Use of the umbilical area for placement of a urinary stoma.

Children with myelodysplasia are best managed in medical centers by a team consisting of a urologist, an orthopedist, a neurosurgeon, a pediatrician, a social worker, an orthotic technician and physical therapists. A co-operative approach aids in the selection of a urinary diversion stoma site which will not interfere with the multiple orthopedic procedures these children must undergo. The urologic and orthopedic complications and benefits of 24 patients with umbilical stoma are compared with 24 patients with matched right lower quadrant stoma. The incidence of urologic complications is equal, while the orthopedic advantages manifest by the first group vastly outweigh the problems encountered in the second group. We advocate the use of a midline stoma site for urinary diversion in children with myelodysplasia.


Location of the force of wound contraction.

Contractile fibroblasts were found on electron microscopy to be distributed throughout the substance of contracting pig and rat wounds. The force of wound contraction is probably caused by these cells contracting and pulling on each other and on the surrounding stroma. This evidence suggests that the pull theory of wound contraction is correct.


The symptoms of an amebic abscess of the liver simulating an acute surgical abdomen.

Amebic abscess of the liver has protean manifestations that often resemble causes of an acute surgical abdomen. Patients presenting at University of California, Los Angeles Hospital with acute abdominal injuries who underwent exploratory laparotomy and subsequently were found to have an amebic hepatic abscess were studied. There are various clinical symptoms of amebic hepatic abscess as well as problems of differentiating this pathologic entity from an acute surgical abdomen. Most patients with amebic hepatic abscess that mimics an acute abdomen present as acute cholecystitis or acute appendicitis. All patients recovered uneventfully once the diagnosis was made and appropriate therapy instituted. The salient features of the history, physical examination and laboratory data that can identify the amebic abscess were analyzed. The key to correct diagnosis is cognizance of the condition.


Experimental and clinical hepatorenal bypass as a means of revascularization of the right renal artery.

In patients with severe atherosclerosis of the abdominal aorta or previous operations on the abdominal aorta, right renal revascularization may be difficult to achieve using aortorenal bypass. An experimental study was performed demonstrating the efficacy of hepatorenal bypass as an alternative operative procedure in this regard. Follow-up studies in these dogs demonstrated no adverse postoperative effects on hepatic function or morphology. In addition, two patients underwent hepatorenal bypass with a saphenous vein graft as surgical treatment for azotemia and hypertension caused by atherosclerotic right renal artery stenosis. Postoperatively, the blood pressure diminished and renal function improved in both patients. No evidence of persistent hepatic dysfunction was observed.


Side-effects of topical proteolytic enzyme treatment.

The results of this study indicate that short term treatment of wounds with topical enzymes appears to be safe and is accompanied by no clinically significant side-effects. Topical wound treatment with this enzyme did not interfere either with healing of experimental wounds or the activity of the antibiotics. Wounds subjected to this enzyme treatment exhibited a normal capacity to resist infection, even though this enzyme interferred with leukocyte phagocytosis in vitro. The potential benefits of this treatment in experimental wounds as an adjunct to antibiotics considerably outweigh its damaging effects. Its clinical use in patients must await the results of carefully controlled clinical trials in which the efficacy of this treatment is evaluated.


The hemodynamics of extra-anatomic bypass grafts.

The hemodynamics of extra-anatomic bypass were studied with the use of right to left iliac artery bypass grafts. An arteriovenous fistula on the recipient side was used to increase the flow through the graft. Flow measurements in this model under normotensive conditions showed proportionate increases in the suprarenal aortic blood flow and in the blood flow through the segment of donor artery proximal to the bypass graft anastomosis. Stealing of blood was not observed even when the graft flow was increased to approximately 11 times the normal flow in the donor artery. Arfonad was used for producing hypotension through vasodilatation. In the presence of peripheral vasodilatation, adequate blood flow can be expected after such bypass grafts at blood pressures as low as 80 millimeters of mercury and hypotension per se does not produce vascular steal.


The effects of a minidose of heparin on peritonitis in rats.

Sprague-Dawley rats with peritonitis treated with either a subcutaneous or intraperitoneal minidose of heparin show a significant increase in survival time when compared with controls. In the treatment groups, adhesions and abscesses were less severe and localized to the area of gangrenous bowel. Heparin also significantly reduced the incidence of recovery of viable bacteria from the blood and peritoneal cavity. These findings may be related to a decreased deposition of fibrinogen within the abdomen or to the early mobilization of fibrin.


Local treatment of squamous cell carcinoma of the anus.

Selected patients with squamous cell carcinoma of the anus can be treated by local excision with excellent results. The results of local and radical excision cannot be compared because patients must be selected for local excision. Lesions included in this study varied widely in regard to the site, size and degree of differentiation. The size of the lesion should not preclude the consideration of local excision, as a skin graft can be used to cover the area excised. Close observation and examination for short intervals of time to detect a recurrent lesion are mandatory, especially in the early postoperative period. Rectal digital examination can help in identifying metastases to the presacral lymph nodes, indicating the need for radical treatment.


Treatment of microemboli of the upper extremity.

A patient with microembolism of the left hand from an ulcerated lesion in the proximal part of the left subclavian artery was treated by a simple procedure for removing the embolic source from the arterial circulation. Through a supraclavicular approach, the subclavian artery was divided from the aorta distal to the lesion and anastomosed to the left common carotid artery. This technique was effective not only in restoring unobstructed distal circulation but also in avoiding the use of the more complicated thoracotomy.


Percutaneous cannulation of the internal jugular vein in infants and children.

A technique for percutaneous catheterization of the internal jugular vein in infants and children was used since January 1975 in 206 patients ranging in age from a few hours to 12 years old. The series included 31 premature infants weighing less than 2,500 grams and 107 babies weighing less than 4,000 grams. Five attempts at cannulation failed. Each catheterization procedure required an average of 1.8 needle insertions before the vein was entered. In 129 patients, the first attempt was successful. Sixteen complications related to the procedure occurred early in our experience, seven of which were life threatening. One death was directly ascribed to the actual insertion of the catheter and mediastinal extravasation of infusion material. Most of the early complications probably could have been injected through the catheter immediately after cannulation, in addition to aspirating the blood and lowering the infusion bottle. The 22 late complications were related to infection; one infant died because of catheter sepsis. To minimize septic complications, an arbitrary limit of seven days was set, after which the catheter was replaced. Cannulation of the internal jugular vein in infants and children should be regarded as a serious surgical procedure to be performed by a trained team and only when properly indicated.


In vivo use of human umbilical vessels and the ductus venosus arantii.

Clinical use of umbilical vessels in the neonate is commonplace. In the adult, surgical reopening of the umbilical vein is feasible in the majority of patients, providing direct access to the portal circulation. Umbilical vein catheterization allows for portal manometry in the intact, unanesthetized state. Prolonged catheterization has served to facilitate physiologic and pharmacologic studies hitherto unavailable. Selective splanchnic catheterization with hepatoportography permits roentgenographic studies, important in the evaluation of patients with hepatobiliary diseases. Clinically, the umbilical vein has been used in the study of portal hemodynamics, portal decompression and hemofiltration, portal arterialization and in evaluating hepatic trauma. This method of access to the portal circulation has provided a route for study of the effects of drugs, hormones and other biologic materials on the portal circulation and for administration of antibiotics and other chemotherapeutic agents into the portal system. The procedure of umbilical vein catheterization is simple and repeated catheterization is possible. The ductus venosus, on the other hand, is not clinically usable and pertinent information has been reviewed. The ex vivo use of neonatal umbilical veins as vascular conduits is not included in this review.


Experimental and clinical postnatal craniofacial skeletal changes.

An understanding of normal and abnormal postnatal skeletal changes can aid in the prevention, early recognition and proper surgical treatment of craniofacial deformities. Research findings may have important implications and applications in relation not only to the basic problem of change of bone form but also to the clinical problems of craniofacial operations. Precise analogies, however, should not be made between animals and human beings. Change of the craniofacial skeleton, a three-dimensional mosaic of bones and cavities, is a result of the synchronous co-ordination of the differential activities at various sites. The dynamics of normal and abnormal postnatal growth and change of the craniofacial skeletal system are a fascinating, complex, incomplete chapter in the field of biology.


Interposition mesocaval shunt for chronic primary occlusion of the hepatic veins.

Five patients with primitive chronic Budd-Chiari syndrome were treated by Dacron interposed mesocaval shunts for medically uncontrollable ascites. In two instances, hepatomegaly and ascites disappeared for four and four and one-half years. In one patient with severe stenosis of the inferior vena cava, moderate ascites required tapping once a month one year later, despite proved prosthesis patency. In two patients, death occurred ten and 30 days after shunting due to thrombosis of the graft. Inferior vena cava stenosis appears to be the major factor for decision of opportunity and type of portacaval shunt. From our material, we can describe three types of stenosis: type I, due to caudate lobe hypertrophy, and type II, due to right lobe hypertrophy, are suitable for side-by-side portacaval or mesocaval shunts. Type III, regular and extended narrowing of inferior vena cava, observed in long term evolutive forms, is presumably due to fibrosis and is not a good indication for conventional infrahepatic shunting procedures. Since this study was completed, another patient had a side-to-side portacaval anastomosis for chronic Budd-Chiari syndrome without caval stenosis. The patient has been observed for seven months, and ascites did not reappear. This underlines the importance of a complete radiologic and hemodynamic preoperative study of inferior vena cava outflow impairment.


The treatment of pancreatic pseudocysts by external drainage.

Twenty-two patients were treated for 25 occurrences of pancreatic pseudocysts. The male to female ratio was 3:1, and the average age was 39 years. Alcoholism was the most common cause of the preceding episode of pancreatitis. The pseudocyst rarely developed from end-stage chronic pancreatitis. Our preferred treatment for the majority of pancreatic pseudocysts is external sump drainage, if there is no obstruction of the distal part of the pancreatic duct. This form of treatment was followed by a 100 per cent survival rate, and neither a pancreaticocutaneous fistula nor a pancreatic abscess occurred. The two instances of a recurrence were due to our treatment with a Penrose drain alone, and this practice is not recommended. Obstruction of the distal part of the pancreatic duct negates external sump drainage, and in such instances, a Roux-en-Y cystojejunostomy should be the treatment of choice and not transgastric cystogastrostomy, which does not offer dependent drainage. The treatment of a pancreatic pseudocyst should not be equated with that of chronic fibrotic pancreatitis, as the basic pathologic clinical features and response to surgical treatment are quite different.


Plasma catecholamine levels and pulmonary dysfunction in sepsis.

In a retrospective analysis of 18 patients with sepsis and adult respiratory distress syndrome, we found that high plasma epinephrine and noradrenalin levels were associated with severe defects in oxygenation that accompany this disease. The result of previous experimental work support the concept that high plasma catecholamine levels augment already existing defects in the ventilation to perfusion ratio and increases the measured intrapulmonary shunt fraction. The results of this study do not, however, delineate whether or not the relationship between high circulating plasma catecholamine levels and severe adult respiratory distress syndrome is causal or simply a measurement of two indexes which reflect the severity of the underlying disease process.


Carotid endarterectomy in a community hospital.

One hundred consecutive patients underwent carotid endarterectomy in a small community hospital in North Dakota during a period between 1969 through 1976. All operative procedures were performed by the same surgeon using the Javid shunt. A 1 per cent operative mortality and permanent morbidity resulted. These findings are comparable with those reported from large medical centers having extensive experience in carotid endarterectomy. It is concluded that patients with carotid artery disease can be safely and effectively treated in small medical centers by well trained experienced vascular surgeons.


Changes in intrarenal blood flow during sepsis.

The intrarenal hemodynamics of nine dogs were studied using 15 micron diameter plastic radioactive microspheres labeled with either 85Sr or 141Ce injected before and with the alternative isotope injected 30 minutes after the induction of sepsis. Total renal microsphere trapping increased by 30.6 per cent, p less than 0.01, after the induction of sepsis. The glomerular filtration rate was unchanged. Microsphere trapping in the outer and inner cortex increased by 36.9 per cent, p less than 0.005, and by 20.3 per cent, p less than 0.05, respectively, reflecting increased renal blood flow. Fractional renal microsphere distribution in the outer cortex increased from 70.0 to 73.4 per cent, p less than 0.01, following the induction of sepsis. These data confirm that sepsis results in renal vasodilatation. In addition, a shift in intrarenal blood flow to the outer cortex was demonstrated. Since the outer cortex is perfused with blood which first passes through the inner cortex, it can be hypothesized that renal blood flow in septic states may be passing through dilated glomerular vessels unable to trap microspheres in the inner cortex or passing through precapillary open arteriovenous shunts, or both, thereby bypassing inner cortical functioning glomeruli. This may partly explain the decreased renal function associated with increased renal blood flow in septic states.


Analysis of forty-five patients with pseudocysts of the pancreas treated surgically.

The analysis of 45 patients with pancreatic pseudocysts treated surgically suggests that a significant proportion of the pancreatic pseudocysts detectable by physical examination, upper gastrointestinal tract x-ray series and sonography undergo major complications which, if neglected, may require an emergency or semiemergency type operation which, for obvious reasons, carries a higher operative mortality than when the same operation is performed electively. Therefore, pancreatic pseudocysts which are palpable and reontgenographically distort the anatomy of the upper part of the abdomen should be operated upon electively but promptly. Internal drainage by a cystogastric stoma or cystojejunal stoma, the latter being most favored in this series, apppears to be the best choice. Realistically, expectations are satisfactory results in 85 per cent of the patients, a recurrence rate of about 7 per cent and unsatisfactory results in about 12 per cent. Recurrent cysts are, in most instances amenable to a second surgical procedure.


Evaluation of a new method for treating segmental renal disease.

Experimental segmental renal artery embolization was performed to evaluate the feasibility of therapeutic segmental renal embolization. In group 1, a two kidney dog model, segmental embolization of the right kidney was performed in ten dogs using Gelfoam, Silastic elastomer and barium sulfate. In group 2, a one kidney dog model, segmental embolization of left kidney was performed using Gelfoam and Silastic elastomer. In the remaining three dogs of group 2, embolization was not done for control. Sequential blood pressure measurements, plasma renin activities and renal arteriograms were obtained. Three dogs in group 2 died following unintentional complete renal embolization. Seventeen of the 18 dogs of the entire study remained normotensive after embolization. One dog had persistent hypertension develop which was controlled by a second, total renal embolization. The results suggest that therapeutic segmental renal embolization is a feasible method for treating segmental renal disease.


Endoscopic management of choledocholithiasis and papillary stenosis.

Endoscopic papillotomy was performed in 50 of 53 patients, 31 females, with an age range of 29 to 87 years, a mean of 63.1. The indications for the procedure included retained or recurrent choledocholithiasis, primary choledocholithiasis and papillary stenosis, which were responsible for persistent or intermittent cholestasis. The procedure was successful in all but three patients in whom the primary diagnosis was papillary stenosis. The major complications were bleeding in three patients, pancreatitis in one patient and an infected pseudocyst in one patient. Surgical intervention was not required, and there were no deaths. Endoscopic papillotomy has proved to be safe, producing a permanent biliary enteric fistula, thus reducing the probability of formation of recurrent stones. It has been shown to reduce hospitalization and convalescence, permitting an earlier return to normal activity.


A technique for preservation of nasal projection in midface advancement.

The execution of this procedure has proved to have lower morbidity than a complete cranio-facial separation. We have performed this technique upon eight patients when the opportunity to tailor this operation more precisely to the defect has proved most beneficial.


Localization of the parathyroid glands by intraoperative methylene blue staining.

Exploration of the neck for primary hyperparathyroidism has increased in our institution, as evidenced by nine patients treated in the past one year, as compared with six in the previous three years. Our experience indicates that methylene blue staining has served as an important adjunct in the localization of abnormal parathyroid glands. No complications were noted intraoperatively or postoperatively as a result of its use. Operating time was measurably decreased. The results of this study support the routine use of methylene blue in both primary and secondary parathyroid exploration, and this is currently being done in our institution.


Fat necrosis.

Fat necrosis has been found to be associated with many forms of pancreatitis, carcinoma of the pancreas and pancreatic trauma. The causative agents seem to be pancreatic lipase and colipase, which presumably escape from the pancreas during the development of the disease. The precise mechanism by which these factors attack the adipose tissue, leading to the formation of foci of fat necrosis, is not known. The pathologic finding of fat necrosis is not restricted to the peritoneal-retroperitoneal region, where a direct contact with these factors is the most likely cause. In other patients, fat necrosis involves peripheral tissues, notably in subcutaneous adipose tissue throughout the body, in joints of the hand and foot and in bone marrow. This is associated with additional complications dependent upon the sites involved and is manifested as skin lesions, polyarthritis and osteolytic defects in patients who sometime suffer from a primary pancreatic disease.


Ruptured thoracic aorta: evolving radiological concepts.

The chest roentgenograms of 18 patients with ruptured aortas were studied and the radiographic features tabulated. Fifteen patients survived to undergo angiography, and 14 aortograms were available for review. Distortion of the normal aortic contour and blurring of the aortic outline occurred on the initial chest film in each of the 18 cases. Obliteration of the medial left upper lung field and displacement of the superior vena cava to the right were observed in 16 and 15 films, respectively. Increased mediastinal width was not the most common noted abnormality. The mean mediastinal width on 100 cm anteroposterior supine chest film was 8.8 cm. One patient exhibited a mediastinal width within the normal range. Other frequently occurring abnormalities included opacification of the clear space between the aorta and pulmonary artery, obliteration of the distal aortic shadow, and tracheal shift to the right. At aortography nine patients demonstrated both linear radiolucent defects across the aorta and pseudoaneurysm formations, three patients showed only pseudoaneurysms, and two exhibited only linear radiolucent defects.


Atherosclerotic aneurysms of the subclavian artery.

The case reports of three adult men, in whom four atherosclerotic aneurysms of otherwise normal subclavian arteries were detected in the absence of thoracic outlet syndrome or a history of trauma, are detailed. Two patients complained of supraclavicular discomfort--one having a history suggestive of peripheral arterial emboli and the other was asymptomatic. These aneurysms can be resected safely using a supraclavicular incision with resection of the medial clavicle. In cases requiring more proximal arterial control, median sternotomy is advisable. Our one patient with bilateral atherosclerotic aneurysms appears to be the first such reported case in the surgical literature.


Eosinophilic occlusive pulmonic panarteritis associated with long-term antibiotic therapy.

The administration of antibiotics through central catheters for short periods of time frequently is encountered clinically. This report is an in vivo experimental study of long-term bolus administration of antibiotics through a central catheter inserted in the external jugular vein. Approximately 30 calves, which weighed between 180 and 225 kg, had silicone-rubber catheters inserted for protracted periods of time. Various concentrations of either penicillin, cephalothin, or streptomycin were given intravenously in bolus doses. Minimal doses given for long periods of time or large doses given over short periods of time did not produce any pulmonary vascular lesions. Large doses of antibiotics administered for long experimental periods routinely produced a pulmonary vascular lesion in the medium-size and small-size pulmonary arterioles. The vasculitis consists of a diffuse eosinophilic infiltrate located perivascularly and throughout the intima and media. Associated with the vasculitis was a diffuse hyperplasia of the intima and media which frequently stenosed the vascular lumen. These studies suggest an association between large bolus dosages of antibiotics given over a prlonged period via a central catheter and a constrictive pulmonary arteriolar eosinophilic panvasculitis.


Final inline filtration: a means of decreasing the incidence of infusion phlebitis.

Infusion phlebitis is the most common complication of intravenous therapy. Six methods of reducing the incidence of infusion phlebitis including inline final filtration, buffers, heparin, hydrocortisone, heparin-hydrocortisone combinations, and frequent set changes were tested in a two part randomized prospective double-blind study of 266 surgical patients. Patients who received filtered fluids had a significantly decreased incidence of infusion phlebitis as compared with that of controls (P = 0.0000001). Of the other methods tested, only the heparin-hydrocortisone combinations achieved any significant decrease in phlebitis (P less than 0.5). Therefore, inline filtration is a highly effective means of decreasing the incidence of infusion phlebitis and should be considered as a routine part of intravenous therapy.


Platelet aggregation inhibition in human umbilical vein grafts and negatively charged bovine heterografts.

Glutaraldehye-tanned human umbilical vein grafts (4 mm) and negatively charged bovine heterografts (4 mm) were placed as bypasses in the femoral arteries of 20 dogs randomized into 10 treated with aspirin and dipyridamole and 10 were not treated. Autogenous vein grafts were placed as controls. Platelet aggregation inhibition by aspirin and dipyridamole significantly improved the patency of human umbilical vein grafts from 10% to 60%. It had no effect on patencies of autogenous veins (100%) or on negatively charged  bovine heterografts (0% patency). Inherent graft properties continue to play an important and sometimes overriding role in long-term graft patency in small vessel bypasses. Neointimal fibrous hyperplasia at both proximal and distal anastomoses again was shown to be intimately associated with late graft occlusions.


Oxygen toxicity in normal and anoxic ventilated perfused canine lungs.

Oxygen toxicity was studied in 26 canine isolated, perfused lung lobes which included nine control lobes, 13 lungs ventilated with FIO2 1.0 for 4 hours, and four lobes ventilated with FIN2 1.0 for 1 hour prior to 4 hours of FIO2 1.0 to evaluate the postulated protective effect of anoxia. A significant increase in wet weight was seen in the O2 ventilated lungs which did not alter pulmonary  capillary isogravimetric pressure (PCI), alveolar-arterial oxygen gradient, or pulmonary vascular resistance. In contrast, preliminary N2 ventilation resulted in a significant increase in PCI and greater weight gain while pulmonary vascular resistance was reduced. Pulmonary compliance was reduced minimally in all groups. Anoxic ventilation not only failed to protect the isolated canine lung from presumed increased capillary permeability of oxygen toxicity, but seemed to contribute to the formation of interstitial pulmonary edema.


The effects of the concentration and function of hemoglobin on the survival of rats after hemorrhage.

Hemodilutional techniques of resuscitation, which are becoming popular, add anemia to the acute increase in the affinity of hemoglobin for oxygen that occurs in massively transfused patients when old liquid stored blood is used. A model simulating these conditions was established in rats, using blood stored in citrate for different durations ("fresh" for 1 day, P50 of 34.5 torr, and "old" for 14 to 20 days, P50 of 23.5 torr). Animals were exchange transfused of 90% of the original red cell mass with fresh or old blood at one of three different hematocrits, then hemorrhaged and treated with the same blood used for exchange. There was little difference in survival throughout the range of hematocrits when fresh blood was used (10 of 17, 11 of 16, and 10 of 16 rats). Survival was significantly less in recipients of old blood at low hematocrits (five of 21), but not at higher hematocrits (nine of 19, eight of 14). Ability to salvage the most vulnerable subgroup was tested in rats exchange transfused with old blood at low hematocrits, hemorrhaged, and treated with fresh or old blood, each at low or high hematocrits. Again survival was comparable with fresh blood at low or high hematocrits and old blood at high hematocrits (15 of 20, 19 of 21, 18 of 25) but was lower with old blood at low hematocrits (12 of 24). These results indicate that the oxygen-delivering capacity of blood can become a limiting factor in promoting survival after hemorrhage in otherwise normal animals when it is reduced below half of normal by a combination of anemia and impaired function of hemoglobin. Above that level, fresh blood was more efficacious than old blood in this model.


The effect of vagotomy on human gastroesophageal sphincter pressure in the resting state and following increases in intra-abdominal pressure.

The effect of surgical isolation and extrinsic denervation of the distal 5 to 7 cm of the human esophagus on resting gastroesophageal sphincter pressure and its response to graded increases of external abdominal compression was determined in 89 patients with duodenal ulcer. Fasting serum gastrin concentration also was measured. No significant changes in resting sphincter pressure were obtained before and after vagotomy of various types: parietal cell vagotomy, selective gastric vagotomy plus drainage, and selective gastric vagotomy plus precise antrectomy. No correlation between resting sphincter pressure and fasting serum gastrin concentration was found in any of the groups studied. The increase in gastroesophageal sphincter pressure was similar to the increase in intragastric pressure after 10, 20, and 30 mm Hg of external abdominal compression and was unchanged after all types of vagotomies. These results suggest that (1) extrinsic innervation of the lower esophageal sphincter in humans does not regulate the resting tone of the sphincter; (2) extrinsic "mechanical" influence does not play any role in the maintenance of resting pressure; (3) the effect of increased abdominal pressure is a pure mechanical effect, is unchanged after vagotomy, and therefore is not regulated by external neural reflex.


Demonstration of pancreatic protease-antiprotease complexes in the peritoneal fluid of patients with acute pancreatitis.

During a 4 year period (1972 to 1975), 69 patients with acute severe pancreatitis, of whom 58 had hemorrhagic pancreatitis, were treated with peritoneal lavage at the intensive care ward of Malmö General Hospital. The mortality rates in these four years were 27%, 28%, 17%, and 14%, respectively. Peritoneal exudates were analyzed from 10 patients with hemorrhagic pancreatitis, four of whom died. About 65% of alpha 2-macroglobulin was in complexed form, as was 15% of alpha 1-antitrypsin. Immunochemical analyses of the alpha 1-antitrypsin revealed the presence of trypsin, chymotrypsin, and elastase complexed with alpha 1-antitrypsin. This means that the pancreatic proteases had been activated, as only active proteases are bound by plasma protease inhibitors.


Sodium cholate dissolution of retained biliary stones: mortality rate following intrahepatic infusion.

The reported complication rate from T-tube infusion of sodium cholate for dissolution of retained biliary stones is low. Among 84 patients reported in the English-language literature, and 10 additional cases of our own, there have been no deaths, an incidence of liver enzyme elevation in 7%, fever in 5%, cholangitis in 2%, and pancreatitis in 2%. Recently, we have infused 100mM sodium cholate at 30 cc/hr into patients through transhepatic biliary stents in an effort to rid the intrahepatic biliary tree of retained stones and biliary sludge. Appropriate precautions were taken to prevent increased biliary pressures by the insetion of a 30 cm manometer into the perfusion system. During four transhepatic infusions in three patients, all experienced nausea and vomiting, and two of the three patients developed diarrhea and abdominal pain. Liver enzymes became elevated during all four infusions, and two of the three patients became septic and died shortly after their infusions. Experimental work in animals suggests that intrahepatic sodium cholate infusion results in injury to the ductal epithelium and predisposes patients to bactermia and sepsis. Even though T-tube infusion of sodium cholate into the common bile duct is well tolerated, direct infusion into the intrahepatic biliary tree through a transhepatic tube is not and carries a high risk of sepsis and death.


Muscular, renal, and metabolic complications of acute arterial occlusions: myonephropathic-metabolic syndrome.

Acute arterial occlusions of the extremities may result, in approximately 7.5% of cases, in a severe and complex metabolic syndrome which often leads to loss of limb and life. The manifestations of this syndrome are divided into two stages: (1) the ischemic or devascularization phase, and (2) the revascularization phase. The ischemic phase includes severe clinical manifestations, of which the rigidity of the limb ("rigor mortis") is an outstanding sign, as are nephropathic-metabolic changes (oliguria, acidosis, myoglobinuria, azotemia, hyperkalemia). Their identification and correction at this phase may minimize their impact on the revascularization syndrome. The clinical and metabolic manifestations during the latter phase are more severe and may determine the outcome of the viability of the limb and the survival of the patient. Amputation rates are quite high (40% to 50%) and mortality rates range between 30% and 80%. The ischemic rhabdomyolysis appears to be the initiating event which leads to the biochemical and metabolic alterations that dominate the prognosis as to limb and life. The guiding principles of the management in these severe ischemic cases consist of early revascularization with emphasis on concurrent fasciotomy, alkalinization of the patient, reestablishment of acid-base balance, hemodialysis for renal shutdown, and often early amputation for better control of the metabolic omplications.


Gardner's syndrome complicated by mesenteric desmoid tumors.

Mesenteric desmoid tumors present difficult management problems among patients with Gardner's syndrome. Appearance of the problem is associated with prior abdominal surgery and with pregnancy. In the authors' experience, radical surgery alone has failed to control the disease and they recommend that it should be avoided when possible. Bypass procedures, interstitial implantation of radioactive materials, and chemotherapy represent alternatives which require further evaluation.


Internal pancreatic fistula to the pericardium and pleura.

A report of a 38-year-old man with a 10 month course of illness characterized by recurrent pericardial and pleural high-protein, high-amylase effusions is presented. Operative pancreatogram demonstrated fistulization from the mid-pancreas through the mediastinum into both pleural spaces and the pericardium. Surgical detachment of the fistula and Roux-en-Y decompression of the pancreatic duct resulted in cure of the condition.


Improved results of operation for ruptured abdominal aortic aneurysms.

Of 1,393 consecutive patients operated on for aneurysm of the abdominal aorta between 1964 and 1978, 61 consecutive patients had undergone emergency operation for ruptured abdominal aortic aneurysm, for an incidence of 4.4% (61 of 1,393). There were 57 men and four women; their mean age was 77.5 years, with a range of 49 to 93 years. In 21 patients the diagnosis of aneurysm had been known from 1 day to 5 years prior to rupture. Hypotension (less than 100 mm Hg systolic) was present in 27.9% of patients (17 of 61) on admission to hospital and prior to operation in a total of 44.3% patients (27 of 61). Operation was begun in eight patients with an initially unrecordable blood pressure. The perioperative mortality rate (30 day) was 14.8% (nine of 61). The two factors most influencing survival were age [no patient younger than 60 years died vs. 40% of patients (four of 10) older than 80 years] and the magnitude of blood loss (survivors lost a total of 4,513 ml vs. 8,500 ml in those who died). Thus the most common cause of death was myocardial infarction (six of eight) in elderly patients, secondary to poorly tolerated severe hypovolemia. The results of this study suggest the need for avoidance of technical problems during operations, earlier referral of patients with known abdominal aortic aneurysms, especially the elderly, and early diagnosis with immediate operation for ruptured aneurysms.


Steroid administration and acute pancreatitis: studies with an isolated, perfused canine pancreas.

Steroid administration has been suspected of causing acute pancreatitis for over 20 years. Clinical and experimental data, however, have failed to firmly establish the association or to uncover a pathogenic mechanism. Utilizing an isolated, ex vivo, perfused, canine pancreas preparation, the acute effects of large doses of steroids on the pancreas were evaluated. Using a dose of 200 mg of methylprednisolone, there were no significant differences between the control and steroid-treated preparations in terms of gross appearance, weight gain, serum amylase, or pancreatic secretion over a 4 hour perfusion period. When the dose of methylpredisolone was increased to 400 mg, again there were no significant differences in gross appearance, weight gain, or serum amylase during a 3 hour perfusion period. However, pancreatic secretion was initially depressed in the steroid-treated preparations. Following a maximal secretory stimulus (secretin), secretion markedly increased during the fourth hour of perfusion, but again was significantly less in the steroid-treated glands. Viscosity of pancreatic secretions was significantly increased in the steroid-treated glands. These studies suggest that steroids have a mild inhibitory effect on pancreatic secretion, which might be mediated through an increase in viscosity.


Internal vascular access for hemodialysis in children weighing less than fifteen kilograms.

An arteroarterial femoral graft using expanded polytetrafluoroethylene is described which has been successfully for vascular access in young children having small peripheral vessels. This graft allows high flow and favorable patency for dialysis without the complications of arteriovenous shunting or the risks associated with an external hemodialysis device. This graft has been used successfully for outpatient dialysis in children weighing as little as 9 kg and may be a useful adjunct in long-term dialysis of patients for whom more conventional means of vascular access are not acceptable.


The ligation of the splenic artery in the treatment of traumatic rupture of the spleen.

Overwhelming sepsis is splenectomized children may be a real threat to life. As an alternative to splenectomy, ligation of the splenic artery in combination which splenorrhaphy was used successfully in two children with splenic trauma involving major segmental vessels. In both patients the postoperative course was normal. Peripheral blood tests, immunological studies, and scintigraphies disclosed no abnormalities of the spleen after the ligation of the splenic artery. Aortographies showed a collateral arterial network in the spleen. Therewith, 11 and 12 months after the operation, respectively, both cases--the first of our series--are presented and discussed.


Gastric acid secretion after chemical sympathectomy.

Adrenergic nerve terminals in several organs are selectively destroyed by 6-hydroxydopamine (6-OHDA) resulting in a chemical sympathectomy that is reversible. In this study the acute and chronic effects of 6-OHDA on gastric mucosa and acid secretion were evaluated. Four dogs were given 6-OHDA (40 mg/kg, intravenously). Gastric biopsies were taken before treatment and biweekly thereafter and were analyzed by fluorescence microscopy (Hillarp-Falck). Degeneration of adrenergic nerve terminals in the mucosa was complete at 1 week. Early regeneration was noted at 3 weeks and appeared to be complete at 9 weeks. In another group of seven dogs with a gastric fistula, dose-response curves to pnetagastrin (PPG, 0 to 5 microgram/kg/hr) were determined. Then 6-OHDA (40 mg/kg) was given to these dogs and secretory studies were repeated weekly thereafter for 8 weeks. After 6-OHDA administration, acid secretion increased in response to submaximal doses of PPG, whereas maximal secretion was unchanged. The peak increase occurred the second week; thereafter secretion gradually returned to control values. We conclude that chemical sympathectomy (6-OHDA) increases gastric acid secretion in response to submaximal PPG stimulation. This increase correlates well with the 6-OHDA--induced degeneration of adrenergic terminals in the mucosa. These data suggest that the adrenergic innervation of the stomach has an inhibitory effect on the control of acid secretion in the dog.


Neutrophil function in surgical patients: in vitro correlation of abnormal neutrophil chemotaxis by Levamisole.

Cutaneous anergy to recall skin test antigens is associated with decreased polymorphonuclear neutrophil (PMN) chemotaxis (CTX). This decreased PMN chemotaxis is mediated by factors circulating in the sera (AS) from patients with anergy. Levamisole hydrochloride will correct the chemotactic defect of neutrophils from anergic patients, in vitro, from 96.2 +/- 1.2 to 125.1 +/- 1.7 microns at concentrations of 10(-3) M to 10(-18) M. Pretreatment of normal PMN with Levamisole at 10(-4) M will protect them from the chemotactic inhibiting effect of AS. Normal PMN migrating in the normal range, 128.1+/- 2.7 microns, can be made to behave like anergic PMN by treatment with AS. These PMN which now migrate in the anergic range 92.1 +/- 1.7 microns can be converted back to normal by Levamisole treatment at 10(-3) M to 10(-18) M. In 35 surgical patients who demonstrated the spectrum of decreased PMN CTX, the majority toward the anergy level, Levamisole improved the PMN CTX toward normal levels in every instance, while not affecting the CTX of the normally migrating PMN.


Contact double-contrast cholangiography.

Recently operative cholangiography has become an essential step in biliary surgery. However, an usual technique in which x-ray film is set beneath the patient has its limitation in visualization of fine changes. The author devised a new technique to resolve this problem. A triangular mammography film designed for good positioning is vaccum-packed, coupled with an intensifying screen of the same size, and then is sterilized in advance. Barium solution mixed with Gascon drop (a defoaming agent) is used as contrast material. The duodenum and head of the pancreas are mobilized. Usual cholangiography is performed at first, introducing angiographic media through a catheter placed into the catheter placed into the common duct via the cystic duct. After this study a triangle film pack is set beneath the second part of the duodenum. Two to three milliliters of barium, 1 to 2 ml of Gascon, and 15 ml of air are pushed in; thus a contact double-contrast cholangiogram is obtained. This technique promises clear demonstration of the distal bile duct without risk, and even fine mucosal plicae may be discernible in the film.


Increased peripheral amino acid release following burn injury.

Turnover rates of 10 amino acids were determined in four normal subjects and 18 burned patients (mean burn size, 41% of total body surface) by measuring leg blood flow by venous occlusion plethysmography and arterial (A) and femoral venous (FV) amino acid concentrations. Patient arterial plasma amino acid concentrations generally were low or normal, although phenylalanine was elevated. Only alanine demonstrated significant A-FV concentration difference (-9 +/- 2 mumole/100 ml in patients vs -5 +/- 1in controls, mean +/- SEM). Leg blood flow was 6.26 +/- 0.57 ml/100 ml of leg volume . min in the patients and 2.62 +/- 0.57 in controls. While the net peripheral release of the 10 amino acids was accelerated following injury, only alanine release was consistently greater in the patients (0.27 plus or minus 0.05 mumole/100 ml in leg volume . min) as compared with that of controls (0.08 +/- 0.02). The increased alanine release from legs of patients generally was related to the extent of total body surface injury and oxygen consumption of the patient, but was unrelated to size of limb burn or leg blood flow. The accelerated rate of alanine release from limbs of burn patients relates to the generalized catabolic effects of injury rather than to local inflammatory or metabolic events which may occur in the injured extremity.


Compartmentalized gastrosplenic and mesenteric venous hypertension after distal splenorenal shunt occlusion: response to mesocaval shunt and splenectomy.

This is a report of a patient with a thrombosed Warren shunt and recurrent variceal hemorrhage who demonstrated compartmentalized venous hypertension in the mesenteric and gastrosplenic systems. Although the mesenteric presssure was normalized by the construction of a mesocaval interposition shunt, the gastrosplenic venous pressure remained elevated until splenectomy was performed. Warren shunt occlusion should be considered as a cause of segmental portal hypertension. Splenectomy may be a necessary adjunct in patients suitable for reshunting.


Vertebral artery aneurysm: case report and review of the literature.

A nontender, nonpulsatile large anterior neck mass was found at operation to be an atherosclerotic aneurysm of the vertebral artery, an extremely rare condition. Proximal control and distal control were obtained and the aneurysm was excised. Aneurysms of the vertebral artery are infrequent but well-defined complications in connective tissue disorders such as the Ehlers-Danlos syndrome, and they can develop subsequent to penetrating neck trauma. However, no cases of atherosclertic vertebral artery aneurysms have been reported recently in the English-language literature. The case presented illustrates that this rare condition should be considered in all patients who have neck masses of undetermined etiology.


Fungal infection of a vascular prosthesis.

Chronic debilitating hematological disorders and cytotoxic drugs may create conditions causing a predisposition to fungal infections of vascular grafts. Under such circumstances routine bacteriological investigations should be supplemented by specific fungal media cultures and microscopic examination of removed infected graft.


Congenital cystic dilatation of the intrahepatic bile ducts (Caroli's disease): report of a case and review of the literature.

A case of congenital cystic dilatation of the intrahepatic bile ducts (Caroli's disease) followed for more than 7 years is reported. This patient presented also with congenital hepatic fibrosis, gallstones, and biliary hypersecretion of more than 3,000 ml in 24 hours. An analysis of the literature relating to Caroli's disease disclosed 46 well-documented cases of both hepatic histopathology and biliary tree studies. Six cases (13%) were found to be isolated forms of intrahepatic cystic dilatations; 16 (34.7%) were associated with congenital hepatic fibrosis; 10 (21.7%) presented with either a choledochal cyst or nonobstructive extrahepatic biliary tree dilatation; and in 14 cases (30%) the three anomalies were found together in the same patient. After these findings, we think that congenital hepatic fibrosis, congenital cystic dilatations of the intrahepatic bile ducts (Caroli's disease), choledochal cyst and other nonobstructive dilatations of the extrahepatic biliary tree are possibly the same congenital disease with different levels of involvement.


Possible aspects of normal unphysiological commercial conditions on the estrus and early pregnancy in pigs.

Gilts and sows kept under unphysiological commercial conditions may show delayed puberty, delayed estrus postweaning and delayed returns after insemination. It is postulated that in all three manifestations gonadotropic insufficiency is the causative factor, produced by inadequate exteroceptive stimulation, mainly of olfactory origin, or by a configuration of stimuli which is experienced as in-appropriate by the individual organism. Pituitary L.H. is necessary to induce teritary follicles to secrete estrogens, which play a prominent part in estrus expression and in turn evoke the pre-ovulatory L.H. peak flow. Pituitary L.H. also appears to be necessary for persistence of of the corpora lutea during early pregnancy and this L.H. release may also be inhibited under inadequate physiological conditions. Therefore anaphrodisia in big commercial piggeries can be a normal physiologic reaction of the animal and more or less an adaptation to these unfavourable circumstances. For the greater part delayed puberty and delayed estrus postweaning seem to be coupled with anestrus and can easily be overcome by gonadotropin treatment in this case. Resulting fertility can be normal, even under severe stressful conditions. The delayed returns after insemination are partly caused by embryonal mortality. This mortality is at least for a part caused by gonadotropin insufficiency which in future may be prevented by application of a proper treatment as well.


Perilobular fibrosis in chronic bovine fascioliasis.

The character, extent, and localization of perilobular fibrosis were studied in cattle experimentally infected with Fasciola hepatica. Such fibrosis is indirectly due to the liver flukes. The regionally localized fibrosis results from cholestasis due to transient occlusion of branches of the biliary tree. In periobular fibrosis it is possible to distinguish a florid, an intermediate, and an uncomplicated form. The florid phase is marked by proliferation of the biliary epithelium and is followed by infiltration of inflammatory cells.


Milk production increase following treatment of Dutch dairy cattle with thiabendazole.

In a trial involving 542 dairy cattle on 28 farms, 276 were treated once with thiabendazole within two days of calving. The treated group showed an average increase in milk yielded over the non-return group of 229.8 kg during the subsequent lactation. In the treated group, total milk fat production was increased over that of the controls by 7.4 kg per cow; milk protein was increased by 6.9 kg per cow. All treatment parameter differences were highly significant at the 1% level of probability.


Contribution to the aetiology of synovitis in chickens, with special reference to non-infective factors. IV.

The comparative study reported in the present paper was undertaken to collect data on the collagen content and collagen quality of tendons showing high (low) tensile strength levels and a compact (loose) histological structure. It was shown that tendon tissues of these two groups do not differ in this regard. The effect of administering a number of mutrients (known to be essential in collagenesis) was tested during this study. Administration of these mutrients did not prevent synovitis and did not increase tensile strength.


[Babesiosis in dogs in the Netherlands (author's transl)].

In recent years, babesiosis is frequently observed in dogs which have been on holiday with their owners in southern Europe. The epidemiology and wide variety of symptoms are discussed. Satisfactory results were obtained on treatment with Berenil (Hoechst) and Acaprin (Bayer). In addition to tick control, Imizole (Burroughs Wellcome) might be adopted in preventive treatment.


[Malignant tumors of the nasal cavity and paranasal sinuses (author's transl)].

Therapeutic results from 134 cases with malignant tumors of the nasal cavity and paranasal sinuses are reported. Retrospective classification based on clinical and roentgenological findings was possible in 121 cases. 49 patients underwent primary radiation treatment by 60Co-teletherapy, 46 were exposed to postoperative irradiation. The mean 2-year survival rate considering all stages and all kinds of malignant tumors amounts to 52%, the 5-year survival rate to ca. 32%. The 5-year survival rate obtained by means of curative tumor doses was 59%. Recurrences of the tumor appeared in 58 cases (43%), most of them in the course of a year. The therapeutic control of local tumor disease and the possibilities of an early detection of recurrences, improved with the help of new diagnostic methods, must therefore be regarded as the essential problems. No generally approved clinical classification of tumors of the nasal cavity and paranasal sinuses is available as yet, and the comparison of therapeutic results from different authors thus is difficult.


[Local recurrences in keratoid squamous cell carcinomas of the oral cavity: incidence, causes and therapy after a curative primary treatment (author's transl)].

The frequency of local recurrences in keratoid squamous cell carcinomas of the oral cavity is analyzed in view of the following criteria: Irradiation technique, volume of the primary tumor, irradiation parameters considering the factor of dose and time. The values of the dose, measured by ret, were calculated using the Ellis-formula modified by Gabriel-Jürgens et al. A focal dose of 1,700 ret is recommended for Stage T1 carcinomas of the tongue, a dose of 1,900 ret for the stages T2 and T3. The importance of the concept of nominal standard dose is emphasized with regard to its clinical application. Surgery seems to be superior to the renewal of radiation therapy in the treatment of recurrences.


[The period of time between operation and irradiation of a mamma carcinoma and its cytostatic treatment (author's transl)].

The critical attitude towards the additional chemotherapy of the mamma carcinoma is justified by the results of 453 patients submitted to post-operative irradiations. With the indication corresponding to their stade, 43 patients were treated by chemotherapy according to Ward. The remission rate was 70%.


[Diagnosis of tumors of the parotid gland by sialography and saialoscintigraphy. A comparative study on 49 patients (author's transl)].

169 patients with different diseases of the salivary glands were examined by means of sialography and sialoscintigraphy. The results of these examinations were analysed by a blindfold test. The sialographic diagnosis was correct for 47 of 49 tumors checked by histologic examinations. There is no specific criterium for the scintigraphic determiation of a tumor; there are concentrations as well as filling defects and retentions. The correct side, however, was found by scintigraphy in 46 cases. Only if a Warthin's tumor is suspected, the diagnosis can be confirmed by scintigraphy if a concentration is found. Generally, sialoscintigraphy should only be executed if sialography has technically failed. A distinction by means of sialography of benign and malignant tumors is not possible.


[Measurement by means of 99mTc-pertechnetate of the function of salivary glands before and after stimulation with pilocarpine in cases of sicca-syndrome of the parotidic glands (author's transl)].

Judgement on xerostomia in systemic diseases of the salivary glands and on the sicca-syndrome as a side-effect of radiation therapy or of a treatment with psychopharmaca has been improved by the function test of the parotidic glands for each side individually with 99mTc-pertechnetate, particularly in view of the detection of lateral differences. Measurements of the salivation volume and activity are completive of the function test, yielding knowledge of the total excretory power of all the salivary glands. Functional remainders and reserves can be visualized objectively by additional utilization of the pilocarpine stimulation test (to-day performed with carbachol). The findings will be still more precise if the parotidic salivation is collected and measured for each side separately. This exploration method is appropriate for frequent controls in the course of a disease and for the forming of an opinion upon therapeutic effects of sialagogic agents.


On output variations of therapeutic x-ray equipment.

The author has measured the exposure rate of 56 orthovolt X-ray units. A comparison of consecutive measurements resulted in a 4.2% standard deviation which is mainly due to output variation of the X-ray equipment itself and due to the variation of mains supply. The repeatability of an irradiation controlled by a timer is therefore +/- 9% (on the 95% confidence level), which is much lower than recommended by the ICRU or stipulated in Hungarian National Standards. This accuracy is however sufficient in non-tumor therapy. The output variation among therapeutic X-ray units is high (sigma x approximately 22%) and correlates with the HVL measurements. The advantage of a central dosimetric service is the reduction of the number of unnecessary radiation qualities and superfluous combinations of radiation qualities, tube current and FSD.


[Tangential pendulum irradiation of the thoracic wall with co-60 during radiation therapy of surgically treated cancers of the breast: comparison of measurement and computation methods for irradiation planning (author's transl)].

The irradiation technique for tangential pendulum 60-Co-irradiation of the thoracic wall is described, and the possibility of a homogeneous irradiation of the thoracic region of interest by means of individual irradiation planning together with a careful, but practicable, technique of positioning and adjustment is shown. The radiation load to the lung can be kept on a moderate level. Phantom measurements with thermoluminescence probes, films and an ionization chamber have been performed for three typical forms of the thorax. Dose distributions thus obtained show a satisfying accordance with calculated values of the dose, the deviations amounting to 3 to 8%. The EDP program applied, COMRAD, thus permits computation of individual pendulum isodoses with sufficient accuracy in practice, and therefore, may be used regularly.


[Contribution of the local resolution in measurements using detectors with a cylindrical section (author's transl)].

The method reported in this notice is permitting to correct the influence of finite detector diameters on the shape of measured isodose curves.


[Decorporation of radionuclides investigations on the pharmacokinetics of DTPA by means of its decorporating effect on 144Cer (author's transl)].

The influence of Zn-DTPA on the retention of 144Cer in several organs of the rat was investigated 4 days after 144Cer application either with intact or with prevented renal excretion. As the 144Cer activity mobilized from the liver is recovered in gut and faeces an excretion of DTPA bount 144Cer with the bile can be assumed. In animals with impeded renal function an amount of 144Cer is accumulated in blood and extracellular water which corresponds to that mobilized from the skeleton and is normally excreted with the urine.


Effect of dextran on cerebral function and blood after cardiac arrest. An experimental study on the dog.

EEG activity and regional cerebral blood flow were monitored during 5 hour survival following cardiac arrest in 32 pentobarbital anesthetized mongrel dogs. The animals were mechanically ventilated and blood gases were maintained at physiologic levels. Regional cerebral blood flow and cardiac output were measured using 15 mu microspheres. EEG was recorded from 6 epidural electrodes using bipolar techniques. The animals were divided into 3 groups. The animals in Group I had an arrest of 8-11 minutes and those in Group II and III had an arrest of 12-16 minutes. Group II animals received no treatment. Group III animals were given 1 g/kg of dextran 40 at a concentration of 10% in normal saline following the arrest and maintained with 10 mg/kg/min during the 5 hours of recovery. In Groups I and III there was shorter duration of a flat EEG and 5 hours after the arrest the EEG activity was closer to normal than in Group II. After 5 hours the EEG scores of Group III were significantly greater than Group II (p less than 0.03). The cortical grey matter and hippocampus had the greatest reduction of blood flow following cardiac arrest. The mean cortical grey matter blood flow in Group II was less than in Groups I and III at 3 hours. After 5 hours the grey matter blood flow was greater in Group III than in Group II (p less than 0.09). The findings of this study are consistent with the hypothesis that after cardiac arrest perfusion abnormalities persist or develop after return of blood pressure and that these can be corrected or prevented with improved functional survival by treatment with dextran 40 after the arrest.


Dyadic death: murder-suicide.

Twenty homicide-suicides, drawn from death records of three major eastern United States cities, were analyzed in comparison to prior studies and samples of homicide offenders and suicide victims. Results indicated a lower incidence for this event than reported previously and several distinguishing characteristics of the murderer who subsequently commits suicide. Two primary types, from the perspective of ego fusion, are discussed.


Suicide attempts among drug abusers.

The relationship between substance abuse and suicide is indicated by the high rate of attempted suicide among alcoholics and drug abusers as well as the increased likelihood of repeated attempts in these populations. This study reports on the psychological characteristics of male drug suicide attempters who are in treatment for their addiction problem. Data collected from 166 veterans included background information, symptoms, mood, social functioning, and attitude measures. Of the drug abuse patients, 26 percent reported having made a suicide attempt. These subjects were found to be significantly more depressed, angry, insecure, and anxious than the nonsuicide-attempt drug abusers. Treatment staff need to be sensitized to the possibility of repeated suicide attempts among substance abuse patients.


Brain edema and blood-brain barrier permeability following quantitative cerebral microembolism.

Cerebral microemboli were formed in rats by injecting 4,000 carbonized microspheres, 50 +/- 10 mu in diameter, labelled with 85Sr, into the internal carotid artery. The use of radioactive microspheres as embolic agents enabled the number of microspheres to be determined in each cerebral hemisphere. The microspheres were mainly distributed in the cerebral hemisphere on the side of the injection. In 61 rats this hemisphere contained 582 +/- 20 microspheres against 99 +/- 9 in the contralateral hemisphere. Brain edema was assessed by measuring brain content of water, sodium and potassium. Blood-brain barrier (BBB) permeability was determined by brain accumulation of 125I-albumin. In the ipsilateral hemisphere brain edema and an increase in BBB permeability appeared 6 hours after embolization and progressed up to 48 hours. Twenty-four hours after embolization, significant correlations were observed between the microsphere content of the cerebral hemispheres and 1) the increases in water and sodium levels, 2) the decrease in potassium level, 3) the increase in BBB permeability. The study of these correlations should make it possible to ignore the poor reproducibility of embolizations and to analyze with increased accuracy the results of various experiments.


Suicide in the 1970s: a second look.

The decade of the 70's has been reviewed with the document Suicide Prevention in the 70's serving as a guide. Twenty-one goals put forward in the report were reviewed in light of subsequent progress in the field. Although progress was noted on many fronts, four areas were outstanding in the sense that envisioned goals were met or exceeded. These involved the areas of promulgation of information about suicide, establishment of standards and certification procedures, development of regional organizations to forward training and program development, and education of the public to improve awareness of suicide as a public problem. This analysis also identified areas where little or no progress has been made. From this there developed four recommendations: 1. The funding and establishment of a national case file using a standard nomenclature and a standard data base to improve epidemiologic knowledge, and to provide pooled data appropriate for more sophisticated research analyses. 2. The establishment of a task force to study the application of program evaluation methods to suicide prevention efforts. 3. The development of new programs at local levels to try to reach known high-risk groups and to provide relevant programs of suicide prevention for them. 4. Making creative efforts toward elaboration of a comprehensive theory of life-threatening behavior and exploration of developmental corrolates of such behavior.


Total cerebral ischemia: a new model system for the study of post-cardiac arrest brain damage.

The pathophysiology of post-cardiac arrest brain damage is not well understood. Many of the model systems presently used to study global ischemia have serious limitations. A new model system for total cerebral ischemia (TCI), using aortic and inferior vena caval occlusion balloons, is described. This model system produces verifiable TCI and avoids surgical invasion of the thorax or the use of vasoactive drugs. It does not impede cerebral venous return and protects the cardiopulmonary system from damage. This model system can be used to study the efficacy of various therapeutic interventions following a standardized CNS global ischemic insult.


The working through of patients' suicides by four therapists.

In 1976 four psychotherapists in training at one institution had patients who committed suicide. The therapists met as a group over a one-year period. This paper presents brief case summaries, explores the reactions of each therapist, presents conclusions regarding the mourning process following patients' suicides, and puts forth implications and suggestions for training programs. The authors conclude that it is necessary for therapists, supervisors, and training programs to recognize the inevitability of crises and tragedies when working with disturbed persons and that, though the process of mourning must be worked through individually, training settings can permit therapists to experience the pain and loneliness while providing opportunities for mastery and growth.


Pathophysiological mechanisms of brain edema development: role of tissue factors.

In experiments carried out on adult rabbit "chest-head" preparations the volume changes of the exposed brain (BrV) were determined in repeated tests during a controlled increase of the systemic venous pressure (SVP) of about 13 mm Hg. The changes of both SVP and BrV were usually parallel at the onset of the experiments, but when the brains became preedematous hysteresis appeared in the plots of their relationships. The hysteresis increased gradually (sometimes with periods of partial decrease) thus indicating a delay in the draining of blood from the brain's venous system and in the removal of excess extracellular fluid from the cebral tissue. Evidence for water filtration through the capillary walls during increase of the SVP, and, thus, of brain intravascular pressure, was obtained by detecting the dynamics of [Na+] and [K+] in the extracellular fluid of the cerebral cortex by ion-selective electrodes. This process appeared reversible in normal brains while in the preedematous ones the excessive water filtration resulted in brain edema. The preedematous state of the brain is believed to be caused by changes of the mechanical properties of brain tissue and/or by changes in osmolarity.


Starting a therapy group in a suicide prevention and crisis center.

This report outlines the experience of one center in establishing a group therapy program, discussing the "readiness" of the center, reservations of the governing board, qualifications and number of group leaders, composition of the group, time-place-duration of meetings, "open" versus "closed" structure, vagaries of obtaining participants, integration with the 24-hour telephone crisis service, problems of confidentiality, and dealing with the suicide of a group member.


Antibodies that define NANA-independent MN-system antigens.

The hemagglutinating properties of a large proportion of anti-M and anti-N reagents, and sera containing antibodies to MN-related antigens, have been shown to be unaffected by treatment of red blood cells with neuraminidase. These antibodies, which define NANA-independent MN-system structures, provide further evidence that MN blood group specificity may also be determined by moieties other than N-acetylneuraminic acid.


Pedi-pack transfusion in a newborn intensive care unit.

Two hundred and ninety-one transfusions using 221 pediatric frozen red blood cell packs (Pedi-Packs) were given to 141 newborn babies and infants in the newborn intensive care unit. In 18 patients, 47 transfusions were studied for transfusion and clinical characteristics. Two possible hemolytic episodes are described in detail and remain unexplained. Blood loss for laboratory tests was found to average 3.1 ml/kg per day spent in the newborn intensive care unit. The rise in hematocrit was found to be excellent. Overall, the transfusion of thawed pediatric red blood cell packs was found to be convenient, safe and effective. Because of pretesting possibilities with the use of this source of red blood cells, one of the problems associated with a walking donor program is eliminated.


Hemophilia: cost consideration for prescribing therapeutic materials.

Costs for therapeutic products utilized in treating hemophilia can be prohibitive to patients. The costs can be effectively reduced by understanding the elements comprising the total cost of these products. By calculating appropriate dosage schedules, avoiding indiscriminate purchasing practices, and monitoring costs to patients, physicians can help reduce the total financial burden to patients and third party payers.


Ultrasonic purification of Bridge anticoagulant neutralizing agent (BANA) and a study on its effect on factor VIII inhibitor.

Ether precipitation of globulins from the supernatant fraction of prothrombin complex concentrate, followed by adsorption on tricalcium phosphate and elution gives a beta2 fraction termed Bridge anticoagulant neutralizing agent (BANA). Although this is completely free of all known blood clotting factors, it improves recalcification time, PTT and thromboplastin generation of hemophilic plasma. It also counteracts the effect of factor VIII inhibitor. Ultrasonic elution produced more activity per mg N than did citrate elution. The possibility is discussed of incorporating BANA preparation in the routine fractionation of plasms without reduction in the yield of factor VIII or prothrombin comples concentrate.


Characteristics of stored granulocytes collected from donors stimulated with dexamethasone.

Two hours after normal donors were given intravenous dexamethasone, their leukocytes were collected by intermittent flow centrifugation. Neutrophils were tested immediately after collection and following storage at 4 to 6 C for 24, 48, 72 and 96 hours. Tests included total leukocyte and absolute neutrophil counts, plasma glucose concentrations, the percentage of phagocytic neutrophils, the ability of phagocytes to accumulate particles, candidacidal activity, bactericidal capacity and chemotaxis. Total leukocyte and absolute neutrophil counts in the stored suspensions were decreased after 48 hours (p = .005). Plasma glucose levels in the suspensions declined at first, then stabilized at 48 hours of storage probably because of loss of cellular integrity. Chemotaxis, candidacidal activity, phagocytosis and dye exclusion showed statistically significant decreases at 24 hours. Chemotaxis deteriorated rapidly, with a mean 63 per cent functional loss at 48 hours. We conclude that treatment of donors with dexamethasone does not extend the storage limits of granulocyte concentrates used for clinical transfusions. Based on these and our previous observations, unless the storage changes should be shown to be reversible, granulocyte concentrates should probably not be stored more than 24 hours before transfusion.


Platelet behavior in extracorporeal circulation (ECC).

Compatibility of blood with nonphysiologic materials is of increasing importance. The basis of estimating such compatibility has shifted from the determination of hemolysis to the estimation of the clotting capacity. This can be specified in terms of number and function of curculating thrombocytes and the resulting bleeding time. In this study components of commonly used standard equipment for open heart surgery have been compared to alternatives. The parameters studied yeild more relevant information for ranking materials in relation to their blood compatibility than does estimation of hemolysis alone. The behavior of the thrombocytes showed an initial dip (acute aggregation phenomenon), a plateau (equilibrium between aggregation and desaggregation) and a secondary dip (elimination of irreversibly damaged cells). Correlated to criteria of major hematological differences as observed between membrane-oxygenators and bubble-oxygenators, the percentage of circulating thrombocytes at the moment of the secondary dip gives the best overall information about hemocompatibility.


Plasma adenine and cellular ATP in red cell concentrates collected and stored in modified CPD at 4 C.

Eight units of blood were drawn into modified CPD containing 25 per cent higher glucose and 17.3 mg adenine (0.25 mM in blood). Red blood cell concentrates (RCC) were prepared to a mean hematocrit (Hct) of 70, the cells stored at 4 C, and plasma adenine and red blood cell adenosine triphosphate (ATP) were measured weekly for 42 days. The removal of plasma in the preparation of RCC reduced by 39 per cent the available adenine. As a result measurable plasma adenine was depleted by 21 days. The loss of ATP in RCC occurs at a significantly faster rate than in whole blood stored under the same conditions. When red blood cells are stored at higher HCT or for periods longer than 35 days, increased anticoagulant adenine levels are recommended.


The effects of temperature variations on cryoprecipitate.

The effect of temperature on Factor VIII levels in blood and cryoprecipitate was assessed. Freshw collected units of blood required several hours to reach 4 C, but this delay seemed of little importance since equal amounts of cryoprecipitated Factor VIII were recovered from blood stored either at 22 C or at 4 C. Freezing at -80, -60, or -40 C produced identical yields of Factor VIII, whereas freezing at -20 C resulted in significantly lower recoveries. This might be expected if one considers the physiochemical changes that occur during the freezing process.


Lack of predictive value of antileukocyte antibody screening in granulocyte transfusion therapy.

To clarify the relationship between recipient presensitization and response to granulocyte (PMN) transfusion, we tested 187 non-HL-A matched donor-recipient pairs for the presence of antileukocyte antibody using granulocytotoxicity (G), lymphocytotoxicity (L), microleukoagglutination (M), and capillary leukoagglutination (C) assays. PMN increments per 10(11) transfused PMNs per square meter of body surface area, ascertained one hour following termination of transfusion, and the occurrence of nonhemolytic transfusion reactions, were correlated with the assay results. Although circulating anti-donor-leukocyte antibody was detected in 52 per cent of recipients, there was no statistically significant relationship between the presence of these antibodies and either PMN recovery or incidence of transfusion reaction. We conclude that the prospective use of these assays is of little value in predicting the recipient's response to PMN transfusion.


Experience with an albumin-enhanced, 15-minute incubation, emergency crossmatch.

During a 40-month period, an emergency crossmatch procedure using an albumin-enhanced 15 minute incubation indirect antiglobulin technique was evaluated along with a standard procedure for 2,276 patients involving 6,423 units of blood. One hundred-forty unsuspected allo-antibodies were detected during this study, of which 130 were detected by both techniques. In five instances where antibodies were not detected by the emergency technique, the antibodies were not though to be clinically significant.


The effects of red blood cell suspending media on hemagglutination and the antiglobulin test.

Evaluation of the effects of four suspending media for test cells in antibody detection and identification is reported. The media under investigation are normal saline, low ionic strength salt solution, 22% bovine albumin and polymerized albumin. Hemagglutination at 37 C was enhanced in the test systems employing polymerized albumin. With shortened incubation times, the antiglobulin test was enhanced in tests against red blood cells suspended in the low ionic strength salt solution. When incubation times were extended to 30 minutes, all suspending media were apparently equally effective.


The use of an oxygen dissociation curve analyzer in transfusion therapy.

Two automatic apparatuses utilizing a dual wave-length spectrophotometric method were developed to perform oxygen dissociation curves on microsamples of blood. This method provides a complete printout of an oxygen dissociation curve in 15 to 20 minutes and the P50 values obtained agree closely with those obtained by classical methods. This technique was used as part of a routine clinical evaluation in assessing oxygen delivery in anemic patients. These apparatuses allowed identification of patients with well-compensated anemia, patients with no compensatory decrease in oxygen affinity, and several patients with a paradoxical increase in oxygen affinity. Knowledge of the oxygen-releasing capacity of the blood permits a more thorough evaluation of oxygen transport in anemic patients than the hemoglobin level and a more precise assessment of the need for transfusion therapy. The ready availability of an oxygen dissociation curve by this method is feasible for routine clinical evaluation and permits more judicious use of blood products.


Studies on platelets contained in eluates following filtration leukapheresis.

Platelets eluted from nylon fiber filters after filtration leukapheresis have been studied. The platelet yield from 61 routine donations was 1.25 +/- 0.18 x 10(11), (mean +/- SEM) corresponding to 1.78 x 10(10) per 500 ml blood processed. Filtered platelets labeled with radiochromate demonstrated reduced recovery in vivo 15 minutes after infusion (38.5 +/- 1.7%) when compared to the control value (68.5 +/- 6.8, p less than 0.001). The survival of those platelets remaining in the circulation after 15 minutes did not however differ from the control value. ADP (10 micrometer, 1 mM), adrenaline (100 micrometer) and collagen (7.25 mg/ml) added in vitro induced less aggregation of filtered platelets than normal control platelets and electron microscopy revealed structural abnormalities. It is concluded that recipients of granulocyte transfusions obtained by filtration leukapheresis are unlikely to be benefited by the platelets contained in these transfusions.


Di-2-ethylhexyl phthalate (DEHP) and mono-2-ethylhexyl phthalate (MEHP) accumulation in whole blood and red cell concentrates.

Plasma DEHP concentrations were measured weekly in whole blood and red cell concentrates (RCC) during 21 days of storage in standard CPD within PL-130 blood bags. In addition, DEHP and MEHP accumulation patterns were investigated in blood stored for 42 days in modified CPD with adenine within PL-146 and BB-69 storage containers. Total per-unit plasma DEHP of RCC units was 49 to 71 per cent of the total in plasma of whole blood units (PL-130). From 28 to 42 days, mean DEHP levels were 12 to 19 per cent higher in whole blood stored in PL-146 than in BB-69. Although MEHP was not found in any blood bag plastic, MEHP accumulated in plasma during whole blood storage. MEHP concentrations were 2.8 to 3.8 times higher in plasma stored in BB-69 than in PL-146. It is postulated that MEHP arises from hydrolysis of DEHP by plasma lipase, even in frozen plasma sample, and that the rate of this reaction is influenced by blood bag plastic surface characteristics.


Therapeutic plateletpheresis in thombocythemia.

Patients with myeloproliferative thrombocythemia have usually been managed with chemotherapy. Generally, removal of platelets from such patients has been performed intermittently to lower the platelet mass rapidly when neurologic or hemorrhagic complications were manifest or concurrently with the initiation of chemotherapy. A platelet count of 1,000,000/microliter or less was maintained by the use of repeated plateletpheresis over a period of three months in a patient with essential thrombocythemia, who had frequent syncopal episodes. A second patient with secondary thrombocytosis, who sustained two cerebrovascular accidents, underwent intermittent plateletpheresis over a 22-day period until her underlying disorder improved. It is concluded from the experience, combined with that of others, that plateletpheresis is not only a life-saving procedure in an acute episode but may also be used to maintain a lowered platelet count over a prolonged period in selected patients with primary thrombocythemia, in whom chemotherapy cannot be undertaken, and in symptomatic patients with secondary thrombocythemia.


The effect of an educational program on transfusion practices in a regional blood program.

With the increased complexity of blood component therapy, it is important to be able to modify physician behavior with reliable educational programs. A standardized educational program on the use of red blood cells and whole blood was tested in 22 hospitals in a regional blood program using medical audit and computer monitoring to evaluate effectiveness. Most hospitals were eager to take advantage of the education program but were unwilling to use the audit-education cycle. At the same time, computer monitoring of indivisual hospital ordering and transfusion practices demonstrated an increased utilization of red blood cells in 64 per cent of hospitals with an overall improvement of 8 per cent. The improved use of red blood cells was appreciated within the month of the program and then sustained for six to twelve months at the new level.


Technique for increased granulocyte recovery from human whole blood by counterflow centrifugation elutriation I. In vitro analyses.

Human granulocytes were isolated from 120 ml of whole blood by a modified counterflow centrifugation-elutriation (CCE) technique. Overall recovery of isolated granulocytes averaged 2.82 +/- 0.25 x 10(8) cells or 77 per cent yield from whole blood with 96 per cent granulocyte purity and 4 per cent mononuclear leukocytes. The granulocyte fraction was assayed in vitro to determine chemotactic response, stimulated oxygen consumption in the presence of latex beads, bactericidal capacity, and enzyme activities. Cellular integrity was determined by scanning and transmission electron microscopy as well as by cell volume analysis. The data suggest that granulocytes isolated by CCE suffered no discernible loss of function or morphologic damage. The granulocytes are free of platelets and most mononuclear leukocytes and erythrocytes, and have not been exposed to sedimenting agents or surface adhesive agents such as dextran, nylon or glass wool.


Red blood cell membrane storage lesion.

Storage of human erythrocytes in CPD produced a lesion of the erythrocyte membrane manifested by abnormal endocytosis in resealed ghosts and in intact erythrocytes. Endocytosis produced by resealing Ca, Mg, and ATP into ghosts was impaired by five weeks of storage and this defect was promptly reversed by the prior regeneration of ATP in the stored erythrocytes. Drug-induced endocytosis was studied in intact stored erythrocytes. Vinblastine endocytosis was not affected by storage. Chlorpromazine endocytosis was not affected by storage. Chlorpromazine endocytosis was variably but never completely inhibited by storage. Chlorpromazine endocytosis was variably but never completely inhibited by storage, and restoration of ATP occasionally resulted in complete restoration of chlorpromazine endocytosis to base line values. However, primaquine endocytosis was usually totally inhibited after three to four weeks of storage at a time when residual ATP levels were 30 to 50 per cent of base line values. Restoration of ATP levels to at least base line values did not completely primaquine endocytosis to control values. Study of primaquine endocytosis provides an opportunity for defining an erythrocyte membrane storage lesion.


Phenotype i associated with congenital cataract in Japanese.

A Japanese family with two siblings of phenotype i is presented. Both had a past history of surgical treatment for congenital cataract. In Japan, 18 individuals of phenotype i, including our case, have been found in ten unrelated families. Seventeen of them had congenital cataract. Cataract was not found in any of the 45 phenotype I members in these families. It is briefly discussed why these two linked and quite rare genes were found in combination only in Japanese persons.


The effect of dexamethasone on platelet function.

To assess the effects of dexamethasone on platelet function, aggregation studies were performed on nine healthy adults before and after ingestion of a single dose of dexamethasone 10 mg, and on six patients receiving daily dexamethasone. Bleeding times were done on 14 volunteers before and after a similar drug dose. Platelet aggregation by ADP, epinephrine and collagen was unchanged after dexamethasone in the healthy subjects and aggregation curves in the patient group were comparable to the normals. Bleeding times were moderatley prolonged in women (from 284 +/- 58 seconds to 389 +/- 114 seconds) but not in men. This prolongation was much less pronounced than that which occurs with low doses of aspirin and no subject experienced delayed bleeding. Dexamethasone in single high doses probably does not cuase a clinically important effect on platelet function.


The effects of combined platelet and leukapheresis on the blood coagulation system.

Analysis of blood coagulation was done on samples of blood collected from ten donors undergoing combined platelet and leukapheresis using the Haemonetics Model 30 Blood Processor. Blood samples were obtained from the donors prior to, during, and following pheresis. Blood was also obtained from the blood-return line after the first collection of leukocytes and platelets, but before it was returned to the donor. Although the citrate anticoagulant was returned to the donor and there were some decreases in the concentrations of fibrinogen, platelets, and factors V and VIII, there were no changes of sufficient degree to suggest that development of a potential bleeding disorder. In addition there was no evidence to suggest that any activation of blood coagulation occurred during the pheresis or that thrombogenic substances were returned to the donors. Combined platelet and leukapheresis using the Haemonetics Model 30 Blood Processor, therefore, do not appear to subject the donor to risks for either bleeding or thrombotic complications.


Coagulation factor activity in platelet concentrates.

Coagulation factor activity in platelet concentrates stored under different condtions was investigated. At both 22 C and 4 C, coagulation factors, II, VII, IX, X, XI, and XII and fibrinogen were well maintained up to 72 hours. Factor V activity declined slightly in platelet concentrates stored at 4 C (to 78% at 72 hours), but fell to 47 per cent activity in platelets stored at 22 C. Factor VIII activity declined to approximately 68 per cent of normal activity by 72 hours at both 22 C and 4 C. Agitation did not make a difference in levels of coagulation factors. While the decline in Factor V was clearly more pronounced in platelet concentrates than in platelet-poor plasma from the same units, the decline in Factor VIII was decreased by the presence of platelets. Platelet concentrates are a source of coagulation factor activity which should be considered in a component program.


Macrophage-alloantibody-target cell interactions. II. Nonphagocytic effects.

Two nonphagocytic effects of macrophages on antibody-coated lymphocyte target cells were studied: antibody-dependent cell-mediated cytotoxicity (ADCC) and abrogation of complement lysis (ACL) by nonphagocytic mechanisms. Macrophages did not mediate ADCC, and actually inhibited K cell-mediated ADCC, presumably by direct interactions with the antibody-coated target cells. These interactions were studied in the ACL assay previously described, in which macrophages, antibody, and 51Cr-labelled target cells were incubated for 1 hr. Then complement lysis (as measured by 51Cr release) was performed to assess the status of the target cells. The nonphagocytic component of ACL could be distinguished from the phagocytic component by the addition of a second antibody during the complement lysis phase. This procedure revealed that some of the target cells which were resistant to the original antibody were susceptible to lysis by a second antibody and were therefore not phagocytized. Such cells had apparently been stripped of their antibody and the associated antigen by the macrophages. In support of this interpretation, specific antigen alterations were demonstrable on these stripped cells under certain conditions. These alterations were produced more consistently when the macrophages were less than maximally stimulated, and were detected better by guinea pig complement than by rabbit complement. The mechanism of stripping may involve inactivation, redistribution, or removal of target cell-bound antibody by the macrophages. Possible in vivo roles for the stripping mechanism, for example, in the enhancement of tumours or allografts, are discussed.


Platelet glycolysis in platelet storage I. The glycolytic enzymes.

Sixteen glycolytic enzymes were measured in essentially leukocyte-free platelets before storage and daily after room temperature storage or platelets as concentrates. Most of the glycolytic enzymes proved to be very stable to storage. Even the most severely affected enzymes, enolase, triosephosphate isomerase, and lactate dehydrogenase lost less than one-quarter of their enzyme activity. Depletion of glycolytic enzymes does not seem to be a major factor in the storage lesion of platelets.


False positive and false negative reactions in HLA B-27 antigen testing.

The recent commercial availability of HLA B-27 antiserum now enables laboratories without prior experience in HLA typing to test for this antigen. False positive and false negative reactions frequently occur and require judicious interpretation. In our laboratory, 30 of 100 specimens were positive for B-27 and 70 were negative. Of the 30 positive, 10 (33%) failed to react against every antiserum tested. Twenty-nine of the 70 negative specimens (41%) reacted falsely with one or more B-27 antisera. A significant cause of false positive reactions was cross-reaction of the B-7 antigen with B-27 antisera (13 of 15 B-7 positive, B-27 negative specimens). For valid B-27 testing, use of more than one B-27 antiserum is included.


Combined platelet-leukapheresis: a technique for preparing separate platelet and granulocyte-platelet units from single donors.

One donor can provide separate platelet and granulocyte-platelet units that have the potential to fulfill the needs of two recipients. Combined platelet and leukapheresis were performed in the presence of hyddroxyethyl starch and citrate employing the Haemonetics Model 30 Blood Separator. Platelets and granulocytes were separated subsequently by centrifugation and two individual units were prepared for transfusion. The platelet units contained a mean of 4.4 x 10(11) platelets/unit and were nearly devoid of leukocytes. The combined granulocyte-platelet units contained a mean of 7.38 x 10(9) neutrophils/unit and 3.06 x 10(11) platelets/unit. Thus two separate units containing sufficient numbers of cells for transfusion can be obtained from pheresis of one donor.


Effects of steroid hormones on phytohemagglutinin-stimulated human peripheral blood lymphocytes.

The interactions of steroid hormones and human peripheral blood lymphocytes (PBLs) have been investigated following glass-wool column separation of PBLs and incubation in a serum-free medium in the presence of phytohemagglutinin (PHA). Addition of hydrocortisone or progesterone above physiological concentrations resulted in inhibition of [14C]2-TdR incorporation. 17beta-Estradiol and 5alpha-dihydrotestosterone inhibited [14C]2-TdR incorporation only at steroid concentrations thousands of times higher than the physiological concentrations. The kinetics of hydrocortisone and progesterone inhibition appeared to be similar and suggested that events occurring early after PHA addition were most sensitive to steroid inhibition and that addition of steroid at 28 hr, at the end of the early prereplicative phase of the cell cycle, inhibited DNA synthesis only at very high concentrations. The PHA-induced increase in RNA synthesis could be prevented by hydrocortisone addition even if delayed for up to 4 hr; morphological transformation was similarly affected. These data, and other investigations showing that progesterone binds to a specific glucocorticoid receptor in PBLs suggest that the progesterone inhibition of macromolecular synthesis in human  PBLs is exerted via a glucocorticoid-like mechanism, and that glucocorticoid sensitivity is greatest during the early phases of lymphocyte activation. These results also provide a rationale for the apparent in vivo immunosuppressive capability of progesterone.


Differential susceptibility of human peripheral blood lymphocyte subpopulations to mitogenic activation. Influence of methylprednisolone.

The inhibition of the mitogenic activation of human peripheral blood lymphocyte (PBL) subpopulations by methylprednisolone (MP) was dependent on the mitogen used. Purified human T cells were more sensitive to the effects of MP than were B cells or PBLs, especially when these cells were activated by pokeweed mitogen (PWM). MP did not function by inhibiting binding of mitogen to the cell surface. After being mitogenically activated, human lymphocytes were resistant to the effects of MP. These effects of MP were shown to be reversible. Monocytes did not provide a significant degree of protection to mitogenically activated human T cells incubated with MP. These data suggest that MP-induced inhibition of the mitogenic activation of human PBLs may be a reflection of lymphocyte heterogeneity, and that the differential sensitivity of PBLs to MP may be used to isolate functionally different subpopulations of these cells.


In vitro generation of nonspecific suppressor cells and their characterization.

In vitro preculture of C3H/He splenocytes for 48 to 96 hr induces aspecific suppressor cells evaluated by their ability to reduce 3H-TdR uptake by fresh syngeneic splenocytes stimulated by different amounts of Concanavalin A (Con A) in vitro. This suppressive activity is obtained in medium containing 10% heat-inactivated fetal calf serum (FCS) or similar amounts of heat-inactivated bovine serum, syngeneic, or allogeneic murine sera but not by unheated FCS. Suppressive activity is resistant to mitomycin C and radiation up to 5,000 R. Exposure of precultured cells to carbonyl iron or plastic adherence, but not to anti-Thy 1.2 serum plus complement, results in removal of the suppressive activity.


Cell-mediated lymphocytotoxicity directed against HLA-D gene products.

Cytotoxic effector cells were generated in human mixed lymphocyte cultures (MLCs) between cell donors differing at the HLA-D/DR region but not at HLA-A,B(C). These cells killed Epstein-Barr virus-infected lymphoblasts (EBV blasts) from donors sharing the HLA-D/DR determinants with the normal MLC-stimulating cells, but not phytohaemagglutinin (PHA) lymphoblasts from the same donors. Because EBV blasts are derived from B cells and express HLA-D/DR antigens, the most likely interpretation of these findings is that the HLA-D/DR antigens may, by themselves, act as targets for cell-mediated cytotoxicity.


[Distribution of chromosome material during division of giant nuclei by fragmentation in rodent trophoblast. Morphologic and cytophotometric study].

A study was made of a population of secondary giant cells (in the placenta of white rats and mice), of which a rather high polyploidy (128c--1024c) is characteristic, and which remains viable up to the end of pregnancy. At a certain stage of cell differentiation, some giant nuclei, looking as interphase nuclei, are divided into numerous smaller nuclear fragments bound with nuclear membranes. Two ways of division have been described: by a progressive budding of small nuclei into the cytoplasm, and the total division of the original nucleus into numerous tightly contracting nuclear fragments. Multinuclear cells originating from the nuclear fragmentation rather soon degenerate. The cytophotometrical measurement of the DNA amount in newly formed fragments has shown their ploidy extending from 1 to 32c, di-, three-, tetra-, and octoploid nuclei predominating. The distribution of chromosomal markers of the interphase nuclei (nucleoli, heterochromatinous blocks of nucleolus-forming chromosomes) confirms the photometrical evidence on the trends of chromosome fragmentation into genes. The fragmentation of the giant nucleus is preceded by a complex rearrangement of genetical material in the original nucleus, resulting in becoming polygenomal from polytene, with individual genomes separating to be segregated again, during division.


[Sorption of neutral red by actomyosin threads during contraction and heating].

Studies of the equilibrium distribution of the cation dye-neutral red by actomyosin threads allowed to establish the fact that different concentrations of dye reveal the existence of different bonds with contractile proteins. Firm bonds (7.3 ccal/M) are discovered at low dye concentrations, and weaker bonds (4.5 ccal/M) are seen at higher concentrations. The contraction of actomyosin threads evoked by ATP or heating is accompanied with similar changes, i. e. by the diminishing of the maximum dye sorption within the range of low dye concentrations and by the increase in the maximum dye sorption within the range of high concentrations.