Mechanisms of mucus release in exposed canine gastric mucosa.

Mucus release was studied in the exposed gastric mucosa of anesthetized fasted dogs using scanning and transmission microscopy as well as histochemical and autoradiographic techniques. Under unstimulated conditions, the gastric epithelium was composed of both nonsecreting and mucus-secreting epithelial cells, with the former being predominant. Nonsecreting cells were characterized by an intact apical mucus package of granules and a continuous plasma membrane. The secreting mucus cell population was found in the foveolar (pit region) as well as interfoveolar areas. Three mechanisms of mucus release were observed: (a) exocytosis, (b) apical expulsion, and (c) cell exfoliation. Evidence for exocytosis was found in all mucus cells, especially in the sulfated glycoprotein-rich foveolar cells. Exocytosis involved only a few granules at a time; this mode of secretion is likely slow and continuous. In contrast, apical expulsion resulted in an explosive release of the entire apical mucus package followed by in situ degeneration of the cell itself. This occurred in the oldest cells forming mucosal crests in the interfoveolar area, whose mucus predominantly stains for neutral glycoproteins. Cell exfoliation, in which the entire cell was extruded into the lumen, was rarely observed and may provide, in addition to apical expulsion, a second mechanism to rid the mucosa of senescent epithelial cells. Mucus secretion is a complex function of the gastric epithelium. The mechanism of secretion and the histochemically defined type of mucus secreted are variables which are dependent on the age of the cell, its position on the foveolae, and the microenvironment within the gastric lumen. The mucus-containing surface and pit cells of gastric epithelium have been described morphologically and ultrastructurally in a number of studies. These cells are highly differentiated, forming a layer which is dynamic and responsive to conditions present in the gastric lumen. Mucus cells arise from multipotent progenitor cells which differentiate in the course of migration up the gastric pits and are involved in the complex macromolecular synthesis of glycoproteins. Although mucus release occurs throughout cell life, very little attention has been given to the cellular ultrastructural changes that deal with mucus secretion. As a result, the mucus-containing surface and pit cells have been described primarily in terms of their nonsecreting functional state. Exceptions to this are a few transmission and scanning electron microscopy studies which describe loss of intact mucus granules, cell extrusion, and in situ degeneration. These previous ultrastructural studies describe cellular patterns, in both normal and injured mucosa, which we fell are related to mucus release. Because of a paucity of knowledge concerning the normal mechanisms of mucus secretion, it was the purpose of this study to define the ultrastructural changes which result in and accompany the production of mucus in canine gastric epithelium.


A case of familial visceral myopathy with atrophy and fibrosis of the longitudinal muscle layer of the entire small bowel.

The case of a 21-yr-old man, who died in cachexia after 2 yr of intermittent abdominal pain, bouts of diarrhea, and anorexia, is reported. Laboratory tests performed shortly before death disclosed signs of malabsorption. Radiologic examination of the gastrointestinal tract showed a coarse mucosal relief in the upper jejunum and a tubular aspect in the rest of the small bowel. There was no dilatation of the loops. Autopsy revealed severe to complete atrophy with fibrosis of the outer muscle layer of the entire small bowel, extending from the pylorus to the ileocecal valve. The only other lesion discovered was a moderate portoportal fibrosis of the liver. The patient's brother had died a few months earlier after 2.5 yr of similar symptoms. An upper gastrointestinal series had shown dilatation of the stomach with fluid retention and a tubular aspect of the small bowel with generalized widening of the loops. No autopsy was performed. There was a high degree of consanguinity on the mother's side. Family history revealed no other evidence of possible genetic factors in the disease.


Fecal incontinence in chronic diarrhea. Report of a case with improvement after training with rectally infused saline.

Patients with chronic diarrhea and fecal in continence are unable to retain as much rectally infused saline as patients without incontinence. We explored the effect of training such a patient to retain rectally infused saline. The patient was a 31-yr-old female with chronic diarrhea of obscure etiology who had daily episodes of fecal incontinence which markedly restricted her lifestyle. Training was accomplished by urging the patient to retain as much of a 25-min rectal infusion of 1500 ml saline as possible. After 10 training sessions, the patient increased her ability to hold rectally infused saline almost sevenfold. This increase was well maintained over 10 wk. In spite of continued diarrhea, the patient's incontinence did not recur after the first week of training, and she was able to resume a normal life. Anal sphincter pressure and a test of continence for a solid sphere did not change during or after training. This simple training technique has potential as a treatment for disabling fecal incontinence in patients with chronic diarrhea.


Primary shunt hyperbilirubinemia with secondary iron overload: a case report.

A patient with familial primary shunt hyperbilirubinemia is described. Splenomegaly, arthritis, and iron overload were striking features of the illness.


Acute eosinophilic cholecystitis in association with hepatic echinococcosis.

A patient with acute eosinophilic cholecystitis is presented. This was in association with hepatic hydatid disease and was the presenting feature of that disease.


Rederived values of the eight coefficients of the Crohn's Disease Activity Index (CDAI).

A previous paper reported derivation of the Crohn's Disease Activity Index (CDAI) from data on 112 patients. We have now rederived the values of the eight coefficients of the CDAI using data from 1058 visits of patients enrolled in the National Cooperative Crohn's Disease Study and the Trial of Adjunctive Sulfasalazine in Crohn's Disease. The rederived coefficients are similar to the original ones. New and original index values calculated on the same data from patient visits correlated very highly. Because there is so little difference between the original and the rederived versions, continued use of the original version is suggested in order to maintain comparability of new studies employing this tool with those previously accomplished.


National Cooperative Crohn's Disease Study: extraintestinal manifestations and perianal complications.

Among 569 patients with Crohn's disease, 24% had a history of at least one extraintestinal manifestation and 36% had a history of perianal disease before randomization. Multiple extraintestinal manifestations occurred in the same patient more frequently than would be expected by chance. Seventy-six percent of patients with ileocolitis had perianal disease, extraintestinal manifestations, or both. This was significantly greater than the 58% incidence in patients with disease confined to the small bowel. Perianal complications alone were significantly more common in patients with colitis or ileocolitis than in those with disease of only the small bowel. This was true also of internal fistulization. There was a significant positive association between perianal disease and the presence of extraintestinal features. Perianal abscess appeared to respond to sulfasalazine and anal fissure to prednisone or azathioprine. These results require confirmation in larger series of patients.


Clinical usefulness of rectal biopsy in Crohn's disease.

Initial rectal biopsies from 349 patients judged on clinical, radiologic, or pathologic grounds to have Crohn's disease were studied, and findings were compared with a variety of clinical varibles. Biopsies from only 54 patients (15% of total) contained histologic changes characteristic of Crohn's disease, and all but one of these were previously known to have colonic involvement. Yield of diagnostic findings was directly associated with the presence of sigmoidoscopic or radiologic abnormality in the distal colon or rectum. Minor, nondiagnostic abnormalities were more common. It is concluded that routine single rectal biopsy in unselected cases of Crohn's disease has limited diagnostic value under usual conditions of practice, and that histologic abnormalities are most likely to be found in patients with known colonic, and especially sigmoid and rectal involvement.


[The value of microsurgical techniques in tubal surgery (author's transl)].

Tubal surgery by help of microsurgical techniques was performed in 86 women from January 1976 until December 1978. 70 patients suffered from tubal sterility due to pelvic inflammatory disease. 16 women asked for reversal of sterilization. As result of 83 operations 17 life births respectively undisturbed intrauterine pregnancies were achieved. Two patients had an abortion. Three more pregnancies could not be added to the success rate, because in these women we found only one blocked tube intraoperatively, while the contralateral one seemed to be intact. Up to now we haven't had an ectopic pregnancy. In 39 patients the operation was done within the last half year. The value of microsurgery in the field of tubal reconstructive surgery is discussed in regard to the literature and to our own experiences and operative results.


[Comparative clinical investigation of oral contraceptives with different doses (author's transl)].

The investigation of four oral contraceptives with different doses in adolescent girls showed that bleeding disturbances occur more frequently with low-dose preparations at the beginning of treatment. Nevertheless, these disturbances should be considered indicative of lesser central suppression. For this reason adolescent girls -- especially those with still immature cycles -- should be treated chiefly with preparations having only a low inhibitory effect on the central endocrine system in order not to disturb the maturation of the cycle.


[Comparative biochemical investigations with contraceptives at different dose levels (author's transl)].

In adolescent girls the administration of hormonal contraception raises special problems because of the still unstable menstrual cycle of this group. The influence of four oral contraceptives with different high doses on the levels of the two gonadotropins, estradiol and progesterone has been studied with the aid of the GnRH-test before, during and after treatment. According to the results obtained low-dose combination preparations should be administered to adolescents with stable cycles as in this group normal physiological conditions reappeared without delay after discontinuation of a one-year treatment. If the cycle pattern is still irregular a low-dose gestagen ("minipill") preparation may be chosen. This type of treatment showed the least central inhibition, probably advantageous with regard to the still immature cycle.


[Neonatal hypoglycemia (author's transl)].

The paper describes the symptomatology, pathophysiology, diagnostics and therapy of neonatal hypoglycemia. Early diagnosis is required to prevent brain damage due to hypoglycemia. In addition to conventional enzymatic blood glucose determination a new test strip sensitive for lower concentrations enables the diagnosis exactly.


[Vaginoscopic investigation of the cervical ectopy in the neonate (author's transl)].

The percentage of the physiologic ectopy of the endocervical epithelium onto the portio vaginalis of the cervix in the neonate was unknown. Vaginoscopy of 124 new born females in our Obstetric unit showed that the ectopy of the cervix is not found in 36% but in almost all cases (90%). Colposcopy and cytology excluded pathology of the portio. The cervical ectopy retracts in the physiologic involution process of the neonate. Vaginoscopy of the newborn was technically quite feasible and in some cases medically necessary.


[Microscopic, micro-chemical and fluorescent optical findings in endometrium with a copper-T intrauterine device in situ (author's transl)].

The uteri of ten patients who wore a copper-T for several months up to two years were examined immediately following hysterectomy by conventional microscopic techniques, fluorescent optical techniques after Acridin-Orange-Fluorochromization and by histo-chemical techniques for copper. With none of these methods changes in the endometrium could be found which explained the effect of the copper-T to inhibit implantation. Since practically any morphological change from the normal was absent it is suggested that the inhibiting effect on pregnancy of the copper intra-uterine devices is due to biochemical changes of the intra-uterine environment.


[Prenatal diagnosis of triploidy (69, XXX) (author's transl)].

By amniocentesis we succeeded in finding a case of triploidy (69,XXX). Because of an extreme fetal dystrophy and missing fetal movements in the 33rd week a severe malformation was suspected. The clinical, ultrasonographical, cytogenetital, hormonal and autopsy findings are reported and discussed.


[The haemodynamic principle of action of diazoxide (hypertonalum) in the treatment of acute hypertensive crises in late pregnant women (author's transl)].

In ten hypertensive late pregnant women with passing crises of hypertension cardiovascular analysis with the method of quantitative sphygmometry, the unbloody recording of the blood pressure and the direct electronic measuring of the pulse wave velocity were made before and after the intravenous injection of 300 mg Diazoxid (Hypertonalum). This drug is recommended to the treatment of severe preeclampsia and eclampsia because of lessening the arterial blood pressure and the total peripheral resistance, increasing the heart rate, stroke volume and cardiac output.


[The value of magnesium sulfate in intensive care of severe toxemias of pregnancy (author's transl)].

A view on the employment of magnesium sulfate in pregnancy is given and the statement of the cardiovascular changes before, during and after the intravenous infusion of 4,0 g magnesium sulfate in ten hypertensive late pregnant women. The drug induces a mild decrease of arterial blood pressure with a distinct increase of stroke volume, cardiac output, heart rate, heart work and the heart's power. The pathologically increased total peripheral resistance is reduced. These hemodynamic effects are very favourable concerning intensive care of severe toxemias of pregnancy.


[Adaptive association of inversions in a natural population of the malaria mosquito Anopheles messeae Fall].

The dependent combination of chromosomal variants by five paracentric inversions (IL1, IL2, IIR1, IIIR1, IIIL1) in Anopheles messeae population from the West Siberia was discovered. It is found that the inversion interactions interactions are the same at both larval and imaginal parts of the population, and they are stable during four years of studying. The inversion of hetero- and homozygotes demonstrates identical properties, that is, phylogenetic secondary sequencies dominate in heterozygotes. Two associative groups of chromosome variants were revealed. The association correlates with geographic distribution and temporal dynamics of inversions and on the whole, it reflects the evolutionary history of inversion polymorphism in A. messeae. It is supposed that the adaptive association of inversions found is the high degree polymorphism formed and functioned on the basis of the groups of inversion chromosome blocks.


[Cytogenetic effects induced by neutrons in human peripheral blood lymphocytes in vitro. I. Dose-effect relationship for different types of chromosome aberrations when exposed to neutrons with different energies].

Human lymphocytes were irradiated in vitro during G0 stage by graded doses of thermal neutrons and of neutrons with mean energy of 0.04; 0.09; 0.35; 0.85 and 14.7 MeV as well as by 60Co gamma-rays. The data were fitted to the linear and linear-quadratic relations. The neutrons of low and intermediate energies showed the linear dependence on the dose, 14.7 MeV neutrons and gamma-rays--a linear-quadratic one, whereas the data obtained with 0.85 MeV neutrons fitted well the both models. Terminal and interstitial deletions produced by both gamma-rays and neutrons showed different dependencies upon the dose. Some qualitative pecularities of aberration spectra were found in the experiments with neutrons as compared with the data on gamma-irradiation: the ratio of exchanges to fragments was greater, and aberrations of chromatid type were produced. The specially designed experiments and calculations showed that the last effect was not connected with induced radioactivity.


[Spontaneous level of sister chromosome exchanges and their distribution in human cells].

Blood of practically healthy donors of both sexes (27 females and 23 males) was cultured under the standard conditions during 96 hours. Bromodeoxyuridine (BUdR) was added at the final concentration of 10 mkg/ml 28 hours before harvesting. The slides were stained with acridine orange and Giemsa for differential staining of chromatids. In each culture sister chromatid exchanges (SCE) were analysed in 50 cells, and the part of cells undergoing the first, second and third mitoses at the time of harvesting, was calculated. According to the mean number of SCE per cell, the distribution of individuals was consistent with the normal law, the mean being 6.525 and standard deviation--0.956. A significant heterogeneity in the speed of cell cycle of cultures was observed. The coefficient of variation for the part of cells undergoing the first mitosis was 50%, for the cells in the second mitosis--15%, and for the cells in the third mitosis--154%. Correlation analysis showed a positive dependence of the mean level of SCF upon the age of a donor and upon the part of cells in the second mitosis in this individual. No reliable correlation of the SCE level with the donor's sex was observed. The distribution of cells, obtained from the culture of one individual, was best approximated by beta-distribution, and the distribution of cells obtained from the cultures of different individuals--by gamma-distribution. In both there was obtained a satisfactory approximation by Pearson's distribution of the 1 type, and significant deviations were found from the normal, Poison's and the negative binomial distribution. The conditions were found of similarity of empirical distribution of SCE in cells to the normal one. For that, it is not the value of SCE for a separate cell that should be used as a unit of measurement, but the mean from the values of frequencies for 5-10 cells. Hence, it was shown that for the evaluation of the mean frequency of SCE with the precision of 1 exchange in separate individuals it is necessary to analyse 40 cells, and to observe the 15% increase of spontaneous SCE level under the action of deleterious factors--8 individuals are enough to analyse.


Summary and critique of the new NIH guidelines for recombinant DNA research.

New NIH Guidelines for research involving recombinant DNA (R-DNA) molecules were issued on December 15, 1978. These are composed of four main parts, the first defining R-DNA and specifying prohibitions and exemptions, the second describing physical and biological containment, the third assigning the containment levels for many R-DNA experiments, and the fourth detailing the roles and responsibilities of the investigator, research institutions and NIH. Although the new Guidelines reduce restrictions, principally on those R-DNA experiments that use Escherichia coli K-12 host-vector systems, and exempt from the Guidelines several classes of experiments on prokaryotes that naturally exchange their DNA, most of their provisions are unjustified by the present assessment of the absence of any practical risks; many totally innocuous experiments are unnecessarily restricted and even virtually prohibited mainly because no host-vector systems were officially certified. The term Guidelines is a misnomer since they are mandatory regulations, even without any statutory basis. They impose large but unnecessary bureaucratic burdens on scientists, research institutions, research committees and NIH, and represent unwarranted censorship of basic research, which is antithetical to the creativity of human thought, thus posing serious dangers to the traditional freedom of inquiry.


Nomenclature of transposable elements in prokaryotes.

Transposable elements are defined as specific DNA segments that can repeatedly insert into a few or many sites in a genome. They are classified as simple IS elements, more complex Tn transposons and self-replicating episomes. Definitions and nomenclature rules for these three classes of prokaryotic transposable elements are specified.


Office management of cardiac disease in the diabetic.

Atherosclerotic vascular disease is very common in diabetic patients. It often occurs at an earlier age and is more severe than in nondiabetic individuals. The medical management of cardiac disease in diabetics is much the same as in nondiabetics. Risk factors such as obesity, hypertension, and hyperlipidemia must be vigorously treated, and smoking should be restricted.


Herpes zoster: a geriatric disease.

Both the incidence and the severity of herpes zoster increase with advancing age. Postherpetic neuralgia may persist for more than a year. Treatment is usually symptomatic, and early corticosteroid therapy should be considered in patients over age 50. Psychotropic drugs also may be indicated to overcome depression.


Appendicitis in the elderly: learn to discern the untypical picture.

Symptoms and signs of appendicitis in the elderly may be vague and referable to other abdominal diseases. Diagnosis is often delayed or missed, leading to a prolonged preoperative period and increased morbidity and mortality. In this study of elderly appendicitis patients, we noted a high incidence of ruptured appendixes. At least 80% of these patients could have been operated on earlier.


When to suspect spinal cord lesions in the elderly.

Motor or sensory disturbance in the lower extremities--sometimes with gait disturbance--is the most common symptom of spinal cord disease. History and examination may localize the lesion, but spine x-rays and myelography usually are necessary to determine its cause. The most common causes of cord compression in the elderly are spondylosis and neoplasm. Compressive lesions are usually treated by surgery. Once compression has been excluded and diagnosis established, treatment should be directed toward the underlying disorder.


Rehabilitating the geriatric patient: potential and limitations.

Rehabilitation of the elderly can reverse the trend toward greater dependence and escalating costs if the staff is specially trained.


Variations in the incidence and the spatial distribution of patients with primary acute pancreatitis in Nottingham 1969-76.

During the eight year period 1969-76, 214 patients with primary acute pancreatitis were admitted to Nottingham hospitals from the Nottingham defined population area (the City of Nottingham and the four adjacent urban districts, which had a population of 469,720 in 1971). There was considerable variation in both the incidence and distribution of the disease within the study area and the crude average incidence rates ranged between 31.8 and 388.7 per million. Six of the eight wards with rates in excess of 200 per million were contiguous with similar wards; together these formed a U-shaped area extending from the city centre to the eastern boundary of the study area. These findings could not be accounted for by the age structure of the population or its social class structure. Although the Nottingham defined population area is relatively small (147 km2 or 57 sq. miles), it is subdivided into distinct and fixed domestic water supply areas. The distribution of patients among the six water supply areas showed that the Burton Joyce supply area, which is a particularly 'hard' water, contained significantly more patients than could have occurred by chance (P less than 0.002). This investigation of some social and geographical factors suggests that the chemical composition of the domestic water supply may affect the distribution of this disease within this particular urban area. This concentration of patients in the Burton Joyce water supply area suggests that some, as yet unidentified, property of the water supply may be an aetiological factor.


Chronic persistent hepatitis: hepatitis B virus markers and histological follow-up.

Twenty-six untreated patients with chronic persistent hepatitis were followed prospectively for one to 17 years (mean 5.6 years). The patients developed no clinical features of chronic liver disease. Raised serum transaminase levels were usually, but not consistently, the only biochemical abnormality; gamma globulin values were normal. Serum markers of past or present hepatitis B infection were found initially in 14 patients: another two developed markers during their follow-up. Nine patients progressed to a mild or moderate chronic active hepatitis as shown by serial needle liver biopsies but there was no evidence of cirrhosis. This progression was not associated with any clinical or biochemical deterioration. Seven of these patients had presented with insidious symptoms, seven had serum markers of hepatitis B infection, and the four who were HBsAg positive had relatively lower serum HBsAg concentrations than did those patients who continued with chronic persistent hepatitis.


Chronic oral arsenic intoxication as a possible aetiological factor in idiopathic portal hypertension (non-cirrhotic portal fibrosis) in India.

Estimates were made of the arsenic concentration in liver specimens from nine patients having idiopathic portal hypertension (IP), and in four livers these were found to be significantly higher than those in patients with cirrhosis and in control subjects. The splenovenogram revealed extensive portosystemic collateral circulation. Corrected sinusoidal pressure and blood flow studies showed higher levels in four patients than in normal subjects. Microscopic examination of liver tissues revealed periportal fibrosis. The higher hepatic arsenic levels that were found were due to the inadvertent drinking of water contaminated with arsenic, adulterated opium, and indigenous medicines. A history of opium intake was not forthcoming but two patients had drunk water contaminated with arsenic and two others had taken bhasams (Ayurvedic medicines prepared by repeated oxidation of ores). Though the aetiology of idiopathic portal hypertension is not known, it is possible that arsenic intake may be one of the factors.


Endogenous prostaglandins in peptic ulcer disease.

Plasma concentrations of prostaglandins E and F have been measured by radioimmunoassay in patients undergoing diagnostic upper intestinal endoscopy. The results fail to support a previously reported deficiency of plasma PGE in duodenal ulcer patients. Plasma prostaglandin concentrations failed to correlate with the parameters of gastric secretion studied; and were unaffected by histamine H2-receptor blockade or the activity of duodenal ulceration. During combined pentagastrin and insulin secretory studies there was a significant correlation between the outputs of PGE and acid into gastric juice.


Rectal absorption of short chain fatty acids in the absence of chloride.

The absorption of short chain fatty acids by the human rectum in the absence of chloride has been studied using a dialysis bag technique. Absorption rates of sodium, water, and short chain fatty acids were unchanged on replacing chloride with sulphate. Final concentrations of bicarbonate were 35.4 +/- 3.4 mmol/l in the presence of chloride and 37.1 +/- 5.2 mmol/l in the absence of chloride. The rates of movement of bicarbonate into the dialysates were similar. If bicarbonate is secreted in exchange for chloride then it also appears to be secreted in exchange for absorbed short chain fatty acids.


Effect of long-term cimetidine on gastric acid secretion, serum gastrin, and gastric emptying.

Gastric acid secretion, gastric emptying, fasting serum gastrin and the serum gastrin response to a meal were measured in duodenal ulcer patients before, and at least five days after completing prolonged treatment with cimetidine (1 or 2 g/day for four or eight weeks followed by 600 mg twice daily for six months). Fasting serum gastrin and the gastrin response were also measured during treatment. Compared with pretreatment values, fasting serum gastrin concentrations were raised both during and five to 31 days after stopping treatment (P less than or equal to 0.02). The integrated gastrin response and the rate of gastric emptying of the solid component of the meal were increased during treatment (P less than 0.001 and P less than 0.002 respectively) but returned to pretreatment levels after stopping therapy. No significant changes were observed in the basal or maximal acid outputs or the rate of emptying of the liquid component of the meal. The results imply that the hypergastrinaemia associated with long-term cimetidine therapy does not result in increased gastric acid secretion.


Morphology of experimental antibiotic-associated enterocolitis in the hamster: a model for human pseudomembranous colitis and antibiotic-associated diarrhoea.

The morphology of antibiotic-associated enterocolitis in the hamster is described and compared with human antibiotic-associated pseudomembranous colitis. It is shown to be a caecal disease with proliferative mucosal changes and in this respect unlike the human counterpart. The bacteriology and toxicology, however, are identical. In addition, mucosal changes are described in animals on antibiotics but without established enterocolitis. As a result we suggest that there may be a spectrum of human disease ranging from mild antibiotic-associated diarrhoea to established pseudomembranous colitis. Therefore, despite the morphological variation, the hamster remains a good model for investigating the pathogenesis of pseudomembranous colitis and antibiotic-associated enteropathy in general.


Colonic myoelectrical activity in man: comparison of recording techniques and methods of analysis.

Both monopolar and bipolar recordings of human colonic myoelectrical activity have been made on 29 occasions from implanted serosal electrodes attached to either the ascending colon or transverse colon. Visual and computer analysis of the signals were made and the incidences of the two electrical rhythms present in the colon were compared for the two recording techniques, recording sites, and methods of analysis. The percentage incidence of both rhythms was similar for the mono and bipolar recording techniques in both parts of the colon. The incidence of the two rhythms in the transverse colon was approximately twice that recorded in the ascending colon, this being true for both recording techniques and methods of analysis, but neither was detected for more than 50% of the time. It is concluded that the methods of data analysis probably account for the differing incidences of electrical activity in the human colon that have been reported previously.


Method of preparing isolated colonic epithelial cells (colonocytes) for metabolic studies.

Suspensions of isolated colonic epithelial cells (colonocytes) have been obtained from rats by incubating everted lengths of colon with EDTA at 37 degrees C in Krebs-Henseleit saline from which calcium was omitted and containing 0.25% (w/v) bovine serum albumin. Measurements of oxygen consumption and lactate production by cell suspensions indicate that they are metabolically active for at least one hour. The method has been modified for the preparation of isolated epithelial cells from the human colon by including an enzyme digestion step and by increasing the concentration of EDTA to 10 mM. Human colonocytes have been obtained either from normal mucosa (ascending and descending colon) or from the mucosa in ulcerative colitis (descending colon). Oxygen consumption of human cell suspensions is lower than in the rat but in colonocytes from both species the rate is increased by glucose and by n-butyrate, a normal constituent of the colonic lumen. The method yields metabolically active cell suspensions from diseased colonic mucosa and promises to be of value for biochemical studies of ulcerative colitis.


High flow oxygen therapy for pneumatosis coli.

Symptomatic and radiological resolution of pneumatosis coli was achieved by intermittent high flow oxygen therapy in five patients. In each case the extent of the disease was defined by colonoscopy and contrast radiography before treatment. Despite the confirmation of pneumocyst resolution, recurrence of colonic gas cysts was noted in two patients at six months and one year after treatment. Bacteriological studies indicated that resolution of the disease, induced by oxygen therapy, was not associated with eradication of anerobic bacteria from stool and colonic mucosa. The clinical features and response to treatment of this group of patients are discussed, with particular reference to previously reported methods of oxygen administration.


Absorption studies in patients six to 10 years after construction of ileostomy reservoirs.

The absorption of fat, bile salts, and vitamin B12 was studied in 14 proctocolectomised patients six to 10 years after construction of a continent ileostomy. All patients were in excellent health and displayed no signs of malnutrition. Schilling test disclosed subnormal absorption of vitamin B12 in one patient and borderline values in five. Faecal loss of bile acid was increased in 12 patients and fat malabsorption occurred in two. Except for slightly pathological liver tests in two patients, routine laboratory tests, including plasma concentration of vitamin B12 and folic acid, were normal. There were no signs of sodium or potassium depletion.


Ultrastructural analysis of plasma cells in coeliac patients.

By accurate morphometry the length of the rough endoplasmic reticulum (RER) was estimated in electron micrographs of a population of jejunal plasma cells in biopsies obtained from normal volunteers, untreated coeliac disease patients, and coeliac disease patients treated for one year on a gluten free diet. Increase in length or hypertrophy of the endoplasmic reticulum is an indication of increased protein synthesis of the cell (Ghadially, 1977). An increase compared with normal length was demonstrated in the mean length of the plasma cell rough endoplasmic reticulum in plasma cells obtained from both groups of coeliac patients. This estimate of increased protein production--in this case immunoglobulin--indicates an increase in the immunological activity of plasma cells even after treatment and suggests not only a reaction to dietary gluten but probably to other antigens also.


Effect of 16,16-dimethyl prostaglandin E2 on the gastric mucosal barrier.

16,16-dimethyl prostaglandin E2 (16DM) can protect the gastric mucosa from injury and yet apparently damages the gastric mucosal barrier. The effect on the gastric mucosal barrier of 16DM (26.2 micromol/l), a dose 50 times the ED50 for inhibition of acid secretion, was investigated in Heidenhain pouches in four dogs by measuring plasma shedding from the pouches after the topical application of histamine (2.7 mmol/l) and ionic fluxes. The results were compared with those using 30% ethanol, a known barrier breaker. The topical application of histamine after three hours' perfusion with 30% ethanol led to plasma shedding at a rate of 7.5 (+/-2.6) ml/h, which was significantly greater than the rate of 1.2 (+/-1.4) ml/h after three hours' perfusion with 16DM and of 1.5 (+/-1.7) ml/h in the control group. Ethanol also caused an increase in the flux of H+, Na+, and Cl-, indicating an increase in mucosal permeability, whereas 16DM increased the flux of Na+ and Cl- but not of H+. It is concluded that 16DM does not damage the gastric mucosal barrier but stimulates the secretion of fluid containing Na+ and Cl-.


Lipid composition of bile in diabetics and obesity-matched controls.

Duodenal bile from 27 diabetes was compared with samples from healthy subjects matched for age, sex, and body mass index. Cholesterol saturation and the molar percentages of bile acids, phospholipids, and cholesterol were not significantly different. Most bile samples were supersaturated in both groups. The maturity onset diabetics who were almost all obese had more saturated bile than the slimmer juvenile onset patients. Body fatness and plasma triglyceride levels were both positively correlated with the cholesterol saturation of bile in the controls but not in the diabetics. Bile was less concentrated in female diabetics than in controls, which is consistent with impaired gallbladder emptying. It is possible that the increased prevalence of gallstones in diabetics is due not so much to diabetes itself as to the frequently associated obesity.


Amino acid control mechanism for bacitracin formation by Bacillus licheniformis.

Several amino acids affected the amount of bacitracin produced by Bacillus licheniformis ATCC 10716 and the high-yielding mutant B. licheniformis AL. The possibility of an amino acid control mechanism for bacitracin biosynthesis is discussed. The two strains showed a different response to the addition of some amino acids. This indicate that they may have differences in their amino acid control mechanism.


Effect of bacterial polysaccharides on the growth of Gaeumannomyces graminis var. tritici and wheat roots.

Agrobacterium sp. and related species which in the soil and in the rhizosphere of wheat accompany the fungus Gaemannomyces graminis var. tritici and cause take-all of the wheat roots produced polysaccharides in pure cultures (glucans, mannoglucans and galactomannoglucans). These polysaccharides were utilized better by the mycelium of G. graminis than glucose and polysaccharides of plant origin that occurred on the surface of wheat roots (the so-called mucigel). At lower concentrations these bacterial polysaccharides stimulated growth of wheat roots, higher concentrations (more than 0.1%) were inhibitory. Bacteria inoculated on the surface of wheat first inhibited and then stimulated the development of the plants and their growth. Changes in the growth rate of wheat, the rhizosphere of which was colonized by bacteria simultaneously with the fungus G. graminis and also some changes in the course of the disease of wheat roots caused by the fungus can be explained by the inhibitory or stimulatory effect of polysaccharides of accompanying bacteria.


Studies on the frequencies of PGM1, PGM3 and Es-D types from hair roots in Japanese subjects and the determination of these types from old hair roots.

The frequencies in Japanese subjects are reported of hair roots type PGM1, PGM3, and Es-D, and the determination of these types from old hair roots. The gene frequencies were: PGM11, 0.762; PGM21, 0.230; PGM 71, 0.008; PGM13, 0.621; PGM23, 0.379; Es-D1, 0.625; and Es-D2, 0.375. The old hair roots were analysed after storage at 25 degrees C, 4 degrees C and -80 degrees C; the enzyme activities were detected and typed at 25 degrees C within PGM1 10 days, PGM3 4 days, and Es-D 4 days.


Frequencies of salivary genetic marker systems in the Japanese population and their application to forensic medicine.

Seven salivary polymorphic systems were studied using whole and parotid saliva from random Japanese individuals. The gene frequencies obtained were: Pa+ = 0.212, Pb1 = 1.000, Pb2 = 0, Pr1 = 0.763, Pr2 = 0.237, Db+ = 0.051, Pm+ = 0.409, Ph+ = 0.026 and Amy1v = 0.013, respectively. Based on these gene frequencies, the chances for exclusion of falsely alleged fathers were calculated. The chance of exclusion on the basis of five salivary polymorphic systems was 0.305. The combined chance of exclusion utilizing only blood, serum and red-cell enzyme polymorphic systems among the Japanese population was 0.919; however, by applying salivary polymorphic systems to the calculation, the total exclusion rose to 0.944.


Determination of phenotypes of esterases (Set) in fresh saliva and saliva stains by disc electrophoresis and the distribution of Set phenotypes in the Japanese population.

A rapid and simple disc electrophoretic technique for the determination of saliva esterase (Set) types is described. The frequency of Set types was F 16.4%, FS 49.8% and S 33.8%. The estimated gene frequency of Set-1F was 0.413 and of Set-1S was 0.587. An accurate determination of Set types was possible in 5--7 week-old saliva stains. This system may be useful in medicolegal applications.


The significance of medicolegal autopsy in determining mode and cause of death.

A comparative examination has been made to evaluate decisions as to causes and modes of death among 436 consecutive medicolegal deaths before and after coming to autopsy. All available information was used. including police reports, in evaluating mode and cause of death prior to the autopsy. Among the women, the mode of death evaluation differed in 23.4% of the cases and the cause of death evaluation differed in 77.5% of the cases. Among the men, the mode of death evaluation differed in 23.4% of the cases and the cause of death evaluation differed in 46.9% of the cases. These figures were achieved, however, on the basis of the fact that in most cases the mode of death and cause of death were reported as unknown. After autopsy, the cause of death remained unknown in 3.3% of the females over the age of 2 years and in 4.2% of the male over the age of 2 years. No characteristic relationship was established between the differences found and the age groups. The investigation shows the importance of the medicolegal autopsy for correctly recording cases where the death is obscure.


[3 vaccines against influenza--which to choose].

Three types of a killed influenza vaccine are available in the Federal Republic of Germany: Whole-virus-vaccine, split-vaccine, subunit-vaccine. It is not only necessary to enforce the vaccination against influenza virus infection, but additionally to differentiate between the different types of vaccine in vaccinating children and adults with special risks.


Separation and identification of 9-chloro-10-methoxy (9-methoxy-10-chloro)hexadecanoic and octadecanoic acids in adipocere.

Two homologs of 9-chloro-10-methoxy(9-methoxy-10-chloro) fatty acids were found in adipocere from the human neonate, and identified as 9-chloro-10-methoxy(9-methoxy-10-chloro)hexadecanoic acid and 9-chloro-10-methoxy(9-methoxy-10-chloro)-octadecanoic acid. The chemical structures of these compounds were confirmed by thin-layer chromatography, gas-liquid chromatography, gas chromatography--mass spectrometry, nuclear magnetic resonance spectrometry and elemental analysis. The adipocere contained approximately 7.2% 9-chloro-10-methoxy(9-methoxy-10-chloro) fatty acids in the total fatty acids.


False positive reaction for carboxyhemoglobin in blood from liver tissue.

On spectrophotometric determination of carboxyhemoglobin in blood collected from the liver of three bodies at three days post-mortem, false positive results were found (5--15 per cent saturation), since samples of heart blood collected a few hours after death did not contain carboxyhemoglobin.


[Pathogenesis of essential hypertension. Plasma noradrenaline, plasma renin and pressor effects of noradrenaline and angiotensin in normotensive patients and patients with essential hypertension].

Plasma noradrenaline, plasma renin and pressor action of exogenous noradrenaline and angiotensin in normotensive subjects and patients with essential hypertension. In normotensive subjects an inverse correlation was observed between the index of sympathetic nervous activity, the plasma noradrenaline concentration during physical exercise, and reactivity to exogenous noradrenaline. The relationship between the index of sympathetic nervous activity and reactivity to noradrenaline was invariably disturbed in age-matched patients with essential hypertension. A multiple regression analysis revealed a highly significant correlation between the combination of both factors and the height of mean arterial blood pressure (r = 0.91). The data suggest that both factors combined, sympathetic nervous activity and pressor response to noradrenaline, are an important determinant of the arterial blood pressure level. An inverse relationship could also be demonstrated between plasma renin concentration and pressor response to angiotensin II in normotensives and hypertensives. However, this relationship was unaltered in the hypertensives. Therefore angiotensin II does not appear to contribute directly to the high blood pressure.


[The animal experiment in toxicology. Current situation and further development].

In view of recent public reproaches against medical animal experimentation this article describes the present status of animal experimentation in the field of toxicology. Possible perspectives and the limitations of "alternative" methods are reviewed. Toxicological methods which are based on cell culture and metabolic in vitro-systems, as well as "short-term-tests" for mutagenicity and/or carcinogenicity are invaluable for screening purposes. However, a risk assessment, i.e., evaluation of hazard of chemical compounds to man, must be based on animal experiments. Further efforts must be directed towards improvement of extrapolation of toxicological results from one species to the other.


The human distribution of some barbiturate sedatives in combination with miscellaneous CNS-active drugs.

This paper presents 14 cases in which the distribution of barbiturates and the hydroxylated metabolites in combination with miscellaneous CNS-active drugs was studied. In 7 of these cases the other drug present was methadone, and in the remainder dihydrocodeine, morphine, propoxyphene, amitriptyline, meprobamate, cyclizine and dipipanone, diphenhydramine and methaqualine. Amitriptyline, methadone, cyclizine and dipipanone, methaqualone and diphenhydramine appeared to modify the distribution of amylorbarbitone and quinalbarbitone. Likewise, the barbituates seemed to alter the distribution of amitriptyline, propoxyphene and, in one instance, methadone.


[Acetlysalicylic acid, protective antacid effect and lesions of the gastric mucosa. Effect of acetylsalicylic acid and an antacid drug (Gastropulgit Tabs) on the transmural electric potential in the human stomach].

Antacids are able to prevent acetylsalicylic acid-induced functional and morphological changes of the gastric mucosa. In order to test whether a new antacid in chewing-tablet form (Gastropulgit Tabs) might be able to protect the gastric mucosa from acetylsalicylic acid-induced functional changes similarly to liquid antacids the effect of this antacid on acetylsalicylic acid-induced changes of transmural gastric potential difference was measured in healthy volunteers. The decrease of transmural potential differences induced by 640 mg acetylsalicylic acid could be prevented by simultaneous addition of 2 tablets of Gastropulgit Tabs. Thus the antacid in tablet form is able-like liquid antacids-to protect the gastric mucosa against acetylsalicylic acid-induced functional changes.


[Studies on the estimation of the postmortem interval. 9. Synthetic judgment of all sorts of cadaveric findings (author's transl)].

The authors have investigated the relationship between the postmortem interval and all sorts of cadaveric findings, summarizing the results of the previous reports, and have devised a cadaveric-phenomena diagram and a chart with which the postmortem interval can be estimated easily. The validity and utility of the diagram and the chart have been demonstrated by applying them to other autopsy cases than those from which they have been derived.


[Chronic hepatitis--clinicopathological studies of 687 cases (author's transl)].

Chronic hepatitis is one of liver diseases with arguments from the clinical and histopathological aspects. Histopathological examinations were made on 687 biopsy cases clinically diagnosed as chronic hepatitis. Histopathological classification was based on our own criteria by referring to discussions in the series of Inuyama symposia on hepattis and others. The correlation between histological diagnosis and clinical data was also examined. Histopathological diagnoses made of the 687 cases were classified as follows; normal liver or liver with no pathognomonic changes of 77 cases (11.2%), non-specific reactive hepatitis of 56 cases (8.0%), viral hepatitis of 488 cases (71.0%), alcoholic hepatitis of 25 cases (3.6%), fatty liver of 23 cases (3.3%), massive liver necrosis of 3 cases, liver fibrosis of 2 cases, congestive liver of 1 case, and unclassified 12 cases due to inadequate specimens or other reasons. Among 488 viral hepatitis cases, histological stages were as follows; acute hepatitis (38 cases, 7.8%), persistent hepatitis (23 cases, 4.7%), chronic inactive hepatitis (142 cases, 29.1%), chronic active hepatitis (165 cases, 33.8%), chronic hepatitis with subloblar necrosis (33 cases, 6.8%), precirrhosis (51 cases, 10.5%), cirrhosis (27 cases, 5.5%). The relationship between histological aspects and clinical features was discussed by sex, age, and others. Of 41 follow up cases, significant values of histological type, presence of HB ag., or alcoholic were discussed as for the causative factors evolving liver cirrhosis.


[Studies on the diagnosis of schistosomiasis japonica. (1) Circumoval precipitin (COP) test as a method of screening of the subjects for fecal examination (author's transl)].

Examinations were performed on 351 individuals of Shikishima village, Yamanashi Prefecture. Three fecal samples were collected at one-week intervals and examined by MIFC method without iodine. Reactions with a diameter of 9 mm or more in wheal and/or 20 mm or more in erythema were regarded as the positive for the intradermal reaction using Melcher's antigen (1 : 1,000). For the COP test, each one drop of serum and a saline suspension of eggs were mixed on a microscope slide and sealed a coverslip with vaseline. The number of eggs showing precipitates were counted after 48 hrs at 37 degrees C. The results showed that all the precipitates were small in size in the COP titer less than 40%. Medium precipitates appear first in the cases of a 40.% class and the percentage increased thereafter as the COP titer increased. Large precipitate was found in 10% of the eggs affected in a 50% class and found in 40% in the titer of a 80% class. Of 351 tested, a significant higher rate of egg-passers (42.7%, 41/96) was obtained in the COP reactors, as compared with other two groups; 19.4% (41/211) in the dermal reactors, 11.7% (41/351) in the total subjects. Moreover, the egg-passers were recovered in 60--70% of the cases in the COP titer of more than 70%. It was considered that the COP test was a useful diagnostic method for schistosomiasis japonica and the sensitivity and efficiency of this test were superior to those of intradermal test with regarded to the screening of the subjects for fecal examination.


[Halothane-pentazocine interaction in dogs (author's transl)].

It is known that narcotics reduce the alveolar concentration of inhalation anesthetics in man and animals. However the magnitude and duration of narcotic effect on inhalation anesthesia is not known. Accordingly, I determined in dogs the temporal effect of various doses of pentazocine, a commonly used anesthetic adjuvant, on the minimum alveolar concentration (MAC) of halothane. In addition, I compared plasma pentazocine concentrations in dogs both awake and during halothane anesthesia using an identical intramuscular dose of pentazocine. Intramuscular injection of pentazocine, group II (2.5 mg/kg), group III (5 mg/kg), group IV (10 mg/kg) reduced MAC of halothane required for anesthesia. The magnitude of MAC depression were 19.3% of control halothane MAC in group II, 36.4% of control in group III and 41.7% of control in group IV. Postinjection plasma concentration was fitted by computer with a 2-compartment open pharmacokinetic model. Plasma pentazocine concentration for awake (group I) and anesthetized (group II) dogs given the same dose (2.5 mg/kg) did not differ significantly on biological half-life, total apparent volume of distribution and body clearance. Halothane minimum alveolar concentration (MAC) was correlated to plasma pentazocine concentration (r= -0.60) and cerebrospinal fluid pentazocine concentration (r= -0.74).


Sodium sparing effect of alanine in fasting obese females.

In obese females, 50 g of alanine given orally on the fifth day of fasting, produced a decrease in urinary sodium that persisted the following day. Plasma renin did not increase the day following alanine intake.


Effect of experimental diabetes on the incorporation of amino acids into protein in rat aorta.

The incorporation of 14C-labelled leucine or phenylalanine into alkali-soluble protein was determined under in vitro conditions in aortic intima-media of normal and streptozotocin-diabetic rats. Two weeks after the induction of diabetes the incorporation of the amino acids into aortic protein was reduced. When determined after diabetes of one week's duration the leucine-14C incorporation was not significantly reduced, while after 5 weeks of diabetes it was severely impaired. After administration of insulin to diabetic rats in vivo for 2 weeks there was no difference in leucine-14C incorporation between normal and diabetic rats. Addition of insulin (0.1 U/ml) in vitro had no effect on the leucine-14C incorporation in either normal or diabetic aorta during incubation times of 3 or 6 h. Elevation of the glucose concentration in vitro from 5.6 to 22.2 mmol/l did not influence the leucine incorporation in diabetic aorta. Both the aortic wet weight and the aortic content of alkali-soluble protein were decreased after 5 weeks of diabetes. The decrease in the protein content of aorta of diabetic animals suggest that the protein synthesis is impaired in vivo.


Indomethacin fails to alter basal or phenothiazine-induced prolactin concentrations in man.

In order to evaluate the possible role of prostaglandins in pituitary prolactin (PRL) secretion, PRL was serially measured following perphenazine (Trilafon) ingestion in 8 men before and after 5 days of indomethacin administration. Since estrogens have been shown to modulate prolactin secretion in man, serum steroids including estrone (E1), estradiol (E2), progesterone (P) and testosterone (T) were measured before and after indomethacin ingestion. Serum E1, P and T levels were similar during the pre- and post-indomethacin study periods: 56 +/- 4 (1 SEM) vs 48 +/- 5 pg/ml, 298 +/- 28 vs 315 +/- 32 pg/ml, and 8.1 +/- 0.7 vs 8.6 +/- 0.7 ng/ml, respectively. Serum E2 levels were slightly, but significantly, lower following indomethacin treatment at 30 +/- 3 vs 37 +/- 3 pg/ml (p less than .01). Basal serum PRL concentrations were unaffected by indomethacin administration (9 +/- 3 pre- vs 8 +/- 2 ng/ml post-drug treatment). Integrated perphenazine-induced PRL responses were likewise similar during the 2 study periods: 101 +/- 16 ng . hr/ml during the control period and 104 +/- 14 ng . hr/ml following indomethacin. Thus, short-term indomethacin treatment had no effect on basal or perphenazine-stimulated PRL secretion in men.


The blocking effect of magnesium on the secretion of adrenal catecholamines induced by the omission of sodium from the extracellular medium.

The blocking action of Mg++ on catecholamine release induced by the substitution of extracellular Na+ by an osmotic equivalent amount of sucrose was studied in isolated, perfused bovine adrenal glands. Perfusing glands with 10 mM Mg++ produced at 51.1% inhibition on catecholamine release evoked by Na+ omission. Increasing the concentration of Mg++ to 20 mM this inhibitory effect was enhanced to 90.3%. D-600 (0.3 mM) promoted a marked blockade of acetylcholine-induced release of catechol hormones that was partially and significantly reverted increasing the concentration of Ca++ in the perfusion medium. D-600 (0.3 mM) failed to inhibit the catecholamine-releasing effect of Na+ deprivation. In adrenal glands previously perfused with D-600 (0.3 mM) and then exposed to a Locke solution containing D-600 (0.3 mM) + Mg++ (10 or 20 mM) the inhibition of the secretory responses evoked by the omission of Na+ was of the same magnitude as that obtained when the glands were perfused with Mg++ (10 or 20 mM) in the absence of D-600. These results are compatible with the view that the blocking effect of Mg++ may involve an intracellular site of action and that the access of Mg++ into the chromaffin cell may not be mediated through the Ca++ channels.


Plasma vasopressin variation and renin activity in normal active humans.

Plasma concentrations of vasopressin and plasma renin activity were measured every 30 min for 24 h in 5 normal active humans, in 1 normal woman confined to bed (except for brief periods up to the bathroom), in 2 active patients with primary aldosteronism and in 1 patient with low-renin hypertension. Plasma vasopressin varied markedly over the day and night in a pattern suggesting episodic secretion of the hormone in the normal subjects. Assumption of upright posture was accompanied by a rise in plasma levels from undetectable to 20--50 pg/ml. Episodic secretion, however, also occurred during bed rest and sleep. In contrast, patients with primary aldosteronism and low-renin hypertension had plasma vasopressin levels considerably lower than the normals, and their profiles of plasma concentration lacked the peaks seen in normals. In the normals, although vasopressin and renin secretion often coincided, only 2 of 6 studies showed a significant correlation between the plasma levels of the two hormones. This study, therefore, shows that vasopressin is secreted periodically in normal humans, that upright posture is an important modulator of secretory activity and that the renin-angiotensin system may or may not influence the pattern of secretion. In addition, it underlines the necessity of recumbency in establishing the existence of a circadian rhythm of plasma vasopressin levels.


Comparative study of ethynyloestradiol metabolism in the rabbit, guinea pig and rat.

Ethynyloestradiol was administered to rabbits, guinea pigs and rats, and the concentration of the steroid in blood was measured by radioimmunoassay. In both rabbits and guinea pigs, levels of conjugated steroid were much higher than those of the freely extractable form. Whereas considerable amounts of steroid were present in a congugated form in plasma 24 h after injection, none was present at this time in a freely extractable form. There were significant differences between young and adult rabbits and guinea pigs in the rate at which ethynyloestradiol was metabolized. The amounts present in the freely extractable form in rats were higher than in the other two species but no steroid was detected in the conjugated fraction. The results are compared with previous findings in humans.


[Microbial degradation of papaverine (author's transl)].

A bacterium growing on papaverine as sole carbon and nitrogen source was isolated by incubation of soil with papaverine. The bacterium could be identified as a Nocardia strain by morphological and physiological tests. When growing on papaverine, this strain excretes metabolites into the medium. Based on the structure of the metabolites 1--9 a degradation pathway is proposed. 1 = 1-(3,4-Dimethoxybenzyl)-3,4-dihydro-6,7-dimethoxy-3,4-isoquinolinediol; 2 = 1-(3,4-dimethoxybenzyl)-6,7-dimethoxy-3,4-isoquinolinediol; 3 = 2-(3,4-dimethoxyphenyl)-1-[2-(2-hydroxyethyl)-4,5-dimethoxyphenly]ethanone; 4 = 2-hydroxy-4,5-dimethoxybenzeneethanol; 5 = 3,4-dimethoxybenzeneacetic acid; 6 = 2-hydroxy-4,5-dimethyoxybenzeneacetic acid; 7 = 4-hydroxy-3-methoxybenzeneacetic acid; 8 = 3,4-dimethoxybenzaldehyde; 9 = 2-(hydroxymethyl)-4,5-dimethoxybenzeneethanol.


A novel method for the rapid purification of human and rat fibrin(ogen) degradation products in high yields.

A novel method is described for the preparation and purification of fibrin(ogen) degradation products in high yields. The high yields are due to two factors: a) an improved preparation method in which the heterogeneity in the size of the degradation products D is greatly reduced by performing the digestion with plasmin at well-controlled calcium concentrations (see ref.[22]). b) a new purification method, which includes Sephadex G-200 filtration and separation of D and E fragments by preparative isoelectric focusing. The latter step gives a complete separation of D and E fragments, without any overlap, and with a nearly 100% recovery in a short period of time. The properties of human and rat fibrin(ogen) degradation products are very similar.


Hemocyanins in spiders, VI[1]. Comparison of the polypeptide chains of Eurypelma californicum hemocyanin.

The subunits of the hemocyanin from the tarantula, Eurypelma californicum, were isolated, following dissociation at pH 9.6, by a sequence of chromatographic and electrophoretic steps. Fraction 2 (containing two chains, a and c2) and the constituent polypeptide chains of the dimeric subunit 4D (b and c4) were resolved by anion exchange chromatography at pH 8.9 and 6.5, respectively. Since c2 and c4 have different electrophoretic mobilities in polyacrylamide gradient gels, the total number of different polypeptide chains is seven. The amino acid compositions of the seven chains are reported. There are major differences for at least half of the amino acids, while more consistent proportions become evident, if the amino acids are grouped by types of side chains. The N-terminal amino acid is proline in the case of chains b and e,, while no end group called be detected in any of the other chains by different methods. The C-terminal end group was found to be valine in both chains d and e. Cleavage by 70% formic acid, and by cyanogen bromide in formic acid results in fragmentation patterns distinct for each chain. After cyanogen bromide cleavage, the two largest peptides of each chain are of molecular weight near 2400. Tryptic fingerprints also reveal significant differences between all chains. Subunit heterogeneity of Eurypelma hemocyanin is clearly not the consequence of secondary modifications, but resides in major differences of the amino acid sequences.


Purification and N-terminal amino acid sequence determination of anionic and cationic canine trypsinogens.

Anionic and cationic canine trypsinogens were purified from pancreatic juice by affinity chromatography with Trasylol coupled to Sepharose 4B followed by ion exchange chromatography with SP-Sephadex C-50. Automatic N-terminal amino acid sequence determination showed the following structures for the activation peptides: Thr-Pro-Thr-Asp-Asp-Asp-Asp-Lys for anionic trypsinogen, and Phe-Pro-Ile-Asp-Asp-Asp-Asp-Lys for cationic trypsinogen.


[The primary structure of the hemoglobin of the greylag goose (Answer anser) and the unequal evolution of the beta-chains (an experimental approach to a biochemical analysis of behaviour (author's transl)].

The primary structures of the alpha- and beta-chains from greylag goose (Anser anser) hemoglobin are given. The sequence was deduced automatically in the sequenator. They differ from chicken alpha-chains in the exchange of 30, from beta-chains in the exchange of only 8 amino acid residues, respectively. The contact points of inositol pentaphosphate with the beta-chains are identical in chicken and greylag goose. Unequal evolution of the beta-chains was found, which is published here for the first time. By comparing the sequences of chicken and greylag goose and considering paleontological data, we found the mutation rate of the alpha-chains to be normal, i.e. 6 million years/mutation. This corresponds to the values for other species. The mutation rate of beta-chains is reduced and was calculated at 25 million years/mutation. This is possibly due to a specific function of beta-chains. This paper is the basis of our attempt to explain on a molecular basis the ability of bar-headed goose (Anser indicus) to fly and breathe at high altitudes.


Hepatic membrane proteins involved in ribosome binding: identification by three procedures.

Rat liver ribosomes, isolated from rough-surfaced endoplasmic reticulum using non-ionic detergent in the presence of 25 mM KCl, were associated with non-ribosomal proteins, presumably of membranous origin. These proteins could be isolated by extracting such ribosome fractions with either deoxycholate or non-ionic detergents at higher concentrations of KCl. Analysis of the extracts by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulphate revealed the presence of a number of discrete polypeptides having the following approximate molecular weights: 166,000, 107,000, 100,000, 65,000 and 36,000. Ribosomes associated with the membrane-derived proteins reattached to degranulated membranes in vitro less well than did ribosomes prepared in ways which removed the proteins. Extraction of a set of similar proteins from degranulated endoplasmic reticulum by treatment with buffered 1 M urea, also interfered with ribosome reattachment. A third approach to the identification of proteins associated with ribosome attachment sites involved the labelling with radioactive succinic anhydride of apparently similar proteins in degranulated membranes, after prior treatment of the latter, before removal of bound ribosomes, with unlabelled reagent. The results indicate that certain membrane proteins may be part of the receptor sites for binding of ribosomes to the endoplasmic reticulum in rat liver.


[Synthesis of the human proinsulin sequence 71-86, I: Synthesis of sequence 71-86 as a monomeric cyclic biscystine peptide derivative and as its tetra-S-trityl derivative (author's transl)].

The synthesis of sequence 71-86 of human proinsulin (sequence 6-21 of human insulin A-chain) via its monomeric cyclic dicystine peptide derivative (XXII) and the corresponding tetra-S-trityl-peptide derivative (XVIII) is described. The good solubility of the derivatives (XXII, XVIII) in orgranic solvents makes it possible to purify both the derivatives in their protected form. The S-trityl derivative (XVIII) enables the synthesis of the fragment 71-86 in a scale needed for the planned synthesis of human proinsulin.


Synthesis of human proinsulin sequence 71-86, II: Improved synthesis of the fragment.

An improved synthesis of a fully protected hexadecapeptide Bpoc-Cys(Trt)-Cys-(Trt)-Thr(But)-Ser(But)-Ile-Cys(Trt)-Ser(But)-Leu-Tyr(But)-Gln-Leu-Glu(OBut)-Asn-Tyr(But)-Cys(Trt)-Asn-OBut, which corresponds to the amino acid sequence 71-86 of human proinsulin, is described. The final product was obtained by the condensation of three fragments 71-74, 75-77 and 78-86.


[Synthesis of the human proinsulin sequence 71-86, III: Synthesis via the fragments 71-78 and 79-86 (author's transl)].

The synthesis of the sequence 71-86 (XIII) of human proinsulin (sequence 6-21 of human insulin-A-chain) via the fragments 71-78 (XIy1,3) and 79-86 (XII) is described. The good solubility of the protected peptide derivatives belonging to the sequences 75-78 (IXx1,2), 79-86 (X), and 71-78 (XIy1,2), and of the fragment 71-86 (XIII) itself in organic solvents allows a quick and efficient purification of these derivatives by liquid chromatography on silica-gel columns.


Localization of the charge differences in the actins of rabbit skeletal muscle and chicken gizzard by two-dimensional gel electrophoretic analysis of tryptic fragments.

Partial tryptic cleavage products of pure actin from rabbit skeletal muscle and chicken gizzard are compared by two-dimensional electrophoresis in polyacrylamide gels with respect to isoelectric point and molecular weight. While the intact polypeptides (Mr 42,000) have different isoelectric points, two large cleavage products (Mr 35,000) generated from both both actin species have identical isoelectric points and identical molecular weights. These relatively trypsin-resistant cleavage products are presumably identical to the known "core actin" fragments which lack the aminoterminal region of the polypeptide chain. Therefore the differences that are responsible for the different isoelectric points of rabbit skeletal muscle actin and chicken gizzard actin seem to be restricted to the aminoterminal part of the actin polypeptide chains as was proposed on the basis of partial amino acid sequence data.


[Synthesis of tyrosin O-sulfate-containing peptides (author's transl)].

A new synthetic route to tyrosine-O-sulfate-containing peptides based on the direct use of N alpha-acyltyrosine-O-sulfate is described and exemplified by the synthesis of the [Thr28,Leu31]cholecystokinin-pankreozymin-(25-33)-nonapeptide.


Müllerian adenosarcoma of the uterine body: a report of nine cases.

Nine cases of Mullerian adenosarcoma of the uterine body, first defined in 1974 by Clement & Scully, are described. The tumour usually occurs in elderly women and appears macroscopically as a polypoid mass filling the uterine cavity. Histologically these neoplasms are characterized by having a benign epithelial component set in a sarcomatous stroma. The epithelial element consists of tubular glands, cystically dilated glands and a surface epithelium. The glandular and surface epithelium usually resembles that of proliferative endometrium but may be of mucinous type and can undergo squamous metaplasia. Occasional mitotic figures, multilayering and intraluminal tufting are seen in the actively growing but benign glands which are considered to be an integral component of the tumour. The sarcomatous stroma contains spindle cells, round cells and, less frequently, multinucleated giant cells and rhabdomyoblasts. The Mullerian adenosarcoma represents a relatively benign variant of the mixed mesenchymal sarcoma of the uterus and is probably more common than is generally realized. Myometrial invasion is rarely deep and the majority of patients with this neoplasm survive. Vaginal recurrence occurs only in a minority of patients and distant metastasis is exceptional.


Morphological findings in idiopathic calcification of the ascending aorta and aortic valve affecting a young woman.

The pathology of a case of idiopathic calcification affecting the ascending aorta in a young woman is presented. A varying width of media throughout the aorta and extending into its proximaques of calcium, found in the acellular media, were confined to the ascending aorta. No inflammatory or reparative reaction was seen in the vessel wall. Electron microscopically, the calcium seemed to have an affinity for elastic tissue elements of all sizes and the mode of deposition appeared to be by 'avenues' of the microfibrillar component. Possible pathogenetic mechanisms are discussed.


A variant of intestinal metaplasia associated with gastric carcinoma: a histochemical study.

Gastrectomy specimens including 32 cases of carcinoma and 35 cases of peptic ulcer were examined in detail histologically and histochemically to show the distribution of intestinal metaplasia (IM) and types of mucin secreted. A variant of IM, with extensive involvement of both antrum and body and excessive secretion of sulphomucin, was found to be associated with carcinomas showing appreciable extracellular sulphomucin secretion. The identification of such a variant of IM may help the interpretation of gastric biopsies.


Temporal (granulomatous) arteritis: a histopathological study of 32 cases.

Thirty-two cases of temporal arteritis were reviewed. All patients were adults with a mean age of 69.6 years, and no sex predominance. The erythrocyte sedimentation rate was raised and there was a good response to steroid therapy in the 29 patients who were adequately documented and followed up. Detailed histopathological study of the temporal artery biopsies showed three main histopathological variants; 12 cases (37.5%) had predominantly intimal proliferative changes, four cases (12.5%) had granulomatous inflammation without giant cells and 16 (50%) had granulomatous inflammation with giant cells. The predominantly intimal change variant, consisting of a cellular proliferation of fibroblasts and myointimal cells with little or no changes in the media represent an active pathological process and not a healed disease as has been previously suggested. The internal elastic lamina showed abnormal features in all three morphological variants. The need to recognize this variant, the temporal relationship between these variants and the need to study multiple sections are discussed. Biopsy of clinically normal temporal arteries in patients suspected of having temporal arteritis is recommended as some of these vessels may show disease. No correlation was observed between the clinical picture and the histopathological findings.


The pathology of a cricopharyngeal dysphagia.

The paper describes the changes in the cricopharyngeal muscle in seven cases of dysphagia resulting from obstruction at this level which was relieved by myotomy. Histological features included degeneration and regeneration in the muscle fibres with interstitial fibrosis which was severe in some of the cases. It is considered that this restrictive fibrosis is the cause of the dysphagia and that it is secondary to muscle fibre damage, the cause of which is at present obscure. Minor degrees of muscle damage and regeneration were seen rarely in controls and fibrosis was never present. There was no evidence of underlying vascular or neurological disease in six cases; the seventh had a previous history of scleroderma but this was not thought to be the cause of the cricopharyngeal lesion. The age incidence ranged from 1 to 5 years at the onset of dysphagia; in six of the seven it was 50 years or more.


Case report: ultrastructure of mature neurogenic implants from ovarian immature teratoma.

An ultrastructural study of mature (grade O) neurogenic peritoneal implants from an ovarian immature teratoma grade I is presented. The presence of different types of neuroectodermal cells challenges the current terminology of this lesion, which implies a single proliferating cell type. The ultrastructural features were indicative of maturity in all cell lines and even the neurons exhibited well formed synapses. Marked cytoplasmic fibrillary change, similar to that found in central nervous system gliosis, was observed in the astrocytes. The ependymal cells had abnormal cilia with an altered configuration and number of microtubules.


The non-specific nature of the myocardial wavy fibre.

Wavy myocardial fibres were found in about half each of a series of 28 normal and 31 infarcted human hearts, as well as in the normal heart of an infant. Such fibres were also seen in rather more than half of a series of normal rat hearts. Thus, the wavy fibre is not a specific feature of acute ischaemic heart disease. Some experimental evidence was obtained that patchy loss or preservation of ATP promotes the formation of wavy fibres.


Sudden unexpected cardiac death--a practical approach to the forensic problem.

Sudden cardiac death can usually be resolved by the pathologist into ischaemic heart disease, non-vascular cardiac disease such as aortic stenosis or hypertrophic obstructive cardiomyopathy and infrequently a morphologically normal heart on naked eye examination. When ischaemic heart disease is present one third of cases have a recent occlusive coronary artery thrombosis. Two thirds of patients have coronary stenosis only; the minimum degree of disease reasonably associated with sudden death is one area of 85% stenosis. The majority of patients, however, have multiple areas of stenosis. The predominant causes of non-ischaemic sudden death are severe LV hypertrophy, hypertrophic obstructive cardiomyopathy and the prolapsing mitral valve syndrome. Where the heart and coronary arteries are morphologically normal, review of any previous ECG's, a family history and histological examination of the myocardium and conduction system may reveal a cause or at least allow a reasonable assumption of cardiac arrhythmia to be made. Sudden unexpected death where the circumstances strongly suggest a cardiac cause may pose problems for the pathologist. Ischaemic heart disease (coronary atherosclerosis) is undoubtedly the most frequent cause but even when this is so the detailed pathology is controversial. It is when coronary artery disease is conspicuously absent, often in young individuals previously in good health, that a problem exists. Sudden death in infancy (cot death) is a different entity with its own problems and is not here discussed further.


New findings of a lamina densa in relation to plasma cells.

In an ultrastructural study of oral lesions in lichen planus, it was found that some plasma cells have an associated lamina densa. Subsequently, similar appearances have been found in pemphigus vulgaris, in the inflammatory cell infiltrates in dental granulomas and cysts and in a patient with Ehlers-Danlos syndrome. The lamina densa was mainly present adjacent to those parts of the membrane of the plasma cell that were invested with fibrillar connective tissue. The lamina was similar in thickness and electron density to that surrounding Schwann cells and endothelial cells. It is believed that lamina densa has not previously been reported in relation to plasma cells. It is of interest that in all other situations in which lamina densa has been described, the cells are considered to be part of the normal cell population of the tissue, whereas plasma cells are not regarded as part of the resident population of connective tissue.


Hodgkin's disease with lymphocytic predominance, nodular type (nodular paragranuloma) and progressively transformed germinal centres--a cytohistological study.

The histology, cytology, and enzyme cytochemistry of a nodular variant of Hodgkin's disease with lymphocytic predominance, called 'nodular paragranuloma', are presented. The histological features of nodular paragranuloma are compared with those of progressively transformed germinal centres, which are enlarged follicles showing a predominance of small lymphocytes and some residual germinal centre cells. Progressively transformed germinal centres are sometimes found in nonspecific lymphadenitis (reactive hyperplasia). The histological similarity and the association between lymph nodes with nodular paragranuloma and lymph nodes with progressively transformed germinal centres in the same patient at different moments or at the same time, suggest that progressively transformed germinal centres are the origin of nodular paragranuloma. Hence, it must be concluded that nodular paragranuloma takes place in B-cell areas of the lymph node, unlike the other, or at least most of the other, types of Hodgkin's disease.


Benign and malignant lymphoid lesions of the stomach. A histological reappraisal in the light of the Kiel classification for non-Hodgkin's lymphomas.

Twenty-two cases of lymphoid tumours of the stomach were reviewed by application of the Kiel classification for non-Hodgkin's malignant lymphomas. Four cases of pseudolymphomas were found, one of which had been previously misdiagnosed as malignant lymphoma. The remaining cases were all malignant tumours with B-cell lymphoma features. These were divided into seven low grade lymphomas (three immunocytomas and four centroblastic/centrocytic) and II high grade lymphomas (six centroblastic and five immunoblastic lymphomas). No cases of Hodgkin's disease or lymphoblastic lymphoma were observed. The Kiel nomenclature was not only easy to apply, but also helped to differentiate pseudolymphoma from malignant lymphoma. Both the pseudolymphomas and the malignant lymphomas were consistently associated with follicular gastritis. This lesion, while intrinsically non specific, was sometimes accompanied by suggestions of transition between itself and the lymphoma, a fact which at least raises the possibility of a transformation of the former into the latter.


The trachea in children with tracheo-oesophageal fistula.

Forty tracheas from children with tracheo-oesophageal fistulae were histologically analysed for structural deformity. Thirty (75%) had a deficiency of cartilage; 24 (60%) showed an increase in the length of the transverse muscle, and 26 (65%) had a longer than average internal perimeter. Only six tracheas were entirely normal. The position of the fistula bore little relationship to the abnormalities found. Since in only nine patients were abnormalities restricted to the site of the fistula, we believe that careful examination of the whole length of the trachea is needed at the time of surgery to determine the extent of the anomaly and to anticipate tracheal problems. This is also relevant to autopsy studies and to elucidate the cause of death.


Foetal remnants in the uterus and their relation to other uterine heterotopia.

Foetal remnants were found in uterine curettings obtained from three women complaining of irregular vaginal bleeding. These findings are discussed in relation to other cases in the literature in which heterotopic tissues have been found in curettings and also for the light they throw on the origin of the so-called uterine teratomas.


The effect of deinstitutionalization on the state hospital.

Recalling the important statement about the bankruptcy of the state hospital system and the need for a multitude of treatment settings made by Harry Solomon, M.D., in 1958, the authors acknowledge that the changes he prophesized have largely come about. Using the Massachusetts Mental Health Center as the model, they describe how an inpatient unit operates as part of a deinstitutionalized network of services for seriously ill patients. They discuss the five general types of patients admitted and the problems of providing adequate care to such a diverse population. Finally, they make a strong plea for the establishment of regional facilities to care for patients with unusual, complicated problems.


The effect of deinstitutionalization on a general hospital's inpatient psychiatric service.

As a result of the deinstitutionalization movement, increasing numbers of former state hospital patients are being rehospitalized in general hospital psychiatric units. Because of this change in patient population, the general hospital has had to adjust its treatment strategy to emphasize meticulous review of previous psychiatric history, including medications; plans for meeting the patients' posthospital housing, vocational, and social needs; and development of plans with community care-givers for continuing care. General hospital staff members have to be educated to develop competence in working with the new patient population and a tolerance for chronicity; that can be done through several forums ranging from large staff meetings to individual supervision.


Paradoxes in programming for chronic patients in a community clinic.

In attempting to build a successful program for chronic patients at the Somerville (Mass.) Mental Health Clinic, the authors first found it necessary to uncover, address, and resolve six fundamental paradoxes engendered by deinstitutionalization that were stressful to mental health clinic staff and inhibited effective programming. The paradoxes involve issues relating to community mental health ideology, clinicians' sources of self-esteem and professional ability, and clinicians' views of chronicity and the deinstitutionalization movement in general. Resolution of the paradoxes requires major value changes, which can be brought about by effective clinical leaders who serve as role models and teachers, and who set the tone for patient care.


From the hospital to the prison: a step forward in deinstitutionalization?

In Massachusetts there is a growing trend to transfer both direct and indirect mental health service delivery from civil mental hospitals to prison facilities. Three factors associated with deinstitutionalization and a community-based delivery system appear to have contributed to the trend. Those factors are the over-all compromising of programming caused by unitization of state hospitals and the requirement that a full range of psychiatric services be available in every community, the decrease in morale and training of state hospital employees not involved in community treatment, and the lack of outreach to patients in the community who are dangerous or difficult to deal with.


Deinstitutionalization: avoiding the disasters of the past.

The reasons for the problems created by deinstitutionalization have only recently become clear; they include a lack of consensus about the movement, no real testing of its philosophic bases, the lack of planning for alternative facilities and services (especially for a population with notable social and cognitive deficits), and the inadequacies of the mental health delivery system in general. Providing care for the chronically ill and preparing for future deinstitutionalization means that the issue must be reconceptualized not as one of where people should be housed but as the need to provide the full range of treatments and services that are available in a total institution. Attitudinal and institutional biases and discriminatory practices must be combated, planning for community facilities and services must be improved, and funding for both institutional and community services must be provided during the phasing down of institutional services. The author proposes a set of ten commandments or basic rules to guide future deinstitutionalization activities.


An assessment of after-hours visits to a community mental health center.

Walk-in clinics, originally established in community mental health centers to provide primary and secondary prevention through around-the-clock emergency services, may be serving many people other than those in crisis. The authors conducted an 11-week study of utilization patterns at one center's after-hours walk-in clinc and found that most of the patients were already enrolled in psychotherapy sessions at the center. Some might have been acting out resistance in therapy, the authors theorize. Few patients seen for the first time at the clinic later enrolled in psychotherapy, and few inpatient admissions were made. Although the authors assert that walk-in clinics provide a valuable service, they question whether their original purpose has been distorted and whether the services they provide are always therapeutic.


Famous works of art create a therapeutic patient environment.

Works of art by famous American artists hang in patient rooms, in hospital corridors, and in outpatient clinic waiting rooms. An art library allows patients to choose paintings for their rooms, giving them some control over their hospital environment.


Health care in the shadow of Old Faithful.

Yellowstone National Park is served by a unique hospital and clinic system that includes primary care, inpatient stabilization, and professional education for health care professionals.


AHA surveys major source of hospital data.

The Annual Survey of Hospitals and the National Hospital Panel Survey work together to provide a thorough picture of hospital activities.


New life for the country doctor.

Health Systems Research Institute, a Utah-based hospital and clinic system, is successfully recruiting physicians for rural areas through creation of 'a dispersed group practice'.


Survey shows who is sharing which services.

An AHA survey shows overall growth in shared services from 1975 to 1978 and participation according to type of hospital, bed-size category, type of service, and other specifics.


Insurance plan raises benefits, lowers costs.

The Direct Service Contract encourages hospital employees to use their own hospital for medical services. The plan benefits the hospital, cuts costs, and raises employee morale.


MBO clears way for humanistic approach.

Social worker became patient service counselor, classification clerk became patient service interviewer, and together they became a team with a more humanistic philosophy.


What's going on in the community?

Hospitals that are innovators in community health programming were surveyed in order to uncover trends and gain insight into this developing field.


Marketing: what it is, what it isn't.

If the marketing concept is to be successfully applied to the health care field, it must be viewed in its entirety. It must be seen as a business function that is tied to the goals of the hospital.


A new identity can create a new image.

An image study may show that a hospital is failing to project its strengths to area physicians or may indicate that certain departments need to be redefined.


Environmental assessment helps in planning process.

The AHA's planning document, which identifies factors that affect the hospital industry on a nationwide basis, can be a useful reference for individual hospitals in identifying similar factors that affect them on the local level.


Who's going to pay the bill? Health promotion.

Most people believe that health promotion activities are a good thing, but they see an important need to answer the question of how to finance them.


Hospital's role expanded with wellness effort. Health promotion.

A community hospital's "wellness" center provides programs in health assessment, health education, and preventive health care.


Clinic expands adolescents' access to care: Health promotion.

A Minneapolis health center opened a mini-clinic in a local high school to provide adolescents with better access to care, appropriate referrals, and health education.


hospitals adopt new role: Health promotion.

The American hospital system has made outstanding contributions to the care of the stick. It now faces the challenge of promoting the concept of "wellness".


Is it a change for the better? Health promotion.

The public's expectations of hospitals are changing in that they want to know more about taking care of themselves. It is therefore inevitable that hospitals will change.


Climate ripe for marketing strategies: Health promotion.

Now is the ideal time for hospitals to promote wellness in the community as part of their marketing strategies.


Patient relations program offers listening and follow-up.

Patient relations programs give patients another avenue for communication and complement the services of direct care personnel. At St. Francis Medical Center, Lynwood, CA, administrators give high marks to their two-year-old program staffed by volunteers.


The basis of medicine and religion: respect for persons.

The nature of the physician-patient relationship underlies the professional's obligation to respect each person. Religion moves those involved in caring for the sick beyond professionalism to a profound sense of common humanity under the Father, of healing as a work of God, and of love as the primary bond with patients.


The self in mission and hospitality.

The Catholic health care provider's self-definition must be "servant." Individuals and institutions are called upon to avoid selfism and to accept exhilarating tensions between "going-out" (mission) and "welcoming-in" (hospitality).


Creation, the eschaton, and bioethics.

The Christian's role in renewing the universe is to discover the true name of God's creation and to use technology as a serious enterprise of co-creation. Guided by a bioethics based on Gospel values, the Christian healer brings the eschaton closer to realization.


MBO works for managers who understand, apply system.

Where MBO has suceeded, managers thoroughly understood, planned, and adapted the system to their organization's needs. Informed managers in nonprofit organizations can avoid the common mistakes made in business and industry in the 25 years since MBO was first adopted.


Handling grievances: guidelines for RNs.

Top management depends on nurses--even though they are not titled "supervisors"--to handle day-to-day grievances and questions arising on the nursing unit.


The effect of Public Law 94--484 on pathology residency programs.

The Health Professions Educational Assistance Act of 1976 (Public Law 94--484) will affect graduate medical programs. The author surveyed directors of medical education in one major metropolitan area to study what the effects might be. With regard to pathology residency programs there are a number of important influences. For example, there will be fewer foreign medical graduates available to study in United States pathology programs. However, those who do come may be of higher quality. Also, owing to financial incentives to increase primary care, medical schools and hospitals may show less interest in the development of speciality programs such as pathology. The changing environment poses challenges to pathology directors to maintain or improve their programs.


Drug related vasculitis. Clinicopathologic correlations in 30 patients.

Drug related vasculitis has variously been described as necrotizing hypersensitivity or allergic angiitis or microscopic panarteritis nodosa. We reviewed tissue sections from 30 patients with validated drug hypersensitivity and vasculitis in order to precisely define this entity. No evidence of necrotizing vascular lesions or of fibrinoid associated with necrosis was found. The vascular lesions in all 30 patients involved small arteries, arterioles, capillaries, and venules. The inflammatory infiltrate consisted primarily of mononuclear cells and prominent numbers of eosinophils and was present in all three layers of the involved vessel walls. Clinically the patients developed either localized or systemic vasculitis, which could not be predicted on the basis of the associated drug. The findings of a skin rash, fever, or eosinophilia and the development of symptoms consistent with a hypersensitivity reaction while medication was being taken were all suggestive of the diagnosis of drug related vasculitis.


Juxtaposition of the atrial appendages.

Juxtaposition of the atrial appendages is a rare congenital cardiac anomaly almost universally associated with severe conotruncal abnormalities, especially transposition of the aorta. This presentation describes a case of right sided juxtaposition of the atrial appendages without concomitant conotruncal malformations. This finding contradicts previous hypotheses concerning the genesis of juxtaposition.


Focal myositis of the neck.

Focal myositis is a recently defined, rapidly growing, inflammatory pseudotumor of skeletal muscle. It is characterized by marked myopathic changes of muscle fibers, hypocellular fibrosis of perimysium and endomysium, and an intense inflammatory reaction in the fibrous septa. This report describes the first instance involving the neck muscle of a 40 year old man. A brief discussion of other histologically similar subcutaneous lesions is also presented.


Pleomorphic pulmonary hamartoma: an apparently unique variant of pulmonary hamartoma.

Pulmonary hamartomas of limited variety have been described. Most present as asymptomatic coin lesions in adults and consist of mesenchymal tissue, usually cartilage, in combination with irregular spaces lined by epithelium. Another form is found in the neonate and involves large portions or all of a lung. This is associated with a developmental aberration and is best described as a "congenital adenomatoid malformation". An apparently unique noninvasive tumor mass was resected from the lung of a middle aged man where it was associated with anomalous lung segmentation and the bronchial and blood supply to the lung. The tumor appeared to be undifferentiated by light microscopic criteria. Neurilemoma, leiomyoma, chordoid tumor, mixed tumor, and neurogenic sarcoma all entered the differential diagnosis. Ultrastructural examination demonstrated a highly complex and unique organization. Such a lesion, apparently developmental in this case, should be recognized and carefully distinguished from the malignant mesenchymal, neurogenic, and teratomatous lesions with which it may be confused. Electron microscopy may be helpful in this regard.


The pathology of noncirrhotic portal fibrosis: a review of 32 autopsy cases.

A wide spectrum of clinical and morphologic changes in 32 autopsy cases of noncirrhotic portal fibrosis have been described. The disease frequently occurs in younger patients with a long history of splenomegaly, usually with a history of hematemesis. Females are affected almost equally as often as males in contrast to cirrhosis. The patients tolerate the bleeding episodes well. Death is usually due to massive hemorrhage. The diagnosis is achieved through a process of exclusion. A critical analysis of hemodynamic data, a splenoportogram, liver function tests (particularly Bromsulphalein retention) and angiographic data is mandatory. Needle biopsy of the liver appears to have limited value in making the diagnosis. The gross anatomic findings vary from a nearly normal liver to gross nodularity, seen particularly on the posteroinferior surface. In some cases these nodules are seen to physically impede the portal blood flow and contribute to portal hypertension. Phlebosclerosis of the smaller radicles of the portal vein and irregular scarring are the outstanding morphologic features of the disease. These changes are usually associated with irregular dilatation of some of the larger intrahepatic branches of the portal vein as well as fibroelastosis with or without occluding or organizing thrombi in both intra- and extrahepatic branches of the portal vein. The changes in hepatic venous radicles are characterized by irregular sclerosis, which seems to contribute significantly toward postsinusoidal block in advanced cases. The probable mode of evolution is discussed.


Chronic glomerular microangiopathy and metastatic carcinoma.

Two patients with metastatic colonic adenocarcinoma developed deterioration of renal function six and nine months after the diagnosis of malignant disease. A renal biopsy specimen in one case and both postmortem specimens revealed thickening of glomerular capillary loops with focal reduplication of basement membrane-like material. Ultrastructural examination of all three specimens demonstrated a lucent subendothelial zone and no evidence of electron dense deposits. Antifibrinogen staining outlined most capillary loops in one case. It appears that chronic intravascular coagulation induced by the neoplasm was the major pathogenetic process involved in the production of the glomerular lesion in each case.