially available antigen has been attempted in the treatment of women suffering from recurring monilial vaginitis. Ten women entered the trial, each being used as her own control. Eight of them showed undoubted improvement and the average interval between relapses increased from 5.1 to 15.7 months (p. less than .01). Reasons are given for believing that allergic reactions play a part in recurrent vaginal thrush.


[Autoplastic bone-grafting on repair of long bones of hands (author's transl)].

Cortico-spongious autoplastic bone grafts have in reconstructive hand surgery several precise indications. Bone infusion is certain if the technique used is appropriated permitting the cosmetic and functional recovery of the corresponding digital ray. The indications are: post-traumatic non-union, great loss of bone, bone neoplasm. The authors basing their causistic on 28 cases discuss the indications, surgical technique and results.


Maturation and regulation of megakaryocytopoiesis.

The in vitro cloning technique for detecting megakaryocyte precursor cells was employed to compare stimuli known to influence megakaryocytopoiesis. Preparations of thrombopoietic stimulating factor (TSF) did not directly stimulate the growth of megakaryocyte colonies (CFU-m) but increased the frequency of CFU-m when TSF was added to the cultures with a constant amount of megakaryocyte colony stimulating factor. Platelets or platelet homogenates did not influence the frequency of CFU-m or the size of individual colonies. Analysis of cell surface properties of megakaryocytes obtained either by isolation from bone marrow or from in vitro colonies revealed species differences. The possibility that megakaryocytopoiesis and platelet release are regulated both within the marrow as well as by humoral factors is discussed.


Antibodies against pluripotent stem cells: their use in studying stem cell function.

The biologic characteristics and specificity of rabbit anti-mouse brain (RAMB) serum for pluripotent hemopoietic stem cells (CFU-s) is reviewed. The application of RAMB serum to the functional analysis of stem cell differentiation and self renewal characteristics is discussed. Preliminary data are presented which suggest the existence of two stem cell subcompartments. The majority of stem cells express membrane determinants that are detected by RAMB serum. A minor (5%-10%) stem cell subpopulation lacks the stem cell antigen and exhibits a greater self-renewal capacity than those cells expressing the antigen.


Transplantation of murine bone marrow without prior host irradiation.

The experiments presented test the hypothesis that pluripotential stem cells (assayed in the mouse as CFU-S) are normally not in cycle and that the failure of normal marrow transfusions to take in normal recipients is due to the absence of a stimulus to turn CFU-S into cycle. Following marrow transfusion from male donors into female isogeneic recipients, spleen, liver, and various parts of the skeleton were shielded to protect transfused donor cells from lethal doses of radiation gives to the rest of the body. Percentages of hemopoietic donor and host cells were subsequently determined by karyotyping C banded marrow and spleen metaphases and identifying of Y chromosome. The results support the notion that the failure of normal marrow to take in normal recipients is not due to inadequate numbers of transfused cells. Permanent colonization by donor cells, however, requires not only triggering CFU-S into cycle, but also emptying of 'niches' normally occupied by endogenous CFU-S. Partial body radiation meets both requirements. In addition, the results indicate that recently arrived donor cells, protected in the shielded portion of the body, seed more readily into the irradiated areas of the skeleton than do similarly protected host cells.


[Hepato-pulmonary Nocardia infections (report of one case) (author's transl)].

Actinomycosis due to Nocardia asteroides is a mainly pulmonary disease; the metastases are due to migration of the germ in the blood from the primary lung focus. The case reported here concerned a patient whose initial symptoms were mainly hepatic, suggesting an amoebic abscess of the liver. The pulmonary lesions appeared only secondarily with presence in the sputum of the nocardia which was responsible. Prolonged treatment with trimethoprime sulfamethazole led to complete and lasting cure of the lesions, confirmed radiographically and by a liver scan.


[Spontaneous tolerance of liver allograft in the rat (author's transl)].

Several clinical and experimental arguments suggest that the liver has a privileged status regarding allograft rejection. The purpose of our study in inbred rats was to verify this notion in animals with precise histocompatibility relationships. Non auxiliary heterotopic liver transplantation, in which the graft ensures totally the hepatic function of the recipient, is equivalent in this view to orthotopic liver transplantation but has the major advantage to permit more easily the obtention of a low operative mortality. We compared the rejection of heterotopic heart allografts and heterotopic non auxiliary liver allografts in two semi-allogeneic donor-recipient combinations on inbred rats. Our main finding was that, contrasting with the constant acute rejection of heart allografts, about one-third of liver allografts were spontaneously tolerated. Test skin and heart allografts performed in rats with spontaneously tolerated liver allografts suggested that these animals were in a state of donor-specific non responsiveness. Spontaneous tolerance of organ allografts is very uncommon and our observation with liver allografts in inbred rats reinforce the concept that the liver has a privileged status facing rejection.


[Clinical trial of parenteral trimethoprim-sulfamethoxazole].

The combination of trimethoprim-sulfamethoxazole has been used successfully in various infections. However the use of the combination was limited, due to the lack of a parenteral form of the drug. In this study a parenteral (i.m.) form of trimethoprim-sulfamethoxazole was given to 35 patients with various infections due to susceptible bacteria to the drug. Twenty-four patients had urinary tract infections, and 7 had various infections with gram negative organisms, and 4 had staphylococcal infections. In patients with urinary tract infection the cure rate was 62.5%. Twenty five per cent of the patients had persistent infection after treatment, and 12,5% had superinfection. The overall cure rate was 71,4% in 35 patients. No side effect was observed.


[Salmonella typhimurium isolated from a burn wound].

Salmonella typhimurium isolated from a burn wound, in Burn Unit of Hacattepe University Hospital, General Surgery Department.


[The antigenic relationships between Candida albicans, Salmonella cholerae suis, and Salmonella cholerae suis var. Kunzendorf O antigens].

In this study a common antigenic factor (s) between C. albicans CBS-562 and S. cholerae suis 211 (0:6(2),7) was shown with agglutination and absorption tests. This common antigenic factor (s) is different than previously shown Salmonella 0:7 antigen. This new factor (s) is not present in S. cholerae suis var. kunzendorf 1350 (0:6(1), 7) and S. cholerae suis var. kunzendorf 5210 (0:6(2),7) serotypes.


[Antibacterial effects of arsenic on pulp necrosis using the plate diffusion method].

The microorganisms which arrive in various ways to dental pulp causes the infections of pulp. The pulp is necrotised in cases it is not possible to keep it alive. In this study arsenic which is known an available material for devitalisation of pulp and its antibacterial effects on microorganisms which are the causes of the infections of pulp have been investigated.


Ninth Annual Richard G. Scobee Memorial Lecture. Sensory response in exotropia.

The characteristics, methods of clinical investigation, and incidence of amblyopia, suppression, and anomalous retinal correspondence in exotropia have been reviewed from the ophthalmic literature. It is hoped that reemphasizing the sensory anomalies in exotropia may lead to more sensitive clinical investigation in these areas and, ultimately, to a better understanding of the sensory system and some of its enigmatic responses.


The role of the lymphocyte in haemopoiesis.

According to current dogma, circulating blood cells are all derived from the same progenitor, which therefore must be both pluripotent and capable of prolific self-replication. In the irradiated mouse, such haemopoietic stem cells (HSC) give rise to splenic colonies, and thus are designated as CFU-S (colony forming units-spleen). Definitive identification of a similar entity in man so far has proved elusive. However, primitive unipotent cells, committed to development along a single pathway, can be detected in human blood-forming tissues under appropriate culture conditions. Operationally defined as CFU-E (erythrocyte), CFU-GM (granulocyte/macrophage) etc., the ontogenetic relationships of these cells to each other and to the HSC have been the objects of exhaustive study. A population of lymphocytes, classed as "null" cells, do not exhibit the surface membrane markers which characterize commitment to differentiation in the thymus-dependent (T-cell) or bursa- equivalent (B cell) lineages. Accumulating evidence points to the null lymphocyte as a potential precursor of haemopoietic tissue. In bone marrow, the activity of terminal deoxynucleotidyl transferase (TdT) is concentrated in null cells, but the relevance of this unique enzyme to lymphocytic differentiation remains uncertain. Nevertheless, it appears that the functional heterogeneity, expressed within the family of lymphocytes, extends to haemopoiesis. The roles of various lymphocyte populations, in the generation and functional control of blood-forming tissue, are examined in this review.


The effect of treatment on the Treponema Pallidum Haemagglutination test in early syphilis.

The response of the Treponema Pallidum Haemagglutination Assay (TPHA) to treatment was studied in 61 cases of early infectious syphilis. In none of the 55 cases of early syphilis in which the pre-treatment TPHA was positive did the TPHA test become consistently negative after treatment. In primary and early latent syphilis it was not possible to demonstrate any significant changes, but in some cases of secondary syphilis a significant and rapid fall in TPHA titre occurred with treatment. It is suggested that the post-treatment TPHA titre need not necessarily reflect the stage at which the disease was arrested.


Topical steroids in anterior uveitis.

The results are presented of a double-blind trial comparing the efficacy of betamethasone phosphate 0.1 per cent, clobetasone butyrate 0.1 per cent, and placebo in the treatment of acute unilateral non-granulomatous uveitis. The two steroids gave comparable results in improvement of the patients' symptoms, although betamethasone phosphate was significantly more effective than clobetasone butyrate in improving the ocular signs of uveitis. In comparing the placebo group of patients with those given topical steroids, the former group, though improving, appeared to lag behind by approximately 1 week. Four patients receiving placebo, however, had to be withdrawn because of worsening of the condition. Mild cases of anterior uveitis would probably resolve without using topical steroids.


Structural and evolution of chloroplast- and bacterial-type ferredoxins.

Comparisons have been made between amino acid sequences of 26 chloroplast-type ferredoxins and 16 bacterial-type ferredoxins. Their structural characteristics are described and related to a three-dimensional structure of a chloroplast-type ferredoxin. Aspects of molecular evolution of these ferredoxins are presented together with a phylogenetic tree including both chloroplast- and bacterial-type ferredoxins.


Alterations in blood sugar, serum insulin and circulating free fatty acid responses to glucose load produced in dogs by chloralose anaesthesia.

The effects of chloralose anaesthesia on the BS, serum IRI and circulating FEA responses to glucose in dogs, in the course of glucose tolerance tests were studied. Chloralose induced a moderate glucose intolerance, and abolished both, the insulin response to hyperglycaemia in these animals and the lipolytic response at the end of the test. These effects indicate that chloralose anaesthesia is definitely improper for metabolic studied in experimental biology.


Experience with the avulsion technique in pterygium surgery.

A technique for pterygium removal is described which combines the avulsion of the pterygium head off the corneal surface with a precise isolation and resection of the pterygium. The conjunctiva is resutured to allow the sclera to remain bare. B-radiation in 3 divided doses is administered in each case.


Adjustable suture strabismus surgery.

The adjustable muscle recession procedure is described. The criteria for patient selection are reviewed as well as the surgical results during the past 5 years when the technique has been in active use. The philosophy behind the adjustable suture technique is the following: a procedure which would allow the surgeon to bring ocular alignment to a favorable position at the time of the first postoperative dressing change would be of significant value. Adjustable suture surgery is just such a technique. It does not insure a successful result. The ophthalmologist must still decide upon the preferred eye position. The surgeon is merely allowed to come closer to his desired immediate postoperative alignment by the ability to adjust muscle position after surgery.


[Thrombocyte function and systemic effect of prostaglandin I2 inhalation].

After inhalation of prostaglandin I2 minimal effects on lung function and the cardiovascular system could be observed in healthy volunteers. Platelet function, however, decreased significantly. In the future the application of the prostaglandin I2 may be a new approach in the treatment of thromboembolic disorders in man.


Fungal invasion of a therapeutic soft contact lens and cornea.

A fungal corneal infection occurred in a 66-year-old man who wore a therapeutic soft contact lens for 12 months during treatment for a metaherpetic corneal epithelial erosion. The infection was documented by finding positive cultures from both the contact lens and the cornea, and histologic evidence of fungal infiltration of the therapeutic soft lens. The fungus was identified as Cephalosporium acremonium. Pathogenic fungal invasion of soft lenses is unusual. Corneal infections associated with such conditions are rare. This case demonstrates histologically, a pathogenic fungal corneal infection arising from therapeutic contact lens wear. Factors that may influence soft lens infiltration by fungi are: (1) enzymatic activity produced by the fungus, and (2) lens material properties which provide a matrix and a nutrient source for fungal growth. Continuous-wear soft contact lens treatment with topical steroid and prophylactic antibiotics used in combination in an already compromised cornea were thought to be responsible in an already compromised cornea were thought to be responsible for this complication. A therapeutic penetrating keratoplasty was performed when the infection and its accompanying inflammation became clinically unresponsive to multifold therapy, and a corneal perforation was imminent. The eye was salvaged with a resulting clear graft and stable intraocular pressures.


Corneal transplantation for endothelial pigmentation.

Endothelial pigmentation does not usually interfere with vision. This case report documents a dense and extensive deposition of uveal pigment in corneal endothelial cells of a patient who had undergone 2 previous grafts subsequent to an alkali burn injury. The previous graft in which the pigmentation occurred remained compensated, but vision was impaired secondary to dense endothelial pigmentation. A combination of the initial chemical injury, recurrent iritis, chronic glaucoma, and multiple intraocular procedures may have resulted in the stimulus for the uveal tract to disperse a large amount of pigment onto the cornea and its subsequent phagocytosis by the endothelium. Endothelial pigmentation may become a more commonly seen complication in attempts to treat the severely damaged anterior segment.


Donor eye contamination.

One hundred twenty-seven cultures were taken from donor eyes in McCarey Kaufman (M-K) media and 60 from anterior chamber cultures of whole eyes. From the 127 eyes, 17 positive culture were obtained, 13 of which came from anterior chamber cultures of the whole eye and 4 from the M-K media. Of the 16 eyes used for corneal transplantation, there was 1 successfully treated clinical corneal infection. It is concluded that patients with chronic debilitating disease possibly have terminal bacteremia and donor contamination. It is our current recommendations that all corneas obtained in tissue culture media be cultured by the eye bank upon arrival and that eyes prepared for M-K media and refrigerated whole eyes have an anterior chamber culture. Any positive results should then be sent to the primary surgeon as soon as the culture results are ascertained.


Thermal burns: the management of thermal burns of the lids and globes.

Our experience with 40 patients with eyelid and globe burns is reviewed. Initial emphasis should be placed on close monitoring, particularly of partially alert patients, debridement and treatment of corneal exposure with artificial tears and scleral shells when needed. The use of soft contact lenses in 2 patients with exposure was unsuccessful. Surgical treatment should be initiated when corneal exposure fails to respond to medical therapy. It is advisable to wait for the end stage of scarring so as to optimize chances for a single definitive correction. The use of retroauricular, supraclavicular or inner arm skin for grafting whenever possible is advised. The use of Frost sutures, tie-on dressings, and separate operations for upper and lower lids is recommended. Superficial wound sepsis is not a contraindication to grafting. Preoperative systemic or topical antibiotics do not seem to affect the outcome of the graft.


Electroencephalographic and histopathological correlations on Jakob-Creutzfeldt disease.

Three patients with Jakob-Creutzfeldt disease were studied. The clinical evolution was followed and several EEG controls were made. In all patients characteristic EEG abnormalities were present. Histopathological features in the cortical, subcortical grey matter and in the white matter were examined. Subcortical and cortical grey matter were involved while the white matter appeared intact. The results were compared with previous studies of other Authors and the correlation between the characteristic EEG alterations and the histopathological features was studied in order to explain the appearance of the paroxysmal EEG findings. In agreement with other studies, the Authors emphasized the cortical and subcortical grey matter involvement in the genesis of EEGraphic paroxysmal aspects. The intervention of other factors, possibly of histochemical nature, was postulated.


[Natural history, treatment and outcome of cerebellar softening (author's transl)].

21 adults with acute cerebellar softening were divided into two groups. In the first group (6 patients) the clinical course was progressive with deterioration of consciousness, signs of brain-stem compression and some degree of enlargement of ventricles (CT scan). Of these patients, three were treated surgically with success, one recovered spontaneously and two others died post-operatively. In the second group (15 patients) the course was much more favourable. Without surgery the cerebellar symptoms and signs improved, in spite of the persistence of discrete cerebellar signs one month after the onset of symptoms. Medical and/or surgical treatment of the disease are discussed, including the differential diagnostic aspects as well as the CT scan features.


[Heterotopic transplantation of rat liver. Preliminary observations with the scanning electron microscope (SEM)].

An eterotopic grafting of their livers has been made between two inbred rats. From 30 to 50 days later the livers has been observed through OM or SEM. In the first case (OM) there was evidence of vacuolar degeneration of liver cells gradually decreasing on the 50th day. In the latter case (SEM) the morphological appearance remained unchanged.


[Effects of some prostaglandins on plasma levels of prolactin in the rat].

In ovariectomized rats treated with estradiol benzoate the ICV introduction of PGE1, 11-deoxy-13,14-didehydro-16S-methyl-PGE2, PGI2 or 6 H-PGI1 produces a marked increase of the plasma prolactin levels. These results suggest that the PGs play a role in the regulation of the prolactin secretion.


[Behavior of the plasma level of digoxin in the rat in induced experimental hyperreninemia].

PRA, plasma and urine aldosterone levels and plasma digoxin were measured in rats in which digoxin had been administered under conditions of high PRA and high aldosterone levels experimentally induced by administering distilled water load and in rats in which digoxin had been administered without distilled water load. Results show that under conditions of high PRA and high aldosterone levels, plasma digoxin concentrations as measured 6 h after treatment were higher (45,3%) than in rats having received digoxin without water load. In assays carried out on rats sacrificed 12 h after digoxin treatment (with or without water load) all values approach basic levels again, thus suggesting that in rats too aldosterone might compete with digoxin at the level of tubular excretion.


Immunological analysis of human microglia: lack of monocytic and lymphoid membrane differentiation antigens.

While it is certain that reactive microglia (phagocytes in damaged brain tissue) originate from monocytes, the derivation of resting microglia (argentophilic cells in undamaged brain tissue) is not clear. In order to examine a possible lymphocytic and/or monocytic origin for resting microglia, cryostat sections of presumably normal human brain tissue were treated with anti-lymphocyte, anti-monocyte and anti-beta 2-microglobulin sera and then stained with the immunoperoxidase technique. No positive reaction was obtained. It must be concluded that resting microglia are not derived from mononuclear blood cells.


Reduction of experimental myocardial infarct size by combined treatment with methylprednisolone sodium succinate and betahistine hydrochloride.

This laboratory and others have shown that methylprednisolone sodium succinate and betahistine hydrochloride can each reduce the size of experimental myocardial infarct in dogs at six hours. In light of the fact that these two agents probably act via different mechanisms, a study was carried out to determine if there would be cumulative effects of using these two agents together. Using a left anterior descending coronary artery ligation model to create an experimental myocardial infarction and an intracellular lactic dehydrogenase (LDH) stain to measure the infarct size, 66 dogs were studied. Nineteen dogs served as controls with no therapy; 20 received a continuous intravenous infusion of betahistine hydrochloride (0.24 mg/kg/min) for six hours following ligation; 10 dogs received methylprednisolone sodium succinate intravenously 30 mg/kg at one hour postligation; and 17 other dogs received betahistine hydrochloride intravenously (0.24 mg/kg/min) over six hours following ligation, plus methylprednisolone sodium succinate intravenously (30 mg/kg) at one hour postligation. At six hours, the combined treatment demonstrated no significant improvement over betahistine HCl alone (control, 16.0%; betahistine HCl, 11.4%; combined, 11.2% P less than 0.05). At 24 hours, only the combined treatment group demonstrated a significant infarct size reduction (control, 15.5%; methylprednisolone, 13.1%; betahistine--HCl, 14.2%; combined, 9.7%; P less than 0.0025). Other parameters that were evaluated and analyzed include mean aortic pressure, left atrial pressure, cardiac index, total peripheral resistance, arterial and coronary sinus pH, pCO2, pO2, hematocrit, O2 consumption, O2 content difference, and coronary sinus lactate and creatine phosphokinase (CPK). These results suggest a significant cumulative effect in reducing infarct size over that achieved with one agent alone; however, further studies are needed to determine the appropriate dosage and temporal factors.


Effect of prostaglandin E1 and steroid combination in the treatment of hemorrhagic shock.

Prostaglandin E1 and methylprednisolone sodium succinate were administered simultaneously after shock in an intact canine hemorrhagic shock model and compared to treatment with each agent singly and with a 60 cc saline infusion. A detrimental effect of the prostaglandin E1/steroid combination was evidenced by decreased heart rate, mean arterial and central venous pressures, cardiac output, and arterial pH, and increased venous lactate. Survival was poor after the combined regimen. These changes may be related to vasodilation in the peripheral vascular system, causing pooling of blood. Lysosomal membranes were stabilized in spite of prolonged hypoperfusion.


Roast pig and scientific discovery. Part II.

In Part I of "Roast Pig and Scientific Discovery" (American Review of Respiratory Disease, May 1977). I gave a classic instance of Chance, or Serendipity, as related by Charles Lamb in his "Dissertation upon Roast Pig." In this essay, Lamb tells how many centuries ago Bo-Bo, the Chinese swine-herd's son, stumbled upon the delicacy of roast pork when he accidentally burned down his father's house and barn and in the process roasted ("burnt") nine newly farrowed pigs. I then gave (A) eight examples in which chance speeded or completed a scientist's ongoing work and (B) five examples in which chance changed the direction of a scientist's work and pointed him toward a new goal. In Part II, I will give more examples of a change in direction of a scientist's work that resulted from chance, and speculate on the role of chance in speeding the advance of science.


[Semi-automatic determination of blood lactate in the newborn infant of the insulin-dependent diabetic mother].

Blood lactate levels were determined by Lactate Analyzer 640 Kontron in 5 infants of diabetic mothers with pregestational insulin-dependent-diabetes, class B-C-D White, BPSP negative, in strict glycemic control all along the pregnancy. In the mothers blood lactate was found in a normal range after-delivery. In the absence of complications, the neonate of diabetic mother did not show blood lactate changes above the normal range. As well as in the neonate of non diabetic mother, blood lactate increases were found only in concomitance with respiratory acidosis. In the cases with favourable course, lactate values above 2 mmol/l were normalized in the first 24 hours after the birth. The semiautomatic determination of blood lactate supplies a good prognostic evaluation of the association between metabolic and respiratory acidosis in the neonate and should therefore be routinely used in centers for management of diabetic pregnancy.


Fluoroimmunoassay: present status and key problems.

Fluorescence immunoassay of biological fluids (for example, blood samples) is discussed. We attempt to chart present methods of assay as well as new possibilities. Different fluorescent probes, their detection limit, and methods for reduction of background are discussed; methods for separating the free and bound fraction are also reviewed. Special consideration is given to the possibilities of enhancing sensitivity by developing both instruments and chemical methods, and in particular to the possibilities inherent in time-resolved fluorometric applications and to the use of metal chelates in this application.


Antibodies to native DNA: detection by immunoperoxidase assay and determination of their immunoglobulin classes.

Antinuclear antibodies are almost always found in sera of patients with systemic lupus erythematosus. To differentiate antinuclear antibodies from antibodies to DNA in the recently described Crithidia luciliae assay, we developed an immunoperoxidase technique for detecting antibodies to native, double-stranded DNA and compared results by it with those by the Farr assay. Smears of cultured Crithidia luciliae were incubated with human sera, peroxidase-labeled anti-human IgG serum, and diaminobenzidine. The peroxidase stain was examined by conventional light microscopy, which facilitated differentiation between the kinetoplast and the nuclear staining. The Crithidia assay appeared to be specific for double-stranded DNA antibodies, seemed to be more sensitive than the Farr assay, and allowed us to determine the immunoglobulin classes of antibodies to native DNA. Some patients with systemic lupus erythematosus had only IgM or IgA antibodies to DNA.


Correlation between X-prolyl dipeptidyl-aminopeptidase and serum amine oxidase in serum of patients with post-burn keloids.

Activities of X-prolyl dipeptidyl-aminopeptidase (EC 3.4.14.1) and amine oxidase (EC 1.4.3.6) in serum were assayed in two groups of patients, children two to nine years old and adults 23 to 60 years old, with hypertrophic scars after severe burn. The peptidase activity tended to be low initially for several months after the burn, but then returned to normal after six months. These changes were marked in the child group, less so in the adult group. Similar but less-pronounced changes were also observed in serum amino oxidase activity. The two serum enzyme activities showed a significant positive correlation (r = 0.668, p less than 0.001, n = 27) in the patients.


Acetate intolerance and an inhibitor of acetate utilization in hemodialysis patients.

Diminished ability to utilize acetate (acetate intolerance) developed in a male patient on chronic hemodialysis after five years of maintenance dialysis. His ability to utilize lactate was also subnormal. We studied acetate metabolism in vitro by isolating lymphocytes from the patient's blood before dialysis and measuring their ability to convert [1-14C]acetate to 14CO2. His cells metabolized acetate only 35% as well as did lymphocytes from normal adults. The inhibition appeared when the patient's lymphocytes were cultured, and the ability of normal lymphocytes to oxidize acetate decreased after they had been incubated in the patient's plasma. We conclude that an inhibitor of acetate utilization is present in the plasma and in (or on) the cells of this acetate-intolerant patient. The diminished ability of the patient to utilize lactate and the presence of normal concentrations of pyruvate, citrate, and ketone bodies in his blood suggest that the inhibitor functions at the cell surface to impede the entrance of acetate into the cells. The inhibitor appears to be dialyzable; its nature is unknown. Its accumulation in the plasma of chronic hemodialysis patients has not been thus far associated with any deleterious effects other than prolonging the metabolic acidosis of such patients.


Incorporation of a SMAC analyzer into the data-processing procedures of a computer-assisted laboratory.

This paper describes the incorporation of a SMAC (Technicon) analyzer into data-processing techniques that have been developed on existing computer hardware during several years. The SMAC system is interfaced directly to a small computer, and suitable peripherals produce a manageable form of result tabulation for subsequent reporting, as well as provide quality-control information to the SMAC operators in real time. The design is such as to facilitate the performance analysis of the SMAC system during its initiation period and during normal service operation.


Short term in vitro cultivation of malaria parasites in Papua New Guinea for preparation of biosynthetically-labelled parasite antigens.

Short term in vitro cultivation has been used successfully for biosynthetic labelling of TCA precipitable macromolecules of Papua New guinean isolates of Plasmodium falciparum. Conditions satisfactory for completion of the asexual erythrocytic cycle were achieved with aa minimum of sophisticated equipment. The techniques used are described in detail and mention is made of possible applications to assessment of chloroquine resistance and the mode of action of inhibitory antisera.


Studies of bacterial populations in the kitchens of the University of Papua New Guinea.

Washed cups, plates, forks, knives, spoons, utensils and table surfaces in the kitchens of the University of Papua New Guinea were assayed for total and coliform bacteria in 1976 and 1977. The total bacterial count per item for crockery and cutlery exceeded the desired limit by five to 6400 times, whilst the count for utensils was also exceeded by over 100 times in both years. Coliform and E. coli. were detected in all samples. Improper hygiene by kitchen staff and a lack of sufficient hot water were mainly responsible for the high counts. Recommendations are given for catering establishments.


Metronidazole for chronic diarrhoea in children.

A double blind prospective controlled trial of metronidazole was performed on children admitted to Goroka Hospital with diarrhoea for seven days or more. There was no significant difference in the duration of diarrhoea after treatment began between children given metronidazole (4.3 days) and those given placebo (4.1 days).


Spatio-temporal structure of migrating chemotactic band of Escherichia coli. I. Traveling band profile.

We developed a rapid-scanning, light-scattering densitometer by which extensive measurements of band migration speeds and band profiles of chemotactic bands of Escherichia coli in motility buffer both with and without serine have been made. The purpose is to test the applicability of the phenomenological model proposed by Keller and Segel (J. Theor. Biol. 1971. 30:235) and to determine the motility (mu) and chemotactic (delta) coefficients of the bacteria. We extend the previous analytical solution of the simplified Keller-Segel model by taking into account the substrate diffusion which turns out to be significant in the case of oxygen. We demonstrate that unique sets of values of mu and delta can be obtained for various samples at different stages of migration by comparing the numerical solution of the model equation and the experimental data. The rapid-scanning technique also reveals a hitherto unobserved time-dependent fine structure in the bacterial band. We give a qualitative argument to show that the fine structure is an example of the dissipative structure that arises from a nonlinear coupling between the bacterial density and the oxygen concentration gradient. Implications for a further study of the dissipative structure in testing the Keller-Segel model of chemotaxis are briefly discussed.


Characteristics of a simple, high-resolution flow cytometer based o a new flow configuration.

A new flow configuration allows a flow cytometer of high resolution and stability to be assembled from an inverted fluorescence microscope with incident illumination, a pulse photometer, and a multichannel pulse height analyzer. A nozzle produces a hydrodynamically focused sample stream in a liquid jet that id directed onto a microscope cover glass in front of the microscope objective. The microscope provides a mechanically stable optical system of high numerical aperture (N.A.) (oil immersion, N.A. = 1.3) for focusing the excitation light and collection of the fluorescence light. The instrument has wide optima with regard to the various characteristics of the flow configuration, such as the rate of sample analysis and sheath flow, and the angle of incidence of the liquid jet, thus making it easy to adjust for optimal performance. DNA histograms of rat thymocytes stained with ethidium bromide and mithramycin demonstrate that all angles of incidence can be used. Large-angle incidence (70 degrees) gives the best resolution, i.e., a coefficient of variance (CV) of 0.9% of the peak of the histogram. This is only slightly better than values obtained at other angles, e.g., CV = 1.3% at vertical (0 degrees) incidence. It is concluded that instrumental resolution is equal to or better than CV = 0.9%. Linearity (proportionality between channel number and fluorescence intensity) is within 1%, and instrumental drift over a 1-h period is normally less than 1-2%.


Deoxythymidine sugars are not direct precursors of DNA-thymine.

A theoretical model for the kinetics of uptake of a putative precursor molecule into nucleotide pools and into replicating DNA has been developed. The relationship between the accumulation of radioactively labeled precursors in the pool and the appearance of radioactivity in DNA is then derived. Experiments have been carried out in bacteria to compare the uptake of radioactive thymine into deoxythymidine triphosphate, deoxythymidine diphosphate sugars, and DNA to test the suitability of either compound as the direct precursor of thymine in DNA. New one-dimensional, thin-layer chromatographic procedures were used to determine the specific activity of deoxythymidine triphosphate and deoxythymidine triphosphate and deoxythymidine diphosphate sugars in growing cultures of 32PO4-labeled Escherichia coli during pulse labeling with [3H]-thymine. A comparison of the experimental data with our theoretical model supports the hypothesis that deoxythymidine triphosphate, but not deoxythymidine sugar, is the direct precursor of thymine in normally replicating DNA in vivo.


Effect of hormones on the killing by antibody and complement of tumor cells treated with proteolytic enzymes.

Line-10 guinea pig hepatoma cells are normally resistant to killing by antibody plus GPC but they are susceptible to killing by antibody plus HuC. Pretreatment of the cells with selected proteolytic enzymes renders the cells susceptible to killing by antibody plus GPC, whereas pretreatment with polypeptide, catecholamine, or steroid hormones renders the cells more resistant to killing by antibody plus HuC. Hormone pretreated tumor cells incubated with proteolytic enzymes remained resistant to antibody-GPC-mediated killing. Enzyme-pretreated cells incubated with hormones were either sensitive or resistant to antibody-GPC-mediated killing depending on the enzyme used to pretreat the cells, the enzyme concentration, the hormone class, and the specificity of the antibody used to sensitize the cells. The enzyme pretreated cells were able to bind amounts of hormone sufficient to render the cells resistant to humoral immune killing. These results suggest that the hormones exert their effects on certain areas of the tumor cell membrane rather than having a generalized effect on the cells. It is postulated that proteins, along with complex lipids, participate in the mechanism whereby tumor cells resist humoral immune killing.


Role of complement in endotoxin initiated lethality in mice.

We have examined the role of complement in eliciting a lethal response in C3H/HeJ and C3H/St mice. The results reported here indicate that endotoxin-initiated complement activation, leading to significant drops in circulating C3 levels, is not sufficient to cause lethality. The complement system in both strains was demonstrated to be responsive in vitro to activation both by E. coli 0111:B4 LPS I, an alternative pathway activator in other systems, as well as S. minnesota R595 LPS, which activates almost exclusively the classical pathway. In vivo injection of high (lethal) doses of E. coli 0111:B4 LPS I and S. minnesota R595 LPS causes a significant decrease in the circulating C3 levels of both strains after 4 hr. In contrast, circulating C3 levels were not significantly different from normal values in either strain following injection with minimal (lethal) amounts of E. coli 0111:B4 LPS II, a weakly anticomplementary LPS preparation. In all cases, lethality was observed in only the C3H/St mice, indicating that neither complement activation, nor the lack of it, is responsible for lethality in mice.


A new assay for the evaluation of antiplatelet antibody in idiopathic thrombocytopenic purpura.

A new approach to the study of antiplatelet antibodies is described. Purified IgG from sera or from the culture of splenic ells was radiolabeled with 125I. Incubation of radiolabeled splenic IgG from ITP patients showed significantly greater binding to target platelets when compared to control IgG samples; conversely, the binding to target platelets of 125I-labeled serum IgG from ITP patients did not differ from controls. In each of the six instances when the binding of splenic and serum IgG from the same ITP patients was compared, the splenic samples contained a much higher concentration of platelet-specific IgG. This suggests that intrasplenic platelets in ITP patients are exposed in vivo to high concentrations of antiplatelet antibody and may explain, in part, the importance of the spleen in platelet destruction in this disease. This assay should prove useful in the further study of immune thrombocytopenia.


Acute endotoxin shock in the dog and an attempt at its therapy.

The present study aimed at monitoring of hemodynamic changes proceeding in a standard model of acute endotoxin shock in the dog, and mainly at an attempt at the therapy of its early phases. Acute endotoxin shock represents a grave state with rapidly advancing changes in blood circulation, therefore we studied the effects of selected drugs, intended to regulate the circulation conditions in the course of shock. In a standard model in the dog, in which endotoxin shock had been induced by intravenous injection of Escherichia coli endotoxin dosed 1.75 mg.kg-1, the effects of dopamine and hydrocortisone were investigated. The course of the hemodynamic changes can be divided into three phases, as follows. In the first phase, during endotoxin infusion, the blood pressure sank steeply, and the myocardial contractility, left ventricular pressure, and renal arterial blood flow decreased. The central venous pressure rose. After the conclusion of endotoxin infusion the second phase of shock began. It was characterized by a transitory partial correction of hemodynamics. In the third phase all hemodynamic indicators gradually worsened. An especially grave phenomenon was the reduction of renal arterial blood flow. The fatal effects of the administered endotoxin dose were preventable by infusion of dopamine, or hydrocortisone, or their combination. Dopamine plus hydrocortisone raised the survival quota of animals in endotoxin shock, enhanced the renal arterial blood flow, maintained the diuresis, enhanced myocardial contractility, and elevated left ventricular blood pressure.


Hemoglobin AIc and red cell oxygen release capacity in relation to early retinal changes in newly discovered overt and chemical diabetics.

The average Hb A1c concentration in consecutive cases of newly discovered nonacidotic diabetics was 11.4% prior to diet and insulin, as compared to 5.5% following prolonged optimal control (p less than 0.001). Hemoglobin A1c was significantly correlated with fasting blood sugar. In a controlled study the average Hb A1c in 30 subjects with chemical diabetes was 5.8% as opposed to 5.3% in controls with normal OGTT (p less than 0.05). Thirty-seven percent of the chemical diabetics had Hb A1c values greater than or equal to 6.5%, while none in the control group showed such high values. Hb A1c in whole blood has increased oxygen affinity. A decrease in red-cell oxygen release was noted in some untreated nonacidotic diabetics, and an adverse effect of insulin on the oxygen release capacity was demonstrated in both newly diagnosed ketoacidotic and nonacidotic diabetics. The importance of this defect in red-cell oxygen-releasing capacity on the function of the microcirculation is discussed. Signs of an early breakdown of the blood-retinal barrier was demonstrated in 20% of the chemical diabetics by fluorescein angiography.


Metabolic control in diabetic patients: assessment by hemoglobin A1 values.

Hemoglobin A1 concentrations were measured in 230 patients with diabetes mellitus. Diabetic patients controlled by diet alone had significantly lower HbA1 levels compared to the insulin or oral hypoglycemic treated groups. Only 13% of insulin-treated patients had HbA1 levels below 10%, while 26% of the oral agent treated group and 70% of the diet treated group fell into this range. The HbA1 levels correlated with fasting and nonfasting plasma glucose concentrations. However, in certain patients, discrepant results between these two variables were found. Hemoglobin A1 was measured on three or more occasions in 60 patients over a 1-yr period. An improvement was noted in 40%, no change in 38%, and a deterioration in 22%. Hemoglobin A1 measurements have proved to be useful in the follow-up and treatment of diabetic patients.


Carbohydrate metabolism in C3H/HeJ (nonresponder) mice during endotoxic shock.

This study was undertaken to evaluate the hypoglycemic effects of endotoxin in C3H/HeJ (nonresponder) mice. Endotoxin from Salmonella enteritidis ser Typhimurium strain SR-11 was used and the median lethal dosed (LD50) for random-outbred Swiss-Webster mice and C3H/HeJ mice were 450 microgram and 3,000 microgram, respectively. At intervals after intraperitoneal injection of endotoxin (1 LD50) animals were killed, and blood glucose, liver glucose, and liver glycogen levels were killed, and blood glucose, liver glucose, and liver glycogen levels were measured. The time course of carbohydrate depletion in both strains of mice was almost identical. Little change from controls was noted, however, in nonresponder mice given the LD50 dose for normal responder mice. Passive transfer of plasma from C3H/HeJ mice appeared to protect conventional responder mice from the carbohydrate-depleting effects of endotoxin; whereas, passive transfer of peritoneal cells from C3HeB/FeJ responder mice to nonresponders appeared to sensitize C3H/HeJ mice to this effect. In order to evaluate clearance and detoxification of endotoxin in non-responder mice, 14 C-labeled lipopolysaccharide was prepared from bacteria grown in broth containing D-glucose-14 C(U). Mice were injected intravenously with labeled endotoxin, and blood, liver, spleen, kidney, heart, lung, and brain were counted for radioactivity at intervals after injection. Results from these tracer studies indicate that the clearance of lipopolysaccharide in nonresponder mice is slower than that seen in conventional animals. The results of this study further support the suggestion that endotoxin exerts its effects on carbohydrate metabolism via mediators resulting from endotoxin-cell surface interactions.


Alterations in insulin action by endotoxin in vitro.

Fat cells isolated from epididymal fat pads of Sprague-Dawley rats were exposed to E coli endotoxin in vitro, and after washing the ensuing alterations in glucose oxidation and antilipolysis were studied. Although endotoxin (500 microgram/ml) exhibited an insulin-like effect on basal glucose oxidation, it diminished insulin stimulation of glucose oxidation, seemingly inducing an insulin-resistant state. On the other hand, identical doses of insulin elicited significantly greater antilipolytic effects in endotoxin-treated cells, than in untreated cells. Thus, endotoxin exposure (in a range of 0.05-200 microgram/0.5 ml cell suspension) rendered adipocytes more sensitive to the antilipolytic effect of insulin. Results of this study indicate that the different physiologic actions of insulin on adipocytes are not affected in a uniform manner by endotoxin exposure in vitro.


The pony as a model for septic shock.

This study was conducted to determine the feasibility of using alert, conscious ponies as a model for septic shock in man. Ten ponies were given 0.7-5 X 10(9) organisms/kg of body weight of live E coli intravenously over one hour. All ponies died and exhibited signs of low cardiac output septic shock. significant decreases were found in cardiac index to 3.15 +/- 0.1 liters/min/m2 (P less than 0.05), white blood cell count to 1,930 +/- 100 cells/m3 (P less than 0.05), preterminal blood glucose to 75 +/- 5 mg/dl (P less than 0.05), PaO2 to 75.7 +/- 5.7 mm Hg (P less than 0.05), and pH to 7.15 +/- 0.5 (P less than 0.05). Increases were noted in systemic resistance to 3,869 +/- 322 dynes/dic/cm-5 (P less than 0.05), pulmonary resistance to 770.8 +/- 11.12 dynes/sec/cm-5 (P less than 0.05), pulmonary arterial pressure to 41 +/- 7 mm Hg (P less than 0.05), pulmonary wedge pressure to 19.5 +/- 2.5 mm Hg (P less than 0.05), intrapulmonary shunt to 16.43 +/- l.73% (P less than 0.05), early blood glucose to 204 +/- 9.0 mg/dl (P less than 0.05), and excess lactate concentration to 53.06 +/- 5.3 mg/dl (P less than 0.05). From these data it appears that the septic pony shows changes similar to low output septic shock documented in man.


Myocardial effects of endotoxin shock: characterization of an isolated heart muscle model.

Atrial myocardium of guinea pigs was used to study effects of Escherichia coli endotoxin shock on inotropic characteristics of heart muscle free from noncardiac influences of the in vivo shock state. In vitro exposure of atrial muscle to large concentrations of endotoxin (10-1,000 microgram/ml, final concentration) for a prolonged period (90 minutes) had no effect on myocardial contractility. However, atrial muscle isolated from endotoxin-shocked guinea pigs exhibited clear evidence of mechanical depression, as reflected by markedly low values for both isometric contractile tension and maximal rate of tension development (dT/dt). Also, since systolic and diastolic time intervals of myocardial contractions were not discernibly affected by shock, the contractile deficit represented a true inotropic dys-function and was not due simply to a temporal change in the active state of the muscle. The shock-induced inotropic disorder was permanent enough to persist in vitro for several hours of observation. However, if the Ca++ concentration of the bathing medium was increased from 2.5 mM to maximally effective concentrations ( greater than 4.5 mM), contractile strength of heart muscle from the shocked group was equal to corresponding responses of control muscles. Present findings verify myocardial contractile dysfunction associated with in vivo endotoxin administration and provide characterization of a test system that should prove useful for further study of functional changes occurring to the heart in shock.


Biphasic alterations in glucose metabolism by soleus muscle from the burned limb.

Tissue temperature and in vitro glucose metabolism by rat soleus muscle were studied following a 3-second burn on one hind limb in 90 degrees C water. The injury increased the subcutaneous temperature in the calf of the burned limb to 53.4 +/- 0.7 (SE) degrees C and that between soleus muscle and fibula to 49.4 +/- 1.3 degrees C, both temperatures returning to normal at approximately 3 minutes postburn. The injury resulted in biphasic alterations in glucose metabolism by the soleus muscle from the burned limb; glucose uptake and lactate release were depressed at 4 hours but were elevated above control levels at 3 days postburn. The maintenance of an approximate 1:2 ratio of glucose uptake to lactate release suggested that changes in glucose uptake reflected primarily conversion to tricarbon units rather than changes in the rate of glucose oxidation. Since glucose metabolism by soleus muscle from contralateral unburned limb of injured animals did not differ from controls at any of the test times, the changes in the burned limb were not likely the result of systemic alterations in metabolic and endocrine environment. The biphasic alterations did not correlate with the degree of soleus muscle edema. It is concluded that proximity to the burn wound is a new determinant of abnormal glucose utilization by skeletal muscle.


Effects of methylprednisolone sodium succinate on clearance of live E coli from the peripheral blood of dogs.

Corticosteroids have been reported to potentiate infections, and yet recent clinical and experimental studies have documented their therapeutic effectiveness in both septic and endotoxin shock. This study was designed to determine if methylprednisolone sodium succinate (MP) affects the clearance of live E coli organisms from peripheral blood of dogs. The experimental group was pretreated with 30 mg/kg of MP, and controls received equal volumes of saline. Both control and MP-pretreated dogs significantly reduced the number of E coli in peripheral blood by almost two orders of magnitude; however, there was no significant difference in clearance of E coli organisms between the two groups. An initial leukopenia occurred in both groups after E coli injections; however, the subsequent development of leukocytosis in the MP group was significantly greater at +6 hours. Rectal temperatures were higher in the MP group from +1 through +4 hours than in the controls. Hyperglycemia developed initially in both groups, followed by a progressive hypoglycemia, with survivors returning to near normal blood glucose concentrations. Hemoconcentration occurred in both groups, with higher hematocrits being associated with mortality. Results support the view that methylprednisolone sodium succinate does not affect the clearance of live E coli organisms.


Effect of endotoxin on hepatic pyruvate kinase activity in normal and diabetic dogs.

The influence of endotoxic administration (0.5 mg/kg) on hepatic pyruvate kinase activity in normal (nondiabetic) and diabetic dogs was investigated. Pyruvate kinase activity was not affected four hours after endotoxin injection in nondiabetic dogs. However, it was stimulated by 288% in dogs that were made diabetic prior to the administration of endotoxin. Since pyruvate kinase activity in diabetic dogs without endotoxin treatment was not affected, these findings suggest that the stimulatory effect of endotoxin on pyruvate kinase activity in diabetic dogs may be associated with insulin deficiency and/or high ambient blood glucose level.


Cerebrospinal fluid composition during endotoxin shock in the dog.

Cerebrospinal fluid (CSF) electrolytes, lactate, pyruvate, total proteins, and osmolality, together with arterial plasma electrolytes, total proteins, osmolarity, and systemic arterial blood pressure were monitored during 2 mg/kg and 5 mg/kg E coli endotoxin shock in spontaneously breathing dogs. During four hours of shock, Na+, K+ osmolarity, and total proteins did not change in either plasma or CSF. CSF lactate and lactate/pyruvate ratio were significantly elevated, whereas pyruvate was decreased throughout the four hours of shock. Systemic arterial blood pressure was below control during the entire shock period. Saline control experiments yielded no significant changes in all parameters monitored. These data show that during four hours of shock the brain has shifted form aerobic to anaerobic metabolism the degree of which is not sufficient to cause any detectable changes in membrane permeability or alterations in Na+/K+ active processes.


Endotoxin-induced intravascular coagulation (DIC) and its therapy.

Anticoagulants in the form of heparin, dipyridimole, steroids, prostaglandin E1, Macrodex, and antithrombin III were administered in separate experiments prior to endotoxin infusion in the dog. The pattern of disseminated intravascular coagulation (DIC) developed consistently when endotoxin alone was administered. Heparin dosages from 1 to 10 mg/kg did not influence the appearance of thrombocytopenia but effectively eliminated the decrease in fibrinogen levels ordinarily found. Antithrombin III (AT III), obtained from the National Red Cross, administered in a dose designed to provide a doubling of the circulating AT III, reduced the fibrinogen utilization to a similar degree as heparin without affecting the platelet loss. Dipyridimole, as administered, was ineffective in this model, and did not alter the development of thrombocytopenia or the hypofibrinogenemia. Steroids, Macrodex, and prostaglandin E1 had minimal effect on the coagulopathy. Our finding would suggest that the endotoxin effect on dog platelets id direct, and not mediated by thrombin, and that the role of heparin in the clinical management of DIC should be considered only in instances in which renal complications exist.


[Detection of IgM by immunofluorescence: application to rubella].

Thirty couples of serum and thirty-five individual sera were tested for the presence of rubella-specific IgM by indirect immunofluorescence. BHK21 cells cultivated on "Lab-tek" were used as an antigenic support. Specific IgM were significantly high in subjects with increased antibody complement fixation or hemagglutination inhibition. Identical findings were observed in a pregnant women having contracted rubella during the seventh month of pregnancy.


[Separation of immunoglobulins by ultracentrifugation in density gradients: application to rubella].

Ultracentrifugation in sucrose density gradients was used to isolate rubella specific IgM. We have studied three individual sera and twenty one couples among which at least one of the sera was positive by indirect immunofluorescent. There was significant correlation between the two technics.


The clinical psychology of Lightner Witmer: a case study of institutional innovation and intellectual change.

The name Lightner Witmer is rarely invoked in the historian's litany of psychological saints. Neither a grand systematizer nor an ardent experimentalist, the "world's first clinical psychologist" is even dismissed by contemporary clinicians because of his purported failure to achieve for psychologists professional hegemony over the "problem child." Yet disciplinary ventures which in Joseph Ben-David's phrase fail to "take off" represent extremely illuminating indicators of a discipline's shifting ideas, roles, and aspirations. Explicitly urging that historians pay more attention to subgroups of larger disciplines, this paper constitutes an attempt to assess the impact of changing social roles upon psychologists' intellectual stances through an examination of Witmer's novel activities at the University of Pennsylvania.


From avant-garde to specialism: psychoanalysis in America.

Psychoanalysis in America functioned first largely as an avant-garde phenomenon. Later psychoanalysis became a specialty within a bureaucratic society. Both roles help explain the importance and the limitations of freud's impact on American culture.


Freud's Reich, the psychiatric establishment, and the founding of the American Psychoanalytic Association: professional styles in conflict.

Freud's vision of a unified theory of the neuroses has foundered on lack of agreed methods for settling scientific disputes in the field of psychotherapy. Clashes in professional styles and formation of self-validating sub groups have been the dominant trend, exemplified by the founding of psychoanalytic organizations.


The "subliminal" versus the "subconscious" in the American acceptance of psychoanalysis, 1906-1910.

Insofar as Frederic W. H. Myers' conceptions of the "subliminal" were spread by the Boston-based "Emmanuel movement" for medically supervised religious psychotherapy (fl. 1906-1910), the movement probably did more to help than to hinder American acceptance of Freudian ideas. Certainly, many academic psychologists' conceptions of the "unconscious" and "subconscious" were a hindrance.


Delboeuf and Janet as influences in Freud's treatment of Emmy von N.

An analysis is made of Freud's treatment of the patient known as Emmy von N. in which for the first time he used what he called "Breuer's technique of investigation under hypnosis." It is shown that the main component of Freud's therapy owed nothing to Breuer: the patient's traumatic memories were altered by direct suggestion under hypnosis. The abreaction which did take place seems to have resulted from Freud's expectation that it should occur. Two cases published by Delboeuf and Janet in late 1888 and early 1889 were treated by a then unusual method which analysis demonstrates to have been virtually identical to the technique used by Freud. Evidence is presented that the Delboeuf and Janet cases could have been known to Freud before he began his treatment of Emmy von N.


Anterior colporrhaphy technique to shorten a pathologically long anterior vaginal wall.

Vaginal eversion is sometimes associated with an increase in length as well as in width of the anterior vaginal wall. Appropriate reconstruction to minimize the risk of postoperative recurrence of cystocele has been achieved by a technique described for full length anterior colporrhaphy embracing transverse plication of the bladder adventitia and reduction in vaginal length as well as width. Separate surgical support of the vesicourethral junction is recommended. Adequate vaginal depth can be provided if suitable attention is given to support of the vaginal vault. Synthetic polyglycolic acid-type suture material is used throughout.


The role of irradiation in the management of squamous-cell carcinomas of the mouth and throat.

Fundamental precepts of radiation biology are presented to provide a basis for the comprehension of radiotherapy. These precepts include cell viability, randomness of cell killing by radiation, the influence of molecular oxygen on radiosensitivity, phases of the cell cycle, and repopulation. The combined-treatment concept is developed, and preoperative and postoperative irradiation options, as well as the optimal extent of the surgical procedure, are discussed. These principles of combined treatment are first applied to the management of neck disease, which is a common denominator to all sites. The anatomic sites of the mouth and throat are then discussed. The capabilities of radiotherapy have greatly altered treatment planning for carcinomas of the mouth and throat; one must now develop an initial overall plan that varies with the extent and anatomic site of the primary lesion, the extent of neck disease, and the probability of spread to clinically uninvolved lymphatic areas.


Effects of radiation on the human gastrointestinal tract.

Radiation therapy directed at the abdomen may damage the digestive tract, the type and extent of injury depending on the dose of the radiation and the radiation sensitivity of the gut. Characteristic early changes are manifest in the mucosa of the gut: for later ulceration, changes in the collagen tissues and particularly in the vascular channels occur. This paper describes and characterizes injuries to the esophagus, stomach, small intestine and colon. It emphasizes the importance of recognizing radiation-induced damage to the gut which may occur early or late after radiation.


[Biochemistry of the life cycle of Triatoma infestans (vinchuca). 1. Lipids and fatty acids composition].

The lipid composition of Triatoma infestans (Vinchuca) was studied by thin layer chromatography and gas lipid chromatography. The main fatty acids found were oleic and palmitic followed by stearic, palmitoleic and linoleic. Only very small amounts of arachidonic and docosahexenoic acids were present. The composition depended on the incorporation of the fatty acids of the blood ingested, but it was modified in a small extent by the insect. The fatty acid composition changed during the development of the eggs to the following stages. The main lipids found were triacylglycerol, phósphatidyl ethanolamine, phosphatidyl choline, cholesterol esters and cholesterol. The analysis of the fatty acid composition of phosphatidyl ethanolamine and phosphatidyl choline spots showed the presence of little amounts of palmityl and stearyl aldehydes, suggesting the existence of the corresponding plasmalogens.


Epidemiology of cancer of the nose and paranasal sinuses: current concepts.

Cancer of the nose and paranasal sinuses (SNC) has been attributed to occupational exposure to nickel, chromium, radium, dichlordiethyl sulphide, isopropyl oil, and hydrocarbons. Occupational groups with an increased SNC risk include furniture, boot and show workers, and workers in U.S. countries heavily involved in both petroleum and chemical manufacturing; specific agents have not been identified with certainty. In most of the studies, the risk for developing SNC in the exposed workers was 21 to 100+ times greater than the risk for SNC in those who were not exposed. Undifferentiated and squamous histologies are associated with nickel refining; adenocarcinomas are found in woodworkers, boot and show manufacturers, and textile workers. Most occupations at risk for SNC were also at risk for cancer of other sites, particularly lung and skin cancer. Study of the epidemiology of SNC may identify unrecognized carcinogens and occupational groups at increased cancer risk.