Inhibition by ethambutol of mycolic acid transfer into the cell wall of Mycobacterium smegmatis.

Ethambutol simultaneously inhibited the transfer (presumably via mycolyl acetyl trehalose) of mycolic acids into the cell wall and stimulated the synthesis of trehalose dimycolates of Mycobacterium smegmatis. Structural similarities of the drug and mycolyl acetyl trehalose suggested that competitive inhibition was involved.


Toxicity of parasporal crystals of Bacillus thuringiensis to the Indian meal moth, Plodia interpunctella.

Toxicity of Bacillus thuringiensis parasporal crystals to the Indian meal moth, Plodia interpunctella, is described. The numbers of insects killed were in relation to crystal dry weight. Mortality was determined by comparing adult emergence in diets treated with crystals to emergence in untreated diets. There was only a 30% survival at an application of 0.414 microgram/cm2, and the mean 50% lethal concentration value was found to be 0.299 microgram/cm2. The use of emergence data has provided a reliable and reproducible bioassay for comparing relative toxicities of crystals, spores, and other cellular components to this economically important insect.


Isolation and characterization of a bacteriophage specific for Sphaerotilus natans which contain an unusual base in its deoxyribonucleic acid.

A bacteriophage was isolated specific for Sphaerotilus natans, an organism for which bacteriophages have not been previously described. This phage (designated SN1) was found to infect both the single-cell (S-type) and filamentous (R-type) forms of the host, although the sheath appeared to provide R-type cells with a degree of physical protection from infection. SN1 had a hexagonal head and a long flexible tail resembling most closely the phages in Bradley's group B. The nucleic acid was found to be deoxyribonucleic acid and contained an unusual base which substituted for 35% of the guanine. Deoxyribonucleic acid base composition was 56% cytosine plus guanine.


Identification of the naturally occurring isomer of zearalenol produced by Fusarium roseum 'Gibbosum' in rice culture.

One diastereomer of trans-zearalenol [2,4-dihydroxy-6-(6,10-dihydroxy-trans-1-undecenyl)-benzoic acid-mu-lactone] was isolated from cultures of Fusarium roseum 'Gibbosum.' This strongly estrogenic metabolite was identified by analysis of its mass spectrum and its behavior in thin-layer, high-pressure liquid and gas-liquid chromatographic systems. The concentration of zearalenol in cultures was 563 mu g/g, or 7% of the 8,000-mu g/g zearalenone content, while the two diastereomers of 8'-hydroxyzearalenone each occurred at 3% of the zearalenone level. Of the two possible diastereomers of zearalenol, the one occurring in cultures was identical to the low-melting-point (171 degrees C) isomer (alpha) obtained by synthesis. In the rat uterus bioassay, the alpha zearalenol isomer was three times more estrogenic than zearalenone while the beta isomer was equal in activity in zearalenone. The two diastereomers of zearalenol can be distinguished from each other by the intensity of the m/e+ 302 fragment of the mass spectrum of the pure underivatized compound.


Multiple antibiotic resistance in Rhizobium japonicum.

A total of 48 strains of the soil bacterium Rhizobium japonicum were screened for their response to several widely used antibiotics. Over 60% of the strains were resistant to chloramphenicol, polymyxin B, and erythromycin, and 47% or more of the strains were resistant to neomycin and penicillin G, when tested by disk assay procedures. The most common grouping of resistances in strains was simultaneous resistance to tetracycline, penicillin G, neomycin, chloramphenicol, and streptomycin (25% of all strains tested). The occurrence of multiple drug resistance in a soil bacterium that is not a vertebrate pathogen suggests that chemotherapeutic use of antibiotics is not required for the development of multiple drug resistance.


Cyclitol utilization associated with the presence of Klebsielleae in botanical environments.

Bacteria of the tribe Klebsielleae are capable of metabolizing the cyclitols myoinositol, sequoyitol, and pinitol, which are present in aqueous extracts of redwood. Of the combined Klebsiella isolates from clinical and environmental origins, 100% (138/138), 97% (34/35), and 86% (119/138) fermented inositol, sequoyitol, and pinitol, respectively. These compounds were also used as a sole source of carbon and energy by Klebsiella. Similar results were obtained with Enterobacter isolates, but most other enteric bacteria tested could not metabolize cyclitols. Strains of Klebsiella multiplied to levels exceeding 10(5)/ml in aqueous extracts of nonsterile redwood within 6 days. Most other enteric bacteria did not grow in these extracts. Cyclitol metabolism was found to correlate well with the ability to multiply in redwood extract in the presence of cyclitol-negative indigenous bacteria. The capacity to use cyclitols, which are present in a variety of plant material, might afford Klebsielleae of both environmental and clinical origins an advantage in competing for nutrients and colonizing botanical environments.


Microbial metabolism of carbon monoxide in culture and in soil.

Nocardia salmonicolor readily oxidized CO to CO2. Slight activity was found among species of Actinoplanes, Agromyces, Microbispora, Mycobacterium, and other nocardias, and no oxidation was detected in the algae, fungi, and other bacteria tested. Carbon monoxide was oxidized rapidly to CO2 in the dark in two soils incubated in air or under flooded conditions, but little of the 14C from 14CO was incorporated into the organic fraction of these soils. The reaction was microbial because appreciable CO was not converted to CO2 in autoclaved or gamma-irradiated soil. Heating the soil for 25 min at 70 degrees C destroyed its CO-oxidizing activity. The incorporation of 14CO2 into the cells of microorganisms in soil and soil suspension was not enhanced by incubating the samples in the presence of CO, suggesting that CO oxidation was not the result of autotrophic metabolism. The oxidation of 17 mu 1 of CO per liter in the head space was nearly complete in 6 h in soil incubated in air or anaerobically.


Dichloran-rose bengal medium for enumeration and isolation of molds from foods.

Overgrowth by spreading molds such as Rhizopus and Mucor species is a problem with fungal enumeration media used for foods. Thirty-one antifungal compounds were surveyed for their ability to selectively inhibit such fungi while allowing growth of mycotoxigenic molds and other species of significance in food spoilage. Dichloran (2,6 dichloro-4-nitroaniline) restricted growth of Rhizopus stolonifer while allowing satisfactory growth of the other test molds. Three Rhizopus and Mucor species were encountered that were not inhibited by dichloran; these were controlled by the addition of rose bengal. The optimal medium, designated DRBC, contained 2 micrograms of dichloran and 25 micrograms of rose bengal per ml. DRBC, in pure culture tests and with food samples, restricted the colony size of spreading molds and recovered a wider range of species in higher numbers than other enumeration media.


Resolution of Penicillium roqueforti toxin and eremofortins A, B, and C by high-performance liquid chromatography.

A method for the quantitative analysis of Penicillium roqueforti toxin using a high-performance liquid chromatography system is proposed.


L-Glutamine formation by Flavobacterium rigense.

A penicillin-resistant mutant of Flavobacterium rigense designated as strain 703, FERM-P no. 3628, was obtained after ultraviolet treatment of F. rigense FERM-P no. 3556. The parent strain produces 0-2-hydroxypropylhomoserine from 1,2-propanediol. The mutant was found to be a good producer of L-glutamine. The physiological characteristics of strain 703 were different from the general group of L-glutamic acid-producing bacteria. Strain 703 required L-tryptophan and thiamine but not biotin for its growth. L-Glutamine formation on a specific basis, however, was independent of L-tryptophan and thiamine. Biotin and penicillin were also not effective. Only ammonium fumarate acted as an effective factor on L-glutamine formation. Accumulation of L-glutamine by strain 703 was 10 mg/ml at 30 degrees C for 48 h in a chemically defined medium containing 3% diammonium fumarate.


Bacterial formation of omega-muricholic acid in rats.

In the feces of conventional rats, the amount of omega-muricholic and hyodeoxycholic acids vary according to the diet. To understand this phenomenon, we investigated the bacterial formation of these bile acids. The present paper reports the first isolation, from conventional rat feces, of a strain of Clostridium group III which transforms beta-muricholic acid, the main bile acid in germfree rats, into omega-muricholic acid.


Comparison of the efficacy of steam sterilization indicators.

Twenty-one commercially available chemical steam sterilization indicators were processed in an empty autoclave for various times at temperatures between 240 and 270 degrees F (ca. 116 and 132 degrees C). The time required to reach a sterilized reading at each temperature was plotted on a semilogarithmic time-temperature plot and compared with the time-temperature sterilization curve for Bacillus stearothermophilus. Five of the indicators had time-temperature kinetics similar to those of B. stearothermophilus, but three of these overestimated the effect of processing. Two of the indicators overestimated the effect of processing and were less sensitive to temperature changes when was B. stearothermophilus. Thirteen of the indicators had time-temperature curves that crossed the B. stearothermophilus plot. One indicator produced such ambiguous results that no determinations could be made with it. Out of 21 indicators tested, only 2 appear to be capable of accurately integrating the time-temperature effect at temperatures between 240 and 270 degrees F. The other indicators should be used only after careful analysis of their suitability for use at a given temperature.


Heat inactivation of catalase from Staphylococcus aureus MF-31.

The effects of heat on catalase from Staphylococcus aureus lysates were examined. Catalase activity increased with increasing concentrations of potassium phosphate buffer, when heated at temperatures between 50 and 65 degrees C for 10 min. Inactivation of catalase by NaCl during heating was demonstrated. Extended heating of S. aureus cells at 52 degrees C resulted in a slight decrease in catalase activity of the resultant lysates. This decrease was more pronounced in the presence of salt. Heating at 62 degrees C caused a decrease in catalase activity, but not complete inactivation. These results implicate the combined effects of heat, and NaCl in the inactivation of catalase from S. aureus. The findings are consistent with the hypothesis that H2O2 may accumulate as a result of decreased catalase activity and be responsible for the decreased colony-forming ability of stressed S. aureus.


Colonization of a portion of the bovine tongue by unusual filamentous bacteria.

Tongue samples from cattle on varied diets and ranging in age from 2 months to adult were studied by transmission and scanning electron microscopy to observe the in situ distribution and adhesion patterns of two readily identifiable genera of filamentous bacterial. The two, both members of the Simonsiellaceae, adhere to the epithelium by means of fibers which are produced on one side of the bacterial filaments and subsequently display a sidedness in their manner of adhesion to epithelial surfaces. Other bacterial populations found on the tongue were normally members of chains and seldom present as single cells. This suggests that filamentous or chain-forming bacteria may have a selective advantage over single bacteria in their ability to colonize and remain attached to the epithelium of the tongue.


Membrane filter procedure for enumeration of Aeromonas hydrophila in fresh waters.

A membrane filter method (mA) for the enumeration of Aeromonas hydrophila in natural water samples was developed. The complex, primary medium employs trehalose as a fermentable carbohydrate and ampicillin and ethanol as selective inhibitors. After 20 h of incubation at 37 degrees C, an in situ mannitol fermentation test followed by an in situ oxidase test is used to further differentiate A. hydrophila from other aquatic and terrestrial microorganisms present in freshwaters. The primary medium decreases background microbial growth by about two orders of magnitude. The recoveries on mA medium from suspensions of A. hydrophila prepared from pure cultures and held for 24 h at 15 degrees C exceeded 95% of the recoveries on brain-heart infusion agar spread plates. The confirmation rate for colonies designated A. hydrophila was 98%, whereas 11% of the presumptively negative colonies were, in fact, A. hydrophila. Recoveries of A. hydrophila from fresh, surface water samples exceeded recoveries by the other methods examined.


Protein-to-wet weight relationships in supragingival plaques from caries-prone tooth surfaces.

The ratio of protein to wet weight in unpooled samples of supragingival plaques from sound and carious tooth surfaces was studied. Protein was assayed by a procedure developed for the study, in order to achieve a sensitivity of 1 microgram with minimum effects upon quantitation from protein composition and nonprotein components. Ratios of protein to wet weight in plaque specimens from caries-free surfaces were almost equally distributed into two main categories of 9.4% and 6.5%. Corresponding values for specimens from carious surfaces were 9.1% and 5.0%. The occurrence of high and of low values among samples from each type of surface indicated that the plaques differed quantitatively in protein, water, or a nonprotein component, possibly extracellular polysaccharide. Although compositional differences between plaques from the two types of surfaces were indicated by the lower ratios of 6.5% from noncarious and 5.0% from carious surfaces, they were not indicated by the higher ratio values, which were similar. These results suggest either that protein-to-wet weight ratios are not related to caries, or that the ratio values are related to caries for some but not all types of plaques.


Purification of an Endogenous polynucleotide phosphorylase from Brevibacterium JM98A.

Polynucleotide phosphorylase was purified form Brevibacterium JM98A (ATCC 29895). Homopolynucleotides were arsenolysed in the order polyadenylate greater than polycytidylic acid greater than polyuridylic acid greater than polyguanylate. The products were ribonucleoside 5'-monophosphates.


Modified lysine iron agar for isolation of Salmonella from food.

Lysine iron agar, modified by the addition of bile salts, novobiocin, lactose, and sucrose, is a valuable plating medium for the isolation of Salmonella, including H2S-negative strains.


Distribution of Aeromonas hydrophila in natural and man-made thermal effluents.

Densities of Aeromonas hydrophila showed distinct thermal optima (25 to 35 degrees C) and thermal maxima (45 degrees C) when measured along thermal gradients created by geothermal and nuclear reactor effluents. Survival of A. hydrophila never exceeded 48 h at temperatures of greater than 45 degrees C. Thermophilic strains could not be isolated at any site.


Exohemagglutinins: new products of vibrios.

A number of vibrio strains isolated from marine water produced high units of phytohemagglutinin-like agglutinins. Sugar specificity of the hemagglutinins was different from that of the sugar-binding bacterial toxins and that of the sugar-binding pili on the bacterial cell surfaces.


Xylose, arabinose, and rhamnose fermentation by Bacteroides ruminicola.

Metabolism and growth yields of Bacteroides ruminicola grown on d-xylose, l-arabinose, and l-rhamnose were studied. Growth yields were 62, 68, and 35.5 g (dry weight) per mol of carbohydrate fermented after correction for storage polysaccharide. Experiments with [1-(14)C]arabinose indicated that pentose was fermented by a pentose phosphate cycle plus glycolysis, with some indication of a minor phosphoketolase-type pathway. The product ratios from pentose were similar to those previously described for hexose. Rhamnose was fermented mainly to 1,2-propanediol, succinate, and acetate, although the latter was quantitatively less than expected. Estimates of adenosine 5'-triphosphate (ATP) molar growth yields could not be calculated with any certainty, as ATP generation by electron transport-linked phosphorylation cannot yet be assessed. If ATP were generated by substrate-level phosphorylation reactions alone, ATP molar growth yields for xylose, arabinose, and rhamnose would be 30, 28, and 35 g/mol. If calculations are based on an assumption that two ATP are generated by electron transport-linked phosphorylation per succinate, ATP molar growth yields become 15, 14, and 22 g/mol; if the assumption is also made that the pathway of lactaldehyde reduction is coupled to production of one ATP per 1,2-propanediol by electron transport-linked phosphorylation, the ATP molar growth yield for rhamnose fermentation becomes 14 g/mol. No preference can be expressed between these alternatives at present.


Elevated heparin-precipitable fraction of plasma in granuloma annulare.

The levels of heparin-precipitable fraction of plasma were determined in 17 patients with granuloma annulare and 26 persons used as controls. The mean level in patients was greater than the mean level in persons used as controls (P LESS THAN .05). Patients with widespread, disseminated lesions tended to have higher levels than patients with more localized disease (P LESS THAN .15). New lesions were actively forming in two patients with widespread disease at the time of study, and levels of heparin-precipitable fraction in these patients were among the highest found. The significance of these findings and their relationship to the etiopathogenesis of granuloma annulare is speculative.


Comparison of crude coal tar and topical methoxsalen in treatment of psoriasis.

Fluorescent sunlamp bulbs have been an effective light source for treatment of psoriasis when they are used in combination with crude coal tar. In addition to their ultraviolet B (UVB) emission, the spectral output of these bulbs contains a substantial amount of ultraviolet A (UVA). Prior testing with this light source and topically applied methoxsalen achieved excellent results in psoriasis. This study compared topically applied methoxsalen to crude coal tar in 16 patients who had plaque-type psoriasis, using the same fluorescent sunlamp source of irradiation. Fourteen of 16 patients had complete clearing of plaques when they were treated with methoxsalen, compared with six patients who had complete clearing with the tar treatment. These results indicate that the use of methoxsalen and ultraviolet light may be more effective than tar, when used as they were in this study. The advantages of a clean, white, nonstaining topical agent also makes outpatient therapy more cosmetically acceptable.


Evans blue dermatitis.

Contact dermatitis developed in five patients due to Evans blue, an azo-type dye used ot outline the lymphatics prior to the injection of a contrast medium in performing lymphangiography. A pathophysiologic mechanism for the development of dermatitis due to Evans blue is proposed.


Combination therapy for psoriasis. Psoralens plus long-wave ultraviolet radiation with betamethasone valerate.

In the treatment of psoriatic patients with psoralens plus long-wave ultraviolet radiation (PUVA), clearing of psoriatic lesions was obtained more quickly and with smaller doses of ultraviolet light when topically applied corticosteroid therapy was added. Twelve patients with symmetrical plaque-type psoriasis were given PUVA on one side of the body and PUVA plus betamethasone valerate on the other side in a paired comparison study. Ten of the patients had faster clearing of lesions on the side that was treated with PUVA and betamethasone than on the side treated with PUVA alone. The other two patients had equal clearing on both sides. All patients remained clear of lesions during maintenance with PUVA alone for at least five months after steroid therapy was discontinued. Combination therapy may save the patient time, expense, and unnecessary exposure to radiant energy.


Actinic reticuloid. A clinical, pathologic, and action spectrum study.

A 54-year-old man suffered from a chronic dermatitis that was more severe on light-exposed areas. Skin biopsy specimens revealed histopathologic findings consistent with those seen in mycosis fungoides. Ultrastructural studies demonstrated the existence of lymphoid cells with hyperconvoluted nuclei, typical of the mycosis fungoides cell or Sézary cell, within the epidermis, dermis, and peripheral blood. Light testing with a monochromator showed abnormal photosensitivity to both short- and long-wave ultraviolet light as well as to the violet, blue, and green wavelengths of visible light. The features of this patient's disease indicate actinic reticuloid.


Median raphe cysts of the penis.

The occurrence of a ventral cystic lesion of the penis should alert the clinician to the diagnosis of a median raphe cyst. The lesions, which are most common near the glans penis, may occur anywhere from the urethral meatus to the anus. Cysts of the median raphe represent defects in the embryologic development of the genitalia and are usually lined by entodermal epithelium. Surgical excision is the treatment of choice.


Pigmented lesion following complete removal of melanoma.

A pigmented lesion developed in three patients in the center of the scar following excision and grafting to remove melanoma. Histologically, the lesions showed hyperplasia of melanocytes resembling junction nevus or lentigo maligna. Some site-specific factor seems to be responsible for this change.


Nodular nonsuppurative panniculitis associated with jejunoileal bypass surgery.

A 32-year-old woman underwent jejunoileal bypass surgery for morbid obesity. Her postoperative course was marked with many of the complications of this type of surgery. In addition, tender, erythematous nodules developed on her legs and abdomen that were grossly and microscopically consistent with nodular nonsuppurative panniculitis. She did not have any condition or disease previously reported to be associated with nodular nonsuppurative inflammation. The nodular panniculitis in this patient appears to be a new complication of small-bowel bypass surgery.


Cutaneous manifestations of tumoral calcinosis.

We have followed up a large family in which seven members have tumoral calcinosis. One girl had the skin lesions of localized calcinosis cutis apart from the typical subcutaneous deposits of calcium. Like most persons with tumoral calcinosis, our patient had normal serum calcium concentrations; however, the serum phosphorus levels were greatly elevated. The familial occurrence and elevated serum phosphorus levels suggest the possibility of some as yet undefined, heritable metabolic defect as the underlying cause. The occurrence of tumoral calcinosis with localized calcinosis cutis is a rare association, and there has been only one other reported case to our knowledge. This report describes our patient and offers a brief discussion of tumoral calcinosis. The therapeutic response to the phosphate depletion regimen and topical steroids was disappointing in our case.


Mycoplasma pneuminia infection. A follow-up study of 50 children with respiratory illness.

Fifty children with a previous history of Mycoplasma pneumoniae respiratory tract infection were assessed clinically, and pulmonary function tests carried out after an interval ranging from 1 1/2 to 9 1/2 years (median 2 1/2). 23 suffered from recurrent wheezy bronchitis or asthma, and in 5 the index illness appeared to precipitate the wheezing tendency. All were symptom-free when respiratory function tests were performed. Simple tests of ventilatory function (PEFR, FEV, and FVC) were within normal limits. Increased bronchial reactivity after exercise (a fall in PEFR greater than 15% resting value) was demonstrated only in children known to have asthma. Maximum expiratory flow rates in air at 50% of vital capacity (V mas50) were within the normal range in all patients with the exception of two. The response in flow rate at 50% of vital capacity after inalation of an 80% helium and 20% oxygen mixture delta V max50) was reduced (P less than 0.001) in asymptomatic patients with a history of M. pneumoniae respiratory infection, when compared with normal data from 48 healthy schoolchildren without a background of significant respiratory illnesses. These findings indicate impairment of small airways function, even in totally symptom-free children in the study group.


Effects of physical training on hormonal responses to exercise in asthmatic children.

A 4-month period of physical training increased the physical working capacity of 16 asthmatic children (aged between 9.3 and 13.6 years) by a mean of 11%. The increase was greater in boys and was negatively correlated with pretraining capacity. Urinary excretion of adrenaline, measured during a submaximal exercise test, decreased during the training period; the decrease was correlated with the increase in working capacity. Be fore the training period, exercise induced an increase in the plasma cortisol level; no increase was evident after training. In contrast, the training did not affect the exercise-induced increase in the plasma growth hormone level.


Dublin-Johnson syndrome with some unusual features in a Chinese family.

Three cases of chronic nonhaemolytic jaundice with conjugated bilirubin in the serum are described in a Chinese family. Bromsulphthalein excretion tests gave results typical of the Dubin-Johnson syndrome. Liver histology in the proband showed cytoplasmic pigment of the lipofuscinmelanin variety, and intravenous cholecystography failed to show visualisation of the gallbladder. Unusual findings included onset during the neonatal period in the proband and the presence of some iron pigment in the hepatic cells with a little canalicular cholestasis. It is suggested that the infant may have had a concomitant nonspecific hepatitis. These cases are regarded as belonging to a disease group in which the Dubin-Johnson syndrome is at one end of a spectrum. The mode of inheritance is discussed.


Carrier detection in Duchenne muscular dystrophy. Evidence from a study of obligatory carriers and mothers of isolated cases.

The mean levels of serum creatinine phosphokinase (CPK) were studied in three groups of women: normal controls (57), obligate carriers for Duchenne muscular dystrophy (30), and mothers of isolated cases of this disease (35). The distribution of the levels in these groups was significantly different and was in keeping with the hypothesis that one-third of isolated cases result from new mutations. The control and carrier ranges overlapped considerably, with the level of CPK of 33% of obligate carriers coming within the 97 1/2 centile of the normal range. Odds against an individual being a carrier were derived for specific mean values of CPK. They should be considered with genetic information using Bayes's theorem. The mean CPK levels in obligate carriers showed significant familial clustering. This may have implications in carrier detection.


Serum C-reactive protein test in diagnosis of septic complications of cerebrospinal fluid shunts for hydrocephalus.

Serial tests for serum C-reactive protein (CRP) were carried out on 40 children undergoing cerebrospinal fluid shunt surgery, to determine the pattern of appearance and disappearance of CRP in relation to this type of operation, in the absence of postoperative complications. Samples of sera from a further 268 children, 79 of whom presented after shunt surgery with symptoms suggesting infective complications related to the shunt, were examined for CRP. The results showed that, while the test in negative in uncomplicated colonisation of ventriculo-atrial shunts, it is reliably positive in patients with colonised ventriculo-peritoneal shunts, ventriculitis, or shunt nephritis.


Two cases of perinatal listeriosis.

Two cases of neonatal listeriosis are described. The incidence in the UK is given and the treatment of the pregnant woman is briefly discussed.


Water intoxication by the oral route in an infant.

Symptomatic water intoxication is common when hypo-osmolar fluids are given therapeutically, usually intravenously, but it is rare after drinking voluntarily (Wynn and Rob, 1954). We report a case of water intoxication caused by voluntary drinking in an infant.


Copper deficiency in a low birthweight infant.

Copper deficiency is reported in an infant of very low birthweight. It was characterised by extensive bone changes, severe neutropenia, and hypocupraemia. These manifestations could have been missed but for an intercurrent pneumonia which led to an x-ray of the chest.


Pulmonary candidiasis in cystic fibrosis.

A child with cystic fibrosis and asthma developed pulmonary candidiasis. Predisposing factors in this patient were prolonged antibiotic therapy, high-dose corticosteroids, and intravenous catherisation. A diagnosis was made by lung puncture and confirmed by rapid response to 5-fluorocytosine.


Neonatal aspergillosis accompanying fulminant necrotising enterocolitis.

A preterm infant developed fulminant necrotising enterocolitis, subsequently resulting in death. Necropsy examination showed diffuse aspergillosis. Reports are reviewed, and possible mechanisms resulting in Aspergillus infection in this infant are discussed.


Toxicity of the herbicides 2,4-D, DEF, propanil and trifluralin to the Dungeness crab, Cancer magister.

Lethal and sublethal responses to the herbicides 2,4-D, DEF, propanil, and trifluralin of various life history stages of the Dungeness crab, Cancer magister, were examined to estimate maximum acceptable toxicant concentrations (MATC) of each compound for this species. Zoeae were found, in long term tests, to be the most sensitive stage. Based on the experiments with this stage, MATCs were concluded to be greater than 0.95, less than 6.9 microgram/L for DEF, greater than or equal to 26, less than 220 microgram/L for trifluralin, greater than or equal to 1,700 microgram/L for propanil, and less than 1,000 microgram/L for the free acid form of 2,4-D.


Studies on the effect of dimecron on the digestive system of a fresh water fish, Channa punctatus.

The effect of exposure to a sublethal concentration (0.32 mg/L) of Dimecron for 20 days on the digestive system of a fresh water teleost fish, Channa punctatus has been studied. The most conspicuous pathological changes in the liver were vacuolation of the cytoplasm of hepatocytes, enlargement of nuclei, rupture of the cell membrane, liver cord disarray, damage of connective tissue, infiltration of phagocytes and necrosis. The mucosa of stomach was ruptured and the gastric glands were degenerated. The mucosal epithelium of intestine and pyloric caeca was also degenerated. The mucus secreting goblet cells showed hyperactivity and the intestinal lumen was filled with mucus. No conspicuous changes were noted in the rectum except for hypersecretion of mucus. Histochemical tests revealed that alkaline phosphatase and glucose-6-phosphatase were inhibited by Dimecron treatment. However, acid phosphatase showed slight increase in activity. Biochemical tests for enzyme activity confirmed the histochemical findings. Alkaline phosphatase activity was significantly inhibited in liver and intestine. There was a slight elevation in the activity of acid phosphatase in the liver and pyloric caeca of exposed fish, but this was not statistically significant. The glucose-6-phosphatase activity was significantly inhibited in the liver, intestine and pyloric caeca.


Absorption and elimination of 14C-cis-chlordane and 14C-photo-cis-chlordane by goldfish Caraccius auratus.

Photo-cis-chlordane is accumulated by goldfish to a greater extent than cis-chlordane during a 16-hr exposure to 5 parts per billion (ppb) of each insecticide. However, the concentration of photo-cis-chlordane in vital organs (brain, nervous system, heart, liver, kidneys) during the 1-, 2-, and 4-day exposure is less than that of cis-chlordane. Only the swim bladder shows a much higher concentration of photo-cis-chlordane than cis-chlordane. These differences could hardly account for twice the higher toxicity of the former to goldfish. The transfer of pre-exposed fish to insecticide-free water resulted in faster elimination of photo-cis-chlordane than cis-chlordane; after five weeks, about 90% of the former was eliminated as compared with only 58% of the latter. High residues of both insecticides in the bile and the intestine during the initial period of exposure indicate a biliary route of elimination.


Effects of inorganic lead on delta-aminolevulinic acid dehydratase activity and hematological variables in the rainbow trout, Salmo gairdnerii.

The activity of the enzyme delta-aminolevulinic acid dehydratase (ALA-D) was strongly depressed in erythrocytes, spleen and renal tissue of rainbow trouts (Salmo gairdnerii) exposed to sublethal levels of inorganic lead (10, 75 and 300 microgram Pb2+/L) for 30 days. The fish exposed to the highest lead concentration also showed an anemic response and basophilic stippling of erythrocytes. The lead exposure did not cause any alteration of the white blood cell picture. The ALA-D inhibition, the anemia and basophilic stippling seemed to persist in the lead-exposed fish even after a recovery period of seven weeks in lead-free water.


Exposure of field workers to organophosphorus insecticides: cotton.

The red blood cell and plasma cholinesterase (ChE) levels of cotton scouts inspecting foliage for insect infestation and damage were monitored. Group means for ChE activity were significantly depressed at one or more time(s) during four of the eight growing seasons studied. Although no symptoms of organophosphate poisoning were confirmed, several scouts exhibited ChE depressions over 50% of pre-exposure levels.


Chlorinated phenoxyacetic acid derivatives and tetrachlorodibenzo-p-dioxin in foliage after application of 2,4,5-trichlorophenoxyacetic acid esters.

Six reforestation areas were sprayed with 2,4,5-T esters. Leaf samples from the areas were analyzed for the esters, tetrachlorodioxin, and dehalogenated phenoxyacetic acid esters. Tetrachlorodioxin was found in one leaf sample only, but the level found, relative to the amount of 2,4,5-T ester found, was lower than in the formulation material used in the study. The concentration of the dichlorophenoxyacetic acid esters present in several leaf samples was greater, relative to the 2,4,5-T ester, which indicated a photochemical breakdown of the 2,4,5-T in the environment.


Effects of chronic cadmium exposure on crayfish survival, growth, and tolerance to elevated temperatures.

Crayfish Cambarus latimanus were subjected over a 5-month period to 0.02, 5, and 10 microgram Cd/L in a continuous flow system at ambient winter temperatures. Uptake of cadmium, growth, and mortality were measured. One-half of the surviving crayfish were analyzed for Cd after completion of the 5-month experiment, while the remaining half were removed from the contaminated water and subjected in a static laboratory experiment to stepwise, daily increases in temperature. The results indicated that (1) the rate of Cd uptake in crayfish was positively related to external concentration, (2) mortality increased significantly with higher Cd concentrations, and (3) neither growth nor thermal tolerance was significantly related to the Cd concentration in the crayfish tissues. The importance of chronic, low-level studies is discussed.


Reproductive responses of quail to bunker C oil fractions.

Bunker C fuel oil was extracted with petroleum ether and the concentrated extract was given to breeding Japanese quail (Coturnix coturnix Japonica). A dose of extract equivalent to 300 mg bunker C reduced both egg production and hatchability. Fractionation of the extract by absorption on Florisil and elution with petroleum ether followed by chloroform yielded fractions that were tested for toxicity. All the fractions had a pronounced effect upon production; however, only the chloroform eluates were found to affect hatchability of the eggs.


Developmental and methylmercury effects on brain protein synthesis.

Sprague-Dawley rats (ages 1 to 21 days, alternate days) were chosen for study. Animals were injected with methylmercuric chloride (8 mg/kg IP); 12 hr later each animal was injected with uniformly labeled L-(14C)leucine, allowed 30 min for incorporation, and decapitated. Brains were analyzed for amounts of radioactivity incorporated into TCA precipitable protein. When compared to baseline curves for control animals, curves of treated animals were compressed overall and had age-dependent increases and decreases in rates of protein synthesis.


Gel and anion exchange chromatographic properties of copper-containing metallothioneins.

Chromatographic properties of copper-binding proteins (copper-containing metallothioneins) induced in rat liver and kidney by the injection of either copper in the liver and kidney or cadmium in the kidney were compared with those of metallothioneins, with low or no copper content, induced by the injection of cadmium or zinc in the liver both on a Sephadex G-75 column and on a DEAE Sephadex A-25 column. The copper-containing metallothioneins were eluted at a slightly slower rate on a Sephadex G-75 column and at a higher buffer concentration on an anion exchange column than the metallothioneins with low or no copper content regardless of the inducing metals, copper or cadmium. The different chromatographic properties of the metallothioneins with high and low copper contents may be explained by the more compact conformation of the proteins with high copper contents than those with low or no copper contents and by the changes of electrostatic charge with coordination by copper.


Studies on the development of cell contacts and of the intercellular matrix during decidualization in the rat.

Cell contacts between developing decidual cells were examined in thin sections and in replicas of freeze-cleaved tissue of rat uterus. At the time of implantation only puncta adhaerentia were found between stromal cells. Gap junctions appeared 24 h after decidualization and thereafter increased in number and extent. Thus, there is little morphological evidence for a propagation of the initial stimulus for decidualization via gap junctions. An increase in amorphous, extracellular material is noted after decidualization with a concomitant decrease of collagen fibers. This amorphous material probably represents fibrinoid.


Pregnancy in a patient with Raynaud's disease.

We report a patient who, at the time of her third pregnancy at the age of 35, had had Raynaud's disease for 18 years. Her first pregnancy (during which she took Marcumar, an anticoagulant) ended in a miscarriage at three months gestation. The second pregnancy ended in fetal death due to placental insufficiency. The third pregnancy was also complicated by placental insufficiency which became evident during the second trimester. The patient was observed carefully and allowed to continue to 37 weeks gestation when a Caesarean section was done for late fetal heart rate decelerations during early labour of spontaneous onset. The baby had a low birth weight but developed normally. The placenta showed certain abnormalities which are described.


[Isolation and characterization of a new placenta specific protein (PP10) (author's transl)].

PP10 was isolated from aqueous extracts of human term placentae by fractionating the proteins with rivanol and ammonium sulfate, by gelfiltration on Sephadex G-150 and by use of immunoadsorbents. PP10 apparently is a protein specific for the placenta; it could not be detected in extracts from other human tissues. From one human term placenta an average amount of 20 mg PP10 can be extracted. In sera from pregnant women PP10 is usually present only in trace amounts (less than 0.1 mg/100 ml). PP10 has the electrophoretic mobility of an alpha1-globulin and an isoelectric point of 5.1. The purified protein sediments with 3.8 S. PP10 was found to have a molecular weight of 48,000 as determined by ultracentrifugation and a molecular weight of 65,000 as determined by SDS-PAA gel electrophoresis. PP10 is a glycoprotein containing 6.65% carbohydrates (hexoses 4.8%, hexosamines 1.2%, fucose 0.05%, sialic acid 0.6%). The amino acid composition of PP10 has been determined, too; the most abundant amino acids in this protein are glutamic acid, aspartic acid, leucine and alanine.


IgG levels in maternal and umbilical cord serum after vaginal delivery and after elective Caesarean section.

Concentrations of IgG is maternal serum and in umbilical cord blood were determined in two groups of patients: one group had spontaneous vaginal deliveries and the other elective Caesarean sections. Mean umbilical cord serum IgG after vaginal delivery was significantly higher than the mean value after elective Caesarean section. The difference between the maternal serum IgG livel and the umbilical cord serum IgG level increased as did the duration of labour.


Trial of the calcium antagonist nifedipine in the treatment of primary dysmenorrhoea.

The effect of the calcium antagonist, nifedipine, on menstrual pain was investigated in 40 women with severe, primary dysmenorrhoea and 36 of them were observed over 3 consecutive menstrual cycles. Twenty-six patients experienced good pain relief, 10 moderate relief and 4 reported no benefit. The frequency of symptoms associated with menstrual pain was not reduced. Fifteen women regularly suffering from migraine during the menstrual period reported increased headache after intake of the drug. Due to this side effect four of these patients did not continue treatment for more than one cycle. All patients had transient facial flushing occurring 15--30 min after drug intake; this was well tolerated. An increase in pulse rate was also invariably found. However, only 5 patients complained of palpitations. Twenty-five of the 36 women completing the three-month trial wanted to continue nifedipine therapy regularly. It is concluded that calcium antagonists like nifedipine can be used for treatment of severe primary dysmenorrhoea, and that further evaluations of these drugs are indicated.


Morphologic survey of the condylomatous lesions in dysplastic and neoplastic epithelium of the uterine cervix.

One hundred eighty-four women with a histologically verified dysplastic or neoplastic lesion in the uterine cervical epithelium were histologically assessed with special reference to the presence of the various histological types of condyloma in these epithelial specimens. Histological changes fulfilling the previously outlined criteria of the flat, inverted, and papillomatous condylomas were encountered in 91 (49.4%) women. Condylomatous lesions were seen in association with all degrees of epithelial atypia from mild dysplasia to frankly invasive cervical carcinoma, which seemed to develop at significantly earlier age when concomitant condylomatous lesion was present than with its absence (p less than 0.001). The serious consideration of the relationship between the condylomatous lesions and the uterine cervical was emphasized.


Factor XIII levels in relation to gynaecological operations.

In 25 patients with vaginal hysterectomies and 14 with abdominal hysterectomies, Factor XIII activity in the antiseruminhibition test of Bohn and Haupt was measured in the first 7 postoperative days. Both groups showed a statistically significant reduction in activity (40--50%) which started at 2 h after operation and lasted until the 3rd postoperative day. The route of operation did not significantly affect the results and neither did the phase of the cycle nor the age of the patient.


The use of prostaglandin gel in obstetrics and gynecology.

The use of prostaglandin gel for therapeutic termination of second trimester pregnancy, the management of intrauterine fetal death, ripening of the cervix and induction of labour is reviewed. For these indications, prostaglandin gel is acceptable to patients, effective, and has low incidence of side effects and complications.


Limits of therapy for malignant chorioepithelioma.

Report on two cases of malignant chorio-epithelioma following hydatidiform mole, both decreased 4 years after inception of the disease despite initially successful therapy and repeated remissions. In the first case a solitary pulmonary metastasis showing obvious de-differentiation and extensive local reparative processes was removed operatively. Associations to cytostatic medication are discussed. The second case was characterized by unusually extensive chronic pulmonary embolism with highly regressive choriocardinomatous aggregates. Death resulted unexpectedly from chronic dextrocardial insufficiency. It is stressed that the treatment is subject ot limitations of not only relative (i.e., resistance to cytostatics, inadequate treatment etc.) but also of an absolute nature, as in case 2.


Sexual differentiation of the hypothalamus in gonadal agenesis and testicular feminization.

Cyclical hypothalamic function was investigated in three patients with an XY karyotype and female external genitalia; in one of them we diagnosed gonadal agenesis, and in the other two testicular feminization. We studied the effect of estradiol and progesterone on gonadotropin release. The patient with gonadal agenesis had cyclical hypothalamic function, but this cyclical function was suppressed in the patients with testicular feminization in whom no LH secretion could be provoked by steroid stimulation. These observations support the concept that hypothalamic sexual differentiation is due to testosterone (which is locally converted to estradiol in the hypothalamus).


[Ultrastructure of the secretory cells of the bovine prostatic gland: a possible secretion mechanism].

An ultrastructural study of the secretory cells of the Bovine Diseminated Prostatic Gland has been carried out. The main features of the glandular epithelium are described. The suggested mechanism of secretion is compared with those studied in other mammals. The proposed mechanism involves the formation of primary and secondary protrusions and accompanying isolating membrane systems. This process can be visualized in three different ultrastructural phases.


[Seminal infection and male sterility].

A study is made of 25 patients suffering from a vesicular prostate pathology causing sterility. We have assessed the age, profession, symptoms, genital exploration and ejaculation study including the amount, pH, visocity, fructose, ascorbic acid, count, motility and morphology of the sperms and the high leukocyte reading. A seminal liquid culture has been carried out on 21 patients, alone or in association with cultures of prostate and urine secretion following prostate massaging with positive results in 16 of them (76%). Treatment was begun on 22 patients, in 13 of whom the results are known. Spermiogram readings became normal in 5 (38%) with one pregnancy; there was an associated pathology in the wife in 3 cases. As antibacterians we have basically used trimetoprim-sulphametoxazol associated with erythromycin or not and sometimes, according to the antibogram, with other antibiotics, as well as drugs to clear the prostate area. The best results were obtained in astenozoospermias. The effectiveness of the treatment was equally due to the use of TMP-SMZ on its own or along with erythromycin. The other drugs have not improved the results, except for minocyclin which megativated a sperm culture. As a preliminary result the author presented three patients with sperm infection produced by E. coli at whom the titer of antibodies in serum was investigated.


[Traumatic sectioning of the isthmus in a case of renal fusion].

In this paper, we present a case of traumatic sectioning of the isthmus in a patient with multiple injuries, suffering from a horse-shoe-shaped kidney, which is extremely rare, according to the review of the literature which we have carried out. In view of the scanty incidence of kidney fusions and the difficulty sometimes involved in classifying them and in their surgical treatment, we shortly comment on the consequences which traumatisms may have on this kind of kidney malformation.


[Postraumatic thrombosis of the renal artery].

We present two cases of thromboses of the left renal artery out of a total of 74 kidney traumatisms observed up to 1978. In one of them, accompanied by arterial hypertension, the tension readings returned to normal after a nephrectomy. Following a review of the literature, in which we observe the infrequency of this pathology (38 cases compiled by R. Fay and S. Brosman up to 1974), we comment upon the etiopathogeny, clinical characteristics, specific radiological signs and other means of exploration which enable the diagnosis to be reached. We point out the importance of an early diagnosis and the conservative and radical forms of surgery.


[Urodynamics in female stress urinary incontinence].

Urodynamic studies are essential in order to rule out the existence of vesical instabilities. In our opinion, the urethral outlines are not always revealing and demand, apart from a highly planned technique, a critical and prudent assessment of the results.


[Evaluation of ultrasonics in extensive kidney processes. Study of 200 cases].

The author carries out a sonographic study on 200 expansive kidney processes, in which he assess the possibilities of this method of diagnosis at the same time offering the echographic semiology of the different disorders being studied. Finally, he explains the limitations and drawbacks of this technique.


Directed migration of circulating polymorphonuclear leucocytes in patients with rheumatoid arthritis: a defect in the plasma.

The migration of peripheral polymorphonuclear leucocytes (PMNs) of patients with rheumatoid arthritis has been studied both in vivo and in vitro. A significant reduction in the accumulation of PMNs in skin chambers in patients with rheumatoid arthritis compared to controls was observed but no defect in cell movement was detected when the isolated PMNs from the patients were exposed to activated control plasma. However, when PMNs from the control group were tested against activated plasma from patients with rheumatoid arthritis there was a significant decrease in their chemotactic response. It is proposed that there is a humoral defect in the plasma of the patients.


[Sisomicin sulfate: its efficacy in the treatment of urologic infections].

The authors explain the good results (80%) obtained with a new antibiotic belonging to the aminoglucoside group, the Sisomycin sulphate. Due to its active kidney excretion, its beneficial bactericide effect on Gram-positive and negative germs and its excellent tolerance, the author advises its use in infectious urological pathologies.


Abnormal polymorphonuclear leucocyte chemotaxis in Behçet's syndrome.

Experiments both in vitro and in vivo have been performed to study the chemotactic response of polymorphonuclear leucocytes (PMNs) in Behçet's syndrome. The experimental results were apparently contradictory. Using modified Boyden chambers we found that the PMNs from patients with Behçet's syndrome responded to a greater extent in vitro than normal cells, but with skin chambers placed over abrasions the in vivo response was less than normal. The significance of these findings is discussed and related to the histological appearances that may be seen in this condition.


Airways obstruction in rheumatoid arthritis.

Owing to the report of an association between rheumatoid arthritis (RA) and obliterative bronchiolitis we have determined the prevalence of airflow obstruction in unselected patients with RA and normal chest radiographs. Spirometry was performed on 100 patients with rheumatoid arthritis and 84 control subjects matched for age, sex, and smoking habits. Patients with rheumatoid arthritis had significantly lower values for FEV1, FVC, FEV1/FVC, and MMEFR when compared with the controls: 39 patients had abnormal spirometry, and at least 32 showed airways obstruction. The prevalence of airflow obstruction is remarkably high, and we suggest that airway disease may be the commonest form of lung involvement in rheumatoid arthritis.


The nail dystrophy of psoriatic arthritis.

Nail abnormalities occur frequently in patients with psoriatic arthritis. This study of the finger nails of 46 patients with psoriatic arthritis, 100 nonpsoriatic rheumatism patients, and 100 nonpsoriatic general medical patients was designed to characterise these abnormalities with particular reference to the severity of nail pitting. The results of the study suggest: (1) Onycholysis alone in the absence of previous injury to the affected nail is in favour of a psoriatic origin for the nail dystrophy. (2) Two or all of onycholysis, horizontal ridging, and nail pitting in the same patient are in favour of a psoriatic origin for the nail dystrophy. (3) The presence or absence of nail pitting alone is a poor discriminator between psoriatic and other causes for nail dystrophy. (4) More than 20 finger nails pits per person is suggestive of a psoriatic cause for the dystrophy. (5) More than 60 pits per person is unlikely to be found in the absence of psoriasis.


[Urine cultures and antibiograms].

A review is made of the urocultures and antibiograms carried out in a period of two months in the Urology Department of a General Hospital. A comparative study is made with the other bacteriological results sent to the laboratory from the different Departments. A study is made of the sensitivity of the isolated stocks to the most widely used antibiotics.


Resumption of treatment with penicillamine after proteinuria.

Penicillamine has been successfully reintroduced and continued for a minimum of 13 months in 5 patients who developed proteinuria during the first course of the drug. The daily maintenance dose during the second course was 150--250 mg taken midway between 2 meals. Proteinuria did not recur; no significant excretion of fibrin degradation products occurred; complement, urea, creatinine, and serum albumin remained within normal limits. Urine microscopy showed no abnormality.


Myelotoxicity of D-penicillamine.

Information has been collected on 10 patients, 9 with marrow depression and 1 in whom the diagnosis was presumed. Six of the 10 patients died. The sequentially recorded blood counts on at least 5 of the patients showed a downward trend of the white cell and platelet counts while D-penicillamine was still being administered. One patient suddenly developed leucopenia and thrombocytopenia with a streptococcal septicaemia.


Quantitative sacroiliac scintigraphy in ankylosing spondylitis and Crohn's disease: a single family study.

A single family is presented in which 2 of the 3 sibs and 3 of 9 first degree relatives had Crohn's disease. Two subjects with Crohn's disease had classical ankylosing spondylitis (AS), and HLA typing revealed HLA B27 in all 5 members of the immediate family. The value of quantitative sacroiliac scintigraphy (QSS) in clinical practice is demonstrated. Both patients with AS had evidence of currently active sacroiliac disease in association with radiological change. One symptomatic sib had QSS evidence of sacroiliitis without radiological abnormality.


Thrombokinetics in giant cell arteritis, with special reference to corticosteroid therapy.

Duplicate platelet survival studies were carried out on 8 patients with giant cell arteritis (GCA), once before the institution of any therapy, and the second time when they were in a completely asymptomatic phase after having received corticosteroid treatment. The time interval between the studies ranged between 5 and 14 months. In the first study the mean peripheral platelet count was 486 +/- 25 X 10(9)/l and in the second 326 +/- 25 X 10(9)/l. The difference between the means was highly significant (P less than 0.001). The mean life-span of the platelets was normal in the duplicate experiments (6.7 +/- 0.3 and 7.3 +/- 0.4 days, respectively). Platelet production rate was significantly (P less than 0.001) raised in the first experiment but became normal in response to corticosteroid therapy. It is concluded that the thrombocytosis seen in GCA is reactive to the inflammation present in this disease, and it seems reasonable to assume that the reduction in the peripheral platelet count which occurs in response to corticosteroid therapy accurately reflects the clinical improvement of the patient.


Behaviour of effector cells, synovial fluids, and sera from rheumatoid arthritis patients in antibody-dependent cell-mediated cytotoxicity.

Antibody-dependent cell-mediated cytotoxicity (ADCC) was examined in patients with rheumatoid arthritis (RA). The cytotoxicity of peripheral blood leucocytes from patients with RA was similar to that found in normal persons, whereas ADCC was less effective in RA synovial fluid cells. It is possible that the activity in these cells is lower because of immune complexes and other factors being absorbed from the synovial fluid itself. Although patients' sera had little effect on normal peripheral blood leucocytes, synovial fluid from RA patients was markedly inhibitory in ADCC. The degree of inhibition correlated significantly with the clinical status of the patients.


Effect of hyperoxia on articular tissues in organ culture.

The effect of hyperoxia on pig articular tissue has been studied in organ culture. Hyperoxia (55% O2) causes an increased release of hydroxyproline and collagenolytic activity from synovial tissue as compared with control explants in 20% O2, but neither 55% nor 95% O2 has any effect on the breakdown of isolated cartilage during 10 days in culture. When synovium and cartilage are cultured in contact, the breakdown of cartilage collagen is greater in the hyperoxic (55% O2) group than in the controls (20% O2), but the breakdown of proteoglycan is not increased. The enhanced collagenolytic action is due to an increase in the direct effect of the synovial tissue on the cartilage matrix. In 20% O2 the synovium causes the chondrocytes to degrade the cartilage matrix, but this effect is inhibited by 55% O2.


[Seroepidemiological considerations on the influenza a in Umbria (1978) (author's transl)].

The authors studied the seroepidemiology of influenza virus A/Victoria/3/75 (H3N2) and A/URSS/90/77 (H1N1) in Umbria, in 1978. The percentage of seroprotection against the subtype H3N2 results low and in such do not inhibit the diffusion of this subtype during the next winter season. The study of seroepidemiology of subtype H1N1 demonstrated that this subtype circulated in Umbria in the winter 1977-78 and that the conditions exist for its circulation.


[Rubella epidemic of 1973 in Umbria: seroepidemiologic study (author's transl)].

The rubella seroepidemiology before 1973 and the epidemic outbreak of rubella in 1973, in Umbria was studied. Antibody movement by specific activity of IgG and IgM was shown, and characterized by duration and in the various phases of the disease and post-disease.


[Study on the immunoglobulin class of the antibody anti-e in acute HBsAg+ hepatitis and in asymptomatic carriers of HBsAg (author's transl)].

The AA. have determined the immunoglobulinic appartenence class of HBeAb in patients with acute hepatitis HBsAg+ and in asymptomatic carriers of HBsAg. In these the HBeAb belongs constantly to the IgG class, while in acute hepatitis patients this antibody results present in the IgM and IgG fractions of the sera. Especially, in patients with acute hepatitis the presence of HBeAb was observed only in some sera obtained during the tardive phase of disease.


[An epidemic of familial toxoplasmosis (author's transl)].

After observation of choroiditis of toxoplasmic nature in a member of a rural family, the authors have led a clinical and serological study on other five members of the household. Three of five had antibody titers and two of these demonstrated antibody titers consistent with recent toxoplasmic infection; one of these members manifested asymptomatic choroiditis. Therefore, it would be interesting to carry out a clinical and serological study on relatives of patient with toxoplasmosis.


[Widal-Wright: a semiautomatic micromethod (author's transl)].

A semiautomatic micromethod is explained to execute the agglutination reaction of Widal type. It is reported the perfect agreement existing between the above-mentioned method and the traditional one, in the test tube. The semiautomatic method is particularly fit for the standardisation of the Widal reaction and moreover it avoids some disadvantages by this method presented.


[Salmonellosis in Messina during 1975-1977: epidemiological considerations and prophylactic recommendations (author's transl)].

The AA. report the results of the bacteriological researches carried during the years 1975-1977 on 8226 cultures. They remark the high percentage of positivity registered for Salmonella, with superiority of S. wien (87.74%), and the onset of serotypes of group E1. At the conclusion of their study point out the nature endemic taken by the salmonellosis in Messina, and suggest the practice of prophylaxis for the control of the epidemiology.


[Prevalence and transferability of the plasmid lac+ character in "Klebsiella" sp. strains with "lac+-forte" phenotype].

36 strains of Klebsiella sp. showing a strong lactose-positive phenotype were examined for presence of R factors and for ability to promote the transfer of character lac+; 10 of the 13 R+ strains were able to transfer lac+ character and 4 showed the presence of R-lac factors. Transfer of R-lac factors from Klebsiella sp. strains to Salmonella typhi clinical isolates has also been obtained.


[Incidence of antibodies inhibiting hemagglutination by influenza virus A/New Jersey/8/76 (Hws1N1) in sera of swine and the population of Umbria].

The authors studied the seroepidemiology of influenza virus A/New Jersey/8/76 (Hsw1N1) in Umbria, in animals and human populations. Human samples demonstrated seropositive evidence only in those subjects with an age above 50 years. The results from swine samples instead proves the circulation of virus in pigs.


[Identification and antibiotic-resistance of microbial strains isolated from urinary infections (author's transl)].

During the year 1977, 1491 urine samples were taken from patients living in the "Alta Valle del Tevere" (Umbria, Italy). The isolated microorganisms were examined and tested against 15 antibiotics. 535 samples (35.88%) were free from bacteria. Among the 1095 isolates, 52.42% were Gram-negative, 46.85% Gram-positive, and only 0.73% Fungi. The genera Citrobacter, Escherichia, Proteus, Pseudomonas, Enterobacter, Klebsiella, Staphylococcus and Enterococcus were identified. A high proportion of strains belonging to the genera Proteus and Pseudomonas were resistant to all the 15 antibiotics tested. However, although in a lower proportion, the multiple drug-resistance was present also in the strains of the genera Escherichia and Staphylococcus.


[New considerations on the role of the mouse skin surface lipids on the "in vivo" penetration of "Schistosoma mansoni" cercariae (author's transl)].

The authors have studied the effect of delipitizing and of the previously extracted skin lipids reapplication on mice experimental infected with Schistosoma mansoni cercariae. The results demonstrated that the amount of living cercariae, not penetrated, recovered after the exposition to the parasite is greater in the delipitized mice than in the other ones. The low amount of worms recovered from the treated mice might be due to the effect of the mouse skin surface lipids not only on stimulating cercarial penetration but also on allowing cercarial transformation to schistosomula during skin crossing.


[CIEP with cellogel (cellulose acetate membrane) in the diagnosis of visceral leishmaniosis (author's transl)].

Technique of counter immunoelectrophoresis (CIEP) was employed for the diagnosis of V.L. (human and canine) using strips of cellulose acetate and an antigen grossly extracted (by means of repeated freezing and thawing) from culture of Leishmania. 4 lots of antigen was prepared, in various time, at the same way. Positive results were obtained in V.L. from 81 to 90% (according to various lots of antigen). False positivities (from 1 to 4.5%) occur in patient with other diseases (especially cirrhosis and blood disorders). None positivity in controls (blood donors). Present results and those obtained with same technique in agar, suggested the validity of method and encouraged the production of antigen in a "kit" form for use in the field.


[New methods on the measles prophylaxis (author's transl)].

As for the preventive measures used towards patients with a measles infection, the Authors review in particular the new methods of isolation on the basis of the latest acquisitions on the way and period of contagiousness. As for the preventive measures for healthy people, the Authors review in particular the vaccination route. After having considered the principal types of vaccine used, they demonstrate the efficiency and harmlesness of the live and attenuated virus vaccine, in general, and in particular the "hyperattenuated" vaccine, reviewing the principal causes of the failure of such a vaccine in some cases. They give an ample documentation of the period of immunity (persistance of HAI antibodies) in the vaccined. Considering the experience of other countries, the Authors suggest that it is time to procede in a large scale vaccination in Italy, underlining the fundamental points (use of live and hyperattenuated vaccine, appropriate storage and care of the vaccine, age of vaccination) to prevent failure and to make more and more efficient this type of vaccination.


[Mathematical models in epidemiology: Study on viral hepatitis in Italy (author's transl)].

In this paper a mathematical approach to the epidemics is proposed. The method is based upon a model able to describe any time-depending phenomena using the following elements: "class", "transition" and "related probability". The solution of the differential equations describing the model are obtained: first, by numerical techniques; second, by a Montecarlo simulation method. Deterministic and stochastic solutions which have been obtained, by applying the model to the study of viral hepatitis in Italy during 1960--1970, have been compared each other, to improve the model itself.


Glucose requirements following burn injury. Parameters of optimal glucose infusion and possible hepatic and respiratory abnormalities following excessive glucose intake.

Glucose and leucine metabolism in 18 severely burned patients were studied using the primed constant infusion of U-13C-glucose and 1-13C-leucine, respectively. The leucine data were used to calculate rates of whole-body protein synthesis. In four additional burn patients and seven normal controls, the effects of exogenously infused insulin on the metabolism of infused glucose were evaluated. Also, the effect on leucine metabolism of adding insulin to infused glucose was tested and rates of protein synthesis were calculated. The protein studies were divided into two groups depending on the rate of glucose infusion. Protein synthesis was 4.3 + 0.54 g protein/kg/day during the lower infusion rates (1.4--4.5 mg/kg/min) and 5.17 + 0.19 g protein/kg/day during the higher infusion rates (4.7--9.3 mg/kg/min) (statistically different, p less than 0.05). However, when the high infusion rate group was divided into two subgroups (high, 4.7--6.8 mg/kg/min, and very high, 7.03--9.31 mg/kg/min), there was no difference in the rate of protein synthesis. When U-13C-glucose was infused during varying rates of unlabeled glucose infusion, we found that the per cent of CO2 coming from the direct oxidation of glucose rose rapidly at the lower infusion rates but reached a plateau at approximately 55% as the infusion rates exceeded 5 mg/kg/min. Addition of insulin did not affect the rate of glucose oxidation but did seem to exert a stimulatory effect on protein synthesis. It was concluded that there appears to be a maximal rate of glucose infusion, beyond which physiologically significant increases in protein synthesis and direct oxidation of glucose cannot be expected. Furthermore, there appears to be a physiological cost of exceeding the optimal glucose infusion rate, as indicated by increased rates of CO2 production during infusion as well as large fat deposits in the liver at autopsy in patients infused with large amounts of glucose.


Correlation between anergy and a circulating immunosuppressive factor following major surgical trauma.

In order to clarify the relationship between anergy and immunosuppressive activity in the serum, we studied 46 previously well patients before and at three, five, seven and 28 days after surgery. Delayed hypersensitivity was measured by skin testing with four common recall antigens, and serum immunosuppressive activity was determined by the ability of the patient's serum in 10% concentration to suppress by 50% or more the phytohemagglutinin (PHA) stimulation of normal human lymphocytes as compared to pooled normal serum. Prior to surgery, all patients manifested delayed hypersensitivity to one or more antigens, and no patient had immunosuppressive serum. Fifteen patients underwent minor surgery under general anesthesia and did not develop anergy or immunosuppressive serum. Thirty-one patients underwent major cardiovascular surgery. Thirteen of these patients became anergic by day 3 after operation, and 11 of the 13 developed immunosuppressive serum. Eighteen patients maintained delayed hypersensitivity after major surgery, and only three developed immunosuppressive serum. The correlation between anergy and immunosuppressive serum was highly significant (p < 0.001). There was a significant difference in the degree of suppressive activity in the serum of the anergic and reactive patient groups for each postoperative day studied until day 28, when there was recovery of delayed hypersensitivity and lack of immunosuppressive serum. The occurrence of postoperative anergy and immunosuppressive serum was not related to the patient's age, sex, number of perioperative blood transfusions or duration of anesthesia but was associated with an increase in postoperative infectious complications (p < 0.05) and in postoperative days in the hospital (p < 0.01). Pooled immunosuppressive serum from anergic patients was fractionated by ion exchange chromatography, gel filtration and preparative high voltage electrophoresis. The majority of the immunosuppressive activity could be accounted for by an electrophoretically homogenous polypeptide-containing fraction not identified in the serum of patients undergoing minor surgery or in normal individuals. We conclude that anergy occurring after major operative trauma is associated with the appearance of a circulating immunosuppressive molecular species and that these events are in turn associated with increased patient morbidity and increased length of hospitalization.


[Bacteriological diagnosis of anaerobic infections (author's transl)].

A review on anaerobic bacteria with special reference to their role in human disease and an outline for clinical laboratory practice (collection of the specimens, culture media, isolation, identification, antibiotic sensitivity tests) is presented.


[The evaluation of antibody-coated bacteria in the urine sediment to watch the efficiency of antibacterial treatment in upper urinary-tract infections (author's transl)].

The effect of up to 6months antibacterial treatment on both urine culture and the presence of antibody-coated bacteria in the urinary sediment was examined in 15 patients with upper urinary-tract infection. At the end of the sixth month all the patients had sterile urine, while about one half still demonstrated antibody-coated bacteria in their sediment. Such a finding strongly suggests that urine culture is "per se" insufficient to exclude the presence of bacteria in the renal parenchyma, and that the evaluation of antibody-coated bacteria might be a better way to watch the effect of treatment in upper urinary-tract infections.


Vasodilator effects of the sodium acetate in pooled protein fraction.

Paradoxical hypotension during rapid infusion of plasma protein fraction (PPF) has been attributed to vasodilation by bradykinin in PPF. This study employed a canine, controlled right heart bypass preparation to assess changes in systemic vascular resistance and venous capacitance during infusion of PPF and other possibly vasoactive mediators. Plasma protein fraction caused consistent vasodilation, whereas purified human albumin did not. This vasodilation could be ascribed entirely to acetate, present in PPF as a buffer. Bradykinin in PPF had no effect during venous infusion. Acetate is used widely as a buffer in intravenous and dialysate solutions. Its vasoactive properties must be recognized when such solutions are administered to patients with limited capacity to compensate for sudden vasodilation.


Surgical treatment of chronic pancreatitis. Twenty-two years' experience.

Seventy-four patients underwent operation for chronic pancreatitis during a 22 year period at UCLA Hospital. Follow-up data obtained for 60% of these patients an average of 3.2 years postoperation were analyzed by computer for statistically significant benefit between paired operation combinations and the variables of pain relief, stool habits, alcohol use, readmission for pancreatitis, and narcotic use. The combined group of total and cephalic pancreaticoduodenectomy proved more effective with respect to pain relief and readmission (p less than 0.05) than the group that had pseudocyst drainage. The comparison of groups that underwent resection or ductal drainage showed no statistical differences for the above variables. Regardless of type of operation, if the patient had evidence of pancreatic calcifications and had abstained from alcohol postoperatively, the likelihood of a return to normal activity was more favorable (p less than 0.05).


Twenty year experience in maxillocraniofacial surgery. An evaluation of early surgery on growth, function and body image.

We have analyzed 404 patients with a wide variety of maxillary and craniofacial deformities. These do not include head and neck cancer patients as generally defined. Satisfaction has been high as judged by the patients, surgeons and psychiatrists. The complication rate has been significant, approximately 30%, the most common being infection or loss of bone grafts. As experience accumulated, the concept of earlier operative intervention has emerged as an aid in unlocking growth potential, diminishing secondary deformity and improving the development of body image.


Congenital diaphragmatic hernia. New concept in management.

The newborn infant with a congenital diaphragmatic hernia (CDH) who develops severe respiratory distress requiring operative repair within the first 24 hours of life represents one of the most challenging problems in pediatric surgery. The mortality in these infants still exceeds 50% and has historically been attributed to ventilatory insufficiency secondary to pulmonary hypoplasia. However, the primary abnormality in these neonates seems to be an increase in pulmonary vascular resistance with an elevation of pulmonary artery pressure, right-left ductal shunting, preductal shunting and progressive hypoxemia. Eighteen neonates with a CDH were operated upon within the first 24 hours of life with a mortality of 38%. In no instance did ventilatory insufficiency seem to be a major factor in the death of the patient. Seven infants with progressive hypoxemia were treated with a vasodilator, tolazoline. Six of the seven infants showed an initial response to treatment, with a rise in preductal PaO2 and a decrease in ductal shunting. Four of these seven desperately ill neonates survived. Pathologic examination of the pulmonary vasculature in the non-survivors revealed an increase in muscle mass within the pulmonary arterioles. An exaggerated vasoconstrictive response of an abnormally hypertrophied pulmonary vascular bed leading to an elevation of pulmonary vascular resistance, rather than abnormalities of ventilation, appears to be the important mechanism leading to the often fatal hypoxemia observed in the neonate with a CDH. Improved survival will depend upon the successful management of the deranged pulmonary vascular hemodynamics seen in these infants.


The fibrinolytic system. A key to tumor metastasis?

Neither histologic nor clinical staging reliably correlates with patient survival or the time course of tumor metastatic spread. There is no general biologic tumor marker which is able to distinguish those patients with microscopic residual cancer who may benefit from adjuvant anticancer treatment from those patients cured by their primary treatment who do not require additional anticancer therapy. Our data suggest that tumor activation and inhibition of fibrinolysis are related to the likelihood of tumor spread. Calculation of mean activation/inhibition ratios (A/I ratios) in groups of tumors with and without metastatic spread demonstrated a statistically significant difference between their respective A/I ratios (p less than 0.001). In addition, the mean activation/inhibition ratios for secondary or "metastatic" lesions were significantly different from the mean activation/inhibition ratios of the original tumors from which they metastasized (p less than 0.001). Therefore, tumor activation/inhibition ratios would appear to have clinical reliability as biologic markers for the presence or absence of tumor metastases. These data may have important therapeutic implications that would permit the use of activation/inhibition ratios as a biologic marker for the presence or absence of tumor spread at the time of primary surgical excision of the tumor. These observations warrant further investigation into the mechanisms of tumor interaction with the fibrinolytic system.


Enhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection.

From 1966 through 1970 we performed resections in 216 patients with carcinoma of the large bowel. The relative five year survival for all patients was 65.5%. The relative five year survival for all potentially curable patients was 80.4%. Patients with positive lymph nodes and full-thickness penetration of their tumors had a five year survival of 70.5% and a 10 year survival of 60.5%. In performing this study we have tested the principles of wide anatomical resection and radical lymphadenectomy. For their specific influences on survival we have also examined stage, site, age, sex, race, margins, local recurrence, hypogastric lymph node dissection, serosal penetration and various aspects of nodal status. The information derived from these parameters has confirmed our hypothesis that survival is directly related to radical anatomical resection and lymphadenectomy. For rectal cancer, extensive resection also reduces the incidence of local recurrence. We are persuaded that the principles of operation for large-bowel cancer are valid and that they merit universal adoption.


Histopathology in the evaluation of total pancreatectomy for ductal carcinoma.

Whipple resections for pancreatic head carcinoma are often inadequate because tumor is left behind in the body and tail. Thirty-six patients have undergone total pancreatectomy for various conditions, of which 25 have undergone total pancreatectomy, for ductal carcinoma. Thirty-seven per cent of these 25 patients have shown histologic evidence that a Whipple resection would not have adequately removed tumor-bearing pancreatic tissue. Three patients had carcinoma spreading up and along the common bile duct from a primary ductal carcinoma in the head of the pancreas. Four patients had tumor infiltrating in continuity into the pancreatic body and tail at a distance from the palpable tumore in the head well to the left of a Whipple transection site. Five patients had widespread multifocal autonomous tumor involving other areas in the gland but with tumor palpable only in the head of the pancreas. Three patients (12%) died postoperatively. The two year survival rate is 32%, and the five year survival, 19%. Histological factors affecting the survival prognosis include 1) positive nodes, 2) tumor extension up the common duct, and 3) intrapancreatic extension and multicentricity of tumor mandating total pancreatectomy for hope of cure in at least 38% of cases.


The price of weight loss by jejunoileal shunt.

In the performance of end-to-end jejunoileal shunt, operative mortality can be nearly eliminated and late deaths largely prevented by assiduous care and follow-up. We attempted to prevent serious complications by regular outpatient visits. However, 703 outpatient visits costing $49.00 per visit failed to improve results. There were 170 readmissions among 64 patients lasting 4--57 days (average hospital stay--16 days per admission at $3,000.00). Twenty-four of those patients alive and followed 18 months or more (53%) sustained adequate weight loss and were free of major problems. Patient satisfaction nevertheless appears high, and when there has been a good weight loss, even severe problems tend to be glossed over by the patient. The ultimate outcome is still unknown, but it seems clear that many of the patients are in a state of controlled malnutrition, which may lead to progressive penalties. We have documented gross pathologic lesions in the bypass enteritis syndrome and draw attention to neurologic sequelae of the bypass, which probably represents deficiency manifestations. Despite brilliant results in some patients and satisfactory results in perhaps half, the cost in life, suffering, dollars, patient and physician time, the uncertain long-term effects, and the unpredictability of the weight loss, all place in question the appropriateness of jejunoileal shunt as the remedy for morbid obesity.


Gastric partitioning for morbid obesity.

The complication rate in jejunoileal bypass for morbid obesity is unacceptably high. Gastric bypass is technically difficult. In our series, 115 patients have undergone gastric partitioning for morbid obesity. The operation consists of stapling across the stomach below the gastroesophageal junction, leaving a gastric food reservoir of 50--60 cc. A 1 cm opening is left in the central portion of the staple line, allowing slow emptying into the distal stomach. The result is a reduced eating capacity and frequency which produce loss in weight. Three-quarters of the patients are women, and the age range is 17--62 years. Preoperative weights averaged 147 kg. Mean operative time was 48 minutes, and postoperative stay was 6.2 days. All patients were extensively evaluated preoperatively with upper GI series, cholecystogram, a number of blood chemistry tests, and endocrinologic and psychiatric consultations. All patients underwent a preoperative Minnesota Multiphasic Personality Inventory test. Cholecystectomy for cholelithiasis was performed on 18% of the patients at the time of operation. Of the seven patients operated on more than one year ago, five have lost an average of 31.6% of their preoperative weight. Of the 12 operated on less than one year but more than six months ago, eight have lost an average of 21% of their initial weight. The early failure rate of 33% has been reduced to 15% at present. One death occurred from pulmonary embolus 10 days following discharge, giving a mortality rate of .08%. The complication rate is 10%, comprising two pulmonary emboli, two psychoses, one wound dehiscence, one wound hernia, and ten wound infections, six of which were minor. There have been no complications of ulcer disease, reflux esophagitis, liver disease, renal disease, or metabolic disorders. Gastric partitioning is a safe, fast effective alternative for the surgical treatment of morbid obesity.


The natural history and surgical significance of hyperlipemic abdominal crisis.

Although it is widely known that patients with severe hyperlipemia may have pancreatitis, it is not generally appreciated that such patients may have recurrent abdominal pain of variable character and intensity not due to pancreatitis. Review of 35 patients followed in our clinic for 1--11 years showed that 54% had recurrent abdominal pain, while only 29% had pancreatitis. Although mild pain occurred frequently with plasma triglycerides in the 2000--5000 mg/dl range, triglycerides over 6000 mg/dl were often associated with severe pain and physical findings which necessitated hospitalization, often led to the misdiagnosis of pancreatitis and other intra-abdominal catastrophes and resulted in multiple unnecessary diagnostic studies and operations. When recognized, the pain subsided within 48 hours upon cessation of oral intake and treatment with intravenous electrolyte solutions. Furthermore, effective treatment of the hyperlipemia prevented both the attacks of severe pain and the pancreatitis which otherwise occurred (or recurred) in a significant fraction of the patients. These data confirm the existence of hyperlipemic abdominal crisis as a distinct entity and testify to the importance of recognizing this syndrome in order to avoid the occurrence of acute pancreatitis and the performance of unnecessary and potentially harmful surgery.


Surgical decision making. The reliability of clinical judgment.

Elective surgery second opinion programs are predicted on strict acceptance of the accuracy of the consultant's surgical judgment. The reliability and reproducibility of clinical judgment, therefore, become basic to the effectiveness of such programs. This aspect, however, has received little attention. We report a randomized and controlled survey of surgical specialists which defines agreement/disagreement patterns in surgical decision-making for seven elective surgical procedures. For each disease process, four case histories, including at least one control, were developed by specialty panels of physicians. The case summaries described fictional patients who were seeking professional consultation. The histories were mailed to a random sample of Board-certified specialists from the State of Maryland and the District of Columbia. The response rate was approximately 80% for all five specialties. The respondents were asked to indicate whether they would (Yes) or would not (No) perform the surgical procedure in question. Factual knowledge was not sought, but instead the application of that knowledge and experience to decide on the need for surgical intervention. By comparing the responses for each case history, the agreement/disagreement patterns of inter-observer surgical judgment were determined. Analysis of the data revealed a marked divergence of opinion concerning the need for surgery. The significant point of this study is that surgical judgment differs to a major degree from one surgeon to the next. In a second-opinion program the number of consultants needed to provide a reliable clinical decision probably exceeds the number who are logistically available and that the patient would be willing to visit. Surgical decision-making is a semi-exact scientific process, and it is unreasonable to expect exact answers to clinical problems.


Recent concepts in the treatment of hepatic trauma: facts and fallacies.

Experience with 85 consecutive patients treated at Bellevue Hospital for hepatic trauma over the past two years has established the importance of several principles of management. Simple liver injuries can be treated by superficial suture and drainage. Using this approach in 57 patients there were no deaths and no postoperative abscesses. Among 28 other patients with complex liver injuries, the first six patients (Group 1) were treated by lobectomy alone (1 patient), lobectomy and intracaval shunt (3 patients), hepatic artery ligation (1 patient), and left lateral segmentectomy (1 patient). Only one of the six survived. In the next 22 consecutive patients managed by the Pringle maneuver combined with finger fracture technique of the hepatic parenchyma and a viable omental pack there was only one death (4.5%). An intracaval shunt was used successfully once in this group, in a patient with a lacerated middle hepatic vein. Only one patient developed a postoperative subphrenic abscess (4.5%), and no patients required reoperation for bleeding. Eighty-two per cent of these 22 patients safely tolerated inflow occlusion of greater than 20 minutes with steroid protection. Hepatic artery ligation is superfluous in the majority of liver injuries. In complex injuries involving lobar branches of the portal vein, the retrohepatic cava or hepatic veins hepatic artery ligation is probably ineffective. Hepatic resection is rarely required and carries a prohibitive mortality. The finger fracture technique provides a direct approach to the source of heniorrhage and is probably the procedure of choice.


Reparative cardiac surgery in infants and small children: Five years experience with profound hypothermia and circulatory arrest.

A five year experience of profound hypothermia and circulatory arrest in the operative management of severe congenital heart disease in 128 infants and children weighing 10 kg or less is reviewed. Hospital mortality was 13% for the entire series--8% in the last two years. Mortality varied with the defect present rather than with the age at operation, and appeared to decline over the five years. There was no morbidity associated particularly with this technique, and no evidence of permanent neurologic nor intellectual impairment. Total arrest time averaged 55 minutes, was related significantly to the defect being repaired, but was not related to hospital mortality. The results support the idea of definitive early cardiac repair for severely symptomatic infants and young children, rather than surgical palliation. The hypothermic arrest technique is attractive since it allows optimal operating conditions, thus permitting an accurate repair and the consequent improvement in surgical results.


Prophylactic revascularization of the gut.

Reconstitution of the mesenteric vascular circulation, in our experience, is advisable when advanced occlusive disease is noted on the preoperative arteriogram of patients selected for aortoiliofemoral, renal artery, or aortic aneurysm surgery. A lateral aortogram is mandatory, and the presence of an anastomotic meandering mesenteric artery on frontal arteriogram is especially valuable in signaling significant disease. This is the first report of prophylactic concomitant revascularization of compromised mesenteric vessels during aortic reconstructive procedures on selected patients. It is our opinion that such an approach can be a significant deterrent to subsequent catastrophic bowel infarction from mesenteric arterial occlusive disease.


Improved exposure for excision of rectal carcinomas: initial experiences with a pubic resection technique.

Preliminary experiences with a transpubic approach for carcinoma of the rectum are described. By excising a wedge of pubic bone and freeing the left lateral attachments of the bladder, the entire length of rectum can be exposed, down to the level of the levator muscles. Dissection of the tumor can be performed under direct vision, even in unfavorable anatomic and pathologic situations. Low rectal anastomoses, at levels of 1--2 cm above the anus, may be performed with greater ease. It is felt that urinary problems should be uncommon and that orthopedic complications should not occur since sacroiliac articulations are not disturbed by retraction.


The anatomic basis for the occasional failure of transfemoral balloon catheter thromboembolectomy.

A Fogarty balloon catheter was advanced from the common femoral artery through the popliteal artery and its branches in 15 cadavers. The catheter passed into the peroneal branch 89% of the time. In all 15 cadavers, the peroneal artery was the direct continuation of the popliteal artery and the arterior tibial and posterior tibial arteries branched off at varying angles from the popliteal. This provides an anatomic explanation for the occasional failure of transfemoral Fogarty catheter embolectomy of the leg. Our study suggests that if the patient's foot does not improve after Fogarty embolectomy, the popliteal artery should be exposed and the catheter directed into the shank arteries using vascular forceps.


Early and late results of surgical correction of pulmonary artery sling.

Since 1976, we have operated on 4 children with pulmonary vascular sling. They were 5, 12, 19, and 54 months old. All patients were seen initially with severe stridor. Diagnosis was made by barium swallow in all 4. Each child was operated on through a left thoracotomy; the left pulmonary artery was dissected deep between the trachea and esophagus. Systemic heparinization and microsurgical techniques were used. All patients improved after operation. Radioisotope pulmonary ventilation/perfusion scans were performed 9, 9, 14, and 21 months after operation. Decreased ventilation was noted in the right upper lobe of one scan; the other three ventilation scans were normal. Perfusion scans showed good patency of both pulmonary arteries in all 4 patients. It is concluded that pulmonary vascular slings should be treated surgically as soon as diagnosed. Delayed operation can lead to severe tracheomalacia, as demonstrated in our 54-month-old patient.


Late right heart reconstruction following repair of tetralogy of Fallot.

Twenty-two symptomatic patients underwent a total of 28 reoperative procedures after initial surgical repair of tetralogy of Fallot. Sixteen of the patients were considered to have unfavorable anatomy of the right ventricular outflow tract (RVOT) or pulmonary artery at the time of initial repair. Pulmonary or tricuspid valve replacement, or replacement of both valves, utilizing a xenograft bioprosthesis was performed in 1 of the 22 initial repairs, 7 of the 22 first reoperations, and 5 of the 6 second reoperations. Ultimately, 14 patients received transannular RVOT patches. The interval between the first and second reoperations for 6 patients who required 2 late reconstructive procedures was 5.8 years. No operative deaths occurred. There were 2 late deaths (1 sudden and 1 due to aspiration). Actuarial survival probability (+/- standard error of the mean) 16 years after initial repair was 72 +/- 21%. Eighteen of the 20 current survivors in the present series are completely asymptomatic without physical restrictions; the other 2 are considered to be in New York Heart Association Functional Class II. No xenograft bioprosthetic dysfunction has occurred to date, but cumulative valve follow-up is limited (13 patient-years). In selected patients, earlier pulmonary or tricuspid valve replacement or replacement of both of these valves can provide some degree of protection against recurrent deterioration.


Thymoma: a continuing survey at the Massachusetts General Hospital.

An analysis is presented of the treatment of 103 patients with thymoma, 56 with myasthenia gravis and 47 without. In a 1966 report on the first 63 patients, it was stated that the presence of myasthenia and the finding of local tumor invasion at operation were ominous prognostic indicators. The augmented series suggests that myasthenia no longer carries this stigma, possibly because of improved methods in its management in patients who have undergone operation.


The role of thymectomy in red cell aplasia.

Red cell aplasia is an unusual cause of anemia. Fifty percent of all patients with red cell aplasia will have a thymoma. Twenty-five to 30% of those who undergo thymectomy will be cured. Data are presented that suggest that any patient with red cell aplasia should have thymectomy through a median sternotomy. One of 3 such patients who underwent the operation has had complete remission for two years.


Dynamic behavior of prosthetic aortic tissue valves as viewed by high-speed cinematography.

Using a valve testing apparatus of our own design and with a high-speed (600 to 800 frames per second) 16 mm movie camera, films were made of Hancock porcine, Carpentier-Edwards porcine, and Ionescu-Shiley bovine pericardial valves mounted in the aortic position and cycled under physiological conditions at 72 to 100 beats per minute. Fresh and explanted valves were observed using saline or 36.5% glycerol as the pumping solution. When fresh valves were studied using saline solution as the pumpint fluid, the Hancock and Carpentier-Edwards porcine valves showed high-frequency leaflet vibration, which increased in frequency with higher cycling rates. Abnormal leaflet motion was decreased when glycerol was used as the blood analogue. The Ionescu-Shiley bovine pericardial valve did not show abnormal leaflet motion under these conditions. Conclusions drawn from tissue valve testing studies that use excessively high pulsing rates and pressures (accelerated testing) and saline or water as pumping solutions cannot be transposed to predict the fate of tissue valves in a clinical setting.


The importance of hyperkalemia in a cold perfusion solution: a correlative study examining myocardial function, metabolism, tissue gases, and substrates.

Twenty-four pigs were studied to assess the effect of potassium in a cardioplegic solution on the ability of the swine myocardium to maintain functional and metabolic integrity following induced ischemia. The pigs were evaluated on total and right heart bypass with measurement at normothermia and after a one-hour intervention of stroke volume (SV), coronary blood flow (CBF), myocardial oxygen consumption (MVO2), and lactate extraction. Myocardial tissue gases (PmO2 and PmCO2) were continuously monitored and, at the conclusion of the procedure tissues were analyzed for adenosine triphosphate (ATP). There were five interventions: (1) hypothermic perfusion (28 degrees C) (Group 1); (2) hypothermic ischemia (28 degrees C) (Group 2); and hypothermic ischemia with a cardioplegic solution (nonlactated Ringer's solution, pH 7.4, 4 degrees C) using (3) normokalemia (4 mEq of potassium chloride/L, 300 mOsm/L (Group 3), (4) hyperkalemia (43 mEq of KCl/L, 390 mOsm/L) (Group 4), and (5) normokalemia with increased osmolarity (3.6 mEq of KCl/L, 400 mOsm/L) (Groups 5). A significant decrease in SV and elevation in peak PmCO2 were seen in all groups subjected to ischemia except those protected with hyperkalemic solution. We conclude that the presence of hyperkalemia in a cold root perfusion solution provides better myocardial protection than cold root perfusion alone. Furthermore, potassium arrest appears to be more protective than coronary perfusion at 28 degrees C.