Ascites in patients undergoing maintenance hemodialysis. Report of six cases and physiopathologic approach.

Six patients with chronic uremia in whom ascites developed during maintenance hemodialysis are described. Their clinical and biochemical findings are reviewed and compared with data of 10 hemodialyzed patients without ascites. Liver cirrhosis was the origin of ascites in only one case. Hypoalbuminemia, liver cirrhosis, congestive heart failure, peritonitis, peritoneal tuberculosis and carcinomatosis were uniformly absent in the other patients. Long-term and marked overhydration seems to be at the origin of ascites. Lack of peripheral edema, probably due to ascites compartmentalization, was a constant finding in every noncirrhotic patient with ascites. When long-term overhydration was stopped after successful kidney transplantation or by means of diminished water and salt ingestion, reversal of the syndrome was attained. Nevertheless, ascites because of liver cirrhosis was not influenced by means of kidney transplantation. In three patients with ascites who did not receive a transplant, a significant reduction in water and salt ingestion was reached after intensive psychotherapy which led to reversal of the ascitic syndrome. In one anephric patient ascites did not develop despite water overloading. Survival has not been influenced by the formation of ascites. Further research is needed to determine the mechanism of sodium transfer across the peritoneal membrane. Influence of humoral factors can be considered, if an active transport mechanism could be demonstrated.


Simultaneous antibiotic levels in "breakthrough" gram-negative rod bacteremia.

Of 237 cases of gram-negative rod bacteremia observed at the UCLA Medical Center during a 12 month period, 52 (22 per cent) occurred while the patient was receiving antibiotics which inhibited the infecting organism by disc diffusion tests. One half of the plasma samples available from 42 such patients with "breakthrough" bacteremia had subinhibitory circulating antibiotic levels when cultures were positive. Sepsis documented within 72 hours of initiation of therapy was usually due to antibiotic-sensitive Esch. coli and was associated with inadequate antibiotic levels; the patient was usually treated with a penicillin or cephalosporin. The source of bacteremia was most frequently the urinary tract or the biliary tree. In contrast, sepsis occurring more than 72 hours after the administration of antibiotics was frequently caused by multiple antibiotic-resistant Esch. coli in patients treated with gentamicin in adequate dosage and was associated with leukopenia or undrained purulent collections. Therapy ultimately failed in 20 cases (48 per cent): in early "breakthrough" bacteremia, failure was associated with subinhibitory antibiotic levels, and in late "breakthrough" bacteremias with inadequate drainage or impaired host defenses.


Serious infections in adults due to group B streptococci. Clinical and serotypic characterization.

Serious infections in adults due to group B streptococci have been infrequently reported. We describe 24 such patients. Bacteremic pyelonephritis, pneumonitis and endometritis were the most common clinical syndromes observed. Group B streptococci infections tended to occur in patients with underlying illnesses, particularly genitourinary disorders and diabetes mellitus. Mortality was surprisingly low (8 per cent). Type III was the serotype most commonly isolated, and there was no significant correlation of different serotypes with specific organ-system involvement. Group B streptococcal isolates from these patients were uniformly sensitive to penicillin, ampicillin, cephalothin, chloramphenicol, erythromycin and clindamycin; all were highly resistant to kanamycin. Eighty-seven per cent were resistant to tetracycline. Although consistently sensitive to penicillin, the minimal inhibitory concentrations were significantly higher for group B than group A streptococci (p less than 0.0005).


Purpura fulminans.

Purpura fulminans is a rare disease characterized by cutaneous ecchymosis, hypotension and fever associated with disseminated intravascular coagulation. It usually follows a preparatory infectious illness. A case in a 55 year old woman challenges the concept that this disease is limited to childhood. A review of 100 case reports is presented in which the often quoted high mortality of 90 per cent is found to be no longer tenable.


Relationship of institution size to quality of care: a review of the literature.

The existing empirical literature on the relationship of institution size and quality of care was reviewed. Quality of care was discussed along four dimensions: (a) resident-care practices, (b) behavioral functioning, (c) discharge rates, and (d) extent of parental and community involvement. Care has been found to be generally more adequate in smaller institutions. However, considerable variation in quality of care has been reported among small community-based facilities. Little evidence was found that the behavioral functioning of residents is different in institutions of different sizes. There are essentially no data on discharge rates of institutions of different sizes. There is some evidence suggesting that parental and community involvement may be enhanced in community-based facilities.


Reflection-impulsivity and reading recognition ability among mildly retarded children.

The Matching Familiar Figures test of reflection-impulsivity and a test of reading recognition ability (Standard Reading Inventory) were administered to 236 youngsters (ages 8 to 17 years) who were in programs for educable mentally retarded students. Age was, of course, associated with reading recognition, but there was no relationship between Matching Familiar Figures and Standard Reading Inventory scores with age and IQ controlled. This finding casts doubt on the association of reflection-impulsivity as defined by performance on the Matching Familiar Figures test and the ability of retarded children to decode words.


Developmental stages of occupational therapy and the feminist movement.

Developmental stages characterize the growth of both the feminist movement and the field of occupational therapy. The human development stages described by Erik Erikson are used to compare the growth stages of these two groups to the human sequence. It is hypothesized that both female-dominated groups began with an "infancy" period in the early 1900s characterized by the beginnings of identity and confidence in their respective groups. Both continued to develop through stages corresponding to the childhood stages characterized by Erikson and into the adolescent acting out stages as characterized by the demonstrations of the 1960s. Present and future trends are explored in relation to developmental stages, as well as to implications for the field of occupational therapy in education, theory, and practice.


A study of dentition in pre-Columbian skulls.

Dentition in pre-Hispanic Mexican skulls has been examined in ancient Tenochtitlan--present-day Mexico City--and many different regions of the country, recently excavated. We have reached the conclusion that then, as now, there existed similar dental anomalies in number and position: the lack of certain teeth and the impaction of third molars and upper canines. So far, we have found decay only in back teeth Figs. 11 and 12 A and B). Most frequent was attrition, the severe wearing away of the chewing surface, which must certainly have been due to the primitive diet of seed, hard and dry, mixed with some abrasive material, produced by the grinding of stone against stone (metate) (Figs. 13 and 14) and the use of the teeth as tools. Finally, we should emphasize that we still find shovel-shaped teeth in the pre-Columbian dentition of Mongoloid influence, as well as in some of the present-day Mexican population.


Preventing enamel decalcification during orthodontic treatment.

One hundred thirty-two extracted premolar teeth were selected and divided into four equal groups. The first group of thirty-three teeth received a topical application of acidulated phosphate fluoride; the second group, a topical application of stannous fluoride; the third group, an application of a polymeric adhesive coating; the fourth group was left untreated to serve as a control. On each tooth a loosely fitted orthodontic band was cemented to place. After cementation, the band was broken to simulate a loose orthodontic band in vivo. The four groups of teeth were simultaneously immersed in a decalcifying gelatin and were left undisturbed for 11 weeks. The teeth were then removed and a record was made of the decalcification produced. A chi-square test was used to compare the teeth in each group to those in every other group. Compared to a control group of teeth, those teeth treated with polymeric adhesive coating, acidulated phosphate fluoride, or stannous fluoride produced a statistically significant reduction in decalcification of the tooth surfaces beneath loose orthodontic bands. For a one-application technique, the polymeric adhesive coating provided more protection against decalcification of teeth under loose orthondontic bands than did either acidulated phosphate fluoride or stannous flouride.


Bicarbonate modulation of glucose-9nduced biphasic insulin release by rat islets.

The role of HCO3 ions in pancreatic beta-cell functions was evaluated with isolated rat islets. The early phase of insulin release was absent when HCO3 ions were omitted from the medium prior to glucose stimuation, but was augmented if HCO3- withdrawal or reintroduction coincided with glucose increase. The inhibition of the late phase augmented as a function of the duration of HCO3- absence, and its reversibility upon readmission of the anion was delayed. Theophylline and cytochalasin B partially corrected the inhibition of the late phase but failed to restore a rapid response. In the presence of 5 mM NaHCO3, the early response was delayed but the total response was normal. In a HCO3--free medium, glucose oxidation and utilization and glucose transport in islet cells were unaltered. Uptake of calcium was reduced in the absence of HCO3 ions, but normal in 5 mM HCO3-. The results document the importance of HCO3- in insulin release and show that the two phases of glucose-induced secretion are differentially modified by its omission. Some of these findings may be explained by alterations in Ca++ uptake by islet cells. It is suggested that the mechanisms regulating insulin granule extrusion upon stimulation by glucose may be partially different for the two phases of release.


Uptake of bile acids by perfused rat liver.

The uptake of 14C-labeled cholic, taurocholic, and chenodeoxycholic acid by the perfused rat liver was studied to characterize the mechanism responsible for hepatic uptake of bile acids. A rapid-injection multiple indicator-dilution technique and the three-compartment model of Goresky were employed. The kinetics of hepatic uptake of the three bile acids could be described by the Michaelis-Menten equation. The maximal uptake velocities (Vmax) were 24.9 +/- 2.2 (mean +/- SD), 20.8 +/- 1.2, 1.2, and 11.4 +/- 0.9 nmol/s-g liver for cholic, taurocholic, and chenodeoxycholic acid, respectively. The corresponding apparent half-saturation constants (Km) were 526 +/- 125, 258 +/- 43, and 236 +/- 48 nmol/g liver. Competitive inhibition could be demonstrated between cholate and taurocholate as well as between cholate and chenodeoxycholate. Substitution of 94% of the Na+ in the perfusion medium decreased the Vmax and the apparent Km of taurocholate uptake by 68 and 55%, respectively. These findings are consistent with the hypothesis that bile acids are taken up into the hepatocyte by Na+-dependent carrier-mediated transport.


Overview: research on the psychology of women. II. Women in families, work, and psychotherapy.

In the first part of this overview the author reviewed research on gender differences in behavior and women's sexual and reproductive lives, and discussed the social and intellectual context of the recent knowledge explosion in women's studies.  In this second part she reviews recent research on selected aspects of the social psychology of women's lives. Highlighted themes include women in relationship to family structure and child rearing, work and achievement motivation, and implications for the psychiatric treatment of women that can be drawn from the psychotherapy research literature. She briefly assesses the possible impact of research in these areas on psychiatric theory and practice.


The functions and regulation of the arousal of anger.

Anger is paradoxically one of the most talked about but least studied of human emotions. The author presents a model of anger arousal that emphasizes the adaptive as well as the maladaptive roles of anger in terms of the diverse functions anger serves in affecting behavior.  In light of the fact that competence in anger management involves dealing with stress situations that require patience, composure, and constructive thought for their resolution, he discusses cognitive self-control processes affecting the regulation of anger.


Negative effects of melatonin on depression.

In order to test the efficacy of the pineal neurohumor melatonin on depression, the hormone was administered in varying doses to six moderately to severely depressed patients and two patients with Huntington's chorea in double-blind crossover study. Melatonin exacerbated symptoms of dysphoria in these patients, as well as causing a loss of sleep and weight and a drop in oral temperature. Melatonin increased cerebrospinal fluid 5-hydroxyindoleacetic acid and calcium in three of four patients studied. The authors discuss the implications of this finding.


A cognitive approach to experimental amnesia.

A review of selected experiments indicates that not all examples of experimental amnesia are due to the failure of a memory to fixate. Briefly, the argument is that the fixation of a memory occurs within a very short time and that its retrieval is aided if it is coded into a contextual memory system. An amnesic agent serves to block (inhibit) memories rather than disrupt them and has its effects on active memories, whatever their age. In sum, the empirical retrograde amnesia gradient does not necessarily support traditional consolidation theory.


An evaluation of a hospital stay regulatory mechanism.

The results of an evaluation of a predischarge utilization review program [PDUR] for Medicaid Patients are presented. A group of hospitals in Allegheny County, Pennsylvania, participated in this program on a voluntary basis prior to the program's being mandated statewide. All other hospitals in the county experienced retrospective review of Medicaid cases. Our analysis incorporates both types of hospitals in a quasi-experimental design. We found that during the period studied the length of stay of Medicaid patients fell proportionately more than that of the Blue Cross patients in both groups of hospitals; the relative decrease in the length of stay began to occur prior to the introduction of the PDUR program, but no differential effect of the PDUR review process could be demonstrated. The decline in the length of stay was, however, more continuous and smooth in those hospitals participating in the program.


Compensatory renal enlargement in older patients.

Renal size (product of length and width) was measured at urography before and after nephrectomy performed for tumor in 33 patients aged 38-78 years (mean, 59). In 88% a statistically significant enlargement of the remaining kidney was found (P less than .001). Earlier reports stating that compensatory renal hypertrophy does not occur in older patients cannot be supported.


Pulmonary telangiectasia.

Pulmonary telangiectasia is an uncommon developmental anomaly characterized by minute arteriovenous fistulae disseminated throughout both lungs. It should be suspected in patients with cyanosis and digital clubbing who do not have chronic lung disease or a cyanotic cardiac anomaly. The presence of telangiectases of skin or mucous membranes in the patient or members of his family is an important diagnostic clue. The chest film usually shows a coarse spidery appearance of the peripheral vascular markings in the lungs. More specific findings are obtained in the pulmonary angiogram where the normally invisible capillary phase is replaced by irregular vascular channels bridging the peripheral branches of pulmonary arteries and veins. The intrapulmonary right-to-left shunt may be confirmed by pulmonary scintigraphy using technetium-labeled albumin. Two cases are presented with a brief review of the literature.


A new versatile breathing system for CPPB. The application of PEPP during assisted and controlled ventilation or demand flow CPAP during spontaneous ventilation, with or without IMV.

A system is described which has been designed to improve the management of patients requiring CPPB. It makes use of a modified Bird Mark 7 or 8 ventilator adapted with a PEPP compensator and a new breathing circuit. This versatile unit provides several advantages over other currently available systems and makes it possible to apply PEPP during controlled and/or assisted ventilation as well as CPAP during spontaneous respiration, with IMV if another servo ventilator is included. This system has been in clinical use for 2 years and has proved to be highly reliable and efficient in both adults and children.


Stanislav Klikovich (1853-1910). Pioneer of nitrous oxide and oxygen analgesia.

The career and work of Stanislav Klikovich (1853-1910) has been reviewed. He was born in Russian occupied Poland and was a pioneer of the use of analgesic concentrations of nitrous oxide in oxygen for many painful conditions including childbirth. He based his clinical work on sound research and animal and human experimentation and recognised that the analgesic state was distinct from anaesthesia.


Continuous positive airway pressure in children.

Difficulties in the treatment of respiratory disturbances in children and the principles and rationale of continuous positive airway pressure respiration (CPAP) are discussed. The authors present personal experiences with this method, based on 88 cases, and the clinical usefulness and safety of CPAP. Development of acute respiratory failure in children after operations, mainly, after cardiac operations, during penumonia, lung oedema and respiratory distress syndrome in newborns, were effectively prevented on condition, however, that diagnosis was made sufficiently early. Systemic recording of PA-aO2 significantly contributed to early diagnosis. The use of CPAP allowed lower oxygen concentrations in the respiratory air to be used.


Train-of-four fade and edrophonium antagonism of neuromuscular block by succinylcholine in man.

Thumb twitch in response to train-of-four stimulation (2 Hz for 2 sec) of the ulnar nerve was measured in 36 patients anesthetized with halothane and N2O and paralyzed with succinylcholine chloride (SCC). Train-of-four fade was detected whenever a block was produced. The train-of-four ratio decreased with continued exposure to SCC. Edrophonium effect was predictable by the train-of-four ratio in a semiquantitative manner, a high ratio predicting block enhancement and a low ratio, antagonism. When calculated at 30 to 50 percent recovery (from complete block), a train-of-four ratio of 0.4 or less reliably predicts antagonism. The magnitude of antagonism is also predictable in a semiquantitative manner, although complete antagonism cannot be ascertained. The lower the ratio, the more effective the antagonism becomes. Train-of-four fade, therefore, appears to be a consistent and sensitive quantitative sign of phase II neuromuscular block by SCC in man.


Neutrophil chemotaxis during and after general anesthesia and operation.

The neutrophil granulocytes of 43 patients undergoing general anesthesia and operation were examined to determine if altered function occurs during these procedures. Neutrophil chemotaxis, random migration, and total and differential leukocyte counts were determined immediately before anesthesia; after 35 to 60 minutes of anesthesia but before operation; 60 minutes after initiation of operation; and 60 minutes after operation. Anesthetic agents included 1 to 3.5% enflurane, 0.5 to 2% halothane, or 0.5 to 1.1 mg/kg of morphine plus N2O-O2 (60:40). Neutrophil and total white blood cell counts were uninfluenced by any of the anesthetics; however, marked rises in both occurred during operation and persisted postoperatively after each of the anesthetic technics. Neutrophil chemotaxis was reduced an average of 36, 32, and 21%, respectively, by halothane, enflurane, and morphine before operation and 20, 10, and 5% intraoperatively. Preoperative reductions in chemotaxis were statistically significant after all anesthetics. However, only halothane produced a significant intraoperative reduction in chemotaxis. Postoperative neutrophil chemotaxis did not differ from control (preanesthesia) values after any of the anesthetics. Halothane and enflurane reduced leukocytic random migration before but not after operation. Morphine had no effect on random migration at any time. These data demonstrate that anesthesia impairs neutrophil function in man but that operation appears to reverse this depression.


Hypertension and decreased renal blood flow following methylene blue injection.

Renal blood flow (RBF) and arterial blood pressure (BP) were monitored in 12 patients undergoing nephrolithotomy in the lateral flexed position. All patients were preoxygenated and were anesthetized with sodium thiopental, N2O, O2, and fentanyl. Maintenance relaxation was obtained with pancuronium bromide. Arterial pressure was monitored by percutaneous arterial catheter. Following exposure of the kidney and renal pedicle, an electromagnetic flow probe was attached to the renal artery and baseline flows recorded. Following baseline measurements, 20 ml of 1 percent methylene blue was given intravenously. All patients studied showed an immediate rise in BP, and 11/12 showed a simultaneous decrease in RBF. The average fall in RBF was 35 percent at one minute. Both parameters returned to normal values on the average in 177 seconds. The decreased RBF appeared to be part of a generalized vasoconstrition caused either by sympathetic reflexes or by the direct action of methylene blue.


The physiologic effect of an intravenous glucocorticoid in bronchial asthma.

The intent of this investigation was to determine the acute effect on the airways of a single dose of intravenous corticosteroid in patients with severe bronchospasm. Following the intravenous injection of corticosteroid the initial response occurred at one to two hours and peaked at four hours. Significant changes occurred at four to six hours in central airways and in smaller airways.


[Cytochrome P450. Its importance in toxicology. II. Regulation of its biosynthesis and its activity. Activation and inhibition].

The authors emphasize the influence of hormonal and nutritional factors on the activity level of microsomal enzymes. Induction process of hepatic cytochrome P450 and microsomal enzymes by xenobiotics are described. The existence of different types of hemoprotein P450 in response to the action of different inductors is discussed. We also propose some hypothesis concerning the action mechanism of inhibitors of microsomal enzymes and we point out the role of environmental pollutants.


[Urinary infection and its development. Current diagnostic biological data].

The main object of the present article was to show that, independently of the clinical symptoms, the results of three laboratory examinations permit one to make the diagnosis of urinary infection and its degree of severity. 1) Bacteriuria equal or greater than 10(3) bacteria per ml is already significant of an urinary infection and infection of tissues of the urinary tree. If leukocyturia accompanies this bacteriuria, this does not necessarily show the degree of the infection. 2) The demonstration of specific serum antibodies of the bacterial species responsible for the infection (agglutination technique) is evidence of infection of tissues of the urinary tree, sometimes before the onset of radiological lesions. Furthermore, supervision of the course of the titer of these antibodies assesses the efficacy of the antibiotic treatment undertaken. 3) Using an immunofluorescent technique, the discovery of bacteria antibody immune complexes in the urinary sediment is also a sign of infection of the tissues of the urinary tree.


[Morphological changes of the cell surface during phagocytosis of asbestos fibers].

The Sandersand Shubik transparent chamber inserted in the golden hamster cheek pouch has been found a simple and easy technique to study the in vivo phagocytosis of asbestos fibers. Use of this device in a scanning and transmission electron microscopy study provided a three-dimension view of some phases of the process, of the cell-fiber relationships as well as of the modifications which occured on the cell surfaces in contact with the fibers in the chambers. The advantages presented by this experimental model over the others are discussed as well as some recent data regarding the cytotoxic effect of the asbestos fibres.


Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome.

In 45 consecutive patients referred for severe hypoxemia (Pao2 less than 100 mm Hg on positive end-expiratory pressure of 5 cm H2O and fraction of inspired O2 of 1.0), physiologic studies of gas exchange were correlated with pathologic features from 36 open lung biopsies and 15 autopsies. Three distinct groups were defined. Group 1 included 11 patients with the most severe hypoxia (Pao2, 47 +/- 12 mm Hg), minimal Pao2 response to a 10 cm H2O increase in positive end-expiratory pressure (+2.0 +/- 4.0 mm Hg), and a fixed shunt at all fractions of inspired O2. Pathologic study showed edema, exudation, and hemorrhage to the point of consolidation. In group 2 were 13 patients who had less severe hypoxia (Pao2, 60 +/- 17 mm Hg) and a moderate Pao2 response to a 10 cm H2O increase in positive end-expiratory pressure (+15 +/- 8 mm Hg), but whose maximal response was slowly achieved (30 min to several hours). Pathologic examination showed extensive fibrosis. The 21 patients in group 3 had the least hypoxia (66 +/- 15 mm Hg), and had a rapid and marked improvement in Pao2 with a 10 cm H2O increase in positive end-expiratory pressure (+68 +/- 59 mm Hg). Pathologic features were similar to but less severe than those in group 1. Venous admixture increased with decreasing inspired concentrations of O2, indicating diffusion or ventilation-perfusion abnormalities in groups 2 and 3.  Prognosis was best for group 3, with 10 of 21 long-term survivors. Two of 11 group 1 patients survived, but only after prolonged periods of extracorporeal membrane oxygenation. Despite biopsy evidence of extensive fibrosis, 3 of 13 in group 2 survived with moderate to good pulmonary function, including 1 survivor who had had extracorporeal membrane oxygenation. Such combined physiologic and pathologic studies are useful (1) for optimal respiratory care, (2) for prognosis, (3) for development of indications for extracorporeal membrane oxygenation, and (4) for better understanding of the pathophysiology of adult respiratory distress syndrome.


Interaction between fibrous dust and cells in vitro.

Studies carried out jointly with macrophages, fibroblasts and epithelial cells in vitro, have shown that the long fibers of asbestos or glass are incorporated in a special way. Phagocytosis of the long fibers is delayed and/or remains incomplete. Incomplete incorporation of the fiber causes a localized discontinuity in the cell membrane. There results continuous liberation of intra-cellular enzymes, which is compensated for by an increasing glycolytic metabolism. The effect of fibrous dusts cannot be compared with those of granular SiO2-dusts. Fibrous dusts, e.g. asbestos and glass fibers, induce the formation of polykaryotic giant cells by way of fusion; asbestos possibly also causes the interspecific fusion of cells. There are indications that in the process of asbestos induced cell fusioning integrated virus genomes are activated and infectious virus are released. The interaction between the cell and fiber causes a chronic irritation of the cell, which is discussed as a factor for tumour induction. There seems to be a causal relationship between the fibrogenic and carcinogenic effects of anorganic dusts and their shape, i.e. their length and diameter, regardless of their chemical composition. Thus the fibrogenic and carcinogenic effect is limited by a minimal length and a maximal diameter.


Incidence of serum antibodies to several Aspergillus species and to Candida albicans in cystic fibrosis.

The incidence of serum IgE antibodies to several species of aspergillus and the incidence of serum precipitins to these species and to Candida albicans were determined in 22 children with cystic fibrosis, 17 children with bronchial asthma, and 18 control subjects. IgE antibodies were found in 50 per cent of the patients with cystic fibrosis and in 29 per cent of the patients with bronchial asthma; none was found in the control subjects. Precipitins to aspergillus species were present in 59 per cent of the patients with cystic fibrosis, 35 per cent of the patients with bronchial asthma, and 11 per cent of the control subjects. Greater differences were noted when the total number of precipitin bands in each group was compared. There was a trend for the more severe cases of cystic fibrosis (based on the Shwachman-Kulczycki score) to have a greater incidence of precipitins and a lower frequency of IgE antibodies to aspergillus than the milder cases. Candida precipitins were found more frequently in patients with cystic fibrosis (45 per cent) than in patients with bronchial asthma (18 per cent); none was found in the control group. The potential role of fungal hypersensitivity in cystic fibrosis and the therapeutic implications are discussed in light of these findings.


Fatal Neisseria (Branhamella) catarrhalis pneumonia in an immunodeficient host.

A 64-year-old man with far-advanced IgA multiple myeloma presented with fulminant and rapidly fatal bronchopneumonia. Gram stains of expectorated sputum and of transtracheal aspirate revealed gram-negative intracellular and extracellular diplococci. Cultures of these specimens yielded Neisseria catarrhalis. Subsequent histologic examination of the lung confirmed the presence of numerous gram-negative diplococci in the alveolar spaces. The pathogenic potential of this nasopharyngeal commensal is discussed in both the normal and the immunosuppressed host.


A new heat-stable acid phosphatase test for mycobacteria.

The heat-stable (70degrees C) acid phosphatase test performed by the method of Kind and King is a simple method for differentiating Mycobacterium kansasii, M. marinum, M. gastri, M. nonchromogenicum, and M. triviale from other slowly growing mycobacteria, and M. fortuitum from other rapidly growing acid-fast bacilli.


Controlled clinical trial of four 6-month regimens of chemotherapy for pulmonary tuberculosis. Second report. Second East African/British Medical Research Council Study.

A comparison has been made of the relapse rates between 7 and 30 months for four 6-month regimens. Streptomycin plus isoniazid plus rifampicin had a relapse rate of 2 per cent of 171 patients; isoniazid plus rifampicin had a relapse rate of 7 per cent of 164. An initial 2 months of streptomycin, isoniazid, rifampicin, and pyrazinamide, when followed by thiacetazone plus isoniazid, had a relapse rate of 7 per cent of 179, and when followed by streptomycin plus isoniazid plus pyrazinamide twice a week the relapse rate was 4 per cent of 159 patients. Of the 36 relapses, 32 occurred in the first 6 months after stopping chemotherapy and 35 were with drug-susceptible organisms. The difference between the relapse rate on the streptomycin plus isoniazid plus rifampicin regimen and the isoniazid plus rifampicin and thiacetazone plus isoniazid regimens approached significance (P =0.06 for both comparisons).


Transbronchial biopsy for the diagnosis of lung transplant rejection. Comparison with needle and open-lung biopsy techniques in canine lung allografts.

The accurate diagnosis of lung transplant rejection requires histologic examination of the grafted lung. Because transbronchial lung biopsy has been advocated as an effective diagnostic procedure for a variety of lung diseases, it was elected to assess this technique in rejecting transplanted lungs. Twenty-two dogs received allografts and underwent simultaneous lung biopsy by 3 techniques when signs of rejection occurred. Open lung biopsy was diagnostic of rejection in all instances. Transthoracic needle biopsy correlated with the open biopsy in 59 per cent of the cases. No specimen obtained by transbronchial lung biopsy provided sufficient material to permit fulfillment of the strict histologic criteria needed to diagnose allograft rejection. Although transbronchial lung biopsy is successful in many pulmonary infiltrative processes, it appears to be inadequate for the diagnosis of lung allograft rejection.


Diazo replication of the lung: an improved methodology.

The methodology of diazo replication has been improved to provide replicas of 60 mum-thick lung sections with high contrast and sharp delineation of airways and air spaces. The newly introduced techniques are critical temperature control, embedment in isopentane, Bismarck brown staining, and parallel light, halogen lamp illumination.


Critical sequelae in biliary tract disease.

The high incidence of calculous biliary tract disease accounts for surgical operation upon the biliary tract disease accounts for surgical operation upon the biliary tract being the most frequently performed within the abdomen. Untreated surgically critical sequelae tend to occur with advancing age and duration of the disease. The more common of these are: acute cholecystitis, choledocholithiasis, acute obstructive suppurative cholangitis, biliary enteric fistulas, liver abscess, related pancreatitis, and biliary cirrhosis. The greater the pathological changes in the biliary tract and the more debilitated the individual, the greater is the risk of surgery. However, the risk is even greater without operation.


Carcinoma arising in thyroglossal duct remnants.

Papillary adenocarcinoma arising in a thyroglossal cyst is described in a 38-year-old man to make a total of 83 cases in the literature. Most cases appear to be benign thyroglossal duct cysts. The malignant nature of the lesion was recognized only after the permanent pathology sections were reviewed. Paillary carcinoma was the most common type of carcinoma arising in thyroglossal duct remnants. Local resection by the Sistrunk method is the standard treatment when the malignancy has not extended beyond the confines of the cyst. The differentiation between a carcinoma arising in a thyroglossal duct remnant and a metastatic papillary carcinoma from an occult primary in the main thyroid gland is discussed.


Antibody response to influenza vaccination in renal transplant patients: correlation with allograft function.

Thirty renal transplant recipients received 0.5 ml of Influenza Virus Vaccine, Bivalent, USP, intramuscularly. Serum hemagglutination-inhibiting and nasal secretory neutralizing antibodies were measured before and 3 to 4 weeks after vaccination. Creatinine clearance and urinary protein excretion were measured before and weekly for 4 to 8 weeks after vaccination. Ten of 13 patients (77%) with creatinine clearance of greater than or equal to 70 ml/min-1.73m2 (group I) had greater than or equal to a fourfold increase in hemagglutination-inhibiting antibody titers to influenza A or B virus after vaccination, while only six of 17 patients (35%) with creatinine clearance of greater than  70 ml/min-1.73m2 (group II) had a similar increase (chi-square = 5.129; P less than 0.05). Six of 13 patients (46%) in group I had greater than or equal to a fourfold increase in neutralizing antibody titers to influenza A or B virus after vaccination, whereas none in group II had a similar increase (chi-square = 7.135; P less than 0.01). There were no adverse effects on the allografts. Only minor side effects were noted in a few patients. Because of its safety and antigenicity, influenza vaccination should be offered to renal transplant recipients particularly during threats of epidemic outbreaks.


Pathogenesis of Osler's nodes.

Four patients in whom endocarditis had been verified at autopsy had the pathogenic organism isolated from aspirates of Osler's nodes. In three cases the responsible organism was identified in Gram stains made from aspirates. The etiologic agent was Staphylococcus aureus in three cases and Candida albicans in one case. Histologic examination of an Osler's node from one of the patients with S. aureus endocarditis showed a microabscess in the papillary dermis together with microemboli in nearby dermal arterioles. Workers previously have interpreted similar histologic findings as consistent with perivasculitis resulting from an immunologic reaction to the pathogenic organism. The present findings support Osler's original contention that the skin lesions that bear his name are "in all of probability caused by minute emboli".


Minocycline.

Minocycline has proved to have a wider spectrum of activity against both aerobic and anaerobic bacteria and has enhanced tissue penetration when compared with its tetracycline congeners. The latter, and possibly the former, can be related to its increased lipophilicity in the physiologic pH range. It appears to be a superior chemoprophylactic agent against sulfonamide-resistant meningococci that do not become minocycline resistant as a result of treatment. The clinical promise of this agent has been dimmed, however, by recent reports of vestibular toxicity manifest in ambulatory patients. Though data on the frequency and severity of these symptoms are in some conflict, minocycline cannot currently be recommended for general clinical use.


The liver and the antigens of hepatitis B.

A decade ago an antigen was identified by immunodiffusion and subsequently proved to be closely associated with hepatitis B virus. Further studies showed that hepatitis B virus circulates as a large particle containing a protein coat and a DNA core, and that excess coat particles are produced and circulate freely. Immunization with surface protein produced protective antibodies, and this led to the development of a prototype vaccine. Patients with hepatitis may develop a variety of extrahepatic manifestations, including polyarteritis, vasculitis, and glomerulonephritis. These associated symptoms may be due to immune complexes consisting of hepatitis B surface antigen and its antibody. The role of cellular immunity in hepatitis B is unknown. The relation between type B virus and the liver is both destructive (leading to severe acute hepatic disease and eventually to cirrhosis) and symbiotic (existing among carriers who have neither liver disease nor symptoms). If the factors that cause these divergent courses were delineated and understood, the results may lead to the prevention and cure of hepatitis B and its sequelae.


Influenza in 1918: recollections of the epidemic in Philadelphia.

When the great influenza epidemic struck Philadelphia in 1918, the author was just starting his third year at the University of Pennsylvania School of Medicine. After a single lecture on influenza, classes for the third and fourth year students were suspended while he and his mates manned an emergency hospital, in which they worked under little or no medical supervision and in the presence of an alarming patient mortality. This essay describes what happened in the hospital, and in the city as a whole, during the pandemic. Certain features of the clinical course of most patients permit the hope that modern therapy will prevent a repetition of the horrendous mortality.


[The concept of madness in Talmudic literature and its commentaries].

In spite of their spatial and temporal dispersion, the talmudic literature and its commentaries proceed from a fundamental unity. On one hand, the definition of madness are, a priori, extremely rigid; originally, they were exemplaries, quoted to resolve practical problems. On the other hand, the handling of these definitions requires a very important suppleness in the jurisprudence of legal implications of madness. Obviously, the dialectics of the rabbis show the care to respect the personal life of the individual and the spiritual life of the community. And if these conceptions have still an application nowadays, that is because the Talmud speaks of the mad and not of the mental ill without any cross-checking between the socio-legal model of madness and the medical model.


[Neurophysiological and biological bases of active and passive avoidance behaviors. Somatic consequences. Behavioral level. Semantic problems].

After a discussion concerning the semantic contents of terms such as: emotions, pulsions, motivations, as much from the physiological as from the psychological point of view as well as with regard to the role of the processes of memory and learning in their elaboration, the neurophysiological plane of fundamental behaviour patterns is approached. The role of the dorsomedian amygdala and of the lateral hypothalamus in the processes of behavioural activation as well as that of the septal area, of the hippocampus, of the lateral amygdala, of the ventro-median hypothalamus in the processes of inhibition are recalled. The action upon the environment and the reaction to the environment (conditioned or unconditioned) of this system are studied. Anxiety is considered as resulting from the inhibition of action and its endogenous or exogenous causes, as well as the mechanisms of its disappearance, are examined. The distinction between hypophyso-corticoadrenal alarm reaction and sympatho-adrenergic defence reaction is recalled. Basing himself upon the experimental work of his laboratory, the author shows that in the defence reaction it is necessary to make the distinction between the sympathetic reaction, noradrenergic, brrenergic reaction, medullo-adrenal, controlled by the system of behavioural activation. He shows the interest of such a distinction on the physio-pathological plane. Finally he approaches the biochemical level, that of the neuro-modulators and of their central role. He suggests that the effect alpha of catecholamines and the nicotinic effect of acetylcholine indeed seem to have a direct role in the control of synaptic activity, while the beta effect and the muscarinic effect could have a secondary role through the intermediary of the synthesis of cAMP and cGMP respectively. The second messengers would intervene principally in the neuronal protein synthesis and the long term memory. The work ends with a rapid summary concerning the biochemical and neurophysiological mechanisms of drugs which act upon behaviour patterns. This summary is based on the outline previously elaborated.


[Epilepsy and Szondi test].

After having briefly recalled the different studies of epilepsy done on the basis of the Szondi test, the author proposes to study the drive structure of three groups of epileptics (19 cases of primary generalized epilepsy, 18 cases of partial temporal lobe epilepsy, 31 cases of partial non-temporal epilepsy) with the purpose of finding possible differences in psychological drive among the three groups and, at the same time, evaluating the test's capacity for discrimination by using the statistical method. The three groups show the same type of profile generally characterized by an extreme need for acceptance and affection (h + !, C- + !) counteracted by a strong repression (hy - !, k -) resulting in agressiveness (s + !). However, statistical analysis (chi square test), the drive formula, the drive class and the EKP showed that, beyond this shared area, there are differences among the three groups. The author then attempts to sort out the meaning of these differences. Finally, based on certain passages from Szondi as well as the test results, the author puts forward an hypothesis linking the psychological drive problematic in primary generalized epilepsies to a very early disturbance in the history of the individual's psychic development, the origins of which would go back to a split in the unity between mother and child. On the other hand, drive disturbances in partial epilepsies would be considered secondary to the illness.


[Empirical research in psychotherapy. Recent studies in the English-language literature].

Empirical psychotherapeutic research has much progressed in the last teen years. In that field the american-english workers afford a great number of meaningfull studies and papers. Very definite experimental work has been made in subjects like therapeutic situation, therapist ways, patient's reactions and outcome facts or content analysis studies, in assessment of results and processes. In that paper an approach is made of: 1 degree psychotherapeutic research general trends, 2 degrees results from various theroretical orientations: psychoanalytic, behaviour therapy, Rogers or Balint, 3 degrees evaluation of main factors for therapeutic sessions, 4 degrees special fields like brief psychotherapies or group therapies.


[Indications for relaxation in geriatrics].

On a three years base experience in the geriatiic department of Geneva's University Psychiatric Clinic the paper studies the problem of selecting aged patients to be treated by relaxation according to the method of J. De Ajuriaguerra et M. Cahen. Observations are presented in an attempt to define three main points: a) the role played by relaxation when there is an objective [corrected] impairment of the body's integrity; b) relaxation effect on aged persons neurotic states evolution; c) the reality of considering dementia as a counter-indication of relaxation therapy. These remarks complete those presented previously about the training of therapists in relaxation, the type of control to be organized for them and their patients, the technical management of the cure, the place of relaxation in the post graduate psychiatric training, the effects of the therapy on the patients human environnement behavior in and out of the hospital, the way body is perceived through relaxation by the aged patients and it's consequences on the adjustment of an aging person.


[Distinction between beta-lactamases of immunotypes 1 or 2 using a new beta-lactam antbiotic (author's transl)].

The resistance of Gram negative bacteria to ampicillin and carbenicillin is often associated with the presence of plasmidic transferable beta-lactamase (class III of Richmond and Sykes). Using immunological and physico-chemical tests, two sub-classes have been identified. The sensitivity of Escherichia coli K12 with plasmid P111 (immunotype 1) or plasmid P453 (immunotype 2) determined by means of the minimal inhibitory concentrations, contrasts significantly with a new beta-lactam antibiotic, X-587. Study of the kinetic constants (Km, Vmax) of the beta-lactamases confirms and explains this difference. Thus we have a simple and rapid method for differentiation of these 2 types of enzymes.


[Influence of air enriched with oxygen injection on the bacterial yield during the fermentation and correction of the anti-foam effect (author's transl)].

Addition of an anti-foam such as the silicon "Rhodorsil" during fermentation provokes an important diminution of the dissolved oxygen rate and an interruption of bacterial growth. Injection of air enriched with oxygen prevents the interruption of bacterial growth.


[Severe epistaxis in hemorrhagic syndromes (excepting Rendu-Osler disease)].

The existence of a general abnormality in haemostasis causes more copious and protracted haemorrhage but does not, in theory, cause epistaxis. Abnormalities in primary haemostasis are at the root of these serious haemorrhages (thrombocytopenia and Willebrand's disease). Haemophilia is more rarely the trigger for intractable epistaxis. Treatment consists of local measures and replacement therapy. In all cases local treatment should have as little traumatic effect as possible in order to avoid a recurrence of haemorrhage when compression is removed. In women with abnormal constitutional haemostasis, establishment of anovulatory cycles by means of oestro-progestatives prescribed to combat menorrhagia often lessens the seriousness of these epistaxes. Replacement therapy consists of platelet transfusions for thrombocytopenia, the introduction of Willebrand's factor for Willebrand's disease and antihaemophilic factors for haemophilia.


Keratinization of the oral epithelium.

The morphology of the keratinizing epithelia in the mouth is reviwed in the light of recent knowledge. There appears to be a spectrum of degrees of keratinization rather than distinct types, and a degree of keratinization is reflected in the degree of packing and orientation of tonofilaments. The role of keratohyaline and other granules in the process is discussed and it is suggested that modification of the cell membrane is an important part of keratinization. Although the potential of the various areas in the mucosa is genetically determined and appears early in fetal life, the connective tissue exerts an influence on the extent of keratinization of the surface in a manner which is not understood.


[Severe epistaxis caused by carotid artery rupture].

Epistaxis due to rupture of the carotid, usually occurs as a result of cranial or closed cranio-facial traumatism. Heamorrhage is secondary to the formation of post-traumatic arterial aneurysms or arterio-venous fistulas. Frequently, the lesion is along the intra-cavernous pathway of the internal carotid. Rupture of a spontaneous arterial aneurysm in the sphenoidal sinus is, however, extremely rare. Carotid arteriography is the main method of investigation, and this method alone is capable of detecting the carotid lesion. In addition to obvious cases, it should be requested in cases of severe, copious and recurrent epistaxis when interrogation of the patient reveals the merest hint of trauma, often a long time previously. Immediate treatment consists of anterior bilateral and naso-pharyngeal tampnage. This allows enough time for arteriography to be carried out under the most favourable conditions and also testing for carotid substitution. In order to ensure permanent thrombosis of the aneurysmal pocket or the arteriovenous fistula, most methods resolve themselves into occlusion of the carotid axis. Cervical ligature of the carotid on its own, and isolated trapping have given way to techniques employing either a combination of trapping and embolization, or the placing of a balloon probe without trapping. At present, Serbinenko is advocating using balloons released when arteriography is carried out, obliterating the fistula and left in position permanently. Finally, there is the method by which the sphenoidal sinus is approached para-lateronasally after ethmoidectomy: this is an effective method which is much less incursive than the endo-cranial approach.


[Treatment of epistaxis of carotid origin by rhino-sinusal route].

Epistaxis of carotid origin usually calls for adventurous and complicated techniques such as trapping, embolization or releasable balloons. But there is an O.-R.-L. technique which is no less effective: the direct rhino-sinusal approach to the sphenoidal sinus followed by tenting or occlusion through the fascia lata. This tamponage, when applied very close to the source of the bleeding, has proved very effective and only cuts off the carotid axis progressively and is generally well-tolerated. To set against theoretically possible risks of extensive thrombosis are the indisputable practical advantages. In particular, any O.-R.-L. practitioner well versed in surgery of the sinuses can follow this procedure. Several cases are described.


[Current treatment of Rendu-Osler disease, excluding radiation].

All the methods available to O.-R.-L. practitioners for the treatment of epistaxis in Rendu-Osler disease are reviewed. In an emergency, gentleness is essential. Over the long term, procrastination for as long as possible is advisable. Super-selective arteriography and embolization are of great value in an emergency and can give some good long-term results. In fact, there is not one exclusive curative therapy. Estrogenotherapy has its advocates. Saunder's dermoplasty gives variable results, but these can be improved upon if a broad access route is used and dermoplasty extended to above and behind the nasal fossae. Because of its aggressive nature, irradiation must be kept as a last resort.


Orchidectomy and immune response.

The effects of orchidectomy on the structure and function of lymphoid tissues in mice have been studied. Both pre- and postpuberal orchidectomy caused relative hypertrophy of the thymus. There was also an increase in size of peripheral lymph nodes to reach a sustained maximum (6 weeks). Sychronous thymectomy and orchidectomy prevented the lymph node enlargement that follows orchidectomy alone. Enlargement of the thymus was due to increased numbers of thymocytes, and it could be abrogated by administration of androgens. Orchidectomy was associated with an acceleration of rejection of skin allografts which was prevented by androgen administration and abrogated by antilymphocyte serum. The reactivity of orchidectomized mice to sheep red blood cells and the early response to oxazolone, which is limited by thymus-processed cells, was increased, whereas production of antibodies to oxazolone, skin allografts, and pneumococcal polysaccharide was unchanged. It is suggested that orchidectomy increases cell-mediated immune responses but has no direct effect upon responses that are mainly dependent on B cells. Orchidectomy prolongs the interval between the subcutaneous injection of methylcholanthrene and the appearance of subcutaneous sarcomas. In tumour transplantation experiments orchidectomy casued protection against the Meth A tumour grown in ascitic or subcutaneous form. This protection was counteracted by antilymphocyte serum and partially countered by adult thymectomy combined with orchidectomy. In contrast, the appearance in AKR mice of spontaneous leukaemia, a tumour known to be thymus dependent, was increased after orchidectomy. The results of experiments with hypopituitary mice suggested that the effects of orchidectomy on immune response result from androgen withdrawal rather than interference with the hormonal milieu.


[Contribution to study of Ixodidae (Acarina, Ixodoidea) in Cantabric Mountains (Spain) (author's transl)].

Five Ixodidae species parasites of small mammals have been identified in North-western Spain and particularly on the cantabrique Mountains. The authors mention that among these species there are Ixodes acuminatus (Neumann, 1901) and Ixodes trianguliceps (Birula, 1895), which according to their own knowledge, have never been noticed in the Iberian Peninsula so far.


[Management of severe epistaxis caused by so-called vascular or hypervascular tumors].

The authors begin by recalling the various tumoral conditions responsible for severe epistaxis. They differentiate between: angiomas and pseudo-tumoral angiomatous formations, vascular or so-called vascular tumours and hypervascularized tumours. In an emergency, immediate tamponage is essential. Treatment is also preventive: a gentle clinical examination and biopsies in the operating theatre. Particular stress should be laid on the contribution of super-selective arteriography which enables embolization to be carried out during the investigation. Embolization is particularly advocated, notably in cases of naso-pharyngeal fibroma, when there is a tumoral projection obstructing the pterygo-maxillary fossa or when there is considerable vascularization stemming from a branch of the external carotid other than the internal maxillary. Whatever the situation, any embolization, if it is to be permanently effective should be followed within 48 to 72 hours by surgical excision.


The antiemetic effect of dixyrazine in postoperative patients-- a double-blind study.

A double-blind controlled study based on 197 women undergoing legal abortion (part I) or gynaecological surgery (part II) was employed to estimate the antiemetic effect of dixyrazine. Dixyrazine or part I) or intramuscularly at the end of anaesthesia (part II) and repeated when necessary. The follow-up period lasted 12 and 18 hours, respectively. Overall, a marked antiemetic response in the dixyrazine groups was observed when compared with the placebo treated groups in both part I and II (p less than 0.001). Dixyrazine proved to be superior to placebo especially in patients who were not prone to nausea or who received no major postoperative analgesics (p less than 0.001).


Effect of sediments on the survival of Escherichia coli in marine waters.

Escherichia coli, a fecal coliform, was found to survive for longer periods of time in unsterile natural seawater when sediment material was present than in seawater alone, and at least on one occasion growth was observed to occur. This enteric bacterium was found to increase rapidly in number in autoclaved natural seawater and autoclaved sediment taken from areas receiving domestic wastes, even when the seawater had salinities as high as 34 g/kg. However, in autoclaved seawater, growth was always more gradual and never reached numbers as high as those observed when sediment was present. It was found that nutrients were easily eluted from the sediment after autoclaving or upon addition to artificial seawater, but little elution occured during mixing of the sediments with unsterile natural seawater. The longer survival of E. coli in the sediment is attributed to the greater content of organic matter present in the sediment than the sweater. These laboratory results, in part, could explain why on a volume basis larger numbers of coliforms and fecal coliforms and fecal coliforms were found in estuarine sediments than the overlaying water at field sites.


Influence of postirradiation incubation temperature on recovery of radiation-injured Clostridium botulinum 62A spores.

The number of colonies formed by unirradiated Clostridium botulinum 62A spores was independent of temperature, in the range from 20 to 45 degrees C (in 5 degrees C increments); no colonies developed at 50 degrees C. Spores irradiated at 1.2 or 1.4 Mrads produced more macrocolonies at 40 degrees C than at higher or lower temperatures. Apparently, radiation-injured spores were capable of repair of 40 degrees C than at the other temperatures studied. More than 99% of the radiation (1.2 Mrads) survivors were injured and were unable to form macrocolonies in the presence of 5% NaCl. The germinated radiation-injured spores were also sensitive to dilution, resulting  in the loss of viability of 77 to 79% of the radiation survivors. At 30 and 40 degrees C, the irradiated spores did not differ significantly in the extent of germination (greater than 99% at both 30 and 40 degrees C), emergence (64% at 30 degrees C and 67% at 40 degrees C), and the maximum number of emerged cells that started to elongate (69% at 30 degrees C and 79% at 40 degrees C). However, elongation was remarkably more extensive at 40 degrees C than at 30 degrees C. Many elongated cells lysed within 48 h at 30 degrees C, indicating an impaired repair mechanism. If the radiation-injured spores were incubated at 40 degrees C in the recovery (repair) medium for 8 to 10 h, they germinated, emerged, and elongated extensively and were capable of repair. If, after 8 to 10 h at 40 degrees C, these cultures were shifted to 30 degrees C, the recovery at 30 increased by more than eightfold, resulting in similar colony counts at 30 and 40 degrees C. Thus, repair appeared to be associated with outgrowth. Repair did not occur in the presence of chloramphenicol at 40 degrees C, whereas penicillin had no effect, suggesting that the repair involved protein synthesis but did not require multiplication.


Phage typing system for Salmonella enteritidis.

A system is described for the phage typing of Salmonella enteritidis. The system was developed using a number of bacteriophages that were isolated from sewage.


Spiral plate count method for the examination of raw and pasteurized milk.

The spiral plate count method (SPLPC) was compared with the standard plate count (SPC) method by examining 201 samples of raw and pasteurized milk. Although the means of the two methods differed significantly at alpha = 0.01,the difference was less than 10% and was not considered to be of any practical importance. The pooled replicate variances of both methods were less than 0.003, indicating good agreement between duplicate plates, with the variance of the SPLPC slightly less than that of the SPC. We believe this study indicates that the SPLPC could be substituted for the SPC in the bacteriological examination of milk.


Influence of possible disinfectant transfer on Staphylococcus aureus plate counts after agar contact sampling.

Asbestos-vinyl tile floor panels were mopped with three types of chemical disinfectant product, as well as after contact, with the untreated control panel were prepared according to the manufacturer's label instructions. Similar floor panels were inoculated artificially with Staphylococcus aureus. RODAC (replicate organism detection and counting) surface sampling plates were pressed to the disinfectant-treated panels or to the untreated control panel and then immediately pressed to sampling sites on the artificially inoculated floor panels. Plate counts were determined after contact with panels treated with each type of disinfectant, product, as well as after contact with the untreated control panel. Results indicate that disinfectant residues on environmental surfaces do not alter the average plate counts obtained by RODAC samplings.


Characterization of microbial isolates from an estuarine ecosystem: relationship of hydrocarbon utilization to ambient hydrocarbon concentrations.

Water collected at 12 sites in the Neuse River estuary of North Carolina was analyzed for total viable counts on three isolation media (Trypticase soy agar [TSA], marine agar 2216, Sabouraud agar) and total hydrocarbons by fluorescence spectroscopy. Counts of 3.9 X 10(1) to 3.8 X 10(3) cells/ml were found for total heterotrophs, well within the range commonly reported for marine and estuarine waters. Generally, marine agar 2216 gave higher counts than TSA at stations with salinities greater than 6.0 mg/ml; TSA gave higher counts than marine agar 2216 at sites with salinities less than 4.0 mg/ml. The microbial species isolated on the three media agree well with those previously reported for estuarine microbial communities. Water analyses, using XAD-2 resin and fluorescence spectroscopy, revealed petroleum hydrocarbon concentrations in the range of 5 to 79 ng/ml. Representatives of the microbial species isolated from these communities were tested individually for their ability to grow using kerosene as a sole source of carbon and energy. At all but two stations, the majority of the species isolated were able to grow on hydrocarbons, indicating that this ability is widespread even in environments not subjected to high levels of hydrocarbon pollution.


Specimen housing unit for cinemicrographic studies in the vertical plane.

A compact housing unit for low-power (X6 to X50) cinemicrographic studies of microbial specimens in the vertical plane is described. This unit was used successfully to record the development of a "halo" of cells around subsurface colonies of Escherichia coli.


Evaluation of millipore HA and HC membrane filters for the enumeration of indicator bacteria.

Millipore type HA and HC membrane filters were compared for recoveries of total coliforms, fecal coliforms and fecal streptococci from natural waters and wastewater effluents. Bacterial and fecal coliform recovery was better on HC than on HA filters.


[Influence of temperature on the rate of spermatogenesis, duration of spermatogenic activity and development of secondary sex characteristics in the wall-lizard, Lacerta muralis L. (Reptilia, Lacertidae)].

A series of experiments was carried out primarily between the 22nd of March and the 27th of June, on 60 Lacerta muralis maintained either under semi-natural conditions in large enclosures or in constant-temperature cabinets maintained at 17.5 degrees C, 20 degrees C, 22.5 degrees C and 27.5 degrees C with a natural photoperiod. Following an injection of tritiated thymidine, the animals were sacrificed at regular intervals and the rate of spermatogenesis was deduced from the progression of the radioactive front in the seminiferous epithelium. The following results were obtained: 1. The rate of spermatogenesis is temperature dependent and increases by a factor of approximately 1.2 per degree centigrade between 17.5 and 27.5 degrees C. The rate is seven times greater at 27.5 degrees C than at 17.5 degrees C. 2. Under semi-natural conditions the interval leptotene-spermatozooid lasts 70 days, slightly less than that found at a constant temperature of 22.5 degrees C. 3. Under semi-natural conditions the rate of spermatogenesis was similar to that in August-September, April-May and May-June which indicates that the lizards were able to maintain their body temperature at an equivalent level by behavioural temperature regulation during the greater part of their activity period. 4. Under semi-natural conditions, or at temperatures in excess of 22 degrees C, spermiogenesis lasts 1.8 times as long as meiosis. 5. At constant temperatures lower than 21 degrees C the development of the cellular lineage is aressted at the young spermatid stage. 6. Constant temperatures between 17.5 and 22.5 degrees C had no effect on the time of involution of the testis at the start of summer. 7. At low constant temperatures, secondary sexual characteristics regress before the usual time: after 4 weeks at 20 degrees C and after 8 weeks at 17.5 degrees C. An expected regression after 8 weeks produced after exposure to a temperature of 22.5 degrees C is probably due to factors other than temperature. 8. In the case of different individuals kept either under natural, semi-natural or experimental conditions, there was no close relationship observed between the time of involution of the seminiferous tubules and regression of secondary sexual characters. ters. 9. These results confirm the concept of endogenous control of sexual regression at the commencement of summer and argue in favour of 2 separate gonadotrophic hormones in reptiles.


A histochemical study of vegetative innervation of blood-vessels of serosa.

Research was carried out into the morphological substrate of the dual (sympathetic and parasympathetic) innervation of blood-vessels of the serosa, including the vessels of microcirculatory system. Tests were carried out on total preparations of the pericardium, pleura and peritoneum of dogs and cats. Using histochemical methods to show up adrenergic (Falck-Hillarp's method) and cholinergic (Koelle-Gomori's method) nerve structures the architectonics of both components of vasomotor innervation in various parts of the arterial and venous sytem of the serosa was described a gradient of their saturation with adrenergic and cholinergic innervation structures gradually decrease, the vessels branching out shown and entering the region of the terminal blood supply. Vegetative innervation of the precapillary arterioles and capillaries appears inconsistent and is mainly restricted to single synaptic contacts arising along the route of adrenergic and cholinergic terminals. In vessels of the venus system, including postcapillary venules and small collecting veins, vegetative innervation (adrenergic and cholinergic) invariably appears scanty and frequently can not be detected at all.


Detection of circulating IgG aggregates and immune complexes using 125I protein A from Staphylococcus aureus.

A method for detection of circulating immune complexes by the use of 125I labelled staphylococcal protein A is described. In a polyethylene glycol solution as little as 1-2 mg/l of soluble heat aggregated human IgG could be quantitated. Variables which might influence the assay were examined. Separation of immune complexes in serum from monomeric IgG was essential and achieved by gel chromatography on Sephadex G200. This assay may be suitable for clinical routine for detection and quantitation of immune complexes. A preliminary study on the clinical application of the method is presented. 58% of patients with systemic lupus erythematosus and 42% of patients with rheumatoid arthritis had increased levels of immune aggregates in serum compared to a group of healthy individuals.


A prospective study to determine the efficacy of antibiotics in acute pancreatitis.

This study is a double "blind" prospective evaluation of the efficacy of antibiotics (Ampicillin) in the treatment of acute alcohol-induced and idiopathic pancreatitis. Fifty-eight patients with acute pancreatitis were randomly divided into antibiotic and non-antibiotic treatment groups. The two groups were comparable clinically at the onset of the study and other than for antibiotics received identical therapy. The patients without antibiotics had a clinical course equal or slightly more favorable than the antibiotic treatment group in all parameters examined. These data indicate that prophylactic use of Ampicillin is not indicated in patients with routine acute alcohol-induced or idiopathic pancreatitis. The role of prophylactic antibiotics in patients with pancreatitis related to biliary calculi and those with more severe varieties of acute hemorrhagic or necrotizing pancreatitis remains to be more clearly defined.


The chemotherapy of rodent malaria, XXIV. The blood schizontocidal action of erythromycin upon Plasmodium berghei.

Erythromycin inhibits chloroquine-induced pigment clumping in Plasmodium berghei in vitro. The drug was therefore tested against infections of P. berghei in mice and was found to be active at non-toxic doses. Given orally, the stearate salt was more effective than the base, but subcutaneously the base was more effective than the stearate. Erythromycin potentiated the action of chloroquine against two chloroquine-resistant strains of rodent malaria, the mildly resistant NS, and the highly resistant RC strains of P. berghei, but not against the drug-sensitive N strain.


[Clinical importance and epidemiological position of chronic carriers of Australia antigen (HB Ag)].

A complete examination of the position of the healthy carrier of the Australia antigen is here exposed. This type of carrier appears to day not a healthy but a carrier of a minimal sort of hepatitis. The outline is however silent and for that reason very dangerous in the all conditions of life of the carrier. The problem of the prophylaxis is now very open.


[Use of potassium chloride hypertonic saline solution (3M KC1) for extraction of soluble antigens from Candida albicans].

Soluble antigens have been obtained from Candida albicans cultures of different age treated with hypertonic salt solution (3M KC1). The antigens reached against anti-Candida immune sera in double diffusion agar test, also after adsorption of immune serum on Candida cells. Electron microscopic pictures revealed a marked reduction of the outer layers of 3M KC1 extracted cells.


The chemotherapy of rodent malaria, XXV. Antimalarial activity of WR 122,455 (a 9-phenanthrenemethanol) in vivo and in vitro.

WR 122,455, 3,6-bis-(trifluoromethyl)-alpha-(2-piperidinyl)-9-phenanthrenemethanol HCl, suppresses infection with drug-sensitive Plasmodium berghei N strain in mice. It acts rapidly and affects all the stages of the asexual intraerythrocytic parasites, the effective dose levels being about three times those of chloroquine and one-twelfth to one-fifteenth those of quinine. Under the influence of WR 122,455 haemozoin seems to disappear from the affected parasites following an initial coarsening of the fine pigment granules. These changes are similar to those exerted by quinine. Large doses of WR 122,455 have a residual affect due in part, at least, to deposition of insoluble material in the tissues. The drug appears to exert an antagonistic action on chloroquine when both drugs are administered simultaneously. It has no causal prophylactic effect. In vitro WR 122,455 is a competitive antagonist of chloroquine in a similar manner to quinine, and appears to have a dissociation constant (Ki) of 2-26 x 10(-8) M, making it about 18 times as active as quinine. WR 122,455 interacts strongly with calf thymus DNA, but the mechanism of interaction has yet to be defined. Mice tolerate single doses of a saline/Tween 80 suspensions up to about 400 mg/kg but sc administration induces necrotic changes at the injection site. Up to 30 mg/kg daily po for seven consecutive days is well tolerated systemically but local tissue reaction may occur if the drug is given by the sc or ip routes. However, systemically up to 60 mg/kg is tolerated sc or ip. The relation of WR 122,455 to drug resistant malaria will be reported later.


The chemotherapy of rodent malaria, XXVI. The potential value of WR 122,455 (a 9-phenanthrenemethanol) against drug-resistant malaria parasites.

The phenanthrenemethanol compound WR 122,455 is an effective blood schizontocide against lines of Plasmodium berghei that are highly resistant to primaquine, sulphonamides, pyrimethamine and cycloguanil. It is also active against the NS line that is moderately resistant to chloroquine. WR 122,455 is inactive against the RC line which is highly resistant to chloroquine.  Resistance to WR 122,455 is fairly readily developed by the drug-sensitive N strain of P. berghei, using a relapse technique. Resistance develops very readily to the NS line of P. berghei. Both resistant lines exhibit cross-resistance to quinine, but a roughly normal response to chloroquine, primaquine, sulphonamides, dapsone, pyrimethamine and cycloguanil. Resistance to WR 122,455 is stable through cyclical transmission and through cryopreservation, as well as in the absence of drug selection pressure. The resistant parasites have an essentially normal morphology and virulence. A warning is given against the widescale use of WR 122,455 or similar new drugs for human malaria other than in a suitable combination, in order to minimize the danger of the development of resistance to them.


Application of immunofluorescence to detection of antibody in Leishmania infections.

Indirect immunofluorescence was used for determination of antibody in human cases of cutaneous leishmaniasis, mice infected with Leishmania tropica and guinea pigs infected with L. enriettii. Results indicated that antibody in mice is detectable 23 days after infection with L. tropica. The antibody titre correlates well with the extent of infection. In guinea pigs infected with L. enriettii, antibody appears much faster and is detectable 12 days after infection. Here also the antibody titre increased during the course of infection until about 76 days at which time the leishmanial lesion was at its height. Guinea pigs having metastatic lesions consistently showed a high titre of antibody. In several cases of human cutaneous leishmaniasis antibody was detectable at the titre of not more than 1/128. In five cases of suspected systemic leishmaniasis antibody titre was much greater than in cutaneous leishmanial infection. Upon characterization of anti-leishmanial serum of guinea pig with DEAE-cellulose chromatography and analysis of the fractions by immunoelectrophoresis, it was found that the antibody activity detected by the indirect immunofluorescence resided in the gamma2 portion of guinea pig globulin.


[Bacterial flora of the conjunctival sac of the horse].

The AA. report the results of taxonomic research conducted on the conjunctival sac of 59 horses for identification of the present bacterial flora. In the controlled animals, it was observed, at the level of the considered niche, a community constituted of normal bacterial populations, but not autochtonous in the significance they attributed from DUBOS et al., relative to the characterization of the indigenous microbiota of the intestine. The isolated normal bacterial flora seems to be constituted of: Micrococcus (subgroup 6 of Baird-Parker, M. luteus, Micrococcus spp.) isolated in 49,15% of the samples; Staphylococcus aureus and St. epidermidis (18,64%); Moraxella osloensis, M. phenylpiruvica, M. equi and Moraxella spp. (11,86%); Bacillus cereus (11,86%); Neisseria catarrhalis (8,47%); Streptococcus equi and Str. zooepidemicus (6,77%); Corynebacterium spp. (6,77%) and Acinetobacter lwoffi (5,08%). The AA. have found, besides, a particular group of bacteria of uncertain classification, attributed to the coryneforms and found in 30,50% of the examined horses. So-called transient bacteria taxa have been considered are Streptomyces spp., isolated in the 10,16% of the controlled subjects, Aerococcus viridans and Bacillus spp. found in only one equine.


The incidence of venous thrombosis following long-term transvenous pacing.

Long-term cardiac pacing with permanent transvenous electrodes has achieved wide acceptance with only occasional reports of venous obstruction and edema. To determine the incidence of venous abnormalities associated with transvenous electrodes, 34 venograms were obtained in 32 patients paced 18 months or longer. Eleven venograms demonstrated severe obstruction with collateral circulation communicating with the opposite cervical and innominate venous channels; 7 of these showed total occlusion. Seven venograms revealed no obstruction. The remaining 16 venograms showed venous stenosis without collaterals. It is concluded that venous abnormalities associated with permanent transvenous pacing occur commonly but are not usually associated with arm or facial edema.


Human heart transplantation: current status.

The overall survival rate for 97 heart transplant recipients operated on from 1968 to 1975 has been 49% at one year and 23% at five years. Progressive improvement in one-year survival has been achieved, from 22% in 1968 to 62% in 1974. The major factors responsible for increasing survival are better understanding and management of acute and chronic rejection. Current results suggest that heart transplantation deserves wider application in the treatment of selected patients with end-stage myocardial insufficiency.


Noninvasive diagnosis of deep venous thrombosis.

Eighty-five patients suspected of having lower-extremity deep venous thrombosis (DVT) participated in a prospective study to test the diagnostic accuracy of four noninvasive techniques: Doppler ultrasonic flow study, electrical impedance plethysmography, the serial dilution protamine sulfate test, and an extensive physical examination. Ascending radiocontrast phlebography was the diagnostic standard of reference. We found that (1) when both Doppler and impedance examinations were positive, the diagnosis of DVT could be considered virtually certain; (2) impedance and Doppler examinations, when used in combination, were reliable screening tests capable of establishing or excluding the presence of thigh DVT; (3) physical examination and the serial dilution protamine sulfate test were unreliable screening techniques for DVT; (4) techniques other than the noninvasive methods investigated were needed to reliably detect or to exclude popliteal and call DVT.


Gentamicin-associated acute renal failure.

Five patients are described in whom only gentamicin sulfate appeared responsible for acute renal failure. Subjects received 1.2 to 2.88 gm over 12 to 18 days. All were over 45 years of age, and premorbid kidney abnormalities may have enhanced susceptibility to toxic effects of the drug. Renal failure appeared 8 to 17 days after beginning gentamicin therapy and was characterized by creatinine clearances 4 to 10 ml/min, urine to plasma creatinine ratios less than 20, urinary sodium concentrations 16 to 60 mEq/liter, proteinuria, and cylindruria. Oliguria was not observed and this feature may impair recognition of kidney damage. Clinical recovery required an average of 42 days and was complete in four of five patients. Gentamicin alone may be nephrotoxic and should be given with particular caution to the elderly and those with even mild kidney abnormalities.


Hemodialysis in diabetics: complications in insulin-dependent patients accepted for renal transplantation.

The hemodialysis complications in 67 insulin-dependent diabetic patients accepted for renal transplantation were compared with those in 67 nondiabetic hemodialysis patients. Eleven of the 67 diabetic patients died before receiving a renal transplant-four of myocardial infarction, three of dialysis-related causes, and four of infections. One of the 67 nondiabetic patients died of infection before transplantation. The diabetic patients experienced more complications on dialysis than did the nondiabetic patients; they were more hypertensive and required more ultrafiltration during dialysis. In addition, the diabetic patients had a higher incidence of hypertensive episodes during dialysis, as well as a high incidence of predialysis hyperglycemia. These findings suggest that diabetic patients with renal failure should be dialyzed more frequently and transplanted as soon as possible in order to decrease the complications associated with hemodialysis.


[Attempt to treat a case of chronic familial granulomatous disease by allogenic bone marrow transplantation].

A bone marrow graft was performed in a 3 1/2 year old boy suffering from chronic granulomatous disease. Donor-recipient matching was complete in the ABO, HL-A and M.L.C. systems. The number of injected cells amounted to 5.4 X 10(9) (3.6 X 10(8) cells/kg body weight). The immunosuppression regimen consisted of cyclophosphamide and A.L.S. before the graft, and methotrexate after it. Neither graft versus host reaction, nor secondary infection developed. The take of the graft was monitored by the Gm allotypes. Rejection, however, occurred after 2 months.


[Neuro-psychological development of a group of children with neonatal respiratory distress treated with intermittent positive-pressure respirator].

The first results of long-term evolution of 99 children, most of which were premature, and who survived after intermittent positive pressure respiration for hyaline membrane disease, have been analyzed. No matched series could be set up. With a follow-up ranging from 3 1/2 years to 6 years, 51% of the children were normal, 12.5% presented with severe neurological and psychological sequellae, 31% had acceptable, sometimes slight handicap. As compared with series of the literature, prognosis was improved with intensive care and artificial respiration. This is far more obvious for the children at stage III, of which none survived without artificial respiration.


[Endocrine exploration in Prader-Labhardt-Willi syndrome].

In nine children with Prader-Labhardt-Willi syndrome, some tests of anterior pituitary functions and insulin secretion have been performed. The endocrine disturbances found in these cases have been those commonly encountered in obese and/or cryptorchid subjects, so that they do not allow to ascertain a primary hypothalamo-pituitary defect.


Schizo-affective psychosis: fact or fiction? A survey of the literature.

The classification of functional psychoses has traditionally been dichotomous with schizophrenia and manic-depressive disorder, which are considered separate entities. However, the psychiatric literature is replete with descriptions of psychoses with mixed features. A variety of names has been applied to these psychoses, including the term "schizo-affective." Confusion exists regarding the nature of these psychoses, much of it resulting from a tendency to limit investigation to an acute view of symptom complexes.  This article examines the schizo-affective states across a variety of dimensions, including the acute symptomatologic picture, response to lithium carbonate therapy, follow-up studies, family history, and genetics. While the term "schizo-affective," as commonly used, probably describes a heterogeneous group of psychoses, considerable evidence supports the hypothesis that at least a subgroup of these psychoses has a definite relationship to the major affective disorders.


Glycerinated glycol methacrylate mounting medium in highlighting non-coated or glycerin-substituted microsamples under the scanning electron microscope.

Glycol methacrylate hardened with 10-15% glycerin showed no charging and gave dark contrast in the scanning electron microscope with an acceleration voltage of 25kV and a specimen current of 1x10(-10) A. Using human blood cells, it was shown that this conductively treated resin is a useful mounting substrate to highlight the non-coated microsamples or to obtain their highly contrasted images under the scanning electron microscope. It was also demonstrated that the glycerin-substituted blood cells can be scanned with little shrinkage.


Corrosion casts of lymphatics.

After direct injection of Mercox into the thyroid parenchyma we obtained the corrosion casts of lymphatics to be observed by scanning electron microscopy. It seems reasonable to deduce from the following points that these corrosion casts were of the lymphatic system: 1) variable size of columnar vessels, 2) their three-dimensional anastomoses, 3) occurrence of blind endings, 4) V-shaped reliefs on parts of the columns, certainly indicative of valves, 5) bead-like structures formed by closure of valves, 6) depressions and surrounding saw-toothed figures on the surfaces of the casts, probably corresponding to the nuclei and boundaries of endothelial cells. The method described in this study seems useful in the study of the structures and changes of lymphatics in various organs.


Immunohistochemical demonstration of glucagon- and GLI-containing cells in the canine gut and pancreas.

Cells possessing glucagon- and glucagon-like immunoreactivity (GLI) were studied by an indirect immunofluorescence technique in the normal canine gastrointestinal mucosa and pancreas. Glucagon-immunoreactivity was demonstrated in the basal-granulated cells in the deeper portion of the fundic gland of the stomach as well as in the A cells of the pancreatic islet. GLI-positive basal-granulated cells were found in the fundus of the stomach, jejunum, ileum and colon. None of them were found in the pyloric antrum and duodenum. Careful examination of the immunofluorescence specimens gave us the impression that essentially every GLI-positive cell in the gastric fundus and pancreas contained glucagon. It was observed that the GLI-positive cells in the jejunum, ileum and colon were open in type reaching the lumen with their tapered luminal process, whereas the glucagon/GLI-positive cells in the stomach were always separated from the lument by a layer of other epithelial cells so that they were close in type. The possible difference in the way of stimulus-reception between the GLI-positive cells in the intestine and glucagon/GLI-positive cells in the stomach was discussed with particular reference to the idea that basal-granulated cells could receive information for their secretory activity not only from the gut lumen but also from the blood side.


Relaxation training: effects on the communicative ability of aphasic adults.

A verbal test battery (VTB) of four 15-item tests was administered to 16 aphasic adults following a period of relaxation training and a control period. Results indicate that verbal communication of aphasic persons is positively influenced by relaxation training. Subjects had significantly higher overall VTB scores and naming test scores following relaxation. Findings are discussed in terms of the use of relaxation procedures as an adjunct to conventional language therapy approaches for the aphasic adult.


Thromboembolic disease in renal allograft recipients. What is its clinical significance?

Detailed analysis of the clinical data and autopsy material of 100 consecutive renal transplant recipients revealed significant thromboembolic disease in 25 patients and a total of 41 complications. In six of them, thromboembolism was associated with sepsis. Nine patients died (20% of total number of deaths) due to a primary thromboembolic event. The incidence of pulmonary embolism was 14%; myocardial infarction, 3%; cerebrovascular disease, 4%; renal artery thrombosis, 2%; renal vein thrombosis, 3%; thrombophlebitis/deep vein thrombosis, 13%; and miscellaneous, 2%. The incidence of thromboembolism was higher in patients older than 40 years of age (P = .02) and during the earlier months after transplantation. We summarize the general incidence and mortality related to thromboembolism and discuss the factors predisposing the graft recipient to thromboembolic disease. Prevention and therapy of this complication should decrease the morbidity and mortality in graft recipients and enhance the success of renal transplantation.


Cadaver kidney preservation with Viacell organ perfusion apparatus.

Sixty-five kidneys (63 homografts and two autografts) underwent ex vivo preservation for periods of up to 34 hours with the Viacell renal perfusion system. Eighty percent of the homografts and both of the autografts functioned immediately. A correlation existed between poor perfusion characteristics and poor immediate function. Prolonged perfusion with this apparatus (more than 20 hours) probably had no deleterious effect on ultimate than 20 hours) probably had no deleterious effect on ultimate graft function. The machine offers portability, rapid refitting, and the ability to perfuse each kidney separately.


Analysis of 75 discarded cadaver kidneys.

Of 431 cadaver kidneys available for transplantation, 75 were discarded after a period of pulsatile perfusion. Kidneys were discarded because of poor flow, multiple arteries with segmental obstruction, prolonged warm ischemia time, perfusion pump malfunction, and lack of donor cells for cross-matching, among other reasons. Certain selected variables common to transplantated kidneys and kidneys discarded have been analyzed. The most significant finding was that 70% of transplanted kidneys came from donors who had recieved pretreatment with either phenoxybenzamine hydrochloride, methylprednisolone sodium succinate, or phentolaminemesylate. Only 33.3% of kidneys discarded were taken from donors who had received such pretreatment (P less than .01). Attention is focused on the need for careful consideration of the technical aspects of donor nephrectomy as well as the need for donor pretreatment, in order to decrease the number of discarded kidneys.


Venous embolus to a transplanted kidney. Diagnosis and treatment.

We are reporting the first case, to our knowledge, of a venous embolus to a transplanted kidney. The embolus occurred five days after transplantation of a cadaver kidney in a 31-year-old woman who was receiving estrogen-progesterone therapy for menorrhagia. Five hours after acute onset of left flank pain and anuria, the embolus was identified at the anastomosis of the donor renal vein to the external iliac vein. The embolus was manipulated distally in the external iliac vein and excluded by proximal division of the vein. Recovery was eventually complete, despite two major postoperative complications, acute tubular necrosis and a perirenal hematoma secondary to heparin sodium therapy. Radionuclide scanning was critically important in establishing the diagnosis and in assessing the potential for the kidney to recover from acute tubular necrosis. On the basis of this experience, we believe that prompt surgical intervention is indicated for acute venous occlusion.


Administration of obidoxime tablets to man. Plasma levels and side reactions.

Twenty-four male volunteers were given obidoxime tablets in quantities ranging from 1.84-3.58 g in a single dose, or 7.36 g divided into 4 equal doses. With the lowest dose, average peak plasma level of the drug was 1.9 mug/ml and after the highest single dose it was 5.6 mug/ml, both attained 1.5 h after administration. In the multiple-dosed individuals, plasma levels of the oxime increased gradually following each additional dose, reaching a peak of 3.5 mug/ml after the last dose. Thirteen individuals complained of one or more of the following side effects: pallor, nausea, pyrosis, headache, generalized weakness, sore throat, and paresthesia of the face muscles. Activities of blood cholinesterase, glutamic oxalacetic transaminase, glutamic pyruvic transaminase, as well as hematocrit values, heart rate, and blood pressure were not affected. It is postulated that due to the undesirable side effects, the general use of obidoxime tablets should not be recommended. However, prophylactic oral treatment with obidoxime could be considered for persons at high risk of organophosphate poisoning or when parenteral administration might not be feasible.


Measles virus: study of induced transfer of biological properties. II. Fluorescence studies on rescue of neurotropic strain in cell culture.

HeLa cells are non-permissive for the neurotropic suckling mouse strain of measles virus (MMV), but are permissive for cell-adapted Edmonston strain of measles virus (EDm). Fluorescence and electron microscopy demonstrated no membrane fluorescence and no membrane associated viral components, as well as characteristic lack of nuclear antigen after MMV infection of HeLa cells. This appearance differs markedly from the membrane, cytoplasmic and nuclear fluorescence after Edm infection of HeLa cells. Fluorescence microscopy demonstrates fusion of the two dissimilar syncytia after mixed infection. This suggests Edm envelopment of MMV nucleocapsids may be the means of MMV rescue in this system.


Early repeated corneal grafts.

Case reports are presented of four corneal grafts that were replaced 7 to 26 days after the initial surgery. The reasons for regrafting were incomplete epithelialization of the donor cornea by the host, poor donor material, and ring synechiae with secondary glaucoma. All regrafts in these cases have remained transparent. The advantages of early regrafting include earlier visual rehabilitation, avoidance of host corneal vascularization, and prevention of fibrotic organization of synechiae when present. Despite the prevalent notion that early corneal regrafting is inadvisable, when faced with a corneal graft that has little chance of success and then only with prolonged and intensive treatment, we believe that early regrafting may be advisable.


The endothelium of clear corneal transplants.

The endothelium of 36 clear penetrating keratoplasties, performed 1 to 19 years previously, was examined and photographed with the clinical specular microscope. There were fewer central endothelial cells in the transplants than in normal corneas. There was no significant correlation between graft endothelial cell density and corneal thickness, rejection episodes, the disease necessitating kertoplasty, or the method of donor tissue preservation. Corneas transplanted from younger donors to younger recipients had significantly more central endothelial cells. Transplanted corneas appeared to lose endothelial cells over a period of time, just as normal corneas do.


Human conjunctivitis. I. Diagnostic evaluation.

One hundred forty-three patients (207 eyes) with conjunctivitis or blepharoconjunctivitis were studied. Attempts were made to establish an etiologic diagnosis by clinical and laboratory methods. The etiologic diagnosis that was made on the basis of the initial clinical examination correlated poorly with the results of standard laboratory tests. Conversely, the standard laboratory evaluation failed to establish a definitive diagnosis in the majority of cases. These findings suggest that the diagnostic dogmatism prevalent in conjunctivitis is unwarranted. Morphologic signs and routine laboratory tests leave us without a verified etiologic diagnosis in a substantial number of cases.¿


The maxillary sinus: a surgical approach via a gingivomucoperiosteal flap.

The classic surgical approach to the maxillary sinus described originally by Caldwell and Luc, which is still very much in use, calls for an incision in the upper part of the buccal vestibulum. This incision has many disadvantages. A surgical technique that uses the full-thickness gingivomucoperiosteal flap avoids these disadvantages. This method was used in 74 cases during the last three years,and the results have been most satisfactory.


Effect of prostaglandin E2 on the healing of gastric ulcers: a double-blind endoscopic trail.

A double-blind trial was performed to assess the effect of prostaglandin E2 on the healing of gastric ulcers. The prostaglandin preparation was given orally in doses of 1 mg, 6 hourly for two weeks to ten subjects with proven gastric ulcer. The control group consisted of ten subjects with proven gastric ulcer, without prostaglandin treatment. Gastric ulcer healing was assessed endoscopically with a duodenofiberscope. The maximum diameter of the ulcer crater was determined endoscopically just before and after two weeks of treatment. In the prostaglandin group, complete healing was seen in two cases, considerable healing (50% and more) in three cases, and the overall mean healing rate was 42%. In the control group, complete healing was seen in none, considerable healing in one case, and the overall mean healing rate was 14-3%. The difference, statistically, was significant. The results show that prostaglandin E2 is effective in promoting the healing of gastric ulcers.


Ventricular visualization on the brain scan associated with a corpus callosum tumour.

Ventricular visualization and a corpus callosum abnormality were diagnosed by brain scan and confirmed subsequently. Post mortem revealed an infiltrating microglioma impinging also on the floor of the lateral ventricle giving a naked eye appearance consistent with a granular inflammatory reaction of the ventricular surface.


Calcium metabolism after renal transplantation.

Calcium metabolism was studied in four patients who had undergone renal transplantation from eight to 19 months previously. The studies included conventional biochemical and radiological parameters, undecalcified bone histology and metabolic balances. The only abnormality found was biochemical and histologic evidence of mild hyperparathyroidism. All patients were in approximate calcium balance, and there was no evidence of osteoporosis, osteomalacia or osteitis fibrosa. It is suggested that transplantation patients with stable, well functioning grafts and normal biochemical and radiologic parameters are unlikely to have or to be at risk of developing metabolic bone disease.