An evaluation of bacterial resistance to chemo-antibiotics in a homogeneous area comprising East Veneto and South Friuli.

The experiment, now in progress, consists in the gathering and processing of data obtained from the Antibiotic Sensitivity Test done in all the hospital laboratories in the aforesaid area and within which there may well be some interchange of patients. The Antibiotic Sensitivity Tests are arrived at from the identification of all the microorganisms found in the various biological specimens by rigorously standardized methodology. The data, reported on identical modules by all the laboratories and computerized by the CED of Treviso Hospital for half-yearly evaluation, will furnish information on the evolution of bacterial resistance and the related activity of the chemo-antibiotics for each individual hospital, for hospital groups, and for all the hospitals taken together. Details of the program of this operation, of the difficulties encountered, and of the current state of the survey are discussed.


CSF shunt infection management in adult age.

This retrospective study of nine patients in whom infection developed following operation for placement of an extrathecal drainage shunt, although it is not a complete biometric evaluation, shows an incidence of infection (10.5%) that corresponds with averages reported from other centers [7, 15--17]. Furthermore, it points out the limitations of antibiotic treatment when three significant aspects of therapy are not considered fully: 1) sensitivity of the identified organism, 2) CSF level of drug that can be achieved, and 3) pharmacokinetic action of drug in CSF.


Enquiry on the antibiotic usage at Ancona Regional Hospital.

A survey of the use of antimicrobial agents in the Regional Hospital of Ancona was carried by the Infectious Disease Department in collaboration with the Hygiene Institute, Ancona, in all patients admitted in the hospital in a 15-day period, March 1--15, 1978. This study has shown an overuse of antibiotics in this series of patients. Despite the limitations of the survey it can be a useful aid to know the situation of antibiotic therapy in this Italian hospital.


Trends in the research on antimicrobial agents.

The pharmacotherapy of microbial diseases has achieved brilliant success in the last 40 years, but it still deserves a great research interest. In fact, microbial infections remain the major cause of morbidity, with a definite incidence in mortality. Several dozen antimicrobial agents have been introduced in the therapy of infectious diseases. An active area of research concerns deepening knowledge of chemotherapeutic activity in various pathological conditions, mechanism of action, development of resistance, kinetics, and untoward effects of the available drugs in order to achieve the best utilization. Many researches are also directed at identifying the proper use of combinations of antimicrobials to define synergistic effect or inhibition of resistant strain selection. Finally there are continuous research efforts toward the development of new agents to overcome the drawbacks of the available ones. This problem is approached mainly in two ways, either by modification of the present antimicrobial drugs or by search for completely new entities through various screening sophistications. Examples of studies and results in the mentioned fields are reviewed.


Effects of phencyclidine, d-amphetamine and pentobarbital on spaced responding in mice.

The effects of acute IP administration of phencyclidine (PCP), d-amphetamine (AMPH) and pentobarbital (PB) were determined in 10 mice trained to lever press on a differential reinforcement of low rate 10 sec schedule of sweetened milk presentation. The effects of PCP were highly consistent, with large response rate increases (and a corresponding shift toward shorter interresponse times) at doses of 1 and 3 mg/kg. Higher doses generally decreased response rates and resulted in a bimodal interresponse time distribution. The effects of AMPH were similar to PCP but less consistent. Although some of the subjects showed substantial response rate increases at doses between 0.3 and 10 mg/kg, half of the subjects did not show increased response rates at any dose. The effects of AMPH on the interresponse time distribution were similar to PCP. The effects of PB were least like those of PCP. The effect in most subjects was to produce a dose-related decrease in response rate and a flattening of the interresponse time distribution. Occasional small response rate increases were observed with PB.


Central cholinergic mechanisms in electrical self-stimulation and in drug-induced tremor in rats.

Oxotremorine, a specific stimulant of central muscarinic acetylcholine receptors, inhibited lateral hypothalamic self-stimulation at a dose-level less than one-tenth of that necessary to produce body tremor. Tremor induced by oxotremorine (0.5 mg/kg) was inhibited by pretreatment with hyoscine (scopolamine) (0.3 mg/kg) or propranolol (20 mg/kg) but not by methylhyoscine (0.3 mg/kg) or apomorphine (0.3 mg/kg). Inhibition of self-stimulation by oxotremorine (.03 mg/kg) was prevented by hyoscine (0.3 mg/kg) but not by any other of the drugs tested and thus constitutes a uniquely specific in vivo model for assessing central antimuscarinic activity. The results confirm the presence of centrally situated ACh receptors eleciting tremor and inhibiting self-stimulation but provide no evidence of an effect on tremor by central adrenergic beta-receptors.


Long-term consequences of early iron deficiency in the rat.

A period of severe early iron deficiency (birth to 28 days of age) produced a persistent deficit (22%) in brain non-heme iron in adult rehabilitated animals. Long-term effects on behavior and physiological responsiveness were also observed. Although rehabilitated and control animals did not differ either in basal levels of plasma corticosterone or in the time course of the stress response following ether and cardiac puncture, possible differences in pituitary-adrenal responsiveness appeared to emerge following testing in an exploratory task. In addition, significant differences between rehabilitated and control animals were observed in both active and passive avoidance learning. Rehabilitated males made more intertrial responses than control males during active avoidance learning, and rehabilitated animals of both sexes performed better (i.e. showed longer reentry latencies) in a passive avoidance situation. It was suggested that shock may differentially affect motivation or arousal in rehabilitated and control animals.


Lack of cross-tolerance between morphine and autoanalgesia.

The acquisition of autoanalgesia (behaviorally-induced antinociception) was investigated in morphine-tolerant and non-tolerant rats. Tolerance to morphine did not affect analgesia acutely-elicited by a brief (15 sec) schedule of footshock. Similarly, analgesia elicited by classically conditioned fear wasnot attenuated by morphine tolerance. These data suggest that endorphins may not be the principle mediators of autoanalgesic phenomena.


Lack of effect of naloxone on autoanalgesia.

Autoanalgesia (behaviorally-induced antinociception) may be elicited by acute stress or clasically conditioned fear. Antinociception within both of these paradigms is reportedly associated with increased CNS opioid peptide activity. Large doses of naloxone (20 mg/kg) failed to modify antinociception elicited by acute footshock or conditioned fear in rats. Naloxone (4 mg/kg) was also ineffective against antinociception following footshock in mice. These data suggest that if an endorphin does mediate autoanalgesia, the affinity of its receptor for naloxone is very low. Alternatively, parallel opioid and non-opioid systems may be activated by autoanalgesic procedures, with antagonism of the opioid component being insufficient to reduce the antinociception.


GABA and hypothalamic feeding systems. II. A comparison of GABA, glycine and actylcholine agonists and their antagonists.

Microinjections of various compounds into the paraventricular hypothalamic nucleus (PVH) were made and the effects on feeding observed. During the light phase of the lighting cycle, injections of 0.3 microliter of muscimol (100 ng) and flurazepam diHCl (20 micrograms) increased feeding. Similar injections of glycine (500 ng) did not influence feeding during the light phase. During the dark phase, 0.3 microliter injections of bicuculline methiodide (30 ng) and picrotoxin (160 ng) suppressed feeding. Similar i-jections of carbachol increased drinking during the dark phase. Injections of strychnine during this phase were without effect. Tilt box activity levels were not altered by injection of picrotoxin (160 ng) into the PVH.


Effects of clozapine, chlorpromazine and haloperidol on schedule-controlled behavior.

The effects of clozapine, chlorpromazine, and haloperidol were determined in mice and pigeons responding under a multiple fixed-ratio 30, fixed-interval 600 sec schedule of food presentation. In both species, low doses were without effect and moderate to high doses of all three antipsychotics decreased responding. In contrast to other behavioral tests used to predict antipsychotic activity, clozapine was equipotent or more potent than chlorpromazine in decreasing responding under the multiple fixed-ratio 30, fixed-interval 600 sec schedule. The order of potency observed in the mouse was: haloperidol greater than chlorpromazine greater than or equal to clozapine. The order of potency in the pigeon was: haloperidol greater than clozapine greater than chlorpromazine. In mice and pigeons, the rate of responding under the fixed-ratio component was decreased at lower than, or the same doses of clozapine as that required to decrease fixed-interval responding. However, in both species, chlorpromazine and haloperidol decreased fixed-interval responding at lower doses or the same dose as that required to decrease fixed-ratio responding.


Effects of cocaine on propagation of limbic seizure activity.

Effects of cocaine on the spread of epileptiform discharges within the limbic system were studied in cats prepared with bilateral arrays of indwelling electrodes. Low frequency focal electrical stimulation at threshold intensity was employed to initiate after-discharges in the hippocampus and amygdala. Latencies for the propagation of epileptiform activity to distant limbic sites were determined. Saline and drug tests were alternated, with 96-hr intervals between cocaine administrations. Three subconvulsant doses (1--10 mg/kg cocaine hydrochloride, injected intramuscularly) were tested in a counterbalanced order. Cocaine administration significantly increased the speed at which epileptiform discharges spread to the amygdala and to the hippocampus. This effect was dose-related, it followed both hippocampal and amygdalar stimulation and was evident in ipsilateral as well as contralateral projection sites. These changes were found when limbic seizure patterns were localized and also after fully developed motor convulsions were evoked. In addition, cocaine decreased the duration of the propagated discharges. These results suggest that subconvulsive doses of cocaine have an excitatory effect on the hippocampus and amygdala, increasing their sensitivity to repetitive discharges originating in distant sites. A concurrent inhibitory effect is suggested by the decreased duration of the propagated discharges.


Stress responses of rats with septal lesions.

Rats which had received septal lesions or underwent control surgery were exposed to stress in four experiments. We examined plasma corticosterone (Experiment 1), gastric ulceration (Experiment 2), motor activity (Experiment 3) and whole brain norepinephrine (Experiment 4) following 3 hours of prone-restraint-stress conditions at 21 degrees C or 5 degrees C. Rats with special lesions had higher steroids, less severe ulceration, greater motor activity and higher brain norepinephrine than controls following stress. Changes in hyperemotionality and differences in coping strategies are discussed.


Possible non-narcotic component to action of opiate peptides on tonic immobility.

Chickens were tested in a tonic immobility paradigm after a single intraperitoneal injection of either 0.0, 0.1, 1.0, 10.0; 100.0, or 1000.0 microgram/kg of the potent opiate analog, (D-Ala2, F5Phe4)-Met-enkephalin-NH2. An inverted-U relationship was obtained, with 100 microgram/kg being the most effective in prolonging immobility. This dose was used in subsequent studies involving pretreatment with naloxone or diluent followed by treatment with diluent, (D-Ala2, F5Phe4)-Met-enkephalin-NH2 (a strong opiate), or (D-Phe4)-Met-enkephalin (a weak opiate). The results indicated that although naloxone had mixed effects in attenuating the duration of tonic immobility, even the analog with negligible opiate activity reliably potentiated the response. Therefore, a component of the effect of opiate peptides on tonic immobility could be due to a non-narcotic action.


Effects of phenobarbital on taste aversion induced by X-radiation.

The effects of phenobarbital on taste aversion induced by X-radiation were examined. Rats were adapted to a 23 hr 50 min water deprivation schedule. On the Treatment Day animals were given a novel 0.125% Na saccharin solution during the 10 min drinking session and were then exposed to 100 rads of X-radiation. The saccharin solution was presented again on six subsequent Test Days. Phenobarbital in doses of 20, 40, 60 and 80 mg/kg was administered 15 min prior to drinking on the first Test Day. Results demonstrate that phenobarbital in all doses tested has a significant attenuating effect on radiation induced taste aversion.


Analgesia after peripheral administration of enkephalin and endorphin analogues.

Several analogues of Met-enkephalin and beta-endorphin were tested for their analgesic properties after systemic injection. The latencies of mice to flick their tails away from a source of heat revealed that analogues of the opiate peptides can cause analgesia when injected by this route. In particular, compounds specifically designed to be more lipophilic or to possess additional binding sites were shown to be potent analgesic after peripheral administration.


Naloxone-induced suppression of food intake in normal and hypothalamic obese rats.

Intraperitoneal injections of naloxone hydrochloride (1, 2, 4, and 8 mg/kg) suppressed food intake in both normal and hypothalamic obese rats maintained on a 4-hr per day feeding schedule. The decrease in feeding was more pronounced in the animals with ventromedial hypothalamic lesions. Appetitively motivated feeding, i.e., the consumption of sweetened milk under nondeprived conditions, was also suppressed by naloxone, but there was no reliable difference between groups. It is concluded that opiate receptors located in the ventromedial hypothalamus are not essential for the effects of opiate agonists and antagonists on feeding behavior.


Experiments with a reported anorexigenic tripeptide: pyro-Glu-His-Gly-OH.

A newly described tripeptide, pyro-Glu-His-Gly-OH, which was reported to produce profound and long-term anorexia and weight loss in female mice, was initially tested in female rats. After total dose of either 8, 16, or 32 microgram SC of the peptide, administered across an eight day interval, there was no detectable effect on food intake, body weight, or estrous cycles of female rats. In a second study, we attempted to verify the anorexigenic potency of this peptide in mice. Total doses of 3.4 and 6.8 microgram, injected across a 20 day period, had no effect on the food intake or body weight of S/W albino female mice. Thus, the anorexigenic potency of pyro-Glu-His-Gly-OH has yet to be established.


An analyst in biomedical research.

Fluorescamine is a nonfluorescent substance that reacts with primary amines to yield intensely fluorescent products. We have utilized high performance liquid chromatography along with fluorescamine assay for many studies relating to the biochemistry of the opioid peptides.


A sensitive gas-chromatographic assay using a nitrogen-phosphorus detector for determination of antipyrine and aminopyrine in biological fluids.

A method using gas chromatography with organic nitrogen-sensitive detection is described for measurement of antipyrine and aminopyrine concentrations in biological fluids. The analysis was performed isothermally on 3% SP-2250 DB after alkalinized saliva was extracted into chloroform. Phenacetin served as internal standard. Low oral doses of antipyrine (1.0-1.8 mg/kg) and/or aminopyrine (2 mg/kg) were measured accurately in saliva of normal human subjects. The standard curves for antipyrine and aminopyrine were linear from 0  to 10 microgram/ml. The coefficient of variation, determined at a salivary concentration of 2 microgram/ml, was 1.7% for antipyrine and 2.4% for aminopyrine. Saliva concentrations obtained by this method in normal human subjects after either an oral dose of antipyrine (18 mg/kg) or aminopyrine (9 mg/kg) agreed closely with those determined by the flame ionization gas-chromatographic method used to measure higher concentrations of antipyrine and aminopyrine. Antipyrine (1.8 mg/kg) administered concomitantly with aminopyrine (1 mg/kg or 2 mg/kg) to normal male volunteers prolonged mean saliva antipyrine half-life by about 25-33% compared to values obtained when these same subjects received the same dose of antipyrine alone.


Kinetic evidence for multiple chemically reactive intermediates in the breakdown of phenacetin N-O-glucuronide.

N-hydroxyphenacetin glucuronide has been previously shown to be an unstable compound (half-life 8.7 h) that breaks down to phenacetin, 2-hydroxyphenacetin glucuronide, acetaminophen, acetamide, and a deethylated metabolite that covalently binds to protein. Evidence was presented that the acetamide, acetaminophen and a compound that binds covalently were formed from a common intermediate which was postulated to be N-acetylimidoquinone. In the presence of phosphate buffer, 3-hydroxyphenacetin phosphate is formed at the expense of acetaminophen, acetamide and covalent binding. Phosphate buffer, however, only partially blocks covalent binding to protein suggesting that two deethylated reactive metabolites are formed that can covalently bind to protein. These metabolites also may be converted to acetaminophen but only one of them leads to acetamide. Since the phosphate conjugate contains the ethyl group apparently a third reactive intermediate, which can react with phosphate but not with protein, serves as a precursor of one of the metabolites.


Stimulatory effect of phenobarbital on the metabolism of the oral contraceptive 17 alpha-ethynylestradiol-3-methyl ether (mestranol) by rat liver microsomes.

Pretreatment of rats with phenobarbital for 4 days stimulates the activity of liver microsomal enzymes that metabolize 17 alpha-ethynylestradiol-3-methyl ether (mestranol). This effect provides an explanation for the decreased uterotropic action of mestranol in rats pretreated with phenobarbital and may provide an explanation for unwanted pregnancies in women taking oral contraceptives in combination with phenobarbital or other enzyme-inducing drugs.


Formation of alpha-methyldopamine ("Catecholamphetamine") from p-hydroxyamphetamine by rat brain microsomes.

Amphetamine is a sympathomimetic and psychotropic drug which is extensively metabolized in liver and in brain. One of its major metabolites, p-hydroxyamphetamine, is accumulated by cortical and striatal synaptosomes. In order to learn whether p-hydroxyamphetamine can be further metabolized to a catecholamine, a sensitive radioenzymatic assay was developed which couples the formation of the "catecholamphetamine" to rapid O-methylation by catechol-O-methyltransferase in the presence of [3H]-methyl-S-adenosylmethionine. Rat brain microsomes contain a cytochrome P-450-dependent monooxygenase which synthesizes catecholamphetamine from p-hydroxyamphetamine. The formation of this catechol metabolite may be involved in the development of tolerance in chronic amphetamine use.


1,4-Benzodiazepines and gamma-aminobutyric acid: pharmacological and biochemical correlates.

The high affinity receptors or GABA present in brain interact with an endogenous thermostable inhibitor (GABA modulin) which allosterically modifies GABA binding sites. This is the type of GABA receptor that we term GABA2 receptor in comparison to GABA1 receptor which has low affinity for GABA and is not regulated by GABA modulin. The 1,4-benzodiazepines interact competitively with GABA modulin and thereby modify GABA2 receptor binding. In contrast the occupancy of GABA receptor increases the affinity of 1,4-benzodiazepine receptors for their specific agonist. The GABA modulin and both GABA receptors are located on the membranes of C6 and NB2a cells. The NB2a cell membranes also contain CL- ionophore, thus the complete receptor complex is present in the membranes of NB2a cell clone. It was proposed that the inability of clonazepam to displace 3H-diazepam from specific binding sites characterizes the nonneuronal 1,4-benzodiazepine receptor. This characterization was shown to relate to the properties of other membrane components rather than to the characteristics of the specific benzodiazepine receptors.


Metabolism of protriptyline by rabbit liver in vitro.

A new metabolite of protriptyline formed by incubation of the drug in a rabbit liver microsomal system was identified as the hydroxylamine derivative by mass spectral and NMR analysis.


Intraindividual similarity in the metabolism of amitriptyline and chlorimipramine in depressed patients.

The two structurally similar tricyclic antidepressant drugs amitriptyline (AT) and chlorimipramine (CI) were administered to 15 patients in a cross-over study. Approximately equimolar daily doses of the two drugs (5 mumol/kg body weight) were given as commercial tablets. Steady state plasma levels of the parent drugs and the demethyl metabolites were determined by high performance liquid chromatography. An about 5-fold interindividual variation was found in plasma levels of all four compounds. As the reciprocal plasma level during multiple dosing is proportional to the clearance of a compound, this parameter was used for linear regression analysis. In the 15 patients there was a significant correlation between the reciprocal plasma levels of CI and its metabolite demethylchlorimipramine (r = 0.76; p less than 0.001) and also between AT and its metabolite nortriptyline (r = 0.52; p less than 0.05). The reciprocal plasma levels of the parent compounds AT and CI were closely correlated (r = 0.87; p less than 0.001). A similar correlation was found for the demethyl metabolites (r = 0.77; p less than 0.001). The results indicate that similar factors control the plasma levels of AT and CI during treatment and that similar enzymes may be involved in the metabolism of the two drugs.


Endorphins in schizophrenia: hemodialysis/hemoperfusion are ineffective in clearing beta-Leu5-endorphin and beta-endorphin from human plasma.

Beta-Leu5-endorphin, a relative of "normal" beta-endorphin in which leucine is substituted for methionine at position 5 of the latter, has previously been found in high concentrations in the dialysate of schizophrenics. Its removal from plasma by means of hemodialysis has been claimed to relive the symptoms of schizophrenia. Using a highly sensitive radioimmunoassay of equal sensitivity to beta-endorphin and beta-leu5-endorphin, we have compared the plasma immunoreactivity of three schizophrenic patients befofe and after performance of their first session of membrane hemoperfusion. As compared to normal subjects, plasma beta-endorphin-like immunoreactivity was not greatly elevated in the schizophrenic patients before hemoperfusion.However, instead of the expected decrease, a consistent increase in the plasma levels of immunoreactive beta-endorphin was detected after hemoperfusion. In vitro experiments in which two different membranes and hemodialysis as well as hemoperfusion were used, revealed that synthetic beta-leu5-endorphin (and beta-endorphin) from human plasma was not cleared with any of these methods. This finding is inconsistent with the hypothesis that the claimed therapeutic effects of hemodialysis in schizophrenics are due to the removal of a beta-endorphin-like material from the plasma. Consequently, it seems to be unprobable that high concentrations of beta-leu5-endorphin occur in the dialysate or ultrafiltrate of schizophrenics.


Hydergine: a review of 26 clinical studies.

This report reviews 26 clinical drug trials which investigated the effectiveness of Hydergine, a dihydrogenated ergot alkaloid, used frequently in geriatric psychopharmacology. The methodological characteristics and significant results for each study are presented in outline form. In total, 32 symptoms were assessed in six or more studies. Therapeutic benefits following Hydergine treatment occurred in the areas of cognitive dysfunctions, mood depression, and the composite scores as measured by subjective clinical behavioral rating scales. It is suggested that the improvement reported in cognitive functions and mood depression is a reflection of the global change observed by clinicians in patients' overall behavior duirng the interview. This conclusion that Hydergine does produce some global improvement indicates that further research with Hydergine is warranted, provided more objective instruments are employed such as those described in the report.


Effect of lithium carbonate on circadian periodicity in humans.

Five groups of two volunteers lived during four weeks under arctic summer conditions (Spitsbergen) isolated in huts, without time information. They received lithium carbonate or placebo. All showed free-run of their circadian temperature and activity/rest rhythms with periods longer than 24 hours. Under lithium carbonate, a period-lengthening effect can be shown. This could help to understand theprophylactic effect of lithium salts in manic-depressive episodes.


Endocrinological changes in patients with sexual dysfunction under long-term neuroleptic treatment.

Endocrine changes induced by dopaminergic inhibition may play a part in the development of sexual dysfunction (reduced libido/potency) in schizophrenic patients on long-term neuroleptic treatment. Prolactin, testosterone, LH and FSH serum level determinations by radioimmunoassays were performed in 24 schizophrenic males on long-acting fluphenazine decanoate treatment. Of these patients, sexual dysfunction was present in 17 cases, in 10 patients sexual activity remained unchanged. As compared to the 15 healthy controls (7.33 +/- 0.91 ng/ml), a significant increase of prolactin concentrations was found, i.e. 28.2 +/- 5.15 in the impotent groups, and 16.7 +/- 2.12 in the non-impotent group. The difference between the latter two mean values was, however, not significant. In the patients with normal sexual activity the increase of LH concentration was highly significant. It might be assumed that normal sexual behaviour despite neuroleptic treatment and hyperprolactinaemia is related to the high concentration of LH, though the mechanism of increased LH secretion has not been cleared as yet. The testosterone and FSH concentrations showed no differences in various groups.


Antidepressive treatment and mood swing patterns in endogenous depression.

In 105 patients with endogenous depression treated with antidepressants or ECT the course of the depressive state was evaluated by means of a self-rating mood scale (Befindlichkeits-Skala by von Zerssen). The scale was filled out every second day. The course of the depressive mood was computed by various algorithms for each patient. Two different courses of depressive mood could be identified: some patients showed a relatively continuous decline in the depressive mood, whereas others showed strong fluctuations. Although there were some correlations between type of treatment and extent of mood swings, other factors also seemed to be relevant. Thus, there appears to be an interaction between treatment effects and spontaneous rhythms.


Studies on the distribution of 14C-sulpiride and its metabolites in the rat and guinea pig.

After ip. injection of 14C-labelled sulpiride in rats, about one third is metabolized while the other two thirds are excreted unchanged in feces and urine. The highest level of its metabolites was found in the liver (about 65% of total radioactivity). In the brain, 90% of the radioactivity consisted of unchanged sulpiride, which seems to be responsible for the central effects of the drug. The highest concentrations within the brain were found in the median eminence, circumventricular organs, plexus, and pineal body.


C-C2W is the physical cause of cholesterol gallstones.

Cholesterol gallstones are made up of cholesterol.H20, traces of body temperature cholesterol, and a cholesterol-cholestanol-water adduct (C-C-2W). For the first time C-C-2W has been chemically and optically located in such gallstones, specifically in the nucleus, in the groove, and on the surface. These findings suggest a novel yet rational theory of cholesterol-stone quantitatively related to prevention and dissolution: (1) Bile is chemically abnormal if cholestanolH2O is present as a foreign unwanted substance. (2) When cholestanol.H2O in portal blood approaches 10(-4) mg/ml, precipitation of C-C-2W occurs in the hepatocytes because it finds sufficient cholesterol.H2O to reach the solubility product of the adduct. The resulting C-C-2W microcrystallites flow with bile down the biliary tree and then seed the supersaturated cholesterol solution in the gallbladder. (3) On the other hand, for concentrations of cholestanol.H2O around 10(-5) mg/ml, C-C-2W precipitation occurs exclusively in the gallbladder. (4) The adduct is the physical cause of cholesterol gallstones since however it arrives in the gallbladder, it produces swift crystallization of cholesterol.H20.


Interactions among bovine and human factor VIII, ristocetin, and DL-polylysine in the induction of guinea pig platelet aggregation.

Guinea pig and human platelets were aggregated by bovine factor VIII plus ristocetin a concentrations not allowing either substance alone to induce aggregation. Using combinations, it was shown that aggregation required bovine factor VIII and restocetin at levels where the sum of their concentrations exceeded a critical value. With guinea pig platelets, combinations of polylysine and bovine factor VIII or polylysine and human factor VIII did not show full aggregations. These results do not support the hypothesis that aggregation by mixtures of factor VIII and ristocetin arises solely from neutralization of negative charges on the platelet surface membrane.


Comparison of temperature effect on the guanidine hydrochloride and urea denaturations of lysozyme.

Guanidine hydrochloride (GdnHCl) and urea denaturations of lysozyme have been observed at various temperatures by measuring changes in fluorescence. Both transitions appear to be two state, with GdnHCl almost twice as effecitve a denaturant as urea for this protein. By plotting the denaturant concentrations at midpoint of the transition vs. the experimental temperature, it can be demonstrated that urea-denatured lysozyme does not obtain the degree of unfolding found in lysozyme denatured by GdnHCl.


Production of S-sulfocysteine from so-called cystine disulfoxide in the presence of aspartate aminotransferase.

S-Sulfocysteine production occurred when so-called cystine disulfoxide was incubated with aspartate aminotransferase and 2-oxoglutarate. Evidence was provided indicating that the alanine sulfinic acid portion of cystine disulfoxide was transaminated and the resulting sulfinylpyruvic acid portion decomposed non-enzymatically to give S-sulfocysteine and pyruvic acid.


Evidence for differences in the binding of triton X-100 to sheep and human serum albumins.

The binding of triton X-100 to bovine serum albumin has been shown to exhibit positive cooperativity. Subsequent equilibrium dialysis studies indicate that the binding of Triton X-100 to sheep serum albumin likewise shows positive cooperativity, the first two stepwise equilibrium constants being K1 = 1.24 X 10(4) M-1 and K2 = 1.62 X 10(4) M-1. However, the mechanism for Triton X-100 binding to human serum albumin differs in that the binding isotherm indicates the binding sites are independent and identical. In the latter case the binding is described by the Scatchard model with an equilibrium constant of K = 7.2 X 10(3) M-1. The studies were conducted at 16 degrees C  in pH 7.0, I = 0.05 phosphate buffer.


Quaternary structure, hydration, and self-association of hemoglobin. A proton magnetic relaxation study.

The hydration of oxyhemoglobin, carbonylhemoglobin, and deoxyhemoglobin does not depend on the quaternary state of the hemoglobin molecule as revealed through the concentration dependence of proton magnetic relaxation rates. The biphasic relaxation behavior of isotopically diluted solutions of hemoglobin confirms that the self-association of hemoglobin molecules at higher concentration is independent of the quaternary structure. In the case of aquomethemoglobin, a biphasic relaxation and a diminished heme accessibility at higher concentrations are observed, caused by interaction of the associating hemoglobin molecules.


Cirrhosis and the synthesis of proline and glycine in rat liver.

The relation between availability of free amino acids and development of cirrhosis in rat liver has been experimentally evaluated. Levels of free glycine and proline were found to increase when animals are treated with phenobarbital and carbon tetrachloride. This increase is concomitant with increase in collagen and loss of activity of enzymes responsible for degradation of amino acids. It is concluded that elevated levels of proline observed in the serum of cirrhotic patients may be a consequence, rather than a cause, of collagen accumulation in the liver.


[Some problems of Wilson's disease].

The Leipzig Center for Wilson's Disease in the GDR is charged with the registration and diagnosis of all homozygous Wilson gene carriers, the clarification of all suspected cases, including the heterozygote test, and the co-ordination of long-term treatment. At present, there are 78 recorded Wilson gene carriers living. On the basis of our own comprehensive observations and investigations over prolonged periods of time, questions concerning pathogenesis, genetics, diagnosis and therapeutic measures, including their side-effects, are dealt with.


[Diphenylhydantoin stimulation test in Wilson's disease].

Coeruloplasmin and diphenylhydantoin levels were studied both in patients who were stabilised for the first time on diphenylhyantoin (300 mg daily) up to reaching a stable serum concentration (N = 6) and during steady-state concentration (N = 25). No significant DPH-dependent influence on the coeruloplasmin level in the serum was found. In our opinion, DPH is no suitable for the stimulation of coeruloplasmin and thus for the diagnosis of Wilson's disease, particularly in the preclinical stage, because absence of coeruloplasmin increase in the serum being found also in healthy persons.


[Filling of the Circle of Willis in carotid angiography using halothane anesthesia].

A comparative study of 150 carotid angiographies carried out under local anaesthesia and the same number under halothane anaesthesia did not show any great deviation from the well-known filling rates of the counter-lateral carotid region and the ipsilateral A. cerebri posterior nor any striking differences in the two methods of anaesthesia which could convince of a favourable influence of halothane on the demonstration of the vessels. The causative factors of the filling of adjacent vascularisation regions can certainly only be explained from the complex co-action of physiological and any external factors in cerebral angiography.


[Localization of rhythmic activity around 4/s].

The results of the studies carried out in four carriers of characteristics are presented under localistic aspects proceeding from the different local distribution of rhythmized activity around 4/s with unipopular and bipolar lead technique. A hypothesis of the origin of the activity is presented which would be in agreement with its distribution characteristics and reactivity.


[Results of EMG analysis using the Polish mini-computer ANOPS].

During a study tour of the Neurological Clinic in Warsaw, the automatic EMG analysis procedure by means of the Polish computer ANOPS was tested, standard values worked out and their diagnostic information value tested on patients with neuromuscular diseases. To obtain normal values, leads from four muscles of each of 21 healthy persons were made and the electromyograms of each muscle described by five different parameters. For a differentiated neuromuscular diagnosis it is significant that the computer not only calculates the mean values of each EMG parameter but provides histograms from which further statistical indices and diagnostic information can be obtained.


[The proportion of neurological diseases among patients in an observation department of a pediatric-neuropsychiatric university clinic].

In view of the fact that neurology and psychiatry in childhood and adolescence necessarily form a unity, the proportion of neurological diseases is analysed on the basis of the in-patients of five clinic years of a pediatric-neuropsychiatric university hospital. In this analysis, age and sex distribution, catchment area and referring institutions, reasons for the admission and duration of the stay are taken into account. A generally valid statement cannot be made, and the study is intended to encourage similar investigations.


Psychosocial risk factors for lung cancer.

The existence of psychosocial risk factors for the development of malignancy has been postulated by many investigators. This study investigated selected psychosocial factors as predictors of malignancy. 110 male patients with undiagnosed subacute or chronic pulmonary x-ray lesions participated in a semistructured interview. Ratings were made of 5 subscales: 1) childhood instability, 2) job stability, 3) marriage stability, 4) lack of plans for the future, and 5) recent significant loss. The composite scale correctly predicted the diagnosis of 53 (80%) of the 66 patients with benign disease and 27 (61%) of the 44 with lung cancer. The scale was at least as important as smoking history in predicting diagnoses. Thus, significant psychosocial risk factors for the development of malignant disease might well be incorporated in selecting high-risk individuals for cytological or other screening for lung cancer.


Psychological correlates of stress-induced cortisol and growth hormone releases in neurotic patients.

The mirror drawing test was performed in 23 neurotic patients and plasma cortisol (Fk) and growth hormone (GH) were measured serially throughout the test. The patient's personality was assessed by the Minnesota Multiphastic Personality Inventory and related to the endocrine findings. The results indicated that 1) Fk and GH have different personality correlates; 2) the Fk responders tend to be more "defensive" trying to maintain good "self-control" over inner mental processes; 3) high GH level seems to be associated with personality features such as exaggeration, hostility, and a distorted thinking process; 4) psychoendocrine control mechanisms for Fk and GH tend to offset, rather than enhance, each other.


Changes in weight during treatment for depression.

Changes in appetite and weight were examined in a group of 47 carefully diagnosed primary depressives who were treated in a random design with either placebo (N = 17) or amitryptyline (N = 30) over a 35-day protocol. While the amitriptyline treated group as a whole showed a greater gain in weight than did the placebo group (4.5 vs. 0.5 lb, p less than 0.05), no differential effects could be demonstrated between drug responders and nonresponders. Likewise, while a consistent relationship between the self-report of decreased appetite and final weight change was noted in the placebo group, no simple relationship between final weight change and self-reported changes in appetite were apparent in the drug-treated patients. There was, however, a relationship between the report of decreased appetite and clinical severity of depression in the drug nonresponder subgroup despite significant weight gain during the protocol. Thus, weight change during this study period did not appear to show a simple relationship to corresponding clinical change. The clinical lore that has supported the notion that increased appetite and weight gain in patients being treated with tricyclic antidepressants are "good" signs cannot be confirmed by our findings.


Limitations of psychological tests in a dialysis population.

Psychological tests are being used increasingly in dialysis populations, both for psychosomatic research and for clinical evaluations, warranting careful examination of their uses and limitations. Characteristics associated with dialysis populations can limit the validity of many psychological tests which are useful in other populations. These characteristics include such factors as the great biological heterogeneity of dialysis patients, their uniquely dependent relationship to treating staff, and their tendency to respond with socially desirable answers. There is a need to develop psychological tests that are specific for dialysis populations and take into account social desirability response bias. At present, the limitations of psychological tests in a dialysis population are substantial.


Pregnancy in chronic active hepatitis.

The outcome of pregnancy in chronic active hepatitis (CAH) was studied retrospectively, together with a survival analysis of patients and a comparison of fertility with that expected from controls drawn from the normal Australian population. Clinical records of 73 cases of CAH included 37 women who were potentially fertile (aged 15-45 years) and there were 30 pregnancies among 16 of these women. Hepatic and obstetric complications and the outcome for the foetus and the mother were compared with the results from 36 reports accumulated from the literature. The results showed an incremental increase in survival of patients with CAH according to decade of diagnosis from 1950 and similar severity of liver disease in those who did, or did not, become pregnant. Fertility was reduced in patients with CAH. Relapse of CAH occurred during pregnancy in only two patients, hepatic complications were minimal, and there was no consistent pattern of alteration in liver function; 12 of 16 mothers are alive for a mean period of eight years after pregnancy. Obstetric complications included urinary tract infections (six), toxaemia of pregnancy (nine) and prematurity (seven); of the 30 pregnancies, four were terminated on medical advice in the early years of the study, three ended in spontaneous abortion, and there were four perinatal deaths giving a foetal loss rate of 33 per cent. Despite the maternal disease and use of prednisolone and azathioprine during pregnancy, the single congenital abnormality was pyloric stenosis. We conclude that in CAH fertility is reduced but pregnancies which occur can proceed without detriment to the mother provided that prednisolone treatment is maintained; that a higher than normal foetal loss can be expected; and that babies may be born prematurely but will be normal.


Chronic interstitial nephropathy in patients on long-term lithium treatment.

One-hundred and ten patients treated with lithium for more than six months were studied in order to determine the prevalence of lithium induced nephropathy. Eighteen of 69 patients (26 per cent) who had been treated for more than two years presented a chronic interstitial nephropathy characterized by a marked decrease in renal concentrating ability with a disproportionate preservation of glomerular filtration rate. Histologically, increased amounts of fibrotic tissue in the medulla and the cortex were found together with tubular atrophy. In 40 per cent of the patients who underwent renal biopsy, cystic formations in the cortex were found. The impairment of renal concentrating ability could be related to the duration of lithium treatment and the degree of tubular damage correlated with the degree of impairment of renal concentrating ability. Lithium induced, chronic nephropathy is a rather common complication of long-term lithium treatment and reduces the patients capacity to regulate water and electrolyte metabolism. As water and electrolyte loss appears to precede the slowly progressing lithium intoxication, the main hazard of lithium induced nephropathy is lithium intoxication.


Plasma volume contraction: a significant factor in both pregnancy-associated hypertension (pre-eclampsia) and chronic hypertension in pregnancy.

The role of plasma volume in hypertension in pregnancy (pre-eclampsia) was investigated. Significant volume expansion from non-pregnant levels (16.5 +/- 1.60 ml/cm height) was present throughout pregnancy in 189 normal women, reaching 23.1 +/- 1.21 ml/cm at 33-36 weeks amenorrhoea. In another 40 initially normotensive pregnant women who developed hypertension, similar early volume expansion was followed by significant volume contraction in the third trimester, before evaluation of blood pressure in 29 (20.6 +/- 1.26 ml/cm), after it in 11 (18.6 +/- 1.27 ml/cm). Equivalent volume contraction was present in another 44 women studied only after hypertension developed in the third trimester. Oedema had no value as a clinical sign. In another 30 women with chronic hypertension, blood pressure was inversely related to plasma volume (r = 0.822) and to fetal growth (r = -0.710), which was directly related to plasma volume (r = 0.701). Plasma volume depletion plays a significant role in hypertension in pregnancy.


Splenic influences on the blood in chronic liver disease.

The influence of the spleen on the blood has been assessed in a series of 187 consecutive patients with chronic liver disease. Patients were described as having 'hypersplenism' if the white blood count and/or platelet count were below 4.0 X 10(9)/1 and 100 X 10(9)/1 respectively at the time of biopsy diagnosis and on at least one subsequent occasion. Using this definition 17 per cent of patients with alcoholic cirrhosis had hypersplenism, compared with 38 per cent with cryptogenic cirrhosis and 26 per cent with active chronic hepatitis. Studies with 51Cr labelled autogenous erythrocytes in 36 of the patients with different types of chronic liver disease showed that the spleen rarely caused anaemia either by excessive splenic pooling or splenic haemolysis. Further studies with 51Cr labelled platelets in 20 other patients showed that the splenic platelet pool was usually considerably increased and the platelet life span reduced. Some patients showed excessive destruction of platelets in the spleen but none of these features consistently related to thrombocytopenia. Splenic enlargement per se did not cause expansion of the plasma volume in chronic liver disease. Of a total of 17 patients who underwent surgical operations for reduction of portal pressure five had hypersplenism but in these the haematological state was not significantly improved at one month. However, none of the survivors of these operations subsequently developed hypersplenism. One patient with severe hypersplenism who underwent simple splenectomy was cured of leucopenia but not of thrombocytopenia.


The aetiology, presentation and natural history of extra-hepatic portal venous obstruction.

Extra-hepatic obstruction of the portal vein is a well known cause of hypertension in childhood and 55 out of the 97 patients (57 per cent) seen with this condition presented before they were 15 years old. However, nearly half our cases (43 per cent) presented in adult life. Haematemesis was the commonest mode of presentation in both the adult and childhood group although splenomegaly was common, especially in the children. The severity and frequency of haematemesis increased during puberty in the children. Twelve children and three adults have now not bled for between five and 30 years, 10 of them ceasing spontaneously and five following surgery. Intra-abdominal infection or septicaemia precipitated the portal venous obstruction in 38 patients (39 per cent), though the exact cause of such obstruction in patients who had no cirrhosis was obscure in about half the cases. Ascites was present in 18/51 (35 per cent) of the children and 24/35 (69 per cent) of the adults. Its presence was associated with an increased mortality (p less than 0.01). Nineteen out of 42 (45 per cent) patients with ascites also had portal-systemic encephalopathy. Twenty-four patients died, nine having presented during childhood, variceal haemorrhage was responsible for death in 19 and infection in five. Sixty-four patients underwent 114 operations for variceal haemorrhage. Mortality was greater in the surgical group compared with those managed conservatively. Surgery is therefore indicated only in the rare case where bleeding cannot be controlled by medical means.


Fibreoptic bronchoscopy and fluoroscopic percutaneous needle biopsy--a combined approach to the investigation of thoracic lesions.

Ten patients are presented in whom a combined approach of fibreoptic bronchoscopy immediately followed by needle biopsy (if indicated) has been performed. The diagnosis was ascertained in nine patients. There were no significant complications. Most patients were treated as day patients.


[Freedom in disorders of the mind and spirit].

The much used and popular word "freedom" is being examined as to its significance and in that context the peculiar expression "freedom of will" is also brought into the discussion. In the course of this clarification, philosophy, jurisprudence, poetic-literary and our everyday language all had to lend a hand. In its application to psychic abnormal and sick persons one finds that in the endogenous psychoses, because of the profound change of existence, some patients experience the freedom of being for the very first time; this, however, can in the course of the illness turn into its opposite.


["Emitted" cerebral activity and attention processes in a group of schizophrenics. Methodologic problems].

This is a study of the relationship between cerebral events and visual attentional processes of schizophrenic patients by means of a spectral analysis method described in this paper. With recorded data it is possible to study the EEG, standard visual evoked potential, visual evoked potention with attention and visual "emitted" potentials when stimuli were expected but absent. Compared with the sommation method and unitary analysis, the spectral analysis method appears very interesting, especially for the study of "emitted" potentials because it avoids the subjectivity of operators and reduces the number of stimulations. The results show the interest of this simple reliable and effective method for the detection and objectivation of evoked activities with only very few (10) stimulations.


[Patients in remission and their psychoses. Comparison by means of audiovisual aids].

Patients in complete or partial remission were shown a videotape of their acute psychotic illness, if possible in the presence of one of their relatives. The tape was then discussed with the patients and their relatives. The videotape and the discussion were recorded again, thus allowing for an analysis of verbal and nonverbal reactions and attitudes of the participants. The psychologically unique situation of direct confrontation with the acute psychotic state enables certain problems in this area to be more closely examined and indirectly highlights possibilities of different therapeutic approaches. The investigations will be continued.


A comparative study of involutional depressive patients in French Canada and in Hungary.

The data dealing with 200 involutional depressive patients who were treated in Quebec City and in Budapest are presented. A questionnnaire prepared for this purpose is produced and evaluated. Half of the Canadian and 80% of the Hungarian patients were personally interviewed by the author. Those patients with organic brain syndromes were not included in the population studied. Besides many similarities between the two groups, there were also symptomatological differences observed, e.g. the agitated type of involutional melancholy occurred twice as often in Canada as in Hungary, the apathetic cases were rarer in Canada, and the illness began earlier among Canadian women. Self-blame in Canada was often linked to religious observation. Two typical syndromes in male and female patients are detailed as special disease patterns. The symptomatology of this disorder has become identical in the last few years in both countries, therefore it is improbable that a similar study in the future could point out the differences described here.


Studies on the trace element distribution in the diets and population of Italy.

For various reasons an increasing importance has been given in recent time in many parts of the world to the evaluation of the trace element pathways from environment to man. In Italy a large program was recently started based on the study in different groups of population of the relationship existing between the trace element dietary intake and the trace element content in the total excretion and in some human tissues (mainly blood). In this paper the complete data concerning the daily dietary intake, the urinary and fecal excretion, and the blood concentration referred to five population groups living in different regions of Italy will be reported. The main trace elements considered are: Ag, Co, Cr, Cs, Eu, Fe, Hg, Ni, Rb, Sb, Sn, Sc, Se and Zn; all the measurements were performed by means of non-destructive neutron activation analysis.


A review of environmental characteristics and health effects of barium in public water supplies.

A comprehensive review is made of sources, occurrence, removal, health effects and water quality standard of barium in public drinking water supplies. The primary source of naturally occurring barium in drinking water results from the leaching and eroding of this metal from sedimentary rocks into the aquifers of ground water. It is a localized problem in several areas of the United States. The removal of barium from drinking water appears to be most efficiently accomplished utilizing ion exchange softening. Health effects studies are based primarily on animal experimentation. Such effects include stimulation of smooth, striated, and cardiac muscle, elevation of blood pressure, initiation of catecholamine release, rapid and preferential deposition in bone, and excretion principally in the feces. Humans over 60 years of age appear to be at high risk to developing cardiac arrhythmias following the barium enema. The current United States drinking water standard of 1.0 mg/l is based on several faulty assumptions and should be critically reevaluated.


Exposure data for the study of acute health effects of air pollution.

The use of aerometric network data has been criticized before on the grounds that it might give an unreliable picture of population exposure. However, the extensive data obtained from networks is still being used for studies of health effects of air pollution. This study uses a rigorous approach in analyzing these data to test their suitability for studies of acute health effects of air pollution. New York City, with one of the most extensive aerometric networks, consisting of 40 air pollution monitoring stations, is taken as an example. Three years of hourly SO2 readings and bi-hourly readings of smokeshade have been analyzed. The use of one aerometric station to represent the daily exposure of the population of New York City as has been done in previous studies is shown to be invalid. The use of individual monitoring stations of the New York City aerometric network to represent the day-to-day exposure to SO2 and smokeshade of the populations surrounding these monitoring stations is examined, with results showing that further work will be necessary before such an approach is justified.


[Digestive diseases morbidity and need for medical care requirements. Prevalence study of declared symptoms and demand for medical care in a French "department" (author's transl)].

A survey on digestive morbidity and demand for medical care in a pilot area concerned 3504 persons, eighteen years old and over; 69.3 p. 100 of them reported that they had been affected by one or several digestive symptoms during the previous year. However, it concerns mostly just common symptoms, probably benign, observed in all age groups; only 9.4 p. 100 of those complaining (half of them being old persons) reported disorders which can be suspected as serious ones. Among the subjects presenting symptoms, there is a majority of women, of urban population, of higher educational levels and higher social classes. During this year 18.9 p. 100 of the total population sought medical advice for digestive symptoms, the average number of consultations being 0.7 for every subject. This demand is related to the age, the number and gravity of the complaints, and to the presence of a digestive history; 24.5 p. 100 of the subjects used self medication: this is related to the perception of benign disorders, to digestive history, sex and social class: factory workers, farm workers and self-operating farmers are using this least. Women complain of digestive disorders more often than men and practice self medication more frequently. They do not report serious symptoms or a history of digestive disease more often than men, nor do consult doctors more frequently.


A mathematical model for the 1973 cholera epidemic in the European Mediterranean region.

For the cholera epidemic that occurred in the European Mediterranean region in the summer of 1973, a simple deterministic mathematic model is proposed; it consists of a system of two ordinary differential equations which concern the evolution of the human infective population in a town community and of bacteria population in the sea. It is conjectured that the infection process obeys a non linear saturation-type law. A phase space analysis is performed for the system of equations. Conclusions are drawn which concern the evolution of the epidemic and which suggest some indications for the selection of public health policies. The validity of the model is compared with the available data for the town of Bari (Italy).


[Analysis of the geographical variations of twinning rate in France. An indirect approach to study spontaneous abortions (author's transl)].

The hypothesis of the existence of spatial variations of spontaneous abortion rates has two logical consequences on dizygotic twinning rates: they must be heterogeneously distributed and show a positive correlation with natality. French data available on dizygotic twinning rates from 1950 to 1974 are in agreement with both implications. Although alternative explanations are possible, these findings do reinforce the relevance of dizygotic twinning rate variations as a tool for the assessment of reproduction failures.


[Monoclonal gammapathy in the adult population of Finistère (France). Results of an inquiry resting on 30,279 persons (author's transl)].

The study of 30,279 adult sera, most issued from Finistère, detected 334 monoclonal gammapathies. The analysis of the results discloses that monoclonal gammapathies appear more frequently in this district (Finistère) than in Paris' one and that their repartition is not homogeneous. Two areas seem to be more particularly affected: one in the north-east, where IgG paraproteins are particularly frequent and the other in southwest, more particularly touched by IgM. The role of a genetic tendency could be backed by a discovery of numerous cases of monoclonal gammapathies occuring in families, and the high rate occuring between "half brother and sisters", but the case study of three couples would be more in favor of an environmental stimulus.


[Ecology of indigenious arbovirus in Alsace. Tick Central European Encephalitis. I.--Complex Ixodes ricinus--bank voles. II.--Study of bank voles population immunity. III.--Virologic results in bank voles population (author's transl)].

I.--After showing that bank voles are parasited only by Ixodes ricinus larvae, the authors attempt to found different factors (demographic, biometric, and sexual) who favor individual parasitism. The authors conclude to absent of anti tick immunity for this rodent specie. II.--The search for anti-central european encephalitis antibodies (I.H.A.) are shown that 2 p. cent animals were immuns. Yearly and monthly chronologies of antibodies apparition are shown, factors favoring the growth of specific Central european encephalitis antibodies are discussed. III.--The Central european encephalitis tick viral infection of bank vole is studied according to the number of viral strains isolated from different viscera. The monthly chronology of this infection is shown.


[A self-administered questionnaire applied to 30,000 teen-agers. Assessment of this method of data collection (author's transl)].

In the French "département" of "Bas-Rhin", about 30,000 teen-agers filled in a self-administered questionnaire about respiratory symptoms, in spring 1976. The assessment of this method of data collection shows a very high response rate (99,7 p. cent). If we consider as incomplete all the questionnaires having at least one unanswered question concerning respiratory symptoms or smoking, 55,8 p. cent of them were incomplete, but for most questions non-response rate was lower than 4 p. cent. The consistency of answers was very satisfactory (mean inconsistency rate: 0,39 p. cent) and the likelihood of answers was proved.


[The influence of the geographic, demographic and socio-economic factors on the mortality from ischaemic heart disease in Switzerland (author's transl)].

The age-standardized mortality rate of Swiss men from ischaemic heart disease (ICD 8th revision, codes 410-414) can be placed between the higher mortality rate of the Federal Republic of Germany and the lower one of France. A geographical gradient is also found within Switzerland: the German speaking areas register higher rates than the French speaking areas, and this difference is more pronounced for comparisons of large cities than for rural locations. These mortality rates are not biased by the other diseases of the heart (ICD codes 420-429). In addition to this geographical gradient, the socio-economic classes, marital status and the number of children are the best demographic and social indicators to discriminate in multivariate form the deaths from ischaemic heart disease among all deaths of men aged 45 to 64 years: the relative risk of dying from ischaemic heart disease is higher among men in non-manual professions (especially in non-independent situations) and among married men with two or none children. The results confirm the importance of the psycho-socio-cultural factors in the etiology of ischaemic heart disease.


[Social security for people in need of care -- proposals for the development and financing of aids for this group (author's transl)].

The article points out a serious deficiency in the social security system, i.e., that the old and infirm can only seldon obtain institutional care without calling on social assistance. It discusses possible solution of including the attendance allowances into the scope of social security benefits. The solutions are formulated in the amendment of the Association of German Cities and Towns (Deutscher Städtetag) to the insurance regulations of the earlier German Reich (Reichsversicherungsordnung). It is proposed that the Länder and communities as well as, to a small extent the Federal Government, assume the responsibility for investments, whereas the legal sickness insurance funds cover the costs for medical treatment and nursing and the patient pays an estimated rent value and the "hotel services".


[Who needs more psychosocial oriented rehabilitation -- women after breast cancer or women after genital cancer? -- A sociopsychological study of 308 women (author's transl)].

A standardised questionnaire and personality test were used to study whether women after breast cancer treatment, or women treated for genital cancer need psychosocial counselling more frequently. The interview was given to 308 women during the author's tumor after-care consultations. 1. Repercussion on their marital lives were reported three times more often by women treated for genital cancer than by women after mastectomy (p less than 0.01). There was not significant difference with regard to their family status. 2. As epidemiologically expected -- mastectomy patients had born less children than women treated for genital cancer (p less than 0.05). 3. A reduced self-confidence was reported more often by patients treated for breast cancer than by the other patient group (p less than 0.01). 4. No decrease in working performance was observed by 50% of the women treated for genital cancers as against one third of the masectomy patients. 5. Work resumption was reported more often to be strenuous for masectomy patients than for women treated for genital cancer (p less than 0.05). 6. Woman after mastectomy experiences 50% less sexual repercussions than genital cancer patients (p less than 0.05).


[The lower-limb amputation in geriatrics suffering from occlusive artery disease (author's transl)].

Owing to the biology of arteriosclerosis elderly previously affected patients have, as a rule, to undergo lower limb amputation for occlusive artery disease. This creates particular problems which must be taken into account when choosing the surgical technique and providing the prosthesis. The article surveys the common methods and describes, in particular, the knee disarticulation including the early prosthetic fitting carried out at the author's hospital, which in their experience can decisively improve the patient's rehabilitation.


[On the therapy and rebabilitation of juvenile drug addits in a special hospital (author's transl)].

A successful therapy of drug-dependents can only be carried out in special facilities providing intensive inter-disciplinary care. In the Hochstadt district hospital (Bezirksklinik Hochstadt) treatment encompasses detoxication, weaning and after-care. The goal of the therapy is the permanent abstinence of the patient, finding of his identity, treatment of his somatic and psychic disturbances and diseases as well as the learning of techniques enabling him to resist addiction producing substances after his discharge from hospital, and his social re-integration. The methods used are group-therapy, as a behavioural therapy with psychodynamic aspects, ergotherapy and physiotherapy as well as socio-therapeutic measures. The therapy has a high success rate. Catamnestic studies show that 50% of the patients were still abstinent one year after their date of discharge.


[Report of the work at a psychiatric transitional home (declared as a model centre in the Rheinland (author's transl)].

The complete vocational and social re-integration of the psychiatrically disabled (schizophrenic type) is only possible to a certain degree, even after a temporary stay of approximately one year at a transitional home for the psychiatrically disabled where comprehensive therapeutic measures are provided. This is shown by the experiences gained during a three-year period of work with a study sample of 190 persons at the socio-psychiatric rehabilitation centre "Bodelschwinghaus" in Neuss, Federal Republic of Germany. A partial rehabilitation i.e., the ability to live in a community home and work in a workshop for the disabled was more successful. As a rule, the psychiatrically disabled need a long time in an encouraging and sheltered living situation which, nevertheless, must be open to the social environment, to obtain, in some cases, the degree of stabilisation necessary to one day lead an independent life. Accelerated measures structured according to economical and financial principles do not meet the needs of the psychiatrically disabled. This is why a rigorous separation between transitional and permanent homes is not appropriate in psychiatric rehabilitation.


Localisation of the changes of the sensitivity of the airways by proteolytic enzymes (pronase) against acetylcholine.

Proteolytic enzymes increase the sensitivity of the bronchial system against acetylcholine when inhaled as aerosols. These experiments were performed on 33 dogs in order to localize the area of sensitivity in the bronchial system responsible fe aerosol only to the upper part of the airtract sensitises the lower part of the airways against acetylcholine. Pronase aerosol given to the lower part of the airways needs higher dosages for sensitization to acetylcholine. This effect assumes an interaction between the upper sensoric part in the reflex way of airway obstruction and the lower airways. Changes caused by proteolytic enzymes in the upper part of the airtract can cause increased reactivity of the lower airways.


Calcium hypersensitivity in airways smooth muscle. Isometric tension responses following anaphylaxis.

The isometric tension of anaphylactic guinea pig trachealis muscle preparation was examined at subphysiologic extracellular calcium concentrations, in vitro. Paired observations of control to passively sensitized (egg albumin antiserum) and antigen-challenged muscles (anaphylaxis) were made to exposure to trace Ca++ followed by cumulative Ca++ replacement. Following anaphylaxis, a leftward shift of the Ca++ concentration-tension responses was found at 0.25--0.5 mM Ca++ (p less than 0.001); EC50 was 1.5 x greater than control. A greater maximal tension was also noted at 2.52 mM Ca++. Passively sensitized muscles did not exhibit this heightened response. Subthreshold tissue chemical mediators are tentatively excluded as causative. An increased sensitivity to extracellular Ca++ exists in resting smooth muscle following anaphylaxis.


Efficacy of reproterol assessed by the acetylcholine provocation test.

The acute broncholytic efficacy and the protective anticonstrictive effectiveness of a new beta 2-receptor stimulator, Reproterol, was tested in 16 patients with the acetylcholine (ACH) provocation test. Plethysmographic airway resistance determinations (Raw) and flow volume curves (VEmax50%/FVC) were used as assessment parameters. All patients proved susceptible to ACH provocation, in as much they demonstrated a significant rise in the Raw from 2.46 to 11.53 cm H2O/1/sec and a significant decline of the VEmax50%/FVC from 884 to 565 (ml/sec/1) following ACH administration. With Reproterol inhalation (2 puffs at 500 mu each), almost complete elimination of ACH-induced bronchial constriction was achieved. The ACH provocation with the same patients the following day, however, was almost absent 60 min after oral ingestion of 20 mg of Reproterol tablets. Dose-efficacy studies in 7 volunteers from the same group revealed a subjectively better tolerance of the 10-mg tablets, but with a correspondingly lower antibronchia constrictive efficacy.


Condylomatous changes in neoplastic bronchial epithelium. Report of a case.

The present communication is a report of a case where histological changes, identical to those described recently to be of condylomatous nature in the genital tract, were found in the bronchial epithelium adjacent to an invasive squamous cell carcinoma. The significance of this finding in the light of squamous cell carcinogenesis is discussed, and the conclusion is drawn that these lesions are worth recording until proved to be unrelated to the carcinogenesis, or to be involved in it.


Phlebotomy improves pulmonary gas exchange in chronic mountain polycythemia.

There is not unanimous agreement in the literature regarding the effects of bleeding on pulmonary gas exchange in polycythemic patients. Spirometry, alveolar arterial O2 and CO2 tension differences, PaO2 breathing 100% oxygen and carbon monoxide-diffusing capacity were measured before and after 1 week of chronic phlebotomy in 4 chronic mountain polycythemic patients. Studies were carried out at 3,700 m above sea level (PB = 491 mm Hg). Before phlebotomy, 2 patients showed abnormal spirometry and gas exchange. Only 1 patient had high PaCO2 and all of them showed low values of PaO2 breathing oxygen. Phlebotomy improved both spirometry and gas exchange. Improvement in arterial oxygen saturation and PaO2 could not be attributed to changes in alveolar ventilation, but rather to better distribution of VA/Qc ratios since physiological dead space decreased. Our results are similar to those reported in polycythemia vera patients. A significant correlation between the changes in PaO2 with phlebotomy and the control PaO2 have been found from 45 polycythemic patients with chronic obstructive pulmonary disease collected from the literature. It is concluded that excessive polycythemia worsened hypoxemia and that phlebotomy improved gas exchange.


A simple method for computing airway resistance and specific airways conductance from scalar plethysmographic recordings.

An alternative procedure to evaluate plethysmographic tracings is described for the determination of airway resistance (Raw) and specific airway conductance (SGaw). Raw and SGaw obtained with this method reflect the average resistive impedance over one breathing cycle. Although both work and apparative expenditures are minimal, the results are well comparable with those calculated with more involved methods. The technique is particularly well suited for patients with impaired cooperation since SGaw can be determined without measuring the intrathoracic gas volume.


Lymphomatoid granulomatosis. Case report from the thoracic services Boston University Medical School.

Lymphomatoid granulomatosis is one of a group of pulmonary disorders characterized by necrotizing, aseptic granulomas, usually with angiitis. Multisystem dissemination is common especially to the skin and central nervous system. The diagnosis can be established only by histologic examination. Lymphomatous transformation apparently occurs in 10-20%. Treatment is generally unsatisfactory, although corticosteroids appear to be indicated initially. We present 4 patients, 3 of whom died relatively rapidly with progressive pulmonary lesions despite therapy with corticosteroids and cytotoxic agents. 1 of these patients developed a lymphoma. The fourth recovered after local excision. Pathologic diagnosis, classification, clinical and radiographic features and therapy are discussed.


[Subacute sclerosing panencephalitis. A case with a prolonged course in an adult. Isolation and characteristics of a "defective" measles virus (author's transl)].

A 33-year-old man had a 6-year history of clinical signs suggesting multiple sclerosis : visual lesion at 27 years of age, cerebellar and visual disturbances at 31, which partly regressed, lymphocytosis and increased-gammaglobulin levels in the cerebrospinal fluid. Biological and anatomical (optical and ultrastructural) examinations gave results typical of a subacute sclerosing panencephalitis. A cytopathogenic measles virus was isolated from a cerebral biopsy specimen. The agent was transmissable to vero cells by co-culture but infectivity was always related to the cells and was therefore an incomplete viral infection. Virus-like particles were found in the nucleus and cytoplasm after electron microscopy examination of the co-cultures. Biochemical tests demonstrated that the viral proteins were all synthesized except hemagglutinin, which is a characterist abnormality of a "defective" measles virus.


[Binswanger's subcortical encephalopathy. Study of a case with predominant left hemispheric lesion (author's transl)].

We report the clinical and pathological study of a patient with vascular leucoencephalopathy almost restricted to the left posterior hemisphere. A 65 year--old right handed hypertensive woman has presented with a neuropsychological symptomatology of transcortical sensorial aphasia. We discuss the following points: 1) the patient's disease must be considered as Binswanger's subcortical encephalopathy despite the asymetric topography of the lesions ; 2) particular hemodynamic cerebral factors has possibly determined the asymetric nature of the disease ; 3) a lesion of the left temporo-parieto-occipital area that was strictly sub-cortical, with complete destruction of the posterior part of the arcuate fasciculus has presented with the clinical picture of a transcortical sensorial aphasia.


[Encephalitis and acute amnesic encephalopathies. Retrospective study of 16 cases (author's transl)].

A retrospective study was conducted on sixteen cases of encephalitis or acute amnesic encephalopathies, only one of which was confirmed by pathological examination, seen over the last fifteen years. The amnesic syndrome was always associated with a very marked anterograde deficiency and the absence of severe disturbances of other higher functions. Its onset was always acute, was secondary to disturbances of consciousness or associated with epilepsy, and in half of the cases presented as a severe infections disorder with high fever. The mood and behavioural disorders, and the temporal epilepsy, were evidenced clinically as a pure or predominant hippocampic lesion. The diversity of the progressive nature of the disorders, and the etiological environmental factors, enable divison into three groups : a group of six cases of postencephalitic Korsakoff's syndrome, probably of herpetic origin, and associated with a stable amnesic syndrome which remained as a sequela ; a group of 5 patients with non-herpetic but probable viral "curable amnesic encephalitis" ; another group of 5 patients with "acute amnesic encephalopathy" with various etiologies and with obvious encephalitic lesions.


[A study of 14 cases of Bourneville's tuberous sclerosis, including two pathological reports and seven cases investigated by computer tomography (author's transl)].

The authors studied 9 girls and 5 boys, with ages ranging from 9 months to 26 years, suffering from Bournevilles tuberous sclerosis, for an average period of 7 years. The various types of epileptic attacks and their progression were studied as well as the degree of mental retardation. Only two of the children had a normal IQ. The accepted value of computer tomography examinations in this disease is confirmed. Pathological examinations were conducted in two cases, one complete (autopsy) and one partially only (histological examination of a paraventricular tumor removed by operation).


[Treatment of multiple sclerosis with antilymphocyte serum: results of a pilot study on 50 patients followed-up over a 4-year period (author's transl)].

Intensive antilymphocyte serum treatment was given to 50 patients with severe, progressive multiple sclerosis for a period of 6 weeks. Conclusions were favourable as regards the possibility of using this treatment and its immunodepressive effect. Therapeutic efficacy is difficult to evaluate, but a favourable impression was obtained from the fact there was improvement and transitory stabilization in some of the patients. These results suggest that the study should be continued, using longer treatment, on more recent cases, and with a randomized control group.


[Electrophysiological study of cutaneous reflexes during avoidance reaction of the arms (author's transl)].

Electrophysiological studies of the cutaneous reflexes during avoidance reaction of the arms demonstrate more particularly the presence of facilitation of late reflex responses and stimultaneous activation of flexor and extensor muscles. The avoidance reaction is not the inverse electrophysiological image of pathological prehension, as it produces, at least in one of its aspects, a much more fundamental modification of the segmental reflex systems of muscle contraction regulation. This motor disorganization is rarely observed, and could result from a disequilibrium between proprioceptive sensitivity and skin sensitivity: the loss of proprioceptive control would facilitate contact reactions.


[Lumbosacral dysraphia and "long spinal cord" of delayed appearance (9 cases)].

Urinary disorders, deformities of the feet, and sensory of trophic disturbances appearing during, or increasing in severity at adolescence, were observed in 9 patients. In seven cases there appeared to be an abnormality of the teguments of the lumbosacral region, and in all cases, as shown by straight radiological examination of a spina bifida of L5 or S1, a sacral dehiscence and wide sacral canal, and a subjacent nervous tissue abnormality was suspected. Radiculography showed the presence of a "long spinal cord" terminating in the sacrum by a tumor mass. Examination of this mass in the seven operated cases demonstrated that the tumor was an intradural lipoma with a wedge-shaped penetration into the end of the medulla, fixing the cord in the sacrococcygial region, in the absence of the filum terminale and cauda equina. The etiology of this "long spinal cord" is discussed, and it appears to be the consequence of a dysraphia, which is also the cause of the lipoma. Mechanical factors appear later and produce neurological signs.


[Use of cerebral computer tomography for the diagnosis of multiple sclerosis].

The authors describe computer tomography findings in multiple sclerosis (MS)), and attempt an evaluation of the value of cerebral computer tomography for the diagnosis of this disease, especially those forms in which the clinical diagnosis is uncertain. A total of 33 patients, 15 men and 18 women, were studied. According to McAlpine's criteria, 21 patients had established MS, 2 were probably MS cases, and the other 10 were possible cases of the disease. The scanner used was an EMI 1010 apparatus giving 13 mm thick sections, with a matrix of 160 X 160. A contrast medium was injected systematically. Abnormal computer tomography results were noted in 28 of the 33 patients, including one or more low density areas in the white substance in 26 patients, taking up of the contrast medium after injection in 10 patients, and cerebral atrophy in 24 patients. Cases where only one of these anomalies was present are rare, and the various anomalies noted on computer tomography are usually associated in varying proportions. In most cases, the computer tomography findings were not related to any specific clinical picture. In cases of established MS, computer tomography can provide information on the extension and progression of the lesions at the time of examination. Out of the 12 cases in which clinical diagnosis was uncertain, 9 presented abnormal findings (low densities and/or taking up of contrast medium); the level of CSF gamma-globulins was normal in 4 of these 9 patients; visual evoked potentials were not altered in the 5 out of these 9 patients studied. In 3 patients with medullary signs, several low cerebral trunk and white substance of the cerebral hemispheres. When diagnosis is uncertain, cerebral computer tomography is the method of choice for demonstrating latent MS lesions of a certain type: it complements neurophysiological studies (visual, auditory, and somesthesic evoked potentials), used at the present time for the diagnosis of MS by exploration of the optic tracts and cerebral trunk.


[Value of extra-intracranial anastomosis: based on a series of 65 cases].

The authors describe the results obtained in a series of 65 patients following extra-intracranial cortical anastomosis. The best indications for this procedure are transitory ischemic accidents which cannot be approached by the direct cervical route. Cases of prolonged or definitive vascular accidents and more especially localized lesions also gave valuable results but these depend upon the condition of the cerebral parenchyma which must be carefully evaluated.


[Release of diethyl-2-hexyl phthalate from stored blood on contact with polyvinyl chloride].

Softness and flexibility of PVC are due to the addition of plasticizers in high concentration; the most used of them for blood storage bags is DEHP. In this work, a method for labelling DEHP with 14C from 14C phtalic anhydrid is given. A piece of PVC from a commercial blood bag is labelled, in our laboratory, with 14C DEHP and used to follow the kinetics of DEHP leaching in blood during storage. It is also used to study the influence of some parameters such as lipids amount of blood, shaking, and plastic sterilisation on this leaching. DEHP leaching is a three steps phenomenon and the level is not correlated to lipids content of blood. Thermal treatment of PVC and shaking have an influence on leaching. DEHP is not metabolised during blood storage at 4 degrees C and can not be detected as free molecule; it is absorbed on plasmatic proteins.


[Quantitative study of ABH antigens in the saliva of newborns and adults].

The results of comparative quantitative investigations of the inhibiting strength of salivas from adults and newborn infants are presented. It is found that A and B salivary antigens of newborn infants have a significantly weaker inhibiting strength than those of adults. Opposite proportions are established in relation to salivary H antigens. Two types of quantitative changes of the inhibiting strength of the salivas from AB groups are registered and they are supposed to be a result of the competition of A and B gene products.


[Synthesis of natural allohemagglutinins of the ABO system in healthy children aged 3 months to 3 years].

The work was carried out to establish the titre and score of haemagglutination of natural anti-A and anti-B antibodies in healthy children during the first three years of life. The material studied included 900 healthy children aged between 3 months and 3 years and 100 adults serving as controls. The method of test tube haemagglutination was used for determining the titre and score of alloagglutinins in relation to standard erythrocytes always obtained from the same donors. In addition, in 72 children and 10 adults the levels of IgG, IgA and IgM were determined quantitatively. A statistical analysis of the results showed that the levels of anti-A and anti-B alloagglutinins were relatively high at the age of 3 months / about 25% of the adult levels / and increased very rapidly in the first years of life reaching about 90% of the adult level at the end of the 3rd year of life. Besides that, it was demonstrated that it is useful in clinical practice to use the titre and score of natural alloagglutinins as indicators of humoral immunity, especially in children in the first years of life. Acceleration was demonstrated in the intensity of haemagglutination of natural antibodies in the last 40 years since their titre in the contemporary infantile population / up to the age of 1 year / is about 50% higher than that found in 1929. These findings suggest that increased immune reactivity of children observed presently may be due to prophylactic vaccinations.


[Radiological study of painless knees in 50 women more than 65 years old. I. Frontal teleradiography in an upright position].

Fifty women over 65 who had never suffered from knee problems had a frontal teleradiography of the lower limbs in a vertical standing position. Two knees (out of one hundred) were affected by an external femoro-tibial arthrosis. The femoro-tibial angle of the knees without arthrosis was very close to 0 (0.02). The typical difference was 2.46. The normal level is thus approximately -5 to +5 degrees, and there was thus no "physiological" genu-valgum in the population studied. Marginal osteophytosis and the tibial spines is very frequent and has no pathological significance. A menischondrocalcinosis was found in 14 per cent of subjects.


[Postoperative sciatica from epidural fibrosis and lumbar arachnoiditis. Results of 38 repeat operations].

Lumbar epiduro-arachnoiditis is a well-known complication of surgery of the intervertebral disc. The epidural fibrous scar is the normal outcome of inflammatory activity secondary to the mechanical tissue disturbance resulting from surgery. In certain individuals, perhaps genetically predisposed as excessive quantity of fibrous tissue is deposited in the epi and/or nitradural space. This abnormal situation, comparable to cheloid cutaneous scars, is perhaps at the origin of the clinical symptoms. The authors report the clinical and radiological signs observed in 38 patients having had at least one operation for discal hernia, and who underwent further operations in the aim of freeing the roots and the dural sack from fibrous compression. Results of excision of the epidural "cheloid" were good in 13 cases, and average in 8 others. There was a complete failure in 17 other patients. Three explanations were offered to explain the frequency of the failures: 1) formation of a new cheloid, 2) difficulty of neurolysis of the arachnoiditis, 3) possibility of intrinsic lesions of the nerve associated with the epiduro-arachnoiditis.


[Lumbar phelbography without catheterization. Technic, indications and results in the diagnosis of intervertebral disk herniation].

The authors present a new method of lumbar phlebology without catheterism by direct venous puncture of the femoral veins. An analysis of 300 contrast tests maked it possible to identify different types of pathological images characterized by disappearance and displacement of epidural veins corresponding as a rule to discal hernia when the uncharacteristic shadowy images do not allow one to make a precise conclusion or to determine whether an operation is needed. With equal reliability (96 percent), lumbar phlebography without catheterism is, by its simplicity and harmlessness and the absence of minor and major venous complications, preferable to phlebography by catheterism. Carried out in all subjects, whatever their age, without special precautions, it seems to us to now be the most desirable test to be used in the radiological investigation of lumbar discal hernias.


[Cryoglobulins and circulating immune complexes in rheumatoid arthritis. Clinical and biological correlations].

We studied circulating immune complexes using a test involving the precipitation of these complexes with polyethylene glycol 6000 at 2.5 percent, and characterization of the Clq bound in vivo to immunoglobulins in the serum of 126 healthy subjects, 95 hospitalized controls and 181 patients suffering from rheumatoid arthritis (RP). Likewise, the RP benefited from a study of cryoglobulins (CG). The PEG-Clq proved positive (PEG +) in 7 per cent of the healthy controls, 25 per cent in the seronegative RP. ThePEG & RP have a level of proteins, gammaglobulins, IgM and IgG that is higher than in patients in whom the test is negative. On the other hand, they have a lower level of C4. One CG was detected in 43 patients who were all PEG +. The level of CG is proportionate to the intensity of the articular inflammation, the sedimentation rate, the level of seric iron and that of hemoglobin. The composition of the precipitins obtained by activity of the PEG is very close to that of the CG.


[Massive and sudden bone resorption in rapid destructive coxarthrosis. Radiologic  and anatomic study].

Twenty hips with rapid destructive coxarthrosis (early form, 3; delayed form, 17) showed, during their development, a massive and sudden bone resorption. Preexisting problems of the bone structure of the hips were dispersed and constantly changing; they were different from those of common arthrosis and primary necrosis of the hip, conditions characterized by a progressive organization of the lesions in the relatively homogenous major areas. In five femoral heads sampled during the resorption, vascularization is ensured by a more or less dense network of capillaries. Medullar tissue was replaced by clumps of reticular cells, which later developed into differenciated cells (fibroblasts, osteoblasts and osteoclasts). The bone trabeculas also underwent several changes. Such tissue transformations are identical to those brought about by more or less severe experimental ischemia. In our samples, the confluence of centers of osteoclasia, very active, explains the massive bone resorption seen on x-rays.


Dietary heme iron absorption. A discussion of possible mechanisms for the absorption-promoting effect of meat and for the regulation of iron absorption.

Two main findings are reported. 1) The absorption of heme iron from a composite meal was very little if at all influenced by the subject's iron status at doses in the usual physiological range, but at high doses of heme iron there was a strong correlation with the subject's iron status. A hypothesis is presented to explain the regulation of iron absorption, so as to account for the impact of the subject's iron status, which is always evident with non-heme iron absorption but occurred only at high doses with heme iron. 2) Meat enhanced the absorption of heme iron. A probable explantation for the influence of meat on the separate absorbing mechanisms is that meat may stimulate the digestion of food, so that iron in either form is more efficiently released and made available for absorption.


Serum ethanol estimations in the control of alcohol abstinence in patients with liver disease.

Eighty-eight patients with a non-alcoholic and 105 patients with an alcoholic liver disease were warned against alcohol consumption. On three consecutive ambulatory visits, serum ethanol was measured and compared with patients' admission of alcohol intake. None in the non-alcoholic group had a positive serum ethanol test, whereas 60 samples from 40 patients with alcoholic liver disease were positive. The serum ethanol values were higher in women than in men. Continuation of drinking was unrelated to sex, age, or type of alcoholic liver disease. Twenty-seven of the 40 patients with ethanol in serum denied alcohol consumption. The reliability of the patients was unrelated to sex, age, or type of alcoholic liver disease. Serum ethanol was more valuable than aspartate aminotransferase, alkaline phosphatase, bilirubin, and coagulation factors in pointing out the patients who continued drinking.


Serum disappearance rate of gastrin-17 after vagotomy.

Six duodenal ulcer patients were investigated before and after truncal vagotomy and pyloroplasty. Four doses of gastrin-17 were injected intravenously (15.625, 31.25, 62.5, and 125 micrograms/kg body weight); the gastric secretory response and the disappearance rate of gastrin were measured. After vagotomy the basal level of gastrin increased from 64 pg/ml to 106 pg/ml. When corrected for the basal levels of gastrin, the peak levels and disappearance rate of gastrin-17 were observed to be the same after vagotomy as before (half-life before vagotomy, 5.6 min; after, 5.8 min). This indicates that vagus does not influence the metabolism of exogenous gastrin-17. The gastric secretion of acid was reduced to 30% after vagotomy, which shows that there is a synergism between vagus and gastrin-17.


Morphological, functional and immunological state of the gastric mucosa in gastric carcinoma families. Comparison with a computer-matched family sample.

Three hundred and one first-degree relatives (series) of 73 gastric carcinoma patients and 358 control relatives (controls) of 73 computer-matched probands from a general population were studied by direct-vision gastric biopsy and functional and immunological examinations. The controls were representative of the series with respect to age, sex, birth and dwelling place, and relationship of the relatives. Series and controls behaved similarly as to total prevalence of gastritis, age and sex distribution of gastritis, serum gastrin level, and circulating gastric antibodies. On the other hand, the total prevalence of hyperplastic polyps, atrophic gastritis of the body and antrum, severe atrophic gastritis of the body, intestinal metaplasia, epithelial atypia, and achlorhydria was significantly higher in the series than in the controls. In subjects below 50 years of age the prevalence of severe atrophic gastritis of the body, intestinal metaplasia, and epithelial atypia was also significantly higher in the series. In addition, the mean age of the subjects with atrophic gastritis, intestinal metaplasia, epithelial atypia, and achlorhydria was lower in the series than in controls; however, significant differences were found only in female subjects with epithelial atypia and atrophic gastritis of the body. The results suggest that the prevalence of signs often considered premalignant is significantly higher in carcinoma relatives than in controls and that these signs show a trend to occur at an earlier age in carcinoma relatives. This could explain the significantly higher than expected death rate from gastric carcinoma in close relatives with this disease, found in the present and in other series.


Long-term follow-up of e-antigen (HBeAg)-positive acute viral hepatitis.

Eighteen consecutive patients with HBeAg in serum and histologically verified acute viral hepatitis were included in a follow-up study of the natural course of the disease. Five patients were followed up for from 2 to 6 months. Two of these healed clinically and cleared both HBeAg and HBsAg, while three were positive for HBeAg and HBsAg at the last control. Thirteen patients with a follow-up of from 27 to 102 months became HBeAg-negative during the time of observation. In all but one, progression of the liver disease stopped when HBeAg was cleared. The results further indicate a close association between the duration of HBe antigenemia and the severity of the liver disease.


Acquired, transient factor X (Stuart factor) deficiency in patient with mycoplasma pneumonial infection.

A case of severe haemorrhagic diathesis due to acquired deficiency of factor X (both immunologically and in procoagulant activity) is presented. The clinical and serological features of this case indicated mycoplasma pneumonial infection. Factor X in the peripheral blood did not appear to be influenced by administration of vitamin K, prothrombin-complex concentrate, fresh plasma or fresh whole blood. Circulating inhibitors of blood coagulation were absent and systemic amyloidosis could not be demonstrated. After 20 d, factor X spontaneously returned to normal. In view of the absence of other known causes of factor X deficiency, a possible relationship with mycoplasma pneumonial infection is suggested.