[Efficacy of disinfectants against rabies virus (author's transl)].

A variety of disinfectants was tested against, their efficacy against Rabies virus Flury LEP strain. The efficacy was tested by intracerebral inoculation of a mixture of virus and disinfectant into 11-15 g white mice after evaluation of the intracerebral toxic dose. Two disinfectants, based on Phenolecompound, showed a marked superior effect compared with other disinfectants. One disinfectant based on quarternary Ammoniumbase showed insufficient efficacy.


Leukocyte migration test for the study of immune reactivity in cases of Graves disease associated with infiltrative ophthalmopathy.

The leukocyte migration test was carried out in 26 untreated cases of Graves disease, using crude thyroid extract, human eye muscle antigen and actomyosin as antigens. A significant reduction in the spontaneous (antigen-free) migration values was demonstrable in the cases of Graves disease, compared with the controls. The migration inhibition test gave positive results with the thyroid antigen in the hyperthyroid cases, in opposition to euthyroid ophthalmopathy, where it was found negative. The results were positive with retrobulbar muscle antigen in hyperthyroid and euthyroid infiltrative ophthalmopathy. In advanced cases of infiltrative ophthalmopathy, the results were positive with actomyosin as well.


Underside lesions of the meniscus.

A total of 180 menisectomies were performed with special attention to lesions located only on the underside of the menisci. Thirty-six lesions (20 per cent) were found with this location, all in the posterior part of the menisci. Half of these were atypical horizontal cleavage lesions. The clinical features of these lesions were compared with normal meniscal lesions and no differences could be demonstrated. The subjective results after meniscectomy for 35 underside lesions were 94 per cent good or excellent after an average follow-up period of 22.3 months. Meniscectomy is the treatment of choice for these lesions. It is emphasized that careful examination of the underside of the meniscus is necessary if a patient presents a clinical picture of meniscal lesion and no other lesions can be found.


[Rheumatoid factors in Basedow's disease].

In patients with untreated Basedow's disease rheumatoid factors were determined by Waaler-Rose and Latex tests. The Waaler-Rose test was positive in 61.5% of 143 cases. After the acute disease stage settled the titers fell in more than 90% of the re-tested cases. In 50% the decrease in titre was of two dilutions or more. The Latex test was carried out in 152 patients. It was positive in 9.2% of the cases and became negative in 50% of the cases after the acute disease stage settled. In 5 out of 6 patients in whom the test remained positive there was in addition a rheumatic disease. The detectable rheumatoid factors are regarded as auto-antibodies against immuno-globulins. This suggests that polyarthritis in Basedow's disease is based on the same pathogenetic mechanisms as rheumatoid arthritis.


Formation of new menisci after polycentric knee arthroplasty. Report of four cases, one with a bucket handle tear.

This paper presents four patients with polycentric artificial knee joints in whom reoperation revealed new menisci interposed between the artificial joint surfaces. One of the menisci had a bucket handle tear and was excised. Histological examination showed a fibrocartilage structure with the appearance of a newly formed meniscus. The artificial knees functioned well and the reoperations were performed because of trauma in one patient, because of femoro-patellar problems in one knee, and for conversion of a hemi-arthroplasty to an arthroplasty including all the compartments of the knee joint in two patients.


Hypocholesterolemic effect of yogurt and milk.

In order to determine the effect of milk products on serum cholesterol, triglycerides, and diet, 54 volunteers were studied for varying periods with dietary supplementation of nonpasteurized yogurt, pasteurized yogurt and 2% butterfat milk. Serum cholesterol was significantly reduced by 5 to 10% after 1 week of supplementation with either nonpasteurized or pasteurized yogurt; 2% butterfat milk reduced serum cholesterol to a smaller and less significant effect. Serum triglycerides were unaffected by the diet and dietary intake studies confirmed that intake of other nutrients remained relatively stable throughout the study. Supplementation of diet with yogurt may have a helpful hypocholesterolemic effect.


Voting behavior of HSA interest groups: a case study.

A study of the voting behavior of both consumers and providers involved on a Health Systems Agency (HSA) review committee was undertaken to determine the amount of voting cohesion (solidarity) demonstrated by these two basic interest groups as well as the directions in review decisions desired by both of these groups. The case study involved the application of the Rice Index of voting cohesion behavior to 23 decisions in one of the largest HSAs in the country. The conclusions reached are that: 1) consumers and providers do have differences in their intra-group voting cohesion, but that more importantly 2) they do not appear to be different with respect to the decisions (approve or deny) both groups desire for project reviews.


[Electron-microscopic characteristics of nodular variants of prolymphocytic lymphosarcomas].

Electron microscopic examinations of the lymph nodes tissue in prolymphocytic lymphosarcomas with nodular growth established that tumor cells forming neoplastic nodules retain the ultrastructural characteristics of their analogues (cells with cleaved melei) in unaltered or reactive germ centers of lymphatic follicles.


2 [(methylsulfinyl) acetyl] pyridine (Oxisuran): a new immunosuppressive agent in EAE.

The authors discuss the effects of a new immunosuppressive agent on the development of EAE. Animals (albino rabbits) were inoculated with an encephalitogenic emulsion, according to Kies' method, whereas a control group was inoculated by a physiological saline solution. Some animals were treated by Oxisuran in the first day after challenge; some others after initial symptoms (18th day). Thirty days after challenge, the animals were sacrificed. No toxicity was found in thoracic and abdominal structures neither in blood count. Pharmacological effectiveness of Oxisuran is well documented either in pretreatment or in therapy; the course was positively influenced in animals, when treated after the appearance of initial symptoms.


Differential scanning calorimetry of dipalmitoyl phosphatidylcholine analogues and of their interaction products with basic polypeptides.

The thermotropic behaviour of dipalmitoyl phosphatidylcholine analogues with a varying number (n) of CH2 groups between the phosphate and the quaternary ammonium has been investigated. The temperature (Tm) and the enthalpy (deltaH) of the phase transition are non-monotonous functions of the number of CH2 groups. Tm oscillates between 40 and 45 degrees C and deltaH between 7 and 13 kcal/mol for a variation of n between 2 and 11. It is concluded that the hydrocarbon chains in the head groups do not penetrate the hydrocarbon region and do not contribute directly to the melting of the acyl chains. It is suggested that their length may affect the critical balance between the attractive and the repulsive forces within the bidimensional lattice of the head groups. Copolypeptides of lysine with phenylalanine do not appreciably affect the Tm but have a pronounced effect on deltaH of the lipid phase transition, which depends strongly on the ratio of the two amino acids in the polypeptide. The effect of copolypeptide of any defined composition on deltaH is also a non-monotonous function of the number of CH2 groups in the phosphatidylcholine head group, but it does not parallel completely the oscilations in the Tm and deltaH of the pure lipids.


Antagonism between high pressure and anesthetics in the thermal phase-transition of dipalmitoyl phosphatidylcholine bilayer.

The antagonizing action of hydrostatic pressure against anesthesia is well known. The present study was undertaken to quantitate the effects of hydrostatic pressure and anesthetics upon the phase-transition temperature of dipalmitoyl phosphatidylcholine vesicles. The drugs used to anesthetize the phospholipid vesicles included an inhalation anesthetic, halothane, a dissociable local anesthetic, lidocaine and an undissociable local anesthetic, benzyl alcohol. All anesthetics decreased the phase-transition temperature dose-dependently. In the case of lidocaine, the depression was pH dependent and only uncharged molecules were effective. The application of hydrostatic pressure increased the phase-transition temperature both in the presence and the absence of anesthetics. The temperature-pressure relationship was linear over the entire pressure range studied up to 340 bars. Through the use of Clapeyron-Clausius equation, the volume change accompanying the phase-transition of the membrane was calculated to be 27.0 cm3/mol. Although the anesthetics decreased the phase-transition temperature, the molar volume change accompanying the phase-transition was not altered. The anesthetics displaced the temperature-pressure lines parallel to each other. The mole fraction of the anesthetics in the liquid crystalline membrane, calculated from the van't Hoff equation, was independent of pressure. This implies that pressure does not displace the anesthetics from the liquid membrane, and the partition of these agents remains constant. The volume change of the anesthetized phospholipid membranes is entirely dependent upon the phase-transition and not on the space occupied by the anesthetics.


Bubble clicking in pharyngeal aspirate compared with lecithin/sphingomyelin ratio.

Tracheal fluid flows into the pharynx, so surfactant can be measured in pharyngeal aspirate. The walls of bubbles in air-free water show rhythmic movements (bubble clicking) if they contain surfactant. Babies with respiratory distress syndrome (RDS) have very little lung surfactant which can be shown by a low lecithin/sphingomyelin (L/S) ratio. To investigate surfactant in newborn babies we analysed 125 pharyngeal aspirates for the L/S ratio and bubble clicking. Both tests became more positive towards term and were related to the incidence of RDS. Babies with birth asphyxia or mild respiratory difficulties had lower L/S ratios and less clicking than normal babies. Both investigations could be used to chart the course of RDS. The L/S ratio is a chemical measurement of surfactant. Bubble clicking, which takes only a few minutes, demonstrates surface tension effects.


Conformational nonequivalence of chains 1 and 2 of dipalmitoyl phosphatidylcholine as observed by Raman spectroscopy.

Raman spectroscopic data indicate that the conformations of the two hydrocarbon chains of dipalmitoyl phosphatidylcholine in aqueous dispersions of the lipid differ signficantly. The compounds 1-palmitoyl, 2-palmitoyl-d31-3-sn-phosphatidylcholine and 1-palmitoyl-d31, 2-palmitoyl-3-sn-phosphatidylcholine were synthesized. Aqueous dispersions of these phospholipids display very similar phase behavior, with both premelting and melting transitions at nearly identical temperatures, midway between the comparable transition temperatures of undeuterated and completely deuterated dipalmitoyl phosphatidylcholine. We have monitored the state of chains 1 and 2 of these molecules simultaneously and independently by Raman spectroscopy. Raman difference spectra taken between samples of the two compounds under identical conditions show significant features. We attribute these spectral differences to nonequivalent conformations of the fatty acyl chains attached at positions 1 and 2 on the glycerol backbone. Below the pretransition the conformation of chain 2 is, on average, slightly less all-trans than is the chain at position 1. There is some evidence that the conformations of the terminal methyl group of the two chains are significantly different at low temperatures.


The effects of some hydrophobic gases on the pulmonary surfactant system.

1. Decompression from exposures to raised ambient pressure of sulphur hexafluoride, carbon tetrafluoride, hexafluoro-ethane and nitrous oxide results in the formation of dense foam and pulmonary oedema. 2. The degree of pulmonary oedema produced is dependent on the exposure pressure, although the exposure time required is short in comparison to tissue saturation times. 3. The effect is not prevented by atropine, ephedrine or hydrocortisone. 4. The effect is also produced in vitro by saturated solutions of halothane, chloroform and ether. 5. It is suggested that the mechanism of action is physical with physico-chemical factor involved being a differential partition of these gases within the surfactant: membrane complex.


Successful treatment of exophthalmos and pretibial myxoedema with plasmapheresis.

A patient with Graves's disease with acute progressive exophthalmos and pretibial myxoedema was treated twice with plasmapheresis. Two weeks after the first treatment the symptoms recurred, but 20 weeks after the second treatment the exophthalmos was much improved and the pretibial myxoedema had disappeared. Analysis of sequential serum IgG concentrations and the thyroid-stimulating immunoglobulin index suggested that the two conditions were caused by specific IgGs. The results suggest that plasmapheresis has a useful place in the treatment of acute and rapidly progressive ophthalmopathy and pretibial myxoedema in patients with Graves's disease.


Diagnostic, treatment, and reporting criteria for non-specific genital infection in sexually transmitted disease clinics in England and Wales. 2: Treatment and reporting criteria.

The current methods of treating and reporting non-specific genital infection (NSGI) are described. The most commonly used drug was tetracycline in one or other form. Epidemiological treatment was widely used, particularly for female sexual contacts. There was considerable variation in the reporting criteria for the quarterly returns. The establishment of acceptable and uniform criteria for notification of NSGI is discussed.


Relative and seasonal incidences of the sexually transmitted diseases. A two-year statistical review.

In the United States statistics on sexually transmitted diseases (STDs), other than gonorrhoea and syphilis, are meagre. In this study the relative and seasonal incidences of most STDs in an American clinic where 34,938 patient visits were recorded over a two-year period (1975-76) are assessed. Gonorrhoea was the most common STD in male and female patients combined (18%), while nongonococcal urethritis (NGU) was most common in men (23%), and vaginitis (trichomonal 7.5%, yeast 7.1%, and non-specific 7.1%) was the most common in women. A significantly higher incidence of NGU occurred in Caucasian (63%) than in black (42%) men (P less than 0.005). No other STD was diagnosed in more than 5% of patients, and 31% had normal findings on clinical examination and investigation, and could be described as the 'worried well'. Two or more STDs co-existed in 4.2% of patients. In 1976 the incidence of genital herpes and scabies decreased in contrast to other STDs and total patient visits, which increased. A seasonal peak in late summer and early autumn was observed for most STDs. These observations indicate the importance of a comprehensive approach when attempting to compile accurate statistics on selected epidemiological aspects of sexually transmitted diseases.


Late onset chronic mucocutaneous candidiasis with lymphoma and specific serum inhibitory factor.

A patient with late onset chronic mucocutaneous candidiasis developed lymphocytic lymphoma. A specific inhibitor of in vitro lymphoproliferative responses to candidal antigen was detected in her serum which persisted following clinical remission of candidiasis after combined amphotericin-B and 5-Fluorocystosine therapy. It is unclear whether the combined therapy was exclusively anticandidal, nonspecific immunostimulant or cytotoxic affecting the underlying incipient lymphoma.


Biochemical analysis of a lithopedion.

Lithopedions are very rare; the medical literature mentions 330 cases. In the present case, a calcified lithopedion was found in the abdominal cavity of a 69-year-old woman who had died of unrelated causes. In general, the different organs of the lithopedion were easily distinguishable macroscopically. Microscopic examination detected reasonably well preserved structure only in skeletal muscle. Dry weight studies showed a definite dehydration (mummification) had taken place. Chemical analysis revealed a shell consisting mostly of inorganic constituents. Quantitative inorganic analysis of tissues was done and results compared to normal tissues. These results showed significant decrease of K and Cl, significant increase in Mg, P, Na and enormous increase in Ca. These data are compatible with the histologically observed calcification of the tissues. Under proper conditions, presumably dormant enzymes were reactivated in brain, liver, and muscle, although the total activity was low. Discernible LDH isoenzymes were found in liver and muscle. Discernible CK isoenzymes were found in brain and muscle.


The inflammatory role of immune complexes trapped in joint collagenous tissues.

The inflammatory role of immune complexes trapped in joint collagenous tissues has been investigated. Joint collagenous tissues obtained from rabbits with antigen-induced arthritis generated mediators of acute inflammation when incubated with fresh normal rabbit serum as a source of complement. The role of trapped immune complexes in chronic inflammation was also studied by the surgical insertion of menisci, obtained from arthritic and control joints, into the suprapatellar pouches of previously immunized or naive recipient animals. It was shown that when immune complex containing menisci were inserted into immune rabbits, a chronic inflammatory capsule developed around the donor tissue, reminiscent of the inflammatory pannus seen in rheumatoid cartilage. Normal menisci and immune complex containing menisci inserted in naive animals developed capsules rich in fibroplasts and collagen fibres. Since we have previously shown the presence of immune complexes in the great majority of joint collagenous tissues obtained from patients with rheumatoid arthritis, our results suggest that these complexes may play a role in the formation of pannus, which constitutes a major mechanism responsible for cartilage destruction.


[Hypoproteinemia causing postoperative "interstitial" paralytic ileus].

On the basis of recent pathophysiological data and clinical observations in three patients, this paper draws attention to the commonly neglected importance of postoperative hypoproteinemia as the cause of an edema of the intestinal wall with a consequent "interstitial" paralytic ileus. The characteristic features of this syndrome are its onset between the third and the eighth postoperative day; the absence of other known causes of intestinal hypomotility; the benign, but protracted course without treatment; and the therapeutic success achieved by the correction of a hypoproteinemic fluid overload with concentrated albumin and a diuretic. In addition, parenteral hyperalimentation and Rheomacrodex-Sorbit may be indicated, but the hypoproteinemia should at any rate be corrected.


Directed biosynthesis of analogues of ergot peptide alkaloids with Claviceps purpurea.

Analogues of peptide ergot alkaloids can be obtained by feeding a producing culture of Claviceps purpurea with an analogue of one of the amino acids of the peptide chain of the alkaloid.


Structural aspects of gas exchange.

The lung is composed of several million small air spaces, lined by a delicate tissue membrane separating air from capillary blood. The design features of the gas exchange region in the lung are optimal for gaseous diffusion, by having a very extensive contact surface but with a minimal tissue barrier composed of an epithelial and endothelial layer separating an interstitial layer. The extent of the gas exchange surface in adult lungs is determined by general maturation which in turn is influenced by metabolic requirements of the organism. Environmental factors can modulate the pattern of ultimate lung development. Lung inflation causes air spaces to expand mainly by a process of tissue unfolding beneath an extremely thin layer of alveolar surfactant. This ensures cellular integrity during extreme deformations while at the same time providing a reserve of gas exchange surface so that functional diffusion capacity at all lung volumes is less than the structural maximum.


Plasma levels of tricyclic antidepressants and clinical efficacy: review of the literature -- part II.

The authors have critically reviewed the literature regarding the relationship between plasma levels of tricyclic antidepressant and their clinical efficacy. When available, drug-drug interactions, pharmacokinetics, and other factors influencing plasma levels of tricyclic antidepressants are discussed. Although many studies are confounded by significant methodological and statistical problems, it appears to these reviews that the available evidence suggests a curvilinear relationship between nortriptyline plasma levels and antidepressant efficacy in tricyclic responsive endogenously depressed inpatients, with maximal therapeutic efficacy achieved with notriptyline plasma levels between 50-175 ng/ml. The evidence for imipramine supports a linear relationship between plasma levels of imipramine plus desmethylimipramine and clinical response in nondelusional endogenously depressed tricyclic responsive inpatients. For amitriptyline, the picture is less clear. However, with the exception of one well-controlled study, the available evidence suppprts some significant relationship between amitriptyline plus nortriptyline plasma levels and antidepressant efficacy in tricyclic respoonsive endogenously depressed patients, but it is not clear as to whether this is a linear relationship or a curvilinear one. For the other antidepressants: protriptyline, desmethylimipramine, doxepin, clomipramine, maprotiline, and butriptyline, a significant relationship (if any) awaits further elucidation. It is important to point out that these plasma level relationships probably do no generalize to other types of depressions (e.g. neurotic, characterological, delusional, acute situationa, etc.) and clearly do not apply to every endogenous tricyclic responsive patient. /owever, it appears that, in general, a clinician will obtain therapeutic efficacy for endogenously depressed patients if these guidelines are followed. The actual therapeutic levels will depend on the assay's sensitivity and specificity and may vary from center to center, illustrates the importance of each center defining its own therapeutic limits, or conversely all centers adoptina a universal reproducible assay methodology for each compound measured. Despite these limitations, these reviewers feel that routine monitoring of plasma levels of the tricyclic antidepressants is a useful method to maximize therapeutic efficacy and prvent undue side effects, as well as to insure good medication compliance.


Suppression of antibody-sensitized tumor cells by macrophages: insufficient supply or activation of macrophages within large tumors.

Systemic administration of antibody against the C3H lymphosarcoma 6C3HED caused complete suppression of the growth of 10(5) tumor cells. When the size of the tumor inoculum was increased to 10(6) tumor cells, excess antibody was unable to cause complete suppression unless exogenous macrophages were added to the tumor inocula. The decreased effectiveness of antibody was shown to be caused by a local deficiency in the supply or activation of macrophages within the large tumor grafts and not by a systemic deficiency.


The secular changes of skin and venereal diseases in Nigeria.

A retrospective review of the changing phase of the incidence of dermatological and venereal diseases, as seen in University Teaching Hospital practice in Lagos, Nigeria is presented. About 8,849 new patients were seen over a 5-year-period. An analysis of the dermatological conditions encountered is made, while brief reports of few common skin conditions are also given. The clinical pattern was similar to those of Western countries, but with addition of a great number of dermatoses. This similarity has been modified by epidemiological factors. A national program for improvement of the environmental health including control of industrial and communicable diseases will ameliorate the increasing morbidity of tropical dermatology.


Vaginal evisceration after forcible coitus with intraabdominal ejaculation.

An unusual case is presented of vaginal evisceration after forcible coitus in a healthy young woman with no anatomic defects or history of previous pelvic surgery. Intraabdominal ejaculation, documented cytologically, provided evidence of penile penetration of the pouch of Douglas. Etiologic mechanisms and management are discussed.


Electromyographic changes in postmeniscectomy patients. Role of the pneumatic tourniquet.

Delayed rehabilitation in postmeniscectomy patients may be due to a slowly resolving axonal compression syndrome secondary to the use of the pneumatic tourniquet. Twenty-five patients who underwent meniscectomy were examined to determine whether the pneumatic tourniquet used during the procedure caused a neurological dificit detectable by electromyography (EMG). Of these, 18 had postsurgical EMG changes that eventually resolved. Analysis of the data suggests a relationship between the occurrence of EMG abnormalities, the duration of the tourniquet inflation during surgery, and patient's recovery time. Quadricep muscle weakness after knee surgery has generally been attributed to disuse atrophy. In an attempt to prevent this problem, patients participate in a quadriceps exercise program, if possible, before surgery, with continuation after surgery. The persistence of weakness has been believed to be secondary to inadequate exercise.


Experience of the blood bank at the American University Hospital during the war in Lebanon.

The difficulties of switching from a community hospital blood bank type of practice to a field hospital blood bank operation with all the associated problems, are presented. Whole blood consumption markedly increased during the war while components use dropped and the voluntary benevolent donorship became the only source of blood supply. Guidelines of blood bank practice are derived from this experience.


Anaesthesia for condylectomy: a technique for blind nasal intubation.

A method of blind nasal intubation, using a muscle relaxant, has been described. The method is recommended in the absence of upper respiratory tract obstruction. If the anaesthesiologist does not have enough courage to administer a relaxant in the presence of ankylosis of the jaw, he can induce anaesthesia by an inhalational agent and if obstruction is not detected a muscle relaxant can safely be given to make intubation more easy and less traumatic.


Effects of analgesics during labor.

Four analgesic agents were studied during labour: pethidinesparine, ketamine hydrochloride, nitrous oxide-oxygen, and trichloroethylene in air (Trilene). Excellent analgesia was achieved with ketamine, however hallucinations were troublesome. Trichloroethylene analgesia was good without side-effects. Pethidine-sparine produced moderate analgesia but with nausea and/or vomiting. Nitrous oxide 50% presented poor analgesia. Uterine activity was insignificantly diminished in the late first stage after administration of all analgesic agents except with ketamine. There were no untoward effects on fetuses.


Cytology in surgical practice.

Early cytological diagnosis in a patient presenting with acute abdominal pain averted laparotomy and expedited successful management. The place of cytological diagnosis in patient management is discussed.


[Cholangiographic agents in chronic liver diseases: Can toxic liver cell damages be caused by jodoxamid?].

Jodoxamid, a new intravenous radiocontrast agent, did not increase serum enzymes and serum bilirubin in 40 patients with active chronic liver diseases diagnosed by laparoscopy and biopsy. The most necessary examination of the biliary tract in patients with liver diseases is obviously unobjectionable using this radiocontrast agent as well by injection as by infusion.


Dominant-lethal assay of selected cytostatics.

Dominant-lethal assays in male mice were made with the following cytostatics: Cyclophosphamide, TS-160, Edikron, Penberol, Cytembena, Mercaptopurine, Butocin, and Damvar. The cytostatics were administered mostly for 14-day periods, with the exception of Butocin (7 days) and high doses of Cyclophosphamide and TS-160 (single administrations). From the first day of administration on, the males were mated with intact females mostly at eight one-week intervals, and the quality of pregnancy was checked. Antifertility effects were found with TS 160, Penberol (at high dosage), and Mercaptopurine. Effects on permiogenesis with genetic risk were found with Cyclophosphamide, TS-160, Mercaptopurine, and less marked ones also with Cytembena. The effects were mostly manifested by increases in the numbers of early fetal resorptions, and less frequently by preimplantation loss of ova. No genetic risk was revealed by the assay in the cytostatics Edikron, Penberol, Butocin, and Damvar.


[Effects of conjugates of linolenic acid and erucic acid on rat cardiac and liver lipids].

Cardiac and liver lipids (triglycerides and phospholipids) were analyzed in weanling rats fed for 8 days diets containing 15% by weight of four different lipid mixtures: trierucin and peanut oil (1/1), trierucin and linseed oil (1/1), triolein and peanut oil (1/1), triolein and linseed oil (1/1). Linolenic acid (8 cal% of the diet) does not influence the steatogenic effect of erucic acid (15 cal% of the diet) on the myocardium but seems to increase the hepatic conversion of erucic acid into shorter monoenes (C 18:1 mainly). The (n-6), (n-3) fatty acid spectra in heart and liver phospholipids are strongly affected when linolenic acid is added to the diet whereas erucic acid has little effect.


Sexually transmitted infections in homosexual men.

Because of the form of sexual contact and the number of such contacts among homosexual men, physicians should be watchful for sexually transmitted infections in the homosexual community. Hepatitis B, anorectal gonorrhea, shigellosis, amebiasis, and giardiasis are now known to be among these infections. For treatment to be effective and epidemics avoided, physicians should question affected male patients about their sexual habits and advise abstinence from sexual contact until treatment is finished and cultures or smears are negative.


[Fibrinogen degradation products, soluble fibrin and antithrombin III in toxic goiter patients].

A total of 31 patients with toxic goiter of various severity were investigated; the blood and urine content of the products of fibrinogen and fibrin degrading (PFD), of soluble fibrin, antithrombin III, fibrinogen and fibrinolytic activity were studied. There was a marked elevation of PFD content in the blood and their normal content in the urine, an increase in soluble fibrin level, and fibrinolysis activation. Hyporegulation revealed in patients with toxic goiter is apparently connected with increased fibrin degradation, and is secondary in character.


[Role of thermovision in the diagnosis of surgical diseases of the thyroid gland].

Thermovision (thermography) was applied to the examination of patients with different thyroid gland pathology. The majority of benign formations of the organ were hypothermic, and hyperthermia was observed in the area of malignant tumour localization. A combined use of scannographic and thermovision methods widened possibilities of preoperative differential diagnosis of benign and malignant pathology of the thyroid gland. Hyperthermia was recorded in the area of the hyperfunctioning tissue localization in patients with diffuse toxic goiter with or without a node. Hyperthermia diminished during the treatment with thyrostatic agents; this could serve as control of the efficacy of the therapy and aid in the choice of the optimal periods for surgical intervention.


[Measurement of fluorescent polarisation in the amniotic fluid to assess fetal lung maturity (author's transl)].

A new method for determining fetal lung maturity is discussed. Molecular mobility can be determined spectrophotometrically by measuring the fluorescent polarisation (FP) in lipid solutions. This method of determining the microviscosity in lipid solutions can now be applied also in the amniotic fluid. Measurement of FP by means of an electro-optical microviscosimeter is proportional to the lipid concentration in the amniotic fluid and is in good correlation with fetal lung maturity. FP was measured between the 17th and 41st weeks of gestation in 147 amniotic fluid samples. During pregnancy the FP value drops significantly from 0.350 to 0.200. A FP value of 0.290 was fixed as the limit value beyond which RDS may be expected to occur. With a limit value of 0.290, the RDS identification probability was calculated at 94%, whereas the calculated probability of RDS was 81% and the exclusion probability of RDS 97%. At the same time, the probabilities, calculated on the parallel determination of the L/S ratio, yielded a slightly more unfavourable result. The drop in the FP level correlates significantly with the increase of the L/S ratio in the investigated amniotic fluid samples (correlation coefficient 0.77). The method, which requires very special equipment, offers many advantages: it is very accurate, simple, well reproducible and can be performed within half an hour at relatively low laboratory cost.


Carcinomas of the liver in Osborne-Mendel rats ingesting DDT.

Osborne-Mendel male and female rats ingested 200, 400, 600, or 800 ppm DDT composed of 81.8% p,p isomer and 18.2% o,p isomer for periods up to 2 years. Male and female rats developed highly significant incidences of hepatocellular carcinomas. The carcinomas varied from well-differentiated to undifferentiated. There was a highly significant increase in carcinomas of the ovary in treated female rats. Lymphosarcomas were also increased in DDT-treated male rats.


Cytoplasmic fragments causing spurious platelet counts in the leukemic phase of poorly differentiated lymphocytic lymphoma.

A patient with a leukemic phase of poorly differentiated lymphocytic lymphoma had a spuriously high automated platelet count because of cytoplasmic fragments. The number and relative percentage of cytoplasmic fragments increased during chemotherapy. The cytoplasmic fragments did not interfere with platelet aggregation using adenosine diphosphate, collagen, and epinephrine even though they were found in platelet-rich plasma. The ultrastructure of the cytoplasmic fragments is discussed. Cytoplasmic fragments as a cause of spuriously high automated platelet counts should be considered in cases of leukemic patients.


The declining incidence of infantile hypernatremic dehydration in Great Britain.

The feeding habits of 70 infants under 6 months old hospitalized with acute gastroenteritis were studied to determine whether current efforts to discourage high-solute feeding were having an effect on the incidence of hypernatremic dehydration. Fifteen infants (21%) were fed modified (low-solute) milks and 55 (79%) unmodified (high-solute) milks. Of 47 infants under 3 months old, 15 (32%) had commenced mixed feeding. Plasma sodium level was estimated in 60 infants. Mean values in the modified and unmodified groups were the same, at 137 mEq/liter. Only one infant was hypernatremic (sodium level, 152 m/eq/liter). Osmolalities of 65 samples of milk were measured to provide a measure of milk concentration. Only ten (16%) exceeded by more than 25% that recommended by the manufacturers. Twenty-two (34%) were less than 75% of the recommended concentrations. These improved feeding practices have probably contributed largely to the very low incidence of hypernatremia by preventing dangerously high solute intakes at a time of particular vulnerability.


Stimulation of fetal lung surfactant production by administration of 17beta-estradiol to the maternal rabbit.

We have investigated the effect of 17beta-estradiol on lung surfactant production in the fetal rabbit. Pregnant rabbits were administered intramuscularly 75microgram of 17beta-estradiol per day at 25 and 26 days' gestation. Control rabbits were similarly injected with the solvent only. At 27 days' gestation the fetuses were delivered by cesarean section and the lungs of the newborn rabbits were lavaged in situ with 0.9 per cent NaCl. Analysis of lung lavage and lavaged lung tissue phospholipids yielded the following results: (a) The 17beta-estradiol--treated group had three to four times more total phospholipid and phosphatidylcholine in the lung lavage than the control group. (b) The phosphatidylcholine/sphingomyelin ratio in the lung lavage was significantly higher in the treated than in the control group. (c) The lavaged lung tissue of the treated group had almost twice as much total phospholipid and phosphatidylcholine as the control group. These changes in lung phospholipid content and composition are in the direction of increased lung maturity and suggest that estrogen may have a role in fetal lung maturation and surfactant production.


The Friberg spermagglutination test--a modification.

In our laboratory we encountered problems interpreting the standard Friberg test. After an incubation period of four hours we could not interpret the test in 52 per cent of cases due to a high number of immobile spermatozoa and debris in the supernatant used as antigen in this test. By shortening the incubation period to two hours we could objectively interpret 76 per cent of cases. The applicability of the test was further improved by modifying the preparation of the antigen. Instead of using the supernatant of diluted semen, we "filtered" the motile sperm by means of the sperm penetration meter of Kremer. The capillary tube of the penetration meter was filled with virgin serum and incubated for one hour. After a four hour incubation this test could be applied in 80 per cent of cases, and after a two hour incubation period in all the cases. The reliability of this test was compared with the standard Friberg, the Kibrick and the Franklin-Dukes tests. The modifications did not alter the reliability of the test.


The effect of epinephrine on tracheal fluid flow and surfactant efflux in fetal sheep.

A marked decrease in fetal tracheal fluid flow and an increase in pulmonary surfactant efflux were found after infusion of epinephrine into fetal sheep. The data suggest that endogenous catecholamines may play a role in preparing the fetal lung for birth.


Neurotoxicity of intrathecal gentamicin: a case report and experimental study.

Distinctive lesions occurred in the brainstem of a 59-year-old patient who had had recent Pseudomonas aeruginosa meningitis treated with parenteral and intrathecal gentamicin sulfate. The lesions were multiple, minute, and discrete, and were characterized by loss of axons, spongiosis, axonal swelling with frequent calcification, loss of astroglia and oligodendroglia, and slight inflammatory response. These lesions were restricted to the myelinated fiber bundles of the pons and mesencephalon. Because similar lesions can occur with other intrathecally administered medications and emboli to the brain, an experimental study in rabbits was done. Similar lesions were produced in normal adult rabbits after a single intracisternal injection of gentamicin sulfate with or without preservative at doses equivalent to 50 and 100 times the human therapeutic dose. Lesions were not seen after injection of normal saline, preservative, or gentamicin sulfate with preservative at doses equivalent to 1 and 10 times the human therapeutic dose. A direct relationship was observed between the cerebrospinal fluid concentrations of gentamicin, brain tissue concentrations of gentamicin, and occurrence of the lesions.


Integrated electromyography of the vastus medialis muscle after meniscectomy.

Integrated electromyography (IEMG) is a valuable method for evaluating a muscle and documenting muscle rehabilitation. In a study of six adult males who had meniscectomies following tears of the medial meniscus, IEMG was performed to record the condition of the vastus medialis muscle preoperatively and at intervals (1 week, 1 month, 2 months, and 3 months) after the operation. The evidence shows that at 3 months postoperatively, all patients had a normal range of motion, and the extension force of the quadriceps muscle had reached values of the control leg; but the IEMG relative to the extension force revealed that the vastus medialis portion of the quadriceps was far from restored and needed a significantly higher activity to produce the same force as it had in the control leg.


Oxalosis in hemodialysis patients: a pathologic study of 80 cases.

The incidence and distribution of deposition of oxalate crystals were studied in various organs of 80 patients with chronic renal failure maintained on hemodialysis for periods ranging from three weeks to seven years. The most frequently involved organs were the kidneys, thyroid, and myocardium. Less prominent deposit was found in the spleen and the lungs. Moderate to severe renal oxalosis was encountered more frequently in patients maintained for longer periods on hemodialysis. The therapeutic implication of distinguishing secondary from primary oxalosis is stressed. The identification and the mechanism of deposition of oxalate in tissues are discussed.


Chronic interstitial nephritis and mixed cryoglobulinemia associated with drug abuse.

Two cases of chronic interstitial nephritis with renal insufficiency were associated with mixed cryoglobulinemia and parenteral drug abuse. Previously recognized causes of interstitial nephritis were not present in either case. Despite extensive interstitial inflammatory infiltrates, no substantial glomerular abnormalities or immune deposits were present in either patient. One patient had a history of intravenous injection of suspended methadone tablets containing talc crystals, and there was evidence of talc embolization in biopsy specimens of liver, spleen, and kidney. Interstitial nephritis associated with drug abuse has not been previously described to our knowledge, but the association in these cases seems not to have been fortuitous and warrants consideration in the evaluation of both parenteral drug abusers and patients with unexplained interstitial nephritis.


Identification of dense deposit disease: a report for the International Study of Kidney Diseases in Children.

The fluorescent dye thioflavin T stains intensely the deposits in dense deposit disease and can be used for identification purposes. Comparison of thioflavin T staining with electron microscopy was carried out in 25 patients and showed excellent congruity. Thioflavin T is much easier to use, but is less specific than electron microscopy. Cases of light chain disease and of some gammopathies can be a source of confusion. In nearly all other instances, the pattern of staining helps to differentiate dense deposits from other types of deposits and from amyloid.


Nodular renal blastema in trisomy 13.

The autopsy records and material of 14 cases of karyotype-proved trisomy 13 were reviewed. There were one or more foci of nodular renal blastema in six cases. Patients with nodular renal blastema had lived up to five days; patients in whom foci were not found at autopsy had lived six to 37 days. The presence of nodular renal blastema did not substantially correlate with other renal anomalies or the number or severity of extrarenal anomalies. The presence of nodular renal blastema in trisomy 13 expands the spectrum of syndromes associated with nodular renal blastema and supports its relationship with disorders of growth regulation. The presence of the lesions only in very young infants suggests that most, or all, foci of nodular renal blastema regress with age.


Neonatal nonbacterial thrombotic endocarditis.

Neonatal nonbacterial thrombotic endocarditis (NBTE), a rare disorder yet to be diagnosed antemortem, is described in two infants. The first infant was postmature and suffered from polycythemia and meconium aspiration. The meconium-stained placenta manifested evidence of ischemia and disseminated intravascular coagulation (DIC). The second patient was delivered near term by cesarean section, and hyaline membrane disease developed. The pathogenesis of NBTE may relate to perinatal hypoxia with transient tricuspid insufficiency, polycythemia, and DIC.


Quantitative changes in astrocytes after portacaval shunting in chimpanzees and in man with normal liver parenchyma.

Chimpanzees without liver cell damage, but subjected to portacaval anastomosis, showed behavioral changes that were accompanied by "Alzheimer II" astrocyte hyperplasia and nuclear enlargement. These findings were similar to those in a human patient with encephalopathy, secondary to a portacaval shunt, whose liver was normal. Controlled quantitative study of astrocytic hyperplasia in different anatomic regions showed the hyperplasia to involve the gray matter with only moderate topographic variation. Individual degrees of hyperplasia somewhat paralleled the severity of clinical symptoms and ammonia levels; no clear-cut relationship with time after shunting could be established. Portacaval shunt encephalopathy in chimpanzees greatly resembles that in man and, thus, lends itself to more detailed experimental analysis.


Angiosarcoma complicating generalized lymphangiectasia.

Multifocal angiosarcoma of the lower extremities developed in a 23-year-old patient with generalized lymphangiectasia. Eighteen cases of angiosarcoma complicating congenital or idiopathic lymphedema have previously been reported. The ages of the patients ranged from 13 to 65 years, with an average age of 40 years. There was an equal sex ratio. The extremities were the principal sites of involvement. No conclusion can be made regarding blood vessel or lymphatic origin of these tumors.


Glycocalyceal bodies and microvillous core rootlets: their value in tumor typing.

An ultrastructural study of the cell surface of lumen-forming tumors was carried out to determine the distribution of two morphologic markers seen in relation to the microvilli. These are membrane-bound glycocalyceal bodies and microvillous filament cores that penetrate the underlying cytoplasm as rootlets. They were found (especially when in combination) to be valuable in identifying tumors of what is referred to as intestinal-type epithelium, and could be seen in cases in which brush borders were absent. They have been demonstrated in intestinal-type carcinomas of the stomach and gallbladder, in adenocarcinomas of the small and large intestines and pancreatic ducts, in mucin-forming bronchiolar carcinomas, and in certain mucinous ovarian and endocervical tumors. Other tumors, whether mucin-producing or not, have been found to consistently lack these structures.


Venereal disease: what should the family doctor look for?

Venereal diseases, or sexually transmitted diseases as they are more aptly named, are emerging as a major medical problem. Although syphilis and gonorrhoea are the traditional venereal diseases, it is now widely accepted that sexual transmission occurs, at least to some degree, in a wide range of relatively common infective disorders. For the family physician coping with this group of diseases, there are a number of problems which include diagnostic difficulties, adequate supervision of treatment and general care and confidentiality within the family situation.


Thermotropic behavior of monoglucocerebroside--dipalmitoylphosphatidylcholine multilamellar liposomes.

The thermotropic behavior of multilamellar liposomes prepared from mixtures of glucocerebroside and dipalmitoylphosphatidylcholine has been studied by high-sensitivity scanning calorimetry. It is shown that glucocerebroside has a marked effect on the gel--liquid crystalline transition of dipalmitoylphosphatidylcholine. The pretransition seen in pure samples of dipalmitoylphosphatidylcholine is undetectable at small mode fractions of glucocerebrosides (less than 10%). The main transition is shifted to higher temperatures and becomes broader and less cooperative in the presence of glucocerebroside. The enthalpy change of the main transition decreases with increasing the glucocerebroside content. However, this decrease is not linear with the glucocerebroside/phospholipid mole ratio. Glucocerebroside itself does not show a separate transition in the temperature range of these studies (10--75 degree C). The origin of these effects and their dependence on the glucocerebroside content suggest that the in-plane distribution of glucocerebroside molecules is affected by the physical state of the lipid bilayer and by the glucocerebroside/phospholipid mole ratio.


Isoxsuprine infusion to the pregnant rabbit and its effect on fetal lung surfactant.

Rabbit does, pregnant on the 28th day, were infused with isoxsuprine 2.5 mg/kg body weight/h in 50 ml 5% glucose, or with glucose only. The isoxsuprine caused maternal heart rate to increase and blood pressure, mean and diastolic, to decrease. The volume of fetal pulmonary fluid (FPF) and the wet lung weight/body weight ratio were significantly lowered by isoxsuprine. Lecithin/sphingomyelin ratio of FPF in isoxsuprine-infused animals was higher, compared with controls, not infused. Minimal surface tension of FPF, evaluated with pulsating bubble, was significantly lower in treated fetuses. Histologic examination of the fetal lungs after fixation with potassium dichromate and mercuric chloride showed that in isoxsuprine-treated litters FPF contained more granular and sudanophilic material. The results offer further evidence that isoxsuprine causes dehydration of fetal lungs and a release of pulmonary surfactant.


Prevention of cicatricial retrolental fibroplasia by cryotherapy.

A premature infant who was developing cicatricial retrolental fibroplasia, was given cryotherapy to both eyes. This stopped the progress of the disease in almost all areas of the retina. The infant died three months later of complications related to prematurity. A comparison between the inadequately treated areas and those adequately treated during the clinical follow-up prior to death and in the pathology of the eyes confirms the value of cryotherapy in preventing cicatricial retrolental fibroplasia and indicates where it should be applied.


Changes in lymph node size following systemic irradiation for malignant lymphoma.

Changes in surface area of lymph nodes visualised on abdominal radiographs following lymphography were measured in 18 patients treated by systemic irradiation for non-Hodgkin's lymphoma. Eleven radiologically normal nodes in testicular tumour patients receiving higher doses of external irradiation were measured for comparison. Following lymphography spontaneous shrinkage by up to 20% of the surface area of the node was observed. Since spontaneous and continual regression of abdominal nodes can occur exceptionally in nodular lymphoma, treatment was deferred until there was evidence of an increase in the size of nodes judged as being involved by lymphoma. Two forms of systemic therapeutic irradiation were employed, total body (TBI) and hemi-body (HBI). The rate of nodal regression with both was comparable but the amount of regression, time to nadir of node size and subsequent growth delay, was greater for HBI than TBI.


[The correlationship between basal prolactin levels and the suppressive effect of CB-154 or L-DOPA on GH release in acromegalic patients (author's transl)].

It has been reported that the plasma growth hormone (GH) and prolactin (PRL) levels in acromegalic patients were suppressed after intensive administration of dopaminergic drugs, but we found that the plasma GH levels in some acromegalic patients were not suppressed. Plasma GH and PRL levels after a single oral administration of CB-154 (2.5mg) and L-DOPA (1g) were measured in 18 active acromegalic patients with and without galactorrhea. 1. The mean plasma GH levels after the administration were clearly suppressed in 8 patients with galactorrhea, while they were not suppressed in 10 patients without galactorrhea. These drugs were more effective in suppressing plasma GH levels in acromegalic patients with galactorrhea and hyperprolactinemia. 2. We calculated the responsiveness of the plasma GH level as follows: GH responsiveness (%) = (mean plasma GH level after the administration of CB-154 or L-DOPA)/ (basal GH level) x 100. The basal plasma PRL levels were inversely correlated with GH responsiveness (CB-154: r=-0.690, p less than 0.01. L-DOPA: r=-0.541, p less than 0.05). It was found that the effect of dopaminergic drugs on plasma GH levels was closely correlated with basal PRL levels in acromegalic patients. This implies that the chronic administration of CB-154 may be effective in acromegalic patients with galactorrhea and hyperprolactinemia.


Thyroglobulin and microsomal autoantibody production by cultures of Hashimoto peripheral blood lymphocytes.

Peripheral blood lymphocytes from patients with Hashimoto's thyroiditis have been cultured for 2--3 weeks in Marbrook flasks. During this period, readily detectable amounts of thyroglobulin and microsomal antibodies were synthesized by the cells and secreted into the culture medium. Gel filtration studies indicated that the autoantibodies produced in culture were of a similar molceular weight to the serum antibodies and this provided evidence that autoantibody synthesis in vitro was representative of autoantibody synthesis in vivo. Our data suggest that this culture technique may be used to make a detailed investigation of the human autoimmune disease process.


Fractures of the tibia through the proximal tibial epiphyseal cartilage.

Thirty-nine fractures of the tibia involving the proximal tibial epiphyseal cartilage were treated at the Campbell Clinic over a twenty-five-year period. Stress roentgenograms were essential in making the diagnosis in three patients. Two patients had disruption of the popliteal artery, and both had posterior displacement of the tibial shaft. The other immediate complications that we encountered were anterior compartment syndrome, peroneal-nerve palsy, and associated ligamentous and meniscal injuries. Of twenty-eight fractures (twenty seven patients) with an average follow-up of 7.1 years, there were satisfactory results in twenty-four. Unsatisfactory results (four fractures) were due to chronic neurovascular insufficiency, growth disturbance, or traumatic arthritis.


Cell division and cell allocation in early mouse development.

Cell division was observed in intact and dissociated mouse embryos between the 2-cell stage and the blastocyst in embryos developing in culture. Division to the 4-cell stage was usually asynchronous. The first cell to divide to the 4-cell stage produced descendants which tended to divide ahead of those cells produced by its slow partner at all subsequent stages of development up to the blastocyte stage. The descendants of the first cell to divide to the 4-cell stage did not subsequently have short cell cycles. The first cell or last cell to divide from the 4-cell stage was labelled with tritiated thymidine. The embryo was reassembled, and it was found that the first pair of cells to reach the 8-cell stage contributed disproportionately more descendants to the ICM when compared with the last cell to divide to the 8-cell stage.


Features of cell lineage in preimplantation mouse development.

The cell lineage of the mouse was studied from the 2-cell stage to the blastocyst. Lineage to the 8-cell stage was followed under the microscope. Each cell from the 2-cell stage divided to form two daughter cells which remained attached. Subsequently, these two daughters each produced two descendants; one of these descendants regularly lay deep in the structure of the embryo while the other was peripheral. Lineage to the blastocyst was followed by injecting oil drops into cells at the 8-cell stage, and then following the segregation of these drops into the inner cell mass and trophectoderm. Between the 8-cell stage and the blastocyst, the deep cells contributed more frequently to the inner cell mass than did the peripheral cells.


Surface activities of procaine, lidocaine, and tetracaine and their interaction energies with phospholipid monolayers.

The free energies of adsorption of procaine, lidocaine, and tetracaine at the air--water interface were estimated from plots of surface pressure (pi less than or equal to 5 dynes/cm) against bulk concentration. Their interaction energies with dipalmitoylphosphatidylethanolamine and dipalmitoyllecithin monolayers, previously spread at the air--water interface, were estimated from the increase of surface pressure with increasing concentrations of the subphase-injected anesthetic. Free energies of adsorption and the interaction energies were in the order procaine less than lidocaine less than tetracaine and correlate with relative anesthetic potencies and the blocking of nerve conduction.


Rate of fertilization in vitro and subsequent nuclear development as a function of the post-ovulatory age of the mouse egg.

Evidence is presented to indicate that older mouse eggs are fertilized more rapidly and also develop more rapidly to the pronuclear stage than younger ones. After a low (1.5 i.u.) or a high (7.5 i.u.) dose of PMSG, female mice were killed 13 or 17 h after hCG. The eggs were mixed in vitro with preincubated spermatozoa and fixed 1--1 1/4 h later. Although fertilization levels were high in all groups, the stages of egg activation and sperm head decondensation differed significantly. The observed ranking, from most to least rapid fertilization, of eggs obtained from females treated with 7.5 i.u. and killed 17 h after hCG, 1.5 i.u. and 13 h, and 7.5 i.u. and 13 h, was consistent with the approximate length of time the eggs had resided in the oviduct, i.e. the longer that time period, the more rapid the fertilization. When eggs were fixed 4 1/4 h after mixing with spermatozoa, the majority of older eggs were fully pronuclear while only a few of the younger eggs were as advanced, indicating accelerated nuclear development in the cytoplasm of the older eggs.


Focal dermal hypoplasia.

A case of focal dermal hypoplasia (FDH) or Goltz syndrome is described. The patient is a black female infant whose syndrome was first diagnosed at birth. This is a disorder of the mesoectoderm which is manifested by pigmentary skin changes similar to other disease entities, eg, incontinentia pigmenti and Rothmund-Thomson disease, but it is easily confirmed by specific significant histologic findings. The characteristic features are all noted in this infant throughout her follow-up, viz, atrophy and linear pigmentation of the skin, localized alopecia, papilloma and marked syndactyly. FDH is an X-linked condition and any physician caring for children should consider this diagnosis of the illness of the patient (especially female) who presents with the above dermal and skeletal changes.


The Rees system in infants: fresh gas flow and PaCO2.

Fresh gas flow from the anaesthetic machine can be set to determine the low level of PaCO2 that is achieved during anaesthesia using Rees variation of the T-piece. It does not however set the upper limits for PaCO2 which is more reliant upon the minute ventilation. For a PaCO2 of 40 mm Hg, it is suggested that the fresh gas flow from the machine be 220 cc/kg. For small infants, a higher flow rate is necessary.


Penetrating injuries of the heart and the great vessels.

An account of a personal experience with 18 cases of penetrating injuries of the heart and/or the great vessels due to shrapnels or bullets during the civil war in Lebanon is presented. Six of 18 patients were children. A survey of the literature did not disclose a description of these injuries in the pediatric group. Seven patients had signs of cardiac tamponade preoperatively. Fifteen patients had concomitant injuries to other organs. Emergency thoracotomy was used in patients within two hours after arrival to the hospital and was not preceded by pericardiocentesis. Cardio-pulmonary bypass was not used in any patient. There was one death which was related to associated injuries, giving a mortality rate of 5.5%. All survivors have resumed regular activities. Though the author is basically a pediatric surgeon, his expertise had to be stretched during the civil war to cover casualties in all age groups.


Metabolism of halothane after its repeated administration in man.

Metabolism of halothane following its repeated administration, was studied in three patients by estimating the blood bromide concentrations before, during and after halothane anaesthesia. In one patient, the blood halothane concentration was measured during and after its administration. The fraction of halothane metabolised was found to be increased after its repeated administration. This was proved by the rapid clearance of halothane and the increased blood bromide concentration.


Estimation of halothane in tissues by gas chromatography.

Halothane was extracted from tissues by n-heptane and estimated by gas-chromatography using an electron capture detector unit. Variation in halothane concentrations between adjacent pieces of tissue was found. The 95% confidence limits of a single estimation was +/- 10.8% of the mean for liver and +/- 6.1% for the muscle in pigs. The corresponding figures in rats were +/- 9.5% and +/- 3.0%.


Malignant lymphoma associated with marked eosinophilia.

A 60-year-old black man with poorly differentiated lymphocytic lymphoma presented with generalized lymphadenopathy and marked eosinophilia. Extensive evaluation of the eosinophils revealed them to be normal morphologically and functionally. The patient responded to corticosteroid therapy with resolution of the lymphadenopathy and reversion of the peripheral blood counts to normal limits. Recurrence of the original clinical picture within months prompted institution of systemic chemotherapy. Response was transient, and the patient expired after an unremitting downhill course. Recent advances in our knowledge of mechanisms of eosinophilia and eosinophil function are reviewed. The relationship of lymphoma to eosinophilia is discussed.


Comparison of the immediate effects of five beta-adrenoreceptor-blocking drugs with different ancillary properties in angina pectoris.

We compared the immediate effects of five beta-adrenoreceptor-blocking agents in 16 patients with stable angina pectoris. Acute dose-response studies showed that all five drugs improved exercise tolerance and reduced ST-segment depression, heart rate and blood pressure by a similar degree in comparison with a placebo (P less than 0.01). Near maximum improvement in exercise tolerance occurred when the acute cumulative oral dose had reached 160 mg for propranolol and oxprenolol, 200 mg for metoprolol and tolamolol and 400 mg for practolol. When these drugs were administered as a single doses, increase in walking time before the development of angina and reduction in ST-segment depression, heart rate and systolic blood pressure all occurred within one hour and persisted for eight hours--effects markedly different from the response to a placebo (P less than 0.01). These data show that non-cardioselective agents (propranolol and oxprenolol), cardioselective agents (practolol, metoprolol and tolamolol), as well as drugs with intrinsic sympathomimetic activity (oxprenolol and practolol), were equally effective in the treatment of angina pectoris.


Polyneuropathy, alopecia areata, and chronic lymphocytic thyroiditis.

A 14-year-old boy developed alopecia totalis shortly after a pertussis-like illness and, subsequently, developed chronic lymphocytic thyroiditis and diffuse polyneuritis.


Galvanic skin response in photosensitive children.

Investigations of galvanic skin response under stress by different stimuli were carried out in 65 photosensitive and 70 non-photosensitive subjects aged 11--17 years. Photosensitive individuals at the age of 12--15 years showed a more pronounced skin reaction than non-photosensitive ones. The emotional reagibility (expressed by IE = (SEE TEXT), Traxel 1960, Stocksmeier and Langosch 1973) shows significantly higher values than in nonphotosensitive children. In addition to this, photosensitive subjects demonstrate a delayed habituation. Together with further results (Gross-Selbeck et al. 1976) the findings indicate that photosensitivity is not the isolated symptom of a genetically determined increased cerebral excitability, which can represent a factor in the pathogenesis of epilepsy for instance, but must be understood as a special characteristic of a particular constitution.


Removal of craniopharyngioma by subnasal-transsphenoidal operation.

Two children with transsphenoidal microneurosurgical extirpation of a craniopharyngioma are presented. The value of this relatively new surgical approach is demonstrated, and the indication for transsphenoidal microsurgery in selected cases of craniopharyngioma is discussed in relation to the hitherto few similar case reports in the pertinent literature. The subnasal-transsphenoidal approach is the operative method of choice in purely or mainly intrasellar craniopharyngioma. This operation is also indicated in combined intra- and suprasellar craniopharyngiomas where the solid portion of the tumor is located intrasellarly and where the cystic part extends suprasellarly. In addition, the transsphenoidal operation may be a safe procedure in emergency cases with rapid loss of vision provided that the craniopharyngioma does not have a purely supra- and parasellar expansion. The esseential prerequisite for transsphenoidal neurosurgery in craniopharyngioma is an enlarged sella turcica. The importance of computerized cranial tomography with regard to preoperative differential diagnosis of a predominantly solid or cystic lesion and to postoperative control of radical tumor excision is emphasized. It is assumed that 25% of all patients with craniopharyngioma could benefit from transsphenoidal operation.


Computed tomography of the brain in children with minimal brain damage: a preliminary study of 46 children.

Forty-six children aged 4 to 15 years with minimal brain damage (MBD) underwent computed cranial tomography (CT). The criteria used for a diagnosis of MDB was the presence of clinical features of a developmental disturbance of the central nervous system causing incoordination. CT revealed abnormalities in 15 cases (32.6%), consisting in cerebral atrophy, asymmetry or an anomaly.


Sexually transmissible vaginal infections in pregnancy. 1. Common infections.

Infections of the reproductive tract in women of childbearing age menace not only the mother but also the offspring. Syphilis and gonorrhea may be lethal to the fetus. Candidiasis, trichomoniasis, and condylomata acuminata have less drastic effects on the fetus but if untreated are often troublesome to both the mother and child.


[Surveillance of sexually transmitted diseases: practical approach (author's transl)].

Even today we still do not have enough precise information either on the number of diseases which should be included in this collective concept or on the frequency of the diseases and their complications. Information is also lacking on methods for measuring these frequencies and assuring satisfactory surveillance. Various methods of gauging the frequency of these diseases are examined and evaluated and a practical surveillance programme is suggested.


Leukemic (or stage V) lymphosarcoma.

We have studied 24 cases of secondarily leukemic (stage V) lymphosarcoma (LS), 31 cases of "d'emblée" leukemic LS, and ten cases of lymphoid leukemic neoplasias transitional between "d'emblée" leukemic LS and chronic lymphocytic leukemia (CLL). These cases only concern the common types of the WHO classification of LS, i.e., the prolymphocytic, the lymhoblastic, and the immunoblastic. Some cases have also been classified by cell surface markers. The secondarily leukemic conversion occurred in 40% of the lymphoblastic types, in 14% of the prolymphocytic types, and in 17% of the immunoblastic types. It never occurred at stage I but could occur after any other stage. The mediastinal involvement was observed in three types, but most often in the lymphoblastic type. The prognosis after an acute lymphoid leukemia (ALL) treatment comprising active immunotherapy following chemo(radio)therapy is better for the leukemic prolymphocytic and lymphoblastic LS than for the immunoblastic type. Two patients (one of the lymphoblastic type) are in complete remission after 8 and 5 years, respectively. We have described ten cases of "d'emblée" leukemic LS with either large lymphoid or extra-lymphoid masses, bone marrow leukemic cell involvement, and LS aspects of neoplastic cells. Mediastinal abdominal, or other tumor masses are frequent. The prognosis for "d'emblée" leukemic LS following an ALL treatment is less favorable than ALL prognosis for patients of all ages including children. However, the first remission curve breaks at the 18th month and may form a plateau for about 30% of the patients of all ages. One patient has been in remission for more than 8 years after immunotherapy. We have also described ten cases of lymphoid neoplasia, whose cells cytologically and by the intensity of Ig secretion resemble leukemic prolymphocytic LS cells. However, the disease is more sensitive to CLL treatment than to LS or ALL treatment. Hence, there may be transitional conditions between leukemic LS and CLL. Finally, we have discussed the different possible frontiers between nonleukemic and leukemic LS and proposed two tests to detect the leukemic stage early: the systematic search for LS cells in the peripheral blood after concentration of nucleated cells by centrifugation and for cells carrying immune markers in the isolated mononuclear cell population of peripheral blood and the bone marrow.


[Autoimmunological receptor diseases].

Specific chemical signals are recognized by cell receptors which initiate an appropriate biologic response. Autoimmune reactions against hormone receptors can lead to failure of receptor function. Several mechanisms are responsible for either abnormal stimulation or blockade of the receptor-mediated intracellular events. Immunoglobulins which compete with hormone binding to receptors have been found in Graves' disease, in myasthenia gravis, in acanthosis nigricans with insulin resistance, and in a seizure disorder with primary IgA deficiency.


Cytokinetic analysis at various ages of an ascites tumor after radiation.

A cytokinetic analysis has been made of 5-day and of 10-day old murine 6C3HED ascites lymphosarcoma (Gardner) by using a growth curve, percentage of labeled mitoses curves, and continuous labeling curves. The doubling time increased from 36 h in the proliferative phase of growth to 252h in the stationary phase. The slowing down of the growth rate was due to prolongation of the cell cycle time, with greatest extension in G1 and increased cell loss. The measurement of the kinetic parameters made immediately after irradiation with a whole-body single dose of 3 Gy (300 rad) showed an increase in duration of the cell cycle in the 5-day-old tumor, while in the 10-day-old tumor the cell cycle time was decreased due to reduce length in the G1 phase.


[Rare malignant tumors of the lungs (44 cases)].

Since 1963 in the All-Union Research Institute of Clinical and Experimental Surgery 1445 patients with malignant lung tumors were operated upon, in 44 patients (3%) rare tumors were observed. The source of the rare tumors origination was: epithelium--in 14 cases, connective tissue--in 3, vessels--in 10, smooth muscle--in 3, nervous tissue--in 2, hemopoietic tissue--in 6, pleura--in 4. In one observation the tumor showed a mixed genesis, and in one case it exhibited a dysembryogenetic character. Rare malignant lung tumors (especially sarcomas, plasmocytomas, mesotheliomas) show a definite specificity of clinico-roentgenological manifestations, that should be taken into accout in establishing the differential diagnosis. The ultimate diagnosis was most frequently put after histological assay of the removed neoplasm. A total of 46 operations were performed (two patients were repeatedly operated upon). An extent of surgical interventions in rare malignant tumors is determined by the size, type of the tumor growth and its localization, and it is largely identical to that in lung cancer.


[The value of low-dose segmental or total body irradiation in generalized disease of the lymphoreticular system: a case report (author's transl)].

The application of low-dose segmental or total body irradiation to patients with generalized malignant non-Hodgkin lymphoma is discussed. The indications and irradiation procedure are presented in the light of a case report of a patient with generalized intra-abdominal lymphosarcoma and no evidence of disease 5 years after treatment.


[Suspension cultures of human malignant lymphoma in the leukocyte migration test].

The effects of supernatants of primary and secondary malignant human lymphoma cell cultures were analyzed as parameters of spontaneous secretion of factors by these cells using the leukocyte migration test (LMT). Spontaneous cultivation for up to five weeks was successful in four cases. The postulated production of mediators, i.e. the inhibitory and stimulating effects on leukocyte migration were characterized by testing the influence of (a) concentration, (b) temperature and (c) absorption with normal blood leukocytes on the effect. Reproducible stimulatory and inhibitory effects on the migration of normal leukocytes were dependent on concentration and temperature and were apparently mediated by one or more factors. The supernatants of a lymphoblastic lymphosarcoma of the T-cell type and of a lymphoblastic lymphosarcoma clearly revealed congruous and reproducible inhibitory effects. A further case of lymphoblastic lymphosarcoma that could not exactly be defined with immunological methods either and a case of centroblastic/centrocytic lymphosarcoma exhibited stimulating effects which could be reduced in a time-dependent manner through preincubation with blood leukocytes. The results of these studies support the assumption that malignant lymphoma cells are capable not only of secreting immunoglobulin, but also of other biologically effective secretion. The effects of such secretion are differentiated into stimulating and inhibitory ones. They might be important for the spreading of a tumor or for resistance of the organism to the disease.


Antibody-dependent cell-mediated cytotoxicity in Graves disease.

The antibody-dependent cell-mediated cytotoxicity of peripheral lymphocytes from patients with Graves disease was tested using chicken erythrocytes coated with rabbit antichicken red blood cell antibody and labelled with 51Cr. An increased cytotoxic activity was found in untreated Graves disease without ophthalmopathy. The cytotoxic activity was less elevated in the groups of patients with severe ophthalmopathy or high level of anti-thyroglobulin antibody, and approximately normal after methimazole treatment.


Ultrastructural alterations in mammary glands of pregnant rats after ovariectomy and hysterectomy: effect of adrenal steroids and prolactin.

Pregnant rats were subjected to oophorectomy and hysterectomy (O-H) on the seventeenth day of pregnancy, a time when serum levels of prolactin, estrogen, and corticosterone are not substantially greater than the respective levels in nonpregnant rats. At 32 hours after O-H, serum prolactin and corticosterone both rose more than threefold, and lactose appeared in the mammary glands. Biopsies of mammary tissue obtained at 8 hour intervals after O-H showed a progressive secretory response over 16 hours, similar to that previously shown to occur within a period of about 4 hours on the last day of pregnancy. Suppression of serum prolactin by ergocriptine administration and adrenalectomy 24 hours before O-H each prevented the secretory response. However, some differences in the effects of deprivation of the two types of hormones were evident. After cortisol acetate administration at O-H, mammary tissue responded rapidly despite adrenalectomy 24 hours earlier. It is concluded that simple withdrawal of progesterone is not sufficient to initiate lactation in the pregnant rat; glucocorticoids must be present continuously during progesterone withdrawal, and prolactin elevation and other factors present at parturition may be required as well.


Comparative cranial CT enhancement in a primate model of cerebral infarction.

The value of various enhancement techniques as opposed to nonenhanced CT scanning was compared in 15 baboons with cerebral infarction secondary to embolization of the left middle cerebral artery. The most prominent CT findings in infarction included an area of low absorption in the opercula--basal ganglia--centrum semiovale region and generalized lateral ventricular enlargement. Intravenous enhancement of the low-density region occurred in 25% of the animals and often obscured the preenhancement abnormality. However, a rapid bolus injection of contrast material followed by immediate consecutive CT scans (computed angiotomography) permitted prominent visualization of early-shunting veins. Delayed scanning following intrathecal enhancement better defined small infarctions that did not exhibit the usual cerebral blush. The CT imaging of inhaled xenon provides a new technique for evaluating subtle abnormalities in cerebral perfusion, even when the routine CT scan shows no abnormality.


Pyrrolo (1,4) benzodiazepine antitumor antibiotics: Biosynthetic studies on the conversion of tryptophan to the anthranilic acid moieties of sibiromycin and tomaymycin.

Biosynthetic intermediates between tryptophan and the anthranilate moieties of tomaymycin and sibiromycin have been suggested, based upon a combination of feeding experiments with either carbon-14-labeled substrates or competition experiments between radiolabeled tryptophan and unlabeled intermediates. In the case of sibiromycin and tomaymycin, substitution of the aromatic ring most likely takes place at the kynurenine stage. Feeding experiments with the anthramycin culture were inconclusive, most likely because of the cell impermeability.


Modification of the effects of LSD-25, d-amphetamine and tryptamine on electrically evoked responses in the visual system by methiothepin and octoclothepin.

LSD-25 (32 microgram/kg), d-amphetamine (3.2 mg/kg), and tryptamine (320 to 3200 microgram/kg) given intravenously depressed the response recorded in the visual cortex to electrical stimulation of the optic chiasm of the chloralose anesthetized cat. Relatively large doses of 1 mg/kg of the dibenzothiepin derivatives, methiothepin and octoclothepin, antagonized the depressant effects of both LSD-25 and tryptamine to a greater degree than d-amphetamine.


Melanosis of the choroid plexus, ependyma, subependymal neuroglia, and dentate and trigeminal motor nuclei: observations on the choroidal and ependymal cilia.

Melanosis of the choroid plexus, ependyma, subependymal neuroglia of the fourth ventricle, and dentate and trigeminal motor nuclei was found in a 50-year-old man who died with cor pulmonale, hypertensive cardiovascular disease, and intracerebral hemorrhage. This case is the first known example of melanosis not associated with neurocutaneous melanosis to involve multiple structures of the brain. Nonenzymatic conversion of lipofuscin into melanin is suggested as the mechanism of the melanosis. Cilia of the choroidal epithelium and ependyma were identified in this case, despite a long delay in postmortem examination. These observations on choroidal epithelium confirm previous reports that the choroid plexus of man is ciliated, as in other mammals and lower vertebrates.


Anencephaly and heterotopic central nervous tissue in lungs.

Heterotopic nodules of moderately well-differentiated central nervous tissue were seen in the lung of a full-term anencephalic baby who survived a few hours after birth. The pathogenesis of this rare condition remains obscure. None of the three hypotheses previously offered to explain this condition can be accepted or rejected on the basis of the recorded evidence.


Neuroblastoma and adrenal morphologic features in anencephalic infants.

At autopsy, an incidental congenital neuroblastoma was found in the adrenal gland of an 8-day-old full-term anencephalic baby. This previously unreported coincidence of neuroblastoma and anencephaly prompted a retrospective study of adrenal morphologic features in 20 anencephalic patients and 20 matched controls. Anencephalic adrenal glands were smaller and the fasciculoreticular zone was thinner (average 32%) than in the normal controls (average 76%). The neural crest-derived cells represented an average of 2% of the total gland area in anencephalic patients and 0.5% in the controls. These findings, statistically significant and compatible with previous studies, verify the deficient development of the fetal cortex in anencephalic patients. Furthermore, the neural component in anencephalic patients may be delayed in its maturation by the abnormal cortex, and thus may be prone to undergo malignant transformation and become a neuroblastoma.


Angiosarcoma of the spleen: a report of two cases and review of the literature.

Results of the ultrastructural study of one of two cases of splenic angiosarcoma established the blood vessel origin of this tumor. Fifty-three previously reported cases were reviewed. None of the 55 patients had a history of exposure to thorium dioxide, vinyl chloride, or arsenic, which are known to be associated with hepatic angiosarcoma and other tumors. A comparison of the splenic and hepatic angiosarcomas showed that tumors not associated with exogenous material frequently involve the spleen and liver simultaneously, and that tumors associated with thorium dioxide, vinyl chloride, or arsenic commonly involve the liver with sparing of the spleen.


The big and/or soft spleen: a survey of necropsy specimens.

A statistical survey of the necropsy population, for the year 1973, at the Veterans Administration Hospital, Long Beach, Calif, was performed to determine changes occurring in the spleen. When cirrhosis of the liver was present, spleens were usually enlarged but not substantially firmer. In cases in which there was no cirrhosis, severe systemic infection was not accompanied by splenomegaly, although spleen softening was present. Generally, spleen size did not appear to be related to its own consistency. However, when cirrhosis of the liver was present, severe infection was accompanied by a decrease in the size of the spleen, with no change in consistency; but in these cases, there was less infection at the time of death. Splenomalacia was not shown to be related to postmortem autolysis. The spleen weight decreased only slightly with aging.


Campylobacter fetus sepsis with mycotic aortic aneurysm.

Campylobacter fetus is a fastidious, curved, Gram-negative bacillus that has been increasingly associated with human disease. To our knowledge, we are reporting the first documented case of C fetus sepsis associated with an aortic mycotic aneurysm. Typical of previously reported cases of infections caused by this organism, this case involved a debilitated patient who was seen initially with a subacute febrile illness associated with bacteremia, but who died suddenly when the unsuspected aneurysm ruptured. The isolate was presumptively identified by its growth characteristics, motility, curved shape, and the presence of a single polar flagellum.


Hepatitis B antigen in hepatocytes of chronic active liver disease.

To study the morphologic interrelation of hepatocytes with the replication of hepatitis B vius (HBV) and immunocompetent cells in chronic active liver disease(CALD), organ cultures were prepared from liver biopsy specimens. Replication of hepatitis B core antigen (HBcAg) appears to occur in the nucleus of the hepatocyte in close association with intranuclear electron-dense strands and sometimes intranucleolar matrixes (likely HBcAg genomes), and cytoplasmic maturation of the HBcAg takes place in the preautolytic condition of host hepatocytes. Immunocompetent cells became progressively autolyzed in the early period of cultures. No difference in progression of hepatocyte injury in tissues from normal subjects and from hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative patients with CALD may suggest that intracellular synthesis of HBV alone is not cytopathic to host hepatocytes. This model is promising for the study of HBV replication and development, and also for testing the efficacy of new antiviral agents against the virus.


Indeterminate colitis in the spectrum of inflammatory bowel disease.

During a ten-year period, a double-blind retrospective study of 32 colectomy specimens from patients with inflammatory bowel disease (IBD) showed that the majority of cases could be clearly separated into ulcerative colitis (UC, 65%) and Crohn's disease (CD, 19%). However, in five (16%) colectomy specimens, the pathologic changes did not fulfill the criteria generally accepted for UC and CD. Criteria were laid down to differentiate the indeterminate form of colitis from the two more familiar types of IBD. We discuss the value of the category "indeterminate colitis" and emphasize that the term "transmural inflammation" is loosely used and that accurate definition of this criterion removes much of the difficulty from the differential diagnosis of IBD.


Lysosomes in Brenner's tumor simulating secretory argentaffin granules.

Argentaffin cells were searched for in the epithelial nests of 30 Brenner's tumors, with the Fontana-Masson stain for the screening. Although these cells were found in five tumors, ultrastructural examination of one case, in which the argentaffin cells were multiple, identified the cytoplasmic granules as lysosomes and not as amine precursor uptake and decarboxylation (APUD)-type granules. We conclude that the epithelial component of Brenner's tumors consists of urothelium only and does not include the cells containing argentaffin APUD-type granules.


Glomerular lesions in benign essential hypertension. A study of eight biopsy specimens with laboratory evidence suggestive of glomerular abnormalities.

We performed renal biopsies on eight patients who had benign essential hypertension but laboratory abnormalities suggestive of glomerulonephritis. Persistent microscopic hematuria was detected in four patients, proteinuria in five, RBC casts in two, and decreased glomerular filtration in seven. In all eight biopsy specimens, we detected hyaline arterionephrosclerosis, focal glomerular obsolescence, and segmental, afibrillar thickening of glomerular basement membranes. Direct immunofluorescence studies performed on all eight samples were negative for immunoglobulins, complement, and fibrinogen. Although the patients in our study had laboratory findings suggestive of glomerulonephritis, the morphologic changes were indicative of benign essential hypertension.


Conus medullaris syndrome following multiple intrathecal corticosteroid injections.

Few serious complications have been associated with the intrathecal administration of corticosteroids in the treatment of lumbar radiculopathy. This case of conus medullaris syndrome, which occurred coincident with multiple intrathecal steroid injections, suggests a more cautious approach to the treatment of benign disease by this method.


Interaction of polymorphonuclear leukocytes with immune complexes trapped in joint collagenous tissues.

The present experiments were designed to investigate in vitro interactions between polymorphonuclear leukocytes (PMN) and rabbit joint collagenous tissues containing trapped immune complexes. Articular cartilages and menisci from antigen-injected and control joints were incubated with normal PMN isolated from rabbit peritoneal exudates or blood. After incubation of cartilage and menisci from antigen-injected joints with PMN, large numbers of PMN became attached to the articular surface. In areas of superficial erosion, the PMN invaded the tissue several cell diameters below the articular surface. Through immunoelectron microscopy, degranulated PMN were observed in scattered areas to phagocytose amorphous material containing rabbit Ig. Following addition of PMN to control tissues, only a few PMN became attached to the articular surface. When tissues from monosodium urate-injected joints were incubated with PMN, these cells were found attached to the surface in moderate numbers, but invasion into the tissues was not seen. These studies indicate that immune complexes trapped in joint collagenous tissues may lead to enhanced release of lysosomal hydrolases.


Improved prognosis for patients with mediastinal lymphoblastic lymphoma.

Patients with diffuse lymphoblastic lymphoma (which includes convoluted lymphocytic lymphoma) with mediastinal involvement have predictable progression of disease to a leukemic phase that is cytologically indistinguishable from acute lymphoblastic leukemia (ALL). Therefore we treated 12 patients with diffuse lymphoblastic lymphoma involving the mediastinum with therapy that is effective in ALL. Treatment consisted of intermittent combination chemotherapy with adriamycin and preventive central nervous system therapy (craniocervical irradiation and intrathecal methotrexate). Mediastinal irradiation was given either for initial respiratory distress or to patients who had incomplete regression of disease following induction chemotherapy. Eleven patients achieve complete remission. With a median follow-up of 41 mo, and using life table analysis, 86% of these patients have remained in continuous complete remission. The results of this study demonstrate the efficacy of treating diffuse lymphoblastic lymphoma with mediastinal presentation as a disseminated lymphoid malignancy.


Alternative postmeniscectomy regimen.

Eighty patients who had undergone routine meniscectomy were divided into two groups for postoperative management. The first 40 patients were treated by the traditional method of a compression bandage with a backsplint, followed by a 10-day stay in hospital. In the other 40 patients a compression bandage was applied, reinforced by a plaster cylinder. Weight-bearing was allowed with the aid of crutches, and patients were discharged after four days in hospital. Adequate splintage and early ambulation was more convenient and comfortable for postoperative management, and no complications ensued. Less time was needed for physiotherapy, and earlier return to work and resumption of normal activities were made easier.


Induction of neurofibrillary degeneration following treatment with maytansine in vivo.

The effects of maytansine (MYT), a naturally occurring ansa macrolide and potent antimitotic drug that binds to tubulin, were studied by light and electron microscopy in the central nervous system of rabbits. Respectively, 17 and 5 animals were sacrified at various time intervals following a single intrathecal or intraocular injection of the agent. The rabbits responded to the intrathecal injection with progressively severe weakness. By 19 h following injection the neurons of the cervical spinal cord, medulla and pons showed, by light microscopy, a marked clumping of the Nissl substance, while on the third day and later the nerve cell perikarya and dendrites displayed severe neurofibrillary changes. By electron microscopy several cytological alterations were observed as early as 19 h; among them were the clumping of the rough endoplasmic reticulum, the reduction in number of microtubules, and the presence of a fine, floccular and amorphous material. The perikaryonal and dendritic neurofibrillary changes appeared as tangles and/or bundles of10 nm neurofilaments. In the intraocularly injected rabbits the earliest changes observed in retinal ganglion cells were the severe reduction in microtubule number and the presence of an amorphous material. The neurofibrillary changes seen at later times were comparable with those observed in the cervical cord and brain stem. Although the molecular events occurring between the formation of the intracytoplasmic MYT-tubulin complexes and the accumulation of filaments are not known, the present results indicate that the proliferation of neurofilaments is chronologically preceded by the reduction in number of the microtubules and by the appearance of an amorphous floccular material in the cytoplasm. It is emphasized that despite differences in binding characteristics and physico-chemical properties, maytansine, colchicine and the Vinca alkaloids have, as a common denominator, the property of interfering with the process of utilization of tubulin and in that way they seem to differ from other chemical agents known to induce neurofibrillary degeneration.


Effect of non-fat dry milk on recovery of staphylococcal thermonuclease from foods.

Modification of the method of Tatini et al. (1976) by addition of non-fat dry milk (NFDM) to food samples and subsequent acid precipitation at pH 3.8 enhanced the recovery of staphylococcal thermonuclease (TNase) from most of 37 foods tested. The modified TNase assay method allowed detection of 10 ng (0.002 units) of the enzyme per gram of each of the following foods: ground beef, boiled egg products, whey powder, fruit-containing yogurt, dressings and spreads, potato and egg salads, and pastas, all of which gave false-negative results without NFDM.


The effects of fenclozic acid on fertility of male rats.

Fenclozic acid, a prostaglandin synthesis inhibitor, was administered to male rats by stomach intubation. A second group of rats received the vehicle (1% methylcellulose) alone. The dose schedule used was 75 mg/kg on day 1, 50 mg/kg on day 2 and 25 mg/kg on days 3, 4 and 5. The dose was progressively reduced to eliminate the toxic effects seen in the initial stages of the treatment. All the animals had normal fertility and libido before treatment and during administration of the vehicle. However, sterility or subfertility was seen in 4 of the 6 animals treated with fenclozic acid. Sperm were always present in the vaginal smears. It was concluded that the reduction in fertility was probably caused by an effect of the drug on maturation or metabolism of the sperm.


Esophageal motor function in Graves' disease.

Esophageal motor function was studied in 10 patients with untreated Graves' disease and 15 healthy volunteers who served as controls. A noncompliant recording system with a triple-lumen assembly was used. Resting upper- and lower-esophageal-sphincter pressures, amplitude, duration, and velocity of peristaltic contractions in the body of the esophagus, and the number of repetitive and simultaneous contractions were measured. There was no significant difference in peristaltic amplitude and duration between the controls and the patients with Graves' disease. However, there was a significant increase in velocity of contractions in Graves' disease as compared with controls. On restudy of 5 patients who became euthyroid after treatment with 131I, all the measured parameters were unchanged except for velocity of the peristaltic contractions. The value for this measurement decreased essentially to the same as that found in the control subjects. It is concluded that: (1) thyrotoxicosis increases the propagation velocity of esophageal contraction, and (2) thyroid hormones may play a physiologic role in the control of esophageal motor function.


[Tracheal phospholipid composition and respiratory distress syndrome of the newborn].

Tracheal or pharyngeal aspirates were collected in 50 newborn infants with and without respiratory distress syndrome (RDS). After lipid extraction the phospholipids were analyzed with 2-dimensional thin layer chromatography. Surface-active are lecithin (PC), phosphatidylglycerol (PG), and phosphatidylinositol (PI). Newborn infants with RDS always have a complete lack of PG, which makes up to 11% of phospholipid-phosphors in mature newborns. In all infants with and without RDS, a sharp increase of PC occurs in the lung effluent after birth. The recovery from RDS is characterized by marked changes of PI: this phospholipid rises up to twice its initial value if the infants survive. The PI-increase parallels the clinical improvement and reaches its maximum usually on the 5th day of life. At the time of the PI-peak, the infants' surfactant function is sufficient to maintain alveolar stability with spontaneous breathing. In infants dying from RDS the PI-increase was not observed.


Preparative merits of the mixed anhydride (MA) method in the excess use of DDZ-amino acids in the peptide synthesis of biologically active new antamanide analogues.

The mixed anhydride (MA) method of peptide synthesis is further simplified by the repetitive excess use of Ddz-amino acids. In six comparative preparations of decapeptides this is demonstrated by the ease and speed of the synthetic manipulations, the efficiency of the monitoring of the reactions and purifications, and by the complete recycling of excess amino acid derivatives. In using of Ddz-amino acyl isobutylformate mixed anhydrides, side reactions are effectively suppressed, as proved by good coupling of Ddz-proline on to prolyl-peptides. Hydrophilic, crystalline and biological active antamanide analogues are obtained containg various functional side groups. The known cis-conformation of the antamanide prolyl-prolyl bonds is also established in the analogues by 13C-n.m.r. measurements. All new compounds are characterized by molecular peaks in the mass spectra.