Serum IgE levels in healthy black American children: a case for environmental influences on IgE.

Serum IgE was determined in 115 healthy, non-atopic black American children, aged 0-16 years, living in Urban Chicago. The mean IgE level varied from 1.48 u/ml at birth to 70 u/ml at adolescence. These values are comparable to those observed in American whites but differ significantly from the IgE levels of both African blacks and European Caucasians. Thus, environmental factors apparently exert a strong influence on IgE production in non-atopic individual.


Terbutaline elixir in preschool children with chronic asthma.

In a double-blind, single-dose trial asthmatic children, ages two to six years, received 25, 50 or 100 ug/kg terbutaline and placebo on four consecutive days. After ingestion of all doses and placebo mean pulmonary index score and mean total respiratory resistance (Rrs), measured by forced oscillation decreased significantly at 0.5, 1, 2, 3 and 4 hours, with maximal decrease at two hours. A dose response was apparent but was significant only between doses of 25 ug/kg and 50 ug/kg at four hours. Adverse effects included elevation of heart rate two hours after the 100 ug/kg dose and tremor. In a subsequent nine-week, single-blind trial clinical wheezing was completely prevented by terbutaline 50 ug/kg tid in five of eight patients and by 75 or 100 ug/kg tid in two patients. Baseline Rrs did not decrease. No adverse ophthalmologic, hematologic or biochemical changes were observed.


Incidence of fungal spores at the homes of allergic patients in an agricultural community. II. Correlations of skin tests with mold frequency.

A mold survey in and out of the homes of 145 allergy patients was conducted over the course of a year and frequency of mold recovery was correlated with skin test reactivity in 131 of these patients. The highest percentage correlation with positive skin test and finding mold in the home was with Cladosporium. Penicillium and Alternaria, while Helminthosporium, Fusarium, Aureobasidium (Pullularia) and Mucor each had correlations of one percent or less. The 0-10 age group was the most skin test reactive to molds in general while the over-50 age group was the least reactive. The percentage of patients sensitive to Alternaria also responding to other mold antigens was the highest with Helminthosporium. Since Helminthosporium was rarely recovered in this survey the data suggest that cross reactivity and not dual reactivity between Alternaria and Helminthosporium is occurring.


The effect of sympathomimetic drugs on immediate skin reactions and metabolic responses in asthmatic patients.

The varied effects of intradermal injection of isoproterenol and propranolol on the immediate skin reaction were studied in relation to the metabolic responses to the intravenous injection of epinephrine. In asthmatic patients whose skin reaction was not suppressed with 10(-7) M isoproterenol, the hyperglycemic response after the injection of epinephrine was significantly reduced.


An ultrastructural study on the interaction of Mycoplasma gallisepticum with the chicken tracheal epithelium.

Seven-day-old chickens wee intratracheally inoculated with Mycoplasma gallisepticum. The tracheas collected 6 and 14 days after chickens were inoculated were subjected to titration of mycoplasma and examination by light and electron microscopy. The mycoplasma organisms grew well; 10(7) to 10(8) color-changing units in a milligram of tissue were determined. Tracheal lesions occurred in close association with the presence of mycoplasmas and were characterized by degeneration of the epithelial cells and inflammatory cellular infiltration of the mucosa. Mycoplasmas were predominantly found extracellularly and only rarely in phagocytic vacuoles of the epithelial cells. Although the mycoplasmas exhibited considerable pleomorphism in size and shape, most of them were oval or round, and the largest diameters were between 300 and 700 mn. Elongated and irregular forms were also observed, particularly in those mycoplasmas adhering to the epithelial cells. The organism had a limiting unit membrane, the fibrillar nuclear area, the peripheral cytoplasmic area containing numerous ribosomes, and a terminal bleb structure. Mycoplasmas attached to the epithelial cells by their blebs close to the host cell membrane. At the attachment site, neither fusion of the membranes of the mycoplasma and host cell nor injury to the host cell membrane could be demonstrated. Nevertheless, seemingly, the intimate association between the adhering mycoplasmas and the epithelial cells might be an important factor in pathogenesis of the disease.


Luminal lymphoid cells of the cloacal bursa.

Following cloacal bursal lavage of 1- to 4-week-old White Leghorn chickens, substantial numbers of viable mononuclear cells can be demonstrated in the effluent. These cells are predominantly lymphocytes and have been examined by light microscopy, and transmission and scanning electron microscopy. Their possible origin, fate, and function are discussed.


Survey of leptospiral agglutinins in the sera of swine of southeastern Alabama.

The occurrence of leptospirosis in swine of southeastern Alabama was determined. A total of 627 sera were tested, using the microscopic agglutination method, with live antigens of 12 serovars. Of the sera tested, 121 (19.3%) had a titer of 1:100 or greater to the serovars employed. The percentage distribution of sera with titers of greater than or equal to 1:100 among serovars most commonly reported was as follows: Leptospira interrogans serovars pomona, 3.8%; icterohaemorrhagiae, 3.3%; canicola, 1.6%; hardjo, 0.7%; and grippotyphosa, 0.16%. Of the less commonly recognized leptospiral serovars, the percentages reacting were as follows: ballum, 4.9%; autumnalis, 3.2%; pyrogenes, 1.1%; and bataviae, 0.4%. None of the sera reacted with antigen of serovars australis, tarassovi, or wolffi.


Fascicular nerve biopsy in the dog.

A nerve fascicular biopsy technique that preserves the functional integrity of the parent nerve is reported in the dog. Fascicular biopsies from ulnar and peroneal nerves did not produce clinical sensory or motor deficits. Electrodiagnostic testing for the modalities of latency, duration, amplitude, and conduction velocities were not markedly altered after fascicular biopsies. Morphometric analysis of muscle fiber types, delineated by histochemic techniques, revealed no statistical (P greater than 0.05) difference between muscles from biopsied or control limbs. Fascicular biopsies resulted in small neuromas in all dogs.


Efficacy of avermectin B1a against microfilariae of Dirofilaria immitis.

Avermectin B1a given at a dose level of 0.05 or 0.1 mg/kg of body weight caused rapid removal of Dirofilaria immitis microfilariae from the blood of dogs with heartworm infections. If the adult worms were also killed with an arsenical (melarsoprol), the removal of microfilariae was permanent.


Canine atypical malignant lymphoma.

An instance of canine malignant lymphoma with some similarities to human Hodgkin's disease is described. Although the clinical data were all within normal limits, the histopathologic changes indicated that in many organs, the normal cell architecture was replaced by a pleomorphic cell population.


Survival of contagious equine metritis bacteria in transport media.

Survival of bacteria that cause contagious equine metritis (CEM) was evaluated in Amies modified transport (AMT) medium, in AMT medium with charcoal, and in Stuart transport medium at 37, 22, 4, and -70 C. The CEM bacteria suspended in transport media survived at 22, 4, and -70 C for longer periods in AMT medium with charcoal than they did in AMT and Stuart transport media. In 1 day, the number of bacteria in exudate stored in the absence of any transport medium decreased 15-fold at 22 C and twofold at 4 C. The CEM bacteria were isolated from exudate on cotton-tipped swabs from all three transport media at 4 and -70 C on day 10, the termination of the experiment. However at 4 C, the survival of CEM bacteria was greater in AMT medium with charcoal than it was in AMT and Stuart transport media.


Prevalence of mycoplasmal bovine mastitis in California.

Seven species of mycoplasma plus one or more unknown species were found to cause bovine mastitis in California. Both the frequency of cases and number of species of mycoplasma in samples received at the laboratory have increased from 1976 to 1978. By survey, nearly 4% of samples of bulk tank milk from dairy farms were found to contain mycoplasma of potential pathogenic significance. Acholeplasma laidlawii was frequently isolated from samples both from cows and from farm bulk tanks during wet, rainy weather in the spring of 1978, apparently as contaminants only. The prevalence of positive bulk tank milk samples in an area appeared to parallel the prevalence of clinical mycoplasmal mastitis problem herds.


Appositional bone formation rates in the Beagle.

Measurements of haversian appositional bone formation rates were carried out on 400 haversian systems in 28-month-old standardized research colony-raised Beagles, using the midshaft of the 11th rib. The appositional bone formation rate was gradual and regular when the circumference of the outer tetracycline ring was more than 0.35 mm, but the regularity of the measured rate disappeared when the outer tetracycline ring circumference was less than 0.35 mm. Erroneous conclusions could be drawn from measurements of appositional bone formation rate in these animals if this fact were not taken into consideration, and we concluded that in pre- and postexperimental biopsy sections in the ribs of these animals, haversian systems with tetracycline ring circumferences above 0.35 mm must be measured in both situations if the differences in appositional bone formation rate are to be construed as being truly significant.


Intraconal contrast orbitography in the dog.

Intraconal contrast orbitograms were obtained, using a nonionic water-soluble contrast agent, on 15 normal dogs to evaluate the technique and to define the basal orbitogram. Thirty-three intraconal orbitograms were prepared, utilizing three different injection techniques. In 21 of the intraconal orbitograms, the orbital cone was well outlined with contrast or with the optic nerve visible (or both). These were judged to be of satisfactory diagnostic quality. In the 12 other studies, the presence of most of the contrast material outside the orbital cone resulted in failure to identify the intraconal structures. These were, therefore, classified as nondiagnostic. The contrast agent used provided an adequate density and persisted in the orbital cone long enough for radiograms to be obtained. Serious complications did not appear during the study. Intraconal orbitography provides a safe method for evaluating the orbital cone.


Evaluation of gamma radiation therapy in experimentally induced hemorrhagic pancreatitis in dogs.

Acute bile-trypsin pancreatitis was induced in two groups of six dogs each. One group was given supportive treatment only; the second group was treated with irradiation of the pancreas (400 rad). A third group of six dogs was irradiated, but pancreatitis was not induced. A 13-fold increase in survival time was observed in the dogs with pancreatitis which had been irradiated. Irradiation alone was found to reduce the volume of pancreatic secretion with a relative increase in trypsin content. Modification of the inflammatory reaction by irradiation and reduction in pancreatic secretion probably account for the therapeutic effect.


Adrenocortical suppression in dogs on daily and alternate-day prednisone administration.

Three groups of eight normal dogs each were orally given prednisone at doses of 0.22 mg/kg of body weight/day, 0.55 mg/kg/day, or 1.1 mg/kg on alternate mornings. Four dogs served as nontreated controls. Samples were obtained from members of each group to determine baseline serum cortisol and ACTH-stimulated cortisol values and histologic features in the lateral thoracic skin before prednisone administration, and after 1, 2, 3, and 4 weeks of administration. Some animals from each group were necropsied after 1, 2, 3, and 4 weeks of prednisone administration. Each course of prednisone administration resulted in adrenocortical atrophy and hypofunction, but adrenocortical suppression was less severe and slower in onset in the group given prednisone on alternate days. Extra-adrenal effects observed were atrophy of the skin and focal, fatty change of the liver. These changes were most evident in dogs given daily pharmacologic doses of prednisone (0.55 mg/kg/day). Fewer extra-adrenal effects were observed in dogs given alternate-day therapy. There were no extra-adrenal lesions in the dogs given equivalent glucocorticoid replacement doses (0.22 mg/kg/day).


Variations in the canine thoracic duct system and the effects of surgical occlusion demonstrated by rapid aqueous lymphography, using an intestinal lymphatic trunk.

An alternative method for lymphography was developed in an attempt to improve the outlining of the thoracic duct system. Lymphograms obtained on 20 normal dogs demonstrated a large extent of anatomic variation. A complete obstruction of the thoracic duct was created in six dogs through transpleural resection and ligation. The lymphatic system responded by opening lymphaticovenous anastomoses proximal to the site of obstruction.


Feline lymphocytes: observations on surface membrane concanavalin A receptor mobility.

The mechanics of concanavalin A receptor mobility of the feline lymphocyte surface membrane were investigated, utilizing fluorescein-labeled lectin to quantitate lymphocyte capping. The results of this study indicated that lectin concentration and buffer selection were critical for extensive receptor redistribution with cap formation of feline lymphocytes. Maximal capping was obtained with 50 microgram of concanavalin A/ml of minimal essential medium. The mean capping rate of peripheral blood lymphocytes increased significantly with colchicine exposure at 10(-7) M concentration. The mean values of capping increased slightly with advancing age of feline donors, although this difference was not statistically significant. Concurrent work has indicated that concanavalin A capping may be useful in the study of immunosuppression in feline leukemia virus-infected cats.


Transfer of insulin-binding antibodies from nanny goats to kids.

In 30 female goats hyperimmunized with bovine insulin, antibody concentrations in serum were determined by radioimmunoassay. Blood samples were taken from the newborn lambs immediately after birth and during the 12 weeks thereafter. Twin lambs were separated and reared in either a colostrum-fed or a colostrum-deprived group. Bovine insulin was added to the milk rations of colostrum-deprived lambs. At the age of 10 weeks, these kids were given a single dose of 1 IU of insulin in combination with complete Freund's adjuvant. Colostrum from nanny goats was also secured for further investigations. Most of the hyperimmunized adult goats responded with the development of insulin antibodies. Their kids were born without these specific immunoglobulins, but several hours after they were allowed to suckle colostrum, the antibody concentration reached values comparable with the values measured in the nanny's blood. Colostrum-deprived kids did not show an increase in binding capacity. The addition of insulin to the milk rations of bottle-fed kids did not act as a primer in antibody production. Immunoglobulins in blood serum of nanny goats and kids and in colostral whey belong mainly to the IgG class. These results indicate that in goats, maternal insulin antibodies are transferred from nanny to offspring only by colostrum.


Pharmacokinetics of ketamine in the horse.

Ketamine HCl was administered IV to xylazine HCl-treated horses. The plasma concentration of ketamine was measured several times after administration of the drug and these data were used to develop a two-compartment pharmacokinetic model. The distribution and the elimination phase half-lives averaged 2.9 and 42 minutes. The volume of the central compartment averaged 212 ml/kg of body weight and the volume of the peripheral compartment was approximately threefold larger. The total body clearance of ketamine averaged 26.6 ml/minute/kg. Plasma protein binding of ketamine averaged 50% over the concentration limits of 0.3 to 20 microgram/ml. The duration of anesthesia from a single 2.2 mg/kg IV bolus dose of ketamine HCl appeared to be determined largely by distribution; 40% of this dose was predicted to remain in the horse at the time of its recovery from anesthesia.


Physiologic alterations in the horse produced by food and water deprivation during periods of high environmental temperatures.

Eight normal horses were held without access to food or water for 72 hours during a period of high environmental temperatures. During this period, the horses had an average weight loss of 51.6 kg (10.7% of body weight). Highly significant (P less than 0.001) decreases in extracellular fluid volume (18.6 L) and plasma volume (5 L) were observed during this period as compared with base-line values. Plasma protein, sodium, chloride, and osmolality progressively increased in response to the dehydration, whereas packed cell volume, plasma potassium, calcium, magnesium, and phosphate were not significantly altered. The dehydration and clinicopathologic alterations produced were similar to those observed in other species in which the principal problem was a water deficit. After the end of the experimental dehydration period, the horses replaced 62% of the weight loss during a 1-hour period with access to water only.


Effect of exercise, phenylbutazone, and furosemide on the plasma renin activity and angiotensin I in horses.

Circulating concentrations of angiotensin I and plasma renin activity (PRA) were determined in 45 Thoroughbreds before prerace medication (at rest), 1 to 1 1/2 hours before racing but after prerace medication (prerace), within 15 minutes after racing (immediately postrace), and between 1 to 2 hours after racing. Angiotensin I was measured by radioimmunoassay, and PRA was determined by the rate of generation of angiotensin I in plasma incubated at 37 C. Irrespective of prerace medication, there was a marked increase in angiotensin I (0.478 +/- 0.034 to 0.848 +/- 0.051 ng/ml) and PRA (0.191 +/- 0.018 to 0.522 +/- 0.061 ng/hour/ml) from the at-rest samples to the immediate-postrace samples, with the exception of anhidrotic horses in which increases in angiotensin I (0.7131 +/- 0.0794 to 0.8081 +/- 0.0608 ng/ml) and PRA (0.1635 +/- 0.0379 to 0.2176 +/- 0.0437 ng/hour/ml) were not as marked as they were in other horses. Administration of 1 mg of furosemide/kg 2 hours before racing caused an increase in PRA from 0.2438 +/- 0.0324 to 0.3706 +/- 0.1110 ng/hour/ml, whereas horses under the influence of 4 mg of phenylbutazone/kg had a decrease in PRA from 0.2090 +/- 0.0440 to 0.0669 +/- 0.0206 ng/hour/ml. Marked increases in angiotensin I and in PRA did not occur when horses were administered furosemide and phenylbutazone as prerace medication.


Effects of postural drainage, exercise, and cough on mucus clearance in chronic bronchitis.

The effects of postural drainage, exercise, and cough on mucus clearance were compared in 8 patients with chronic bronchitis. A bolus of 99mTc albumin aerosol was inhaled at a high inspiratory flow rate to enhance proximal deposition. Retention of deposited aerosol in the lung, as a function of time, was quantified using a gamma camera and subsequent computer analysis. Coughing greatly accelerated total lung (P less than 0.005) and peripheral (P less than 0.005) mucus clearance. Exercise resulted in much smaller changes than did cough, but significantly increased total lung clearance (P less than 0.005). Postural drainage in which coughing was prohibited did not alter clearance. These results have therapeutic implications and stress the importance of controlling cough when evaluating therapeutic interventions by these techniques.


Effects of sulfur oxides and respirable particles on human health. Methodology and demography of populations in study.

As part of a study of health effects of sulfur dioxide and particulate matter, we have established a cohort of adults 25 to 74 yr of age in 6 communities who will be followed prospectively. At the conclusion of our first cycle of measuring the health of adults in 6 sites we found that, although we used different sampling frames, our samples were close to the distribution shown in the U.S. Census for age, sex, and occupation, with the possible exception of one city. Analysis of the cross-sectional data indicated that for both age- and height-adjusted values for forced expiratory volume in 1 s and for selected rates of various respiratory symptoms standardized for age, differences among smoking groups were apparent. Differences in these parameters between sites suggest trends that were associated with levels of pollution. Further analyses of the prospective data currently being collected will be required before definitive statements can be made about the effect of specific levels of exposure.


Analysis of the cores of asbestos bodies from members of the general population: patients with probable low-degree exposure to asbestos.

Asbestos bodies were isolated from the lungs of 21 patients who had 300 to 9,000 of such bodies/g of lung tissue, a concentration frequently found in manual laborers in the general population who are not primary asbestos workers. All of the 123 bodies examined by electron diffraction produced diffraction patterns consistent with amphibole varieties of asbestos. Electron microprobe analysis (energy dispersive x-ray spectroscopy) of 46 bodies revealed that 38 of the cores were composed of the commercial amphiboles, amosite and crocidolite, whereas only 8 were composed of the noncommercial amphiboles, anthophyllite and tremolite. Review of the occupations of these patients revealed that all but one had blue-collar jobs. For many of these persons, putative sources of asbestos exposure such as construction work could be defined, but for some, the source could not be determined. One woman was apparently exposed to asbestos in the practice of her hobby of ceramics, in which she used anthophyllite-contaminated clay. We concluded that commercial amosite/crocidolite asbestos forms the cores of most asbestos bodies in manual laborers in the general population and that the source is usually occupational.


Hypoxemia during exercise in patients with chronic obstructive pulmonary disease.

Arterial oxygenation at rest and during maximal treadmill exercise was studied in a group of 17 patients with chronic obstructive pulmonary disease. Patients who developed exertional hypoxemia (subgroup 1) were compared to others who did not (subgroup 2). There was no significant difference between the 2 subgroups at rest in terms of mixed venous PO2, cardiac output, or venous admixture. Subgroup 1 had more severe respiratory impairment than subgroup 2, but there was marked overlap of their respective lung volumes and flows. Both subgroups showed the same extent of desaturation of mixed venous blood during maximal treadmill exercise, so that exertional hypoxemia cannot be explained on the basis of low mixed venous O2. The marked difference between subgroup 1 and subgroup 2 was that the latter showed decreased venous admixture on exercise. Because of the relative constancy of mixed venous blood desaturation, arterial saturation was closely correlated with venous admixture both at rest (r = 0.931) and during exercise (r = 0.985).


Experimental chemotherapy of histoplasmosis in nude mice.

Nude (nu/nu) mice were infected with Histoplasma capsulatum and treated with varying doses of 3 drug regimens: oral ambruticin, intraperitoneal amphotericin B, and amphotericin B plus oral rifampin. Therapy with amphotericin B alone was the most effective regimen. High-dose ambruticin (50 mg/kg of body weight every 8 hours) led to significantly prolonged survival compared to that of untreated control animals, but no long-term cures. Addition of rifampin produced no benefit and might actually have decreased the efficacy of amphotericin B; this combination may be deleterious in a setting of immunodeficiency.


The effect of a respiratory tract infection on histamine-induced changes in lung mechanics and irritant receptor discharge in dogs.

The effects of intravenously administered histamine on total lung resistance (RL), dynamic lung compliance (Cdyn), and the discharge of lung irritant receptors have been measured in normal dogs and in dogs whose upper respiratory tract was naturally infected with the organism Bordetella bronchiseptica. The resting values for RL and irritant receptor discharge were similar for the infected and control dogs, but Cdyn was significantly lower in the infected group of dogs. Intravenous administration of 20 microgram of histamine/kg of body weight produced significantly greater direct and reflex changes in RL in the infected dogs than in the control animals. The changes in Cdyn in both groups of animals were similar. Intravenous administration of histamine (20 microgram/kg) produced a significantly greater increase in the rate of discharge of lung irritant receptors found in infected dogs than in control dogs. A possible mechanism responsible for the hyperreactivity to histamine is seen in the hypersensitivity of the irritant receptors introduced by the epithelial lesions observed in the infected dogs.


Lung mucociliary clearance after anesthesia with spontaneous and controlled ventilation.

Anesthesia and controlled ventilation for 2 h delays mucociliary clearance from the lung. To elucidate the contribution of controlled ventilation, mucociliary clearance was assessed by tantalum bronchography and serial chest roentgenograms in 6 dogs. After an induction dose of 25 mg of thiopental/kg of body weight, tantalum insufflation, and immediate recovery from anesthesia, 7 +/- 7 per cent of the tantalum remained in peripheral airways at 6 h. This was not significantly different from the 16 +/- 7 per cent remaining at 6 hours when the dogs had breathed humidified air spontaneously through an endotracheal tube during 2 hours of anesthesia with thiopental (total, 40 mg/kg of body weight). However, when ventilation was controlled during 2 h of anesthesia with 40 mg of thiopental/kg, with a tidal volume of 10 ml/kg or 30 ml/kg, and with a partially deflated endotracheal tube cuff, 43 +/- 11 per cent and 48 +/- 9 per cent of the tantalum, respectively, remained in peripheral airways at 6 h. We conclude that peripheral lung mucociliary clearance is delayed by mechanical ventilation through an endotracheal tube, even with an inspiratory air leak, independent of the tidal volume chosen.


Aspergillosis and atopy in cystic fibrosis.

Forty-six patients with cystic fibrosis (CF) were studied for colonization and sensitization by Aspergillus organisms. The fungus was cultured from 21 of 37 (57%) patients who produced sputum. The non-CF sputum isolation rate was 6.5%. Sputum hyphae were seen in 95% of patients with positive cultures. Sputum eosinophilia accompanied colonization by Aspergillus. Aspergillus precipitins were found in 37% of CF patients; positive immediate skin tests were found in 39%. "Atopy" defined by skin test criteria was found in 46%. All of these findings were more common in patients with more severe disease (p less than 0.05). CF patients had predominant mold sensitivity in contrast to predominant pollen sensitivity in a control group of asthmatic subjects. Serum IgE concentrations were increased in 22% of CF patients. CF patients who had increased serum concentrations of IgE were more likely to have a family history of atopy. Wheezing was more common in those who were atopic, especially the group with predominant mold sensitivity who had more severe disease. Four patients fulfilled the diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) during the time of study and follow-up. A fifth patient had ABPA diagnosed before the study. The incidence of ABPA during a 2-yr period in our CF population was 11%.


Effect of infusing histamine into pulmonary or bronchial artery on sheep pulmonary fluid balance.

We determined the dose-response curve for the effect of histamine on pulmonary fluid and protein exchange when histamine was infused directly into the bronchial artery or pulmonary circulation in anesthetized sheep with a right thoracotomy and an acutely prepared lung lymph fistula. We measured pulmonary hemodynamics, lung lymph flow, and lymph-to-plasma protein concentration ratios in 14 sheep. We infused histamine at constant rates of 0.1, 1, 3, and 10 micrograms/kg . min until a steady state was achieved at each level for 1 h. In the bronchial circulation the lowest effective dose of histamine was 1 microgram/kg . min, which increased lymph flow at constant ratio of lymph to plasma protein concentration. Lymph flow increased further as the dose of infused histamine increased. Infusions into the pulmonary circulation had similar effects, but in addition, pulmonary vascular resistance decreased. The dose-response curves for the effects of histamine on lung lymph and protein flow were identical for the 2 routes of infusion. The effect of histamine was to increase lung microvascular permeability modestly. We conclude that the site of continued action of histamine is probably in the pulmonary microcirculation, because for any given infusion rate, the local concentration of histamine in the bronchial microcirculation must be much greater than that in the pulmonary microcirculation because the ratio of blood flows is so different.


Transport of water and solutes across sheep visceral pleura.

The fluid and solute transport properties of pleural tissue were studied using specimens of intact visceral pleura from adult sheep lungs. After thoracotomy, a shallow incision through the pleural surface permitted 10-cm2 by 10-micrometer pieces of visceral pleura free of lung parenchyma to be peeled off the lung surface. The pleura was then mounted as a planar sheet separating 2 reservoirs of Krebs-Ringer solution. Electrical potential and resistance, hydraulic water permeability, and diffusional permeability to water and several hydrophilic solutes were measured. The results showed that (1) no spontaneous voltage difference was present across the pleura; (2) electrical resistance (27.1 omega/cm2) was very low; (3) hydraulic water permeability was extremely high (1.64 X 10(-8) ml/dyne-s); and (4) diffusional permeability was high, varying from 5.24 X 10(-4) cm/s for water to 4 X 10(-5) cm/s for hemoglobin. Blue dextran (molecular weight, 2 X 10(6) daltons) did not cross the pleura in measurable quantities. We concluded that the isolated visceral pleura of the adult sheep is an extremely "leaky" tissue that probably does not actively transport salt and water. These findings are consistent with a passive model of pleural fluid formation and reabsorption, and suggest that the transport properties of normal pleural tissue are unlikely to be responsible for any differences in composition between interstitial and pleural fluids.


Large airway obstruction secondary to endobronchial coccidioidomycosis.

When clinically apparent, coccidioidomycosis usually presents either as an interstitial pulmonary infiltrate or, later in its course, a parenchymal nodule often with cavitation. The present report concerns a young adult woman whose presentation was one of shortness of breath with wheezing and stridor, secondary to a localized endobronchial coccidiodal granuloma producing nearly complete obstruction of the right mainstem bronchus. Such a presentation has not been reported previously in an adult. The possible association of serious fungal disease with previous jejunoileal bypass surgery is discussed.


The effect of smoking cessation on pulmonary function: a 30-month follow-up of two smoking cessation clinics.

To obtain further information about the effects of cessation of smoking on pulmonary function, we followed subjects who attended 2 smoking cessation clinics during a period of 30 months. This paper reports the results from 15 persons who succeeded in stopping smoking for the full 30-month period and from 42 who did not succeed for more than one month. Testing included a respiratory questionnaire, spirometry, and the single-breath N2 test. Standardized methods, the same equipment, and the same experienced personnel were used throughout the study. We found that forced vital capacity, one-second forced expiratory volume, closing volume as a percentage of vital capacity, closing capacity as a percentage of total lung capacity, and the slope of the alveolar plateau of the single-breath N2 test all improved significantly in the subjects who stopped smoking. This improvement continued for as long as 6 to 8 months, and then remained stable. There was no sex difference in the response to smoking cessation, nor could we find a threshold of function below which cessation did not result in improvement. On the contrary, those subjects with the greatest impairment initially showed the greatest improvement. Respiratory symptoms virtually disappeared in those who stopped smoking. Subjects who continued to smoke showed an initial improvement in some function tests, probably due to a marked decrease in consumption, but no significant improvement during the whole period. We concluded from this study that cessation of smoking results in definite improvement in pulmonary function, that there is greater improvement in persons who begin with impaired function than in those whose function is initially normal, that respiratory symptoms disappear rapidly.


Lysosomal enzyme activities in pulmonary macrophages from rabbits breathing iron oxide.

The effects of an in vivo exposure to a nontoxic particle, iron oxide, on lysosomal hydrolases in pulmonary macrophages were examined. Rabbits breathed a submicron-sized aerosol of iron oxide for 3 h (mass concentration, 186 to 222 mg/m3). Macrophages were recovered by lung lavage 0, 12, 18, and 24 h later. The number of cells lavaged after iron oxide was significantly greater than the control number, whereas the amount of protein recovered per 10(8) cells decreased, suggesting the influx of smaller cells. Macrophages from animals exposed to iron oxide reacted histochemically for acid phosphatase showed increased stain intensity and redistribution of enzyme within the cytoplasm. Considerable cell-to-cell variability in enzyme activity was evident in these macrophages. Homogenates of cells exposed to iron oxide assayed for 6 lysosomal acid hydrolases showed little change in specific activity or in total enzyme per 10(8) cells when compared to homogenates of cells from control animals. Sucrose density gradient centrifugation demonstrated that exposure to iron oxide caused an increase in lysosome heterogeneity over that seen in control preparations and the appearance of a population of lysosomes of increased density. An aerosol of iron oxide did not greatly alter the average concentrations of lysosomal enzymes in pulmonary macrophages, but did stimulate recruitment of new cells and thus increases the total amount of some enzymes in the lung.


Generation and use of three types of iron-oxide aerosol.

Three distinct submicrometric aerosols of iron oxide can be reproducibly generated by combustion of iron pentacarbonyl vapors under varying conditions. Each aerosol was sized with a concentric aerosol spectrometer and was examined with an electron microscope; the specific surface area of each aerosol type was also determined. The "feathers" hematite has a man median aerodynamic diameter (MMAD) of 0.17 micrometer and a large surface area because it is an agglomerate of units 0.005 micrometer in diameter. The "birdshot" hematite has a MMAD of 0.31 micrometer, but has a smaller surface area because the subunits are 0.03 micrometer in diameter. The third aerosol, "gamma-oxide," has a MMAD of 0.73 micrometer and has crystalline subunits 0.2 micrometer in diameter; it is a magnetic form of hematite, gamma-Fe2O3. These aerosols are well suited for studies of deposition and clearance in animal lungs because the particles can be visualized in both light and electron microscopy and can be quantified colorimetrically. The magnetic properties of gamma-Fe2O3 permit enhancement of deposition and noninvasive detection.


The significance of wheezing in chronic airflow obstruction.

Eighty-three patients with chronic airflow obstruction were examined prospectively to determine the relationships among wheezing intensity, severity of obstruction, and response to inhaled isoproterenol. For each patient, expiratory wheezing scores were assigned during deep unforced breathing and during forced vital capacity efforts at spirometry. Unforced wheezing scores were independently correlated with severity of obstruction (r = 0.42) and bronchodilator response (r = 0.46), but these correlations did not permit consistent prediction of either variable for clinical purposes. The highest wheezing scores, however, were uniformly associated with moderate or severe obstruction. Twenty-nine of 48 patients with wheezing but only 3 of 35 patients without wheezing demonstrated 15% or greater improvement in one-second forced expiratory volume after bronchodilator inhalation (p less than 0.001). Wheezing during forced exhalation was not correlated with either degree of obstruction or bronchodilator response.


Changes in pulmonary function after naturally acquired respiratory infection in normal persons.

Changes in pulmonary function due to naturally occurring respiratory tract infection were examinated in 26 normal healthy volunteers during a period of 6 months. Forced expiratory maneuvers in each volunteer were recorded at 2-wk intervals throughout the study and daily during illness. Significant impairment of peak expiratory flow rate, forced vital capacity, forced expiratory volume in one second, and maximal mid-expiratory flow rate at 50% of the vital capacity was observed during infection, whereas changes in the maximal expiratory flow rate at 75% of vital capacity were nonsignificant. From these results, we conclude that large airways are certainly affected during uncomplicated respiratory infections in normal healthy persons and from the changes observed in FVC we suggest that more widespread involvement of the small airways may occur.


Detection of respiratory mechanical dysfunction by forced random noise impedance parameters.

Respiratory mechanical parameters were computed from forced random noise impedance data in normal adults (group 1), asymptomatic smokers (group 2), and patients with obstructive pulmonary disease (group 3). Mean values for all derived parameters were significantly different (p less than 0.025) for group 3. Mean values of resonant frequency, the ratio of low-frequency (5 to 9 Hz) resistance to high-frequency resistance (15 to 19 Hz), and conductance normalized by height, were significantly different (p less than 0.05) between groups 1 and 2. This approach appears to yield respiratory mechanical parameters that are sensitive to mechanical alterations induced by early pulmonary disease. The rapid, noninvasive, and effort-independent nature of this approach make it especially useful for epidemiologic studies and for studies of "noncooperative" subjects.


Self-limited blastomycosis: a report of thirteen cases.

Blastomycosis is not generally recognized to be a self-limited pulmonary infection. We report 13 patients with blastomycosis who followed a self-limited course. Presenting complaints were usually those of an acute pulmonary infection with fever, productive cough, and pleurtiic chest pain. The duration of symtpoms before diagnosis was usuallms were variable and not diagnostic. The blastomycin skin test and complement-fixing serologies to blastomycin were generally not helpful. In all patients the diagnosis was made by either cultural or visual identification of the organism from sputum, bronchial washings, or pleural fluid. All patients were improving both clinically and by chest roentgenograms by the time the diagnosis was reached, and thus therapy was withheld. Follow-up of these 13 patients ranged from 5 months to 8 yr (mean, 43 months), and in no instance has there been any evidence of reactivation of the illness.


IgA and IgG antibody activities of serum and bronchoalveolar fluid from symptomatic and asymptomatic pigeon breeders.

Serum IgA and IgG antibody activities against pigeon serum were measured in 16 symptomatic pigeon breeders, 20 asymptomatic pigeon breeders, and 3 normal subjects by radioimmunoassay. The IgA and IgG antibody activities against pigeon antigen of the group of patients with disease was significantly greater than those of patients in the asymptomatic and the control group. The overlap of results for the symptomatic and asymptomatic breeders limits the diagnostic value of these individual IgA or IgG antibody determinations. Bronchoalveolar fluid and serum samples from a smaller group of pigeon breeders who underwent lung lavage were available for studies of antibody activity against pigeon serum. Ten asymptomatic and 6 symptomatic breeders were available for study. Both IgG and IgA antibody activities were detected by radioimmunoassay in serum samples and bronchoalveolar fluid. The IgA antibody activity determined by the radioimmunoassay was higher in the respiratory secretions.


Increased alveolar epithelial permeability with acid aspiration: the effects of high-dose steroids.

Using the in vivo, liquid-filled dog lung model, we found that aspriation of acid with a pH of 2.5 or less led to increased alveolar epithelial permeability for albumin (molecular weight, 69,000 daltons; molecular radius, 35 a) and exogenously administered, polydispersed dextrans (molecular weight, 150,000 to 170,000 daltons: approximately molecular radius, 100 a). This increased permeability occurred with a large-volume (3 to 5 ml/kg) or small-volume (1 to 1.5 ml/kg) aspirate and with acid nebulization (1 to 1.5 ml/kg). When animals were either pretreated (30 min before aspiration) or post-treated (30 min after aspiration) with 30 mg of methylprednisolone/kg of body weight, there was no improvement in the increased permeability associated with acid aspiration. We conclude that, acutely, steroids have no effect on the increased alveolar epithelial permeability associated with acid aspiration.


Normal lung growth and response after pneumonectomy in rats at various ages.

Lung growth was accompanied by alveolar multiplication in rats from 4 to 10 wk of age; the multiplication then ceased until 14 wk of age, and in this latter interval the alveolar walls appeared to lengthen. The relationship between size of surface alveoli and size of internal alveoli of the lower lobe changed with age, and the relationship was not altered by pneumonectomy. The surface alveoli were smaller than internal alveoli at 4 wk of age, the same size at 6 and 10 wk of age, and larger at 14 wk of age. Four-week-old rats responded to pneumonectomy with an increase in size of the contralateral lung and an increase in the number of alveoli. Direct alveolar counts did not show a significant increase in number of alveoli after pneumonectomy in 8- and 12-wk-old rats. the alveolar surface area incresed almost directly with the increase in gas-exchanging lung volume in 8-wk-old rats, suggesting that alveolar multiplication might have occurred. In 12-wk-old rats, however, the alveolar surface area increased to the 0.71 power of the increase in gas-exchanging lung volume, suggesting that alveolar enlargement, rather than alveolar multiplication, had occurred. Taken in conjunction with the data for growth in normal and sham-operated animals, these results suggest that compensatory alveolar multiplication is part of the adaptive response to pneumonectomy when this operation is performed at a time at which alveolar multiplication normally occurs. When pneumonectomy is performed after alveolar multiplication has ceased, the adaptive response is primarily one of air-space enlargement. Lung volume, weight, surface area, and protein responses to pneumonectomy were smaller at 12 wek of age than at 4 and 8 wk of age.


Basal lamina of alveolar epithelium and capillaries: quantitative changes with aging and in diabetes mellitus.

Epithelial and capillary basal laminae (BL) of alveoli are significantly thicker in diabetics than they are in age-matched control subjects. The degree of thickening does not correlate significantly with patient age or with known duration of diabetes. The thickness of both types of BL in the lungs correlates significantly with thickness of BL in renal tubules and muscle capillaries. However, in muscle capillaries and in renal tubules, the BL deposits are 5 to 10 times greater than they are in the lungs. The effects of BL changes on pulmonary function remain to be explored.


Massive spontaneous hemoperitoneum due to rupture of visceral branches of the abdominal aorta.

Review of 153 cases of massive spontaneous hemoperitoneum following visceral arterial rupture showed that 94% of all young women and 100% of all pregnant women had ruptured congenital splenic artery aneurysms at the time of hemorrhage, whereas young males bled from a variety of sources. Individuals who were 45 years old or older bled either from lesions of the celiac axis or its branches (66%) or from arterial mesenteric system lesions (34%). Only 22% of the older individuals of either sex bled from splenic artery sources. Arterial hypertension was present in 40% and previous or simultaneous intracranial hemorrhage occurred in 9% of the older patients. There were no survivors among those in whom the bleeding source was not operatively controlled. With operation, 79% of the younger patients and 57% of the older ones survived. Results emphasize the high mortality of visceral artery rupture with intraperitoneal bleeding. Prophylactic excision is advised for all complicated aneurysms regardless of age and all uncomplicated aneurysms in healthy individuals, especially in fertile or pregnent women.


Traumatic splenic injury: splenectomy vs. repair.

Splenectomy has been the standard treatment during this century for traumatic splenic injuries. Because of the association between asplenia and overwhelming sepsis, recent attempts have been made to repair injured spleens. Details of splenic anatomy and blood supply allow prediction of the usual type of splenic injury that can be repaired. By utilizing a topical hemostatic agent, capsular sutures, and arterial ligation, severely traumatized spleens have been repaired. Postoperative splenic scanning is available in assessing remaining splenic tissue. The present and future ramifications of reparative splenic surgery are presented.


Two-year review of hand infections at a municipal hospital.

Although an unromantic topic, the management of hand infection can tax the patience and skill of the modern day surgeon. The addition of antibiotics to the surgeon's armamentarium have made the job easier than in the days of Kanavel and Koch but has not altered the basic surgical principles of elevation, immobilization and properly planned drainage. Awareness of hand anatomy in relation to infection and awareness of special categories of problems are necessary in preventing crippling deformities in one of our most precious possessions--the hand.


Flexible sigmoidoscopy: is it of value?

The use of 60 cm flexible fiberoptic sigmoidoscope increases the potential for finding significant colonic disease beyond the cutomary 25 cm. Patient comfort and cost effectiveness recommended the procedure for routine examination and for short operating colonoscopy.


Chemoneurolysis of the canine gastric submucosa: changes in acetylcholinesterase activity.

Infiltration of the gastric fundic submucosa with 25 per cent ethyl alcohol markedly reduces the mean acetylcholinesterase rate of activity in the fundic mucosa and submucosa. This can be considered as evidence for a reduction in the acetylcholine concentration caused by a destruction of the submucosal plexus.


The use of stapling devices in the management of postgastrectomy syndromes.

By the use of the stapling devices, a large spectrum of postgastrectomy syndromes can be managed with minimal manipulation and dissection, shortened operative time, decreased blood loss and spillage, and reduced morbidity while attaining uniformly good amelioration of symptoms. As others have recommended, the application of these techniques at the primary procedure should be considered. The author's experience in ten primary procedures has been quite gratifying to date.


Occult liver abscess and foreign body perforation of the bowel.

A unique case of foreign body perforation of the ileum and large occult liver abscess is reported. Preoperative abdominal ultrasonography localized the abscess cavities, permitting successful drainage and eventual full recovery of the patient. Due to the serious morbidity and mortality associated with undrained hepatic abscess, the possibility of this complication should be remembered in all patients with localized inflammatory conditions of the abdomen, particularly when hepatic dysfunction is unexplained.


Cystadenoma of the common bile duct demonstrated by percutaneous transhepatic cholangiography.

Benign neoplasms of the extrahepatic biliary tract are uncommon and rarely diagnosed preoperatively. Percutaneous transhepatic cholangiography will demonstrate such lesions, and, if contrast outlines only the wall of the mass, a benign tumor may be suspected. An example of a cystadenoma of the common bile duct demonstrating this principle is presented.


Chylothorax following division of patient ductus arteriosus in an adult.

A case of postoperative chylothorax following division of a patent ductus arteriosus in an adult is presented. The patient recovered following reoperation for ligation of the thoracic duct after an 11-day trial of conservative management. Arguments for conservative and operative management are discussed and the anatomy of the thoracic duct is shown.


Primary tumors of the small intestine.

Seventy-two malignant and 19 benign tumors were seen at the Veterans Administration Hospital, Hines, Illinois, from 1950 to 1976. Of these, 44 malignant and 14 benign tumors were seen in the clinical setting--the remainder were found at autopsy. Carcinoid tumors were the most common malignant tumors, followed by adenocarcinoma, lymphoma and leiomyosarcoma. Patients with malignant tumors usually presented with abdominal pain, vomiting and weight loss. The most common clinical signs were anemia, abdominal tenderness and abdominal distention. The most useful diagnostic tests were upper GI series and plain x-ray of the abdomen. Twenty-one (50%) five year survivals and 14 (33%) ten year survivals were obtained with small bowel malignancies. The majority of the five and ten year survivals were patients who had carcinoid tumors and lymphoma. Various theories on the causation of small bowel malignancies are discussed.


Acute appendicitis during pregnancy.

From this study, we note: (1) misdiagnosis of appendicitis in pregnancy is comparable to that of the general female population; (2) with a maternal mortality of zero per cent, the operation is safe even when complicated by perforation; (3) fetal mortality is minimal; (4) clinical judgement rather than laboratory data must be relied on for diagnosis; and (5) the pregnant patient presenting with abdominal pain should be assessed and treated as one would any patient with the same complaint. The general use of this principle may explain the marked improvement in maternal and fetal mortality and morbidity in recent years.


Deep vein thrombosis following aortic surgery: prospective evaluation of I125 fibrinogen and impedance plethysmography.

A prospective comparison of I125 Fibrinogen uptake testing (FUT) and Impedance Plethysmography (IPG) was made in 22 patients (44 limbs) following aortic reconstructive surgery to determine the incidence of postoperative deep venous thrombosis (DVT). Normal FUT was obtained in 34 limbs, whereas ten limbs had abnormal uptake over the calf area consistent with venous thrombosis. Nine of the ten limbs with a positive scan underwent phlebography. All venograms and IPG readings obtained were normal. No evidence of DVT following aortic surgery was noted in this study. A high incidence of false positive FUT was evident. IPG is noninvasive, reliable and relatively inexpensive and is therefore recommended if prospective evaluation for DVT in patients undergoing aortic surgery is desired.


Central vessel trauma.

During a 24 month period, 30 patients were treated for central vessel trauma (CVT). Injured vessels included all of the major arteries and veins in the chesk, neck and abdomen except the infrarenal aorta. Overall survival was 70 per cent. Experience with specific injuries is reviewed with commentary on surgical access to difficult areas including the thoracic outlet, suprarenal aorta and inferior vena cava. Common factors in the nine deaths are reviewed with the findings that cardiac arrest at any time during pre- or intraoperative management is uniformly lethal; emergency thoracotomy for control of bleeding carries an expectedly high mortality; cross-clamping of the descending thoracic aorta to control hemoperitoneum has a limit of tolerance of about one hour, and prolonged shock, whether compensated or profound is poorly tolerated and is associated with a high mortality.


Transaxillary sympathectomy in the treatment of hyperhidrosis of the upper limb.

Idiopathic (primary) hyperhidrosis is a common and distressing condition. Excessive axillary sweating responds to local excision of the eccrine glands. In severe cases, sympathectomy may be indicated to deal with hyperhidrosis of the hands and feet. The surgical anatomy of transthoracic sympathectomy is described.


Tumors of the salivary glands.

In a series of 65 salivary gland tumors seen in patients over eight years, 86 per cent were seen in the parotid gland, fewer than 10 per cent were in the submandibular gland, and none were in the sublingual gland. The remaining tumors were in minor salivary glands. About one half of the patients were in the sixth decade of life. Over 80 per cent of the lesions were benign; 50 per cent were from 1.5 to 2.5 cm in diameter, and the average delay between discovery and removal was over two years. In only one patient was there facial nerve involvement.


Anatomic complications of abdominal surgery with special reference to the ureter.

Respect and knowledge of and for the ureter should be in every surgeons armamentarium. An intravenous pyelogram should be done in selected cases for precise definition of the location and nature of any pathologic or anamolous condition of the ureters.


Surgical anatomy of the submandibular triangle.

The topographic anatomy of the submandibular triangle and its contents are described in terms of four surgical planes, with considerations of the anatomic complications during surgery. Attention is called to the importance of identifying and sparing five nerves in this triangle--the mandibular and cervical branches of the facial nerve, the hypoglossal nerve, the lingual nerve, and the chorda tympani.


A thoracolumbar incision of many parts.

The thoracolumbar incision developed by Newton and Dwyer has not seemed to receive the attention it perhaps deserves outside of orthopedic surgical circles. In selected instances, it can be used quite effectively in other types of surgery and may solve very difficult problems of approach and exposure. A fairly detailed description of the technique is given and some of its potential uses outlined. Briefly, the author's own limited experience with its use is presented and examples of clinical problems in the use of the incision are used for illustration.


Orbital decompression.

A new technique for exposure of the orbit for decompression of the orbit is described. It may be used for other purposes such as orbital fracture repair, orbital exploration for tumors in the inferior orbit, or reconstruction of the orbit by a variety of methods. The technique provides ready, broad exposure. The approach also avoids not uncommon complications of the eyelid, approaches to the orbit such as skin shrinkage and ectropion of the lower lid. It also results in minimal cosmetic deformity.


Obstructive jaundice secondary to nonbiliary extrahepatic inflammatory disease.

Two patients with persistent obstructive jaundice secondary to chronic pancreatitis and one patient with this picture secondary to a periduodenal fibrosis are reported. The infrequent occurrence of obstructive jaundice in such inflammatory processes is noted and it is suggested that the presence of a circular muscle coat in the common bile duct protects it from inflammatory narrowing. The need for preoperative anatomic evaluation by radiographic techniques is discussed along with methods of therapy.


[A programm of childhood accident prevention, 1979 (author's transl)].

This paper presents a programm for prevention of children's accidents written by the Committee for Prevention of Children's Accidents (Asociación Española de Pediatría) and delivered to the Public Health Department. The programm has three parts: The first deals with the need of a stronger action in preventive measures. The second gives general lines of action and organization. The third suggests technical and educatives advices for prevention of each class of accident.


[Long term renal function following acute failure in the newborn (author's transl)].

A long-term follow-up study of 27 survivors of acute renal failure in newborns was performed. A study of the evolution of renal function was possible in 20 cases, with follow-up periods ranging from 15 to 62 months (mean follow-up: 38 months). Renal function was determined by assessing glomerular filtration rate, free-water reabsorption, tubular reabsorption of phosphate and acidification ability. Results show a marked difference, according to the etiology of the acuete renal failure, between the two groups studied: 1) Most of those displaying renal failure following neonatal hipoxia, maintained persistent nephrological sequels. II) Parameters of renal function normalized between 6 and 12 months of age in those in which renal failure was related to hypovolemic shock, caused by hypertonic dehydration. Of the six patients with acute renal failure caused by neonatal hypoxia and shock (group 1), only one displayed normal renal function after 17 months. In the remaining fire patients, glomerular filtration rate continued to decrease even after three years. Three of them displayed urinary acidification disorders. An alteration in free-water reabsorption was found in the majority of the patients in both groups during the first year. This alteration persisted after three years in only four patients of group 1, although in relation to decreased glomerular filtration rate.


[Critical pulmonary stenosis in infants (author's transl)].

Eighteen infants carrying pulmonary stenosis with a complete interventricular wall whose most frequent clinical data are: precocius cyanosis, congestive cardiac insufficiency and in 25% of them hypoxic crises are presented. Complementary explorations of this entity are not definitive, but clinical diagnosis described with evolutional cardiomegaly at the expense of the right cavities and pulmonary ischemia forces authors to think that there is a severe obstruction of the infumdibulum with complete interventricular septum. The different parameters which have been proposed to evaluate severity of the stenosis are discussed and compared, finding among them significative differences. Authors consider the concept of the right diminutive ventricle, finding in these cases the electrocardiographic pattern rS in V1 and observing a great mortality both spontaneous and postsurgical. The high mortality of this heart disease, both in its' natural evolution as well as after surgery is to be pointed out as in most published series.


[Inguinal hernia and testicular feminization in childhood (author's transl)].

Three cases of Morris Syndrome were detected among 103 girls admitted to the hospital for inguinal hernia. Diagnosis was made possible by routine sexual chromatine study in oral mucosa smear, but it can also be suspected when familial antecedents of amenorrhea exist. An early diagnosis of this condition is imperative in order to provide the patient with an adequate medical and surgical management, including the conservation of the gonads until pubertal age.


[Toxic epidermal necrolysis (Lyell's syndrome) (author's transl)].

One case of toxic epidermal necrolysis (Lyell's syndrome) in a 6 1/2 year old girl is presented. The patient had received penicillin and streptomycin for four days two weeks before the onset, and was admitted to the hospital with epidermal lesions characteristic of the bullous stage of Lyell's disease. A biopsy of the skin confirmed the diagnosis. Cultures of blood, skin and exudate from the bullae were negative, and immunological tests were normal. No immunohistologic studies on the skin biopsy were done. The patient was treated with cephalosporins and corticosteroids, and the evolution was favorable. The main clinical traits found in this patient are discussed on the light of information available from previous reports. Several aspects of the diagnosis, management, and natural history of the disease are also discussed.


Three new Salmonella serotypes of subgenera I, II and III and four serological variants.

Description of three new Salmonella serotypes of the subgenera I, II and III, and four serological variants which have been isolated and diagnosed in 1977-1978 at the National Reference Centre for Salmonella, Institute of Hygiene, Hamburg. The strains are as follows: S. blitta 47:y:e,n,x; S. II 1, 40:Z42:1,5,7; S. III arizonae 52:k:Z53 (Arizona 31:29:25); S. infantis with phase 2 R antigen 6,7:r:1,11; S. stuivenberg var. Z13-1,3,19:1,Z28:1,5; S. III arizonae 35:k:Z53 (Arizona 20:29:25) var. fimbriae+ (O-inagglutinable); S. III arizonae 38:Z10:Z53 (Arizona 16:27:25) var. fimbriae+ (O-inagglutinable).


Comparison of sensitivity and specificity of counter electrophoresis, complement fixation and radioimmunoassay for detecting antibodies against hepatitis B core antigen.

Sensitivity and specificity of anti-HBc detection by counter-immunoelectrophoresis (CEP), complement fixation (CF) and radioimmunoassay (RIA) tests were compared in sera from 69 patients with chronic hepatitis, 61 black African people suffering from primary hepatocellular carcinoma and 50 controls composed of French country people. CEP and CF tests gave the same results in detecting anti-HBc antibodies. The RIA test was found to be more sensitive and seems to be more specific than CEP and CF.


[Hepatitis B vaccine: characterization of the polypeptides of hepatitis B surface antigen (author's transl)].

In order to realize a new kind of hepatitis B vaccine, the polypeptide components of the outer-coat of the hepatitis B virus have been studied. The characterization of the polypeptides of purified hepatitis B surface antigen (HBsAg) was performed by SDS-polyacrylamide gel electrophoresis. Seven polypeptides were observed, designated P1 to P7, according to their increasing molecular weight: P1 (MW = 24,000), P2 (MW = 32,500) and P6 (MW = 78,000) represented the major components. When the reducing action was increased and followed by alkylation and citraconylation, a single polypeptide of low MW (5,000 less than MW less than 10,000) was isolated from HBsAg.


Degradation of lignocellulosic material and humus formation by fungi.

Cellulase activity and degradation of cellulose and lignin in wheat straw and formation of humus during degradation by Aspergillus sp., Chaetomium globosum, Fusarium solani, Paecilomyces varioti, Penicillium chrysogenum and Trichoderma viride QM9414 were studied. C. globosum, F. solani, P. varioti and P. chrysogenum produced little or no cellulase when grown on cellulose powder. However, all produced cellulase (filter paper degrading activity) when grown on wheat straw. All the cultures degraded cellulose and lignin to some extent, but P. varioti was the most efficient in cellulose and lignin degradation. There was an increase in humus-like substances after inoculation with fungi.


[Amoebae in the water supply: an epidemiological study (author's transl)].

Drinking water samples (836) of various origins have been examined for amoebae. For collector water, half of the samples are contamined without influence of the origin. So, occurrence of amoeba in underground waters is discussed. Filtration and disinfection are generally inefficient. Bottles of drinking water are very often polluted during bottling. International mineral waters of french origin are not so damaged during conditioning operation. Bacteria and amoebae populations are quite independant and can't be indicators one for another. Thermophilic amoebae strains are very rare and any pathogenic amoeba has been found during the study.


[Six new serotypes of "Flavobacterium meningosepticum" (author's transl)].

Six new serotypes (G to L) of Flavobacterium meningosepticum are described herein. Cross-reactions between the 12 serotypes, A to L (including the 6 serotypes A to F of Owen and Lapage, 1974) are described. Sixty-six strains isolated in France (61 from Strasbourg) belong to the following serotypes (with number of strains): A (1), F (4), G (51), H (1), I (1), J (6), K (1) and L (1). Use of meningosepticum serotyping is recommended as an epidemiological tool.


Experimental Salmonella abortus ovis infection of normal or primo-infected CD1 mice.

CD1 mice were inoculated intravenously or subcutaneously with sublethal doses of Salmonella abortus ovis. Kinetic studies demonstrate the invasion and multiplication potentiality of these bacteria in normal mice. Primo-infected mice challenged subcutaneously into a hind footpad manifest an increased capacity to withstand the dissemination of the challenge bacteria from the inoculated region and to control the bacterial population in the draining lymph node and in the spleen.


[An automatic bacteriophage distributor (author's transl)].

The apparatus described in this article can distribute simultaneously 22 drops of different phage suspensions at a rate of 13,200 drops per hour, which is superior than the one obtained with the presently available apparatuses. It could eventually be attached to a Petri dish distributor.


[Sero-epidemiological characteristics of the MENINGOCOCCAL carrier state in Greece (author's transl)].

Nasopharyngeal swabs for the isolation and identification of meningococci, and blood specimens for the detection of antimeningococcal A, B and C antibodies were obtained from 341 Army and Navy recruits in the spring and autumn 1977. Samples were taken twice, at the arrival at the training camp and after 25 days. The main findings are as follows. 1) About 1/3 of the inductees at the arrival at the training camp were carriers of meningococci. Strains of serogroup B were more prevalent, followed by non-typable strains and strains of group C. After 25 days of residence in the camp the prevalence of carriers of meningococci has increased by 42%, and about half of the recruits were carriers. The prevalence of serogroup C has increased by 86%, of the non-typable strains by 48% and of serogroup B by 36%. 2) At the induction, 73% of the recruits had anti-B antibodies, whereas the corresponding figure was 33% for anti-A and 24% for anti-C. After 25 days in the camp the prevalence of anti-B antibodies was 83%, of anti-A 36% and of anti-C 47%. 3). At the induction the prevalence of meningococci B was higher among those who had no anti-B antibodies. Furthermore, the probability of a recruit who was not carrier of meningococcus B at the induction to become a carrier of meningococcus B at the second sampling was higher when he had no anti-B antibodies at the induction. Similar associations were not evident for serogroups A and C probably on account of the much smaller numbers in these groups. 4) The carrier state is associated with an increase of the titre of the corresponding antibodies.


Preliminary characterization of the particles from productive and abortive infections of L cells by fowl plague virus.

Particles produced during the abortive infection of L cells by fowl plague virus (Dobson strain) have been characterized and compared to the infectious particles produced by a mutant of this virus adapted to mammalian cells. The former are of apparently normal morphology but most of them are non-infectious. They have the same RNA/protein ratio as the infectious particles and the same polypeptide composition. They contain also the same RNA segments as those found in infectious particles. Possible reasons for the defectiveness of these particles are discussed.


[Schwartz-Bartter syndrome. Presentation of a sub-glottal small cell laryngeal carcinoma (author's transl)].

Inappropriate secretion of antidiuretic hormone or Schwartz-Bartter syndrome is considered to be a paraneoplastic endocrine syndrome, most frequently associated with a small cell anaplastic carcinoma of the lung. The authors present a case of sub-glottal laryngeal carcinoma discovered several months after the onset of clinical (disturbances of conscious level) and laboratory (hyponatraemia, hypochloraemia, blood hypo-osmolarity which preservation of urinary sodium output) manifestations which form the original features of this syndrome, the criteria of which are reviewed. The y conclude by the need for complete examination, not excluding unusual sites of primary tumour.


[Lymphadenopathies associated with carcinoma of the larynx (author's transl)].

On the basis of 287 cases of carcinoma of laryngeal origin, treated by total or horizontal sub-glottal laryngectomy, the authors study the prognosis in lymphadenopathies. This prognosis is envisaged in the light of the international nomenclature NO, N1, N2, N3, in relation to the size of the nodes and, finally, in relation to the surgical or radiotherapeutic treatment given to the node areas. The authors emphasise the need for bilateral surgery to the node areas, this procedure being all the more extensive when the lymphadenopathy is larger. On the basis of this size, a choice must be made between radical dissection, extended cellulo-adenectomy (or functional excision).


[Two cases of total ophthalmoplegia after section of the vidian nerve (author's transl)].

The authors report two cases of complete ophthalmoplegia occurring during surgical section of the homolateral vidian nerve for chronic nasal obstruction due in one case to hypertrophic rhinitis and in the other to nasal polyposis. In both cases, whilst there was more or less complete regression of the oculomotor paralyses, unilateral amaurosis persisted as a permanent sequela. This paper is published with the aim of drawing attention to the possibility of complications which are out of proportion with the initial symptomatic discomfort and which may occur whatever the surgical approach used since one of the operations was performed via a pure endonasal approach whilst the other was transmaxillary. In both cases there was no damage to the orbit during surgery and the most likely pathogenesis would appear to be a reflex aciton.


[Carcinoma of the nasal sub-septum (author's transl)].

On the basis of 13 cases, the authors describe the anatomical characteristics and course of primary carcinomas of the nasal sub-septum. This is a transitional form between nasal carcinomas and those of the nasal fossa. The cases described were treated either by conventional radiotherapy (200 Kv) or by electron therapy. The successful results obtained (12/13) confirmed the value of irradiation in this special site, without the risk of radionecrosis. The technique should conform with precise rule, as in all tumours of the face or nasal pyramid and the quality of the results obtained is compared favourable with those of all other methods.


[Clinical and therapeutic pitfalls of a bilateral acoustic neurinoma (author's transl)].

A case of bilateral fluctuating deafness accompanied by vertigo and assumed to be Menier's syndrome, a diagnostic hypothesis supported by the effectiveness, on repeated occasions, of medical treatment. In fact, progressive worsening of hearing led to the finding of a bilateral perceptive deafness with a complex vestibular syndrome, whilst tomograms of the petrous temporal bones revealed bilateral acoustic neurinomas. The results of special investigations in this case are analysed: audiometry, Sisi (?) test adaptation, nystagmography, in the light of the radiological findings. It was decided to operate upon the tumour which was larger radiologically. In addition, it revealed multiple neurofibromas of neighboursing nerves (von Recklinghausen's disease). The mid-term course is described. The article ends with a review of clinical concepts in such cases and an attempt to classify therapeutic attitudes to bilateral acoustic neuromas.


[Wegener's granulomatosis with atypical beginning (author's transl)].

The authors report a case of Wegener's disease starting in the sub-maxillary region and spreading to the auricular region. The diagnosis was evoked by the correlation between the granulomatous lesions observed in the sub-maxillary region and on the tympanic membrane; there was also renal failure of rapid onset. A remission of five months has been obtained by treatment with corticosteroids and immunodepressant agents. Around this case the authors collected 267 cases from the literature and point out the rarity of the auricular form and the exceptional nature of the sub-maxillary localization of this disease.


[Evolutive stages of the iliac compression syndrome (Cockett's syndrome) (author's transl)].

The term of Cockett's syndrome stands for a lower limb dysfunction with venous stasis originating from the left common iliac compression by the right common iliac artery at the pelvis inlet level. For the authors, there are three evolutive stages. First stage: a simple compression without any anatomic venous parietal lesion. Second stage: to the previous, are added left common iliac vein lesions consisting of an inner vascular band formation. This must be surgically treated to remove the obstacle. Third stage: the final evolution: the ilio-femorale thrombosis. Therefore, the diagnosis must be done as early as possible. It lies on the left lower limb phlebography.


[Skin fibrosis in hyperthyroidism treated by sotalol and radioactive iodine (author's transl)].

The authors present detailed data about skin fibrosis appearing in hyperthyroidism treated by Sotalol and radioactive iodine. Cutaneous thickening is discovered quite rapidly when the patient is monitored daily (as in case 4). It is asymptomatic and no other features of scleroderma are found. Regression occurs within 4-10 months. Histologically, fibrosis is located in the entire dermis. Dermal appendages are normal and no inflammatory changes occur. No anomalies of collagen structure and fibroblasts have been observed ultrastructurally. Immunological studies (direct immunofluorescence of the skin, lymphocyte transformation and leucocyte migration tests with Sotalol) were normal. The mechanism is unknown, but an immunological or a toxic one is excluded; however a pharmacological action is possible. The role of other betablockers must be assessed by a randomised study.


[Leg ulcer. Vascular and thrombosis factors. Each responsibility of those factors? (author's transl)].

In this paper the authors try to specify the leg ulcers physiopathology. They have first studied the vascular deficits, and they are able to conclude that this deficit is not the only factor responsible for the thrombosis. They try to rediscover the factors which could lead to the thrombosis, on the created local conditions (circulatory slackening, cooling, ischemia), by using clinical and biological "check-ups" as well as an exploration of the clotting. In many patients we find an anomaly such as: clotting "check-ups" disturbance, thrombocyte hyperaggregability, fibrinolysis deficit, antithrombin III deficit, cryoprecipitate, circulating immune complexes, hepatic "check-up" alteration. It is difficult to establish an accurate relation between these anomalies and a thrombosis but the frequent existence of such anomalies makes us think that they play a part in the ulcerations coming-up.


[Pellagra: a disease resurging in Zaire. A study of 231 cases (author's transl)].

231 cases of pellagra among 8,000 consulting patients has been observed from May 1977 to June 1978 in the Dermatological Dispensary of the Hospital G.E.C.A.-Mines of Lumbumbashi (Zaire). This disease by nutritional deficiency can be easily recognized especially through its dermatological symptomatology. It occurs mainly in young patients fed solely on maize, but the most severe cases have been observed in prisoners. Three age groups seem particularly prone to pellagra: children after weaning, pubescent adolescents in quick growing age, grown-up women during pregnancy and lactation. Vitaminotherapy is effective in a few days; a simultaneous treatment of intestinal parasites has to be required. The incidence of this endemic pellagra worsened after the war of May 1978, reaching 7 p. 100 among the population around the main towns of the province Shaba.


[Chondrodermatitis nodularis helicis: epidermal hyperplasia with transepithelial elimination (author's transl)].

CNH strongly resembles, both clinically and histopathologically, other lesions showing transepithelial elimination. WE studied 14 cases, only one of which was a woman. Ths lesions had either a smooth surface or a scaly one. Histological findings were rather poor in the smooth lesions; the scaly lesions, instead, which were more advanced, showed epidermal proliferation and perforation, dermal acidophilic necrosis, transepithelial elimination, granulation tissue, and perichondritis. Actinic elastic degeneration seemed to be the first alteration; it was present in all. This, together with the repeated adverse climatic factors and the fact that circulation is of the terminal type in the region affected, is followed by the acidophilic necrosis between the apex of the cartilage and the epidermis. The processes which take place in both cartilage and epidermis are secondary to the dermal lesion. The former perforates and this is followed by elimination of the altered tissues. Persistence of the lesion is to be ascribed to the fact that the diseased cartilage can not be eliminated completely. CNH is the most frequent of the conditions which show transepithelial elimination. It is less frequent in women because they protect themselves from adverse climatic factors by covering their ears with their hair.


Abdominal gynaecological emergencies in the surgical unit.

We have studied two types of emergency cases that occurred in the surgical unit who were found to have gynaecological aetiology: 1) patients with the so-called "morbus acutum dexter", i.e. appendicitis, or a gynaecological disease and 2) late complications in patients who had earlier benign gynaecological disease, usually such as tumour and surgery for it. The material with seven years follow-up consisted of 97 patients, who were treated during the periods 1959--60 and 1969--70. The relative numbers in both groups increased during the latter period. Of the patients in the reproductive age with suspected appendicitis, gynaecological diseases--mostly ovarian tumours with complications--constituted 7.6% of patients who had undergone appendicectomy in the surgical unit during the former period and 9.6% during the latter. The late complications consisted mainly of small bowel obstruction, resulting from adhesions caused by previous gynaecological surgery. The time interval between initial surgery and the obstruction was rather long, 3.5 years on the average. In the surgical unit the surgery was carried out in about two thirds of these patients. Our analysis demonstrates the necessity of recognizing cases with gynaecological aetiology as a significant factor in surgical practice; it has to be taken into consideration both in surgical and gynaecological education.


Necrosis of the colon and the rectum after resection of ruptured abdominal aortic aneurysm.

Two male patients with gangrene of the rectum and left colon following operation for a ruptured abdominal aortic aneurysm are reported. Both patients were in shock over a prolonged period, but ligation of the inferior mesenteric artery in the presence of insufficient collateral circulation to the large bowel was regarded as the main responsible factor for the visceral infarction. Both patients died postoperatively. The anatomical and pathophysiological factors generally involved in the development of colon ischaemia after abdominal aortic aneurysm surgery are analyzed. The different modalities of prevention of colon necrosis, diagnosis and management of the established lesions are described.


Arthrodesis in failed knee replacement in eight rheumatoid patients.

The series of eight rheumatoid patients is presented in whom arthrodesis of the knee had been performed after a failed knee replacement. Compression arthrodesis was used as a salvage procedure. The fusion rate was 75% (6/8 knees). In two patients arthrodesis was attempted three times before fusion occurred. The causes of failure are discussed. The compression technique of Charnley or Hoffman is recommended but with two frames. When the arthrodeses were properly fixed fusion seemed to occur in 2-3 months.


Regression of lymphomatous polyposis of the rectum after COP-treatment.

A case of localized lymphomatous polyposis of the rectum successfully treated with a combination of cyclophosphamide, vincristine and prednisone (COP regimen) is reported and the literature is briefly reviewed.


Rupture of the penis.

Traumatic rupture of the penis is a rare accident. One or both corpora cavernosa may be affected. Approximately one third of the cases are associated with rupture of the urethra. In view of previous studies, and the present case reports both of which occurred during the same night, the authors propose primary surgical repair of the corpora cavernosa.


The effect of lynestrenol and norethindrone on the carbohydrate and lipid metabolism in subjects with gestational diabetes.

The aim of this study was to investigate the effect of two different low-dose progestogens--norethindrone 0.3 mg per day and lynestrenol 0.5 mg per day--on carbohydrate and lipid metabolism in women who have had gestational diabetes. Fifteen patients were treated with norethindrone and 17 with lynestrenol, over a period of one year. The control group consisted of 13 women using an IUD. In both treatment groups all the women had normal OGTT curves during the use of norethindrone or lynestrenol. A very slight deterioration in the glucose tolerance was observed in the norethindrone group. There was no deterioration in the glucose tolerance in the lynestrenol and the IUD groups. We could not find any significant changes in mean fasting plasma cholesterol and triglyceride values.


The effect of sequential oral contraceptive pill (Fysioquens) administration on carbohydrate and lipid metabolism.

The aim of this study was to investigate the effect of a new sequential oral contraceptive pill, Fysioquens, (7 tablets containing 0.05 mg ethinylestradiol and 15 tablets containing 0.05 mg ethinylestradiol plus 1 mg lynestrenol) on carbohydrate and lipid metabolism. In our investigation we found slight changes in the carbohydrate metabolism during and after treatment with Fysioquens but it was chiefly the changes in plasma insulin response during glucose tolerance tests that were significant. We could not find any significant changes in mean fasting serum cholesterol and triglyceride values.


Metals in spinal cord tissue of patients dying of motor neuron disease.

To evaluate the role of toxic metals in causing motor neuron disease (MND), we used a photon-excited, energy-dispersive x-ray analytical system to measure the metal content of spinal ventral horn tissue. Specimens were taken from the cervical and lumbar enlargements of 7 patients who died of MND and the results compared with those found in 12 control patients. Anterior horn lead levels were elevated in MND patients compared to controls (mean, 40.7 micrograms/gm versus 14.6 micrograms/gm; p less than 0.05) and lead levels correlated with the duration of illness (r = +0.84, p less than 0.05). Only 2 MND patients had detectable manganese levels (72.3 and 132.2 micrograms/gm) whereas 1 control had detectable manganese (14.3 micrograms/gm). One MND patient had 244 micrograms/gm selenium, but 3 controls had levels of 180, 58, and 62. Patients with the histories of greatest environmental exposure to metals during life exhibited the highest tissue levels of metals after death; despite chelation therapy for about a year, high lead levels remained in their tissue.


Use of a self-administered questionnaire for detection of transient cerebral ischemic attacks: I. Survey of elderly persons living in retirement facilities.

A self-administered questionnaire designed to identify people with transient cerebral ischemia (TIA) in large population groups was distributed to approximately 10,000 elderly persons living in public and private retirement facilities in the United States. The population resided in eight cities, and 74% completed the survey. Transient focal neurological symptoms compatible with a diagnosis of TIA within the previous year were reported by 6.4% of the respondents. Uncertain manifestations of TIA, i.e., dizziness, light-headedness, or loss of balance, were noted by an additional 15.4%; the remaining 78.2% had no manifestations of this disorder. A clinical history for TIA was taken by a neurologist in a sample of 1,712 respondents to determine the validity of the questionnaire responses. Thirty (7.1%) of 423 persons presumed by the questionnaire to have TIA met the standard clinical criteria for the diagnosis. An additional 8 cases of TIA were found by the neurologist among the 1,289 interviewed persons presumed by the questionnaire to have uncertain TIA or no evidence of the disorder. The twelve-month period prevalence of TIA was estimated to be 8.2 per 1,000 in the total respondent population and 5.8 per 1,000 among those without a history of prior completed stroke. Despite the high proportion of false-positive neurological symptoms of TIA elicited by the questionnaire, this survey instrument nevertheless screened out for further study the 6% of the population in whom 55% of the TIAs occurred.


Periodic lateralized epileptiform discharges in infants and children.

Clinical and electroencephalographic data on 7 infants and children with periodic lateralized epileptiform discharges (PLEDS) in their electroencephalograms were reviewed. The waveform, periodicity, and transitory nature of these discharges were similar to those reported in adults. In children, as in adults, PLEDs reflect severe underlying brain dysfunction which is often associated with metabolic and structural abnormalities. In adults, PLEDs are usually associated with altered states of consciousness and with acute unilateral cerebral lesions; in children, however, they often occur with little or no alteration in consciousness and with chronic, diffuse lesions of the central nervous system.


Dynamic properties of partially denervated muscle.

The mechanical and electrical properties of the partially denervated first dorsal interosseous muscle were measured in 14 patients and 14 normal control subjects. The following variables were studied during isometric contraction: maximum voluntary contraction; maximum rate of rise of tension in a rapid voluntary contraction; amplitude, rate of rise, time to peak, and duration of peak of the compound muscle action potential; twitch force, maximum rate of rise, contraction time, and half-relaxation time; and tetanic (50 Hz) force, rate of rise, and tetanus/twitch ratio. The force produced during repetitive stimulation of the ulnar nerve at 10, 20, 50, and 100 impulses per second was also analyzed. The major findings were: (1) decreased load bearing (voluntary contraction, twitch, and tetanus), (2) prolonged twitch contraction times and half-relaxation times, (3) decreased tetanus/twitch ratio, and (4) preserved rate of rise of tension.


The cubital tunnel syndrome: diagnosis and precise localization.

The cubital tunnel syndrome is a subgroup of ulnar neuropathies arising at the elbow, with nerve entrapment under the aponeurosis connecting the two heads of the flexor carpi ulnaris muscle. To separate this condition more clearly from tardy ulnar palsy, the clinical and electrophysiological features of 9 patients are presented, 6 of whom had the syndrome bilaterally. There was no history of trauma and no clinical or roentgenographic evidence of joint deformity in any of the patients. In 9 of the 15 ulnar nerves, abnormal conduction was localized to the level of the cubital tunnel (1.5 to 3.5 cm distal to the medial epicondyle). The findings were confirmed intraoperatively in 7 patients and corresponded to a tight band compressing the ulnar nerve and causing narrowing at the cubital tunnel with swelling proximally. This syndrome represents a common and distinct subgroup of ulnar neuropathies at the elbow.


Evaluation of insulin receptor in myotonic dystrophy.

Only 2 of 6 patients with myotonic dystrophy had glucose intolerance and hyperinsulinemia. All, however, had markedly reduced insulin binding to specific receptors on circulating monocytes. A significant difference in receptor affinity for insulin was observed, but the difference in affinity was not as marked as that in the amount of 125I-insulin bound per cell, which was sixfold greater in control cells. No evidence for a circulating factor competing with insulin for binding sites could be demonstrated. These alterations in binding did not directly correlate with glucose intolerance or hyperinsulinemia and are consistent with a postulated generalized membrane defect. Study of the insulin receptor in this disorder may uncover regulatory mechanisms in normal and pathological conditions, including myotonic dystrophy.


Failure of chronic dorsal column stimulation in multiple sclerosis.

In view of the favorable claims of Cook and others, an open trial of chronic dorsal column stimulation was undertaken in 9 patients who had moderately advanced multiple sclerosis (MS) but were still ambulatory. No objective improvement was noted by either author during the postoperative observation period of 6 to 37 months; the occasional subjective improvement was ascribed to placebo effect. This procedure can no longer be recommended for MS patients.


Ophthalmoplegia and bulbar palsy in variant form of maple syrup urine disease.

This is the third reported case of a neonate with ophthalmoplegia in whom the diagnosis of maple syrup urine disease (MSUD) was delayed into infancy. In this case, the demonstration of significant residual branched-chain ketoacid decarboxylase activities suggests that this atypical presentation may be characteristic of the MSUD variant form.


Cerebral embolism from septal fibromuscular dysplasia of the common carotid artery.

A rare type of fibromuscular dysplasia of the common carotid artery, in the form of a septum, was observed in a patient suffering from recurrent cerebral infarctions. Angiography demonstrated growth of the lesion and documented the presence of an intraluminal thrombus attached to it. Comparison with reported cases of the more common "string of beads" lesion of fibromuscular dysplasia suggests that the risk for development of ischemic neurological problems is higher for this type of fibromuscular lesion. Surgical correction is recommended, especially for symptomatic patients.


Lidase treatment of spinal cord transected rats.

Russian investigators have recently reported clinical recovery of enzyme treated, spinal cord transected rats. Using the exact protocols outlined by Matinian and Andreasian, we repeated a portion of their experiment using a Lidase preparation manufactured in the USSR. Animals were evaluated for return of bladder function, clinical evidence of hind limb motor function, cortical evoked response after sciatic nerve stimulation, and axonal transport of cortically injected tritiate proline by regenerated corticospinal axons. The only difference between treated and control animals was that the mean total body weight of the treated animals increased more than that of controls (p less than 0.05). No animal walked, had return of voluntary motor activity, showed cortical evoked response, or had evidence for transport of tritiated proline over regenerated corticospinal axons.


[Role of the components in the methylation system in the cobalamin-dependent gentamycin biosynthesis by a Micromonospora purpurea culture].

It was found that under conditions of a short-term cultivation of the Co-deficient mycelium of M. purpurea var. violaces 1935 in the synthetic medium the level of gentamicin biosynthesis increased on the average by 2--2.5 times when cyancobalamine, methylcobalamine, L-methionine or L-serine were added to the medium. Glycine and H2-pholate increased the gentamicin yield on the average by 1.5--1.8 times. When the concentration of L-methionine in the medium was optimal, production of gentamicin by the Co-deficient mycelium markedly increased on addition of extra amounts of cyancobalamine into the medium. An analogous high level of gentamicin biosynthesis was observed in the absence of L-methionine, when combinations of H2-pholate and L-serine or cyancobalamine, H2-pholate and glycine were added to the medium. The data of the study indicate that the pholate-dependent neogenesis of -CH3 group and the methyl-B12-dependent resynthesis of L-methionine play an important functional role in biosynthesis of gentamicin.


[Significance of determining novobiocin sensitivity in the taxonomy of staphylococci].

Novobiocin sensitivity of 96 strains belonging to various staphylococcal species was studied. It was noted that Staph. saprophyticus significantly differed from Staph. aureus and Staph. epidermidis with respect to the above antibiotic. The MIC up to 2 micrograms/ml and the growth inhibition zones of 26--35 mm in diameter were characteristic of Staph. aureau and Staph. epidermidis, while the respective figures for most of the strains of Staph. saprophyticus were 32--64 micrograms/ml and 12--17 mm. However, 28 percent of the strains of Staph. saprophyticus did not differ with respect to their movobiocin sensitivity from the other 2 species. It is concluded that the "novobiocin test" may be used for differentiation of staphylococci, within the genera. At the same time it was shown that the method of the paper sensitivity discs compares very favourably with the method of serial dilutions in agar not only because of its simplicity and convenience of manipulation with single strains, but also of the possibility of identifying the population heterogenicity with respect to novobiocin sensitivity.


[Bacteriocin properties of Lactobacillus fermenti, Lactobacillus brevis and Lactobacillus buchneri].

Four bacteriocins of L. fermenti, 3 bacteriocins of L. brevis and 1 bacteriocin of L. buchneri were studied with respect to morphology of the inhibition growth zones of the indicator strains, capacity for diffusion through cellophane, sensitivity to high temperature, bacterial proteases, trypsin, chymotrypsin, pepsin, papain, nucleases and lysozyme. According to the differences in their properties the bacteriocins were classified as belonging to 8 types, including 4 types of L. fermenti bacteriocins and 3 types of L. brevis bacteriocins.


[Comparative study of the interaction of cephalosporins with blood serum proteins and organ homogenates].

Interaction of 7 semisynthetic antibiotics (cephaloridine, cephalexin, cephradine, cephazolin, cephalotin, cephacetrile and cephapirin) with proteins of human, bovine and rabbit blood serum, as well as organ and tissue homogenates of rats was studied comparatively. The study showed that binding of the cephalosporins by the blood serum depended on both the chemical structure of the antibiotic and the species affiliation of the protein substrate. The binding lvels of cephazolin and cephalotin by the blood serum proteins (except bovine serum) were the highest, while the binding level of cephaloridine was the lowest. A significant decrease in the values of binding by the serum proteins of the drugs with high percentage of binding was observed when the drug concentrations in solution were increased. Binding of the cephalosporins by the blood serum proteins was in most cases completely reversible. The activity of the cephalosporins decreased in the presence of the rat organ and tissue homogenates. The levels of the activity decrease as compared to the theoretical ones were the highest with the use of cephalotin, cephacetrile and cephapirin. The lowest values of detection of these antibiotics were noted on their incubation with the liver, kidneys and lungs.


[Biochemical analysis of the microvillose membranes of the small intestine mucosa of dogs after levorin administration].

The effect of oral levorin used for a prolonged period of time on the lipid composition and activity of alkaline phosphatase and invertase of the microvilli membranes of the small intestinal enterocytes of old dogs was studied. Higher ratios of cholesterol/phospholipids in the membranes and inactivation of alkaline phosphatase and invertase were noted in the old dogs as compared to the young ones. Exposure of the old dogs to levorin had a significant effect on the microvilli membranes of the intestinal epithelial cells. It was evident from a lower ratio of cholesterol/phospholipids in the membranes and stimulation of the alkaline phosphatase activity. It is supposed that the changes in the state of the microvilli membranes of the small intestinal mucosa due to levorin play a definite role in the mechanism of its hypercholesterolemic action.