The long-term results of ileal conduit urinary diversion in children.

Sixty-seven children undergoing urinary diversion by ileal conduit tolerated this procedure well. The initial results were most satisfying, but late complications occurred in 55 children (82%), and this is a cause for concern. Even when the surgical complications were avoided, it seemed important to consider carefully the psychological problems that these children with ileal loop diversion could develop as they advanced into adult life.


A long-term follow-up of the colonic conduit operation in children.

The results of colonic conduit urinary diversion have been reviewed in 41 children with an average follow-up of 13.2 years. There was a high incidence of stomal stenosis (61.5%), ureterocolic stenosis (22%), ureteric reflux (58%) and upper tract deterioration (48.4%). Comparison with results of ileal conduit diversion in children show no advantage in the use of colon.


Tumour of the colon as a late complication of ureterosigmoidostomy for exstrophy of the bladder.

Two cases of cancer of the colon have occurred recently in our series of 38 patients with exstrophy of the bladder treated by ureterosigmoidostomy. Twenty-six and 14 years elapsed between the original operation and the diagnosis of malignancy. Since 1929 the literature contains reports of 55 patients who have developed bowel neoplasms as a late complication of this form of diversion. The operation was performed for exstrophy in 35 of these, in whom the resulting tumour at the anastomotic site was malignant in 28 and benign in 7 patients. The shortest interval between ureterosigmoidostomy and recognition of the growth was 10 years with a mean latent period of 25 years. The aetiology remains uncertain but it is clear that long-term survivors after ureterosigmoidostomy should have diagnostic large bowel studies included in the follow-up.


Ureters that show both reflux and obstruction.

Eight ureters in 6 male patients have been shown radiographically and dynamically to exhibit both reflux and obstruction. The greater the degree of obstruction the more dilated the upper urinary tract. Reflux may be considerable, but in severely obstructed ureters it may be minimal. Both urologists and radiologists should be aware of this unusual association. When it occurs patients should not be managed conservatively, but should have their ureters reimplanted.


Duplications of the lower urinary tract in children.

Seven cases of bladder duplication are described, and compared with 27 cases of urethral duplication. Bladder duplication was collateral while urethral duplication was usually in the sagittal plane. The conditions may coexist when the duplication of the bladder extends caudally to produce a collateral urethral duplication, but in one boy bladder duplication was associated with 4 urethrae in the sagittal plane. In 5 cases the bladders were united; in 2 cases, one bladder was excised. The results were satisfactory in 6 and in one the bladder failed to empty. The basic defects that lead to duplication are unknown. Several features of the conditons suggest that there are different aetiologies in each type. There are similarities with the exstrophy epispadias complex. Even when there are major abnormalities in other systems the general and urological prognosis is good.


Müllerian duct remnants in the male.

Persistent remnants of the caudal Müllerian duct in the male may occasionally give rise to symptoms and pose a problem of management. We describe 13 cases which have been seen over a 24-year period. In 4 cases the remnant took the form of a cyst, whilst the other 9 had tubular utricular structures. Not all had an associated maldevelopment of the genitalia and there was no relationship between the size of a tubular remnant and the degree of genital abnormality. Infection generally appeared to be related to the presence of obstruction to the free drainage of the contents of the remnant, and epididymitis occurred where free reflux into the vasa was present. Apparent incontinence was sometimes the result of urine pooling in the utricular pouch. The radiological demonstration of these structures was not always easy and in our experience voiding cystourethrography was the best means of achieving a diagnosis. Surgical excision of these structures can be difficult, and if they do not produce symptoms they should be left alone.


A comparison of vaginal and suprapubic surgery in the correction of incontience due to urethral sphincter incompetence.

A preliminary comparison is presented, with pre-operative and post-operative objective assessment, of 25 women undergoing anterior repair and 25 women undergoing colposuspension for the correction of incontinence due to urethral sphincter incompetence. Colposuspension was found to be effective. The mechanism of successful cure was likely to be a combination of bladder neck and proximal urethral elevation and narrowing.


Intravesical lignocaine and detrusor instability.

The effect of intravesical lignocaine solution on detrusor instability of mixed aetiology was examined in 20 patients; 40 ml of 1% lignocaine solution with 40 ml of 8.4% sodium bicarbonate solution was instilled into the bladder. This produced increased bladder capacity in 19, altered bladder sensation in 9, changed the character of the cystometrogram in 9, and lowered the maximum detrusor pressure during bladder filling in 16. The symptomatic effect of lignocaine was short-lived in all but one patient in whom it lasted 24 h. The possible mechanism of this inhibitory effect on bladder function is discussed.


Hesitancy and poor stream in younger men without outflow tract obstruction--the anxious bladder.

Sixteen younger men who presented with frequency, hesitancy and poor stream have been examined by clinical, urodynamic and endoscopic means. These urological symptoms have been found to be associated locally with a poor detrusor action and generally with a high incidence of dyspepsia and anxiety disorder. It is suggested that an initiating factor may be common to all 3 systems and hence a general rather than a local solution should be sought.


Selective sacral neurectomy in the management of urinary incontinence due to detrusor instability.

Since Torrens (1974) reported on the use of selective sacral neurectomy in the management of bladder instability, the procedure has been used increasingly in specialised centres. We report the clinical and urodynamic findings in 9 patients in whom this procedure has been performed. The results suggest that selective sacral neurectomy is a valuable procedure in a highly selected group of patients with neurogenic bladder dysfunction. Patient selection, contraindications and the choice of which sacral nerves to divide are discussed.


The urological status of 86 females following spinal cord injury.

A review of the urological problems in 86 female spinal cord injury patients is presented. There were no urological or renal deaths. Three urinary diversions were performed. Fifty-five patients are catheter-free and 28 are managed with permanent catheter drainage. The problems of "bladder training" are presented.


Hibitane bladder irrigation in the prevention of catheter-associated urinary infection.

The effect of regular chlorhexidine bladder irrigations on catheter-induced urinary infection in patients admitted as urological emergencies was investigated. Excluding patients infected on admission the urine remained sterile throughout the period of catheterisation in 52% of those receiving chlorhexidine but in only 26% of a control group of patients.


The role of multiple mucosal biopsies in the management of patients with bladder cancer.

The results of multiple biopsies from apparently non-tumour bearing bladder mucosa were studied in 154 patients with bladder cancer; 33% of the biopsies from apparently normal mucosa showed histological abnormalities including 4.5% with carcinoma. When the mucosa appeared red but flat, 52% of the biopsies showed histological abnormalities including 14% with carcinoma. Biopsies from mucosa that had a granular or mossy appearance showed carcinoma in 42%. A more aggressive management policy was adopted in 12 patients (8%) as a direct result of the biopsy findings.


Cystectomy for carcinoma of the bilharzial bladder: 138 cases 5 years later.

Our experience is outlined with 138 cases of bilharzial bladder cancer treated by radical cystectomy and followed for 5 years. The operative mortality was 13.7%. The 5-year survival rate was 32.6%. Analysis of survival figures revealed that the tumour grade was the most important prognostic factor. Most treatment failures were due to local recurrence which developed early after treatment. It was concluded that improvement in survival might be obtained by some form of pre-operative irradiation augmented by the use of a hypoxic cell sensitiser.


Long-term follow-up in patients with superficial bladder tumours treated with intravesical Epodyl.

Sixty-four patients with multiple, superficial papillary bladder tumours which had ceased to be controlled by endoscopic resection and diathermy were treated before July 1972 with intravesical Epodyl instillations. Of these, 19 had developed no further recurrences; 20 patients were free of tumour to one year, but later developed recurrences. Twenty-four patients were never entirely free of tumour after starting Epodyl and one patient became free of recurrences 2 years after starting Epodyl. Only the patients whose histology showed no invasion of the lamina propria responded to treatment. The overall 5-year survival rate was 66%, with a disease-free interval of 61% at one year and 25% at 5 years. Failure to clear the bladder of tumour after 12 months' treatment, or worsening of biopsy stage from PIS to Pla or Plb while on treatment, were associated with a high risk of dying of invasive tumour and in future should be used as immediate indications for radical treatment.


The evaluation of 68 patients with post-prostatectomy incontinence.

Sixty-eight patients with incontinence following prostatectomy for benign prostatic hypertrophy were studied. Detrusor instability was present in 45 patients, most commonly associated with sphincter damage (28 patients), but alone in 11, and with residual obstruction in 6 patients. Sphincter damage was the cause of incontinence in 47 patients (alone in 18, with detrusor instability in 28, and with residual obstruction in 3). Some patients who complained of a combination of frequency, nocturia and urgency before prostatectomy were later found to have detrusor instability, but post-operatively no association between symptoms and pathology was noted. It is suggested that the need for surgery should be definitely established in patients who present with equivocal symptoms. All patients with a combination of frequency, nocturia and urgency should have a urodynamic assessment before prostatectomy.


Prostatic lymphoscintigraphy.

Techniques of prostatic lymphoscintigraphy using 99mTc phytate (TP) and 99mTc antimony sulphide colloid (ASC) have been evaluated in 30 patients. The most successful technique was a superficial perianal injection of ASC. In general, definition of the regional lymph nodes lacked the precision and clarity that would be required for the technique to be used in staging of prostatic or other pelvic tumours; further development of the technique is recommended.


Improved techniques in radionuclide imaging of prostatic lymph nodes.

Further improvements have been made in the technique of human prostatic lymphoscintigraphy, allowing better anatomical localisation of the areas of uptake of activity. A single median injection into the capsule of 99mTc labelled antimony sulphide colloid has been found to give as good imaging as 2 injections on either side of the midline. By placing markers on the umbilicus, pubic symphysis and both anterior superior iliac spines, a "pelvic grid" can be superimposed on the antero-posterior view. Further help with accurate localisation may be attained by taking 3 views; antero-posterior, postero-anterior and lateral, in 9 instances, prostatic injection was performed without any sedation or anaesthesia. The resulting scintigrams were indistinguishable in quality from those of anaesthetised patients.


Urinary hydroxyproline excretion in carcinoma of the prostate. A comparison of 4 different modes of assessment and its role as a marker.

Urinary hydroxyproline (HP) excretion has been estimated without prior dietary restriction in 33 patients with carcinoma of the prostate and expressed as either 24-h HP output or as the hydroxyproline/creatinine (HP/Cr) ratio in 24-h urine sample, an early morning urine sample or a spot urine sample. The early morning urine hydroxyproline/creatinine ratio (EMU HP/Cr) appears to be the most accurate and avoids the disadvantages of formal dietary restriction and prolonged urine collection. The rest is useful in monitoring the responses to treatment of a patient with bony metastatic disease and relapse of a patient when his tumour ceases to be hormone sensitive. Furthermore, changes in EMU HP/Cr occur earlier than changes in other clinical or investigative variables, giving the test predictive value.


Transitional cell carcinoma of the prostate.

Thirty-three cases of transitional cell carcinoma involving the prostate gland are reviewed. Four different types of involvement are described. The mortality of 66% was largely confined to those with primary prostatic transitional cell carcinoma and those in whom there was direct invasion of the prostate by a bladder tumour. The relationship of some of these lesions to urothelial carcinoma in situ is discussed.


A technique for selecting and concentrating the motile sperm from semen in oligozoospermia.

Using an albumen-filled column, it was possible to separate highly motile sperm from autoagglutinated, dead and immotile sperm, as well as from other seminal debris. Motility was increased from a mean of 45.4 to 74.3% (P less than 0.001), although the sperm density fell from a mean of 28.2 million per ml to 9.7 million per ml (P less than 0.001). When these selected highly concentional AlH had been repeatedly tried without success, 3 pregnancies were achieved in 18 women (16.7%).


Improvement of semen and pregnancy rate after ligation and division of the internal spermatic vein: fact or fiction?

Male partners with left-sided varicoceles of 96 infertile couples were studied. Fifty-one patients were submitted to ligation of the testicular veins and 45 individuals were randomised as controls. During an observation period of 53 months (range 36 to 74 months) we found no statiscally significant improvement in the semen crude variables, the morphology or the progressive motility in the series of men submitted to surgery. The pregnancy rate was lower in those who had an excision of varicocelle.


Negative pressures in surgical drains.

Laboratory and clinical experiments were done to measure the pressure in tube drains. It was found that the fluid in drains connected to floor bags exerted a negative pressure equal to the height of the fluid column in the tube. There was no negative pressure when the drain opened into a urostomy bag at wound level. It is suggested that this negative pressure might tend to maintain a urinary fistula once a leak in the suture line has begun.


Has the mortality of male doctors improved with the reductions in their cigarette smoking?

From 1951 to 1971 male doctors reduced their cigarette smoking more than did men in social classes I and II combined. In 1970-2, 665 male doctors died aged under 65. Had they shown the same improvements in cause-specific death rates over the 20 years as men in classes I and II, 699 deaths would have been expected. This "saving" of 34 deaths in the doctors comprised savings from coronary heart disease (83), stroke (16), and lung cancer (8) balanced by 60 "losses" from three stress-related causes--namely, accident, poisonings, etc (30); suicide (26); and cirrhosis of the liver (4)--plus 13 from other causes. As a relative reduction in mortality from heart disease in doctors (as compared with that in social classes I and II) also occurred during 1931-51--that is, before they began to give up smoking--some of the saving in heart-disease deaths in 1951-71 was probably not related to changes in smoking habits. The relative worsening in mortality from stress-related diseases may have been due partly to a possible adverse effect of giving up smoking if smoking had acted to reduce stress. From these findings, the benefits of giving up smoking may not be so great as has commonly been assumed.


Dietary fibre and blood pressure.

Ninety-four volunteers participated in a three-day weighed dietary survey and had their blood pressures measured once. They were classified according to their fibre intake. Subjects with a high-fibre intake were found to have lower mean blood pressures than those with a low-fibre intake. Forty-two of the volunteers further participated in a group of experiments. Those eating a high-fibre diet decreased their dietary fibre, and those eating a low-fibre diet increased their dietary fibre. The first group (11 subjects) showed increased mean blood pressures after four weeks of eating the experimental diet. The last group (31 subjects) showed decreased mean blood pressures after four weeks of eating the experimental diet. The 11 subjects consuming the low-fibre experimental diet showed a decrease in mean blood pressure when some of the saturated fat in their diet was replaced by polyunsaturated fat. A similar substitution carried out by 14 of the subjects consuming the high-fibre experimental diet also resulted in decreased mean blood pressure, but this was not statistically significant. Twelve more volunteers, with hypertension, were all found to have low-fibre diets. They consumed a high-fibre diet for a six-week experimental period, but their mean blood pressures did not decrease significantly; individual recordings varied substantially during this period.It is suggested that differences in the type and quantity of dietary fibre and fat may be responsible for the lower mean blood pressures of groups of vegetarians compared with similar groups of non-vegetarians.


Pruritus ani: is anal sphincter dysfunction important in aetiology?

Forty-three patients whose principal symptom was pruritus ani were studied. Twenty-eight had anal disease, while in 15 no such disease could be shown. Maximum resting pressures and transient and sustained pressures of the anal canal in response to rectal distension were measured by manometry. Although the maximum resting pressure in the patients with no disease was about the same as that in the group with disease, the pressures recorded in response to rectal distension were significantly lower. These results show that the anal sphincter relaxes in response to rectal distension more readily in patients with no anal disease. Hence soiling may occur, which may be a factor in the genesis of pruritus ani.


Iron-deficiency anaemia and its effect on worker productivity and activity patterns.

The effects of iron-deficiency anaemia on workers productivity were studied in a tea plantation in Sri Lanka. The quantity of tea picked per day was studied before and after iron supplementation or placebo treatment. After one month's treatment significantly more tea was picked when the haemoglobin (Hb) concentration was increased by iron supplementation than when it was not. The degree of improvement was greater in more-anaemic subjects (those with concentrations of 6.0-9.0 g Hb/dl). The level of physical activity of anaemic subjects in their everyday environment was also recorded for four or 24 hours continuously both before and after treatment. After three weeks these levels was significantly greater in the iron-treated than matched placebo-treated subjects. The economic implications of increased work productively with iron treatment are evident, particularly in developing countries. These results also provide strong evidence for the clinical impression that people with iron-deficiency anaemia suffer from tiredness and weakness.


Thrombocytosis, circulating platelet aggregates, and neurological dysfunction.

In 12 patients whose neurological dysfunction was associated with thrombocytosis or evidence of abnormal platelet activation, or both, correction of the platelet disorder corresponded with reversal of the neurological symptoms. This suggests that platelet abnormalities may, in certain cases, produce several syndromes of neurological dysfunction, presumably as a result of obstruction of the cerebral microcirculation.


The transformation of arsenicals by Candida humicola.

An analytical procedure for the separation, detection, and identification of some of the compounds produced by a cell preparation of the fungus Candida humicola from 74As-arsenate, [14C]-methylarsonate, and [14C]-dimethylarsinate has been devised and tested. It has been possible to detect five distinct 74As-containing compounds following the incubation of 74As-arsenate with a broken cell homogenate, three of which have been identified as arsenite, methylarsonate, and dimethylarsinate. With [14C]methylarsonate as substrate, [14C]dimethylarsinate and [14C]trimethylarsine oxide are produced. Products from [14C]dimethylarsinate include [14C]methylarsonate and [14C]trimethylarsine oxide as well as an unknown species. The absence of any transformation when buffer replaces the cell preparation implicates these various compounds as intermediates in a biological synthesis of trimethylarsine.


Measurement of antibodies to rabies virus by immunoelectron microscopy.

Immunoelectron microscopy (IEM) was used to measure rabies antibodies in 47 serum samples from vaccinees with results similar to those obtained by mouse neutralization test (MNT). The use of inactivated rabies virus for IEM eliminated the hazard associated with live virus used in the MNT.


The effects of a pesticide program on microbial populations from apple leaf litter.

The leaf litter microbial community was quantitatively and qualitatively changed when a standard pesticide schedule that comprised an insecticide, a bactericide, and a fungicide was applied to McIntosh apple trees in the summer. Effects were observed for two winters by four indirect assays and three direct methods. Populations were altered qualitatively both years, but the most striking difference was the quantitative impact from year to year. Bacteria, filamentous fungi, and yeasts from treated leaves were reduced 10- to 10 000-fold between November 1976 and April 1977 and did not recover until snow cover had melted in March. Reductions in 1977-1978 were negligible. The marked seasonal difference is attributed to meteorological influences. Fluorescent pseudomonads were among the bacteria depressed by chemicals. Of the 49 genera of fungi and yeasts isolated, Coniothyrium sp., Penicillium spp., Arthrobotrys spp., and Nodulisporium sp. were appreciably reduced, whereas Typhula spp., Pleurophomella sp., Sporobolomyces spp., and Rhodotorula spp. were substantially enhanced by the spray program.


Scanning electron microscopy of Acholeplasma colonies on agar.

The colony formation and morphology of Acholeplasma laidlawii and of an Acholeplasma species was studied by scanning electron microscopy. In the colonies of both Acholeplasma spp. large irregularly shaped cells, spherical cells, chains of beads, and long filaments with small bulbous distensions were seen. The membrane of some of the large cells seemed to be perforated, giving the cell a pitted appearance.


Sulfur isotope fractionation by Salmonella heidelberg: inverse isotope effects during growth on high concentrations of Na2SO3.

During growth on minimal salts - glucose media supplemented with high concentrations of Na2SO3 (10-3 and 10-2 M), Salmonella heidelberg exhibited cytological and growth responses which indicated increased cellular toxicity with increasing sulfite concentrations. The large quantities of sulfide evolved during growth at both SO32- concentrations were accompanied by large normal and inverse isotope effects. Consistent with earlier findings, this organism was found capable of rapidly metabolizing both the sulfane and sulfonate sulfur of thiosulfate. Therefore, the isotope effects do not appear to be caused by extracellular chemical thiosulfate formation.


Uptake of [14C]methylammonium by plankton communities: a comparative assay for ammonium transport systems in natural waters.

A diverse range of freshwater plankton communities were tested for their ability to take up [14C]methylammonium. Uptake occurred at low substrate levels by high-affinity, energy-requiring, transport systems which were competitively inhibited by ammonium but not by L-amino acids or nicotinamide. A simple competitive inhibition model was used to examine the effects of increasing ammonium levels on uptake in a eutrophic lake. Apparent K1 values for the labelled substrate markedly increased with increasing ammonium. The transport systems had an approximately five-fold greater affinity for ammonium than for methylammonium. The Vmax for methylammonium uptake was relatively insensitive to large changes in ambient ammonium levels. This kinetic parameter may be a useful comparative measure of ammonium transport capacity in natural waters, particularly where low ambient ammonium concentrations preclude the use of 15N.


[Origin and formation of different types of vacuoles induced by the multiplication of the alphavirus Sindbis virus in various cell systems].

Spherule-containing vacuoles and nucleocapsid-bearing vacuoles (cytopathic vacuoles types 1 and 2 respectively of Grimley et al. 1968) induced by Alphavirus Sindbis were studied in brains from newborn mice, chicken embryo fibroblasts, and two lines of tumoral glial cells from muridae. Endoplasmic reticulum (ER) elements and finely granular electron-dense material also seen in contact with nucleocapsids seemed to be involved in the formation of the classical single-membrane spherule-containing vacuoles. A second type of spherule-containing vacuoles were characterized by their double membrane and an amorphous electron-dense content and were probably derived from mitochondria. Nucleocapsid-bearing vacuoles were formed from modified ER elements and seemed to be linked to excessive synthesis of viral material. Such ER alterations were not observed in RG6 cells. In these cells, there were only spherule-containing vacuoles, while nucleocapsids were seen associated with the cytoplasmic membrane only.


Interspecific relationships of antibiotic resistance in Staphylococcus sp.: isolation and comparison of plasmids determining tetracycline resistance in S. aureus and S. epidermidis.

Tetracycline resistance in Staphylococcus aureus and S. epidermidis was confirmed to be determined by plasmids of the same size. Digestion of plasmids from each strain with restriction endonucleases EcoR1, HindIII, and AluI showed a high degree of similarity in their DNA sequences. At least 10 cleavage sites which appear to be common to both plasmids were detected. An additional three cleavage sites appear to be unique to the S. epidermidis plasmid. Further, a survey of recent clinical isolates of tetracycline-resistant staphylococci detected 7 or 10 S. aureus strains and 8 of 9 S. epidermidis strains with plasmids which were of similar size to the purified reference plasmids and which, by hybridization, showed extensive DNA homology to the S. aureus reference plasmid DNA.


Cold snaps, snowfall and sudden death from ischemic heart disease.

The short-term effect of low temperature on the incidence of ischemic heart disease over a 15-year period was examined. To reduce confounding by other seasonal factors the analysis was restricted to the winter months and was based on the change in the daily rate of sudden death at the time of cold snaps (arbitrarily defined as days on which the mean temperature was at least 4.4 degrees C lower than the day before) and around the time of heavy snowfalls. A statistically significant increase in the daily rate of sudden death at the time of cold snaps occurred only in men under 65 years of age, and even in this group the effect was of relatively small magnitude (+16%) compared with the large change in rate following heavy snowfalls (+88%). Among persons aged 65 years or over cold snaps had virtually no effect, and only the men in this group showed an increased daily rate of sudden death following a snowfall. These results suggest that much of the increased frequency of death from ischemic heart disease in winter, particularly among the elderly, must be due to factors other than short-term cold stress.


A study of drug residues in milk following intrauterine infusion of antibacterial drugs in lactating cows.

Intrauterine infusion of nine antibacterial compounds caused detectable drug residues in 17 out of 165 cows or in 25 out of 1110 posttreatment milkings. Four cows treated with pyrolidinomethyl tetracycline suspension had drug residues at the first milking. One cow had residues after oxytetracycline treatment, two after procaine penicillin G, three after acriflavin and after chloramphenicol-dapsone and four after hibitane. Nitrofurazone, nitrofurathiazide and Hibitane Compound(R) did not cause detectable inhibitory residues in any milk sample.


A livestock disease survey from auction mart inspection in Saskatchewan.

The data on health problems from visual livestock inspection at an auction mart in Saskatchewan during a two year period were tabulated for swine, cattle and calves. The major conditions seen in swine were underweight animals, infectious diseases or congenital abnormalities. Infectious diseases such as Hypoderma spp. infestations, ringworm or eye infections were the primary troubles in older cattle. Young calves demonstrated a predominance of congenital (herniation) and infectious (enteritis or navel infection) diseases.


Blood flow in pulmonary veins: I. Studies in dog and man.

The pattern of blood flow in the large extra parenchymal pulmonary veins is pulsatile in both dog and man. This pulsatility is dominated by the changes in left atrial pressure taking place throughout the cardiac cycle. No pulsatile component of low in the large pulmonary veins could be attributed to forward transmission of a flow pulse conducted from the lung capillaries. The findings suggest that there must be a region of considerable compliance in the pulmonary venous system which can absorb pulsations from the lung capillaries and eliminate their transmission to the left atrium.


Blood flow in pulmonary veins: II. The influence of events transmitted from the right and left sides of the heart.

The wave form of blood flow in the large extra parenchymal pulmonary veins has an inverse relationship to the pressure wave form in the left atrium during each cardiac cycle. However, when vein flow from the lungs is separated from the left atrium by diverting it into a constant pressure reservoir, its wave form then resembles a lung capillary flow pulse, though delayed from it in time and reduced in ampliture. The pulsatility of flow in pulmonary veins separated from the left atrium is further reduced when transcapillary pressure is elevated by lung inflation. However, in the intact state, the relation between the pattern of pulmonary vein flow and left atrial pressure remains unaffected by lung inflation. It is postulated that the thin walled extraperenchymal pulmonary veins together behave as a collapsible reservoir which enables outflow from them to be determined by changes in left atrial pressure, in spite of variations of pulsatile flow into them from the lungs.


Blood flow in pulmonary veins: III. Simultaneous measurements of their dimensions, intravascular pressure and flow.

Vein flow in the large extraparenchymal pulmonary veins is pulsatile and its wave form has an inverse relationship to left atrial pressure. Extraparenchymal pulmonary veins are thin walled and collapsible. This enables them to behave as highly compliant structures. Dimensional measurements of their cross sectional area in living open chested dogs showed them to be non circular at low left atrial pressures. They rapidly assumed a circular cross section as left atrial pressure rose. Only at pressures above 1.5 kPa (11 mmHg) were the pulmonary veins circular in cross section. The aggregate volume of the large extraparenchymal pulmonary veins, when fully distended, was found to be equal to or greater than one stroke volume of the heart. The extraparenchymal pulmonary veins act as a reservoir to the left atrium so that left ventricular stroke volume can be maintained relatively unaffected by beat by beat changes in right ventricular stroke output. Their behaviour at normal mean left atrial pressures also enables them to isolate the lung capillaries from retrograde transmission of positive pressure transients from the left atrium, which could otherwise impede venous outflow of blood from the lung capillary bed.


Sequence of shortening of the normal human left ventricle.

Left ventricular sequence of shortening was studied through the analysis of cineventriculograms in 30 degree right anterior oblique projection of 11 normal patients.  In all patients transverse shortening progressed in base to apex direction, in a concentric fashion.  Base descent started simultaneously with the first transverse inward motion and continued throughout systole. There was a slight protrusion of the apex in the beginning of systole, lasting a mean of 115 ms.


Antiarrhythmic effects of solvents: II. Effects of propylene glycol and benzyl alcohol on the effective refractory period of isolated rabbit atria.

The effect of propylene glycol, benzyl alcohol, quinidine, and procainamide on the effective refractory period of isolated rabbit atria were compared.  The lengthening of effective refractory period reached its maximum at approximately 10 min for solvents and 40 to 50 min for quinidine and procainamide. The slopes of the effective refractory period curves were similar for propylene glycol and benzyl alcohol.  The slopes of the effective refractory period curves for quinidine and procainamide were similar, but they differed from those obtained with propylene glycol and benzyl alcohol.  These differences suggest that propylene glycol and benzyl alcohol lengthen the effective refractory period by different mechanism than that of quinidine and procainamide.  The effective dose 50% required for lengthening the effective refractory period is 20-fold greater for quinidine than for procainamide with similar relative responsiveness.  On the other hand, the solvents showed low affinity and low relative responsiveness, although the combination of propylene glycol and benzyl alcohol showed similar relative responsiveness to procainamide.  Despite the fact that these solvents have a lower antiarrhythmic potency, their therapeutic index is 5- to 50-fold greater than quinidine and/or procainamide.


The mast cells of the mammalian central nervous system. IV. Culture of neurolipomastocytoid cells from rabbit and rat leptomeninges.

Leptomeningeal cells of 1-3 day-old rabbits and rats were cultured in Hamm's complete medium or in Eagle's Basal Medium (BME); the latter proved to be favorable for the present research. Three types of granular cell could be differentiated and isolated from other mesenchymal, neuronal and neuroglial elements. These three closely resembled (i) mast cells (MCs), (ii) neurolipomastocytoid cells (NLMs), and (iii) typical macrophages. Because MCs are absent from adult rabbit leptomeninges but present in the rat, it was concluded that the MC-like elements in rabbit cultures were derived from precursor cells normally capable of producing NLMs. The macrophages appeared typical, but their cell of origin, as that of the MCs and NLMs, could not be determined conclusively; a small round mononuclear cell might have given rise to all three cell types. NLMS, like MCs but unlike macrophages, are sensitive to the MC-discharger compound 48/80. This finding, plus the peculiar morphological features of the NLMs, in addition to evidence of a strong phagocytic activity by the macrophages, distinguishes the mature NLMs from mature macrophages as distinct cellular entities. It is closely concluded that NLMs in culture resemble ordinary MCs more closely.


The fine structural localization of acid phosphatase in pore cells of embryonic and newly hatched Deroceras reticulatum (Pulmonata: Stylommatophora).

The fine structure of the pore cells in pre- and post-hatched Deroceras reticulatum is described. The cells have been divided into three main types on morphological grounds, one type being particulary rich in glycogen. Certain pore cells contain haemocyanin granules in grooves below cytoplasmic tongues, and in characteristic double-membrane-bounded vesicles within dilated cisternae of rough endoplasmic reticulum, as well as in other identified areas. All types of pore cells show fine fibres reminiscent of collagen associated with the basal lamina and pore complexes. In addition to acid phosphatase activity in lysosomes and Golgi elements, intra- and extracisternal activity has been demonstrated in association with the rough endoplasmic reticulum. The intracisternal activity is in close proximity to the Golgi apparatus and may represent enzyme that is about to enter the GERL system. Extracisternal activity may be associated with cellular lysis and death, or may represent local areas of degradation leading to cytodifferentiation. Remnants of lysed pore cells appear to be taken up by connective tissue amoebocytes.


Conjugated effects of thyroxine and X-rays on the intestinal wall of Alytes obstetricans larvae (Anuran Amphibian).

The conjoined effects of thyroxine and X-rays on the intestinal wall were studied using Alytes obstetricans tadpoles in premetamorphosis. Thyroxine alone induces degeneration of the larval epithelium (primary epithelium) and its replacement by a secondary epithelium. The latter is derived from stem cells via the development of islets. In animals submitted to irradiation only, many of these stem cells showed signs of necrosis. In irradiated larvae treated with thyroxine, the secondary epitheliocytes were rare and never formed islets. Radioautographic observations confirmed their very low proliferation rate. Contrary to what was observed in the hormone treated larvae, cell fragments of the primary epithelium were extruded in the connective tissue, and phagocytes appear to infiltrate the epithelium. In animals treated with thyroxine and later submitted to irradiation, islets of secondary epitheliocytes developed while some cells degenerated. There again, the phagocytes were noted in both the connective tissue and the epithelium.


Effect of gossypol on the ultrastructure of rat spermatozoa.

Gossypol was found to induce sterility in male rats when administered orally. A reduction in the number of spermatozoa in the epididymis from the gossypol-treated rats was observed when compared to the control animals. An examination of the spermatozoa from the treated rats showed the following ultrastructural modifications: disorganization of the mitochondiral sheath and missing cell membrane from the middle piece, broken cell membrane and missing members of both outer fibers and inner microtubules of the principal piece, and broken cell membrane of the sperm head. Serial mating experiments proved that gossypol-treated males were indeed sterile. The results suggest that gossypol at low concentrations is able to affect the motility of spermatozoa, thus contributing to its contraceptive action.


Quantative radioautographic light and electron microscopic analysis of the localization of monoamines in the median eminence of the rat.

Serotonin containing structures in the median eminence of the rat have been studied by quantitative light and electron microscopic radioautography following intraventricular infusion of tritiated 5-hydroxytryptophan. One hour after injection of the tracer the highest density of silver grains was recorded in the ependymal and external zones, especially in the lateral palisade zone. The proportion of labelled neurosecretory terminals was also larger in the lateral palisade zone (29%) as compared with the medial palisade zone (13%), although the mean number of developed silver grains per one terminal was higher in the latter. On the average, 16% of neurosecretory terminals sequestered radiolabelled 5-hydroxytryptophan in the external zone of the rat median eminence. It is suggested that serotonin, like catecholamines, is discharged from neurosecretory terminals localized in the external zone and via the portal circulation affects the function of the anterior pituitary. The sites of origin of serotoninergic structures of the median eminence as well as the possible role of monoamine (catecholamine and indolamine) neurohormones in a dual peptidergic and monoaminergic control of anterior pituitary functions are discussed.


The hypothalamo-hypophysial system of the lamprey, Lampetra fluviatilis L. II. The proximal neurosecretory contact region.

The proximal neurosecretory contact region (PNCR) of the lamprey, a homologue of the median eminence of tetrapods, was studied by light, fluorescence and electron microscopy. Paraldehyde fuchsin-positive neurosecretory fibers are seen mainly in the central part of the rostral subdivision of the PNCR. The Falck-Hillarp technique reveals a weak, mainly diffuse yellow-green fluorescence in the PNCR. The ultrastructure of the tanycyte layer of the PNCR is very similar to that in the neurohypophysis of the same species, although the funnel-shaped protrusions of the third ventricle in the rostral part of the PNCR are more frequent than in the neurophypophysis. Peptidergic A1 and A2 neurosecretory fibers are characterized by neurosecretory granules of 120-200 nm and 100-150 nm in diameter, respectively. Monoaminergic B type fibers contain granules 80-100 nm in diameter. Neurosecretory terminals and the vascular endfeet of tanycytes make contact with the basement membrane of the avascular connective tissue layer separating the PNCR from the hypophysial pars distalis. It is suggested that both peptide and monoamine neurohormones diffuse through the thick connective tissue septa into the underlying blood vessels which supply the pars distalis and thus affect the function of its glandular cells.


Effects of dimethylmaleic anhydride and a polyaldehyde fixative on the fertilization of the sea urchin egg, Paracentrotus lividus.

Two agents, dimethylmaleic anhydride and a polyaldehyde, capable of reacting with amino groups at the surface of the eggs of sea urchin do not prevent fertilization.


Redundant nutritive tubes in insect ovarioles: the fate of an extensive microtubule transport system.

The developing oocytes in the ovarioles of hemipteran insects receive materials from nutritive cells by way of channels known as nutritive tubes. The tubes contain an extensive system of microtubules which are thought to be involved in the transport between the two cell types. At the onset of vitellogenesis the connection is discontinued. Redundant nutritive tubes have been identified, compared with functional tubes, and their fate discussed.


The influence of cold insoluble globulin on platelet morphological response to substrata.

Light microscopic studies have been carried out on the attachment and morphological responses of washed human platelets in serum-free medium to fibrinogen-coated, collagen-coated and uncoated tissue culture plastic substrata. Platelets were observed to attach to the substratum, extend filipodia and undergo spreading. Subsequently, lysis of platelets occurred. On uncoated tissue culture plastic substrata, the addition of cold insoluble globulin to the incubations had no effect on the above morphological changes. On the other hand, on the protein coated substrata, there was very little platelet spreading or lysis without the addition of cold insoluble globulin.


Keratinocyte substrate adhesion is magnesium-dependent and calcium-independent.

Primary cell cultures were prepared from guinea pig epidermis and six days old mice kidneys and hearts. Along with subcultures of Hep cells, plating experiments were performed using media devoid of bivalent cations containing dialzyed fetal calf serum. Upon stepwise supplementation with either calcium ++ or magnesium ++, keratinocytes displayed a unique dependency on magnesium ++ for cell attachment, whereas all other cell types could make use of either of these ions. Melanocytes, being a minority component of the epidermal cell population, do not conform to the predilection of keratinocytes for magnesium ++. Epidermal cell cultures prepared in media containing only calcium ++, therefore, result in pure melanocyte cultures.


Changes in the sub-types of soluble alanine aminotransferase in the liver of rats during development and aging.

DEAE-cellulose column chromatography and polyacrylamide gel electrophoresis of crystalline soluble alanine aminotransferase of the liver shows only a single molecular species in both immature and senescent rats. In the case of adult rat, there are two species; one corresponding to that of the immature and the other to that of the old. The former sub-type of the isozyme is designated as sAAT-A and the latter as sAAT-B. sAAT-A is predominantly present in the immature rat and sAAT-B in the old. There is thus a gradual and sequential change in the two sub-types of sAAT as a function of age of the rat.


Further studies on the inhibition of sterol biosynthesis in animal cells by 15-oxygenated sterols.

The chemical syntheses of a number of C27 15-oxygenated sterols and their derivatives have been pursued to permit evaluation of their activity in the inhibition of sterol biosynthesis in animal cells in culture. Described herein are chemical syntheses of 3 alpha-benzoyloxy-5 alpha-cholest-8(14)-en-15-one, 5 alpha-cholest-8(14)-en-3 alpha-ol-15-one, 5 alpha-cholest-8(14)-en-15-one-3 beta-yl pyridinium sulfate, 5 alpha-cholest-8(14)-en-15-one-3 beta-yl potassium sulfate (monohydrate), 5 alpha-cholest-8(14)-en-15-one-3 alpha-yl pyridinium sulfate, 5 alpha-cholest-8(14)-en-3 alpha-yl potassium sulfate (monohydrate), 5 alpha-cholest-8(14)-en3,7,15-trione, 5 alpha-cholest-8(14)-en-15 alpha-ol-3-one, 5 alpha, 14 alpha-cholestan-3 beta, 15 beta-diol diacetate, 5 alpha, 14 beta-cholestan-3 beta, 15 beta-diol diacetate, 5 alpha, 14 alpha-cholestan-3 beta, 15 alpha-diol, 5 alpha, 14 alpha-cholestan-15 alpha-ol-3-one, 5 alpha, 14 beta-cholestan-3 beta, 15 beta-diol, 5 alpha, 14 alpha-cholestan-3,15-dione, and 5 alpha, 14 beta-cholestan-3,5-dione. The effects of 8 of the above compounds and of 5 alpha-cholesta-6,8(14)-dien-3 beta-ol-15-one, 3 beta-he misuccinoyloxy-5 alpha-cholest-8(14)-en-15 one, 3 beta-hexadecanoyloxy-5 alpha-cholest-8(14)-en-15-one, 5 alpha-cholest-8(14)-en-3,15-dione, 5 alpha-cholesta-6,8(14)-dien-3,15-dione, 5 alpha-cholest-8-en-3 beta, 15 alpha-diol, 5 alpha-cholest-7-en-3 beta, 15 alpha-diol, 5 alpha-cholest-8(14)-en-15 alpha-ol-3-one, 5 alpha-cholest-8-en-15 alpha-ol-3-one, and 5 alpha-cholest-7-en-15 alpha-ol-3-one on the synthesis of digitonin-precipitable sterols and on levels of HMG-CoA reductase activity have been investigated and compared with previously published data on 7 other C27 15-oxygenated sterols.


A fluorescence study with polarised incident light of the compression of phospholipid monolayers spread at the air/water interface: orientation processes in the glycerol region.

Monolayers of phospholipids spread at the air/water interface were studied by means of fluorescence measurements. Using linearly polarised incident light and following the behaviour of a fluorescent covalently-labelled phospholipid (dansylphosphatidylethanolamine) embedded in the monolayer, it was possible to obtain information about the orientation changes at the glycerol level of the phospholipid. When using dipalmitoylphosphatidylcholine as phospholipid, the main orientation of the probe appears unchanged during the phase transition process. On the other hand, the standard deviation of the distribution function of orientation is larger in the liquid-expanded state relative to the condensed state. When using phosphatidic acid or a mixture of dipalmitoylphosphatidylcholine and phosphatidic acid as phospholipids, the same orientation of the probe is observed as with pure dipalmitoylphosphatidylcholine. This orientation stays the same whatever the ionic content of the subphase, i.e. the ionisation state of the polar head. The glycerol region of a phospholipid spread in monolayer at the air/water interface appears unaffected structurally either by the nature of the polar moiety, by its ionisation state, or by the physical state of the hydrocarbon chains.


[The biological results of duodenocephalopancreatectomy. Clinical evaluations based on a long-term follow-up].

The authors discuss the main features of the complex pathophysiology of patients subjected to duodenocephalopancreatectomy, and particularly the difficulties inherent in clinical assessment of the digestive and metabolic impairment consequent upon the duodeno-gastro-pancreatic mutilation. Out of a total of 57 cases of this description, they singled out for recheck 23 patients who had undergone duodenocephalopancreatectomy not less than six months and not more than seven years before (chronic pancreatitis, 11 cases; various malignancies of the periampullar area, 10 cases; Zollinger-Ellison syndrome, 1 case; retroperitoneal lymphoma, 1 case). Seventy-six per cent of patients who had been gainfully employed were able to resume their jobs after surgery. Steatorrhea, assessed in terms of fecal fats, was present in all cases; notwithstanding, 70% of the patients gained weight (average increase 7 kg). All patients were on enzyme replacement therapy. Only 4% developed diabetes, and none developed postoperative peptic ulcers. Conversely there was a high incidence (65%) of bone structure reshuffling, signally osteoporosis, probably imputable to steatorrhea and vitamin D malabsorption, plus the often associated increase of serum alkaline phosphatase activity.


[Preliminary study of ultrastructural changes of the gastric mucosa due to cholecysto-gastrostomy. Experimental research].

After reviewing the literature on anatomo-histological lesions of the gastric mucosa in so-called "biliary reflux gastritis", the Authors undertook an experimental study of ultrastructural alterations of the gastric mucosa after cholecysto-gastrostomy operation conducted in the dog. In this preliminary note they report the alterations observed 60 days after the operation and consider it necessary to continue observations for a longer space of time after the operation.


[Closed needle-biopsy in the diagnosis of neoplasms].

The AA. demonstrate with this communication the validity of the needle biopsie for the diagnosis of neoplasms. They had used it for the breast, thyroid, flg and some other superficial tumefactions. In the mass-screening for the feminine neoplasms the clinical examination and the needle biopsy are very good method for a careful diagnosis.


[Barium peritonitis: report of four cases (author's transl)].

Prompted by several cases of barium peritonitis of their own observation, the authors review the literature on the subject and outline the more common etiopathogenetic factors involved and gross and histological aspects of the disorders. After describing their own four cases of barium peritonitis, the authors outline some basic principles for the prevention and treatment of this rare complication.


[Agenesis of the gallbladder and cystic duct (author's transl)].

The authors describe a case of agenesis of the gallbladder and cystic duct diagnosed at operative cholangiography; they discuss the embryological, etiopathogenetic and clinical aspects of this abnormality, and pertinent treatment policies. They stress the need for operative teleradiocholangiomanometry for the correct diagnosis and treatment of the disorder.


[Use of a 1:1 association of ampicillin and flucloxacillin in surgical patients (author's transl)].

This clinical trial was designed to assess the validity of an association of equal parts of ampicillin and flucloxacillin in surgical patients; the product was administered by injection in daily doses of 2-3 grams. In a group of 20 patients the same product was used prophylactically against infection, with positive results in 85% of the cases; the mean duration of treatment was 5 days. In 13 patients affected by urinary and biliary infections the product was effective. After a 7 days-therapy, 11 cases showed a marked improvement of the clinical symptomatology. Allergic cutaneous reactions (rashes, itching) appeared in five cases. No other side-effects had been noticed.


[The Harrington operation (long-term review of 100 cases)].

The authors review the results of 100 cases of idiopathic scoliosis treated surgically by the Harrington procedure. The mean remove was 31 months. After a brief introductory section dealing with preparation methods, the paper illustrates the technicalities of the procedure, the usefulness of correction in two stages with a fortnight interval, the various types of mounting and postoperative care. They assess the improvement obtained in terms of vertebral rotation (mean correction achieved: 4.6 degrees, representing 10%) and of lateral flexion (49% improvement over pretreatment values), and they discuss in particular the need for a correct choice of instrument placement and appropriate evaluation of arthrodesis extent in view of avoiding loss of correction. While they acknowledge the value of the Harrington procedure in regard to correction of lateral flexion, the authors propose further refinement of the original method to include correction of vertebral rotation and so improve on current results.


[The H reflex during the Harrington operation (author's transl)].

The authors describe the technic of elicitation of the H reflex (electrical activity associated with contraction of the triceps muscle of the calf induced by electrical stimulation of the posterior tibial nerve) and the preliminary results of monitoring said reflex in the course of Harrington's operation.


[Posterolateral vertebral arthrodesis (author's transl)].

The authors review a number of more or less original technics of posterolateral vertebral arthrodesis, and report published results relative to intersomatic, posterior, and posterolateral arthrodesis. To this they add a presentation of their own cases treated by posterolateral arthrodesis, noting that this method is not unduly difficult to perform and gives good results in a high percentage of cases.


[Epidemiologic study of leprosy in metropolitan France].

322 new cases of leprosy in France are registered by a postal survey among 11 towns, from 1970 to 1978. 217 are detected in Paris, 105 in other parts of France. 137 are foreigners, 104 come from overseas French territories, 45 are reapatriated French nationals. 39.7% are lepromatous, 43.6% tuberculoid, 13.9% indeterminate. 35 cases are followed out of which 16 cases in Alsace were discovered in Strasbourg.


[Mediterranean boutonneuse fever (apropos of 40 recent cases in Marseilles].

The Marseilles area continues to be an endemic region of mediterranean tick bite fever. During the period 1975-1978 40 cases were observed in two medical departments in Marseilles. Maximum occurrence was in August. The real incidence of the disease was difficult to appreciate as declaration is not always made eventhough obligatory. Clinical manifestations remained typical.


[Isolation of Ilheus virus in french Guyana].

This is the first case in man of Ilheus virus infection in french Guyana. We noted the mild febrile illness in this case. This strain of virus was shown to be closely related to Ilheus virus. The serological reactions are reported.


[Retinopathy due to 4-aminoquinolines in the prevention of malaria].

The authors give a study about retinopathy by 4-amino-quinoleine in malaria prevention. Twelve observations are known in patients after 12 to 20 years of treatment. The authors suggest systematic research of this retinopathy.


[Serological studies of a pygmy population in Cameroon].

Serological studies made in a community of 106 pygmies led to 60% positive reactions with parasitic antigens, mainly of nematodes and trematodes. IgG and IgM levels are increased (about two times and four times the levels found in a normal population). These results prove the importance of these infestations by human or animal parasites in a tropical forest population.


[3 new cases of Korle-Bu hemoglobin in the Antilles].

After the case of haemoglobin Korle-Bu found in Martinique by Bookchin (2) in 1970, we have also detected one case of haemoglobin S/Korle-Bu in 1975 from a man native of Martinique. A family study allowed us to find again this abnormal haemoglobin from his two children with the form A/Korle-Bu. We study the different possibilities to detect haemoglobin S/Korle-Bu by singlet ests of laboratory whose some ones do appear antagonist effect given by haemoglobin Korle-Bu for haemoglobin S.


Multiple steroid receptors in human breast cancer. III. Relationships between steroid receptors and the state of differentiation and the activity of carcinomas throughout the pathologic features.

Histopathologic features (tumor cell density, histological type, and histoprognostic grade) were analyzed in 314 breast cancers investigated for estrogen (E) and progestin (P) receptors (R). The presence of PR is associated with the presence of ER. A relationship was found between the acinoductal differentiation of the lesions and the presence of SR: the more differentiated the carcinoma, the higher the frequency of ER. HPG III carcinomas have the lowest frequency of positive ER and HPG I tumors the opposite: the likelihood of the presence of SRs is inversely correlated with HPG. No statistically significant relationship existed between tumor cell density (TCD) and the presence of ER or ER content. Similar findings were observed for the stromal reaction. The results are discussed with respect to the biological significance of SR and histopathologic features: SR presence could be correlated with (1) a differentiated state of the tumors and (2) a slow rate of cellular replication.


[Quality control in parasitology].

A quality control in parasitology has been organized since 1977, under the direction of the Exotic Pathology Society. In 1978, more than 1 200 voluntary laboratories were participating. In 1979, according to the law of the eleventh of July 1975, this control is going to be obligatory for the 3 750 public or private laboratories effecting parasitologic tests. That should improve the quality of these tests, outside any repressive aspect.


Contour mapping of the temporal-spatial progression of a contagious disease.

A methodology for contour-map study of contagious-disease epidemics is presented. Its application is exemplified in a smallpox epidemic occurring in a small Brazilian town. Computer-controlled contour-mapping of dates of introduction of variola minor into 169 households and the coordinates of the affected dwellings did not show a single contour pattern, but a group of subareal patterns of within-household outbreaks. Introduction by adults and pre-school children were distributed throughout the whole city area. However, introduction by school children formed two groups of contours and of affected dwellings. Each group was included in a discrete area corresponding to the zone of pupil recruitment of the two schools enrolling 91% of the school-child introductory-cases. The latter were responsible for introduction of the disease into 45% of the city's affected households. Altogether, both zones practically covered the whole city area. In either zone, several patterns surrounded the corresponding school. Even though no time value was entered for any school, contour maps clearly evidenced the influence of those two schools on spread of the epidemic. An estimated rate of linear spread of variola minor was 1.35 m per day in a city subarea.


Cytotoxicity of p-chloroamphetamine in dimethylhydrazine-induced carcinomata of rat colon.

Previous studies have shown that several serotonin-related compounds are cytotoxic to dimethylhydrazine-induced carcinomata of the colon of rat. This paper reports the cytotoxicity of another serotonin-related compound, p-chloroamphetamine.


Cardiomyopathy in leukemia, with reference to rubidomycin cardiotoxicity.

Sixteen patients who had died with leukemia were studied at autopsy between September 1975 and Februrary 1977. Special attention was given to degenerative changes in the heart. Five of the patients died of cardiac failure, all with no or only slight leukemic infiltration in various organs at autopsy. Five patients showed basophilic necroses in the myocardium, and two of these also showed necroses in the bone marrow. The myocardial lipofuscin was significantly (P less than 0.01) higher in the autopsies of leukemic patients (mean age 45 years) than in autopsies performed at the Department of Forensic Medicine in 18 cases of accidental death (mean age 36 years). No dose-response relationship could be found between the amount of myocardial lipofuscin and the total dose of rubidomycin. Eight of twelve patients with malignant lymphoma (mean age 45 years) also had increased amount of myocardial lipofuscin.


Mathematical modeling -- guide to high-dose methotrexate infusion therapy.

A mathematical model that describes methotrexate pharmacokinetics has been refined for use as a guide to dose escalation during high-dose methotrexate infusion therapy. Parameters for the model are adjusted for a patients by the SAAM computer program of Berman and Weiss, on the basis of plasma concentrations obtained during the initial course of therapy. Various dose escalations can be simulated by the computer and a print-out of predicted plasma concentrations obtains. The model has been used successfully to predict plasma concentrations after high-dose infusions in patients, including those with abnormal creatinine clearances. The program is designed to allow comparisons among infusions of any duration. This can be helpful when a change from a 24-hour infusion to a 6-hour infusion is contemplated for a patient. Deviations of observed values from those predicted are used to warn of the possibility of delayed toxicity secondary to methotrexate and alert the physician that increased amounts of rescue agent may be required.


Phase-II trial of tamoxifen in advanced breat cancer.

Seventy-eight advanced breast cancer patients, most of whom had had prior treatment, were treated with the synthetic antiestogen tamoxifen. The overall objective response rate was 27% (21/78). An additional 19% (15/78) showed disease stabilization. Sixty-seven percent (14/21) of the responses were in soft tissue sites, 24% (5/21) on bony sites and one each occurred in liver and nodular lung disease. Forty percent of patients with soft-tissue disease alone responded, while less than 10% of patients with visceral disease showed responses in visceral sites. The response rate was 28% among patients with a known positive estrogen receptor (ER) assay. It was 21% among patients who had previously received cytotoxic drugs. Toxicity was mild and was seen in nausea and vomiting, hot flushes and vaginal bleeding, and occasional myelosuppression. One patient was withdrawn from the study because of a rash. In two patients the disease flared, once with concomitant hypercalcemia. Tamoxifen is a useful agent for advanced breast cancer even in some patients with visceral disease.


A new steroidal alkylating agent with improved activity in advanced murine leukemias.

The homo-aza-steroidal ester of [p-[bis(2-chloroethyl)amino]phenoxy] acetic acid, 3 beta-hydroxy 13 alpha - amino - 13,17 - seco - 5 alpha-androstan-17-oic-13,17-lactam-p-bis(2-chloroethyl)aminophenoxyacetate, gave a 100% increase in lifespan over controls in the treatment of L1210 leukemia by IP administration on a days 1 and 4 treatment schedule. This ester gave a maximum activity of 383% increased lifespan over controls in the treatment of P388 leukemia by IP administration on a daily treatment schedule. Activity in advanced L1210 (41% increased lifespan) and P388 leukemias (173% increased lifespan) was maintained, indicating that this compound is the most promising of a number of congeners tested to date.


Elevation of serum lipid peroxide level associated with doxorubicin toxicity and its amelioration by [dl]-alpha-tocopheryl acetate or coenzyme Q10 in mouse (doxorubicin, toxicity, lipid peroxide, tocopherol, coenzyme Q10).

Elevations of serum lipid peroxide levels were demonstrated in mice after an equitoxic dose of doxorubicin. When BDF1 mice were injected with doxorubicin (20 mg/kg body weight, IP), lipid peroxide levels in sera were elevated 1 day after the injection and the levels declined on subsequent days. 5-Fluorouracil (400 mg/kg body weight, IP) never changed the peroxide levels in serum. Furthermore, it was found that the co-administration of [dl]-alpha-tocopheryl acetate or coenzyme Q10 IM strongly inhibited the doxorubicin-induced elevation of lipid peroxides in serum. The effectiveness of [dl]-alpha-tocopheryl acetate or coenzyme Q10 in reducing the lethality of doxorubicin in mice was also confirmed. These results indicate that the measurement of serum 2-thiobarbituric acid-reacting substances provided a useful measurement of lipid peroxide levels, which may be involved in some way with doxorubicin toxicity, and that the administration of antioxidants provide protection against some of the side effects of doxorubicin.


Enhancement of methotrexate absorption by subdivision of dose.

A comparison was made in fasting patients between a single 100 mg oral dose of methotrexate formulated as its sodium salt in a palatable syrup and the same total quantity of drug administered in four divided doses of 25 mg taken at 2-h intervals. Allocation to the order of these treatment schedules was on a random basis. The area under the serum methotrexate concentration-time curve until 50 h was found to be considerably greater after the divided dose regimen, the mean ratio AUC 25 mg x 4/AUC 100 mg being 1.86 (+/- 0.90). There was no significant difference in peak serum methotrexate concentrations or methotrexate half-life estimates between the two regimens, however. The results of this study are consistent with saturation of an intestinal transport process when methotrexate is administered orally in a single large dose.


Bioavailability of methotrexate: implications for clinical use.

The absorption of oral methotrexate in syrup form has been compared in six patients with that of an identical IV dose (50 mg/m2). There was variable absorption amongst the group with respect to maximum levels achieved and the time taken to reach those levels. The area under the time-concentration curve was always smaller when the drug was given orally than after IV administration. A total of 33 patients receiving methotrexate for a variety of tumour types were followed for response to treatment and toxicity. A significantly longer methotrexate half-life (t1/2) was found in nine partial responders (9.2 +/- 1.6 h) than in the nonresponders (3.8 +/- 0.7 h). Severe methotrexate toxicity was not seen though occasional mucositis, conjunctivitis, and diarrhoea occurred in seven patients. The side effects could not be predicted from the dose, the bioavailability data, or the serum creatinine. Measurements of serum and urine methotrexate levels are useful in the assessment of absorption and bioavailability of the drug the prediction of tumour response.


Human pharmacokinetics of the daunorubicin-DNA complex. An alternative view of the lysosomotropic theory.

Plasma kinetics and urinary execretion of daunorubicin (DNR) and its active metabolite, daunorubicinol (DNR-ol) were studied in 15 leukemic patients after a 4-h infusion of 75 mg DNR/m2 either as the free drug or as a complex with DNA. The data obtained after infusion of the DNR-DNA complex were compared with the data obtained after infusion of the free drug. The DNR plasma levels were found to be higher during the 2 h following the infusion of the complex; the levels of DNR-ol were only higher for a few minutes after infusion. Kinetic analysis showed that complexing with DNA does not fundamentally modify the three-compartment model described for DNR. Only quantitative modifications were observed: a marked lengthening of the alpha-phase and a shortening of the gamma-phase. Urinary excretion of DNR and DNR-ol was increased after infusion of the complexed drug, in relation to the persistence of higher plasma levels. The data recorded in this work do not confirm the lysosomotropic mechanism postulated for the DNR-DNA complex, but show a delayed distribution of DNR, which is progressively released by dissociation of the circulating DNR-DNA complex, as previously demonstrated in rabbits infused under same conditions.


Evaluation of early doxorubicin-induced cardiotoxicity by means of systolic time intervals.

Systolic time intervals (PEP/LVET ratio) were used for detection of acute variations in myocardial contractility after a single dose of 30, 60, or 75 mg of doxorubicin/m2. This drug induces an acute impairment of left ventricular function (increase in the PEP/LVET ratio) detectable 1 h after doxorubicin injection. The phenomenon appears to be dose-related, with a threshold dose of 30-40 mg/m2. The decrease in myocardial contractility is fully reversible within 24 h, at least after the first dose. This kind of evaluation appears applicable to phase I studies of new anthracycline derivatives.


The disposition of cyclophosphamide in a group of myeloma patients.

The disposition of cyclophosphamide and its alkylating metabolites was investigated in a group of myeloma patients with varying degrees of renal function impairment. No correlation between renal function and clearance of cyclophosphamide or its alkylating metabolites was found. No evidence of accumulation of cyclophosphamide or alkylating activity was found in four patients receiving radiolabelled cyclophosphamide. Renal function was found to be related to the reciprocal of the area under curve of alkylating activity, indicating that this area increased as renal function decreased. In view of the large nonrenal component of alkylating activity elimination and the large inter-subject variability, it is recommended that dose of cyclophosphamide is not altered in moderate impairment of renal function.


Comparative study of anti-endotoxic potency of dexamethasone based on its different ester types.

Difference in the anti-endotoxic potency in mice between dexamethasone 21-disodium phosphate (DM-P) and 21-sodium sulfate (DM-S) was investigated. Changes in the plasma levels of free 17-hydroxycorticoids (17-OHCS), further, were defined after intravenous administration of 2 mg/kg dexamethasone in elective surgical patients for elucidation of the metabolic basis of the different anti-endotoxic potencies of the two ester types of dexamethasone. Young male mice of DDN strain were pretreated with 0.2 mg DM-P or DM-S. Following the pretreatment, 0.5 mg of the endotoxin was administered at varying intervals of 0--24 hours, and survival rates were determined after 72 hours. In the DM-P group the mice exhibited a significant resistance to the endotoxin within two hours after the pretreatment, but in the DM-S group, the mice exhibited no anti-endotoxic potency. When different doses of dexamethasone (from 3.2 to 0.00625 mg) were administered with 0.5 mg of the endotoxin simultaneously, the mice in the DM-P group showed improvements in survival rates that tended to be dose related, but the mice in DM-S group showed no improvement in survival rates. Plasma levels of free 17-OHCS in elective surgical patients, further, were remarkably elevated after administration of DM-P, 2 mg/kg, but they showed no elevation after administration of DM-S, 2 mg/kg. Thus, it is clear that the in vivo metabolism of the two esters is different. DM-P easily liberates its free form, whereas DM-S does not. From this evidence, it was concluded that there is a close correlation between the anti-endotoxic potency of dexamethasone and its plasma level of free form, and that glucocorticoids can demonstrate their anti-endotoxic action when they are present at pharmacologically high levels in the bloodstream. There is considerable difference in biological action, moreover, between the two water-soluble esters of dexamethasone. More attention should be paid to this difference when investigating the treatment of shock with glucocorticoids.


Chronic ventricular sympathectomy: effect on myocardial perfusion after ligation of the circumflex coronary artery in dogs.

Using the tracer microsphere technique, the effect of circumflex artery ligation on regional myocardial perfusion was studied in 8 ventricles which had been sympathectomized 2 weeks earlier and in 9 nonsympathectomized controls. Preocclusion flow values in the chronically sympathectomized ventricles were approximately 75% of those in the controls even though heart rate and arterial pressure were maintained at the same levels in the 2 groups. After circumflex artery ligation, flow to the central ischemic region was slightly greater in the sympathectomized ventricle, but this difference was not statistically significant. However, in the ischemic region adjacent to the central ischemic region, flows in the chronically sympathectomized ventricle were 250--450% of those in the nonsympathectomized ventricle. When these flows were normalized to the preocclusion values, these differences were even greater. Thus, following circumflex artery occlusion, ischemic perfusion of the chronically sympathectomized myocardium is substantially improved.


Deposition and clearance of fibrin in the rat lung following acute haemorrhage.

The effect of acute haemorrhage on the deposition and clearance of fibrin in the rat lung after thrombin-induced intravascular coagulation was investigated. Haemorrhage was followed by less embolization of fibrin to the lungs and delayed elimination from the lungs. As lung tissue fibrinolysis was not diminished, the peripheral and pulmonary circulatory disturbance was probably in itself responsible for the observed effects.


Effect of haemorrhagic hypotension on the circulation of rats with Guérin carcinoma.

After transplanting Guérin carcinoma in rats the cardiac output (Evans-blue dilution), the distribution of cardiac output (Sapirstein's isotope indicator fractionation technique), the nutritive blood flow of the organs, and their circulatory resistance were investigated in haemorrhagic hypotension (40 or 70 mm Hg). The posthaemorrhagic redistribution of cardiac output in tumor-bearing rats was similar to that found in normal bled animals: the renal and skin fractions of cardiac output decreased and that of the brain, myocardium, and carcass increased. As a result of bleeding the decrease of the tumor fraction of cardiac output was the greatest compared to the other organs. Thus the tumor seems to be the main target organ of the posthaemorrhagic redistribution.


Depression of the reticuloendothelial system following graded isoproterenol-induced myocardial injury.

The effect of experimental myocardial injury on reticuloendothelial system (RES) phagocytic function was investigated. Graded myocardial injury was produced in rats by the subcutaneous injection of isoproterenol in doses of 5, 50 or 500 mg/kg. Phagocytic index, determined from the clearance rate of gelatinized lipid emulsion at six hours after isoproterenol injection, showed a progressive depression with increasing severity of myocardial injury. The depression in phagocytic index was due primarily to a depression of hepatic phagocytosis. RES blockade induced with colloidal carbon prior to isoproterenol injection (650 mg/kg) increased the mortality rate from 20% to 87%. It was concluded that the depression of RES function during this form of myocardial injury may hasten the deterioration of the organism and that it may be important to consider the role of RES function during clinical cardiogenic shock.


The ultrafast alkaline phosphatase isoenzyme is not a bilirubin albumin artifact.

A unique isoenzyme of alkaline phosphatase (ALP) has been identified in the serum of patients who had neoplastic lesions involving the liver. The isoenzyme migrates in an ultrafast position near the albumin band on cellulose acetate electrophoresis.


Creatine kinase (EC-No.2.7.3.2) and creatine kinase isoenzymes during pregnancy and labor and in the cord blood.

Total CK and CK isoenzyme activity in serum was investigated during pregnancy, labor and after delivery as well as in cord blood. Total CK was decreased in the second trimester of pregnancy but increased in late pregnancy. Low CK-MB activity in serum was found in patients with early labor pains. CK-BB activity could never be detected during pregnancy. Total CK and isoenzyme activity increased after delivery. The rise of total CK and CK-MB in maternal serum is directly correlated with the following: type of delivery, duration of labor, parity of the mother, and birth weight. From this it can be deduced that postpartum CK levels depend on skeletal muscle activity as well as on the activity of uterine muscle. Prematures and infants "small for date" have significantly lower total CK and slightly more elevated CK-BB activity in cord blood than children of normal maturity. CK-BB activity is much more pronounced in high risk patients with low Apgar score.


2,3-Diphosphoglycerate, a cellular ageing metabolite.

The concentration of 2,3-diphosphoglycerate was increased in whole venous blood of patients with various cancers, including those of breast, ovary, lung and colon, but not rectum, compared with age-matched controls. Higher values, increasing with age, were also found in patients with Hodgkin's disease and other lymphomas. This abnormality is considered to be due to increased synthesis of the metabolite by the tumour tissue.


Interrelations between plasma and tissue concentrations of 17 beta-oestradiol and progesterone during human pregnancy.

Oestradiol and progesterone concentration in plasma, decidua, myometrium and placenta obtained from women undergoing Caesarian section at term and abortion at weeks 16-22 of pregnancy were determined. There was a significant increase in oestradiol concentration (per g wet wt) both in placenta, decidua and myometrium from mid-term to term. Both at mid-term and term oestradiol concentrations in decidua and myometrium were much smaller than those in the plasma (per ml). Progesterone concentration in placenta and in myometrium did not increase from mid-term to term where it increased significantly in decidua. Decidual and myometrial progesterone concentrations at mid-term were 2-3 times higher than those in plasma, but at term the concentrations in both these tissues were lower than in plasma. The ratio progesterone/oestradiol in plasma, decidua, myometrium and placenta at mid-term was 8.7, 112.2, 61.4 and 370.0, respectively, and it decreased significantly in the myometrium and placenta but was nearly unchanged in plasma and decidua at term. The general conclusion to be drawn from the present study is the lack of correspondence between the plasma concentrations and the tissue concentrations of female sex steroids during pregnancy.


Increased plasma activities of N-acetyl-beta-D-glucosaminidase isoenzymes in human diabetes mellitus.

Plasma N-acetyl-beta-D-glucosaminidase activities are raised in maturity-onset insulin-dependent diabetic patients. Continuous gradient DEAE-cellulose column chromatography and assay of heat-stable enzyme activity both show that the activities of all isoenzymes are equally increased rather than a previously described increase of specific isoenzymes. Plasma enzyme activities are similarly increased in patients with and without diabetic retinopathy, and correlate with simultaneous plasma glucose concentrations.


Metabolism of human beta 1H: studies in man and experimental animals.

Metabolic studies were performed with a purified, functionally-active preparation of human beta 1H. In seven normal human subjects, the half-life ranged from 66--87 hr with fractional catabolic rates (FCR) of 1.04--1.63%/hr. Synthesis rates were 0.22--0.57 mg/kg/hr and extravascular distribution ratios were 0.34--0.67. There was evidence of extra-vascular catabolism in each subject. In sixteen patients with immunological disease four showed hypercatabolism of beta 1H. However, three patients with C3 mephritis factor (NeF) had normal beta 1H turnover despite profound reduction in C3 concentration; it is suggested that the reaction of beta 1H with the C3b. Bb convertase exposes it to a catabolic site and that in the NeF patients the NeF stabilized convertase prevents such exposure. Studies of the acute phase response were carried out in nine patients following elective surgery, with C-reactive protein (CRP) used as the control protein: six patients showed no rise in beta 1H levels and three showed a small (20%) rise whereas all exhibited a gross rise in CRP. Pre-incubation of 125I- beta 1H with NHS, with NHS in the presence of NeF and with C3b+C3b 1NA caused no change in beta 1H turnover in animals despite demonstrable total C3 conversion with the NeF.


The association of cryoglobulinaemia with nodules, vasculitis and fibrosing alveolitis in rheumatoid arthritis and their relationship to serum C1q binding activity and rheumatoid factor.

Two measurements of serum immune complexes, cryoglobulinaemia and 125I-C1q binding, have been performed in patients with severe rheumatoid arthritis (RA) and compared with normal levels. Cryoglobulinaemia was present in 20 out of 28 patients (71%) with extra-articular disease (mean level 17 micrograms/ml) including nodules, digital vasculitis, cutaneous ulcers, rash, neuropathy, lung disease and scleritis, but in none of 32 patients with joint disease alone (uncomplicated RA) (mean level 3 micrograms/ml). Cryoglobulinaemia correlates with, but probably does not antedate, extra-articular disease, and may be useful in predicting morbidity and mortailty in this group of patients. In contrast, serum 125I-Clq binding was raised in patients with uncomplicated RA and those with extra-articular disease, although levels were higher in the latter group. Both tests showed a negative correlation with serum haemolytic complement and a positive correlation with IgM rheumatoid factor although there were some sera with raised levels of rheumatoid factor without cryoglobulinaemia. These results suggest that cryoglobulinaemia is a better test than Clq-binding for demonstrating the presence of circulating immune complexes involved in the pathogenesis of extra-articular lesions.


The effects of protein malnutrition on the course of Leishmania mexicana infection in C57Bl/6 mice: nutrition and susceptibility to leishmaniasis.

The course of cutaneous infection with Leishmania mexicana was studied in normally nourished and protein deprived C57Bl/6 mice. Mice fed a normal diet showed self-resolving lesions and produced cellular and humoral responses against the parasite. In contrast, mice fed a protein deficient diet which developed chronic protein calorie deficiency failed to recover from L. mexicana infection. Non-healing protein deprived mice had depressed delayed hypersensitivity response (DHR) and in vitro lymphocyte reactivity to leishmanial antigen. Responses to PHA and Con A were also suppressed. The possible interaction between malnutrition, impairment of the immune response and chronicity of cutaneous leishmaniasis is discussed.


In vitro proliferation of macrophage depleted human peripheral blood lymphocytes.

The incorporation of thymidine by normal human peripheral blood lymphocytes was tested in vitro following various culture conditions. A significant increase of thymidine uptake was observed in cultures depleted of plastic adherent, nylon wook adherent, or phagocytic cells. This proliferative activity occurred in the presence of various sera but was not due to a blastogenic response to a foreign protein, since it was also observed when autologous plasma was the only source of protein in the culture medium. The similarities and differences between this 'spontaneous' proliferative phenomenon and other blastogenic responses which are regulated by macrophages are discussed.


Effects of acetaminophen on normal human peripheral blood lymphocytes: enhancement of mitogen- and antigen-stimulated incorporation of tritiated thymidine.

This report describes hitherto unrecognized immunoenhancing properties of acetaminophen on cultured human lymphocytes. The addition of acetaminophen (2.5--300 micrograms/ml) significantly enhanced mitogen-induced blastogenesis. The stimulation of cells by Candida albicans, from individuals who were skin-test positive for antigen and two-way responses of mixed lymphocytes, were similarly augmented. Cells stimulated in the presence of acetaminophen were comparably enhanced in cultures lasting for 24--168 hr. Enhancement of stimulated cells was noted only if the drug was added during the first hours of culture. Exposure of cells to acetaminophen before mitogen stimulation did not enhance responses unless tha cells were simultaneously cultured with mitogen and the drug. Cells obtained from normal subjects before, during and after ingestion of therapeutic amounts of acetaminophen for 3 days, were cultured in a medium without acetaminophen, and did not display increased in vitro responses during or after drug consumption. These data indicated: (1) pharmacological concentrations of acetaminophen significantly enhanced lymphocyte responses to specific, non-specific, soluble and insoluble stimulation in vitro; and (2) enhancement by acetaminophen occurred only when the drug was in contact with cells during the early period of cell activation.


Characterization of the human peripheral effector cells mediating antibody dependent cellular cytotoxicity against allogenic cells.

The effector cell populations in human peripheral blood responsible for antibody-dependent cellular cytotoxicity against allogenic cells coated with HLA polyspecific antibodies were investigated using several separation techniques including preparative electrophoresis. Electrophoresis produced a marked effector cells enrichment in a range of 2--5 fractions which exhibited an intermediary electrophoretic mobility. Monocytic cells do not contribute an effector mechanism but minor subsets of polymorphonuclear cells and nylon wool non-adherent non-phagocytic lymphocytes displayed ADCC. Both effector cell populations were found to exhibit a similar electrical charge of cell surface centered around -1.05 micrometer . sec-1 V-1 cm. These observations provided a precise biophysical basis for the identification of effector cells in ADCC.


Human colostral cells. I. Separation and characterization.

Analyses of the cells present in human colostrum obtained from fifty-four healthy donors during the first four days of lactation revealed that there were 3.3 x 10(6) (range 1.1 x 10(5)--1.2 x 10(7)) cells per ml of colostrum. Based on histochemical examinations, it was found that this population consisted of 30--47% macrophages, 40--60% polymorphonuclear leucocytes, 5.2--8.9% lymphocytes, and 1.3--2.8% colostral corpuscles; epithelial cells were rarely encountered. The identity of various cell types was confirmed by Wright's stain and by a series of histochemical techniques which disclosed the presence of non-specific esterase, peroxidase, and lipids. For further characterization, the different types of cells were separated by various methods, such as Ficoll-Hypaque density centrifugation, isokinetic centrifugation on a linear Ficoll gradient, adherence to glass or plastic, and phagocytosis of carbonyl iron. Immunohistochemical staining with FITC- and/or TRITC-labelled reagents to IgA, IgM, IgG, K- and lambda-chains, secretory component, lactoferrin, and alpha-lactalbumin were applied to unseparated as well as separated colostral cells. Polymorphonuclear leucocytes (staining for peroxidase) as well as macrophages and colostral corpuscles (staining for non-specific esterase) exhibited numerous intracellular vesicles that contained lipids as well as various combinations of milk proteins. Lymphoid cells did not stain with any of these reagents and plasma cells were not detected among the colostral cells. Individual phagocytic cells contained immunoglobulins of the IgA and IgM classes, both K and lambda light chains, secretory component, lactoferrin, and alpha-lactalbumin. The coincidental appearance of these proteins in single, phagocytic cells but not in lymphoid cells indicate that the cells acquired these proteins by ingestion from the environment. Markers commonly used for the identification of B lymphocytes (surface immunoglobulins) and T lymphocytes (receptors for sheep red blood cells) were unreliable for the analysis of colostral cells (unless accompanied by subsequent morphological characterization) because strong fluorescence was observed on the surface of many non-lymphoid cells and because numerous macrophages and colostral corpuscles formed rosettes with sheep red blood cells (SRBC). Lymphocytes, often found in association with colostral macrophages or corpuscles, were classified as T cells.


Reticular dysgenesis: report of two brothers.

We describe two brothers with marked leucopenia, lymphopenia, no immunologicl response to infections (no Ig production, negative PHA response and very low number of T and B lymphocytes in peripheral blood) and hypocellular marrow. They died at 12 and 8 days of life with infection (E. coli and Klebsiella, respectively).


Patellaplasty or patellectomy?

A series of patients whose patella has been resurfaced by a prosthesis has been compared with a similar group whose patella has been resected. Patellectomy has been an acceptable procedure in the treatment of severe injuries and degenerative changes of the patella, but the indications for this operation are not well defined in all fields. Satisfactory results following Vitallium patellaplasty have been better than those following patellectomy in osteoarthrosis. Extension is more complete; flexion has been satisfactory; cosmetic appearance is more desirable. Prosthetic resurfacing with a Vitallium prosthesis has been a satisfactory procedure in individuals who develop symptoms from a painful patellofemoral joint when the remainder of the joint has not deteriorated sufficiently to indicate need for total knee replacement. Patellaplasty has provided years of pain-free patellofemoral function and prevented the alteration of normal joint mechanics that occurs with patellectomy.


A rational approach to the treatment of patellofemoral pain.

Chondromalacia of the patella should be considered a separate entity and not the necessary precursor of osteoarthrosis. It is rarely associated with significant discomfort. Isolated softening, fibrillation of the central medial facet, and a diagnosis of chondromalacia of the patella should be limited, in our view, to isolated fibrillation occurring in the central medial facet and is probably asymptomatic. Symptomatic patellar pain can be treated by realignment if the patella is malaligned, by lateral release and synovial fringe excision if there is an anomalous facet or synovial fringe entrapment syndrome, and by drilling and curettage and stress-relieving operations (if necessary) if there is an osteochondral injury. For osteoarthrosis stress can be relieved on a permanent basis by the Maquet anterior tibial tubercle advancement operation. We recommend approaching patellofemoral pain by establishing a specific diagnosis and applying a specific treatment.


Z-plasty lateral retinacular release for the treatment of patellar compression syndrome.

Lateral retinacular release by Z-plasty technique in selected patients provides a relatively simple procedure for relief of symptoms in patellar compression syndrome and is a satisfactory initial surgical procedure in cases not responding to conservative therapy. Unfortunately, there is no specific symptom complex, physical finding, radiographic finding, or arthrotomy finding which delineates the patient with patellar compression syndrome who will benefit from an isolated lateral retinacular release. Some patients may require further extensor mechanism realignment procedures (e.g., medial capsular reefing, tibial tubercle transplantation, tibial tubercle elevation, etc.) to relieve the aggravating symptoms of parapatellar and retropatellar pain.


Partial chondrectomy and subchondral bone drilling for chondromalacia.

Twenty-nine knees in 25 patients with chondromalacia patella resistant to conservative treatment were subjected to localized chondrectomy and subchondral bone plate drilling. Good or excellent results were achieved in most patients under the age of 30. The results in patients over the age of 30 were less satisfactory.


Constrained total shoulder joint replacement: a critical review.

Constrained total shoulder replacement is a salvage procedure for the patient with disabling pain and a nonfunctioning rotator cuff mechanism. The results of pain relief have been gratifying. When active overhead motion is a goal of treatment a strong deltoid muscle is required. The rationale for fixing a fulcrum is to substitute for the loss of the rotator cuff mechanism that stabilizes the humeral or prosthetic head on the shallow glenoid. The best method of attachment for the glenoid component to an intact glenoid vault described herein has been found to be superior to other methods. In particular, the vault should not be mutilated. This is borne out by the clinical experience and laboratory testing that loosening or pull-out does not occur with an intact glenoid. Moreover, the attachment is stronger than the dry bone just medial to the vault where fracture always occurred through the suprascapular notch in laboratory tests. Although there may be good pain relief with this operation, active function still depends on residual deltoid muscle power wherein a poor deltoid will only allow passive motion. Moreover, the outcome of any shoulder operation still depends in large measure on the excellence of the postoperative rehabilitation program. Finally, other worthwhile shoulder operations should be given first consideration in order to serve the needs of individual patients.


A modified posterolateral approach to the elbow and proximal radioulnar joints.

A modified posterolateral approach is useful for extensive exposure of the elbow and proximal radioulnar joints. The patient is placed prone and the elbow flexed over a padded support: a pneumatic tourniquet is placed proximally on the arm. The laterally curved skin incision extends from the center of the posterior surface of the arm, at the upper limit of the triceps tendon, to the back of the lateral epicondyle and thence to the posterior border of the ulna 3 finger-breadths distal to the tip of the olecranon. The large medial and smaller lateral flaps are secured with sutures. The ulnar nerve is exposed and protected. A distally based tongue of triceps tendon is fashioned and retracted downwards. The anconeus is separated from the extensor carpi ulnaris muscle and retracted medially with the underlying capsule. The common extensor origin and the lateral collateral ligament, with the adjacent capsule, are partially reflected from the humerus. Excellent exposure of the elbow and proximal radioulnar joints is easily achieved and visualization can be increased by putting a varus strain on the elbow.


Dislocation of the distal radioulnar joint: anatomy and clues to prompt diagnosis.

The articular disk is a strong, complex structure responsible for the stability of the distal radioulnar joint. It is injured by a hyperpronation or hypersupination injury which disrupts the disk or its strong central attachment to the ulna. Prompt diagnosis is essential for a good result as no good late reconstruction is available. Reliance on radiographs for the diagnosis will seldom be rewarding, and they are mainly of value in ruling out associated fractures. A careful clinical examination and a high index of suspicion are the best tools available for diagnosis in this injury.


Intercarpal fusion for treatment of carpal instability: a preliminary report.

Post-traumatic instability was once considered to be a rare but important injury recognized among the various carpal trauma. However, recent literature suggests that reports on this entity are increasing in number. Methods of treatment for this injury were few in the past and were not well established. Following the lesson of 2 cases of failure with open reduction and ligamentous reconstruction, 4 such cases were treated by intercarpal fusion; 3 had no pain or tenderness at a follow-up period of 16 months to 27 months. This procedure should be performed before radiocarpal degenerative arthritis develops.


The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation.

The X-ray technique for the tangential visualization of the patellofemoral joint is described; 3 X-ray signs (patellofemoral angle, patellofemoral index and patellofemoral displacement) are proposed as diagnostic aids in cases of subluxation of the patella and chondromalacia patellae. Theoretically, the pathogenesis of chondromalacia patellae and patellofemoral osteoarthritis may be explained as manifestations of cartilage damage secondary to lateral patellofemoral hyperpressure and medial patellofemoral hyperpressure.


Clinical experiences with a titanium alloy total hip prosthesis: a posterior approach.

Using a titanium alloy femoral prosthesis (STH Zimmer) and an ultra high molecular weight polyethylene acetabular cup with a posterior surgical approach to the hip joint, 237 consecutive total hip arthroplasties in 215 patients were performed between December 1975 and May 1977. The preliminary results and early postoperative complications suggest that this system can be considered an alternative to total hip arthroplasty using other materials and surgical approaches.