Extent of vascularization by the two branches of the renal artery in the brown bear (ursus arctos).

The renal arteries of four brown bears (Ursus arctos) have been investigated after filling with a polyester resin. It is shown that in all cases the renal artery devides into ventral and dorsal, sub- and suprapelvic arteries. The distribution of these arteries and the number of renculi supplied are described.


Histochemical studies on the autonomic innervation of the femoral artery and vein.

The innervation of the femoral artery and vein in the dog was studied using: a) glyoxylic acid fluorescence (for the histochemical localization of adrenergic nerve fibers); b) acetylcholinesterase (for the histochemical localization of cholinergic nerve fibers). -Andrenergic nerve fibers and related terminals in both vessels are confined to the adventitial-medial transitional zone and the outer layers of the media. Acetylcholinesterase containing nerve fibers are localized in the adventitial-medial transitional zone of the femoral artery. These findings may indicate the presence of a cholinergic vasodilatator system in the control of the circulation in the femoral artery.


Extraction of human and rabbit acrosomes: a comparison of sequential and sonication methods.

Two methods for the extraction of acrosomal membranes and enzymes from both human and rabbit spermatozoa were compared. Treatment of spermatozoa with hypotonic MgCl2 (0.05 M) solution causes removal of the plasma membrane, vesiculation, disruption and removal of the outer acrosomal membrane posterior to the equatorial segment with accompanying loss of soluble acrosomal material. Subsequent exposure to Hyamine 2389 and Triton X-100 removes acrosomal material bound to the inner acrosomal membrane with concomitant solubilization of this membrane. The MgCl2 extract from rabbit spermatozoa contained a higher yield of hyaluronidase, acrosin, and total proteinase activities, whereas the subsequent detergent extracts contained higher yields of both arylsulfatase A and B activities. By comparison, after 4 minutes of sonication to separate heads and tails, both rabbit and human spermatozoa when viewed by transmission electron microscopy showed alterations of plasma and outer acrosomal membranes with considerable loss of the acrosomal contents. Analysis of acrosomal enzymes indicates the greatest percentage of all the enzymes assayed was located in the extract obtained by sonication in contrast to either the separated head or tail fractions used for further subcellular extraction. Subsequent treatment with Hyamine and Triton yields only minimal amounts of enzyme activity.


Halothane does not inhibit synthesis of nucleic acids in Tetrahymena pyriformis.

The effect of halothane on precursor incorporation into nucleic acids was studied in Tetrahymena pyriformis, a ciliate protozoan. At concentrations that blocked cell division (1.2 and 2.4 per cent), halothane inhibited incorporation of 14C-thymidine and 14C-uridine into DNA and RNA, respectively, in intact cells. However, in nuclei isolated from T. pyriformis, the anesthetic did not inhibit DNA and RNA synthesis when these processes were assayed using the nucleoside triphosphates (3H-thymidine triphosphate and 3H-uridine triphosphate) as precursors. It is concluded that halothane does not directly inhibit nucleic acid synthesis (i.e., the nucleic acid polymerase reactions), and that the inhibition of precursor incorporation observed in intact cells is due to an effect at a locus other than the DNA and RNA polymerase reactions.


[Circadian rhythm of plasm testosterone levels. II. Testosterone levels during the 1st and 2d half-day].

Testosterone in plasma is measured in 50 young males in the morning and in the evening by radioimmunoassay. Peaks are found in the morning. At 07,00 h and 10,00 h the values lie on a plateau: 91,77% at 07.00 h and 90,59% at 10.00 h. The difference is not significant. Significant differences however can be noted in comparison between values in the first and second half-day. The difference between the 07.00 h value and the 16.00 h value amounts to 17,08%; between the 07.00 h value and the 19.00 h value, to 22,6%.


Anti-acrosin antibodies in sera, colostrum and genital organs of vaccinated ewes: estimation and correlation with fertility.

Three ewes were vaccinated with boar sperm acrosin. Despite the presence of antiacrosin antibodies which crossreact with ram acrosin in the sera of the immunized sheep, no significant reduction in fertility was observed. Incubation of ejaculated or capacitated boar spermatozoa with anti-acrosin serum or IgG did not reduce the halos of digestion in the gelatinolysis test. However, an unexplained decrease of the forward progression and number of lytically active spermatozoa was observed after this treatment. We found antiacrosin antibodies and determined their titers in the sera of the vaccinated ewes, in colostrum and in aqueous extracts of cervix, uterus, oviduct and ovary. No antiacrosin antibodies could be detected in the sera of new born lambs. The immunoglobulins IgA, IgG and IgM were isolated from the sera of the ewes. The acrosin-specific antibodies belonged exclusively to the IgG class. In genital extracts the amount of IgG, IgA and IgM was determined. IgG was found in higher amount in every extract. IgA is present in similar amount only in the cervix, in the other parts only in traces. In all extracts IgM is found in a very low level. The specificity of the antibodies for acrosin was proven by active enzyme staining of the precipitin lines obtained by immunodiffusion.


Propranolol binding in plasma during cardiopulmonary bypass.

The effect of cardiopulmonary bypass on the plasma binding of propranolol was examined in seven patients. The fraction of propranolol free in plasma doubled, increasing from 6.6 to 13.5 per cent (P less than 0.001) following the administration of heparin, 400 IU/kg. Once cardiopulmonary bypass was concluded and protamine, 8 mg/kg, given, the free fraction decreased from 13.4 to 8.7 per cent (P less than 0.005). There was a further significant decrease to 6.5 per cent over the next 3.1 hours (SE +/- 0.3). Those alterations in the free fraction, which would result in more drug being available for binding to receptor sites and for exerting its pharmacologic effect, were due principally to the changes in free fatty acid levels produced by heparin and protamine, but also to the hemodilution produced by the pump prime.


Glutamic acid concentration in human semen--its origin and significance.

Glutamic acid content of semen was determined photometrically in over 400 semen specimens. Glutamatic acid content was found to increase proportionately to temperature in the first few hours post ejaculation. The glutamate estimation should therefore be performed on semen at 30 min. after ejaculation. The frequency distribution of glutamic acid concentration with 400 unselected specimens, 50 "normozoospermias" as well as 42 azoospermias is shown. The mean value of normozoospermias was 10.6 mg% (+/- 4.6 mg%) that of azoospermias 7.7 mg% (+/- 4.7 mg%). There was no correlation found between glutamic acid content and pH value. A correlation however, was demonstrated between glutamic acid and following: sperm count, citrate concentration, gamma-GT and carnitine. No correlation to fructose content was detectable. That suggests that glutamate gets to the ejaculate with the secretions from the prostate gland and epididymis whereas the seminal vesicles do not play a role in the level in the total semen.


Fetal morphology in mice exposed to halothane.

The teratogenic potential of subanesthetic and anesthetic exposure to halothane was studied in Swiss/ICR mice. Two treatment regimens were employed: daily exposure of males and females for nine weeks prior to conception and on days 1 through 17 of pregnancy; and exposure of females only on days 6 through 15 of pregnancy. Mice were exposed to subanesthetic concentrations of halothane for 0.025, 0.1, 0.4, and 1.2 MAC hours/day; anesthetic exposure was 4.0 MAC hours/day. Fetal morphologic development was normal at the two lowest exposures. Exposures of 0.4 MAC hours/day and more were associated with decreased fetal ossification. At the 1.2 MAC hour/day exposure, renal pelvic masturation was retarded and the incidence of skeletal variants was increased. The incidences of major malformations and minor anomalies were not increased following exposure to subanesthetic concentrations of halothane. Anesthetic exposure to 4.0 MAC hours/day was lethal to both dams and embryos, and resulted in major developmental malformations in surviving fetuses. These effects were probably due to altered maternal physiologic status. It is concluded that exposure of mice to subanesthetic concentrations of halothane does not result in important morphologic abnormalities in their offspring.


A rapid, sensitive method for quantifying enflurane in whole blood.

Thermal conductively detection (TCD) in conjunction with gas-liquid chromatography was employed for the analysis of enflurane in n-heptane extracts of whole blood. Enflurane was estimated to be 98 per cent extracted from whole blood by n-heptane. Analysis of enflurane standards ranging in concentration from 4.1 to 813 muM demonstrated linearity, with a correlation coefficient of 0.9999. As little as 8 muM enflurane may be detected in whole blood. TCD gas-liquid chromatography is a rapid and sensitive method for quantifying enflurane in whole blood.


[Contributions to the parasitic fauna of the GDR. 4. Studies of the presence of helminths in the brown rat (Rattus norvegicus)].

120 Brown rats (Rattus norvegicus), caught in a territory with animal production buildings in GDR, were infected with Ganguleterakis spumosa (58,3%), Hymenelopesis diminuta (44,1%) and Hydatigera taeniaeformis larv. (3,3%). The parasitological findings were compared with those of other authors from the neighbouring countries like CSSR, Poland, FRG and the former Deutsches Reich. For faunistic information results are necessary of researches in different parts of the country.


Echinococcus granulosus and E. multilocularis: in vitro culture of the strobilar stages from protoscoleces.

The techniques for the in vitro culture of Echinococcus granulosus and E. multilocularis are described in detail. The sheep strain of E. granulosus was grown to sexual maturity but fertile eggs were not produced due to the failure to achieve insemination in vitro. The horse strain of E. granulosus grew only slightly in vitro and then ceases to develop, although remaining active for long periods. E. multiloculoris differentiated largely into unsegmented, sexually mature, "monozoic" forms; some organisms developed "pseudo-proglottids" with the interproglottid membrane absent or poorly formed. After prolonged culture, some strobila of E. multilocularis developed an extra scolex.


[German cockroaches (Blattella germanica) in a refrigerator].

German cockroaches (Blattella germanica) regularly occurred in a refrigerator of a hospital in Leipzig. Larvae of instars 1--6 of a population of high density but uneven spatial distribution infiltrated through the defective magnetic tape packing of the refrigerator door into an area maintaining +7...12 degrees C. In this way they utilised their temperature dependent ability to move almost down to the lower limit and gave a new example of the plasticity of their reactions. Behavioural and ecological aspects of the observations as well as hygienic consequences and prophylactic measures are discussed.


The eimeriid Aggregata kudio n. sp. from Sepia elliptica.

A new species of an Eimeriid coccidian, Aggregata kudoi n. sp. from the gut of the cuttle fish, Sepia elliptica Hoyle, is described. The oocysts are large measuring 0.5--1.0 mm in diameter and have a thin wall. The number of sporoblasts produced is very large. Each sporoblast in the fresh condition measures 9.4--10.8 microns in diameter. The sporocysts give rise to 6 sporozoites. A few abnormal sporocysts measuring 13.2--14.5 microns and producing 12 sporozoites are occasionally seen.


Seasonal variation of bovine anti-J in the tropics.

Close to the Equator at an altitude of 1750 m above sea level a total of 27 cows of various breeds have been studied with regard to the fluctuation of their anti-J naturally occurring antibodies. Over 16 consecutive months the average total score of anti-J varied from a minimum of 20 in October to a maximum of 37 at the end of December. Practically all the sera had the lowest level of anti-J in October. This is about two months after the lowest yearly maximum temperature. It is concluded that gradual changes in temperature can cause variation in anti-J titer, and that the magnitude of the seasonal temperature changes influences the fluctuation of the natural anti-J.


Polymorphism of the serum proteins of wild pigs.

One hundred and ninety five wild pigs from two different regions of Poland were investigated for transferrin, amylase and ceruloplasmin polymorphism. A new tranferrin phenotype Tf PB was detected. This phenotype differed from Tf AB in the electrophoretic mobility of the more anodal transferrin. Tf P is assumed to be the product of a new allele Tf P at the Tf locus. Two amylase phenotypes Am 1-2 and Am 2 were observed. The Am 1 allele was absent from the pigs in the Poznan region. Only one ceruloplasmin phenotype, Cp B, was found.


The blood group factor Kf and allele Kae in the pig.

By means of alloimmune reagents used in the indirect Coombs test and the dextran test a new factor Kf in the K bloodgroup system of pigs was found, controlled by alleles Kacf, Kacef and Kbf. A new allele Kae was also detected. The K system with 6 alleles, 11 phenotypes and 21 combinations of genotypes remains (from the genetic point of view) an open system.


The nature of the prealbumin 'esterases' of horse serum.

Evidence is presented to suggest that the acidic prealbumin esterases in horse serum represent a protease-inhibitory protein. The esterase activity may arise from residual enzymic activity of the bound protease.


Inhibition of polymorphonuclear leukocyte chemotaxis by streptokinase-streptodornase.

Leukotaxis of circulating polymorphonuclear leukocytes (PMN's) appears to be a critical step in the generation of local inflammatory reactions. The present studies demonstrate a reversible, dose-dependent inhibition of PMN chemotaxis by streptokinase-streptodornase (SK-SD). This inhibition does not appear to depend upon the presence of lymphocytes or the release of chemokinetic humoral factors and phagocytic and bactericidal capacities of PMN's are unaffected by the doses of SK-SD employed.


Mechanism for the diluent response in asthma.

To investigate the mechanism underlying the airway response to diluent challenge, three adult asthmatic patients who were known to be reactive to inhaled diluent were studied. Airway response as measured by conventional pulmonary function testing was measured under the conditions of time, inhalation of room air, diluent and placebo. Two of the patients responded to time or to room air, suggesting that the response was not due to the phenol-buffered diluent. The third subject reacted primarily to the diluent and not to time, room air or normal saline. Two of the three patients were placebo responders.


Is there a negative correlation between malignancy and respiratory atopy?

A history of respiratory atopy (seasonal hay fever or asthma) was sought among 218 patients with malignancy of endodermal origin (lung, gut, bladder, prostate), 104 patients with mesodermal malignancy (hematological, sarcomas, genitourinary system), 70 patients with ectodermal malignancy (skin and breast) and 303 age and sex matched controls. There was a significantly lower frequency of respiratory allergy in patients with endodermal malignancy when compared with their matched controls (6.4% compared to 13.2%, p less than 0.005). There were no significant differences among any of the other groups. Patients with respiratory atopy appeared to have some degree of protection against developing malignancies of endodermal origin. This may relate to immunologic factors, an inherent difference in the endodermal cell layer in atopic individuals or as yet undertermined factors.


Relationship between serum and brain concentrations of phenytoin in the dog.

The concentrations of phenytoin (DPH) in the CNS of adult dogs given the drug by IV injection, continuous IV infusion, or repeated daily oral administration and of newborn pups given DPH by IV injection were consistently proportional to serum concentrations of the drug at the time of blood sample collections. Adult dogs injected IV with [14C]DPH failed to show predilection of the drug for the 13 anatomic brain sections sampled. The pharmacokinetics of DPH were studied in adult and neonatal dogs given 15 mg of the drug/kg of body weight as a single IV injection. The mean half-life of the drug in adult dogs injected IV was 4.5 hours. The serum half-life of injected DPH was lowest in pups 30 days of age when compared with that in other age groups. The serum half-life of injected DPH was increased in adult dogs under pentobarbital anesthesia.


Inhibition of erythropoiesis by plasma component(s) from sheep, goats, and rabbits.

Plasma from hypertransfused and normal sheep and experimentally induced anemic and normal goats was fractionated by ultrafiltration. Fractions obtained were assayed for erythropoiesis stimulatory factor (ESF) or erythropoiesis inhibitory factor (EIF) activity (or both) in the posthypoxic polycythemic mouse assay. The most potent sheep plasma-inhibitor fraction was found in the retentate on a membrane with a cutoff at mol wt 50,000. The most potent EIF fraction from anemic goats passed into the ultrafiltrate, but the comparable EIF from normal goats remained in the retentate on a membrane with a cutoff at mol wt 500. The yield of the most potent EIF fraction was higher from anemic goats than was the yield from normal goats. During thin-layer chromatography, EIF extracted from goat plasma fractions had the same mobility as did prostaglandin F2 alpha. Cohn rabbit plasma fraction IV-4 had an inhibitory factor, and a benzene extract of the fraction contained a component that had the same mobility as did prostaglandin F2 alpha. Cohn rabbit plasma fraction V contained a component that potentiated an erythropoietin-generating factor.


High pressure liquid chromatographic determination of cantharidin, using a derivatization method in specimens from animals acutely poisoned by ingestion of blister beetles, Epicauta lemniscata.

Experimental animals (rabbit, rat, goat, sheep, and pony) were given cantharidin or dried preparations of blister beetles (Epicauta lemniscata) to stimulate naturally occurring toxicosis in which beetles were ingested with alfalfa hay. A sensitive high-pressure liquid chromatographic method, involving derivatization of cantharidin with p-nitrobenzyloxyamine, was developed to detect the toxin extracts of ingesta, fluids, and tissues from these severely poisoned animals. Urine and ingesta from the upper portion of the gastrointestinal tract, containing from 1 to 20 ppm of cantharidin, were the most satisfactory samples for diagnosing toxicosis. Beetle preparations also were assayed and found to contain widely varying amounts of cantharidin (0.89% to 5.40% of dry weight). Blood chemical analyses on sera and urine samples from the sheep and pony indicated renal dysfunction.


Experimentally induced respiratory syncytial viral infection in lambs.

Signs of clinical illness, lesions, and seroconversion were observed in lambs experimentally inoculated with a respiratory syncytial virus of bovine origin. Signs of clinical illness were mild and consisted of fever and hyperpnea. Multifocal areas of interstitial pneumonia were seen in lambs necropsied during the period of clinical response. All lambs seroconverted to viral antigen, and the virus was isolated from two of the lambs.


Biophysical and serologic comparison of four equine adenovirus isolates.

Four equine adenovirus isolates have been characterized with regard to their biophysical and serologic properties. Electron microscopic studies demonstrated that purified virions have a typical adenovirus morphologic characteristic, with 50-nm-long fiber projections at each vertex of an 80-nm-diameter icosahedron. Extracted viral DNA was found to be a linear duplex of molecular weight 21 to 22 x 10(6). All four isolates were found to have a buoyant density in CsCl of 1.346 +/- 0.002 g/ml. Hexon structural components prepared from each isolate were shown to carry the same relative net charge, as judged from anion exchange elution profiles. Sodium dodecyl sulfate (sodium lauryl sulfate)-polyacrylamide gel electrophoresis revealed that the four isolates were composed of which the electrophoretic migration pattern was distinct from that of a human adenovirus reference. Serologic data (serum-neutralization and hemagglutination-inhibition tests) did not reveal any distinct antigenic diversity among the four isolates. On the basis of data obtained in this study, it is proposed that equine adenovirus isolates thus far available do, in fact, constitute a single serotype.


Anatomic location and age-related changes in the chinchilla thymus.

Thymuses of chinchillas varying from 2 weeks to 8 years of age were studied grossly and histologically and were determined to be entirely intrathoracic. Histologically, the amount of actual thymic tissue in the older chinchillas appeared to be less than that in the younger chinchillas. Lymphocyte concentration within medullary centers of the older chinchillas was significantly (P less than 0.05) less than that of the younger animals. Lymphocytopoietic activity was evident in the oldest animals studied. Body weight and thymic mass (thymus plus adipose tissue) weight were greater (P less than 0.05) in the older chinchillas.


Use of fenbendazole suspension (10%) against experimental infections of Toxocara canis and Ancylostoma caninum in beagle pups.

Eleven nematode-free Beagle pups were inoculated with Ancylostoma caninum and Toxocara canis; infection became patent 13 and 35 days later, respectively. Eight pups were treated with fenbendazole oral suspension (10%) at a dosage of 50 mg/kg of body weight/day for 3 days. The remaining three animals were unmedicated controls. The drug was effective in reducing both ascarid and hookworm burdens, and there was marked improvement in the clinical condition of treated pups as compared with unmedicated control pups. Natural expulsion of worms in control animals was 53% for ascarids and 2% for hookworms. Drug-related toxicosis was not observed in any of the medicated animals. It was concluded that fenbendazole oral suspension (10%) at the 50-mg/kg dosage is easily administered and is an effective drug for reducing nematode burdens in experimentally infected pups.


Structural considerations in tracheal disease.

Examinations were made of three sections of trachea obtained from eight dogs. The sections examined were at the regions of the second ring caudal to the larynx, the thoracic inlet, and the origin of the brachiocephalic trunk. Measurements were made of the lateral and ventrodorsal diameters, the lumen area of the trachea, the width and thickness of the tracheal cartilages, and the thickness of the trachealis muscle. Cell counts-per-square-micrometer of the cartilage and trachealis muscle were made. The results of these measurements were subjected to statistical analyses by means of one-way and two-way analyses of variance. The tracheal diameters, cartialge thickness, muscle thickness, and tracheal lumen area had significantly different measurements among the areas compared with both statistical methods. Ventrodorsal tracheal diameter and lumen area were not found to have significantly different measurements between the levels of the thoracic inlet and the brachiocephalic trunk. The cell counts did not have significantly different values among the areas considered when body weight was not a factor, but the values were significant when weight was a factor.


Influence of progestin upon hemodynamics in castrated male pygmy goats.

Effects of progestin administration for 5 to 6 weeks upon hemodynamics were studied in two separate experiments, using trained, adult castrated male Pygmy goats. Measurements of cardiac output, blood pressure, plasma volume, and oxygen content of arterial and mixed venous blood were made before, during, and after treatment. In experiment 1, four animals were used. Progesterone was implanted subcutaneously in silicone envelopes which released an average of 44 mg of progesterone/day/goat. A 20% decrease in cardiac output occurred by the 5th week of treatment. Blood pressure was maintained by an increased peripheral vascular resistance. The five animals in experiment 2 were given (IM) 6 mg of 17-alpha-hydroxyprogesterone/kg of body weight/day. Cardiac output decreased 17% in the 2nd and 3rd weeks of hormone treatment. 17-alpha-Hydroxyprogesterone caused a transient natriuresis followed by sodium retention. Urinary aldosterone excretion increased after 9 days of treatment, but returned to normal by the 15th day.


Use of the double-isotope single-injection method for estimating renal function in normal cross-bred swine.

The double-isotope single-injection method to estimate renal function which utilizes the radiolabeled chemicals [131I]sodium iodohippurate and [125I]sodium iothalamate was evaluated in swine. A total of 46 normal, cross-bred swine were used to determine the applicability of this method for measuring the glomerular filtration rate and effective renal plasma flow. The mean glomerular filtration rate in pigs was determined to be 5.33 +/- 0.82 ml/kg of body weight/minute for [125I]sodium iothalamate with a biological half-life (T 1/2) of 39.18 +/- 7.44 minutes. The mean effective renal plasma flow was determined to be 19.25 +/- 3.12 ml/kg of body weight/minute for [313I]sodium iodohippurate, with a T 1/2 of 18.45 +/- 1.74 minutes. These values are more closely related to the glomerular filtration and effective renal plasma flow values reported for dogs and cats than they are to values reported for man. The method is rapid and reliable; results are available 6 to 8 hours after the experiment. This method is advantageous when information about renal function variables is a prerequisite to pharmacokinetic or toxicologic studies.


Pathophysiologic studies of calves given 3-methylindole intraruminally.

Intraruminal administration of 0.25 g of 3-methylindole (3MI; skatole/kg of body weight) to seven young calves generally caused mild respiratory signs and lesions, accompanied by only slight changes in cardiopulmonary function. Moderate depression, trembling, and irregular respiratory rate were observed between postadministration hours (PAH) 6 and 12. By PAH 24 at this dosage, abnormal clinical signs were not present. Statistically significant (P less than or equal to 0.05) changes observed in blood gas data from the seven calves were a decrease in aortic oxygen tension at PAH 12, increases in free-flowing venous oxygen tension in the intervals between PAH 6 and 12 and between PAH 6 and 24, and an increase in occluded venous oxygen tension at PAH 24. All calves had increases (although generally not statistically significant) in heart rate, cardiac output, cardiac index, stroke volume, and stroke index after 3MI administration. Mean aortic and pulmonary arterial pressure changes were generally small and variable. At necropsy, the lungs of the calves did not collapse when the thorax was opened. Patchy areas of consolidation (0.5 cm in diameter) were scattered throughout the parenchyma. Pulmonary edema or emphysema was not observed grossly. Microscopically, the alveolar septae were irregularly thickened because of edema, infiltration by polymorphonuclear and mononuclear cells, and vascular congestion. Interstitial lesions were patchy in distribution and severity and corresponded to the areas of consolidation observed grossly. Alveolar epithelial hypertrophy and hyperplasia were present, and an occasional focus of alevoli contained fluid of edema. Degeneration of individual hepatocytes was observed in scattered areas of the liver, especially in the periportal areas. It was concluded that differences in 3MI dosage response may exist between young calves and adult cattle in which calves are more resistant to the pulmonary cytotoxicity of 3MI.


Neutralizing antibody to bovine adenovirus serotype 3 in healthy cattle and cattle with respiratory tract disease.

A serosurvey of healthy cattle for the presence of serum-neutralizing antibody to bovine adenovirus serotype 3 (BAV-3) established the widespread prevalence of this agent in Iowa cattle. Of the animals studied, 19.1% (involving 157 calves that represented 40 outbreaks (herds) of respiratory tract disease) seroconverted to BAV-3. This pathogen was implicated serologically as being involved in the cause of respiratory tract disease in six herds. Bovine adenovirus serotype 3 was isolated from cattle in two of these herds. Based on seroconversion and lack of isolation of other viral agents, it appeared that BAV-3 could have been the sole virus involved in the respiratory tract disease in one of these two herds. In another herd, seroconversion was observed only to BAV-3, but other viral agents as well as BAV-3 were isolated. The remaining four herds presented a problem because the cattle seroconverted to more than one agent and additional viral agents were isolated from some animals. Whether the disease manifestations observed in these six herds were due solely or in part to BAV-3 can only be speculated. Cattle are capable of undergoing a natural infection, as indicated by seroconversion, in the absence of overt clinical signs of illness. It appears that maternal (passive) antibody decreases to a point at which infection by this virus becomes possible and an active immune response occurs.


Luteinizing hormone during sexual maturation in pony mares.

Luteinizing hormone (LH) was quantified in pony mares during artificially induced sexual maturation. Ovarian follicular development was also assessed by rectal palpation of the ovaries. With the exception of large periovulatory LH concentrations in two mares that ovulated, LH concentrations were not significantly different in mares undergoing sexual maturation and thus having marked follicular development when compared with mares that were not undergoing sexual maturation and thus did not have marked follicular development. These results indicate a dissociation in time between the onset of follicular development and the increase in LH which is associated with the first ovulation of the year.


Volume dilution of sodium thiocyanate as a measure of extracellular fluid volume in the horse.

Volume dilution of sodium thiocyanate as a measure of extracellular fluid volume was determined in 24 normal adult horses and 4 ponies. The method employed yielded highly reproducible results on multiple determinations in individual horses. A highly significant (P less than .001) correlation between thiocyanate space and body weight was demonstrated.


Benzimidazole resistance of equine stronygles--critical tests of six compounds against population B.

Critical tests were conducted on eight horses naturally infected with several species of large and small strongyles from population B. Tested were six benzimidazoles, including thiabendazole (2 lots) (44 mg/kg of body weight); mebendazole (8.8 mg/kg); cambendazole (two formulations) (20 mg/kg); fenbendazole (10 mg/kg); oxibendazole (10 mg/kg); and oxfendazole (10 mg/kg). All compounds were administered by stomach tube except one of the two cambendazole formulations which was an intraoral paste. Removal of large strongyles (when present), Strongylus vulgaris and Strongylus edentatus, was 100% by each drug. In general, five species of small strongyles (Cyathostomum catinatum, Cyathostomum coronatum, Cylicocyclus nassatus, Cylicostephanus goldi, and Cylicostephanus longibursatus) exhibited varying degrees of resistance (% removal) to all of the drugs except oxibendazole. A total of 19 other species of small strongyles from seven genera, including the three described earlier were about 100% removed by the six benzimidazoles. Poor removal of immature (fourth-stage larvae) forms was also characteristic of the six drugs.


Influence of vagal tone on rheology and transportability of canine tracheal mucus.

The influence of vagal tone on the rheology of tracheal mucus was studied in 6 conscious, tracheostomized dogs. Mucus was sampled via the tracheostomy with a cytology brush before and after administration of atropine. After vagal blockade, a clear decrease in the mucus collection rate was seen. The viscoelastic properties of the mucus were not altered by atropine when control elasticity was high, but when control elasticity was low, administration of atropine led to increased elasticity. In neither case was there a significant change in transportability of the mucus samples. The increase in elasticity from a small initial value was consistent with the blocking of moderate vagal activity, because administration of methacholine in the same group of dogs had been shown to cause a decrease in mucus elasticity.


The effect of increased ventilation on resistive load discrimination.

The ability of normal subjects to detect the addition of external resistive loads was determined both at rest and when ventilation was increased to more than 30 L/min by CO2 administration or exercise. Tidal volume, flow, and mouth and transpulmonary pressures were recorded during resistive load discrimination using standard psychophysical techniques. The mean resistance detection threshold was 0.40 +/- 0.06 cm H2O/L/s at rest, 0.36 cm H2O/L/s during administration of CO2, and 0.44 cm H2O/L/s with exercise. The Weber fraction was 0.28 +/- 0.04 at rest, 0.29 +/- 0.08 with CO2, and 0.34 +/- 0.04 with exercise. The lack of change in the ability to detect resistive loads when ventilation was increased was surprising because changes in both pressure and flow were tripled. The findings were supportive of the hypothesis that resistance or something like it is perceived, rather than change in flow or pressure.


Forced expiratory spirometric parameters derived by feature-extraction techniques.

Spirometric data from 200 patients seen in the pulmonary function laboratory were analyzed retrospectively. Using standard criteria, the spirometric patterns of the subjects were classified as indeterminate, normal, restrictive, or obstructive; obstruction was further classified as mild, moderate, severe, or very severe. A formal feature-extraction technique was used to define 2 new parameters. These were linear combinations of the 5 standard spirometric parameters and explained 94% of the variation in the original parameters. The derived parameters provided better separation of the various classes than the combination of the normalized forced vital capacity and the ratio of the forced expiratory volume in 1 s to the forced vital capacity.


Characterization of antibody-dependent cytotoxicity mediated by human alveolar macrophages.

Antibody-dependent cellular cytotoxicity is believed to be an important host defense mechanism. Although this reaction has been shown to be mediated by various Fc receptor-bearing effector cells, the ability of a mature macrophage population to mediate this reaction has not been previously demonstrated. In this study, alveolar macrophages obtained from normal subjects by subsegmental lung lavage were used to determine whether this mature macrophage population had the ability to mediate antibody-dependent cell killing. The results of this study demonstrated that alveolar macrophages clearly mediate antibody-dependent cellular cytotoxicity against antibody-coated erythrocyte targets and that the kinetics of the reaction are characteristic of an enzyme-substrate interaction. Furthermore, this study demonstrated that alveolar macrophages are more efficient at mediating antibody-dependent cytotoxicity than is their precursor cell, the peripheral blood monocyte.


HLA-Bw15 and tuberculosis in a North American black population.

Peripheral blood lymphocytes from 60 black patients with Mycobacterium tuberculosis disease proved by culture and 100 healthy black persons were HLA phenotyped using a standard lymphocytotoxicity test. Statistical analysis of the results showed that only Bw15 antigen had a significantly increased frequency among patients with tuberculosis when they were compared to healthy persons. Furthermore, examination of disease manifestations among patients with tuberculosis demonstrated that patients with Bw15 had significantly more far-advanced pulmonary disease with cavitation than did patients without Bw15. These observations suggest that Bw15 may influence both susceptibility to tuberculosis and the course of the disease.


Murine influenzal tracheitis: a model for the study of influenza and tracheal epithelial repair.

The murine model of influenza virus infection is generally a lethal pneumonitis produced by a highly mouse-adapted virus. However, we infected mice with a less adapted virus and produced a nonlethal disease that involved the airways without producing gross pneumonitis. Changes that occurred in the tracheal epithelium were studied by scanning and transmission electron microscopy. Complete desquamation of the epithelium occurred within 3 days after infection, regeneration began within 5 days, and repair was complete within 2 wk after infection. This model is proposed as an alternative to the lethal pneumonitis for the study of murine influenza and also as a model for the study of repair of the respiratory ciliated epithelium.


Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974.

Between 1950 and 1974, 318 cases of initial pneumothorax were diagnosed among the residents of Olmsted County, Minn. Seventy-five cases were due to trauma, and 102 were iatrogenic. One hundred forty-one cases were spontaneous in onset, of which 77 were primary and 64 secondary to a specific underlying pulmonary disease. The age-adjusted incidence of primary spontaneous pneumothorax was 7.4/100,000/yr for males and 1.2/100,000/yr for females. For secondary spontaneous pneumothorax, the incidence was 6.3 and 2.0/100,000/yr for males and females, respectively. The ratio of male-to-female incidence was 6.2:1 for primary and 3.2:1 for secondary spontaneous pneumothorax. The differences between the incidence rates for primary and secondary pneumothorax by sex or in total were not significantly different.


Postulated sources of Mycobacterium intracellulare and Mycobacterium scrofulaceum infection: isolation of mycobacteria from estuaries and ocean waters.

Mycobacteria biochemically and serologically similar to those isolated from humans have been found in estuaries and ocean waters in the south-eastern United States. This is consistent with the hypothesis that aerosols from these waters are one potential source of infection with these mycobacteria.


Primary tumors of the heart: a rewarding challenge.

During a 10-year period 21 patients were treated for tumors of the heart, including 19 myxomas, one fibroma, and one sarcoma. The latter two cases are presented separately, and the 19 myxomas are analyzed together. An unusual association of left-sided myxoma with mitral valve abnormalities was found. In the surgical group (18 patients) there were no deaths and one case of postoperative cerebrovascular accident (CVA) with residual sequelae during a mean follow-up of 55 months. The results show the good prognosis of patients operated upon for myxomas of the heart and that there is no need for routine full-thickness excision of the septum in its treatment.


Aortic valve replacement and the senior citizen.

The elderly patient, regardless of age, faces an early demise from progressive cardiac decompensation secondary to aortic valve disease. Aortic valve replacement can be carried out at a reasonable operative risk and extend the longevity to very close to that of normal life expectancy. It is our feeling, based on these results, that patients with significant symptoms secondary to aortic valvular disease, regardless of age and without other major organ problems, should be given the choice of aortic valve replacement to enhance the quality and quantity of their lives.


Early diagnosis of pancreatic cancer using ultrasound and fine needle aspiration cytology.

Ultrasonography was performed on 37 patients with proven cancer of the pancreas. Three patients had lesions too small to be detectable, but, in the remainder, abnormalities were found in 30 (88%). Subsequently, percutaneous fine needle aspiration cytology was obtained in 12 patients with suspected pancreatic cancer, in whom ultrasound confirmed the presence of a mass. There were two false negative results and no false positive diagnosis. For seven patients laparotomy was avoided. Ultrasonography should be the first investigation in patients with suspected cancer of the pancreas, and, if a mass is detected, it should be aspirated percutaneously using a fine needle.


The results of surgical treatment of bowel obstruction caused by peritoneal carcinomatosis.

Thirty-four patients with malignant bowel obstruction have been evaluated with particular regard to survival, success of decompression and incidence of reobstruction. In patients with intestinal obstruction caused by peritoneal carcinomatosis the following have been determined: 1) surgery is not urgent, 2) surgical decompression usually is possible, 3) surgical decompression may facilitate additional adjuvant therapy, and 4) death is usually not caused by reobstruction after surgical decompression.


Surgical problems in sarcoidosis.

Sarcoidosis ranges from asymptomatic lymphadenopathy to debilitating cavitary lung disease and involves surgeons in diagnostic and therapeutic procedures. In 89 patients two died of pulmonary insufficiency from Stage III sarcoidosis. Sixty-two patients underwent 74 diagnostic surgical procedures, with mediastinoscopy most frequently used, yielding 100 per cent diagnostic accuracy. Biopsies of other obviously diseased sites, including lung, liver and skin were effectively used. Surgical treatment of sarcoidosis involved both general and thoracic procedures in seven patients. The severity of pulmonary problems in Stage III sarcoidosis is emphasized in two patients with Aspergillus infections, hemoptysis and Aspergillus empyema with bronchopleural fistula. Sarcoidosis becomes a significant surgical problem in both diagnosis and the treatment of its complications.


Colitis cystica profunda.

Colitis cystica profunda, although rare in occurrence, deserves recognition as a distinct pathologic entity. Several types of clinical presentation have been recognized, the most common being a solitary lesion in the rectum. The cause is generally ascribed to the reparative process associated with chronic mucosal inflammation. Differentiation of this entity from mucus-producing adenocarcinoma should be possible with an adequate biopsy. Conservative excision is appropriate therapy, depending on the clinical manifestations.


PTFE graft arteriovenous fistulae for hemodialysis access.

The use of expanded PTFE graft arteriovenous fistulae for hemodialysis access is becoming increasingly popular. Its low infection rate, low thrombogenicity, low body reactivity, and longevity make it an ideal vascular substitute. From May 1976 to June 2, 1978 we have placed 102 grafts in 89 patients, many of whom represent management problems of other access means. Major complications are pseudointimal proliferation at the venous anastomosis, pseudoaneurysm formation, and thrombosis, usually associated with low blood volume. These problems are, however, readily rectifiable. Other types of grafts, according to the literature, have not been successful for hemodialysis access.


Passive-active immunity from hepatitis B immune globulin. Reanalysis of a Veterans Administration cooperative study of needle-stick hepatitis. The Veterans Administration Cooperative Study Group.

The mechanism of action of hepatitis B immune globulin (HBIG) and immune serum globulin was sought in a reanalysis of a Veterans Administration cooperative study on needle-stick exposure to hepatitis B surface antigen (HBsAg)-positive blood. Sera from 296 exposed persons were tested for HBsAg, antibody to HBsAg (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc) by radioimmunoassay. Type B hepatitis developed in three HBIG (2%) and in 12 ISG (8%) recipients. In contrast, subclinical infection (development of HBsAg or anti-HBs and anti-HBc without symptoms or jaundice) developed in 16 HBIG (10%) but only six immune serum globulin (4%) recipients. Thus, infection occurred equally in both groups but was more likely to be subclinical in HBIG recipients, indicating that HBIG permitted development of passive-active immunity to type B hepatitis. An additional 53 immune serum globulin recipients (36%) but only one HBIG recipient developed anti-HBs alone, without hepatitis, HBsAg, or anti-HBc. This response was more compatible with immunization by HBsAg than with infection. Ultracentrifugation analysis revealed occult HBsAg in the immune serum globulin but not the HBIG, indicating that some immune serum globulin preparations contain HBsAg and can induce active immunity to type B hepatitis.


Delta-9-tetrahydrocannabinol as an antiemetic for patients receiving cancer chemotherapy. A comparison with prochlorperazine and a placebo.

The antiemetic activity and side-effects of delta-9-tetrahydrocannabinol (THC) were evaluated in 116 patients (median age 61 years) receiving combined 5-fluorouracil and semustine (methyl CCNU) therapy for gastrointestinal carcinoma. In a double-blind study, patients were randomized to receive THC, 15 mg orally three times a day, prochlorperazine, 10 mg orally three times a day, or placebo. The THC had superior antiemetic activity in comparison to placebo, but it showed no advantage over prochlorperazine. Central nervous system side-effects, however, were significantly more frequent and more severe with THC. With the dosage and schedule we used, and in our patient population of largely elderly adults, THC therapy resulted in an overall more unpleasant treatment experience than that noted with prochlorperazine or placebo. Although THC may have a role in preventing nausea and vomiting associated with cancer chemotherapy, this role must be more clearly defined before THC can be recommended for general use.


Complete remissions in metastatic breast cancer treated with combination drug therapy.

One hundred sixteen patients with metastatic breast cancer who achieved complete remission with combination chemotherapy were analyzed to ascertain the factors that affect the duration of complete remission and the patterns of relapse. The median duration of complete remission was 17 months. Disease recurred in 81 patients (70%) at periods ranging from 3 to 44 months after achievement of complete remission. The duration of complete remission was inversely related to the bulk of metastatic tumor. Twenty-three patients treated with combined oophorectomy and chemotherapy experienced the longest remissions (median duration of 33 months); only eight (35%) of them have relapsed. Seventy-six percent of the relapses occurred in previously known sites of tumor involvement; most of the remainder involved the brain. The short duration of complete remissions and tendency to relapse in sites of initial involvement suggest that patients with metastatic breast cancer who achieved complete remission with combination chemotherapy still had substantial residual tumor. Consolidation treatments, using hormonal therapy and non-cross-resistant chemotherapy along with irradiation to initial sites of metastases, whould be investigated to ascertain their usefulness in prolonging the remissions.


Potassium iodide sensitivity in four patients with hypocomplementemic vasculitis.

During metabolism studies of radiolabeled proteins in 126 participants four patients were suspected of being sensitive to potassium iodide (Kl) because they repeatedly developed urticaria and other symptoms after Kl administration. Two of the four patients suspected of Kl sensitivity and 10 control patients were orally challenged with Kl to document and characterize Kl sensitivity and to evaluate the possible association(s) of Kl sensitivity with urticaria, hypocomplementemia, and vasculitis. The Kl challenges in the two sensitive patients precipitated urticaria, angioedema, polymyalgias, conjunctivitis, and coryza. One of these two patients also developed a severe systemic illness characterized by fever, headache, peritonitis, episcleritis, and pneumonitis. The four sensitive patients were strikingly similar in that they exhibited hypocomplementemia and dermal vasculitis associated with chronic urticaria or systemic lupus erythematosus, suggesting that other patients with similar clinical features may be sensitive to Kl and that Kl may precipitate severe systemic illness in them.


Seizures and intraventricular conduction defect in propranolol poisoning. A report of two cases.

We have recently seen two cases of propranolol poisoning. In both instances, plasma propranolol levels were elevated. Both patients experienced generalized seizures and had a transient intraventricular conduction defect on electrocardiogram. The literature on intoxication of propranolol and other beta-adrenoceptor blocking drugs suggests that the effects of massive propranolol intoxication observed in our patients can be explained on the basis of the pharmacologic properties of propranolol. Therapy consisted of gastric lavage and agents to antagonize the beta-adrenoceptor blockade effect. Both patients recovered.


Guidelines for the care of patients hospitalized with viral hepatitis.

For years patients hospitalized with viral hepatitis have been placed in two categories of isolation--enteric precautions and blood precautions. This strategy was based on the inability to differentiate between hepatitis A and B and on the assumption that feces and blood from patients with either type might be infective. It is now known that patients with hepatitis A do not pose a problem of disease transmission through direct contact with blood, and although blood of patients with hepatitis B may be infective, the virus is not transmitted via feces. The enteric route is the principal mode of transmission for hepatitis A, but maximal levels of hepatitis A virus excretion occur before the onset of jaundice. Non-A, non-B hepatitis is similar epidemiologically to hepatitis B. Thus, the major thrust for caring for patients hospitalized with viral hepatitis is toward blood precautions; the same precautions used when handling feces, urine, and excretions from all other hospitalized patients are appropriate for patients admitted with a diagnosis of hepatitis A.


Clinical hypocompetence: the interview.

In observing more than 300 clinical interviews, we have seen a high frequency of physician-engendered defects. Most of the defective examples can be classified as one or a combination of five syndromes: the therapeutic lack; inattention to primary data (symptoms); a high control style; an incomplete data base usually omitting patient-centered data and active problems other than the present illness; and a thoughtless interview in which the physician fails to formulate needed working hypotheses. Proper diagnosis of these defects allows for better prescription of educational correction.


Geriatrics and internal medicine.

If medical education is to respond adequately to the growing number of citizens encompassed by the field of geriatric medicine, it must intensify its commitment to the special health and health-related problems of the elderly at every level, from student to certified specialist. This paper discusses the various intellectual, epidemiologic, economic, and attitudinal factors related to the teaching and practice of geriatric medicine. The emergence of a positive philosophy emphasizing coping and possible reversibility of disease is vital. The recent report of the Institute of Medicine on Aging and Medical Education is also reviewed, as well as graduate training opportunities and ways in which the American Board of Internal Medicine could play a leading role in this process by providing increased emphasis on geriatrics in its training programs and certifying examinations. The medical profession must continue its self-evaluation to ascertain how it can most effectively contribute to improving the lives of the elderly, perhaps our greatest national resource.


The drug regulation process and the challenge of regulatory reform.

After 17 years of experience with the far-reaching 1962 amendments to the law regulating new drugs, a major effort is underway to overhaul the law. Important questions of health policy are involved. An extensive recent study by the Department of Health, Education, and Welfare's Review Panel on New Drug Regulation concluded that the system of regulation that requires governmental pre-market clearance of prescription drugs, based on evidence of safety and effectiveness, is fundamentally sound. But the Review Panel identified four principal deficiencies in the drug approval process: a lack of openness and public accountability, an inadequate science environment at the Food and Drug Administration (FDA), imprecision in the standards and procedures for pre-market approval, and limited FDA authority in the post-marketing period. Former FDA commissioner Donald Kennedy took useful administrative steps to mitigate these problems, but legislation is badly needed. Although the bill that recently passed the Senate is not perfect, it contains substantial improvements over the status quo and merits support.


Organ of Corti in the human fetus: scanning and transmission electronmicroscope studies.

The organ of Corti in the five-month human fetus was studied by transmission and scanning electronmicroscopy. Differentiation of the surface organization of the organ of Corti into a single row of inner and three to four rows of outer hair cells was complete at this stage except at the apical end. The morphological aspects of the hair bundles changed with maturation of the sensory cells; the inner hair cells preceded the outer hair cells in cytodifferentiation at a given location.


Traveling waves demonstrated by a revolving helix: a simple teaching aid.

A simple procedure for the demonstration of traveling waves in actual motion in the classroom is described. Using a matched set of experimental data on a) peak amplitude of basilar membrane oscillations, and b) phase-lag along the membrane, both for a given frequency of stimulation, it is possible to construct a solid spiral, or helix, of constantly changing diameter and pitch. When projected on a screen, the helix will look like a longitudinal amplitude gradient along the basilar membrane; as the helix is rotated, the projection will appear as a traveling wave. It is suggested that the device, because of its inherent simplicity, is a useful aid in a teaching laboratory for future otolaryngologists, audiologists and other professionals related to the field of hearing.


Otoscopy and photography: a new method.

A new hand-held otoscope photographic system, convenient and suitable for clinical application, is introduced. This instrument allows clear otoscopic examination in stenotic or tortuous ear canals, and photographs the subject in one procedure. The instrument consists of a rod-lens optical system, a fiberoptic light source, a camera, and exchangeable speculum and a strobe light. Color photographs of tympanic membranes and middle ear pathology are presented.


Relearning the swallowing process.

Three patients were encountered who had physical defects that prevented them from swallowing food. They had received nourishment for a long period of time by means of tube feedings, gastrostomy in two cases and nasogastric tube in the third. Following surgical correction of the physical problems, they were still unable to swallow food. It was conceived that they had forgotten how to swallow. A program to enable them to relearn the technique of swallowing was established, similar to that used in premature infants. The three patients were successfully rehabilitated, able to eat a regular diet. The method is being evaluated in stroke patients who have lost the ability to swallow food and saliva.


Change in the force-summed pressure measurements of the upper esophageal sphincter prelaryngectomy and postlaryngectomy.

The pharyngoesophageal high pressure zone (PE-HPZ) was measured prelaryngectomy and postlaryngectomy with a new force-summing probe that accounts for sphincter pressure asymmetry. A total of 31 patients were studied six times each. Postoperatively, pressures dropped from 130+/-24 mm Hg to 66+/-9 mm Hg. After a standardized, intensive laryngectomy rehabilitation program, 12 of 19 postoperative patients acquired acceptable esophageal speech and 7 did not. Speakers and nonspeakers were found to have nearly identical PE-HPZ pressures (speakers = 70+/-10 mm Hg, nonspeakers = 59+/-18 mm Hg). Differences in sphincter length or relaxation likewise did not discriminate between these two groups. We conclude that PE-HPZ pressure is not a critical determinant of the acquisition of esophageal speech.


Laryngoscopy in space travel.

The need for laryngoscopy aboard a spacecraft on a mission of one to three years is anticipated. Therefore, the inexperience of the potential endoscopists and the problems they face in the free-floating environment of space are considered. A simplified coaxial intubation technique employing a split-apart modification of a Jako-type laryngoscope is suggested.


Endotracheal and tracheostomy tube cytology. A noninvasive technique for early detection of carcinoma of the lung and aerodigestive tract.

Carcinoma of the lung is the leading cause of death from malignancy in this country. Twenty percent of patients with lung carcinoma are asymptomatic early in the course of the disease. Survival rates are much better when lung carcinoma is discovered at the asymptomatic or radiographically occult stage, therefore improved screening methods should be investigated. Many tumors in the tracheobronchial tree shed malignant cells into the bronchi and sputum cytology has been of value in the early diagnosis of carcinoma of the tracheobronchial tree. Thousands of patients are intubated daily. During endotracheal anesthesia, secretions are stimulated in the tracheobronchial tree and endotracheal or tracheostomy tubes are coated with these secretions. In a preliminary study, the cytology examination of the secretions adherent to 50 endotracheal tubes suggests that endotracheal and tracheostomy tube cytology will prove to be a reliable, noninvasive and cost-effective means of screening high risk patients for occult primary carcinomas of the lung and upper aerodigestive tract.


Vocal cord dysfunction - an industrial health hazard.

Vocal cord dysfunction has a definite incidence of association with high environmental noise levels. Our study has shown roughly an 8% incidence of vocal cord dysfunction (vocal cord nodules, vocal cord polyps and chronic laryngitis) in individuals working in high noise environments. In addition, those individuals who have surgery for vocal cord nodules and who work in high noise environments will have over a 30% incidence of recurrent vocal cord dysfunction following surgery. Our study indicates that females tend to be more at risk in high noise environments than males.


Optical stylet: an aid to intubation and teaching.

An optical stylet was developed which can be inserted into an endotracheal tube, and the passage through the vocal cords and position of the cuff in the trachea could be controlled visually. It is of great help in difficult intubations in adults and children. It became an invaluable tool in teaching endotracheal intubation by coupling a teaching attachment (beam splitter) to theoptical system. The operator and the second observer (student) can see the actual manipulations simultaneously.


Epiglottitis: evolution in management during the last decade.

In the past decade, changes have occurred in the management of epiglottis. A ten-year retrospective study of 64 patients admitted to the Children's Hospital of Philadelphia with the diagnosis of epiglottis was performed. An evolution in the management of epiglottitis was demonstrated in this series of patients. The morbidity and mortality of currently employed modes of airway management (medical observation, endotracheal intubation or tracheostomy) were complication than treatment with tracheostomy. A small, select group was conservatively managed with close observation. The use of antibiotics and steroids was analyzed. Suggested guidelines for management of epiglottitis are presented.


Value of radionucleotide scanning in the staging of head and neck carcinoma.

The presence or absence of distant metastases in squamous cell carcinoma of the head and neck is critical in making rational therapeutic decisions. Radionucleotide bone and liver scans are frequently utilized in the initial evaluation of these patients for possible distant metastases. The true value of routine bone and liver scans in the initial staging of primary squamous cell carcinoma of the head and neck is unknown. One hundred eighteen patients with primary squamous cell carcinoma of the head and neck, evaluated during a five-year period, were retrospectively reviewed. Eight percent were stage I, 18% stage II, 21% stage III, 53% stage IV. Because metastatic carcinoma of the head and neck is primarily regional or pulmonary, the low prevalence of liver and bone metastases limits the usefulness limits the usefulness of these radionucleotide scans. We conclude that routine bone and liver scanning is not a valuable diagnostic technique in the initial staging of head and neck carcinoma when clinical or biochemical evidence of distant metastases is not present.


Laryngeal clefts: a histopathologic study and review.

The histopathologic findings in a case of laryngeal cleft studied by serial sectioning, and a literature review of this clinical entity are presented. The primary micropathologic findings include a cleft deformity of the posterior cricoid lamina, and alterations in muscle differentiation involving the interarytenoid and posterior cricoarytenoid muscles. Possible embryogenic mechanisms are discussed. The clinical picture is characterized by signs and symtpoms of aspiration with airway obstruction, and definitive diagnosis is achieved by endoscopic examination. Treatment consists of surgical repair, although some patients with type 1 laryngeal clefts may be managed on a conservative trial. The need for uniform classification of laryngeal clefts in future reporting is emphasized.


Multiple primary malignancies of the upper aerodigestive system.

Multiple primary carcinomas were found in 11.5% of 1,518 patients presenting with an index tumor in the oral, pharyngeal or laryngeal areas. These additional malignancies were subdivided into two groups: 1) those occurring in distant or unrelated tissues and 2) those occurring in a multicentric zone defined as including the oral area, pharyngeal area, larynx, esophagus and tracheobronchial tree. Although some trends were noted, a primary lesion may be found anywhere in the zone of multicentricity. The dynamic nature of the progressive transition of the potentially malignant tissues in the multicentric zone is reemphasized. The physician, treating patients with head and neck cancer, should be prepared not only to cope with simultaneously occurring primary cancers but also to be constantly vigilant for the later development of subsequent primary carcinomas.


Stomal recurrence following laryngectomy: a critical evaluation.

Recurrent tumor in or around the tracheal stoma following laryngectomy almost always terminates in a fatal outcome. Several investigators have attempted to determine the factors that predispose a patient to stomal recurrence, but their conclusions are not entirely in agreement. The records of 251 consecutive laryngectomy patients treated at the UCLA Hospital between 1955 and 1977 were reviewed. The variables evaluated included type of operation, preoperative tracheostomy, interval from operation to recurrence, presence of neck metastases, performance of thyroidectomy, site of lesion, and control of tumor margins. While certain events, such as preoperative tracheostomy, appeared more frequently than others in the stomal recurrence patients, no single factor or group of factors could explain all the recurrences. It appears that stomal recurrences arise from heterogeneous causes. Good planning and utilization of the principles outlined should reduce the incidence of this dreaded complication.


Tracheotomy for infant botulism.

Botulism is a serious intoxication caused by ingestion of food containing preformed botulinus toxin and characterized by rapidly progressive bulbar paralysis, generalized weakness, and respiratory insufficiency. In 1976 a distinct clinical entity of infant botulism was recognized. The disease apparently results from intraintestinal toxin production which produces a defect in neuromuscular transmission by interfering with release of acetylcholine at cholinergic synapses. Five cases of infant botulism were identified at the Children's Hospital of Philadelphia between 1975 and 1977. Initial symptoms included constipation, slow feeding, lethargy and weak cry. Four of the patients progressed to respiratory insufficiency requiring nasotracheal intubation. Three of the infants with respiratory failure required tracheotomy. Because infants with respiratory failure may require support for months, we recommend that a tracheotomy be performed early in the management to avoid the complications associated with prolonged intubation. The effectiveness of antitoxin or antibiotics to treat infant botulism remains questionable and therefore prolonged respiratory supportive care is the mainstay of therapy. In addition, we offer guidelines for decannulation in cases of infant botulism. None of the patients in our series could be decannulated prior to initial discharge from the hospital.


Foreign body and caustic ingestion: management 1979.

Most physicians involved in the diagnosis and management of foreign body aspiration and caustic ingestion assume that the numbers of these cases are decreasing. A sizeable number of patients die of caustic ingestion and poisoning annually, and deaths from foreign body ingestion have more than doubled since 1950. Increasing the significance of these needless tragedies is the fact that the most frequent victim is a young, healthy child. Physicians should encourage educational campaigns to alert parents to the dangers of caustic agents and small items capable of being aspirated. They should be conversant with the treatment of both. This paper reviews current opinions regarding management.


Electron microscopy in the diagnosis of liposarcoma and fibrosarcoma of the larynx.

Electron microscopy (EM) was useful in establishing the final diagnosis in specific instances of liposarcoma and fibrosarcoma of the larynx. In the first case light microscopy revealed cells that met the histologic criteria of a low grade liposarcoma; EM revealed cells that displayed a varied ultrastructural differentiation; thus the tumor was classified as a mixed mesenchymal tumor rather than liposarcoma per se. In the second case, pathologic evaluation indicated a grade 2 fibrosarcoma. EM revealed malignant mesenchymal cells that closely recapitulated normal fibroblasts (no epithelial differentiation was present). This kind of information enables more accurate determination of the source of the primary lesion than results of light microcsopy alone.


Reliability of serum ferritin determinations after total dose infusion of iron dextran in pregnancy.

Serum ferritin, serum iron, total iron binding capacity, and haemoglobin levels were measured in a group of 36 pregnant women before, one week after, and four weeks after a total dose infusion of iron dextran (T.D.I.). The serum ferritin level is considered to provide a reliable index of maternal iron stores one month, but not one week, after TDI.


Quality control of radioimmunoassays for proteins: the first two and a half years of a national scheme for serum growth hormone measurements.

The philosophy and achievements of the first two and a half years of a national quality control scheme for serum growth hormone assays are described. Three serum samples were distributed to participating laboratories every two weeks. A computer-produced summary of the quality control results, which contained scattergrams and a statistical analysis, was returned to participants four weeks after despatch. The performance of 11 experienced (SAS) laboratories was found to fulfil the necessary accuracy criteria, and their results provided the 'reference group mean', which served as the target value. Gross positive bias exhibited by several laboratories was due to the use of assays with inadequate sensitivity, and this practice was eliminated during the first six months. During the course of the Scheme the average bias fell from 30 to 14%. With assays of adequate sensitivity, bias was almost invariably due to the misuse of standards. Median within-laboratory, between-batch precision (CV) improved from 23 to 15%. The best performers achieved between-batch CV of 7% which was 1.5 x their within-batch CV: the worst had three- to four-fold differences between within- and between-batch CV. Rudimentary quality control of interpretation was found to result in improvements in interpretation per se and also served to reinforce the desire to improve numerical agreement. A 'recommended procedure' based upon supplied first and second antibody, and a communal 'reference range' from 280 untreated acromegalics, both proved valuable.


Radioimmunoassay of trypsin. A new aid in the assessment of pancreatic function.

This review describes the development and application of a novel test to determine levels of human immunoreactive trypsin, an enzyme produced solely by the pancreas, in biological fluids. Being organ-specific, the assay of immunoreactive trypsin should be an ideal marker of pancreatic function, and this is supported by the results of a number of clinical and research investigations. Use of this assay in studies of chronic pancreatitis, juvenile-onset diabetes, and cystic fibrosis has yielded much valuable data, and it is expected that further research will lead to an improved understanding of these and other conditions associated with the pancreas in health and disease.


Colorimetric method for determination of urinary methylmalonic acid.

The colorimetric method for the determination of methylmalonic acid by coupling with diazotised p-nitroaniline has been re-examined. Extraction of the diazotised product into amyl alcohol and tetra-methyl ammonium hydroxide considerably increases its stability and sensitivity and reduces background absorbance. Preliminary solvent extraction and ion-exchange chromatography are desirable but can be accomplished simply and quickly using very small quantities of urine. In this form, the method is very reliable and gives recoveries of about 95% and a coefficient of variation of about 7%.


Detection of alcoholic cardiomyopathy by serum enzyme and isoenzyme determination.

Serum creatine kinase and lactate dehydrogenase isoenzymes were studied in 73 patients with alcoholism, including two patients with clinical alcoholic cardiomyopathy and 28 patients with haemodynamic evidence (systolic time interval abnormality) of disordered myocardial function. No isoenzyme abnormalities suggestive of myocardial injury were observed. We conclude that isoenzyme examination is unsuitable for the early detection of myocardial damage from alcohol.


Successful operation of a regional scheme for the maintenance of automatic analysers.

The main operational and financial aspects of the maintenance service provided by the West of Scotland Health Boards' Department of Clinical Physics and Bio-Engineering (DCPB) to the clinical chemistry laboratories in the region are described. The scheme, in operation since March 1976, covers all breakdown servicing and engineering preventive maintenance for Technicon Auto-Analyzer equipment valued at pounds 1 1/4 million in terms of direct replacement costs. The engineering team works closely with the laboratory staffs to ensure that the performance of the equipment is maintained to specification. The direct economies for the Health Boards through savings in maintenance contract charges total around pounds 60,000 per year. In addition, considerable sums have been saved by servicing, modifying, and constructing other instruments for the laboratories outwith the immediate remit of Technicon maintenance. Other economic and operational benefits which result from the scheme are commercially disinterested advice on equipment obsolescence and replacement, and redistribution between the laboratories of old but useful equipment to meet specific needs of the service in the region.


Theophylline estimation-a comparative evaluation of a gas chromatographic method and a high-performance liquid chromatographic method.

A comparative evaluation of a gas-liquid chromatographic (GLC) assay and a high-performance liquid chromatographic (HPLC) assay for the determination of plasma theophylline levels has been carried out. Both methods are reliable, accurate, and technically simple and appear to be specific for theophylline. The HPLC system is more sensitive (sample volume 25 micrliter) than the GLC system (sample volume 500 microliter) and is therefore suitable for the estimation of theophylline in microsamples. The HPLC system also has better precision (coefficient of variation: within-batch 2.0%, between-batch 3.0%) than the GLC system (coefficient of variation: within-batch 3.5%, between-batch 5.6%). Good correlation (r=0.964) was found between plasma theophylline levels (n=75, observed range 4-186 mumol/l) determined by each procedure. The results of this study indicate that, of the two systems investigated, HPLC is the method of choice.


Paracetamol: a report of a regional quality control scheme.

The results from an external quality control scheme for the assay of paracetamol in serum are reported. A preferential method of assay has not become evident, but, as a result of the scheme, some laboratories have changed or modified their techniques or have re-established the limits of detection. The majority of laboratories were able to estimate paracetamol satisfactorily at those levels which are of clinical importance. The overall group performance has shown little change. The programme has had considerable impact in so far as it has led to a mutually useful interchange of information and trouble shooting.


Alkaline phosphatase activity in lyophilised quality control serum.

The rise in alkaline phosphatase activity has been studied after reconstitution of 16 commercial preparations of lyophilised quality control material. The effects of storage temperature and analytical method on the rise in activity have also been studied, with a view to producing a reconstitution protocol suitable for recommendation to participants in external quality control surveys. Great differences were found in the magnitude of this rise in activity; these differences can be reduced to negligible levels if the material is mixed for 30 minutes at ambient temperature after reconstitution and then stored for not more than 4 hours at 4 degrees C before assay.


Nulliparous women, IUD and pelvic infection.

Two copper-releasing IUDs were compared in a randomized study performed simultaneously in Denmark, Finland and Sweden. Pelvic infections were carefully observed and the IUDs removed when these were diagnosed. The overall removal rate because of infection was low during the year. The rates were the same with each device overall and in different age and parity groups. The rate was higher in women under 25, in nulliparae and primiparae but lower in the 25-29 age group, in those over 35, and in women having two or more children. The insertion was performed always during menstruation or few days after. It seems that the removal rate because of infection reflected the sexual behaviour of women more than the parity or the use of an IUD.


Diagnosis of primary empty sella syndrome by computed tomography.

Eight cases of primary empty sella diagnosed on pneumoencephalography (PEG) were examined using computed tomography (CT). The diagnosis was made correctly in every case and it was possible to differentiate an empty sella from a pituitary adenoma. Slices 5 mm thick and an overlapping technique were necessary because of the small volume of the tissues analysed. PEG does not seem to be necessary in most cases of suspected intrasellar cisternal herniation, and it is needed only in the difficult case in which the clinical picture and the CT finding are not in harmony.


Photosensitivity and cutaneous acid hydrolases in porphyria cutanea tarda.

In the present study the participation of lysosomal enzymes in the primary photosensitizing process in the skin of porphyric patients were investigated. Cutaneous photosensitivity reactions were produced in patients with porphyria cutanea tarda by irradiation with near UV light and also to a lesser degree with visible light. The reactions occurred almost exclusively in patients with urinary uroporphyrin excretion exceeding 900 nmol/24 h and preceeded any noticeable increase of lysosomal enzyme activity by several hours. These results indicate that lysosomal enzymes are not primarily involved in the photosensitizing reaction in porphyric patients but that they participate in the cutaneous inflammatory process in porphyric skin at a later stage.


Tests for ischaemia and left ventricular function in young patients with effort-induced chest pain.

The type of angina pectoris was determined in 47 women and 27 men aged 40 or less who then underwent quantitative left cineventriculography, coronary arteriography and atrial pacing test with determination of lactate concentrations from arterial and coronary sinus blood samples. The 29/74 patients with atypical angina and no narrowings on coronary arteriography (Group I) gave no pathological atrial pacing tests but 9 had pathological lactate tests. Group II consisted of 27/74 patients with typical angina but normal coronary arteriography. In these the atrial pacing test was pathological in 20 and the lactate test in 11. Coronary narrowings of 50% or more were found in 18/74 patients (Group III), who all had pathological pacing tests but only 9 pathological lactate tests. No statistical differences could be elicited between diagnostic groups in the quantitative evaluation of left ventricular function and it could be regarded as normal in 42/74 patients. The left ventricular mass index exceeded the control level in 6 patients in Group I and in 10 patients in Group II who all had a net lactate production upon pacing. The end-diastolic volume index was above control level in 11 patients in Group II, in whom the ST depression in pacing test was the only finding indicating ischemia. The hoop stress values exceeded the control level in both of these subgroups. In Group III 7 patients had a high left ventricular mass index and 4 a billowing mitral leaflet. The changes observed suggest disturbed functioning of left ventricle.


Cholescintigraphy in the determination of disturbed hepatobiliary function in acute cholecystitis.

The hepatobiliary transit of 99mTc-diethyl-IDA was studied in 50 cases of acute cholecystitis. The intrahepatic transit was characterized by the liver mean transit time of the tracer. The extrahepatic passage through the biliary tract was assessed from a series of scintigrams. The data were classified according to previously obtained knowledge of normal and pathological states of the liver and the biliary tract. (Normal liver mean transit time less than or equal to 70 minutes, normal appearance-time of the tracer in the biliary tract less than or equal to 15 minutes and in the intestine less than or equal to 20 minutes, no retention of the tracer in the biliary tract in cases of later appearance-times). Abnormal hepatobiliary transit of the tracer was recorded in 27 cases; it was retarded at the intrahepatic level in 11 cases, at the gallbladder neck in 3 cases, distally in the biliary tract in 12 cases, and a tight extrahepatic obstruction was seen in 1 case. In consequence, acute cholecystitis is often associated with disturbed hepatobiliary function. The functional changes in acute cholecystitis were similar to those associated with other hepatobiliary disorders of either intrahepatic or extrahepatic origin.


Plasma lidocaine concentrations after different methods of releasing the tourniquet during intravenous regional anaesthesia.

Different methods of tourniquet release have been proposed to decrease the concentrations of local anaesthetic released into the systemic circulation at the end of intravenous regional anaesthesia. The effect of releasing the tourniquet intermittently with 5 seconds (group I) and 30 seconds (group II) deflation periods or at once (group III) was studied in 25 adult patients after intravenous regional anaesthesia with 40 ml of 0.5% lidocaine. The venous plasma lidocaine concentrations from the contralateral arm were measured by gas chromatography. There was no leakage of lidocaine from the occluded arm into the systemic circulation. The mean maximum plasma lidocaine concentration in group I 1.99 +/- 1.45 (SD) microgram/ml, in group II 1.33 +/- 0.54 microgram/ml and in group III 1.56 +/- 0.88 microgram/ml (P greater than 0.05) was below the toxic concentrations reported in the literature. There were subjective complaints such as dizziness and ringing in the ears in 4 out of the 7 patients in group I, in 2 out of the 9 patients in group II and in one of the 9 patients in group III (P greater than 0.05). There was no correlation between the duration of tourniquet time (range 12-87 minutes) and the maximum plasma lidocaine concentration. The intermittent release of the tourniquet did not decrease the venous plasma lidocaine concentrations in the contralateral arm; neither did comparing the lidocaine pharmacokinetics in 5 patients of group II after tourniquet release and in the 5 healthy volunteers after a single 100 mg intravenous lidocaine injection reveal any differences.


Rehabilitation of Caisson's disease with spinal cord involvement.

Fifteen cases of Caisson's Disease or Decompression Sickness with spinal cord involvement treated at the Department of Rehabilitation Tan Tock Seng Hospital, from 1973 to 1978 are described. All the cases had bladder and bowel function involvement. Five cases developed bone complications, one of whom was referred to us primarily for rehabilitation after he had an operation for collapsed right femoral head which occurred two years after the incident.


Rehabilitation of traumatic spinal cord lesions--results of 145 cases treated between 1973 and 1977.

An analysis of 145 traumatic spinal cord lesions admitted to the Department of Rehabilitation Medicine, Tan Tock Seng Hospital, between 1973 and 1977 is made. The annual incidence based on this figure and on a population of 2.2 million was 16.3 per million population. 68% of the cases were within the employable age group of 15 to 45 years. 40% of them were due to industrial accidents, 36% from road traffic accidents and 24% resulted from other causes like domestic accidents, sports mishaps and criminal violence. An analysis of the site of lesion shows that 71 cases had lesions at the cervical level, 50 at the thoracic lumbar region, 9 at the upper thoracic region and 15 at the lumbar region. After a course of rehabilitaion 66% were able to walk either independently or with some form of aids, 27% were wheelchair-bound and the rest were bedridden at time of discharge. In self-care activities 79% were independent, 15% were partially dependent and the rest totally dependent after rehabilitation.


Treatment of chancroid with Bactrim.

Bacterim in either oral or intramuscular injection forms were given to 67 patients with Chancroid. It was found that after one week of treatment, clinical cure rate was 46.3% and bacteriological cure rate was 73.1%. After two weeks, the clinical cure rate was 77.6%. Three patients (4.5%) had persistent sores at the end of two weeks and only one of these (2.5%) was bacteriologically active. Twelve patients defaulted. Adverse side-effects were observed in five patients. The effectiveness of Streptomycin, Sulphonamide and Tetracyclines, the other commonly used therapeutic agents, was discussed and compared with Bactrim. It was concluded that Bactrim was a safe and effective drug to use, and recommended as an alternative to Streptomycin and Sulphonamides in the management of Chancroid.


Arthrography--a diagnostic aid to knee injury.

Injuries of the knee often present diagnostic problem. Using double contrast arthrography, each segment of the two menisci can be studied in detail. In addition, ligamentous tears can be detected. This method is particularly useful when the clinical signs are non-specific and the symptoms atypical. In the present series, double contrast arthrography was performed in 100 cases of suspected internal derangement of the knee. Abnormal radiological findings were recorded in 31 cases. Confirmation of the diagnosis was available in 17 out of 21 patients, subjected to surgery, giving a pre-operative diagnostic accuracy of 81%. This figure could be improved with experience and can be further enhanced, if used in conjunction with arthroscopy.


Study of lumbar disc pathology among a group of dockworkers.

Low back disorders pose a serious health problem among workers engaged in heavy manual lifting and carrying. In order to determine the extent to which this type of activity may contribute to the prevalence and pattern of lumbar disc degeneration, a group of dockworkers doing heavy lifting and carrying and a control group of clerks were compared. The prevalence of disc changes was higher among the dockworkers at all disc levels studied (T12-L5). No significant differences in pattern of distribution of affected discs were demonstrated. A higher prevalence of anterior and posterior disc changes, occurring more in combination than singly, was observed in the dockworkers. There was a significant excess of such combined changes in the T12, L4 and L5 discs among the dockworkers, compared with only L5 involvement in the controls.


Surgical treatment of mandibular prognathism--a review of 25 cases.

Mandibular prognathism is a common developmental jaw deformity with functional disabilities and facial disfigurement, characterised by a prominent mandible. Very satisfying cosmetic and functional results can be achieved by surgery and the literature is replete with surgical techniques for correcting this deformity. This paper discusses the surgical treatment of mandibular prognathism and reviews a series of 25 consecutive patients treated by an extra-oral technique known as Subsigmoid Oblique Osteotomy (Vertical Subcondylar Osteotomy) during a seven-year period, (1969-76).


Additional day-to-day precision estimates based on regional chemistry quality control data.

State-of-the-art precision values are presented for the following serum constituents: aldolase (EC 4.1.2.13), alpha-hydroxybutyrate dehydrogenase (EC 1.1.1.30), cholinesterase (EC 3.1.1.8), cortisol, gamma glutamyl transferase (EC 2.3.2.2), haptoglobin, immunoglobulins, lactic acid, leucine aminopeptidase (EC 3.4.1.1), total lipids, osmolality, protein fractions, T3 uptake, thyroxine and vitamin B12. Precision estimates are based on values reported for four lyophilized serum pools analyzed by participants in the Pennsylvania Association of Clinical Pathologists regional quality control program for clinical chemistry, during 1976, 1977 and 1978. Use of the upper limit of the "most common range" of precision (that range including the 75 percent most precise laboratories) as a warning level for trouble-shooting is advocated.


Heparin induced platelet aggregation: in vitro confirmation of thrombotic complications associated with heparin therapy.

Eleven patients who developed thromboembolic complications while receiving heparin were studied for a possible adverse reaction to heparin as the cause of their progressive thrombosis. Fifteen additional patients who were receiving heparin for recurrent thromboembolism, but who did not develop signs of thrombotic complications, were studied as patient controls. The most significant finding was an abnormal in vitro aggregation response to heparin alone in all of the patients who developed complications who were tested for it (64 percent). None of the patient controls demonstrated this abnormality. In addition, thrombocytopenia was noted in all of the former but in only one of the latter. Results of prothrombin times, fibrinogens and fibrin split products eliminated disseminated intravascular coagulation as the cause of the thrombocytopenia in the majority of cases. Finally, an approach to the early detection of the abnormal heparin response is presented and guidelines for its therapeutic management are recommended.


Measurement of salicylsalicylic acid and salicylic acid in plasma by high pressure liquid chromatography.

Salicylsalicylic acid (SS) and salicylic acid (SA) both appear in plasma after the oral ingestion of the former. They can be estimated in the presence of each other after extraction into dichloromethane using high pressure liquid chromatography. SS is unstable in plasma, being converted to SA in vitro. Conversion can be prevented by using ethylene diaminetetraacetic (EDTA) as an anticoagulant and carrying out the extraction in the cold. An aliquot of the extract is dried and dissolved in methanol. Weak solutions of SS in methanol are unstable at room temperature. Methanolysis can be prevented by the addition of dilute hydrochloric acid. By adding phenylbutazone to the plasma as an internal standard, variations in extraction and sample application are nullified. Quality control is achieved by concurrent extraction of two different plasma standards containing SS and SA in known amounts. About 40 ng of SS and SA can be detected; reproducibility at 200 ng and above is better than 6.5 percent.


Secretion of nickel in rabbit saliva.

Secretion of nickel into unstimulated and stimulated saliva of rabbits was studied after a single intraperitoneal injection of nickel chloride labelled with 63Ni. Maximum 63Ni in unstimulated saliva was obtained in specimens collected one hr after maximum serum-63Ni was reached and two hrs after the nickel administration. Compared to serum-63Ni, the secretion of isotope into saliva was low whether or not stimulation was carried out. After 24 hrs, only traces of radioactivity were left in saliva. Forty to 60 percent of salivary-63Ni was ultrafiltrable. Most nickel associated with salivary proteins was weakly bound. Two acidic protein fractions obtained by gel filtration of saliva seemed to bind nickel firmly at neutral pH. No such binding of nickel to salivary proteins was observed after the in vitro addition of normal saliva to 63NiCl2.


Circadian rhythms of serum aldosterone, cortisol and plasma renin activity in burn injuries.

Circadian rhythm of serum aldosterone and cortisol concentrations and of plasma renin activity (PRA) were measured by radioimmunoassay in 10 adults with thermal injuries. The determinations were begun 6 to 48 hours after the injury and continued for five consecutive days four times a day. In all patients, the normal pattern of the circadian rhythm for all three hormones disappeared and values remained quite high at any time of the day or the night. Four patients developed an hypertensive crisis with quite elevated levels of aldosterone, cortisol and plasma renin activity. The same hormones were also found very elevated in two hypotensive patients with 80 percent or more of injured body surface who were in agonal conditions and succumbed to the injury.


Application of electroimmunoassay to the study of plasma protein synthesis in cultured hepatocytes.

Electroimmunoassay has been applied to the study of plasma protein synthesis and secretion in liver cell cultures. The assay is performed on unconcentrated samples of culture medium containing the secreted plasma proteins and yields results within 2 hours. The characteristics of plasma protein production by the cultured hepatocytes coupled with the sensitivity of this assay permit the study of plasma protein in synthesis and its regulation by hormones and other agents without the routine use of radioisotopes.


Clotting, activated partial thromboplastin and coagulation times in monitoring heparin therapy.

The automated-activated coagulation time, manual-activated coagulation time and the activated partial thromboplastin time were compared to the whole blood clotting time in the measurement of hypocoagulation of heparinized blood. The normal ranges and degree of reproducibility were determined for each clotting assay. Each method was examined for its sensitivity to various concentrations of heparin. In addition, blood samples from patients treated with heparin were assayed by all four methods and their results were compared. The results indicated that the manual-activated clotting time correlated best with the whole blood clotting time, was sensitive to low concentrations of heparin, formed a discernible clot within a convenient time period in blood containing high concentrations of heparin, was reproducible and was easily performed.


[Three hypothalamic tumours: clinical, biologic, X-ray and therapeutic study (author's transl)].

On the basis of 3 cases of hypothalamic tumours (glioma of the hypothalamus or of the stem of the pituitary, glioma of the hypothalamus or of the optic chiasma, pinealoblastoma), the authors emphasise: (1) the existence of a special endocrine "formula" since it often combines anterior pituitary insufficiency, diabetes insipidus and moderate hyperprolactinaemia; (2) the remarkable efficacy, in all 3 cases, of cobalt therapy, tumour regression becoming complete during the 6 to 10 months following the end of radiotherapy; (3) the post-radiotherapeutic endocrine complications, endocrine deficit becoming greater whilst the tumour disappeared; (4) the diagnostic possibilities and above all regular surveillance now made possible by tomodensitometry.


[Thyrotoxic periodic paralysis: case report (author's transl)].

Boy 19, french -- Attacks of hypokaliemic flaccid tetraplegia in 1972 -- 4 months later thyreotoxicosis -- Disappearance of neurologic symptoms and euthyroid condition after carbimazole. Relapse 5 years later of concomitant thyreotoxicosis, hypokaliemic tetraplegia attacks and lower limbs myalgias. Normal conventional and enzymatic light histology of quadriceps. Anomalies of membraneous system (T system and sarcoplasmic reticulum) on electron microscopy -- subtotal thyroidectomy -- hormonal and neurologic total recovery. Caucasoid erythrocyte and HLA groups.


ABO blood groups and renal disease.

This study compares the frequency of ABO blood group distribution between 184 patients with renal parenchymal diseases and 3,820 apparently healthy subjects. The renal diseases were confirmed by renal biopsy studies in all patients. The distribution of renal patients among the blood groups was significantly different (p less than 0.01) from the blood group distribution of normal subjects. The differences occurred mainly in the B and O Groups with renal patients showing a 7 percent increase in Group B and a 10 percent decrease in Group O.


[In vivo regulation by calcium of the thyroidal iodine metabolism and its modulation by sodium, in the rat (author's transl)].

In vivo experiments, in the rat, using diets deficient in calcium, or sodium or both ions, proved these cations to regulate the thyroidal iodine metabolism. Calcium enhanced iodine entry into the thyroid and the intrathyroidal iodine and T4 pools. T4 level in serum was also increased by calcium. Sodium enhanced iodine entry and secretion. The two cations have local regulatory functions on the thyroid gland and do not affect TSH levels in serum and the hypophysis. The effects of calcium and sodium are interdependent, sodium deficiency suppressed the effects of calcium and the effects of sodium were significantly limited by calcium deficiency. Results from chromatography of the thyroid extracts and data from the literature are compatible with the hypothesis of calcium enhancing iodine entry and accumulation into the thyroid gland mainly through an effect on exocytosis of thyroglobulin, the was this ion enhances exocytosis of protein in stimulus-secretion coupling. An addition to this theory is pur forward in order to reconcile with it the whole set of experimental data obtained with the two cations, in vivo and in vitro, on thyroidal iodine metabolism.


[The study of the influence of prolactin on gonadal steroids metabolism by the human chorionic gonadotropin test. Plasma and urinary determinations in 27 subjects (control, hyperprolactinemic, normoprolactinemic but hypogonadic subjects) (author's transl)].

In order to determine whether hyperprolactinemia besides its action at the hypothalamic level, acts at the gonadal level, a serie of 28 stimulations by Human Chorionic Gonadotropin (HCG : 5 000 IU X 3) is reported. The following parameters were measured in plasma and in urine before and during 4 consecutive days following the injection of HCG : Progesterone (P), 17 OH Progestérone (17 OHP), Androstenedione (A), Testostérone (T), Dihydrotesterone (DHT), Estrone (E1), 17 beta estradiol (E2), Urinary Androstanediol (Adiol) Testosterone Glucuronide (G.T.) and phenolsteroids (PS). The test was performed in both sex, in 3 different groups including normal, hyperprolactinemic and normoprolactinemic but hypogonadic subjects (hypopituitarism). These data suggest that in hyperprolactinemic subjects: there is no steroid 5 alpha reductase abnormality in male patients, and there is no gonadal resistance to HCG stimulation in both sex, at least to the high doses of HCG used in this study.