Isolated FSH deficiency in a male. A case report.

This report describes the case of a 26-year-old man investigated because of infertility. The patient appeared healthy with normal sexual activity, physical appearance and karyotype. Repeated semen analyses showed a marked oligozoospermia. A testicular biopsy specimen revealed arrested spermatogenesis and normal Leydig cells. Hormone analyses were normal except for a markedly reduced serum FSH level. Only a few such cases have been previously reported.


Giant cell arteritis. Clinical features and involvement of different organs.

Sixty-eight patients with giant cell arteritis (GCA) are described. In 42, histological evidence of arteritis was recorded at biopsy of a temporal artery. Twenty-six patients were included according to clinical criteria. In 20 patients the onset of illness was associated with an infection. The first symptom was: in 30 patients, muscle pains; in 14, fever; in 11, headache with temporal localization, and in 13 patients, tiredness and anorexia. In all, 50 patients had muscular symptoms and 30 had symptoms of localized temporal arteritis. In 5 patients neither muscular symptoms nor localized arteritis were found. A high erythrocyte sedimentation rate was seen in all cases and elevated platelet count was found in 24 patients. Abnormal liver function was a common finding, whereas impaired renal function was not observed. In 8 cases reversible eye symptoms were noted and reduced hearing capacity was demonstrated in 5 patients.


HLA antigens in females with ankylosing spondylitis and other forms of seronegative rheumatic diseases.

A total of 222 female patients with seronegative rheumatic diseases were investigated by sacroiliac joint X-ray and HLA-A, B and Ctyped. The frequency of the B27 antigen was significantly increased in the following groups: definite pelvospondylitis (26 patients and relative risk (RR) = 99), possible pelvospondylitis (20 patients, RR=4.5), definite sacroiliitis (14 patients, RR-20.1) and uroarthritis (8 patients). When 24 B27 negative patients from these B27 associated diseases were analysed, significantly increased frequencies of the BW22 (RR=16.7) and CW1 (RR=14.4) antigens were found. There were no significantly deviating HLA frequencies in the following diagnostic groups: clinical sacroiliitis (20 patients), polyarthritis with clinically silent sacroiliitis (12 patients), polyarthritis without sacroiliitis (47 patients), arthralgia preceded by beta-streptococcal infection (17 patients), other arthralgia (33 patients), osteo-arthritis (13 patients) and other arthritis (12 patients).


Use of physician services by a middle-aged population in a rural health centre district in southwest Finland. Descriptive distributions.

The use of physician services by a middle-aged population was investigated in connection with a multiphasic screening programme in two rural municipalities in Southwest Finland. The screening programme was attended by 1223 (93.2%) females and 1045 (93.4%) males, 40 to 64 years of age. Two-thirds of the subjects (61% of the men and 69% of the women) had seen a doctor during the previous year because of illness, symptoms or accident. The mean of the face-to-face physician contacts was 2.3 times a year per person, the women having had more contacts (2.4) than the men (2.1). In all, about half (52%) of the subjects had visited the health centre physician during the previous year for the previously mentioned reasons. Ten per cent of the subjects had seen a private specialist and another 10% had seen a physician at an outpatient clinic of a central or district hospital. More than one-third of those who had seen a physician at the health centre had visited the health centre at least three times within a year, whereas only one-sixth of those who had used the services of a private practitioner had seen the private practitioner as often. Proportionately, those visiting mental health offices used the services of a physician the most often, for the majority of them (77%) had seen a psychiatrist at this office at least three times during the year.


Untreated psychiatric disability. A study of disabled persons with major psychiatric health impairment, having never received psychiatric treatment.

The presented investigation, from a county seemingly representative of the average for Norway, showed that at least 15% of male Disability Pensioners with a psychiatric primary diagnosis, become pensioned without having had any psychiatric treatment. The purpose of the investigation was to describe this group of untreated psychiatric disabled, both numerically and regarding social, personal and nosological factors. It was found that the absence of treatment was due to lack of opportunity, but to the pensioner's own attitude, a stubborn resistance to being defind as a psychiatric patient. This is enhanced by a general tendency in our culture to choose, when possible, the role of a somatic patient rather than that of a psychiatric patient. The untreated group of male Disability Pensioners had a normal distribution of social status and stability, and showed a strong preponderance of neurosis-like conditions, combined with pains and other symptoms from the musculo-skeletal system in 51% of the clients. Among War Pensioners there were also found many untreated psychiatric disabled, especially ex-wartime seamen, showing a surprisingly constant syndrome of mixed anxiety and asthenia. The material comprised 150 males, 101 applicants for Disability Pension and 49 for War Pension, all untreated.


A new method for investigating the relation between change and initial value in longitudinal blood pressure data. II. Comparison with other methods.

Whether initial value affects blood pressure change or not is of interest in longitudinal blood pressure studies. The change/initial value relationship is, however, biased by the regression towards the mean phenomenon, as blood pressure measurements contain random errors (short-term intra-individual variation and measurement errors). Two methods (here called C and D) of avoiding this bias have earlier been proposed and used in population studies in South Wales and Framingham, with conflicting results. In the preceding paper a new method of avoiding the bias has been presented. In the present paper a comparison of the new method with the two earlier is made by applying them to the same data set. Method C indicates, as in South Wales, a highly significant positive relationship, while method D (as in Framingham) and the new method give a regression coefficient close to zero. The structure of the three methods is analysed. Method C is shown to be valid only under very restricted conditions and is best avoided. Method D gives a fairly accurate result, but underestimates the coefficient by approximately 30% in this case. The new method proposed seems to be the best method hitherto for this kind of analysis.


Mortality by marital status and social class in Finland during 1969--1971. Mortality from natural and violent causes.

In this paper a study of the distribution of mortality rates by social class and marital status for men and women in three age groups (25--44, 45--64 and 65--84) is presented. Natural and violent causes of death are analysed separately. The death certificates of Finnish citizens for the years 1969, 1970 and 1971 (totalling 137780) were analysed and mortality rates standarized using as reference population the data from the 1970 census. It is shown that certain combinations of social class and marital status can be considered as significant risk factors for mortality in the Finnish population.


Distributing medical care services. Coronary care units in the United States and Sweden.

Planning in the United States is based on an institution's perceived need, whereas in many other countries it is based on population need. These unique approaches to planning have led to widely differing distributions of facilities and services. Planning by the U.S. method leads to a more generous provision of services than does population-based planning. In both planning systems, the planning process appears of paramount importance, while the fundamental questions of effectiveness outcome and impact of medical care services are usually ignored. Even population-based planning either cannot or will not deal with the conflict between professional desire for highly developed technology on the one hand and treatment effectiveness on the other. Nevertheless, population-based planning has at least the virtue of providing a less expensive yet more efficient system. Physicians and the public appear able to adjust to the quite different resource provisions of the two planning systems; both the abundant U.S. supply and the restricted supply in Sweden are perceived as adequate.


Clinical evaluation of the Björk-Shiley tilting disc valve in the tricuspid position. Early and late results in 10 isolated and 51 combined cases.

Tricuspid valve replacement with the Björk-Shiley tilting disc valve was performed in 61 consecutive patients with either organic disease causing valve malfunction or functional regurgitation of severe degree. The early mortality rate was 21% (13/61) for the entire series. It was 10% (1/10) for tricuspid valve replacement alone, 27% (9/33) for mitral and tricuspid valve replacement, and 18% (3/17) for triple valve replacement. Age over 60 years, functional capacity group IV (N.Y.H.A.) and heart volume over 900 ml/m2 BSA were factors associated with a high operative mortality. There were 3 late deaths, 42, 42 and 45 months, respectively, after surgery, due to arrhythmia (2) and anticoagulant complications (1). The Björk-Shiley prosthesis has functioned well and with satisfactory clinical improvement in the majority of the 48 long-term survivors, for an average period of 2.8 years. There were, however, 3 cases of prosthetic valve failure due to thrombotic obstruction following isolated tricuspid replacement because of Ebstein's anomaly (2) and traumatic tricuspid valvular incompetence (1). Reoperation with insertion of a new Björk-Shiley prosthesis involved no mortality. One patient, however, had a recurrent prosthetic thrombosis which was successfully treated with streptokinase. Only one patient in the series, who underwent triple valve replacement, suffered from systemic embolism, an incidence of 0.7 per 100 patient years. There were no episodes of pulmonary embolism or infective endocarditis.


Aortic valve replacement. A randomized study comparing the Björk-Shiley and Lillehei-Kaster disc valves. Peroperative haemodynamic evaluation and early results.

Three hundred patients were selected at random in order to compare the Björk-Shiley and the Lillehei-Kaster valves in the aortic position. Peroperative haemodynamic evaluations were carried out in 106 cases. The effective orifice area of the valves and the effective area index were calculated. The results indicate that the Björk-Shiley valves utilize the available space in the aortic root about 12% better than the Lillehei-Kaster valves. There were 11 hospital deaths, but none of them were valve related.


Circulatory adaptation after aortic valve replacement. A clinical study peroperatively and in the early postoperative period.

The myocardial function and the central and peripheral circulation were studied after aortic valve replacement. All patients showed a similar postoperative pattern of response. During the operation, after termination of bypass, the mean arterial blood pressure (Pa,m) was low. The total peripheral vascular resistance (TPR) and pulmonary vascular resistance (PVR) were normal. Immediately after the operation Pa,m, TPR and PVR were higher than peroperatively. The cardiac index (CI) and stroke index (SI) were low, and the heart rate (HR) was high. At this stage the oesophageal temperature was increasing, but there was no shivering. Then followed a period in which Pa,m and TPR decreased, while CI and SI remained essentially unchanged. The oesophageal temperature reached its highest value 5 hours postoperatively. Peripheral warming began in the 3rd hour postoperatively and was completed in the 6th hour, when the peripheral temperature was 35 degrees C. The progressive peripheral warming, with peripheral cutaneous vasodilatation and slight reduction of the heart rate, took place without signs of increasing CI or SI. The left and right ventricular function, expressed as the relation between LVSWI and Pla,m, and RVSWI and Pra,m, respectively, varied postoperatively and showed no signs of improvement at the time of peripheral warming. Cardiac output and myocardial function seemed to be little affected by the obvious changes appearing during the systemic and peripheral vasodilatation in connection with central and peripheral warming.


Haemodynamic effects of ethanol immediately after aortic valve replacement. A clinical study peroperatively and in the early postoperative period.

The haemodynamic effects of intravenous (i.v.) administration of ethanol were studied in two groups of patients--groups IV and V--during the first hours after aortic valve replacement. A group of seven patients, who underwent the same operation but were not treated with ethanol, served as controls (Klingen et al., 1978 c). The ethanol was given by continuous i.v. infusion. It was started after termination of bypass and was continued for 6 hours postoperatively. Group IV (9 patients) had a blood concentration of about 20 mmol/l. Group V (8 patients) had a blood concentration constant at 35-40 mmol/l. Groups IV and V differed from group III in their reactions in the following respects, and the differences may be attributed to the ethanol. In the former groups the arterial (systemic) blood pressure and total peripheral vascular resistance were lower (P less than 0.01 and P less than 0.001, respectively). Cardiac output was higher (P less than 0.05) and the arteriovenous oxygen difference lower (P less than 0.01) in group IV and V and increased at an early stage (P less than 0.01). The study shows that ethanol in blood concentrations of 20 and 35-40 mmol/l has approximately the same vasodilative effect, with no influence on the heart rate and no depressive effect on myocardial function; on the contrary this function tended to be stimulated at a blood concentration of 35-40 mmol/l.


Effect of initial myocardial anoxia on coronary flow during aortic valve replacement.

Flow to the right and left coronary arteries was recorded continuously during aortic valve replacement using continous constant-pressure coronary perfusion at 32 degrees C in 13 patients. The initially high coronary flow decreased gradually until a certain level, the so-called resting flow level, was reached and stabilized there as long as perfusion temperature remained unchanged. At 32 degrees C, resting flow was about 50% of the peak hyperaemic flow. The length of preceding anoxia had a significant effect on the duration of reactive hyperaemic response. After a short anoxic period, resting flow level was reached in about 3 min, after moderate period in 15 min and after long anoxia in 35 min, respectively.


Mediastinal tumours. A follow-up study of 208 patients.

During the twenty-year period 1954--1973, 208 patients were referred to the Department of Thoracic and Cardiovascular Surgery for treatment of mediastinal tumours. Forty-nine patients had malignant tumours (24%), 86 benign tumours and 73 non-neoplastic lesions. The most common histologic types were neurogenic tumours and malignant lymphomas, followed by thymomas and germinal tumours. Most non-neoplastic lesions were cysts. The mediastinal tumours were often asymptomatic, the malignant tumours in 31%, the benign tumours and tumourlike lesions in 65% of the cases. The most common symptom was pain, which occurred in one-fifth of the patients. The most useful diagnostic method was X-ray examination of the chest. However, a final diagnosis could usually be made only at operation. Thirteen malignant tumours were excised radically, 18 palliatively and 18 were only biopsied. Almost all benign tumours were radically excised. Forty-four patients received postoperative radiation therapy and 6 received chemotherapy. The hospital mortality was 8.2% for the patients with malignant tumours and 1.9% for those with benign tumours. At the end of the follow-up period, which varied from 2 to 21 years (median 10.3 years), 41% of the patients with malignant tumours were alive. Two patients with benign tumours had died of an apparently malignant change in a neurofibroma.


Thoracic duct cyst of the mediastinum. A case report.

There are only a few reports in the literature on cysts of the thoracic duct. This case report concerns a 56-year-old female patient, who was operated on because of a mediastinal mass that later proved to be a cyst of the thoracic duct. The operation and immediate postoperative course were uneventful. Six months later, the patient was doing well and no further investigations were recommended.


Oesophageal tissue reaction to different suture materials. An experimental study in the cat.

Oesophageal tissue reaction to different suture materials (chromic catgut, silk, prolene and stainless steel wire) was analysed and compared in 45 cats with and without reflux oesophagitis. Diffuse reflux oesophagitis was produced in 12 out of 21 animals subjected to oesophagocardiomyotomy (Marwedel-Wendel) combined with production of a fixed hiatal hernia of sliding type. Steel wire sutures produced minimal tissue reaction and undisturbed fibroplasia both in the intact oesophagus and in the presence of reflux oesophagitis. The steel wire sutures were found to be superior to the chromic catgut, silk, and prolene.


Pigmenturia following direct muscle injury and delayed arterial reconstructive surgery. A case report.

A case is presented with severe muscular trauma to the lower leg and ischaemia of nine hours duration secondary to a totally disrupted popliteal artery and vein. Following successful revascularisation and fasciotomies, the patient developed an extreme local muscular oedma, pigmenturia and impaired renal function. It is concluded that the pigmenturia was a mixture of both myoglobinuria and haematuria, dependent on an acute toxic nephrosis, due in part to rhabdomyolysis and in part to the effect of delayed revascularisation. Extensive fasciotomies completed at the time of revascularisation almost certainly attenuated the metabolic-toxic process to a large degree and contributed to the fair functional outcome.


Debrisan: an effective new wound cleanser.

Debrisan (Pharmacia GB), an insoluble hydrophilic powder of polymerised dextran, has recently become available in Britain as a wound cleansing agent. So far it has proved to be an effective, if costly, agent for the initial cleaning of moist varicose ulcers, but once the slough has been removed, it has no advantage over more traditional methods in promoting ulcer healing.


Indications for the use of tranylcypromine and trifluoperazine (Parstelin).

Thirty-two patients were treated with the combination of tranylcypromine and trifluoperazine (Parstelin). The patients fell into 3 clinical groups, namely, endogenous depression (7 patients), neurotic depressive reaction (10 patients) and phobic anxiety with some depressive features (15 patients). Satisfactory response was found in 10 out of the 15 patients with phobic symptoms. The response in the other 2 groups was not significant. Side effects were troublesome in the neurotic depressive reaction group. In the phobic group the symptoms of the patients who responded were inclined to recur when the treatment was discontinued. It is considered that it is a useful preparation in the treatment of some phobic patients, but one must expect that the patients are likely to have to remain on the drug for long periods of time.


Loss of division potential in vitro: aging or differentiation?

We have examined the hypothesis that diploid cells grown in vitro age, and propose that only proliferative potential and not life-span is telescoped. We suggest that explanted or transplanted diploid cells are driven to divide by the process of subculturing in vitro or in vivo and, in response to this pressure, also complete their differentiation and become refractory to further mitotic stimulation. We conclude that differentiation rather than "mortality" distinguishes diploid from transformed cells and that the former may not age in vitro, but are lost because culture methods are selective for cycling cells.


Intracellular calcium: its release from granules during bursting activity in snail neurons.

Pentylenetetrazole induces a bursting activity accompanied by intracellular movement of calcium toward the cell membrane in the snail neuron. The calcium appears to originate from the dense lysosome-like granules in the cytoplasm. Pentylenetetrazole markedly depletes the granules of calcium and alters them ultrastructurally from dense granules to lamella type granules.


Intraventricular alloxan eliminates feeding elicited by 2-deoxyglucose.

Evidence suggests that alloxan reacts with membrane-bound glucoreceptors and that it competes with glucose molecules for these sites. We therefore administered small quantities of alloxan into the cerebrospinal fluid of rats to determine what effect this might have on their ability to react to changes of glucose concentration. Rats treated in this manner did not eat as much as controls in response to the intraperitoneal administration of 2-deoxyglucose or to a 24-hour fast, and they became hypoglycemic significantly sooner than controls when fasted. The data suggest that the function of brain glucoreceptors is to protect the body from sudden decreases of glucose and that these glucoreceptors play little if any role in the normal regulation or maintenance of feeding, body weight, or blood glucose concentrations.


Short-term memory: the "storage" component of human brain responses predicts recall.

An evoked potential component with a poststimulus peak at about 250 milliseconds is related to the storage of information in short-term memory. This storage component was found in an investigation of brain potentials in relation to a number and letter comparison task. In replications of this experiment at three different light intensities spaced 1.0 log unit apart, the component had essentially the same waveform and pattern of scores. The memory storage interpretation was confirmed in a behavioral experiment that probed short-term memory. Recall was predicted by the magnitude of the storage component.


Exponential decrease during aging and random lifetime of mouse spermatogonial stem cells.

Variation in the number of spermatogonial stem cells during the lifespan of the mouse was examined by assaying the number of clonogenic cells, that is, spermatogenic stem cells, surviving known doses of radiation. The results indicated that the stem cell number decreased exponentially with age.


Cloning human fetal gamma globin and mouse alpha-type globin DNA: preparation and screening of shotgun collections.

Shotgun collections of Charon 3A bacteriophages containing Eco RI fragments of human and mouse DNA were constructed with the use of in vitro packaging. Plaques were screened by hybridization, and globin-specific clones were isolated from both human (Charon 3AHs51.1) and mouse (Charon 3AMm30.5). The fragments cloned were detected in unfractionated genomic DNA by the Southern method of hybridization.


Cloning human fetal gamma globin and mouse alpha-type globin DNA: characterization and partial sequencing.

Two globin-related clones isolated from collections of bacteriophages containing unfractionated Eco RI fragments of human and mouse DNA were characterized. Charon3AHs51.1Hbgamma includes 2.7 kilobase pairs of human DNA containing a large part of a fetal gamma globin chain structural gene; Charon 3AMm30.5 includes 4.7 kilobase pairs of mouse DNA related to alpha globin. The human fetal gamma globin gene has within its coding region two intervening sequences of noncoding DNA, IVS 1 and IVS 2, of approximately 1-0 and 900 base pairs. Sequence IVS 1 is located at the position of one of the two intervening sequences occurring in adult globin genes; IVS 2 is located at the position of the other.


Human leukocyte interferon purified to homogeneity.

One of the species of human interferon produced by incubation of leukocytes with Newcastle disease virus was purified to homogeneity. It exhibited one peak of activity coinciding with a single protein band on sodium dodecyl sulfate-polyacrylamide gel electrophoresis.


Cell lineage analysis by intracellular injection of a tracer enzyme.

Cell lineages during development of leeches can be ascertained by injection of horseradish peroxidase as a tracer into identified cells at early stages of embryogenesis. The injected embryos continue their normal development, in the course of which horseradish peroxidase is passed on in catalytically active form to the descendants of the injected cell. The distribution of the tracer enzyme and hence of the progeny of the injected cell can then be observed at a later stage of development by staining the preparation for horseradish peroxidase.


Endoplasmic reticulum sequesters calcium in the squid giant axon.

Axons were loaded with calcium, rapidly frozen, and freeze-substituted. The endoplasmic reticulum, in addition to mitochondria, contained calcium deposits, as indicated by electron probe x-ray microanalysis. Oxalate injected into living axons helped to preserve calcium-containing deposits during preparation for microscopy. It is concluded that the endoplasmic reticulum is a calcium-sequestering compartment in the squid giant axon.


Tricyclic antidepressants: long-term treatment increases responsivity of rat forebrain neurons to serotonin.

Long-term treatment of rats with clinically effective tricyclic antidepressant drugs induced a selective increase in the inhibitory response of forebrain neurons to serotonin applied by microiontophoresis. Long-term administration of some related drugs which lack antidepressant efficacy failed to induce such a change. The enhanced response to serotonin induced by the clinically active tricyclic drugs took 1 to 2 weeks to develop, a time course which correlates with the delayed onset of therapeutic effects in humans.


Role of the psyche in recovery from myocardial infarction.

The need for psychosocial counseling in survivors of myocardial infarction is often overlooked. A few casual remarks at the bedside will not suffice. These patients progress through three definable stages: (1) stress, (2) disorganization, and (3) reconstruction. The assistance of the physician in helping the patient through these phases is imperative to complete recovery.


Optimal enzyme test combination for diagnosis of acute myocardial infarction.

One hundred consecutive patients admitted to our cardiology service with the suspected diagnosis of acute myocardial infarction were evaluated with serical enzyme and isoenzyme determinations in an attempt to develop the medically and financially optimal combination of enzyme tests. In patients with onset of chest pain less than 24 hours before admission, creatine phosphokinase MB determination on admission and after 12 hours was sufficient to diagnose of exclude myocardial infarction. One serum LDH isoenzyme determination 24 hours after admission confirmed the diagnosis in 74% of patients.


Hemodialysis in chronic schizophrenic patients.

Ten schizophrenic patients were dialyzed once a week for 16 weeks. They showed marked abnormalities in thinking, affect, and behavior. When out of the hospital, they lived vegetative, nonproductive lives. Seven patients at the end of the 16-week period showed no or minimal symptoms involving thinking, affect, and behavior. One patient showed moderate improvement, and there were two treatment failures.


Two-plane fixation of acute supracondylar and intracondylar fractures of the femur.

In 37 cases of supracondylar and intracondylar fractures of the femur treated by open reduction and internal fixation, a two-plane compression device, affording firm fixation in either the sagittal or frontal plane, was used with excellent results. Certain anatomic factors and associated injuries to the musculoskeletal system deserve classification, to enable the orthopedic surgeon to accurately evaluate and treat such fractures in the distal third of the femur. A negative attitude has been perpetuated concerning the ability of the trained orthopedic surgeon to reduce these fractures and adequately maintain the reduction for early mobilization. In 97% of our cases, results were good to excellent, and complications were infrequent. The purpose of this paper is, first, to describe a practicable classification of supracondylar and intracondylar fractures of the femur and, second, to describe the results in our series of cases treated a compression device specifically designed for these types of fractures.


Sternoclavicular joint involvement in ankylosing spondylitis.

Two patients with sternoclavicular joint involvement in ankylosing spondylitis are described, both of whom presented with referred pain syndromes which delayed diagnosis. The anatomy of the sternoclavicular joint and the salient features of this entity are reviewed.


Ferritin as an index of bone marrow iron stores.

We examined the relationship of serum ferritin to bone marrow iron stores in 73 anemic male medical inpatients with liver disease, alcoholism, chronic inflammatory disease, and malignancies. A correlation of r = 0.75 (P less than .00005) was found between serum ferritin and bone marrow iron stores (BMIS) for the entire group. Liver disease as manifested clinically or by increased levels of serum glutamic-oxaloacetic transaminase did not appear to significantly affect this relationship. Patients with folic acid deficiency did tend to have a disproportionate increase in ferritin in relation to BMIS, but this did not seem to destroy the usefulness of ferritin levels. A useful clinical rule seems to be that serum ferritin of greater than 100 ng/ml tends to exclude iron deficiency, and a level of less than 30 ng/ml tends to confirm decreased iron stores.


Serum IgE levels and recurrent abdominal pain in children.

Serum IgE levels were measured in 25 consecutive children with recurrent abdominal pain (RAP) of undetermined cause and 25 consecutive controls of similar age and sex without evidence of RAP, allergy, or parasitic infection. No significant difference in serum IgE levels was demonstreated in children with and without RAP.


Diagnosis of lymphangitic carcinomatosis by transbronchial lung biopsy.

The records of patients who had transbronchial lung biopsy at Walter Reed Army Medical Center between January 1974 and September 1977 were retrospectively reviewed. Nine patients were found whose clinical and radiographic presentations were compatible with lymphangitic carcinomatosis. In five patients in lymphangitic spread of carcinoma was diagnosed from transbronchial lung biopsy specimens. A single patient had a false-negative biopsy, proven at autopsy three weeks later. The other three patients with negative biopsies are alive and receiving chemotherapy 12 months later (two patients) or are lost to follow-up (one patient). Transbronchial lung biopsy is an accurate procedure for diagnosing lymphangitic carcinomatosis. In addition, aggressive chemotherapy should not be used in these patients without a tissue diagnosis.


Photochemotherapy: dermatologic uses.

Photochemotherapy is a new concept in treating selected skin disease. Psoralens taken orally two hours before high-intensity UVA radiation results in clinical clearing of psoriasis, mycosis fungoides, vitiligo, and atopic eczema. The results of two large cooperative studies in the treatment of psoriasis presented similar results.


Facial reanimation in Möbius syndrome.

The psychosocial deformity associated with total lack of facial animation (as seen in Möbius syndrome) is an extremely crippling situation. This inability to show happiness, sadness, or anger by facial expression frequently results in severe introversion and a reclusive personality. Restoration of even a minimal degree of controlled facial movement is beneficial. Recent experience in the treatment of two patients with this syndrome using both dynamic and static procedures has been most rewarding. Operating simultaneously on both sides of the face poses some problems that are different from those in teh patient with unilateral paralysis. The operative details are described, with preoperative and postoperative evaluation.


Pancreatic pseudocyst as a cause of jaundice.

Three cases of jaundice caused by a pseudocyst in the head of the pancreas which compressed the distal common bile duct are presented. These were seen at the VA Hospital, Clarksburg, West Virginia, in a four-year period. The need for bypass drainage of the biliary tree in such cases is emphasized. Simple drainage of the pancreatic pseudocyst in our patients has not relieved the obstructive compression of the intrapancreatic portion of the common bile duct.


Chronic diarrhea in returing travelers: intestinal parasitic infection with the fluke Metagonimus yokogawai.

An unusual intestinal infection with the parasite Metagonimus yokogawai was acquired by an American traveling in the Orient. Diarrhea began abroad, and recurred at intervals until she was seen 1 1/2 years later. Stool examinations resulted in the recovery of small operculated ova characteristic of intestinal or biliary fluke infection. Treatment with hexylresorcinol failed to eradicate the infection, but subsequent use of tetrachloroethylene was successful and facilitated recovery of adult parasites, leading to the specific diagnosis of metagonimiasis. Metagonimiasis and related intestinal fluke infections should be considered as a possible cause of persistent diarrhea in travelers returning from endemic areas abroad.


Blood chemistry abnormalities in bacterial endocarditis of narcotic addicts.

We recently treated two narcotic addicts with bacterial endocarditis who developed the syndrome of inappropriate antidiuretic hormone secretion (SIADH). This prompted a retrospective review of blood chemistry studies in all narcotic addicts admitted to our hospital over a 30-month period because of a clinical suspicion of bacterial endocarditis. Patients with culture-positive endocarditis (group 1) had significantly lower plasma osmolality, sodium, calcium and albumin values (P less than .02, .001, .005, and .005 respectively) than addicts without endocarditis (group 2). More than 90% of those in group 1 had hyponatremia, and 48% had plasma hypoosmolality. These findings may be of value in the initial evaluation of ill narcotic addicts for hospitalization.


Botryomycosis: first report of human brain involvement.

A 57-year-old man, previously well except for dental caries and a history of Wolff-Parkinson-White syndrome, presented with marching right-sided motor seizures of sudden onset. Cerebral arteriography and scan demonstrated an avascular left frontal lobe mass. At operation, it was identified as an abscess and was totally excised. Histologically, granules resembling those seen in actinomycosis were demonstrated in the abscess wall, but special stains revealed gram-positive cocci in chains within and outside the granules. Fungal spores, mycelia, or branching filamentous structures were absent. Acid-fast stains were negative, and alpha-hemolytic streptococcus was recovered in pure culture from the abscess. While the patient was convalescing with penicillin therapy, a dental survey revealed the presence of periodontal abscesses which were drained by exodontia. Culture of the tooth sockets showed alpha-hemolytic streptococcus and Staphylococcus aureus. The literature on this relatively rare bacterial disease which histologically resembles actinomycosis is reviewed.


Normal vaginal axis.

Vaginograms were done on 20 normal women to determine the exact axis, length, and direction of the normal vagina. The vagina was found to be a curved organ with a distinct upper portion that has an axis between the third and fourth sacral vetebrae. The importance of restoring this axis in pelvic surgery, especially for vault prolapse, is discussed.


New method for obtaining uncontaminated urine from women.

Midstream sampling and colony counts have greatly improved precision in diagnosing urinary tract infections. In women, however, contamination by vaginal flora and cells still poses a diagnostic problem. We have devised an instrument for helping collect uncontaminated urine from women and have tested it in three sets of observations. Approximately 96% of 200 women were able to use the device successfully after minimal instruction. Bacterial colony counts and quantitative estimation of vaginal epithelial cells were performed on urine collected by 18 female volunteers using conventional clean-catch technics and on urine collected by the same 18 women using the Clean Streamer. The average bacterial colony count in conventionally collected urine was 8,100/ml while in Clean Streamer collected urine it was 1,722/ml. The average number of vaginal epithelial cells in conventionally collected urine was 22.4/ml while in Clean Streamer collected urine it was 14.1/ml. The difference in both comparisons is statistically significant (P = .01). We believe that use of the Clean Streamer greatly facilitates the ability of a woman to collect a urine sample uncontaminated by vaginal secretions and flora.


Staging laparotomy in Hodgkin's disease: a critical appraisal of its value.

Although staging laparotomy changes the stage of one third of patients with Hodgkin's disease, this change in stage does not establish that routine staging laparotomy is of clinical value. The value of laparotomy depends on the results of clinical decisions which are based on the information provided by laparotomy. Increased accuracy in staging may improve clinical results by eliminating undertreatment, with an increased risk of relapse, or overtreatment with an increased risk of morbidity--including second malignancies. In some clinical settings information provided by laparotomy may be clinically irrelevant. Since clinical studies have not established the optimal therapy for every stage of Hodgkin's disease, rigid guidelines for performing staging laporotomies cannot be established. However, staging laparotomy should be done only after consideration of how the information provided by laparotomy will affect clinical decisions. Recent evidence that the extent of abdominal nodal involvement has major prognostic implications may play a role in this decision-making process.


Reversal of chronic diabetes insipidus during treatment with protriptyline.

We have described a 13-year-old white boy with Ondine's curse, sleep apnea and cataplexy who simultaneously developed progressive hypothalamic neuroendocrine deficiencies requiring replacement therapy. The patient was treated with protriptyline, a nonsedating tricyclic antidepressant, for control of the sleep-related symptoms. An unexpected result was the apparent reversal of his chronic diabetes insipidus by protriptyline, necessitating discontinuation of lysine-vasopressin. Some possible mechanisms of action were discussed.


Duodenal pseudotumor with ball-valve syndrome.

Prolapse of the gastric mucosa into the duodenum must be considered when a round soft tissue mass is seen in the right upper quadrant on scout abdominal film. Gastric prolapse may mimic tumor in the duodenum when the prolapse is large. Examination with barium meal is necessary to exclude prolapse of the gastric mucosa into the duodenum as a cause of epigastric pain and vomiting. Medical treatment is suggested for patients with mild symptoms, but patients with severe symptoms, repeated hemorrhage, anemia, severe intermittent epigastric pain and vomiting due to ball-valve syndrome should have operation.


Sarcoidosis of the spinal cord as the presenting manifestation of the disease.

Involvement of the spinal cord by sarcoid is quite rare, with only 11 previous histologically proved cases. One finds an almost uniform increase in the spinal fluid protein level. Even with the presence of other stigmas of sarcoidosis, the diagnosis of spinal cord sarcoidosis is difficult, and biopsy usually must be done to rule out a malignant tumor.


Fracture of a temporary pacemaker electrode catheter.

We have reported an instance of fracture of a temporary bipolar electrode catheter with embolization of the distal fragment to the lung. The patient had no untoward effects for 45 days before death. Autopsy revealed no thrombosis proximal or distal to the catheter fragment. The inability of the catheter to withstand the stress of usage questions the efficacy of its design. Careful inspection of the catheter before its use might have prevented this complication.


Skeletal muscle involvement in Rocky Mountain spotted fever.

A case of Rocky Mountain spotted fever in a 10-year-old boy accompanied by an unusually high degree of myalgia and muscle weakness was presented. On admission to the hospital, his creatine phosphokinase, SGOT, SGPT, and aldolase values were all abnormally high. Rash did not appear until the fourth hospital day. On the same day results of a proteus OX-19 titer of blood were reported as positive (titer 1:320) and intravenous therapy with chloramphenicol was started. The child's condition gradually improved and five months later he had no detectable muscle weakness.


Immune thrombocytopenia, red cell aplasia, lupus, and hyperthyroidism.

A patient is presented with multiple manifestations of an autoimmune diathesis: immune thrombocytopenia, red cell aplasia, hyperthyroidism, a lupus-like syndrome, and an anti-i autoantibody, with inability to be transfused. Some of these entities are known to be commonly associated, but some are not, and it is unusual to find five of these phenomena in a single patient.


T4 toxicosis.

We have described a 25-year-old man with hyperthyroidism and normal levels of serum T3 and reverse T3, but with abnormalities in serum T4I, T3U, FTI, FT4, and T3 suppression and TRH stimulation tests consistent with the diagnosis of T4 toxicosis. Serum total iodine was elevated several-fold, and the observed response to iodine depletion and loading suggested that the T4 toxicosis in this patient probably resulted from an increased iodine load, with production of T4 preferentially to T3. There appeared to be no evidence of a defect in peripheral conversion of T4 to T3.


Cold water syncope.

Cardiac bradyarrhythmias upon swallowing have been reported previously and most commonly have been related to esophageal abnormalities. We have reported the case of an unusual patient who experiences bradycardia and syncope only upon swallowing cold liquids.


Depersonalization in a 16-year-old boy.

A prolonged period of depersonalization resolved in this 16-year-old boy with only supportive therapy. Reasons for the depersonalization and withholding of other treatment are discussed. Observations are shared of the very intriguing phenomenon of derealization and allied conditions, psychiatric syndromes which are appearing with increasing frequency among so-called "normal adolescents" who indulge in drugs or other experiences which alter the state of consciousness, and among adolescents who survive disasters or harrowing experiences.


"Dome and dart" P waves.

P waves with a "dome and dart" configuration have been observed in patients with congenital and acquired heart disease while having arrhythmias of left atrial origin. This report describes a patient who has dome and dart P waves that appear to be neither ectopic nor associated with structural heart disease.


Pathological findings in four cases of human angiostrongyliasis.

Three adults and a 3 1/2-year-old child presented with eosinophilic meningitis. A history of consumption of raw snails was elicited in 2; evidence of a constant diet of raw food, in the form of opisthorchiasis and taeniasis, as well as angiostrongyliasis, was present in the third; no history of raw food ingestion was obtained in the fourth, the child. Pathologic changes were similar in all 4 cases. There was infiltration of the meninges and around intracerebral vessels by varying proportions of lymphocytes, plasma cells and eosinophils. Numerous tracks and microcavities were found in the brains, and in the spinal cords in 2 cases, varying in size from 0.1 to 2 mm, and in age, with older tracks containing debris and gitter cells, newer tracks showing disruption of brain tissue, with and without haemorrhage. Numerous 4th and 5th stage Angiostrongylus larvae, alive and dead, were found in the meninges and brain tissue, sometimes in blood vessels or perivascular spaces, in 3 cases; in the fourth case a 5th stage larva was found on the surface of the right frontal lobe. In one case a degenerating larva was found in a pulmonary vessel. Cellular reaction was more often associated with dead larvae.


Cysticercosis in Surabaya, Indonesia.

Six new cases of cysticercosis and three previously reported cases in Surabaya have been examined in order to determine the age, sex, religion, sites of location and size of cyst. The host response was also discussed. A comparative study was also conducted with other centres in Indonesia. The relative high prevalence of cysticercosis in Bali and the probable influencing factors was also presented.


Studies on the prevalence of hookworms in the dog's intestine and the pathology of the intestinal wall.

During the period January to April 1977, 34 dogs were autopsied and examined for hookworms in Yogyakarta, Indonesia, A. caninum was found in all 34 dogs (100%), A. ceylanicum in 33 dogs (97.1%) and A. braziliense in 7 dogs (20.6%). The dogs yielded 2,213 ancylostomes, of which 1,188 were A. caninum, 989 A. ceylanicum and only 36 were A. braziliense. All species of hookworms appeared to be more concentrated in the jejunum than in the duodenum or ileum. The lesion produced, proved to be a traumatic injury and was mostly superficial and never reached the submucosa.


Histopathological study of typhoid perforation of the small intestines.

A retrospective study was made on 184 cases of typhoid fever with perforation of the small intestines, during the period of 1972--1976. There is a constant increase noted in the morbidity and perforations of the small intestines complicating this disease. 50% of the cases were young adults between the age of 15 to 30 years and the 2 youngest cases were 3 year old children. Contrary to other reports, our studies revealed a significant predominance among male patients (77.2%). The pathological changes were typical and basically similar to that described by other investigators.


Prevalence of parasitic infections in Malaysian oil palm estate workers.

A survey of workers and families resident in an oil palm estate in Malaysia revealed high incidence of parasitic infections. The commonest parasites are T. trichiura (56%), A. lumbricoides (52%), hookworm (28%), Entamoeba coli (11.3%) and Giardia lamblia (11.3%). Mixed infections by two or more parasites was seen in 46% of the subjects. Anaemia was present in 70% of children with hookworm infection. Eosinophilia was observed in 69% of subjects. One each of Hymenolepis nana and Hymenolepis diminuta infection was detected. This is the first report of Hymenolepis diminuta infection in man in Malaysia.


Improved cognition after external carotid endarterectomy.

Recent clinical results support the conclusion that internal carotid endarterectomy not only serves as a prophylactic measure against catastrophic stroke, but may improve cognitive functioning as well. Improvement in cognitive testing after internal carotid endarterectomy has been amply substantiated in recent literature. 3, 4, 5, 8, This report illustrates that improvement in cerebral blood flow by any means is equally effective in improving cerebral function.


Spontaneous cervical epidural hematoma with complete recovery.

Spontaneous spinal epidural hematomas are very rare. Only 25% of them are located in the cervical area. Patients who survive an acute spontaneous cervical epidural hematoma are usually left with severe neurological deficits. The case of an elderly patient with an acute cervical epidural hematoma who fully recovered after surgical treatment is presented.


The use of antifibrinolytic drugs in aneurysmal subarachnoid hemorrhage.

Antifibrinolytic drugs have been investigated in a series of 58 patients with recent aneurysmal subarachnoid hemorrhage. It is concluded that tranexamic acid (AMCA) provides a rational method for reducing the frequency of recurrences, and that antifibrinolytic treatment is a preliminary to surgical intervention. In the present series, ischemic complications, which often follow aneurysmal hemmorrhage, seem to be of a more serious nature. There is evidence also that hydrocephalus due to adhesive arachnoiditis is a rare occurrence. The last 20 patients of the present series have been treated with very low doses of AMCA associated with parotid kallikrein inhibitor (Trasylol); this dosage has been effective in preventing recurrence and has appeared to be freer from severe side effects.


Traumatic internal carotid occlusion at the base of the skull.

A case of traumatic thrombosis of the internal carotid artery at the base of the skull is reported, and 23 similar cases collected from the literature. This review shows that 85% of the patients either died or were left with major neurological deficit, and only 15% recovered completely. There were two primary sites for the onset of thrombosis. One in the petrous pyramid and usually associated with basal skull fracture, and the other immediately distal to the posterior communicating artery in patients with minor head trauma.


Dissecting aneurysm of the vertebral artery.

A patient presented with a subarachnoid hemorrhage associated with a vitreous hemorrhage. Angiography was first interpreted as revealed a saccular aneurysm at the junction of the vertebral and posterior inferior cerebellar arteries. At operation it was evident that the aneurysm was a dissecting one of the vertebral artery. The proximal portion of the intracranial vertebral artery was clipped. The patient survived without any attributable neurological deficit. A review of the relevant literature is presented.


Preoperative diagnosis of conjoined roots anomaly with herniated lumbar disks.

Twelve cases of nerve root anomalies encountered during investigation for low back pain and sciatica are presented. Most of these patients had a herniated lumbar intervertebral disk and were operated upon with the preoperative knowledge of an associate nerve root malformation. Three patients were found to have a symptomatic nerve root malformation without disk herniation. These patients were conservatively treated. In all cases we found a constant myelographic sign that is described.


The relationship between suture number and quality of anastomoses in microvascular procedures.

Microvascular end-to-side arterial anastomoses of vessels 1 to 2 mm in diameter were performed in 30 Sprague-Dawley rats. The animals studied differed in only one aspect, variance of suture number to complete the anastomosis. Angiographic and gross pathological evaluation of each animal demonstrated a direct correlation between quality of patency and number of sutures used to complete the anastomoses. A significant observation was made regarding unrecognized pathology in angiographically patent anastomosis.


Interventional neuroradiology: a joint effort of the neuroradiologist and neurosurgeon in the treatment of vascular lesions of the head and neck.

Close cooperation between the neuroradiologist and neurosurgeon has made possible the treatment of certain lesions of the head and neck by embolization procedures. The experience at Emory University Hospital with embolizations of arteriovenous malformations, carotid-cavernous fistulae, dural-cavernous sinus fistulae and glomus jugulare tumors is discussed.


Cranioplasty made easier.

Subdural temperature recordings under hardening methyl-methacrylate cranioplasties of varying sizes but standard thickness were analyzed. If 29.7 degrees C saline irrigations are used during hardening, the subdural temperature rises no more than 0.55 degrees C. The conclusion is that letting methyl-methacrylate harden in situ during cranioplasty is safe provided 29.7 degrees C saline irrigation is utilized.


Reversal of seven-year old visual field defect with extracranial-intracranial arterial anastomosis.

A variety of neurologic deficits has been reversed following extracranial-intracranial arterial anastomoses. We are presenting an unusual case of complete resolution of a documented seven-year-old defect in the right homonymous visual fields following anastomosis of the superficial temporal artery and the angular branch of the middle cerebral artery.


Pustules in secondary syphilis.

In an otherwise typical case of palmoplantar secondary syphilis, large intact pustules were also present. Spirochetes were demonstrated in these lesions by darkfield microscopy. The distinctive pathologic finding in the pustular lesions was migration of polymorphonuclear leukocytes into the epidermis, with formation of microabscesses. This pattern is the same as that seen in "framboesiform" secondary syphilis and in yaws.


Aneurysm of the anterior inferior cerebellar artery at the internal auditory meatus.

An aneurysm of the anterior inferior cerebellar artery is reported. Symptoms were a sudden and intermittent hearing loss. Electrocochleography indicated that the patient's deafness was of retrolabyrinthine origin. Vertebral angiography disclosed the aneurysm. At operation the aneurysm was coated. The literature is reviewed.


Obliteration of an internal carotid-internal jugular fistula using a prolo catheter.

Obilteration of a traumatic internal carotid-internal jugular fistula at the base of the skull using a Prolo catheter is reported.


Cerebral vasospasm: a clinical observation.

Three cases of subarachnoid hemorrhage from intracranial aneurysms are presented. Two of the patients survived long enough to develop delayed cerebral vasospasm. The computerized tomograms and angiograms were correlated with the clinical course. It is suggested that delayed cerebral vasospasm may be preceded by relative vasodilation, or at least inhibition of vasocontraction, and concomitant increased vascular permeability of the parent vessels diagnosed by contrast enhanced computerized tomography. This phenomenon, if confirmed in larger series of patients, may allow prediction of that patient destined for vasospasm and may suggest some of the pathophysiology of this devastating problem.


Thoracic sympathectomy for palmar hyperhidrosis: report of 457 cases.

A thoracic sympathetic ganglionectomy was performed on 457 patients with palmar hyperhidrosis, resulting in a complete cessation of the excessive palmar sweating but not a total abolition of the sweating of the upper extremity, forehead, face, neck, upper chest and upper back. This procedure does not produce a Horner's syndrome. The present data provide evidence that sympathetic pathways for controlling sweating of the above-mentioned skin areas come mainly through the second thoracic ganglion, and therefore from the spinal cord segment below T1 in man.


Nasolabial condylomata lata: report of case.

The clinical manifestations of secondary syphilis are many and varied. Thus the venereologist frequently does not see the common textbook picture of this stage of syphilis. The present history of an atypical case of secondary syphilis illustrates one of the many manifestations of syphilis.


Computed tomography and mortality rate in brain abscess.

A small series of eleven consecutive cases of brain abscess, with one death, is presented. Early diagnosis and accurate localisation by computed tomography (ct) are emphasized and the clinical features discussed.


Anatomic variations of the sella turcica.

Structural variations of the sella turcica occur more often than might be supposed. Some of these may assume technical significance in surgery for intracranial aneurysm.


Treatment of early latent syphilis of less than a year's duration: an evaluation of 275 cases.

The author's recommended treatment for early latent syphilis of less than a year's duration is im administration of benzathine penicillin G, 2.4 million units weekly for two consecutive weeks. Patients allergic to penicillin are given tetracycline, 500 mg orally four times daily for 12 days (total dose, 24 g). Two hundred seventy-five patients who had early latent syphilis of less than a year's duration were treated with these regimens; of these, 252 were given benzathine penicillin G, and 23 received tetracycline. All but two of the patients became seronegative within four years.


Secondary aneurysm due to arterial injury during surgical procedures.

Most secondary aneurysms following trauma to the cerebral artery were reported as a complication of head injury. Three cases of aneurysm due to arterial injury during operations are reported. A search of the world literature revealed ten other cases. The responsible surgical procedure and the location of these aneurysms varied. Rupture of these aneurysms was observed in four cases at 10 to 23 days following the primary operation. Only two patients died.


Hazards of computerized tomography: renal failure following contrast injection.

Acute renal failure in a diabetic patient following contrast injection for computerized tomography is discussed. Like a variety of serious complications associated  with contrast media, dye-induced renal failure is an important iatrogenic complication to which the diabetic population may be unusually susceptible.


Tuberculous brain abscess.

Brain abscess is probably the least common manifestation of tuberculous infection of the central nervous system. Some authors have made a rigid distinction between tuberculous brain abscess and variants of cerebral tuberculoma. Such a distinction is not supported by our own case of tuberculous brain abscess, or by review of similar, recently reported cases.


Computed tomography in herpes simplex encephalitis.

Nine patients with herpes simplex encephalitis examined by CT scan were reviewed. A total of 15 satisfactory scans was analyzed. The majority of our cases had CT scan abnormalities: lucency 63% (5 of 8, one case with suboptimal scan), mass effect 50% (4 of 8), abnormal contrast enhancement 57% (4 of 7). The earliest CT scan finding was lucency, presented in two out of three cases studied within 48 hours following onset of symptoms. The primary role of CT scan is to support the suspected diagnosis of herpes simplex encephalitis as well as to indicate the best site for brain biopsy and to permit early effective treatment with adenine arabinoside.


Traumatic intracerebellar haematoma.

A case of traumatic intracerebellar hematoma is presented. The salient feature of the patient's early clinical course was delayed, rapid deterioration in the absence of antecedent focal neurological findings. The rarity of this lesion and its high mortality due to delay in correct diagnosis have been previously emphasized. Reported cases have followed a subacute clinical course and deterioration has been preceded by focal neurological findings. Prompt ventricular drainage followed by evacuation of the hematoma can be expected to yield a satisfactory clinical result.


Surgically correctable lesions detected by CT in 143 patients with chronic epilepsy.

CT findings justified surgical intervention in four young patients who had suffered from intractable epilepsy for many years. Previous non-invasive and invasive neurodiagnostic procedures with these patients had failed to show focal cerebral lesions amenable to surgical treatment. All four patients achieved significant relief from seizures after the operations.


Anomalous anterior inferior cerebellar artery simulating intracanalicular acoustic nerve tumor.

A case is described of tinnitus and hearing loss associated with widening of the left internal meatal canal. Surgical exploration revealed a vascular loop adherent to the VIIIth nerve. Release of the adhesions was followed by cessation of the tinnitus and improvement in hearing.


A rational basis for the epidemiologic treatment of gonorrhea in a clinic for sexually transmitted diseases.

Epidemiologic treatment of gonorrhea refers to the administration of antibiotics when the diagnosis is considered likely, but before the results of confirmatory tests are available. Unfortunately, the risk of infection is seldom known. To place epidemiologic treatment on a more rational basis, infection rates were determined for groups of clinic patients defined by easily collected indexes of risk such as reason for attending the clinic, sex, race, and sexual preference, history of contact with gonorrhea, and history of a urethral or vaginal dischange. Infection rates ranged from 0.8% for men seeking marriage licenses to 65.1% for female contacts of men with "established" gonorrhea. By selectively employing gram-stained smears, it is possible to reduce further the need for epidemiologic treatment within the various defined groups of patients. Epidemiologic treatment policies should be determined by each large clinic and should be based on known infection rates for clearly defined groups of patients. Such rates are necessary for obtaining informed consent from patients and for evaluation of the cost-effectiveness of epidemiologic treatment in the overall effort to control gonorrhea.


Examination of men with nongonococcal urethritis and their sexual partners for Chlamydia trachomatis and Ureaplasma urealyticum.

Chlamydia trachomatis was recovered from 39 (52%) of 75 men who had nongonococcal urethritis and from 28 (37%) of their sexual partners. Of the partners of men with Chlamydia-positive nongonococcal urethritis, 64% excreted Chlamydia, compared with 8% of the partners of men with Chlamydia-negative nongonococcal urethritis. In contrast, an apparently sexual mode of transmission was not observed with Ureaplasma urealyticum. Rates of recovery of U. urealyticum from men with nongonococcal urethritis whose cultures were Chlamydia-positive and those whose cultures were Chlamydia-negative were the same. Significant seroconversion was detected bythe single-antigen immunofluorescence test in about 50% of patients who had Chlamydia-postive cultures.


Chromosome banding patterns of L1210 leukemia of the mouse.

The chromosomal characteristics of 2 L1210 mouse leukemia lines, 1 grown in vivo and 1 in vitro, were compared. The procedures used were: G-banding, C-banding and silver staining for nucleolar organizer regions. The 2 lines are not exactly the same, but share some cytogenetic characteristics.


Urinary glycopeptides and glycosaminoglycans in children and adults as affected by age.

The glycopeptide and glycosaminoglycan excretion was studied in the urine of normal human subjects from newborns to 68 years of age. The glycopeptide and glycosaminoglycan preparations were made by digesting the urine with peoteolytic enzymes followed by removal of enzyme and undigested protein and finally freeze-drying of the supernatant. The contents of hexose, sialic acid and uronic acid were determined on these preparations. Because of the striking differences in body weight all values were expressed in terms of milligrams per 24 hours per kilogram of body weight. When corrected for body weight, all of the carbohydrate levels were significantly higher in infants and young children under 5 years of age than in older children and adults. No other significant changes with age were found after the age of 7 years. There were no significant differences between the sexes at any age.


Studies on ovarian and uterine weight responses to follicle stimulating hormone.

A uterine weight response may potentially provide a plausible qualitative method for detection of "asialo" follicle stimulating hormone (FSH). Asialo FSH is a biologically inert species of FSH when assayed for ovarian weight response by the hCG augmentation method. Numerous experiments have been performed under a uniform set of conditions for normalization of ovarian and uterine weight responses. The influence of several hormones and 2 injection routes on the gonadal responses to FSH have been assessed. Immature female, 24--25 day old Sprague-Dawley rats were injected subcutaneously (sc) or intraperitoneally (ip) twice daily for 3 days. On the 4th day the rats were sacrificed, the ovaries and uterus were removed, cleaned and weighed. Uterine weights were obtained before and after removal of the fluid. NIH-FSH-S9 and its asialo derivative prepared by neuraminidase digestion were the species of follicle-stimulating hormone (FSH) used in all experiments. Addition of either 21 IU prolactin or 0.05 mg histone to FSH did not significantly alter the ovarian weight response augmented by hCG (P = 0.2). Addition of histone to 90 and 180 microgram FSH elicited neither a uterine weight response when injected sc nor an ovarian weight change when injected ip. Both routes of injection of the 2 dose levels of FSH had little effect on the uterine weight. In marked contrast, 90 and 180 microgram asialo FSH injected either sc or ip gave increased uterine weight responses in the presence of hCG. On further examination the uterine weight increase in response to asialo FSH injections proved to be statistically significant (sc. P = 0.02; ip, P = 0.05). Use of the uterine weight response might be exclusively proposed as a qualitative method for detecting asialo FSH. Such biologically inactive species, which elicit no increased ovarian weight response in the hCG augmentation assay, are frequently generated in the preparation of FSH. Determination of the uterine weights may provide meaningful use of auxiliary data from the hCG ovarian augmentation assay of putative FSH preparations which fail to elicit the desired ovarian weight responses.


Research training in psychiatric residency programs: a survey.

Although it seems reasonable to assume that the absence of research training may account for the fact that few psychiatrists involve themselves in research, there is at present little, if any, objective data regarding the extent of research training in psychiatric residency programs. Accordingly, an 11-item questionnaire designed to assess training opportunities and staff and resident interest in research was sent to 400 training facilities in general and child psychiatry. An 82% return rate was obtained. In general, findings suggest that while in many training centers research is viewed as unimportant and frequently given the lowest priority, most facilities appear to have ample personnel to provide adequate research training. While opportunities for research training may be "available" in most training programs for those students sufficiently motivated to seek them out, the low priority assigned to this aspect of training may deflect most residents from becoming involved in research. This is likely to leave the resident poorly equipped to engage in research activities after the completion of training. The implications of the findings for residency training are discussed.


Surface direct current bioelectric potentials in the normal and injured human thigh.

Skin bioelectric potentials were obtained from both normal and injured human thighs using surface direct current silver/silver chloride monitoring electrodes. Electrical patterns in normal subjects fell into 4 distinct groups. In subjects with injured thigh significant electrical differences were associated with bone formation. The findings are discussed.


Air quality correlates of chronic disease mortality: Harris County, Texas 1969--1971.

Air quality correlates of chronic disease mortality in 180 census tracts of Harris County, Texas, were studied using 3 years mortality for 1969--1971. This study was designed to test with a different data base the universality of several study results which have reported significant correlations between heart disease and air pollutants. Air quality data (suspended particulates, benzene solubles, sulfur dioxide, and metals associated with particulates: copper, mercury, manganese, lead, nickel, zinc, chromium, and cadmium) were related to both sex and age adjusted crude death rates, and cause-specific death rates for age cohorts for 7 categories of heart disease, and pneumonia, asthma, cancer, tuberculosis, and accident deaths. The results of the study were in agreement with the findings of the other researchers who used national data. Suspended particulates and cadmium concentrations were found to be correlated (r=.38, .36; P less than .001) with ischemic heart disease (IHD). Many other significant correlations are reported but are not cause-specific. Socio-economic indicators were also correlated with IHD, thus confounding the issue. Further work is planned using more sophisticated statistical techniques to disentangle the relative contribution of each of these highly intercorrelated factors. No causality can be assigned at this stage, although this study, with the other cited, points to possible risk factors for IHD which need further evaluation.


Potential gains in life expectancies by partial elimination of leading causes of death in Texas.

Potential gains in life expectancies among Texas population by partial elimination of 3 major causes of death are examined on the basis of the available statistics from the population census and mortality statistics for 1970. Contrary to the popular anticipation of longer potential gains, the results are not particularly encouraging. The number of years of life that would be gained during the working ages by 50% elimination of major cardiovascular diseases is less than 1/2 of 1 year, about 1/4 of 1 year by 50% elimination of malignant neoplasms, and less than 1/4 of 1 year by 50% elimination of motor vehicle accidents. Even with a scientific breakthrough in combating those causes of death it appears that future gains in life expectancies for working ages will not be spectacular. The implications of the results in relation to the current debate on the national health policy are discussed.


A conjecture about the prevalence of essential hypertension and its high incidence in the black.

The high incidence in certain racial groups of essential hypertension is attributed to the advantage which this disease confers when the availability of sodium is deficient in the environment. This conjecture is supported by alterations in behaviour of sodium in the body economy of the hypertensive as evidenced by: the effects of sodium depletion on the blood pressure; the elevated sodium content of the tissues in the hypertensive; the reduced rate of sodium excretion in spontaneous and experimental hypertensive disease; the fact that hypertension can be induced in the offspring of rats subjected to a deficient sodium intake or to natriuretic drugs during pregnancy; the increased appetite for sodium observed in the hypertensive; and the effect of an increased sodium intake on the blood pressure. It is suggested that the substantial within-species variation in the incidence of essential hypertension reflects the availability of the sodium requirement of the individual suffering from the genetic mutation responsible for this disease.


"Particle-filament complex" in tumor cells of northern pike, Esox lucius L.

Examination of the cells of lymphoreticular neoplasms of the northern pike (Esox lucius L.) by electron microscopy has demonstrated the presence of unusual cytoplasmic crystalloid inclusions in cells of a spontaneous trunk tumor. The ultra-structural analysis revealed that the inclusions are composed of parallel arrays of filaments associated with rows of particles. This is designated as "particle-filament complex". The filaments of the complex measured 90--120A in diameter and 0.6--2.8 micron in length. A row of dense particles measuring 250A in diameter was arranged in regular manner between the parallel filaments. It is of interest that the complex was always accompanied by an unusual structure of nucleus of the tumor cell. The nuclei were composed entirely of filaments which were distorted and closely packed. The significance of the particle-filament complex associated with altered nucleus remains to be determined.


The biochemical basis of cystic fibrosis: an hypothesis based upon the polyelectrolytes of mucus.

The evidence shows that the pathology of cystic fibrosis (CF) is related to mucoid secretions. Consequently, the question of what governs the viscosity of mucus is examined in detail. It is generally agreed that the mucin gel consists of polyanionic glycoproteins and a hitherto unidentified poly cationic cross-linking protein. It is proposed that larger amounts of polycations increase viscosity and, in excess, cause mucus to become a polycation. As these compounds are known to inhibit the ductal reabsorption of sodium, the two principal aspects of the pathology of CF can be related to the same mechanism. The mucus globule membrane (MGM) has been proposed as the cross-linking protein.


Human transferrin C: the sequence and cystine bridges of the N-terminal region.

Human transferrin c (76,000 molecular weight) can be cleaved by cyanogen bromide and separated by gel filtration into 4 fractions, CNBr I, II, III, and IV. CNBr II, the smallest cystine containing fragment, can be separated further into 2 fragments of approximately 3,000 and 9,000 daltons by performic acid oxidation; the smaller fragment is the N-terminus of Tf C. The sequence of both fragments, their relationship to each other through cystine bridges, and their relationship within the whole transferrin molecule is given.


Observations of globular membranes and apparent elementary particles in rat mitochondria, in situ.

Ultrastructural details of rat skeletal muscle, fixed in a PIPES-buffered glutaraldehyde solution, included the globular configuration of the outer and inner mitochondrial membranes as well as small transparent particles (80--100A diameter) distributed throughout the matrix of these organelles. The size of these particles and their intimate relationship with the innermost surface of the cristae suggests that they may represent an in situ visualization of the elementary particles once reported in intact cells and frequently observed in negatively stained mitochondrial preparations. The membrane configurations and particles were not discernable in these tissues when a phosphate buffer system was used in the fixation regimen.


Primary and secondary tryptic cleavages of human IgM at high temperature.

Previously it was shown that the tryptic digestion of human IgM at 65 C yield Fc'mu fragments in addition to Fabmu and (Fc)5mu fragments. This Fc'mu was found to be derived from the Cmu4 domain of the mu-chain. Additional studies were done on the effects of tryptic digestion time and temperature on the proteolytic process of IgM, IgM digestion by 2% trypsin at 65 C produced (Fc)8mu and Fc'mu in approximately a 3:2 ratio. While an appreciable amount of intact (Fc)5mu was present along with Fc'mu in the IgM digest, no residual "(Fc)5mu fragment" with its C-terminal segment missing was found. If the temperature of digestion is held constant at either 56 C or 60 C and the digestion time is varied from 20 to 90 min, there is also progressive cleavage of IgM with a concomitant increase in the yield of Fc'mu. It appears that the tryptic digestion of IgM is a stepwise process and that the primary cleavage of IgM occurs at Arg-325(2) of all ten mu-chains and the (Fc)5mu is subsequently degraded to Fc'mu fragments by secondary cleavage.


Effects of addicting and nonaddicting drugs on HeLa cells.

After 70 subcultivations of HeLa cells in the presence of amphetamine, diphenhydramine hydrochloride, caffeine, codeine, or morphine, cells were obtained with increased tolerance to the respective drug. Withdrawal of amphetamine, diphenyhydramine hydrochloride or morphine from cells cultivated 645 days in the presence of the drug yielded  cells that had either a decreased growth rate in the absence of drug or superior plating efficiencies with low drug concentration when compared to untreated HeLa cells. These observations would be expected from addicted cells. Cinematographic observations showed cell membrane undulation decreased in the presence of morphine. The membrane undulations of cells tolerant to morphine were less sensitive to that drug.


Cholesterol in the lungs of heavy cigarette smokers.

Electron microscopy of "normal" lung tissue from four heavy cigarette smokers showed acicular crystal clefts thought to represent cholesterol in the cytoplasm of virtually every type II pneumocyte. Similar but less pronounced changes were found in two cases of obstructive pneumonia distal to bronchial tumours, a condition characterised by excess cholesterol. Cholesterol pneumonitis is particularly prevalent in smokers, and the changes in our smokers' lungs possible represent an early stage in a process that if progressive would lead to this disease. The cholesterol may represent a degenerative change in type II pneumocytes or a byproduct of increased surfactant synthesis stimulated by cigarette smoke.


Lower oesophageal sphincter tone in patients with peptic stricture.

Radiographic studies of 161 patients with a stricture within the cardiac sphincter segment showed that in appropriate circumstances all patients could herniate stomach and reflux barium freely, but that the sphincter could obliterate the lumen and sustain this contraction by its basal tone in at least 122. The sphincter could also relax and contract in response to a swallow. The capacity to remain closed depended on the position of the patient and on circumstances in which hiatal flow and reflux did not occur. Manometric studies of the cardiac sphincter were made in a further 14 patients with a stricture in the sphincter segment, and appropriate circumstances the "basal tone" of the sphincter was found to be within our range of normal.


Valve replacement for rheumatic aortic incompetence in adolescents.

The timing of valve replacement in patients with rheumatic aortic regurgitation is assessed by balancing the mortality and complications associated with the operation and the prosthetic valves against the natural history of the lesion. The time course without surgery is determined by the severity of the volume overload and the gradual deterioration of myocardial function. We wished to obtain information both on the haemodynamic recovery achieved after aortic valve replacement in young patients and also on the risks of operation in this group. Twenty patients, in whom the aortic valve was replaced at a mean age of 15 years, were reviewed. An improvement in symptoms and in the cardiothoracic ratio on the chest radiograph occurred in every case, and the voltage measurements suggestive of left ventricular hypertrophy on electrocardiogram diminished in all but two. The left ventricular end-diastolic pressure decreased in the 11 patients who were recatheterised after operation. The ejection fraction improved in three patients and stayed the same in three others. While there were no operative deaths in our series the incidence of serious morbidity, in terms of myocardial damage at or after operation, was disappointingly high. Early valve replacement to preserve myocardial function is especially attractive in young patients but cannot be advised if the insertion of the prosthetic valve is associated with appreciable myocardial damage.


The anti-reflux mechanism after cardiomyotomy.

Only 18 or 83 patients who had had a cardiomyotomy for achalasia could be induced to reflux barium. Mucosal herniation through the myotomy was shown in most by radiography. Perfusion manometry showed a higher pressure zone in the oesophagogastric junction region in 22 of 24 patients studied. This high pressure zone responded to an increment in abdominal pressure by a greater increment. The same response was seen in a patient with a small hiatal hernia and myotomy. We concluded that the persisting high pressure zone seen by perfusion manometry is likely to be caused by the hiatus, and that the hiatus rather than the sphincter is likely to be responsible for the incremental response of the high pressure zone to increased abdominal pressure. The anti-reflux mechanism after cardiomyotomy is more likely to be the hiatal mechanism than persisting sphincter fibres.


Aortic valve replacement in rheumatoid aortic incompetence.

Rheumatoid aortic valve disease is uncommon. and there are few reports of valve replacement in this condition. Aortic valve replacement and partial pericardiectomy was performed in a patient with acute rheumatoid aortitis and aortic incompetence. Previous reports suggest that any patient with rheumatoid arthritis who develops cardiac symptoms should be carefully assessed for surgically treatable involvement of the pericardium or heart valves.


Pulmonary manifestations of hypogammaglobulinaemia.

Fifty-five patients with late-onset idiopathic immunoglobulin deficiency were studied and upper or lower respiratory tract infections were encountered in about 90%. Cylindrical bronchiectasis was shown in all of the 21 patients in whom bronchograms were done. A thymoma was found in four patients. Three patients had diffuse interstitial pulmonary disease--two with proved and one with presumed lymphocytic interstitial pneumonitis. Five patients had no evidence of pulmonary disease, including two patients with long-standing late-onset immunoglobulin deficiency who had essentially no serum immunoglobulins. This small subgroup of patients with immunoglobulin dificiency without severe pulmonary infections cannot be explained in the context of current understanding of immunoglobulin deficiency. Thirty-two patients were followed up for long enough for the response to treatment to be assessed.


Single primitive ventricle with normally related great arteries and atresia of the left A-V valve.

A child aged 2 years and 9 months was angiocardiographically diagnosed to have a single ventricle with normally related great arteries and atresia of the left A-V valve. A Blalock-Hanlon procedure and division of a large patent ductus arteriosus were followed by reduction in pulmonary artery pressure, but after operation the patient showed signs of left ventricular failure unresponsive to medical treatment, necessitating pulmonary artery banding. We have found only three similar published cases, and this is the only one with full angiographic documentation.


Pulmonary haemodynamics and function immediately after canine left lower lobe preservation.

After temporary reimplantation of the left lower lobe in dogs, the effects of various preservation techniques on the canine lung were assessed. Vascular resistance, shunt fraction, weight gain, and airway pressure were found to reflect and predict the effectiveness of various preservation techniques compared with reported survival data.


Reversibility of airways obstruction in bronchiectasis.

Patients with airways obstruction and bronchiectasis were investigated for features of allergic disease and for reversibility of airways obstruction in respinse to inhaled and intravenous salbutamol. There was a 26% increase in PEFR and a 16% increase in FEV1 after inhaled salbutamol, and the response to the intravenous drug was not significantly better than that to the inhaled. Those patients who responded to bronchodilators could not be identified by clinical or immunological features.


Long-term follow-up of two cases of pulmonary varicosity.

Before diagnosis by pulmonary angiography two cases of pulmonary varicosity, one in a young girl and the other in a middle-aged man, had been misdiagnosed as pulmonary tuberculosis. Both patients were asymptomatic and received no specific treatment. Six and four years later there was no radiological change in either patient. Previously reported cases are briefly reviewed.


Correction of tye C atrioventricular canal associated with tetralogy of Fallot.

Type C complete atrioventricular canal associated with tetralogy of Fallot in a 5-year old child was successfully corrected. Repair of the atrioventricular canal was combined with infundibular resection and the insertion of an outflow tract patch across the pulmonary valve ring. The postoperative course was uneventful, and the child is well one year after operation.


Storage of heart valve allografts in glycerol with subsequent antibiotic sterilisation.

Fresh allograft valves stored in a nutrient medium at +4 degrees C have a limited storage time of eight weeks. Dura mater has been stored in glycerol for longer periods, and this paper presents work on the glycerol storage of allograft heart valves. The elastic properties of the valve cusps showed a fall during storage in glycerol that was associated with an altered histological appearance of the cusp tissue. The loss in nuclearity in the histological sections of stored tissue was partially responsible for the observed decrease in viability during storage. All these changes during storage in glycerol, or glycerol and subsequent antibiotic treatment, were similar to the changes seen in valves stored in a nutrient medium. Glycerol therefore offers an alternative storage system to the cold nutrient medium but has no practical advantages. Glycerol alone will not sterilise the allograft tissue, and a post-storage treatment with antibiotics is essential.


The inhibiting effect of a plasma globulin on arterial thrombus formation, (as compared to dipyridamole).

The inhibiting effect on arterial white thrombus formation of a globulin prepared from beef plasma has been compared to dipyridamole in white Wistar rats. It was demonstrated that the globulin fraction had a greater effect in inhibiting thrombus formation as judged by the lag time [t(l)], the maximal thrombus value [m(T)], the maximal thickness of the thrombus [m(D)] and the maximal thrombus surface [m(O)].


Ultrastructural studies on the surface coat of human platelet aggregated by polylysine and dextran.

Positively charged macromolecule, polylysine (mol. wt. 15,000; 23,000; 180,000) could induce the platelet aggregation in low concentration but high concentration was required in the case of neutral macromolecule, dextran (mol. wt. 40,000; 250,000; 2,000,000). The larger molecules of polylysine and dextran were more effective in inducing platelet aggregation. In the dextran-induced aggregation, positively charged Thorotrast particles on the cell surface did not decrease significantly. On the other hand, the surface membranes of platelets aggregated by polylysine were essentially devoid of bound particles. Heparin inhibited the polylysine-induced platelet aggregation but not the dextran-induced aggregation. These findings suggested that polylysine induced aggregation more effectively than dextran by reducing the negative surface charge and giving stronger adsorption force on cell surface. In platelet-rich plasma, polylysine elicited the release reaction of 14C-serotonin but dextran did not. Possible mechanism by which polylysine could elicit the release reaction is the formation of more tightly packed platelet aggregate than that by dextran in the presence of the low calcium ion concentration in citrated platelet-rich plasma. Average distance between plasma membranes of aggregated platelets, however, did not vary with the degrees of polymerization of these macromolecules.


Smoking and risk factors in deep vein thrombosis.

The incidence of deep vein thrombosis (DVT) as diagnosed by the 125I fibrinogen test (125IFT) was determined in a series of 300 newly admitted medical and 201 surgical patients. 6 medical patients died before 125IFT screening could be completed. The incidence of DVT was 14% in medical patients and 18% in surgical patients. Increasing age, a malignant condition and a past history of thromboembolism all increased the risk of DVT. Increasing levels of cigarette smoking were found to be associated with a reduced incidence of DVT. Although statistical significance was achieved at only the 10% level for this finding it is in agreement with the results from studies on patients with myocardial infarction. The protective effect of cigarrette smoking was observed at all ages, and in both medical and surgical patients.


Subcutaneous ancrod after operation for fractured hip--a dose-ranging and feasibility study.

We have conducted a dose-ranging and feasibility study of daily subcutaneous injections of ancrod (Arvin) as a potential antithrombotic method in 28 patients following operation for fractured neck of femur. Sustained, predictable fibrinogen depletion during the first post-operative week was induced by four different regimes. A total dose of 10 units/kg weight, given in divided doses starting on the day of operation, is suggested as a possible antithrombotic regime. Ancrod treatment produced a rise in fibrinogen/fibrin degradation products, prolongation of the thrombin clotting time, and a fall in plasminogen, plasma fibrinogen and corrected blood viscosity were observed in 14 control patients. Plasma fibrinogen was correlated with plasma viscosity and corrected blood viscosity. No adverse effects of treatment occurred. Subcutaneous ancrod appears to be a simple, safe, and feasible potential antithrombotic method, and merits trials of efficacy in the prevention of post-operative thromboembolism.


In vivo platelet kinetics in 31 diabetic patients. Correlation with the degree of vascular impairment.

In vivo platelet survival was estimated, in 31 diabetic patients, using 51Cr-labelled autologous platelets. A mathematical analysis attempted to measure the "potential" life span (senescence process) and the degree of a superimposed aleatory destruction (consumption process). The potential platelet life span in diabetics did not differ from normal values. However, excessive consumption was observed in one third of the studied cases, without correlation with the age of the patients, the clinical duration of diabetes, and the degree of vascular impairment. Thus, platelet kinetic studies did not provide presently useful indications, in a particular patient, regarding the prognosis of the vascular disease, and the justification of anti-aggregant therapy.


Platelet monoamine oxidase and epinephrine-induced platelet aggregation.

Platelet MAO activity and the aggregation response to epinephrine, ADP, and collagen were measured in normal subjects. There was a direct correlation between the amount of platelet MAO activity and the per cent aggregation induced by 1 and 2 micrometer epinephrine. There were lesser correlations between platelet MAO and ADP or collagen-induced aggregation. These findings suggest that platelet MAO may play a role in determining the response of human platelets to epinephrine.


Effects of autoprothrombin II-A on epinephrine-induced platelet aggregation of normal- and coumadin-treated dogs.

Platelet-rich plasma from dogs and from coumadin-treated dogs aggregated at the same optimum concentration of epinephrine. Neither protein C nor its active form called autoprothrombin II-A was necessary for aggregation of dog platelets with epinephrine. For platelet aggregation, suboptimal concentrations of epinephrine were potentiated by addition of purified autoprothrombin II-A. The latter, by itself, induced platelet aggregation in high concentration.


Thromboxane generation and platelet aggregation in survivals of myocardial infarction.

Arachidonic acid (AA)-induced platelet aggregation was studied in platelet-rich plasma of 30 male patients who survived myocardial infarction and in 30 healthy men of similar age. Mean platelet aggregation thresholds to AA were 746 +/- 62 micrometer, and 869 +/- 57 micrometer, respectively. Only in 2 healthy subjects, but in 12 patients, irreversible platelet aggregation was induced consistently with low concentrations of AA, under 500 micrometer. The rate of conversion of AA to thromboxane A2 (TXA2) by platelets of these patients was augmented. Furthermore, less endogenous TXA2 was required to trigger aggregation of their platelets as compared to the controls. We have also shown that in platelet-poor plasma of these patients with "hyperreactive" platelets there exists a transferable factor which makes platelets of healthy subjects more prone to aggregatory action of AA. It is proposed that the assessment of platelet aggregability with AA provides a tool for identifying a subgroup of patients with coronary heart disease who might substantially benefit from the secondary preventive treatment with aspirin and with other antiplatelet drugs which inhibit the generation of TXA2 in platelets.


In vitro interaction between cultured cells and human blood platelets.

The effects of washed human cultured cells (tumour cells and Chang liver cells) on human blood platelets in heparinized plasma were studied. Platelet aggregation was induced by suspensions of the tumour cells. Ultrastructural examination showed that the platelets, especially in the central regions of the aggregates, were tightly packed and the alpha-granules were mostly present. In the periphery of the aggregates the platelets appeared swollen and devoid of organelles, and fibrin strands were seen. The platelet aggregation was not completely abolished by incubation with apyrase. The washing fluids from the tumour cells also induced platelet aggregation, but the aggregation could be abolished by incubation with apyrase. When three different lines of the Chang cells were used, suspensions of two lines of these cells induced platelet aggregation, but the third line did not. Presence of ADP could be demonstrated in the washing fluids from the cultured cells, except for the one line of Chang cells which did not induce platelet aggregation. The experiments indicated that the platelet aggregation induced by the various types of cells was mediated via ADP, but with a possible additional effect of coagulation activity.


[Three lambings within two years following induction of oestrus (author's transl)].

The annual number of weaner lambs per ewe is a factor of major importance in the profitability of sheep farming. In the Netherlands, approximately 80 per cent of the incomes are derived from the returns for lambs sold. Induction of oestrus makes it possible for the ewes to lamb three times in two years. To achieve a high conception rate, tupping should take place under supervision. In the Experimental Livestock-Farming Station, Lelystad, studies on the possibilities of inducing oestrus were done in ewes in which tupping occurred for the first time at an age of approximately seven months during natural oestrus in the months of October and November. The results obtained by inducing oestrus in July and August were similar to those obtained with natural oestrus in October and November. The results obtained in February and March were slightly inferior, which probably was also due to the fact that the condition of the ewes was not very good immediately after weaning of the lambs at six weeks. The number of lambs born showed an average increase of 0.5 lamb per ewe mating with the ram per year. A further increase of the annual number of lambs per ewe is likely to be achieved.


Cystic fibrosis and HLA.

In 94 children suffering from cystic fibrosis, no abnormal frequencies of HLA markers of the A and B locus were observed in comparison with the distribution of these antigens in control series. Furthermore, the HLA genotypes of seven pairs of diseased sibs are incompatible with the hypothesis of a closed linkage between CF--an autosomal recessive transmitted disease--and HLA.


The distribution of HLA antigens in the Motilones Indians of Venezuela.

The HLA antigen profile of the Bari and Yupa Indians who live in the Motilones Valley on the border between Venezuela and Colombia was studied. Both groups showed very limited polymorphism. HLA--A1, A3, A11, Aw23, A25, A26, A29, Aw30, Aw32, and Aw33, and HLA--B7, B8, B12, B13, B14, B17, B18, Bw22, and B27 were not observed in either population.


Detection of thrombocyte antibodies by 125I labeled protein A.

Protein A from Staphylococcus aureus interacts in a specific manner with most subclasses of human IgG. In the present study a method is described which utilizes Protein A labeled with 125I for the detection of antibody sensitization of platelets. The clinical applicability of the test for detection of in vivo or in vitro sensitization is demonstrated in three patients with platelet antibodies.


The HLA antigens in women with recurrent abnormal pregnancies of unknown etiology.

Women with recurrent abnormal pregnancies of unknown etiology--as compared with those with recurrent abnormal pregnancies of known etiology and with normal controls--had a significantly increased frequency of antigen HLA--A9 (corr. P less than 0.01). Analysis of the frequencies in matings performed at different levels of HLA incompatibility between parents in 35 couples with recurrent abnormal pregnancies of unknown etiology revealed a high degree of wife husband compatibility of the antigens of the HLA--A locus, but not of the antigens of the HLA--B locus. These results indicate that the HLA chromosomal region may influence the reproductive efficiency and the fate of the fetus.


Relations between the HLA-antigens and immune responsiveness to SK/SD in healthy Japanese subjects.

A possible association between the HLA antigens and immune responsiveness to SK/SD was studied in 90 healthy Japanese volunteers. No association was found between the HLA antigens, including B5, and SK/SD stimulated blastoid transformation. There was a week indication of an association between Bw22 and responses to SK/SD. But this was not statistically significant as far as the corrected P value was concerned.


HLA system and affective disorders: a sibship genetic study.

The authors have investigated HLA-haplotype zygotic assortment in 21 families with multiple cases of affective disorders and in 19 sibling pairs discordant for the disease. The finding of excess similarity between affected sibs stressed the possibility of the existence of genes in the HLA chromosomal region which are involved in the susceptibility to affective disorders. The mode of inheritance of such an hypothesized DS gene was also tested and some theoretical implications are discussed.